RESUMEN
Diabetes mellitus (DM) type 2 is the serious progressing chronic disease representing independent risk factor of development of cardiovascular complications. The mortality from cardiovascular diseases at the persons suffering from DM type 2 continues to grow around the world, despite constant augmentation of expenses on treatment and prophylaxis. In this article factors of cardiovascular risk at DM are analyzed and possible ways of their correction are surveyed.
Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/complicaciones , Enfermedades Cardiovasculares/mortalidad , Diabetes Mellitus Tipo 2/mortalidad , Humanos , Mortalidad/tendencias , Factores de RiesgoRESUMEN
Ultrasound duplex scanning was used to compare the results of the treatment of 162 patients suffering from atherosclerosis obliterans of the lower extremities. It is to be noted that 50 patients were administered only gravitation therapy, 72 patients underwent a complex of treatment measures including, in addition to gravitation therapy, physiotherapy and drug treatment, and 40 patients received conservative treatment alone. The assessment criteria were the maximal systolic velocity of blood flow (V(max)), end diastolic mean, velocity (V(min)), mean maximal velocity (V(mean)), volume velocity of blood flow (V(vol)), ankle/brachial index (ABI), and index of regional perfusion (IRP), proposed by us and representing the percent ratio of the volume velocity of blood flow to the minute heart volume (MHV). It has been revealed in the course of the treatment that the best clinical outcome was recorded in patients who received a complex of treatment measures. The use of gravitation therapy alone provided better treatment results as compared to those obtained in patients administered standard conservative therapy. Of all the indicators used, only V(mean), V(vol), ABI and IRP are of the clinical significance. However, the most significant information on the segmental blood flow was obtained on the assessment of the IRP whose values did not depend on the changes in central hemodynamics. In contrast to the ABI, the advantage of the IRP lies in the possibility of blood flow assessment in different segments and arteries of the extremities. So, the use of the quantitative indicators of ultrasound duplex scanning and, first of all, of the IRP, allows an objective evaluation of the segmental blood flow and may serve one of the significant criteria of the treatment effectiveness.
Asunto(s)
Arteriosclerosis/diagnóstico por imagen , Arteriosclerosis/terapia , Gravitación , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Adulto , Anciano , Arteriosclerosis/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Diástole/fisiología , Femenino , Hemodinámica/fisiología , Humanos , Extremidad Inferior/fisiopatología , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Sístole/fisiología , Ultrasonografía Doppler DúplexRESUMEN
The article sums up results of treatment of 152 patients with obliterating atherosclerosis of the lower extremity arteries which were exposed to 2-3 G gravitation overloading made in a centrifuge of a short radius in direction head--pelvis. The gravitation overloading in the regimen followed were not found to have negative effects of central hemodynamics. Peripheral circulation was noted to considerably improve which is confirmed: 1) by clinical data showing 2-5 times longer distance of painless walking; 2) by the data of ultrasound dopplerography manifested as larger volume rate of blood flow and regional perfusion index; 3) by thermographic explorations evidencing the recovery of the thermoprophile of the legs and feet. Thus, the application of gravitation overloading is a new effective method of conservative treatment of patients with the pathology in question.
Asunto(s)
Arteriosclerosis Obliterante/terapia , Hipergravedad , Extremidad Inferior/irrigación sanguínea , Anciano , Arteriosclerosis Obliterante/fisiopatología , Presión Sanguínea , Temperatura Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
A concept of strategic development of territorial service of maternity and childhood protection has been developed in the Samara region making use of international experience. The results indicate improvement of qualitative parameters of the service activities after introduction of international programs.
Asunto(s)
Mortalidad Infantil , Bienestar del Lactante , Mortalidad Materna , Bienestar Materno , Aborto Criminal/tendencias , Aborto Inducido/tendencias , Aborto Espontáneo/prevención & control , Adolescente , Adulto , Factores de Edad , Niño , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Cooperación Internacional , Masculino , Mortalidad Materna/tendencias , Embarazo , Federación de RusiaRESUMEN
Recently married elderly people change attitude to hospital treatment and living in asylums; they prefer care rendered at home and hospital-substituting forms of care; hospitalization and ambulance care are less needed and permanent social workers are required less. All this promotes rational utilization of the potentialities of therapeutic institutions and saving of public health and social protection resources.
Asunto(s)
Anciano , Servicios de Salud/estadística & datos numéricos , Estado de Salud , Matrimonio , Factores de Edad , Consumo de Bebidas Alcohólicas , Femenino , Servicios de Salud/economía , Servicios de Atención de Salud a Domicilio/economía , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Federación de Rusia , Factores Sexuales , Fumar , Servicio Social/economía , CaminataRESUMEN
Development of hospital-substituting forms of medical care in the Samara region is discussed, 13% of patients treated at hospitals were rendered medical care through hospital-substituting institutions, which resulted in economy of 137 million roubles. The authors make their suggestions on optimizing statistical forms of files and records to be used in registration of medical care at day-time hospitals.
Asunto(s)
Atención Ambulatoria , Centros de Día , Adulto , Atención Ambulatoria/economía , Niño , Costos y Análisis de Costo , Centros de Día/economía , Femenino , Hospitalización/economía , Humanos , Masculino , Pacientes Ambulatorios/estadística & datos numéricos , Pacientes/estadística & datos numéricos , Embarazo , Federación de RusiaRESUMEN
Presents data on the non-hospital forms of medicosocial care of elderly and senile subjects in the Russian Federation, which proved to be the most effective as regards the economy and staff under conditions of the population aging.
Asunto(s)
Atención Ambulatoria/organización & administración , Servicios de Salud para Ancianos/organización & administración , Anciano , Instituciones de Atención Ambulatoria/organización & administración , Centros de Día/organización & administración , Medicina Familiar y Comunitaria/organización & administración , Humanos , Persona de Mediana Edad , Federación de Rusia , Servicio Social/organización & administraciónRESUMEN
The role of "training practice" in the formation of teams of specialists of the reformed primary health care is discussed. Innovation models of a "general practitioner" ("family doctor"), "family office manager", "general practice nurse" are mastered at "experimental" sites of an organization experiment. The philosophy of a tutor in general practice, individual requirements of students, and regulations of training are defined. Scheme of information of all interested persons and organizations on the alterations is presented. Prospects in development of primary health and social care of the family are outlined on the basis of general practices in the Samara region.
Asunto(s)
Educación en Enfermería , Medicina Familiar y Comunitaria , Atención Primaria de Salud , Enseñanza , Enfermeras Practicantes , Federación de RusiaAsunto(s)
Medicina Preventiva , Administración en Salud Pública , Salud Pública , Regionalización , Adolescente , Adulto , Niño , Humanos , Federación de RusiaRESUMEN
Hospital forms of medicosocial care of elderly and senile subjects in Russia are reviewed on the basis of published reports and authors' data. Together with outpatient forms, hospital forms of care of the elderly have been widely used of late and are functioning within the framework of public health and social protection systems. Integration of medical and social services in the sphere of health protection of the elderly is emphasized.
Asunto(s)
Servicios de Salud para Ancianos , Hogares para Ancianos , Hospitalización , Casas de Salud , Anciano , Humanos , Persona de Mediana Edad , Federación de RusiaRESUMEN
Organization of a cardiological obstetrical daytime hospital, contribution of physicians of many profiles, and use of a wide spectrum of methods for examination improved the quality of follow-up of women of fertile age with cardiovascular diseases and promoted timely cardial, cardiosurgical, and obstetrical care of this patient population. Improvement of follow-up of adolescent girls with cardiovascular diseases permits detection of disease before gestation, timely surgical correction, and preparation to gestation. Follow-up of pregnant patients with cardiovascular diseases resulted in decrease of perinatal and maternal mortality.
Asunto(s)
Atención Ambulatoria/organización & administración , Servicio de Cardiología en Hospital/organización & administración , Reforma de la Atención de Salud , Servicio de Ginecología y Obstetricia en Hospital/organización & administración , Femenino , Humanos , Embarazo , Federación de RusiaRESUMEN
Advantages of the formation of gastroduodenal anastomosis using the microsurgical precision technique as compared to the two-row interrupted Albert-Lembert suture and the one-row suture of Pirogov-Mateshuk were established in an experimental investigation in 63 dogs. The article describes the precision suture technique proposed by the authors which was used in Billroth-I resection of the stomach in 15 patients. It was shown that the use of the precision suture resulted in healing by the first intention type, without motor evacuatory disorders and with shorter time of hospital treatment.
Asunto(s)
Duodeno/cirugía , Gastrectomía/métodos , Microcirugia/métodos , Estómago/cirugía , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Animales , Perros , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Factores de TiempoAsunto(s)
Reforma de la Atención de Salud , Demografía , Femenino , Humanos , Masculino , Federación de RusiaRESUMEN
The strategic concept of territorial service of maternity and childhood health protection developed in the Samara Region with consideration for obligatory medical insurance can improve the health status of women and children, ameliorate the demographic situation, and decrease the reproductive loss in the Region.
Asunto(s)
Servicios de Salud del Niño , Obstetricia , Adolescente , Niño , Femenino , Humanos , Federación de RusiaRESUMEN
A program "Introduction of General Practitioners (Family Doctors) in the Primary Health Care System" has been developed in the Samara region. The first results are presented.
Asunto(s)
Medicina Familiar y Comunitaria , Reforma de la Atención de Salud , Atención Primaria de Salud/organización & administración , Federación de RusiaRESUMEN
The authors share the experience they gained in rendering medical care to elderly and senile patients and describe the specific features of such care under conditions of obligatory medical insurance. The study was carried out in the Samara region.
Asunto(s)
Servicios de Salud para Ancianos/organización & administración , Seguro de Salud , Anciano , Humanos , Persona de Mediana Edad , Federación de RusiaRESUMEN
In experimental study (40 dogs) variant of precisional (microsurgical) suture and anastomosis was developed, which was successfully carried out in clinical practice in 72 patients with various diseases of gastro-intestinal tract. For precisional formation of gastro-intestinal and bowel anastomoses magnifying optics, atraumatic suturing material and microsurgical instruments were used. Separately were sutured by knot sutures gastric or bowel serosa (external layer) and musculosubcutaneos layer of these organs together with mucous membrane tangentially, without its penetrating puncture (internal layer). The developed precisional method of formation of the anastomoses promotes healing of gastro-intestinal wound by primary intention and may be recommended for wider practical application.