卷 24, 编号 3 (2020)

The article presents an overview of methods of treatment of coronavirus infection based on available data from recent clinical studies and methodological recommendations. Drugs recommended as pathogenetic therapy are considered. Data from clinical trials and expert opinions are analyzed.

Aim. To compare US, Russian and Indian primary care physicians’ attitudes, comfort and experiences providing palliative care.

Design. Cross sectional survey.

Settings. Iowa, USA; Leningrad Oblast, Russia; Mangalore, India.

Participants. Primary care physicians.

Methods. Chi-squared testing for dichotomous variables and t-tests for mean scores.

Results. 66 US, 81 Russian and 95 Indian physicians completed the survey. More US physicians preferred end of life care at home (83% v 56% Russian and 29% Indian) p < 0.001 and Indian physicians preferring hospitals (36% v 0% US and 1% Russian) p < 0.001. 94% percent of US physicians preferred patient make their own decisions, 57% of Russian sample preferred physicians as decision makers, and Indian physicians preferred family members to patients themselves (44%) p < 0.001. Patient should be informed (US vs Russia vs India) of terminal illness “Always” (74% vs 31% vs 33%) p < 0.001, “If Asked” (9% vs 64% vs 12%) p < 0.001 or “Physician’s Judgement” (15%, 5%, 54%) p < 0.001. US physicians reported higher comfort rates with managing symptoms at the end of life. In the last 6 months US physicians were more satisfied with provided care “Often or Always” (63% vs 36% Russian v 21% Indian) p < 0.001.

Conclusions. US sample was more concerned with patient autonomy and had more comfort and satisfaction in providing end of life care compared to Russian and Indian samples.

这篇文章专门介绍了一名59岁女性严重冠状病毒感染的临床病程特点，她属于伴随病理的危险组。提供了关于COVID-19严重发病机制的数据。高危个体冠状病毒感染不良结果的预后实验室体征被考虑。根据新的冠状病毒感染的治疗方案，描述了患者的管理策略。在门诊阶段对病人的管理进行评估。

风险患者一旦感染新的冠状病毒，病情会迅速恶化，不仅表现为计算机断层显示的严重肺损伤，还表现为急性呼吸窘迫综合征的临床症状。这类患者病情的严重程度是由于明显的病毒侵袭和细胞因子风暴的发展。采用协议推荐的治疗方案治疗危重患者的新冠病毒感染并不总能得到预期的阳性结果。

The case of asymptomatic 3^rd stage myxomatous degeneration of the mitral valve in a 42-year old male patient is presented. The patient was referred to Tuberculosis dispensary No. 5 for investigation of pathological findings revealed by fluorography during the coronavirus pandemic period. The patient was examined by TB specialists and the general practitioner in accordance with new interdisciplinary diagnostic algorithms primary involving the GP. As а result of the detailed investigation the patient was found to have previously undiagnosed consequences of pneumonia caused by COVID-19 and 3^rd stage myxomatous degeneration of the mitral valve.

The article presents the results of research of theoretical knowledge and practical skills of general practitioners with more than 5 years of experience.

The aim of the study is to assess the level of proficiency in otoscopy by General practitioners using a simulator, depending on various socio-demographic characteristics.

Materials and methods. The study was conducted at the Department of family medicine of North-Western State Medical University named after I.I. Mechnikov. Doctors who agreed to participate in the project filled out a socio-demographic questionnaire, tests to test theoretical knowledge, for the level of proficiency in otoscopy, was evaluated using a checklist. Statistical analysis of the data was performed using the SPSS 22.0 program (SPSS Inc., Chicago, Illinois, USA). The study involved 24 General practitioners with more than 5 years of experience.

Results. Analysis of the results showed that 66.7% of General practitioners rated their skill in otoscopy as “satisfactory” or higher, but only 54.1% were able to correctly perform 70% of the actions according to the checklist.

Conclusions. 1. The level of theoretical knowledge in otoscopy among General practitioners with experience who took part in the study was quite low: 62.5% of respondents did not achieve satisfactory results. A low level of proficiency in otoscopy among General practitioners was also revealed when evaluating the performance of manipulation on the simulator — only 20.8% of doctors correctly performed 80% of the actions according to the checklist. 2. Independent assessment of the level of proficiency in otoscopy in General practitioners is not a predictor of the success of its demonstration on the simulator in accordance with the checklist. 3. The level of proficiency in otoscopy in the study group of General practitioners did not have a statistically significant relationship with the basic level of theoretical knowledge, work experience and regular otoscopy in everyday practice.