535 research outputs found
The problem of obesity «through the eyes» of patients (results of the survey of patients of the outpatient registry)
Aim. To assess, based on the results of the questionnaire, patients' awareness of the presence, possible causes and health effects of overweight /obesity; to determine patients' self-assessment of their own weight, information about the methods used to treat the disease, adherence to therapy.Material and methods. The survey of patients of the outpatient registry was carried out as part of a face-to-face visit of inclusion in the observational study of EVA using a specially designed questionnaire. Out of 582 patients of the PROFILE registry who came for a visit in the period from 08.04.2019 to 24.03.2020, 295 people with a body mass index (BMI) were included in the study>25 kg/m2.Results. According to the BMI values, the patients of the study cohort were divided into 4 groups: 108 (36.6%) with pre-obesity, 124 (42.1%) with class I obesity, 42 (14.2%) with class II obesity, 21 (7.1%) with class III obesity. With an increase in the class of obesity, the number of patients who admit the presence of this pathology in self-assessment increases (p<0.0001): 26.6% of patients with grade I obesity, 47.6% with grade II obesity and 81% of patients with grade III obesity gave correct answers. Among the possible causes of overweight/obesity, every third patient of the study indicated physical inactivity (31.3%) and every fifth specified excessive nutrition (20.8%). The majority of patients, 244 (82.7%), believe that being overweight worsens their health, the same number of patients, 255 (86.4%), are sure that they need to lose weight. The most common (70% of responses) for weight loss patients used various dietary restrictions, fasting, only 17% of patients increased the level of physical activity. Frequent violation of the principles of rational nutrition was revealed (insufficient amount of fruits and vegetables in the diet, salting food, eating a large amount of easily digestible carbohydrates. One hundred and thirty nine (47.1%) patients noted that it was difficult for them to observe any restrictions in food, to adhere to a diethalf of all patients and 70% of patients with class III obesity experience a constant feeling of hunger. Of the 25 patients to whom pharmacotherapy was recommended, 21 (84%) people were adherent.Conclusion. Overweight and obese patients are not always critical of self-assessment of their body weight, and the main reasons for being overweight or obese considered to be inactivity and various violations of the principles of rational nutrition. The patients of the study cohort were characterized by eating disorders and half of the patients showed signs of food addiction. Recommendations for the pharmacotherapy of obesity were received by less than 10% of patients in the study cohort, while the patients' adherence to drug therapy was high
Assessment of the Quality of Drug Therapy in Patients with Stable Coronary Artery Disease in the Second Stage of the ALIGN Study
Aim. To assess adjusted pharmacotherapy for prescribing drugs of the main classes, according to clinical guidelines, and achieving target levels of lowdensity lipoprotein cholesterol (LDL-C) in patients with stable coronary heart disease (CHD).Material and methods. Of the 73 patients included in the ALIGN study, 64 patients (53 males and 11 females; mean age 68,2±9,4 years) with stable coronary artery disease attended a second visit (3 months after the initial treatment adjustment). Prescribed drug therapy, its compliance with clinical guidelines, achievement of lipid profile and blood pressure (BP) targets were studied in all patients.Results. An increase in the frequency of taking beta-blockers (p=0.002), lipid-lowering drugs (p=0.008) by patients was found during the second visit. The proportion of patients taking all 4 groups of drugs according to clinical guidelines (statins, antiplatelet agents, beta-blockers, angiotensinconverting enzyme inhibitors / angiotensin II receptor blockers) increased from 44% to 65.5% (p<0.001) after correction of therapy, as well as an increase in the proportion of patients taking 1 antianginal drug in the presence of exertional angina from 75% to 89% (p<0.001) was found. About 90% of hypertensive patients achieved the target level of systolic blood pressure (p<0.001). Achievement of the target level of cholesterol low density lipoprotein (<1.8 mmol/l) during the second visit was found in half of the patients (p=0.004).Conclusion. Despite the initial correction of drug therapy by the staff of the cardiology department, the prescribed treatment for patients with stable coronary artery disease did not in all cases comply with clinical guidelines due to insufficient adherence of doctors and insufficient adherence of patients to prescribed medical recommendations.Working group of the register PROFILE: Voronina V. P., Dmitrieva N. A., Komkova N. A., Zagrebelny A.V., Kutishenko N.P., Lerman O.V., Lukina Yu. V., Tolpygina S.N., Martsevich S.Yu
The Study of Adherence to Drug Therapy at the Stage of Outpatient Follow-up in Patients with Acute Myocardial Infarction (Data from the PROFIL-IM Registry)
Aim. To assess adherence to the recommended therapy at the stage of outpatient follow-up and its impact on long-term outcomes in patients after acute myocardial infarction based on the materials of the prospective PROFILE-IM registry.Material and methods. The PROFILE-IM register included 160 patients who applied to one of the polyclinics in Moscow after a myocardial infarction. The combined endpoint (CE) included death from any cause, cardiovascular events (nonfatal myocardial infarction, nonfatal cerebral stroke), emergency hospitalizations for cardiovascular diseases, significant cardiac arrhythmias. Patients' adherence to therapy was assessed using the original questionnaire "Scale of Adherence of the National Society of Evidence-based Pharmacotherapy" (NODF) and a direct standardized patient survey by a doctor about taking medications. Visits to the doctor were carried out every two months, data from the first year of patient follow-up are presented.Results. In a personal interview with a doctor, the ratio of the proportion of committed, partially committed and non-committed patients did not change significantly over the entire follow-up period, while the proportion of committed patients was 81-85%. The "NODF Adherence Scale" showed that the proportion of non-committed patients was about 10 times higher than with direct patient responses to the doctor, and the proportion of non-committed and partially committed patients remained high at all stages of follow-up (respectively 28% and 10% at the beginning of the study, 18% and 10% at the end of the study). Among the main factors of non-commitment, there was a decrease in the importance of forgetfulness and an increase in factors such as fear of side effects of medications, doubt about the need for long-term use of medications and well-being. A direct relationship of adherence with the male sex, the presence of hypertension, a feedback relationship with alcohol consumption was revealed. The risk of CE in non-committed patients was higher compared to the group of committed and partially committed patients (p<0.01).Conclusion. The proportion of non-committed and partially committed patients remained high at all stages of follow-up. There was a direct relationship between adherence to therapy with the male sex, the presence of hypertension in the anamnesis, and a feedback relationship with alcohol consumption. Low adherence to therapy significantly increased the risk of cardiovascular events
Secondary Prevention and Quality of Life of Patients with Stable Coronary Heart Disease
Aim. To assess the quality of life of patients with stable coronary heart disease (CHD) initially and 12 months after drug and non-drug secondary prophylaxis according to clinical guidelines.Material and methods. 73 patients (57 men, 16 women) with confirmed stable coronary artery disease were included in the study, of which 44 patients described a clinic for angina pectoris of functional class I-IV. The study included 2 patient visits: an initial treatment visit (V0) and a repeat visit after 12 months (V2). At both visits, blood pressure (BP), low-density lipoprotein cholesterol (LDL-c), quality of life (QL) were assessed using SAQ (Seattle Angina Questionnaire), drug therapy. Compliance with 5 basic principles of prevention was also assessed, which included: (1) healthy lifestyle (healthy lifestyle) (rejection of bad habits (smoking), moderate physical activity, lowcholesterol and low-carb diet); (2) normalization of body weight; (3) optimal drug therapy (the frequency of taking medications was evaluated using the original questionnaire); (4) achievement of target values of LDL-c in the entire group; (5) blood pressure in hypertensive patients. During V0, if necessary, drug therapy was adjusted in accordance with clinical recommendations. During V2, 57 patients (47 men and 10 women) were examined. The response was 80.8%.Results. After 12 months of follow-up, a statistically significant improvement in exercise tolerance (p=0.003), angina stability index (p=0.045) and the frequency of stress angina attacks (p=0.003) was noted when assessing the median of QL indicators. After 12 months of follow-up, 59% of patients used optimal drug therapy, including 4 drugs according to clinical guidelines. A healthy lifestyle (regular physical activity and smoking cessation) was achieved in 20.4% after 12 months of follow-up, the target level of LDL-c ˂ 1.8 mmol/L was achieved in 44.5% of patients, and the target blood pressure was achieved in 74,6%. The achievement of all 5 principles of secondary prevention of coronary heart disease according to the results of the work carried out by the visit after 12 months of follow-up was revealed only in 7% of patients (4 patients), and the implementation of 4 principles of prevention was noted in a quarter of patients from the group (24.5%, n=14).Conclusions. With drug and non-drug secondary prevention of coronary heart disease in patients with stable CHD after a year of follow-up, a statistically significant increase in QL indicators was noted due to increased exercise tolerance and a decrease in the frequency of angina attacks. Nevertheless, the basic principles of prevention were fully implemented only in 7% of patients
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
Detection and Treatment of Hyperuricemia in Clinical Practice (According to the PROFILE Outpatient Registry)
Aim. To study the frequency of detection of hyperuricemia (HU) in patients with high and very high cardiovascular risk and the frequency of prescribing drugs that lower serum uric acid (sUA) levels in real clinical practice.Material and methods: The general information of the study was based on the data of 2457 patients who were consistently included in the «PROFILE» registry until November 30, 2020: 1250 men (50.9%) and 1207 (49.1%) women. All patients with HU were selected (UA level ≥360 pmol/l in women, ≥420 pmol/l in men). At the stage of inclusion of the patient, data on MC indicators were available in 1777 (72.3%), upon re-examination - only 262 (33.2%) out of 790 patients who returned to the appointment.Results: The most common study of the level of sUA was performed in patients with gout (65.2%), with arterial hypertension (AH) and dyslipemia in 29.1% of cases, with diabetes mellitus (DM) - 30.1%, with impaired tolerance to glucose (IGT) - 40.2%, with other diseases, the proportion of patients with a known UA was even less. A positive relationship was found between the presence of AH and IGT with the frequency of UA control (p<0.001). In patients with AH, an increase in the level of sUA was detected significantly more often than in patients without AH (p<0.001), and less frequently in patients with DM and IGT (p<0.001 and p<0.01, respectively). The frequency of allopurinol prescribing was low: 49 (2%) patients received therapy, while of the 284 patients with HU, only 20 (7%) were prescribed allopurinol.Conclusion: in real clinical practice, only 29.1% of patients with AH and 20-25% of patients with other CVDs were monitored for sUA levels, every third patient had data on sUA levels at a repeat visit. In the presence of gout, the proportion of patients with current UA was higher (65%). For those with AH and IGT, positive correlations were found between the presence of the disease and control of sUA levels. A low frequency of prescribing drugs for the correction of HU was revealed
Combined QCD and electroweak analysis of HERA data
A simultaneous fit of parton distribution functions (PDFs) and electroweak
parameters to HERA data on deep inelastic scattering is presented. The input
data are the neutral current and charged current inclusive cross sections which
were previously used in the QCD analysis leading to the HERAPDF2.0 PDFs. In
addition, the polarisation of the electron beam was taken into account for the
ZEUS data recorded between 2004 and 2007. Results on the vector and
axial-vector couplings of the Z boson to u- and d-type quarks, on the value of
the electroweak mixing angle and the mass of the W boson are presented. The
values obtained for the electroweak parameters are in agreement with Standard
Model predictions.Comment: 32 pages, 10 figures, accepted by Phys. Rev. D. Small corrections
from proofing process and small change to Fig. 12 and Table
Limits on the effective quark radius from inclusive scattering at HERA
The high-precision HERA data allows searches up to TeV scales for Beyond the
Standard Model contributions to electron-quark scattering. Combined
measurements of the inclusive deep inelastic cross sections in neutral and
charged current scattering corresponding to a luminosity of around 1
fb have been used in this analysis. A new approach to the beyond the
Standard Model analysis of the inclusive data is presented; simultaneous
fits of parton distribution functions together with contributions of "new
physics" processes were performed. Results are presented considering a finite
radius of quarks within the quark form-factor model. The resulting 95% C.L.
upper limit on the effective quark radius is cm.Comment: 10 pages, 4 figures, accepted by Phys. Lett.
Measurement of the cross-section ratio sigma_{psi(2S)}/sigma_{J/psi(1S)} in deep inelastic exclusive ep scattering at HERA
The exclusive deep inelastic electroproduction of and
at an centre-of-mass energy of 317 GeV has been studied with the ZEUS
detector at HERA in the kinematic range GeV,
GeV and GeV, where is the photon virtuality, is the
photon-proton centre-of-mass energy and is the squared four-momentum
transfer at the proton vertex. The data for GeV were taken in
the HERA I running period and correspond to an integrated luminosity of 114
pb. The data for GeV are from both HERA I and HERA II
periods and correspond to an integrated luminosity of 468 pb. The decay
modes analysed were and for the
and for the . The cross-section ratio
has been measured as a function of
and . The results are compared to predictions of QCD-inspired
models of exclusive vector-meson production.Comment: 24 pages, 8 figure
Search for a narrow baryonic state decaying to and in deep inelastic scattering at HERA
A search for a narrow baryonic state in the and
system has been performed in collisions at HERA with the ZEUS detector
using an integrated luminosity of 358 pb taken in 2003-2007. The search
was performed with deep inelastic scattering events at an centre-of-mass
energy of 318 GeV for exchanged photon virtuality, , between 20 and 100
. Contrary to evidence presented for such a state around 1.52
GeV in a previous ZEUS analysis using a sample of 121 pb taken in
1996-2000, no resonance peak was found in the invariant-mass
distribution in the range 1.45-1.7 GeV. Upper limits on the production cross
section are set.Comment: 16 pages, 4 figures, accepted by Phys. Lett. B. Minor changes from
journal reviewing process, including a small correction to figure
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