СУЧАСНІ КОМП’ЮТЕРНІ ТА МУЛЬТИМЕДІЙНІ ТЕХНОЛОГІЇ ЯК ЗАСІБ ПРОБЛЕМНО-ОРІЄНТОВАНОГО НАВЧАННЯ ПРИ ВИКЛАДАННІ КАРДІОЛОГІЇ НА ЗАСАДАХ ЄВРОПЕЙСЬКОЇ КРЕДИТНО-ТРАНСФЕРНОЇ СИСТЕМИ ОРГАНІЗАЦІЇ НАВЧАЛЬНОГО ПРОЦЕСУ (ЄКТСОНП)

The aim of the study – to analyze the experience of modern computer and multimedia technologies implementation in teaching Inner Medicine according to ECTS principles.The main body. The experience of the cardiology teaching at department of internal medicine and nursing of SHEI “Ivano-Frankivsk National Medical University” of Ministry of Healthcare of Ukraine is analyzed in the article. It is proved that conduction of part of cardiology practical classes as morning conferences (1.5 hours) caused to creative thinking formation in students based on the traditional theoretical knowledge and practical skills and also on modern interactive computer technologies and visualization methods using (electrocardiograms, photo and video protocols of echocardiography and coronarography, multispiral computer tomography with multiplane reconstruction, magnetic resonance tomography etc). Results of cardiology teaching signi ed about positive in uence of this method into clinical thinking development, level of theoretical knowledge and practical skills in 6-year students of medical faculty and faculty of foreign students’ training.Conclusion. The introduction of modern computer and multimedia technologies in educational process on the principles of problembased learning contributes to the higher level of training of students and bringing them closer to current international standards, and increases the competitiveness of Ukrainian universities in the reformation of modern medicine.Мета роботи – проаналізувати досвід упровадження сучасних комп’ютерних та мультимедійних технологій при викладанні внутрішньої медицини згідно з принципами Європейської кредитно-трансферної системи організації навчального процесу.Основна частина. У статті проаналізовано досвід викладання кардіології на кафедрі внутрішньої медицини № 2 та медсестринства ДВНЗ “Івано-Франківський національний медичний університет” МОЗ України. Доведено, що проведення частини практичних занять із кардіології у форматі ранкових конференцій (1,5 год) сприяє формуванню креативного клінічного мислення студентів на основі не лише традиційних теоретичних знань і практичних навичок, але й застосування сучасних інтерактивних комп’ютерних технологій та методів візуалізації (електрокардіограм, фото і/або відео протоколів ехокардіографії, коронарографії, мультиспіральної комп’ютерної томографії з мультипланарною реконструкцією, магнітно-резонансної томографії тощо). Результати викладання кардіології свідчать про позитивний вплив такого методу на розвиток клінічного мислення, рівень теоретичних знань та практичних навичок студентів 6 курсу медичного факультету і факультету підготовки іноземних громадян.Висновок. Упровадження сучасних комп’ютерних та мультимедійних технологій у навчальний процес на засадах проблемно-орієнтованого навчання сприяє зростанню рівня підготовки студентів і наближенню їх до сучасних світових стандартів та підвищує конкурентоспроможність випускників українських ВНЗ у сучасних умовах реформування медицини

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)

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

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

New Oral Anticoagulants in the Treatment of Patients with Atrial Fibrillation

New oral anticoagulants are important pharmaceuticals for prevention of stroke and systemic embolism in non-valvular atrial fibrillation patients. Recently for prevention and treatment of thromboembolism in atrial fibrillation patients antagonists vitamin K, in particular warfarin were used. However, narrow therapeutic window, the need for lifelong monitoring of coagulation and negative interactions with many food products and pharmaceuticals reduces its use. Besides, long-term use of warfarin and its antagonism against vitamin K, which is the regulator of elimination of calcium from the body, can cause calcification of the coronary arteries and valvular heart. In connection with this new oral anticoagulants: dabigatran, rivaroxaban, apixaban are actively used in modern conditions. Their efficacy and safety is proved in randomized clinical trials: RF-LY, ROCKET -AF, ARISTOTLE

Multispiral Computed Tomography as a Universal Screening Method for Stable Coronary Artery Disease and Non-Coronarogenic Heart Diseases

Coronary bed condition in patients with different clinical forms of ischemic heart disease and painless myocardial ischemia was investigated in order to visualize atherosclerotic changes in coronary vessels during screenings.The results of multispiral computed tomography in 29 patients with different forms of coronary arteries disorders (stable coronary artery disease, unstable angina, painless myocardial ischemia) and in patients without severe coronary symptoms were analyzed in order to determine “calcium score” as a marker of atherosclerotic coronary vascular disease. Relation between the degree of increase in the coronary calcium score (CCS) (particularly in patients with hypertensive crisis in case history) and basic cardiodynamic characteristics was observed in patients with increased CCS. Reliable correlation between CCS and aortic stiffness index (r=0.82; p≤0.01), between CCS and pulse pressure (r=0.63; p&lt; 0.05)

Effect of humidity of method error for determining the calorific value of natural gas

W pracy opisano autorską metodę wyznaczania ciepła spalania gazu ziemnego. Metodę tę porównano ze znanymi w literaturze metodami pomiarowymi. Przeprowadzono symulacje wpływu wilgotności gazu oraz wilgotności względnej powietrza dostarczanego w procesie spalania, na względną różnicę wyznaczania ciepła spalania gazu ziemnego. Praca zawiera wyniki symulacji wraz z analizą wpływu wilgotności powietrza i gazu na wartość ciepła spalania gazu ziemnego.The paper presents the original method of determining the CALORIFIC VALUE of natural gas, which does not require drying the gas. The method consists in measuring the combustion temperature in a gas burner while maintaining a constant stream of gas mixture with air. This method was compared with methods known in the literature. Many currently used measuring methods that allow to determine the heat of combustion require the use of dry gas, which under industrial conditions is very often troublesome. The work discusses the basics of the natural gas combustion process based on which the simulations of the influence of water vapor contained in both natural gas and air supplied to the burner on the calorific value of gas were carried out. The results of the simulation were used to determine the errors of the proposed measurement method. Simulations were carried out for diversified chemical composition of natural gas and various water vapor content. Based on the conducted simulations, it was found that the relative difference error is within 0.5% to 1.7% for different values of moisture contained in both the gas and air involved in the combustion process

Effect of Different Chemotherapy Regimens on the Development of Drug-Induced Liver Disease in Patients with Chronic Lymphocytic Leukemia

The objective of the research was to establish the frequency and variability of drug-induced liver disease (DILD) in patients with chronic lymphocytic leukemia (CLL) according to the chemotherapy (CT) regimens. It was proved an adverse effect of investigated chemotherapeutic agents on the dynamics of functional state of the liver and heterogeneity of peculiarities of drug-induced lesions of hepatocytes based on the type of drug applied due to cytostatic treatment was established. Type of drug-induced liver disease (DILD) was determined depending on the degree of increase of alanine aminotransferase and alkaline phosphatase. It was established that usage of leukeran as the main drug in the chemotherapy of chronic lymphocytic leukemia led to holestastatic syndrome (70.27%) that caused growth of serum bilirubin and alkaline phosphatase. The application of the FC scheme for the CLL treatment led to formation of the cytolysis syndrome (81.58%) with increased plasma concentration of transaminases. The use of the CHOP contributed to such signs as cholestatic cytolytic syndromes (65%). It was established the dependence of the degree of hepatotoxicity on chemotherapy regime and presence of risk factors. The presence of two or more risk factors had unfavorable prognosis regarding the degree of hepatotoxicity.

Мультимедійні методи навчання іноземних студентів як спосіб підвищення мотивації їх у навчанні

The paper deals with topical issues of teaching internal medicine to foreign students in a higher educational establishment at the present stage. It presents new methods, in particular, computer multimedia, movies, 3D technologies and elements of visual diagnostics, which contributes to a deeper understanding and effective mastering of theoretical knowledge of students, simultaneously the demonstration of a thematic patient, followed by a discussion of the problem according to the type of a dialogue between a teacher and student is the most effective method of learning practical skills, which are aimed at an improvement of the educational process.В статье изложены актуальные вопросы преподавания внутренней медицины студентам-иностранцам в высшем учебном заведении на современном этапе. Приведены новые методики, в частности компьютерных мультимедийных видеосюжетов, 3D технологий и элементов визуальной диагностики, что способствует углубленному пониманию и эффективному усвоению теоретических знаний студентов, вместе с тем демонстрация тематического больного с последующим обсуждением проблемы по типу диалога между преподавателем и студентом является наиболее эффективным методом усвоения практических навыков, которые направлены на улучшение учебного процесса.У статті викладено актуальні питання викладання внутрішньої медицини студентам – іноземцям у вищому навчальному закладі на сучасному етапі. Наведені нові методики, зокрема комп’ютерних мультимедійних відеосюжетів, 3D технологій та елементів візуальної діагностики, що сприяє поглибленому розумінню та ефективному засвоєнню теоретичних знань студентів, водночас демонстрація тематичного хворого з подальшим обговоренням проблеми шляхом діалогу між викладачем і студентом є найбільш ефективним методом засвоєння практичних навиків, які спрямовані на покращання навчального процесу