ФУНКЦІОНАЛЬНИЙ СТАН СЕРЦЕВО-СУДИННОЇ СИСТЕМИ ЗА РЕЗУЛЬТАТАМИ ВЕЛОЕРГОМЕТРІЇ І ЛІПІДНИЙ СКЛАД КРОВІ У ХВОРИХ НА СТАБІЛЬНУ ІШЕМІЧНУ ХВОРОБУ СЕРЦЯ ЗАЛЕЖНО ВІД КІЛЬКОСТІ УРАЖЕНИХ КОРОНАРНИХ АРТЕРІЙ

SUMMARY. Ischemic heart disease (IHD) occupies a leading position in cardiac pathology. Prolonged myocardial ischemia is the cause of mortality and disability of the population, regardless of the socio-economic development of the country. The main proven risk factors for cardiovascular disease are hyper- and dyslipidemia and abdominal obesity. The aim of the study – to analyze hemodynamic and ergometric parameters of the heart according to veloergometry (VEM) data, lipid composition of the blood and to evaluate anthropometric data in patients with stable coronary artery disease depending on the number of coronary arteries (CA) affected. Material and Methods. The study involved 62 patients with stable coronary heart disease with functional angina (FC) III with heart failure (HF) IIА FC III with preserved left ventricular ejection fraction (LVEF). Among the surveyed men were dominated by 52 persons (83.9 %). The mean age of the patients was (61.2±1.2) years. Clinical groups are divided into subgroups depending on the number of affected CA: in 16 (25.8 %) patients according to the coronary angiography (CAG) revealed a single-vessel lesion, and in 46 (74.2 %) patients – a multi-vessel. Results. Coronary and myocardial reserves and myocardial contractility according to VEM were shown to be reduced in both observation subgroups, however, such changes were observed in the case of two or more CA (p<0.05). According to anthropometric indices, body mass index (BMI) and waist circumference exceeded the normative value in 42 (67.7 %) patients (p<0.001), and in patients with multivascular CA the data of patients with the affected one CA (p<0.05) prevailed. The amount of total cholesterol (TC), triglycerides (TG), low and high density lipoprotein cholesterol (LDL cholesterol, HDL cholesterol) in the serum were significantly different in both groups of patients (p<0.05).РЕЗЮМЕ. Среди кардиальной патологии ишемическая болезнь сердца (ИБС) занимает ведущую позицию. Длительная ишемия миокарда является причиной смертности и инвалидизации населения независимо от социально-экономического развития страны. Основными доказанными факторами риска развития сердечно-сосудистых заболеваний являются гипер- и дислипидемия и абдоминальное ожирение. Цель – проанализировать гемодинамические и эргометрические показатели сердца по данным велоэргометрии (ВЭМ), липидный состав крови и оценить антропометрические данные пациентов со стабильной ИБС в зависимости от количества пораженных коронарных артерий (КА). Материал и методы. В исследовании приняли участие 62 больных стабильной ИБС со стенокардией напряжения функционального класса (ФК) ІІІ с сердечной недостаточностью (СН) ІІА ФК ІІІ с сохраненной фракцией выброса левого желудочка (ФВ ЛЖ). Среди обследованных преобладали мужчины – 52 человека (83,9 %). Средний возраст пациентов составил 61,2±1,2 года. Клинические группы поделены на подгруппы в зависимости от количества пораженных КА: у 16 (25,8 %) больных по данным коронароангиографии (КАГ) обнаружено однососудистое поражение, а у 46 (74,2 %) пациентов – многососудистое. Результаты. Доказано, что коронарный и миокардиальный резервы и сократительная способность миокарда по данным ВЭМ были сниженными в обеих подгруппах наблюдения, однако выраженными такие изменения наблюдались в случае поражения двух и более КА (р<0,05). Антропометрические показатели – индекс массы тела (ИМТ) и окружность талии – превышали нормативное значение у 42 (67,7 %) больных (р<0,001), причем у пациентов с многососудистом поражением КА эти изменения были более выражены, чем у пациентов с пораженной одной КА (р<0,05). Количество холестерина общего (ХСЗ), триглицеридов (ТГ), ХС липопротеидов низкой и высокой плотности (ХС ЛПНП, ХС ЛПВП) в сыворотке крови достоверно отличалось в обеих группах пациентов (р<0,05).РЕЗЮМЕ. Серед кардіальної патології ішемічна хвороба серця (ІХС) займає провідну позицію. Тривала ішемія міокарда, незалежно від соціально-економічного розвитку країни, є причиною смертності та інвалідизації населення. Основними доведеними факторами ризику розвитку серцево-судинних захворювань є гіпер- та дисліпідемія й абдомінальне ожиріння. Мета – проаналізувати гемодинамічні та ергометричні показники серця за даними велоергометрії (ВЕМ), ліпідний склад крові та оцінити антропометричні дані у пацієнтів із стабільною ІХС залежно від кількості уражених коронарних артерій (КА). Матеріал і методи. У дослідженні взяли участь 62 хворих на стабільну ІХС з стенокардією напруги функціонального класу (ФК) ІІІ із серцевою недостатністю (СН) ІІА ФК ІІІ із збереженою фракцією викиду лівого шлуночка (ФВ ЛШ). Серед обстежених переважали чоловіки – 52 особи (83,9 %). Середній вік пацієнтів становив (61,2±1,2) року. Клінічні групи поділені на підгрупи залежно від кількості уражених КА: у 16 (25,8 %) хворих за даними коронароангіографії (КАГ) виявлено односудинне ураження, а в 46 (74,2 %) пацієнтів – кількасудинне. Результати. Доведено, що коронарний та міокардіальний резерви і скоротлива здатність міокарда за даними ВЕМ виявилися зниженими в обох підгрупах спостереження, проте вираженими ці зміни були у випадку ураження двох і більше КА (р<0,05). Антропометричні показники – індекс маси тіла (ІМТ) та обвід талії – перевищували нормативне значення у 42 (67,7 %) хворих (р<0,001), причому в пацієнтів із ураженням двох і більше КА ці зміни були більш виражені, ніж у пацієнтів з ураженою однією КА (р<0,05). Кількість холестерину загального (ХСЗ), тригліцеридів (ТГ), ХС ліпопротеїдів низької та високої щільності (ХС ЛПНЩ, ХС ЛПВЩ) в сироватці крові достовірно відрізнялися у обох групах пацієнтів (р<0,05)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

BACKGROUND Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled trial involving patients with established cardiovascular disease or with diabetes and other risk factors, who had been receiving statin therapy and who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52 to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of 41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients were randomly assigned to receive 2 g of icosapent ethyl twice daily (total daily dose, 4 g) or placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. The key secondary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS A total of 8179 patients were enrolled (70.7% for secondary prevention of cardiovascular events) and were followed for a median of 4.9 years. A primary end-point event occurred in 17.2% of the patients in the icosapent ethyl group, as compared with 22.0% of the patients in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the corresponding rates of the key secondary end point were 11.2% and 14.8% (hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of additional ischemic end points, as assessed according to a prespecified hierarchical schema, were significantly lower in the icosapent ethyl group than in the placebo group, including the rate of cardiovascular death (4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A larger percentage of patients in the icosapent ethyl group than in the placebo group were hospitalized for atrial fibrillation or flutter (3.1% vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the patients in the icosapent ethyl group and in 2.1% in the placebo group (P=0.06). CONCLUSIONS Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo. (Funded by Amarin Pharma; REDUCE-IT ClinicalTrials.gov number, NCT01492361

The features of leukogram parameters in patients with acute myocardial infarction and arterial hypertension

Мета дослідження: вивчення популяційного складу лейкоцитів у хворих на гострий Q-інфаркт міокарда, який виник на тлі артеріальної гіпертензії, і його зв’язок з типом ремоделювання серцевого м’яза. Об’єкт і методи: обстежено 130 хворих з інфарктом міокарда (ІМ), яких розділили на 2 групи — 67 пацієнтів з ІМ без артеріальної гіпертензії (АГ) і 63 — з АГ. Проводили ЕхоКГ, визначали тип геометрії лівого шлуночка. Визначали кількість лейкоцитів в крові і їх популяції. Результати: відзначали збільшення кількості лейкоцитів у крові хворих на ІМ на 21% (p <0,001), а при ІМ і АГ — на 23,75% (p <0,001). У хворих з ІМ і АГ збільшення лейкоцитів було за рахунок нейтрофілів, лімфоцитів і моноцитів. У той час, як у хворих на ІМ тип геометрії лівого шлуночка (ЛШ) не впливав на показники лейкограми, при супутній АГ відзначали значне збільшення кількості моноцитів при концентричній гіпертрофії і ремоделюванні міокарда ЛШ. Висновки. Гострий ІМ, який виник на тлі АГ, характеризується збільшенням загальної кількості лейкоцитів за рахунок нейтрофілів, лімфоцитів і моноцитів. Концентричне ремоделювання і гіпертрофія ЛШ характеризуються збільшенням кількості моноцитів, що можна розглядати як незалежний предиктор патологічного ремоделювання міокарда; Цель исследования: изучение популяционного состава лейкоцитов у больных острым Q-инфарктом миокарда, который возник на фоне артериальной гипертензии, и его связь с типом ремоделирования сердечной мышцы. Объект и методы: обследованы 130 больных с инфарктом миокарда (ИМ), которых разделили на 2 группы - 67 пациентов с ИМ без артериальной гипертензии (АГ) и 63 - с АГ. Проводили ЭхоКГ, определяли тип геометрии левого желудочка. Определяли количество лейкоцитов в крови и их популяции. Результаты: отмечали увеличение количества лейкоцитов в крови больных ИМ на 21% (p<0,001), а при ИМ и АГ - на 23,75% (p<0,001). У больных с ИМ и АГ увеличение лейкоцитов было за счет нейтрофилов, лимфоцитов и моноцитов. В то время, как у больных ИМ тип геометрии левого желудочка (ЛЖ) не влиял на показатели лейкограммы, при сопутствующей АГ отмечали значительное увеличение количества моноцитов при концентрической гипертрофии и ремоделировании миокарда ЛЖ. Выводы. Острый ИМ, который возник на фоне АГ, характеризуется увеличением общего количества лейкоцитов за счет нейтрофилов, лимфоцитов и моноцитов. Концентрическое ремоделирование и гипертрофия ЛЖ характеризуются увеличением количества моноцитов, что можно рассматривать как независимый предиктор патологического ремоделирования миокарда; Nowadays, arterial hypertension (AH) is possesses among 1 billion people worldwide and caused of 7.5 millions death every year. The age-related correlation between AH and incident of myocardial infarction (MI) and stroke was established: 54% cases of acute disturbances of cerebral circulation and 47% cases of acute coronary syndrome caused by high blood pressure. In the 1980s and 1990s, experimental evidence derived predominantly from large animal studies suggested that post infarction inflammation may accentuate ischemic myocardial injury in the reperfused heart; thus, inhibition of inflammatory signals was considered a potentially promising therapeutic target. In the infarcted heart, sudden necrosis of a large number of cardiomyocytes results in release of their intracellular contents and initiates an intense inflammatory reaction. Leukocytes play crucial role in acute and chronic inflammation. It’s known their role in MI incident and prognosis. But their count in different types of myocardial remodeling is still unknown. The purpose of study was to investigate of leukocyte population count in patients with MI and preliminary AH and discover its connection with myocardial remodeling. Object and methods. 130 patients with ST-elevation MI were involved to this study: 82 males (63.07%) and 48 (36.93%) females. The average age was (64.68±12.59) years. All patients were divided into 2 groups: 67 persons without AH and 63 persons with AH. Control group - 30 practically healthy persons similar for age and sex. Transthoracal echocardiography was performed and types of myocardial remodeling were calculated according to the recommendations of the American Society of Echocardiography (ASE) and the European Association of Echocardiography. The count of leukocytes and their population in blood were studied. Results. The leukocyte’s count in patients with acute MI was higher for 21% compared control group, and in patients with MI and previous AH - for 23.75% (p<0.001). We observed the increase of neutrophils, monocytes and lymphocytes in blood of patients with MI and AH compared with patients with MI without AH. No differences in leukocyte count and their population in blood in patients with acute MI without AH were observed. The monocyte’s count in blood of patients with MI and previous AH was higher for 25% in excentric hypertrophy, for 28.95% in concentric hypertrophy and for 35.71% in concentric remodeling of left ventricle (p<0.05). Conclusions. Acute myocardial infarction with preliminary arterial hypertension is characterized of leukocyte count increase with high levels of neutrophils, monocytes and lymphocytes. Concentric remodeling and concentric hypertrophy of left ventricle myocardium is characterized of monocyte count growth which can be used as predictor of pathological myocardial remodeling

Methodological approaches and features holding seminars on discipline «Ethics and deontology in pharmacy» at faculty of pharmacy

У статті наведені дані про методологічні підходи проведення семінарських занять з дисципліни «Етика і деонтологія у фармації» в рамках кредитно-модульної системи. Наводиться план та етапність підготовки до заняття, участь викладача у цьому процесі, методи активізації мислення студентів, сприйняття та осмислення завдань, активні форми навчання, які сприяють максимальному засвоєнню матеріалу. Подано етапність проведення заняття, форму оцінювання знань та вмінь студентів з урахуванням організаційної структури, що діє в умовах кредитно-модульної системи. Дана форма занять сприяє інтелектуальному розвитку студентів, стимулює у них пізнавальну активність, формує науковий світогляд, систему методів і прийомів пошуку істини та вчить культурі спілкування; В статье приведены данные о методологических подходах к проведению семинарских занятий по дисциплине «Этика и деонтология в фармации» в рамках кредитно-модульной системы. Приводится план и этапность подготовки к занятию, участие преподавателя в этом процессе, методы активизации мышления студентов, восприятия и осмысления заданий, активные формы обучения, которые способствуют максимальному усвоению материала. Подано этапность проведения занятия, форму оценивания знаний и умений студентов с учетом организационной структуры, действующей в условиях кредитно-модульной системы. Данная форма занятий способствует интеллектуальному развитию студентов, стимулирует в них познавательную активность, формирует научное мировоззрение, систему методов и приемов поиска истины и учит культуре общения; The article presents data on methodological approaches of seminars on the subject «Ethics and deontology in pharmacy» as part of credit-modular system. An phasing plan and prepare for class, the teacher involved in the process, methods of activating students thinking, perception and comprehension tasks, active learning, which promote maximum learning. Posted stages of employment, forms of assessment of knowledge and skills of students based organizational structure that acts as a credit-modular system. This form of employment promotes the intellectual development of students, stimulate their cognitive activity, forms the scientific worldview, a system of methods and techniques of searching for truth and teach the culture of communication. The purpose of the work — formation of cognitive activity, learning new methods of training to quality learning at seminars in students of 1st year of the Pharmaceutical Faculty. Object and methods. The study of ethics and deontology in pharmacy and is held at the I course of the Pharmaceutical Faculty. According to the program are trained pharmaceutical ethics in relation to the patient’s, physician, colleagues. Students also learn the principles of business ethics, guidelines for formation of steady moral status, principles of management, which will function effectively in the market. Important is knowledge on using ethical criteria for promotion of drugs on the market, since the work in the pharmacy is commercial in nature, but in the center of activity pharmacist should be no profit and the interests of the patient (client). The technology of preparation and holding of seminars involves a sequence of teachers and students, which includes two stages. I. Preparatory phase: 1. Board seminar topics (according to the thematic plan) formulation of its goals, objectives, basic and advanced questions. 2. Distribution cognitive tasks between students. 3. Recommendations on selection of basic information materials. 4. Conducting group and individual consultations. II. The main stage (in class): 1. Topic, goals, objectives classes. 2. Motivation training activities. 3. Hearing reports, papers, essays, presentations prepared by students. 4. Discussion, analysis of speeches and reports, organizing discussion of adjustments within the proposed theme. 5. The structural analysis of all speeches and responses, stimulation activity of students. 6. Holding results. During the classes the students can put some specific problematic issues that require independent thinking that will help more deeply understand the topic as a whole. Problem late workshop encourages a deeper understanding of the material contributes to its best consolidation, allows you to check the degree of mastering topics discussed. By active learning that facilitate the absorption of up to 70% of the material include role-playing, which are used in solving situational problems built on real facts on practice pharmacists and doctors. The purpose of role-playing games is to help students to study their feelings, thoughts and actions in a free supportive environment. Role play can provide a wealth of material for discussion. Each student has the opportunity to express their opinion without fear of censure or skepticism should play a situation suitable for all of this means. Teacher directs discussion, and engages her students all controls debates listens to arguments for «against» focuses on the principles of medical ethics. In studying this discipline students must: 1. To learn the basic concepts of ethical pharmaceuticals, pharmaceutical ethics, morals category. 2. Use the findings of WHO material about the role of pharmacists, pharmacists ethical Code of Ukraine in their careers. 3. Combine GPP principles with the basic requirements of ethics and deontology in pharmacy. 4. Determine the rules of communication with colleagues, patients, physician. 5. To learn the basics of professional communication algorithms communication with consumers medicine. 6. Consider the areas of motivation in activities pharmacist. 7. Illustrate examples of content WHO criteria to promote the medicine on the market. 8. Treat the key issues of advertising drugs. 9. Make a conclusion about the importance of bioethics as a modern direction of medicine and pharmacy. 10. Analyze examples (events that occur in practice) proper and improper performance of professional duties pharmacist. Current control is carried out on each class according to the specific objectives for each topic. In evaluating the learning activities of students standardized control methods: tests bank, structured written work, a structured procedure for the control of practical skills — modeling specific problems and ways to solve it. Final module control study carried out on completion of the module. Before final control students who have completed all work provided the curriculum and the study module scored the number of points not less than the minimum (56 points). The form of the final control are standardized and include control of theoretical and practical training. The following forms of control: 1) control of theoretical knowledge — tests (40 tests) from a database (maximum score 40, minimum — 30). 2) control of practical skills — solving two problems situational or psychological situations modeling 2 (maximum score 10, minimum — 4); 3) oral answers to questions 2 theoretical questions according to the module (maximum of 30 points, minimum — 16). The maximum number of points at the module — 200, including the current educational activity — 120 points, according to the final module control — 80 points

Does sex affect anticoagulant use for stroke prevention in nonvalvular atrial fibrillation?: The prospective global anticoagulant registry in the FIELD-Atrial Fibrillation

Background.Among patients with atrial fibrillation (AF), women are at higher risk of stroke than men. Using prospective cohort data from a large global population of patients with nonvalvular AF, we sought to identify any differences in the use of anticoagulants for stroke prevention in women and men. Methods and Results.This was a prospective multicenter observational registry with 858 randomly selected sites in 30 countries. A total of 17 184 patients with newly diagnosed (.6 weeks) nonvalvular AF and .1 additional investigatordefined stroke risk factor(s) were recruited (March 2010 to June 2013). The main outcome measure was the use of anticoagulants (Vitamin K antagonists, factor Xa inhibitors, and direct thrombin inhibitors) for stroke prevention at AF diagnosis. Of 17 184 patients enrolled, 43.8% were women. More women than men were at moderate-to-high risk of stroke (CHADS2 score .2: 65.1% versus 54.7%). Rates of anticoagulant use were not different overall (60.9% of men versus 60.8% of women) and in patients with a CHADS2 score .2 (adjusted odds ratio for women versus men, 1.00; 95% confidence interval, 0.92.1.09). In patients at low risk (CHA2DS2-VASc of 0 in men and 1 in women), 41.8% of men and 41.1% of women received an anticoagulant. In patients at high risk (CHA2DS2-VASc score .2), 35.4% of men and 38.4% of women did not receive an anticoagulant. Conclusions.These contemporary global data show that anticoagulant use for stroke prevention is no different in men and women with nonvalvular AF. Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk

Predictors of NOAC versus VKA use for stroke prevention in patients with newly diagnosed atrial fibrillation: Results from GARFIELD-AF

Introduction: A principal aim of the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) was to document changes in treatment practice for patients with newly diagnosed atrial fibrillation during an era when non–vitamin K antagonist oral anticoagulants (NOACs) were becoming more widely adopted. In these analyses, the key factors which determined the choice between NOACs and vitamin K antagonists (VKAs) are explored. Methods: Logistic least absolute shrinkage and selection operator regression determined predictors of NOAC and VKA use. Data were collected from 24,137 patients who were initiated on AC ± antiplatelet (AP) therapy (NOAC [51.4%] or VKA [48.6%]) between April 2013 and August 2016. Results: The most significant predictors of AC therapy were country, enrolment year, care setting at diagnosis, AF type, concomitant AP, and kidney disease. Patients enrolled in emergency care or in the outpatient setting were more likely to receive a NOAC than those enrolled in hospital (OR 1.16 [95% CI: 1.04-1.30], OR: 1.15 [95% CI: 1.05-1.25], respectively). NOAC prescribing seemed to be favored in lower-risk groups, namely, patients with paroxysmal AF, normotensive patients, and those with moderate alcohol consumption, but also the elderly and patients with acute coronary syndrome. By contrast, VKAs were preferentially used in patients with permanent AF, moderate to severe kidney disease, heart failure, vascular disease, and diabetes and with concomitant AP. Conclusion: GARFIELD-AF data highlight marked heterogeneity in stroke prevention strategies globally. Physicians are adopting an individualized approach to stroke prevention where NOACs are favored in patients with a lower stroke risk but also in the elderly and patients with acute coronary syndrome