[The problems of efficient functioning of hot lines in health care].

The article analyzes experience of interaction of public authorities of the subjects of the Russian Federation in area of health protection with civil society using hot-lines. The advantages and disadvantages of this type communication channel are established too. The justifications for implementation of principles of "open health care" are presented considering "hot-lines" as tool of interaction between the government and society (citizens and public organizations).

[Adherence to guidelines on management of acute coronary syndrome in Russian hospitals and outcomes of hospitalization (data from the RECORD-2 Registry)].

BACKGROUND: Complete following existing guidelines for management of acute coronary syndrome (ACS) is known to be associated with better outcomes. Partly this is explained by lesser adherence to recommendations in high risk patients. Aim of our study was to assess relationship between degree of following current guidelines and in hospital outcomes independently from initial assessment of risk. METHODS: Each key recommendation from guidelines issued between 2008 and 2011 (13 for STE ACS, 12 for NSTE ACS) was given weight of 1. Sum of these units constituted index of guideline adherence (IGA). IGA was retrospectively calculated for 1656 patients included in Russian independent ACS registry RECORD-2 (7 hospitals, duration 04.2009 to 04.2011). The patients were divided into 2 groups according to quartiles of IGA distribution: 1) low adherence group (quartiles I-II); 2) high adherence group (quartiles III-IV). RESULTS: In low adherence compared with high adherence group there were significantly more patients more or equal 65 years (=0.0007), with chronic heart failure [CHF] (<0.0001), previous stroke (<0.0001), atrial fibrillation [AF] (=0.0002), Killip class more or equal II (=0.0065), high risk of death by GRACE score (=0.035). Inhospital mortality was 9.3 and 2.4% in low and high adherence group, respectively (p<0.0001). The following independent predictors of inhospital death were identified: IGA quartiles I-II (odds ratio [OR] 4.0; 95% confidence interval [CI] 2.3-7.1; <0.0001), high GRACE score (OR 3.3; 95% CI 1.8-6.0; <0.0001), admission systolic BP less or equal 100 mm Hg (OR 3.1; 95% CI 1.8-5.4; <0.0001), admission serum glucose more or equal 8 mmol/l (OR 2.9; 95% CI 1.8-4.7; <0.0001), age more or equal 65 years (OR 2.3; 95% CI 1.3-4.0; =0.005), ST elevation more or equal 1 mm on first ECG (OR 1.7; 95% CI 1.1-2.5; =0.013). From groups with low and high adherence to guidelines we selected pairs of patients (n=588) with similar (or close) age, type of ACS, GRACE score, Killip class, presence of other important risk factors (CHF, AF, previous stroke), and formed 2 equal subgroups without significant differences in important demographic, anamnestic, clinical and laboratory data. Hospital mortality was 7.8 and 2.7% in low and high adherence subgroup, respectively (p<0.0001). CONCLUSIONS: In RECORD-2 ACS registry low adherence to guidelines was more frequent among high risk patients and was independent predictor of inhospital death. Association between degree of guidelines adherence and outcomes persisted after equalizing groups by some factors of risk of mortality.

[Cerebral perfusion in patients with arterial hypertension associated with type 2 diabetes].

The aim of the study was to assess cerebral perfusion (CP) in patients with arterial hypertension in combination with type II diabetes. The subjects were 57 patients with stage II AH (mean age 51.6 +/- 5.7 years), among who there were 33 patients without disturbances in carbohydrate exchange and 24 patients with compensated or subcompensated type II diabetes. All the patients underwent single-photon emission computed tomography of the brain with 99m Tchexamethylpropyleneamineoxime. The study showed that patients suffering from AH with or without type II diabetes had signs of cerebral hypoperfusion and lowered cerebrovascular reserve even in the absence of focal neurological symptoms. Disturbances in cerebral perfusion were more prominent in patients suffering from AH with type II diabetes vs. patients without carbohydrate exchange disorder.

[Hypotensive activity and cerebroprotective properties of carvedilol in patients with arterial hypertension associated with type 2 diabetes mellitus].

Aim of the study was to elucidate peculiarities of influence of carvedilol on 24-hour blood pressure (BP) profiles and changes of parameters of cerebral perfusion in patients with arterial hypertension (AH) associated with type 2 diabetes mellitus. Investigations were performed in 30 patients with I-III degree AH associated with type 2 diabetes of compensation and subcompensation stages. At baseline and after 24 weeks of treatment with carvedilol we carried out 24-hour BP monitoring, single photon emission computer tomography of the brain, and assessed the state of carbohydrate and lipid metabolism. According to data of 24-hour BP monitoring marked lowering of BP parameters occurred under the influence of therapy. This was accompanied with 26% decrease of the number of hypoperfused sectors of the brain (chi2=6.04, =0.014). During adenosine test number of hypoperfused sectors decreased from 136 to 117 (chi2=2,10, =0,147) what evidenced for a tendency to improvement of reactivity of cerebral vessels in response to vasodilating influences. The preparation exerted favorable effect on metabolic parameters and lowering of level of postprandial glycemia in dynamics of treatment was statistically significant.