The Influence of Self-Concept on Clinical Decision-Making in Nurses and Nursing Students: A Cross-Sectional Study.

The aim of this study is to examine the influence of nurses' self-concept (NSC) on clinical decision-making (CDM) among nursing students and hospital nurses. A further aim is to examine whether there is a difference in CDM and NSC between hospital nurses with various levels of experience and nursing students. A cross-sectional study was conducted during 2018 in the Faculty of Dental Medicine and Health and the University Hospital Center, in Osijek, Croatia, EU. The respondents consisted of 568 hospital nurses, and 129 BSc nursing students. Data were collected with the clinical decision-making in nursing scale (CDMNS) and the nurses' self-concept questionnaire (NSCQ). There was no correlation between CDM and NSC in either students or hospital nurses. Hospital nurses generally had significantly higher scores in CDM than nursing students. On the other hand, students had a significantly higher total NSC level. The results of this study suggest that experience has a positive impact on nurses' CDM skills. The high NSC estimated by students enables them to easily take up their clinical roles and approach the patient in a holistic manner, which is an attitude that gradually develops during studies and with clinical experience.

Personality traits of core self-evaluation as predictors on clinical decision-making in nursing profession.

Core self-evaluation (CSE) is a theory that includes four personality dimensions: self-esteem, self-efficacy, locus of control and emotional stability. CSE proved to be a significant predictor of the research on cognitive, emotional and behavioral responses across various situations in the workplace. The aim of this study was to examine the relationship between personality traits of the core self-evaluation and clinical decision-making in nurses' profession. A cross-sectional design was applied. Data was collected with standardized instruments: Core Self-Evaluation Scale and Clinical Decision-Making Nurses Scale, 584 nurses have participated in the study. Correlation and hierarchical regression analysis were used to test the relations and prediction of variables. The findings of the study revealed that there is a significant positive relationship between overall core self-evaluation and nurses' clinical decision-making, and there is a significant contribution of self-esteem, self-efficacy and locus of control on all dimensions of clinical decision, especially in the area of canvassing of objectives and values. Nurses with high CSE have positive self-views and tend to be confident in their ability and they also feel in control while performing nursing interventions, whereas those with low CSE tend to have fewer accessible positive resources and are more prone to risk aversion.

Measuring Healthcare Quality - Paradigm of Medqual.

Medical activity is assumed to be service activity the effects of which can be measured. The SERVQUAL scale was used as a starting point for our research, which resulted in a new, adopted scale called MEDQUAL. The MEDQUAL scale aims to measure the quality of healthcare provided by medical staff of one hospital department instead of the overall quality of hospital services or parts of services on which medical staff in one department has no influence. The study was conducted in a clinical hospital department in Croatia and included 300 respondents (169 patients and 131 medical staff members). The MEDQUAL scale, designed and tested in the study, showed high reliability in all established dimensions, i.e. trust in doctors (Cronbach's Alpha 0.923), nursing professionalism (0.913), medical professionalism (0.938), and departmental organization (0.810). The scale proposed evaluates both patient satisfaction with the quality of healthcare received and medical staff satisfaction with the quality of healthcare provided. The results were comparable to the groups of respondents, departments, and institutions with potential longitudinal studies of this phenomenon. MEDQUAL is a simple, repeatable and cost-effective scale, applicable to almost all departments and used for measuring the quality of healthcare services both provided and received, the aim of which is to contribute to the assessment of healthcare quality and its improvement.

Acute Postoperative Pain in Trauma Patients - The Fifth Vital Sign.

AIM: To determine average pain intensity perceived by trauma patients at hospital admission, lowest and highest pain intensity during their hospitalisation and their satisfaction with provided pain treatment. PATIENTS AND METHODS: The research included 114 operated patients at the Clinical Department of Trauma Surgery. We used the standard Numerical Rating Scale (NRS) for a clinical measure of pain. RESULTS: The average pain intensity at hospital admission was NRS median 7 (range 4-10), the severest perceived rate of pain during hospitalisation was NRS median 5 (range 4-7). Ninety-four percent of our respondents were satisfied with provided pain treatment. Thirty-two percent of patients were not asked to assess their pain during their hospitalisation, and 40.4% of patients assessed their pain occasionally. CONCLUSION: Female patients, as well as patients admitted to the emergency department, reported higher NRS scores. Those respondents who perceived severe pain answered more often that medical staff didn't ask them to assess their pain on any occasion. Good communication between medical staff and patients, together with adequate assessment and evaluation of acute pain are of great importance in its treatment.

No difference in the intention to engage others in academic transgression among medical students from neighboring countries: a cross-national study on medical students from Bosnia and Herzegovina, Croatia, and Macedonia.

AIM: To asses if the level of intention to engage others in academic transgressions was comparable among medical students from five schools from neighboring Southern-European countries: Croatia, Bosnia and Herzegovina, and Macedonia; and medical students from western EU studying at Split, Croatia. METHODS: Five medical schools were surveyed in 2011, with ≥87% of the targeted population sampled and a response rate of ≥76%. Students' intention to engage a family member, friend, colleague, or a stranger in academic transgression was measured using a previously validated the Intention to Engage Others in Academic Transgression (IEOAT) questionnaire and compared with their intention to ask others for a non-academic, material favor. Data on students' motivation measured by Work Preference Inventory scale, and general data were also collected. Multiple linear regression models of the intention to engage others in a particular behavior were developed. RESULTS: The most important determinants of the intention to engage others in academic transgression were psychological factors, such as intention to ask others for a material favor, or students' motivation (median determinant's ß of 0.18, P≤0.045 for all), whereas social and cultural factors associated with the country of origin were either weak (median ß of 0.07, P≤0.031) or not relevant. A significant proportion of students were aware of the ethical violations in academic transgressions (P≤0.004 for all transgressions), but a large proportion of students also perceived academic cheating as a collective effort and were likely to engage people randomly (P≤0.001 for all, but the most severe transgression). This collective effort was more pronounced for academic than non-academic behavior. CONCLUSION: Culture differences among neighboring Southern-European countries were not an important determinant of the intention to engage others in academic cheating.

Are there differences in students' school success, biorhythm, and daytime sleepiness depending on their school starting times?

Chronotype is a characteristic of a person in a certain point of one's lifetime and it slowly changes with age. Adolescents start to go to bed later while schools impose early starting hours, which may become a problem for students who are unable to adapt their circadian rhythm. The aim of this study was to determine if differences in school starting times affect the students' chronotype, school success, or daytime sleepiness. We tested a total of 1020 students from four high schools in Osijek, Croatia. The students had alternating school shifts (school starting hours 7 AM or 13 PM and 8 AM or 14 PM, every other week, alternatively, respectively). The participants were tested using the Epworth Sleepiness Scale and the Morningness--Eveningness Questionnaire. Earlier chronotypes were characteristic of the students starting school earlier, but without significant difference in daytime sleepiness in comparison with those starting school later. Differences were also found between different age and gender groups, female and older students having earlier chronotypes. Students going to school earlier showed better school success than the latter. In conclusion, the study shows that students starting school earlier also have earlier chronotypes, which might be consequence of the adaptation to one hour earlier school starting time.

Medical informatics in croatia - a historical survey.

A historical survey of medical informatics (MI) in Croatia is presented from the beginnings in the late sixties of the 20th century to the present time. Described are MI projects, applications in clinical medicine and public health, start and development of MI research and education, beginnings of international cooperation, establishment of the Croatian Society for MI and its membership to EFMI and IMIA. The current status of computerization of the Croatian healthcare system is sketched as well as the present graduate and postgraduate study MI curricula. The information contained in the paper shows that MI in Croatia developed and still develops along with its advancement elsewhere.

Medical students and e-Health.

The term eHealth is widely used in both scientific literature and in everyday life. There are many activities related to eHealth both globally and in Europe. In Croatia, eHealth is a priority area of the eCroatia programme. There is no doubt that eHealth is the environment where present and prospective medical students will work after leaving medical schools. In order to find out what medical students think eHealth is and which information about eHealth reach them, we started this project with second year medical students in academic year 2010/2011. At the very beginning of medical informatics course, students were asked to write an essay with the title "eHealth" based on their existing knowledge and experiences on this topic. Till now 147 written contributions were analyzed. We performed lexicometric analysis and correspondence analysis using French software Dtm-Vic for textual analysis. Very modest vocabulary and choice of words imply that students have little personal experience and knowledge about eHealth. Students who had medical secondary school education described eHealth differently, probably because they encounter some of eHealth applications while attending lectures in health care institutions.

Usage of insecure E-mail services among researchers with different scientific background.

AIM: Free web­based e-mail services are considered to have more security flaws than institutional ones, but they are frequently used among scientific researchers for professional communication. The aim of this study was to analyze frequency of usage of the insecure free e-mail services for professional communication among biomedical, economical and technical researchers, who published papers in one of three different journals: Croatian Medical Journal, Automatika and Economic Research. METHODS: Contact details of the authors who provided their e­mail address from the papers published in those three journals during one year period were collected. These e­mail addresses were collected from the electronic archive of the journals in question. The domains of all e­mail addresses were assessed and contacts were categorized into three groups according to the following types: world-wide known free web­based e­mail services, national Internet Service Provider (ISP) e-mail services, and institutional or corporate e-mail addresses. RESULTS: The proportion of authors using free web-based e-mail services, the least secure group type, was highest among biomedical researchers (17.8%) while every e­mail address collected from the technical journal belonged to the secured institutional e­mail group type. CONCLUSIONS: It seems that all researchers from the technical scientific field and most of the researchers from the economical field value good security practice and use more secure systems for professional communication. High percentage of the biomedical researchers who use insecure e­mail services may mean that they need to be warned of the possible security disadvantages of those kinds of e­mail addresses.

Writing and drawing with both hands as indicators of hemispheric dominance.

Brain lateralization is a common term used to describe dominance of one brain hemisphere over another for a specific function. The right hand dominance in writing, controlled by the left hemisphere, is preceded by development of communicative gesticulation and followed by development of speech in the same hemisphere. We assumed that some people are not aware of their own capability of using the other hand for tasks involving fine motor sequential movements. To prove this hypothesis, the participants were asked to perform one trained task (writing) and one less-trained task (drawing) with a dominant and a non-dominant hand. The final sample was comprised of 1189 children from 14 elementary schools and 8 high schools in the Osijek area, of which 685 elementary school children were attending 1st to 4th grade and 504 high school children were attending 3rd and 4th grade. The participants were asked to write two words, draw a specific object (a vase with flowers) and fill out a questionnaire with 10 questions concerning the classification of handedness and cerebral hemisphere dominance. The self-reported cerebral lateralization assessed in the questionnaire was compared with the drawing and the writing performance. The self-reported and objectively measured hand dominance deviated in the cases of the ambidextrous who consider themselves right-handers. Given the fact that the number of ambidextrous persons was greater in elementary schools than in high schools, we concluded how training of the right hand decreases the ability of using both hands equally for either of the tested functions - writing and drawing.

Comparison of emotion recognition from facial expression and music.

The recognition of basic emotions in everyday communication involves interpretation of different visual and auditory clues. The ability to recognize emotions is not clearly determined as their presentation is usually very short (micro expressions), whereas the recognition itself does not have to be a conscious process. We assumed that the recognition from facial expressions is selected over the recognition of emotions communicated through music. In order to compare the success rate in recognizing emotions presented as facial expressions or in classical music works we conducted a survey which included 90 elementary school and 87 high school students from Osijek (Croatia). The participants had to match 8 photographs of different emotions expressed on the face and 8 pieces of classical music works with 8 offered emotions. The recognition of emotions expressed through classical music pieces was significantly less successful than the recognition of emotional facial expressions. The high school students were significantly better at recognizing facial emotions than the elementary school students, whereas girls were better than boys. The success rate in recognizing emotions from music pieces was associated with higher grades in mathematics. Basic emotions are far better recognized if presented on human faces than in music, possibly because the understanding of facial emotions is one of the oldest communication skills in human society. Female advantage in emotion recognition was selected due to the necessity of their communication with the newborns during early development. The proficiency in recognizing emotional content of music and mathematical skills probably share some general cognitive skills like attention, memory and motivation. Music pieces were differently processed in brain than facial expressions and consequently, probably differently evaluated as relevant emotional clues.

Helicobacter pylori and trace elements.

The metabolism of the trace elements is altered in infection or inflammation. Helicobacter pylori infection is a causative in chronic gastritis, duodenal ulcer disease and gastric cancer. It is not known whether H. pylori infection is associated with the changes in the serum levels of trace elements. The aim of this study was to determine serum concentrations of zinc and copper, using atomic absorption spectrophotometer, in patients with H. pylori positive chronic gastritis, patients with H. pylori negative chronic gastritis and healthy individuals. Serum Zn was significantly higher in patients with H. pylori positive chronic gastritis compared to both patients with H. pylori negative chronic gastritis and to healthy individuals, while serum Cu and Cu/Zn ratio was not significantly different in any study group. The serum zinc and copper concentrations were not altered in patients with chronic gastritis.

Survey of mammography practice in Croatia: equipment performance, image quality and dose.

A national audit of mammography equipment performance, image quality and dose has been conducted in Croatia. Film-processing parameters, optical density (OD), average glandular dose (AGD) to the standard breast, viewing conditions and image quality were examined using TOR(MAM) test object. Average film gradient ranged from 2.6 to 3.7, with a mean of 3.1. Tube voltage used for imaging of the standard 45 mm polymethylmethacrylate phantom ranged from 24 to 34 kV, and OD ranged from 0.75 to 1.94 with a mean of 1.26. AGD to the standard breast ranged from 0.4 to 2.3 mGy with a mean of 1.1 mGy. Besides clinical conditions, the authors have imaged the standard phantom in the referent conditions with 28 kV and OD as close as possible to 1.5. Then, AGD ranged from 0.5 to 2.6 mGy with a mean of 1.3 mGy. Image viewing conditions were generally unsatisfying with ambient light up to 500 lx and most of the viewing boxes with luminance between 1000 and 2000 cd per m(2). TOR(MAM) scoring of images taken in clinical and referent conditions was done by local radiologists in local image viewing conditions and by the referent radiologist in good image viewing conditions. Importance of OD and image viewing conditions for diagnostic information were analysed. The survey showed that the main problem in Croatia is the lack of written quality assurance/quality control (QA/QC) procedures. Consequently, equipment performance, image quality and dose are unstable and activities to improve image quality or to reduce the dose are not evidence-based. This survey also had an educational purpose, introducing in Croatia the QC based on European Commission Guidelines.

Reliability of disclosure forms of authors' contributions.

BACKGROUND: The contribution disclosure forms used by medical journals to assess and confirm authorship are surveys of self-reported behaviour that follow the cognitive rules of psychometric instruments. We sought to analyze how autobiographical memory, defined as memory for events and issues related to oneself, affected the reliability of contribution forms for the judging of authorship of research articles. METHODS: We conducted a prospective study, which ultimately included 919 authors of 201 articles submitted to a general medical journal from July 2001 through December 2002. A authorship disclosure form with a checklist of 11 possible contribution choices for all authors was sent first to each article's corresponding author, who was asked to fill it out for all authors. A blank form was then sent to each author individually to disclose his or her own contribution to that article. The main outcome measure was test- retest differences between the corresponding authors' self-declarations, expressed in percent as the gross difference rate (GDR) for each article. RESULTS: More than two-thirds of the corresponding authors (69.7%) differed in at least 1 contribution choice between the 2 disclosure statements made about their own contributions. The reliability of their answers was low to moderate (GDRs > 10%), especially for contributions on the provision of study materials or patients or final approval of the article (GDR 22.9%), guarantor of the study (GDR 20.9%) and drafting of the manuscript (GDR 20.4%). As a proxy for their coauthors' contributions, corresponding authors also differed from them in the perception of noncorresponding authors' contributions, disagreeing in 69.4% of cases. Of the 718 noncorresponding authors, 204 (28.4%) met all the criteria for authorship set out by the International Committee of Medical Journal Editors according to the statement given by the corresponding author. When they described their own contributions, this prevalence increased to 40.5%. INTERPRETATION: Psychological factors such as autobiographical memory may confound contribution disclosures as an evaluation tool for authorship on scientific articles and affect responsible authorship and publication practices.

Long-term follow-up of blood pressure in family members of soldiers killed during the war in Bosnia and Herzegovina.

AIM: To asses prevalence of essential arterial hypertension in family members of soldiers killed in 1992-1995 war in Bosnia and Herzegovina. METHODS: The study enrolled 1144 subjects who lost a family member in the war and 582 of their close neighbors who experienced no such loss. Data on their medical history and habits were collected, and their blood pressure was recorded in 1996 and 2003. Arterial hypertension was defined as systolic blood pressure > or =140 mm Hg (> or =130 mm Hg in patients with diabetes mellitus), or diastolic blood pressure > or =90 mm Hg (> or =80 mm Hg in patients with diabetes mellitus), or taking antihypertensive therapy. Additional laboratory and clinical tests were performed in subjects with hypertension. RESULTS: The prevalence of hypertension at both time points was higher in the group with a killed family member than in the group without the loss (55.1% vs 42.1%, P<0.001 in 1996, and 50.7% vs 39.0%, P<0.001 in 2003, respectively). However, there was also a significant decrease in the prevalence of hypertension in the group with the loss in 2003 (P<0.001), but not in group without the loss. Posttraumatic stress disorder (PTSD), smoking, and alcohol consumption were more prevalent in the group with a killed family member, but not cholesterol and triglyceride blood concentrations. In both groups, hypertension was more prevalent in subjects with PTSD and smoking or drinking habit. Proportion of subjects with hypertension who smoked and used alcohol was similar in both groups. Proportion of subjects with hypertension who did not smoke or drink was higher in the group with the loss (51.1% vs 36.7%, P<0.001; 46.2% vs 35.0%, P=0.006; respectively). CONCLUSION: This study showed higher prevalence of hypertension in family members of killed soldiers, regardless of the presence of other cardiovascular risk factors. Only the stress of mourning was associated with higher prevalence of hypertension. Over time, proportion of hypertensive subjects with the loss decreased in the group with a killed family member, further suggesting that at least a part of their hypertension might have been of psychological origin.

[Follow up of traumatic brain injury sequels in war victims]. / Pracenje posljedica traumatske ozljede mozga u stradalnika domovinskog rata.

Most evaluation scales used in the follow up of war victims with traumatic brain injury used to date have been focused on physical disability rather than psychological and social dimensions of the handicap. The aim of this study was to assess the applicability of the European Head Injury Evaluation Chart (EHIEC) in the follow up of traumatic brain injury in patients attending the War Veterans Rehabilitation Center in Osijek. The study included 20 patients with traumatic brain injury sustained during the war in Croatia and their families. The EHIEC form was filled out by a professional examiner using data from the patient's medical records and those obtained by evaluation of the patient's physical, mental and social status on his first visit to the Center. Study results showed the majority of these patients to suffer relatively moderate disability consequential to traumatic head injury (mild to moderate hemiparesis, moderate chronic pain, attention impairment, and frequent affective disorder such as depression and anxiety). The patients had significantly reduced capacity for work and impaired community adaptation. However, EHIEC questionnaire was found to suffer from some shortcomings, including time-consuming procedure, problems with interpretation of answers, and inadequate adaptability to local social service. Additional studies are needed to evaluate the questionnaire applicability to outpatient follow up of individuals with traumatic head injury.