THE DEVELOPMENT AND VALIDATION OF AN EVALUATION SYSTEM FOR PATIENTS’ ASSESSMENT OF HEALTH SERVICES

Background: In the service industry, perceived value is a concept of ever-increasing importance. It allows us to describe patients’ perceptions of health services in a significantly more complex manner. To measure patients’ perceptions of health services, we need a different measuring instrument, one that would take into account the multi-dimensional nature of perceived value. Purpose: the development and validation of a new instrument for measuring patient-reported outcomes after treatment. Methodology: the development of this instrument includes test construction, item reduction, validation, and the evaluation of its structure and internal consistency. Both exploratory and confirmatory factor analyses (EFA, CFA) were used. Results: The results of Cronbach’s alpha for different constructs are: is 0.87 for Quality, 0.96 for Reputation, 0.83 for Perceived Value, 0.88 for Price, 0.89 for Satisfaction, and 0.90 for Loyalty. The values of other coefficients (Kaiser-Meyer-Olkin, Bartlett in explained variance) are also adequately high. The final absolute fit indices are: chi-square 426.3, df=137, RMSEA=0.05, NFI=0.96, CFI=0.98. Conclusion: our measuring instrument is characterized by high reliability and validity for measuring outcomes after treatment

Role of synbiotics in reducing postoperative infections in patients with hip fracture: pilot study: Vloga sinbiotikov v zmanjšanju okužb po operacijah zloma v predelu kolčnega sklepa: pilotska študija

Purpose: Despite the development of surgical methods, infections continue to be serious postoperative complications. Probiotics have been shown to be effective in reducing the prevalence of infections. We explored the effectiveness of probiotics in reducing the prevalence of infections in subjects undergoing surgery for hip fractures. Methods: Fifty-one patients admitted for surgical treatment of hip fractures were divided randomly into two groups: Synbiotic 2000 Forte and placebo. The occurrence of infection was closely observed upon hospital admission until the fifth postoperative day using, among other parameters, the C-reactive protein (CRP) level. Additionally, the patients’ tolerance to Synbiotic 2000 Forte was established using subjective (self-reported problems) and objective means. Results: Infection was confirmed in 4 patients in each group. Urinary tract infection was noted in 7 subjects and a local wound infection in 1 patient. No differences were found in CRP levels upon hospital admission and the fifth postoperative day. Tolerance to Synbiotic 2000 Forte was lower in patients undergoing placebo treatment. Conclusion: Synbiotic 2000 Forte did not reduce the number of postoperative infections. Further studies are needed to confirm these findings.Vloga sinbiotikov v zmanjšanju okužb po operacijah zloma v predelu kolčnega sklepa: pilotska študija Namen: Število bolnikov z zlomom v predelu kolčnega sklepa narašča skupaj s staranjem prebivalstva. Okužbe, ki nastopajo po samem posegu, tako sistemske kot lokalne, pomembno vplivajo na uspeh operacije. Uporaba probiotikov dokazano zmanjšuje okužbe, zato nas zanima, ali lahko uporaba le-teh zmanjšuje okužbe tudi v skupini bolnikov po operacijah zlomov v predelu kolčnega sklepa. Metode: Opravili smo dvojno slepo randomizirano študijo pri 51 bolnikih.Ob sprejemu so dobili ali preparat SYNBIOTIK 2000 FORTE ali placebo. Opazovali smo nastanek okužb, merili vrednost C reaktivnega proteinain opazovali, kako so bolniki prenašali uživanje preparata. Rezultati: Okužbe so se pojavile prištirih bolnikih v vsaki skupini. Pri sedmih bolnikih je šlo za uroinfekt in pri enem za okužbo rane Zaključek: V raziskavi nismo dokazali vpliva SYNBIOTICA 2000 FORTE na zmanjševanje okužb po operacijah zlomov v predelu kolčnega sklepa. Število bolnikov bi moralo biti večje, skupina bi morala biti manj heterogena glede na stopnjo ogroženosti bolnikov pred operacijo in na čas med poškodbo in operacijo

Role of synbiotics in reducing postoperative infections in patients with hip fracture

Namen: Število bolnikov z zlomom v predelu kolčnega sklepa narašča skupaj s staranjem prebivalstva. Okužbe, ki nastopajo po samem posegu, tako sistemske kot lokalne, pomembno vplivajo na uspeh operacije. Uporaba probiotikov dokazano zmanjšuje okužbe, zato nas zanima, ali lahko uporaba le-teh zmanjšuj eokužbe tudi v skupini bolnikov po operacijah zlomov v predelu kolčnega sklepa. Metode: Opravili smo dvojno slepo randomizirano študijo pri51 bolnikih. Ob sprejemu so dobili ali preparat SYNBIOTIK 2000 FORTE ali placebo. Opazovali smo nastanek okužb, merili vrednost C reaktivnega proteinain opazovali, kako so bolniki prenašali uživanje preparata. Rezultati: Okužbe so se pojavile prištirih bolnikih v vsaki skupini. Pri sedmih bolnikih je šlo za uroinfekt in pri enem za okužbo rane Zaključek: V raziskavi nismo dokazali vpliva SYNBIOTICA 2000 FORTE na zmanjševanje okužb pooperacijah zlomov v predelu kolčnega sklepa. Število bolnikov bi moralo bitivečje, skupina bi morala biti manj heterogena glede na stopnjo ogroženosti bolnikov pred operacijo in na čas med poškodbo in operacijo.Purpose: Despite the development of surgical methods, infections continue to be serious postoperative complications. Probiotics have been shown to be effective in reducing the prevalence of infections. We explored the effectiveness of probiotics in reducing the prevalence of infections in subjects undergoing surgery for hip fractures. Methods: Fifty-one patients admitted for surgical treatment of hip fractures were divided randomly into two groups: Synbiotic 2000 Forte and placebo. The occurrence of infection was closely observed upon hospital admission until the fifth postoperative day using, among other parameters, the C-reactive protein (CRP) level. Additionally, the patientsʼ tolerance to Synbiotic 2000 Forte was established using subjective (self-reported problems) and objective means. Results: Infection was confirmed in 4 patients in each group. Urinary tract infection was noted in 7 subjects and a local wound infection in 1 patient. No differences were found in CRP levels upon hospital admission and the fifth postoperative day. Tolerance to Synbiotic 2000 Forte was lower in patients undergoing placebo treatment. Conclusion: Synbiotic 2000 Forte did not reduce the number of postoperative infections. Further studies are needed to confirm these findings

Role of synbiotics in reducing postoperative infections in patients with hip fracture: pilot study

Purpose: Despite the development of surgical methods, infections continue to be serious postoperative complications. Probiotics have been shown to be effective in reducing the prevalence of infections. We explored the effectiveness of probiotics in reducing the prevalence of infections in subjects undergoing surgery for hip fractures.&#x0D; Methods: Fifty-one patients admitted for surgical treatment of hip fractures were divided randomly into two groups: Synbiotic 2000 Forte and placebo. The occurrence of infection was closely observed upon hospital admission until the fifth postoperative day using, among other parameters, the C-reactive protein (CRP) level. Additionally, the patients’ tolerance to Synbiotic 2000 Forte was established using subjective (self-reported problems) and objective means.&#x0D; Results: Infection was confirmed in 4 patients in each group. Urinary tract infection was noted in 7 subjects and a local wound infection in 1 patient. No differences were found in CRP levels upon hospital admission and the fifth postoperative day. Tolerance to Synbiotic 2000 Forte was lower in patients undergoing placebo treatment.&#x0D; Conclusion: Synbiotic 2000 Forte did not reduce the number of postoperative infections. Further studies are needed to confirm these findings.</jats:p

Development of the perceived value model for the health care service and it\u27s empirical testing

V doktorski disertaciji podamo celoten in sistematičen pregled teorije o zaznani vrednosti ter oblikovali koncept zaznane vrednosti zdravstvenih storitev, nato pa model empirično preverimo. Model zaznane vrednosti v današnji storitveni dejavnosti ni novost, saj je raziskovan v številnih storitvenih dejavnostih, npr. v turizmu in bančništvu. V zdravstveni dejavnosti, ki sodi med storitvene dejavnosti s posebnimi značilnostmi, takega modela v celovitem pogledu, kot ga predstavljamo mi, nismo zasledili. V doktorski disertaciji podrobno opišemo vse gradnike konceptualnega modela zaznane vrednosti, in sicer tako predhodnike kot posledice. Pri vseh gradnikih vključimo tudi posebnosti, ki veljajo v zdravstveni dejavnosti. Po teoretičnem raziskovanju do zdaj znanih povezav med posameznimi gradniki oblikujemo konceptualni model povezav predhodnikov in posledic zaznane vrednosti storitev. Na podlagi tega oblikujemo naslednje hipoteze: H1: Višja kot je zaznana kakovost zdravstvene storitve, višja je njena zaznana vrednost. H2: Višja kot je zaznana kakovost zdravstvene storitve, večje je zadovoljstvo bolnikov. H3: Večji kot je ugled ponudnika zdravstvene storitve, višja je njena zaznana kakovost. H4: Večji kot je ugled ponudnika zdravstvene storitve, višja je njena zaznana vrednost. H5: Višja kot je zaznana vrednost zdravstvene storitve, večje je zadovoljstvo bolnikov. H6: Višja kot je zaznana vrednost zdravstvene storitve, večja bo zvestoba bolnikov. H7: Višja kot je zaznana cena zdravstvene storitve, višja je njena zaznana kakovost. H8: Nižja kot je zaznana cena zdravstvene storitve, višja je njena zaznana vrednost. H9: Med uporabniki zdravstvenih storitev v javnem in zasebnem sektorju prihaja do statistično značilnih razlik v zaznavanju vrednosti zdravstvenih storitev. Empirično prevetritev smo naredili na vzorcu 800 bolnikov (400 v javnem zavodu in 400 pri koncesionarju). Analiza zanesljivosti in veljavnosti potrjuje kakovost uporabljenega vprašalnika. Zanesljivosti posameznih merjenih konstruktov v modelu, merjenih s Cronbachovim koeficientom zanesljivosti α, so naslednje: zaznana kakovost 0,80, ugled 0,96, zaznana vrednost 0,83, zaznana cena 0,88, zadovoljstvo 0,89 in zvestoba 0,89. Za pomembno boljše prilaganje podatkov modelu v konceptualni model vključimo povezavo med zadovoljstvom bolnikov in zvestobo. Ta povezava je tudi vsebinsko podprta v literaturi. Po dodani povezavi se indeksi globalne ustreznosti bistveno izboljšajo oz. presegajo minimalno želene vrednosti, in sicer: hi-kvadrat = 349,6 (sig. = 0,00), df = 143, RMSEA = 0,05, NFI = 0,96, CFI = 0,97. Na podlagi predstavljenih statističnih značilnosti povezav iz končnega strukturnega modela lahko potrdimo vse postavljene hipoteze. Po testiranju H9 lahko zaključimo, da prihaja med uporabniki zdravstvenih storitev v javnem in zasebnem sektorju do statistično značilnih razlik v zaznavanju vrednosti zdravstvenih storitev. Prispevkov naše doktorske disertacije je veliko. Iz fragmentiranega znanja smo naredili celovit pregled znanj s področja zaznane vrednosti na področju zdravstva. Razvoj končnega merilnega instrumenta je metodološki prispevek v zakladnico znanja. Verjetno ni treba posebej poudariti, da tako izvedene raziskave v slovenskem prostoru na področju zdravstva ni bilo, tako obsežnega modela, ki bi bil empirično preverjen, pa tudi nismo našli v svetovni zakladnici znanja.In our doctoral thesis, we have introduced a complete and systematic overview of a theory on perceived value, we have formed a concept of the perceived value in health services and we have empirically tested the model. The model of the perceived value is not a novelty in a nowadays service activity, the model is researched in numerous service activities, such as also tourism and banking. Regarding the health care service, which belongs among the service activities with significant characteristics, we had not come across any such model within the comprehensive view as we present it. In our thesis, we describe in details all cornerstones of the conceptual model of the perceived value, that is forerunners as well as consequences. Within all cornerstones there are included also significances which are characteristic in the health care service. After the theoretical research of the, up to this point, known connections among the individual cornerstones, we formed the conceptual model of the connections among the forerunners and the consequences of the perceived value of the services, and thus we formed the following hypotheses: H1: The higher perceived quality of the health service, the higher its perceived value. H2: The higher perceived quality of the health service, the higher satisfaction of the patients. H3: The higher reputation of the health service provider, the higher its perceived quality. H4: The higher reputation of the health service provider, the higher its perceived value. H5: The higher perceived value of the health service, the higher satisfaction of the patients. H6: The higher perceived value of the health service, the higher loyalty of the patients. H7: The higher perceived price of the health service, the higher its perceived quality. H8: The lower perceived price of the health service, the higher its perceived value. H9: There are statistically significant differences in perceiving the value of the health services among users of the health services in public and private sector. We carried out the empirical verification on a sample of 800 patients (400 in a public institution and 400 at a concessionaire). The analysis of certainty and validity confirms the quality of the used questionnaire. The certainty of measured individual constructs in the model, measured with the certainty coefficient Cronbach α, is: the perceived quality 0,80, the reputation 0,96, the perceived value 0,83, the perceived price 0,88, the satisfaction 0,89 and the loyalty 0,89. Due to significantly better adjustment of the data within the model, we included in the conceptual model the connection between the satisfaction of the patients and the loyalty. This connection is also substantively supported in literature. After the connection is added, indexes of a global adequacy are significantly improved, respectively they exceed required minimal values: Hi – square=349,6 (sig.=0,00), df=143, RMSEA=0,05, NFI=0,96, CFI=0,97. On the basis of the presented statistical characteristics of connections from the final structural model, we can confirm all formed hypotheses. After testing H9 we may conclude that there are statistically significant differences in perceiving the value of the health services among users of the health services in the public and the private sector. There are many contributions of our doctoral thesis. By using the fragmentary knowledge, we have made a complete overview of different knowledge regarding a field of the perceived value on the field of health care. The development of the final measuring instrument is a methodological contribution to the knowledge treasure trove. It is probably not necessary to specifically point out that there had not been any researches carried out in such way in Slovenian area before, and in the world knowledge treasure trove we had also not found such extensive model, which would be empirically checked

Safety culture in the operating room

Izhodišča in namen raziskave: Bolnikova varnost je postala glavna skrb izvajalcev in kreatorjev zdravstvenega sistema, saj se v Evropi varnostni zapleti zgodijo pri 8 % do 12 % vseh sprejetih bolnikov v bolnišnice. Metode: Razvili smo slovenski vprašalnik odnosa do varnosti v operacijskih dvoranah in na istem vzorcu zaposlenih v operacijskih dvoranah v sedmih od deset slovenskih regionalnih bolnišnicah ugotavljali vpliv poklicne skupine in izkušenj na odnos do varnosti. Nadaljevali smo s kvalitativno raziskavo, kjer smo pri predstavnikih poklicnih skupin, ki delajo v operacijskih dvoranah, ugotavljali odnos do incidentne situacije. Na koncu pa preverili, kako se upoštevajo priporočila za uporabo preventivne antibiotične zaščite. Rezultati: Slovenska verzija vprašalnika odnosa do varnosti v operacijski dvorani vsebuje 28 vprašanj in izkazuje primerne kriterije veljavnosti in zanesljivosti. Pri reševanju incidentov ne pride do pomoči med različnimi profili zaposlenih v operacijski dvorani. Vsi elementi perioperativne antibiotične zaščite so bili pravilno upoštevani pri 82 % bolnikov. Zaključek: Slovenski vprašalnik o varnostni kulturi v operacijskih dvoranah je dober merilni instrument, in se lahko uporablja tako pri opredelitvi potencialno nevarnih področij za varnost bolnikov kakor za merjenje učinka ukrepov za povečanje kulture varnosti.Basis and purpose of the survey: Patient safety has become the main concern of providers and creators of the healthcare system, since in Europe safety complications occur with 8-12 % of all patients admitted to hospitals. Methods: We developed a Slovenian questionnaire on attitudes towards safety in operating rooms, and on the same sample of employees in the operating rooms of seven out of the ten Slovenian regional hospitals, ascertained the influence of occupational groups and experience in attitudes towards safety. We continued with a qualitative study, where we looked at the attitude of representatives of the occupational groups working in operating rooms towards an incident situation. Finally, we checked how well the recommendations for the use of preventive antibiotic protection were followed. Results: The Slovenian version of the questionnaire on attitudes towards safety in the operating room contains 28 questions and demonstrates adequate criteria of validity and reliability.When dealing with incidents, there is no assistance between different profiles of employees in the operating room. All the elements of perioperative antibiotic protection were properly considered in 82% of patients. Conclusion: The Slovenian questionnaire on safety culture in operating rooms is a good measuring instrument, and it can be used both for defining potentially dangerous areas for the patient’s safety, and for measuring the effect of measures to increase the culture of safet

Safety culture in the operating room

Background: Measuring the safety culture in Healthcare is an important step in improving patient safety. One of the most commonly used instruments to measure the safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the current study was to establish the validity and reliability of the Slovenian version of the SAQ for the operating room SAQ-OR. Methods: The SAQ, consisting of six dimensions, was translated and adapted to the Slovenian context and applied in operating rooms from seven out of ten Slovenian regional hospitals. Cronbach\u27s alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument. Results: The sample consisted of 243 health care professionals who hold positions in the OR, divided into 4 distinct professional classes, namely, 76 surgeons (31%), 15 anesthesiologists (6%), 140 nurses (58%) and 12 auxiliary persons (5%). It was observed a very good Cronbach\u27s alpha (0.77 to 0.88). The CFA and its goodness-of-fit indices (CFI 0.912, TLI 0.900, RMSE 0.056, SRMR 0.056) showed an acceptable model fit. There are 28 items in the final model. Conclusions: The Slovenian version of the SAQ-OR revealed good psychometric properties for studying the organisational safety culture

Visi deformity after wrist fracture: Case report

Background: Distal radius fractures (fractura radii loco typico) are an everyday task for a surgeon that deals with injuries. Oftentimes complicated associated injuries of the ligamentous apparatus occur, which are hard to recognise and demand appropriate care. If such injuries remain unrecognised, they lead to more serious functional disorders, which is why the purpose of this report is to point out a rare and serious complication of distal radius fracture.Case presentation: We report the case of a 20-year-old man who suffered a fracture of the radius and developed a serious associated ligamentous disorder that was discovered relatively late.Conclusion: Ligamentous injuries associated with distal radius fractures represent a serious diagnostic challenge and, due to their consequences, also a serious clinical challenge. They are often hard to recognise and get discovered late. If the treatment shows no improvement, diagnostic images should be carefully analysed, and the physician should be well acquainted with relevant pathological conditions.</jats:p

Pogled na izvajanje brezšivne skrbi v regionalni bolnišnici – kvalitativna raziskava

In Slovenia, the notion of seamless care has been relatively new in the recent past. It suggests that clinical pharmacists have a significant role in working closely with patients and enhancing their safety. The perspective of clinical pharmacists in a novel work environment piqued our curiosity. We conducted a qualitative research. We obtained the necessary information through interviews conducted with four clinical pharmacists who have the most theoretical and practical knowledge in the field of seamless care. The interviewees believe that the implementation of seamless care in clinical practice is important and positive. However, they are distracted by administrative obstacles in carrying out seamless care. The detection of clinical pharmacists is appropriate and enables the development of the method to other professional groups.Koncept brezšivne skrbi je v Sloveniji novost zadnjih let. Pomeni pomembno vključitev kliničnih farmacevtov pri neposrednem delu z bolniki in prispeva k bolnikovi varnosti. V polni obliki se v naši ustanovi izvaja dobro leto. Zanimal nas je pogled kliničnih farmacevtov na nov način dela. Izvedli smo kvalitativno raziskavo. Potrebne informacije smo pridobili s pomočjo intervjujev, ki smo jih izvedli s štirimi kliničnimi farmacevti, ki imajo največ teoretičnega in praktičnega znanja s področja brezšivne skrbi. Intervjuvanci menijo, da je implementacija brezšivne skrbi v klinično prakso pomembna in pozitivna. Motijo jih administrativne ovire pri izvajanju brezšivne skrbi.&nbsp; Zaznava kliničnih farmacevtov je primerna in omogoča razvoj metode še na ostale poklicne skupine