The Safety Culture of The Ljubljana Community Health Centre's Employees.

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.

Effectiveness of the Use of Augmented Reality in Teaching the Management of Anaphylactic Shock at the Primary Care Level: Protocol for a Randomized Controlled Trial.

BACKGROUND: Augmented reality (AR) has benefits and feasibility in emergency medicine, especially in the clinical care of patients, in operating rooms and inpatient facilities, and in the education and training of emergency care providers, but current research on this topic is sparse. OBJECTIVE: The primary objective is to evaluate the short-term and long-term effectiveness of the use of AR in the treatment of patients with anaphylactic shock. The secondary objectives are to evaluate the safety in the treatment of patients with anaphylactic shock, evaluate the short-term and long-term effectiveness of stress management in this process, and determine the experiences and attitudes towards the use of AR in education. METHODS: The study will be conducted in 3 phases. In the first phase, we will develop and test the scenario for simulation of anaphylactic shock and the evaluation scale for assessing the effect of the intervention. In the second phase, a single-blinded, randomized controlled trial will be conducted. In the third phase, the use of AR in teaching the management of anaphylactic shock using focus groups will be evaluated qualitatively. All participants will participate in a 1-day training program consisting of a lecture on emergency care and anaphylactic shock as well as exercises in manual dexterity (aspiration, airway management, alternative airway management, artificial respiration, chest compressions, safe defibrillation, oxygen application, use of medication during emergency care). The test group will also focus on education about anaphylactic shock in AR (the intervention). The main outcome will be the evaluation of the participants' performance in coping with a simulated scenario of anaphylactic shock using a high-fidelity simulator (simulator with high levels of realism) and a standardized patient in an educational and clinical environment. The study will be conducted with primary care physicians. RESULTS: A scenario for the simulation with a high-fidelity simulator and standardized patient has already been developed. For the time being, we are developing an evaluation scale and starting to recruit participants. We plan to complete the recruitment of participants by the end of December 2020, start the randomized controlled trial in January 2021, and finish 1 year later. The first results are expected to be submitted for publication in 2021. CONCLUSIONS: This will be the first study to evaluate the effectiveness of the use of AR in medical teaching. Specifically, it will be based on a clinical case of anaphylactic shock at the primary care level. With our study, we also want to evaluate the translation of these educational results into clinical practice and assess their long-term impact. TRIAL REGISTRATION: ISRCTN Registry ISRCTN58047410; http://www.isrctn.com/ISRCTN58047410. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/22460.

Development of an Algorithm for Determining of Genetic Risk at the Primary Healthcare Level - A New Tool for Primary Prevention: A Study Protocol.

INTRODUCTION: Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia. METHODS: A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented. RESULTS: The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared. CONCLUSION: By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.

Glucose transporter-1 (GLUT-1) immunoreactivity in benign, premalignant and malignant lesions of the gallbladder.

GLUT-1 is a transmembrane glucose transport protein that allows the facilitated transport of glucose into cells, normally expressed in tissues which depend mainly on glucose metabolism. Enhanced expression of GLUT-1 can also be found in a large spectrum of carcinomas. This study aimed to investigate GLUT-1 expression in gallbladder tissue: from normal tissue samples, hyperplasias, low-grade and high-grade dysplasias to gallbladder carcinomas. In all, 115 archived samples of gallbladder tissue from 68 patients, presented after cholecystectomy, were immunohistochemically stained for GLUT-1. According to the intensity of GLUT-1 immunoreactivity, samples were divided into negative (stained 0-10% of cells stained), positive with weak to moderate (10-50%) and positive with strong (>50%) GLUT-1 expression. The GLUT-1 immunoreactivity of the samples showed a characteristic increase from premalignant lesions to carcinomas. Normal gallbladder tissue samples did not express GLUT-1 (100%). Weak expression was shown only focally in hyperplasias, but to a greater extent with low-grade dysplasias (20%), high-grade dysplasias (40%) and carcinomas (51.8%). Normal gallbladder tissue is GLUT-1 negative. GLUT-1 expression in carcinoma tissue is significantly higher than in dysplastic lesions. Strong GLUT-1 expression indicates 100% specificity for detecting gallbladder carcinomas. Therefore, GLUT-1 is a candidate as a diagnostic as well as a tissue prognostic marker in gallbladder carcinoma patients.