ANALYSIS OF PSYCHOLOGICAL, SOCIAL, AND LEGAL MEDICAL ASPECTS IN EVALUATING THE QUALITY OF PEDIATRIC ASSISTANCE.

Relevance and purpose: The current state of society is characterized by increasing awareness of citizens about their rights and state obligations in all spheres of human activity including healthcare. It is crucial to note the importance of conflict provoking factors, conflict development, and the propositions for its prevention which is impossible without the study of attitude towards various aspects of providing medical assistance to children. The purpose of the study is the identification of the relationship of pediatricians to the importance of juridical and psychological aspects of care. MATERIALS AND METHODS: Analysis legal and psychological aspects of quality of care was carried out on the results of a questionnaire various specialties of pediatric survey among employees of "Regional Children's Clinical Hospital by N.F. Filatov" and several children's clinics in Penza. RESULTS: The most important role in the prevention of conflict plays juridical knowledge and mental preparation, as well as the ability to use them in clinical practice. Formulated for execution and real proposals for the prevention of conflicts between children's doctors, patients and their parents indicate the practical significance of the work. CONCLUSIONS: Conclusions are consistent with that goal; they are based on reliable information obtained in the course of the study. The implementation of the measures proposed by researchers of conflict's prevention in pediatrics will reduce the number of calls to the police, the investigating committee and the courts.

Harmonization of patient data card structure with messaging standards.

Harmonization of patient data card (PDC) structure with messaging standards is discussed on example of pilot project of patient data card system implemented by the Medical Center of the Russian Federation President's Management Department. Such a harmonization may help to improve medical PDC interoperability on the seventh, application level.

A Russian version of SNOMED-International.

Medical information systems are becoming widely used in Russia--most of them based on small- and medium-sized networks of PCUs running xBASE software. The major difficulty facing these systems is not the availability of adequate hardware and software, but rather the absence of standard terminology. The only international standard currently in use is the Russian translation of ICD-9. Development, adoption, and promotion of other international classifications and nomenclatures could remedy this situation. SNOMED-International [1] appeared to be well-suited for adaptation to the Russian medical environment because of its multiaxial structure and rich terminology. Its use could also facilitate international as well as national data collection and cooperative studies, and it may find its first application in a planned correlation of toxicology and autopsy data from the Leningrad region. Since the complete SNOMED-International contains more than 130,000 terms, the first phase of this project is restricted to the translation of the SNOMED-International Microglossary, a subset of 12,500 pathology-related diagnoses and descriptive terms. Each term was given up to three Russian equivalents which were entered in a database. Then all the Russian terms were printed, edited, and their corrections were entered in the same database. This core set of the Russian terms will be continuously updated and expanded as it is used in actual coding applications. The procedure will be as follows: if a phrase is encountered that could not be mapped to a term in the current version of the Russian nomenclature, the complete SNOMED lexicon will be searched manually for an English equivalent, its code applied to a Russian term, and this term will then be added to the Russian SNOMED database. This approach has the advantage that most of the terms in the Russian nomenclature will not be apriori translations from English, but will arise from the original texts found in real documents. This project is now in progress; the translation of the SNOMED-International Microglossary has been completed. The more difficult task of developing procedures for parsing free text sentences and updating the nomenclature is under development.

[The concept of informatics applied to Soviet public health]. / O kontseptsii informatizatsii otechestvennogo zdravooxhraneniia.

Development of integrated medical information systems (IMIS) was proposed as a main direction of health care informatization in this country. The IMIS are meant to function both on the out- and in-patient basis covering a region (city) with a population amounting to two hundred thousand. They are aimed primarily at providing information supply continuity for the prevention, diagnosis, and the treatment of diseases, and at establishing intercommunications between institutions, departments, physicians, and specialists. The IMIS may serve a data base to give objective information to higher administrative levels, and a basis for creating autonomous information systems intended to automate the work of a separate establishment (department, or physician). The IMIS may also be used to develop medical educational systems (teaching systems, biomedical data banks and data base for medical workers, reference-information service for the population), medical expert systems, and systems of scientific work provision. Expenses on the development and establishment of IMIS are estimated, and possible social sequelae of health care informatization are assessed.

[Use of automated information systems for improving and accelerating communication between hospital units]. / Ispo'lzovanie informatsionnykh sistem dlia uluchsheniia i uskoreniia vzaimodeistviia podrazdeleniia statsionara.

The article tackles the problems of interaction between the units of multidisciplinary hospitals and the feasibility of its improvement by means of introduction of a modern automated information system (AHIS). In the AHIS structure highlighted are the systems of order input and data communications ensuring more rapid interrelation of clinical departments with a pharmacy, laboratory, nutrition and other auxiliary services. The experience gained in the application of the system of order input in the central clinical hospital and abroad has been analyzed along with the role of organizational activities during the introduction of such systems. Additional functions of the order input system are pointed out. They assist not only in intensifying the curative and diagnostic process but also in raising its quality.

Creatine kinase in regulation of heart function and metabolism. I. Further evidence for compartmentation of adenine nucleotides in cardiac myofibrillar and sarcolemmal coupled ATPase-creatine kinase systems.

In isolated and purified cardiac myofibrillar and sarcolemmal preparations, the route of movement of ADP produced in the Mg2+-ATPase reactions was studied by investigating the efficiency of competition between the endogenous creatine kinase and exogenous pyruvate kinase reactions. In the homogeneous control system composed of hexokinase and glucose as ATPase, soluble creatine kinase rapidly rephosphorylated ADP produced in the presence of 1 mM ATP, but the addition of pyruvate kinase in an increasing amount inhibited the reaction of creatine release from phosphocreatine and symmetrically increased the rate of pyruvate production from phosphoenol pyruvate. At a pyruvate-kinase/creatine-kinase activity ratio (PK/CK) of 50, all ADP was used by the pyruvate kinase. In myofibrillar and sarcolemmal preparations containing particulate creatine kinase, the creatine kinase reaction was much less efficiently suppressed by pyruvate kinase, and at PK/CK = 50 half-maximal release of creatine was still observed. The rate of immediate myofibrillar MgADP rephosphorylation in the endogenous creatine-kinase reaction was observed to be governed by the concentration of phosphocreatine in accordance with the kinetics of this enzyme. The physiological significance of these findings is discussed.

Phosphocretine production coupled to the glycolytic reactions in the cytosol of cardiac cells.

Phosphocreatine production ctalyzed by a cytosolic fraction from cardiac muscle containing all glycolytic enzymes and creatine kinase in a soluble form has been studied in the presence of creatine, adenine nucleotides and different glycolytic intermedites as substrates. Glycolytic depletion of glucose, fructose 1,6bis(phosphate) and phosphoenolpyruvate to lactte was coupled to efficient phosphocreatine production. The molar ratio of phosphocreatine to lactate produced was close to 2.0 when fructose 1,6bis(phosphate) was used as substrate and 1.0 with phosphoenolpyruvate. In these processes the creatine kinase reaction was not the rate-limiting step: themass action ratio of the creatine kinase reaction was very close to its equilibrium value and the maximal rate of the forward creatine kinase reaction exceeded that of glycolytic flux by about 6-fold when fructose 1,6-bis(phosphate) was used as a substrate. Therefore, the creatine kinase raction was continuously in the state of quasi-equilibrium and the efficient syntheses of phosphocreatine observed is a result of constant removal of ADP by the glycolytic system at an almost unchanged level of ATP ([ATP]>>[ADP]), this leading to a continuous shift of the creatine kinase equilibrium position. When phosphocreatine was added initially at concentrations of 5---15 mM the rate of the coupled creatine kinase and glycolytic reactions was very significantly inhibited due to a sharp decrease in the steady-state concentration of ADP. Therefore, under conditions of effective phosphocreatine production in heart mitochondria, which maintain a high phosphocreatine: creatine ratio in the myoplasm in vivo, the glycolytic flux may be suppressed due to limited availability of ADP restricted by the creatine kinase system. The possible physiological role of the control of the glycolytic flux by the creatine kinase system is discussed.

[Steady state kinetics of pyruvate kinase from muscle]. / Statsionarnaia kinetika myshechnoi piruvatkinazy.

The dependence of the forward pyruvate kinase reaction on the concentrations of ADP and Mg2+ was studied. It was shown that high total ADP concentrations (2-15 mM) exceeding total Mg2+ concentration in the medium lead to the inhibition of the pyruvate kinase reaction, whereas relatively high Mg2+ concentrations (up to 15 mM) do not cause any inhibition. The kinetics of the reaction can be described in the best way by a scheme incorporating the active PEP . E . Mg2+ . Mg . ADP complex and dead-end complexes containing free ADP. An analysis of the experimental data allows to determine all coefficients of the rate equation and to calculate the values of all kinetic parameters. The values of the constants obtained were used for mathematical simulation of the reaction on the basis of the kinetic scheme given. The mathematical model obtained describes satisfactorily the experimentally determined dependences, which is indicative of the correctness of the model.