907 research outputs found
THE ROLE OF PUBLIC ORGANIZATIONS IN THE ORGANIZATION OF MEDICAL CARE: ACCORDING TO A SURVEY OF PARENTS OF CHILDREN SUFFERING FROM ORPHAN DISEASES
The activities of public patient organizations are multifaceted: providing legal support to patients in order to protect their legal rights; information and educational work, conducting “schools”, providing specific types of assistance that can provide those involved in the problem. Public patient organizations are the “voice” of all patients with orphan diseases in solving their problems at the level of the highest echelons of power. From 2016-2017 years in the Reference center of congenital hereditary diseases, genetic disorders, orphan and other rare diseases of GBUZ “Morozovskaya DGKB DZM” on a specially designed questionnaire conducted a sociological study on awareness of parents of children suffering ABOUT the public patient organizations. Public organizations provide information and legal support, contact with pharmaceutical companies, participate in solving the problems of patients at the state level. Taking into account the rights and opportunities of public associations, it is necessary for doctors to inform parents about the existence of charitable organizations and their involvement in public patient organizations, as well as to participate in the work of health schools for parents
CATEGORY OF MARKETING OF RELATIONS IN MEDICAL ORGANIZATIONS
The need for intensification of health care, raises the issue of improving the efficiency of medical organizations. The article analyzes the current management technology: “marketing relationships in medical organizations”. The aim of the research was to find the correct “definition of the concept and professional fullness” of the content of relationship marketing in medical organizations. The authors defined the marketing of relations in medical organizations as “the relationship (mutual relation) of the subjects of medical care at the level of “doctor-patient”, “administration-personnel”, “relations between medical organizations and counterparts”, in order to improve the efficiency of activities and the quality of medical care, patients and medical personnel. The results are obtained on the basis of a comparative analysis of scientific literature data and authors’ own research. In the formulation of the research, methods of content analysis of bibliographic data, the sociological method and the authors’ own experience were used. Based on the results of the research, the role of the individual characteristics of patients (gender, age, occupation, relationship to the composition of patients, transport accessibility, organization of admission) in the formation of relations between consumers and providers of medical services is shown. In conclusion, based on the results of the study, the development of marketing relationships at the level of medical organizations of different ownership forms and the need to improve marketing of communications, social networks and distant forms of work with potential and real patients are justified. Conceptual bases of the marketing relationship concept in medical organizations of different ownership forms have been developed
Experimental study of the pattern of genes activated by multi-day intermittent hypoxia in the rat pancreas
Intermittent hypoxia affects a variety of pathological conditions in the body and is used in medicine to reproduce the sanogenic therapeutic effect. Intermittent hypoxia is used for clinical indications to improve lung function; increase the body’s adaptive capacity; in obstructive sleep apnoea syndrome; in anaemia, diabetes mellitus. In cancer radiotherapy, intermittent hypoxic training helps to increase the sensitivity of the tumour to treatment. Intermittent hypoxia is useful in rehabilitation medicine to improve the physical recovery of patients after surgery or injury to improve the body’s functional capabilities. However, to date, the activity of regulatory genes, that activate the molecular mechanisms of the above-mentioned sanogenic effects of intermittent hypoxia has not been sufficiently studied.
The aim of the study: to determine the expression of hypoxia-related genes in pancreas of Wistar rats under intermittent hypoxia.
Materials and methods. The CFX-96 Touch™ real-time reverse transcription polymerase chain reaction (PCR) (Bio-Rad, USA) and the RT2 Profiler™ PCR Array Rat Hypoxia Signalling Pathway kit (QIAGEN, Germany) were used to analyse gene expression in experimental animals, where 84 genes involved in the hypoxia signalling pathway identified in the pancreas were studied.
Results. According to the results of PCR analysis of pancreatic samples from intact animals and animals exposed to hypoxic training, the activity of the gene panel can be distributed as follows: genes with high expression compared to the intact group of animals, genes with low expression compared to the intact group of animals and genes in which no significant changes were detected in the samples compared to the intact group of animals. We have found, that the genes Cops5, F10, Jmjd6, Lgals3, Rbpjl, Vegfa have high expression activity compared to the intact group of animals.
Conclusions. The increase in the expression of Cops5 by 10.29 times, Lgals3 by 2.94 times and Rbpjl by 5.73 times as a result of intermittent hypoxia can be regarded as an activating factor for the increase in the proliferation of endocrine and exocrine pancreatic cells and the growth of their antiapoptotic potential. The 3.20-fold increase in Jmjd6 gene expression under intermittent hypoxia can be interpreted as a regulatory effect through protein dehydroxylation and promotion of antiapoptotic protein activity in endocrine and exocrine pancreatic cells. The 5.99-fold increased level of Vegfa expression may promote angiogenesis in the pancreas under intermittent hypoxia
Remote clinical quality management of endovascular care
Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p<0.001). The frequency of performing PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI.Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p<0.001). The frequency of performing PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI
Фармакоэкономический анализ применения схем антиретровирусной терапии у пациентов в Сирийской Арабской Республике
Background. Due to the significant prevalence of human immunodeficiency virus (HIV) and limited funding in the Syrian Arab Republic (SAR), pharmacoeconomic study of antiretroviral therapy (ART) regimens is relevant, as it allows to choose a rational, pharmacoeconomically reasonable therapy for HIV-infected patients.Objective: to perform pharmacoeconomic analysis of ART regimens HIV-infected in patients in SAR.Material and methods. The following algorithm of actions was used: assessment of the cost of prescribed antiretroviral drugs; cost analysis of applied ART regimens. From the auction documentation, information was taken on the total number of purchased drugs and their cost at the end of the auction. To calculate prices in rubles, currency conversion was carried out as of January 1, 2021. To calculate the cost of an assigned regimen, the summation of the costs of its components was carried out. Based on the obtained data, the average cost of combinations of certain antiretroviral drugs classes was calculated. To predict the results of using various ART regimens for 5 years, discounting was used for each year of the time horizon, except for the first year.Results. It was revealed that the most expensive drugs are the reserve series: Fuzeon® (enfuvirtide; F. Hoffmann-La Roche Ltd., Switzerland) – 66,492.1 rubles and Isentress® (raltegravir; Merck Sharp & Dohme, Netherlands) – 31,634.6 rubles, and the lowest price per package was noted for Russian drugs Timazid® (zidovudine) – 471.0 rubles and Nikavir® (phosphazide) – 743.8 rubles (both – AZT Pharma K.B. LLC, Russia). The average cost of the first prescribed regimen was 8,970.0 rubles/month, while the most expensive first-line regimens included a protease inhibitors class drug as the third component. As a result of the analysis of the cost of second-line and third-line regimens, it was revealed that the average cost of second-line therapy per month exceeded the average cost of first-line therapy by 4 times (40,154.2 rubles/month). The initial “azidothymidine, zidovudine / lamivudine + efavirenz” group had fewer hospitalizations, lower mortality, and fewer years of life expectancy lost than on “azidothymidine, zidovudine / lamivudine + atazanavir, ritonavir” and “phosphazide + didanosine + efavirenz” regimens.Conclusion. A pharmacoepidemiological study showed that the cost of second-line therapy per month was 40,154.2 rubles, which exceeded the average cost of first-line therapy by 4 times (9,266.1 rubles). It was revealed that the average cost of the first prescribed ART regimen based on two nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitor was 2 times higher than the average cost of regimens based on two NRTIs + non-nucleoside reverse transcriptase inhibitors, which, along with clinical aspects, raised the question of the expediency of their appointment as first-line regimens.Актуальность. Из-за значительной распространенности заражения вирусом иммунодефицита человека (ВИЧ) и ограниченного финансирования лечения таких пациентов в Сирийской Арабской Республике (САР) актуальным является изучение применения схем антиретровирусной терапии (АРВТ), т.к. оно позволяет выбрать рациональную, фармакоэкономически обоснованную терапию ВИЧ-инфицированных больных.Цель: провести фармакоэкономический анализ применения схем АРВТ у ВИЧ-инфицированных пациентов в САР.Материал и методы. Использовали следующий алгоритм действий: оценка стоимости назначенных антиретровирусных препаратов и анализ затрат на применяемые схемы АРВТ. Из аукционной документации были взяты сведения о стоимости закупленных препаратов, рассчитывали цены в рублях на 1 января 2021 г. Определяли стоимость схем, суммируя стоимости компонентов. Полученные данные позволили рассчитать среднюю стоимость комбинаций определенных классов антиретровирусных препаратов. Для прогнозирования результатов применения различных схем АРВТ в течение 5 лет использовали дисконтирование по каждому году временного горизонта, за исключением 1-го года.Результаты. Выявлено, что наиболее дорогостоящими являются препараты резервного ряда: Фузеон® (энфувиртид; F. Hoffmann-La Roche Ltd., Швейцария) – 66 492,10 руб. и Исентресс® (ралтегравир; Merck Sharp & Dohme, Нидерланды) – 31 634,60 руб., а наименьшая цена за упаковку отмечена у отечественных препаратов Тимазид® (зидовудин) – 471,00 руб. и Никавир® (фосфазид) – 743,80 руб. (оба – ООО «АЗТ Фарма К.Б.», Россия). Средняя стоимость первой назначенной схемы составляла 8970,0 руб/мес, наиболее дорогие схемы первого ряда включали препараты класса ингибиторов протеазы. В результате анализа стоимости схем второго и третьего рядов выявлено, что средняя стоимость терапии второго ряда превосходит таковую первого ряда в 4 раза (40 154,20 руб/мес). В группе, в которой изначально назначалась схема «азидотимидин, зидовудин / ламивудин + эфавиренз», отмечено меньшее число случаев госпитализации, более низкие показатели смертности и меньшее число потерянных лет жизни, чем при схемах «азидотимидин, зидовудин / ламивудин + атазанавир, ритонавир» и «фосфазид + диданозин + эфавиренз».Заключение. На основе фармакоэкономической оценки стоимости применяемой в САР антиретровирусной терапии выявлено, что средняя стоимость терапии второго ряда в месяц составляет 40154,2 руб., что превосходит среднюю стоимость терапии первого ряда в 4 раза (9266,1 руб.). Определено, что средняя стоимость первой назначенной схемы АРВТ на основе двух нуклеозидных ингибиторов обратной транскриптазы (НИОТ) и ингибитора протеазы в 2 раза выше средней стоимости схем на основе двух НИОТ и ненуклеозидного ингибитора обратной транскриптазы, что наряду с клиническими аспектами ставит вопрос о целесообразности их назначения в качестве схем первого ряда
Z-graded differential geometry of quantum plane
In this work, the Z-graded differential geometry of the quantum plane is
constructed. The corresponding quantum Lie algebra and its Hopf algebra
structure are obtained. The dual algebra, i.e. universal enveloping algebra of
the quantum plane is explicitly constructed and an isomorphism between the
quantum Lie algebra and the dual algebra is given.Comment: 17 page
A CLINICAL CASE OF SYNGAP1 GENE MUTATION IN A GIRL WITH EPILEPSY, MENTAL RETARDATION, AUTISM, AND MOTOR DISORDERS
The introduction of the latest genetic techniques into practice could discover a basis for the comorbidity of genetic epilepsies and behavioral disturbances with cognitive impairments. Some chromosomal syndromes are characterized by a specific electroencephalogram (EEG) pattern, the type of seizures, and the variant of the course of epilepsy. This paper describes a case of synaptic RAS GTP-ase-activating protein 1 (SYNGAP1) gene mutation in a 9-year-old female patient with eyelid myoclonic epilepsy, atypical absences, and atypical autism with mental retardation. The patient’s parents visited a physician for epilepsy (myoclonic absences), markedly delayed psycho-speech development, and specific communication problems in the child. The characteristics of autistic behavior were manifested from birth; routine EEG recorded epileptiform activity at the age of 2 years; epileptic seizures appeared at 5 years. Valproic acid and levetiracetam in this patient exerted a good effect on seizures; however, a clinical and encephalographic remission was achieved by a combination of levetiracetam and ethosuximide. The clinical case including the neurological and psychic statuses, logopedic characteristics, the result of psychological testing, and video-EEG monitoring findings are analyzed in detail.The SYNGAP1 gene is located on chromosome 6p21.3. About 50 cases of SYNGAP1 syndrome are now known worldwide. After normal maternal pregnancy and delivery, the patients show delayed psychomotor development with pronounced regression at 1 to 3 years of age. At this age, there are diffuse polyspike discharges on the EEG or an onset of generalized epileptic seizures (atonic, myoclonic, eyelid myoclonic, and absence seizures), commonly photosensitivity and autoinduction, mental development stops, speech regresses, behavioral disorders that are typical of autism develop. Drug-resistant epilepsy is noted in approximately half of the described cases. There is a correlation between the severity of epilepsy and cognitive deficit
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