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Medical Assistance in the De-Occupied Ukrainian Territory
- Oleg V. Mazurenko, Georgiy G. Roshchin, Ivan Yo Slychko
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- Journal:
- Prehospital and Disaster Medicine / Volume 38 / Issue 6 / December 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. 807-812
- Print publication:
- December 2023
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Introduction:
The Russian invasion of Ukraine in 2022 has affected more people and destroyed a local public health facility. When some territories in Ukraine were de-occupied, national and international mobile clinics (MCs) were involved for medical assistance to local inhabitants. Knowledge about population health, medical, and humanitarian needs after they have been de-occupied has to improve planning for health system response.
Objective:The aim of this study was to summarized the MC experience at the first month after the area was de-occupied, as well as to show out-patient visits and to identify a need for medicines and medical equipment in the MC.
Methods:The information related to the missions was obtained by direct observation and estimation on empirical data gathering in the field during a twelve-day mission in April-May 2022. All patients were divided by age, sex, and diseases according to the International Classification of Diseases-10 (ICD-10). During the twelve-day MC mission, medical assistance was provided for 478 out-patients. Descriptive statistical methods were undertaken using Microsoft Office 2019, Excel with data analysis.
Interventions:All out-patients were evaluated clinically. Personal medical cards were completed for each patient. Glucose testing as well as tests for coronavirus disease 2019/COVID-19 had been done, if it was necessary. All sick persons were treated for their disease.
Results:The priority needs for emergency and primary medical care, medicines, and hygienic and sanitation supplies after the area was de-occupied were fixed. The most frequent reasons for visiting the МС were: hypertension (27.6%), musculoskeletal-related (arthritis) diseases (26.9%), heart and peripheral vascular diseases (12.1%), upper gastrointestinal disorder (5.4%), upper respiratory infection (5.0%), and diabetes Type-2 (3.7%). Other diagnoses such as lower respiratory tract infection, diagnoses of the digestive system (hemorrhoids and perianal venous thrombosis), chronic obstructive pulmonary disease/COPD or asthma, eye diseases, gynecology-related condition, menstrual condition, and urinary tract disorder were distributed almost equally (0.21%-2.51%) among the patient population.
Conclusions:In the de-occupied territories, a health responder could be ready for medical assistance to patients with noncommunicable diseases (NCDs) as well as to support a person with psychological reactions who asked for sedatives and sleep-inducing medicines. These data clearly demonstrate that MCs must be equipped by blood pressure (BP) monitor, stethoscope, pulse oximeter, and diabetes testing kit glucose with essential medicines. This study improves health response planning for local civilian populations in de-occupied territory.
3038 Examining the association between inpatient opioid prescribing and patient satisfaction.
- Olena Mazurenko, Justin Blackburn, Matthew Bair, Areeba Kara, Christopher A. Harle
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- Journal:
- Journal of Clinical and Translational Science / Volume 3 / Issue s1 / March 2019
- Published online by Cambridge University Press:
- 26 March 2019, pp. 121-122
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OBJECTIVES/SPECIFIC AIMS: Research overview: Providing patient-centered care is increasingly a top priority in the U.S. healthcare system.1,2 Hospitals are required to publicly report patient-centered assessments, including results from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction surveys.3 Furthermore, clinician and hospital reimbursements are partially determined by performance on patient satisfaction measures.3 Consequently, hospitals and clinicians may be incentivized to improve patient satisfaction scores over other important outcomes.4 Paradoxically then, the pursuit of patient-centered care may lead clinicians to fulfill patient requests for unnecessary and potentially harmful treatments.5 Opioid prescribing during hospitalizations may be particularly affected by clinicians’ seeking to optimize patient satisfaction scores.6,7 Satisfaction with pain care is an important predictor of overall patient satisfaction in the HCAHPS surveys,8,9 and clinicians report increased pressure to fulfill patient requests for immediate pain-relief.10,11 Therefore, clinicians may prescribe opioids to avoid receiving lower patient satisfaction scores.12,13 Furthermore, clinicians lack clear guidance on opioid prescribing for some populations, including non-surgical inpatients, who represent almost half of all hospitalizations.14 To reduce clinicians’ incentive to prescribe opioids as a means of achieving patient satisfaction, the Center for Medicare and Medicaid Services (CMS) temporarily removed questions related to patient satisfaction with pain care from the clinician and hospital reimbursement formulas beginning in 2018.15 Importantly, prior research16-20 has not rigorously tested the hypothesis implied by the CMS policy change: that certain opioid prescribing practices in inpatient pain care are associated with higher patient satisfaction. Objectives: The purpose of this study was to evaluate the association between the receipt/dose of opioids during non-surgical hospitalizations and patient satisfaction measured by the HCAHPS survey. METHODS/STUDY POPULATION: Methods/Study Population: We conducted a pooled cross-sectional study of adults (18 and older) with non-surgical hospitalizations within the 11-hospital healthcare system in a Midwestern state from 2011-2016. Data were extracted from electronic health records and linked to HCAHPS patient satisfaction surveys. We estimated the propensity score for receipt of any opioids during hospitalization and separately the receipt of high dose opioids (≥100 morphine milligram equivalent [MME]) based on patient, encounter, and facility characteristics for all hospitalizations with complete data. We used nearest neighbor matching to construct two matched samples to minimize selection bias and confounding by indication. We used a standardized difference threshold of < 0.1 as an indication of the balance between matched groups. Outcomes were compared with a test on the equality of proportions using large-sample statistics. All analysis was performed in STATA 14.0 analytical software. Main outcomes: We analyzed four dependent variables. Two pain-specific patient satisfaction variables were derived from the responses to the following survey questions: 1) “During this hospital stay, how often your pain was well controlled? (pain control)” and 2) “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain? (pain help)”, with 4-point Likert scale responses ranging from “Never” to “Always.” We also used two global satisfaction measures derived from the responses to the following survey questions: 1) “Using any number from 0 to 10, where 0 is the worst hospital possible and 10 is the best hospital possible, what number would you use to rate this hospital during your stay (overall patient satisfaction)?” and 2) “Would you recommend this hospital to your friends and family (willingness to recommend a hospital)? (4-point scale of “Definitely Yes” to “Definitely No”). Because the responses are not normally distributed, and the response options are truncated, we dichotomized each of these questions following previously published approaches8 and CMS methodology3 (e.g. “always” vs. all other responses or “9 or 10 rating” vs. all others). RESULTS/ANTICIPATED RESULTS: Results: Among 17,691 patients who reported that they needed pain medications during hospitalization in their HCAHPS survey, 43.7% (n=7,735) received opioids. Among the matched sample (n=8,848), 55% were female, 90% were white, 9% were black, 74% were emergency admissions, 29% had a circulatory diagnosis, 92% were discharged home, and the average pain score ranged from 0.2 to 7.1 during the hospital stay. Compared to matched patients hospitalized but did not receiving opioids, those who received opioids did not significantly differ in their rating of pain help (75% of patients without opioids rated that they always received help for their pain versus 75% of patients with opioids; p=.78), pain control (55% of patients without opioids reported that their pain was well controlled versus 54% on opioids; p=.93), willingness to recommend the hospital (69% of patients without opioids reported that they would definitely recommend a hospital versus 71% with opioids; p=.16) and overall rating of their care (47% of patients without opioids rated their hospitalization as 10 versus 46% on opioids; p=.22). DISCUSSION/SIGNIFICANCE OF IMPACT: Discussion: We found no evidence that receipt of opioids is associated with patient satisfaction, including at doses. To our knowledge, this is the first study that used propensity score matching to examine the association between inpatient opioid prescribing practices and patient satisfaction. Furthermore, our sample is unique in the inclusion of patients hospitalized for non-surgical indicators over a five year period in the multi-hospital healthcare system in a Midwestern state. Our findings add to the existing literature which has shown contradictory associations between opioid prescribing and patient satisfaction.16-22 Specifically, few studies that looked at surgical inpatients showed a lack of association between patient satisfaction16,18 and opioid prescribing, whereas others showed that receipt of opioids was associated with lower patient satisfaction.17-20 Our findings may imply that satisfaction with pain care may be achieved without administering opioids to non-surgical inpatients. Alternatively, satisfaction with pain care may not be influenced by opioid prescribing for non-surgical inpatients. Future research should further examine the association between opioid prescribing and patient satisfaction among non-surgical inpatients on a national scale to get a better understanding of the relationship between certain pain care practices and patient satisfaction.
Magnetic Ordering of Perovskite-Like La-, Nd-, and Gd-Doped Bismuth Ferrite
- Valery Sobol, Barys Korzun, Olga Mazurenko, Temirkhan Bizhigitov, Sabit Tomaev
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- Journal:
- MRS Advances / Volume 4 / Issue 36 / 2019
- Published online by Cambridge University Press:
- 29 July 2019, pp. 1989-1999
- Print publication:
- 2019
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Bismuth ferrite (BiFeO3) and La-, Nd- and Gd-substituted bismuth ferrite of the Bi1-xLaxFeO3, Bi1-xNdxFeO3, and Bi1-xGdxFeO3 types with the atomic part of the substitution element x equal up to 0.20 were synthesized by the solid-state reaction method using powders of oxides Bi2O3, Fe2O3, and La2O3, or Nd2O3, or Gd2O3 of pure grade quality and investigated using X-ray diffraction analysis. The magnetization was measured in the magnetic field up to 6.5⋅106 A/m at 5 and 300 K. It was found that the total substitution up to 0.20 atomic part of Bi by La, Nd, and Gd leads to the paramagnetic behavior of the doped bismuth ferrite at low temperatures in a wide range of magnetic field. Strong nonlinear dependence of magnetization on the magnetic field was detected and a ferromagnetic-like dependence of magnetization was observed for small magnetic fields. This can be explained by the exchange interaction between doping magnetic ions, as well as by the exchange interaction of these ions with ions of iron. The enhancement of magnetic properties with the increase of the content of the substitution is monotone and is more pronounced for the Bi1-xGdxFeO3 ceramics.
2183 Balancing patient-centeredness and patient safety in the hospitals: The case of pain care and patient satisfaction
- Olena Mazurenko, Basia Andraka-Christou, Matthew Bair, Areeba Kara, Christopher A. Harle
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 79
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OBJECTIVES/SPECIFIC AIMS: This study seeks to understand the relationship between opioid prescribing and patient satisfaction among non-surgical, hospitalized patients. As part of this study, we qualitatively examined challenges in delivering safe and patient-centered care through voices of physicians’, and nurses.’ METHODS/STUDY POPULATION: We collected data through in-person interviews using semi-structured guides tailored to the informant roles. Study participants came from 1 healthcare system located in a mid-Western state. Each interview lasted 30–45 minutes, was audio-recorded with consent, and transcribed for analysis. Two researchers each coded 17 transcripts for discussions around patient-centeredness (including patient satisfaction, patient experiences), and patient safety for hospitalized patients experiencing pain. Analysis followed a general inductive approach, where researchers identified themes related to the research questions using an open coding technique. They discussed and reached consensus on all codes, and extracted several preliminary themes. The analysis was supported by NVivo software. RESULTS/ANTICIPATED RESULTS: The following themes emerged: (1) complex decision-making process to prescribe opioids for hospitalized patients; (2) the role of objective findings in prescribing decisions; (3) bargaining process in prescribing opioids; (4) balancing patient-centeredness and patient safety for selected populations; (5) opioids are the predominant medications for pain care. DISCUSSION/SIGNIFICANCE OF IMPACT: Clinicians’ decision to prescribe opioids for nonsurgical hospitalized patients is based on multiple factors, including patient’s condition, patient’s preference for pain medications, or standard hospital’s pain care regimen. Interventions that improve clinicians’ ability to prescribe opioids may be needed to improve delivery of patient-centered and safe pain care.
Crystal Lattice Dynamics of the Substitutional Solid Solutions in the Bi(Gd) - Fe - O and Bi(Nd) - Fe - O Systems
- Valery Sobol, Barys Korzun, Cheslav Fedorcov, Olga Mazurenko, Temirkhan Bizhigitov, Sabit Tomaev, Bibara Nushnimbaeva, Sofia Egemberdieva, Altynbek Nauryzbaev
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- Journal:
- MRS Advances / Volume 3 / Issue 55 / 2018
- Published online by Cambridge University Press:
- 22 May 2018, pp. 3243-3248
- Print publication:
- 2018
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The substitutional solid solutions in the Bi(Gd) - Fe - O and Bi(Nd) - Fe - O systems of the Bi1-xGdxFeO3 and Bi1-xNdxFeO3 types with x up to 0.20 were synthesized by the solid-state reaction method and investigated using X-ray diffraction analysis and infrared reflective spectrometry in the wavelength range from 12.5 to 24 μm. It was determined that the Bi1-xGdxFeO3 and Bi1-xNdxFeO3 crystal structure is a distorted form of perovskite, R3c space group. Two extremums at 18.2 μm (strong extremum) and 22.5 μm (rather weak extremum) on the infrared reflection spectra of the Bi1-xGdxFeO3 and Bi1-xNdxFeO3 solid solutions were discovered. The extremum at 18.2 μm corresponds to the Fe – O stretching vibrations and the extremum at 22.5 μm corresponds to the O - Fe – O bending vibrations of the FeO6 groups. The growth of reflectivity of the Bi1-xGdxFeO3 and Bi1-xNdxFeO3 solid solutions in comparison with pure BiFeO3 and the displacement of the reflectivity band maximum into the side of the spectrum with longer wavelengths with the increase of the atomic part of the substitutive element x up to 0.20 were found.
Anisotropic Elastic Properties of Low-k Dielectric Materials
- A.A. Maznev, A. Mazurenko, G. Alper, C.J.L. Moore, M. Gostein, Michelle T. Schulberg, Raashina Humayun, Archita Sengupta, Jia-Ning Sun
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- Journal:
- MRS Online Proceedings Library Archive / Volume 812 / 2004
- Published online by Cambridge University Press:
- 17 March 2011, F5.9
- Print publication:
- 2004
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A non-contact optical technique based on laser-generated surface acoustic waves (SAWs) was used to characterize elastic properties of two types of thin (150-1100 nm) low-k films: more traditional non-porous organosilicate glass PECVD films (k=3.0) and novel mesoporous silica films fabricated in supercritical CO2 (k=2.2). The acoustic response of the non-porous samples is well described by a model of an elastically isotropic material with two elastic constants, Young's modulus and Poisson's ratio. Both parameters can be determined by analyzing SAW dispersion curves. However, the isotropic model fails to describe the SAW dispersion in the mesoporous samples. Modifying the model to allow a difference between in-plane and out-of plane properties (i.e., a transversely isotropic material) results in good agreement between the measurements and the model. The in-plane compressional modulus is found to be 2-3 times larger than the out-of plane modulus, possibly due to the anisotropic shape of the pores. Elastic anisotropy should therefore be taken into account in modeling mechanical behavior of low-k materials.
Ukranian's Disaster Medicine Team Mission to India following the Earthquake of 2001
- George G. Roshchin, Oleg V. Mazurenko
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- Journal:
- Prehospital and Disaster Medicine / Volume 17 / Issue 3 / September 2002
- Published online by Cambridge University Press:
- 28 June 2012, pp. 163-166
- Print publication:
- September 2002
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This article describes the basic principles around establishing a Disaster Medicine Camp and the organization of the Ukrainian Disaster Medicine Mobile Hospital, which provided medical aid to victims of the 2001 earthquake in India. All of the information was obtained through direct observation and estimates based on empirical data gathered in the field.