Ukrainian Hospitals Research Articles

Wartime penetrating traumatic brain injury of the anterior skull base involving the paranasal sinuses: a single-center, first-year experience from Dnipro, Ukraine.

Since February 2022, the number of casualties in the Russian-Ukrainian war have dramatically increased, with a high incidence of penetrating traumatic brain injuries (pTBIs). To date, there has been limited evaluation of pTBI of the anterior skull base involving the paranasal sinuses. The objective of this study was to highlight the authors' experience with this injury pattern and identify specific factors associated with favorable short-term (1-month) outcome and survival. The authors conducted a single-institution retrospective review of patient data collected from the 1st year of the Russian-Ukrainian war at a frontline civilian Ukrainian hospital. To prevent complications from conservative treatment of pTBI with paranasal sinus injury, a protocol of early primary neurosurgical treatment including debridement/hematoma evacuation, repair of dural defects with vascularized pericranial flaps, and titanium plating of external/skull base defects was implemented. Using 1-month postoperative Glasgow Outcome Scale scores, the authors defined a favorable outcome as good recovery/moderate disability and a poor outcome as severe disability/vegetative state/death. Patient demographics, injury characteristics, imaging findings, and postoperative complications were assessed. Logistic regression models were used to estimate the effect of patient characteristics on unfavorable outcome or survival. From February 2022 to February 2023, there were 141 pTBIs (20%) involving the paranasal sinuses, 134 (95%) due to blast fragmentation. One hundred eighteen patients (84%) had a favorable outcome. Most patients with pTBIs (69%) had other nonbrain-related injuries. While 48 patients (34%) presented with preoperative CSF leak, only 1 patient (0.7%) had persistent postoperative CSF leak, which was managed with lumbar drainage. High admission Glasgow Coma Scale (GCS) score, favorable injury lateralization (single hemisphere involved), and low Injury Severity Score (ISS) were associated with significantly increased odds of favorable short-term outcome, whereas high admission GCS scores and no midline shift were associated with significantly increased odds of survival. This was the largest single-year study on neurosurgical treatment of wartime pTBI involving the paranasal sinuses. Implementation of primary neurosurgical intervention at the time of presentation demonstrated promising early results and a shift away from expectant management of this injury pattern. The association of high admission GCS score, low ISS, favorable injury lateralization, and no midline shift on favorable short-term outcomes or survival has not been previously documented with this injury pattern.

Temporal evolution of bacterial species and their antimicrobial resistance characteristics in wound infections of war-related injuries in Ukraine from 2014 to 2023

This study continues surveillance of antimicrobial resistance associated with combat injuries in Ukraine. To compare species composition, antibiotic resistance profiles, and emergence of new resistance genes between 2014-2020 and 2022-2023. This was a retrospective multi-centre microbiological survey in Ukrainian hospitals. Antibiotic susceptibility, whole-genome sequencing and multi-locus sequence typing were conducted on 154 organisms obtained from 125 casualties between 2022 and 2023. The data revealed a predominance of Gram-negative bacteria, particularly Acinetobacter baumannii (35.7%), Pseudomonas aeruginosa (14.9%) and Klebsiella pneumoniae (20.7%). High levels of carbapenem resistance were observed among A.baumannii {meropenem 72.2% [39/54, 95% confidence interval (CI) 58.4-83.5]; imipenem 66.7% (36/54, 95% CI 52.5-78.9)}, K.pneumoniae [meropenem 90.6% (29/32, 95% CI 75.0-98.0); imipenem 81.2% (26/32, 95% CI 63.6-92.8)] and P.aeruginosa [meropenem 47.8% (11/23, 95% CI 26.8-69.4); imipenem 60.8% (14/23, 95% CI 38.5-80.3)] strains. A.baumannii sequence type (ST)-78 and ST-400 were prevalent from 2014 to 2020, while five strains of ST-1077 were newly identified in 2022-2023. P. aeruginosa strains showed diversity across 16 STs, with ST-773 increasing in frequency and new STs emerging, but lacking carbapenemase genes. K.pneumoniae exhibited increased genetic diversity over time, with three STs from 2014 to 2020 and six new STs, including blaNDM-1, blaOXA-48 and blaKPC2 carriers, in 2022-2023. The prevalence of multi-drug-resistant isolates with STs associated with a high risk of global dissemination is increasing.

A Comparison of Ukrainian Hospital Services and Functions Before and During the Russia-Ukraine War

Since the full-scale Russian invasion, hospitals in Ukraine have been compelled to close or operate at reduced capacity due to inadequate supplies, damage, or destruction caused by war. To analyze hospital services in Ukraine during the period before and after the Russian invasion. Of the 450 hospitals currently functioning in Ukraine, a cross-sectional survey was carried out with the participation of 74 hospitals from 12 oblasts. Hospital administrators responded to an online survey with questions on the use of hospital services. Data were abstracted from hospital databases for the prewar period (before February 23, 2022) and during the war (February 23, 2022, to May 30, 2023). Hospital services (including emergency services, preventive services, screenings, laboratory tests, obstetrics, telehealth, pharmacy, and rehabilitation services) were compared during the prewar and war periods. Of 450 Ukrainian hospitals in operation, 74 hospitals (16.0%) across 12 oblasts provided data for the current analyses. During the war, daily emergency admissions increased to 2830, compared with 2773 before the war. At the same time, hospitals reported reduced laboratory testing (72 [97%] vs 63 [85%]), tobacco education (52 [70%] vs 36 [49%]), cancer screening (49 [66%] vs 37 [50%]), gynecological services (43 [58%] vs 32 [43%]), rehabilitation services (37 [50%] vs 27 [36%]), pharmacy services (36 [49%] vs 27 [36%]), and telehealth programs (33 [45%] vs 21 [28%]). Hospitals reported additional difficulties during the war, including disruptions in the supply chain for essential equipment and pharmaceuticals, shortages of laboratory test kits, delays in the delivery of crucial medications, and problems around appropriate medication storage due to power outages. The ongoing war has inflicted profound devastation on Ukraine's hospitals. The findings of this cross-sectional survey offer valuable insights into the formidable challenges that hospitals confront in war-affected regions and underscore the pressing necessity for bolstering support to sustain and enhance hospital services during wartime.

Development of partnership relations between hospitality industry entities amid Ukraine’s European integration process

The development of partnership relations among hospitality industry entities has gained particular relevance amid Ukraine’s European integration course. Collaboration between government institutions, business entities, and local communities creates new opportunities for enhancing competitiveness and integrating into the European market. The aim of the study was to propose approaches for establishing partnerships between business entities based on the analysis of existing types of partnerships that promote the development of the hospitality industry and contribute to regional economic growth. The study’s main methodological framework included economic-mathematical and comparative analyses, as well as empirical and theoretical methods. The article analysed tax revenues from hospitality industry entities for the period 2021-2023, revealing a general decline in tax revenues from the hospitality industry overall. It has been proven that cooperation between government institutions, local communities, private businesses, and non-governmental organisations creates conditions for balanced resource use and the development of innovative solutions that contribute to the preservation of the natural environment and cultural heritage. A stakeholder grouping was carried out, which allows for a multi-level approach to developing the hospitality industry based on integrating the interests of various market participants. The structure of relationships between hospitality industry entities in the context of European integration has been identified and systematised (cooperative relations, competitive relations, symbiotic relations, contractual relations, alliance, and cluster relations). The effectiveness of specialised alliances and cluster associations, which are based on voluntary cooperation between various industry participants striving to achieve long-term development goals, has been proven. The impact of partnership relations on the development of Ukraine’s tourist destinations has been studied and described. The study emphasised the adaptation of Ukrainian hospitality industry entities to European quality standards and their cooperation in achieving sustainable development. The practical significance of the study lies in the development of methodological recommendations that can be used by: business entities to improve partnership relations and enhance competitiveness in the European market; local authorities to promote the development of the hospitality industry; and educational institutions to train personnel in accordance with the requirements of the European market

O03 Phenotypic antimicrobial resistance to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients

Abstract Background Since March 2022, there has been an emergence of MDR microorganisms (MDRO) in Europe because of an increasing number of Ukrainian patients with MDRO. The goal was to collect large-scale phenotypic susceptibility data to assess implications for clinical practice. Methods For 122 MDRO (carbapenemase-producing Enterobacterales (CPE, n=96), Pseudomonas aeruginosa CPPA (n=20), carbapenem-resistant Acinetobacter baumannii-calcoaceticus (CRAB, n=6), collected from March to December 2022, broth microdilution (BMD), fosfomycin agar dilution, gradient strip ampicillin/sulbactam, sulbactam/durlobactam, ceftazidime-avibactam-aztreonam and disc diffusion (DD) cefiderocol was performed. Epidemiological data was obtained as part of mandatory reporting by Municipal Health Services (CPE), and surveillance questionnaires (CPPA/CRAB). Results Admission at a Ukrainian hospital in the last year was a risk factor for acquiring MDRO. Of all isolates, 65% (79/122) were blaNDM-positive. For meropenem, aminoglycosides, ceftazidime-avibactam, ceftolozane-tazobactam and imipenem-relebactam susceptibility rates were low (0-30%). For cefiderocol, results depended on reading with or without microcolonies, applying EUCAST or CLSI breakpoints, and whether DD or BMD was used: e.g. for Klebsiella pneumoniae, 30%–97% were susceptible, depending on these variables. For colistin, 103/111 (93%) non-intrinsically resistant CPE/CPPA/CRAB isolates were susceptible. For the majority of CPE, a low MIC of <0.5 mg/L was measured for tigecycline and ceftazidime-avibactam-aztreonam. For CPPA, cefiderocol tested susceptible in 65%–100% of isolates. For CRAB, ampicillin/sulbactam MICs were ≥128 mg/L, for sulbactam/durlobactam 1–2 mg/L. Conclusions There is extensive phenotypic resistance to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients. For cefiderocol, interpretation of susceptibility results depends on a number of variables. In case of infection, treatment options are colistin, cefiderocol (CPE/CPPA/CRAB), tigecycline (CPE/CRAB), ceftazidime-avibactam-aztreonam (CPE), sulbactam/durlobactam (CRAB).

UNVEILING TECHNICAL ASPECTS OF THE KYPS SYSTEM IN THE HOSPITALITY SECTOR OF UKRAINE

The article explores some technical aspects of the KYPS System, a pioneering Smart Measurement Technology reshaping Ukraine's hospitality sector. It focuses on the technical synergy between the ESP32 SX1276 Lora Development Board and the Si7021 sensor, spotlighting their role in real-time environmental monitoring within the food and beverage domain. As an emblematic case of SMT integration, KYPS showcases the transformative potential and engineering nuances driving efficiency and innovation within Ukrainian hospitality.

Peculiarities of the Hospitality Industry Development in Ukraine

Topicality. The hospitality industry plays a significant role in solving the problems of bringing the national economy out of the crisis, contributing to its structural transformation, which is of exceptional importance for Ukraine nowadays. Despite the huge recreational potential, the Ukrainian market of hotel and restaurant services is significantly lower than the world market of the hospitality industry in terms of economic efficiency. The main problems of the hospitality industry development are insufficient amounts of investment in renovation and building of new establishments, an inadequately developed market for the provision of hospitality services, imperfect infrastructure, technological backwardness of the industry, low solvency of the population, and the use of environmentally hazardous raw materials. It is no coincidence that improvement of modern infrastructure and introduction of modern technologies in the field of hospitality is recognized as one of the priority areas of the national economy development. The martial law declaration has negatively affected the activity of hotel and restaurant business establishments in Ukraine. All this determines the indisputable relevance of studying main trends and problems of the development of Ukrainian hospitality industry in today’s conditions. The aim of the article and research methods. The aim of the article is to analyze the current state and peculiarities of the hotel industry development in Ukraine. When conducting the research, general scientific research methods were used: comparison, generalization, analysis, synthesis and systematization, induction and deduction, tabular and graphic method, as well as scientific and theoretical developments of domestic and foreign scientists, informational materials of statistical and reference publications. Results. The article analyzed the current state of the hospitality industry in Ukraine. The practical aspects of hotel and restaurant business functioning were disclosed. It was established that the military aggression of the enemy has a negative effect on the dynamics of the development and functioning of hotel and restaurant enterprises. A significant number of them are functional or have been partially repurposed. The dynamics of temporary accommodation and catering organization enterprises were analyzed as the main criterion for the development of hotel and restaurant services. It was established that a significant decrease of enterprises and a reduction in the number of employed workers in the hospitality industry occured in 2021. It was noted that the consumer price index in 2022 increased significantly due to the raising in production expenses of the hotel and restaurant business from 103.7 to 122.5 %. In 2022, CPI growth was 100.9% in January, and 103.7% in December. So, the main reasons for the increase of CPI are the rapid growth of the dollar currency and consumer prices, as well as the devaluation of the Ukrainian currency. The financial activity of hotel and restaurant business enterprises was characterized. In 2020, temporary accommodation and catering organization establishments suffered a loss of UAH 6.500 million. However, in 2021, a slight increase in profit could be observed, as UAH 7.003 million. Thus, in 2021, a slight increase in profit could be noticed – UAH 7.003 million. The profitability of enterprises in 2021 was 9 %. This indicates the adaptation of the hospitality industry as a promising direction. Conclusions and discussion. So, in the course of the study, it was established that the hospitality industry is currently in unfavorable conditions, which are caused by the military aggression, which negatively affects the dynamics of the hotel and restaurant business development. In 2021, compared to 2020, there was a slight improvement in the financial result of the business, in accordance with the increase in income and profitability of temporary accommodation and catering organization establishments. However, with the aim of effective development and functioning of the hospitality industry, programs and projects of supporting the hotel and restaurant business are being implemented in the country with the assistance of international organizations.

Help for Ukrainian Hematology Patients (HUP) - a Global Initiative Supporting the Establishment of Hematology Centers and Hematopoietic Cell Transplantation Programs in a Time of War

Background In 2021 most of the Ukrainian patients with hematological diseases and in need of allogeneic hematopoietic cell transplantation (HCT) were treated outside the country with governmental funding or not treated. Only 147 autologous and 6 allogeneic HCT in adults (75 and 33 in children, respectively) in a country of 44 million population were reported to the Worldwide Network for Blood ad Marrow Transplantation (WBMT). In the same year, the European Leukemia Net (ELN) and the WBMT were approached to support or establish sustainable HCT programs for adults in the country. Methods After a site visit at different Ukrainian hospitals in November 2021, daily supervisory telemedicine was initiated in January 2022, immediately before the war in February affected daily life and the existing healthcare in the country. With the mission to establish sustainable care for hematology patients, representatives from major international hematology (ASH, ASCO, EHA, DGHO, ECO), transplant organizations (WBMT, EBMT, ASTCT) and physicians from multiple Ukrainian institutions formed the HUP (Help for Ukrainian Hematology Patients) network with the participation of the Ministry of Health and the World Health Organization (WHO). On weekly video conference meetings, the need and solutions were discussed starting with a list of patients in need for treatment. Results Patients were allocated according to their wishes in Ukrainian Hospitals or abroad with the help of EBMT, WBMT, EHA and ECO. In the same time, the daily grand rounds were pursued to help Ukrainian physicians to treat patients with blood disorders remaining in the country. While many drugs were already available, a list of drugs not available and not registered in the Ukraine was created. Medicines were donated from different sources including sister cities, governments and EU commission. In parallel, standard operating procedures were provided to the institutions. Despite war and during bombing, autologous HCT activities continued and allogeneic HCT programs for adults initiated. To ensure highest quality, the EBMT instituted a routine tumor board with global experts to discuss the indication for treatments and, if this was not possible in the country (e.g. CAR-T cell, bispecific antibody treatment), transfer to transplant centers abroad was organized. In order to identify unrelated transplant donors, the Ukrainian unrelated donor search and registry was supported. The cooperation of the Ukrainian institutions with regard to exchange of drugs and other needs was impressive and a transplant society (UABMT) for adult and pediatric patients with the participation of all Ukrainian centers was founded. The volume of allogeneic HCT in adult patients increased rapidly to 45 patients from related, unrelated and haploidentical donors at the BMT center in Kyiv, in the Cherkhasy Regional Hospital in Cherkhasy, and in the Children Hospital “Ohmatdyt” in Kyiv (Table 1) in the same year 2022. Autologous HSCT also increased in these and other hospitals in Lviv and Kyiv. The activities are now continuously increasing and will reach an even higher number in 2023. It rapidly became apparent that with HCT also the other hematological infrastructure had to be improved. While basic hematological diagnostics were available in the Ukraine, a possibility to have the most sophisticated diagnostics was created with the help of ASH and ASTCT. Blood or marrow samples from the whole country are now transferred weekly to the Munich Leukemia Lab (MLL) laboratory to be tested for cytological, cytogenetical, immunophenotyping, and molecular analyses and results made available to Ukrainian hospitals within a few days free of charge. Up to now samples from 341 patients from all Ukraine have been analyzed at diagnosis and at different time points during their treatment. Conclusion Despite the hostile environment, intense cooperation and support by international societies, private institutions, WHO, together with the personal involvement of the committed local physicians and the Ministry of Health were able to provide an example on how to establish a sustainable healthcare system for hematological patients in a low resource country in extreme distress. This effort represents a model that by using solidarity and new technologies may greatly impact other countries affected by socio-economic, or conflict challenges. SK, IK and MA, TH, AG, AS, DR, DN contributed equally

Current approaches of health technologies introduction in Ukrainian hospitals

The study aimed to gather insights regarding current decision-making approaches and identify challenges and opportunities related to health technology implementation in Ukrainian hospitals. Materials and methods. A total of 28 respondents from three public hospitals across different regions of Ukraine participated in online semi-structured interviews conducted between September 2022 and March 2023. The respondents for this study encompassed a diverse range of stakeholders, including general managers, medical directors, economists, representatives from procurement departments, heads of clinical and diagnostic departments, clinicians, and pharmacists. To effectively guide the interview process, a comprehensive questionnaire was developed. The data collected from the respondents were analyzed and synthesized to results and conclusions. Results. The semi-structured interview study consistently revealed a common pattern in all the interviewed hospitals regarding the adoption of new health technologies. The process of introducing these technologies entails several stages, each demanding meticulous planning, coordination, and active engagement from various stakeholders. What stood out was that stakeholders from the same speciality were consistently involved in the same decision-making stage across all the hospitals we studied. The technical stages of implementing new health technologies, as outlined by the Law of Ukraine "On Public Procurement," are well-established in Ukrainian hospitals. However, there is room for improvement in selecting which type of health technology to procure. The current assessment process often relies on limited sources of information, lacking comprehensive literature reviews or robust comparisons with existing practices or placebos. This information gap hampers the ability to make well-informed decisions that account for all relevant factors. The study also identifies specific challenges for the future implementation of the Hospital Health Thechnology Assessment (HB-HTA) in Ukraine. These challenges necessitate investment in building HTA expertise at the hospital level, cultivating strong leadership support, providing professional staff training, and establishing robust data collection and management systems. Overcoming these obstacles is crucial for hospitals to bolster their capacity to effectively implement new health technologies and make informed decisions about their utilization. Conclusions. Our study has revealed that all the technical stages involved in implementing new health technologies in Ukraine are well established. It was observed that there is room for improvement in the process of selecting which new health technology to purchase. This stage, known as the decision-making process based on HTA, requires implementation at the hospital level. Our study highlights the evident interest and potential benefits associated with adopting HB-HTA in the hospitals under investigation. By integrating HB-HTA into existing practices and approaches, hospitals can significantly enhance their decision-making processes when introducing new health technologies. There is an urgent need to introduce the term "hospital-based HTA" into Ukrainian legislation, as well as to activate the training of HTA experts at the hospital level

STRUCTURAL CHANGES IN THE HOTEL BUSINESS IN THE CONDITIONS OF WAR TIME

Problem Statement and Purpose. The hotel and tourism industry is one of the most attractive sectors of the economy for investment due to small initial capital investments, the ever-growing demand of society for tourism and hotel services, a high level of profitability and the average payback period of projects. The hotel and tourism industries stimulate the development of related sectors of the national economy, primarily construction and trade, and contribute to the creation of new jobs. The hotel and tourist industries actively influence the economy of the city (region, country in general), in particular, the spheres of economic and social activity. Military actions on the territory of Ukraine since the beginning of 2022 have significantly affected the demand and supply of hotel services in the country. The destruction of accommodation facilities damaged by shelling and their loss as a result of the occupation was the result of a decrease in the supply of the hotel market. As a result, number pools were emptied in many regions. The hotel industry of the northern, eastern and southern regions of Ukraine, as well as the city of Kyiv, suffered the greatest negative impact. The best situation in the hotel business is currently demonstrated in the western part of Ukraine, where accommodation establishments are operating in full and in fact at 100 percent capacity. As for the hotel sector in other parts of the country: companies have faced difficulties in providing services. The main goal of accommodation facilities was to adapt companies to the realities of wartime, taking into account curfews and air raids. Searching for new forms of service and re-equipment of establishments according to safety requirements became important tasks of hotels. Data & Methods. The research used data from official websites and articles from Ukrainian web magazines. Empirical research methods (observation and monitoring of hotel services) and the forecasting method were used to achieve the goal. Results. Since the beginning of the full-scale invasion, the country’s tourism industry has significantly decreased It is also complicated by the fact that Ukraine, like many other countries of the world, has not yet fully “recovered” from the coronavirus pandemic. For these very reasons, foreign tourism is not developing. First, a large number of citizens have increased expenses and decreased incomes. Secondly, conscripts cannot go abroad with their families, even if they have the means to do so. Third, there are logistical problems. Besides, there will be no flow of foreign tourists until the country becomes safe. And today’s visit to Ukraine is this mainly representatives of foreign mass media and industry workers who move around the country for work. In such difficult conditions for the Ukrainian hospitality sector, as martial law, service failures are an unpredictable state, where work standards are very important and demonstrate service to the guest. That is why accommodation establishments must be able to identify possible problems that may be caused by external factors and develop options for behavior in the event of their occurrence (as in the case of a power outage – hotels operate with the help of generators). It is also very important to “show concern for the guest”. This applies to such details as: the mode of operation of various services, the format of check-in and check-out, the operation of room service and, as relevant, the mode of operation of the generator, and what services are available with it. Currently, the western part of Ukraine continues to function actively (which will continue to be popular over the next 5 years, due to the need to restore infrastructure in other parts of the country) and domestic tourism is developing. I can assume that in the future, after the liberation of the state from the occupiers, inbound tourism will be active and will be associated with business trips and the involvement of European countries in the reconstruction process. There will also be the resumption of work of some hotel chains and the launch of accommodation facilities that have suspended their opening due to martial law. Regarding the speed of restoration of the hotel industry, such two factors as the duration of hostilities on the territory of Ukraine and the level of migration of the country’s citizens abroad can testify. So far, the guests of accommodation establishments are mainly Ukrainians (99%), the latter (1%) – foreign journalists, military personnel, volunteers and representatives of international organizations.

SAFETY OF REGIONAL ANESTHESIA IN UKRAINE SURVEY: ARE HOSPITALS READY FOR THE LOCAL ANESTHETIC SYSTEMIC TOXICITY (LAST)?

Background. A survey was conducted among anesthesiologists in 38 Ukrainian hospitals to evaluate the current incidence and treatment quality of the local anesthetic systemic toxicity (LAST). With the growing preference for regional anesthetic techniques, implementation of measures for timely detection and treatment of LAST is becoming a priority for many surgical hospitals. This study aims to provide primary country-wide epidemiological data to guide further safety improvement in Ukraine.
 It should be noted, that the survey was performed before the beginning of the full-scale Russian invasion of Ukraine. The resulting surge in the incidence of limb injury has resulted in an unprecedented scale of application of regional anesthesia, including out-of-hospital cases with very limited monitoring, which will no doubt generate great amount of new data on the subject. We hope that our current analysis may be used as a reference point for the future research on this subject.
 Material and methods. A link to the survey was distributed via e-mail to the members of the Association of Anesthesiologists of Ukraine. Data submission was anonymous. Statistical analysis was performed using Microsoft Excel. Descriptive statistics are provided.
 Results. Responses were submitted by 186 anesthesiologists from 38 Ukrainian cities. Among them, 65.9% practice in public hospitals, 25.4% - in private hospitals, 8.7% - in university hospitals. Majority of respondents (60.3%) reported performing over 100 regional anesthetic procedures per year. Peripheral nerve blocks were routinely performed in the hospitals of 76.9% of respondents. 42.4% are using peripheral nerve blocks or more times per week, 24.4% perform this amount monthly, 21.7% - yearly, with 11.5% not utilizing peripheral nerve blocks at all.
 Ultrasound guidance was commonly used by 64.1% of anesthesiologists, 60.3% reported relying on landmark techniques often and 38.5% are routinely using a neuromuscular electrical stimulator.
 LAST cases were previously encountered by 37.2% of respondents. However, only 37% have reported having a LAST protocol in their hospital and 42.3% did not have a lipid emulsion available. Regarding patient education, in 62.8% of cases the patients were specifically warned about the possible complications of regional anesthesia prior to procedures, where it was performed. When the local anesthetic related adverse events did occur, they were recorded in the patient’s card in 27.2% of cases; the chief of anesthesiology department was informed in 36.9%, while in 35.9% the event was not reported in any way.
 Conclusions. The practice of regional anesthesia is becoming more widespread in Ukraine, but the minimal measures required to provide patient safety during such procedures are still not being employed in many hospitals.

ORGANIZATIONAL TECHNOLOGIES TO DEACREASE A RISK OF CRITICAL INCIDENTS DURING ANESTHESIA

Resume. The introduction of checklists during anesthesia could affects the critical incidents incidence during anesthesia.
 The purpose of the study. Studying the impact of organizational technologies the checklist «Safe Surgery» and the checklist of anesthesia equipment on the frequency of critical incidents in Ukrainian hospitals during anesthesiology.
 Materials and methods. The audit was conducted at the Department of Surgery, Anesthesiology and Intensive Care of Postgraduate Education of Bogomolets NMU.
 Results. Critical incidents occurred in 150 (12,73%) cases in the control group and 63 (5,95%)) in the intervention group (OR 0.43 [0.32-0.59], p<0.0001).
 Conclusions. Being a method with a consistently proven positive effect in almost any surgical environment, a checklist is a reliable way to implement modern safety standards. The checklists used by most anesthesiologists during anesthesiology helped reduce the number of errors and shortcomings during manipulations.

The hospitality market in Ukraine: War challenges and restoration possibilities

The Crimea annexation and the military aggression of the Russian Federation, which first began in some territories of the Donetsk and Luhansk regions in 2014 and escalated into a full-scale war on February 24, 2022, resulted in heavy losses of life and a humanitarian crisis, exacerbating economic, political and social instability. To restore Ukraine’s economy, all businesses, including hospitality (hotel and restaurant business) sector, should continue functioning, though it is a challenging but crucial task. The paper aims to analyze the state of the hospitality market in the current war conditions in Ukraine and assess the possibilities of its restoration and development. An online survey was conducted among 282 representatives of the hospitality business in Kyiv, Sumy, Chernihiv, Dnipropetrovsk, Kharkiv, Poltava, Ivano-Frankivsk, Lviv, Ternopil, and Zakarpattia regions. Based on the results, in 2022, almost 23% of hospitality industry representatives suspended their activities, and 54% functioned only partially. Many surveyed hotels and restaurants (36%) have gradually changed and adapted their business strategies. For more than half of the hospitality representatives, expenses increased by 20-50%, and profits dropped by more than 20%. The critical consequences of the full-scale war for the Ukrainian hospitality market are as follows: disruption of supply chains, reduction in consumers’ purchasing power, changes in consumer demand, shortage of certain types of products, shortage of personnel, and business unprofitability.

P123 Development of an end-to-end Mayo endoscopic score machine learning algorithm for use in clinical trials of ulcerative colitis

Abstract Background Scoring colonoscopy videos of UC patients requires a high level of expertise, but even among trained expert readers there are disagreements. In clinical trials, this can negatively impact both subject selection and assessment of treatment response. Consistency among central readers might be improved by algorithms that automatically process videos to identify salient features and estimate the level of disease activity using established scoring methods. Methods We propose an end-to-end system using machine learning (ML) models to process colonoscopy videos, both shortening the time required for a human expert reader to score a video by filtering out non-informative parts and supplying a second-opinion of Mayo Endoscopic Score (MES) on each informative frame and the full video. Our dataset included videos from UC patients with a representative range of disease activity acquired at a Ukrainian hospital (n=505) and an Israeli hospital (n=227). Video annotation was performed by 12 reviewers, trained and supervised by an expert gastroenterologist (DM) with >10 years central reading experience. Out of almost 3 million frames over ~34% were classified by human reviewers as non-informative (e.g., out of focus, motion blurring, stool). The remaining informative frames were further annotated by the reviewers as containing ulcers (6%) and hence classified as MES=3, erosions (22%) as MES=2, loss of vascularity or erythema (23%) as MES= 1, or none of the above (49%) classified as MES=0. Informative frames were split to 80% training set, 10% validation set and 10% test set. The data set included low quality frames on which the reviewers could still estimate the MES. Models consisting of image processing algorithms, Convolutional Neural Networks (CNN), CNN+Long Short Term Memory (LSTM) model and classical ML classifiers were trained to filter out non-informative frames and score independently each frame and the full video for MES. Results Model performance was evaluated using Cohen’s Quadratic Weighted Kappa (QWK) with 95% Confidence Interval [95% CI]..Model agreement with humans is shown in the middle column. Inter-reviewer agreement based on a subset of ‘clear frames’ from various videos of the test set is shown in the last column. Conclusion We developed a full end-to-end pipeline for processing colonoscopy videos that estimated MES with accuracy comparable to human-human agreement. Such a model has the potential to make human readers more efficient by highlighting frames with relevant pathology. It can also aid inter-reader agreement by providing a second-opinion MES. Future work will expand model training and testing with new data sources and explore paradigms to combine the model with human readers to improve clinical trial central reading.

ПЕРСПЕКТИВИ РОЗВИТКУ ТУРИСТИЧНОЇ ГАЛУЗІ УКРАЇНИ У ПІСЛЯВОЄННИЙ ПЕРІОД

The article examines the main problems of the development of the tourism industry of Ukraine and the world as a result of the global crises caused by the coronavirus infection and the full-scale invasion of the Russian Federation on the territory of Ukraine. The basic assumptions and principles underlying the promising directions of tourism development in the context of the economy of impressions are specified. A change in the nature of Ukraine's domestic tourism is predicted – after the end of the war, cultural and educational tourism and memory tourism, which are non-commercial types of tourism, will be popular. The places of glory of the modern war will be added to the places of Cossack glory, such as Haydamatsky Yar, Kholodny Yar, Berestetska battlefield and Khortytsia, and new tourist programs related to the struggle and victory of Ukraine will appear. The international experience of post-war recovery and development of the tourism sphere is analyzed. The factors that will contribute to the development of tourism or restrain it are characterized. Traditional types of tourism, such as beach tourism, sports tourism, agrotourism, will have a delayed demand, as the demining of occupied territories will continue for some time in Ukraine. The restoration of the tourism industry of Ukraine can take place at the expense of product innovations, such as the development of new tours previously unknown on the market and the creation of new tourist and recreational areas, the development of exotic and military tourism, as well as memory tourism. Ukrainian ethnic tourism has a significant potential for development on the domestic and global tourism markets and improvement of the economic and social situation of Ukraine due to unique national traditions, Ukrainian hospitality and national cuisine, a vast history and rich culture. Priority measures for the development of the tourism sector are proposed, including restoring the image of a safe country for a comfortable stay of tourists, creating economic conditions to stimulate the development of tourism, liberalizing fiscal policy for tourist enterprises, attracting foreign investments, implementing innovative projects for marketing and organizing tourist activities.

Nosocomial transmission of multi-drug-resistant organisms in Ukrainian hospitals: results of a multi-centre study (2019–2021)

The increasing emergence and spread of multi-drug-resistant organisms (MDROs) in hospitals is a public health problem and continues to challenge infection control and hospital epidemiology practice worldwide. The aim of this study was to characterize the epidemiology of transmission of MDROs via healthcare workers (HCWs) and the environment in the hospital wards/patient rooms. A multi-centre prospective observational study was conducted in 17 hospitals in Ukraine. Species identification was performed with standard microbial methods. β-Lactamase genes were investigated by polymerase chain reaction. Pulsed-field gel electrophoresis (PFGE) was used to determine the genetic similarity between isolates. Among 51,656 isolates, 19.5% were MDROs. The proportions of MDROs among isolates from patients with healthcare-associated infections, environmental surfaces and HCWs (hands, gown/gloves) were 29.2%, 16.3% and 24.2%, respectively. In 51.9% of the tested isolates, identical MDROs were found in clinical isolates, environmental samples and HCWs' hands. Meticillin resistance was found in 32.4% of Staphylococcus aureus (MRSA) isolates, and vancomycin resistance was found in 28.9% of enterococci (VRE). Resistance to third-generation cephalosporins was detected in 48.4% of Enterobacterales, and carbapenem resistance in 19.1%. Overall, 37.4% of MDROs had broad-spectrum β-lactamase genes, including extended-spectrum β-lactamase (35.8%), OXA-type (29.7%), AmpC-type (25.1%), KPC-type (25.7%) and metallo-β-lactamases, including IMP-type (5.7%), VIM-type (31.7%) and NDM-1 (21.3%). In Ukrainian hospitals the prevalence of healthcare-associated infections caused by MDROs continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients.

Digitalization of Business Processes in the Hospitality Industry

This research is related to the study of technologies for the digital transformation of business processes in the hospitality industry on the example of Ribas Hotels Groups - the leading hotel chain in the Ukrainian hospitality industry. This article aims to study the main trends and features of the digitalization of hospitality industry enterprises’ business processes. We built the methodology on a qualitative approach, which involved analyzing the results of semi-structured interviews with Ribas Hotels Groups’ top management through digital communication means. The results show the main trends in digitalizing enterprises’ business processes. The first tendency is to form an integrated value chain by introducing software products that provide personalized service to customers by combining them in a single virtual space. The second tendency is the introduction of effective and innovative business processes that transform the traditional basic operations of hospitality industry enterprises. Finally, the trend in the hospitality industry to be client-oriented and improve service determines the enterprises’ digitalization level. It’s making it possible to personalize the client’s experience in receiving services. The main features of digitalization are: analysis and selection of software products for hotel needs (room stock, priority business processes, and problems), which reduces the cost of digitalization; gradual improvement of essential business processes for the needs of the hotel chain object; transformation of effective business processes into innovative ones thanks to new level software products and technologies - big data analysis, artificial intelligence, customer interaction algorithms embedded in software solutions. Precisely the use of these technologies provides the company with additional value, additional profit, forms the brand and position in the market, and customer loyalty.

ДОСВІД ЄВРОПЕЙСЬКИХ КРАЇН У ВПРОВАДЖЕННІЕКОЛОГІЧНИХ ІННОВАЦІЙ В ГОТЕЛЬНОМУ БІЗНЕСІ

The article is devoted to the study of the experience to develop the ecological hotel business in European countries on the possibilities of its use in Ukraine. The formation of ecological hotels concept is aimed at a quality system of comfortable living in harmony with the environment and allows to outline the features of the ecological hotel. These features include: a system for saving resources; use of alternative energy sources; minimization of chemical reagents used; application of bactericidal methods that decompose dirt and waste; reducing or preventing the use of allergens; high-quality utilization of waste and garbage; use of completely closed systems for water and air regeneration; catering with certified products and purified water. The interior design of ecological hotels, which is based on the use of "natural" colors and recycled materials, is no exception for eco-hotels. A unique approach is to adhere to the philosophy of abandonment of electronic devices. The availability of eco-labels in ecological hotels increases its attractiveness to potential customers, and the use of ecological certification includes the coverage area and objects of certification. The international program of voluntary environmental certification of hotel business enterprises "Green Key" and the activities of the association BIO HOTELS, whose experience is appropriate to use in the hotel and restaurant business of Ukraine, are analyzed. The advantages of the latter are determined: construction biology and use of natural building materials; regionality and seasonality of organic products; availability of certified organic and natural cosmetics and hygiene products only; complete waste recycling; exclusion of plastic use; environmental electricity; availability of electronic charging stations for electric vehicles. To support environmentally sound operation, the independent experts carry out the inspection and draw up a climate balance sheet, in which the company's own CO2 emissions are recorded. The association aims to define its climate-positive activities, combined with common goals and ideas. Promoting the idea of environmentally friendly organic origin and living in accordance with this goal distinguishes BIO HOTELS among other associations that exist in Europe. The environmental field covers all spheres of life and business in Europe, and trends in this development are rapidly supported by Ukrainian hospitality enterprises. The creation of hotel enterprises' associations and the possibility of creating such associations in Ukraine are considered. Keywords: ecological hotel business, ecological hotels, eco-labeling, ecological certification, climate balance, association of hotel enterprises.

The Phenomenon of Integration of Religious Practices as an Auxiliary Tool in Contemporary Medicine: Ukrainian Hospital Chapels in Modern Times

The relevance of the research topic is ensured by the wide integration of such religious practices as an aid in contemporary medicine. The article describes the activities of more than 15 currently operating famous hospital chapels. The histories behind the foundation of each of them are analyzed, and the facts of public participation and the leadership of hospitals in the establishment of chapels at medical institutions are given. Special attention is paid to the characteristics of the psychological support component as an auxiliary factor along with the main course of treatment. For clarity of the descriptive part, the study presents nine drawings, emphasizing the diversity and uniqueness of each of the described religious objects. It has been established that chapels at hospitals, in addition to their function as psychological support, also serve as support for spiritual orientation, as well as an additional area for the direct expansion of religious influence in society. At the same time, it is believed that the peculiarity of this kind of integration of religious practices into medical rehabilitation is that the spiritual component of treatment, even at the placebo level, can contribute to the patient's recovery process. In the course of the study, insufficient public coverage of comprehensive information on the functioning of hospital chapels was revealed, and it was also found that Ukrainian and foreign scientists did not study the issue of hospital chapels in the latest relevant publications.

КЛАСИФІКАЦІЯ ГОТЕЛІВ «ADULTONLY» ТА ЇХ ГЕОГРАФІЯ

The article examines the format of hotels, which is becoming popular in the world practice of hotel business and is developing very quickly – «adults only».Was detected that «adults only» hotels have appeared and are developing in contrast to the format of recreation with children and club family hotels with all inclusive system.The result of market relations for these needs is the emergence of hotels «adults only», and the booking application will be approved only if all customers listed in the booking have passed the announced age limit.Synonymous with the term «adults only» is «child-free», «hotel for adults» and so on.In the scientific practice of Ukrainian hospitality there is no such format of hotels. But scholars and practitioners today often use this format of temporary accommodation as a concept, investing in this concept of temporary residence style with a ban on people under 16 years of age.Adult-only hotel should be a temporary accommodation that strictly states that its custo-mers can only be visitors over 16 years or older and is more of a hotel-oriented hotel business model. .Suggested scheme of classification of hotels «adults only» on four indicators: class(4 *****, 5 *****) stars, age characteristics of the client (16+, 18+, 21+, 40+), the status of relations, couples, companies, large families) and individual preferences of the client (entertainment, quiet recreation, dating, nudism, sex challenge).It has been found that adults only hotels are geographically located in the tourist market of the world in four regions of the world: Europe, Southeast Asia, North Africa and Central America.The factors that determine their location on the world map have been identified and adults-only hotels have been analyzed, which have a point location in some countries of the world −Egypt, UAE, Tanzania, Tunisia.The conclusion is made about implementation of the need for theoretical and practical research on the classification and research of the peculiarities of the functioning and prospects of location of hotels «adults only».Key words: hotel, hotel format, adults only, child-free, hotel without children, hotel for adults.