Improving the productivity, quality and availability of medical services directly depends on the effectiveness of motivational mechanisms for personnel management. Despite the sufficient empirical and practical experience in the field of health workforce management, data on the comparison of labor motivation among different professional categories of medical personnel are not often found. The article analyzes the main labor motives of nurses and doctors, reveals the differences in the motivational profiles of these categories of workers.Purpose of the study. Is to study and compare the motivation of doctors and nurses from budgetary healthcare institutions providing TB care to the population.Materials and methods. A sociological survey was conducted using a questionnaire form containing questions to study the labor motivation of healthcare workers. The study involved employees of various professional categories of public medical institutions – the Republican Clinical Tuberculosis Hospital and the Makeyevka Municipal TB Dispensary. Labor motives are structured into 3 blocks: material, socio-psychological and individual.Results. In the overwhelming majority, doctors and nursing staff of public health care institutions with a phthisiology profile are equally satisfied with the work they do. The most significant labor motives were identified for each category of medical personnel. For paramedical personnel, the factor of material motivation came out on top, but a convenient work schedule, relationships with superiors and a favorable psychoemotional climate made up the five most significant work motives. Physicians are more influenced by individual and socio-psychological motives: self-realization and professional interest are in the lead, remuneration, relationships with colleagues and patient care have a complex effect on the activities of doctors.Conclusion. This study confirms the principle of polymotivation of all categories of employees, therefore, the modernization of the motivational environment should be carried out taking into account group affiliation, individual characteristics, preferences and personal qualities of employees. Personnel-oriented system of motivation of medical personnel will solve most of the problems faced by the healthcare sector in today's changing market relations.
Tuberculosis of the tongue is one of the rare localizations of extrapulmonary tuberculosis. The article presents a clinical case of secondary tuberculous glossitis with concurrent multidrug-resistant pulmonary tuberculosis in a 35-year-old HIV-infected patient. Despite relatively rapid verification of the diagnosis, the clinical situation was difficult due to differential diagnosis with nonspecific lesions, unknown HIV status, and detection of drug resistance of Mycobacterium tuberculosis. This case illustrates the step-by-step diagnosis and treatment of tuberculous ulcers of the tongue and lungs. The comprehensive examination with the use of molecular genetic, bacteriological, histological, and X-ray diagnostic tools contributed to the timely prescription of the adequate anti-tuberculosis therapy regimen.
The article analyzes the current HR of the local healthcare organization. There was carried a SWOT-analysis of personnel management has been out, disclosed the main problems of the management system of a medical institution. Development strategies and an algorithm for improving personnel policy are formulated in order to increase the efficiency of management and the quality of medical care to the population.Purpose of the study. Is to analyze the current personnel policy, SWOT-analysis of personnel management, develop a strategies and set of practical recommendations for improving the management system of a public health institution while ensuring high quality medical services to the population.Materials and methods. An analysis of the personnel policy in a phthisiatric institution (Makeevka Municipal TB Dispensary, Donetsk region) was carried out, the heads of the main structural divisions were questioned. The analysis results are structured using the SWOT scale.Results. Based on the results of the sociological survey, the main advantages and disadvantages of personnel policy were identified, a SWOT analysis matrix was drawn up, and strategies for the development of a budgetary healthcare institution were developed. The breakthrough strategy is based on improving the material and technical base, attracting funding and investment, increasing the speed and quality of TB care at the regional level using information technology, while the survival strategy is based on increasing the income of health workers, social protection, improving working conditions and developing personnel motivation systems. The main recommendations include increasing the number of employees, creating a strategy for the formation of qualified personnel, improving the quality of the working environment, creating a favorable psycho-emotional climate, and developing an effective system of incentive payments.Conclusion. The medical industry is in dire need of modernization in order to improve personnel processes, financial, economic and regulatory support. The conducted research and developed recommendations will have a beneficial effect on the achievement of the main strategic goal - improving the health and quality of life of the population of the state.
The epidemiological significance of combined forms of especially dangerous infections has not been studied enough, unlike mono-infections. Currently, there is a tendency towards an increase in the incidence of multidrug-resistant tuberculosis. The formation of severe forms of the disease is caused by other widespread infections, such as chronic viral hepatitis and HIV. Polymorbid conditions distort the clinical manifestations of tuberculosis, reduce the effectiveness of anti-tuberculosis therapy and worsen the prognosis of the disease. Risk factors among patients in this category need analysis to carefully monitor patients and ensure infection control. Objective is to analyze the factors affecting the course of multidrug-resistant tuberculosis in HIV-infected patients with concomitant viral hepatitis. Materials and methods. Cases of the combined pathology of multiresistant tuberculosis, HIV infection and viral hepatitis with a dominant diagnosis of tuberculosis are analyzed. Results and discussion. The influence of the immunological status on the course of combined pathology was revealed. Since all the patients under study had clinical stage 4 of HIV infection, tuberculosis developed as an opportunistic infection. Severe immunosuppression (CD4 < 200 cells/ml) contributed to the progression of the generalized tuberculosis process. Long-term immunodeficiency was an unfavorable factor; in the overwhelming majority of cases, antiretroviral therapy was prescribed only after tuberculosis was detected. The dependence of the clinical form of tuberculosis on the level of CD4-lymphocytes was noted: isolated lesion of the chest organs prevailed in patients with a level of CD4-lymphocytes more than 200 cells/ml, generalization of TB process — with CD4 less than 200 cells/ml. Patients with miliary tuberculosis had a higher mortality rate compared to patients with other clinical forms, regardless of antiretroviral therapy. It was revealed that socially disoriented young people with viral hepatitis C prevailed in the structure of patients, the prevalence of which was due to the influence of aggravating factors, such as alcohol and drug abuse, and stay in prisons. Against the background of combined treatment, there was no significant effect of viral hepatitis on the course of polymorbid conditions and the effectiveness of the therapy.
A clinical case of HIV-associated multiple drug resistant tuberculosis in a pregnant woman is presented. The clinical situation was complicated since during the main course of treatment this patient had two pregnancies and delivery with an interval of less than 2 years, and the onset of the disease occurred during the early period in the first pregnancy. This case demonstrates effective treatment of the specific disease and favorable perinatal outcomes. The article assesses medical tactics, analyzes the time of diagnosis, complex therapy, the choice of the way of delivery, considers the need for interdisciplinary interaction at all stages of observation to improve the quality of care.
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