A remote care model for patients at high risk of hospital admission due to COVID-19 deterioration: who makes it at home? - a multicenter follow-up case from Slovenia.

AIM: To assess the feasibility of a remote care model for high-risk COVID-19 patients, identify risk factors for hospital admission, and propose modifications to the tested model. METHODS: We conducted a multicenter observational study of 225 patients (55.1% male) treated at three primary care centers between October 2020 and February 2022. Patients were enrolled into a telemonitoring program if they had a mild-moderate course of COVID-19 confirmed by polymerase chain reaction testing and were classified as high-risk for COVID-19 deterioration. Patients measured their vital signs three times daily, consulted their primary care physician every other day, and were followed up for 14 days. At inclusion, data were collected with a semi-structured questionnaire, and blood was drawn for laboratory analysis. A multivariable Cox regression model was used to determine predictors of hospital admission. RESULTS: The median age was 62 years (range 24-94). The hospital admission rate was 24.4%, and the mean time from inclusion to hospital admission was 2.7±2.9 days. A total of 90.9% of patients were hospitalized within the first five days. A Cox regression model, adjusted for age, sex, and the presence of hypertension, revealed that the main predictors of hospital admission were type-2 diabetes (hazard ratio [HR] 2.38, 95% confidence interval [CI] 1.19-4.77, P=0.015) and thrombocytopenia (HR 2.46, 95% CI 1.33-4.53, P=0.004). CONCLUSION: Telemonitoring of vital signs is a feasible method of remote care that helps identify patients requiring immediate hospital admission. For further scale-up, we suggest shortening call intervals in the first five days, when the risk of hospital admission is highest, and giving special attention to patients with type-2 diabetes and thrombocytopenia at inclusion.

Tailoring First Aid Courses to Older Adults Participants.

Relevant organizations emphasize the importance of first aid (FA) for older adults due to the increased risk of injuries and sudden illnesses in old age. Even though FA training guidelines have been developed, no program for an FA course adapted for the older adults has been formally adopted in Europe. This study's objective is to identify older adults' needs, beliefs, desires, advantages, and possible limitations in connection with FA. This qualitative study used semistructured interviews with 22 laypersons and retired health professionals older than 60 years old. The qualitative content analysis indicated that the major themes elicited by the older adults are motivation to participate in the FA training, older adults' specific features as a resource or obstacle for participating in FA training, general suggestions, and content suggestions for FA training. Older adults are very differently motivated to participate in FA training due to the heterogeneity of their psychophysical abilities. They need and want to obtain additional knowledge from the field of FA and health protection for which any psychophysical limitations are not as relevant as when learning cardiopulmonary resuscitation. They want to learn how to recognize emergency situations and more about calling emergency services with the use of modern technology. In addition to cardiopulmonary resuscitation without rescue breaths, they also want to learn about topics related to the treatment of injuries. Those who had practiced FA in their work-life think that they can be a good source to transfer their knowledge to persons from their generation. While planning an FA training course, it has to be taken into consideration that older adults want a short course, adjusted to their varied psychophysical abilities. Due to the wide array of contents they want to learn, it would be reasonable to prepare a selection of different programs for short training courses.

European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

BACKGROUND: the European Union of Medical Specialists (UEMS-GMS) recommendations for training in Geriatric Medicine were published in 1993. The practice of Geriatric Medicine has developed considerably since then and it has therefore become necessary to update these recommendations. METHODS: under the auspices of the UEMS-GMS, the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA), a group of experts, representing all member states of the respective bodies developed a new framework for education and training of specialists in Geriatric Medicine using a modified Delphi technique. Thirty-two expert panel members from 30 different countries participated in the process comprising three Delphi rounds for consensus. The process was led by five facilitators. RESULTS: the final recommendations include four different domains: 'General Considerations' on the structure and aim of the syllabus as well as quality indicators for training (6 sub-items), 'Knowledge in patient care' (36 sub-items), 'Additional Skills and Attitude required for a Geriatrician' (9 sub-items) and a domain on 'Assessment of postgraduate education: which items are important for the transnational comparison process' (1 item). CONCLUSION: the current publication describes the development of the new recommendations endorsed by UEMS-GMS, EuGMS and EAMA as minimum training requirements to become a geriatrician at specialist level in EU member states.

The Drinking Habits of Users of an Alcohol Drinking Screening Website in Slovenia.

BACKGROUND: Alcohol consumption in Slovenia is one of the highest in Europe. In Slovenia there were a few epidemiological studies on drinking habits among adult population, but none of them has used the AUDIT questionnaire or the Internet for research. OBJECTIVE: The aim of this study was to analyse the drinking habits of the visitors of our website www.nalijem.si, which included an anonymous questionnaire for self-assessment of alcohol drinking. METHODS: A cross sectional survey was conducted between January 2010 and December 2013. The front page of our website included an invitation to fill in the anonymous web-based questionnaire; a part of it was the AUDIT 10 questionnaire. Everyone who filled in the questionnaire completely received an individualized feedback on his drinking. RESULTS: 54.020 persons visited our website, 15.817 (29.3%) of them started to fill in the questionnaire, 12.800 (80.9%) filled it in completely. In the analysis, 9.087 (71.0%) persons were included who completed the questionnaire for themselves. There were 37.1% (N=3.373) women and 62.9% (N=5.714) men. The average age was 33 years, the majority was employed (59.7%, N=5.222). The minority drank alcohol 2-4 times per month (32.8%, N=2.977) and most of them (64.5%, N=5.869) drank more than 3 units of alcohol per one occasion on a typical day. The average AUDIT 10 score was 11.7 for men, 8.1 for women. CONCLUSIONS: A large percentage of participants were identified as hazardous and harmful drinkers, which should be a matter of serious concern.

Alcohol Drinking Among the Students of the University of Maribor, Slovenia.

BACKGROUND: Hazardous and harmful alcohol drinking is an important health, social and economic issue in Slovenia amongst all age groups. While drinking in Slovenia has been well researched amongst elementary and high school students, there is a lack of research on drinking amongst university students. METHODS: We conducted a cross-sectional study among first- and fourth-year students of the University of Maribor, Slovenia, attending the mandatory preventive health check between October 2009 and May 2010. During this health check, they filled in a non-anonymous lifestyle questionnaire. AUDIT-C questionnaire on alcohol use and questions on smoking and illicit drug use were also included. RESULTS: 3.130 students were included in the analysis, 1219 (38.9%) were males. There were 871 (27.8%) students that were screened as risky drinkers. The highest percentage of risky drinkers attended the Faculty for Wood Technology and the lowest the Faculty for Health Sciences. Students, recognized as healthier by the physicians, reported risky drinking significantly less often (p=0.015). Students with higher BMI reported risky drinking significantly more often (p=0.012). Variables, proved to be independently associated with the risky drinking in the multivariate analysis, were: bad health status (p=0.044), male sex (p<0.001), daily consumption of fried food (p=0.017), smoking (p<0.001), illicit drugs (p<0.001), attending the Faculty for Civil Engineering (p=0.006), not attending the Faculty for Health Sciences (p=0.002). CONCLUSIONS: While the prevalence of risky drinking among students in this study is high, a structured preventive programme should be implemented for students, which will include also illicit drug use and smoking.

Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation.

BACKGROUND: Post-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) and is difficult to treat. The role of antiviral agents and nonpharmacologic procedures in preventing PHN is not entirely clear. Recent retrospective study showed that transcutaneous electrical nerve stimulation (TENS) may completely prevent PHN. The aim of our study was to identify predictors for PHN and evaluate the treatment with antiviral agents and TENS. METHODS: We conducted a multicenter prospective, randomized intervention study in patients with a new onset of HZ. Immunocompromised patients were excluded. Patients were randomly assigned to four groups (TENS, Antiviral agents, TENS and Antiviral agents, and Control Group). At the inclusion, the following criteria were recorded: age, gender, duration of pain before the onset of the rash, the number of efflorescence, the intensity of pain, and the analgesic prescribed. During the follow-up, we recorded a spontaneous pain sensation, pain intensity, and presence of allodynia, hyperalgesia, or paraesthesia. RESULTS: With each additional year of age, the odds for the presence of PHN with unchanged values of other predictors increase (odds ratio (OR) = 1.03 [1.01; 1.05], p = 0.001). The same is true for the initial intensity of the pain (OR = 1.25 [1.09; 1.43], p = 0.002). The odds for acute and subacute herpetic neuralgia are greater than for PHN. The odds for subacute herpetic neuralgia are the lowest in the group treated with TENS (OR = 0.15 [0.05; 0.47], p = 0.001). CONCLUSIONS: PHN cannot be completely prevented. TENS as a single therapy was found the most successful among the tested treatments in reducing the incidence of subacute herpetic neuralgia.

Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners.

AIMS: To document the attitudes of general practitioners (GPs) from eight European countries to alcohol and alcohol problems and how these attitudes are associated with self-reported activity in managing patients with alcohol and alcohol problems. METHODS: A total of 2345 GPs were surveyed. The questionnaire included questions on the GP's demographics, reported education and training on alcohol, attitudes towards managing alcohol problems and self-reported estimates of numbers of patients managed for alcohol and alcohol problems during the previous year. RESULTS: The estimated mean number of patients managed for alcohol and alcohol problems during the previous year ranged from 5 to 21 across the eight countries. GPs who reported higher levels of education for alcohol problems and GPs who felt more secure in managing patients with such problems reported managing a higher number of patients. GPs who reported that doctors tended to have a disease model of alcohol problems and those who felt that drinking was a personal rather than a medical responsibility reported managing a lower number of patients. CONCLUSION: The extent of alcohol education and GPs' attitudes towards alcohol were associated with the reported number of patients managed. Thus, it is worth exploring the extent to which improved education, using pharmacotherapy in primary health care and a shift to personalized health care in which individual patients are facilitated to undertake their own assessment and management (individual responsibility) might increase the number of heavy drinkers who receive feedback on their drinking and support to reduce their drinking.

Slovenian adaptation of the original AUDIT-C questionnaire.

BACKGROUND: Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. METHODS: Changes in second and third questions with theoretical simulation of possible answers' combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. RESULTS: Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. CONCLUSIONS: Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor-patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.

Opinions of Slovenian family physicians on medically unexplained symptoms: a qualitative study.

OBJECTIVES: To determine the views of Slovenian family physicians on medically unexplained symptoms (MUS) and learn more about potential types of treatment for such patients. METHODS: Five focus groups, comprising 24 family medicine physicians (FMPs) from two Slovenian University centres, were convened. Conversations were led towards the research objectives by professionally trained researchers and followed a preliminarily established protocol. Qualitative content analysis of audio and transcripts of the discussions was performed using ATLAS.ti software to establish categories ('codes') relevant to issues regarding MUS. RESULTS: Slovenian FMPs emphasized the importance of good communication and trust between physicians and patients with MUS. Systemic barriers to effective management of MUS arising from the Slovenian health system were highlighted. FMPs stressed the need for more education in the recognition and treatment of MUS in primary care. From the discussions, 64 codes comprising broader research fields of MUS were developed, then grouped into a further eight categories: communication; doctor-patient relationship; causes of MUS; patient characteristics; physician characteristics; courses of action so far; positive relationship with patients; proposals for treatment. CONCLUSIONS: The results are valuable in terms of investigating the treatment of patients with MUS in Slovenia, thereby opening new avenues of research on the subject of MUS.

Health-related lifestyle, physical and mental health in children of alcoholic parents.

AIM: To identify potential differences between children of alcoholics (COAs) and controls in their health-related lifestyle, mental and physical health. METHODS: The recruitment of COAs took place in inpatient and outpatient treatment and rehabilitation units. Controls were recruited in elementary and high schools. 57 COAs (72% response rate) and 84 controls (88% response rate) aged between 12 and 18 years completed a postal questionnaire about their health-related lifestyle, and mental and physical health. RESULTS: Bivariate analysis showed that COAs' families have higher unemployment rates and lower economic status (P = 0.000). COAs reported poorer school performance (P = 0.000), spending more time in sedentary (television: P = 0.000, Internet: P = 0.014, music: P = 0.040) and less time in physical activities (P = 0.048), having poorer eating habits (fruits and vegetables: P = 0.001, sweets: P = 0.001, fast food: P = 0.000, soft drinks: P = 0.004), a higher substance use (cigarettes: P = 0.030; marijuana: P = 0.564, heavy drinking: P = 0.050) and more mental health difficulties (emotional symptoms: P = 0.015, conduct problems: P = 0.012, suicidal tendencies: P = 0.007, mental disorder: P = 0.040). Among COAs, girls reported more emotional and somatic symptoms compared to boys (P = 0.020 and P = 0.047, respectively). Multivariate analysis showed that after controlling for socioeconomic status, significant mental health and health-related lifestyle inequalities between COAs and controls persist. CONCLUSION: Our findings suggest that COAs have a less healthy lifestyle and more mental health difficulties above and beyond the poorer economic environment they live in.

TENS - an alternative to antiviral drugs for acute herpes zoster treatment and postherpetic neuralgia prevention.

QUESTIONS UNDER STUDY: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) in treatment of Herpes zoster (HZ), and prevention of postherpetic neuralgia (PHN) compared with antiviral drugs. PHN is frequent complication of HZ and may last for months, its treatment isn't very successful. Nonpharmacological regimens for treatment of HZ and prevention of PHN haven't been evaluated. METHODS: Retrospective observational study of medical records of patients of three family physicians in Health centre Litija, Slovenia was done. 109 of 6613 patients on their lists had HZ from 1999 to 2008. 102 medical records were analyzed (6 could not be reached; one patient with corneal HZ was excluded). RESULTS: Four treatment groups were compared: only TENS therapy, only antiviral drug, antiviral drug and TENS, no therapy (neither antiviral drug or TENS). All groups were similar with respect to demographic characteristics of patients with HZ. Patients treated only with TENS had no PHN, 28.6% of patients treated with antiviral drugs had PHN. Less analgesic drugs have been prescribed to patients treated only with TENS. CONCLUSION: Study suggests TENS may be safe adjunct or even alternative to antiviral drugs for treatment of acute HZ. It looks that TENS may be at least as good as antiviral drugs for treatment of HZ, and it may be better in reducing and preventing PHN - such conclusion would necessitate controlled, prospective study. Use of TENS provided pain relief and resolution of skin lesions with no higher rate of other HZ complications compared to antiviral therapy.

Family doctors' views of pharmaceutical sales representatives: assessment scale development.

BACKGROUND: The prescribing patterns depend on the physicians' attitudes and their subjective norms towards prescribing a particular drug, as well as on their personal experience with a particular drug. The physicians are affected by their interactions with pharmaceutical industry. OBJECTIVE: The objectives were to develop a scale for assessment of pharmaceutical sales representatives (PSRs) by the family doctors (FDs) and to determine factors for their evaluation. METHOD: Cross-sectional anonymous postal study. We included a random sample of 250 Slovenian FDs. Settings. Slovenian FDs' surgeries. MAIN OUTCOME MEASURE: The score of various items regarding FDs' assessment of PSRs on a 7-point Likert scale. RESULTS: We got 163 responses (65.2% response rate). The most important characteristic of PSRs, as rated by respondents on the scale from 1 to 7, was the fact that they did not mislead when presenting products' information. The second most important characteristic was the ability to provide objective information about the product. The first three most important characteristics, as rated by the respondents by themselves, were 'Shows good knowledge on the promoted subject', 'Provides objective product information' and 'Makes brief and exact visits'. Cronbach's alpha of the composite scale was 0.844. Factor analysis revealed three PSRs' factors: selling skills, communicating skills and sense of trustworthiness. CONCLUSION: FDs evaluate PSRs mainly by their managerial skills and trustworthiness. The scale proved to be a reliable tool for assessing PSRs by FDs.

Why do general practitioners not screen and intervene regarding alcohol consumption in Slovenia? A focus group study.

AIM: To identify barriers influencing general practitioners' decisions regarding alcohol screening and brief intervention (SBI) in Slovenia. BACKGROUND: Slovenia occupies third place in a league of 51 European countries with respect to alcohol consumption. General practitioners in Slovenia have the majority of contacts with patients in primary healthcare but they rarely or never ask patients about their drinking habits. METHOD: Six focus groups with a total of 32 general practitioners from different parts of the country were set up. Participants discussed varied topics and the most significant barriers were identified through qualitative analysis. RESULTS: The identified barriers were lack of funding, absence of societal support, lack of knowledge and guidelines, inadequate counselling skills, different interpretations regarding definitions of what constitutes an alcoholic beverage, lack of time, alcohol screening not considered to be an integral part of general practice, personal characteristics of general practitioners, patients' unwillingness to participate in SBI, and ethical dilemmas. CONCLUSION: Lack of knowledge and guidelines, and inadequate counselling skills can be solved through educational programs. In order to change drinking habits, substantial changes in public and personal attitudes towards alcohol consumption, involving many partners, are necessary.

Implementing electronic medical record in family practice in Slovenia and other former Yugoslav Republics: barriers and requirements.

The author describes problems related to the implementation of electronic medical record in family medicine in Slovenia since 1992 when first personal computers have been delivered to family physicians' practices. The situation of health care informatization and implementation of electronic medical record in primary health care in new countries, other former Yugoslav republics, is described. There are rather big differences among countries and even among some regions of one country, but in the last year the situation improved, especially in Montenegro, Serbia and Slovenia. The main problem that is still unsolved is software offered by several companies which do not offer many functions, are non-standardized or user friendly enough and is not adapted to doctors' needs. Some important questions on medical records are discussed, e.g. what is in fact a medical record, what is its purpose, who uses it, which record is a good one, what should contain and confidentiality issue. The author describes what makes electronic medical record better than paper-based one (above all it is of better quality, efficiency and care-safe, easier in data retreival and does it offer the possibility of data exchange with other health care professionals) and what are the barriers to its wider implementation.

Qualitative study on community and primary health care involvement on alcohol and tobacco actions in seven European countries.

Alcohol and tobacco use are important determinants of illness and have important country-specific dimensions. It's important to also consider them at community and primary health care (PHC) levels. A collaborative qualitative research (Delphi study and focus groups methodology) was conducted during the process of 10 new countries joining the European Union (EU) and implemented in culturally socio-economically different European countries: four EU (Belgium, Brussels region; Hungary, Pest County; Italy, Friuli Venezia Giulia region; Latvia, Riga region; Slovenia, Ljubljana region) and two Eastern European countries (Bulgaria, Sofia region; Russia, St. Petersburg region). Countries were chosen from the WHO international project according to the criteria noted in the application for EU INCO-COPERNICUS funding. Focus groups were conducted among lay people and PHC professionals in order to identify factors that influence (facilitate and prevent or minimize) PHC management of alcohol- and tobacco use-related problems. A Delphi study was conducted among four different groups in order to develop tasks for instances to be involved in community health policies. There are some limitations of such a qualitative study; e.g., such studies give ideas that cannot simply be transformed to actions in every country. In order to manage tobacco-and alcohol-related problems a comprehensive community-based approach, that also include PHC teams and policymakers, would be supported in participating countries.

Specialist training of Slovene family physicians.

UNLABELLED: Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. CONCLUSION: A comparison with UEMO countries shows that the new model is comparable to other countries.

Community actions against alcohol drinking in Slovenia--a Delphi study.

AIM: To define the national strategy and public actions to reduce alcohol related harm, based on societal consensus. BACKGROUND: Alcohol abuse is an avoidable behaviour that can threaten health. In Slovenia, only a few public campaigns against drinking alcohol are under way. It is important to establish which community measures are acceptable to society in Slovenia in order to reduce alcohol-related risks. METHODS: A Delphi study with 45 professionals from different disciplines was conducted. Participants offered many suggestions to improve the current situation. After three rounds of questionnaires, 86 participant statements were accepted as a consensus. RESULTS: Actions such as: state monopolies, alcohol taxation, legislative restrictions on availability and purchase of alcohol, age-related restriction on sales, drink-driving laws, school-based alcohol education and media information campaigns are most likely to be achieved by consensus. The main target populations for implementation of alcohol-related educational programs are children, young people and employees. CONCLUSIONS: As a result of the study, a number of community actions against drinking alcohol that could be acceptable for society can now be suggested. They vary across different target populations, change agents (individuals, organizations and institutions) and methods of implementation.

Introducing performance-based assessment of family physicians.

Slovenia has implemented a new final summative assessment for vocational training in family medicine. As all family medicine trainees work independently in practice, the assessment is focused on actual performance. The preparation included a literature search, consultation with foreign experts, consultation with tutors and trainees in general practice and testing the assessment with experienced practitioners. The assessment includes three elements: (1) a trainee's report with data on population served, audit of practice and family profiles; (2) a visit to the trainee's practice which includes sitting in with the trainee, and assessment of patients' records, equipment and premises; (3) the final assessment, which includes an MCQ written test, OSCE stations, and an oral exam with discussion about the candidate's report, presentation of five cases from his/her practice and one question by each examiner to assess problem-solving skills. Initial experience has been favourable but further work is needed for evaluation of the assessment.