Publications by authors named "Dominik Romic"

16 Publications

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Structural changes in brains of patients with disorders of consciousness treated with deep brain stimulation.

Sci Rep 2021 Feb 23;11(1):4401. Epub 2021 Feb 23.

Department of Neurosurgery, Dubrava University Hospital, Avenija Gojka Suska 6, 10000, Zagreb, Croatia.

Disorders of consciousness (DOC) are one of the major consequences after anoxic or traumatic brain injury. So far, several studies have described the regaining of consciousness in DOC patients using deep brain stimulation (DBS). However, these studies often lack detailed data on the structural and functional cerebral changes after such treatment. The aim of this study was to conduct a volumetric analysis of specific cortical and subcortical structures to determine the impact of DBS after functional recovery of DOC patients. Five DOC patients underwent unilateral DBS electrode implantation into the centromedian parafascicular complex of the thalamic intralaminar nuclei. Consciousness recovery was confirmed using the Rappaport Disability Rating and the Coma/Near Coma scale. Brain MRI volumetric measurements were done prior to the procedure, then approximately a year after, and finally 7 years after the implementation of the electrode. The volumetric analysis included changes in regional cortical volumes and thickness, as well as in subcortical structures. Limbic cortices (parahippocampal and cingulate gyrus) and paralimbic cortices (insula) regions showed a significant volume increase and presented a trend of regional cortical thickness increase 1 and 7 years after DBS. The volumes of related subcortical structures, namely the caudate, the hippocampus as well as the amygdala, were significantly increased 1 and 7 years after DBS, while the putamen and nucleus accumbens presented with volume increase. Volume increase after DBS could be a result of direct DBS effects, or a result of functional recovery. Our findings are in accordance with the results of very few human studies connecting DBS and brain volume increase. Which mechanisms are behind the observed brain changes and whether structural changes are caused by consciousness recovery or DBS in patients with DOC is still a matter of debate.
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http://dx.doi.org/10.1038/s41598-021-83873-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902623PMC
February 2021

Frameless stereotactic brain biopsy: A prospective study on robot-assisted brain biopsies performed on 32 patients by using the RONNA G4 system.

Int J Med Robot 2021 Jun 4;17(3):e2245. Epub 2021 Mar 4.

Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

Background: We present a novel robotic neuronavigation system (RONNA G4), used for precise preoperative planning and frameless neuronavigation, developed by a research group from the University of Zagreb and neurosurgeons from the University Hospital Dubrava, Zagreb, Croatia. The aim of study is to provide comprehensive error measurement analysis of the system used for the brain biopsy.

Methods: Frameless stereotactic robot-assisted biopsies were performed on 32 consecutive patients. Post-operative CT and MRI scans were assessed to precisely measure and calculate target point error (TPE) and entry point error (EPE).

Results: The application accuracy of the RONNA system for TPE was 1.95 ± 1.11 mm, while for EPE was 1.42 ± 0.74 mm. The total diagnostic yield was 96.87%. Linear regression showed statistical significance between the TPE and EPE, and the angle of the trajectory on the bone.

Conclusion: The RONNA G4 robotic system is a precise and highly accurate autonomous neurosurgical assistant for performing frameless brain biopsies.
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http://dx.doi.org/10.1002/rcs.2245DOI Listing
June 2021

Hemoglobin A1c in Patients with Glioblastoma-A Preliminary Study.

World Neurosurg 2020 09 31;141:e553-e558. Epub 2020 May 31.

Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia; Department of Surgery, Zagreb University School of Medicine, Zagreb, Croatia.

Background: Glioblastomas are among the most common primary brain tumors with an abysmal prognosis. The significance of glucose metabolism in glioblastoma cell metabolism and proliferation is well-known. However, a significant correlation between the systemic metabolic status of the patient and the cellular proliferation of the glioblastoma has not yet been established.

Methods: Our aim was to observe and analyze for a possible correlation between glioblastoma cellular proliferation and patients' glycated hemoglobin (HbA1c) levels as a marker of chronic systemic glycemia. We analyzed the data from 25 patients and compared their Ki-67 values with their preoperative HbA1c values.

Results: We observed a statistically significant correlation (P < 0.03) between chronic glycemia (measured using HbA1c) and the cellular proliferation of glioblastoma (measured by cellular Ki-67 expression).

Conclusions: These results imply a possible positive correlation between glioblastoma cell proliferation and chronic systemic glycemia, a correlation that, to the best of our knowledge, has not yet been reported. Further research in this area could not only lead to a better understanding of glioblastoma but also have significant clinical applications in treating this devastating disease.
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http://dx.doi.org/10.1016/j.wneu.2020.05.231DOI Listing
September 2020

A biphasic tumor in posterior cranial fossa and the pineal region in young adult.

Surg Neurol Int 2020 11;11:64. Epub 2020 Apr 11.

Departments of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

Background: Biphasic tumors of the central nervous system are rarely described and mainly consisted out of the glial and mesenchymal component. The tumor originated out of both astrocytes and pinealocytes, best to our knowledge, has not been described. We present a case of a brain tumor consisted out of pilocytic astrocytoma (PA) and pineocytoma as components situated in the pineal region and posterior cranial fossa in young adult.

Case Description: We present a 21-year-old patient with a history of intermittent headache, followed by nausea and vomiting, double vision, and dextropulsion. Magnetic resonance imaging revealed an extensive cystic-solid expansive formation in the posterior cranial fossa with a solid part in the area of the pineal gland. The patient underwent surgical resection. The pathohistological analysis showed two types of tumor cells; the major part of tumor showed features of PA, while minor part corresponded to pineocytoma.

Conclusion: PA accounts for 5% of all gliomas and is most common in children and young adults. It usually occurs in the cerebellum, the optic pathway, third ventricular region, etc. Pineocytomas are rare, accounting up to 1% of all intracranial tumors. Since tumors origin is different, there must be complex molecular events or mutations that can lead to cell rearrangements and generation of two histologically different tissues in the same tumor mass. The course of treatment options is different for PA and pineocytoma; therefore, the case of brain mass consisted out of two different tissues can be helpful when deciding about the treatment of tumors in posterior cranial fossa and pineal region.
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http://dx.doi.org/10.25259/SNI_288_2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193197PMC
April 2020

Dynamics of inflammatory factors expression in ischemic brain tissue injury.

Neurol Int 2019 Nov 2;11(4):8282. Epub 2019 Dec 2.

Department of Neurosurgery, University Hospital Dubrava, Zagreb.

Ischemic stroke is one of the most common cause of mortality and disability in the modern world. Still, therapeutic options remain modest. Aim of the study was to present dynamics of inflammatory factors expression (C reactive protein, procalcitonin, interleukin 10) in patients after ischemic stroke. Our study included 101 patients divided in thrombolised and nonthrombolised groups. Inflammatory factors concentration in serum was determinate at admission, 24, 48 hours and seven days after the initial onset, while neurological assessment was measured at the admission, 24 hours, seven days and three months after the initial onset using National Institute of Health Stroke Scale and Rankin Scale. Certain pattern was observed in dynamics of inflammatory factors: intensive increase in first and second day after the stroke, followed by decrease till day seven in both groups. Additionally, thrombolised group showed significant neurological improvement. Although well investigated, the role of inflammatory factors in the ischemic stroke still stays controversial. High association of C reactive protein and interleukin 10 values suggest potential prognostic role in patient's follow-up, while the role of procalcitonin values still remains unclear.
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http://dx.doi.org/10.4081/ni.2019.8282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6908952PMC
November 2019

The Dubrava Model-A Novel Approach in Treating Acutely Neurotraumatized Patients in Rural Areas: A Proposal for Management.

J Neurosci Rural Pract 2019 Jul 7;10(3):446-451. Epub 2019 Oct 7.

Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

Neurotrauma is one of the leading causes of death and disabilities nowadays and represents one of the largest socioeconomic problems in rich countries, as well as developing ones. A satisfying, medically viable, and cost-effective model of managing acutely neurotraumatized patients, especially ones who come from distant and/or rural areas, has yet to be found. Patient outcome after acute neurotrauma depends on many factors of which the possibility of urgent treatment by an experienced specialist team has a crucial role. Here, we present our own way of managing acutely neurotraumatized patients from distant places which is unique in Croatia, the Dubrava model. We present our 5-year experience cooperating with general hospitals in four neighboring cities (Ĉakovec, Bjelovar, Sisak, and Koprivnica) in managing, operating, and taking care of acutely neurotraumatized patients. More than 300 surgeries have been performed in these hospitals through the Dubrava model. Our experience so far provides encouraging results that this system could also be successfully implemented in other institutions. Furthermore, we recorded an increased number of surgeries each year, as well as a good mutual cooperation with the local general hospitals. This trauma managing model is one of a kind in Croatia. We argue that it is not only better for the patients, providing them with better chances of survival, and disability-free recovery, but is also far superior in many ways to the dominant and currently prevalent way of treating these patients in other parts of Croatia. The Dubrava model of treating patients in rural and distant areas is a reliable and proven model with many benefits and as such its implementation should be considered in other institutions as well.
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http://dx.doi.org/10.1055/s-0039-1697777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6779563PMC
July 2019

Intracranial Mature Teratoma in an Adult Patient: A Case Report.

J Neurol Surg Rep 2019 Jan 3;80(1):e14-e17. Epub 2019 Apr 3.

Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

: Primary intracranial teratoma is a subtype of germ cell tumors, classified into three subtypes. They occur very rarely, with only several reported individual cases in adults.  We present a patient with an intermittent headache in the right frontal region. Magnetic resonance imaging (MRI) revealed a right sided high frontal parasagittal mass that compressed the falx, the right lateral ventricle, as well as the brain parenchyma. Patient underwent surgical treatment. Histopathological analysis described mature teratoma. Four months after the surgical treatment there were no signs of residual intracranial mass or relapse.  Primary intracranial teratoma in adults has a nonspecific clinical presentation. MRI reveals a solitary irregular mass with multilocularity and mixed signals derived from different tissues. The patients age, biochemical markers, and patohistological analysis are necessary to confirm the diagnosis.  Teratoma treatment strategy still remains controversial. It includes radical resection whenever possible. Since the residual portion of mature teratoma may contain part of immature or malignant tissue, tumor recurrence after surgical removal is possible. Also, new tumor mass could occur at other sites intracranial after the initial one was removed. Thus, although patients usually recover, they should be followed-up for a long period of time.
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http://dx.doi.org/10.1055/s-0039-1685213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6447400PMC
January 2019

Primary dural lymphoma mimicking meningioma: a clinical and surgical case report.

J Surg Case Rep 2018 Aug 6;2018(8):rjy189. Epub 2018 Aug 6.

Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

Introduction: Primary central nervous system lymphoma and its subtype, primary dural lymphoma, are types of non-Hodgkin's lymphoma that only occur in the central nervous system without any dissemination. They are extremely rare cases of extra nodal lymphomas accounting for 1--5% of intracranial tumors.

Case Report: We present a patient diagnosed with primary dural lymphoma in right frontal brain region who underwent surgical resection. Histopathological analysis revealed diffuse B-type large cell non-Hodgkin lymphoma. Patient underwent four cycles of R-CHOP and intrathecal methotrexate protocol. Six months postoperative, no signs of newly onset infiltration were present.

Discussion: Primary dural lymphoma most likely presents with unusual radiological signs, which can easily be mistaken for meningioma, the main differential diagnosis. A thorough immunological, histopathological and clinical patients profile should be conducted in order to establish the certainty of diagnosis. Although there are few treatment options: surgery, radiotherapy or chemotherapy, there is no established treatment protocol.
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http://dx.doi.org/10.1093/jscr/rjy189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6077807PMC
August 2018

RANKL/RANK/OPG Axis Is Deregulated in the Cerebrospinal Fluid of Multiple Sclerosis Patients at Clinical Onset.

Neuroimmunomodulation 2018 19;25(1):23-33. Epub 2018 Jun 19.

Department of Physiology and Immunology, and Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.

Objectives: Our study focused on the RANKL (receptor activator of nuclear factor-κB ligand)/RANK/OPG (osteoprotegerin) axis and selected proinflammatory/immunoregulatory upstream mediators in the peripheral blood (PBL) and cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients.

Methods: PBL and CSF were collected from healthy controls (n = 35) and MS patients at the clinical onset of the disease (n = 33). In addition, PBL samples were obtained from relapse-remitting (RR)-MS patients (n = 30). Patients were assessed by means of the expanded disability status scale (EDSS) and routine laboratory parameters. Soluble (s)RANKL and OPG were measured in the CSF and plasma; gene expression was detected for RANKL, RANK, OPG, and selected cytokines/chemokines (interleukin [IL]-4, IL-10, IL-17, CCL2, and CXCL12) in PBL mononuclear cells.

Results: The OPG level in the CSF was lower in MS patients at clinical onset than in controls. Moreover, the sRANKL/OPG ratio was higher in the CSF of MS patients at clinical onset and in the plasma of RR-MS patients than in controls. Gene expression of RANKL/RANK/OPG in PBL mononuclear cells was higher only in RR-MS patients. IL-4, CCL2, and CXCL12 were positively correlated and IL-10 was negatively correlated with RANKL/RANK expression. OPG was negatively correlated with EDSS and alkaline phosphatase level.

Conclusion: Our study revealed that changes of RANKL/RANK/OPG axis are associated with MS, particularly the decreased OPG level in the CSF at disease onset. Therefore, these factors may serve as disease biomarkers and molecular targets of novel therapeutic approaches.
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http://dx.doi.org/10.1159/000488988DOI Listing
January 2019

Brain biopsy performed with the RONNA G3 system: a case study on using a novel robotic navigation device for stereotactic neurosurgery.

Int J Med Robot 2018 Feb 12;14(1). Epub 2017 Dec 12.

Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia.

Background: Robotic neuronavigation is becoming an important tool for neurosurgeons. We present a case study of a frameless stereotactic biopsy guided by the RONNA G3 robotic neuronavigation system.

Methods: A 45 year-old patient with a history of vertigo, nausea and vomiting was diagnosed with multiple periventricular lesions. Neurological status was unremarkable. A frameless robotic biopsy of a brain lesion was performed.

Results: Three tissue samples were obtained. There were no intraoperative or postoperative complications. Histological analysis showed a B-cell lymphoma. After merging the preoperative CT scan with the postoperative MRI and CT scans, the measured error between the planned and the postoperatively measured entry point was 2.24 mm and the measured error between the planned and postoperatively measured target point was 2.33 mm.

Conclusions: The RONNA G3 robotic system was used to navigate a Sedan brain biopsy needle to take tissue samples and could be a safe and precise tool for brain biopsy.
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http://dx.doi.org/10.1002/rcs.1884DOI Listing
February 2018

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio help identify patients with lung cancer, but do not differentiate between lung cancer subtypes.

Croat Med J 2016 Jun;57(3):287-92

Marko Žarak, Clinical Department for Laboratory Diagnostics, Clinical Hospital Dubrava, Avenija Gojka Šuška 6, Zagreb, Croatia,

Aim: To assess the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in lung cancer (LC). We compared the ratios between healthy participants and all LC patients, as well patients with different pathohistological LC subtypes.

Methods: We retrieved the data on neutrophil, lymphocyte, and platelet levels in 449 patients with different pathohistological LC subtypes (non-small cell LC, small-cell LC, atypical or metastatic LC, neuroendocrine, and sarcomatoid carcinoma) and 47 healthy controls. NLR and PLR were calculated by dividing the absolute number of neutrophils or platelets with the absolute number of lymphocytes.

Results: There were significant differences in both NLR and PLR (P<0.001) between all LC patients and the control group, but there were no differences between patients with different LC subtypes. Reciever operating characteristics analysis for NLR showed the optimal cut-off value of 2.71, with a sensitivity of 77.05% and specificity of 87.23%. The optimal cut-off value for PLR was 182.31, with a sensitivity of 51.09% and specificity of 91.49%.

Conclusion: The results showed that the NLR and PLR may have added value in the early diagnosis of LC, but further research is needed to confirm these results.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937224PMC
http://dx.doi.org/10.3325/cmj.2016.57.287DOI Listing
June 2016

Decreased level of sRAGE in the cerebrospinal fluid of multiple sclerosis patients at clinical onset.

Neuroimmunomodulation 2014 1;21(5):226-33. Epub 2014 Mar 1.

Department of Physiology and Immunology, University of Zagreb School of Medicine, Zagreb, Croatia.

Objectives: Receptor for advanced glycation end products (RAGE) ligands/RAGE interactions have been proposed to have a pathogenic role in neuroinflammatory disorders. Our study aimed to assess changes in high-mobility group box (HMGB)1 and its receptor RAGE in peripheral blood (PBL) and cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) at the disease onset compared with control subjects.

Methods: PBL and CSF were collected from control subjects (n = 30) and MS patients (n = 27) at clinical onset. Soluble RAGE (sRAGE), HMGB1, S100 calcium-binding protein A12 (S100A12), interleukin (IL)-1β and tumor necrosis factor (TNF)-α were measured in the CSF and plasma by enzyme-linked immunosorbent assay. Gene expression in PBL mononuclear cells (PBMCs) was detected by quantitative PCR for RAGE, HMGB1, S100A12 and several proinflammatory/immunoregulatory cytokines.

Results: We found a significantly lower expression of IL-10 (p = 0.031) in the PBMCs of MS patients. The level of sRAGE in the CSF of MS patients was lower (p = 0.021), with the ability to discriminate between MS patients and control subjects. Moreover, PBMC gene expression for HMGB1 and S100A12 positively correlated with IL-6.

Conclusions: Our study confirmed that the cytokine network is disturbed in PBL and CSF at MS clinical onset. The deregulated HMGB1/RAGE axis found in our study may present an early pathogenic event in MS, proposing sRAGE as a possible novel therapeutic strategy for MS treatment.
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http://dx.doi.org/10.1159/000357002DOI Listing
January 2015

Prevalence of the metabolic syndrome in the old institutionalized people in Zagreb, Croatia.

Coll Antropol 2013 Mar;37(1):203-6

University of Zagreb, Dubrava University Hospital, Department of Neurology, Zagreb, Croatia.

Metabolic syndrome (MeS) is defined by a cluster of abnormalities comprising obesity, hypertension, carbohydrate intolerance and dyslipidemia. MeS increases the risk of developing various diseases, including coronary heart disease, stroke, peripheral angiopathy and type 2 diabetes. In our study, the subjects were 561 persons, residents of 11 homes for the elderly in Zagreb, Croatia. There were 160 men (28.5%) and 401 women (71.5%), aged from 56 to 96 years (the average being 79 years). Physical examination was conducted, which included blood pressure measurement, and body height and weight. Blood samples were taken for biochemical analysis. Along with other biochemical parameters, the levels of glucose, triglycerides and cholesterol (LDL, HDL-C) were also measured. The results have shown the prevalence of MeS in the elderly instutionalised people to be in the range of 20.8%, according to WHO criteria. The most common MeS component was hypertension, and it was significantly more frequent in women than in men; also, the elevated triglyceride levels were more often found in women; the difference between men and women was also statistically significant. MeS is a serious and growing health problem not only in Croatia but worldwide as well. Further studies are needed to verify the prevalence of MeS in Croatia, as it is a major risk for CVD and many other severe diseases.
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March 2013

Glycemic index in diabetes.

Coll Antropol 2011 Dec;35(4):1363-8

University of Zagreb, Dubrava University Hospital, Division of Endocrinology, Diabetes and Metabolic Disease, Zagreb, Croatia.

The Glycemic Index (GI) is a rating system that ranks carbohydrate-containing foods according to their postprandial blood glucose response relative to the same quantity of available carbohydrate of a standard such as white bread or glucose. The concept of GI was first introduced in the early 80's by Jenkins and coworkers. Since then, numerous trials have been undertaken, many indicating benefits of a low GI diet on glycemic control, as well as lipid profiles, insulin and C-peptide levels, inflammatory and thrombolytic factors, endothelial function and regulation of body weight. As a result, a low-GI diet may prevent or delay the vascular complications of diabetes. However, despite many studies supporting the benefits of the Glycemic Index as part of the treatment of diabetes mellitus, several areas of controversy have been raised in the literature and are addressed here. Clinicians treating diabetic patients should be aware of the potential benefits of low-GI foods in the prevention and treatment of diabetes and its complications.
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December 2011

Enzyme catalytic activities in chronic obstructive pulmonary disease.

Arch Med Res 2006 Jul;37(5):624-9

Department of Medical Biochemistry and Hematology, School of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia.

Background: Altered muscle amino acid metabolism resulting in skeletal muscle dysfunction is one of the systemic effects of chronic obstructive pulmonary disease (COPD) associated with systemic oxidative stress and inflammation. The aim of the study was to investigate the existence and extent of changes in the activities of the enzymes catalyzing transamination reactions (aminotransferases), the enzyme involved in bone rearrangement (alkaline phosphatase), and the enzyme reflecting hypoxia that is characteristic of these patients (lactate dehydrogenase). In addition, the effect of cigarette smoking on these enzyme activities was also assessed.

Methods: Enzyme activities such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyltransferase and lactate dehydrogenase were determined by standard analysis in sera of 29 COPD patients (FEV(1) = 46.6 +/- 12.1%) and 58 healthy subjects (21 nonsmokers, 17 ex-smokers and 20 smokers).

Results: The activity of aspartate aminotransferase and alanine aminotransferase was significantly decreased, and the activity of lactate dehydrogenase increased in sera of COPD patients as compared with the group of healthy nonsmokers. According to centile values, the activity of alkaline phosphatase, gamma-glutamyltransferase and lactate dehydrogenase was increased in 50, 5, and 50% of COPD patients, respectively.

Conclusions: Study results revealed significant changes in the activities of transamination enzymes in patient sera, thus supporting the reports on altered amino acid metabolism in skeletal muscle in COPD. The elevated activity of alkaline phosphatase provides additional evidence for altered bone rearrangement in these patients. Smoking was not found to have any major effect on these enzyme activities in the present study.
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http://dx.doi.org/10.1016/j.arcmed.2006.01.004DOI Listing
July 2006

Medical students' clinical skills do not match their teachers' expectations: survey at Zagreb University School of Medicine, Croatia.

Croat Med J 2006 Feb;47(1):169-75

Medical students, Zagreb University School of Medicine, Zagreb, Croatia.

Aim: To evaluate self-assessed level of clinical skills of graduating medical students at Zagreb University School of Medicine and compare them with clinical skill levels expected by their teachers and those defined by a criterion standard.

Method: The study included all medical students (n=252) graduating from the Zagreb University School of Medicine in the 2004-2005 academic year and faculty members (n=129) involved in teaching clinical skills. The participants completed anonymous questionnaire listing 99 clinical skills divided into nine groups. Students were asked to assess their clinical skills on a 0-5 scale, and faculty members were asked to assess the minimum necessary level of clinical skills expected from graduating medical students, using the same 0-5 scale. We compared the assessment scores of faculty members with students' self-assessment scores. Participants were grouped according to their descriptive characteristics for further comparison.

Results: The response rate was 91% for students and 70% for faculty members. Students' self-assessment scores in all nine groups of clinical skills ranged from 2.2-/+0.8 to 3.8-/+0.5 and were lower than those defined by the criterion standard (3.0-4.0) and those expected by teachers (from 3.1-/+1.0 to 4.4-/+0.5) (P<0.001 for all). Students who had additional clinical skills training had higher scores in all groups of skills, ranging from 2.6-/+0.9 to 4.0-/+0.5 (P<0.001 for all). Male students had higher scores than female students in emergency (P<0.001), neurology (P=0.017), ear, nose, and throat (P=0.002), urology (P=0.003), and surgery skills (P=0.002). Teachers' expectations did not vary according to their sex, academic position, or specialty.

Conclusion: Students' self-assessed level of clinical skills was lower than that expected by their teachers. Education during clinical rotations is not focused on acquiring clinical skills, and additional clinical skills' training has a positive influence on students' self-assessed level of clinical skills. There was no consensus among teachers on the required level of students' clinical skills.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080370PMC
February 2006