Репозитарій

УДК: 614.2: 519.2

The research aims at improving the quality assessment of clinical audit results in Ukraine using the complex of statistical methods and studying statistical methods in foreign reports of the clinical audit and personal experience.

Materials and Methods. The research was performed by analyzing the reports of clinical audit (n=62), held during 2021 by the Healthcare Quality Improvement Partnership. The spectrum of statistical methods was extended by the analysis of the example of a sociological survey of patients (n=405) regarding the quality assessment of medical care. The methods applied in the current study included systemic approach and analysis, structural and logical analysis, correlation and regressive analysis, calculation of relative values.

Results and Discussion. All 100% clinical audit reports, carried out by the Healthcare Quality Improvement Partnership were based on the results of the statistical calculations. The most common method of processing results is the epidemiological statistics (93.5%), ratio of chances/risks (30.6%), probability assessment by Х² Pearson's method (21.0%). It is noteworthy that for pointing the central tendency almost in half of the cases (46.8 %) the median and the Interquartile Range were used. Complex mathematical methods such as the survival assessment by Kaplan- Meier and method multiple regression were used in 6.5 % та 4.8 % reports, accordingly.

Conclusions. Based on our own experience, we suggested implementation of standardization methods, a detailed correlation and regressive analysis, neuro networks and power analysis into the methodology (technique) of the clinical audit. Implementation of spectrum of evidentially substantiated methods of statistical analysis will allow to increase the evidence level and to deepen the statistical analysis of databases when conducting the clinical audit, аnd therefore, the quality assessment of clinical audit results will increase.

УДК: 618.39:618.179(477+477.83)"2014-2021"

Aim. The research aims at rationalizing of the epidemiological component in the process of developing a model for preventing miscarriage among the female population of Ukraine.

Materials and Methods. A retrospective analysis of the indicators of miscarriage among the female population of Ukraine and Lviv region for the period from 2014 to 2021 was carried out. Statistical data of the Center for Medical Statistics of the Ministry of Health of Ukraine were used, namely Form No. 21 "Report on medical care for pregnant women, women in labor and women giving birth". The study uses the methods of a systemic approach and structural-logical analysis, medical-statistical analysis, namely the calculation of chain (relative to the previous year) indicators of a dynamic series: absolute growth, growth rate and increment rate.

Results and Discussion. A decrease in the female population of fertile age by 13.03% in Ukraine and by 5.81% in Lviv region was noted in the analyzed period of 2014-2021, while the number of spontaneous abortions in Ukraine decreased by an average of 3.45% per year, and grew in Lviv region in 2015, 2018, 2019 and 2020 by 5.72%, 6.87%, 19.29% and 6.59%, respectively. The rates of spontaneous abortions per 1,000 women of fertile age in Lviv region were twice as low as in Ukraine. Over the analyzed 8-year period, the share of premature children among all live births increased from 4.68% to 5.68% in Ukraine, and from 4.18% to 5.65% in Lviv region, respectively; these indicators in Lviv region were smaller compared to the indicators in Ukraine. The share of premature babies among stillbirths averaged 63.07% in Ukraine and 67.69% in Lviv region, had a growing trend, and the indicators in Lviv region were higher every year compared to the indicators in Ukraine. The ratio of the total rate of miscarriage to the total number of pregnancies (cases of miscarriage per 100 pregnancies) increased from 5.50 in 2014 to 6.22 in 2021 in Ukraine and from 3.57 to 4.72 in Lviv region respectively.

Conclusions. There was a trend of annual increase in the index of the ratio of the total miscarriage rate to the total number of pregnancies, the share of prematures from the total number of live births and the share of premature births from the number of stillbirths in the analyzed 8-year period, both in Ukraine and in Lviv region. The analyzed indicators of the share of premature newborns from the total number of live births in Lviv region were lower every year, and the share of newborns from the total number of stillbirths was higher compared to the average annual indicators in Ukraine. The dynamics of spontaneous abortions showed a clear trend towards an annual decrease in Ukraine and their increase in 2015, 2018-2020 in Lviv region. The rate of spontaneous abortions among women of fertile age in Lviv region from 2014 to 2021 was annually half as low compared to the average annual levels of this indicator in Ukraine.

УДК: 614.2:616-073.7:303.4

The aim of this work was to assess the current state of the X-ray diagnostic service in the Lviv region, namely, to identify existing problems and elaboration of ways to solve them.

Material and Methods. A retrospective analysis of the current state of the X-ray diagnostic service in the Lviv region was carried out in comparison with the data throughout Ukraine for 2015-2020 years. The information was received according to the data of the State Statistics Service of Ukraine.

Results and Discussion. Analysis of changes in the total number of X-ray diagnostic apparatuses in the Lviv region for 2015-2020 years showed a slight downward trend in their number. Thus, as of the end of 2020 year, the total number of such apparatuses on the balance of regional health care institutions was equal to 452 units, which is 7,38% less than in 2015year. In the Lviv region and in Ukraine as a whole, there was a decrease in the number of devices of X-ray image amplifiers (X-ray IA) ((by -10,96% and -5,28%) and fluorographs (by -23,08% and - 17,49% respectively). At the same time, there was a significant increase of angiographic apparatuses (by +66,67% and +81,54%), CT scanners (by+40,00% and +26,32%), and mammography machines (by +33,33% and +12,46% respectively). The number of carried-out diagnostic fluorograms for 1 operating apparatus in the Lviv region during the studied period was decreasing, and the same trend persisted in 2020 year as well: Тgrowth2018/2015=-5,07%, Тgrowth2020/2019=-7,64%, just like the quantity of diagnostic fluorograms for one position of a radiologist: Тgrowth2018/2015=-11,76%, Тgrowth2020/2019=-20,78%. While the number of CT per one operating device and on one position of a radiologist in the Lviv region for the last 5 years significantly increased and in 2020 year was equal to 10605 studies /1 device and 220 studies/1 physician, but only in the last year, the growth was by +29,16% and +41,03%, although the number of operating tomographs remained unchanged for the last 5 years (n=5). Such a significant positive trend is explained by intensive work of the X-ray diagnostic service during the Cоvid-19 pandemic.

Conclusions. The decreased frequency of the fluorographic and radiological studies and the increase of the number of diagnostic CT scanners in the Lviv region have been determined. A number of problems in the work of the X-ray diagnostic service have been identified, the most important of which are the significant overload of radiologists, particularly, during the Cоvid-19 pandemic and lack of modern equipment. Modern healthcare is competitive and therefore, in the conditions of today's needs, the development of the most modern visualization technologies is very important, the key of which are computed tomography and magnetic resonance imaging in the field of radiation diagnostics.

За допомогою визначення біохімічних показників стану артеріальної, венозної крові та сечі вперше було вивчено реакцію організму на фізичні навантаження, засоби відновлення та засоби фізичної реабілітації спортсменів з інвалідністю різних нозологічних форм захворювань. Зміни у функціональній активності м’язів насамперед відображаються в біохімічних показниках креатину і креатиніну в сироватці (плазмі) крові, а тому їх кількісне визначення служить маркером стану м’язів. Ми не виявили істотних відмінностей вмісту даних мікроелементів між групами досліджуваних, а також між нозологічними формами захворювань. Для спортсменів з інвалідністю визначення екскреції 17-КС у добовій сечі може бути показником рівня фізичного навантаження й емоційного напруження. Найсуттєвіші зміни  у показниках були виявлені у спортсменів з наслідками церебрального паралічу: після фізичного навантаження екскреція  17-КС зростає на 82 % на початку дослідження у спортсменів основної групи, та на 92 % у спортсменів групи порівняння; наприкінці дослідження у спортсменів основної групи екскреція 17-КС підвищилася на 63 %, та на 96 % у спортсменів групи  порівняння. Аналогічна динаміка простежується і у групі спортсменів після ампутацій. Підвищення вмісту даних метаболітів є результатом стрес реакції організму у відповідь на застосовані фізичні навантаження. Вперше методом термографії ми встановили зміну фізіологічних процесів, які відбуваються в організмі спричинені механічною дією, фізичним навантаженням, засобами відновлення та фізичної реабілітації. Ми довели, що застосування засобів фізичної реабілітації сприяє посиленню інтенсивності кровообігу, кровонаповнення судин, покращенню тонусу артеріол і венул, що призводить до нормалізації венозного відтоку і температури шкіри ділянок тіла у спортсменів з інвалідністю.