АСПЕКТЫ НУТРИЦИОННОЙ ПОДДЕРЖКИ В РАМКАХ ПРОГРАММЫ УСКОРЕННОГО ВЫЗДОРОВЛЕНИЯ ПРИ ПЛАНОВЫХ ОНКОЛОГИЧЕСКИХ ОПЕРАЦИЯХ НА ТОЛСТОЙ КИШКЕ У ГЕРОНТОЛОГИЧЕСКИХ ПАЦИЕНТОВ

Goal: to develop and evaluate the efficiency of the tactics for peri-operative nutritional-metabolic therapy as a component of Fast Track programme (FTP) in elderly patients suffering from colon cancer and having planned surgery. Methods. Treatment outcomes were analyzed for 400 elderly patients with colon cancer divided into two groups: main group (prospective n = 170), who were treated complying with optimized FTP and nutritional-metabolic therapy and control group (retrospective, n = 230), who were managed in the traditional way. Peri-operative nutritional-metabolic therapy in the main group included detection of those initially suffering from protein-calorie deficiency basing on changes in body mass loss and body weight index, and provision of integral nutritional support for them. During pre-operative preparation period lasting from 10 to 14 days they were prescribed with residue-free diet additionally to which, depending on the volume of food consumed by sipping, they received liquid nutritional mixture (Impact® Oral, Nestle) with high protein (7.6 g per 100 ml) and calories (1.4 kcal in ml) content. Post-operative nutritional support included early (from the 1st day after the surgery) enteral feeding with use of standard multisubstrate nutritional mixtures with protein content of 40g/l (Isosource® Standard, Nestle) in order to prevent paresis of gastro-intestinal tract combined with early activation of patients. Results. Patients in the main group confidently earlier restored the protein pool and immune status, nasogastric tube was removed faster, the duration of stay in the intensive care department and hospital after the surgery was less, the severity of complications as per Clavien – Dindo classification was lower, and life quality and late treatment outcomes were better. Conclusions. Use of the offered tactics of peri-operative nutritional-metabolic therapy as a component of FTP allowed speeding up rehabilitation and enhancing surgical and oncological outcomes in the burdened elderly patients having planned surgery due to colon cancer. Цель: разработка и оценка эффективности тактики периоперационной нутритивно-метаболической терапии как компонента программы ускоренного выздоровления (ПУВ) у геронтологических больных раком толстой кишки при плановых хирургических вмешательствах. Методика. Проанализированы результаты лечения 400 геронтологических хирургических пациентов с диагнозом рака ободочной кишки, разделенных на две группы: основную (проспективную, n = 170), в которой лечение осуществляли с соблюдением оптимизированной ПУВ и нутритивно-метаболической терапии, и контрольную (ретроспективную, n= 230), ведение которой осуществляли традиционным способом. Периоперационная нутритивно-метаболическая терапия в основной группе заключалась в выявлении на основе оценки индекса массы тела в сочетании с динамикой потери массы тела пациентов, исходно имеющих белково-энергетическую недостаточность, и осуществлении их комплексной нутриционной поддержки. При предоперационной подготовке в период от 10 до 14 дней им назначали бесшлаковую диету, дополнительно к которой, в зависимости от объема съеденной пищи методом сипинга, назначали жидкую питательную смесь (Impact® Oral, Nestle) с высоким содержанием белка (7,6 г на 100 мл) и энергии (1,4 ккал в мл). Послеоперационная нутриционная поддержка заключалась в осуществлении раннего (с 1-х сут после операции) энтерального питания с использованием стандартных полисубстратных питательных смесей с содержанием белка 40 г/л (Isosource® Standard, Nestle) с целью профилактики пареза желудочно-кишечного тракта в сочетании с ранней активизацией больных. Результаты. У больных основной группы достоверно раньше восстанавливались белковый пул и иммунный статус, меньше было время стояния назогастрального зонда, пребывания в отделении интенсивной терапии и стационаре после операции, легче степень тяжесть осложнений по классификации Clavien – Dindo, лучше качество жизни и отдаленные результаты лечения. Выводы. Применение предложенной тактики периоперационной нутритивно-метаболической терапии как компонента ПУВ позволило ускорить реабилитацию и улучшить хирургические и онкологические результаты лечения отягощенных геронтологических пациентов при плановых операциях по поводу рака толстой кишки.

Многоэтапное хирургическое лечение первично-множественного синхронного рака толстой кишки у больного старческого возраста: клиническое наблюдение

А clinical case of successful multistage surgical treatment of elderly patient with primary synchronous colon cancer is presented. Locallyadvanced tumor are in ascending colon, the secod tumor are in sigmoid colon. The treatment realized in two stages after assessment by multidisciplinary team based on decision of council of physicians consist of oncologist, anaesthesiologist, therapeutist and neurologist. First stage include an ileotransversal bypass. After the complex rehabilitation during one month in aggregate with pre-operative council of physicians second stage are simultaneous radical right hemicolectomy with abdominal wall resection and sigmoidectomy with abdominal wall defect plastic by own tissues. Staged surgical treatment allowed to perform radical resection of the giant malignant neoplasm of the colon with good clinicasl result.Представлен клинический случай успешного многоэтапного хирургического лечения пациента старческого возраста с первично-множественным синхронным раком ободочной кишки. Местно-распространенная опухоль локализовалась в восходящей ободочной кишке, еще одна – в сигмовидной кишке. Лечение проводилось в 2 этапа после оценки мультидисциплинарной командой на основании решения консилиума в составе онколога, анестезиолога, терапевта и невролога. На 1-м этапе был наложен обходной илеотрансверзоанастомоз. После проведения комплексной реабилитации в течение месяца в сочетании с предоперационной подготовкой была выполнена симультанная операция в объеме радикальной правосторонней гемиколэктомии (с резекцией передней брюшной стенки) и резекции сигмовидной кишки, а также пластика дефекта передней брюшной стенки местными тканями (2-й этап). Этапное хирургическое лечение в сочетании с мультидисциплинарным подходом позволило выполнить радикальное удаление гигантского злокачественного новообразования толстой кишки с хорошим клиническим результатом

Characteristics of Early-Onset vs Late-Onset Colorectal Cancer: A Review.

The incidence of early-onset colorectal cancer (younger than 50 years) is rising globally, the reasons for which are unclear. It appears to represent a unique disease process with different clinical, pathological, and molecular characteristics compared with late-onset colorectal cancer. Data on oncological outcomes are limited, and sensitivity to conventional neoadjuvant and adjuvant therapy regimens appear to be unknown. The purpose of this review is to summarize the available literature on early-onset colorectal cancer. Within the next decade, it is estimated that 1 in 10 colon cancers and 1 in 4 rectal cancers will be diagnosed in adults younger than 50 years. Potential risk factors include a Westernized diet, obesity, antibiotic usage, and alterations in the gut microbiome. Although genetic predisposition plays a role, most cases are sporadic. The full spectrum of germline and somatic sequence variations implicated remains unknown. Younger patients typically present with descending colonic or rectal cancer, advanced disease stage, and unfavorable histopathological features. Despite being more likely to receive neoadjuvant and adjuvant therapy, patients with early-onset disease demonstrate comparable oncological outcomes with their older counterparts. The clinicopathological features, underlying molecular profiles, and drivers of early-onset colorectal cancer differ from those of late-onset disease. Standardized, age-specific preventive, screening, diagnostic, and therapeutic strategies are required to optimize outcomes

Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Digital transformation as the main condition for the development of modern higher education

The article considers the potential and limitations that arise in the higher education system as a result of the e-technology use. E-learning has become an integral part of the 21st century education system. The pace of dissemination and implementation of e-technologies in all spheres of public life, in science and education in particular, is constantly growing. There are different views in the scientific community and the public on the digital transformation of education. However, with the entry into our lives of COVID-19, the use of e-technologies in education ceases to be a matter of innovation, and becomes a vital necessity for the functioning of the educational system and the activities of educational institutions. Analysis of more than 50 concepts that characterize the modern education system, educational technologies and the process of digital transformation of education allowed the authors to draw conclusions about the importance of information technology in education and the main trends in their development. The article also summarizes the different views of scientists on the digital transformation of higher education, the use of e-technology in the educational process. The advantages that e-technologies provide to the educational process and the challenges of their use that need to be addressed are outlined. The study of the experience of the leading universities of Ukraine allowed the authors to draw conclusions about the state of digital transformation of higher education in Ukraine. Elaboration of scientific literature, own observations and research have allowed to define the tendencies of development of higher education in the epoch of digital transformation

NUTRITIONAL SUPPORT ASPECTS WITH FAST TRACK PROGRAMME IN PLANNED SURGERIES FOR COLON CANCER IN ELDERLY PATIENTS

Goal: to develop and evaluate the efficiency of the tactics for peri-operative nutritional-metabolic therapy as a component of Fast Track programme (FTP) in elderly patients suffering from colon cancer and having planned surgery. Methods. Treatment outcomes were analyzed for 400 elderly patients with colon cancer divided into two groups: main group (prospective n = 170), who were treated complying with optimized FTP and nutritional-metabolic therapy and control group (retrospective, n = 230), who were managed in the traditional way. Peri-operative nutritional-metabolic therapy in the main group included detection of those initially suffering from protein-calorie deficiency basing on changes in body mass loss and body weight index, and provision of integral nutritional support for them. During pre-operative preparation period lasting from 10 to 14 days they were prescribed with residue-free diet additionally to which, depending on the volume of food consumed by sipping, they received liquid nutritional mixture (Impact® Oral, Nestle) with high protein (7.6 g per 100 ml) and calories (1.4 kcal in ml) content. Post-operative nutritional support included early (from the 1st day after the surgery) enteral feeding with use of standard multisubstrate nutritional mixtures with protein content of 40g/l (Isosource® Standard, Nestle) in order to prevent paresis of gastro-intestinal tract combined with early activation of patients. Results. Patients in the main group confidently earlier restored the protein pool and immune status, nasogastric tube was removed faster, the duration of stay in the intensive care department and hospital after the surgery was less, the severity of complications as per Clavien – Dindo classification was lower, and life quality and late treatment outcomes were better. Conclusions. Use of the offered tactics of peri-operative nutritional-metabolic therapy as a component of FTP allowed speeding up rehabilitation and enhancing surgical and oncological outcomes in the burdened elderly patients having planned surgery due to colon cancer

Innovative Work System of Higher Education Institution Department for Scientific Personnel Training

Статтю присвячено узагальненню пошукового досвіду роботи кафедри державної служби, адміністрування та управління Луганського національного університету імені Тараса Шевченка з формування інноваційної системи підготовки наукових кадрів. Формування даної системи пройшло три етапи – етап індивідуальної роботи наукових керівників з аспірантами та докторантами, етап аспірантських семінарів, етап кафедральних методологічних семінарів. Стаття презентує форми завдань пошукувачам для методологічних семінарів та декілька планів їх проведення. У статті висвітлено 14 теоретичних положень, які було покладено в основу інноваційної системи підготовки наукових кадрів.The article is devoted to the coverage of the department of higher education institution work experience on forming innovative system for training of scientific personnel. Article aims to justify the theoretical and methodological foundations of innovative activity of the higher education institution department for training of scientists. For the implementation of the purposes of the article the following methods were used: analysis of scientific literature on research training, generalization of the features of the traditional system of researchers’ training and experience of the department of higher education institution, the method of cause-and-effect analysis to determine the factors of low efficiency of doctoral programmes and PhD programs in researchers’ training, simulation for justifying the theoretical and methodological foundations of the functioning of the innovative systems of the department of higher education institution for scientific training. The article highlights fourteen theoretical assumptions that were used as the basis for innovative training system: orientation of candidates selection to postgraduate studies to diagnostics of readiness of applicants for research work; outrunning way of organising of the applicants’ research work; connection of research work of graduate students and doctoral candidates with scientific problems that are relevant for department activity; orientation of department research supervisors for justification of methodological foundations of scientific research; an increase of amount of educational process in training of graduate students; moving focus while teaching graduate students from activity of supervisors to activity of applicants using interactive methods of organising the educational process, etc. The use of reasonable ideas will effectively implement the provision of the Law of Ukraine “On higher education” about the training of scientific personnel. Relevant problem for further development is a problem of building a system of department activities while having small number of graduate students, attracting graduate students and doctoral students to complex research topics

Exploring the landscape of e-learning for lifelong education of public servants: trends, challenges, and implications

This article provides a comprehensive overview of the various components comprising the lifelong education system for public servants. With the advancement of e-government being a pivotal aspect of public administration, the significance of e-learning as a crucial tool for equipping public servants to fulfill this objective is examined. The study analyzes both domestic and international experiences of e-learning for public servants, encompassing distance education, blended learning, and its integration within traditional classroom settings. The article sheds light on the potential threats and benefits of Information and Communication Technology (ICT) training, drawing insights from a survey conducted among civil servants who received ICT training in Ukrainian higher educational institutions. By drawing upon scientific and empirical evidence, the trends in e-learning development are identified, with certain countries serving as exemplars in addressing the current challenges in this field. This article serves as a valuable resource for understanding the current landscape of e-learning in the context of lifelong education for public servants, highlighting emerging trends, inherent challenges, and the wider implications for effective governance

RESULTS OF ENHANCED RECOVERY PROTOCOL IN GERONTOLOGICAL PATIENS WITH COLON CANCER

The study evaluated the results of introduction of enhanced recovery protocol in elderly and senile patients who underwent planned colon cancer surgery. The largest rate of colon cancer was noted in elderly and senile patients in Russia and majority of countries. These patients had an increased rate of complications, hospital stay and mortality compared with young patients. The authors proposed the enhanced recovery protocol for gerontological patients based on clinical data and literature analysis. The protocol implementation decreased the number and severity of complications, shortened the postoperative patient day and improved the quality of life of the patients

Modeling the training system of masters of public service using Web 2.0

The article concerns grounding the technology of training masters of public service with the use of Web 2.0. This technology is based on the concept of sign-contextual learning, the positions of the laboratory-brigade method, the concept of Web 2.0, case technology, project method, problem learning. The main features of this technology are changes in the correlation between theoretical and practical training, in-class and individual studying; changing teachers’ functions; extensive use of information technology capabilities in learning