No 74 (2018)

The program of the Department of faculty therapy forms the 4th year students clinical thinking due to work at the patient's bed and in the simulation training center, allowing the student to master the complex actions during resuscitation. When writing a medical card of a hospital patient there is the development and consolidation of specific skills of clinical thinking and its logical structure. Good psychological contact of the student with the patient determines the reliability of anamnestic data. The teacher should explain to students that the clinical diagnosis is formed on the basis of National recommendations for the diagnosis and treatment of the disease, approved by the Ministry of health of the Russian Federation. Great importance is attached to improving the lecture activities of experienced professors and associate professors. The lectures emphasize the role and importance of discoveries and achievements made by domestic clinicians. Of great importance is the work of the student scientific club for curious and hardworking students.

The article is devoted to the study of the features and structure of Smoking among patients of the therapeutic area of the city clinical clinic. According to the data obtained, the frequency of patients with nicotine dependence and the index of smoker among men is higher than in women in a separate section of the city polyclinic. In the structure of tabakokurenie changes ladyt person age category of 41 to 60 years. With the aim of reducing consumption of tobacco products and prevention of diseases correlated with tobacco Smoking, further legal, or-ganization and health measures at the state level, gra-moty in scientific terms, and an optimal, practical approach to solving this problem.

Psychosocial stress, anxiety and depression are independent risk factors for cardiovascular disease development, progression and death. 58 patients with somatoform dysfunction of the autonomic nervous system were examined in men aged 22.9 ± 1.6 years. The prevalence of risk factors in male patients was studied, including: psychosocial stress, anxiety, and depression. Patients had an average level of psychosocial stress and subclinical anxiety. The average level of psychosocial stress and subclinical anxiety were observed in patients with somatoform dysfunction of the autonomic nervous system with the studied leading risk factors for cardiovascular diseases. Revealed a strong correlation between stress and anxiety, moderate - between anxiety and depression, stress and depression.

The article deals with the prevalence and severity of urinary incontinence syndrome in women at the outpatient stage of medical care. It was found that among the patients who applied for help, the syndrome of incontinence was detected in approximately every 6 patients. Also, the most frequent comorbid conditions in this syndrome have been established. The leading factors affecting the occurrence of urinary incontinence in women were determined and the type of incontinence was determined. The level of influence of this condition on the quality of life and daily activity of the examined patients was revealed. The study identified the most common pathologies associated with the syndrome of incontinence: pathology of the cardiovascular system, respiratory system, diseases of the urinary system, gynecological pathology.

This article deals with the problems of rehabilitation of patients with acute disorders of cerebral circulation (onmc) in outpatient practice. According to the data obtained from the examined patients with stroke, are under medical supervision, identifies affective disorders and disorders of chronoligical sleep-Wake. The main part of the examined patients with a history of cancer suffers from minor and clinically expressed insomnia, others need medical correction of sleep disorders. Development of individual programs of rehabilitation measures taking into account the violations of the psycho-emotional sphere in patients with ommc in history, achieving compliance between the doctor and the patient can reduce the severity of sleep disorders, improve the quality of life of patients.

In this paper, we analyzed questionnaires of the Montreal cognitive assessment scale (MoCA) and out-patient charts of patients diagnosed with cerebrovascular disease, dyscirculatory encephalopathy (DEP) to identify the presence of cognitive impairment. Also in the study of patients was determined the severity of cognitive impairment depending on gender, age, stage of disease and the presence of other comorbidities (hypertension stage I, II, III, acute cerebrovascular disease, diabetes). In the course of the work it was found that cognitive disorders were observed in patients with this pathology, but more pronounced in patients with the diagnosis of DEP stage III, hypertension stage III, with an acute violation of cerebral circulation in the anamnesis, the older the greater the degree of cognitive impairment.

Questions of clinical, laboratory, functional features of patients with a phenotype of chronic obstructive pulmonary disease (COPD) with frequent exacerbations are studied; the patient-specific algorithms of dispensary observation for patients with use of the retrospective questionnaire by on identification of COPD exacerbations are developed. It is shown that the level of pro-inflammatory cytokine (interleukin-8, TNF-α), C-reactive protein, fibrinogen is correlated with disease exacerbation frequency. The efficiency of clinical questionnaires use for retrospective identification of COPD exacerbations is estimated.

The results of periodic health examinationof adult population certain groups of health locality are presented in the article, risk factors are revealed, the assessment of physical activity levels at patients of the II group of health is carried out, the reliable way of assessment, control and correction of physical activity level in compliance with the principle of "10 000 steps" is picked up.

Arterial hypertension is the leading risk factor of cardiovascular accidents of the globe. The number of the patients informed on presence of the elevated blood pressure is annually enlarged, but there is low a percent of the persons which reached the objective blood pressure still. The last years much attention is paid to diseases preventive and rising of patient retention to treatment. The purpose of investigation was the assessment of distant dispensary observation influence on arterial hypertension current. Methods: The research included 342 patients with arterial hypertension follow-up dispensary observation by general practice doctor. There were 2 groups: the 1st group was 141 patients of active remote control, the 2nd group was- 201 patients without active remote control. It was comparison group. In the 1st group there was daily blood pressure self-checking, dates were communicate to attending medical doctor by phone or by e-mail. If necessary to find the antihypertensive therapy, the information about blood pressure communicated once a day, after this - once a week. Comparison group patients were observed according to health ministry Russian Federation dispensary observation guidelines. Results: During observation in the 1st and 2nd groups there was statistically significant difference in ambulance calls-out, admissions, time on sick leave. In 12 months in the 1st group 92,2% patients succeeded to reach the objective blood pressure, in 2nd group only 43,3% patients succeeded to reach the objective blood pressure. Conclusion. The active dispensary observation of patients with arterial hypertension leads to rising of patient’s number who reached the objective blood pressure, rising of treatment patient compliance, reduction of incapacity for working and patient’s hospitalization.

The results of the clinical examination of a limited contingent of the population of the Kominternovsky district of the city of Voronezh (the number of 630 people surveyed) are analyzed. It is established that the body mass index (BMI), which is higher than the norm, is the leading risk factor (RF) in this population and increases the multiple risk of developing cardiovascular diseases (CVD). The revealed regularity of the dependence of increased BMI on age and sex is the basis for the development of a target program for the prevention of CVD, taking into account gender patterns.

The specificity of training of the adult contingent of students is determined by the social and psychological characteristics of students. The formed persons cannot be trained effectively by means of traditional pedagogical technologies, methods and forms [2]. An important andragogical principle is the principle of systematic training. This principle determines the formation of the goal, the development of forms and methods of training. The andragogical model is characterized by readiness of students to determine their needs in studying of the interesting subject for the solution of concrete problems. The student plays a leading role in the formation of motivation and determination of learning goals. Contextnode training involves the implementation of joint activities obeysekara and teacher in terms of language teaching goals, and implementation and evaluation of the learning process [8]. Modernization of medical education, as well as the development of modern education system, involves training with a high level of independence with the leading role of the student's personality. The organization of continuing professional education requires an understanding of the motivation system and should be based on the principles of andragogical training, which contribute to the formation of students ' needs for self-continuous acquisition of professional knowledge and skills.