Front Matter: Volume 2

This PDF file contains the front matter of the Proceedings of CBU in Proceedings of CBU in Medicine and Pharmacy Volume 2 including the Title Page, Copyright information, Table of Contents, Introduction, and Conference Committee listing.

eRESEARCH IN THE DEGREE OF ADHERENCE BY ASTHMA PATIENTS – A PILOT STUDY

Introduction: Non-adherence to treatment is a global issue which in recent years has reached epidemic proportions. The WHO has reported that treatment adherence in chronic patients is 50% in developed countries on average. According to data from the Association of Bulgarians with Bronchial Asthma (ABBA) the percentage of asthma patients who are not regularly treated is the highest compared with other chronic diseases. Non-adherence to treatment not just influences the patient’s quality of life but increases the health care costs in society. Objectives: The aim of this study is to analyse the degree of adherence to prescribed treatment in asthma patients. Methods: An anonymous survey was made among 50 outpatients with asthma using an adapted survey card consisting of two parts: a questionnaire that collects information about the demographic profile of the patient (gender, age, educational background, etc) and a validated tool, the Morisky test, which is a questionnaire that defines the degree of treatment adherence. Results: The results from the Morisky test (Morisky coefficient 2.22) showed a mean degree of adherence both for the whole sample and for men and women separately, with a minimal difference of 0.01 in favour of men (Morisky coefficient 2.24 in men and 2.23 in women). Conclusions: The studied asthma patients show unsatisfactory adherence to the prescribed treatment. The mean degree of adherence reported in the study indicates the need for educating patients, monitoring and collaboration among doctors, patients, pharmacists and other healthcare professionals.

ORGANIZATION AND HOLDING OF HOSPITAL THERAPEUTIC NUTRITION IN HOSPITALS FOR ACTIVE TREATMENT IN RUSE’S TERRITORY

Introduction: Daily food consumption is a basic factor for improving both the quality of life and the well-being of people. Hospital medical nutrition needs to suit certain standards and requirements, so as to provide all the necessary micro- and macronutrients for patients. It has to be high-quality food and also has to mind the technological requirements for its preparation in the hospital, in addition to looking aesthetically pleasing and tasting good. Objective: This report’s goal is to study the hospital dietary nutrition in the hospitals for active care in Ruse, Bulgaria – University hospital Kanev; University hospital Medika; Mental health center Ruse; Complex-oncological center Ruse and the Specialized Hospital for active treatment of pneumo-phthisiatric diseases - Dr Dimitar Gramatikov. Methods: The survey was conducted between the months of April and September 2020. The criteria for inclusion of those hospitals are: to perform an organized hospital nutrition, and the medical institution to be a hospital itself. Results: In the medical establishments that are included in the study, medical dietary nutrition is carried out in accordance with the normative documents and standards which are in force for the country. The numerological system of nutrition Pevzner is applied, as the basic diets are from №1 to 15, as well as their varieties according to the disease’s acuteness. Conclusions: We find that, just because contemporary requirements for nutrition in the Republic of Bulgaria have been presented in developed national recommendations for healthy eating, this is not enough. What is needed is to develop and apply a fully adequate hospital diet, based on an individual assessment of nutrition status, and degree of risk from malnutrition.

STUDENTS’ VIEWS ON THE ROLE OF ETHICS EDUCATION FOR THEIR FUTURE MEDICAL PRACTICE

INTRODUCTION: Worldwide, in different ways, ethical dilemmas arise in medicine and life sciences. It is critical for medical professionals to respond with confidence when ethical challenges are addressed in their clinical practice. Medical ethics and bioethics education is recognized as an essential course of the medical curriculum. The course aims to provide students with knowledge and competencies on dealing with moral problems. OBJECTIVES: In this article, we aim to explore students’ views about the importance and role of medical ethics education for their future practice. Their suggestions on specific medical ethics and bioethics topics were also considered, as well as previous knowledge on ethics before they enrolled in university. METHODS: A paper questionnaire was developed and distributed among first-year foreign medical students from the Faculty of Medicine in the Medical University-Sofia in Bulgaria. All students participated in the study anonymously and voluntarily. The study was conducted during January and February 2020. RESULTS: Completed questionnaires were received from 366 medical students. Data collected demonstrates that only 19% of the students were taught ethics before enrolling in university and covered topics on philosophy and ethics, civil and human rights. The majority (92%) of the responders believe that the study of medical ethics and bioethics helps medical professionals to improve their skills in identifying ethical problems in their everyday practice. Interesting were the suggestions for topics in medical ethics and bioethics that needed further study during lectures and seminars and included principles of medical ethics and bioethics, ethical behavior in medicine and health care, ethical dimensions of new technologies in health care, ethical dimensions of clinical decisions and patients’ quality of life, ethics and health management. CONCLUSIONS: Medical ethics education is significant for future physicians, helping them to improve their skills in identifying ethical issues, and base their decisions on fundamental ethical principals in their everyday practice. Attention should be given to topics related to principles of medical ethics, models of patient-physician relationships, new technologies in health care, ethics and health policy.

TO DEVELOP FORENSIC CRITERIA FOR THE DIFFERENTIAL DIAGNOSIS OF INTRACEREBRAL HEMORRHAGE OF TRAUMATIC AND NON-TRAUMATIC ORIGIN USING MUELLER-MATRIX MICROSCOPY OF LINEAR DICHROISM

Differential diagnosis of intracerebral hemorrhage due to traumatic and non-traumatic origin is a challenging issue, especially in the absence of visible body injuries and other signs of violence. For a forensic expert-practitioner, the main thing is objectivity, accuracy, and speed of obtaining the result, which could fully satisfy the methods of laser polarimetry in the case of differential diagnosis of hemorrhages of traumatic and non-traumatic origin in the human brain matter. The purpose: To develop forensic criteria for the differential diagnosis of intracerebral hemorrhage of traumatic and non-traumatic origin using Mueller-matrix microscopy of linear dichroism. Materials and methods: The object of the study was brain matter samples, collected in 115 corpses of both sexes aged 22 to 86 years with accurately known causes of death. The causes of death included coronary artery disease, traumatic brain hemorrhage, ischemic brain infarction, and non-traumatic brain hemorrhages. Brain matter samples have been frozen rapidly, and histological sections have been made using a freezing microtome. The slices have been evaluated using the method of azimuthal-invariant Mueller-matrix microscopy, followed by mathematical and statistical processing of the results. Results: significant topographic heterogeneity of Mueller-matrix invariants of brain matter samples linear dichroism maps among all research groups have been found. Individual and significant variations of dispersion, asymmetry, and kurtosis magnitude have confirmed the heterogeneity of Mueller-matrix invariants. The difference of images and histograms among groups is explained by the presence of necrotic changes in the case of ischemic brain necrosis and blood cells in the brain matter samples. For the set of central statistical moments of the 1st, 3rd, and 4th orders, which characterize the distributions of circular dichroism, the method of MM-microscopy in the differentiation of samples of non-hemorrhage and hemorrhage groups reaches a satisfactory level - 78% - 84%. Conclusions: Brain matter samples Muller-matrix microscopy of linear dichroism is effective for solving diagnostic problems of forensic medicine related to evaluating the cause of death from intracerebral hemorrhage of various origins. Diagnostic efficiency of Mueller-matrix mapping of polarization manifestations of linear dichroism method for intergroup differentiation of samples of deaths from traumatic hemorrhage (Group 2) and ischemic cerebral infarction (Group 3) reaches a satisfactory level of 79 - 84%.

THE EXPERIENCE OF A NEWLY IMPLEMENTED ONLINE LEARNING PLATFORM FOR MEDICAL STUDENTS

INTRODUCTION: In the context of the current public health emergency, an adequate adjustment imposed a transition from a conservative approach to medical education to online teaching and interaction. E-learning also brought advantages to the students, which were assessed in this survey in order to learn how to keep and benefit from them in the future. METHODS: the data was collected through a questionnaire which included general data (gender, year of study) and the self-perceived progress. Specific questions addressed the quality of the teacher-student communication, or the advantages e-learning offered, while the platform's functionalities were analyzed through a five-point scale. RESULTS: Among the 536 respondents, 99.81% mentioned at least one feature used specifically in the online training that would be valuable to retain in the future. Students perceiving progress better than expected had a higher appreciation of the e-learning tools. Gender differences in opinion were only correlated with the standardization of the studying process. While time management was accepted as a main advantage, 25% of the participants considered the overall communication better than before. A major disapproval regarding online communication was encountered in years 3, 4, and 5, while the desire to continue the communication through the existing platform was the highest in the first and last year of study. CONCLUSION: Even in a blended learning process, the digital delivery of medical training needs further improvement and adaptation in order to align with the fast-developing society and its expectations.

DETERMINATION OF THE NUMBER OF NURSES FOR HOSPITAL AID IN THE REPUBLIC OF BULGARIA

The nurses in the Republic of Bulgaria addressed a number of official demands to the Ministry of Health, one of them was to work out a long-term strategy for the development of standards, including detailed minimal requirements for the number of staff for both hospital, and outpatient care. Objectives: The goal of the current report is a summary of the regulatory documents, concerning the number of nurses in the Republic of Bulgaria, in context of the global practices. Methods: Current medical standards in the Republic of Bulgaria are being taken into account, and methods for determining the number of nurses in other countries. Results: In the period between November and December 2020, within the public consultations for projects of different Regulations for approval of medical standards, the proposed and developed methods by the Bulgarian association of health professionals in nursing to be included in the standards, which concern calculating the necessary staff of nurses, was not admitted for inclusion in any of those standards. Conclusions: Until now, the number of active nurses in the Republic of Bulgaria in all active medical standards is calculated either on the basis of doctors (not patients), or it’s pointed out that the methods of calculating the sufficient number of nurses may be applied. It should be noted that the International Council of Nurses, actually does not recommend universal methods for all countries worldwide.

MATERNAL LEUKOCYTOSIS AS DIAGNOSTIC MARKERS IN SPONTANEOUSLY DECLARED PRETERM BIRTH

Spontaneous preterm birth is the basic problem of perinatal mortality in Bulgaria. Pregnancy is characterized by physiological leukocytosis - determined by twice increased neutrophils levels, unchanged monocyte levels, and a reduction in the levels of lymphocytes, eosinophils, and basophils. The leukocytosis is particularly pronounced in the last trimester, due to physiological stress during pregnancy, and it is a result of the increased inflammatory response, a consequence of selective immune tolerance, immunosuppression, and fetus-immunomodulation. The objective of this study was to investigate and to appreciate maternal leukocytosis as potential diagnostic markers in spontaneously declared preterm birth and term birth declared cases. Methods: The case–control study was performed in UMBAL-City Hospital, Stara Zagora during 2017–2020. The study involved 200 patients, split into two groups: G1- the healthy pregnant women, n1=100 with а registered singleton pregnancy, at gestational age 37-39+6, gave birth on the term (TB); G2- the PTB patients, n2=100, confirmed clinically by cardiotocography for gestation >32 weeks. The highly sensitive Leuko-TIC-ELISA-WBC (upper limit of the normal number of Leuc during pregnancy - 15x109 per L) test was used for investigation. Blood samples were taken by puncture of the v.cubitalis in an anticoagulant at the time of hospitalization and examined within 1 hrs. Patients with systemic chronic illness and infections were excluded from the study. The results showed statistically significant Leuc reduction in SPTB patients (14.31±2.66×109/L, p>0.03), compared to the increased (14.67±3.21×109/L) (in normal-15x109L) Leuc values in the TB group.In conclusion, the results of the Leuc value confirm the presence of a systemic leukocytosis/oxidative inflammatory reaction at the time of declaring SPTB and TB.

DIFFICULTIES ENCOUNTERED BY NURSE STUDENTS WHEN WORKING WITH ELDERLY PEOPLE

During the training process, nurse students acquire knowledge, skills and competencies to work with different groups of patients. Working with elderly people has its difficulties and specificities. The acquisition of practical skills by students for planning and documenting individual health care for the elderly people is a process in which teachers and mentors have a leading role. Objectives: To identify the factors which make it difficult for nurse students to work with elderly people. Methods: The study involved 52 3rd year nurse students – from the Faculty of Medicine of Trakia University in Bulgaria. A questionnaire was used, including open-ended and closed-ended questions, allowing more than one answer. The data was processed mathematically and graphically. Results: The main difficulties for students in working with the elderly people are as follows: the process of communication (92.16%), difficult perception of new information (80.64%) and memory impairment in the elderly patient (61.44%); The main difficulties related to the organization of activity - insufficient experience in working with geriatric patients (92.16%); insufficient time for communication with patients (94.08%); lack of comfort in the patient's home (57.60%); a "Diary for tracking and self-monitoring of the condition" of an elderly person - it is very useful for 90.24% of students so that they can monitor the condition of the elderly person; It was found that 65.28% of students do not want to work with elderly people, as 46.09% of them indicate the motive for this as mental strain. Conclusion: The teacher and the mentor are leading figures in preparing students to work with elderly people. The practical preparation for planning and documenting individual health care for elderly people is very important in the training process of nurse students.

A QUANTITATIVE ASSESSMENT OF AN INNOVATIVE EDUCATION PROJECT FOR PHARMACY STUDENTS

The changing environment of pharmacy care represents an opportunity to implement an innovative educational form into the teaching process, which represents a significant potential in preparing pharmacy students for their future profession. The main objective of the assessment was to evaluate the contribution of the innovative education project Advanced Training in Pharmacy Care (ATIP) as a complement to the compulsory curriculum at the Faculty of Pharmacy of the Comenius University in Bratislava. Another objective was to analyse the obstacles to dispensation and counselling perceived by students of the educational project. The assessment uses data from the ATIP educational project carried out between 2015/2016 and 2020/2021 at the Faculty of Pharmacy of the Comenius University in Bratislava. Data collection was provided through a questionnaire survey among the participating students after completing each year of the project. The assessment focused on students' perception of the ATIP educational project, characterizing their readiness to provide pharmacy care and obstacles to the implementation of pharmacy care. Students perceived the project as an interesting addition to the curriculum, which was organized at a high professional level with reasonable difficulty. In the case of their readiness for their future profession by studying and passing compulsory practice, students were critical in their answers. Obstacles affecting the implementation of pharmacy care that prevailed among students were a lack of practical experience, a lack of time to address the patients' problems, and different requirements of patients from the knowledge acquired during study at the faculty. In other obstacles, such as a patient's lack of interest, lack of privacy to talk, etc., students have taken a neutral stance. This innovative education project pointed out the importance of cooperation between various organisations, such as academic, pharmaceutical and student, in the field of education of future health professionals.