Possibilities of conservative treatment of patients with lymphedema of the extremities (literature review)

The literature review describes various methods for treating patients with lymphedema of the extremities. Statistics show an increase in the incidence and disability of patients with this pathology. However, the possibilities of therapeutic measures in lymphedema are far from perfect.The analysis of literature data showed that the basis of treatment for lymphedema of the extremities is comprehensive conservative therapy with the use of pathogenetically grounded physical, mechanical, and medical methods. In complex schemes of conservative treatment for lymphedema, physiotherapy methods occupy a prominent place. The most common technique among them is regular combined decongestive therapy. This method is recognized by leading experts as the main one in treating patients with lower extremity lymphedema. Commitment of patients to treatment and their social and psychological counseling are of great importance. The choice of the volume and method of surgical intervention requires a difficult and individual assessment of pathological changes developing throughout the course of the disease.Despite certain improvements in treatment methods, lower extremity lymphedema is still an unsolved issue. The experience of most specialists involved in lymphedema treatment demonstrates a reasonable balance between basic conservative and surgical treatment methods. Undoubtedly, results of evaluation of these methods will improve the choice of an optimal technique for treating patients with lymphedema of the extremities.

Assessing the sustainability development of an organization

Introduction. The article presents a review of scholarly literature and the author's assessment of the potential for sustainable development of a medical organization. The purpose of the article is to describe the author's methodology for assessing the potential for sustainable development, and to evaluate the effectiveness of its application in a medical organization. Materials and Methods. The study used the following research methods: comparative analysis, T.L. Saati, and the author’s methodology for assessing the potential for sustainable development of a medical organization. Results. In the process of analyzing the methodology for self-assessment of the maturity on the way to achieving the sustainable development of the ISO 9004 standard organization, the author revealed a number of problems. They include low sensitivity to individual assessment of processes, the lack of a mathematical expression of the level of development for certain areas of activity, and the absence of an integral indicator sensitive to minimal changes. The author describes in detail process of developing her methodology for assessing the potential for sustainable development of an organization and illustrates the application of this methodology within a medical organization for evaluating sustainable development in statics and dynamics. Conclusions. Finally, conclusions are drawn about the ways of applying the author's assessment methodology by the head of the medical organization.

Analysis the Safety and Efficacy at Different Types of Anesthesiological Support During Aesthetic Interventions on the Breast Glands in Ukraine

The aim is to learn the features of aesthetic and reduction surgical interventions on the mammary glands in Ukraine. Materials and methods. The study was conducted by analyzing the inpatient ambulatory cards of 320 patients. Anesthesia was provided by propofol (n=130), sevoflurane (n=140) and combined use of sevoflurane and nalbuphine (n=50). The results of the study. It was found that usage of combined inhalation analgesia of sevoflurane with opioids was characterized by 41.9% less recovery time. It was found that 8 hours after surgery, the individual assessment of pain was lower in the group of combined analgesia with opioids relative to intravenous anesthesia with propofol (87.5%, p<0.05) and inhalation anesthesia with sevoflurane (71, 3%, p<0.05). After 24 hours all patients reported about pain below 1.0 point, however, in groups where sevoflurane and nalbuphine were used, the level of pain self-esteem was 2.61 and 3 times lower than after intravenous propofol. It was found that within 1 hour after surgery, the average cognitive score on the Montreal scale decreased in the group of intravenous propofol by 5.0% (p<0.05) and by 1.7% under inhalation anesthesia with sevoflurane. Under combined anesthesia the cognitive score remained at 12.0 points. The frequency of postoperative nausea was the highest level in the group of inhalation anesthesia - 16.7%. The addition of nalbuphine to sevoflurane significantly reduced the risk of postoperative nausea (χ2=7.250; p=0.007). Conclusions. Combined anesthesia with opioids is a highly effective anesthetic choice for aesthetic and reconstructive interventions on the mammary glands.

Formation of the Concept of Assessing the Educational Potential of Labor Resources As a Factor of Increasing Human Capital

Within the framework of the study, issues related to the importance of human capital in the process of improving the efficiency of enterprises and organizations were considered. The necessity to link the processes taking place in the education system with the processes of accumulation and formation of human capital is substantiated. The analysis of the possibility of using education as one of the significant factors for the development of human capital and its actualization according to the constantly changing external environment is carried out. The concept is developed within the framework of the approach resulting from the economic equilibrium in the short term, and assuming the immutability of cash flows in this period. The study defines the essence of higher education and forms assumptions that characterize the construction of a model of individual assessment of the quality of education. The results obtained in the course of the study can serve as a basis for optimizing the methodology for establishing a link between the individual trajectory of the formation of educational programs.

Child-Friendly Legal Aid and Individual Assessment of Children in Conflict with the Law: Building the Basis for Effective Participation

This article focuses on the importance of the right to effective participation of children in conflict with the law in criminal (youth justice) proceedings. In particular, it explores two procedural aspects which are closely related to the right to child-friendly legal aid and the role of individual assessment. The authors claim that qualitatively identifying the needs of the child (through the instrument of individual assessment) and establishing a relationship of trust with a specifically trained legal aid lawyer is critical in raising the child’s status to that of an active participant in the proceedings and ensuring that the best interests of the child are observed. The authors also suggest that such an initial encounter within the justice system forms an attitude (of either confidence or rejection) of the child towards public institutions and, accordingly, directly affects the effectiveness of further interventions. To support their position, the authors of the paper bring several examples from the comparative research carried out in two European projects, noting, regretfully, that the initial interventions often suffer from formal implementation and lack a systemic approach.

Developing a team-based assessment strategy: direct observation of interprofessional team performance in an ambulatory teaching practice

Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.

Collectivized Discretion: Seeking Explanations for Decreased Asylum Recognition Rates in Finland After Europe's 2015 “Refugee Crisis”

In 2015, during the so-called “refugee crisis” in Europe, Finland was among the European countries receiving exceptionally large numbers of asylum applications. As the volume of asylum applications surged, however, the percentage of positive asylum decisions in Finland declined substantially. In this article, we explore reasons for this dramatic drop in recognitions rates and examine Finnish immigration control authorities’ use of discretion in asylum credibility assessment. Our approach is unique in its application of mixed methods to examine asylum decisions in pre- and post-crisis situations. We found that asylum caseworkers’ inconsistent assessment of similar facts and lack of faith in the veracity of applicants’ claims were essential to the mass denial of young Iraqi asylum applicants in Finland. This finding is important because it illustrates how asylum officers are able to “shift the border,” or generate a shift in asylum decision-making on a grand scale, without meaningful changes in law. Asylum officers, we show, are able to bring about such a shift via what we call collectivized discretion, or large-scale use of discretion, in asylum status determinations to control migration. Prior research on discretion in asylum decision-making highlights the individual decision-maker. This article expands discretion research by offering new insights on large-scale, collective discretionary shifts in the application of asylum law. We conclude that it is crucial that asylum status determinations be anchored in the individual assessment of each applicant's case, as collectivized discretion can lead to arbitrary results in the application of asylum law, potentially forcing those in need of refugee protection to face deportation.

Mathematics Disability vs. Learning Disability: A 360 Degree Analysis

A fundamental issue for research in mathematics disability (MD) and reading disability (RD) is: If these disabilities are clearly distinct, why is there so high a level of comorbidity, together with the converse; if these disabilities are so similar, why are there clear differences in underlying causes and aetiology? In order to address this puzzle, we introduce the “360 degree analysis” (360DA) framework and apply it to the overlap between RD and MD. The 360DA process starts by analyzing the issue from four perspectives: theoretical, developmental, affective, and pedagogical. Under 360DA, these analyses are then integrated to provide insights for theory, and for individual assessment and support, together with directions for future progress. The analyses confirm extensive similarities between arithmetic and reading development in terms of rote learning, executive function (EF), and affective trauma, but also major differences in terms of the conceptual needs, the motor coordination needs, and the methods of scaffolding. In terms of theory, commonalities are interpreted naturally in terms of initial general developmental delay followed by domain-independent affective trauma following school failure. Dissociations are interpreted in terms of cerebellar vs. hippocampal learning networks, sequential vs. spatial processing, and language vs. spatial scaffolding, with a further dimension of the need for accurate fixation for reading. The framework has significant theoretical and applied implications.