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Vol 76, No 5S (2021)

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OBSTETRICS AND GYNAECOLOGY: CURRENT ISSUES

Programmable Births in Gestational Diabetes Mellitus: Minimizing Risks — Improving Maternal and Perinatal Outcomes

Startseva N.M., Radzinsky V.E., Papysheva O.V., Esipova L.N., Oleneva M.A., Lukanovskaya O.B., Cheporeva O.N., Tazhetdinov Е.K.

Abstract

Background. Modernity is characterized by an avalanche-like increase in the frequency of gestational diabetes mellitus (in 4–5 times over the past 20 years). The main tasks of the work in the risk strategy of gestational diabetes mellitus are: prediction of pregnancy complications and the searchingh for new technologies for their delivery. To date, there are still very controversial questions about the timing and methods of delivery of patients with gestational diabetes mellitus. Due to the high incidence of unfavourable perinatal outcomes in gestational diabetes mellitus, the percentage of cesarean sections in some countries reaches 60%, which leads to maternal morbidity and a decrease in the reproductive health of the population. Aims — is to improve of maternal and neonatal outcomes based of the rational choice of delivery technology in gestational diabetes mellitus. Methods. A retrospective analysis of delivery methods was performed in 9769 patients with gestational diabetes mellitus at full-term gestation. Results. The developed and implemented programmed delivery technique was an alternative to cesarean sections, it allowed to reduce the frequency of abdominal delivery, while improving maternal and neonatal outcomes. The frequency of cesarean sections in programmed delivery was 2 times lower than in the presented facilities and significantly lower than in the population (10.0–10.7%). In the programmed delivery group there was a significant reducing morbidity of hypoglycemia in newborns compared to planned caesarean section — by 2 times and respiratory distress syndrome — by 2.5 times (p < 0.05). The indices of cerebral status impairment, birth traumatism corresponded to physiological childbirth and did not exceed the average population. Conclusions. The method of programmed delivery presented in this paper was one of the reserves for reducing the frequency of cesarean sections and allowed to personalize delivery in respiratory distress syndrome.

Annals of the Russian academy of medical sciences. 2021;76(5S):525-532
pages 525-532 views

CARDIOLOGY AND CARDIOVASCULAR SURGERY: CURRENT ISSUES

Clinical and Anamnestic Characteristics of Acute Coronary Syndrome after Suffering COVID-19

Orlova N.V., Lomajchikov V.V., Bonkalo T. ., Chuvarayan G.A., Spiryakina Y.G., Petrenko A.P., Pinchuk T.V.

Abstract

Background. COVID-19 increases the risk of developing thromboembolic complications, including acute myocardial infarction, in the acute period of the disease. The long-term consequences of COVID-19 are poorly understood. At the same time, the available data on an increased risk of acute coronary syndrome after infectious diseases allow us to make an assumption about a similar risk in COVID-19. The aim of the study was to study the anamnestic and laboratory diagnostic data in patients with acute coronary syndrome after COVID-19. Methods. The study included 185 patients with acute coronary syndrome who were admitted to the State Clinical Hospital No. 13 in Moscow in the period from May to December 2020. 2 groups were identified: group 1 — 109 patients with ACS who had previously suffered COVID-19, group 2 — 76 patients with ACS without COVID-19 in the past. The patients were collected anamnesis, including: the fact of smoking and alcohol consumption, heredity, previous diseases, including diabetes mellitus, acute myocardial infarction, previously performed PCI. Information about the COVID-19 infection has been collected (the duration of the disease, the course of the disease). A clinical and laboratory examination was conducted, including the determination of body mass index (BMI), examination for antibodies to COVID-19, determination of the lipid profile level (total cholesterol, LDL, HDL, triglycerides), blood glucose level, C-RB. The analysis was performed on automatic biochemical analyzers Hitachi-902, 912 (Roche Diagnostics, Japan). All patients underwent coronary angiography. Results. In patients with ACS with previously transferred COVID-19, the development of the disease occurred at a younger age compared to patients without transferred COVID-19. Among the patients with COVID-19, body weight was significantly lower, there were fewer smokers, concomitant type 2 diabetes mellitus and transferred ONMC were less common. In laboratory parameters, lower triglyceride levels were observed in patients with ACS with COVID-19 compared with those of patients without COVID-19. In the laboratory parameters of blood clotting in patients with ACS with COVID-19, higher APTT, thrombin time, fibrinogen level, D-dimer were noted. The indicated laboratory parameters in the groups had statistically significant differences. In ACS patients with a previous COVID-19, compared with patients without COVID-19, the lesion of 2 or more coronary vessels was more common in the anamnesis. Conclusion. According to the results of our study, it was revealed that multivessel coronary artery damage in patients after COVID-19 in comparison with patients without COVID-19 develops significantly more often, while these patients are significantly less likely to have DM and previously suffered ONMC, the level of TG is significantly lower.

Annals of the Russian academy of medical sciences. 2021;76(5S):533-538
pages 533-538 views

Left Ventricular Global Longitudinal Strain by Speckle Tracking Echocardiography in Pregnant COVID-19 Patients

Doroshenko D.A., Rumyantsev Y.I., Konisheva O.V., Samorukova A.S., Vechorko V.I., Adamyan L.V.

Abstract

Background. The new coronavirus disease (COVID-19), which has arisen as a result of infection SARS-CoV-2, which causes severe respiratory syndrome, is characterized by high morbidity, mortality and is a big problem in the health sector. The aim — to use 2-dimensional speckle-tracking echocardiography (STE) in combination with transthoracic echocardiography (TTE) in the assessment of left ventricular longitudinal strain (LVGLS) in pregnant women with confirmed coronavirus infection, hospitalized in the O.M. Filatov Municipal Clinical Hospital No. 15, Moscow, Russian Federation. Methods. The results of STE were analyzed in 102 pregnant women with confirmed coronavirus infection at the hospital stage of treatment. Results. There was no decrease in LVGLS values in pregnant women with COVID-19 without a history of cardiovascular pathology. There was also no additional decrease in the LVGLS value in pregnant women with COVID-19 and initially reduced LVGLS in the presence of a cardiovascular history (the results were consistent with those in pregnant women with concomitant cardiovascular pathology, but without a new coronavirus infection). Conclusions. In pregnant women with COVID-19 without a history of concomitant pathology, STE did not provide additional information regarding possible subclinical left ventricular dysfunction.

Annals of the Russian academy of medical sciences. 2021;76(5S):539-543
pages 539-543 views

NEUROLOGY AND NEUROSURGERY: CURRENT ISSUES

Comparative Cohort Study of the Use of Immersive Technologies in the Complex Psychological Rehabilitation of Patients with Motor Disorders

Kukshina A. ., Kotel'nikova A.V., Razumov A.N., Pogonchenkova I.V., Turova E. ., Rassulova M.A., Lyamina N.P.

Abstract

Background. Successful correction of the psychological consequences of motor disorders is the key to improving the effectiveness of medical rehabilitation. The literature data on the use of immersive technologies in the correction of psychoemotional disorders of various origins suggest that they can also be effective in the context of psychorehabilitation of patients with motor disorders. However, at the moment there is no scientific and methodological base that allows for the widespread introduction of high-tech VR and AR tools into the practical work of a medical psychologist in a rehabilitation hospital. Aims — evaluation of the effectiveness of the inclusion of immersive technologies in the complex psychological rehabilitation of patients with motor disorders. Materials and methods. The design was planned as a controlled empirical randomized open study conducted during 1 calendar year on the basis of a medical rehabilitation hospital, which involved 336 patients with motor function disorders that occurred as a result of a previous stroke or against the background of chronically occurring degenerative-dystrophic diseases of large joints and spine. The results were compared in three groups for each studied high-tech tool – the main, comparison and control. 81 patients were included in the study of the effectiveness of the use of the Visual Medicine program in patients with stroke. The effectiveness of the inclusion of the HTC Vive Focus Plus EEA virtual Reality System in the psychological correction of pain syndrome against the background of degenerative and dystrophic diseases was studied in 130 patients. The study of the possibility of using the PRAK — hardware and software complex included 125 people with motor disorders: the consequences of stroke (n = 65) and the consequences of chronic degenerative-dystrophic diseases (n = 60). The basis for assessing the stability of indicators of higher efficiency of psychocorrective measures with the inclusion of immersive technologies in comparison with the comparison groups and control groups was the reliability of the results obtained at p < 0.05. Results. With a high degree of confidence recorded a positive trend in relation to recovery all kinds of praxis in patients with movement disorders due to stroke, by using the Visual Medicine program; in the case of psychological correction of neuropathic and mixed pain in patients with chronic flowing RSD — with the application of the HTC Vive Focus Plus EEA virtual Reality System; to achieve a stable positive dynamics in the correction of the psychoemotional state of patients with impaired motor functions-when the PRAK — hardware and software complex is included in the “relaxation” mode in the complex of psychological rehabilitation. Conclusions. The clinical effectiveness of the use of immersive technologies in relation to the psychological consequences of motor disorders is shown, which makes a significant contribution to solving the problem of optimizing the work of a medical psychologist in a rehabilitation hospital.

Annals of the Russian academy of medical sciences. 2021;76(5S):544-553
pages 544-553 views

HEALTH CARE MANAGEMENT: CURRENT ISSUES

Medical Informatics in Ensuring Quality Control of Cancer Care: Promising Directions of Development

Andreev D.A., Zavyalov A.A.

Abstract

The surge in development of oncology informatics facilitates the accommodation of next generation digital approaches into cancer care quality assurance workflow. Hence, the remarkable progress in clinical informatics might shape the construction of the extremely efficient model of quality assurance in real hospital practice. This review reflects the description of innovative approaches to automated assessments of the cancer care quality in real world. The PubMed (Medline) database GOOGLE were used to search for helpful information. Ultimately, 35 sources were included in this review. The processing of big data variables possessing plenty characteristics and integration of those into the unified cancer care databases could give the unbelievably valuable results connecting the diagnostic and treatment indicators with the clinical outcomes especially at patient level. The newly emerging information technology tools include the rapid feedback systems to deliver the results of automated appraisal of care quality to the individual physicians and caregivers. Moreover, such digital systems as CancerLinQ and the CAPTIVE infrastructure can be considered as vigorous examples of state-of-the-art technologies that were trialed in cancer care settings with positive results. This paper reviews some of the elements mentioned above. Clinical oncology informatics has opened a new era in improving the practical instruments for care efficiency and safety assurance. The issues of legal policy for automated data processing using artificial intelligence are actualized. The methodology utility depends mostly on the characteristics of primary data collected, analytical algorithms, software design, and properties of high-speed computing hardware. Integration of all data sources together with brand-new computing systems is an obligatory condition for consistent rolling-out of comprehensive digital cancer care network to achieve the better outcomes in the tough battle with malignant neoplasms.

Annals of the Russian academy of medical sciences. 2021;76(5S):554-559
pages 554-559 views

Partnership in Healthcare System Sustainability and Resilience: Russian Healthcare System Analysis

Aksenova E.I., Wharton G., Vosheva N.A., Gocke D., Kamynina N.N.

Abstract

Background. In 2020 the global community faced a serious unexpected challenge — COVID-19. Fighting the aggressive spread of the coronavirus required rapid reconfiguration of the Russian healthcare system, while exposing its weak spots and pressure points. Critical evaluation of the Russian healthcare system’s resilience to crises offers new perspectives on the most effective management and organizational solutions for resolving this crisis. Research objective. The main goal of this study is to make a significant long-term contribution to the Russian healthcare system by developing a set of recommendations for increasing the system’s sustainability and resilience to crises. Methods. For this study, specialists developed a framework that includes a set of questions in the 1) domains of governance, 2) financing, 3) workforce, 4) medicines and technology and 5) service delivery, which align closely with the well-recognised WHO health system building blocks. In each domain, a series of targeted questions concerned both sustainability and resilience. Findings. The main areas of work for increasing the Russian healthcare system’s sustainability and resilience to crises include: adapting the existing legislative framework to the current crisis, and to prepare it for similar crises in the future; increasing healthcare funding; improving the image of the medical profession; promoting healthcare digitalization; reducing the pressure on the inpatient and emergency care services by strengthening preventive and rehabilitative care services. Conclusion. The synthesis and analysis of materials relevant to understanding the impact of the coronavirus pandemic on the Russian healthcare system, supplemented by expert assessments and examples drawn from practice, allowed the authors to compile a list of recommendations for ensuring the healthcare system’s sustainability and resilience to future crises. This list offers potential for healthcare industry development.

Annals of the Russian academy of medical sciences. 2021;76(5S):560-571
pages 560-571 views

International Aspects of the COVID-19 Infodemic

Pivovarova O.A., Gorbatov S.J., Korotkova E.О., Kamynina N.N.

Abstract

At present, the speed and scale of the dissemination of false health information has increased significantly, due to the Internet and social networks, which has become a serious problem and challenge for the world’s public health systems. The issue of spreading implausible news has become most acute against the background of the COVID-19 pandemic. Since February 2020, the World Health Organization has introduced the term “infodemiс”, which characterizes the rapid growth of unreliable and false reports of a pandemic by analogy with the spread of the virus. The purpose of this article is to study the issues of the emergence and ways of spreading misinformation about health, to consider approaches for taking effective response measures in the conditions of infodemiс. The article was prepared using a systematic review of research publications based on strict selection criteria in the bibliographic databases PubMed, ScienceDirect, as well as online resources that addressed the issues of dissemination and countering false information in the field of healthcare. Countering disinformation needs to be done through correcting information, purposeful refutations based on evidence, implementing initiatives to improve the media literacy of the population, as well as by improving the supervision of social networks. Coordinated interaction between governmental and international organizations, the scientific community, the media, and global Internet social media platforms is crucial in this process.

Annals of the Russian academy of medical sciences. 2021;76(5S):572-580
pages 572-580 views

Study of Citizens of CIS Countries Receiving Medical Services on the Territory of the Russian Federation: Insights for Development of the Export of Medical Services (Based on Material of Focus Group Interviews)

Aksenova E.I., Bogdan I.V., Gataulin R.G., Grin S.I., Kriukova K.K., Pravednikov A.V., Radetskaia A.V., Chistyakova D.P.

Abstract

Background. The export of medical services is one of the most dynamically developing areas both in the structure of the world economy and in the structure of world health care. By decree of V.V. Putin of May 7, 2018 “On national goals and strategic objectives of the development of the Russian Federation” the need to increase the volume of exports of medical services was outlined. The real experience of receiving medical care by foreign citizens living in the territory of the Russian Federation has a serious impact on the broadcasted image of Russian medicine. Sociological research aimed at studying the opinion of foreign citizens about domestic medicine is a promising tool for ensuring a targeted approach in the export of medical services. Aims — to study the opinion on the Russian medicine among foreign citizens of the CIS countries living in the territory of the Russian Federation in order to form an effective strategy for promoting medical services provided for foreigners in the territory of the Russian Federation. Methods. The focus group interviews with citizens of the CIS countries who received medical services and residing in Russia were held. For the analysis, the text data encoding procedure was carried out. At the same time, the study was not aimed at revealing the prevalence of opinions, statistical criteria were not used. An adapted COM-B model was used as a theoretical basis for the analysis, and the BCW (Behavior change wheel) method was used to develop recommendations. Results. The study examined some important details of the image of Russian medicine in the opinion of group participants (good equipment, reliable ambulance, feeling of “conveyor belt”, bureaucracy, etc.). The results are structured using the adapted COM-B model. The study identified the main strategies used by foreign citizens when seeking medical care. Insufficient awareness of foreign citizens about their rights in the field of medical provision in the territory of the Russian Federation was revealed. The main channels of communication used by citizens of the CIS to select a medical organization / specialist for seeking help have been studied, it is primarily «word of mouth». It has been established that in order to be attractive, for Russian medicine it’s not enough to have advantages, they should be perceived as sufficient to overcome the convenience of conservative respondents to refer to “native”, “familiar”, as well as the fear of the “stranger”. Based on the results obtained using the BCW model, the recommendations have been developed and interventions have been proposed to promote medical services provided in the Russian Federation among foreigners.

Annals of the Russian academy of medical sciences. 2021;76(5S):581-589
pages 581-589 views

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