[Organizational and managerial problems of the risks in the health service system and the safe medical practice].

For the creation of the safety of the medical aid it is necessary to make a complex systems efforts, which includes a lot of professional, organizational, juridical and psychological actions for the improvement of the treatment and diagnostic process, the promotion of the real conditions for the risk-management in the organizational and clinic practice.

[Organizational and socio-medical problems of palliative care in Russia].

The system of palliative care to the population is being formed in Russia. This article considers stages of this work and results of research on organizational and socio-medical aspects of palliative care. Scientifically substantiated proposals on the development of the hospice service in all territorial units of the Russian Federation based on recommendations of the World Health Organization are presented.

[Philosophic and medical aspects of palliative care and the problems of euthanasia].

The attitude of the society to the problem of euthanasia remains ambiguous from both moral and legal viewpoints. The authors review the attitudes of well-known philosophers, historians, and writers to the man's right for peaceful dying, and analyze various points of view on the problems of euthanasia. The article analyses ethical problems of palliative care as active care for a dying patient and his/her family. The philosophy of modern palliative medicine must favor the realization of the right for a peaceful death. The authors of the article consider palliative care for the dying to be an alternative to euthanasia.

[The issues of palliative care].

In Russia, the medical social, organizational and ethic principles of palliative care of the incurable patients are developed. The theoretical aspects of the tanatological issues of terminally ill patients are covered. The focus is made on the organization of palliative care at the stages of social and psychological death.

[Potential of antiinflammatory therapy in patients with chronic obstructive lung disease].

The aim of the study was to investigate the effects of erespal (fenspirid) on the clinical manifestations and parameters of inflammation in patients with chronic obstructive lung disease (COLD). The two stages of the study included 3-weak treatment during exacerbation periods and a 3-month outpatient follow-up during clinical remission periods. Erespal was administered twice a day in a total dose of 160 mg/day. The study included evaluation of clinical symptoms, respiratory function, bronchoscopic data, laboratory indices of inflammation, antioxydative status, life quality (LQ), as well as cytological and cytochemical analysis of induced sputum (IS). During exacerbation periods of COLD the researchers observed early and noticeable antitussive and mucolytic action of erespal, which were associated with lessening of bronchial obstruction and inflammation, significant fall of C-reactive protein level, cytosis in IS, proportion of neutrophiles (p < 0.01), elevation of lysosomal cation proteins in neutrophiles (p < 0.01), increase of total oxidant serum level (in 46.2% of the patients vs. 26.3% of the patients in the conventional therapy group). Long term (3 months) treatment with erespal led to further positive dynamics of clinical and laboratory indices of inflammation, and improved the results of cytological and cytochemical study of IS. The results of the study demonstrate that inclusion of erespal in complex therapy of COLD increases efficacy of treatment, due to its anti-inflammatory action during the periods of exacerbation and relative remission, prevents augmenting of bronchial obstruction, and improves patients' LQ.