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diplomisSemdgomi samedicino ganaTlebis programahematologia/transfuziologia/xangrZlivoba – 3 w. - 33 Tve/

I.Sesavali

1.zogadi debulebebiwinamdebare dokumenti asaxavs rezidenturis saswavlo kurss (kurikulums) specialobaSi-“hematologia da transfuziologia”.aRniSnuli programiT maZiebels dasrulebuli unda hqondes medicinis erTsafexuriani saganmanaTleblo programa.

2. specialobis aRweriloba2.1. definicia: hematologia aris medicinis dargi, romelic Seiswavlis: sisxlisa da sisxlmbadi organoebis Senebas da funqciur mdgomareobas normaSi da paTologiaSi, moicavs am organoTa embriogenezs, morfogenezs, ujredovani elementebis morfofiziologias, sisxlis sistemis daavadebaTa etiologiis, paTogenezis, paTologiuri anatomiis, klinikis mkurnalobis da prevenciis ZiriTad aspeqtebs.hematologiis mniSvnelovan nawilia transfuziologia,romelic Seiswavlis da moicavs organizmis sisxlwarmoqmnis darRvevebiT, sisxlis ujredovani da cilovani deficitiT an sxva paTologiuri mdgomareobiT gamowveuli homeostazis darRvevis dros sisxlis,misi ujredovani da cilovani komponentebis da sxva satransfuzio areebis Terapiuli gamoyenebis Cvenebebs, samkurnalo efeqturobas, posttransfuziul garTulebebs da maT profilaqtikas, aseve komponenturi hemoTerapiis alternatiuli meTodebis gamoyenebas. Transfuziologia Seiswavlis aseve zemoTCamoTvlili satransfuzio saSualebebis damzadebas (sisxlis bankingi). hematologi/transfuziologi medicinis dargis specialistia, romelsac:a. gaaCnia Sesabamisi Teoriuli codna da praqtikuli gamocdileba klinikur da laboratoriul hematologiaSi;b. miRebuli aqvs specialuri codna _ dauflebulia hematologiis, imunologiis da transfuziuli medicinis safuZvlebs;g. gaaCnia garkveuli gamocdileba da unar-Cvevebi damyarebuli sisxlis warmoqmnis, citologiis, histomorfologiis, imunologiis, citogenetikis sakiTxebis codnaze;d. nebismier samkurnalo, klinikur da samecniero samedicino dawesebulebaSi SeuZlia Seasrulos kvalificiur specialist _ konsultant hematolog/transfuziologis roli diagnostikuri da Terapiuli problemebis gadawyvetaSi;e. gaaCnia maqsimaluri efeqturobis da usafrTxoebis garantirebis unari rogorc donoris, ise pacientisaTvis (recipientisaTvis) sisxlis da misi komponentebis aRebis da transfuziis dros.v. romelsac SeuZlia hematologiis da transfuziologiis dargSi monawileoba miiRos klinikur da elementarul samecniero kvlevebSi;

z. gaaCnia unari hematologiur da transfuziologiur medicinaSi miRebuli codna da gamocdileba gauziaros studentebs da medicinis sxvadasxva dargSi momuSave eqim-specialistebs.2.2. specialistisTeoriuli codna:2.2.1. sisxlis sistemis normaluri da paTologiuri fiziologia.

klinikuri hematologiaSi Semavali qvemoT CamoTvlili darRvevebis klasifikacia, daavadebebis da sindromebis paTogenezi, etiologia, klinika, mkurnaloba, prevencia:2.2.2. anemiebi – Tandayolili da SeZenili;2.2.3. leikemiebi da limfomebi; mwvave limfoblasturi mwvave aralimfoblasturi mwvave promielocituri qronikuli limfocituri leikemia bususovanujreduli leikemia mozrdilTa T ujreduli leikemia-limfoma histiocitozi qronikuli mieloiduri leikemia hojkinis limfoma mielodisplastiuri sindromi mravlobiTi mieloma da monaTesave moSlilobebi (plazmurujredovani) arahojkinis limfomebi – indolenturi, agresiuli, Zlier agresiuli da

pirveladi, eqstranoduluri filadelfiis Ph qromosoma-negatiuri qronikuli mieloproliferaciuli

neoplazmebi2.2.4. hemoragiuli diaTezebi - hemostazis darRvevebiT gamowveuli daavadebebi da paTologiuri mdgomareobani Trombocitopeniebi da TrombocitopaTiebi koagulaciuri/plazmuri hemostazis Tandayolili da SeZenili darRvevebi Trombofiliebi sisxlZarRvovani da Sereuli genezis hemostazis Tandayolili da SeZenili

darRvevebi 2.2.5. transfuziuri medicina. imunologiis da genetikis principebi, romlebsac emyareba transfuziuri medicina. sisxlis jgufebi da qvejgufebi, sistema Rh eriTrocituli, leikocituri, Trombocituli antigenebi, tipireba, imunuri sistemis ujredebi, imunuri pasuxi, aglutinacia, precipitacia, Hhemolizi, imunoglobulinebi, transfuziuli Terapiis principebi. usafrTxo sisxli, hemotransmisiuli infeqciebi. hemokomponentebis klasifikacia sisxlis bankingis principebi, sisxlis komponentebis damzadebis normativebi, xarisxis kontroli, eTikuri da samarTlebrivi sakiTxebisisxlis komponentebis gamoyeneba paTologiuri mdgomareobis saxis, simZimis xarisxis, transfuziis riskebis gaTvaliswinebiT.

transfuziuli Terapiis Cvenebebi da moculoba mwvave sisxldakargviT, anemiis gamomwvevi faqtorebis SeZenili deficitiT, medikamentozuri mielosupresiiT, hemolizuri, aplastiuri (maT Soris sisxlis da soliduri avTvisebiani simsivneebis, sistemuri daavadebebis, infeqciuri, virusuli, parazituli, imunodeficituri moSlilobebis, sxvadasxva mizezebiT ganpirobebuli plazmuri koagulaciuri, fibrinolizuri cilebis an maTi inhibitorebis ukmarisobis, Trombofiliebis, TrombocitopaTiebiT, TrombocitopeniebiT da sxva mdgomareobebiT gamowveuli daavadebebis/ sindromebis dros.hemokomponenturi Terapiis garTulebebi – klasifikacia, diagnostika, mkurnaloba, prevencia.hemokomponenturi Terapiis ukuCvenebebi, Hhemotransfuziis alternativebi, sisxlisSemcvlelebi.sisxlis gravitaciuli qirurgiis safuZvlebi – hemaferezi klinikur dasawarmooo transfuziologiaSi. 2.2.6. Zvlis tvinis da sisxlis Rerovani ujredebi klinikur praqtikaSi hemoblastozebis, soliduri sismsivneebis da sxva SeZenili da Tandayolili daavadebebis samkurnalod. autologiuri da alogenuri Rerovani ujredebis transplantacia – Cvenebebi, miReba, Senaxva, gadanergva.2.2.7. qimioTerapiis principebi - qimiopreparatebis klasifikacia, moqmedeba, dozireba, miRebis gzebi, gverdiTi movlenebi, toqsiuroba, antidotebi, poliqimioTerapia, qimioTerapiis garTulebebi, maRaldozirebuli qimioTerapia2.2.8. imunoTerapiis principebi, biologiuri reaqciis modifikatorebi- -interferonebi, - interferonebi, koloniamastimulirebeli rekombinantuli faqtorebi, onkohematologiuri daavadebebis mkurnaloba monoklonuri antisxeulebiT, simsivnissawinaaRmdego targetuli Terapia;2.2.9.hormonoTerapis safuZvlebi - kortikosteroidebiT da da sxva hormonCanacvlebiTi medikamentebiT mkurnaloba;2.2.10. antiTrombozuli Terapiis zogadi principebi antikoagulaciuri, fibrinolizuri, dezagregaciuli preparatebi;2.2.11.hemostazuri Terapiis principebi – hemostatikuri preparatebi, angioproteqtorebi, rekombinantuli plazmuri koagulaciuri faqtorebi;2.2.12. antibaqteriuli, antivirusuli da antimikozuri Terapiis safuZvlebi (antibiotikebis klasifikacia, moqmedebis meqanizmi, Cvenebebi, antivirusuli, antimikozuri preparatebi), febriluri neitropenia.2.2.13.anTebis sawinaaRmdego Terapia, anTebis sawinaaRmdego, arasteroiduli preparatebis moqmedebis principebi;2.2.14. tkivilis marTva analgetikuri preparatebi;2.2.15. paliatiuri daxmarebis ZiriTadi aspeqtebi, Hhospisi.2.2.16. kargi klinikuri praqtika, GGCP – ZiriTadi aspeqtebi. 2.3.eqim-specialistisaTvis aucilebeli diagnostikuri unar-Cvevebi:hematologiuri daavadebis/paTologiuri mdgomareobis diagnostika - anamnezis Sekreba da fizikuri gamokvleva, klinikuri da instrumentuli gamokvlevebis Sesaxeb gadawyvetilebis miReba da yvela qvemoTCamoTvlili sadiagnostiko gamokvlevis Sedegebis interpretacia; ZiriTadi (hematologiuri) daavadebis Tanmxlebi nozologiebis da garTulebebis diagnostika. zogierTi ZiriTadi diagnostikuri manipulaciebis Sesruleba (mag. Periferiuli sisxlis

analizi, zogadi koagulaciuri testebi, sisxlis ABO da RH sistemiT SeTavseba da sxv.):1. hemograma2. Zvlis tvinis ujredovani Semadgenloba (mielograma)3. Zvlis tvinis histomorfologia4. periferiuli sisxlisa da Zvlis tvinis ujreduli elementebis citogenetikuri gamokvlevebi. kariotipis struqturuli da raodenobrivi cvlilebebi hemoblastozebis dros (translokacia, inversia, hipo- da hiperdiploidia).5. periferiuli sisxlis, Zvlis tvinis punqtatis imunofenotipireba.6. imunoeleqtroforezi.7. trepanobioptatis imunohitoqimiuri gamokvlevebi8. periferiuli sisxlisa da Zvlis tvinis citoqimiuri gamokvlevebi9. limfuri kvanZis citologiuri da histologiuri Seswavla10. limfuri kvanZis imunocitoqimiuri, imunohistoqimiuri gamokvlevebi da maTi diagnostikuri mniSvneloba11. splenograma da histograma12. elenTis histomorfologiuri Taviseburebebis Seswavla hemoblastozebis dros13. gamokvlevis radionukliduri meTodebi14. eriTrocitebis radionukliduri moniSvnis mniSvneloba15. Zvlis tvinis funqciur-topografiuli mdgomareobis Sefaseba16. kompiuteruli da magnitur-rezonansuli tomogramebis analizi17. koagulogramis maCveneblebis interpretacia: 17.1 hemostazis I fazis maxasiaTeblebi: 17.1.1. sisxldenis xangrZlivoba (diukeTi)17.1.2. proTrombinis warmoqmna. 17.1.3. Trombocitebis raodenoba periferiul sisxlSi; 17.1.4. Trombocitebis agregacia adf-iT; 17.1.5. Trombocitebis agregacia ristocetiniT;), 17.2 hemostazis II fazis maxasiaTeblebi:17.2.1. proTrombinis dro;17.2.2. V faqtoris aqtivoba;17.2.3. VII faqtoris aqtivoba;17.2.4. II faqtoris aqtivoba.17.3 hemostazis III fazis maxasiaTeblebi:17.3.1. fibrinogenis koncentracia plazmaSi;17.3.2 Trombinis dro.17.3.3. antiTrombini III;17.3.4. heparini;17.3.4. sisxlis Sededebis aqtivirebuli dro:17.3.5. proteini C; 17.3.6. proteini S.17.3.7. plazminogeni;17.3.8 D – dimeri.18. antiglobulinuri testireba19. sisxlis eriTrocituli antigenebi ABO, H da Lewis,

20. sistema Rh21. HLA antigenebis gamovlineba22. sisxlis serologiuri testireba23. “krosmaC” testireba24. pirdapiri antiglobulinuri testi25. Rerovani ujredebis testireba 26. gamdinare citometria27. antisxeulebis gansazRvra da SeTavseba28. sinji SeTavsebaze: 1. eriTrokoncentratis fiziologiur xsnarSi2. arapirdapiri antiglobulinuri testi29. sicivis autoaglutininebis gansazRvra30. donoris sisxlis gamokvleva: ABO da Rh kuTvnileba, serologiuri testi aTaSangze, infeqciuri daavadebebis markerebi

2.4. eqim-specialistisaTvis aucilebeli ZiriTadi samkurnalo Cvevebi:hematologiuri darRvevebis – daavadebebis da sindromebis mkurnaloba, sisxlis eferentuli Terapia, sisxlis ujredebis komponentebiT Terapia, maT Soris Rerovani ujredebis transplantacia, kerZod:1. racionaluri farmakoTerapiis SerCeva (qimioTerapia, imunoTerapia, hormonoTerapia, antibaqteriuli, antivirusuli, antimikozuri Terapia da sxv.). mkurnalobis standartiT gaTvaliswinebuli nebismieri jgufis medikamentis daniSvna da monitoringi;2. sisxlis komponenetebis transfuziis Cvenebis gansazRvra da warmarTva. transfuziuli garTulebebis drouli diagnostika da mkurnaloba.3. sisxlis SemcvlelebiT mkurnaloba. infuziuri Terapiis Cvenebebis gansazRvra da warmarTva.4. hemaferezi, sisxlis komponentebis da sisxlisSemcvlelebis CanacvlebiT, an Canacvlebis gareSe – Cvenebis gansazRvra, proceduris Catareba da monitoringi;5. hematologiuri daavadebebis samkurnalo da diagnostikuri mizniT saWiro qirurgiuli mkurnalobisaTvis gadawyvetilebis miReba, qirurgiuli Carevis Semdeg pacientis marTvaSi monawileoba. sareabilitacio periodis gavlis Semdeg pacientis mkurnaloba;6. samkurnalo kvebis racionis daniSvna;7. onkohematologiuri daavadebis paliatiuri Terapia;8. pacientis monitoringi sicocxlis bolomde (onkohematologiuri da memkvidreobiTi daavadebebis SemTxvevaSi).mkurnalobisZiriTadi principebi:multidisciplinuri marTva

hematologir darRvevaTa marTvisas eqTnis, fsiqoTerapevtis, dietologis, fsiqologis, diagnostikuri ganyofielbis eqimebis da laborantebis da sxvaTa SeTanxmebuli muSaobis uzrunvelyofa.

socialuri movla qveyanaSi dadgenili socialuri servisebi/daxmareba

eTikuri aspeqtebi

klinikuri hematolgiis eTikuri aspeqtebi myari unarSezRudulobis da progresuli mdgomareobebis, maT Soris, prenataluri diagnostikis sakiTxebi, sasicocxlo funqciebis SemanarCunebeli movla

kvleviTi saqmianobis warmoebis eTikuri aspeqtebi; informirebuli Tanxmoba

klinikuri kvlevebis CatarebisaTvis aucilebeli eTikis sakiTxebi da Tanxmobis miRebis uzrunvelyofa

gaerTianebuli erebis organizaciis konvencia da qveyanaSi moqmedi sxva sakanonmdeblo aqtebi

o saqarTvelos kanoni “janmrTelobis dacvis Sesaxeb”o saqarTvelos kanoni “saeqimo saqmianobis Sesaxab”o saqarTvelos kanoni “pacientis uflebebis Sesaxeb”o eqimisa da pacientis urTierTobebis safuZvlebio bioeTikis Tanamedrove principebi

2.5. specialobiT – “hematologia da transfuziologia” gaTvaliswinebuli unar-Cvevebia. klinikuri unar-Cvevebiklinikuri kvleva da analizi.

saTanado diagnostikuri da laboratoriuli saSualebebis gamoyeneba pacientis klinikuri mdgomareobis interpretaciisaTvis, saTanado daskvnebis gamotana da saWiro mkurnalobis dagegmva

kritikuli mdgomareobebis dros marTvis koordinacia: gadaudebeli mdgomareobebis marTva

konsultirebis procesis saWiroebisamebr uzrunvelyofa, ufro gamocdili da/an sxva specialistebis daxmarebis saWiroebis droulad gansazRvra

sxva hematologiur/transfuziologiuri konsultaciis uzrunvelyofa samedicino istoriis adekvaturi warmoeba.

1. pacientis klinikuri gasinjva da Sefaseba Civilebisa da anamnezuri monacemebis Sekreba, srulfasovani Sejereba

da interpretacia (anemiuri sindromi – sindromis xangrZlivoba, xarisxi, specifiuri Civilebis gamovlena. intoqsikaciis simptomebis - temperaturis momateba, oflianoba, Semcivneba, wonaSi dakleba, qavili, Zvlebis tkivili. moZraobis SezRudva, simZimis SegrZneba marcxena ferdqveSa areSi, sisxldenebi, kanis qavili da a.S.)

Inspectio (daxedva, daTvaliereba):kanis da xiluli lorwovanis feri, sisxlCaqcevebi: peteqiebi, hematomebi. simsivnuri warmonaqmnebi kanze. piris Rrus daTvaliereba: wylulovan-nekrozuli stomatiti, sisxlcaqcevebi enaze da rbil sasaze, glositi, makroglosia, gingiviti, angularuli naxeTqebi. periferiuli limfuri kvanZebis lokalizacia, zoma, mtkivneuloba, konsistencia, elastiuroba, simetriuloba, feri. farisebri jirkvlis inspeqcia. Zvalsaxsrovani sistema: Tavisa da saxis Zvlebis, xerxemlis svetis da sxva Zvlebis deformacia.

hemodinamikuri maCveneblebis Sefaseba (pulsi, arteriuli wneva sunTqva). zemo Rru venis sindromi.

muclis formis, zomis, sunTqvaSi monawileobis, asciti, kolateralebis da varskvlavebis arsebobis, gareTa sasqeso organoebis daTvaliereba.

hemodinamikuri maCveneblebis Sefaseba (pulsi, arteriuli wneva sunTqva). Pulmo et Cor – perkusia, auskultacia, eleqtrokardiogramis gadaReba, Sefaseba. muclis Rrus palapacia.

2. periferiuli sisxlis aReba periferiuli sisxlis nacxis, retikulocitebis preparatebis, sisxlis bioqimiuri, koagulaciuri da yvela sxva gamokvlevis Catarebis mizniT;3. vena punqcia, kaTeterizacia, sainfuzio sistemis momzadeba da dadgma, infuzomatis da perfuzoris gamoyeneba;4. Zvlis tvinis punqcia, Zvlis tvinis eqsfuzia. punqciuri biofsiis Catareba, TeZos Zvlis trepanopiofsia;5. kanqveSa limfuri kvanZis punqciuri biofsia, kanqveSa, zedapiruli simsivnuri warmonaqmnis punqcia;6. Tavzurgtvinis sadiagnostiko punqcia, citostatikuri preparatebis intralumbalurad Seyvana;7. Zvlis tvinis da limfuri kvanZis punqtatis, biofsiuri limfuri kvanZis anabeWdebis momzadeba;8. qimiopreparatebis momzadeba citostatikuri Terapiis Catarebis mizniT – gaxsna, infuzia, proceduris monitoringi 9. imunopreparatebis momzadeba imunoTerapiis Catarebis mizniT – gaxsna, infuzia, proceduris monitoringi; 10. sisxlis Semcvlelebis, sxvadasxva sainfuzio preparatebis momzadeba, infuzia, prozeduris monitoringi; 11. intramuskuluri da kanqveSa inieqciebi, preparatebis momzadeba, infuzia, prozeduris monitoringi; 12. sisxlis komponentebis - mTliani sisxlis, wiTeli sisxlis ujredebis, garecxili wiTeli sisxlis ujredebis, leikocit-reducirebuli wiTeli sisxlis ujredebis, gayinuli deglicerinizirebuli wiTeli sisxlis ujredebis, Trombocitebis, axladgayinuli plazmis, krioprecipitatis, granulocitebis, sisxlis Rerovani ujredebis, dasxivebuli sisxlis ujredebis miReba, Senaxva, momzadeba, gadasxma; adamianis imunoglobulinis, rekombinantuli sisxlis Sededebis faqtorebis intravenuri gadasxma, Senaxva, momzadeba da gadasxma.13. sisxlis komponentebis individualuri in vitro SeTavsebis da biologiuri sinjebis Catareba;14 donoris da recipientis sisxlis ABO da Rh kuTvnilebis Semowmeba;15. sisxlis komponentebis gadasxmisaTvis gankuTvnili sistemis (martivi da leikofiltriani) momzadeba da gamoyeneba gadasxmisaTvis;16. diskretuli plazmaferezis Catareba pacientebsa da janmrTel donorebze17. uwyveti plazmaferezis Catareba pacientebsa da janmrTel donorebze;18. diskretuli da uwyveti samkurnalo citaferezis Catareba19. flebotomis Catareba;

20. maRaldozirebuli qimioTerapiis Catareba Rerovani ujredebis transplantacia: pacientis/donoris periferiulsisxlSi Rerovani ujredebis mobilizaciisaTvis saWiro gamokvlevebis da manipulaciebis Catareba, donoris momzadeba periferiuli sisxlidan Rerovani ujredebis misaRebad; Rerovani ujredebis miReba sisxlis separatorebze hemaferezis gziT, damuSaveba da kriokonservacia, transfuzia; pacientis movla aseptikur palataSi, daavadeba “transplantati maspinZlis winaaRmdeg” specifikuri mkurnaloba, pacientis monitoringi 21. infuziuri, transfuziuli, da sxva manipulaciebiT gamowveuli Sokis sawinaaRmdego manipulaciebi (pirveladi daxmareba): medikamentebis Seyvana, intubacia, filtvebis xelovnuri ventilacia;22. kanis da lorwovanis dazianebiT gamowveuli Wrilobis pirveladi damuSaveba, aseptikuri naxvevis dadeba;23. sisxldenis SeCereba, pirveladi hemostatikuri manipulaciebis Catareba;24. Sardis buStis kaTeterizacia;25. eleqtrokardiogramis gadaReba;26. Zvlis motexilobis dros kiduris imobilizacia (pirveladi daxmareba)27. analgetikuri preparatebis (maT Soris narkotikuli) gamoyeneba;28. antibaqteriuli, antivirusuli da antimikozuri TerapiisaTvis saWiro manipulaciebis Catareba; 29. saqarTvelos janmTelobis da socialuri uzrunvelyofis saministros unificirebuli da samkurnalo dawesebulebis SinaganawesiT miRebuli yvela zemoTCamoTvlil manipulaciasTan dakavSirebuli dokumentaciis warmoeba.

b. akademiuri unar-Cvevebi literaturis mimoxilvisa da miRebuli klinikuri Sedegebis kritikuli Sefaseba xelnawerTa momzadeba zepiri prezentaciebis momzadeba aqtiuri kvleva an kvlevis mxardaWera formaluri da araformaluri pedagogiuri muSaoba studentebsa da dabali

kursis rezidentebTan

3. saswavlo programis Sinaarsispecialoba `hematologia da transfuziologia~-Si eqimTa diplomisSemdgomi mzadeba efuZneba Semdeg principebs: a. rezidentisaTvis bazisuri codnis miRebis uzrunvelyofa sisxlis sistemis normalur, paTologiur fiziologiaSi, klinikur hematologiasa transfuziologiaSi;b. saswavlo kursis Catareba srulad aRWurvil klinikur bazaze (ganyofilebaSi an klinikaSi), romelsac miRebuli aqvs akreditacia kanonmdeblobiT gansazRvruli wesiT;g. mocemul saswavlo klinikur bazaze zogierTi specifikuri aRWurvilobisa da gamocdilebis uzrunvelyofis SeuZleblobis SemTxvevaSi sxva hospitalSi individualuri trening-programis ganxorcielebis uzrunvelyofa (kanonmdeblobiT gansazRvruli wesis Tanaxmad); d. hematologiasa da transfuziologiaSi praqtikuli muSaobisas warmoqmnili multidisciplinuri aspeqtebis saswavlo programaSi gaTvaliswineba;

e. rezidentisTvis fundamenturi kvleviTi muSaobis warmoebis uzrunvelyofa.

diplomisSemdgomi mzadebis programis Sedegad rezidentma unda SeiZinos codna da kompetenciebi qvemoTCamoTvlil yvela sferoSi:pacientis movla:

anamnezis srulyofili Segroveba; pacientis srulyofili gasijva; pacientis diagnozis maRali sizuste; Aambulatoriuli da hospitalSi moTavsebuli pacientis xarjTefeqturi

marTva rogorc farmakologiuri, aseve arafarmakologiuri mkurnalobis meTodebiT;

samedicino problemebis amocnoba da prioritetebis mixedviT ranJireba; teqnikuri unarebis (mag. Zvlis tvinis, periferiuli venis, limfuri kvanZis

punqciis warmoeba da sxv) srulyofa; pacientis xangrZlivi mkurnalobis da movlis srulfasovani da

xarjTefeqturi dagegmva; samedicino da qirurgiuli Carevebis hematologiuri garTulebebis

prevencia, amocnoba da drouli marTva; hospitaluri movlis gaumjobeseba; pacientismovlisaseTikisnormebis dacvada misdamigulisxmieri

damokidebuleba.samedicino codna:

bazisuri codnis gaumjobeseba specialobaSi “hematologia da transfuziologia”;

codnis gaRrmaveba ambulatoriuli da stacionirebis saWiroebebis mqone hematologiuri daavadebebis Sesaxeb;

hematologiuri daavadebebis da sxvadasxvdaavadebebis hematologiuri garTulebebis Sefasebisa da diagnostikis gaumjobeseba;

laboratoriuli da diagnostikuri teqnologiebis codna, am teqnologiebis usafrTxo, efeqturi da ekonomikuri gamoyeneba;

daavadebisa Tu mkurnalobis mosalodneli garTulebebis drouli amocnobisa da marTvis unari;

pacientis daavadebasTan dakavSirebuli samedicino informaciisa da samecniero mtkicebulebebis kritikuli Sefasebis unari.

interpersonuli da komunikaciuri unar-Cvevebi: pacientebsa da maT ojaxebTan efeqturi komunikaciis unari, rac

moicavs pacientis da misi ojaxis wevrebis mosmenas da gagebas, kulturuli da religiuri Taviseburebebis gaTvaliswinebas da daZlevas;

kolegebTan efeqturi komunikacia (rogorc zepiri, aseve werilobiTi); pacientis Sesaxeb informaciis mkafiod gadmocemis unari rogorc

zepiri Sefasebisas, aseve werilobiT; kolegebisa da studentebis efeqturi swavlebis unari.

praqtikaze dafuZnebuli swavleba da gaumjobeseba: hematologiuri daavadebis mqone diagnostikis, mkurnalobis da

prevenciis pacientTa daavadebis Sesaxeb sakuTari codnisa da

unarebis deficitisa da susti mxareebis amocnoba da maT gaumjobesebaze muSaoba

pacientis movlis gasaumjobeseblad mecnieruli da praqtikuli literaturidan Tanamedrove informaciis mopoveba

praqtikuli muSaobis gasaumjobeseblad da Sesafaseblad Sesabamisi sistemebis Seswavla, maT Soris pacientis mxridan Sefaseba da gamosavlis analizi

samedicino literaturis Sefasebis unari codnis gaumjobesebis zogadi da individualuri strategiis SemuSaveba

profesionalizmi: gamoavlinos pativiscema, TanagrZnoba, erTianoba pacientsa da mis

ojaxTan iyos gulisxmieri da pativi sces pacientis asaks, kulturul Rirebulebebs,

sqess, religiur mrwamss daicvas eTikuri principebi, pacientis konfidencialurobis ufleba da aseve

informirebuli Tanxmobis aucilebloba profesiuli muSaobis procesSi iyos punqtualuri, sando, Tanmimdevruli,

hqondes damoukidebeli swavlis da profesiuli ganviTarebis unari pativi sces ufrosebs, kolegebs, studentebs da samedicino gundis yvela

wevrssistemaze dafuZnebuli praqtika: icodes jandacvis mTeli sitemis muSaoba, maT Soris praqtikuli

gaidlainebi da yvela sxva resursebi, rac gaaumjobesebs pacientis cxovrebis xarisxs da gavlenas moaxdens pacientis movlis yvela aspeqtze;

icnobdes da iyenebdes multidisciplinuri, gunduri midgomis principebs qronikuli pacientebis marTvis procesSi;

saukeTeso movlis gaxorcielebisaTvis samedicino gundis sxva wevrebTan axorcielebdes efeqtur kolaboracias;

pacientis movlis procesSi iyenebdes mtkicebulebebze dafuZnebul, xarjTefeqtur strategiebs;

aanalizebdes pacientis qronikuli movlis Soreul zegavlenas mis socialur-ekonomikur statusze;

pacientis individualuri finansuri SezRudvebis pirobebSi efeqturad iyenebdes xelmisawvdom resursebs;

jandacvis arsebuli sistemis farglebSi icnobdes praqtikuli medicinis samarTlebrivi sakiTxebs.

4. profesiuli mzadebis struqturaaRniSnuli programis gasavlelad saWiro periodi moicavs 3 wels. pirveli etapi, erTi akademiuri wlis xangrZlivobiT, moicavs swavlebas Sinagan medicinaSi.am etapze rezidentma unda gaiaros modulebi, romlis saSualebiTac Seiswavleba Sinagani medicinis ZiriTadi daavadebebis diagnostikis, marTvisa da maTTan asocirebuli praqtikuli unar-Cvevebi.

swavleba Sinagan medicinaSi:

programis zogadi nawili - profesiuli mzadebis I weli

mod.# modulis dasaxeleba xangrZlivoba

1.1. ambulatoriuli Terapia 4Tve

1.2 Terapiuli pacientebis marTva stacionarSi 3 Tve

1.3. gadaudebeli medicina 2 Tve

1.4. gul-sisxlZarRvTa daavadebebi 2Tve

saswavlo kursihematologia/transfuziologia-Si 22 saswavlo Tvis xangrZlivobiT Sedgeba Semdegi komponentebis kombinaciisagan: 1. pacientTa klinikuri marTva xelmZRvanelis zedamxedvelobis qveS; 2. saswavlo programa, Semdgari leqcia-seminarebisagan;3. mecadineobebi araformaluri klinikuri da samuSao Sexvedrebis saxiT da prezentaciebi; 4. qveynis SigniT da mis gareT treningebSi, konferenciebSi, da sxva specialur saswavlo ciklebSi monawileoba; 5. biblioTekaSi muSaoba.

zemoTCamoTvlili komponentebis detaluri ganxilva ar moxdeba mimdinare dokumentSi, Tumca gamotanili iqneba sasurveli Sedegebis CamonaTvali.

qvemoT warmodgenilia savaldebulo modulebi hematologia/transfuziologiaSi:

cxrili 1.

moduliM modulis dasaxeleba xangrZlivobaIsaswavlo weli

1.1 SeZenili da Tandayolili anemiebi.anemiebi sxvadasxva daavadebebis dros.

2 Tve

1.2 mwvave leikemiebis diagnostikis da mkurnalobis Tanamedrove principebi.

3 Tve

1.3 qronikuli mieloproliferaciuli daavadebebi 3 Tve1.4 hemostazis sistemis darRvevebi (Tandayolili da

SeZenili koagulopaTiebi.hemoragiuli diaTezebi.Trombozebi da hemoragiebi klinikur praqtikaSi,dik sindromi)

3 Tve

II saswavlo weli2.1 adenopaTiebi,splenomegaliebi,limfoproliferaciuli 3 Tve

daavadebebi.2.2 limfomebis (hojkinis da arahojkinis) diagnostikis

da mkurnalobis Tanamedrove principebi.3 Tve

2.3 klinikuri da sawarmoo transfuziologiis safuZvlebi. 3 Tve2.4 hemotransfuziis garTulebebi, mizezebi,

mkurnaloba, profilaqtika, hemokomponenturi Terapiis alternativebi.

2 Tve

5. programis marTva da administrireba

kurikulumis Sinaarsi, misi dizaini efuZneba im kompetenciebs da samuSao normativebs, romelic miRebuli da aRiarebulia aSS-sa da evropis ganviTarebuli qveynebis warmatebuli hematologiuri skolebis mier da romelTa adaptireba da danergva unda moxdes Cvens qveyanaSi. kurikulumis Seqmnis procesSi Sefasda is aucilebeli admianuri da instituciuri resursebi (literatura, samedicino bazebi da sadignostiko-samkurnalo teqnologiebi), romelic SesaZlebels gaxdida programis ganxorcielebas, procesis efeqtur marTvas da saboloo miznebis miRwevas. saswavlo kursi specialobaSi “hematologia da transfuziologia” Sedgeba 8 modulisagan, xangrZlivobiT 22 Tve. saswavlo moduli warmoadgens disciplinis mniSvnelovan sferos, romelic uzrunvelyofs swavlebis logikurobas, ramac sabolood unda ganapirobos rezidentis kompetenciisa da klinikuri unar-Cvevebis sistemuroba.rogorc rezidenturis programas, aseve yovel kurss da moduls hyavs xelmZRvaneli-pedagogi, romelic swavlebis garda axorcielebs procesis zedamxedvelobas da xarisxobriv Sefasebas. sawavlo bazaze rezidentebis mzadebis process koordiancias da zedamxedvelobas uwevs programis xelmZRvaneli – aRiarebuli klinikuri da pedagogiuri gamocdilebis hematolog/transfuziologi. igi meTvalyureobs mzadebis programis mimdinareobas da sistematiurad afasebs rezidentebis momzadebis dones. pedagogebi – modulze pasuxismgebeli pirebi uSualod meTvalyureoben TiToeuli rezidentis mzadebis process da xelmoweriT asabuTeben rezidentis mier Catarebul saswavlo saqmianobas (gatarebuli pacientebis raodenoba, aTvisebuli unar-Cvevebi, Catarebuli manipulacebis tipi, raodenoba, Sesrulebis xarisxi, da a.S.) mis specialur dRiurSi.

programis xelmZRvanelis movaleobebi:

misaRebi gamocdis programis Sedgena da rezidenturaSi miRebis procesSi monawileoba

specialobis aRwerilobis safuZvelze Sedgenil diplomisSemdgomi profesiuli mzadebis (rezidenturis) akreditebuli programis ganxorcielebas

samedicino dawesebulebis da modulze pasuxismgebeli piris miTiTebiT rezidentis individualuri gegma-grafikis Sedgena

direqtoratis wevrebTan erTad dadgenili wesis mixedviT yovelwliurad rezidentis muSaobis Sefaseba da angariSis Cabareba.

yovelwliuri Sefasebis Sedegebis gaTvaliswinebiT rezidentisaTvis rekomendacias micema programis gagrZelebis Sesaxeb.

rezidentis saqmianobis aradamakmoyofilebli wliuri Sefasebisas dasabuTebuli moxsenebiT baraTis wardgena garicxvis Sesaxeb

modulze pasuxismgebeli piris saqmianobis zedamxedveloba da Sefaseba.

rezidenturis kursis warmatebuli dasrulebis Semdeg rezidentis Semajamebeli atestaciis Catareba da diplomisSemdgomi ganaTlebis (profesiuli mzadebis) kursis gavlis damadasturebeli mowmobis gacemis Sesaxeb rekomendaciis micema

klinikuri xelmZRvanelis – modulze pasuxismgebeli piris movaleobebi:

winaswar dadgenili individualuri grafikis mixedviT rezidentis mier Sesasrulebeli samuSaos moculobasa da Casatarebeli manipulaciebis raodenobaze kontroli;

TiToeuli modulis dasrulebis Semdeg dadgenili wesis mixedviT, program direqtorisaTvis rezidentis mier gaweuli samuSaos Sesaxeb angariSis wardgena;

rezidentis dRiurSi rezidentis mier Sesrulebuli samuSaos xelmoweriT dadastureba;

program xelmZRvanelTan erTad rezidentis atestaciis formatis SemuSaveba;

program-xelmZRvanelTan erTad yovelwliurad rezidentebis muSaobis dadgenili wesis mixedviT Sefaseba;

rezidentis Semajamebeli atestaciis procesSi monawileoba; saWiroebis SemTxvevaSi, programis xelmZRvanelisaTvis rezidenturis

programasTan dakavSirebul nebismier sakiTxze konsultaciis gaweva.

rezidentis ufleba/movaleobebi:

rezidenti SeiZleba garicxuli iqnas rezidenturidan erTi Tvis ganmavlobaSi gamoucxadeblobis an programis ver daZlevis

SemTxvevaSi. gadawyvetilebas rezidentis garicxvis Sesaxeb iRebs programis direqtori;

rezidents ufleba aqvs programis kurikulumis darRvevis an Seferxebis Sesaxeb werilobiT acnobos administracias;

rezidents ufleba aqvs programis daubrkolebeli daZlevisaTvis moiTxovos Sesabamisi samuSao pirobebiT uzrunvelyofa (kvalificiuri xelmZRvaneli, Tanamedrove tipis klinikuri da sainformacio/sakomunikacio teqnologiebi, samuSao oTaxi);

rezidenti valdebulia Seasrulos rezidenturis programiT gansazRvruli kurikulumi;

rezidenti valdebulia programiT gansazRvruli da Sesrulebuli saqmianoba daafiqsiros personalur dRiurSi;

rezidenti valdebulia yoveli wlis bolos warudginos programis direqtors gaweuli muSaobis angariSi da gaiaros etapobrivi da damasrulebeli atestacia dadgenili wesiT;

rezidenti valdebulia daicvas samedicino dawesebulebis Sinaganawesi da Seasrulos dawesebulebis ganrigiT gansazRvruli saqmianoba.

II. programis zogadi nawili - profesiuli mzadebis I weli

programis zogadi nawili - profesiuli mzadebis I weli

mod.# modulis dasaxeleba xangrZlivoba

1.1. ambulatoriuli Terapia 4Tve

1.2 Terapiuli pacientebis marTva stacionarSi 3 Tve

1.3. gadaudebeli medicina 2 Tve

1.4. gul-sisxlZarRvTa daavadebebi 2Tve

1.1. modulis dasaxeleba, xangrZlivoba - ambulatoriuli Terapia(pirveladi jandacvis rgolebSi) - 4 Tve;

modulis mizani - zogadi klinikuri da simptomze dafuZvnebuli kompetenciebis daufleba. diagnistikuri TvalsazrisiT rTuli sindromebis diagnostika, marTva da monitoringi. ZiriTadi kompetenciebis daufleba;

modulis ganxorcielebis pirobebi –akreditaciis mqone nebismieri ambulatoriuli dawesebuleba Sesabamisi asakobrivi kontigentis momsaxurebis (Sinagani medicina, ojaxis eqimi) profiliT.

kompetencia

zogadi klinikuri kompetenciebi (ganmartebebi dawvrilebiT ix. silabusSi)

anamnezis Sekreba

klinikuri kvleva

wamlebi da usafrTxi receptura

daavadebis simwvavis xarisxis dadgena da gadawyvetilebis miRebis unari

gadawyvetilebis miReba da klinikuri azrovneba

pacienti, rogorc zrunvis centraluri fokusi

pacientisaTvis usafrTxoebis prioritetis miniWeba

jgufuri muSaoba da apcientis usafrTxoeba

xarisxis da usafrTxoebis gaumjobesebis principebi

infeqciis kontroli

gaxangrZlivebuli mdgomareobebis marTva da pacientis TviTzrunvis xelSewyoba

pacientTan urTierToba da komunikacia konsultaciis dros

obieqturi informaciis miwodebis unari

komunikacia da kolaboracia kolegebTan

sazogadoebrivi jandacva

samedicino eTikis da konfidencialobis principebi

informirebuli Tanxmoba

muSaobis legaluri CarCoebi

eTikuri kvlevebi

mtkicebulebebi da gaidlainebi

simptomze dafuZvnebuli kompetenciebi (ix. qvemoT)

uxSiresi klinikuri mdgomareobebi:

muclis tkivili

mwvave zurgis tkivili

haeris ukmarisoba

tkivili gulis areSi

xvela

diarea

gonebis kargva

cxeleba

hematemezi da melena

Tavis tkivili

siyviTle

kiduris tkivili da SeSupeba

gamonayari

gulisreva da Rebineba

sisuste da dambla

sxva mniSvnelovani klinikuri situaciebi:

warmonaqmni mucelSi da hepatosplenomegalia

paTologiuri mgrZnoneloba (paresTezia da mgrZnobelobis dakargva)

agresiuli da paTologiuri qceva

SfoTva da panikuri aSliloba

sisxlCaqcevebi da spontanuri sisxldena

dispefsia

dizuria

gamonadeni da wylulebi sasqeso organoebze

hematuria

hemoptizi (sisxliani xvela)

moZraobis SezRudva

SemTxveviT gamovlenili darRvevebi

saxsrebis SeSupeba

limfadenopaTia

welis tkivili

qirurgiuli procedurebis Semdgomi problemebi da garTulebebi

orsulobis dros aRmocenebuli darRvevebi

SardvasTan dakavSirebuli problemebi

fizikuri simptomebi organuli daavadebis gareSe

polidifsia

poliuria

qavili

sisxldena swori nawlavidan

kansa da piris RruSi arsebuli wylulebi

ylapvasTan dakavSirebuli problemebi

wonasworobis dakargva/disbalansi

wonaSi kleba

literaturis nusxa:

1. g.qavTaraZe diagnostikuri Zieba Sinagan sneulebaTa klinikaSi. simptomidan diagnozamde.

2. n.tatiSvili g.simonia – “Sinagani daavadebebi”3. Harrison – “Internal Diseases”4. Merck Manuel5. vaSintonis Terapiuli cnobari

Sesasrulebeli samuSaos moculoba da modulis Sefasebis meTodebi.

Sesrulebuli procedurebi da manipulaciebi

raodenoba

avadmyofis damoukidebeli gasinjva da diagnozis dasma

30

avadmyofobis istoriis damoukidebeli dawera 30

morigeoba TveSi minimum 4

Sefasebis sistema lokaluri xelmZRvanelis xelmowera

kargi

damakmayofilebeli

aradamakmayofilebeli

sfero, romelic saWiroebs daxvewas

komentari

moduli 1.2.

modulis dasaxeleba, xangrZlivoba – Terapiuli pacientebis marTva stacionarSi- sami Tve

modulis mizani - zogadi klinikuri da simptomze dafuZvnebuli kompetenciebis daufleba.. diagnistikuri TvalsazrisiT rTuli sindromebis diagnostika, intensiuri Terapia da marTva,

modulis ganxorcielebis pirobebi – Sesabamisi akreditaciis mqone nebismieri stacionaruli dawesebuleba.

kompetencia

zogadi klinikuri kompetenciebi

anamnezis Sekreba

klinikuri kvleva


mdgomareobis simwvavis xarisxis gansazRvra da gadawyvetilebis miRebis unari



pacientis usafrTxoebis prioritetis miniWeba



infeqciis kontroli



cusdi ambebis Setyobineba

saCivrebi da samedicino Secdomebi






eTikuri kvlevebi


simptomze dafuZvnebuli kompetenciebi

uxSiresi klinikuri mdgomareobebi:

muclis tkivili


Tirkmlis mwvave dazianeba da Tirkmlis qronikuli daavadeba

kolafsi

haeris ukmarisoba da qoSini

tkivili gulis areSi

mwvave konfuzia/deliriumi

xvela

diarea

cxeleba

hematemezi da melena

siyviTle


mowamvla


pacientebis marTva, romlebic saWireoben paliatiur mzrunvelobas da

terminalur mdgomareobaSi myofi pacienti

sxva mniSvnelovani klinikuri SemTxvevebi

warmonaqmni mucelSi da hepatosplenomegalia

asciti da gauvaloba



alkoholsa da narkotikul saSualebebze damokidebuleba

hematuria

hemoptizi

xmis CaxleCa da stridori

hipoTermia

SemTxveviT gamovlenili darRvevebi

saxsrebis SeSupeba

limfadenopaTia

welis tkivili





polidifsia

poliuria

qavili



wonaSi kleba

literaturis nusxa:

6. g.qavTaraZe diagnostikuri Zieba Sinagan sneulebaTa klinikaSi. simptomidan diagnozamde.

7. n.tatiSvili g.simonia – “Sinagani daavadebebi”8. Harrison – “Internal Diseases”9. Merck Manuel10. vaSintonis Terapiuli cnobari


modulis Sefasebis meTodebi: zepiri gamokiTxva/ prezentaciis Sefaseba/referatis Sefaseba.

Sesrulebuli procedurebi da manipulaciebi raodenoba


30


periferiuli venis punqcia da venis kaTeterizacia; 30

centraluri venis kaTeterizacia; saTanado unar-Cvevebis mqone eqim specialistTan erTad

Torakocentezi, plevris punqcia saTanado unar-Cvevebis mqone eqim specialistTan erTad

paracentezi saTanado unar-Cvevebis

mqone eqim specialistTan erTad

sisxlis aReba arteriuli midgomiT da arteriuli airebis analizi;

saTanado unar-Cvevebis mqone eqim specialistTan erTad

eleqtrokardiografia (eleqtrokardiogramis gadaReba da interpretacia);

50

nazogastraluri zondis Cayeneba saTanado unar-Cvevebis mqone eqim specialistTan erTad

Sardis buStis kaTeterizacia; 15



kargi

damakmayofilebeli


komentari

moduli 1.3.

modulis dasaxeleba, xangrZlivoba - gadaudebeli medicina- 2 Tve.

modulis mizani - zogadi klinikuri da simptomze dafuZvnebuli kompetenciebis daufleba. kritikuli da gadaudebeli mdgomareobebis diagnostika da marTva.

modulis ganxorcielebis pirobebi - Sesabamisi akreditaciis mqone dawesebuleba.

ganxorcielebis pirobebi – Sesabamisi akreditaciis mqone dawesebuleba.

kompetencia


anamnezis Sekreba

klinikuri kvleva

wamlebi da usafrTxo receptura

drois marTva da gadawyvetilebis miRebis unari




jgufuri muSaoba da pacientis usafrTxoeba


infeqciis kontroli



cusdi ambebis Setyobineba







eTikuri kvlevebi



gadaudebeli mdgomareobebi:

gulis gaCereba

Sokuri statusis mqone pacientis marTva

ugono pacientis marTva

anafilaqsia

uxSiresi samedicino mdgomareobebi:

muclis tkivili


kolafsi


tkivili gulis areSi

mwvave konfuzia/deliriumi

xvela

diarea

gonebis dakargva


gulis friali

mowamvla

gamonayari


sisuste da dambla


asciti da gauvaloba


alkoholsa da narkoikul saSualebebze damokidebuleba


dializi

hemoptizi

Tavis travma

xmis CaxleCa da stridori

hipoTermia

moZraobis SezRudva

uneblie moZraobebi

saxsrebis SeSupeba

welis tkivili




tkivili kisris midamoSi



metyvelebis gaZneleba


sinkope da presinkope

wonasworobis dakargva/disbalansi

mxedvelobis darRveva (diplopia, mxedvelobis velis defeqtebi, daqveiTebuli simaxvile)


procedurebisa da manipulaciebis Sesruleba unda moxdes saTanado unar-Cvevebis mqone eqim specialistTan erTad

Sesasrulebuli procedurebi da manipulaciebi


avadmyofobis istoriis damoukidebeli dawera

periferiuli venis punqcia da venis kaTeterizacia;

sareanimacio RonisZiebebis Catareba: filtvis xelovnuri ventilacia, gulis arapirdapiri masaJi, gulis eleqtruli stimulacia, eleqtruli defibrilacia, kardioversia, traqeis intubacia;

transfuziuli Terapiis Cvenebebis gansazRvra da teqnika;

cxviris wina da ukana tamponada sisxldenis dros;

pirveladi saswrafo daxmareba Tvalis travmis, Wrilobebis, damwvrobis dros;

centraluri venis kaTeterizacia;

Torakocentezi, plevris punqcia

paracentezi

sisxlis aReba arteriuli midgomiT da arteriuli airebis analizi;


nazogastraluri zondis Cayeneba

sisxldenis SeCerebis droebiTi meTodebi;

motexilobebis droebiTi imobilizacia;

Sardis buStis kaTeterizacia;

morigeoba


kargi

damakmayofilebeli



komentari

literaturis nusxa:

a. Harrison – “Internal Diseases”b. Merck Manuelc. Judith Tintinali., Emeregency Medicine Textbook. 2009

1.4. gul-sisxlZarRvTa sistemis daavadebebi – ori Tve. modulis mizani: gul-sisxlZarRvTa sistemis daavadebebis dignostika da marTva.

modulis ganxorcielebis pirobebi – Sesabamisi akreditaciismqone dawesebuleba.

kompetencia


anamnezis Sekreba

klinikuri kvleva


drois marTva da gadawyvetilebis miRebis unari






infeqciis kontroli



cudi ambebis Setyobineba







eTikuri kvlevebi



uxSiresi samedicino mdgomareobebi

kolafsi


tkivili gulis areSi

xvela

gonebis kargva, sinkope


gulis friali


SfoTviTi /panikuri aSliloba

sinkope da presinkope

subspecialobebze dafuZvnebuli kompetenciebi

stabiluri stenokardia

mwvave koronaruli sindromi, miokardiumis mwvave infarqti

qronikuli haeris ukmarisoba

gulis ukmarisoba

kardiomiopaTiebi

gulis sarqvlovani daavadebis mqone pacientis Sefaseba

perikaditebi

pirveladi da meoradi prevencia

arteriuli hipertenzia

infeqciuri endokarditis profilaqtika da marTva

aortis daavadebebi

gulis simsivneebi

gulis reabilitacia

pacientebis Sefaseba arakardioqirurgiuli operaciebis dros

pacientebis Sefaseba kardioqirurgiuli operaciebis dros

pulmonuri hipertenzia

literaturis nusxa:

1. n.tatiSvili, g,simonia – “Sinagani daavadebebi:

2.g.qavTaraZe diagnostikuri Zieba Sinagan sneulebaTa klinikaSi. simptomidan diagnozamde.

3.muraSko - eleqtrokardiografia

1. Brawnwald– “Heart Diseases”2. Merck Manuel


Sesrulebuli procedurebi da manipulaciebi raodenoba

avadmyofis damoukidebeli gasinjva da diagnozis dasma30


periferiuli venis punqcia da venis kaTeterizacia; 20


50

datvirTvis testi saTanado unar-Cvevebis mqone eqim specialistTan erTad

holter-monitoringi saTanado unar-Cvevebis mqone eqim specialistTan erTad

eqokardioskopia saTanado unar-Cvevebis mqone eqim specialistTan erTad

sareanimacio RonisZiebebis Catareba: filtvis xelovnuri ventilacia, gulis arapirdapiri masaJi, gulis eleqtruli stimulacia, eleqtruli defibrilacia, kardioversia, traqeis intubacia;

saTanado unar-Cvevebis mqone eqim specialistTan erTad

laboratoriuli maCveneblebis interpretacia 100


Sefasebis sistema lokaluri xelmZRvanelis

xelmowera

kargi

damakmayofilebeli



komentari

III. saswavlo kursi hematologia/transfuziologiaSi

moduli 1.1 SeZenili da Tandayolili anemiebi. Anemiebisxvadasxva daavadebebis dros1.1.1. modulis xangrZlivobaa 2 Tve

1.1.2. modulis mizani:

P klinikur praqtikaSi (romelic moicavs klinikuri medicinis TiTqmis yvela dargs) didi mniSvneloba eniWeba anemiuri sindromis ZiriTadi aspeqtebis codnas. Aanemia SeiZleba iyos sxvadasxva daavadebis pirveladi gamovlineba. yoveldRiuri praqtikul saqmianobaSi. klinicisti did siZneleebs awydeba anemiis genezis verificirebisa da Sesabamisi mkurnalobis SemuSavebisas. Uukanasknel wlebSi Seicvala midgoma im anemiebis mimarTac, romlebic viTardeba saxvadasxva qronikuli daavadebebis dros. AamJamad es anemiebi gamoyofilia calke jgufebad. maTi mkurnaloba moiTxovs did praqtikul gamocdilebasTan erTad diagnostikis axali teqnologiebisa da Terapiis Tanamedrove meTodebis codnas. modulis mizania rezidents Seaswavlos pacientis damoukideblad gasinjva,mdgomareobis simZimis Sefaseba,anemiuri sindromis gamovlena,diferencialuri diagnozi gatareba,rac SeZenili da Tandayolili anemiebis diagnostikis,mkurnalobis da prevenciis Tanamedrove principebs efuZneba.1.1.3. modulis amocanebia:programis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:

1. cneba eriTronis Sesaxeb (sisxlmbadi qsovilis erT-erTi mniSvnelovani sistema, romelic moicavs: a) eriTropoezis winamorbed ujredebs. b) morfologiurad identificirebad ujredebs. g) hemoglobinis masinTezirebel ujredebs. d) mwife ujredebis klasebs. eriTrocitebis produqcia. ZiriTadi aspeqtebi. araefeqturi eriTropoezis cneba.2. anemiebi. klasifikacia. anemiis ZiriTadi paTogenezuri faqtorebi; 3. rkinadeficituri anemiebi. epidemiologia. ganviTarebis ZiriTadi mizezebi; diferenciuli diagnozi. mkurnaloba. 4. megaloblasturi anemiebi. klasifikacia. diferenciuli diagnozi. mkurnaloba.5. porfirinebis sinTezis moSliT ganpirobebuli Tandayolili da SeZenili anemiebi,paTogenezi,mkurnaloba.6 Tandayolili da SeZenili hemolizuri anemiebi.7. parcialuri wiTelujredovani aplazia. SeZenili da Tandayolili formebi. diagnostikuri kriteriumebi. prognozi.8. anemiebi qronikuli daavadebebis dros. etiopaTogenezi, klinikuri suraTi, diferencialuri diagnozi, mkurnaloba.9. aplastiuri anemia.1.1.4. praqtikuli unar-Cvevebis nusxa mocemulia #1 cxrilSi:

cxrili # 1profesiuli unar-Cvevebi Sesasrulebe

li manipulaciis raodenoba

davaleba

1. periferiuli sisxlis nacxis da retikulocitebis preparatis damzadeba (aReba, SeRebva). eriTrocitebis morfologiuri Taviseburebebis Sefaseba.2. anemiebis diagnostikisaTvis aucilebeli hematologiuri maCveneblebi:hemoglobini,eriTrocitis raodenoba,eriTrocitis saSualo moculoba,feradobis maCvenebelis gansazRvra.3. eriTrocitis zoma da forma,hemoglobinis saSualo Semcveloba da koncetracia,eriTrocietebis morfologiuri saxecvlilebani:mikrocitozi,makrocitozi,megalocitozi,anizocitozi,poikilocitozi,hipo-,hiper- da poliqromatofiluri eriTrocitebis gansazRvra.4. eriTrocitebis CanrTebi:kebotis rgolebi,Jolis sxeulebi,bazofiluri marcvlovaneba,heinc-erlixis sxeulakebi.sisxlSi bazofiluri poliqromatofiluri da oqsifiluri normoblastebis identificireba.5. eriTrocitebis osmosuri rezistentoba.namgliseburi eriTrocitebi.glukoza-6-fosfatdehidrogenazas aqtivoba.siderocitebi da sideroblastebis identificireba.

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6. erlixis cda.sicivis da siTburi aglutininebi sisxlis SratSi.kumbsis pirdapiri da arapirdapiri testebis interpretacia.7. retikulocitebis raodenobis gansazRvra.Zvlis tvinis aReba, preparatebis damzadeba, SeRebva.

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1.1.5. aucilebeli da rekomendebuli literaturis nusxa: 1. Руководство по Гематологии: в 3т. Т1 под ред. А.И. Воробьева. Москва 2002г. 280с2. Воробьев П.А. Анемический синдром в клинической практике, Москва 2001г. 168с3. Гусева С.А., Вознюк В.П. Болезни системы крови. Справочник. Москва 2004г .489с 4. Дворецкий Л.И. Железодефицитные анемии, Москва 1998г. 37с5. Козинец Г.И. Интерпретация анализов крови и мочи. Клиническое значение анализов, Москва 1995г. 123с6. Новик А.А. Богданов А. Н. Анемии (от А до Я), Санкт-Петербург 2004г. 315с7. Михаилова Е.А., Ядрихинская В. Н. Савченко В.Г. Апластические анемии и вирусные гепатиты (постгепатитные апластические анемии) // Тер. архив – 1999г. №7 С64-698. Михаилова Е.А., Савченко В.Г. Устинова Е.Н. Эффективность циклоспорина А в лечении больных апластической анемией // Тер. архив – 2001г. №7 С56-619. Румянцев А.Г. , Морщакова Е.Ф., павлов А.Д. Эритропоэтин, Москва 2002г. 397с.10. Шиффман Фред Дж. Патофизиология крови, Санкт-Петербург 2000г. 250с11. Шиффман Фред Дж. Патофизиология анемии, Санкт-Петербург 2000г. 446с12.Смирнов А.Н. «Болезни крови» Москва, 200513. Козинец Г.И., Погорелов В.М., Дягилева О. А., Наумова И.Н. «Кровь», Москва 200614.Bacigalippo A., Bruno B., Saracco P., et al. Antilymphocyte globuline, cyclophosphamide, prednisolone, and granulocyte colony-stimulating factor for severe aplastic anemia : an update of the GITMO/EBMT study of 100 patients // Blood. – 2000. –vol.95, #6- p 1931-1934.15. Baer A. N., Dessypris E. N. krantz S. B. The pathogenesis of anemia in theumatoid arthritis: a clinical and laboratory analysis // Eur. J. Clin. Invest.-1995.Vol. 25.p383-38916. Brown K.E. Tisdale J., Dunbar et al., Hepatitis-associated aplastic anemia// N. Engl. J. Med.-1997-vol336-p1059-106217. Cash J.M., Sears D.A. The Anemia of chronic diseases in series unselected hospitalized patients // Am.J. Med.- 1989 – Vol 87 – p 638-64218. Hematology: basic principles and practice/ed BybRoland Hofman et al., 3td ed.- Churchfull livingstone, 2000. -2584p19.Horne D.W. transport of Folates and antifolates in liver// Proc. Soc.Exp. Biol. Med.-1993.-Vol.202.- p385-390.

20. Littlewood T.j. Cella D., Nortier J.W,R., Erythropoetin o\improves quality of life // The Lancet Oncology. – 2002. –Vol.3 #8 – p235-23921. Ludwig H., Fritz E., Leitgeb C.et al., prediction of response to erythropoetin treatment in chronic anemia of cancer// Blood. – 1994. – Vol.84.- p 1056-105922. Wintrope’s clinical hematology/ ed.by D.W.Pine, Jr, 11th ed. – Williams&Wilkins, 199923.Young N.S. Maciejewski J. The pathophysiology of acquired aplastic anemia// N. Eng. J. Med.- 1997. Vol.336.- p 1365-137024. Zecca M., De Stefano p., Nobeli B., Locatelli F. Anti-CD20 monoclonal antibody for the treatment of severe, immune-mediated, pure cell aplasia amd hemolitic anemia// Blood – 2001.- Vol.97.#12- p 3995-3997

moduli 1.2. mwvave lekemiebis diagnostikis da mkurnalobisTanamedrove principebi 1.2.1. modulis xangrZlivobaa 3 Tve

1.2.2. modulis mizania:

mwvave leikemiebis biologiis, diagnostikis, klasifikaciis da mkurnalobis Tanamedrove principebis Seswavlas.

1.2.3. modulis amocanebi: programis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:1. mwvave leikemiebis biologia, citogenetikuri, molekulur-biologiuri, imunologiuri meqanizmebi, statisikuri monacemebi,etiologia. 2. mwvave leikemiebis Tanamedrove klasifikacia, diagnostikis kriteriumebi: klinikuri,hematologiuri,morfologiuri(citologiuri,citoqimiuri),imunologiuri:periferiuli sisxlis da Zvlis tvinis punqtatis imunofenotipireba(hemopoeturi ujredebi,limfocitebis subpopulacia da sxva.)citogenetikuri:kariotipis struqturuli da raodenobrivi cvlilebebi(translokacia,iversia,hipo- da hiperdiploidia,normaluri kariotipi).3. mwvave leikemiebis klinika (ZiriTadi klinikuri sindromebi), ganviTarebis dinamika, stadiebi.4. mkurnalobis principebi, qimioTerapia, sxivuri Terapia, imunoTerapia, Rerovani ujredebis da Zvlis tvinis transplantacia. mkurnalobis alternatiuli meTodebi. 5. formebis mkurnaloba. cneba wamlismieri da SedarebiTi rezistentobis Sesaxeb. 6. dacviTi mkurnaloba. komponenturi Terapia. 7. neiroleikemia, prevencia da mkurnaloba.

1.2.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 2 saxiT:cxrili # 2

profesiuli unar-Cvevebi Sesasrulebeli davaleba

manipulaciis raodenoba

1.avadmyofis mdgomareobis obieqturi Sefaseba ,klinikuri sindromebis gamovlena.2.periferiuli sisxlis nacxis damzadeba,hemogramis monacemebis Sefaseba.3.mwvave leikemiis hematologiuri Taviseburebebis gansazRvra.4.Zvlis tvinis punqcia,punqtatis citologiuri Semadgenlobis Seswavla,daavadebis substratis dadgena,citologiuri Taviseburebebis gamovlena.citoqimiuri,imulogiuri da citogenetikuri kvlevebis interpretacia.5.TeZos Zvlis trepanobiofsia,Zvlis tvinis histologiuri preparatebis Seswavla,aRwera,daavadebis substratis gamovlena. 6.qimiopreparatebis momzadeba,citostatikuri Terapiis CatarebismizniT-gaxsna,infuzia,proceduris monitoringi(gvediTi movlenebi-toqsiuroba,antidotebi)7.Tavzurg-tvinis sadiagnostiko punqcia,citostatikuri preparatebis intralumbarulad Seyvana.8.atinbaqteriuli,antivirusuli da antimikozuri Terapiis Catareba,pancitopeniis (anemia,Trombocitopenia,neitropenia)-marTva.sisxlis komponentebis gadasxma.9.koloniamastimulirebeli rekombinanturi faqtorebis gamoyeneba.

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1.2.5. aucilebeli da rekomendebuli literaturis nusxa: 1. Chang K.L., O’DonellM. R. ,SlovakM.L .et all “Primary mielodisplazia in adults under 50 years old: a clinicopathologic study of 52 patients. Leukemia, 2202; 16, 623-6312. De Writte T. et all “ A recent study that evaluated 184 patients with MDS or secondory AML after MDS, who underwent induction therapy with conventional chemotherapy, folloudedby consolidation and an allogeneic or autologous transpleant depending on donor aviability” Blood, 2001, 98:2326-23313. Steensman d.p. et all “ Antithymocite globulin has limited efficacy and substantial toxicity in inselected anemic patients with myelodysplastic syndrome” Blood, 2003,101:2156-2158

4. Fenduse P. et all “ Cytogenetics of myelodisplastic syndromes” Semin. Hematol. , 1996, 33:127-385. Greenberg P. at all “Hematology (American Society Hematology Education book)” 2002, 136-616. Jaffe E.S., Harris N.L., Stein H, Vardiman J.W et all World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of Haematopoetic and Lymphoid Tissues, Lyon< France, IARC, 2001.1. National Comprehensne cancer Network, Clinical Practice Guidelines in oncology. 2004,

vol.12. Cheson B.D. et all “Novel therapeutic agents for the treatment of myelodisplastic

syndromes” Semin. Oncology< 2000, 27:560-773. Rigolin G.M., Bigoni R et all “Clinical importance of interphase cytogenetics detecting

occult chromosome lesions in myelodisplastic syndromes with normal kariotype.” Leukemia, 2001, 15:1841-7

4. Nossilingen T., Reiser R et all “Myelodisplastic syndromes from French-American-British to World Health Organization: comparison of classification on 431 unselected patients from a single institution” Blood, 2001, 98:2435-41

moduli 1.3. qronikuli mieloproliferaciuli daavadebebi1.3.1. modulis xangrZlivoba: 3 Tve 1.3.2. modulis mizania:qronikuli mieloiduri leikemiis,subleikemiuri mielozis,WeSmariti policitemiis biologiis,etiologiis,diagnostikisa da mkurnalobis Tanamedrove principebis Seswavla1.3.3. modulis amocanebi:

programis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:

1. qronikuli mieloiduri leikemiis biologia,citogenetikuri, molekulur-biologiuri, citoqimiuri Taviseburebebi. diagnostikis kriteriumebi: klinikuri, hematologiuri, morfologiuri, citogenetikuri(qr.mieloiduri leikemiis citogenetikuri markerebi). molekuler-biologiuri, citoqimiuri.

2. qr. mieloiduri leikemiis klinika, ZiriTadi klinikuri sindromebi, ganviTarebis dinamika, stadiebi. klinikuri formebi(bavSvTa, iuveniluri da mozrdilTa forma). mkurnalobis Tanamedrove principebi – monoqimioTerapia, imunoTerapia, poliqimioTerapia, Zvlis tvinis transplantacia. mkurnalobis axali principebi, prognozi.

1. subleikemiuri mielozis daignostikis kriteriumebi: klinikuri, hematologiuri, histomorfologiuri, citoqimiuri. Hhemopoezis funqciur-topografiuli Taviseburebebi. klinika: ZiriTad klinikuri sindromebi, ganviTarebis dinamika, stadiebi (morfogenezis formebi), imunuri garTulebebi. mkurnalobis Tanamedrove principebi: monoqimioTerapia, imunuri garTulebebs mkurnaloba, spleneqtomiis Cveneba. reducirebuli

hemopoezis mkurnaloba. imunoTerapia. blasturi krizis murnaloba. dacviTi mkurnaloba. komponenturi Terapia.

2. WeSmariti policitemiis biologia - citogenetikuri, molekulur-biologiuri darRvevebi. diagnostikis kriteriumebi: klinikuri, histomorfologiuri, citogenetikuri, radiologiuri, citoqimiuri. WeSmariti policitemiis klinika: ZiriTadi klinikuri sindromebi, ganviTarebis dinamika, stadiebi. WeSmariti policitemiis garTulebebi. mkurnalobis Tanamedrove principebi: citaferezi, monoqimioTerapia, imunoTerapia, trombozebis, Trombohemoragiuli garTulebebis prevencia da mkurnaloba. WeSmariti policitemiiT daavadebulTa socialuri adaptacia da reabilitaciis problemebi

1.3.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili #3 saxiT:cxrili # 3

profesiuli unar-Cvevebi Sesasrulebeli manipulaciis raodenoba

davaleba

1.avadmyofis obieqturi mdgomareobis Sefaseba. 2.periferiulisisxlis gamokvleva,Zvlovani qsovilis,parenqimis da mikrogaremos Sefaseba.Zvlis tvinis punqciis da trepanobiofsiis Catareba Zvlis tvinis citologiuri da histologiuri gamokvleva.

3.qimioTerapiis Catareba. daavadebis da qimioTerapiis garTulebaTa sawinaaRmdegoRonisZiebaTa ganxorcieleba.4.Sededebis sistemis mdgomareobis Sefaseba –dsS riskis gansazRvra.5.mieloiduri qsovilis struqturisa da ujreduli Semadgenlobis cvlilebebis klinikuri interpretacia mieloproliferaciuli daavadbebis dros.6. samedicino dokumentaciis warmoebaAavadmyofobis istoriaAambulatoriuli baraTi

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kvlevis Sedegebis prezentacia

1.3.5. aucilebeli da rekomendebuli literaturis nusxa: 1. Vardiman J. W., Harris N.I, et all “ The World Health Organization (WHO)

classiffication of the myeloid neoplasm” Blood, 2002, 100:2292-3022. Jeferri a. “ Polysytemia vera: a compretensive revieus and clinical recomendations”

Mayo Clin. Proc. 2003, 78:174-94

3. Spivak J.L. “ Polysytemia vera: myths, mechanisms and menagement” Blood, 2002,100:4272-420

4. Prchal J.T. “ Classification and molecular biology of polycytemias (erithrocytoses0 and thrombocytosis” hematol. Oncol. Clin. North ttm. 2003, 17:1151-8

5. Lin E., Jelinek J., Pastore Y. d. et all “Discrimination of Polysytemias and thromcytoses by novel, simple, accurante assays and comparison with PRV-I exspression and BFUO-E response to erythropoietin” Blood, 2003,101:3294-302

6. Spivak J.L., Barosi G. et all “Chronic myeloproliferation disorders” Hematology , 2003, 200-24

7. Barosi G. “Myelofibrosis with myeloid metaplasia” Hematol. Oncol. clinic. N. Am. 2003, 17:1211-26

8. Michiels J.J. at all “ Clinical and pathological criteria for the diagnosis of essential thrombocythemia, polycythemia vera and idiopathic myelofibrosis (agrocenic myeloid metaplazia) “ hematology, 2002, 76:133-45

9. Koch C.A. et all “ Nonhepatosplenic extramedullary hematopoesis: associated diseases, pathology, clinical course and treatment” Mayo Clin. Proc. 2003, 78:1223-33

10. Deeg H.J., Gooley T.A. et all “Allogenic hematopoetic stem cell transplantation for myelofibrosis” Blood, 2003,102-3912-8

11. Melo J.V., Hughes T.P. et all “Chronic myeloid leukemia” Hematology , 2003, 132-5212. Goldman J. , Melo J. “Chronic myeloid leukemia: advances in bilogy and new

treatment approaches ti treatment” N. Engl. J. Med. 2003, 349. 1451-6413. O’Dwyer M.E., Mauro M. J. et all “Clonal evolution and lack of cytogenetic response

are adverse prognostic factors for hematologic relapse of chronic phase CML patints treated with imatinib mesylate” blood, 2004, 103:451-5

14. Deiminger M.W. at all “ Specific targeted therapy of chronic myeloidous leukemia with imatinib” Pharmacol Rev. 2003, 55:401-23

15. Olavarria E., Ottmamm O.G. et all “ Chronic leukemia working partyof the European group of Bone Marrow transplantation. Response to imatinib in patients who relapse after allogenic stem cell transplantation for chronic myeloid leukemia” 2003,17:1707-12

moduli 1.4. hemostazis sistemis darRvevebi(Tandayolili da SeZenili koagulopaTiebi. hemoragiuli diaTezebi. Trombozebi da hemoragiebi klinikur praqtikaSi, dik sindromi) 1.4.1. modulis xangrZlivobaa 3 Tve 1.4.2. modulis mizania hemostazis sistemis da hemoreologiis darRvevebiT gamowveuli daavadebebis da paTologiuri mdgomareobebis paTogenezis, klinikuri gamovlinebis, mimdinareobis, profilaqtikis da mkurnalobis swavleba.

1.4.3. modulis amocanebia:zemoTaRniSnuli miznis misaRwevad modulis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:

1. hemostazis fiziologia da paTofiziologia2. pirveladi hemostasis darRvevebi fon vilebrandis faqtori. vilebrandis

daavadeba. Tipebi, epidemiologia, etiologia,paTogenezi, klinika, mkurnaloba. Trombocitebis roli pirvelad hemostazSi

3. Trombocitopenia - Zvlis tvinis dazianebiT mimdinare sistemuri daavadebebis, Zvlis tvinis pirveladi ukmarisobiT, simsivniT, dagrovebis daavadebebiT, qronikuli mieloproliferaciuli an granulomatozuri daavadebiT, vitaminis deficitiT, infeqciT, mielodisplaziuri sindromi. B12an foliumis mJavis xangZlivi deficiti. Trombotuli Trombocitopeniuri purpura.imunuri Trombocitopeniuri purpura – epidemiologia, etiologia,paTogenezi, klinika, mkurnaloba, diferenciuli diagnozi . gestaciuri Trombocitopenia. hepariniT gamowveuli Trombocitopenia. posttransfuziuli purpura hipersplenizmi.

4. Trombocitozi- esenciuri da meoradi. diferencialuri diagnozi. Mmkurnaloba.

5. Trombocitebis funqciis darRveviT gamowveuli moSlilobani.6. angiopaTiebi.7. meoradi hemostazi (koagulacia) – fiziologia da paTpfiziologia plazmuri

koagulaciuri faqtorebis Tandayolili deficitiT gamowveuli moSlilobani. hemofilia A, hemofilia B, diferencireba,hemofiliis mkurnalobis garTulebebi inhibitorebi. hemostasis SeZenili darRvevebi. Tanmxlebi paTologiuri mdgomareobani -RviZlis daavadebis, alkoholizmis, sxvadasxva autoimunuri daavadebebis, medikamentebis gverdiTi movlenebis da sxv.

8. SededebissawinaaRmdego meqanizmebi. fibrinolizi. 9. pirveladi fiziologiuri antikoagulantebi. maTi deficitis, fibrinolizis

darRvevis anomaliebiT gamowveuli daavadebebis diagnostikis Taviseburebebi, klinikuri mimdinareoba, mkurnaloba, profilaqtika.

10. Tandayolili da SeZenili Trombofiliebi. Trombozi. Ddik sindromi - etiologia prevenciis principebi, diagnostika, stadiebi, mkurnaloba. medikamentozuri mkurnaloba. antifosfolipiduri sindromi –paTogenezi, diagnostika mkurnaloba, profilaqtika

1.4.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 4 saxiT:cxrili # 4

profesiuli unar -CvevebiSesasrulebelimanipulaciebisraodenoba

davaleba

1. hemostatiuri darRvevebis mqone pacientTa Sefaseba

detaluri anamnezis Sekreba da hemoragiuli diaTezis saxis da simZimis dadegena.

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2. Oojaxuri anamnezis Segroveba3. hemostazis kontrolisTvis

hospitalizaciis saWiroebis dadgena

4. hemotransfuziis da faqtorebis transfuziis Cvenebebis gansazRvra

5. peteqia, purpura, ekqimosi, hematomis diferencireba6. laboratoriuli kvlevebi. hemostazur daavadebaze eWvisas laboratoriuli kvlevebis SerCeva anamnezis da fizikaluri gasinjvis safuZvelze7. Trombocitebis raodenobis gansazRvra da interpretacia, Trombocitebis daTvla nacxSi.8. zogadkoagulologiuri testebi – gansazRvris principebi. Kkoagulogramis interpretacia.9. sisxldenis drois gansazRvra 10. Trombocitebis funqciis damatebiTi kvlevis saWiroebis gansazRvra.11. Trombocitebis agregaciis In vitro kvleva12. fon vilebrandis faqtoris aqtivoba, ristocetin kofaqtori 13. protein Cda S, homocisteini - testebis interpretacia14. fibrinogenis gansazRvra sxvadasxva meTodebiT15. laboratoriuli kvleva TTP-ze eWvis dros. intravskularuli hemolizis gamovlena (anemia, dabali an gamouvlinebeli haptoglobini, LDH-is momatebuli done), Trombocitopenia, normaluri koagulacia da Tirkmlis

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3Kklinikuri SemTxvevis garCeva

ukmarisoba.16. Sededebis faqtorebis ganmsazRvreli testebis Sedegebis interpretacia17. Trombocitebis transfuziis Cvenebebi da ukuCvenebebi18. laboratoriuli monitoringi dik sindromis dros19. heparinoTerapia da misi monitoringi20. arapirdapiri antikoagulantebiT Terapiis monitoringi.21. mgluras antikoagulanti,antifospilipiduri autoantisxeulebi – Sedegebis interpretacia. gestaciuri periodis Aantikoagulaciuri Terapia.

22. avadmyofobis istoria

1.4.5. aucilebeli da rekomendebuli literaturis nusxa: 1. 3. Воробьев П.А. Актуальный гемостаз, М.,2004. Медицина, 1986. – 235 с.2. Гаврилов О.К. Гравитационная хирургия крови М.,19943. Жибурт Е.Б. Трансфузиология.- СП, 2002 - 733с.4.Зотиков Е.А., Бабаева А.Г. Путешествие в трансфузиологию. . М., 2002 – 105 с.5. Рагимов А.А., Щербакова Г.Н., Руководство по инфузионно-трансфузионной терапии. М., 2003 – 179 с.6. Румянцев А.Г., Аграненко В.А. Клиническая трансфузиология. – М., ГЕОТАР Медицина,1997. – 575 с.7. “Клиническая онкогематология,” под ред. Волковой М.А, Москва, Медицина, 2001, 314- 3758. “Руководство по ггематологии”, ппод ред. Воробъева А.И., т.2, Москва, 2002, 82-1139.“Болезны системы крови”, Гусева С.А., Вознюк В.П., Москва, 2000,262-26810. Гусева С.А., Вознюк В.П. Болезни системы крови. Справочник. Москва 2004г .489с11. Robert S. Hillman, Kenneth A. Ault, Henry M. Rinder. Hematology in clinical practice, fourth edition, 2006, 440 pages.12. “Technical manual of American Association of Blood Banks” –12 edition, Milan, 2000, 1056 pages.13. Beul R. W., Isbister J.P., Blood component therapy in clinical practice. Melburn, Oxford,

London. Bleckwell Sci. Publication, 1985.14.Gibbs W.N., Britten A.F. Guidelines for the organization of a blood transfusion service, 1992 Geneva, WHO15. Tomas E. at all “ Cecil essentials of medicine” Hematology Disease Philadelphia-London, 2004, 2, 403-44916. Robert S. Hillman, Kenneth A. Ault, Henry M. Rinder. Hematology in clinical practice, fourth edition, 2006, 440 pages.

moduli 2.1.adenopaTiebi, splenomegaliebi, limfoproliferaciulidaavadebebi2.1.1.modulis xangrZlivobaa3 Tve2.1.2. modulis mizania:limfuri jirkvlebis hiperplaziis drouli gamovlena, diferenciuli diagnostika, etiopaTogenezuri mkurnaloba. leikemoiduri reaqciebis drouli gamovlena, diferenciuli diagnostika, etiopaTogenezuri mkurnaloba. qronikuli limfoiduri leikemiis, mravlobiTi mielomis da valdenstremis daavadebis diferencialuri diagnostika, eTiopaTogenezuri mkurnalobis Tanamedrove meTodebi, xelSmwyobi Terapiis SemuSaveba da ganxorcieleba.2.1..3. modulis amocanebi: gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba :1.limfuri jirkvlis hiperplaziis mizezebi :reaqtiuli limfadenitebi :a)granulomatozuri epiTeluujredovani-tuberkulozis,brucelozis,tularemiis,toqsoplazmas da sxva daavadebebis dros.b)virusuli limfadenitebi :infeqeciuri mononukleozi,b,c-hepatitebi,citomegalovirusi.g)qr.araspecifikuri limfadenitebi.d)reaqtiuli limfadenitebi kolagenozebis da endokrinuli daavadebebis dros,adenomegaliebi sisxlis sitemis daavadebebis dros :mwvave limfoiduri leikemia,qr.limfoiduri leikemia,hojkinis da arahojkinis limfomebi,valdenstremis daaavadeba. maTi diferencialuri diagnostika, etiologiis dasadgenad aucilebeli da damxmare klinikuri da paraklinikuri meTodebi, maTi interpretacia da mkurnaloba. 2.leikemoiduri reaqciebis drouli gamovlena, etiologiis dadgena da adeqvaturi mkurnalobis SerCeva. 3.splenomegaliebi :infeqciebis(-mwvave infeqciebi :muclis tifi,tularemia,miliaruli tuberkulozi,leptospirozi,septiuri endokarditi,virusuli daavadebebi.-qronikuli infeqciebi:brucelozi,elenTis tuberkulozi,sifilisi.-umartivesebiT ganpirobebuli splenomegaliebi:malaria,toqsoplazmozi,leiSmania,tripanosomozi da sxva);helminTozebis dros,portuli hipertenizia,elenTis venis Trombozi,karis venis trombozi,RviZlis cirozi,bantis daavadeba,bad-kiaris daavadeba da sxva.elenTis infarqti,elenTis arteriis anevrizma,elenTis abcesi,kista.4.splenomegaliebi sisxlis sistemis daavadebebis dros(mwvave limfoiduri leikemia,mieloproliferaciuli daavadebebi-qr.mieloiduri leikemia,subleikemiuri mielozi,WeSmariti policitemia,limfoproliferaciuli daavadebebi:qr.limfocituri

leikemia,valdenstremis,hojkinis da arahojkinis limfomebi.Tandayolili hemolizuri anemiebi.5.qronikul limfoiduri leikemia, mravlobiTi mielomia da valdenstremis daavadeba etiologia,paTogenezi diferencialuri diagnostika,mkurnalobis optimaluri sqemebis gamoyeneba, qimioTerapiis periodSi SesaZlo garTulebebis drouli gamovlena da koreqcia, kliniko-laboratoriuli monacemebis swori interpretacia, prognozuli faqtorebis gaTvaliswinebiT daavadebis mimdinareobis da mkurnalobis efeqturobis gansazRvra.2.1.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 5 saxiT:cxrili # 5

profesiuli unar-Cvevebi Sesasrulebeli manipulaciebis raodenoba

davaleba

1.Civilebisa da anamnezuri monacemebis Sekreba, srulfasovani Sejereba da interpretacia. 2.inspeqcio(daxedva,daTvaliereba) 3.hemogramis daTvla. 4.Zvlistvinis ujredovani Semadgenlobis Seswavla. 5.Zvlis tvinis histomorfologiis Seswavla. 6.periferiuli sisxlisa da Zvlis tvinis ujreduli elementebis citogenetikuri gamokvleva. 7.periferiuli sisxlis, Zvlis tvinis punqtatis imunofenotipireba. 8.trepanobioptatis imunohitoqimiuri gamokvlevebi, interpretacia. 9.sisxlis da Sardis imunoeleqtroforezi.radialuri imunodifuzia,imunofermentuli analizi mocirkulire imunuri kompleqsebi,krioglobulinebi.cilovani fraqciebis Sefaseba,m-gradientis mniSvnelobis Sefaseba.10.imunoglobulinebis Tvisobrivi da raodenobrivi cvlilebebis gansazRvra. 11.limfuri kvanZis citologiuri da histologiuri Seswavla. imunohistoqimiuiri gamokvleva12.splenograma. elenTis morfologiuri da imunohistoqimiuri Taviseburebebis Seswavla. 13. gamokvlevis radionukliduri meTodebis gansazRvra. 14. RviZlis da elenTis gama-scintigrafia. limfoscintigrafiis gacnoba.

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3 Tematuri prezentacia

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3 kvlevis Sedegebis prezentacia

15. kompiuteruli da magnito-rezonansuli tomografiis gacnoba.16.samedicino dokumentaciis warmoebaAavadmyofobis istoriaAambulatoriuli baraTi

2.1.5.aucilebeli da rekomendebuli literaturis nusxa:1. “Клиническаяонкогематология,” подред. ВолковойМ.А, Москва, Медицина, 2001, 376-3922ю“Руководствоппоггематологии”, пподред. ВоробъеваА.И., т.2, Москва, 2002, 69-813ю “Програмноелечениелейкозов”, СавченкоВ.Г. исоавт., Москва, 2002, 215-2234. “HHematology journal”, P. Reimer et all, v-5, 2004, 132-1375. “Hematology journal ”, Palumbo A. et all, v-5, 2004, 318-3246. “Болезнысистемыкрови”, ГусеваС.А., ВознюкВ.П., Москва, 2000,262-2687ю”Химитерапияоопухолевыхзаболеваний”, подред. ПереводчиковойН.И., Москва, 2000, 230-2618. “Haematologica” CadovsbyD., v-9o, 1, 2005, 45-53

moduli 2.2.limfomebis (hojkinis da arahojkinis) diagnostikis da mkurnalobis Tanamedrove principebi2.2.1…modulis xangrZlivobaa 3 Tve2.2.2.modulis mizania:hojkinis da arahojkinis limfomebis citologiuri, histomorfologiuri, imunologiuri diagnostika risk-faqtorebis gaTvaliswinebiT, daavadebis mimdinareobis prognozireba, mkurnalobis Tanamedrove principebis Seswavla.2.2.3. modulis amocanebia: gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba: 1. avTvisebiani limfomebis etiologia da paTogenezi.2. diferencialuri diagnostika3. klasifikacia.4. imunodiagnostika.5.klinikuri Taviseburebani.6. hojkinis da arahojkinis limfomebis citologiuri,histomorfologiuri,citogenetikuri da imunologiuri maCveneblebi.7. reaqtiuli limfadenitebis da avTvisebiani limfomebis diferencialuri diagnostika.8. hojkinis da arahojkinis limfomebis mimdinareobis prognozireba da mkurnalobis Tanamedrove principebi.2.2.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 6 -is saxiTcxrili # 6

profesiuli unar-Cvevebi Sesasrulebeli davaleba

manipulaciis raodenoba

1).anamnezuri monacemebis Sefaseba, srulfasovani Sejereba da interpretacia.2). limfuri kvanZis citologiuri,histomorfologiuri,imunohisoqimiuri gamokvleva3) periferiuli sisxlis da Zvlis tvinis ujreduli elementebis imunofenotipireba,citologiuri, histomorfologiuri da citogenetikuri Seswavla. 4)trepanobioptatis morfologiuri da imunohistoqimiuri gamokvleva.5)kompiuteruli da magnitur-rezonansuli tomografia hematologiaSi,interpretacia.6)Zvlebis rentgenologiuri da scintigrafiuli monacemebis interpretacia.7)muclis Rrus ultrasonografiuli gamokvleviT miRebuli Sedegebis interpretacia.8)sisxlis bioqimiuri gamokvleva, Sedegebis interpretacia.sisxlis serologiuri gamokvleva, Sedegebis interpretacia.9).mkurnalobis maqsimalurad efeqturi programis SerCeva da qimioTerapiis procesisganxorcieleba. 10)avTvisebiani limfomebis mimdinareobis marTva remisiis fazaSi.11) qimioTerapiisadmi rezistentuli formebis mkurnaloba. 12) samedicino dokumentaciis warmoebaAavadmyofobis istoriaAambulatoriuli baraTi

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K kvlevis Sedegebis prezentacia

2.2.5. aucilebeli da rekomendebuli literaturis nusxa:1. “Клиническая онкогематология,” под ред. Волковой М.А, Москва, Медицина, 2001, 314-3752ю“Руководство ппо ггематологии”, ппод ред. Воробъева А.И., т.2, Москва, 2002, 82-1133ю “Програмное лечение лейкозов”, Савченко В.Г. исоавт., Москва, 2002, 215-2234. “Annals of Oncology”, S. Rao et all, v-15, 9, 2004, 1413-14185. “Annals of Oncology”, H. Bertz at all, v-15, 9, 2004, 1419-14256. “Болезны системы крови”, Гусева С.А., Вознюк В.П., Москва, 2000,262-2687ю”Химитерапия оопухолевых заболеваний”, под ред. Переводчиковой Н.И., Москва, 2000, 230-261

moduli 2.3.klinikuri da sawarmoo transfuziologiis safuZvlebi

(sisxlis bankingi. transfuziuli medicinis imunologia, genetika, serologia, hemokomponenturi Terapiis principebi. plazmacitaferezi, Rerovani ujredebi - miReba da gamoyeneba)

2.3.1. modulis xangrZlivobaa 3 Tve2.3.2. modulis mizania – rezidentebisaTvis transfuziuli medicinis, kerZod sawarmoo da klinikuri transfuziologiis Teoriuli safuZvlebis swavleba da praqtikuli unar-Cvevebis daufleba2.3.3. modulis amocanebia: aRniSnuli miznis misaRwevad modulis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:1. transfuziologiuri samsaxuris normativebi. sisxlis bankingi. donacia, sisxlis komponentebi, maTi damzadebis, Senaxvis da gamoyenebis principebi, hemokomponentebis xarisxi da usafrTxoeba. donorobis da hemotransfuziis eTikur-samarTlebrivi aspeqtebi. 2. sisxlis komponentebis gadasxmis Cvenebebi da ukuCvenebebi. transfuziuli Terapiis moculoba sxvadasxva paTologiuri mdgomareobis, daavadebebis da sindromebis dros. transfuziuli Terapiis optimizacia paTologiuri mdgomareobis saxis, misi simZimis xarisxis, Terapiis riskis gaTvaliswinebiT. sisxlis SemcvlelebiT an rekombinanturi koloniamastimulirebeli faqtorebiT. aRniSnuli areebis da preparatebis gamoyenebis Taviseburebebi;3. transfuziuli medicinis imunologiuri da genetikuri aspeqtebi - sisxlis ujredebis antigenebi, maTi mniSvneloba klinikur transfuziologiaSi, gadasaxmeli sisxlis komponentis recipientTan SeTavsebis ZiriTadi principebi;4. hemaferezi klinikur da sawarmoo transfuziologiaSi 5. Rerovani ujredebi, gamoyeneba klinikur praqtikaSi. Hsisxlis avTvisebiani da soliduri sismsivneebis maRaldozirebuli qimioTerapia da sxva daavadebebis mkurnaloba hemopoeturi Rerovani ujredebis autologiuri da alogenuri transplantaciiT. D2.3.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 7 -is saxiT:

cxrili # 7profesiuli unar-Cvevebi Sesasr. Pproc.

raod. davalebadonoris miReba, gamokvleva, skriningi;sisxlis eriTrocituli da leikocituri antigenebis gansazRvra;donoris da recipientis sisxlis individualuri SeTavseba;

sisxlis komponentebis damzadeba;sisxlis fraqcionireba, eriTrocituli masis damzadeba, Trombocituli masis damzadeba axladgayinuli plazmis damzadeba;

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PTematuriPprezentacia

sisxlis komponentebis konservacia da Senaxva;bankingis monitoring;sisxlis komponentebis transportireba, sisxlis komponentebis momzadeba gadasxmisaTvis. transfuziuli anamnezis Sekreba

sisxlis ujreduli/cilovani deficitis simZimis xarisxis dadgena;hemotransfuziis mosalodneli riskis da sargebelisSefaseba;pacientisaTvis hemotrnsfuziis Sesaxeb informaciis miwodeba;informirebuli Tanxmobis gaformeba;sisxlis komponentebis gadasxmis dokumentaciis gaformeba

eriTrocituli masis gadasxma Trombocituli masis gadasxma

Reovani ujredebis damzadeba (bankingi) Reovani ujredebis momzadeba gadasxmisaTvissisxlis komponentebis dasxiveba

sisxlis recxvasisxlis gafiltvra

gadasaxmeli sisxlis da recipientis sisxlis ABO, Rh kuTvnilebis gansazRvra.individualuri SeTavsebis sinjebis Catareba in vitro da in vivo; sasicocxlo funqciebis monitoringi

samedicino dokumentaciis warmoebasisxlis komponentebis gadasxmis oqmiAavadmyofobis istoriaAambulatoriuli baraTi

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3Treningi foto davideomasaliT

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referati

2.3.5. aucilebeli da rekomendebuli literaturis nusxa:1. transfuziuli samsaxuris normativebi. Tbilisi, 1999. - 431 gv

2.“Technical manual of American Association of Blood Banks” –12 edition, Milan, 2000, 1056 pages. 3. Robert S. Hillman, Kenneth A. Ault, Henry M. Rinder. Hematology in clinical practice, fourth edition, 2006, 440 pages. 4. Gibbs W.N., Britten A.F. Guidelines for the organization of a blood transfusion service, 1992 Geneva, WHO 5. Nambiar A., Leitman S. Transfusion Therapy. p.607-631 (from Michael M., Boyiadzis, Peter F. Lebowitz, James N. Frame, Tito Fojo Hematology-Oncology Therapy) McGrawHill, 20076. Beul R. W., Isbister J.P., Blood component therapy in clinical practice. Melburn, Oxford, London. Bleckwell Sci. Publication, 1985.7. ГавриловО.К. ГравитационнаяхирургиякровиМ.,19948. Жибурт Е.Б. Трансфузиология.- СП, 2002 - 733с.9. Зотиков Е.А., Бабаева А.Г. Путешествие в трансфузиологию. . М., 2002 – 105 с.10. Рагимов А.А., Щербакова Г.Н., Руководство по инфузионно-трансфузионной терапии. М., 2003 – 179 с.11. Румянцев А.Г., Аграненко В.А. Клиническая трансфузиология. – М., ГЕОТАР Медицина,1997. – 575 с.

moduli2.4.hemotransfuziis garTulebebi, mizezebi, mkurnaloba, profilaqtika, hemokomponenturi Terapiis alternativebi2.4.1. modulis xangrZlivobaa 2 Tve2.4.2. modulis mizani modulis mizania rezidentebisaTvis sisxlis komponentebis gadasxmis Semdgomi adreuli da gviani garTulebebis Teoriuli safuZvlebis swavleba da praqtikuli unar-Cvevebis daufleba. modulis gavlis Semdeg rezidentma unda icodes rom alogenuri sisxlis gadasxma yovel konkretul SemTxvevaSi unda ganixilebodes rogorc alogenuri qsovilis transplantacia da mas SeiZleba Tan axldes seriozuli garTulebebi rogorc sisxlis komponentis gadasxmis dros, ise transfuziis Semdeg. 2.4.3. modulis amocanebia:aRniSnuli miznis misaRwevad modulis farglebSi gaTvaliswinebulia Semdegi Teoriuli masalis aTviseba:

1. posttransfuziuli garTulebebis prevencia – usafrTxo sisxli;2. posttransfuziuli garTulebebi - paTogenezi, diagnostika, klinikuri

mimdinareoba; 3. mwvave da mogvianebiTi hemotransfuziuli reaqciebi4. imunodamokidebuli da imunodamoukidebeli hemoliziT gamowveuli

garTulebebi, maTi profilaqtika da mkurnaloba.5. arahemolizuri cxelebiTi reaqciebis profilaqtika da mkurnaloba. - -

anafilaqsiuri reaqcia, cirkulatoruli gadatvirTva.6. citratuli intoqsikacia - paTofiziologia, profilaqtika, mkurnaloba.7. hipoTermiis paTofiziologia, profilaqtika, mkurnaloba.

8. hiperkaliemia da hipokaliemia, haerovani embolia. mwvave hemotransfuziuli reaqciis diagnostika;

9. hemotransfuziuli Soki;10.posttransfuziuli Trombocitopenia;11.sisxlis gadasxmis gviani garTulebebi. eriTrocitul antigenebTan

aloimunizacia; leikocitur antigenebTan aloimunizacia;12.hemotransmisiuli infeqciebi;13.eriTrocituli masis transfuziis garTulebebi;14.Tromboocituli masis transfuziis garTulebebi;15.leikocituli masis transfuziis garTulebebi;16.daavadeba „transplantati maspinZlis winaaRmdeg“17.sisxlisSemcvlelebi, maTi gadasxmis Cvenebebi18.sisxlis gadasxmis farmakologiuri alternativebi (eriTropoetinis,

granulocituri da granulocitur-makrofaguri mastimulirebebli faqtorebi). maTi gamoyeneba klinikur praqtikaSi;

19.hemostazis xelSemwyobi rekombinantuli preparatebi20. sisxlisSemcvleli satransfuzio xsnarebis fiziko-qimiuri da biologiuri

maxasiaTeblebi da maTi klinikuri gamoyeneba. sisxlisSemcvlelebis gamoyeneba sisxldakargvis, sxvadasxva genezis Sokuri mdgomareobis, sxvadasxva qirurgiuli Carevebis dros hemodinamikis da mikrocirkulaciis aRdgenis da hemodiluciis mizniT. dezintoqsikaciuri moqmedebis sisxlisSemcvlelebis gamoyeneba mowamvlis, damwvrobis, sxivuri daavadebis, leikemiebis, soliduri simsivneebis, toqsiuri dispepsiis, RviZlis da Tirkmlis daavadebis dros. parenteraluri kvebisaTvis gamoyenebadi preparatebi. kristaloidur marilovani xsnarebi da osmodiuretuli xsnarebi.

2.4.4. Sesasrulebeli samuSaos moculoba da Casatarebeli manipulaciebis raodenoba mocemulia cxrili # 8 -is saxiT:

cxrili # 8

profesiuli unarebi Sesasrulebeli manipulaciebis raodenoba

Davaleba

eriTrocituli masis gadasxmaTrombocituli masis gadasxmaaxladgayinuli plazmis gadasxmaalbuminis xsnaris gadasxmahemotransfuziuli reaqciis prevenciuli RonisZiebebi – sislis individualuri SeTavseba, sinjebi in vitro da in vivo.

posttransfuziuli reaqciis mkurnaloba

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pacientTa raodenoba ar aris winaswar


gansazrvruli

sisxlis komponentebis gadasxmasTan dakavSirebuli dokumentaciis Sevseba,sisxlis gadasxmis oqmis warmoeba.H

50

sisxlis konteineris utilizacia, dokumentaciis warmoeba

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autohemotransfuzia rekombinantuli faqtorebiT mkurnaloba

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sisxlisSemcveli satransfuzio xsnarebis gadasxma.

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samedicino dokumentaciis warmoebaAavadmyofobis istoriaAambulatoriuli baraTi

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2.4.5. aucilebeli da rekomendebuli literaturis nusxa:

1. transfuziuli samsaxuris normativebi. Tbilisi, 1999. - 431 gv2. “Technical manual of American Association of Blood Banks” – 12 edition, Milan, 2000, 1056 pages. 3. Robert S. Hillman, Kenneth A. Ault, Henry M. Rinder. Hematology in clinical practice, fourth edition, 2006, 440 pages. 4. Gibbs W.N., Britten A.F. Guidelines for the organization of a blood transfusion service, 1992 Geneva, WHO 5. Nambiar A., Leitman S. Transfusion Therapy. p.607-631 (from Michael M., Boyiadzis, Peter F. Lebowitz, James N. Frame, Tito Fojo Hematology-Oncology Therapy) McGrawHill, 20076. Beul R. W., Isbister J.P., Blood component therapy in clinical practice. Melburn, Oxford, London. Bleckwell Sci. Publication, 1985.7. ГавриловО.К. ГравитационнаяхирургиякровиМ.,19948. Жибурт Е.Б. Трансфузиология.- СП, 2002 - 733с.9. Зотиков Е.А., Бабаева А.Г. Путешествие в трансфузиологию. . М., 2002 – 105 с.10. Рагимов А.А., Щербакова Г.Н., Руководство по инфузионно-трансфузионной терапии. М., 2003 – 179 с.11. Румянцев А.Г., Аграненко В.А. Клиническая трансфузиология. – М., ГЕОТАР Медицина,1997. – 575 с.

IV. rezidintis Sefaseba

1. winaswari Sefaseba

yoveli modulis bolos rezidenti fasdeba Semdegi komponentebi:Teoriuli codna (T) - maqsimum 10 quliTpacientTan muSaobisas gamomuSavebuli Cvevebi (A) - maqsimum 20

quliT. Sefaseba SeiZleba grZeldebodes 1 saaTi. rezidentis miergasinjuli unda iyos misTvis nacnobi pacienti. pedagogis miercal-calke Sefasdeba Semdegi qvekomponentebi:

a)anamnezis Sekreba, 15 wuTi – maqsimum 5 quliTb) pacientis gasinjva, 15 wuTi – maqsimum 5 quliT g) kvlevis Sedegebis interpretacia da diferencialuri diagnozi, 15wuTi – maqsimum 10 quliT

modulSi gawerili manipulaciebis Sesrulebis unari (M) - maqsimum 10 quliT;

Tematuri sajaro prezentacia (P) - maqsimum 5 quliT klinikuri SemTxvevis garCeva (C) - maqsimum 5 quliTP da C komponentebis Sefaseba xdeba modulze pasuxismgebeli piris, rezidenturis programis xelmZRvanelis, klinikis eqimebis da sxva rezidentebis mier winaswar darigebuli Sefasebis kiTxvaris saSualebiT.

Aamrigad, yoveli modulis bolos Sefaseba Seadgens maqsimum 50 qulas,Sesabamisad8 modulis dasrulebis Semdeg rezidenti agrovebs maqsimum 400 qulas, rac winaswari Sefasebis 40 qulas Seesabameba. qulaTa 50% dagrovebis SemTxvevaSi (20 qula) barieri gadalaxulad CaiTvleba.

cxrili #9

rezidentis winaswari Sefasebis forma

T( max 10

q)

A( max 20

q)

M( max 10

q)

P( max 5

q)

C( max 5 q) jami Kwinasw.

Sefasebis qula

I wlis

Mmoduli 4.1.

Mmoduli 4.2.

Mmoduli 4.3.

Mmoduli 4.4.

II wlis

Mmoduli 4.5.

Mmoduli 4.6.

Mmoduli 4.7.

Mmoduli 4.8.

modulze pasuxismgebeli piris xelmowera -------------------------------------------------rezidentis xelmowera --------------------------------------------------TariRi -------------------------------------

I wlis modulebis dasrulebis Semdeg rezidenturis programis xelmZRvaneli da modulze pasuxismgebeli pirebi ikribebian da ganixilaven TiToeuli rezidentis muSaobis Sedegebs, dgeba CamonaTvali im unarebisa, romelTa gaumjobesebaze saWiroa muSaoba.

rezidenturis bolos, II wlis modulebis dasrulebis Semdeg yvela modulis SefasebiT miRebuli qulebi jamdeba. es cifri iyofa 10 –ze da miiReba rezidentis winaswari Sefasebis qula, romelic Seadgensmaqsimum 40 qulas. Tu rezidentma ver daagrova qulaTa 50% (20qula), rezidenti gadis axlidan im modulebs, romlebic programis xelmZRvanelobis gadawyvetilebiT iqneba misTvis amorCeuli.20 da meti qulis dagrovebis SemTxvevaSi xdeba rezidentis finalur gamocdaze daSveba.

2. saboloo Sefaseba (finaluri gamocda)

rezidentis saboloo Sefaseba xdeba finalur gamocdaze, romelic Sedgeba weriTi da zepiri nawilisgan.

2.1. weriTi gamocda

warmoadgens gamocdas test kiTxvariT romelSidac Sedis rezidentisaTvis 100 testi. Aam komponentisMmaqsimaluri Sefaseba 10 qulas.barieri daZleulia, Tu rezidentma moagrova qulaTa 75%.

2.2. zepiri gamocda

rezidenturis zepiri gamocda Catardeba kursis dasrulebamde araugvianes 3 TviT adre, raTa SesaZlebeli iyos arsebuli xarvezebis gamosworeba. zepir gamocdas rezidenti abarebs rezidenturis programis xelmZRvanels da modulze pasuxismgebel pirebs. Ggamocdis Sinaarsi moicavs yvela im komponents, rasac modulis Semajamebeli Sefaseba.

gamocdaunda iTvaliswinebdes Sefasebas 4 sferoSi: anamnezis Sekreba pacientis gasinjva profesionalizmi da konsultirebis unari prezentacia/formulirebis unari

rezidentis mier gasinjuli unda iyos misTvis (da sasurvelia danarCeni rezidentebisTvisac) ucnobi 3 pacienti.pacientebis SerCevas awarmoebs rezidenturis programis xelmZRvaneli (an modulze pasuxismgebeli pirebi). TiToeul rezidents damoukideblad afasebs minimum 3 sertificirebuli (da sasurvelia isin iyvnen programis modulze pasuxismgebeli pirebi) specialisti Sesabamisi qulebiT (gamocdebis dros gamosayenebeli specialuri Sefasebis formebi warmodgenilia damatebis saxiT).Sefasebis erTi dRe unda gagrZeldes daaxloebiT 1 saaTi.rezidents unda mieces maqsimum 45 wuTi anamnezis Sesagroveblad da gasinjvisaTvis. damatebiT eZleva 15 wuTi Sedegebis Sesajameblad da prezentaciisTvis.

2.3. Sefasebis komponentebi da kriteriumebi

a. anamnezis Sekrebis unarikompetenciebisRerZswarmoadgensrezidentismierpacientisdaavadebisnaTeli, zustiistoriisSekrebisunari. rezidentiundaflobdesunarsistoriismixedviTmoaxdinosdaavadebisdiagnosti

kadadazianebislokalizacia. SemfasebeliakvirdebaamunarsdamisiganxorcielebisTanmimdevrobas.

rezidentmaSeiZlebasxvadasxvastrategiagamoiyenosanamnezisSesagroveblad, magramSedegadundamoagrovossrulyofiliinformaciaqvemoTCamoTvlilsakiTxebze:

daavadebis amJamindeli istoria daavadebis adreuli istoria ojaxuri anamnezi socialuri anamnezi sxva sistemebis Sesaxeb monacemebi

Sefasebul unda iyos monacemTa xarisxi da maTi amomwuravoba.garda anamnezisa rezidentma yuradReba unda gaamaxvilos im sistemebze da faqtorebze, romlebis maprovocirebel an etiologiur faqtorebs SeiZleba warmoadgendnen. pacientis asakis da inteleqtis mixedviT.rezidents unda SeeZlos strategiis Secvla. Semfasebeli akvirdeba rezidentis moqnilobasa da komunikaciis unars.rezidenti ar unda ecnobodes pacientis adreul istorias (Tu arsebobs) Canawerebis mixedviT, aramed TviTon unda SeZlos amomwuravi informaciis Segroveba pacientisa Tu misi ojaxis wevrebisagan.rezidentma unda moipovos informacia daavadebis xangrZlivobisa da mimdinareobis Sesaxeb. umjobesia rom es procesi qronologiis mixedviT iyos, Tumca sxva strategiac misaRebia Tu saboloo amocana kargad iqneba Sesrulebuli. daavadebis xangrZlivi mimdinareobis SemTxvevaSi rezidentma unda daafiqsiros axali niSnebi, aseve xangrZlivoba, maprovocirebeli da Semamsubuqebeli faqtorebi. rezidentma unda SearCios SekiTxvebi da aRmoaCinos rogorc mniSvnelovani “plus” (igulisxmeba axlad ganviTarebuli simptomebi), aseve “minus” (romlebic an ar arian, an aRar arian) simptomebi. rezidentis mier Segrovili samedicino informaciiT Semfaseblisa da rezidentis mier SesaZlebeli unda iyos daavadebis bunebis dadgena.

b. pacientis gasinjvis unar-Cvevagardazogadigasinjvisa, TiToeulisferosgamokvlevisasrezidentiundaiTvaliswinebdespacientisproblemebsdaSesabamissferosufrodetalurSefasebasawarmoebdes, undaSefasdesrezidentisurTierTobapacientTan: xomariyouxeSi? tkivilisarsebobisasgaiTvaliswinagasinjvisasesTuara? sworadCaataragasinjva? xomargamotovagasinjvismniSvnelovanidetalebi? amoicnoTuaramniSvnelovaniniSnebi? sworadSeafasamaTiklinikuriRirebulebaTuara? gasinjvisasgaiTvaliswinaanamnezidaCivilebi, gasinjviTmiRebuliSedegebisanalizisSemdegdasvaTuaradamatebiTikiTxvebi?Sefasebuli unda iqnes rogor Seafasa rezidentma laboratoriuli da instrumentuli gamokvlevevis Sedegebi da ramdenad daexmara isini diagnozis dasmaSi. Ra damatebiTi gamokvlevebis Catareba miiCnia saWirod,

rogoria misi strategia pacientis Semdgomi gamokvlevisa da mkurnalobis TvalsazRisiT.gasinjvis damTavrebis Semdeg rezidents da Semfasebels unda hqondes naTeli warmodgena paTologiuri procesis Sesaxeb. miRebuli Sedegebi unda eTanxmebodes pacientis anamnezur monacemebs.

g. profesionalizmi da konsultirebis unaripacientTan da mis ojaxTan efeqturi komunikaciis unari erT-erT mTavar kompetencias warmoadgens. efeqturi komunikacia aris mkurnalobis procesSi Zalian saWiro pacient-eqimis kavSiris Camoyalibebis safuZveli. Sefasebisas unda dadgindes ramdenad Seiswavla rezidentma es kompetencia.Sefaseba iwyeba rezidentis pacientTan SexvedriT.komunikacia gulisxmobs rogorc verbalur, aseve araverbalur urTierTobas. unda dadgindes ramdenad moaxerxa rezidentma gasinjvis dros urTierToba pacientTan.rezidenti sensitiuri unda iyos eTikuri, kulturuli da religiuri sakiTxebis mimarT. unda Sefasdes rezidentis dialogi pacientsa da mis ojaxTan. ramdenad komfortuli iyo es dialogi ojaxisaTvis? Camoyalibda Tu ara pozitiuri ganwyoba? moeqca Tu ara pativiscemiT pacientsa da mis ojaxs? xom ar iyo uxeSi, imperatiuli? ahyva Tu ara pacientis an ojaxis komentarebs? bolomde moTminebiT moismina kiTxvebze pasuxebi Tu ara? Tu kiTxva gaugebari iyo ojaxisa da pacientisaTvis, gaimeora an Secvala kiTxvis forma ufro gasagebi rom gamxdariyo Tu ara? auxsna gasagebad gasinjvis Sedegebi da SesaZlo daavadeba Tu ara?

d. prezentaciaunda Sefasdes rezidentis mier pacientis SemTxvevis moxsenebis da ganxilvis unari.

e. saboloo Sefasebasaboloo Sefaseba emyareba zemoT aRwerili oTxi komponentis Sedegebs. klinikuri unar-Cvevis dadebiTi SefasebisaTvis rezidentma unda daimsaxuros minimum 5 qula TiToeul kompetenciaSi. qvemoT mocemulia Sesafasebeli formebi oTxive sferosTvis.

cxrili@# 10anamnezis Segrovebis Sesafasebeli formaQqula anamnezis Segrovebis unaris Sefasebis kriteriumebi10 gansakuTrebu

lianamnezi Segrovda unaklod.

9 saukeTeso anamnezSi aris Zalian umniSvnelo defeqtebi an uzustoba

8 Zalian kargi anamnezSi aris mcire defeqtebi an uzustoba7 Kargi anamnezSi aris defeqtebi an uzustoba, magram

monacemebi sakmarisia SemTxvevis formulirebisTvis6 mosazRvre,

magram anamnezSi aris iseTi defeqtebi an uzustoba, ris gamoc daikarga informacia

miuRebeli5 Aaradamakma

yofilebelianamnezSi aris iseTi didi defeqtebi an uzustoba, ris gamoc daikarga mniSvnelovani informacia

4 Cudi gamotovebulia anamnezis ZiriTadi nawili, ris gamoc SemTxveva Sefasda araadekvaturad

3 Zalian cudi anamnezis Sekreba imdenad cudad moxda, rom rezidentma ver gaacnobiera SemTxveva

cxrili # 11pacientis gasinjvis da gamokvlevis Sedegebis interpretaciis Sesafasebeli formaqula Ppacientis gasinjvis da gamokvlevebis Sedegebis

interpretirebis Sefasebis kriteriumebi10 gansakuTrebu

liPpacientis gasinjvis da gamokvlevebis Sedegebis interpretireba Sesrulda unaklod

9 saukeTeso Sesrulda Zalian umniSvnelo defeqtebiT an uzustobiT8 Zalian kargi mcire defeqtebi an uzustoba 7 kargi Aarsebobda rigi defeqtebi an uzustoba magram inaxa

sakmarisi monacemebi SemTxvevis formulirebisTvis6 mosazRvre,

magram miuRebeli

iseTi defeqtebi an uzustoba, ris gamoc daikarga informacia

5 aradamakmayofilebeli

iseTi didi defeqtebi an uzustoba, ris gamoc daikarga mniSvnelovani informacia

4 cudi gasinjvisas da gamokvlevis Sedegebis ganxilvisas gamorCa ZiriTadi nawili, ris gamoc SemTxveva Sefasda araadeqvaturad

3 Zalian cudi Ggasinjva da gamokvleva imdenad cudad Catarda rom rezidentma ver gaacnobiera SemTxveva

cxrili # 12profesionalizmisa da konsultirebis unaris Sesafasebeli forma

qula profesionalizmisa da konsultirebis unaris Sefasebis kriteriumebi

10 gansakuTrebuli

efeqturi komunikaciis unar-Cvevebi da pacient-eqimis urTierToba

9 saukeTeso umniSvnelo problemebi komunikaciasa da pacient-eqimis urTierTobaSi

8 Zalian kargi mcire problemebi komunikaciasa da pacient-eqimis urTierTobaSi

7 kargi problemebi komunikaciasa da pacient-eqimis

urTierTobaSi, magram urTierTgagebis SenarCuneba 6 mosazRvre,

magram miuRebeli

problemebi komunikaciasa da pacient-eqimis urTierTobaSi, ris gamoc urTierTgageba mosazRvrea an ar aris kargi


didi problemebi komunikaciasa da pacient-eqimis urTierTobaSi, urTierTgagebis SeuZlebloba

4 cudi didi problemebi komunikaciasa da pacient-eqimis urTierTobaSi, uxeSoba an usiamovneba

3 Zalian cudi komunikacia da pacient-eqimis urTierToba imdenad cudi iyo, rom saWiro gaxda gamomcdelis Careva

cxrili #13prezentacia/formulirebis Sesafasebeli formaqula prezentacia/formulirebis unaris Sefasebis kriteriumebi10 gansakuTrebu

liar aris deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi

9 saukeTeso erTi mcire (meorexarisxovani) deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi

8 Zalian kargi ori mcire (meorexarisxovani) deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi

7 kargi ramdenime (cota) mcire an erTi didi deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi

6 mosazRvre, magram miuRebeli

ramdenime (bevri) mcire da ori didi deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi, gamorCenilia calkeuli sakiTxi


ramdenime didi deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi, gamorCenilia ramdenime sakiTxi

4 cudi ramdenime didi deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi, monacemTa Sejameba gaugebaria

3 Zalian cudi mravali didi deficiti anamnezis da gasinjva/gamokvlevis sakvanZo monacemebis aRweraSi, monacemTa Sejameba gaugebaria

cxrili #14saboloo gamocdos Sefasebis formaqula/ aradamakmayofilebeli damakmayofilebeli

kompetencia 3 4 5 6 7 8 9 10anamanezis Segrovebis unarigasinjva da gamokvlevebis Sedegebis interpretaciaprofesionalizmisa da konsultirebis unariprezentacia/formulirebis unari

j a m i

saerTo Sefaseba: aradamakmayofilebeli/damakmayofilebeli (markeriT aRiniSneba Sesabamisi)gamomcdelis komentari:--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------gamomcdelis xelmowera -------------------------------------------------rezidentis xelmowera --------------------------------------------------TariRi -------------------------------------

amrigad, zepiri gamocdis maqsimalur qulaTa jamia 40. Tu rezidenti vermoagrovebs qulaTa 2/3-s barieri ar CaiTvleba gadalaxulad. rezidents eZleva saSualeba araumokles 3 Tvis vadisa, modulebis damatebiT gavlis gareSe xelaxla Caabaros zepiri gamocda.

damatebiTi aqtivobis Sefasebarezidentis Yyvela damatebiTi aqtivoba – klinikaSi arasavaldebulo morigeoba, adgilobriv da saerTaSoriso konferenciebze monawileoba, saswavlo procesis ganmavlobaSi gamoCenili misTvis da sxva rezidentebisaTvis sasargeblo iniciativa da sxv. Sefasdeba maqsimum 10 kredit quliT.aRniSnuli Sefaseba xdebarezidenturis xelmZRvanelis da sxva rezidentebis mier.cxrili # 15 rezidentis jamuri Sefasebis formarezidentis saxeli, gvari ---------------------------------------------------------------------------------

M qulaTa maqsimaluri raodenoba

rezidentis Sefasebis Sedegad miRebuli qulebi

I da II wlis modulebis Sefaseba

40

Ffinaluri gamocdis weriTi nawilis Sefaseba

10

Ffinaluri gamocdis zepiri nawilis Sefaseba

40

damatebiTi aqtivobis Sefaseba

10

jamuri Sefaseba 100

rezidenturisxelZRvaneli ------------------------------------------------- / gvari, saxeli, wodeba / xelmowera

rezidentis xelmowera -------------------------------------------------- TariRi --------------------------------

finaluri gamocdis warmatebiT Cabarebis Semdeg rezidents eZleva diplomisSemdgomi mzadebis damadasturebeli mowmoba, rac misi saxelmwifo sasertifikacio gamocdaze daSvebiis sawindaria.

PSefasebis Sedegebis gaTvaliswinebiT program-xelmZRvanelis Semdgomi aqtivobebi:

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