The possibilities of photodynamic therapy in palliative care for patients with oncological diseases of the upper digestive tract
Photodynamic therapy is a binary effect, both components of which - dye and light - are individually non-toxic and only when used together in the presence of oxygen in the tissues destroy tumor cells.
The PDT method in oncology clinics has been widely used in the Russian Federation since 2000. During this period, scientific research was conducted on the use of photodynamic therapy in the treatment of early and advanced forms of malignant neoplasms, both in combination with other treatment methods, and as an independent method of improving the quality of life of weakened patients who have contraindications to surgical intervention. PDT is used in the combined treatment of tracheal, bronchial, lung cancer, pleural mesothelioma, gastric carcinoma, esophageal cancer, skin melanoma and its intradermal metastases, intradermal metastases of breast cancer, bladder cancer, cervical, vulvar, vaginal and ovarian cancer.
Analysis of the need for palliative medical care and pain relief in the Voronezh region
Abstract. To date, measures to provide palliative care to citizens in the Voronezh Region are carried out in 51 medical organizations in accordance with the Order of the Department of Health of the Voronezh Region dated 08/26/2022 ¹2163 «About the rules for the organization of palliative care for adult population in the Voronezh region». Statistical evidence that quantitatively reflect patients registered and receiving opioid for pain management in the Voronezh Region are collected in the Register of Persons who Need to Prescribe Narcotic Drugs for Medical Reasons and receive such drugs when providing palliative care. The article presents an analysis of the Registry data with an assessment of the structure of incurable progressive diseases and conditions requiring palliative care, and the ongoing relief of chronic pain syndrome with opioid analgesics recommended for use.
Improvement of the quality of life and stabilization of the disease in an elderly patient with melanoma of the skin on the background of immunotherapy with the first PD-1 inhibitor of the IgG1 isotype with a modified Fc fragment
Key words: malignant neoplasms, melanoma, immunotherapy for skin melanoma, immunotherapy, the first PD-1 inhibitor of the IgG1 isotype with a modified Fc fragment, side effects, quality of life, ñlinical observation.
Stepanova A.M., Obukhova O.A., Merzlyakova A.M., Gameeva E.V., Tkachenko G.A.
Rehabilitation of patients with tumors of the gastrointestinal tract
Abstract: the improvement of antitumor treatment has significantly increased the survival rate of patients with tumors of the gastrointestinal tract, so the question of the quality of life of these patients becomes relevant. To improve the quality of life, comprehensive rehabilitation is necessary, including physical, social, psychological recovery, diet correction /nutritional support.
Keywords: rehabilitation; tumors of the gastrointestinal tract; nutritional support; physical rehabilitation
Method for reconstruction of the gastrointestinal tract after gastrectomy in patients with disseminated forms of gastric cancer
Annotation
The purpose of the study is to create a new method for reconstruction of the gastrointestinal tract after gastrectomy in incurable (palliative) patients with disseminated forms of gastric cancer complicated by bleeding to perform salvage surgery and improve the quality of life.
Material and methods. In the oncology department of the hospital of the Russian Academy of Sciences (Chernogolovka, Moscow region) and in the clinic of Faculty Surgery No. 1 of the First Moscow State Medical University. THEM. Sechenov, 34 patients underwent gastrectomy using conventional methods and 34 patients using a new method.
Results. In a study of gastrectomies in patients with gastric cancer in the late stage of the disease, it was reliably proven that the new method of reconstructive surgical treatment virtually eliminates the occurrence of reflux esophagitis, stenosis, and anastomositis in comparison with conventional methods of such operations.
Conclusion. The proposed method of forming an esophageal-intestinal anastomosis seems promising in reconstructive surgery after gastrectomy in patients with advanced gastric cancer.
Key words: advanced gastric cancer, method of reconstruction after gastrectomy.
Improving the results of surgical treatment of incurable patients with tumors of the stomach, pelvis, rectum and breast
New proprietary methods of surgical treatment of incurable patients with complicated malignant neoplasms were used during emergency surgery, which was rescue surgery for such a severe group of patients, which made it possible to improve the quality of life and prolong it.
Laser radiation in surgical treatment of cancer patients
Annotation
Until now, the treatment of most patients with malignant neoplasms has been based on radical surgery, which, if there are certain indications, can be supplemented with radiation therapy and (or) one or another type of drug treatment. Over time, in the surgical specialty, the question of reducing the volume of radical treatment arises, however, it should be noted that such a measure not only does not relieve patients from the need to perform regional lymph node dissection, but also involves the use of radiotherapy or drug treatment in combination with surgery. In this regard, the number of patients suffering from a variety of organic and functional disorders, the development of which is caused not only by surgical tissue trauma, but also by the toxic effects of ionizing radiation and chemotherapy, is significantly increasing. One of the factors that can have a positive effect in limiting, compensating and eliminating undesirable effects of radical treatment methods is laser radiation. Its effect on the biological tissues of the patient can cause various photobiological effects and induce corresponding reactions not only in organs and tissues, but throughout the entire body. The effectiveness of the technique largely depends on the combination of many characteristics and parameters of laser radiation, methods and modes of its influence on the patient's body. In this regard, today, research is actively being carried out in the field of using laser radiation in the treatment of cancer patients.
PSYCHOTHERAPEUTIC ASPECTS
Goncharenko E.V., Argun S.N., Taysaeva S.B., Murzova O.A., Jack a A.A., Yasnopolsky Yu.V., Wexler Yu.A.
Anthropological and psychological aspects of altruistic behavior of medical workers
Abstract. The instinct of altruism in mammals is closely interrelated with the instinct of reproduction and attachment in child-parent contact. People with a developed brain structure are able to expand "kinship" ties not only within their family and the collective to which they belong, but also to show empathy for any representative of humanity who needs help. The medical profession is such an example of showing mercy and caring for a patient, which is based on altruistic behavior. A medical professional needs to demonstrate an ethical and understanding approach to the patient, as this improves communication, feedback between them and is the prevention of psychological burnout.
Key words: altruism, doctor, medicine, evolutionary approach, medical care
Palliative surgical treatment of patients with metastatic breast cancer
Annotation. Palliative surgical treatment of patients with stage IV breast cancer is aimed at improving the quality of life when radical treatment options have been exhausted and the likelihood of a complete cure is minimal.
The program of accompanying therapy for generalized patients with breast cancer that we have developed allows us to perform palliative surgical interventions to the planned extent, improve the immediate results of treatment and reduce the incidence of surgical complications and improve the quality of life for patients.
The role of neoadjuvant chemoradiotherapy in the treatment of esophageal cancer
Annotation. Currently, the choice of a method of treating patients with stage II-III esophageal cancer using neoadjuvant chemoradiotherapy is considered justified. This paper presents the results of evaluating the effectiveness of treatment of locally advanced esophageal cancer by independent remote radiotherapy, as well as competitive chemoradiotherapy conducted over the period 2018-2022. Analysis of treatment results (follow-up period from 1,5 to 4 years) showed that clinically marked (50-70%) and complete (18,2%) regression of the tumor, as well as high rates of therapeutic pathomorphosis of III-IV degree (72,8%).
Keywords: esophageal cancer, locally common process, chemoradiotherapy.
Zenkevich A.A., Zotov P.B., Garagasheva E.P.
The role of epigenetic modulation in the pathophysiology of pain
Chronic pain is a pressing public health problem and a serious psychological and socioeconomic burden affecting a large proportion of the population worldwide. More than 20% of patients experience various types of pain, characterized by increased pain sensitivity and a decrease in the quality of life. Several approved pain management regimens are available, but current analgesics are often hampered by lack of efficacy and serious side effects. Therefore, new strategies for the safe and highly effective treatment of chronic pain syndrome (CPS) are needed. Recent studies have shown that epigenetic mechanisms underlie CPS; elucidation of the molecular mechanism of DNA methylation, histone modification, and microRNA is of decisive importance for the discovery of new therapeutic methods for pain therapy.
Keywords: epigenome, DNA, RNA, pain, pain relief, palliative care
Non-invasive ventilation in patients providing palliative care
SUMMARY
Palliative care for patients with painful shortness of breath (dyspnea) and impaired breathing includes instrumental methods to ensure gas exchange function in the format of artificial pulmonary ventilation (ALV) and various modes of non-invasive pulmonary ventilation (NIV therapy). A special feature of NIV therapy is the ability to perform it at home for a long time, which allows you to effectively control and eliminate dyspnea, improve the quality of life and exercise tolerance. However, there is currently no evidence of its effect on the mortality rate of palliative patients and prolongation of time until the need for tracheostomy mechanical ventilation (ITV). With the rapid development of respiratory failure (acute respiratory failure - ARF), some modes of NIV therapy can be used to eliminate painful shortness of breath, reduce the reversible components of ARF (for example, pulmonary edema) and/or «per se» (in its pure form) as a palliative replenishment tool respiratory function (in case of an irreversible process).
The fate of persons with a positive test for hidden blood in the feces who refused further examination
Summary. Colorectal cancer is one of the leading oncological diseases in terms of morbidity and mortality, accounting for 10% of the total incidence of cancer of various localizations. Screening for colorectal cancer (CRC) remains a complex task, the solutions to which are becoming the subject of close attention of researchers around the world. Currently, the FOB GOLD method is available, which allows you to accurately determine the quantitative content of hemoglobin (Hb) in feces. Patients do not need to follow a special diet or change their lifestyle. The method is based on the antigen-antibody agglutination reaction between human hemoglobin present in the sample and anti-hemoglobin-antibody on latex particles [6]. If the indicator is >100 ng/ml, there is a high probability of a malignant neoplasm (MNO), a colonoscopy is required to clarify the diagnosis [8]. The data of the official accounting and reporting medical documentation of the Smolensk region, available in the Smolensk Regional Oncological Clinical Dispensary (SROCD), were used in the work. Patients were divided into groups depending on age, gender, stage of the process and were comparable according to these criteria.
Due to insufficient sanitary work, most of the patients have not been further examined: out of 1035 people, only 231 underwent colonoscopy. Analysis of the data of the consequences of this showed that within 1.5 years 15 patients from the group of "refused" were forced to apply urgently for neglected cases of CRC, when radical treatment was no longer possible, and therefore 53.3% died within a year.
Keywords: colorectal cancer, early diagnosis, FOB GOLD method, advanced forms.
Comprehensive medical rehabilitation against the background of adjuvant radiation therapy for breast cancer
Abstract: The resulting radiation reactions not only worsen the quality of life of patients, but can also lead to the interruption of the course of antitumor therapy, which necessitates comprehensive medical rehabilitation at the stage of adjuvant radiation treatment of breast cancer. A study of the effectiveness of the program of comprehensive medical rehabilitation of patients diagnosed with breast cancer at the stage of adjuvant radiation therapy with the use of nutritional support and physical factors was conducted. The study involved 75 patients at the stage of adjuvant radiation therapy for breast cancer. All patients underwent comprehensive medical rehabilitation, including: physical therapy, biofeedback training on the support reaction (balance therapy), classes with a medical psychologist, general magnetic therapy. The difference between the comparison group (n=38) and the main group (n=37) was that the patients of the main group additionally received specialized therapeutic and preventive nutrition LEOVIT ONCO, as well as exposure to low-temperature plasma. The results showed that the use of a specialized dietary product LEOVIT ONCO, general magnetotherapy, low-temperature plasma is an effective method of medical rehabilitation. The use of nutritional support and physical factors, as a component of comprehensive medical rehabilitation, contribute to maintaining the optimal nutritional status of the patient, reduces the manifestations of skin radiation reactions, improves the psycho-emotional state and quality of life of patients.
The use of medical devices in palliative care: review and prospects
Summary. This scientific article presents an overview of the use of medical devices in the provision of palliative care. Regulatory legal acts and various categories of medical devices, their application possibilities, accessibility and effectiveness in providing palliative care in hospital and at home, as well as future prospects for their use are considered.
Keywords. Medical devices, home use, palliative medical care, regulatory legal acts.
PSYCHOTHERAPEUTIC ASPECTS
Kalyuzhny I.P., Zorin K.E.
The role of a clinical psychologist in the comprehensive rehabilitation of a patient with acute leukoblastic leukemia on the basis of the pediatric oncology department
Annotation. The modern world, at the current stage of development, has not found an effective way to fully eliminate oncological diseases and their consequences. For a long period of time, a person has been trying to find a cure for this ailment, but, in modern conditions, we can only see certain ways to facilitate the course of various oncological pathologies. All this, of course, is a prerequisite for technological progress in the medical field of scientific knowledge. However, there is no full-fledged medicine. This fact, in itself, is a determinant of psychotraumatic influence. Therefore, every person who is faced with oncology is already at risk for an increased likelihood of psychological difficulties. In such cases, the work of a psychologist is not just important, it is an integral part of any treatment and rehabilitation process. This article is devoted to just such an activity - the role of a clinical psychologist. Using the example of a specialist's work with a child suffering from acute neuroblastic leukemia, we would like to show how significant the psychological state of the patient is in the overall picture of the course of cancer. After all, a small patient, like no one else, critically needs help in such a traumatic situation. His own mechanisms of coping with stress, often, are not yet sufficiently developed and cannot effectively cope with such a serious stimulus. A child with oncological pathology needs help from the outside. Moreover, this assistance should affect not only the medical aspect, but also many others that intersect, one way or another, with psychological science.
Keywords. psychological care, oncology, palliative care, psychological correction, rehabilitation, psychological counseling, neuroblastic leukemia.
Methods for assessing adherence to therapy in chronic diseases
Summary: This article discusses the problem of compliance and ways to improve it, which is important in the treatment of chronic diseases and the prevention of complications. The authors describe the main groups of factors influencing the decline in adherence to therapy. The characteristics of the main methods of assessing compliance are also given.
Surgical treatment of palliative patients with metastatic tumors of the spine
The purpose of the study: to increase the effectiveness of surgical treatment of palliative patients with metastatic tumors of the spine, improve the quality of life.
Materials and methods: 60 patients with metastatic lesions of the spine were operated on, 30 of them were the main group, 30 people were the control group. In the main group, accompanying therapy was used with the use of adaptogens (Phenibut, Adaptol) and the antiseptic Anolyte neutral, which washed the surgical wound for 3 minutes in an amount of 1.5 liters.
Results: Surgical treatment of palliative patients with metastatic lesions of the spine with the use of accompanying therapy improves the functional state of the body and allows you to quickly start early rehabilitation to prolong life.
Conclusion: active surgical tactics in the treatment of palliative patients with metastatic lesions of the spine in combination with accompanying therapy significantly improves the quality of life.
Key words: surgery for palliative patients, metastases to the spine, accompanying therapy, quality of life, pain syndrome.
The results of palliative chemotherapy for ovarian cancer in the chemotherapeutic department No. 2 of the Smolensk Regional Oncological Clinical Oncological Dispensary (2019 - 2021)
Objective. To evaluate the results of treatment of patients with ovarian cancer who underwent palliative chemotherapy in the chemotherapy department No. 2 of the Smolensk Regional Oncological Clinical Dispensary for the period from 2019 to 2021.
Materials and methods. Based on the data of the territorial cancer registry of the Smolensk Regional Oncological Clinical Dispensary, the official accounting and reporting medical documentation (case histories, statistical coupons, outpatient cards) of patients with a morphologically confirmed diagnosis of ovarian cancer who underwent inpatient treatment for the period from 2019 to 2021 was carefully studied . in the chemotherapy department No. 2 of the Smolensk Regional Oncological Clinical Dispensary in the form of palliative chemotherapy. Statistical processing of the results included methods of descriptive statistics and was carried out using MS Excel 10.
Results. The total study group consisted of 41 patients with an established diagnosis of ovarian cancer who underwent palliative chemotherapy. The mean age of the patients was 64.8 years. A complete response to chemotherapy was noted in 65.8%, a partial response (stabilization) - in 9.9% of cases, and progress of the disease was observed in 24.3%. As a concomitant pathology, 30.9% of patients had coronary heart disease. In 25 patients who received neoadjuvant chemotherapy, drug pathomorphosis was studied, which was noted in grade I - in 8%, grade II - in 24%, grade III - in 32% and grade IV - in 36%.
Conclusion.The largest proportion of patients with OC in the group studied by us fell on the age category from 61 to 70 years (63.4%). Despite the elderly average age of the patients (64.8 years) and the presence of concomitant pathology in 67% of all patients, chemotherapy was completed completely. Despite the fact that the treatment of patients with ovarian cancer was palliative, the HT regimen we used (Carboplatin + Paclitaxel) allowed us to obtain a complete response in 65.8%, a partial response (stabilization) in 9.9%, progress was noted in 24.3% female patients. The addition of Bevacizumab to the HT regimen (Carboplatin+Paclitaxel) increased the rate of drug pathomorphosis by 1.3 times. In 2021, the relapse-free period for 12 months was 66.6%.
Possibilities of simulation training for specialists in the field of palliative medicine. Methodological aspects of organizing palliative medicine centers
Summary. Due to the aging of the human population and advances in medical science, the number of patients suffering from chronic diseases is increasing throughout the world. In these settings, palliative care (PCC) begins at the time of first decompensation of a chronic disease, complements primary care, and is guided by the patient's values and preferences regarding long-term care and preferred place of death. Training of physicians in the basics of palliative medicine should begin as early as possible and be based on the principles of caring, compassion, competence, communication, courage and devotion to duty. There is currently no uniform standard for training doctors. According to numerous studies, the development of educational programs requires the participation of a wide range of specialists in the field of medicine, sociology and psychology, as well as the training of experienced mentors, determination of criteria for the quality of training, assessment of the importance of educational technologies, with the formation of short-term and long-term communication trainings. It is urgent for future medical specialists to undergo professional training in various institutions providing primary care. Training programs should inform doctors about the main trends in the development and innovative models of providing primary care, ensuring its early availability, continuity and succession, which forms a person-oriented approach to the patient and his needs and reflects the social significance of the problem. Changes in the demographic structure of the population require the involvement of all segments of the population in teaching the basics of palliative medicine, among which the role of the doctor is decisive. In this regard, it becomes extremely important to organize schools of palliative medicine for doctors, in which, with the help of simulation training, they will master communication skills, diagnostic techniques, algorithms for action in unforeseen and emergency situations, basic and advanced skills and abilities in palliative medicine and related specialties, as well as Team interaction trainings are conducted.
Key words: palliative medical care, educational programs, competencies, simulation training technologies, end of life period, schools of palliative medicine.
Ovchinnikova S.V., Aleshkevich M.A.
The importance of medical and social work in the system of palliative care in the assessments of citizens of the Russian Federation
Annotation. The article considers a comprehensive approach to palliative care for terminally ill patients and their relatives. Attention is drawn to the importance of medical and social work in the system of palliative care. The results of the applied research made it possible to analyze the awareness of citizens about palliative care in our country and to assess the importance of medical and social work in the palliative care system. The questionnaire questions are also aimed at getting respondents an idea of the technologies of medical and social work, with the help of which the social problems of palliative patients and their immediate environment in the palliative care system are solved.
Key words: palliative care, palliative care system, medical and social work in the palliative care system, medical and social work technologies, multidisciplinary team.
Treatment of urgent abdominal complications in cancer patients
Summary. The immediate results of surgical treatment in oncological patients with urgent abdominal complications were studied - 106 oncological patients out of 2080 people admitted to surgical departments providing emergency care in 2022. All abdominal complications are divided into several groups: obstruction of various parts of the gastrointestinal tract; mechanical jaundice; bleeding from a tumor; inflammatory complications of tumors with peritonitis. The nature of the complication, the type of surgical aid, and the immediate results of surgical treatment were studied. The obstruction was 46%; at the same time, colonic obstruction, the main cause of which was colorectal cancer - 33.9%. Mechanical jaundice in 37.7%. Inflammatory complications with peritonitis - in 9.6%: intestinal perforation in 6.6%. Bleeding from a tumor in 6.6% of patients: the most common cause of bleeding was decaying stomach cancer - 3.8%. Thus, operations for urgent abdominal complications in abdominal cancer account for 7.6% of the total number of all operations in emergency surgical departments; mortality after surgery in this group is 17.9%, the highest mortality in cases of mechanical tumor jaundice and inflammatory complications of tumors with the development of widespread peritonitis.
Keywords: abdominal complications of tumors; emergency surgery; results of surgical treatment.
Oncology issues: treatment of benign breast dysplasia depending on its types
Aim. Breast diseases are on the rise among women of all ages every year. According to statistics, benign breast dysplasia is diagnosed in 50-60% of women.
Objective. To evaluate the effectiveness of non-hormonal drugs in the treatment of benign mammary dysplasia, depending on the type of diffuse dyshormonal dysplasia.
Materials and research methods. 180 women of reproductive age with a regular menstrual cycle were treated, who were prescribed first-line drugs for benign mastopathy: herbal medicine, a drug based on the common tarantula, indole carbinol, cabergoline. The main evaluation of the results of treatment was carried out after 6 and 12 months. Mathematical analysis: a method for constructing four-field tables, for comparison, McNemar's chi-square test.
Results. In patients with hyperprolactinemia, improvement in well-being on taking drugs was not earlier than 6 months. The best result (decrease in radiation and palpation density, decrease in complaints) was registered in patients with a predominance of the fibrous component in the treatment with a preparation based on the common tarantula, with a predominance of the glandular component - with the use of indole carbinol. After 12 months of observation, a decrease in the effectiveness of treatment with this group of drugs for diffuse non-proliferative mastopathy was revealed both in patients without hyperprolactinemia and in patients with hyperprolactinemia. After 6 months, improvement was noted in 110 patients (61%), and after 12 months, only 20 (11%). The observed decrease in improvement was statistically significant (p=0.003)
Conclusions. The decrease in the effectiveness of treatment of patients after 12 months dictates the need for annual dispensary observation by a gynecologist of this group of patients. It is important to adjust the tactics of managing patients. This will be a secondary prevention of the development of nodular forms of mastopathy, breast cancer.
Keywords: benign breast dysplasia, hyperprolactinemia, treatment of diffuse mastopathy
Clinical example of managing a patient with EGFR positive NSCLC
Summary. Lung cancer remains one of the most aggressive human tumors, being the most common cause of death in both men and women worldwide. Conducting molecular genetic testing in patients with adenocarcinoma, on the one hand, made it possible to expand the arsenal of drugs in the presence of genetic breakdowns (in particular, mutations or deletions in the EGFR gene), on the other hand, made us think about EGFR+ NSCLC as a more aggressive tumor than previously thought . This article presents a clinical case of treating a patient at different stages of the development of EGFR+ NSCLC, and also shows the role of palliative care at an advanced stage of the disease. The use of targeted therapy and specialized palliative care made it possible to increase life expectancy and maintain an acceptable quality of life in a patient with stage 4 EGFR+ NSCLC with metastases to the meninges, brain, and bones.
Evolutionary behavioral patterns in psychological self-regulation of a patient with oncological disease
Abstract. The article examines the psychological reactions of the patient to the oncological diagnosis, possible psychological, emotional and social disorders during the treatment process. The team of authors attaches great importance to evolutionary behavioral patterns, which can be the basis of self-regulation of the emotional-volitional sphere and the neuropsychic state. Tactile touch, trance state, creativity, social support are forms of behavior of homo sapiens, hominids and primates and contribute to the activation of the mesolimbic dopamine system of the brain and the harmonization of physical and mental state.
Features of metastasis to the bone tissue of malignant neoplasms of various localizations
Summary: In this study, we collected and analyzed the data of the official accounting and reporting medical records of patients with malignant neoplasms (MN) with bone metastases, the territorial cancer registry of the Smolensk Regional Oncological Clinical Dispensary for the period from 2010 to 2020. The sample included 639 patients with MN who had bone metastases detected by bone scintigraphy (OSG). Both men (47.9%) and women (52.1%) are equally prone to bone metastasis, regardless of the primary source of MN. The highest peak of bone metastasis is observed at the age of 61 to 70 years (43.51%). The leading localizations of cancer metastasizing to the bone tissue are the mammary and prostate glands (39.12% and 35.37%, respectively), bronchi and lungs (6.1%), kidney (5.48%) and uterus (5.16%). %). Topographic localizations, in which bone metastases are detected more often than in the rest, are: the central quadrant of the mammary gland (68%); tumor extending beyond the main bronchi, upper, middle or lower lobe of the bronchi or lung (28.2%); with uterine malignancy - endometrial tumor (39.4%). It is necessary to carry out OSG before treatment in patients with diagnosed malignant neoplasms, since timely detection of bone metastases will allow to correctly stage the tumor process and prescribe adequate treatment in time, which in turn will improve the quality and life expectancy of patients, and will also make it possible to count on a good survival outcome. When conducting dynamic monitoring, it is necessary to increase the frequency of OSG in patients aged 61 to 70 years with cancer.
Key words: bone metastases, bone scintigraphy, breast cancer, prostate cancer.
Surgical rehabilitation of oncological patients with persistent facial nerve paralysis
Abstract. Currently, most patients with neoplasms of the head and neck undergo surgical intervention at the stage of pronounced clinical manifestations, when the preservation of the facial nerve is a difficult and sometimes impossible task. One of the main problems after radical operations is to improve the results of functional and aesthetic rehabilitation of patients with persistent facial nerve paralysis. Surgical correction of the consequences of facial nerve damage is very diverse, the choice of one or another method of rehabilitation of this category of patients depends on the persistence and duration of paralysis. The presented work demonstrates a new method of static correction of damage to the facial nerve of the upper zone of the face when reinnervation technologies cannot be applied.
Keywords: facial nerve damage, head and neck tumors, nerve revitalization
The role of endoscopic stenting in the palliative treatment of patients with inoperable esophageal cancer
The impact of endoscopic stenting on median survival in patients with inoperable esophageal cancer has been evaluated. The results obtained indicate that endoscopic stenting not only improves the quality of life of patients, but also the long-term outcomes of treatment in some patients.
Opportunities for simulation training of specialists in the field of palliative medicine. Methodologicalaspectsoftheorganizationofschoolsofpalliativemedicine
Summary. Palliative care is a new type of medical care that is actively developing both in our country and around the world. A change in the structure of morbidity due to the predominance of long-term non-communicable diseases, as well as the rapid aging of the human population, leads to an avalanche-like increase in the number of people in need of long-term care. According to numerous studies, the resources of national health systems are insufficient to meet today's needs in palliative care. The problem of attitudes towards death, palliative care, medical ethics and competencies in these areas is actively discussed by society and in the media. Unfortunately, the level of training of specialists in the field of palliative medicine remains insufficient, which leads to the emergence of conflict situations in medicine at various levels. Despite the obvious relevance, generally accepted training programs for specialists in palliative care have not yet been developed. Among the requirements for the content of these programs, the most frequently mentioned are: accessibility for various segments of the population, perceptibility, continuity, versatility, ethics, practical orientation with an emphasis on the widespread use of simulation technologies in the training of relatives, volunteers, nurses, nurses and paramedics. The desire of the majority of severely suffering patients to die at home dictates the need to teach the basics of care to the general population with different mental abilities, cultural, national and religious differences. In this regard, the organization of schools of palliative medicine of the first and second levels for the training of relatives, volunteers, nurses, nurses and paramedics using simulation technologies becomes extremely relevant.
Key words: palliative care, educational programs, competencies, simulation learning technologies, end-of-life period, schools of palliative medicine.
Mironchenko M.N., Kuznetsova A.I.
On the occasion of the 65th anniversary of Andrei Vladimirovich Vazhenin, Academician of the Russian Academy of Sciences: Organization of palliative care in the South Urals
Radiotherapeutic approach in the treatment of breast cancer in a patient with Arnold-Chiary malformation type I. Case from practice
Abstact. radiation therapy for breast cancer plays an important role and accounts for 1/3 of radical treatment. The possibilities of planning on the treatment table during the radiotherapy treatment are limited and may deviate from the standards due to diseases of the musculoskeletal system or congenital pathologies. The article presents a clinical case of modification of styling and dosimetric planning in breast cancer patient with an anomaly in the development of the brain. The modified position during radiotherapy made it possible to do the treatment.
Key words: breast cancer, Chiari malformation type I, radiation therapy.
Optimization of treatment options for basal cell carcinoma, taking into account the results of ultrasound scanning of the skin
Annotation. During the last decade, there has been no decrease in the incidence of basal cell skin cancer. This pathology is characterized by a tendency to the occurrence of local relapses. To better determine the degree of local spread of the tumor, ultrasound scanning of the focus and surrounding tissues was used, which made it possible to determine the depth and area of the focus. The results of the study made it possible to choose a more adequate treatment strategy (surgical excision, photodynamic therapy, laser). Two-year treatment results showed the prospects of this study.
Keywords: basal cell skin cancer; ultrasound scan of the tumor; treatment tactics.
Psychological characteristics of patients with malignant neoplasms of the most frequent localizations
Psychological characteristics of patients with malignant neoplasms of the most frequent localizationscomplicated multifactorial nature of cancer attracts the attention of scientists of various sciences, including psychology. The article presents systematized data on the data available in the world science on the psychological characteristics of cancer patients, as well as the results of the study of the psychological characteristics of patients with malignant neoplasms of the most frequent localizations: breast cancer, prostate cancer, stomach, lung, colon and rectum cancer. As a result, significant differences were found in the studied groups in all the studied parameters: basic beliefs, coping behavior, indicators of subjective control, resilience, life orientation. The obtained results can serve as a scientific basis for the development of a system of psychological support for patients with malignant neoplasms, individualization of antitumor therapy.
The use of therapeutic physical factors in the reabilitation of patients with oncological profile
Summary. Cancer patients have various psychological disorders, including in palliative patients, anatomical defects, often requiring reconstructive surgery, damage to the immune and metabolic systems, temporary and permanent disability, complicated by adverse consequences, which requires careful organization of the rehabilitation process. Currently, a three-stage complex rehabilitation of oncological patients is used with the use of various physiotherapeutic methods of treatment. Also considered important is the early use of rehabilitation methods ("pre-rehabilitation") - before the initiation of therapeutic and surgical treatment, which improves the prognosis of the disease. In patients with oncological profile, complex rehabilitation treatment, selected taking into account the individual approach, including the use of electrotherapy, magnetic fields, therapeutic massage, ultrasound therapy, EHF therapy, darsonvalization, low-intensity laser therapy, intermittent pneumocompression, contributes to the successful implementation of the rehabilitation potential of patients.
Practical aspects of personalized doctor-patient communication in palliative medicine
Summary. Palliative care is a special type of medical care, in the implementation of which the doctor's communication skills play a crucial role. The previous article covered in detail the methodological aspects of communication, its relevance, the historical path in the light of changing models of medical care, as well as the benefits of teaching the communication skills of doctors, which subsequently leads to a decrease in the frequency of repeated hospitalizations, appointment of duplicate studies and, ultimately, to an increase in satisfaction of patients with the quality of medical care provided. The difficulties faced by physicians of all specialties in informing patients about the presence of a serious disease, the low and inconsistent effectiveness of various treatments and a disappointing prognosis were demonstrated. This article will consider the practical aspects of communication between the doctor, the patient and his relatives. It has already been proven that the low efficiency of personalized doctor-patient communication may be due to the insufficient preparedness of the doctor-specialist, the incorrectly built structure of the message itself, the imperfection of the means of communication, as well as the limited possibilities in the perception and interpretation of information by the patient. Often, the high workload of doctors does not allow enough time to discuss key issues with the patient, which leads to the emergence of so-called «situational dramas». Most doctors forget that 93% of communication time is represented by non-verbal communication. The fears that patients experience before a frank conversation with a doctor are often expressed in «false speech constructions».At all stages of communication, certain rules should be followed to avoid counter-transference, show empathy, maintain neutrality and objectify emerging emotions. Methods used in related disciplines, such as discourse analysis, neurolinguistic programming, clinical and cognitive interviews, can be of particular help in this regard. Separately, cases of limited communication capabilities of patients due to various diseases and ways to overcome them are considered. In such situations, special attention should be paid to innovative technologies that allow both the doctor and the patient to find new opportunities for personalized communication to develop a compromise solution in determining the methods and place of treatment, taking into account the possibilities of palliative care.
Key words: palliative care, personalized communication, medical competence, «situational dramas», countertransference, empathy, objectification of emotions, discursive analysis, clinical interview.
Definition of the CD4/CD8 index as a possible criterion for the severity of the course and prognosis of lung cancer among HIV-infected people
Abstract. People, living with HIV, have a greater chance of malignancies due to many factors, especially HIV-related immunosuppression, which worsens the control of inflammatory agents, coinfection and oncogenic viruses. Here with, lung cancer, despite of the absence of proven direct or indirect viral carcinogenesis, is one of the most common causes of death from cancer in HIV-infected persons.
The main purpose of this article is to research HIV-associated risk factors, which may affect on the tumor course and period of life in this group of patients.
Retrospectively were analyzed the medical documentation of 98 patients with lung cancer and HIV-infection (FAS(full analyses set ) population) who were in database of St. Petersburg «Center for the Prevention and Control of AIDS and Infectious Diseases» and received specialized treatment in St. Petersburg State budget institution of healthcare «City Clinical Oncology Dispensary» and St. Petersburg State budget institution of healthcare «City Tuberculosis Hospital No. 2» from 2008 to 2018 years. This statistic analyses describe the specific HIV-associated factors impacting the possible prognosis and course of lung cancer during ART to view further possible changes in prevention and proper treatment in this group of patients.
Nutritional and physiotherapeutic support for post-pancreatectomy syndrome
Annotation. Pancreatic cancer (PJ) is one of the most aggressive and common tumors.
The purpose of the work is to clarify the tactics of neoadjuvant alimentation after various types of PD, taking into account the huge database of existing drugs for nutritional correction.
Material and methods.
27 patients with pancreatic tumors of various localization were examined. The nutritional status, intoxication, indications for accompanying physiotherapy, and three-year survival of patients were determined.
Results.
Supportan is an electrically neutral drug that allows, when carrying out artificial alimentation in combination with detoxifying environments of nutritional maintenance, to remove toxins more efficiently.
Due to electrical neutrality, it is possible to introduce physiotherapeutic procedures and remaxol dezination into the complex of therapy and nutritional correction of gastrointestinal diseases, which increase the effectiveness of the treatment.
Artificial alimentation (in particular, SUPPORTAN) - is mandatory in the structure of the treatment of enterological pathology, does not give side complications from the gastrointestinal tract.
Complex treatment of pancreatic tumors is preferable in comparison with the traditional one.
Abstract: the incidence of primàry bone neoplasms is often diagnosed before the age of 35, at a socially significant age. Bone metastases are in third place in frequency of occurrence after lung and liver metastasis. This indicates the need for full-fledged rehabilitation of this category of patients, including a multidisciplinary approach. The article presents an algorithm for step-by-step rehabilitation of oncoortopedic patients with a detailed description of the methods used
Effects of biotherapy on the quality of life of a patient with cecal NET
Despite the fact that NETs are often described as rare tumors, their frequency has increased markedly over the past four decades, which can be explained by improved diagnostic measures (Dasari - 2017). In particular, this fact can be explained by 1) increased alertness for these diseases, 2) more frequent use of endoscopic methods for screening of OCs, 3) high sensitivity of immunohistochemical and radiological diagnostic methods of examination, 4) as well as optimization of the NET classification.
According to the US Cancer Registry, the incidence of NET increased by 6.4 times from 1973 to 2012 (Dasari -2017). 000 people in the US, which is higher than the incidence of cancer of the stomach, pancreas, esophagus or hepatobiliary system.
Key words: neuroendorin tumors, NET, immunohistochemistry, somatostatin, carcinoid syndrome, ECOG, quality of life.
The right to anesthesia: the use of epidural ports in palliative cancer patients
Summary. The article analyzes the literature data, which presents data from studies and clinical cases of the use of port systems in the treatment of pain relief in palliative patients and other groups, present own experience of implantation and operation of the spinal port system in palliative cancer patients of the inpatient department of palliative care.
Keywords. Cancer patients, palliative care, inpatient department, port systems, epidural anesthesia
Psychological risks of breast cancer among women living in a megalopolis: factor model
Breast cancer is the most common form of cancer in women. The need to search for risk factors for breast cancer is due to high rates of morbidity and mortality from this disease. Women at high risk of breast cancer should be offered more intensive monitoring and preventive measures. As a result of the study, it was found that the factor model of psychological risks of breast cancer includes four groups of factors represented by indicators of personal helplessness, cognitive beliefs, subjective control and coping strategies. Each of the factors obtained contributes to the peculiarities of the system of mental organization of patients with malignant neoplasms and to the likelihood of malignant neoplasms, in particular breast cancer.
Keywords: breast cancer, risk factors, oncopsychology, depression, morbidity, coping strategies, subjective control, personal helplessness, worldview
DIGEST
Khabibullina Z.A., Mironov P.I.
Modern approaches in the treatment of chronic pain syndrome using implanted paravertebral ports
Àuthors presents an analysis of the major contemporary approaches to the treatment of chronic pain syndrome in Oncology. Basic methods to study the quality of life and methods of diagnosis of chronic pain syndrome in cancer patients with generalized forms of cancer. The article also addresses the issues of chronic pain treatment: pharmacotherapy, regional block, epidural and paravertebral blocks with the installation of implantable systems under ultrasound control.
The problem of personalized doctor-patient communication in palliative medicine
Summary. Palliative care is a new type of medical care aimed at improving the patient's quality of life, including alleviating the symptoms of a patient suffering from a chronic illness. Along with medical aspects, the doctor must deal with difficulties of a psychological and social nature, for the solution of which knowledge of the basics of effective communication is a decisive factor. However, the availability of communicative training while obtaining basic education is about 29%, and almost half of the doctors do not know how to inform the patient about his formidable disease, treatment goals, prognosis, and the possibilities of palliative medicine. This leads to difficulties in the diagnostic and treatment process, patient dissatisfaction with the quality of medical care and an increase in financial costs for non-targeted additional studies and repeated hospitalizations. According to foreign authors, when providing palliative care, advance planning of long-term care is carried out in less than 60% of cases. In the context of the modern bioethical model of medical care, based on the principles of «respect for human rights and dignity», communication between a doctor and a patient becomes a larger and more complex problem. Despite the abundance of information, there are few evidence-based studies in this area, and the results discussed remain largely contradictory and difficult to generalize. This article opens a series of publications devoted to the problems of personalized communication between a doctor, a patient, and his relatives.
Key words: palliative care, communication, models of medical care, medical competence, advance care planning, end-of-life period
Evaluation of subjective and personal characteristics of patients with different variants of the course of prostate cancer
Prostate cancer is one of the most common malignant neoplasms of the genitourinary system of men. Determining the psychophysiological characteristics of patients before and during treatment can serve as a factor influencing the choice of method and timing of the early rehabilitation period.
The assessment of subjective and personal characteristics was carried out in 46 patients diagnosed with prostate cancer who received various radical treatment options. The assessment was carried out according to the following methods: a scale of basic beliefs, a test of life orientation, a test of resilience, a questionnaire of subjective control, a questionnaire of quality of life (SF-36). It was revealed that patients with stage IV of the disease are characterized to a greater extent by internality in the sphere of interpersonal relations, restriction of activity as a result of the intensity of the pain syndrome. Patients with stage I-II of the disease are more likely to experience limitations in performing daily work associated with a deterioration in their emotional state, which, in turn, requires rehabilitation programs aimed at this area of mental health.
Key words: Prostate cancer, quality of life, internality, resilience, life orientation
Stepanova A.M., Merzlyakova A.M., Tkachenko G.A.
Low anterior resection syndrome: modern methods of rehabilitation of patients
Low Anterior Resection Syndrome (LAR syndrome) is a collection of symptoms that occurs after resection of the rectum and loss of reservoir and evacuation function. The most frequent violations, according to various authors, are fecal incontinence of varying severity (97%), frequent stools (80%), urgent urge to defecate (67%), violation of bowel movement with fractional defecation and a feeling of incomplete emptying (47%), increased gas formation (34%). In addition, dysuric disorders and disorders of sexual functions may be observed. That leads to a significant detriment in the quality of life. Multimodal treatment of LAR syndrome should include the correction of the diet, lifestyle changes, drug therapy, the use of cleansing enemas, pelvic floor muscle training, neurostimulation, psychotherapy. Implementing a complex rehabilitation intervention for patients suffering from LAR syndrome improves their quality of life and social adaptation.
Organization of work to provide palliative medical care to oncological patients in the south-eastern zone of the Republic of Tatarstan in the conditions of the hospital
Summary. The article analyzes the organization of work on palliative care for cancer patients in the inpatient department of palliative care. The provision of palliative medical care in a hospital allows you to prolong life and improve its quality in patients in the terminal stage of the disease, and also makes life easier for the patient's able-bodied relatives. Based on the results of the analysis, the main problems were identified and possible solutions were identified.
Keywords. Cancer patients, palliative care, inpatient department.
EXCHANGE OF EXPERIENCE
Goryacheva K.V., Portnyagin I.V.
Catheter techniques for interventional pain management
According to the modern consensus of therapy, pain syndromes of any etiology require the appointment of analgesic drugs. According to the WHO Pain Management Ladder (WHO, Geneva 1986), it is recommended to start analgesic therapy with non-steroidal anti-inflammatory drugs, using them from minimally effective to maximum dosages for a prolonged period of time.
Key words: oncological diseases, therapy of pain syndromes
Ethical and psychological approach of specialists of the palliative visiting patronage service in the communication "The physician-legal representative"
Abstract. The work of doctors of the palliative visiting patronage service requires high psycho-emotional resources and protective mechanisms of the psyche, because the death of a terminally ill child is a psychological trauma not only for parents, but also for medical workers. To avoid professional burnout, aggression of parents who are in chronic stress and grief, service specialists use an ethical and psychological approach with family members of a palliative patient for an environmentally friendly and productive interpersonal interaction in providing assistance.
Key words: palliative care, communication, rapport, grief, chronic stress.
Analysis of psychological rehabilitation of cancer patients in the VOCOD Medical Center
The purpose of the study was to analyze the results of various psychological tests, assess the nature and impact of psychological rehabilitation on the quality of life of cancer patients.
Assessment of the risks of abuse of tapentadol, a new strong opioid with a dual mechanism of analgesic effect, a review of the results of foreign studies
Abstract. In the review, data from foreign medical publications are presented, which are dedicated to the narcogenic potential of a strong opioid with dual mechanism of analgesic action - tapentadol. Risk assessments of drug addiction development, of its diversification into illegal trafficking for non-medical use are given. Assessment data have a comparative character with other opioids. In analyzed articles, authors used different methodological approaches to the assessment of tapentadol narcogenicity, in particular to the evaluation of the results of population-based cohort studies, to the analysis of large databases accumulating data on different drug abuse including opioids, data on intoxication with preparations of the group, and some others. Based on the analysis of published assessment results of potential risks of tapentadol use, the author gives the evaluation of the organization of its accountability and prescription in Russia
CLINICAL AND ECONOMIC ANALYSIS OF DRUGS FOR THE TREATMENT OF SPINAL PAIN SYNDROME ASSOCIATED WITH DEGENERATIVE-DYSTROPHIC CHANGES
Resume. Pain syndrome in the spine associated with degenerative-dystrophic changes is one of the most important problems of modern medicine. This is primarily due to its high share in the structure of morbidity of the middle-aged population and high rates of temporary labor losses. According to statistics from the World Health Organization, about 80% of the population have experienced at least one episode of back pain during their lifetime. In the Russian Federation, about 48% of patients seek help due to local pain syndrome in the lumbosacral region, against the background of degenerative-dystrophic changes of the spine (DDIP), 8.9% - due to radicular pain syndrome. Despite the high prevalence of the disease, the treatment of pain syndromes associated with DDPP seems to be a difficult task. The treatment approaches that currently exist can be divided into medicamental, non-medicamental, interventional and surgical. The main drugs for the treatment of back pain are nonsteroidal anti-inflammatory drugs, glucocorticosteroids, muscle relaxants, antiepileptic drugs and antidepressants (selective serotonin and norepinephrine reuptake inhibitors, tricyclic). Among non-medicinal products, various modalities of physiotherapy, massage, manual therapy, physical therapy are distinguished. Interventional methods are understood as the introduction of drugs (mainly a local anesthetic with or without glucocorticosteroids) into the area of the pain generator - muscle, facet joint, epidural space. In case of ineffectiveness of the above methods, surgical intervention can be performed. The creation of algorithms for the treatment of various variants of pain syndromes associated with DDIP will improve the level of treatment, reduce the risk of chronization of the process, reduce the need and timing of hospitalization, therefore, improve the quality of life and reduce economic costs.
Keywords: pain, clinical and economic simulator, choice of treatment, spinal pain, muscle pain, root pain, short-term, cost -effectiveness, quality of life.
PALLIATIVE CARE FOR CHRONIC HEART FAILURE: RELEVANCE, OBJECTIVES AND PROBLEMS
Summary. Since the middle of the 20th century, the main paradigm of medical care has been the fight against noncommunicable diseases. Palliative care (PHC) is an integral part of this strategy for patients with end-stage chronic diseases, including chronic heart failure (CHF). In connection with the aging of the human population and the "rejuvenation" of key risk factors for public health, patients with CHF are very heterogeneous both in age and in the state of the cardiovascular system at the time of the need for PHC. Despite the urgency of the problem, there are single regulatory documents in the world regarding the specifics of the provision of PHC in CHF. Having left the oncology service, palliative care faces many problems in patients with non-oncological, including cardiac diseases. Features of their solution and related difficulties are discussed in the presented article.
Keywords: noncommunicable diseases, palliative care, chronic heart failure, global disease burden, comorbidity, long-term care, quality of life.
Pchelintsev M.V., Modorskaya A.N.
ANALYSIS OF THE PRESCRIPTION OF STRONG OPIOIDS USED TO TREAT PAIN IN ST. PETERSBURG IN 2021 AMONG CITIZENS ELIGIBLE FOR PREFERENTIAL DRUG COVERAGE
Abstracts. In this work, based on the information from the Medical Center for Information and Analysis database of the Saint-Petersburg Healthcare Committee, we analyzed the qualitative and quantitative structure of the opioid analgesics' prescription to out-patients entitled to pharmaceutical benefits in Saint-Petersburg in 2021. The analyzed year, a quantitative comparison of prescribed medications, using the Defined Daily Dose (DDD) calculation method was performed. The directions of further improvement of the opioid analgesics' prescription to out-patients suffering from severe chronic pain are suggested.
PALLIATIVE TREATMENT OF CANCER OBTURATIONAL JAUNDICE USING INTERVENTION TECHNOLOGIES
A significant problem of emergency surgery is the treatment of patients with obstructive jaundice, developed as a result of malignant neoplasms of the pancreas and bile ducts. The analysis of surgical treatment of 64 patients who were treated at the clinic of Faculty surgery and Oncology of Saratov Medical University was carried out. Radical treatment was possible only in 8 of them. When choosing the method of decompression of the biliary tract, it was confirmed that interventional techniques for resolving tumor jaundice are a good alternative option for both staged and palliative treatment of patients with tumor mechanical jaundice.
Keyword. Obstructive jaundice; decompression of the biliary tract
Likhacheva D.S., Soloviev V.I., Zuy V.S.
ECONOMIC EFFECT OF THE SURGICAL STAGE OF TREATMENT OF PATIENTS WITH BREAST CANCER
Summary: In the present study, data were collected and analyzed from the territorial cancer registry of the Smolensk region and the official accounting and reporting medical documentation of the surgical departments of the regional state budgetary healthcare institution (OGBUZ) «Smolensk Regional Oncological Clinical Dispensary». For the period from 2018-2019. 1377 patients with tumors of the mammary glands were treated, including 713 people with malignant neoplasms. In 96 out of 713 patients, the diagnosis was made only after sectoral resection, which increased the cost of surgery per patient by 75,208.82 rubles. In total, the radical standard surgery after sectoral resection in this group of patients amounted to 7,220,046.72 rubles. (96 people * 75 28.82 rubles). The average bed-day upon receipt of a planned histological verification was 5.8 days. The cost of one bed-day was 7520.83 rubles. Thus, in 18 patients who required a planned histological examination, the additional costs for treatment amounted to 785,174.65 rubles. (18 people * 5.8 days * 7520.83 rubles). Summing up the economic loss of unverified cases of breast cancer during intraoperative sectoral resection and sectoral resection with the duration of hospitalization of patients in case of waiting for a planned histological conclusion, it amounted to 8,005,221.37 rubles. (7,220,046.72 rubles + 785,174.65 rubles) or about 13%.
REHABILITATION OF URINARY DISORDERS IN PATIENTS AFTER PROSTATECTOMY
Summary. Background. Radical prostatectomy is the main and effective treatment option for localized prostate cancer. The frequency of urinary incontinence after prostatectomy is becoming an increasingly common urological problem with a prevalence of 2.5 to 90%, depending on the determination of the degree of urinary incontinence.
The purpose of the study. To analyze the frequency of urinary incontinence in patients with prostate cancer after radical prostatectomy.
Materials and methods. A retrospective analysis of the results of treatment of patients under dispensary observation at the State Medical Institution «MKMC «Medical City», with a diagnosis of prostate cancer from 2014 to 2020, was carried out. The study analyzed the primary documentation of 206 patients with localized prostate cancer (T2ñ-3áN0M0) after radical prostatectomy. The median follow-up time was 36±10.3 months.
Results. Complications within 30 days after radical prostatectomy were registered in 10 (4.8%) patients and manifested: pelvic hematomas and failure of vesicourethral anastomosis). Urinary incontinence of severe and moderate degrees 3 months after surgery was observed in 32 (15.5%), after 1 year - in 19 (9.2%). Overall survival was 98.4%, cancer-specific - 100%, relapse-free survival - 71.3%, median time to PSA relapse - 21.5±6.4 (6-37) months.
Conclusion. No more than 10% of men who have undergone radical prostatectomy may need surgical treatment for urinary incontinence. To date, no randomized trial has yet demonstrated the effectiveness of one surgical treatment compared to another, however, it is recommended to obtain additional research data.
EXPERIENCE OF USING LAVRIK® TONING GEL AND LAVRIK® ANTISEPTIC LOTION FOR SKIN CARE OF PATIENTS WITH MOTOR DISABILITIES AGAINST THE BACKGROUND OF A NEW COVID 19 CORONAVIRUS INFECTION IN A MULTIDISCIPLINARY INFECTIOUS HOSPITAL
Abstract. Trophoneurotic skin defects (bedsores) significantly increase the economic costs of care and treatment of patients with COVID 19. The objectives: To evaluate the effects of using LAVRIK® gel and LAVRIK® lotion in skin care in patients with motor disabilities against the background of a new coronavirus infection COVID 19. Methods: A prospective comparative clinical study included 80 patients at risk of developing bedsores or diagnosed with bedsores of the first and second stages. All patients were diagnosed with a new coronavirus infection COVID 19, moderate or severe course, bilateral polysegmental pneumonia, respiratory failure of 0 or 1 degree. The patients were divided into 2 groups. For skin care of group 1 patients (n=40), daily treatment of the affected areas with LAVRIK® antiseptic lotion and LAVRIK® toning gel was used. Patients in the group 2 (n=40) were treated with standard external agents used to treat this pathology. The follow-up period is 3 weeks from the start of treatment. The following indicators of the activity of the pathological process were studied: the presence or absence of edema, erythema, cyanosis, scaling, pain syndrome. Results: Against the background of the use of LAVRIK® products in patients of the first group, a faster subsiding of the local aseptic inflammatory reaction and a decrease in the risk of progression of bedsores were noted. In addition, faster epithelization of wound skin defects was revealed in patients with the second stage of the trophoneurotic process, compared with the control group, where traditional drugs were used. The pronounced analgesic effect of LAVRIK® gel was noted. Conclusion: Thus, we recommend the wider use of LAVRIK® toning gel and LAVRIK® antiseptic lotion in patients with bedsores of the first and second stages and for their prevention.
LOWER URINARY TRACT SYMPTOMS DURING BCG THERAPY FOR LOCALIZED BLADDER CANCER: CORRECTION METHODS
Summary
Relevance. BCG therapy for localized bladder cancer is an integral part of modern urological oncological treatment protocols. at the same time, patients increasingly turn to urologists for manifestations of lower urinary tract symptoms (LUTS) that reduce their quality of life.
Purpose of the study. To assess the effectiveness of standard symptomatic treatment of LUTS in the course of BCG therapy for localized bladder cancer and its combination with the domestic combined phytocomplex Nefrobest.
Materials and methods. A comparative study of the effectiveness of various treatment regimens for LUTS arising in the course of BCG therapy for localized bladder cancer in 30 patients was carried out. We studied urination diaries, the results of the questionnaire survey, the results of instrumental examinations of the bladder and cystoscopy. A comparative retrospective study of the results of PET / CT of the whole human body with 18F-FDG before the start of BCG therapy and one year after it was carried out.
Results and discussion. BCG therapy for localized bladder cancer is an effective method of prolonging the disease-free course of the disease, but the manifestations of LUTS significantly reduce the quality of life of these patients. Standard symptomatic therapy eliminates the manifestations of an adverse event (AE), and its combination with the domestic combined phytocomplex Nefrobest improves the results of the treatment. Non-invasive PET / CT tomography of the whole body, performed in these patients in order to control the course of the underlying disease, makes it possible to additionally assess the state of the molecular-cellular metabolism of energy-intensive glucose molecules that provide the processes of suppressing inflammation and, possibly, protecting the bladder from tumor recurrence, which requires additional research. and refinement.
Conclusions. The quality of life of patients receiving BCG therapy for non-invasive bladder cancer is determined not only by the duration of the disease-free course of the disease, but also by the rehabilitation under the conditions of AE in the form of manifestations of LUTS.
THE EFFECT OF «CHEMICAL FOG» AND ANXIETY AS COMPLICATIONS OF ADJUVANT CHEMOTHERAPY IN PATIENTS WITH CANCER
Annotation. Further progress in the treatment of malignant neoplasms will be associated not only with improved early diagnosis of cancer, but also with increased attention to systemic drug antitumor therapy, all types of which are associated with various complications. Unfortunately, practitioners are very poorly informed about such complications as cognitive impairment and anxiety, which significantly impair the quality of life of patients.
Objective: to study the effect of adjuvant chemotherapy on cognitive functions and anxiety in patients with cancer.
Materials and Methods. The study included 150 patients with cancer, who underwent adjuvant chemotherapy. The age of the patients ranged from 22 to 79 years. Cognitive function was assessed using the short mental status assessment scale (MMSE) and the Montreal cognitive impairment assessment scale (MoCA test). The assessment of the level of anxiety was based on testing by the Hospital scale of anxiety and depression (HADS). The nonparametric statistical criterion Mann-Whitney U-test was used to compare groups of patients. The results were presented as the arithmetic mean and standard deviation (M (SD)).
Results. The data obtained indicated that patients who underwent adjuvant chemotherapy showed signs of cognitive impairment. Mild cognitive impairment was observed in patients who received less than 10 courses of anticancer therapy. Memory, attention, and concentration disorders were most affected. Patients who had undergone more than 10 courses of chemotherapy experienced moderate cognitive impairment. In addition to memory, attention, and concentration disorders, patients had disorientation in space and time, as well as short-term memory. Subclinical anxiety was observed in patients who had undergone less than 10 courses of chemotherapy. However, in patients with a history of more than 10 courses of chemotherapy, the level of anxiety was within the normal range.
MULTIMODAL APPROACH TO THE TREATMENT OF LOCALLY ADVANCED PROSTATE CANCER
Background. Currently, the choice of treatment for locally advanced forms of prostate cancer (prostate cancer) remains a subject for discussion in the oncourological community. For prostate cancer T3a-bN0M0, the following treatment options are possible: radical prostatectomy, radiation, hormone therapy and a combination of these methods. The validity of a combination of types of treatment for locally advanced prostate cancer is an object for many clinical studies.
The purpose of the study. To evaluate the long-term results of radical robot-assisted prostatectomy with adjuvant hormone-radiation therapy in patients with stage T3a-bN0M0 in comparison with radical robot-assisted prostatectomy.
Materials and methods. A retrospective analysis of the medical history of 50 patients with stage T3a-bN0M0 prostate cancer in the period from 2015 to 2019 was carried out. Patients were divided into 2 groups: I (n=25) after RARP, II (n=25) - after RARP and adjuvant hormone-radiation therapy. Selection criteria: the presence of morphologically confirmed prostate cancer; the degree of prevalence of the malignant process corresponding to the T3a-3b stages; the absence of regional and distant metastases according to the results of the examination.
Results. The average age of patients was 64±4.7 and 62±5.9 years, preoperative PSA levels were 9.6±7.6 and 12.8±12.1 ng/ml, and the median follow-up duration was 1.9±1.08 years in group I and 2.25±0.98 years in group II. All patients from group II received radiation therapy with a total focal dose (SOD) of 70 Gy on the prostate bed and 50 Gy on the area of regional nodes. Adjuvant hormone therapy was received by 100% of patients from group II for an average of 6 ± 1.7 months. Biochemical relapse in 36% of patients in group I, in 16% in group II of combined treatment. At the same time, the average timing of the onset of biochemical relapse averaged 8.2±4.2 months in group I, 13±4.8 months in group II. Local relapse was registered in 4% of group I in the period of 10 months after RARP. Overall survival in both groups was 100%, cancer-specific survival was also the same in the comparison groups and was equal to 100%. Indicator of 5-year relapse-free survival.
Conclusion. The results of our study showed that combined adjuvant treatment improves relapse-free survival, but without affecting overall and cancer-specific survival.
STATE AND PROSPECTS OF PALLIATIVE CARE IN THE REPUBLIC OF BASHKORTOSTAN
The article discusses the status of palliative care for patients in the Republic of Bashkortostan. The following are described in detail: the structure of palliative care, provision of beds, organizational and methodological assistance, training for 2021. The article also outlines a plan for the further development of palliative care for adults and children in the republic.
Key words: palliative medical care, structure, field service, malignant neoplasm, pain.
QUALITY OF LIFE OF PATIENTS WITH MALIGNANT NEOPLASMS IN THE PERIOPERATIVE PERIOD IN NEED OF NUTRITIONAL SUPPORT: METHODOLOGY OF THE SURVEY AND INTERPRETATION OF THE RESULTS
Summary. The purpose of preoperative nutritional support in patients with tumors of the gastrointestinal tract, CRC and head and neck was to study changes in clinical parameters and quality of life indicators. Despite the fact that practically on all functional scales for all types of tumors, the changes were not significant from 2 to 10% maximum, while only the general health status showed a serious increase in each group.
Key words: head and neck tumors, quality of life
SolovyovV.I., ZuiV.S., TashkunasD.O.
THE RESULTS OF THE ACTIVITY OF VISITING TEAMS OF THE HOSPICE OF THE SMOLENSK REGIONAL ONCOLOGICAL CLINICAL DISPENSARY IN THE CITY OF SMOLENSK
Summary. Target. To analyze the performance of mobile hospice teams of the Smolensk Regional Oncological Clinical Dispensary (SOOKD) for the period from 2010 to 2020.
Methodology. The data of the cancer registry of the Smolensk region and the official accounting and reporting documentation of the activities of the mobile team of the SOOKD hospice were carefully studied. Depth of information processing 2010-2020. This study was based on a study of the results of palliative care provided at home during the period from 2010 to 2020.
Statistical processing of the results of the study was performed using the calculation of average values, including methods of descriptive statistics. The analysis is carried out using the software package: OC Windows 10, Microsoft Excel.
Results. The indicator of the work of the SOOKD hospice mobile team for the period from 2010 to 2020 was analyzed. In order to provide palliative care to patients with advanced forms of malignant neoplasms, since 1998, a territorial center for palliative care has been organized on the basis of the regional state budgetary healthcare institution «Smolensk Regional Oncological Clinical Dispensary». The main link in the work of the center is the patronage service, which provides home care to patients with the IV clinical group of registration.The study was based on a study of the results of palliative care provided at home, in the period from 2010 to 2010. for 2020. In the period from 2010 through 2018, the number of house calls fluctuated between 685 and 1006 and averaged 890 calls per year. Between 2019 and year to 2020 there is a sharp trend towards an increase in the number of incoming calls. 2019 - 1142 (11.2%), 2020 - 1032 (10.1%), compared to 2017. - 790 (7.6%). We concluded that the total number of calls received more often in 2019. - 1552 (12.5%). The smallest number of calls for palliative care at home was noted in 2017. - 713 (5.7%). The already existing call system in the SOOKD hospice operates in the same mode as when it was opened in 1998.
Conclusion. 2019 accounted for the largest number of calls for palliative care at home, which amounted to 1552 (12.5%). Active departures in 2019 - 411 (19.1%) were more than in 2013 - 2 (0.1%). The number of visits provided by the patronage service of the hospice department, both on call and active since 2019. - 1142 (11.2%) in 2020 - 1032 (10.1%), compared to 2017 - 790 (7.6%) was more, which is associated with a pandemic caused by a new coronavirus infection COVID-19.
EFFICIENCY OF REHABILITATION AT PATIENTS WITH SUCCESSFULLYCURED TUBERCULOSIS
Resume: Patients with cured pulmonary tuberculosis not only retain residual post-tuberculosis changes but also various clinical and functional disorders which leads to a deterioration in the quality of life.
The aim of the study was to determine the effectiveness of rehabilitation measures at patients with cured pulmonary tuberculosis (post-TB).
Materials and methods. 22 patients (11 male and 11 female) who underwent sanatorium treatment in the tuberculosis sanatorium «Glukhovskaya»were the object of the study. The effectiveness of rehabilitation was assessed by pulse oximetry, the severity of dyspnea on the mMRC scale, exercise tolerance on the Borg scale, the state of psychological status on the Hospital Anxiety and Depression Scale (HADS), and determining the function of external respiration. Patients underwent sanatorium- rehabilitation using dry carbonic baths.
Results. During the treatment there was an increasing of arterial oxygen saturation (SpO2) from 96.6 ± 0.7% to 97.9 ± 0.7%, decreasing of the severity of dyspnea during exercise on the Borg scale from 3 ± 1.1 to 2, 2 ± 0.4 points and degreeing of dyspnea (mMRC) from 1.2 ± 0.4 to 0.8 ± 0.4 points. There was a significant decreasing of the level of anxiety from 8.1 ± 0.7 to 5.0 ± 0.7 points (p<0.05) and depression from 8.9 ± 2.8 to 5.4 ± 2.4 points (p<0.05).
According to spirometry data in half of the patients, the indicators were below the norm upon admission to the sanatorium: vital capacity (VC) was reduced at 10 (45.5%), forced VC (FVC) - at 11 (50%), forced expiratory volume in first second (FEV1) -at 10 (45.5%) patients. After rehabilitation normalization of parameters was noted: VC from 76.6 ± 7.3 to 80.7 ± 6.3%, FVC from 77.8 ± 9.1 to 81.6 ± 7.9%, FEV1 from 78.1 ± 9.4 to 82 ± 8.9%. Improvement of indicators was defined at 8 (80%), 5 (45.5%), 5 (50%) patients with initially low levels of VC, FVC and FEV1 respectivly.
Conclusion. Rehabilitation measures can significantly reduce the anxiety-depressive psychological background, the frequency of detecting subjective and objective manifestations of dyspnea, normalize spirometry indicators and improve the quality of life of patients.
Key words: tuberculosis, clinical cured tuberculosis, residual changes after pulmonary tuberculosis, rehabilitation, shortness of breath, functional tests
EXCHANGE OF EXPERIENCE
Kovner E.V., Ishutin A.A., Zolotareva L.S.
EXPERIENCE OF A PALLIATIVE CARE HOSPITAL WORK ON THE BASIS OF MOSCOW REGIONAL HOSPICE (FOR CHILDREN)
Abstract. Palliative care for children provides active and complete care for the body, spirit and mental state of a child with a life-limiting or life-threatening illness, as well as support for his family.
Aim. Description of the hospital palliative care model using the example of the «Moscow Regional Hospice (for children)».
Material and methods. The work was carried out on the basis of the «Moscow Regional Hospice (for children)». The data analysis from federal statistical observation forms (FSN): FSN ¹ 14 «Information on the activities of medical organization units providing medical care in inpatient settings», FSN ¹ 30 «Information about the medical organization», including forms ¹ 003/u «Medical card of an inpatient patient»; and data from the pediatric palliative care register were performed. From 2019 to 2021, 212 children, ages 2 months to 17 years inclusive, were hospitalized in the 24-hour inpatient hospice for children in Moscow region.
Results. At the moment, the structure of the children's hospice includes a 'round-the-clock' hospital with 13 beds, the course of stay in which is 21 days. In the hospital, we correct the analgesia and anticonvulsant therapy; observe the terminal child's state; relieve severe symptoms; train parents how to manage respiratory support; carry out a complex of measures of psychological support. Patients were admitted based on the decision of the medical commission (MC), according to the internal order ¹1240od «On the work of the hospitalization commission of patients in the inpatient palliative care unit for children of MOHD». In the fourth quarter of 2019 the hospice admitted 27 children, in 2020 - 85, and in 2021 - 100 patients, and the increase was 15%. The basis of the structure of morbidity were diseases of the nervous system (70%), congenital anomalies and chromosomal disorders (11%), endocrine system disorders, nutritional and metabolic disorders (5%), blood and hematopoietic organs diseases and certain disorders involving the immune mechanism (5%).
Conclusion. Palliative care for children has a number of features: from morbidity structure to the volume of assistance. It is comprehensive support for both the child and his family. Palliative care for children is the work of a team of professionals who practice a multidisciplinary approach and work towards one goal: to improve the quality of a child's life.
Keywords: Palliative Care, Pediatric; Hospice and Palliative Care Nursing; Seriously ill child; Medico-social approach; Quality of Life
LOWER URINARY TRACT SYMPTOMS DURING BCG THERAPY FOR LOCALIZED BLADDER CANCER: CORRECTION METHODS
Summary
Relevance. BCG therapy for localized bladder cancer is an integral part of modern urological oncological treatment protocols. at the same time, patients increasingly turn to urologists for manifestations of lower urinary tract symptoms (LUTS) that reduce their quality of life.
Purpose of the study. To assess the effectiveness of standard symptomatic treatment of LUTS in the course of BCG therapy for localized bladder cancer and its combination with the domestic combined phytocomplex Nefrobest.
Materials and methods. A comparative study of the effectiveness of various treatment regimens for LUTS arising in the course of BCG therapy for localized bladder cancer in 30 patients was carried out. We studied urination diaries, the results of the questionnaire survey, the results of instrumental examinations of the bladder and cystoscopy. A comparative retrospective study of the results of PET / CT of the whole human body with 18F-FDG before the start of BCG therapy and one year after it was carried out.
Results and discussion. BCG therapy for localized bladder cancer is an effective method of prolonging the disease-free course of the disease, but the manifestations of LUTS significantly reduce the quality of life of these patients. Standard symptomatic therapy eliminates the manifestations of an adverse event (AE), and its combination with the domestic combined phytocomplex Nefrobest improves the results of the treatment. Non-invasive PET / CT tomography of the whole body, performed in these patients in order to control the course of the underlying disease, makes it possible to additionally assess the state of the molecular-cellular metabolism of energy-intensive glucose molecules that provide the processes of suppressing inflammation and, possibly, protecting the bladder from tumor recurrence, which requires additional research. and refinement.
Conclusions. The quality of life of patients receiving BCG therapy for non-invasive bladder cancer is determined not only by the duration of the disease-free course of the disease, but also by the rehabilitation under the conditions of AE in the form of manifestations of LUTS.
THE EFFECT OF «CHEMICAL FOG» AND ANXIETY AS COMPLICATIONS OF ADJUVANT CHEMOTHERAPY IN PATIENTS WITH CANCER
Annotation. Further progress in the treatment of malignant neoplasms will be associated not only with improved early diagnosis of cancer, but also with increased attention to systemic drug antitumor therapy, all types of which are associated with various complications. Unfortunately, practitioners are very poorly informed about such complications as cognitive impairment and anxiety, which significantly impair the quality of life of patients.
Objective: to study the effect of adjuvant chemotherapy on cognitive functions and anxiety in patients with cancer.
Materials and Methods. The study included 150 patients with cancer, who underwent adjuvant chemotherapy. The age of the patients ranged from 22 to 79 years. Cognitive function was assessed using the short mental status assessment scale (MMSE) and the Montreal cognitive impairment assessment scale (MoCA test). The assessment of the level of anxiety was based on testing by the Hospital scale of anxiety and depression (HADS). The nonparametric statistical criterion Mann-Whitney U-test was used to compare groups of patients. The results were presented as the arithmetic mean and standard deviation (M (SD)).
Results. The data obtained indicated that patients who underwent adjuvant chemotherapy showed signs of cognitive impairment. Mild cognitive impairment was observed in patients who received less than 10 courses of anticancer therapy. Memory, attention, and concentration disorders were most affected. Patients who had undergone more than 10 courses of chemotherapy experienced moderate cognitive impairment. In addition to memory, attention, and concentration disorders, patients had disorientation in space and time, as well as short-term memory. Subclinical anxiety was observed in patients who had undergone less than 10 courses of chemotherapy. However, in patients with a history of more than 10 courses of chemotherapy, the level of anxiety was within the normal range.
MULTIMODAL APPROACH TO THE TREATMENT OF LOCALLY ADVANCED PROSTATE CANCER
Background. Currently, the choice of treatment for locally advanced forms of prostate cancer (prostate cancer) remains a subject for discussion in the oncourological community. For prostate cancer T3a-bN0M0, the following treatment options are possible: radical prostatectomy, radiation, hormone therapy and a combination of these methods. The validity of a combination of types of treatment for locally advanced prostate cancer is an object for many clinical studies.
The purpose of the study. To evaluate the long-term results of radical robot-assisted prostatectomy with adjuvant hormone-radiation therapy in patients with stage T3a-bN0M0 in comparison with radical robot-assisted prostatectomy.
Materials and methods. A retrospective analysis of the medical history of 50 patients with stage T3a-bN0M0 prostate cancer in the period from 2015 to 2019 was carried out. Patients were divided into 2 groups: I (n=25) after RARP, II (n=25) - after RARP and adjuvant hormone-radiation therapy. Selection criteria: the presence of morphologically confirmed prostate cancer; the degree of prevalence of the malignant process corresponding to the T3a-3b stages; the absence of regional and distant metastases according to the results of the examination.
Results. The average age of patients was 64±4.7 and 62±5.9 years, preoperative PSA levels were 9.6±7.6 and 12.8±12.1 ng/ml, and the median follow-up duration was 1.9±1.08 years in group I and 2.25±0.98 years in group II. All patients from group II received radiation therapy with a total focal dose (SOD) of 70 Gy on the prostate bed and 50 Gy on the area of regional nodes. Adjuvant hormone therapy was received by 100% of patients from group II for an average of 6 ± 1.7 months. Biochemical relapse in 36% of patients in group I, in 16% in group II of combined treatment. At the same time, the average timing of the onset of biochemical relapse averaged 8.2±4.2 months in group I, 13±4.8 months in group II. Local relapse was registered in 4% of group I in the period of 10 months after RARP. Overall survival in both groups was 100%, cancer-specific survival was also the same in the comparison groups and was equal to 100%. Indicator of 5-year relapse-free survival.
Conclusion. The results of our study showed that combined adjuvant treatment improves relapse-free survival, but without affecting overall and cancer-specific survival.
STATE AND PROSPECTS OF PALLIATIVE CARE IN THE REPUBLIC OF BASHKORTOSTAN
The article discusses the status of palliative care for patients in the Republic of Bashkortostan. The following are described in detail: the structure of palliative care, provision of beds, organizational and methodological assistance, training for 2021. The article also outlines a plan for the further development of palliative care for adults and children in the republic.
Key words: palliative medical care, structure, field service, malignant neoplasm, pain.
QUALITY OF LIFE OF PATIENTS WITH MALIGNANT NEOPLASMS IN THE PERIOPERATIVE PERIOD IN NEED OF NUTRITIONAL SUPPORT: METHODOLOGY OF THE SURVEY AND INTERPRETATION OF THE RESULTS
Summary. The purpose of preoperative nutritional support in patients with tumors of the gastrointestinal tract, CRC and head and neck was to study changes in clinical parameters and quality of life indicators. Despite the fact that practically on all functional scales for all types of tumors, the changes were not significant from 2 to 10% maximum, while only the general health status showed a serious increase in each group.
Key words: head and neck tumors, quality of life
SolovyovV.I., ZuiV.S., TashkunasD.O.
THE RESULTS OF THE ACTIVITY OF VISITING TEAMS OF THE HOSPICE OF THE SMOLENSK REGIONAL ONCOLOGICAL CLINICAL DISPENSARY IN THE CITY OF SMOLENSK
Summary. Target. To analyze the performance of mobile hospice teams of the Smolensk Regional Oncological Clinical Dispensary (SOOKD) for the period from 2010 to 2020.
Methodology. The data of the cancer registry of the Smolensk region and the official accounting and reporting documentation of the activities of the mobile team of the SOOKD hospice were carefully studied. Depth of information processing 2010-2020. This study was based on a study of the results of palliative care provided at home during the period from 2010 to 2020.
Statistical processing of the results of the study was performed using the calculation of average values, including methods of descriptive statistics. The analysis is carried out using the software package: OC Windows 10, Microsoft Excel.
Results. The indicator of the work of the SOOKD hospice mobile team for the period from 2010 to 2020 was analyzed. In order to provide palliative care to patients with advanced forms of malignant neoplasms, since 1998, a territorial center for palliative care has been organized on the basis of the regional state budgetary healthcare institution «Smolensk Regional Oncological Clinical Dispensary». The main link in the work of the center is the patronage service, which provides home care to patients with the IV clinical group of registration.The study was based on a study of the results of palliative care provided at home, in the period from 2010 to 2010. for 2020. In the period from 2010 through 2018, the number of house calls fluctuated between 685 and 1006 and averaged 890 calls per year. Between 2019 and year to 2020 there is a sharp trend towards an increase in the number of incoming calls. 2019 - 1142 (11.2%), 2020 - 1032 (10.1%), compared to 2017. - 790 (7.6%). We concluded that the total number of calls received more often in 2019. - 1552 (12.5%). The smallest number of calls for palliative care at home was noted in 2017. - 713 (5.7%). The already existing call system in the SOOKD hospice operates in the same mode as when it was opened in 1998.
Conclusion. 2019 accounted for the largest number of calls for palliative care at home, which amounted to 1552 (12.5%). Active departures in 2019 - 411 (19.1%) were more than in 2013 - 2 (0.1%). The number of visits provided by the patronage service of the hospice department, both on call and active since 2019. - 1142 (11.2%) in 2020 - 1032 (10.1%), compared to 2017 - 790 (7.6%) was more, which is associated with a pandemic caused by a new coronavirus infection COVID-19.
EFFICIENCY OF REHABILITATION AT PATIENTS WITH SUCCESSFULLYCURED TUBERCULOSIS
Resume: Patients with cured pulmonary tuberculosis not only retain residual post-tuberculosis changes but also various clinical and functional disorders which leads to a deterioration in the quality of life.
The aim of the study was to determine the effectiveness of rehabilitation measures at patients with cured pulmonary tuberculosis (post-TB).
Materials and methods. 22 patients (11 male and 11 female) who underwent sanatorium treatment in the tuberculosis sanatorium «Glukhovskaya»were the object of the study. The effectiveness of rehabilitation was assessed by pulse oximetry, the severity of dyspnea on the mMRC scale, exercise tolerance on the Borg scale, the state of psychological status on the Hospital Anxiety and Depression Scale (HADS), and determining the function of external respiration. Patients underwent sanatorium- rehabilitation using dry carbonic baths.
Results. During the treatment there was an increasing of arterial oxygen saturation (SpO2) from 96.6 ± 0.7% to 97.9 ± 0.7%, decreasing of the severity of dyspnea during exercise on the Borg scale from 3 ± 1.1 to 2, 2 ± 0.4 points and degreeing of dyspnea (mMRC) from 1.2 ± 0.4 to 0.8 ± 0.4 points. There was a significant decreasing of the level of anxiety from 8.1 ± 0.7 to 5.0 ± 0.7 points (p<0.05) and depression from 8.9 ± 2.8 to 5.4 ± 2.4 points (p<0.05).
According to spirometry data in half of the patients, the indicators were below the norm upon admission to the sanatorium: vital capacity (VC) was reduced at 10 (45.5%), forced VC (FVC) - at 11 (50%), forced expiratory volume in first second (FEV1) -at 10 (45.5%) patients. After rehabilitation normalization of parameters was noted: VC from 76.6 ± 7.3 to 80.7 ± 6.3%, FVC from 77.8 ± 9.1 to 81.6 ± 7.9%, FEV1 from 78.1 ± 9.4 to 82 ± 8.9%. Improvement of indicators was defined at 8 (80%), 5 (45.5%), 5 (50%) patients with initially low levels of VC, FVC and FEV1 respectivly.
Conclusion. Rehabilitation measures can significantly reduce the anxiety-depressive psychological background, the frequency of detecting subjective and objective manifestations of dyspnea, normalize spirometry indicators and improve the quality of life of patients.
Key words: tuberculosis, clinical cured tuberculosis, residual changes after pulmonary tuberculosis, rehabilitation, shortness of breath, functional tests
EXCHANGE OF EXPERIENCE
Kovner E.V., Ishutin A.A., Zolotareva L.S.
EXPERIENCE OF A PALLIATIVE CARE HOSPITAL WORK ON THE BASIS OF MOSCOW REGIONAL HOSPICE (FOR CHILDREN)
Abstract. Palliative care for children provides active and complete care for the body, spirit and mental state of a child with a life-limiting or life-threatening illness, as well as support for his family.
Aim. Description of the hospital palliative care model using the example of the «Moscow Regional Hospice (for children)».
Material and methods. The work was carried out on the basis of the «Moscow Regional Hospice (for children)». The data analysis from federal statistical observation forms (FSN): FSN ¹ 14 «Information on the activities of medical organization units providing medical care in inpatient settings», FSN ¹ 30 «Information about the medical organization», including forms ¹ 003/u «Medical card of an inpatient patient»; and data from the pediatric palliative care register were performed. From 2019 to 2021, 212 children, ages 2 months to 17 years inclusive, were hospitalized in the 24-hour inpatient hospice for children in Moscow region.
Results. At the moment, the structure of the children's hospice includes a 'round-the-clock' hospital with 13 beds, the course of stay in which is 21 days. In the hospital, we correct the analgesia and anticonvulsant therapy; observe the terminal child's state; relieve severe symptoms; train parents how to manage respiratory support; carry out a complex of measures of psychological support. Patients were admitted based on the decision of the medical commission (MC), according to the internal order ¹1240od «On the work of the hospitalization commission of patients in the inpatient palliative care unit for children of MOHD». In the fourth quarter of 2019 the hospice admitted 27 children, in 2020 - 85, and in 2021 - 100 patients, and the increase was 15%. The basis of the structure of morbidity were diseases of the nervous system (70%), congenital anomalies and chromosomal disorders (11%), endocrine system disorders, nutritional and metabolic disorders (5%), blood and hematopoietic organs diseases and certain disorders involving the immune mechanism (5%).
Conclusion. Palliative care for children has a number of features: from morbidity structure to the volume of assistance. It is comprehensive support for both the child and his family. Palliative care for children is the work of a team of professionals who practice a multidisciplinary approach and work towards one goal: to improve the quality of a child's life.
Keywords: Palliative Care, Pediatric; Hospice and Palliative Care Nursing; Seriously ill child; Medico-social approach; Quality of Life
¹1 2022 ã.
ORGANIZATIONAL AND METHODOLOGICAL ASPECTS
Cherchintseva E.A., Konopatskova O.M., Evdokimov G.M. DEVELOPMENT OF A SYSTEM FOR PROVIDING PALLIATIVE CARE TO CANCER PATIENTS IN THE SARATOV REGION
The analysis of the palliative care service in the Saratov region is Carried out. The experience of organizing palliative care for cancer patients in the region contributes to maintaining the quality of life of patients and increases the efficiency of its work. The analysis focused on the remaining problems.
Keyword. Palliative care; cancer patients; regional features.
GazizovR.A., GurylevaM.E., GrigorevaI.A., MaximovI.L., SaetgaraevA.K., ShaimardanovI.V. ONCOLOGICAL PATIENT: ON THE ORGANIZATION OF CARE IN THE POSTOPERATIVE PERIOD IN THE ICU WITH THE ENGAGEMENT OF VOLUNTEERS FROM THE PATIENT'S ENVIRONMENT
Abstract. Cancer patients are at high risk of postoperative complications and complex therapy of rehabilitation can reduce their number. At the same time, the best results are obtained when it is possible to involve trained and informed relatives of the patient.
The article presents the results of a study of the readiness of doctors of the intensive care and intensive care departments of an oncological dispensary to implement the concept of "open resuscitation", and the immediate environment of patients, to participate in the process of care and early rehabilitation of a relative.
Keywords: ICU department, medical staff, patient environment, volunteer, care, psychological support
CLINICAL AND EXPERIMENTAL RESEARCH
Ivanova D.V., Soloviev V.I., Zui V.S. RESULTS OF CHEMOTHERAPEUTIC TREATMENT OF PATIENTS WITH COMMON FORMS OF MALIGNANT NEOPLASMS IN THE DEPARTMENT OF PALLIATIVE CHEMOTHERAPY OF THE SMOLENSK REGIONAL ONCOLOGICAL CLINICAL DISPENSARY
Abstract. Objective. Evaluation of the effectiveness of chemotherapeutic treatment of patients with common forms of malignant neoplasms in the department of palliative chemotherapy of the Smolensk Regional Oncological Clinical Dispensary in 2019-2020.
Materials and methods. In the course of the work, the data of the official accounting and reporting medical documentation of the Department of palliative chemotherapy of the Smolensk Regional Oncological Clinical Dispensary (logs of hospitalization, medical histories, outpatient records of patients) and data of the regional cancer registry for 2019-2020 were carefully studied.
The evaluation of the effectiveness of chemotherapeutic treatment was carried out according to the following criteria: the severity of the pain syndrome was assessed according to the verbal assessment scale, the degree of physical activity - according to the ECOG/WHO scale, the degree of dysphagia - according to the radiography of the gastrointestinal tract, the quality of night sleep - according to its duration.
Statistical processing of the results of the study was performed using the calculation of average values, the Student's criterion at a critical significance level of 0.05. The analysis was carried out using the Microsoft Excel program.
Results. Palliative chemotherapy has been found to improve the quality of life in at least 37.2% of cases.
Conclusion. The possibilities of improving the quality of life for patients with common forms of malignant neoplasms are very limited and, nevertheless, this problem can be solved using the same therapeutic techniques that are used in the implementation of radical antitumor treatment. These include surgical treatment, radiation therapy and, among other things, chemotherapy. Palliative and supportive therapy becomes more effective in improving the quality of life if it is resorted to in conjunction with other methods of treatment, in particular chemotherapy
Keywords: palliative chemotherapy, breast cancer, stomach cancer, colorectal cancer
PERSONNEL TRAINING
ShevtsovaV.I., ZuikovaA.A., BolotskihV.I. EXPERIENCE OF TEACHING DISCIPLINE «PALLIATIVE MEDICINE» IN TIME TRAINING IN PROGRAMS OF AN INTERNSHIP
Summary. Development of palliative medical care as separate type of medical care is demands training of competent experts. Rendering palliative medical care is included in labor functions of experts. Formation of professional knowledge and skills happens when training the top skills according to programs of an internship. Discipline "Palliative medicine" for interns is implemented since 2018 in Burdenko Voronezh State Medical University. Experience of realization of discipline at faculty of training of the top skills is given in article.
Keywords: palliative medical care, internship, training of the top skills, palliative medicine
EXCHANGE OF EXPERIENCE
Vavilov V.V. ORGANIZATION OF THE WORK OF HOSPICE AND PALLIATIVE CARE IN THE REPUBLIC OF TATARSTAN BY THE NGO «ANGELA VAVILOVA FOUNDATION»
Summary. According to the experience of the Kazan hospice, due to the lack of funding from the state for palliative hospice care, the best way out for the regions in this situation is a public-private partnership in the construction and further financing of the work of hospices.
Key words: hospice, organization of work.
Markarova E.V., Kogoniya L.M. IMPROVING THE QUALITY OF LIFE AGAINST THE BACKGROUND OF EFFECTIVE IMMUNOTHERAPY IN AN ELDERLY PATIENT WITH SQUAMOUS CELL CARCINOMA OF THE PALATINE TONSIL
Over the past few years, significant success has been achieved in the use of immunotherapy in the treatment of solid tumors, including rare nosologies. In this work, we present our own clinical example of improving the quality of life of an elderly patient with squamous cell carcinoma of the palatine tonsil against the background of ongoing immune therapy.
Khabibullina Z.A., Mironov P.I., Akhmetova E.I. COMPARATIVE ANALYSIS OF METHODS OF ANALGESIA OF ONCOLOGICAL PATIENTS OF THE FOURTH CLINICAL GROUP WITH CHRONIC PAIN SYNDROME
Abstract. This article discusses approaches to the treatment of chronic pain syndrome in cancer patients. We propose to implement a previously unused method of analgesia - paravertebral analgesia with the use of a port system under ultrasound control. A comparative study of anesthesia methods was performed. The results of the study were analyzed using the method of expert evaluations. The article is intended for oncologists, anesthesiologists, medical workers of palliative care.
Keywords: chronic pain syndrome, the fourth clinical group, pharmacotherapy, methods of anesthesia, epidural blockades, implantable port systems.
Psychological work not only reduces and alleviates the feeling of anxiety and tension of a grieving person, but also contributes to the normalization of the process of experiencing grief, reduces the risk of various diseases on this basis, returns a person to everyday duties, the usual course of life.
DIGEST
Gusenbekova D.G., Ametov A.S. OBESITY. STRUCTURE AND FUNCTIONS OF ADIPOSE TISSUE
Summary. Obesity - excessive deposition of fat in the tissues of the human body, ch. arr. in subcutaneous adipose tissue. It is believed that the average weight of a person in 30 years is the most desirable in subsequent years. A significant increase in body weight, if there is no water retention in the body, almost always indicates obesity. Usually, a certain normal weight corresponds to a certain height of an adult. To find out it, you need to measure the height of an adult and subtract one hundred from the resulting number (in centimeters) (for example, with a height of 150 cm, the normal weight will be 50 kg). Fluctuations exceeding ± 5 kg indicate an abnormal weight.
Fat in the human body is formed from fats and carbohydrates that come with food. In a normal state of health, fat makes up about 18% of the total body weight, while with significant obesity, it can reach up to 50% and even up to 80% of the weight.
MODERN POSSIBILITIES OF USING ISOLATED LIVER CHEMOPERFUSION IN THE TREATMENT OF METASTATIC UVEAL MELANOMA
Summary: Uveal melanoma is the most common intraocular malignancy in adults. Local treatment of uveal melanoma are enucleation of oculus or high-dose brachytherapy. Regardless of the type of local treatment, distant metastasis develops in 35-50% of patients. The main target for metastases is the liver and in half of the cases the lesion is unresectable. The average overall survival of patients with liver metastases is 6-12 months. Current treatment strategies for isolated liver metastases are systemic and locoregional treatment of the metastases, but to date, none of the existing treatment options in phase III studies has demonstrated long-term overall survival in patients with uveal melanoma metastases to the liver. Isolated liver chemoperfusion is an interesting and promising locoregional technique for controlling uveal melanoma metastases, is one of the most resource-intensive and therefore one of the least investigated, despite its maximally transparent mechanism of action on metastases. The potential benefits of the survival rate are currently being studied in randomized clinical trials and metanalysis. The paper describes the technique of performing isolated liver chemoperfusion as performed by a team of authors.
TOPICAL ISSUES OF FINANCING MEDICAL NUTRITION AT THE EXPENSE OF THE MANDATORY MEDICAL INSURANCE FUND FOR PATIENTS WITH PROTEIN-ENERGY DEFICIENCY
Resume. Nutritional disorders and the trophological status of patients with malignant neoplasm (ZNO) significantly affect the results of treatment, overall survival and quality of life, especially in patients during chemotherapy and after surgery. Nutritional support should become an integral part of clinical protocols of antitumor treatment.
Goal. To develop a clinical and economic version of the model of a patient with protein-energy deficiency (ICD- 10: E 44. BEN) for a new clinical and statistical group (CSG) with the calculation of direct costs for the formed list of medical services and medicines. Calculate the tariff for 28 days, including enteral probe and siping nutrition, parenteral nutrition and overhead costs.
Methods. Analytical, methodological, pharmaco-economic (analysis of direct costs), expert assessments.
Results. The inclusion of nutritional status screening in the state guarantee program for the provision of free medical care to patients with ZNO will allow the formation of clinical and statistical groups and tariffs for the completed case of treatment of a patient with ZNO in need of nutritional support.
Conclusion. A model of a patient with ZNO undergoing surgical treatment is presented, based on a clinical study conducted at the P.A. Herzen Moscow State Medical Institute, which allowed the formation of a new clinical and statistical group for nutritional support at a cost of 77,900.99 rubles for 28 days of therapy in a round-the-clock hospital.
ASPECTS OF PRIMARY PALLIATIVE CARE FOR PATIENTS WITH CHRONIC HEART FAILURE
Summary. Ðatients with cardiovascular pathology take first place in the structure of those in need of palliative medical care. The outcome of all cardiovascular diseases is chronic heart failure (CHF). Patients with CHF will be in long-term need of palliative medical care. The article describes key points of providing palliative medical care to patients with CHF at the outpatient stage.
Keywords: palliative medical care, chronic heart failure, dyspneà, painful symptoms.
MODERN PRINCIPLES OF TRAINING AND TECHNOLOGIES FOR THE DEVELOPMENT OF EDUCATIONAL PROGRAMS ON PALLIATIVE MEDICAL CARE
Resume. An important step in the development of palliative care in Russia was the adoption on March 6, 2019 of Federal Law No. 18-FZ «On Amendments to the Federal Law «On the Fundamentals of Health Protection of Citizens in the Russian Federation » on the provision of palliative care», in which palliative care was divided into primary (pre-medical and medical) and specialized. This approach implies compulsory training in palliative care for medical workers employed not only in the palliative care system, but also in other medical organizations providing multidisciplinary outpatient and inpatient medical care, including training for nurses.
STRESSFUL AND SUICIDAL CONDITIONS OF HEALTH WORKERS IN THE COVID-19 PANDEMIC
In a multicenter anonymous survey of health workers (n=528) of multidisciplinary hospitals using the SAVE-9 questionnaire, the prevalence of psychosocial distress (> 40%); suicidal risk (5%) of respondents was shown; highlighted typical "portraits" of those at risk and requiring targeted preventive care
Keywords: COVID-19 pandemic; medical workers; distress, suicidal behavior, prevention
MULTIMODAL APPROACH TO THE TREATMENT OF LOCALLY ADVANCED PROSTATE CANCER
Summary. Background. Currently, the choice of treatment for locally advanced forms of prostate cancer (prostate cancer) remains a subject for discussion in the oncourological community. For prostate cancer T3a-áN0M0, the following treatment options are possible: radical prostatectomy, radiation, hormone therapy and a combination of these methods. The validity of a combination of types of treatment for locally advanced prostate cancer is an object for many clinical studies.
The purpose of the study. To evaluate the long-term results of radical robot-assisted prostatectomy with adjuvant hormone-radiation therapy in patients with stage T3à-áN0M0 in comparison with radical robot-assisted prostatectomy.
Materials and methods. A retrospective analysis of the medical history of 50 patients with stage T3à-áN0M0 prostate cancer in the period from 2015 to 2019 was carried out. Patients were divided into 2 groups: I (n=25) after RARP, II (n=25) - after RARP and adjuvant hormone-radiation therapy. Selection criteria: the presence of morphologically confirmed prostate cancer; the degree of prevalence of the malignant process corresponding to the T3à-á stages; the absence of regional and distant metastases according to the results of the examination.
Results. The average age of patients was 64±4.7 and 62±5.9 years, preoperative PSA levels were 9.6±7.6 and 12.8±12.1 ng/ml, and the median follow-up duration was 1.9±1.08 years in group I and 2.25±0.98 years in group II. All patients from group II received radiation therapy with a total focal dose (SOD) of 70 Gy on the prostate bed and 50 Gy on the area of regional nodes. Adjuvant hormone therapy was received by 100% of patients from group II for an average of 6 ± 1.7 months. Biochemical relapse in 36% of patients in group I, in 16% in group II of combined treatment. At the same time, the average timing of the onset of biochemical relapse averaged 8.2±4.2 months in group I, 13±4.8 months in group II. Local relapse was registered in 4% of group I in the period of 10 months after RARP. Overall survival in both groups was 100%, cancer-specific survival was also the same in the comparison groups and was equal to 100%. Indicator of 5-year relapse-free survival.
Conclusion. The results of our study showed that combined adjuvant treatment improves relapse-free survival, but without affecting overall and cancer-specific survival.
IMPROVING THE QUALITY OF LIFE OF A PATIENT WITH BREAST CANCER DURING THERAPY WITH CDK 4/6 INHIBITORS.
Breast cancer is a malignant tumor that develops from the epithelium of the lobules and ducts of the breast. Among the female population of the population, breast cancer occupies a leading (1) position in the structure of cancer incidence. The malignant transformation of breast cancer is based on somatic and inherited mutations, and the process itself is a sequence of random events. In this regard, the tumor may not have invasive growth for a long time or go to invasive growth, but not metastasize. That is why timely diagnosis and treatment are so important and relevant (2,4).
A new oral targeted drug (2) Ibransa (palbociclib) was approved on October 5, 2016 in the Russian Federation for the treatment of locally advanced or metastatic hormone receptor positive (HR +) breast cancer, human epidermal growth factor receptor 2 negative (HER2 -), in combination with fulvestrant after previous hormone therapy.
This is the first representative (2,4) of a new class of inhibitors of cyclin-dependent kinases (CDK) 4 and 6, which leads to the restoration of cell cycle control and blockade of tumor cell proliferation. Loss of control of the cell cycle is a characteristic feature of malignant neoplasms; in many of their types, CDK 4/6 hyperactivation occurs, which entails a loss of control over proliferation. CDK 4/6 are key cell cycle regulators that initiate cell progression from the growth phase (G1) to the phases associated with DNA replication (S). CDK 4/6, whose activity is often increased in breast cancer expressing estrogen receptors (ER+), are key downstream targets of ER-mediated signaling in ER+ breast cancer. Preclinical data have shown that dual inhibition of CDK 4/6 and the ER signaling pathway (3, 4) is synergistic and blocks the growth of ER+ breast cancer cell lines in the G1 phase.
Key words: breast cancer, breast adenocarcinoma, luminal type A, CDK4/6 inhibitors, hormonal therapy, ECOG status, efficacy.
Abstract. The analysis of the results of the quality of care for patients with stomy in the Saratov region was carried out. The experience of the organization shows the need to create specialized care for this category of patients in order to improve the quality of life.
THE HISTORY OF THE FORMATION OF PALLIATIVE CARE IN THE REPUBLIC OF TATARSTAN
Abstract. The term «palliative care» was first introduced by the American surgeon Balfour in 1975, however, palliative care takes its development from primitive people, on the study of the remains of which it can be concluded that people lived with various malformations and tumors, in which case, without an outsider survival assistance was not possible.
Attempts to provide palliative care in Russia are described as early as the 18th century. Palliative care received a powerful impetus for development from the late 1970s and early 1980s, when the concept was introduced and the first international documents were adopted, reflecting the basics of palliative care. The development of palliative care at the present stage dates back to 1987, when the first rooms for pain therapy were opened. In the Republic of Tatarstan in 1993, within the walls of the City Oncological Dispensary, an outbound ambulance service was opened for patients with malignant neoplasms. The initiator of the creation was the current head of the Department of Oncology, Radiation Diagnostics and Radiation Therapy of the FSBEI HE «Kazan State Medical University»of the Ministry of Health of the Russian Federation, Doctor of Medical Sciences, Professor F.Sh. Department of Health of Kazan I.S. Abdullina. This service was the prototype of the further palliative service in the republic. To date, over 28 years in the Republic of Tatarstan, a palliative care system has been created, where an outpatient service is represented - first-aid rooms and out-of-hospital and inpatient departments of palliative care and the public-private Kazan Hospice.
Key words: palliative care, organization of palliative care, malignant neoplasms, history of palliative care, quality of life
¹3 2021 ã.
CLINICAL AND EXPERIMENTAL RESEARCH
Babak S.L., Gorbunova M.V., Malyavin A.G.
OSCILLATING POSITIVE EXPIRATORY PRESSURE (OPEP) TECHNOLOGIES IN AIRWAY CLEARANCE THERAPY IN POST-COVID PATIENTS
Summary. The use of the technology of Oscillating Positive Expiratory Pressure (OPEP), implemented in modern breathing trainers and complexes of respiratory support, makes it possible to increase the mobilization, drainage and expectoration (coughing up) of sputum from the airways of patients with mucus hypersecretion. For post-COVID patients with hypersecretion, timely drainage with expectoration significantly improves pulmonary mechanics and gas exchange, reduces the severity of shortness of breath, and improves the quality of life. We analyzed the available OPEP devices for their efficacy and therapeutic benefits, based on available clinical studies, and formulated proposals for the inclusion of some OPEP devices in airway clearance therapy regimens post-COVID patients.
RECONSTRUCTIVE OPERATIONS AS A REHABILITATION STAGE IN PATIENTS WITH RECTAL CANCER WHO UNDERWENT SPHINCTER-SPARING INTERVENTIONS
Abstract. Aim: to study the results of reconstructive interventions in patients who underwent sphincter- sparing operations for rectal cancer. Materials and methods: the material of our study was data of 152 patients who were treated for rectal cancer. The main criterion for inclusion of patients in the study was preventive colostomy. The patients underwent the following operations: anterior rectal resection, low anterior rectal resection and intersfincter rectal resection with laparotomic or laparoscopic access. Of the 152 surgical interventions, 83 were completed without preventive colostomy. In 69 cases, intestinal stomas were applied either on preoperative stage or during main surgical intervention. Among these patients, 64 patients had loop transverse colostoma, 5 -ileostoma. Results: 40 (58%) of 69 patients had operations to "close" preventive colostomies and restore the continuity of gastrointestinal tract. In 29 (42%) patients, reconstructive surgery was not performed. The personal refusal of patients; the presence of contraindications for reconstructive interventions, associated with colorectal anastomosis, tumor progression or presence of concomitant pathology; the need of long-term adjuvant treatment were the main reasons for refusal of recovery operations. Conclusion: the performing of reconstructive operations is important stage in rehabilitation of patients with rectal cancer who had operations with formation of low intestinal anastomosis. According of our data, the protection of low colorectal anastomosis with preventive colostoma will not always ensure the restoration of intestinal continuity. The development of reliable methods for prevention of anastomotic leakage is an urgent task to improve the quality of life these patients.
Lutovinin R.V., Zotov P.B., Musaeva F.A.
REGIONAL INTRA-ARTERIAL CHEMOTHERAPY IN THE COMPLEX TREATMENT OF MALIGNANT NEOPLASMS OF THE HEAD AND NECK
Abstract. Today, head and neck tumors rank 6th in terms of frequency of occurrence among all other localizations. More than 500,000 new cases of head and neck neoplasms are diagnosed worldwide every year, and about 300,000 die. In 2018, 3378 cases of malignant neoplasms of the oropharynx were registered in Russia. Most often, the disease is detected at the age of 40 to 54 years. Key words: malignant neoplasms, head and neck tumors
ORGANIZATIONAL AND METHODOLOGICAL ASPECTS
Kucher M.A., Saltykova N.G.
BASIC ASPECTS OF PARENTERAL NUTRITION IN PALLIATIVE CARE
Abstract. Parenteral nutrition (PN) is one of the modern nutrition support types, which is used in many areas of medicine, including palliative care and is aimed at improving the effectiveness of treatment and quality of life. The implementation of PN is associated with the development of infectious and metabolic complications and requires compliance with the rules of asepsis, the correct choice of venous access, PN solutions, their dose and administration speed. The competence of medical professionals is of key importance for ensuring effective and safe PN.
Keywords: parenteral nutrition, nutrition support, palliative care
EXCHANGE OF EXPERIENCE
Kogoniya L.M.,GubenkoM.S.
SOME MILESTONES IN THE DEVELOPMENT OF PALLIATIVE MEDICINE IN GERMANY
Abstract. Palliative care is the active general care of patients with an incurable disease. This type of assistance is most often related to patients with advanced, rapidly progressing stages of the disease, which leads them to death in the near future.
Traditionally, the focus of palliative care has been on symptom control along with various forms of support. While palliative care can and should be provided at any stage of an incurable illness, along with optimal control of symptoms, the emphasis in caring for terminally ill people in the terminal phase is on the quality of life, rather than on prolonging or curing the illness. The German experience shows significant advances in palliative care for cancer patients.
Key words: oncology, palliative medicine, history of palliative care in Germany.
8-YEAR EXPERIENCE IN PERFORMING «V» SHAPED HETEROTOPIC ILEOCYSTOPLASTY IN THE TYUMEN REGION
Abstract. Introduction. Bladder cancer occupies the 2nd place, after prostate cancer among all malignant neoplasms of the genitourinary system. In the structure of cancer incidence in the Russian Federation, bladder cancer occupies the 13th place. The incidence of bladder cancer is increasing every year. The increase in Bladder cancer for the period 2010-2020 among both sexes was 51 %. The incidence in the Russian Federation over the past ten years has increased from 53.8 to 79.9 per 100,000 population.
Statistical data shows an increase in the incidence over the past 10 years, which confirms the relevance of the problem for study by the medical community.
Purpose of research. To analyze the results of treatment of patients who underwent radical cystoprostectomy with the formation of a «V» - shaped heterotopic reservoir (patent RU2716458C1) and compare the results obtained with the control group (classical Bricker ileocystoplasty).
Materials and methods. The results of treatment of patients diagnosed with bladder cancer who underwent radical cystectomy (RCE) from 1999 to 2018 with Bricker ileocystoplasty (n=46) and patients who underwent RCE with modified «V» - shaped heterotopic ileocystoplasty (n=49) were retrospectively analyzed. The follow-up time of the first (control) group of patients is from 3 to 144 months, the median follow-up is 23.5 months. The follow-up time of the study group is from 3 to 97 months, the median follow-up is 29.1 months.
Results. The number of severe postoperative complications according to Clavien-Dindo was comparable in both groups (p>0.05). In the study group it is 12%, in the control group it is 11%. The overall and cancer-specific survival of patients who underwent «V » - shaped heterotopic ileocystoplasty and Bricker ileoconduit showed statistically unreliable results (p>0.05).
When performing «V» - shaped heterotopic urine derivation, there is a statistically significant decrease in the number of postoperative pyelonephritis, compared with Bricker ileocystoplasty (p<0.05). In the study group, the probability of developing postoperative pyelonephritis is 8.16%, in the control group - 23.9%
Conclusion. Taking into account the comparable number of severe postoperative complications, comparable results of general and cancer-specific survival, with a statistically significant decrease in the probability of developing postoperative pyelonephritis, «V»- shaped heterotopic urine derivation can be recommended for routine practice.
MODERN ORGANIZATION OF NUTRITIONAL SUPPORT IN CANCER PATIENTS
The frequency of nutritional insufficiency among cancer patients reaches 40-80%. Nutritional insufficiency is associated with a decrease in overall survival, deterioration of immediate and long-term treatment results, deterioration of the tolerability of the treatment and, accordingly, a decrease in the quality of life. Modern approaches to the treatment of nutritional insufficiency are an integral part of accompanying therapy at all stages of antitumor treatment of the patient.
The literature review presents an assessment of the nutritional status, the degree of nutritional insufficiency, as well as the types and principles of nutritional support in cancer patients. Modern methods of treatment of nutritional insufficiency are described.
Jubilee article dedicated to the 70th anniversary of the birth of A.V. Palekhov
¹2 2021 ã.
In memory of the teacher
Stages of a Long Way
CLINICAL AND EXPERIMENTAL RESEARCH
Luft V.M., Lapitsky A.V., Sergeeva A.M.
ENTERAL NUTRITIONAL MIXTURES IN PALLIATIVE MEDICINE: DIFFERENTIATED CHOICE POSSIBILITIES
In the case of medical care for palliative patients, timely prescribed nutritional support takes an important place, aimed at optimizing the substrate supply of patients with incurable diseases with all nutrients necessary for life using special methods and artificially created modern nutritional mixtures. The main purpose of prescribing clinical nutrition is to oppose, first of all, the growing sarcopenia in these patients and associated asthenia, which significantly reduce the quality of life. The implementation of supportive clinical nutrition is of particular relevance when patients are at home. Currently, Russia has all the necessary conditions to provide differentiated NP in almost all areas for any category of patients.
QUALITATIVE AND QUANTITATIVE TRENDS IN THE DISCHARGE OF STRONG OPIOIDS IN ST. PETERSBURG IN 2018 - 2020, CITIZENS ELIGIBLE FOR PREFERENTIAL DRUG PROVISION
Abstracts. In this work, based on the information from the Medical Center for Information and Analysis database of the Saint-Petersburg Healthcare Committee, we analyzed the qualitative and quantitative structure of the opioid analgesics' prescription to out-patients entitled to pharmaceutical benefits in Saint-Petersburg in 2018, 2019, 2020. Over the analyzed years, a quantitative comparison of prescribed medications, using the Defined Daily Dose (DDD) calculation method was performed. The directions of further improvement of the opioid analgesics' prescription to out-patients suffering from severe chronic pain are suggested.
DETERMINATION OF SIZE OF VOCAL PROSTHESIS IN DELAYED VOCAL PROSTHESIS AFTER LARYNGECTOMY
Abstract. The authors of the article proposed an original method of determining the size of a vocal prosthesis in patients after laryngectomy. Essence of developed method consists in carrying out endoscopic ultrasound examination through tracheostomy opening in preparation for delayed tracheo-esophageal bypass with vocal prosthetics. Total thickness of tissues in area of fistula formation corresponding to minimum length of vocal prosthesis is determined.
The method proposed by the authors is applied in delayed vocal prosthetics in 21 patients after laryngectomy. Tissue thickness in the area of tracheo-esophageal shunt formation, measured by endoultrasound, ranged from 7-14 mm. According to endoscopic sonography data, a voice prosthesis of appropriate length was implanted. All patients took possession of a sonorous speech within 1 to 3 days after the operation.
The correct assessment of the dimensions of the vocal prosthesis ensures its optimal location in the formed tracheo-esophageal fistula and increases the percentage of rehabilitated patients, reduces the risk of postoperative complications.
Keywords: laryngeal cancer, vocal rehabilitation, complications of vocal prosthetics.
Kucher M.A., Rotan N.G.
FEATURES OF FEEDING AND NUTRITION SUPPORT IN PALLIATIVE CARE
Abstract. Current individualized nutrition support (NS) based on the patient's diagnosis, nutritional status and metabolism rate include sipping, enteral and/or parenteral nutrition and increases the effectiveness of treatment, quality of life and overall survival in patients with various diseases. In palliative care, timely NS can also lead to an increase in life expectancy and quality of life, the benefits of which, however, are leveled and are not obvious in the end of life stage of the disease. Untimely and unbalanced NS can lead to the development of metabolic disorders and impair the organs function, which requires compliance with recommendations and standards, as well as increasing the education level of medical coworkers according to further development of clinical nutrition.
Keywords: feeding, enteral nutrition, nutrition support, palliative care
FACTORS OF MALIGNANT TRANSFORMATION AND PERSONAL EXPERIENCE IN THE PALLIATIVE TREATMENT OF RECURRENT BRAIN GLIOMA
Abstract. The aim of this work was to determine the most significant factors influencing the results of treatment in patients with the transformation of recurrent low-grade glioma into highly malignant glioma.
This study included 25 patients with a morphologically confirmed diagnosis of the transformation of recurrent low-grade gliomas into high-grade ones, who received treatment since 2000. to 2019 in oncology centre (Chelyabinsk). Malignancy was noted within 10 to 50 months. The average age of patients was 40 ± 4.7 years. The ratio of men to women is 2: 1. Patients with a primary morphological conclusion of Grade I astrocyoma (n = 10) prevailed, in 7 cases protoplasmic astrocytoma Grade II was diagnosed, in 8 - oligodendroglioma. A relapse with transformation into glioblastoma was diagnosed in 12 patients, and in 13 - into anaplastic astrocytoma.
So the median overall survival was 72 months, the 1-year OS was 96.6%; 3-year-olds - 81.3%; 5 years old - 75.9%. The median overall survival after treatment for relapse for all patients was 36 months.
The main factors influencing the poor prognosis in terms of overall survival, according to our study, were transformation to glioblastoma and age over 50 years.
Key words: malignant transformation, recurrence of malignant gliomas, temozolomide.
QUALITY OF LIFE IN PATIENTS WITH TIN0M0 STAGE BLADDER TUMOR COMPLICATED BY URINARY TRACT INFECTION
Relevance. TUR of bladder tumors in the early stages of the oncological process is the method of choice; however, the pre- and postoperative period is often accompanied by clinical manifestations of lower urinary tract infections that reduce the quality of life of these patients.
Purpose of the study. To assess the causal relationship of manifestations of urinary tract infection, with the presence of a tumor process and performed transurethral resection of the tumor.
Materials and methods. Anamnestic and clinical and laboratory analysis of the relationship between manifestations of lower urinary tract infections that reduce the quality of life of patients with the presence of a tumor process in the bladder and underwent transurethral resection was carried out with an analysis of the effectiveness of preventive and therapeutic measures aimed at improving the quality of life of these patients.
Results and discussion. In the course of the study, it was found that the initial manifestations of lower urinary tract infection coincided with or preceded the period of oncological diagnosis and intensified after TUR of the tumor. Etiotropic antibacterial treatment was accompanied only by a temporary decrease in the clinical manifestations of bladder dysfunction.
Findings. The quality of life of patients after TUR of the bladder for cancer is significantly reduced due to exacerbation of lower urinary tract infection and does not respond well to antibacterial treatment, which requires a special study of the causes of this phenomenon.
Key words: bladder cancer. TUR of the bladder, urinary tract infection
FEATURES OF PROGRESSION OF ANDROGEN - RECEPTOR POSITIVE CANCER IN GROUP OF TRIPLE NEGATIVE BREAST CANCER
Abstract. Introduction. Triple negative breast cancer (TNBC) is the most unfavorable subtype of breast cancer. This is due not only to the lack of effective treatment, but also to the frequent development of locoregional recurrence and distant metastases in this particular type of malignant tumours. Our study was based on the study of the characteristics of the progression of one of the TNBC subgroups - androgen receptor-positive triple-negative breast cancer.
Materials and methods. The analysis of tumor progression data was carried out in 253 patients with morphologically verified invasive triple negative breast cancer (TNBC) who received treatment at the Regional Clinical Oncological Center in Ulyanovsk in the period from 2014 to 2020.
Results and discussion. For the progression of TNBC in our study, we took the development of locoregional relapse (LRR) and distant metastasis. There were 12 cases of LRR and 34 cases of distant metastasis. It was shown that cases with AR expression were characterized by a more frequent occurrence of LRR than cases without AR expression (11% versus 2% respectively). We did not found a correlation between AR expression and the development of distant metastasis in TNBC.
Conclusions. Expression of androgen receptors in TNBC is associated with locoregional recurrence and is not associated with distant metastasis.
Key words: Breast cancer, triple negative breast cancer (TNBC), androgen receptors (AR), locoregional relapse (LRR), progression of TNBC.
DIGEST
Astakhov D.A., Panchenkov D.N.
MINIMALLY INVASIVE SURGICAL TECHNIQUES FOR UNRESECTABLE HEPATIC METASTASES
Abstract. In recent years, a large arsenal of minimally invasive surgical technologies has appeared in modern oncology, allowing to provide effective assistance to the most numerous groups of patients with disseminated oncological process. Previously, patients with stage 4 of the disease in the presence of distant metastases could not, with rare exceptions, rely on a surgical component in their treatment and traditionally underwent palliative chemotherapy regimens. Currently, existing technologies are being actively implemented as part of a multidisciplinary approach to treatment algorithms. The paper discusses the technologies of local action on primary and metastatic tumors, their mechanism of action and physical principles. The data of studies on comparative assessment, the effectiveness of the combination of methods are presented.
P.Pankov, M. Salpogarov, N.Yakovleva, A.Andronov, S.Fursov
SYMPTOMS OF CANCER THAT MAY BE SUCCESSFULLY ADRESSED BY PALLIATIVE RADIOTHERAPY
Radiation therapy is a very effective method of treatment patients with metastatic bone complication with a pronounced analgesic effect. Bone metastases are a common manifestation of malignancy that can cause severe and debilitating effects including pain, spinal cord compression, and pathologic fracture. Radiation therapy (RT) provides successful palliation of painful bone metastases that is time-efficient and associated with very few side effects. Palliative radiotherapy may be effective near the end of life and to improve the quality of life. Some predictive models would help predict survival and optimal treatment. Use of shorter or single fraction regimens may be beneficial, especially in patients with poor performance status. Careful consideration of the benefits of palliative RT in this patient population can benefit the most from palliative RT at the end of life.
Key words: palliation radiotherapy, pain, metastatic bone complication.
THE MAIN PROGNOSTIC FACTORS AFFECTING THE QUALITY OF LIFE OF PATIENTS TREATED FOR RECTAL CANCER
Abstract: The article assesses the impact of various factors on the quality of life of patients treated for rectal cancer. The leading of them, which significantly affect various indicators of quality of life, have been revealed. The experience of using EORTC QLQ C30 version 3.0 questionnaires with CR29 version 2.1 colorectal cancer module is presented. Based on the data obtained, prognostically unfavorable groups of patients who need to develop and implement rehabilitation measures at early stages are identified.
Key words: rectal cancer, quality of life, rehabilitation of patients with cancer, EORTC QLQ C30 and CR29 questionnaires.
Luzheckaya A.A., Solov'ev V.I., Semkina E.N.
NON-ADJUVANT POLYCHEMOTHERAPY AND RADIATION THERAPY AS FACTORS OF THE DEVELOPMENT OF POSTOPERATIVE VENTRAL HERNIAS
Summary: In this study, the data of the the territorial cancer registry of the Smolensk region and official accounting and reporting medical documentation of surgical Department ¹1 of the RSBIH «Smolensk regional Oncology clinical dispensary» (RSBIH «SROCD») was collected and analyzed. 469 patients with malignant tumors of rectum, endometrium and cervix who were treated at the RSBIH «SROCD» during the period from 2016 to 2019 were revealed. The analysis of the incidence of postoperative ventral hernias (PVH) depending on the presence in the anamnesis of radiation (RT) and polychemotherapy (PCT). The study concluded that there was a significant increase in the developing of PVH in patients undergoing LT and PCT. Practical recommendations on the specifics of preparing and conducting surgical treatment are given.
IMPROVING THE QUALITY OF LIFE OF AN ELDERLY PATIENT WITH SQUAMOUS CELL LUNG CANCER DURING IMMUNOTHERAPY
Background: Since the beginning of the 70s of the twentieth century, the improvement of methods for the diagnosis and treatment of cancer led to lengthening without a relapse period. There was a need not only to assess the effectiveness of treatment of cancer patients and count the number of years lived, but to assess the quality of life in these years. At present, quality of life, along with survival rates, are the most important criteria for the effectiveness of treatment in oncology. The quality of life associated with health is considered as an integral characteristic of the physical, mental and social functioning of a sick person, based on his subjective perception.
CRYOGENIC TECHNOLOGIES IN THE PALLIATIVE TREATMENT OF PATIENTS WITH ADVANCED SQUAMOUS CELL CARCINOMA OF THE SKIN
Abstract. Palliative cryosurgery was performed in 26 patients in cases of locally advanced squamous cell carcinoma of the skin (T4N1M1) with decay, infection, and bleeding. 15 patients underwent cryogenic treatment in a specialized oncology center, and 7 in an outpatient setting. Each patient was given from one to ten treatment sessions under local anesthesia or anesthesia. Four patients hospitalized in the city's purulent-septic surgery department under "ambulance" underwent cryodestruction to stop the arrosive bleeding from the tumor. In addition, case histories of nine hospice patients with extensive tumor spread and cancer cachexia in the presence of severe comorbidity were analyzed, which excluded cryotherapy procedures. In cases of cryodestruction, a positive result was obtained: a decrease in the intensity of the pain syndrome, a hemostatic effect, cytoreduction, an improvement in the general condition, and an increase in the quality of life.
Keywords: palliative medicine, squamous cell carcinoma of the skin, cryodestruction, cryoablation, cryosurgery, cryotherapy, cytoreduction, pain syndrome, quality of life.
Makishev A.K., Àitbaeva A.A.
INTERACTION OF THE PALLIATIVE CARE CENTER AND THE CITY AMBULANCE STATION IN PROVIDING EMERGENCY CARE TO ONCOLOGICAL PATIENTS WITH PAIN (FOR EXAMPLE, THE CITY OF NUR-SULTAN)
Summary. The article highlights the experience of cooperation between the palliative care Center and the City ambulance station in providing emergency care to oncological patients with pain breakthrough in the city of Nur-Sultan. Analysis of the work done to service of 24-hour emergency calls via the hotline from oncological patients in the conditions of the City ambulance station, prospects for the development of the service, types of assistance, resources, problems.
Priority tasks of palliative medicine are: providing qualified, timely palliative care, improving the quality of life of patients by providing full-fledged care both in the hospital and at home, the possibility of round-the-clock treatment during a pain breakthrough. Continuity of services at all stages of assistance. Prevention and relief of sufferings of the patient due to early detection, careful assessment and relief of pain and other symptoms.
Keywords: emergency care for breakthrough pain, palliative care, chronic pain syndrome.
THE SIGNIFICANCE OF SELECTIVE INTRA-ARTERIAL INTERVENTIONS FOR PALLIATION CARE IN MALIGNANT HEAD AND NECK TUMORS
Abstract. Chemotherapy is the standard for inoperable head and neck tumors. In the presence of a residual tumor and its continued tumor growth only one option of palliation remains. It is a palliative chemotherapy. The possibilities of intra-arterial technologies are clearly underestimated. , Selective embolization of various external carotid artery branches is highly effective for bleeding arising from the tumor. Palliative intra-arterial chemotherapy is underestimated. The superselective intra-arterial volume-controlled infusion of Cisplatin at 65 mg/m2 is well tolerated even by weakened patients ECOG 2-3. Comparing this technology in 39 patients with standard PF chemotherapy in 34 patients, encouraging results were obtained. A complete response was observed in 5,1% of patients of group 1 (n = 2) and in none of the patients of group 2. A partial response was noted in 2 8,2% (n = 11) of patients of the 1-st group and in 1 1,8% (n = 4) of patients of the 2-nd group, respectively (p < 0,05). Stabilization was observed in 59% (n = 23) of group 1 patients and 5 2,9% (n = 18) of group 2 patients (p = 0,93). Progression was noted in 1 0,3% (n = 4) of group 1 patients and in 3 5,3% (n = 12) of group 2 patients, respectively (p < 0,05). The median survival of patients in the 1st group was 325 days, in the 2nd group - 173 days, respectively (p < 0,05). The overall 1-year survival of patients of the 1st group since the detection of continued tumor growth was 4 6,2% (n = 18), in the 2nd group, no patient survived 1 year. In the 1st group: 2-year survival rate was 2 5,6% (n = 10); 3-year survival rate of 5,1% (n = 2). It is clear that endovascular technology should be provided for palliative care for relapses of head and neck tumors.
Keywords: Palliative treatment, head and neck cancer, relapse after chemoradiotherapy, intra-arterial chemotherapy, embolization.
PET / CT BRAIN METABOLISM DURING THE TREATMENT AND LONG-TERM REHABILITATION OF CHRONIC PAIN SYNDROME WITH LOWER URINARY TRACT DYSFUNCTION
Summary: Relevance. Chronic pain syndrome in combination with dysfunction of the lower urinary tract remains one of the significant reasons for the decline in the quality of human life and an important medical and social problem requiring the introduction of new treatment methods, as well as rehabilitation.
Purpose of the study. To analyze PET / CT brain metabolism in conditions of chronic pain syndrome with lower urinary tract dysfunction before, after various methods of treatment, as well as during long-term rehabilitation.
Materials and methods. Clinical observation and PET / CT examination of the brain in 30 patients who received standard drug therapy and electrical stimulation of the spinal cord for refractory manifestations of chronic pain syndrome combined with urinary tract dysfunction, as well as the effect of these methods on the quality of life of patients during treatment and long-term rehabilitation were carried out.
Results and discussion. The PET / CT studies of the brain showed that chronic pain syndrome against the background of degenerative-dystrophic diseases of the spine and various oncological processes is accompanied by the activation of the entire brain with the predominant involvement of the middle part of the cingulate gyrus, islet and thalamus. During the treatment and long-term rehabilitation of these patients under conditions of successful combined drug therapy, there was a decrease in the activity of the cerebral cortex as a whole and at the level of the cingulate gyrus (VAS scale 8 and 4 points; QOL scale 8 and 5 points).Treatment and long-term rehabilitation of manifestations of chronic pain syndrome refractory to standard therapy against the background of degenerative-dystrophic diseases of the spine (up to five years) and chronic oncological combat syndrome (up to six months), by the method of spinal cord electrical stimulation, turned out to be more effective.
Conclusions. Treatment and long-term rehabilitation of patients with chronic pain syndrome in combination with dysfunction of the lower urinary tract by the method of drug therapy and electrical stimulation of the spinal cord are the method of choice.
Keywords: chronic pain syndrome, rehabilitation, PET / CT control
PROSPECTS FOR THE USE OF PERSONAL TELEHEALTH IN PALLIATIVE MEDICAL CARE
Resume. Telemedicine technologies are a promising direction for the development of palliative care. In combination with mobile nursing teams, personal telemedicine systems can provide high-quality out-of-hospital care to patients with various incurable diseases and improve their quality of life through remote support in solving a complex of medical, social, psychological, and spiritual problems.
The article analyzes the existing technological and organizational solutions of personal telemedicine, and defines the basic principles of building personal telemedicine complexes taking into account the needs of patients receiving palliative care.
Keyword: Telemedicine, palliative care, hospices, mobile nursing teams, personal telemedicine complexes, video conferencing.
LYMPHOSTASIS AS A COMPLICATION OF THE SURGICAL TREATMENT OF VULVAR CANCER, A FACTOR AFFECTING THE QUALITY OF LIFE
Abstract: Vulvar cancer is a rare disease. The main treatment for vulvar cancer is surgery. Standard vulvectomy with one-block bilateral inguinal-femoral lymphadenectomy is associated with a significant number of complications, both in the early postoperative period and in the subsequent life of patients. One of the factors affecting the quality of life is lymphostasis of the lower extremities. The work assessed the degree of lymphostasis in patients who underwent standard surgery for vulvar cancer and economical operations - vulvectomy with the determination of the sentinel lymph node. Reducing the amount of surgical treatment, using the method of detection and biopsy of the sentinel lymph node can reduce the number and severity of lymphostasis.
Key words: Lymphostasis, quality of life, vulvar cancer, surgical treatment.
Summary. The main task of the rehabilitation of ostomy patients is to improve the quality of life of patients, comprehensive medical, social and psychological assistance.
Patients and their relatives receive comprehensive advice on all aspects of the life of ostomy people, and are provided with the necessary background information. Accounting for ostomy patients ensures the identification of risk groups and reduces the likelihood of developing late surgical complications.
Keywords: rehabilitation, medical rehabilitation, social rehabilitation, psychological rehabilitation, disability disease, stoma, tracheostomy, colostmoma, oncology.
EXPERIENCE OF ATTRACTING INFORMED AND PREPARED RELATIVES TO TREATING A GERIARTHRIC PATIENT ON AN EXAMPLE OF ANTI-ANTI-EVENT ACTIVITIES IN THE EARLY POST-OPERATION PERIOD
Abstract. Older and senile oncological patients are at high risk of developing pressure sores. The inclusion of early rehabilitation in the scheme of complex postoperative therapy reduces the number of complications. In this case, the best results are obta
Keywords. Pressure ulcers, rehabilitation, early postoperative period, diffuse peritonitis, colorectal cancer, obstructive intestinal obstruction, elderly and senile age, trained and trained relatives of the patient.
STEREOTACTIC RADIATION THERAPY IN THE PALLIATIVE TREATMENT FOR RECURRENT OF MALIGNANT GLIOMA
Summary: The aim of this study was to determine the effectiveness of stereotactic radiation therapy (HSRT) in palliative treatment recurrent of malignant brain gliomas. This study included 50 patients who underwent a course of stereotactic radiation therapy using a CyberKnife with cumulative dose of 25 to 42 Gy for 3-7 fractions for relapse of malignant brain gliomas from 2011 to 2018. in the Chelyabinsk regional clinical center of oncology and nuclear medicine. The average age of the patients was 46 ± 12.75 years. The ratio of men to women was equal. Re-operated 10 patients. In 26 patients, a relapse of glioblastoma was diagnosed, in 24 - anaplastic astrocytoma. In 33 patients, STLT was performed on its own, 17 patients after radiation treatment in the adjuvant regimen completed from 4 to 6 cycles of temozolomide monochemotherapy.
The median overall survival (OS) for all patients with relapses from the time of diagnosis from the time of diagnosis was 41 months, the 1-year OS was 97,8%; 2-year-old - 69,6%; 3-year-old - 52,8%; 5-year-old - 35,0%, respectively. Median survival after treatment of relapse (specific survival method) is 22 months. The median OS was slightly higher in patients when temozolomide was added to the treatment regimen compared with patients who underwent HSRT alone 41 months and 39 months, respectively (p> 0.5). The main prognostic factors affecting the results of treatment were the age of the patients, the histological conclusion and the reoperation.
Key words: recurrence of malignant gliomas, stereotactic radiation therapy, temozolomide.
ORGANIZATION OF PALLIATIVE MEDICAL CARE FOR PATIENTS IN THE REPUBLIC OF BASHKORTOSTAN
The article discusses the status of palliative care for patients in the Republic of Bashkortostan. The following are described in detail: the structure of palliative care, provision of beds, organizational and methodological assistance, training for 2019. The article also outlines a plan for the further development of palliative care for adults and children in the republic.
Key words: palliative medical care, personnel training, field service, malignant neoplasm, pain.
COMPARATIVE ASSESSMENT OF THE QUALITY OF LIFE IN PATIENTS AFTER SURGICAL TREATMENT OF VULVAR CANCER
Summary: Vulvar cancer is a rather rare disease, but in the last few years there has been a distinct tendency, both to an increase in the incidence of disease, and to a younger contingent of patients. The main treatment for vulvar cancer is surgical. Standard vulvectomy with a single-sided bilateral inguinal-femoral lymphadenectomy is accompanied by a significant number of complications, both in the early postoperative period and in the subsequent life of the patients. Quality of life is currently a significant factor. The work assessed the quality of life of patients who underwent standard surgery for RV and economical operations - vulvectomy with the definition of a sentinel lymph node.
THE FORMATION OF PALLIATIVE MEDICAL CARE IN CHELYABINSK
Abstract. The concept of palliative care (PHC) is formulated in the article, the need for primary care in the Russian Federation for the adult population is studied, the average standards for the volume of palliative care in stationary and outpatient settings at the regional level are determined. The main groups of patients with incurable progressive diseases and conditions that receive palliative care are presented. The measures to strengthen palliative care are listed.
Keywords: palliative medical care, orders of palliative care, availability of palliative care, multi-level system of palliative medical care.
Petrova O.M., Kudryashova L.N., Kudryashov A.A.
Experience of the department of palliative medical care on the basis of the republican clinical oncological dispensary
The article analyzes the work of the palliative care department for 2017 - 2019. (work experience 25 years). The analysis of patients who received inpatient treatment by age, severity of pain, and localization of the tumor process is presented. The main methods of palliative care used in the department, outpatient and at home are reflected.
ÐALLIATIVE MEDICAL CARE FOR PATIENTS WITH CHRONIC HEART FAILURE
WHO emphasizes that patients with cardiovascular pathology rank first in the structure of those in need of palliative medical care. The development of palliative medical care at the present stage requires the study of the possibility of using prognostic scales for patients with nononcoological pathology. Prognostic scales used in palliative medicine have been found to reflect the clinical course of the disease and can be successfully used in patients with chronic heart failure.
Keywords: palliative medical care, chronic heart failure, palliative medicine.
PSYCHOTHERAPEUTIC ASPECTS
Kulagina N.V.
WILLINGNESS TO PROVIDE PALLIATIVE CARE FOR MEDICAL WORKERS, VOLUNTEERS AND RELATIVES OF PATIENTS: A COMPARATIVE ANALYSIS
Ànnotation: The article raises the urgent problem of the need to improve the development of a system of measures to provide medical and psychological palliative care to incurable (dying) patients. A review of approaches to the modern interpretation of the concept of "palliative care", its components. The contours of the Russian system of palliative care for the population are shown. The results of a comparative study of the level of preparedness for palliative care for medical workers, relatives of terminal patients and volunteers with experience in caring for bedridden, seriously ill people are presented. The study was conducted in April 2019. The study was conducted by the method of sociological survey on a questionnaire specially developed for research purposes. The sample was 160 people. The age of the study participants is 30-60 years. It turned out that volunteers had the highest level of willingness to provide palliative care. However, the relatives of the sick, the most unprepared people, also demonstrate a high willingness to provide all the necessary assistance to their dying relatives. The overwhelming majority of the average medical personnel interviewed for this does not have special knowledge and skills, only one third of the respondents are psychologically ready for such work, the other third could provide such morally and psychologically difficult help to incurable patients, but only on a paid basis.
Key words: incurable patient, volunteer, quality of life, palliative care, relatives of incurable patient, psychological support, dying patients, health services, physical care, hospice care.
DIGEST
Zaydiner B.M., Savina S.A., Chernicova I.V.
COGNITIVE DISORDERS IN CANCER PATIENTS
Number of cancer survivors continues to grow, not just because of earlier detection and treatment, but because of revolutionary new therapies. For many individuals, this changes the landscape from a terminal illness to more of a chronic illness. This perspective has broadened the scope of care from treating the disease alone to managing cancer-related symptoms including mental disorders. Cognitive impairments in patients receiving treatment for cancer have been well documented. These disorders are often multifactorial, especially in the setting of advanced cancer. Its prevalence reaches 75%. To assess cognitive impairment, neuropsychological tests and self-reports are commonly used. For cognitive impairments to alleviate wide spectrum of psychosocial and pharmacological interventions are developed.
REGIONAL ORGANIZATIONAL - METHODOLOGICAL MODELS PROVISIONS OF PALLIATIVE CARE IN SUBJECTS OF THE RUSSIAN FEDERATION
Subjects of the Russian Federation have significant differences in geographical, demographic and economic indicators. This dictates the need for an individualized approach to organizing a regional model for the provision of palliative care, taking into account existing local characteristics, to ensure the availability and quality of this care for the population. Based on the analysis of the current situation, the article suggests two main types of organizational and methodological models for the provision of palliative care in the constituent entities of the Russian Federation. In regional model 1, one of the structural units is assigned the functions of an organizational and methodological center that will analyze the state of palliative care for the population, its effectiveness and quality, as well as dispensary monitoring of patients in the territory of the subject of the Russian Federation. The basis of the regional model 2 is the center/hospital of palliative care, which has all the necessary capabilities to provide outpatient, inpatient, visiting patronage and advisory care, and which carries out, inter alia, organizational and methodological functions. The palliative care center / hospital is in functional interaction with various medical organizations in the subject providing palliative care, as well as with social services institutions. According to the authors, it is a model of choice, since it has a number of significant advantages. The proposed types of organizational and methodological models are developed taking into account the need for interagency cooperation in the provision of primary and specialized palliative care for patients.
Key words: palliative care, types of organizational and methodological models, center of palliative care, effectiveness and quality.
EXCHANGE OF EXPERIENCE
Vorobtsova E.S.
METHOD OF TEAMWORK IN HEALTHCARE ORGANIZATIONS PROVIDING PALLIATIVE MEDICAL AID
Due to the integrated nature of medical, psychological, legal and social issues of patients getting palliative medical aid as well as their families, specialists from different areas of expertise take part in rendering this aid.
In that regard palliative aid healthcare organizations as well as social service institutions and other organizations providing different kind of help and assistance to people with various disabilities should implement and develop teamwork method involving polyprofessional teams of specialists.
Knowledge, experience and skills of teamwork method must be developed by all members of such teams on different stages of their professional training. Moscow State University of Medicine and Dentistry n.a. A.L. Eudokimov has experience in preparing rising doctors and professional social workers for operating in polyprofessional teams of specialists in social sphere organizations and institutes.
Key words: social work in healthcare, medical social work in healthcare organizations providing palliative medical aid, method of teamwork, polyprofessional team of specialists.
ULTRASOUND ASSESSMENT OF QUALITATIVE CHANGES IN MUSCLE TISSUE IN GERIATRIC PATIENTS WITH COLORECTAL CANCER COMPLICATED BY ACUTE INTESTINAL OBSTRUCTION
Qualitative changes in the ultrasound parameters of the quadriceps femoris muscle associated with the criteria for muscle failure and the development of postoperative complications in geriartic patients with colorectal cancer complicated by acute intestinal obstruction were revealed. Ultrasound can be used as a bedside instrumental method for assessing the state of muscle mass.
Key words: Ultrasound, qualitative changes in muscle tissue, myopathy, colorectal cancer, ileus, old age, femur quadriceps].
TREATMENT OF PAINFUL BONE METASTASES OF BREAST CANCER
The results of treatment of painful bone metastases of breast cancer in two randomized groups are presented. In the main group, radiotherapy was used in combination with a vortical magnetic field, in the control group only radiation therapy was used.
The objective effect of treatment to the main group at follow-up 8, 12 and 20 weeks from the start of therapy is higher than in the control group. In the main group, the therapeutic effect persists throughout all observation periods, and in the compared groups there was a difference in favor of the main group - (for 8 weeks p = 0.0334380, for 12 weeks p = 0.000001, for 20 weeks p = 0.000001 ). By 20 weeks, complete and partial remission in the main group was 80.0%, in the control group it was 47.0%, which is 1.7 times less, while at the same time there were no patients with progression of the disease in the main group, and in the control group they accounted for 18.1%. In the main group, the patients improved 25.0%, in the control group - 7.2% (p = 0.002), and the patients with the deterioration in the main group were not observed, in the control group - 25.3% (p <0, 00001).
Comparison of the subjective effect on the scale of pain intensity according to two alternative signs - the effect of treatment is or is not present, showed a less significant registration of the effect in the control group at the observation frequency of 89.2%, compared with that in the main group - 100.0% (p = 0.002445). When registering a complete, partial effect or lack thereof, the following was obtained: the total effect was 1.4 times more common in the main group (p = 0.006351), and patients with no effect were significantly less in the basal group than in the control group (p = 0.042051); In patients with registration before treatment of severe pain, the full effect was significantly more frequent in the main group (p = 0.016324), and the absence of the effect was greater in the control group (p = 0.013027).
Key words: painful bone metastases, breast cancer, radiation therapy, vortical magnetic field
MEDICO-SOCIAL REHABILITATION OF PATIENTS WITH MALIGNANT TUMORS AND OTHER DISABLING DISEASES
The goals of rehabilitation are to improve the quality of life of patients. Rehabilitation is a system of state, social, economic, medical, professional, pedagogical and other measures. The term medical and social rehabilitation unites the stages of medical, social and vocational rehabilitation. Regardless of the nosological form and localization of the tumor, 4 stages of medical rehabilitation of patients are distinguished. The social consequences of cancer cause great economic damage to the state. The role of all types of rehabilitation in improving the quality of life of people with disabilities is undoubtedly relevant.
Key words: rehabilitation, disabled person, medical rehabilitation, social rehabilitation, psychological rehabilitation, disability diseasóe.
THE ANALYSIS OF MOBILE PATRONAGE SERVICE OF PALLIATIVE MEDICAL CARE ACTIVITIES IN THE CITY POLYCLINIC ¹18 IN VORONEZH
Palliative care in Russia is developing rapidly. The criteria for the selection of patients in need of palliative care, the optimal methods of evaluation and the principles of chronic pain therapy are determined. The increase in the number of incurable patients with progressive diseases in the terminal stages of the development determines the necessity to look for an effective organizational model that can allow to provide palliative care to as many people in need as it is possible. The organization of palliative care in the structure of polyclinics in the close cooperation with the primary care specialists increases the availability of palliative care to the population. The article provides the analysis of mobile patronage service of palliative medical care activities in the City Polyclinic ¹19 in Voronezh.
Key words: cancer, palliative medical care, pain syndrome, chronic pain, narcotic drugs, pain treatment, mobile patronage service.
NEUTROPENIC FEVER AS PROGNOSTIC COMPLICATION OF POLYCHEMOTHERAPY
Chemotherapy of malignant tumors is always associated with numerous complications, such as toxic effect on hemopoesis. Neutropenia is one of the most dangerous manifestations of myelotoxicity. Cytostatic therapy is capable of causing neutropenia in 30-40% of clinical cases. Neutropenia means the number of neutrophil cells below 500 cells/mm3 or less 1000 cells/mm3 with the prognostic decrease below 500 cells/mm3. Risk factors that leads to infection include depth and duration of neutropenia, existing damages of natural anatomical barriers, associated immunodeficiency and presence of chronic infections. The earliest and leading symptom of manifestation of infection among patients with neutropenia is fever. The combination of fever with a decrease in the number of neutrophil cells is called "neutropenic fever". If patient have increase in body temperature higher than 38,0°C at least twice a day or a single increase in temperature higher than 38,3°C with quantity of neutrophil cells below 0.5×109/L, patient have a case of neutropenic fever. According to the national recommendations, antibiotic therapy should be prescribed for patients with neutropenia when the body temperature measured in mouth is 38,5°C and higher (one provided measure), or 38 °C and higher, when measures were provided two or more times, within 12 hours. Empiric antibiotic therapy should be given for patients with high risk of infections, deep and long-term neutropenia, symptoms of neutropenic fever, at the first signs of any infection or according to the fever criteria described above. Choice of antibiotics must rely on data on the taxonomic structure and antibiotic sensitivity of clinically significant pathogens in a specific hospital and the possibility of developing cumulative toxicity when using cytostatics with a similar range of side effects.
Key words: neutropenic fever, complications of chemotherapy, chemotherapy, oncology.
Salpagarov M., Pankov P., Yakovleva N., Fursov S., Kopichev U., Andronov A.
MANAGEMENT OF BONE METASTASIS WITH PALLIATION RADIOTHERAPY (REVIEW)
The main aim of this review of the publications about radiotherapy at the end of life and about palliative radiotherapy bone metastasizes, a number of other questions remain to be explored. These and other questions must continue to guide research and clinical care in patients receiving palliative radiotherapy to allow for the continued optimization of care for patients with advanced disease.
1. What prognostic models are most likely to be clinically useful in practice to help classify patients are likely to have prolonged survival and which patients are likely to have short survival?
2. How can these prognostic models be incorporated into practice to allow clinicians to use evidence-based medicine in recommending palliative radiotherapy treatment?
3. What are the optimal dose fractionation schemes are used for patients with visceral metastasis and a short life expectancy?
4. What methods of Radiotherapy are used for palliative therapy?
5. What model of radiotherapy should be used for treatment of a pathological fracture in patients with a limited lifespan.
6. How can increase collaboration among radiation oncologists, medical oncologists, surgical oncologists (including neurosurgeons) and palliative care clinicians for radiotherapy and help to improve care for a patient with metastatic cancer and palliative care organization?
Keywords: External beam radiotherapy; bone metastases; fractionation; pain; highly conformal therapy; stereotactic body radiation therapy (SBRT).
Cheporov S.V., Khisamov A.A.
PALLIATIVE TARGET THERAPY OF DISTRIBUTED NSCLC, WITH EGFR MUTATION IN A TUMOR
Lung cancer is the most frequently diagnosed malignant neoplasm in the world, the number of newly established diagnoses is estimated at 1,8 million new cases annually, which is 13% of all MN in the world. The number of deaths is nearly 1,6 million cases annually, which makes LC the main cause of death worldwide among MN. The chemotherapeutic drugs, using today, are not effective and specific enough. The achievements in molecular diagnostics in recent years allow to carry out individually-selected therapy depending on the genetic profile of the tumor. The presence of EGFR mutation in patients with advanced non-small cell lung cancer allows to provide the most frequently used target therapy in clinical practice.
Pain remains one of the most frequent and serious clinical problems faced by patients in need of palliative care. Adequate control of chronic pain is not achieved, according to various estimates, in 25-60% of patients. When providing palliative care to patients with advanced and progressive chronic diseases of cancer or non- cancer profile, the etiological factor of the development of the disease should not determine the choice of tactics for the treatment of chronic pain. Of crucial importance are the pathogenetic factors of the formation of pain syndrome in a patient, taking into account his individual psychological, social and spiritual needs. Equally important are the issues of proper organization of pain management and availability of necessary medicines for patients at the stages of palliative care. The article presents the features of pain assessment in the elderly, in patients with dementia and in critical conditions. Emphasized personalized approach to the choice of pain therapy. The principles and methodology of pain treatment are given, the importance of drawing up a treatment plan and a constant assessment of the effectiveness of pain relief and any problems arising during treatment are emphasized. Examples of a clinical audit of the quality of chronic pain treatment from world practice are given.
Key words: palliative care, chronic pain, pain treatment, clinical audit of treatment quality
EXCHANGE OF EXPERIENCE
Shakhgildyan V.I.
PALLIATIVE CARE FOR HIV PATIENTS AS PART OF THE OVERALL SYSTEM OF PALLIATIVE MEDICINE AND REHABILITATION
The article presents the latest data on morbidity and mortality in HIV infection, the number of patients at the AIDS stage in the Russian Federation. The need for palliative care in HIV-positive patients is shown. The general aspects and features of palliative care for patients with HIV infection are considered. A review of regulatory documents is given and suggestions are made for improving the regulatory framework in the field of palliative care for people with HIV infection.
Key words: palliative care, HIV infection, regulatory documents
Balasanyants G.S.
DOES A TUBERCULOSIS PATIENT NEED PALLIATIVE CARE?
The main difficulties of the implementation of the palliative care to phthisiology are analyzed. In addition to the absence of a regulatory justification for this type of care, the stereotype of tuberculosis as well cured infection is important. The article presents the most significant reasons for treatment failure, such as drug resistance of mycobacteria to anti-tuberculosis drugs and a high proportion of socially distorted patients.
Keywords: tuberculosis, palliative care, multidrug-resistant tuberculosis, medical and social care
Vorobtsova E.S.
MEDICAL SOCIAL WORK IN HEALTHCARE ORGANIZATIONS PROVIDING PALLIATIVE MEDICAL AID ACCORDING TO DOCTORS' ESTIMATES
The integrated cross-disciplinary approach to rendering palliative medical aid requires participation of not only medical, but also professional social workers. The need to provide succession and cooperation of doctors and specialists of the mentioned sphere of expertise presupposes that medical community is well-informed about the place and role of medical social work in palliative medical aid. In the following article we represent the insights of doctors' perceptions about contents and practices of medical social work in healthcare organizations providing palliative medical aid.
Key words: social work in healthcare, medical social work in healthcare organizations providing palliative medical aid, method of teamwork, polyprofessional team of specialists, doctors' perception of the place and role of medical social work in healthcare organizations providing palliative medical aid 26
ANALGITIC THERAPY IN PALLIATIVE ONCOLOGY ENHANCEMENT. CLINICAL AND PHARMACOECONOMIC ASPECTS OF HYDRAZINE SULFATE (SEHYDRIN) APPLICATION
The article presents the analysis of the two studies carried out at various clinics in which the domestic drug of hydrazine sulfate (Sehydrin) in advanced cancer patients therapeutic effects were studied. Research results show that the use of hydrazine sulfate in incurable cancer patients led to a decrease in the dose of opioid analgesics and accordingly the rate of opioid tolerance as well as the reduction of adjuvant and symptomatic agents demand thus avoiding the induced polypharmacy. Using the results obtained the use of hydrazine sulfate in the complex palliative therapy of cancer patients pharmacoeconomic analysis was carried out and it has shown the pharmacoeconomic validity of this drug early inclusion in the complex palliative therapy.
KulikovE. P., SudakovA. I., KaminskyYu. D., SudakovI. B. Mertsalov, A. S., GolovkinE. Yu.
ULTRASOUND AS A CRITERION FOR ASSESSING CHANGES IN THE MUSCLES OF THE CLOSING APPARATUS IN THE RADICAL TREATMENT OF RECTAL CANCER
The article presents an ultrasound assessment of changes in the muscles of the rectal closure apparatus in the process of combined treatment of patients with rectal cancer. On the example of 80 treated patients, a correlation between the quality of their life estimated using questionnaires EORTC QLQ C30 version 3.0 with the module of colorectal cancer CR29, and the degree of detected undesirable changes was carried out. The ultrasound technique allows to estimate and predict the severity of undesirable changes in the rectal closure apparatus in this group of patients.
Key words: rectal cancer, muscle ultrasound, quality of life, EORTC QLQ C30 and CR29 questionnaires
PALLIATIVE TREATMENT WITH THE USE OF ANTEGRADE MINIINVASIVE TECHNOLOGIES IN TUMORS OF PROXIMAL BILE DUCTS
In 2010 - 2016 there were 18 patients with cholangiocarcinoma of the proximal bile duct, complicated with obstructive jaundice syndrome under our supervision. In the study group there were performed 34 antegrade minimally invasive interventions, which acted as a palliative care and allowed to prepare patients for the main stage of the operation. The lethal outcome occurred in 1 patient and was associated with an increase in multiple organ failure against the progression of the underlying disease.
THE CLINICAL SIGNIFICANCE OF ULTRASOUND DIAGNOSIS IN THE ALGORITHM OF MINIMALLY INVASIVE TREATMENT OF BREAST CYSTS
The subject of our study is evaluation of minimally invasive fibrocystic breast disease treatment effectiveness based on multiparameter radiologic imaging. We have examined and treated 55 patients diagnosed with breast cyst. We performed a complete physical examination of all patients before treatment, including mammography, B-scan ultrasonography, doppler sonography, and two types of elastography. After the examination, we conducted minimally invasive treatment using three methods: 96% ethanol sclerotherapy, oxygen-ozone sclerotherapy and interstitial laser photocoagulation. Treatment effectiveness was evaluated ten days, one month, three months, six months and twelve months after treatment. It was established that the most efficient treatment method is ozone therapy and interstitial laser photocoagulation.
Key words: fibrocystic mastopathy, ultrasound diagnostic, breast cyst
POLYNEUROPATHY IN PATIENTS WITH MALIGNANT TUMORS (A LITERATURE REVIEW)
The peripheral nervous lesions are often a complication of the oncological process or a complication of its treatment. Even with successful treatment of the underlying disease, complications can reduce the quality of life of patients. Article review presents of data of the epidemiology, pathogenesis, clinical picture, diagnosis of paraneoplastic (5% of patients) and chemotherapy-induced polyneuropathy (38% of patients). About half of all cases of polyneuropathy are associated with pain syndrome. The pathogenesis of polyneuropathy is a very complex problem and specific mechanisms of development of polyneuropathic disorders are not fully understood. This leads to difficulties in determining the appropriate treatment of these complications.
ROLE AND PLACE OF INSTRUMENTAL METHODS IN PALLIATIVE CARE
Palliative care (PC) includes a set of medical interventions aimed at improving the quality of life of incurable patients, while having a positive impact on the course of the disease. PC is applicable in the early stages of the disease in combination with other therapies designed to prolong life. High-tech methods of diagnosis and therapy have been developed, which are widely used in PC and without which it is impossible to achieve a high level of quality of life. According to the authors, there is no doubt the need for the use of instrumental methods in the general clinical practice of PC, taking into account the clear definition of indications and contraindications to their use in the specific conditions in which they should be applied.
Key words: palliative care, instrumental methods, diagnosis and therapy, quality of life.
IMPROVING THE QUALITY OF LIFE OF AN ELDERLY PATIENT WITH GIST THROUGH INDIVIDUALIZATION OF THE TREATMENT REGIMEN
Introduced own experience of effective treatment with imatinib using high-performance liquid chromatography with detection of tandem mass spectrometry of an elderly patient with disseminated form of GIST, for individualization of therapy.
MINIMALLY INVASIVE CRYOABLATION OF SOFT TISSUE TUMORS IN PALLIATIVE MEDICINE
The procedure of palliative puncture cryoablation of tumors was performed in 19 patients for decrease the severe pain syndrome. The cryotherapy system was used with cryo-probes with a diameter of 1.5 mm with liquid nitrogen. The navigation of instrument and control procedures were provided by ultrasound or CT scanning. The cryotherapy was conducted from one to 9 procedures for each patient in conditions of local anesthesia or narcosis. In all cases a positive result was obtained: a decrease in the intensity of pain, cytoreduction, an improvement of the general condition.
ANALYSIS OF THE RESULTS OF RECONSTRUCTIVE SURGERIES IN PATIENTS WITH A DIAGNOSIS OF PRIMARY RESECTABLE BREAST CANCER
Under the conditions of the State Budgetary Institution of Healthcare of the Samara Regional Clinical Oncologic Dispensary, a planned, prospective, randomized study was conducted, reflecting the results of treatment of patients diagnosed with primary resectable breast cancer in the period from 2013 to 2018. Subcutaneous mastectomy was performed in patients of the control group (n = 115) with reconstruction of the endoprosthesis with full muscle shelter. Subcutaneous mastectomy was performed to patients of the main group (n = 121) using a new one-step reconstruction method. Analysis of the results showed that the use of a new one-step reconstruction method statistically significantly (p = 0.000) improves the immediate results of treatment and the quality of life of patients diagnosed with primary resectable breast cancer in comparison with the group of patients who underwent mastectomy with an endoprosthesis with a standard method.
Key words: primary resectable breast cancer, mastectomy, reconstruction, quality of life.
USE OF QUADRICEPS FEMORIS ULTRASOUND FOR BEDSIDE SCREENING FOR MALNUTRITION IN ELDERLY PATIENTS WITH COLON CANCER COMPLICATED BY ACUTE INTESTINAL OBSTRUCTION
The deficiency of nutrition for colorectal obstructive cancer patients is common. Application of ultrasound for femur quadriceps is a new tool for determination of nutritional status. In our study we report the results of use of ultrasound in this field.
We revealed the link between femur quadriceps thickness and the extent of nutritional insufficiency.
Ultrasound is portable and useful bedside device for nutritional status identification. It allows to prevent the other postoperative complications.
Key words: Ultrasound, deficiency of nutrition, albumin, colorectal cancer, ileus, old age, femur quadriceps, prognosis, postoperative complications.
PSYCHOTHERAPEUTIC ASPECTS
Gorokhov K.V., Kornilova O.A.
PERIODIZATION OF THE FORMATION OF ADHERENCE TO TREATMENT IN TERMINALLY ILL PATIENTS IN THE PROVISION OF PALLIATIVE CARE. COMMITMENT SCALE (SHORT VERSION)
This article is a continuation of a series of works devoted to the periodization of the formation of commitment. The article presents a description of each stage of the formation of adherence to the treatment of patients taking drugs for a long time or for life and provides a brief interpretation of them. In conclusion, the paper proposes a five-point "scale of adherence", which allows the doctor to quickly assess the formation of adherence to treatment, which is especially important in palliative medicine to improve the quality of life of patients.
Palliative care, HIV/AIDS, periodization; adherence to treatment; psychological care; psychological correction; medication intake; adherence scale; quality of life.
DIGEST
Boulyubash I.D.
PROSPECTS FOR THE STUDY OF VITALITY AND PSYCHOLOGICAL STABILITY IN PATIENTS WITH THE EFFECTS OF SPINAL CORD INJURY AT THE STAGE OF REHABILITATION TREATMENT
The paper reviews the literature and assesses the prospects for the study of resilience and hardiness in patients with spinal cord injury. The tools for measuring these psychological characteristics, as well as the relationship between them and other psychological factors are described. The questions concerning the increase of hardiness and resilience at the stage of rehabilitation are formulated. The types of statistical analysis, the results of which will highlight the psychological variables important for the formation of these characteristics in patients, are presented
Key words: spinal cord injury, rehabilitation, palliative care, resilience, hardiness.
THE FIRST RUSSIAN EPIDEMIOLOGICAL STUDY OF THE NEED FOR PALLIATIVE MEDICAL CARE AND EFFICIENCY AND SAFETY OF DIAGNOSTIC METHODS IN CANCER PATIENTS
The article presents the main results of the first Russian epidemiological study of the need for palliative medical care and diagnostic methods evaluation in cancer patients. Based on the data obtained the methodology for defining the need for palliative medical care and its organizational forms has been developed; the number of cancer patients requiring palliative care has been defined. This will solve the problem of palliative care planning and its targeted financing in the regions; will allow using only reqired and safe diagnostic methods in palliative care and thereby preventing the spending for inefficient and expensive investigations.
Keywords: Oncology, Palliative Care, epidemiological studies, cancer incidencer, cancer mortality, need for palliative care, instrumental methods in palliative care, symptom diagnosis and control, quality of life in cancer patients
TRANSRECTALPUNCTUREBIOPSYUNDERTHECONTROL OF ULTRASOUND DIAGNOSTICS IN DIAGNOSIS OF PROSTATE CANCER
There is review of the material on the application of the method of transrectal puncture biopsyunder the control of ultrasound diagnostics, which used for actual diagnostics of prostate cancer in this article. The description and assessment of method, used by authors, described in the paper.
The prostate cancer is one of the most serious medical problem among men all over the world. The prostate cancer is widespread disease with a higher index of death and incidence rate.
The index of death from prostate cancer is about 3,9% among the index of death from other oncological diseases. Because of the high prevalence of disease, the problem of earlier detection of the disease arises.
The key words: a prostate cancer, a transrectal puncture biopsy, ultrasound navigation
EXPERIENCE OF PALLIATIVE PHOTODYNAMIC THERAPY IN THE TREATMENT OF PATIENTS WITH EARLY GASTRIC CANCER
According to the world statistics, the incidence and mortality from gastric cancer over the past dozens of years has been steadily increasing. In the structure of the incidence of malignant neoplasms of the Russian population, stomach cancer ranks fourth in men and 5 in women, with the disease being detected at stage I in only 9.9% of cases. Often, malignant tumors are diagnosed in people over 60 years of age. Patients in this age group often have a pronounced concomitant pathology, excluding the possibility of surgical treatment, and therefore new methods of treatment, including endoscopic intraluminal photodynamic therapy, are increasingly used in this category of patients.
On the basis of the "Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine", 4 patients were treated between 2014 and 2017, who had an early form of stomach cancer T1N0M0. Due to severe concomitant pathology and advanced age, surgical treatment has not been shown. By decision of the consultation, these patients underwent photodynamic therapy. A total of 2 men and 2 women were treated. In all cases, the tumor was located in the body of the stomach in different parts of it. Tumor sizes according fibrogastroskopii ranged from 0.5 to 2.5 cm. Histological characterization in all cases was verified adenocarcinoma.
During all sessions of PDT, no clinically significant complications were noted. In the course of our endoscopic intraluminal photodynamic therapy, we managed to achieve the following results: in 3 patients complete resorption of the tumor, in 1 patient a relapse-free period of the tumor process was 23 months, in 1 patient stabilization of the process for 12 months. Thus, the method of intraluminal PDT is an effective method of treatment of patients with early gastric cancer, in cases of impossibility of carrying out radical surgical treatment.
Key words: photodynamic therapy, oncology, stomach cancer, early cancer, palliative care, endoscopy, fibrogastroduodenoscopy
Grechkin F.N.
MINIMALLY INVASIVE THERMAL DEGRADATION IN THE COMPLEX TREATMENT OF METASTATIC COLORECTAL
Data on 35 patients with non-resectable metastatic liver affection at cancer of large intestine T3-4N0-2M0 have been analyzed. In 15 cases percutaneous radio-frequency thermoablation of liver metastases in combination with intratissue chemotherapy on autoplasma has been performed. 20 patients received standard chemotherapy. Complex treatment of patients with non-resectable metastatic liver affection at cancer of large intestine significantly reduces the rate of disease progression (by 35%) without disturbance of the patients' general habitus and quality of life at postoperative period.
Key words: liver metastases, cancer of large intestine, radio-frequency ablation, intratissue chemotherapy
Masljakov V.V., Smirnova T.V., Zepp I.V.
THE ACTIONS DIRECTED TO IMPROVEMENT OF QUALITY OF DELIVERY OF HEALTH CARE BY THE ONCOLOGICAL PATIENT WHO IS ON TREATMENT IN OFFICE OF PALLIATIVE CARE
Results of introduction of "School of health" for the oncological patients in a terminal stage of a disease who are on treatment in office of palliative care and their relatives are presented in article. The conclusion is drawn that use of "School of health" dictates need of carrying out training in leaving and social rehabilitation both relatives of patients with oncological diseases, and patients.
Keywords: oncological patients, office of palliative care, school of health
Ogoshkov P.A., Spichak I.I., Kremlev S.L.
RESULTS OF THE INVESTIGATION OF THE ESTIMATION OF THE LEVEL OF CHILDREN'S ONCOLOGICAL TREATMENT OF PRIMARY CHIEF OF CHELYABINSK REGION
The article substantiates the urgency of the problem of childhood cancer morbidity, presents the results of a sociological study conducted in the Chelyabinsk region. The purpose of the study was to assess the awareness of primary health care personnel on pediatric oncology and to determine the level of their cancerous alertness. Analysis of the results of the survey showed that a full physical examination of the patient during treatment, collection of history data that can lead to the development of congenital diseases, information about the harmful habits of the patient's parents, taking into account the environmental situation of the mother's place of residence before and / or during pregnancy, the child at present and his previous place of residence is always or in most cases (70% or more) of respondents, which indicates a sufficient, but not high oncological alertness. At the same time, about 50% of the respondents take into account the data on the presence of cancer cases in the patient's family, the occupational hazards of the patient's parents, the nature of the patient's diet.
Keywords: oncological diseases, children, oncologic alertness, sociological research
RESULTS AND COMPLICATIONS OF PALLIATIVE ESOPHAGEAL STENTING IN ITS MALIGNANCY
Despite modern advances in the diagnosis and treatment of malignant diseases, most patients with esophageal cancer presented in the advanced stages of the disease, when radical (surgical, radiological) treatment is impossible. Therefore, the help of this category of patients remains an important section of clinical Oncology and palliative medicine. We analyzed the results of esophageal stenting in 75 patients with esophageal cancer. Revealed that all patients were relieved of symptoms of dysphagia. In 3% of cases there were complications-tumor perforation, which required surgery. All patients were discharged, there were no cases of mortality in the hospital. All patients died within 12 months after stenting. In 76% of patients dysphagia after esophageal stenting did not recur. Thus, in patients with esophageal cancer stenting is an effective and safe procedure, the implementation of which improves the quality of life.
Keywords: esophageal cancer, esophageal stenting, complications of esophageal stenting, inoperable esophageal cancer, palliative care for patients with esophageal cancer
Zotov P.B.
SUICIDE OF CANCER PATIENTS: GENDER AND AGE CHARACTERISTICS OF THE CONTINGENT
Discusses issues of suicides in cancer patients. On the basis of the model for identifying cases of suicide, proposed by the author and introduced into practical health care, data on the number and sex and age composition of this contingent were obtained. It was shown that the proportion of cancer patients in the total mass of suicides was 1.05-1.33%. The average age in the group of cancer patients who have committed suicide is 66.8 years, which is 13-16 years higher than the average age of suicides of the general population, but lower than the age of death from cancer (for men, 67.7; for women, 69.8 years). Distribution by sex - male: female - 4: 1 (compared with the total population - 4.8: 1). The author also points out some limitations of the presented model - it is difficult to differentiate the cases of suicides of persons who are sufferers who have committed suicide for reasons not related to the neoplasm. It was noted that it is important to assess the role of the family and other psycho-social factors in this direction. In conclusion, it is concluded that the proposed accounting system allows to obtain objective data and the number and sex-age composition of suicidal acts among this cohort. Reported indicators can be used to develop more differentiated suicide prevention measures among oncological patients.
PROBLEMS OF ADAPTATION IN PATIENTS WITH THYROID CANCER
Research objective: to rate the adaptation problems of patients with thyroid cancer at different stages of surgery. Research of 90 patients with thyroid cancer. Techniques are applied: the alarm and depression tests of Zang, MMPI-SMOL in dynamics. At patients the expressed emotional problems which amplify in the postoperative period are noted. By results of research patients with cancer of a thyroid gland can draw a conclusion on need of carrying out psychological correction, as a component of a complex of rehabilitation actions.
THE MAIN GROUPS INVOLVED IN THE HIV EPIDEMIC, THEIR PSYCHOLOGICAL PORTRAIT AND OBJECTIFICATION OF QUALITY OF LIFE
The article presents two main groups of participants in the HIV epidemic. The psychological portrait is described, the quality of life is objectified. Mental, social, psychological problems in the context of the HIV epidemic in the world hinder the provision of assistance to PLHIV, reduce their quality of life, professional and social adaptation of people living with HIV in society.
Key words: HIV infection; people Living with HIV; personality; quality of life; loneliness; psychology
METHODOLOGY FOR CONDUCTING AN EPIDEMIOLOGICAL STUDY OF THE NEED FOR CANCER PATIENTS IN PALLIATIVE CARE
The authors described the methodology of an epidemiological study conducted in the constituent entities of the Russian Federation in order to determine the need of cancer patients for palliative care, including conducting an epidemiological study based on the available official statistical data; an observational analytical study to study the needs of cancer patients using a sociological survey method; statistical processing, analysis of the obtained data and calculation of the need for various types of palliative care, as well as the development of proposals for improving the organization of palliative care for cancer patients based on the analysis of all the results. The above methodology is intended for use at any level of palliative care based on information on the number of patients registered in a specific territory.
Key words: epidemiologic study, cancer patients, palliative care in Russia
Zubarevà N.N., Govorun N.I., Ponomareva I.P.
PROJECT MANAGEMENT IN SYSTEM DEVELOPMENT OF PALLIATIVE CARE TO THE POPULATION OF BELGOROD REGION
The article presents the key provisions of the regional project for the strategic development of palliative care for adults in the Belgorod region. Palliative care is being provided at several stages: 309 palliative care beds: 35 beds on the basis of Belgorod regional oncological dispensary and 274 beds in the regional hospitals. In the future, new departments, offices with the function of patronage service will be opened.
Keywords: palliative care, hospice
Tkachenko G.A., Grushina T.I.
INTERACTION CLINICAL PSYCHOLOGIST AND PHYSICAL THERAPIST AT THE REHABILITATION-STAGE OF BREAST CANCER PATIENTS
Under supervision were 172 women - patients with breast cancer I-IIIB stages. The analysis of the results of the interaction between a medical psychologist and a physiotherapist showed, at the first stage of rehabilitation, a reduction in all anxious breast cancer patients by an average of 3.5 ± 0.9 points (p>0.05), a reduction in the number of patients with a high depression level up to 52, 8%, an increase of 21.4% in the number of patients without signs of depression (p<0.05), prevention of stiffness in the shoulder joint and healing of the postoperative wound in 100% of patients. In the second stage of rehabilitation, the use of physical rehabilitation methods (pneumatic compression, electro- and magnetotherapy) led to a decrease in postmastectomy lymphedema of I degree by 97 ± 5.4%, II d.- by 89 ± 5.6%, IIId. - by 80,1 ± 9.8% (p <0.05). Complex rehabilitation allowed reducing the number of patients with signs of depression by 52.0% and with anxiety - by 100%. Consequently, interdisciplinary interaction not only significantly improved the functional results of antitumor therapy, but also reduced the manifestations of psychological distress and vice versa.
Keywords:psychological rehabilitation, breast cancer, physical rehabilitation, physiotherapy
EXCHANGE OF EXPERIENCE
Palekhov A.V., Vvedenskaya E.S.
TACTICS OF OPIOID SELECTION AND USE FOR CHRONIC PAIN CONTROL
The Government of Russia is carrying out the large-scale measures to improve the quality of pain control in patients suffering from chronic pain. Numerous changes have been made to the federal regulatory framework for the opioid analgesics (OA) medical use that to a great extent solves their availability problems. The modern and effective OA have been applied to medical practice. The authors give the characteristics of certain OA which are recommended for use by the Russian Federation Ministry of Health orders, justify the selection of specific drugs and their certain forms, and consider the social aspects of OA use.
Keywords: adequate pain control, opioid analgesics, chronic pain, non-medical use
MINIMALLY INVASIVE TECHNOLOGIES IN THE DIAGNOSIS, TREATMENT AND REHABILITATION OF PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS
In the article The modern controlled miniinvasive techniques of acute destructive pancreatitis diagnostic and treatment and its complications are discussed. Perspective miniinvasive techniques as many-frequent bioimpedancometry and crystallography are described. Different controlled miniinvasive interventions were used in the particular sequence in dependence on clinico-morphological form of pathological process. Endocavital ultrasound research in the perspective area in the development of miniinvasive techniques at the destructive pancreatitis.
PALLIATIVE CONCURRENT CHEMOTHERAPY AND RADIATION THERAPY OF PATIENTS WITH LOCALLY ADVANCED MALIGNANT TUMORS OF THE HEAD AND NECK
More than a half of patients with the first-time diagnosed cancer of the head and neck have the advanced stages of the disease. This article presents the review of the recent years literature related to effective, accessible, and acceptable in terms of toxic side effects the concurrent chemotherapy and the radiation care. The study has evaluated the advantages of various schemes of the induction and the simultaneous chemoradiotherapy, variants of fractionation and variants of radiation dose delivery methods. Nevertheless, the choice of optimal antineoplastic treatment variant that preserves the acceptable quality of life in patients remains debatable.
SOCIOLOGICAL RESEARCH OF THE NEED OF THE POPULATION OF THE COUNTRY IN QUALITATIVE PALLIATIVE CARE
The provision of palliative care to the population of the Russian Federation takes place in accordance with federal legislation and territorial programs of health development. It is proposed to conduct an epidemiological study that will determine the problems of regulatory and legal regulation of the organization of palliative care, examine the consistency of the data contained in the current forms of federal statistical observation with modern needs in assessing the provision of palliative care, calculate the adult population's need for outpatient and inpatient PMP based on morbidity rate on the request and hospitalization on bunks of round-the-clock stay under basic classes and groups of diseases for different age groups, as well as security standards to calculate the adult population in palliative care in outpatient and inpatient settings.
Key words: palliative care, epidemiology, assessment of palliative care, need for palliative care.
Danilov V.M., Abramov S.I.
A 10-YEAR EPIDEMIOLOGICAL STUDY OF MORTALITY RATE FROM MALIGNANT NEOPLASMS OF THE POPULATION VORONEZHSKOI REGION
Regular analysis of state statistics data allows decision makers and the chief specialist service to effectively use budget funds for the development of cancer services and support programs aimed at improving statistics. In 2013, the Russian government adopted a strategy for the development of health care until 2020, which clearly defines the tasks of the Oncology care. The implementation of the tasks should improve the situation for the early detection of malignant neoplasms, change the proportion of the accumulation in the direction of the early stages of cancer, as well as increase the 5-year survival rate in the case of diagnosis of malignant neoplasms. The article analyzes statistical data on mortality from malignant neoplasms in the Voronezh region, in comparison with the Central Federal district and Russia for the period 2006-2016. The data of Rosstat on the distribution of deaths from malignant neoplasms by sex and age (form ¹ 5) and the average annual population of the administrative territories of Russia are used. The world standard of age distribution of the population is used to calculate standardized mortality rates. Calculation of growth / decline indicators for the 10-year period was carried out with preliminary alignment of dynamic series. The mortality rate by age and sex was calculated. Cancer statistics allows to trace the situation with the state of cancer care in the Voronezh region over the past 10 years.
Key words. Malignant neoplasms, epidemiology, mortality from malignant tumors, statistics.
EXCHANGE OF EXPERIENCE
Vavilov V.V.
«AS ONE FAMILY»
UNIQUE EXPERIENCE IN PROVIDING PALLIATIVE CARE FOR CHILDREN AND ADULTS IN THE KAZAN HOSPICE
Studying the experience of hospice work in Russia, the post-Soviet space and abroad has shown that children's and adult hospices work separately from each other, choosing their own model of palliative care to patients. The Angela Vavilova Foundation, implementing the project of opening a children's hospice with two departments, children and adults, set the task of maintaining the principle of continuity in providing hospice care for children with the prospect of further transferring them to the adult branch upon reaching adulthood. With the existing budget financing of domestic health care and the lack of sufficient number of children's and adult hospices in virtually all regions of Russia, it is especially important to assess the economic effectiveness of the proposed organizational model of the hospice. The analysis of expenses for the construction of the Kazan Hospice, as well as the cost of its operation, showed that the work of children's and adult in-patient departments in the same building under the jurisdiction of one medical institution reduced the cost of maintaining the hospice by 30% compared to the construction and financing of two separate hospices. Administrative non-medical expenses decreased, at the same time, the high level of provided medical and social services was maintained. Thus, the model of work of the Kazan hospice has shown its viability and is the most acceptable for regions where both children's and adult hospices are absent.
Key words: palliative care, hospice care, children's hospice, economic efficiency.
Pchelintsev M.V., Kubynin A.N.
CHANGES IN QUALITATIVE STRUCTURE OF PRESCRIPTIONS FOR STRONG OPIOIDS FOR OUTPATIENTS IN SAINT-PETERSBURG IN 2017 COMPARING TO 2001 AND 2005.
Changes in qualitative structure of prescriptions for strong opioids for outpatients in Saint-Petersburg in 2017 comparing to 2001 and 2005.
The qualitative structure of prescriptions for strong opioids (SOs) for outpatients with severe chronic pain was analyzed in 4 administrative districts of St. Petersburg in 2001, 2005 and 2017. Time changes in the prescription of different SOs and their dosage forms were detected and analyzed. Measures to improve the administration of SOs to outpatients with severe chronic pain are proposed.
Keywords: pain, analgesia, opioids, TTS with fentanyl, morphine, pharmacoepidemiology
EVALUATION OF THE NECESSITY MODERN MOBILE APPLICATIONS FOR SOLVING HEALTH PROBLEMS
To estimate the need to use specialized reference applications in the practice of a therapeutic physician. To achieve this goal, we interviewed 7636 physicians of therapeutic specialties. Statistical processing of the data was carried out using open versions of the program Exell and Statistica-6. Among the doctors surveyed, the majority rated the availability of medical care as low, linking this fact primarily to lack of time for admission. One of the possible ways to solve this problem may be the usage of specialized reference and informational applications. As a result of our survey, it was found that most of the therapeutic physicians surveyed agreed with the need to implement an application combining the information needed by the physician-therapeutic profile, as well as the specialized tools needed in the process of work. One of the most significant factors in reducing the availability of medical care to the population is the lack of time for admission. In modern medicine, it is necessary to implement a universal reference application and widespread it.
Key words: reference application, accessibility of medical care, mobile devices
Balasaniantc G.S.
JURIDICAL REGULATION OF THE PROVISION OF PALLIATIVE CARE IN TUBERCULOSIS
The absence of a legal framework hinders the integration of palliative care into the practice of TB care. Therefore along with formation of the concept and accounting of features of this type of the help in phthysiology it is necessary to enter palliative care and its basic principles in the main normative documents: the Federal law 77-FZ dated 08.06.2001 «About the prevention of tuberculosis distribution in the Russian Federation», the Resolution of the main sanitary doctor ¹ 60 dated 22.10.2013»On approval of sanitary and epidemiological rules SP 3.1.2.3114-13 «Prevention of tuberculosis» and order of Ministry of health of Russia 932-N dated 15.11.2012 «On approval of the Order of rendering medical care to tuberculosis patients».
IMPROVING THE QUALITY OF LIFE OF AN ELDERLY PATIENT WITH NON-SMALL-CELL LUNG CANCER ON THE BACKGROUND OF CONDUCTING TARGETED THERAPY WITH A EGFRMUTATION BLOCKER OF THE SECOND GENERATION
Despite the advances made in the treatment of small cell lung cancer, the results in the treatment of non-small cell lung cancer are still disappointing. The IHC data, which revealed a mutation in a number of patients in the 19th exon, made it possible to observe the effectiveness of the use of drugs from groups of tyrosine kinase blockers. The appearance of each new drug of this group is encouraging and of great interest for clinical oncology. In the present work, data on the effective use of Afatinib in an elderly patient with lung adenocarcinoma (mutation in the 19th exon) are presented for 11 months.
Key words: quality of life, oncology, age, old age, lung cancer, adenocarcinoma, non-small cell lung cancer, EGFR mutation, chemotherapy, targeted therapy, efficacy, side effects, Afatinib
EPIDEMIOLOGICAL STUDY OF CANCER PATIENTS' NEED FOR PALLIATIVE CARE IN RUSSIA
The authors demonstrate that an epidemiological study of cancer patients' need for various kinds of palliative care in Russia is a paramount. They analyze the existing approaches and methodologies for its assessment. They describe the objectives of the research to be conducted with the main goal for scientific justification and design the measures for organization and availability of cancer palliative care upturn.
Key words: epidemiological study, cancer patients, palliative care in Russia.
PERFORMING MODIFIED RESECTIONS FOR MALIGNANT DISEASES OF THE MAMMARY GLANDS
The use of modified radical resections on the basis of the Samara regional clinical oncological dispensary with the use of methods of reduction surgery helped maintain high quality of life in patients with a diagnosis of breast cancer. The implementation of radical resections does not worsen the immediate and long-term results of surgical treatment of patients, and the technical capabilities of modern surgery neutralize the consequences of operations, ensuring the social activity of patients.
Key words: breast cancer, modified radical resections, the results of treatment, social activity.
Yerugina M.V., Krom I.L., Shmerkevich A.B., Balakina D.D.
FORMATION OF THE ONCOLOGICAL HELP CONTINUUM IN THE PROJECTION OF THE INTEGRATED HEALTHCARE SYSTEM
Chronic diseases, which assume the interdisciplinary care complex models usage and the overcoming of an integrated healthcare system fragmentation and formation are considered as one of the most important problems of healthcare in the XXI century.
Oncological diseases are considered to be the most common chronic diseases that determine patient's life expectancy. According to the authors of the article, the oncological care continuum, as well as the continuum of care within other chronic diseases, integrates a specialized, palliative care and rehabilitation.
However, in most regions of Russia, oncological care is limited mainly to specialized care. The existing order of rendering help to oncological patients does not take into account the continuum scenario in the situations of a disease. In the authors opinion due to the absence of a formed continuum of oncological care in Russia, there is a need for its conceptualization.
Keywords: integrated health care system, oncological care continuum, situation of a disease.
Dolzhenko V.V., Garibyan G.S.
HAS A PSYCHOLOGIST THE RIGHT TO WORK IN A HOSPITAL WITHOUT ANY MEDICAL TRAINING?
Our study has been carried out by means of telephone interviews with Heads of Palliative Care's hospital units, living and working in different Russian regions. The subject matter is the presence (29 %) and the absence (71%) of a psychologist in their department. With regard to their absence, we have identified the causes ( 63,5 % see no need to have this employee, 36,5 % can't find suitable candidate). We have identified that the working psychologists have a medical training, we have also exposed their length of service, the average salary and number of working hours per week. Authors of the article have explored legislative framework to identify whether a psychologist has the right to work in the Palliative Care's hospital unit. So, according to the law, he has the right on an exceptional basis under that three obligatory conditions: a probationary period, then the Certification to determine their suitability for this post ( there are all necessary forms to arrange the certification in the annex to the present article), in addition employee has the obligation to be retrained in the specialty «Clinical Psychology».
Keywords: medical psychologist, therapist, psychiatrist, medical training, clinical psychology, Palliative Care's unit, hospital, Hospice, nursing care department, Certification to determine the suitability for the post, length of service, psychologist's average salary, conference in Sochi, exchange of experience.
PALLIATIVE TREATMENT WITH THE USE OF ANTEGRADE MINIINVASIVE TECHNOLOGIES IN INOPERABL EPANCREASCANCER
In 2010 - 2016 years 160 patients with malignant pancreas disease complicated by mechanical jaundice syndrome, as palliative treatment, performed antegrade minimally invasive interventions on the biliary tract.Sensitivity, specificity and diagnostic accuracy of a cholangiography during cholangiostomy were 91.2%, 80.1% and 85.3%, respectively. In total of 204 minimally invasive interventions were performed. The lethality was 7,5% and was associated with the progression of multiple organ failure.
CLINICAL AND EXPERIMENTAL RESEARCH Novikov G.A., Zelenova O.V., Rudoy S.V., Vaysman M.A., Kreknina E.A., Abramov S.I.
ECONOMIC ASPECTS OF TREATMENT OF CHRONIC PAIN BY THE EXAMPLE OF DIRECT COSTS FOR THERAPY OF MILD TO MODERATE PAIN
Assessment of health technologies in a limited budget is an important task for healthcare providers and decision-makers. In accordance with the roadmap adopted by the government of the Russian Federation for the development of palliative care, providing patients with modern analgesic technologies is an integral part. Creation of clinico-economic simulators allows to answer two tasks: clinical choice of therapy depending on the stage of pain syndrome and economic indicators of direct costs when using various analgesics.
Key words: evaluation of medical technologies, social cost of the disease, palliative care, chronic pain syndrome, direct costs.
Secundova M.A., Sdvizhkov A.M., Yakovenko I.Yu.
THREE TIMES NEGATIVE BREAST CANCER - TREATMENT FEATURES
The authors present the results of treatment of 128 patients with operable three times negative breast cancer. All patients underwent a surgical intervention, the volume of which depended on the stage of the disease. The efficacy of neoadjuvant and adjuvant chemotherapy, as well as pre- and postoperative radiotherapy, was assessed. Side effects of various types of treatment are analyzed. The five-year recurrence-free and overall survival in this group of patients was tracked. The conclusion about a high degree of efficiency of the applied methods of complex treatment of operable forms of thrice negative breast cancer is made.
SUBJECT MATTER AND TECHNOLOGY OF MEDICO-SOCIAL WORK IN THE INSTITUTES OF MEDICO-SOCIAL EVALUATION AND REHABILITATION AREA
Medico-social work as a specific area of social work has its own peculiarities in informatory and technological components depending on the sphere of health protection. In the article we examine peculiarities of medico-social work in the institutes of medico-social evaluation and rehabilitation area. We demonstrate its potential on different stages of medico-social evaluation, and also while implementing separate directions of medico-social rehabilitation of the disabled. We analyse directions and experience of social-psychological service, organized in rehabilitation facility organized for the children, disabled due to oncology disease.
Key words: medico-social work, medico-social evaluation, direction of medico-social rehabilitation of the disabled, subject matter and technology of medico-social work, social work specialist, medico-social work in the bureau of medico-social evaluation, medico-social work in the rehabilitation institution.
Kharagezov D.A., Poluektov S.I.
ROLEOFHORMONES OF ADRENAL CORTEX IN PREDICTING EFFICIENCY OF COMPLEX TREATMENT OF PATIENTS WITH GASTRIC AND COLON CANCERS
Objectives: Assessmentofthesecretion of hormones by the adrenal cortex in patients with gastrointestinal cancer during the complex treatment and in the disease prognosis.
Materialandmethods: We analyzed the data of 347 patients with gastric (n=247) and colon (n=100) cancers (mainly stage III) treated at Rostov Research Institute of Oncology in 2012-2015. Patients received surgical treatment plus neoadjuvantpolychemotherapy. The secretion of total (17-OCS T) and free (17-OCS F)oxycorticosteroids was determined in the daily urine.Cortisol (F), cortisone (E) and their tetrahydroforms(THF, THE) were measured. The central regulation unit was evaluated by the level of corticotropin(ACTH) in the blood plasma. The state of the androgenic zone of the adrenal cortex was studied by the daily secretion of total ketosteroids (17-KS T), their fractions of dehydroepiandrosterone (DHEA), 17-OH-17-KS, androsterone (A) andetiocholanolone (Et).
Results: The tumor development at stage III and IV gastrointestinal cancer was accompanied by significant changes in the function of the studied system.
Conclusions: Effective antitumor treatment was accompanied by the normalization of the metabolism of glucocorticoids, and the ratio of cortisol tocortisone in the daily urine after the treatment could be used as a prognostic criterion for its effectiveness. The rise of the ratio by 1.5 times (p<0.01) indicated the generalization of the tumor process before any clinical signs.
The levels of 17-ketosteroids and their fractions in the daily urine corresponded to the tumor extent. After the complex treatment, the total amount of 17-ketosteroids in men increased by 1.5 times compared to the initial levels, and treatment in women caused an increase in dehydroepiandrosterone by 1.4 times (p<0.01).
PALLIATIVE SURGERY IN COMBINATION WITH INTRAOPERATIVE PHOTODYNAMIC THERAPY IN PATIENTS WITH GASTRIC CANCER
The article presents the results of surgical treatment of patients with gastric cancer with the presence or high risk of peritoneal dissemination with the use of intraoperative photodynamic therapy. The authors developed a technique for intraoperative photodynamic therapy that allows for effective intraoperative exposure without increasing the risk of increasing the number and severity of postoperative complications.The technique was used to treat 140 patients with stomach cancer of stage T3-4N0-3M0-1. The control group consisted of 100 patients with stomach cancer of stage T3-4N0-3M0-1, who did not perform intraoperative photodynamic therapy or other methods of intraoperative exposure. The groups were comparable at the stage of the disease, the index of peritoneal carcinomatosis, the nature and extent of the surgical procedures performed. Long-term results are evaluated: in the group of patients with intraoperative photodynamic therapy, a three-year disease-free survival was 55.1 ± 10%, in the control group - 29.5 ± 6.6%
VALUES IN THE MODEL OF BIOPSYÑHOSOCIAL REHABILITATION OF PERSONS WITH ONCOLOGICAL DISEASES
Authors carried out a pilot study of properties of the value sphere and behavioral coping-strategies of people with oncological diseases, which results were used to identify the correlates between individual characteristics of the value sphere with personality features and variants of behavioral coping-strategies of individuals, whose personality functions in an extremely stressful situation (as per DSM-4R). Authors made a profile of value characteristics (personal strengths) as markers of characterological positivity by the quantitative level in the descending order: "Gratitude", "Dedication, passion, enthusiasm", "Mirth and humor", "Kindness and generosity", "Forgiveness and mercy", which speaks for the prevalence of most positive values. It has been found that the variants of behavioral coping-strategies of the people taking part in the study are mainly represented by constructive and relatively constructive behavioral models, the leading of which are "Planning", "Admission of responsibility", "Self-control", "Search of support", "Positive revaluation", "Distancing". Non-constructive behavioral coping-strategies include "Confrontation" and "Escape-evasion", which were least represented. Authors concludes that in extremely stressful conditions there is a mobilization of the inner personal resources, which allow the individual to realize positive personal characteristics and to reorient towards constructive and relatively constructive behavioral coping-strategies.
Keywords: values, personality, coping-behavior, social adaptation, oncological diseases.
Zinchenko I.A.
THE EXPERIENCE OF THE OFFICE OF PALLIATIVE CARE OF THE STATE EDUCATIONAL INSTITUTION CLINICAL POLYCLINIC ¹ 28 IN THE CITY OF VOLGOGRAD
The article is devoted to experience in the office in the provision of palliative care to the adult population. The relevance of this article is not in doubt, as the demand in the offices of palliative care is steadily increasing because of the increasing number of patients. A detailed analysis of indicators of activity of the Cabinet of palliative care Dzerzhinsky district of Volgograd city for 9 months of 2017.
Key words: palliative care, the adult population.
PSYCHOTHERAPEUTIC ASPECTS
Bulyubash I.D., Groznova E. V.
PSYCHOLOGICAL FACTORS SUPPORTING A POSITIVE MOTIVATIONAL STATE IN PATIENTS WITH CONSEQUENCES OF SPINAL CORD INJURY DURING REHABILITATION
The hope for a positive result of rehabilitation is one of the effective mechanisms of adaptation in SCI patients. The article evaluates psychological factors that support a positive motivational state (hope) in the rehabilitation process. A total of 50 patients with SCI were examined, a correlation analysis was made between the degree of hope expressed for success and the severity of other psychological factors. The factors that contribute the most to the maintenance of hope are determined: the degree of hardiness, the degree of psychological well-being, the emotional state and the social environment. These factors are focuses of the work of the therapist, aimed at achieving a positive motivational state in patients with SCI.
THE ROLE OF PSYCHOTHERAPY IN COMPLEX REHABILITATION OF PATIENTS WITH ONCOLOGICAL PATHOLOGY
The article discusses the mental health of women who undergo radical surgery for cancers of the reproductive system. Outlines the most current psychological and psychiatric problems in this population of patients in the context of General issues of psycho-oncology- actual problems of practical medicine. Discusses the specifics of psychotherapeutic interventions in patients with cancer. Outlines the original concept of the development of mental disorders in cancer patients from the positions of the biopsychosocial approach. 47
Key words: Tumors of the female reproductive system, psycho-oncology, mental disorders, psychotherapy, rehabilitation, quality of life.
¹3 2017 ã.
CLINICAL AND EXPERIMENTAL RESEARCH
Kaymakchi D.O., Grechkin F.N.
CHARACTERISTICS OF PHARMACOKINETICS OF 5-FLUOROURACIL AND CISPLATIN IN EXPERIMENTAL INTRATISSUAL CHEMOTHERAPY
Increasing the effectiveness of antitumor treatment is anactual problem for modern oncology resulting in combining various therapy methods, development of novel drugs and improvement of ways to affect the tumor tissue.
Thestudyshowedthatatintratissual injections of 5-fluorouracil, induetime, the amount of the drug in the liver parenchymaafter its injection with autoplasmawas 5 times higher than after the injection with the standard solvent.
The opposite picture was observed in the blood serum at the indicated time. Themaximalamountwasregisteredafterintratissual injections of 5-fluorouracilwith the saline, while after injections usingautoplasma the drug was not determined in the blood serum of rats in this period.
Theanalysisofcisplatinlevelsintheliverparenchyma and in the blood serum of rats demonstrated that at regular intervals after intratissualcisplatin injections, the maximal drug levels were determined in the liver parenchyma at the use of autoplasma. Thedruglevelswere 23.8% higherthanattheuseofthestandardsolvent.
In this study, the effectiveness of intratissual injectionsof 5-fluorouracil and cisplatinusing the autoplasmawas showed experimentally influencing tumor tissues.
The residence time of the chemotherapy drugs incubated with the autoplasma after their injections to the liver parenchyma was confirmed to increase.
EXCHANGE OF EXPERIENCE
Rudoy S V, Alexeev M V, Novikov G A, Vaisman M A
DEVELOPMENT OF THE DISCIPLINE PROGRAM "PALLIATIVE MEDICINE" FOR STUDENTS OF THE MEDICAL UNIVERSITY
The demand for the qualified personnel in the medical organizations which provide palliative care has increased dramatically in Russian Federation which dictates the need for training specialists in the medical universities. For the first time in Moscow State University of Medicine and Dentistry a new discipline called "Palliative Medicine" is included in the specialty program "Medical business". A sequence (an algorithm) of constructing the working program has been developed in order to create a working program for this discipline, on the base of which the program of the educational discipline "Palliative Medicine" has been prepared and introduced into the educational process of the students studying at the medical faculty.
Key words: professional training, palliative care, working program of the discipline.
Zhigalov S.N., Antipin P.A., Shaitanova N.Y.
FORMATION AND DEVELOPMENT OF PALLIATIVE CARE IN ARKHANGELSK
The analysis of the situation and socio-economic conditions of the formation of the service of palliative care in the Arkhangelsk region was carried out. Based on the experience gained in the region in organizing palliative, social and psychological care for patients and their relatives, with the support of regional health authorities, a decision was made to create a "Training room" on the basis of the Center for Palliative Care, to conduct classes with relatives caring for incurable patients at home.
Key words: Center for palliative care, care for terminally ill patients.
Malyar K.V., Moskvicheva M.G.
TECHNOLOGY INCREASE THE AVAILABILITY OF ANESTHESIA FOR CHILDREN RECEIVING PALLIATIVE CARE
The analysis of the dynamics of needs and provision of narcotic drugs of children receiving palliative care in the outpatient setting in the city of Chelyabinsk and Chelyabinsk region for 2013-2016. The experience of the application of organizational technologies that improve the availability of analgesia to children receiving palliative care in the outpatient setting, in the presence of chronic pain syndrome.
Key words: pain management, palliative care, videoconsultation.
Schurov V.A, Sazonova A.A.
DURATION PAIN AND RECOVERY LIMB MUSCLE STRENGTH
Checked the hypothesis of somatic afferent nociceptive role in the restoration of muscle strength in the examined 80 patients with children with closed fractures of the lower leg under treatment Ilizarov method, as well as a group of adult patients with osteoarthritis of the lower limbs (288 pers.).All surveyed using dynamometers determines the maximum torque of the front and back muscle groups femur and tibia. It was found that the timing of fusion of bone fragments is relatively smaller pediatric patients treated with painkillers pharmaceuticals for 3 days and the level of recovery of the contractility of the muscles - in children taking the drug 1-2 days. Patients 20-35 years at the initial stages of the disease osteoarthritis revealed compensatory rate increase contractility of the muscles of the affected limb, which was not in the subsequent development of the disease.
Keywords: pain, bone fracture, osteoarthritis, muscle strength.
MEDICAL AND ECONOMIC BENEFITS PREVENTION EARLY POSTOPERATIVE COMPLICATIONS IN KIDNEY SURGERY
Medico-economic efficiency of the process of prevention of erosive and ulcerative lesions of the gastrointestinal tract in the early postoperative period, with operations in the kidneys . Results.
STUDY THE EFFECTIVENESS OF PHOTODYNAMIC THERAPY ON THE MEDIAN SURVIVAL OF PATIENTS WITH CENTRAL SQUAMOUS CELL LUNG CANCER STAGE IV
Within the framework of the present study evaluated the effect of photodynamic (PDT) therapy on median survival in patients with central lung cancer. The study included 41 patients with central squamous cell lung cancer stage IV, not previously treated special methods of tumor treatment. Patients were divided into two groups: group 1 received photodynamic therapy with palliative chemotherapy, the standard scheme, 2 receiving only palliative chemotherapy. PDT was performed before the start of chemotherapy with photosensitizers chlorine of «Photolon» and «Radachlorin». The median survival in group 1 was 13.31 months in group 2 - 8.09 months (p = 0,038). The toxicity of the treatment in patients of both groups did not differ. Thus, endobronchial photodynamic therapy, carried out together with chemotherapy, is characterized by efficiency and safety, can increase the median survival of patients with Central squamous cell lung cancer stage IV.
Keywords: central lung cancer; Photodynamic therapy; Photolon; Radachlorin.
Malyar K.V., Moskvicheva M.G.
RESEARCH SOCIAL ASPECTS IN PEDIATRIC PALLIATIVE MEDICINE
A sociological study of the social aspects of families raising a child incurable.Analysis of the social status of families raising incurable child who is under the supervision of the office of children's palliative care revealed some individuality. Firstly, incurable child - often a welcome first baby born to healthy young parents aged 20 to 30 years. Second, the observed families live in good social conditions, have an average wealth, young, healthy parents have enough time and desire to practice with a sick child. The resulting study data should be considered when planning and organizing assistance to families raising incurable child in need of palliative care.
Key words:palliative medicine, children, surveys, social status.
EXCHANGE OF EXPERIENCE
Krom I.L., Erugina M.V., Shmerkevich A.B., Chernyak M.D. THE SIGNIFICANCE OF QUALITY OF LIFE ASESSMENT WITHIN THE OBJECTIVIZATION OF STRATEGIES OF PALLIATIVE CARE TO CANCER PATIENTS
The authors consider palliative care strategies in the context of quality of life of chronic diseases patients. According to the authors quality of life parameters and the palliative care subject-matter to patients with chronic diseases are destined by the disease pathway and situation.
Quality of life index, designated using the questionnaire WHO QOL-100 is considered to be a multi-factorial criterion of evaluation of patients condition with chronic diseases. In course of studying it was shown that the arised due to the disease changes in quality of life indicators in the «Physical» sphere and in the sphere of «Independence level» assign palliative care rehabilitation direction trends to patients with breast cancer in nonterminal stage of the disease. Quality of life index evaluation makes it possible to objectify the strategies and to prevent palliative care to these patients medicalisation.
Keywords: chronic disease, palliative care, rehabilitation direction, disease pathway, quality of life, relevant to health.
Kumirova E.V., Grigiryants L.Y. THE CURRENT SITUATION IN THE FIELD OF EDUCATION IN PEDIATRICS PALLIATIVE CARE
Pediatric palliative care in recent years is actively developing in the worl and Russia. Peculiarities of childhood and the necessary competencies of various specialists in the provision of palliative care dictate the need for the formation of an educational system for palliative pediatrics in accordance with WHO recommendations and the world trends. A key role in training is the relationship between organizations that conduct training courses and provide palliative care for children.
Keywords: palliative care, children, education, palliative approach, competences.
Novikov G.A., Vaisman M.A., Rudoy S.V. THE CHOICE OF TACTICS OF PALLIATIVE CARE FOR THE CANCER PATIENT
The issues of determining the tactics of palliative care for cancer patients are considered in the context of predicting the life expectancy of the patient. Scale prediction based on the functional
Key words: palliative care, cancer patient, palliative prognostic score
QUALITY OF LIFE AND DISTRESS IN PATIENTS WITH OVARIAN CANCER
Quality of life and distress in ovarian cancer patients. Objective: to analyze the impact of - distress, anxiety and depression on quality of life in patients with ovarian carcinoma. Methods: 70 patients with ovarian cancer were included in study group. The Screening Tools for Measuring Distress was used for distress diagnosis, the Hospital Anxiety and Depression scale was used for depression and anxiety diagnosis, the EORTC QLQ-C30 was used for measuring the quality of life. Results: 57,1% of patients had significant distress, 41,37% of patients had anxiety, 27,58% - depression. Regression analysis was applied to assess the impact of stage, type of distress, anxiety, depression, received treatment, age, marital status, education on the quality of life. Only distress significantly decreased quality of life, p<0.0001. Conclusion: distress decreases quality of life in ovarian cancer patients.
Key words: distress, anxiety, depression, quality of life, ovarian cancer.
Shmerkevich A.B.
SOCIAL RISKS IN THE CONTEXT OF A PREVENTIVE DIRECTION OF PALLIATIVE CARE FOR CANCER PATIENTS (REVIEW)
Prophylactic direction of palliative care for patients with chronic diseases, presumes prevention of social risk factors that contribute to the occurrence and progression of socially determined diseases.
Social environment is the source and context of the formation of social risks for health of the population. Many researchers point out the relevance of the problem of the influence of social risks to health and scientific studies on the verification of social risks.
Typology of social risks is one of the most significant problems in the etiology of cancer research, occupying last decades high ranking positions in the group of chronic non-communicable diseases.
Interdisciplinary analysis of social factors of etiology of cancer allows to oncopathology to be considered from the perspective of multicasual pathology. The authors cited in the article publications consider the changing of the environmental standards lifestyle, poverty, high psycho-emotional stress, premorbid personal characteristics in the context of major social risks of cancer in modern Russia.
Keywords: palliative care, social risks, the etiology of cancer.
Gorokhov K.V.
THE CONDITIONS OF LIFE, THE ABILITY TO SELF-CARE AS SOCIAL DETERMINANTS OF HEALTH AND MONITORING THE WORK OF THE PSYCHOLOGIST SERVICES OF PALLIATIVE CARE
The analysis of living conditions and abilities to self-service at patients of interdistrict office of palliative medical care as social determinants of health is presented in this article. by definition of World Health Organization social determinants of health are conditions in which people are born, grow, live, work and grow old, including health care systems. Social determinants of health are the main reason for injustice concerning health - unfair and preventable distinctions in the state of health. As a result social determinants make impact on decline in quality of life of the palliative patient that is inadmissible considering life expectancy of the person - the recipient of palliative care.
Keywords: social determinants of health; World Health Organization; quality of life; palliative care; ability to self-service; self-service; housing conditions; needs; public assistance; family.
DIGEST
Boulyubash I.D.
SOCIAL ACTIVITY AND SOCIAL INTEGRATION OF PATIENTS WITH CONSEQUENCES OF CEREBROSPINAL TRAUMA
In a review of the literature over the last 15 years are considered factors contributing to social integration and prevent patients with spinal cord injury. The questions of social stigma, the relationship between disability and society, society and the mutual responsibility of patients for the implementation of equal rights of persons with disabilities, the psychological barriers in the perception of patients and healthy individuals by the patients themselves. Detailed description of features of the physical and psychological impact on the professional employment and social activities.
Keywords: spinal cord injury patients, social stigma, rehabilitation, social integration, social activity, employment, leisure and adaptive sports.
Novikov G.A., Vaisman M.A., Rudoy S.V.
PALLIATIVE CARE FOR CANCER PATIENTS WITH SPINAL CORD COMPRESSION
Data on prevalence and clinical manifestations of compression of the spinal cord in cancer patients are presented. The choice of tactics of palliative care for these patients, treatment options and tactics of terminal care are considered.
Key words: palliative care, cancer patient, spinal cord compression.
¹1 2017 ã.
Osipova N.A., Novikov G.A.
OPIOID THERAPY OF CHRONIC PAIN AT THE PRESENT STAGE. MEDICAL, ORGANIZATIONAL, LEGAL, ECONOMIC ASPECTS
Comparative evaluation of the current status of opioid therapy in chronic pain in countries around the world, including Russia. Discusses the most relevant aspects: availability of opioid analgesics for patients; legal and regulatory framework to ensure the availability and accessibility of these vital controlled drugs for medical and scientific purposes; list of opioid analgesics for long non-invasive treatment of chronic pain - from the standpoint of economic feasibility for companies, patient's rights, experiences, and opinions of experts; features and specific properties of opioids, affecting the efficiency and safety of treatment with prolonged use; the relevance of scientific and clinical research aimed at improving the efficacy and safety of opioid therapy.
Key words: chronic pain, opioid therapy, opioid tolerance and hyperalgesia, availability of therapy, legislative framework, perspectives.
PALLIATIVE CARE NEEDS IN MOSCOW-BASED INSTITUTIONS FOR ORPHANED CHILDREN AND CHILDREN WITHOUT PARENTAL CARE
Aim of study was palliative care needs assessment in the institutions for orphaned children and children without parental care in Moscow (these institutions within the social protection and health care system were previouslycalled orphanages and children's homes, and have now been transformed into the Family Upbringing Support Centres). Results. Our study shows that around 14% of all children in the Moscow Family Upbringing Support Centres require palliative care; more than half of such children in need of palliative care suffer from severe mental retardation, with 72% having no rehabilitation potential. Majority of their physical (somatic) diseases are nervous system diseases and congenital defects / genetic pathology. Minimal equipment needs of children who require palliative care, are covered at just 12%. Conclusion. Accordingly, today we have an urgent need to introduce new approaches to palliative care for children in the Family Upbringing Support Centres.
Key words: orphaned children, palliative care, needs
Ðonomareva I.P., Ðrashchayeu K.I., Ilnitski A.N.
FEATURES OF PALLIATIVE CARE TO PERSONS ELDERLY AND SENILE AGE FROM THE POINT OF VIEW OF MODERN CONCEPT OF GERIATRICS
The basic concept of research-the concept of geriatric syndromes, are of fundamental importance for the medical and social assessment, which is a prerequisite when planning types and volumes of palliative care, aimed at preserving and maintaining the quality of life of older adults. The comparative analysis showed that in elderly and senile patients after suffering stroke reliably more common geriatric syndromes, such as violation of walking, dizziness, falling and pelvic dysfunction with urinary incontinence and fecal incontinence, combined with acute social problems and cognitive impairment, r < 0.05. Differential geriatric diagnostic approach in conjunction with the functional integral evaluation helps to differentiate the nature and scope of palliative care.
Keywords: geriatrics, old age, elderly, geriatric syndromes, palliative care.
EARLY COGNITIVE AND EMOTIONAL REHABILITATIN WITH ONCOLOGICAL PATIENS REALATIVES ASSISTANCE IN INTENSIVE CARE UNIT
The early rehabilitation in intensive care is a new direction, developing in the last time. The complex approach, including assistance of intensive care and rehabilitation specialists, medical staff and patient's relatives, is still under invention to the intensive care practice. We explored the rehabilitation process in the surgical intensive care unit with patient's relatives' assistance. We observed 106 patients after elective abdominal cancer surgery. They were divided to 3 groups. First group included 32 patients, they were rehabilitated with medical staff only assistance. Second group included 32 patients, they were rehabilitated with medical staff and relatives' help assistance. Control group included 42 patients. Psycho-emotional status was assessed by Mini Mental State scale (MMS) during the first six postoperative days. The best results were in the second group, with the medical staff's and relatives' assistance.
Key words: early rehabilitation, cancer surgery, postoperative period.
Erugina M.V., Krom I.L., Shmerkevich A.B., Vodolagim A.V.
ON THE QUESTION OF PALLIATIVE CARE TO THE POPULATION ORGANIZATION IMPROVING
The article presents the author's analysis of the Russian regulations on palliative care. According to the authors, palliative medical care to the population regulatory support allows planning and developing in Russia the specified type of assistance. To ensure palliative medical care availability scientific and methodological basis and development of a unified classification of conditions under which palliative medical care is needed and should be organized are required. The procedure for the provision of medical care is to be brought into conformity with the said classification.
The authors consider palliative care medicalization trends in Russia in the context of the dysfunctional practices of a palliative care subinstitute forming in Russia.
Keywords: regulatory support, palliative care, procedure for the provision of medical care, medicalization
Boulyubash I.D.
SUBJECTIVE (PSYCHOLOGICAL) WELL-BEING AND QUALITY OF LIFE IN PATIENTS WITH SPINAL CORD INJURY
In a review of the literature over the past 15 years provides information relating to the methods and results of the study of subjective well-being, quality of life and life satisfaction of patients with spinal cord injury. They discussed the differences in these concepts on psychology and medicine and presented frequently used questionnaires and the main measurement problems. We present the clinical, diagnostic and socio-psychological factors that determine the psychological well-being and quality of life of patients with spinal cord injury and marked target for psychotherapeutic influence to improve psychological well-being and quality of life of these patients.
Keywords: spinal cord injury, rehabilitation, the effects of spinal cord injury rehabilitation, the subjective (psychological) well-being, quality of life, life satisfaction, research methods.
Novikov G.A., Vaisman M.A., Rudoy S.V.
PALLIATIVE CARE FOR CANCER PATIENTS IN THE FINAL PERIOD OF LIFE
Data on the clinical features of the final period of life of cancer patients are presented. The choice of tactics and the most relevant aspects of palliative care for patients during this period, variants of
terminal care are considered.
Key words: palliative care, cancer patient, terminal status, terminal care.
¹4 2016 ã.
EXCHANGE OF EXPERIENCE
Egorova A. G., Isabekov S. N., Somov A. N., Orlov A. E.
RÓGIONAL ORGANIZATIONAL MODEL PALLIATIVE CARE CANCER PATIENTS IN SAMARA REGION AND CONTROL SYSTEM QUALITY
This article describes the regional quality management model of palliative care developed in the course of business, Oncology Service of the Samara region. Its main component is the aspect of adequate pain relief of cancer patients. The model recommended by the authors as the institutional development of technology for effective management decisions to optimize, improve the quality and availability of palliative care to cancer patients in other regions of the Russian Federation.
Keywords: standardization of service activities palliative care to cancer patients, methods of organizational and methodological assistance and support to the region's medical institutions for the management of patients with chronic pain, the automated control system expert service results palliative care activities.
Kokoreva M.E.
THE RESOCIALIZATION OF PERSONS WHO SUFFERED STROKES AND ITS ROLE IN THE PROCESS OF MEDICAL-SOCIAL REHABILITATION
The article considers the essence of desocialization through the disclosure of its main components - distress, depersonalization, disintegration of personality. Integrate the results of the survey, which involved the relatives of patients, stroke victims brain, and experts (specialists) health and social services. Analyses the existence of signs and consequences of desocialization of persons who have suffered strokes. The conclusion about the necessity of forming a specific social environment, are adequate conditions to overcome the negative effects of desocialization. We provide evidence that its essential for the polyprofessional brigades of specialists to take part in the process of medical-social rehabilitation of the persons who suffered strokes. This activity should be carried out in the centres of rehabilitation and palliative care organizations.
APPLICATION OF THE METHOD OF ELECTROCHEMICAL LYSIS IN THE TREATMENT OF PATIENTS WITH PROSTATE CANCER
Oncologic efficacy and functional results of treatment of patients with prostate cancer by the method of electrochemical lysis is carried out in this study.
Materials and methods. 51 patients of older age with contraindications to radical treatment were included in the study. Patients were stratified into 3 risk groups. All patients received 3-5 sessions of non-invasive electrochemical lysis.
Results. The decrease in PSA, prostate volume, residual urine volume, IPSS and Qol scores, increased peak flow rate in all groups of patients was statistically significant 3 months after treatment. Quality of life questionnaire SF-36 improved in all groups of patients. Oncological and functional results were lower in comparison with previous results in the group of patients with intermediate risk after 12 months. In the low-risk group the results were the same. Overall survival rate was 95.7 per cent, of 81.3% and 66.7%, and disease-free survival rate was 91,3%, 75% and 41.7% for patients groups low, intermediate and high risk, respectively. The median follow-up was of 16.6 months.
Conclusion. Electrochemical lysis improves oncological and functional results of treatment, improves the quality of life of patients in early period after treatment. Electrochemical lysis can be used for the treatment of patients at low risk. Electrochemical lysis in combination with other methods can be used patients intermediate and high risk.
Key words: prostate cancer, electrochemical lysis, oncological results, quality of life.
PSYCHOTHERAPEUTIC ASPECTS
Grushina T.I., Tkachenko G.A.
PSYCHOLOGICAL ASPECTS OF PHYSICAL REHABILITATION OF PATIENTS WITH BREAST CANCER LATE "POSTMASTECTOMY EDEMA"
Analysis of current scientific literature and the authors' study of the mental statesusinga questionnaire assessing the severity of psychopathological symptoms (Symptom Check List, SCL-90-R) and personality characteristics using a questionnaire of the «Big Five» 22 patients, selected by random sampling from the entire group observed 930 patients with upper limb lymphedema following breast cancer treatment, indicate the presence of «lymphedema - dependent» psychological distress. Physical rehabilitation, which included safe with oncology positions methods ofphysiotherapy (pneumatic compression of the swollen limb, electromyostimulation lymphatic drainage, low-intensity magnetic therapy and electrotherapy, massage, physical therapy), decreasedlate swelling II degreeon 82,0+5,6% in 532 patients and late swelling III degree on 70.1+6,8%in 398 patients (p< 0,05). As a result of 15-day course of this rehabilitation subjective health of patients by «Visual analog scale assessment of well-being» (VAS) increased by 21 points out of a possible 100 (T=0,00, p=0.001), decreased symptoms of psychological distress, thereby improving the quality of life of patients. Recognition of not only physical but also psychological effects of postmastectomy edema make informed carrying a mandatory psychological correctionat the same timewith physical rehabilitation.
STRATEGY EXPERIENCE TRAUMATIC EVENTS IN WOMEN WITH BREAST CANCER
The question of choice in psychological rehabilitation of women who diagnosed a breast cancer is mentioned in number of foreign publications. This article presents a personal experience, which allows using the results in the psychological work with women with breast cancer. And provide high-quality psychological support of this group of patients, since it significantly affects the treatment and quality of life in general.
Keywords: breast cancer, breast reconstruction, psychology, alexithymia
Zelenkova L.A., Gorokhov K.V.
EVALUATION OF THE IMPACT AND NEUROTIC CONDITIONS AND THEIR DETERMINANTS IN THE QUALITY OF LIFE OF THE PATIENT
In this article the authors- - psychologists of service palliative medical care on the basis of practical experience estimate the neurotic condition of patients and allocate the feeling of loneliness in the form of separate psychosomatic determinants, trace its influence on quality of the patient's life and suggest ways of reducing its impact. Also in the article critically considered innovative group and individual approaches in psychology, psychophysiology and psychosomatic from the point of view of future standards psychological help in palliative medicine.
The keywords: palliative medical care, neurotic condition, feeling of loneliness, psychosomatic determinants, quality of life, psychological help
IMPROVING MANAGEMENT OF PATIENTS WITH FIBRO-CAVERNOUS PULMONARY TUBERCULOSIS BASED ON THE RESULTS OF PSYCHOLOGICAL RESEARCH
Fibro-cavernous tuberculosis is the most severe form of the disease with a poor prognosis. We studied the personality traits of people with this form of the disease to develop recommendations for their psychological support in the treatment. Patients distinguishes instability, isolation, low aspirations, lack of discipline, unstable emotional background, poverty, emotional reactions, the simplicity of behavior, relaxation. Overlay features on the adverse psychological climate in the family, lack of understanding and support requires the inclusion of the psychological component in the complex therapy of patients with fibro-cavernous tuberculosis.
Keywords: fibro-cavernous tuberculosis, psychological characteristics of personality, complex therapy, psychological support
TECHNOLOGIES FOR RESPIRATORY SUPPORT IN PALLIATIVE CARE
The methodical recommendations are the rules of respiratory support in the provision of palliative care, including ventilation support and the use of a number of manipulations to ensure adequate ventilation, with appropriate medical indications, regardless of the cause of the development of acute or chronic respiratory failure.
The principles of palliative care in the Russian Federation, proposed a system of regional models of palliative care and the organization of life of patients of respiratory support. Presented interpretation types of respiratory failure, its causes, the purpose of various types of ventilatory support, the use of adjuvants to improve ventilation (appointment of bronchodilators and mucolytic drugs through a nebulizer, otkashlivateley and respiratory exercise equipment, physiotherapy).
COMPLEX PHYSICAL AND PSYCHOLOGICAL REHABILITATION OF PATIENTS WITH STOMACH ULCER WITH MAGNETIC LASER THERAPY
The purpose of research - to improve clinic efficacy of rehabilitation and quality of life of patients with gastric ulcer with a magnetic laser therapy. The study involved 80 patients divided into 3 groups - main (30) and control (29) and placebo (21). The fastest way to clinical parameters and quality of life returned to normal in the group treated with magnetic laser therapy.
Key words: peptic ulcer, magnetic laser therapy, quality of life
COMPREHENSIVE FEATURES AND FORECASTING HEALTH DISORDERS IN CHILDREN WITH SPASTIC FORM OF CEREBRAL PALSY
The article presents the particular health problems in young children with spastic forms of cerebral palsy. They are characterized by a high frequency of somatic diseases, particularly acute respiratory infections, deficiency anemia, malnutrition, deviations of physical development of a mass deficit, low body length, and combinations thereof, reduced emotional status, autonomic dysregulation with increased activity of the parasympathetic division and reduced autonomic reactivity, presence tissue hypoxia, increased intensity of free radical oxidation of lipids and antioxidant activity. Are not capable of walking children have greater severity of violations of emotional status, autonomic regulation of the manifestations of disadaptative to verticalization, tissue hypoxia, the intensity of free radical oxidation of lipids and antioxidant activity, they are more frequent deviations of physical development. The article also presents the risk factors for the most common physical problems of these children, it was found that frequent acute respiratory diseases have the largest share of neonatal and postneonatal risk factors for the formation of anemia and malnutrition - antenatal and neonatal risk factors.
RESPIRATORY CARE IN PALLIATIVE MEDICINE: CURRENT CLINICAL PARADIGM?
The article considers the principles, indications, contraindications and rules for respiratory support and oxygen therapy in palliative care medicine. A special place is occupied by a ventilating support and a series of manipulations, providing adequate ventilation, with appropriate medical evidence, regardless of the cause of the development of acute or chronic respiratory failure. We outlined the interpretation of the types of respiratory failure, its causes, the different types of ventilatory support, use of assistive devices for improving ventilation.
PALLIATIVE CARE FOR PATIENTS WITH HIV INFECTION. ASSESSMENT OF THE SITUATION IN RUSSIA.
There is an ongoing epidemic of HIV infection, which are involved in various Russian, including affluent social strata of the population. Remain unresolved a number of common organizational, administrative, medical problems in the provision of medical care for HIV-infected people. As a result, a growing number of seriously ill patients in need of hospital treatment, patients with AIDS, in the terminal stage of the disease (from 4.3 to 7.1% of the number of infected people), as well as the growing number of deaths, which is an annual number of about 50 thousand people. It is becoming extremely urgent as the need to provide complete palliative care that includes patient examination to determine the stage of HIV infection, the identification of concomitant diseases, assess the nature and severity of complications; the comprehensive treatment, including urgent, symptomatic and, regardless of the severity of the disease, antiretroviral therapy. palliative care service in HIV infection is at the stage of formation, but already has some experience and needs further comprehensive development.
Key words: HIV, palliative care, multi-professional teams, Department of Palliative Medicine.
Silaev M.A., Lifentsov I.G., Zakaryan G.G.
A COMPARATIVE STUDY OF TRANSCUTANEUS PUNCTURE METHODS FOR CONTROL OF REFRACTORY PAIN IN CHRONIC PANCREATITIS
It was performed comparative study of four transcutaneus puncture methods for pain relief in chronic pancreatitis. The results of research showed higher effectiveness of two low-invasive methods: caeliac chemical neurolisis and caeliac plexus block with local anaesthetic and glucocorticoid (sometimes in combination with intraosseous blockade T6, T7 spinal processes of vertebra). It was found the necessity of different approach of these methods application, considering probability of side effects.
Key words: the chronic pancreatitis, the chronic pain syndrome, the visual-analog scale of pain, the blockade and neurolysis of caeliac plexus, the intraosseous blockade, the low-invasive methods for pain treatment
Vazhenin A.V., Shanazarov N.A., Shunko E.L.
MOST OFTEN ENCOUNTERED COMBINATIONS POLYNEOPLASIA AFTER CHEMORADIOTHERAPY
Currently, the risk of treatment-induced multiple primary malignant tumors is a major problem for radiation and chemotherapy worldwide. Several large studies have shown a marked increase in multiple primary malignant tumors as a result of consistent application of radiotherapy and chemotherapy, or a combination thereof. The aim of our study is to analyze the combination of metachronous multiple primary tumors developed after chemoradiotherapy first tumor. In our study, in general, the most frequent localization of the tumor was first observed in the breast and female genital mutilation, the second tumor was mostly localized as in the breast and skin. The most frequent localization of the first tumor in men was malignant tumors lips, mouth and throat, the second tumor - malignant tumors of the alimentary system, malignant tumors of urinary tract and malignant tumors of respiratory and chest. In women, the most common site of the first tumor was malignant tumors of breast and female genital mutilation; second tumor - breast cancer and malignant tumors of skin
PSYCHOLOGICAL PECULIARITIES OF PERSONALITY AND ATTITUDE TOWARDS SICK PATIENTS WITH MALIGNANT TUMORS
Article presents the results of empirical research of psychological peculiarities of personality and attitude towards sickness of patients with malignant tumors. The most common attitudes when choosing patients with oncology are the hypochondriacal and neurasthenic types. In the choice of oncology patients, connections were established between types of attitudes towards sickness and psychological peculiarities of personality. Direct correlation was found between the hypochondriacal as well as neurasthenic types of attitudes towards sickness and personal traits such as emotional instability, diplomacy, reclusiveness, daydreaming, anxiety, conservatism.
STRATEGY EXPERIENCE TRAUMATIC EVENTS IN WOMEN WITH BREAST CANCER
The question of choice in psychological rehabilitation of women who diagnosed a breast cancer is mentioned in number of foreign publications. This article presents a personal experience, which allows using the results in the psychological work with women with breast cancer. And provide high-quality psychological support of this group of patients, since it significantly affects the treatment and quality of life in general.
Keywords: breast cancer, breast reconstruction, psychology, alexithymia
THE VALUE OF UTRASOUND DIAGNOSTICS IN HOSPITAL OF PALLIATIVE MEDICAL CARE
Application of ultrasound diagnostics in palliative care hospital has the features determined patients condition. Ultrasound diagnostics is used for detection of pleural and peritoneal exudate, installation of catheters, detection of tumors and inflammation of musculoskeletal system, cardiovascular pathology and other.
Key words: hospital of palliative medical care, ultrasound diagnostics, ultrasound-guided
The modern opinions about palliative care in cardiology are analyzed in the article. Palliative care in patients with heart failure are discussed. The aims and step-by-step algorithm of palliative care are done. Review of palliative care criteria for cardiological patients, multidisciplinary therapy was justified in patients with heart failure.
Key words: palliative care, palliative care for noncancer patients, palliative care in cardiology, heart failure.
THE TEACHING OF THE SUBJECT «PALLIATIVE CARE IN ONCOLOGY» FOR STUDENTS OF MEDICAL UNIVERSITIES
Summary: modernconcepts ofpalliative carein oncology, its rolein the modern worldandthe importance of learningforfuture expertare present in the article. Presents the experience of teaching this discipline at the Department of Oncology and possibility of its integration and interrelation with other fields of medicine.
SOCIAL WORK WITHIN THE SYSTEM OF PALLIATIVE MEDICAL CARE
One of the focus areas of professional welfare work is medicalsocial work, implemented by professional community workers in the sphere of medicare, including the system of palliative medical care. Medical social work represents multi-disciplinal type of professional activity that has medical, psycho-pedagogical and social legal nature, and is oriented at maintenance, improvement and recovery of health.
Palliative medical care is implemented by polyprofessional body of specialists, involving doctors, psychologists, professional social workers and others. Its integrated nature is due to the existing complex of mutually casual and potentiative problems of medical, psychological, legal and social character that patients of palliative aid healthcare organizations as well as their relatives and their inner circle have.
Consequently, we give relevancy to the scientific rationale of medical social work's content and technologies, its regulatory affairs that allow to introduce this type of professional activity into health organizations of palliative medical caresystem.
Keywords: palliative medical care, medical-social work in the system of palliative medical care, objects, subjects, content and technologies of medical-social work in the system of palliative medical care.
THE ROLE AND PLACE OF STATE BUDGETARY MOSCOW HEALTH INSTITUTION «CENTER FOR PALLIATIVE MEDICINE OF MOSCOW HEALTH DEPARTMENT» IN THE SYSTEM OF PALLIATIVE CARE
A new kind of medical care - "palliative medical care" - is defined by Federal Law N 323 FL from November,21,2011 " On the fundamentals of health protection of the Russian Federation citizens". Palliative medical care is a complex of medical interventions directed at pain relieving and at alleviating other serious clinical manifestations in order to improve the quality of life for incurably sick people.
The order of rendering medical palliative care is defined by Order of the Ministry of Health of the Russian Federation ¹ 187 from April,14, 2015 and constitutes the legal base for further organizing and developing palliative medical care system for the adult population of the Russian Federation.
The basis for rendering medical palliative care in Moscow is "the Centre of palliative care" formed by Order of Moscow Department of Medical Protection ¹ 106 from February,17 ,2015. The Centre is supposed to render dispensary, stationary, home-nursing and consultative aid and is also intended to solve organizational and methodical tasks. The functions of the center are: to render aid to patients with progressive oncological and other progressive chronic diseases to whom specialized kinds of treatment are not prescribed (expressed neurologic deficiency at different nosologies, coronary artery disease, chronic heart deficiency, cardiac defects, cardiomyopathy, myocarditis, chronic disabling lung diseases, liver, kidney and joints diseases, chemotherapy consequences) The main aim is improving quality of patients' life. The work of the Centre in cooperation with the University hospital will make it possible to create and launch into practice the Standards for rendering medical palliative care ensuring that such kind of care is fulfilled at the high quality level with the use of modern complex of medical interventions and that control over their realization is exercised. Close cooperation with charity organizations improves conditions for rendering medical palliative care and increases its accessibility to Muscovites.
Vvedenskaya E.S., Palekhov A.V.
ON THE ISSUE OF OUTPATIENT PALLIATIVE MEDICAL CARE ORGANISATION
The article presents the core tasks of a palliative medical care (PMC) outpatient office at a local polyclinic as one of the main forms of outpatient specialist PMC and the functions of its staff. Detailed analysis of the office organization, the interaction of PMC doctor with various medical professionals as well as the patients' routing is described. The authors emphasize that the life quality improving in patients suffering from pain is impossible without effective pain control. To provide adequate pain control quality training of the doctor and the organization of timely and full providing patients with non-invasive forms of needed drugs are required. For PMC development it is advisable to establish regional PMC center/department for organization and methodological work under the leadership of Chief PMC Specialist in the region.
Keywords: palliative medical care outpatient office, chronic pain syndrome; cancer patients; analgesics noninvasive forms; palliative medical care center for organization and methodical work, providing patients with analgesics, adequate pain control.
Abuzarova G.R., Moiseev S.V.
TTS FENTANYL FOR TREATMENTCHRONIC CANCER PAIN
Fentanyl is indicated for the management of chronicpain in patients who require opioid analgesia for painthat cannot be managed by lesser means such as paracetamol-opioid combinations, nonsteroid analgesics, oras-needed dosing with short-acting opioids. Transdermal therapeutic system (TTS patch) is characterized by increased bioavailability of fentanyl, provides continuoussystemic delivery of fentanyl for 72 h at a nearlyconstant amount per unit of time and can be used as an alternative to oral opioids in patients who can't swallow tablets or can't tolerate morphine have low compliance to treatment. In controlled clinical trials fentanyl TTS is as effective as oral sustained release morphine, but has the advantages of portability, in particular less likely to cause constipation. The novel matrix formulation with ratecontrollingmembrane has a number of advantages over conventionaltransdermal application. Notably, it providesreliable, sustained serum concentration levels offentanyl while being smaller in size. In addition to the advantages of the traditional matrix technologymentioned above, the special composition of thismatrix patch allows for a high degree of drug utilization,whereas the use of a control membraneensures a constant delivery rate over 3 days.TTC fentanyl is most often used to treat moderate to severe pain in cancer patients, but the drug can be used for chronic pain of other origin, requiring repeated anesthesia narcotic analgesics.
ECONOMIC FEASIBILITY OF LONG-TERM HOME MECHANICAL VENTILATION IN CHILDREN'S PALLIATIVE CARE
Home ventilation can improve a patient's quality of life. Aim of the study is to provide economic assessment to compare costs for invasive ventilation in children at home and inintensive care units.
Results. Total expenses for invasive ventilation support at home in Moscow are 4117 rubles per day and 1 503 000 per year. Total expenses in the intensive care units in Moscow are 28 000 rubles per day and 10 220 000 rubles per year. Total costs for home ventilation can be decreased due to equipment and service optimization.
Conclusion. Invasive home ventilation in children has economic feasibility and can decrease the total expenses for Health Care in the country.
Keywords: invasive ventilation support, home mechanical ventilation, economic assessment, children
Palekhov A.V., Danil'yan V.M., Vvedenskaya E.S.
WAYS TO IMPROVE THE EFFECTIVENESS OF PAIN THERAPY IN PALLIATIVE ONCOLOGY
In recent years cancer in Russia has been one of the main causes of death and disability. About 80% of patients who die from cancer are in need for palliative care. The outcomes of Sehydrin (Hydrazine Sulfate) treatment of patients with advanced cancer of various localizations for whom all methods of specific treatment (surgery, radiation, chemotherapy) had been exhausted are presented in this work. À clear link between the use of Sehydrin in patients with advanced cancer and analgesics' dosage decrease as well as decrease of the need for adjuvant and symptomatic treatment have been identified that leads to a forced polypharmacy reduction.
Within the study period none of the patients treated with Sehydrin used strong opioids while these drugs were assigned for 2/3 of the control group patients. Sehydrin related reduction of intoxication had caused the quality of life improvement and due to that some patients could undergo special treatments which had been banned before. On the basis of observations available Sehydrin may be assessed as an alternative medicine for symptom control in patients with some advanced cancer at a disease stage when the other methods of treatment cannot be used.
Keywords: palliative medical care, cancer patients with advanced disease, Sehydrin (Hydrazine Sulfate), quality of life, opioids use decrease
NEEDS IN PEDIATRIC PALLIATIVE CARE AND HOME CARE TEAMS IN RUSSIA
Development of children's palliative care requires needs understanding in the country. Aim of this study is evaluation of the minimal number of children needed in pediatric palliative care and necessary number of home care teams and specialists. Results. About 180,000 children up to 18 years old need in palliative care annually (68,2 per 10,000 children's population), and half of them need in specialized PPC (30,7 per 10,000).
93% of patients have non-oncologic diseases, of them: congenital malformation - 42%, cardiovascular diseases - 23%, certain disorders of neonatal period - 12%. About 700 children's home care teams should be opened (370 in urban area, 411 in rural area); as a fact, only 17 home care teams worked by the end of 2014 year (2% of the necessary number).
According to the normative proposed by Ministry of Health, mean number of patients per pediatrician at home care team is 155 children (155 in urban area, and 60 in rural area). The number of required PPC doctors is 3 716 (only 5% worked by the end of 2014), PPC nurses - 3 698 (9% worked in 2014), psychologists and social workers - 390 and 781m respectively (14% and 2% were opened by 2014, respectively).
Conclusion. Creation of pediatric palliative care registries is necessary for the actual needs estimation. The indicator as "home care teams" should be incorporated into the national program of health care development with establishment of financial support to stimulate opening of children's home care teams in the regions.
THE EFFICIENCY OF STRONTIUM-89 CHLORIDE THERAPY IN THE RELIEF OF BONE PAIN IN PATIENTS WITH BONE METASTASES
The most common symptom of bone metastases of the skeleton is a chronic pain syndrome (CPS) that requires the use of analgesics and significantly impairs the quality of life of patients. One of the struggling methods with chronic pain syndrome is a radionuclide therapy. We evaluated the results of 110 patients treatment who received radionuclide therapy Sr-89 in GBUZ «CHOKOD» to 2011 to 2014. Complete pain relief was achieved in 35.4% of patients, a partial response - 18.2% of patients. The was no effect of the treatment in 41.8% of patients. The duration of response ranged in a period of 1 to 18 months, the median was 5.9 months.
Keywords: radionuclide therapy, bone metastases, strontium-89 chloride
Pchelintcev M.V., Palekhov A.V., Vvedenskaya E.S.
COMPARATIVE ANALYSIS OF STRONG OPIOIDS CONSUMPTION PHARMACOEPIDEMIOLOGY CHARACHTERISTICS IN ST. PETERSBURG AND IN THE STAVROPOL KRAY IN 2006-2013
The article presents the results obtained by the authors in the study of different strong opioid analgesics (SOA), both for invasive and non-invasive drug delivery, consumption pharmacoepidemiology in St. Petersburg and in the Stavropol Kray in the years of 2006-2013. Pharmacoepidemiology of the SOA consumption and its dynamics in the two regions have been analyzed and compared. The authors discuss the factors that influenced the volume and the structure of SOA consumption change in the period under review.
The estimation and comparison made it possible to propose the ways for optimizing the SOA consumption for pain control in patients suffering from chronic pain.
ASSESSMENT OF THE INTENSITY OF CHRONIC PAIN SYNDROME IN PALLIATIVE ÎNCOLOGY
Discusses the clinical aspects of the diagnosis of pain intensity in cancer patients. Shows the role of subjective scales, features of their application. On clinical examples proved further need of complex diagnostics with a deeper study of pain anamnesis, data of inspection and the patient examination. Shows the use of certain analgesics in clinical practice of palliative cancer with regard to pain intensity.
Keywords: pain, chronic pain, diagnosis of pain, a scale of verbal assessments, palliative care, Promedol, Prosidol, Targin, Fendivia.
PSYCHOTHERAPEUTIC ASPECTS
Arpentieva M.R.
Elderly people relationship to death and psychological assistance in situations of death and acute grief
The article is devoted to problems of the relationship of older and a hundred sects of the people to life and death, deals with the General aspects of productive relations to death and psychological support to the dying and after death the elderly. Special attention is paid to the tricks and techniques of socio-psychological work with older people and older people in situations of collision with death. The article discuss some problems of psychological assistance to the elderly in the face of situations of death and acute grief, deals with the general aspects of psychological support to the dying and after death the elderly. Special attention is paid to the stages and nature of psychological work with older people and older people in situations of collision with death.
Describes the technology of psychological debriefing, its possibilities and limitations of elderly and old people in a terminal dangerous situation or faced with the death of loved ones
Annotation. In the article the concept of euthanasia and legal possibility of her realization are examined and analysed as it applies to Russia. The questions of the legal adjusting of euthanasia are affected by international normatively-legal acts, and similarly by the legislation of Russian Federation. The methods of sociological research and logic analysis of literature and official normatively-legal records, being the basis of the investigated question, are in-process used . In conclusions an accent is done on the necessity of development of the system of palliative medicine on territory of Russian Federation; medical duty performance within the framework of indemnification of the state of patient, with the facilitation of the physical and psychical suffering; search and development of methods of early diagnostics, to therapy and ìåäèêî-ñîöèàëüíîé rehabilitation at diseases standing in a "high-risk group", the flow of that can result in the states at that the question of euthanasia becomes actual for a patient.
Key words: euthanasia, right on life, right on abandonment from treatment
EXCHANGE OF EXPERIENCE
Verbo E.V., Buzan S.B., Ordzhonikidze M.Z.
RECONSTRUCTION OF THE MAXILLOFACIAL AREA - PAST AND PRESENT
Resume. The history of the development of maxillofacial surgery presents in the article. The formation of oral and maxillofacial surgery in the world is closely connected with names of Cells, Galen, Taliacozzi, Blair, Limburg etc. The development of maxillofacial surgery seriously accelerated during the First and Second world wars, , what is connected with numerous wounds to the face, jaw, cheek bones and teeth as well as a variety of diseases these areas in peace time.
INFLUENCE OF CHEMOTHERAPEUTIC TREATMENT ON KINETICS OF GROWTH OF THE RECURRENT AND METASTATIC COLORECTAL CANCER
This research is executed in areas of theoretical and clinical oncology. Authors developed model in which tumoral growth is considered how result of balance between multiplying and death of cancer cells. Using this model, extent of influence of chemotherapeutic treatment on kinetics of tumoral growth of the recurrent and is analyzed.
Key words: recurrent and metastatic colorectal cancer, chemotherapy, model of tumoral growth.
Chernekhovskaya N., Korgeva I., Povalayev A., Chomaeva A.
COMPLEX DIAGNOSTICS AND TREATMENT OF GASTROINTESTINAL BLEEDING IN PATIENTS UNDER STRESS
Severe erosion and ulcer detected during endoscopy 76 patients. The patient was treated with nitric oxide. Bleeding stopped in all patients, erosions and ulcers epithelization.
THE LOW-INTENSIVE LASER THERAPIES CORRECTIVE ACTION IN VASCULAR-PLATELET DISTURBANCES IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
The aim of the work was to estimate the disturbances of vascular-platelet hemostasis in patients with Chronic Obstructive Pulmonary Disease and the effects of low intensive laser therapy in it.
Results: the excess agrregative disruption of platelets was revealed, the trustworthy improvements of aggregative parameters in patients treated with low intensive laser therapy were shown.
The conclusion: the use of laser therapy in complex treatment of patients with Chronic Obstructive Pulmonary Disease promotes correction of hemostatic violations.
SURGICAL REHABILITATION OF PATIENTS WITH RADICULAR CYSTS OF JAWS
Prolonged asymptomatic radicular cyst jawbone leads to late treatment of patients to the dentist. At all stages of treatment should be actively involved not only the dental surgeon, but physicians and allied health professions. Timely surgical intervention leads to a favorable outcome and complete recovery of jaw bone.
CIRCADIAN PATTERNS OF PAIN IN CANCER PATIENTS IN HOSPICE
Circadian patterns of pain of cancer patients in hospice have chronobiological nature. The study has been cared out, using original circadian visual analog pain scale (C-VAS) of daily active nociception rhythm of 82 patients receiving palliative hospice care. The study revealed that the acrophase pain of the cancer patients with Clinical Group IV falls on the period from 7 p.m. to 9 p.m., which should be initially considered in the drafting of empirical pain therapy. The data obtained during the research do not contradict the data of other studies in the field of daily cancer pain structure, but one should take into account the peculiarities of cancer patients at end of life.
Rogov A.V.
MASSAGE IN COMPLEX REHABILITATION OF PATIENTS WITH INFANTILE CEREBRAL PALSY
The article shows the role of massage in complex rehabilitation of patients with infantile cerebral palsy. The use of formulations for massage on the basis of saffron, cedar oils enhances the efficacy of therapy.
GENDER DIFFERENCES IN CONCENTRATION OF SEX HORMONES IN TUMOUR NODE, SURROUNDING TISSUES AND PERIPHERAL BLOOD OF PATIENTS WITH LUNG CANCER
Sex hormones in tumour tissue of lung and peripheral blood of male and female patients with lung cancer have been studied. Both similarity and difference in hormonal status of men and women depending on the type of tumour growth are shown.
Presents the results of surgical treatment of 549 patients with locally advanced colorectal cancer complicated by intestinal obstruction. Data are presented on a combined radical,cytoreductive and symptomatic surgery depending on intensity of intestinal obstruction, as well as a three-year disease-free survival rates.
THE EFFECTIVENESS OF PALLIATIVE PHOTODYNAMIC THERAPY FOR STENOSING ESOPHAGEAL CANCER, GASTRIC CARDIA
The objective of our study was to evaluate the effectiveness of photodynamic therapy stenotic esophageal cancer and gastric cardia. The study included 80 patients (65 (81.25%) men, 15 (18.75%) females, mean age was 63 years). The results of study showed that the photodynamic therapy of patients with stenosing esophageal cancer, gastric cardia has a good symptomatic efficiency, which manifests the elimination or reduction of the degree of dysphagia, weight gain, positive dynamics at x-ray and endoscopic control, normalization of protein and electrolyte metabolism .
REHABILITATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND METABOLIC SYNDROME
In the article possibilities of optimization of medical and preventive measures for patients with chronic obstructive pulmonary disease with metabolic syndrome are considered.
STUDY THE PREVALENCE OF OSTEOPOROSIS, ITS COMPLICATIONS AND A SIGNIFICANT RISK FACTOR
The article presents the results of the analysis of epidemiological characteristics of osteoporosis in Lower Volga Region by method of the one-stage retrospective analysis of case historys of 6120 patients (high-risk group) of the Center for diagnostics and treatment of osteoporosis was for the first time carried out in this article. The decrease in density of bone stock below age norm is revealed at 1460 women (34,79%) and 297 men (15,44%). Among the patients with osteoporosis, the prevalence of hip, vertebrae and forearm fractures considerably exceeded the average figures. The authors evaluated the significance of risk factors for osteoporosis by discriminant analysis.
DEVELOPMENT STRATEGY OF PALLIATIVE CARE SYSTEM IN PERM REGION. SOLUTIONS
The paper presents a program of Palliative Care in the Perm Region; possible solutions to problems that arise in the process of creating a new type of health care are discussed. Much attention is drawn to the need of rapid interagency of health care system, social protection system and public institutions in solving palliative patient's problems. Also possible risks of Palliative Care system organization are considered in detail and the ways of their reducing are presented.
Key words: palliative care, health care organisation
The aim of the study was an analysis of pediatric palliative care services (PPC) in Russia by survey of regional health authorities. ByNovember 2014, 111 PPCserviceswereannounced, 30% of Russian regionshave no services. 71% of PPC services were beds in non-palliative departments and 1/4 were specialized PPC services including departments (n=15, 13%), home care teams (n=13, 12%), children's hospices (n=2, 2%), ambulatory service (n=1, 1%) and PPC Center (n=1, 1%). In total, 545 PPC beds were opened in 97 inpatient departments. Additional staff was not provided in non-palliative departments where PPC beds were opened. Local budget financing was in about 90% of PPC services, and charity organization financing - in 5%.
Key words: palliative care, children, service
Vazhenin A.V., Shanazarov N.A., Shunko E.L.
SURVIVAL OF PATIENTS WITH PRIMARY MULTIPLE METACHRONOUS CANCER AFTER CHEMORADIOTHERAPY
In the last two decades the problem of primary multiple cancer induced by treatment, namely chemoradiation first tumor, is becoming increasingly important and widely covered in modern Russian and English literature. This is due, primarily, an increase in survival of cancer patients conducted after chemoradiotherapy. The aim of our study was to determine the survival of patients with metachronous multiple primary cancer after chemoradiotherapy first tumor and the risk of an adverse outcome during treatment. Our study showed that, in general after chemoradiotherapy first tumor patients lived an average of 82.78 months (80.05 and 85.51 months, respectively, from the beginning of chemotherapy and radiation therapy first tumor). In this case, the risk of an adverse outcome is slightly increased in intervals of up to 32 and 60-70 months after treatment, which requires a mandatory medical examination of this patient is in a given time interval after chemoradiotherapy.
Key words: multiple primary malignant tumor, chemoradiotherapy, the risk of the second tumor
THE IMPACT OF RADIATION THERAPY ON THE SEVERITY OF COGNITIVE IMPAIRMENT IN PATIENTS WITH COMPLEX TREATMENT OF MALIGNANT GLIOMA OF THE BRAIN
In order to assess the impact of radiation therapy on the severity of cognitive impairment in patients with complex treatment of malignant brain glioma conducted a study involving 30 patients (20 men, 10 women). The median age was 48 years. 22 of patients with glioblastoma (GB) and 8 of patients with anaplastic astrocytoma (AA). The study we did not get a clear conclusive evidence of the deterioration of cognitive functions in patients with malignant glioma of the brain that received course conformal radiotherapy, depending the location, age, morphological conclusion.
PALLIATIVE TREATMENT OF PATIENTS WITH GENERALIZED PROSTATE CANCER
Summary: a group of men was selected with the first established prostate cancer are generalised stage with distant metastases in bone, with anemia, problems urinating and pain syndrome, just 7 patients. All the patients immediately after the diagnosis assigned to palliative care. As a result of the polučenoznačitel′noe improving the quality of life of patients. Drug treatment in such cases must necessarily be combined with psychological assistance to patients, their social rehabilitation. And the growth of prostate cancer incidence probably is brewing, and the need to establish offices of palliative care for patients with onkourologičeskoj disease.
Keywords: prostate cancer, palliative care, bone metastases, the quality of life
Moskin V.G., Kogoniya L.M.
POSSIBLE APPLICATIONS OF BISPHOSPHONATES IN THE TREATMENT OF METASTATIC BREAST CANCER WITH METASTASES IN BONES
Bisphosphonates play an important role in the treatment of the metastasis of breast cancer. In case of long usage of the medicaments of zolendronic acid, there may appear such complications as osteonecrosis of the mandible (1-2%) and the chronic renal failure (6-9%). The possibility of the scheduled replacement of the medicaments of zolendronic acid after 3-6 months of the therapy for clodronate is demonstrated on the example of the treatment of 70 patients with metastatic bone lesion in case of breast cancer. The level of pain, the quality of life, the number of analgesics, the cost of the treatment were the criteria of the efficiency. The replacement of the medicaments of zolendronic acid after 3-6 months of the therapy for clodronate demonstrated the same effect, and also the reduction of the material costs by 60-62%.
Key words: breast cancer, bisphosphonates, syndrome of chronic pain
Astakhov VA, Gladko S.A., Kurina E.A., Rahimov L.A., Panyukov A. I. Popova J.O.
CIRCADIAN PATTERNS OF MORTALITY IN CANCER PATIENTS IN HOSPICE
Cancer patients are characterized by having both normal and altered circadian rhythms with more pronounced disorders of patients with a common form of disease. Among the most studied circadian disorders of cancer patients are the circadian rhythm disorders of the functional activity of the endocrine system. However, the data on circadian lethal regularity still remain contradictory to the present day.
Materials and methods. A retrospective analysis of 711 cases of lethal outcome was carried out in hospice in order to identify the circadian lethal regularity of patients with clinical group IV.
Results and conclusions. In the course of the study it can be stated that the cancer patients with clinical group IV die mostly at the period from 5 till 9 a.m. with maximum lethal cases (acrophase) at 6 a.m.
Frantziyantz E.M., Bandovkina V.A., Moiseenko T.I., Adamyan M.L.
CONCENTRATION OF STEROID HORMONES AND PROLACTIN IN UTERINE TISSUE AT COMBINED DEVELOPMENT OF BENIGN AND MALIGNANT PROCESS AGAINST A BACKGROUND OF HYPERPLASTIC ENDOMETRIUM
The results showed differences in concentration of steroid hormones and prolactin in tumour and perifocal zone in case of independent development of myoma and uterine cancer, as well as at combination of these pathologies. Combined development of benign and malignant pathologies was characterized by interaction of uterine myoma and uterine cancer, that affected local level of steroid hormones and prolactin in tumour tissue and perifocal zone.
ORGANIZATION OF PALLIATIVE CARE TO CANCER PATIENTS IN KAZAN
Presents a unique experience created in 1993 in Kazan, emergency services palliative care to cancer patients - organized socio-directional universal model of care in a modern big city. Since 1993, the department carried out extensive advisory activities at home and in hospitals of general health. Organised inpatient aftercare at home, emergency assistance previously treated patients and emergency care in complicated cancer in newly diagnosed patients. It was established for the follow-up somatically seriously ill. Solve social and psychological problems of patients and their relatives. Implemented original methods outpatient pain therapy - epidural anesthesia, skeletal traction metastases in the spine. To improve the quality of life of patients IV clinical group administered anticancer drug Sehydrin and immune-boosting drugs Neovir. Activities palliative department allows you to develop and put into practice new methods of health care, improving the quality of life of patients. Funds invested in the existence of such a structure, pay off by reducing the length of stay of patients on the bed, reducing the time of examination, active involvement in the care of their sick relatives.
Key words: cancer, cancer patients, palliative medical care
DIGEST
Kudryashova L.N., Khabibulina Z.A.
TREATMENT OF THE CHRONIC PAIN SYNDROME AT DAMAGES OF THE TRIGEMINAL NERVE TUMOURS OF THE HEAD AND NECK
The retrospective analysis of the basic principles of pharmacotherapy of a chronic pain syndrome at damages of a trigeminal nerve is presented in the review of literature by malignant new growths of the head and neck. Modern methods of treatment of pain are stated: blockade of a trigeminal nerve, rizotomie, scale knife, epidural neurostimulation of a motor cerebral cortex.
STRATEGY OF DEVELOPMENT OF PALLIATIVE MEDICAL CARE IN THE RUSSIAN FEDERATION. SOME OVERALL RESULTS AND PROSPECTIVE
The palliative medical care of RF population is organized in accordance with the federal legislation and territorial programs of healthcare development. Nowadays, there is a risk of disproportion in availability of medical care for patients instead of full complex of medical interventions, mainly medical and social care. It is important to understand the role of divisions of palliative care system: palliative care departments and hospitals (centers) render a full -scale complex of medical interventions for cancer and non-cancer patients, while hospice and nursing care department/center render mainly medical and social care. The approach is offered for implementation of development strategy for palliative medical care which is based on development and implementation: regional models of palliative medical care with regards to geographical, economical particularities of the Russian Federation subjects; educational programs in palliative medical care to prepare lecturers and healthcare professionals; new medical technologies and algorithms for symptom control to improve patients' quality of life; national clinical recommendations in palliative medical care.
Key words: palliative medical care, educational programs, regional model.
EXCHANGE OF EXPERIENCE
Kudryashova L.N.
CALCULATION OF COST AND ASSESSMENT OF AVAILABILITY OF ANTIPAINFUL THERAPY AT ONCOLOGICAL PATIENTS
Calculation of cost of a monthly course of treatment of a chronic pain syndrome at oncological patients in out-patient conditions depending on force of pain and the used analgetic is presented in article. The factors influencing untimely providing incurable oncological patients with narcotic analgetics for treatment of chronic pain in the Republic of Bashkortostan are considered.
Sytov A., Nechaev I., Lomidze S., Stilidi I., Shalenkov V.,Matveeva I., Davydova T., Kadagidze Z., Zabotina T., Korotkova O.
EVALUATING THE EFFECTIVENESS OF ENTERAL NUTRITION WITH A HIGH CONTENT OF PROTEIN AND ENERGY ENRICHED WITH OMEGA-3 FATTY ACIDS AND DIETARY FIBER IN PATIENTS OPERATED ON FOR GASTRIC CANCER
Recent research results of the study show the effectiveness and safety of enteral feeding with a high content of protein and energy enriched in omega-3 fatty acids and dietary fiber used in the composition of enteral nutrition in cancer patients operated on for gastric. Statistically significant increase of prealbumin 7 days after surgery in the test group compared to the control, indicates an improvement in anabolic processes of enteral nutrition. The use of enteral nutrition in these patients, including probes and systems for introducing gravitational mixtures, is 1,5-2 times cheaper than the useof parenteral nutrition.
CLINICAL RECOMMENDATIONS FOR NUTRITIONAL SUPPORT IN PALLIATIVE CARE
Disease related malnutrition (DRM) creates extremely unfavorable conditions for adequate implementation of the basic methods of palliative care . Cachexia, loss of muscle mass, low serum proteins always lead to the development of a number of serious complications, and low efficiency of drug therapy. In order to maintain adequate water balance and nutritional status of patients in palliative care should be used methods of nutritional support- enteral and parenteral nutrition.. Authors proposed a draft clinical guidelines, defining the main indications, contraindications, technological protocols of key nutritional therapy methods implementation. The main types of enteral diets and parenteral nutrition solutions , which can be used in palliative medicine, were presented with necessary clinical comments.
Key words: Palliative care, malnutrition, nutritional support
Pchelintsev M.V.
THE ADMINISTRATION OF A POTENT OPIOID OXYCODONE AND OPIATE RECEPTOR ANTAGONIST NALOXON COMBINATION AS TARGIN PREPARATION - AN APPROACH TO IMPROVE SAFETY AND TOLERABILITY OF EFFECTIVE INTENSE PAIN TREATMENT
Summary : data are presented on the possibility to reduce obstipation severity at intense pain treatment by potent opioid - oxycodone.
Advantages of combined preparation, Targin, containig oxycodone and opiate receptor antagonist (naloxone), in treatment of intense pain of different etiology and pathogenetic nature are discussed.
PSYCHOLOGICAL REHABILITATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
We studied the quality of life 117 patients with COPD. All indicators of quality of life are interconnected. Identified the main causes of psychological problems and distress due to illness in patients with COPD is the number of exacerbations per year, oxygen therapy, the purpose of systemic corticosteroids. In addition to pharmacotherapy group of patients was carried out targeted awareness concerning the causes of distress. The treatment efficiency was found to be higher than when the same drug therapy, the results were determined by clinical, laboratory and functional indicators.
Key words. Chronic obstructive pulmonary disease, quality of life, psychological problems, distress when illness, targeted information, the effectiveness of the treatment.
ORGANISATIONAL AND METHODICAL APPROACHES TO IMPROVEMENT OF PALLIATIVE MEDICAL CARE RENDERED TO ADULT POPULATION IN THE RUSSIAN FEDERATION
Currently, the necessary regulatory base has been established in Russia for arrangement and development of the system of palliative medical care. With regards to necessity of prospective development of the healthcare area, the regional model for arrangement of palliative medical care is discussed which considers certain geographic, demographic and economical conditions, and the concept of arrangement of palliative medical care in RF subjects is proposed.
The authors assume that the proposed organizational and methodological approaches will allow to provide equally available palliative medical care in short terms to incurable non-cancer and cancer patients in each RF subject.
Key words: palliative medical care, regional model, non-cancer and cancer patients.
EXCHANGE OF EXPERIENCE
Avagimyan A.A.
PREPARING NURSES TO WORK WITH PALLIATIVE PATIENTS AT HIGH SCHOOL
Key role in palliative care nursing professionals belongs. The quality of life of the patient and his family depends on the quality of care. When working with palliative patients nurses formed the professional burnout syndrome. Prevention of negative phenomena should begin from the moment the training of future medseter in higher education.
Keywords: palliative care, inñurabe patient, nursing, burnout syndrome, Balint groups.
FEATURES THE APPLICATION OF DIFFERENT RADIOPHARMACEUTICALS IN PATIENTS WITH BONE METASTASES
Nuclear therapy with bone seeking agents is a kind of treatment patients with multiple bone metastases. Long-term pain relief and quality of life increase are proven effects of nuclear therapy. By this time, there are some studies demonstrated antitumor effects of bone seeking radiopharmaceuticals with benefits in overall survival.
Radiopharmaceuticals differs from each other in there chemistry and physical characteristics. These differences have impact on clinical usage. In the latter days evaluation of new drugs and elaboration of new patterns of radiopharmaceuticals application are the main stream in nuclear therapy development. Some data suggests that repeated treatments can slow progression of the disease and prolong survival. However, myelosuppression is a heavy limitation of nuclear therapy, especially in case of repeated treatments and combinations with chemotherapy. In Russian Federation 89Sr chloride and 153Sm-EDTMP are routinely used and new 188Re-based radiopharmaceuticals are under investigation. 188Re Zoledronic acid - the first agent with radiometabolic effect, is the most perspective one. 188Re Zoledronic is characterized by high efficacy and low hematologic toxicity, which potentially allows multiple retreatments.
CONTRIBUTION TO THE SURVIVAL AND LIFE QUALITY SPECT / CT IN DETECTION FOR BONE METASTASES IN BREAST AND PROSTATE CANCERS
The study compared the survival of patients with breast and prostate cancers with bone metastases detected by SPECT / CT compared with OSG, CT, standard radiography (SR). Were examined 84 patients with breast cancer and 67 prostate cancer with bone metastases in age from 35 to 85 years. Depending on the diagnostic method, which revealed tumor foci in the skeletal system under study were divided into 4 groups: group 1 - 36 (23.8%) patients using SPECT / CT, group 2 - 26 (17.2%) CT, group 3 - 44 (29.1%) OSG, group 4 - 45 (29.9%) of the SR. In each group was calculated survival with bone metastases in breast cancer and prostate cancer alone. Median survival for each group was 33.3; 22.8; 17.4; 15.7 months, respectively. It was found that detection of bone metastases by SPECT / CT in breast and prostate cancers can improve the quality of life in the form of prevention of pain in 29% of patients, 25% relief in 33% reduction in its intensity. At the same time, hybrid technology enhances performance three-year survival rate of breast cancer with bone metastases from 36.3% at OSG, from 36.3% at CT to 47.3% and of prostate cancer from 36.3% at OSG, from 35.0 at CT% to 45.9%.
Keywords: bones of the skeleton, metastatic cancer, radionuclide diagnosis.
THE CHOICE OF TREATMENT IN GERIATRIC PATIENTS WITH OBLITERATING ATHEROSCLEROSIS OF THE LOWER EXTREMITIES IN CONJUNCTION WITH ISCHEMIC HEART DISEASE
Studies has shown that the effectiveness of treating patients with obliterating atherosclerosis of the lower extremities ( OALL ) in combination with ischemic heart disease ( IHD) , represented by two groups : the first group ( 45 people ) received conventional treatment , the second group (45 people) received assonated perftoran carvedilol and rosuvastatin with a base of drug therapy.
Application of ozonated perftorana, carvedilol and rosuvastatin in treatment OAANK combined with CHD contributed to the improvement of treatment results by 1.4 times.
Positive outcomes of treatment in the first group were observed in 93.4% of patients in the second - 97.5% at constant continuous treatment by the scheme adopted in the clinic, and negative treatment outcomes are marked , respectively, 6.6% and 2.5%.
Key words: atherosclerosis obliterans of the lower limb arteries, coronary artery disease, treatment, assonated perftoran carvedilol and rosuvastatin.
THE EFFECTIVENESS OFEXTERNAL BEAM RADIOTHERAPYIN THE TREATMENT OFPATIENTS WITH VERTEBRAL METASTATICLESIONSTHAT CAUSESPINAL CORD COMPRESSION
Spinal cord compression syndrome is a threatening complication of metastatic lesions of the spine in patients with cancer. No specific treatment or ineffectiveness of such treatment lead to the development of sensory disturbances and motor functions of limbs, pelvic organ dysfunction, severe pain syndrome. Timely conducted course of external beam radiotherapy in separate mode or complex therapy prevents the patient's disability, and significantly improve the quality of life. This article provides two examples of the successful treatment of patients with spinal cord compression syndrome with the use of external beam radiation therapy as part of comprehensive treatment.
Maslyakov V.V., Dralina O.I., Zepp I.V., Semechuk T.A., Timralyaev R. A.
RENDERING PALLIATIVE CARE TO ONCOLOGICAL PATIENTS IN THE CONDITIONS OF THE CENTER OF PALLIATIVE CARE
In work the analysis of work of the center of the palliative care directed on rendering palliative care to the patients who are in a terminal stage of oncological diseases is submitted. It is established that work of the center of palliative care, on assistance to incurable oncological patients is demanded that demands expansion of such help, thus the main action at implementation of palliative care to such patients is decrease in a pain syndrome, treatment of complications and training of patients and his relatives in the main actions for leaving and treatment, depending on a disease. Besides, patients of the center need carrying out actions for personal hygiene, providing conditions for rest and physical activity (walk, gymnastics according to indications), existence of library and other kinds of activity, satisfying need of the person for communication (visit by volunteers, creative collectives, the organization of exhibitions, the dramatized programs, is obligatory spiritual, religious communication).
Keywords: palliative care, oncological patients, terminal stage
FAMILY THERAPY IN THE REHABILITATION OF DISABLED CHILDREN
The article notes that mothers who are raising children with disabilities, are characterized by impulsiveness, anxiety, elation, normal levels of empathy. Type of relationship with the child, they often cause a violation of their own health or authoritarian. Most mothers take sick children, but the worst is not always understood and correctly respond to their behavior. Emotional contact with the child they often optimal, but noted hypo- and overprotection. In the hierarchy of family units have a primary role of these women takes a child, they want to keep the family together and give the man a leading role.
Mothers are not satisfied with the development of the child to feel responsible for his state of helplessness in the rehabilitation process, not of its prospects, oschu-schayut not satisfied with their knowledge and skills in parenting. Greater knowledge chenie in the rehabilitation of children with disabilities mother withdrawn the help of experts, underestimating the role. Mothers of children with disabilities are characterized by high activity in terms of the Treatment tions to specialists, but not high satisfaction from communicating with them. They do not always follow the recommendations given to them. Most mothers believe that children with disabilities cannot become equal members of society.
The revealed features justify the need and direction of family therapy: correction of emotional disturbances in the mother, child-parent otnomaking in families, improving medical and psychological competence of mothers, which improves the efficiency of the rehabilitation of children.
Tags: mothers of children with disabilities, rehabilitation, family therapy
¹1 2014 ã.
EXCHANGE OF EXPERIENCE
Shytikov T.À.
ADAPTED-PATHOBIOMECHANICAL CHANGES OF AN IRIDESCENT ENVIRONMENT OF AN REHABILITATION A POSTTRAUMATIC BRAIN
More accurate definition of the leading factors of development of a posttravnatic encephalopathy in patients of different age groups was the aim of this investigation. The analysis of correlation dependences between clinical displays of a encephalopathy and adapted-trophic changes of an iridescent environment of an eye was spent. It was found that the MRI, mechanic, iridodiagnostic researches are expedient, but in a complex estimation of chromatic, structural and pupillodiagnostic changes. In most cases correlate with a degree of a significance of a cerebral blood flow and in a number of cases allow to determine is conducting pathogenetic part. The iridodiagnostic does not allow authentically to determine a stage, prescription of disease and to differentiate depth of structural changes.
QUALITY OF LIFE OF PATIENTS WITH BREAST CANCER UNDERWENT FUNCTIONAL CONSERVING MASTECTOMY
The article is about of results after functional- saving variant of surgical treatment or breast cancer - radical mastectomy with conserving of v. chephalica and thoraco-acromialis bundle in the prism of investigation of quality of life
Keywords: postmastectomic syndrome, radical mastectomy, quality of life
CURRENT TREATMENT STRATEGIES IN SMALL CELL LUNG CANCER
The objective of our study was to evaluate the comparative effectiveness of different treatment regimens small cell cancer patients. The study included 86 patients (22 (25,6%) were women, 64 (74,4%) - males, mean age 62 +- 4,87 years), divided by 2 groups: group 1 - 46 (53,4%) people with limited-stage disease, group 2 - 40 (46,6%)patients with extensive-stage disease. The results of the study showed that surgical treatment followed by adjuvant chemotherapy in patients with with limited-stage disease A-II A and II B stage significant improved three-year survival rates, compared with chemotherapy alone. Ñhemoradiotherapy in patients with extensive-stage disease significantly increases one-and two-year survival rates, partial response and stability of disease, compared to the chemotherapy alone.
PSYCHOLOGICAL NEEDS AND MOTIVATION OF PATIENTS WITH SPINAL CORD INJURY
Review of scientific papers over the past fifteen years dedicated to the diagnosis of the needs of patients with the consequences of spinal cord injury in the recovery process. Describes the factors that influence the motivation for physical (and other) activities and the main strategies used by members of the rehabilitation team to more fully realize the needs of patients and increase their motivation.
Keywords: spinal cord injury, specific psychological needs, motivation, rehabilitation, active lifestyle, strategies for increasing motivation.
EXPERT OPINION
White Paper
ON STANDARDS AND NORMS FOR HOSPICE AND PALLIATIVE CARE IN EUROPE
This official document of the European Association for Palliative Care (CVR) Lukas Radbruch, Sheila Payne and Board of Directors of the EAPC are the recommendations of the Association with respect to the basic terms and standards of palliative care of good quality and give explanations to them.
FUTURE DEVELOPMENT AND INTEGRATION OF PALLIATIVE CARE EDUCATIONAL PROGRAMS IN THE RUSSIAN FEDERATION
The analysis and evaluation of educational programs in the Russian Federation for staff training of palliative care services, and also for skill development of all health workers on issues related to palliative medicine are given in the article.
Keywords: palliative care/palliative medicine, staff training, improvement of quality and accessibility of medical care
EXCHANGE OF EXPERIENCE
Chernekhovskaya N.E., Shishlo B.K., Chomaeva A.A.
NON MEDICAMENTOUS METHODS TREATMENT VENOUS TROPHIC ULCERS OF THE LOWER EXTREMITIES
Treatment of 186 patients with venous trophic ulcers of the lower extremities. 103 patients were treated with nitric oxide from the device"Plason", 46 patients - with anolit neutrality ANK, 37 patients - with laser therapy. Under NO-therapy healing time of venous trophic ulcers of the lower extremities was 15,8±0,4 day wich is 2 times less than conventional treatment. Under anolit neutrality ANK irrigation venous trophic ulcers were epithelislization after 12±1,4 days, under laser therapy venous trophic ulcers were epithelization after 1 month.
PALLIATIVE CARE FOR CHILDREN. PROBLEMS AND THEIR SOLUTIONS
The article briefly describes the history of the emergence and development of palliative care in Western countries and in the Russian Federation. Author analyses distribution and presentation of life- threatening pediatric diseases, which determine main difference of palliation for children Solved problems in palliative medicine: an acute shortage of trained personnel and hospital beds, the low efficiency of drug treatments, the high cost of treatment of children in need of such assistance. The issues of funding of palliative medicine. The necessity of inclusion in standards of pediatric palliative care of low-level laser therapy. Given problem facing children's palliative care Centre in Moscow and the Department of Pediatric Palliative Medicine.
Keywords: children's palliative care, life-threatenuig diseases, low-level laser therapy
Mugerman B.I., Paramonova D.B., Sabirov R.B.
PATHOGENESIS OF PROGRESSING DISORDERS OF POSTURE AND VOLUNTARY MOVEMENTS IN CHILDREN WITH CEREBRAL PALSY
Authors of the article «Pathogenesis of progressing disorders of posture and voluntary movements in children with cerebral palsy» Mugerman B.I.,Paramonova D.B.,Sabirov R.B. conducted a study of 65 children of 7-12 years old with a spastic diplegia ( Little's form). Prolonged observation of these children with use of an electromyograthy showed the growing violations of intermuscular coordination, posture and voluntary movements. The authors consider that the study of bioelectric activity of functional pairs of muscles at rest and during voluntary tension can reveal the mechanisms of progression of static-dynamic disorders in children with cerebral palsy.
Keywords: children's cerebral paralysis, progressing of disorders of posture and voluntary movements, electromyograthy.
Shaposhnikov A.V., Morozov A.N.
PALLIATIVE TREATMENT OF HEPATOCELLULAR CARCINOMA
In this study authors represent short review and own results using of targer multimodal systemic agent - sorafenib in palliative treatment of patients with advanced hepatocellular carcinoma. 20 patients undergo sorafenib therapy in complex with cytoreductive operations and nontarget agents (5-FU, doxorubicin). The study show that this mode of therapy increase median overall survival time up to 14,3 months. Comporison of two life time prognostic scores (Okuda and CLIP) reveals that CLIP index show more objective data.
Keywords: hepatocellular carcinoma, palliative treatment, prognosis of survival time.
PAIN AND PAIN MEASUREMENT AT ONCOLOGY PATIENTS IN THE HOSPIS
(REVIEW OF A PROBLEM AND METHODS OF THE POSSIBLE(PROBABLE) DECISION)
The questions of therapy of a pain at oncological patients are the primary questions of palliative treatment. The subjectivity of a pain doesn't make it possible to measure the pain impulse and remains unresolved till nowadays. The authors propose a method of correction the pain syndromes in oncology based on pain assessment using the original visual analog scale , taking into account the circadian rhythms. Materials and methods. For revealing daily laws of pain sensation we made the research of dynamics of pain in 82 patients, suffering from chronic pain syndrome (CPS). Conclusion. Circadian visual analog scale of pain is a convenient and simple way for definition of intensity of pain. It reveals dynamic of daily pain sensations, acrophase of pain during the day. Also it gives you the opportunity to select and correct the individual analgesia at the patients suffering with CPS in the hospital and hospice service outside the hospital.
Keywords: Cancer, Pain, Palliativ care. Visual scale of pain.
Yatsun S.M., Tarasova E.S., Turlapov R.N.
RESEARCH OF DYNAMICS OF THE MECHATRONIC DEVICE FOR MECHANOTHERAPY ELBOW JOINT
The article investigates the kinematics of mechatronic device for the rehabilitation of the elbow joint, providing the opportunity flexion - extension, forearm rotation. Proposed and investigated the basic modes of rehabilitation devices: software movement, a gradual increase in the volume of traffic, zero effort and constant reactive force, the algorithms of the control program implementing described modes.
OPTIMIZATION LOCAL THERAPIST AID CANCER PATIENTS IV CLINICAL GROUP
Presents a new organizational and functional model of the process of rendering of medical aid to cancer patients IV clinical group, different expansion of target component, the change of the General specifications of the functions of a local doctor in this direction, the syndromic approach to treatment of patients, management optimization. Formed a system of evaluation criteria, allowing to change the tactics of generalized cancer patients.
Keywords: generalized cancer patients, palliative care.
Kudryashova L.N.
THE ORGANIZATION OF PALLIATIVE MEDICAL CARE BY THE ONCOLOGICAL PATIENT IN THE REPUBLIC OF BASHKORTOSTAN
Data on the organization of palliative medical care are presented in article in the Republic of Bashkortostan. The analysis of work of office of the palliative help for 2011 - 2013 (experience of 22 years) is in detail stated. Ways of further development of palliative medical care in the republic are planned.
Keywords: palliative help, pain, malignant new growth, pharmacotherapy.
ORGANIZATIONAL MODEL FOR PREVENTION OF CHILD NEUROLOGICAL DISABILITY FOR EXTREMELY PREMATURE INFANTS WITH PERINATAL CENTRAL NERVOUS SYSTEM LESIONS
Objective. To elaborate organizational and functional models for habilitation for extremely premature infants with perinatal central nervous system (CNS) lesions. Subject and methods. The efficiency of a proposed therapeutic and rehabilitation care model for extremely premature children was investigated in long-term experiments. Results. The habilitation model for extremely premature infants with perinatal CNS lesions must involve regional and interregional organizational structures, their interaction algorithm, a set of procedures for the prediction and early diagnosis of abnormalities, and step-by-step measures for the maximal recovery of impaired functions and the prevention of disability. Conclusion. The found sociomedical efficiency of the interregional organizational and functional model for the habilitation of extremely premature children with perinatal CNS lesions allows it to be recommended for introduction into practice.
DISABILITY AND ESPECIALLY MEDICAL AND SOCIAL ASSESSMENT, REHABILITATION OF PATIENTS DUE TO MALIGNANT NEOPLASMS (LITERATURE REVIEW)
Summary: Provides an overview of the literature describing the disability, especially ITU and rehabilitation of patients due to malignant neoplasms in the world over the last decade, given the concept of ICF - International Classification of Functioning.
Keywords: cancer, disability, medical and social assessment, rehabilitation, ICF.
¹3 2014 ã.
Selected articles of the International Medical Congress «Palliative medicine in the healthcare of the Russ ian Federation and the CIS»
17-18 June 2014
June 17-18, 2014 in Moscow the International Medical Congress «Palliative care in the health of the Russian Federation and the CIS.» The congress was attended by over 370 delegates from 60 regions of the Russian Federation, Armenia, Belarus, Kazakhstan and Ukraine. The congress held plenary sessions, thematic sections and round tables which discussed the concept of palliative care. At the end of the congress delegates on the basis of proposals prepared by the final resolution.
DIAGNOSTICSANDTREATMENTOFPARATESTICULARTUMORS IN CHILDREN: 19-YEARS OF EXPERIENCE
From 1990 to 2009, at the Research Institute Children Oncology and Gemotologyexamination and treatment were 30 children with testicular germ cell tumors. The average age of our patients was 6.2 years (range 3 months to 15 years). All children performed a study of tumor markers titer, ultrasound. In 6 children identified metastases. Surgical treatment is the first stage in the volume orhifunikulektomii held 26 children. Retroperitoneal limfoadenektomiya made 4 children and 1 child thoracotomy with removal of metastases in the lung. Drug treatment was performed in 26 children with malignant paratesticulartumor. Using a combined method of treatment of malignant tumors led to 92.3 % overall survival.
Keywords: children, testicle, rhabdomyosarcoma.
Moshurov I.P., Kolosova N.P., Kravets B.B.
OPTIMIZATION OF SUPERVISION TO THE LOCAL CANCER THERAPIST IV CLINICAL GROUP
Presents a new organizational and functional model of the process of rendering of medical aid to cancer patients IV clinical group, different expansion of target component, the change of the General specifications of the functions of a local doctor in this direction, the syndromic approach to treatment of patients, management optimization. Formed a system of evaluation criteria, allowing to change the tactics of generalized cancer patients.
Keywords: generalized cancer patients, palliative care.
Maslyakov V.V., Dorzhiyev P.S.
QUESTIONS OF QUALITY OF LIFE OF PATIENTS AFTER INJURIES OF HEART
Results of studying of the remote postoperative period and quality of life of 30 patients operated concerning heart wounds are presented. It is established that in the remote postoperative period, at the patients operated concerning wounds of heart, complication develop in 60% of supervision. The majority of complications are connected with the developed adhesive process in a chest cavity. In the remote postoperative period the executed operation don't influence a physical component of health. Thus the psychological component of health changes: fatigue, absence of feeling of internal energy and decrease in working capacity, decrease in social activity is noted, tendencies to development of depressions are found.
Keywords: injury of the heart, remote postoperative period, quality of life.
PALLIATIVE CARE NEEDS ASSESSMENT IN CHILDREN WITHCANCER ATEND-OF-LIFE IN RUSSIA
Aimofstudyisa palliative care needsassessmentinchildren with cancerinend-of-life in Russia. Material and Methods. Children 0-17 yearsolddiedin 2012 wereincluded in to the study and 30-dayp eriodbeforedeathwasassessed. Results. Annualpalliative care needs in Russia was0,3persons with cancer at end-of-lifeper 10 000 childrenpopulation. Total number of required palliative care specialists over the country is 65 (physicians 8,75; nurses 40, psychologists and social worker 8,75 respectively). Conclusion. Palliative care needsinend-of-life cancerpatientsisrelatively low due to high effectiveness of anti-tumor treatment in children. Thus, it is reasonable to have a universal pediatric palliative care multiprofessionanl team that can serve both oncological and non oncological patients.
Keywords: children's palliative care, needsassessment
Strazhev S.V., Berezantsev A.Yu., Mekhtiev V.N.
SEGIDRIN (HYDRAZINE SULFATE) - DRUG OF CHOICEIN THE PRACTICE OFPALLIATIVECANCER CARE
The articlediscusses the mechanismsof action and efficacySegidrin(hydrazine sulfate)in cancer patients. ConcludesthatSegidrinisthe drug of choicein the practice ofpalliativecancer care.
«ROAD MAP» TO PHYSICIAN THE APPLICATION OF ANALGESIC NARCOTIC DRUGS IN AMBULATORY PRACTICE
Given administrative measures regulated by regulations in the use of drugs in outpatients. Reference is made to the basic regulations governing medical narcotic analgesics in ambulatory practice.
CURRENT TREATMENT STRATEGIES IN SMALL CELL LUNG CANCER
Development and introduction of new drugs for patients with bone metastases will improve the results of treatment of this category of patients. Due to studies it gradually became clear that tumor cells interacted with bone microenvironment and activated cells of the immune system, which in turn released a variety of factors capable of stimulating formation of bone metastases. The above interactions caused formation of "vicious circles" related to multiple activation of cellular signal cascades. This currently resulted in a number of potential molecular targets for prevention and treatment of bone metastases.
Keywords: metastatic cancer, bone metastases, drug therapy.
¹4 2014 ã.
CLINICAL AND EXPERIMENTAL RESEARCH
Budnevskiy A.V., Shiryaev O.Yu., Yankovskaya V.L.
QUALITY OF LIFE IN PATIENTS WITH CHRONIC HEART FAILURE WITH PSYCHOSOMATIC DISORDERS
The article presents the analysis of the clinical features of the disease and quality of life in patients with chronic heart failure and anxiety and depressive disorders. These data suggest that mental disorders in heart failure exacerbated the severity of the patient, reduce its adaptive capacity and, thus, have an adverse effect on the course and outcome of the underlying disease.
Keywords: chronic heart failure, quality of life, anxiety, depression
AFFECTIVE DISORDERS IN TYPE 2 DIABETES: THE IMPACT ON QUALITY OF LIFE
The aim of the study was to investigate the influence of anxiety and depression on quality of life (QoL ) of patients with Type 2 diabetes mellitus (T2DM) (n=94, mean age 52,2 ± 7,6 years). Severity of depression was measured using the Hospital Anxiety and Depression Scale (HADS). To evaluate the QoL has been used SF-36 questionnaire. One in three diabetic patients defined by the presence of clinically significant anxiety and depressive disorders. We have found that type 2 diabetes impairs both physical and mental aspects of patients QoL, which becomes the lowest in case of affective disorders addition.
Keywords: type 2 diabetes, depression, quality of life
THE ROLE OF SURGERY IN THE TREATMENT OF CHILDREN WITH GONADAL GERM CELL TUMORS
The paper evaluates the feasibility of surgery as the only treatment modality in gonadal germ cell tumor. The factors, which influence the results of the treatment, are analyzed: tumor pathology, size and site, tumor markers levels, surgical exposure and extent.
ROLE OF HOSPICE IN PROVISION OF MEGAPOLIS POPULATION WITH PALLIATIVE CARE
The aim of this paper is a formation of integrative regional model of palliative care organization for population of megapolis and monitoring of this model efficiency. Organization structure of hospice care was formed in "megapolis - region" complex. Statistic data about Nizhny Novgorod hospice work from September 2009 to December 2011 were analyzed. We fixed monthly and quarterly number of patients, treating by hospital and out-hospital service. These parameters were collated with planned levels. Estimation of hospice work efficiency was also executed with patients questionnairing. It was shown that now hospice of Nizhny Novgorod is optimized specialized center of palliative care is providing this medical care to megapolis population.
Keywords: hospice, palliative care, organization, efficiency
INFLUENCE OF WEIGHT LOSS OF CLINICAL AND LABORATORY PARAMETERS IN OSTEOARTHRITIS
Visfatin level was determined in the serum of 80 patients with osteoarthritis. We studied dynamic of visfatin level in serum and clinical manifestations of osteoarthritis in connection with decreasing of body weight in patients with osteoarthritis.
Keywords: visfatin, osteoarthritis, overweight.
Vvedenskaya E.S., Varenova L.E.
SEARCHING FOR METHODOLOGY OF THE ADULT POPULATION NEED FOR PALLIATIVE CARE ASSESSMENT
Palliative medical care (PMC) system is currently being established in Russia. The aim of the work was to study the existing methodologies used to assess the population's need for PMC and design the author's approach. The existing needs assessment methodologies and mortality in Russia have been analyzed by the experts (focus-group) to select the causes of death which could indicate the patients likely in need for PMC in the last year of life. Based on the synthesis of expert opinion a list of diseases and conditions (causes of death) when patients require PMC. Minimum, median and maximum need for PMC of adult population was calculated. The study shows that not all subjects who died from chronic diseases and conditions require PMC.
Keywords: need for palliative care, causes of death, methodology, incurable patients.
CASE OF LONG-TERM SURVEY OF THE PATIENT WITH CRANIOVERTEBRAL JUNCTION TUMOR
The case of long-term survey of the patient with craniovertebral junction tumor, undergoing treatment at the hospice since 2011 is described. The features of this case are the following: the onset of the disease with the symptoms of nasopharynx tumor, an unusual anterior tumor extension into the nasopharynx lumen with cuff inclusion of vertebral bodies C1-C2 and posteriorly into the lumen of the spinal canal, the presence of dysontogenesis signs and organic perinatal CNS damage, the dissociation between the large size of tumor and obliterated neurological manifestations, the ambiguity of the results of histological and immunochemical studies on tumor biopsy specimen. The nature of the tumor - intra- or extramedullary, and its source failed to establish. A significant difficulty in determining the nature and structure of the tumor process influenced the choice of the treatment.
Keywords: craniovertebral junction tumor, hospice, spiral computed tomography, magnetic resonance imaging, the difficulties in the diagnosis and interpretation of its results.
PSYCHOTHERAPEUTIC ASPECTS
Tkachenko G.A., Gladilina I.A., Ivanova A.V.
THE DYNAMICS OF THE MENTAL STATE OF PATIENTS WITH BREAST CANCER DURING RADIOTHERAPY
The article presents the results of clinical and psychological study of 52 patients with breast cancer, which was planned radiotherapy. Analysis of the data showed that the majority of patients during radiotherapy is developing asthenic-depressive state.
Keywords: mental state; breast cancer; radiotherapy
ESPECIALLY OF TREATMENT LONG TUBULAR BONES TO DEFICIENCY THE IODINE DISEASE
As a result executed experimental study is graphically shown that using preparation containing hormones of the thyroid gland, chondroitin sulfate and ATP render the stimulating influence upon processes regeneration long tubular bones at to deficiency the iodine disease. Herewith exists increase the relative share mature bone fabrics. The Most effect of the treatment with using the said preparation exists to be at regenerations bone fabrics on secondary type to say through enchondral stage osteogenesis.
Keywords: delayed union, to deficiency the iodine disease, of treatment long tubular bones, to slowing-down the grow together bones.
DIGEST
Rostovtsev D. M., Yakovenko I.V., Olyushin V. E., Vazhenin A.V.
EPIDEMIOLOGY OF MALIGNANT ASTROCYTOMAS: LITERATURE REVIEW AND OWN DATA
Over the last years investigators from many countries focus on the increasing of total oncological incidence rate. This trend is steadily followed up during the last three decades. This article presents data concerning morbidity rate of both primary brain tumors, and specially of malignant glial tumors based on the information of Russian and foreign publications, as well as on our own data resulted from the mass study of malignant supratentorial tumors incidence in Saint Petersburg.
SYSTEMIC RADIONUCLID THERAPY: VARIANTS OF BONE METASTASES TREATMENT
Purpose: to estimate efficacy of treatment of bone metastasis in patients with breast and prostate cancer using different variants of systemic radiotherapy.
Materials and methods: Medical histories of patients, who were treated in the department of radiological medicine from 2006 to 2010 from bone metastases, caused by different types of cancer, have been analyzed (340 patients). The efficacy of pain syndrome treatment and the rate of hematopoiesis suppression using different types of systemic radiotherapy have also been analyzed. Four groups of patients have been compared: 1)2 groups of 30 people, one received 89Sr-chloride monotherapy (activity 150 mBk), the second one, in addition, received remote radiotherapy treatment; 2)2 groups of 30 patients, one also received 89Sr-chloride monotherapy (activity 150 mBk), the second one also received fractial radiotherapy.
Results: Quantative assessment of treatment efficacy applying different types of systemic radiotherapy has been obtained. The results of different types of treatment have been compared. The treatment pattern for patients with significant myelosupression has been developed.
Conclusion: 1)The second line of bone metastasis treatment includes different types of systemic radiotherapy.
2)The best analgesic effect according to the research is caused by 89Sr-chloride monotherapy (activity 150 mBk), supplemented by remote radiotherapy treatment ( pain syndrome reduced by 36%); less effective is 89Sr-chloride monotherapy (27%). The poorest efficacy is shown by fractial radiotherapy (14%).
3) The decrease in white blood cells and platelets has been detected in all groups.
4) Fractial radiotherapy can be chosen in case of significant blood cell depletion or thrombocytopenia.
Keywords: 89Sr-chlorid radionuclide therapy, monotherapy, fractial therapy, bone metastases, myelosupression.
EXCHANGE OF EXPERIENCE, PRACTICAL OBSERVATIONS, ERRORS AND COMPLICATIONS
EVALUATION OF ACTUAL NUTRITION AND HEALTH STATUS OF STUDENTS OF HIGHER EDUCATIONAL INSTITUTION
Results of investigation of actual nutrition, nutrient provision, and impact made by these factors on morbidity of first-year students are presented in this article. Morbidity of first-year student girls studying at Orenburg state medical academy was investigated. Obtained data show that nutrition of student girls is irrational and inadequate because of low nutritional value of diet, insufficient consumption of macronutrients and micronutrients. That causes increase of total morbidity and alimentary-dependent diseases morbidity.
PRIMARY AND RECURRENT BREAST CANCER: PECULIARITIES OF STATUS OF SEX HORMONES IN TUMOUR AND INTACT TISSUES
Abstract: Status of sex hormones in pathologic, perifocal and conditionally healthy tissues of patients with locally-advanced breast cancer depending on efficacy of neoadjuvant autohemochemotherapy has been studied. Contingency of local levels of separate hormones and degree of tumour regression has been revealed. At partial regression, in comparison with process stabilization, malignant tissue contained higher concentrations of progesterone, testosterone, DHEA and 17-hydroxyprogesterone, whereas perifocal tissue contained higher levels of progesterone, prolactin, DHEA and 17-hydroxyprogesterone, and intact tissue was characterized by lower levels of estradiol and progesterone, and higher concentration of testosterone, prolactin, DHEA and 17-hydroxyprogesterone.
Keywords: breast cancer, sex hormones, tissue concentration, relation to chemotherapy efficacy
NEED FOR AND PERSPECTIVES ON CANCER PALLIATIVE CARE IN THE NIZHNY NOVGOROD REGION
Summary.The article presents thedata on cancer morbidity and mortalityin theNizhny Novgorod region in comparison with those in Russia in the past decade. Need for palliative care beds in the region has been identified,the analysisof medical recordsrevealed the mostcommon bothering symptomsin cancer patients in thelast year of their life. A palliative care service for cancer patients establishment in the region is a paramount.
Keywords: palliative care, palliative medicine, cancer, malignancies, mortality, cancer prevalence in the Nizhny Novgorod region, end-of-life care, pain control, need for palliative care, symptoms in cancer patients in the last year of life.
Tarasova N.V., Vazhenin A.V.
ANALYSIS OF THE QUALITY X-RAY EXAMINATION OF TRAUMA PATIENTS
The analysis of results of radiological researches of traumatologic patients is one of parameters of an overall performance of system of healthcare, will help to reveal priority objectives, parameters of their achievement, to give clear concept about primary results of activity, to describe its major qualitative and quantitative characteristics.
Keywords: defect, assistance, quality, analysis, and responsibility.
Dhifaoui S., Aristarkov V.G.
CONDITION REMAINING PARTS OF TYROID GLAND IN LONG TERM AFTER SURGICAL TREATMENT OF MULTINODULAR COLLOID GOITER
To study the condition of remaining parts of throid gland in long term after surgical treatment of multinodular colloid goiter, a total of 95 patients aged from 29 to 64 years were examined. Its found that patients with multinodular non toxic colloid goiter within 6 months after different types of resections in the thyroid remnant on ultrasound three types of body-structures changes are identified (stable - 20%,hypertrophic - 35,8%, and hypotrophic - 44,2% ) accompanied by hypothyroidism in 60% of patients. It was found that after surgery for colloid goiter in the posoperative period , iodine should be prescribed. In case of large volume resections, thyroid therapy should be started without waiting for hypothyroidism. The study recommended that in order to determine the final volume of resection in any opeartion on the thyroid gland, it is advisable to use intraoperative urgent histological examination of the nodule and the surrounding tissues.
HEALTH TECHNOLOGY ASSESSMENT OF THE DIFFERENT KINDS OF TREATMENT PATIENTS WITH PROSTATE CANCER
Health technology assessment is an innovative approach allows health authorities and clinicians to found out the best method of treatments base on clinical and economical benefits for patients. Actually today we need to realize economical impact of each oncology disease for Country Health Care system. Increasing of prevalence last several years depends on increased survival and raised the number of middle-age people. Cost distribution is mane important target for health technology assessment researches.
Keywords: health technology assessment, prostate cancer, prostatectomy, teletherapy.
STUDY OF TRIPSIN-LIKE PROTEINASES AND THEIR INHIBITORS IN PATIENTS WITH CANCER OF NASOPHARYNX IN THE DYNAMICS OF RADIOTHERAPY
Summary: Blood plasma of 46 patients with cancer of nasopharynx (T1-4N0-3M0) receiving remote gamma-therapy in standard regime has been analyzed. During successful treatment of malignant tumour we observed pathologic changes in activity of kinin system, tripsin proteinases and inhibitors of blood plasma at decrease of efficacy of their interaction, starting from the 1st day after the 1st stage of gamma-therapy, as regards pre-treatment data, and during the whole period of observation. We came to conclusion about direct relationship between disturbance of proteinase-inhibitory balance of blood and progression of inflammatory reaction in organo-tissue complex of nasopharynx, parameters under study being of diagnostic value.
Keywords: cancer of nasopharynx, radiotherapy, proteinases, inhibitors, kinin system
Safronova E.A.
EFFECTS ON HEART RATE VARIABILITY IN THE DIFFERENT CHEMICAL STRUCTURE OF ORGANIC NITRATES IN PATIENTS WITH STABLE ANGINA, 3 AND 4 FUNCTIONAL CLASSES
In the method rhythmocardiography (GSC) was estimated peripheral autonomic pharmacodynamics of nitroglycerin, isosorbide mononitrate and isosorbide dinitrate in patients with stable angina pectoris 3 and 4 functional classes with concomitant hypertension. Were found positive - increased heart rate variability (HRV) and negative points - an increase of humoral-metabolic and sympathetic with a decrease in parasympathetic regulation of pacemaker activity of the sinus node of the heart under the influence of the drugs. Smaller dysregulated in Sino-atrial node called isosorbide mononitrate.
NEED OF DISABLED PEOPLE OWING TO DORSOPATHYA IN REHABILITATIONAL MEASURES
Studying of need of disabled people owing to a dorsopathya in rehabilitational measures depending on groups of disability. There were needs in measures of medical and social rehabilitation. These programs of rehabilitation are developed by everything to disabled people with this pathology irrespective of group. The need for professional rehabilitation at disabled people of the first group was absent that was caused by the legislation existing in 2009-2011. Programs of professional rehabilitation of 37,2% of disabled people of the second group and 21,6% of disabled people of the third group aren't developed, in connection with achievement by these disabled people of a retirement age and lack of a spirit to continue labor activity. The highest need for means of rehabilitation (TSR) at disabled people of the first and second group of disability.
EVALUATION OF HEPATIC DRUG AFFECTION FEATURES OF TBC PATIENTS WHO RECEIVE SPECIFIC THERAPY
This article represents the results of evaluation of biochemistry blood indices dynamic, which define the development of hepatic cytolytic syndrome during TBC therapy in timing aspect. Changes in status of CD lymphocytes during TBC treatment in comparison with healthy donors are shown in consideration of age and gender related features.
Keywords: tuberculosis, hepatotoxicity.
Simakova E., Zavodovsky B., Polyakova G., Sivordova L., Zborovskaya I.
VALUE OF VISFATIN LEVEL DETERMINATION IN SERA OF RHEUMATOID ARTHRITIS PATIENTS
To study visfatin levels in blood of rheumatoid arthritis patients. We study 120 rheumatoid arthritis patients (the average age was 57,3+1,6 years) and 50 healthy persons as control group. Visfatin level was determined with ELISA-test (RaiBiotech, cat ¹ EIA-VIS-1). The increased visfatin level was revealed in 46 rheumatoid arthritis patients (38,3 %). The visfatin level was 6,27+0,59 ng/ml in rheumatoid arthritis patients and 2,30+0,21 ng/ml - in control group (ð <0,001). Rheumatoid arthritis patients with high visfatin level had higher desease activity index (DAS28 - 2-nd degree), increased level of antibodies to citrullinated vimentin, higher level of C-reactive protein and erythrocyte sedimentation rate.
Keywords: visfatin, rheumatoid arthritis.
Evdokimov V.M., Yusupkhodzhaev R.V.
SANATORIUM REHABILITATION OF PATIENTS WITH MYOCARDIAL INFARCTION
In the presented materials examines influence of different programs of physical aftertreatment in sanatorium conditions with physiotherapy exercises use, bicycle training sessions, trainings on a racetrack in a combination to sessions of a biological feedback on the psychological status sick of a myocardial infarction.
Keywords: trainings on a racetrack, bicycle training sessions, a myocardial infarction.
¹2 2013 ã.
CLINICAL AND EXPERIMENTAL RESEARCH
P.V.Svetitsky
RECONSTRUCTIVE - PLASTIC FOR RESTORATION OF PHARYNX AND ESOPHAGUS IN CANCER PATIENTS
Abstract: In some cases operation on larynx and laryngopharynx are complicated by formation of pharyngostomas and pharyngoesophagostomas. Stoma liquidation with restoration of pharynx and esophagus is a complex branch of reconstructiveplastic surgery. Of special difficulty is the usage of local tissues in patients with pronounced hair coat on neck skin. We have developed and apply the method of stoma closure by three linings: internalpreserved mucous membrane of pharynx and esophagus, middledeepidermic skin, and external-skin.
The method has been applied in 28 patients: 10 patients with cancer of larynx and 18 patients with cancer of laryngopharynx. In 21 cases (75%) hialing by primary intention was observed, whereas in 7 cases (25%) secondary operation was required. In all patients pharynx function, i.e. natural mastication, food swallowing and speech, have been rehabilitated.
Gumenetskaya Yu.V., Mardynsky Yu.S.
RADIOTHERAPY IN THE PALLIATIVE TREATMENT OF PATIENTS WITH BLADDER CANCER
In this article, we present a review of the literature on potentialities of radiotherapy in the palliative treatment of patients with bladder cancer.
The efficacies and toxicities of different dose-fractionation regimens are evaluated.
Keywords: radiotherapy, palliative treatment, bladder cancer
CURRENT TREATMENT STRATEGIES IN SMALL CELL LUNG CANCER
Summary: The objective of our study was to evaluate the comparative effectiveness of different treatment regimens small cell cancer patients.
The study included 86 patients (22 (25,6%) were women, 64 (74,4%) - males, mean age 62 +- 4,87 years), divided by 2 groups: group 1 - 46 (53,4%) people with limited-stage disease, group 2 - 40 (46,6%)patients with extensive-stage disease. The results of the study showed that surgical treatment followed by adjuvant chemotherapy in patients with with limited-stage disease A-II A and II B stage significant improved threeyear survival rates, compared with chemotherapy alone.
Ñhemoradiotherapy in patients with extensive-stage disease significantly increases one-and two-year survival rates, partial response and stability of disease, compared to the chemotherapy alone.
EVALUTION REHABILITATIVE TREATMENT OF SPASTIC MUSCULAR HYPERTONICITY IN ACUTE PERIOD STROKE USING BOTULINUM TOXIN
Abstract: Currently, the treatment of post-stroke spastic muscle hypertonus, drugs were applied botulinum toxin type A. Although, traditionally, botulinotherapy should be used in combination with other existing means of medical rehabilitation, to determine the optimal timing of treatment, it is necessary to conduct additional research. This paper presents the results of 79 patients undergoing rehabilitation treatment in acute stroke with the development of spastic movement disorders. The role of timing in these botulinotherapy disease.
EVALUATION OF PATIENTS FUNCTIONAL STATE AND QUALITY OF LIFE IN THE REMOTE PERIOD AFTER CORONARY BYPASS SURGERY DEPENDING ON THE PASSAGE SANATORIUM REHABILITATION
Summary: It was performed the evaluation of quality of life in patients with coronary heart disease by questionnaire EuroQol-5D-5L (version 1.0, 2011) in the late period after surgery, depending on the completeness of the rehabilitation measures implementations. Found that in the group of patients receiving the sanatorium stage of rehabilitation experienced higher levels of evaluation of the condition in the long term as compared to the baseline quality of life after the operation. In patients who have not undergone sanatorium stage of rehabilitation the quality of life have been worsening. It is concluded that the relatively small volume and the duration of the rehabilitation program at a local nursing home provides long-term positive results. Thus saving on the cost of small sanatorium rehabilitation after coronary artery bypass grafting, the State and the federal authorities depreciate investments in high-tech medical care.
These data clearly confirm the need for a system in the area of specialized treatment and rehabilitation assistance that contributes to activation of the patients, their return to work and active life.
SURGICAL REHABILITATION OF THE PATIENTS WITH POSTTRAUMATIC COMBINED DEFORMATIONS OF A NOSE
The surgical treatment combined posttraumatic deformations of a nose is a rather difficult task and frequently is accompanied by development of repeated deformations in the postoperative period.
For improvement of cosmetic results of rhinoplastic operations a number of new tools and technologies is offered. The application of the developed tools and techniques rhinoplasties has allowed considerably to improve cosmetic results of operations. The clinical efficiency of use of the offered techniques is proved.
Keywords: posttraumatic combined deformation of a nose, rhinoplasty
Petrunko O.V., Kisel S.V.
DRUG REHABILITATION OF PATIENTS WITH CHRONIC DEPRESSIVE DISORDER
Summary. Among the stationary contingent 33 patients with current chronic (duration of more than 2 years) depressive episode according to ICD-10 were examined. The comparative effectiveness analysis of antidepressants different generations was conducted in the rehabilitated drug therapy of patients with chronic depressive disorder. The statistical analysis results of the rehabilitated drug therapy effectiveness in the logistic regression model with the definition of the odds ratios (OR) and 95% confidence intervals (CI) indicates that treatment of SSRI antidepressant escitalopram or paroxetine was more effective than the appointment of tricyclic antidepressants (OR = 0.34, 95% CI -7.91 - 2.06), or venlafaxine (OR = 2.44, 95% CI -2.46 - 7.32). Comparing treatment with venlafaxine and tricyclic antidepressants shows the effectiveness of venlafaxine (OR = 0.83, 95% CI -5.46 - 4.46).
Keywords: depressive disorder, chronic course, drug rehabilitation.
Frantziyantz E.M., Bandovkina V.A., Moiseenko T.I., Shishkina O.G.
CONCENTRATION OF SEX STEROIDS AND THEIR METABOLITES IN PERIPHERAL BLOOD OF WOMEN OF DIFFERENT AGE GROUPS HAVING UTERINE CANCER
Abstract: In order to reveal similarities and differences in hormonal status of patients, the blood level of sex hormones and their metabolites of patients of different age groups with uterine cancer has been studied.
AGE SPECIFICITIES OF ANXIETY-DEPRESSIVE DISORDERS AND METRICS OF THE PATIENTSÒ LIFE QUALITY DURING EARLY AND LATE RECOVERY PERIODS AFTER CEREBROVASCULAR ACCIDENT
Metrics of anxiety-depressive disorders and quality of life during early and late recovery periods for the post stroke patients have been studied in the different age groups. The differences in psycho-emotional area, amenity adaptation and adaptation in socium after disease have been revealed. Functioning fields of patients in their late recovery period with noted depression of the life quality level have been determined.
Keywords: cerebrovascular accident, quality of life, anxiety, depression.
Tkachenko G.A., Cheban O.I., Kropotov M.A.
THE QUALITY OF LIFE OF PATIENTS AFTER CONSERVATIVE SURGERY FOR MALIGNANT TUMORS OF THE MAXILLOFACIAL REGION
The article presents the results of clinical and psychological study of the quality of life in 52 patients after conservative surgery for malignant tumors of the maxillofacial region. Analysis of these data revealed that the majority of patients observed various degrees of emotional disturbances that reduce the quality of life satisfaction.
Keywords: quality of life, cancer of the maxillofacial area; ablative surgery.
DIGEST
Boulyubash I.D.
MOTIVATION IN PATIENTS WITH SPINAL CORD INJURY IN REHABILITATION
Summary. Review of scientific articles in the past fifteen years dedicated to the diagnosis of the patient's motivation with the consequences of spinal injury in the recovery process. The internal and external factors which motivate them to physical (and other) activities are described.
Some of the basic strategies used by members of the rehabilitation team to enhance the patient's motivation are presented.
Keywords: spinal cord injury, motivation, rehabilitation, active lifestyle, strategies for increasing motivation.
NOTE TO READERS
¹3 2013 ã.
CLINICAL AND EXPERIMENTAL RESEARCH
Novikov G.A., Rudoy S.V., Samoylenko V.V., Vaisman M.A.
INTEGRATION OF PALLIATIVE CARE IN HEALTHCARE OF THE RUSSIAN FEDERATION
Palliative care received official recognition in the Russian Federation in 2011 after the adoption of the Federal Law. Funding for palliative care is enshrined the state guarantee the provision of free medical care to citizens. Adoption of the law resulted in the need to update and develop the regulatory framework, including the work of the hospice. In February of 2013 established the Department of Palliative Medicine at the Faculty of Postgraduate Education, Moscow State University of Medicine and Dentistry im.A.I.Evdokimova. Palliative medicine in Russia supports the Russian Association of Palliative Medicine, a member of the European Association for Palliative Care. In 2013, the All-Russian scientificpractical conference «Palliative medical care in the Russian Federation», which was attended by over 1,500 representatives of the medical community and public organizations.
Keywords: palliative care, department of palliative medicine, postgraduate education, healthcare.
Teryoshin A.T., Avlastimov Y.F.
ENDOVASCULAR LAZEROTHERAPY AND SINUSOIDAL MODULATED CURRENTS IN POSTOPERATIVE AFTERTREATMENT OF GENESIAL FUNCTION AT PATIENTS WITH THE CHRONIC SALPINGO-OOPHORITIS
There were 110 patients with a chronic salpingo-oophoritis at the age of 31,3±1,8 years which have transferred reconstructive plastic surgeries on uterine pipes under our observation. Patients were distributed by a randomized method on 2 groups. The 1st group (60 patients) in the 1st day after operation received endovascular lazero-therapy and sinusoidal modulated currents, 2nd (50 patients) - only sinusoidal modulated currents. Pregnancy during 1 year after treatment in the 1st group came at 80% of patients with a two-phase menstrual cycle, at 57,9% - with luteal phase defect, at 28,6% - with an anovulation with sterility duration to 5 years, in the 2nd group - at 55,6%, 26,3%, 7,7% of patients according to sterility duration till 3 years.
Keywords: oophoritis, endovascular laser and SMÑ-therapy, infertility
Gantsev S.H., Abdurakhmanov B.A.
COMBINATION MINIINVAZIV TECHNOLOGY WITH PREVENTIVE CORRECTION HEPATOPORTAL HEMODYNAMIC IN TREATMENT DIURETICORESISTANT ASCITES BESIDE SICK LIVER CIRRHOSIS
On cause, diureticoresistant ascites is handled 30 patients by liver cirrhosis. 16 sick are made implantation peritoneal port-system Celsite with preventive reduction blood current in lineal pool by embolitation to lineal artery, 14 - an implantation peritoneal port-system Celsite in insulated variant. Undertaking embolitation to lineal artery has allowed reaching the reductions an portal pressures with regress ascites, correction splenomegalia and cytophenia. Use peritoneal port allows to realize autoascitereinfuzion with portiones, doses, that at the end excludes occurrence of serious complications as haemorrogical syndrome. The most firm positive result is received under multifunction using peritoneal port-system with preventive embolitation of the lineal artery.
MEDICAL AND ECONOMIC RATIONALE FOR THE USE OF LASER THERAPY IN PEDIATRIC PALLIATIVE CARE
This article represents the rationale for a holistic approach to the treatment of children in need of palliative care. In this context, a role of laser blood irradiation is specifically highlighted. It is emphasized the entire safety effectiveness and efficiency of laser therapy is also emphasized since no complications or side effects have been reported so far.
Keywords: paediatrics, palliative care, laser therapy
Palexov A.V.
CHOICE OF OPIOID PAIN THERAPY AS A CRITERION FOR THE QUALITY OF PALLIATIVE MEDICAL CARE
The paper gives data on the use of strong opioids (narcotic drugs) in Russia. It analyzes the main reasons for their insufficient use and defines the basic organizational measures contributing to the higher quality of therapy for chronic pain syndromes.
MODERNSTATE OF A PROBLEM OF SURGICAL TREATMENT OF URGENTLY COMPLICATIONS OF COLORECTAL CANCER AT REGIONAL LEVEL
In work various options of surgical treatment of urgently complications of colorectal cancer are considered. The retrospective analysis of results of treatment of 534 patients in hospitals of Smolensk is submitted. From them intestinal obstruction was observed in 439 cases (82,3%), perforation of a tumor 56 (10,4%), bleeding of 7,3% (n = 39). Results of surgical treatment are analyzed.
SURGICAL REHABILITATION OF THE PATIENTS WITH POSTTRAUMATIC RHINOLORDOSIS, COMBINED WITH OTHER DEFORMATIONS OF A NOSE
Rhinoplasty at saddle nose deformity is uneasy operation. The complexity of intervention considerably grows, if it is made concerning rhinolordosis, combined with other deformations of a nose. The given operation can be accompanied by set of various complications, one of which is the displacement the cartilaginous implant.
The analysis of cosmetic results and complications 66 rhinoplastic interventions, made concerning rhinolordosis, combined with other deformations is carried out. The general number of complications has made 4 (6 %). Only in two cases of complication are connected to displacement implant (3 %). In two cases (3 %) for elimination of complications is carried out treatment, which without operations has resulted in recovery and achievement of necessary cosmetic effect. The received data confirm sufficient efficiency of used technologies.
Keywords: rhinolordosis; rhinolordosis, combined with other deformations of a nose; rhinoplasty; cartilaginous implant.
Frantziyantz E.M., Bandovkina V.A., Moiseenko T.I., Adamyan M.L.
THE LEVEL OF SEX HORMONES IN TUMOUR TISSUE AND PERIFOCAL ZONE OF MYOMA AND UTERINE CANCER DEPENDING ON ENDOMETRIUM TYPE
The relationship between endometrium type and local saturation of tumour and perifocal zones of uterus with steroid hormones and prolactin at benign and malignant processes has been studied. According to the results, endometrium type at which malignant or benign process is developed, significantly changes the level of local sex hormones, but doesn't influence prolactin concentration. The level of steroid hormones in malignant tumour depended to a lesser degree on endometrium type, in comparison with benign process.
CORRECTION OF LIVER TOXICITY IN THE COMBINED CHEMORADIATION THERAPY OF CANCER PATIENTS
In 29 patients with various malignant tumors there has been carried out an estimation of the preparation Thiotriazoline efficacy in the treatment of hepatotoxicity in the process of combined chemoradiation therapy. It has been shown that ten-day application of Thiotriazoline in double dose: 2.5% solution intravenously by 4.0 ml twice within 24 hours and 1 tablet (100 mg) twice within 24 hours, in patients with I and II degree of hepatotoxicity at the background of combined chemoradiation therapy enables to remove completely manifestations of cytolysis in 100% of patients, not changing regimen of chemotherapy. To normalize levels of biochemical indices of blood in III degree of hepatotoxicity, more a long intake of Thiotriazoline (about 4 weeks) was required. Regimen of chemoradiation therapy in the period of Thiotriazoline application was not changed.
Hodjimatov G.M., Korabaev U.M., Ten D.O., Koraboev B.B.
MINIMALLY INVASIVE INTERVENTION FOR ACUTE CHOLECYSTITIS COMPLICATED WITH OBSTRUCTIVE JAUNDICE
This work contains the analysis of the results in application of minimally invasive treatment methods of 141 patients with acute calculous cholecystitis complicated by mechanical jaundice. High effectiveness of abilities in minimally invasive interventions for the treatment of this type of patients is shown, that enables not only the radical cure of patients but also to reduce the index of complication frequency and mortality and to get good and satisfactory results in 94% of monitoring.
TECHNOLOGICAL IMPACT IN SHAPING THE ENVIRONMENTAL CONDITIONS AND THE HEALTH STATUS OF THE POPULATION
This is a literature review. Today it is proved that the changes in the environment, lifestyle and consumer habits of the population of developed countries in recent decades have a determining role in increasing the frequency of respiratory diseases. Industrial toxic and chemical pollution of the environment currently has reached extraordinary proportions due to industrial emissions. In addition to industrial enterprises, vehicles are one of the main air pollutants. Respiratory organs and cutaneous covering receive the major part of the exposition to harmful substances in the atmospheric air. During the last decades, on the territory of the country, and in particular in Ural and Siberia, demographic and morbidity health indices continue to deteriorate. According to official data of 2012, in children's polyclinics of Chelyabinsk 2247 children with disabilities due to various diseases were observed. 370 of them need palliative care. However, the analysis of the relationship of diseases prevalence among the population in all the regions of the Russian Federation with the environmental situation was not conducted. We are implementing research in this direction.
Keywords: ecology, public health, palliative care.
EXPERT OPINION
Osipova N.A.
ANALYSIS OF TRENDS IN DRUG THERAPY OF CHRONIC PAIN IN ADVANCED CANCER PATIENTS
Osipova Nadezhda A. - Honored Worker of Science, Doctor of Medical Sciences, professor, chief researcher at the Department of Anesthesiology and Intensive Care FGBU MNIOI them. PA Herzen, a member of the Russian Ministry of Health working group to prepare proposals on changes to the regulations related to narcotic and psychotropic drugs
¹4 2013 ã.
Clinical and experimental research
Osipova N.A.
CHRONIC PAIN SYNDROME IN ONCOLOGY: PROBLEM OF A PATIENT, PHYSICIAN, STATE
Problem analgesic drug therapy in terminally ill people is extremely relevant and currently in Russia is not solved. Most of these patients do not receive adequate care for them due to unavailability of effective narcotic drugs , despite their presence in the country in sufficient quantities. The publication analyzes the development and current state of Pain Palliative Care cancer patients in Russia in accordance with international norms and principles in this area in order to identify specific gaps and identify the necessary measures to improve the quality of care Pain incurable patients.
Keywords: analgesic drug therapy, palliative care, narcotic drugs.
Exchange of experience
Savva N.N., Kumirova E.V., Maschan A.A.
IMPORTANT STEPS TO IMPROVE PAIN CONTROL IN CHILDREN OF RUSSIA
According to the recommendations of World Health Organization (WHO, 2012) and Association of Pediatric Palliative Medicine (APPM, 2012), non-invasive 'short' morphine are recognized as most effective and save form for pain control in children with cancer to use at home.senceofthisformofmorphineisoneofthemaintasksofpalliative pediatricsatpresentbecausemostofregisteredinRussiaopioidsare licensedforthe ageafter 18 years old. Moreover, registeredprolonged morphineisnot suitable for dose titration and management of breakthrough pain, so it can be prescribe after pain control is achieved by 'short' morphine. Authors consider that it is very important now to register children's non-invasive forms of 'short' morphine, approve standards and clinical recommendations as well as implement educational courses on children's pain control into the basic and post-graduate education of pediatricians, general practitioners, and oncologists.
RESULTS AND PROSPECTIVES OF ACTIVITY OF PALLIATIVE CARE SERVICE FOR ONCOLOGICAL PATIENTS IN THE SAMARA REGION
In article the organizational model of service of the palliative help is presented to oncological patients in the Samara region. The structure, capacity of resource base and standards of the organization of activity of service at the qualified and specialised level are described. Following the results of work in 2010-2012 the assessment of results of rendering of the palliative help in specialised hospitals oncology service, in offices of the palliative help, hospices, and also in divisions of local service is carried out. It is shown that as a result of wide use of hi-tech surgical interventions and realisation of actions of the Program of the guaranteed provision of medicines by anaesthetics availability and quality of the palliative help to the oncological patient have raised.
Keywords: the specialised and qualified level of service of the palliative help onkobolny, hi-tech palliative operations, offices of the palliative help, hospices, an educational program on diagnostics and pain correction, monthly monitoring of quality of treatment and dispanserny supervision of onkobolny 4 class. gr.
Melnikov O.R., Rusanov A.A., Lapshin A.S.
COMBINED ENDOSCOPIC PALLIATIVE TREATMENT FATALITY OF INOPERABLE CANCER OF THE GASTROINTESTINAL TRACT
combined using of different methods in therapeutic endoscopy leads to an improvement the quality of inoperable patients' life;
empowering the local exposure on the tumor leads to high efficiency of combined endoscopic palliative treatment;
photodynamic therapy used in pulsed mode is high performance in the cancer treatment;
one of the priority directions of development of palliative care for cancer patients should be endoscopy.
Keywords: palliative endoscopic treatment, esophageal cancer, gastric cancer, colon cancer, stenting of a tumor, photodynamic therapy, argon plasma coagulation.
PREVENTION OF HEALTH PROBLEMS IN INFANTS UNDERGOING PERINATAL LESION OF THE CENTRAL NERVOUS SYSTEM, TAKING INTO ACCOUNT FAMILY RISK FACTORS
Based on the identified features of the mental health of infants with perinatal lesion of the central nervous system, identified family risk factors have been developed to complement the program of dynamic observation of the one - Kimi children, including the prediction of health problems in a socio - biological and psychological risk factors of parents, early diagnosis of emotional and psychological disorders, neuropsychological development of children and family rehabilitation aimed at reducing anxiety, development of communication - ence, correction of the motivational sphere of parents and harmonization of parent-child relations, thus improving the efficiency of rehabilitation of children.
Kudryashovà L.N. Kudryashov A.A. Petrovà O.M.
TREATMENT OF THE CHRONIC PAIN SYNDROME AT THE INKURABELNYKH OF ONCOLOGICAL PATIENTS (ON THE EXAMPLE OF EXPERIENCE OF OFFICE OF THE PALLIATIVE HELP OF THE REPUBLICAN CLINICAL ONCOLOGICAL CLINIC OF UFA)
The material is presented in article about the principles of treatment of a chronic pain syndrome at oncological patients on the example of experience of office of the palliative help of the Republican clinical oncological clinic of Ufa. The office structure, methods and schemes of treatment of pain at patients with generalized forms of a cancer are in detail stated.
Keywords: palliative help, pain, malignant new growth, pharmacotherapy.
Abdurakhmanova B.A.
ROENTGEN-ENDOVASCULAR SURGERY IN MANAGEMENT OF PORTAL HYPERTENSION IN PATIENTS WITH LIVER CIRRHOSIS
The analysed results to correction portal hypertension beside 75 sick cirrhosises liver, of them 41 patients are made implantation infusion port-systems Celsite: 22 - in insulated variant, 19 - after preventive reduction blood current on splenetic artery by way her embolitation. 34 sick are executed traditional portocaval shunts: 18 - shlenorenal anasthomosis in different variant and 16 - portosystems shunts after preliminary embolitation of the splenetic artery. Åmbolitation to lineal artery with implantation infusion portsystems allows to realize gradual, step-like change hepatoportal hemodynamic with efficient selective portodecompressiv outside of dependencies from condition degree to compensations portal hemodynamic.
THE DETECTABILITY ANALYSIS OF RISK FACTORS, DISORDERS OF TARGET ORGANS AND ASSOCIATED CLINICAL CONDITIONS IN PATIENTS WITH PRE-HYPERTENSION AND ARTERIAL HYPERTENSION
The article analyzes the detection of risk factors, target organ damage and associated clinical conditions in comparison with the total cardiovascular risk in informal male and female population in Andijan with prehypertension and hypertension. In the list of risk factors in the population studied suggested to include ethnic characteristics, social and educational status of the patients. The values of these risk factors should be taken into account to determine the prospects for population strategy and tactics of high-risk patients.
POSTOPERATIVE REHABILITATION OF PATIENTS WITH THE CANCER OF THE MAMMARY GLAND
Research objective - to improve quality of life at patients after the mammary gland operations, executed concerning a cancer. For achievement of a goal we carried out studying of indicators of quality of life at 56 patients to whom the mastectomy concerning a cancer of a mammary gland was executed. Average age of patients made 48 ± 5 years. Term from the moment of expeditious treatment made from 1 year to 5 years. To all patients the mastectomy, then chemotherapy and beam therapy was executed.
Level of a depression defined by Bek's scale. The special questionnaire including 33 questions was developed for an assessment of indicators of quality of life.
As a result of the conducted researches it is established that at patients after a mastectomy executed concerning a cancer of a mammary gland in the postoperative period complications which influence quality of life of these patients develop. Thus all complications can conditionally be divided into two groups: 1. The mental depressions connected with development. 2. The complications connected directly with expeditious treatment, chemotherapy and beam therapy. For the purpose of reduction of influence of these complications by quality of life of the operated patients, we offered rehabilitation actions.
Keywords: cancer of a mammary gland, mastectomy, postoperative rehabilitation.
ROLE OF RADIOTHERAPY IN COMBINATION TREATMENT CANCER OF PANCREAS
Despite the important improvements made in the fields of surgery, chemotherapy and radiation therapy, pancreatic cancer remains one of the most lethal malignancies with an overall survival of less than 5% at 5 years. Most tumors of the pancreas are indeed diagnosed when the disease is in a locally advanced stage and is not likely to undergo surgical resection. The main method for the treatment locally-advanced pancreatic cancer is chemoradiotherapy. In this article we present analysis of investigations which include different image of chemoradiotherapy, single and summary doses of 3DCRT and side effects.
