The last decade of the XXI century was marked by the active development and introduction into clinical practice of the technology of Enhanced recovery after surgery. It allows you to ensure a quick and high‑quality recovery after surgery, reduce the number of complications, reduce the time of hospitalization and medical costs without increasing repeated hospitalizations, postoperative morbidity and the need for observation in the intensive care unit, minimize differences in the provision of perioperative care in various medical institutions and improve the quality of medical care to the population.Aim. To describe the history of development and current state of Enhanced recovery after surgery (ERAS or fast‑track), to present the ERAS Society protocol for spine surgery in adults and a consolidated protocol in children, and also have determined the results of the implementation of ERAS in various sections of spinal neurosurgery.

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INTRODUCTION: Low adherence to doctors prescriptions turns into an increased risk of complications and high mortality for patients, and economic losses and deepening of negative demographic trends for the society. AIM: To study adherence to therapy in polymorbid patients with chronic heart failure (CHF). MATERIALS AND METHODS: The study included 313 patients hospitalized in the city center for treatment of chronic heart failure (CHF) in the period from February 1, 2019 to October 1, 2020 at the age of 75 ± 8.22 years. 66.77% Of patients were diagnosed with CHF with preserved left ventricular ejection fraction (EF), 19.81% — with intermediate, 13.42% — with low ejection fraction. Adherence to treatment was assessed by Morisky–Green questionnaire: 4 points — compliant patients, 2 and less points — non-compliant, 3 points — insufficiently compliant. RESULTS: In the groups, the majority of patients had arterial hypertension (AH) and coronary heart disease (CHD), 99.04% and 67.09%, respectively; 65.49% of patients had rhythm disorders in the form of atrial fibrillation or flutter (AFb/AFl); 20.45% of patients had chronic lung diseases, chronic obstructive pulmonary disease (COPD), 21.72% — malignant diseases, a third of patients (38.98%) — diabetes mellitus (DM), 14.69% — various joint diseases. Almost all patients (99.04%) with CHF were diagnosed with chronic kidney disease (CKD), 45.05% had anemia of different severity. The incidence of acute kidney injury (AKI) was higher in the group of compliant patients (30.59%, 35% and 44.72%; pmg = 0.046), mainly due to AKI diagnosed by the initial creatinine (pmg=0.038), predominantly of I stage (12.94%, 15% and 17.07%; pmg = 0.805). The groups were comparable in the frequency of AKI diagnosed in the hospital by the dynamics of creatinine (4.11%, 5% and 5.69%; pmg = 0.823). Patients did not differ in frequency until dialysis stages of chronic kidney disease (pmg = 0.763). CONCLUSION: Every third patient at the outpatient stage did not take drug therapy. Among non-compliant patients, there was a lower incidence of stable angina and joint diseases, a smaller number of patients with more than 5 diseases, they were more rarely hospitalized and more often had bad habits. On the contrary, in the group of compliant patients, there were more polymorbid patients with pain syndrome of different location, they were more often re-hospitalized.

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This article discusses ethical and deontological issues of informing patients about cancer, which concern not only oncologists, but also doctors of other specialties. It is known that cancer is the strongest stress factor, therefore, competent and timely informing patients about this disease is of primary importance. Currently, a doctor who provides information about an existing disease is faced with the problem of overcoming ethical principles established in society, and also the need to comply with legal requirements. When solving this issue, a medical specialist should be guided by article 22 of Federal Law No 323-ФЗ of 2011, November 21, which states that every patient has the right to receive information about his health status in an accessible form in a medical organization. However, information about the state of health cannot be provided to the patient against his will, and in case of an unfavorable prognosis, the information must be given in a sensitive form to a person or his spouse or to one of the close relatives who were declared in medical records as allowed to be given such information. But, despite this, to overcome these difficulties, the doctor needs an individual approach to each patient, based on his/her professional experience. The peculiarity of informing patients about the disease, the degree of reliability of information should be determined by the specificity, type and stage of the cancer process, as well as the psychological, social and cultural characteristics of the patient, his age, gender, and profession. In addition, it is necessary to develop and implement state programs directed to improvement of cancer care and development of the social and psychological support services for patients suffering such pathology.