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Background: The aim of this study was to explore correlation between health locus of control (HLOC) and clinical outcomes in patients with diabetes mellitus type 2 (DMT2). Subject and methods: Cross-sectional study. A multistage, stratified proportional sampling was used to draw a random sample of 46 GPs and, systematic sampling of the first 6 DMT2 patients visiting the chosen GPs with recently registered blood pressure, lipid and glycaemic profile. The patients completed Croatian version of HLOC (ZKL-90-2) and socio-demographic data questionnaires after signing informed consent. Results: DMT2 patients mostly displayed internal HLOC, followed by circumstances, powerful others and chance. Almost all observed objective clinical outcomes, except fasting blood glucose and LDL cholesterol, are in correlation with internal HLOC scale. Correlations were mostly negative. The patients considering themselves to be in command over diabetes obtained the lower scores at total cholesterol (p=0.014), triglycerides (p=0.037), systolic (p=0.003) and diastolic blood pressure (p=0.025). Positive correlation with Es and Eo scales measuring external HLOC was found regarding levels of LDL cholesterol (p=0.032), triglycerides (p=0.009) and systolic (p=0.001) blood pressure. HbA1c (p=0.001). Fasting blood glucose (p=0.002) was higher in patients believing in external circumstances. Conclusion: DMT2 patients who believed they had control over their disease obtained better disease outcomes than those believing in external circumstances., Pozadina: Cilj ovog istraživanja bio je istražiti postoji li povezanost između zdravstvenog lokusa kontrole (ZLK) i kliničkih ishoda u bolesnika sa šećernom bolešću tip 2 (ŠBT2). Ispitanici i metode: Presječno istraživanje. Stratificiranim reprezentativnim slučajnim uzorakovanjem odabrano je 46 liječnika opće/obiteljske medicine koji su potom odabrali prvih 6 bolesnika koji su ih posjetili tijekom perioda istraživanja, a koji su imali nedavno zabilježenu vrijednost arterijskog tlaka, lipidni profil te kratkoročnu i dugoročnu vrijednost vrijednost glukoze. Po davanju informiranog pristanka bolesnici sa ŠBT2 ispunili su hrvatsku verziju upitnika za procjenu zdravstvenog lokusa kontrole (ZKL-90-2) i upitnik o sociodemografskim podacima. Rezultati: U bolesnika sa ŠBT2 većinom je bio izražen unutarnji lokus kontrole, potom je slijedila vjera u okolnosti, moćne druge i utjecaj slučaja. Većina proučavanih objektivnih kliničkih ishoda DMT2, osim glukoze na tašte i LDL kolesterola u korelaciji su sa skalom koja mjeri unutarnji ZLK. Korelacije su većinom negativne, bolesnici koji su imali izražen unutarnji ZLK imali su niže vrijednosti ukupnog kolesterola (p=0.014), triglicerida (p=0.037), sistoličkog (p=0,003) i dijastoličkog (p=0,025) arterijskog tlaka. Utvrđene su pozitivne korelacije skala Es i Eo (koje mjere vanjski ZLK) s razinama: LDL kolesterola (p=0,032), triglicerida (p=0,009) i sistoličkog arterijskog tlaka (p=0,001). Utvrđene su više vrijednosti HbA1c (p=0,001) i glukoze na tašte (p=0,002) u bolesnika koji su imali izreženo vjerovanje u utjecaj okolnosti (vanjski ZLK). Zaključak: Bolesnici sa ŠBT2 koji su imali izražen unutarnji lokus kontrole imali postignute bolje vrijednosti kliničkih ishoda liječenja ŠBT2 u odnosu na bolesnike koji su imali izražen vanjski lokus kontrole.

U radu su pregledno prikazane promjene i izazovi medicinske edukacije u svijetu i kod nas od 70-tih godina prošlog stoljeća. Medicinski fakultet Sveučilišta u Zagrebu odgovorio je na izazove vrlo rano i već početkom 80-tih osnovao Zavod na nastavnu tehnologiju sa zadaćom da pripremi smjernice za razvoj medicinske edukacije, osigura podršku u primjeni smjernica te preuzme institucionalnu odgovornost u osposobljavanju nastavnika. Zavod je potaknuo osnivanje Hrvatskog društva za medicinsku edukaciju (HDME) za sve profile nastavnika u području biomedicine i zdravstva. HDME je

The specialization in family medicine (FM) was introduced in the academic year 1960/61, but there was an almost 12-year gap in its implementation. Specialized training (ST) was reintroduced in 2003 through the project "Harmonization of family medicine with EU standards introducing a FM specialization". The aim of this paper is not to present all of the developmental phases of the ST curriculum, but to provide accounts of some of the challenging experiences which might be of help to the readers. Experience in several areas is examined: experience in educational need assessment using focus group method; introduction of a new specialist exam; development of the Study Guide, the Trainee Manual, and the Trainer Manual; selection procedure and training of trainers; and skill-lab training and peer-group learning. Systematic evaluation was planned for the next year, when the current project finishes and is to be replaced by another one. The general impression is that ST in FM is perceived as quite challenging, both for the trainees and for the teachers.

It is well known that countries with strong primary care achieve better health outcomes at lower costs. Therefore, the effort of World Health Organization in promoting primary care as a basic principal of successful health care system is an ongoing process. Although Croatia was recognized as a country with primary care orientation due to the development of health centers and introduction of specialist training of general practitioners, it seems that many health care reforms aimed at better organization of health institutions and decreasing of health care costs did not result with higher primary care orientation. By application of the Primary Care Score instrument in 2014 (Croatia received 11.2 out of 20 possible points), and international comparison performed in 2002, it was concluded that among the eighteen OECD countries Croatia could be categorized as an "intermediate primary care country", obtaining the scores just a bit above the average.

Uvod: Analiziranje lijekova s najvećim opsegom potrošnje, kao i onih s najvećim financijskim troškovima, daleko premašuje puki zdravstveno- statistički značaj, otvarajući brojna pitanja o njihovom pravom mjestu i ulozi u suvremenoj farmakološkoj terapiji. Cilj: Cilj rada je istražiti ukupnu potrošnju lijekova u 2012. godini, terapijsku potrošnju izraženu u DDD i financijsku izraženu u kunama, te specifično, potrošnju najpropisivanijih lijekova u izvanbolničkoj zaštiti. Materijali i metode: Istraživanje je kritička analiza (audit), temeljeno na rutinski prikupljenim podacima Hrvatske agencije za lijekove i medicinske proizvode. Iz javno dostupnih podataka o godišnjem potrošnji lijekova prikupljeni su podaci o općoj potrošnji bolničkoj i izvanbolničkoj, te podaci o potrošnji dvadeset lijekova koji su najčešće propisani na recept (na teret HZZOa), dvadeset lijekova u režimu slobodne prodaje, te prvih dvadeset s obzirom na financijski trošak, kao i podaci o potrošnji lijekova po županijama. Rezultati: Najveća ukupna, bolnička i izvanbolnička potrošnja, terapijska (izražena stopom DDD/ 1000 stanovnika/ dan) i financijska, odnosila se na kardiovaskularne lijekove, iza kojih su slijedili lijekovi s djelovanjem na živčani sustav. Među 20 najpropisivanijih lijekova na recept u PZZ, na prvom mjestu su bili ramipril, amlodipin i diazepam, dok su prema financijskim pokazateljima na prva tri mjesta atorvastatin, pantoprazol i lizinopril HCT. Također veliki udio u financijskoj potrošnji otpada na lijekove koji su propisani po preporuci kliničkih specijalista, kao što su atipični antipsihotici i biološki lijekovi. U potrošnji lijekova koje pacijenti sami kupuju (OTC lijekovi) najčešća je acetilsalicilna kiselina, te analgetici i antipiretici, uključujući i nesteroidne antireumatike. Također je uočena velika razlika u potrošnji među pojedinim županijama. Zaključak: U komparaciji s literaturnim spoznajama, visoka potrošnja kardiovaskularnih lijekova je razumljiva zbog javno-zdravstvenog značaja tih bolesti, ali bi se trebao preispitati, s terapijskog i financijskog aspekta, visok udio u potrošnji nekih lijekova, kao što su ramipril, atorvastatin, diazepam, pantoprazol kao i udio lijekova koji su izvan propisivačke ingerencije liječnika obiteljske medicine.

Uvod: Istraživanje bolesnikova iskustva unutar “prirodnog konteksta” bolesnikova života preporučena je metodologija identifikacije čimbenika i strategija koji pomažu bolesniku u prilagodbi na kroničnu bolest. Cilj: Istražiti bolesnikovo inicijalno iskustvo suočavanja s novo postavljenom dijagnozom infarkta miokarda (IM) . Metode: Provedeno je 30 semistrukturiranih individualnih intervjua. Paralelno s intervjuiranjem provedena je analiza podataka vodeći se principima utemeljene teorije. Rezultati: Proizašla su tri obrasca bolesnikova suočavanja s novopostavljenom dijagnozom IM. “Bliski susret sa smrću”, “snažna bol”, i “tihi IM”. Šest čimbenika olakšalo je nošenje s novopostavljenom dijagnozom IM: boravak u bolnici, dovršenost dijagnostičkih postupaka, povjerenje u liječnika, bolesnikov prethodni predosjećaj da bi mogao doživjeti IM, bolesnikova osobnost, te potreba za samoćom. Zaključak: Liječnici moraju biti svjesni da različiti obrasci bolesnikova suočavanja s dijagnozom IM mogu implicirati na drugačije potrebe bolesnika za psihološkom podrškom i komunikacijom.

Rad je opservacijsko-populacijsko istraživanje temeljeno na podacima objavljeni u Hrvatskim zdravstveno-statističkim ljetopisima za razdoblje od 1995. do 2012. godine. Prikazano je očekivano trajanje života pri rođenju, opće i specifične stope smrtnosti prema MKB-skupinama, struktura hospitalizacija (bolničkog pobola) te drugi pokazatelji.

Background: «The art of medical education» is the basic course for young and inexperienced medical teachers. The course was developed and delivered by the members of the Croatian Association for Medical Education. 220 teachers from the Me dical School, University of Zagreb finished the course. A comprehensive evaluation, including focus group discussion, was performed after ten years of experience. We would like to present here the results of qualitative evaluation related to the participants' learning experiences. Summary of work: Four topics have been discussed within the focus-groups: motivation for the course ; positive learning experience during the course ; impact on the everyday teaching and suggestions for the course improvement. Four focus groups, with 32 participants, were held. Discussions were audio-taped, transcribed and analysed using grounded theory. Summary of results: Nine themes emerged important as positive learning experience during the course: 1) possibilities to exchange experiences with teachers and colleagues ; 2) feedback of peers as a learning tool ; 3) self-reflection as a method of learning ; 4) learning as being learner ; 5) learning from the teachers as a role model ; 6) small-group as a learning tool ; 7) task based learning ; 8) handbook as a source for learning and 9) enthusiasm and positive atmosphere as a vehicle for learning. Conclusion: The participants highly appreciated the applied adult learning principles and methods.

Background: Croatian Associatiation for Medical Education (CAME), in collaboration with the Department for Educational Technology, School of Medicine, University of Zagreb, are organizing the postgraduate course entitled „The Art of Medical Education“ since 2002. The main aims of the program are to encourage and enable medical teachers early in their career to learn and put into practice contemporary approaches in medical education and motivate them to improve quality of their work. The aim of this study was to investigate factors affecting their attending the organized six-day training program on medical education.. Summary of work: The survey was conducted among participants-teachers at School of Medicine, Zagreb, who attended the course from 2002-2010 (N=224). Method used was questionnaire sent to all previous participants. The study showed that the most important motives for their coming were to learn something new, renovation of existing knowledge and need to complete the course for future academic promotion. Less important motives were associated with promotion in assistant professor, referral by Chair and least desire for renew of existing knowledge. Take-home message: External and internal motives are extremely important factors influencing the effectiveness of organized training programme for teachers on quality of their work.

U pripremi Projekta «Usklađivanje obiteljske medicine s Europskim standardima uvođenjem obvezne specijalizacije», pored akata kojim su regulirani izvođenje i financiranje, izrađen je novi nastavni plan i program specijalizacije, te je razrađen završni, specijalistički ispit. Cilj ovog rada je prikazati teorijski okvir i iskustvo u pripremi i izvođenju ispita iz obiteljske medicine. Dvije su faze ispita: pripremne i završne. U pripremnoj fazi, specijalizant treba prikupiti i priložiti dokaze o učenju i onom što je praktično radio tijekom specijalizantskog staža u obliku portfolija, te priložiti završno mišljenje mentora o napretku tijekom specijalizantskog staža i profesionalnoj osposobljenosti, te 8 eseja. Završna faza specijalističkog ispita se sastoji iz 3 dijela: pismenog ispita-testa, praktičnog ispita kliničkih vještina, OSKI-ja i usmenog ispita. Od 582 kanidata koji su pristupili završnoj fazi specijalističkog ispita, njih 84.4% je taj ispit polažilo u prvom pokušaja, 15.6 je ponavljalo pojedine djelove ispita, te je 96.9 taj ispit i pložilo, a 3.1% kanidata će ponavljati pojedine djelove ispita.

Realizacijom Projekta «Usklađivanje obiteljske medicine s Europskim standardima uvođenjem obvezne specijalizacije», revitalizirana je specijalizacija iz obiteljske medicine. Specijalizacija je započela 1960 godine, ali je devedesetih godina skoro prekinuta. Prekid, ali i promjene u medicinskoj znanosti i praksi bili su motiv za izradu novog kurikuluma. Cilj ovog članka je podjeliti iskustva u njegovoj izradi i izvođenju. U planiranju kurikuluma obuhvaćeno je deset uobičajenih faza: određivanje edukativnih potreba, definiranje edukativnih ciljeva i s njima povezanog sadržaja nastave, definiranje edukativne strategije, uključujući i metoda poučavanja, izrada izvedbenog plana i definiranje uvjeta izvođenja, određivanje metoda evaluacije kurikuluma i metoda ispitivanja i ocjenjivanja polaznika, prezentaciju kurikuluma javnosti, te planiranje upravljanja i vođenja. Posebno naglašavamo izvedbeni dio kurikuluma, izvedbene programe A, B i C kako je definirano Projektom za prijelazni period do 2015. Također upućujemo na dokumente i radne materijale potrebne za izvođenje nastavnog plana i programa, kao što su: Vodič kroz specijalizaciju s edukativnim ciljevima i Priručnici za specijalizante i mentore. Iznesena su iskustva s izvođenjem i predložene mjere za unapređenje kvalitete.

Interes za probleme seksualnog zdravlja uvećala je spoznaja da je učestalost te vrste problema daleko veća no što se pretpostavljalo, zapažanje da se bolesne osobe teško odlučuju otvoreno progovoriti o svojim seksualnim tegobama i napredak na planu liječenja seksualnih tegoba. Temeljna podjela seksualnih problema oslonjena je na tijek seksualnog akta i dijeli probleme na one uzrokovane seksualnom željom/motivacijom, te na probleme uzbuđenja i probleme orgazma. Podjela usmjerena na partnere dijeli probleme na one osobne prirode (mogu biti tjelesni i psihički), probleme veza (kontakta i komunikacije), te na probleme proizašle iz pritiska okoline. U dijagnostici seksualnih problema postoje specifičnosti koje su usmjerene na pitanja spolnog identiteta i uloge, hormonalnog funkcioniranja pacijenta, seksualnog iskustava pacijenta, seksualnih navika i znakova zlostavljanja. Paleta terapijskih intervencija u rješavanju seksualnih problema uključujje kirurške, psihološke, medikamentozne i ostale intervencije. Napredak u liječenju erekcijske disfunkcije u muškaraca na medikamentoznom planu privlači posebnu pozornost. U primjeni modernih lijekova za liječenje erekcijske disfunkcije potrebna je dobra upućenost stručnjaka kako bi adekvatno indicirali upotrebu tih lijekova i adekvatno savjetovali pacijente kao lijekove koristiti. Rekreativna upotreba te vrste lijekove nije poželjna niti među ženama niti među muškarcima.

Uvod: Polimedikacija je česta pojava u zdravstvenoj skrbi za starije ljudi. Podaci govore da oko 40% ljudi starijih od 65 godina uzima pet, a 12% i više od deset različitih lijekova. Učestalost je još i veća kod ljudi koji su smješteni u domovima umirovljenika. Cilj: Utvrditi zastupljenost i stupanj polimedikacije u populaciji bolesnika starijih od 65 godina, stanara jednog doma umirovljenika. Metode i ispitanici: U istraživanju je primijenjena metoda medicinskog audita. Medicinski audit je definiran kao pregled učinjenog, odnosno kao sistematska analiza kvalitete zdravstvene zaštite, u ovom slučaju kvaliteta propisivanja lijekova Podaci su prikupljeni iz osobnih zdravstvenih kartona (100 kartona, svaki drugi) ispitanika stanara doma umirovljenika. Za svakog ispitanika, prikupljeni su podaci o spolu, dobi, broju propisanih lijekova za trajno uzimanje, broju i vrsti dijagnoza i broju lijekova koje bolesnici uzimaju u samomedikaciji. Stupanj polimedikacije je definiran kao blaga (2 ili 3 lijeka), umjerena (4 ili 5 lijekova) i visoka ili maior ( 6 i više lijekova). Rezultati: Usporedbom sa standardom, u ovom slučaju sličnim rezultatima iz literature, utvrđena je velika zastupljenost i visok stupanj polimedikacije. Najveći broj lijekova uzimaju ispitanici od 65 do 75 godina (6 lijekova), zatim slijede ispitanici od 76 do 85 godina (4.5 lijekova), a namnaje oni stariji od 86 godina (4, 2 lijeka). Od 100 ispitanika, dva do tri lijeka uzima njih 31, četiri do pet lijekova uzima 30, a 39 uzima šest i više lijekova. Rezultati unutar dobnih skupina pokazuju da 57.9% ispitanika u dobnoj skipini od 65 do 75 godina ima visoku polimedikaciju, za razliku od 35.6% ispitanika dobne skupine od 76 do 85 godina, i 31, 8% u dobnoj skupini starijoj od 86 godina. Zaključak: Budući da se radi o velikoj zastupljenosti i visokom stupanju polimedikacije, kao mjere unapređenje kvalitete rada predviđeno je: analiza osobnih obrazaca propisivanja, uključivanje bolesnika u donošenje odluke o propisivanju, uključivanje uprave i sosoblja u pronalaženje alternativnih načina riješavanja zdravstvenih problema bolesnika i usuglašavanje propisivanja lijekova s kolegama specijalistima konzultantima.

Cilj ove studije je bio istražiti zastupljenost smetnji u ponašanju i učenju školske djece u dobi između 7 i 10 godina u Osnovnoj školi Vidovec, Markuševečka Trnava, Zagreb, za koje skrbi liječnik obiteljske medicine, radi unapređenja kvalitete vlastitog rada. Izvor podataka predstavljali su osobni zdravstveni kartoni djece. Iz njih su prikupljeni podaci o spolu i dobi djeteta, obiteljskom statusu, ekonomskom stanju obitelji, postojanju duševnih bolesti u obitelji, te o poremećajima ponašanja i učenja. Od ukupno 103 djeteta izdvojeno je 20 učenika koji imaju evidentirane smetnje u ponašanju i učenju (19, 4%, ), od kojih 6 ima ADHD, a tipičnu sliku komorbiditeta ima 6 učenika. U prvom razredu, od ukupno 26 đaka, 2 imaju ADHD ili neurotski poremećaj (7, 7%). U drugom razredu, od 25 učenika, 7 ih ima ADHD, dislaliju i/ ili poteškoće u čitanju i pisanju (28, 0%). U trećem razredu, od 26 učenika, 7 ih ima teškoće u čitanju i pisanju, dislaliju ili neurotske smetnje (26, 9%). U četvrtom razredu, od 26 učenika, 4 ima ADHD, a od njih jedan još ima i poteškoće u čitanju i pisanju, slabovidnost i nagluhost (15, 4%).

percepcija socijalne podrške i kvalitete života bolesnica oboljelih od karcinoma dojke u ordinacijama obiteljske medicine?

Cilj istraživanja: Istraživanje je provedeno s ciljem ispitivanja i analize mišljenja liječnika opće medicine o preduvjetima za kvalitetno funkcioniranje zdravstva i promjenama u sustavu zdravstva te utvrđivanja razlika u mišljenjima djelatnika doma zdravlja, zakupaca i privatnika. Metoda: U istraživanju je sudjelovalo 145 liječnika iz Republike Hrvatske na specijalizaciji iz Obiteljske medicine od kojih 42, 8% radi u praksi duže od 15 godina.Instrumnt je bila posebno pripremljena anketa. Podaci su analizirani prema statusu ordinacije u kojoj ispitanici rade: uspoređeni su odgovori djelatnika doma zdravlja (36, 6% ispitanika), onih u zakupu (51, 7%) te liječnika u ordinaciji izvan doma zdravlja uz ugovor s HZZO (11, 7% „privatnika“). Rezultati: Usporedba mišljenja o današnjim promjenama u izvanbolničkoj zaštiti pokazuju sličnosti i razlike između tri skupine ispitanika. Svi podjednako smatraju da su danas jako prisutni „podilaženje pacijentima“ i nedostatak timskog rada. Liječnici u zakupu značajnije od ostalih ističu prisutnost nelojalne konkurencije, dok privatnici više od ostalih navode razlike u pozitivnoj kometiciji i ulaganju privatnih sredstava u prostor i opremu. Prema mišljenju djelatnika doma zdravlja, reforma ne donosi promjene u kvaliteti rada, dok zakupci i privatnici smatraju da je ona dosta i bino promijenjena. Svi ispitanici smatraju da su materijalna motivacija djelatnika i naknada troškova uloženih u nove investicije najvažnniji preduvjet kvalitetnog rada. Suradnja s kolegama različito je vrednovana: za djelatnike doma zdravlja važno je surađivanje s kolegama iste struke i patronažnom službom, dok je za privatnike i zakupce važnija suradnja saa sekundarnom zaštitom. Privatnici i zakupci suradnju s javnim zdravstvom i preventivnim službama smatraju manje važnom. Za sve skupine važnije je redefinirati način ugovaranja opsega i financiranja rada nego reorganizirati današnji dom zdravlja. Zaključak: Legislativne promjene u zdravstvu neophodno je pratiti ne samo kroz pokazatelje zdravstvenog stanja i troškove sustava već i kroz zadovoljenje očekivanja korisnika i davatelja usluga. U tome je osobito važno kontinuirano praćenje zahtjeva i mišljenja djelatnika u izvanbolničkoj zaštiti.

Procjena bolesnikova doživljaj šećerne bolesti primjenom IPQ-B upitnika

Background During the implementation of Bologna process, all medical schools in Croatia harmonised the core curricula. However, Zagreb Medical School, as a leading medical school in Croatia, recognized the need to go beyond traditional teacher-based and knowledge-based curriculum and move towards learning-outcomes delivery. Working process The first step in development learning-based curriculum was to form Zagreb Task Force Group. The members are well experienced teachers, students and administration representatives. The first task was to analyse and compare /the well known European documents, with expected competencies for so called «The Croatian Doctor». In the second phase, Task Force Group defined the essential domains for national doctors. Communication skills, Practical and clinical skills and Skills in emergency were subdivided into detailed learning outcomes, description of learning methods and appropriate assessment. The next step is to include the stakeholders and prepare a document to be accepted by other medical schools in Croatia. Take-home messages Delivering medical curriculum based on learning-outcomes is challenging process with many advantages for all involved, but it is not an easy task. Learning-outcomes are not just a tool in medical curriculum (re)design. It is also an important approach in development of national qualification framework («The Croatian Doctor»).

Introduction: Continuing Medical Education (CME) / Continuing Professional Development (CPD) is in fact the longest part of the whole continuum of medical education. In many countries CME/CPD is steered by accreditation of the specific events and programs offered and linked to the re-certification/re-licencing of the individual doctors. The purpose of the whole process of CME/CPD in General Practice/Family Medicine (GP/FM), its accreditation and re-certification is to assure the best possible practices for primary medical care: to make sure that when a citizen (healthy or not) visits a general practitioner, he will have easy access and get up-to-date care in a professional and humanistic context. Main objective of workshop: To explore and disseminate information about the situation in European countries concerning: the accreditation of the CME/CPD events and programs in GP/FM and the re-certification/re-licencing procedures for general practitioners. Methods of work: - Presentation of first results of a study by questionnaire within EURACT Council on the situation of accreditation in CME/CPD in GP/FM and on re-certification / re-licensing in Europe. - Exploring and exchanging personal experiences in different countries in small groups and finding conclusions based on these experiences. Questions to be discussed: Accreditation and re-certification rules and procedures in different countries? Relationship between CME/CPD and re-certification? How the individual educational needs can be fulfilled within the re-certification process? What is the role of peers? What is the role of governmental and university instances? Who should and could finance the procedure? How to collect the evidence? What are the quality assurance criteria?

Health locus of control (LOC) refers to the person beliefs who or what has control over his/her health. A person's LOC orientation is one of several factors that determine which health-related behaviors a person will perform. AIM: To explore LOC of diabetes mellitus type 2 (DMT2) patients, also in relation to patient' socio-demographic characteristics (sex, education, working status, and family status), context (place of birth, experience with chronic diseases in family, economic status), social support and quality of life. METHODS: This cross-sectional study was carried out in 77 DMT2 patients in two family medicine practices. Patients filled out two questionnaires: on patient general data and ZLK-90-2 questionnaire. Statistic analysis was done using Statistica, version 7.1 software, and values of P < 0.05 were considered statistically significant. RESULTS: The patient mean age was 63.4 years +/- 13.1 (M +/- SD), and mean duration of diabetes 10.3 +/- 8.2 years (M +/- SD). The belief ininternal LOC was most common in study patients, followed by the belief in health dependence on circumstances, influence of chance, destiny or God, and finally influence of powerful others. Highly educated patients had a statistically significantly less expressed internal LOC and belief in the influence of chance, destiny or God. The patients that underestimated their quality of life, showed a statistically significantly lower rate of belief in health dependence on circumstances. DISCUSSION: In spite of the small sample size and unfavorable patient distribution according to age, work status, disease duration and education, results of this and other studies on LOC, forcing LOC orientation regarding self-treatment and self- control of DMT2 patients could be of high importance, with the assumption of good internal responsibility and belief in help of other important people. CONCLUSION: Understanding LOC of DMT2 patients is essential for developing more efficient educative and intervention medical programs for care of these patients, since it could help in making the right access to care for every single patient or group of patients that have the same LOC.

Background: It is argued that too much emphasis has been placed on treatment oriented medical care models, while not enough attention has been given to issues relating behavior and experience that people with chronic illness actually live through. Research question(s): To describe diabetes mellitus type 2 (DMT2) or myocardial infarction (MI) patients experience in confronting, getting acquainted with, accepting and living with those chronic illnesses. Methods: The mixed-method research with triangulation design will be used. The qualitative research part will be based on the principles of grounded theory methodology (simultaneous data collection and analysis, constant comparative analysis, theoretical sampling). 64 patients (32 DMT2 and 32 IM) will purposefully be sampled and interviewed in depth by 16 randomly selected family doctors (from the 3 Zagreb Health Centers). In the quantitative research part, using standardized questionnaires, data on illness perception, health locus of control, quality of life and social support will be collected from this 64 patients. Statistic analysis will be done using Statistica, version 7.1 statistic program, and P

Introduction: Vocational training in General Practice / Family Medicine in Croatia lasts 3 years and consists of 3 parts: postgraduate course (7 months) ; hospital and outpatients (14 months) and practical work at GP's, trainers' practice (12 months). Specialist's exam consists of 2 parts: 1) preparatory part: portfolio, 8 written essays, trainer's assessment of clinical competence, trainer's progress report ; 2) final: written test – 120 questions, 25 OSCE, 5' stations and oral exam in front of three members jury. Each portfolio is assessed by the members of this jury. Aim of this study was to see if there were any differences among the portfolio assessors. Method: Portfolio assessment is qualitative according agreed criteria. Four learning outcomes are assessed: 1) aquisition of knowledge, comprehensive skills and attitudes ; 2) developmental achievement ; 3) clinical competence ; 4) ability to be «reflective practitioner». A quantity, the number of evidence and owerall quality are also assessed using scale from 1 (fail) to 5 (exelent). Resulta: Here are presented averrage grades for the quantity and owerall quality of the portfolios. Nine examiners reviewed in between 30 and 80 portfolios. There were differences between the assessors. Averrage marks for quantity (number of evidence) varied in between 2, 69 and 4, 06, and for owerall quality in between 3, 00 and 4, 19. For both category differences appeared in between two assessors. There were no big differences between seven other assessors. Conclusion: Those differencess were discussed within the group of examiners in order to improve a validity of the portfolio assessment.

Cilj. Procijeniti uspješnost liječenja opijatskih ovisnika metadonom u ordinaciji liječnika obiteljske medicine (LOM). Ispitanici i metode. Praćenje uspješnosti liječenja metadonom opijatskih ovisnika provedeno je u periodu 31. siječnja 1995. do 31. siječnja 2007. na terenu Novog Zagreba u kojem je ugovoreno 60 timova LOM. U ovom istraživanju registrirani su i analizirani svi ovisnici liječeni metadonom u navedenom periodu, a nalaze se ili su se nalazili na listama pacijenata ugovornih LOM područja Novog Zagreba. Osobnim kontaktom s liječnicima koji su u skrbi imali pacijente u metadonskom programu i uvidom u osobne zdravstvene listove te prateću medicinsku dokumentaciju bilježeni su svi relevantni podaci. Rezultati. Među liječenim ovisnicima bilo je 255 (81, 73%) muškaraca i 57 (18, 27%) žena. Prosječna dob ispitanika na kraju istraživanog perioda iznosila je 34, 9±6, 9 godina, a na početku liječenja 26, 3±6, 4 godine. Prosječna duljina heroinskog staža prije početka liječenja iznosila je 6, 3±4, 7 godine. Prosječna dnevna doza na početku liječenja iznosila je 50 mg metadona, a na kraju istraživanja 55 mg. Na kraju praćenja za 29 (9, 29%) ovisnika liječnici su procijenili da su u remisiji bez terapije, a za 135 (43, 27%) da su u remisiji uz terapiju. Zaključak. Zdravstvena skrb za ovisnike o drogama i pristup u liječenju su identični pristupu svim drugim kroničnim bolestima, a plan liječenja treba prilagoditi individualnim potrebama ovisnika. S obzirom na kronični i recidivirajući tijek bolesti, temelj terapije mora biti u izvanbolničkom liječenju što podrazumijeva stalnu aktivnu ulogu liječnika obiteljske medicine te njihovu usku suradnju s psihijatrima u centrima za prevenciju i izvanbolničko liječenje ovisnosti i sličnim ustanovama.

Aims and purpose: To investigate illness perception of myocardial infarction (MI) patients and its association with the patients' cardiovascular risk (CVR) factors. Design and Methods: Cross-sectional study was carried out in 94 MI patients in three Croatian family medicine practices. Patients filled two questionnaires: on patients’ general data and the brief illness perception questionnaire (IPQ-B). Included CVR factors data were: fasting blood glucose, total cholesterol, LDL and HDL cholesterol, and blood pressure. Statistic analysis was done using Statistica, version 7.1 statistic program, and values P

Background Although medical doctors face moral dilemmas every day and presumably have higher requirements for morally competent professional behavior than any other profession, medical students are mostly trained only to handle the scientific and technical aspects of the profession but not the moral. Available data world wide suggest that many medical students show little change in their moral development or even experience a decline of moral judgment competencies. Summary of work Lind's Moral Judgment Test (MJT) was used to assess moral judgment competences of medical students of 1st, 3rd, and 5th year at University of Zagreb Medical School. Summary of results Results from our cross-sectional study revealed that the MJT Competence-score (C-score) of tested medical students (N=182) showed a decline tendency, indicating a regression in their moral judgment competences. Students' C-score: 1st year = 21.27 ; 3rd year = 16.39 ; 5th year = 17.12. Conclusions Medical students get a highly sophisticated technical training but not the moral education needed to cope with the dilemmas that they are confronted with in their professional life. It seems like there is a hidden curriculum in the structure of medical education that prevents rather than fosters the development of moral judgment competencies. Take-home message For holistic development of medical students a change of the curriculum and organization of medical education is needed that will create an academic atmosphere fostering students' moral development.

Nema sažetka

Research indicates that traditional CME is not effective in changing performance. Multifaceted interventions are needed to change performance. The progressively growing medical knowledge and changing demands on the society form an ethical obligation for all doctors to update there knowledge and skills, but also to perform in practice according to what they have learned. Traditional CME has to be enriched with assessment of one’s own work and practice performance to identify the real learning needs, a concrete learning plan has to be formed and followed to achieve continuous professional development. A desired change in performance is the objective of any learning process. The EURACT CME/CPD –Committee (Continuing Medical Education/Continuous Professional Development) has developed this model workshop. Participants first identify their learning needs in practice using qualitative tools, make their own learning agenda and develop a concrete plan for learning, reviewed by colleagues. As tools in this workshop we will use consultation diary, self-reflection of competence using position mapping and significant event analysis, As a result of this workshop, the participants will understand some basic concepts of continuing professional development, as planned and peer-reviewed learning agenda based on identified learning needs. They will be able to use the introduced tools and methods in their own practice and in the training of others.

Continuing Professional Development (CPD) is the longest and an interesting part of the continuum of medical education. In many countries CPD is combined with accreditation and re-licensing procedures. The purpose of the process is to assure the best possible practices for public health: that when a citizen (healthy or not) visits a general practitioner, it is assured they he will have access and get up-to-date care. The main objective of the workshop is to explore and disseminate information about the situation about CPD, accreditation, licensing and re-licensing procedures in European countries. The methods of work will be that of exploring experiences in small groups. The following questions are expected to be discussed: Accreditation and re-licensing procedures in use? Are CPD and re-licensing related? How educational needs are fulfilled within the re-licensing procedures? How to guarantee learning and change in performance instead of picking up the points? What is a role of peers? What is a role of governmental and university instances? How to collect evidence? Who should be responsible? Who should and could finance the procedure? How often it should be done? What are the quality criteria? What, if an individual GP fails to meet the standards? A composition of the workshop: 1. Introduction: definition of the used terms, objectives and the methods of work ; 2. Overview of the known European situation – Eexamples of European countries ; 3. Small group work - AIM: formulate an ideal system of CPD, accreditation, re-licensing ; 4. Plenary – small groups presentations ; 5. Evaluation of the workshop

Aims were to explore Health locus of control (LOC)of diabetes mellitus type 2 (DMT2) patients, also in relation to patinets` sociodemographic characteristics (sex, education, working status, and family status), context (place of birth, experience with chronic diseases in family, economy status) and quality of life. Cross sectional study was carried out in 77 DMT2 patients in two Croatian family medicine practices. Patients filled two questionnaires: on patients` general data and questionnaire for evaluation of LOC (ZLK-90-2). Statistic analysis was done using Statistika, version 7.1 statistic program, and values P>0, 05 were considered statistically significant. The patients` average age was 63.4 years +/-13, 1 (M+/-SD), and average duration of DMT2 was 10.3+/-8.2 years(M+/-SD). In patients was mostly expressed believe in internal LOC. On second place was believe in dependence of health on circumstances, than believe in influence of chance, destiny or God, and finally influence of powerful others. Highliy educated patients had statistically significantly less expressed internal LOC and believe in influence of chance, destiny or God. Patients who underestimated their quality of life statistically significantly less believed in dependence of health on circumstances. Statistic significance between other investigated characteristics was not found. Understanding LOC of DMT2 patients are base for developing more effective educative and intervention medical programs for caring those patients, since it could help in making the right access in caring for every single patinet or group of patinets who has the same LOC.

Depertment of GP/FM at Medical Scool, University of Zagreb, was established 1980 under the same conditions like other departments (persistence of teaching subject – GP/FM, textbook, suficient numbers of teaching practices, enough number of teachers – professors: Master thesis, PhD thesis, publications…) Anabling conditions: 1) VT designed by the GP according to their own educational needs (research, publishing…) ; 2) Accredited Postgraduate course at the Medical school as a obligatory part of VT ; 3) Additional Master Course to accredited Postgraduate course at the Medical school - on volontery basis ; 4) Support (formal and informal) from the clinical and public health professors at the medical schools ; 5) Selection and training of the tachers – students and VT mentors ; 6) Establishment and continuation in publishing the Jornal of GP in 1968 ; 7) Work on own research projects and participation in others ….

U uvodniku se predstavljaju i detaljno objašnjavaju smjernice Europskog društva za hipertenziju i Europskog kardiološkog društva (ESH/ESC) za dijagnosticiranje i liječenje arterijske hipertenzije prilagođeno uvjetima i organizaciji zdrastvene službe u Hrvatskoj. Smjernice imaju temeljnu svrhu pridonošenja kvalitetnijoj kontroli hipertoničara u Hrvatskoj. Ovaj dokument službeni je stav stručnih društava i institucija koje su sudjelovale u njegovoj izradi.

Social skills can be defined as a set of social behaviors that can produce a favorable effect in another person, in the case of medical education, changes of learner's behavior. As educational psychologists use to say, social skills of teachers are very important. We conducted a small research to see how socially skillful/competent are teachers in two Croatian medical schools, Rijeka and Zagreb. It was a 16-items, 5-point Likert scale questionnaire (minimum 16, maximum 80 points). The items measured social skills such as: persistence, certainty and self-confidence, approval, emphasis, empathy, cooperation and coordination, and capacity of caring for and adaptability to the person or situation. Fifty teachers participated, 29 from Rijeka, 22 male, 41.7 average age, 27 clinical, 16 preclinical and 6 public health and primary care. They exhibited rather high level of social skills (mean = 61.7 ± 7.2). But we identified 3 teachers with less than 48 and 3 less than 52 points, which could be estimated as poor social skills. It is interesting that 10 teachers did not show any empathy. Although, the questionnaire should be evaluated and standardized, the question still remains: Do we need to evaluate/work on the improvement of social skills of medical teachers?

Cilj: istražiti zdravstveni lokus kontrole bolesnika koji boluju od ishemijske bolesti srca. Uzorak i metoda: 47 bolesnika koji boluju od ishemijske bolesti srca, ZLK-90 standardizirani upitnik za ocjenu lokusa kontrole. Rezultati: Bolesnici su pretežiti iskazali da posjeduju kombinirani lokus kontrole ; elemente vanjskog i unutarnjeg lokusa kontrole

Introduction: Project is supported by the Croatian Ministry of Science. It is focused on two diseases: myocardial infarction and diabetes mellitus, type 2 (30 + 30 patients) Methods: deep structured interviewing with the individual patient, traing to find their experience, audiotaped ad transcibed to the text ; b) grounded therory as a method of analysing the tekst (done by the researcher itself, and by 3 independent experts as a control method) Preliminary results: all patients are passing through several stages: schoc, ingorance, becaming aware that they have disease and that they should do sometning, chnaging lifes (even life golas), adoptation to and continuation to live with the disease as a partner…

The planned, comprehensive inclusion of general practitioners/family physicians in specialist education has begun with the project entitled Harmonization of Family Medicine Service with European Standards by the Implementation of Compulsory Residency. According to the Project, all physicians working in family medicine practice should have an opportunity to complete the respective residency by 2015. Analysis of the planned and completed family medicine residency in Croatia during the 2002-2006 period is presented. Of the total family medicine residency positions planned during the four-year period, 543 (90.5%) have been completed, with the greatest discrepancy recorded in program A applying to physicians younger than 35 having concluded a contract with the Croatian Institute of Health Insurance. In addition, this relationship varied among different countries. There are a number of obstacles hindering the Project implementation. However, it should be noted that the Project has made a breakthrough in upgrading the quality of family medicine practice, as a pledge of future development and rational performance of the entire health care system in Croatia, in order to promote the health care of the population at large.

Research indicates that traditional CME is not effective in changing performance. Multifaceted interventions are needed to change performance. The progressively growing medical knowledge and changing demands on the society form an ethical obligation for all doctors to update there knowledge and skills, but also to perform in practice according to what they have learned. Traditional CME has to be enriched with assessment of one’s own work and practice performance to identify the real learning needs, a concrete learning plan has to be formed and followed to achieve continuous professional development. A desired change in performance is the objective of any learning process. The EURACT CME/CPD –Committee (Continuing Medical Education/Continuous Professional Development) has developed this model workshop. Participants first identify their learning needs in practice using qualitative tools, make their own learning agenda and develop a concrete plan for learning, reviewed by colleagues. As tools in this workshop we will use consultation diary, self-reflection of competence using position mapping and significant event analysis, As a result of this workshop, the participants will understand some basic concepts of continuing professional development, as planned and peer-reviewed learning agenda based on identified learning needs. They will be able to use the introduced tools and methods in their own practice and in the training of others.

Polazeći od objašnjenja što je umijeće medicinske edukacije i koji je njen značaj te od iskustava i tradicije unaprjeđenja medicinske edukacije, rad pregledno opisuje razvoj edukativne tehnologije i rađanje znanosti o učenju. Opisane su četiri strategije unaprjeđenja medicinske edukacije (ad hoc pristup, administrativno-politički pristup, gospodarsko-tenološki pristup te organizirana i sustavna pouka temeljena na razmjeni iskustava i iskustvima nastavnika). Razmotreni su čimbenici koji utječu na primjenu umijeća nastave. Detaljno su prikazana iskustva Hrvatskog društva za medicinsku edukaciju i Zavoda za nastavnu tehnologiju Medicinskog fakulteta Sveučilišta u Zagrebu, osobito tečaj „Umijeće medicinske nastave koji se kontinuirano organizira od 2000. godine.

nema sažetka

Specialistic exam fo General Practitioners in Croatia is comprenhesive. Besides the written essays, MCQ and EMQ test and oral exam in front of three members jury, portfolio is ussed as additional assessment methods. Assessment of the portfolios are done by each member of the jury inependently, employing predifined criteria and guidelines. They use marking sheet to insert their assessment grades. One day before the oral exam the examiners meet and discuss trainees portfolio. Because we look at the portfolio as a sample of learning evidence collected over time, we decided to assess a quantity, the number of evidence, and the quality of 4 learning outcomes. First, it is aquisition of the knowledge, comprehensive skills and especially attitudes. Second, it is developmental achievement, a demostration of the development of learning outcomes during the time. Third, it is individual profesional clinical practice, because portfolioa are good examples of work-realated activities, examples of clinical situations, case presentations or organisational activities. Forth, it is ability to reflect on, to evaluate trainee's own profesional activities, ability to be reflective practitioner. Each learning otcome are greded as: 1) definitive fail ; 2) marginal fail ; 3) satisfactory ; 4) very good ; 5) exelent. The same grades are applied for owerall assessment of the portfolio. During the presentation, we would like to share our experience with the collegues to see whether there are any other possibilities for qualitative assess of the portfolios.

How cardiovascular patients perceive their illness? A pilot study Petricek G, Cerovecki-Nekic V, Lazic D, Ozvacic Z, Soldo D, Tiljak H, Vrcic-Keglevic M Aim: The illness perception approach begins with the patients experience of illness and the main emphasis is on the patients own cognitive model of their bodily changes that reflect either transient symptoms or more long-term illness. The aim of this study is to describe components of the illness perception of cardiovascular patients (identity, cause, timeline, consequences and cure/control), to determine emotive representation of illness and illness coherence. Design and methods: Descriptive study with 68 cardiovascular patients was carried out in two Croatian general/family practices, during June 2006. Patient illness perception was assessed using Illness Perception Questionnaire – revised (IPQ-R). Data were analyzed using SPSS for Windows. Results: Illness identity was described with symptoms (chest pain (68/68), wheeziness (60/68), fatigue (54/68), nausea (53/68), breathlessness (54/68) and headache (43/68)). Patients considered stress or worry (55/68) the main cause of their illness. Most of patients perceived their illness will last for a long time (59/68), was likely to be permanent (60/68), with periodically improvement and worsening (53/68). More than half patients perceived their illness as serious condition (45/68), which strongly affected way other people see them (42/68), and had serious financial consequences (43/68). Patients stated they could control illness personally (49/68) as well with proposed treatment (61/68). Patients were mostly worried with their illness (49/68). Most of patients understood their condition coherently (58/68). Patients perception of illness consequences correlated positively with perception of illness timeline (p

A field programme in the community aims to help students to understand how environmental and other factors influence health and to what extend health is a result as well as a prerequisite of weilbeing ; how moral, cultural, social and other values influence health. Students, live in community, assisting in implementation of specific programmes, and participate in regular activities relating to health services. Visits to local industries, historical and cultural sights are important parts of teaching. At the end the student is able to recognize health needs of the community, to assess efficiency of measures for particular health problems, and to critically examine health services. Skills such as communication skills, health education, presentation, interview, as well as assessment of living and working environment, epidemiological survey, organization of vaccination etc. are required. According to our experience, students are willing to participate in and commit themselves to any programme with a clear purpose and goals. Observation alone has small effect. The best results are achieved through activities that local health services are interested in, developed together with the teachers, and when there is a clear need in the community for such activities achieving direct benefit for the community. Two weeks in the community is necessary.

Introduction: In a year 2003 in Croatia started a project “Family medicine vocational training harmonization with european standards bringing in the obligatory vocational training”. Trainees who started vocational training within that project had they final family medicine specialist exam in November 2005. Final Family medicine specialists exam consists of:written part (125 questions, type of multiple choice questions, questions with associated answers) ; OSCE (objective structured clinical examination) ; and oral exam (in front of tree man commission). Objective: To evaluate the results of OSCE assessment instrument, to see if there is some space for quality improvement. Results: 25 observers on every OSCE station, exept rest stations, carried the assessment out using the assessment instrument – the mark sheets. Since there were 27 stations with 78 candidates, 1910 mark sheets were analysed in two dimensions: percentage of maximum of global marks per candidate and percentage of global marks per stations.Pass mark of 70% was agreed, resulting in 4 failures (5%), 48 candidates which was 62% of all, achieved results in between 70-80%, 25 candidates which is 32% of all, achieved results in between 80-90%, 1 candidate achieved 95%. All of three groups achieved similar results, there are only minor differencies (stations breast exam, sterile field preparation, glucometer). Conclusion: Results indicated some space for quality improvement. There was a need for careful revision between person responsible for station setting, examiners-observers and candidates.

bologna declaration, curricula changes

Osposobljavanje nastavnika na studiju medicine provodi se na različite načine. Jedan od njih je pohađanje poslijediplomskog tečaja prve kategorije pod naslovom „Umijeće medicinske nastave“ u organizaciji Hrvatskog društva za medicinsku edukaciju.