Features of communication of a doctor with special groups of patients and in conflict situations.

The article describes an important component of the medical process which should be paid a special attention: the preparation of a young doctor – the communication between the physician and the patient and his relatives. Distinctive features of a modern patient: the tendency to control the state of his own health with simultaneous irresponsible attitude towards it; when revealing a disease, he/she is looking for the worst in himself/herself; the reduction of the moral character against the background of a decline in the morals of society, which affects the culture of the patient's behavior, makes him/her more aggressive; a modern patient is more lenient to himself/herself with an extremely demanding attitude to the doctor. Several interrelated functions of communication are distinguished: informational, interactive, perceptual, emotive (affective-commutative). The levels of communication are distinguished: social-role (ritual); business; intimate-personal. There are three types of communication: imperative; manipulative; dialogical (based on equal partnership). In the process of communication of the physician with patients, depending on the circumstances, two systems of communication can be used: verbal and nonverbal. In the relationship "patient-physician" R. Witch identifies 4 models: paternalistic, technocratic, collegian, and contractual. Each patient needs an individual approach, individual forms of communication and measures of physician’s psychotherapeutic influence, especially in the communication of the doctor with so-called “difficult” patients, as well as at the risk of conflict situations. Causes of conflict situations are: insufficient attention to the patient; characteriological features of a doctor and a patient; unreliable information about the state of health of the patient from the part of junior and middle medical personnel; lack of patient’s information consent for treatment; lack of coordination of the actions of different medical specialists; defects in the maintenance of medical records; professional incompetence

The choice of blood transfusion strategy in severe traumatic brain injury

Traumatic brain injury (TBI) remains one of the leading causes of long-term disability, especially among young and middle-aged people. One of the main directions of treatment for patients with TBI is to prevent the development of secondary brain damage due to systemic dysfunction. Anemia occupies an important place among them. Anemia is considered a marker of illness severity in critically ill patients and is included in the list of parameters for risk prediction in intensive care units. However, the relationship between anemia and adverse outcomes in patients with TBI is controversial. Aim. The purpose of the work is to analyze the effect of anemia on the course of severe TBI, to determine the position of anemia in the pathophysiological mechanisms of brain damage, the development of blood transfusion-associated complications, to evaluate different blood transfusion strategies (liberal and restrictive) and their impact on treatment results, taking into account individual tolerance to anemia. Studies suggest that the restrictive transfusion strategy could be useful in reducing complications and length of hospital stay. However, the lack of clear evidence for optimal hemoglobin levels as a trigger to initiate blood transfusions reinforces the need for further clinical studies. The use of multimodal neuromonitoring allows to evaluate the latest approaches to assessing individual hemoglobin thresholds. These methods could help in identifying patients at increased risk of complications and determining optimal strategies to manage anemia. Conclusions. The problem of tolerance to anemia in patients with severe TBI remains a controversial topic, and determining hemoglobin thresholds for blood transfusion in this group of patients requires further studies, special attention should therefore be paid to an individual approach to resolving the issue of red blood cell transfusion, in particular, integrating clinical status of a patient and concomitant pathology. The risk of possible brain damage worsening associated with anemia due to deterioration of cerebral oxygenation should always be weighed against the risk of developing transfusion-associated complications

Test strategies for industrial testers for converter controls equipment

Power converters and their controls electronics are key elements for the operation of the CERN accelerator complex, having a direct impact on its availability. To prevent early-life failures and provide means to verify electronics, a set of industrial testers is used throughout the converters controls electronics' life cycle. The roles of the testers are to validate mass production during the manufacturing phase and to provide means to diagnose and repair failed modules that are brought back from operation. In the converter controls electronics section of the power converters group in the technology department of CERN (TE/EPC/CCE), two main test platforms have been adopted: a PXI platform for mixed analogue-digital functional tests and a JTAG Boundary-Scan platform for digital interconnection and functional tests. Depending on the functionality of the device under test, the appropriate test platforms are chosen. This paper is a follow-up to results presented at the TWEPP 2015 conference, adding the boundary scan test platform and the first results from exploitation of the test system. This paper reports on the test software, hardware design and test strategy applied for a number of devices that has resulted in maximizing test coverage and minimizing test design effort

The influence of studies in Cognitive Wellness University for the elderly people on maintaining their cognitive functions.

Progressive aging of the population is accompanied by age-related changes in the body, primarily from the central nervous system, which causes a decline in the cognitive health of man and society as a whole. The emergence of cognitive deficits leads to a decrease in a person's ability to think, learn, actively perceive information, make decisions, worsen other psycho-physiological functions.The aim of our study was to assess the state of cognitive functions of the elderly people, the dynamics of their changes, depending on the age stage of life, as well as under the influence of program exercises and specially designed trainings aimed at activating mental and physical activity. 165 students of the university aged 55-85 years took part in the study. Two groups of subjects were identified. The first one numbering 100 people we divided into 3 subgroups in order to identify phased age-related changes in cognitive functions and, depending on this definition, the need for preventive or corrective measures: 1 subgroup - 55-65 years, 2 subgroup - 66-75 years and 3 subgroup - 76 years and older. The study of their cognitive functions was determined upon admission to the university. The second group consisted of 65 people, whose indicators of cognitive functions were determined in dynamics: at admission to the university and at the completion of training. To assess the level of cognitive functions, we used a formalized screening technique - the Montreal Scale. The established dynamics of the components of cognitive functions, depending on age, makes it possible to differentially approach the choice of preventive or corrective measures aimed at activating cognitive functions, in each age group with an emphasis on those of them that have been changed to a greater extent. The effectiveness of the proposed structure of studies at the university for the elderly was shown

The Influence of Studies in Cognitive Wellness University for the Elderly People on Maintaining Their Cognitive Functions.

Progressive aging of the population is accompanied by age-related changes in the body, primarily from the central nervous system, which causes a decline in the cognitive health of man and society as a whole. The emergence of cognitive deficits leads to a decrease in a person's ability to think, learn, actively perceive information, make decisions, worsen other psycho-physiological functions.The aim of our study was to assess the state of cognitive functions of the elderly people, the dynamics of their changes, depending on the age stage of life, as well as under the influence of program exercises and specially designed trainings aimed at activating mental and physical activity. 165 students of the university aged 55-85 years took part in the study. Two groups of subjects were identified. The first one numbering 100 people we divided into 3 subgroups in order to identify phased age-related changes in cognitive functions and, depending on this definition, the need for preventive or corrective measures: 1 subgroup - 55-65 years, 2 subgroup - 66-75 years and 3 subgroup - 76 years and older. The study of their cognitive functions was determined upon admission to the university. The second group consisted of 65 people, whose indicators of cognitive functions were determined in dynamics: at admission to the university and at the completion of training. To assess the level of cognitive functions, we used a formalized screening technique - the Montreal Scale. The established dynamics of the components of cognitive functions, depending on age, makes it possible to differentially approach the choice of preventive or corrective measures aimed at activating cognitive functions, in each age group with an emphasis on those of them that have been changed to a greater extent. The effectiveness of the proposed structure of studies at the university for the elderly was shown

Cognitive profile of victims in critical conditions associated with combat and non-combat trauma

Мета дослідження: визначити особливості когнітивних порушень при критичних станах, пов’язаних з бойовою і небойовою травмою. Обстежено 56 постраждалих: 19 з бойової травмою і 37 з небойовою травмою. Тяжкість травми оцінювалася за шкалою ISS, тяжкість при надходженні – за шкалами SAPS II і EmTraS. Стан когнітивних функцій до травми оцінювався ретроспективно з використанням опитувальника CFQ. Когнітивні функції після травми оцінювалися на другу добу, перед переведенням з відділення інтенсивної терапії та перед випискою з лікарні. Для оцінки когнітивних функцій використовували шкали MoCA і MMSE. Результати: У хворих з небойовою травмою відповідно до шкали MoCA зниження найбільше торкнулося уваги і мови, а у хворих з бойовою – уваги, зорово-конструктивних навичок і відстроченого відтворення. Згідно з даними шкали MMSE у хворих з небойовою травмою зниження відзначалося переважно за субшкалах уваги і рахунку, відтворення і малювання. У хворих з бойовою травмою картина зниження когнітивних функцій була схожою. Висновки: Застосування шкал MoCA і MMSE є важливим елементом моніторингу стану ЦНС при інтенсивній терапії постраждалих з бойовою та небойовою травмою; постраждалі з бойовою травмою мають деякі відмінності в когнітивному профілі від хворих з небойовою травмою.Цель исследования: определить особенности когнитивных нарушений при критических состояниях, связанных с боевой и небоевой травмой. Обследовано 56 пострадавших: 19 с боевой травмой и 37 с небоевой травмой. Тяжесть травмы оценивалась по шкале ISS, тяжесть при поступлении – по шкалам SAPS II и EmTraS. Состояние когнитивных функций до травмы оценивалась ретроспективно с использованием опросника CFQ. Когнитивные функции после травмы оценивались на вторые сутки, перед переводом из отделения интенсивной терапии и перед выпиской из больницы. Для оценки когнитивных функций использовали шкалы MoCA и MMSE. Результаты: У больных с небоевой травмой согласно шкале MoCA снижение больше всего коснулось внимания и речи, а у больных с боевой – внимания, зрительно-конструктивных навыков и отсроченного воспроизведения. Согласно данным шкалы MMSE у больных с небоевой травмой снижение отмечалось преимущественно в субшкалах внимания и счёта, воспроизведения и рисования. У больных с боевой травмой картина снижения когнитивных функций была похожей. Выводы: Применение шкал MoCA и MMSE является важным элементом мониторинга состояния ЦНС в интенсивной терапии пострадавших с боевой и небоевой травмой; пострадавшие с боевой травмой имеют некоторые отличий в когнитивном профиле от больных с небоевой травмой.The purpose of the study: to determine the peculiarities of cognitive impairment in critical conditions associated with combat and non-combat trauma. 56 injured were examined: 19 with combat trauma and 37 with non-combat trauma. The severity of the injury was assessed according to the ISS, the severity at admission on the scales of SAPS II and EmTraS. The state of cognitive functions prior to trauma was evaluated retrospectively using the CFQ. Cognitive functions after the injury were assessed on the second day, before transfer from the intensive care unit and before discharge from the hospital. MoCA and MMSE scales were used to assess cognitive functions. Results: Patients of both groups were comparable in age and severity of the trauma. In patients with non-combat trauma according to the MoCA scale, the decline was most affected by attention and speech, and in patients with combat was reduced attention, visual-constructive skills and delayed reproduction. According to the MMSE scale in patients with non-combat trauma, the decline was noted mainly in the attention and counting subscales, reproduction and drawing. In patients with combat trauma the picture of cognitive decline was similar. In patients with non-combat trauma, the condition of impaired cognitive functions during treatment in the intensive care unit did not change, but by the time of discharge, a partial restoration of visual-constructive/performing skills and increased attention, combined with a slight decrease in the subscale “abstraction” was noted. In the group with combat trauma, the level of cognitive functions remained unchanged throughout the period of treatment in the hospital with some improvement in the subscales “abstraction” and “orientation”. According to the MMSE scale in patients with noncombat trauma, the dynamics of the state of cognitive functions was generally consistent with the data obtained with the MoCA scale. In patients with combat trauma, the tendency to recovery was noted only at the stage of transfer from the intensive care unit and concerned only the subscale “reproduction”, “speech” and “writing”. At the stage of discharge from the hospital, most cognitive functions remained at the level of the previous stage, and such as “repetition” and “drawing” even decreased. Conclusions: The use of the MoCA and MMSE scales is an important element of the monitoring of CNS condition in intensive care for victims with combat and non-combat trauma; victims with combat trauma have some differences in the cognitive profile from patients with non-combat trauma