Pub Date : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.11
А.S. Zdelova
The aim: to conduct an analysis and generalization of scientific publications regarding the current state and prospects for further development of the ophthalmological care system in Ukraine. Materials and methods. An analysis and generalization of scientific research and publications regarding the current state and prospects for further development of the ophthalmological care system in Ukraine has been carried out. Methods were used: systematic approach, bibliosemantic, analytical. Results and discussion. According to medical statistics, the most common eye pathology is inflammatory eye diseases, which in 80% of cases lead to temporary disability. Age-related macular degeneration occupies the leading position in the world ranking of causes of blindness. On average, the incidence is about 15 people per 1,000 population, increasing significantly with age, for example, in the age group from 52 to 64 years it is 1.6%, from 65 to 74 years - 15%, from 75 to 84 years - 25% , and among people over 85 years old – 30%. The strategic areas of WHO activity are embodied in the national health care policy of Ukraine. When developing programs to preserve and improve the health of the population of disabled age at the state and regional levels, attention should be paid to measures against the most common age-related pathology. In addition, issues of ensuring the availability of high-quality ophthalmic care remain unresolved; the activity of the ophthalmology service in conditions of deficit of budget funding of the health care system; reduction of the cost of ophthalmic care against the background of maintaining its high quality; modernization of the system for managing the efficiency and quality of ophthalmic care, etc. Conclusions. The analysis of the domestic and foreign experience in the theory and practice of quality assurance and management in health care, its types, approaches and methods showed that one of the priority directions of the development of the domestic health care system at present is the creation and development of the management system of health care , in particular in the system of ophthalmological care for the population.
{"title":"OPHTHALMOLOGICAL CARE IN UKRAINE. STATUS AND PERSPECTIVES OF IMPROVEMENT (literature review)","authors":"А.S. Zdelova","doi":"10.31612/2616-4868.1(23).2023.11","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.11","url":null,"abstract":"The aim: to conduct an analysis and generalization of scientific publications regarding the current state and prospects for further development of the ophthalmological care system in Ukraine. \u0000Materials and methods. An analysis and generalization of scientific research and publications regarding the current state and prospects for further development of the ophthalmological care system in Ukraine has been carried out. Methods were used: systematic approach, bibliosemantic, analytical. \u0000Results and discussion. \u0000According to medical statistics, the most common eye pathology is inflammatory eye diseases, which in 80% of cases lead to temporary disability. \u0000Age-related macular degeneration occupies the leading position in the world ranking of causes of blindness. On average, the incidence is about 15 people per 1,000 population, increasing significantly with age, for example, in the age group from 52 to 64 years it is 1.6%, from 65 to 74 years - 15%, from 75 to 84 years - 25% , and among people over 85 years old – 30%. \u0000The strategic areas of WHO activity are embodied in the national health care policy of Ukraine. \u0000When developing programs to preserve and improve the health of the population of disabled age at the state and regional levels, attention should be paid to measures against the most common age-related pathology. \u0000In addition, issues of ensuring the availability of high-quality ophthalmic care remain unresolved; the activity of the ophthalmology service in conditions of deficit of budget funding of the health care system; reduction of the cost of ophthalmic care against the background of maintaining its high quality; modernization of the system for managing the efficiency and quality of ophthalmic care, etc. \u0000Conclusions. The analysis of the domestic and foreign experience in the theory and practice of quality assurance and management in health care, its types, approaches and methods showed that one of the priority directions of the development of the domestic health care system at present is the creation and development of the management system of health care , in particular in the system of ophthalmological care for the population.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47715596","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.08
A. Shevtsov, O. L. Zyukov, O. O. Oshivalova
The purpose of the research is to study doctors’ attitude towards the role of psychological competencies in their professional activities and its assessment as well as to investigate doctors’ self-assessment of their psychological knowledge, skills and abilities to demonstrate various forms of communication with certain groups of patients as an important component of professional reflection. Participating in the research doctors were different specialty experts of different age groups and experience, employed in multidisciplinary health care institutions. Materials and methods. A pilot sociological survey of department heads employed in a multidisciplinary health care institution with a focus group were followed with a sociological survey of a sample (40,9%) of the institution population of the doctors of various specialties, age and experience. Statistical analysis of the survey results was carried out with the use of Microsoft Excel software. The results. The assessment of the importance of doctors’ psychological competence in professional activity and doctors’ self-assessment of their psychological competence in various areas of professional work were obtained in the frame of the conducted research. Conclusions. The doctors’ self-reflective assessment of their psychological competencies proved the professional competencies and the corresponding motivational potential among health care workers need advancing. Relatively low scores of doctors’ self-assessment in certain types of professional psychological competence allow us to make a conclusion about the need to launch relevant training in the field of psychological competence. Among the topic issues the training should cover are the ability to prevent professional stress, professional deformation and professional burnout of a doctor; conflict management skills and interpersonal crisis situations at work; psychological knowledge, skills and communication skills with difficult patients in behavioral aspects. Analysis of the Pearson correlation coefficient of answers to various questions with data on age and professional work experience make it possible to conclude that both samples with a significant professional experience as well as elder respondents need taking an advanced training program in the field of psychological competence. Since psychological resilience and resistance to stress skills develop more efficient with life experience obtaining than through workplace experience, it makes possible to summarize that the need to conduct psychological training on stress resistance and resilience for doctors directly in the health care institution conditions, e.g. as a professional school.
{"title":"DOCTORS’ ATTITUDE TOWARDS THEIR PSYCHOLOGICAL COMPETENCES AS A COMPONENT OF PROFESSIONAL SELF-REFLECTION","authors":"A. Shevtsov, O. L. Zyukov, O. O. Oshivalova","doi":"10.31612/2616-4868.1(23).2023.08","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.08","url":null,"abstract":"The purpose of the research is to study doctors’ attitude towards the role of psychological competencies in their professional activities and its assessment as well as to investigate doctors’ self-assessment of their psychological knowledge, skills and abilities to demonstrate various forms of communication with certain groups of patients as an important component of professional reflection. Participating in the research doctors were different specialty experts of different age groups and experience, employed in multidisciplinary health care institutions. \u0000Materials and methods. A pilot sociological survey of department heads employed in a multidisciplinary health care institution with a focus group were followed with a sociological survey of a sample (40,9%) of the institution population of the doctors of various specialties, age and experience. Statistical analysis of the survey results was carried out with the use of Microsoft Excel software. \u0000The results. The assessment of the importance of doctors’ psychological competence in professional activity and doctors’ self-assessment of their psychological competence in various areas of professional work were obtained in the frame of the conducted research. \u0000Conclusions. The doctors’ self-reflective assessment of their psychological competencies proved the professional competencies and the corresponding motivational potential among health care workers need advancing. Relatively low scores of doctors’ self-assessment in certain types of professional psychological competence allow us to make a conclusion about the need to launch relevant training in the field of psychological competence. Among the topic issues the training should cover are the ability to prevent professional stress, professional deformation and professional burnout of a doctor; conflict management skills and interpersonal crisis situations at work; psychological knowledge, skills and communication skills with difficult patients in behavioral aspects. Analysis of the Pearson correlation coefficient of answers to various questions with data on age and professional work experience make it possible to conclude that both samples with a significant professional experience as well as elder respondents need taking an advanced training program in the field of psychological competence. Since psychological resilience and resistance to stress skills develop more efficient with life experience obtaining than through workplace experience, it makes possible to summarize that the need to conduct psychological training on stress resistance and resilience for doctors directly in the health care institution conditions, e.g. as a professional school.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48622918","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.14
M. Yakymchuk, S. I. Prylypko
Introduction: The method of bioresonance therapy is now quite widespread and occupies a certain and occupies a certain niche in the medical services market. The goal of the work: to study the possibility of using the frequency resonance method research for the detection of Bifidobacterium and Helicobacter pylori and the impact of frequency resonance on the biological environment. Materials and methods: The hardware complex was used in the work developed on the basis of the National Technical University of Ukraine «Igor Sikorsky Kyiv Polytechnic Institute» together with employees of the Institute of Applied Problems of Ecology, Geophysics and Geochemistry». On the basis of the clinical diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine conducted verification of Bifidobacterium and Helicobacter pylori in the in biological media, as well as the study of patients’ blood for sterility according to standard methods. In order to neutralize the pathogens identified during the laboratory the following frequency range was used to neutralize the pathogenic microorganisms detected during the laboratory Х81Х39.2ХХ2 Hz. (X – closed numbers, which will be removed after the protection of intellectual property rights of the authors). Results: Investigation of the possibility of verification of Bifidobacterium and Helicobacter pylori on photographs by frequency resonance method was carried out for the period from October 2021 to January 2022. Comparative analysis of the diagnostic value of the frequency resonance method in comparison with traditional standard methods used in the clinical and diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine showed a sufficiently high verification probability of more than 96 %. Conclusions: The research conducted requires more thorough additional study with the involvement of medical, biological, physical, and radiophysical scientists.
{"title":"SOME ASPECTS OF THE APPLICATION OF THE FREQUENCY- RESONANCE METHOD IN THE DIAGNOSIS AND NEUTRALIZATION OF PATHOGENS","authors":"M. Yakymchuk, S. I. Prylypko","doi":"10.31612/2616-4868.1(23).2023.14","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.14","url":null,"abstract":"Introduction: The method of bioresonance therapy is now quite widespread and occupies a certain and occupies a certain niche in the medical services market. The goal of the work: to study the possibility of using the frequency resonance method research for the detection of Bifidobacterium and Helicobacter pylori and the impact of frequency resonance on the biological environment. \u0000Materials and methods: The hardware complex was used in the work developed on the basis of the National Technical University of Ukraine «Igor Sikorsky Kyiv Polytechnic Institute» together with employees of the Institute of Applied Problems of Ecology, Geophysics and Geochemistry». On the basis of the clinical diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine conducted verification of Bifidobacterium and Helicobacter pylori in the in biological media, as well as the study of patients’ blood for sterility according to standard methods. In order to neutralize the pathogens identified during the laboratory the following frequency range was used to neutralize the pathogenic microorganisms detected during the laboratory Х81Х39.2ХХ2 Hz. (X – closed numbers, which will be removed after the protection of intellectual property rights of the authors). \u0000Results: Investigation of the possibility of verification of Bifidobacterium and Helicobacter pylori on photographs by frequency resonance method was carried out for the period from October 2021 to January 2022. Comparative analysis of the diagnostic value of the frequency resonance method in comparison with traditional standard methods used in the clinical and diagnostic laboratory of the State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department of Ukraine showed a sufficiently high verification probability of more than 96 %. \u0000Conclusions: The research conducted requires more thorough additional study with the involvement of medical, biological, physical, and radiophysical scientists.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48428710","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.02
M. Koshkina
Introduction: the relevance of determining peculiarities of treatment of coronary artery disease with concomitant type 2 diabetes mellitus is high, as it solves several important medical, social and economic problems of society. The aim: of research was to evaluate state of heart function (development of heart failure) and changes in glucose metabolism in patients with CAD with concomitant type II DM depending on diabetes stage and treatments with telmisartan and valsartan. Materials and methods: Study included 106 patients with coronary artery diseases and type II DM with mean age 68.8±8.9 years; mean age of males (46.2 %) was 65.2±9.0 years and females (53.8 %) — 71.6±7.8 years. All patients were treated in cardiology department of CME “City clinical hospital № 27” of Kharkiv city government, which is clinical base of Departments of internal medicine № 2, clinical immunology and allergology of L. T. Malaya of Kharkiv National Medical University. All patients were divided into 4 groups depending on stage of diabetes. First group included patients with CAD and with no concomitant DM (n=36; mean age = 66.4±10.1 years); second — CAD and mild course of DM (n=21; mean age = 71.9±9.4 years); third group included patients with CAD and moderate DM (n=28; mean age = 69.7±8.0 years); and fourth group — patients with CAD and severe DM (n=21; mean age = 67.9±6.5 years). Results: After treatment with valsartan and telmisartan no difference was observed in SBP, DBP and HR in both valsartan and telmisartan patients. However, it is obvious that levels of described variables mostly normalized, which suggests on high effectiveness of performed treatment. Comparison of initial and post-treatment data showed significant changes observed both in heart function and glucose metabolism. It was found that valsartan users showed significant decrease in SBP, DBP and HR in patients with CAD only and CAD with moderate T2DM. In all patients suggest that valsartan users will show decrease of HbA1c independently on DM stage, while telmisartan provides normalization of HbA1c only in moderate to severe DM patients. This suggests that telmisartan acts as protective and repairing medication in patients with concomitant CAD and T2DM, predominantly in moderate to severe stages of DM; valsartan increases cardiac function mostly in CAD only patients and in mild to severe DM, but influence on systolic and diastolic function was not found. Conclusions: Our study demonstrates strong connection between glucose metabolism and heart function. It was shown that stage of T2DM significantly influence indices of morphological state of heart with effects on development of systolic and, predominantly, diastolic dysfunction, which further leads to development of heart failure. Moreover, it was shown, that treatments of patients with CAD with concomitant T2DM of different stages with ARBs (valsartan and telmisartan) provides protective effects on heart muscle and glucose metabolism. Study fo
导论:确定冠心病合并2型糖尿病的治疗特点具有很高的相关性，因为它解决了几个重要的社会医学、社会和经济问题。研究的目的是评估冠心病合并II型糖尿病患者的心功能状态(心力衰竭的发展)和糖代谢的变化，这取决于糖尿病的分期和替米沙坦和缬沙坦的治疗。材料与方法:纳入冠心病合并II型糖尿病患者106例，平均年龄68.8±8.9岁;平均年龄男性(46.2%)为65.2±9.0岁，女性(53.8%)为71.6±7.8岁。所有患者均在哈尔科夫市政府“第27市临床医院”CME心内科接受治疗，该医院是哈尔科夫国立医科大学L. T. Malaya临床免疫学和变态反应学第二内科的临床基地。所有患者根据糖尿病分期分为4组。第一组包括有CAD但不伴有糖尿病的患者(n=36;平均年龄= 66.4±10.1岁;第二阶段CAD和轻度DM (n=21;平均年龄= 71.9±9.4岁);第三组为冠心病合并中度糖尿病患者(n=28);平均年龄= 69.7±8.0岁);第四组为冠心病合并重度糖尿病患者(n=21;平均年龄= 67.9±6.5岁)。结果:缬沙坦与替米沙坦治疗后，缬沙坦与替米沙坦患者收缩压、舒张压、心率无显著差异。然而，很明显，所描述变量的水平大多归一化，这表明治疗的有效性很高。治疗初期和治疗后的数据比较显示，在心功能和葡萄糖代谢方面观察到显著的变化。发现缬沙坦使用者在单纯冠心病和冠心病合并中度T2DM患者的收缩压、舒张压和HR有显著降低。在所有患者中，缬沙坦使用者在DM期单独显示HbA1c的降低，而替米沙坦仅在中重度DM患者中提供HbA1c的正常化。这表明替米沙坦对伴有冠心病和2型糖尿病的患者具有保护和修复作用，主要是在糖尿病的中重度阶段;缬沙坦增加心功能的主要是冠心病患者和轻至重度糖尿病患者，但没有发现对收缩和舒张功能的影响。结论:我们的研究表明糖代谢与心脏功能有密切的联系。结果表明，T2DM分期显著影响心脏形态学指标，影响心脏收缩功能障碍的发生，主要影响舒张功能障碍的发生，进而导致心力衰竭的发生。此外，研究表明，冠心病合并不同阶段T2DM患者使用arb(缬沙坦和替米沙坦)治疗对心肌和葡萄糖代谢具有保护作用。研究发现，不同阶段T2DM患者的血压、收缩压和舒张功能水平与血糖和糖化血红蛋白水平存在显著相关性。
{"title":"PECULIARITIES OF TREATMENT OF CORONARY ARTERY DISEASE WITH CONCOMITANT TYPE 2 DIABETES MELLITUS WITH ANGIOTENSIN RECEPTOR BLOCKERS","authors":"M. Koshkina","doi":"10.31612/2616-4868.1(23).2023.02","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.02","url":null,"abstract":"Introduction: the relevance of determining peculiarities of treatment of coronary artery disease with concomitant type 2 diabetes mellitus is high, as it solves several important medical, social and economic problems of society. \u0000The aim: of research was to evaluate state of heart function (development of heart failure) and changes in glucose metabolism in patients with CAD with concomitant type II DM depending on diabetes stage and treatments with telmisartan and valsartan. \u0000Materials and methods: Study included 106 patients with coronary artery diseases and type II DM with mean age 68.8±8.9 years; mean age of males (46.2 %) was 65.2±9.0 years and females (53.8 %) — 71.6±7.8 years. All patients were treated in cardiology department of CME “City clinical hospital № 27” of Kharkiv city government, which is clinical base of Departments of internal medicine № 2, clinical immunology and allergology of L. T. Malaya of Kharkiv National Medical University. All patients were divided into 4 groups depending on stage of diabetes. First group included patients with CAD and with no concomitant DM (n=36; mean age = 66.4±10.1 years); second — CAD and mild course of DM (n=21; mean age = 71.9±9.4 years); third group included patients with CAD and moderate DM (n=28; mean age = 69.7±8.0 years); and fourth group — patients with CAD and severe DM (n=21; mean age = 67.9±6.5 years). \u0000Results: After treatment with valsartan and telmisartan no difference was observed in SBP, DBP and HR in both valsartan and telmisartan patients. However, it is obvious that levels of described variables mostly normalized, which suggests on high effectiveness of performed treatment. \u0000Comparison of initial and post-treatment data showed significant changes observed both in heart function and glucose metabolism. It was found that valsartan users showed significant decrease in SBP, DBP and HR in patients with CAD only and CAD with moderate T2DM. \u0000In all patients suggest that valsartan users will show decrease of HbA1c independently on DM stage, while telmisartan provides normalization of HbA1c only in moderate to severe DM patients. \u0000This suggests that telmisartan acts as protective and repairing medication in patients with concomitant CAD and T2DM, predominantly in moderate to severe stages of DM; valsartan increases cardiac function mostly in CAD only patients and in mild to severe DM, but influence on systolic and diastolic function was not found. \u0000Conclusions: Our study demonstrates strong connection between glucose metabolism and heart function. It was shown that stage of T2DM significantly influence indices of morphological state of heart with effects on development of systolic and, predominantly, diastolic dysfunction, which further leads to development of heart failure. Moreover, it was shown, that treatments of patients with CAD with concomitant T2DM of different stages with ARBs (valsartan and telmisartan) provides protective effects on heart muscle and glucose metabolism. Study fo","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47904185","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.01
V. Horoshko
Resume. Chronic pain in injured patients is a negative outcome of pain management in the stages of treatment. Chronic pain is diagnosed in 83.3% of patients with mine-explosive wounds, and in 70% of patients with gunshot wounds. The frequency of chronic pain also depends on the type of injury and the number of injured anatomical parts of the body. So, in patients with gunshot wounds in 1 or 2 anatomical parts of the body, chronic pain is diagnosed in 69.7% of cases, and in 3 or more cases - in 71.2% of cases. Also, in patients with mine-explosive wounds - 82.2% and 91.7% of cases, respectively. Patients in civilian life who have received serious injuries suffer from chronic pain in 11-40% of cases. Considering the high frequency of chronic pain in this category of patients, the study of the relationship between the operations performed and the injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment with chronic pain will play an important role, and will also contribute to the improvement of the treatment of this category of patients . The goal of the work. To investigate the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment. Materials and methods. Study of patients with gunshot and mine-explosive injuries. The tool for pain intensity research was a visual analog scale. The method of constructing univariate and multivariate logistic regression models was used to analyze the relationship between the risks of receiving a negative treatment result and factor characteristics. The quality of the models was evaluated by the area under the ROC curve. To quantify the degree of influence of the factor characteristic, the odds ratio indicator was calculated. Results of the research. Studying the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment, it was found that there is a relationship (AUC=0.54 95% CI 0.51-0.57) of the risk of chronicity pain with the number of injured anatomical parts of the body - with the number of injured 3 or more, the risk of pain chronicity increases (p=0.010), OR=1.45 (95% CI 1.09-1.92) compared to patients who have injured 1 or 2 parts of the body. Also, two factors related to the risk of chronic pain were found - the number of injured anatomical parts of the body and the type of injury, AUC=0.56 (95% CI 0.53-0.59). Conclusions. The tactics of pain treatment in patients with gunshot and mine-explosive wounds at the stages of treatment should take into account the type of injury and the number of injured anatomical parts of the body. This, potentially, can reduce cases of chronic pain, and will also contribute to the improvement of treatment results for this category of patients.
重新开始受伤患者的慢性疼痛是治疗阶段疼痛管理的负面结果。83.3%的地雷炸伤患者诊断为慢性疼痛，70%的枪伤患者诊断为慢性疼痛。慢性疼痛的频率还取决于损伤的类型和身体受伤解剖部位的数量。因此，在身体1个或2个解剖部位受枪伤的患者中，慢性疼痛在69.7%的病例中被诊断出来，在3个或更多的病例中-在71.2%的病例中。此外，在地雷炸伤患者中，分别有82.2%和91.7%的病例。平民生活中受到严重伤害的患者中有11-40%患有慢性疼痛。考虑到这类患者慢性疼痛的发生率较高，在慢性疼痛治疗阶段研究枪伤和地雷炸伤患者所做的手术与身体损伤解剖部位的关系将起到重要作用，也将有助于提高这类患者的治疗水平。工作的目标。探讨枪伤和地雷炸伤患者在治疗阶段的慢性疼痛与手术干预和身体解剖部位损伤的关系。材料和方法。枪击和地雷爆炸伤患者的研究。疼痛强度研究的工具是视觉模拟量表。采用构建单因素和多因素logistic回归模型的方法，分析治疗结果为阴性的风险与因素特征之间的关系。用ROC曲线下面积来评价模型的质量。为了量化因子特征的影响程度，计算了比值比指标。研究结果。研究枪伤和地雷炸伤患者在治疗阶段的慢性疼痛与手术干预和身体解剖部位损伤的关系，发现慢性疼痛的风险与身体解剖部位损伤的数量存在关系(AUC=0.54 95% CI 0.51-0.57)，当受伤3个及以上时，疼痛的慢性风险增加(p=0.010);OR=1.45 (95% CI 1.09-1.92)，与1或2个身体部位受伤的患者相比。此外，还发现了与慢性疼痛风险相关的两个因素——身体受伤解剖部位的数量和受伤类型，AUC=0.56 (95% CI 0.53-0.59)。结论。枪伤和地雷炸伤患者在治疗阶段的疼痛治疗策略应考虑到受伤的类型和身体受伤解剖部位的数量。这可能会减少慢性疼痛的病例，也将有助于改善这类患者的治疗结果。
{"title":"The relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment","authors":"V. Horoshko","doi":"10.31612/2616-4868.1(23).2023.01","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.01","url":null,"abstract":"Resume. Chronic pain in injured patients is a negative outcome of pain management in the stages of treatment. Chronic pain is diagnosed in 83.3% of patients with mine-explosive wounds, and in 70% of patients with gunshot wounds. The frequency of chronic pain also depends on the type of injury and the number of injured anatomical parts of the body. So, in patients with gunshot wounds in 1 or 2 anatomical parts of the body, chronic pain is diagnosed in 69.7% of cases, and in 3 or more cases - in 71.2% of cases. Also, in patients with mine-explosive wounds - 82.2% and 91.7% of cases, respectively. Patients in civilian life who have received serious injuries suffer from chronic pain in 11-40% of cases. Considering the high frequency of chronic pain in this category of patients, the study of the relationship between the operations performed and the injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment with chronic pain will play an important role, and will also contribute to the improvement of the treatment of this category of patients . \u0000The goal of the work. To investigate the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment. \u0000Materials and methods. Study of patients with gunshot and mine-explosive injuries. The tool for pain intensity research was a visual analog scale. The method of constructing univariate and multivariate logistic regression models was used to analyze the relationship between the risks of receiving a negative treatment result and factor characteristics. The quality of the models was evaluated by the area under the ROC curve. To quantify the degree of influence of the factor characteristic, the odds ratio indicator was calculated. \u0000Results of the research. Studying the relationship of chronic pain with performed surgical interventions and injured anatomical parts of the body in patients with gunshot and mine-explosive wounds at the stages of treatment, it was found that there is a relationship (AUC=0.54 95% CI 0.51-0.57) of the risk of chronicity pain with the number of injured anatomical parts of the body - with the number of injured 3 or more, the risk of pain chronicity increases (p=0.010), OR=1.45 (95% CI 1.09-1.92) compared to patients who have injured 1 or 2 parts of the body. Also, two factors related to the risk of chronic pain were found - the number of injured anatomical parts of the body and the type of injury, AUC=0.56 (95% CI 0.53-0.59). \u0000Conclusions. The tactics of pain treatment in patients with gunshot and mine-explosive wounds at the stages of treatment should take into account the type of injury and the number of injured anatomical parts of the body. This, potentially, can reduce cases of chronic pain, and will also contribute to the improvement of treatment results for this category of patients.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47602960","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.10
D.D. Dіachuk, G. Moroz, I. Hidzynska, A. Kravchenko
The aim of the research: to conduct an analysis and generalization of scientific publications on the issue of the patient-centered care implementation in clinical practice setting. Results. The concept of a patient-centered care, proposed in the USA in the early 1990s, was subsequently used by the WHO in the development of the program for the development of the health care system in the 21st century. This approach shifts the focus from the traditional biomedical model, in which the doctor is given a priority role in decision-making to a model that establishes a partnership among practitioners, patients, and their families. Recent scientific publications identified eight principles of patient-centered care: respect for patient's values, preferences, and expressed needs, provision of information and education, emotional support to relieve fear and anxiety, involvement of family and friends, physical comfort and symptom`s relief, continuity and secure transition between healthcare settings, coordination of care, access to care. The implementation of a patient-centered care in clinical practice faces a number of difficulties, in particular, with regard to the influence of social, economic, financial factors, training of medical personnel and patient education. Another aspect is the heterogeneity of patients in terms of their ability to take a partnership approach and be involved in the decision-making process. Further clinical trials are needed to provide evidence for the practical use of the most effective approaches to patient-centered care implementation. Conclusions: The patient-centered care has become a key element of the quality of medical care and assumes that the care provided should meet the individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The introduction of a patient-centered care requires appropriate medical education of doctors to improve communication skills and patient`s education for involve patients in the treatment process as partners.
{"title":"IMPLEMENTATION OF PATIENT-CENTERED CARE AND MEDICAL CARE IMPROVEMENT: CURRENT STATE (review)","authors":"D.D. Dіachuk, G. Moroz, I. Hidzynska, A. Kravchenko","doi":"10.31612/2616-4868.1(23).2023.10","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.10","url":null,"abstract":"The aim of the research: to conduct an analysis and generalization of scientific publications on the issue of the patient-centered care implementation in clinical practice setting. \u0000Results. The concept of a patient-centered care, proposed in the USA in the early 1990s, was subsequently used by the WHO in the development of the program for the development of the health care system in the 21st century. This approach shifts the focus from the traditional biomedical model, in which the doctor is given a priority role in decision-making to a model that establishes a partnership among practitioners, patients, and their families. Recent scientific publications identified eight principles of patient-centered care: respect for patient's values, preferences, and expressed needs, provision of information and education, emotional support to relieve fear and anxiety, involvement of family and friends, physical comfort and symptom`s relief, continuity and secure transition between healthcare settings, coordination of care, access to care. The implementation of a patient-centered care in clinical practice faces a number of difficulties, in particular, with regard to the influence of social, economic, financial factors, training of medical personnel and patient education. Another aspect is the heterogeneity of patients in terms of their ability to take a partnership approach and be involved in the decision-making process. Further clinical trials are needed to provide evidence for the practical use of the most effective approaches to patient-centered care implementation. \u0000Conclusions: The patient-centered care has become a key element of the quality of medical care and assumes that the care provided should meet the individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The introduction of a patient-centered care requires appropriate medical education of doctors to improve communication skills and patient`s education for involve patients in the treatment process as partners.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47197791","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 : 2023-02-26DOI: 10.31612/2616-4868.1(23).2023.12
О. I. Ruban, Y. Yashchenko
The aim. To analyze the main indicators of dental care to the population, the system of financial support for dental care in Ukraine and to study modern WHO initiatives to improve dental care for the population, increase its availability and quality. Methods – system approach and system analysis, bibliosemantic, content analysis. Results. Over the past decades, the country has revealed a significant deterioration in the dental status of the population due to the unsatisfactory state of preventive activities, changes in the financing of the dental industry. Taking into account the current WHO initiatives to protect oral health, it is promising to improve the existing forms of interdisciplinary cooperation of doctors of various practices to prevent the development of dental diseases, improve interdisciplinary education in the prevention of the most common diseases of the oral cavity of doctors of various specialties. Formation of motivation among the population to preserve dental health and provide it with preventive services, introduction of new forms of financing of the dental industry, in particular, at the expense of social insurance, the introduction of public-private partnership, increasing the state's responsibility for dental care to socially vulnerable segments of the population will help reduce the financial burden for the patient when receiving dental services in the conditions of modern realities in the system of financing dental care.
{"title":"DENTAL HEALTH OF THE POPULATION AND PRIORITY DIRECTIONS OF ITS IMPROVEMENT","authors":"О. I. Ruban, Y. Yashchenko","doi":"10.31612/2616-4868.1(23).2023.12","DOIUrl":"https://doi.org/10.31612/2616-4868.1(23).2023.12","url":null,"abstract":"The aim. To analyze the main indicators of dental care to the population, the system of financial support for dental care in Ukraine and to study modern WHO initiatives to improve dental care for the population, increase its availability and quality. \u0000Methods – system approach and system analysis, bibliosemantic, content analysis. \u0000Results. Over the past decades, the country has revealed a significant deterioration in the dental status of the population due to the unsatisfactory state of preventive activities, changes in the financing of the dental industry. Taking into account the current WHO initiatives to protect oral health, it is promising to improve the existing forms of interdisciplinary cooperation of doctors of various practices to prevent the development of dental diseases, improve interdisciplinary education in the prevention of the most common diseases of the oral cavity of doctors of various specialties. Formation of motivation among the population to preserve dental health and provide it with preventive services, introduction of new forms of financing of the dental industry, in particular, at the expense of social insurance, the introduction of public-private partnership, increasing the state's responsibility for dental care to socially vulnerable segments of the population will help reduce the financial burden for the patient when receiving dental services in the conditions of modern realities in the system of financing dental care.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70040834","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 : 2022-10-21DOI: 10.31612/2616-4868.4(22).2022.13
O. Kostiukevych, L. Benkovska, A. Kravchenko, T. Chursina, K. Mikhaliev
Aim: to provide a literature review of the presently available data on the risk of thromboembolic events and current options for antithrombotic prophylaxis in patients with myeloproliferative neoplasms (MPN) patients with concomitant coronavirus disease 2019 (COVID-19). Material and methods. The thematic scientific papers, published predominantly during the last decade (including the references regarding SARS-CoV-2 infection (COVID-19) of the last three years), constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis. Results and discussion. MPN and SARS-CoV-2 infection (COVID-19) are both conditions with inherently enhanced susceptibility to thromboembolic events (venous and arterial). Along with the specific pathophysiological pathways, MPN and COVID-19, in case of their constellation, share overlapping pathomechanisms of hypercoagulability. As of today, the antithrombotic prophylaxis in MPN/COVID-19 patients (primary and secondary) is carried out according to the guidelines and algorithms, including those regarding general principles of the use of anticoagulants (oral or parenteral) and antiplatelet agents, and those specifically addressed to MPN or SARS-CoV-2 infection. These documents are constantly updating as the results of ongoing trials become available. Considering the relatively low prevalence of MPN, and the absence of specific guidelines, devoted to MPN in tandem with SARS-CoV-2 infection, the conduction of global registry studies is of crucial importance, aiming to provide a continuous and thorough collection and analysis of the data, related to the characteristics of this particular patients` population, pathological background and clinical features of thromboembolic complications, as well as short- and long-term outcomes. Conclusion. The comprehensive study of basic, epidemiological and clinical data regarding various aspects of thrombosis/thromboembolism in case of MPN/COVID-19 constellation, is a multidisciplinary task, which should be performed with an ultimate goal to improve already implemented and develop novel approaches to antithrombotic management of such patients.
{"title":"COVID-19 IN PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS: THE RISK OF THROMBOEMBOLIC EVENTS AND CURRENT OPTIONS FOR ANTITHROMBOTIC PROPHYLAXIS","authors":"O. Kostiukevych, L. Benkovska, A. Kravchenko, T. Chursina, K. Mikhaliev","doi":"10.31612/2616-4868.4(22).2022.13","DOIUrl":"https://doi.org/10.31612/2616-4868.4(22).2022.13","url":null,"abstract":"Aim: to provide a literature review of the presently available data on the risk of thromboembolic events and current options for antithrombotic prophylaxis in patients with myeloproliferative neoplasms (MPN) patients with concomitant coronavirus disease 2019 (COVID-19). \u0000Material and methods. The thematic scientific papers, published predominantly during the last decade (including the references regarding SARS-CoV-2 infection (COVID-19) of the last three years), constituted the study material. The research methodology involved bibliosemantic method and structural and logical analysis. \u0000Results and discussion. MPN and SARS-CoV-2 infection (COVID-19) are both conditions with inherently enhanced susceptibility to thromboembolic events (venous and arterial). Along with the specific pathophysiological pathways, MPN and COVID-19, in case of their constellation, share overlapping pathomechanisms of hypercoagulability. As of today, the antithrombotic prophylaxis in MPN/COVID-19 patients (primary and secondary) is carried out according to the guidelines and algorithms, including those regarding general principles of the use of anticoagulants (oral or parenteral) and antiplatelet agents, and those specifically addressed to MPN or SARS-CoV-2 infection. These documents are constantly updating as the results of ongoing trials become available. Considering the relatively low prevalence of MPN, and the absence of specific guidelines, devoted to MPN in tandem with SARS-CoV-2 infection, the conduction of global registry studies is of crucial importance, aiming to provide a continuous and thorough collection and analysis of the data, related to the characteristics of this particular patients` population, pathological background and clinical features of thromboembolic complications, as well as short- and long-term outcomes. \u0000Conclusion. The comprehensive study of basic, epidemiological and clinical data regarding various aspects of thrombosis/thromboembolism in case of MPN/COVID-19 constellation, is a multidisciplinary task, which should be performed with an ultimate goal to improve already implemented and develop novel approaches to antithrombotic management of such patients.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49535370","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 : 2022-10-21DOI: 10.31612/2616-4868.4(22).2022.08
A. Denysenko, V. Cherniy
Is relevant to study the perioperative use of minimal gas flow (minimal flow) during inhalation anesthesia in patients undergoing laparoscopic surgical interventions, in particular with hiatal hernia (HH). The aim of the study. To study the possibility of using minimal flow anesthesia with sevoflurane and evaluate its place in the perioperative management of patients with HH. Material and methods. The study was prospective, not randomized: 128 patients with HH, who underwent laparoscopic cruroraphy with Nissen fundoplication under general anesthesia with sevoflurane with low and minimal gas flow. Age 33-78 years, ASA II-III. (m.-67, w-61). ). In group I (n=66) Fresh Gas Flow (FGF) = 1,0 l/min, in group II (n=62) – FGF ≤0,5 l/min. All patients underwent personalized perioperative energy monitoring using indirect calorimetry. The results. The baseline metabolic parameters were without disturbance and significantly exceeded the basal metabolism. Anesthesia in Group I with a gas flow of 1 L/min was more stable, manageable and predictable. In group II with gas flow ≤ 0,5 l/min, at the stage of crurorrhaphy and fundoplication, there was a decrease in the FiO2–FeO2 gradient to 4,4% and a metabolic disorder of 27,2%, which in 14 (22,6%) patients needed a transition for low flow ventilation mode with gas flow 1l/min. Conclusions. Personalized perioperative energy monitoring makes it safer to perform inhalation anesthesia with gas flow ≤0,5 l/min. in patients with HH.
{"title":"MINIMAL FLOW ANESTHESIA, ITS PLACE IN PERIOPERATIVE MANAGEMENT IN PATIENTS WITH HIATAL HERNIA","authors":"A. Denysenko, V. Cherniy","doi":"10.31612/2616-4868.4(22).2022.08","DOIUrl":"https://doi.org/10.31612/2616-4868.4(22).2022.08","url":null,"abstract":"Is relevant to study the perioperative use of minimal gas flow (minimal flow) during inhalation anesthesia in patients undergoing laparoscopic surgical interventions, in particular with hiatal hernia (HH). \u0000The aim of the study. To study the possibility of using minimal flow anesthesia with sevoflurane and evaluate its place in the perioperative management of patients with HH. \u0000Material and methods. The study was prospective, not randomized: 128 patients with HH, who underwent laparoscopic cruroraphy with Nissen fundoplication under general anesthesia with sevoflurane with low and minimal gas flow. Age 33-78 years, ASA II-III. (m.-67, w-61). ). In group I (n=66) Fresh Gas Flow (FGF) = 1,0 l/min, in group II (n=62) – FGF ≤0,5 l/min. All patients underwent personalized perioperative energy monitoring using indirect calorimetry. \u0000The results. The baseline metabolic parameters were without disturbance and significantly exceeded the basal metabolism. Anesthesia in Group I with a gas flow of 1 L/min was more stable, manageable and predictable. In group II with gas flow ≤ 0,5 l/min, at the stage of crurorrhaphy and fundoplication, there was a decrease in the FiO2–FeO2 gradient to 4,4% and a metabolic disorder of 27,2%, which in 14 (22,6%) patients needed a transition for low flow ventilation mode with gas flow 1l/min. \u0000Conclusions. Personalized perioperative energy monitoring makes it safer to perform inhalation anesthesia with gas flow ≤0,5 l/min. in patients with HH.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69342339","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 : 2022-10-21DOI: 10.31612/2616-4868.4(22).2022.02
D. Dyachuk, O. L. Zyukov, O. O. Oshivalova, O.K. Biloshitska
Abstract. In the conditions of the rapid development of modern medicine, the search and implementation of new approaches to the study of the diagnostic and treatment process of diseases with the mastery of manual methods are of great importance. The inability to apply acquired knowledge in practice is often the basis of medical errors and ineffective medical measures. There are new requirements for the training program for medical interns using modern medical technologies. Therefore, ensuring the availability of high-quality training for interns on a clinical internship basis should be considered a mandatory component of maintaining the high-quality level of training of medical interns at the current stage of medical reform in Ukraine. This is evidenced by our survey of intern doctors, who emphasized the importance of the availability and staffing of workplaces with awareness of safety techniques, the availability of sufficient volumes of medical care and the availability of standards of medical care based on internships, training with a sufficient level of comfort and a level of timely awareness.
{"title":"CURRENT ISSUES OF THE ORGANIZATION OF THE CORRESPONDENCE PART OF THE INTERNSHIP PROCESS ON THE CLINICAL BASE OF INTERNSHIP","authors":"D. Dyachuk, O. L. Zyukov, O. O. Oshivalova, O.K. Biloshitska","doi":"10.31612/2616-4868.4(22).2022.02","DOIUrl":"https://doi.org/10.31612/2616-4868.4(22).2022.02","url":null,"abstract":"Abstract. In the conditions of the rapid development of modern medicine, the search and implementation of new approaches to the study of the diagnostic and treatment process of diseases with the mastery of manual methods are of great importance. The inability to apply acquired knowledge in practice is often the basis of medical errors and ineffective medical measures. There are new requirements for the training program for medical interns using modern medical technologies. Therefore, ensuring the availability of high-quality training for interns on a clinical internship basis should be considered a mandatory component of maintaining the high-quality level of training of medical interns at the current stage of medical reform in Ukraine. This is evidenced by our survey of intern doctors, who emphasized the importance of the availability and staffing of workplaces with awareness of safety techniques, the availability of sufficient volumes of medical care and the availability of standards of medical care based on internships, training with a sufficient level of comfort and a level of timely awareness.","PeriodicalId":34164,"journal":{"name":"Klinichna ta profilaktichna meditsina","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69342255","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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