No 1 (2015)
EDITORIALS
5-10 372
Abstract
This article devoted to the analyses the service management as a condition for the successful modernization of healthcare in Russia. The features of the service management formation as an independent discipline in the foreign and Russian science. On example of an analysis of the best practices in health care service organizations show features of services as the penetration of activities in the healthcare industry of the economy, which allowed to determine the main directions of development of the «new service economy». Disclosed the problem of formation and implementation of service policy of health facility conducted by senior management as health facility policy to involve staff in the process of creating a unique service product that combines necessary medical service and a group of additional services that facilitate the adoption of health care and increase its usefulness to the consumer.
REVIEWS
11-15 365
Abstract
Medications safety is a relevant problem in the world, requiring global action. International system of pharmacovigilance is based on the method of spontaneous adverse drug reaction reporting, which helps to build databases and detect signals of possible new adverse drug reactions using statistical methods. This method is used internationally, however, organizational features may be different. European Union obliges pharmaceutical companies to monitor adverse drug reactions related to each international nonproprietary name, but not each trade name. In the USA, as well as in Russia, quality of single drug batches is monitored, aiming at identification of poor quality products. In order to improve efficiency of pharmacovigilance several measures can be used - teaching interventions, use of healthcare databases etc. Important aspect is support of research centers, doing research in the area of various aspects of drug safety. Specific approach is required for organization of pharmacovigilance in pregnant women, where spontaneous reporting is not that effective. The most widely used methods are registries and prospective non-interventional observation. In order to provide effective functioning of pharmacovigilance all participants of the healthcare system should be equally involved, including patients, doctors, pharmaceutical companies, regulatory organs, research and educational centers.
16-20 243
Abstract
Russian system of medical care for patients with chronic hepatitis C does not allow to control the epidemic process. It is necessary to establish standards for diagnosis and treatment of hepatitis C within the framework of compulsory health insurance. It is necessary to change the terms of the delivery of medical care by including therapeutic and gastroenterology services in the medical care of patients with chronic viral hepatitis, as well as the implementation of that medical care to the outpatient care and day care therapy, infectious and gastrointestinal profiles. Mandatory condition of effective financial expenditures is also the formation of an effective antimonopoly regulation of the pharmaceutical market and price regulation on diagnostic equipment and medicines.
21-25 248
Abstract
A brief overview of recent data of the etiology, epidemiology, immunopathogenesis, clinical picture and treatment of hemorrhagic fever with renal syndrome (HFRS) - feral herd infection, widespread in Eurasia. Annual increase in morbidity with the expansion of natural focus of disease, often severe acute and high mortality rate determines the importance of HFRS for healthcare, in particular for the Russian Federation and its Far East region. Significance and seriousness of the problem is caused by many unclear questions of epizootology, immunopathogenesis, diagnosis, and, especially, the treatment of infection. The review describes the current information on HFRS discussed at the IX International Conference on hantavirus infection in Beijing (2013).
26-29 292
Abstract
In review summarized the literature and the results of outhors studies of axovasal, and dendrovasal and somatovasal links inhibitory interneurons in the cerebellar cortex of humans and animals. Described associations related to the localization of constitutive nitroxide synthase in Lugaro cells , basket cell and afferent fibers. Substantiated position about dependence of local blood flow from impulse load of interneurons. Vasomotor effects of gamma-aminobutyric acid and nitric oxide are part of the joint regulatory pathways of neural activity that support specific background of activate or inhibitory impulsation and become internal factor in the dynamic organization of the modular structure of the cortex.
ORIGINAL RESEARCHES
40-42 267
Abstract
Background. Zones of adjacent blood supply of pial network of the brain have the greatest vulnerability in hypoxia. Nevertheless morphofunctional studies of these areas of the vascular bed in the circulatory ischemia was not conducted. Methods. Ischemic disorders of brain modeled in rats by ambilateral ligation of the common carotid arteries. Estimated vasomotor activity of pial arteries zones of adjacent blood supply of frontal and parietal regions with Kernogan index. By scanning electron microscopy were determined three-dimensional structure of pial arteries in areas of adjacent blood supply. Results. Dynamics of changes in vasomotor activity of pial arteries in the circulatory ischemia was as follows: after 10 min began vasodilatation, reaching a maximum in 20 minutes. After 30 minutes, marked the return of value of the vascular lumen to the basic. After 40 minutes, the second wave of dilatation developed. During this period there was eritrodiapedesis. Conclusions. The most labile section of the vascular bed of rat brain arteries are the frontal and parietal regions of 50-69 microns in diameter, which play the most important role in the adaptation of the brain to hypoxia.
43-47 268
Abstract
Background. Aortic stiffness has independent prognostic value in relation to the fatal and nonfatal car-diovascular events in patients with hypertension, particularly in patients of young and middle age. Methods. 50 observations of essential hypertension (EH) II stage in 23 men and 27 women 25-60 years evaluated the association between body mass index, cholesterol levels, adiponectin and blood leptin, pulse wave velocity, augmentation index and coronary perfusion area. Results. Obvious connection between plasma adiponectin concentration and the degree of aortic stiffness in patients with essential hypertension register failed. Adiponectin levels had a close negative cor-relation with body mass index, waist circumference and levels of cholesterol and triglycerides. Was founded direct link between tenuous relationship between coronary perfusion index and blood leptin. Also, the concentration of leptin was positively associated with weight and cholesterol levels. The greatest number of statistically significant relationships was observed in the group of women with EH. Conclusions. In hypertensive patients young and middle age regardless of gender increased aortic stiff-ness and violated the conditions of coronary perfusion. Interconnection of blood concentrations of leptin and adiponectin, and excessive stiffness of arterial bed, mostly expressed in women.
48-50 244
Abstract
Background. Chronic drug intoxication accompanied by deep progressive disorders of exchange with the subsequent formation of endotoxemia and development of organ pathology. Strengthening of anti-oxidant protection is important in breaking of this pathogenetic chain. In order to increase the activity of antioxidant enzymes, depending on the presence in their structure of bio-elements, into the standard treatment of addition of cuprum and selenium (in biologically active additives composition). Methods. Of the 120 men 18-40 years with a syndrome of opioid dependence have formed 4 groups of 30 persons: 1st - experimental group (baseline), 2nd - the standard treatment, 3rd - the standard treatment with the addition of cuprum, 4th - the standard treatment with the addition of selenium. Control - healthy men 18-28 years. In the blood of patients, determined the concentration of malondialde-hyde, activity of antioxidant enzymes, level of bio-elements and level of average weight molecules. Results. In the blood, drug addicts found elevated levels of malondialdehyde, a significant decrease in the activity of superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase-tionperoksidazy - 41, 21, 79, 42%, decrease of levels of selenium (50%) and cuprum (97%), increasing the concentration of average weight molecules. Addition to the standard treatment of cuprum and sele-nium increased the level of cuprum by 85.7%, selenium - 60%. Combined use of standard treatment and copper achieve a significant increase in the levels of enzymes studied at 23, 12,97 and 41% selenium - 10, 11, 83 and 15%. Number of malondialdehyde decreased by 20%, reduced the level of average weight molecules. More pronounced effect was observed with using cuprum. Conclusions. In chronic drug intoxication develop serious violations in system “free radical oxidation - antioxidant protection”. Standard therapy has no effect on this drug dependence pathogenetic link. Addition to complex treatment bioelemets (Cu, Se) physiological concentration of which provides the metal-dependent antioxidant enzymes, allow significantly increase the activity of the leading factors of antioxidant protection.
51-55 220
Abstract
Background. Presents the results sociological research of public satisfaction with the Far Eastern Federal District of outpatient, inpatient and emergency care. Methods. The target of research - 3370 citizens of all subjects of the Far Eastern Federal District over 18 years, who seek medical advice for a year. Questions were asked about their attitudes toward the organization, accessibility and quality of care in an area of population. The study was conducted in 2013-2014. Results. The average age of respondents was 46 years. Half of the respondents rated income level as low or very low. Outpatient care were not satisfied with the majority of respondents (75.5%), hospital care - more than half (59.1%) and ambulance services - one in two (52.2%). Conclusions. Was founded that citizens express the greatest dissatisfaction with health care settings, which include staffing, availability and condition of medical equipment, the condition of buildings, de-partments, rooms and patient’s room, food quality, standards and regulations for sanitary and ant epi-demical regimes, ambulance team. Secondary importance for the citizens had the organization of work and services in the last place standing staff professional quality and achieved medical result.
56-59 219
Abstract
Background. We studied the clinical course of pregnancy, status of the fetus and newborn in patients with chronic cytomegalovirus infection (CMV). Methods. A total of 150 pregnant women with chronic recurrent CMV infection (study group), out of which 50 backset was 9-14 weeks (1st subgroup), 50 - in the 15-21 week (2nd subgroup) and 50 - 22-37 weeks (third subgroup). A control group of 50 pregnant women seronegative for cytomegalovirus. Studied history, performed a physical, special obstetric and basic laboratory research. Determined the level progesterone in serum. Results. Showed an increase the frequency of complications of pregnancy in recurrent CMV infection. In the 1st subgroup threatening difficult pregnancy miscarriage (60%), primary (20%) and chronic (64%) and placental insufficiency and placenta previa (20%). In 23.5% of the mothers in this subgroup had children with hypotrophy and 22.5% - es in the brain). In the 2nd subgroup more often than in the 3rd diagnosed chronic placental insufficiency, polyhydramnios, oligohydramnios and fetal growth retardation. conclusions. Pregnancy complications which are shown with placental disorders and perinatal pathology in the newborn are formed at an early backset of CMV gestation period.
60-62 267
Abstract
Background. The purpose of the study - evaluation of the effectiveness of using a personalized approach to the use of warfarin with pharmacogenetic testing. Methods. Open, prospective, non-randomized study of the efficacy of complex algorithm with indirect anticoagulants in patients with permanent atrial fibrillation in a clinic. Results. The correlation coefficient between the calculated and selected dose of warfarin was 0.93. That mean that, the predictive value of the selected algorithm for calculating the initial dose of warfarin was very high. Conclusions. implementation into the outpatient practice of complex algorithm of individual dose indirect anticoagulant warfarin, based on the results of pharmacogenetic testing Gage et al. algorithm contributes significantly increase to the quality of anticoagulation therapy, efficiency of individual dose of warfarin and increase the stability of the anticoagulant effect.
I. A. Edelstein,
M. V. Edelstein,
A. V. Romanov,
S. A. Ratchina,
S. B. Yatsyshina,
I. V. Rakovskaja,
R. S. Kozlov
63-66 483
Abstract
Background. Mycoplasma pneumoniae is a widespread pathogen of the respiratory tract diseases. In recent years, the data of foreign publications indicate the appearance and spread of resistant M. pneumoniae to macrolide antibiotics, which is associated with mutations in the 23S pRNA gene, mainly in positions 2063, 2064 and 2617. Methods. Studied 146 clinical samples obtained in 2006-2013. of patients with infections of the lower respiratory tract. Primary screening was done for the presence of DNA material M. pneumonia based on polymerase chain reaction (PCR) in real time. Results. The possibility of detecting and differentiation of various mutations in positions 2063, 2064 and 2617 in the 23S pRNA gene format single sample multiplex PCR in real time with subsequent melting curve analysis of fluorescently-labeled probes. In the study of clinical samples in all cases been detected 23S pDNA sequences of M. pneumoniae “wild-type” typical for phenotype of sensitivity to macrolides. Conclusions. Detection of single nucleotide corresponding replacements allows effective predict macrolide resistance phenotype, but used for this purpose methods are laborious and expensive. At present data on the prevalence and mechanisms of macrolide resistance in strains of M. pneumoniae in Russia are absent. The present study focuses on the development and validation of a new method for the determination of mutations associated with resistance to mac-rolides in M. pneumoniae, and also its use for the analysis of clinical samples in patients with lower respiratory tract infections.
67-70 255
Abstract
Background. Arterial hypertension (AH) in Russia is the leader in cardiovascular morbidity and an important predictor of disability and mortality of the adult population. Methods. The study included 30 patients with hypertension, amlodipine 5-10 mg / day for 36 weeks. Conducted daily monitoring of blood pressure (BP), echocardiography, Holter monitoring electrocardiogram, body sphygmography. Results. Statistically significant reduction in average daily, average nighttime systolic and diastolic blood pressure, decreased pulse pressure in the daytime and nighttime. The number of patients with physiological night BP reduction increased from 36.7 to 60%. The treatment resulted in a reduction of vascular remodeling of elastic and muscular type, reduce their structural changes. Amlodipine helped to improve left ventricular diastolic function. Statistically significant normalization of diastolic indicators was accompanied by decrease in the volume of the left atrium and the regression of cardiac hypertrophy (decrease myocardial mass index and relative left ventricular wall thickness by 9.6 and 8.7%, respectively). Conclusions. The results of our study showed beneficial effects of amlodipine on the process of ventricular repolarization. In women with hypertension in postmenopausal amlodipine slowed the progression of cardiovascular remodeling, lead to normalization of the circadian rhythm of blood pressure and helped stabilize the electro-physiological properties of the myocardium.
71-73 346
Abstract
Background. In the structure of infants diseases dominated pathological conditions originating in the perinatal period, which indicates their link with the mother>s health and gestation course. Methods. The study included 38 children born by mothers with physiological pregnancy (group 1) and 35 children born by mothers whose pregnancies complicated by the threat of interruption (group 2). Evaluated anthropometric indicators, physical status, morbidity and cellular and humoral immunity. Results. In the 2nd group of children was significantly more frequent in prematurity and birth asphyxia and intrauterine growth retardation. In this cases diagnosed with greater frequency hemorrhagic syndrome, disorders of the gastrointestinal tract, and central nervous system diseases and allergic diseases of skin. These children during the first year of life indicate disorders of processes of immunological tolerance to the depletion of the general resistance of the organism. Conclusions. Gestation course complicated with threat of miscarriage, affects the performance of physical, somatic and immunological status of the child>s first year of life. In practice, pediatrician and neonatologist should form risk groups of these children, especially for allergic diseases, and carry out preventive measures.
74-75 274
Abstract
Background. Of the general problem of mortality of its social significance stands the problem of perinatal mortality. The concept of health-care development of Russia until 2020 provides for the reduction of infant mortality to 7.5 per 1,000 live births (by 20% incomparing to 2007). Methods. On the basis of the VMH No 4 been provided retrospective analysis of annual reports of providing medical care to pregnant women, new mothers and lying-in woman for 2011-2013. During this period, perinatal mortality was registered in 44 cases. Also analyzed cards of dispensary observation of pregnant woman reports of histological study of retained products, medical certificate of perinatal death. Results. In all cases of perinatal death in mothers been registered one or another extragenital pathology. Of the total number of stillbirths 20 girls and 24 - boys. Antenatal death was noted in 92.4%, intrapartum death - in 7.5% of cases. The total rate of stillbirths during the first pregnancy was equal to 28.2%. Most of intrauterine foetal demise (49%) happened at 26-27 weeks of gestation. Conclusions. In order to reduce perinatal morbidity and mortality it is recommended early (before pregnancy) recognition of extragenital pathology, its qualified treatment and individual preparatory courses for pregnancy in women of this category. Also necessary early diagnosis of pregnancy complications such as gestosis, threatened miscarriage and placental insufficiency with earlyl referal of pregnant patients to the hospital.
LECTURES
30-34 269
Abstract
The legal system of the Russian Federation is developing dynamically, which confirms its correlations with the needs of society. Medical law in Russia is also undergoing some changes. Key issues relating to the legal aspects medical care are reflected in the Federal Law 61-FZ, FZ-323, 326-FZ, enacted in 2010-2011. At the same time, everyone>s right to health protection and health care is protected in the Basic Law - the Constitution of Russia. Certain aspects of the implementation of the basic rights of citizens in the health sector are detailed in numerous sub-legal acts. In order to improve the quality and accessibility of health care in the 2011 Federal Law № 323-FZ was introduced legal term «medical rehabilitation». To fulfill the requirements of the law by the order of the Ministry of Health approved the procedure of medical rehabilitation. Also implementing the activities of medical rehabilitation is regulated by the regularly Resolution of the Government of the Russian Federation. Despite a number of difficulties of a procedural nature, arising from the implementation of the provisions of these legal actsб in general it is possible to expect a positive result obtained by the introduction of new requirements by the legislation to the health care system.
35-39 438
Abstract
Presented multiple-criteria decision analysis from the attitude of a decision taking assessing of medical technologies. multiple-criteria decision analysis is regarded as one of the methods in Fore-sight methodology and represents a consensus in the process of consilium, based on scientific struc-tured approach and compromise in the evaluation of pre-agreed criteria. multiple-criteria decision anal-ysis is an addition to the decision-making approaches in the evaluation of medical technologies and cannot be decisive.
PUBLIC HEALTH ORGANIZATION
76-79 347
Abstract
A study to improve the organization of system of hightech medical assistance (HIMA) in the Primorye Territory. The evaluation of the HIMA in health care organizations of the region. Been given the recommendations for the development of a complex of measures aimed to increase the amount and improving the results of providing high-tech medical care for diseases of the surgical type, as well as the routing of patients for the rehabilitation after the delivery of HIMA in medical organizations located in the Primorsky Territory, independently of its organizational and legal forms, departmental and territorial subordination.
80-82 249
Abstract
Background. The frequency of surgical infections in the general structure of surgical diseases, according to the literature, remains at 35-45%, and the proportion of nosocomial infection 12-22%, and the mortality rate reaches 25%. Methods. The analysis of the structure and properties of agents of wound infections in multifield surgical hospital for the 2006-2014 biennium. Results. In the structure of pathogens of wound infections dominated Escherichia coli, Staphylococcus aureus, Klebsiella pneumonia and Klebsiella oxytoca. Statistical forecast assumes further increase in the proportion of Enterobacteriaceae microorganisms. Conclusions. According to the results of microbiological monitoring the most effective antimicrobial drugs for the treatment of surgical infections should be considered a group of protected aminopenicillins, cefoperazone + sulbactam, meropenem, or combination of these drugs with vancomycin.
83-85 263
Abstract
The analysis of the efficiency and quality of resource using of first-aid station in Vladivostok for the 2009-2013 period. Identified methodological approaches to the delivery of first-aid to the population. On the basis of specific indicators been studied the level and quality of continuity and interaction between the first-aid station and the medical organizations of the city. Outlined the ways of improving the organization of the service in Vladivostok.
86-89 274
Abstract
Studied the state of health care manpower resources of Primorsky Krai and the analysis of the scientific literature on this issue. Assessed the main trends of the personnel policy. The practical significance of the study is to develop a conceptual propositions and recommendations for the formation of personnel policy as a strategic level - the personnel management system, so and tactical, based on available resources. Identified methodological approaches to the research and development of personnel policies of medical organizations. Identified and analyzed the main factors that affect the personnel policy in health care of Primorye. Been assessed the state of personnel policy and personnel processes of health care of the region, analyzed qualitative and quantitative composition of the managerial staff.
90-92 263
Abstract
Background. In modern conditions exists necessity of forming in antenatal clinics complex of medical and organizational activities aimed to the optimizing the work to prevent pregnancy complications, reduce gynecological diseases, promoting healthy lifestyles. Methods. Conducted socio-hygienic research devoted to studying women attending antenatal clinics lifestyle, and the factors that influence it. Was questioned 488 women (365 pregnant women), statistical processing of questionnaires and set up an organizational experiments under conditions of the antenatal clinic. Results. Anonymous questioning of pregnant women showed their lack of medical activity (78.6%), the presence of bad habits before pregnancy (80.5%) and during pregnancy (18.9%), stressful situations (100%) and non-constructive behaviors (87.3%), and low awareness about the impact of different perinatal factors on the growth and development of their future children. With the opinion that the health of a child is formed, including under the influence of lifestyle parents-to-be disagreed over half (57.4%) of pregnant women, and only 43.7% of women rated their health as good. Conclusions. In order to optimize preventive work of antenatal clinic may be prompted to design a solution including a set of medical and organizational activities. It is necessary to create a new structural unit of antenatal clinic - the Cabinet of medical prevention, formation of an action plan aiming to the awareness of patients. Developed and tested a “School of prenatal pedagogics”, which can be widely implemented in the activities of women>s clinics.
93-95 249
Abstract
Proposes a model of efficient organization of health care, health protection and promotion of workers of oil and gas company engaged in the development of oil and gas fields on the continental shelf of the Russian Federation, as well as transport and export of hydrocarbons. The organization of works carried out on the basis of short-term (annual) and long-term (5-year) planning in the conditions of self-financing, government regulation of medical institutions of various forms of ownership in conjunction with the use of voluntary health insurance.
MEDICAL HISTORY
96-100 607
Abstract
Article provides information on laws and legal acts regulated the provision of medical carestarting from ancient civilizations. The object of the analysis become modern systems of social and health insurance from different countries. Reveals the main elements of socio-economic background of origin of health insurance. Distinguished stages of evolution, trends in the transformation of systems of compulsory health insurance from its creation to the present level of development. Studied legislative and regulatory documents, identified the development priorities of health insurance, and directions for its improvement. In XXI century medical insurance has another organizational and legal framework, is developing in a different relationship with the state and on the basis of new technologies.
ISSN 1609-1175 (Print)