Anticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications ...remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians.
A cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran's scale and Drug Burden Index.
Altogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%).
Though the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives.
Purpose
An increasing number of older adults suffer from multimorbidity and receive multiple medications. Despite that, underprescribing of potentially beneficial medications is widespread in this ...population. Our aim was to examine influence of polypharmacy and multimorbidity on the presence of prescribing omissions (PO) in general practice attenders.
Methods
We conducted a cross-sectional study of older adults attending general practices in Slovenia who were regularly prescribed at least one medication. Patients’ data was entered into a computer application evaluating the presence of START (Screening Tool to Alert doctors to Right Treatment) criteria for PO. Demographic data, CIRS-G (Cumulative Illness Rating Scale for geriatric patients) questionnaire, number of medications, and healthcare utilization data were also collected. We defined polypharmacy as five or more concurrent medications.
Results
Five hundred three patients were enrolled, 258 (56.7%) female. The average age was 74.9 and average value of CIRS-G index 1.48 (± 0.6). Patients took on average 5.6 medications and 216 (42.9%) patients had at least one PO according to START criteria. In bivariate analysis, there was a significant association between age, number of medications, polypharmacy and CIRS-G index measures, and presence of PO. In multivariate analysis, only age and number of affected CIRS-G categories significantly predicted PO (
p
< 0.05).
Conclusions
Older patients with more affected CIRS-G categories were at higher risk for PO. Polypharmacy was not an independent risk factor for the presence of PO. A possible reason is that in multimorbid older people, physicians and patients set individual priorities to treatment instead of treating all diseases and conditions.
To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents', physicians', and nursing home characteristics ...associated with prescribing.
In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients' medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents', physicians', and nursing home characteristics associated with prescribing.
Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents' characteristics associated with psychotropic medication use were female sex (odds ratio OR, 1.36; 95% confidence interval CI, 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians' characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76).
Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In more than half of elderly chronically-ill family clinic attendees, drug prescribing deviates from the internationally acknowledged STOPP/START recommendations. Our study will determine whether it ...is possible to improve the quality of drug prescriptions in chronically-ill elderly people living at home by regularly monitoring the prescribed drugs according to STOPP/START criteria.
The project started in 2014 and will run until 2017. Forty general practitioners (GPs) are participating in a pragmatic randomized controlled trial. From the patient register, GPs randomly selected 20 patients older than 65 years who regularly receive at least one drug and invited them to participate in the study. We will use the START/STOPP criteria to determine the (in)adequacy of drug prescribing in the elderly by a web application (WA). Expected.
The use of the WA will be the basis of the implementation of the final version of the application into the regular family medicine practice, thereby reducing the problems of inappropriate prescribing, correct medication, polypharmacy and adherence; we will identify the stability of the factors of drug prescribing in the elderly. By comparing the test and control groups, it will be possible to distinguish which are related to the WA and which act independently.
Therapeutic alliance is a term most commonly associated with psychotherapeutic treatment, but recently its use has become increasingly significant in the other fields of medicine. An increasing ...amount of evidence implies that the quality of the therapeutic alliance between the doctor and patient substantially affects treatment outcomes. A European consensus chose the Working Alliance Inventory - Short Revised (WAI-SR) scale as the most efficient for European primary care. This paper presents the process of establishing the semantic and cultural equivalence of the two WAI-SR scales in Slovene.
As a part of a larger international project, a group of four experts translated the two WAI SR scales (physician and patient versions) from English into Slovene. Twenty-six Slovenian family medicine doctors participated in the process of obtaining semantic, idiomatic, experiential and conceptual equivalence in translation using a Delphi consensus procedure. Afterward, a cultural equivalence was made to adapt the translations within the national context.
Agreement on translation was achieved after two Delphi rounds. The back-translation and cultural equivalence were accomplished without major problems, with some minor additional linguistic corrections.
A Slovene version of the WAI-SR scale was successfully adapted and is available for further scale validation and research on therapeutic alliance.
Osnovna zdravstvena dejavnost in z njo družinska medicina predstavljata temelj vsakega zdravstvenega sistema. V Sloveniji imamo sistem osnovne zdravstvene dejavnosti, ki je konceptualno priznan kot ...zelo dober s strani mednarodnih strokovnjakov in organizacij. Ob tem se soočamo z resnimi kritikami in težavami. Prispevek predstavlja pregled izzivov, s katerimi se sooča družinska medicina v Sloveniji zdaj. V devetih točkah so zbrani predlogi ukrepov, ki bi jih bilo potrebno izpolniti, če želimo, da se stanje na področju družinske medicine izboljša.
Izhodišča: V času epidemije covida-19 v Sloveniji je bilo potrebno celotni teoretični del pouka družinske medicine izvesti po spletu.
Metode: Pouk družinske medicine smo prilagodili izvedbi preko ...videokonferenčnega sistema. Dodali smo aktualne teme o epidemiji, uvedli redne domače naloge, povečali uporabo spletne učilnice in vzpostavili možnost foruma. Uporabili smo nove metode, na primer predavanje z “obrnjeno učilnico”, problemsko usmerjeno učenje s kliničnimi vinjetami in video-posvet o pouku sporazumevanja. Posebej se je obnesla metoda igrifikacije oz. uvedba kviza v pouk.
Rezultati: Kakovost, prednosti in nevarnosti spletnega pouka smo ocenili z anketo študentov in mnenjem pedagogov. Študenti so ocenili, da je pouk dobro potekal, sodobne metode so jim ugajale, predlagali pa so več kliničnih primerov in predstavitev najpogostejših stanj v družinski medicini. Spletni pouk so ocenili enako visoko kot klinične vaje. Pedagogi so navedli visoko lastno motivacijo in inovativnost pri spremembi pouka, poudarili prednost časovne prilagodljivosti, po drugi strani pa časovno zahtevnost spletnega poučevanja. V prihodnosti bi lahko s pomočjo spletnega poučevanja določen delež študentov opravljal klinične vaje v domačem okolju, s čimer bi potrebovali manj mentorjev v Ljubljani. Spletno poučevanje ponuja možnost učenja modernih veščin zdravnika družinske medicine (npr. videoposvet), aktivacije študentov (npr. igra vlog) ter omogoči ustvarjanje repozitorija učnih gradiv in sodelovanje gostov iz tujine. Slabost pa je odsotnost osebnega stika s študenti ter neustreznost za učenje kliničnih veščin.
Zaključek: Ob takojšnjem prehodu na spletno poučevanje smo preizkusili nove metode pouka, ugotovili nekatere prednosti in pomanjkljivosti. Te izkušnje bodo pomembne za spremembe pouka v naslednjih letih.
Namen: Empatija je najpogosteje omenjena človeška lastnost v odnosu do bolnika in predstavlja pomembno vrednoto v zdravniškem poklicu. Krepitev empatičnega odnosa pri študentih medicine je pogosto ...poudarjena v mednarodnih smernicah za medicinsko izobraževanje. Namen raziskave je bil validacija in adaptacija slovenske variante študentske različice Jeffersonove lestvice za merjenje empatije na vzorcu študentov prvega letnika medicine.
Objective: Empathy is the most frequently mentioned humanistic dimension of patient care and is considered to be an important quality in physicians. The importance of fostering the development of ...empathy in undergraduate students is continuously emphasised in international recommendations for medical education. Our aim was to validate and adapt the Slovenian version of the Jefferson Scale of Empathy- Students version (JSE-S) on a sample of first-year medical students.
First-year students of the Medical faculty in Ljubljana participated in the research. JSE-S version, a selfadministered 20-item questionnaire, was used for collecting the data. Descriptive statistics at the item level and at the scale level, factor analysis, internal consistency and test-retest reliability (two weeks after the first administration) of the JSE-S were performed.
234 out of 298 (response rate 78.5%) students completed JSE-S. The mean score for the items on the 7-point Likert scale ranged from 3.27 (SD 1.72) to 6.50 (SD 0.82). The mean score for the scale (possible range from 20 to 140) was 107.6 (from 71 to 131, SD 12.6). Using factor analysis, we identified six factors, describing 57.2% of total variability. The Cronbach alpha as a measure of internal consistency was 0.79. The instrument has good temporal stability (test-retest reliability ICC = 0.703).
Findings support the construct validity and reliability of JSE-S for measuring empathy in medical students in Slovenia. Future research is required to evaluate factors contributing to empathy.
Namen: Empatija je najpogosteje omenjena človeška lastnost v odnosu do bolnika in predstavlja pomembno vrednoto v zdravniškem poklicu. Krepitev empatičnega odnosa pri študentih medicine je pogosto poudarjena v mednarodnih smernicah za medicinsko izobraževanje. Namen raziskave je bil validacija in adaptacija slovenske variante študentske različice Jeffersonove lestvice za merjenje empatije na vzorcu študentov prvega letnika medicine.
V raziskavo so bili vključeni študentje prvega letnika Medicinske fakultete v Ljubljani. Podatke smo zbrali s pomočjo študentske različice Jeffersonove lestvice - vprašalnika z 20 vprašanji, ki so ga izpolnili študentje. Naredili smo osnovno statistično analizo posameznih vprašanj, analizo celotne lestvice, faktorsko analizo ter analizo notranje konsistentnosti in časovne stabilnosti lestvice štirinajst dni po prvem izpolnjevanju.
234 od skupno 298 študentov je sodelovalo v raziskavi in izpolnilo vprašalnik. Povprečna vrednot za posamezno vprašanje na 7-stopenjski Likertovi lestvici se je gibala od 3,27 (SD 1,72) do 6,50 (SD 0,82). Povprečna vrednost celotne lestvice (mogoč razpon od 20 do 140) je bila 107,6 (od 71 do 131, SD 12,6). S faktorsko analizo smo prepoznali šest faktorjev, s katerim smo pojasnili 57,2 % celotne variabilnosti. Cronbach alfa kot merilo notranje konsistentnosti je znašal 0,79. Potrdili smo časovno stabilnost lestvice (ICC = 0,703).
Potrdili smo veljavnost in zanesljivost slovenske variante študentske različice Jeffersonove lestvice za merjenje empatije. Potrebno bo nadaljnje raziskovanje, ki bo pojasnilo dejavnike, ki prispevajo k empatiji.
Minotov zakon, po katerem je relativna stopnja rasti padajoča na vsem območju, kjer je mikrobna rastna krivulja naraščajoča, razširimo še na območje, kjer opazovana kultura umira. Pokažemo, da je ...rastna krivulja, za katero velja ta zakon, logaritmično konkavna in da ima zato vselej obliko , kjer je padajoča funkcija. Konec lag-faze definiramo kot začetek logaritmične konkavnosti rastne krivulje. V nadaljevanju naštejemo ostale splošne lastnosti takih rastnih krivulj, utemeljimo osnovni princip aproksimacije konkretnih podatkov in predlagamo preprost model.
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