Aim To evaluate frequency of administration of anticoagulant therapy (ACT) for atrial fibrillation and to study the effect of chronic antithrombotic therapy (ATT) on kidney function.Material and methods Due to a high medical and social significance of AF, much attention is presently paid to appropriate administration of ACT for AF in clinical practice. The study retrospectively analyzed 776 case reports of hospitalized patients with AF. The effect of chronic ATT on kidney function was studied in 70 patients who were rehospitalized, including 25 patients treated with warfarin, 25 patients treated with direct oral anticoagulants (DOAC), and 20 patients treated with acetylsalicylic acid (ASA).Results In January 2014, at the prehospital stage, 74.3 % of patients did not receive ATT, 14.7 % of patients received antiplatelet therapy, and only 11 % received anticoagulants. In the hospital in January 2014, ACTs were administered to 74.3 % of patients (warfarin, 58.6 %; DOAC, 15.7 %), 20.6 % of patients received antiplatelet drugs, and 5.1 % of patients were discharged without ATT. In January 2019, the number of patients receiving ACT at the prehospital stage increased to 58.1 % (warfarin, 13.8 %; DOAC, 44.3 %); 12 % of patients received antiplatelet drugs; and 29.9 % of patients did not receive ATT. The number of patients treated with warfarin and DOAC in the hospital increased to 14.8 % and 70.6 % (rivaroxaban, 33.4 %; apixaban, 25.5 %, and dabigatran, 11.7 %), respectively. The number of patients taking antiplatelet drugs decreased to 3.7 %, and the number of patients without ATT decreased to 10.9 %. There were no statistically significant differences in glomerular filtration rate (GFR) between these three groups at baseline. Only in the warfarin treatment group, GFR was significantly decreased from baseline during the follow-up period. Comparison of GFR in three study groups at the finale stage of the study showed significant differences between mean GFRs in the warfarin treatment group and the DOAC treatment group and between the warfarin treatment group and the ASA treatment group.Conclusion Among the prescribed and taken anticoagulants, DOACs are presently in the first place. Among DOACs, the most frequently prescribed drug is rivaroxaban. GFR decreases with the DOAC treatment slower than with the warfarin treatment. Despite the slower decrease in GFR with the ASA treatment compared to warfarin, ASA is not indicated for prevention of stroke in AF due to its low efficacy.

The article is devoted to the study of the effectiveness of training graduates of medical universities when a trained student is included in the educational process, able to fulfill the role of a mentor. All over the world, the number of students is increasing in medical universities every year, but there is no equivalent increase in the teaching staff. One of the potential methods of overcoming the above problems is the use of trained mentors from among peer students. This method was used when students practiced practical skills in a simulation center in anticipation of primary accreditation. The purpose of the study is to optimize the preparation of students for a practical exam in a simulation environment with the help of a student mentor. Of the 468 students of the medical faculty of the North-Western State Medical University named after I.I. Mechnikov, studying in the VI year, was chosen by their colleague, who was trained at the center of simulation technology. A sample of 100 graduates was randomly generated, which were randomized into two groups of 50 people each (the main group in which the training was conducted with the participation of a mentor student and a control group trained under the guidance of teachers from one of the university departments). The most difficult for students was the station simulating the provision of emergency medical care (EMF). The evaluation checklist for checking the quality of the tasks at this station includes 233 points that must be implemented when providing EMF in 13 different situations requiring this type of medical care. To improve the quality of mastering practical skills, a training scheme was developed that allows you to learn the algorithm of actions when providing EMF. A basic assessment of students knowledge and skills revealed a low level of knowledge of diagnostic techniques and emergency assistance. Using the developed training scheme with the help of a student mentor has significantly increased the level of knowledge and practical skills in the provision of EMF. The quality of training in the main group did not significantly differ in most of the assessed parameters from the control group in which classes were held with the teacher. Statistical analysis of the data was performed using the SPSS 20.0 program (SPSS Inc., Chicago, IL, USA).

Background The key points in the treatment of patients with atrial fibrillation (AF) with the ABC (Atrial Fibrillation Better Care) pathway are the prevention of stroke and increasing patient adherence to therapy. The basis for increasing adherence to therapy is regular communication between medical staff and the patients. Purpose To assess the effect of telephone contact (TC) frequency on patient adherence to anticoagulant therapy (ACT). Methods A prospective, non-interventional observational study was carried out, during which 84 patients with non-valvular AF were observed remotely after being discharged from the hospital. Patient education was provided in the hospital, which included an explanation of the importance of ACT. The observation period was 12 months. All enrolled patients were 18 years of age or older; AF was documented before enrolment on the basis of objective electrocardiographic evaluation; all patients had indications for taking anticoagulants (AC) for stroke prevention. Adherence to therapy was assessed using the Morisky-Green test. Results The patients were randomized into 2 groups: group 1 – TC monthly, group 2 – TC every 6 months. In the first group, 85.7% of patients received the non–vitamin K antagonist oral anticoagulants (NOAC), and 14.3% received warfarin; in the 2nd group, 92.9% of patients received NOAC, and 7.1% received warfarin. The mean score of the adherence to therapy according to the Morisky-Green test was initially 3.3±0.8 in group 1, and 3.3±0.7 in group 2, p=0.78. After 12 months: in group 1, 14.6% of patients refused to take AC; and in group 2, 25.0% did the same. The mean value score of the adherence to therapy in group 1 underwent a statistically insignificant change over time (from 3.3±0.8 to 3.1±1.5, p=0.48). In group 2, after 12 months, the mean score of adherence to therapy saw a significant decrease from 3.3±0.7 to 2.7±1.6, p=0.03. Both in group 1 and in group 2, the decrease in the mean score of adherence to therapy occurred mainly due to patients with an initially insufficient level of adherence. Conclusions The results of our study confirm the need for individual strategy for managing patients through the ABC pathway. In most cases, face-to-face or telephone contact with medical staff once every six months is sufficient for patients who are initially adherent to therapy, after receiving an introductory briefing. Patients with insufficient level of adherence require more frequent contact. FUNDunding Acknowledgement Type of funding sources: None.