Treatment Process Of Patients Research Articles

Predictive factors for mortality in intensive care patients with Fournier's gangrene: five years' experience from a single center in Turkey.

The aim of this study was to analyze mortality-related factors and scoring systems in order to better manage the treatment process of patients monitored in the intensive care unit (ICU) due to Fournier's gangrene (FG). The study included 28 male patients who were monitored in the surgical ICU with the diagnosis of FG between December 2018 and August 2022. The patients' comorbidities, acute physiological and chronic health evaluation scoring system II (APACHE II), Fournier gangrene severity index (FGSI), sequential organ failure assessment (SOFA) scores, and laboratory data were evaluated retrospectively. Of the patients, 67.9% (n=19) had diabetes mellitus, 78.6% (n=22) had hypertension, and 71.4% (n=20) had coronary artery disease. The mortality rate was 42% (n=11). There was no statistically significant difference between the patients who died and those who survived in terms of the SOFA score, comorbidities, and albumin, glucose, and procalcitonin values (p > 0.05), but age, APACHE II and FGSI scores, and the C-reactive protein (CRP) value were significantly higher in the non-survivor group. There was a positive correlation between the FGSI, APACHE II, and SOFA scores. Older age, high CRP levels at the time of admission, and the presence of comorbidity are still determining factors in the prediction of mortality in patients with FG. We also determined that in predicting mortality in patients monitored in the ICU with the diagnosis of FG, in addition to the routinely used FGSI, the APACHE II score was also useful, but the SOFA score did not have significant predictive value.

Changing or stopping testosterone-lowering medication in men convicted of sexual offenses: clinical evaluation of the COSTLow-R Scale.

Individuals convicted of a sexual offense (ICSO) can be treated with testosterone-lowering medication (TLM) in order to support the control of paraphilic sexual fantasies and to decrease the risk of sexual recidivism. However, due to partly severe side effects, TLM should not be a lifelong treatment. The aim of the current study was to further evaluate the Change or Stop Testosterone-Lowering Medication (COSTLow)-R Scale in forensic outpatient aftercare practice. The scale was developed to assist forensic professionals in deciding on whether to change or stop TLM treatment in ICSO. The COSTLow-R Scale was applied retrospectively in a forensic-psychiatric outpatient institution in Hesse, Germany, on 60 ICSO. TLM was terminated in 24 patients (40%). Moreover, 10 forensic professionals of the institution as well as an experienced working group within the institution focusing on the treatment of ICSO, qualitatively evaluated the COSTLow-R Scale by participating in an open designed survey. The COSTLow-R Scale ratings as assessed by forensic professionals were collected. In addition, a survey was performed among these professionals about the usefulness of the scale and their practical experiences with it. A binary logistic regression analysis was conducted to ascertain the predictive power of the scale regarding the stopping of TLM. Three items of the COSTLow-R Scale significantly predicted stopping decisions: the possibility of psychotherapy before TLM treatment, psychopathic traits, and a substantial decrease of paraphilic severity. Thus, a decision towards stopping TLM was more likely for patients who showed greater treatment readiness before starting TLM, lower psychopathy scores, and a higher decrease of paraphilic severity. The forensic professionals described the scale as a good and structured tool that displays which aspects are important to consider during TLM treatment decisions. The COSTLow-R Scale provides structure to the decision of whether to change or stop TLM and should thus be implemented in the forensic treatment process of patients with TLM more frequently. Although the small sample size limits generalizability of the findings, the present study was conducted directly in a forensic outpatient practice and, therefore, has high external validity and a strong impact on the life and health of patients treated with TLM. The results indicate that the COSTLow-R Scale can be a useful instrument facilitating the TLM decision-making process by providing a structured compendium of criteria. Further research is still needed to evaluate the scale and to provide additional evidence for the results of the current study.

Assessment of Patient Treatment and Rehabilitation Processes Using Electromyography Signals and Selected Industry 4.0 Solutions.

Funding treatment and rehabilitation processes for patients with musculoskeletal conditions is an important part of public health insurance in European Union countries. By 2030, these processes will be planned in national health strategies (sequential process activities will be identified, care packages will be defined, service standards will be described, roles in the implementation of activities will be distinguished). Today, in many countries of the world (including the EU countries), these processes tend not to be very effective and to be expensive for both patients and insurance companies. This article aims to raise awareness of the need for process re-engineering and describes possible tools for assessing patient treatment and rehabilitation processes (using electromyographic signals-EMG and selected Industry 4.0 solutions). This article presents the research methodology prepared for the purpose of process evaluation. The use of this methodology will confirm the hypothesis that the use of EMG signals and selected Industry 4.0 solutions will improve the effectiveness and efficiency of treatment and rehabilitation processes for patients with musculoskeletal injuries.

Moral distress in psychiatric nurses in Covid-19 crisis

BackgroundThe COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient’s lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic.MethodThis qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman.ResultsBy continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses’ Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies).ConclusionNew dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

A qualitative study of Covid-19 effects on nutrition associated problems in recovered patients

BackgroundWorld is currently challenging with Covid-19 pandemic. Nutritional status is a determinant factor in the treatment process and recovery for patients with Covid-19. Although a limited data is available about the effects of nutrition on this disease. Therefore, the aim of this study was to identify nutritional problems in patients recovering from Covid-19 before, during and after the disease.MethodsThis qualitative descriptive study was carried out based on the specified inclusion criteria through targeted sampling of 45 patients recovered from Covid-19, 2021–2022. In-depth semi-structured individual interviews were used to collect data. Interviews were recorded, transcribed and analyzed using qualitative content analysis method and MAXQDA Software.ResultsBased on the participants’ description of this stage, it can be reported that most of the individuals who were infected had no specific symptoms. Nutrition-linked problems in the main stage of the disease included troubles in tolerating foods and nutrition (e.g., fatty and solid foods), highly consumed foods in the main stage of the disease (e.g., beverages), individuals’ approaches to improve nutritional challenges (e.g., consumption of herbal teas and soft texture foods) and using supplements. The patients stated fewer nutritional problems after recovering from the disease. The most significant change included their desire to eat solid foods such as rice, bread, pasta and fast foods.Conclusionappropriate nutrition with medication can help accelerate the recovery process of the patients, especially hospitalized patients with further severe degrees of the illness.

DETERMINATION OF OPTIMAL ACTIVITY OF RADIOACTIVE IODINE 131 AT TREATMENT OF THYROID CANCER OF POPULATION OF REPUBLIC OF KAZAKHSTAN

This article is devoted to the problem of a high level of oncological diseases of the population of the Republic of Kazakhstan. The analysis of the presented statistical data indicates an annual increase in the number of detection of registered oncological diseases in the population of the Republic of Kazakhstan. With regard to our region, the annual increase in the number of cancer detection in the population of the Abai region, which is undoubtedly due to the existence of the former Semipalatinsk nuclear test site on this territory, leads to the need for further research to improve the prediction of the treatment process of patients with cancer. Currently, the method of radioiodotherapy presented in the work is actively used for the treatment of oncological diseases, and in particular thyroid cancer. This method of treatment allows you to destroy cancer cells, surgical removal of which is not possible. An accurate calculation of the activity of the drug to be taken by the patient allows you to reduce the dose load on the patient and at the same time achieve the desired therapeutic effect. The paper presents formulas that are used to calculate the radiation dose of patients for the successful treatment of thyroid cancer. This method of treatment is carried out in the department of "Radionuclide Therapy" of the Center for Nuclear Medicine and Oncology of Semey.

Development of a Methodological Approach to Support and Analysis of the Execution of Standards for Diagnostic and Treatment Processes in a Multidisciplinary Hospital

Standardization is one of the most important tools for ensuring the quality of medical care. The paper presents analysis results of a number of existing federal and regional standards that regulate the processes of providing medical care, which confirm the need and expediency of developing internal standards for diagnostic and treatment processes (DTP) in a medical institution. The authors also formulate requirements for their minimum content. The importance of the effective implementation of the developed internal DTP standards necessitates the development of a methodological approach to standard execution support and analysis.The approach presented in the article is methodically based on the use of modified operogrammes, which allow taking into account the DTP specifics and resource equipment of a particular medical institution. The authors propose key areas for standard execution support and possible forms of implementation in information systems, as well as basic directions for standard execution analysis with integral indicators for assessment of those standards.Approbation of the developed methodological approach was carried out on the example of the N.V. Sklifosovsky Research Institute for Emergency Medicine in terms of DTP standard execution support and analysis in relation to ordering laboratory, instrumental tests and consultations at various stages of the patient treatment process. The results of the approbation confirmed that the introduction of the methodological approach increases the effectiveness of the implementation of the developed DTP standards in the activities of a medical institution, and also ensures the achievement of a number of important systemic management effects.

Investigating polymorphisms related to chronic kidney disease and the effect of health and nursing education on self-management ability and quality of life in hemodialysis patients.

The effects of health and nursing education are fundamental and essential in achieving the desired quality of life. In recent years, the impact of health and nursing education and self-management ability in many diseases, including kidney patients and those undergoing dialysis and hemodialysis, have been highly regarded. Studies have shown that modern nursing training and self-management ability have an influential role in the treatment process of hemodialysis patients. In general, self-management is a common term in health education and includes symptom management, treatment principles, consequences, and lifestyle changes to maintain and improve quality of life. Planning and continuity of care are necessary for self-management, and the set of these factors is an important and effective issue in kidney and hemodialysis patients and has caused hope, encouragement, and encouragement to more and more patients, improving their quality of life and correct use of healthcare services. In this study, we investigated some health management parameters in the quality of life of hemodialysis patients. The results of this study showed that family support, self-management of personnel, and the nursing system have a positive and significant correlation with the quality of life in these patients (p=0.002). This means that family and social support along with the modern nursing system and self-management can lead to an increase in the quality of life in hemodialysis patients. Also, the results of polymorphism analysis in the GATM locus related to chronic kidney disease showed that the frequency of the A allele in SNP rs2453533-GATM is higher in CKD patients independent of dialysis (non-dialysis) compared to healthy people. Also, the intronic C allele of SNP rs4293393 (UMOD) was more common in healthy subjects than in CKD patients, and the intronic T allele of SNP rs9895661 (BCAS3) is associated with a decrease in eGFRcys and eGFRcrea.

Effects of Continuous Nutrition Care on Nutritional Status and Dietary Habits of Patients With Colorectal Cancer Receiving Adjuvant Chemotherapy After Surgery.

Patients with colorectal cancer may experience symptoms such as diarrhea, nausea, and anorexia, during surgery and chemotherapy, which can increase the risk of malnutrition. In addition, dietary habits play a key role in the onset of colorectal cancer; therefore, it is necessary to improve dietary habits to prevent recurrence during treatment after diagnosis. In this study, a clinical nutritionist conducted 4 interviews for patients diagnosed with colorectal cancer and scheduled for colectomy: before surgery, after surgery, 1st chemotherapy, and 2nd chemotherapy, and provided nutrition care for each treatment course to determine its effects on nutrition status and disease prognosis. Significant weight loss but no decrease in muscle mass was observed during treatment. Body fat mass, although not statistically significant, showed a decreasing tendency. The percentage of people who responded 'yes' to the below items increased after compared to before receiving nutrition education: 'I eat meat or eggs more than 5 times a week,' 'I eat seafood at least three times a week,' 'I eat vegetables at every meal,' 'I eat fruits every day,' and 'I eat milk or dairy products every day.' These results indicate that the patients changed their dietary habit from a monotonous eating pattern to a pattern of consuming various food groups after receiving nutrition education. These results suggest that continuous nutrition care by clinical dietitians, according to the patient's treatment process, can help improve the patient's nutritional status and establish healthy eating habits.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Clinical Practice Guidelines for Assessment and Management of Patients with Substance Intoxication Presenting to the Emergency Department.

Web-Based Health Service Management Information System Development With The Linear Sequential Model Method

The clinic has several health facilities such as outpatient, inpatient, dental clinic, laboratory, family planning/MCH, pharmacy, and pharmacy. However, at the clinic, administrative processes are still carried out manually and are not computerized properly, making it difficult for staff because the process of storing and integrating data has not been carried out effectively and efficiently. Therefore we need a systematic and automatic information system to assist the administrative and managerial processes of the clinic. The information system developed in this study is based on a web application using the Laravel 8 framework. The method used for system development is the linear sequential model commonly known as the classic life cycle or waterfall development model. The system that has been made is tested using the black box texting method combined with the UAT (User Acceptance Testing) method to find out whether the system meets functional requirements and is by the design. Based on testing using the UAT method, the average value of 6 different indicators is 91%. Therefore it can be concluded that the web-based information system for this clinic has an easy-to-understand way of working and attractive features so that it can provide convenience in the patient treatment process and clinical managerial processes.

INFLUENCE OF THE PATIENT’S SEX AND AGE, VOLUMES OF THE SALIVARY GLAND AND PLEOMORPHIC ADENOMA ON THE TUMOR HISTOLOGICAL VARIANTS

Aim: The purpose of the study was to identify the influence of the patient’s sex and age, the volumes of the salivary gland and pleomorphic adenoma on the histological variants of the tumor. Materials and Methods: The study included 21 women and 9 men with pleomorphic adenomas of the salivary gland. In 15 cases, a mesenchymal variant of pleomorphic adenoma was identified, in 5 cases – an epithelial variant, in 10 cases – a mixed variant. The average age of the patients was 39.7±2.9 years. Patients with pleomorphic adenomas underwent magnetic resonance imaging using a Siemens MAGNETOM Aera 1.5T device (Germany), during which three projections of the tumor and salivary gland were measured (antero-posterior, lateral, vertical) with subsequent calculation of their volumes, and then the ratios of these volumes. Classification trees were used to determine whether patients belonged to one of three variants of pleomorphic adenoma. The CART (Classification And Regression Tree) algorithm was used as a branching option. Stopping branching was carried out using the FACT (Fact-style direct stopping) method until each terminal (final) node of the tree does not contain incorrectly classified observations or when their number becomes less than a given proportion of the total group size (less than 5%). Determination of the structure and relationships between the tumor variants and such indicators as gender, age and radiological indicators (volume of the tumor, volume of the salivary gland, ratio of tumor volume to salivary gland volume) was carried out using correspondence analysis. Results: Epithelial variant of pleomorphic adenoma is more typical for women, and the mixed and mesenchymal variant is more common for patients of both sexes. The epithelial variant can develop in patients of any age, while the mixed variant occurs mainly in patients older than 41 years, and the mesenchymal variant – mainly in patients younger than 41 years. The ratio of the volume of the tumor to the volume of the salivary gland will be predominantly >0.17 in the epithelial variant of pleomorphic adenoma, predominantly ≤0.17 in the mesenchymal variant, and can take any value in the mixed variant. Conclusions: The authors conducted a study in order to identify the influence of sex, age of the patient, and the ratio of the volume of pleomorphic adenoma to the volume of the salivary gland on the histological variant of the tumor. The revealed data will be useful in the treatment and diagnostic process in patients with pleomorphic adenoma of the salivary gland.

Abstract B107: Exploring patient-centered themes following diagnosis in a cohort of African American pediatric oncology patients

Abstract Introduction: Pediatric patients diagnosed with cancer report lower quality of life and increased psychological distress. Furthermore, African American pediatric oncology patients face unique and extensive obstacles upon diagnosis. The present study sought to identify patient-centered experiences following a cancer diagnosis in a sample of African American pediatric oncology patients. Methods: This study examined semi-structured interviews of pediatric African American oncology patients (N = 13; Mage = 13.54 years; 7-17 years). Interviews were audio recorded and transcribed. Response patterns examining patient perceptions of being diagnosed with cancer were derived through thematic analysis. Results: Four themes related to initial diagnosis emerged: negative emotions, quality of life, cognitions, and physical appearance. The majority of patients disclosed feeling fear, hurt, and sadness in relation to their cancer diagnosis. A myriad of cognitions surrounding initial diagnosis also emerged. Many patients reported being unaware of their diagnosis and reported a sense of confusion related to extended hospitalizations and taking medication. Patients disclosed worry and embarrassment regarding losing their hair (e.g., “my hair is my pride and joy,” and, “the first thing that did come to my mind was my hair. As a teenage girl, I was just like “my hair.”). Patients also expressed worries about quality of life and prognosis. Finally, a fear of the unknown, ability to attend school and activities, and possible death emerged as common themes. Conclusion: This study described perceptions of African American pediatric oncology patients during the initial diagnosis of cancer. Key themes included negative emotions, quality of life, cognitions, and physical appearance. A pattern between cognitions related to life changes due to diagnosis and resulting emotions such as fear emerged. This finding suggested a strong connection between the perceptual aspects of initial diagnosis and patient experiences through treatment, indicating that psychological interventions could serve as a tool to decrease negative emotions. The significant importance of patient-centered education delivered immediately at diagnosis emerged as a significant factor as many patients reported unawareness of their diagnosis (e.g., “I just didn’t know what was going to happen next, like all of the medicine, how they were going to treat it and all that”). Although level of patient education may differ based on family preferences, developmentally appropriate communication may enhance the treatment process for patients, and ultimately decrease psychological distress. These findings also indicate the cultural and historical importance of physical appearance with hair being an important piece of identity for African American patients. These findings highlight the relative importance of investigating patient-centered experiences and culturally appropriate interventions across the illness trajectory from new diagnosis to survivorship, especially among African American pediatric oncology patients. Citation Format: Irene Jacobs, Jennifer Rohan, Andrea Jewell, Kelly Tran, Jasmine Nguyen. Exploring patient-centered themes following diagnosis in a cohort of African American pediatric oncology patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B107.

COVID-19 AMONG TUBERCULOSIS PATIENTS IN MOSCOW

Introduction. In connection with the emergence of a new coronavirus infection COVID-19, since 2020, a set of measures has been carried out in Moscow to ensure the identification, isolation and organization of the treatment process of patients with tuberculosis combined with COVID-19. Based on the data of the TB/COVID-19 co-infection monitoring system created in Moscow, the study analyzed all 430 confirmed cases of COVID-19 among TB patients registered or followed up in Moscow in 2021 in groups I and II of dispensary observation. Aim. To study the incidence of COVID-19 in tuberculosis patients in 2021 and to identify epidemiological features among tuberculosis patients in the second year of the pandemic. Results. The analysis showed that with an increase in the territorial incidence and an increase in the total number of newly diagnosed TB patients in the capital in 2020–2021, the number of confirmed cases of TB/COVID-19 co-infection decreased by 212 cases. Among all 430 patients, 52.3% are permanent residents of the city, 22.3% are residents of other subjects of the Russian Federation, 12.3% are homeless persons and 13.1% are foreign citizens. In 80.5% of cases, the diagnosis of coronavirus infection caused by the COVID-19 virus was established based on the results of etiological laboratory diagnostics (detection of SARS-CoV-2 RNA by PCR in smears with mucosa from the nasopharynx and oropharynx), and in other cases - only according to radiation diagnostics (computed tomography of the chest). More than half of those with combined tuberculosis/COVID-19 infection – 59.8% were unemployed and 14.4% were old-age pensioners. In 2021 in among tuberculosis/ COVID-19 patients, 63.3% (272 people) were newly diagnosed tuberculosis patients, of which: – 53.3% were permanent residents of Moscow, – 19.1% residents of other subjects of the Russian Federation, – 14.7% are homeless, – 9.9% are foreign citizens. For new tuberculosis cases, the maximum number of patients, co-infected with a new coronavirus infection was at the age of 31–45 years, which was somewhat different from the age characteristics of the incidence for other patients. Because of treatment of coronavirus infection, 84% of patients cured of COVID-19 already in 2021, 12.1% (52 people) died. The created tuberculosis/COVID-19 co-infection monitoring system in Moscow allows for a full assessment of the course of a new coronavirus infection in tuberculosis patients, patient routing, analysis of the incidence of COVID-19 among tuberculosis patients, the effectiveness of their treatment and the causes of mortality.

The Role of Interactive Technologies in Optimizing the Process of Patient Treatment: Prospects and Challenges for Health Care

The introduction of medical digital technologies can provide better access and flexibility of healthcare for the population. It includes the availability of open information about health, treatment, complications, and recent progress in biomedical research. Nowadays, even in low-income countries, diagnostic and medical services are becoming more accessible. However, many issues related to digital health technologies remain unresolved, including reliability, security, testing, and ethical issues.The penetration of AI currently affects almost all areas of work of medical organizations and government and supervision bodies in the field of healthcare, as well as all major nosological groups. The leading areas of AI application are: medical diagnostics and image analysis, predictive clinical and managerial analytics, medical decision support systems, data analysis of wearable devices, telemedicine, monitoring of patients with chronic non-communicable diseases, virtual assistants, including robot-assisted surgery, decision assistance mental health problems, etc.This article explores the role of interactive technologies in optimizing the patient care process and discusses the prospects and challenges they present for healthcare. In recent years, interactive technologies such as mobile applications, virtual reality, remote medical consultations and electronic health monitoring systems have become increasingly common in medical practice. Digital platforms can help optimize patient diagnosis, counselling and treatment. However, due to the lack of official regulations and recommendations, stakeholders, including private and public organizations, face the problem of adequate verification and testing of new digital health technologies. In this regard, proper scientific research is needed before a digital product is deployed for the health sector.The authors emphasize that interactive technologies have a significant potential for optimizing the process of treating patients in healthcare. They can improve the availability and quality of medical care, as well as increase patient satisfaction.

Comprehensive assessment of the morpho-functional state of the back skin integument in adolescents with idiopathic scoliosis

BACKGROUND: In the formation of scoliotic deformity of the spinal column, the skin of the back on the protruding parts of the body is a vulnerable area. However, the study of the characteristics of the skin condition of the back of adolescents with idiopathic scoliosis has not been given due attention.
 AIM: To conduct a comprehensive assessment of the morphological and functional properties of the skin of the back of adolescents with idiopathic scoliosis and to determine the information content of the research methods used.
 MATERIALS AND METHODS: In 20 adolescents with idiopathic scoliosis, the skin of the back was examined. The following methods were used: visual clinical examination, local thermometry, laser Doppler flowmetry, esthesiometry, elastometry, histological methods.
 RESULTS: Visually, in 70% of cases, a change in the skin was revealed. In the region of the spinal deformity apex, the skin temperature was higher on the convex side than on the concave side. In the skin of the paravertebral region, capillary blood flow from the convex side and in the distal spine was more intense than on the concave side. In the dermatomes corresponding to the apex of the deformity, hyperesthesia, hypesthesia, and the absence of thermal sensitivity were noted. In the paravertebral and scapular projections, in the region of the deformity apex, the lowest indicators of skin elasticity were recorded, compared with the areas located above and below. Histostructural differences in the skin were revealed in the area of the convex and concave sides of the apex of the deformity. On the convex side, a significant decrease in the thickness of the epidermis and dermis, an increase in the thickness of the subcutaneous fat, a greater severity of reactive-destructive changes in the fibrous, vascular and innervating components of the dermis were determined.
 CONCLUSIONS: The use of an integrated approach in the study of the skin of the back of adolescents with idiopathic scoliosis made it possible to identify the features of structural and functional changes, which indicates the information content of the selected methods. The results obtained must be taken into account when planning the treatment and rehabilitation process of patients with this pathology.

ОСОБЛИВОСТІ ПІДГОТОВКИ ЛІКАРІВ-СТОМАТОЛОГІВ-ХІРУРГІВ В УМОВАХ ВІЙСЬКОВОГО СТАНУ

The article summarizes the experience of training dentists-surgeons under martial law at the Department of Surgical Dentistry of the I. Horbachevsky Ternopil National Medical University of the Ministry of Health of Ukraine, who study under the second (master's) level «Dentistry» educational and professional program of higher education, the field of knowledge 22 «Health care», specialty 221 «Dentistry». The organizational conditions for ensuring the adaptation of the entire educational process to the realities of war (transition to asynchronous training, arranging a safe shelter, developing an algorithm for actions during air raids), ways of regulating and stabilizing the emotional state of recruits, and involving them in volunteer activities are revealed. Considerable attention is paid to those changes that affected the work program of the discipline «Surgical Stomatology», in particular the modules «Military Stomatology» and «Maxillofacial Traumatology». In particular, the emphasis is shifted to the preparation of future dentists-surgeons to provide medical assistance to patients with injuries of the maxillofacial area, the peculiarities of the clinical course of such injuries, the basics of diagnosis and therapeutic manipulations, the methods, and means, algorithms of actions for providing emergency care at the site of injury, on various stages of medical evacuation. In addition, the topics are supplemented with questions related to the study and understanding of the psychological state of the wounded and the provision of essential psychological assistance. The specifics of conducting practical classes directly in medical institutions are highlighted. Furthermore, ways of effective interaction between the teacher and the acquirer in the diagnostic and treatment process of outpatient and inpatient patients are shown (perception of the acquirer as an equal partner, interaction with him on a parity basis, recognition of the equality of goals, rights, and obligations about the patient), which is confirmed by the indicators of algorithmic and analytical thinking of the future specialist in the military-medical field, available surgical, therapeutic and deontological skills and abilities. Key words: dentist-surgeon, professional training, military status, psychological stress resistance, maxillofacial area

Artificial Intelligence-Assisted Peer Review in Radiation Oncology

<h3>Purpose/Objective(s)</h3> Peer review is reflective of the entire patient treatment process with clinical information, therapeutic parameters and potential treatment variations. Our hypothesis is that using artificial intelligence (AI), we can enhance the efficacy of the peer review process by screening cases with a potential for treatment interruption. <h3>Materials/Methods</h3> From 3,899 radiotherapy patients (7,168 plans) treated from 2014-2021 in our department, 36 features of clinical and therapeutic parameters were used as input for two AI models: multivariable least absolute shrinkage and selection operator (LASSO) logistic regression model and pattern recognition feed forward neural network (NN). LASSO is a shrinkage regularization method that assigns coefficients to significantly useful features. NN passes input features through multiple hidden nodes to assign weights and biases for feature selection. Each method results in continuous probability of treatment interruption. Performance metrics of accuracy, sensitivity and specificity were calculated for evaluations. <h3>Results</h3> Overall, 8.1% of all cases had treatment interruptions, most commonly in head and neck (18.8%) compared to other sites (19% vs 7-9%, p<0.01). For LASSO model, testing set sensitivity, specificity and accuracy ranged from 65-89%, 31-53% and 35-54%, respectively, with higher sensitivity than specificity. Spine/Extremity and Brain sites had the highest accuracy (54%). Higher sensitivity than specificity indicated that the model was more able to predict true positives. For NN model, testing set sensitivity, specificity and accuracy ranged from 23-62%, 66-90% and 64-86%, respectively. Higher specificity than sensitivity was observed. The Brain site had highest accuracy (86%). Accuracy of NN was higher than LASSO for all treatment sites (68% vs. 50%), which is particularly true for the brain (86% vs. 54%) and the pelvis/prostate (77% vs. 35%). This result indicates that the linear hyperplane of LASSO was insufficient to classify the underlying complex clinical dataset accurately. Including more input features is expected to improve the accuracy for both models. <h3>Conclusion</h3> Our results provide proof-of-concept that AI can be used as a screening tool to aid the peer review process. It can help to predict treatment interruptions, which include replanning or treatment cessation. Early identification of patients at risk of radiotherapy interruptions using this method may potentially translate into higher treatment completion rates. The study is being continued at our institution to further explore the capabilities of AI in the peer review process.

Episodic Relatedness in Socioeconomically Disadvantaged Families Where a Parent has Multiple Diagnoses.

There is a strong association between social relationships and health. In this article, we ask how a view of social relationships played out in time can help to nuance the role of patients' social networks in their healthcare-seeking behavior. We investigate this link by exploring the dynamics of relatedness in socioeconomically vulnerable young families with a multimorbid parent and their extended networks. Data were generated through repeated semi-structured and open-ended interviews and participant observation. The study found that, for much of their lives, participants experienced life as a series of events that happened to them and were out of their control. This way of being-in-the-world was linked to a consistent pattern of intense and then suddenly discontinued relationships. The relevance for health professionals is that there is a growing trend in healthcare systems worldwide to involve relatives and extended networks in a patient's treatment process. Our findings indicate challenges to this approach and recommend that health professionals are aware that for socioeconomically vulnerable patients with multimorbidity, important relationships can change dramatically, quickly, and repeatedly, over short periods of time.

Analysis of modern approaches to cardiorehabilitation of patients with the acute coronary syndrome

Aim. To study modern approaches to cardiorehabilitation of patients with the acute coronary syndrome based on foreign and national scientific publications and recommendations.&#x0D; Materials and methods. The analysis of foreign and national scientific literature sources was performed, during which the system-analytical, comparative, logical methods and the method of generalization of information were used.&#x0D; Results. When analyzing foreign and national scientific literature it has been found that cardiorehabilitation is an important component of the treatment process of patients with the acute coronary syndrome. The basis of the cardiorehabilitation program is regular physical activity and training. The exercise program is developed on an individual basis and includes a combination of strength training and aerobic endurance training. Most recommendations prefer aerobic exercise, which includes walking, jogging, cycling, and so on. The exercises proposed by different researchers differed in frequency, intensity, type, and time. When evaluating the effectiveness of cardiorehabilitation programs, researchers note a positive effect of exercise on the condition of patients, and the study of long-term results indicates a significant reduction in the risk of hospitalization for cardiovascular events and cardiovascular mortality. Many researchers have noted low adherence of patients to long-term cardiorehabilitation affecting the prognosis of the disease and quality of life.&#x0D; Conclusions. According to current recommendations, multidisciplinary exercise-based cardiorehabilitation is indicated for patients with the acute coronary syndrome. In many countries around the world, the basis of the exercise program is aerobic exercise. Differences in exercise performance relate to frequency, intensity, time and type. The studies on the effectiveness of cardiorehabilitation programs have shown a significant reduction in the risk of hospitalization from cardiovascular events, cardiovascular mortality. Low adherence of patients to long-term physical rehabilitation affects the effectiveness of treatment, prognosis and quality of life of patients.