Predictors of a severe course and mortality in patients with COVID-19-associated pneumonia

INTRODUCTION

Severe and critical forms of SARS-CoV-2 pneumonia are associated with high morbidity and mortality. Numerous research studies have been conducted around the world to investigate various variables (demographic, clinical, laboratory, etc.) in an attempt to understand the relationships between them and the course and outcome of patients with COVID-19 infection and pneumonia.

Prognostic Value of Weekly Delta-Radiomics during MR-Linac Radiotherapy of Glioblastoma

PURPOSE/OBJECTIVE(S)

MRI after chemoradiotherapy (chemoRT) shows areas of presumed tumor growth in ≤ 50% of glioblastoma (GBM) patients, which can be true progression (TP) - tumor growth with poor treatment response, or pseudoprogression (PP) - edema and tumor necrosis with favorable treatment response. Patients with TP have median overall survival (OS) of only 7 months, while patients with PP have median OS of 36 months. However, on imaging, TP and PP are usually not discernible during treatment, making it difficult to adapt radiation for poor responders. The purpose of this study was to investigate the prognostic value of delta radiomic features from MR-Linac for GBM.

MATERIALS/METHODS

Using an IRB-approved prospective cohort of GBM patients undergoing 30 fractions of chemoRT to 60 Gy on a 0.35T MR-Linac, 2 regions of interest (ROI) were contoured on daily T2-weighted treatment set-up scans: 1) tumor/edema (lesion) and 2) post-surgical resection cavity (RC). The lesion ROI were used to calculate texture features: second order radiomics features based on the gray-level co-occurrence matrix (GLCM), gray-level size zone matrix (GLSZM), gray-level run length matrix (GLRLM), and neighborhood gray-tone difference matrix (NGTDM). Each of these describe the probability of spatial relationships of gray levels occurring within the ROI. Features from fraction 1 (pre-radiation) were subtracted from fractions 5, 10, 15, 25, and 30 to create delta features at 5 timepoints (D5-D30). Patient response was retrospectively defined as no progression (NP), TP, or PP. Supervised machine learning was utilized using a 500-tree random forest (RF) classification model with TP or PP as the outcome. Variable importance analysis was conducted by calculating the out-of-bag errors with multiple bootstrapped data sets. The most prognostic features were selected using the RF importance scores.

RESULTS

Thirty-six patients were screened for inclusion: 9 were excluded due to no T2 lesion (RC ROI only). Of the remaining 27 patients: 10 had NP, 11 had TP, and 6 had PP. Thirty-nine texture features, plus lesion volume and mean lesion intensity (for a total of 41 variables per time point) were calculated and included in the model. Of the 10 most prognostic features, 6 were from D10, suggesting that prognostic changes in the underlying lesion microenvironment are occurring within the first 10 fractions of treatment. The model selected GLSZM high gray-level zone emphasis (HGZE) D10, IBSI code 5GN9, as the most prognostic feature. The receiver operator characteristic (ROC) area under the curve (AUC) for GLSZM HGZE D10 was 0.94 (95% CI = 0.81-1.00).

CONCLUSION

Delta radiomic features extracted from MR-Linac imaging may predict between PP and TP in GBM patients during treatment, which is earlier than current methods. This could allow physicians to adapt/intensify treatment in real time for poorly responding patients. Future directions include analysis with a larger patient cohort and with additional MRI contrasts (MR-Linac multiparametric MRI).

Dose-Volume Parameters to the Urinary Tract Sub-Volumes and Predictors of Genitourinary Acute Toxicity in a Phase 2 Clinical Trial Assessing MRI-Guided Prostate Boost for Localized Prostate Cancer - The Miami BlastM Trial

PURPOSE/OBJECTIVE(S)

The relationship between radiotherapy dose to the sub-volumes of the genitourinary (GU) tract and GU toxicity is poorly understood, particularly in prostate cancer patients treated with an intraprostatic dominant lesion (IDL) boost. While the use of IDL boost improves outcomes, it results in higher doses to GU structures and potentially increased toxicity. We investigated the association between dose-volume histogram (DVH) parameters for urinary tract sub-volumes and GU toxicity in the context of IDL boost in patients enrolled in the Miami BlastM Trial.

MATERIALS/METHODS

DVH data were assessed for patients enrolled in the Miami BlastM, a randomized phase 2 trial (NCT20140627) evaluating upfront versus integrated IDL boost. IDL GTV boost consisted of either 12-14 Gy administered on day 1 or integrated boost of 2.4 Gy per fraction (91.2 Gy total, 98.5 Gy 2.0 Equiv), with the prostate receiving 76 Gy in 38 fractions. Bladder trigone (BTg) and urethra sub-volumes were contoured retrospectively on planning CT scans. GU toxicity was assessed using Common Toxicity Criteria for Adverse Events (CTCAE) version 4 and International Prostate Symptom Score (IPSS). DVHs of the bladder, BTg, bladder minus BTg, prostatic urethra, and bulbomembranous urethra were examined. The primary composite endpoint was CTCAE GU acute toxicity grade (G) ≥2 and/or IPSS increase of ≥10 from baseline. Secondary endpoints were GU acute toxicity G≥2, GU late toxicity G≥2, and IPSS increase of ≥10 from baseline. Univariable and multivariable logistic regression analyses were performed.

RESULTS

A total of 129 patients treated between February 2015 and January 2022 were eligible for analysis. One hundred and one (78%) patients developed either GU acute toxicity G≥2 (68%) and/or an IPSS increase of ≥10 from baseline (30%). Less than 2% of patients developed GU toxicity G≥3. BTg V30 Gy was significantly associated with IPSS increase ≥10 (p = 0.046). The bulbomembranous urethral maximum dose was significantly associated with GU acute toxicity G≥2 and GU late toxicity G≥2 (p <0.05 for both). Average maximum and mean urethral doses were 88.9 and 81.5 Gy, respectively. The BTg maximum dose, V20 Gy, V30 Gy, and V40 Gy were not significantly associated with the primary composite endpoint (p = 0.56, 0.75, 0.89, 0.82, respectively). On multivariable analysis, a higher bulbomembranous urethral maximum dose was significantly associated with GU acute toxicity G≥2 and/or IPSS increase of ≥10 from baseline (p = 0.019).

CONCLUSION

Our data suggest a dose-effect relationship between maximum doses to the bulbomembranous urethra and GU toxicity. A better understanding of RT-related changes to specific sub-volumes of the urethra and strategies to mitigate urethral dose could enhance the therapeutic ratio in prostate cancer patients treated with MRI-guided IDL boost.

Pattern Analysis of Daily Lesion Volume Trajectories for Early Prediction of Glioblastoma Progression During MR-Linac Radiotherapy

PURPOSE/OBJECTIVE(S)

Distinguishing between true progression (TP) and pseudoprogression (PP) post-radiotherapy (RT) is of paramount importance for treatment management of patients with glioblastoma (GBM). MR-Linac systems allow for daily monitoring of tumor changes throughout the course of RT. We hypothesized that the patterns of tumor volume change during RT may enable early prediction of treatment response.

MATERIALS/METHODS

Using an IRB-approved prospective cohort of GBM patients undergoing 30 fractions of chemoRT to 60 Gy on a 0.35T MR-Linac, tumor/edema (tumor lesion) regions of interest (ROI) were contoured on daily T2-weighted treatment set-up scans. The obtained tumor lesion (TL) volume changes during treatment were smoothed with a moving average Gaussian window over time. Non-negative Matrix Factorization (NMF) was applied to the data matrix D (N x F), containing the trajectories in its rows for each patient, where N is the number of patients analyzed and F is the number of fractions. NMF represents D as a linear combination of three temporal (hidden) patterns and their weights in each individual trajectory. The same analysis was performed for ΔD, containing the changes in volumes with reference to the first fraction. The calculated weights were scaled in [0, 1], expressed as probabilities (by ℓ1-normalization) and used as features in Linear Discriminant Analysis (LDA). The LDA model was trained to differentiate between no progression (NP), PP and TP, and assessed by leave-one-subject-out cross-validation.

RESULTS

Thirty-six patients were screened for inclusion: 9 were excluded due to no T2 lesion (resection cavity only). Of the remaining 27 GBM patients analyzed, 10 had no tumor growth on first post-RT diagnostic MRI, 6 were determined to have PP based on regression or long-term stability of findings, and 11 had TP due to continued progression of disease past 6 months, rapid patient death from disease, or tissue sampling showing active malignancy. With the use of only 2 features, LDA achieved an overall accuracy of 70.4% classifying correctly: 6 (60%), 4 (67%), and 9 (82%) patients with NP, PP, and TP, respectively. The temporal NMF patterns (monotonous decrease, rapid increase during the third part of the treatment, etc.) indicate that there is enough signal to classify patients' response based on the pattern tumor volume changes during RT.

CONCLUSION

We identified tumor dynamics' patterns during RT, indicative of differential behavior of tumor growth between TP and PP. Although with a limited number of patients, these initial results suggest that tumor volume changes during treatment may provide early markers of treatment response. This could allow physicians to adapt/intensify treatment in real time for poorly responding patients. Next steps include automating the process of real-time tumor volume monitoring by incorporating a deep learning solution for automatic volume delineation on daily treatment set-up scans.

COVID-19 Peritraumatic Distress Index Instrument – Translation and Validation of Bulgarian Version

BACKGROUND: COVID-19 peritraumatic distress index (CPDI) self-report questionnaire was designed to measure peritraumatic psychological distress in a pandemic emergency. AIM: The aim of the study was the validation of Bulgarian COVID-19 peritraumatic distress index (CPDI) questionnaire and its application to measure psychological distress level in Bulgarian population. METHODS: The study was conducted among 42 adults from February 2022 to March 2022. The average age of respondents participating in the validation of COVID-19 peritraumatic distress index (CPDI) questionnaire is 40.88 ± 13.309, women being predominant - 71.4% (n = 30), as well as individuals with higher education- 69% (n = 29). Following the preliminary instruction, all participants filled out the online Bulgarian version of the questionnaire anonymously 2 times within a period of 2 weeks. Data were analyzed using descriptive statistic, the Wilcoxon signed-rank test, Cronbach’s alpha, and Corrected Item-Total Correlation. RESULTS: The CPDI instrument was linguistically validated according to a standard procedure (8) and cross-culturally adapted (9) into Bulgarian in several stages. The overall Cronbach’s alpha for the Peritraumatic Distress Index (CPDI) questionnaire is 0.940. Almost all corrected item-total correlations exceeded the accepted cut off of 0.30 indicating each item was related to the overall scale except for Q5 “I feel sympathetic to COVID-19 patients and their families.” CONCLUSION: The Bulgarian version of the questionnaire reveals good reliability and cross-cultural validity and can be applied widely for measuring the prevalence of psychological suffering and distress in the pandemic emergency.

Correlations between preoperative clinical factors and treatment outcome of spinal meningiomas - A retrospective study of a series of 31 cases

Background:

The purpose of the current study is to identify the correlations between the most important preoperative clinical factors and the outcome of surgery of spinal meningiomas (SM).

Methods:

We performed a retrospective analysis of the medical history, clinical, paraclinical, neuroimaging, and surgical protocol data in 31 patients with SM who underwent surgical resection at our institution from January 2011 to July 2020. The degree of resection was assessed on the Simpson scale. The modified McCormick scale was used to monitor the effect and outcome of treatment at admission, discharge, and at further follow-up.

Results:

The average age of the patients was 65 years (37-78). Vertebral pain and motor deficits were the most common initial symptoms that occurred in 26 (89.6%) and 29 (93.5%) patients, respectively. Sphincter disorders were found in 9 (29%) patients. Total resection (Simpson Grade I – II) was achieved in 29 patients (93.5%). We achieved a favorable outcome (McCormick Gr. I to III) in 93.3% of patients. The degree of the neurological deficit (P = 0.026) and the presence of sphincter disorders (P = 0.009) were the preoperative clinical factors that most significantly correlated with the outcome of treatment.

Conclusion:

The outcome from the surgical treatment of SM correlated significantly with the degree of the preoperative neurological deficit. Therefore, patients presenting with more severe symptoms are expected to have worse outcomes.

Outcome of Surgical Treatment of Spontaneous Spinal Epidural Abscesses for a 10-year Period

INTRODUCTION

Spinal epidural abscess is uncommon but potentially debilitating infection. Delay in early diagnosis may be associated with increased morbidity and mortality despite recent advances in medicine.

AIM

To present the clinical course and outcome of treatment of spontaneous spinal epidural abscesses.

MATERIALS AND METHODS

Thirty-four patients (20 men and 14 women) with clinical, neuroimaging and/or histological data for spinal epidural abscess were treated at the Clinic of Neurosurgery at St George University Hospital, Plovdiv, Bulgaria, for the period 2009-2018.

RESULTS

The average age of patients was 62 years (21-76 years) and the ratio of men to women was 1.4:1. All patients (100%) presented with vertebralgia, 13 patients (38.2%) had additional radiculalgia, and 10 patients (29.4%) presented with sensory or motor deficit. The duration of complaints varied from 4 to 180 days. At hospital admission, only 9 patients (26.4%) had intact neurological status. The most common localization of the spinal epidural abscess was in the lumbar and lumbosacral area (52.9%), concomitant spondylodiscitis was present in 31 patients (91.2%). Twenty-four patients (70.6%) underwent emergency surgery within 24 hours, and the rest had planned surgery. Decompressive interlaminotomy or hemilaminectomy was performed in 9 patients (26.5%). The remaining 25 patients (73.5%) underwent laminectomy, in 15 patients (44.1%) it was combined with posterior pedicle screw fixation. After the treatment, 23 patients (67.6%) had a good outcome, the remaining 11 (32.4%) had a poor outcome, and 3 patients died (8.8%).

CONCLUSION

In patients with spinal epidural abscess, emergency surgery is the treatment method of choice. It allows decompression of neural structures, correction of the spinal deformity, segmental stabilization and rapid mobilization of patients.

Burnout among nurses and correctional officers

BACKGROUND

The work of nurses and correctional officers alike has long been pointed at as among the most stressful in the world.

OBJECTIVE

The primary aim was to evaluate the prevalence and level of occupational burnout among 214 hospital nurses and 201 correctional officers from Bulgaria. One of the focuses was to examine whether gender roles or occupational roles were more related to burnout.

METHODS

The current work used a descriptive cross-sectional inter-occupational comparative survey design. The participation was voluntary, individually and anonymously without any financial compensation. The only qualification in the sample selection was that the employee had direct contact with patients and inmates respectively. A translated MBI-Bulgarian version was used to measure burnout. Data were entered into SPSS17.0 to carry out data analysis.

RESULTS

The level of emotional exhaustion and personal accomplishment of nurses were significantly higher than that of correctional officers. Mean depersonalization score of correctional officers was significantly higher than that of nurses. Correctional officers demonstrated a higher prevalence of burnout syndrome compared with nurses. To examine whether gender is associated with burnout, Mann-Whitney U test was utilized to assess gender differences of correctional officers. Our results suggest that being male or female is not a critical determinant of burnout.

CONCLUSION

Correctional officers were found to have a higher prevalence of burnout syndrome compared with nurses.

Psychometric properties of the Bulgarian version of Hospital Survey on Patient Safety Culture

OBJECTIVE

To explore the psychometrics of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its suitability for use in Bulgaria.

DESIGN

A national web-based cross-sectional survey of the safety patient culture.

SETTING

The hospitals' staffs from 28 administrative areas in the country.

INTERVENTIONS

Web-based self-administered questionnaire.

PARTICIPANTS

Physicians and non-physicians such as nurses, midwifes, etc., working at hospitals.

MAIN OUTCOME MEASURES

Confirmatory factor analysis (CFA) was performed to assess the psychometric properties of the original US structure. Assessment of construct validity included convergent validity, discriminant validity, and nomological validity of constructs.

RESULTS

A total of 525 valid cases were included in the analysis. The results of CFA revealed acceptable values for absolute indices and lower for the incremental index, comparative fit index. Due to the very low convergence validity, the dimension 'staffing' was removed from the model. Additionally, one item was removed from another dimension. The B-HSOPSC included 11 dimensions and 37 items.

CONCLUSIONS

The B-HSOPSC had acceptable levels of global and local fits. Its safety culture dimensions were sufficiently distinguishable and correlated with outcome variables.

Eco-compatible oxides enabling energy storage via Li+/Mg2+ co-intercalation

The storage of energy by means of reversible intercalation of bivalent magnesium ions represents, nowadays, the shortest route for doubling the energy density of conventional lithium ion batteries. Contrary to the intercalation of monovalent lithium ions, the intercalation of Mg²⁺ is a kinetically limited process. Herein we demonstrate a new approach for improving Mg²⁺ intercalation, which is based on dual intercalation of Li⁺ and Mg²⁺ ions with a synergic effect. The concept is proved on the basis of eco-compatible oxides such as magnesium manganate spinels, MgMn₂O₄, and lithium titanates Li₂TiO₃ and Li₄Ti₅O₁₂ with a monoclinic and spinel structure. These two types of oxides are selected since they exhibit high and low potentials of ion intercalation due to the redox couples Mn^2,3+/Mn^3,4+ and Ti³⁺/Ti⁴⁺, respectively. Through a newly developed method of synthesis, we succeeded in the preparation of well-crystallized nanosized spinels with a specific cationic distribution. The intercalation properties of MgMn₂O₄, Li₂TiO₃ and Li₄Ti₅O₁₂ are first examined in model cells versus the metallic Li anode. The Li⁺ and Mg²⁺ intercalation is directed by the kind of the used electrolyte: a lithium electrolyte consisting of 1 M LiPF₆ solution in EC : DMC and a magnesium electrolyte consisting of 0.5 Mg(TFSI)₂ solution in diglyme. The mechanism of Li⁺ and Mg²⁺ co-intercalation is assessed by ex situ X-ray diffraction and high-resolution transmission electron microscopy (HR-TEM). Finally, a new type of hybrid Li-Mg ion cell combining MgMn₂O₄ and Li₄Ti₅O₁₂ oxides as electrodes is constructed. The cell configuration allows reaching an operating voltage of around 1.7 V by using an electrolyte containing 0.5 M LiTFSI in diglyme.

Comparing patient safety culture in Bulgarian, Croatian and American hospitals - preliminary results

Background and aims

Patient safety culture (PSC) is an essential component of the quality of healthcare. Improving PSC is considered a priority in many developed countries. A specialized software platform for registration and evaluation of hospital patient safety culture has been developed with the support of the Medical University Plovdiv Project №11/2017.The aim of the study is to assess the status of PSC in Bulgarian hospitals and to compare it to that in USA and Croatian hospitals.

Methods

The study was conducted from June 01 to July 31, 2018 using the web-based Bulgarian Version of the Hospital Survey on Patient Safety Culture Questionnaire (B-HSOPSC). Two hundred and forty-eight medical professionals from different hospitals in Bulgaria participated in the study. In order to quantify the differences of positive scores distributions for each of the 42 HSOPSC items between Bulgarian, Croatian and USA samples, the χ²-test was applied. The research hypothesis assumed that there were no significant differences between the Bulgarian, Croatian and US PSCs.

Results

The results revealed 14 significant differences in the positive scores between the Bulgarian and Croatian PSCs and 15 between the Bulgarian and the USA PSC, respectively. Bulgarian medical professionals provided less positive responses to 12 items compared with Croatian and USA respondents. The Bulgarian respondents were more positive compared to Croatians on the feedback and communication of medical errors (Items - C1, C4, C5) as well as on the employment of locum staff (A7) and the frequency of reported mistakes (D1). Bulgarian medical professionals were more positive compared with their USA colleagues on the communication of information at shift handover and across hospital units (F5, F7). The distribution of positive scores on items: "Staff worry that their mistakes are kept in their personnel file" (RA16), "Things 'fall between the cracks' when transferring patients from one unit to another" (RF3) and "Shift handovers are problematic for patients in this hospital" (RF11) were significantly higher among Bulgarian respondents compared with Croatian and US respondents.

Conclusions

Significant differences of positive scores distribution were found between Bulgarian and USA PSC on one hand and between Bulgarian and Croatian on the other. The study reveals that distribution of positive responses could be explained by the cultural, organizational and healthcare system differences.

Academic Staff Satisfaction with their Work: A Cross-Sectional Study in a Medical University

BACKGROUND:

Employees’ work satisfaction, combined with democratic management, are important predictors of future productivity in any organisation.

AIM:

The aim of this study is to investigate job satisfaction in academic staff as well as the associated working environment factors, using an original self-administered questionnaire.

METHODS:

A cross-sectional survey was conducted using an original standardised questionnaire. It involved 370 academic staff members at one of the five medical universities in Bulgaria. The questionnaire consists of 17 items (including occupational hazards, management style, conflict solving and demographic characteristics) rated on a 5-point Likert scale.

RESULTS:

The results revealed that the majority of academic staff (71.7%) works in a risky environment. Employees indicate that “mental strain”, “work with chemical agents and dust” and “work with biological hazards” are the most common risk factors. Democratic leadership and cooperation are most commonly applied management styles.

CONCLUSION:

The instrument for the measurement of job satisfaction revealed high values of psychometric characteristics for reliability and validity. The study found a high level of satisfaction of academics with their working conditions. It is necessary to conduct similar studies periodically to detect more precisely the decrease in academic staff work satisfaction and take timely and adequate measures to improve it.

LiMnPO4-olivine deposited on a nanoporous alloy as an additive-free electrode for lithium ion batteries

A new strategy for the fabrication of binder- and carbon-free electrodes for lithium ion batteries is demonstrated.

Do Personality Characteristics Constitute the Profile of Burnout-Prone Correctional Officers?

AIM:

This study examined the relationship between personality characteristics and burnout syndrome among Bulgarian correctional officers.

METHODS:

The cross-sectional study took place through individual, voluntary and anonymous interviewing of 307 employees from three district prisons. Maslach burnout inventory, Eysenck personality questionnaire and demographic characteristics were administered.

RESULTS:

The personality predictors of emotional exhaustion were low emotional stability and low level of dimension extraversion. The predictors of depersonalization were high levels of neuroticism and psychoticism and low level of extraversion.

CONCLUSION:

This research helps to identify employees who are at risk for developing burnout as a result of their personalities. In Bulgaria, there is still no official information about studies in this area.

Mixed-methods study of reported clinical cases of undesirable events, medical errors, and near misses in health care

RATIONALE, AIMS, AND OBJECTIVES

Patient safety is recognized as a key indicator of quality of medical care. International experience has shown that all efforts should focus on the delivery of a safer work environment and health care system as a whole in order to reduce or mitigate medical errors and their impact on society. The aim of this study is to investigate and classify the most common incidents regarding patient safety as well as their contributory factors, based on personal real-life experiences and situations in medical care reported by health care professionals.

METHODS

A mixed-methods study design was used. Sixty-five respondents participated (aged from 23 to 58 y). Reported cases of undesirable events (UE), medical errors (ME), and near misses (NM) were collected, processed, and analysed based on our original conceptual framework. A qualitative content analysis and descriptive statistics were conducted on the narratives in all 34 reported valid case files. Intercoder reliability was measured through the kappa statistics (κ = .69). The overall agreement of judgments on all codes was excellent (95%).

RESULTS

A total of 29 MEs in 34 cases were reported. In 85% of them, an average of 1.83 contributory factors were identified. The most common contributory factors were "Incompetence," "Neglect," "Severe work overload," and "Shortage of staff."

DISCUSSION

Important steps to prevent medical errors are their identification and reporting.

CONCLUSION

Health care professionals appear able to report UEs, MEs, and NMs occurring in medical care practice. They seem more willing to report and distinguish incidents related to MEs than to UEs and NMs.

Involvement of general practitioners in colorectal cancer voluntary screening campaign: a mixed-methods study

PURPOSE

To investigate the attitudes and willingness of the general practitioners (GPs) as well as their actual participation in the voluntary colorectal cancer (CRC) screening campaign without additional financial incentives for them, combining quantitative and qualitative approaches.

METHODS

A multiple-case practice based study was designed using a mixed method, triangulation techniques and a sequential explanatory design strategy. The study included all 41 GPs practices in the Municipality of Asenovgrad. A questionnaire, face-to-face semi-structured interviews, nonparticipant direct structured observations and documentation review were used to collect data. Variation analysis, alternative analysis for percentage calculation and Mann-Whitney U test to compare two independent groups and Fisher's Exact Test were used. Statistical significance of the null hypothesis was assumed at p<0.05.

RESULTS

Older GPs (p=0.015) and those working with a practice nurse (p=0.000) were more inclined to participate in the CRC screening campaign. GPs more knowledgeable of the importance of CRC screening with iFOBT (immunochemical faecal occult blood test), (p=0.002) and those trusting its quality (p=0.007) were more willing and ready to take part in the screening campaign. Among barriers that GPs encountered in the present screening campaign were lack of knowledge and experience about iFOBT, lack of materials and insufficient incentives.

CONCLUSION

Some limitations influence the voluntary participation of GPs in CRC screening campaign that have to be considered before decisions can be made on the implementation of population-based CRC screening programme in Bulgaria in accordance with European guidelines on best practice.

Linguistic Validation and Cultural Adaptation of Bulgarian Version of Hospital Survey on Patient Safety Culture (HSOPSC)

BACKGROUND:

Patient safety (PS) is one of the essential elements of health care quality and a priority of healthcare systems in most countries. Thus the creation of validated instruments and the implementation of systems that measure patient safety are considered to be of great importance worldwide.

AIM:

The present paper aims to illustrate the process of linguistic validation, cross-cultural verification and adaptation of the Bulgarian version of the Hospital Survey on Patient Safety Culture (B-HSOPSC) and its test-retest reliability.

METHODS:

The study design is cross-sectional. The HSOPSC questionnaire consists of 42 questions, grouped in 12 different subscales that measure patient safety culture. Internal con­sistency was assessed using Cronbach’s alpha. The Wilcoxon signed-rank test and the split-half method were used; the Spear­man-Brown coefficient was calculated.

RESULTS:

The overall Cronbach’s alpha for B-HSOPSC is 0.918. Subscales 7 Staffing and 12 Overall perceptions of safety had the lowest coefficients. The high reliability of the instrument was confirmed by the Split-half method (0.97) and ICC-coefficient (0.95). The lowest values of Spearmen-Broun coefficients were found in items A13 and A14.

CONCLUSION:

The study offers an analysis of the results of the linguistic validation of the B-HSOPSC and its test-retest reliability. The psychometric characteristics of the questions revealed good validity and reliability, except two questions. In the future, the instrument will be administered to the target population in the main study so that the psychometric properties of the instrument can be verified.

Economic costs due to workers' sick leave at wastewater treatment plants in Bulgaria

BACKGROUND

The compensatory mechanisms of social security include expenses for sick leave. The aim of the study is to determine the economic cost due to sick leave among workers in wastewater treatment plants (WWTPs), comparing with the same economic indicators of the National Social Security Institute (NSSI) in Bulgaria.

MATERIAL AND METHODS

The sick leave of 111 workers at 3 WWTPs was studied in the period 2012-2014 on the grounds of registered absences from work due to temporary incapacity for work. The economic indicators of the NSSI, the gross salary at WWTPs, payable social security contributions and compensatory payments for sick leave have been used for economic cost calculation for temporary incapacity of the workers.

RESULTS

The frequency of cases and the frequency of lost days due to temporary incapacity were increased in the observed period at WWTPs and in Bulgaria, and it is significantly higher for the employed at WWTPs. The percentage share of workers equivalent to 1.66% at WWTPs have not worked for an entire year as a result of temporary incapacity in 2012, 2.76% - in 2013, and 4.61% - in 2014. The economic burden due to sick leave at WWTPs was raised from EUR 4913.02 in 2012 to EUR 16 895.80 for 2014 for employers and the NSSI.

CONCLUSIONS

The frequency of cases and the frequency of lost days due to temporary incapacity were increased in the observed period at WWTPs and in Bulgaria, and it is significantly higher for the employed at WWTPs. The economic burden was equally distributed between employers and the NSSI. Med Pr 2018;69(2):129-141.

The EUROPEP questionnaire for patient's evaluation of general practice care: Bulgarian experience

Aim

To validate the Bulgarian EUROPEP-questionnaire and its implementation to measure patient evaluation of general practice care in Bulgarian population.

Methods

A multicenter cross-sectional study was conducted at twenty five primary care practices from South-Central Region of Bulgaria. A total of 1000 adult patients aged over 18 years and visiting the practice for more than a year were approached consecutively to take part in the study. The internal consistency and test-retest reliability of the EUROPEP questionnaire were evaluated. To confirm the construct validity of the questionniare, еxplanatory factor analysis was performed.

Results

Cronbach’alpha for “clinical behaviour” is 0.95 and for “organisation of care” 0.81. Factor analysis identifed two factors, which accounted for 77.0% of the total variation in these items. On average, 58.7% of respondents rated the level of care received as excellent. The waiting time in the waiting room was the item most poorly rated (33.8%). The item “keeping patients' records and data confidential” was the most highly rated (88.8%). Patients were less satisfied with “providing quick services for urgent health problems” (78.5% excellent or good) and “getting an appropriate for them appointment” (76.2% excellent or good).

Conclusion

Two scales with satisfactory psychometric properties were established in the Bulgarian version of the EUROPEP-questionnaire. The study identified areas requiring improvement in general practice, such as reduction in waiting times and obtaining patient’s convenience appointment.

Combined use of EPR and 23Na MAS NMR spectroscopy for assessing the properties of the mixed cobalt–nickel–manganese layers of P3-NayCo1−2xNixMnxO2

EPR and ²³Na MAS NMR are used to gain insights into the structural peculiarities of the mixed cobalt–nickel–manganese layers of P3-Na_yCo_1−2xNi_xMn_xO₂.

Crystal chemistry of Mg substitution in NaMnPO4olivine: concentration limit and cation distribution

In Mg-substituted NaMnPO₄, Na⁺, Mg²⁺and metal vacancies reside in the M1 olivine position, while Mn²⁺ions are predominantly in the M2 position.