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ДМИТРИЙ ДМИТРИЕВИЧ ПЛЕТНЕВ (К 240-ЛЕТИЮ ЕКАТЕРИНИНСКОЙ БОЛЬНИЦЫ, НЫНЕ МОНИКИ ИМ. М.Ф. ВЛАДИМИРСКОГО)
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ОЦЕНКА КЛИНИКО-ЭКОНОМИЧЕСКОЙ ЭФФЕКТИВНОСТИ МЕДИКАМЕНТОЗНОЙ ТЕРАПИИ ПАЦИЕНТОВ СО СТАБИЛЬНЫМ ТЕЧЕНИЕМ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА, ПЕРЕНЕСШИХ РЕВАСКУЛЯРИЗАЦИЮ МИОКАРДА
No full textBackground: Impractical use of pharmaceuticals is a serious problem of the Russian healthcare system. Implementation of pharmacoeconomic analysis into the logistic technologies of medical organizations may promote the solution of this problem.Aim: To analyze real-practice data on medical therapy of patients with stable ischemic heart disease (IHD) during their hospital stay for transcutaneous coronary stent placement and coronary artery bypass grafting.Materials and methods: With the help of a structured form on medical treatment we extracted and analyzed data from 131 clinical records of patients with stable IHD who were hospitalized in 2014 to the Department of Internal Diseases and Department of Cardiovascular Surgery; 60 were patients after stent placement and 71, after coronary artery bypass grafting. We performed an ABC/VEN analysis of their treatment. Groups of pharmaceuticals for VEN analysis were formed according to the Recommendations of Russian National Atherosclerosis Society on Diagnosis and treatment of chronic IHD (Recommendations of Russian National Atherosclerosis Society, 2013) based on European Society of Cardiology guidelines on the management of stable coronary artery disease (ESC guidelines, 2013). We assessed if the treatment administered corresponded to the current Standard of care to patients with stable IHD – SMP No 2.01.216.0 (Russian Federal Standard, 2007).Results: A mismatch between medical treatment that was performed in the Departments of Internal Diseases and of Cardiovascular Surgery, and that recommended by the Russian Federal Standard (2007), was found. The regimens used include the majority of agents recommended by the Russian National Atherosclerosis Society (2013) and the ESC guidelines (2013). In the Department of Internal Diseases, the mean cost of medical treatment during the whole period of stay in the hospital was 79.6 rubles. The group A agents (those with cumulative cost percentage = 80%) were represented by 9 items from the total of 54. There was a low percentage of medicines that were not indicated for this disease (13 agents, or 9.5% of the total medical costs), and all of them were administered for the treatment of concomitant disorders. In general, medical treatment performed in the Department of Internal Diseases corresponded to the ESC guidelines (2013). The costs of medical treatment during the whole period of stay in the Department of Cardiovascular Surgery was 10 741.9 rubles. The group A included 9 agents from the total of 78 used. Sixty eight per cent of costs were related to pharmaceuticals not having compelling indications (solutions, detoxification agents, agents for prevention of gastrointestinal adverse effects), whereas the costs of vitally important drugs were only 12.3% of the total and those of necessary drugs (including antibacterials), 19.7%.Conclusion: It is obviously necessary to update the current Russian Federal Standard (2007), with inclusion of data corresponding to the worldwide trends and guidelines of the Russian National Atherosclerosis Society (2013), at least for two patient groups: those after coronary stent placement and after coronary artery bypass grafting. The elaboration of criteria for administration of medical treatment and strict compliance with them in the real practice would allow for controlling of medical treatment costs, to prevent polypragmasia and adverse drug reactions. Актуальность. Нерациональное применение лекарственных препаратов – серьезная проблема российского здравоохранения, решению которой может способствовать внедрение методов фармакоэкономического анализа в логистические технологии медицинских организаций.Цель – проанализировать реальную практику медикаментозной терапии пациентов со стабильным течением ишемической болезни сердца (ИБС) при проведении стентирования коронарных артерий и аортокоронарного шунтирования во время нахождения в стационаре.Материал и методы. При помощи разработанной карты регистрации медикаментозной терапии были систематизированы данные 131 истории болезни пациентов со стабильным течением ИБС за2014 г., проходивших лечение в отделениях терапии и сердечно-сосудистой хирургии (60 историй болезни пациентов, перенесших стентирование, и 71 история болезни пациентов, перенесших аортокоронарное шунтирование). Проведен ABC/VEN-анализ медикаментозной терапии. Группы препаратов для VEN-анализа формировались на основании клинических рекомендаций Национального общества по изучению атеросклероза по диагностике и лечению хронической ИБС от2013 г. (Рекомендации Национального общества по изучению атеросклероза, 2013), разработанных с учетом рекомендаций Европейского общества кардиологов по лечению стабильной ИБС от2013 г. (ESC, 2013). Изучено соответствие проводимой терапии действующему Стандарту медицинской помощи больным со стабильной стенокардией СМП № 2.01.216.0 (Федеральный стандарт, 2007).Результаты. В отделениях терапии и сердечно-сосудистой хирургии выявлено несоответствие проводимой медикаментозной терапии рекомендованной Федеральным стандартом (2007). При этом используемые схемы лечения включают подавляющее большинство препаратов, рекомендованных Национальным обществом по изучению атеросклероза (2013) и содержащихся в рекомендациях ESC (2013). В отделении терапии средняя стоимость медикаментозного лечения составила 79,6 руб. за все время пребывания в стационаре, на долю группы “А” (препараты, кумулятивный процент затрат на закупку которых равен 80%) пришлось 9 препаратов из 54 использовавшихся. Выявлен низкий процент назначения препаратов, не имеющих показаний при данном заболевании (13 препаратов и 9,5% от общей суммы затрат на медикаментозную терапию), все они назначались для лечения сопутствующих заболеваний. Проводимое в отделении терапии медикаментозное лечение в целом соответствовало рекомендациям ESC (2013). Стоимость медикаментозной терапии за все время пребывания в отделении сердечно-сосудистой хирургии составила 10 741,9 руб. Из 78 использовавшихся лекарственных препаратов в группу “А” вошли 9. При этом 68% затрат пришлось на препараты, не обязательные к назначению (растворы, дезинтоксикационные препараты, средства, предназначенные для профилактики осложнений со стороны желудочно-кишечного тракта), а на долю жизненно важных препаратов – только 12,3% средств, на долю необходимых (включая антибактериальную терапию) – 19,7%.Заключение. Очевидна необходимость пересмотра действующего Федерального стандарта (2007) с представлением дезагрегированных данных, соответствующих общемировым трендам и рекомендациям Национального общества по изучению атеросклероза, как минимум для двух групп пациентов – стентирования коронарных артерий и аортокоронарного шунтирования. Разработка критериев назначения препаратов и жесткое следование им в условиях реальной практики позволят контролировать расходы на медикаментозную терапию, а также осуществлять профилактику полипрагмазии и осложнений от назначаемого лечения.
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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