Publications by authors named "Ana Borovecki"

41 Publications

80th Anniversary of the Publication of Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb.

Acta Dermatovenerol Croat 2020 Aug;28(2):102-104

Professor Ana Borovečki, MD, PhD, University of Zagreb School of Medicine Andrija Stampar School of Public Health, Rockefelleorva 4, 10 000 Zagreb, Croatia;

Certain regions of Bosnia and Herzegovina were prominent European sites of endemic syphilis. In 1934 and 1935 the School of Public Health in Zagreb, later the Andrija Štampar School of Public Health, conducted two surveys on endemic syphilis in Bosnia and Herzegovina. The surveys were well-described in the monograph published in 1939 by the School, under the title Endemic Syphilis in Bosnia: Survey by the School of Public Health in Zagreb ("Endemski sifilis u Bosni anketa Škole narodnog zdravlja u Zagrebu"). This paper provides a description of the publication for the first time, presents the most important data from it, and explores its significance from the historical perspective.
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August 2020

The first nationwide study on facing and solving ethical dilemmas among healthcare professionals in Slovenia.

PLoS One 2020 14;15(7):e0235509. Epub 2020 Jul 14.

Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.

Background: Healthcare professionals (HCPs), patients and families are often faced with ethical dilemmas. The role of healthcare ethics committees (HECs) is to offer support in these situations.

Aim: The primary objective was to study how often HCPs encounter ethical dilemmas. The secondary objective was to identify the main types of ethical dilemmas encountered and how HCPs solve them.

Subjects And Methods: We conducted a cross-sectional, survey-based study among HCPs in 14 Slovenian hospitals. A questionnaire was designed and validated by HCPs who were selected by proportional stratified sampling. Data collection took place between April 2015 and April 2016.

Results: The final sample size was n = 485 (385 or 79.4%, female). The response rates for HCPs working in secondary and tertiary level institutions were 45% and 51%, respectively. Three hundred and forty (70.4%) of 485 HCPs (very) frequently encountered ethical dilemmas. Frequent ethical dilemmas were waiting periods for diagnostics or treatment, suboptimal working conditions due to poor interpersonal relations on the ward, preserving patients' dignity, and relations between HCPs and patients. Physicians and nurses working in secondary level institutions, compared to their colleagues working in tertiary level institutions, more frequently encountered ethical dilemmas with respect to preserving patients' dignity, protecting patients' information, and relations between HCPs and patients. In terms of solutions, all HCPs most frequently discussed ethical dilemmas with co-workers (colleagues), and with the head of the department. According to HCPs, the most important role of HECs is staff education, followed by improving communication, and reviewing difficult ethical cases.

Conclusions: Waiting periods for diagnostics and treatment and suboptimal working conditions due to poor interpersonal relations are considered to be among the most important ethical issues by HCPs in Slovenian hospitals. The most important role of HECs is staff education, improving communication, and reviewing difficult ethical cases.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0235509PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360038PMC
September 2020

Are Štampar's principles valid in the light of the Sustainable Development Goals?

Croat Med J 2020 04;61(2):173-176

Ana Borovečki, Depatrment of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230416PMC
April 2020

Ethical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review.

J Crit Care 2020 08 31;58:10-19. Epub 2020 Mar 31.

Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Johna Davidsona Rockfellera 4, 10000 Zagreb, Croatia.

Purpose: Intensive care unit health care professionals must be skilled in providing end-of-life care. Crucial in this kind of care is end-of-life decision-making, which is a complex process involving a variety of stakeholders and requiring adequate justification. The aim of this systematic review is to analyse papers tackling ethical issues in relation to end-of-life decision-making in intensive care units. It explores the ethical positions, arguments and principles.

Methods: A literature search was conducted in bibliographic databases and grey literature sources for the time period from 1990 to 2019. The constant comparative method was used for qualitative analysis of included papers in order to identify ethical content including ethical positions, ethical arguments, and ethical principles used in decision-making process.

Results: In the 15 included papers we have identified a total of 43 ethical positions. Ten positions were identified as substantive, 33 as procedural. Twelve different ethical principles emerged from the ethical arguments. The most frequently used principles are the principles of beneficence, autonomy and nonmaleficence.

Conclusions: We have demonstrated that recommendations and guidelines designed specifically by intensive or critical care experts for intensive care units promote similar ethical positions, with minimal dissenting positions.
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http://dx.doi.org/10.1016/j.jcrc.2020.03.010DOI Listing
August 2020

Reprogenetics, reproductive risks and cultural awareness: what may we learn from Israeli and Croatian medical students?

BMC Med Ethics 2019 11 27;20(1):85. Epub 2019 Nov 27.

Yezreel Valley Academic College, Afula, Israel.

Background: Past studies emphasized the possible cultural influence on attitudes regarding reprogenetics and reproductive risks among medical students who are taken to be "future physicians." These studies were crafted in order to enhance the knowledge and expand the boundaries of cultural competence. Yet such studies were focused on MS from relatively marginalized cultures, namely either from non-Western developing countries or minority groups in developed countries. The current study sheds light on possible cultural influences of the dominant culture on medical students in two developed countries, potentially with different dominant cultures regarding reprogenetics and reproductive risks: Israel and Croatia.

Methods: Quantitative-statistical analyses were employed, based on anonymous questionnaires completed by 150 first year medical students in Israel and Croatia. The questionnaires pertained to the knowledge and attitudes regarding genetics, reproduction and reproductive risks. These questionnaires were completed before the students were engaged in learning about these topics as part of the curriculum in their medical school.

Results: Substantial differences were revealed between the two groups of medical students. Israeli medical students were less tolerant regarding reproductive risks and more knowledgeable about genetics and reproductive risks than Croatian medical students. For example, while nearly all Israeli medical students (96%) disagreed with the idea that "Screening for reproductive risks in prospective parents is wrong," less than 40% of their Croatian counterparts shared a similar stance. Similarly, all (100%) Israeli medical students correctly observed that "A carrier of a recessive genetic disease actually has the disease" was wrong, as opposed to only 82% of Croatian students.

Conclusions: By linking applicable theoretical literature to these findings, we suggest that they may reflect the hidden influence of the dominant culture in each country, disguised as part of the "culture of medicine." Acknowledging and learning about such influence of the dominant culture, may be an important addition to the training of medical students in cultural competence, and specifically their cultural awareness. Such an acknowledgement may also pave the road to drawing the attention of existing physicians regarding a less known yet an important aspect of their cultural competence, insofar as the cultural awareness component is concerned.
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http://dx.doi.org/10.1186/s12910-019-0427-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880344PMC
November 2019

The use of placebo in schizophrenia relapse prevention studies: scientific or ethical debate?

Acta Psychiatr Scand 2019 10;140(4):386-387

School of Medicine, University of Zagre, Zagreb, Croatia.

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http://dx.doi.org/10.1111/acps.13085DOI Listing
October 2019

A Cross-sectional Study Among Healthcare and Non-healthcare Students in Slovenia and Croatia About Do-not Resuscitate Decision-making.

Zdr Varst 2019 Sep 26;58(3):139-147. Epub 2019 Jun 26.

University Medical Centre Ljubljana, Division of Obstetrics and Gynecology Department of Perinatology, Neonatal Intensive Care Unit, Šlajmerjeva ulica 3, 1000 Ljubljana, Slovenia.

Objective: To survey university students on their views concerning the respect for autonomy of patients and the best interest of patients in relation to the withholding of resuscitation.

Methods: A cross-sectional survey among university students of medicine, nursing, philosophy, law and theology of the first and the final study years at the University of Ljubljana and the University of Zagreb was conducted during the academic year of 2016/2017. A questionnaire constructed by Janiver et al. presenting clinical case vignettes was used.

Results: The survey response rates for students in Ljubljana and Zagreb were 45.4% (512 students) and 37.9% (812 students), respectively. The results of our research show statistically significant differences in do-not resuscitate decisions in different cases between medical and non-medical students in both countries. Male and religious students in both countries have lower odds of respecting relatives' wishes for the withholding of resuscitation (odds ratio 0.49-0.54; 95% confidence interval). All students agreed that they would first resuscitate children if they had to prioritize among patients.

Conclusions: Our study clearly shows that gender, religious beliefs, and type of study are important factors associated with the decisions pertaining to the respect for autonomy, patient's best interest, and initiation or withholding of resuscitation.
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http://dx.doi.org/10.2478/sjph-2019-0018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598388PMC
September 2019

Social egg freezing under public health perspective: Just a medical reality or a women's right? An ethical case analysis.

J Public Health Res 2018 Dec 20;7(3):1484. Epub 2018 Dec 20.

Department of Molecular Medicine, University of Padua, Italy.

In recent years, a social trend toward delaying childbearing has been observed in women of reproductive age. A novel technomedical innovation was commercialized for non-medical reasons to healthy, ostensibly fertile women, who wished to postpone motherhood for various reasons such as educational or career demands, or because they had not yet found a partner. As a consequence, these women may be affected by age-related infertility when they decide to conceive, and fertility preservation techniques can be obtained through the so-called . This paper examines, from an ethical point of view, the impact of social egg freezing under some aspects that can involve policy making and resources allocation in public health. Due to the increasing demand for this procedure, some debated issues regard if it is reasonable to include social egg freezing in Public Healthcare System and consequently how to manage the storage of cryopreserved oocytes also from individual donors, how to support these egg banks and how to face, in the future, with the possibility that egg freezing will play a role in enabling childbearing for gays, lesbians, and unmarried persons. Social freezing may be advertised to harmonise gender differences, but we wonder if it is the proper solution to the problem or if it could also create further challenges. An ethical argumentation on these topics should address some questions that will be discussed.
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http://dx.doi.org/10.4081/jphr.2018.1484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6321944PMC
December 2018

The frequencies of micronuclei, nucleoplasmic bridges and nuclear buds as biomarkers of genomic instability in patients with urothelial cell carcinoma.

Sci Rep 2018 12 14;8(1):17873. Epub 2018 Dec 14.

Departament of Biology, Faculty of Natural Sciences, University of Pristina "Hasan Prishtina", Pristina, Kosovo.

Bladder urothelial cell carcinoma (UCC) is an increasingly prevalent cancer worldwide, and thus, gaining a better understanding of its identifiable risk factors is a global priority. This study addressed this public health need with the understanding that cancer-initiating events, such as chromosome breakage, loss and rearrangement, can be reasonably used as biomarkers to evaluate an individual's cancer risk. Overall, forty bladder cancer patients and twenty controls were evaluated for genomic instability. To the best of the investigators' knowledge, this is the first study to perform micronucleus (MN) assays simultaneously in urothelial exfoliated cells (UEC), buccal exfoliated cells (BEC), and peripheral blood lymphocytes (PBL) in first-diagnosed, non-smoker bladder UCC patients. Additionally, the frequency of nucleoplasmic bridges (NPBs) and nuclear buds (NBUDs) in PBL was evaluated. The MN frequencies in UEC, BEC, and PBL, as well as the frequencies of NPBs and NBUDs, were significantly higher in patients than in controls. In conclusion, MN assays, particularly in UEC, may be used to identify individuals who are at high risk of developing UCC, as single or as additional triage test to UroVysion FISH test. Our results further validate the efficacy of biomarkers, such as MN, NPBs, and NBUDs, as predictors of genomic instability.
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http://dx.doi.org/10.1038/s41598-018-35903-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294807PMC
December 2018

Informed consent and ethics committee approval in laboratory medicine.

Biochem Med (Zagreb) 2018 Oct;28(3):030201

Research Integrity Editor, Biochemia Medica.

Informed consent is a process in which a human subject who is to participate in research needs to give his or her consent after being properly informed of the expected benefits as well as the potential harm of the research that will be performed. The function and purpose of the research ethics committee is to ensure that the research that will take place is in accordance with the relevant ethical standards. This means that the committee must assess the appropriateness of the design of the study reviewed. Research in the field of laboratory medicine has specific features, the use of samples that remain after routine analysis, data collection from databases containing patient information, data mining, collection of laboratory management data, method/instrument comparisons and validation, As most of such research is either retrospective or not directly associated with patients, the question arises as to whether all types of research require informed consent and ethics committee approval. This article aims to clarify what is specific about obtaining informed consent and ethical approval in laboratory medicine, to provide general guidance on informed consent and ethical approval requirements based on the type of study, and what information should be included in applications for ethical approval and informed consent. This could also provide some guidance for future contributors to the
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http://dx.doi.org/10.11613/BM.2018.030201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214688PMC
October 2018

Abdominal aortic and iliac aneurysm presented as lower limb deep vein thrombosis: case report.

Acta Chir Belg 2020 Aug 13;120(4):271-273. Epub 2018 Nov 13.

Department of Pathology, School of Medicine, Univerisity Zagreb, Zurich, Switzerland.

We report a rare case of a symptomatic abdominal aneurysm presented as a lower limb deep vein thrombosis (DVT). A 63-year old male presented to our hospital with a recent progressive onset of the right lower limb swelling and pain. The patient had a history of a previous cardiovascular disease. A Duplex ultrasound was performed, which confirmed a right lower limb DVT extending to the right iliac vein. The patient had a pulsatile abdominal mass. Computed tomography scan of the abdomen showed an abdominal aortic and a right iliac artery aneurysm compressing the thrombosed inferior caval and the right iliac vein. The patient was treated with low molecular weight heparin. After resolution of the DVT on day 3 of hospitalization, a surgery on the abdominal and iliac artery aneurysm was performed. The aneurysm was resected and an aortobifemoral bypass was placed using a Dacron prosthesis. The patient remained to be asymptomatic for 6 months after the surgery. Follow up computed tomography demonstrated a fully patent inferior caval and iliac vein and the absence of the aneurysmal disease. Although rare, our case confirms that the DVT should be considered as a possible symptom of an abdominal aneurysm in selected patients.
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http://dx.doi.org/10.1080/00015458.2018.1538282DOI Listing
August 2020

Discourse, ethics, public health, abortion, and conscientious objection in Croatia.

Croat Med J 2017 08;58(4):316-321

Ana Borovečki, "Andrija Štampar" School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,

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August 2017

Readability and Content Assessment of Informed Consent Forms for Medical Procedures in Croatia.

PLoS One 2015 16;10(9):e0138017. Epub 2015 Sep 16.

University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia.

Background: High quality of informed consent form is essential for adequate information transfer between physicians and patients. Current status of medical procedure consent forms in clinical practice in Croatia specifically in terms of the readability and the content is unknown. The aim of this study was to assess the readability and the content of informed consent forms for diagnostic and therapeutic procedures used with patients in Croatia.

Methods: 52 informed consent forms from six Croatian hospitals on the secondary and tertiary health-care level were tested for reading difficulty using Simple Measure of Gobbledygook (SMOG) formula adjusted for Croatian language and for qualitative analysis of the content.

Results: The averaged SMOG grade of analyzed informed consent forms was 13.25 (SD 1.59, range 10-19). Content analysis revealed that informed consent forms included description of risks in 96% of the cases, benefits in 81%, description of procedures in 78%, alternatives in 52%, risks and benefits of alternatives in 17% and risks and benefits of not receiving treatment or undergoing procedures in 13%.

Conclusions: Readability of evaluated informed consent forms is not appropriate for the general population in Croatia. The content of the forms failed to include in high proportion of the cases description of alternatives, risks and benefits of alternatives, as well as risks and benefits of not receiving treatments or undergoing procedures. Data obtained from this research could help in development and improvement of informed consent forms in Croatia especially now when Croatian hospitals are undergoing the process of accreditation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0138017PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573755PMC
May 2016

The quality of informed consent in Croatia-a cross-sectional study and instrument development.

Patient Educ Couns 2016 Mar 1;99(3):436-442. Epub 2015 Sep 1.

University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia.

Objective: To examine the informed consent process implementation and quality in Croatia using a specially developed instrument.

Methods: A cross-sectional questionnaire study was conducted in 300 patients (response rate 73%) from six hospitals in Croatia, along with psychometric evaluation of the questionnaire.

Results: Signing the informed consent form was a formality for 64% of patients, 54% of patients did not give their written consent, and in 39% of cases physicians made treatment decisions by themselves. The overall informed consent process score was 4.06±0.60 (of 5.00). Physician-patient relationship score was 4.61±0.57, Verbal information 3.99±0.98, Decision making 3.94±0.75, and Written information 3.60±1.42. The overall Cronbach's alpha coefficient was 0.890. Significant correlations were found in relation to Physician-patient relationship and education levels (OR=0.43, 95% CI=0.18-0.99, p=0.048), and Verbal information and duration of health problems (OR=1.83, 95% CI=1.02-3.25, p=0.041).

Conclusion: The developed questionnaire is reliable and valid. The informed consent process quality in Croatia was reasonably high, although insufficient and inadequate written materials represent a weak spot that require enhancement.

Practice Implications: The study contributes to the development of suitable measuring instrument for assessment of the informed consent process quality in clinical practice. The questionnaire could be of use in the hospital accreditation process.
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http://dx.doi.org/10.1016/j.pec.2015.08.033DOI Listing
March 2016

20 years of the ICRC Code of Conduct for Disaster Relief: what do we need to improve?

Lancet 2015 Apr;385(9976):1391

Medical Genetics Centre Doutor Jacinto Magalhăes, Centro Hospitalar do Porto, and Faculty of Medicine, University of Porto, Portugal.

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http://dx.doi.org/10.1016/S0140-6736(15)60710-3DOI Listing
April 2015

Physicians' interpersonal relationships and professional standing seen through the eyes of the general public in Croatia.

Patient Prefer Adherence 2014 25;8:1135-42. Epub 2014 Aug 25.

Department of Environmental and Occupational Health, School of Public Health "Andrija Štampar," University of Zagreb, School of Medicine, Zagreb, Croatia.

Purpose: Medical professionalism, as a cornerstone of medicine's social contract with society, demands physicians adhere to high professional standards while placing public interest ahead of self-interest. This study's objective was to investigate perceptions of the basic elements of medical professionalism related to physicians' interpersonal relationships and their professional standing in the view of the broader public.

Methods: A field survey was conducted using an independently created questionnaire on a nationally representative three-stage probabilistic sample of 1,008 Croatian citizens. By including weights, the sample became nationally representative in terms of sex, age, education, and regional representation. The survey was carried out from April 17 to May 13, 2012.

Results: The Croatian public recognizes the importance of collaboration among physicians, but their everyday experiences tell a different story, in which almost half of the respondents evaluated physicians' collaboration as being mediocre, poor, or nonexistent. The perception of physicians' priorities and their primary interests, where every sixth respondent believes physicians always or almost always puts their own interest in front of that of the patients, as well as the perception of their inadequate adherence to professional standards, is indicative of a disillusioned stance of the public toward the medical profession in Croatia.

Conclusion: This research offered insight into findings that can have a profound and long-lasting effect on a health care delivery process if they are not further analyzed and rectified.
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http://dx.doi.org/10.2147/PPA.S65456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154889PMC
September 2014

Croatian National Centre for Biobanking--a new perspective in biobanks governance?

Croat Med J 2014 Aug;55(4):416-22

Ana Borovečki, University of Zagreb, School of Medicine, Andrija Štampar School of Public Health, Zagreb, Croatia,

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157382PMC
http://dx.doi.org/10.3325/cmj.2014.55.416DOI Listing
August 2014

[Informed consent with special emphasis on Croatia].

Lijec Vjesn 2014 Mar-Apr;136(3-4):104-9

Respecting the informed consent and its implementation is one of the fundamental components of high-quality health care. This article discusses the informed consent with an overview of Croatian and international legal documents and scientific studies dealing with this issue. Based on the review of the literature it can be concluded that this is an important issue that contains several key components that should be observed and investigated. It is necessary to evaluate the purposefulness and quality of the implementation of the informed consent, to systematically examine respect of the patients' right to information regarding the medical procedure during treatment, to explore decision-making model in the physician-patient encounter in Croatian hospitals, to determine the content and amount of information shared between physicians and patients, to determine the content and readability of consent forms and written patient information on the medical procedure. In order to assure higher quality of the implementation of the informed consent it is necessary to define by law a list of medical procedures that require written consent and to uniform consent forms for the same medical procedures country-wide.
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October 2015

Informed consent in Croatia. A work in progress.

Camb Q Healthc Ethics 2014 Jul 27;23(3):356-60. Epub 2014 May 27.

As Croatia makes the transition from one political system and type of economy to another, there are inevitable social and political changes that have a profound affect on the healthcare system. This article charts some of the progress of change with respect to patients' rights and informed consent.
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http://dx.doi.org/10.1017/S0963180113000972DOI Listing
July 2014

Recent parvovirus B19 infection in late pregnancy.

Int J Gynaecol Obstet 2013 Sep 24;122(3):262-3. Epub 2013 Jun 24.

Department of Obstetrics and Gynecology, Merkur University Hospital, Zagreb, Croatia.

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http://dx.doi.org/10.1016/j.ijgo.2013.04.006DOI Listing
September 2013

Coil embolization and surgical removal of carotid body paraganglioma.

J Craniofac Surg 2013 May;24(3):e242-5

Department of Vascular Surgery, University Hospital Mekur, Zagreb, Croatia.

Carotid body paraganglioma has considerable malignant potential and locally aggressive behavior, so it should be treated as soon as it is discovered.We report the case of 60-year-old male patient with a carotid body paraganglioma (Shamblin group II) that was causing the carotid arteries to spread. Angiography showed 1 dominant feeding artery arising from the right external carotid artery. Selective angiography was performed 2 days before surgical removal of the tumor, and the feeding artery was successfully embolized with coils.Literature review reveals previous reports where preoperative embolization of the feeding arteries was done using ethanol, polymers, or other liquid agents. In our case, angiography (via femoral artery) was performed 2 days before surgical removal of the tumor, and the main feeding artery (a single branch arising from external carotid artery) was successfully embolized with coils rather than liquids.Performing coil embolization before operating reduced subsequent blood loss and made it easier to identify the feeding artery during surgery. Supraselective coiling, although as difficult as embolization with liquids, may reduce the incidence of postoperative stroke. At 1 year after surgery, the patient had no signs of tumor recurrence.
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http://dx.doi.org/10.1097/SCS.0b013e31828607efDOI Listing
May 2013

Are physician-patient communication practices slowly changing in Croatia? -- a cross-sectional questionnaire study.

Croat Med J 2013 Apr;54(2):185-91

Institute for Ear, Nose and Throat Disease and Head and Neck Surgery, University Hospital Merkur, Zajceva 19, Zagreb, Croatia.

Aim: To explore physician-patient communication practices during the process of obtaining informed consent in a hospital setting in Croatia.

Methods: Two hundred and fifty patients (response rate 78%) from five tertiary level hospitals in Zagreb, Croatia, anonymously filled in the questionnaire on informed consent and communication practices by Nemcekova et al in the period from April to December 2011.

Results: Eighty five percent of patients received complete, understandable information, presented in a considerate manner. Patients in surgical departments received a higher level of information than those in internal medicine departments. Patients were informed about health risks of the proposed treatments (in 74% of cases) and procedures (76%), health consequences of refusing a medical intervention (69%), and other methods of treatment (46%). However, patients pointed out a number of problems in physician-patient communication.

Conclusion: Communication practices during informed consent-obtaining process in hospitals in Zagreb are based on a model of shared decision-making, but paternalistic physician-patient relationship is still present. Our results indicate that Croatia is undergoing a transition in the physician-patient relationship and communication.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3641876PMC
http://dx.doi.org/10.3325/cmj.2013.54.185DOI Listing
April 2013

The quest for Mediterranean bioethics.

Authors:
Ana Borovecki

Med Health Care Philos 2012 Nov;15(4):417-8

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http://dx.doi.org/10.1007/s11019-012-9434-4DOI Listing
November 2012

[The unclassifiable myeloproliferative neoplasm--morphological, cytogenetic and clinical features].

Acta Med Croatica 2011 Sep;65 Suppl 1:31-6

Merkur University Hospital, Department of Pathology and Cytology, Zagreb, Croatia.

Myeloproliferative neoplasm, unclassifiable (MPN,U) has clinical, laboratory and morphological features of an MPN but fails to meet the criteria for any of the specific MPN entities. Because overlapping features, morphological findings in bone marrow, BCR-ABL1 fusion gene, V617F JAK2 mutation and cytogenetic abnormalities were analyzed in ten patients diagnosed with MPN,U. Bone marrow biopsy showed hypercellularity with trilineage myeloproliferation, dispersed megakaryocytes with mild pleomorphism and mature nuclei, and absence of reticulin fibrosis. All patients were BCL-ABL1 negative, while V617F JAK2 mutation was found in 6 of 8 patients. Trisomy 8 was found in two patients and t(6;12)(q12;p13) in one patient. Morphological features of MPN,U are nonspecific, however, in study cases they were most similar to diagnostic morphological features of polycythemiea vera. The high frequency of V617F JAK2 mutation in MPN,U cases analyzed revealed that its presence does not confirm a specific type of MPN.
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September 2011

Institutional challenges for clinical ethics committees.

HEC Forum 2011 Sep;23(3):193-205

Zentrum für Gesundheitsethik (ZfG), Hannover, Germany.

Clinical ethics committees (CECs) have been developing in many countries since the 1980s, more recently in the transitional countries in Eastern Europe. With their increasing profile they are now faced with a range of questions and challenges regarding their position within the health care organizations in which they are situated: Should CECs be independent bodies with a critical role towards institutional management, or should they be an integral part of the hospital organization? In this paper, we discuss the organizational context in which CECs function in Europe focusing on five aspects. We conclude that in Europe clinical ethics committees need to maintain a critical independence while generating acceptance of the CEC and its potential benefit to both individuals and the organization. CECs, perhaps particularly in transitional countries, must counter the charge of "alibi ethics". CECs must define their contribution to in-house quality management in their respective health care organization, clarifying how ethical reflection on various levels serves the hospital and patient care in general. This last challenge is made more difficult by lack of consensus about appropriate quality outcomes for CECs internationally. These are daunting challenges, but the fact that CECs continue to develop suggests that we should make the effort to overcome them. We believe there is a need for further research that specifically addresses some of the institutional challenges facing CECs.
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http://dx.doi.org/10.1007/s10730-011-9160-yDOI Listing
September 2011

[Ethics of scientific research using patients' archived biological material and their medical data].

Lijec Vjesn 2011 Mar-Apr;133(3-4):133-9

Skola narodnog zdravlja Andrija Stampar, Medicinski fakultet, Sveuciliste u Zagrebu, Rockefellerova 4, 10000 Zagreb.

Informed consent represents the standard for adequate protection of all participants in biomedical research. This standard is affirmed in international legal documents concerning biomedical research, as well as in Croatian legislation. However, some questions regarding informed consent remain open. One of such questions that research ethics committees around the world and in the Republic of Croatia often deal with, is the question of whether to obtain informed consent for the research on archived material or previously collected research data taken from the patients during diagnostic or therapeutic procedures. This contribution provides an overview of both Croatian and international legal documents and guidelines that deal with this issue, together with an overview of the literature concerning this issue. Since in the Republic of Croatia there are no regulations regarding this type of research, the authors of this contribution are presenting conduct guidelines for researchers and ethics committees in such cases. The implementation of the proposed guidelines would facilitate scientific research and international cooperation for Croatian scientific institutions.
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June 2011

Immunohistochemical localization of CD31, NOTCH1 and JAGGED1 proteins in experimentally induced polycystic ovaries of immature rats.

Acta Histochem 2011 May 22;113(3):262-9. Epub 2009 Nov 22.

Department of Gynaecological Pathology and GY & OB, University Hospital Merkur, Zajceva 19, Zagreb, Croatia.

We analyzed histomorphometrical changes and blood vessel immunohistochemical staining of CD31, NOTCH1 and JAGGED1 in induced polycystic ovaries of immature female Wistar rats, as well as serum hormone levels. The rats were randomly divided into control (n=18) and treated (n=18) groups. Treated animals received intramuscularly testosteronenantat weekly (0.1mg/g). Controls received the same amount of ricinus oil. Rats were weighed daily. Control and treated subgroups (6 rats per subgroup) were subsequently sacrificed after 21, 28 and 35 days of treatment. In ovaries of treated rats we found large cystic follicles, thick stromal tissue, many atretic preantral follicles, no ovulation and a thinner granulosa cell layer. CD31 stained blood vessels in the theca layer were reduced, with reduced JAGGED1 and NOTCH1 immunostaining. In controls, preantral and antral follicles were larger than in the treated group. Treated animals showed statistically significant lower progesterone and higher testosterone levels. They gained more weight than controls. Reduced immunostaining for NOTCH1 and JAGGED1 of reduced blood vessels of the theca layer was found in all stages of folliculogenesis with a distinct reduction in cystic and atretic follicles. Our results provide evidence of intrinsic abnormality during all stages of folliculogenesis in polycystic ovaries and this may result from crosstalk between circulating gonadotropins and follicular angiogenesis.
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http://dx.doi.org/10.1016/j.acthis.2009.10.008DOI Listing
May 2011

Prognostic significance of B-cell differentiation genes encoding proteins in diffuse large B-cell lymphoma and follicular lymphoma grade 3.

Croat Med J 2008 Oct;49(5):625-35

Department of Clinical Pathology and Cytology, Merkur University Hospital, Zajceva 19, 10000 Zagreb, Croatia.

Aim: To define prognostic significance of B-cell differentiation genes encoding proteins and BCL2 and BCL6 gene abnormalities in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern.

Methods: In 53 patients with diffuse large B-cell lymphoma and 20 patients with follicular lymphoma grade 3 with >75% follicular growth pattern the following was performed: 1) determination of protein expression of BCL6, CD10, MUM1/IRF4, CD138, and BCL2 by immunohistochemistry; 2) subclassification into germinal center B-cell-like (GCB) and activated B-cell-like (ABC) groups according to the results of protein expression; 3) detection of t(14;18)(q32;q21)/IgH-BCL2 and BCL6 abnormalities by fluorescent in situ hybridization in diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern as well as in GCB and ABC groups; and 4) assessment of the influence of the analyzed characteristics and clinical prognostic factors on overall survival.

Results: Only BCL6 expression was more frequently found in follicular lymphoma grade 3 with >75% follicular growth pattern than in diffuse large B-cell lymphoma (P=0.030). There were no differences in BCL2 and BCL6 gene abnormalities between diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern. Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients were equally distributed in GCB and ABC groups. t(14;18)(q32;q21) was more frequently recorded in GCB group, and t(14;18)(q32;q21) with BCL2 additional signals or only BCL2 and IgH additional signals in ABC group (P=0.004). The GCB and ABC groups showed no difference in BCL6 gene abnormalities. There was no overall survival difference between the diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients, however, GCB group had longer overall survival than ABC group (P=0.047). Multivariate analysis showed that BCL6, CD10, and BCL2 expression, BCL2 and BCL6 abnormalities, and International Prognostic Index were not significantly related to overall survival.

Conclusion: Diffuse large B-cell lymphoma and follicular lymphoma grade 3 with >75% follicular growth pattern patients have very similar characteristics and their prognosis is more influenced by protein expression of B-cell differentiation stage genes than by tumor cells growth pattern, BCL2 and BCL6 abnormalities, and International Prognostic Index.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582355PMC
http://dx.doi.org/10.3325/cmj.2008.5.625DOI Listing
October 2008

Report on the conference "Clinical ethics consultation: theories and methods--implementation--evaluation," February 11-15, 2008, Bochum, Germany.

Med Health Care Philos 2009 Mar 1;12(1):109-10. Epub 2008 Jul 1.

Institute of Medical Ethics, University of Tübingen, Tubingen, Germany.

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http://dx.doi.org/10.1007/s11019-008-9146-yDOI Listing
March 2009