Analysis of the hospitalization time impact on hospital mortality from acute myocardial infarction

Diseases of the circulatory system and their most severe form – acute myocardial infarction (AMI) – is one of the most important problems of modern medicine due to the steady increase in morbidity, negative impact on quality of life, early disability of patients. 19.5 % of patients die from AMI, 50 % among which die 90-120 minutes after the first symptoms of the disease. The aim of the research was to analyse the impact of hospitalization on the mortality of patients with AMI and predict the risk of death in case of untimely hospitalization of this category of patients. Materials and methods. We have conducted a retrospective analysis of 876 medical records of patients diagnosed with AMI who were treated in the cardiology department of Kharkiv Regional Clinical Hospital in 2019. During the study, we have used retrospective, logical, medical and statistical methods. Odds ratios and a 95 % confidence interval were also calculated. Results and discussion. The research revealed the impact of hospitalization on the organization of medical care and hospital mortality of patients with AMI. It was found that the largest share of patients with AMI, both among the dead and those who left the hospital, were hospitalized in the period from 2 to 12 hours from the onset of the disease (49.6 % and 52.33 %, respectively), as well as in period after 24 hours – 28.00 % and 21.70 %, respectively. The largest share of patients with AMI, regardless of the time of hospitalization were persons older than 60 years. The results of the analysis showed that in the period up to 2 h from the onset of the disease, the share of hospitalized patients with more severe heart muscle damage (presence of Q wave) was 91.35 % against 8.65 % of patients with AMI without ST segment elevation. It should be noted that in almost 50 % of cases, patients with AMI without ST segment elevation were hospitalized after 24 h from the onset of the disease. At the same time, the largest share of deaths in this group of patients was observed in the hospital stay from 12 to 24 hours. According to the results of the research, risk factors for fatal outcome in AMI were identified, in particular male gender, the presence of an established ECG diagnosis of NSTEMI, conducting SKA in patients with AMI. It was also found that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %. Conclusions. The obtained data indicate a strong relationship between the time of hospitalization and the organization of medical care and hospital mortality of patients with AMI. It is reliably established that timely hospitalization of patients within the therapeutic window reduces the chances of hospital mortality by 52 %: HS is 0.483 (95 % CI 0.238 – 0.981), p=0.175

Analysis of indicators of time spent by emergency medical service team in acute coronary syndrome with elevation of st segment at the stage of direct stay on call

Urgency. The period of a patient’s hospitalization from the beginning of the disease has an important role in the provision of medical care. According to the Unified Clinical Protocol for the provision of medical care to acute coronary syndrome (ACS) patients, the latter must be hospitalized to an expert healthcare center in 90-120 minutes. That is why the main areas of pre-hospital care include the rapid recognition of acute myocardial infarction (AMI), stabilization of the patient's condition and his rapid transportation to the appropriate medical institution. The time from the appearance of the first symptoms of a heart attack to the arrival of the patient in the admission department of the hospital is an important factor influencing the course of AMI in further treatment, so to reduce the loss of time at this stage is important. The aim of the study was to analyze the time spent on the implementation of the protocol of assistance in AMI with the rise of the ST segment at direct stay of the emergency team on call. Materials and methods. A questionnaire survey of 85 emergency physicians working in Kharkiv was conducted. System approach, analytical, sociological (questionnaire), computer data processing and statistical methods were used. Results and discussion. The time spent on the implementation of each item of the protocol of medical care in ACS with elevation of ST segment by emergency teams directly on call have been analysed and several important patterns were identified. It has been revealed that according to some indicators of time, individual teams differed by 5-10 times. An emergency physician job seniority turned out to be an important factor. The general trend was the lowest time spent on individual tasks by doctors who had an average length of service in the ambulance (10 - 20 years), slightly higher - by doctors who had the longest work experience (over 20 years), and the largest - in doctors with the shortest work experience (up to 10 years). The differences between the senior and middle groups were less significant than between the junior and middle groups. Conclusions. The results obtained indicate significant variability in the implementation of protocol items in different emergency teams. A longer time to perform protocol items in the group with long job seniority may be related to the doctors’ age perculiarities (the average age is 57 y.o., with the presence of people over 70 y.o.). The longest execution time is in the group with the shortest experience in the emergency medical service. This naturally reflects the lack of experience and a greater number of diagnostic and treatment errors

Theoretical bases of management of enterprise risks

На сьогодні виникають великі проблеми в дослідженні інноваційних проектів, пов’язані з принциповою новизною продукту, невідомістю ринку, спеціальною підготовкою персоналу, а також із підприємницькими ризиками. Під час інвестування капіталу завжди присутній ризик. Він є обов’язковим елементом ринкової економіки. Ризик і небезпека втрат властиві будь-якій економічній діяльності. Існування підприємницьких ризиків робить необхідним управління ними. Управління підприємницькими ризиками визначає можливості забезпечення стійкості підприємства. В сучасній економічній науці ідентифікація багатьох видів ризиків здійснюється суб'єктивно на основі експертних оцінок. Управління ризиками повинне бути невід'ємним елементом фінансової стратегії і тактики підприємства. Для вирішення поставлених завдань застосовувалися загальнонаукові та спеціальні методи, в тому числі спостереження, аналіз і синтез інформації, метод експертних оцінок. використовувалося графічне, табличне та схематичне уявлення розглянутих економічних процесів. Досліджено поняття «ризик», «підприємницький ризик», охарактеризовано класифікацію ризиків в умовах ринкової економіки, проаналізовано різновиди ризиків в підприємницькій діяльності. Як інструмент управління кредитними ризиками розроблена рейтингова модель оцінки кредитоспроможності дистриб'юторів, на основі якої необхідно проводити комплексний аналіз фінансових і нефінансових факторів, що характеризують платоспроможність і надійність контрагентів, і на підставі отриманих даних визначати максимальну величину обсягу поставки продукції кожному дистриб'ютору на умовах відстрочення платежу. Систематизація наявних ризиків і застосування обґрунтованих інструментів для їх зниження дозволить підприємствам збільшити ефективність своєї діяльності. Розробка способів і методик у сфері розвитку системи управління підприємницькими ризиками є актуальним аспектом ведення підприємницької діяльності для забезпечення можливості розвитку підприємницької діяльності та впровадження інноваційних механізмів.Today, there are major problems in the study of innovation projects related to the fundamental novelty of the product, market unknown, special training of personnel, as well as business risks. Investing in capital is always at risk. It is an indispensable element of a market economy. The risk and the risk of losses are inherent in any economic activity. Existence of business risks makes it necessary to manage them. Business risk management determines the ability to ensure enterprise sustainability. In modern economic science, identification of many types of risks is carried out subjectively on the basis of expert assessments. Risk management should be an integral part of the company's financial strategy and tactics. For solving the tasks used general scientific and special methods, including observation, analysis and synthesis of information, method of expert assessments. graphical, table and schematic representation of the considered economic processes was used. The concept of "risk", "entrepreneurial risk" is investigated, risk classification in a market economy is characterized, varieties of risks in entrepreneurial activity are analyzed. As a credit risk management tool, a rating model for assessing the creditworthiness of distributors has been developed, which requires a comprehensive analysis of financial and non-financial factors that characterize the solvency and reliability of counterparties and, based on the data obtained, determine the maximum amount of output for each distributor under conditions deferred payment. Systematization of existing risks and the use of grounded tools for their reduction will allow enterprises to increase the efficiency of their activities. The development of methods and techniques in the field of developing an enterprise risk management system is an important aspect of entrepreneurial activity in order to ensure the development of entrepreneurial activity and the introduction of innovative mechanisms

To the fauna of chewing lice (Phthiraptera) of birds in the Lower Don region, Russia. Non-Passeriformes. Part 2

The aim of this work is to study the fauna of chewing lice in birds of the Lower Don region, Russia. The paper continues our previous investigations. Chewing lice were collected in 2001–2019. In total, 441 birds of 37 species from five orders of nonpasserines were examined: Anseriformes (4), Apodiformes (1), Charadriiformes (22), Columbiformes (5), Coraciiformes (2), Pelicaniformes (1) and Podicipediformes (2 species). Fifty four species of chewing lice belonging to the families Menoponidae and Philopteridae were collected from 322 birds and identified. Among them 16 species of chewing lice are recorded for the fauna of Russia for the first time: Bonomiella columbae Emerson, 1957, B. concii Eichler, 1947, Eidmanniella pellucida (Rudow, 1869), Meromenopon incisum (Giebel, 1874), Acidoproctus moschatae (Linnaeus, 1758), Campanulotes drosti Eichler, 1950, Capraiella subcuspidata (Burmeister, 1838), Columbicola bacillus (Giebel, 1866), Cummingsiella aurea Hopkins, 1949, Lunaceps actophilus (Kellogg et Chapman, 1899), L. falcinellus Timmermann, 1954, Pectinopygus gyricornis (Denny, 1842), Rhynonirmus helvolus (Burmeister, 1838), Quadraceps anagrapsus (Nitzsch, 1866), Q. phaeonotus (Nitzsch, 1866), Saemundssonia laticaudata (Rudow, 1869). Some of these species are illustrated in the paper. We also found one new host record: Saemundssonia lari (Fabricius, 1780) from Larus ichthyaetus Pallas, 1773. Austromenopon transversum Złotorzycka, 1968 and Actornithophilus piceus (Denny, 1842) are formally confirmed for recently separated two species of birds, Larus michahellis (J.F. Naumann, 1840) and Larus cachinnans (Pallas, 1811)

THE LEVEL OF MENTAL STRESS, AND SELF - ESTEEM OFCHILDREN’S HEALTH WITH CHRONIC KIDNEY DISEASE

The most frequent mental changes in children can include increased anxiety, depression, aggression and anger, the existence of which may contribute to the progression of physical illness. Materials and methods. The study involved 49 children aged 7 to 17 years (mean age 12,7 ± 3,1let) with chronic kidney disease. Further assess psychological stress based on the level of anxiety, aggression, anger, and depression. Results. In assessing the level of anxiety, aggression, anger, and depression in all groups of children prevailed with the average of 73,1 ± 7% to 87,8 ± 5,1% of children in the group. At 24,3 ± 7% of children identified elevated levels of aggression, half of whom had congenital abnormalities of the urinary system. Most children 38 (86,3 ± 5,2%) level of depression was within average. Established cases of depression to improve small, moderate and significant among girls 13,5 ± 1,5years, which amounted to 13,6 ± 5,2% of children. Conclusions. The most vulnerable are children, particularly girls with chronic kidney disease on the background of congenital anomalies of the urinary system. All children with chronic kidney disease is necessary to evaluate the level of mental strain for the optimization of measures to prevent recurrence of the disease and improve the quality of life ofchildren

PCR Results of Vector and Carrier Investigations for the Presence of Tick-Borne Borreliosis, Human Monocytic Ehrlichiosis, and Human Granulocytic Anaplasmosis Agents in Natural Foci of the Rostov Region

Objective of the study is to detect the circulation of the agents of ixodic tick-borne borreliosis (ITB), human monocytic ehrlichiosis (HME), and human granulocytic anaplasmosis (HGA) in samples collected from carriers and vectors of transmissible tick-borne infections using PCR-assay. Materials and methods. Field material was studied in PCR for evaluating the rate of infection by causative agents of tick-borne infections (tick-borne borrelioses, ehrlichioses, anaplasmosis) in combined natural foci on the territory of the Rostov Region. Results and conclusions. The data obtained during epizootiological investigations carried out in 21 administrative districts and 10 cities of the Rostov Region between 2014 and 2016 were used in the study. The results were indicative of spontaneous infection in ixodic ticks by ITB causative agent on the territory of the Rostov Region, as well as of presence of corresponding natural focus. Since 2013 the activity of different components of ITB natural focus was confirmed by the detection and official registration of patients. Moreover, in the Rostov Region for the first time ever the circulation of HME and HGA causative agents was recorded and territorially combined foci of HME and HGA with ITB were identified. The results obtained allow assuming the genesis of a focus of ixodic tick-borne borreliosis and monocytic and granulocytic ehrlichioses owing to annual expansion of the areal of ticks, infected by these pathogens, and animals on which the ticks are feeding. PCR-analysis is of significant value for assessment of spread of causative agents of the “tick-borne” infections in the Rostov Region, forecasting of epidemiological situation, as well as implementation of preventive measures in the region

Мухи кровососки (Hippoboscidae: Diptera) дневных (Falconiformes) и ночных (Strigiformes) хищных птиц Палеарктики

The purpose of the research: the study of the species composition of louse flies in diurnal (Falconiformes) and nocturnal (Strigiformes) birds of prey from Palearctic. Materials and methods. The material was collected during ornithological research on stationary plots of lands of Moscow and Moscow Region, Ukraine, Belarus and Kazakhstan. In 1997-2016 we examined six species of diurnal (Falconiformes) and seven species of nocturnal (Strigiformes) birds of prey, which are collected from 224 individuals of 4 species of louse flies. Results and discussion. 224 flies on diurnal (Falconiformes) and nocturnal (Strigiformes) birds of prey from Palearctic were determined. Four species of louse flies were registered: Ornithomyia avicularia (61,11 %), O. fringillina (29,03 %), Pseudolynchia canariensis (1 %), O. chloropus (0,1 %). O. avicularia was recorded in 18 species of Palearctic raptors. O. fringillina was observed on 5 of 26 species Palearctic raptors. P. canariensis was registered on 7 of 26; O. chloropus on 12 of 26 species of birds of prey. The greatest species diversity of louse flies (7 species: Ornithoica unicolor, Ornithomya avicularia, O. chloropus, O. fringillina, Ornithoctona auslatras, Pseudolynchia canariensis, P. garzettae) were found on the Eurasian Sparrowhawk (obligate ornitofag), on Goshawk - 3 species of keds (Ornithoica unicolor, Ornithomya avicularia, O. chloropus).Цель исследований: изучение видового состава мух кровососок дневных (Falconiformes) и ночных (Strigiformes) хищных птиц Палеарктики. Материалы и методы. Материал собирали в процессе орнитологических исследований на стационарных участках Москвы и Московской области, Украины, Беларуси, Казахстана. В 1997-2016 гг. обследовано 6 видов дневных (Falconiformes) и 7 видов ночных (Strigiformes) хищных птиц, с которых собрано 224 особи мух кровососок четырех видов. Результаты и обсуждение. Определено до вида 224 мух на дневных (Falconiformes) и ночных (Strigiformes) хищных птицах Палеарктики. Зарегистрировано четыре вида кровососок: Ornithomyia avicularia (61,11%), O. fringillina (29,03%), Pseudolynchia canariensis (1%), O. chloropus (0,1%). O. avicularia известна для 18 видов хищных птиц Палеарктики. O. fringillina отмечена на 5 из 26 видов хищных птиц Палеарктики. P. canariensis зарегистрирован у 7 из 26 видов хищных птиц, O. chloropus - у 12 из 26 видов хищных птиц. На ястребе перепелятнике (облигатный орнитофаг) обнаружено самое большое видовое разнообразие кровососок - 7 видов: Ornithoica unicolor, O. avicularia, O. chloropus, O. fringillina, Ornithoctona auslatras, P. canariensis, P. garzettae, на тетеревятнике - 3 вида кровососок: Or. unicolor, O. avicularia, O. chloropus

Epizooty of Tularemia, Detected in the Population of the Common Vole in the Natural Focus of Steppe Type in the South-East of the Rostov Region in 2020

The aim of study was to conduct epizootiological monitoring of natural tularemia foci of the steppe type and investigate epizootic activity in the south-east of the Rostov Region.Materials and methods. An epizootiological survey was carried out on the territory of Remontnensky, Sal’sky and Peschanokopsky districts of the Rostov Region in 2019–2021. To capture and collect mammals, Ixodidae ticks and to study the samples of field material conventional methods were used.Results and discussion. Habitation of 16 species of small mammals, 6 species of Ixodidae ticks has been found. Molecular-genetic analysis of the voles has revealed the presence of the species Microtus arvalis obscurus in the studied area of the region. The circulation of the tularemia agent has been established in the population of common and social voles, forest mouse, hare, rook, Dermacentor marginatus, Hyalomma marginatum, removed from rooks. In May 2020, a high increase in the number of the social vole in the Remontnensky district (up to 21 %), in July 2020 – the common vole in the agrocenoses of the Sal’sky district (up to 33 %) was observed. An extensive epizooty of tularemia was detected in the population of common vole in the south-east of the Rostov Region and in adjacent territories in the Republic of Kalmykia and the Stavropol territory. Two cultures of the pathogen were isolated from the fallen and captured social voles, and four cultures – from the common vole. The isolated strains belong to the Holarctic subspecies of Francisella tularensis EryR. The results obtained attest to the activation of the natural tularemia focus in the south-east of the Rostov Region and its high epizootic activity

Epidemiological analysis of the lyme borreliosis incidence in Rostov region

Purpose: to conduct an epidemiological analysis of the Lyme borreliosis incidence in Rostov region to determine the modern nosoareal and to identify the characteristics of the epidemic process in clinical practice.Materials and methods: the analysis of incidence was performed according to the data provided by the Center for Hygiene and Epidemiology in Rostov Region with the use of the traditional methods of retrospective and operational analysis. For data processing we used generally accepted methods of variational statistics.Results: the level and the long-term dynamics of incidence of Lyme borreliosis (LB) in Rostov region during the period from 2012 to 2018 have been analyzed. It was determinated that human infection occurs in natural, mixed and anthropurgic foci, with an obvious seasonal character - increasing in May-July. The most affected is working-age population from urban areas. The illness is flowing in erythemal form of moderate severity. We have determined that the modern nosoareal consists of 22 administrative territories of the region.Conclusion: The obtained data indicate relevance and necessity for proper clinical and epidemiological researches in the study of Lyme borreliosis in Rostov region

Аналіз фармацевтичної складової системи екстреної медичної допомоги в Україні

Aim. To determine the role of the pharmaceutical component of emergency medical care inUkraine.Materials and methods. Methods of information search, content-analysis, methods of comparison and generalization were used to carry out the research tasks.Results and discussion. The organizational structure of emergency medical care inUkraine has been studied. It has been detailed that sub-subordinated structural units of the Department of Emergency Medical Care and Disaster Medicine at the Ministry of Health ofUkraine are the Department of Pre-hospital and Hospital Emergency Medical Care, as well as the Department of Coordination and Provision of Medical Care during antiterrorist operations, emergency and martial law. The methodology of forming a list of medicines for the provision of medical services for disasters has been described; it is based on the standards of a set of medical equipment for medical assistance in emergencies, developed by the World Health Organization. The formation of a departmental reserve of medicines and medical products has been specified. At the same time, it has been determined that the supply, replenishment and replacement of medicines is carried out at the expense of domestic manufacturers and imports of active pharmaceutical ingredients, which list in total covers approximately 60 pharmacological groups of a specific and wide spectrum of action. The analysis of the pharmaceutical component of theEmergencyMedicalCenter and Disaster Medicine in various modes of operation has been performed.Conclusions The results of the study of the pharmaceutical component of the emergency medical care system in Ukraine and detalization of its organizational structure make it possible to emphasize the validity of the complete set of mobile medical service formations of disaster medicine with normative stocks of medicines and medical equipment, which effectiveness in the conditions of higher-preparedness regimes and/or emergency situations will provide a complex of measures aimed at timely, complete and safe caretaking the medical, sanitary, and specialty property of medical institutions, medical formations and the population of the country. Цель работы – определение роли фармацевтической составляющей экстренной медицинской помощи в Украине.Материалы и методы. Для реализации поставленных задач исследования использовались методы информационного поиска, контент-анализа, приемы сравнения и обобщения.Результаты и их обсуждение. Исследована организационная структура экстренной медицинской помощи Украины. Детализировано, что субподчиненными структурными подразделениями Управления экстренной медицинской помощи и медицины катастроф при МЗ Украины являются отдел догоспитальной и госпитальной экстренной медицинской помощи и отдел координации и обеспечения медицинской помощи во время антитеррористических операций, чрезвычайного и военного положения. Охарактеризована методика формирования перечня лекарственных средств для оснащения службы медицины катастроф, в основу которого заложены нормативы комплекта медицинского оснащения для оказания медицинской помощи при чрезвычайных ситуациях, разработанного Всемирной организацией здравоохранения. Конкретизировано формирование ведомственного резерва лекарственных средств и медицинских изделий, при этом установлено, что наполнение, пополнение и замена лекарственных средств осуществляется за счет отечественных производителей и импортных поставок активных фармацевтических ингредиентов, перечень которых в совокупности охватывает около 60 фармакологических групп специфического и широкого спектра действия. Проведен анализ деятельности фармацевтической составляющей Центра экстренной медицинской помощи и медицины катастроф в различных режимах функционирования.Выводы. Результаты проведенного исследования фармацевтической составляющей системы экстренной медицинской помощи в Украине и детализация ее организационной структуры позволяют подчеркнуть актуальность комплектации мобильных формирований службы медицины катастроф нормативными запасами лекарственных средств и медицинского оборудования, эффективность использования которого в условиях режимов повышенной готовности и/или чрезвычайных ситуаций обеспечит комплекс мероприятий, направленных на своевременное, полное и бесперебойное обеспечение медицинским, санитарно-хозяйственным и специальным имуществом лечебных учреждений, медицинских формирований и население страны.Мета роботи – визначення ролі фармацевтичної складової екстреної медичної допомоги в Україні.Матеріали та методи. Для реалізації поставлених завдань дослідження використовувались методи інформаційного пошуку, контент-аналізу, прийоми порівняння та узагальнення.Результати та їх обговорення. Досліджено організаційну структуру екстреної медичної допомоги в Україні. Деталізовано, що субпідлеглими структурними підрозділами Управління екстреної медичної допомоги та медицини катастроф при МОЗ України є відділ догоспітальної і госпітальної екстреної медичної допомоги та відділ координації та забезпечення медичної допомоги під час антитерористичних операцій, надзвичайного та воєнного стану. Охарактеризована методика формування переліку лікарських засобів для оснащення служби медицини катастроф, в основу якого закладені нормативи комплекту медичного обладнання для надання медичної допомоги при надзвичайних ситуаціях, розроблених ВООЗ. Конкретизовано формування відомчого резерву лікарських засобів і медичних виробів, при цьому встановлено, що наповнення, поповнення і заміна лікарських засобів здійснюються за рахунок вітчизняних виробників і імпортних поставок активних фармацевтичних інгредієнтів, перелік яких у сукупності охоплює близько 60 фармакологічних груп специфічного і широкого спектра дії. Проведено аналіз діяльності фармацевтичної складової Центру екстреної медичної допомоги та медицини катастроф у різних режимах функціонування.Висновки. Результати проведеного дослідження фармацевтичної складової системи екстреної медичної допомоги в Україні та деталізація її організаційної структури дозволяють підкреслити актуальність комплектації мобільних формувань служби медицини катастроф нормативними запасами лікарських засобів і медичного обладнання, ефективність використання якого в умовах режимів підвищеної готовності і/або надзвичайних ситуацій забезпечать комплекс заходів, спрямованих на своєчасне, повне і безперебійне забезпечення медичним, санітарно-господарським і спеціальним майном лікарняних закладів, медичних формувань і населення країни.