Patients with coronary heart disease (CHD) commonly present with more than one comorbid condition, contributing to poorer health-related quality of life (HRQoL). The aim of our study was to identify ...the associations between HRQoL and patient characteristics, vascular comorbidities and anxiety/depression disorders.
This observational study was conducted in 36 family medicine practices selected by random stratified sampling from all regions of Slovenia. HRQoL was assessed using the European Quality of Life - 5 Dimensions (EQ-5D) questionnaire and EQ Visual Analogue Scale (EQ-VAS). The associations between HRQoL and patient characteristics stratified by demographics, vascular comorbidities, health services used, their assessment of chronic illness care, and anxiety/depression disorders were identified by ordinal logistic regression and linear regression models.
The final sample included 423 CHD patients with a mean age of 68.0 ± SD 10.8 years; 35.2% were female. Mean EQ-VAS score was 58.6 ± SD 19.9 (median: 60 with interquartile range of 45-75), and mean EQ-5D index was 0.60 ± SD 0.19 (median: 0.56 with interquartile range of 0.41-0.76). The statistically significant predictors of a lower EQ-VAS score were higher family physician visit frequency, heart failure (HF) and anxiety/depression disorders (R² 0.240; F = 17.368; p < 0.001). The statistically significant predictor of better HRQoL, according to EQ-5D was higher patient education, whereas higher family physician visit frequency, HF and peripheral artery disease (PAD) were predictors of poorer HRQoL (Nagelkerke R
= 0.298; χ
= 148.151; p < 0.001).
Results of our study reveal that comorbid conditions (HF and PAD), family physician visit frequency and years in education are significant predictors of HRQoL in Slovenian CHD patients.
Physical activity has a positive effect on general health, but its influence on burnout remains unclear. The aim of this study was to determine the association between physical activity and the ...incidence of burnout in Slovenian family physicians (FPs) and family medicine trainees (FMTs) during the COVID-19 pandemic, which exacerbated the already-existing problem of burnout. We conducted a cross-sectional observational study among Slovenian family physicians and FMTs in which sociodemographic variables, the type and duration of physical activity, and an assessment of burnout were collected using the Maslach Burnout Inventory. Comparisons between groups were made using the independent-samples
-test, Fisher's exact test, and the Wilcoxon sign-rank test. A value of
< 0.05 determined the limit of statistical significance. Of 1230 FPs and FMTs invited to participate, 282 completed the survey (22.9% response rate); there were 243 (86.2%) FPs and 39 (13.8%) FMTs. The overall rating for burnout during the pandemic was high, at 48.6% of FPs and FMTs; 62.8% of respondents reported a high rating for emotional exhaustion and 40.1% for depersonalization. Compared to FMTs, emotional exhaustion and total burnout scores were higher for FPs (
< 0.001 and
= 0.010, respectively), but work status was not related to personal acomplishment, which 53.5% of all participants rated as low. Physical activity did not appear to be a statistically significant factor in the occurrence of burnout during the pandemic. Therefore, work status or occupational role (FP vs. FMT) should be thoroughly investigated in the future along with some other factors and a better response rate.
Abstract
Objectives
Family medicine plays an important role in quality of care (QoC) of coronary heart disease (CHD) patients. This study’s aim was to determine the quality of secondary ...cardiovascular disease prevention in the everyday practice of family physicians.
Design
This study was observational cross-sectional.
Setting
About 36 randomly selected family medicine practices stratified by size and location in Slovenia.
Participants
CHD patients randomly selected from a patient register available in family medicine practices.
Main Outcome Measure(s)
The instrument for assessment of quality included a form for collecting data from medical records, a general practice assessment questionnaire and a patient questionnaire. QoC was defined by two composite variables, namely risk factor registration and CHD patient process of care, as the two care outcomes. In multivariate analysis, we performed multilevel regression analysis to identify the associations between QoC, the patient and the practice characteristics.
Results
The final sample included 423 CHD patients from 36 family medicine practices. Risk factor registration was associated with the practice organisation score (P = 0.004), practice size (P = 0.042), presence of comorbid atherosclerotic diseases (P = 0.043) and a lower age of CHD patients (P = 0.001). CHD patient process of care was associated with the practice organisation score (0.045) and a lower age of CHD patients (P = 0.035).
Conclusions
The most important factors affecting the quality of CHD patient care were linked to the organisational characteristics of the family medicine practices.
During the COVID-19 pandemic, family physicians (FPs) served as the the initial point of contact for patients potentially infected with the virus, necessitating frequent updates to treatment ...protocols. However, practices also faced organizational challenges in providing care to other patients who also needed their medical attention. The pressure on FPs increased and affected their well-being. The international PRICOV-19 study, titled "Primary care in times of COVID-19 pandemic," investigated how FPs functioned during the COVID-19 pandemic. This article examines the correlation between various organizational and structural COVID-19-related variables and the well-being of FPs in Slovenia.
Between October 2020 and January 2021, we conducted an online cross-sectional survey. The questionnaire was distributed to 1040 Slovenian FPs and 218 family medicine (FM) trainees. Part of the questionnaire assessed the cooperation and well-being of FPs. The Mayo Clinic Well-being Index was used for the assessment. FP's well-being was also assessed descriptively by asking open-ended questions about maintaining mental health during the pandemic. Potential factors associated with FPs' well-being were identified using a multivariate linear regression method.
The final sample comprised 191 participants (response rate 14.1%). The mean value ± standard deviation of the Mayo Well-being Index was 3.3 ± 2.6 points. The FPs with the poorest well-being had 5-15 years of work experience and worked in a practice where work could not be distributed in the absence of a co-worker without compromising the well-being of colleagues. Physical activity was identified as the most common method of maintaining mental health among FPs.
The results of the study suggest that targeted interventions are needed to support FPs mid-career, increase resilience in practice, promote strong team dynamics, and prioritise physical activity in healthcare. Addressing these aspects can contribute to the well-being of individual FPs and the overall health of the healthcare workers.
Immunosenescence is the adverse change in the human immune function during aging, leaving older people more prone to an increased risk of infections and morbidity. Acute upper respiratory tract ...infections (URTIs) are very common among older people, often resulting in continued morbidity and mortality. Therefore, approaches, such as consuming probiotics, that shorten the duration or even reduce the incidence of URTIs in older people are being studied. The aim of this study was to determine the effects of a multi-strain probiotic OMNi-BiOTiC
Active, which contains 11 live probiotic strains, on the incidence, duration, and severity of URTIs in older people. In this randomized double-blinded placebo-controlled study, 95 participants, with an average age of 70.9 years in the probiotic group and 69.6 years in the placebo group, were randomly allocated to two groups: 10
cfu per day of the multi-strain probiotic intervention OMNi-BiOTiC
Active (49) or placebo (46). The incidence of URTIs in older people after 12 weeks supplementation with OMNi-BiOTiC
showed no statistically significant difference between the two groups (
= 0.5244). However, the duration of the URTI infections was statistically significantly different between the groups (
= 0.011). The participants that consumed the probiotic had an average duration of illness of 3.1 ± 1.6 days, whilst participants that received the placebo had symptoms for an average of 6.0 ± 3.8 days (
= 0.011). Statistically significant differences in lymphocyte counts in both groups after supplementation (
= 0.035 for the probiotic group and
= 0.029 for the placebo group) and between both groups were found (
= 0.009). Statistically significant differences in eosinophil (
= 0.002) and basophil counts (
= 0.001) in the probiotic groups before and after supplementation with probiotics were also found. Supplementation with the multi-strain probiotic OMNi-BiOTiC
Active may benefit older people with URTIs. Larger randomised controlled clinical trials are warranted. Clinical Trial Registration; identifier NCT05879393.
Health-related quality of life (HRQoL) is measuring a patient's experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is ...positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.
A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient's HRQoL as an independent variable.
871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).
This study has been performed on a specific group of patients, not being "really sick", but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.
During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with ...suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia.
A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables.
From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012).
Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.
Aim
To systematically review the scientific evidence of biomarker validity, reliability, specificity and sensitivity in identifying malnutrition in the elderly.
Methods
Peer-reviewed journals were ...searched using PUBMED and EBSCO from January 1998 to April 2018. The articles included description of the association between malnutrition blood biomarkers and validated nutritional status assessment instruments and studies were conducted among community-dwelling elderly or nursing home residents.
Results
The research strategy identified a total of 293 studies. This literature review picked out seven articles for follow-up evaluation. A total of sixteen blood biomarkers were identified. Six studies found a significant association between the nutritional assessment score and albumin level.
Conclusion
Combining serum concentrations of malnutrition biomarkers with nutritional status assessment tools has a great potential in identifying the risk of malnutrition in the elderly, while also increasing sensitivity and specificity.
There has been increased interest in the use of capnometry in recent years. During cardiopulmonary resuscitation (CPR), the partial pressure of end-tidal carbon dioxide (PetCO2) correlates with ...cardiac output and, consequently, it has a prognostic value in CPR. This study was undertaken to compare the initial PetCO2 and the PetCO2 after 1 min during CPR in asphyxial cardiac arrest versus primary cardiac arrest.
The prospective observational study included two groups of patients: cardiac arrest due to asphyxia with initial rhythm asystole or pulseless electrical activity, and cardiac arrest due to acute myocardial infarction or malignant arrhythmias with initial rhythm ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). The PetCO2 was measured for both groups immediately after intubation and then repeatedly every minute, both for patients with and without return of spontaneous circulation (ROSC).
We analyzed 44 patients with asphyxial cardiac arrest and 141 patients with primary cardiac arrest. The first group showed no significant difference in the initial value of the PetCO2, even when we compared those with and without ROSC. There was a significant difference in the PetCO2 after 1 min of CPR between those patients with ROSC and those without ROSC. The mean value for all patients was significantly higher in the group with asphyxial arrest. In the group with VF/VT arrest there was a significant difference in the initial PetCO2 between patients without and with ROSC. In all patients with ROSC the initial PetCO2 was higher than 10 mmHg.
The initial PetCO2 is significantly higher in asphyxial arrest than in VT/VF cardiac arrest. Regarding asphyxial arrest there is also no difference in values of initial PetCO2 between patients with and without ROSC. On the contrary, there is a significant difference in values of the initial PetCO2 in the VF/VT cardiac arrest between patients with and without ROSC. This difference could prove to be useful as one of the methods in prehospital diagnostic procedures and attendance of cardiac arrest. For this reason we should always include other clinical and laboratory tests.
The Chronic Care Model (CCM) is a conceptual framework that supports the evidence-based proactive and planned care of chronic diseases. Our aim was to validate a Slovenian translation of Patient ...Assessment of Chronic Illness Care (PACIC)--a self-reported instrument designed to measure the extent to which patients with chronic illnesses receive care congruent with CCM--on a sample of patients with coronary heart disease. Secondary analysis of patients' evaluation of general practice care (EPA Cardio study) was done in patients with coronary heart disease in Slovenia. Patients completed a written questionnaire, which included the instrument for assessing chronic illness care (PACIC), the EUROPEP questionnaire and demographical data. Internal consistency was expressed in terms of Cronbach's alpha. Reliability was expressed as the intra class correlation coefficient (ICC). Correlation between PACIC and EUROPEP was considered as a measure of construct validity. Factor analysis was done to identify number and types of domains in the instrument. Questionnaires of 843 patients were analysed. The mean age was 68.2 (SD 11.1) years, 34.6% of participants were female. 32.7% of PACIC questionnaires were not completely fulfilled. The internal consistency of the entire questionnaire assessed by Cronbach's alpha was 0.953 and reliability was 0.937. Construct validity was confirmed with important and significant correlation between PACIC and EUROPEP questionnaire (Spearman's correlation coefficient = 0.60, p < 0.001). Principal component factor analysis identifies two major factors which we labeled according to the PACIC domains as "Patient activation, decision support and problem solving" and "Goal settings and coordination". A translated and validated Slovenian version of PACIC questionnaire is now available. Further research on its validity in other groups of chronically ill patients and the use of instrument for monitoring changes of chronic care over time is recommended.
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