Physical exercise as a stress management mechanism
The way of reacting to potentially stressful situations is individual and depends on two basic factors. The first is the way a person perceives and interprets the situation, and the second factor relates to the state of the body itself, or the organism. Chronic stress, burnout syndrome and post-traumatic stress disorder often lead to the development of diseases. Stress can affect health directly, through the autonomic and endocrine reactions it causes, but also indirectly, through changes in health behavior that can occur due to stress. Physical exercise is often recommended as part of a stress management program. It has been proven that exercise reduces stress hormones and stress reactivity. Exercises adapted to the degree of physical capabilities and the levels of motivation of the person are considered an excellent initial approach to managing psychological stress. Physical activity is important not only as a primary prevention of many chronic diseases, but also as a secondary prevention that slows down and reduces the symptoms of chronic diseases. In addition to its impact on chronic diseases, physical activity also has a beneficial effect on improving self-confidence, social skills, cognitive functioning, and reducing symptoms of stress, which, together with other positive effects, contributes to a better quality of life. The results of existing research show that physical exercise can affect cognitive functioning throughout the lifespan directly, through physiological mechanisms and structural changes in the brain, and indirectly through its impact on mood and stress reduction. Physical exercise, through various mechanisms, has a strong impact on the manifestation of stress levels.
APPLICATION OF TELEMEDICINE IN PALLIATIVE CARE FOR PATIENTS WITH ADVANCED ENDOCRINE DISEASES: BENEFITS, CHALLENGES, AND PRACTICE RECOMMENDATIONS
Background: Telemedicine is becoming an increasingly important component of healthcare, particularly in palliative care, where it contributes to improving access, continuity, and personalization of services. For patients with advanced endocrine diseases, the need for continuous monitoring and support makes this technology especially relevant. Objective: The aim of this paper was to identify the key benefits and challenges of implementing telemedicine in palliative endocrine care and to develop practice-based recommendations. Methods: A systematic review of 24 publications published between 2015 and 2024 was conducted, focusing on telemedicine within the context of palliative or endocrine care. The findings related to effectiveness, acceptability, and implementation challenges were analyzed. Results: The most commonly identified benefits of telemedicine included improved access to healthcare services (83.3%), more effective symptom monitoring (72.2%), increased patient satisfaction (66.7%), and reduced need for hospitalization (55.6%). Key challenges included technical issues and limited access to technology (77.8%), insufficient staff training (61.1%), and ethical-legal concerns (50%). Recommendations include staff education, development of specialized platforms, and enhancement of the regulatory framework. Conclusion: Telemedicine holds significant potential to improve the quality of palliative care in endocrine patients. However, successful implementation requires a comprehensive approach involving technical infrastructure, staff training, and supportive healthcare policies.
Use of Digital Tools in Self-Monitoring of Thyroid Diseases: A Systematic Review of Available Solutions
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Methods: A systematic literature review was conducted following PRISMA guidelines, using the PubMed, Scopus, Web of Science, and IEEE Xplore databases for the period 2010–2025. The analysis included mobile applications, web platforms, and wearable devices designed for adults. The quality of the tools was assessed using the uMARS scale, which evaluates engagement, functionality, aesthetics, and information quality. Results: A total of 18 digital tools were identified. The most common features included symptom tracking (78%), laboratory result monitoring (67%), and medication logging (56%). The average uMARS score ranged from 3.8 to 4.5 (out of a maximum of 5). Only 28% of the tools were medically validated, while five were integrated with healthcare systems. The main shortcomings included the lack of personalized algorithms (22%) and unclear data protection policies (61%). Discussion: These tools enable real-time monitoring but lack standardization, clinical validation, and interoperability. Multidisciplinary collaboration between clinicians, developers, and regulatory bodies is essential. Conclusion: Digital solutions have the potential to improve self-monitoring of thyroid diseases but require more rigorous validation studies, better data protection, and personalized approaches.
Transanal Excision for early rectal cancer: An effective approach for selected patients
Introduction: Transanal excision (TAE) is a rectum-preserving procedure for early-stage colorectal cancers in the lower and mid rectum. While total mesorectal excision (TME) remains the gold standard for rectal cancer, TAE is considered a viable alternative for selected patients. In cases where clinical and MRI findings suggest malignancy, and yet repeated biopsies show benign lesion, TAE could be both diagnostic and therapeutic procedure. Case Report: Three patients were evaluated for symptoms including the presence of blood and mucus in the stool and defecation difficulties. Clinical examination revealed tumor formations in the distal rectum, located no more than 4 cm from the anocutaneus line. Biopsy results confirmed the presence of tubulovillosus adenomas with high-grade dysplasia. Due to the tumor characteristics, irregular surface contours, firm consistency, and a wider base of tumor, malignancy was suspected prompting further diagnostic imaging. Pelvic MRI confirmed the suspected malignancy, leading to the decision to perform transanal excision in all patients. Histopathology confirmed early rectal adenocarcinoma with clear (R0) margins. The cases were reviewed by the Oncology board, recommending standard follow-up. Over 18 to 30 months, patients underwent regular monitoring with no recurrence or symptoms. Conclusion: Transanal excision is an effective, rectum-preserving procedure for selected patients with early rectal cancer or benign lesions. The reported cases demonstrate TAE's success in achieving clear margins and favorable outcomes. Regular follow-up is crucial for detecting recurrences, and TAE remains a valuable alternative to more extensive surgeries in properly selected patients.
Accuracy evaluation of artificial intelligence-based mobile applications for assessing the severity of traumatic injuries using photo analysis: a simulation study
<p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Introduction: Rapid and accurate assessment of traumatic injury severity is crucial for effective triage and timely intervention in emergency medicine. Mobile applications based on artificial intelligence (AI) offer an objective assessment of injury severity through photographic analysis; however, their accuracy has not been sufficiently explored. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Objectives: To evaluate the accuracy of available AI-based mobile applications for assessing traumatic injury severity in simulated conditions. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Methods: This simulation study tested five mobile applications (DermaScore AI, SkinVision, Tissue Analytics, WoundCheck AI, and BurnCare App). A total of 200 simulated images of traumatic injuries, classified by the Abbreviated Injury Scale (AIS) as mild, moderate, severe, and critical, were analyzed by each application. Accuracy, sensitivity, specificity, and ROC analysis were evaluated, along with the impact of photo resolution on app performance. <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Results: DermaScore AI achieved the highest overall accuracy (89%), sensitivity (92%), and ROC-AUC value (0.91). The lowest accuracy was recorded by BurnCare App (74%). Higher photo resolution (above 12 MP) significantly improved the accuracy of all tested apps (p=0.0014). <p style="margin: 0px 0px 16px; text-align: justify; font-style: normal; font-variant-caps: normal; font-width: normal; font-size: 16px; line-height: normal; font-family: 'Times New Roman'; font-size-adjust: none; font-kerning: auto; font-variant-alternates: normal; font-variant-ligatures: normal; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-position: normal; font-variant-emoji: normal; font-feature-settings: normal; font-optical-sizing: auto; font-variation-settings: normal; -webkit-text-stroke-width: 0px; -webkit-text-stroke-color: #000000;">Conclusion: AI-based mobile applications can reliably assess traumatic injury severity from photographic analysis, but their performance significantly varies depending on technical and algorithmic factors. Additional clinical research is required to validate these findings in real-world settings.
Digital Pathology and Bioinformatics Analysis of PIT1 Expression in Pituitary Macroadenomas
Introduction: Pituitary macroadenomas pose a challenge in clinical endocrinology due to their impact on hormonal balance and subsequent clinical complications. Traditional diagnostic methods often suffer from subjectivity, highlighting the need for a more objective approach. Materials and Methods: This study was conducted as a retrospective secondary analysis of publicly available, de-identified data. Digital histopathological images were obtained from a digital pathology repository, while RNA-seq data, including PIT1 gene expression, were retrieved from the NCBI GEO database. Convolutional neural networks (CNN) were applied for tumor tissue segmentation and classification, while differential expression analysis was performed using DESeq2. Results: The model achieved an accuracy of 92.3% in identifying tumor regions, while bioinformatics analysis revealed a significant upregulation of PIT1 expression in adenomas with more pronounced clinical symptoms (log2FC = 1.8, p < 0.01). Integrated analysis confirmed a strong correlation between morphological patterns and PIT1 expression levels, while regression analysis indicated that this gene is an independent predictor of clinical outcomes. Discussion and Conclusion: The integration of digital pathology and bioinformatics analysis has shown promise in improving the diagnosis and classification of pituitary macroadenomas, paving the way for personalized therapy. Further studies on more heterogeneous samples could further validate the utility of this multidisciplinary approach.
Sealed-off perforation of colorectal carcinoma initially interpreted as diverticulitis: intra-abdominal abscess as a diagnostic and therapeutic dilemma
Introduction: Intraabdominal abscess often arises as a complication of gastrointestinal tract perforation caused by inflammatory diseases, trauma, or malignancy. Although most commonly associated with diverticulitis, perforation of colorectal cancer, especially in the form of a sealed-off perforation can present with an identical clinical manifestation, making timely diagnosis and treatment more difficult. While diverticulitis is frequently suspected, malignancy as the underlying cause of an abscess often remains undiagnosed during the acute phase. Case presentation: We present the case of a 61-year-old female admitted with fever, right lower quadrant abdominal pain, and laboratory signs of inflammation. Radiological findings revealed an abscess collection in the right iliac region, initially suggestive of complicated diverticulitis. The presence of dolichosigmoid colon with a right-sided (dextropositioned) sigmoid further complicated the diagnostic process. Initial treatment was conservative with antibiotic therapy, resulting in both clinical and radiological improvement. In the post-acute phase, protocol-mandated colonoscopy revealed a tumor in the sigmoid colon, along with extensive diverticulosis of the left colon. Histopathological examination confirmed adenocarcinoma. The patient subsequently underwent elective surgery with high anterior resection of the rectum and colo-rectal end-to-end anastomosis (without the need for stoma formation), followed by inclusion in an adjuvant oncological treatment protocol. Conclusion: Sealed-off perforation of colorectal carcinoma can clinically and radiologically mimic diverticulitis with abscess formation, potentially delaying the diagnosis of malignancy. In cases with atypical anatomy, thorough and complete diagnostic workup is essential, including mandatory colonoscopy after resolution of acute inflammation. This case highlights the importance of differential diagnosis in the initial phase and adherence to protocolized colonoscopic evaluation, which enables timely identification of colorectal cancer and improves treatment outcomes.
Conservative Management of Small Bowel Enterocutaneous Fistulas: Possibilities and Limitations
Introduction: Enterocutaneous fistulas (ECF) are complex and potentially life-threatening complications characterized by a pathological communication between the gastrointestinal tract and the skin. They most commonly arise as a consequence of abdominal surgical procedures, while spontaneous occurrence is rarer and seen in patients with inflammatory bowel diseases, malignancies, or after radiation therapy. Spontaneous closure is possible but uncommon, depending on a number of clinical and local factors. This paper aims to present the current principles, possibilities, and limitations of conservative treatment of small bowel enterocutaneous fistulas, with a focus on factors influencing their spontaneous closure. Methodology: This is a narrative literature review. The search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library for articles published between 2010 and 2025. Keywords used were: enterocutaneous fistula, conservative management, spontaneous closure, intestinal fistula. Studies in English and Serbian addressing conservative approaches to treating small bowel fistulas were included. Factors influencing the course and outcome of treatment were analyzed. Main findings: Key factors influencing spontaneous closure of ECF include low output (<200 mL/day), absence of infection, good nutritional status, simple anatomical configuration, and a closed abdomen. Conservative therapy includes an individualized nutritional plan, control of sepsis and infection, skin protection with barrier agents, and pharmacological modulation of gastrointestinal secretion (e.g., somatostatin and its analogs). Therapeutic methods such as negative pressure wound therapy and fibrin glue show promising results in selected cases. Conclusion: A detailed understanding of factors affecting spontaneous closure of ECF allows for more precise patient selection for conservative treatment. This approach can not only avoid surgical intervention but also significantly improve outcomes in patients who eventually require surgery. A multidisciplinary approach remains crucial for successful management of these patients.
Factors influencing general practitioner choice among working-age population in Serbia
This study investigates how sick leave and socio-demographic and occupational factors affect the choice of general practitioners in Serbia. The objective was to identify the factors influencing the choice of a general practitioner among employees in Serbia, considering incidences of sick leave. The study analyzed data from the 2019 Serbian National Health Survey, including 4,652 participants aged 18 to 65 years, using descriptive statistics and binary logistic regression. Overall, 92.4% of participants, mostly employees in the public sector (85.2%), chose a general practitioner, with a higher prevalence among episodes of prolonged sick leave (92.8%). The choice of a general practitioner is influenced by socio-demographic and health-related factors. Being employed by an employer increases the likelihood of choosing a general practitioner (OR = 2.277), while blue-collar workers (OR = 0.757) and employees of middle and poor wealth status have a lower likelihood among participants without sick leave (middle OR = 0.709, poor OR = 0.701). Employees in Vojvodina with sick leave have a lower likelihood of choosing a general practitioner (OR = 0.111). The last visit to a general practitioner is a significant predictor for both groups. Socio-demographic, work-related factors, and health status significantly influence the choice of general practitioner among employees in Serbia, indicating the importance of accessible primary healthcare during periods of sick leave.
ORGANIZATIONAL MODELS OF “ONE-STOP” CLINICS FOR THYROID DISEASE: A REVIEW OF PROCESSES, PERFORMANCE INDICATORS, AND OUTCOMES FROM THE LITERATURE
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Background: Fragmented care pathways for thyroid nodular disease prolong time to decision and increase costs. “One-stop” clinics (OSCs) integrate clinical evaluation, ultrasound, ultrasound-guided fine-needle aspiration (FNA) and, when appropriate, rapid on-site evaluation (ROSE)/telecytology in a single visit. Objective: To map organizational models of OSCs, define key performance indicators (KPIs), and summarize outcomes (time, visits, adequacy, repeat FNA, costs, patient satisfaction, safety). Methods: Scoping review following PRISMA-ScR and JBI guidance. MEDLINE, Scopus, and Web of Science were searched (2000–August 2025). We included studies that operationalized OSCs and/or reported KPIs/outcomes. Data extraction covered organizational features, protocols (ACR/EU-TIRADS, Bethesda), flow metrics, FNA/ROSE adequacy, economics, satisfaction, and safety. Narrative synthesis was performed. Results: Identified OSC models consistently shorten lead time to decision and reduce the number of visits. Sample adequacy is high—especially with ROSE/telecytology—thereby lowering repeat FNA rates. Patient satisfaction is high; the safety profile of FNA remains favourable. Economic analyses indicate that the cost-effectiveness of ROSE is context-dependent and greatest when baseline inadequacy is higher and/or ROSE costs are lower. A KPI set is proposed: lead time, proportion of “single-visit” completions, Bethesda I rate, ROSE utilization, repeat FNA ≤90 days, cost per episode, and satisfaction. Conclusion: OSCs are an applicable, value-oriented model for thyroid diagnostics. Selective use of ROSE/telecytology and KPI-driven management enable efficient and safe implementation across diverse resource settings.
SMART CITIES AND HEALTH INFORMATICS: TRANSFORMING URBAN HEALTHCARE SYSTEMS
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<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> The integration of health informatics into smart cities offers a transformative approach to addressing the challenges of urban healthcare systems. This study evaluates the potential of health informatics in enhancing healthcare delivery, optimizing public health, and addressing inefficiencies in urban settings while identifying barriers to its implementation. The Introduction highlights the development of smart cities and positions health informatics as a critical tool for managing urban healthcare demands, including aging populations and chronic disease prevalence. The Theoretical Framework and Literature Review explores technologies such as IoT, Big Data, and AI, alongside case studies from Singapore and Barcelona that demonstrate improved healthcare outcomes. The Methodology employs a mixed-methods approach, including a systematic literature review and case study analysis in cities such as Amsterdam and Tokyo. The Results show a 40% reduction in emergency response times and a 25% decrease in chronic disease hospitalizations, while challenges such as data privacy, high costs, and interoperability persist. The Discussion emphasizes the importance of robust privacy frameworks, public-private partnerships, and inclusive strategies for improving digital literacy. The study concludes with the transformative potential of health informatics to build resilient and efficient urban healthcare systems, with recommendations for future research.
GENERATIVE AI FOR TEN-YEAR PREDICTION OF MULTIMORBIDITY: A METHODOLOGICAL STUDY BASED ON PUBLICLY AVAILABLE AND SYNTHETIC DATA
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Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction/Aim: The aim of the work is to present a methodological framework for a ten-year prediction of multimorbidity using a generative, sequential model based on transformer architecture, with full reliance on publicly available and synthetic data, without processing identifiable patient data. Methods: A methodological study was conducted with primary training and evaluation on the Synthea synthetic cohort (≥100,000 records), with technical checks on MIMIC-III (de-identified real intensive care data). Outcomes (≥1,000) were defined by mapping ICD-10/ICD-10-CM codes to PheCode categories. The model is a transformer with multitask outputs (one for each target) and time embeddings, with evaluation of discrimination (AUPRC, AUROC), calibration (Brier, intercept/slope) and clinical utility (Decision Curve Analysis). Sensitivity analyzes and basic fairness checks (gender, age) were conducted. Results: The model achieved the best results in cardiometabolic and oncological domains, moderate in respiratory/renal, and more modest in mental/infectious outcomes. Calibration was good in the intermediate risk ranges; DCA showed a positive net benefit at thresholds relevant for opportunistic screening (≈5–15% 10-year risk). Sensitivity analyzes confirmed the stability of ranking performance across changes in rarity thresholds and history length, with no evidence of significant label leakage. Conclusion: A reproducible and ethically acceptable approach to long-term multi-disease risk prediction using a generative transformer on public/synthetic sets is presented. This "health barometer" can support triage and personalized prevention, while recommending mandatory external validation, local re-calibration and equity monitoring prior to clinical application.
The effect of Tocilizumab on the course and outcome of the disease in patients with COVID-19 pneumonia - experience of a secondary-level hospital
Introduction: The significant role in the progression of COVID-19 pneumonia is played by IL-6. Tocilizumab is a monoclonal antibody that blocks its activity. The aim was to assess the effect of tocilizumab on the clinical course, laboratory parameters, radiographic changes in COVID-19 pneumonia, and predictors of mortality. Methods: A retrospective analysis was conducted on data from 340 patients with COVID-19 pneumonia treated with tocilizumab. Data were collected on the day of tocilizumab administration and five days later. Information on sex, age, clinical course, disease outcome, comorbidities, nosocomial infections, oxygenation method, and radiographic changes was gathered. Parameters were compared based on mortality outcomes. Statistical analysis was performed using the SPSS statistical package, v.25.0. Results: The mean age of patients was 66.22 ± 11.37 years, with 66.4% being male. 65.4% had comorbidities, most commonly arterial hypertension (56.2%). Nosocomial infections were present in 8.5%, bacterial pneumonia being the most frequent (34.5%). Oxygen support was non-invasive in 64.1% of cases, and 24% required mechanical ventilation. 23.8% of patients had an R/F index <200 before tocilizumab, and 15.9% after treatment. The total radiographic score (CXR-SS) before tocilizumab showed severe changes in 71.5%, and very severe in 27.1%. Mortality was 21.8%, with 78.3% of deaths occurring in patients >65 years old. 75.7% of deceased patients had very severe CXR-SS. Conclusion: Tocilizumab led to improvements in respiratory function and regression of biochemical inflammatory parameters. Age >65, comorbidities, and nosocomial infections were associated with higher mortality, with significant radiographic changes and mechanical ventilation being key predictors of mortality.
ACCESS TO HEALTHY FOOD AND ADULT OBESITY: A SECONDARY SYNTHESIS OF EVIDENCE WITH CLINICAL IMPLICATIONS FOR ENDOCRINOLOGY
Background: Obesity is highly prevalent and determined, in addition to individual factors, by characteristics of the food environment. Understanding how access to healthy food affects obesity risk is important for endocrinology. Objective: To summarize the relationship between access to healthy food and adult obesity and to highlight clinical and public health implications. Methods: A focused secondary synthesis based on a contemporary systematic review and meta-analysis, complemented by representative observational studies. Exposures were operationalized as proximity, density, and composite indices (e.g., RFEI). Pooled odds ratios (OR) with 95% confidence intervals were extracted; no new re–meta-analysis was performed. Quality and bias were considered within PRISMA and ROBINS-I domains. Results: It is consistently observed that closer access to fast food is associated with higher odds of obesity (≈OR 1.15), whereas proximity to supermarkets and higher density of fresh produce stores are associated with lower odds (≈OR 0.90 and ≈OR 0.93). Composite indices are more often near a neutral effect. Heterogeneity depends on the definition of the exposure zone (signal clearer in wider buffers, e.g., 1.5–3 kilometers) and on socioeconomic conditions. Although effects are moderate at the individual level, they can be clinically significant at the population level. Conclusion: Spatial access to healthy food is measurably associated with obesity risk. Endocrine practice should combine individual counseling with “mapping” local sources of fresh foods and referring patients to realistically available resources. Public policies that reduce the dominance of unhealthy offerings and encourage opening/sustainability of outlets with healthier foods have the potential for meaningful population benefit. Standardization of exposure metrics and evaluation of interventions in real-world settings are needed.
Correlation between fractional clearance and optical outcomes of LASIK myopia correction
Excimer laser pulses using the LASIK method ablate the corneal stroma, achieving its remodeling to desired optical characteristics. Besides correcting ametropia, it is desirable to minimize the induction of higher-order optical aberrations (HOA), as they affect the occurrence of glare and halos in night vision conditions. Fractional clearance (FC) represents the ratio of the treated optical zone (OZ) diameter to the pupil diameter in scotopic lighting conditions. The aim of this study is to examine the relationship between the enlargement of the treated OZ diameter and the increase in FC index on postoperative HOA levels. A prospective study included 37 subjects (74 eyes) with myopia treated with the LASIK method. The eye with higher residual stromal bed value was treated with an OZ diameter of 7.0 mm, and the other eye of the same patient with an OZ diameter of 6.5 mm. After 6 months, objective evaluation of optical outcomes was performed using an Analyzer device. The mean FC value in the group of eyes treated with OZ 6.5 mm is 2.138 (SD 0.30), and in the group treated with OZ 7.0 mm is 2.325 (SD 0.37), with a statistically highly significant difference (t=3.64; p<0.001). A smaller induction of all measured HOA was found when a wider OZ of 7.0 mm was treated, with the statistically most significant reduction observed in spherical aberration induction. The increase in FC index is proportional to the enlargement of the treated OZ diameter. With an increase in FC value, the level of all HOA decreases after the LASIK procedure, with the most significant reduction observed in spherical aberration induction. Enlargement of OZ to 7.0 mm, when corneal structural characteristics allow it, improves postoperative optical outcomes.
Graves’ orbitopathy (GO), the most common extrathyroidal manifestation of autoimmune hyperthyroidism, typically occurs within the first year after diagnosis, although it may rarely develop in euthyroid and hypothyroid patients as well. Following total thyroidectomy, GO may develop in approximately 10–20% of patients, symptoms usually appear several months to one year after surgery. The risk is higher in patients with elevated thyrotropin receptor antibodies (TRAb), smokers, and patients who do not initiate levothyroxine replacement therapy promptly. Intravenous corticosteroid therapy represents the first-line treatment. A 69-year-old female patient with autoimmune thyroid disease initially presented with autoimmune hyperthyroidism and received antithyroid drug therapy for five years without developing orbitopathy during treatment. Failure to achieve sustained disease control, second-line treatment was implemented, and total thyroidectomy was performed, resulting in hypothyroidism and hypoparathyroidism. Subsequently, she was adequately substituted with levothyroxine, alfacalcidol, and calcium supplementation. The patient also underwent surgery for colon adenocarcinoma and received chemotherapy postoperatively. Nine years after thyroidectomy, despite regular vaccination, she developed COVID-19 infection and was treated with biologic therapy consisting of a monoclonal antibody targeting the SARS-CoV-2 spike protein, together with antiviral treatment. Eleven years after total thyroidectomy, the patient developed moderate-to-severe GO with moderate clinical activity, intermittent diplopia, and elevated TRAb levels. Intravenous corticosteroids resulted in a satisfactory therapeutic response. The occurrence of GO, as the most common extrathyroidal manifestation of autoimmune hyperthyroidism, is exceptionally rare several years after the onset of hyperthyroidism and even more uncommon following surgical treatment of autoimmune hyperthyroidism. COVID-19 infection, biologic therapy, and coexisting comorbidities may have acted as potential triggers for reactivation of autoimmune processes in this patient.
Quality Management in Academic Medical Education: A Focus on Serbia
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Definition"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Keyboard"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Preformatted"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Sample"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Typewriter"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="HTML Variable"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Normal Table"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="annotation subject"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="No List"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Outline List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Simple 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Classic 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Colorful 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Columns 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Grid 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 4"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 5"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 7"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table List 8"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table 3D effects 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Contemporary"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Elegant"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Professional"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Subtle 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 1"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 2"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Web 3"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Balloon Text"/> <w:LsdException Locked="false" Priority="39" Name="Table Grid"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Table Theme"/> <w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/> <w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading"/> <w:LsdException Locked="false" Priority="61" Name="Light List"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/> <w:LsdException Locked="false" SemiHidden="true" Name="Revision"/> <w:LsdException Locked="false" Priority="34" QFormat="true" Name="List Paragraph"/> <w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/> <w:LsdException Locked="false" Priority="30" QFormat="true" Name="Intense Quote"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/> <w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/> <w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/> <w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/> <w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/> <w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/> <w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/> <w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/> <w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/> <w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/> <w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/> <w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/> <w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/> <w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/> <w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/> <w:LsdException Locked="false" Priority="19" QFormat="true" Name="Subtle Emphasis"/> <w:LsdException Locked="false" Priority="21" QFormat="true" Name="Intense Emphasis"/> <w:LsdException Locked="false" Priority="31" QFormat="true" Name="Subtle Reference"/> <w:LsdException Locked="false" Priority="32" QFormat="true" Name="Intense Reference"/> <w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/> <w:LsdException Locked="false" Priority="37" SemiHidden="true" UnhideWhenUsed="true" Name="Bibliography"/> <w:LsdException Locked="false" Priority="39" SemiHidden="true" UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/> <w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/> <w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/> <w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/> <w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/> <w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/> <w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 1"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 1"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 2"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 2"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 3"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 3"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 4"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 4"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 5"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 5"/> <w:LsdException Locked="false" Priority="46" Name="List Table 1 Light Accent 6"/> <w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/> <w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/> <w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/> <w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/> <w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful Accent 6"/> <w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful Accent 6"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Mention"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Smart Hyperlink"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Hashtag"/> <w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true" Name="Unresolved Mention"/> </w:LatentStyles> </xml><![endif]--><!-- [if gte mso 10]> <![endif]--> Introduction: This study analysed quality management practices in Serbian vocational higher medical schools, focusing on their alignment with national and international standards and the specific challenges of practically oriented medical education. Methods: A mixed-methods design was applied in five accredited vocational institutions. Quantitative data included accreditation documents, institutional indicators (enrolment, dropout and graduate employment rates), and structured surveys of teaching staff (n = 124) and students (n = 298). Qualitative data were obtained through semi-structured interviews with directors, department heads and quality-assurance coordinators (n = 18), eight student focus groups, and analysis of internal QA policies and strategic plans. Results: Quantitative findings showed moderate overall satisfaction among staff and students, with higher ratings for practical training and curriculum relevance and lower ratings for infrastructure, equipment and assessment transparency. Dropout rates remained relatively low, while graduate employment was generally high. Qualitative data highlighted persistent resource constraints, staff shortages, and uneven adoption of e-learning and simulation technologies. Accreditation was widely perceived as necessary but often approached as a periodic compliance exercise rather than a driver of continuous improvement. Stakeholder feedback mechanisms existed but were inconsistently used, resulting in weak feedback loops. Discussion: Serbian vocational higher medical schools demonstrate resilience and strong practical training despite systemic and financial constraints. Strengthening strategic investment in infrastructure, embedding continuous QA processes into everyday practice, modernising assessment methods and expanding digital and telemedicine-related learning environments are key priorities for enhancing educational quality and healthcare workforce preparedness.