Comprehensive Treatment Of Patients Research Articles

Comprehensive treatment for patients with chronic pain in a 12-step based substance use disorder program

Patients with chronic pain (CP) and substance use disorder (SUD) are complex, not yet adequately described, and in need of comprehensive treatments that address both diseases concurrently. Our objectives were to (a) describe a cohort of CP patients who failed traditional treatment (mainly opioids) – then developed opioid use disorder (OUD) and other SUDs and (b) evaluate a comprehensive inpatient treatment program for these patients. Patients were enrolled in an inpatient CP program. Treatment consisted of medical detoxification, group process/education, external and internal qigong, osteopathic manual medicine, and qigong-based mindfulness. Patients also received 20 h per week of 12-step recovery-based SUD treatment. Patients were evaluated at the beginning of treatment (first assessment, day 1–5 range) and at days 30 and 45. Assessments were: Beck Depression Inventory-II, Brief Pain Inventory, West Haven-Yale Multidimensional Pain Inventory (patient section), and McGill Pain Questionnaire. The Global Impression of Change Scale was administered at day 45. A mixed model analysis was used to evaluate treatment progress. Demographic data revealed an older cohort with OUD, other SUDs, and multiple pain diagnoses who failed traditional treatment. Questionnaire evaluations were consistent and similar across all of the above measures: patients’ scores showed marked, statistically significant improvements in depression, pain, and quality of life ratings. The most substantial improvements occurred between the first and second assessments. The findings are sufficiently encouraging to warrant further evaluation of the protocol and to plan comparative studies.

Expression of intercellular adhesion molecule-1 and myeloperoxidase in peripheral blood and its significance in elderly patients with OSAHS

Objective:To investigate the detection and significance of serum intercellular adhesion molecule-1 (ICAM-1) and myeloperoxidase (MPO) in elderly patients with OSAHS in adults.Method:Ninety-three cases of elderly OSAHS patients who confirmed by PSG were observed. According to the range of AHI, they were divided into 3 groups (severe, moderate and mild). 31 cases of healthy person were observed as control group. The serum ICAM-1 and MPO were determined by ELISA method; ICAM-1 and MPO were measured after comprehensive treatment in patients with elderly severe OSAHS, and the correlation between ICAM-1, MPO and PSG were analyzed.Result:①With the severity of snoring increased, the serum levels of ICAM-1 and MPO increased gradually (F=29.937,18.946; P< 0.01); The concentration of ICAM-1 and MPO in each group showed that there was no significant difference between the mild group and the control group (P> 0.05), there were significant differences between the rest each two groups (P< 0.05). ②There was no correlation between serum levels of ICAM-1, MPO, BMI, age in OSAHS patients (P> 0.05). There was a positively relationship between ICAM-1 and MPO . Both of them were negatively correlated with AHI, and positively correlated with LSaO2 (P< 0.01). ③The concentration of ICAM-1, MPO and AHI in 31 elderly patients with severe OSAHS decreased and LSaO₂ increased significantly after 3 months of comprehensive treatment (P< 0.01).Conclusion:The increase of ICAM-1 and MPO concentration in peripheral blood is one of the mechanisms of cardiovascular damage in elderly patients with OSAHS. Determination of peripheral blood ICAM-1, MPO levels in elderly patients with OSAHS to help determine the severity of disease, the evaluation of treatment,which may have a certain reference value for the prediction of cardiovascular disease risk in patients with severe OSAHS.

IMPROVING THE SYSTEM OF MASS HEALTH EXAMINATIONS OF CHILDREN

Screening health examinations of children are a powerful tool for monitoring the health of the younger generation, in other words, it is an active method of dynamic monitoring of children's health. The objective of screening is early detection of disorders with further linkage to care, follow-up care, and comprehensive treatment of patients. Currently, the Russian Federation has a regulatory document on the conduct of preventive periodic and preliminary examinations (Order of the Ministry of Health of the Russian Federation No.1346). The problem is the lack of time and resources, which leads to a formal approach to this necessary part of preventive measures. The article suggests ways out of the current situation that would satisfy both the heads and the district pediatricians themselves.

Comprehensive treatment of patients with lower limb postthrombotic disease

The study was aimed to optimize the treatment of patients with the postthrombotic disease (PTD) of the lower limbs by means of a differentiated approach. 152 patients with the postthrombotic disease of the lower limbs were enrolled in the study. Depending on a clinical case, vascular bed patency (the presence and character of recanalization), valve apparatus viability, all patients were subjected to the conservative treatment or operative interventions combined with the conservative treatment. Laboratory and instrumental investigative methods were applied (Doppler ultrasound study, duplex angioscanning). Clinical efficacy assessment of the conducted treatment was carried out using a clinical scoring scale and a visual analogue scale (VAS). Digital material was statistically treated using standard packages of application software Statistica-10.0. As a result of the conducted research it has been established that carrying out operations aimed to eliminate the horizontal and the vertical reflux, use of wound dressings for the treatment of trophic ulcers as well as special treatment methods of ulcer surface in the comprehensive treatment of patients with PTD permits to reduce the number of septic complications, creates favorable conditions for the early closure of ulcers, reduces treatment time and permits to restore quicker the ability to work. One may achieve effective treatment results for PTD patients only using pathogenetically grounded methods with the elimination of reflux causes. The performed studies have shown that treatment of PTD patients should be individual and comprehensive; aimed to correct existing hemodynamic disturbances; restoration of the "muscular-venous" pump function; arrest of clinical symptoms and trophic disturbances.

Expression of thrombus regulatory protein and myeloperoxidasein peripheral blood of adult with obstructive sleep apnea hypopnea syndrome

Objective:To investigate the expression of serum TM and MPO in adult patients with obstructive sleep apnea hypopnea syndrome(OSAHS).Method: Ninety OSAHS patients who confirmed by PSG as OSAHS group. According to AHI, the patients were divided into 3 groups include heavy, medium and light, and 30 healthy outpatients were control group. The serum TM and MPO were determined by ELISA; TM and MPO were measured after comprehensive treatment in patients with severe OSAHS, and the correlation between TM, MPO and PSG were analyzed. Result: ①With the severity of OSAHS patients increased, the serum levels of TM and MPO increased gradually（F=20.761,21.433；P<0.01). There was no significant difference about the concentration of TM and MPO between light and control group（P>0.05）；The concentration of TM and MPO was significantly higher in heavy and medium group compared with light and control group（P<0.01）.②There was no correlation between serum levels of TM, MPO, BMI, age and sex in OSAHS patients(P>0.05). The serum concentration of TM was positively related to MPO. The serum concentrations of TM and MPO were positively correlated with AHI, but negatively with LSaO₂ (P<0.05). ③LSaO₂ was significantly increased, AHI and peripheral blood TM, MPO levels were significantly reduced in thirty severe OSAHS cases received the combined treatment(P<0.01).Conclusion:The increase of TM and MPO concentration in peripheral blood is one of characteristics of cardiovascular damage in patients with OSAHS. Combined detection of serum TM and MPO concentrations in patients with the disease is helpful for evaluation and risk assessment of cardiovascular disease.

Comprehensive Treatment of Patients with Constricted Hernias and Metabolic Syndrome Signs

57 patients with constricted abdominal hernia and diagnosed metabolic syndrome were examined. They were performed the urgent hernia defect plastics with polypropylene mesh Linteks-Esfil (St. Petersburg). Patients were divided into two clinical groups: clinical group I (20) included patients in the postoperative period treated with conventional comprehensive conservative treatment. Clinical group II (37) consisted of patients treated with 2.5% solution of 2 ml tiotriazolini in muscle and metformin in a dose of 500 mg / day for metabolic syndrome correction in addition to above mentioned conventional treatment. Lipid metabolism indices improved on the 7th day in 59.2% of patients in clinical group II and only in 15% of patients in clinical group I.Postoperative wound complications such as seromas and infiltrations developed in 6.3% of patients and were eliminated by conservative methods of treatment. Patients of group II tolerated postoperative period better. Average duration of hospital stay decreased by 2.03±0.2 bed days. Thus, the treatment of patients with constricted hernia of anterior abdominal wall and metabolic syndrome should be in complex with hernia defect plastics by propylene mesh and medicamentous correction of metabolism disorders.

COMPARATIVE CHARACTERISTICS OF THE METHODS OF CHEMODRUGS ADMINISTRATION IN THE TREATMENT OF PATIENTS WITH LOCALLY-ADVANCED BREAST CANCER

COMPARATIVE CHARACTERISTICS OF THE METHODS OF CHEMODRUGS ADMINISTRATION IN THE TREATMENT OF PATIENTS WITH LOCALLY-ADVANCED BREAST CANCER

Assessment of Abdominal Belts Impact on the Lungs Ventilation and Their Application in Early Physiotherapy after Major Abdominal Surgery - Prospective Trial.

Early physiotherapy is an important part of the comprehensive treatment of patients after major abdominal surgery (MAS). Accelerated mobilization should be safe and requires the use of appropriate techniques. Most of the physiotherapists and surgeons recommends using abdominal belts. Opponents claim that belts have an adverse effect on lungs ventilation. The aim of the study was to determine the effect of abdominal belt on lung ventilation efficiency in the early period after MAS. The study involved 20 patients after MAS. Including 9 women and 11 men, aged between 40 to 90 years (x̅ 66.7). In the scheduled 7 patients and urgent 13. All of them were in the early period after surgery. Dynamic spirometry was performed twice in the postoperative period. For the first time wearing a belt, and then without the belt in the same group. Evaluated the forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF). For the analysis uses the Wilcoxon matched-pairs test and Spearman's rank correlations. P values <0.05 were considered significant. The value of the ventilation indicators measured wearing abdominal belt were slightly lower than the values evaluated without the belt. The results are shown in percent predicted for age and gender, FEV wearing belt 52%, without belt 53%; FEV1 59% vs 61%; PEF 46% vs 51%. There were no statistically significant differences Conclusions. There were no significant negative influence of abdominal belt on lungs ventilation in early period after MAS. There was no correlations between age, body mass index and changes in ventilation indicators.

Эффективность препарата Пиаскледин в комплексной терапии у пациентов с остеоартрозом в условиях коморбидности

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Correlation analysis of personality characteristics and situation of mental health in patients with sudden deafness

Objective To investigate and analyze the personality characteristics and situation of mental health in patients with sudden deafness, and discuss the relationship between the two, so as to provide basis for the auxiliary diagnosis and mental health intervention. Methods Eighty-eight patients with sudden deafness(sudden deafness group) were evaluated by Symptom Checklist 90 (SCL-90) and adult Eysenck Personality Questionnaire (EPQ) .The survey results were compared with the norm of healthy people (norm group). The correlation analysis was performed between SCL-90 results and EPQ score. Results The SCL-90 total score in sudden deafness group was higher than that in normal group,but there was no significant difference,P>0.05. The scores of somatization,depression, anxiety, panic, psychosis and positive number, positive projects split were (1.58±0.46), (1.71±0.43), (1.59±0.44), (1.38±0.39), (1.46±0.51) scores, (32.65±15.81) nubmers, (2.96±0.65) scores in sudden deafness group, which were higher than those in normal group (1.37±0.48), (1.50±0.59), (1.39±0.43), (1.23±0.41), (1.29±0.42) scores, (24.92±18.14) nubmers, (2.60±0.59) scores, and there were significant differences,t=3.640, 2.996, 3.855, 3.045, 3.314, 3.562, 5.033, P<0.01. The standard T points of psychotic, neurotic and emotional stability dimensions were (54.63±10.37), (45.59±8.67) scores in sudden deafness group, which were higher than those in normal group (48.14±9.74), (41.27±9.42) scores, and there were significant differences,t=8.207, 3.811,P<0.01. The standard T points of internal and external dimensions, hide were (52.28±11.67), (48.68±8.57) scores in sudden deafness group, which were lower than those in normal group (57.75±8.26), (51.27±10.43) scores,and there were significant differences,t=5.455, 2.066,P<0.01 or 0.05. Neurotic and emotional stability dimension, psychotic part dimension were a positive correlation with SCL-90 factor points. Multi-factor stepwise regression analysis showed that the neurotic or emotional stability were correlated with interpersonal relationship, depression, anxiety, hostility, terror. Conclusions Patients with sudden deafness overall mental health status is poorer, the somatization, depression, anxiety, terror, psychoticism of various factors on negative emotions is more obvious. Sudden deafness patients have emotional instability and psychotic personality characteristics. The personality characteristics of sudden deafness patients have a correlation with the mental health. In the process of comprehensive treatment for patients with sudden hearing loss, individual psychological health intervention is necessary. Key words: Hearing loss, sudden; Eysenck Personality Questionnaire; Symptom Checklist 90; Mental factors

Возможности медикаментозного лечения и психотерапии в потенцировании ремиссии у пациентов на ранних стадиях шизофрении

В статье определены критерии клинической ремиссии, которые используются на современном этапе для пациентов с шизофренией (международные критерии Andreasen N.C., 2005). Отмечено, что недостатком данных критериев является отсутствие среди них критериев, отражающих социальную адаптацию пациентов, уровень их функционирования в обществе. В статье проведено комплексное исследование 237 пациентов с первым манифестным приступом шизофрении и представлены результаты оценки исходов болезни за 2-летний период, включая клинический, социальный и личностный аспекты. Проведен сравнительный анализ исходов шизофрении в группе пациентов (122 человека), которые были включены в комплексную программу лечения, и в группе пациентов (115 человек), получавших стандартную терапию. Комплексное лечение включало медикаментозную терапию и разработанную автором систему психотерапевтической реабилитации, содержание которой тезисно представлено в данной статье. Выявлены положительные корреляционные связи между более высоким уровнем социального функционирования, качества жизни, когнитивного функционирования пациентов, степени осознания пациентами психической болезни и благоприятными клинико-социальными исходами шизофрении. Методом построения многофакторных математических моделей установлены значимые предикторы двухлетних исходов болезни. Среди них: особенности лечебно-реабилитационной тактики, длительность нелеченого заболевания, выраженность симптоматики в продромальном периоде психоза, клиническое состояние пациента после купирования острой продуктивной симптоматики, уровень качества жизни пациентов и степень осознания пациентами психической болезни. Установлено, что при стандартизации по всем значимым факторам риска применение комплексного лечения пациентов с использованием медикаментозной терапии и разработанной автором системы психотерапевтической реабилитации позволяет снизить риск неблагоприятного двухлетнего исхода болезни (p &lt; 0,001), отношение шансов равно 0,17 (95% доверительный интервал 0,06–0,45). Представлено клиническое наблюдение, которое демонстрирует то, как меняется прогноз болезни при использовании стандартного или комплексного лечения.

Oral Ciclopsorin in Steroid Refractory, Acute, Severe Ulcerative Colitis

Patients with curatively resected gastric cancer patients with positive peritoneal wash cytology are called P0/Cy1 status. The aim of the present study is to verify the survival benefit of the comprehensive treatment for patients with P0/Cy1 status. Twenty gastric cancer patients were diagnosed as P0/Cy1 by laparoscopy or laparotomy, and were treated with a comprehensive treatment consisting of neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), cytoreductive surgery (CRS) consisting of gastrectomy with lymph node dissection and peritonectomy, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and postoperative systemic chemotherapy. At the second look laparotomy, the peritoneal wash cytology became negative in 15 patients. No grade 3, 4, 5 complications were experienced after second look operations for CRS. Median follow-up time is 3.7 years. Eight patients died of recurrence, but the other 21 patients are alive without recurrence. Five-year survival rate was 42%. The present study demonstrated the efficacy and safety of the comprehensive treatment on the gastric cancer patients in P0/Cy1 status.

Multiple Organ Failure Syndrome In Patients With Acute Diffuse Peritonitis

The results of the surgical treatment of 123 patients with acute diffuse peritonitis have been analyzed. The dynamics of necrotic processes activity in the mucous membrane of the small intestine according to its affection marker I-FABP, the liver – LFABP and of the heart – H-FABP in preoperative period and on 1, 3, 5, 7 day after the operation. Due to the level of multiple organ failure according to G.R. Bernard et al. scale (1995) and the level of bacterial contamination of the abdominal cavity during the operative treatment of patients with acute diffuse peritonitis, the choice of the method (closed and open) of intestinal intubation, programmed laparostomia is indicated. The methods of pharmacological (inotropic, antibacterial, infusion) correction of multiple organ failure syndrome during a comprehensive treatment of patients in toxic and terminal stages of acute diffuse peritonitis are worked out enabling to reduce the frequency of post-operational complications from 73,6% to 39,1%, and to reduce the level of post-operational lethal outcome from 14,1% to 8,5%.

Алгоритм комплексного лечения пациентов с зубо-челюстными аномалиями, осложненными нарушениями целостности зубного ряда

Алгоритм комплексного лечения пациентов с зубо-челюстными аномалиями, осложненными нарушениями целостности зубного ряда

Effects of sitagliptin beyond glycemic control: focus on quality of life

BackgroundRecently, incretin hormones, including glucagon-like peptide-1 (GLP-1) analogue and dipeptidyl peptidase-4 (DPP-4) inhibitor, have been found to regulate glucose metabolism. The aim of this study was to elucidate the efficacy and safety of the clinical usage of DPP-4 inhibitors in Japan.MethodsThis study was designed as a prospective, open-label, multi-center trial. Patients with diabetes mellitus type 2 (T2DM) with poor glycemic profiles (HbA1c ≥ 6.2%) in spite of receiving a medical diet, therapeutic exercise, and/or medications were eligible for this study. The participants received 50 to 100 mg of the DPP-4 inhibitor sitagliptin once daily for 12 months.ResultsOne hundred and eighty-eight subjects were enrolled. After 12 months of sitagliptin treatment, HbA1c levels decreased (7.65% ± 1.32% to 7.05% ± 1.10%, p < 0.001) as well as fasting plasma glucose (FPG) (145 ± 52 mg/dl to 129 ± 43 mg/dl, p = 0.005). The rate of glycemic control achieved (in accordance with the guidelines of the Japanese Diabetes Society) significantly increased. Blood pressure and serum levels of triglycerides and total cholesterol decreased significantly. Furthermore, the Pittsburgh Sleep Quality Index (PSQI) and Diabetes Symptomatic Scores improved significantly. Adverse events such as hypoglycemia and loss of consciousness occurred in twenty three subjects (11%).ConclusionsThese results suggest that the actions of DPP-4 inhibitors improve not only glycemic control, but also blood pressure, lipid profiles, and quality of life (QOL). Sitagliptin is a sound agent for use in the comprehensive treatment of patients with T2DM.

EFFECT OF MULTILEVEL AIR CLEANING FOR PATIENTS WITH SEASONAL ALLERGIC RHINITIS AND ASTHMA

A randomized placebo-controlled study to evaluate the effectiveness of the air cleaning technology with device IQAir HealthPro Series Model 250 (Switzerland) for comprehensive treatment of patients with seasonal allergic rhinitis and bronchial asthma was carried out. The significant reduction in the number of pollen grains in the air space and the clinical improvement was demonstrated, but no effect on lung function, blood and nasal mucus eosinophilia was revealed.

Factors influencing the quality of life of cancer patients with bone metastasis

Objective To investigate factors influencing the quality of life (QOL) of cancer patients with bone metastases. Methods Eighty-two cancer patients with hone metastasis were investigated.A questionnaire designed according to European Organization for Treatment of Cancer quality of life questionnaire ( EORTC QLQ-C30),Monroe Dunaway Anderson symptom inventory-Chinese edition (MADSI-C) and hospital anxiety and depression scale (HADS) standards was used to collect the information. Results The average total standardized QOL score of these cancer patients was 53.28±19.20.Among the function subscales,social function got the lowest average score (47.54),while among the symptom subscales fatigue got the highest average score (56.65).According to the MDASI-C,the most serious symptom burdens were fatigue,distress and pain; working and walking experienced the most interference.The symptom burdens correlated significantly with the QOL results.Twenty-four of the patients (29.3％) had been diagnosed with anxiety,and 17 (20.7％) were diagnosed with depression.Anxiety and depression continued to be significantly associated with overall QOL and its various dimensions. Conclusions The results show that the burden of fatigue and pain,as well as of anxiety and depression are significantly associated with impaired QOL among cancer patients with bone metastasis.Work (housework) and walking were the most severely affected activities.Psychological rehabilitation should be focused on the comprehensive treatment of patients with bone metastasis along with other appropriate rehabilitation strategies to enhance their overall functioning,relieve their symptoms and improve their QOL. Key words: Cancer; Metastasis; Symptom burden; Emotional status; Quality of life; Influencing factors

Fusion,complementary,fine selection:all thinking about the current status of comprehensive treatment in patients with hepatobiliary or pancreatic tumor

Comprehensive treatment is an important treatment for unresectable or recurrent multiple tumors under the background of surgical and technical development.Medical treatments for patient should be applied individually and high selectively according to their own situation, and should also emphasize the key role of clinical specialized physicians. The situation what we worry about is that the imaging or interventional technicians have many problems to chose or conduct comprehensive treatment independently.Solution: Make the departments of surgery, inter medicine and relative medical technique unit as an entirety for cooperation, complementary and fine selection. In this mater, we will neither miss the chance of surgery nor effective comprehensive treatment. Overall, we should reinforce the management of patient and help them to release pain and prolong their survival. Key words: Hepatobilary tumor; Comprehensive treatment; Fusion, complementary and fine selection of multiple departments

Analysis of small incision with laser comprehensive in treatment of 210 patients with the great saphenous vein varices

Objective To explore the clinical effect of the small incision with laser comprehensive treatment for patients with the great saphenous vein varices. Methods Small incision surgical ligation was done at the top and end of the great saphenous vein. Then took out the whole part or subsection of the great saphenous vein, with laser to treat the main part of the great saphenous vein and varicose vein group. Results 210 cases of 230 limbs all cured, cure rate was 100%. Conclusion The small incision with laser comprehensive treatment was an effective method for the great saphenous vein varices. It was worthy of clinical application and dissemination. Key words: Varicose veins; Laser coagulation

A new paradigm for managing dyslipidemia with combination therapy: laropiprant + niacin + simvastatin

Importance of the field: Despite effective lowering of low-density lipoprotein cholesterol (LDL-C) with statin for prevention of cardiovascular adverse events, residual risk remains high due to low high-density lipoprotein cholesterol (HDL-C) levels in patients with mixed dyslipidemia. As a result, alternative treatment options to raise HDL-C are being investigated intensively. Currently, niacin is the most potent lipid lowering agent for raising HDL-C levels together with lowering of triglyceride and LDL-C. Previous clinical studies have demonstrated that niacin therapy significantly reduces the risk of cardiovascular events in high risk subjects. However, the clinical use of niacin is limited by its major adverse effect, cutaneous flushing. Although the use of extended-release (ER) formulation can reduce flushing, the tolerability and compliance of niacin remains suboptimal. A selective antagonist of prostaglandin D Type 1 receptor, laropiprant, has been investigated in a number of clinical studies and shown to be effective in reducing niacin-induced flushing. Despite the potential of laropiprant in reducing niacin-induced flushing, the long-term clinical efficacy and potential off-target side effects are not well studied.Areas covered in this reviews: In this article, the pharmacological properties, clinical efficacy and future perspective of this combination therapy of simvastatin/ER niacin/laropiprant are reviewed.What the reader will gain: Readers will understand both the mechanism and clinical effects of the combination therapy of simvastatin/ER niacin/laropiprant.Take home message: The triple combination therapy of simvastatin/ER niacin/laropiprant may reduce flushing side effects and facilitate a more comprehensive treatment for patients with mixed dyslipidemia.