Kharkiv Medical Academy of Postgraduate Education
Kharkiv, Ukraine
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Gibbs T.,Kharkiv Medical Academy of Postgraduate Education
Medical Teacher | Year: 2011

As new developments in medical education move inexorably forward, medical schools are being encouraged to revisit their curricula to ensure quality graduates and match their outcomes against defined standards. These standards may eventually be transferred into global accreditation standards, which allow "safe passage" of graduates from one country to another [Educational Commission for Foreign Medical Graduates (ECFMG) 2010. Requiring medical school accreditation for ECFMG certification-moving accreditation forward. Available from:]. Gaining much attention is the important standard of social accountability ensuring that graduates" competencies are shaped by the health and social needs of the local, national and even international communities in which they will serve. But, in today's "global village", if medical schools address the needs of their immediate community, who should address the needs of the wider global community? Should medical educators and their associations be looking beyond national borders into a world of very unequal opportunities in terms of human and financial resources; a world in which distant countries and populations are very quickly affected by medical and social disasters; a world in which the global playing field of medical education is far from level? With medical schools striving to produce fit-for-purpose graduates who will hopefully address the health needs of their country, is it now time for the medical education fraternity to extend their roles of social accountability to level this unlevel playing field? We believe so: the time has come for the profession to embrace a global accountability model and those responsible for all aspects of healthcare professional development to recognise their place within the wider global community. © 2011 Informa UK Ltd All rights reserved.

Lakhno I.V.,Kharkiv Medical Academy of Postgraduate Education
Serbian Journal of Experimental and Clinical Research | Year: 2017

Pre-eclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim of the investigation was to determine the role of maternal respiratory sinus arrhythmia (RSA) in regulation of fetal circulatory system in case of healthy pregnancy and in PE. The investigation of maternal and fetal HRV and umbilical venous blood flow velocity spectral analysis in 106 patients at 34-40 weeks of gestation was performed. 30 of them had healthy pregnancy and were involved in the Group I. In Group II 44 pregnant women with mild-moderate PE were observed. 32 patients with severe PE were monitored in Group III. The maternal sympathetic overactivity modulated HRV in PE. The suppression of RSA was explored in preeclamptic patients. The Doppler spectrograms of the umbilical veinous blod flow had the oscillatory peak with a frequency about 0.5 Hz. The above peak characterized the participation of the maternal RSA in fetal hemodynamics. Strong relationship between maternal RMSSD and amplitude of RSA associated peak, maternal and fetal RMSSDs was found in healthy pregnancy. No considerable relationship was revealed between the maternal RMSSD and the amplitude of 0.5 Hz frequency peak, the maternal and fetal RMSSDs in the patients with severe PE. The maternal RSA propagated its influence on the fetal umbilical venous blood flow and the fetal autonomic nervous regulation in normal gestation. The control of fetal hemodynamics diminished in the mild-moderate PE and even disappeared in severe PE. © 2017, University of Kragujevac, Faculty of Science. All rights reserved.

Lakhno I.,Kharkiv Medical Academy of Postgraduate Education
Archives of Perinatal Medicine | Year: 2016

Pre-eclamsia is a gestational disease that leads to hemodynamic disorders, hypoperfusion of end organ and multiple organ failure. Respiratory sinus arrhythmia is known to be participated in regulation of heart rate, cardiac output, blood pressure and peripheral vascular tone. The study was aimed to the survey of respiratory sinus arrhythmia involvement in the maternal cardiovascular system regulation in PE. 116 patients at 28-38 weeks of gestation were enrolled in the study. 30 women with healthy pregnancy were included in Group I (control). In Group II, 49 pregnant women with mild-moderate pre-eclampsia were observed. 37 patients with severe preeclampsia were monitored in Group III. The types of maternal central hemodynamics and maternal heart rate variability were investigated. The decreased autonomic tone was found in pre-eclamptic patients. The increased sympathetic activity in the mild-moderate pre-eclampsia could contribute to better perfusion of end organ. The explored autonomic modulations were associated with gradual decrease of respiratory sinus arrhythmia. Severe pre-eclampsia was featured by dramatic sympathetic overactivity. High peripheral vascular resistance and hypovolemia caused hypoperfusion of end organ in severe pre-eclamptic patients. Therefore, the decreased respiratory sinus arrhythmia was a sign of cardiac failure. Maternal respiratory sinus arrhythmia was an evident biophysical marker of pre-eclampsia and could be used as an additional criterion of its severity.

Lakhno I.,Kharkiv Medical Academy of Postgraduate Education
Scientifica | Year: 2016

Preeclampsia (PE) is one of the severe complications of pregnancy that leads to fetal deterioration. The aim was to survey the validity of fetal distress diagnostics in case of Doppler ultrasonic umbilical vein and arteries blood flow velocity investigation and ECG parameters analysis obtained from maternal abdominal signal before labor in preeclamptic patients. Fetal noninvasive ECG and umbilical arterial and venous Doppler investigation were performed in 120 patients at 34-40 weeks of gestation. And 30 of them had physiological gestation and were involved in Group I. In Group II 52 pregnant women with mild-moderate PE were observed. 38 patients with severe PE were monitored in Group III. The most considerable negative correlation was determined in pair Apgar score 1 versus T/QRS (R = -0.50; p < 0.05). So the increased T/QRS ratio was the most evident marker of fetal distress. Fetal noninvasive ECG showed sensitivity of 96.6% and specificity of 98.4% and, therefore, was determined as more accurate method for fetal monitoring. © 2016 Igor Lakhno.

Gordon M.,University of Central Lancashire | Gordon M.,Blackpool Victoria Hospital | Gibbs T.,Kharkiv Medical Academy of Postgraduate Education
BMC Medicine | Year: 2014

Background: Evidence synthesis techniques in healthcare education have been enhanced through the activities of experts in the field and the Best Evidence Medical Education (BEME) collaborative. Despite this, significant heterogeneity in techniques and reporting of healthcare education systematic review still exist and limit the usefulness of such reports. The aim of this project was to produce the STORIES (STructured apprOach to the Reporting In healthcare education of Evidence Synthesis) statement to offer a guide for reporting evidence synthesis in health education for use by authors and journal editors.Methods: A review of existing published evidence synthesis consensus statements was undertaken. A modified Delphi process was used. In stage one, expert participants were asked to state whether common existing items identified were relevant, to suggest relevant texts and specify any items they feel should be included. The results were analysed and a second stage commenced where all synthesised items were presented and participants asked to state whether they should be included or amend as needed. After further analysis, the full statement was sent for final review and comment.Results: Nineteen experts participated in the panel from 35 invitations. Thirteen text sources were proposed, six existing items amended and twelve new items synthesised. After stage two, 25 amended consensus items were proposed for inclusion. The final statement contains several items unique to this context, including description of relevant conceptual frameworks or theoretical constructs, description of qualitative methodologies with rationale for their choice and presenting the implications for educators in practice of the results obtained.Conclusions: An international expert panel has agreed upon a consensus statement of 25 items for the reporting of evidence synthesis within healthcare education. This unique set of items is focused on context, rather than a specific methodology. This statement can be used for those writing for publication and reviewing such manuscripts to ensure reporting supports and best informs the wider healthcare education community. © 2014 Gordon and Gibbs; licensee BioMed Central Ltd.

Sergienko N.M.,Kharkiv Medical Academy of Postgraduate Education | Sergienko N.M.,Eye Microsurgery Center | Shargorogska I.,Kharkiv Medical Academy of Postgraduate Education
Graefe's Archive for Clinical and Experimental Ophthalmology | Year: 2012

Background: The weakened biomechanical properties of the sclera is an important feature of myopic eyes. The quantitative evaluation in vivo of posterior scleral resistance to the elongation remains a challenge. Methods: This study comprised 172 eyes from 86 subjects with a mean age of 20.6 years (range, 18-28 years). Ultrasound biometry was performed using an immersion technique and the A-scan device (the Biometer AL-1000 - TOMEY). The axial length of the eye was measured twice: before and during the application of an external pressure of 30 g on the eye. The difference between two mean values of AL measurements before and during the pressure application was considered as a degree of change in the axial length that resulted from the IOP elevation. The data were entered into an Excel spreadsheet (Microsoft Corp.) for subsequent analysis. Statistical analysis was performed using SigmaPlot software (version 11.0, Systat Software, Inc.). A value of 0.05 or less was considered statistically significant. Results: The means ± SD of axial changes before and during the external pressure for hyperopia, emmetropia, myopia 0.5-3.0 D, myopia 3.25-6.0 D, myopia 6.25-12.0 D and myopia over 12.0 D were as follows: 0.03±0.01 mm, 0.05± 0.01 mm, 0.18±0.07 mm, 0.31±0.02 mm, 0.38 ± 0.07 mm, and 0.51±0.9 mm, respectively. The difference among groups was statistically significant. Conclusions: In conclusion, our study indicates that the biomechanical properties of the scleral coat, in terms of stretching and AL elongation, are measurable. The hypermetropic and emmetropic eyes possessed stiff sclera. The extent of AL remained practically unchanged during IOP elevation in these eyes. The absolute majority of the myopic eyes revealed a biomechanical weakness of the scleral shell. A higher degree of myopia was associated with increased AL elongation. Our approach to measuring the biomechanical properties of the sclera may have clinical significance in the future. © Springer-Verlag 2012.

Lakhno I.V.,Kharkiv Medical Academy of Postgraduate Education
Archives of Perinatal Medicine | Year: 2014

The aim of the investigation was a survey of the fetal HRV and ECG parameters in preeclampsia. It was performed fetal noninvasive ECG recordings in 94 pregnant women at 34-41 weeks of gestation and 66 of them were preeclamptic patients. The fetal deterioration in preeclampsia was characterized by lowered fetal heart rate variability and all its fractal components. The autonomic tone was diminished in direct proportion to the severity degree of preeclampsia. The mean value of short term vagal mediated parameters: RMSSD (root mean square of successive differences), pNN50 (the proportion of the number of pairs of successive NNs that differ by more than 50 ms divided by total number of NNs), HF (high frequency) and STV (short term variability) was also decreased. The relative predominance of the central sympathetic baroreflex mediated regulation of fetal hemodynamic was the main event in the preeclampsia induced scenario. The increased value of AMo (the amplitude of mode) and SI (stress index) was associated with abnormal myocardial adrenergic stimulation. It has induced pQ and QT shortening, increased T/QRS ratio and decelerations appearance. The augmented sympathetic tone played the significant role in fetal rigid rhythm and decelerations appearance and has formed the fetal myocardium hypoxic injury and suppressed sinus node response.

Lakhno I.V.,Kharkiv Medical Academy of Postgraduate Education
New Armenian Medical Journal | Year: 2015

Preeclampsia is a serious complication of pregnancy that leads to maternal multiple organ failure and fetal growth retardation. The objective of the study was to investigate the parameters of cardiac activity of mother and fetus affected by antihypertensive therapy for pregnant women with preeclampsia. Types of central maternal hemodynamics based on bioimpedance cardiography, parameters of maternal heart rate variability and fetal electrocardiogram in 72 preeclampsia patients with 32-38 weeks of gestation were examined. The control group was comprised of 30 women with factors associated with physiological pregnancy. In the presence of mild preeclampsia, an increased capacity of the central and peripheral sympathetic regulation of the hemodynamics and almost constant power of the vagal tone were observed. These changes were essential for the hyperkinetic type of central maternal hemodynamics. In the presence of moderate and severe PE, relative hypersympathicotonia associated with reduced heart rate variability was observed. It was accompanied by generalized vascular spasm and decreased cardiac index. The use of carvedilol has contributed to the correction of hypersympatheticotonia with decreased autonomic balance in pregnant women with mild preeclampsia. The use of methyldopa and nifedipine has not had any normalizing effect on total spectrum and separate branches of maternal heart rate variability in pregnant women with moderate and severe preeclampsia. The effect of antihypertensive drugs on the fetal cardiac activity was also not determined. © 2015, Yerevan State Medical University. All rights reserved.

Shalimova A.S.,Kharkiv Medical Academy of Postgraduate Education
New Armenian Medical Journal | Year: 2014

run a pathophysiological cascade leading to endothelial dysfunction, cardiac remodeling and vascular immunoinflammatory activation and apoptotic processes. The research, which aimed to assess the contribution of type 2 diabetes to the development of cardiac and vascular remodeling in patients with essential hypertension, was carried out. The study involved 180 examined patients: 107 patients with essential hypertension in combination with type 2 diabetes and 73 patients with essential hypertension without type 2 diabetes. Our findings showed that patients with essential hypertension and type 2 diabetes were characterized by preserved systolic function of the left ventricle and, compared to patients without type 2 diabetes, more pronounced predominance of concentric (67.3%) and eccentric (17.8%) hypertrophy of the left ventricle, which are the worst cases of remodeling. In patients with essential hypertension in combination with type 2 diabetes, the degree of left ventricle diastolic dysfunction was more pronounced than in nondiabetic patients. Diastolic dysfunction type violations of the left ventricle relaxation were present in 100% of patients with essential hypertension without type 2 diabetes, while in 13.1% of patients with type 2 diabetes heavier pseudonormal type of the left ventricle diastolic dysfunction was diagnosed. The distinctive feature in the group of patients with a combination of essential hypertension and type 2 diabetes compared with a group of patients with essential hypertension without type 2 diabetes were significantly higher values of intima-media thickness, pulse wave velocity in carotid arteries and abdominal aorta, as well as a significantly lower value of endothelium-dependent vasodilation.

Lakhno I.V.,Kharkiv Medical Academy of Postgraduate Education
New Armenian Medical Journal | Year: 2014

The spectral characteristics of maternal and fetal heart rate variability and umbilical vein hemodynamics were investigated in 63 pregnant women with preeclampsia that was associated with the suppression of the vagal tone. Sympatovagal value above 2.0 was a marker of pregnancy complication. It was determined that fetal compromise in preeclamptic patients was accompanied with decreased total spectrum power and fractal components of heart rate variability and the relative predominance of central sympathetic control. The resulting state influenced negatively on fetal myocardial metabolic response and was characterized with T/QRS ratio above 1.5. The autonomic nervous regulation reduction of the fetus demonstrated the loss of independence from the maternal hemodynamics that had synchronized the maternal and fetal heart rate by increased vagal tone power. The fetal distress development marked an increased regulatory role of maternal origin slow-wave processes and depletion of the proper myogenic umbilical cord arrangements which reinforced the penetrating of umbilical vein pulsative waves.

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