Репозиторий Университета

Background: Lifting The Burden (LTB) and European Headache Federation (EHF) have developed a set of headache service quality indicators, successfully tested in specialist headache centres. Their intended application includes all levels of care. Here we assess their implementation in primary care. Methods: We included 28 primary-care clinics in Germany (4), Turkey (4), Latvia (5) and Portugal (15). To implement the indicators, we interviewed 111 doctors, 92 nurses and medical assistants, 70 secretaries, 27 service managers and 493 patients, using the questionnaires developed by LTB and EHF. In addition, we evaluated 675 patients’ records. Enquiries were in nine domains: diagnosis, individualized management, referral pathways, patient education and reassurance, convenience and comfort, patient satisfaction, equity and efficiency of headache care, outcome assessment and safety. Results: The principal finding was that Implementation proved feasible and practical in primary care. In the process, we identified significant quality deficits. Almost everywhere, histories of headache, especially temporal profiles, were captured and/or assessed inaccurately. A substantial proportion (20%) of patients received non-specific ICD codes such as R51 (“headache”) rather than specific headache diagnoses. Headache-related disability and quality of life were not part of routine clinical enquiry. Headache diaries and calendars were not in use. Waiting times were long (e.g., about 60 min in Germany). Nevertheless, most patients (> 85%) expressed satisfaction with their care. Almost all the participating clinics provided equitable and easy access to treatment, and follow-up for most headache patients, without unnecessary barriers. Conclusions: The study demonstrated that headache service quality indicators can be used in primary care, proving both practical and fit for purpose. It also uncovered quality deficits leading to suboptimal treatment, often due to a lack of knowledge among the general practitioners. There were failures of process also. These findings signal the need for additional training in headache diagnosis and management in primary care, where most headache patients are necessarily treated. More generally, they underline the importance of headache service quality evaluation in primary care, not only to identify-quality failings but also to guide improvements. This study also demonstrated that patients’ satisfaction is not, on its own, a good indicator of service quality.

© 2020 EManuscript Technologies. All rights reserved. Relevance In the context of the global financial crisis, there is a shortage of budgetary resources that exacerbates the problem of meeting the social needs of the Russian citizens, including medical services. Currently, there is an active reform of audit activities associated with changes in the system of relations between countries, integration processes, restructuring of the institutional structure of business entities in the country and their assets. The central problem in these conditions is the further development of the organization and methodology of audit activity and its methodological binding to business entities of different organizational and legal forms. Purpose: To analyse the current situation on the audit of medical organizations and to justify the need to create a methodology for its implementation.

© 2020 EManuscript Technologies. All rights reserved. Relevance In the context of the global financial crisis, there is a shortage of budgetary resources that exacerbates the problem of meeting the social needs of the Russian citizens, including medical services. Currently, there is an active reform of audit activities associated with changes in the system of relations between countries, integration processes, restructuring of the institutional structure of business entities in the country and their assets. The central problem in these conditions is the further development of the organization and methodology of audit activity and its methodological binding to business entities of different organizational and legal forms. Purpose: To analyse the current situation on the audit of medical organizations and to justify the need to create a methodology for its implementation.

© 2020 EManuscript Technologies. All rights reserved. Relevance In the context of the global financial crisis, there is a shortage of budgetary resources that exacerbates the problem of meeting the social needs of the Russian citizens, including medical services. Currently, there is an active reform of audit activities associated with changes in the system of relations between countries, integration processes, restructuring of the institutional structure of business entities in the country and their assets. The central problem in these conditions is the further development of the organization and methodology of audit activity and its methodological binding to business entities of different organizational and legal forms. Purpose: To analyse the current situation on the audit of medical organizations and to justify the need to create a methodology for its implementation.

© 2020 Elsevier Inc. Mitochondria are essential for neuronal function because they serve not only to sustain energy and redox homeostasis but also are harbingers of death. A dysregulated mitochondrial network can cascade until function is irreparably lost, dooming cells. TBI is most prevalent in the young and comes at significant personal and societal costs. Traumatic brain injury (TBI) triggers a biphasic and mechanistically heterogenous response and this mechanistic heterogeneity has made the development of standardized treatments challenging. The secondary phase of TBI injury evolves over hours and days after the initial insult, providing a window of opportunity for intervention. However, no FDA approved treatment for neuroprotection after TBI currently exists. With recent advances in detection techniques, there has been increasing recognition of the significance and roles of mitochondrial redox lipid signaling in both acute and chronic central nervous system (CNS) pathologies. Oxidized lipids and their downstream products result from and contribute to TBI pathogenesis. Therapies targeting the mitochondrial lipid composition and redox state show promise in experimental TBI and warrant further exploration. In this review, we provide 1) an overview for mitochondrial redox homeostasis with emphasis on glutathione metabolism, 2) the key mechanisms of TBI mitochondrial injury, 3) the pathways of mitochondria specific phospholipid cardiolipin oxidation, and 4) review the mechanisms of mitochondria quality control in TBI with consideration of the roles lipids play in this process.

© 2020 Elsevier Inc. Mitochondria are essential for neuronal function because they serve not only to sustain energy and redox homeostasis but also are harbingers of death. A dysregulated mitochondrial network can cascade until function is irreparably lost, dooming cells. TBI is most prevalent in the young and comes at significant personal and societal costs. Traumatic brain injury (TBI) triggers a biphasic and mechanistically heterogenous response and this mechanistic heterogeneity has made the development of standardized treatments challenging. The secondary phase of TBI injury evolves over hours and days after the initial insult, providing a window of opportunity for intervention. However, no FDA approved treatment for neuroprotection after TBI currently exists. With recent advances in detection techniques, there has been increasing recognition of the significance and roles of mitochondrial redox lipid signaling in both acute and chronic central nervous system (CNS) pathologies. Oxidized lipids and their downstream products result from and contribute to TBI pathogenesis. Therapies targeting the mitochondrial lipid composition and redox state show promise in experimental TBI and warrant further exploration. In this review, we provide 1) an overview for mitochondrial redox homeostasis with emphasis on glutathione metabolism, 2) the key mechanisms of TBI mitochondrial injury, 3) the pathways of mitochondria specific phospholipid cardiolipin oxidation, and 4) review the mechanisms of mitochondria quality control in TBI with consideration of the roles lipids play in this process.

© 2018, SICOT aisbl. Objective: To investigate the effect of knee arthroscopic synovectomy (AS) on the disease activity, quality-of-life (QoL), and the functional status of patients with rheumatoid arthritis (RA). Materials and methods: A retrospective analysis was conducted on the outcomes of AS performed on 138 RA patients; pre-surgery assessments were done using Disease Activity score (DAS 28) and Routine Assessment of Patient Index Data З (RAPID-3) on а multidimensional health-assessment questionnaire for disease activity, EuroQol-5D (EQ-5D) and the Short-Form Medical Outcomes Study (SF-36) for quality of life, and the Health Assessment Questionnaire (HAQ) for functional status. The pain response to SA was measured by а visual analogue score (VAS) and the Knee Society Score (KSS). Results: All parameters assessed in the study showed significant positive changes: the activity of the disease decreased, and patients’ functional status and QoL improved. Conclusion: AS is effective treatment for recurrent synovitis of the knee in RA patients. This technique improves the functional status of patients and their quality of life and reduces the activity of the disease.

© 2018; Pediatria Ltd. All rights reserved. Chronic pathology of the urinary system (US) among children is widespread. Continuously relapsing course of the disease significantly reduces the quality of life (QOL) of patients and their caregivers. Objective of the research - to analyze the necessity of QOL study of children with US chronic pathology. The article presents modern methods, approaches to the assessment of QOL of children of this group. It explains the need to study the evaluation of QOL in children in pediatric practice. QOL indicators of children with chronic diseases are presented as a criterion for assessing the effectiveness of their treatment and socialization. The revealed flaws of QOL of children of different medical and social groups testify to the need to include this indicator in their survey program to optimize medical care for these patients.

© 2017 The mitochondrial membrane potential (ΔΨm) generated by proton pumps (Complexes I, III and IV) is an essential component in the process of energy storage during oxidative phosphorylation. Together with the proton gradient (ΔpH), ΔΨm forms the transmembrane potential of hydrogen ions which is harnessed to make ATP. The levels of ΔΨm and ATP in the cell are kept relatively stable although there are limited fluctuations of both these factors that can occur reflecting normal physiological activity. However, sustained changes in both factors may be deleterious. A long-lasting drop or rise of ΔΨm vs normal levels may induce unwanted loss of cell viability and be a cause of various pathologies. Among other factors, ΔΨm plays a key role in mitochondrial homeostasis through selective elimination of dysfunctional mitochondria. It is also a driving force for transport of ions (other than H+) and proteins which are necessary for healthy mitochondrial functioning. We propose additional potential mechanisms for which ΔΨm is essential for maintenance of cellular health and viability and provide recommendations how to accurately measure ΔΨm in a cell and discuss potential sources of artifacts.

© 2018 John Wiley  &  Sons A/S. Published by John Wiley  &  Sons Ltd Background: The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema. Objectives: The aim of this study was to identify the psychological, social and clinical characteristics of patients with hand eczema, in particular the prevalences of depression, anxiety, suicidal ideation, and comorbidities. Materials and methods: Data on patients with hand eczema were analysed from a large European multicentre study conducted with dermatology outpatients from 13 countries. Groups of patients and controls were compared to analyse the psychological burden of hand eczema. Results: Female patients with hand eczema had higher Hospital Anxiety and Depression Scale (HADS) scores for anxiety (n = 86, median = 7.0) than controls (n = 900, median = 5.0, P =.02), and for depression (median = 4.0) than controls (3.0, P <.001). Patients with high suicidal ideation, with low socioeconomic status and who were widowed or divorced were more likely to fulfil the HADS criteria for anxiety [odds ratio (OR) > 1, P =.038, P <.001, and P <.001, respectively]. The median Dermatology Life Quality Index score was 7.0 (n = 68). Discussion: This study identifies a specific psychological burden experienced by hand eczema patients, highlighting the need for focused psychosocial interventions. Physicians in particular should be aware of the need to identify anxiety and depression in female patients.

© 2018 Counterfeit medicines of ‘high quality’ are the most difficult to detect as they have the same chemical composition as the genuine ones, but they are produced by underground manufacturers who violate technological regulations. Our approach is to consider a remedy as a whole object, taking into account the complex composition of APIs, excipients and manufacturing conditions. For rapid testing, the Near Infrared (NIR)-based approach is applied. It entails the acquisition of NIR spectra and processing of the collected data using a modern one-class classifier method called data driven soft independent modeling by class analogy (DD-SIMCA). We present an exemplary analysis of the suspected drugs, which have the same designation and a very similar chemical composition to the brand of a widely used medication used to treat allergies. We recognized the counterfeits using a model that had been previously developed and stored in a library for everyday monitoring in drugstores. We also describe the steps taken in development and validation of DD-SIMCA library models. In the case under consideration, the NIR-based analysis reveals 100% of counterfeits, and this result surpasses the results of the routine compedial tests. Additionally, we present a new instrument, VisCam, that is used in visual analysis of the primary and secondary packages. This instrument combines a tenfold web-camera with different light sources. It is shown that VisCam helps to reveal hidden violations in the primary and secondary packages.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The article describes special aspects of Good Manufacturing Practice (GMP) for biomedical cell products (BMCP) that imply high standards of aseptics throughout the entire productio process, strict requirements to donors and to the procedure of biomaterial isolation, guaranty of tracing BMCP products, defining processing procedures which allow to identify BMCP as minimally manipulated; continuous quality control and automation of the control process at all stages of manufacturing, which will ensure product release simultaneously with completion of technological operations.

© 2018, Dynasty Publishing House. All rights reserved. The objective. A comparative study of the dose uniformity, dose reproducibility, imprint areas on a planar simulation model as indicators of dispersion of spray-aerosol pharmaceutical forms of various trademarks for treatment of diseases of the mouth cavity and throat. Materials and methods. As objects of study we selected 10 drugs manufactured in the «aerosol» and «spray» forms. Test for dose uniformity was performed in accordance with articles of the State Pharmacopoeia of the Russian Federation «Aerosols and sprays», comparison of dose reproducibility was performed by comparing average dose mass dispersions according to Fisher. The test for the width of dispersion was performed by imprints obtained of a single release of drugs on filter paper with Dragendorff’s reagent and plates for thin-layer chromatography. Results. All metered-dose sprays successfully passed the test for dose mass uniformity. The test for dose mass reproducibility showed a high enough stability of dosage in all the examined drugs: the percentage error of the average dose mass was at the level 1–3%. The test for dispersion width performed on planar simulation models showed significant differences in the character of drug dispersion. For comparing the width of dispersion we calculated imprint areas from a single-dose release on PSM, which permitted to determine drugs with wide and fine dispersion as the most effective with respect to the way of drug delivery to the focus of inflammation – on the mucous membranes of the throat and mouth cavity. Conclusion. The optimal combination of the examined spray characteristics was found in the spray Tantum® Verde, which permits to recommend it as a drug of choice in paediatrics for local therapy of inflammatory diseases of the throat in children beginning from the age of 3 years.

© 2018, Dynasty Publishing House. All rights resvered. The objective. A comparative study of components of the quality of life of parturient women, whose pregnancy developed both after in vitro fertilisation (with the use of donor or own oocytes) or spontaneously. Patients and methods. We assessed the quality of life of 160 parturient women. In 40 women pregnancy developed after IVF with the use of donor eggs, in 40 women – after IVF with own eggs, 40 patients participated in the programme «Surrogate motherhood», and 40 women had a spontaneous pregnancy. The standard SF-36 questionnaire was used. Results. Surrogate mothers demonstrate a somewhat higher self-assessment of their physical condition, underestimate their limitations on physical activities (daily self-care, walking, climbing stairs, carrying heavy objects, etc.), estimate their health at the moment of the survey higher than respondents of other groups and overestimate their mental health (mood, absence of depression and anxiety, the general index of positive emotions) as compared with respondents of other groups. Conclusion. Preventive psychological diagnostics, psychological follow-up of women during preparation to pregnancy, during carrying a baby and in the postpartum period have favourable effects on the successful outcome of the «Surrogate motherhood» programme.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: High prevalence of ischemic heart disease (IHD) is currently both of medical and social concern, thus requiring treatment with drugs capable of influencing not only the prognosis of the disease but also quality of life of patients. This study was undertaken to investigate the possibilities of antianginal therapy with nicorandil and isosorbide dinitrate in order to improve quality of life of patients with stable angina pectoris. Method: The authors carried out a comprehensive examination of a total of eighty-four 44-to-76-year-old patients suffering from IHD with functional class 2-3 stable angina of effort and followed up in ambulatory settings. The patients were randomized into two groups of treatment to receive either nicorandil or isosorbide dinitrate as antianginal agents added to basic therapy. The groups of patients did not significantly differ by anamnestic and demographic characteristics. The duration of follow up amounted to 24 months. We determined the physical and mental components of health-related quality of life and their dynamics on the background of antianginal therapy with nicorandil and isosorbide dinitrate. The parameters of quality of life were evaluated by the findings of two screening tools: the General Health Questionnaire (GHQ-28) and Seattle Angina Questionnaire (SAQ). Results: The findings obtained within the timeframe of the study demonstrated that patients suffering from FC 2-3 stable angina of effort and taking standard therapy with beta-adrenoblokers, calcium antagonists, and antiplatelet drugs were found to have a decrease in their quality of life. The lowest scores were observed by the scales reflecting the psychological component of health, whereas the scores of physical limitation, angina stability, and angina frequency were considerably better. After 24 weeks of treatment with nicorandil and isosorbide dinitrate, the patients of both groups were found to have significantly improved scores for quality of life assessed by the SAQ on all scales. Initially high scores by the GHQ characterizing the patient’s psychological discomfort were revealed in both groups of patients, with no statistically significant differences between the groups. The highest score was revealed by the scales of somatic symptoms and social dysfunction in both the nicorandil group (11.8 and 13.2 points, respectively) and isosorbide dinitrate group (12.1 and 13.5 points, respectively). The mentioned alterations underline the significance of such disease as IHD in adaptation of the patient to the social environment. Angina attacks, physical limitations lead to deterioration of the emotional state and interfere with daily activity. High scores by the scales of anxiety and depression suggested a low level of mental health of IHD patients with stable angina pectoris. After 24 months of treatment, manifestations of anxiety and depression in patients of both groups significantly decreased (with the results comparable in both groups), with clear advantage in the nicorandil group. Conclusion: Nicorandil turned out to be superior to isosorbide dinitrate in improvement of physical and psychological components of quality of life of patients with stable angina of effort.

© 2018 Media Sphera Publishing Group. All rights reserved. The study demonstrated the results of the comparative analysis of various types of renal replacement therapy effects on the quality of life patients with terminal stage of chronic kidney disease on the basis of standardized questionnaires. It has been shown that the quality of life is significantly improved after a kidney transplantation. At the same time, it has also been found that the introduction of home dialysis, epoetins, active metabolites of Vitamin D, calcimimetics in the clinic care expanded the opportunities for the labor rehabilitation of the dialysis patients and made their quality of life comparable with the same of the kidney transplant recipients.

© 2018, Silicea-Poligraf. All rights reserved. Aim. Study of efficacy and safety of taurin in management of stable angina patients with postinfarction cardiosclerosis. Material and methods. Totally, 95 postinfarction cardiosclerosis patients included, with stable angina of II and III functional class. The patients that were included, had refused revascularization. To the main group, 48 were included with added taurin (Dibicor, “PIK-Pharma”, Russia, 750 mg daily), and to comparison group — 47 patients that were taking standard treatment and placebo. Treatment duration 3 months. Results. Clinical efficacy of taurin in postinfarction cardiosclerosis and stable angina is confirmed by significant improvement of the following parameters: subjective state (decreased fatigue, less complaints on palpitation, less severity of dyspnea and rarer angina attacks), of the life quality parameters by Seattle questionnaire; echocardiographic parameters, normalized cardiac rhythm. Postive changes achieved on the basis therapy with taurin, remained for 3 months after drug discontinuation. Conclusion. Positive influence of taurin on clinical and instrumental parameters of patients make it to recommend its prescription for stable angina treatment in postinfarction cardiosclerosis patients.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To study the quality of life of feeding mothers and toe establish whether the adherence to breastfeeding influences physical and mental health of women. Patients and methods. We conducted a questionnaire survey of 151 mothers who had small infants. Their quality of life was studied with the help of the SF-36 questionnaire. Results. As we have found, the higher is the material wellbeing of the family, the less women adhere to breastfeeding (per capita income of the family of breastfeeding mothers are almost 2 times lower than in nonbreastfeeding women – 22500 ± 3.800 and 43958.33 ± 4.240 rubles, respectively, р < 0.05). Subjective perceptions of physical health (functioning), parameters of life activity (Vitality – VT) and subjective assessment of their health (General Health – GH) were similar in both breastfeeding and nonbreastfeeding mothers (VT 56.48 ± 3.77 and 58.33 ± 2.91; GH 68.52 ± 4.13 and 65.83 ± 1.95, р > 0.05). Irrespective of breastfeeding adherence, women after childbirth did not report of worsening of their health (50.93 ± 4.01 and 44.79 ± 2.61, respectively, р > 0.05). But in breastfeeding mothers parameters of the quality of life were demonstrative of a higher endurance (physical functioning 73.89 ± 1.66 and 85.22 ± 3.19, role functioning 52.78 ± 2.16 and 65.63 ± 3.73, р < 0.05). Breastfeeding mothers more rarely had difficulties in routine activities due to their physical condition and pain (bodily pain 73.89 ± 3.77 and131.35 ± 2.16, р < 0.05), physical and emotional condition did not interfere with communication and social activity (social functioning 67.13 ± 1.93 and 139.8 ± 6.92, р < 0.05, mental health 95.11 ± 7.18 and 58.17 ± 8.11, р < 0.05). They are less prone to depression and have higher values of the positive emotions parameter (role emotional functioning 64.08 ± 3.98 and 215.73 ± 12.67, р < 0.01). Conclusion. The results of the study can be used in programmes aimed at expanding breastfeeding.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. Abstarct:-Background. An important goal of treating patients with juvenile idiopathic arthritis (JIA) is to achieve the best quality of life associated with health. Objective. Our aim was to assess the impact of methotrexate plus etanercept therapy on the quality of life of patients with early and late JIA. Methods. The prospective study included patients with early and late JIA without systemic manifestations. The patients' quality of life was assessed with the help of questionnaires for children and parents: the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale, the Pediatric Quality of Life Inventory (PedsQL) Rheumatology Module, and the Health Utilities Index Mark 3 (HUI3). The quality of life was assessed prior to the therapy and after one, six, and 12 months of treatment. Results. 150 children with JIA aged 5.1 (2.0; 17.7) years; 50 children aged 4.0 (2.3-11.4) years in the group of etanercept monotherapy, 50 children aged 5.0 (3.2-9.0) years in the group of methotrexate monotherapy, and 50 children aged 9.9 (6.4-13.0) years in the group of methotrexate plus etanercept combination therapy. All groups showed low scores on all questionnaires before treatment, compared to healthy children. In the course of therapy, there was a tendency for score increase to almost 1.0 according to the HUI3 questionnaire in all groups. After one year of etanercept therapy, the parameters of the quality of life of children with early JIA did not differ from healthy children; the score increased from 56 to 90 p = 0.942 according to the physical functioning scale and from 60 to 85 p = 0.889 according to the emotional functioning scale. In the 2nd group, there was a tendency for score increase, but a statistically significant difference was found across all scales of the questionnaire. After 12 months of etanercept plus methotrexate combination therapy in patients with late JIA, the questionnaire analysis showed that the responses of healthy children and children with JIA differed with probability p = 0.001 for the physical functioning scale, p = 0.001 for the social functioning scale, p = 0.001 for role functioning, and p = 0.001 for the total score. The score increase from 60 to 85 p = 0.789 was noted for emotional functioning scales. Conclusion. The use of questionnaires to assess the quality of life in children with severe chronic diseases can significantly improve the efficacy of treatment and ensure its control.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In this article we have described clinical pharmacology and data of clinical studies of an innovational drug valsartan + sacubitril in patients with chronic heart failure (CHF). The use of supramolecular complex valsartan + sacubitril allows to elevate quality of life and improve prognosis of patients with CHF. High efficacy of valsartan+sacubitril relative to impact on composite primary end-point (cardiovascular death + hospitalization due to CHF) was demonstrated in the clinical trial PARADIGM-HF in which it was compared with angiotensin converting enzyme inhibitor enalapril. Advantages of the use of valsartan + sacubitril for the budget were demonstrated in pharmacoeconomic studies. These advantages are maximally realized at long-term administration. Cost-efficacy of the use of valsartan+sacubitril in pharmacotherapy of CHF is comparable with that of statins in the treatment of ischemic heart disease or implantation of a cardioverter-defibrillator in prevention of sudden cardiac death. Thus, introduction of the drug into practice can be expected to reduce budget expenditures.