Hrvatska je među vodećim zemljama u svijetu po stopi transplantacija jetre. Zahvaljujući sve dužem preživljenju nakon transplantacije povećana je potreba za dugoročnom skrbi pacijenata, pri čemu sve ...veći dio skrbi preuzimaju obiteljski liječnici. Kasne komplikacije transplantacije jetre uključuju širok spektar metaboličkih poremećaja koji se javljaju u značajnom postotoku transplantiranih; šećerna bolest (do 30%), dislipidemija (45 – 69%), hipertenzija (50 – 90%), pretilost (do 40%), osteoporoza (37%), hiperuricemija (14 – 47%), dok je
pojava pojedinih malignih bolesti i do 4 puta viša nego u netransplantiranoj populaciji. Kardiovaskularne bolesti i malignomi vodeći su uzroci smrtnosti dugoročno nakon transplantacije jetre. Uz ostale faktore rizika, imunosupresivni lijekovi, kalcijneurinski inhibitori, antimetaboliti i mTOR inhibitori značajno pridonose razvitku navedenih
komplikacija. Nadalje, kod 22 – 33% pacijenata nakon transplantacije jetre prisutan je neki oblik poremećaja raspoloženja, od kojih najčešće anksioznost i depresija. Prevencija, prepoznavanje i zbrinjavanje komplikacija nakon transplantacije jetre ključni su za poboljšanje dugoročnih ishoda. Cilj ovog preglednog rada jest približiti problematiku dugoročnog zbrinjavanja pacijenata nakon transplantacije jetre u primarnoj zdravstvenoj zaštiti
While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward ...referral.
To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis.
A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer.
Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data.
A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately.
The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.
Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of ...this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general practitioners/family physicians during the COVID-19 pandemic and to identify levers to mitigate the risk of distress. Data were collected by means of an online self-reported questionnaire among GP practices. Statistical analysis was performed using SPSS software using Version 7 of the database, which consisted of the cleaned data of 33 countries available as of 3 November 2021. Data from 3711 respondents were included. eWBI scores ranged from -2 to 9, with a median of 3. Using a cutoff of ≥2, 64.5% of respondents were considered at risk of distress. GPs with less experience, in smaller practices, and with more vulnerable patient populations were at a higher risk of distress. Significant differences in wellbeing scores were noted between countries. Collaboration from other practices and perception of having adequate governmental support were significant protective factors for distress. It is necessary to address practice- and system-level organizational factors in order to enhance wellbeing and support primary care physicians.
Sažetak. Europska unija (EU) definirala je procese i norme obrazovanja medicinskih sestara. Cilj je ovog rada opisati njihovo obrazovanje u Hrvatskoj i usporediti ga s obrazovanjem medicinskih ...sestara u Ujedinjenom Kraljevstvu (UK) kao kolijevci modernog sestrinstva te Sloveniji kao tranzicijskoj zemlji. Kao izvor podataka upotrijebljeni su Direktiva 2005/36/EZ i Direktiva 2013/55/EU te zakoni, pravilnici i dokumenti navedenih zemalja koji su vezani uz obrazovanje medicinskih sestara. Medicinske sestre u Hrvatskoj obrazuju se u srednjoškolskome strukovnom obrazovanju te obrazovanju na visokoškolskoj razini. Obrazovanje medicinskih sestara u Sloveniji započinje nakon dvanaest godina općeg obrazovanja i održava se na razini stručnih studija. U UK obrazovanje se provodi na sveučilišnoj razini nakon dvanaest godina općeg obrazovanja, a mogućnost za ulazak u sestrinstvo uključuje strukovne kvalifikacije na sličnoj akademskoj razini te tečajeve visokog obrazovanja. Iskustva u obrazovanju medicinskih sestara u UK i Sloveniji mogu biti korisna u procesu unapređenja obrazovanja medicinskih sestara u Hrvatskoj.
The impact of physician burnout on the quality of patient care is unclear. This cross-sectional study aimed to investigate the prevalence of burnout in family physicians in Croatia and its ...association with physician and practice characteristics, and patient enablement as a consultation outcome measure.
Hundred and twenty-five out of 350 family physicians responded to our invitation to participate in the study. They were asked to collect data from 50 consecutive consultations with their adult patients who had to provide information on patient enablement (Patient Enablement Instrument). Physicians themselves provided their demographic and professional data, including workload, job satisfaction, consultation length, and burnout Maslach Burnout Inventory - Human Services Survey (MBI-HSS ). MBI-HSS scores were analysed in three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA).
Of the responding physicians, 42.4 % scored high for EE burnout, 16.0 % for DP, and 15.2 % for PA. Multiple regression analysis showed that low job satisfaction and more patients per day predicted high EE scores. Low job satisfaction, working more years at a current workplace, and younger age predicted high DP scores. Lack of engagement in education and academic work, shorter consultations, and working more years at current workplace predicted low PA scores, respectively (P<0.05 for each).
Burnout is common among family physicians in Croatia yet burnout in our physicians was not associated with patient enablement, suggesting that it did not affect the quality of interpersonal care. Job satisfaction, participation in educational or academic activities and sufficient consultation time seem to reduce the likelihood of burnout.
Povezanost sindroma izgaranja liječnika i kvalitete skrbi nije potpuno jasna. Cilj rada bio je istražiti učestalost sindroma izgaranja u liječnika obiteljske medicine (LOM) u Hrvatskoj te povezanost sindroma izgaranja i obilježja liječnika i njegove prakse te osposobljenosti bolesnika kao mjere ishoda konzultacije.
Provedeno je presječno istraživanje na nacionalnom stratificiranom slučajnom uzorku od 350 LOM koji su prikupili podatke od 50 odraslih bolesnika tijekom 50 susljednih konzultacija. Za bolesnike su prikupljeni podaci o osposobljenosti bolesnika (Upitnik za procjenu osposobljenosti bolesnika, PEI), duljini konzultacije, a za liječnike podaci o demografskim i profesionalnim značajkama, opterećenju poslom, zadovoljstvu poslom, prisutnosti sindroma izgaranja na poslu (Maslach Burnout Inventory - MBI-HSS). Vrijednosti MBI-HSS analizirane su u tri dimenzije: emocionalna iscrpljenost (EI), depersonalizacija (DP) i osobno postignuće (OP).
Među 125 liječnika, EI visokog stupnja zabilježena je kod 42,4 %, DP visokog stupnja kod 16,0 % te OP visokog stupnja kod 15,2 % liječnika. U regresijskoj analizi visoke vrijednosti EI su predviđali manje zadovoljstvo poslom i veći broj bolesnika dnevno. Visoke vrijednosti DP su predviđali manje zadovoljstvo poslom, više godina na sadašnjem radnom mjestu i mlađa dob. Niske vrijednosti OP su predviđale izostanak sudjelovanja u nastavnim ili akademskim aktivnostima, kraće konzultacije te više godina na sadašnjem radnom mjestu (P<0.05 za svaki).
Sindrom izgaranja prisutan je među LOM u Hrvatskoj. Nismo utvrdili povezanost sindroma izgaranja liječnika i osposobljenosti bolesnika, odnosno prisutnost sindroma izgaranja nije bila povezana s kvalitetom komunikacijske skrbi. Zadovoljstvo poslom, sudjelovanje u nastavnim ili akademskim aktivnostima te dostatno vrijeme konzultacije mogli bi imati zaštitni učinak u nastanku sindroma izgaranja u liječnika.
The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching ...process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.
Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.
To elucidate obstacles and facilitators ...of the transition from face-to-face to distance education.
A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.
In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.
The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.
Family physicians are burdened with a great number of guidelines considering different conditions they treat. We analyzed opinions of family physicians on electronic tools which help managing chronic ...conditions and their influence on patient care by cardiovascular disease (CVD) prevention guideline availability, usage and adherence. A descriptive study was performed on a convenient sample of 417 (response rate 56.0%) Croatian family physicians. Data on physician characteristics and availability, usage and adherence to CVD prevention guidelines were analyzed. The χ2-test was used for comparisons. Significance was defined as p<0.05. Family physicians who used additional electronic tools in Electronic Health Record software on more than 80% of their patients had CVD prevention guidelines more available (p<0.01) and used them more frequently (p<0.01). A group who used electronic tools on more than 80% of their patients had CVD prevention guidelines available to them frequently and used them on more than 60% of their patients, also strictly adhering to the guidelines (p<0.01). Physicians who used CVD prevention guidelines on more than 60% of their patients spent more time doing patient education (p=0.036). Using electronic tools helps Croatian family physicians in terms of availability, usage and adherence to the guidelines and quality improvement.
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