Актуальность. Около 75 % населения мира из более 100 стран не имеют надлежащего лечения сильной боли из-за ограниченной доступности опиоидных анальгетиков (ОА), которые являются жизненно необходимыми лекарственными средствами (ЛС) при лечении сильного болевого синдрома и оказании паллиативной помощи (ПП). Целью исследования было изучение факторов, влияющих на доступность ОА для осуществления адекватного обезболивания паллиативных пациентов на основе анализа международных и отечественных литературных источников. Материалы и методы. Поиск литературы осуществлялся в базах данных Pubmed, Google scholar и Национальной библиотеки Украины имени В. И. Вернадского. Результаты. Проблема доступности ОА является мультифакторной и обусловлена преградами, аналогичными во всех странах, в том числе и в Украине. Среди них: низкий приоритет проблемы облегчения боли в системе здравоохранения и низкая осведомленность среди медицинского персонала; значительно преувеличенные опасения относительно возможности развития привыкания и побочных реакций при приеме ОА; чрезмерные ограничения, введенные национальными органами по контролю за указанными препаратами; ограниченный ассортиментом этих лекарственных средств, очень низкое количество аптек, осуществляющих их реализацию, а также высокая цена опиоидов.

The State Budget of Ukraine in 2021 is 159,2 billion UAH. It is 36.8 % more than in 2020, but this amount is still insufficient to cover all the healthcare needs in Ukraine. Economic hardships, the lack of funds in the healthcare system of Ukraine, as well as COVID-19 pandemic have increased the importance of Health Technology Assessment (HTA) as a tool of cost optimization. The introduction of hospital-based HTA along with national / regional HTA allows providing the use of effective, safe and economically justified health technologies that will give our citizens the access to treatment and the rational use of funds, in particular the budget ones. Aim. To analyze the world experience of using hospital-based HTA and its main differences from national / regional HTA. Materials and methods. The scientific information of international and domestic literary sources was analyzed. The methods of content analysis, historical, system-analytical and generalization were used during the research.Results. The authors reviewed the literature in Pubmed and Google Scholar databases devoted to the international experience of hospital-based HTA and its main differences from national / regional HTA. It has been determined that the transfer of the national / regional HTA results to the hospital level is hindered by a number of differences between the country as a whole and hospitals in particular. These include, first of all, features related to demographic indicators, epidemiology of diseases, the level of resistance, local approaches to treatment, various types of equipment used in hospitals, and others. In order to have practical benefits, HTA must be built taking into account the peculiarities of a medical institution where the health technologies studied will be used in the future.Conclusions. The need of effective management of hospital resources when a number of health technologies is increasing, the desire to improve clinical outcomes, improve the quality of life and its expectancy using health technologies with the proven effectiveness and safety, the need to evaluate medical equipment and consider organizational aspects related to introduction of a health technology, as well as assess the current equipment and treatment methods require to develop the scientific and practical approaches to hospital-based HTA and recommendations on collaboration between national / regional and hospitalbased HTA in Ukraine.

The article explores the directions of contemporary Ukrainian sacral art in the work of the painter I. Zilinkо, his contribution to the development of sacred art of the temples of Ternopil region. The main directions of stylistic orientation in the formation of modern sacral art, the evolution of paintings from realistic tendencies of Ukrainian sacral painting of the seventeenth century to experiments with stylization of iconic figures in search of greater spirituality of the face, the introduction of our own modern iconography, based on tradition. The article explores the directions of contemporary Ukrainian sacral art in the work of the painter I. Zilinkо, his contribution to the development of sacred art of the temples of Ternopil region. Sacred art is the object of study of many scientists, historians, archivists, art historians, local historians, journalists. Among them, in particular, D. Stepovyk, M. Golubets, K. Moskalets, V. Sventsitska. However, the issue of the development of the modern sacred art of Ternopil region (1990–2018) requires additional study. The purpose of the article is to highlight the main directions in the work of Igor Zilinka, to specify the formation of the sacral and artistic environment of the churches of the city of Ternopil, to study the temples with modern interiors, to analyze the observance of traditions in icon painting and the search for modern aesthetic forms. After the revival of the Ukrainian Church, the construction of new temples began. The construction of churches led to the search for masters who could carry out their interior decoration. Famous Ternopil painter Igor Zilinko has become a “sacred” artist who has been successfully working in this field for many years. One of the first works of Igor Ivanovich was the decoration of the church of the Sacred Heart of Christ in the village of Veluky Gai, Ternopil district (1920). The murals of the church are classic paintings that date back to the works of the famous master of Ukrainian icon painting of the seventeenth century Ivan Rutkovych. It is the only church that reflects the realistic trends of Ukrainian sacral painting of the seventeenth century. Here the traditions of folk art are combined with creative bold search for new content and form. Next was the work on painting the temples in the villages of Petrykiv, Pronyatin, Kupchintsy, in the Ternopil region. On the initiative of Fr. Pavel Repely, the parish priest of the church of the village of Petrykiv, the painter was oriented to the heritage of Byzantine-Ukrainian icon painting. It is the first church in the Ternopil region that depicts the Eastern traditions of icon painting. Igor Zilіnko later managed to form his own style in the contemporary Ukrainian icon, following the Byzantine iconographic tradition. Particularly noteworthy is the iconostasis created by Igor Ivanovich for the Cathedral of the Archangel Michael in Ternopil in 2007. The artist very responsibly approached the choice of plots, taking as a basis the traditional composition of Ukrainian iconostases. The author has preserved the foundations of Ukrainian church traditions and has reflected the saints of the Ukrainian Church. An interesting development in the decoration of the spatial environment of the temple is the Church of St. Sophia of the Wisdom of God in Ternopil. For the decoration of the church, the parish priest Fr. dr. Vitaliy Kozak invited the already known master of sacral painting Igor Ivanovich Zilinko, who at that time developed his own iconographic style. The figures of the saints are exaggerated, unnatural in height, reflecting the idea of an invisible celestial world, without a realistic image. Creativity of Igor Zilinko is one of the most striking pages of contemporary Ukrainian art culture, evokes joyful aesthetic experiences, encourages contemporaries to creative pursuits to create monumental images that combine tradition with the actual spiritual needs of modern society.

Despite the widespread recognition of the importance of opioid analgesics for the treatment of moderate to severe pain in oncology and in the palliative care in many countries the adequate pain relief and availability of opioids for medical purposes is still a problem. To analyze prescribing and use of opioids for palliative patients, the data of 43 patients treated by mobile palliative care teams in Western Ukraine have been collected. The results obtained have been compared with international guidelines of pain relief and use of opioids in palliative care. It was determined that 60.5% of patients consumed opioids for 44 days on average; more than half of cancer patients received morphine, usually at the end of life. Opiods prescribed for pain relief were: tramadol -to 48.8% patients, morphine or omnopon -to 39.5%; nalbuphine -to 9.3%; promedol -to 7.3%. Only one third of the patients administered opioids orally. Morphine drugs were received by 54.8% of cancer patients, an average daily consumption of morphine was 26.17 mg and the average duration of administration 9.82 days. Most patients received morphine and omnopon 2 or 3 times a day. Prescriptions of morphine started with a single injection of 10 mg of injection morphine (or 11.5 mg in the case of omnopon injection). A limited range of opioids and peculiarities of providing these medicines to patients in Ukraine restricted the application of pain relief in accordance with international guidelines: prescribing oral forms of opioids at first; introduction of opioids at fixed intervals of time; titrating the dose.

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