ДОСЛІДНИЦЬКА КОМПЕТЕНТНІСТЬ НА ДОДИПЛОМНОМУ РІВНІ НАВЧАННЯ

The aim of the article is to provide a justification for the introduction of “research competency” concept and to describe the ways of its formation among students of higher medical institution, based on the experience of the Students' Scientific Society (SSS) work at the Department of Internal Medicine 3 of State Institution “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”. The need to implement the research competency in the medical students training is substantiated in this article on the base of current legislation of Ukraine and today's requirements. A SSS work at a clinical department is analysed as one of the possible ways of the research competency acquisition, with the aspects that contributes to the development of the desired skills as well as those that may impede its mastery. Research work is a powerful impetus to the motivation to learn, as it directs students to scientific research. During working at SSS, students learn how to make a literary search, critically assimilate and assess of primary research literature and formulate a scientific problem, which require solution. At next step, they choose and apply the appropriate research methods that could be used in solving this problem. And finally, participants comprehend the statistics and process the obtained data followed by their scientific papers presentation in literary scientific sources or conferences. The work at SSS helps graduates be more competitive in today's job market as it brings up and cultivates professionally required qualities, including teamwork, ability to manage time and workload properly, an understanding of medical ethics and a range of communication skills. Currently, working in a SSS remains one of the best available options for introduction of the research competency in the training of the medical students, but it does not provide complete involvement of all undergraduate students, as required by the law of Ukraine.Метою роботи є обґрунтування виділення окремого поняття «дослідницька компетентність» та висвітлення шляхів формування дослідницької компетентності у студентів закладу вищої медичної освіти на прикладі роботи студентського наукового товариства на базі кафедри внутрішньої медицини 3 Державного закладу «Дніпропетровська медична академія Міністерства охорони здоров’я України». У статті на основі існуючого законодавства України та вимог сьогодення обґрунтовано необхідність імплементації дослідницької компетентності у навчання студентів закладу вищої медичної освіти. З позицій власного досвіду та даних літератури наведено бажані цілі навчання з урахуванням можливості засвоєння «дослідницької компетенції». Проаналізовано роботу студентського наукового товариства (СНТ) клінічної кафедри, як один із можливих шляхів набуття дослідницької компетентності. Наведено аспекти роботи студентів у СНТ, які сприяють набуттю бажаної компетентності, а також ті, які можуть перешкоджати оволодінню нею. Дослідницька робота – це потужний поштовх до мотивації навчатися, оскільки спрямовує студентів на науковий пошук. Під час відвідування СНТ студенти розвивають навички літературного пошуку, критичного засвоєння інформації та оцінки існуючої первинної дослідницької літератури; формулювання наукової проблеми, що потребує вирішення; розробки та використання відповідних методів дослідження, що допоможе у вирішенні цієї проблеми; розуміння статистики та обробки даних із наступним представленням їх до літературних наукових джерел. Робота в СНТ виховує та формує професіонально необхідні якості, включаючи командну роботу, можливості управління часом та навантаженнями, розуміння медичної етики та ряд комунікативних навичок, що сприяє випускникам бути більш конкурентоспроможними на сучасному ринку праці. На сьогодні робота в СНТ залишається одним із оптимальних існуючих варіантів впровадження дослідницької компетентності у процес навчання магістрів медичного профілю, але він не забезпечує повне охоплення усіх здобувачів вищої освіти, як того вимагає закон України

Characteristics of articular syndrome in systemic vasculitis

The purpose of the study – investigation the separate joint lesion in systemic vasculitis, their X-ray sonographic characteristics, the correlation of the articular syndrome severity with extra-articular manifestations of the diseases, as well as aspects of the arthritis pathogenesis in this category of patients. The study included 525 patients in the ratio of the examined with Henoch-Schonlen purpura, microscopic polyangiitis, cryoglobulinemic vasculitis, polyarteritis nodosa, Takayasu’s arteritis, Wegener’s granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis Churg-Strauss as a 7:4:3:1:1:1:1. Joint’s damage in the form of arthritis or arthralgia observed in 32-67% different groups of patients, that depending on the disease duration, the degree of the pathological process’s activity, extraarticular signs severity, lung parenchyma involving and hemodynamic status in the pulmonary circulation. The frequency of the certain bone lesions, existence of tenosynovitis and enthesopathies, X-ray sonographic signs of articular syndrome in different kind of vasculitis has its own gender dimorphism. The immune system malfunction, the rheological properties of blood and endothelial function of vessels collaborate in pathogenetic constructions of arthropathy. What is more, the high value of rheumatoid factor in blood associates with severe course of joint damage. Joint syndrome at different variants of systemic vasculitis is progressing in 1/3-2/3 of cases, this syndrome has definite features of clinical course and pathogenesis

Clinical course and risk prediction of permanent atrial fibrillation development in patients with chronic heart failure and mid-range ejection fraction of the left ventricle.

The purpose of the study was to establish clinical features of permanent atrial fibrillation (AF) in patients with heart failure mid-range ejection fraction (HFmrEF) and to develop a mathematical model for predicting arrhythmia development. The study included 42 patients with IHD, arterial hypertension (AH), permanent AF and HFmrEF (1 group), mean age – 68.0±1.2 years (21 men and 21 women) and 36 patients with CAD / АH and HFmrEF without AF, mean age- 67.5±0.7 years (22 men and 14 women). The results of the study show, that patients with permanent AF and HFmrEF are characterized by the higher diastolic arterial pressure, higher values of the LDLP, iESV LV, index of end-systolic volume of LV septal thickness and lower EF of the LV in comparison with patients without AF. Patients with permanent AF and HFmrEF also have increased plasma levels of hsCRP, IL-1β, IL-6 and IL-10 in comparison with patients without AF. A mathematical model with scoring system of hsCRP, IL-1β, LV mass index, HDLP, LDLP was developed to assess the risk of AF development in patients with HFmrEF with accuracy of 85.9%, sensitivity of 85.7% and  specificity of 86.1%

ВИКОРИСТАННЯ МЕТОДУ ЛОГІЧНИХ ІГОР ПРИ ВИКЛАДАННІ НЕВІДКЛАДНИХ СТАНІВ У СТРУКТУРІ ДИСЦИПЛІНИ “СІМЕЙНА МЕДИЦИНА”

The aim of the work – to evaluate the efficacy of using logic games method as the students’ independent work during the study of the discipline of Family Medicine. The main body. A logic game method (crossword puzzle) was used in the research to prepare for the topic “Organization of emergency care in the practice of a family doctor. Emergency aid that to be provided by the family doctor in case of sudden death at a prehospital stage” in the 6th year students who studied the subject “Family medicine”. 56 students participated in the research were divided into 2 groups: the group 1 (25 students) was preparing for the class, using only methodological recommendations, the group 2 (31 students) in addition to the methodological recommendations received a crossword with 30 questions on the relevant topic composed by the staff of the department. The crossword puzzle was given 1 day prior to the topic in order to direct the students attention to important details during the preparation for the lesson, e.g. etiology, drugs and their dosage, features of the ECG. At the lesson, “cases” on the topic with questions without the suggested possible answers were given to both groups. The obtained results revealed an increase in the progress of the students of the group 2 in comparison with the students of the group 1. Conclusions. On the one hand, the use of logic games method helps to increase the active component of learning and add positive emotions to the learning process. This, in turn, promotes a better assimilation of the gained knowledge. On the other hand, this technique helps to focus attention to remember the terms and drug names with accurate dosages, which is important in the doctor practice.Мета роботи – оцінити ефективність використання методу логічних ігор як самостійної роботи студентів під час вивчення дисципліни “Сімейна медицина”. Основна частина. У дослідженні було використано метод логічних ігор (кросворд) для підготовки до теми “Організація надання невідкладної допомоги в практиці сімейного лікаря. Невідкладна допомога, що надається сімейним лікарем у випадку раптової смерті на догоспітальному етапі” у студентів 6 курсу, що вивчали дисципліну “Сімейна медицина”. У дослідженні взяли участь 56 студентів, які були розподілені на 2 групи: перша (25 студентів) готувалася до заняття, використовуючи лише методичні рекомендації, друга (31 студент) – на додаток до методичних рекомендацій отримала кросворд, складений співробітниками кафедри, який містив  0 питань з відповідної теми. Кросворд було видано за 1 день до теми з метою спрямувати увагу студента на важливі деталі під час підготовки до заняття: етіологію, препарати та їх дозування, особливості ЕКГ. На занятті було роздано кейси за темою з питаннями без запропонованих можливих відповідей. Отримані результати виявили збільшення успішності студентів другої групи порівняно зі студентами першої. Висновки. Використання методу логічних ігор допомагає, з одного боку, підвищити активну складову навчання та додати позитивних емоцій у навчальний процес. Це, у свою чергу, сприяє кращому засвоєнню отриманих знань. З іншого боку, дана методика сприяє спрямуванню уваги на запам’ятовування важливих у діяльності лікаря термінів і назв лікарських засобів з точним дозуванням

Features of the arterial hypertension clinical course in patients with ischemic heart disease and atrial fibrillation.

More than 30% of the world's population suffer from arterial hypertension (AH). AH is one of the important cardiovascular risk factors. AH is associated with a 1.5-fold increase in the risk of atrial fibrillation (AF). AF is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, in consideration of the broad range of its negative consequences not only due to significant deterioration in the quality of the patients’ life but also due to related significant increase in the incidence of serious complications and death. Objective: to study the features of the AH clinical course, the nature of the target organs lesion in patients with ischemic heart disease with and without permanent form of atrial fibrillation. The study included 78 patients, average age was 66,3±1,0, men – 43 (55,1%). Patients were divided into 2 groups: group 1 (n=42) consisted of patients with AH, IHD and permanent AF; group 2 (n=36) included patients with AH and IHD without heart rhythm disturbances. The analysis of the frequency of lesions of target organs in groups 1 and 2 showed that the III degree of hypertension was detected in 25 (59,5%) patients in group 1 and in 8 (22,2%) patients in group 2. Degree III was diagnosed in 17 (40,5%) and 24 (66,6%) patients of 1-st and 2-nd groups, respectively. Absence of targets organ damage in group 2 was documented in 4 (11,1%) patients. AF presence is associated with a severe course of hypertension and more frequent lesion of target organs. Based on the research results, it was established a direct relation between the duration of AH and the duration of the permanent form of AF. It is expedient for patients with AF arisen against the background of AH to achieve target levels of BP for prevention disease progression and improving the prognosis

Features of the myocardial infarction course in patients with a permanent atrial fibrillation.

Atrial fibrillation (AF) is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, considering the broad range of its negative consequences, not only due to significant deterioration in the quality of the patients’ life, but also due to related significant increase in the incidence of serious complications and death. The presence of permanent AF is associated with a twofold increase in the risk of myocardial infarction (MI) development. The purpose of the research is to study the features of the MI course, the condition of intracardiac hemodynamics, the volume of the cardiac muscle injury in patients with a permanent AF. It was done a retrospective study of 1145 patients’ case histories who were undergoing in-patient treatment for the acute MI on the basis of the CI "Dnipropetrovsk Clinical Association of Emergency Medical Aid". The first group included 134 patients with acute MI without concomitant heart rhythm disorders. The second group consisted of 102 patients with acute MI which arose on the background of a permanent form of AF. The groups were comparable in age and gender. The presence of permanent AF was associated with prognosis deterioration, early hospital mortality in patients with acute MI due to progression of heart failure, development of acute left ventricular insufficiency. A larger amount of myocardial necrosis was observed in patients with permanent AF compared to those with sinus rhythm. Conclusion: the presence of permanent AF impairs the course of acute MI, increases the risk of early hospital mortality, which requires a personalized approach to the management of patients with a permanent AF for preventing the risk of MI developing and thromboembolic complications

Features of the arterial hypertension clinical course in patients with ischemic heart disease and atrial fibrillation.

More than 30% of the world's population suffer from arterial hypertension (AH). AH is one of the important cardiovascular risk factors. AH is associated with a 1.5-fold increase in the risk of atrial fibrillation (AF). AF is the most common cardiac arrhythmias in the population. Nowadays, AF is regarded as potentially lethal arrhythmia, in consideration of the broad range of its negative consequences not only due to significant deterioration in the quality of the patients’ life but also due to related significant increase in the incidence of serious complications and death. Objective: to study the features of the AH clinical course, the nature of the target organs lesion in patients with ischemic heart disease with and without permanent form of atrial fibrillation. The study included 78 patients, average age was 66,3±1,0, men – 43 (55,1%). Patients were divided into 2 groups: group 1 (n=42) consisted of patients with AH, IHD and permanent AF; group 2 (n=36) included patients with AH and IHD without heart rhythm disturbances. The analysis of the frequency of lesions of target organs in groups 1 and 2 showed that the III degree of hypertension was detected in 25 (59,5%) patients in group 1 and in 8 (22,2%) patients in group 2. Degree III was diagnosed in 17 (40,5%) and 24 (66,6%) patients of 1-st and 2-nd groups, respectively. Absence of targets organ damage in group 2 was documented in 4 (11,1%) patients. AF presence is associated with a severe course of hypertension and more frequent lesion of target organs. Based on the research results, it was established a direct relation between the duration of AH and the duration of the permanent form of AF. It is expedient for patients with AF arisen against the background of AH to achieve target levels of BP for prevention disease progression and improving the prognosis

Transformations of organ lesions in hemorrhagic vasculitis

Background. Hemorrhagic vasculitis or Henoch-Schönlein purpura (HSP) is the most common variant of systemic vasculitis in childhood, and peculiarities of the further transformation of the pathological process in adult patients remain unexplored. Objective. To explore the transformation of juvenile HSP, comparing the nature of skin lesions, joints and kidneys of patients in childhood and adulthood. Material and methods. The study included 92 patients (61 men and 31 women on the average age of 27 years, and at the onset of the disease in 11 years). I degree of the activity of the pathological process is determined in 40% of cases, II - in 35%, III – in 25%. Seropositivity by hyperimmunoglobulinemia A occurred in 27% of cases, by the presence of rheumatoid factor – in 21%. At the time of the survey cutaneous syndrome was diagnosed in 55% of patients, the joint – in 45%, kidney – in 71%. There were performed renal biopsy in 15 cases. Results. The cutaneous, joint-cutaneous-abdominal and cutaneous -abdominallyrenal forms of the disease, lesions of the skin, gastrointestinal tract, wrist, ankle and knee joints become more rarely in the course of evolution of juvenile HSP, but exceptionally renal variant of the pathological process, the change of skeletal muscle, liver, spleen are revealed more often. Chronic kidney disease with the kidney failure progression is developed in 12% of patients (in 17% of cases of nephropathy). Sacroiliitis, spondylopathy, tendovaginitis, enthesopathies, epiphyseal osteoporosis, meniscitis of knee joints are arisen. II, III, VI and IV morphological classes of Henoch glomerulonephritis are formed in a ratio of 8:4:2:1 with tubulointerstitial component in all cases. And lymphohistiocytic infiltration of the vascular wall is the unfavorable sign for the prognosis of the disease. Conclusions: In cases of transfer of juvenile HSP in chronic adult form disease often obtain progressive course as regards, first of all, the pathology of the joints and kidneys

Management of patients with pulmonary arterial hypertension against systemic sclerodermia (part 2).

Pulmonary arterial hypertension (PAH) is a serious condi­tion caused by the damage of the small pulmonary vessels, leading to the increase of pulmonary artery pressure, pulmonary vascular resistance, development of right ventricular failure and death. PAH is one of the actual problems of modern medicine due to low survival rate, rapid disability of the patients and a high cost of treatment. PAH is one of the leading causes of death in systemic sclerodermia (SSD). PAH associated with scleroderma is a unique phenotype combining the manifestations of both SSD and PAH, the pathogenetic mechanisms of which modify the clinical picture and the course of these conditions. Timely diagnosis and treatment of PAH show significant effect on survival rates, however, early detection of PAH is still difficult in SSD due to several factors. The main causes are restriction of modern screening methods and polyorganic involvement in SSD. In comparison with other subgroups of PAH the patients with SSD-PAH poorly answer to the specific PAH therapy. SSD-PAH, along with idiopathic pulmonary hypertension (IPAH), belongs to group I of pulmonary hypertension classification and according to modern consensus has a similar pathogenesis and clinical picture, however, differences in the response to therapy are observed in these groups, that indicates the role of other pathobiological mechanisms. Recent investigations explain these differences by such factors as autoimmune and inflammatory responses, more severe vascular remodeling and direct myocardial damage in the SSD. Drug therapy of PH in SSD is similar to that in IPAH and includes prostaglandins, endothelin receptor antagonists, calcium channel blockers, which are prescribed in cases of a positive vasoreactive test, PDE-5 inhibitors. In this literature review we showed traditional and new methods of PAH treatment and their relevance to SSD-PAH in accordance with randomized clinical trials

ІМПЛЕМЕНТАЦІЯ СИМУЛЯЦІЙНОГО ТРЕНІНГУ НАДАННЯ НЕВІДКЛАДНОЇ ДОПОМОГИ ДЛЯ СТУДЕНТІВ 6 КУРСУ ПРИ ВИВЧЕННІ ДИСЦИПЛІНИ “ВНУТРІШНЯ МЕДИЦИНА” (ОГЛЯД ЛІТЕРАТУРИ ТА ВЛАСНИЙ ДОСВІД)

The aim of the work – to analyze, generalize existing points of view in the education system, which affect the issue of necessity, effectiveness and features of the simulation programs use for medical students. The main body. An overview of modern literature on the implementation of simulation methods in medical education. Simulation training is one of the effective ways to learn how to manage errors. Simulation training allows to learn how to work in accordance with modern algorithms for diagnosis and emergency care, to develop team interaction and coordination, to increase the level of implementation of complex medical manipulations and to evaluate the effectiveness of their own actions. In particular, at the Internal Medicine Department No. 3 of Dnipropetrovsk Medical Academy a method of simulation training is developed  involving university staff as “standardized patients” for modeling clinical situations of differentiation and assistance in various urgent states. Conclusions. In our view, this implementation of the simulation training is a valuable tool for improving the professional skills of medical students. Elements of this technique are applicable at different stages of educational activity: not only in the development of skills in emergency care, but also during the final certification of the 6th year students.Мета роботи – аналіз, узагальнення існуючих точок зору в системі освіти, які торкаються питання про необхідність, ефективність та особливості використання симуляційних програм навчання студентів-медиків. Основна частина. Проведено огляд сучасної літератури по впровадженню симуляційних методів навчання в медичній освіті. Симуляційне навчання є одним з ефективних способів навчитися керувати помилками. Симуляційне навчання дозволяє навчатися працювати відповідно до сучасних алгоритмів діагностики та надання невідкладної допомоги, виробити командну взаємодію та координацію, підвищити рівень виконання складних медичних маніпуляцій та оцінити ефективність власних дій. Зокрема, в ДЗ “ДМА МОЗ України” на кафедрі внутрішньої медицини 3 розроблена методика імітаційного навчання із залученням співробітників ВНЗ в якості стандартизованих пацієнтів для моделювання клінічних ситуацій диференціації та надання допомоги при різних невідкладних станах. Висновки. На наш погляд, дана імплементація симуляційного тренінгу є цінним інструментом вдосконалення професійних навичок студентів медичних вузів. Елементи даної методики застосовні на різних етапах освітньої діяльності: не тільки при відпрацюванні навичок невідкладної допомоги, а також при проведенні підсумкової атестації студентів 6 курсу