Повышение психологической компетентности сестринского персонала в педиатрии: направления, формы, содержание

Relevance. In recent years the powers of nurses have been considerably expanded, which determines the increase of their responsibilities and the need of permanent improving of their skills.Object: determination of directions, forms and contents of training courses for increasing psychological competence of pediatric nurses in connection with their status and work experience.Methods and the object of research. The main method was a questionnaire developed by the article’s authors. 59 pediatric nurses from different regions of the Russian Federation who participated in remote educational cycles in Moscow and Yekaterinburg have been included in the survey. Nurses were divided into two groups based on their status and experience in the specialty. The group consisted of 31 respondents (average age 41,2 years). 28 respondents were Managers of nursing (average age 40,8 years).Results and conclusions. Stress management skills are more essential for nurses than for nursing managers and nursing staff with work experience of up to 10 years and over 20 years. Communication skills are relevant for nursing managers and nursing staff with experience of over 20 years. For all the nurses, situational assistance in complicated communicative situations and stress management is a priority compared to the long-term psychological support. The choice of education form (seminar, training) does not depend on the nursing staff’s status and work experience.Актуальность. В последние годы значительно расширяются полномочия медицинской сестры, что определяет уровень ее ответственности и необходимость постоянного повышения своей квалификации.Цель: определение направлений, форм и содержания образовательных курсов повышения психологической компетентности педиат рических медицинских сестер в связи со статусом и стажем работы. Методы и объект исследования. Основным методом являлась оригинальная анкета, разработанная авторами статьи. В анкетирование были включены педиат рические медицинские сестры (59 человек) из различных регионов Российской Федерации, которые участвовали в выездных образовательных циклах в Москве и Екатеринбурге в 2014 г. Медицинские сестры были разделены на две группы с учетом статуса и стажа работы по специальности. Группа медицинских сестер состояла из 31 респондента (средний возраст 41,2 года). Менеджеры сестринского дела представлены 28 респондентами (средний возраст 40,8 года).Результаты и выводы. Навыки управления стрессом востребованы в большей степени медицинскими сестрами, чем менеджерами сестринского дела, и сестринским персоналом со стажем до 10 и более 20 лет. Коммуникативные навыки актуальны для менеджеров сестринского дела и сестринского персонала со стажем более 20 лет. Ситуативная помощь по управлению сложными коммуникативными ситуациями и стрессом является приоритетной по сравнению с долгосрочным психологическим сопровождением для всех медицинских сестер. Выбор формы обучения (семинары, тренинги) не зависит от статуса и рабочего стажа сестринского персонала

Старт и интенсификация инсулинотерапии у пациентов с сахарным диабетом 2-го типа: анализ влияния на бюджет

To date, several options for starting and intensifying insulin therapy in patients with type 2 diabetes mellitus (T2DM) have been proposed. Meta-analyzes of the recent results shows that, with adequate use, all these regimens have the similar efficacy and safety; therefore, when choosing a therapeutic approach, the patient’s requirements and preferences become highly significant. The aim of this study was to assess how changes in the current practice of insulin therapy in patients with T2DM can impact the federal healthcare budget. Materials and Methods. Based on the results of the DURABLE clinical trial, we created a “decision tree” model that allowed us to calculate the costs of 48-week insulin therapy in 1000 T2DM patients who had never received insulin before that trial. The cases selected for modeling included patients on one of two starting regimens – basal insulin (glargine) or a ready-made mixture (biphasic lispro 25). After 24 weeks, upon achieving or not achieving the target HbA1c values, a decision was made whether to intensify the therapy by using the basal bolus therapy (glargine and lispro) or the ready-made mixtures (biphasic 25 or 50 lispro). The weighted average price of 1 IU insulin (according to public procurement data) was used for calculations. Results. Within the current practice of prescribing ready-made mixtures at the start and the intensification rate of 20%, the annual cost of purchasing insulin for the model population of 1,000 patients was 22.5 million rubles. If the use of ready-made mixtures increased to 35% at initiation and to 50% with intensification, the costs would be reduced by by 1.9 million rubles. In the cases when only basal insulin was prescribed for the start, the annual costs amounted to 23.8 million rubles (if only 20% of patients received a ready-made mixture with intensification) and to 22.8 million (if 50% of patients received a ready-made mixture with intensification). Conclusion. As a result of this analysis, an increase in the number of patients who use a ready-made mixture for the initiation or intensification of insulin therapy can lead to reducing the budget costs for purchasing insulin analogues for patients with type 2 diabetes mellitus.На настоящий момент предложено несколько вариантов старта и интенсификации инсулинотерапии у пациентов с сахарным диабетом (СД) 2-го типа. Проведенные в последние годы мета-анализы результатов клинических исследований показали, что при адекватном использовании эти режимы обладают одинаковой эффективностью и безопасностью, таким образом, при выборе подхода к терапии большую роль стали играть индивидуальные особенности пациента и его предпочтения. Целью настоящего исследования была оценка влияния на государственный бюджет изменения текущей практики старта и интенсификации инсулинотерапии у пациентов с сахарным диабетом 2-го типа. Материалы и методы. На основании результатов клинического исследования DURABLE была построена модель «древа решений», в которой рассчитывались затраты на инсулинотерапию в течение 48 недель у популяции из 1000 пациентов с СД 2-го типа, ранее не получавших инсулин. При входе в модель пациентам назначался один из стартовых режимов – базальный инсулин (гларгин) или готовая смесь (двухфазный лизпро 25). Через 24 недели на основании достижения целевых значений HbA1c принималось решение о необходимости интенсификации с использованием базис-болюсной терапии (ББТ) – гларгин и лизпро или готовых смесей – двухфазный лизпро 25 или 50. Для расчетов были использованы средневзвешенные цены за 1 МЕ, по данным государственных закупок. Результаты. При текущей практике (частота назначения готовых смесей при старте и интенсификации инсулинотерапии 20%) годовые затраты на закупку инсулинов для моделируемой популяции составили 22,5 млн руб. Увеличение частоты назначения готовых смесей до 35% при старте и 50% при интенсификации позволило снизить затраты на 1,9 млн руб. В случае, если для старта назначался только базальный инсулин, годовые затраты составили 23,8 млн руб. (готовая смесь при интенсификации назначается в 20% случаев) и 22,8 млн (готовая смесь в 50% случаев при интенсификации). Заключение. В результате проведенного анализа было показано, что увеличение числа пациентов, у которых для старта или интенсификации инсулинотерапии используется готовая смесь, позволяет сократить бюджетные затраты на закупку аналогов инсулина для пациентов с сахарным диабетом 2-го типа.

Analysis of thermal work of boiler DKVR-20-13

The paper presents the results of a study of the thermal efficiency of the boiler DKVR-20-13. Based on the results of the study, the efficiency of the boiler is determined at various loads. There are given recommendations for increasing thermal efficiency.В работе изложены результаты исследования тепловой эффективности котла ДКВР-20-13. По результатам исследования определён КПД котла при различных нагрузках. Даны рекомендации по увеличению тепловой эффективности

Molecular markers as tools in breeding for resistance to Potato Virus Y

Potato virus Y (PVY) is an economically important pathogen of potato as a vegetatively propagated crop. High resistance to all strains of PVY is determined by Ry-genes, which are introgressed into modern potato varieties from a limited number of sources of resistance ‒ Solanum stoloniferum Schlechtd. et Bche., Solanum andigenum Juz. et Buk., Solanum chacoense Bitt. Use of new species Solanum and interspecific hybrids based on them provides for the expansion of existing potato gene pool in breeding for resistance to PVY. Traditional breeding for resistance to viruses has still a great potential, though, it is a long and laborious process. Molecular markers linked to Ry-genes are widely integrated in order to increase the effectiveness of practical breeding. Previous studies have revealed a number of shortcomings in using the molecular markers of Ry-genes. To assess the predictive abilities of molecular markers RYSC3, M45, M6 of the Ryadg gene and YES3-3A of the Rysto gene for resistance to PVY, the F1 generation of two potato populations was studied, in the creation of which inter-specific hybrids were used. The nature of segregation 5:3 obtained by phenotype showed that the original parental forms can be the sources of not only previously identified, but also unidentified Ry-genes and Ny-genes of hypersensitivity. Correlation coefficient between the presence of markers and resistance to PVY was 0.64 for the YES3-3 marker (79 % matching) and 0.54 for RYSC3, М45, М6 markers (76 % matching). There have been revealed the cases of “false positive” results of the study (the presence of a marker in susceptible genotypes), which indicate to the insufficient effectiveness of the markers used. The marker segregation observed in the populations was consistent with chromatid segregation, confirming the simplex nature of Ry-genes inheritance from resistant parents. The ratio of genotypes with the presence/absence of markers was 0.86:1

Influence of nodular and severe forms of diffuse adenomyosis on reproductive function: a review of reproductive outcomes of surgical interventions and IVF

This review includes an analysis of clinical studies evaluating the effect of adenomyosis on reproductive function, as well as a review of studies on the relationship between surgical treat-ment options for adenomyosis and reproductive outcomes. Different studies of women populations after in vitro fertilization and/or intracytoplasmic sperm injection (IVF/ICSI) and after surgical treatment of  deep adenomyosis have shown that adenomyosis in both cases has a negative effect on the reproductive outcome, although there are significant differences in these populations. In the literature, there are relatively few data on the degree of influence of the depth of the lesion on the realization of the reproductive function, however, a significant correlation was revealed between them. The positive effect of treatment with gonadotropin-releasing hormone agonists, followed by surgical treatment of adenomyosis, has also been described in several literary sources, but there have been no controlled studies on this topic. Many studies do not meet the validity criteria due to the lack of clear criteria for inclusion and exclusion from the study.The choice of the optimal treatment options for adenomyosis based on the actual data is difficult due to the lack of reliable evidence of the relationship between fertility and the degree of adenomyosis. However, it is known that adenomyosis can reduce the likelihood of successful implantation so  ramatically that surgical or other treatment options are reasonably recom-mended. At the same time, it is necessary to assess the possible positive effect of the treatment options available in the doctor’s arsenal. Thus, timely referral to specialized treatment of ade-nomyosis may be crucial for the successful implementation of reproductive function in patients with suspicion or with an established diagnosis of adenomyosis in combination with recurrent miscarriage, who refuse to use assisted reproductive technologies, medical institutions. This review will analyze the relationship between infertility and adenomyosis, as well as review studies of reproductive outcomes in different options for surgical treatment of adenomyosis in infertile patients

Chronic endometritis and infertility — in vitro fertilization outcomes: systematic review and meta-analysis

Background. The relevance of the problem is related to the high prevalence of chronic endometritis (CE); its role in female infertility, implantation failures during assisted reproductive technology procedures, and recurrent miscarriage; as well as the lack of a unified strategy in the diagnosis and treatment of this pathology. The present systematic review with a meta-analysis focuses on evaluating the impact of CE and its therapy on the outcome of in vitro fertilization. In addition, the effect of CE of various severity on the outcomes of assisted reproductive technologies is analyzed. Objective. To analyze the effect of CE of varying severity and its treatment on the outcomes of in vitro fertilization. Methods. Using PubMed, Medline, Scopus, Embase, ELibrary, Cochrane Central Register of Controlled Trials (CENTRAL), WHO International Clinical Trials Registry, and Russian Science Citation Index, a systematic search was conducted for articles published over the past 12 years that met the following criteria: randomized controlled trial examining the effect of CE of varying severity on fertility and ways to treat it. The following indicators were calculated: ongoing pregnancy/live birth, clinical pregnancy, and miscarriage rates. A total of 4145 patients (from ten studies) were included. A meta-analysis was performed using Stata 11.0 software (The Cochrane Collaboration, Oxford, UK). The heterogeneity was considered low at I2 <30%, moderate at 30–50%, and high at >50%. Results. Women with CE exhibited lower ongoing pregnancy/live birth (OR 1.97; p = 0.02) and clinical pregnancy rates (OR 2.28; p = 0.002) as compared to women without it. CE treatment increased the ongoing pregnancy/live birth (OR 5.33; p < 0.0001) and clinical pregnancy rates (OR 3.64; p = 0.0001). In vitro fertilization outcomes were comparable in women treated for CE and women without CE (ongoing pregnancy/live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Women with severe CE exhibited lower ongoing pregnancy/live birth (OR 0.43; p = 0.003) and clinical pregnancy rates (OR 0.40; p = 0.0007). Mild CE showed no significant effect on in vitro fertilization outcomes (ongoing pregnancy/ live birth rate, clinical pregnancy rate, and miscarriage rate: p = ns). Conclusion. The conducted meta-analysis showed that CE significantly reduces the ongoing pregnancy/live birth and clinical pregnancy rates in infertile women undergoing in vitro fertilization. Noteworthy is that antimicrobial therapy in such patients improves the results of assisted reproductive technologies, which are comparable to those of patients without CE. The negative impact of this pathology on the implantation capacity of the endometrium is most often observed in the severe form, while its mild form has virtually no effect on the in vitro fertilization outcome

СТРЕССОГЕННЫЕ СИТУАЦИИ В РАБОТЕ ОПЕРАТОРОВ CALL-ЦЕНТРА МНОГОПРОФИЛЬНОГО ДЕТСКОГО МЕДИЦИНСКОГО УЧРЕЖДЕНИЯ

Stressful situations in the work of a pediatric medical facility's call center are associated with patients' violation of social communication norms and aggressive behavior, as well as the operator's professional/maternal conflict. The following psychological resources facilitate better stress resistance of operators: self-confidence, mature and rational attitude, personal activity, inner satisfaction, optimism, emotional breadth and emotional colleague support. Стрессогенные ситуации в работе операторов call-центра детского медицинского учреждения обусловлены нарушением социальных норм коммуникации и агрессивным поведением пациента, а также конфликтом между профессиональной и материнской ролью оператора. Повышению стрессоустойчивости оператора способствуют такие психологические ресурсы, как уверенность в себе, зрелая и рациональная жизненная позиция, личностная активность, внутренняя удовлетворенность, оптимистичность, эмотивность, эмоциональная поддержка коллег.

Evaluation of the effectiveness of age macular degeneration treatment

We examined 176 patients with an established diagnosis of age-related macular degeneration 'dry* form in the early and intermediate stages. The average age - 71,2 + 2,6, the average duration of the disease from the time of diagnosis of the disease 1,9 ± 1,3 years. All patients were divided into two groups: primary - 90 people and a comparison group of 86 people. The study group consisted of patients who underwent neyroprotektional vasodilator therapy: 5 mg Retinalamin subconjunctival injection number 10 and intramuscular injections of nicotinic acid 2,0 № 10. In the comparison group performed neuroprotective and vasodilator therapy in combination simpatocorrection number 10. The result has been found most effective therapeutic strategy: simpatocorrection in combination with the following regimen: 5 mg subconjunctival injection Retinalamin number 10, and intramuscular injection of nicotinic acid, 2.0 N° 10.Нами обследовано 176 больных с установленным диагнозом возрастной макулярной дегенерации «сухая» форма в ранней и промежуточной стадиях. Средний возраст-71,2 + 2,6, средняя продолжительность заболевания от момента диагностики заболевания 1,9+1,3 года. Все пациенты были разделены на две группы: основную - 90 человек и группу сравнения 86 человек. В основную группу вошли пациенты, которым была проведена нейропротекторнаяи сосудорасширяющая терапия: Ретиналамин 5 мг субконъюнктивально №10 и внутримышечные инъекции никотиновой кислоты 2,0 №10. В группе сравнения проводилась нейропротекторная и сосудорасширяющая терапия в сочетании симпатокоррекцией №10. В результате была выявлена наиболее эффективная терапевтическая стратегия, а именно, сочетание симпатокоррекции со следующей схемой лечения: Ретиналамин 5 мг субконъюнктивально № 10, внутримышечные инъекции никотиновой кислоты 2.0 №10

APPLICATION OF MOLECULAR MARKERS IN BREEDING FOR RESISTANCE TO POTATO CYST NEMATODE

The article presents the results of the application of molecular markers of the genes controlling resistance to potato cyst nematode in different stages of potato breeding - for screening genetic collections and promising hybrids of the All-Russian Institute of Potato Research and the Vavilov Institute of Plant Genetic Resources. It has been established that "pseudopositive" and "pseudonegative" results of a marker-mediated breeding process are associated not only with the specificity of the used markers, but with a lack of objectivity in phenotypic evaluation for resistance to the nematode

Yarrowia lipolytica growth under increased air pressure: influence on enzymes production

Improvement of microbial cell cultures oxygenation can be achieved by the increase of total air pressure, which increases oxygen solubility in the medium. In this work, a pressurized bioreactor was used for Yarrowia lipolytica batch cultivation under increased air pressure from 1 to 6 bar. Cell growth was strongly enhanced by the pressure rise. Fivefold and 3.4-fold increases in the biomass production and in specific growth rate, respectively, were observed under 6 bar. The increase of oxygen availability caused the induction of the antioxidant enzyme superoxide dismutase, which indicates that the defensive mechanisms of the cells against oxidative stress were effective and cells could cope with increased pressure. The pregrowth of Y. lipolytica under increased pressure conditions did not affect the lipase production ability of the cells. Moreover, the extracellular lipase activity increased 96% using a 5-bar air pressure instead of air at 1- bar pressure during the enzyme production phase. Thus, air pressure increase in bioreactors is an effective mean of cell mass and enzyme productivity enhancement in bioprocess based in Y. lipolytica cultures