Volume 64, Nº 6 (2020)
- Ano: 2020
- ##issue.datePublished##: 01.01.2021
- Artigos: 11
- URL: https://modernonco.orscience.ru/0044-197X/issue/view/9553
HEALTH CARE ORGANIZATION
Incidence with the temporary disability according to data from both Federal Service on Customers Rights Protection and Human Well-being Surveillance (Rospotrebnadzor) and health authorities in the Russian Federation
Resumo
The purpose of the study was to analyze the comparability of data from the bodies of both the Federal Service on Customers Rights Protection and Human Well-being Surveillance (Rospotrebnadzor) and health authorities in terms of the incidence of the temporary disability in the constituent entities of the Russian Federation.
Material and methods. Information on indices of the incidence with the temporary disability, presented in state reports “On the sanitary and epidemiological well-being of the population” of the Territorial Departments of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Surveillance, is examined. The information on incidence indices with the temporary disability, presented in the Unified interdepartmental information-statistical system, is investigated.
Result and discussion. The incidence rates with the temporary disability presented by the Russian Federation’s executive bodies in the field of healthcare and used by the Territorial Departments of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Surveillance do not correspond to each other. The composition of data on morbidity with the temporary disability in state reports “On the sanitary and epidemiological well-being of the population” of the Territorial Departments of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing has a high degree of heterogeneity. Most government reports do not include data on the incidence of temporary disability.
Conclusion. To provide comparability of the working population’s health indices at the national and regional levels, the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Surveillance bodies and institutions have to develop the uniform methodological approaches to assessing and controlling the incidence rate with temporary disability. The territorial administrations of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing Surveillance (Rospotrebnadzor) are required to receive data from public health authorities of the constituent entities of the Russian Federation that correspond to data provided for statistical purposes at the federal level.



Management of the quality control and safety of medical activities in the field of «oncology» on the example of Western European countries
Resumo
Introduction. Quality assurance plays a pivotal role in the health industry. The countries of Western Europe demonstrate good outcomes of cancer care.
The purpose of the study. This paper focuses on various backbones of quality assurance systems in oncology in Belgium, Germany, and the Netherlands.
Material and methods. Authors retrieved information from PubMed (Medline), Google, and public websites. The key phrases related to the organization of quality management systems for cancer care were used. About 40 informational sources were selected, including scientific articles and media.
Discussion. All reviewed countries equipped with the quality management structures affecting such cancer care aspects as:
- Creating regulatory acts and policy for next-generation healthcare in oncology;
- Employing the top-qualified personnel;
- Updating the clinical guidelines and improving medical processes;
- Organizing the cyclical processes for monitoring the quality of cancer care and patient needs;
- Implementing the innovations;
- Implementing the principles of «transparency» in assessing the quality of cancer care.
Conclusion. It seems logical to further study Western Europe’s experience in developing quality management systems for cancer care.



PROBLEMS OF SOCIALLY SIGNIFICANT DISEASES
Regional experience in assessing medical technology on the example of antiviral therapy for chronic hepatitis C with direct antiviral drugs
Resumo
Introduction. Such medical technology like a direct antiviral drugs for treatment for chronic hepatitis C (CHC) remains inaccessible due to high absolute cost for health care systems, lack of assessment in specific region of Russian Federation and correlation with results of used antiviral therapy options.
The purpose of the study is to determine most cost-effective option of drug provision with direct antiviral drugs for the treatment of chronic hepatitis C.
Material and methods. Based on the population of chronic hepatitis C adult patients receiving medications at expense of Moscow budget funds, was performed a pharmacoeconomic analysis of drug therapy with direct antiviral drugs.
Results. The use of new pangenotypic direct antiviral drugs for the treatment of CHC in a clinically heterogeneous population of Russian adults with 1-6 genotypes of the hepatitis C virus is economically justified. Both alternative scenarios demonstrated an advantage over the baseline scenario in the form of financial savings of 66,028,192. 45 rubles and 83,647,819.27 rubles and an increase in the number of effectively treated patients by 197 and 287 people per year, respectively.
Conclusion. An increase in the share of new direct antiviral drugs in drug supply programs will increase the efficiency of the use of financial resources and increase the availability of direct antiviral drugs, which may ultimately lead to the achievement of an epidemiological effect on a population scale.



The acute cholecystitis in COVID-19 patients: treatment in conditions of reprofiled hospital
Resumo
Introduction. Routine surgical care has been suspended during the COVID-19 pandemic. For the treatment of patients with acute cholecystitis, conservative treatment, percutaneous drainage of the gallbladder or cholecystectomy is offered. Tactics of treatment of patients with acute cholecystitis against the background of COVID-19 have not been studied. It is important to study the data concerning the time of cholecystectomy in acute cholecystitis, comparing “early” and “delayed” cholecystectomy, which is performed after a period of conservative therapy.
Aim. To present and evaluate the results of treatment of patients with acute cholecystitis against the background of COVID-19 in the conditions of a repurposed multi-specialty hospital on the basis of the O. M. Filatov Clinic Hospital No. 15 in Moscow.
Material and methods. A retrospective comparative study with history control included 16 patients with acute cholecystitis against the background of COVID-19. Mechanical jaundice syndrome was diagnosed in 3 (18.75%) patients. The diagnosis of coronavirus infection using PCR was confirmed in 5 patients, serological method-in 2 patients, and in 9 patients the diagnosis was confirmed by X-ray or CT examination with negative/doubtful PCR test results.
Results. Nine (56.25%) patients were operated 4 (25%) percutaneous interventions were performed, in 3 (18.75%) cases conservative therapy was performed. Most patients were operated on within the first day of admission. In the main group, a fatal outcome occurred in 1 (6.25%) case (death from a thromboembolic complication in a patient with mechanical jaundice syndrome).
Discussion. The choice of «early» cholecystectomy for acute cholecystitis, provided the condition is stable and the initial changes in the lungs are appropriate in most COVID-19 patients.
Conclusion. Performing cholecystectomy in patients with coronavirus infection in an infectious hospital did not lead to an increase in the duration of inpatient treatment and the prevalence of complications. The approaches mentiobed in the results section can be used as a safe method in the discussed category of patients.



Semantic regulation of anxiety expectations during the COVID-19 pandemic: conspiracy trends
Resumo
Introduction. The COVID-19 pandemic is associated with the spread of conspiracy theories, which are heterogeneous in terms of the structure of their views. The hypothesis is that the substrate for the spread of conspiracy trend is an increased level of anxiety, reduced due to the paralogical (conspiracy) interpretation of events.
The purpose of this research was to study the prevalence of conspiracy trends during the preparation for the COVID-19 pandemic in Moscow (before the introduction of strict restrictive measures).
Methods: 320 people, randomly selected from the general population, were asked if they agree or disagree with 9 statements regarding the conspiracy interpretation of events, compared with the level of anxiety/depression (using the HADS scale). There are 3 trends (COVID-conspiracy, COVID-skepticism, COVID-obscurantism).
Results: 45.7% of respondents were ready to agree with one or the other conspiracy idea. I The level of anxiety in all adherents of conspiracy theory was found to be higher than in the rest of the sample. Differences in sociodemographic characteristics of adherents of different conspiracy tendencies are revealed. Among COVID skeptics, there are significantly fewer students and pensioners, and among COVID conspiracy theorists, the level of education received is lower, with unstable labor and family status.
Discussion. Conspiracy trends were universal for all social groups in the background of increased anxiety among the population of Moscow in preparation for the COVID-19 pandemic. It is suggested that the mechanism for the development of conspiracy tendencies may be the process of rationalization of an increased level of anxiety as a protective response during a crisis.



The relationship between body mass index and mental disorders in the adult population
Resumo
The purpose of the work is to study the features of the body mass index (BMI) in schizophrenia patients (SP) who live in Chuvashia.
Material and methods. 607 SP were examined (307 men and 300 women) aged 18 to 82 (average - 44.51 ± 12.3 years). The diagnosis of schizophrenia met the criteria for ICD-10 (F20-29); disease duration ranged from 0 to 52 years (mean - 18.9 ± 10.7 years). BMI was taken into account according to the Ketle index. For each SP, a survey card with clinical, therapeutic, and socio-demographic indices was filled out. The comparison group included a sample of 3417 residents of Chuvashia. Mathematical and statistical processing was carried out using descriptive statistics and χ2 distribution.
Results. 9.2% of SP had underweight, 54.2% - normal body weight, 36.6% - excess body weight and obesity. Among women there were significantly more persons with increased BMI and obesity, among men - with normal BMI. In SP, BMI did not depend on the group of taken antipsychotics (typical, atypical, mixed-use) and the disease’s duration. With patients’ age, BMI increased to excess BMI (25-29.9 kg/m2). Among SP, persons with underweight were much more common (among healthy people, 2% vs 9.2% in SP). From 40 years of age and older, among the healthy population, persons with an increased BMI and obesity begin to predominate significantly compared with the SP group. Observations of BMI during inpatient treatment from 1.5 to 22 months showed multidirectional dynamics, including increased body weight in 42.2% of SP, a decrease in 30.1%, without changes in BMI in 27.7%; it was not possible to retrospectively identify any patterns of BMI fluctuations.
Conclusion. The revealed paradoxes of BMI for SP in Chuvashia, especially a high proportion of SP with underweight, require refinement considering ethnic, genetic, sex and age, hormon and metabolic factors.



Methodology and tools for creating training samples for artificial intelligence systems for recognizing lung cancer on CT images
Resumo
Introduction. Medical imaging techniques can diagnose many diseases at the early stages of their development, improving the patient survival. Artificial intelligence (AI) systems, requiring the high-quality annotated and marked-up sets of medical images, are a suitable and promising means of improving the diagnostics’ quality.
The purpose of the study was to develop a methodology and software for creating AIS training sets.
Material and methods. We compared the main annotation methods’ performance and accuracy and based the information system on the most efficient method in both domains to develop an optimal approach. To markup objects of interest, we used the cluster model of lesions localization previously developed by the authors. We used C++ and Kotlin programming languages for software development.
Results. A structured annotation template with delivered a glossary of terms became the basis of the information system. The latter consists of three interacting modules, two of which are executed on a remote server’s capacities and one on a personal computer or mobile device of the end-user. The first module is a web service responsible for the workflow logic. The second module, a web server, is responsible for interacting with client applications. Its role is to identify users and manage the database and Picture Archiving and Communication System (PACS) connections. The front-end module is a web application with a graphical interface that assists the end-user in images’ markup and annotation.
Conclusions. An algorithmic basis and a software package have been created for annotation and markup of CT images. The resulting information system was used in a large-scale lung cancer screening project for the creation of medical imaging datasets.



TOXICOLOGY (PREVENTIVE, CLINICAL, ECOLOGICAL)
Oxidative carbonilation of liver tissue proteins under the influence of pesticide based on glyphosate in a subchronic experiment
Resumo
Introduction. Currently, the pathogenetic mechanisms of the action on the body of widely used glyphosate-based herbicides and the search for the markers of the health status that changes under the influence of these herbicides remain open for study and discussion. Carbonyl derivatives of proteins can be used as the markers of oxidative stress caused by the herbicidal composition of the isopropylamine salt of glyphosate.
The purpose of this study was to assess the severity of oxidative carbonylation of liver tissue proteins under the influence of a glyphosate-based pesticide in a subchronic experiment.
Material and methods. The material for the study was subcellular fractions of liver tissue homogenates obtained from 90 Wistar rats, which were administered solutions of glyphosate isopropylamine salt at doses of 280 mg/kg and 100 mg/kg per os for 3 months. The severity of oxidative carbonylation of proteins was determined by the method of R.L. Levine modified by E.E. Dubinina.
Results. Statistically significant changes in the content of products of oxidative damage to proteins at various stages of the experiment in the study groups were obtained compared with the control group due to a significant increase in the products of oxidative damage to proteins in subcellular fractions of liver tissue.
Conclusion. The changes in carbonyl stress indices and the decrease in the reserve-adaptive potential indicate the depletion of antioxidant protection in the liver cells. A statistically significant increase in secondary markers of carbonyl stress after 1 month from the start of seeding of animals compared with the control with a slight increase in this index after 3 months may indicate the launch of adaptation mechanisms, including the induction of proteolytic utilization of oxidized proteins or additional protein synthesis.



OCCUPATIONAL MEDICINE
Compliance of the expert with the self-isolation in the situation of the COVID-19 pandemic as a factor of the psychological well-being
Resumo
Introduction. Experts in many occupations are to carry out their occupational activities in unusual conditions. And in particular, in a remote mode, which can be a factor that reduces the level of psychological well-being of the individual if there is no compliance with the situation of self-isolation.
The purpose of the study is to study the teachers’ compliance with the situation of self-isolation during the COVID-19 pandemic. The tasks of the study include the detection of the grade of the compliance with the situation of self-isolation during the pandemic, the analysis of the level of compliance with the situation of self-isolation during the pandemic as a factor of psychological well-being of teachers.
Material and methods. We surveyed 124 teachers (between 23 to 67 years). The respondents’ answers are represented on three scales: Understanding the situation of self-isolation’, ‘Understanding of oneself in the situation of isolation, ‘Understanding the characteristics of the interactions and communication in the situation of isolation’.
Results. Most respondents agree with the need for self-isolation and consider it to be a practical approach to prevent the incidence of COVID-19. The most pronounced responses are the ones on improving occupational and cultural levels. Most of the respondents note a high level of understanding of the value of relationships.
Discussion. In particular, the problem of insufficiently high level of self-understanding in the situation of self-isolation, along with the acknowledgement of the need to comply with it, to be revealed. In this regard, it is advisable to provide psychological assistance in the form of information support for the population.
Conclusion. That the better the respondents understand the need for self-isolation, the more effective the process of communication and interaction with others is, and, consequently, the less damage is caused to the level of psychological well-being of the individual. Due to the established lack of understanding of oneself in the situation of self-isolation, the following can be considered practical areas of informational psychological support: critical attitude to information that appears in various sources; building positive relationships within the family; managing work at home to ensure good performance; preserving the ability to return to the usual mode of life after the period of self-isolation.



The anxiety in healthcare workers and other populations due to the spread of COVID-19
Resumo
The COVID-19 pandemic has created threats and risks not only for the physical but also for people’s mental health. To date, there is not enough scientific data on anxiety, depressive states of medical workers who do not directly interact with infected people but who work under conditions of new coronavirus infection.
Aim of the study is to evaluate anxiety experiences in healthcare workers who do not interact directly with COVID-19 patients and those working in other fields during the coronavirus pandemic.
Material and methods. As part of the study, authors carried out online monitoring of anxiety experiences in medical workers who are not working on the front line with COVID-19 patients and other population groups in the context of the coronavirus pandemic (102 participants, including 32 men, 70 women). The average age of the subjects was 38.9 [24.5; 64.7].
Results. A survey of two groups: medical workers who do not interact directly with COVID-19 patients (group I, n = 55) and who work in other fields (group II, n = 47), revealed the highest level of reactive and personal anxiety in the medical group workers (the results are statistically significant, the level of significance is p ≤ 0.05).
Discussion. Our results on medical workers’ high anxiety make it possible to classify medical workers who directly work with the sick as a risk group and medical workers who do not interact directly with them.
Conclusions. A comparative analysis of anxiety indices in the surveyed groups showed medical workers who do not interact directly with the sick cases but work in a pandemic to be especially susceptible to psychological stress during the COVID-19 pandemic, confirming the need to correct distressing fears in this population group and provide targeted clinical-psychological assistance.



LITERATURE REVIEWS
Management of the radiotherapy quality control using automated Big Data processing
Resumo
Introduction. In Moscow, the state-of-the-art information technologies for cancer care data processing are widely used in routine practice. Data Science approaches are increasingly applied in the field of radiation oncology. Novel arrays of radiotherapy performance indices can be introduced into real-time cancer care quality and safety monitoring.
The purpose of the study. The short review of the critical structural elements of automated Big Data processing and its perspectives in the light of the internal quality and safety control organization in radiation oncology departments.
Material and methods. The PubMed (Medline) and E-Library databases were used to search the articles published mainly in the last 2-3 years. In total, about 20 reports were selected.
Results. This paper highlights the applicability of the next-generation Data Science approaches to quality and safety assurance in radiation oncological units. The structural pillars for automated Big Data processing are considered. Big Data processing technologies can facilitate improvements in quality management at any radiotherapy stage. Simultaneously, the high requirements for quality and integrity across indices in the databases are crucial. Detailed dose data may also be linked to outcomes and survival indices integrated into larger registries.
Discussion. Radiotherapy quality control could be automated to some extent through further introduction of information technologies making comparisons of the real-time quality measures with digital targets in terms of minimum norms / standards. The implementation of automated systems generating early electronic notifications and rapid alerts in case of serious quality violation could drastically improve the internal medical processes in local clinics.
Conclusion. The role of Big Data tools in internal quality and safety control will dramatically increase over time.


