Abstract
The Catholic University of Croatia marks the twentieth anniversary of its founding this year. Guided by the Apostolic Constitution Ex corde Ecclesiae, which affirms that Catholic universities are “born from the heart of the Church” (1), the University was founded by decision of Cardinal Josip Bozanić, Archbishop of Zagreb and Metropolitan. Over the past two decades, it has grown into a recognised institution within the Croatian academic and social community. This growth has been built on the dedicated work of our faculty, researchers, and staff, as well as on the continued confidence that students have placed in this institution.

Abstract
Background: Nursing education in Croatia is primarily based on traditional frontal teaching methods. There is limited evidence comparing collaborative learning and ICT based gamification with traditional methods regarding knowledge acquisition and student satisfaction.

Aim: This study compared the effects of three teaching methods – gamification with ICT, collaborative learning, and frontal teaching – on the knowledge and satisfaction of nursing high school students during an emergency medical procedures course.

Methods: This was a non-randomised quasi-experimental study with parallel pretest-posttest groups including 65 fourth-grade nursing high school students in Zagreb, Croatia. Three classes were assigned to gamification with ICT (n=24), collaborative learning (n=18), or frontal teaching (n=23). All groups received eight hours of instruction over two months. Outcomes were measured using a standardised knowledge exam and a satisfaction questionnaire.

Results: A total of 54 participants completed the questionnaire. Baseline knowledge did not significantly differ between the groups. Following the interventions, the gamification and ICT group achieved significantly higher total knowledge scores compared to both the frontal teaching group (p=0.021) and the collaborative learning group (p=0.040). Significant differences were also observed across all specific cognitive domains, including factual knowledge, understanding, and application/analysis. Regarding student satisfaction, the collaborative learning group reported significantly lower perceived teacher support compared to the other two groups.

Conclusion: Gamification with ICT was associated with higher post-intervention knowledge scores than frontal teaching and collaborative learning, while overall student satisfaction did not differ significantly. These findings suggest that gamification with ICT may be a promising approach for improving short-term knowledge acquisition in nursing education.

Keywords: nursing; frontal teaching; collaborative learning; gamification; information and communication technologies

Abstract
Background: Cosmetic surgery has become an increasingly prominent aspect of contemporary healthcare and is closely linked to the global beauty industry, where medical procedures intersect with societal beauty standards and media influence. Procedures are undertaken for a range of reasons, from correcting congenital abnormalities to enhancing appearance and reducing signs of ageing. Attitudes toward cosmetic procedures are shaped by a combination of sociodemographic, cultural, and religious factors.

Aim: To assess the attitudes and awareness of students at the Catholic University of Croatia toward cosmetic surgery, and to examine their main sources of information, as well as differences according to selected sociodemographic characteristics.

Methods: This cross-sectional study was conducted at the Catholic University of Croatia between March and April 2025. Data was collected using an anonymous online questionnaire distributed via official university email addresses. The questionnaire assessed sociodemographic characteristics, awareness, and attitudes toward cosmetic surgery.

Results: A total of 263 students participated. Most respondents were familiar with cosmetic surgery (95%), but only 35% reported a positive attitude toward it. Only 1.1% of
respondents stated that cosmetic surgery would negatively affect their relationships. However, 46% believed that others’ opinions of them would change if they underwent
such a procedure. Attitudes toward the social acceptability of cosmetic surgery in Croatia were divided, and 46% of respondents considered cosmetic surgery to be religiously acceptable. Social media was identified as the primary source of information. Significant differences were observed according to sex, age, religiosity, and study type.

Conclusion: Although awareness of cosmetic surgery is high, positive attitudes remain limited. Students’ perspectives are influenced by gender, religious beliefs, and social factors, with social media playing a central role in shaping attitudes toward cosmetic procedures.

Keywords: cosmetic surgery; attitudes; awareness; students; social media; religious beliefs

Abstract
Background: Communication between nurses and patients is crucial for the quality of healthcare, as well as for patient satisfaction and safety. Research shows that effective communication increases trust and leads to better treatment outcomes, while its absence can result in dissatisfaction.

Aim: This study aimed to examine patients’ perceptions of communication with nurses and to identify factors influencing it.

Methods: A cross-sectional study was conducted at the University Hospital Centre (UHC) Zagreb during March and April 2025. Hospitalised patients from the Department
of Internal Medicine were included. Data were collected using a customised survey questionnaire and analysed using descriptive and inferential statistical methods.

Results: A total of 309 participants took part in the study. The average satisfaction score with communication was 4.41 on a scale from 1 to 5. The highest satisfaction was recorded for approachability, kindness, and consistency in care, while the lowest scores were given for nurse introductions (average 4) and family involvement (average 4.1). A statistically significant association was found between patient gender and satisfaction with communication, with male patients giving higher average ratings (4.5) than female patients (4.3; p=0.007), as well as between the presence of support from loved ones and satisfaction with communication, where patients with support rated communication higher (4.43) compared to those without support (3.97; p=0.031). No statistically significant association was found between patient age or type of hospital accommodation and satisfaction with nurse communication.

Conclusion: The majority of patients participating in the study had a positive perception of communication with nurses. The results highlight the importance of continuous
development of communication skills and may serve as a basis for improving work organisation and nurse education in Croatian hospitals.

Keywords: nurse-patient relations; patient satisfaction; communication; nursing care; hospitals

Abstract
Background: Infertility is a significant medical and psychosocial burden for couples. Patient-centred care (PCC) promotes informed decision-making by integrating patients’ values and preferences. Within this approach, it is important to provide information about all therapeutic options, including less invasive treatments such as Restorative Reproductive Medicine (RRM).

Aim: To assess perceived patient-centred infertility care among couples undergoing treatment at the University Hospital Sveti Duh in Zagreb, and to examine the importance they attribute to being offered less invasive treatment options before medically assisted reproduction (MAR).

Methods: This cross-sectional study was conducted between January and April 2022 at the University Hospital Sveti Duh in Zagreb. The survey combined sociodemographic questions with selected items from the Patient-Centredness Questionnaire – Infertility (PCQ-I). The study included couples undergoing infertility treatment during the study period.

Results: A total of 101 couples participated in the study. Care was generally perceived as mostly or fully patient-centered. No significant link was found between being offered less invasive methods and overall satisfaction (p=0.34). However, respondents interested in less invasive treatments rated the domain of respect for patients’ values and needs significantly lower compared to those not interested (median 2.3 vs 2.7; p=0.007). Married women reported significantly lower satisfaction than unmarried women in several PCC domains, including communication (median 2.42 vs 2.83; p=0.007) and overall patient-centeredness (median 2.49 vs 2.85; p<0.001).

Conclusion: While infertility care at the University Hospital Sveti Duh has been largely perceived as patient-centred, less invasive and restorative reproductive options remain insufficiently offered and integrated. Greater awareness and availability of restorative and fertility-awareness-based approaches may help strengthen shared decision-making and better align infertility care with patient-centred principles.

Keywords: infertility, patient-centred care, restorative reproductive medicine, medically assisted reproduction, patient satisfactions

Abstract
Background: Beauchamp and Childress’ principle of respect for autonomy has been criticised by scholars for privileging individualism due to its Anglo-American (‘Western’) origin and orientation. Consequently, researchers in clinical ethics need to consider alternative normative models and culturally diverse approaches to autonomy.

Aim: Guided by philosophical inquiry, this paper seeks to re-envision the concept of autonomy in biomedical contexts by focusing on the contributions of Confucian perspectives to its understanding and application in clinical contexts.

Methods: The research methodology is philosophical inquiry based on a textual analysis of the Analects (Lunyu), which records the teachings and conduct of Confucius. The research methodology of philosophical inquiry comprises philosophical retrieval and philosophical reconstruction. Philosophical retrieval aims to review, shed light on, and analyse key concepts, theories, and presuppositions with respect to one or more classical texts. Philosophical reconstruction, on the other hand, is geared towards applying ancient intellectual ideas and practices to contemporary issues and challenges.

Results: The textual analysis of the Analects reveals that Confucius’ notion of autonomy is relational, embodied, and authentic. Rather than ‘self-rule’, Confucius’ interpretation of autonomy advocates ‘selves-rule’ by harmonising interdependence, mind-body integration, and moral self-cultivation. What makes Confucius’ relational autonomy unique is its emphasis on morality, particularly the all-encompassing virtue of ren (an achieved state of humanity).

Conclusion: A major implication of Confucian ideas in clinical settings is the need to respect and consider the consent of patients as well as that of their family members based on the value of ren (an achieved state of humanity). Confronted with complex ethical dilemmas, especially in clinical scenarios, medical professionals need to recognise that the autonomy of an individual is intrinsically tied to that of their family and inseparable from pre-existing ethical commitments. In other words, medical professionals should be mindful of the relational, embodied, and authentic aspects of autonomy by giving balanced recognition to both patient autonomy and shared decision-making, which contributes to the realisation of ren. Confucian bioethics converges with Christian bioethics by underscoring the relational dimension of autonomy, especially in settings involving family, healthcare professionals, and the patient.

Keywords: autonomy, Confucius, interdependence, mind-body integration, ren, self-cultivation

Abstract
The development and implementation of three- and four-dimensional ultrasound in clinical practice have enabled both qualitative and quantitative assessment of fetal movements, including analysis of the fetal face. Ultrasound studies of fetal behaviour, compared with morphological assessments, have demonstrated that fetal behavioural patterns directly reflect the developmental and maturational processes of the fetal brain. This suggests that changes in fetal movements may allow the prenatal identification of neurological impairment.

Recently, a four-dimensional ultrasound-based prenatal screening approach for assessing fetal behaviour has been introduced. In this context, the Kurjak Antenatal Neurodevelopmental Test (KANET) has emerged as a 4D ultrasound-based scoring system for evaluating fetal neurobehavior and identifying fetuses at risk of later neurodevelopmental impairment.

This study presents a narrative review of the literature, based on a structured literature search, on fetal behaviour in normal and high-risk pregnancies, with particular emphasis on the potential for prenatal prediction of neurological development using this screening approach. The findings suggest that four-dimensional ultrasound-based prenatal assessment may be associated with postnatal neurodevelopment. However, scoring systems such as KANET should be interpreted with caution, as they remain promising but not yet definitive predictive tools.

Keywords: fetal behaviour; three-/four-dimensional ultra-sound; KANET

Abstract
The blockbuster drug model has become a central driver of growth in the pharmaceutical industry, generating substantial economic and healthcare impacts. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist marketed under brand names such as Ozempic (subcutaneous, 0.25–1 mg for type 2 diabetes), Wegovy (subcutaneous, 2.4 mg for obesity), and Rybelsus (oral formulation), represents a contemporary example of a blockbuster pharmaceutical innovation demonstrating strong clinical performance alongside remarkable commercial success. This narrative review examines the clinical, economic, and policy dimensions of semaglutide’s market trajectory.

Since its approval, semaglutide has significantly improved glycemic control, promoted weight reduction, and reduced cardiometabolic risk, while becoming a major contributor to Novo Nordisk’s financial growth and market leadership, most notably through the commercial launch of Ozempic, which served as a primary catalyst for the company’s rise to become one of the world’s most valuable pharmaceutical corporations. Its rapid global adoption has expanded the therapeutic landscape for metabolic diseases and stimulated further pharmaceutical innovation. However, increasing demand, off-label utilization, supply shortages, access disparities, reimbursement challenges, and rising healthcare costs have introduced important regulatory, ethical, and sustainability considerations. Semaglutide illustrates the evolving relationship between biomedical innovation, pharmaceutical economics, and healthcare policy, highlighting both the benefits and challenges of blockbuster drug success in modern healthcare systems.

Keywords: semaglutide; Ozempic; blockbuster drugs; economic impact