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2 2019 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A., Vaysman M.A., Rudoy S.V., Podkopaev D.V.

PALLIATIVE CARE FOR PATIENTS WITH CHRONIC PAIN

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

Palekhov A.V., Vvedenskaya E.S., Koichuev A.A., Guliyeva L.A., Shallaeva E.I.

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.

Keywords: palliative care, adequate pain control, opioid analgesics, opioid tolerance, chronic pain, polypharmacy, hydrazine sulfate, pharmacoeconomic aspects

Kulikov E. P., Sudakov A. I., Kaminsky Yu. D., Sudakov I. B. Mertsalov, A. S., Golovkin E. 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

Alyanov A.L., Mamoshin A.V., Snimshchikova I.A., Borsukov A.V., Ivanov Yu.V., Smul'ko D.V.

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.

Keywords: obstructive jaundice, tumor proximal bile duct, biliary decompression, antegrade stenting

Arabachyan M.I., Solovyev V.I., Borsukov A.V.

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

DIGEST

Beznosov E.V., Lebedev I.A., Zotov P.B., Zainetdinova D.Z., Fadeeva A.I., Tarasov D.O.

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. 

Key words: polyradiculoneuropathy, chemotherapy-induced polyneuropathy, paraneoplastic polyneuropathy, radiation therapy, neurotoxicity, anti-neuronal antibodies, cytostatics

1 2019 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A., Vvedenskaya E.S., Zelenova O.V., Vaisman, M.A., Rudoy S.V., Palekhov A.V., Podkopaev D.V., Abramov S.I., Bessonov A.P., Bulgakova I.E., Zolotykh T.M., Ivanov A.V., Mironchenko M.N., Shaimardanov I.V., Shaitanova N.Yu.

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.

EXCHANGE OF EXPERIENCE

Adleiba S.T., Kogonia L.M., Gurevich L.E., Sidorov A.V., Koroleva A.M.

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.

Keywords: gastrointestinal stromal tumors, chemotherapy , targeted therapy, tyrosine kinase inhibitors , imatinib, sunitinib, regorafenib. senile age, elderly patients

Belyaev A.M., Prokhorov G.G. Burovik I.A., Deniskin O.N., Petrik S.V., Baykalova O.I., Levin D.Y.

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.

Key words: palliative medicine, cryoablation, cytoreduction, cryosurgery, cryotherapy, pain syndrome

Orlov A.E., Kozlov S.V., Kaganov O.I., Vozdvizhensky M.O., Savelev V.N., Tkachev M.V., Borisov A.P.

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.

Saetgaraev A.K., Shaymardanov I.V., Zakirov I.I., Pasheev A.V., Sadykov K.K.

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.

4 2018 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A. , Vvedenskaya E.S. , Zelenova O.V. , Vaisman M.A., Rudoy S.V., Palekhov A.V., Podkopaev D.V., Abramov S.I., Bessonov A.P., Bulgakova I.E., Zolotykh T.M., Ivanov A.V., Mironchenko M.N., Shaimardanov I.V., Shaitanova N.Yu.

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

EXCHANGE OF EXPERIENCE

Sashina E.L., Besov S.N., Budanov A.N., Kulikov E.P., Kaminskiy Y.D., Smirnov A.I., Vinogradov B.Y.

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

Vazhenin A.V., Yusupov I.M., Kulayev K.I., Zuikov K.S., Gyulov H.Y.

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

Yablokov I.N., Chervonogorodsky I.V., Babich A.I., Unguryan V.M.

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.

Keywords: suicide, cancer, gender, delight, suicide detection, suicide registration, suicide accounting, suicide statistics

PSYCHOTHERAPEUTIC ASPECTS

Semenchenya V.A., Makienko A.A., Konopatskova O.M.

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.

Keywords - thyroid cancer, adaptation problems, personality traits

Gorokhov K.V., Vorobieva E.P., Kornilova O.A.

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

3 2018 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A., Vvedenskaya E.S., Zelenova O.V., Podkopaev D.V..

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

 


 

Zubarev 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

 


 

Mamoshin AV, Alyanov AL, Snimshchikova IA, Borsukov AV, Ivanov Yu.V.

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.

Keywords: acute destructive pancreatitis, ultrasonography, miniinvasive intervention, rehabilitation

 


 

DIGEST

Zotov P.B., Kudryakov A.Yu., Logvinenko A.V., Oschepkov V.N..

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.

Key words: locally advanced cancer, chemoradiotherapy, dose fractionation

2 2018 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A., Zelenova O.V., Vvedenskaya E.S., Rudoy S.V., Vaysman M.A., Abramov S.I.

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 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

Khomanov K.E., Gavrilov E.L., Korotkova A.V, Shevchenko E.A.

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 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».

Keywords: tuberculosis, juridical regulation, normative documents

Kogoniya L.M., Markarova E.V., Stashuk G.A.,Byakhova M.M.

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

1 2018 .

CLINICAL AND EXPERIMENTAL RESEARCH

Novikov G.A., Vvedenskaya E.S., Zelenova O.V., Rudoy S.V., Vaysman M.A., Podkopaev D.V., Abramov S.I.

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.

Kaprin A.D., Orlov A.E., Vozdvizhensky M.O., Savelev V.N., Tkachev M.V., Borisov A.P.

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.

Aljanov AL, Mamoshin AV, Snimshchikova IA, Borsukov AV, Muradyan VF

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.

Keywords: obstructive jaundice,pancreascancer, antegrade stenting.

4 2017 .

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.

Key words: triple negative breast cancer, chemotherapy, surgical treatment, radiation therapy.

 


 

Vorobtsova E.S.

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).

Key words: gastric cancer, colon cancer, adrenal cortex, glucocorticoids, androgens.

 


 

EXCHANGE OF EXPERIENCE

Kaprin A.D., Suleymanov E.A., Filonenko E.V., Khomyakov V.M., Urlova A.N.

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%

Key words: intraoperative photodynamic therapy, peritoneal dissemination, photosensitizer.

 


 

Sharova O.N., Vazhenin A.V.

VALUES IN THE MODEL OF BIOPSYHOSOCIAL 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 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.

Keywords: spinal cord injury patients, rehabilitation, mechanisms of adaptation, hope (positive motivational state), psychological factors.

 


 

Berezantsev A.Yu., Strazhev S.V.

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.

 


 

3 2017 .

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.

 


 

Kutukov V.V., Dzhanibekova D.E., Zaytsev I.V., Kudasheva E.S.

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.

Keywords: prevention, operations, retroperitoneal

 


 

2 2017 .

CLINICAL RESEARCH

Gatyatov R.R., Vazhenin A.V., Jajcev S.V., Lukin A.A., Gjulov H.Y., Kulaev K.I., Mironchenko M.N., Mancyrev E.O., Gnatjuk J.A., Timofeev S.N., Kolosova E.S., Pecherica E.D., Kovalev D.D.

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


 

PSYCHOTHERAPEUTIC ASPECTS

Oleynikova I.N., Gens G.P., Sirota N.A. Shikin E.V., Sadikov O.E., Kirkin V.V., Nazarenko Z.N.

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.

 


1 2017 .

 

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.

 


EXCHANGE OF EXPERIENCE

 

Savva N.N., Krasko O.V., Tarakanova E.G., Vinyarskaya I.V., Chernikov V.V., Ustinova N.V.

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

 


onomareva I.P., rashchayeu 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.


Sayetgaraev A.K., Shaimardanov I.V., Zacirov I.I., Pasheev A.V., Sadykov K.K.

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.

 


Kharlamova U.V., Ilyicheva O.E. Vazhenin A.V., Mironchenko M.N.

 

CHRONIC KIDNEY DISEASE AND RISK FACTORS FOR ANALGESIC NEPHROPATHY IN PATIENTS OF PALLIATIVE PROFILE

Painisoneofthesymptomsthatcausesufferingwithmalignanttumors. Usedforpharmacotherapyofpaindrugsthatarepotentiallynephrotoxic. Inthestudyofthestatusofrenalfunctionandtheprevalenceofriskfactorsforanalgesicnephropathyinpatientswithpalliativeprofilerevealed a highprevalenceofchronickidneydisease (42,3%), riskfactorsforanalgesicnephropathy, comorbidity.

Keywords:analgesic nephropathy, decreased renal function, palliative care

 


Demko A.N., Besov S.N., Victorov I.L., Kulikov E.P., Pinaeva T.A., Sashina E.L., Chernova V.V.

 

EXPERIENCE OF THE USING OF COMBINED STEROID IN THE CASE OF EXTENDED SEROMA AFTER BREAST CANCER SURGERY

The article is about of reducing of volume and duration of postmastectomic prolonged seroma by using of combined steroid DIPROSPAN.

Key words: postmastectomic syndrome, seroma, steroids

 


DIGEST

 

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.

4 2016 .

EXCHANGE OF EXPERIENCE

Egorova A. G., Isabekov S. N., Somov A. N., Orlov A. E.

RGIONAL 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.

Keywords: socialization, desocialization, resocialization,disadaptation, disintegration, reintegration, stroke, brain, characteristics, consequences, medical-social rehabilitation.           

 


 

Velsher L.Z., Stakhanov M.L., Pushkar D.Yu., Gorchak Yu.Yu., Anikanova E.V., Ishevsky G.B., Firsov K.A., Gainetdinov, S.M.

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.

Keywords: physical rehabilitation, physical therapy, breast cancer, postmastectomy lymphedema, psychological state, «lymphedema - dependent» psychological distress.

 


 

Prikhodko K.A., Dolgov, M.V., Ptukh E.Y., Stegniy K.V.

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

 


 

DIGEST

Mordyk A.V., Udalova T.Y., Bagisheva N.V., Gurova Y.V., Rudenko S.A.

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           

 


 

GUIDELINES

Malyavin A.G, Novikov G.A, Babak S.L, Gorbunova M.V, Rudoy S.V.

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).

3 2016 .

CLINICAL AND EXPERIMENTAL RESEARCH

Nikitin A.V., Mikheeva E.S., Vasilyeva L.V., Malukov D.A.

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

 


Vorobyova E.A., Gordeeva N.V., Filkina O.M., Dolotova N.V., Kuzmenko G.N., Sitnikova O.G., Nazarov S.B.

 

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.

Key words: impairments, cerebral palsy, infants, risk factors.

 


EXCHANGE OF EXPERIENCE

 

Babak S.L., Gorbunova M.V., Maliavin A.G.

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.

Key words: respiratory care, palliative medicine, non-invasive ventilation (NIVL), artificial lung ventilation (ALV), long-term oxygen therapy (DOT), intensive oxygen therapy (ICT), oxygen concentrators, respiratory failure.

 


Leonov O.N., Rassokhin V.V., Belyakov N.A.

 

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

Key words: multiple primary malignant tumor, chemoradiation therapy

 


PSYCHOTHERAPEUTIC ASPECTS

 

Biktina N.N., Galkina T.A., Karpets A.V., Kekk A.N.

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.

Key words:Somatic symptom disorder, oncological patients, attitudes towards sickness, personality traits, malignant tumors.

 


Prikhodko E.P., Dolgov M.V., Ptukha E.Y., Stegniy K.V.

 

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

 


DIGEST

 

Shchikota A.M, Yalymov A.A, Zadionchenko V.S., Fedorova I.V.

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

 


 

2 2016 .

Nesterenko O.I., Adasheva T.V., Novikov G.A., Zadionchenko V.S.

PALLIATIVE CARE IN CARDIOLOGY - MYTH OR REALITY?

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.


Kulikov E.P., Sudakov I.K., Kaminsky Y.D., Mertsalov S.A., Demko A.N., Sudakov A.I.

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.

Keywords: Oncology, palliative care, teaching.


Vorobtsova E.S., Martynenko A.V., Ovchinnikova S.V.

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.


EXCHANGE OF EXPERIENCE

Druzhinin A.E., Sokolov A.A., Goncharova N.G., Treasurers V.M., Panasenko S.L.

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 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 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.

Keywords: chronic pain, cancers, opioid analgesics, fentanyl, the transdermal therapeutic system.


ECONOMY AND FINANCE ISSUES IN HEALTH CARE

Avxentyeva M.V., Savva N.N., Tsarenko S.V., Kumirova E.V.

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. 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

 


 

1 2016 .

CLINICAL AND EXPERIMENTAL RESEARCH

Savva N.N., Krasko O.V., Vinyarskaya I.V., Ustinova N.V., Prityko A.G., Albitski V.Yu.

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.

Key words: palliative care, children, needs

 


 

EXCHANGE OF EXPERIENCE

Vasil'eva E.B., Vazhenin A.V., Geliashvili T.M., Syrchikova E.A.

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.

Key words: opioids consumption, pharmacoepidemiology characteristics, chronic pain control, palliative care.

 


 

Zotov P.B.

ASSESSMENT OF THE INTENSITY OF CHRONIC PAIN SYNDROME IN PALLIATIVE NCOLOGY

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

Keywords: old age, aging, limiting opportunities acute grief, death, debriefing, rehabilitation, palliative care.

 


 

1 2015 .

LAW AND LEGAL ISSUES

Parakhina E.O., Mikhailova E.N., Mikhailov I.V., Razin'kov D.V., Khalilov M.A., Snimschikova I.A.

EUTHANASIA: THE RIGHT TO LIFE OR DEATH?

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 - 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.

Key words: oral and maxillofacial surgery, plastic surgery, implants, autotransplants, revascularizatory tissue.


Terentyev I.G., Kuznezov S.S., Bazanov K.V.

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.

Keywords: stress, gastrointestinal bleeding, endoscopy, nitric oxide


Aksenova I.Z.

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.

Key words: vascular-platelet hemostasis, platelets aggregation, Chronic Obstructive Pulmonary Disease, low-intensive laser therapy.


Panin A.M., Kim L.., Yurkevich R.I.

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.

Keywords: radicular cyst jawbone, complex treatment.


Astakhov V.A., Gladco S.A., Kurina E.A., Ragimova L.A. Panukov A.I., Popova J.O.

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.

Keywords: massage, cerebralpalsy, rehabilitation, orthopedicpathology.


Frantziyantz E.M., Bandovkina V.A., Komarova E.F., Babenkov O.Yu., Sergostyantz G.Z.

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.

Key words: lung cancer, estradiol, progesterone, testosteron


Shaeva S. N., Solovyev V.I., Evdokimov A.N.

INTESTINAL TUMOR OBSTRUCTION WITHLOCALLY ADVANCED COLORECTAL CANCER.

FEATURES OF SURGICAL TACTICS

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.

Keywords: locally advanced colorectal cancer, intestinal obstruction, surgical treatment.


Gatiyatov R.R.

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 .

Keywords: esophageal cancer, gastric cardia, photodynamic therapy, photolon, radachlorin.


2 2015 .

CLINICAL AND EXPERIMENTAL RESEARCH

Isaeva Ja.V., Budnevskiy A.V., Ovsyannikov E.S.

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.

Key words: chronic obstructive pulmonary disease, metabolic syndrome, pulmonary rehabilitation.


Zavodovsky B.V., Sivordova L.E., Polyakova J.V., Akhverdyan Y.R., Zborovskaya I.A.

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.

Keywords: osteoporosis, osteopenia, forearm fractures, hip fractures, vertebrae fractures, risk factors


EXCHANGE OF EXPERIENCE

Kruten .., Chudinova L.N., Shavrin .P., Khovaeva Y.B., Ermachkova L.V., Kiryanova N.V., Plaschevskaya I.I.

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


Savva N.N., Krasko O.V., Vinyarskaya I.V., Ustinova N.V., Pritiko A.G., Albitski V.Yu.

PEDIATRIC PALLIATIVE CARE SERVICES IN RUSSIA

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


Pimenova M.M., Vazhenin A.V., Sharabura T.M., Davydova O.N., Neuwirt E.V.

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.

Keywords: malignant glioma, conformal radiotherapy, cognitive impairment


Ganov D.I., Varlamov S.A., Lazarev A.F.

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.

Key words: uterine cancer, myoma of uterus, progesterone, estradiol, testosterone, prolactin


Akhmetzyanov F.S., Shaikhutdinov N.G., Hasanov R.Sh., Shaimardanov I.V.

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.

Keywords: trigeminal nerve, chronic pain syndrome, pharmacotherapy, blockade, tiaminization, malignant new growth.


3 2015 .

THE ORGANIZATION OF PALLIATIVE CARE

Novikov G.A., Rudoy S.V., Vaisman .., Tarasov B.., Podkopaev D.V.

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.

Keywords: chronic pain syndrome, analgetic, availability factor, «opioidophobia», treatment cost.


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.

Keywords: enteralfood, prealbumin, omega-3 fattyacids.


Kulikov E.P., Mertsalov S.A., Mertsalov A.S., Mastyugin M.V., Bubnov L.V., Baranov I.A., Klevtsova S.V.

ENDOSCOPIC STENTING IN PALLIATIVE TREATMENT OF PATIENTS WITH ESOPHAGEAL CANCER

The estimation of the median survival of patients with inoperable esophageal cancer, depending on the conductivity of palliative treatment.

The results suggest endoscopic stenting leading role in the provision of palliative care for patients with inoperable esophageal cancer.

Key words: esophageal cancer, endoscopic stenting, palliative care.


Leiderman IN, Girsh AO, Smirnov MV, Sytov AV

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.

Key words: opiates, opioids, pain, oxycodone, naloxone, targin


PSYCHOTHERAPE UTIC ASPECTS

Sukhova E.V., Sukhov V.M., Pothanin I.I.

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.


4 2015

THE ORGANIZATION OF PALLIATIVE CARE

Novikov G.A., Rudoy S.V., Vaisman .., Tarasov B.., Podkopaev D.V.

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, inurabe patient, nursing, burnout syndrome, Balint groups.

 


 

Krylov V.V., Kochetova T.Yu., Belozerova M.S., Voloznev L.V.

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.

Key words: bone metastases, radionuclide therapy, pain syndrome, palliation therapy, 89Sr chloride, 153Sm EDTMP, 188Re HEDP, 188Re zoledronic acid.

 


 

Glushkov E.A., Kislichko A.G., Ramazanova M.S.

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.

 


 

Magomedov M.G., Ismailov H.M., Magamedov T.M., Magomedov M.N., Hazamov Sh.A.

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.

 


 

Nazarenko A.V., Tkachev S.I., Medvedev S.V., Glebovskaya V.V., Timoshkina E.V., Romanov D.S., Trofimova O.P., Gerasimov Ju.A., Jurieva T.V., Gutnik R.A., Zaychenko O.S.

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

 


 

PSYCHOTHERAPEUTIC ASPECTS

Kocherova O.J., Filkina O.M. Dolotova N.V. Malyshkina A.I., Ilyin A.G., Antysheva E.N.

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

 


 

1 2014 .

EXCHANGE OF EXPERIENCE

Shytikov T..

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.

Keywords: craniofacial asymmetry, trauma brain syndrome, iridology.


Demko A.N., Kaminskyi U.D., Kulikov E.P., Fedotova M.S., Shomova M.V.

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


Kislichko A.G., Ramazanova M.S., Kislichko S.A., Glushkov E.A.

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. hemoradiotherapy 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.

Keywords: Small cell lung cancer, extensive-stage disease, limitedstage disease, chemoradiotherapy, surgical treatment.


DIGEST

Boulyubash I.D.

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.


2 2014 .

CLINICAL AND EXPERIMENTAL RESEARCH

Sharafutdinov M.G., Novikov G.., Rudoy S.V., Gorbunov V.I., Rodionov V.V.

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.

Keywords: venous trophic ulcers, anolit neutrality ANK, NO-therapy, laser therapy


Prityko D.A., Burkov I.V., Safonov V.V., Klimov D.E., Gusev L.I.

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.


Astakhov V.A., Gladco S.A., Kurina E.A., Panyukov A.I., Popova J.O, Ragimova L.A.

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.

Keywords: mechatronic device, elbow joint, rehabilitation.


Moshurov I.P., Kolosova N.R., Kravetz B.B.

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.


Malyshkina A.I., Pesikin O.N., Samsonova T.V., Vasilyeva T.P., Chasha T.V.

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.

Keywords: extremely premature infants, perinatal CNS lesions, therapeutic and habilitative care.


DIGEST

Ivanilov A.K.

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.


3 2014 .

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.

EXCHANGE OF EXPERIENCE

Rokhoev M.A., Nechushkina I.V., Mikhaylova E.V., Kapkova O.A., Kerimov P.A.

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.


Savva N.N., Krasko O.V., Vinyarskaya I.V., Ustinova N.V., Kumirova E.V., Pritiko A.G., AlbitskiV.Yu.

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.

Keywords: Segidrin, palliative cancercare, painrelief


Pchelintsev M.V., Baranova M.I.

«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.

Keywords: pain, narcotic pain relievers, analgesics, opiates, opioids.


DIGEST

Kislichko A.G., Ramazanova M.S., Popov M.U., Kislichko S.A., Glushkov E.A., Ovsjannikova T.P.

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.


4 2014 .

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


Kravchenko A.Ya., Sakhnenko V.V., Budnevsky A.V., Podvigin S.N.

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


EXCHANGE OF EXPERIENCE

Nechushkina I.V., Kerimov P.A., Kaminskaya I.V., Koshechkina N.A., Mikhaylova E.V.

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.

Keywords: pediatric oncology, germ cell tumors, ovary, testis, surgical treatment.


Bukhvalov S.A., Martusevch A.K., Ulitin D.N.

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


Polyakova J.V., Seewordova L.E., Akhverdyan Y.R., Zavodovsky B.V., Simakova E.S.

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.


Levina I.L., Matveeva O.V., Stupnikova A.Yu., Doroshilova A.V., Belykh E.V.

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


Magomedov M.G., Magomedov Sh.M., Magamedov T.M., Magomedov M.N.

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.

Keywords: epidemiology, incidence rate, malignant gliomas, malignant astrocytomas.


1 2013 .

CLINICAL AND EXPERIMENTAL RESEARCH

Fomin D.K., Tararuchina O.B., Nazarov A.A.

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

Setko A.G., Kvashennikova E.A., Ponomareva S.G., Trishina S.P., Volodina E.A.

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.

Keywords: students' nutrition, nutrient provision, morbidity.


Kozlova M.B., Frantziyantz E.M., Lisutin A.E., Kasyanenko V.N., Luganskaya R.G., Vereskunova M.I.

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


Vvedenskaya E.S., Kobzeva L.F., Dayutova M.V., Vvedenskaya I.I.

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.

Keywords: thyroid remnant , multinodular colloid goiter


Zelenova O.V.

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.


Frantziyantz E.M., Kozlova L.S., Dzhabarov F.R., Rosenko L.Y., Kolycheva E.V., Chugunova N.S.

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.

Keywords: rhythmocardiography, heart rate variability, nitroglycerin, isosorbide dinitrate, isosorbide mononitrate, stable angina.


Samosvat S.M., Petrunko I.L., Davydova O.V.

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.

Keywords: disability, dorsopathya, complex rehabilitation


Koroleva M., Merkulov S.

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 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 ( <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.


2 2013 .

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


Kislichko A.G., Ramazanova M.S., Kislichko S.A., Glushkov E.A.

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.

hemoradiotherapy 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.

Keywords: Small cell lung cancer, extensive-stage disease, limitedstage disease, chemoradiotherapy, surgical treatment.


EXCHANGE OF EXPERIENCE

Korolev A.A.

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.

Keywords: stroke, spasticity, muscle hypertonicity, botulinum toxin, botulinum therapy, neurorehabilitation.


Efros L.A., Samorodskaya I.V.

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.

Keywords: ischemic heart disease, coronary artery bypass surgery, cardiac treatment, functional status, quality of life, rehabilitation


Medvedev V.A.

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.

Keywords: estradiol, progesterone, testosterone, uterine cancer, estrogen metabolites


PSYCHOTHERAPEUTIC ASPECTS

Kolmykova E.V., Duda E.E., Kolmykova J.A., Martsijash A.A.

AGE SPECIFICITIES OF ANXIETY-DEPRESSIVE DISORDERS AND METRICS OF THE PATIENTS 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

3 2013 .

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 SM-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.

Keywords: liver cirrhosis, portal hypertension, diureticoresistant ascites, embolitation to lineal artery peritoneal port-system.


EXCHANGE OF EXPERIENCE

Prityko D.A., Truhan A.N., Gusev L.I.

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.

Keywords: pain, narcotic drugs, prolonged-release formulations


Shaeva S. N., Solovyev V.I.

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.

Keywords: colorectal cancer, acute intestine obstruction, tumor perforation, an intestinal bleeding, surgical treatment.


Medvedev V.A.

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.

Keywords: steroid hormones, prolactin, hyperplastic endometrium, atrophic endometrium


Korytova L.I., Zhabina R.M., Meshechkin A.V., Gopta E.V., Maslyukova E.A., Sokurenko V.P., Peganova Yu.A.

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.

Keywords: chemoradiation therapy, hepatotoxicity, hepatoprotector.


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.

Keywords: mechanical jaundice, acute cholecystitis, minimally invasive interventions


DIGEST

Malyar K.V.

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


4 2013 .

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.

Keywords: pain control in children, opioids.


Egorova A.G., Orlov E.E., Osetrova O.V., Ischeryakov S.N., Somov A.N., Popov T.F.

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.


Kocherova O.Yu., Filkina O.M., Malyshkina A.I., Dolotova N.V., Pykhtina L.A., Shanin T.G.

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.

Kudryashov L.N. Kudryashov A.A. Petrov 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. mbolitation 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.

Keywords: liver cirrhosis, portal hypertension, embolitation to lineal artery. infusion port-system, portosystems shunts.


Valieva M. Yu., Salakhiddinov Z.S.

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.

Keywords: risk factors , prehypertension , hypertension.


Psychotherapeutic aspects

Maslyakov V.V., Levina V.A., Nakayeva E.Yu.

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.


Digest

Korytova L.I., Pavlovskiy A.V., Vasilev G.L., Popov S.A., Vlasova E.V.

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.

Keywords: pancreatic cancer, chemoradiotherapy.