[Assessment of effectiveness of use of resources of rural medicine].

OBJECTIVE: Іntroduction: Today, due to a lack of financial resources, rural medical and preventive institutions are in serious condition, the inefficient use of available means is increasing. Therefore, one of the directions of solving problems, on improving the functioning of the healthcare sphere, is to determine the level of efficiency of the use of available resources. The aim: the study is to develop an assessment of the effectiveness of the use of rural health resources. PATIENTS AND METHODS: Materials and methods: The analysis and systematization of key health indicators in the districts of the Poltava region. With the help of correlation analysis, a reliable correlation between medical and demographic, economic and social indicators was revealed, and indicators for assessing the effectiveness of the health care sector were identified. Statistics on medical and demographic and economic indicators of the Poltava region are provided by the Poltava Regional Information and Analytical Center for Medical Statistics. The statistical processing of the obtained data was carried out with the help of a program for statistical analysis IBM SPSS Statistics 21. The Pearson correlation criterion was used. An estimate of the strength of the correlation relation was obtained using the Cheddock table. RESULTS: Results: Іn order to determine the effectiveness of the rural health care system, we carried out a correlation analysis of economic, social and medical-demographic indicators. Evaluation of the effectiveness of health care expenditure showed the following results. With the increase in budget financing of the health care system, lethality and morbidity significantly decreases. A significant direct connection between the budget of health institutions, doctors of all specialties and on the other hand - the primary incidence of the population, in our opinion, is associated with an improvement in the detection of diseases by doctors. With an increase in the volume of services provided per person, there is a decrease in mortality and morbidity rates. CONCLUSION: Conclusions: Therefore, such medical and demographic indicators as mortality and morbidity can be used to assess the effectiveness of the rural health system by comparing them with economic indicators. The systematization of indicators characterizing the level of health of the population, including medical-demographic and socio-economic indicators, allows you to select among them the most informative.

Anterior vitreous detachment: risk factor for intraoperative complications during phacoemulsification.

PURPOSE: To confirm the presence of incomplete vitreolenticular adhesion via microscope-integrated intraoperative optical coherence tomography (iOCT) during cataract surgery and via diagnostic spectral-domain OCT (SD-OCT) postoperatively. SETTING: S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia. DESIGN: Prospective noninterventional single-center study. METHODS: Clinical characteristics and surgical videos of 27 patients (28 eyes) who had cataract surgery were documented. Real-time iOCT integrated into the surgical microscope was directed to view the retrolenticular anatomy at the end of the surgery. Postoperatively, SD-OCT was also performed. RESULTS: This study comprised 28 eyes of 27 patients. Berger space was identified in 21 cases (75%) intraoperatively via iOCT and in 23 cases (82%) postoperatively via stationary OCT. Depth dimensions varied from 33.5 ± 87.0 µm to 383.1 ± 226.3 µm. Hyperreflective dots and particles of different shapes and sizes were documented within Berger space in 16 cases (57%) intraoperatively and in 9 cases (32%) postoperatively. Capsular rupture occurred in 1 case due to excessive posterior capsular movement anteriorly. The posterior capsular rupture was converted into a posterior capsulorhexis, leaving the anterior hyaloid membrane intact. CONCLUSIONS: iOCT confirmed the penetration of crystalline lens microfragments, cellular material, or medical suspension (triamcinolone) into the space between the posterior lens capsule and the anterior hyaloid membrane. This occurs due to discontinuity of both lenticular zonules and Wieger ligament attachment. A Wieger ligament rupture can also allow excessive Berger space hydration during phacoemulsification leading to anterior displacement of the posterior lens capsule increasing the risk of instrument touch and posterior capsule rupture.