QUALITY OF LIFE OF DIALYSIS PATIENTS

Mjerenje kvalitete života povezane sa zdravljem (engl. Health Related Quality Of Life - HRQOL) dio je općeg koncepta kvalitete života. Prema istraživanjima, u bolesnika na dijalizi kvaliteta života je značajno niža u odnosu na opću populaciju. Cilj rada je prikazati važnost i utjecaj kvalitete života bolesnika na dijalizi na ishode liječenja. Za izradu rada korišten je pregled literature baze podataka MEDLINE i EBSCO u listopadu 2016. godine, za razdoblje od 2005. do 2016. godine. Transplantacija bubrega nudi bolju HRQOL od dijalize, dok između bolesnika na hemodijalizi i onih na peritonejskoj dijalizi nema nema značajne razlike u HRQOL. Dobra klinička praksa u liječenju bolesnika na dijalizi zasniva se na individualnom pristupu i poboljšanju kvalitete života, za što je nužna suradnja obiteljskih liječnika i konzultanata-nefrologa. U svakodnevnoj praksi, korištenjem upitnika o kvaliteti života pacijenata na dijalizi povećala bi se svijest o iznimno važnom segmentu skrbi za dijalizirane bolesnike, jer je kvaliteta života mjera ishoda liječenja tih bolesnika.Measuring the Health Related Quality of Life (HRQOL) is part of the general concept of quality of life. According to the survey, quality of life in dialysis patients is signifi cantly lower as compared to general population. The aim is to show the importance and impact of the quality of life in dialysis patients on treatment outcomes. In October 2016, the MEDLINE and EBSCO databases were searched for the 2005-2016 period. Kidney transplantation offers better HRQOL as compared to dialysis, since there is no signifi cant difference in HRQOL between patients on hemodialysis and those on peritoneal dialysis. Good clinical practice in the treatment of dialysis patients is based on individual approach and on improving the quality of life, for which collaboration of family doctors and consultant nephrologists is necessary. In daily practice, using questionnaires on the quality of life of dialysis patients would increase the awareness of this very important segment of care for dialysis patients because quality of life is an outcome measure of treatment in these patients

QUALITY OF LIFE IN PATIENTS WITH FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL SYSTEM

Osnovna značajka funkcionalnih gastrointestinalnih poremećaja (engl. Functional GastroIntestinal Disorder – FGID) je da se njihovi simptomi (barem za sada) ne mogu objasniti strukturnim ili biokemijskim abnormalnostima. Najčešći funkcionalni gastrointestinalni poremećaji su funkcionalna dispepsija i sindrom iritabilnog crijeva. Stresom inducirane promjene u neuroendokrino-imunološkim putevima djeluju na osovini mozak-probavna cijev i uzrokuju pojave simptoma. Kvaliteta života ovih pacijenata znatno je narušena i povezana sa subjektivnom procjenom jačine simptoma i psihološkim faktorima. Za kontrolu simptoma FGID-a iznimno je važan kvalitetan odnos liječnika i pacijenta.The characteristic of functional gastrointestinal disorders (FGID) is that, at least for now, their symptoms cannot be explained by structural or biochemical abnormalities. The most common functional gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. Stress-induced changes in the neuro-endocrine-immune pathways act on the brain-gut axis and cause symptoms. In these patients, the quality of life is signifi cantly impaired and is associated with subjective assessment of symptom severity and psychological factors. Good doctor-patient relationship is important to control the symptoms of FGIDs

QUALITY OF LIFE OF DIALYSIS PATIENTS

Mjerenje kvalitete života povezane sa zdravljem (engl. Health Related Quality Of Life - HRQOL) dio je općeg koncepta kvalitete života. Prema istraživanjima, u bolesnika na dijalizi kvaliteta života je značajno niža u odnosu na opću populaciju. Cilj rada je prikazati važnost i utjecaj kvalitete života bolesnika na dijalizi na ishode liječenja. Za izradu rada korišten je pregled literature baze podataka MEDLINE i EBSCO u listopadu 2016. godine, za razdoblje od 2005. do 2016. godine. Transplantacija bubrega nudi bolju HRQOL od dijalize, dok između bolesnika na hemodijalizi i onih na peritonejskoj dijalizi nema nema značajne razlike u HRQOL. Dobra klinička praksa u liječenju bolesnika na dijalizi zasniva se na individualnom pristupu i poboljšanju kvalitete života, za što je nužna suradnja obiteljskih liječnika i konzultanata-nefrologa. U svakodnevnoj praksi, korištenjem upitnika o kvaliteti života pacijenata na dijalizi povećala bi se svijest o iznimno važnom segmentu skrbi za dijalizirane bolesnike, jer je kvaliteta života mjera ishoda liječenja tih bolesnika.Measuring the Health Related Quality of Life (HRQOL) is part of the general concept of quality of life. According to the survey, quality of life in dialysis patients is signifi cantly lower as compared to general population. The aim is to show the importance and impact of the quality of life in dialysis patients on treatment outcomes. In October 2016, the MEDLINE and EBSCO databases were searched for the 2005-2016 period. Kidney transplantation offers better HRQOL as compared to dialysis, since there is no signifi cant difference in HRQOL between patients on hemodialysis and those on peritoneal dialysis. Good clinical practice in the treatment of dialysis patients is based on individual approach and on improving the quality of life, for which collaboration of family doctors and consultant nephrologists is necessary. In daily practice, using questionnaires on the quality of life of dialysis patients would increase the awareness of this very important segment of care for dialysis patients because quality of life is an outcome measure of treatment in these patients

Job Satisfaction among Medical Doctors in One of the Countries in Transition: Experience from Croatia

Our aim was to explore and compare the job satisfaction between family physicians and hospital specialists in Split, Croatia. The survey was carried out in 2005 and 2006. A validated questionnaire was composed of two parts: 92 statements and questions about job satisfaction in the form of a Lickert scale (range 1–5) and eight questions concerning demographic issues. The questionnaire was completed and returned by 165 hospital specialists from the University Hospital and by 131 family physicians from the Split County. Response rate for family physicians was 39.81% and 41.46% for hospital specialists. Hospital doctors were divided in two groups: internal and surgical. There were no significant differences between family physicians and hospital specialists in total job satisfaction (F=1.02; p=0.41). Family physicians were more satisfied with their workplace conditions than internal medicine specialists (19.37±4.23 vs. 17.37±4.59; F=5.93; p=0.003), and less satisfied with the possibilities for postgraduate training than surgeons (5.27±1.90 vs. 6.59±2.07; F=9.26; p<0.001). Global job satisfaction was rather low but does not differ between the three medical groups. Disparities were observed in some segments (opportunity for further training and academic advancement, vacation, and salary). The reason for the family physician\u27s relative satisfaction may be due to stable working conditions, independence in organizing work schedules and personal responsibility

Writing letters to patients as an educational tool for medical students

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6(th) year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 – poor, 1 – medium, 2 – good) for 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category “Technical terms unclear to a lay reader”. CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care

QUALITY OF LIFE IN PATIENTS WITH FUNCTIONAL DISORDERS OF THE GASTROINTESTINAL SYSTEM

Osnovna značajka funkcionalnih gastrointestinalnih poremećaja (engl. Functional GastroIntestinal Disorder – FGID) je da se njihovi simptomi (barem za sada) ne mogu objasniti strukturnim ili biokemijskim abnormalnostima. Najčešći funkcionalni gastrointestinalni poremećaji su funkcionalna dispepsija i sindrom iritabilnog crijeva. Stresom inducirane promjene u neuroendokrino-imunološkim putevima djeluju na osovini mozak-probavna cijev i uzrokuju pojave simptoma. Kvaliteta života ovih pacijenata znatno je narušena i povezana sa subjektivnom procjenom jačine simptoma i psihološkim faktorima. Za kontrolu simptoma FGID-a iznimno je važan kvalitetan odnos liječnika i pacijenta.The characteristic of functional gastrointestinal disorders (FGID) is that, at least for now, their symptoms cannot be explained by structural or biochemical abnormalities. The most common functional gastrointestinal disorders are functional dyspepsia and irritable bowel syndrome. Stress-induced changes in the neuro-endocrine-immune pathways act on the brain-gut axis and cause symptoms. In these patients, the quality of life is signifi cantly impaired and is associated with subjective assessment of symptom severity and psychological factors. Good doctor-patient relationship is important to control the symptoms of FGIDs

The use of a letter to the patient as a method in the education of medical students

Cilj. Procjena mogućnosti uporabe pisma pacijentu kao edukacijske metode tijekom izobrazbe studenata medicine završne (šeste) godine studija na predmetu Obiteljska medicina Medicinskog fakulteta Sveučilišta u Splitu. Ispitanici i postupci. Istraživanjem su obuhvaćeni svi studenti šeste godine Medicinskog fakulteta u Splitu akademskih godina 2010./11., 2011./12., 2012./13 (n=121). Uzorak su predstavljala pisma koja su ti studenti napisali pacijentima za vrijeme vježbi iz kolegija Obiteljska medicina (svaki student 4 pisma; n=484). Primijenjen je obrazac za ocjenu konzultacije i pisma; ocijenjene kategorije bile su: jasnoća opisa bolesti/stanja, znanje, kvaliteta/korisnost preporuke, pristojnost, umijeće usmenog/pismenog izražavanja, ocjene 1-5, raspon bodova od 1-25), instrument za mjerenje liječnikova suosjećanja (empatije) u konzultaciji (engl. Consultation and Relational Empathy, CARE) i instrument za mjerenje pacijentove osposobljenosti za nošenje s bolešću (engl. Patient enablement instrument, PEI). Odabranim pacijentima studenti su nakon konzultacije napisali pismo s opisom i objašnjenjem bolesti, liječenja i preporukama za nošenje s bolešću. Nakon što su sva pisma prikupljena, ocijenili su ih pacijenti (n=222), mentori (n=22) i nezavisni ocjenjivači (n=3). Pacijenti su u pismu podcrtali dijelove pisma koje nisu razumjeli, a ocjenjivači dijelove za koje su procijenili da ih pacijenti neće razumjeti. Pisma smo analizirali kao jedinice i grupirana prema studentima - autorima („klasteri“). Uz standardne metode, postojanje klastera uvaženo je korištenjem višestruke linearne regresije (klasteri kao 'dummy' varijabla). Rezultati. Analiza pisama kao pojedinačnih, nezavisnih jedinica i kao »klastera« dala je slične rezultate, pa je prikazana analiza pisama kao nezavisnih jedinica. Postojala je slaba korelacija između kvalitete napisanih pisama (ocjene mentora) i zadovoljstva pacijenata (ocjene pacijenata) (r=0,184; P=0,007). Iako im je konzultacija sama po sebi bila razumljivija od pisma (62,3% vs. 37,7%), pacijenti (n=194) su nešto bolje razumjeli terapiju i preporuke za liječenje nakon što su im studenti napisali pismo [pacijentova ocjena (M,95%-tni raspon pouzdanosti): 4,45 (4,36-4,56), mentorova ocjena: 4,10 (3,98-4,22)]. Pacijenti su ocijenili pisma ocjenom: 23.7 (23.5-24.0), slično kao i mentori: 22.3 (21.8-22.6), dok su nezavisni ocjenjivači bili nešto stroži: 20.2 (20.0-20.5). Postojala je pozitivna povezanost između ocjena konzultacija i pisama kako pacijenata (r=0,620; P<0,001) tako i mentora (r=0,530; P<0,001). I pacijenti i mentori su dali neznatno više ukupne ocjene pismima nego konzultacijama: ocjene pacijenata, pismo vs konzultacija [(23,7 (23,5-24,0) vs 23,1 (22,7-23,4)] i ocjene mentora [(22,2 (21,9-22,6) vs 21,6 (21,2-21,9)]. Značajno više mentora (60.3%) nego pacijenata (45.7%) smatralo je da se u pismu dobije više informacija (P<0,001), da se bolje može ocijeniti znanje studenata (56,1% vs. 45,9%; P=0,003), te da je pisana preporuka korisnija od usmene (63,8% vs. 53,1%; P<0,001). U analizi sadržaja pisama pacijenti i ocjenjivači su se preklapali u 27 podcrtanih izraza, od kojih se 20 odnosilo na stručne izraze. Između kvalitete pisama i uspješnosti na ispitu provjerene standardnim pisanim testom nije bilo značajne povezanosti u generacija studenata koje su pisale pismo (2010./11. r=0,016; P=0,909; 2011./12. r=0,069; P=0,596). Međutim, prosječna ocjena na pisanom ispitu generacija s pismom [(11./12. 4,67 (4,52 – 4,81)] u odnosu na generacije bez pisma [(08./09. 3,65 (3,45-3,85) i 09./10. 3,81 (3,59-4,82) bila je značajno viša (P<0,001)]. Zaključak. Pisma studenata pacijentima o njihovoj bolesti pokazala su se kao kvalitetna dopuna konzultaciji, kao sredstvo za unaprjeđivanje komuniciranja (ocjena pacijenata) i kao edukacijski instrument (ocjena mentora). Najčešći razlog poteškoća i nerazumijevanja u komunikaciji između pacijenata i studenata (liječnika) je stručna terminologija. Dokazi za povezanost između studentskog pisma pacijentima i uspjeha na pisanom testu nisu uvjerljivi, te na osnovu njih ne možemo stvoriti jasan zaključak.Aim. Assessment of the possibility of using students’ letters to patients as educational method in training final (sixth) year students at the Department of Family Medicine, Faculty of Medicine, University of Split. Examinees and methods. The study included all 6th year students of the Medical Faculty in academic year 2010-11., 2011./12., 2012./13. attending their rounds in Family Medicine (FM), structured into two 10-day cycles (n=121). Students were represented by the letters they have written to patients during the rounds in FM (each student has written 4 letters; n=484). The letters were evaluated by patients (n=222), mentors (n=22) and independent evaluators (n=3) who used a grading instrument (consisted of five rated categories: 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style; score 1-5, the range of points from 1-25), questionnaires Consultation and Relational Empathy (CARE) and Patient enablement instrument (PEI). Patients and evaluators were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. Letters were analyzed as a unit and grouped by students - authors (" clusters "). In addition to standard methods, the existence of clusters has endorsed the use of multiple linear regression (clusters as a ' dummy ' variable). Results. Analysis of letters as single, independent units and as a "cluster " gave similar results, so an analysis of letters as independent units was presented. There was a low correlation between the quality of written letters (mentors’ score) and patient satisfaction (patients’ score) (r = 0.184, P = 0.007). Although consultation was easier to understand (62.3 % vs . 37.7 %), patients (n = 194), understood slightly better their therapy and treatment recommendations after they have read letter [patient's score (M, 95% confidence interval): 4.5 (4.4 to 4.6), mentor’s score: 4.1 ( 4.0 to 4.2). Patients evaluated letters with a score: 23.7 (23.5 to 24.0), similar to the mentors: 22.3 (21.8 to 22.6), while independent evaluators were somewhat stricter: 20.2 (20.0 to 20.5). There was a positive correlation between the score of consultations and letters in patients (r=0.620, P<0.001) and in mentors (r=0.530, P<0.001). Patients and mentors gave slightly higher total scores to the letters than consultations: patients’ score, letter vs. consultation [(23.7 (23.5 to 24.0) vs. 23.1 (22.7 to 23.4)] and mentors’ score [(22.2 (21.9 to 22.6 ) vs. 21.6 (21.2 to 21.9)]. Significantly more mentors (60.3 %) compared to patients (45.7 %) considered to get more information from the letter (P<0.001), to improve the assessment of the students' knowledge (56.1 % vs. 45.9 %, P=0.003), and to strengthen the nature of information (63.8 % vs. 53.1 %, P<0.001). In analyzing the content of the letters, patients and evaluators overlapped in 27 underlined expressions, 20 of which were related to technical terms. Between the quality and efficiency of letters on a standard written examination verified test there was no significant correlation in the generation of students who wrote the letter (2010./11. R=0.016, P=0.909; 2011./12. R=0.069, P=0.596). However, the average score on the written test, generation with letters [(11./12. 4.67 (4.52 to 4.81)] in relation to generation without letters [(08./09. 3.65( 3.45 -3.85) and 09./10. 3.81(3.59 to 4.82)] was significantly higher (P < 0.001). Conclusion. The letter is a good quality supplement to the consultation process, as a communication means (patients’ score) and as an educational tool (mentors’ score). The most common reason for difficulties and misunderstandings in communication between the patient and the student (doctor) is the professional jargon (terminology). Evidences for the interconnection between the student letters to patients and the efficacy of the written test are not conclusive, and based on them, we can not create a clear conclusion

The use of a letter to the patient as a method in the education of medical students

Cilj. Procjena mogućnosti uporabe pisma pacijentu kao edukacijske metode tijekom izobrazbe studenata medicine završne (šeste) godine studija na predmetu Obiteljska medicina Medicinskog fakulteta Sveučilišta u Splitu. Ispitanici i postupci. Istraživanjem su obuhvaćeni svi studenti šeste godine Medicinskog fakulteta u Splitu akademskih godina 2010./11., 2011./12., 2012./13 (n=121). Uzorak su predstavljala pisma koja su ti studenti napisali pacijentima za vrijeme vježbi iz kolegija Obiteljska medicina (svaki student 4 pisma; n=484). Primijenjen je obrazac za ocjenu konzultacije i pisma; ocijenjene kategorije bile su: jasnoća opisa bolesti/stanja, znanje, kvaliteta/korisnost preporuke, pristojnost, umijeće usmenog/pismenog izražavanja, ocjene 1-5, raspon bodova od 1-25), instrument za mjerenje liječnikova suosjećanja (empatije) u konzultaciji (engl. Consultation and Relational Empathy, CARE) i instrument za mjerenje pacijentove osposobljenosti za nošenje s bolešću (engl. Patient enablement instrument, PEI). Odabranim pacijentima studenti su nakon konzultacije napisali pismo s opisom i objašnjenjem bolesti, liječenja i preporukama za nošenje s bolešću. Nakon što su sva pisma prikupljena, ocijenili su ih pacijenti (n=222), mentori (n=22) i nezavisni ocjenjivači (n=3). Pacijenti su u pismu podcrtali dijelove pisma koje nisu razumjeli, a ocjenjivači dijelove za koje su procijenili da ih pacijenti neće razumjeti. Pisma smo analizirali kao jedinice i grupirana prema studentima - autorima („klasteri“). Uz standardne metode, postojanje klastera uvaženo je korištenjem višestruke linearne regresije (klasteri kao 'dummy' varijabla). Rezultati. Analiza pisama kao pojedinačnih, nezavisnih jedinica i kao »klastera« dala je slične rezultate, pa je prikazana analiza pisama kao nezavisnih jedinica. Postojala je slaba korelacija između kvalitete napisanih pisama (ocjene mentora) i zadovoljstva pacijenata (ocjene pacijenata) (r=0,184; P=0,007). Iako im je konzultacija sama po sebi bila razumljivija od pisma (62,3% vs. 37,7%), pacijenti (n=194) su nešto bolje razumjeli terapiju i preporuke za liječenje nakon što su im studenti napisali pismo [pacijentova ocjena (M,95%-tni raspon pouzdanosti): 4,45 (4,36-4,56), mentorova ocjena: 4,10 (3,98-4,22)]. Pacijenti su ocijenili pisma ocjenom: 23.7 (23.5-24.0), slično kao i mentori: 22.3 (21.8-22.6), dok su nezavisni ocjenjivači bili nešto stroži: 20.2 (20.0-20.5). Postojala je pozitivna povezanost između ocjena konzultacija i pisama kako pacijenata (r=0,620; P<0,001) tako i mentora (r=0,530; P<0,001). I pacijenti i mentori su dali neznatno više ukupne ocjene pismima nego konzultacijama: ocjene pacijenata, pismo vs konzultacija [(23,7 (23,5-24,0) vs 23,1 (22,7-23,4)] i ocjene mentora [(22,2 (21,9-22,6) vs 21,6 (21,2-21,9)]. Značajno više mentora (60.3%) nego pacijenata (45.7%) smatralo je da se u pismu dobije više informacija (P<0,001), da se bolje može ocijeniti znanje studenata (56,1% vs. 45,9%; P=0,003), te da je pisana preporuka korisnija od usmene (63,8% vs. 53,1%; P<0,001). U analizi sadržaja pisama pacijenti i ocjenjivači su se preklapali u 27 podcrtanih izraza, od kojih se 20 odnosilo na stručne izraze. Između kvalitete pisama i uspješnosti na ispitu provjerene standardnim pisanim testom nije bilo značajne povezanosti u generacija studenata koje su pisale pismo (2010./11. r=0,016; P=0,909; 2011./12. r=0,069; P=0,596). Međutim, prosječna ocjena na pisanom ispitu generacija s pismom [(11./12. 4,67 (4,52 – 4,81)] u odnosu na generacije bez pisma [(08./09. 3,65 (3,45-3,85) i 09./10. 3,81 (3,59-4,82) bila je značajno viša (P<0,001)]. Zaključak. Pisma studenata pacijentima o njihovoj bolesti pokazala su se kao kvalitetna dopuna konzultaciji, kao sredstvo za unaprjeđivanje komuniciranja (ocjena pacijenata) i kao edukacijski instrument (ocjena mentora). Najčešći razlog poteškoća i nerazumijevanja u komunikaciji između pacijenata i studenata (liječnika) je stručna terminologija. Dokazi za povezanost između studentskog pisma pacijentima i uspjeha na pisanom testu nisu uvjerljivi, te na osnovu njih ne možemo stvoriti jasan zaključak.Aim. Assessment of the possibility of using students’ letters to patients as educational method in training final (sixth) year students at the Department of Family Medicine, Faculty of Medicine, University of Split. Examinees and methods. The study included all 6th year students of the Medical Faculty in academic year 2010-11., 2011./12., 2012./13. attending their rounds in Family Medicine (FM), structured into two 10-day cycles (n=121). Students were represented by the letters they have written to patients during the rounds in FM (each student has written 4 letters; n=484). The letters were evaluated by patients (n=222), mentors (n=22) and independent evaluators (n=3) who used a grading instrument (consisted of five rated categories: 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style; score 1-5, the range of points from 1-25), questionnaires Consultation and Relational Empathy (CARE) and Patient enablement instrument (PEI). Patients and evaluators were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. Letters were analyzed as a unit and grouped by students - authors (" clusters "). In addition to standard methods, the existence of clusters has endorsed the use of multiple linear regression (clusters as a ' dummy ' variable). Results. Analysis of letters as single, independent units and as a "cluster " gave similar results, so an analysis of letters as independent units was presented. There was a low correlation between the quality of written letters (mentors’ score) and patient satisfaction (patients’ score) (r = 0.184, P = 0.007). Although consultation was easier to understand (62.3 % vs . 37.7 %), patients (n = 194), understood slightly better their therapy and treatment recommendations after they have read letter [patient's score (M, 95% confidence interval): 4.5 (4.4 to 4.6), mentor’s score: 4.1 ( 4.0 to 4.2). Patients evaluated letters with a score: 23.7 (23.5 to 24.0), similar to the mentors: 22.3 (21.8 to 22.6), while independent evaluators were somewhat stricter: 20.2 (20.0 to 20.5). There was a positive correlation between the score of consultations and letters in patients (r=0.620, P<0.001) and in mentors (r=0.530, P<0.001). Patients and mentors gave slightly higher total scores to the letters than consultations: patients’ score, letter vs. consultation [(23.7 (23.5 to 24.0) vs. 23.1 (22.7 to 23.4)] and mentors’ score [(22.2 (21.9 to 22.6 ) vs. 21.6 (21.2 to 21.9)]. Significantly more mentors (60.3 %) compared to patients (45.7 %) considered to get more information from the letter (P<0.001), to improve the assessment of the students' knowledge (56.1 % vs. 45.9 %, P=0.003), and to strengthen the nature of information (63.8 % vs. 53.1 %, P<0.001). In analyzing the content of the letters, patients and evaluators overlapped in 27 underlined expressions, 20 of which were related to technical terms. Between the quality and efficiency of letters on a standard written examination verified test there was no significant correlation in the generation of students who wrote the letter (2010./11. R=0.016, P=0.909; 2011./12. R=0.069, P=0.596). However, the average score on the written test, generation with letters [(11./12. 4.67 (4.52 to 4.81)] in relation to generation without letters [(08./09. 3.65( 3.45 -3.85) and 09./10. 3.81(3.59 to 4.82)] was significantly higher (P < 0.001). Conclusion. The letter is a good quality supplement to the consultation process, as a communication means (patients’ score) and as an educational tool (mentors’ score). The most common reason for difficulties and misunderstandings in communication between the patient and the student (doctor) is the professional jargon (terminology). Evidences for the interconnection between the student letters to patients and the efficacy of the written test are not conclusive, and based on them, we can not create a clear conclusion

The use of a letter to the patient as a method in the education of medical students

Cilj. Procjena mogućnosti uporabe pisma pacijentu kao edukacijske metode tijekom izobrazbe studenata medicine završne (šeste) godine studija na predmetu Obiteljska medicina Medicinskog fakulteta Sveučilišta u Splitu. Ispitanici i postupci. Istraživanjem su obuhvaćeni svi studenti šeste godine Medicinskog fakulteta u Splitu akademskih godina 2010./11., 2011./12., 2012./13 (n=121). Uzorak su predstavljala pisma koja su ti studenti napisali pacijentima za vrijeme vježbi iz kolegija Obiteljska medicina (svaki student 4 pisma; n=484). Primijenjen je obrazac za ocjenu konzultacije i pisma; ocijenjene kategorije bile su: jasnoća opisa bolesti/stanja, znanje, kvaliteta/korisnost preporuke, pristojnost, umijeće usmenog/pismenog izražavanja, ocjene 1-5, raspon bodova od 1-25), instrument za mjerenje liječnikova suosjećanja (empatije) u konzultaciji (engl. Consultation and Relational Empathy, CARE) i instrument za mjerenje pacijentove osposobljenosti za nošenje s bolešću (engl. Patient enablement instrument, PEI). Odabranim pacijentima studenti su nakon konzultacije napisali pismo s opisom i objašnjenjem bolesti, liječenja i preporukama za nošenje s bolešću. Nakon što su sva pisma prikupljena, ocijenili su ih pacijenti (n=222), mentori (n=22) i nezavisni ocjenjivači (n=3). Pacijenti su u pismu podcrtali dijelove pisma koje nisu razumjeli, a ocjenjivači dijelove za koje su procijenili da ih pacijenti neće razumjeti. Pisma smo analizirali kao jedinice i grupirana prema studentima - autorima („klasteri“). Uz standardne metode, postojanje klastera uvaženo je korištenjem višestruke linearne regresije (klasteri kao 'dummy' varijabla). Rezultati. Analiza pisama kao pojedinačnih, nezavisnih jedinica i kao »klastera« dala je slične rezultate, pa je prikazana analiza pisama kao nezavisnih jedinica. Postojala je slaba korelacija između kvalitete napisanih pisama (ocjene mentora) i zadovoljstva pacijenata (ocjene pacijenata) (r=0,184; P=0,007). Iako im je konzultacija sama po sebi bila razumljivija od pisma (62,3% vs. 37,7%), pacijenti (n=194) su nešto bolje razumjeli terapiju i preporuke za liječenje nakon što su im studenti napisali pismo [pacijentova ocjena (M,95%-tni raspon pouzdanosti): 4,45 (4,36-4,56), mentorova ocjena: 4,10 (3,98-4,22)]. Pacijenti su ocijenili pisma ocjenom: 23.7 (23.5-24.0), slično kao i mentori: 22.3 (21.8-22.6), dok su nezavisni ocjenjivači bili nešto stroži: 20.2 (20.0-20.5). Postojala je pozitivna povezanost između ocjena konzultacija i pisama kako pacijenata (r=0,620; P<0,001) tako i mentora (r=0,530; P<0,001). I pacijenti i mentori su dali neznatno više ukupne ocjene pismima nego konzultacijama: ocjene pacijenata, pismo vs konzultacija [(23,7 (23,5-24,0) vs 23,1 (22,7-23,4)] i ocjene mentora [(22,2 (21,9-22,6) vs 21,6 (21,2-21,9)]. Značajno više mentora (60.3%) nego pacijenata (45.7%) smatralo je da se u pismu dobije više informacija (P<0,001), da se bolje može ocijeniti znanje studenata (56,1% vs. 45,9%; P=0,003), te da je pisana preporuka korisnija od usmene (63,8% vs. 53,1%; P<0,001). U analizi sadržaja pisama pacijenti i ocjenjivači su se preklapali u 27 podcrtanih izraza, od kojih se 20 odnosilo na stručne izraze. Između kvalitete pisama i uspješnosti na ispitu provjerene standardnim pisanim testom nije bilo značajne povezanosti u generacija studenata koje su pisale pismo (2010./11. r=0,016; P=0,909; 2011./12. r=0,069; P=0,596). Međutim, prosječna ocjena na pisanom ispitu generacija s pismom [(11./12. 4,67 (4,52 – 4,81)] u odnosu na generacije bez pisma [(08./09. 3,65 (3,45-3,85) i 09./10. 3,81 (3,59-4,82) bila je značajno viša (P<0,001)]. Zaključak. Pisma studenata pacijentima o njihovoj bolesti pokazala su se kao kvalitetna dopuna konzultaciji, kao sredstvo za unaprjeđivanje komuniciranja (ocjena pacijenata) i kao edukacijski instrument (ocjena mentora). Najčešći razlog poteškoća i nerazumijevanja u komunikaciji između pacijenata i studenata (liječnika) je stručna terminologija. Dokazi za povezanost između studentskog pisma pacijentima i uspjeha na pisanom testu nisu uvjerljivi, te na osnovu njih ne možemo stvoriti jasan zaključak.Aim. Assessment of the possibility of using students’ letters to patients as educational method in training final (sixth) year students at the Department of Family Medicine, Faculty of Medicine, University of Split. Examinees and methods. The study included all 6th year students of the Medical Faculty in academic year 2010-11., 2011./12., 2012./13. attending their rounds in Family Medicine (FM), structured into two 10-day cycles (n=121). Students were represented by the letters they have written to patients during the rounds in FM (each student has written 4 letters; n=484). The letters were evaluated by patients (n=222), mentors (n=22) and independent evaluators (n=3) who used a grading instrument (consisted of five rated categories: 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style; score 1-5, the range of points from 1-25), questionnaires Consultation and Relational Empathy (CARE) and Patient enablement instrument (PEI). Patients and evaluators were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. Letters were analyzed as a unit and grouped by students - authors (" clusters "). In addition to standard methods, the existence of clusters has endorsed the use of multiple linear regression (clusters as a ' dummy ' variable). Results. Analysis of letters as single, independent units and as a "cluster " gave similar results, so an analysis of letters as independent units was presented. There was a low correlation between the quality of written letters (mentors’ score) and patient satisfaction (patients’ score) (r = 0.184, P = 0.007). Although consultation was easier to understand (62.3 % vs . 37.7 %), patients (n = 194), understood slightly better their therapy and treatment recommendations after they have read letter [patient's score (M, 95% confidence interval): 4.5 (4.4 to 4.6), mentor’s score: 4.1 ( 4.0 to 4.2). Patients evaluated letters with a score: 23.7 (23.5 to 24.0), similar to the mentors: 22.3 (21.8 to 22.6), while independent evaluators were somewhat stricter: 20.2 (20.0 to 20.5). There was a positive correlation between the score of consultations and letters in patients (r=0.620, P<0.001) and in mentors (r=0.530, P<0.001). Patients and mentors gave slightly higher total scores to the letters than consultations: patients’ score, letter vs. consultation [(23.7 (23.5 to 24.0) vs. 23.1 (22.7 to 23.4)] and mentors’ score [(22.2 (21.9 to 22.6 ) vs. 21.6 (21.2 to 21.9)]. Significantly more mentors (60.3 %) compared to patients (45.7 %) considered to get more information from the letter (P<0.001), to improve the assessment of the students' knowledge (56.1 % vs. 45.9 %, P=0.003), and to strengthen the nature of information (63.8 % vs. 53.1 %, P<0.001). In analyzing the content of the letters, patients and evaluators overlapped in 27 underlined expressions, 20 of which were related to technical terms. Between the quality and efficiency of letters on a standard written examination verified test there was no significant correlation in the generation of students who wrote the letter (2010./11. R=0.016, P=0.909; 2011./12. R=0.069, P=0.596). However, the average score on the written test, generation with letters [(11./12. 4.67 (4.52 to 4.81)] in relation to generation without letters [(08./09. 3.65( 3.45 -3.85) and 09./10. 3.81(3.59 to 4.82)] was significantly higher (P < 0.001). Conclusion. The letter is a good quality supplement to the consultation process, as a communication means (patients’ score) and as an educational tool (mentors’ score). The most common reason for difficulties and misunderstandings in communication between the patient and the student (doctor) is the professional jargon (terminology). Evidences for the interconnection between the student letters to patients and the efficacy of the written test are not conclusive, and based on them, we can not create a clear conclusion