СОЦИАЛЬНО-ЭКОНОМИЧЕСКИЙ ПОДХОД К АНАЛИЗУ УДОВЛЕТВОРЕННОСТИ НАСЕЛЕНИЯ КАЧЕСТВОМ ПЛАТНЫХ МЕДИЦИНСКИХ УСЛУГ

With the development of medicine in the commercial segment of the Russian health issues relevance, related to ensuring the quality of paid medical services, their economic and physical access to the public are becoming increasingly relevant. This article reveals the main aspects related to the systematization of the factors and conditions that aff ect the quality level of paid medical services.In the first part of the article presents a study of basic patterns and problems of development of the Russian segment of commercial medicine, sufficiently detailed and considered as a consumer dimension in the context of the key parameters that aff ect the state of demand in this segment. In the second part of the article examined and described the main factors that infl uence the quality level of paid medical services to the population.The purpose / goal. The main purpose of the present article is the systematization and structuring of the key factors that determine the quality of paid medical services.Methodology. As a general methodological basis of this paper we used the methods of economic-statistical and content analysis of public data characterizing the dynamic development of commercial medicine in the Russian segment of the health sector.Conclusions / relevance. The practical significance of the results of the study is to develop a logically unified schemes consistently systematizing the main factors that aff ect or may aff ect the quality of paid medical services to the population. The proposed scheme is in the article can be used in practical activities related to the management of sustainable and planned development of commercial medical organizations in modern conditions.С развитием сегмента коммерческой медицины в российской сфере здравоохранения актуальность вопросов, связанных с обеспечением качества платных медицинских услуг, их экономической и физической доступности для населения становятся все более актуальными. Данная статья раскрывает основные аспекты, связанные с систематизацией факторов и условий, которые влияют на уровень качества платных медицинских услуг.В рамках первой части статьи представлено исследование основных закономерностей и проблем развития российского сегмента коммерческой медицины, в достаточной степени детально также рассмотрен и потребительский аспект в контексте ключевых параметров, влияющих на состояние спроса в этом сегменте. Во второй части статьи исследованы и описаны основные факторы, которые оказывают влияние на уровень качества платных медицинских услуг населению.Цель/задачи. Основной целью представленной статьи является систематизация и структурирование ключевых факторов, определяющих качество платных медицинских услуг.Методология. В качестве общей методической основы данной статьи использованы методы экономико-статистического и контент-анализа открытых данных, характеризующих динамизм развития сегмента коммерческой медицины в российской сфере здравоохранения.Выводы/значимость. Практическая значимость результатов проведенного исследования состоит в выработке логически унифицированной схемы, последовательно систематизирующей основные факторы, которые оказывают или могут оказать влияние на качество платных медицинских услуг населению. Предложенная в статье схема может быть использована в практической деятельности, связанной с управлением устойчивым и планомерным развитием коммерческих медицинских организаций в современных условиях

Падения в стационаре у пациентов старческого возраста с сердечно-сосудистыми заболеваниями и полипрагмазией

Background. The fall in the elderly is observed much more often than in younger people, and according to statistics the number of people over 65 years who have suffered a fall during the year reaches 30 %, while the probability of injury. Most of the falls in elderly patients does not lead to injury, but the developing at the same time unfavorable psychological discomfort can sharply limit the usual activity, lead to the formation of dependence on outside help, disadaptation in the home and form a fear of a possible fall. Falls, accompanied by the development of trauma, are observed in 10–15 % of cases. The objective was to study the relationship between polymorbidity, polypragmasia and the development of the fall in elderly patients cardiological profile.Results. Polymorbidity prevailed in the group of patients who suffered a fall in the hospital (8.9 ± 2.6 vs 7.5 ± 1.5 in men. 8.5 ± 2.2 vs 7.2 ± 1.6 in women). In patients undergoing a decline, it was also noted, and polypharmacy to a greater extent than cohort patients without falling (9.4 ± 1.9 vs 78.4 ± 2.2 in men. and 9.6 ± 2.7 vs 9.1 ± 2.5 for women). In addition, patients who suffered a fall in the hospital by age were older than patients in the comparison group (86 ± 6 vs 85 ± 5 in men, 87 ± 5 vs 84 ± 5 in women). We also revealed the tendency of the predominance of women in the subgroup of patients with the incidence and development of trauma. Conclusion. Minimizing the amount of drugs received, as the fight against polypragmasy can help reduce the incidence of falls in elderly patients. Введение. Падения у пожилых отмечаются значительно чаще, чем у лиц более молодого возраста. По данным статистики, число лиц старше 65 лет, перенесших падение в течение года, достигает 30 %. Бόльшая часть падений у пациентов пожилого возраста не приводит к травме, однако развивающийся при этом психологический дискомфорт способен резко ограничить привычную активность, привести к формированию зависимости от посторонней помощи, дезадаптации в быту и сформировать страх перед возможным падением. Падения, сопровождающиеся развитием травмы, наблюдаются в 10–15 % случаев. Цель исследования – изучение взаимосвязи между полиморбидностью, полипрагмазией и падением у пациентов старческого возраста кардиологического профиля.Результаты. Полиморбидность преобладала в группе пациентов, перенесших падение в стационаре (8,9 ± 2,6 vs 7,5 ± 1,5 у мужчин; 8,5 ± 2,2 vs 7,2 ± 1,6 у женщин). У пациентов, перенесших падение, также отмечалась полипрагмазия в большей степени, чем у пациентов без падения (9,4 ± 1,9 vs 78,4 ± 2,2 у мужчин; 9,6 ± 2,7 vs 9,1 ± 2,5 у женщин). Кроме того, пациенты, перенесшие падение в стационаре, были старше пациентов группы сравнения (86 ± 6 лет vs 85 ± 5 лет у мужчин; 87 ± 5 лет vs 84 ± 5 лет у женщин). Нами также выявлена тенденция преобладания женщин в группе пациентов с падением и развитием травмы. Заключение. С учетом того, что полипрагмазия является модифицируемым фактором риска падений, минимизация количества получаемых лекарственных средств может способствовать снижению частоты падений у пациентов старческого возраста.

Photometric observations of LO peg in 2014-2015

We performed new observations of an ultra-fast rotator of the spectral class K - the LO Peg star - in SAO RAS in 2014 and in Zvenigorod Observatory of INASAN in 2015. The light curves were used to build the maps of temperature inhomogeneities on the LO Peg surface in order to determine the longitudes corresponding to the location of active regions. The obtained measurements suggest the ongoing evolution of movements of active regions and probably the cyclic character of such movements. According to our estimations, the area of the star surface covered with spots decreases and by now it reached 14% of the total visible area of its surface. New observations of the star in V filter allowed us to specify LO Peg long-term variability cycles. Based on spectropolarimetric observations of LO Peg the null result for measurements of mean longitudinal component of magnetic field is obtained

Падения у коморбидных пациентов старческого возраста при сочетанном применении психотропных и кардиологических лекарственных средств

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented. В статье рассмотрены аспекты лекарственно-индуцированных падений у коморбидных пациентов старческого возраста на фоне полипрагмазии, а также оценена роль сочетанного применения лекарственных средств, отнесенных к высокоопасным по риску падения. Проведен лекарственный аудит базы данных получаемой фармакотерапии у пациентов старше 75 лет с коморбидной патологией на предмет выявления лекарственных средств, отнесенных к высокоопасным по риску падения, ранжированных по степени этого риска согласно светофорной классификации, и их значимых взаимодействий. Представлены данные по анализу исследования вклада психотропных, кардиологических лекарственных средств и их сочетания на риск развития падения в стационаре у коморбидных пациентов старческого возраста на фоне полипрагмазии

Effect of Amiodarone, Sotalol and Bisoprolol on Heart Rate Variability in Patients with Atrial Fibrillation

Aim. To study the effect of class III antiarrhythmic drugs (amiodarone and sotalol), and the β-blocker bisoprolol on the spectral parameters of heart rate variability in patients with different forms of atrial fibrillation (AF).Material and methods. Spectral analysis of heart rate variability of 5-minute electrocardiography intervals was used. The study included patients with newly diagnosed AF and having a duration of the disease from 6 months to 8 years. Arterial hypertension, coronary artery disease, myocardial infarction (in history), conduction disorders and type 2 diabetes mellitus were diagnosed as comorbidities. The following parameters were calculated: the total power (TP) of the spectrum, the power of very low frequencies (VLF), low frequencies (LF) and high frequencies (HF).Results. In the group of patients with newly diagnosed AF without concomitant diseases after administration of amiodarone, VLF prevails in the spectrum structure, which indicates a significant role of humoral factors in the regulation of heart rate. The power of LF, reflecting the activity of the sympathetic nervous system, prevails over HF power after administration of amiodarone. In patients with newly diagnosed AF, having concomitant diseases, sympathetic influences prevail over parasympathetic ones by 3.6 times after administration of amiodarone. In the group of patients who have reduced the number of comorbidities, the LF/HF decreases and is only 1.66 after administration of amiodarone. The decrease in the number of negative factors is also accompanied by an increase in the influence of the vagus nerve on the activity of the heart. In the study of the effects of sotalol, the LF/HF in this group was twice lower in the group of patients with long-term AF. In patients receiving bisoprolol as antiarrhythmic therapy, the proportion of LF in the group of patients with newly diagnosed AF is 2 times lower, and the proportion of HF is twice higher than in the group of patients with long-term AF.Conclusion. The effect of antiarrhythmic drugs on the spectral parameters of heart rate variability depends on the duration AF. The presence of concomitant diseases of the cardiovascular system can significantly change the effect of antiarrhythmic drugs on the spectral parameters of heart rate variability and is accompanied by an increase in sympathetic activity. In patients with newly diagnosed AF, amiodarone and sotalol cause a similar effect – the predominance of sympathetic influence; when using bisoprolol, the predominant influence belongs to the vagus nerve. In patients with long-term AF, the opposite effect of drugs is observed: the use of amiodarone is accompanied by a more pronounced influence of the vagus nerve, and bisoprolol – the predominance of sympathetic influence. When using sotalol, sympathetic influences also prevail, more pronounced in patients with newly diagnosed AF

THE SOCIO-ECONOMIC APPROACH TO THE ANALYSIS OF PUBLIC SATISFACTION WITH THE QUALITY OF PAID MEDICAL SERVICES

With the development of medicine in the commercial segment of the Russian health issues relevance, related to ensuring the quality of paid medical services, their economic and physical access to the public are becoming increasingly relevant. This article reveals the main aspects related to the systematization of the factors and conditions that aff ect the quality level of paid medical services.In the first part of the article presents a study of basic patterns and problems of development of the Russian segment of commercial medicine, sufficiently detailed and considered as a consumer dimension in the context of the key parameters that aff ect the state of demand in this segment. In the second part of the article examined and described the main factors that infl uence the quality level of paid medical services to the population.The purpose / goal. The main purpose of the present article is the systematization and structuring of the key factors that determine the quality of paid medical services.Methodology. As a general methodological basis of this paper we used the methods of economic-statistical and content analysis of public data characterizing the dynamic development of commercial medicine in the Russian segment of the health sector.Conclusions / relevance. The practical significance of the results of the study is to develop a logically unified schemes consistently systematizing the main factors that aff ect or may aff ect the quality of paid medical services to the population. The proposed scheme is in the article can be used in practical activities related to the management of sustainable and planned development of commercial medical organizations in modern conditions

Role of the autonomic nervous system in atrial fibrillation pathogenesis

The aim of this review was to study the role of the autonomic nervous system in the pathogenesis of atrial fibrillation (AF), as well as to establish the relationship of autonomic regulation with other mechanisms underlying the AF At present, the molecular and cellular mechanisms underlying the AF have not been precisely established. There is interest in evidence showing that both sympathetic outflow and an increased vagal tone can initiate and support AF. As modern studies have shown, autonomic cardiac regulation can be an important factor in the pathogenesis of AF