Papers by Zalika Klemenc-ketis
Acta Medico-Biotechnica
Aim: The aim of this study was to determine whether a simple intervention could foster adherence ... more Aim: The aim of this study was to determine whether a simple intervention could foster adherence to treatment guidelines in women with uncomplicated lower urinary tract infections (LUTIs) in after–hours primary care settings. Methods: This was a cluster, randomised, prospective intervention study in female patients conducted in 20 out–of–hours primary care (OOHC) settings in Slovenia (10 in the intervention group and 10 in the control group). In each OOHC centre, we included 10 consecutive patients with LUTIs who sought evaluation by a physician, called in for advice, or called in for a home visit. The OOHC centres in the intervention group received a poster with a schematic presentation of LUTI treatment treatment guidelines, which was displayed on the wall in the OHC practice. Results: Of 20 OOHC centres, 14 were willing to participate in the study (seven in the intervention group and seven in the control group). The final sample consisted of 118 (59.0%) female patients (64 in th...
Acta Medico-Biotechnica
Purpose: The aim of this study was to determine the prevalence of 1 month musculoskeletal pain sy... more Purpose: The aim of this study was to determine the prevalence of 1 month musculoskeletal pain symptoms in a representative sample of the Slovenian general population and to determine factors associated with the symptoms. Methods: We performed an observational cross–sectional study in June 2011 in a representative sample of 1,002 randomly selected Slovenian citizens, stratified according to gender and age, using a computer–assisted telephone interview method. Results: At least 1 day in the past month, 559 participants (55.7%) experienced musculoskeletal symptoms; 226 participants (22.5%) experienced musculoskeletal symptoms everyday of the past month. Older age, female gender, lower education, lower monthly income, seeking lay advice, seeking medical advice, self–treatment, self–reported mobility problems, problems with self–care, pain, difficulties in daily activities, anxiety and/or depression, employment, retired, and a chronic disease were associated with the presence of musculo...
International Journal of Environmental Research and Public Health
The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teac... more 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 pra...
Public Health Genomics, 2021
Introduction: The development of a family history (FH) questionnaire (FHQ) provides an insight in... more Introduction: The development of a family history (FH) questionnaire (FHQ) provides an insight into a patient’s familiarity of a trait and helps to identify individuals at increased risk of disease. A critical aspect of developing a new tool is exploring users’ experience. Objective: The objective of this study was to examine users’ experience, obstacles and challenges, and their views and concerns in the applicability of a new tool for determining genetic risk in Slovenia’s primary care. Methods: We used a qualitative approach. The participants completed a risk assessment software questionnaire that calculates users’ likelihood of developing familial diseases. Audio-taped semi-structured telephone interviews were conducted to evaluate their experience. There were 21 participants, and analyses using the constant comparative method were employed. Results: We identified 3 main themes: obstacles/key issues, suggestions for improvements, and coping. The participants were poorly satisfie...
European Journal of General Practice, 2020
Both medical education and research in the field of general practice/family medicine have been ch... more Both medical education and research in the field of general practice/family medicine have been challenged by the COVID-19 pandemic, opening new perspectives in these areas. COVID-19 has significantly caused a rapid and successful implementation of the telemedicine and remote care model, however, the long-term consequences of these changes remain uncertain. WONCA Europe makes efforts to uphold the integrity of family medicine as an academic discipline, threatened by the COVID-19 pandemic.
Slovenian Medical Journal, 2012
Background: Burnout as a distinct work-related syndrome is established by the combination of high... more Background: Burnout as a distinct work-related syndrome is established by the combination of high scores for emotional exhaustion (EE) and depersonalisation (D), and a low score for personal accomplishment (PA). The aim of the study was to assess the prevalence of burnout among Slovenian family medicine trainees and the influence of the socio-demographic characteristics on burnout assessment. Methods: The study included 127 family medicine trainees in a modular part of the residency in the study year 2008/09. A self-administered questionnaire addressed the socio-demographic variables (age, gender, marital status, and years of practice and labour details – number of patients per day, number of night shifts per month); the second part consisted of the Slovenian version of the Maslach Burnout Inventory. Results: The responses were received from 117 trainees (92 % response rate). In terms of burnout, 45.9 % respondents scored high for EE, 43.1 % for high D, and 45.9 % for low P, with 18...
PLOS ONE, 2021
BackgroundIndependence in daily activities is defined as the ability to perform functions related... more BackgroundIndependence in daily activities is defined as the ability to perform functions related to daily living, i.e. the capacity of living independently in the community with little or no help from others.ObjectiveWe focused on non-attenders as a subgroup of patients whose health status is not well known to family practice teams. Our goal was to estimate the prevalence of dependence and its severity level in the daily activities of patients, and to determine the factors that are associated with the occurrence of dependence.DesignCross-sectional observational study.Settings and participantsData was obtained in family medicine settings. Participants in the study were adults living in the community (aged 18 or over) who had not visited their chosen family physician in the last 5 years (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome...
Advances in Medicine, 2018
Introduction. A “virtual patient” is defined as a computer program which simulates real patients’... more Introduction. A “virtual patient” is defined as a computer program which simulates real patients’ cases. The aim of this study was to determine whether the inclusion of virtual patients affects the level of factual knowledge of family medicine students at the undergraduate level. Methods. This was a case-controlled prospective study. The students were randomly divided into experimental (EG: N=51) and control (CG: N=48) groups. The students in the EG were asked to practice diagnosis using virtual patients instead of the paper-based clinical cases which were solved by the students in the CG. The main observed variable in the study was knowledge of family medicine, determined by 50 multiple choice questions (MCQs) about knowledge of family medicine. Results. There were no statistically significant differences in the groups’ initial knowledge. At the final assessment of knowledge, there were no statistically significant differences between the groups, but there was a statistically signi...
European Journal of Public Health, 2019
Many countries struggle to find the best way to treat hypertension (HT) and type 2 diabetes (T2D)... more Many countries struggle to find the best way to treat hypertension (HT) and type 2 diabetes (T2D). As a result, many patients receive suboptimal care, especially vulnerable groups in society. The SCale up Integrated Care for diaBetes and hYpertension (SCUBY) project addresses this important societal issue, by examining the scale-up of existing evidence-based interventions for the control of HT and/or T2D. The study undertaken in countries with very different health systems, i.e. a developing health system in a low-middle income country - Cambodia; a former socialist high-income country with a centralised health system - Slovenia; and a Western European federal country with a decentralised system- Belgium, develops, implements and assesses roadmaps for the scale-up of an integrated chronic care package (ICP). The ICP consists of (a) identification of people with HT or T2D, (b) subsequent treatment in primary care services, (c) health education, (d) self-management support to patients...
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2011
Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitat... more Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitation, on the incidence of neardeath experiences (NDEs). Methods. We conducted a prospective observational study in the three largest hospitals in Slovenia in a consecutive sample of patients after out-of-hospital primary cardiac arrest. The presence of NDE was assessed with the self-administered Greyson's near-death experiences scale. The electrocardiogram pattern at the beginning of resuscitation was recorded. Main outcome measure was the presence of near-death experiences. Univariate analysis was used. Results. The study included 52 patients. There were 42 (80.8%) males in the sample; median age ± standard deviation of the patients was 53.1 ± 14.5 years. Near-death experiences were reported by 11 (21.2%) patients. Patients with ventricular fibrillation had significantly less NDEs than other patients (12.2% vs. 54.5%, P = 0.006). Patients with pulseless electrical activity had significantly more NDEs than others (60.0% vs. 11.9%, P = 0.003). Patients with asystole and pulseless electrical fibrillation had significantly more NDEs than patients who had ventricular fibrillation and ventricular tachycardia (60.0% vs. 11.9%, P = 0.003). Patients with at least one defibrillation attempt had significantly less near-death experiences than others (62.5% vs. 13.6%, P = 0.007). Conclusion. Our study found a possible correlation between electrocardiogram pattern in cardiac arrest patients and the incidence of near-death experiences. Further studies should address this problem in larger samples.
Signa Vitae - A Journal In Intensive Care And Emergency Medicine, 2013
Introduction. One of the basic premises of sonographic lung imaging is the concept of lung slidin... more Introduction. One of the basic premises of sonographic lung imaging is the concept of lung sliding. Identification of clear lung sliding excludes pneumothorax (PTx) at that specific local point. Methods. Fifty-seven 4th year medical students were given a 20-minute lecture on sonographic identification of lung sliding and exclusion of PTx. After the lecture, students were asked to correctly position the probe, identify shown structures and on each attempt (six attempts in a row) state whether lung sliding is present or not. Results. There were 57 students in the sample. Fifty students (87.7%) successfully positioned the probe (all 4 positions) for PTx identification. All but five students (91.2%) recognized the anatomic structures of the thorax. Mean number of correctly identified cases per student was 5.1 ± 1.1. In 292 (85.4%) cases, the answer was correct. In 298 (87.1%) cases, students were confident in the correct answer. Students who were confident in the right answer gave the right answer significantly more often when compared to others (90.3% vs. 52.3%, p < 0.001). Sensitivity of this method for 4th year medical students was 82.6% and its specificity was 87.9%. For correct identification of lung sliding in the sixth attempt, students on average needed 4.5 correct attempts. Conclusion. Our study suggests that 4th year medical students with no prior experience in lung ultrasonography can easily acquire knowledge and skills needed to detect thoracic wall structures and identify lung sliding with a high degree of sensitivity and specificity.
European Journal of General Practice, 2016
The international Bled course for teachers in family medicine with its stable long-term learning ... more The international Bled course for teachers in family medicine with its stable long-term learning aims, typical course structure, and stable environment, provides a safe, well-structured learning environment for the participants from many countries. There are many challenges and opportunities that the course directors need to address to stimulate the evolution of the course.
BMC Medical Education, 2016
Background: A new project on education in family medicine training was implemented last year in S... more Background: A new project on education in family medicine training was implemented last year in Slovenia by establishing regional coordinators in the specialist training programme. They are responsible for conducting regular small-group meetings with family medicine trainees. This study wanted to explore the attitudes and opinions of regional coordinators and family medicine trainees concerning this new method. Methods: This was a qualitative study based on focus groups. The participants were regional coordinators and family medicine specialist trainees. The data were analysed based on the principles of thematic content analysis with inductive technique. Results: The study revealed five themes which were the same for the analysis of transcripts of both regional coordinators and family medicine trainees: 1) Meetings with trainees; 2) Coordination; 3) Characteristics of regional coordinators; 4) Position of regional coordinators, and 5) Evaluation of regional coordinators. Conclusion: Participants of the study have many expectations for this new programme. They expect progress in trainees' clinical knowledge through experience-based group learning and with the help of the tutorship role of regional coordinators. The role of regional coordinators represents a new possibility for solving problems in the training programme in their coordinating role. In future, they have the potential to develop into an expert body that supervises the quality of training. A close follow-up is necessary to see if the position of regional coordinators is adequate and if they meet the expectations of the trainees as well as their own goals. Administrative and financial support for the programme is necessary. The project is important also in enabling the adaptation of the training programme's needs and the regional characteristics of medical care.
BMC Family Practice, 2015
Background: The aim of our study was to describe variability in process quality in family medicin... more Background: The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care. Methods: The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level. Results: None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation. Conclusions: A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians' characteristics.
Education for Primary Care, 2012
INTRoDUCTIoN Quality improvement (QI) includes the combined and continuous efforts of healthcare ... more INTRoDUCTIoN Quality improvement (QI) includes the combined and continuous efforts of healthcare professionals, patients and their families, researchers, payers, planners and educators to make changes that will lead to better patient outcomes, system performance and professional development. 1 QI needs to be taught at all levels of medical education and in all aspects of medical care. 2 In family medicine, quality of healthcare extends to all aspects of family doctors' work: primary care management, community orientation, specific problem-solving skills, comprehensive approach, personcentred care and holistic approach. 3 The Educational Agenda developed by the European Academy of Teachers in General Practice/Family Medicine (EURACT) 4 covers most of these aspects. However, it is not clear if this agenda includes techniques and competencies of QI. Namely, QI as a separate topic is not specifically mentioned or incorporated in the agenda. This is in contrast with the document set out in the USA by the Accreditation Council for Graduate Medical Education (ACGME) in 1999 involving 'practice-based learning and improvement' as the centre of six doctors' core competences. 5 So what happens within the different European countries? Until now, very little was known about the inclusion, content and outcomes of teaching QI topics within the medical curricula in the various countries. 6-11 Engels et al published an extensive overview of the situation of teaching QI in the Netherlands in 2007. 2 A teaching QI working group was formed in 2008 as part of the European Association for Quality and Safety in General Practice/Family Medicine (EQuiP; a WoNCA Europe network organisation). one of the aims of this group was to provide a comprehensive overview of how and at which levels QI is actually taught in European countries. This stimulated the discussion on themes and topics that should be taught and at what educational level they could be introduced in the medical teaching curriculum.
Acta Informatica Medica, 2015
Objectives: Virtual patients (VP) have been present within the medical education process for some... more Objectives: Virtual patients (VP) have been present within the medical education process for some time. Although they are assumed to be of great benefit for student learning, very little is know about student perception and outcomes of learning, especially during the pre-clerkship years. Therefore we have decided to investigate the use of VPs during lectures, which has never been analyzed before, but could present an opportunity for more effective and holistic learning. Methods: This was a qualitative study among the 4th year undergraduate medical students at the Medical Faculty, University of Maribor, Slovenia. Students, after completing 4 virtual patient cases during the semester, were asked to participate in focus groups. Using these focus groups we asked students to provide information about their perceptions of VP cases, their learning, and suggestions for educational improvements. Data was transcribed and analyzed using the grounded theory-based coding method (open coding). Results: Medical students reported having a positive attitude towards virtual patient learning. They perceived them as helpful for filling in knowledge gaps, learning appropriate patient care and clinical reasoning. However, especially within the setting of early clinical learning, students felt the need to discuss their questions with their tutors in order to achieve better learning outcomes. Conclusion: Students on teaching courses feel the need for structured instructor sessions and the integration of VPs in the course planning in order to maximize their learning outcomes.
Turkish Journal of Trauma and Emergency Surgery, 2011
Travmatik beyin hasarı, sağ kalan kişilerde yüksek mortalite ve morbiditeye neden olan majör bir ... more Travmatik beyin hasarı, sağ kalan kişilerde yüksek mortalite ve morbiditeye neden olan majör bir kamu sağlığı problemidir. GEREÇ VE YÖNTEM Ağır travmatik beyin hasarına sahip olan hastalara ilişkin retrospektif bir kohort çalışması gerçekleştirdik. Tedavi eden doktorun hastanın bilincine ilişkin değerlendirmesi, hastanın demografik özellikleri, rutin fiziksel ölçümleri ve tıbbi girişimler kaydedildi. Glasgow Koma Skalası ve genişletilmiş Glasgow Sonuç Skalası kullanıldı. BULGULAR Bu çalışmaya 60 hasta (%83,3 erkek, ortalama yaş 49,5 yıl) dahil edildi. Glasgow Koma Skalası skoru 4,8±1,9 ve genişletilmiş Glasgow Sonuç Skalası skoru 2,9±2,5 puan idi. Daha yüksek genişletilmiş Glasgow Sonuç Skalası skoruna yönelik lineer regresyon, varyansın %59,8'ini açıkladı ve önemli prediktörler olarak epidural hematomanın varlığını gösterdi. Daha yüksek genişletilmiş Glasgow Sonuç Skalası skoruna yönelik sınıflama ağacı, şu değişkenlerin önemli olabileceğini gösterdi: Hastanede kalma süresi, Glasgow Koma Skalası skoru, parsiyel karbondioksit basıncı, cerrahi, hastane dışı acil ekibinin yanıt zamanı, sistolik ve diyastolik kan basıncı, düşme ve kafa kaidesi kırığı. SONUÇ Ağır travmatik beyin hasarlı hastalara yönelik bakımı geliştirmek için travma merkezleri arasında gelecekte daha yararlı karşılaştırmalar yapmak ve karşılaştırmalı değerlendirmeyi ilerletmek üzere; izleme, girişim ve sonuç kaydı ile ilgili standardize yatılı tedavi protokolü benimsenmelidir.
Advances in Medical Education and Practice, 2014
In family medicine, decisions can be difficult due to the early presentation of often poorly deve... more In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problemsolving skills, and a comprehensive and holistic approach to be taught to medical students. Purpose: The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students. Materials and methods: This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students' written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale. Results: The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement. Conclusion: Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students' performance should be further evaluated.
Acta Medica Academica, 2014
European family medicine/general practice (FM/GP) has travelled the long and successful journey o... more European family medicine/general practice (FM/GP) has travelled the long and successful journey of pro ling the discipline and has produced valuable position papers on education and research. Nowadays, academic medicine is one of the pillars in the future development of FM/GP in Europe. A common European curriculum on undergraduate and postgraduate family medicine is needed. Also, a sound international platform of teaching institutions and/or teachers of family medicine would foster the further development of family medicine as an academic discipline. is would stimulate students and teachers to engage in international exchange to gain new knowledge and experiences, present their work and ideas abroad and prepare the conditions for further exchange of students and teachers. Conclusion. Established departments of FM/GP, led by a teacher who is a family physician/general practitioner, at each Medical School in Europe should provide students with knowledge and skills related to the core attributes of FM/GP. International exchanges of teachers and students should foster the development of a common curriculum on FM in Europe and foster improvement in the quality of FM education.
Medical Archives, 2012
A im: The objective of this study was to validate an international instrument addressing family p... more A im: The objective of this study was to validate an international instrument addressing family physicians' competency level from the primary health care users' perspective in Albania, a post-communist country in Southeast Europe. Methods: This validation study, conducted in March-April 2012, included a sample of 114 primary health care users in Tirana municipality aged 18+ years (49 males and 65 females; mean age: 60±15 years). All participants were asked to self-assess the level of abilities, skills and competencies of their respective family physicians regarding different domains of quality of health care. Overall, the questionnaire included 37 items organized into 6 subscales/domains. Answers for each item of the tool ranged from 1 ("novice" physicians) to 5 ("expert" physicians). An overall summary score (including 37 items; range: 37-185) and a subscale summary score for each domain were calculated for male and female participants. Socioeconomic data were also collected. Cronbach's alpha was used to assess the internal consistency, and Mann-Whitney U test was used to compare mean scores for the overall scale and each subscale between men and women. Results: Overall, internal consistency of the whole scale (37 items) was Cronbach's alpha=0.89; it was higher in women than in men (0.91 vs. 0.82, respectively). The overall summary score for the 37 items of the instrument was 89.3±9.1; it was slightly higher in women than in men (89.7±10.6 vs. 88.8±6.7, respectively, P=0.218). There were no statistically significant differences in the subscale summary scores between men and women. Overall, there was no correlation of the whole summary score or subscale scores with age. Conversely, there was evidence of a weak positive correlation with educational level. Conclusions: In the Albanian context, we provide evidence on the process of cross-cultural adaptation of a simple instrument measuring patients' self-perceived level of abilities and competencies of their family physicians regarding different domains of the quality of primary health care services
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Papers by Zalika Klemenc-ketis