The purpose of this section is to highlight the opportunities for digitizing important processes in the healthcare system to improve the efficiency of population health management. The introduction of these digital processes will increase patient satisfaction with the healthcare system, as well as provide a holistic outlook of patient health through access to data and give patients more control over their own health. Healthcare managers will also be using the developed Internet applications to conduct clinical audits and monitor health problems in the administrative district. It is proposed to develop and use free Internet applications and computer programs, namely: 1) Drug Compatibility Test online application, which is designed primarily for students. This app is designed to test knowledge of drug compatibility and
certain aspects of diet and behavioral habits; 2) electronic individual antenatal drug passport for a promising way to predict, prevent and reduce the risk of allergic reactions; and 3) Medical Intelligence app using the artificial intelligence technologies to develop an individual educational trajectory for doctors and pharmacists.
Results. Antibiotics were administered for 44.2% (95%CI 34.9%–53.9%) of patients. The main reasons for antibiotic prescriptions were acute tonsillitis (30.0%) and acute upper respiratory tract infections (26.0%). Macrolides, cephalosporins, penicillins, and sulfonamides with trimethoprim presented 40.0%, 36.0%, 20.0%, and 4.0% of antibiotic prescriptions, respectively. Antimicrobials from the Access group accounted for 26.0% of antibiotic prescriptions (instead of at least 60.0%, WHO) and antibiotics from the Watch group constituted 74.0% (instead of a maximum of 40.0%, WHO). Antibiotics were prescribed to 61.9% of outpatients with acute upper respiratory tract infections, 93.7% of patients with acute tonsillitis, and 45.5% – with otitis media instead of recommended 0-20% (ESAC-Net). The first-line antibiotics were used in 23.1% of cases of acute upper respiratory infections, 26.7% of cases of acute tonsillitis, and 40.0% of otitis media, which is below the acceptable range (80–100%, ESAC-Net). In total, 22 antibiotic-associated drug-related problems (DRPs) were found in 34.0% of written doctor’s prescriptions with antimicrobials. The most common were: (1) excessive length of therapy (36.4%) and (2) potential drug-drug interactions (31.8%). Conclusions. The rate of antibiotic prescriptions for children is high and associated with different DRPs. The majority of antibiotic prescription quality indicators are outside the recommended ranges. Thus, effective interventions and campaigns to improve antibiotic therapy in children are needed.
УДК 616.72-002.77-06:[616.71-018.4:612.015.7]-073.48-73.75
Вступ. Ревматоїдний артрит (РА) – хронічна системна хвороба сполучної тканини нез’ясованої етіології складного автоімунного патогенезу, яка часто ускладнюється вторинним остеопорозом (ОП), що погіршує перебіг і прогноз основної хвороби.
Мета. Дослідити частоту й характер уражень кісток у хворих на ревматоїдний артрит, виявлених за допомогою ультразвукової та рентгеностеоденситометрії, з’ясувати їх діагностичну цінність для оцінки мінеральної щільности кісткової тканини.
Матеріали й методи. У дослідження в рандомізований спосіб із попередньою стратифікацією за наявністю РА, діагностованого згідно з критеріями Американської колегії ревматологів та Європейської ліги проти ревматизму (2010) у жінок пременопаузального періоду та чоловіків зрілого віку, включено 74 хворих (62 жінки (84,93 %) і 12 чоловіків (15,07 %) віком від 38 до 60 років (середній вік на час обстеження жінок – 48,67 ± 2,34 року, чоловіків – 45,42 ± 2,78 року)), що лікувалися, вживаючи метилпреднізолон (4,0–24,0 мг/добу) та не отримуючи лікарські засоби для лікування ОП, у ревматологічному відділі Комунального некомерційного підприємства Львівської обласної ради «Львівська обласна клінічна лікарня» з 2013 по 2019 рік (дослідна група – ДГ). Контрольну групу (КГ) створено з 29 здорових осіб (22 жінки (75,86 %) та 7 чоловіків (24,14 %), середній вік жінок на час обстеження 44,95 ± 2,12 року, чоловіків – 40,71 ± 2,75 року) аналогічних статі й віку. Усім хворим проведено оцінку МЩКТ за допомогою ультразвукової кісткової денситометрії п’яткової кістки та рентгеностеоденситометрії кисти.
Результати. Виявлено міцний кореляційний зв’язок між результатами ультразвукової денситометрії п’яткової кістки та рентгеностеоденситометрії кисти, що дає підстави рекомендувати діагностувати зміни МЩКТ обома методами, причому, чутливішим виявився метод рентгеностеоденситометрії.
Висновки. Застосування обох методів діагностики ОП, а саме – ультразвукової денситометрії п’яткової кістки та рентгеностеоденситометрії кисти у хворих на ревматоїдний артрит є науково обґрунтованим.
УДК 616.72-002:611-018.4]-07
Introduction. Patients with rheumatoid arthritis(RA)are twice as likely to have osteoporosis (OP) compared to the general population. The strength of bones depends on mineral substances, mainly represented by calciumphos phatemicrocrystals. The chiefrole in the regulation of calcium-phosphorus metabolism is played by vitamin D and parathormone(PTH).
The aim of the study. To investigate markers of calcium-phosphorus metabolism in patients with rheumatoid arthritis accompanied by bone mineral density (BMD) disorders and to find out their diagnostic value.
Materials and methods. 76 patients with RA (64 premenopausal women and 12 mature men) were included in the study. All patients with RA were subjected toultrasound bone densitometry and according to its results, patients were divided into three groups: patients with RA and osteopenia, patients with RA and OP; RA patients without BMDdisorders. The control group included 22 healthy individuals of both genderswithout BMD abnormalities. To evaluate calcium-phosphorus metabolism, ionized calcium, total calcium, phosphorus, PTH, and vitamin Din blood serum, and levels of calcium and phosphorusin urine were detected.
Results. It was revealedthat concentration of total calcium in blood serum of patients with RA is lower compared tohealthy individuals, while the same index in urine ofpatients with RA accompanied byosteopenia,OP or without BMD disorders is higher compared to healthy people. The concentration of vitamin D is significantly lower in patients with RA and OP compared to patients with RA with osteopenia, without BMD disorders,or healthy individuals. The concentration of PTH is higher inhealthy individuals compared to patients with RA without BMD abnormalities or with osteopenia.
Conclusions. In patients with rheumatoid arthritis with osteopenia orosteoporosis, significantly more often than in patients with rheumatoid arthritis without a violation of bone mineral density, ionized and total calcium, phosphorus in serum and urine, as well asvitamin D indices have deviations from the reference valuesand are of diagnostic significance.
УДК 616.5-002.525.2-031.81:616.1]-06
Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations.
Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients.
The aim of the study.To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterizethemdepending on the gender, age and the disease duration.
Materials and methods. Prior to performing the study all patients signedthe voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of dif-ferent severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed(58.04 %), III disability grouppatients(45.54 %), city residents (62.50 %).According to the results of the diseaseduration assessment, a significant numberof patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council "Lviv Regional Clinical Hospital" from 2016 to 2021.The research was carried out in several stages, duringwhich the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated.
Results. While completingthe study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3– with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. Thevaricose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, veinthrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) includingstable angina pectoris, cardiomyopathy and post-infarction cardiosclerosiswere found with the decreasing frequency. Raynaud’s syndrome was significantly more often diagnosedin femalesand young people;retinal angiopathy, livedo reticularisand symptomatic arterial hypertension – in femalesand those patients whose SLE lastedfor more than 10 years;myocarditis, varicose veins of the lower extremities – in males;capillaritis – in patients with the shortest duration of SLE;atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lastingfor6–10 years;veinthrombosis and stable angina – in elderly patients and those with SLElasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis werethe most characteristic for theelderly patients with SLE.
Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into considerationduring the screening examination of circulatory systemdisorders inpatients with systemic lupus erythematosus and providing them the
integrated care to improve their lifequality. With this in mind, systemic lupus erythematosus requires further detailed study.