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- Unified system and classification of indicators for integral assessment of
the performance and effectiveness of medical care organization at the
regional level in the Russian Federation
Authors: V. V. Omelyanovskiy, I. А. Mikhailov, D. V. Lukyantseva, Е. S. Samsonova, G. G. Lebedenko
Abstract: Objective: development of a unified system and classification of indicators for an integral assessment of performance and effectiveness of the organization of medical care (MC) at the regional level in the Russian Federation (RF).Material and methods. A systematic search for domestic and foreign scientific publications and a comprehensive analysis of the current regulatory legal acts in the field of health care for the presence of indicators characterizing the effectiveness of MC organization in the RF regions were performed. The search for indicators of effectiveness was carried out in analytical reports based on the results of field events of national medical research centers (NMRC) in the constituent entities of the RF for 2019, 2020 and 2021 in various profiles of MC. In total, 3019 analytical reports on the results of field events and 97 annual public reports on the results of the NMRC activities were analyzed.Results. Three options for classifying indicators were formed: according to the method of obtaining (primary, calculated, secondary qualitative); in relation to the final result (resulting, process (surrogate)); classification of parameters that determine the MC system, including in the context of profiles, forms, types, conditions of MC (18 positions). The proposed unified system and classification of indicators has a number of advantages compared with the Organisation for Economic Cooperation and Development, Centers for Medicare & Medicaid Services and Commonwealth Fund indicators adopted in a number of countries. It was established that international systems use mainly resulting indicators, while the domestic health care system uses exclusively process indicators that are not combined into a single system and are monitored by various departments.Conclusion. The presented approach to a unified system and classification of indicators for an integrated assessment of performance and effectiveness of MC organization allows to determine the priorities for the development of a monitoring system. At the same time, it should be noted that this approach requires further discussion and improvement.
PubDate: 2023-01-20
Issue No: Vol. 15 (2023)
- Analysis of the main indicative values of the pharmaceutical market retail
sectors in the constituent entities of the Russian Federation
Authors: I. К. Petrukhina, Т. К. Ryazanova, А. I. Khusainova, А. V. Egorova, P. R. Blinkova
Abstract: Objective: to study various typological characteristics of the retail pharmaceutical market sector in 23 constituent entities of the Russian Federation (RF), as well as to analyze the availability of socially important types of pharmaceutical care as of 2021.Material and methods. The study materials were the data obtained on the basis of specially developed card-queries in the health authorities of constituent entities of the RF, and data from Rosstat, the Federal Antimonopoly Service of the RF, Roszdravnadzor. Methods of comparative, structural, logical and content analysis, as well as the method of data grouping were used. The study included analysis of the overall structure of retail sectors of regional pharmaceutical markets, the structure of pharmacy organizations (POs) depending on the form of ownership, availability of pharmaceutical care to the population of the RF constituent entities, and quantitative characteristics of POs that provide socially important types of pharmaceutical care: extemporaneous compounding of dosage forms, sales of drugs, psychotropic substances and their precursors included in the Lists II and III of the Decree No. 681 of the RF Government of June 30, 1998. Based on the obtained values of the indicative indicators, a typologization of the constituent entities of the RF was carried out.Results. By the total number of retail sales facilities the top five are regional pharmaceutical markets of Novosibirsk Region (2688), Nizhny Novgorod Region (2265), Samara Region (2493), Tula Region (1516), and Belgorod Region (1383). As of 2021, the share of pharmacies in the total pharmacy retail sector structure of the analyzed regions amounted to 45.5%, pharmacy outlets and kiosks – 54.1% and 0.4%, respectively. In most cases, the pharmaceutical market of constituent entities of the RF was concentrated: the mean value of the mean population per PO indicator was 2,215 persons. The pharmaceutical markets of Tula, Kursk and Pskov Regions are the most concentrated, the markets of Chechen Republic, Murmansk Region and Krasnoyarsk Territory are the least concentrated. The main burden of providing socially significant types of medicines falls on the state and municipal sectors, with the state sector accounting for 11.2% in the total structure of POs.Conclusion. Based on the study of basic indicators the situation in the pharmaceutical market retail sectors of different constituent entities of the RF was characterized. The revealed in 2021 downward trend in the total number of retail sales facilities may be caused by an excessively high degree of PO concentration on regional markets, as well as a noticeable reduction in the profitability of pharmaceutical activities (including due to a decline in the solvency of the population associated with the spread of a new coronavirus infection) and the impact of legislative changes.
PubDate: 2023-01-19
Issue No: Vol. 15 (2023)
- Antibiotic resistance of uropathogens in patients with nephrolithiasis and
concomitant coronary heart disease
Authors: R. V. Royuk, S. K. Yarovoy, I. B. Shikina
Abstract: Objective: to identify the main causative agents of chronic calculous pyelonephritis and determine their antibiotic resistance in patients with nephrolithiasis combined with coronary heart disease (CHD).Material and methods. A retrospective case-control study included 181 patients aged 57 to 82 years old who were treated at the urological center of branch no. 1 of Burdenko Main Military Clinical Hospital in 2014–2019. All patients long-term suffered from urolithiasis complicated by chronic calculus pyelonephritis in combination with CHD. Clinically significant results of bacteriological urine examinations (CFU≥103) were analyzed. The midstream urine specimen cultivation was performed sectorally on Endo agar. The minimum suppressive concentration of the test antibacterial preparations for each of the detected microorganisms was determined by dilution on a dense Müller–Hinton agar culture medium (BBL, USA). The results were processed using the Shapiro–Wilk, Kolmogorov–Smirnov, and χ2 Pirson criteria. The values of p≤0,05 were considered as statistically significant.Results. Specimen culturing revealed Escherichia coli – 24.8%, Klebsiella pneumoniae – 18.3%, Pseudomanas aeruginosa – 11%. Staphylococcus spp., and Enterococcus spp. were most important among gram-positive pathogens (total 26.6% of cases). The sensitivity of the detected infectious agents to basic antibacterial drugs turned out to be sharply reduced. It is noteworthy that 65% of P. aeruginosa strains were sensitive to meropenem.Conclusion. In patients with recurrent urolithiasis combined with CHD, the proportion of gram-positive coccas was increased on the background of calculous pyelonephritis with a simultaneous decrease in the proportion of poly-resistant gram-negative infectious agents (nosocomial strains of E. coli and K. pneumoniae).
PubDate: 2023-01-19
Issue No: Vol. 15 (2023)
- Pharmacoeconomic analysis of antithrombotic therapy in patients with acute
coronary syndrome and patients with atrial fibrillation who underwent
percutaneous coronary intervention
Authors: V. А. Ryagina, К. I. Matrenin, D. G. Shchurov, Т. S. Teptsova
Abstract: Objective: to assess the clinical and economic feasibility of ticagrelor in combination with acetylsalicylic acid (ASA) in comparison with clopidogrel in combination with ASA in patients with acute coronary syndrome (ACS), including both those who underwent, and those who did not undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG); and new oral anticoagulants (NOACs) in combination with clopidogrel in comparison with warfarin in combination with clopidogrel and ASA in patients with atrial fibrillation (AF) who underwent PCI; to identify the impact of the above strategies of antithrombotic therapy on the targets of the State Health Care Program of the Russian Federation (RF) “Development of Health Care” and the Federal Project “Cardiovascular Diseases Control”.Material and methods. The clinical and economic study (CES) of ticagrelor in combination with ASA in ACS patients was based on a costbenefit analysis. A combined model, including a decision tree and Markov model was developed. The horizon period of the analysis was 5 years. Quality-adjusted life year (QALY) was used as an efficiency criterion and only the direct medical costs associated with the conditions identified in the modeling were taken into account. A discount rate of 5% was taken into account during the CES. The application of NOACs in combination with clopidogrel was studied in the CES using a cost minimization analysis considering the costs per patient characterized by the presence of AF regardless of the presence of ACS and a history of PCI.Results. We used a decision tree and Markov modeling in adult patients with ACS, who had or had not undergone PCI or CABG, in the horizon period of 5 years considering the discount rate of the added quality-adjusted life year (incremental cost-effectiveness ratio (ICER) per QALY). The result for ticagrelor in combination with ASA compared to clopidogrel in combination with ASA was 605,199 rubles, which was significantly lower than the willingness-to-pay threshold (2,235,201 rubles). Assessment of the impact of the therapy regimen including ticagrelor in combination with ASA on the target indicators of the State Health Care Program of the RF “Development of Healthcare” and the Federal Project “Cardiovascular Diseases Control” showed that the use of this therapy regimen will reduce mortality from myocardial infarction (MI) and cardiovascular causes by 2.45 cases per 100 thousand population provided that 100% of patients with MI and unstable angina in the RF are transferred from clopidogrel + ASA scheme to ticagrelor + ASA. The potential contribution of ticagrelor in combination with ASA compared to clopidogrel in combination with ASA in patients with ACS in achieving the target reduction of mortality from circulatory diseases will be 6.48% by 2023. In all simulated scenarios, in the group of patients with AF who had undergone PCI, pharmacotherapy regimens containing NOACs (dabigatran etexilate, rivaroxaban, apixaban) were more costly than therapy regimens containing warfarin (with not significantly different effectiveness).Conclusion. The results of the evaluation of clinical and economic feasibility of antiplatelet therapy strategies demonstrated the costeffectiveness of ticagrelor in combination with ASA compared to clopidogrel in combination with ASA in patients with ACS, including those who had undergone PCI or CABG and those who had not. The strategy of ticagrelor + ASA showed a favorable effect on the rates of mortality from MI, as well as from circulatory diseases. The results of the clinical and economic evaluation of the four strategies of antithrombotic drug therapy in patients with AF who had undergone PCI showed higher costs of the regimens containing NOACs with a presumed zero effect on the mortality from circulatory diseases.
PubDate: 2023-01-18
Issue No: Vol. 15 (2023)
- Dietary factors influencing the COVID-19 epidemic process
Authors: S. V. Ponomarenko
Abstract: Objective: to analyze the role of diet in the epidemiological parameters of the SARS-CoV-2 Coronavirus and identify factors that correlate withthe reduction in the severity of the consequences of COVID-19 disease, namely the rate of prevalence (RPr) and infection fatality rate (IFR) in different regions.Material and methods. The information and data required for this study were found in scientific publications and the media available on the Internet, as well as obtained from statistical databases using specific keywords, both for a single tag and in various combinations of them. Statistical samples were managed from sources and facts available on the Internet. Pearson correlation coefficient (r) was used to understand a statistical relationship between two variables.Results. The relationship between nutritional factors and the impact of the 15-month COVID-19 pandemic in different regions was investigated using various available statistics for five continents and 47 countries. A clear relationship was found between the outcomes of the SARSCoV-2 epidemic (RPr and IFR) and the amount of consumed essential nutrients, with correlations in the negative range r=–0.98 and r=–0.66 for plant proteins and with correlation coefficients r=0.92 for animal proteins. Also, excessive sugar consumption increased the severity of COVID-19 with correlation coefficients in the range of r=0.99–0.72 in the representative samples.Conclusion. Statistical analysis presented that the number of diagnosed patients with SARS-CoV-2 (RPr) and deaths from COVID-19 (IFR) was significantly lower in regions where more plant foods were consumed than animal products. A detailed study of the relationship between the Coronavirus and the host as well as the metabolism of protein and sugar may reveal the diet factors responsible for resistance to the pathogen. Edible plants can contain components responsible for suppressing the replication cycle of the SARS-CoV-2 virus. Biochemical investigation of these components would help in the development of etiological oral administrated anti-COVID-9 medicine.
PubDate: 2023-01-18
Issue No: Vol. 15 (2023)
- Concentration of vitamin D metabolite – 25(OH)D3 as a predictor of
breast cancer progression
Authors: D. Е. Frolova, N. P. Lapochkina, О. А. Gromova, I. Yu. Torshin
Abstract: Background. Prediction of breast cancer (BC) progression is important for the timely correction of patient therapy.Objective: to assess a relationship between BC progression and degree of vitamin D deficiency.Material and methods. A retrospective controlled study was performed. The results of examining 67 women aged 29–48 years with histologically verified BC and vitamin D deficiency are presented. All patients were divided into two groups: the main group – 34 women administered with vitamin D, comparison group – 33 patients not taking vitamin D.Results. It was shown that 25(OH)D3 level less than 18.9 ng/ml was significantly associated with prominent disease progression, regardless of the tumor molecular subtype. Additional criteria were developed allowing to predict BC progression.Conclusion. In order to detect secondary changes (distant metastases in ВС patients) and improve patient monitoring, it is recommended to use additional diagnostic methods and determine the intermediate metabolite of vitamin D – 25(OH)D3 in peripheral blood.
PubDate: 2023-01-08
Issue No: Vol. 15 (2023)
- Medical rehabilitation of patients with menopausal syndrome and surgical
menopause: contribution of magnesium deficiency correction
Authors: D. V. Blinov, А. G. Solopova, Е. Е. Achkasov, G. К. Bykovshchenko, D. А. Petrenko
Abstract: Background. The increase in the proportion of patients with menopausal syndrome (MS) and surgical menopause, including women in the recovery phase after radical surgical treatment of the reproductive system cancer, is a characteristic trend of the 21st century. Part of them receive menopausal hormone therapy (MHT). This determines the relevance of the analysis of the specified cohort of patients to enhance rehabilitation programs designed to improve the quality of life (QoL) in this category of gynecological patients.Objective: subanalysis of primary data from the MAGYN study cohort of MHT treated women with MS and surgical menopause.Material and methods. The MAGYN observational non-interventional study of the real clinical practice included 9168 women, of whom 1528 represented a group of previously not characterized MHT treated women with MS and surgical menopause. To determine the number of patients with magnesium deficiency (MD), a Magnesium Deficiency Questionnaire (MDQ) was used, a biochemical blood test with an indicator of serum magnesium concentration was evaluated. The profile of the participants was analyzed by the presence of general somatic pathologies, obstetric, gynecological history, complaints, symptoms of MD on a visual-analog scale. The QoL was assessed with the help of The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) before the start of a 4-week course of MD supplementation and after treatment.Results. According to the MDQ results, the prevalence of DM was 79.4%, which exceeded the results of all other groups in the study. Women with MD had a higher incidence of viral infections (19.2% vs. 22.7%; p=0.028), vegetative-vascular dystonia (26.2% vs. 29.7%; p=0.0466) and osteochondrosis (42.9% vs. 46.8%; p=0.0453). A subgroup of participants with verified MD demonstrated significantly more pronounced symptoms, such as irritability (4.9±3.5 vs. 4.6±3.4 points in the general group; p=0.0437), sleep disorders (4.4±2.3 vs. 4.2±2.3 points; p=0.0491), back pain (3.9±2.0 vs. 3.7±2.0; p=0.0405), and increased fatigue (4.6±2.3 vs. 4.4±2.3 points; p=0.0444). After the end of the course of therapy with fixed dose combination of magnesium citrate and pyridoxine, the sum of MDQ scores decreased from 46.0±12.7 to 29.2±15.1 points (p<0.001) in combination with an increase in the plasma concentration of magnesium to 0.79±0.23 mmol/l; women's satisfaction with their physical, psychological, social well-being increased (from 21.1±4.5 to 26.2±3.5 points; from 24.8±4.9 to 28.1±4.4 points, and from 9.3±2.7 to 11.0±2.8 points, respectively; p<0.001); self-perception increased from 18.2±3.7 to 22.2±3.6 points. Thus, there was a significant decrease in the severity of MD and a significant improvement in QoL according to WHOQOL-BREF, which is important in the rehabilitation of such patients.Conclusion. The profile of patients with MS and surgical menopause receiving MHT, including the period of recovery after radical surgical treatment of reproductive cancer, is characterized by MD and decreased QoL. It seems effective to introduce MD correction into the complex rehabilitation program of such patients. It is necessary to conduct further studies to improve the rehabilitation measures in this cohort of patients.
PubDate: 2023-01-08
Issue No: Vol. 15 (2023)
- Possibilities of physical therapy and electrophysical modalities in the
complex therapy of pneumonia
Authors: D. I. Korabelnikov, V. V. Grigoryev, О. V. Efimova
Abstract: Pneumonia is one of the most common infectious diseases and the leading infectious cause of death worldwide. High rates of morbidity, frequency of complications, mortality, the emergence of new highly virulent strains of pneumonia pathogens, antibiotic resistance determine the global medical and social problem of community-acquired pneumonia. The economic consequences of pneumonia are represented not only by direct medical costs (the cost of maintaining a patient in a medical institution, the cost of medical services, the cost of medicines, laboratory and instrumental studies, other medical procedures, etc.), but also include non-material costs from pneumonia, which include pain, psycho-emotional experiences of the patient due to a decrease in the quality of life during the illness. One of the directions of increasing the effectiveness of pneumonia therapy is the widespread introduction of physical therapy (PT) and electrophysical modalities (EM) into complex treatment, which are an important part of the medical rehabilitation for pneumonia, aimed at the speedy restoration of the health and working capacity of patients. The effectiveness of EM in the treatment of pneumonia is due to the versatile therapeutic effect of physical factors that have anti-inflammatory, desensitizing, bacteriostatic, broncholytic, mucolytic, immunostimulant effects, improve blood supply to the lungs. PT contributes to the normalization of pulmonary ventilation, has an expectorant effect, strengthens the respiratory muscles, accelerates the resorption of the inflammatory focus, prevents the formation of pleural adhesions, activates blood and lymph circulation. PT and EM are relevant in the comprehensive treatment of community-acquired pneumonia since they accelerate the regression of clinical symptoms, decrease the drug load, reduce the duration of inpatient treatment, that is confirmed by the results of clinical studies. We assume that the inclusion of PT and EM in the comprehensive treatment of pneumonia can lead to minimizing the total cost of the disease while reducing the duration and volume of drug treatment.
PubDate: 2023-01-08
Issue No: Vol. 15 (2023)
- Historical milestones of the invention and use of placebo
Authors: A. N. Koterov
Abstract: The review is based on the originals of nearly all major sources on the history of placebo and the placebo effect for 1945–2020. Data on the etymology and semantics of the term “placebo”, on its introduction into the Catholic service and, then, into everyday English are given. The placebo effect is considered as one of the mechanisms ensuring the “success” of ancient, medieval, old, non-traditional (alternative) and esoteric medicine. It is indicated that the origins of the experimental placebo are exorcism techniques dated from 16th century.Uniform understanding of priorities in the invention and use of both therapeutic and experimental placebo has not been established. In the first case, A. Sutherland (1763) and A. Duncan (1770) from Scotland, but not W. Cullen (1772), as is now given in most sources, should be named as pioneers. In the second case, the priority is given to the Commission of the Franch Academy of Sciences (with the participation of the US Ambassador to France B. Franklin), which investigated the effects of mesmerism (A. Mesmer) in 1784, but not to J. Haygarth's test of magnetism therapy in 1801, not to a comparison of the effects of homeopathy and allopathy in St. Petersburg in 1829–1830 and, moreover, not to the therapy of rheumatism studied by A. Flint in 1863. The last date is often erroneously given in manuals and reviews.From the beginning of placebo use and until the middle of the 20th century, it was considered as an active compound that could theoretically have a therapeutic effect, but since 1937 placebo has been defined in medical dictionaries only as an inactive, inert substance or effect. Data on the inclusion of the term “placebo” in general and medical dictionaries in different languages are presented (priority was given to the new medical dictionary by G. Motherby written in English and published in 1785).The increased interest in the history of placebo in the last one and a half to two decades (relevant reviews from at least 15 countries are known) might be associated not only with its introduction into controlled trials, but also with the current popularity of alternative and even esoteric medicine methods with the penetration of those, at times, into conventional medicine.
PubDate: 2023-01-08
Issue No: Vol. 15 (2023)
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