Area of Competence of Primary Healthcare Specialists in the Implementation of Person-Centered Programs of Educational and Behavior Modification in Chronic Dermatoses

Due to a significant shortage in both physicians and practical nurses that is of special relevance for healthcare services in rural areas, the distribution and cooperation of health production functions are of great importance.In this context, the effectiveness of EMB is associated, on the one hand, with the patient adherence to the substantiated recommendations and, on the other hand, with the qualification level of medical personnel in the GFM ambulatories while carrying out EBM.The objective of the research was to conduct the problem-oriented analysis of cooperating and distributing the duties of specialists in the implementation of EBM among patients with CD at the stage of primary healthcare.ResultsThere was conducted the problem-oriented analysis of qualification competencies to verify the possibility of implementing EBM by practical nurses considering typical activities of professionals. The analysis revealed the compliance of the main components of professional competence of physicians and nurses with their involvement in the process of EBM implementation among patients with CD

Quality Assessment of Medical Care at the Stage of Primary Healthcare: the Range of Diagnostic Procedures in Patients with Eczema

According to the results of studying the ranges of diagnostic measures among 75 patients with eczema, primary health care quality was assessed. The adequacy/completeness of clinical and anamnestic examination of patients with eczema by general family medicine physicians was at the level of (56.5÷59.8)% being characterized by the underestimation of the state of skin derivatives (microelementosis, vitamin deficiency) in (86.7±3.9)% of patients; the constitutional and biological markers, visceral and functional markers of undifferentiated connective tissue dysplasia in (74.7±5.0)% and (74.7±5.0)% of patients, respectively; the influence of unfavorable regional environmental factors, living conditions and professional activity, clinical and morphological evaluation of rash in (49.3±5.8)% of patients. According to the generalized quality index, the adequacy/completeness of clinical and laboratory examination of patients with eczema was at the level of (58.4÷63.4)% being characterized by a low level of examinations aimed at the detection of possible disorders of microelement homeostasis and comorbidity. According to the generalized quality index, the adequacy/completeness of clinical and instrumental examination of patients with eczema was at the level of 66.5 being characterized by a low level of instrumental diagnostics of autonomic homeostasis state, densitometry, anesthesiometry, imaging study of the joints

Substantiation, Development and Implementation of Person-Centered Assessment of Psychosocial Significance of Chronic Dermatosis at the Stage of Primary Healthcare

High prevalence and incidence of chronic dermatoses among different age groups of Ukrainian population in combination with their multifactorial etiology and the progredient clinical course determine the need for the provision of general family medicine physicians with simple and accessible at the stage of primary healthcare technologies of medical care delivery to such patients. Patients with chronic dermatoses are known to be characterized by certain metabolic features, clinicopathologic cutaneous manifestations, as well as the development of special mental state associated with psychological trauma due to chronic dermatoses. The objective of the research was to substantiate, develop and implement person-centered assessment of psychosocial significance of chronic dermatoses at the stage of primary healthcare delivery by general family medicine physicians. Materials and methods. The study was carried out according to a specially developed program for collecting, accumulating and analyzing the results and included 114 patients with chronic dermatoses at the age of 29-58 years. Patients were divided into 2 groups: Group I included patients with chronic dermatosis duration of <10 years and Group II comprised patients with chronic dermatosis duration of over 10 years. Medical and psychological examination of patients with chronic dermatoses was performed using the method of differentiated self-assessment of the functional state - the WAM (well-being, activity, mood), the Spielberger State Anxiety Scale modified by Khanin Yu.L., the personality questionnaire of the Bekhterev Institute (LOBI) etc. Conclusions. The prognostic value of the decrease in strength and energy is an adverse effect on a relatively long clinical course of the disease. The diagnostic value of work/study limitations is 0.896 bit, and the prognostic value of this factor is a psychological limit of psychosocial functioning of an individual due to long-term clinical course of the disease. The presence of chronic skin disease was found to affect the patients’ daily lives; taking (physical, aesthetic, intellectual, etc.). The diagnostic value of work/study limitations is 0.896 bit, and the prognostic value of this factor is a psychological limit of psychosocial functioning of an individual due to long-term clinical course of the disease. The presence of chronic skin disease was found to affect the patients’ daily lives; taking (physical, aesthetic, intellectual, etc.). This indicated greater (p<0.050) psychosocial limitation in individuals with long-term clinical course of chronic dermatoses being an indicator of the need for psycho-educational activities at the stages of clinical manifestations of chronic dermatoses

Актуальні уявлення про патогенез та інтенсивну терапію тяжкого перебігу COVID-19 (літературний огляд)

The aim of the research. The aim of this work was to summarize the scientific literature data on the pathogenesis and intensive care of the severe course of coronavirus infection. Materials and methods. Databases such as PubMed, Google Scholar, Scopus and Web Of Science 2020-2021 were used for literary searches. Results. An intense inflammatory response against the SARS-CoV-2 virus in COVID-19 patients causes a cytokine storm and hypercoagulability with the development of acute respiratory distress syndrome (ARDS) and multiple organ failure. Approximately 17 % to 35 % of hospitalized patients with COVID-19 are treated in the intensive care unit, most often due to hypoxemic respiratory failure and the development of ARDS, and between 29 % and 91 % of patients in intensive care units require invasive ventilation. In addition to acute respiratory failure, hospitalized patients may have acute renal failure (9 %), liver dysfunction (19 %), coagulation disorders (10 %–25 %), and septic shock (6 %). More than 75 % of hospitalized patients require additional oxygen therapy. Respiratory support could vary from the need for oxygen supplementation through a nasal catheter to invasive ventilation or extracorporeal membrane oxygenation in patients with the most severe ARDS. The uncontrolled inflammation and coagulation seen in COVID-19 patients is similar to multifactorial ARDS, where a plethora of evidence has demonstrated the ability of long-term corticosteroid therapy (CST) to reduce inflammation-coagulation-fibroproliferation and accelerate recovery. With regard to the assessment of the benefits of therapeutic anticoagulation in patients with elevated D-dimer, the question has not yet been finally resolved, and research devoted to this is still ongoing. Conclusions. The approaches to respiratory, anticoagulant, anti-inflammatory therapy in critically ill patients with COVID-19 require further research to determine the optimal treatment tacticsЦель исследования. Целью данной работы было обобщение данных научной литературы о патогенезе и интенсивной терапии тяжелого течения коронавирусной инфекции. Материалы и методы. Для литературного поиска были использованы такие базы данных, как PubMed, Google Scholar, Scopus и Web Of Science 2020-2021 г.г. Результаты. Интенсивная воспалительная реакция против вируса SARS-CoV-2 у пациентов с COVID-19 вызывает бурю цитокинов и гиперкоагуляцию с развитием острого респираторного дистресс-синдрома (ОРДС) и полиорганной недостаточности. Примерно от 17 % до 35 % госпитализированных пациентов с COVID-19 лечатся в отделении интенсивной терапии, чаще всего из-за гипоксемической дыхательной недостаточности и развития ОРДС, и от 29 % до 91 % пациентов отделений интенсивной терапии нуждаются в инвазивной вентиляции легких.  В дополнение к острой дыхательной недостаточности у госпитализированных пациентов может развиться острая почечная недостаточность (9 %), нарушение функции печени (19 %), нарушения системы свертывания (10 %–25 %) и септический шок (6 %). Более 75 % госпитализированных пациентов нуждаются в дополнительной кислородной терапии. Респираторная поддержка может отличаться от потребности в дотации кислорода через носовой катетер до инвазивной вентиляции легких или экстракорпоральной мембранной оксигенации у пациентов с наиболее тяжелой формой ОРДС. Неконтролируемые воспаление и коагуляция, которые наблюдаются у пациентов с COVID-19 аналогичны многофакторному ОРДС, где множество доказательств продемонстрировали способность длительной кортикостероидной терапии (КСТ) снижать воспаление-коагуляцию-фибропролиферацию и ускорять выздоровление. Что касается оценки пользы от терапевтической антикоагуляции у пациентов с повышенным D-димером, вопрос еще не решен окончательно, и исследования, посвященные этому, еще продолжаются. Выводы. Подходы к респираторной, антикоагулянтной, противовоспалительной терапии у тяжелых пациентов с COVID-19 требуют дальнейших исследований для определения оптимальной тактики леченияМета дослідження. Метою даної роботи було узагальнення даних наукової літератури щодо патогенезу та інтенсивної терапії тяжкого перебігу коронавірусної інфекції. Матеріали та методи. Для літературного пошуку було використано такі бази даних, як PubMed, Google Scholar, Scopus та Web Of Science 2020-2021 р.р.. Результати. Інтенсивна запальна реакція проти вірусу SARS‐CoV‐2 у пацієнтів із COVID-19 викликає бурю цитокінів і гіперкоагуляцію з розвитком гострого респіраторного дистрес-синдрому (ГРДС) та поліорганної недостатності. Приблизно від 17 % до 35 % госпіталізованих пацієнтів з COVID-19 лікуються у відділенні інтенсивної терапії, найчастіше через гіпоксемічну дихальну недостатність та розвиток ГРДС, та від 29 % до 91 % пацієнтів відділень інтенсивної терапії потребують інвазивної вентиляції легень. На додаток до гострої дихальної недостатності у госпіталізованих пацієнтів може розвинутися гостра ниркова недостатність (9 %), порушення функції печінки (19 %), порушення системи коагуляції (10 %–25 %) та септичний шок (6 %). Понад 75 % госпіталізованих пацієнтів потребують додаткової кисневої терапії. Респіраторна підтримка може відрізнятися від потреби в додаванні кисню через носовий катетер до інвазивної вентиляції легень або екстракорпоральної мембранної оксигенації у пацієнтів із найбільш важкою формою ГРДС. Неконтрольовані запалення та коагуляція, які спостерігаються у пацієнтів з COVID-19, є подібними до багатофакторного ГРДС, де безліч доказів продемонстрували здатність тривалої кортикостероїдної терапії (КСТ) знижувати запалення-коагуляцію-фібропроліферацію та прискорювати одужання. Щодо оцінки користі від терапевтичної антикоагуляції у пацієнтів з підвищеним D-димером, питання ще не вирішено остаточно, та дослідження, присвячені цьому, ще тривають. Висновки. Підходи до респіраторної, антикоагулянтної, протизапальної терапії у важких пацієнтів з COVID-19 потребують подальших досліджень для визначення оптимальної тактики лікуванн

Current Conception About the Pathogenesis and Intensive Care of Severe COVID-19 (Review)

The aim of the research. The aim of this work was to summarize the scientific literature data on the pathogenesis and intensive care of the severe course of coronavirus infection. Materials and methods. Databases such as PubMed, Google Scholar, Scopus and Web Of Science 2020-2021 were used for literary searches. Results. An intense inflammatory response against the SARS-CoV-2 virus in COVID-19 patients causes a cytokine storm and hypercoagulability with the development of acute respiratory distress syndrome (ARDS) and multiple organ failure. Approximately 17 % to 35 % of hospitalized patients with COVID-19 are treated in the intensive care unit, most often due to hypoxemic respiratory failure and the development of ARDS, and between 29 % and 91 % of patients in intensive care units require invasive ventilation. In addition to acute respiratory failure, hospitalized patients may have acute renal failure (9 %), liver dysfunction (19 %), coagulation disorders (10 %–25 %), and septic shock (6 %). More than 75 % of hospitalized patients require additional oxygen therapy. Respiratory support could vary from the need for oxygen supplementation through a nasal catheter to invasive ventilation or extracorporeal membrane oxygenation in patients with the most severe ARDS. The uncontrolled inflammation and coagulation seen in COVID-19 patients is similar to multifactorial ARDS, where a plethora of evidence has demonstrated the ability of long-term corticosteroid therapy (CST) to reduce inflammation-coagulation-fibroproliferation and accelerate recovery. With regard to the assessment of the benefits of therapeutic anticoagulation in patients with elevated D-dimer, the question has not yet been finally resolved, and research devoted to this is still ongoing. Conclusions. The approaches to respiratory, anticoagulant, anti-inflammatory therapy in critically ill patients with COVID-19 require further research to determine the optimal treatment tactic