Quality Of Medical Care Research Articles

Erb palsy due to birth injury (a draft of the clinical recommendations)

The article presents a draft of clinical recommendations for the diagnosis and treatment of Erb palsy in birth injury. These recommendations are intended for physicians of maternity hospitals and are aimed at providing information support for decision-making by a doctor in the event of a birth injury, as well as improving the quality of medical care to a patient. The recommendations correspond to the latest scientific data on the topic, and also contain information that is of an applied nature for practical activities. These practical recommendations are offered for public discussion and are posted in full on the website of the Ministry of Health of the Russian Federation. The recommendations contain an information note on Erb palsy in birth injury, including the definition, etiology and pathogenesis of the disease. Three types of classification of generic traumatic lesions of the brachial plexus are presented: by prevalence, by severity of nerve damage and by severity of paresis. The clinical features of the disease are considered in detail. To diagnose the disease, an algorithm of physical examination is proposed, and the use of instrumental research methods: MRI, ultrasonic, X-ray and electromyographic studies. Recommendations for the conservative treatment of pathology and the use of physiotherapy and rehabilitation techniques are given. An algorithm of the doctor’s actions and an information certificate about the disease are proposed to inform the patient’s parents. The recommendations are given taking into account the level of credibility of the recommendations and the level of reliability of the evidence.

Determining trends in the epidemiological process and quality of medical care for breast cancer

Determining trends in the epidemiological process and quality of medical care for breast cancer

THE ROLE OF MONOCLONAL B-CELL LYMPHOCYTOSIS IN PREDICTING LYMPHOPROLIFERATIVE DISEASES: A LITERATURE REVIEW

Relevance: Monoclonal B-cell lymphocytosis (MBL), introduced by the World Health Organization in 2017 to classify certain types of blood diseases, opens up new perspectives in classification but also raises issues that require further study. MBCL studies are important for improving diagnosis and monitoring, which can contribute to the early detection and prevention of chronic lymphocytic leukemia (CLL). The study aimed to evaluate the immunophenotypic aspects of monoclonal B-cell lymphocytosis and the risk of progression to chronic lymphocytic leukemia. Methods: A review of scientific publications examined the causes of MBL and its association with CLL, emphasizing immunophenotypic aspects of these conditions. The literature survey provided information on factors associated with the progression of MBL to CLL, including biomarkers and clinical characteristics, allowing a more comprehensive assessment of the risk of leukemia in patients with MBL. Results: Numerous studies regarding the association between MBL and CLL were analyzed. The analysis showed that MBL often precedes the development of CLL, with MBL clones being detectable years before clinical diagnosis. This supports the hypothesis that MBL may be an early biomarker for detecting developmental risk. Various studies emphasize significant ethnic and geographic differences in the prevalence and progression of MBL and CLL. These differences may be related to epigenetic factors, immunoglobulin rearrangements, and other genetic features. Understanding these differences is important for more accurate diagnostic and prognostic approaches considering individual and patient population characteristics. ОБЗОРЫ ЛИТЕРАТУРЫ Онкология и Радиология Казахстана, №4 (74) 2024 73 Conclusion: The analysis shows that further investigation of the association between MBL and CLL and the introduction of screening programs for early detection of MBL can significantly improve the prognosis and health of patients in Kazakhstan. The review results emphasize the importance of early diagnosis and an individualized approach to treatment. This will help prevent MBL progression to CLL and improve the quality of medical care in our country.

Объяснимость поведения агентов в системах поддержки принятия клинических решений

The article considers the task of improving the explainability of agent behavior in clinical decision support systems using multi-agent reinforcement learning, taking into account the behavioral characteristics of individual agents. Special attention is paid to the application of the proximal policy optimization (PPO) algorithm, which is used to simulate the interaction of artificial and natural intelligence agents. In addition, the importance of taking into account the behavior-al characteristics of patients is considered, which is achieved through the use of the developed framework «beliefs-desires-intentions» (BDI). The framework allows you to model patient behavior more accurately, taking into account their individual preferences and needs, which contributes to improving the quality of medical care. To increase the explainability of agent behavior and ensure transparency of decisions, the use of a large language model (LLM) is pro-posed. To assess the quality of the framework as a means of ensuring the requirements of XAI (explicable artificial intelligence), a set of criteria has been developed and its representativeness has been demonstrated. The assessment was carried out by comparing the explanations generated by four popular language models for seven gameplay launches with different initial data. The proposed approach to ensuring explainability in multi-agent simulations opens up opportunities for further development and implementation of such systems in clinical practice.

Reasons for the increase and ways to reduce the frequency of cesarean sections in modern obstetrics

The progressive increase in the number of cesarean sections, which is not accompanied by a decrease in the perinatal mortality rate, is an urgent problem not only in obstetrics, but in the health care system in general. The frequency of operative delivery is influenced by both medical and non-medical factors. Moreover, the frequency varies across regions of the world and countries with different levels of economic development. At the present stage, the increase in the number of surgical deliveries in developed countries is due to changes in population health indicators (age, morbidity). The attention of WHO and associations of obstetricians and gynecologists is drawn to the development of measures to stabilize and reduce the frequency of cesarean sections. However, the proposed measures to reduce it through administration in obstetric hospitals and non-medical measures do not have an effect. There is evidence of an increase in the incidence of complications for the mother and fetus when indications for cesarean section are limited. A safe reduction in the frequency of caesarean sections is possible only with an integrated approach, including new solutions that improve the quality of medical care in general (social measures to support families, optimization of medical processes, introduction of decision support systems, improvement of medical technologies for pregnancy and childbirth).

Avoidable Mortality in Municipalities and Administrative Okrugs of Moscow

Background. Avoidable mortality serves as an integral indicator of healthcare system performance. The living conditions of Muscovites and the developments in Moscow healthcare have determined the highest life expectancy rates for the population of Moscow. However, the availability and quality of medical care as well as the prevalence of behavioral risk factors vary within the metropolis. Therefore, it is of great practical value to consider an uneven spatial distribution of avoidable mortality in order to implement corrective management actions.Objective. To analyze the avoidable mortality of the population of Moscow by administrative okrugs and municipalities in 2023.Materials and methods. The calculations were based on the list of avoidable causes of death from the "European Community Atlas of ‘Avoidable Death’" (the edition of 1997) for the age range 0-65 years. Data on mid-year population and number of deaths by municipality in 2023 were taken from the Moscow regional database "Death Registration" (RFS EMIAS) and then used to analyze an uneven spatial distribution of avoidable mortality.Conclusions. There is a large reserve for reducing mortality not only by improving living conditions and strengthening adherence of the population to a healthy lifestyle, but also by improving availability and quality of medical care.

Introduction of methodology for assessing the quality of medical examination of adult population in system of internal control of quality and safety of medical activities

INTRODUCTION: It is reasonable that the realization of the state project of medical examination of adult population (MEAP) be assessed simultaneously with the assessment of the quality of medical care, and be integrated into the internal control of quality and safety of medical activities. The process approach is effective in realization of quality control of medical care provided as part of MEAP. AIM: To develop and introduce the methodology of assessing MEAP quality, to assess the results of expertise conducted at the initial stage of MEAP introduction, and on the basis of the results of introduction of measures that improved MEAP organization. MATERIALS AND METHODS: To assess the quality of MEAP, the ‘Expert Assessment Card for a Medical Examination Case’ was developed and introduced using the integrated quality assessment method. The assessment was carried out according to the blocks of the Card developed by I. V. Uspenskaya and O. N. Selyavina in accordance with the adopted assessment scale (0–0.5–1). The expertise of MEAP cases was carried out twice: in 2013 at the initial stage of realization of MEAP according to the new procedure, and in 2018 on the basis of the results of the realization of measures to improve the organization of MEAP. RESULTS: Comparative analysis of defects identified at the initial stage of the medical examination in 2013 and as a result of the work performed for the introduction of the quality control system of medical examination cases in 2018, revealed a marked decrease (by 27.0%) in the defects in determining risk factors for chronic non-communicable diseases and indications for prescribing II stage MEAP measures. For other defects, a marked decrease by 5.2%–17.3% was revealed. Nevertheless, the leading positions were retained by defects in prescribing stage II measures (34.5% of the analyzed expert cards) and in determining risk factors for chronic non-communicable diseases (26.5% of the analyzed expert cards), which requires continuation of the work on MEAP control quality as part of the internal control of quality and safety of the medical activities. CONCLUSION: Expert integration of the assessment of organization and introduction of MEAP and of the internal system of control of the quality and safety of medical activities led to a reliable reduction of the number of defects according to the results of expert assessment of medical examination cases.

Association of GUCY1A3 (rs7692387), CYP2C19*2 (rs4244285), CYP2C19*3 (rs4986893) gene polymorphism with antiplatelet drug metabolism and prognosis of cardiovascular complications

Introduction: The identification of predictors for resistance to antiplatelet drugs including the search for new gene polymorphisms responsible for the development of the pathological process is an important direction to reduce the risk of complications after cardiac surgery and improve postoperative prognosis. Objective: The study was aimed at investigating the available data on the molecular genetic markers GUCY1A3 (rs7692387), CYP2C19*2 (rs4244285), CYP2C19*3 (rs4986893) and their association with antiplatelet drug metabolism and adverse outcome after cardiac surgery.Methods: The systematic review was conducted in accordance with the PRISMA criteria. The search was performed in databases Medline (PubMed), Google Scholar and the Russian Science Citation Index using queries and keywords. During the first selection, 3,210 results were obtained. The final analysis included 21 studies conducted between 2004 and 2024.Results: Since 2017 a number of studies have revealed the association of GUCY1A3 gene polymorphism with a high risk of cardiovascular diseases, as well as with an abnormal reaction to acetylsalicylic acid. The mechanism of the pathological process was related to the impact of gene polymorphism on vasoreactivity, platelet aggregation and, as a consequence, on the risk of thrombotic complications.Polymorphisms of CYP2C19*2 and CYP2C19*3 were the most common variants of alleles that reduced clopidogrel metabolism and increased the risk of cardiovascular events. However, therapy based on CYP2C19 genotyping requires a more detailed investigation with the inclusion of ethnic, demographic and socio-economic factors in the analysis.Conclusion: Resistance to acetylsalicylic acid, clopidogrel and other antiplatelet drugs depends on many genetic factors. Further investigation of the GUCY1A3 and CYP2C19 gene polymorphisms is promising for the development of algorithms for genotype-oriented antiplatelet therapy, the introduction of which into medical practice will reduce the number of complications after cardiac surgery and improve the quality of medical care. Received 16 September 2024. Revised 2 November 2024. Accepted 5 November 2024. FundingThe study did not have sponsorship. Conflict of interestThe authors declare no conflict of interest. Contribution of the authorsConception and study design: A.V. Kurguzov, O.V. KamenskayaData collection and analysis: I.Yu. Loginova, A.S. Isaev, D.V. DoroninDrafting the article: I.Yu. Loginova, A.S. KlinkovaCritical revision of the article: O.V. Kamenskaya, A.M. ChernyavskiyFinal approval of the version to be published: I.Yu. Loginova, A.V. Kurguzov, A.S. Isaev, O.V. Kamenskaya, D.V. Doronin, A.S. Klinkova, A.M. Chernyavskiy

Assessment of Satisfaction with Knowledge and Practical Skills in the Discipline “Otolaryngology” of Graduates of the Specialty 222 “Medicine” and Interns of the Specialty “Otolaryngology”

One of the main tasks in the health care system is the improvement of personnel policy. The qualification of the healthcare workforce is one of the most important components of ensuring the quality of medical care, along with their effective distribution, appropriate number, age structure, and motivation to work, in line with the medical needs of the population. The objective: to assess the level of undergraduate training in the discipline “Otolaryngology” by graduate persons of the specialty “Medicine” and interns of the specialty “Otolaryngology”. Materials and methods. During the study it was determined whether graduates and interns were satisfied with the duration and scope of the training program in the discipline “Otolaryngology”, the level of knowledge and practical skills in otolaryngology obtained at the undergraduate level, and also analyzed the respondents’ desire to improve their knowledge and practical skills after completingh teir studies. 174 graduates of higher education institutions of Ukraine and 103 interns who studied before internship in nine different higher medical educational institutions took part in the study. The respondents were quite young people: the average age of graduates was 22.4±2.3 years, interns – 23.6±1.9 years. During the analysis, sociological, medical-statistical, analytical, generalization, graphic research methods were used. Results. It was found that only 51.1% of graduates were satisfied with the level of theoretical knowledge, 62.1% – with the level of practical skills, 25.6% and 14.0% of graduates were partially satisfied, respectively, and 23.3% and 23.9% persons were dissatisfied, respectively. Only 37.4% of interns were satisfied with the level of theoretical knowledge, 15.9% – with the level of practical skills, partially satisfied – 9.1% and 27.7% of these respondents, respectively, dissatisfied 33.5% and 56.4% of interns, respectively. Data differences in both groups were significant (p < 0.05). All respondents had a desire to improve their knowledge and skills in otolaryngology, most of them – in emergency conditions and inflammatory diseases. Conclusions. The results of the study showed a low level of readiness to provide high-quality medical care in the conditions of real clinical practice by graduates of higher education institutions and interns, which indicates shortcomings in the organization of training and control of knowledge in this discipline at specialized departments and clinical bases.

Current status and factors associated with sexual harassment among operating room nurses: a multi-center cross-sectional study.

The purpose of this study was to investigate the prevalence of sexual harassment among operating room nurses, and to analyze the influencing factors. Sexual harassment in the healthcare field has a high incidence and nurses are the main victims; sexual harassment not only leads to physical and mental problems, but also undermines nurses' performance and affects the quality of medical care. A multi-center cross-sectional study was conducted using an online survey to investigate the sexual harassment experiences of 483 operating room nurses. The survey included demographic information, personality traits (Ten-Item Personality Inventory), sexual harassment experiences (Workplace Sexual Harassment Questionnaire), negative consequences, coping strategies, and social support status. 63% of operating room nurses experienced sexual harassment in the past 12 months, with gender harassment predominating (56.7%), followed by unwanted sexual attention (28.6%) and sexual coercion (13.6%). Surgeons (81.20%) and married ones (66.7%) were the most common perpetrators. Most victims possess limited knowledge regarding sexual harassment laws and exhibit weak awareness of their rights protection. 47.8% remained silent after being sexually harassed; most of nurse employed passive coping strategies. Sexual harassment had the most prominent impact on the work of operating room nurses, mainly in the form of decreased work quality and efficiency (87.3%), as well as decreased work engagement (77.0%) and negative workplace pressure experience (72.2%); emotional disturbances, such as anxiety (76.6%), stigma (71.8%), and fear (71.5%); and was accompanied by sleep disorders (74.9%), headaches (56.0%) and nausea and vomiting (54.3%); as well as reduced trust in the opposite sex (83.8%) and disruption of family life (82.1%).Only 39.2% of the hospitals had sexual harassment reporting channels or methods, 30.7% had departments to deal with sexual harassment in the workplace, and 46.8% had communication discussions about psychological safety after sexual harassment. Personality traits, drinking behaviour, age, marriage, and social support were associated with sexual harassment behavior in the operating room. The high incidence of sexual harassment in the operating room affects nurses' productivity and physical and mental health. Operating room nurses had insufficient legal knowledge about sexual harassment and lacked hospital organizational support. agreeableness and openness personality traits, alcohol consumption, age, being married, and lack of social support were influential factors of sexual harassment in the operating room. Healthcare organizations should encourage reporting, care for victims, and join with the police department, judiciary, and women's federation to develop reporting procedures and training programs on sexual harassment knowledge to create a safe and comfortable professional environment.

Variations in physiological responses to painful stimuli in preterm and term neonates: an observational study

Background: Appropriate neonatal pain assessment and management is a key component of quality medical care. Assessment of pain, however, is a challenge due to their inability to verbalize this subjective sensation. Preterms are hyper-sensitive to pain and experience it for prolonged periods but it is postulated that they may not express it as robustly and reliably as term neonates. This paper aims to assess and compare the behavioral and physiological pain responses in these groups. Methods: This prospective observational study was conducted in the outpatient and post-natal wards of a tertiary care teaching hospital. 90 clinically stable term and late preterm neonates requiring IV cannulation, IV blood sampling or heel prick were included. NIPS Pain Scale Scores and physiological parameters (heart rate, respiratory rate, SpO2, mean arterial pressure, total crying time) were recorded before and after the procedure. Results: 90 neonates were analysed. Significant pain response was noted in both groups post-procedure. In response to the same procedures, preterm neonates demonstrated lower NIPS Scores (4.00 vs. 4.93, P=0.003) and shorter cry times (64.30s vs. 87.35s, P=<0.05). Also noted were higher heart rates and respiratory rates with a prolonged fall in SpO2 and Mean Arterial Pressures in this group. Conclusions: Preterms, compared to term neonates demonstrate a blunted behavioral response to pain but a heightened and prolonged physiological response. This potential underestimation of pain in preterms indicate the need for incorporation of behavioral cues, physiological parameters and gestational age in the assessment of pain in newborns.

Characteristics of therapeutic and diagnostic errors in the management of traumatic brain injury by healthcare professionals: insights from forensic medical examinations on the quality of medical care

Characteristics of therapeutic and diagnostic errors in the management of traumatic brain injury by healthcare professionals: insights from forensic medical examinations on the quality of medical care

On the issue of quality of medical care for patients with diabetic retinopathy.

On the issue of quality of medical care for patients with diabetic retinopathy.

Chronic pelvic pain: modern approaches to diagnosis, treatment and routing of patients

Chronic pelvic pain is an urgent problem for many patients. A multidisciplinary approach and proper routing of patients will improve the quality of medical care, patient satisfaction with medical care, as well as the quality of life of patients. This article discusses the probable mechanism of origin and pathogenesis of chronic pelvic pain, criteria for differential diagnosis, as well as treatment options for pain syndrome. Evaluation of the effectiveness of these treatment methods is evaluated according to standard scales and questionnaires.

Neuroinflammation as an Integral Component of Neurodegeneration in Parkinson's Disease

Parkinson's disease (PD) is a progressively advancing neurodegenerative disorder, the pathogenetic mechanisms of which remain poorly understood. The disease is characterized by the degeneration of dopaminergic neurons in the substantia nigra of the midbrain. Given the improvement in the quality of medical care provided to the population, it is projected that the total number of patients diagnosed with PD worldwide will rise to 8.7 million by 2030. This review addresses the fundamental aspects of neuroinflammation in the context of PD pathogenesis. There is no doubt that pro-inflammatory immunological mechanisms play a critical role in the onset and progression of the disease. Neuronal-derived cells, such as microglia and astrocytes, act as inducers of neuroinflammation, affecting the permeability of the blood-brain barrier to peripheral immune-competent cells. Furthermore, cytokine patterns of the immune response in PD appear to exist. Potential therapeutic approaches for mitigating neuroinflammation in PD, which have been studied in experimental and in vitro models, are also discussed.

Outpatient visits and treatment methods of patients with hand and wrist injuries in Vreden National Medical Research Center of Traumatology and Orthopedics

Background. Number of injuries of the hand and wrist is constantly growing from year to year. Inpatient treatment of these patients increases both time and financial costs for healthcare organizations. Thus, analysing the structure of patients who applied to the emergency department would make it possible to take more objective decisions on the organization of healthcare delivery. The aim — to analyse outpatient visits and treatment methods of patients with hand and wrist injuries who applied to the emergency department of the Vreden National Medical Research Center of Traumatology and Orthopedics. Methods. A sample of 18.848 patients who applied to the emergency department with hand and wrist injury in the period from 2020 to 2023 was drawn in the database of the Medialog medical information system of the Center. Results. The most common types of hand and wrist injuries were: metacarpal and phalangeal fractures, damage to the skin and subcutaneous tissue, damage to the finger flexor tendons and nerves. Of the operations performed, K-wire osteosynthesis and primary suture of the extensor or flexor tendons of the fingers were most often used. Significantly less common were the following operations: primary surgical debridement, suture of nerves and blood vessels, replantation and revascularization. About 20% of patients with hand injuries can receive emergency medical care in emergency rooms of Saint Petersburg, thereby reducing the queue for surgical service in the Center’s emergency department. Conclusion. Treatment of patients with hand and wrist injuries requires comprehensive approach involving doctors of various specialties at each stage of the treatment. Proper organization of such patients’ treatment will significantly improve the quality of medical care and the treatment outcomes.

The impact of emotional burnout in psychiatrists on the outcomes of the care they provide

The quality of medical care largely depends on the mental well-being of medical staff. One of the most common manifestations of work-related distress is emotional burnout syndrome (EBS). The emotional burnout in psychiatrists is favored by many specific work factors.Objective: to investigate the relationship between EBS in psychiatrists and the outcomes of the care they provide.Material and methods. Eighty-two psychiatrists working in psychiatric clinics in Moscow took part in the study. They completed the Maslach Burnout Inventory on their own. Two hundred medical records of hospitalized patients suffering from paranoid schizophrenia were selected. A total of 100 patient records of psychiatrists with emotional burnout and 100 patient records of psychiatrists without emotional burnout were analyzed.Results. Emotional burnout was found in 25.6% of psychiatrists. In cases of emotional burnout, psychiatrists were more likely to prescribe anticholinergic corrective medication for extrapyramidal symptoms (61% versus 44%; p=0.023). The presence of emotional burnout in psychiatrists correlated with a longer duration of hospitalization of patients they cared for (31.2 versus 29 days; p=0.004) and with more frequent polypharmacy (67% versus 51%; p=0.031).Conclusion. Emotional burnout in psychiatrists has a negative impact on the quality of care they provide.

Trends and tools for the digital transformation of healthcare in the Republic of Crimea

Subject. This article discusses the issues related to the large-scale digital transformation of the economy of the Russian Federation and the problems of increasing labor productivity. Objectives. The article aims to develop tools to improve the socio-economic efficiency of the healthcare system in the Republic of Crimea. Methods. For the study, I used the methods of logical and statistical analyses. Results. The article determines that the formation of an information and technical base that ensures the effective distribution and use of resources while improving the quality and speed of medical care will contribute to the success of digital transformation in the healthcare sector of the Republic of Crimea. Conclusions. Reducing the bureaucratic burden, improving the quality of interdepartmental cooperation, optimizing time and labor costs for the provision of medical care are the main tasks for the healthcare industry of the Republic of Crimea.

The Importance of Pre-Anesthetic Evaluation in Patient Safety: A Systematic Review

Background: Pre-anesthetic evaluation is the initial stage of anesthesia procedures for patients. This evaluation involves elucidating the patient's medical history, determining patient readiness, screening for undisclosed disorders, and identifying risk factors. Safety measures help mitigate patient-related risks within medical environments. The aim of this study is to investigate the role of Pre-anesthetic evaluation in patient safety. Methods: The present study was a review conducted in the year 2024. Databases including PubMed, Direct Science, MEDLINE, Proquest, SID, Scopus, Google Scholar, Magiran, and library resources were searched using keywords such as Pre-anesthetic evaluation, pre-anesthetic visit, anesthesia clinic, patient safety, and their English equivalents. A logical combination of these keywords was performed using "OR," "AND," and "NOT" operators. The search was conducted in relevant articles from the year 2000 to January 2024. Results: Initially, 22,000 articles were screened, and ultimately, 16 relevant articles were used for preparing this paper. In all the reviewed articles, pre-anesthetic evaluation played a key role in patient safety. Conclusions: Studies indicate that pre-anesthetic evaluation is a key improver of surgical outcomes. These measures not only mitigate potential risks but also enhance surgical outcomes. Overall, pre-anesthetic evaluation has a direct correlation with patient safety, playing a significant role in postoperative improvement and elevating the quality of medical care.

Results of a non-interventional multicenter observational study on the diagnosis and treatment of patients with axial psoriatic arthritis in rea-world clinical practice in the Russian Federation (NiSaXPA)

Objective: The aim of the NiSaXPA study is to evaluate the quality of diagnosing, socio-demographic characteristics and treatment tactics of patients with axial psoriatic arthritis (axPsA) in real-world clinical practice in the Russian Federation.Material and methods. The study involved 600 patients from 21 clinical centers in the Russian Federation.Results and discussion. The diagnosis of axPsA was confirmed in 357 (59.5%) of 600 patients according to the centralized expert assessment. All 357 patients with axial lesions met criteria of the clinical guidelines for the treatment of patients with PsA. Of these, 201 (69%) patients had radiologically significant sacroiliitis (SI) according to Kellgren and 103 (59.2%) had active SI according to magnetic resonance imaging. The presence of syndesmophytes was confirmed in 119 (43.9%) patients. Inflammatory back pain was observed in approximately 80% of patients, most commonly in the lumbar and cervical spine. "Silent" sacroiliitis were found in 1.1–3.5 % of cases. 26.8% of patients were positive for HLA-B27. In the 6 months prior to the study, high PsA activity was present in 21.6% of patients according to the rheumatologist's assessment, while high activity according to the BASDAI index was found in 71.9 % of patients, and moderate and high activity according to the DAPSA index – in 82.7%. On the 24th week of observation, the number of patients with low activity according to BASDAI doubled and reached 66.3 %, while low activity and remission according to the DAPSA index amounted to 52.5% and 8.1% of patients, respectively. In most cases (about 27%), patients with axial manifestations were prescribed interleukin (IL) 17A inhibitors, about 14% of patients received tumor necrosis factor-α inhibitors, and about 4% received IL23 inhibitors.Conclusion. In 40.5% of patients, axial skeletal involvement in PsA was over-diagnosed due to misinterpretation of clinical and imaging data. The vast majority of patients (77%) were treated with synthetic disease-modifying antirheumatic drugs, mainly methotrexate, which do not affect the activity of spondylitis. Biologic disease-modifying antirheumatic drugs (bDMARDs) were taken by 46.5% of patients. Switching therapy to bDMARDs led to a significant reduction in disease activity.In order to improve the quality of medical care, the Russian clinical guidelines for the treatment of patients with PsA and the algorithms for the diagnosis of axial involvement need to be comprehensively implemented.