CONFLICT OF INTEREST: NONE DECLARED Goal The goals of this study are to: a) determine the prevalence of diabetic polyneuropathy (DPNP) in hospitalized patients with diabetes mellitus (DM) type 2; b) determine the frequency of DPNP in hospitalized patients with type 2 DM in relation to gender, duration of diabetes, fasting blood glucose and HbA1c; c) identify the dominant DPNP symptoms and the presence of variable risk factors in hospitalized patients; and d) determine the frequency and motor nerve conduction velocity of n. peroneus (electroneuromyography) in relation to the treatment of type 2 DM in hospitalized patients with DPNP. Material and methods The study was conducted on 141 patients diagnosed with type 2 diabetes who were hospitalized at the Neurological clinic of Clinical Center of Sarajevo University in the period from June 1 2009 to June 1 2010. All patients included in the study were older than 18. Values determined for all subjects are: age, sex, dominant symptoms, duration of type 2 DM, fasting blood glucose, HbA1c, motor conduction velocity of n. peroneus, diabetes risk factors (hyperlipidemia, hypertension, smoking, alcoholism, obesity) and DM treatment type. Results Of 141 patients with type 2 DM, DPNP was confirmed in 50 patients (35.5%). Men were slightly more represented in the total sample (51.8%). In a sample of patients with DPNP, there were slightly more male patients (n=26; 52%). The average age of patients with DPNP was higher in men (58.3±12.5) (p<0.05). The average age of the patients with DPNP was 55.1± 13.2. Average values of fasting glucose was higher in the group of patients with DPNP (11.032±5.4 mmol/l) compared to patients without DPNP (9.7±2.8 mmol/l) (p<0.05). Mean values of HbA1C were higher in patients with DPNP (8.212±3.3%) compared to patients without DPNP (6.9±2.6%) (p<0.05). Analysis of DM duration between patients with and without DPNP did not show statistically significant difference (chi-square=3.858, p>0.05). In both groups, most of the patients had duration of DM over 10 years, with a minimum duration of DM of 12 months. There are statistically significant differences in applied DM therapy by gender (chi-square=11.939, p<0.05). Hypertension was more frequent in women (79.2%:69.2%), hyperlipidemia was equally presented in both sexes (50%:50%), obesity was more prevalent among women (25%:7.7%), while alcoholism and smoking were more frequent in men (7.7%:0%; 34.6%:8.3%). There are statistically significant differences in the prevalence of risk factors by gender (chi-square=10.013, p<0.05). Conclusions The DPNP incidence was higher in patients with longer duration of the disease, but without significant gender differences. Fasting blood glucose and HbA1c were significantly higher in patients with DPNP compared to patients without DPNP (p<0.05). The dominant symptoms of DPNP were paresthesia (44%) and hypoesthesia (28%). Regarding variable risk factors, the most common were hypertension and hyperlipidemia, without statistical significance in gender distribution, while smoking was significantly more common in men than women (34.6%:8.3%). DPNP was present in 43.2% of men who use insulin therapy, while 54.2% of women with DPNP used oral therapy. The lowest frequency of DPNP was found in patients treated with combined therapy. Motor conduction velocity of n. peroneus was significantly lower in men using insulin therapy and/or combined therapy (p<0.05), whereas in patients on oral therapy there was no significant gender difference. Timely DM type 2 diagnosis with proper treatment and electromyoneurographic monitoring (especially in older men) can prevent onset of diabetic polyneuropathy and contribute to its successful treatment.
Summary Introduction: XXII European Congress of Medical Informatics (MIe 2009) took place in Sarajevo from August 30th to September 2nd 2009. Assessment of quality of papers presented at MIe 2009 was a process of observation, measurement, comparison and evaluation of the quality of orally presented papers. Methodology: For this study, and for the first time since EFMI founding (1976) and MIE congresses, the authors introduced a specially created quality assessment form with five relevant paper quality variables (methodological approach, international influence, scientific content, language quality, technical features) which the first author of this article used in peer-review process of papers submitted for publication in the journal Acta Informatica Medica (as Editor-in-Chief for last 18 years). The survey was conducted on the principle of random sampling of participants of MIE 2009 Conference in Sarajevo, where specially trained interviewers (final year students of medicine and engineering at the University of Sarajevo) interviewed 33 session’s chairs and 110 participants/listeners of MIE 2009 paper presentations in 33 sessions (of total 40). Data was collected, entered into a specially created database, analyzed and presented. Results: From the total of 150 oral presentations at the MIE 2009, 110 oral presentations were graded by both chairs and participants/ listeners. Grading results were compared and we found that in 60% of cases (66 papers) session chairs gave higher ratings than other participants of the congress. The highest rating was 10, and the lowest 3. Only 3 of the papers received all four grades 10 from the session chairs. The most common grade given by chairs of the session was 8 (26.36%), followed by 7 (20%), 9 (19.32%), 6 (13.18%), 10 and 5 (7.50%), 4 (5%) and 3 (1.14%). Significant differences in quality assessment of papers done by chairs and those done by other participants/listeners are observed. Conclusion: This work should demonstrate the importance of introducing universal (uniform) scale for assessment of articles at conferences that would provide objective and relevant assessment, which has not been the practice. Results obtained using a single standardized scale can be compared to each other and thus improve the quality of the articles and the congress. Future congresses can be organized in this manner and become leading events in certain fields of medical science.
Development of computer networks and introduction and application of new technologies in all aspects of human activity needs to be followed by universities in their transformation on how to approach scientific, research, and education teaching curricula. Development and increased use of distance learning (DL) over the past decade have clearly shown the potential and efficiency of information technology applied in education. Use of information technology in medical education is where medical informatics takes its place as important scientific discipline which ensures benefit from IT in teaching and learning process involved. Definition of telemedicine as "use of technologies based on health care delivered on distance" covers areas such as electronic health, tele-health (eHealth), telematics, but also tele-education. Web based medical education today is offered in different forms--from online lectures, online exams, web based continuous education programs, use of electronic libraries, online medical and scientific databases etc. Department of Medical Informatics of Medical Faculty of University of Sarajevo has taken many steps to introduce distance learning in medical curricula--from organising professional--scientific events (congresses, workshop etc), organizing first tele-exam at the faculty and among first at the university, to offering online lectures and online education material at the Department's website (www.unsa-medinfo.org). Distance learning in medical education, as well as telemedicine, significantly influence health care in general and are shaping the future model of medical practice. Basic computer and networks skills must be a part of all future medical curricula. The impact of technical equipment on patient-doctor relationship must be taken into account, and doctors have to be trained and prepared for diagnosing or consulting patients by use of IT. Telemedicine requires special approach in certain medical fields--tele-consultation, tele-surgery, tele-radiology and other specific telemedicine applications should be introduced to the curricula. Telemedicine and distance learning are best suited for medical education and doctor-to-doctor consultation--first contact between doctor and a patient should stay face-to-face when possible. In this paper, we present the results of the project Introduction and Implementation of Distance Learning at the Medical Faculty of University of Sarajevo and compare it with the following expected outcomes: development and integration of information technology in medical education; creation of flexible infrastructure which will enable access to e-learning to all students and teaching staff; improvement of digital literacy of academic population; ensuring high educational standards to students and teaching staff; helping medical staffto develop "life-long learning" approach in work and education.
Extensive and fast advancements in biomedical sciences created a significant delay in receiving relevant and updated information in medical practice - physicians use old techniques and treat patients incorrectly. Bosnia and Herzegovina signed the Bologna Declaration on 18 September 2003, and in the light of this new approach to university education, and the process of joining The European Union, the authors set the following aims: to determine the current level of knowledge among medical students at the Medical Faculty of the University of Sarajevo, to determine the level of knowledge among medical students before their enrolment at the faculty, and to find out students opinion on their needs for further education. Students also left their suggestions on what should be changed in the curriculum. 203 students were included in the survey and results show that they demand more practical work, direct contact with patients and presentation of interesting clinical cases. Many of them use the internet as professional education means. Professional papers are rarely used. At present, the availability of learning material is insufficient at the faculty library.
Health care systems today require some important changes. Many patients, doctors and other health professionals with right have suspicions that the health care system are managing available resources and information of interest in an optimal way, and as a result of that, health care that we receive isn’t of best possible quality. Considering the large investment in health systems, and the population with an increasing life expectancy, the mobility of patients and the emergence of new highrisk infectious diseases (HIV, SARS, etc.), modern systems of treatment must be proactive, efficient, economical and safe. To provide a basis for improving the quality of health care the system needs to meet several key preconditions and requirements. Professional groups from the world’s most advanced countries (USA, Japan, EU countries) have recognized the introduction of specialized computer and business solutions to national integrated information system in the field of health as a key component to improve the efficiency of the system, all in order to better manage the information of interest, and optimize the consumption and quality of resource management. Information systems must however meet very important common criteria that are based on openness, integration, security of data management, reliability and modularity. In this way it would ensure the vertical (within single health care institutions) and horizontal (between different separate institutions) interoperability of different solutions, and connectivity of different levels of health care within and outside the borders of individual states. Bearing in mind the requirements mentioned, this paper provides a short overview of Health Level 7 (HL7) as open information and communication technology (ICT) standard that should be adopted at the global level by professionals and users. Without quality standards that meet the needs of the business health systems, and ensure the applicability of existing and new solutions the above vision of integrated health care system is certainly not achievable.
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