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Ali so pogosti obiskovalci za zdravnika tudi težavni bolniki?
Janko Kersnik, Marija Kuralt, 2008, original scientific article

Keywords: osnovno zdravstvo, družinska medicina, odnos zdravnik-bolnik, obiski, stres, konzultacija, težaven bolnik, pogosti obiskovalci
Published in DKUM: 19.04.2024; Views: 164; Downloads: 5
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Pogostnost etičnih dilem med zdravniki družinske medicine v Sloveniji
Zalika Klemenc-Ketiš, Janko Kersnik, 2009, original scientific article

Abstract: Purpose: To de termine the per~ ceived prevalence of ethical dilem~ mas in family practice.Methods: Selfadministered ques~ tionnaire sent to a random sample of 259 Slovenian family physicians.The main outcome measure was the percentage of doctors reporting the frequency of ethical dilemmas on a 5 ~point scale.Results: Ethical dilemmas were common ( mean score standard de~viation, 36.2 12.5, out of a maxi~ mum of 100). The most common dilemmas involved decision~making regarding use of limited resources (23.9%), patient attempts to abuse the health care service (20.4%) and interfacing with the rest of the health care system (20.4%). Dealing with patients suspected of being physically abused, sexually abused, or involved in other violent acts was the least common ethical dilemma 0.1 %), followed by issues involving breaking bad news 0.1 %) and special situations regarding adolescents (0.7%).Older physicians and those with more experience reported ethical dilemmas less commonly (32.3 11.9 vs.40.1 11.9, P < 0.001; 32.4 11.8 vs. 39.5 12.2, P = O. OO 1 , respectively) . Specialists in family medicine and family medicine residents reported ethical dilemmas more commonly than general practitioners without specialist training (37.0 12.6 vs. 30.7 1O.8, P = 0.05 and 39.5 12.5 vs. 30.7 1O.8, P = 0.04, respectively).Conclusions: Ethical issues are common in Slovenian family practice and are most of ten reported byresidents in specialist training. This supports the need to continue and even improve specialist training in recognizing and comprehending ethical dilemmas.
Keywords: bioetika, pogostnost, družinska medicina, odnos med zdravnikom in bolnikom, presečna študija
Published in DKUM: 19.04.2024; Views: 111; Downloads: 1
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Stališča zdravnikov družinske medicine in njihovih bolnikov do izvajanja 24-urnega neinvazivnega merjenja krvnega tlaka v ambulanti družinske medicine
Marija Petek Šter, Janko Kersnik, 2009, original scientific article

Abstract: Purpose: Ambulatory blood pressure monitoring (ABPM) is increasingly being used in general practice, but there is a lack of information about the attitudes of general practitioners and their patients about the use of ABPM inprimary care in Europe. Methods: Cross sectional survey performed on consecutive patients with uncontrolled hypertension treated by at least two different antihypertensive drugs and referred for ABPM in 38 general practicesin Slovenia. Patients and physicians completed a questionnaire about their satisfaction with, attitudes about and acceptance of ABPM in general practice; the latter two were assessed using 5 point Likert scales. Results: We obtained complete data for 185 patients; 95 female (51.4%) and 90 (48.6%) male, aged 37 to 79 years (mean 59.5, SD 9.5 years). 106 (67.3 %) patients were completely satisfied with the instructions given before ABPM. Patients found ABPM an acceptable method of blood pressure control. They believed that ABMP helped to reach better blood pressure control (Likert scale: 4.46, SD 1.03) and valued having access to ABPM in general practice (Likert scale: 4.65, SD 1.01). General practitioners strongly believed that ABPM was acceptable to patients, improved patient and physician interest in blood pressure control, improved compliance with treatment and reduced prescription of antihypertensive drugs. They recognised ABPM as being most valuable in cases of patients with suspected white-coat hypertension (Likert scale: 4.79, SD 0.49). Conclusions: Patients and general practitioners find ABPM to be an acceptable method for investigating blood pressure. Patients value being able to access ABPM in general practice rather than in a specialist setting.
Keywords: arterijska hipertenzija, 24-NMKT, stališča, sprejem, družinska medicina
Published in DKUM: 19.04.2024; Views: 120; Downloads: 3
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Factors associated with health-related quality of life among university students
Zalika Klemenc-Ketiš, Janko Kersnik, Ksenija Eder, Dušan Colarič, 2011, original scientific article

Abstract: Introduction: University students are subjected to different kinds of stressors, i.e.academic pressures, social issues and financial problems. This can affect their academic achievements and quality of life. Objective: The aim of this study was to determine the health-related quality of life of university students, and how it is affected by the presence of chronic diseases, mental disorders comorbidity, and patterns of medical services' use. Methods: This web-based study included a sample of 1,410 Slovenian university students. We used a self-administered questionnaire, containing a sheet with demographic data, Zung's self-assessment inventories about anxiety and depression, and EQ-5D questionnaire. The main outcome measures were scores on EQ-5D part and VAS part of the EQ-5D questionnaire. Results: Independent factors associated with the health-related quality of life of university students, were the presence of chronic pain, the presence of depression and anxiety, need for urgent medical help and at least one visit to a clinical specialist in the past year. The independent factors associated with the health status of university students were the presence of chronic diseases, chronic pain, depression and anxiety, a visit to a clinical specialist, a need for urgent medical help and a visit to an emergency unit in the past year. Conclusion: Health-related quality of life of university students can be seriously affected by the presence of mental disorders and chronic pain. Appropriate health-related measures should be adopted to achieve early recognition of worse health-related quality of life, the presence of mental disorders and other chronic conditions, and to enable their effective treatment.
Keywords: quality of life, students, chronic disease, pain, depression, anxiety
Published in DKUM: 04.08.2017; Views: 1272; Downloads: 475
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Deficiency areas in decision making in undergraduate medical students
Zalika Klemenc-Ketiš, Janko Kersnik, 2014, original scientific article

Abstract: Background: 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 problem-solving 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.
Keywords: assessment, family medicine, undergraduate medical education, decision making
Published in DKUM: 03.08.2017; Views: 1228; Downloads: 375
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The role of the European Academy of Teachers in General Practice and Family Medicine in family medicine education in Europe : the experience of the University of Maribor
Zalika Klemenc-Ketiš, Janko Kersnik, 2012, review article

Abstract: Primary health care is important item of political agendas since Alma Ata conference in 1978. West Balkans share common history in development of primary care since 1920' when Andrija Stampar introduced social and community based primary care concepts. The first known specialist training in general practice in the world started in former Yugoslavia in the early 1960'. Since then, much has been done in the field of general practice and family medicine and this is reflected in The European Academy of Teachers in General Practice and Family Medicine (EURACT), which is a network organisation within World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Region Europe (WONCA Europe). Its aim is to foster and maintain high standards of care in European general practice by promoting general practice as a discipline by learning and teaching. EURACT developed several documents and teachers' courses which can serve the development of family medicine curricula in new established departments of medical schools. This is also the case at Maribor Medical School, where learning outcomes and teaching methods are in concordance with EURACT teaching agenda, but also some innovative approaches are used, such as art and e-learning environment as teaching methods.
Keywords: family practice, education, Europe, Slovenia
Published in DKUM: 24.07.2017; Views: 1216; Downloads: 154
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Importance of international networking in academic family medicine
Zalika Klemenc-Ketiš, Janko Kersnik, 2014, review article

Abstract: European family medicine/general practice (FM/GP) has travelled the long and successful journey of profiling 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. This 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.
Keywords: family practice, education, network, exchange
Published in DKUM: 24.07.2017; Views: 1644; Downloads: 366
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Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countries
Iztok Tomazin, Miljana Vegnuti, John Ellerton, Oliver Reisten, Guenther Sumann, Janko Kersnik, 2012, original scientific article

Abstract: Background: The outcome of severely injured or ill patients can be time dependent. Short activation and approach times for emergency medical service (EMS) units are widely recognized to be important quality indicators. The use of a helicopter emergency medical service (HEMS) can significantly shorten rescue missions especially in mountainous areas. We aimed to analyze the HEMS characteristics that influence the activation and approach times. Methods: In a multi-centre retrospective study, we analyzed 6121 rescue missions from nineHEMS bases situated in mountainous regions of four European countries. Results: We found large differences in mean activation and approach times among HEMS bases. The shortest mean activation time was 2.9 minutes; the longest 17.0 minutes. The shortest mean approach time was 10.4 minutes; the longest 45.0 minutes. Short times are linked (p < 0.001) to the following conditions: helicopter operator is not state owned; HEMS is integrated in EMS; all crew members are at the same location; doctors come from state or private health institutions; organization performing HEMS is privately owned; helicopters are only for HEMS; operation area is around 10.000 km2; HEMS activation is by a dispatching centre of regional government who is in charge of making decisions; there is only one intermediator in the emergency call; helicopter is equipped with hoist or fixed line; HEMS has more than one base with helicopters, and one team per base; closest neighboring base is 90 km away; HEMS is about 20 years old and has more than 650 missions per year; and modern helicopters are used. Conclusions: An improvement in HEMS activation and approach times is possible. We found 17 factors associated with shorter times.
Keywords: emergency medical services, air ambulances, emergency helicopters, quality of health care, activation and approach time
Published in DKUM: 29.06.2017; Views: 1584; Downloads: 311
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The effect of carbon dioxide on near-death experiences in out-of-hospital cardiac arrest survivors: a prospective observational study
Zalika Klemenc-Ketiš, Janko Kersnik, Štefek Grmec, 2010, original scientific article

Abstract: Introduction: Near-death experiences (NDEs) are reported by 11-23% of cardiac arrest survivors. Several theories concerning the mechanisms of NDEs exist - including physical, psychological, and transcendental reasons - but so far none of these has satisfactorily explained this phenomenon. In this study, we investigated the effect of partial pressures of O2 and CO2, and serum levels of Na and K on the occurrence of NDEs in out-of-hospital cardiac arrest survivors. Methods: A prospective observational study was conducted in the three largest hospitals in Slovenia. Fifty-two consecutive patients (median age 53.1 years, 42 males) after out-of-hospital cardiac arrest were included. The presence of NDEs was assessed with a self-administered Greyson's NDE scale. The initial partial pressure of end-tidal CO2, the arterial blood partial pressures of O2 and CO2 and the levels of Na and K in venous blood were analysed and studied. Univariate analyses and multiple regression models were used. Results: NDEs were reported by 11 (21.2%) of the patients. Patients with higher initial partial pressures of end-tidal CO2 had significantly more NDEs (P < 0.01). Patients with higher arterial blood partial pressures of CO2 had significantly more NDEs (P = 0.041). Scores on a NDE scale were positively correlated with partial pressures of CO2 (P = 0.017) and with serum levels of potassium (P = 0.026). The logistic regression model for the presence of NDEs (P = 0.002) explained 46% of the variance and revealed higher partial pressures of CO2 to be an independent predictor of NDEs. The linear regression model for a higher score on the NDE scale (P = 0.001) explained 34% of the variance and revealed higher partial pressures of CO2, higher serum levels of K, and previous NDEs as independent predictors of the NDE score. Conclusions: Higher concentrations of CO2 proved significant, and higher serum levels of K might be important in the provoking of NDEs. Since these associations have not been reported before, our study adds novel information to the field of NDEs phenomena.
Keywords: near-death experience, cardiac arrest, survivors
Published in DKUM: 29.06.2017; Views: 1294; Downloads: 375
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Using movies to teach professionalism to medical students
Zalika Klemenc-Ketiš, Janko Kersnik, 2011, original scientific article

Abstract: Background: Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognizededucational activities, which makes them difficult to teach and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics. Method: This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 +/- 0.9 years. The authors used students' written reports and oral presentations as the basisfor qualitative analysis using thematic codes. Results: Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think abouttheir attitudes towards their own life, death and dying. Conclusion: The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactiveteaching methods could become an indispensible aid in teaching professionalism to new generations.
Keywords: teaching methods, movies, medical students
Published in DKUM: 28.06.2017; Views: 1719; Downloads: 402
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