Vprašalnik za samooceno kompetenc zdravnika družinske medicine na področju izboljševanja kakovosti

Aim: To perform a cross-cultural adaptation of the Quality Improvement Competency Self Assessment (QICS) questionnaire for family physicians into the Slovenian language and to validate it in a representative sample of Slovenian FPs. Methods: This cross-sectional observational postal survey was conducted in a random sample of 398 Slovenian FPs. We used the QICS questionnaire that was developed on the basis of the new Quality Improvement Competency Framework for family medicine. The QICS questionnaire consists of 37 items included in six domains. The questions can be answered on a five-point Likert scale. The validity of the translation was provided by the backward translation from Slovenian to the English language and by the reference group consisting of experienced FPs in the consensus process. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient and Spearman rho to determine the test-retest reliability (the questionnaire was sent to the physicians in the sample twice in a period of two weeks). Results: The final sample consisted of 100 (25.1%) family physicians, out of which 71 (71.0%) were women. Mean age of the sample was 43.3 ± 9.6 years. Mean score of the QICS questionnaire was 127.0 ± 30.1 points (first round) and 127.8 ± 30.6 points (second round). Cronbach’s alpha scores were 0.984 (first round) and 0.988 (second round). Spearman’s rho for the summary score of the whole scale was 0.829 with p < 0.001. Conclusion: The Slovenian version of the QICS questionnaire proved to be a valid and reliable tool for selfassessment of quality improvement competencies by FPs in terms of continuous professional development.Namen: Izvesti medkulturno prilagoditev vprašalnika o samoocenjevanju kompetenc zdravnika družinske medicina na področju izboljševanju kakovosti (vprašalnik QICS) in ga validirati na reprezentativnem vzorcu slovenskih zdravnikov družinske medicine. Metode: Ta presečna opazovalna raziskava je bila izvedena v naključnem vzorcu 398 slovenskih zdravnikov družinske medicine. Uporabili smo vprašalnik QICS, ki je bil razvit na podlagi novega teoretičnega okvira izboljševanja kakovosti v družinski medicini. Vprašalnik QICS je sestavljen iz 37 vprašanj, vključenih v šest področij. Na vprašanja je mogoče odgovoriti po petstopenjski Likertovi lestvici. Veljavnost prevoda je bila zagotovljena z dvosmernim prevodom in s pomočjo referenčne skupine, ki so jo sestavljali izkušeni zdravniki družinske medicine. Zanesljivost vprašalnika smo ocenjevali s pomočjo koeficienta Cronbach alfa in koeficienta Spearman rho za ugotavljanje časovne stabilnosti (vprašalnik je bil poslan zdravnikom v vzorcu dvakrat v razmiku dveh tednov). Rezultati: Končni vzorec je bil sestavljen iz 100 (25,1 %) zdravnikov družinske medicine, od katerih je bilo 71 (71,0 %) žensk. Povprečna starost vzorca je bila 43,3 ± 9,6 leta. Povprečno število točk na vprašalniku QICS je bilo 127,0 ± 30,1 (prvo pošiljanje) in 127,8 ± 30,6 (drugo pošiljanje). Cronbach alfa je bil 0,984 (prvo pošiljanje) in 0,988 (drugo pošiljanje). Spearman rho je bil 0,829 s p < 0,001. Zaključki: Slovenska različica vprašalnika QICS je zanesljivo in veljavno orodje za samooceno kompetenc zdravnikov družinske medicine na področju izboljševanja kakovosti v sklopu stalnega podiplomskega izobraževanja oz. stalnega strokovnega dograjevanja

Immunotherapy for squamous cell carcinoma of the head and neck - experience from Slovenia

Izhodišča: Imunoterapija z zaviralcem imunskih kontrolnih točk nivolumabom, zaviralnim protitelesom proti proteinu programirane celične smrti 1 (PD-1), je za bolnike z neozdravljivo ponovitvijo bolezni ali sistemskimi zasevki ploščatoceličnega karcinoma glave in vratu (P/Z PKGV), pri katerih je bolezen neobčutljiva na preparate platine, pomembna nova možnost zdravljenja. V primerjavi s citostatiki pomembno podaljša njihovo preživetje. Metode: Opravljena je bila retrospektivna analiza zdravljenja z nivolumabom pri slovenskih bolnikih s P/Z PKGV, ki so prejeli prvi odmerek nivolumaba do marca 2020. Zbiranje podatkov je bilo končano septembra 2020. Uporabljene so bile opisne statistične metode in test log-rank. Rezultati: V raziskavo je bilo vključenih 27 bolnikov. Srednji čas sledenja od prve aplikacije nivolumaba do konca opazovanja je bil 7,4 meseca, relativno šestmesečno celokupno preživetje pa 59- odstotno (95-odstotni interval zaupanja pri 41–78 %). Odgovor na zdravljenje je bil pri 85 % bolnikov ocenjen s kliničnim pregledom in rentgenskim slikanjem prsnega koša, pri čemer je bil pri 41 % kot najboljši odgovor ugotovljen delen odgovor na zdravljenje. Imunsko pogojeni neželeni dogodki so se pojavili pri 30 % bolnikov, pri čemer so bili vsi gradusa ≤ 2. En bolnik je bil sočasno z nivolumabom tudi obsevan. Zaključek: Glede na zbrane podatke se je tudi v slovenski populaciji bolnikov s P/Z PKGV zdravljenje z nivolumabom izkazalo za varno. Zaradi kratkega časa sledenja ugotovljene učinkovitosti ni mogoče primerjati z rezultati tujih raziskav. S pričakovano odobritvijo pembrolizumaba bodo zaviralci imunskih kontrolnih točk tudi v Sloveniji dobili mesto v prvem redu zdravljenja P/Z PKGV.Background: Immunotherapy with the immune checkpoint inhibitor nivolumab – an inhibitory antibody against programmed death receptor-1 (anti-PD-1) – represents an important new treatment option for patients with an incurable recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) that is unresponsive to platinum-based chemotherapy. It significantly prolongs survival compared to standard chemotherapy. Methods: A retrospective analysis of treatment with nivolumab in patients with R/M HNSCC in Slovenia who received their first dose of nivolumab by March 2020 was performed. Data collection was completed in September 2020. Descriptive statistics and log rank tests were used. Results: Twenty-seven patients entered the study. The median time of follow-up from the first nivolumab application onward was 7.4 months, and the relative six-month overall survival rate was 59% (95% confidence interval 41–78%). In 85% of patients, the response to treatment was evaluated using clinical examination and chest x-ray only. In 41% of patients the partial response to treatment was declared as the best response achieved. Thirty per cent of patients experienced immune-related adverse events, of which all were grade ≤2. In one patient radiotherapy was delivered concurrently with nivolumab. Conclusion: According to the presented results, treatment with nivolumab has also been shown to be safe in Slovenian patients with R/M HNSCC. Due to the short follow-up time, the observed efficacy cannot be compared with the results of foreign studies. With the expected approval of pembrolizumab, immune checkpoint inhibitors will also be given a place in the first line treatment of R/M HNSCC in Slovenia

How Can We Advance Integrative Biology Research in Animal Science in 21st Century?:Experience at University of Ljubljana from 2002 to 2022

In this perspective analysis, we strive to answer the following question: how can we advance integrative biology research in the 21st century with lessons from animal science? At the University of Ljubljana, Biotechnical Faculty, Department of Animal Science, we share here our three lessons learned in the two decades from 2002 to 2022 that we believe could inform integrative biology, systems science, and animal science scholarship in other countries and geographies. Cultivating multiomics knowledge through a conceptual lens of integrative biology is crucial for life sciences research that can stand the test of diverse biological, clinical, and ecological contexts. Moreover, in an era of the current COVID-19 pandemic, animal nutrition and animal science, and the study of their interactions with human health (and vice versa) through integrative biology approaches hold enormous prospects and significance for systems medicine and ecosystem health

Market research for the needs of the company dgr d.o.o.

Trge vedno bolj določa tesna konkurenca, zato je za podjetja še posebej pomembno, da poznajo in razumejo preference svojih potrošnikov ter prepoznajo in analizirajo ustrezne ciljne trge, saj svetovni splet podjetjem odpira ogromno novih priložnosti in možnosti cenejšega poslovanja ter širjenja na tuje trge zaradi zmožnosti učinkovitega nagovarjanja ciljne publike. Tržne raziskave lahko dosežejo visoko raven zadovoljstva strank, zmanjšajo upad le-teh in razvijejo podjetje. Tržne raziskave zagotavljajo dragocene informacije o trgih, strankah in lastnih izdelkih podjetja, pomagajo ugotoviti, kaj stranke želijo in kaj lahko pričakujejo. Z razumevanjem potreb strank in s poznavanjem ciljnih trgov, predvsem naraščajoče globalizacije, lahko podjetja napovedujejo svojo proizvodnjo in prodajo ter ustrezno načrtujejo tudi zaradi učinkovitih transportnih rešitev. Namen diplomskega dela je bil ugotoviti, katere tržne raziskave so primerne za storitev proučevanega podjetja. S pomočjo kvalitativne raziskave – intervjuja smo skušali ugotoviti, kakšno raziskavo trga so izvedli v proučevanem podjetju in na kakšen način, koliko postavk, ki smo jih predhodno opredelili v teoriji raziskav trga, so upoštevali, ter kako lahko nadgradijo svojo raziskavo trga. Ugotovili smo, da je proučevano podjetje opravilo raziskavo trga, v sklopu katere so identificirali potencialne stranke, določili velikost trga, analizirali konkurenco, izvedli analizo zmožnosti, zastavili cilje ter analizirali trende. Glede na rezultate priporočamo razširitev raziskave trga z analizo zadovoljstva.Due to increasingly intense competition, it is vital for companies to know and understand the preferences of their clients as well as to analyze and recognize relevant target markets. Because the Internet opens up a huge number of new opportunities and possibilities for companies to do business cheaper and to expand to foreign markets and persuade the general public, or it makes it possible to persuade the target audience more effectively. Market research can contribute to higher client satisfaction and increased client retention, contributing to the company’s growth. Market research entails gathering information about markets, clients and the company’s own products in order to establish understanding of potential clients needs and expectations. By understanding the client needs and target markets, mostly increasing globalization, companies can better plan and budget their production and sales also due to efficient transport solutions. The purpose of the thesis was to determine which market research is suitable for the service of the studied company. With the help of qualitative research and interviews, we tried to find out what kind of market research was carried out in the studied company and in what way, how many items that we previously defined in the market research theory have taken into account and how they can upgrade their market research. We found that the subject company had conducted market research, in which they identified potential customers, determined the size of the market, analyzed the competition, performed a capability analysis, set goals and analyzed trends. Based on the results, we recommend expanding the market research by analyzing customer satisfaction

Immunohistochemical analysis of glucocorticoid receptor expression in early breast cancer and its influence on response to treatment with neoadjuvant systemic therapy

Background: The glucocorticoid receptor (GR) is differentially expressed on tumour and immune cells in breast cancer, and its expression may depend on the molecular subtype of the cancer, and it may also influence the response to neoadjuvant systemic therapy. Our primary aim is to introduce reliable immunohistochemical staining with anti-GR antibodies, and our second aim is to evaluate the expression of GR in breast cancer samples and to study whether it is expressed differently in different subtypes and whether its expression has an impact on the response to neoadjuvant systemic therapy. Methods: In the preclinical part of the research, we selected a reliable antibody against GR, and then we calibrated and validated the immunohistochemical staining procedure with the selected antibody. In the clinical part of the research, we evaluated the expression of GR on tumour and immune cells in breast cancer. Samples from 162 patients were selected prospectively as part of the AKRA study, which took place at the Institute of Oncology Ljubljana, and later analysed. We also obtained data on the associated tumour. Results: We introduced reliable immunohistochemical staining with antibodies against GR and evaluated its expression on tumour and immune cells. On tumour cells, GR was positive in the triple- -negative subtype in 93.5%, in the HER2-positive subtype in 88.4% and in the luminal B subtype in 87.5%; the difference between the subtypes was not statistically significant (p = 0.746). A complete pathological response to neoadjuvant systemic therapy was present in the case of positive GR in 31.8%, and in the case of negative GR in 22.2%, which was also not statistically significantly different (p = 0.589). Expression on immune cells was present in all samples on ≥ 80% cells with an intensity level of 3, so we did not analyse these results. Conclusions: We successfully introduced immunohistochemical staining for glucocorticoid receptor and evaluated its expression on the samples, but we failed to demonstrate the association of GR expression with subtypes and response to neoadjuvant systemic therapy

Neuroendocrine carcinoma of the larynx and pharynx

Neuroendocrine carcinomas (NECs) of the head and neck are rare and the experience scanty. The Cancer Registry of Slovenia database was used to identify cases of laryngeal and pharyngeal NECs diagnosed between 1995%2020. Biopsies were analyzed for the expression of standard neuroendocrine markers (synaptophysin, chromogranin, CD56), INSM1, Ki-67, p16, and PD-L1 (using the combined positive score, CPS). In situ hybridization for human papillomavirus (HPV) and Epstein%Barr virus (EBV) was performed. Twenty patients (larynx, 12pharynx, 8) were identified. One tumor was well differentiated (WD), five were moderately differentiated (MD), and 14 were poorly differentiated (PD). Disease control was achieved solely by surgery in 4/4 MD/PD T1-2N0-1 tumors. Eight patients died of the disease, seven of which were due to distant metastases. All three traditional markers were positive in 11/17 NECs and the INSM1 marker in all 20 tumors. Two of fourteen p16-positive tumors were HPV-positive, but all three nasopharyngeal NECs were EBV-negative. Three tumors had CPSs % 1. In conclusion, INSM1 was confirmed to be a reliable marker of neuroendocrine differentiation. Except in WD and early-stage MD/PD tumors, aggressive multimodal therapy is neededthe optimal systemic therapy remains to be determined. p16, HPV, and EBV seem to bear no prognostic information