Aim To determine the use of evidence-based medicine
(EBM) information and the level of awareness and knowledge
of EBM among patients in Croatia.
Methods A cross-sectional study was conducted among
...987 patients in 10 family medicine practices in Croatia. Patients
from both urban (n = 496) and rural (n = 482) areas
were surveyed. A 27-item questionnaire was used to collect
data about sources that patients searched for medical
information, patient awareness and use of Cochrane systematic
reviews and other EBM resources, and their demographic
characteristics.
Results Half of the patients searched for medical information
from sources other than physician. Internet was
the most common place they searched for information.
Very few patients indicated using EBM sources for medical
information; one fifth of patients heard of EBM and 4%
of the patients heard of the Cochrane Collaboration. Patients
considered physician’s opinion as the most reliable
source of medical information. A logistic regression model
showed that educational level and urban vs rural residence
were the predictors of awareness about EBM and systematic
reviews (P < 0.001 for both).
Conclusion Our finding that patients consider a physician’s
opinion to be the most reliable source of healthrelated
information could be used for promotion of highquality
health information among patients. More effort
should be devoted to the education of patients in rural areas
and those with less formal education. New avenues for
knowledge translation and dissemination of high-quality
health information among patients are necessary.
Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.
To elucidate obstacles and facilitators ...of the transition from face-to-face to distance education.
A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.
In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.
The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.
To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia.
A cross-sectional study was conducted among 987 patients ...in 10 family medicine practices in Croatia. Patients from both urban (n=496) and rural (n=482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics.
Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P<0.001 for both).
Our finding that patients consider a physician's opinion to be the most reliable source of health-related information could be used for promotion of high-quality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary.
Abstract
Aim. White coat hypertension (WCH) is hard to differentiate from sustained hypertension without the use of 24-h ambulatory blood pressure monitoring (ABPM). This invaluable procedure is ...nevertheless cumbersome and expensive. A simple test of deep breathing over 30 s (DBT) was proposed as a method to unveil WCH. Methods. Two hundred and fourteen outpatients referred for the evaluation of uncontrolled hypertension (blood pressure, BP > 140/90 mmHg despite therapy) were enrolled in a controlled clinical trial. The examinees were randomly divided in two groups: control (n = 108; sequential standard BP measurement only) and intervention (n = 106; the same+DBT), using ABPM as the reference standard. Results. The relative decrease in BP was significantly larger in the intervention group than in the control group, by 15/4 mmHg (p = 0.005). The best detection of WCH was obtained at ≥ 15% systolic BP reduction following DBT, with a positive predictive value of 94.0% (95% CI 72.0-100.0). BP reduction of ≤ 8% may rule WCH out with a negative predictive value of 78.4% (95% CI 64.0 - 85.9). Conclusion. DBT is a reliable, inexpensive and fast test for the detection of WCH in primary care.
Glavni cilj ovog istraživanja bio je ispitati razlikuju li se stavovi o cijepljenju protiv bolesti COVID-19 studenata medicine i liječnika obiteljske medicine u Splitsko-dalmatinskoj županiji. ...Provedeno je presječno istraživanje u kojem je sudjelovalo 176 studenata medicine, 47 studenata dentalne medicine, te 100 liječnika obiteljske medicine. Ispitanici su rješavali anketni upitnik putem Google forms internetske aplikacije tijekom lipnja 2021. Korištena je peterostupanjska Likertova skala koja je sadržavala 27 tvrdnji. Prikupljeni podaci obrađeni su u programima STATISTICA 14 i Python. Utvrđeno je da pozitivan stav o svim cjepivima protiv bolesti COVID-19 ima statistički značajno više liječnika u odnosu na studente (P=0,038). Zadovoljstvo organiziranošću cijepljenja protiv bolesti COVID-19 statistički je značajno veće u liječnika nego studenata (P=0,006). Iako u procijepljenosti između studenata i liječnika nema statistički značajne razlike, ona je pronađena između studenata pretkliničkih i kliničkih godina studija (P=0,005). Udio cijepljenih veći je u studenata kliničkih godina (67%). Također, utvrđeno je, sa statistički značajnom razlikom, da su ispitanici koji su cijepljeni protiv gripe spremniji i na cijepljenje protiv COVID-19 bolesti (P=0,001), te da se značajno više liječnika nego studenata odlučilo na cijepljenje protiv gripe ove ili prethodnih sezona (P<0,001). Studijom je dokazano da su opći stavovi studenata medicinskog fakulteta i liječnika obiteljske medicine o cijepljenju pozitivni. Naime, poznato je da se stavovi pojedinca prema primjeni cjepiva uvelike odražavaju na procijepljenost i incidenciju zaraznih bolesti u populaciji, te je jako važno da i studenti, koji će biti aktivni sudionici zdravstvenog sustava i liječnici obiteljske medicine, koji su najdostupniji sudionici zdravstvenog sustava, imaju jednake stavove o najučinkovitijoj metodi zaštite populacije od širenja zaraznih bolesti.
The main goal of this research was to examine whether the attitudes about vaccination against the COVID-19 disease distinguish between medical students and family medicine doctors in the County of Split. In this cross-sectional study 176 medical students participated, 47 students of dental medicine and 100 family medicine doctors. The respondents answered a questionnaire via the Google forms internet application during June 2021. A five-point Likert scale containing 27 statements was used. The collected data were processed in STATISTICA 14 and Python programs. It was found that statistically significantly more doctors had a positive attitude about all vaccines against the COVID-19 disease than students (P=0.038). Satisfaction with the organization of vaccination against the COVID-19 disease was statistically significantly higher in doctors than in students (P=0.006). Although there was no statistically significant difference in vaccination between students and doctors, it was found between students in the preclinical and clinical years of study (P=0.005). The proportion of those vaccinated was higher in students of clinical years (67%). It was also determined, with a statistically significant difference, that respondents who had been vaccinated against the influenza were more willing to be vaccinated against the COVID-19 disease (P=0.001) and that significantly more doctors than students decided to get vaccinated against the influenza this season than in previous seasons (P<0.001). The study proved that the general attitudes of medical school students and family medicine doctors concerning vaccination are positive. To be specific, it is known that an individual's attitude towards the use of vaccines are largely reflected in the vaccination rate and incidence of infectious diseases in the population. It is very important that both students, who will be active participants in the health system and family medicine doctors, who are the most accessible participants in the health system, have equal views on the most effective method of protecting the population from the spread of infectious diseases.
Integriranje novih znanstvenih spoznaja u kurikule medicinskih fakulteta (MF) i programe specijalističkog usavršavanja doktora medicine te postizanje podudarnosti stečenih kompetencija sa stvarnom ...zdravstvenom potrebom pučanstva izazovi su obrazovanja doktora medicine 21. stoljeća. Kako je obiteljski liječnik temelj dobro organiziranoga zdravstvenog sustava, neophodno je osigurati njegovu dobro strukturiranu izobrazbu. Cilj ovoga rada jest opisati obrazovanje obiteljskih liječnika u Republici Hrvatskoj i usporediti ga sa standardima izobrazbe obiteljskih liječnika Europske unije. Europska akademija nastavnika opće/obiteljske medicine (EURACT) dala je preporuke za petnaest obveznih tema koje treba sadržavati predmet Obiteljska medicina u okviru studija medicine te preporuke za specijalističko usavršavanje iz obiteljske medicine koje treba biti više praktičnog nego teorijskog karaktera. U RH kurikuli svih četiriju MF imaju predmet Obiteljska medicina. Predmet Obiteljska medicina MF-a u Zagrebu uključuje svih petnaest tema sukladno preporukama EURACT-a, implementaciju instrumenta za neposredno nadgledanje proceduralnih vještina, izradu e-portfolija i poticanje učenja kroz stjecanje kliničkoga iskustva tijekom boravka u nastavnim praksama obiteljske medicine (OM). Predmet Obiteljska medicina MF-a u Splitu uključuje svih petnaest tema sukladno preporukama EURACT-a za diplomski studij medicine te organizaciju kliničke nastave koja uključuje boravak studenata i u gradskim i u otočkim nastavnim praksama OM. Nastava predmeta Obiteljska medicina na MF-u u Rijeci podrazumijeva teorijsku i praktičnu nastavu u nastavnim praksama OM te izradu pismenih odgovora na odabrano kliničko pitanje koje se temelji na iskustvu rada s bolesnikom. Nastava iz OM na MF-u u Osijeku izvodi se kroz integrirani program „Obiteljska medicina, školska medicina i medicinska sociologija” te uključuje kombinaciju kliničke nastave u nastavnim praksama OM i vježbi u kabinetu vještina. Četverogodišnji program specijalističkog usavršavanja iz OM temelji se na definiranim kompetencijama te podrazumijeva da specijalizant polovinu specijalističkog usavršavanja provodi u ordinaciji mentora koja je akreditirana za specijalističko usavršavanje iz OM. Slijedom navedenoga izobrazba obiteljskih liječnika u RH u skladu je s europskim i globalnim preporukama.
Family physicians (FPs) are exposed to high amounts of stress, and could be susceptible to the development of mental health disorders (MHD), especially after the emergence of the COVID-19 pandemic. ...The aim of the current study was to assess MHD history, attitudes toward MHDs and stress-coping strategies in FPs. An additional goal was to estimate their comprehensive well-being and investigate connections with resilience and a healthy lifestyle. A total of 483 FPs submitted their responses via online survey. MHD attitudes were assessed with the according questionnaires, while burnout levels, healthy lifestyle, resilience, job and life satisfaction were estimated with validated scales. Results have shown that 32.5% of FPs disclosed positive MHD history, while 68.7% used professional help. Resilience and healthy lifestyle levels were significantly higher in MHD negative FPs (
< 0.001), while burnout levels were lower (
< 0.001). Moreover, healthy lifestyle (β = 0.03,
< 0.001) was an independent correlate of resilience, while healthy lifestyle (β = -0.35,
< 0.001, and resilience (β = -1.82,
< 0.001) were of burnout levels. Finally, resilience (OR = 0.387,
< 0.001) and healthy lifestyle (OR = 0.970,
= 0.021) were shown as independent predictors of positive MHD history status. Strong promotion and education of FP population regarding resilience and healthy lifestyle should be utilized in practice in order to alleviate the possibility of mental health disturbances and the according consequences.
The clonal hematopoiesis of indeterminate potential (CHIP) is a term used to describe individuals who have detectable somatic mutations in genes commonly found in individuals with hematologic cancers ...but without any apparent evidence of such conditions. The mortality rate in individuals with CHIP is remarkably higher than the influence ascribed to hematologic malignancies, and it is plausible that cardiovascular diseases (CVD) could elucidate the apparent disparity. Studies have shown that the most frequently altered genes in CHIP are associated with the increased incidence of CVDs, type 2 diabetes mellitus (T2DM) and myeloid malignancies, as well as obesity. Additionally, multiple research studies have confirmed that obesity is also independently associated with these conditions, particularly the development and progression of atherosclerotic CVD. Considering the shared pathogenetic mechanisms of obesity and CHIP, our objective in this review was to investigate both preclinical and clinical evidence regarding the correlation between obesity and CHIP and the resulting implications of this interaction on the pathophysiology of CVDs and malignancies. The pro-inflammatory condition induced by obesity and CHIP enhances the probability of developing both diseases and increases the likelihood of developing CVDs, T2DM and malignancies, suggesting that a dangerous vicious loop may exist. However, it is vital to conduct additional research that will suggest targeted treatment options for obese individuals with CHIP in order to reduce harmful effects connected to these conditions.
Glavni cilj ovog istraživanja bio je ispitati razlikuju li se stavovi o cijepljenju protiv bolesti COVID-19
studenata medicine i liječnika obiteljske medicine u Splitsko-dalmatinskoj županiji. ...Provedeno je presječno
istraživanje u kojem je sudjelovalo 176 studenata medicine, 47 studenata dentalne medicine, te 100 liječnika
obiteljske medicine. Ispitanici su rješavali anketni upitnik putem Google forms internetske aplikacije
tijekom lipnja 2021. Korištena je peterostupanjska Likertova skala koja je sadržavala 27 tvrdnji. Prikupljeni
podaci obrađeni su u programima STATISTICA 14 i Python. Utvrđeno je da pozitivan stav o svim
cjepivima protiv bolesti COVID-19 ima statistički značajno više liječnika u odnosu na studente (P=0,038).
Zadovoljstvo organiziranošću cijepljenja protiv bolesti COVID-19 statistički je značajno veće u liječnika
nego studenata (P=0,006). Iako u procijepljenosti između studenata i liječnika nema statistički značajne
razlike, ona je pronađena između studenata pretkliničkih i kliničkih godina studija (P=0,005). Udio
cijepljenih veći je u studenata kliničkih godina (67%). Također, utvrđeno je, sa statistički značajnom
razlikom, da su ispitanici koji su cijepljeni protiv gripe spremniji i na cijepljenje protiv COVID-19 bolesti
(P=0,001), te da se značajno više liječnika nego studenata odlučilo na cijepljenje protiv gripe ove ili
prethodnih sezona (P<0,001).
Studijom je dokazano da su opći stavovi studenata medicinskog fakulteta i liječnika obiteljske medicine
o cijepljenju pozitivni. Naime, poznato je da se stavovi pojedinca prema primjeni cjepiva uvelike
odražavaju na procijepljenost i incidenciju zaraznih bolesti u populaciji, te je jako važno da i studenti, koji
će biti aktivni sudionici zdravstvenog sustava i liječnici obiteljske medicine, koji su najdostupniji sudionici
zdravstvenog sustava, imaju jednake stavove o najučinkovitijoj metodi zaštite populacije od širenja
zaraznih bolesti.
The prevalence and incidence of gout doubled from 1990 to 2017. Therefore, we can expect that a number of doctors have come across a patient with gout in their daily practice. Hence, we wanted to ...investigate how familiar our medical students, as future medical professionals, are with gout. This cross-sectional survey included Medical Studies students from the two largest universities in Croatia: the University of Split School of Medicine, and the University of Zagreb School of Medicine, and included a total of 221 fifth or sixth year medical students. Most students gave correct answers to questions about treatment approach and non-pharmacological interventions in asymptomatic hyperuricemia (>80%). Less than 3% of all students agreed they knew enough about care for patients with asymptomatic hyperuricemia, whereas almost 15% thought they were well familiar with care for gout patients. Less than 8% of students considered their school education adequate on both topics, and less than 2% were aware of the existence of EULAR guidelines. Physicians lacking in the latest knowledge on the pathophysiology of gout, the influence of lifestyle, and genetic factors limits their ability to properly manage gout. With increasing prevalence, gout should be more represented in medical students' education.
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