ABSTRACT
Actuality. The results of the EPOCH study showed that in 16 years in the Russian Federation the number of patients with chronic heart failure (CHF) of I-IV FC increased significantly. The main objectives of the treatment of CHF are the stabilization of the patient's condition and the reduction of the risks of cardiovascular mortality, decompensation and repeated hospitalizations for heart failure. But a single concept of "stable" CHF does not exist either in Russian or in foreign recommendations. OBJECTIVE: To assess how ofen the subjective assessment of a doctor regarding the stability of a patient with CHF coincides with the subjective opinion of the patient with CHF regarding the stability of his condition; and to identify those parametrs that have a leading inï¬uence on the assessment of the stability of the state from the point of view of the physician and the patient. MATERIALS AND METHODS: Data collection was carried out in the form of interviews among general practitioners and cardiologists in outpatient clinics (OC) of Nizhny Novgorod, which were randomly selected by the method of blind envelopes. In parallel, a survey was conducted of patients with CHF who applied for outpatient medical care about this syndrome to this OC, which the doctors were not informed about, because patient interviews were conducted after the end of outpatient admission in a separate room. Answers of doctors about a patient with CHF were compared with the answers of the corresponding patient; for this, a single code was assigned to both questionnaires. The study included 211 patients with CHF of any etiology older than 18 years. The study involved 25 doctors. The study was conducted from 11/01/17 to 11/30/17. RESULTS: Analysis of the data suggests that the doctor is more likely to consider the patient more stable in cases when the patient notes a decrease in the severity of shortness of breath, weakness and does not detect edema, while the fact of therapy with loop diuretics (LD) or an increase in them did not aï¬ect assessment of stability from the point of view of the doctor. From the point of view of the patient, the absence of the first three signs also testifies to the stability of the condition, however, unlike doctors, patients more often (p <0.001) considered themselves unstable in those cases when they needed LD therapy or an increase in LD dose. A logit regression analysis and ROC analysis based on selected signs and symptoms of CHF confirmed that a model that combines questions about persistent weakness and edema is best suited to predict the patient's subjective assessment of patient's stability from a doctor's point of view (61.8% of the results can be correctly predicted), and at the cutoï¬ threshold of 0.5, it has the highest sensitivity of 64.9%. To predict the subjective assessment of stability in relation to the patient, the optimal model turned out to be the one that includes answers to the questions of "shortness of breath", "weakness" and "intake of loop diuretics", which allows to predict 66.7% of the results correctly at the cutoï¬ threshold 0, 5 has a better balance of sensitivity and specificity (54.9 and 78.6, respectively). CONCLUSION: Reducing the severity of dyspnea, weakness and lack of edema of the lower extremities are important signs of the stability of the condition, both in the opinion of the doctor and in the opinion of the patient. Unlike the doctor, the patient is more likely to be classified as unstable in those cases when he is forced to receive therapy with loop diuretics at the outpatient stage or to increase their dose. The model for assessing the stability of a patient with CHF from the point of view of a physician more often allows one to confirm the patient's stable condition, while the model used by patients more often allows to identify patient instability and worsening of the course of CHF.
Subject(s)
Heart Failure , Chronic Disease , Hospitalization , Humans , Male , Russia , Sodium Potassium Chloride Symporter InhibitorsABSTRACT
AIM: To study the phenomena of visual-hemispatial neglect in healthy people and patients with brain diseases of different genesis. MATERIAL AND METHODS: Eighty-eight patients with schizophrenia spectrum disorders, 68 patients with exogenous organic brain diseases and 240 healthy adults of different age were included in the study. The digit cancellation test modified by the authors was used. RESULTS AND CONCLUSION: The validity of the modified digit cancellation test was approved and its age standards were obtained. In healthy right-handed people, there was the bias of attention focus to the left, the decrease of asymmetry intensity of visual-spatial inattention during physiological aging and the presence of some clinical peculiarities of neglect in schizophrenia spectrum disorders and lateralized organic damages of the brain. This variant of the test can be recommended for practical use as the sensitive psychometric tool.
Subject(s)
Perceptual Disorders , Schizophrenia , Attention , Brain , Extremities , Functional Laterality , Humans , Neuropsychological TestsABSTRACT
Stem cells from the endometrium isolated during menstrual bleeding were characterized. By their main surface markers, differentiation potential, and morphological signs these cells belong to mesenchymal stem cells. Specific features of this cell type are high clonogenic activity and low capacity to adipocyte differentiation.
