Consilium Medicum (May 2024)
The use of additive technologies to increase adherence to treatment, increase the efficiency of chemotherapy and correction of indicators of anxiety and depression among patients with destructive pulmonary tuberculosis
Abstract
Background. Currently, there is no «golden standard» in terms of correction of adherence to treatment of patients with tuberculosis and its adequate assessment. This paper presents the experience of applying the 3D lung reconstruction method, which was used among patients with tuberculosis to modify their level of adherence, as well as to increase the effectiveness of treatment and change the indicators of anxiety and depression. Aims. To give a brief description of the level of adherence to treatment and the overall effectiveness of chemotherapy in newly diagnosed patients with tuberculosis according to the data of the department for patients with respiratory tuberculosis of the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary. To increase the level of adherence to treatment and increase the effectiveness of chemotherapy in newly diagnosed patients with destructive forms of pulmonary tuberculosis using additive technologies using the method of three-dimensional reconstruction of lung tissue. To assess and correct the dynamics of manifestations of symptoms of anxiety and depression among newly diagnosed patients with destructive forms of pulmonary tuberculosis using additive technologies using the method of three-dimensional reconstruction of lung tissue. Materials and methods. The present work is based on a retrospective-prospective analysis of the results of treatment of newly diagnosed patients with destructive forms of pulmonary tuberculosis (167 people), who were observed in the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary. The patients included in the study were divided into two groups. For patients of the 1st group, lung models were made, among them a questionnaire was conducted using the MMAS-4 questionnaire and the HADS scale. For patients of the 2nd group, lung models were not made, and no survey was conducted. Results. According to the results of the study in the department for patients with respiratory tuberculosis of the Nizhny Novgorod Regional Clinical Tuberculosis Dispensary (observation period from 2016 to 2020), a negative trend was found in an increase in the number of unauthorized departures from the structural unit and violations of the regimen among patients. A course of polychemotherapy was recognized as effective in the 1st group (in terms of bacterial excretion) in 93.0% of patients (64/69), and in the 2nd group (the same indicator) – in 67.3% (66/98); χ2=16.940, df=1; p0.001. The largest number of abacilated patients was observed in the 1st group. In the case of showing patients three-dimensional anatomical tactile models of the lungs, the probability of closing decay cavities increased by 32.2% (γ-test=-0.322; p=0.034). The absence of the demonstration of personalized three-dimensional anatomical tactile models of the lungs contributed to an increase in the occurrence of disadvantage in the outcome of therapy by 77.2% (γ-test=-0.772; p0.001). The chance of achieving an effective course of chemotherapy was 4.2 times higher among patients of the 1st group (odds ratio 4.267, 95% confidence interval 1.523–11.953). In the absence of data on the patient’s interaction with the tactile pulmonary model, the risk of noncompliance increased by 47.6% (γ-test=-0.476; p=0.020). After the use of three-dimensional anatomical tactile models of the lungs among patients of the 1st group, their level of adherence to treatment increased (according to the MMAS-4 questionnaire) with a result of 4 points [4; 4] – maximum score of the MMAS-4 questionnaire – (W=2278, Z=-7.267; p0.001) and the psychological load significantly decreased (according to the HADS scale) with a score of 7 points [5; 10] – «no significant symptoms of anxiety and depression» (W=2405, Z=-7.165; p0.001). Conclusion. The use of additive technologies in the anti-tuberculosis organization has made it possible to improve the profile of adherence of tuberculosis patients to polychemotherapy, increase the effectiveness of treatment, and correct indicators of anxiety and depression among newly diagnosed patients with destructive pulmonary tuberculosis.
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