Respiratory rehabilitation for post-COVID-19 patients [РЕСПИРАТОРНАЯ РЕАБИЛИТАЦИЯ ПОСТ-COVID-19 ПАЦИЕНТОВ.]

In the presented clinical review, we evaluated the possibilities of drug and non-drug strategies for eliminating and preventing pathophysiological changes in the respiratory system of post-COVID-19 patients. We offer up-to-date rehabilitation algorithms based on the assessment of the severity of clinical manifestations of COVID-19, the possibilities of rehabilitation techniques and the patient’s personal compliance with their implementation. © Russian Archives of Internal Medicine.All right reserved

Metabolic Profile Correction in Patients with Obstructive Sleep Apnea Depends on the Duration of CPAP Therapy Sessions [КОРРЕКЦИЯ МЕТАБОЛИЧЕСКОГО ПРОФИЛЯ ПАЦИЕНТОВ С ОБСТРУКТИВНЫМ АПНОЭ СНА В ЗАВИСИМОСТИ ОТ ДЛИТЕЛЬНОСТИ СЕАНСОВ CPAP-ТЕРАПИИ]

Obstructive sleep apnea (OSA) is a common, heterogeneous chronic disease with sleep fragmentation, metabolic and cardiovascular disorders. Continuous Positive Air Pressure (CPAP) therapy is the primary treatment for patients with OSA. However, the effects of long-term CPAP therapy with night sessions > 6 hours remain poorly understood. The aim of the study was to study the effects of different durations of night sessions of CPAP therapy on the “metabolic profile” of patients with severe OSA. Materials and methods. In a retrospective case-control study comparing two CPAP-therapy regimens by matching pairs from among patients with verified severe OSA (apnea-hypopnea index> 30/h), arterial hypertension, obesity of I-II degrees according to the WHO classification (1997), signed informed consent, 2 groups of 18 people each were formed, comparable in age, anthropometric and somnographic indicators, using CPAP therapy 4-6 hours/night and more than 6 hours/night, respectively. Patients received CPAP therapy for a year, visits were carried out at 3, 6 and 12 months. The severity of sleep apnea was verified during nighttime computed somnography (CSG) on WatchPAT-200 hardware (ItamarMedical, Israel) with original software zzzPATTMSW ver. 5.1.77.7 (ItamarMedical, Israel) by registering the main respiratory polygraphic characteristics from 11.00 PM to 7:30 AM. The optimal therapeutic level of CPAP therapy was titrated at home using devices for automatic selection of therapeutic pressure (PR System One REMstar Auto CPAP Machine with A-Flex (Philips Respironics, USA)) within 7 days after the diagnostic study. To assess the compliance of OSA patients at 3-6-12 months of CPAP-therapy, we used the original compliance analysis program Encore Pro v.2.14 (Philips Respironics, USA). Results. With the initial comparability of the groups, by the 3rd month of therapy, patients with CPAP > 6 h/night showed a statistically significant advantage over the patients with 4-6 h CPAP-therapy in ESS, neck circumference and testosterone. By the 6th month, statistically significant differences of BMI, VAI, leptin, oral glucose tolerance test, fasting insulin, HOMA-IR, lipid metabolism (HDL, LDL, triglycerides, Apo-B) appeared. By the 12th month of therapy, the CPAP group > 6 h/night had a statistically significant advantage in waist circumference, fasting blood glucose and uric acid. Differences between groups at control points persisted throughout the observation period. Conclusions. Long-term home-based CPAP therapy with sessions > 6 h/night has an advantage over therapy with sessions 4-6 h/night in achieving a rapid and pronounced improvement in metabolic profile and hormonal levels in patients with severe OSA. © 2022 SINAPS LLC. All right reserved

ПЕРВЫЙ РОССИЙСКИЙ КОНСЕНСУС ПО КОЛИЧЕСТВЕННОЙ ОЦЕНКЕ РЕЗУЛЬТАТОВ МЕДИЦИНСКИХ ВМЕШАТЕЛЬСТВ

The first Russian Consensus on the quantitative evaluation of treatment results was approved by the XIII National Congress of therapists (Moscow, November 21-23, 2018).Первый Российский консенсус по количественной оценке результатов медицинских вмешательств одобрен XIII Национальным конгрессом терапевтов (г. Москва, 21-23 ноября 2018 года)

The first Russian consensus on quantitative assessment of treatment outcome

The first Russian Consensus on the quantitative evaluation of treatment results was approved by the XIII National Congress of therapists (Moscow, November 21-23, 2018). © 2019, Stavropol State Medical University. All rights reserved

Management of adherence-based treatment. Consensus document – Clinical guidelines. English version [упРАВЛЕНИЕ ЛЕЧЕНИЕМ НА ОСНОВЕ пРИВЕРЖЕННОСТИ. КОНСЕНСуСНЫй ДОКуМЕНТ – КЛИНИЧЕСКИЕ РЕКОМЕНДАЦИИ. АНГЛОЯзЫЧНАЯ ВЕРСИЯ]

Consensus Document «Management of adherence-based treatment» developed based on clinical guidelines of Russian Scientific Medical Society of Internal Medicine approved by the XIV National Congress of physicians (Moscow, 20 November 2019). The document is intended primarily to assess adherence to drug therapy, adherence to lifestyle modification, and adherence to medical support for patients who need long-term or permanent treatment. The document’s authors considered the treatment adherence unanimously as the compliance of the patient’s behavior with the recommendations received from the Doctor regarding medication, dieting, and other measures of lifestyle modifications. Insufficient adherence to treatment is a global problem. Assessing adherence as a basis for making medical decisions is an essential element of improving the quality of the healthcare system. Predictions of treatment outcomes cannot be considered effective if individualized levels of adherence are not used to justify project planning and evaluation. In medical practice, quantitative assessment of adherence is preferred, suitable for patients with various diseases, and with the possibility of automated data entry and processing. Therefore, sections on medical interventions based on the assessment of treatment adherence should be reflected in national clinical guidelines. These Joint Recommendations are based on these provisions. © Group of authors, 202

Treatment management based on adherence: Patient recommendation algorithms. Cross-disciplinary guidelines [УПРАВЛЕНИЕ ЛЕЧЕНИЕМ НА ОСНОВЕ ПРИВЕРЖЕННОСТИ: АЛГОРИТМЫ РЕКОМЕНДАЦИЙ ДЛЯ ПАЦИЕНТОВ. МЕЖДИСЦИПЛИНАРНЫЕ РЕКОМЕНДАЦИИ]

The algorithms (sample templates) of recommendations for patients, which are an integral part of adherence-based treatment management technologies, were developed by an interdisciplinary Working Group coordinated by the Treatment Adherence Section of the Russian Scientific Medical Society of Physicians. The Working Group includes opinion leaders and experts in the therapeutic, gastroenterology, cardiology, preventive medicine, gerontology, oncology, hematology, immunology, phthisiopulmonology, infectious diseases, oncohematology, neurology, intensive care, rehabilitation and other specialties, both involved by the section of RSMSIM, and recommended by the Gastroenterological Scientific Society of Russia, National Association of experts in Thrombosis, Clinical Hemostasiology and Hemorheology, Gerontological Society of the Russian Academy of Sciences, Russian Oncohematologists Society, Russian Society of Phthisiatrists, Society of Evidence-based Neurology. The algorithms are based on the materials of «The First Russian Consensus on Quantitative Assessment of adherence to treatment», approved by the XII National Congress of Internal Medicine (2017) and Clinical Guidelines «Treatment Management on the Basis of adherence», approved by the XIV National Congress of Internal Medicine (2019), taking into account the Consenting Document - Interdisciplinary Guidelines of RSMSIM, GSSR, NATH, SEN, GSRAS, ROHS, RSP «Treatment Management on the Basis of Adherence» (2020). The algorithms of treatment strategies are recommended by the Working Group to be used as a basis for inclusion into relevant sections of clinical guidelines and clinical handbooks developed by professional medical communities, as well as for use by practitioners in medical practice. © 2020 Stavropol State Medical University. All rights reserved