Медицински факултетhttp://digilib.nalis.bg/xmlui/handle/nls/303372024-03-29T02:09:14Z2024-03-29T02:09:14ZПрофесионална кариера на лекарите в общата медицинска практикаhttp://digilib.nalis.bg/xmlui/handle/nls/318532019-10-29T07:40:47Z2014-01-01T00:00:00ZПрофесионална кариера на лекарите в общата медицинска практика
Introduction: Primary health care is the only level of the Healthcare System which allows the most effective usage of the limited financial resources for achieving better outcome in health preservation and improvement. Primary health care in Bulgaria is entirely based on the general practitioners work.
Goal: Measurement and analysis of the professional path, legislation barriers and satisfaction of the general practitioners, as key resource ensuring stability of the primary health care.
Research task:
1. Studying the components and perspectives for professional career of the general practitioners;
2. Examination of the profile of the GPs as workforce;
3. Research of the organizational aspects of physicians’ work and defining the main issues in organizational context;
4. Investigating the factors of satisfactions from the general practitioner’s job;
5. Examination of characteristic determining the ethical context of the GPs work – trust, acknowledgement and public recognition;
6. Studying the legislation barriers met in the general practice and the development of the primary health care practices.
Materials and methods:
The study uses for its purposes the following methods: quantitative methods with the execution of empiric sociological research among the general practitioners in Stara Zagora Region, through individual semi standardized interview – face to face, and qualitative methods – analysis of documents and monitoring. Statistical methods are being used as well. Subject of research are all general practitioners on the territory of Stara Zagora District. . The questionary contains 34 questions divided into six main areas: characteristics of the physicians; characteristics of the practice; morally-ethical dimensions of the professional career; work-life balance; professional activities. The professional satisfaction is being studied using JSS – job satisfaction scale.
Results and discussion: There are 235 physicians (as of the period of the research July – December 2012) owners of outpatients’ departments for primary health care on the territory of Stara Zagora District, who are contractual counterparts of the Regional Health Insurance Fund Stara Zagora for providing primary health care (PHC). A total number of 223 out of 235 participated the study which defines 94.9% participation rate. The group of general practitioners working on the territory of Stara Zagora District is one of the biggest in the country. Their average age is 49 years. The greatest number and percentage is in the 45-54 years group. There is only 1 doctor in the age group up to 35 years. The women represent almost three fourths of the workforce in the healthcare area in the EU, and in the physician’s profession they are half of it. In our survey the women represent almost two thirds -62.8% (140). The professional characteristics of the general practitioners show that 30.6% have qualification General Medicine and 44.4% have no qualification. Based on the characteristics of their outpatients departments, GP’s are being distinguished as follows: 92% work in individual practices and only a very small number in group ones.
The satisfaction model is being studied by the basic indications of stratification. Statistically sizable differences per gender, type of practice and some of the satisfaction factors have been identified. The development of healthcare in the conditions of market economy, affects traditional values in the
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medical profession like trust and acknowledgement. The trust is key element in all interpersonal relations, but has a significant importance in the relations doctor – patient. Relatively small number physicians – 15.2% put the highest possible rate of the trust of their patients.
The characteristics of primary health care in the different countries are various, but nevertheless the complexity and well developed system of primary care should possess the four basic elements: access, continuity of the health care, complexity (integrity) and coordination of the activities. Every third GP (30%) out of the studied group shares that the responsibility and provision of out hours care is amongst the most common issues in their work.
Conclusions: There is a real threat of lack of physicians in the general medical practice. The opportunities for career development in the area of the general practice are critical especially for the young professionals. Urgent measures should be taken in order to make the general medicine practice more attractive and satisfactory. The multiple challenges in front of the GPs in the small villages do not reflect the aspirations and interests of the physicians for professional realization and career development. GPs are, in a big extent, skeptical in regards of the recognition for their work both by the patients and the doctors. Se well determined insufficient acknowledgment of the physicians work in the general practice is being perceived as indicator showing the perspective of the GP’s career. More than half of the general practitioners think that the medical professions is not possessing sufficient public prestige. Every third GP defines the problem with the continuous twenty four hours access, as one of the most common in their practice. The satisfaction rate as per the applied scale outlines a model in which all studied factors have contribution. Clinical freedom is being assessed as the most satisfying thing in the general medical practice. The lack of satisfaction is related predominantly to the regulations which should be followed.
The contributions of the dissertation are as follows: Implemented for a first time methodological approach with opportunity of in depth analysis of the problem for career development. This approach could be applied as a model for comparison of the effectiveness of the implemented policies in following researches. The practical contributions are in the context of the goals set. They are as follows: The profile of the general practitioners as a workforce is being studied; The organizational aspects of physicians’ work are being studied and basic issues are being determined; The factors of professional satisfactions are explored; Ethical determinant features of the GPs work like trust, acknowledgement and public recognition are examined.
2014-01-01T00:00:00ZСравнително проучване на ефектите при терапията с дълбока осцилация /Deep oscillation/ и някои преформирани физикалнн фактори при лечението и рехабилитацията на пациенти с остеоартрозаhttp://digilib.nalis.bg/xmlui/handle/nls/318512019-10-29T07:04:08Z2018-01-01T00:00:00ZСравнително проучване на ефектите при терапията с дълбока осцилация /Deep oscillation/ и някои преформирани физикалнн фактори при лечението и рехабилитацията на пациенти с остеоартроза
Osteoarthritis (OA) is the most common rheumatic disease with a predilection for the joints of lower limbs, knee and hip. OA of knee joint (KJ) is the cause of a severe, long-term pain, a decrease in daily functional activity, a deterioration in quality of life, and a treatment and rehabilitation cost increase.
Among the priorities of modern Physical and Rehabilitation Medicine are development and application of new methods in complex treatment and rehabilitation of degenerative joint disease.
Low frequency pulsation electrostatic field is the basis of the Deep Oscillation(DO) treatment method. Main therapeutic effects are realized as a result of the electric field pulse generated with low frequency from 5 to 250 Hz, with small amperage 5–7 μA and biphasic mode. Therapeutic effects depend on the frequency range. Rapid and sustained pain relief, improvement of microcirculation and reduction of swelling is achieved. The fibrinolytic effect and increased tissue elasticity lead to normalization of the muscle tone and improves mobility of joints system. Anti-inflammatory and immune-stimulating effect is observed.
The aim of the research project is to investigate the therapeutic effects of the application of Low frequency pulsation electrostatic field using the DO method in patients with OA of KJ and to compare the therapeutic effects of the application of Deep Oscillation, Interference Current (IFC) and placebo-DO.
Material and methods The study includes 144 patients diagnosed with radiologically proven gonarthrosis II and III degree of Kellgren-Lawrence scale median age (mean ± SD) of 66.0 ± 10.3 years, 101 female and 43 male. Patients were divided into three groups at random: Test Group (TG, n=57), performs ten days Deep Oscillation treatment using a hand applicator - 9.5 cm. The KJ, the surrounding tissues and the m.Quadriceps femoris area are treated. Therapeutic Modes: Variable frequency 100-144 Hz 5 min, constant frequency 85 Hz 5 min., Variable frequency 14-20 Hz 4 min, modulation mode 1: 1 (slight vibrations). Routine
Group(RG, n=54) conducts 10 procedures with IFC with variable frequency 90-100Hz, followed by 0-100 Hz. The Control Group(CG; n=33) conducted a ten-day Placebo-DO course, in the treated area there were no vibrations in the depth of the tissues.
The therapeutic course for all three groups includes 10 kinesitherapy procedures (KT) carried out immediately after electrotherapy. The KT procedure includes: Aerobic exercises; Analytical gymnastics for femoral muscles, with emphasis on Vstus medialis et lateralis m. Quadriceps femoris; Relaxing techniques for shortened muscles; Exercises against resistance; Exercises to increase the volume of movement in the KJ.
The results were tracked four times before and after treatment, at I-st and III-rd month, for all of the three groups and objectified by Manual Muscle Test, measuring the circumference of the knee, Range of Motion, pain assessment at rest and physical activity (walking along, descending and climbing stairs) through VAS(a Visual-Analogue Scale for pain) and questionnaire WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index).
A comparison of the therapeutic effects of the application of the electrical physical factors (DO, IFC and Placebo-DO) and kinesitherapy(applied to all three groups) was performed. The relevant value of the reformed physical factor on the basis of the KT was evaluated.
A statistically significant decrease in edema, increased range of motion(flexion) in KJ, and m. Quadriceps femoris muscle weakness for three-time periods(TTP) versus baseline (p<0.001) was obsereved in the TG, as well as a tendency to a better influence of the levels of muscle weakness and range of motion in the KJ for the groups (test and routine) in which patients received complex physiotherapeutic treatment: electro-procedure and KT.
A statistically significant reduction in pain after treatment in ТG, I and III months at rest(p<0.001), motion(p<0.001), descent(p<0.001) and ascending(p<0.001) were reported compared to baseline values and retention of post-treatment outcomes and at month III. In the RG, there was a significant reduction pain in rest until the end of the first month(p<0.001), retention of I month(p=0.152) and III month(p=0.265) versus post-therapy and increase of III versus I-st month(p<0.001). When walking a reduction was observed in I-month(p>0.001) versus baseline, a retention on the III-month(p=0.039) versus post-therapy and an increase in III versus I month(p=0.386). When descending on stairs a decrease from baseline for the three post-treatment time points, I and III months post-treatment(p<0.001), retention of I month versus post-treatment(p=1,000), and increase of III month compared to posttreatment and I Month (p & lt; 0.001). When climbing up stairs, a reduction in the TTP from baseline(p<0.001), retention on I month(p=1.000) versus post-treatment and increase of III vs. I month(p=0.028). The CG showed a reduction in pain at rest (p<0.001) for the three time periods, compared to
baseline values, increase in the III month compared to posttreatment(p=0.002), pain-motion reduction after treatment and increase in the III month compared to posttreatment(p=0.001), pain-down stairs reduction for TTP, compared to baseline(p<0.001), increase in III month versus post-therapy(p=0.016), pain-up stairs decrease in TTP (p <0.001), and retention of the effect achieved up to 1 month after treatment(p=1.00).
The total WOMAC Index for TG shows a statistically significant reduction in the TTP score (p<0.001) as well as retention of the effect on III month post-therapy (p=1.00) versus post treatment was observed. In RG WOMAC Index reduction was observed in the three time periods(p <0.001), retention of the effect by the end of I month(p<0.001) and increase of the III versus I month(p<0.001). In CG, a significant reduction after treatment(p<0.001), on I month (p<0.001) was observed and no statistically significant difference on III month compared to baseline was found(p=0.170).
Deep Oscillation effectively reduces edema, stiffness, pain in rest position, and physical activity in gonarthrosis. The complex application of KT and DO permanently affects the muscle imbalance and the volume of movement in the affected joint. The established therapeutic effects of DO are comparable to a comprehensive rehabilitation course involving MFIC. They have a long-term effect (at least 3 months) vs placebo-DO. The inclusion of DO in the complex rehabilitation leads to improved patient self-esteem for daily activity and quality of life.
Deep Oscillation is well tolerated by patients, without side effects in compliance with safety rules. The studied methodology can be easily applied in practical conditions.
2018-01-01T00:00:00ZОценяване качеството на обучение във висшите медицински училищаhttp://digilib.nalis.bg/xmlui/handle/nls/317912019-10-22T12:32:28Z2012-01-01T00:00:00ZОценяване качеството на обучение във висшите медицински училища
The goal of the dissertation is to reveal the factors that determine the quality of medical education and to develop a model for assessing the quality of higher education in medical schools.
Research tasks
1. To examine students’ expectations as participants in the learning process on factors that define the term "quality of the learning process" and their motivation for learning.
2. To develop specifications and criteria that define quality medical training.
3. To measure the significance of the factors that determine student satisfaction of medical education.
4. To develop a concise model to predict the likelihood of positive and negative assessment of training for operational research.
Materials and methods
A direct individual inquiry with 541 medical students at the beginning, middle, and end of their training was conducted, from October 2010 to November 2011. Response rate from surveyed students was 79.5%.
The study was designed as an observational cross-sectional study for assessing the quality of education on the basis of questionnaires. The evaluation of individual elements of the training process was done using the five point Likert scale. Descriptive statistics, single and multiple logistic regression analysis with risk assessment (cross-sectional odds ratio), tests for normality of distribution, Fischer exact test to examine the significance of the association, and the non-parametric independent sample test of Man Witney were used. Raw data were entered and processed in IBM SPSS Statistics 19.
The dissertation contains a theoretical study of student opinion surveys of medical education and an in-depth empirical study of a complex analysis of the attitudes of medical students towards the quality of education.
Multiple logistic regression analysis was used to create three predictive models and derive relationships between factors of the quality of teaching and their dependents – assessment of the quality of education, average grade and lectures attendance. Quantitative estimates of significant relationships were also obtained. According to the students’ assessment of the education, factor characteristics were defined that have predictive value for future evaluation and practical significance for determining the students’ definition and expectations of quality education.The dissertation has theoretical, methodological, and applied contributions to enriching the knowledge of the quality of medical students’ academic training and revealing what determines their learning satisfaction. An original questionnaire to assess student opinion was developed and tested. The practice for assessing the quality of education in terms of content and technology tools was enriched. The dissertation has a scientific and management potential, opening roads to link research in this area and the management of higher medical schools, as well as to generate reasonable rules to improve the quality of education. The practice of fundamental and operational research on medical education through the assessment of its quality was enriched.
2012-01-01T00:00:00ZПроучване на интра-абдоминалната хипертензия и възможностите за повлияването и при пациенти в интензивно отделениеhttp://digilib.nalis.bg/xmlui/handle/nls/317882019-10-22T09:22:07Z2013-01-01T00:00:00ZПроучване на интра-абдоминалната хипертензия и възможностите за повлияването и при пациенти в интензивно отделение
The aim of this prospective study is to examine the frequency and the severity of intra-abdominal hypertension (IAH) and the opportunities for nonsurgical management in intensive care unit. To realize this purpose we set the following tasks:
1. To examine the available data concerning IAP for measurement in clinical settings, to create reproducible and reliable method for intermittent measurement of IAP.
2. To the validated proposed by a parallel comparison of the values with those from the standard medical equipment for intraoperative monitoring of IAP.
3. To study factors caused by the investigator which affect negatively the accuracy of the proposed method.
4. To the frequency and the severity of intra-abdominal hypertension in ICU patients
5. To determined the influence of nondepolarizing muscle relaxants and analgesia upon IAP.
A closed system for intravesical intermittent measurement of IAP has been constructed. The method was validated in a study of 30 patients, who had a laparoscopic cholecystectomy by using Bland Altman plot as WSACS recommended. The effect of installed intravesical volume upon IAP has been studied. It was established that the introduction of volumes more than 50 ml in the bladder for intravesical measurement of IAP through fluid filled monitoring system with external transduser will lead to falsely increased values of IAP. This will result in wrong clinical decisions.The effect of patient’s position on IAP was also explored. From the statistical analysis (Repeated Measures ANOVA and Dunnett test) a significant difference was found between the results from measuring IAP in supine position and HOB 30°, 45° and lateral position. Patients in semirecumbent position with 30° or 45° HOB elevation IAP is between 4-10mmHg higher than in supine position.The frequency and the severity of IAH were examined in the period from June 2009 to December 2012 among 240 ICU patients separated in 3 groups (patients undergo elective, emergency surgery and medical patients) in University Hospital, Stara Zagora. In the elective group of patients there is 12,5% IAH, while in the emergency group IAP is 43.75%, and in the medical patients it is 42.5%.There is no statistical significant difference in the frequency of IAH among the mixed population of patients we examined and those studied by other authors with the same type of population.We found out that the use of nondepolarizing muscle relaxants leads to significant reduction in IAH which may have a beneficial effect on the patients with IAH. In patients with first and second degree of abdominal hypertension which we examined, adequate analgesia results in reduction in IAP, but there is an insignificant change of IAP in patients with higher degree of IAH
The standardized measurement of IAP is fundamental for defining intra-abdominal hypertension and Abdominal compartment syndrome. Our point of view is that before there are indications for a surgical decompression, less invasive treatment options should be optimized.
2013-01-01T00:00:00Z