Introduction. Self-reported scales, such as the Jefferson Scale of Empathy - Student version (JSE-S), had been recognised to measure the empathic disposition rather than behavioural expression. This ...study aimed to re-validate the JSE-S and its factor structure prior further research on empathy in medical students.
Methods. A convenience sampling method was employed in two consecutive academic years, in 2012/13 and 2013/14, at the Faculty of Medicine in Ljubljana, Slovenia; first and final year students participated voluntarily. The JSE-S examined empathy levels. The principal component analysis was performed with Oblimin rotation and Kaisers’ criteria. Factors with eigenvalues ≥ 1.25 were retained and items loading ≥ |0.40| were required for the interpretation of the factor structure.
Results. The total study sample size was 845 students, (580 (68.6%)) of them women; 327 (72.2%) were in the first (19.2 ± 1.9 years old) and 253 (61.7%) in the sixth (24.9 ± 1.1 years old) year of medical school. Females achieved higher JSE-S scores in all groups. The three-factor JSE-S was confirmed, but only seven items were concordant in all groups. A higher proportion of explained variation for Perspective Taking and Standing in the Patient`s Shoes, and better internal consistency, was found in a reduced-item scale (16-18 items). When performing factor analysis of a seven-item scale, the percentages of explained variance increased with two factors extracted.
Conclusions. Only the cognitive dimension of JSE-S gave results as expected, therefore proper terminology, i.e. the object of assessment, must be used in further administration of JSE-S and empathy-related research in medical students.
Izhodišča. Samoocenjevalne lestvice, kakršna je Jeffersonova lestvica empatije - oblika za študente (JSE-S), so se izkazale kot mere naravnanosti (stališč) in ne kot pripomočki za oceno in napoved vedenja. Zato je bilo treba pred nadaljnjimi raziskavami empatične naravnanosti pri študentih in preučevanjem odnosa med študijskim programom ter pristopi in empatično naravnanostjo študentov ponovno preveriti veljavnost JSE-S, bolj jasno opredeliti predmet merjenja ter variacije/razlike, povezane s spolom.
Metode. S priložnostnim vzorčenjem v dveh zaporednih študijskih letih (2012/13 in 2013/14) so bili študenti prvega in šestega letnika Medicinske fakultete v Ljubljani povabljeni k anonimnemu in prostovoljnemu sodelovanju. Svojo empatično naravnanost so ocenjevali z JSE-S. S Student t-testom za neodvisne vzorce in enosmerno analizo variance so bile izračunane razlike po spolu in letniku študija. Vsi testi so bili dvosmerni, z mejo statistične pomembnosti P <0,05. Izvedena je bila validacija lestvice po metodi glavnih komponent z rotacijo Oblimin, ob upoštevanju Kaiserjevih meril. Nasičenost posameznih trditev ≥ |0,40| in faktorji z lastno vrednostjo ≥ 1,25 so bili podlaga za razlago faktorske strukture.
Rezultati. Celotni vzorec je vključeval 845 študentov, med njimi je bilo 580 (68,6%) žensk, 327 (72,2%) je bilo študentov prvega letnika, starih 19,2 ± 1,9 leta, 253 (61,7%) pa študentov šestega letnika, starih 24,9 ± 1,1 leta. Ženske so dosegle višje skupne vrednosti na JSE-S v vseh skupinah. Tri faktorska struktura JSE-S se je potrdila, vendar se je le sedem trditev/postavk ujemalo v vseh štirih skupinah študentov. Ko je bila lestvica skrajšana na 16 oziroma 18 trditev, se je povečal delež pojasnjene variance pri faktorjih upoštevanje zornega kota drugega in zavzemanje pozicije drugega, boljša je bila tudi notranja konsistentnost. V faktorski analizi lestvice s sedmimi trditvami/postavkami je bil delež pojasnjene variance še večji, ne pa tudi notranja konsistentnost (Cronbach’s α > 0,70). Izločena sta bila dva faktorja, oba po vsebini opisujeta kognitivno razsežnost empatije.
Zaključki. Pokazalo se je, da JSE-S meri empatično naravnanost, kar je treba upoštevati v prihodnjih raziskavah ter temu prilagoditi tudi poimenovanje lestvice. Predlagamo uporabo skrajšane lestvice s 16 trditvami, s skupno vrednostjo točk JSE-S kot mero samoocene kognitivne komponente empatije.
Background. Self-care for common colds is frequent, yet little is known about the spectrum, regional differences, and potential risks of self-care practices in patients from various European regions. ...Methods/Design. We describe the study protocol for a cross-sectional survey in 27 primary care centers from 14 European countries. At all sites, 120 consecutive adult patients, who visit their general practitioner for any reason, filled in a self-administered 27-item questionnaire. This addresses patients’ self-care practices for common colds. Separately, the subjective level of discomfort when having a common cold, knowing about the diseases’ self-limited nature, and medical and sociodemographic data are requested. Additionally, physicians are surveyed on their use of and recommendations for self-care practices. We are interested in investigating which self-care practices for common colds are used, whether the number of self-care practices used is influenced by knowledge about the self-limited nature of the disease, and the subjective level of discomfort when having a cold and to identify potential adverse interactions with chronic physician-prescribed medications. Further factors that will be considered are, for example, demographic characteristics, chronic conditions, and sources of information for self-care practices. All descriptive and analytical statistics will be performed on the pooled dataset and stratified by country and site. Discussion. To our knowledge, COCO is the first European survey on the use of self-care practices for common colds. The study will provide new insight into patients’ and general practitioners’ self-care measures for common colds across Europe.
Objectives: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences ...in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences.
Design: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed.
Setting: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland.
Subjects: This study included 2543 GPs from 29 countries.
Main outcome measures: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (<50% started treatment) or high (≥50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country.
Results: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98).
Conclusions: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old.
Key Points
* General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age).
* In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years.
* However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60.
* These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old.
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.
Telemedicina je hitro razvijajoče se področje, ki na učinkovit način zagotavlja zdravstvene storitve. Ker se pri telemedicini, tako kot v vsakdanji običajni klinični praksi, rokuje z občutljivimi ...osebnimi podatki, se je treba zavedati nevarnosti spletnega kriminala ter spoznati načine za zaščito pred takimi napadi. Področje varovanja osebnih podatkov je slovenski in evropski pravni prostor dobro opredelil, obstajajo pa odprta še nekatera nerazrešena vprašanja na področju telemedicine. Telemedicinske storitve delimo na sinhrone (v realnem času, npr. videokonference) in asinhrone (z zaostankom v komunikaciji, npr. spletna pošta) ter na spremljanje parametrov zdravja na daljavo (spremljanje arterijskega tlaka, krvnega sladkorja ipd.). Vsako od teh področij ima svoje varnostne značilnosti in posebnosti. Varovanje osebnih podatkov je pri telemedicinskih storitvah potrebno zagotoviti na sistemski in individualni ravni. Vsak zaposleni v zdravstvu, ki izvaja storitve na področju telemedicine, mora pri svojem delu skrbeti za varnost podatkov. Posebej pomembno se je redno izobraževati na temo informacijske varnosti. Tudi v Sloveniji se izvaja že sorazmerno veliko telemedicinskih projektov, med katerimi jih je nekaj tudi prešlo v redno uporabo. Eden najobsežnejših zdravstvenih projektov pri nas je projekt eZdravje, ki med drugim vključuje tudi nekatere telemedicinske storitve (TeleKap, Teleradiologija, ePosvet).
Parenteralna uporaba zdravil za lajšanje bolečine v križu se zaradi odsotnosti dokazov o njihovi večji učinkovitosti in dodatnem tveganju za zaplete odsvetuje. Namen raziskave je bil ugotoviti, ...kolikšen delež in kateri bolniki z bolečino v križu so dobili zdravilo v injekciji.
V presečni študiji smo med 12.596 zaporednimi obiski pri 42 naključno izbranih zdravnikih družinske medicine analizirali vse obiske zaradi bolečine v križu. Na vzorcu bolnikov v starosti med 18 in 65 let smo analizirali pogostnost in dejavnike, ki vplivajo na odločitev za uporabo protibolečinskih zdravil v injekciji.
Zaradi bolečine v križu je zdravnika obiskalo 819 (6,5 %) vseh obiskovalcev ambulante, 300 (2,4 %) bolnikov z akutno in 519 (4,1 %) s kronično bolečino v križu. Injekcijo je prejelo 132 (20,7 %) obiskovalcev z bolečino v križu, starih med 18 in 65 let. Med dejavniki, ki so se v multivariatnem modelu izkazali kot pomembni pri odločitvi za injekcijo, so bili dejavniki bolnika (višja starost, nižja stopnja izobrazbe), vrsta bolečine v križu (akutna radikularna bolečina) in dejavniki zdravnika (zdravnik specialist, nižja starost). Razlike v odločitvi za injekcijo so bile med zdravniki zelo velike: 8 od 42 zdravnikov injekcije ni dalo niti enemu bolniku, medtem ko se je en zdravnik za injekcijo odločil pri 19 od 32 (59,4 %) bolnikih.
Velike razlike med zdravniki v pogostnosti odločitve za uporabo protibolečinskih zdravil v injekciji pri bolečini v križu kažejo na potrebo po usmerjeni intervenciji, katere cilj bi bil poenotiti delo zdravnikov ter povečati kakovost in varnost obravnave bolnikov.
Injections are not recommended due to the lack of evidence about their effectiveness and potential additional risks. We would like to know the proportion and characteristics of general practice attainders with low back pain who were treated with medications in injection.
In a cross-sectional study including 12,596 consecutive attainders of general practice in 42 general practices, we analysed all the contacts due to low back pain. In a sample of attainders in the age group from 18 to 65, we analysed the proportion and factors influencing a decision for treatment with medications in injection.
Low back pain was the reason for attendance in 819 (6.5%) patients; 300 (2.4%) with acute and 519 (4.1%) with chronic low back pain. 132 (20.7%) patients from 18 to 65 years were treated with medications in injection. In multivariate analysis, several factors were found to be important for the decision for injection of medications: patients’ characteristics (older age, lower level of education), type of pain (acute ishialgic pain) and physicians’ factors (specialisation in family medicine, younger age). Differences between physicians in using injections were significant: 8 out of 42 physicians did not use injections, but there was a physician who used injections in 19 out of 32 patients (59.4%).
Huge differences in the use of medications in injection in patients with low back pain indicate a necessity for intervention whose aim would be to reduce the differences between physicians and improve the quality and safety of patient care.
Izhodišča: Uvedba klinične prakse v začetne letnike študija pomeni uvedba zgodnjega stika z bolnikom in priložnost, da se v učni proces dejavno vključijo klinični mentorji. Namen prispevka je ...ugotoviti, kako so študenti ocenili izpolnjevanje zastavljenih učnih ciljev, ter predstaviti analizo kvantitativnih in kvalitativnih ocen pouka prve generacije študentov prvega letnika medicine in dentalne medicine o obvezni klinični praksi v študijskem letu 2021/22. Metode: Med študenti 1. letnikov medicine in dentalne medicine smo izvedli za študente obvezno anonimno anketo ob koncu izvajanja klinične prakse v študijskem letu 2021/22. Sestavljena je bila iz vprašanj zaprtega tipa, pri katerih je bila uporabljena Likertova skala z oceno od 1 do 5, in vprašanj odprtega tipa. Kvantitativne podatke smo analizirali z uporabo metod deskriptivne statistike in Mann-Whitneyevega testa za dva neodvisna vzorca, kvalitativno zbrane podatke smo analizirali z deskriptivno analizo prejetih opisnih odgovorov študentov. Rezultati: Anketo so izpolnili 304 študentje (100 % odziv), med katerimi je bilo 245 študentov medicine (80,6 %) in 59 (19,4 %) študentov dentalne medicine. Število študentk je bilo 271, kar je predstavljalo 71,4 % udeležencev. Študenti so poročali, da so bili učni cilji v celoti izpolnjeni. Pretežno so bili zadovoljni z osvojitvijo kliničnih veščin in veščin nudenja nujne medicinske pomoči. Pomembno slabše so osvojitev kliničnih veščin ocenili študentje dentalne medicine (Mann-Whitney 8689,5; p =0,009). Najbolje ocenjeni del celotnega predmeta je bila prav praksa v kliničnem okolju, ki je bila ocenjena z mediano 5 (interkvartilni razmik 0). Vlogo mentorja so študenti ocenili izjemno pozitivno, kar 288 (94,7 %) študentov bi namreč svojega mentorja zanesljivo priporočilo kolegom. Zaključki: Študenti so klinično prakso v prvem letniku ocenili kot izjemno pozitivno izkušnjo. Najvišjo oceno so podelili kliničnim mentorjem. Prepoznani vlogi mentorjev klinične prakse v izobraževanju študentov medicine in dentalne medicine bo zato sledila še formalna ureditev statusa mentorjev klinične prakse.
Izhodišča: Večino bolnikov z nezapleteno arterijsko hipertenzijo obravnavamo zdravniki družinske medicine. Namen raziskave je bil ugotoviti, kako poteka obravnava bolnikov z arterijsko hipertenzijo v ...timu družinske medicine v Sloveniji ter oceniti urejenost krvnega tlaka.
Metode: V prospektivni opazovalni raziskavi smo v obdobju od 21. 11. 2017 do 28. 3. 2019 šest mesecev spremljali obravnavo dotlej še nezdravljenih bolnikov z esencialno arterijsko hipertenzijo v 158 ambulantah družinske medicine v Sloveniji. Ob koncu spremljanja smo ocenili urejenost krvnega tlaka (KT).
Rezultati: Vključenih je bilo 1.060 bolnikov, katerih povprečna starost je bila 58,6 ± 12,1 let. Med vključenimi bolniki je bilo 579 (55 %) moških in 481 (45 %) žensk. Povprečna vrednost sistoličnega KT ob vstopu je bila 165,2 ± 14,5 mm Hg, diastoličnega pa 96,2 ± 10,0 mm Hg. 751 bolnikov (70,8 %) je imelo pridružene dejavnike tveganja za bolezni srca in ožilja. 408 (38,5 %) bolnikov je imelo ocenjeno srčno-žilno tveganje kot veliko oz. zelo veliko. Antihipertenzivna zdravila so bila uvedena pri 1.046 (98,7 %) bolnikih; pri 418 bolnikih (39,4 %) je bilo uvedeno kombinacijsko zdravljenje dveh ali več učinkovin v prosti ali fiksni kombinaciji. 331 bolnikov (31,6 %) je med spremljanjem opravilo obisk pri diplomirani medicinski sestri.
Raziskavo je zaključilo 929 (87,6 %) bolnikov. Povprečna vrednost sistoličnega KT ob zaključku raziskave je bila 135,4 ± 10,9 mm Hg, diastoličnega pa 81,8 ± 8,0 mm Hg, ciljni KT je dosegalo 63,3 % bolnikov.
Zaključek: Prepoznali smo nekatere priložnosti za izboljšanje vodenja. V prihodnje bo potrebno še okrepiti timsko obravnavo bolnikov ter spodbujati zdravnike k uvajanju kombinacijskega zdravljenja, najbolje v obliki dveh oziroma treh zdravilnih učinkovin v eni tableti.
Summary
AIM: To survey attitudes towards prescribing statins in a family practice setting and to develop an explanatory model of determinants for prescribing statins. METHODS: A random sample of 250 ...GPs were drawn from a Slovenian Family Medicine Society register and were contacted by anonymous postal questionnaire between June and October 2006. RESULTS: We found no major differences in decisions among the GPs with regard to their age, sex or time in general practice. We identified six factors that influence statin prescribing behavior in GPs and explain 63.5% of the variation: efficacy and utility explained 14.9% of the variation, personal involvement in drug promotional activities accounted for a further 14.3%, attitudes towards drug marketing 10.3%, patient expectations 9.5%, drug price 8.1% and peer pressure 6.5%. CONCLUSIONS: The determinants that influence statin prescribing behavior among GPs in our study covered an array of explanatory items consistent with proposals in the literature but factors differ to some extent from proposed theoretical models. The explanatory model explained a high proportion of the variation in deciding on a particular statin. Efficacy and safety remain important factors in selection of an appropriate drug but are far from being the most or only important factors.
PDF
