[Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings].

Aim      To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods  This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion      The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working conditions, and emotional exhaustion (a component of professional burnout), older age of patients and their excessive alcohol consumption.

Occupational Burnout, Psychological Status and Quality of Life in Primary Care Physicians Working in Outpatient Settings.

Aim      To study features of the psychological status, job burnout syndrome (JBS)m and quality of life (QoL) in outpatient physicians.Material and methods  This cross-sectional study was performed at 16 randomly selected municipal outpatient hospitals of Moscow and included physicians (district physicians, primary care physicians, and cardiologists). The participants signed an informed consent form and then filled out a registration card that included major social and demographic (sex, age, education, position) and professional characteristics (specialization, work experience, qualification category), and questionnaires. The degree of job burnout was evaluated with the Maslach Burnout Inventory (MBI-HSS), and the presence of anxio-depressive symptoms was evaluated with the Hospital Anxiety and Depression Scale (HADS). The level of stress was assessed with a visual analogue scale (VAS) in a score range from 0 to 10. The QoL of physicians was assessed with the short version of the World Health Organization Quality of Life (HOQOL-BREF) questionnaire.Results This study included 108 physicians from 16 municipal outpatient clinics aged 24 to 70 years (mean age, 44.0±13.1 years), mostly women (87.0 %). Among JBS components, a high level of emotional exhaustion was observed in 50.0 % of physicians, a high level of depersonalization in 34.1 %, and a severe reduction of personal accomplishment in 37.5 %. A high level of stress (VAS score ≥7) was observed in 66.3 % of physicians; symptoms of anxiety and depression of any degree (HADS-A and HADS-D subscale score ≥ 8) were found in 23.8 and 22.7 % of participants, respectively. 42.0% of physicians evaluated their QoL lower than "good" and 41.6% of physicians evaluated their health condition lower than "good". Most of the studied factors did not significantly depend on the gender and the duration of work, except for emotional exhaustion (55.3 % of women and 16.7 % of men; p=0.0086) and a high level of stress (72.2 % of women and 28.6 % of men; р=0.002).Conclusion      The study showed a high prevalence of personal factors that potentially adversely affect the work of outpatient physicians. These factors included high degrees of stress, anxio-depressive symptoms, job burnout, unsatisfactory QoL, and low satisfaction with own health. Management decisions and actions are required to create the optimum psychological climate at the workplace of physicians, to develop new strategies for prophylaxis and correction of their psychological condition, and to implement comprehensive programs for improving the professional environment to maintain and enhance the mental health and to increase the professional prestige of the medical speciality.

Psychosocial Risk Factors in Ambulatory Patients With Arterial Hypertension and Ischemic Heart Disease of 30 Cities in Russia: Data from the КОМЕТА (Сomet) Study.

BACKGROUND: Psychosocial (PS) risk factors (RF) make a substantial contribution in populational burden of cardio-vascular diseases (CVD) and their complications. PURPOSE: The KOMETA (Comet) study was directed to obtaining actual information on PSRF among ambulatory patients with arterial hypertension (AH) and / or ischemic heart disease (IHD) in 30 cities of Russian Federation. MATERIALS AND METHODS: This multicenter cross-sectional study was conducted in 2016-2017. Doctors participating in the study (n=325) recruited in state polyclinics 2775 patients aged ≥55 years with AH and / or IHD. Information collected from these patients comprised social-demographic and clinical characteristics, data on RF, adherence to therapy. Assessment of PSRF was carried out with consideration of levels of anxiety, depression and stress, presence of personality type D. RESULTS: Population of patients studied (72 % women) was characterized by considerable prevalence of PSRFs. Low levels of education and income were found in 24.5 and 44.2 % of patients, respectively; 25.2 % of patients reported living alone, 6.3 % - felt social isolation. Elevated, extremely high levels of stress, type D personality were detected in 67.8, 10, and 37.6 % of patients, respectively; clinically significant symptoms of anxiety and depression were found in 25.5 and 16.3 %, respectively. Most RFs were significantly more often detected in women, and older people. One third of patients (33.1 %) during a year preceding inclusion took some psychotropic drugs mainly herbal or barbiturate-containing (27.1 %). Moreover, 30 % of patients had lowering of cognitive functioning. CONCLUSION: In this large-scale study we revealed high prevalence of PSRFs among ambulatory patients with AH and / or IHD in Russia. Despite positive dynamics of prevalence of states of anxiety and depression relative to earlier studies in this country their negative impact on prognosis of CVD and quality of life of affected patients requires optimization of efforts for organization of adequate care and directed to timely diagnosis and correction of these states.

[Efficacy of primary prevention for atherosclerosis-induced diseases in patients with high cardiovascular risk in Russia and other European countries (Part 1)].

RELEVANCE: Evaluation of the effectiveness of risk management in persons with high cardiovascular risk is an important element in reducing the death rate of the population from cardiovascular diseases (CVD). AIM: Analysis of the prevalence and level of risk factors control in patients with high CV risk CVD from the Russian centers of the primary care unit of the EUROASPIRE IV study in comparison with the general population of the study. MATERIALS AND METHODS: In this cross-sectional study, 14 European countries, including the Russian Federation, participated. Patients aged 18 to 79 years were included in the study, without clinical manifestations of atherosclerosis, who were prescribed antihypertensive therapy and/or lipid lowering therapy and/or treatment for diabetes between the ages of ≥6 months and.

[Efficiency of primary prevention for diseases caused by atherosclerosis in patients at high cardiovascular risk in Russia and other European countries (Part 2)].

BACKGROUND: The picture of primary prevention obtained from real-life practice makes possible scheduling measures for prevention improvement. AIM: To analyze features of drug and non-drug therapy aimed at decreasing cardiovascular risk in Russian patients with a high risk (HR) of CVD compared with the study general population. MATERIALS AND METHODS: 14 European countries, including the Russian Federation, participated in this cross-sectional study. The study included patients aged 18-80 without clinical signs of atherosclerosis who have received antihypertensive and/or lipid-lowering therapy and/or therapy for diabetes mellitus (DM) within >6 to.

[Awareness of the Risk Factors for Cardiovascular Disease in Different Types of Hospitalized Medical Patients].

OBJECTIVE: to study medical awareness of cardiovascular risk factors (FR) in hospitalized patients of the cardiac and internal medicine units (CU and IMU). MATERIALS AND METHODS: A total of 100 patients from CU (n=50) and IMU (n=50) of a Moscow city hospital were included into the survey. The patients were interviewed during the I-II days of hospital stay. A special questionnaire was developed including socio-demographic and clinical indicators, open questions on the knowledge of traditional cardiovascular RFs and their target values. RESULTS: Patients of both units did not differ in gender and age. The survey revealed an extremely low awareness of major cardiovascular RFs of patients in both units: practically none of them indicated as RFs for cardiovascular disease elevated cholesterol (0 and 2 %, respectively, p>0.05) and blood pressure (0 % and 2 %, respectively, p>0.05). The majority of patients in both units (74 and 68 %, respectively, p>0.05) reported only 1-2 RFs. Patients in both units often believed that stress is the main cardiovascular RF (66 % and 50 %, respectively, p>0.05). CONCLUSION: The survey revealed a low awareness of cardiovascular RFs in different types of medical patients at time of hospital admission.

[A Single Preventive Counseling in the Hospital Does Not Improve the Prognosis of Patients After Percutaneous Coronary Intervention].

The purpose of the study "Invasive Techniques for the treatment of atherosclerosis: the effectiveness of secondary preventive intervention" (IMLA-TRAC) - long-term efficacy of single preventive counseling of patients with coronary heart disease (CHD) in a stationary treatment for percutaneous coronary intervention (PCI). MATERIAL AND METHODS: In a prospective, randomized, controlled trial included 160 patients with coronary artery disease who underwent PCI between the ages of 38 to 87 years (mean age 59,43+/-8,94 years, 81.9% male). Included in the study, patients were randomized in a ratio of 1: 1 into 2 groups - the primary (n=80) and control (n=80). Patients in both groups received standard hospital treatment and hospital doctors recommendations. In addition to these patients of the main group carried out a preventive educational program After being discharged from hospital patients in both groups were followed for 12 months. RESULTS: The study showed that a single prevention counseling, conducted in patients with coronary heart disease at the stage of hospital treatment over a planned or emergency PCI, does not provide a stable positive dynamics of the main risk factors and has no effect on mortality and combined end point. There is only a small positive dynamics of individual indicators, for example, significantly lower intake of saturated fats, an increase in adherence to treatment, in particular, receive aspirin. CONCLUSION: Further studies are needed to determine the most effective models for preventive intervention in patients with coronary artery disease, which can start in a hospital, but should continue on an outpatient or remote formats.

[Effect of high-frequency positive pressure artificial ventilation on gas exchange and hemodynamics during anesthesia in neonatal infants with esophageal atresia].

Adequate artificial ventilation (AV) is one of the most important problems in modern neonatal anesthesiology. Various earlier classical AV modes had a number of limitations that presented problems in the work of surgical and anesthesiological teams at surgery. The capacities of high-frequency AV (HFAV) even in the presence of a wide tracheoesophagostomy to generate an effective pressure in the lung make the HFA V mode irreplaceable in neonatal surgery, by reducing postoperative mortality rates from 10.9% in 1990-1995 to 6.8% in 1996-2007 The present paper evaluates the efficiency of volumetric HFA Vperformed in the anesthetic maintenance in neonatal infants with esophageal atresia, by comparing the data of a clinical observation, the results of studying blood gas composition, acid-base balance, and hemodynamics in 2 patient groups differing in the mode of AV. Group 1 received myorelaxants and underwent assisted mask AV, followed by classical ASV after tracheal intubation. In Group 2, the trachea was intubated in the presence of preserved spontaneous respiration, during basic anesthesia, volumetric HFAV at a respiration rate of 120-140 per min, FiO2 70%, PiP 8-10 cm H2O, PeeP 2 cm H2O; I:E 1:2. The used volumetric HFAV procedure ensures a more stable course of anesthesia, produces an effective and easily controlled mean pressure in the airway, provides better oxygenation, prevents severe acid-base balance changes, and reduces the cardiosuppressive effect of AV, by improving the hemodynamic parameters.