PRIMARY ACCREDITATION OF PREVENTIVE MEDICINE ALUMNI: EVALUATION OF PROFESSIONAL COMPETENCE TO ENSURE SANITARY AND EPIDEMIOLOGICAL WELL-BEING
O.G. Khurtsilava 1, A.V. Meltser 1, А.А. Pronina 2, Т.И. Aristova 2,N.V.Erastova 1, T.V. Samsonova 1 1North-Western State Medical University named after I. I. Mechnikov, Russia, 195015, Saint- Petersburg,Kirochnaya Street, 41. 2Federal Service for Supervision of Consumer Rights Protection and Human Well-Being, Russia, 127994, Moscow, Vadkovskiy pereulok, 18/5 and 7 3Russian Medical Academy of Postgraduate Education, Russia, 125993, Moscow,Barrikadnaya Street, 2/1 and 1 Abstract Introduction: The successful problem solving of Federal Service for Supervision of Consumer Rights Protection and Human Well-Being (Rospotrebnadzor) is impossible without a competent and highly professional specialists. In this regard, the formation of professional competences, as well as their evaluation within primary accreditation, are of a high importance. The aim of the study was to analyze the results of primary accreditation of preventive-medicine alumni with further development of its improvement. Materials and Methods: It were analyzed the results of the primary accreditation of 29 educational institutions preparing preventive medicine specialists. Results: It was observed the decrease in the number of alumni’s refusals to undergo the primary accreditation in comparison with 2017. The majority of alumni (97,3%) successfully underwent three stages of primary accreditation, taking into account all attempts. Educational institutions proposed measures for the optimization of the primary accreditation procedure, including: revision of the list of practical skills (skills); actualization of the test and simulation tasks database; as well as the expansion and enrichment with simulation tasks. Conclusion: In order to improve the primary accreditation procedure, it is necessary to revise the content of practical skills, update of test and simulation tasks database and their annual expert audit. Key words: preventive medicine, preventive medicine specialists, professional competence, Rospotrebnadzor, sanitary and epidemiological well-being, training of medical staff.
RISK-ORIENTED ASSESSMENT OF EPIDEMIOLOGICAL PREDICTORS OF INFECTIONS DEVELOPMENT AND PATIENT PHYSICAL STATE IN THE INTENSIVE CARE UNITS
A.S. Zakhvatova 1,2 ,M.G. Daryina 1,2, Y.S. Svetlichnaya 1,2, L.P. Zueva 1, B.I. Aslanov 1 ,A.V. Meltser 1 1North-Western State Medical University named after I.I. Mechnikov,, Russia, 191015, Saint- Petersburg, Kirochnaya Street,. 41. 2Medical Information and Analytical , Russia, 198095, Saint-Petersburg,Shkapina Street, 30
Abstract Introduction. Risk-oriented monitoring system of infection predictors in the intensive care units with simultaneous assessment of the patient’s physical state contributes to early detection of infectious complications. Materials and methods. In order to substantinate the necessity of implementation of modern information system it was conducted the analysis of the main risk factors of healthcare associated infections according to the data of 48 hospitals in Saint- Petersburg. Results. It is shown that the current information system does not correspond to the modern level of public health. Conclusion. The creation of specialized database of of intensive care patients allows to monitor the duration of exposure to risk factors and trace changes in patients’ condition in order to control timely the epidemic process of healthcare associated infections. Key words: intensive care unit, risk-oriented technologies, healthcare associated infections, monitoring of patient state.
HEALTH LITERACY: CONCEPT, CLASSIFIXATIONS, EVALUATION METHODS, PROMOTE MEASURES (Review)
K.R. Amlaev, H.T. Dahkil'gova Stavropol State Medical University, Russia, 355017, Stavropol, Mira Street, 310
Abstract: The present article is devoted to the problem of health literacy. The article considers classification, assessment methods and tests, scales and questionnaires used for the measurement of health literacy. It is described the consequences of low health literacy among population: a lack of understanding of the importance of screening, a lack of knowledge in medical terminology, the importance of treatment and regular visits to a doctor ,resulted in the necessity of measures development to promote health literacy. These measures included the provision of more reliable and easily accessible information, overall increase of health literacy, training of medical personnel to communicate with patients in respect to individual characteristics. Special attention is paid to the role of the mass media in the promotion of health literacy among the population. Key words: health literacy, literacy rates, low literacy, social media, quality medical care.
ADVANCED TECHNOLOGY OF STANDARDS OF PRIMARY HEALTH CARE BASED ON REHABILITATION EFFECTIVENESS ANALYSIS IN PATIENTS WITH DEGENERATIVE DISC DISEASES
Yu.A. Kreneva 2, V.P. Panov 1,2, M.V. Avdeeva 1,V.N. Filatov 1, M.A. Kroshilina1 1North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya Street,41 2City polyclinic №14, Russia, 194021, Saint-Petersburg, Myrinskii Prospect, 35 Abstract. Introduction. Insufficient effectiveness of rehabilitation of patients with degenerative spine diseases is a topical medical and social issue, whereas the improvements of standards of primary health care allow to promote the approaches to quality control of primary health care in rehabilitation departments. Material and methods. The analysis of the rehabilitation effectiveness was carried out based on the results of a two-fold dynamic clinical and instrumental examination of 200 patients with degenerative spine disease. It were studied 200 patients aged 56.0±17.7 years. The integral indicators of the rehabilitation effectiveness were calculated for each of 51 treatment regimen. The integral efficiency index was calculated for each patient individually, depending on the used treatment regimen. Results. Averagely, the rehabilitation treatment regimen included 3.7±0.8 recreational components. Frequently, patients were assigned a three-component regimen of rehabilitation treatment, consisting of therapeutic physical training, massage and laser therapy (15.0%). However, the most effective was the three-component regimen included a combination of therapeutic physical training, mud therapy and ultrasound therapy (integral efficiency coefficient - 117.00±13.61 [95% CI 90.11-143.89]). Conclusion. The study revealed that 22 out of 51 used rehabilitation treatment had a significant pain relieving effect and improve the functional state of spine. Keywords: efficacy, rehabilitation treatment, medical rehabilitation, primary health care.
HYGIENIC ASSESMENT OF WASTES MIGRATION FROM ROAD-TRAFFIC NETWORK IN THE CONTIGUOUS AREAS
L.A. Alikbaeva, S.P. Kolodiy, А.А. Zolotareva North-Western State Medical University named after I.I. Mechnikov, Russia,191015, Saint-Petersburg, Kirochnaya Street,41
Abstract Introduction. Intensive development of the road-traffic network associates with various risk factors, one of them is the environmental pollution and direct or indirect negative impact on public health. The possible direct negative impact of road-traffic network wastes on public health determines the necessity and importance of studying of their migration to contiguous areas for further measures development to optimize the habitation in urban areas. The aim of the study is to provide the hygienic assessment of water migration and air migration indicators of the harmfulness and phytotoxicity of road traffic wastes. Materials and methods.It was investigated the wastes in Saint-Petersburg, Perm, Chelyabinsk and Ufa. Statistical data processing was carried out by using the program "Statistics" version 10. Results and conclusions. The wastes includedsubstances of hazard class 1 and 2 (copper, nickel, zinc, arsenic, chromium, cobalt and benzo(a)pyrene), there is a dispersed fraction of particles up to 10 microns, the concentration of which can be up to 24 mg / m³ in the air. According to the phytotoxic effect and assessment of referential water migration indicators, the wastes belongs to the IV class of danger. The waste composition includes highly volatile compounds - phenols, petroleum products, chlorides, surfactants. Key words: waste from road-traffic network, water migration hazardous indicator, phytotoxicity, air migration hazardous indicator.
COMPARISON OF SELECTIVE CORONAROGRAPHY AND CORONARY COMPUTER ANGIOGRAPHY IN PATIENTS WITH CHRONIC OCCLUSION OF CORONARY ARTERIES
G.G. Khubulava1, K.L. Kozlov2, A.N. Shishkevich1, O.O. Volikov1, S.S. Mikhailov1, I.A. Menkov1, Z.M. Abdullaev1, L.A.Bobrovskaya3, E.E. Bobrovskaya1 1 Military Medical Academy named after S.M.Kirov, Russia, 194044, Saint- Petersburg, Akademika Lebedeva street, 6. 2Pavlov First Saint Petersburg State Medical University, Russia, 197022, St. Petersburg, Leo Tolstoy street, 6-8. 3Altai State Medical University, Russia, 656000, Altai Territory, Barnaul, Lenin prospect, 40
Abstract Introduction: coronary angiography is the only minimally invasive method of visualizing of the lumen, the coronary arteries walls, discharge angle of the lateral branch and assessing the stenosis degree of its lumen. Materials and methods: The study included 26 patients, 16 male and 10 female with average age 62.31 ± 10.36. According to the main risk factors for coronary artery disease, the characteristics of patients are presented in Table 1. Results: The main aim of the study was to compare the data from selective coronarography with coronary angiography based on the obtained results, and to reveal that coronary angiography could be successfully used for planning coronary interventions, thereby allowing to select the necessary equipment, prepare the necessary coronary guides, predict the variety of stents, choose recanalization tactics for chronically occluded coronary arteries , respectively, to reduce the operation time, radiation exposure to personnel and financial costs. Conclusions: Thus, coronary angiography, while achieving a good image quality, is a highly informative, fast, minimally invasive method for assessing lesions in chronic coronary total occlusion. The method may be recommended for wide use in clinical practice for the detailed study of occluded coronary arteries. Key words: coronarography, chronically occluded coronary arteries ,computed tomography, computed tomography of the coronary arteries, coronary computed tomography angiography, minimally invasive evaluation of the coronary arteries, atherosclerosis.
LONG-TERM RESULTS OF INTRAOPERATIVE PHOTODYNAMIC THERAPY IN PATIENTS WITH GASTRIC CANCER
K.V. Pavelets1,2,3, M.A. Protchenkov1,3, V.Y. Kravtsov4, E.F. Latsko1, D.S. Rusanov1,2, M.K. Pavelets1, Y.D. Kostina1,2, R.A. Karpova1, V.V. Orel2 1Mariinsky hospital, Russia, 194104, Saint-Petersburg, Liteiny avenue, 56 2Saint-Petersburg State Pediatric Medical University, Russia, 194100, Saint-Petersburg, Litovskaya street, 2 3 North-Western Medical University named after I.I. Mechnikov, Russia, 191015, St.-Petersburg, Kirochnaya Street, 41. 4Military Medical Academy named after S.M.Kirov, Russia, 194044, St. Petersburg, Academica Lebedeva street, 6 Abstract Introduction: Gastric cancer is second among the commonest cancers in mortality rate comprising 13-18%. Herewith, despite modern complex treatment methods, five-year survival rate is only 29%. The aim of this study was to evaluate the long-term results after surgical treatment of patients with gastric cancer with and without intraoperative photodynamic therapy (PDT). Materials and methods: During 2010-2016 the study is involved 45 (47,3%) patients (main group) with verified gastric cancer undergoing radical surgical treatment with the use of intraoperative photodynamic therapy with the irradiation of lymph node dissection area and 50 (52,7%) patients (control group),who didn’t undergo intraoperative PDT. Results: Comparing the long-term results, 6 months survival rate for patients of study group was 80% in the comparison with the control group – 64%, one-year survival rate was 73,3% in comparison with 50%. Median survival rate in the study group was 22 months, in control group – 12 months. Conclusion: Photodynamic therapy improves the long-term results of combined treatment for gastric cancer. It could be considered as an efficient method of intraoperative intervention on tumor tissue. Key words: gastric cancer, combined treatment, photodynamic therapy, long-term results
CLINICAL EFFICACY AND SAFETY OF VARIOUS ANTITHROMBOTIC TREATMENT OPTIONS IN PATIENTS AFTER EMBOLISM OF MAIN ARTERIES OF EXTREMITIES (CLINICAL STUDY).
A.V. Sotnikov, M.V. Mel’nikov, P.M. Malkova North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street,41 Abstract. Introduction: Clinical efficacy of various antithrombotic treatment options in patients after embolism of main arteries of extremities is quite unstudied. Aim of the study wasto assess clinical efficacy and safety of various antithrombotic treatment options in patients after embolism of main arteries of extremities. Material and methods: It were studied the long-term clinical treatment results of 77 patients after embolectomy of main arteries of extremities aged 73,5±2,9 years, 43 (55,8%) female. Results. Maximum observation period after surgery was 5 years, 24 patients (31,2%) died during this period. Other patients were divided into 3 groups according to antithrombotic treatment option: monotherapy with acetylsalicylic acid (1 group), monotherapy with oral anticoagulant (2 group), dual therapy with acetylsalicylic acid and oral anticoagulant (3 group). It was revealed low efficiency of monotherapy with acetylsalicylic acid in comparison with other treatment options regarding prevention of myocardium infarction and recurrent arterial embolism. Dual therapy with acetylsalicylic acid and anticoagulant (3 group) did not increase bleeding rate but was effective in the prevention of thrombotic complications. Conclusion: Patients after embolism of main arteries of extremities together with generalized atherosclerosis have to be treated with acetylsalicylic acid and anticoagulant to reduce risk of myocardium infarction and recurrent arterial embolism. Key words: embolism of main arteries of extremities, acute limb ischemia, antithrombotic therapy.
BODY OXYGEN CONSUMPTION DURING MAGNETIC STORMS IN PATIENTS WITH ISCHEMIC HEART DISEASE WITH VARIOUS PSYCHOSOMATIC STATUS
G.А. Usenko2, D.V. Vasendin1,, S.M. Bekmurzov3, A.G. Usenko4, O.M. Belkina2, N.А. Shakirova5, V.G. Zabara3 1 Siberian State University of Geosystems and Technologies, Russia, 630108, Novosibirsk, Plakhotnogo Street, 10 2 Novosibirsk state medical University, Russia, 630091, Novosibirsk, Krasny Prospect, 52 3Military clinical hospital №425 of the defense Ministry of Russia, Russia, 630017, Voinskaya Street street,1 4Novosibirsk Regional Hospital of War Veterans №2, Russia, Novosibirsk, Shamshin Family Street, 95a. 5Western-the Siberian management on Hydrometeorology and environment monitoring, Russia, Novosibirsk, 630099, Sovetskaya Street,30 Abstract Introduction: During magnetic storms there is an increase of gamma-ray power and psycho-emotional stress, as well as changes of physiological processes. However, there are no studies on correlation of environmental gamma background during magnetic storms and body oxygen consumption in patients with ischemic heart disease. The aim of the study was to evaluate the body oxygen consumption in male patients with ischemic heart disease during magnetic storms depending on psychosomatic status. Methods: The study included651 patients with coronary heart disease and 465 healthy controls dividing into 8 groups: 4 groups of patients with increased anxiety and 4 groups with decreased anxiety. It was studied the levels of sympathetic and parasympathetic parts of the autonomic nervous system, minute volume of blood circulation, cortisol level in blood, insulin and aldosterone; data on external respiration: frequency and depth of respiration, respiratory minute volume, data on tissue oxygen consumption was obtained within basal metabolism on an oxypyrograph. It was determined the differences in the oxygen content in arteriovenous and venous blood. Hemoglobin content was determined by using cyanide method. Results: During magnetic storms the patients were observed with increased minute volume of blood circulation, respiratory minute volume and the amount of oxygen consumption correlating with the decreased tissue oxygen consumption (by the amount of oxygen consumption and coefficient of tissue oxygen consumption). Discussion: During the period of solar activity increased the body was affected by a various factors together with ionizing radiation contributed to the coefficient reduction of the tissue oxygen consumption resulted in the development of adaptive reaction, particularly the increase of minute volume of blood circulation and changes of studied indicators of homeostasis. Conclusion: It was found the significant correlation between indicators of solar activity, meteorological factors and studied physiological factors indicating the possibility of a combined effect of the studied factors on the increase in the functional activity of the cardiovascular system. Key words: coronary heart disease, oxygen consumption, solar activity, gamma background.
Cytokine status and left ventricle diastolic function in patients with essential hypertension
A.G. Polupanov 1,2, I.S. Sabirov 1, T.B. Zalova 1, L.G. Tsoy 1, A.I. Sabirova 1, F.T. Rysmatova 3 1Kyrgyz-Russian Slavic Universitн, Kyrgyz Republic,720000, Bishkek, Kiyevskaya Street, 44 2National of Cardiology and Internal Diseases named after academician Mirsaid Mirrakhimov ,Kyrgyz Republic, 720020, Bishkek, Togolok Moldo Street,3 3 Osh State University, Kyrgyz Republic, 723500, Osh, Lenina Street, 331 Abstract Introduction: Formation of left ventricle dysfunction with progression from asymptomatic to severe chronic heart failure occurs with the participation not only of neuro-humoral systems, such as renin-angiotensin and sympathoadrenal, but also with the participation of immune activation and systemic inflammation mediated by pro - and anti-inflammatory cytokines. Aim of the study was to investigate the correlation between cytokines concentration (tumor necrosis factor-alpha and interleukin-10) in the blood with the state of the left ventricle diastolic function in patients with essential hypertension (EG). Material and methods: The study included 144 patients with essential hypertension aged 40 to 70 years (male aged 56.3 ± 7.4 years), including 51 female and 93 male. Left ventricular diastolic dysfunction was diagnosed in 85 patients (59.0%), comprising the first group. The second (control) group included 59 patients with no signs of diastolic dysfunction. The groups were comparable in terms of age and sex (p> 0.05). All patients underwent general clinical and biochemical examination with determination of the glucose level, creatinine and lipid spectrum (low density lipoproteins, high density lipoproteins and triglyceride levels), as well as echo- and doppler echocardiography (Sequoia-512, Acuson, USA). Determination of the mass of tumor necrosis factor-alpha and interleukin-10 was carried out by the method of solid-phase enzyme-linked immunosorbent assay (ELISA) using specialized test systems "CITOKIN-STIMULUS-BEST", Novosibirsk (Russia). Results: The concentration of tumor necrosis factor-alpha in patients without left ventricle diastolic dysfunction was 8.21 ± 1.64 pg / ml, was comparable with the concentration of this cytokine in patients with EG with its presence (8.56 ± 1.64 pg / ml, p > 0.05). This pattern was typical for both male and female. The correlation analysis also did not reveal the association of the level of tumor necrosis factor-alpha with the indices of the diastolic spectrum of the echocardiogram (p> 0.05). Gender peculiarities in the interrelation of the level of interleukin-10 with the presence of diastolic dysfunction were revealed. For example, in male, the concentration of cytokine in the groups of patients with / without diastolic dysfunction wasn’t significantly different, in female with diastolic dysfunction the level of interleukin-10 was 14.6 ± 2.6 pg / ml, it was significantly higher than the values in the female group without diastolic dysfunctions (12.5 ± 1.9 pg / ml, p <0.025). Corrections to the gender and the level of systolic blood pressure and diastolic blood pressure with multivariate regression analysis confirmed the independent association of interleukin-10 concentration by the left ventricular diastolic dysfunction (β = -0.30, p <0.025). Conclusion: There was no correlation between the concentration of tumor necrosis factor-alpha and the development of diastolic myocardial dysfunction. At the same time, in female the level of interleukin-10 was associated with a violation of left ventricular relaxation. Key words: essential hypertension, diastolic dysfunction, tumor necrosis factor-alpha, interleukin-10.
SILENT MYOCARDIAL ISCHEMIA: PATHOGENESIS, DEVELOPMENT, DIAGNOSTICS AND TREATMENT (SCIENTIFIC REVIEW).
K.L. Kozlov 3, G.G. Khubulava 1, A.N. Shishkevich 1, Z.M. Abdullaev 1, S.S. Mikhailov 1, O.O. Volikov 1, L.A. Bobrovskaya 2, E.E. Bobrovskaya 1 1 Military Medical Academy named after S.M.Kirov, Russia, 194044, Saint- Petersburg, Akademika Lebedeva street, 6. 3Altai State Medical University, Russia, 656000, Altai Territory, Barnaul, Lenin prospect, 40. 3 Saint Petersburg Institute of Bioregulation and Gerontology ,North-West Branch of the Russian Academy of Medical Sciences, 197110, Russia, Saint-Petersburg, Dynamo Avenue, 3 Abstract.
Silent myocardial ischemia is one of the forms of ischemic heart disease, characterized by an adverse outcome, high mortality rate, and young age of patients. The majority of the authors revealed the risk factors, however, the predictors of silent myocardial ischemia and cardiovascular disease remain unstudied. Highly informative diagnostics methods, such as coronary angiography, scintigraphy, single-photon emission computed tomography are not used for persons not being related to the risk group and sometimes due to technical difficulties. At the same time, the use of screening, research methods do not provide the comprehensive results. Currently, there are recommendations how to examine persons with increased responsibility (pilots, public transport drivers, etc.), however, the use of these methods are limited to small groups and non-systemic. Key words: cardiovascular diseases, silent myocardial ischemia, coronary heart disease, myocardial infarction, coronary angiography.
RARE ANATOMICAL LOCATION OF RIGHT HEPATIC VEIN AND PREVENTION OF IATROGENIC INJURY
V.V. Oleinic 1.2, S.V. Vasilyev 1, I.P. Mavidi 1,2, T.O. Boitcova2, O.O. Andrusenko 1 1Pavlov First Saint Petersburg State Medical University, Russia, 197022 ,Saint-Petersburg,, Leo Tolstoy Street, 6-8. 2 State budgetary healthcare institution "City hospital № 2», Russia, 194354, Saint-Petersburg, Uchebny lane, 5. Abstract: Introduction: Nowadays, laparoscopic cholecystectomy is one of the most common endovideosurgical interventions. Complications arising during the surgical treatment of gallstone disease include iatrogenic injuries of bile duct, hollow organs, and great vessels. The frequency of intraoperative complications is 0.1–3.5%. One of the factors for the complications development is the variant anatomy of the vascular structures. The aim of the study was to demonstrate the variant of the abnormal location of the right hepatic vein diagnosed intraoperatively. Materials and methods: the article reveals a retrospective analysis of the clinical case of an anatomical location of the right hepatic vein. Results: It is presented the case of planned hospitalization and surgical treatment of patient with
gallstone disease, acute calculous cholecystitis underwent laparoscopic cholecystectomy. Intraoperatively, at the stage of subserous ejection of the gallbladder, an abnormal location of the right hepatic vein was revealed. Conclusion: This feature of the location of the right hepatic vein and other variants of biliary and vascular anatomy are the risk factors for iatrogenic injury. In the presented clinical observation, injury was avoided due to a significant fat layer between the liver parenchyma and the gallbladder. Key words: liver anatomy, hepatic veins anatomy, laparoscopic cholecystectomy, complications prevention.
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