Vol 23, No 4 (2019)

Reviews
Tactics of primary care physician in the management of patients with asthma in accordance with the latest changes in international and national guidelines
Pokhaznikova M.A.

Abstract

The article addresses to changes in the management of patients with bronchial asthma in accordance with international and national recommendations of 2019. The new management strategy for patients with mild asthma, the rejection of short-acting β2-agonist (SABA) reliever medication monotherapy in favor of an anti-inflammatory bronchodilator drug will improve disease control, patient compliance, reduce the risk of severe exacerbations and death. The use of the algorithm for diagnosing and management asthma by primary care physicians, developed by experts of the Russian Respiratory Society and the Russian Association of Allergologists and Clinical Immunologists, will reduce the time for diagnosing asthma, timely and correctly prescribe anti-inflammatory therapy and control the course of the disease.

Russian Family Doctor. 2019;23(4):5-11
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Lectures
Viral hepatitis E
Kuznetsov N.I., Romanova E.S., Startseva G.Y., Zlateva N.V.

Abstract

The lecture sets out modern ideas about the etiology of viral hepatitis E, considering its species, physical and chemical properties. The questions of epidemiology are covered, namely, a characteristic of the zones of the spread of the virus, transmission routes, depending on the genotype of the virus, is given. Issues of the pathogenesis of the disease are also given taking into account new data on the virus genotypes. The acute and chronic forms of the course of the disease and extrahepatic manifestations of this infection are described. Their clinical picture, laboratory diagnostic methods, modern principles of therapy and prevention are given.

Russian Family Doctor. 2019;23(4):13-18
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Theory and practice
Progress in the development of general practice / family medicine in the city of Saint Petersburg (Russian Federation)
Gillan U., McQuiston R., Slevin O.

Abstract

In previous years, indeed in some respects preceding the establishment of the Russian Federation, consideration had been given to the establishment of new approaches to general medical practice in Russia. Particular attention centred upon the establishment of Family Medicine and the preparation of doctors as Family Practitioners to advance this initiative. A number of pilot studies were initiated, including in the city of Saint Petersburg. These were intended to provide real-world opportunities to test and develop new and more effective approaches to primary health care that would more efficiently integrate with secondary care. The authors were involved in the initial pilot studies in the mid to late 1990s and subsequent follow-up projects to further advance the initiatives in the early years of the 21st century (2002–2010). This brief paper reports on a review of progress made in respect of the above initiatives. It is not at this time a comprehensive evaluation of the healthcare systems as they now operate. The authors nevertheless present some indications of satisfactory progress across a range of practices, some insights into challenges that have arisen, and some suggestions that might be helpful in the current rounds of strategic planning for health.

Russian Family Doctor. 2019;23(4):19-31
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Original studies
General physician’s and primary care nurse’s contribution to the osteoporotic hip fracture identification in the Republic of Uzbekistan
Zakroyeva A.G., Shakirova M., Ismailov S.I., Alikhanova N.M., Lesnyak O.M.

Abstract

Precise population-based data on the osteoporotic hip fracture (HF) rate play an invaluable role in the assessment of burden of osteoporosis as well as in development of the national clinical fracture risk prediction tool (FRAX). Currently, these data in Uzbekistan is unavailable. Aim. To create a system for the all HF detection to calculate their incidence in Uzbekistan, and to assess the general physician’s (GP) and primary care nurse’s role in this system.

Materials and methods. Cohort study was carried out in 2011–2017 in the Pap district of Uzbekistan We had revealed the national trauma care records peculiarities and then organized the prospective study. The trauma care records were monitored. Besides, all medical specialists including GPs, GP nurses and the community leaders were actively involved into the search and verification of non-hospitalized hip fracture patients escaping trauma care statistics.

Results. Overall, among HF patients, only 34% were hospitalized, and 26% took outpatient trauma care. Additional 29% of HF patients were found only with the help of GPs. GP nurses in collaboration with the community leaders disclosed additional 11% patients who had been staying at home without any medical care. The annual standardized HF incidence in people older than 40 years enriched 357.7 for women and 190.2 for men per 100 000.

Conclusion. Collection of epidemiological information on HF incidence in Uzbekistan was possible only with the help of GPs and GP nurses as key figures of primary care. The obtained epidemiological data will be incorporated into the first created Uzbek national FRAX model to assess the 10-year risk of osteoporotic fracture in clinical practice.

Russian Family Doctor. 2019;23(4):31-40
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The effectiveness of atrial fibrillation screening with the MyDyagnostick 1001R device in a population and in a group at risk
Petrosyan Y.M., Dumbadze R.D., Bakshanskaya E.O., Korogodina V.A., Koval’ I.P., Chentsov D.V., Frolova E.V., Turusheva A.V.

Abstract

Due to the low detectability of atrial fibrillation (AF), more attention is paid to AF screening. Screening procedure requires new diagnostic devices that allow immediate assessment of heart activity. One such portable device is the MyDyagnostick 1001R.

The aim. Сomparison of the clinical effectiveness of screening in people who participated in the preventive health examinations and in patients with AF risk factors admitted to the City geriatric medical hospital.

Materials and methods. 101 patients hospitalized to City geriatric medical center were included using the method of continuous selection. Another sample of patients included 102 volunteers who participated in a preventive health examinations organized by the City center for medical prevention in St. Petersburg (convenience sample). Heart activity was registered with portable device MyDyagnostick 1001R.

Results. AF was diagnosed in 25 (24.8%) patients from geriatric medical center were. Of these, 12 patients were not suspected of having AF. Among the volunteers undergoing a routine examination, AF was found in 5 people, 3 of whom had paroxysmal AF in anamnesis.

Conclusions. In a population of individuals with risk factors, AF was detected in 24.8% of cases; in 48%, AF was not previously detected using standard registration methods, which is in favor of periodic screening of AF in a population with risk factors for its development. In the population of participants of preventive health examinations, AF was found in 5 people, which indicates a low detectability of AF not at risk. Significant signs indicating possible AF were a feeling of palpitations and a history of stroke, which may confirm the need for screening for AF of persons with such symptoms.

In screening purposes portable device MyDyagnostick 1001R may be used effectively.

Russian Family Doctor. 2019;23(4):41-48
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Medical Education
Optimization of training of graduates of medical universities for primary accreditation with participation of the student-tutor
Kuznetsova O.Y., Turusheva A.V., Lopatin Z.V., Bogdanova M.O., Frolova O.I., Ashurov A.B., Podoprigora E.A., Hagush A.L., Shayakhmetova G.R.

Abstract

The article is devoted to the study of the effectiveness of training graduates of medical universities when a trained student is included in the educational process, able to fulfill the role of a mentor. All over the world, the number of students is increasing in medical universities every year, but there is no equivalent increase in the teaching staff. One of the potential methods of overcoming the above problems is the use of trained mentors from among peer students. This method was used when students practiced practical skills in a simulation center in anticipation of primary accreditation. The purpose of the study is to optimize the preparation of students for a practical exam in a simulation environment with the help of a student mentor. Of the 468 students of the medical faculty of the North-Western State Medical University named after I.I. Mechnikov, studying in the VI year, was chosen by their colleague, who was trained at the center of simulation technology. A sample of 100 graduates was randomly generated, which were randomized into two groups of 50 people each (the main group in which the training was conducted with the participation of a mentor student and a control group trained under the guidance of teachers from one of the university departments). The most difficult for students was the station simulating the provision of emergency medical care (EMF). The evaluation checklist for checking the quality of the tasks at this station includes 233 points that must be implemented when providing EMF in 13 different situations requiring this type of medical care. To improve the quality of mastering practical skills, a training scheme was developed that allows you to learn the algorithm of actions when providing EMF. A basic assessment of students’ knowledge and skills revealed a low level of knowledge of diagnostic techniques and emergency assistance. Using the developed training scheme with the help of a student mentor has significantly increased the level of knowledge and practical skills in the provision of EMF. The quality of training in the main group did not significantly differ in most of the assessed parameters from the control group in which classes were held with the teacher. Statistical analysis of the data was performed using the SPSS 20.0 program (SPSS Inc., Chicago, IL, USA).

Russian Family Doctor. 2019;23(4):49-54
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