Dispensary Observation Research Articles

К вопросу о критериях и показателях оценки организации качества и эффективности диспансерного наблюдения пациентов с психическими расстройствами.

An important area of improving mental health protection of the population is to increase the efficiency of dispensary observation of patients in psychiatric medical organizations, which allows achieving stabilization or improvement of their health, thereby increasing the quality of life of both patients and their relatives. To make the necessary management decisions on the part of the management of medical organizations aimed at improving the quality indicators of the organization and the efficiency of dispensary observation, appropriate information support is necessary. However, there are currently no separately developed criteria for assessing dispensary observation in the framework of primary specialized health care for mental disorders. Purpose of study is to substantiate the basic principles of systematization of criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders for the purpose of monitoring and correct assessment of quality with subsequent adoption of adequate management decisions. Materials and methods. To systematize the criteria and indicators for assessing the organization of quality and efficiency of dispensary observation of patients with mental disorders, we used regulatory documents defining the activities of the psychiatric care system of the constituent entity of the Russian Federation, primary accounting and reporting medical forms, and the results of expert assessment. Results. Organizational and methodological approaches to the development and scientific substantiation of indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders included work with regulatory documents and analytical indicators used in the work of the OGBUZ «IOPD» and an expert assessment of the indicators of the effectiveness of dispensary observation of patients with mental disorders. The criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders were systematized into three groups, including a number of subgroups, which allows you to correctly assess the activities of the district psychiatrist’s office for dispensary observation of patients with mental disorders. Findings. Thus, the criteria and indicators for assessing the organization of quality and effectiveness of dispensary observation of patients with mental disorders allow you to receive information and make adequate management decisions regarding improving the structural efficiency of the psychiatric service as a whole, determine further actions to link them to regulatory documents and their subsequent digitalization. In general, the proposed methodological approaches make it possible to form an appropriate system of indicators for each hierarchical level of management of the psychiatric service.

Statistical Data on Myelodysplastic Syndrome in the Russian Federation

Introduction. Myelodysplastic syndrome (MDS) is a nosology that requires examination using cytogenetic, molecular-genetic and immunophenotypic analysis of bone marrow and/or blood, as well as mandatory bone marrow trepan biopsy with pathomorphological and immunohistochemically studies. Until recently, there was no official statistical data on MDS in Russia.Aim: to present data on the incidence and prevalence of MDS in Russia based on official statistical forms.Materials and methods. Information from statistical form №7 «Information on malignant neoplasms» (SF No. 7) for 2022 and 2023 on the incidence and prevalence of MDS, updated at the initiative of the National Medical Research Center for Hematology, is presented. For the first time, additional lines (35–37) with information on the movement of patients, including MDS (code D46 according to ICD-10), have been introduced into table 2100.Results. According to SF No. 7, in 2022 and 2023, 2,827 and 3,411 cases of MDS were registered, respectively. The estimated primary incidence in the Russian Federation was 0.58 and 0.50 per 100 thousand of the adult population in 2022 and 2023, respectively, and the prevalence was 2.4 per 100 thousand of the adult population. The estimated incidence of MDS by federal districts in 2022 ranged from 0.13 to 1.05 with variations from 0.03 to 2.57 per 100 thousand of the adult population, depending on the region of residence. At the end of 2023, 3001 (88 %) patients with MDS were registered under dispensary observation, of which 860 (28.7 %) were under observation for 5 years or more.Conclusion. The obtained statistical data on the incidence and prevalence of MDS showed the high significance of the work carried out both for the subsequent improvement of the system of registration of patients with diseases of the blood system in general, and MDS, particularly the Russian Federation, and will make it possible to use this data in the planning of healthcare in the Russia.

Retro and prospective analysis of complex treatment of a patient with a polyostotic form of osteoclastoma of the maxillofacial region: clinical observation

In global literature there is not sufficient information on the course of the polyostotic form of osteoclastoma and methods of its treatment. For this reason, the analysis of this clinical case may be interesting for oncologists, maxillofacial surgeons and dentists of various specialties, who can reveal both the onset and recurrence of the disease. A characteristic feature of the course of this disease is the relapse of neoplasms with localization of foci in various parts of the upper and lower jaw. A clinical case of polyostotic form of jaw osteoclastoma and patient`s management tactics from 2006 to 2024 are described in the article. The disease was first diagnosed in 2006, when a neoplasm was revealed in the right part of the lower jaw. The neoplasm was removed by resection and mandibular defect was replaced by a carbon implant with further prosthesis. In 2011 a new neoplasm was detected on the left side in the frontal part of the upper jaw. At the same time a relapse of the disease was diagnosed with a new tumor focus in the lower jaw on the right. Surgical treatment was performed. Firstly, the neoplasm in the frontal area of the upper jaw was removed with replacement of the defect with a resection prosthesis. And secondly, a removal of the tumor on the lower jaw with resection of the chin within healthy tissues and replacement of the defect with an implant made of carbon-carbon material "Uglecon M" were performed. In 2023 the patient was invited to the dental hospital of the Clinical Multidisciplinary Medical Center of E.A. Vagner Perm State Medical University for dispensary observation and evaluation of the results of the treatment. The obtained results indicate the need for medical follow-up of patients after surgery for osteoblastoclastoma. The effectiveness of jaw implants made of carbon-carbon composite material " Uglecon M" was proved as well.

Organizational features of detection of secondary metachronic primary multiple colorectal cancer in a group of patients with extracolorectal malignancies

Aim – to study the organizational features of detection of secondary metachronous primary multiple CRC in patients with primary extracolorectal malignancies. Material and methods. The medical documentation of 163 oncological patients with extracolorectal malignancies and secondary metachronous CRC was analyzed. The patients were divided into subgroups according to the profile of dispensary observation. Results. In 66% (108) of cases, patients were diagnosed with malignancies of four subgroups: skin, breast, urological and gynecological spheres, the number of cases of malignancies’ localization correlated with the number of accumulated contingent. CRC at stage 1 was detected in 24% of cases. The right parts of the colon were affected in 22.1% (36) of cases, the left – in 38.7% (63), the rectum – in 33.1% (54), tumors of several departments – in 4.9% (8), anal cancer – in 1.2% (2) of cases. CRC was detected in the period from 7 to 678 months after extracolorectal malignancies. Earlier, CRC was diagnosed in cases with skin and urological tumors, later, in the group with breast cancer and oncogynecological profile. Conclusion. The majority of the subjects were women (60.7%), the average age was 69 years. Patients with oncodermatological (22%), oncourological (15.3%), oncomammological (15.3%), oncogynecological (13.5%) profiles, lesions of the left colon (38.7%) and rectum (33.1%) predominated. The time interval between the detection of the primary tumor and the detection of secondary CRC depends on the localization of the primary malignancies (p=0).Screening of CRC is necessary not only among the healthy population, but also in the group of patients with extracolorectal malignancies, it is possible to use an immunochemical quantitative stool test for hidden blood at the stage of providing specialized medical care in the "oncology" profile.

Improving the organization of dispensary observation of patients with chronic dermatosis.

Improving the organization of dispensary observation of patients with chronic dermatosis.

Characteristic of the quality of life in the young population with chronic disease

Introduction. The quality of life and health in the young population is the main component that determines the potential of the country. Study in this area is necessary to determine the adequacy of medical care, as well as the effectiveness of therapeutic and preventive measures. Purpose. Assessment of the quality of life in the young population of Astrakhan region suffering from chronic diseases. Materials and methods. The article presents the results of a study of the quality of life of the young population of the city of Astrakhan, suffering from chronic diseases. The study involved 18–44 year four hundred one resident of Astrakhan. Russian version of questionnaire SF-36 was used as the main method for assessing the quality of life in the study group. Results. In general, the quality of life in young residents of Astrakhan suffering from chronic diseases is average. The physical and social activity of respondents does not decrease, according to the results of the analysis of the physical and psychological components of health. There is a decrease in daily activity, depending on the physical condition in participants with pathologies of the genitourinary system, the hematopoietic system, the respiratory and the circulatory system. Analysis of life activity, daily activity, depending on the emotional background, social functioning, as well as the mental health of respondents, regardless of pathology, showed average values. Research limitations. The limiting factors in the study are the age composition of the study group, the set of factors studied, structure of the diseases, regional characteristics. The study did not involve patients with disabilities, as well as those suffering from severe diseases. Conclusion. The results of the study are applicable in practical healthcare to improve the quality of management and conduct of medical examinations, preventive medical examinations and dispensary observation of the population; training of personnel in the field of prevention of non-communicable diseases and the formation of a healthy lifestyle.

Practical Aspects of the Simulation Course "Dispensary Observation at a Feldsher-Obstetric Station" as an Improvement in the Quality of Education

Currently, the protection of rural population health is of particular importance. This article presents the experience of organizing a simulation course "Dispensary observation at a Feldsher-Obstetric Station ", it also considers practical issues of its implementation and results.

ТРУДНОСТИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ РАКА ОБОДОЧНОЙ КИШКИ

A clinical case of treatment of a patient with cancer of the hepatic angle of the colon with involvement of the duodenum and head of the pancreas is presented. Traumatic surgical treatment was performed in the volume of extended gastropancreatoduodenal resection with hemicolectomy on the right. Subsequently, the patient underwent an adjuvant chemotherapy program. Currently, he has been under dispensary observation for 3 years without signs of relapse and progression of the oncological disease.

Assessment of the social effectiveness of providing medical care to patients with a cardiological profile using the method of remote monitoring of blood pressure

BACKGROUND: Assessing social efficiency currently plays a key role in improving the organization of medical care to citizens. Satisfaction with medical care provided is an indicator of the availability of medical care and the effectiveness of healthcare in general. AIM: To assess the social effectiveness of medical care using the method of remote monitoring of blood pressure in cardiac patients based on the results of remote monitoring. MATERIALS AND METHODS: The study materials included data from an anonymous sociological survey of 200 patients who were under dispensary observation and had a history of periods of deterioration in the functional state of the cardiological profile. The questionnaire offered to patients contained six establishing questions, each of which was distributed on a scale balanced from extreme positive to extreme negative assessment. RESULTS AND DISCUSSION: Before conducting remote monitoring, the level of awareness of patients about their own health status, preventive measures, and the use of devices for remote transmission of blood pressure data from the patient to the doctor was investigated. Subsequently, to increase patient awareness, additional information materials on the procedure for interaction be-tween patients and medical workers, as well as about risk factors for the development of cardiovascular diseases and complications from them. The sociological survey was conducted to summarize the results of remote monitoring of patients’ blood pressure and was aimed at studying patients’ opinions on changes in the organization of medical care provided in outpatient settings. CONCLUSION: The data obtained showed that, in general, the degree of achievement of social results after remote blood pressure monitoring increased by 61.0%. Undoubtedly, such an increase in patient satisfaction was achieved as a result of the redistribution of responsibilities between doctors and nurses, as well as a result of well-established participatory interaction between medical workers and patients in terms of remote monitoring of dispensary groups of cardiac patients, instruction in the method of measuring blood pressure and monitoring it indicators in electronic form.

Dynamics of Some Medical and Demographic Indicators in St. Petersburg During the Period from 2018 to 2023

Background. There have been negative trends in the birth rate and population growth decline in recent years. Forecasts from demographers are also not so encouraging as the next generation of childbearing age is one from the end of the last century which is characterized by low birth rate. Population mortality exceeded the birth rate during the years of challenging and questionable economic reforms. Moreover, there was a high level of chronic morbidity in child population, and physical development had the trend to retardation. Meanwhile under these circumstances, the President of Russian Federation and the Government adopted regulatory documents (decrees, dedicated programs) that determined the directions of state social policy on improving the situation with children in Russian Federation until 2000.Objective. The aim of the study is to evaluate the dynamics of several medical and social indicators of 2018–2023 characterizing demographic trends direction, with proposals on improving medical care in the maternal and child health care system.Methods. The study has covered reporting form No. 19 of Russian Federal State Statistics Service (Rosstat) for children’s outpatient clinics, form No. 14 for children’s hospitals, form No. 030/у “Check-list of dispensary observation”. The study has used the materials of the Presidential Coordination board meeting from November 15, 2016. Statistical data was obtained from the “Office of the Federal State Statistics Service for St. Petersburg and the Leningrad Region” (Petrostat) and the Center for Analysis and Forecast of Mother and Child Health at Health Committee of St. Petersburg, Medical Information and Analytical Center (“Major results in the field of health care in St. Petersburg”, 2019, 2020, 2021, 2022). Statistical processing was carried out via variational statistics methods (Pearson’s criterion, Fisher’s angular transformation criterion) and data from the automated system of prophylactic medical examination, registration certificate FSR No. 2009/05279, corresponding to the order of the Ministry of Health of Russian Federation No. 514н dated August 10, 2017.Results. The analysis of study results confirms the negative demographic patterns in St. Petersburg like the all-Russian. Increase assisted reproductive technologies was noted alongside with birth rate decrease. There are still high rates of stillbirth and perinatal mortality, as well as increased infant mortality rate. The correlation of depopulation processes with children’s health worsening and increasing disability is emphasized.Conclusion. The problems raised in this paper do not have an straightforward solution and require multimodal approach.

Registry of patients with autoimmune liver diseases in St. Petersburg: clinical and epidemiological data

BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics. AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations. MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov. RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases. CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.

Оценка диспансерного наблюдения за детьми первого года жизни.

Children’s health is a powerful resource that can become the key to the future health of the nation. Considering the significant increase in morbidity among children in recent years, the assessment of dispensary observation of children in the first year of life is a relevant topic for research. Purpose: to assess the level and dynamics of dispensary observation indicators for children in the first year of life living in St. Petersburg. Materials and methods. Based on copying information from statistical reporting forms No. 12, a retrospective one-time study of indicators of the frequency of taking children of the first year of life into dispensary registration, the frequency of continuing dispensary observation after the first year of life, as well as the proportion of children of the first year of life remaining under dispensary observation from those registered during the year. The significance of differences in indicators was assessed using Student’s t-test. Differences were considered significant at p<0.05. Statistical data processing was carried out using the MS Office‑2016 and StatSoft-Statistica 10.0 software packages. Results. Most often, children in the first year of life needed examination and treatment on an outpatient basis for diseases of the nervous system, certain conditions that arise in the perinatal period, as well as diseases of the respiratory and digestive organs. Most often, in children’s clinics of the metropolis, after the first year of life, dispensary observation of children with diseases of the nervous system, eyes and its appendages, digestive organs and congenital malformations continued. With a high frequency of children with respiratory diseases and certain conditions arising in the perinatal period being taken under dispensary observation, in most cases, by the end of the first year of life, children with these diseases are removed from the dispensary register. At the same time, with a low frequency of children being admitted to convalescent care, on average 71.3% of such patients remain under further dispensary registration. A high proportion of children who remain under clinical observation are patients with diseases of the genitourinary system, the eye and its adnexa, skin and subcutaneous tissue, the musculoskeletal system and connective tissue and the nervous system. Conclusion. In St. Petersburg, the increase in morbidity among children in the first year of life was due to the growing need for dispensary monitoring of children for almost all classes of diseases, except for respiratory diseases and certain conditions that arise in the perinatal period.

Effectiveness of organizational and legal measures and new practices to against HIV infection in the Novosibirsk region

The purpose of the study: to study the effectiveness of organizational and legal measures and new practices to against HIV infection introduced in the Novosibirsk region in 2019–2022.Materials and methods. The study was conducted on the basis of the State Medical Institution of the NGO «City Infectious Clinical Hospital No. 1», a division of the Center for the Prevention and Control of AIDS.Results. By Order of the Ministry of Health of the Novosibirsk Region No. 3429 of 10/15/2019, mandatory HIV screening was provided for all hospitalized with unknown HIV status during the year, which significantly increased the coverage of HIV screening. In 2019–2022, an AIDS Center information system was introduced for all patients with HIV infection admitted to inpatient treatment: 6,938 notifications were sent to the AIDS Center. Of the 2,717 patients who required measures to increase the level of adherence and involvement in ART, 18.9% of patients resumed ART after the measures taken; 36.5% started taking ART for the first time. The order of the State Medical Institution of the Infectious Clinical Hospital № 247 «On the organization of family support in the department «Center for the Prevention and Control of AIDS» dated 02.08.2021 provides the principle of monitoring the whole family with one doctor, which improves the adherence of children and parents to ART. For 4 months of functioning of family support, the share of parents receiving ART and having a high commitment increased from 15.5% to 77.3%. Among 45 children who had a previously determined level of HIV RNA viral load on the background of ART, 20% (9 abs.) registered an undetectable level of viral load for 3 months, and 13.3% (6 abs.) – for 2 months.Conclusion. The organizational and legal measures implemented in 2019–2022 in the Novosibirsk region and new practices to combat HIV infection have shown high efficiency: the coverage of dispensary observation of patients with HIV infection increased from 79.3% to 86.5%, and the coverage of antiretroviral therapy – from 74.5% to 85.2%.

Predictive factors reducing the effectiveness of the rehabilitation process in patients with congenital orofacial clefts combined with malformations in other organs and systems

Relevance. The successful completion of the rehabilitation process for patients with complex congenital defects, specifically those with a combination of orofacial clefts (OFC) and malformations in other organs and systems, presents a significant challenge. This challenge is pertinent not only to medical practice but also to the socio-psychological development of the child.Objective. To identify predictive factors that diminish the success of the rehabilitation process in patients with congenital OFC combined with malformations in other organs and systems by systematising and addressing these factors at various stages of specialised care.Materials and methods. An analysis of medical records was conducted for 2,475 patients with congenital orofacial clefts (OFC) over a 24-year period (1998-2022) who were under dispensary observation at the "Bonum" Center in Yekaterinburg. Among these patients, 823 (33.25%) had OFC combined with malformations in other organs and systems. A comprehensive study was conducted among these 823 individuals within the framework of dynamic observation and treatment, focusing on patients who had reached 18 years of age and were subsequently removed from dispensary observation. The study included an examination of staged treatment and discharge summaries, alongside the clinical characteristics of the restored midface area following surgical correction of OFC amidst correction for concomitant congenital malformations.Results. Among the 823 individuals surveyed, a retrospective study registered 591 (71.81%) who had completed the main stages of comprehensive specialised care amidst concomitant malformations, while the remaining 232 (28.19%) continue to receive combined rehabilitation. Within the 591 patients, a subgroup of 123 (20.81%) individuals who had reached 18 years of age, completed the full cycle of medical-social rehabilitation at the "Bonum" Center, and were removed from dispensary observation due to age, was selected and studied in detail. Questionnaires, parent interviews, and analysis of the results obtained were conducted. The study identified predictive factors reducing the effectiveness of the rehabilitation process in patients with congenital orofacial clefts (OFC) combined with malformations in other organs and systems.Conclusion. The multifaceted study conducted has facilitated the identification and systematisation of predictive factors that reduce the success of the rehabilitation process. Consequently, this enables the enhancement of comprehensive specialised treatment outcomes for this category of patients.

Prognostic value of biohybrid screening results for assessing cancer risk using the example of lung cancer

Introduction. One of the leading places in the structure of socially significant diseases in the Russian Federation is occupied by malignant neoplasms, among which cancer of the trachea, bronchi and lung occupies the first place in terms of prevalence. Screening for lung cancer is not carried out at the federal level in Russia; recommended screening measures include questionnaires to identify risk factors for the development of the disease (including occupational) and the formation of dispensary observation groups. The study aims to assess the prognostic value of a new method of biohybrid screening of lung cancer by exhaled air. Materials and methods. Scientists conducted a study at the National Medical Research Center of Oncology of the Ministry of Health, Russian Federation, with the participation of 24 conditionally healthy volunteers and 5 patients diagnosed with lung cancer in the early stages of the disease. The design of the study is simultaneous (on-line) with blinding; experts estimated the risk of systematic errors at 10 points on the QUADAS scale. The authors examined exhaled air samples on a gas analyzer (biohybrid detector) of the BGS-APK 02SZZ model, in which the sensor were animals — gray domesticated rats (Rattus norvegicus) with microelectrode matrices implanted into the olfactory bulb, and which were in the internal (ventilated) space of the analyzer in a state of drug anesthesia. The conclusion about the presence or absence of a risk of lung cancer was formed by an artificial neural network of the analyzer, at the input of which bioelectric signals from each microelectrode were received, which were preprocessed using a system for recording the focal activity of the olfactory analyzer. The specialists confirmed the presence or absence of a risk of lung cancer by a reference method, according to computed tomography of the chest in accordance with the Lung Imaging Reporting and Data System (LungRADS™). Results. During the study, experts determined the effectiveness indicators of the method of biohybrid lung cancer screening by exhaled air: sensitivity (64%), specificity (87%), prognosticality of negative and positive conclusions about the presence/absence of disease risk (82% and 72%, respectively). Conclusion. The safety, efficiency and throughput of the investigated method, together with the reproducibility of the analyzer's conclusions, meet the criteria of practicability to ensure the first (population-based) stage of lung cancer screening.

Adherence to endocrine therapy with tamoxifen and satisfaction with follow-up of women with breast cancer by a gynecologist: A survey study

Background. Side effects of endocrine therapy with tamoxifen (TAM) reduce the quality of life of patients with breast cancer (BC) and adversely affect treatment compliance. Against the background of treatment of BC with TAM, the risk of developing endometrial hyperplasia (EH) increases. At the moment, algorithms for monitoring patients receiving TAM by an obstetrician-gynecologist have not been developed and approved. There are also divergent opinions of experts regarding the diagnosis and management of patients in the detection of EH. This article presents the results of the final stage of the study in 2017–2022 – a survey study. The purpose of this study was to assess adherence to endocrine therapy and satisfaction with observation by a gynecologist of women with BC after 5 years of observation and their relationship with the identified early associated polymorphisms of the CYP2D6, CYP3A5, CYP2C9 and ABCB1 genes. Materials and methods. 54 patients with BC, out of 120 who had previously passed the first pharmacogenetic stage of the study, were interviewed with specially designed questionnaire. Due to the small sample size, delta percentages (∆%) were used in each comparison group with a difference threshold of 5%. To assess associations with the studied genetic polymorphisms, previously obtained significant associations of adverse drug reactions with pharmacogenetics in the same patients were used. Results. The prevalence of all adverse drug reactions (ADRs), with the exception of EH, was higher in the group of patients who canceled TAM. Over 5 years of follow-up, 57.4% of patients were regularly observed by an obstetrician-gynecologist, 42.59% of patients visited a gynecologist less than once a year. Of all the respondents, 53.7% of patients are satisfied with the regularity and quality of dispensary observation by an oncologist, 33.33% of patients are satisfied with the regularity and quality of dispensary observation by an obstetrician-gynecologist. All studied ADRs (EH, hot flashes, asthenia, bone pain and dyspepsia) associated with various genetic polymorphisms, prevailed in the group of patients who stopped taking TAM due to drug intolerance (∆%: 25.72, 6.97, 4.81, 6.97 and 24.52 respectively) compared with the TAM-group. Conclusion. The results obtained confirm the role of the studied genetic polymorphisms in the development of ADRs of TAM, but only systemic (hot flashes, asthenia, bone pain and dyspepsia). With regard to endometrial hyperplasia, no significant differences were obtained, which requires more extensive studies.

The effectiveness of treatment depending on an adherence to dispensary observation and antiretroviral therapy in patients with HIV infection

Aim. Determination of the causes of deaths and analysis of the survival of people living with HIV, depending on an adherence to dispensary observation and treatment. Materials and methods. The analysis of socio-demographic characteristics and clinical and laboratory data of 284 adult HIV patients observed in 1999–2011 at the Lomonosov Interdistrict Hospital named after I. N. Yudchenko was carried out. Patients who followed the prescribed monitoring regimen (at least 2 times a doctor’s visit during the year) were considered committed to dispensary supervision. Patients who observed the regularity and continuity of monitoring and receiving antiretroviral therapy (ART) were considered committed to treatment. Among the patients included in the study, 115 people were committed to treatment or follow-up and 169 patients were non-committed. Objective (biological) indicators of adherence and effectiveness of treatmentwere the number of CD4 lymphocytes and the level of HIV viral load. Based on the method of comparing survival curves, factors related to the life expectancy of HIV patients were assessed, taking into account the gender of patients, their adherence to monitoring and treatment, indicators of HIV viral load and the number of CD4 lymphocytes and the outcome of the disease from the moment of registration at the dispensary and over the next 120 months (after 3 months, 6 months, 1.5 years, 2 years, 5, 7 and 10 years). Results and discussion. Significant differences were found in the survival curves of patients who received and did not receive ART (117.9 and 91.4 months, p<0.005) and patients who were committed and non-committed to therapy (116.9 and 83.8 months, p<0.005). Regardless of adherence to outpatient follow-up and therapy, the survival time of women compared to men for the entire follow-up period was longer (105.0 and 92.4 months, respectively, p<0.005). Among those committed to treatment, 21% of patients died due to concomitant somatic pathology, 5% from injuries incompatible with life. In the group of those committedto follow–up, the causes of deaths in 12% were various somatic pathology, brain lymphoma — in 1% and injuries incompatible with life — in 3% of cases. The highest mortality rates were recorded among patients who were not exposed to ART (71%) and the routine of follow-up (52%). Almost half of these patients (49%) died from secondary HIV infections, of which 85% of cases were posthumously diagnosed with tuberculosis, mainly the pulmonary form of the disease. The second most common cause of death was violent death, including drug poisoning. Conclusion. Regular dispensary observation, timely initiation of ART and adherence to therapy make it possible to control the disease, prevent the development of opportunistic pathology, and improve the quality and life expectancy of patients with HIV infection. Despite the increased availability of ART and strategies for active involvement and retention of patients in dispensary care, issues of patient adherence to therapy remain key in the management of HIV patients.

Urticaria

The relevance of the disease is due to its prevalence ― for acute urticaria up to 20% with predominance in the paediatric population, for chronic spontaneous urticaria up to 0.5–5% of the population. The course of the disease is characterised by unpredictability of prognosis of duration, effectiveness of standard therapy, serious impact on the quality of life of the patient, his relatives, the burden on health authorities. The lack of accurate understanding of the mechanisms of disease development, a wide range of pathogenetic treatment complicates the possibility of rapid achievement of drug remission. The clinical Recommendations contain up-to-date information on epidemiology, pathogenesis, clinical picture, differential diagnosis, possibilities of examination and stage treatment, including immunobiological therapy. The procedure of medical care, prophylaxis and dispensary observation, criteria for assessing the quality of patient management and supporting material, including questionnaires to assess the severity of the condition and the effectiveness of treatment are outlined. Clinical recommendations on urticaria are intended for practicing physicians of all specialities, students, teachers of medical schools, residents, postgraduates and researchers.

Low level of the dental health as an indicator of malignant of the oral mucosa

Introduction. The manifestation of oncological alertness during dispensary observation by a dentist is very important. The most accessible options for preventing malignancy of the oral mucosa are sanitation, regular professional oral hygiene, as well as educational work among doctors and the population. However, despite the visual accessibility of tissues and organs of the oral cavity, there is an annual increase in malignant neoplasms in this area. In this case, most patients are diagnosed with a tumor process of the last stage. malignant neoplasms of the head and neck organs require special attention due to high risk of disability even at an early stage. Aim. To evaluate a correlation between malignancy of the oral mucosa and the burdened dental status of patients. Materials and methods. A controlled study was conducted which included 142 patients with cancer of the oral mucosa without sequential or parallel inclusion of patients in groups. Dental status was assessed at help-seeking stage or during clinical examination, as planned, by evaluation of main dental indices. The morphological diagnosis was established using histological verification. Results. The majority of patients with oral tumors had hard dental plaque (81.7 % of cases). The condition of the soft tissues, in addition to presence of the mucous membrane lesion, was characterized by bleeding (69 % of cases). moderate periodontal pathology was detected (19 % of cases). patients with the cavity tumors had an acute traumatic edge of hard tissues (70 % of cases), extensive caries (26 % of cases) and the presence of removable dentures (82 % of cases). Conclusion. The values of parameters evaluated in patients in the study with squamous cell carcinoma of the oral mucosa show its relation to aggravation of general somatic status. All patients in the study required dental treatment and training in oral hygiene care.

ORGANIZATION OF DISPENSARY OBSERVATION OF PATIENTS WITH PATHOLOGY OF THE MACULAR RETINA USING ARTIFICIAL INTELLIGENCE SYSTEMS

Background: Despite the mention in the provision of medical care for diseases of the organ of vision, adnexa and orbit about equipping the medical consultative and diagnostic department of the clinic with an optical coherence tomograph, dynamic monitoring of patients with retinal pathology after the start of treatment is most often carried out in a medical ophthalmological center, which reduces accessibility for patients with primary (first identified) morbidity requiring initiation of treatment. The required technology needs to be changed, intensified, incl. using artificial intelligence technologies.
 Aim: development of methodological foundations for organizational technology for dispensary observation of patients with pathology of the posterior segment of the eye using clinical decision support system (CDSS) based on artificial intelligence.
 Materials and methods: The assessment of the existing regulatory framework was carried out on the basis of an analysis of the Constitution of the Russian Federation, Federal laws, by-laws, and judicial practice. The creation of a methodology for a structured medical document describing an optical coherence tomography image was carried out using an expert method: a survey of 100 ophthalmologists with the appropriate level of education, incl. additional professional, engaged in the provision of medical services - specialized medical care (treatment) to patients with pathology of the posterior segment of the eye.
 Results: Using an expert method, 123 binary signs were selected and described to describe the structure of the macular region of the retina in normal and pathological conditions, of which 26 signs were identified that can be interpreted as predictors of worsening of the clinical course of the disease.
 Conclusion: The developed classifier made it possible to create and train a medical decision support system based on 60,000 medical images, which, as an information service, without making a diagnosis, can change the organization of the dynamic observation process: the formation of patient routing - a primary service using the developed CDSS; if there are signs of deterioration in the clinical picture - routing to a medical ophthalmological center to assess the dynamics, provide specialized services, incl. high-tech medical care.