Medical management determinants of the maxillofacial precancerous and benign diseases malignancy.

OBJECTIVE: Aim: To identify the medical management determinants of the maxillofacial precancerous and benign diseases malignancy. PATIENTS AND METHODS: Materials and Methods: 150 people with maxillofacial cancer and 100 people with precancerous and benign diseases of the same localization were interviewed. RESULTS: Results: There were revealed: a low percentage of detection during check-up (10.2-15.8%), more than a third of cases (35.8-37.4%) are diagnosed by chance; not all patients undergo histological verification of the diagnosis (25.7% in cancerous and 43.2% in precancerous and benign diseases); not all are under follow up observation (24.7-27.7%). The risk of precancerous and benign diseases malignancy is the highest at 40-59 years of age (OR=4.4; 95% CI: 1.9-10.5), andalso increases with the duration of the disease for more than 5 years (2.2; 1.2-4.10 ), in patients who didn't undergo histological verification (2.2; 1.3-3.8), don't follow doctors' recommendation on visits and treatment (2.4; 1.4-4.1), don't trust doctors and are dissatisfied with medical care (2.1; 1.3-3.6). The risk groups of the maxillofacial oncological, precancerous and benign diseases are men, who are 1.5 times more likely to suffer from them than women and are characterized by lower medical care activity. The risk factors of the maxillofacial precancerous and benign diseases malignancy are low financial (4.6; 1.7-12.4) and territorial (3.3; 1.1-10.3) accessibility of medical care, including dental care (2.8; 1.6-4.8). CONCLUSION: Conclusions: It is necessary to improve the prevention and medical care in order to advance the early detection of maxillofacial cancer, taking into account the established medical management determinants of malignancy.

QUALITY OF LIFE OF PATIENTS RECEIVING HOME-BASED PALLIATIVE CARE FROM FAMILY PHYSICIANS AND MOBILE PALLIATIVE CARE TEAM.

OBJECTIVE: The aim: To evaluate the quality of life (QoL) of palliative patients receiving general palliative care and the impact of palliative care provided by mobile palliative care team (MPCT) on their QoL. PATIENTS AND METHODS: Materials and methods: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core30 (QLQ-C30) was used to evaluate QoL of 219 palliative patients receiving general palliative care from family physicians in the Center for primary health care of Uzhhorod city, Ukraine. In the second part of the study, the subgroup of 25 patients who had at least one of fifteen QLQ-C30 scales evaluated lower than 50 points were selected. They were provided with PC from the MPCT for 2 weeks and their QoL was measured again. RESULTS: Results: For the patients who received general palliative care from a family physicians mean m (SD) QoL value was 38.63 (16.9), and the main symptoms that affected QoL were fatigue 48.60 (23.30) and pain 46.11 (20.97). The most impact on QoL scores had role (rs=0,430;), emotional (0.321) and physical (0.301) functioning and such symptoms as pain (-0.392), insomnia (-0.311), dyspnoea (-0.294), financial difficulties (-0.255). For the patients who received palliative care from MPCT mean the mean QoL score increased by 30.0 points, mean pain score decreased by 42.22 points, fatigue score decreased by 38.0 points and level of financial difficulties also decreased by 76.0 points. CONCLUSION: Conclusions: The involvement of the MPCT could have a significant positive impact on the QoL of palliative patients.

Awareness of pediatric palliative care among health care workers.

OBJECTIVE: Introduction: In order to develop such a relatively new type of medical care in Ukraine, as pediatric palliative care, first of all, qualified medical workers are needed. The aim: to assess the awareness of pediatric palliative care among healthcare workers providing medical services to children. PATIENTS AND METHODS: Materials and methods: It was carried out a survey at health facilities of Ivano-Frankivsk region, which provided medical care for children. It was interviewed 578 healthcare workers, among them were generally practitioners - 131, primary care pediatricians - 52, pediatricians-specialists - 36, health care managers - 78, nurses - 281. The half of the respondents (57.2%) had work experience more than 20 years. RESULTS: Results: It was established that every fourth respondent (25.3%) did not know what is mean of pediatric palliative care. At the same time, the main object of its delivery was considered to be patients with cancer (71.5%), and not with incurable chronic diseases (54.8%). Only 59.7% of respondents knew that palliative care (PC) should begin with the diagnosis of an incurable disease, and not at the end of life, as well as half (52.6%) of them knew that the relatives of seriously ill children are object of PC. The majority of respondents recognized the lack of their knowledge of pediatric palliative care (85.8%). All answers differed depending on the position of respondents (p%#60;0.05). However, regardless of this, almost all respondents (94.5%) expressed their desire to receive proper knowledge of pediatric palliative care. CONCLUSION: Conclusion: It was established lack of knowledge on pediatric palliative care among medical workers served children. The majority of respondents recognized the lack and need of knowledge on pediatric palliative care. Overall level of knowledge among healthcare workers about palliative care was poor, and it is necessary to improve it.