Characteristics of therapeutic patient education are: What is the medical effectiveness of patient education at the Health School? Registration and reporting documentation of the patient's schools
Health Progress Improvement medical care patients with chronic diseases- Introduction of high-tech treatment methods (new diagnostic tools, new drugs, invasive methods) Increased life expectancy Improved quality of life Labor and social rehabilitation
Healthcare progress High-tech treatment methods - are most effective when combined with changes in the patient’s lifestyle - require new knowledge and skills from the doctor and the patient - effectiveness makes it possible to better motivate the patient to change their lifestyle
Therapeutic education Therapeutic education is an effective way to improve the treatment of patients with chronic diseases Therapeutic education can be carried out in the form of joint work between the patient, the nurse, and the attending physician The main share of therapeutic education is communication between the patient and the nurse
Therapeutic training – organized work medical personnel aimed at changing the behavior of a patient with a chronic disease. The main resource for change in the organization of work nurses– training of specialists – nursing managers
Requirements for nursing managers Understanding the essence of therapeutic education, its effectiveness and limitations Knowledge of the basic principles of organizing and conducting therapeutic education Knowledge of the features of therapeutic education pedagogy Ability to plan patient education Possession of search skills necessary information
Requirements for nursing managers Understanding of the tasks and essence of monitoring therapeutic training of patients and the ability to plan and monitor the effectiveness of training Ability to transfer their knowledge and skills to nursing staff Ability to organize teamwork in therapeutic training
Structure of the training course Theoretical training: The essence and principles of therapeutic training Independent work: planning therapeutic training Practice: conducting therapeutic training Patient needs and organization of work with patients
Theoretical foundations of TOP Training of 4th year students - 5 lectures and 5 seminars Training objectives - requirements for nursing managers Understanding the essence of therapeutic training, its effectiveness and limitations Knowledge of the basic principles of organizing and conducting therapeutic training Knowledge of the features of the pedagogy of therapeutic training Ability to plan patient training Possession of skills to search for necessary information
“Nurse – TOP organizer” - independent work First semester of the 5th year Learning objectives - requirements for nursing managers Understanding the essence of therapeutic education, its effectiveness and limitations Knowledge of the basic principles of organizing and conducting therapeutic education Knowledge of the features of the pedagogy of therapeutic education Ability to plan patient education Possession of the skills to search for the necessary information
“Nurse – organizer of TOP” - independent work The student’s task is to draw up a TOP plan on the chosen topic. Diseases - diabetes mellitus, coronary artery disease, hypertension, bronchial asthma, post-resection syndromes... The choice of topic depends on previous work experience
“Nurse – TOP organizer” - independent work Structured training plan Lesson topic Identification of the target group and its recruitment Patient needs Lesson objectives Lesson plan - knowledge, skills, motivation formation Training methods Performance monitoring
Needs of patients and organization of work with patients First semester of the 5th year - Training on the basis of the Nizhny Novgorod Diabetes League Determining the needs of patients with chronic diseases using an example diabetes mellitus Patient Needs for Education Program
Learning outcomes One graduating class of students who have fully completed the course of study The second graduating class of students undergoing practical training Students participate in training children with diabetes and their parents at DiaNNa courses and a school for training patients with diabetes
Patient School - is an organizational form of preventive group counseling (hygienic training and education)11. Target patient schools:
Increasing patient awareness about the disease and risk factors for developing diseases and complications;
Increasing the patient's responsibility for maintaining health;
Formation of a rational and active patient’s attitude to health, motivation for improvement, adherence to treatment;
Formation of skills in self-control and self-help in emergency situations;
Formation in patients of skills and abilities to reduce adverse influence on health behavioral, manageable risk factors.
With the group method of counseling (patient school), the process of preventive counseling is facilitated and its effectiveness increases; patients not only receive important knowledge, but also the social support they need.
Benefits of group preventive counseling. Studying in a group enhances the effectiveness of learning - a team atmosphere is created, the feeling of loneliness is leveled, and emotional contact is improved. Efficiency is increased by sharing experiences between patients, examples from their lives, etc. It must be remembered that group training is more effective if supported by individual counseling. In a number of situations it is desirable that training be carried out at the family level, in particular when counseling involves nutrition issues, physical activity, behavioral habits, which, as is known, are often family in nature. The patient school, as a form of group counseling, allows us to fully ensure the effective implementation of the basics of in-depth preventive counseling - during group discussion, conditions are created for more effective application basic principles and techniques for teaching adults, taking into account the psychology of behavior change and behavioral habits.
The history of creating schools for patients with various chronic diseases in our country goes back more than 15 years. We have accumulated a wealth of experience in conducting group patient training in various diseases: diabetes mellitus, arterial hypertension, bronchial asthma, coronary heart disease and other diseases, the clinical, social and economic effectiveness of this method of preventive counseling has been convincingly proven.
Basic principles of conducting patient schools:
(1) the formation of a “thematic” target group of patients with relatively similar characteristics: for example, patients with uncomplicated arterial hypertension, coronary heart disease; sick coronary disease hearts that have suffered myocardial infarction, acute coronary syndrome, interventional intervention, etc.; high risk patients cardiovascular diseases without clinical symptoms illnesses, etc. This group formation creates an atmosphere
11 Health promotion and disease prevention. Basic terms and concepts // Ed. Vyalkova A.I., Oganova R.G. - M., GEOTAR-Media, 2000. - 21 p.
social support , which is important for effective counseling and obtaining long-term sustainable results.
(2) for a selected target group is carried out cycle of classes according to a pre-drawn plan and agreed schedule; one of the main requirements is to attend the entire cycle of classes;
(3) the size of the target group of patients should be no more than 10-12 people; monitoring is necessary to ensure that patients attend all (or most) of the scheduled sessions;
(4) the organization of group counseling should be carried out in a specially equipped room (table, chairs, demonstration material, handouts, notebooks, etc.).
Most should be avoided common mistake when organizing a school. The patient school, unfortunately, is often replaced by a “lecture hall”, when topics are announced in advance on certain days and hours and patients with the most various diseases. This form of work, although very labor-intensive for medical specialists, is practically ineffective, because the main principles of group counseling are violated.
Schools of patients within the framework of clinical examination, preventive medical examinations are carried out medical workers offices (departments) medical prevention(doctor, paramedic for medical prevention). Conducting schools requires trained staff and provision of conditions for effective group counseling.
If necessary, specialized specialists (if they are available in the institution - psychologists, etc.) can be involved in conducting individual classes. Patients are referred to the patient's school by their local physician. It is advisable that a doctor (paramedic)
office (department) of medical prevention previously familiarized himself with the data outpatient card patients.
The training program is built from a series of structured lessons, each lasting about 60 minutes. A total of 2-3 sessions per cycle are optimal, depending on the target group.
Each lesson includes informational material and active forms of learning aimed at developing skills and practical skills in patients. All classes must be timed in advance and have clear instructions for conducting.
Information part classes are carried out during each lesson in fractions, in blocks of no more than 10-15 minutes, in order to avoid the lecture form of working with patients. The content of the training is set out in a special methodological literature and partly in basic information material on in-depth preventive
counseling.
Active part of classes contains active work with patients, which can be carried out in different forms and simple steps:
Questions and answers;
Filling out questionnaires related to the topic of the lesson and discussing their results - targeted advice can be given during the discussion, which is more effective and efficient than untargeted advice;
Carrying out calculations and assessments, for example, calculating body mass index, daily caloric intake, etc.;
Practical skills training - measurements blood pressure, pulse counting, etc.
Familiarization with reference tables and dietary changes, etc.
A health school patient education program can be developed based on the materials presented in the section on advanced preventive counseling.
All visual information used in school should be: colorful, demonstrative, memorable, understandable, interesting, accessible.
patients) as part of medical examination:
School for the correction of the main risk factors for chronic NCDs/CVDs identified during medical examinations and preventive examinations;
School for reducing excess body weight, optimizing physical activity and rational nutrition;
School for patients with high blood pressure.
Kursk State Medical UniversityDepartment of Polyclinic Therapy and General Medical Practice
PATIENT EDUCATION
WITH CHRONIC
NON-INFECTIOUS
DISEASES IN
OUTPATIENT PRACTICE
Lecture
Head department, professor
N.K. Gorshunova
According to WHO, 80% of diseases
population have chronic
flow.
For most of them
proven and
evidence-based therapeutic
measures to slow down
progression of diseases and
prevent their exacerbations.
However, the prescribed treatment
less than 50% used correctly
patients. Relevance of patient education
Patients do not own
necessary knowledge for
everyday
"management" of one's
illness and do not realize
responsibility for
state of your health.
Application of modern
treatment methods required
deep understanding
mechanism of their action, because
they are quite complex and
sometimes dangerous. Relevance of training
patients
Patient education is an integral part
arsenal of therapy for many chronic
diseases: arterial
hypertension, diabetes mellitus, CHF,
obesity, etc.
Treatment results directly depend
from the patient's behavior: he should
follow the doctor's instructions, have
necessary knowledge and skills
for making independent
medical decisions,
be motivated.
Learning Objectives
developing skills in patientsself-government regarding their
chronic disease with
aiming to turn it into
active participant in treatment
process,
preparing the patient for everyday life
use of new effective
technologies for treating chronic
diseases.
raising awareness
patients about the disease and its
risk factors;
increased responsibility
patients for maintaining their
health;
formation of rational and
patient's active attitude towards
illness, motivation to
health improvement, commitment to
treatment and implementation
doctor's recommendations.
MAIN OBJECTIVES OF TRAINING PATIENTS WITH CHRONIC NON-COMMUNICABLE DISEASES
formation of patients' skills andself-monitoring skills
health, first aid
assistance in cases of exacerbations and crises;
developing skills in patients
self-correction of behavioral factors
risk (nutrition, physical activity,
stress management, avoidance of harmful
habits);
formation of practical
skills in drawing up an individual plan
recovery.
Conditions for effective implementation of patient education
Development of training programs forvarious chronic
diseases or specific forms
their currents.
Preparation of methodological
software and demonstration
teaching aids.
Training of training personnel
(doctors, nurses).
arterial hypertension -
Health school for patients witharterial hypertension is included in the industry classifier
(OK) "Complex and complex
medical services" (SKMU)
91500.09.0002-2001 (order of the Ministry of Health of the Russian Federation No. 268 dated
07/16/2001 "Standardization system in
healthcare of the Russian Federation") and
has code 04.015.01 (04 - medical
prevention services; 015 cardiology; 01 - School for patients with
AG as a type of service). Health school for patients with
arterial hypertension - organizational
form of preventive group and
individual counseling.
arterial hypertension - medical
preventive service (i.e. has
independent complete meaning and
certain cost).
Health school for patients with
arterial hypertension - aimed at
prevention of disease complications,
timely treatment, recovery.
School AG - new information and motivational technologies
Targetcontribute
increase
patient adherence to treatment,
create motivation to preserve and
increasing responsibility for health
as for personal property, what
will ensure the quality of preventive
help
to the population
V
process
implementation
preventive
orientation in the work of GPs (GPs)
Necessary structural elements for organizing an AG school
qualified personnel inperforming complex and
for educational activities
patient education;
providing conditions for
effective functioning
schools (rooms, methodological
and educational materials,
tonometers).
Forms of training:
individual conversations with a doctor,group cycle classes,
conducting review lectures,
study by patients
popular literature
for arterial hypertension,
showing videos, etc.
significant increase in the frequency of achievement
target blood pressure level,
obesity,
significant reduction in the number of patients with
moderate and pronounced
hypercholesterolemia,
significant reduction in the number of smokers.
Criteria for the effectiveness of patient education in school
significant reduction in the number of patients,those who abuse fatty, carbohydrate and
salty food.
significant reduction in the number of patients with
hypochondriacal and depressive
manifestations, with high level stress
taking antihypertensive drugs,
downgrading of the dispensary observation group
patient.
Essential to keeping patients' knowledge and skills up to date
Recommended frequency of exercises – 1–2 timesper week in outpatient clinic
institution or 3–5 times a week in
day hospital,
Recommended number of patients per
group – 10–12 people.
Recommended repetition rate
training – 2 times a year.
Keeping a control diary is mandatory
main functional indicators.
Registration and reporting documentation of the patient's schools
Patient registration log,students at the School of Health.
Registration of patients studying at the School of Health,
carried out in a separate journal for each
type of School (indicating the patient’s name, age,
contact phone number, dates of classes,
presence marks).
Outpatient medical record
making entries about the beginning of training at the School
health, dates and topics of each lesson,
certified by a medical professional,
who conducted the lesson.
Mark on the front side of the medical card
completion of the training cycle
Health school option for patients with hypertension
The full cycle consists of 5 lessons of 90 minutes,dedicated to the main most important
problems of hypertension control.
Lesson 1. Arterial hypertension: how to recognize it?
Lesson 2. Arterial hypertension: what contributes to it
development?
Arterial hypertension: how to do it correctly
measure your blood pressure level?
Lesson 3.
Lesson 4. Methods of preventing arterial
hypertension.
Lesson 5. Arterial hypertension: when and to whom
should medications help?
Lesson 1. “Arterial hypertension: how to recognize it?”
explain that arterialhypertension – chronic
progressive disease (main
the symptoms of which are headache,
nosebleeds, fatigue,
decreased performance as
result of high blood pressure), and the task
learn to control the patient
its course in order to prevent
occurrence of crises.
Target:
Lesson 2. “Arterial hypertension: what contributes to its development?”
Purpose: to give a conceptabout risk factors
development of hypertension and create
patient motivation
to overcome them.
Lesson 3. “Arterial hypertension: how to correctly measure blood pressure levels?”
Goal: teach the rulesand methodology
measurements
arterial
pressure.
Features of blood pressure measurement in the elderly
With age, thickening andcompaction of the wall of the brachial artery.
palpable even when exceeded
cuff pressure above
intra-arterial.
To achieve rigid compression
arteries require higher
cuff pressure level, in
resulting in false
overestimation of blood pressure
("pseudohypertension, Osler's symptom).
To recognize this error, you should
determine blood pressure by palpation
forearm.
If there is a difference between systolic blood pressure,
determined by palpation and
auscultation more than 15 mm Hg. Art., for
calculating the patient's true blood pressure
necessary from the measured value
subtract 10-30 mHg. Art.
Lesson 4. “Methods of preventing arterial hypertension.”
Goal: teach patients how tonon-drug treatment and
compliance with recommendations for
healthy lifestyle (refusal
sedentary lifestyle increased physical
activity - and bad habits,
dietary food)
Lesson 5. “Arterial hypertension: when and to whom should medications come to the rescue?”
Goal: to teach patientstake correctly
antihypertensive drugs
with consultation at
necessary with the attending physician
doctor.
The goal of "ASTMA-SCHOOL"
Providing assistance to the sickbronchial asthma based
new principles of organization
treatment and observation.
IN medical complex sick
asthma introduces a learning factor,
which will allow the patient
actively participate in your own
treatment and control the course
diseases.
Conditions for organizing a bronchial asthma school
qualified personnel incompliance with the requirements for
performing complex and
comprehensive medical services;
presence of a license in the institution
for educational
training activities
patients;
providing conditions for
effective
functioning of the school
(room, methodological
materials and asthma kits).
Asthma - set
includes the necessaryaccessories
For
control
patient's condition:
spacer to ensure effective and
peak flow meter to monitor your condition
nebulizer for emergency
safe use of dosed
aerosol inhalers,
and assessment of pulmonary function as under
under the guidance of a doctor and independently
at home,
exacerbation therapy bronchial asthma.
OBJECTIVES OF ASTHMA SCHOOL
Achievement and establishmentcontrol of disease symptoms.
Prevention of exacerbations and
complications of the disease.
Maintaining quality of life
sick.
Preventing Side Effects
from drugs used for
treatment, as well as irreversible
complications of the disease itself
reducing morbidity,
mortality and disability.
Factors influencing the effectiveness of education in asthma schools
trusting relationship betweenhealthcare workers and patients
(mutual understanding and empathy, ability
convince and explain, etc.);
simplicity and accessibility of recommendations and their
realistic for specific patients,
availability of written instructions and reminders,
patient diary, forms and methods
training, premises, environment and
equipping the room where the
training, etc.). Forms of training:
individual conversations with
doctor,
group cycle classes,
conducting review lectures,
study by patients
popular literature
for bronchial asthma,
showing videos, etc.
Asthma-schools program
Keeping a “Self-Control Diary”.Learning the correct technique
medications.
Learning how to use
inhaler
Peak flowmetry training.
Training for orientation during asthma
/zonal rating: green, yellow,
red/.
Training in proper nutrition.
Physical rehabilitation: therapeutic
gymnastics, breathing exercises,
measured walking, exercises
exercise machines, massage, hardening.
“Asthma school” option
The number of patients in the group is 10-12 peopleCycle – 5 lessons of 1-1.5 hours
2 times per week "What's happened
bronchial asthma?"
First lesson:
Purpose: explain that the bronchial
asthma is a chronic disease,
and the patient’s task is to learn
control its flow,
to prevent
the occurrence of exacerbations. Second lesson:
“Peak flowmetry. Asthma and allergies"
Goal: teach patients to use
individual peak flow meter, conduct
daily and weekly diaries; give
block available information about
allergies, methods of diagnosing them with
active participation of the patient,
prevention and treatment of allergies. Third lesson:
"Treatment
chronic inflammation
for bronchial
asthma"
Goal: to teach patients
Right
use
anti-inflammatory
ny drugs. Fourth lesson:
"Non-drug methods
corrections"
Goal: to create in patients
motivation to workout
respiratory muscles,
teach them the tricks
correct breathing. Fifth lesson:
"Self-help during exacerbation
bronchial asthma"
Goal: to teach patients to recognize
exacerbation of bronchial asthma,
stop asthma attacks
of varying severity.
SYSTEM OF COLOR ZONES FOR PATIENTS WITH BRONCHIAL ASTHMA
“Everything is fine” - the disease is goodcontrolled, PEF – 80-100% of
the best/proper indicator for the patient,
daily deviation<20%. Ни ночных, ни
As a rule, there are no daytime asthma attacks.
Maintenance therapy is indicated.
“Warning” - “alarm zone” symptoms of asthma (cyclic or acyclic),
night attacks of coughing or suffocation. PEF – 6080%, daily deviation 20 -30%. Therapy
should be strengthened.
"Anxiety!" - sharp deterioration! – symptoms
asthma at rest, frequent attacks of prolonged
character, the interictal period remains.
PEF<60%. Немедленно обратиться к врачу!
Criteria for the effectiveness of training in school for a patient with asthma
significant reduction in the number of exacerbationsand nocturnal asthma attacks
increase in the number of patients regularly
controlling individual PSV with
keeping peak flow diaries and
symptoms,
reduction in the number of cases of temporary
disability and hospitalization,
downgrading of the dispensary group
patient observations.
School for CHF Patients
Organizationlesson process
schools and
her relationship
participants are being built
according to the principle of a single
teams, and in the center
attention - patient.
Classes are held in
clinic and
home.
Patients with CHF and their relatives need
competent information andtraining including
recommendations for correction
diet, lifestyle,
physical activity, regimen
drug therapy,
acquisition of necessary
self-control skills for
heart symptoms
failure with management
diary. Medical recommendations
it is advisable to give it in a non-directive manner
form of the need for hard
restrictions on habits and image
the patient's life, and in the form
joint search for ways
achieving greater independence
from illness and preservation
quality of life.
School for CHF Patients
Patients do not drop outfamiliar surroundings that
allows them to use
acquired knowledge and skills in
Everyday life.
Training in conditions
clinics are designed for
patients with class II CHF.
School for CHF Patients
To conduct schools withpatients with III-IV FC CHF
should be connected
specially trained
nurses.
Their task is to provide
psychological support and
necessary assistance for
compliance with medical
recommendations received at
inpatient stage of treatment. Alternative
form of submission
patient with CHF
necessary information and
execution control
prescribed
recommendations for distance learning with
using
information
newsletters, booklets,
videos and
videos, participation in
work of webinars on
Internet sites. One of the important elements
organizing school activities
CHF that determines success
its implementation, - a meeting of the doctor with
relatives of patients,
who need to be told
about all the problems with CHF.
Monitoring the clinical condition of patients trained at the CHF school
carried out by twoways:
directly - inspection
patient's doctor or
reception nurse or
at home;
remotely - during
phone calls
(communications via email
email, Skype). Specially held
studies have found that
use of telephone
(electronic) reminders
doctor about the need
fulfillment of prescribed
recommendations for the first time
months after discharge
patients from the hospital
significantly reduced the frequency
readmissions
compared to the group
patients with
traditional approach to
treatment.
Conclusion
Patient educationschools, successfully
carried out on
outpatient stage -
efficient technology
flow control
diseases and improvements
quality of life of patients
and their relatives.
In recent years, medical professionals have increasingly drawn attention to the fact that the achievements of modern medicine may remain unrealized in practice if a relationship of trust and cooperation is not formed between the doctor and the patient.
In recent years, medical professionals have increasingly drawn attention to the fact that the achievements of modern medicine may remain unrealized in practice if a relationship of trust and cooperation is not formed between the doctor and the patient. In accordance with paragraph 8 of Art. 30 Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens, the patient has the right to refuse medical intervention, i.e., in the end, the patient himself decides whether to follow the doctor’s recommendations exactly. Improving the quality of medical care and forming partnerships with doctors in treatment, rehabilitation and prevention is facilitated by the creation of patient schools in health care facilities for patients with non-communicable diseases.
Patient school as a tool for improving the quality of medical care
↯ More articles in the magazine
N.V. Mikhailova,
Ph.D. tech. Sciences, Associate Professor, Chairman of the Committee of the All-Russian Quality Organization (VOK) on the quality of medical care, Ch. scientific co-workers ANO "Center Quality", academician of the Academy of Quality Problems of the Russian Federation, expert on management systems
Treatment and healing is a joint endeavor between the doctor and the patient himself. In each individual case, a certain medical-healing “we” must be created: he and I, I and he, we together and together must carry out his treatment.
I.A. Ilyin,
Russian philosopher, writer and publicist
At the present stage of development, the main goal of Russian healthcare is to improve the quality of medical care. One of the ways to achieve this is to introduce into practice modern technologies for organizing medical care, based on international standards ISO 9000 series. ISO 9000 series standards are focused on the concept of TQM (Total Quality Management) as the most progressive and effective in management quality. The main principles of the ISO 9000 series standards include continuous improvement and customer focus - all activities of healthcare facilities must be carried out, including taking into account the needs and expectations of the patient. In these conditions, the creation and operation of patient schools in health care facilities for patients with major non-communicable diseases, such as diabetes mellitus, coronary heart disease, arterial hypertension, chronic diseases of the gastrointestinal tract, multiple sclerosis, oncological diseases, mental illnesses, etc., is of particular relevance. .
Patient School: a joint project of the portal “Mercy.ru” and the Regional Patient Organization “Cancer is Treated” (St. Petersburg).Location: St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncology).
Participants: patients with various cancer diagnoses.
Issue topic: radiation therapy
Patient questions answered in this issue Alexander Vladimirovich Kirillov, radiologist of the highest category, head of the day hospital of the radiology department.
Is this the same radiation as in Hiroshima?
A. V. Kirillov, radiologist, head of the day hospital of the radiology department
- Tell me, doctor, is the radiation we are being exposed to is the same dangerous radiation that killed many in Hiroshima and Chernobyl? Or other radiation? Useful?
— We have gathered today to talk about radiation therapy. Because when they say “surgery,” people more or less understand what it is. And in the case of chemotherapy, there is some understanding. And people are usually afraid of us, radiologists, frightened by stories about world disasters. And sometimes they even try to avoid radiation therapy. And therefore I would like to start with the simplest, what our method includes, why it is needed and whether it is as dangerous as it seems at first glance.
For example, we are often asked when they find out that someone’s course is five weeks, someone’s six: “Doctor, why can’t it be done at one time?” And then we just remember about Chernobyl and explain that “at one time” this will be a disaster on a local scale.
— Is it necessary to drink red wine to remove radiation? Should you only drink dry red wine?
— Red wine should only be drunk at the movies and while playing dominoes. Just kidding. But I know that a lot is written about wine on the Internet. In general, there is no need to specifically try to combat radiation. Let me clarify once again, you are not sources of radiation, you don’t need to get something out of yourself, because nothing is being injected into you. You only accumulate the effect of our treatment. This means that you can drink red wine solely for pleasure and when there is a reason. And only for a good mood.
— Or maybe everyone doesn’t need radiation therapy?
— It is absolutely certain that about 80-90% of cancer patients need radiation therapy to one degree or another. And that is why our method is quite widespread.
And the first and only thing you need to understand right away, to make it easier for both you and the doctors who will work with you, is that radiation therapy, which is carried out at medical facilities, is not dangerous. It does not turn you into a source of radiation. It works with tumor cells. The main thing is that you need to understand that you are absolutely safe for yourself and for others during the period when you are taking the course. And this is precisely the stumbling block for many. They begin to worry: “What about the relatives, what about the little children who are nearby.” Sometimes it gets to the point of absurdity. We have patients who burned the clothes they wore when they came to our Center for treatment.
You can't do without our method. And radiation therapy, although it causes some harm to the body, certainly does not make you outcasts, dangerous to society.
"Skin Burnt"
- So it becomes clear that this is dangerous, even by the way the body reacts. Burns appear, it’s hard to swallow, everything in the throat seems to be burned, although the chest is being irradiated.
— Yes, they are often afraid of burns. Burns happen. There are predictable complications. There are things that happen spontaneously that we cannot predict. There are acute reactions and there are delayed ones. As a rule, we try to talk through all these points.
Why are there burns on the skin? Because the skin is the first thing that encounters ionizing radiation, it is the first barrier that suffers first. A reaction occurs, but no more than the reaction that occurs with sunburn. This means that it is possible to fight it.
There are also unpleasant moments from the gastrointestinal tract in the form of changes in stool. There are also painful sensations.
Our method (external beam radiation therapy using a linear electron accelerator) is based on the fact that we act on rapidly dividing cells. And in the human body, rapidly dividing cells are usually found either in the epithelium, or they are tumor cells. And here we remember again that this is why the skin suffers during treatment, because it is an epithelium, the mucous membrane suffers, this is also an epithelium. And those unpleasant situations arise that accompany our treatment.
But all this is quite individual, and you must understand that there is no standard approach to complications. For Ivanov, Sidorov and Petrov everything will be different than for you.
And there are patients who have no reactions at all. There is no need to program yourself in advance for the worst.
- And my skin, doctor, really burned. You gave me twenty-five sessions, and after seventeen sessions my skin felt like it had been scalded by boiling water. Is this an isolated case? And it seems to me that this is the case for the majority. So what should we do?
— Skin characteristics are individual. Blue-eyed blonds are most often affected. But there are exceptions. And we come back to the words that everything will be different for each of you. If there is skin discomfort during radiation therapy, you should first inform your doctor, and the doctor will prescribe treatment. There is no need to self-medicate.
There are ointments, creams, foams. But not all time periods can be used. And as a rule, we use non-greasy creams. Because the greasy film distorts the beam path and, accordingly, additional electron radiation from this film appears and the burn only gets worse. That is, you can harm yourself with fatty creams if you prescribe creams that “once helped someone.”
“The day after irradiation, I blow my nose and my nose bleeds.
- This is quite natural. This is what we were talking about. In your situation, the skin and the nasal mucosa underneath, which are young, rapidly dividing cells, are irradiated; they also suffer. That's why the blood vessels burst there. As a rule, after two to three weeks these negative reactions go away, and you will forget about it forever. This is a natural complication, we expect such complications.
— My relative is being treated in her small town, they have one doctor per department and he has no time to answer questions. Tell me, what should I smear myself with? Well, at least the safest product for the skin?
— Relieves skin reactions, as a rule, Panthenol foam. Foam, or sometimes called spray, is what is sold in a can. She's not fat. And after radiation therapy, that is, when the course has already been completed and there are changes on the skin, you can use Bepanten, this is a children's ointment. And it’s just oily, it thickly covers the skin. But I repeat, fatty products can be used after the entire course has been completed, when there is no longer radiation exposure.
Baby fatty cream also does a good job of relieving all the unpleasant effects after treatment. As a rule, after radiation therapy, skin reactions go away within about a week, two, three. Again, depending on the characteristics of the skin.
Intracavitary radiation therapy – what is it?
— My friend was treated in Kazakhstan in Almaty. She was locked in the department for the entire duration of treatment. And she just gave birth. And her little daughter was shown to her through the glass of the department door. And she spent the entire period of treatment in the clinic, because the doctors just said that it was dangerous and that she should not be with a small child.
— There is external beam radiation therapy, which is what we do, and there is radiation therapy, when a radiation drug is injected into the human body. At such moments, yes, the patient is dangerous. Although also not throughout the entire course. But in our Center we do not have such a technique and do not carry out such procedures.
— Do you have weaker radiation therapy than in Almaty?
- No, there is simply external beam radiation therapy, there is intracavitary radiation therapy, interstitial radiation therapy. Radiation therapy is also possible, when a radioactive substance is injected into the blood and it is distributed throughout the body through the bloodstream. Thus, for example, bone changes are treated with the help of strontium. Strontium, already in the bones, continues to decay and emit. And at such moments, patients are truly dangerous. But this happens for a short period of time. (Our clinic does not have a cyclotron and there are no such patients.)
I am treated differently than my friend
— I have uterine cancer. My friend was treated for cancer in another city. She was injected with radiation using some kind of device. Is it better when they treat from the inside? Will they do this to me too? What to prepare for?
- One complements the other. There are different diseases and different methods. So again we return to the words that you should not try to project something that is happening to others, that it will happen to you too. You are all completely different, everyone has different diseases, even if it sounds the same, the histological variants will be different and the approaches to each patient will be different.
Some people need combined radiation therapy, when both remote and intracavitary therapy is used. Some people will only need a remote one. For others, contact is when skin lesions are treated. In this situation it is impossible to say - better or worse. There is only “right or wrong in a particular case.”
Why do they draw marks?
— Why do they draw lines before treatment? Do you remember that you once looked for points on me through a computer and then marked them directly on my body. Isn’t it just me who is being lined up? We compared drawings, many had them.
- Not just you. Although sometimes there are diseases when we do not need such preparation with the help of computed tomography, as was done with you. And in your case it was necessary. And using a computer tomogram, we made a 3D model of your body, and based on this 3D model, the physical department, physicists, made treatment calculations.
— Is it possible to wash these tags? And then one nurse said that it was possible, the second that in no case. Who should I listen to?
- No, you cannot erase marks from the body. And if they wear off during bathing, then we paint them on. Because this is important markup. It would probably be easier if it were a tattoo, but I think that not all patients will agree to get such a tattoo for a long memory. And so, some people have oily skin, others have dry skin. And that’s why some people’s drawings hold up well, but others don’t.
After treatment: what to eat and can I go to the bathhouse?
— I have prostate adenoma. I prepared questions before the meeting. Here I have it written down. Nutrition? A tan? Bathhouse? State of health, tone? Medicines? What vitamins should you take?
- Let's start with nutrition. During treatment, it is better to eat heavily. And this applies to everyone. Whatever treatment you receive, surgical, chemotherapy or radiation, you need to receive fats, proteins and carbohydrates in excess. Try not to even fast.
To the doctor? Be sure to constantly go to the doctor. As a rule, leaving our hospital, many believe that the disease has been cured and “I’m off and running.” So, if you fall out of the dynamic observation of an oncologist at your place of residence or with us here, then troubles will immediately begin. And all relapses that are detected in the early period are also subject to treatment.
About the bathhouse. The bath is a physiotherapeutic effect, so it obviously increases the risk of recurrence of the disease that we are trying to fight together. And it is better to avoid sunbathing.
— Do families need separate dishes and cutlery?
“I repeat that for yourself and for those around you, you are absolutely safe people who do not require isolation. You are no different from the rest. It’s just that at this moment you need treatment.
Surgery or radiation?
— And when the doctor says that you can choose either surgery and radiation therapy, or without surgery, but more intense radiation. Which is better to choose? And how can the patient understand what is best?
— Yes, there are diseases when radiation therapy and surgery are equivalent and equally replaceable. And if for some reason it is impossible to perform surgical intervention due to the general condition of the patient, then we go for radiation therapy.
Sometimes there are situations when, on the contrary, radiation therapy cannot be carried out for reasons of the patient’s general condition, and we are forced to perform surgery. Everything is individual. There is no such thing as just a strict standard approach. We always weigh the benefits and harms of treatment on the scales. If the harm is greater, then we will carry out, for example, chemotherapy to delay the radiation intervention and then carry out radiation a little later.
— Can the same organ be irradiated a second time? What if there was a relapse in him?
- Sometimes yes. But this is very individual. This is quite a risky undertaking.
Irradiation and examinations – can they be combined?
— Tell me, doctor, if I am undergoing radiation therapy, can I undergo a CT scan, ultrasound, MRI or bone check at the same time? Or does it interfere with one another?
— You just named completely different examination methods. MRI can be done despite radiation therapy. Computed tomography, if the area is small, can be combined with sessions. And if you need to examine two or more areas, then it is better to skip the CT scan, because the radiation dose will be too high.
In the case of bone scintigraphy, a bone test, you will be injected with a radiopharmaceutical, and for some time you are unsafe for others, so it is better to wait so as not to expose others to the effect, and yourself to additional exposure.
Therefore, when you have any examinations planned or want to carry them out while undergoing radiation treatment, you must agree with your doctor.
— So it’s just because it’s unsafe? But the examination results will not be distorted due to radiation?
- Not always. Both CT and MRI may show incorrect results, for example due to tissue swelling.
In the hospital or at home? In Russia or abroad?
— What is the difference between inpatient and outpatient treatment?
— In my understanding, it is better to undergo treatment on an outpatient basis, because hospital walls have not yet cured anyone. But there are different life situations when it is difficult to get to the clinic, when it is financially expensive to get there every day.
It’s rare, but it does happen when a person feels psychologically more protected while constantly in the hospital. But it is still better to undergo treatment on an outpatient basis, because with radiation therapy, patients feel quite normal and physically active.
— Do we have good equipment in the clinic? And in the country in general?
- Everything is relative. Of course, there are better devices in the world, more modern ones. But what we have allows us to provide assistance to all patients who come to us.
- This is not an answer. Well, let's talk honestly. Tell me, are the devices abroad better? Now we don’t want to pretend and say “oh how good everything is in our country.” We want to live. And each of us at least once thought, “maybe we should sell everything and go to another country for treatment?”
— In terms of the quality of the treatment itself, one way or another, everything depends on the doctors, and not just on the technology. Improvement of equipment leads to a reduction in possible negative side effects. But the result itself is still the same everywhere. That is, the treatment programs, the protocols that we use (at least in our hospital) are the same as in Europe, as in America, as throughout the world.
A.V.Kirillov with patients
Well, we have what we have. And they don’t buy us any other equipment. And abroad there may be better technology in terms of minimizing the risk of complications.
— I get very tired after each radiation course. Is it just me? Why?
- The fact that you feel very tired means that the overall effect is accumulating. Cells are destroyed, cells release toxins and, accordingly, fatigue accumulates and drowsiness occurs. Over time, the body recovers.
Ask your question!
You can ask a question for the next issue of the Patient School. In the next seven days, readers of Miloserdiya.ru can ask any questions about chemotherapy procedures. About what worries those who are currently undergoing treatment. Those who are about to undergo chemotherapy in any clinic in Russia and the world. Those who support their family and friends in this fight.
And on March 29, as part of a joint project of the charity portal “Miloserdie.ru” and the regional patient organization “Cancer is Treated” with the support of the St. Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Care (Oncology), a School for Cancer Patients and Their Relatives will be held.
Natalya Valerievna Levchenko, candidate of medical sciences, chemotherapist with twenty years of experience, head of the department (o), will answer your questions.
Send questions by email: [email protected]
Or leave a comment on the announcement of the event in the group