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Мультимодальная преабилитация у пациентов с опухолями желудочно-кишечного тракта при наличии раковой кахексии: результаты пилотного исследования
Мультимодальная преабилитация у пациентов с опухолями желудочно-кишечного тракта при наличии раковой кахексии: результаты пилотного исследования
Лядов В.К., Болдырева Т.С., Горшков А.Ю., Зятенкова Е.В., Чащин М.Г. Мультимодальная преабилитация у пациентов с опухолями желудочно-кишечного тракта при наличии раковой кахексии: результаты пилотного исследования. Современная Онкология. 2025;27(2):80–85. DOI: 10.26442/18151434.2025.2.203176
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Обоснование. Пациенты, готовящиеся к хирургическому лечению опухолей желудочно-кишечного тракта (ЖКТ), часто страдают от проявлений кахексии и саркопении. Комплексная предоперационная подготовка («преабилитация») является новым потенциально эффективным подходом в ведении этой группы пациентов.
Цель. Оценить влияние мультимодальной преабилитации на ближайшие послеоперационные и функциональные результаты у пациентов со злокачественными новообразованиями ЖКТ, страдающих раковой кахексией.
Материалы и методы. В ходе проспективного когортного исследования собраны данные о 36 пациентах, оперированных по поводу опухолей ЖКТ с 2022 по 2023 г. на базе ГБУЗ «ГКБ им. С.С. Юдина ДЗМ» (Онкологический центр №1). Оценка саркопении и кахексии проводилась до операции с использованием современных международных консенсусных критериев. Пациенты проходили комплексную подготовку к хирургическому вмешательству, включавшую нутритивную и психологическую поддержку, лечебную физкультуру. По окончании преабилитации проводилась оценка функциональных результатов. Кроме того, оценивалась частота ранних послеоперационных осложнений в течение 30 дней после выполнения оперативного вмешательства по критериям Клавьен–Диндо, 30- и 90-дневная летальность.
Результаты. После преабилитации у 24 (66,6%) пациентов наблюдалось статистически значимое снижение времени ходьбы на 400 м (p=0,028); 25 (69,4%) пациентов набрали от 0,5 до 6 кг массы тела (p<0,001).
Заключение. Комплексная дистанционная преабилитация является потенциальным способом улучшения функциональных и послеоперационных результатов у пациентов с кахексией, получающих лечение по поводу опухолей ЖКТ.
Ключевые слова: преабилитация, саркопения, опухоли желудочно-кишечного тракта, кахексия
Aim. To evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in cachexic patients undergoing gastrointestinal cancer surgery, in comparison to usual clinical care.
Materials and methods. This prospective cohort study included data on 36 patients who underwent surgical treatment for gastrointestinal cancer from 2022 to 2023 at our cancer hospital. Sarcopenia and cachexia were assessed preoperatively using modern international consensus criteria. Patients participated in remote comprehensive prehabilitation program which encompassed nutritional and psychological support and supervised exercise. After prehabilitation functional results were assessed. Also, the 30-day postoperative complication rate measured according to the Clavien–Dindo criteria as well as 30-day and 90-day mortality.
Results. After prehabilitation, 24 (66.6%) patients showed a statistically significant decrease in 400 m walking time (p=0.028); 25 (69.4%) patients gained weight from 0.5 to 6 kg (p<0.001).
Conclusion. Multimodal remote prehabilitation can improve functional status in patients with gastrointestinal cancer and cachexia.
Keywords: prehabilitation, sarcopenia, gastrointestinal tumors, cachexia
Цель. Оценить влияние мультимодальной преабилитации на ближайшие послеоперационные и функциональные результаты у пациентов со злокачественными новообразованиями ЖКТ, страдающих раковой кахексией.
Материалы и методы. В ходе проспективного когортного исследования собраны данные о 36 пациентах, оперированных по поводу опухолей ЖКТ с 2022 по 2023 г. на базе ГБУЗ «ГКБ им. С.С. Юдина ДЗМ» (Онкологический центр №1). Оценка саркопении и кахексии проводилась до операции с использованием современных международных консенсусных критериев. Пациенты проходили комплексную подготовку к хирургическому вмешательству, включавшую нутритивную и психологическую поддержку, лечебную физкультуру. По окончании преабилитации проводилась оценка функциональных результатов. Кроме того, оценивалась частота ранних послеоперационных осложнений в течение 30 дней после выполнения оперативного вмешательства по критериям Клавьен–Диндо, 30- и 90-дневная летальность.
Результаты. После преабилитации у 24 (66,6%) пациентов наблюдалось статистически значимое снижение времени ходьбы на 400 м (p=0,028); 25 (69,4%) пациентов набрали от 0,5 до 6 кг массы тела (p<0,001).
Заключение. Комплексная дистанционная преабилитация является потенциальным способом улучшения функциональных и послеоперационных результатов у пациентов с кахексией, получающих лечение по поводу опухолей ЖКТ.
Ключевые слова: преабилитация, саркопения, опухоли желудочно-кишечного тракта, кахексия
________________________________________________
Aim. To evaluate whether multimodal prehabilitation decreases postoperative complications and improves functional recovery in cachexic patients undergoing gastrointestinal cancer surgery, in comparison to usual clinical care.
Materials and methods. This prospective cohort study included data on 36 patients who underwent surgical treatment for gastrointestinal cancer from 2022 to 2023 at our cancer hospital. Sarcopenia and cachexia were assessed preoperatively using modern international consensus criteria. Patients participated in remote comprehensive prehabilitation program which encompassed nutritional and psychological support and supervised exercise. After prehabilitation functional results were assessed. Also, the 30-day postoperative complication rate measured according to the Clavien–Dindo criteria as well as 30-day and 90-day mortality.
Results. After prehabilitation, 24 (66.6%) patients showed a statistically significant decrease in 400 m walking time (p=0.028); 25 (69.4%) patients gained weight from 0.5 to 6 kg (p<0.001).
Conclusion. Multimodal remote prehabilitation can improve functional status in patients with gastrointestinal cancer and cachexia.
Keywords: prehabilitation, sarcopenia, gastrointestinal tumors, cachexia
Полный текст
Список литературы
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18. Mourtzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomo- graphy images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5): 997-1006. DOI:10.1139/H08-075
19. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. DOI:10.1200/JCO.2012.45.2722
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22. Mareschal J, Hemmer A, Douissard J, et al. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel). 2023;15(6):1881. DOI:10.3390/cancers15061881
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25. Pereira MG, Voltarelli VA, Tobias GC, et al. Aerobic Exercise Training and In Vivo Akt Activation Counteract Cancer Cachexia by Inducing a Hypertrophic Profile through eIF-2α Modulation. Cancers (Basel). 2021;14(1):28. DOI:10.3390/cancers14010028
26. Hardee JP, Counts BR, Carson JA. Understanding the role of exercise in cancer cachexia therapy. Am J Lifestyle Med. 2019;13(1):46-60.
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28. van Stralen KJ, Le Cessie S, Rosendaal FR, Doggen CJ. Regular sports activities decrease the risk of venous thrombosis. J Thromb Haemost. 2007;5(11):2186-92. DOI:10.1111/j.1538-7836.2007.02732.x
2. Jínek T, Adamčík L, Vrba R, et al. Risk factors and post-operative complications after gastrectomy for cancer. Rozhl Chir. 2018;97(8):384-93.
3. Warps AK, Tollenaar RAEM, Tanis PJ, et al. Postoperative complications after colo- rectal cancer surgery and the association with long-term survival. Eur J Surg Oncol. 2022;48(4):873-82. DOI:10.1016/j.ejso.2021.10.035
4. Vagnildhaug OM, Balstad TR, Almberg SS, et al. A cross-sectional study exami- ning the prevalence of cachexia and areas of unmet need in patients with cancer. Support Care Cancer. 2018;26:1871-80. DOI:10.1007/s00520-017-4022-z
5. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95. DOI:10.1016/S1470-2045(10)70218-7
6. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. DOI:10.1093/ageing/afy169
7. Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle. 2015;6:197-207. DOI:10.1002/jcsm.12043
8. Takaoka T, Yaegashi A, Watanabe D. Prevalence of and Survival with Cachexia among Patients with Cancer: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(9):100282. DOI:10.1016/j.advnut.2024.100282
9. Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol. 2018;44(7):919-26.
10. Chmelo J, Phillips AW, Greystoke A, et al. A feasibility trial of prehabilitation before oesophagogastric cancer surgery using a multi-component home-based exercise programme: the ChemoFit study. Pilot Feasibility Stud. 2022;8(1):173. DOI:10.1186/s40814-022-01137-6
11. Chia CL, Mantoo SK, Tan KY. Start to finish trans-institutional transdisciplinary care: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016;18:43-50.
12. Boldyreva TS, Lyado VK, Derevyashkina GV, et al. Remote pre-habilitation in patients with cachexia and resectable gastric cancer: a case series. Journal of Modern Oncology. 2023;25(3):290-4 (in Russian). DOI:10.26442/18151434.2023.3.202259
13. Guo Y, Ding L, Miao X, et al. Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta- analysis. Support Care Cancer. 2022;31(1):57. DOI:10.1007/s00520-022-07541-1
14. Clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of malignant neoplasms. Available at: https://www.rosoncoweb.ru/standarts/minzdrav/ Accessed: 16.09.2024 (in Russian).
15. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
16. Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):113-37. DOI:10.1371/journal.pone.0113637
17. Newman AB, Simonsick EM, Naydeck BL, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295(17):2018-26. DOI:10.1001/jama.295.17.2018
18. Mourtzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomo- graphy images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5): 997-1006. DOI:10.1139/H08-075
19. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. DOI:10.1200/JCO.2012.45.2722
20. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
21. Camarda SR, Tebexreni AS, Páfaro CN, et al. Comparison of maximal heart rate using the prediction equations proposed by Karvonen and Tanaka. Arq Bras Cardiol. 2008;91(5):311-4. DOI:10.1590/s0066-782x2008001700005
22. Mareschal J, Hemmer A, Douissard J, et al. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel). 2023;15(6):1881. DOI:10.3390/cancers15061881
23. Sedalov IE, Popovich AIu, Zaika AN. Neposredstvennye rezultaty gastrektomii pri rake zheludka. Novoobrazovanie. 2019;11(2):72-5 (in Russian).
24. Morinaga M, Sako N, Isobe M, et al. Aerobic Exercise Ameliorates Cancer Cachexia-Induced Muscle Wasting through Adiponectin Signaling. Int J Mol Sci. 2021;22:3110. DOI:10.3390/ijms22063110
25. Pereira MG, Voltarelli VA, Tobias GC, et al. Aerobic Exercise Training and In Vivo Akt Activation Counteract Cancer Cachexia by Inducing a Hypertrophic Profile through eIF-2α Modulation. Cancers (Basel). 2021;14(1):28. DOI:10.3390/cancers14010028
26. Hardee JP, Counts BR, Carson JA. Understanding the role of exercise in cancer cachexia therapy. Am J Lifestyle Med. 2019;13(1):46-60.
27. Tamayo-Torres E, Garrido A, de Cabo R, et al. Molecular mechanisms of cancer cachexia. Role of exercise training. Mol Aspects Med. 2024;99:101293. DOI:10.1016/j.mam.2024.101293
28. van Stralen KJ, Le Cessie S, Rosendaal FR, Doggen CJ. Regular sports activities decrease the risk of venous thrombosis. J Thromb Haemost. 2007;5(11):2186-92. DOI:10.1111/j.1538-7836.2007.02732.x
2. Jínek T, Adamčík L, Vrba R, et al. Risk factors and post-operative complications after gastrectomy for cancer. Rozhl Chir. 2018;97(8):384-93.
3. Warps AK, Tollenaar RAEM, Tanis PJ, et al. Postoperative complications after colo- rectal cancer surgery and the association with long-term survival. Eur J Surg Oncol. 2022;48(4):873-82. DOI:10.1016/j.ejso.2021.10.035
4. Vagnildhaug OM, Balstad TR, Almberg SS, et al. A cross-sectional study exami- ning the prevalence of cachexia and areas of unmet need in patients with cancer. Support Care Cancer. 2018;26:1871-80. DOI:10.1007/s00520-017-4022-z
5. Fearon K, Strasser F, Anker SD, et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol. 2011;12(5):489-95. DOI:10.1016/S1470-2045(10)70218-7
6. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2), and the Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. DOI:10.1093/ageing/afy169
7. Bowen TS, Schuler G, Adams V. Skeletal muscle wasting in cachexia and sarcopenia: molecular pathophysiology and impact of exercise training. J Cachexia Sarcopenia Muscle. 2015;6:197-207. DOI:10.1002/jcsm.12043
8. Takaoka T, Yaegashi A, Watanabe D. Prevalence of and Survival with Cachexia among Patients with Cancer: A Systematic Review and Meta-Analysis. Adv Nutr. 2024;15(9):100282. DOI:10.1016/j.advnut.2024.100282
9. Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol. 2018;44(7):919-26.
10. Chmelo J, Phillips AW, Greystoke A, et al. A feasibility trial of prehabilitation before oesophagogastric cancer surgery using a multi-component home-based exercise programme: the ChemoFit study. Pilot Feasibility Stud. 2022;8(1):173. DOI:10.1186/s40814-022-01137-6
11. Chia CL, Mantoo SK, Tan KY. Start to finish trans-institutional transdisciplinary care: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016;18:43-50.
12. Болдырева Т.С., Лядов В.К., Деревяшкина Г.В., и др. Дистанционная преабилитация при наличии кахексии и резектабельного рака желудка: серия наблюдений. Современная Онкология. 2023;25(3):290-4 [Boldyreva TS, Lyado VK, Derevyashkina GV, et al. Remote pre-habilitation in patients with cachexia and resectable gastric cancer: a case series. Journal of Modern Oncology. 2023;25(3):290-4 (in Russian)]. DOI:10.26442/18151434.2023.3.202259
13. Guo Y, Ding L, Miao X, et al. Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta- analysis. Support Care Cancer. 2022;31(1):57. DOI:10.1007/s00520-022-07541-1
14. Клинические рекомендации МЗ РФ по лечению злокачественных новообразований. Режим доступа: https://www.rosoncoweb.ru/standarts/minzdrav/ Ссылка активна на 16.09.2024. [Clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of malignant neoplasms. Available at: https://www.rosoncoweb.ru/standarts/minzdrav/ Accessed: 16.09.2024 (in Russian)].
15. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
16. Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014;9(12):113-37. DOI:10.1371/journal.pone.0113637
17. Newman AB, Simonsick EM, Naydeck BL, et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA. 2006;295(17):2018-26. DOI:10.1001/jama.295.17.2018
18. Mourtzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomo- graphy images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5): 997-1006. DOI:10.1139/H08-075
19. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. DOI:10.1200/JCO.2012.45.2722
20. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
21. Camarda SR, Tebexreni AS, Páfaro CN, et al. Comparison of maximal heart rate using the prediction equations proposed by Karvonen and Tanaka. Arq Bras Cardiol. 2008;91(5):311-4. DOI:10.1590/s0066-782x2008001700005
22. Mareschal J, Hemmer A, Douissard J, et al. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel). 2023;15(6):1881. DOI:10.3390/cancers15061881
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25. Pereira MG, Voltarelli VA, Tobias GC, et al. Aerobic Exercise Training and In Vivo Akt Activation Counteract Cancer Cachexia by Inducing a Hypertrophic Profile through eIF-2α Modulation. Cancers (Basel). 2021;14(1):28. DOI:10.3390/cancers14010028
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28. van Stralen KJ, Le Cessie S, Rosendaal FR, Doggen CJ. Regular sports activities decrease the risk of venous thrombosis. J Thromb Haemost. 2007;5(11):2186-92. DOI:10.1111/j.1538-7836.2007.02732.x
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18. Mourtzakis M, Prado CM, Lieffers JR, et al. A practical and precise approach to quantification of body composition in cancer patients using computed tomo- graphy images acquired during routine care. Appl Physiol Nutr Metab. 2008;33(5): 997-1006. DOI:10.1139/H08-075
19. Martin L, Birdsell L, Macdonald N, et al. Cancer cachexia in the age of obesity: skeletal muscle depletion is a powerful prognostic factor, independent of body mass index. J Clin Oncol. 2013;31(12):1539-47. DOI:10.1200/JCO.2012.45.2722
20. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.
21. Camarda SR, Tebexreni AS, Páfaro CN, et al. Comparison of maximal heart rate using the prediction equations proposed by Karvonen and Tanaka. Arq Bras Cardiol. 2008;91(5):311-4. DOI:10.1590/s0066-782x2008001700005
22. Mareschal J, Hemmer A, Douissard J, et al. Surgical Prehabilitation in Patients with Gastrointestinal Cancers: Impact of Unimodal and Multimodal Programs on Postoperative Outcomes and Prospects for New Therapeutic Strategies-A Systematic Review. Cancers (Basel). 2023;15(6):1881. DOI:10.3390/cancers15061881
23. Sedalov IE, Popovich AIu, Zaika AN. Neposredstvennye rezultaty gastrektomii pri rake zheludka. Novoobrazovanie. 2019;11(2):72-5 (in Russian).
24. Morinaga M, Sako N, Isobe M, et al. Aerobic Exercise Ameliorates Cancer Cachexia-Induced Muscle Wasting through Adiponectin Signaling. Int J Mol Sci. 2021;22:3110. DOI:10.3390/ijms22063110
25. Pereira MG, Voltarelli VA, Tobias GC, et al. Aerobic Exercise Training and In Vivo Akt Activation Counteract Cancer Cachexia by Inducing a Hypertrophic Profile through eIF-2α Modulation. Cancers (Basel). 2021;14(1):28. DOI:10.3390/cancers14010028
26. Hardee JP, Counts BR, Carson JA. Understanding the role of exercise in cancer cachexia therapy. Am J Lifestyle Med. 2019;13(1):46-60.
27. Tamayo-Torres E, Garrido A, de Cabo R, et al. Molecular mechanisms of cancer cachexia. Role of exercise training. Mol Aspects Med. 2024;99:101293. DOI:10.1016/j.mam.2024.101293
28. van Stralen KJ, Le Cessie S, Rosendaal FR, Doggen CJ. Regular sports activities decrease the risk of venous thrombosis. J Thromb Haemost. 2007;5(11):2186-92. DOI:10.1111/j.1538-7836.2007.02732.x
Авторы
В.К. Лядов*1–3, Т.С. Болдырева3, А.Ю. Горшков4, Е.В. Зятенкова4,5, М.Г. Чащин4
1ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2Новокузнецкий государственный институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Новокузнецк, Россия;
3ГБУЗ г. Москвы «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения г. Москвы», Москва, Россия;
4ФГБОУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Россия;
5ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия
*vlyadov@gmail.com
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia;
3Moscow State Budgetary Healthcare Institution «Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department», Moscow, Russia;
4National Research Center for Therapy and Preventive Medicine, Moscow, Russia;
5Russian University of Medicine, Moscow, Russia
*vlyadov@gmail.com
1ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
2Новокузнецкий государственный институт усовершенствования врачей – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Новокузнецк, Россия;
3ГБУЗ г. Москвы «Городская клиническая больница им. С.С. Юдина Департамента здравоохранения г. Москвы», Москва, Россия;
4ФГБОУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Россия;
5ФГБОУ ВО «Российский университет медицины» Минздрава России, Москва, Россия
*vlyadov@gmail.com
________________________________________________
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
2Novokuznetsk State Institute for Further Training of Physicians – Branch Campus of the Russian Medical Academy of Continuous Professional Education, Novokuznetsk, Russia;
3Moscow State Budgetary Healthcare Institution «Moscow City Hospital named after S.S. Yudin, Moscow Healthcare Department», Moscow, Russia;
4National Research Center for Therapy and Preventive Medicine, Moscow, Russia;
5Russian University of Medicine, Moscow, Russia
*vlyadov@gmail.com
Цель портала OmniDoctor – предоставление профессиональной информации врачам, провизорам и фармацевтам.