Razvoj instrumenta za procjenu profesionalnih odnosa među bolničkim liječnicima [Development of an instrument for the evaluation of professional interpersonal relationships among hospital physicians]

Although, physicians’ professional interpersonal relationships single out as crucial (sub)category of medical professionalism and represents a crucial element of physicians’ everyday practice, they haven’t been systematically researched. About their potential importance, with exception of few studies, one can find out from scientific literature which aim is researching professional relationships among healthcare workers in general. Nonetheless, this scientific literature indicates that physician professional interpersonal relationships have a profound impact on health care processes and outcomes in their entirety. Questionnaire named professional interpersonal relationships among physicians (PIR) was developed as a method of evaluating the quality of professional interpersonal relationship among hospital physicians that will be reliable, valid, applicable and adequate for use in everyday practice. PIR is a self-report, five point Likert-type, internet-based questionnaire. Research was conducted through four steps involving qualitative and quantitative methods, with the aim of determining validity, reliability and usability evidence of the proposed questionnaire. Content validity and face validity of instrument were evaluated by first set of focus groups, after witch 52 items were included in next, pilot phase of research. Within the pilot phase of research (March 2016, n=84) 11 items were excluded from further analysis based on discrimination of items analysis and analysis of reliability of questionnaire subscales. Second set of focus groups confirmed findings from preliminary research phases and included additional criterion for establishing criterion validity that consisted of four self-contained items. Final testing phase, validation study (May, June and July 2016, n=445) included physicians working in hospitals in the City of Zagreb. Analysis preformed with additional established criterion excluded further 16 items from quantitative analysis. Further analysis of the final version of PIR questionnaire, which consist of 25 items, reveals sound psychometric properties. Reliability of questionnaire determined by Cronbach alpha coefficient was α=0,95. Explanatory factor analysis yielded two factor solution where the first was named „negative interpersonal relationships“ (which explained 44% variance), and second „shared and unified professional affect“ (which explained 4% variance). Construct (convergent and discriminant) validity of final questionnaire was well established thorough statistically significant correlation between PIR scores and many independent variables as physicians' age, working experience on institutional unit, working experience in medical field, medical speciality, physicians' satisfaction, physicians' subjective assessment of quality of care within institutional unit, turnover intention, workload index and physicians’ self-assessed general health. Results of the study provide robust evidence that PIR questionnaire is reliable, valid and applicable method of evaluating the quality of professional interpersonal relationship among hospital physicians’

Stres fraktura proksimalne tibije povezana s blagim osteoartritisom koljena: prikaz slučaja

Stress fractures are considered as multifactorial overuse injuries occurring in 0.3%-0.8% of patients suffering from rheumatic diseases, with rheumatoid arthritis being the most common underlying condition. Stress fractures can be classified according to the condition of the bone affected as: 1) fatigue stress fractures occurring when normal bone is exposed to repeated abnormal stresses; and 2) insufficiency stress fractures that occur when normal stress is applied to bone weakened by an underlying condition. Stress fractures are rarely associated with severe forms of knee osteoarthritis, accompanied with malalignment and obesity. We present a patient with a proximal tibial stress fracture associated with mild knee osteoarthritis without associated malalignment or obesity. Stress fracture should be considered when a patient with osteoarthritis presents with sudden deterioration, severe localized tenderness to palpation and localized swelling or periosteal thickening at the pain site and elevated local temperature. The diagnosis of stress fractures in patients with rheumatic diseases may often be delayed because plain film radiographs may not reveal a stress fracture soon after the symptom onset; moreover, evidence of a fracture may never appear on plain radiographs. Triple phase nuclear bone scans and magnetic resonance imaging are more sensitive in the early clinical course than plain films for initial diagnosis.Stres frakture kao sindromi prenaprezanja pojavljuju se u 0,3%-0,8% reumatoloških bolesnika udružene s već prisutnim reumatološkim bolestima, napose reumatoidnim artritisom. Sindromi prenaprezanja mogu se klasificirati prema stanju zahvaćene kosti kao: 1. sindromi prenaprezanja u užem smislu riječi koji nastaju kada je normalna kost izložena ponavljajućem abnormalnom opterećenju i 2. patološki sindromi prenaprezanja koji nastaju kada na kost oslabljenu patološkim procesom djeluje normalno ponavljajuće opterećenje. Stres frakture su u rijetkim slučajevima povezane s teškim oblicima osteoartritisa koljena, praćene patološkim otklonima osi opterećenja i pretilošću. U ovom radu predstavljamo bolesnika sa stres frakturom proksimalnog dijela tibije povezanom s blagim osteoratritisom koljena bez otklona koljenske osi ili pretilosti. Stres frakturu treba uzeti u obzir kada u bolesnika s osteoartritisom nastupi naglo pogoršanje bolesti, znatna lokalizirana osjetljivost na palpaciju, oteklina ili periostealno zadebljanje na bolnom mjestu te lokalno povišenje temperature. Dijagnoza stres frakture u bolesnika s reumatološkim bolestima često može biti odgođena, jer obične radiografske snimke ne mogu otkriti stres frakture nakon pojave prvih simptoma. Štoviše, dokaz frakture može izostati i na ponovljenim običnim rendgenskim snimkama. Scintigrafija kosti u 3 faze i magnetska rezonancija osjetljivije su metode u dijagnostici ranih promjena i metode su izbora za postavljanje početne dijagnoze

Chemical Durability of Dental Ceramic Material in Acid Medium

Stomatološki materijali moraju se ispitati prema strogim kriterijima kako bi se odredila njihova dugotrajna terapijska vrijednost. Kemijska degradacija dentalne keramike povećava njezinu hrapavost i istodobno trošenje antagonističkog zuba ili restorativnog materijala, povećava prianjanje plaka na keramiku, oslabljuje strukturu keramike uzrokujući kritičnu izmjenu iona na njezinoj površini i povećava osjetljivost keramike na buduće kemijske agense. Svrha rada bila je ispitati gubitak mase uzoraka četiriju različitih dentalnih keramika u kiselom mediju. Najmanji gubitak mase izmjeren je kod apatitne staklo-keramike (IPS-Empress 2 za slojevanje) (4,9±0,3 μg/cm2), a najveći kod glinične keramike (Vitadur alpha) (15,0±0,2 μg/cm2). Litijska disilikatna staklo-keramika (IPS-Empress 2 za bojenje) i glinična (IPSClassic) pokazale su vrlo slične rezultate (9,4±3,4 μg/cm2 i 10,1±0,3 μg/cm2). Vrijednosti gubitka mase uzoraka u ovom radu, kao i u većini pronađenih u literaturi, minimalne su, te vjerojatno nemaju kliničke i toksikološke posljedice. Ali, to ne znači da se mogu uopćavati i prenositi na neispitane vrste dentalne keramike.Dental materials need to be thoroughly examined in order to assess their long-term therapeutical value. Chemical degradation of dental ceramic material enhances its roughness, leading to the wear of the opposing natural tooth or restorative material, greater plaque attachment to ceramics, weakening of the ceramic structure causing the critical ion exchange at the surface and enhancing the sensitivity to future chemical agents. The aim of this study was to test loss of mass in samples of four different dental ceramic materials in an acid medium. The least mass loss was recorded in apatite glass ceramic (IPS-Empress 2 for layering) (4.9±0.3 μg/cm2), and most mass loss was recorded in alumina ceramic (Vitadur alpha) (15±0.2 μg/cm2). Lithium disilicate glass ceramic (IPS-Empress 2 for coloring) and alumina (IPS-Classic) showed very similar results (9.4±3.4 μg/cm2 and 10.1±0.3 μg/cm2). The values of mass loss in samples in this work, as well as in the most of the literature, are minimal and presumably do not have any clinical or toxicological effects. However, it does not imply that these values can be generalized and transferred to dental ceramic materials that were not yet analyzed

UTJECAJ SVJETSKE FINANCIJSKE KRIZE NA FORMIRANJE MULTISEKTORSKI-DIVERZIFICIRANIH OPTIMALNIH PORTFELJA UZ POMOĆ MARKOWITZEVE TEORIJE NA ZAGREBAČKOJ BURZI

Na Zagrebačku burzu su 22. veljače 2013. godine uvedeni sektorski indeksi iz čega se može zaključiti da u kontekstu razvoja hrvatskog tržišta kapitala na značenju dobiva promatranje prinosa i rizika po sektorima. Cilj ovoga rada je prikazati rezultate statističke analize povrata i rizik na odabrane dionice uvrštene u sektorske indekse kroz duže razdoblje kako bi se dobila slika o rezultatima pojedinih sektora prije i za vrijeme krize pri čemu je uz pomoć korelacijske matrice provedena analiza povezanosti kretanja cijene dionica. U dosadašnjim radovima vezanima uz kreiranje optimalnog portfelja uz pomoć Markowitzove teorije na hrvatskom tržištu kapitala, optimalni se portfelj kreirao na bazi tjednih podataka ili na bazi mjesečnih podataka prije 2005. godine. Doprinos ovog rada predstavlja analiza utjecaja svjetske financijske krize na uspješnost različitih sektorskih indeksa Zagrebačke burze

Application of Spectrophotometry and Ion Chromatography for Monitoring the Chemical Stability of Dental Ceramics in an Acid Solution

Korozijski procesi dentalnih slitina dobro su znani. Za razliku od njih malo se zna o koroziji dentalne keramike i zato je svrha ove studije bila raščlamba kemijske stabilnosti dviju vrsta keramike u agresivnome kiselome mediju. Uzorci konvencionalne glinične keramike napečeni su na Co-Cr i Ni-Cr slitinu, a uzorak hidrotermalne keramike na visoko plemenitu zlatnu slitinu. Uzorci su bili pohranjeni u otopinu 10-3 mol/L HCl-a na 50°C 6 mjeseci. Otopine su analizirane nakon 1., 2., 3., i 6. mjeseca. Ioni Na+, K+, Ca2+ i Mg2+ bili su određeni ionskom kromatografijom (IC), a kvantitativne vrijednosti izlučenih Si4+ i Al3+ spektrofotometrijskom metodom. Gubitak težine uzoraka mjeren je analitičkom vagom, a promjena pH otopina pH-metrom. Rezultati su pokazali da je najjača eluacija iona u prva tri mjeseca, te da je izlučivanje bilo znatno manje nakon toga razdoblja iz svih uzoraka. Najznačajnije izlučivanje iona i gubitak težine pokazao je uzorak s hidrotermalnom keramikom. U svim su otopinama nastale promjene u pH vrijednosti, a stabilizirale su se nakon 3. mjeseca od početka istraživanja. Zaključak je da zubna keramika nije kemijski stabilna u kiselome mediju.The corrosive process of dental alloys is very well known, although little information is available on the corrosion of dental ceramics. The aim of this study was the analysis of the chemical stability of two dental ceramics in an aggressive acid medium. Two samples of feldspathic ceramic fused to Co-Cr and Ni-Cr alloy and a sample of hydrothermal ceramic fused to high-noble gold alloy were deposited in 10-3 mol/L HCl at 50°C during six months. The solutions were analysed after one, two, three and six months. The determination of Na+, K+, Ca2+ and Mg2+ was performed by ion chromatography (IC), the quantities of the eluted Si4+ and Al3+ were determined by spectrophotometric method and the weight loss of each sample was measured by an analytical scale. The changes of the pH values were determined by means of a pH meter. The results showed that most ions were eluted after the first three months, while after that period of time elution was significantly lower in each sample. The sample with hydrothermal ceramic showed the most significant elution and the highest weight loss. The pH values changed in each leachate sample, but stabilised after the 3rd month of the investigation. It can be concluded that dental ceramics are not stable in an acid medium

NEW INSIGHTS INTO SCHIZOPHRENIA: A LOOK AT THE EYE AND RELATED STRUCTURES

Background: Schizophrenia is a multifactorial neurodevelopmental disorder associated with cognitive dysfunction and changes in primary sensory processing. This article aims to explore the current insights into the relationship between schizophrenia and different visual disturbances. Methods: To provide a literature review of visual impairments in schizophrenia, we performed a PubMed/MEDLINE and Scopus search to identify all articles in English on the topic up to the end of 2018. Results: Multiple retinal functional and structural abnormalities are found in patients with schizophrenia. Wider retinal venules suggest chronically insufficient brain supply of oxygen and this could contribute to the occurrence of psychotic symptoms. Optical coherence tomography studies showed that retinal nerve fiber layer, macular thickness, and macular volume were significantly lowered in the chronic phase of schizophrenia. Results from electroretinogram recordings have demonstrated different declinations such as abnormalities of a - wave activity in the photoreceptors or b - wave activity in the bipolar and Muller cells. Abnormalities in eye movements, such as a notable decrease in saccades and smooth pursuit eye movements, are one of the most reliable and reproducible impairments associated with schizophrenia. Disrupted visual processing of the magnocellular pathway may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking. Visual perceptual abnormalities occur in more than 60% of schizophrenic patients and these are visual hallucinations, perceptual distortion of colors, shapes and light intensity, decrease in contour integration and surround suppression. Other, frequently present eye disorders include impaired visual acuity, strabismus and nystagmus. Conclusion: Visual impairments are one of the most important features of schizophrenia, which could help in defining the disease state and assigning appropriate treatment