Medical management determinants of the maxillofacial precancerous and benign diseases malignancy.

OBJECTIVE: Aim: To identify the medical management determinants of the maxillofacial precancerous and benign diseases malignancy. PATIENTS AND METHODS: Materials and Methods: 150 people with maxillofacial cancer and 100 people with precancerous and benign diseases of the same localization were interviewed. RESULTS: Results: There were revealed: a low percentage of detection during check-up (10.2-15.8%), more than a third of cases (35.8-37.4%) are diagnosed by chance; not all patients undergo histological verification of the diagnosis (25.7% in cancerous and 43.2% in precancerous and benign diseases); not all are under follow up observation (24.7-27.7%). The risk of precancerous and benign diseases malignancy is the highest at 40-59 years of age (OR=4.4; 95% CI: 1.9-10.5), andalso increases with the duration of the disease for more than 5 years (2.2; 1.2-4.10 ), in patients who didn't undergo histological verification (2.2; 1.3-3.8), don't follow doctors' recommendation on visits and treatment (2.4; 1.4-4.1), don't trust doctors and are dissatisfied with medical care (2.1; 1.3-3.6). The risk groups of the maxillofacial oncological, precancerous and benign diseases are men, who are 1.5 times more likely to suffer from them than women and are characterized by lower medical care activity. The risk factors of the maxillofacial precancerous and benign diseases malignancy are low financial (4.6; 1.7-12.4) and territorial (3.3; 1.1-10.3) accessibility of medical care, including dental care (2.8; 1.6-4.8). CONCLUSION: Conclusions: It is necessary to improve the prevention and medical care in order to advance the early detection of maxillofacial cancer, taking into account the established medical management determinants of malignancy.

The prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics in wartime-An observational cross-sectional study six months after outbreak.

Russia's invasion of Ukraine is the largest European land offensive since World War II. Individuals affected by conflicts such as war are at an increased risk of mental disorders, which result from frequent exposure to traumatic events and the breakdown of supportive social networks. The aim of the study was to assess the prevalence and determinants of PTSD, anxiety, and depression in Ukrainian civilian physicians and paramedics six months after the Russian invasion of Ukraine. A cross-sectional study was conducted using validated questionnaires: The Life Events Checklist, PTSD Checklist for DSM-5, The International Trauma Questionnaire (ICD-11), The Generalized Anxiety Disorder-7, The Patient Health Questionnaire-9, The World Health Organization Disability Assessment Schedule 2.0. The study showed that 61.1 % of participants indicated combat or exposure to a war zone as the most bothersome event in their experience. Physicians and paramedics did not differ in the prevalence of PTSD according to the DSM-5 diagnostic rule and of depression (criteria met by 14.5 % and 9 % of participants, respectively). However, more physicians than paramedics met the criteria of PTSD according to the ICD-11 diagnostic rule (5.1 % vs. 1.2 %) and of anxiety (16.5 % vs. 10.0 %). The risk factors for the mental health problems included personal combat experience, total trauma exposure, parenthood, and economic situation. Despite the differences found in the prevalence of PTSD depending on the criteria used, the severity of mental problems and disability in this group is significant. It is advisable to monitor the mental state and need for help among Ukrainian civilian medical personnel.

QUALITY OF LIFE DETERMINANTS IN PERSONS WITH DISABILITY AFTER MUSKULOSCELETAL INJURIES.

OBJECTIVE: The aim: To study the intrinsic and extrinsic factors affecting quality of life in persons with disability after musculoskeletal injuries. PATIENTS AND METHODS: Materials and methods: A medical and social research was conducted on151 individuals with re-confirmed disability after musculoskeletal injuries. RESULTS: Results: It was found that a third of people with disabilities after musculoskeletal injuries (35.8±3.9%) has low quality of life (QoL), females more often than males (OR = 2.73; 95% CI: 1.33-5.59). The following physical determinants of low QoL were identified: severity of disability group (2.77; 1.29-5.92), severity of injury (2.73; 1.11-5.63) related to long-term inpatient treatment (6.36; 2.55-15.86) and need of special tools for rehabilitation (2.42; 1.20-4.92). It was found that QoL in people with disability is decreasing with unemployment (4.44; 2.13-9.23) and reduction in social interaction (2.67; 1.33-5.39) when living with children (3.04; 1.50-6.16), complicated relationship (5.28; 2.54-10.97) and no support in family (3.25; 1.62-6.50). This is accompanied by an increase in the need of psychotherapy (4.07; 2.10-8.24), risky alcohol consumption (3.29; 1.19-9.07) and taking of sedative drugs (2.97; 1.35-6.50). It was established such medical and social determinants of low QoL as inadequate awareness of persons with disability about content of their Individual rehabilitation program (3.85; 1.69-8.76), insufficient covering of special tools (3.41; 1.67-6.96) and dissatisfaction of rehabilitation efficacy (3.79; 1.55-9.28). CONCLUSION: Conclusions: It is necessary to improve the system of rehabilitation of persons with disability after musculoskeletal injuries in view of quality of life determinants.

QUALITY OF LIFE OF PATIENTS RECEIVING HOME-BASED PALLIATIVE CARE FROM FAMILY PHYSICIANS AND MOBILE PALLIATIVE CARE TEAM.

OBJECTIVE: The aim: To evaluate the quality of life (QoL) of palliative patients receiving general palliative care and the impact of palliative care provided by mobile palliative care team (MPCT) on their QoL. PATIENTS AND METHODS: Materials and methods: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (QLQ-C30) was used to evaluate QoL of 219 palliative patients receiving general palliative care from family physicians in the Center for primary health care of Uzhhorod city, Ukraine. In the second part of the study, the subgroup of 25 patients who had at least one of fifteen QLQ-C30 scales evaluated lower than 50 points were selected. They were provided with PC from the MPCT for 2 weeks and their QoL was measured again. RESULTS: Results: For the patients who received general palliative care from a family physicians mean m (SD) QoL value was 38.63 (16.9), and the main symptoms that affected QoL were fatigue 48.60 (23.30) and pain 46.11 (20.97). The most impact on QoL scores had role (rs=0,430;), emotional (0.321) and physical (0.301) functioning and such symptoms as pain (-0.392), insomnia (-0.311), dyspnoea (-0.294), financial difficulties (-0.255). For the patients who received palliative care from MPCT mean the mean QoL score increased by 30.0 points, mean pain score decreased by 42.22 points, fatigue score decreased by 38.0 points and level of financial difficulties also decreased by 76.0 points. CONCLUSION: Conclusions: The involvement of the MPCT could have a significant positive impact on the QoL of palliative patients.

Patient pathways as a tool of improvement in management of urgent and scheduled health care for kidney stone disease.

OBJECTIVE: Introduction: Urolithiasis is one of the most common urological pathologies, which has a significant socio-economic burden on the health care system. The aim: To develop patient pathways based on the current guidelines on urolithiasis, and to assess the effectiveness of kidney stone management within health care system of Ukraine. PATIENTS AND METHODS: Materials and methods: There were analyzed: national and international regulatory documents (12 units); 890 patient records (confirmed urolithiasis) in seven inpatient public health care facilities and private one in Ivano-Frankivsk region; 282 control cards of follow-up examination in seven public outpatient facilities in Ivano-Frankivsk region; 129 patient records in Truskavets health resort (residents of Ivano-Frankivsk region). Used methods: bibliosemantic, epidemiological, modeling, biostatistical, pharmaco-economical analysis and peer review. RESULTS: Results: It was established that national protocols on urgent and scheduled medical care for urolithiasis require renewal. Founded on world, national and personal experience, patient pathways were created as a sequence of outpatient and inpatient care for urolithiasis, which clarified the criteria for hospitalization, the scope and type of facility for delivery the necessary care, taking into consideration the peculiarities of the patient's medical state, the size and location of stone. It was shown that the lack of high-quality clinical protocols of medical care on urolithiasis leads to the irrational use of resources, especially in district health care facilities. CONCLUSION: Conclusion: The proposed patient pathways are an effective tool for assessment of effectiveness and identification the ways of improvement in management of medical care for patients with urolithiasis.

Analysis of social and medical portrait of children with pertussis, meningococcal infectious, scarlet fever and estimation of their assigned pharmacotherapy.

OBJECTIVE: Introduction: The level of childhood bacterial diseases incidence does not have a downward trend. The aim: Conduction of a sociological analysis of medical cards for children with pertussis, meningococcal infection (MI), scarlet fever, and evaluation of consumed pharmacotherapy according to real clinical practice in Ukraine. PATIENTS AND METHODS: Materials and methods: 1215 medical cards of inpatients; methods: sociological - document analysis, retrospective frequency. RESULTS: Results: Among the cards of children with pertussis: 50.2% - female, 49.8%- male; by age children up to 1 year (49.3%) were prevailed. In 79.6% incidence - medium-hard form pertussis, 42.2% with complications. Among patients with MI by sex there were: 50.5 % - boys and 49.5% - girls; by age - children aged 1-4 (40.2%); the structure of generalized forms of MI: 40.2% - meningococcemia, 11.4% - meningitis, 48.4% - combination. Scarlet fever was more frequently: boys (56.4%), children aged 5-9 (44.7%), urban residents (79.7%); it was 93.4% of a medium-hard form. Most of medicines were prescribed to children with MI - 15.8 trade names per 1 person, it was prescribed 191 INN, most often - Sodium chloride (90.0%), Ascorbic acid (68.5%), Ceftriaxone (65.8%); patients with pertussis - 11.2, 196 INN (Chlorpromazine (69.1%), Dexamethasone (53.2%), Butamirate (51.8%)); scarlet fever - 9.3 medicines, 114 INN (local action Comb drug for throat diseases treatment (94.4%), Ceftriaxone (48.7%), Metamizole sodium (38.1%)). CONCLUSION: Conclusions: Frequency analysis data of consumed pharmacotherapy in real pediatric practice in Ukraine shows the need for its further optimization in accordance with the principles of evidence-based medicine, the results of research on the socio-demographic characteristics of patients, forms and complications of course of the basic disease.

[An assessment of medical rescue actions performed by the students in the sixth year of medicine at the national medical universities in Lviv and ivano-frankivsk in an out-of-hospital cardiac arrest (ohca) patient. a simulation study].

OBJECTIVE: Introduction: Sudden cardiac arrest is a condition that requires the implementation of advanced emergency medical procedures. It constitutes a significant medical, economic and social issue. The aim: To assess the medical rescue actions performed by the students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk in an out-of-hospital cardiac arrest (OHCA) patient. PATIENTS AND METHODS: Material and methods: The research involved students in the sixth year of medicine at the National Medical Universities in Lviv and Ivano-Frankivsk. Participation was voluntary and all students were adult. Consequently, no written parental consent was required. The number of participating students amounted to 17 in Lviv and 16 in Ivano-Frankivsk. There were two stages of the study. The research was conducted in compliance with the 2015 guidelines formulated by the European Resuscitation Council. The adopted level of statistical significance was p<0.05. RESULTS: Results: The pre-test percent average amounted to 60.27% whereas the final test average values were 82.39% in the first stage and 77.96% in the second stage. Higher scores were reported in the case of Lviv students which especially refers to the final tests (p< 0.001). The most important element influencing the effectiveness of the procedures is chest compression (compression location, depth, frequency and relaxation). A higher chest compression effectiveness was reported in each subsequent stage of the research. A higher effectiveness rate was observed in students in Ivano-Frankivsk (p<0.028). The other element with a significant impact on the effectiveness of procedures is ventilation. A higher rate of successful ventilation (breath frequency, volume and strength) was noted in Ivano-Frankivsk, especially as far as the first stage after training was concerned (p<0.038). CONCLUSION: Conclusion: The education of students of medicine in Ukraine is insufficient. The results of the effectiveness of resuscitation are not satisfactory and do not prepare future doctors to perform high quality resuscitation procedures.

Awareness of pediatric palliative care among health care workers.

OBJECTIVE: Introduction: In order to develop such a relatively new type of medical care in Ukraine, as pediatric palliative care, first of all, qualified medical workers are needed. The aim: to assess the awareness of pediatric palliative care among healthcare workers providing medical services to children. PATIENTS AND METHODS: Materials and methods: It was carried out a survey at health facilities of Ivano-Frankivsk region, which provided medical care for children. It was interviewed 578 healthcare workers, among them were generally practitioners - 131, primary care pediatricians - 52, pediatricians-specialists - 36, health care managers - 78, nurses - 281. The half of the respondents (57.2%) had work experience more than 20 years. RESULTS: Results: It was established that every fourth respondent (25.3%) did not know what is mean of pediatric palliative care. At the same time, the main object of its delivery was considered to be patients with cancer (71.5%), and not with incurable chronic diseases (54.8%). Only 59.7% of respondents knew that palliative care (PC) should begin with the diagnosis of an incurable disease, and not at the end of life, as well as half (52.6%) of them knew that the relatives of seriously ill children are object of PC. The majority of respondents recognized the lack of their knowledge of pediatric palliative care (85.8%). All answers differed depending on the position of respondents (p%#60;0.05). However, regardless of this, almost all respondents (94.5%) expressed their desire to receive proper knowledge of pediatric palliative care. CONCLUSION: Conclusion: It was established lack of knowledge on pediatric palliative care among medical workers served children. The majority of respondents recognized the lack and need of knowledge on pediatric palliative care. Overall level of knowledge among healthcare workers about palliative care was poor, and it is necessary to improve it.

The impact of cigarette smoking, alcohol drinking and physical inactivity on the risk of urolithiasis occurrence and recurrence.

INTRODUCTION: Prevention of urolithiasis occurrence and recurrence is important issue, due to one affects mainly people of the working age and often leads to disability. AIM: To study the impact of harmful habits like smoking, alcohol drinking, and hypodynamics on the risk of urolithiasis occurrence and recurrence. MATERIALS AND METHODS: It was conducted a retrospective epidemiological study of a representative sample of 443 patients with urolithiasis (basic group, 403 - of them without recurrences and 40 - with recurrences) and 203 patients without urolithiasis - control group, at discharge them from urologic in-patient departments of health care facilities of Ivano-Frankivsk region. RESULTS: It was established widespread of smoking and alcohol consumption among male respondents (31.8% smoke and 42.1% smoked, 43.4% used alcohol weekly or more) and generally low physical activity (53.6% among both sexes). The Odds Ratio was at: smoking - 0.90 (95% CI = 0.64-1.26; p>0.05) for occurrence and 1.43 (0.74-2.74; p>0.05) for recurrence; alcohol drinking - 0.81 (0.56-1.16; p>0.05) and 0.92 (0.43-1.94; p>0.05) respectively; low physical activity - 1.44 (0.81-2.56; p>0.05) and 3.52 (0.47-26.44; p>0.05). CONCLUSION: It was received no credible evidence that cigarette smoking, alcohol drinking and hypodynamics influence the occurrence and recurrence of urolithiasis. The research in this approach should continue.