Репозиторий Университета

© 2020, LLC Science and Innovations. Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.

© 2020, LLC Science and Innovations. Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.

© 2019, The Author(s). Background: In recent years, joint replacement surgery has gradually progressed towards the fast-track model, and early rehabilitation immediately after surgery is regarded fundamental for optimal recovery of function: the aim of the present study is to describe the efficacy in perioperative management of pain in patients undergoing total hip replacement surgery and treated with tapentadol or oxycodone/naloxone in combination with ketoprofene. Methods: Single-center retrospective study on patients with moderate-severe pain, referred to total hip replacement. Patients received either tapentadol (100 mg/twice-daily post-surgery – treatment group) or oxycodone/naloxone (10 mg/5 mg post-surgery – control group) plus ketoprofen 100 mg/ twice daily. Supplemental analgesia (paracetamol 1 g or morphine 0,1 mg/kg sc) was provided if needed. Pain at rest and pain during movement were evaluated on a daily basis for 4 days post-op, after which patients were usually discharged. All adverse events were reported and compared between the two groups. Results: 106 patients were analyzed in the tapentadol group and compared to 105 patients treated with oxycodone/naloxone. Both pain intensity at rest and upon movement were significantly lower in the tapentadol group at all follow-up times (p < 0.001). Throughout T1-T4, supplemental analgesia was needed by significantly less tapentadol patients compared to the control group. Similarly, regarding side effects, a significantly higher occurrence of post-op nausea, vomit, itching and constipation was observed in the control group (p < 0.001 in all cases). Conclusion: Results from the present study support the use of tapentadol in combination with ketoprofen for the management of moderate-severe pain in the setting of major orthopedic surgery, given its effectiveness in reducing pain intensity, and its satisfactory tolerance.

© 2019 Wolters Kluwer Health, Inc. All rights reserved. Purpose of reviewThe frequency of hospitalization for anaphylaxis has increased over the last 20 years across Europe, Australia, and North America, particularly, for food and medication triggers. Adolescents show the highest risk for morbidity and fatality from food-induced anaphylaxis, yet there is little high-quality evidence addressing the reasons for this disproportionate vulnerability.Recent findingsRecent data seem to suggest a possible increasing burden of food-induced anaphylaxis among adolescents. Trends in anaphylaxis mortality are stable in North America and the United Kingdom, but not in Australia where the incidence of fatal anaphylaxis has recently doubled. The age distribution of fatal anaphylaxis varies according to the nature of the culprit trigger, with data suggesting an age-related predisposition to fatal food anaphylaxis in adolescents and young adults. Adolescence represents a critical phase of transition when rapid and substantial physical, emotional, and social changes occur. Therefore, adolescents show challenges in self-management that are different from other age groups, contributing to a higher risk of poor anaphylaxis outcomes.SummaryThe purpose of this review is to summarize recent data on epidemiology and elicitors of anaphylaxis in adolescents and to address currently known barriers and potential facilitators to self-management of anaphylaxis in this vulnerable age group.

© 2019, Pediatria Ltd. All rights reserved. Urinary tract infection (UTI) is one of the most common diseases of the urinary system faced by pediatricians. Objective of the research: To study and analyze outpatient records of patients in their first year of life, sent to a nephrologist for a consultation due to microbial inflammatory changes in urine general analysis. Materials and methods: Outpatient records of 160 children aged from 1 month to 1 year, who were sent in 2017 for a consultation with a nephrologist in consultative diagnostic clinic of G.N. Speransky City Children's Hospital № 9 with directing diagnosis UTI. Results: Authors performed an assessment of guiding diagnoses, age and gender composition of patients, an assessment of life anamnesis and disease clinical symptoms dynamics before referring patients for consultation with a nephrologist. The article discusses mistakes and issues of diagnosing UTI in young children. Conclusion: Authors substantiates pediatrician’s tactics for timely UTI diagnosis in young children and correct tactics of managing these patients.

© 2019 European Association of Urology In this review, we investigated the treatment options for primary urethral cancer. While organ-confined disease can be managed with local resection, growth beyond the organ calls for a combination of different treatment modalities, such as surgery, chemotherapy, and radiotherapy, to improve the survival of patients.

© 2019 John Wiley  &  Sons Ltd Aims and objectives: To examine how nurses' knowledge of behaviours indicating pain in mechanically ventilated patients and self-perceived collaboration between nurses and physicians affects the adequacy of departmental pain management. Background: Pain management is a vital factor of medical treatment in a hospital setting. Inadequate pain management requires attention both from a patient-focused perspective and from a departmental one. It would be particularly troubling in the case of inadequate pain management of mechanically ventilated patients. Design: The study utilised a cross-sectional design. The instruments developed were validated by a focus group of 25 pain management nurses, who reviewed the questionnaire for face validity, feasibility and comprehensibility, and who did not participate in the study. The questionnaire was revised, readjusted and formulated based on their responses and comments. Methods: A self-administered questionnaire administered in Israel with a convenience sample of 187 registered nurses (RN) from internal medicine and surgical departments and ICUs. Data were collected during February–May 2015. The “STROBE” EQUATOR checklist was used. Results: Nurses working in the ICU scored significantly higher on knowledge of behaviours indicating pain in mechanically ventilated patients and on self-perceived collaboration between nurses and physicians. Self-perceived collaboration between physicians and nurses was positively correlated with perceived departmental pain treatment adequacy. Self-perceived collaboration between nurses and physicians, knowledge of behaviours indicating pain in mechanically ventilated patients and seniority (with a borderline significance) explained 27% of the variance of perceived departmental pain management. Conclusion: Nurses' knowledge of behaviours indicating pain in mechanically ventilated patients, as well as self-perceived collaboration between nurses and physicians, promotes reported adequate pain management. Relevance to clinical practice: Pain management would benefit from being conducted as a well-performed interprofessional self-perceived collaborative practice. Knowledgeable nurses tend to critically assess the level of departmental pain management.

© 2018 The Author(s). Background: The approaches to the diagnosis and treatment of chronic spontaneous urticaria (CSU) differ in various parts of the world. We sought to determine the adherence to international and national urticaria guidelines as well as the motives to deviate from the guidelines among physicians worldwide. Methods: A web-based questionnaire was created and launched via e-mail by the World Allergy Organization (WAO) to representatives of all WAO Member Societies, the members of the American Academy of Allergy, Asthma & Immunology (AAAAI) and the members of the WAO Junior Members Group (JMG), regardless of the specialty, affiliation, or nationality in March 2017. Results: We received 1140 completed surveys from participating physicians from 99 countries. Virtually all participants (96%) were aware of at least one urticaria guideline and reported that they follow a guideline. However, one in five physicians who follow a guideline (22%) reported to deviate from it. Reliance on own clinical experience is the most frequent reason for deviation from guidelines or not following them (44%). Young (< 40 years) and less experienced physicians more often follow a guideline and less often deviate than older and experienced ones. Physicians who follow a urticaria guideline showed higher rates of routinely ordering a complete blood count, the erythrocyte sedimentation rate, C-reactive protein, anti-thyroid antibodies, and thyroid-stimulating hormone and of performing the autologous serum skin test as compared to those who do not. Physicians who follow a urticaria guideline showed higher rates of using second generation antihistamines as their first-line treatment of CSU (p = 0.001) and more frequently observed higher efficacy of these drugs (or had more confidence that it would work, p < 0.019) as compared to those who do not follow the guidelines. Conclusions: Physicians' characteristics (e.g. age, clinical experience, and specialty) and country specifics and regional features (e.g. availability of drugs for CSU treatment) importantly influence adherence to urticaria guidelines and CSU patient care and should be addressed in more detail in future research.

© 2018 Background: Fabry disease, an inherited lysosomal storage disorder, causes multi-organ pathology resulting in substantial morbidity and a reduced life expectancy. Although Fabry disease is an X-linked disorder, both genders may be affected, but generally to a lesser extent in females. The disease spectrum ranges from classic early-onset disease to non-classic later-onset phenotypes, with complications occurring in multiple organs or being confined to a single organ system depending on the stage of the disease. The impact of therapy depends upon patient- and disease-specific factors and timing of initiation. Methods: A European panel of experts collaborated to develop a set of organ-specific therapeutic goals for Fabry disease, based on evidence identified in a recent systematic literature review and consensus opinion. Results: A series of organ-specific treatment goals were developed. For each organ system, optimal treatment strategies accounted for inter-patient differences in disease severity, natural history, and treatment responses as well as the negative burden of therapy and the importance of multidisciplinary care. The consensus therapeutic goals and proposed patient management algorithm take into account the need for early disease-specific therapy to delay or slow the progression of disease as well as non-specific adjunctive therapies that prevent or treat the effects of organ damage on quality of life and long-term prognosis. Conclusions: These consensus recommendations help advance Fabry disease management by considering the balance between anticipated clinical benefits and potential therapy-related challenges in order to facilitate individualized treatment, optimize patient care and improve quality of life.

© 2018 Authors. The authors substantiate the need to develop a scientific and methodical approach to modernizing business processes of a pharmacy using information technologies. IK FARM LLC pharmacy has been chosen as a model object of the study. The IDEF0 (Integrated Definition Function Modeling) method adopted as a state standard in the US and recommendations of the State Standard of Russia R 50.1.028-2001 have been used for the analysis, systematization and reorganization of business processes. The article offers methodology for optimizing the pharmacy's activities, which includes the building of two models for managing business processes - before and after modernization (AS-IS and AS-WILL). The structure of the AS-WILL model includes new functions: "Plan the pharmacy's activities" (set the goals and objectives of the organization, plan target sales for the next period) and "Monitor the pharmacy's activities" (control the compliance with the rules of drugs' storage and layout, sanitary regime, and rules of property operation). The complex automation of the pharmacy's trading activities ensures these functions through the Magister software. Estimated efficiency of business processes' modernization based on the net present value has indicated that automation of processes will increase net unreduced profit.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Introduction of amendments to the registration dossier is the responsibility of the marketing application holder (MAH). Increased knowledge on pharmaceuticals, its manufacturing and control processes can reduce the number of documents submitted to the regulatory authorities. The existing requirements establishing the procedure for the introduction of amendments differ in terms of change classification, period of notification of regulatory authorities, ways of conformity validation of pharmaceutical properties, etc. ICH proposed draft guideline Q12 «Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management» which covers the problem of harmonization of regulatory approaches to the changes provided in the «Quality» section of CTD during the commercial phase of drug life cycle. The new guideline can be considered as the continuation and elaboration of previous ICH documents. The article provides explanations on the main provisions and regulatory mechanisms introduced by the draft guideline ICH Q12: categorization of post-approval changes, established conditions, post-approval change management protocol, and drug product lifecycle management.

Published by Oriental Scientific Publishing Company © 2018. The study assessed stress and brux activity among dental students during exam (stress) and non-examination (non-stress) periods. The study was initiated as a single group design with the total number of participants 36 (25 females and 11 males). All the participants were examined twice (once in a stress period and once in a non-stress period) according to “Clinical Functional Analysis”, which includes questions about students’ medical and dental history, as well as muscle palpation results. Two «BruxCheckers» (BCs) were applied, one for the upper jaw, the other for the lower jaw, two times for examination and non-examination periods. After the use, the «BCs» were photographed according to the research protocol and the abraded facets area on «BCs» was calculated in square millimeters. The research showed that during a stress period students may have headaches, cramps and pain in shoulder and neck muscles. The research also revealed that during the stress situation the abraded area shifts from frontal teeth to chewing teeth and brux episodes can occur more frequently and with a higher load. Chewing teeth (premolars in our study) are more adapted and more useful for such a condition. Accordingly, our students shifted their brux behavior from teeth 33 and 31 to teeth 15 and 24. Therefore, exams are a strong stress factor for dental students. In turn, prolongated stress can be an indicator of risk factor and have a negative effect for health of the craniomandibular system.

© Izdatel'stvo Meditsina. All rights reserved. In the article, an overview of the information on the method and application technology of SWOT (Strengths, Weaknesses Opportunities, Threats) analysis is presented. The specific characters of the method, the object domain of its application, the task, the methodology are disclosed. An interesting idea is the scheme of the options used to achieve more complete benefit from the method. The strengths and the shortcomings of the SWOT analysis noted by experts in the field of its application are given. Further on, the authors propose an innovative technology for using the SWOT model to develop personalized forecasting, preservation, development, and management of health, based on the provisions of the functional direction of genetics - phenomics. The advantages of technology, the urgency of its application are revealed. The new technology is based on provisions of the development of the theory of the essential adaptation. To ensure the state of health the functioning level of the body's systems must be consistent with the optimality, namely with their response norms, which determine the individual phenotype. In the process of the organism adaptation to the conditions of the external environment, the central nervous system (it's a known fact) and the significant body system (the system with the maximum response norm), determining, respectively, the specific and nonspecific responses of the organism will be released by their activity. In the interaction of body systems, it is important to take the ordering into consideration. Dominant systems can actively involve other systems of the body to the process of adaptation according to the principle of the interaction with them, by strengthening or decreasing their activity. Taking into account the direction of interaction (inhibition, toning), this fact becomes important for understanding the pathogenesis of diseases, their targeted prevention, and treatment. A comprehensive record of the mechanisms of the formation of a specific and nonspecific reaction is used in the interest of identifying and effectively preventing functional disorders in the body. The SWOT analysis technology of personalized forecasting, preservation, development and health management eliminates the main drawbacks of SWOT analysis. On the other hand, the SWOT analysis technology helps to expand the range of application of phenomics, depending on the opportunities and threats of the environment.

© 2018 Dynasty Publishing House. All rights reserved. Hepatocellular carcinoma (HCC) is rarely diagnosed during pregnancy, its fibrolamellar variant (FHCC) is a specific form that is more often diagnosed in young women and is rarely associated with cirrhosis or chronic infection with hepatitis B or C viruses. Making a diagnosis at early stages is complicated by the fact that the α-fetoprotein (AFP) level is usually not enhanced, and symptoms develop only at advanced stages of disease. A clinical case of FHCC in a 27-year-old woman is presented, diagnosed at the 30th week of pregnancy after persistent dragging and spastic pains in the epigastric region. US detected a tumour with sizes 110 × 81 × 89 mm and foci in the lungs. Variants of treating such patients depending on tumour characteristics, pregnancy period and family preferences are discussed.