Work analysis in emergency neurological department of University Hospital Split in one-year period

Prenapučenost odjela hitne službe rastući je problem u hitnim službama diljem svijeta. Cilj našeg istraživanja bio je utvrditi stupanj opterećenosti Hitnoga neurološkog prijema (HNP) Kliničkoga bolničkog centra (KBC) Split, utvrditi najučestalije razloge dolaska i procijeniti njihovu opravdanost. Napravili smo retrospektivnu analizu svih bolesnika pregledanih u našem HNP-u tijekom jednogodišnjeg razdoblja. U tom periodu pregledano je ukupno 8.146 pacijenata, u prosjeku 22 bolesnika na dan. Najučestaliji razlog dolaska je bio moždani udar (1.822 bolesnika – 22%), ali više od polovice pregledanih pacijenata procijenjeni su kao ne-hitni bolesnici i upućeni su na daljnju ambulantnu obradu. Čak 1.616 pacijenata prezentiralo se sa (sub)akutnim tegobama vratnog i leđnog dijela kralježnice. Ovim istraživanjem dokazali smo preopterećenost HNP-a i postojanje vrlo velikog broja ne-hitnih bolesnika u hitnom prijemu. Smatramo da bi bolja edukacija bolesnika, ali i liječnika obiteljske medicine i hitne medicine trebala pomoći u rješavanju ove problematike.Overcrowding of emergency departments all over the world has been recognised as one of the growing problems. The aim of our investigation was to determine the level of overcrowding in the neurological emergency room of the University Hospital Centre Split. This is a retrospective analysis of all patients that were examined in our emergency reception during the one-year period. We examined 8146 patients (around 22 patients per day). The main reason of their arrival was stroke (1,822 patients – 22%) but more than half of the patients were judged as non- urgent and they were sent to outpatient treatment. A total of 1,616 patients presented to the emergency department with (sub)acute complaints of cervical or lumbar spine. With this investigation we proved that there is a problem of overcrowding in our neurological emergency room and the existence of a very large number of non-urgent patients. We believe that better education of patients and doctors could be the solution of this problem

Designing Anatomy Program in Modern Medical Curriculum: Matter of Balance

Aim To evaluate the structure of the anatomy program in the first year medical curriculum of University of Split School of Medicine by comparing it with the recommendations by the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) and the Terminologia Anatomica (TA); we also quantitatively evaluated the organization of teaching material in contemporary topographical anatomy textbooks and matched them with the AACA recommendations, TA, and the curriculum of the anatomy course taught at Medical School in Split, Croatia. Methods TA, official recommendations of the AACA, 6 contemporary anatomy textbooks, and the structure of the anatomy course were analyzed for the proportion of the terms or text devoted to standard topographical regions of the body. The findings were correlated using Spearman ρ test. Results The curriculum outline correlated both with the AACA recommendations (Spearman ρ = 0.83, P = 0.015) and TA (Spearman ρ = 0.73, P = 0.046). Textbooks contained 8 distinct sections, 7 allocated to topographic anatomy regions and 1 to general anatomy concepts and principles. The structure of all textbooks correlated significantly with the course curriculum. However, 4 out of 6 textbooks did not correlate with TA and only a single textbook showed significant correlation with the AACA recommendations. Conclusion Anatomy textbooks vary in the amount of text dedicated to different parts of topographical anatomy and are not quite concordant with curriculum recommendations and standard anatomical terminology. Planning the structure of an anatomy course should not be based on a single book or recommendation but on evidence

Histological differences in healing following experimental transmural infarction in rats

Mechanisms of cardiac regeneration following transmural myocardial infarction were analysed in rat hearts using immunohistochemistry for α-SMA, caspase-3, Ki-67 and nestin markers. Seven weeks after experimental myocardial infarction, two different types of healing processes were revealed in rats with and without aneurysmatic bulging of the left ventricular wall. Besides thinning of the ventricular wall, three zones characterized both types of scars: the scar zone (divided into central and peripheral parts), the peri-infarct zone and the border zone. The main difference between the types of scars was the presence of a central necrotic zone inside the aneurysmatic wall, while connective tissue with myofibroblasts characterized the same zone in nonbulging wall. Apoptotic caspase-3 positive cells were found in the granulation tissue of the border zone in aneurysmatic scar, while in non-bulging scar they characterized all three zones. Proliferating Ki-67 positive cells displayed reverse expression pattern compared to apoptotic cells. Quantification of α-SMA positive cells revealed 60% α-SMA positive cells inside the central part of the aneurysmatic scar zone and 39% in invaginating areas, versus 19% in non-invaginating areas of the peripheral zone, but only 30% in the peripheral part of the non-bulging scar zone. Nestin positive cells were found in both types of scars, but with different distribution. These results suggest that even seven weeks after myocardial infarction, the healing processes in non-bulging scars are in chronic phase, while aneurysmatic scars are still in subacute phase. Histological differences in scar healing might be important for functional properties of the heart wall and for heart recovery prognosis

Daily Mini Quizzes as Means for Improving Student Performance in Anatomy Course

Aim To evaluate daily-written 10-question quizzes in a medical anatomy course as a way to integrate assessment into the course and to evaluate their effect on the course success. Methods Students answering correctly 8/10 or more questions were awarded 0.5 points per quiz. There were 34 quizzes with a maximum point score 17. Measurable outcomes of academic progress in anatomy course (pass rates on 4 examination terms, total pass rate, and average marks) were calculated, and 2007/08 academic year was compared with the previous academic year in which daily written quizzes were not a part of the course. The relationship between cumulative points on daily quizzes and 3 components of the final examination (written, practical, and oral) for 2007/08 academic year was assessed by nonparametric correlation testing. Results Individual scores on quizzes ranged from 1.5 to 13.5 points. There was a positive correlation between scores on quizzes and grades on 3 components of the final examination: written (Spearman ρ = 0.784, P < 0.001, n = 79), practical (Spearman ρ = 0.342, P < 0.002, n = 79), and oral (Spearman ρ = 0.683, P < 0.001, n = 79) part. Compared with students in the previous academic year, students attending the course with daily quizzes significantly improved their academic achievement, expressed as the pass rate at the first examination term (39% vs 62%, respectively, χ2 test, P = 0.006, ) and the average course grade (2.71 ± 1.08 vs 3.38 ± 1.26, respectively; t test, P < 0.001). Conclusion Despite their frequency and possible associated stress, daily quizzes were associated with better academic success in the anatomy course

The Patho-Neurophysiological Basis and Treatment of Focal Laryngeal Dystonia: A Narrative Review and Two Case Reports Applying TMS over the Laryngeal Motor Cortex

Focal laryngeal dystonia (LD) is a rare, idiopathic disease affecting the laryngeal musculature with an unknown cause and clinically presented as adductor LD or rarely as abductor LD. The most effective treatment options include the injection of botulinum toxin (BoNT) into the affected laryngeal muscle. The aim of this narrative review is to summarize the patho-neuro-physiological and genetic background of LD, as well as the standard recommended therapy (BoNT) and pharmacological treatment options, and to discuss possible treatment perspectives using neuro-modulation techniques such as repetitive transcranial magnetic stimulation (rTMS) and vibrotactile stimulation. The review will present two LD cases, patients with adductor and abductor LD, standard diagnostic procedure, treatments and achievement, and the results of cortical excitability mapping the primary motor cortex for the representation of the laryngeal muscles in the assessment of corticospinal and corticobulbar excitability