Study of the Quality of Medical Therapy and Adherence in Patients with Chronic Heart Failure (According to the COMPLIANCE Study)

Aim. Assess the medical therapy quality in patients with chronic heart failure (CHF) and patients' adherence to the treatment depending on the previous observation in a specialized medical center as part of an of an outpatient registry.Materials and methods. An analysis of the medical therapy quality in patients with CHF was carried out as part of the COMPLIANCE prospective observational study (NCT04262583). 72 patients with CHF verified according to the protocol were included in the study. The average age of the patients was 69.1±9.5 years (31% of women and 69% of men). Patients were divided into groups: those who first applied to a specialized department during the period of the study inclusion, or those who were previously observed in a specialized department. The general adherence assessment to medical therapy was carried out using the original questionnaire «The adherence scale of the National Society for Evidence-Based Pharmacotherapy» which was supplemented with questions to assess the actual adherence to specific medical drugs recommended for patients with CHF.Results. According to the results of the study, beta-blockers were prescribed to 70 (97.2%) patients. Angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) were recommended in 68 (94%) patients. Mineralocorticoid receptor antagonists were included in therapy in 6 out of 9 patients who were shown to be prescribed (66.6%). The choice of medical drugs within the group was not always adequate. For example, ACEi/ARBs with proven efficacy in patients with CHF were prescribed only in 72% of patients. Comparative analysis of adherence to medical therapy between patients of the selected groups demonstrated a higher adherence to the recommended therapy in patients who were previously observed in a specialized center.Conclusion. The medical therapy quality for patients with CHF doesn't always comply with current clinical guidelines. The choice of a medical drug within a group is not always adequate. Regular observation in a specialized center contributes to a higher adherence to the recommended therapy.

Development of National Arthroplasty (Results of 30-Year Research)

Development of modern arthroplasty in Ukraine, according to Academician of the National Academy of Sciences and the National Academy of Medical Sciences of Ukraine O.O. Korzh, began thanks to the activities of O.Ye. Loskutov (Dnipro) who managed to create his own Ukrainian endoprosthesis on the basis of the relevant enterprises of the city and establish specialized endoprosthetic clinic. The article reflects 30 years of experience in the de velopment of national arthroplasty. To solve the problem of development of national arthroplasty, the Orthopedic Joint Replacement initiative program (ORTEN) has been developed. For this purpose, an intersectoral problem laboratory was created which united the efforts of the scientists of different specialties and key enterprises of the Dnipro region. Biomechanical researches on native studying of mechanical properties of articular sites of bones have been carried out through mathematical modeling. Estimation of a stress-strain state of subchondral, spongy bone and various sites of long bones in "bone-implant" system has been carried out in order to define primary and secondary stability of different kinds of the developed im plants. Numerous biochemical, histochemical and toxicological studies on laboratory animals have been performed to evaluate the effects of implant materials and the developed types of protective coatings. X-ray morphometric and anthropometric studies of articular surfaces of bones were used in various pathologies of the joints for the development of implants; technical methods were used to assess the mechanical properties of implants under load. The developed designs of endoprostheses have passed certification and have been brought into pro duction. Clinical introduction of domestic endoprostheses was implemented in the Ukraine’s first specialized department of joint arthroplasty which was opened in Dnipro. The developed methods and methodological support for the use of the elaborated designs of endoprostheses allowed to organize the basic training of Ukrainian specialists through the Basic Course of Prof. O.Ye. Loskutov which was taken by almost 350 Ukrainian orthopedists.

10 EFFECT OF SUBSPECIALTIES OF GASTRO-INTESTINAL SURGERIES ON PATIENT’S OUTCOMES

Subspecialty policy is increasing all over the world aiming to improve the results of heavy esophageal surgeries. Our aim is to define the impact of having surgical specialized esophageal unit on the volume of patients and the results. Methods We reviewed all esophageal cases managed in our esophageal specialized department (from May 2016 to May 2019 Group A) and we compared the results to previous 3 years (from May 2013 to May 2016 Group B) and to the international results. There was 394 cases in group A compared to 104 cases in group B. Results For Gastro esophageal reflux disease (GERD),180 operations were performed in group a (45.7%) compared to 61 cases in group B (68.7%). Forty two (10.7%) modified Heller’s cardiomyotomy (Open and laparoscopic) for achalasia were performed in group A compared to 17 cases (16.3%) in group B. Surgeries for malignant lesions were performed for 122 cases (30.9%) in group A compared to 13 cases (12.5%) in group B. Other Esophageal operations were also done for 50 cases (12.7%) in group A compared to 13 cases (12.5%) in group B. Morbidities and mortalities are reported and compared to the international results. Conclusion Our results in group A are comparable to Hospital mortality rates for patients in medium-volume centers (7.5%). Also we approach the International results for morbidities of benign esophageal disease (5.7–12.7%) for fundoplication. Having a specialized esophageal unit resulted in increase of the volume of patients and improvement of the results.

Motivative measures aimed at increasing the efficiency of labor of medical workers

The aim of the study is to correct the motivational activities of the specialized department and the department of general practitioners of the Samara City Polyclinic No. 10. Results:.The comparison of the factors that form the attitude to work in the medical and nursing staff of the specialized department and the department of general practitioners; the zones of tension of satisfaction with work of the medical and nursing staff of the department of general practitioners were identified; the zones of tension of satisfaction with work of the medical and nursing staff of the specialized department were identified; the ranking of the zones of tension of dissatisfaction with the factors of the working environment for all groups of respondents was carried out. Conclusion. Correction of motivational measures made it possible to formulate practical recommendations to improve the efficiency of the work of medical workers.

Lyell´s syndrome provoked by external drug use

Lyells syndrome is rare. Up to 10 cases are registered per million population per year. The mortality rate for Lyells syndrome is 512%. Two patients were observed aged, respectively, 38 years and 72 years with Lyells syndrome. The disease manifested itself against the background of local application of drugs. In one case ― Dolobens gel as an analgesic at the site of a bruise of the right hand. In another case, a 20% solution of chlorohxidin biogluconate as a mouth rinse for stomatitis. The first symptoms of the disease occurred locally at the site of application of these medicines. In the first case, the skin of the right hand, in the second ― the mucous membrane of the mouth. The outcome of the disease depended on early diagnosis, urgent hospitalization in a specialized department, from the area of skin lesions, the appointment of adequate therapy. Lyells syndrome can occur at any age, and the risk of developing the disease increases in those over the age of 40. In the elderly, SL in terms of the first symptoms and rate of disease progression, the nature of skin and mucous membrane lesions does not have any fundamental differences with those in younger patients. The distinctive features and risk factors of Lyells syndrome in the elderly include, firstly, its occurrence against the background of the already formed comorbid age-related pathology of internal organs, secondly, the concomitant age-related pathology during the development of an acute toxic-allergic reaction is decompensated, a multiorgan failure is formed, which is the cause of more severe Lyells syndrome and higher mortality. In young people, a comorbid viral infection can be considered a risk factor, especially the combination of HIV-infection and chronic hepatitis C.

Traditions and digital innovations in training students for the profession of an advocate at a specialized department in a law university

The article is devoted to the research of traditional and innovative methods of educating future attorneys. The author analyzes ways which teachers of the Kutafi n Moscow State Law University use to help students to gain essential knowledge in law and in advocacy activity, prepare for the bar-exam and shape required professional skills. The author pays attention to the current active development of the corporate digital advocacy ecosystem including the introduction of digital technologies into the practice of passing the bar qualifi cation exam. The article investigates one of the possible algorithm designs that a bar qualifi cation contender should follow starting from the submission of documents to a regional bar chamber and up to the passing the bar qualifi cation exam. The author gives successful examples of student training through distant learning technologies, such as expert venues organized and conducted by the Department of Legal profession, scientifi c project groups, scientifi c and practical conferences, and also tells about the legal clinic “Pro Bono”, which operates at the O. Е. Кутафafi n Moscow State Law University and which involves teachers of the Department of Legal profession who help students master the necessary skills for their future jobs.

Considering the Process of Debt Collection in Community Corrections: The Case of the Monetary Compliance Unit

Monetary sanctions levied on individuals on probation and parole may dramatically influence their ability to reintegrate into the community and to complete their community supervision. Yet very little work has empirically assessed how agencies respond to these obligations. This is critical, given that individuals under community supervision occupy a liminal space: free in the community yet often at risk of violation, rearrest, additional fines, or re-incarceration. In this article, we introduce an approach to the collection and management of monetary sanctions by an adult probation and parole agency in one Pennsylvania county. This specialized department focuses solely on repayment of fines, fees, and costs for a subset of probationers and parolees who have completed all other supervision requirements. We complement the conceptual overview by presenting administrative data on this caseload ( N = 5,811) to describe the population under supervision and assess the factors associated with debt amount, having difficulty with repayment, and being the subject of an enforcement action for non-payment. We conclude with a discussion of the advantages and disadvantages of this model compared with historical and other existing models of debt enforcement during community supervision.

The 100th anniversary of the Ural Higher School of Mine Surveying

The article contains the historical note on the establishment and development of the Ural Higher School of Mine Surveying, the department of Mine Surveying of the Ural State Mining University, within 100 years of existence. The founder and the first chairperson was P. K. Sobolevskii. D. N. Ogloblin, G. I. Vilesov, P. A. Ryzhov, A. A. Igoshin, P. P. Bastan, G. L. Fisenko, I. M. Petukhov and many other renowned scientists and production workers were the graduating students of the department. It is the specialized department training surveyors in the Urals and Western Siberia.

Surgical complications of peritoneal dialysis in children with acute kidney failure

The dialysis department of the Childrens City Multidisciplinary Clinical Specialized Center for High Medical Technologies has been operating since 1977 and is the only specialized department in the North-West Region of the Russian Federation that provides assistance to children with both acute and chronic renal failure. Peritoneal dialysis is the treatment of choice for children with acute renal failure, the most common cause of which is hemolytic-uremic syndrome. Despite widely used measures to improve the results of peritoneal dialysis, complications are extremely common. The article analyzes the complications of peritoneal dialysis in children with acute renal failure who were treated in a hospital from 2008 to 2018. The emphasis in the study is on the analysis of complications of peritoneal dialysis, in the treatment of which the surgeon actively participated or should have taken part in. If the problem of acute renal failure is multidisciplinary in the sense that it requires the participation of nephrologists, resuscitators, infectious disease specialists, then if necessary, renal replacement therapy requires the surgeon to become not only a specialist providing access, but also a full-fledged participant in the treatment process. As follows from the foregoing, the surgeons actions depend not only on the quality of dialysis, but also the timeliness and adequacy of treatment of complications, which ultimately improves or worsens the quality of medical care in general.