Pneumonia in patients on the background of blood cancer.

Problematic issues of etiologic diagnosis and treatment of community-acquired and nosocomial pneumonia are being studied actively. At the same time specific features of pneumonia in patients with severe immune defects, against blood cancer including are studied insufficiently. By the result of microbiological examinations of 149 patients with pneumonia on the background of blood cancer, who have undergone treatment in hematological center of CE “Dnipropetrovsk local multi-field clinical hospital №4” in 2010-2012, bacterial causative agents were determined in 59,7% of accidents, among which gram-negative microorganisms made up 69,7%, gram-positive – 30,3%. In 63% of accidents the asso­ciations of causative agents were determined: the combination of fungal flora made up 58, 4% bacterial associations – 25, 8%. Invasive methods of research have demonstrated a considerably bigger informativeness in determination of possible etiological diagnosis of pneumonia. In determination of causative agent in fluid of brochoalveolar lavage the part of positive results made up 77,4% against 30,3% in examination of sputum

The forecast of lethal outcome in chronic leukemia patients with pneumonia

Цель исследования - создание математической модели прогноза летального исхода пневмонии у больных на фоне хронических лейкозов для определения и своевременной оптимизации лечения. Исследовано 323 больных с пневмониями, которые розвились на фоне хронических лейкозов. Все показатели, полученные в результате исследования, внесены в электронную базу данных формализованных историй болезней в виде таблицы «объект-признак», которую подвергали поэтапной многоплановой статистической обработке методами непараметрического дисперсионного анализа Краскела-Уоллиса, корреляционного анализа с расчетом коэффициента ранговой корреляции Спирмена, Roc-анализа. Статистически достоверным считалось значение уровня значимости p<0,05 (5%). Выявлено, что с летальным исходом больных различными формами пневмонии, которые развились на фоне хронических лейкозов ассоциированы показатели лейкоцитов, лимфоцитов, нейтрофилов, тромбоцитов, эритроцитов, гемоглобина и показатели иммунитета (B(CD19+), Т (СD4+), (СD4+/СD8+), IgG). В результате проведенного исследования создана математическая модель прогноза возникновения летального исхода пневмонии у больных на фоне хронических лейкозов: ПЛИ = exp(-0,073-0,994*(лейкоциты) + 4,842 * (Р. Aerogиnosa)) / [1 + exp (-0,073-0,994 * (лейкоциты) + 4,842 * (Р. aerogиnosa)]. Использование в клинической практике разработаной математической модели позволит определить место лечения больных пневмонией в сочетании с хроническим лейкозом, что позволит своевременно оптимизировать программу лечения. The aim of the study - to create a mathematical model for forecasting of poor pneumonia outcome in patients with chronic leukemia in order to optimize treatment. Study included 323 patients with pneumonia and chronic leukemia. All indicators obtained in the study were entered into electronic database of formalized medical histories like a table "object-feature". These results were subjected to stepwise multidimensional statistical processing using non-parametric dispersive analysis by Kruskal-Wallis, correlation analysis with Spearman's rank correlation coefficient, and ROC - analysis. The statistically significant level was p < 0,05 (5%). We determined that the forecast of pneumonia poor outcome in patients with chronic leukemia is associated with: leukocytes, lymphocytes, neutrophils, platelets, erythrocytes, hemoglobin and immunity: B (CD19+) (G/L), T (CD4+) (%), immunoregulatory index (CD4+/СD8+) and IgG (g/l). A mathematical model for predicting the pneumonia poor outcome in patients with chronic leukemia was created in our study: PPO=exp (-0.073-0.994*(leukocytes) + 4.842*(P.aeroginosa)) / [1 + exp (-0.073-0.994*(leukocytes) + 4.842*(R. aeroginosa)]. Using in clinical practice the proposed mathematical model of prediction pneumonia poor outcome in patients with chronic leukemia will allow determining the treatment place and timely optimizing the treatment program

Relevant approaches to modernization of academic and material and technical process support of academic process in the field of knowledge “Health care” in terms of adapting to international assessment criteria.

One of the important tasks in modernization of Ukrainian medical education is to bring it in line with international assessment criteria, which has become especially relevant after the introduction of the International Basic Medicine Examination in 2018. The aim of this work was to identify the most significant differences between international medical exams (for example, The United States Medical Licensing Examination, USMLE) and the national system of licensed exams KROK, and based on this, determine the direction of modernization of Ukrainian medical education for its adequate adaptation to new systems of assessment. The most significant differences between the two exams are: format (on computers / on paper); presence / absence of digital files with images and audio data in tasks; thematic focus of tests within one / several subjects; different list of items by which tasks are distributed; in the case of USMLE, there is a much higher motivation to pass the exam with the highest possible result. To adapt the medical education system to such features, it is necessary: to provide students with high-quality illustrated textbooks and meaningful digital data bases for each specialized subject; to actively use images (audio, video files) from these sources during the analysis of the material and all types of control (including test ones); to establish cooperation between the fundamental and clinical departments in the process of creating test tasks, as well as the exchange of digital materials for practical classes. Of particular importance is the synchronization of methodological approaches to conducting practical classes and assessment criteria not only in theoretical but also in clinical departments, which will make the learning process more transparent and understandable. Such a set of measures will help not only to adapt students to exams at the international level, but also will increase their interest and improve the effectiveness of the educational process. The employment of digital images, audio, video files will also contribute to the adequate preparation of students for new directions in medicine, such as telemedicine and telepathology

Results from the Survey of Antibiotic Resistance (SOAR) 2011–13 in Ukraine

Objectives: To determine the antibiotic susceptibility of respiratory isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2011–13 from Ukraine. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 134 isolates of S. pneumoniae and 67 of H. influenzae were collected from eight sites in Ukraine. Overall, 87.3% of S. pneumoniae were penicillin susceptible by CLSI oral breakpoints and 99.3% by CLSI iv breakpoints. Susceptibility to amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin was 100% by CLSI and PK/PD breakpoints. Cephalosporin and macrolide susceptibility was ≥95.5% and 88.1%, respectively using CLSI breakpoints. Trimethoprim/sulfamethoxazole was essentially inactive against pneumococci. Of the 67 H. influenzae tested, 4.5% were b-lactamase positive and all H. influenzae were fully susceptible to amoxicillin/ clavulanic acid, ceftriaxone, ciprofloxacin, cefixime and levofloxacin (all breakpoints). Cefuroxime susceptibility was 100% by CLSI but 73.1% by EUCAST and PK/PD breakpoints. A discrepancy was found in macrolide susceptibility between CLSI (100% susceptible), EUCAST (22%–43% susceptible) and PK/PD (0%–22% susceptible) breakpoints. Trimethoprim/sulfamethoxazole was poorly active (59.7% susceptible). Conclusions: Generally, antibiotic resistance was low in respiratory pathogens from Ukraine. However, only amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin were fully active against both species. Trimethoprim/sulfamethoxazole was the least active, particularly against S. pneumoniae. Some susceptibility differences were apparent between CLSI, EUCAST and PK/PD breakpoints, especially with macrolides against H. influenzae. These data suggest that further efforts are required to harmonize these international breakpoints. Future studies are warranted to monitor continued low resistance levels in Ukraine compared with other parts of Eastern Europe

Possible predictors of depressive syndrome in patients with chronic obstructive pulmonary disease.

Recently, the problem of depressive syndrome in COPD patients often attracts the attention of doctors and scientists. It is important to study the relationship between the presence of the depressive syndrome, on the one hand, and the clinical and functional characteristics of COPD patients on the other, in order to determine the categories of patients inclined to develop a depressive syndrome. The purpose of the study: to determine the relationship between the presence of depressive syndrome in COPD patients with the severity of their clinical symptoms of COPD and the level of functional impairments. 52 COPD patients of clinical groups C and D were examined. Depending on the presence of depressive syndrome patients were divided into two subgroups: a subgroup 1 – 15 COPD patients with concomitant depressive syndrome, a subgroup 2 – 37 people without it. The examination included general clinical and functional methods. It was determined that the development of depressive syndrome in COPD patients can be affected by the high severity of clinical symptoms of COPD in general, decreased tolerance to physical activity, long duration of the disease, poor quality of life. At the same time, the levels of functional indicators, in particular, OFV1 and SpO2, may not have a significant relationship with the occurrence of depressive syndrome, even in patients with severe COPD

ДОСВІД ОРГАНІЗАЦІЇ КОМПЛЕКСНОГО ПРАКТИЧНО-ОРІЄНТОВАНОГО ІСПИТУ ЗІ СПЕЦІАЛЬНОСТІ “СТОМАТОЛОГІЯ” ЗА ПРИНЦИПАМИ OSCE

The aim of the work – to highlight the importance of implementing the OSCE principles to ensure an adequate approach to controlling the level of competences in an integrated practical-oriented exam for speciality “Stomatology”.The main body. The implementation of an objective structured clinical examination (OSCE) allows you to check the level of preparation of a graduate student to a future professional activity (work with patient) that is difficult to assess by standardized testing.The usage of simulation technologies in the educational process of the SI “DMA” helps to solve the problem of insufficient number of thematic patients. The simulation equipment allows you to recreate the OSCE elements, and reduce the variability in the assessment of examiners. The standardization of clinical situations using the case-practice method ensures the full identity of the tasks that are provided to students during the certification process, and the testing of communicative skills is carried out by an examiner, who simultaneously performs the function of the simulator. Demonstration by a student of the level of mastering of basic skills and practical skills from dental specialties is carried out on phantom-simulators. Assessment of students is carried out according to the generally accepted methodology.Conclusions.The application of the principles of an objective structured clinical examination (OSCE) and elements of simulation training provides a high level of effectiveness in monitoring the mastery of the “competence” of a future specialist and the level of mastery of practical skills in Stomatology disciplines. Involvement of simulators in combination with the use of phantom simulators allows to improve the complex practical-oriented examination in stomatology. Мета роботи – висвітлити значення впровадження принципів OSCE для забезпечення адекватного підходу до контролю рівня компетентностей під час комплексного практично-орієнтованого іспиту зі стоматології.Основна частина. Впровадження комплексного практично-орієнтованого екзамену (OSCE) дозволяє здійснити перевірку готовності випускника на реальному об’єкті майбутньої професійної діяльності (людині) до виробничих функцій, які важко оцінити методом стандартизованого тестування.Впровадження симуляційних технологій у навчальний процес ДЗ “ДМА” допомагає вирішенню проблеми недостатньої кількості тематичних пацієнтів. Симуляційне обладнання дозволяє відтворити елементи OSCE, та знизити варіативність оцінки осіб, що екзаменуються. Стандартизація клінічних ситуацій із застосуванням методу кейс-стаді забезпечує повну ідентичність завдань, які дають студентам під час атестації, а перевірка комунікативних навичок проводиться екзаменатором, який одночасно виконує функцію імітатора. Демонстрацію рівня засвоєння основних умінь та практичних навичок зі стоматологічних спеціальностей студент здійснює на фантомах-тренажерах. Оцінювання студентів проводиться за загальноприйнятою методикою.Висновки. Застосування принципів об’єктивного структурованого клінічного екзамену (OSCE) та елементів симуляційного навчання забезпечує високу ефективність контролю засвоєння “компетентностей” майбутнього фахівця та рівня оволодіння практичними навичками зі стоматологічних дисциплін. Залучення імітаторів у сукупності із застосуванням фантомів-тренажерів дозволяє удосконалити комплексний практично-орієнтований іспит зі стоматології

Results from the Survey of Antibiotic Resistance (SOAR) 2016–17 in Ukraine: data based on CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints

Objectives: To determine antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae isolates from community-acquired respiratory tract infections (CA-RTIs) collected in 2016–17 from Ukraine. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST (dose-specific) and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 177 viable clinical isolates, including 78 S. pneumoniae and 99 H. influenzae, were collected. Overall, 98% of S. pneumoniae isolates were susceptible to penicillin by CLSI IV or EUCAST high-dose breakpoints and 73.1% were susceptible by CLSI oral or EUCAST low-dose IV breakpoints. Susceptibility rates of 76.9%–100% were observed for most antibiotics by all breakpoints except trimethoprim/sulfamethoxazole (41%–69.2%) and cefaclor, which showed the greatest difference between breakpoints: 0% by EUCAST, 28.2% by PK/PD and 73.1% by CLSI. All S. pneumoniae isolates were susceptible to amoxicillin/clavulanic acid by CLSI and PK/PD breakpoints. H. influenzae isolates were almost all b-lactamase negative (90.9%). One isolate was blactamase negative and ampicillin resistant (BLNAR) by CLSI and four isolates were BLNAR by EUCAST criteria. Susceptibility of isolates was high (90.9%) by CLSI breakpoints for all antibiotics tested except trimethoprim/ sulfamethoxazole (61.6%). Susceptibility using EUCAST breakpoints was similar for ampicillin (90.9%) and amoxicillin/clavulanic acid (95%) but was low for cefuroxime (oral), where only 10.1% of isolates were susceptible. All S. pneumoniae and H. influenzae isolates were susceptible to the fluoroquinolones by all breakpoints. Susceptibility to ceftriaxone was also 100% for H. influenzae and 91% for S. pneumoniae isolates by all breakpoints. The application of different EUCAST breakpoints for low and higher doses for some of the antibiotics (amoxicillin, amoxicillin/clavulanic acid, ampicillin, penicillin, ceftriaxone, clarithromycin, erythromycin, levofloxacin and trimethoprim/sulfamethoxazole) allowed, for the first time in a SOAR study, the effect of raising the dosage on susceptibility to be quantified. Conclusions: Antibiotic susceptibility in these respiratory tract pathogens was generally high in Ukraine. These data are important for empirical therapy choices in the treatment of CA-RTIs

ЗАСТОСУВАННЯ ОБ’ЄКТИВНОГО СТРУКТУРОВАНОГО КЛІНІЧНОГО ІСПИТУ ЯК ЕТАПУ ПРОВЕДЕННЯ АТЕСТАЦІЇ ВИПУСКНИКІВ ДЕРЖАВНОГО ЗАКЛАДУ «ДНІПРОПЕТРОВСЬКА МЕДИЧНА АКАДЕМІЯ МІНІСТЕРСТВА ОХОРОНИ ЗДОРОВ’Я УКРАЇНИ»

The aim of the work – to analyze the use of an objective structured clinical examination (OSCE) as a stage of certification of graduates of the state institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”. The main body. OSCE has certain advantages over traditional methods of assessment – oral interviews, written work, testing and taking practical skills at the patient’s bedside. The OSCE de facto remains practically the only method that can effectively assess the skills of a large number of students in a minimal time at the “show” level of the G. Miller clinical competence pyramid. Unlike written, oral tests and testing, OSCE not only assesses the level of students’ theoretical knowledge, but examines their competence in applying existing knowledge in practice. Conclusion. In comparison with taking practical skills near the patient’s bed, OSCE allows to provide a greater variety of clinical situations, to reproduce rare clinical cases, to test students’ skills in “delicate” situations, admit the possibility of a medical mistake.Мета роботи – аналіз застосування об’єктивного структурованого клінічного іспиту як етапу проведення атестації випуск­ників державного закладу «Дніпропетровська медична академія міністерства охорони здоров’я України». Основна частина. ОСКІ має певні переваги перед традиційними методами оцінки – усними співбесідою, письмовими роботами, тестуванням і прийомом практичних навичок біля ліжка хворого. ОСКІ де-факто залишається практично єдиним методом, що дозволяє ефективно оцінити навички значної кількості студентів за мінімальний час на рівні «показати» піраміди клінічної компетентності G. Miller. На відміну від письмових, усних іспитів і тестування, ОСКІ не просто оцінює рівень теоретичних знань студентів, але перевіряє їх компетентність у застосуванні наявних знань на практиці. Висновок. Порівняно з прийомом практичних навичок біля ліжка хворого ОСКІ дозволяє забезпечити більшу різноманітність клінічних ситуацій, відтворити рідкісні клінічні випадки, перевірити навички студентів в «делікатних» ситуаціях, допускає можливість лікарської помилки

АНАЛІЗ РІВНЯ ДОМАГАНЬ І ПРОФЕСІЙНОЇ САМООЦІНКИ ЛІКАРІВ-ІНТЕРНІВ ПЕРШОГО РОКУ НАВЧАННЯ ЯК ІНСТРУМЕНТ УДОСКОНАЛЕННЯ ПРАКТИЧНИХ НАВИЧОК НА КАФЕДРІ СІМЕЙНОЇ МЕДИЦИНИ

The results of psychologic testing and level of aspiration and analysis of internship doctors’ professional competence self-rating, made according to Dembo – Rubinshtein methodology modified by A. M. Prykhozhan at the Family Medicine Department of State Institution “Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine” are represented in the article. Outsized ambitions and self-evaluation towards professional competences among most of first year internship doctors are identified; 54 % of respondents have basic practical skills particularly the conflict between ideal self and real self in the context of professional abilities. Received data allow to develop practical skills quality correction and management methods among internship doctors.У статті наведено результати психологічного тестування та аналіз рівня домагань і самооцінки професійних компетенцій у лікарів-інтернів, проведеного за методикою Дембо – Рубінштейн у модифікації А. М. Прихожан на кафедрі сімейної медицини Державного закладу «Дніпропетровська медична академія МОЗ України». Виявлено завищені домагання та завищену самооцінку відносно професійних компетенцій у більшості лікарів-інтернів першого року навчання, володіння базисними практичними навичками, зокрема конфлікт між Я-ідеальним та Я-реалістичним у контексті власних професійних здібностей мають 54 % респондентів. Отримані дані дозволяють вчасно розробити методи корекції та контролю якості практичних навичок у лікарів-інтернів

Results from the Survey of Antibiotic Resistance (SOAR) 2011–13 in Ukraine

Objectives: To determine the antibiotic susceptibility of respiratory isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2011–13 from Ukraine. Methods: MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results: A total of 134 isolates of S. pneumoniae and 67 of H. influenzae were collected from eight sites in Ukraine. Overall, 87.3% of S. pneumoniae were penicillin susceptible by CLSI oral breakpoints and 99.3% by CLSI iv breakpoints. Susceptibility to amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin was 100% by CLSI and PK/PD breakpoints. Cephalosporin and macrolide susceptibility was ≥95.5% and 88.1%, respectively using CLSI breakpoints. Trimethoprim/sulfamethoxazole was essentially inactive against pneumococci. Of the 67 H. influenzae tested, 4.5% were b-lactamase positive and all H. influenzae were fully susceptible to amoxicillin/ clavulanic acid, ceftriaxone, ciprofloxacin, cefixime and levofloxacin (all breakpoints). Cefuroxime susceptibility was 100% by CLSI but 73.1% by EUCAST and PK/PD breakpoints. A discrepancy was found in macrolide susceptibility between CLSI (100% susceptible), EUCAST (22%–43% susceptible) and PK/PD (0%–22% susceptible) breakpoints. Trimethoprim/sulfamethoxazole was poorly active (59.7% susceptible). Conclusions: Generally, antibiotic resistance was low in respiratory pathogens from Ukraine. However, only amoxicillin/clavulanic acid (amoxicillin), ceftriaxone and levofloxacin were fully active against both species. Trimethoprim/sulfamethoxazole was the least active, particularly against S. pneumoniae. Some susceptibility differences were apparent between CLSI, EUCAST and PK/PD breakpoints, especially with macrolides against H. influenzae. These data suggest that further efforts are required to harmonize these international breakpoints. Future studies are warranted to monitor continued low resistance levels in Ukraine compared with other parts of Eastern Europe