The assessment of physicians' and senior medical students’ knowledge in the field of communityacquired pneumonia: preliminary results of the KNOCAP-II project (2017-2019)

Внебольничная пневмония (ВП) относится к одной из самых актуальных проблем современной медицины. На сегодняшний день ВП занимает 4 место в структуре смертности (после сердечно-сосудистых, цереброваскулярных заболеваний и злокачественных новообразований) и 1 место среди всех смертей от инфекционных заболеваний. Цель – оценка уровня знаний врачей терапевтического профиля и студентов старших курсов медицинских вузов в вопросах ведения пациентов с ВП. В рамках многоцентрового исследования KNOCAP (полное название проекта – «The assessment of physician and students’ knowledge of community-acquired pneumonia basics») представлены результаты анонимного проспективного опроса по оценке знаний и предпочтений врачей терапевтического профиля и студентов старших медицинских курсов в вопросах ведения пациентов с ВП. По итогам первого периода проекта (2017-2019 гг.) получены и проанализированы результаты анкетирования 588 врачей терапевтического профиля и 394 студентов-медиков из 17 центров России, Украины и Кыргызстана. За основу взят метод анонимного анкетирования, для чего была разработана оригинальная анкета на основании актуальных клинических рекомендаций. Наибольшие сложности вызвали следующие вопросы: сроки проведения повторного рентгенологического исследования при положительной динамике лечения, выбор основного диагностического признака при ведении пациента с ВП, указать типовые ошибки фармакотерапии ВП и выбор стартовой антимикробной терапии у пациентов с факторами риска и без них. В целом исследование показало значимое несоответствие знаний в вопросах ведения пациентов с ВП актуальным клиническим рекомендациям 2010 г. и проектом новых клинических рекомендаций 2018-2019 гг. В настоящее время существует необходимость в повышении уровня знаний и совершенствовании профессиональной деятельности врачей терапевтического профиля и студентов старших медицинских курсов, так как проведенный многоцентровой срез знаний и предпочтений специалистов во многих вопросах выявил их недостаточный уровень для корректного ведения пациентов с ВП. Community-acquired pneumonia (CAP) is one of the most relevant problems of modern medicine. Today, CAP takes 4th place in the structure of mortality (after cardiovascular, cerebrovascular diseases and malignant neoplasms) and 1st place among all deaths from infectious diseases. The aim of the study is to assess the level of general physician’ and senior medical students’ basic knowledge in CAP treatment. The article represents the results of anonymous prospective surveys within the framework of the second stage of KNOCAP multi-centered research project (full name of the project «The assessment of physician’ and students’ knowledge of community-acquired pneumonia basics») aimed at accessing the knowledge and preferences of doctors and students on the fundamental issues in diagnosis and treatment of community-acquired pneumonia. The survey conducted in 2017-2019 involved 588 physicians and 394 students from seventeen Russian, Kyrgyzstan and Ukrainian centers. The method of anonymous questioning was used in this study, for which an original questionnaire was developed on the basis of current clinical recommendations. The following fundamental questions caused the greatest difficulties in the respondents: terms for a repeated X-ray examination in positive dynamics of CAP treatment, the choice of main diagnostic criteria of CAP, the choice of the typical mistakes of CAP treatment, the choice of the initial antimicrobial therapy. In general, the respondents’ knowledge in CAP patients’ management deviates significantly from the current clinical guidelines, as of 2010, and from the new clinical guidelines draft, 2018-2019. Currently, there is a need to increase the level of knowledge and improve the professional activities of therapists and senior medical students, as a multicenter section of the knowledge and preferences of specialists in many issues revealed their insufficient level for the correct management of patients with CAP

Pharmacodynamic and pharmacoeconomic aspects of application of antihypertensive preparations of various groups in patients with arterial hypertension

At the background of the therapy for 3 months with Perindopril, Telmisartan and Bisoprolol, the patients with arterial hypertension were noted to decrease systolic and diastolic arterial pressure. The preparations under investigation had different effects on electrolyte metabolism. Therapy with Telmisartan turned out to have the least effect on electrolyte metabolism. Microalbuminuria is a risk factor in patients with arterial hypertension and may influence on the basic blood electrolyte balance. Bisoprolol should be recommended as the most preferable therapy for arterial hypertension from the pharmacoeconomic point of view. In order to control morning systolic arterial pressure the preference should be given to Perindopril, while for controlling evening systolic arterial pressure the preference should be given to Telmisarta

Investigation Of Arterial Blood Pressure Level And Metabolic Indices In Patients With Arterial Hypertension At Pharmacotherapy With Antihypertensive Medicines Of Various Chemical Structure

The research goal is to carry on the comparative analysis of medicines of various chemical structure, Telmisar-tan and Bisoprolol, and to reveal their effect on the arterial blood pressure level and the indices of various metabolic processes in patients with arterial hypertension. 60 out-patients with arterial hypertension (stage II risk III) both males and females aged 33-55 have been under study taking Telmisartan and Bisoprolol for 3 months. While treating the patients the arterial blood pressure level control and biochemical investigations for determination the indices of metabolic processes have been carried out. The investigated medications have provided the decrease of systolic and diastolic arterial pressure parameters, the increase of concentration of total and ionized calcium, chlorine ions, urea and total bilirubin in blood plasma. Therapy with Telmisartan has shown more significant increase of potassium level in erythro-cytes, decrease of levels of natrium, glucose, glycolized hemoglobin and triglycerides and increased contents of alani-naminotransferase and aspartataminotransferase. The course of therapy with Bisoprolol has restored the normal level of magnesium in blood plasma, has not have any influence on carbohydrate and lipid metabolism, increased the level of alaninaminotransferase and significantly increased the contents of total and ionized calcium, urea and creatinine. 3-months therapy with Telmisartan and Bisoprolol has proved the decrease of systolic and diastolic arterial pressure in patients with arterial hypertension. The medications under study have had active and variable effects on metabolic indice