Method for estimating compliance level of patients with hypertensive disease of i-ii stage in arterial hypertension of 1-3 degree
SUBSTANCE: invention refers to medicine, namely to cardiology. A method involves estimating a compliance level on the basis of 20 test questions of the compliance rating scale applicable for the patients suffering hypertensive disease; each question has three selective answers coded from 1 to 3 points; the patient either fills in the scale independently, or ticks the answers to the questions being read out by the doctor. The result interpretation involves the total score for all the questions: 51-60 means a high compliance level; 41-50 shows a medium compliance level, whereas 40 points or less stand for a low compliance level.
EFFECT: estimating the compliance level and objectifying the results in points in the patients with hypertensive disease of the 1st-2nd stage, in arterial hypertension of the 1st-3rd degree by means of the specifically developed rating scale applicable to estimate the compliance in the patients suffering hypertensive disease.
2 tbl, 2 ex
The invention relates to medicine, in particular to cardiology, and is intended to assess the level of compliance of patients with essential hypertension (GB) stage I-II, regardless of the degree of arterial hypertension (AH).
Compliance ("compliance" - compliance, compliance), a term that defines the accuracy of a patient's compliance with doctor's recommendations: the mode and conditions of taking medications, performing treatments, diet, habit correction, modification, lifestyle and etc. it is Known that in Russia the effectiveness of treatment is 6 GB% in men and 17.5% in women (1). A significant reason for the low effectiveness of treatment is the low compliance of patients.
In chronic diseases of compliance is lower than in acute disease, where therapeutic effect is achieved faster. According to who, about 50% of patients with chronic diseases do not perform medical recommendations (2).
Because of the inferiority of consent in the doctor-patient" in HD patients often refuse treatment, which leads to failure in achieving the target values of blood pressure (BP) and the progression of the disease with the weighting stage and increased total risk of cardiovascular complications and death from them.
Objectification of compliance the hypertensive patients is difficult. In the available literature no�there are standardized scale for assessment of compliance of patients with GB, that could allow the physician to assess the level of commitment of the patient to treatment.
As a prototype used a scale of compliance the Morisky-green created by D. E. Morisky, Green L. W., Levine M. D. in 1985 and published in 1986, intended to assess the degree of compliance of patients with chronic diseases and consisting of four test questions that are measured on the principle of "Yes-no", "Yes" was estimated at 0 points (no) 1 score (3). However, the number of questions in this scale is insufficient for complete information about how medical prescriptions are sick it is GB.
The invention aims at assessing the level of compliance with the objectification results in scores in patients with essential hypertension stage I-II, 1-3 the degree of arterial hypertension with the use of a specially developed scale for assessment of compliance of patients with hypertension.
This goal is achieved by testing patients on a scale of assessment of compliance of patients with essential hypertension (SOCP-GB), the summation of the scores obtained when patient responses by 20 test questions for the scale with the answer to each question is coded in points (1 to 3), then the level of compliance is assessed based on the total score as follows: 51-60 points - high; 41-50 points - average; 40 and less� - low. The doctor, depending on the level of compliance, produces optimal ways of its improvement (table 1).
The proposed method is as follows.
The patient with GB offer themselves to fill the 20 test questions SOCP-GB, or answer questions read by a physician. 19 questions have answers like "Yes", "no" and the intermediate answer is "sometimes" or "always", "may", "partially". The need to enter the intermediate answer is because the majority of patients performs medical prescriptions with breaks and not fully (2).
The first five questions SOCP-GB reflect adherence to antihypertensive therapy.
Question No. 1: "You understand that therapy GB is continuous and requires daily administration of drugs?" Answer options: "Yes" - 3 points, "maybe" - 2 points, "no" - 1 point.
Question No. 2: "You always remember that you need to take medication?" Answer options: "Yes" - 3 points, "not always" - 2 points, "no" - 1 point.
Question No. 3: "are You taking medication at the appointed time every day?" Answer options: "Yes" - 3 points, "not always" - 2 points, "no" - 1 point.
Question No. 4: "You do not make yourself adjustment in the dosage specified by the doctor?" Answer options: "Yes" - 3 points, �sometimes" - 2 points, no - 1 point.
Question No. 5: "You never do treatment interruptions without the consent of the doctor?" Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point.
Question No. 6 is characterized by the possession of hypertensive patients, the skills for emergency self-help with hypertensive crisis: "do you Use drugs for a quick adjustment to HELL in case of symptomatic improvement?" Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point. In the absence crisologo current GB is selected the answer "no."
Question No. 7 allows you to obtain information about the patients in case of missing of antihypertensive drugs: "If you miss a dose, you take double dose next time?" Answer options: "Yes" a score of 1, "sometimes" 2 points, "no" - 3 points. The answers are "Yes" and "sometimes" indicate the wrong tactics patients uncontrolled doubling the dose of antihypertensive drug may lead to symptomatic hypotension.
Question No. 8 reflects the need of the patient GB in consultation with the attending physician, with the development of adverse reactions associated with antihypertensive drugs: "You inform your doctor about side effects or poor tolerability of antihypertensive drugs?" Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point. In the absence of side �of eacci selects the "no"answer.
Question No. 9 on the number of visits to physician hypertensive patients during 1 year: "How many times a year You visit your doctor?" Answers: "4 or more" - 3 points, "2-3" - 2 points, "0-1" - 1 point. In the dispensary observation of patients with GB is considered the optimal inspection doctor at least 1 time per quarter.
Question No. 10 on the frequency of BP measurements performed hypertensive patients independently at home: "You're a self-monitoring AD (SCUD)?" Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point. The answer is "Yes" involves daily measurement of blood pressure by the patient himself with keeping a journal, preferably 3 times a day. The answer is "sometimes" means periodic SCUD, not every day.
Question No. 11 is concerned with informing the attending physician hypertensive patients receiving antihypertensive therapy, SCUD>135/85 mm Hg. article: "You inform your doctor about the lack of target blood pressure (according to the SCUD) on the background of antihypertensive therapy? Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point. Optimal BP level in the measurement of the house is equal to 130/80 mm Hg. article (5).
Issues No. 12-No. 16 provide information about the completeness of the execution diseased GB of measures for the correction of behavioral risk factors (Smoking, diet, physical inactivity).
Question # 12: "You smoke?" Answer options: "Yes" 1 point "sometimes" 2 points, no - 3 points. "No" means no Smoking in the course of a year or more, "sometimes" Smoking is not every day and not more than 1 cigarette a day and "Yes" to Smoking every day or not every day more than 1 cigarette a day.
Question # 13: "You keep antiatherosclerotic diet?" Answer options: "Yes" - 3 points, "not always" - 2 points, "no" - 1 point. "Yes," continued adherence to the nine principles of healthy eating, "no" - a lack of adherence to the principles of healthy eating, "not always" - periodic (yearly) compliance with the principles of healthy eating.
Question # 14: "You are watching your weight? Answer options: "Yes" - 3 points, "not always" - 2 points, "no" - 1 point. "Yes" - a weekly weigh-in and maintaining a normal body weight with a BMI of<25 kg/m2, "not always" - weighing less than 1 time per week, periodic observance of the principles of healthy eating and physical activity, "no", the patient is weighed and has not taken any steps to normalize body weight in the case of BMI>25 kg/m2.
Question # 15: "You you follow a prescribed regimen of physical activity?" Answer options: "Yes" - 3 points, "not always" - 2 points, "no" - 1 point. "Yes" - the amount of dynamic aerobic physical activity of moderate intensity is 2.5 to 5 hours a week (30-60 minutes 5 times a week), no amount of aerobic dynamic�cal physical activity of medium intensity less than 2.5 hours per week, "not always" - periodic adherence to physical activity.
Question # 16: "do You drink alcohol in a dose exceeding 20 grams per day?" The answers "Yes" 1 point, "sometimes" 2 points, "no" - 3 points. The answer is "Yes" corresponds to a regular excess of a daily dose of alcohol (20g), the answer is "sometimes" - episodic excess.
Questions No. 17-No. 20 characterize the readiness of the patient GB strictly follow the recommendations of a physician and show awareness of the patient about GB and its complications.
Question No. 17: "You want to get more information about GB and its possible complications from the attending physician or school health?" Answer options: "Yes" - 3 points, "sometimes" 2 points, "no" - 1 point. The answer is "sometimes" includes the patient's desire to receive information as and when he has questions and does not include its active informing your doctor.
Question # 18: "You ready to cooperate with the doctor during the examination and treatment?" Answer options: "Yes" - 3 points, "partial" - 2 points, "no" - 1 point. A "Yes" answer means the patient's willingness to follow the recommendations of the attending physician on the condition of trust relationships in the system "doctor-patient". The answer is "partially" means that some of the doctor's instructions will be performed by the patient in full, based on its actual�about the opinions and/or advice from other experts.
On question # 19: "You understand that strict compliance with the recommendations of the attending physician preventing the progression of the GB, the development of its complications and improves the quality of life?" and # 20: "You understand that adequate correction of BP reduces the risk of mortality from cardiovascular disease?" - provided answer options: Yes - 3 points, "maybe" - 2 points no - 1 point. A "Yes" answer indicates a high level of awareness of the patient about GB. A "no" answer indicates a probable alexithymia, which is manifested in the refusal of a patient to understand the consequences associated with the progression of GB. The answer is "maybe" emphasizes the uncertainty of the patient in this matter, due to lack of awareness about the disease.
Further, the number of points summed.
Table 1. Scale of assessment of compliance patients with hypertension.
|1.||You understand that treatment of hypertension is continuous and requires daily administration of drugs?||Yes||3|
|2.||You always remember that you need to take medication?||Yes||3|
|3.||Are you taking medication at the appointed time every day?||Yes||3|
|4.||You do not make yourself adjustment in the dosage specified by the doctor?||Yes||3|
|5.||You never do treatment interruptions without the consent of the doctor?||Yes||3|
|6.||Do You use drugs for rapid correction of blood pressure in case it is symptomatic of increasing?||Yes||3|
|7.||If You miss a dose, You take double dose next time?||Yes||1|
|8.||You inform your doctor about side effects or poor tolerability of antihypertensive drugs?||Yes||3|
|9.||How many times a year You visit your doctor?||4 or more||3|
|10.||You are self-control of blood pressure?||Yes||3|
|11.||You inform your doctor about the absence of the target level of blood pressure (according to self-monitoring) on a background of antihypertensive therapy?||Yes||3|
|12.||Do you smoke?*||no||3|
|13.||You comply with anti-atherosclerotic diet?**||Yes||3|
|14.||You are watching your weight?***||Yes||3|
|15.||You You follow a prescribed regimen of physical activity?****||Yes||3|
|16.||You drink alcohol in a dose exceeding 20 grams per day?||no||3|
|17.||Well you�bark to get more information about hypertension and its possible complications from the attending physician or school health?||Yes||3|
|18.||Are you ready to cooperate with the doctor during the examination and treatment?||Yes||3|
|19.||You understand that strict compliance with the recommendations of the attending physician prevents the progression of hypertension, the development of its complications and improves the quality of life?||Yes||3|
|20.||You understand that adequate correction of blood pressure reduces the risk of mortality from cardiovascular disease?||Yes||3|
* there is no Smoking in the course of a year or more, and sometimes do not smoke every day and not more than 1 cigarette per day, Yes - daily smokers or not, every day more than 1 cigarette per day;
** Yes - ongoing compliance with the principles of healthy eating:
• consumption of saturated fatty acids less than 10% of daily calories and replacing them with polyunsaturated fatty acids,
• limit consumption of TRANS-unsaturated fatty acids less than 1% of total calories from natural products,
• less than 5g of salt a day,
• 30-45 grams of dietary fiber from whole grains, vegetables and fruits,
• 200 g of fruit per day (2-3 servings),
• 200 g of vegetables per day (2-3 servings),
• fish at least two times a week (in one of fatty fish),
• limit alcohol intake to two glasses per day (20 grams of alcohol a day)
• matching caloric intake to maintain (or achieve) a normal body weight with a BMI<25 kg/m2,
there is a lack of adherence to the principles of healthy eating, not always - periodic (yearly) compliance with the principles of healthy eating;
*** Yes - weekly weighing and maintaining a normal body weight with a BMI<25 kg/m2, no - patient not weighted and does nothing but for�manisali body weight if BMI >25 kg/m2, not always - weighing less than 1 time per week, periodic observance of the principles of healthy eating and physical activity;
**** Yes - the amount of dynamic aerobic physical activity of moderate intensity is 2.5 to 5 hours a week (30-60 minutes 5 times a week), no amount of dynamic aerobic physical activity of moderate intensity less than 2.5 hours per week, not always - periodic adherence to physical activity
Diagnostic efficiency of the proposed method was studied in 65 men with GB stage I-II (mean age of 39.8+7.4 years), with 1-3 degrees of hypertension.
In all patients the level of compliance was determined by a questionnaire on SOKP-GB and conducted measurement office (according to the method of Korotkov) and outpatient (according to ambulatory BP monitoring conducted using the system for a long period of registration of HELL "SCHILLER", Switzerland, 2010 release) systolic (SBP) and diastolic (DBP) blood pressure in accordance with the criteria outlined in the Russian recommendations for the diagnosis and treatment of hypertension (2010) (5).
All patients were examined and tested by SHOK-GB twice: at baseline and after 12 months after completing a standard training program in school health "hypertension" (consisting of 8 lessons and �otrabotanny specialists of the State research center of preventive medicine under the auspices of the all-Russian scientific society of cardiology (4), provide recommendations for correction of modifiable risk factors and optimization of antihypertensive therapy (hereinafter - the first and the second study).
Statistical analysis of data was performed using the software package StatSoft, Inc. (2008) STATISTICA (data analysis software system), version 8.0. Verifying that the distribution of traits in a normal distribution was performed using the Shapiro-Wilk test. Quantitative data are presented as median (Me), 25 and 75 quartiles of the distribution, qualitative data in the form of absolute numbers and percentages. For comparison of ordinal traits in the dynamics was used the Wilcoxon test. The comparison of relative values was performed using the χ2 test with the application of the amendments Yates and accurate bilateral Fisher. Correlation analysis between quantitative and qualitative ordinal features was performed using the method of τ-Kendall, between dichotomous qualitative and quantitative method of γ-correlations. The differences were considered significant when p<0,05.
The level of compliance with the first and second survey was 38 (34; 45) 50 (45; 53) points, respectively. In a comparative analysis of the levels of compliance in the dynamics obtained statistically significant differences (p=0.0000).
Fig.1 shows the dynamics of the levels of compliance of patients with GI�antonicelli disease, where 1 is the initial level of compliance presented in points 2 - the level of compliance of patients with GB after training in the school of health, represented in points.
It is established that the level of compliance calculated scores for SOCP-GB, statistically significantly correlated with the level of office and ambulatory BP. Identified feedback of moderate intensity between the level of compliance and blood pressure in hypertensive patients, when the first and second studies, which are presented in table 2, where τ is the Kendall's correlation coefficient, p - level of statistical significance.
|The indicator of HELL||τ||p|
|The level of compliance to training at school of health "hypertension", points|
|Office GARDEN, mm Hg. article||-0,47||0,0000|
|Office DBP, mm Hg. article||-0,32||0,0002|
|Average GARDEN, mm Hg. article||-0,33||0,0001|
|Average DBP, mmHg. article||-0,28||0,0011|
|The average daily GARDEN mm Hg. article||-0,32||0,0002|
|Srednesrochnoi DBP, mm Hg. article||-0,31||0,0002|
|The level of compliance in 12 months|
after training in the school of health "hypertension", points
|Office GARDEN, mm Hg. article||-0,54||0,0000|
|Office DBP, mm Hg. article||-0,59||0,0000|
|Average GARDEN, mm Hg. article||-0,47||0,0000|
|Average DBP, mmHg. article||-0,40||0,0000|
|The average daily GARDEN mm Hg. article||-0,39||0,0000|
|Average DBP, mmHg. article||-0,34||0,0000|
|Srednesrochnoi GARDEN, mm Hg. article||-0,40||0,0000|
|Srednesrochnoi DBP, mm Hg. article||-0,28||0,0009|
When the gradation level of compliance determined by SHOK-GB, levels has been hypothesized that the score of 51-60 corresponds to a high level of compliance, 41-50 - average level, and<40 - low level. To confirm this hypothesis investigated the Association of estimated levels of compliance with target values of office BP (<140/90 mm Hg. calendar), average daily GARDEN (<130 mm Hg. calendar) and DBP (<80 mm Hg. calendar).
The first case study revealed a strong positive correlation in the average level of compliance with the target values: GARDEN office (γ=0,94; p=0,0005), average daily GARDEN (γ=0,78; p=0.0000) and mean DBP (γ=0,88; p=0,0029). A negative Association was observed between low level of baseline compliance and target values office GARDEN (γ=-0,92; p=0,0008), average daily GARDEN (γ=-0,77; p=0.0000) and mean DBP (γ=-0,94; p=0,0040). Associations high level of initial compliance with the target office BP values, the average SBP and DBP were not detected (p>0,05) because of the small number of patients with a high level of baseline compliance - 1 of 65 (1.5 percent).
In the second study, a high level of compliance, some patients GB SOCP-GB, was positively associated with target values: GARDEN office (γ=0,95; p=0,0451) office DBP (γ=0,75; p=0,0040), medium�weft GARDEN (γ=0,92; p=0.0000), the average DBP (γ=0,86; p=0.0000). The average level of compliance is positively correlated only with the target average daily GARDEN (γ=0,81; p=0.0000). There was an inverse Association average level of compliance with the target value of the average daily DBP (γ=-0,83; p=0.0000). Dependences of the average level of compliance with the target values of office SBP and DBP (p=0,521 and 0,2007, respectively). Low compliance, with repeated study, negatively correlated with the target values office GARDEN (γ=-0,88; p=0.0000) office DBP (γ=-0,99; p=0.0000) and the average daily GARDEN (γ=-0,92; p=0,0005). Dependencies of the low level of compliance with the target value of the average DBP was not detected, p=0,2341.
Thus, correlation analysis showed that only a high level of compliance identified in the second study, corresponded to the target values, office and daily average SBP and DBP, confirming the earlier hypothesis of the gradation levels of compliance.
The dynamics of the frequency of occurrence of different levels of compliance among hypertensive patients, is shown in Fig. 2, where 1 - frequency of different levels of initial compliance in patients with GB, 2 - frequency of different levels of compliance among hypertensive patients, after 12 months of training in school health. The obtained statistically significant differences for high and low levels at the first and second studies: in �boih cases, p=0.0000. After training in the school of health increased the number of patients with a high level of compliance: 1 (1,5%) to 31 (47.7 per cent) and fewer patients with a low level of compliance: with 36 (55.4% from) up to 4 people (6,15%). In the comparative analysis of dynamics of frequency of detection average level of compliance in primary and repeated studies statistically significant differences were found, p=0,8600.
Specific examples of the use of the proposed method
Example No. 1.
Patient G., 50 years old, diagnosis: Hypertension stage II, grade 1, risk 3. Hypertrophy of the myocardium of the left ventricle. Alimentary obesity I degree. The type IIb dyslipidemia. Gets antihypertensive therapy with amlodipine 5 mg/day., losartan 50 mg/day. and lipid-lowering treatment with atorvastatin at a dose of 20 mg/day. From history we know that GB is suffering for 10 years. Antihypertensive drugs regularly takes.
At the time of the initial survey 15.02.2011 G. office BP - 142/92 mm Hg. article ABPM on therapy with amlodipine 5 mg/day. and losartan 50 mg/day. 07-08.02.2011 conclusion: the circadian BP profile changed in hypertensive type. Average AD - 134/94 mm Hg. article, the average daily AD - 136/95 mm Hg. article, srednesrochnoi AD - 121/80 mm Hg. article Index-time GARDEN for the day - 40,47%, DBP - 68,72 %. Testing SOCP-GB 15.02.2011 G.: the sum of 20 questions was 45 points, equivalentsreal the level of compliance and corresponds to the risk of non-compliance. For questions SOCP-GB concerning compliance with antihypertensive therapy, the patient responded at 3 points on each of 5 questions; commitment to anti-atherosclerotic diet and recommendations for the control of body weight, - 2 points for each that demonstrates compliance with these requirements does not fully; about Smoking status and physical activity - 1 point (minimum point), which allows to draw conclusions about compliance with these regulations.
From 1 to 30 November 2011. in the departmental clinic the patient was undergoing training at school of health "hypertension", consisting of 8 classes (2 classes per week).
When re-examination of the patient G. 09.11.2012 G. office BP is 125/80 mm Hg. article ABPM 19-20.09.2012 on therapy with amlodipine 5 mg/day. and losartan 100 mg/day., conclusion: circadian BP profile normotensive type. Average AD - 118/76 mm Hg. article, the average daily AD - 125/81 mm Hg. article, srednesrochnoi AD - 103/64 mm Hg. article Index-time GARDEN for a day of 9.11%, DBP - 12,2 %.
Retest on SOKP-GB 09.11.2012 G. with the result of 53 points, consistent with the high level of compliance. To questions about adherence to antihypertensive therapy, the patient chose the maximum points - 3 for each of 5; about Smoking status - 3 points, which corresponds to the quitting Smoking; on the mode of physical activity and a ful�nenii recommendations for the control of body weight - 2 points for each that demonstrates a lack of compliance with these regulations.
Conclusion: patient, 50 years of age with a diagnosis of GB II stage, the risk 3. Hypertrophy of the myocardium of the left ventricle, compliance increased from the original middle level to high level when re-testing on a scale SOCP-GB after training in the school of health "hypertension". It is necessary to increase physical activity, enhance the monitoring of adherence to anti-atherosclerotic diet and the observance of recommendations for the correction of body weight.
Example No. 2.
Patient Y., 24 years old, diagnosis: Hypertension stage I, grade 2, risk 2. Assigned to antihypertensive therapy with amlodipine 10 mg/day. and losartan 100 mg/day. From history we know that GB is suffering for 1 year. Antihypertensive drugs takes on an irregular basis.
At the time of the initial survey 17.05.2011 G. office BP - 160/105 mm Hg. article on therapy with losartan 100 mg/day. (amlodipine not accepted). ABPM in therapy with losartan 100 mg/day. (amlodipine not taken), 12-13.05.2011 conclusion: the circadian BP profile changed in hypertensive type. Average AD - 140/81 mm Hg. article, the average daily AD - 146/83 mm Hg. article, srednesrochnoi AD - 119/75 mmHg. article Index-time GARDEN for the day - 59,19%, DBP - 12,82 %. Testing SOCP-GB 17.05.2011 G.: the sum of 20 questions was 39 points, which is equivalent to a low� level of compliance. For questions SOCP-GB concerning compliance with antihypertensive therapy, the patient responded with 2 points for 4 questions and 3 points on question 1, which indicates the irregularity of admission and failure to doses of antihypertensive drugs; the commitment to anti-atherosclerotic diet and recommendations for the control of body weight, - 2 points for each that demonstrates compliance with these requirements does not fully; about Smoking status at 1 point, which indicates the continuation of Smoking, physical activity - 3 points, which allows to conclude that sufficient physical exercise regimen.
From 1 to 30 November 2011. the patient was undergoing training at school of health "Arterial hypertension". He attended 4 out of 8 classes and passed the training material in a volume of 50%.
When re-examination of the patient J. 26.11.2012, office BP - 145/92 mm Hg. article ABPM 19-20.11.2012 on therapy with amlodipine 5 mg/day. (dose reduced patients independently 2 times) and losartan 100 mg/day., conclusion: circadian BP profile changed in hypertensive type. Average AD - 135/87 mm Hg. article, the average daily AD - 137/89 mm Hg. article, srednesrochnoi AD - 121/76 mm Hg. article Index-time GARDEN for the day - 37,77%, DBP - 38,87%.
26.11.2012, the patient underwent repeated testing at SOCP-GB 32 points, which corresponds to the low level of compliance. For questions about compliance�attachment mode of antihypertensive therapy he answered 1 point on 3 questions from 5 and 2 points on the remaining 2 questions; about Smoking status - 2 points, which corresponds to the Smoking not every day and not more than 1 cigarette per day; about antiatherosclerotic diet - 2 points, indicates a lack of commitment to the diet; on the mode of physical activity and the implementation of the recommendations for the control of body weight - 1 point for each that is not in compliance with these regulations.
Conclusion: in a patient Ya., 24 years old with a diagnosis of GB stage I, the achieved level 1, risk 2, was absent dynamics of compliance with repeated testing SOCP-GB 12 months after training in the school of health "hypertension" (initial and renewal compliance low level). It is necessary to motivate the patient to a strict adherence to antihypertensive therapy, Smoking cessation, increasing physical activity and adherence to anti-atherosclerotic diet.
SOURCES of INFORMATION
1. National clinical guidelines. Diagnosis and treatment of hypertension / edited by R. G. Oganov, M. N. Mamedov. M.: Silicea-Polygraph, 2008. - S. 20-56.
2. Danilov D. S. Compliance in medicine and methods of its optimization (clinical, psychological and psychotherapeutic aspects) // Psychiatry and psychopharmacotherapy. - 2008. - T 10. - No. 1. - Pp. 4-8.
3. Morisky D., Donald E., L. Green, Lawrence W., Levine D., David M. Concurrent and Predictive Validity of a Self-reported Measure of MedicationAdherence // Medical Care.- 1986, January. - Vol. 24(1). - P. 67 through 74.
4. Health school. Arterial hypertension. A guide for physicians / edited by R. G. Oganov. Moscow: GEOTAR-Media, 2008. - 192 p.
5. Chazova I. E., Ratova L. G., Boytsov S. A. [and others] Diagnosis and treatment of hypertension. Russian recommendations (fourth revision) // Systemic hypertension. - 2010. - No. 3. - P. 5-26.
Method of assessing the level of compliance of patients with essential hypertension stage I-II, 1-3 the degree of arterial hypertension, characterized in that the measured office blood pressure and conduct a survey of the patient according to the Scale of assessment of compliance of patients with essential hypertension" contained in the description, assess the results, using the following response options: "Yes", "sometimes", "no", estimated at 3, 2 or 1 point, respectively, and the subsequent questions about the double dose of antihypertensive medication in the event of such default, about the facts of Smoking and alcohol consumption of over 20 g / day - 1, 2 and 3 points respectively, on the number of physician visits per year - more than 4 times - 3 points, 2-3 - 2 points, 0-1 - 1 point; summed scores and the total score of 51-60 and office blood pressure <140/90 mm Hg. senior level compliance is considered high.
SUBSTANCE: invention refers to medicine, functional diagnostics and can be used for preclinical, predoctoral examination, assessment of the functional state of body organs and systems, and pre-diagnosis. The method involves measuring electrical conductivity (EC) of 24 representing points of 12 symmetrical meridians, determining an arithmetic mean (AM) value of these measurements and specifying a corridor of permissible values for this patient, to which the derived values are compared in order to assess the functional state of the patient's body. That involves using the following criteria: a ratio of total ECs of Yin meridian points to total ECs of Yang meridian points, a ratio of total ECs of arm points to total ECs of leg points, a ratio of total ECs of left-side points to total ECs of right-side points. ECs are measured at voltages 5V, and/or 9V, and/or 12V. If the measurements are taken at 9V, the measured ECs are re-calculated by formula: I new=9/(29/I measured-0.1)*Coeff, (I); if the measurement process is performed at 12V, the measured values are re-calculated by formula: I new=9/(29/I measured-0.1)*Coeff, (I); and at 5V: I new=1 measured*Coeff, (III), wherein in (I), (II) and (III) respectively: I new is the re-calculated EC; I measured is the measured EC; Coeff is a correction coefficient taking into account a meridian conductivity heterogeneity. The re-calculated values are transformed into adjusted ones by formula: I adjusted=I new/I mean, wherein: I adjusted is the adjusted EC; I new is the non-adjusted re-calculated EC; I mean is the arithmetic mean value of all the 24 measurements. That is followed by delimiting an individual normal corridor for this patient depending on the preset diagnostic sensitivity S and a width of corridor of the permissible EC values Wpv. The Wpv represents a range of EC values measured in this patient, whereas the diagnostic sensitivity S is specified depending on selecting the patients with a certain disease. Delimiting the individual normal corridor for this patient is ensured by measuring intermediate coefficients for lower Kl and upper Ku corridor limits respectively: Kl=1-(1-S)*Wpv/2.1 and Ku=1+(1-Kl)*1.1. Lower L and upper U limits of the individual normal corridor are determined: L=Kl* I mean and U=Ku* I mean. That is followed by comparing I adjusted to the derived limits of the individual normal corridor.
EFFECT: method provides high accuracy of the individual diagnosis.
4 tbl, 2 ex
SUBSTANCE: senior guinea pigs are exposed to optical light generated by light emitting diodes or fluorescent tubes at a colour temperature of 4,500 K within the wavelength region of 360-460 nm for various time distances. The exposure is assessed by functional activity indices of neutrophilic granulocytes and a mononuclear cell count.
EFFECT: using the method requires no expensive equipment, critical chemicals; it is of a particular importance for evaluating the biological safety of new artificial light sources embedded into a light-colour medium; it provides expanded information on biological effects of optical light.
SUBSTANCE: method involves specifying the patient's age in years, measuring a left atrium diameter in millimetres, assessing the anti-arrhythmic therapy provided and determining a degree of aortic and mitral incompetence. The produced values are used to calculate a risk (R) of recurrent atrial fibrillation following a radiofrequency ablation procedure by original formula. If the derived value R is more than 0.5, the development of recurrent atrial fibrillation is predicted to follow the radiofrequency ablation procedure; the value R of 0.5 or less shows no risk of recurrent atrial fibrillation following the radiofrequency ablation procedure.
EFFECT: higher prediction accuracy.
SUBSTANCE: invention relates to medical equipment, namely to equipment for visualisation of physiological data. Method of monitoring physiological parameters contains stages at which physiological parameters are measured periodically or aperiodically by at least one electronic sensor, with each measured value of physiological parameter having corresponding medical expiry date, determined and continuously visualised are: the last measured value of each measured physiological parameter and its designation, medical expiry date for each measured value of physiological parameter, which represents preliminary specified maximal time, during which value of physiological parameter is visualised, remaining medical term to expiry date of each measured value of physiological parameter for inquired time moment is determined, for each measured physiological parameter with non-zero remaining time period before expiry date determined and visualised on display are: the last measured value of physiological parameter, its designation and indication of remaining medical time period before expiry date in form of indicating the number of days, hours, minutes or seconds, during which reading is visualised, or indication of amount of time before visualisation of the following reading, with removal of reading from display in real time after preliminary configured medical term before expiry date finishes, absence of image is replaced with symbol, showing absence of current reading. Method is realised with application of machine-readable carrier, containing programme, recorded on it, and device for visualisation of data values and designations of patient's physiological parameters, which contains electronic sensors for periodical of aperiodical measurement of values of physiological parameters, processor, programmed for determination of the last measured physiological parameter and display device control.
EFFECT: application of invention makes it possible to increase rapidity of determination of data remoteness of the screen.
8 cl, 13 dwg
SUBSTANCE: "orthopaedic index" is calculated as a sum of three values. The first value is derived by conducting densitometry, and points are assigned according to its findings: 1 point for norm, 2 points for osteopenia, 3 points for osteoporosis, and 4 points for severe osteoporosis. The second value is derived by means of Charlson comorbidity index; 0-2 points according to the Charlson comorbidity index scale correspond to 1 point of the second value; 3 points of the Charlson comorbidity index scale are 2 points of the second value; 4 points of the Charlson comorbidity index scale show 3 points of the second value, while 5 points and more of the Charlson comorbidity index scale correspond to 4 points of the second value. The third value is determined by assessing the quality of life as per the scales SF-36; 0-200 points according to the scales SF-36 correspond to 4 points of the third value; 201-400 points of the scale SF-36 show 3 points of the third value; 401-600 points of the scales SF-36 provide 2 points of the third value, and 601-800 points correspond to 1 point of the third value. Total score is deriving by summing up the three values to determine "the orthopaedic index": I - 1-3 points, II - 4-6 points, III - 7-9 points, IV - 10-12 points. The form of treatment is defined: the patients with index I have the endoprosthesis replacement with endoprostheses with a shortened leg of the femoral component, the greater diameter of the head (36 mm or more); the patients with index II have the endoprosthesis replacement with cementless anchored total endoprostheses; the patients with index III have the total hip replacement with cemented endoprostheses; the patients with index IV have the endoprosthesis replacement with cemented anchored bipolar endoprostheses.
EFFECT: through assessing the available factors influencing the postoperative period, prosthesis anchoring in its bed, potential endoprosthesis rejection, functional effect and potential aggravation of comorbidities, the method can improve functional outcomes, reduce the risk of endoprosthesis loosening and the risk of recurrent operations.
SUBSTANCE: invention relates to devices for medical monitoring. The method contains stages at which: a packet (7) of data about a patient is transmitted from a device (10) for patient monitoring to the central server (12); a message (72) with acknowledgement (ACK), transmitted by the central server (12) in response to receiving by the central server (10) of the transmitted packet (70) of data about the patient, with a message with acknowledgement containing a time stamp, provided from the central server (12) clock (46), indicating the time and date, when the central server (12) received the packet (70) of the patient's data; the message time stamp (72) with ACK is compared with the current time of the clock (28) of the patient monitoring device (10); and if the difference between the current time of the clock (28) of the patient monitoring device (10) and the time stamp (74) with ACK is larger than the first preliminarily determined time, the clock (28) is synchronised in accordance with the time and date in the time stamp (74) in the message (72) with ACK.
EFFECT: provision of control of the time synchronisation interface.
13 cl, 5 dwg
SUBSTANCE: non-invasive examination of vessels is performed by means of a probe, installed on the skin surface in the projection of a vessel, by a method of optic coherent (OC) tomography, tomograms, obtained without compression test and OC tomograms under conditions of the compression test by the displacement of tissues by the probe by 1 mm towards the visualised vessel, are analysed. Compressibility of the vessel, tissues and formations and uniformity of the vessel configuration change under compression are estimated on the images. If a non-uniform and/or incomplete compressibility and a non-uniformity of the vessel configuration change are detected, microangiopathy is identified.
EFFECT: method ensures the high accuracy and objectivity of non-invasive diagnostics of the condition of microvasculature, in particular, the presence of intra-vascular formations, including differential diagnostics of vasculopathy due to the identification of particular criteria for the determination of pathological changes.
5 dwg, 4 ex
SUBSTANCE: group of inventions relates to surface hydrophilisation and immobilisation of antibodies on the surface of a cycloolefin copolymer. Disclosed method of making a capillary-action analytical device, which includes steps of: a) providing a capillary substrate, b) changing the hydrophilic property of the surface, c) mixing a matrix and immobilised molecules in solution form to obtain a solution which includes immobilised molecules covalently bonded to the matrix, and d) depositing the solution on a well defined region in at least one storage area. Also a capillary-action analytical device made using said method is described.
EFFECT: enabling change of the substrate by chemical treatment of the surface and depositing immobilised molecules in an optimum matrix on given regions, with less consumption of matrix material, which enables to use several different matrix material in the same chip.
33 cl, 3 dwg
SUBSTANCE: invention relates to medical working process of visualisation. System contains: control unit (114), containing processor (116); and multitude of processing executives (102), connected with it, with processor (116) realising control of realisation with feedback of plane of medical visualisation working process by means of multitude of processing executives (102), and processor (116) is made with possibility of inquiring electronic medical information, dealing with and/or not dealing with visualisation from one or more processing executives; formation of plan of visualisation procedure working process by means of visualisation procedure, based on information inquired; reception of signal, indicating due date of planned visualisation procedure; downloading visualisation protocol, corresponding to visualisation procedure, into visualisation system, used for visualisation procedure; realisation of scanning by means of visualisation system; and updating plan of visualisation procedure working process.
EFFECT: increased reliability of patient diagnostics.
15 cl, 9 dwg
SUBSTANCE: clinical research aimed at detection arterial hypertension is performed. Echocardiographic examination with the detection of signs of sclerogenic changes of the aorta is carried out. A value of function F is calculated. 2 demographic parameters - sex and age are taken into account, 1 clinical parameter is arterial hypertension and 1 echocardiographic parameter - presence of the sclerogenic injury of the aorta. Then the value of a probability level P is calculated. Patients with unchanged coronary arteries have the value P lower or equal 0.204. In patients with non-obstructive coronary-sclerosis it is over 0.204.
EFFECT: method makes it possible to exactly, at early stages of the disease, carry out non-invasive diagnostics, determine indications for effective treatment actions, ensures the prevention of complications due to the application of available clinical and instrumental methods, including in calculation most significant clinical signs, application of methods of determining the probability of the presence of non-obstructive coronary-sclerosis.
2 dwg, 2 tbl, 1 ex
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.
FIELD: medicine; medical engineering.
SUBSTANCE: method involves collecting information and storing it in single database or several databases representing parameter values of significance to enable one to carry out the procedures on his/her own, and operations for processing the mentioned single database or several databases to show alternative variants for making selection among two or more actions and values corresponding to each of two or more actions. Device has means for making calculations, required for implementing the method, and computer system and machine-readable carrier having program written on it and capable of implementing the method corresponding to the invention, on computer.
EFFECT: wider range of means accessible to end user.
69 cl, 8 dwg, 1 tbl
SUBSTANCE: method involves measuring intraocular pressure. Static computer-assisted perimetry method is used in a way that luminous spot serves as test object. The spot acts upon eye in various vision field points with threshold brightness and then in growing sequence. Eye retina light-sensitivity is measured in vision field points under study. The number of points is set with patient examination program. Total light-sensitivity is measured in decibels. Medicamentous reduction of intraocular pressure is achieved with 0.5% Ocupress solution introduced as drops twice with 5-6 min long interval. The intraocular pressure being reduced at least by 4 mm of mercury column, repeated static perimetry examination is carried out. Total light-sensitivity being increased less than by 50 dB, individual initial intraocular pressure tolerance conclusion is drawn. Total light-sensitivity being increased by 50 dB or more, individual initial intraocular pressure intolerance conclusion is drawn.
EFFECT: enhanced effectiveness in determining intraocular pressure tolerance/intolerance.
SUBSTANCE: method involves carrying out urological examination for determining hydrodynamic resistance of ureter calculated from formula Z=8Lμ/(πR4), where Z is the hydrodynamic resistance of ureter, L is the ureter length, R is the ureter radius, μ is the urine viscosity. Angle α at which the ureter enters the urinary bladder is determined from formula cosα = 8l1μ/(ZπR4), where l1 is the perpendicular drawn from the upper edge of the ureter to the its exit projection line, μ is the urine viscosity, Z is the hydrodynamic resistance of ureter, R is the ureter radius. Vesicoureteral reflux recidivation is predicted when the angle of α+90° is less than 120°.
EFFECT: enhanced effectiveness in reducing the number of recidivation cases.
2 dwg, 1 tbl
SUBSTANCE: method involves carrying out physiological examination with electroencephalogram recorded. Cognitive evoked potential method is additionally applied as neuropsychological examination for detecting hard and latent organic brain lesions causing central nervous system pathological disorders. An additional psychophysiological examination is carried out with vision analyzer test, visuomotor response test being applied for obtaining estimations of selection, discrimination, noise immunity and muscle endurance index, movement coordination, response to moving object and integral estimation of attention and ability for perceiving significant information, motor analyzer rapid response production estimation, estimation of nature of cardiovascular system response to given psychoemotional loading estimation. The examination is sequentially carried out as primary control when hiring personnel, as intermediate control in following a training course and emergency training. Psychological testing is of multi-purpose nature. To achieve it, a set reliable tests and methods of prognostic and substantial validity are applied, including intellect and project-building tests and standardized self-reports. When making decisions concerning professional validity based on test and examination results, risk group is selected from operation personnel.
EFFECT: enhanced effectiveness of occupational skill assessment.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with differential diagnostics of prostatic cancer and other prostatic diseases at the stage of primary inspection. The method includes the detection of PCA and calculation of probability coefficient for prostatic cancer (PCC) by the following formula: where e - the foundation of natural logarithm (e=2.718…), PCA - the level of total blood PCA in ng/ml, V - patient's age in years. At PCC value being above 0.2 one should diagnose prostatic cancer and to establish final diagnosis one should perform polyfocal prostatic biopsy. The method enables to increase accuracy of diagnostics at decreased number of unjustified prostatic biopsies.
EFFECT: higher efficiency of diagnostics.
FIELD: medicine, toxicology.
SUBSTANCE: at patient's hospitalization one should detect the values of patient's state such as: the state of consciousness, availability of spasms, scleral injectivity degree, headache, nystagmus, vertigo, ataxia, respiration frequency, exposure of poisoning substance, patient's age, concentration of carboxyhemoglobin, prothrombin index (PTI), creatinine amount and that of leukocytes, sedimentation rate and patient's body temperature. Each parameter should be evaluated in points to sum them up finally. By the value of summed up points it is possible to evaluate indication for urgent hospitalization into resuscitation department. The method enables to obtain objective evaluation for the necessity in resuscitation aid.
EFFECT: higher accuracy of evaluation.
3 ex, 4 tbl
FIELD: medicine, pediatrics.
SUBSTANCE: in neonatals one should apply control set of risk factors that includes detection of maternal body temperature in the course of delivery, evaluation of neonatal's body weight at birth (g), one should characterize each risk factor and evaluate in points and by the value of the sum of points predict the risk for intrauterine infection, moreover, this set of risk factors includes extragenital pathology and its availability, chronic foci of infection and their exacerbation, acute infectious diseases occurred during pregnancy, prenatal waters, the nature of waters, moreover, if risk factors are characterized, correspondingly: the presence of one pathological disease, the presence of infection at no exacerbation, single acute infectious disease occurred during pregnancy, waters at mature pregnancy, waters color - light, moderate polyhydramnios, maternal body temperature in the course of delivery up to 37.5 C, evaluation by a certain scale being 7-8,neonatal's body weight at birth being above 2500 but below 2900 each of them should be evaluated per 1 point, if risk factors are characterized: combination of pathologies, exacerbation of chronic foci of infection occurred more than once, acute infectious diseases happened twice during pregnancy, prenatal waters at 36-wk-pregnancy, the nature of waters - meconial, pronounced polyhydramnios, maternal body temperature during delivery ranged 37.5-38 C, evaluation by a certain scale being 5-6, neonatal's body weight at birth being 1500-2500 each factor should be evaluated per 2 points, if risk factors are characterized: the presence of three and more pathological diseases, exacerbation of chronic foci of infection in every trimester of pregnancy, acute infectious diseases occurred during pregnancy in every trimester, prenatal waters 6 wk earlier the delivery terms, the nature of waters - turbid, with flavoring, maternal body temperature during delivery being above 38 C, evaluation by a certain scale being below 5, neonatal's body weight at birth being below 1500 every factor should be evaluated per 3 points, moreover, if the sum of points is not above or equal 8 points the risk for intrauterine infection in neonatals ins minimal, at the sum of points ranged 9-13 the risk is average and at the sum of points being 13 or above 13 the risk is maximal. The method takes into account extragenital pathology that creates the foundation for initial shifts in homeostasis and weakens resistance to external impacts.
EFFECT: higher accuracy of prediction.
1 ex, 1 tbl
FIELD: medicine, oncology.
SUBSTANCE: one should study the activity of catalase in the tissue of malignant mammary tumor and its perifocal area, and at ratio coefficient of catalase activity in the tissue of malignant mammary tumor to that in the tissue of perifocal area being equal to 1.0 ± 0.2 one should predict the chance for the development of new foci of lesion before their clinical manifestation, that provides necessary treatment in due time.
EFFECT: higher efficiency of prediction.
1 ex, 1 tbl
SUBSTANCE: before applying substitute hormonal therapy (SHT) on should evaluate antithrombogenic activity of vascular wall in women. For this purpose one should determine quantitative values of ADP-induced aggregation of thrombocytes, activity of antithrombin III in blood and fibrinolytic blood activity both before and after "cuff"-test. Then one should detect the indices calculated as the ratio of mentioned values both before and after carrying out the mentioned test. If mentioned indices are decreased against the norm by 20-40% women should be prescribed to undergo SHT at additional introduction of aspirin and supradin. The method provides prophylaxis of cardio-vascular diseases in this category of female patients due to correcting affected functional activity of vascular endothelium.
EFFECT: higher efficiency of prophylaxis.
1 cl, 1 ex, 4 tbl