Exacerbation Of Chronic Disease Research Articles

Difficulties in differential diagnosis of preeclampsia and acute surgical pathology

Aim: to determine the prevalence of preeclampsia and HELLP syndrome among patients hospitalized in surgical departments with complaints of pain in the epigastrium, right hypochondrium and/or nausea and vomiting. Material and methods. An analysis was carried out of visits from pregnant women over 20 weeks to the surgical department in 2023 and 42 cases of hospitalization of pregnant patients with suspected acute surgical pathology hospitalized in surgical departments No. 6 and No. 7 of the Samara City Clinical Hospital No. 1 named after. N.I. Pirogov." The following parameters were assessed: age, gestational age, complaints at the time of admission, general blood test data, urine, biochemical blood parameters (ALT, AST, total protein, creatinine, urea, total bilirubin, LDH, amylase, alkaline phosphatase, CRP), the presence of protein in urine, the state of the hemostatic system, the condition of the fetus according to ultrasound, ultrasound, CTG, the presence of obstetric and gynecological pathology and somatic diseases. Results. Patients with acute appendicitis (7 out of 42 pregnant women) were excluded from the study. Of the remaining 35 patients, the diagnosis of severe preeclampsia, HELLP syndrome was made in 3 cases (8.6%), in 2 cases gestational hypertension or protineria (5.7%) - the main group. Cholelithiasis, acute cholecystitis - in 2 cases (5.7%), in other cases the diagnosis of acute pancreatitis was made - 28 patients (80.0%). The work provides a comparison of clinical and laboratory parameters of patients in two groups - with obstetric and surgical pathology. An clinical case of a combination of severe PE with the development of HELLP-syndrome and cholecystitis is also presented. Conclusions. Based on numerous literature data and the results of our work, we can confidently say that the differential diagnosis between obstetric complications such as PE and HELLP syndrome and acute surgical pathology still remains a pressing interdisciplinary problem. Severe forms of PE can take the form of acute pancreatitis, acute cholecystitis, or exacerbation of chronic diseases of the abdominal cavity and retroperitoneal space. According to the results of our observation, this phenomenon occurred in 15% of patients hospitalized in surgical departments.

A New Hospital-At-Home Model for Integrated Geriatric Care: Data from a Preliminary Italian Experience

ObjectiveHospital-at-home (HaH) has emerged as an alternative to conventional in-hospital care in older adults, possibly reducing hospital admissions and related complications. This study aimed to describe the characteristics and outcomes of patients referred to “Gruppo di Intervento Rapido Ospedale-Territorio” (GIROT), a HaH service based on comprehensive geriatric assessment, developed in Florence, Italy, during the postpandemic period. DesignRetrospective longitudinal study. Setting and ParticipantsGIROT provided home-based care to patients with acute or exacerbated chronic diseases and a high risk of hospital-related complications (ie, patients with moderate-to-severe disability and/or dementia), referred from primary care, emergency departments, or in-hospital units. MethodsAll-cause mortality and hospitalization rates were assessed at 1, 3, and 6 months, and predictors of 6-month mortality were investigated. ResultsAmong 391 patients (mean age, 88.4 years; 62.4% female) referred from emergency departments (58.6%), primary care (27.9%), and acute medical units (13.6%), the main diagnoses were respiratory failure (28.4%), acute heart failure (25.3%), and delirium (13.6%). Patients referred from primary care were older and showed a higher prevalence of severe disability and hypomobility. After 1, 3, and 6 months, mortality rates were 34.5%, 45.6%, and 53.8%, and hospitalization rates 7.2%, 21.5%, and 37.9%, respectively. Predictors of 6-month mortality included age [odds ratio (OR), 1.039], severe disability (OR, 3.446), impossible/assisted walking (OR, 4.450) and referral from primary care (OR, 2.066). High global satisfaction with the service was reported. Conclusions and ImplicationsThe GIROT model may help expanding acute health care capacity for older adults at high risk of hospital-related complications. Customized care plans are needed in patients with severe disability/hypomobility, considering also simultaneous palliative care.

Clinical and immunological characteristics of post-covid patients with infectious immunopathology syndrome

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has caused global morbidity and high mortality worldwide. Today it is known that, despite recovery from COVID-19, confirmed by both laboratory and instrumental diagnostic methods, many patients, regardless of the severity of the disease, suffer from a significant deterioration in health and increased exacerbations of chronic diseases. During examinations by attending physicians, they note fatigue, an increase in cases of acute respiratory viral infections per year, an increase in relapses of skin diseases such as furunculosis, pyoderma, exacerbation of pulmonary pathologies, pathologies of the urinary tract of inflammatory origin, as well as chronic infectious diseases such as herpesvirus and human papillomavirus infections, which occur for the first time or are characterized by frequent relapses no less than six months after recovery from acute COVID-19. Such persistent post-infectious consequences are known as post-COVID syndrome. SARS-CoV-2 infection is accompanied by damage to both the acquired and innate immune systems. In previous work, we determined the role of B cells, cytotoxic T lymphocytes, natural killer cells and the regulatory properties of CD46, as well as its involvement in the processes of viral entry into the cell. In this study, we studied the relationship of immune disorders of these factors of innate and acquired immunity with the clinical manifestations of post-COVID infectious syndrome in this category of patients and the severity of lung damage in these patients during the acute period of COVID-19. The results of the study showed that in some patients more than six months after suffering from COVID-19, the following was revealed: in patients who had a coronavirus infection without lung damage, no violations of the innate and acquired parts of the immune system were detected. In addition, significant differences were identified between clinical manifestations of diseases with increasing cases of relapses or newly identified after clinical recovery from an acute COVID-19 infection, depending on the phenotype of immune status disorders.

Legal regulation of rehabilitation in the field of health care

The article notes that the law guarantees everyone the right to health care and medical assistance. A full-scale invasion calls for the development and updating of legal acts on ensuring a person’s right to medical assistance, in particular, to the provision of rehabilitation services. It is noted that rehabilitation assistance is aimed at a number of main areas, firstly, at supporting the functions of the patient’s body during the exacerbation of chronic diseases. Secondly, for warning, early diagnosis of disorders of the organs and systems of the patient’s body. The third direction is aimed at full or partial restoration of damaged organs or systems and compensation of lost functions of affected organs or systems. The fourth direction is related to the prevention and reduction of the degree of disability. The author emphasizes that the lack of competent and effective medical rehabilitation in Ukraine is a multifactorial problem: there is an insufficient number of inpatient and outpatient rehabilitation departments; lack of medical personnel - rehabilitation specialists, psychologists; there is not enough rehabilitation equipment; there is a need for adequate educational programs for physicians. In the article, the author emphasizes that one of the tasks of the state is to help persons with disabilities realize their constitutional rights; implementation of state policy in the field of rehabilitation of persons with disabilities, support for their integration into society, and the full-scale war on the territory of Ukraine causes an increasing urgency and need for the rehabilitation of persons injured as a result of hostilities. Such factors of the population’s health, such as the increase in morbidity, injuries, temporary loss of working capacity, premature mortality of the population require the development of the rehabilitation medicine market of Ukraine and its legal regulation. The article notes that the positive aspects are the development of new medical rehabilitation technologies, including those based on telemedicine and IT technologies, the preparation of new professional standards for medical rehabilitation at the modern level in accordance with international recommendations. All this requires the effective functioning of the system, which first of all requires the improvement and development of regulatory and legal support in the field of rehabilitation.

Peripheral Intravenous Therapy in Internal Medicine Department-Antibiotics and Other Drugs' Consumption and Characteristics of Vascular Access Devices in 2-Year Observation Study.

The aim of the study was to characterize the procedure of peripheral intravenous therapy (IT), including the characteristics of vascular access and related complications and qualitative and quantitative analyses of drug consumption. A two-year, retrospective, single-center observational study was conducted. The criterion for including a patient in the study was the use of peripheral intravenous catheters (PIVCs) upon admission or during the stay at the internal medicine department (IMD). The main reasons for hospitalization were exacerbations of chronic diseases for 78% of the patients and acute infections for 22%. IT was used in 83.6% of all the patients. IT was used primarily for antibiotics (5009.9 defined daily doses (DDD)). Further, 22.6% of the PIVCs stopped functioning within 24 h, more frequently in infectious patients. The main reasons for PIVC removal were leakage (n = 880, 26.6%) and occlusion (n = 578, 17.5%). The PIVC locations were mostly suboptimal (n = 2010, 59.5%), and such locations were related to leakage and occlusion (p = 0.017). In the IMD, most patients require the use of a PIVC, and antibiotics dominate the group of drugs administered intravenously. Up to 1/5 of peripheral intravenous catheters are lost within the first 24 h after their insertion, with most of them placed suboptimally. A properly functioning PIVC appears to be crucial for antimicrobial treatment.

The impact of frailty syndrome on the occurrence of anxiety disorders and depression in patients with arterial hypertension

Abstract In recent years, there has been an increase in the number of older people, which translates into more frequent diagnosis of frailty among geriatric patients. Anxiety and depressive disorders in geriatric patients very often lead to deterioration of their health and exacerbation of chronic diseases, which results in deterioration of their functioning. The aim of the study was to assess the impact of frailty syndrome on the occurrence of anxiety and depressive disorders among patients with diagnosed hypertension. Material and methods The study included 70 patients with diagnosed hypertension (39 women - 56% and 31 men - 44%, aged between 60 and 92 years). The mean age of those included in the study was 70.3 ± 7.3 years. Results Frailty syndrome was diagnosed in 75.7% of patients participating in the study (77.4% of men and 74.3% of women). Depressive disorders occurred in 28.5% of respondents, including 25.8% of men and 30.8% of women. Anxiety disorders occurred in 24.3% of people, interestingly, men predominated in this group - 32.2%, while there were 17.9% of women with anxiety disorders. It has been shown that in women there is a relationship between the occurrence of frailty and depression in the general frailty syndrome and the physical and psychological domains. However, there is no statistically significant relationship between TFI in the social domain and the occurrence of depression. In this group of respondents, there was a statistically significant correlation between TFI and anxiety only in the psychological domain. There was no correlation between general frailty, physical and social domains and the occurrence of the drug. There is no statistically significant correlation between frailty syndrome and its domains and the occurrence of depressive disorders. A statistically significant relationship appears only between the physical and psychological domains and anxiety. Conclusions In women, weakness in the physical and psychological domain influences the development of depression, while in the case of anxiety it affects only the psychological domain. In men, frailty does not influence the occurrence of depressive disorders. Among men, there is a statistically significant correlation between physical and psychological frailty and anxiety.

Impact of frailty degree, measured by three instruments, on adverse health outcomes in patients admitted for medical illness in an acute care for elders unit

PurposeThe aim of this study is to analyse adverse health outcomes at hospital discharge adjusted to frailty degree measured by three instruments in patients admitted for medical diseases in an Acute Care for Elders (ACE). MethodsThis is a prospective observational study, including 194 frail patients aged 75 years or older. Patients were admitted to a tertiary hospital ACE for an acute medical illness or exacerbated chronic diseases from June 2022 to May 2023. Frailty was assessed by the FRAIL scale, the Clinical Frailty Scale (CFS) and the frail-VIG Index (IF-VIG). Health outcomes analysed were length of hospital stay, home destination at hospital discharge, development of delirium and functional decline. ResultsPatients were on average 85,14 years old, with 56 % women. Mean frailty punctuations were 2,83 for FRAIL scale; 4,1 for CFS and 0,3 for IF-VIG. Patients who did not return home were more fragile: FRAIL 3,1 vs 2,6; CFS 4,5 vs 4,0; IF-VIG 0,3 vs 0,2. Patients with a hospitalization longer than 10 days were more fragile: FRAIL 3,9 vs 2,6; CFS 4,5 vs 3,8; IF-VIG 0,3 vs 0,2. More frail patients had greater delirium incidence and prevalence: CFS 4,7 vs 4,1; IF-VIG 0,3 vs 0,2. These results are statistically significant. ConclusionsA greater degree of basal frailty during a hospitalisation in an ACE is strongly related with smaller return home rates at hospital discharge, as well as with longer mean stay-length and larger amounts of delirium.

Association of Timely Outpatient Follow-Up and Readmission Risk in a Mobile Integrated Health Program.

The objective was to identify medical conditions associated with 30-day readmission, determine patient characteristics for which outpatient follow-up is most associated with reduced readmission, and evaluate how readmission risk changes with time to outpatient follow-up within a mobile integrated health-community paramedicine (MIH-CP) program. This retrospective observational study used data from 1,118 adult patient enrollments in a MIH-CP program operating in Baltimore, Maryland, from May 14, 2018, to December 21, 2021. Bivariate analysis identified chronic disease exacerbations associated with higher 30-day readmission risk. Kaplan-Meier curves and Cox proportional hazard regressions were used to measure how hazard of readmission changes with outpatient follow-up and how that association may vary with other factors. Receiver operating characteristic analysis was used to evaluate how well time to follow-up could predict 30-day readmission. Timely outpatient follow-up was associated with a significant reduction in hazard of readmission for patients aged 50 and younger and for patients with fewer than 5 social determinants of health needs identified. No significant association between readmission and specific chronic disease exacerbations was observed. An optimal follow-up time frame to reduce readmissions could not be identified. Timely outpatient follow-up may be effective for reducing readmissions in younger patients and patients who are less socially complex. Programs and policies aiming to reduce 30-day readmissions may have more success by expanding efforts to include these patients.

Mortality in fracture of the distal femoral bone (review)

Distal femur fractures in the elderly can lead to the exacerbation of chronic diseases and fatal outcomes similar to those observed in femoral neck fractures in the same category of individuals. Thus, this study aimed to determine the factors influencing the mortality of patients with distal femur fractures based on the analysis of foreign studies and results of treated patients. Review of foreign literature was conducted using the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, and Cochrane among articles in English, Chinese, Italian, and Russian, as well as through the Web of Knowledge. We analyzed publications for the last 10 years. Evaluation of treated patients included patients aged 60 years with distal femoral fractures between 2021 and 2023. Analysis of the literature data showed that distal femur fractures are accompanied by high mortality in patients in the first years after injury (from 18% to 35%), commonly in elderly patients without surgical treatment (90%–100%), and the presence of several concomitant diseases accompanied by contractures of the femur, knee joint, and false joint and displacement or fracture of the metal retainer. Early surgical treatment (first 48 h) is an effective treatment method that significantly reduces mortality after distal femur fracture (by 2.8 times).

Features of portal hemodynamics in patients with fatty liver disease: mechanisms of formation, clinical significance

There are few data in the literature on the state of portal and hepatic blood flow in patients with fatty liver disease, and portal hemodynamics at the pre-cirrhotic stage is practically not covered. The aim of the study was to study the features of portal hemodynamics in patients with fatty liver disease at the pre-cirrhotic stage. Materials and methods. The study included 43 patients (25 - patients with fatty liver disease and 18- a comparison group who applied to outpatient clinics of therapeutic profile aged 18-89 years (41.9% of men, 58.1% of women). The average age of the patients was 45.1± 19.4 years. Criteria for inclusion in the study: age 18 years and older; presence of fatty liver disease associated with metabolic conditions. Criteria for not being included in the study: the presence of viral hepatitis, alcoholic liver disease, autoimmune liver diseases, pregnancy, lactation, taking any medications, narcotic drugs, the presence of acute or exacerbation of chronic diseases. The anthropometric indicators of patients were evaluated: waist circumference (OT), body mass index (BMI), steatotic indices (St-index, Fatty Liver Index), liver fibrosis index (Fib 4). Portal hemodynamics was assessed using ultrasound Dopplerography on a Philips Affiniti 50 device. Sensor C5-1. The following criteria were evaluated: vessel diameter (mm), its cross-sectional area (PPP, cm2), time-averaged maximum velocity (TAMX, cm/s), time-averaged average blood flow velocity (TAV, cm/s), Doppler perfusion index was calculated using the formula: V vol SPA / V vol SPA + V vol BB), the stagnation index was calculated using the formula: PPP/TAV. The results obtained. In patients with fatty liver disease, structural and hemodynamic shifts in the portal blood flow system are recorded: an increase in the diameter of the portal and inferior vena cava, a larger cross-sectional area, a low time-averaged maximum blood flow velocity and time-averaged average blood flow velocity, an increase in the stagnation index for these vessels, which reflects the process of remodeling the liver as a target organ in fatty liver disease and its vascular bed, forming a “stagnant liver”. Patients have lower values of the time-averaged average blood flow rate through the splenic vein, which indicates the initiation of collateral blood flow. Portal hemodynamics indicators correlate with metabolic parameters (anthropometric characteristics of patients (OT, BMI), steatotic indices (St index, FLI), but not with the liver fibrosis index (Fib 4). These hemodynamic features at the pre-cirrhotic stage of the disease, correlating with the severity of metabolic disorders, exacerbate structural changes in the liver and necessitate their correction in patients with fatty liver disease.

APOPTOTIC AND PROINFLAMMATORY PROCESSES ESTIMATION IN PATIENTS WITH DIABETIC NEUROPATHY

Relevance. In many countries plants have long been used in folk medicine as a source of medicines, as they are well tolerated, gradual development of therapeutic effect and a mild effect on the body. Due to these features such medicines are being safely used in the treatment and prevention of exacerbations of chronic diseases: of cardiovascular system, respiratory system, digestive system, pathologies of the urinary tract, etc., and also as a rehabilitation therapy after past diseases. The purpose of the study is to systematize and generalize the data of world literature concerning the general health-improving and tonic properties study of plants growing in the Republic of Buryatia. Material and methods. In this work used publication materials from the PubMed and е-library databases, search.rsl. The keyword search: restorative, tonic effect, herbal medicines, medicinal plants of Buryatia, biologically active substances, Astragalus membranaceus, Saposhnikovia divaricatа, Scutellaria baicalensis, Sedum roseum, Crataegus sangunea. The survey comprises the data of foreign and national articles, published on the topic during last 20 years. Conclusions. All the plants listed in this review are used for thousands of years in the Tibetan medicine. Based on the analysis of the presented literature data, their range of medicinal use is much wider, then the applications in modern clinical practice. The information reported in this review may be the basis for the development of new herbal medicines, including officinal mixture, with specified pharmacological properties.

Improve disaster response by planning for and logistically supporting acute exacerbations of chronic diseases.

Provide a more effective medical response by emphasizing the management of acute exacerbations of chronic diseases in disasters. Disaster victims need treatment for their acute exacerbations of and ongoing chronic medical conditions, medication refills, mental health resources, and have an expectation that medical facilities will provide resources beyond medical care. Medical response is more efficient, cost effective, and effectual when these considerations are supported.

MEDICINAL PLANTS WITH RESTORATIVE AND TONIC EFFECT IN THE REPUBLIC OF BURYATIA (REVIEW)

Relevance. In many countries plants have long been used in folk medicine as a source of medicines, as they are well tolerated, gradual development of therapeutic effect and a mild effect on the body. Due to these features such medicines are being safely used in the treatment and prevention of exacerbations of chronic diseases: of cardiovascular system, respiratory system, digestive system, pathologies of the urinary tract, etc., and also as a rehabilitation therapy after past diseases. The purpose of the study is to systematize and generalize the data of world literature concerning the general health-improving and tonic properties study of plants growing in the Republic of Buryatia. Material and methods. In this work used publication materials from the PubMed and е-library databases, search.rsl. The keyword search: restorative, tonic effect, herbal medicines, medicinal plants of Buryatia, biologically active substances, Astragalus membranaceus, Saposhnikovia divaricatа, Scutellaria baicalensis, Sedum roseum, Crataegus sangunea. The survey comprises the data of foreign and national articles, published on the topic during last 20 years. Conclusions. All the plants listed in this review are used for thousands of years in the Tibetan medicine. Based on the analysis of the presented literature data, their range of medicinal use is much wider, then the applications in modern clinical practice. The information reported in this review may be the basis for the development of new herbal medicines, including officinal mixture, with specified pharmacological properties.

Prevalence and clustering of NANDA-I nursing diagnoses in the pre-hospital emergency care setting: A retrospective records review study.

To determine the prevalence and clustering of NANDA-International nursing diagnoses in patients assisted by pre-hospital emergency teams. Retrospective descriptive study of electronic record review. Episodes recorded during 2019, including at least a nursing diagnosis, were recovered from the electronic health records of a Spanish public emergency agency (N = 28,847). Descriptive statistics were used to characterize the sample and determine prevalence. A two-step cluster analysis was used to group nursing diagnoses. A comparison between clusters in sociodemographic and medical problems was performed. Data were accessed in November 2020. Risk for falls (00155) (27.3%), Anxiety (00146) (23.2%), Acute pain (00132), Fear (00148) and Ineffective breathing pattern (00032) represented 96.1% of all recorded diagnoses. A six-cluster solution (n = 26.788) was found. Five clusters had a single high-prevalence diagnosis predominance: Risk for falls (00155) in cluster 1, Anxiety (00146) in cluster 2, Fear (00148) in cluster 3, Acute pain (00132) in cluster 4 and Ineffective breathing pattern (00032) in cluster 6. Cluster 5 had several high prevalence diagnoses which co-occurred: Risk for unstable blood glucose level (00179), Ineffective coping (00069), Ineffective health management (00078), Impaired comfort (00214) and Impaired verbal communication (00051). Five nursing diagnoses accounted for almost the entire prevalence. The identified clusters showed that pre-hospital patients present six patterns of nursing diagnoses. Five clusters were predominated by a predominant nursing diagnosis related to patient safety, coping, comfort, and activity/rest, respectively. The sixth cluster grouped several nursing diagnoses applicable to exacerbations of chronic diseases. Knowing the prevalence and clustering of nursing diagnoses allows a better understanding of the human responses of patients attended by pre-hospital emergency teams and increases the evidence of individualized/standardized care plans in the pre-hospital clinical setting. What problem did the study address? There are different models of pre-hospital emergency care services. The use of standardized nursing languages in the pre-hospital setting is not homogeneous. Studies on NANDA-I nursing diagnoses in the pre-hospital context are scarce, and those available are conducted on small samples. What were the main findings? This paper reports the study with the largest sample among the few published on NANDA-I nursing diagnoses in the pre-hospital care setting. Five nursing diagnoses represented 96.1% of all recorded. These diagnoses were related to patients' safety/protection and coping/stress tolerance. Patients attended by pre-hospital care teams are grouped into six clusters based on the nursing diagnoses, and this classification is independent of the medical conditions the patient suffers. Where and on whom will the research have an impact? Knowing the prevalence of nursing diagnoses allows a better understanding of the human responses of patients treated in the pre-hospital setting, increasing the evidence of individualized and standardized care plans for pre-hospital care. STROBE checklist has been used as a reporting method. Only patients' records were reviewed without further involvement.

The methodology for diagnosing and managing stress developed by Grivtsova, as an independent method and as part of the preparation for inducing lucid dreams within the framework of the “Bancheko Extended Algorithm,” and its application in the “Global Forecasting System,” serves as a means of transferring transcendental states of consciousness within the “Bancheko-Technology Set”

According to the World Health Organization (WHO), the increase in stressful situations due to the accelerating pace of life, environmental pollution, urbanization, technological progress, and low socio-economic living standards of the population, underpins the rise in neurological diseases. Consequently, one of the crucial tasks in practical psychology and applied psychophysiology is the timely and comprehensive diagnosis and correction of borderline forms of psychological disorders. This study examines the application of stress diagnosis and correction methodologies. The foundation is the wave model of brain electrical activity, observed using electroencephalography, based on an algorithm developed during the experiment. The key hypothesis of the study suggests that by following the developed self-organization system, based on performing simple actions, individuals with disrupted brain electrical activity due to various stressors can avoid pharmacological interventions. It has been shown that the consequences of stress primarily include increased tension in the central nervous system (sympathetic component) and insufficient relaxation (parasympathetic component). During the exacerbation of chronic diseases, the following effects were observed in subjects: poor sleep in patients with gastritis, drowsiness and headaches in individuals with allergies, chronic migraines, and neurological pains in the head on the left side along the trigeminal nerve, meteorological dependence in hypertensive patients, and jaw locking and right-side pain in those with traumatic brain injuries. Correction of these disorders took into account their stress-induced nature. A method for rehabilitating emotional-affective disorders in individuals is proposed to overcome stressful situations. The obtained data suggest that the proposed method of restorative alpha rhythm through neurotraining has high potential in therapeutic work for overcoming and correcting stress in people from various social groups, ages, and professions.

ОСОБЕННОСТИ ИЗМЕНЕНИЙ ИНДЕКСОВ КОМФОРТНОСТИ КЛИМАТА В ПЕРМИ И ГОРОДАХ-МИЛЛИОННИКАХ СИБИРИ В ХОЛОДНЫЙ И ТЕПЛЫЙ ПЕРИОДЫ ГОДА

Weather and climate have a great impact on various sectors of the economy, as well as on human well-being andperformance. In weather-sensitive people, a sudden change in weather can be accompanied by a deterioration in their general conditionand exacerbation of chronic diseases. The main meteorological indicators of weather and climate comfort for humans are temperature,humidity and air pressure, wind speed, precipitation. Comfort is characterized through bioclimatic indices, which physically describethe features of the thermal structure of the environment, being an indirect indicator of the state of the thermal field surrounding a person. The paper deals with the most widespread bioclimatic indices – effective temperature (ET) and equivalent effective temperature(EET), which are widely used in Russia and CIS countries. The study of the peculiarities of changes in ET and EET in cold and warmperiods of the year in the cities of Perm, Omsk, Novosibirsk, and Krasnoyarsk, all having over a million inhabitants, for 1991-2020showed that according to EET the climate in all the cities is more severe than according to ET, especially in the cold period. This isexplained by the fact that at temperatures below +7°C, any wind (even for a fully clothed person) is a cooling factor. The maximumvalues of ET in all months of the cold period are observed in Perm, the westernmost of the studied cities, where the warming influenceof the Atlantic has an effect. The maximum values of EET in November-January are recorded in Perm, in other months – in Krasnoyarsk, where, firstly, the wind load is noticeably less than in Perm, and secondly, the presence of a polynya in the lower reach of theKrasnoyarsk Reservoir has an impact, especially in February and March. The variability of ET and EET in the warm period of the yearis more diverse than in the cold period. In both warm and cold periods, there is a stable tendency for positive anomalies to increasewith time, indicating an increase in climate comfort. However, in Krasnoyarsk, in the cold period, there is a tendency for a decrease inpositive anomalies, indicating a decline in climate comfort.

Critical Care in Older People in Low and Middle-Countries (LMICs): Comprehensive Geriatric Assessment (CGA) Protocol in Andes Mountains

Background: The number of older adults in ICU care is increasing. Nowadays, at least fifty percent of ICU patients are aged 65 years and older. The most frequent pathologies to be admitted to the ICU in older people include acute diseases, long-term conditions, and acute or chronic disease exacerbations. Furthermore, new clinical phenotypes, and geriatric syndromes (falls, frailty, immobility) result from the interaction of age-associated conditions and comorbidity. Severity of index disease, multimorbidity, premorbid functional status, frailty, nutritional status, and cognitive level are more important determinants of long-term outcome than chronological age. Comprehensive geriatric assessment (CGA) is a recognized and useful instrument in the management of elderly patients. Methods: We present a protocol for a clinical trial on the application ofCGA in ICU in the Andes Mountains in Colombia, a Low and Middle-Income Country (LMIC). This protocol could provide valuable information for the integration of geriatrics into critical care and provide practical information on how to implement CGA in this context. Results: The selection criteria of the tools to be used during the assessment of the patients were based on the available literature review and on reviews about interdisciplinary team interventions in acute care services based on the CGA. Conclusion: The care of critically ill elderly patients in the ICU is challenging due to factors such as frailty, psychosocial vulnerability, cognitive impairment, dependence on activities of daily living, and the presence of geriatric syndromes which are important conditions for adverse health outcomes in the future. CGA technology could be considered an excellent tool for managing older people in ICU.

LOCKED IN SUFFERING: UNLOCKING HOPE AND IMPROVING CARE FOR ELDER INMATES: A CALL FOR ACTION

Abstract Our program will focus on several key areas, including care for hospitalized inmates, the importance of providing comprehensive care for all prisoners as mandated by 8th amendment, and the importance of identifying inmates facing end of life who would benefit from compassionate release. We will begin with a discussion on the challenges faced by elder inmates and address their unique physical, psychosocial and spiritual needs. With a growing population of aging prisoners, it is critical that we examine the healthcare and social services required to ensure that they receive adequate care. Next, we will explore the differences in healthcare provision for inmates versus non-inmates who are hospitalized. The presentation will examine the acute exacerbation of chronic disease, ethical considerations and legal requirements involved in providing care to both populations. We will also discuss the importance of interdisciplinary care for incarcerated individuals, which requires collaboration among medical providers, mental health professionals, social workers, chaplains and other specialists. Our panel of experts will share their experiences and provide insights on how this approach can improve health outcomes and reduce recidivism rates after release . Finally, we will hear from advocates who are working to ensure that all prisoners receive adequate healthcare and social services, They will share strategies for improving access to care, reducing health disparities, and addressing the unique needs of incarcerated elders Our symposium provides a unique opportunity to explore and share insights on how we can work together to improve the health and wellbeing of incarcerated individuals.

Geriatric patient in the practice of emergency medical teams - observation in 2020-2022.

Analysis of interventions of medical rescue teams for geriatric patients in a three-year period, taking into account the causes, circumstances, medical management, pharmacology. The study included a 3-year retrospective analysis of the trips of medical rescue teams in the northern part of the Lubelskie Voivodeship in the period from January 1, 2020 to December 31, 2022. The data comes from medical documentation. Interventions caused by a health risk in a patient in the 90+ age group were qualified as events. 897 EMT interventions were qualified (2020-327, 2021-269, 2022-301) constituting 4.29% of all interventions carried out in the operational area. In addition, a quantitative analysis of a comparative group of patients aged 80-89 was performed. It was shown that the time of rescue activities was the longest for injuries and the shortest for mental disorders (60 ± 31 vs. 43 ± 21 min). It was shown that specialist EMT teams (S) were statistically significantly more often called for cardiology disorders (63%). It was shown that pharmacological agents were used statistically significantly more often in respiratory disorders (83%) compared to neurology disorders (47%, p < 0.001). It was also shown that patients whose call was caused by neurology disorders were statistically more often transported to the emergency department (N = 76, 76%, p < 0.001). The causes of calls regarding disorders of the circulatory and respiratory systems most often require the implementation of pharmacology during EMT interventions, mainly short-term and symptomatic drugs. Interventions to rural areas dominate in the presented analysis in each year of the analysis and in each group of reasons for calls, which may be associated with more difficult access to a primary care physician. Most EMT interventions concern exacerbation of chronic diseases. Transport to the hospital was necessary mainly due to neurological and traumatic calls.

Training of Emergency Medical Specialists in Contemporary Realities

Relevance. In accordance with Federal Law No. 323-FZ [17], emergency medical assistance, including emergency specialized medical care, is provided in emergency form outside a medical organization, as well as on outpatient and inpatient basis. An ambulance is an emergency medical service that travels to those whose lives and health are in danger. Emergency medical assistance, including emergency specialized medical care, is provided in case of diseases, accidents, injuries, poisonings and other conditions requiring urgent medical intervention. The reasons for calling an ambulance in an emergency form are sudden acute diseases (conditions) and (or) sudden exacerbations of chronic diseases without obvious signs of a threat to life, requiring urgent medical intervention. In the training of doctors, including in postgraduate education, these factors are taken into account.Aim of the study. Improvement of the quality of theoretical and practical training of emergency medical specialists, as well as clinical residents and practical doctors of various specialties, taking into account issues of emergency and military medicine.Material and methods. A review of official documents of the Ministry of Healthcare of the Russian Federation and the literature on postgraduate education of doctors with subsequent primary specialized accreditation for 2018-2022 was carried out. The literature on modern approaches to the provision of emergency medical care to victims was studied, taking into account the specifics of military (tactical) medicine for 2020–2022.Conclusion. The training of emergency medical professionals, taking into account the realities of the present, should include issues of tactical medicine and be practice-oriented using simulation equipment. It is necessary to know and be able to work with modern means of protection and medical care available in the troops; be prepared to work in medical institutions of various levels with the mass flow of injured and wounded.