Transcript cxovrebis xarisxis gansazRvra rezistentuli tuberkuloziT

Mm.kikviZe, l.miqiaSvili, m.oniani, m.erisTavi, l.waqaZe
Tbilisi, tfdec
2011, aprili
“janmrTeloba – es adamianis fizikuri, fsiqologiuri da socialuri sruli keTildReobaa da ara ubralod daavadebis
ar arseboba.”
janmo
“cxovrebis xarisxi – es fizikuri, fsiqologiuri, emociuri da socialuri funqcionirebis daxasiaTebaa, dafuZnebuli
mis subieqtiur aRqmaze.”
janmo
socialuri keTildReoba
“vmkurnalobT avadmyofs
da ara daavadebas”
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aSS kolumbiis universitetis profesorma D.A. Karnovsky 1947 w. gamoaqveyna naSromi –
“qimioTerapiis klinikuri Sefaseba kibos dros”
1980 w. eqimma Engel Seqmna medicinis biofsiqologiuri modeli
1995 wlidan safrangeTSi funqcionirebs saerTaSoriso arakomerciuli organizacia, romelic cxovrebis xarisxs Seiswavlis,
yovelwliurad sazogadoeba - International Society of Quality of Life Research–
ISOQOL atarebs kongresebs.
XXI s. dasawyisidan tardeba mravalricxovani samecniero kvlevebi cxovrebis xarisxis gansazRvrisaTvis sxvadasxva
daavadebebis dros . dazustda misi saxelwodeba - Health–related Quality of Life - HRQoL –
janmrTelobasTan dakavSirebuli cxovrebis xarisxi.
QoL mecnierul SeswavlaSi didi wvlili Seitana janmom, romelmac SeimuSava misi ZiriTadi kriteriumebi
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teqnologiuri progresi zogierTi daavadebebis diagnostikasa da mkurnalobaSi
da mokrZalebuli warmatebebi sxva daavadebebis mkurnalobaSi
viwro specializacia medicinaSi
Aadamianis keTildReobis mravalsafexuriani struqtura
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cxovrebis xarisxis mravalgazomvianoba
droSi cvalebadoba
avadmyofis monawileoba Tavisi mdgomareobis SefasebaSi
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Ddaavadebis zegavlenis Seswavla avadmyofis fizikur, fsiqologiur da socialur funqcionirebaze
Mmkurnalobis zegavlenis Seswavla avadmyofis cxovrebis xarisxis parametrebze
samkurnalo preparatebisa da mkurnalobis meTodebis efeqturobis Sefaseba
cxovrebis xarisxis parametrebis prognozuli mniSvneloba
cxovrebis xarisxi rogorc remisiisa da gankurnebis kriteriumi
cxovrebis xarisxis individualuri monitoringi
socialur-samedicino populaciuri kvlevebis Catareba
axali samkurnalo preparatebis eqspertizis xarisxis amaRleba
mkurnalobis meTodebis ekonomikuri dasabuTeba iseTi maCveneblebis gaTvaliswinebiT, rogoricaa “fasi-xarisxi”,
“Rirebuleba-efeqturoba” , QALY (Quality Adjusted Life Year) da sxva farmako-ekonomikuri
kriteriumebi.
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cxovrebis xarisxis (cx) Seswavlis ZiriTadi instrumentia: profilebi (cx TiToeuli komponentis Sefaseba) da kiTxvarebi (cx
kompleqsuri SefasebisaTvis),
kiTxvarebi DSeiZleba iyos – zogadi (janmrTelobis Sefaseba zogadad) da specialuri (konkretuli nozologiis
SeswavlisaTvis).
zogadi kiTxvarebia mag. Medical Outcomes Study 36-item Short Form Survey 36 (MOS SF-36).
specialuri kiTxvaria mag. "New York Heart Association Functional Classification
Scale" (NYHA), romelic gamoiyeneba fizikuri aqtivobis SezRudvis Sesafaseblad gulsisxlZarRvTa daavadebul
pacientebSi, Quality of Life after Myocardial Infarction Questionnaire"
(QLMI)
SF-36 kiTxvaris struqtura: kiTxvari Sedgeba 11 nawilisagan, Sedegebi warmodgenilia qulebis saxiT 8
Skalis mixedviT.
raodenobrivad fasdeba Semdegi monacemebi:
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General Health (GH)
Physical Functioning (PF)
Role-Physical (RP)
Bodily Pain (BP)
Vitality (VT)
Social Functioning (SF)
Role-Emotional (RE)
Mental Health (MH)
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kvlevis mizani da amocanebi
avadmyofTa CarTvis kriteriumebi
kvlevis dizaini
avadmyofis klinikuri gamokvlevis baraTi
kvlevis instrumentis aRwera
sakvlevi jgufis moculobis gansazRvra
randomizaciis meTodi
instruqcia kvlevaSi monawilTaTvis
pacientis informirebuli Tanxmoba
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kvlevis protokolis SemuSaveba
kvlevis instrumentis SerCeva
monacemTa Segroveba
monacemTa bazis formireba
kiTxvaris monacemTa Skalireba
monacemTa statistikuri damuSaveba
Sedegebis analizi da interpretacia
kvlevis protokoli
mizani - rezistentuli tuberkuloziT daavadebul pacientebSi cxovrebis xarisxis Sefaseba.
Mmasala da meTodebi – tfdec Terapiul ganyofilebebSi 2010 wlis noember – 2011 wlis martis TveebSi Semosuli
avadmyofebi. Seswavlil iqna 25 avadmyofi.
CarTvis kriteriumebi:
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filtvis tuberkulozi
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multirezistentuli forma
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axali da warsulSi namkurnalevi SemTxvevebi
Ggamoricxvis kriteriumebi:
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avadmyofebi 18 wlamde da 70 wlis zemoT
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Tanmxlebi daavadebebi da garTulebebi
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komunikaciuri problemebi (qarTuli enis arcodna da sxva)
kvlevisaTvis gamoyenebul iqna kiTxvari MOS SF-36 . kiTxvaris Sevsebis forma - mklevaris interviu avadmyofTan.
gakeTda analizi kiTxvaris 8 ZiriTadi Skalis mixedviT GH, PF da a.S. TiToeuli Skala fasdeboda 0 – 100.
damatebiT iTvleboda PCS – Physical Component Summary , MCS - Mental Component
Summary. gamoTvlebisaTvis gamoyenebuli iyo standartuli algoriTmi.
statistikuri analizi: aRwerilobiTi statistika (%, standartuli gadaxris, saSualosa da medianis gamoTvla).
intervius win yvela avadmyofs eZleoda informacia kvlevis Sesaxeb, maT Soris survilisamebr werilobiTi saxiT –
“pacientis informaciuli furceli”.
kvlevaSi CarTulma yvela avadmyofma moawera xeli Tanxmobis baraTs – “pacientis informirebuli Tanxmoba”.
tab 1. kvlevaSi CarTuli avadmyofebis daxasiaTeba
avadmyofTa saerTo raodenoba
25
sqesi, mdedri
11 (44%)
asaki (m±sd) * min-max
35,64 ± 13,69 (18-68)
tuberkulozis forma: diseminirebuli
fibrozul-kav.
infiltraciuli
sul
5
3
17
25
tuberkulozis tipi: multirezistentuli
zemdgradi
24 (96%)
1 (4%)
daavadebis xangrZlivoba,wlebi (x±sd) * min-max
3,20 ± 4,55 (0 - 15)
warsulSi namkurnalevi SemTxvevebi: diax
13 (52%)
12 (48%)
*m±sd – mean±StdDev
ara
(20%)
(12%)
(68%)
(100%)
tab. 2 cxovrebis xarisxis parametrebi
avadmyofTa saerTo raodenoba
n=25
m±sd *
GH
51,92±16,56
PF
63,40±33,96
RP
32,00±47,61
BP
66,20±31,01
VT
52,40±22,23
SF
66,88±26,71
RE
40,04±45,17
MH
54,40±19,42
PCS
51,83±26,87
MCS
53,44±21,65
*m±sd – mean±StdDev
Catarebulma kvlevam aCvena:
 filtvis tuberkuloziT daavadebulebSi sicocxlis xarisxis, rogorc fizikuri, aseve fsiqikuri komponentebis Semcireba,
(metad daqveiTebulia PF, RP, RE);
 msgavsiKkvlevis gafarToebis aucilebloba da damatebiTi maxasiaTeblebis gansazRvra (6MWT, spirometria)
tuberkuloziT daavadebul avadmyofebSi;
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HRQoL cnebisa da XXI saukunis axali meTodologiis danergvis saWiroeba fTiziatriul praqtikaSi;
HRQoL parametrebis farTod gamoyenebis saWiroeba tuberkuloziT daavadebul pacientebSi individualuri
mkurnalobis taqtikis arCevisa da prognozuli faqtoris gansazRvris mizniT.