Vol 63, No 5 (2019)

Introduction. The quality of medical care is the main target function and criterion of the health care system. The aim of the study is to assess the quality of medical care, based on the analysis of the existing system of internal control of quality and safety of medical activities. Materials and methods. The analysis of the activity of the quality management system of medical care in 2016-2018 in the Medical center of the Far Eastern Federal University (MC FEFU), providing high-tech medical care were made. The material for the study was a prospective and retrospective study of the documentation of treated patients, questionnaire survey of patients, applied systematic and statistical analysis. Results. There was a decrease in the hospital mortality rate from 0.4% in 2016 to 0.2% in 2018; a high rate of surgical activity: 86.2% in 2016, 80.9% in 2017 and 88.3% in 2018; a sufficiently high satisfaction of patients with the quality of medical care (95.4%); the integral efficiency coefficient (CI) is 0.88-0.93, which indicates the quality of medical care provided by the staff of FEFU MC. Discussion. An important component of the quality management concept of MC FEFU is the introduction of innovative approaches in the organization of medical care: the versatility of the bed fund, combined into centers; decentralization of the registry; ‘tablet distribution’ system; individual approach to patients during complex examinations; the stages of medical care (outpatient, inpatient, rehabilitation). To further improve the system of quality control and safety of medical activities requires the development and implementation of a single medical information system that combines all stages of medical care in the MC FEFU, modern medical technologies, including rehabilitation. Conclusion. The results of internal quality control indicate the high efficiency of medical care provided to the population of Primorsky Krai in need of high-tech medical care.

Рre-natal (congenital) infections - an infectious disease of the fetus and newborn, related to severe pathology, which increases perinatal morbidity and mortality. Objective: to study the role of pre-natal infections in the structure of perinatal mortality (PM) in the Omsk region for 2010-2018. Material and methods. A retrospective analysis of the dynamics and structure of the causes of perinatal mortality was carried out; “Information on medical care for pregnant women, women in labor and women in childbirth” was used (form No. 32) for the analysis. Results. In the Omsk Region, the PM indicator decreased from 14.3‰ in 2010 to 6.7‰ in 2018, which was achieved by reducing the еarly neonatal mortality (from 3.1‰ to 1.9‰) and the stillbirth rate (from 11.2‰ to 4.9‰) for the same years. Еarly neonatal mortality was 11.7% in the group of full-term fetuses from infectious diseases specific to the perinatal period (P35-39), 6.5% - in premature infants with a gestational age of 22-27 weeks, 9.5% - in the group of premature infants with a gestation period of 28-37 weeks. Discussion. The problem of intrauterine infections is relevant, which is due to the high infection rate of women of reproductive age, leading to infertility, low index of their health, and the lack of clear algorithms for diagnosis, treatment and prevention of this disease. Conclusion. Рre-natal infections are the main cause of еarly neonatal mortality in full-term fetuses, accounting for 19.9% of the total number of causes (congenital pneumonia P23 - 8.2%, infectious diseases specific to the perinatal period P35-P39 - 11.7%).

The purpose of the study: an assessment of the diagnostic capabilities of clinical-anamnestic and functional research methods for the timely diagnosis and monitoring of the level of bronchial asthma (BA) control in children. Material and methods. Design is based on a retrospective cohort study. The article presents the clinical and anamnestic characteristics of 872 patients with a verified diagnosis of BA who were examined under inpatient conditions of the Republican Children’s Clinical Hospital (Ufa). Сlinical, allergological, functional, statistical, analytical research methods were used in the work. Results. The age of children diagnosed with BA was 6 [4; 9] years. The debut of atopic BA was at the age of 3 [2; 5] years with preservation of high trigger level of viral infection in 56,09% of children and physical activity in 39,79% of children. In 91,85% children with BA, the manifestations of the disease symptoms were year-round with a significant proportion of household allergens in the sensitization spectrum in 72,70%. It was shown there was no difference in the assessment of respiratory function on the results of spirography and pulsed oscillometry in children with asthma (χ2=0,1432; p=0,7057). Discussion. According to the results, there was a lag in diagnosing children with BA, an average of 3 years after the first episodes of obstructive syndrome. As a rule, the debut of atopic BA was traced at an early age against the background of viral infection, which made it difficult for a timely diagnosis of BA in children. The comparability of the results of functional methods makes it possible to equally effectively apply spirography and pulsed oscillometry in the algorithms for the diagnosis and control of BA in children. Conclusion. The potential debut of BA in children at early age after the first episodes of obstructive syndrome, while maintaining a high trigger level of a viral infection, the year-round manifestations of the symptoms of the disease should alarm pediatricians and encourage more active tactics for managing young children with the involvement of specialists.

Occupational hearing loss is a socially significant disease that occupies the first place in the structure of occupational morbidity of the working-age population of Russia and causes the loss of professional suitability of the employee. The purpose of the research is to analyze the modern aspects of the social significance of professional hearing loss from noise exposure. Material and methods. A systematic analysis of the results of studies published over a 10-year period was performed. The search and synthesis of information was carried out by the keywords «occupational noise exposure or permissible exposure limit or dose-response relationship or acceptable noise level and noise-induced hearing loss» (production noise or permissible level or dose-effect dependence or hearing loss caused by noise) in the Medline database (www.pubmed.com). Results. The disease of the auditory organ of noise etiology - chronic sensorineural (sensorineural) hearing loss (ChSHL), develops in persons working in conditions of exposure to industrial noise exceeding the maximum permissible levels. Early detection and rehabilitation of hearing disorders from noise is of great socioeconomic and deontological importance, allowing to extend the professional suitability of the employee. Discussion. The social significance of hearing loss from noise is determined by the inconsistent provisions of the main regulatory documents that determine additional contraindications for hearing for workers entering or working in the «noise» professions. Insufficiently competent attitude to the diagnosis, incorrect hygienic assessment of noise parameters, erroneous expert decisions and incorrect assessment of the degree of hearing loss, affect the unjustified growth of hearing loss from noise. Conclusion. Social aspects of professional ChSHL are caused by the loss of professional ability to work in the preretirement age, difficulties in diagnosis, imperfection of the examination of the connection of the disease with the profession, imperfection of regulatory documents on professional selection and aptitude, shortcomings of rehabilitation measures. The growth of indicators of professional ChSHL causes unjustified disability of workers in working age, economic losses of employers and the state and determines the social significance of the disease.

Introduction. Active developing sphere of medical services in the field of pregnancy management in Russia requires adequate and timely legal regulation. An important element of the pregnancy management process is perinatal diagnosis, which involves both conventional procedures - perinatal screening (biochemical blood analysis, ultrasound), and special - genetic screening (invasive and non-invasive). In this regard, the issue of a clear and effective legal regulation of genetic research in the framework of perinatal diagnosis and the further use of the results in this area is particularly acute. Aim of the work is to develop restrictions during the prenatal diagnostic procedure. Research objectives: knowledge of the various fundamental terms of this field, analysis of the functioning of the above aspect both in Russia and in foreign countries; identification of positive and negative aspects lobbying for the conduct of this procedure. Results. In many foreign countries for physicians, geneticists and potential parents established a fairly strict framework for perinatal diagnosis, due to the fact that this procedure can be used not only to prevent the birth of patients with hereditary diseases of children, but also for other purposes, dictated by social or cultural factors (e.g., justification of abortion, genome testing for social or psychological characteristics). Discussion. Such use of modern medical technologies will contradict the existing ideas about bioethics, which raises the question of the purpose of introducing stricter legal restrictions on the use of these technologies. A unified concept of legal regulation of genetic research in the framework of perinatal diagnostics with its subsequent implementation in practice is needed. Conclusions. It is necessary to design a Russian Federal law that provides a multifaceted legal regulation of the procedure of perinatal diagnosis, the main emphasis of which should be directed precisely to the modeling and interpretation of the limitations and conditions of this medical procedure.

On materials of the review of articles in the Russian Science Citation Index database problems and methodical approaches to planning of the dental help are considered. It is specified that when developing the priority directions of improvement of the dental help the analysis of prevalence of dental pathology among the population and its negotiability behind medical care is important. A necessary condition is assessment of satisfaction of patients with the provided services. The image of establishment is important that it predetermines realization of the corresponding marketing strategy based on forecasting of realization of dental services. Basic elements of strategic planning in management of dental policlinic as the main establishment assuming the main flow of the population with dental pathology are considered. It is indicated the need of development of analytical approaches to assessment of formation of a flow of patients, demands of the dental and medico-organizational technologies including algorithms of social and hygienic assessment of functioning of the dental organization. It is emphasized that at strategic planning it is necessary to be guided by the volume and structure of a flow of patients, satisfaction of the population with the dental help, priorities of implementation of technologies and further by efficiency of use of capacity of the organization. For this purpose it is necessary to model a flow of patients in dental policlinic, to integrate various indicators of the dental help, to develop predictive models with determination of the importance of these or those characteristics of patients, features of the territory. It is offered to use the personified bases of the dental organizations with development of analytical approaches to assessment of formation of a flow of patients, implementation of dental and medico-organizational technologies by it. Further stages of introduction of strategic planning in activity of the dental organization will be connected with development of information and analytical models of demand of dental technologies with separate types of the dental help.