Practice In Slovenia Research Articles

Talent Management in the Public Sector

Over the past decade, researchers and human-resource managers, par­ticularly in larger private sector organisations, have shown an increased interest in talent management, while this issue has been overlooked in the public sector. The purpose of this paper is to present the literature review about talent management in the public sector and to show how the existing legislation allows the creation of a talent management system for Slovenian public sector organisations. The main methodological ap­proach used was qualitative research with document analysis. The pa­per sought answers to three research questions: (How) are talented em­ployees treated differently from other employees? What types of models or practices in the field of talent management are applied in European countries? What are the legal limitations in the field of civil servant talent management in Slovenia? The literature review shows that organisations that are aware of the importance and contribution to the ultimate or­ganisational objectives treat talented employees differently from other employees in the organisation. Models or practices in the field of talent management vary widely among different European countries. The limitations in Slovenia are strict observance of the principle of equality and thus equal opportunities for inclusion in the system of talented civil servants with limited reward opportunities and, consequently, for the promotion of civil servants. In order to enable good practices in Slovenia, a change of the legal framework is necessary.

Early Cost-effectiveness Analysis of Electrochemotherapy as a Prospect Treatment Modality for Skin Melanoma

PurposeElectrochemotherapy is increasingly entering into national and international guidelines, requiring formal evaluation of treatment costs and cost-effectiveness to ensure that its uptake provides value to budget-constrained health care systems. This study analyzed the early cost-effectiveness of electrochemotherapy in patients with Stage IIIc/IV skin melanoma in clinical practice in Slovenia. The costs of electrochemotherapy were compared to those of the standard of care, consisting of palliative treatment and therapy for symptoms. MethodswThe study enrolled 23 patients treated with electrochemotherapy at the Institute of Oncology (Ljubljana, Slovenia). The mean cost of electrochemotherapy was estimated using patient-specific cost data on electrochemotherapy procedures and subsequent follow-up. Quality-adjusted life-years (QALYs) were estimated by collecting EQ-5D-3L questionnaires at baseline, after complete or partial response following the treatment, and after a relapse of skin lesions. A discrete-time Markov model was built to estimate the lifetime costs and consequences of using electrochemotherapy compared to standard of care, from the perspective of the Slovenian health care system. The analysis was conducted separately in the whole patient sample and in the subset of patients with bleeding lesions. Deterministic and probabilistic sensitivity analyses were conducted to test model assumptions and to characterize the uncertainty around model parameters. FindingsIn the whole patient population, electrochemotherapy for skin melanoma Stage IIIc/IV was expected to increase QALYs by 0.29 (95% credible interval [CrI], 0.10–0.50), at the higher cost of 6568 EUR (95% CrI, 4593–8928) in comparison to the standard of care. At the cost-effectiveness threshold of 20,000 EUR/QALY, the estimated probabilities of electrochemotherapy being cost-effective compared to standard of care were 0.30 and 0.91 in the whole patient sample and in patients with bleeding lesions, respectively. In the whole sample population, a 50% reduction in the price of the electrodes was expected to increase the probability of electrochemotherapy being cost-effective from 0.30 to ~0.64. ImplicationsThe findings from this cost-effectiveness analysis of data from clinical practice were based on a small sample size (ie, 23 patents), which made the subgroup of patients with bleeding lesions very small. Therefore, the findings in this patient population should be carefully interpreted.

Anti-VEGF Treatment of Diabetic Macular Edema: Two-Year Visual Outcomes in Routine Clinical Practice.

Purpose The purpose of this study was to evaluate 2-year visual outcomes in patients with diabetic macular edema (DME) treated with anti-VEGF agents in a routine clinical setting. Methods The medical records of patients treated with ranibizumab or aflibercept due to DME at the Eye Hospital, University Medical Centre Ljubljana, Slovenia, between January 2016 and March 2019 were retrospectively reviewed. After applying inclusion and exclusion criteria, 123 patients (123 eyes) were included in the study. Results Baseline visual acuity (VA) was 60.9 ± 15.2 letters (median 63; range 7–85). Baseline central retinal subfield thickness (CRT) was 440.7 ± 132.5 μm (median 430; range 114–1000). No significant change in VA over 2 years was found (mean change +2.1 ± 16.8 letters (median 2; range −53–52)). However, there was a significant change in VA in the subgroup with baseline VA <70 letters (mean change +5.7 ± 17.9 letters (median 5; range −52–52)). VA gains of ≥15 letters were achieved in 25 eyes (20.3%). Changes in CRT were significant over 2 years. Patients received 4.5 ± 2.1 (median 5, range 1–9) and 2.6 ± 2.3 (median 2, range 0–8) injections in the first and second years, respectively. Conclusions The two-year visual outcomes in this retrospective analysis appear to be comparable to previously reported outcomes in routine clinical practice. Our analysis provides some information about the effectiveness of anti-VEGF treatment in routine clinical practice in Slovenia. More intensive treatment should be implemented in the management of patients in order to achieve better visual outcomes.

Retrospective analysis of treatment-naive Slovenian patients with metastatic melanoma treated with pembrolizumab - real-world experience.

BackgroundBased on recent data from clinical trials, the immune checkpoint inhibitor pembrolizumab prolongs survival and has a good toxicity profile in patients with advanced or metastatic melanoma. However, the question remains whether these results are transmitted into daily clinical practice. The aim of this study was to assess the efficacy and toxicity of pembrolizumab in treatment-naive patients with metastatic melanoma in everyday clinical practice in Slovenia and compare it to the results from clinical trials.Patients and methodsThis observational retrospective cohort study included 138 consecutive metastatic treatment-naive melanoma patients treated with pembrolizumab at the Institute of Oncology Ljubljana in Slovenia, from January 2016 to December 2018. Patient and treatment characteristics were retrospectively collected from hospital data base. Statistical data was obtained using the SPSS software version 22. Survival rate was calculated with the Kaplan-Meier method. Observation period took place between January 2016 and the end of June 2019.ResultsThe estimated median overall survival (OS) was 25.1 months (95% CI, 14.6–35.6) and the median progression-free survival (PFS) was 10.7 months (95% CI, 5.9–15.4). Among all patients, 29 (21.0%) achieved complete response, 31 (22.5%) partial response and 23 (16.7%) reached stable disease. The number of organs with metastatic involvement and the level of baseline lactate dehydrogenase (LDH) concentration had significant influence on survival rates. Immune-related adverse events (irAE) were reported in 88 (63%) patients, while grade 3–4 irAE occurred in 12 (8.7%). Due to toxicity, 16 (11.6%) patients discontinued the treatment.ConclusionsOur real-world data from single centre retrospective analysis of treatment-naive metastatic melanoma patients treated with pembrolizumab showed inferior median OS and similar median PFS, compared to the results from clinical trials. However, patients with normal serum levels of LDH and a small number of organs with metastatic involvement had comparable survival outcomes. Toxicity rates of pembrolizumab were quite similar. These results further support the use of pembrolizumab for metastatic treatment-naive melanoma patients.

The Political Character of Migration after the Second World War: From the Politics of Revanchism to Amnesty

The paper focuses on the complexity of the dynamics of migration in the Republic of Slovenia/Yugoslavia in the immediate aftermath of the Second World War, or more precisely, during the period spanning the wartime and its conclusion to the years of the liberalisation of the Yugoslav international migration policy, linked to the 1962 Law on Amnesty, and to the agreement between SFR Yugoslavia and the Republic of Austria on the regulation of the employment of Yugoslav workers in Austria (1963). The paper aims to provide a concise and structured overview of the prevalent migration practices in Slovenia during this period, highlighting international political processes that had a significant impact on the dynamics of migration.

Pulmonary aspiration prevention strategies: Current training and practice in Slovenia

Pulmonary aspiration prevention strategies: Current training and practice in Slovenia

Anticholinergic Burden and Most Common Anticholinergic-acting Medicines in Older General Practice Patients.

IntroductionAnticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians.MethodsA cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran’s scale and Drug Burden Index.ResultsAltogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%).ConclusionsThough the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives.

INTANGIBLE ASSETS IN THE CONSOLIDATED FINANCIAL STATEMENTS OF SERBIAN AND SLOVENIAN LISTED COMPANIES: A PRELIMINARY OVERVIEW OF THE REPORTING PRACTICES

The aim of the research is to achieve a conclusion what is the level of the reporting practice on intangible assets in two countries - in the Republic of Serbia and in the Republic of Slovenia trough a comparative descriptive statistics. Consolidated financial statements of listed companies in these two countries were used from the Belgrade Stock Exchange (Serbia) and the Ljubljana Stock Exchange (Slovenia). The reason for the use of consolidated financial statements lies in the fact that they can contain unconsolidated intangible assets already recognized in the separate financial statements of the companies included in the group, as well as internally generated intangible assets that meet the conditions for recognition in a business combination (including Goodwill). The general assessment is that the survey results indicate a very low level of reporting practice of intangible assets in Serbia and relatively satisfactory level of reporting practice in Slovenia. Individual results are given in the fourth part of the paper.

Unfair practices and illicit conduct in food supply chains in Slovenia

&lt;p style="margin: 0cm 0cm 0pt; text-align: justify; line-height: normal;"&gt;&lt;span style="font-family: 'Times New Roman','serif'; font-size: 12pt;"&gt;The food supply chain in Slovenia is highly developed, but it involves unequally developed stakeholders with different bargaining power. Upon reviewing all stakeholders through participatory research, it is made clear that in the whole food supply chain, retail chains generally have the greatest and primary producers the smallest bargaining power. For this reason, in the process of regulating mutual relations in contractual commitments and mutual operations, unfair practices and illicit conduct often emerge, through which the parties with significant market power impose additional discounts, rebates and other contributions on the parties with smaller market power in order to improve their own financial management. Unfair practices and illicit conduct lead to the weakening of the entire food supply chain, so it is important to recognise such tendencies in the food chain. In this article, the autor would like to draw attention to the illicit conduct and unfair practices in Slovenia which are used by retail chains in their interpersonal relationships and their dealings with suppliers.&lt;/span&gt;&lt;/p&gt;

Number of medications or number of diseases: what influences underprescribing?

An increasing number of older adults suffer from multimorbidity and receive multiple medications. Despite that, underprescribing of potentially beneficial medications is widespread in this population. Our aim was to examine influence of polypharmacy and multimorbidity on the presence of prescribing omissions (PO) in general practice attenders. We conducted a cross-sectional study of older adults attending general practices in Slovenia who were regularly prescribed at least one medication. Patients' data was entered into a computer application evaluating the presence of START (Screening Tool to Alert doctors to Right Treatment) criteria for PO. Demographic data, CIRS-G (Cumulative Illness Rating Scale for geriatric patients) questionnaire, number of medications, and healthcare utilization data were also collected. We defined polypharmacy as five or more concurrent medications. Five hundred three patients were enrolled, 258 (56.7%) female. The average age was 74.9 and average value of CIRS-G index 1.48 (±0.6). Patients took on average 5.6 medications and 216 (42.9%) patients had at least one PO according to START criteria. In bivariate analysis, there was a significant association between age, number of medications, polypharmacy and CIRS-G index measures, and presence of PO. In multivariate analysis, only age and number of affected CIRS-G categories significantly predicted PO (p<0.05). Older patients with more affected CIRS-G categories were at higher risk for PO. Polypharmacy was not an independent risk factor for the presence of PO. A possible reason is that in multimorbid older people, physicians and patients set individual priorities to treatment instead of treating all diseases and conditions.

Patients' use of and attitudes towards self-medication in rural and remote Slovenian family medicine practices: a cross-sectional multicentre study.

Self-medication is very common in the general population, but its prevalence can differ according to the place of residence. The aim of this study was to determine the prevalence of self-medication in patients attending rural and remote family physicians, and to detect the important factors that are associated with it. A cross-sectional multicentre study was performed in 24 rural and remote family medicine practices in Slovenia was performed. The aim was to include 720 patients who visited their family physicians on a particular day. The authors used a validated questionnaire on self-medication, which consisted of questions about demographic characteristics (sex, age, education and working status), questions about health status, questions about self-medication practices, and questions about attitudes towards self-medication. The level of participants' trust in different sources of medical information was measured by a five-point Likert scale. The participants were asked to take into account the year 2013 when completing the questionnaire. Of 720 invited patients, 371 (51.5%) completed the questionnaire. There were 233 (62.8%) women in the sample. The mean age of the participants was 48.1 (±15.1) years. Self-medication was practised by 300 (80.9%) participants. In multivariate analysis, the variables independently associated with self-medication were information on self-medication obtained from pharmacists, and information on self-medication obtained from relatives. Additionally, some other variables had high odds ratios such as information on self-medication obtained from books, information on self-medication obtained from media, and reason for self-medication: burdening physicians. The practices of self-medication in rural Slovenia as reported by patients can be defined as moderately safe. People tend to seek more information on self-medication but the main sources for this are lay informants. Further studies are needed to explore the safety of such practices.

B.P.M. in transition economies: joint empirical experience of Slovenia and Serbia

Business process management (B.P.M.) is empirically linked to the performance of organisations. Different studies in the business process field have shown that an organisation can benefit from B.P.M. through better financial and nonfinancial performance, which can drive it to competitive advantage. B.P.M. is also a concept which leads to better organised systems and can help companies in transition economies to perform better. The purpose of this paper is to compare B.P.M. practice in Slovenia and Serbia in order to formulate recommendations for companies in transition economies. The survey was carried out in 115 representatives of Slovene companies and 91 Serbian companies in the year 2014. The conclusions and recommendation for B.P.M. implementation in transition economies were drawn upon similarities in B.P.M. practice between Serbian and Slovenian companies. In addition, the differences in B.P.M. practice were analysed in order to identify the ways one country can learn from the experience of the other. The results from Slovenia and Serbia from 2014 are interesting for both countries from the perspective of how B.P.M. practice could be further developed in Slovenia and Serbia. The findings have significant managerial implications, as they will help managers to better understand the key factors for successful B.P.M. implementation transitional countries companies.

Umbilical Cord Management and Stump Care in Normal Childbirth in Slovenian and Croatian Maternity Hospitals.

The aim was to investigate first-care procedures for the newborn's umbilical cord at maternity hospitals in Slovenia and Croatia. The study was based on an empirical survey research approach and quantitative research paradigms and included all Slovenian (n=14) and all Croatian (n=35) maternity hospitals. Leaders of midwifery team of 14 Slovenian and 35 Croatian labor wards were invited to participate. The study was conducted in 2013, with 67% of Slovenian and 66% of Croatian maternity hospitals having responded. A causal and non-experimental method of empirical research was used. The research instrument was a questionnaire. Descriptive statistics was used on data analysis. The independence hypothesis was tested with the χ2-test or Kullback 2Î-test. A vast ma-jority of study wards employed delayed umbilical cord clamping, i.e. clamping the cord after pulsa-tion had ceased. Only 10% of Slovenian in comparison with 36.4% of Croatian maternity hospitals practiced dry cord care. Others applied disinfectant on the cord, in Slovenia most frequently 6% po-tassium permanganate, and in Croatia a combination of octenidine and phenoxyethanol. Most Croa-tian -maternity wards (95.7%) still covered the stump, while it was not regular practice in Slovenia. The authors estimate that the prevailing Slovenian and Croatian practices in regard to cord clamping are in accordance with the evidence, while improvements could be made regarding stump care, since dry cord care is the recommended method.

Pljučnica pri dojenčku, povzročena z bakterijo Chlamydiae trachomatis

Chlamydia trachomatis is the most common bacterial pathogen causing sexually transmitted infections. As prenatal screening for C. trachomatis and treatment of pregnant women is not practice in Slovenia, perinatal transmission of C. trachomatis may therefore occur. We present a case of infant chlamydial pneumonia to illustrate that a high index of suspicion is necessary to make the diagnosis in an afebrile infant with cough and “bronchiolitis”. Unnecessary investigations can be avoided and treatment can be promptly instituted if a diagnosis is made on time.

Development and validation of the Slovenian drug-related problem classification system based on the PCNE classification V 6.2.

Background Classifying drug-related problems increases pharmacists' awareness of patients' drug-related needs and supports the development of counselling skills through increased awareness of the nature and frequency of drug-related problems. No standardised classification system was used in daily pharmacy practice in Slovenia. Objective To translate, upgrade and validate the Pharmaceutical Care Network Europe (PCNE) classification V 6.2 for use in Slovenian community pharmacies. Setting Expert panel meetings at the Faculty of Pharmacy and home-based classification validation. Methods The PCNE classification V 6.2 was translated to Slovenian language by forward-backward translation procedure. An expert panel consisting of nine practicing pharmacists upgraded the content of the translated version. Thirty-one community pharmacists validated this version with the PCNE set of 18 patient cases by coding problems, risk factors and interventions they believed were present in each case. The expert panel discussed the results and upgraded the classification accordingly. Afterwards, 33 community pharmacists validated the upgraded version with a set of 40 actual Slovenian pharmacy patient cases. Based on the results, the expert panel formed a final version of the classification. Main outcome measure Coding consistency between community pharmacists. Results The expert panel performed some major modifications to the PCNE classification V 6.2: the potential problem was added as a sub domain to problems domain; the term adverse drug event was used instead of adverse drug reaction; the causes domain was renamed to risk factors and its sub domains were organized into prescribing, dispensing and use of drugs; dispensing errors were specified; use of drugs was organized into intentional and unintentional use of drugs; the sub domains in the interventions domain were divided according to the communication and agreement with the prescriber. The average coding consistencies in the first validation study were 75% (±16%) for problems, 74% (±20%) for risk factors and 94% (±10%) for interventions. The average coding consistencies in the second validation study were 83% (±16%) for problems, 85% (±17%) for risk factors and 80% (±20%) for interventions. Conclusion A drug-related problem classification for use in Slovenian community pharmacies was developed based on The PCNE classification V 6.2. The validation studies demonstrated high coding consistencies.

170P: Survival of lung adenocarcinoma patients with uncommon EGFR mutations in routine clinical practice in Slovenia

170P: Survival of lung adenocarcinoma patients with uncommon EGFR mutations in routine clinical practice in Slovenia

Slovenski nacionalni register bolnikov s primarno imunsko pomanjkljivostjo

Data from Slovene national primary immunodeficiency (PID) registry are presented. Besides clinical and genetic data of patients with PID, quality indicators in patient care are included. Data are systematically collected in Department of Allergology, Rheumatology and Clinical Immunology in collaboration with physicians of different specialities. Increasing number and spectrum of PID are recognised in Slovenia. After establishment of Slovene multidisciplinary group in PID care in 2007 thorough immunological and genetic diagnostics, subcutaneous immunoglobulin replacement and treatment of PID with haematopoietic stem cell transplantation were introduced in routine clinical practice in Slovenia. Increased medium age of PID patients reflects improved survival and better recognition of PID in adults. According to the data in comparable registries percentages of patients with predominantly antibody deficiencies and complement deficiencies are low and high, respectively.

Students’ opinions on working in rural practice in Slovenia

Students’ opinions on working in rural practice in Slovenia

Police interrogation practice in Slovenia

ABSTRACTInterrogation techniques are well explored, but in Slovenia it has remained unknown what interrogation techniques are used and what the basic characteristics of suspect interrogations are. The Slovenian interrogation manual proposes some coercive interrogation techniques and neglects their weaknesses. The aim of the current study was to examine Slovenian police officers’ beliefs as to the basic characteristics of their interrogations and whether techniques proposed by the manual are used in practice to begin to provide some insight into what actually happens in such interrogations. A survey instrument was used to obtain self-report data from a sample of criminal investigators. From 86 completed questionnaires it was found that a typical interrogation of a suspect lasts around 90 minutes and is not recorded. Interviewers typically use three interrogation techniques namely (i) conducting interrogations in isolation; (ii) identifying contradictions in the suspect's story; and (iii) confronting the suspect with evidence. Findings suggest that some coercive interrogation techniques are used in practice (e.g. offering moral justifications, alluding to have evidence of guilt, good cop/bad cop routine, and minimization). The study is the first insight into the practices of Slovenian investigators when questioning suspects. Differences among general, white-collar and organized crime investigators are also discussed.

Do the experiences of patients of state-employed family physicians and concessionaires in Slovenia differ?

Background: Family practice in Slovenia is provided by state-employed family physicians as well as concessionaires. However, both work under a contract withthe National Health Insurance Institute. This study focuses on comparing patients’ experiences with Slovenian concessionaires and state- employed physicians. Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups regarding the registered status of their family physician. They completed the questionnaires immediately after visiting their family physicians. Data used in the analyses included 76variables:18socio-economic and 58variableslinked to the patient's experience. Results:The analyses showed few differences between concessionaires and state-employed family physicians. In comparison to patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8% vs. 29.2%), were generally more frequent visitors (43.7% vs. 50.7%), and more often felt that opening hours are too restricted (25.7 % vs. 31.9%). Patients of concessionaires believed more often that in general, doctors can be trusted (40.1% vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as provide medical care (61.9% vs. 54.7%). Conclusions: There are few differences in patients’ experiences of state-employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.