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Open access

Marija Petek Šter, Branko Šter, Davorina Petek and Eva Cedilnik Gorup

Abstract

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.

Methods: 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.

Results: 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).

Conclusion: 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.

Open access

Marija Petek Šter, Igor Švab and Gordana Kalan Živčec

Izvleček

Izhodišča: 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.

Metode: 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.

Rezultati: 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.

Zaključki: 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.

Open access

Marija Petek Šter, Ljiljana Cvejanov Kezunović, Milena Cojić, Davorina Petek and Igor Švab

Abstract

Introduction

One of the aims of health care reform in Montenegro is to strengthen primary care. An important step forward is the implementation of specialty training in family medicine (FM). The aim of this article is to evaluate the implementation of specialty training in family medicine in Montenegro, regarding the content, structure and methods, by the first generation of trainees and the coordinator of the training.

Methods

A questionnaire was sent by mail in July and August 2017 to all 26 eligible trainees who started specialty training in 2013. Twenty-two of the 26 trainees (84.6%) responded. The questionnaire consisted of closed and open-ended questions related to the evaluation of the training. A descriptive quantitative and qualitative analysis with predefined themes and a semi-structured interview with the coordinator were carried out.

Results

The process of training in FM was assessed positively by both trainees and the coordinator. The positive assessment included that the specialisation course offered modern design through modules and practice, and trainees both improved their existing knowledge and skills and acquired new ones necessary for everyday work. The coordinator emphasised the importance of the introduction of new teaching methods and formative assessment, the important role of mentors, and the involvement of Slovenian colleagues in the teaching process and supervision of the programme.

Conclusions

The implementation of speciality training in FM in Montenegro was successful. Several assessment methods were used that can be further developed in individual structured feedback, which could stimulate the continual improvement of trainees’ knowledge and competencies.

Open access

Davorina Petek, Marija Petek-Ster and Ksenija Tusek-Bunc

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Open access

Marija Šter, Igor Švab, Davorina Petek and Gordana Živčec

Adherenca Pri Zdravljenju Osteoporoze z Enkrat Mesečnim Bisfosfonatom

Izhodišča: Adherenca pri zdravljenju kroničnih bolezni, zlasti tistih, ki ne povzročajo simptomov, predstavlja problem. Zanimalo nas je, kakšna je adherenca pri enkrat mesečnem jemanju bisfosfonata za zdravljenje osteoporoze, kakšen je vpliv podpornega programa na adherenco ter kakšna so stališča bolnic in njihovih zdravnikov o pomenu zdravljenja osteoporoze ter podpornega programa.

Preiskovanci in metode: V raziskavi je sodelovalo 329 bolnic s primarno osteoporozo. 6-mesečno adherenco pri zdravljenju smo ugotavljali na podlagi števila predpisanih škatlic zdravila. Kot vir podatkov nam je služil zdravstveni karton splošne medicine. Stališča bolnic o osteoporozi in podpornem programu za osteoporozo smo ugotavljali s pomočjo strukturiranega intervjuja, stališča zdravnikov pa s pomočjo vprašalnika, izdelanega za namen te raziskave.

Rezultati: Bolnice z osteoporozo so bile v povprečju stare 70,9 let (SD 10,0 let). Na 7-stopenjski Likertovi skali so ocenile pomembnost zdravljenja osteoporoze z oceno 6,23 (SD 1,28), zdravniki pa z oceno 6,22 (SD 0,83). Ugotovili smo, da je 6-mesečna adherenca pri zdravljenju z enkrat mesečnim odmerkom bisfosfonata 90,6 %. Boljšo adherenco pri zdravljenju je napovedovala višja stopnja šolske izobrazbe (razmerje obetov: 2,17, 95-odstotni interval zaupanja 1,33-3,55) ter pozitivno stališče bolnic do zdravljenja osteoporoze (razmerje obetov: 1,74, 95-odstotni interval zaupanja 1,27-2,38). Sodelovanje v podpornem programu ni vplivalo na boljšo adherenco pri zdravljenju, čeprav so ga bolnice in zdravniki ocenili kot koristnega.

Zaključki: Adherenca pri zdravljenju z enkrat mesečnim odmerkom bisfosfonata je visoka. Pomemben dejavnik, ki je napovedoval adherenco, je prepričanje bolnic, da je zdravljenje osteoproze zelo pomembno.

Open access

Marija Petek Šter and Polona Selič

Abstract

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.

Open access

Eva Gorup, Janez Rifel and Marija Petek šter

Abstract

Introduction

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.

Methods

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.

Results

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%).

Conclusions

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.