Молодежный инновационный вестник

2415-7805

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

8553

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THE EFFECTIVENESS OF COMPLEX TREATMENT OF PATIENTS WITH NEWLY DIAGNOSED TUBERCULOSIS OF THE RESPIRATORY SYSTEM IN OUTPATIENT SETTINGS WITH THE HELP OF VIDEO-CONTROLLED TREATMENT

Velikaya

Olga Viktorovna

<p>Doctor of Medical Sciences</p>vgma-velikaya@yandex.ruhttps://orcid.org/0000-0002-0769-8427Goloktionova

Ksenia Alekseevna

<p>Clinical Resident of the Department of Phthisiology</p>ksyu.goloktionova@mail.ruhttps://orcid.org/0000-0003-1991-7698Bindyukovа

Daria Sergeevna

<p>Student of the Faculty of Medicine 5th year</p>darya.bindyukova66@mail.ruhttps://orcid.org/0000-0002-6364-2380Goncharova

Natalia Vladislavovna

<p>Student of the Faculty of Medicine 5th year</p>ttsshka@gmail.comhttps://orcid.org/0000-0001-8266-4051

Voronezh State Medical University named after N.N. Burdenko

20042023

12S2632635

06032023

28032023

2023

<div class="Translate-Output Translate-Output_size_l"> <div class="Translate-OutputText " role="article" aria-label="Основной перевод: Relevance: Video monitoring when taking medications at home allows you to confirm that the patient really took his PTP (swallowed and washed them down). If there are doubts about whether the patient is taking his medications, with the help of video monitoring, evidence of commitment can be obtained. In addition, video-controlled treatment helps to increase the patient's commitment."> <div class="Translate-Scroll"> <div class="Translate-ScrollBar" style="height: 0px;"></div> </div> <div class="Translate-TargetText Translate-TargetText_userSelect_enabled" aria-hidden="true">Relevance: Video monitoring when taking medications at home allows you to confirm that the patient really took his PTP (swallowed and washed them down). If there are doubts about whether the patient is taking his medications, with the help of video monitoring, evidence of commitment can be obtained. In addition, video-controlled treatment helps to increase the patient's commitment.</div> <div class="Translate-TargetText Translate-TargetText_userSelect_enabled" aria-hidden="true"></div> <div class="Translate-TargetText Translate-TargetText_userSelect_enabled" aria-hidden="true">Objective: to evaluate the effectiveness of tuberculosis therapy using video technologies (Skype)</div> </div> </div> <p>Materials and methods.<br />The study of the effectiveness of video-controlled treatment and processing of the data obtained were carried out on the basis of the Voronezh Regional Clinical Tuberculosis Dispensary named after N. S. Pokhvisneva (hereinafter referred to as VOKPTD) Voronezh in 2022.<br />The materials were analyzed: the medical card of an outpatient patient, the control card of dispensary observation (registration form No. 030/y) and the treatment card (form No. 501-TB/y, form No. 502-TB/y). The study included a cohort of patients in 2019. Studies and a detailed retrospective analysis of the medical records of 100 patients were carried out. Results and discussion.<br />Patients with infiltrative pulmonary tuberculosis of various localizations were selected for this study.<br />After receiving the required number of doses of anti-tuberculosis drugs in the intensive phase in a round-the-clock hospital, patients were transferred to the continuation phase (outpatient treatment). During the transfer, the examined categories I and II categories did not complain.<br />During lung auscultation, wet wheezing was heard in 12 (24.5%) patients from the I category of patients and in 15 (29.4%) patients from the II category.</p> <p>The first and second categories of subjects are united by a common X-ray picture: one of the lungs is mainly affected [40 (81.6%) patients of category I and 43 (84.3%) - category II].<br />An intradermal test with a recombinant tuberculosis allergen in standard dilution (Diaskintest) was positive in category I in 45 patients (91.8%) and in 48 patients (94.1%) in category II.<br />Bacterial excretion at the beginning of treatment using microscopy was found in 18 patients (36.7%) of category I, in patients of category II this indicator is equal to 29 patients (56.8%). The bacterial excretion rate, determined by the culture method, is also higher in patients of category II 37 patients (72.5%), whereas among patients of the I category of the study, this indicator was detected in 24 patients (48.9%).<br />Thus, using one of the above methods, it was possible to identify or refute the presence of drug resistance in all patients from both study groups. In category I, the drug sensitivity of Mycobacterium tuberculosis to anti-tuberculosis drugs was preserved in 30 patients (61.3%), and drug resistance of MBT was determined in 19 (38.7%). In category II, the drug sensitivity of Mycobacterium tuberculosis to anti-tuberculosis drugs was preserved in 24 patients (47%), and drug resistance of MBT was determined in 27 (53%).<br />Treatment of patients with tuberculosis using information and communication technologies (Skype) and other organizational forms of treatment was carried out within the standards (treatment regimens) approved by the Order of the Ministry of Health of the Russian Federation No. 951 of December 29, 2014.<br />The treatment tactics were adjusted individually for each patient, taking into account the peculiarities of the dynamics of the disease, the drug sensitivity of Mycobacterium tuberculosis, the pharmacological properties of the drugs used and their interaction, drug intolerance, the presence of background and concomitant diseases, as well as risk factors. These principles of treatment made it possible to combine standard treatment of the disease with individual patient treatment tactics. Laboratory and instrumental monitoring of side effects of anti-tuberculosis drugs and control of treatment, taking into account data on drug resistance, is carried out in accordance with the requirements of the clinical recommendations "Tuberculosis in adults", ID: KR16/1. 15.</p> <p>The first (I) chemotherapy regimen for drug-sensitive tuberculosis was prescribed to 14 (28.6%) patients of category I and 15 (29.4%) of category II. The second (II) chemotherapy regimen for isoniazid-resistant tuberculosis was prescribed to 4 (8.2%) patients from category I and 4 (7.8%) from category II. The third (III) chemotherapy regimen for drug-sensitive tuberculosis was prescribed to 16 (32.7%) patients from category I and 9 (17.6%) patients from category II. The fourth (IV-test mode) MDR-tuberculosis chemotherapy regimen was prescribed to 12 (24.5%) patients from category I and 15 (29.4%) patients from category II. The fifth (V) chemotherapy regimen for XDR-tuberculosis was prescribed to 3 (6.0%) patients of category I and 8 (15.7%) patients of category II. Subsequently, 2 (4.0%) patients from category II were re-registered for IV-V mode.<br />The duration of treatment met the standards in both study groups. There were no omissions in taking medications in the I and II categories of patients during the study.<br />When comparing the results of treatment of 100 newly diagnosed patients with infiltrative pulmonary tuberculosis, of which 49 were treated with video monitoring (category I), and 51 without video monitoring (category II), treatment was effective in 42 (86%) patients of the first category and 36 (71%) patients of the second category.<br />Of these, the bacteriologically confirmed efficacy was determined in 20 (48% relative to the effective outcome of treatment in the category) and 26 (72% relative to the effective outcome of treatment in the category) I and II categories, respectively. The efficacy was clinically and radiographically confirmed in 22 (52%) patients of the first category and 10 (28%) patients of the second category.<br />An ineffective course of treatment was detected in 1 (2% relative to all treatment outcomes in this group) patient of the first category of the study and in 2 (4% relative to all treatment outcomes) in the second category. 2 (4%) patients died of tuberculosis in the first category, 2 (4%) patients died in the second category. There are no deaths from other causes in the first category, in the second 2 people (4%). There are no patients who interrupted chemotherapy among the patients of the first category, among the patients in the second category, 1 case of interruption of chemotherapy was detected (2%). The diagnosis of tuberculosis was removed in 2 (4%) patients in the first category of the study.<br />With an effective course of chemotherapy, negative seeding and microscopy were achieved for 1 month of treatment in 2 (5%) patients from the first category and 4 (3%) patients from the second category. At the 2nd month of treatment, negative results of bacterioscopic and cultural studies were detected in 14 patients (33%) in the first category, in the second category in 16 people (44%). At 3 months from the start of treatment, negative research results were achieved in 7 people (17%) in the first category and in 1 person (3%) in the second category. During the entire course of anti-tuberculosis chemotherapy, the achievement of negative results of crops and microscopy with an effective course was determined in 19 people (45%) in category I and in 11 people (31%) in category II.<br />When comparing the above data, indications for video-controlled treatment of tuberculosis patients were determined:</p> <p> Age from 18 years and older;<br /> Any form of tuberculosis in the absence of aggravating epidemic factors;<br /> The treatment regimen should not include injectable drugs;<br /> The patient should be highly motivated to try this method of treatment;<br /> The patient should make video calls independently after one or two trainings.<br />Conclusions:<br />1. Infiltrative tuberculosis in all examined patients (first and second categories), whose total number reaches 100 people, was detected in a timely manner.<br />2. According to the results of treatment, patients who received outpatient treatment with video monitoring effectively completed the course of treatment in a larger percentage (86%), when 71% of patients in the category of patients without video monitoring effectively completed the course. <br />3. Treatment using information and communication technologies<br />(Skype) makes the treatment process more comfortable for the patient due to the following factors: <br />- the patient does not need to go to the clinic to receive PTP under the supervision of medical staff to prove his commitment to treatment (reduction of irritability and aggression);<br />- the saved time can be used for other important things; <br />- money is saved on transportation costs associated with trips to the clinic for taking medications; - there is less chance of side effects (such as vomiting, diarrhea, weakness, dizziness or seizures) in transport on the way home, especially in MDR-TB patients; <br />- it is possible to avoid unnecessary contacts with the unfriendly staff of the medical institution (in case of conflict) or with other patients (conflicts, the possibility of infection);<br />- confidentiality when using this method of taking medications is higher;<br />- this is a new, innovative way, it's interesting, it increases self-esteem and gives a feeling of returning to a "normal" life in society.</p>

video-controlledtuberculosiseffectiveness

видеоконтролируемоетуберкулезэффективность

<p>Since the beginning of the two thousandth years, various video technologies have been increasingly used at the outpatient stage of tuberculosis treatment in different countries of the world, allowing monitoring the intake of anti-tuberculosis drugs remotely when the patient is at home (or at the place of study, work). The adherence rate in patients included in the studies reaches 93-96%, the percentage of days with missed admission of PTP is only 2.7% (with a standard deviation of 7.0). The cure rate, according to various studies, reached 96-100%.As a result of the work carried out , 2 categories of subjects were formed: Category I (49 patients) included newly identified patients with infiltrative pulmonary tuberculosis who received TB therapy on an outpatient basis with the help of video-controlled treatment (hereinafter ON). Category II (51 patients) - newly identified patients with infiltrative pulmonary tuberculosis who received TB therapy on an outpatient basis using other forms of treatment: on the basis of a day hospital, a hospital at home (VOKPTD), in tube.offices, in paramedic-obstetric stations, in the offices of general practitioners. The main condition for tuberculosis therapy is continuous monitoring by medical professionals of the intake of each dose of anti-tuberculosis drugs during the main course of chemotherapy. The medical institution in which the patient is being treated organizes the reception of medicines by the patient every day in accordance with the chemotherapy regimen established by the attending physician.The duration and organizational form of treatment were determined in each case by the medical commission, depending on clinical, bacteriological and social characteristics. All the studied patients started the intensive phase in a round-the-clock hospital. Patients from two categories underwent standard examinations for the diagnosis of tuberculosis of the respiratory organs. Additional research methods were carried out as intended. Treatment of patients of the main group after the inpatient stage was carried out in outpatient conditions of the VOKPTD using information and communication technologies (Skype). All patients from the main group had communication devices, an acceptable level of commitment and high motivation for treatment. Every month, the patient received medications according to the prescribed chemotherapy regimen.Video sessions were conducted in the remote control room by a specially trained nurse according to a schedule drawn up in advance with the patients.The observed took anti-tuberculosis drugs and demonstrated that the pill was swallowed while talking to a nurse. All video sessions were recorded on video with subsequent archiving. Data on the daily performance of the treatment regimen were entered into the treatment card form No. 501-TB/y, form No. 502-TB/y.If the video session was missed, the patient was called by phone, if he did not answer, they visited him at home. If side effects occurred, a doctor was connected to the session and conducted counseling. On weekends, patients independently made video recordings of receiving PTP and provided this recording to a doctor or nurse. Every two weeks, patients visited the dispensary for clinical evaluation and correction of the course of treatment, if necessary. The treatment of patients from the comparison group after the inpatient stage was carried out in outpatient conditions of a day hospital (hospital at home) of the VOKPTD, in paramedic and obstetric stations, in the offices of general practitioners, in PHC tube.offices. The priority for determining the form of treatment at the outpatient stage was abacillation of the patient and maximum availability of controlled treatment. Among the observed both categories, men prevailed [32 (65.3%) - in category I; 40 (78.4%) - in category II], whose average age was 41 years in category I, and 49 years in category II. The number of women was slightly lower [17 (35%) - in category I; 11 (21.6%) - in category II], whose average age was 40 years in category I, and 38 years in category II. According to social risk groups, the share of the HOMELESS category in group I was 2 people (4.1%) - men, and in group II 3 people (6%): 2 people - women (67%), 1 person - men (33%); the number of patients who arrived from places of deprivation of liberty (MLS) in category I there were 7 people (14.3%): 6 people men (86%), 1 person women (14%), and in category II 1 person (2%) - men; the number of patients with HIV infection in category I is 4 people (8.2%): 3 people - men (75%), 1 person women (25%), and in category II only 7 people (14%): 5 people men (71%), 2 people women (29%); the number of patients with chronic viral hepatitis in category I was 13 people (26.5%): 2 people women (15.4%), 11 people men (84.6%), and in category II 1 person men (2%); with alcohol dependence in category I 11 people (23%) were identified: 3 people women (27%), 8 people men (73%), and in category II 1 person (2%) - men; 4 people (8.2%) were identified with drug addiction in category I - men, in category II persons with drug addiction were not identified.</p>

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