1. Uporaba vizualizacije za spremembo življenjskega sloga pri pacientih z ogroženostjo za srčno-žilne bolezniAdrijana Svenšek, 2025, doctoral dissertation Abstract: Uvod: Srčno-žilne bolezni so glavni vzrok smrti po vsem svetu, razširjenost pa se povečuje zaradi dejavnikov tveganja, katerih nadzor je ključen ukrep za zmanjšanje pojavnosti. Uporaba moderne tehnologije lahko spodbudi izbiro zdravega življenjskega sloga in pomaga pri ocenjevanju ogroženosti za srčno-žilne bolezni. Namen doktorske disertacije je oceniti, ali se uporaba vizualizacije ogroženosti za srčno-žilne bolezni in možnost sprotnega spremljanja gibanja nivoja glukoze v krvi povezujeta s spremembo življenjskega sloga in percepcijo na osebo osredotočene oskrbe pacientov v ambulantah družinske medicine.
Metode: Raziskava je temeljila na metodologiji raziskav mešanih metod z eksperimentalnim načrtom. Najprej smo izvedli sistematično iskanje in oceno mobilnih aplikacij za oceno ogroženosti za srčno-žilne bolezni v Apple Store in Google Play ter pregled literature v podatkovnih bazah PubMed, CINAHL Ultimate, MEDLINE in Web of Science, s poudarkom na vlogi vizualizacije. V kvantitativnem delu smo v pilotni presečni raziskavi, izvedeni na vzorcu 666 udeležencev, pridobljenem s snežno kepo, validirali vprašalnik o zdravem življenjskem slogu in osebnem nadzoru z uporabo psihometričnih analiz. V glavni raziskavi smo izvedli randomizirano klinično raziskavo s 119 udeleženci, od katerih je 101 zaključilo vse meritve. Udeleženci so bili naključno razporejeni v tri intervencijske in eno kontrolno skupino. Analiza je bila izvedena z uporabo deskriptivne in inferenčne statistike. V kvalitativnem delu raziskave smo uporabili metodo utemeljene teorije, v katero je bilo vključenih 12 udeležencev. Uporabili smo teoretično vzorčenje. Analiza je temeljila na odprtem, aksialnem in selektivnem kodiranju. Integracija je bila izvedena na ravni interpretacije.
Rezultati: Aplikacija z najvišjo skupno oceno je bila MDCalc Medical Calculator, medtem ko je najnižjo skupno oceno dobila aplikacija CardioRisk Calculator. Pri pregledu obsega so bile najpogosteje uporabljene tehnike vizualizacije naslednje: vizualni namigi, stolpčni diagrami in grafi. Pri validaciji vprašalnika v okviru pilotne raziskave je koeficient Cronbach alfa (α) znašal 0,852, vse domene vprašalnika pa so imele pozitivne korelacije. Najnižja povprečna vrednost SCORE2 pri izhodiščni oceni je bila v tretji intervencijski skupini (3,84; SD = 2,08), kar kaže na najnižjo ogroženost za srčno-žilne bolezni. Pri oceni zdravega življenjskega sloga so skupine na začetku najvišje ocenile domeno dnevna rutina, ki se je ob končni oceni izboljšala, čeprav pri nobeni izmed skupin pri meritvah med in po njih ni prišlo do statistično značilne spremembe. Percepcija na osebo osredotočene oskrbe je bila v vseh skupinah najvišje ocenjena v domeni skupnega odločanja, pri čemer med skupinami prav tako ni bilo statistično značilnih razlik. Na podlagi analize intervjujev smo identificirali 5 kategorij (na osebo osredotočena oskrba, poznavanje in spremljanje dejavnikov tveganja, vizualizacija in interpretacija rezultatov, vpliv uporabe tehnologije na življenjski slog ter identifikacija težav in izzivov ter priporočila za izboljšavo in prihodnjo uporabo) in 11 podkategorij.
Razprava in sklep: Na področju zdravega življenjskega sloga in percepcije na osebo osredotočene oskrbe so se rezultati izboljšali, čeprav med skupinami ni bilo statistično pomembnih razlik. To kaže, da so bile intervencije učinkovite pri spremembi življenjskega sloga, vendar bi bile potrebne prilagoditve za doseganje večjega vpliva. Poseben poudarek je bil na uporabi vizualizacije kot ključnega orodja za ozaveščanje pacientov o ogroženosti za srčno-žilne bolezni. Zaključki nakazujejo, da ima uporaba vizualizacije velik potencial za izboljšanje vključenosti pacienta v načrtovanje oskrbe. Daljše intervencije z večjim vzorcem udeležencev bi lahko prispevale k bolj poglobljenemu razumevanju teh učinkov v klinični praksi in optimizaciji uporabe digitalnih orodij za prilagajanje življenjskega sloga pacientov z ogroženostjo za srčno-žilne bolezni.
Keywords: srčno-žilne bolezni, vizualizacija, CGM, zdrav življenjski slog, Petal-X, biološka starost
Published in DKUM: 22.12.2025; Views: 0; Downloads: 12
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2. Which positive view of general practice do medical students and trainees have? : a systematic literature reviewBernard Le Floch, Hilde Bastiaens, Jean-Yves Le Reste, Heidrun Lingner, Robert Hoffman, Radost Spiridonova Assenova, Tuomas Koskela, Zalika Klemenc-Ketiš, P. Nabbe, T Montier, Lieve Peremans, 2020, review article Abstract: Background: Despite several studies focusing on the negative aspects of general medicine, the speciality seems attractive for students. Researchers from the European General Practice Research Network created a group to study job satisfaction in general practice. The aim of this eight-country European study was to determine which positive view students have about general practice.
Method: Systematic review of the literature from Pubmed, Embase and Cochrane databases. Articles published between 01/01/2000 and 12/31/2018 were searched and analysed by two researchers working blind. The data on satisfaction factors were extracted from the full text article used as verbatims. Then the data were coded with a thematic analysis.
Results: 24 articles out of 414 were selected. Satisfaction factors were classified: teaching of general practice, workplace and organisational freedom, quality of life, variety in practice, workload balance and income. The analysis highlighted intellectual stimulation and the relationship built with patients and other professionals.
Conclusion: Literature on the appeal of general practice for students revealed many factors of job satisfaction in general practice. It is possible to create a global view of a satisfied GP on the students' opinion. Courses and clerkships in general practice with positive rolemodels are determining factors in career choice.
Keywords: medical students, career choice, general practitioners, job satisfaction, primary healthcare
Published in DKUM: 20.11.2025; Views: 0; Downloads: 4
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3. Laična podpora kot nadgradnja celostne oskrbe oseb s sladkorno boleznijo in arterijsko hipertenzijo na primarni zdravstveni ravni v SlovenijiTina Virtič Potočnik, 2025, doctoral dissertation Abstract: Namen raziskave je bil razviti znanstveno utemeljen model laične podpore za osebe s sladkorno boleznijo tipa 2 (SB), z ali brez arterijske hipertenzije (AH), in ovrednotiti vlogo te podpore z vključitvijo usposobljenih oseb za njeno izvajanje. To bi omogočilo nadgradnjo celostne oskrbe teh bolnikov na primarni zdravstveni ravni v Sloveniji.
Metode: Pilotna prospektivna intervencijska raziskava tipa pred/potem, z uporabo mešane metodologije, je potekala od maja 2021 do decembra 2023 v urbanem okolju Zdravstvenega doma Ljubljana in ruralnem okolju Zdravstvenega doma Slovenj Gradec. Z namenskim vzorčenjem so bili v dvomesečni strukturirani izobraževalni program vključeni posamezniki s SB, z ali brez AH (n=36), da bi postali usposobljeni za nudenje laične podpore drugim bolnikom (n=226). V skupinah do 10 bolnikov so se srečevali enkrat mesečno, tri mesece zapored. Podatki so bili zbrani iz zdravstvene dokumentacije, kliničnih meritev, vprašalnikov, intervjujev in fokusnih skupin.
Rezultati: 31 udeležencev (stopnja zadržanja 86,1 %) je postalo usposobljenih za nudenje laične podpore, s povprečno starostjo 63,9 let (SD 8,9), med njimi 67,7 % žensk. Usposabljanje je bilo ocenjeno kot izvedljivo, visoko sprejemljivo in učinkovito. Znanje udeležencev o SB (p<0,001) in AH (p=0,024) se je po usposabljanju pomembno izboljšalo, prav tako se je po šestih mesecih zmanjšal njihov indeks telesne mase (ITM) (p=0,020). Treh srečanj laične podpore se je udeležilo 200 bolnikov (stopnja zadržanja 88,5 %), s povprečno starostjo 68,3 let (SD 10,5), med njimi 51 % moških. Srečanja so se izkazala za izvedljiva, visoko sprejemljiva in učinkovita, saj se je opolnomočenje bolnikov pomembno izboljšalo (p<0,001). Multivariatni linearni regresijski model je pokazal pomembno povezavo med opolnomočenjem in nižjo starostjo (p=0,009), s prebivanjem v ruralnem okolju (p<0,001) in odsotnostjo zdravljenja z antihiperglikemičnimi zdravili (p=0,015).
Zaključek: Za izboljšanje (samo)oskrbe oseb s SB in AH je ključno, da se laična podpora sistematično vključi v zdravstveni sistem kot del kontinuuma celostne oskrbe. Potrebne so nadaljnje raziskave za preučitev dolgotrajnih učinkov in strategij širše implementacije.
Keywords: laična podpora, sladkorna bolezen tipa 2, hipertenzija, opolnomočenje, primarno zdravstveno varstvo
Published in DKUM: 19.03.2025; Views: 0; Downloads: 47
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4. Safety culture at primary healthcare level : a cross-sectional study among employees with a leadership roleZalika Klemenc-Ketiš, Tonka Poplas-Susič, 2020, original scientific article Abstract: Introduction: An effective leadership is critical to the development of a safety culture within an organization. With this study, the authors wanted to assess the self-perceived level of safety culture among the employees with a leadership function in the Ljubljana Community Health Centre.
Methods: This was a cross-sectional study in the largest community health centre in Slovenia. We sent an invitation to all employees with a leadership role (N=211). The Slovenian version of the SAQ – Short Form as a measurement of a safety culture was used. The data on demographic characteristics (gender, age, role, work experience, working hours, and location of work) were also collected. An electronic survey was used.
Results: The final sample consisted of 154 (69.7%) participants, out of which 136 (88.3%) were women. The mean age and standard deviation of the sample was 46.2±10.5 years. The average scores for the safety culture domains on a scale from 1 to 5 were 4.1±0.6 for Teamwork Climate, Safety Climate, and Working Conditions and Satisfaction, 3.7±0.5 for Perception of Management, 3.6±0.4 for Communication, and 3.5±0.6 for Stress Recognition.
Conclusion: The safety culture among leaders in primary healthcare organizations in Slovenia is perceived as positive. There is also a strong organizational culture. Certain improvements are needed, especially in the field of communication and stress recognition with regards to safety culture.
Keywords: safety culture, primary healthcare, organizational culture
Published in DKUM: 24.01.2025; Views: 0; Downloads: 428
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5. Academic general practice/family medicine in times of COVID-19 - Perspective of WONCA EuropeAdam Windak, Thomas Frese, Eva Hummers-Pradier, Zalika Klemenc-Ketiš, Sonia Tsukagoshi, Josep Vilaseca, Shlomo Vinker, Mehmet Ungan, 2020, original scientific article Abstract: COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This art-icle focuses on the academic challenges for the discipline, mainly in the field of education,research, and quality assurance. The efforts of the European Region of the World Organisationof National Colleges, Academies, and Academic Associations of General Practitioners/FamilyPhysicians (WONCA Europe) to support academic sustainability of the discipline in the time ofpandemic are presented. Medical education was affected by the pandemic, threatening both itsproductivity and quality. Emerging new educational methods might be promising, but theresults of their rapid implementation remain uncertain. A relatively small number of publicationsrelated to COVID-19 and general practice is available in the medical literature. There is a short-age of original data from general practice settings. This contrasts with the crucial role of GPs infighting a pandemic. COVID-19 outbreak has opened widely new research areas, which shouldbe explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate man-agement of their problems. Rapid implementation of telemedicine brought both threats andopportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. Theseaspects will require discussion and remedy to prevent deterioration of the quality of primarycare. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of thepandemic. It is ready to support future efforts to uphold the integrity of family medicine as anacademic discipline.
Keywords: infectious diseases, quality of care, public health, community medicine, health care organisation, management, medical education
Published in DKUM: 07.01.2025; Views: 0; Downloads: 13
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6. The role of visualization in estimating cardiovascular disease risk : scoping reviewAdrijana Svenšek, Mateja Lorber, Lucija Gosak, Katrien Verbert, Zalika Klemenc-Ketiš, Gregor Štiglic, 2024, review article Abstract: Background: Supporting and understanding the health of patients with chronic diseases and cardiovascular disease (CVD) risk is often a major challenge. Health data are often used in providing feedback to patients, and visualization plays an important role in facilitating the interpretation and understanding of data and, thus, influencing patients’ behavior. Visual analytics enable efficient analysis and understanding of large datasets in real time. Digital health technologies can promote healthy lifestyle choices and assist in estimating CVD risk. Objective: This review aims to present the most-used visualization techniques to estimate CVD risk. Methods: In this scoping review, we followed the Joanna Briggs Institute PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. The search strategy involved searching databases, including PubMed, CINAHL Ultimate, MEDLINE, and Web of Science, and gray literature from Google Scholar. This review included English-language articles on digital health, mobile health, mobile apps, images, charts, and decision support systems for estimating CVD risk, as well as empirical studies, excluding irrelevant studies and commentaries, editorials, and systematic reviews. Results: We found 774 articles and screened them against the inclusion and exclusion criteria. The final scoping review included 17 studies that used different methodologies, including descriptive, quantitative, and population-based studies. Some prognostic models, such as the Framingham Risk Profile, World Health Organization and International Society of Hypertension risk prediction charts, Cardiovascular Risk Score, and a simplified Persian atherosclerotic CVD risk stratification, were simpler and did not require laboratory tests, whereas others, including the Joint British Societies recommendations on the prevention of CVD, Systematic Coronary Risk Evaluation, and Framingham-Registre Gironí del COR, were more complex and required laboratory testing–related results. The most frequently used prognostic risk factors were age, sex, and blood pressure (16/17, 94% of the studies); smoking status (14/17, 82%); diabetes status (11/17, 65%); family history (10/17, 59%); high-density lipoprotein and total cholesterol (9/17, 53%); and triglycerides and low-density lipoprotein cholesterol (6/17, 35%). The most frequently used visualization techniques in the studies were visual cues (10/17, 59%), followed by bar charts (5/17, 29%) and graphs (4/17, 24%). Conclusions: On the basis of the scoping review, we found that visualization is very rarely included in the prognostic models themselves even though technology-based interventions improve health care worker performance, knowledge, motivation, and compliance by integrating machine learning and visual analytics into applications to identify and respond to estimation of CVD risk. Visualization aids in understanding risk factors and disease outcomes, improving bioinformatics and biomedicine. However, evidence on mobile health’s effectiveness in improving CVD outcomes is limited.
Keywords: cardiovascular disease prevention, risk factors, visual analytics, visualization, mobile phone, PRISMA
Published in DKUM: 26.11.2024; Views: 0; Downloads: 18
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7. Scaling-up an integrated care for patients with non-communicable diseases : an analysis of healthcare barriers and facilitators in Slovenia and BelgiumČrt Zavrnik, Katrien Danhieux, Miriam Hurtado Monarres, Nataša Stojnić, Majda Mori-Lukančič, Monika Martens, Zalika Klemenc-Ketiš, Edwin Wouters, Josefien Van Olmen, Tonka Poplas-Susič, 2021, original scientific article Abstract: Introduction: Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.
Methods: This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.
Results: Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.
Conclusions: This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.
Keywords: scale-up, noncommunicable diseases, patientcentered care, primary healthcare, integrated healthcare
Published in DKUM: 22.10.2024; Views: 0; Downloads: 9
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8. The impact of psychological interventions with elements of mindfulness (PIM) on empathy, well-being, and reduction of burnout in physicians : a systematic reviewSara Onuk Tement, Zalika Klemenc-Ketiš, Špela Miroševič, Polona Selič-Zupančič, 2021, review article Abstract: Introduction: Physician's burnout has been recognized as an increasing and significant work-related syndrome, described by the combination of emotional exhaustion (EE) and depersonalization (D), together with low personal accomplishment (PA). It has many negative consequences on personal, organizational, and patient care levels. This systematic review aimed to analyze research articles where psychological interventions with elements of mindfulness (PIMs) were used to support physicians in order to reduce burnout and foster empathy and well-being.
Methods: Systematic searches were conducted in May 2019, within six electronic databases PubMed, EBSCOhost MEDLINE, PsycArticles, Cochrane Library, JSTOR, and Slovenian national library information system. Different combinations of boolean operators were used-mindfulness, empathy, medicine/family medicine/general practice/primary care, burnout, doctors/physicians, intervention, and support group. Additional articles were manually searched from the reference list of the included articles. Studies with other healthcare professionals (not physicians and residents) and/or medical students, and those where PIMs were applied for educational or patient's treatment purposes were excluded.
Results: Of 1194 studies identified, 786 screened and 139 assessed for eligibility, there were 18 studies included in this review. Regardless of a specific type of PIMs applied, results, in general, demonstrate a positive impact on empathy, well-being, and reduction in burnout in participating physicians. Compared with other recent systematic reviews, this is unique due to a broader selection of psychological interventions and emphasis on a sustained effect measurement.
Conclusions: Given the pandemic of COVID-19, it is of utmost importance that this review includes also interventions based on modern information technologies (mobile apps) and can be used as an awareness-raising material for physicians providing information about feasible and easily accessible interventions for effective burnout prevention and/or reduction. Future research should upgrade self-reported data with objective psychological measures and address the question of which intervention offers more benefits to physicians.
Keywords: mindfulness, psychological intervention, physicians, empathy, burnout, well-being, MBSR
Published in DKUM: 18.10.2024; Views: 0; Downloads: 10
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9. The safety culture of the Ljubljana community health centre's employeesŠpela Tevžič, Tonka Poplas-Susič, Zalika Klemenc-Ketiš, 2021, original scientific article Abstract: Introduction: Patient safety is one of the key aspects of healthcare quality and a serious global public health concern. Patient safety culture is a part of the patient safety concept. In Slovenia, primary care is easily accessible, and for medical care, it serves as a gatekeeper to hospital care. For several years, the quality and safety at the primary healthcare level have been the focus of several studies. The present study aimed to assess patient safety culture among all employees of the Community Health Centre Ljubljana.
Methods: We conducted a cross-sectional study in 2017 using the Slovene version of “Medical Office Survey on Patient Safety Culture” from the Agency for Healthcare Research and Quality. Mean percent positive scores on all items in each composite were calculated according to a user guide.
Results: The final sample contained 1021 participants (67.8% response rate), of which 909 (89.0%) were women. The mean age of the sample was 43.0±11.0 years. The dimensions most highly rated by the respondents were: teamwork and patient care tracking/follow-up. The lowest scores came from leadership support for patients’ safety and work pressure and pace.
Conclusion: Patient safety culture in the Community Health Centre Ljubljana is high, but there are certain areas of patient safety that need to be evaluated further and improved. Our study revealed differences between professions, indicating that a customized approach per profession group might contribute to the successful implementation of safety strategies. Patient safety culture should be studied at national levels.
Keywords: patient safety, safety culture, family medicine, primary healthcare, Slovenia
Published in DKUM: 18.10.2024; Views: 0; Downloads: 15
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10. Factors that determine dependence in daily activities : a cross-sectional study of family practice non-attenders from SloveniaTonka Poplas-Susič, Zalika Klemenc-Ketiš, Rok Blagus, Nina Ružić Gorenjec, 2021, original scientific article Abstract: Background: Independence 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.
Objective: We 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.
Design: Cross-sectional observational study.
Settings and participants: Data 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 measure was dependence in daily activities, assessed through eight items: personal hygiene; eating and drinking; mobility; dressing and undressing; urination and defecation; continence; avoiding hazards in the environment; and communication.
Results: The final sample consisted of 1,999 patients (98.7% response rate). The mean age was 59.9 (range 20 to 99). Dependence in daily activities was determined in 466 or 23.3% (95% CI: [21.5, 25.2]) of the patients. Older patients (over 60 years), with at least one chronic disease, increased risk of falling, moderate feelings of loneliness and a lower self-assessment of health were statistically significantly more likely to be dependent in their daily activities, according to our multivariate model.
Conclusions: A considerable proportion of family practice non-attenders were found to be dependent in daily activities, though at a low level. We identified several factors associated with this dependence. This could help to identify people at risk of being dependent in daily activities in the general adult population, and enable specific interventions that would improve their health status.
Keywords: family medicine, ability to perform functions, daily activities
Published in DKUM: 17.10.2024; Views: 0; Downloads: 7
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