Practical approaches to limit turnover nurses

Turnover of health care professionals in our country is particularly topical issue in modern conditions. There is a need for a new attitude to management turnover at medical professionals, analyze and refine their professional development. The aim of the study is to investigate the opinion of nursing leaders and health care sectors of intensive work and offer practical approaches to limit turnover. The most of managers are convinced that adequate material compensation is the basis on which must be built motivational incentive for staff retention (65.80%). The introduction of a modern system of appraisal is among the strategic objectives of 39.00%, while investments in training programs and qualification support and apply only in 36.60% of managers in health care. Self-developed and proposed - Model corrective policy management turnover and Model professional managerial governance and Approach to identifying problems and limiting turnover

Мултидисциплинарен подход при откриване на пациенти със сънна апнея – ролята на здравните професионалисти (опит на Филиал Шумен)

Изясняване ролята на здравните професионалисти при прилагане на мултидисциплинарен подход чрез участие на студенти от специалностите „Медицинска сестра“ и „Акушерка“ - филиал Шумен, при откриване на пациенти със сънна апнея

Информираност относно рисковете при сънна апнея – здравно образование (опит на Филиал Шумен)

Да се проучи мнението на студенти от специалностите „Медицинска сестра“ и „Акушерка“ във филиал Шумен относно информираността за идентифициране на рисковите фактори на синдрома на обструктивната сънна апнея

The profession of dental technician in the modern conditions

Целта на настоящата статия е да се анализира професията на зъботехника при съвременните условия и развитие на технологиите. През последните 30 години технологиите за производство на дентални конструкции претърпяват бурно развитие, което се изразява в три основни направления: цифровизация, симулация и въвеждане на технологиите за послойно изработване на детайлите. В зъботехническите лаборатории това доведе до: 1) коренна промяна в професията на зъботехника - свеждане на ръчния труд при изработване на денталните конструкции до минимум, преминаване към CAD-CAM производство, повишаване на компютърните умения и квалификация на зъботехниците; 2) коренна промяна в работата и взаимоотношенията на екипа дентален лекар - дентален асистент - зъботехник; 3) глобализация в световен мащаб на здравните услуги в денталната медицина и „здравен туризъм`, които оказват обратен положителен ефект и спомагат за създаване на клиники и зъботехнически лаборатории със специалисти и оборудване на високо европейско и световно ниво.The aim of the present paper is to analyze the profession of dental technician in the modern conditions and technological development. During the last 30 years the technologies for production of dental constructions underwent fast development, which is expressed in three main directions: digitalization, simulation and implementation of the additive technologies. In dental laboratories all these changes led to: 1. radical change in the profession of dental technician - reduce manual labor in manufacturing of dental construction to a minimum, transition to CAD-CAM production, increase the computer skills and qualification of the dental technicians; 2. radical change in the work and relationships of the team dentist - dental assistant - dental technician; 3. world globalization of the health services in dentistry and „health tourism`, which have positive effect and help to create clinics and dental laboratories with specialists and equipment of high European and global level

Impact of aquatic sports on the evolution of obstructive sleep apnea and snoring and other breathing disorders

Obstructive sleep apnea (OSA) is a clinical syndrome characterized by periodic reduction (hypopnea) or cessation (apnea) of airflow through the nose/mouth during sleep due to collapse of the upper respiratory tract lasting 10 seconds or more. Severe snoring, hypoxemia and micro-awakenings occur, leading to sleep fragmentation, daytime fatigue and drowsiness. One of the key factors for the development of OSA is obesity. Excessive alcohol consumption, smoking, and presence of relatives with sleep apnea are risk-increasing factors. The gold standard in diagnosis is polysomnographic examination.Various values and indices are monitored, the most important of which is the apnea/hypopnea index. Treatment includes control of risk factors and removal of breathing obstacles. In patients with more severe obstructive sleep apnea syndrome, the gold standard of treatment remains constant positive pressure ventilation during sleep.   Water sports have been part of programs for prevention of breathing disorders during sleep for many years.       Our goal is to confirm whether after active sea treatment, water sports and weight loss of patients symptoms of obstructive sleep apnea and snoring would be favorably affected, as well as to actively promote and educate our patients about a more active sports (and aquatic) life.      Results from our studies on patients with problems with the upper respiratory tract and OSA show that more than half did not practice sport. Some have common diseases, incl. allergic conditions. The influence of bad habits and the hereditary factor were confirmed as well.     Obstructive sleep apnea and snoring syndrome is a serious disease with consequences for patients and other people. Screening of at-risk patients should be continued and studies should be conducted on the effectiveness of current and new methods for diagnosing and treating the syndrome

The evolution of non-small cell lung cancer metastases in TRACERx

Metastatic disease is responsible for the majority of cancer-related deaths1. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relaps

The evolution of lung cancer and impact of subclonal selection in TRACERx

Lung cancer is the leading cause of cancer-associated mortality worldwide. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource

The evolution of non-small cell lung cancer metastases in TRACERx

Metastatic disease is responsible for the majority of cancer-related deaths. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse

Genomic–transcriptomic evolution in lung cancer and metastasis

Intratumour heterogeneity (ITH) fuels lung cancer evolution, which leads to immune evasion and resistance to therapy. Here, using paired whole-exome and RNA sequencing data, we investigate intratumour transcriptomic diversity in 354 non-small cell lung cancer tumours from 347 out of the first 421 patients prospectively recruited into the TRACERx study. Analyses of 947 tumour regions, representing both primary and metastatic disease, alongside 96 tumour-adjacent normal tissue samples implicate the transcriptome as a major source of phenotypic variation. Gene expression levels and ITH relate to patterns of positive and negative selection during tumour evolution. We observe frequent copy number-independent allele-specific expression that is linked to epigenomic dysfunction. Allele-specific expression can also result in genomic–transcriptomic parallel evolution, which converges on cancer gene disruption. We extract signatures of RNA single-base substitutions and link their aetiology to the activity of the RNA-editing enzymes ADAR and APOBEC3A, thereby revealing otherwise undetected ongoing APOBEC activity in tumours. Characterizing the transcriptomes of primary–metastatic tumour pairs, we combine multiple machine-learning approaches that leverage genomic and transcriptomic variables to link metastasis-seeding potential to the evolutionary context of mutations and increased proliferation within primary tumour regions. These results highlight the interplay between the genome and transcriptome in influencing ITH, lung cancer evolution and metastasis