Package of services for children with special needs

Workers medico-social work or those that respond to the needs of the child in difficulty should use packages of care as opposed to a ‘accommodation fix everything. ` Complex needs of children and families are best satisfied by a combination of services - a mix of replacement or day care, counseling, material support and assistance to access local resources. The issue of nursing service for children with special needs provoked strong interest of the respondents. Two-thirds of them believe that such a service would satisfy the needs of their children (65%) units are those who would not trust the services offered by nursing service (3%). In terms of diagnosis of child most - great expectations on improving health are parents of children with musculoskeletal problems - apparatus and premature babies (100%) (p <0.05). When examining the results that professionals have achieved in their work with children with special needs most - a high percentage of parents indicated that their child has learned to communicate with children with the same problems (44.00%) and second place acquisition of social skills (30.00%), which is also associated with communication. Almost all parents of children with special needs have indicated that after the visit to DC have noticed improvement in their child (92.00%). Nursing service and day care center are the best combination for offering a package of medical and social services for children with special needs

Problem of smoking among students from fifth grade and the role of nurse in school health office

The majority of students surveyed confirmed their responses to the importance of the role of the school nurse for effective implementation of prevention of smoking (76.29%). More than half of the students surveyed indicated that they disapproval of their parents will be angry a lot when they realize that smoking (57.77%). Teenagers approved ban on smoking in public places for correct (73.09%). Students are aware that smoking harms and much indicates that it is a bad habit (68.64%). According to the opinion survey students` ways to solve the problem of smoking are basically two: strict laws (73%) and public engagement aimed at prevention (36.54%). The main factors that influence the risk behavior of young people: friendly round (43.95%), family environment (33.57%), education (68.39%), easy access to tobacco products (94.32%), direct and indirect advertising (36.54%), emulation and financial provision of the students (29.13%). The role of the school nurse is outlined on the basis of Decree № 3 of 27.04. 2000. and Ordinance № 1 on 08.02.2011 issued by the Ministry of Health

ERBB2mRNA expression and response to Ado-Trastuzumab Emtansine (T-DM1) in HER2-positive breast cancer

Trastuzumab emtansine (T-DM1) is approved for the treatment of human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (BC) and for residual disease after neoadjuvant therapy; however, not all patients benefit. Here, we hypothesized that the heterogeneity in the response seen in patients is partly explained by the levels of human epidermal growth factor receptor 2 gene (ERBB2) mRNA.We analyzed ERBB2 expression using a clinically applicable assay in formalin-fixed para n-embedded (FFPE) tumors (primary or metastatic) from a retrospective series of 77 patients with advanced HER2+ BC treated with T-DM1. The association of ERBB2 levels and response was further validated in 161 baseline tumors from the West German Study (WGS) Group ADAPT phase II trial exploring neoadjuvant T-DM1 and 9 in vitro BC cell lines. Finally

The Importance of Family Environment in Raising Children with Special Needs Aged 0-6 Years Old /// Значението на семейната среда при отглеждане на деца със специални нужди от 0 до 6 години

[EN] Children with special needs are a sensitive topic for society because they are subject to a policy of radical change from isolation in special institutions to deinstitutionalization and development of alternative care and other social services for them and their families. The present study accentuates on the global trends in child protection and realization of children’s rights, on the advantages of raising children with disabilities in family environment, the legal framework governing the status of children with mental and physical disabilities. Modelling of social services is analysed with emphasis on preventive services. A practice review of different EU countries with services for disabled children is presented, along with various forms of provision of health and social care for children with special needs aged 0-6 years old. The aim of this thesis is: To investigate the opinion of parents, medical professionals and social workers on the quantity and quality of care for children with special needs aged 0-6 years old, and based on the results to propose a model of nursing service which supports family environment care for these children. Tasks: To elicit the specific characteristics of children from orphanages in Varna, Shumen, Dobrich, Stara Zagora and Bourgas; parents` survey about their needs for special training and support; to explore the view of medical professionals and social workers who collaborate with families about the quality of services for children with special needs. Different sources of information have been given to the targeted groups: historical, documentary (many official documents from various state and municipal institutions and NGO`s are analysed), sociological, statistical and other. The presented stages of the study show the sequence of its organizational steps. The methodology includes concepts vocabulary and instruments developed for each of the surveyed groups: parents (61), medical specialists from orphanages (107), and health visitors trained in UNICEF project (43), experts from the social sphere (95). Results give insights on the contingent of children`s centres nosological affiliation (mostly CP), the needs for medical intervention and procedures and corresponding type of staff - speech therapists, psychologists, masseurs, physiotherapists. Parents’ expectations of health status outcome are putted together with actual achievements. These data, along with the opinion of the specialists for the barriers in communication with parents, emphasise the need of training and guidance for the families of children with special needs. Positive impact on the satisfaction of professionals working with special needs children is the emotional attitude of providing care; negative footprint is the workload and time deficit for quality service. Factors and practices designated to increase the satisfaction with the process of care of children with special needs have been derived for each of the studied groups. The degree of education, urban factors, etc., are considered as well. The core of the thesis is the formulation of a concept to create a nursing services model designated to carry out nurses’ duties in the homes of children with special needs to help parents raise their children in the most natural place - the family environment. The proposed model is based first of all on research and exploration of needs of children and their families in times of demanding policy for change towards deinstitutionalization. Not least, it partially challenges the issue of proper use of human resources in health care, particularly nurses’ competences as a product of a new type of education and the implementation of autonomous nursing care model. Conclusions are based on the content of the study; recommendations brought forward to the attention of the Ministry of Health Care, the Ministry of Labour and Social Policy, The Ministry of Education and Science and to the childcare centres are directly related to unresolved problems.[BG] Децата със специални нужди са тема, твърде чувствителна за обществото у нас, защото са обект на политика за коренна промяна – от изолация в затворени заведения към деинституционализация, развитие на алтернативни форми на грижи и различни социални услуги за деца и техните семейства. Поставя се акцент върху световните тенденции за закрила на децата и реализация на правата им, предимствата на отглеждане децата с увреждания в семейна среда, нормативната база, уреждаща статута на деца с психически и физически увреждания. Анализирано е моделирането на социални услуги с акцент върху превантивните услуги. Представен е опита на редица европейски страни за работа с аномални деца, както различни форми на предоставяне на здравни и социални грижи за деца със специални нужди от 0 -6 год. Целта на дисертацията е: „Да се проучи мнението на родители, медицински специалисти и социални работници относно обема и качеството на здравни грижи за деца със специални нужди (ДСН) 0-6 год. и на тази база да се предложи Модел на Сестринска служба (СС), подпомагаща отглеждане на тези деца в семейна среда.” Формулираните задачи са насочени към разрешаване на поставената цел: характеристика на обслужваните деца в Детски центрове към ДМСГД във Варна, Шумен, Добрич, Ст.Загора, Бургас; проучване сред родителите относно потребност от обучение и от подкрепящи структури; проучване мнението на медицински специалисти и експерти от социалната сфера относно работата със семействата и качеството на услугите при ДСН. На изследваните групи са посочени различни източници на информация и методи: исторически, документален (анализирани са множество официални документи на държавни и общински институции, неправителствени организации), социологически, статистически и др. Представените етапи на проучването доказват последователността на организационните стъпки в провеждането му. В методиката е включен понятийният апарат и разработен инструментариум за всяка от анкетираните групи: родители на децата (61), медицински специалисти от ДЦ към ДМСГД (107), патронажни сестри, обучавани по проект на УНИЦЕФ в ЦМДЗ (43), експерти от социалната сфера (95). Получената информация дава представа за контингента на детските центрове по нозологична принадлежност (най-вече ДЦП) , потребности от лечебни намеси и процедури и съответстващ на тях вид персонал - логопеди, психолози, масажисти, рехабилитатори. Очакваните от родителите резултати по отношение на здравословното състояние на децата посещаващи ДЦ са съпоставени с реалните постижения. Тези данни, наред с мнението на специалистите за бариерите при общуване с родителите, утвърждават необходимостта и насоките на обучение на семействата на децата. Положително върху удовлетвореността на специалистите, работещи с ДСН влияе емоционалната им нагласа за полагане на грижи за децата, а отрицателно - претовареността и недостига на време за качествено обслужване. За всяка от изследваните групи са изведени фактори и практики, които биха повишили удовлетвореността им от процеса на обгрижване на ДСН. Информацията е разгледана е по степен на образование, по градове и др. Ядрото на дисертационния труд е формулирането на идеята да се създаде Модел на Сестринска служба (СС), която да осъществява работа на сестрите по домовете на децата със специални нужди с цел подпомагане на родителите да отглеждат децата си в най-естественото място - семейната среда. Предложеният модел е основан на проучванията, на необходимостта от покриване потребностите на децата със специални нужди и техните семейства в период на императивно изискване на политиката за промяна към деинституционализация. Не на последно място той е част от отговора на въпроса за правилно използване на човешките ресурси в здравеопазването, в случая – на компетенциите на медицинските сестри, продукт на нов тип образование и прилагане на автономната дейност на сестрата. Изводите са изведени от съдържанието на проучването, дадените препоръки до МЗ, до МТСП, до МОН, до Детските центрове са пряко отнасящи се до нерешени проблеми

ERBB2mRNA Expression and Response to Ado-Trastuzumab Emtansine (T-DM1) in HER2-Positive Breast Cancer

Trastuzumab emtansine (T-DM1) is approved for the treatment of human epidermal growth factor receptor 2 (HER2)-positive (HER2+) metastatic breast cancer (BC) and for residual disease after neoadjuvant therapy; however, not all patients benefit. Here, we hypothesized that the heterogeneity in the response seen in patients is partly explained by the levels of human epidermal growth factor receptor 2 gene(ERBB2)mRNA. We analyzedERBB2expression using a clinically applicable assay in formalin-fixed paraffin-embedded (FFPE) tumors (primary or metastatic) from a retrospective series of 77 patients with advanced HER2+ BC treated with T-DM1. The association ofERBB2levels and response was further validated in 161 baseline tumors from the West German Study (WGS) Group ADAPT phase II trial exploring neoadjuvant T-DM1 and 9 in vitro BC cell lines. Finally,ERBB2expression was explored in 392 BCs from an in-house dataset, 368 primary BCs from The Cancer Genome Atlas (TCGA) dataset and 10,071 tumors representing 33 cancer types from the PanCancer TCGA dataset. HighERBB2mRNA was found associated with better response and progression-free survival in the metastatic setting and higher rates of pathological complete response in the neoadjuvant setting.ERBB2expression also correlated with in vitro response to T-DM1. Finally, our assay identified 0.20-8.41% of tumors across 15 cancer types asERBB2-high, including gastric and esophagus adenocarcinomas, urothelial carcinoma, cervical squamous carcinoma and pancreatic cancer. In particular, we identified highERBB2mRNA in a patient with HER2+ advanced gastric cancer who achieved a long-lasting partial response to T-DM1. Our study demonstrates that the heterogeneity in response to T-DM1 is partly explained byERBB2levels and provides a clinically applicable assay to be tested in future clinical trials of breast cancer and other cancer types

50 години Катедра „Социална медицина и организация на здравеопазването`

22 Май 201

Abstracts Of The Proceedings And The Posters From The Third Scientific Session Of The Medical College Of Varna

October 2-3, 201