Saratov JOURNAL of Medical and Scientific Research

№2

Motivation of medical staff of dental organizations of various property types: data of sociological research

Year: 2018, volume 14 Issue: №2 Pages: 287-293
Heading: Health Service Organization Article type: Original article
Authors: Kaneva D.A., Breusov A.V.
Organization: Peoples' Friendship University of Russia
Summary:

The searching of effective methods of staff management is the most important task for healthcare managers. The purpose of the study: to assess the degree of work satisfaction of doctors and nursing staff of dental organizations of various forms of ownership and to analyze the factors that determine it. Material and Methods. The survey was conducted using a specially developed questionnaire, which included blocks describing the following parameters: satisfaction with various aspects of the work; factors affecting labor activity; rating characteristics of work; motives that determine professional interest; conditions that stimulate activity. Results. As a result of the study, differences were found in the satisfaction with the professional activity and working conditions of medical and nursing staff of dental organizations of various forms of ownership. Factors determining the motivation of the work of the personnel of the modern medical organization are revealed. This allowed for a differentiated approach to the development of measures to improve the diverse motivation of the staff. Conclusion. It was established that the main directions in improving the staff motivation system may be: material and non-material promotion; optimization of work organization; involving staff in the management of organization and making management decisions; improvement of professional skills of employees, fair distribution of remuneration and social services.

AttachmentSize
2018_2_287-293.pdf301.72 KB

Comparative hygienic assessment of working conditions and quality of life of urban and rural doctors

Year: 2018, volume 14 Issue: №2 Pages: 281-286
Heading: Hygiene Article type: Original article
Authors: Petrosyan А.А.
Organization: Saratov State Medical University
Summary:

Objective: assessment of the impact of labor peculiarities in urban and rural areas on the quality of life of doctors. Material and Methods. The study involved 198 doctors of various specialties from rural areas of the Saratov region and the city of Saratov. Sanitary hygienic examination of labor conditions and questionnaire SF-36 on quality of life assessment of health-care workers were conducted. Results. The objective hygienic characteristics of working conditions of city doctors of various specialties, and physicians working in rural areas are presented. It was found that doctors in rural areas are much more likely to combine work in the main and related specialties than urban ones: 31,6 and 15,6% respectively. It is important to note that the frequent combination of rural doctors in related professions also adversely affects the quality of their lives. Conclusion. The analysis of the results of the conducted research proves that when assessing the severity and intensity of the labor process of rural and urban health workers, it is necessary to take into account not only the working conditions but also the level of compatibility.

AttachmentSize
2018_2_281-286.pdf507.79 KB

Complications after different surgical methods of setting polypropylene suburethral meshes in women with stress urinary incontinence

Year: 2018, volume 14 Issue: №2 Pages: 277-280
Heading: Urology Article type: Original article
Authors: Eisenakh I.A., Korotkevich O.S., Mozes V.G., Vlasova V.V.
Organization: Kemerovo State Medical University, Novokuznetsk State Clinical Hospital № 1
Summary:

The aim: to determine the complication's rate, based on a seven-year experience, after the stress urinary incontinence correction in women with different methods of setting suburethral polypropylene meshes. Material and Methods. The analysis of seven years of experience of surgical correction with different methods of setting suburethral meshes in 1260 women with stress urinary incontinence; obturator fixation the mesh inside-outside and outside-inside: supra-pubic fixation the mesh; non-trocar fixation the mesh type mini-sling was carried out. Results. The greatest frequency of complications were identified in the first two years of implementation the setting of suburethral meshes, after that the complication's rate decreased progressively and it was in the range 7-8% the last three years. The frequency of early operative complications at a different setting of suburethral meshes had no statistically significant differences, but there were more the statistically significant intraoperative and mesh-associated complications at suprapubic fixation. Conclusion. The study confirms that the installation of suburethral meshes by the method of suprapubic fixation of mesh is associated with a higher incidence of complications and should be performed only in the target group of patients who are not suitable for surgical correction in safer ways.

AttachmentSize
2018_2_277-280.pdf223.89 KB

Endoscopic correction of obstructive complications after HIFU-ablation of the prostate with holmium laser

Year: 2018, volume 14 Issue: №2 Pages: 272-277
Heading: Urology Article type: Original article
Authors: Popkov V.M., Fomkin R.N., Shatylko T.V.
Organization: Saratov State Medical University
Summary:

Purpose: to improve the results of treatment of the obstructive complications (an urethra stenosis, a bladder neck sclerosis) caused by application of the high-intensity focused ultrasonic ablation (HIFU) concerning treatment of the localized prostate cancer. Material and Methods. An object of the research included 41 patients, with the infravesical obstruction (IVO) which has arisen in the postoperative period to which elimination the holmium laser is used. Results. The bladder neck was the most frequent place of obstruction. Average time before emergence of the first episode of IVO: 8.2±1.3 months. Distinctions on time before development of an episode of IVO depending on the fact of carrying out TURP before HIFU not confirmed (p=0.440). More advanced age for a moment HIFU-ablation has been associated with much higher frequency of IVO (p=0.021). Considerably smaller frequency repeated was observed by IVO at a larger ratio transurethral resection to the initial volume of a prostate (p=0.031). Duration of a laser endoscopic ure-throtomy was 27 [10-70] minutes, serious perioperative or postoperative complications were not determined. Average term before removal of a catheter of Foley: 3 [1-5] days, hospitalization duration included 4 [3-6] days. After treatment considerable improvement on indicators of the maximum speed of a stream of urine (Qmax) and volume of residual urine was observed. The total score according to the questionnaires of IPSS and QoL has considerably improved, significant changes on symptoms of accumulation are noted. After the first holmium laser urethrotomy of 80.4% of patients have noted satisfactory results without recurrence of IVO; 19.6% of patients were required a repeated laser endoscopic urethrotomy. Recurrence term after the first laser urethrotomy is on average equal to 2.5 months. Conclusion. The endoscopic urethrotomy by means of the holmium laser is safe, effective and minimum invasive type of treatment of a stenosis of a neck of the bladder / urethra after ablative cancer therapy of prostate. The advantages are the minimum of traumas of surrounding tissues and preservation of the mechanism of deduction of urine.

AttachmentSize
2018_2_272-277.pdf253.71 KB

The prospects for application of biomarker "vascular endothelial growth factor" in predicting the treatment outcomes of bladder cancer

Year: 2018, volume 14 Issue: №2 Pages: 268-272
Heading: Urology Article type: Original article
Authors: Zakharova N.B., Ponukalin A.N., Skriptsova S.A.
Organization: Saratov State Medical University
Summary:

Purpose: assessment of the diagnostic value of Vascular Endothelial Growth Factor (VEGF) in predicting the outcome treatment of patients with muscle-invasive bladder cancer. Material and Methods. The study involved 264 people: 204 patients with RMP; 60 people aged 21 to 60 years were the comparison group. Patients with RMP are divided into stages of the disease. With non-muscle-invasive ВС (NIRMP) under TA-1NxMo there were 75 patients. Out of 129 patients with muscle-invasive ВС (MIRE) within the body (pT2aN0M0-T2bN0M0) was diagnosed in 69 of people. In 60 patients, the tumor sprouted paravesical tissue and surrounding organs (rt3a-bn0m0-41; pT36N1M0-11; pT4N1M0-5; T4N1M1-3); 19 patients had metastases to the iliac lymph nodes are installed only after the operation. Metastases were found in three patients out of 19 in addition to the lymphonoduses in the lungs. Tumors had the following gradations: G1-97; G2-37; G3-58. All patients NMIN (n=75) completed a TUR of the bladder wall with the tumor. MERE patients underwent radical cystectomy (n=117), open resection of the bladder (n=12), palliative surgery (n=3). The period of follow-up after surgical treatment was 3.5±0.5years. Quantitative determination of VEGF in blood serum was performed by solid-phase ELISA. Results. Despite the fact that the increase in VEGF level of blood serum in groups of patients with NIMRE and MIRE has significant differences both before and in the postoperative period, it is associated with the aggressiveness of tumor growth, development of metastases and recurrences of the disease. Conclusion. The increase in the content of VEGF serum suitable for use as an indicator: the risk of relapse within the first year after TUR in patients NMIN; development of relapses and metastases in pre and postoperative periods in MERE patients.

AttachmentSize
2018_2_268-272.pdf242.72 KB

Efficacy of surgical treatment of renal form of hyperparathyroidism

Year: 2018, volume 14 Issue: №2 Pages: 265-267
Heading: Surgery Article type: Original article
Authors: Kovalenko Yu.V., Tolstokorov A.S., Rossolovsky A.N., Kravchenya A.R., Manakhov G.A.
Organization: Saratov State Medical University
Summary:

Objective: to study the efficacy of surgical treatment of primary hyperparathyroidism in risk of uronephrolithiasis progression. Material and Methods. The research involved 55 patients, the biochemical and clinical parameters before and after treatment with retrospective-prospective method of analysis were studied and analyzed. Results. It is established that the surgical treatment of patients with uronephrolithiasis is proved to be effective in 96,4% of the cases, as it allows to eliminate the classic symptoms of primary hyperparathyroidism, and urolithiasis. Improvement of laboratory hormonal and biochemical indices of mineral metabolism, and, consequently, reducing the severity of risk factors of urolithiasis is marked. Conclusion. Surgical treatment of renal forms of primary hyperparathyroidism is a pathogeneti-cally reasonable method. Parathyroidectomy performed in an adequate amount prevents relapses and progression of diseases that are the consequence of primary hyperparathyroidism.

AttachmentSize
2018_2_265-267.pdf245.79 KB

Effect of different pancreatic stump closure techniques during distal pancreatectomy to the frequency and severity of acute postoperative pancreatitis

Year: 2018, volume 14 Issue: №2 Pages: 260-265
Heading: Surgery Article type: Original article
Authors: Voskanyan S.E., Naydenov E.V., Uteshev l.Yu., Artemiev A.l.
Organization: State Scientific Research Center n.a. A.I. Burnasyan — Federal Medical Biophysical Center of Federal Medical Biological Agency
Summary:

The Aim: to study the effect of different pancreatic stump closure techniques, including depending on the diameter of the main pancreatic duct to frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomies were performed in 126 patients with neoplasms of the body and/or tail of the pancreas. Patients were divided into 4 groups depending on the pancreatic stump closure techniques. Group 1 (control): isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by gastrocolic omentum or hemostatic sponge; group 2: isolated suturing of the main pancreatic duct of the pancreatic stump with its sealing by biological glue 2-octylcyanoacrylate; group 3: pancreatic stump closure were performed by Endoscopic Linear Cutter; group 4: after distal pancreatectomy were performed external transduodenal transnasal drainage of the enlarged main pancreatic duct of pancreatic stump. Results. The frequency of acute postoperative pancreatitis in the control group of patients was 45.8%, in the group 2 of patients — 44.4%, in the group 3 of patients — 9.7%, in the group 4 of patients — 15.0%. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in a decrease of the frequency of moderate form of acute postoperative pancreatitis. The use of Endoscopic Linear Cutter and external transduodenal transnasal drainage of the enlarged main pancreatic duct resulted in decrease of frequency of acute postoperative pancreatitis in patients with a diameter of the main pancreatic duct of the pancreatic stump up to 5 mm. Conclusion. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy resulted in the decrease of frequency and severity of acute postoperative pancreatitis.

AttachmentSize
2018_2_260-2651.pdf652.22 KB

Comparative analysis of clinical outcomes of various methods of anterior cruciate ligament arthroplasty in knee joint in complete rupture of the ligament.

Year: 2018, volume 14 Issue: №2 Pages: 251-259
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Shormanov A.M., Norkin A.l., Klimov S.S., Chibrikova Ju.A., Ulyanov V.Yu., Bakhteeva N.Kh.
Organization: Saratov State Medical University
Summary:

The aim is to carry out the analysis of outcomes of anterior cruciate ligament arthroplasty undertaken by various methods in patients with complete ligament rupture. Material and Methods. 104 patients diagnosed with complete rupture of anterior cruciate ligament (ACL) in knee joint who underwent knee joint arthroplasty fulfilled by various methods were the object of the present study. Clinical outcomes of the treatment were estimated by clinical signs of ACL failure, the degree of functional impairment of knee joint (IKDC 2000) and motor pathology assessed instrumentally. Results. Significantly better function restoration in knee joint occurring as early as 3 months postoperatively has been stated in the group of patients with two-bundle ACL arthroplasty by synthetic implant "DONA-M" on the basis of IKDC subjective knee indices. Negative Lachman test and Pivot shift test were demonstrated as early as 3 months postoperatively by all patients after two-bundle ACL arthroplasty with synthetic implant "DONA-M", reduced support asymmetry 6 months postoperatively was stated in all patient groups as well as run path and surface area in patients with single-bundle ACL arthroplasty by synthetic implant "DONA-M". Conclusion. The use of single- and double-bundle ACL arthroplasty with synthetic implant and ACL arthroplasty with autograft of semitendinosus (ST) and gracilis allows providing equally full-fledge restoration of injured knee joint, without statistically significant differences between the groups, in great majority of patients up to 12 months of follow-up period which is proved by normalized knee joint function, the absence of ACL failure and motor pathology signs estimated instrumentally. Key words: knee joint, anterior cruciate ligament (ACL), co

AttachmentSize
2018_2_251-259.pdf662.67 KB

Personalized approach to diagnostics and treatment of patients with posttraumatic and degenerative diseases of cervical spine

Year: 2018, volume 14 Issue: №2 Pages: 244-250
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Ostrovsky V.V., Shchanitsyn I.N.
Organization:
Summary:

Aim: to develop a personalized approach to diagnostics and treatment of patients outcomes with degenerative and post-injury deformities of cervical spine. Material and Methods. Between January 2009 and January 2016, 520 patients at the age of 15-80 years with degenerative (227) and traumatic (293) lesions of cervical spine were treated in neuro-surgical department. We conducted a comparative analysis of two groups of patients: treated in the period from 2009 to 2012 (group 1: 235 patients) and in the period from 2013 to 2016 (group 2: 285 patients). The developed diagnostic algorithm was used in patients of group 2 when the operation was planned. Results. The frequency of all complications was significantly lower in group 2. In the analysis of complications it was revealed that more often in group 1 there were: dysphagia, dysphonia, severe postoperative pain in the neck and upper limbs; breakdown or malposition of the screw, graft or plate. Conclusion. The comprehensive algorithms for diagnosis and treatment of patients with degenerative and post-injury deformities of cervical spine that take into account their individual morphometric and functional data allow to form an effective personalized program of surgical rehabilitation and reduce the number of perioperative complications from 35 to 9%.

AttachmentSize
2018_2_244-250.pdf2.34 MB

Optimization of surgical treatment tactics at a customary shoulder dislocation

Year: 2018, volume 14 Issue: №2 Pages: 240-243
Heading: Traumatology and Orthopedics Article type: Original article
Authors: Norkin A.l., Klimov S.S., Levchenko K.K., Shormanov A.M., Alieva A.M., Katerusha A.M., Amanova M.M., Ulyanov V.Yu.
Organization: Saratov State Medical University
Summary:

 Saratov Journal of Medical Scientific Research 2018; 14 (2): 240-243. The aim: the optimization of surgical treatment tactics at a customary shoulder dislocation, based on "on-track Hill-Sachs / off-track Hill-Sachs" concept. Material and Methods. The research group consists of 42 patients aged from 19 to 52 years with chronic recurrent anterior shoulder instability, who underwent a surgical treatment to restore previous shoulder anatomic and topographic correlations. Patients were divided into two subgroups according to diagnostic arthroscopy results. The first subgroup includes 14 patients with impaction visualized (off-track Hill-Sachs), the second one — 28 patients with head shoulder stability (on-track Hill-Sachs). Patients of the first subgroup underwent open surgical intervention according to Bristow — Latarjetand shoulder arthroscopic repair was carried out in the second group. Results. One month after the surgical treatment median total estimated figure exceeded by 1.8 times in patients of the first subgroup and by 1.2 times, by Rowe, in patients of the second subgroup and decreased by 2.1 times in patients of the first subgroup and by 1.7 times, by DASH, in the second subgroup in comparison with the indices before the operation, that was illustrative of a good treatment result. Six months after the operation median total estimated figure exceeded by 1.2 times, by Rowe, in patients both of the first subgroup and the second subgroup and decreased by 2 and 2.1 times, by DASH, in patients of the first and the second group, relatively in comparison with the indices found one month after the operation, that was illustrative of an excellent treatment result in the late postoperative period. Conclusion. Patients with anterior shoulder instability caused by a glenoid fossa deficiency less than 25% in combination with off-track Hill-Sachs lesion, the most convenient way is the replacement of the bone loss by coracoid process transposition. In patients with on-track Hill-Sachs lesion arthroscopic repair is preferable.

AttachmentSize
2018_2_240-243_1.pdf274.25 KB