Репозиторий Университета

The article describes the principles of choosing parameters to be included into account registry of mandatory medical insurance system in 2019. The parameters should be applied for retrospective analysis of anti-neoplasm treatment of solid tumors in adults for accordance with clinical recommendations. It is proposed to extend account registries of mandatory medical insurance system with additional 13 parameters, reflecting both tumor type and course of disease and stages of medical care as well.

© 2018 Aisanov et al. The high prevalence of COPD together with its high level of misdiagnosis and late diagnosis dictate the necessity for the development and implementation of clinical practice guidelines (CPGs) in order to improve the management of this disease. High-quality, evidence-based international CPGs need to be adapted to the particular situation of each country or region. A new version of the Russian Respiratory Society guidelines released at the end of 2016 was based on the proposal by Global Initiative for Obstructive Lung Disease but adapted to the characteristics of the Russian health system and included an algorithm of pharmacologic treatment of COPD. The proposed algorithm had to comply with the requirements of the Russian Ministry of Health to be included into the unified electronic rubricator, which required a balance between the level of information and the simplicity of the graphic design. This was achieved by: exclusion of the initial diagnostic process, grouping together the common pharmacologic and nonpharmacologic measures for all patients, and the decision not to use the letters A–D for simplicity and clarity. At all stages of the treatment algorithm, efficacy and safety have to be carefully assessed. Escalation and de-escalation is possible in the case of lack of or insufficient efficacy or safety issues. Bronchodilators should not be discontinued except in the case of significant side effects. At the same time, inhaled corticosteroid (ICS) withdrawal is not represented in the algorithm, because it was agreed that there is insufficient evidence to establish clear criteria for ICSs discontinuation. Finally, based on the Global Initiative for Obstructive Lung Disease statement, the proposed algorithm reflects and summarizes different approaches to the pharmacological treatment of COPD taking into account the reality of health care in the Russian Federation.

© 2018, Bionika Media Ltd. All rights reserved. Appropriate nutrition is essential for the health and optimal growth of preterm infants. Aim. To investigate the effectiveness of the application of clinical guidelines “Enteral feeding of preterm infants” in infants below 32 weeks’ gestation. Material and methods. The study comprised 114 extremely preterm infants born before (2013-2014, group 1, n=53) and after (2014-2015, group 2, n=61) introduction of the clinical guidelines. Comparative analysis included breastfeeding frequency, the time of initiation of enteral feeding and achieving enteral feeds up to a volume of 150ml/kg/d, the incidence of necrotizing enterocolitis (NEC), gastrointestinal dysfunction, gastric bleeding, the use of breast milk fortifier, and the dynamics of infant postnatal physical growth. A comparative assessment also included the length of hospital stay, postconceptional age (PCA) and body weight at the time of hospital discharge. Results. After the introduction of clinical guidelines, 47 (77%) children received maternal colostrum on the first day of life. Breastfeeding was initiated significantly earlier: within 1 (1-5) day after birth in group 2 compared with 9 (2-28) days in group 1. Most infants received enteral feeding on the first day of life, though the infants in group 2 were administered it significantly earlier [7.5 hours (3.5-51) vs. 12 (6-144)]. A significant part of the extremely preterm infants was fed with breast milk. Sixteen (30%) infants in group 1 and almost twice fewer children in group 2 [10 (16%)] were on artificial feeding. In group 2, full enteral feeding was achieved significantly earlier than in group 1 [12 days (6-48) vs. 18.5 (13-47)], while the incidence of NEC in group 2 decreased 1.7-fold (14.8% vs. 24.5%). By 36 weeks’ PCA, the infants in group 2 had significantly higher body weight than babies in group 1 [2220 g (1420-2818) vs. 2050 g (950-3190)]. Conclusion. The clinical implementation of the guidelines “Enteral feeding of preterm infants” has resulted in significantly higher feeding efficiency in extremely preterm babies.

© 2018 Ima-Press Publishing House. All Rights Reserved. In 2015, the experts from various medical associations of Russia elaborated the clinical guidelines "Rational use of nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice". These guidelines were drawn up to improve the use of NSAIDs, our country's most popular agents to treat pain in acute and chronic diseases. The main purpose of this paper was to reduce the frequency of potentially dangerous class-specific adverse events (AE) that may arise from the use of NSAIDs. To do this, the authors proposed a NSAID choice algorithm based on the assessment of risk factors for AE, the individual characteristics of various representatives of this drug group, and the possibility of prevention of AE. Since then, new data on the efficacy and safety of NSAIDs have been obtained. This has necessitated the revision and addition of a number of provisions in the 2015 guidelines. It seems that the new version of the guidelines, which has been drawn up based on the analysis of a large number of clinical and epidemiological studies, their meta-analysis, by taking into account the clinical experience and opinion of the world's leading experts, presents more fully the main aspects of the use of NSAIDs in real clinical practice. The guidelines are intended for physicians of all specialties.