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Реферати
ПРОГНОЗУВАННЯ ШВИДКОСТ1 ПРОГРЕСУВАННЯ Ф1БРОЗУ ПЕЧ1НКИ ПРИ ХРОН1ЧНОМУ ГЕПАТИТ С НА ОСНОВ1 КЛ1Н1ЧНИХ I ГЕНЕТИЧНИХ ОЗНАК Сизова Л.М., Коваль Т.1., Боднар В.А., Кайдашев 1.П., 1зюмська О.М. Проведене кросс-секцiйне дослщження 166 пацieнтiв iз хронiчним гепатитом С. В результат аналiзу серед 35 можливих факторiв швидкого прогресування фiброзу печiнки при хронiчному гепатит С виявлено 10 найбiльш шформативних: чоловiча стать (р=0,005), 1 генотип ВГС (р=0,040), рiвень аланiн-амiнотрансферази вищий за 3 верхнiх меж норми (р=0,015), рiвнi аспартат-амшотрансферази, у-глутамштранспептидази та загального бшрубшу, що перевищують верхню межу норми (р=0,000, р=0,000 i р=0,001 вщповщно), споживання алкоголю >40 г/добу (р=0,033), хронiчний холецистит та/або панкреатит (р=0,000), цукровий дiабет II типу (р=0,007) i носшство нормального генотипу (01п/01п, 01п/-) гена TLR7 (р=0,001). З метою оптимiзацiI прогнозування вiднесення пацieнта з хрошчним гепатитом С до групи ризику швидкого прогресування фiброзну печiнки запропонована високоефективна математична модель, розроблена на основi множинного дискримiнантного аналiзу, безпомилковий прогноз яко1 складае 82,5 %.
Ключовi слова: хронiчний гепатит С, швидкiсть прогресування фiброзу печiнки, прогностична модель, дискримшантний аналiз.
Стаття надшшла 15.03.2019 р.
ПРОГНОЗИРОВАНИЕ СКОРОСТИ ПРОГРЕССИРОВАНИЯ ФИБРОЗА ПЕЧЕНИ ПРИ ХРОНИЧЕСКОМ ГЕПАТИТЕ С НА ОСНОВАНИИ КЛИНИЧЕСКИХ И ГЕНЕТИЧЕСКИХ ПРИЗНАКОВ Сизова Л.М., Коваль Т.И., Боднар В.А., Кайдашев И.П., Изюмская Е.М.
Проведено кросс-секционное исследование 166 пациентов с хроническим гепатитом С. В результате анализа среди 35 возможных факторов быстрого прогрессирования фиброза печени при хроническом гепатите С выявлено 10 наиболее информативных: мужской пол (р=0,005); 1 генотип ВГС (р=0,040); уровень аланин-аминотрансферазы выше 3 верхних границ нормы (р=0,015); уровни аспартат-аминотрансферазы, у-глутамилтранспептидазы и общего билирубина превышающие верхнюю границу нормы (р=0,000, р=0,000 и р=0,001 соответственно); употребление алкоголя >40 г/сутки (р=0,033); хронический холецистит и/или панкреатит (р=0,000); сахарный диабет II типа (р=0,007) и носительство нормального генотипа (01пЮ1п, 01п/-) гена TLR7 (р=0,001). С целью оптимизации прогнозирования принадлежности пациента с хроническим гепатитом С к группе риска быстрого прогрессирования фиброза печени предложена высокоэффективная математическая модель, разработанная на основе множественного дискриминантного анализа, безошибочный прогноз которой составил 82,5 %.
Ключевые слова: хронический гепатит С, скорость прогрессирования фиброза печени, прогностическая модель, дискриминантный анализ.
Рецензент Катеренчук !.П.
DOI 10.26724/2079-8334-2019-4-70-155-159 UDC 614.23:37.06
O.Ye. Sichkoriz Danylo llalylsky l.viv National Medical I niversity. I.viv
MEDICO-SOCIAL PROFILES OF PHYSICIANS IN TRAINING
e-mail: avfitkalo@gmail.com
The purpose of this paper is to develop recommendations for improving the system of postgraduate medical education in the context of the overall health care reform. The survey method implemented in the form of a standardized (formalized) interview was used as the main tool for collecting social and psychological information. We have interviewed the total of 375 internship doctors after graduation including 33.60% male responders and 66.40% female ones aged 20-34 years. The results of the questionnaire indicate that internship doctors experience such polar feelings as calmness, confidence, non-contentiousness, anxiety, worry, fear, and despair. The responders suggest that health care institutions meet current requirements incompletely. Thus, there is the necessity to significantly improve the material and technical conditions as well as to review the system of medical institutions functioning while developing the strategy of health care system reform.
Keywords: interview, internship doctors, postgraduate medical education, healthcare system reform.
The work is a fragment of the research project "Determinants of rural population health and life expectancy", state registration No. 0118U000099.
The quality health care is provided for the population by means of many tools including the provision of sufficient number of highly qualified personnel. The changes in higher medical education and its integration into the European educational area demand the implementation of new approaches to medical training in the post-graduate period and to the social role and professional status of a specialized physician [6]. Another actual requirement involves organization of a qualitatively new cooperation between higher education institutions and structural health care units directed at the performance of target training, namely further professional medical training and specializing to fulfill the existing needs of practical health care [4, 7].
© O.Ye. Sichkoriz, 2019
In addition to understanding the professional tasks by the physicians it is important for them to be aware of public health problems as well as able to adapt to the life events due to the changeable environmental factors. The quality of health care depends on the professional training that is performed with the help of continuous medical education [1]. Thus, the educational tasks also include the disclosure of the potential and self-realization possibilities of each physician in training [3].
The purpose of the study was to develop recommendations for improving the system of postgraduate medical education in the context of the overall health care reform. The research is directed at studying the professional activity aspects of internship doctors who finished the course of internship at Danylo Halytsky Lviv National Medical University (LNMU).
Materials and methods. The realization of the study purpose involved implementation of a survey method in the form of a standardized (formalized) interview as the main tool for collecting social and psychological information.The target audience was comprised by internship doctors who had completed the course of internship. A total of 375 individuals participated in the survey. They were further subdivided by gender as following: 33.60 % - male responders, 66.40 % - female ones. The responders were aged 2034 years. In general 15.47±1.87% of categorized individuals were referred to work in villages; 31.73±2.40% - in district centres, towns; 19.20±2.03% - in the cities of regional subordination; 12.27±1.69% - in the regional centres. At the same time 21.33±2.12 % of responders did not have the right for the independent job placement. The statistical study of the received data involved the analysis of the relative and mean values.
Results of the study and their discussion. Social and economic changes, which are characteristic for the present, reflect on the development and direction of the individual's life scenario. They cause the changes of emotional characteristics and influence the individual adaptive mechanisms. Emotional state of the individual in its turn reflects on the attitude towards the professional duties and the quality of their performance. Emotional state can be researched by the moods characteristic for the individual at present moment of life activity. The analysis of the moods of internship doctors after graduation indicates that almost a half of responders expressed optimism- 43.20±2.56 %, calmness (26.40±2.28 %), confidence (19.47±2.04 %) (Fig. 1). However, a quarter of the responders that accounts for 25.87±2.26 % feel worry and anxiety, 8.00±1.40 % experience the feeling of anger and indignation, and 6.93±1.31 % are in fear and despair. Every tenth respondent demonstrated indifference (9.07±1.48 %) which is an alerting fact of the conducted survey.
It is important to define individual factors that cause a particular worry and can influence the job attitude (table 1).
Table 1
Problems of personal nature causing particular worry in internship doctors
No. Individual factor % in accordance to the total number
1. Lack of financial resources 34.93±2.46 %
2. Extreme, stressful environmental conditions 28.27±2.33 %
3. Lack of future prospects 22.13±2.14 %
4. Insufficient level of personal qualification 14.13±1.80 %
5. Personal state of health 13.07±1.74 %
6. Economical instability 12.53±1.71 %
7. Misunderstandings with colleagues 11.47±1.65 %
8. Political exertion in the society 10.93±1.61 %
9. Lack of confidence in personal abilities 10.40±1.58 %
10. Problems in relationships with relatives 10.13±1.56 %
11. Loss of professional interest 8.53±1.44 %
13. Alcohol abuse 2.93±0.87 %
Increased personal anxiety is caused by social and economic factors as well as the factors that are directly or relatively associated with the professional activity. The leading ones include: lack of financial resources - 34.93±2.46 %, extreme, stressful environmental conditions - 28.27±2.33%, lack of future prospects - 22.13±2.14%, insufficient level of personal qualification - 14.13±1.80%, personal state of health - 13.07±1.74%, economical instability - 12.53±1.71%, political exertion in the society -10.93±1.61%, lack of confidence in personal abilities - 10.40±1.58%. Among all defined factors we consider "insufficient level of personal qualification" and "extreme, stressful environmental conditions" as profession-associated ones. Thus, almost every seventh internship doctor after graduation realizes personal professional drawbacks and every seventh one is not ready to perform actively in case of uncommon
extreme and stressful conditions. In the context of health care reforms it seems important to determine qualification indexes of professional activity of internship doctors after graduation and to correct existing requirements of higher medical education providing internship training on their basis. It is also important to develop and implement specialized courses (psychological training courses) into curricula. They should be aimed at preparing physicians to practice in extreme environmental conditions, developing their stressresistance and desire for personal growth.
Concerning the life goals of the responders it is worth noting that almost a half of them (48.27±2.58 %) ranked the professional growth number one. Family welfare ranks second (24.80±2.23 %), good health -third (21.33±2.12%). The two latter positions may be estimated as required conditions for the development of professional qualities. The others include: living in good conscience - 18.13±1.99%, earning much money and gaining financial independence -11.47±1.65% (Fig. 2) (the number of possible answers to the question were not restricted).
Fig. 1. Most characteristic moods of internship doctors Fig. 2. Personal life values in internship doctors (%of the
(percentage of the number of responders). number of responders).
The altruistic motives and self-realization desire are dominating among the listed motives for the professional choice (table 2).
Table 2
Factors influencing internship doctors to choose a health care career
No. Motives of the choice % from total number
1. Possibility to be useful for others 28.80±2.34 %
2. Calling 22.13±2.14 %
3. Possibility to realize personal skills 16.00±1.89 %
4. Ambition to quickly reach financial wealth and high level of life 9.33±1.50 %
5. Career ambitions 7.47±1.36 %
6. Illustrative example (relatives, friends, neighbors) 4.80±1.10 %
7. My relatives insisted on my choice (parents, relatives) 2.93±0.87 %
8. Well-respected profession in the society 2.40±0.79 %
9. Recommendation of friends, acquaintances 1.07±0.53 %
10. Relatively easy possibility to enter medical education institution 0.80±0.46 %
11. Entered the institution because others did so 0.80±0.46 %
Several factors can be separated from the list, namely: possibility to be useful for others -28.80±2.34 %, calling - 22.13±2.14 %, possibility to realize personal skills - 16.00±1.89 % (a total of 66.93%). Such motive as a well-respected profession in the society belongs to the outsiders as only 2.40±0.79% of internship doctors indicated it. Thus, in the context of reforms in the branch of health care it is viable to provide for measures aimed at popularization of medical profession in the society.
Altruistic activity motives are proved by the responses to the questions concerning medical profession attractiveness: receiving an effective result of physician-patient interaction is the most important and attractive answer - 56.80±2.56 % as well as the therapeutic process itself - 28.80±2.34 %. Marginally more than a half of responders (54.13±2.57 %), feel calm and happy at their work place - 20.53±2.09%, while every fifth one feels disturbed (17.60±1.97%) and feared (3.73±0.98%). In our opinion, it mainly depends on personal characteristic features of responders, since the medical institutions where they practice are similar with the others as indicated by 59.20±2.54% or even better than the others - 27.47±2.30 %. Most internship doctors are mainly satisfied or very satisfied with their jobs. A total of 64.27±2.47% responders gave positive answers. However, 30.93±2.39% of doctors are not satisfied or hardly satisfied with their jobs.
90,00% 80,00% 70.00% 60.00% 50,00% 40.00% 30,00% 20,00% 10.00% 0,00%
8£00*ö
The level of satisfaction with the chosen activity is provided by a number of components including the main one - job peculiarities, organizations and working conditions, chosen specialty, work place, system of financial compensation in the branch, information supply, engagement in the choice of fateful
decisions, work regimen, prospects of professional growth. The analysis of the results indicates the complete or almost complete satisfaction with: job character -84.00±1.89 %, working conditions -65.33±2.46%, work organization -66.67±2.43 %, personal specialization -76.53±2.19 %, work place -65.33±2.46 %, information supply in the branch - 66.13±2.44 %, engagement in the choice of responsible solutions -76.80±2.18 %, work regimen -76,80±2,18%, prospects of professional growth - 65,33±2,46%. Only 54.40±2.57 % of doctors are satisfied , .. . , ,. , . ... . , with existing system of financial
Fig. 3. Satisfaction (%) of internship doctors with separate components of 0 J
professional activity. compensation for work (fig. 3).
Concerning the primary examination of the patients, medical history taking, planned and thematic clinical rounds, analysis of case histories and other registration and reporting documentation the following numbers of responders are satisfied 69.60±2.38 %, 48.00±2.58 %, 51.20±2.58 %, and 46.93±2.58 % respectively (fig. 4).
The responders are characterized by somewhat pessimistic moods concerning the future of the medical scope. The survey proves the uncertainty of internship doctors concerning the attitude and evaluation of future job perspectives for relatives (children, close relatives) in health care. Thus, the research aimed at studying the aspects of activity of the doctor-intern, who graduated from internship
-•69,60"o
primary filling medical planned and analysis of examination of documentation thematic case histories the patients clinical rounds and other
in the hospital registration and reporting documentation
Fig. 4. Share (%) of internship doctors who are completely satisfied with the possibility to participate in separate work aspects at health care institutions.
at Danylo Halytsky LNMU, allowed to supplement existing information on the adaptation of doctors-interns to professional activity [3, 5]. The data we obtained about the emotional state of doctors in their work activity were consistent with the data of domestic scientists, however, their attention was more focused on the mechanisms of formation of psychological adaptation of the doctor-intern to professional activity, taking into account gender peculiarities, while this work highlighted the emotional and personal characteristics, behavioral qualities of young specialist [2, 7].
Conclusions
1. Internship doctors after graduation are characterized by certain life and psychological instabilities that are related to the adaptation to new developmental situation. This new situation causes the appearance of such polar feelings and emotions as calmness, confidence, conflict-free character, anxiety, worry, fear and despair.
2. In the process of health care reforms it is viable to introduce personal responsibility of managing and administrating staff at health care institutions for the performance of provided qualification requirements by the internship doctors.
Rolci on ccs
1. Araslanova AA. Integratsiya nauki. obrazovaniya i proizvodstva: sinergeticheskiy effekt. Filosofiya obrazovaniya. 2011; 1:2631. [in Russian]
2. Vyun VV. Vplyv profesiynoho dystresu na stan adaptatsiyi likariv-interniv v suchasnykh umovakh. Science Rise: Medical Science. 2017; 7(15):4-6. [in Ukrainian]
3. Lisovyi VM, Kapustnyk VA, Viun VV. Pro stan ta perspektyvy pidhotovky likariv-interniv u Kharkivskomu natsionalnomu medychnomu universyteti. Suchasnyi stan ta perspektyvy pidhotovky likariv-interniv u Kharkivskomu natsionalnomu medychnomu universyteti. Kharkiv: KhNMU. 2014; 3-8. [in Ukrainian]
4. Liubinets OV, Gutor TH, Khodor OYe. Efektyvnist vprovadzhennia informatsiinykh system v zaklady okhorony zdorovia na dumku likariv-orhanizatoriv. Skhidnoievropeiskyi zhurnal hromadskoho zdorovia. 2016; 1:93-94. [in Ukrainian]
5. Pshuk NH, Kaminska AO. Problema profesiynoyi dezadaptatsiyi likariv khirurhichnoho ta terapevtychnoho profilyu. Arkhiv psykhiatriyi. 2013; 19,2(73):151-155. [in Ukrainian]
6. Sazonov BA. Individualno-oriyentirovannaya organizatsiya uchebnogo protsessa kak usloviye modernizatsii vysshego obrazovaniya. Vyssheye obrazovaniye v Rossii. 2011; 4:10-24. [in Russian]
7. Sukhina LA. Osobennosti formirovaniya professionalnogo i sotsialnogo statusa vracha-oftalmologa. Arkhiv oftalmolohii Ukrainy. 2014; 2;1:123-126. [in Russian]
IY(|h-|>:iiii
МЕДИКО-СОЦ1АЛЬНИЙ ПОРТРЕТ Л1КАР1В-ШТЕРШВ Сiчкорiз о. е.
Метою роботи було формування рекомендацш щодо покращення системи тслядипломно! медично! освт в умовах загально! реформи системи охорони здоров'я. Як основний шструмент збору сощально-психолопчно! шформацп використано метод опитування у виглядi стандартизованого (формалiзованого) штерв'ю. Опитано 375 лiкарiв-штершв, яю заюнчили навчання, з них 33,60% -чоловшв, 66,40% - жшок вком 20-34 роки. Результати показують, що у лiкарiв-iнтернiв iснують таю полярш почуття та емоци, як: спокш, впевненiсть, неконфлiктнiсть, тривожнiсть, неспокш, страх та вiдчай. За думкою опитаних, заклади охорони здоров'я незначною мiрою вiдповiдають вимогам. Вiдтак, юнуе необхiднiсть у розробцi стратегiй реформування системи охорони здоров'я, ютотному вдосконаленш матерiально-технiчнi бази, а також у переглядi системи оргашзаци роботи л^вальних закладiв.
Ключовi слова: iнтерв'ю, лжарынтерни, пiслядипломна медична освiта, реформування медично! галуз^
Стаття надiйшла 23.05.18 р.
МЕДИКО-СОЦИАЛЬНЫЙ ПОРТРЕТ ВРАЧЕЙ-ИНТЕРНОВ Сичкориз О.Е.
Целью работы было формирование рекомендаций по улучшению системы последипломного медицинского образования в условиях общей реформы системы здравоохранения. Как основной инструмент сбора социально-психологической информации использован метод опроса в виде стандартизированного (формализованного) интервью. Опрошено 375 врачей-интернов, которые закончили обучение, из них 33,60% - мужчин, 66,40% - женщин в возрасте 20-34 года. Результаты опроса показывают, что у врачей-интернов существуют такие полярные чувства и эмоции как: спокойствие, уверенность, неконфликтность, тревожность, беспокойство, страх и отчаяние. По мнению опрошенных учреждения здравоохранения в незначительной степени соответствуют требованиям. Следовательно, существует необходимость при разработке стратегии реформирования системы здравоохранения существенно улучшить материально-технические базы, а также пересмотреть систему организации работы лечебных учреждений.
Ключевые слова: интервью, врачи-интерны, последипломное медицинское образование, реформирование медицинской отрасли.
Рецензент Скрипник 1.М.
DOI 10.26724/2079-8334-2019-4-70-159-163 УДК 616.155.392-085
1.М. (криимик, I .С. Маслога Укри'мю.ки мешчин стматолоична акиемш. Полтава
РОЛЬ S-АДЕМЕТЮШНУ У СУПРОВ1ДН1И ТЕРАПН ГОСТРИХ М1СЛОБЛАСТНИХ
ЛЕЙКЕМ1Й
e-mail: maslovaas1708@gmail.com
У стата представлен результати власних дослщжень щодо оцiнки частоти i характеру розвитку порушень функцiонального стану печшки у хворих на гострi мieлобластнi лейкемп, а також обгрунтовано доцiльнiсть призначення S-адеметiонiну на фон хiмiотераmI у складi терапи супроводу. Розвиток гепатотоксичних реакцш було зафксовано на 7-й день хiмiотерапil у 32,1% (9/28) хворих I групи, що отримували виключно хiмiотерапiю, i у 4,2% (1/24) хворих II групи, яким додатково призначали S-адеметюнш. Гепатотоксичш реакци на фонi хiмiотерапil гострих мieлобластних лейкемiй у 22,2% (2/9) пащенив вiдповiдали цитолiтичному типу, у 44,4% (4/9) - холестатичному, у 33,3% (3/9) -змшаному типу. На 28-й день спостереження зафксовано зворотшсть гепатотоксичних реакцш. Доведено, що включення до складу терапй супроводу S-адеметюншу на фонi хiмiотерапil гострих мiелобластних лейкемiй асоцiюеться iз зниженням ризику формування гепатотоксичних реакцш (RR=0,13; 95% С1=0,018-0,95; р<0,05).
IGii040Bi слова: rocTpi м1елобластш лейкемп', х1мютерашя, гепатотоксичш реакцп, S-адеметюнш.
Стаття е фрагментом НДР «Розробка Memodie профтактики та л^вання медикаментозно-шдукованих уражень внутрштх оргатв», № державноi реестрацн 0115U001087.
Гостр1 ]шелобластш лейкемп (ГМЛ) належать до одних ¡з найбшьш злояюсних захворювань людини [3, 6]. У крашах Свропи щор1чно фшсують вщ 5 до 8 нових випадюв ГМЛ на 100 000 населення ¡з ч1ткою тенденщею до зростання захворюваносп серед населення вшом старших за 70 роюв, де кшьюсть нових випадюв ГМЛ перевищуе показник 15-25 на 100000 на рш Смертшсть вщ ГМЛ у середньому складае вщ 4 до 6 випадюв на 100 000 населення на р1к [6].
© I.M. Скрипник, Г.С. Маслова, 2019
