Эффективность применения перинатальных медицинских карт в деятельности перинатологических служб

Department of obstetrics and gynecology, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe Republic of Moldova’s goal is to reduce the maternal and perinatal morbidity and mortality by improving the quality of care and by increasing accessibility to qualitative health care by the general population. The government of Moldova and the Ministry of Health has shown the responsibility of improving maternal and child health, as well as assuring pregnancy and birth without risk through implementation of new technological costs to be effective. Ministry of Health Order No 139 of May 28, 2002 “On the approval of medical records in primary evidence health care institutions” and implementing Form 113/e “Medical Perinatal Card” is one of the most important moments for reaching success. The Medical Perinatal Card is one of the basic sources of information about perinatology services in Moldova, which is an obligatory standard for antenatal care. After an analysis of 200 Perinatal Medical Cards (this is one of the important mechanisms for making a decision of treatment during pregnancy, birth, and the period of confinement) of four main components: perinatal counseling service, obligatory and optional programs of investigation, and gravidogram compartment and collecting data of birth, newborn, breast feeding, postnatal period to assess the quality of evidence for medical documentation, showed that the degree of completion of perinatal medical notebook does not fulfill the National Perinatal Guidelines and requires improved implementation of Medical Perinatal Card as an obligatory standard for antenatal care; the more active implication and increase responsibility of medical workers towards evidence of medical documentation.Республика Молдова стремится к сокращению материнской и перинатальной заболеваемости и смертности путем улучшения качества и увеличения доступности к качественному медицинскому обслуживанию населения. Правительство Республики Молдовы и Министерство Здравоохранения продемонстрировали свою приверженность к улучшению здоровья матери и ребенка путем внедрения в медицинскую практику новых рентабельно-эффективных технологий. Приказом Министерства Здравоохранения № 139 от 28 мая 2002 г. «Об утверждении форм первичного медицинского учета в здравоохранительных учреждениях» является одним из ключевых моментов успеха. Медицинская перинатальная карта является одним из основных источников информации в деятельности перинатологических служб в Республике, обязательным стандартом для дородового наблюдения. Во время исследования, после анализа 200 медицинских перинатальных карт (это один из ключевых механизмов принятия решений при ведении беременности, родов и в послеродовом периоде), для оценки качества ведения медицинской документации по четырем основным компонентам: перинатальное консультирование, программа обследования и эволюция беременности, представленная графически – гравидограммой, роды и послеродовый уход, было установлено, что степень заполнения медицинских перинатальных карт не соответствует рекомендациям национальных перенатальных гидов. К сожалению, на сегодня можем констатировать, что предложенная для внедрения данная технология не нашла должного места и мы должны усилить реализацию данной рентабельно-эффективной технологии путем повышения ответственности медицинских работников за заполнение медицинской документации при ведении беременных

Интерактивное обучение в процессе непрерывного медицинского образования семейных медицинских сестер

Center for Continuing Medical Education of Medical and Pharmaceutical Personnel with secundary education, Congresul III al Medicilor de Familie din Republica Moldova 17–18 mai, 2012, Chişinău, Republica MoldovaInteractive learning is not opposed to classical learning, but it is a new quality of the objectives pursued by the formation of personality. Active and creative work is based on the student aimed at his reflection on his identity, the learning needs and expectations by testing in accordance with the particular educational and cognitive possibilities, practical and intellectual and physical effort. Metacognition involves analyzing the degree of difficulty of learning tasks and strategies for achieving them effectively. Lifelong learning – a goal of postmodern education – must be interactive and creative in adopting strategies to seek involvement, conscious learning and interest in continuous improvement. Интерактивное обучение не противоречит классическому обучению, но это новое качество целей, способствующее формированию личности. Активная и творческая работа курсанта направлена на свое отражение как предмет изучения потребностей и ожиданий на тестирование в соответствии с определенными образовательными и познавательными возможностями, практических, умственных и физических усилий. Познание включает анализ степени трудности учебных задач и достижения эффективных стратегий. Непрерывное обучение – цель постмодернистского образования, интерактивная реклама и творческий подход в принятии стратегии добиваться участия, сознательного обучения и интерес к постоянному совершенствованию

Sepsis sever: prezentare de caz

Clinica A.T.I. USMF „Nicolae Testemiţanu”, IMSP SCM „Sfânta Treime”, Chişinău, Republica Moldova, Congresul II Internaţional al Societăţii Anesteziologie Reanimatologie din Republica Moldova 27-30 august 2009Sepsisul reprezintă o problemă majoră de sănătate publică cu o incidenţă în continuă creştere şi o mortalitate extrem de ridicată, în jur de 40%. Sepsisul reprezintă „SIRS (Sindromul de Răspuns Inflamator Sistemic) generat de un proces infecţios”. Sepsisul sever este asociat cu disfuncţie de organ, hipoperfuzie (acidoză lactică, oligurie sau alterarea acută a statusului mintal) sau hipotensiune. O complicaţie potenţial letală este şocul septic ce evoluează cu hipotensiune în pofida resuscitării volemice adecvate. Scopul: Prezentarea unui caz de sepsis sever provocat de Pseudomonas aeruginosa. Pacienta S, 33 ani, a fost transferată la 25.02.2008, în secţia reanimare a SCM „Sfânta Treime” în stare extrem de gravă cauzată de sepsis tegumentar, flegmon al fesei drepte, tromboflebită a venelor profunde a piciorului stâng. Acuză: dureri şi tumefierea în regiunea fesei drepte şi în regiunea coapsei piciorului stâng, febră, temperatura 38.0º C. Din anamnestic: pacienta a născut pe 11.02.2008 în SCM nr.1 unde i s-a administrat metamizol şi diphenhydramin intramuscular. Pe 14.02.2008 a fost externată la domiciliu în stare satisfăcătoare. Peste 3 zile după externare, la pacientă a apărut tumefiere şi durere în locul injecţiilor, febră. A fost internată pe 18.02.2008 în secţia toxicologie cu diagnosticul reacţia alergică alimentară. Examenul de laborator denotă anemie, leucocitoză, VSH crescut, limfopenie, teste funcţionale hepatice uşor crescute, hipoproteinemie, hipokaliemie. Examenul ultrasonografic al abdomenului a decelat hepatosplenomegalie cu schimbări difuze în parenchim. Examenul EchoCG şi Doppler EchoCS a constatat: cavităţile cordului nu sunt dilatate cu fracţie de ejecţie păstrată, FE=66 %, Vmax insuf VM gr. I, vegetaţii pe valve nu s-au depistat. Radiografia cutiei toracice a permis identificarea pneumoniei în focar pe dreapta. Monitoring-ul în secţia reanimare: TAs, TAd, TAm , pulsul, PVC, SpO2, ECG, diureza orară, metabolismul gazos şi acido- bazic, electroliţii, analiza generală a sângelui, coagulograma, analiza biochimică a sângelui. Tratamentul intensiv indicat a inclus: oxigenoterapie, antibiotice administrate i/v (vancomicină 1 g×3ori, levofloxacină 500 mg×2 ori) fragmin, cristaloide, coloide, blocante H1 şi H2, vitamine B1, B6, C, B12. Tratament chirurgical: deschiderea infiltratului din regiunea fesei drepte. Ulterior, starea pacientei s-a agravat. Sepsisul sever a evoluat în Sepsis complicat cu sindrom MODS şi cu şoc septic. Cauza agravării stării generale: Flegmon extins circular a regiunii lombare bilateral şi feselor ambelor coapse. La tratamentul intensiv s-a mai adăugat: catecolamine, componente şi preparate sanguine (eritrocite spălate, PPC, crioprecipitat), terapie eferentă (plasmafereză curativă izovolemică izooncotică), antibioticoterapie ţintită (în baza antibiogramei prelevatului din plagă) – imipenem 0,5 g×3 ori . Starea bolnavei evoluează cu o uşoară ameliorare: în cunoştinţă, adecvată, respiraţie spontană, temperatura 37ºC, FR 20/min, FCC 94 b/min, TA 110/80 mmHg, diureza adecvată. Pe 19.03.2008 pacienta se transferă în secţia chirurgie. Concluzie: Succesul salvării bolnavului în sepsis complicat se bazează pe tratament chirurgical oportun şi adecvat, destinat înlăturării cauzei sepsisului pe fondalul terapiei polimodale intensive cu un monitoring argumentat tuturor disfuncţiilor/ insuficienţelor prezente la bolnav

ARTé: Mecenas

Skills and Ideas Taught: Gameplay engages and immerses students from the Medici perspective to demonstrate the interconnectedness of art patronage,economics and political pressures surrounding the commissioning of famous artworks of Italian Renaissance.Given a variety of scenarios, learners will: • Develop interconnected networks of Renaissance economics, art patronage and production, including art markets and collecting, conventional banking, trade and alternative banking practices such as usury. • Develop strategies to evaluate the impact of art and architecture patronage on generating spiritual and religious status and social and political prestige. • Distinguish between major artistic media, forms, techniques, and theoretical and critical concepts to develop a more holistic interpretation of the Renaissance era. • Leverage historical circumstances, conditions, and events surrounding art and architecture and their commission. Goal or Challenge: Too often in art history courses, students memorize works of art without understanding their context. ARTé: Mecenas helps them grasp the complexities of the works of art, the role of art given societal norms, and the overall relevance to the people and policies of the time period. The game provides an immersive experience to help students better apply and analyze the effects of complex social, cultural, economic, political and ecclesiastical networks on artwork, monuments and institutions.True to the life of the Medici, students must balance relationships with powerful city-states, merchant factions and the Catholic Church to build and maintain a financial empire and play a pivotal role in the creation of famous artworks, monuments and institutions of the Renaissance. By following the historical footsteps of the Medici family, students level up to the status of “Mecenas,” an influential patron of the arts, and experience the political, social and economic factors that shaped the era. The game features the most influential artworks of the 15th and 16th centuries, including more than 130 pieces of art by over 70 artists.Texas A&M University, College of Architecture, Department of Visualizatio

ARTé: Mecenas

Skills and Ideas Taught: Gameplay engages and immerses students from the Medici perspective to demonstrate the interconnectedness of art patronage,economics and political pressures surrounding the commissioning of famous artworks of Italian Renaissance.Given a variety of scenarios, learners will: • Develop interconnected networks of Renaissance economics, art patronage and production, including art markets and collecting, conventional banking, trade and alternative banking practices such as usury. • Develop strategies to evaluate the impact of art and architecture patronage on generating spiritual and religious status and social and political prestige. • Distinguish between major artistic media, forms, techniques, and theoretical and critical concepts to develop a more holistic interpretation of the Renaissance era. • Leverage historical circumstances, conditions, and events surrounding art and architecture and their commission. Goal or Challenge: Too often in art history courses, students memorize works of art without understanding their context. ARTé: Mecenas helps them grasp the complexities of the works of art, the role of art given societal norms, and the overall relevance to the people and policies of the time period. The game provides an immersive experience to help students better apply and analyze the effects of complex social, cultural, economic, political and ecclesiastical networks on artwork, monuments and institutions.True to the life of the Medici, students must balance relationships with powerful city-states, merchant factions and the Catholic Church to build and maintain a financial empire and play a pivotal role in the creation of famous artworks, monuments and institutions of the Renaissance. By following the historical footsteps of the Medici family, students level up to the status of “Mecenas,” an influential patron of the arts, and experience the political, social and economic factors that shaped the era. The game features the most influential artworks of the 15th and 16th centuries, including more than 130 pieces of art by over 70 artists.Texas A&M University, College of Architecture, Department of Visualizatio