Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.04
O. Lytvak, V. Kladiev
The aim. To reduce the frequency of reproductive function disorders and preserve fertility in women after conservative myomectomy by developing and implementing a complex of rehabilitation measures into clinical practice. Materials and Methods. The study involved 301 women of reproductive age (221 with a diagnosis of submucosal uterine fibroid (UF)), who were divided into groups: 1 Group - 121 people who used the proposed postoperative rehabilitation therapy; Group 2 - 100 women operated on for submucous uterine fibroids, but without the use of restorative therapy, Group 3 C (control) - 80 somatically and gynecologically healthy women of reproductive age. Depending on the clinical assessment of the complexity of hysteroscopic resection of the node, hysteroscopy or laparoscopy was performed (according to FIGO recommendations). Clinical, instrumental, and laboratory research methods and methods of statistical analysis were used. Results. The main risk factors for the development of submucosal UF are a combination of interdependent factors - genital endocrine-dependent pathological processes (64%) and chronic inflammation of the endometrium on the background of its traumatization - during abortions or directly by a submucosal node (36%). The obtained results made it possible to substantiate pathogenetically the need to improve the scheme of treatment and rehabilitation therapy for women with submucosal leiomyoma of the uterus in the postoperative period in order to preserve reproductive function, which included drugs with antiproliferative, anti-inflammatory, immunomodulating, NO-donor and angioprotective effects. The proposed scheme of treatment and rehabilitation measures is based on a pathogenetic orientation, which allows obtaining a long-term antiproliferative effect on the endometrium and makes it possible to normalize the hormonal relationships and receptor status of the endometrium without the appointment of long-term traditional progestogen-estrogen monotherapy, makes it possible to restore the processes of synchronization of proliferation /transformation of the endometrium to the follicular and luteal phases of the menstrual cycle with the formation of the window of implantation, which contributes to the onset of pregnancy. Thus, in the operated women of the 1 Group, pregnancy after hysteroscopic myomectomy occurred in 15% after 6 months, after a year - in 22%, after one and a half - in 45%, which ended in childbirth through the natural birth canal - in 48%, by cesarean section in 34.5% of people, and 18% had premature births, 10% had spontaneous termination of pregnancy. Accordingly, in the 2 Group (without the proposed therapy) the following data were observed: pregnancy after 6 months in 12%, after a year in 20%, after one and a half - in 40%, which ended in childbirth through natural birth canals - in 40%, by cesarean section in 30.5% of people, and in 17.5% there was a premature birth, in 12% - spontaneous termination of pregnancy o
{"title":"Repair of the reproductive function of the endometrium after hysteroscopic myomectomy","authors":"O. Lytvak, V. Kladiev","doi":"10.31612/2616-4868.2(24).2023.04","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.04","url":null,"abstract":"The aim. To reduce the frequency of reproductive function disorders and preserve fertility in women after conservative myomectomy by developing and implementing a complex of rehabilitation measures into clinical practice. \u0000Materials and Methods. The study involved 301 women of reproductive age (221 with a diagnosis of submucosal uterine fibroid (UF)), who were divided into groups: 1 Group - 121 people who used the proposed postoperative rehabilitation therapy; Group 2 - 100 women operated on for submucous uterine fibroids, but without the use of restorative therapy, Group 3 C (control) - 80 somatically and gynecologically healthy women of reproductive age. Depending on the clinical assessment of the complexity of hysteroscopic resection of the node, hysteroscopy or laparoscopy was performed (according to FIGO recommendations). Clinical, instrumental, and laboratory research methods and methods of statistical analysis were used. \u0000Results. The main risk factors for the development of submucosal UF are a combination of interdependent factors - genital endocrine-dependent pathological processes (64%) and chronic inflammation of the endometrium on the background of its traumatization - during abortions or directly by a submucosal node (36%). The obtained results made it possible to substantiate pathogenetically the need to improve the scheme of treatment and rehabilitation therapy for women with submucosal leiomyoma of the uterus in the postoperative period in order to preserve reproductive function, which included drugs with antiproliferative, anti-inflammatory, immunomodulating, NO-donor and angioprotective effects. The proposed scheme of treatment and rehabilitation measures is based on a pathogenetic orientation, which allows obtaining a long-term antiproliferative effect on the endometrium and makes it possible to normalize the hormonal relationships and receptor status of the endometrium without the appointment of long-term traditional progestogen-estrogen monotherapy, makes it possible to restore the processes of synchronization of proliferation /transformation of the endometrium to the follicular and luteal phases of the menstrual cycle with the formation of the window of implantation, which contributes to the onset of pregnancy. Thus, in the operated women of the 1 Group, pregnancy after hysteroscopic myomectomy occurred in 15% after 6 months, after a year - in 22%, after one and a half - in 45%, which ended in childbirth through the natural birth canal - in 48%, by cesarean section in 34.5% of people, and 18% had premature births, 10% had spontaneous termination of pregnancy. Accordingly, in the 2 Group (without the proposed therapy) the following data were observed: pregnancy after 6 months in 12%, after a year in 20%, after one and a half - in 40%, which ended in childbirth through natural birth canals - in 40%, by cesarean section in 30.5% of people, and in 17.5% there was a premature birth, in 12% - spontaneous termination of pregnancy o","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.11
T. Gruzieva, L. Kriachkova, N. V. Hrechyshkina, H. V. Inshakova
The aim. Substantiation of the «health care organization» component of the objective structured practical (clinical) exam of the educational-qualification level of specialist, master's degree in the specialties «Medicine» and «Pediatrics» in the field of knowledge «22 Health care». Materials and methods. Bibliosemantic and analytical research methods were used in the work. The sources of information were: legal acts regulating requirements for the training of health care specialists, educational programs of the educational discipline «social medicine, organization and economics of health care»; strategic documents of the WHO. Results. The content of the objective structured practical (clinical) exam of the students of the educational-qualification level of a specialist, the master's degree in the specialties «Medicine» and «Pediatrics» in the field of knowledge «22 Health care» in the «health care organization» component was substantiated. The rationale is based on the requirements for master of medicine, set out in the Standard of Higher Education in the specialty 222 Medicine for the second (master's) level of higher education, the provisions of the educational-professional programs «Medicine» and «Pediatrics» of the Bogomolets National Medical University, Handbook of qualification characteristics of occupations (issue 78 «Health care»), etc. The task of graduates when passing the station to confirm competencies in the organization of health care is to demonstrate the ability to choose and fill out forms of documents to record the health indicators of the population and the doctor's activity in various situations. These scenarios relate to the selection and filling of accounting documents upon diagnosis of cancer or other malignant neoplasms, active tuberculosis or its recurrence, infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination, ascertainment of the case and causes of death with diagnostic coding according to the International statistical classification of diseases and related health problems, XI revision. The algorithm for performing tasks according to each scenario, the general format of the station, the necessary equipment, and the expendable materials have been determined. Also, a set of instructions for the participants of the certification process and checklists for evaluation have been developed. Conclusions. The substantiation of the «health care organization» component of the objective structured practical (clinical) exam of the students of the educational-qualification level of a specialist, the degree of master's degree in the specialties of «Medicine» and «Pediatrics» will allow assessing the ability to fill out the documents necessary for a doctor for the accounting of health indicators of the population and his/her activities in various situations, to confirm the readiness of graduates to carry out professional activities.
{"title":"SUBSTANTIATION OF THE «HEALTH CARE ORGANIZATION» COMPONENT OF THE OBJECTIVE STRUCTURED PRACTICAL (CLINICAL) EXAM OF MASTER'S DEGREE IN THE SPECIALTIES «MEDICINE» AND «PEDIATRICS» IN THE FIELD OF KNOWLEDGE «22 HEALTH CARE»","authors":"T. Gruzieva, L. Kriachkova, N. V. Hrechyshkina, H. V. Inshakova","doi":"10.31612/2616-4868.2(24).2023.11","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.11","url":null,"abstract":"The aim. Substantiation of the «health care organization» component of the objective structured practical (clinical) exam of the educational-qualification level of specialist, master's degree in the specialties «Medicine» and «Pediatrics» in the field of knowledge «22 Health care». \u0000Materials and methods. Bibliosemantic and analytical research methods were used in the work. The sources of information were: legal acts regulating requirements for the training of health care specialists, educational programs of the educational discipline «social medicine, organization and economics of health care»; strategic documents of the WHO. \u0000Results. The content of the objective structured practical (clinical) exam of the students of the educational-qualification level of a specialist, the master's degree in the specialties «Medicine» and «Pediatrics» in the field of knowledge «22 Health care» in the «health care organization» component was substantiated. The rationale is based on the requirements for master of medicine, set out in the Standard of Higher Education in the specialty 222 Medicine for the second (master's) level of higher education, the provisions of the educational-professional programs «Medicine» and «Pediatrics» of the Bogomolets National Medical University, Handbook of qualification characteristics of occupations (issue 78 «Health care»), etc. The task of graduates when passing the station to confirm competencies in the organization of health care is to demonstrate the ability to choose and fill out forms of documents to record the health indicators of the population and the doctor's activity in various situations. These scenarios relate to the selection and filling of accounting documents upon diagnosis of cancer or other malignant neoplasms, active tuberculosis or its recurrence, infectious disease, food poisoning, acute occupational poisoning, unusual reaction to vaccination, ascertainment of the case and causes of death with diagnostic coding according to the International statistical classification of diseases and related health problems, XI revision. The algorithm for performing tasks according to each scenario, the general format of the station, the necessary equipment, and the expendable materials have been determined. Also, a set of instructions for the participants of the certification process and checklists for evaluation have been developed. \u0000Conclusions. The substantiation of the «health care organization» component of the objective structured practical (clinical) exam of the students of the educational-qualification level of a specialist, the degree of master's degree in the specialties of «Medicine» and «Pediatrics» will allow assessing the ability to fill out the documents necessary for a doctor for the accounting of health indicators of the population and his/her activities in various situations, to confirm the readiness of graduates to carry out professional activities.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48516608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.03
O. Komarytsia, M. Kondratyuk, O. Radchenko
The basic aspects of the endogenous intoxication syndrome (EIS) in the pathogenesis of many diseases are still poorly understood - an increase in the content of a wide variety of compounds, most of which belong to middle mass molecules (MMM) with a mass of 500-2000 D, the content of which under the conditions of metabolically associated steatosis of the liver (MASL) as the initial stage of the fatty disease has not been yet established. In order to determine the content of molecules of average mass of total and their fractions in the blood and urine in patients with MASL, 25 patients were examined (14 men, 11 women; average age 63,8 years) with coronary artery disease (CAD), atherosclerotic cardiosclerosis, heart failure of I-II FC and sonographically diagnosed fatty liver disease (19 with MACL and 6 with steatohepatitis (SH)), in which MMMs were additionally determined at 238, 254, 266 and 282 nm in blood and urine at 238, 254, 266, 280, 288, 310 nm; coefficients of aromaticity were calculated, peptide-nucleotide, distributive; de Ritis indices and hepato-steatosis, AST/platelet ratio. The results were calculated statistically. The level of significance is p<0,05. The results. In patients with chronic forms of coronary artery disease, under the conditions of concomitant MASL, the content of total MMM was significantly higher (0,63±0,06 vs 0,34±0,02; p<0,05), which correlated with the level of high-sensitivity C-reactive protein (r=0,86; p<0,05). It was accompanied by the elevation of MMM at all wavelengths in the blood (238, 254, 266, and 280 nm) and hydrophilic chain MMM238 in urine and was associated by significantly higher values of aromaticity coefficients (2,14±0,23 vs 1,60±0,05) and peptide-nucleotide (2,65±0,37 vs 1,38±0,05), all p<0,05. The group with concomitant MASL differed from patients with comorbid SH significantly only in the lower content of hydrophilic MMM238 in urine (1,92±0,18 vs 2,30±0,03; p<0,05). Conclusion. Metabolic-associated steatosis of the liver is accompanied by the activation of the endogenous intoxication syndrome with an increase of the content of MMM in the blood and urine, which occurs in parallel with the syndrome of systemic inflammation.
内源性中毒综合征(EIS)在许多疾病发病机制中的基本方面仍然知之甚少-多种化合物含量增加，其中大多数属于质量为500-2000 D的中质量分子(MMM)，其含量在肝脏代谢相关脂肪变性(MASL)条件下作为脂肪疾病的初始阶段尚未确定。为了测定MASL患者血液和尿液中总分子平均质量及其组分的含量，对25例患者进行了检查(男14例，女11例;平均年龄63,8岁)患有冠状动脉疾病(CAD)，动脉粥样硬化性心脏硬化，I-II型FC心力衰竭和超声诊断的脂肪肝疾病(19例MACL和6例脂肪性肝炎(SH))，其中在血液和尿液中分别测定238,254,266和282 nm的MMMs, 238, 254, 266, 280, 288和310 nm;芳香性系数计算，肽-核苷酸，分布;肝脂肪变性、AST/血小板比值。结果进行统计学计算。显著性水平p< 0.05。结果。慢性冠状动脉疾病患者，在合并MASL的情况下，总MMM含量显著增高(0,63±0,06 vs 0,34±0,02;p< 0.05)，与高敏c反应蛋白水平相关(r= 0.86;p < 0 05)。它伴随着血液中所有波长的MMM(238、254、266和280 nm)和尿中亲水链MMM238的升高，并与芳香性系数(2,14±0,23 vs 1,60±0,05)和肽核苷酸(2,65±0,37 vs 1,38±0,05)的显著升高相关，均p< 0.05。合并MASL组与合并SH组仅在尿亲水性MMM238含量较低(1,92±0,18 vs 2,30±0,03;p < 0 05)。结论。肝脏代谢相关脂肪变性伴随着内源性中毒综合征的激活，血液和尿液中MMM含量增加，与全身性炎症综合征同时发生。
{"title":"Specific indicators of endogenous intoxication syndrome under the conditions of concomitant steatosis of the liver","authors":"O. Komarytsia, M. Kondratyuk, O. Radchenko","doi":"10.31612/2616-4868.2(24).2023.03","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.03","url":null,"abstract":"The basic aspects of the endogenous intoxication syndrome (EIS) in the pathogenesis of many diseases are still poorly understood - an increase in the content of a wide variety of compounds, most of which belong to middle mass molecules (MMM) with a mass of 500-2000 D, the content of which under the conditions of metabolically associated steatosis of the liver (MASL) as the initial stage of the fatty disease has not been yet established. \u0000In order to determine the content of molecules of average mass of total and their fractions in the blood and urine in patients with MASL, 25 patients were examined (14 men, 11 women; average age 63,8 years) with coronary artery disease (CAD), atherosclerotic cardiosclerosis, heart failure of I-II FC and sonographically diagnosed fatty liver disease (19 with MACL and 6 with steatohepatitis (SH)), in which MMMs were additionally determined at 238, 254, 266 and 282 nm in blood and urine at 238, 254, 266, 280, 288, 310 nm; coefficients of aromaticity were calculated, peptide-nucleotide, distributive; de Ritis indices and hepato-steatosis, AST/platelet ratio. The results were calculated statistically. The level of significance is p<0,05. \u0000The results. In patients with chronic forms of coronary artery disease, under the conditions of concomitant MASL, the content of total MMM was significantly higher (0,63±0,06 vs 0,34±0,02; p<0,05), which correlated with the level of high-sensitivity C-reactive protein (r=0,86; p<0,05). It was accompanied by the elevation of MMM at all wavelengths in the blood (238, 254, 266, and 280 nm) and hydrophilic chain MMM238 in urine and was associated by significantly higher values of aromaticity coefficients (2,14±0,23 vs 1,60±0,05) and peptide-nucleotide (2,65±0,37 vs 1,38±0,05), all p<0,05. The group with concomitant MASL differed from patients with comorbid SH significantly only in the lower content of hydrophilic MMM238 in urine (1,92±0,18 vs 2,30±0,03; p<0,05). \u0000Conclusion. Metabolic-associated steatosis of the liver is accompanied by the activation of the endogenous intoxication syndrome with an increase of the content of MMM in the blood and urine, which occurs in parallel with the syndrome of systemic inflammation.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.09
T. Yu. Malysh, M.A. Trishchynska
The relevance of the issue of asthenic disorders is determined by a high prevalence among patients with various chronic pathologies and its impact on the disease course, treatment efficacy, and quality of life. The purpose of the study was to analyze the dependence of cognitive disorders and the quality of life of patients with Lyme borreliosis on the level of fatigue.
Materials and Methods. The study involved 48 patients with Lyme borreliosis. The MOS 36-item Short Form Health Survey (SF-36) was used to study the quality of life of patients. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), and the impact of fatigue was evaluated using the Fatigue Severity Scale (FSS).
Results. According to the results of assessing asthenia/fatigue severity (FSS), the prevalence of asthenic disorders in patients with Lyme borreliosis was 45.8%. Cognitive impairment with an MMSE score of <28 was found in 64.6% of patients, and the MoCA score of <26 was revealed in 56.2% of patients. Manifestations of moderate or severe fatigue were more common among women (OR 5.43; 95% CI [1,29-22,94]), patients with neuroborreliosis (OR 13.64; 95% CI [2,62-70,9]), patients with late-stage of disease (OR 9.23; 95% CI [2,46-34,58]), and those with a lower MMSE score (26.14±2.53 vs. 27.54±2.25 scores, р=0.048) and MoCA score (23.59±2.77 vs. 25.46±2.42 scores, р=0.016). Fatigue significantly reduces the quality of life of patients with Lyme-borreliosis, in particular: physical functioning (p=0.002), role physical and role emotional (p<0.001), bodily pain (p=0.037), vitality (p<0.001), social functioning (p=0.048).
Conclusions. It was found that the presence of asthenia depends on the gender (female), the presence of clinical manifestations of damage to the nervous system (neuroborreliosis) and cognitive disorders, as well as the late stage of the disease. The presence of fatigue significantly reduces the quality of life of patients with Lyme borreliosis.
{"title":"The effect of fatigue on the cognitive status and quality of life of patients with Lyme- borreliosis","authors":"T. Yu. Malysh, M.A. Trishchynska","doi":"10.31612/2616-4868.2(24).2023.09","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.09","url":null,"abstract":"The relevance of the issue of asthenic disorders is determined by a high prevalence among patients with various chronic pathologies and its impact on the disease course, treatment efficacy, and quality of life. The purpose of the study was to analyze the dependence of cognitive disorders and the quality of life of patients with Lyme borreliosis on the level of fatigue.
 Materials and Methods. The study involved 48 patients with Lyme borreliosis. The MOS 36-item Short Form Health Survey (SF-36) was used to study the quality of life of patients. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), and the impact of fatigue was evaluated using the Fatigue Severity Scale (FSS).
 Results. According to the results of assessing asthenia/fatigue severity (FSS), the prevalence of asthenic disorders in patients with Lyme borreliosis was 45.8%. Cognitive impairment with an MMSE score of <28 was found in 64.6% of patients, and the MoCA score of <26 was revealed in 56.2% of patients. Manifestations of moderate or severe fatigue were more common among women (OR 5.43; 95% CI [1,29-22,94]), patients with neuroborreliosis (OR 13.64; 95% CI [2,62-70,9]), patients with late-stage of disease (OR 9.23; 95% CI [2,46-34,58]), and those with a lower MMSE score (26.14±2.53 vs. 27.54±2.25 scores, р=0.048) and MoCA score (23.59±2.77 vs. 25.46±2.42 scores, р=0.016). Fatigue significantly reduces the quality of life of patients with Lyme-borreliosis, in particular: physical functioning (p=0.002), role physical and role emotional (p<0.001), bodily pain (p=0.037), vitality (p<0.001), social functioning (p=0.048).
 Conclusions. It was found that the presence of asthenia depends on the gender (female), the presence of clinical manifestations of damage to the nervous system (neuroborreliosis) and cognitive disorders, as well as the late stage of the disease. The presence of fatigue significantly reduces the quality of life of patients with Lyme borreliosis.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135702875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.10
L. Lytvynova, N. V. Hrechyshkina, L. Artemchuk, O.B. Tonokovуd, N.Y. Slutu
The aim. To determine the relevance and analyze the problems of using assisted reproductive technologies against the background of assessing the state of reproductive health in modern conditions in Ukraine. Materials and methods. The research materials were official statistical data from the reports of the Center for Medical Statistics of the Ministry of Health of Ukraine "Health of the Female Population in Ukraine", "Health of the Male Population of Ukraine", "Information and Statistical Guide on Assisted Reproductive Technologies in Ukraine", "Gender Peculiarities in the provision of medical care in health care institutions" for 2015-2020. Results. The dynamics of the demographic situation in Ukraine in recent years, the state of reproductive health of the population, and the use of assisted reproductive technologies (ART) were analyzed. It has been established that the depopulation of the population is a negative manifestation of the modern demographic crisis. Reproduction of the population largely depends on its reproductive potential, in the preservation of which ART plays a certain role. The medical, legal, and economic aspects of the use of ART, which become relevant during hostilities, the serious consequences of which can harm the fertility of the population, are clarified. Conclusions. Against the background of the demographic crisis in Ukraine, which is characterized by a decrease in the birth rate and population depopulation, it is important to improve the reproductive health of the population, treat infertility, and help solve the problem of postponing the birth of children in wartime conditions. Improving the quality and accessibility of ART should become one of the priorities of the state's demographic policy.
{"title":"RELEVANCE OF THE USE OF ASSISTED REPRODUCTIVE TECHNOLOGIES IN CURRENT CONDITIONS IN UKRAINE","authors":"L. Lytvynova, N. V. Hrechyshkina, L. Artemchuk, O.B. Tonokovуd, N.Y. Slutu","doi":"10.31612/2616-4868.2(24).2023.10","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.10","url":null,"abstract":"The aim. To determine the relevance and analyze the problems of using assisted reproductive technologies against the background of assessing the state of reproductive health in modern conditions in Ukraine. \u0000Materials and methods. The research materials were official statistical data from the reports of the Center for Medical Statistics of the Ministry of Health of Ukraine \"Health of the Female Population in Ukraine\", \"Health of the Male Population of Ukraine\", \"Information and Statistical Guide on Assisted Reproductive Technologies in Ukraine\", \"Gender Peculiarities in the provision of medical care in health care institutions\" for 2015-2020. \u0000Results. The dynamics of the demographic situation in Ukraine in recent years, the state of reproductive health of the population, and the use of assisted reproductive technologies (ART) were analyzed. It has been established that the depopulation of the population is a negative manifestation of the modern demographic crisis. Reproduction of the population largely depends on its reproductive potential, in the preservation of which ART plays a certain role. The medical, legal, and economic aspects of the use of ART, which become relevant during hostilities, the serious consequences of which can harm the fertility of the population, are clarified. \u0000Conclusions. Against the background of the demographic crisis in Ukraine, which is characterized by a decrease in the birth rate and population depopulation, it is important to improve the reproductive health of the population, treat infertility, and help solve the problem of postponing the birth of children in wartime conditions. Improving the quality and accessibility of ART should become one of the priorities of the state's demographic policy.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47930270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.05
D. D. Dyachuk, R. Tkachenko, N. Kondratyuk
Introduction. The problem of secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) has drawn the attention of numerous researchers in many countries, including those where kidney transplantation is a routine procedure. The most acute aspects include determining the most effective methods of therapeutic treatment, diagnostic and prognostic criteria, indications for surgery, its scope, and methods of avoiding relapses. The aim. To study the quality of life of patients who underwent surgery for secondary and tertiary hyperparathyroidism on the background of chronic kidney disease. Materials and Methods. During the study, we conducted a survey of 60 patients with secondary and tertiary hyperparathyroidism who underwent surgery between 2020 and 2023. The surveys were conducted twice: before the surgical intervention and within a period of up to 9 months after it. Among those surveyed, there were 35 (58%) women and 25 (42%) men. The average age of the respondents was 51.31±9.16 years. Results and Discussion. Quality of life is one of the most important indicators of the effectiveness of treatment. We observed an improvement in the quality of life in all surveyed patients with Tertiary Hyperparathyroidism (THPT) after surgical treatment. From the physical component point of view, this effect is undoubtedly associated with a decrease in the level of PTH and ionized calcium in the blood. This is evidenced by the significant correlation between these indicators and the obtained values of physical functioning scales before and after the operation. Conclusions. A significant correlation was observed between the levels of parathyroid hormone, ionized calcium, and physical functioning scales before and after surgery.
{"title":"STUDY OF THE QUALITY OF LIFE OF PATIENTS WITH HYPERPARATHYROIDISM ON THE BACKGROUND OF CHRONIC KIDNEY FAILURE","authors":"D. D. Dyachuk, R. Tkachenko, N. Kondratyuk","doi":"10.31612/2616-4868.2(24).2023.05","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.05","url":null,"abstract":"Introduction. The problem of secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) has drawn the attention of numerous researchers in many countries, including those where kidney transplantation is a routine procedure. The most acute aspects include determining the most effective methods of therapeutic treatment, diagnostic and prognostic criteria, indications for surgery, its scope, and methods of avoiding relapses. \u0000The aim. To study the quality of life of patients who underwent surgery for secondary and tertiary hyperparathyroidism on the background of chronic kidney disease. \u0000Materials and Methods. During the study, we conducted a survey of 60 patients with secondary and tertiary hyperparathyroidism who underwent surgery between 2020 and 2023. The surveys were conducted twice: before the surgical intervention and within a period of up to 9 months after it. Among those surveyed, there were 35 (58%) women and 25 (42%) men. The average age of the respondents was 51.31±9.16 years. \u0000Results and Discussion. Quality of life is one of the most important indicators of the effectiveness of treatment. We observed an improvement in the quality of life in all surveyed patients with Tertiary Hyperparathyroidism (THPT) after surgical treatment. From the physical component point of view, this effect is undoubtedly associated with a decrease in the level of PTH and ionized calcium in the blood. This is evidenced by the significant correlation between these indicators and the obtained values of physical functioning scales before and after the operation. \u0000Conclusions. A significant correlation was observed between the levels of parathyroid hormone, ionized calcium, and physical functioning scales before and after surgery.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.13
G. Moroz, I. Holovanova, S. Bychkova, O. O. Dzyzinska
The aim of the research: to conduct an analysis and generalization of scientific publications on the engaging patients to shared decision-making and partner participation in the treatment process. Materials and methods. The analysis and generalization of scientific publications on the implementation of shared decision-making strategy and the engaging of patients to self-management and participation in the treatment process were carried out. Methods were used: systematic approach, bibliosemantic, analytical. Results. In modern conditions, partner participation of patients in the treatment process has become a mandatory component of the development of a patient- centered model of medical care and is recommended by the WHO. A necessary component of this process is the implementation of shared decision-making strategy by the doctor and the patient. Organizational approaches to the implementation of the shared decision-making strategy in clinical practice are being improved and generalized, in particular, in 2021 NICE (Great Britain) experts published guideline NG197 «Shared decision-making». One of the most important factors of the shared decision-making strategy implementation in clinical practice is the training of medical staff on improving communication skills and empathy, engaging the patient to independent control of the disease, etc. WHO pays considerable attention to the engaging of patients self-management of health status and treatment results, as a component of patient partnership in the organization of medical care. It has been proven that self-management programs reduce the number of unplanned hospitalizations of patients with chronic obstructive pulmonary disease and bronchial asthma, heart failure, etc. A wide range of approaches have been proposed to support patient engagement in self-management and partnership in treatment, including information leaflets, online peer support, individual counselling, group educational sessions, telephone coaching, symptom monitoring technologies and change interventions psychological behavior. Conclusions: The implementation of a patient-centered model of medical care requires engaging patients in the treatment process as partners, which involves joint decision-making by the doctor and patient and self-management. It is essential to improve the communication skills of physicians and educate patients about participating in shared decision-making and self-management.
{"title":"CURRENT ASPECTS OF ENGAGING PATIENTS TO SHARED DECISION-MAKING AND PARTNER PARTICIPATION IN THE TREATMENT PROCESS (review)","authors":"G. Moroz, I. Holovanova, S. Bychkova, O. O. Dzyzinska","doi":"10.31612/2616-4868.2(24).2023.13","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.13","url":null,"abstract":"The aim of the research: to conduct an analysis and generalization of scientific publications on the engaging patients to shared decision-making and partner participation in the treatment process. \u0000Materials and methods. The analysis and generalization of scientific publications on the implementation of shared decision-making strategy and the engaging of patients to self-management and participation in the treatment process were carried out. Methods were used: systematic approach, bibliosemantic, analytical. \u0000Results. In modern conditions, partner participation of patients in the treatment process has become a mandatory component of the development of a patient- centered model of medical care and is recommended by the WHO. A necessary component of this process is the implementation of shared decision-making strategy by the doctor and the patient. Organizational approaches to the implementation of the shared decision-making strategy in clinical practice are being improved and generalized, in particular, in 2021 NICE (Great Britain) experts published guideline NG197 «Shared decision-making». One of the most important factors of the shared decision-making strategy implementation in clinical practice is the training of medical staff on improving communication skills and empathy, engaging the patient to independent control of the disease, etc. WHO pays considerable attention to the engaging of patients self-management of health status and treatment results, as a component of patient partnership in the organization of medical care. It has been proven that self-management programs reduce the number of unplanned hospitalizations of patients with chronic obstructive pulmonary disease and bronchial asthma, heart failure, etc. A wide range of approaches have been proposed to support patient engagement in self-management and partnership in treatment, including information leaflets, online peer support, individual counselling, group educational sessions, telephone coaching, symptom monitoring technologies and change interventions psychological behavior. \u0000Conclusions: The implementation of a patient-centered model of medical care requires engaging patients in the treatment process as partners, which involves joint decision-making by the doctor and patient and self-management. It is essential to improve the communication skills of physicians and educate patients about participating in shared decision-making and self-management.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.02
V. Horoshko, Y. Kuchyn
In patients with gunshot wounds, chronic pain is observed in 70% of cases. One of the factors that influence such a high frequency of pain chronicity is the number of localizations of injured anatomical parts of the body – in patients with injuries in 1 or 2 anatomical parts of the body, the frequency of chronicity is 69.7%, and in patients with injuries in 3 – 71.2% of cases. Also, the presence of a neuropathic component of pain in this category of patients and its possible impact on such a high frequency of chronicity remains unexplored. Materials. The treatment of 769 patients was analyzed. The Douleur Neuropathique 4 questions were used to identify neuropathic pain. The Shapiro-Wilk, Mann-Whitney, Friedman's Bonferroni correction, and chi-square test with a continuity correction were also used. In all cases, the critical level of significance was set at 0.05. Results. Douleur Neuropathique 4 questions data indicate that all patients had a neuropathic pain component (scores range from 4 to 5). At the time of discharge at the stage of treatment in military medical clinical centers, we observed the absence of a neuropathic component of pain in some patients – these were those patients who did not have chronic pain. After 1 month – p=0.918, 3 months – 0.713, 6 months – p=0.824, and 12 months – p=0.911 observation, the data did not differentiate. Conclusions. Patients who received gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients of this category, so it may be one of the key components of such a high frequency of chronicity.
{"title":"Presence of a neuropathic pain component in patients with chronic pain after gunshot wounds","authors":"V. Horoshko, Y. Kuchyn","doi":"10.31612/2616-4868.2(24).2023.02","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.02","url":null,"abstract":" In patients with gunshot wounds, chronic pain is observed in 70% of cases. One of the factors that influence such a high frequency of pain chronicity is the number of localizations of injured anatomical parts of the body – in patients with injuries in 1 or 2 anatomical parts of the body, the frequency of chronicity is 69.7%, and in patients with injuries in 3 – 71.2% of cases. Also, the presence of a neuropathic component of pain in this category of patients and its possible impact on such a high frequency of chronicity remains unexplored. \u0000Materials. The treatment of 769 patients was analyzed. The Douleur Neuropathique 4 questions were used to identify neuropathic pain. The Shapiro-Wilk, Mann-Whitney, Friedman's Bonferroni correction, and chi-square test with a continuity correction were also used. In all cases, the critical level of significance was set at 0.05. \u0000Results. Douleur Neuropathique 4 questions data indicate that all patients had a neuropathic pain component (scores range from 4 to 5). At the time of discharge at the stage of treatment in military medical clinical centers, we observed the absence of a neuropathic component of pain in some patients – these were those patients who did not have chronic pain. After 1 month – p=0.918, 3 months – 0.713, 6 months – p=0.824, and 12 months – p=0.911 observation, the data did not differentiate. \u0000Conclusions. Patients who received gunshot wounds have a high risk of chronic pain. It was found that the neuropathic component of pain is present in all patients of this category, so it may be one of the key components of such a high frequency of chronicity.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.08
N. M. Kalashnykova
The aim. To determine the age-sex and regional characteristics of the dynamics of melanoma incidence in Ukraine during 2010-2020. Material and methods. The research materials were the official statistical data of the reports of the Center for Medical Statistics of the Central Hospital of the Ministry of Health of Ukraine "Incidence rates of malignant neoplasms and activities of the oncology service in Ukraine", the National Cancer Registry for 2010–2020. Results. The dynamics of the incidence of melanoma in the population of Ukraine during 2010-2020 were analyzed. The age-sex characteristics of the prevalence and primary incidence of melanoma, as well as among different regions of Ukraine, were studied. Conclusions. The prevalence of melanoma in 2020 was 69.2 cases per 100,000 people. and increased during 10 years by 52.4%. The negative dynamics of the prevalence of melanoma affected the population of all regions of Ukraine without exception. The incidence of melanoma was 5.1 cases per 100,000 population. (decreased by 4.8%). The incidence of men is lower than that of women by 15.7% (in 2010 – by 27.2%), in men, it increased by 6.3%, and in women, it decreased by 13.7%. Melanoma cases are three times more common in people of retirement age than in working age (14.1 versus 3.6 cases per 100,000 population). The relevance of studying the morbidity of the population of Ukraine is only increasing, as war events increase the risk of skin cancer.
{"title":"ANALYSIS OF DYNAMICS OF REGIONAL AND AGE-GENDER CHARACTERISTICS OF MELANOMA INCIDENCE IN UKRAINE DURING 2010-2020","authors":"N. M. Kalashnykova","doi":"10.31612/2616-4868.2(24).2023.08","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.08","url":null,"abstract":"The aim. To determine the age-sex and regional characteristics of the dynamics of melanoma incidence in Ukraine during 2010-2020. \u0000Material and methods. The research materials were the official statistical data of the reports of the Center for Medical Statistics of the Central Hospital of the Ministry of Health of Ukraine \"Incidence rates of malignant neoplasms and activities of the oncology service in Ukraine\", the National Cancer Registry for 2010–2020. \u0000Results. The dynamics of the incidence of melanoma in the population of Ukraine during 2010-2020 were analyzed. The age-sex characteristics of the prevalence and primary incidence of melanoma, as well as among different regions of Ukraine, were studied. \u0000Conclusions. The prevalence of melanoma in 2020 was 69.2 cases per 100,000 people. and increased during 10 years by 52.4%. The negative dynamics of the prevalence of melanoma affected the population of all regions of Ukraine without exception. The incidence of melanoma was 5.1 cases per 100,000 population. (decreased by 4.8%). The incidence of men is lower than that of women by 15.7% (in 2010 – by 27.2%), in men, it increased by 6.3%, and in women, it decreased by 13.7%. Melanoma cases are three times more common in people of retirement age than in working age (14.1 versus 3.6 cases per 100,000 population). The relevance of studying the morbidity of the population of Ukraine is only increasing, as war events increase the risk of skin cancer.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70041840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.31612/2616-4868.2(24).2023.01
Serhiі Krasiuk
Introduction. The article reveals the role of university clinics (hereinafter - UC) in the system of healthcare institutions in Ukraine and their role in implementing the right of every citizen to receive free medical care in state and communal healthcare institutions at the expense of the state budget under the program of medical guarantees. The results of a medical and social study to determine patients' attitudes towards UCs and identify risk factors for non-acceptance are presented.
The aim. To determine the place of the University Clinic of the O.O. Bogomolets National Medical University in the medical-industrial cluster system of Kyiv city, conduct a medical and social study of patient attitudes towards the university clinic, and identify the main factors of non-acceptance.
Materials and methods. The study was conducted on the principle of systematicity, using medical-statistical methods, methods of anonymous questionnaire survey, and analytical generalization. The construction of the sample of respondents is based on the fact that, based on the study of their opinion, it is possible to draw conclusions about the public opinion of potential clients.
The results of the study show that university clinics, as a component of the healthcare system, meet the needs of citizens in terms of the effectiveness of services provided and accessibility to the population. With innovative equipment and the involvement of highly qualified specialists from the University's departments in the diagnostic and treatment process, university clinics are increasingly gaining the trust and support of patients.
The results of the survey confirm that the university clinic of the National Medical University named after O.O. Bogomolets has successfully integrated into the medical-industrial cluster of Kyiv, establishing cooperation with the university, the Ministry of Health, other ministries and agencies, as well as with patients.
Analysis of the socio-demographic indicators of the respondents in 2022 showed a significant volume of services provided by the clinic to the population of Kyiv and other regions of Ukraine (with the highest number of visits from pensioners - 83, and civil servants - 57 out of 213 surveyed), thus ensuring the implementation of the state program of medical guarantees for citizens. The risk of low probability recommendations by the clinic is influenced by increasing age (p=0.013) and decreasing educational level (p=0.040) of patients. The risk of low satisfaction with the comfort of the clinic increases (p=0.002) when patients visit the medical facility on the recommendation of acquaintances (patients of the clinic).
Conclusions. The positive conclusion of the survey is the absence of a risk of probability of re-appealing to the UC based on the analyzed characteristics.
{"title":"DETERMINING COMMITMENT TO THE UNIVERSITY CLINIC OF O. O. BOGOMOLETS NATIONAL MEDICAL UNIVERSITY","authors":"Serhiі Krasiuk","doi":"10.31612/2616-4868.2(24).2023.01","DOIUrl":"https://doi.org/10.31612/2616-4868.2(24).2023.01","url":null,"abstract":"Introduction. The article reveals the role of university clinics (hereinafter - UC) in the system of healthcare institutions in Ukraine and their role in implementing the right of every citizen to receive free medical care in state and communal healthcare institutions at the expense of the state budget under the program of medical guarantees. The results of a medical and social study to determine patients' attitudes towards UCs and identify risk factors for non-acceptance are presented.
 The aim. To determine the place of the University Clinic of the O.O. Bogomolets National Medical University in the medical-industrial cluster system of Kyiv city, conduct a medical and social study of patient attitudes towards the university clinic, and identify the main factors of non-acceptance.
 Materials and methods. The study was conducted on the principle of systematicity, using medical-statistical methods, methods of anonymous questionnaire survey, and analytical generalization. The construction of the sample of respondents is based on the fact that, based on the study of their opinion, it is possible to draw conclusions about the public opinion of potential clients.
 The results of the study show that university clinics, as a component of the healthcare system, meet the needs of citizens in terms of the effectiveness of services provided and accessibility to the population. With innovative equipment and the involvement of highly qualified specialists from the University's departments in the diagnostic and treatment process, university clinics are increasingly gaining the trust and support of patients.
 The results of the survey confirm that the university clinic of the National Medical University named after O.O. Bogomolets has successfully integrated into the medical-industrial cluster of Kyiv, establishing cooperation with the university, the Ministry of Health, other ministries and agencies, as well as with patients.
 Analysis of the socio-demographic indicators of the respondents in 2022 showed a significant volume of services provided by the clinic to the population of Kyiv and other regions of Ukraine (with the highest number of visits from pensioners - 83, and civil servants - 57 out of 213 surveyed), thus ensuring the implementation of the state program of medical guarantees for citizens. The risk of low probability recommendations by the clinic is influenced by increasing age (p=0.013) and decreasing educational level (p=0.040) of patients. The risk of low satisfaction with the comfort of the clinic increases (p=0.002) when patients visit the medical facility on the recommendation of acquaintances (patients of the clinic).
 Conclusions. The positive conclusion of the survey is the absence of a risk of probability of re-appealing to the UC based on the analyzed characteristics.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135752237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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