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Vol 24, No 3 (2020)

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Treatment changes of coronavirus infection disease (COVID-19). What general practitioner should know? Part 2
Frolova E.V.

The article presents an overview of methods of treatment of coronavirus infection based on available data from recent clinical studies and methodological recommendations. Drugs recommended as pathogenetic therapy are considered. Data from clinical trials and expert opinions are analyzed.

Russian Family Doctor. 2020;24(3):5-10
Original studies
US, Russian and Indian physician perspectives regarding end of life care
Jackson J.G., Raj S.M., Matveeva Y., Xu Y., Jogerst G.J.

Aim. To compare US, Russian and Indian primary care physicians’ attitudes, comfort and experiences providing palliative care.

Design. Cross sectional survey.

Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India.

Participants. Primary care physicians.

Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores.

Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p < 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p < 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p < 0.001. Patient should be informed (US vs Russia vs India) of terminal illness “Always” (74% vs 31% vs 33%) p < 0.001, “If Asked” (9% vs 64% vs 12%) p < 0.001 or “Physician’s Judgement” (15%, 5%, 54%) p < 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care “Often or Always” (63% vs 36% Russian v 21% Indian) p < 0.001.

Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

Russian Family Doctor. 2020;24(3):11-20
Case reports
Course of severe coronavirus (COVID-19) in a patient at risk
Kuznetsov N.I., Vasiliev V.V., Romanova E.S., Startseva G.Y.

The article is devoted to the peculiarities of the clinical course of severe coronavirus infection in a 59-year-old woman at risk for comorbidities. Data on the pathogenesis of the severe form of COVID-19 are presented. Prognostic laboratory signs of an unfavorable outcome of coronavirus infection in people at risk are considered. The patient management tactics are described in accordance with the protocol for the treatment of new coronavirus infection. The assessment of patient management at the outpatient stage is given.

A new coronavirus infection in at-risk patients can quickly lead to a worsening of the condition, which is manifested by severe lung damage not only according to computed tomography data, but also by the clinical symptom of ARDS. The severity of the condition in this category of patients is due to severe viral aggression, the development of a cytokine storm. The use of the recommended protocol for the treatment of new coronavirus infection in patients at risk does not always give the expected positive result.

Russian Family Doctor. 2020;24(3):21-26
Features of glucocorticoides using for treatment of a patient with a new coronaviral infection in the conditions of the observator on the basis of students’ dormitory. Clinical case
Kuznetsova O.Y., Lubimova A.V., Pleshanova Z.V., Zamyatina O.S., Donetskov N.V., Osinskaya Z.R.

The article is devoted to the peculiarities of providing medical care for coronavirus infection in a university student who has been moved to an observatory organized in a hotel-type hostel of the university to prevent the spread of COVID-19 among students living in hostels. The article provides data on the positive experience of using dexamethasone in the treatment regimen for moderately severe disease, follow-up and examination data. The article considers the tactics of managing a patient with suspected COVID-19 in the presence of data for pneumonia according to computed tomography and clinical manifestations characteristic of a new coronavirus infection, which was later confirmed in the study of antibodies to SARS-CoV-2. The importance of round-the-clock medical monitoring of persons placed in the observatory, finding out the details of the epidemiological history from them, as well as determining the tactics of their treatment with limited hospitalization opportunities in a growing number of patients with severe manifestations of COVID-19 requiring inpatient treatment is emphasized.

A new coronavirus infection can lead to a rapid deterioration of the condition in young patients, which is not always manifested by severe lung damage according to computed tomography data, but is characterized by persistent fever that cannot be stopped by antipyretics, as well as severe muscle pain, severe asthenia, which can be considered as clinical indicators of the development of hyperactive inflammatory syndrome. The use in the treatment regimen of intravenous dexamethasone at a dose of 0.1 mg / kg of body weight twice led to a rapid normalization of temperature, relief of all clinical symptoms and was not accompanied by any complications both in the early period of convalescence and 2 months after discharge from the observatory.

Russian Family Doctor. 2020;24(3):27-32
A case of finding of asymptomatic 3rd stage myxomatous degeneration of the mitral valve in general practice
Yubrina I.V., Filippova S.O., Bozhkov I.A., Vrabiy D.A.

The case of asymptomatic 3rd stage myxomatous degeneration of the mitral valve in a 42-year old male patient is presented. The patient was referred to Tuberculosis dispensary No. 5 for investigation of pathological findings revealed by fluorography during the coronavirus pandemic period. The patient was examined by TB specialists and the general practitioner in accordance with new interdisciplinary diagnostic algorithms primary involving the GP. As а result of the detailed investigation the patient was found to have previously undiagnosed consequences of pneumonia caused by COVID-19 and 3rd stage myxomatous degeneration of the mitral valve.

Russian Family Doctor. 2020;24(3):33-38
Medical Education
Development of otoscopy skills among general practitioners: how to improve the effectiveness of training?
Kuznetsova O.Y., Lopatin Z.V., Degtyareva L.N., Ovakimyan K.V., Frolova O.I., Madysheva A.R., Klyuchuk E.A., Gunina A.S.

The article presents the results of research of theoretical knowledge and practical skills of general practitioners with more than 5 years of experience.

The aim of the study is to assess the level of proficiency in otoscopy by General practitioners using a simulator, depending on various socio-demographic characteristics.

Materials and methods. The study was conducted at the Department of family medicine of North-Western State Medical University named after I.I. Mechnikov. Doctors who agreed to participate in the project filled out a socio-demographic questionnaire, tests to test theoretical knowledge, for the level of proficiency in otoscopy, was evaluated using a checklist. Statistical analysis of the data was performed using the SPSS 22.0 program (SPSS Inc., Chicago, Illinois, USA). The study involved 24 General practitioners with more than 5 years of experience.

Results. Analysis of the results showed that 66.7% of General practitioners rated their skill in otoscopy as “satisfactory” or higher, but only 54.1% were able to correctly perform 70% of the actions according to the checklist.

Conclusions. 1. The level of theoretical knowledge in otoscopy among General practitioners with experience who took part in the study was quite low: 62.5% of respondents did not achieve satisfactory results. A low level of proficiency in otoscopy among General practitioners was also revealed when evaluating the performance of manipulation on the simulator — only 20.8% of doctors correctly performed 80% of the actions according to the checklist. 2. Independent assessment of the level of proficiency in otoscopy in General practitioners is not a predictor of the success of its demonstration on the simulator in accordance with the checklist. 3. The level of proficiency in otoscopy in the study group of General practitioners did not have a statistically significant relationship with the basic level of theoretical knowledge, work experience and regular otoscopy in everyday practice.

Russian Family Doctor. 2020;24(3):39-45

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