Добавил:
ivanov666
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Comprehensive geriatric assessment from theory to practice. Study aid
.pdf
21
Ivanovich Eroshevsky, Corresponding Member of the USSR Academy of
Medical Sciences, made his contribution to the development of geriatrics.
The expansion of gerontological research was facilitated by the opening of
a problematic research laboratory for the study of glaucoma (1966), in
which clinical, laboratory, electron microscopic indicators of aging of the
anterior and posterior parts of the eyeball were developed. Together with
the Russian Research Institute of Gerontology, the pathogenesis of
cataracts was studied. The students of T.I. Eroshevsky — Professor
V.M. Malov, V.M. Petukhov continued research in the field of geriatric
ophthalmology. In the clinic. T.I. Eroshevsky, the most complex
vitreoretinal technologies, excimer laser surgery, femtosecond laser, tunnel
ultrasonic cataract surgery are used.
At the Department of Traumatology, Orthopedics and Extreme
Surgery under the guidance of Academician of the Russian Academy of
Medical Sciences, at that time the rector of the Medical Institute, Professor
A.F. Krasnov also studied the problems of elderly and senile patients.
A.F. Krasnov considered them from the standpoint of an internist, rightly
noting that geriatrics “cannot be taught in a month”, that knowledge of
geriatrics is necessary for a doctor of any specialty: surgeon, cardiologist,
nephrologist, etc. The first in the country, A.F. Krasnov used oxygen under
high pressure in the treatment of orthopedic and trauma patients. His
business, which he served all his life, A.F. Krasnov handed it over to a
talented student — the rector of the Samara State Medical University,
Academician of the Russian Academy of Sciences, Honored Scientist of
the Russian Federation Gennady Petrovich Kotelnikov, whose scientific
interests include works on gerontology and geriatrics.
Scientific activity of Professor M.V. Angular, conducted in the
laboratory of the Medical Institute since 1975, has become the basis for
complex studies of human systems and organs during aging.
Under the guidance of the head of the Department of Hospital
Therapy, Honored Scientist of the RSFSR Professor Vladimir
Anatolyevich Germanov, the staff of the department studied the blood
system in ontogenesis, the features of the clinical picture and the treatment
22
of diseases during aging. V.A. Germanov said: “The greatest joy is to see
how your student grows. Science is not only ideas and methods, it is also
the fate of people.” The result of many years of research were scientific
works, dissertations of his students O.N. Peksanov, I.A. Elizarova,
L.A. Chakina, E.D. Zinoviev, V.A. Kondurtseva, Yu.M. Titugin,
Yu.S. Pimenova, N.O. Zakharova. The works of Yu.S. Pimenov in the
field of hematology in aging made it possible to talk about the creation of a
new direction — gerontohematology.
It was at the Department of Hospital Therapy, where for many years
students got acquainted with geriatric problems in the cycle of geriatrics,
in 1995, first a course in geriatrics was organized, and then, in 1997, by
order of the rector, academician of the Russian Academy of Medical
Sciences A.F. Krasnov, an academic department of geriatrics was first
opened at Samara State Medical University, where undergraduate and
postgraduate training in gerontology and geriatrics is still being carried
out. The head of the department was appointed student V.A. Germanova,
Doctor of Medical Sciences, Professor Natalya Olegovna Zakharova. The
Samara Regional Clinical Hospital for War Veterans has become a
practical base for the training of doctors, which has been cooperating with
the Samara State Medical University since 1956, studying the features of
the course of diseases, diagnosing and preventing diseases in the disabled
of the Great Patriotic War and participants in local conflicts.
Since 1991, at the initiative of the head of the health department of
the administration of the Samara region, Professor R.A. Galkin and his
deputy professor V.V. Pavlov, medical and social departments and wards
began to open in the region, where lonely veterans of the Great Patriotic
War and the elderly were sent for treatment and care. By 2000, there were
more than 1,400 such beds.
In 1995, Samara hosted the 1st All-Russian Conference on
Geriatrics, Gerontology and the Organization of Medical and
Pharmaceutical Care for War Veterans, dedicated to the 50th anniversary
of the Victory. This caused a great public outcry and gave a new impetus
to the development of gerontology in Samara.
23
The next step on this path, on the initiative of the rector of the
Samara State Medical University, Academician of the Russian Academy
of Sciences G.P. Kotelnikov with the support of the Governor of the region
K.A. Titov, Head of the Health Department of the Administration of the
Samara Region Professor R.A. Galkin was the creation of the research
institute “International Center for the Problems of the Elderly” (NII
“ICPP”). The main goal of creating such an institution is to ensure and
improve the quality of medical and social assistance provided to veterans
of wars and labor and persons equated to them in terms of benefits, the
integration of scientific research and practical activities in the field of
gerontology and geriatrics, the development and implementation of
evidence-based approaches into practice. to the solution of medical and
social problems of older people. The tasks of the Institute included not
only further improvement of the quality of medical care for war and labor
veterans, but also the implementation of the federal program of the
Russian Federation “Older Generation”, which meets internationally
recognized norms of the social rights of an elderly person. Since 1996,
with the support of the Ministry of Health of the Russian Federation and
the chief gerontologist of the Russian Federation L.B. Lazebnik, Samara
State Medical University and Research Institute “MTsPP” in Samara
began to conduct annual international seminars on gerontology called
“Samara Lectures”. They were attended not only by scientists from
Samara, but also by experts from the WHO and the Council of Europe —
Secretary of the Congress of Regional Authorities of the Council of
Europe D. Cessario, leading scientists of the country Academician
M.I. Davydov, A.M. Wayne, Yu.P. Nikitin, N.N. Kornilov, Yu.P. Lisitsyn,
V.S. Gasilin, V.N. Shabalin, V.A. Tutelyan, L.K. Moshetova,
Corresponding Member of the RAS V.Kh. Khavinson, V.N. Anisimov,
professors L.B. Lazebnik, N.O. Zakharova, S.N. Shatokhina,
P.A. Vorobyov and many others. In 2002, within the framework of the
Samara Lectures Conference, the All-Russian Conference on Teaching
Geriatrics was held. Based on the results, a decision was made on the need
24
to teach the subject both at the undergraduate and postgraduate stages of
training doctors.
The uniqueness of the created Research Institute “MCPP” was that
the study of gerontological problems had an integrated approach —
medical, social and mental. For 10 years of work, 58 research papers have
been completed, six doctoral and 23 master's theses have been defended.
The results of the research have been introduced into the work of
healthcare facilities in Samara, Ulyanovsk, Voronezh, Orenburg and other
regions. Since 1996, twice a year, the Research Institute “MTsPP”
published the journal “The Older Generation”, focused on the interests and
needs of elderly readers, as well as doctors and scientists involved in the
problems of gerontology (Editor-in-Chief Academician of the Russian
Academy of Sciences G.P. Kotelnikov). The editorial board included
V.V. Bezrukov (Ukraine), K. Marquart (France), B. Molstedt (Sweden),
O.G. Yakovlev (Samara), N.O. Zakharova (Samara).
In 1995, a guide for doctors “Practical Geriatrics” was published, in
1999 — a guide for doctors “The Elderly Patient”. Over the following
years, conferences were held annually in Samara and scientific collections
“Clinical and Fundamental Aspects of Gerontology” were published.
In 1997, the first Russian textbook “Gerontology and Geriatrics” was
published. Leading scientists from Moscow, Samara, Chelyabinsk took
part in the work on the textbook. It consists of four sections: general
gerontology, general issues of geriatrics, private geriatrics and social
aspects of gerontology. General patterns of age-related changes in
physiological systems are presented, age-related features of the
development and treatment of the most common diseases in the elderly
and senile age are described. The psychological and social aspects of
gerontology, the most important legal laws protecting the rights of an
elderly person are given.
The recognition of the merits of Samara scientists was the
organization in Samara in 1999 of the 1st Russian Congress of
Gerontologists and Geriatricians, which marked an important stage in the
development of geriatrics in our country. The preparation and holding of
25
the congress was carried out with the active support of the Ministry of
Labor and Social Development of the Russian Federation. It was attended
by specialists from 65 regions of Russia, as well as representatives of the
WHO, the Council of Europe, Belgium, Great Britain, the USA, the
Republic of Belarus and Ukraine. At the congress, Vice-President of the
Russian Academy of Medical Sciences, Chairman of the Interdepartmental
Council of the Russian Academy of Medical Sciences and the Ministry of
Health of the Russian Federation for Gerontology, Honored Scientist and
Honored Doctor of the Russian Federation A.I. Martynov, together with
the chief gerontologist of the Russian Federation, Professor L.B. Lazebnik
was presented to Academician of the Russian Academy of Sciences
G.P. Kotelnikov, professors R. A. Galkin and O. G. Yakovlev the first
prize of the Russian Academy of Medical Sciences and the Ministry of
Health “For advanced scientific work and ideas that have already been
implemented and have become the property of the country's practical
health care.”
Samara gerontologists participate in the work of regional, Russian
and international conferences. At the IV European Congress in Helsinki,
31 scientific papers by Samara researchers were published. In Berlin, at
the congress, out of 85 reports, 15 were presented from Samara. In
Budapest, at the international conference under the motto “Towards a
society of all ages”, 18 representatives from 18 countries were attended by
the director of the Samara Research Institute “ICPP” V.M. Dubkov.
In 2005, professors N.O. Zakharova and O.G. Yakovlev. Research
materials were presented at other Russian and international forums of
gerontologists in Denmark, Switzerland, Australia, and Finland. More than
100 scientific articles and abstracts of Samara scientists were published in
St. Petersburg and Moscow.
A special place in the issues of gerontology today belongs to the
Department of Endocrinology and Geriatrics of the Samara State Medical
University, which since 2016 has received a new development and a new
name, and the doctor of medical sciences, associate professor S.V. region
N.O. Zakharova. Such continuity is very symbolic for the department,
26
which turned 25 in 2022. The main tasks of the department are to improve
the training of medical personnel, scientific research in the field of
fundamental and clinical gerontoendocrinology. At the department,
students are educated, their ideas about an elderly person are changing,
thinking stereotypes are broken, in which preventive aspects begin to take
the leading role, which means that the role of a doctor armed with
knowledge of geriatrics is increasing. The main scientific topic of the
department is “Socially significant chronic non-communicable diseases in
the elderly and senile age”. Prevention of premature aging.
From the moment of foundation to the present, the base of the
department has been the Samara Regional Clinical Hospital for War
Veterans, which is currently a multidisciplinary medical and diagnostic
institution equipped with the most modern diagnostic equipment, medical
equipment, and a rehabilitation department. This undoubtedly improves
the effectiveness of teaching. In addition to the main base, the department
is located in the Samara Regional Clinical Geriatric Hospital, which
includes a geriatric center, as well as in the Clinics of Samara State
Medical University.
Currently, students of the 6th year of the Institute of Clinical
Medicine, the 3rd year of the specialty “Social Work” (the cycle “Medical
and social rehabilitation of the disabled and the elderly”, the 4th and
5th “Premature aging”), foreign students, residents and graduate students
in the specialties “Therapy”, “Geriatrics”, “Endocrinology”. The main goal
of training at the department is to provide each graduate with basic
knowledge of geriatrics, which is necessary for a doctor of any specialty,
both in therapeutic and surgical practice. Working educational programs
are developed at the department by its employees.
The Department of Endocrinology and Geriatrics conducts
professional retraining cycles in the specialty “Geriatrics” (576 hours) for
specialists with basic education (internship, residency in the specialties
“Therapy”, “General Medical Practice”, “Internal Medicine”), advanced
training (144 hours) majoring in Geriatrics. In the system of continuous
medical education (18 and 36 hours), improvement is carried out for
27
specialists of various specialties on topical issues of geriatrics in general
medical, therapeutic, endocrinological, neurological, cardiological,
nephrological, gastroenterological, rheumatological, surgical and other
practices. In 2017, a new cycle of improvement is presented, also aimed at
doctors of medical and social expertise. Physicians from various regions of
Russia are trained in advanced training cycles at the department.
Information about ongoing cycles is publicly available and presented on
the official website of Samara State Medical University in the section
“Institute of Vocational Education”.
For many years, the department has been conducting active research
work to study the pathogenetic mechanisms of the development of
cardiovascular diseases against the background of aging, namely, the
distinction between the features of diseases and involutive processes that
accompany aging as such. The study of pathogenetic interactions in case of
polymorbidity of indicators of the hemostasis system, rheological
parameters of blood, functional characteristics of the state of the heart,
macrovessels and microcirculation, as well as the state of psychological
status were devoted to the work of the staff of the department, graduate
students. A series of works culminating in the defense of dissertations
made it possible to identify factors of an unfavorable course and the degree
of thrombotic risk in geriatric patients against the background of
polymorbidity, which should be taken into account when managing
patients both in a hospital setting and at an outpatient stage.
The state of reactivity of the body of persons of older age groups
under conditions of surgical stress has been studied. Reactivity parameters
were studied in patients subject to adenomectomy and in patients
undergoing hip arthroplasty. These studies made it possible to develop
programs for the prevention of complications during surgical
interventions.
The study of involutive osteoporosis against the background of
polymorbidity showed a relationship between the parameters of bone
metabolism and lipid metabolism, the hemostasis system. The
development of systemic osteoporosis aggravates the course of coronary
28
artery disease, increases the risk of thrombotic complications and falls,
which is a serious problem in geriatrics. Due to the high prevalence of this
pathology in older age groups, in 2001, on the basis of the Samara State
Medical University, the Samara Regional Interdepartmental Center for the
Prevention of Osteoporosis was created.
An important direction in the scientific research of the department
was the study of markers of accelerated aging in combatants. The
contribution of hormonal imbalance, mental maladjustment to the
implementation of the accelerated type of aging of combatants, mediated
by disorders in the hypothalamus-pituitary-adrenal system and the
sympathetic-adrenal system, has been established.
The study of the phenomenon of longevity in the Samara region.
revealed the role of socio-hygienic, psychological, medical, genetic
aspects of longevity in people who have crossed the 90-year mark and
retained their health. The study of indicators characterizing the state of the
cardiovascular system, parameters of platelet-vascular and coagulation
hemostasis in centenarians revealed that they differ slightly from those in
young and middle-aged people. The important role of social and hygienic
well-being, psychological balance, which determine the rate of aging of
the cardiovascular system and maintain the homeostasis of centenarians,
has been established. Genetic factors, namely the presence of relatives of
centenarians, were found in men in 55 %, in women — in 47 % of cases.
The significance of the role of the urinary system in late ontogenesis
in patients with coronary artery disease and arterial hypertension was
presented in works that reflected diagnostically significant markers of
renal dysfunction, disorders of phosphorus-calcium metabolism,
erythropoiesis, and stiffness of the main arteries. As a result of the studies
performed in senile patients with cardiovascular pathology in combination
with chronic kidney disease, risk factors for adverse outcomes were
established and ways to prevent them were developed through the timely
implementation of therapeutic and preventive measures.
The study of the causes of sudden cardiac death in senile patients
with coronary artery disease made it possible to establish the
29
morphological characteristics of the “senile heart”, the features of the state
of cardiomyocytes, nerve ganglia in various myocardial structures
(ventricles, atria, pathways). This study made it possible to define the
concept of “arrhythmogenic death” in senile patients with coronary artery
disease. Further studies of this problem open up new possibilities for the
prevention of such a formidable syndrome as sudden cardiac death.
One of the important scientific directions at the department was the
development of methods for influencing the pain syndrome in deforming
osteoarthritis in geriatric patients. The use of physiotherapeutic methods
(hyperbaric oxygen therapy, magnetotherapy, DENS-phoresis) is a safe
and effective way to deal with pain in patients of older age groups.
The creation of the department contributed to the development of
inter-departmental scientific cooperation in the field of gerontology on the
organization of health care, anesthesiology and resuscitation, skin and
venereal diseases, and dentistry. From 2007 to the present, the dissertation
council D 208.085.05 has been functioning at the Samara State Medical
University for the defense of doctoral and master's theses in the specialty
14.01.30 “Gerontology and Geriatrics”. During the existence of the
department, 32 candidate and three doctoral dissertations were defended,
105 residents were trained. Thus, the department of geriatrics and agerelated endocrinology is a kind of forge of scientific personnel, where
young scientists defend dissertations for the degrees of candidate and
doctor of medical sciences on topical geriatric aspects.
Currently, research in the field of gerontology and geriatrics is
ongoing in the Samara region and the Russian Federation. However, many
unresolved problems remain, which is a reserve for future scientific
research.
If in the middle of the twentieth century. there was no urgent need to
create a geriatric service, now it has appeared. At the end of the 20th and
the beginning of the 21st century. the need for knowledge of the basics of
geriatrics and the expansion of geriatric care has increased. In 1995, by
order of the Minister of Health and Medical Industry, the specialty
“Geriatrician” was approved.
30
In the Samara region, all types of planned and emergency medical
care for people of older age groups can be received in all medical
institutions. Specialized inpatient care in the field of “Geriatrics” is
provided in the region by the Samara Regional Clinical Geriatric Hospital,
the Samara Regional Clinical Hospital for War Veterans.
Particular attention in the region is given to the treatment of diseases
in people of older age groups. Therapy requires different approaches than
in younger people. It is our deep conviction that the concept of treatment
in geriatrics should not be replaced by enhanced care. The main thing in
modern medical practice is the provision of the most modern, specialized,
high-tech medical care. To date, a sufficient regulatory and legal
framework has been created in the Russian Federation for the development
of the geriatric service as a unified system of medical and social care due
to the continuity of patient management between different levels of the
health care system, as well as between health care and social protection
services — order of the Government of the Russian Federation of
February 5, 2016 №. 164r “Approve the attached Action Strategy in the
interests of the older generation in the Russian Federation until 2025”,
order of the Ministry of Health of the Russian Federation dated
January 29, 2016 № 38n “On approval of the procedure for providing
medical care in the profile “Geriatrics”” (registered in the Ministry of
Justice of Russia 14.03.2016 № 41405), order of the Ministry of Health of
the Russian Federation of 14 April 2015 № 187n “On Approval of the
Procedure for Providing Palliative Care to the Adult Population”
(registered with the Ministry of Justice of Russia on 08.05.2015
№. 37182), order of the Ministry of Health RF dated December 20, 2019
№ 1067n “On amendments to the procedure for providing medical care in
the profile “Geriatrics”, approved by order of the Ministry of Health of the
Russian Federation of January 29, 2016 № 38n (registered with the
Ministry of Justice of Russia on December 30, 2019 № 57070). In this
regard, the Samara region cannot remain aloof from solving geriatric
problems. On October 28, 2016, the All-Russian Conference on Geriatrics
was held in Samara with the inclusion of the region among seven regions
Соседние файлы в предмете [НЕСОРТИРОВАННОЕ]