Research'n Practical Medicine Journal
ISSN / EISSN : 2409-2231 / 2410-1893
Published by: QUASAR, LLC (10.17709)
Total articles ≅ 462
Latest articles in this journal
Research and Practical Medicine Journal, Volume 9, pp 180-191; https://doi.org/10.17709/2410-1893-2022-9-3-14
Purpose of the study. To compare the perception of the safety culture of the organisation by medical staff in Germany and Russia.Materials and methods. In the study carried out in Germany (Bohmann F. O. et al.), the original Safety Attitudes Questionnaire (SAQ), was used. The Russian sample, an adapted and validated Russian-language version of the questionnaire was used (Tsaranov, K.N. et al.).Results. According to the indicator "Experience of work" among German medical workers, the results of the questionnaire showed higher results for all of the studied indicators except "Stress recognition" in the group of medics with more than 5 years of work experience. Among Russian medics higher results were observed in the group of respondents with less than 5 years of work experience except for the "Perceptions of management".For the indicator "professional position" among medics in Germany, the results of the questionnaire showed higher results for all of the studied indicators in the group of medics who occupy the professional position of "physician". In Russia nursing staff score higher on the "Working conditions" factor, while physicians score higher on "Teamwork climate", "Safety climate" and "Stress recognition", showed a coincidence of results on "Job satisfaction" and "Perceptions of management" scales.The neuroradiology department scores higher than the neurology department of German clinics on the factors "Teamwork climate", "Safety climate", "Job satisfaction" and "Working conditions". The coincidence with the results of the mean values in both groups is observed for the factor "Perceptions of management". Russia has the highest scores for most of the factors: "Safety climate", "Job satisfaction", "Perceptions of management" and "Working conditions" were shown by the staff in the reception and diagnostic department. Low scores were found for the factors "Teamwork climate" and "Safety climate" among staff in the infectious diseases department, and "Stress recognition" in the intensive care and combustiology departments.Conclusion. Significant differences were revealed according to the indices "length of professional experience", "professional position" and "department of work" among employees of medical clinics in Russia and Germany. The results enable the identification of target points for the design of a medical organisation development program aimed at increasing the level of evaluation of the safety culture of a medical organisation.
Research and Practical Medicine Journal, Volume 9, pp 129-144; https://doi.org/10.17709/2410-1893-2022-9-3-10
In recent years, more foreign publications are devoted to the use of texture analysis or radiomics in solving certain diagnostic problems, including the diagnosis of hepatocellular cancer (HCC). This method of processing medical images allows for a comprehensive assessment of the structure of neoplasms by extracting a large number of quantitative features from medical images.The purpose of the study was to determine the role of texture analysis of CT and MR images in differential diagnosis and determination of the degree of differentiation of HCC based on a review and analysis of the results of publications.We searched for scientific publications in the PubMed information and analytical system for 2015–2021. by keywords: “HCC”, “texture analysis” (texture analysis), “radiomics”, “CT”, “MRI”, “grade”, “differential diagnosis”. After excluding reviews of publications and studying the full text of articles, 21 articles were selected for analysis.Despite the growing number of publications devoted to the successful use of textural analysis of CT and MR images, including non-invasive assessment of the histological grade of HCC and in the differential diagnosis of HCC with hypervascular neoplasms, metastases, regenerative and dysplastic nodes, the use of such type of analysis in routine practice is limited due to the lack of standardized methods for performing texture analysis, which leads to low reproducibility of the results. The parameters of image acquisition and methods of image preprocessing and segmentation affect the reproducibility of the obtained texture features. In addition, the presented studies were performed using different MR sequences and phases of contrast enhancement, as well as different software, which makes it difficult to compare the obtained data.The use of texture analysis certainly demonstrates promising results and requires further investigation to systematize and standardize the obtained data in order to develop an optimal diagnostic model for wide clinical use.
Research and Practical Medicine Journal, Volume 9, pp 160-170; https://doi.org/10.17709//2410-1893-2022-9-3-12
Currently, taking into account the pronounced competition among modern medical organizations, attracting patients and forming a high degree of their loyalty requires significant efforts both in the field of ensuring the quality of medical services provided, and in the field of full implementation of legally enshrined patient rights, compliance with ethical and deontological norms, the formation of effective communication and integration processes between employees of a medical organization and patients and/ or their relatives, and in the context of the activities of a private medical organization, special work is also largely required to optimize the main business processes. All the activities described above are united by the concept of «patient-centered approach».Purpose of the study. To increase the degree of satisfaction of patients with the organization of medical care through the introduction of a patient-centered approach.Materials and methods. This study was undertaken using methods of analysis and synthesis, experiment and sociological measurements (questionnaires, qualitative interviews of 64 patients and 10 employees), included the study and generalization of specialized research and practical experience, work with local regulatory documents.Results. Сomprehensive work on the introduction of patient-centered principles into the activities of a medical organization had a positive impact on both the degree of patient satisfaction with the organization of medical services provided and on the assessment of modified working conditions by employees of a medical organization.Conclusion. Сonstructive optimization of the activities of a medical organization through the introduction of patient-centered principles should be carried out using an integrated approach based on international experience using project management, risk management and patient-orientation methodologies. To determine the main areas of activity and monitor the effectiveness of implemented measures, the most appropriate, relevant tools are internal audit and conducting a patient survey.
Research and Practical Medicine Journal, Volume 9, pp 67-79; https://doi.org/10.17709/2410-1893-2022-9-3-5
Purpose of the study. To study the effect of copper nanoparticles on the characteristics of the transplanted tumors of rats, as well as to assess the dependence of the effect on the method of administration of nanoparticles.Materials and methods. In experiments on 163 white outbred male rats, 160–200 g, the size and growth rate of transplanted sarcoma 45 and Pliss' lymphosarcoma were determined in dynamics when a suspension of copper nanoparticles in physiological saline was injected intratumorally or intraperitoneally in a total dose of 10 mg/kg. Nanoparticles had a "core-shell" structure with variable diameter in the range of 30–75 nm. Contrary to other researches, we started the exposure to metal nanoparticles only when the tumors had become visible and had grown up to the sizes at which their spontaneous regression was unlikely.Results. In most animals (up to 89 %), significant antitumor effects of copper nanoparticles were obtained up to complete regression of tumors with large volumes. The effects of nanodispersed copper differed in tumors with different histological structures and growth patterns. Experiments on a transplantable, slowly growing sarcoma 45 showed a decrease in the specific tumor growth rate after a single injection of nanoparticles (1.25 mg/kg), a decrease in tumor size could be observed after 4 injections (a total dose of 5 mg/kg). In the case of a rapidly growing tumor model (Pliss' lymphosarcoma), a decrease in tumor growth rates caused by copper nanoparticles occurred at later stages of exposure, after the animals received nanoparticles at a total dose of 5–10 mg/kg. The efficiency depended on the approach of nanoparticles injection.Conclusion. In case of sarcoma 45, intraperitoneal injection of copper nanoparticles was more effective than intratumoral one, while in rats with Pliss' lymphosarcoma intratumoral injection of the nanoparticles had some advantages. The results indicate that nanodispersed copper is a promising antitumor factor. The mechanisms of regression of large transplanted tumors under the influence of copper nanoparticles are discussed.
Research and Practical Medicine Journal, Volume 9, pp 80-90; https://doi.org/10.17709/2410-1893-2022-9-3-6
Purpose of the study. The study was aimed to investigate the effectiveness of PET / CT with 18 fluoro‑2 deoxy-D-glucose (18F-FDG) in the differential diagnosis of focal lung neoplasms.Materials and methods. Patients (n = 108) with newly diagnosed lung focal lesions were enrolled in the study. All patients underwent PET / CT with 18fluoro‑2deoxy-D-glucose in the "whole body" mode in accordance with the standard protocol. The next step was surgical treatment with morphological verification. According to the results of the morphological conclusion, malignant neoplasm was not diagnosed in 11 (10.2 %) patients, while post-inflammatory changes were detected in 7 patients (SUVmax from 2.3 to 15.15), hamartoma was verified in 3 patients (SUVmax from 1.1 to 4.2) and anthracosis was detected in 1 patient.Results. The median radiopharmaceutical accumulation (SUVmax) was 6.0 (ICR 3.9–8.4, n = 108). In turn, in patients with diagnosed lung cancer this indicator was 7.0 (ICR 5.8–10.9, n = 60), in patients with metastatic lesions 4.3 (ICR 2.5–7.1, n = 37). The threshold for SUVmax was 5.4 for the detection of malignant tumors. PET/CT with 18F-FDG demonstrated high data variability regarding the size of lung focal lesion. An error within 35 % was observed in 76 % of cases, underestimating small lesions (up to 40 mm) but overestimating the major neoplasms. Application of a linear model for adjustment of neoplasm size assessment allows to estimate the actual size of neoplasms with parameters 5.862 + 0,817 × х (х – PET / CT size) in 84.5 % of cases with an error of 50 %. The optimal diagnosing size for metastatic lesions is in the range between 16.4 and 19 mm.Conclusion. Taken together the results of the study show that PET / CT with 18F-FDG gives a relatively accurate estimation of the tumor size. Application of the linear model corrects a radiological size measurements and helps to predict an actual size of a neoplasm in 84.5 % of cases with an error of 50 %. The prospective threshold for SUVmax was at least 5.4 for the detection of malignant neoplasms.
Research and Practical Medicine Journal, Volume 9, pp 145-159; https://doi.org/10.17709/2410-1893-2022-9-3-11
Colorectal carcinoma (CRC) is the third most common cancer worldwide and ranks second as a cause of cancer mortality. CRC screening is carried out in many countries for detection early-stage CRC and its prevention by removing precancerous lesions, and includes fecal occult blood testing and colonoscopy. Different countries use their own approach to screening, including methods of detection of fecal occult blood. The strategy for fecal occult blood testing is based on the fact that already in the early stages the tumor can bleed, and small traces of blood in the stool are detected before the onset of clinical symptoms of the disease. Different countries use their own approach to the CRC screening, including methods for fecal occult blood testing. Chemical and immunochemical methods are used to determine occult blood in the feces. The chemical method is based on the detection of heme peroxidase activity. The immunochemical method detects human globin using specific antibodies. The immunochemical method can be qualitative and quantitative. The sensitivity of a quantitative immunochemical test depends on the selected threshold and the stage of CRC. The lower the threshold value, the higher the sensitivity, but the lower the specificity due to false positive results. CRC screening programs use different thresholds for quantitative immunochemical testing in different countries, which is caused by the availability of colonoscopy in a positive test result, as well as the rate of CRC in this population. To increase the sensitivity of the immunochemical test, some programs suggest using it in combination with other methods: detection of DNA in stool, examination of other proteins in feces (transferrin, haptoglobin). This review presents the methods used in the world for fecal occult blood testing, their advantages and limitations; recommendations for reporting the results of a quantitative immunochemical test; thresholds recommended in screening programs in different countries for quantitative immunochemical tests. The results of pilot screening for fecal occult blood testing in some regions of the Russian Federation are also presented.
Research and Practical Medicine Journal, Volume 9, pp 25-38; https://doi.org/10.17709/2410-1893-2022-9-3-2
Purpose of the study. An analysis of parameters of the blood coagulation system in breast cancer patients after coronavirus disease.Materials and methods. 50 breast cancer patients were divided into groups: the main group included 30 patients after coronavirus disease, the control group 1–20 patients without confirmed COVID‑19, and control group 2–20 non-cancer women after corona‑ virus disease. All cancer patients received appropriate chemotherapy. The following parameters were studied: activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR), prothrombin index (PTI), fibrinogen, soluble fibrin monomer complexes (SFMCs), thrombin time (TT), antithrombin III, D-dimer and plasminogen, fibrin degradation products. Blood tests were performed 4–6 weeks after the infection and two negative PCR test results for COVID‑19.Results. Patients of the main group demonstrated differences in INR values after treatment in the subgroups with asymptomatic disease (Me = 1.24) and with mild symptoms (Me = 0.97) U = 10; Z = 2.766; р = 0.0057, in subgroups with asymptomatic disease (Me = 1.24) and with moderate to severe symptoms (Me = 0.98) U = 26.5; Z = 2.199; р = 0.027, and in TT values in subgroups with asymptomatic disease (Me = 14.5) and with moderate to severe symptoms (Me = 16.5) U = 18.5; Z = –2.725; р = 0.0064. The comparison of the parameters in patients after COVID‑19 before (Me = 0.83) and after treatment (Me = 0.4) showed differences in the D-dimer values in patients with moderate to severe disease U = 6.5; Z = –2.2861; р = 0.022 towards their decrease after the therapy. Differences were found in APTT values between the main group (Me = 30.65) and control group 1 (Me = 27.85) U = 119; Z = 3.574; р = 0.00035, in antithrombin values between the main group (Me = 94) and control group 1 (Me = 106) U = 112; Z = 3.713; р = 0.00021, and in SFMCs values between the main group (Me = 17) and control group 1 (Me = 8) U = 180.5; Z = 2.356; р = 0.018.Conclusions. Determination of plasminogen levels can become an independent factor in detecting thrombotic risk in cancer patients who recovered from COVID‑19. Previous infection with COVID‑19 should be considered an additional risk factor for venous thromboembolic complications for cancer patients.
Research and Practical Medicine Journal, Volume 9, pp 91-105; https://doi.org/10.17709/2410-1893-2022-9-3-7
Purpose of the study. To assess ultrasound features and patterns of features for metastatic papillary thyroid cancer (PTC) in soft tissues of the neck.Materials and methods. The study included 335 histologically confirmed metastases and 102 benign lymph nodes (LN). Statistical processing was carried out in the SPSS program. The reliability between the groups was assessed by criterion t with a significance level of p < 0.05. The informative value of ultrasound signs and patterns of signs, and the probability of the presence of metastasis using binary logistic regression are calculated.Results. The 14 criteria for metastasis have been studied. There are 33 signs, i.e. types of criteria. During the statistical analysis, six most informative criteria were established: calcifications, contours, shape, depth-to-width ratio in the transverse scanning plane, state (differentiation) of the cortical and cerebral layers, echostructure. To create complexes (patterns) of ultrasonic signs, a combination of these signs was used among themselves, and five patterns were established. The first pattern, including the depth-to-width ratio in the transverse scanning plane and the echo structure, has a sensitivity (Se) of 97 %, diagnostic accuracy (Ac) of 96.5 %, area under the curve (AUC) of 96 %, the probability ranges from 95 to 99 %. The Se of the second pattern, including the ratio of depth to width in the transverse scanning plane, echostructure and shape, was 97.2 %, Ac – 96.8 %, AUC – 97.3 %, probability – 95–100 %. The third pattern, including the ratio of depth to width in the transverse scanning plane, nature, shape and contours, and the fourth pattern, including the following criteria, the ratio of depth to width in the transverse scanning plane, echostructure, shape, contours and differentiation into cortical and cerebral layers, have Se 96.9 %, Ac – 97.1 %, AUC – 98.7 %, probability – 88–100 %. The fifth pattern, including the ratio of depth to width in the transverse scanning plane, echostructure, shape; contours; state (differentiation) of the cortical and cerebral layers; calcinates, has Se – 99.6 %, Ac – 99.5 %, AUC – 99.9 %, probability – 94–100 %.Conclusion. Five patterns of metastatic involvement of lymph nodes in PTC were found. The informative value of US increased from the first to the fifth pattern achieving a Se of 99.6 %, Ac of 99.5 %, AUC of 99.9 %. The probability ranged from 94 % to 100 %.
Research and Practical Medicine Journal, Volume 9, pp 171-179; https://doi.org/10.17709/2410-1893-2022-9-3-13
Improving the productivity, quality and availability of medical services directly depends on the effectiveness of motivational mechanisms for personnel management. Despite the sufficient empirical and practical experience in the field of health workforce management, data on the comparison of labor motivation among different professional categories of medical personnel are not often found. The article analyzes the main labor motives of nurses and doctors, reveals the differences in the motivational profiles of these categories of workers.Purpose of the study. Is to study and compare the motivation of doctors and nurses from budgetary healthcare institutions providing TB care to the population.Materials and methods. A sociological survey was conducted using a questionnaire form containing questions to study the labor motivation of healthcare workers. The study involved employees of various professional categories of public medical institutions – the Republican Clinical Tuberculosis Hospital and the Makeyevka Municipal TB Dispensary. Labor motives are structured into 3 blocks: material, socio-psychological and individual.Results. In the overwhelming majority, doctors and nursing staff of public health care institutions with a phthisiology profile are equally satisfied with the work they do. The most significant labor motives were identified for each category of medical personnel. For paramedical personnel, the factor of material motivation came out on top, but a convenient work schedule, relationships with superiors and a favorable psychoemotional climate made up the five most significant work motives. Physicians are more influenced by individual and socio-psychological motives: self-realization and professional interest are in the lead, remuneration, relationships with colleagues and patient care have a complex effect on the activities of doctors.Conclusion. This study confirms the principle of polymotivation of all categories of employees, therefore, the modernization of the motivational environment should be carried out taking into account group affiliation, individual characteristics, preferences and personal qualities of employees. Personnel-oriented system of motivation of medical personnel will solve most of the problems faced by the healthcare sector in today's changing market relations.
Research and Practical Medicine Journal, Volume 9, pp 106-116; https://doi.org/10.17709/2410-1893-2022-9-3-8
Purpose of the study. The aim of this work was to study the effect of conservation in various cryoprotectants on the biomechanical and morphological properties of the umbilical cord (UCA) arteries.Materials and methods. The material for this work was 12 umbilical arteries, which were divided into 4 study groups: (1) native UCA – control without freezing; (2) APC frozen in 5 % dextran with the addition of dimethyl sulfoxide (DMSO) to 10 % and 7.5 % human serum albumin (HSA); (3) APC frozen in glycerin and (4) UCA frozen in propanediol. For all groups, morphological and biomechanical studies were carried out. The statistical data were processed using the GraphPad Prism 9.2.0 program. Analysis of variance was used to find significant differences.Results. Freezing with 5 % dextran, 10 % DMSO and 7.5 % human albumin did not lead to significant changes in the morphology of vascular tissue compared to control. The conserved vascular tissue retains a moderate level of type I collagen, regardless of the method of conservation. The presence of statistically significant differences between the control and frozen UCAs was shown for Young's modulus (p < 0.05; 6.9 [6.8; 7.0] for the native artery; 2.3 [2.0; 2.6] for the artery preserved with the use of dextran, DMSO and human albumin; 2.3 [1.4; 3.2] for the artery preserved in glycerin and 0.8 [0.6; 1.0] – in propanediol, respectively).Conclusion. 1) Freezing and storage of UCA at 5 % dextran, 10 % DMSO and 7.5 % HSA does not lead to a significant change in the morphology of vascular membranes and cell nuclei; 2) The preservation of type I collagen according to the results of IHC is qualitatively reduced from a conditional indicator of +2 to +1 for frozen agroindustrial complexes compared with control ones; 3) Conservation leads to a significant decrease in the modulus of elasticity of the walls of the agroindustrial complex compared with control vessels (p < 0.05).