Vol 27 (2019): VOL 27, NO (2019)

Full Issue

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Articles
Duties, rights and activity monitoring of the head of a medical organization worldwide
Aksenova E.I., Khodyreva L.A., Dudareva A.A., Turzin P.S.
Abstract
The quality of medical care in a medical organization is largely determined by the effectiveness of its Head. The article looks at current regulatory acts, main factors of healthcare organization process in developed countries (France, Switzerland, Australia and South Korea) and methods for assessing the quality of health services. This work analyzes the world practice of appointment, functioning and activity effectiveness of the heads of healthcare system.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:517-521
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Senior management in Moscow healthcare: search for answers to urgent questions
Aleksandrova O.A., Yarasheva A.V., Aksenova E.I., Alikperova N.V., Nenakhova Y.S.
Abstract
The article is devoted to the topical issues of formation and postgraduate training of senior management in Moscow healthcare. The authors conducted an expert survey based on developed research methodology, which included qualitative sociological methods. It was done in the form of a series of in-depth structured interviews with heads of Moscow healthcare medical organizations (adult and children outpatient clinics, hospitals), as well as with top executives of the institutions of postgraduate professional training.Research results allowed the authors to postulate the following key questions: 1) Who should head a medical institution - a clinician or a manager?; 2) What management skills should a top executive of a medical organization possess?; 3) What advantages and disadvantages does a postgraduate training system of senior management have?; 4) What is the procedure of a top management pool formation?Results analysis showed that the key problems are still acute. Problems revealed in 2016-2017 are still to be solved in 2019. They concern formation of manager competencies for healthcare top executives, forms and topics of postgraduate professional training. The article defines the competences which medical managers miss and possibilities of their obtaining by means of postgraduate professional training and professional requalification.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:522-528
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Deliberate medication poisoning in adolescence as a medical and socially significant problem
Afukov I.I., Dolginov D.M., Ipatova M.G., Kovalenko A.A., Buromskaya N.I.
Abstract
One of the urgent medical and social problems of modern society is the steady growth of auto-aggressive behavior and deliberate medication poisoning among adolescents and young adults. This investigation was held to optimize the provision of specialized medical care for acute deliberate self-poisoning in teenagers. We examined 498 patients admitted to the Toxicology Department of N. F. Filatov Children City Clinical Hospital No. 13 with a diagnosis of acute deliberate medication poisoning. The diagnosis was confirmed by chemical and toxicological urine test using thin-layer chromatography. From 2016 to 2018 the number of patients with deliberate medication poisoning increased by more than 2.5 times and amounted to 236 cases. Female patients were prevalent and accounted for up to 85% of cases. The leading position among medication self-poisoning is held by psychopharmacological drugs at 56%, in second place are non-steroidal anti-inflammatory drugs at 18.5%. The main causes of self-poisoning were social or family conflicts (47%), problems at school (35%), and Internet-related complaints (18%). The clinical manifestations of the disease in the acute period of chemical poisoning depended on the toxic agent and the dose taken. Psychological testing revealed a high level of neuroticism in 71% of adolescents, severe anxiety was observed in 57% of patients, and depression was diagnosed in 28% of cases. All patients were provided specialized medical care, including resuscitation, detoxification, and psychiatrist examination. Based on the accumulated clinical experience, an algorithm for managing adolescents with deliberate medication poisoning has been developed, which has reduced the number of repeated suicides by 1.8 times.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:529-535
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Art therapy in treatment, rehabilitation, microand macrosocial adaptation of children with autism spectrum disorders by means of a special rehabilitation and adaptation program “Art therapy (drama therapy): ‘Because You are Needed...’ for children with general disorders of psychological development and other mental disorders”
Bebchuk M.A., Khodyreva L.A., Basova A.Y., Dovbysh D.V., Dzhavadova E.I., Konshina E.E.
Abstract
For the first time, the effectiveness of art therapy (drama therapy) in children with mental disorders has been studied on substantial clinical data. Psychotherapeutic work involved certain form of drama therapy that included patients watching Moscow theaters performances and then discussing them with family and in group therapy sessions with psychologists. Researchers have developed drama therapy methods for children with mental disorders, determined indications and contraindications for this treatment. The study shows effects of art therapy on the child adaptation to the conditions of the micro-social environment, particularly on his family adaptation, formation of harmonious, supportive, rehabilitative family relations. It is noted that art therapy influences adolescent's adaptation to the conditions of the macrosocial environment, particularly his adaptation in a peer group, behavior in various situations and formation of normal behavioral patterns in different environmental conditions.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:536-542
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“Our Patient - Our Citizen”
Berezkin A.S., Popova E.M., Chernyaev M.I., Pankevich A.A.
Abstract
The study conducted in the framework of “Our Patient - Our Citizen” Project has examined methods and possibilities of rehabilitating mentally ill people who were prone to anti-social behaviors and have been committed to involuntary treatment. The research has introduced the criteria for identifying patients with high rehabilitation potential. The work has described methods and possibilities of their rehabilitation in hospital (training psychological programs, ergotherapy, art therapy, occupational therapy, etc.) and analyzed possibility of their outpatient implementation. Concrete examples of such successful rehabilitation have been considered. Financial value was determined.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:543-551
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Four “Big” Stereotypes on Nurses in Mass Consciousness: on the Materials of the Moscow People Opinion Analysis in Social Media
Bogdan I.V., Gurylina M.V.
Abstract
Staffing problems (including staff shortage) in nursing reveal the connection with the stereotypical perception of the profession. The study of stereotypes was limited to Moscow healthcare and was based on downloading messages from social media (31,613 posts), the relevance of their study is determined by the growth of social media influence on public opinion. 24% of messages about nurses in the sample contain “large” stereotypical images (excluding spam). It was studied four “large” stereotypical images of a nurse: “guardian angel”, “doctor's assistant”, “authoritarian nurse” and “sensual nurse”, and each one has negative aspects. Authors considered the specific perception of each of the images in social media. The remaining 76% of messages do not offer an alternative image of a nurse. The conclusion offers recommendations aimed at increasing the prestige of the profession: creating a new positive image of the profession, promoting it, encouraging nurses to join public space and increasing their autonomy.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:552-558
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Multiparametric magnetic resonance imaging markers of clinically significant prostate cancer
Goncharuk D.A., Veliev E.I., Loran O.B., Paklina O.V., Setdikova G.R., Shabunin I.V., Sokolov E.A.
Abstract
Authors aimed to assess the correlation between the apparent diffusion coefficient (ADC of the tumor, ADC ratio) and final grade group (GG) after radical prostatectomy (RP), and to determine the threshold values of ADC for detecting clinically significant prostate cancer (PC) with subsequent evaluation in a prospective group. 118 patients with PC were included in the retrospective group. These patients underwent RP from 2012 to 2017 with preoperative 3 Tesla multiparametric MRI (mpMRT) with contrast enhancement in a single center. After analyzing all the MRI studies, the average values of tumor ADC and benign tissue ADC were calculated using the maps of ADC. The prospective part of the study included 60 patients with completed pre-biopsy mpMRI and subsequent RP from January 2018 to March 2019. The prospective part of the study demonstrated the effectiveness of applying the obtained diffusion coefficient thresholds. When used as a criterion for determining clinically significant prostate cancer (GG > 6), threshold value of ADC ratio had sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84%, 91%, 87%, 94% and 78% respectively.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:559-564
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New Technologies in the Diagnostics and Treatment of Brain Deseases: from Neurosciences to the Multidisciplinary Clinical Practice and Maintaining of Mental Health
Gulyaeva N.V., Akzhigitov R.G., Gersamiya A.G., Druzhkova T.A., Gekht A.B.
Abstract
Over the past years, the prevalence of brain diseases and, consequently, their social significance and economic burden for society has been steadily increasing throughout the world. Brain diseases are a heterogeneous group of diseases that unite a number of disorders that are within the competence of both neurology and psychiatry, often concurrent or comorbid with each other. Z. P. Soloviev Research and Clinical Center for Neuropsychiatry is a leading medical organization in Moscow, which performs a full treatment cycle, studies the data and has postgraduate training programs in this field of medicine. It is conducting a number of relevant research programs; some in collaboration with international clinics. This study deals with the following programs: fundamental aspects of depression and stress-reactivity, suicidal and self-damaging behavior, usage of biofeedback and gravity therapy in rehabilitation and training programs for medical workers in successful communication.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:565-577
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Regulatory Support for Monitoring the Effectiveness of Medical Managers
Dudareva A.A., Aksenova E.I., Khodyreva L.A., Turzin P.S., Bogdan I.V., Lukichev K.E.
Abstract
Authors considered the issue of regulatory support for dynamic control methodology concerning the performance efficiency of a head (head physician) of the medical organization of Moscow healthcare system. The regulatory framework for assessing the performance of managers in the public healthcare management system is described. The indicators for assessing the execution effectiveness of the state program “Development of Healthcare in the Russian Federation” and Moscow program “Development of Healthcare in Moscow (Capital Health)” are given. Authors analyzed recommendations of the federal executive authorities on the development of performance indicators of social organizations, as well as experience of their implementation by the constituent entities of the Russian Federation. Proposals to improve the system for assessing performance efficiency of head managers of medical organizations were developed.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:578-586
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Surgical Short Stay Unit at a Metropolitan Children’s Hospital
Korochkin M.V., Kravchuk S.V., Poddubnyj G.S., Sumarokova E.V., Tarusin D.I.
Abstract
Currently, the development of day care hospitals is determined by the need to improve medical, social and economic efficiency of medical institutions, and high demand among population for this type of medical service. Our foreign colleagues’ experiance shows that the volume of planned surgical care in such structural units reaches 80%. The article analyzes the results of the Surgical Short Stay Unit at the Moscow Morozov children’s hospital. From February 2017 to December 2018, 5684 surgical interventions were performed in the Department, 1073 of them were performed via the laparoscopic method in patients with inguinal hernias, varicocele, and non-palpable testicular syndrome. The length of patients’ stay at the hospital averaged 6-8 hours. A unique algorithm of anesthetic support using 2-lumen laryngeal masks without muscle relaxants and narcotic anesthetics was performed. Only 1 patient needed to be transferred to a 24-hour hospital from the Unit. There were no surgical complications. The organization of the short stay unit in Morozov Moscow Children’s Hospital allowed to radically improve the availability of minimally invasive modern medical care for children, to free highly specialized round-the-clock surgical beds, and to increase economic benefits for the medical institution.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:587-593
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Modern Approach and Successful Experience of Conservative Treatment of Infantile Hemangiomas with Non-Selective Beta-Blocker Propranolol
Kotlukova N.P., Osmanov I.M., Konstantinova N.K., Trunina I.I., Lavrova T.R., Karelina E.V., Grishkin A.N., Mosin I.M.
Abstract
The article deals with the actual problem of modern treatment of infant hemangiomas. The accumulated 10-year experience of using propranolol in 512 patients has shown its effectiveness and safety. The team of authors developed a protocol for managing patients with infantile hemangiomas of various localization at all stages of treatment. Special attention was paid to the cardiological aspect of patient monitoring using modern methods of instrumental diagnostics. Due to the clear application of the created protocol with the use of ultrasound control, in most cases, it was possible to achieve complete cure of this pathology, minimize incidence of undesirable effects and avoid the formation of relapses (rebound effect). The effectiveness of the developed algorithm of diagnosis and treatment is confirmed by both clinical results and the results of instrumental examinations.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:594-597
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Persistant dysfunction of the eustachian tube: solving the problem
Kryukov A.I., Kunelskaya N.L., Tsarapkin G.Y., Garov E.V., Ivojlov A.Y., Sidorina N.G., Sudarev P.A., Panasova (.A., Morozova Z.N., Gorovaya E.V.
Abstract
Each person experienced an unpleasant sensation of congestion of the ear during a flight or in rhinorrhea, which is caused by dysfunction of the Eustachian tube (ET). People with persistent ET dysfunction live with this sensation for months and years. Persistent ET dysfunction in children reaches 40%, in adults it is up to 5%. Most of the pathological conditions of the middle ear, leading to socially significant hearing loss, and the main reasons for failures in hearing-improving operations are associated with persistent ET dysfunction.The effectiveness of various methods of treating this pathology, despite their large quantity, still remains doubtful due to the lack of clear criteria and golden standard for diagnosis, indications for specific methods and long-term results of treatment. According to the aim of the study a diagnostic and treatment algorithm was developed for persistent ET dysfunction in adults and children.We researched this problem for more than 10 years, and the effectiveness of the proposed diagnostic and therapeutic measures has been statistically proven, both by a large sample of patients and by a long period of observation.Researchers of L. I. Sverzhevsky Research Institute of Otorhinolaryngology have developed a diagnostic algorithm for persistent ET dysfunction, optimized the treatment of persistent dysfunction and recurrent concomitant secretory otitis media, and also determined the indications and methods for conducting ET balloon dilatation in adults and children with persistent ET dysfunction. We improved the functionality results of hearing-improving operations (tympanoplasty) in patients with persistent ET dysfunction.All of the above allowed us to reduce the treatment time for this group of patients by up to 50%, to achieve high clinical efficacy in up to 100%, and to obtain a lasting functionality in hearing-improving operations in 93% of cases.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:598-607
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Unique Experience of Cherubism Targeted Therapy
Kugushev A.Y., Lopatin A.V., Yasonov S.A.
Abstract
The family form of giant cell reparative granuloma or cherubism is a rare benign lesion of the jaws which causes face deformation reminiscent of the cherubs portrayed in Renaissance art. Radical surgery, especially in children before puberty, is impossible or irrational, because it leads to disablement. For four years, a child with cherubism was undergoing an outpatient supervision in the Department of Maxillofacial Surgery in Russian Children Clinical Hospital. During the observation period it was noted that tumor masses were slowly progressing leading to exoorbitism. The child had a diagnosis histological verification; a treatment using human monoclonal antibodies to RANKL was developed, adapted and approved by the ethical committee. The clinical effect was observed from the third month of therapy - jaws corners sharpened, the volume reduced. The control biopsy material taken at the end of the 6-month course did not reveal any giant cells which meant complete pathomorphism. Computed tomography showed that at the end of the therapy bone density increased by 6-7 times in the affected zones and was additionally growing over the next 6 months of observation. Such dynamics allowed making effective contouring surgery of excessive bone tissues. Inoperable and early stages of cherubism require a combined treatment which includes a course of monoclonal antibodies followed by alendronic acid therapy that increases osteoblasts survival. After the treatment, if it is necessary to improve the appearance, contouring surgery of excessive bone tissue is performed
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:608-622
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Moscow screening: breast cancer screening with mammography as a method of improving early stage cancer detection
Morozov S.P., Vetsheva N.N., Ovsyannikov A.G., Ledihova N.V., Panina E.V., Polishchuk N.S., Puchkova O.S.
Abstract
A list of organizational, management, and clinical steps that are crucial for creating an effective breast cancer screening program as part of the state medical benefits scheme in Moscow is presented. We identified key performance indicators for each stage of the screening program. Performance of radiologists and radiology technicians was evaluated, including assessing the accuracy of both single and double reading of mammograms. We streamlined an efficient system for patient routing between the stages of the screening program and developed methodological materials for patients and medical specialists. A shortened structured protocol for mammography interpretation, including second reading, was created in compliance with terms of Moscow Compulsory Medical Insurance Fund. We conceived a framework of educational activities to assess and improve skills and knowledge of radiologists and other specialists participating in the screening.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:623-629
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Moscow Screening: Lung Cancer Screening With Low-Dose Computed Tomography
Morozov S.P., Kuzmina E.S., Vetsheva N.N., Gombolevskiy V.A., Lantukh Z.A., Polishuk N.S., Laipan A.S., Ermolaev S.O., Panina E.V., Blokhin I.A.
Abstract
For the first time in Moscow and Russia, a program of selective lung cancer screening has been implemented with a comprehensive approach, including organizational, management, medical, technical and educational aspects and quality control. Unique ultra-low-dose protocols (ultra-LDCT) have been developed to implement the screening program. These protocols allow performing high-quality chest computed tomography for lung nodule detection with an effective dose of less than 1 mSv. The possibility of using neural networks (“artificial intelligence”) for quality control of screening results has been proven for the first time.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:630-636
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Natural Childbirth after the Previous Caesarian Section is a Solved Problem
Papysheva O.V., Esipova L.N., Radzinskiy V.E., Startseva N.M., Vuchenovich Y.D., Kotaysh G.A., Gagaev C.G., Semenov P.A.
Abstract
Тhe rapid increase in the frequency of сesarian section (CS) observed in recent years (up to 60% in some countries) is alarming and reduces the reproductive potential of the population. The operated uterus remains the main indication for CS (up to 40%). This is the factor which may allow reducing the frequency of the CS by subsequent delivering through the birth canal.A comparative analysis of maternal and neonatal outcomes enabled the authors to develop a two-stage delivery technology for patients with a caesarean scar, including the usage of the programmed delivery method. The presented algorithm confirmed the validity of vaginal delivery in such patients, and reduced the number of complications up to 4 times. Neonatal morbidity in children born through the birth canal in such patients was comparable to physiological birth.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:637-642
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Permanent Cardiostimulation Training Course - from Simple to Complex. Patient Management and Electrocardiographic Diagnosis
Pervova E.V.
Abstract
The article deals with methods of treating patients with bradyarrhythmias, life-threatening tachyarrhythmias and chronic heart failure with the use of implantable antiarrhythmic devices permanent pacemakers, cardioverter defibrillators, and cardio-resynchronizing systems. Methods of instrumental and electrocardiographic diagnosis acceptable for such patients are described. The work defines management approaches to these patients in the postoperative and subsequent periods of life.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:643-652
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Formation and Unique Experience of the Center For the Treatment of Cerebrovascular Pathology in Children and Adolescents Located in a Multidisciplinary Pediatric Hospital, as the Only Primary Center of Pediatric Stroke in the Russian Federation
Petryaykina E.E., Shcherderkina I.O., Vitkovskaya I.P., Livshits M.I., Drozdova I.M., Svirin P.V., Gorokhov D.V., Kharkin A.V., Gorbunov A.V., Kessel A.E.
Abstract
Stroke is in the top ten causes of children death, ahead of brain tumors. Х-ray diagnostics development has significantly improved the detectability of pediatric stroke. The average incidence of cerebrovascular diseases in children was 13 per 100,000 children annually. The main feature of children's stroke is its multifactorial character, which complicates diagnostic process and requires involvement of doctors of different specialties to determine the leading etiological factors and choose optimal therapy and management tactics. The Center for the Treatment of Cerebrovascular Pathology in Children and Adolescents was established on the basis of Morozov Children City Clinical Hospital by Moscow Healthcare Department, Order No. 169, dated February 27, 2014. The main task was to create a pediatric stroke center on the basis of multidisciplinary Morozov Children City Clinical Hospital, which met the main international requirements of the primary center for pediatric stroke. It was done to improve early diagnostic process, refine the algorithm for maintaining patient data in acute periods, develop preventive measures, maintain city pediatric stroke register, introduce family consultations, coordinate medical care for children with cerebrovascular pathology at various levels in Moscow, and improve medical care quality for children with cerebrovascular pathology and their families. Since April 2014 more than 800 children have undergone inpatient treatment and more than 420 have been treated in outpatient departments of Morozov Children City Clinical Hospital.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:653-666
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Medical Rehabilitation after Hydronephrosis Surgical Treatment in Children
Pogonchenkova I.V., Khan M.A., Novikova Y.V., Mikitchenko N.A.
Abstract
The article presents modern technologies of medical rehabilitation of children operated for hydronephrosis. The importance of medical rehabilitation of children with hydronephrosis is associated with high incidence, possibility of developing chronic kidney disease, and early disability of these patients.After surgery on the ureter it is important to use medical rehabilitation technologies aimed at preventing urodynamics disorders of upper and lower urinary tract, and at stimulation of regenerative processes. In recent years, particular attention has been paid to high-intensity pulsed electromagnetic field therapy, which has a more significant and long-term stimulating effect compared to various types of electrical stimulation.Clinical studies were conducted in 80 children operated for hydronephrosis, aged 3 to 15. The main group consisted of 40 children who received high-intensity pulsed magnetic therapy, and 40 children were included in the control group (without physiotherapy). Basic treatment included uroseptics and exercise therapy.Effectiveness of the method was assessed using clinical, laboratory and ultrasound data, and Doppler ultrasound of the renal blood flow. The results of the study demonstrated the rationale of including high-intensity pulsed electromagnetic field therapy in medical rehabilitation of children operated for hydronephrosisThe positive effect of high-intensity pulsed electromagnetic therapy on the urodynamics of the urinary tract (reduction in the size of renal pelvis and calyx) and renal blood flow (restoration of blood flow to the renal cortex) were revealed. This method helped to reduce inflammation in the renal parenchyma (reduction of proteinuria, leukocyturia) in children operated on for hydronephrosis.A significantly higher effectiveness of medical rehabilitation with the use of high-intensity pulsed magnetic therapy was proved (87.5%).
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:667-670
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Myocardial ischemia in patients with hypertrophic cardiomyopathy
Poteshkina N.G., Kovalevskaya E.A., Krylova N.S., Fettser D.V.
Abstract
Authors present is comprehensive clinical and instrumental evaluation of patients with HCM with myocardial ischemia. 104 patients (38.4% of men) with HCM were examined, mean age 58.2±14.7. The examination included risk factors assessment for CAD, ECG, Echo, stress ECG test, 24-hour ECG monitoring. In the presence of myocardial ischemia, CAG (n=66) and MSCT of the coronary arteries (CA) (n=4) were performed. All patients were split up on 2 groups: I - 70 HCM patients with myocardial ischemia, 67.3%, and II (the control group) - 34 HCM patients without myocardial ischemia, 32.7%. The group I was divided on 2 subgroups: 1 - 29 patients with coronary atherosclerosis (41.4%), 2 - 41 patient without coronary atherosclerosis (58.6%). Age (p=0.046), family history (p=0.037), higher systolic and diastolic arterial pressure, long-term arterial hypertension (p<0.05) were determined as significant risk factors for CAD. Smaller diameter of LAD (p=0.008), higher LV mass index, greater LV diastolic function disorder (p<0.05) were detected in group 2 compared to group II. The decrease in myocardial perfusion (MBG scale) was associated with high LV mass index and cardiac arrhythmias. The frequency of concomitant coronary atherosclerosis among HCM patients with myocardial ischemia was determined as 41.4%. Analysis of traditional risk factors for CAD in patients with HCM revealed the strong relation to age, aggravated by a family history of CAD, blood pressure level and duration of hypertension. Smaller diameter of LAD, higher LV mass index, greater LV diastolic function disorder were observed in HCM patients with myocardial ischemia without CAD.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:671-676
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Moscow program of early detection and treatment of prostate cancer
Pushkar D.Y., Govorov A.V., Vasilyev A.O., Kolontarev K.B., Prilepskaya E.A., Kovylina M.V., Sadchenko A.V., Sidorenkov A.V.
Abstract
The aim of this study is to improve the results of detection and treatment of patients with prostate cancer (PCa) in the Moscow. For this purpose, we performed our own clinical diagnostic, epidemiological, autopsy, experimental and comparative studies that emphasize the relevance of the stated subject in the study of the diagnosis and treatment of patients with PCa. Urology Department of A. I. Evdokimov Moscow State University of Medicine and Dentistry was at the forefront of the Men's Health program in Moscow and in early 2003 it was the first to have an office for early diagnosis of prostate diseases, as part of the Program. Over 20,000 patients were screened for PCa. For the first time in Russia, methods for the early detection of PCa were investigated on a cohort of Russian men using PCA3 and the Prostate Health Index. The role and significance of prostate saturation biopsy was examined. The investigation of aspects of the morphological assessment of prostate diseases formed the basis for the development of an electronic atlas of PCa images. A series of studies on various prostate visualization methods, including Histoscanning system and MRI, have been performed. A new minimally invasive method for the treatment of prostate cancer has been introduced - a robot-assisted radical prostatectomy and cryoablation. The concept of surgical treatment of localized forms of PCa has been developed and the factors predicting the success of treatment have been determined. This study is reflected in numerous publications both in Russia and abroad, in monographs and dissertations.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:677-686
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Minimally Invasive Technologies in Surgery of the Chest Wall in Children
Razumovsky A.Y., Alkhasov A.B., Mitupov Z.B., Savelieva M.S., Geodakyan O.S., Demakhin A.A.
Abstract
Today, in our country, as well as throughout the world, there is no single approach to the tactics of managing patients with deformations of the anterior chest wall. These patients constitute a large and heterogeneous group. The team acquired great experience in treating children with pectus excavatum and pectus carinatum, as well as a unique experience in the surgical treatment of pediatric thoracic outlet syndrome and sternum clefts. Now in the world there are a lot of surgical methods used for the correction of congenital deformities of the chest wall, however, the majority of them are extremely traumatic for the patient, and the postoperative scar often presents a minor cosmetic problem than the deformation itself. In addition, almost all methods require the use of expensive technologies, the patient’s long hospital stay and the use of potent drugs.As for the children with thoracic outlet syndrome and sternum clefts, these patients are extremely difficult in terms of timely diagnosis and surgical care, due to the fact that pediatric surgeons and pediatricians are very little aware of this pathology. The team of authors developed a number of techniques, based on the collaborative work of surgeons, anesthesiology and resuscitation specialists and pediatric services. They resulted in successful surgical correction of these malformations and gave patients the opportunity to lead a normal life.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:687-692
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Development and practical implementation of organ preservation surgery in case of placenta accreta in patients with a scar on the uterus
Savelieva G.M., Kurtser M.A., Breslav I.Y., Latyshkevich O.A., Grigoriyan A.M., Shtabnitsky A.M., Panina O.B., Sichinava L.G., Evteev V.B., Spiridonov D.S.
Abstract
Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary ‘devascularization’ of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity.The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well.Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section.The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:693-698
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Complex Program of Neurocognitive Rehabilitation for Elderly Patients Suffering from Mild Cognitive Impairment Syndrome in Medical Rehabilitation Department «Memory Clinic»
Savilov V.B., Pak M.V., Burygina L.A., Kurmyshev M.V., Korovin Y.V.
Abstract
The article introduces a complex program of neurocognitive rehabilitation into the system of dementia prevention in patients with mild cognitive impairment syndrome. It took about a year to prepare and form a complex program of neurocognitive rehabilitation (the Program). The researchers have also developed clear algorithms of the specialized medical rehabilitation unit Memory Clinic. The conducted study has proved the effectiveness of cognitive functions improvement in patients with mild cognitive impairment after participation in the Program in Memory Clinic. The authors, Professor Kostyuk, and Research Institute for Healthcare Organization and Medical Management have prepared Medical Rehabilitation Guidelines for Elderly Patients with Early Signs of Cognitive Deficits (Structural and Functional Model). The guidelines serve as a tool for practice distribution and transforming them into a project Memory Clinic.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:699-703
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Creating Organizational Conditions for Healthy Lifestyle Formation Among Population
Turzin P.S., Gurylina M.V., Aksenova E.I., Khodyreva L.A., Bogdan I.V., Chistyakova D.P.
Abstract
The key role in healthy lifestyle (HLS) formation among the population belongs to medical specialists, who possess reliable scientific knowledge in this field. The effectiveness of spreading healthy living message is connected with organizational conditions: principles of segmentation and patient routing, role of non-physician staff, development of remote forms of work and staff training system. Much attention is given to healthy living attitudes among medical specialists. According to the conducted sociological study and review of foreign and national experience, the authors present practical recommendations which include organizational changes aimed at greater effectiveness of HLS promotion by healthcare professionals.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:704-709
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Medical Errors: Medical, Social and Legal Aspects
Khodyreva L.A., Turzin P.S., Anikeev D.A., Lukichev K.E.
Abstract
The article examines the main types of medical errors and their causes. It systemizes typical iatrogenic diseases. The work defines leading directions for medical errors prevention, including the effective usage of simulation learning technologies. Authors analyze current regulatory acts and the main rule-making trends in the field of medical errors.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:710-714
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Development and implementation of Single Reference Laboratory Testing Directory, as the basis for the digitalization of the laboratory service of Moscow
Tsibin A.N., Latypova M.F., Strebkov V.G., Ivanushkina O.I.
Abstract
Authors considered the possibilities and limitations of EMIAS implementation in the laboratory service of the city of Moscow on the example of the development and implementation of an integrated Single Reference Laboratory Testing Directory (SRLTD). The article describes the analytical and methodological work performed to systematize the nomenclature when creating the directory. The advantages of SRLTD are assessed: new opportunities for further digitalization of the city’s laboratory service, streamlining of medical documentation, convenience in obtaining laboratory data from doctors and patients, and the expected economic effect.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:715-720
views
New combined endoscopic method of Zenker’s diverticulum treatment
Shishin K.V., Nedoluzhko I.Y., Pavlov I.A., Kurushkina N.A., Shumkina L.V.
Abstract
Endoscopic treatment methods are currently a priority in the treatment of patients with Zenker’s diverticulum. The optimal endoscopy should combine the positive aspects of traditional and tunnel technologies and be fairly simple from technical standpoint, the most radical and safe for the patient. This work evaluates the effectiveness of endoscopic cricopharyngeal esophagomyotomy using combined methods of treating patients with Zenker’s diverticulum. From June, 2014 to December, 2018 A. S. Loginov City Clinical Scientific Centre performed 30 surgeries using a new combined technique. The average surgery time is 37.5 minutes. No postoperative complications. Control X-ray examination has shown almost complete absence of the residual cavity of the diverticulum. The combined endoscopic method of treating patients with Zenker’s diverticulum allows to create conditions for preventing the recurrence of the disease, thereby ensuring the best result of treatment.
Problems of Social Hygiene, Public Health and History of Medicine. 2019;27:721-728
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