Steps towards implementing evidence-based screening in family medicine in Ukraine: SWOT-analysis of an approach of multidimensional empowerment.

BACKGROUND: The purpose of this study is to forward the implementation of an operational evidence-based state screening program of common diseases in Ukraine, where currently no state-based and evidence-based screening (EBS) exists. EBS should be performed by Family Doctors in a primary care setting and concern prevalent diseases in adults, such as: obesity (BMI), hypertension (BP measurement), diabetes (glycaemia), dyslipidemia (cholesterol/lipids), colon cancer (FOBT/colonoscopy), breast cancer (mammography), STIs (chlamydia, syphilis), HIV, HBV, HCV (i.e. serology or other rapid tests), HPV (swabs), cervical cancer (test Pap). depression (i.e., PHQ-9), and smoking (i.e., Fagerstrom). METHODS: Four needs-based research actions were led among citizens and healthcare professionals, based on multidimensional empowerment. Internal Strengths and Weaknesses of the ongoing implementation process were identified through these studies, whereas external Opportunities and Threats were determined by the present socio-cultural and political context. This SWOT analysis is likely to guide future state-based initiatives to accomplish EBS implementation in Ukraine. RESULTS: Internal Strengths are the bottom-up multidimensional empowerment approach, teaching of EBS and the development of an internet-based platform "Screening adviser" to assist shared decision making for person-centred EBS programs. Internal Weaknesses identified for the Family Doctors are a heterogeneous screening and the risk of decreasing motivation to screen. External Opportunities include the ongoing PHC reform, the existent WONCA and WHO support, and the existence of EBS programs in Europe. External Threats are the lack of national guidelines, not fully introduced gate keeping system, the vulnerable socio-economic situation, the war situation in the East of Ukraine and the Covid-19 pandemic. CONCLUSIONS: We started EBS implementation through research actions, based on a multidimensional empowerment of citizens, HCP and in EBS pathways involved stakeholder teams, to foster a sustainable operational human resource to get involved in that new EBS pathway to implement. The presented SWOT-analysis of this ongoing implementation process allows to plan and optimize future steps towards a state based and supports EBS program in Ukraine.

Introducing primary care research teaching in Ukraine: description and evaluation of the 'ABC' research methods course.

Ukraine has a developing and expanding system of general practice, but only a rudimentary academic primary care system and no research skills training for general practitioners (GPs). We designed and evaluated a transnational primary care research skills course for Ukrainian GPs.The ABC course is series of three 2-day workshops, designed to teach the basics of primary care research to early-career Ukrainian GPs. It was delivered by Ukrainian and British experts, using innovative, interactive teaching methods. Evaluation measures included participants' assessment of their research abilities, and changes in their attitudes, intentions and actions regarding their research practice.Seventeen Ukrainian GPs took part. There was a 1.32-point increase in research ability self-assessment 5-point Likert scores, with particular increases in literature review and budgeting abilities. Scores for research attitudes, intentions and actions increased by 4.0%, though limited by a ceiling effect. Many participants subsequently developed their own research projects, and some set up primary care research skills courses in their own Ukrainian academic organisations.The course resulted in increased levels of self-confidence and ability to plan primary care research, with improvements in participants' stages of change. It sets out a model for providing and evaluating innovative educational interventions in post-soviet countries, and gives them a basis for high-quality primary care research.

The role of nutritional support with probiotics in outpatients with symptomatic acute respiratory tract infections: a multicenter, randomized, double-blind, placebo-controlled dietary study.

BACKGROUND: A number of laboratory data and clinical studies have shown that probiotic bacteria may be beneficial in respiratory viral diseases. We investigated the role of probiotics in coronavirus disease-19 (COVID -19), post-disease symptoms, and humoral immune responses to viral antigens. METHODS: This was a randomized, double-blind, placebo-controlled, prospective, multicenter study. We included symptomatic patients aged 18-65 years without risk of severe disease, and positive antigen/PCR test for SARS-CoV-2. Patients received (Bifidobacterium (B.) lactis BI040, B. longum BL020, Lactobacillus (L) rhamnosus LR110, L. casei LC130, L. acidophilus LA120, 5 billion CFU total) or placebo 1 capsule a day for 28 days and recorded symptoms. Three months later patients completed Post-COVID-19 Questionnaire (PCQ-19). On days 0-5 and 28-35, blood was sampled for IgG to nucleocapsid protein (NCP) and receptor binding domain (RBD)/spike 1 (S1) protein. The primary outcome measure was a patient global symptom score on day 10 of observation. The difference between groups was assessed using the Mann-Whitney U test. RESULTS: Seventy-three patients were assessed for clinical endpoints and 44 patients were evaluated for antibody production. At day 10, the median global symptom score (interquartile range) was lower in the probiotic group (0.0 (0.0-2.0) vs. 2.0 (1.0-5.0), P < 0.05). The probiotic group had a shorter duration of fatigue and anxiety after COVID -19 (P < 0.05) and a greater change in IgG concentration on RBD/S1 (225.9 vs. 105.6 binding antibody units/mL, P < 0.05). CONCLUSIONS: Use of probiotics alleviates acute and post-disease symptoms, and improves humoral immune response to viral antigens. TRIAL REGISTRATION: Registered at clinicaltrials.gov as NCT04907877, June 1, 2021.

Identification and Ranking of Core Values in Family Medicine: A Mixed Methods Study From Ukraine.

Introduction/Context: The term core value (CV) can be defined as fundamental beliefs or principles, guiding one's behavior in a social context. Though core competencies of family medicine (FM) have been clearly defined by WONCA, there has been an ongoing debate on what the CVs are for family doctors (FDs). Ukraine is a developing country in the middle of Europe with a population of 43 million inhabitants, gained independence from the Soviet Union in 1991. Ukraine is a low-income country, developing a modern European healthcare system, especially regarding FM. To implement WONCA standards, it is mandatory to assess the ongoing understanding of CVs in clinical daily practice among active FDs, working in different countries of Europe including Ukraine. Research questions: How do Ukrainian FDs (Delphi group experts) define the CVs of FM in Ukraine and how important are these CVs to a wider population of Ukrainian FDs in their everyday practice? Methods: A mixed method study was conducted in two steps during August and September 2020 in Ukraine. The first part was a qualitative Delphi round (three rounds) design among 20 Ukrainian FDs who were familiar with teaching and terms like CV. A consensus list of six CVs has emerged from the Delphi round study. The second part was a quantitative survey among Ukrainian FDs, who were not specially used to discussing CVs. The consensus list of those six CVs was then submitted to 2000 FDs (randomly selected) who were not involved in the Delphi team, to rank those values from one to nine, according to the importance from their personal point of view. Demographic characteristics have been assessed for all the participants of the Delphi round and quantitative survey. Results: Twenty FDs were involved as experts in the first Delphi round, whereas only five experts continued their participation in the second and the third rounds of the survey. The following six CVs emerged from the Delphi round: comprehensive approach, care coordination, first recourse, continuity of care, integrated approach, and patient and family centered care. The final sample consisted of 375 FDs (19% response rate). There were 323 (88.7%) female and 34 (9.3%) male FDs in the sample. The mean age of the participants was 44.6±13.5 years. Discussion/Conclusion: Defining CVs for FM by Ukrainian FDs in a given socio-economical and historical-cultural setting is crucial to optimize primary medical care and to guarantee an appropriate and successful implementation of WONCA standards as well as CVs in different countries including those where reformation of the health system is ongoing.

Training Family Doctors and Primary Care Nurses in Evidence-based Prevention, Screening and Management of Cardiovascular Risks in Western Ukraine: A Longitudinal Study.

INTRODUCTION: The Ukrainian primary healthcare programme of preventive and screening recommendations has not been evidence-based. The traditional system of continuous medical education in Ukraine places participants in the role of passive listeners. This study explored the effects of an interactive training course on evidence-based prevention and screening of cardiovascular risks, on changes in Ukrainian family doctors' (FDs) and primary care nurses' (PCNs) knowledge and readiness to change practice over time. METHODS: Three hundred and seven FDs and PCNs participated in the study. Changes in participants' knowledge were assessed with 20 multiple choice questions, and their readiness to change practice with a five-item questionnaire. These were administered before, immediately after, three and twelve months after training. RESULTS: The mean pre-course knowledge score was 6.1 (SD 1.8) out of 20, increasing to 14.9 (SD 2.3) immediately afterwards (p<0.001). Three months later it was 10.2 (SD 3.2) and at one year it was 10.4 (SD 3.3), both of which were significantly higher than the pre-training level (p<0.005). The percentage of participants that were highly motivated to change their practice increased from 18.4% before the training to 62.3% immediately afterwards (p<0.001). Three months later, this fell to 40.4%. At 12 months it further reduced to 27.4%, but was still significantly higher than the baseline level (p<0.001). CONCLUSIONS: The interactive training was effective in increasing both participants' knowledge and their readiness to change their clinical practice. The impact of the training diminished over time, but was still evident a year later.

Development of family medicine in Ukraine.

This article includes a personal history of a family physician working in Ukraine. In June 2012, Pavlo Kolesnyk, Ukrainian Assistant Professor and a Family Doctor was awarded the second Montegute Scholar grant and had the chance to attend the Wonca Europe Conference 2012 in Vienna. In many developed countries, family medicine is already well established. In Ukraine, which has the legacy of a socialist health care system the implementation of the discipline started only at the end of the last century. The changes in the health care system were of greater importance in primary care and family medicine. It gave greater decentralization of the health care system and supported investment in primary care. This article describes the development of family medicine in undergraduate and postgraduate education. Whilst family medicine is officially a priority of health care policy, there is still a long process ahead. Family medicine needs financial support from the government and doctor's wages have to be increased, to prevent this branch of medicine being unpopular among graduating medical students.