[Anorexia nervosa: a life threatening condition]. / Anorexia nervosa: stanje zivotne ugrozenosti.

Anorexia nervosa is an eating disorder which, in case of life threating complications, requires admission to the intensive care unit. Our experience shows that danger for these patients does not always stop upon the admission to the intensive care unit. Four young, vitally endangered patients with anorexia nervosa were described. Three of them had severe acute inflammation (2 pneumonias and peritonitis) and severe electrolyte imbalance which in one case resulted in cardiorespiratory arrest and the need for resuscitation. One of them died despite all measures taken in sepsis with multiple organ dysfunction syndrome. Prolonged electrolyte disturbances in anorexia nervosa, catabolism and insufficient immunity are main factors for developing an acute inflammation, as well as some other complications such as cardiorespiratory failure, nosocomial infection, and sepsis with multiple organ failure. Weak and totally exhausted body can not adapt in MODS and sepsis, so our recommendation is urgent admission to the hospital before it is too late.

How the structure of contribution disclosure statements affects validity of authorship: a randomized study in a general medical journal.

OBJECTIVE: Many biomedical journals have introduced disclosure of research contribution in journal articles as a way to limit irresponsible authorship. Over the years, journals have developed different contribution disclosure policies and procedures, but it is not known how these policies and procedures affect authorship. The aim of our study was to analyse possible causative relationships between the structure of the contribution disclosure form and the number of authors who do not meet authorship criteria in biomedicine set by the International Committee of Medical Journal Editors (ICMJE). RESEARCH DESIGN AND METHODS: In a single-blind randomized trial, 1462 authors of 332 manuscripts submitted to a general medical journal answered one of three different contribution disclosure forms: (1) open-ended -- asking the respondents to describe in their own words their contributions in the submitted work; (2) categorical -- with 11 possible contribution choices and (3) instructional -- guiding through the ICMJE definition and instructing how many contributions are needed to satisfy individual criteria. MAIN OUTCOME MEASURE: The number of authors not satisfying ICMJE authorship criteria. RESULTS: The group answering the instructional form had significantly fewer authors whose reported contributions did not satisfy ICMJE criteria (18.7%) than the groups answering the categorical (62.8%) or open-ended (54.7%) form (chi2(2 ) = 210.833, p < 0.001). The group receiving instructional forms also had the fewest articles with honorary authors (32.5%) compared with those who responded in a categorical (68.7%) or open-ended (83.0%) form (chi2(2 ) = 63.378, p < 0.001). All authors who answered the open-ended form, regardless of their compliance with authorship criteria, reported significantly fewer contributions (median 3 [95% confidence interval = 3-3]) than authors responding to either the categorical (4 [4-4]; z score = -7.1899, p < 0.001) or instructional form (4 [4-5]; z score = -13.9760, p < 0.001). Honorary authors answering the instructional form reported more contributions than those answering either the categorical or open-ended form (z score = 2.7637, p = 0.0057 and z score = -3.3773, p < 0.001, respectively). Most honorary authors (39.9%) lacked only the third ICMJE criterion (final approval of the submitted manuscript). CONCLUSIONS: The structure of the contribution disclosure form significantly influenced the number of contributions reported by authors of submitted manuscripts and their compliance with the ICMJE authorship criteria. Journal editors should be aware of the cognitive aspects of survey methodology when they construct for their authors self-reports about behaviour, such as contribution disclosure forms.

Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: a three year prospective study.

AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy. METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure. RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P < 0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60 mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P < 0.001). A critical decrease in oxygen saturation (< 90%) was documented in 27 patients (2.4%). CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA III group) require monitoring and care of an anesthesiologist.

Authorship criteria and disclosure of contributions: comparison of 3 general medical journals with different author contribution forms.

CONTEXT: A number of general medical journals and the International Committee of Medical Journal Editors (ICMJE) request authors to disclose their contributions. Little is known about the effect of journal policies on authors' disclosure of their contributions. OBJECTIVE: To determine the number of named authors who do not meet ICMJE criteria for authorship, according to their published contributions, in 3 medical journals with different contribution disclosure practices. DESIGN: Observational study of authors' contributions in research articles published in 2002 in Annals of Internal Medicine (n = 72), BMJ (n = 107), and JAMA (n = 81). BMJ asks authors to describe research contributions in their own words; Annals asks authors to choose from a list of coded contributions; and JAMA uses a structured checklist with instructions on contributions that qualify for ICMJE authorship criteria. Honorary authorship was defined as the lack of contribution from the first ICMJE criterion (study conception and design, or acquisition of data, or analysis and interpretation of data) and/or second (drafting the article or critical revision for important intellectual content) ICMJE criterion. RESULTS: According to authors' published contributions, the number of honorary authors was highest in Annals (121/562 authors, 21.5%), followed by BMJ (46/482, 9.5%), and JAMA (3/641, 0.5%) (chi2(2) = 146.67, P<.001). The number of articles with honorary authors was 60% in Annals, 21% in BMJ, and 4% in JAMA. Honorary authors had fewer published contributions than authors who met ICMJE criteria and were positioned more toward the end of the byline. Honorary authors either lacked contributions for both ICMJE criteria (10% in Annals and 22% in BMJ) or contributions to the second ICMJE criterion (75% in Annals, 67% in BMJ, and 2 out of 3 in JAMA). CONCLUSIONS: General medical journals differed in prevalence of honorary authors according to published research contributions of named authors. Different authorship/contributorship policies and procedures should be explored as a possible explanation for the differences in contributions disclosed by authors among these journals.

Analysis of European medical schools' teaching programs.

AIM: To compare the teaching programs of European medical schools with the minimum requirement medical curriculum recommended by the European University Association. Methods. Information on the curricula was gathered from the websites of 32 medical schools from 18 European countries. The data collected were the number of courses and proportion of each course in the study plan according to the class hours or credits. Each curriculum was compared with the standard medical curriculum recommended by the European University Association. Courses were clustered in 3 large groups: preclinical, clinical, and public health. RESULTS: The proportion of preclinical subjects was the highest at the Medical Schools in Brussels, Dublin, Milan, and Madrid, and the lowest in Athens, London, Lund, and Bucharest. The proportion of clinical subjects was the highest at the Medical Schools in London, Bucharest, and Genoa, and the lowest in Brussels, Dublin, and Milan. Croatian Medical Schools (Zagreb, Osijek, Split, and Rijeka) and the Medical School in Milan had the highest proportion of public health and humanistic subjects in their curricula. Neuroscience was found in less than half of the analyzed medical school curricula, and Psychology in about two-thirds. Nuclear Medicine course was found only in 7 out of 28 schools. Intensive Care, Anesthesiology, and Urology courses were found in less than half of the curricula. Two-thirds of analyzed curricula offered Primary Care course within the group of public health and humanistic courses. Epidemiology and Social Medicine courses were taught at more than half, and Anthropology at one-sixth of the medical schools. CONCLUSION: The lack of uniform curriculum in European medical schools makes mutual accreditation and mobility of students very difficult. Great deviations from the standard, ie, medical curriculum recommended by the European University Association, question the possibility of a quick medical curricula reform.