Hospitals In Slovenia Research Articles

Experiences with paediatric hospital health care: a cross-sectional study among paediatric patients

Abstract Background The measurement of patient experiences is gaining importance in many healthcare systems, including the Slovenian one. The need for a national survey on patient experiences in the paediatric inpatient settings emerged recently. Methods The survey took into account various aspects of inpatient healthcare such as admission, hospital staff, safety, food and discharge from hospital. As part of the study, children/parents were able to give praise and suggestions for improvements. We used three different questionnaires adapted to the cognitive abilities of children - a child questionnaire for the age group 9-13 years in paper form, an online adolescent questionnaire for the age group 14-18 years, and an online parent questionnaire for the age group 0 (1 month)-8 years. The questionnaires were cognitively tested and piloted before national rollout. Results The national survey was conducted between September 2023 and March 2024 and included paediatric patients who spent at least one night in an acute paediatric hospital ward. The survey included 25 paediatric wards and totally 1965 questionnaires were valid for analysis. The rough response rate was 17,6 %. The first preliminary results of the qualitative analysis suggest that surveyed paediatric patients and their parents rate highly inpatient health care services received, however they point out also to areas that need improvement such as environmental factors (noise, temperature), food, infrastructure (outdated facilities & equipment) and in some cases attitude of hospital staff. Conclusions National institute of public health carried out the first national survey on paediatric patient reported experience measures in acute hospitals in Slovenia. The results of this survey will be used to improve the quality of inpatient health care services in paediatric wards, as well renew focus on the requirements of European charter of children rights and United Nations Convention on the Rights of the Child. Key messages • National institute of public health carried out the first national survey on paediatric patient reported experience measures in hospitals in Slovenia. • The results of this survey will be used to drive hospital quality improvements.

Perceptions of patients, nurses, other healthcare workers, and general hospital managers about the content and challenges of transforming the clinical pathway into an integrated clinical pathway: a qualitative pilot study

Abstract Aim. Hospital health care of a patient represents a part of the patient’s “journey” through the healthcare system and as such is not delivered independently, but in a personalized integrated manner. To achieve a better outcome of personalized medical health care of patients in hospital, it is necessary to systematically transform the existing clinical pathways (CPs) into integrated clinical pathways (ICPs). The aim of the study was to investigate stakeholder’s perceptions of the content and barriers to transforming CPs into ICPs on the example of a general hospital in Slovenia. That is how we obtained microdata for systemic measures at the level of general hospitals in Slovenia. Material and methods. The cross-sectional study used a qualitative method with interviews and focus groups with patients, nurses, other healthcare workers and managers working in ICPs for chronic kidney disease and hip replacement in a typical Slovenian hospital. Results. The results showed that ICPs could be divided into five basic phases. In all phases, additions to the existing CPs in order to turn them into ICPs were necessary, which was an additional burden, especially for the nurses. Conclusions. Personalized health care through ICPs is patient-centered, shorter, holistic, coordinated, continuous, of higher quality for patients and sustainably more efficient for providers.

Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial.

Transitions of care often lead to medication errors and unnecessary healthcare utilization. Medication reconciliation has been repeatedly shown to reduce this risk. However, the great majority of evidence is limited to the provision of medication reconciliation within clinical trials and countries with well-established clinical pharmacy. Thus, this pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on medication errors and unplanned healthcare utilization in adult general medical patients hospitalized in a teaching hospital in Slovenia. All patients hospitalized in a ward where medication reconciliation was integrated into routine clinical practice were included in the intervention group and received admission and discharge medication reconciliation, coupled with patient counselling. The control group consisted of randomly selected patients from the remaining medical wards. The primary study outcome was unplanned healthcare utilization within 30 days of discharge, and the secondary outcomes were clinically important medication errors at hospital discharge and serious unplanned healthcare utilization within 30 days of discharge. Overall, 414 patients (53.4% male, median 71 years) were included-225 in the intervention group and 189 in the control group. In the intervention group, the number of patients with clinically important medication errors at discharge was significantly lower (intervention vs control group: 9.3% vs 61.9%). Multiple logistic regression revealed that medication reconciliation reduced the likelihood of a clinically important medication error by 20-fold, while a higher number of medications on admission was associated with an increased likelihood. However, no significant differences were noted in any and serious unplanned healthcare utilization (intervention vs control group: 33.9% vs 27.8% and 20.3% vs 14.6%, respectively). The likelihood of serious healthcare utilization increased with the age of the patient, the number of medications on admission and being hospitalized for an acute medical condition. Our pragmatic trial confirmed that medication reconciliation, even when performed as part of routine clinical practice, led to a substantial reduction in the risk of clinically important medication errors at hospital discharge but not to a reduction in healthcare utilization. Medication reconciliation is a fundamental, albeit not sufficient, element to ensure patient safety after hospital discharge. Clinical Trial Registration: https://clinicaltrials.gov/search?id=NCT06207500, identifier NCT06207500.

Spatial Accessibility Models of the Efficient Network of Secondary Healthcare Providers in Slovenia

The main purpose of our research was to assess the accessibility of existing providers of secondary healthcare using established theoretical models of spatial accessibility. In the study, we analyzed the optimal locations and the optimal number of healthcare providers needed for an efficient network of secondary healthcare providers in Slovenia. We used four different location–allocation models and found that the MA-model is the most suitable for planning a potentially efficient network of general hospitals in Slovenia. We showed various scenarios for the development of the general hospital network based on three distinct accessibility travel time intervals, while also taking into account various population coverage proportions that can access hospital services within a given travel time interval. The key finding is that the same coverage of the population with hospital services could be achieved with a smaller number of general hospitals, if the hospitals were optimally located.

Deprescribing proton pump inhibitors: A study in hospitalized patients in Slovenia.

To evaluate the possibility of deprescribing proton pump inhibitors in adult inpatients hospitalized in a teaching hospital in Slovenia. We conducted a prospective observational clinical study in 120 patients taking a proton pump inhibitor. Data were obtained from hospital medical records and patient interviews. First, treatment compliance with relevant guidelines was assessed, and then the possibility of deprescribing was considered. Treatment with a proton pump inhibitor was in accordance with guidelines in only 39% of the 120 patients. In 24% of patients, the indication for proton pump inhibitor use was invalid, and 22% and 15% of patients were taking a proton pump inhibitor at a higher dose or for a longer period than recommended, respectively. Deprescribing could be undertaken in 61% of patients, as discontinuation in 38%, and dose reduction in 23%. A deprescribing possibility was noted more frequently in patients prescribed proton pump inhibitors for peptic ulcer disease, Helicobacter pylori infection, or without a valid indication (p < 0.001), as well as in patients taking a double or higher dose of a proton pump inhibitor (p < 0.001). Deprescribing of proton pump inhibitors could be undertaken in nearly 2/3 of our cohort of adult hospitalized patients. Hospitalization may serve as an opportunity to deprescribe proton pump inhibitors.

Influence of Non-financial Factors on Cost-efficiency of a General Hospital in Slovenia

Introduction: Hospitals account for the largest share of health care expenditures, which are mainly financed by public funds. In healthcare, it is of paramount importance that the management focus not on reducing costs at the expense of patient health, but on improving the value and thus the healthcare outcomes. In addition to the economic factors used to determine a hospital's cost efficiency, non-economic or soft factors should be considered. The aim of this study was to elucidate the influence of non-financial factors on a hospital's cost-efficiency.&#x0D; Method: An online survey was conducted among the staff of a typical Slovenian general hospital (N = 150).&#x0D; Results: Self-assessment of cost-efficiency was influenced by communication in the hospital, satisfaction and cooperation within the multidisciplinary team, willingness of employees to innovate, cooperation with external providers and evaluation of the quality of healthcare. Communication with the patient had the greatest impact, followed by communication with external providers and communication with the management.&#x0D; Conclusion: In order to reduce costs while maintaining or even improving the healthcare outcomes, communication with patients is extremely important.

Optimal Network of General Hospitals in Slovenia

This article explores how the minimum number of general hospital locations can be determined with optimal population coverage. Due to the increasing financial problems of hospitals and the poor organization of general hospital healthcare, Slovenia is currently working to reform the healthcare system. Defining the optimal network of hospital providers is one of the key elements in reforming the healthcare system. To define the optimal network of general hospitals, the allocation-location model was used, and the maximize attendance model was used as the central method. The chief purpose of maximize attendance model is to optimize the demand attendance with respect to distance and time spent getting to the point of demand. In the analysis of optimal locations and the number of Slovenian general hospitals, we used data on the locations of settlements with their number of inhabitants and data on the Slovenian road network, based on which we defined average travel speeds on the categorized road network. The hypothetical locations of general hospitals and the number of optimally located general hospitals that provide access to the nearest provider were determined in three different time intervals. We found that the same accessibility to hospital services as provided by the existing network of general hospitals can be achieved with only ten optimally located general hospitals within a 30-min time interval. This means that two general hospitals could be rationalized or reorganized, which would bring significant savings in the field of hospital activity, which creates a large loss in the health system in Slovenia.

Health Service Quality and its Relationship to Team Collaboration and Communication during the COVID-19 Pandemic

BACKGROUND: In the search for innovative methods to improve the quality and efficiency of health services, integrated clinical pathways (ICPs) have been introduced. AIM: As there is a gap in research on ICP efficiency, the aim of the study was to investigate the role and impact of collaboration and communication among three interprofessional ICP teams on the self-assessment of efficiency of ICPs. METHODS: A cross-sectional study was conducted using a descriptive quantitative with a survey (N = 152) and qualitative methods with a focus group (N = 27) and in-depth interviews (N = 22) in a typical general hospital in Slovenia. RESULTS: The results showed that health care professionals found patient health care and the work of health care professionals’ better quality with ICP than without ICP. The ICPs team members assessed communication, cooperation and effectiveness in the ICP team as relatively good but identified the lack of staff as the main reason for their limitations. The impact of ICP team collaboration and communication on ICP safety exists but it does not explain a sufficient proportion of the variance and the corelation is medium strong. The result also revealed that the Covid-19 pandemic did not primarily affect ICP team members' fear of possible infection, as studies have shown in the first wave of the Covid-19 pandemic, but rather staff shortages leading to increased fear of errors and possible complaints and lawsuits from patients and relatives. CONCLUSION: Measures are needed for the additional employment of team members and the retention of current staff through financial compensation and the promotion of supportive workplace characteristics.

Challenges in establishing optimal pediatric palliative care at the university hospital in Slovenia

The integration of pediatric palliative care (PPC) should become a standard of care for all children with life-limiting and life-threatening illnesses. There are many barriers and misperceptions in pediatrics which hinder the early implementation of PPC. The aim of the study was to design starting points for the establishment of accessible PPC with early involvement of patients in a tertiary-level children’s hospital. An intervention, presentation, and discussion on PPC were offered by the hospital PPC team to all employees in the hospital. A total of 237 participants (physicians 30.4%, nurses 49.4%, psychologists 8.4%, and others) completed a questionnaire before and after the intervention. The personnel’s knowledge, self-assessment of their ability to perform PPC, attitude to participate in PPC, and their awareness and understanding of the need for PPC were evaluated. The results were analyzed using Pandas and SciPy libraries in Python. The knowledge, awareness, and attitude of the physicians, nurses, and other professionals improved significantly after the intervention. However, the self-assessment of their ability to perform PPC did not increase. Previous experience with the death of a patient has proven to be a stimulus for self-initiative in acquiring knowledge in PPC and was linked with a better attitude and higher awareness of the need for PPC.Conclusions: More education and practical work tailored to the different professional profiles are needed, with adjustments for specific subspecialist areas, especially where patients could be included in early PPC. Although additional studies are needed, we identified the main directions for the further implementation of PPC in clinical practice in our setting.What is Known:• Every child and adolescent living with a life-limiting or life-threatening condition should receive pediatric palliative care (PPC) to alleviate suffering and enhance their quality of life. There exists a plethora of recognized barriers to the effective implementation of palliative care, specifically PPC. These barriers are often connected to the emotional burden of requesting PPC. Early identification and inclusion of patients is important for improving PPC in hospital settings. Finding strategies to overcome the barriers is crucial for improving the well-being and improving the quality of life of the patients and their families.• Early identification is only possible with a high level of knowledge and understanding of PPC among healthcare professionals. In a hospital setting where there are interdisciplinary palliative care teams, the inclusion is still only possible if all staff are capable of recognizing patients in need of PPC and are willing to start the process. Since most healthcare education systems only recently included PC into the healthcare curriculum, most of the professionals currently working in hospitals are only educated to the extent of self-initiative.What is New:• To bridge the existing gap in knowledge, the hospital PC team organized an intervention, presentation, and discussion on PPC, which was offered to all employees in the hospital who are in contact with patients. The personnel’s knowledge, self-assessment of their ability to perform PPC, attitude to participate in PPC, and their awareness and understanding of the need for PPC were evaluated. These four categories have not been tested together before. The knowledge, awareness, and attitude of the physicians, nurses, and other professionals improved significantly after the intervention. All the profiles that work together in a team were evaluated simultaneously for the first time.• The self-assessment of their ability to perform PPC did not increase—in fact, it decreased. This was unexpected, as existing literature establishes a link between education and quality of PC. Previous experience with the death of a patient has proven to be a stimulus for self-initiative in acquiring knowledge in PPC and was linked with a better attitude and higher awareness of the need for PPC. We re-established the importance of education and practical work tailored to the different professional profiles, with adjustments for specific subspecialist areas, especially where patients could be included in early PPC. Although additional studies are needed, we identified the main directions for the further implementation of PPC in clinical practice in our setting.

Strah od kovida 19 među zdravstvenim radnicima - studija preseka

Objective. Working conditions for health professionals can be affected significantly by pandemic caused by COVID-19. The aims of the study were to identify the level of fear of COVID-19 in hospital staff. Methods. This study was carried out in a convenience sample of nurses and medical doctors from four public regional hospital in Slovenia. This was a cross-sectional survey study in which a fear of COVID-19 scale (FCV-19s) was used. The questionnaire was completed by 110 participants. Results: The sample mean score was 16.3±6.1. More than half of the study participants (61%) considered it as low levels of fear, and 39% of the participants considered it as high levels of fear. The employees with less than 27 weeks experience with COVID-19 had a higher mean FCV-19s score (17.6±6.3) than the employees with more than 27 weeks of COVID-19 experience (14.7±5.4) and we found a significant difference of p=0.006. Statistically significant differences were also found between employees regarding COVID-19 units (intensive care unit - ICU and acute unit -AU; item "afraid of losing life"). Conclusions. Regardless of the duration of the epidemic, fear is still present. Experience reduces fear among employees.

Working Hour and Schedule Characteristics among Nurses: A Retrospective Study

Introduction: To describe and compare characteristics of working hours and work schedules among nurses in 2019 and 2021. Evidence about the association regarding the relationship between nurses’ working hours and schedules with the COVID-19 pandemic is limited. Materials and Methods: The research was conducted at a medical unit of a secondary care regional hospital in Slovenia. Of 71 employees who were eligible, 24 fulfilled the criteria and their data were included in the study. Results and Discussion: There were substantial differences in working hour and schedule characteristics between 2019 and 2021. Compared to 2019, nurses in 2021 worked more hours, more long shifts, had fewer free weekends and education days, and almost double the number of sick days. Conclusion: While the nurse manager managed some of the working hour and schedule characteristics appropriately, additional awareness raising, and implementation of a related computer program, are suggested to optimize and develop work schedules.

A Comparative Analysis of the Occurrence of Lower Respiratory Tract Infections Caused by Respiratory Syncytial Virus among Newborns in the Years before and during Covid-19 Pandemic at a Tertiary Referral Hospital in Slovenia

Objective − In this study we aimed to compare the occurrence of lower respiratory tract infections caused by respiratory syncytial virus in the neonatal population in the years before and during the COVID-19 pandemic.Methods − Cases of newborns, hospitalized due to viral lower respiratory tract infection from 2015 to 2020, were analyzed retrospectively, and compared according to cause (respiratory syncytial virus, non-respiratory syncytial virus) and treatment requirements before (2015−2019) and after (2020) the outbreak of the COVID-19 pandemic.Results − The number of newborns with lower respiratory tract infections and newborns contracting respiratory syncytial virus declined significantly during the COVID-19 pandemic. Respiratory syncytial virus was the major causative agent before the pandemic, while after the lockdown no more cases were reported. There were no significant differences between the two periods regarding the number of patients requiring treatment with oxygen (P=0.705), non-invasive (P=0.842) and invasive ventilation (P=0.574), or in terms of median hospital stay (P=0.670) and the duration of non-invasive (P=0.350) and invasive ventilation (P=0.556), while the difference in the duration of treatment with oxygen was statistically significant (P=0.048).Conclusions − A decline was found in the number of newborns hospitalized due to respiratory syncytial virus and non-respiratory syncytial virus lower respiratory tract infections during the COVID-19. Our results strongly suggest that social distancing and other lockdown strategies were effective in slowing down the spread of respiratory syncytial virus and decreasing the need for hospitalization among newborns, but may be not equally effective for all agents causing lower respiratory tract infections.

Preoperative antibiotic prophylaxis in a single tertiary hospital in Slovenia—the role of education in recommendation compliance

Purpose: The aim of the present study was to evaluate the impact of an educational intervention package on perioperative antimicrobial prophylaxis (PAP) prescription practice in three elective procedures—total hip arthroplasty (THA), caesarean section (CS), and radical prostatectomy (RP)—in a single tertiary care hospital in Slovenia.&#x0D; Methods: An interventional study was performed to evaluate the impact of an educational intervention package on PAP compliance. PAP prescription practices for three elective types of surgery (THA, CS, and RP) were observed. Thirty operative reports for each type of surgical procedure were evaluated according to indication, timing of preoperative prophylaxis administration, antibiotic selection and dosage, and total prophylaxis duration. This was followed by an educational intervention package that included a discussion with department leaders led by an infectious disease specialist and an educational seminar and discussion for surgeons, supplemented by PAP recommendations provided as pocket reminders. Then, the compliance with PAP recommendations for the same types of procedures performed in the post-interventional period (3–6 months after the intervention) was evaluated again.&#x0D; Results: Complete pre-interventional compliance with local guidelines was observed in 67%, 70%, and 3.3% of THA, CS, and RP cases, respectively. A major deviation from PAP recommendations was observed in the timing of preoperative PAP administration before surgery and in the total PAP duration A deviation from recommendations for RP, which is a major surgical procedure, was observed as a longer postoperative PAP duration compared to the intraoperative course. In the post-interventional period, an improvement in total compliance with PAP recommendations was observed in 80.0%, 90.0%, and 50.0% of THR, CS, and RP procedures, respectively.&#x0D; Conclusion: Our study revealed an improvement in adherence to PAP recommendations after an educational intervention package for selected procedures at the University Medical Centre Maribor. This simple intervention can have an important impact on patient care quality by reducing antimicrobial medication use, resistance development, and treatment cost.

OP0219 HIGH INCIDENCE OF MIS-C AND OTHER AUTOIMMUNE DISEASES AFTER SARS-COV-2 INFECTION COMPARED TO COVID-19 VACCINATION IN PEDIATRIC POPULATION FROM SOUTH CENTRAL EUROPE

BackgroundIn contrast to adults, children are less likely to develop serious disease upon infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) but are at increased risk for inflammatory and autoimmune diseases linked to the virus (1). The reported incidence of multisystem inflammatory syndrome in children (MIS-C) varied from 0.2 to 11.4/100,000 persons under 21 years (2,3). It is yet unknown whether MIS-C can recur after SARS-CoV-2 reinfection or COVID-19 vaccination.ObjectivesTo estimate the incidence and describe the spectrum of inflammatory and autoimmune diseases linked to SARS-CoV-2 infection and coronavirus (COVID-19) vaccination in pediatric patients from two neighbouring South Central European countries and regions, Slovenia and Friuli Venezia Giulia (FVG), Italy.MethodsWe performed a multi-centre prospective cohort study of all children and adolescents (under 18 years) newly diagnosed with MIS-C or other inflammatory/autoimmune diseases linked to SARS-CoV-2 infection, who were admitted to the pediatric tertiary care hospitals in Slovenia or FVG, Italy during the period from January 1, 2020, to December 31, 2021. These hospitals serve a combined population of 587,053 children and adolescents. Only patients who had positive anti-SARS-CoV-2 antibodies and/or positive SARS-CoV-2 PCR test within 3 months prior to disease onset were considered for estimating the disease incidence. We obtained the number of patients with serious adverse events (SAE) after COVID-19 vaccination and the number of patients with severe COVID-19 in the same population. This study was conducted as a part of the EU interregional Italy-Slovenia project CATTEDRA (Cross border cooperation for innovative diagnosis of rare diseases in paediatrics).Results192 children and adolescents were diagnosed with inflammatory and autoimmune diseases linked to SARS-CoV-2 (Figure 1). Median age at diagnosis was 11.9 years (IQR 7.6 -14.7). All included patients were White. Incidence of MIS-C was one in 921 children and adolescents after SARS-CoV-2 infection and one in 5870 of all children and adolescents. Cumulative incidence of MIS-C since the start of the pandemic was 17/100,000 children and adolescents. Until December 31, 2021, 92,139 children and adolescents (15.7 %) received at least one dose of COVID-19 vaccine. Three patients presented with inflammatory/autoimmune disease after COVID-19 vaccination, including 2 patients with MIS-C and one patient with myositis. All 3 had evidence of recent SARS-CoV-2 infection in form of positive anti-N SARS-CoV-2 antibodies. In the same period, 15 children and adolescents were hospitalised with severe COVID-19. Seven patients from our cohort were vaccinated against COVID-19 median 8 months after MIS-C and further 6 patients had a SARS-CoV-2 reinfection 3-14 months after MIS-C. None of them experienced SAE or recurrence of MIS-C.Figure 1.Inflammatory and autoimmune diseases linked to SARS-CoV-2 and severe COVID-19 in pediatric population in Slovenia and FVG, ItalyCOVID-19=coronavirus disease, FVG=Friuli Venezia Giulia region in Italy, MIS-C=multisystem inflammatory syndrome in children, SARS-CoV-2=severe acute respiratory syndrome coronavirus 2ConclusionMIS-C was the most common manifestation and its incidence in this predominantly white population was higher than previously reported. Based on our limited experience, MIS-C does not seem to recur after SARS-CoV-2 reinfection or COVID-19 vaccination, however long-term data are lacking. Autoimmune diseases were much more common after SARS-CoV-2 infection than after COVID-19 vaccination. Hospitalisations due to MIS-C were seven times as frequent as hospitalisations due to severe COVID-19 in children.

Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study.

ObjectiveMost guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards.MethodsA multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards.ResultsIn the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.221; 0.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.238; 0.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease.ConclusionDe-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT05166278].

Slovenian nurses’ research utilization competence and received support from nurse managers

Abstract Introduction. Research utilization is the core of evidence-based practice. Nurse managers have an important role to support competence management and research utilization in nursing care. Aim. The aim of the study was to investigate the research utilization competence of Slovenian nurses working in hospitals and the received support from nurse managers related to research utilization. Research utilization competence comprises attitudes and the knowledge and skills. Methods. A descriptive, cross-sectional study design was used. The participants were nurses (n=154) from eight hospitals in Slovenia. Data was collected using the Competence in Research Utilization instrument and analyzed statistically. Results. Nurses’ attitudes were positive. Nurses’ appreciation of research utilization was higher than their readiness to commit themselves to research utilization. Nurses’ knowledge related to acquisition research evidence and reading and appraising research was rather limited even if they assessed their skills as above moderate. The received support from nurse managers related moderately to nurses’ research utilization skills. Conclusions. The research utilization competence of nurses is recommended to be strengthened with systematic competence management and support from nurse managers in clinical practice. Nurse managers can support nurses’ research utilization competence by encouraging them to participate in continuing education and by building systematic academic cooperation and networking between educators, researchers, and nurse clinicians.

High incidence of multisystem inflammatory syndrome and other autoimmune diseases after SARS-CoV-2 infection compared to COVID-19 vaccination in children and adolescents in south central Europe.

To estimate the incidence and describe the spectrum of inflammatory and autoimmune diseases linked to SARS-CoV-2 infection and COVID-19 vaccination in children from two neighbouring south central European countries. We performed a multi-centre prospective cohort study of children under 18 years diagnosed with inflammatory/autoimmune diseases linked to SARS-CoV-2 infection or COVID-19 vaccination, who were admitted to the paediatric tertiary care hospitals in Slovenia and Friuli Venezia Giulia, Italy, from January 1, 2020, to December 31, 2021. Disease incidence was calculated based on laboratory-confirmed cases only. Inflammatory and autoimmune diseases linked to SARS-CoV-2 were diagnosed in 192 children (127 laboratory-confirmed), of whom 112 had multisystem inflammatory syndrome (MIS-C), followed by vasculitis, neurological and cardiac diseases. Calculated risk of MIS-C was 1 in 860 children after SARS-CoV-2 infection and cumulative incidence of MIS-C was 18.3/100,000 of all children. Fifteen children had severe COVID-19. Two patients with MIS-C and a patient with myositis presented after COVID-19 vaccination. All 3 had at presentation also a serologically proven recent SARS-CoV-2 infection. After MIS-C, nine patients were vaccinated against COVID-19 and 25 patients had a SARS-CoV-2 reinfection, without recurrence of MIS-C. Autoimmune diseases following SARS-CoV-2 infection in children were 8.5 times as common as severe COVID-19. MIS-C was the most common manifestation and its incidence in this predominantly white population was higher than previously reported. MIS-C does not seem to recur after SARS-CoV-2 reinfection or COVID-19 vaccination. Autoimmune diseases were much more common after SARS-CoV-2 infection than after COVID-19 vaccination.

Analgesic efficacy of remifentanil patient-controlled analgesia versus combined spinal-epidural technique in multiparous women during labour

To compare the analgesic profile of remifentanil patient-controlled analgesia (RPCA) and combined spinal-epidural analgesia technique (CSEA) in multiparous women during the entire labour. We hypothesized that CSEA would provide a better and more sustained pain reduction than RPCA. A prospective observational trial under ID NCT02963337 at a university hospital in Slovenia 2017-2018. Analgesic efficacy, satisfaction with pain-relief, adverse effects, labour progress, and outcomes between RPCA (80) and CSEA (81) were compared. CSEA provided significantly lower pain scores during the entire labour. Compared to baseline, significant pain reduction was recorded in both groups after 15 min. No difference was recorded compared to baseline with RPCA and CSEA after 45 and 90 mins, respectively. CSEA provided higher satisfaction than RPCA (5 [5-5] vs 5 [4-5], p < 0.0001). More patients with CSEA opted for the same technique for the next labour [CSEA; 77 (95%) vs RPCA; 65 (81%), p = 0.003]. No crossovers were observed. RPCA was associated with desaturation (34%), bradypnea (21%) and apnoea (25%), which were transitional and easily managed. None had severe sedation. No differences were recorded in labour progress and outcomes. Apgar scores were reassuring in all neonates (> 8). None had umbilical artery pH < 7.0. In multiparas, CSEA provided superior analgesia and satisfaction than RPCA. Nevertheless, RPCA provided a satisfactory experience, suggesting it could be used when neuraxial analgesia is not available, preferred, or contraindicated. In that case, constant presence of midwife is mandatory for management of clinically significant hypoventilation.

Incidence of surgical site infections in a tertiary hospital in Slovenia

Purpose: Surveillance is an essential element of surgical site infection (SSI) prevention. Few studies have evaluated the long-term effect of these programs in Slovenia. SSIs are among the most commonly reported health care-associated infections, yet there is a paucity of data on SSI from Slovenia. We aimed to determine the incidence of SSI and explore its associated factors at a tertiary hospital in Slovenia.&#x0D; Methods: Direct and indirect surveillance methods, based on European Centre for Disease Control andPrevention guidelines, were used to define SSI. Patients were followed at 30 days and 1 year postoperatively. Demographic and medical data were collected and risk factors were assessed. Risk factors for SSI and the effect of surveillance time on SSI rates were statistically analyzed.&#x0D; Results: Of 8074 patients analyzed, the SSI rate was found to be 0.28%. One of the statistically significant risk factors for SSI included age (average age 66 years vs. 58 years: p=0.0206, t=2.315, p&lt;0.005). Other known risk factors, such as disease severity, presence of drains, history of previous hospitalization,preoperative stay, wound classification, and surgery duration did not influence the outcome in this study.&#x0D; Conclusion: The incidence of SSI at our hospital was lower than reported in many comparable studies. We establish baseline data for targeted implementation strategies to further improve the quality and safety of health care in this and similar hospitals in Slovenia.

Adverse drug events during transitions of care : Randomized clinical trial of medication reconciliation at hospital admission.

During transitions of care, patient's medications are prone to medication errors. This study evaluated the impact of pharmacist-led medication reconciliation at hospital admission on unintentional medication discrepancies and adverse drug events. Arandomized controlled clinical trial was conducted in 120 adult medical patients hospitalized in atertiary hospital in Slovenia. In the intervention group, apharmacist-led medication reconciliation was performed on admission, while the control group received usual care. Patient's drug treatment before admission was compared with their admission and inpatient treatment to identify discrepancies. The intention of discrepancies and related adverse drug events were assessed as aconsensus of an expert panel. Included patients were elderly (median 72years) and treated with polypharmacy (median 7medications). Upon admission, discrepancies and unintentional discrepancies, representing amedication error, were identified in 61.2% (825/1347) and 18.3% (247/1347) of medications, respectively. In the intervention group, only 29.1% (37/127) of unintentional discrepancies were reported to the physicians in person. The majority of admission discrepancies (88%) persisted through hospitalization. Unintentional discrepancies resulted in 51adverse drug events even during hospitalization. There were no differences between the intervention and control group in the occurrence of unintentional discrepancies (p = 0.481) or adverse drug events (p = 0.801). Medication reconciliation at hospital admission failed to reduce unintentional discrepancies and adverse drug events, possibly due to its poor integration into clinical practice. Discrepancies resulted in patient harm even during the short period of hospitalization, which warrants the implementation of medication reconciliation at hospital admission.