20 research outputs found
ΠΡΠ΅Π½ΠΊΠ° Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΠ΅ΠΌ Π·Π΄ΠΎΡΠΎΠ²ΡΡ ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΠΊΠ°ΠΊ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΠΌΠΎΠ΄Π΅ΡΠ½ΠΈΠ·Π°ΡΠΈΠΈ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ ΡΠ°Π½Π΅Π½ΠΈΡ
Is determined that the populationβs attitude to accessibility, quality of charge-free and paid medical services is depended on a financial status, state of health, availability of diseases and age. The paid medical service development will reduce the use of medical aid according to the compulsory medical insurance program that will allow to spend more resources on less wealthy groups of people. The expediency of health indexes monitoring, competitive relations development, motivation in public health service is proved to be necessary.Π£ΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΡ ΠΊ Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΠΈ, ΠΊΠ°ΡΠ΅ΡΡΠ²Ρ Π±Π΅ΡΠΏΠ»Π°ΡΠ½ΡΡ
ΠΈ ΠΏΠ»Π°ΡΠ½ΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΡΠ»ΡΠ³ (ΠΠΠ£) Π·Π°Π²ΠΈΡΠΈΡ ΠΎΡ ΡΠΈΠ½Π°Π½ΡΠΎΠ²ΠΎΠ³ΠΎ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ, ΡΠΎΡΡΠΎΡΠ½ΠΈΡ Π·Π΄ΠΎΡΠΎΠ²ΡΡ, Π½Π°Π»ΠΈΡΠΈΡ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ, Π²ΠΎΠ·ΡΠ°ΡΡΠ°. Π Π°Π·Π²ΠΈΡΠΈΠ΅ ΠΠΠ£ ΠΏΠΎΠ½ΠΈΠ·ΠΈΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΠΏΠΎ ΡΠΈΡΡΠ΅ΠΌΠ΅ ΠΎΠ±ΡΠ·Π°ΡΠ΅Π»ΡΠ½ΠΎΠ³ΠΎ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠ³ΠΎ ΡΡΡΠ°Ρ
ΠΎΠ²Π°Π½ΠΈΡ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΡ Π·Π°ΡΡΠ°ΡΠΈΡΡ Π±ΠΎΠ»ΡΡΠ΅ ΡΠ΅ΡΡΡΡΠΎΠ² Π½Π° ΠΌΠ΅Π½Π΅Π΅ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½Π½ΡΠ΅ Π³ΡΡΠΏΠΏΡ. ΠΠ±ΠΎΡΠ½ΠΎΠ²ΡΠ²Π°Π΅ΡΡΡ ΡΠ΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎΡΡΡ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΠ½Π³Π° ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ Π·Π΄ΠΎΡΠΎΠ²ΡΡ, ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΊΠΎΠ½ΠΊΡΡΠ΅Π½ΡΠ½ΡΡ
ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΉ, ΠΌΠΎΡΠΈΠ²Π°ΡΠΈΠΈ Π² Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠΈ
Antithrombotic Therapy in Patients with Paroxysmal Atrial Fibrillation after Catheter Treatment
Aim. To study the efficacy and safety of antithrombotic therapy in patients with paroxysmal atrial fibrillation (AF) after catheter treatment during 36 months of follow-up.Material and methods. The retrospective observational study included 592 patients (283 men) who underwent catheter treatment of AF, aged 26 to 86 years (median age was 61.0 [55; 67]) with paroxysmal AF, treated in cardiac arrhythmias department of the Institute of Cardiology of Tomsk National Research Medical Center from 01.01.2017 to 31.12.2019. All patients were retrospectively divided into 2 groups: the first group consisted of patients with effective AF ablation, the second - with ineffective AF ablation. During follow-up after 12, 24 and 36 months, patients' complaints, documented arrhythmia recurrences, adherence to the prescribed treatment, and adverse clinical events were taken into account.Results. In patients with paroxysmal AF, the effectiveness of catheter treatment was 73.1% after 12 months of follow-up, 69.3% β after 24 months, 71.6% β after 36 months. The analysis of our data showed that during the follow-up period of 36 months, the incidence of ischemic stroke against the background of anticoagulant therapy and effective catheter treatment of paroxysmal AF was significantly lower than in patients with unsuccessful ablation (0.3% (n=1) and 3.7% (n=4), respectively), even despite the fact that not all patients from the first group received prescribed medication.Conclusion. The use of anticoagulant therapy in patients with paroxysmal AF after interventional treatment is safe, since the invasive strategy in combination with anticoagulant therapy does not increase the risk of major and minor bleeding, and in the case of effective intervention allows statistically significantly reduce the risk of ischemic stroke and almost completely eliminate the likelihood of other thromboemolic complications
IDIOPATHIC FORM OF ATRIAL FIBRILLATION, INFLAMMATION AND CLINICAL RESULTS OF RADIOFREQUENCY ABLATION
ΠΠΏΡΡ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΡ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΡΠ½Π΄ΠΎΠΊΡΠΈΠ½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΡΡΠ΅Π΄ΠΈ ΡΡΡΠ΄Π΅Π½ΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠΎΠ»ΠΎΠ΄Π΅ΠΆΠΈ Π³. Π’ΠΎΠΌΡΠΊΠ°
We studied the data for the period 2007β2009 about incidence by an endocrine pathologies of trained youth in Tomsk. On the basis of the system approach are studied is lead the complex analysis of the organization of the preventive help of student's youth, the effective system of actions on perfection of the organization of the medical-preventive help to students is generated and introduced.ΠΠ·ΡΡΠ΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π΅ΠΌΠΎΡΡΠΈ ΡΠ½Π΄ΠΎΠΊΡΠΈΠ½Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠ΅ΠΉ ΠΎΠ±ΡΡΠ°ΡΡΠ΅ΠΉΡΡ ΠΌΠΎΠ»ΠΎΠ΄Π΅ΠΆΠΈ Π³. Π’ΠΎΠΌΡΠΊΠ° Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2007 ΠΏΠΎ2009Β Π³. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π΅ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡΠΉ Π°Π½Π°Π»ΠΈΠ· ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΡΡΡΠ΄Π΅Π½ΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠΎΠ»ΠΎΠ΄Π΅ΠΆΠΈ, ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π° ΠΈ Π²Π½Π΅Π΄ΡΠ΅Π½Π° ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½Π°Ρ ΡΠΈΡΡΠ΅ΠΌΠ° ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΠΉ ΠΏΠΎ ΡΠΎΠ²Π΅ΡΡΠ΅Π½ΡΡΠ²ΠΎΠ²Π°Π½ΠΈΡ ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠΎ-ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΡΡΡΠ΄Π΅Π½ΡΠ°ΠΌ
ΠΠ¦ΠΠΠΠ ΠΠ ΠΠΠ‘Π₯ΠΠΠ―Π©ΠΠ₯ Π ΠΠ€ΠΠ Π Π ΠΠΠ ΠΠΠΠΠ₯Π ΠΠΠΠΠΠ Π ΠΠΠΠ’ΠΠΠΠΠΠ Π€ΠΠΠΠ ΠΠΠ¬ΠΠ«Π₯ Π£Π§Π ΠΠΠΠΠΠΠ
During studying of opinion of physicians and heads of Tomsk oblast federal healthcare institutions' departments it was revealedΒ that stuff of institutions have a positive attitude to current changes only in case of being informed enough about territorial program of state guarantees of providing of free medical care to population and about main directions of reforms. On the basis of received results of survey suggestions were formed, which are directed to improving the awareness of employees and formation of personnel policy of institutions.ΠΡΠΈ ΠΈΠ·ΡΡΠ΅Π½ΠΈΠΈ ΠΌΠ½Π΅Π½ΠΈΡ Π²ΡΠ°ΡΠ΅ΠΉ ΠΈ ΡΡΠΊΠΎΠ²ΠΎΠ΄ΠΈΡΠ΅Π»Π΅ΠΉ ΡΡΡΡΠΊΡΡΡΠ½ΡΡ
ΠΏΠΎΠ΄ΡΠ°Π·Π΄Π΅Π»Π΅Π½ΠΈΠΉ ΡΠ΅Π΄Π΅ΡΠ°Π»ΡΠ½ΡΡ
ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΡ, Π½Π°Ρ
ΠΎΠ΄ΡΡΠΈΡ
ΡΡ Π½Π° ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠΈ Π’ΠΎΠΌΡΠΊΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ, ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ°Ρ
ΡΠ΅ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΈ ΠΌΠΎΠ΄Π΅ΡΠ½ΠΈΠ·Π°ΡΠΈΠΈ ΠΎΡΡΠ°ΡΠ»ΠΈ Π²ΡΡΠ²Π»Π΅Π½ΠΎ, ΡΡΠΎ ΡΠΎΡΡΡΠ΄Π½ΠΈΠΊΠΈ ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΠΈΠΌΠ΅ΡΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΊ ΠΏΡΠΎΠΈΡΡ
ΠΎΠ΄ΡΡΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΡΠΈ ΡΡΠ»ΠΎΠ²ΠΈΠΈ Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ ΠΏΠΎΠ»Π½ΠΎΠΉ ΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΡΡΠΈ ΠΎ ΡΠ΅ΡΡΠΈΡΠΎΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ΅ Π³ΠΎΡΡΠ΄Π°ΡΡΡΠ²Π΅Π½Π½ΡΡ
Π³Π°ΡΠ°Π½ΡΠΈΠΉ ΠΎΠΊΠ°Π·Π°Π½ΠΈΡ Π±Π΅ΡΠΏΠ»Π°ΡΠ½ΠΎΠΉ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΡ ΠΈ ΠΎΡΠ½ΠΎΠ²Π½ΡΡ
Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½ΠΈΡΡ
ΡΠ΅ΡΠΎΡΠΌ. ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΡΠΎΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΎΠΏΡΠΎΡΠ° ΡΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Ρ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ΠΈΡ, Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΡΠ΅ Π½Π° ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΠΈΠ½ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½Π½ΠΎΡΡΠΈ ΡΠ°Π±ΠΎΡΠ½ΠΈΠΊΠΎΠ² ΠΈ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΊΠ°Π΄ΡΠΎΠ²ΠΎΠΉ ΠΏΠΎΠ»ΠΈΡΠΈΠΊΠΈ Π² ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡΡ
Ultrasound diagnosis of congestion in the pulmonary and systemic circulations in patients with atrial fibrillation and chronic heart failure
Π‘Π½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΌΠ° ΠΊΠ°ΠΊ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΠΉ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΡΡ ΡΠ°Ρ ΠΈΠ°ΡΠΈΡΠΌΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ°
Highlights. The implantation of cardioverter-defibrillator is the most effective method for preventing sudden cardiac death. However, almost 25% patients have normally functioning CD at the 5-years follow-up. This has necessitated the search for new non-invasive diagnostic methods for detecting patients at high risk of ventricular tachyarrhythmias.Aim. To evaluate whether the estimated heart rate variability may be used as a predictor for ventricular arrhythmias (VTA) in patients with coronary artery disease.Methods. 51 patients (mean age of 65.4Β±8.4 year; 41 male patients (80,3%)) with coronary artery disease (CAD) and indications for cardioverter-defibrillator (ICD) implantation were included to the study. The 6-minute walk distance, echocardiography, heart rate variability (HRV) were assessed and compared between the groups. The statistical analysis was performed using the Statistica 10.0, StatSoft (USA) and MedCalc statistical software (USA).Results. 43 (84.3%) patients with VTA within the 18-months follow-up were assigned to Group 1, and 8 (15.7%) patients without VTA during the 18-month follow-up were assigned to Group 2. The univariate ROC-analysis showed that a reduction in the average NN interval less than 1130 ms (p = 0.0282), root mean square of successive differences less than 18 ms (p = 0.0037) and high frequency spectral component less than 770 ms (p = 0.0001) contributed to the onset of of VTA. Multivariate ROC-analysis demonstrated that the end-diastolic index (p = 0.0185) and standard deviation of NN interval (p = 0.0370) were independent predictors of VTA. An increase of the VTA predictive index (calculated according to the presented predictive model) by >0.5613 suggested the onset of VTA (AUC = 0.927; p = 0.0001).Conclusion. Reduced HRV may be a non-invasive VTA predictor in patients with CAD. The combined use of echocardiography and HRV analysis allows identifying a group of patients with high risk of sudden cardiac death.ΠΡΠ½ΠΎΠ²Π½ΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΡ. ΠΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π΅ΡΡΠ΅ΡΠ°-Π΄Π΅ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΎΡΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°ΠΌΡΠΌ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ Π²Π½Π΅Π·Π°ΠΏΠ½ΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ. ΠΠ΄Π½Π°ΠΊΠΎ, ΠΏΠΎ Π΄Π°Π½Π½ΡΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 5-Π»Π΅ΡΠ½Π΅Π³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π° ΠΏΠΎΡΠ»Π΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΠΠ, ΡΠΎΠ»ΡΠΊΠΎ Ρ 25% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΡΠ°Π±Π°ΡΡΠ²Π°ΡΡ ΡΡΡΡΠΎΠΉΡΡΠ²Π°. Π ΡΠ²ΡΠ·ΠΈ Ρ ΡΡΠΈΠΌ, Π°ΠΊΡΡΠ°Π»ΡΠ½ΡΠΌ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠΎΠΈΡΠΊ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π½ΡΡ
ΠΌΠ΅ΡΠΎΠ΄ΠΎΠ² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠΈ Π΄Π»Ρ Π²ΡΡΠ²Π»Π΅Π½ΠΈΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΡΡ
ΡΠ°Ρ
ΠΈΠ°ΡΠΈΡΠΌΠΈΠΉ.Π¦Π΅Π»Ρ. ΠΠ·ΡΡΠΈΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΎΡΠ΅Π½ΠΊΠΈ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΌΠ° Π² ΠΊΠ°ΡΠ΅ΡΡΠ²Π΅ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ° ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΡΡ
ΡΠ°Ρ
ΠΈΠ°ΡΠΈΡΠΌΠΈΠΉ (ΠΠ’Π) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ°.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΡΒ Β Β Β Β Β Β Β Β Β Β Β Β Β . Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠ΅Π½ 51 ΠΏΠ°ΡΠΈΠ΅Π½Ρ (ΡΡΠ΅Π΄Π½ΠΈΠΉ Π²ΠΎΠ·ΡΠ°ΡΡ - 65,4Β±8,4 Π»Π΅Ρ), ΠΈΠ· Π½ΠΈΡ
41 ΠΌΡΠΆΡΠΈΠ½Π° (80,3%), Ρ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠΉ Π±ΠΎΠ»Π΅Π·Π½ΡΡ ΡΠ΅ΡΠ΄ΡΠ° (ΠΠΠ‘) ΠΈ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡΠΌΠΈ Π΄Π»Ρ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΠΊΠ°ΡΠ΄ΠΈΠΎΠ²Π΅ΡΡΠ΅ΡΠ°-Π΄Π΅ΡΠΈΠ±ΡΠΈΠ»Π»ΡΡΠΎΡΠ° (ΠΠ). ΠΡΠ΅Π½ΠΈΠ²Π°Π»ΠΈ ΠΈ ΡΡΠ°Π²Π½ΠΈΠ²Π°Π»ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ ΡΠ΅ΡΡΠ° 6-ΠΌΠΈΠ½ΡΡΠ½ΠΎΠΉ Ρ
ΠΎΠ΄ΡΠ±Ρ, ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ, Ρ
ΠΎΠ»ΡΠ΅ΡΠΎΠ²-ΡΠΊΠΎΠ³ΠΎ ΠΌΠΎΠ½ΠΈΡΠΎΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ»Π΅ΠΊΡΡΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΠΌΠΌΡ Ρ Π°Π½Π°Π»ΠΈΠ·ΠΎΠΌ Π²Π°ΡΠΈΠ°Π±Π΅Π»ΡΠ½ΠΎΡΡΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΡΠΌΠ° (ΠΠ‘Π ) ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ. Π‘ΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈΠΉ Π°Π½Π°Π»ΠΈΠ· ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΠ°ΠΊΠ΅ΡΠ° ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌ Statistica 10.0, StatSoft (USA) ΠΈ MedCalcstatisticalsoftware (USA).Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ΅ΡΠ²ΡΡ Π³ΡΡΠΏΠΏΡ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΈ 43 (84,3%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, Ρ ΠΊΠΎΡΠΎΡΡΡ
Π·Π° 18 ΠΌΠ΅ΡΡΡΠ΅Π² Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΡ Π±ΡΠ»ΠΈ Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½Ρ ΠΏΠ°ΡΠΎΠΊΡΠΈΠ·ΠΌΡ ΠΠ’Π. ΠΡΠΎΡΡΡ Π³ΡΡΠΏΠΏΡ - 8 (15,7%) ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Ρ ΠΊΠΎΡΠΎΡΡΡ
Π½Π΅ Π±ΡΠ»ΠΎ Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠΈΡΠΎΠ²Π°Π½ΠΎ ΠΏΠ°ΡΠΎΠΊΡΠΈΠ·ΠΌΠΎΠ² ΠΠ’Π. ΠΠ΄Π½ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΡΠΉ ROC-Π°Π½Π°Π»ΠΈΠ· Π²ΡΡΠ²ΠΈΠ», ΡΡΠΎ ΠΏΡΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠΈ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»Π° NN ΠΌΠ΅Π½Π΅Π΅ 1130 ΠΌΡ (Ρ = 0,0282), ΠΊΠ²Π°Π΄ΡΠ°ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΡΠ½Ρ ΠΈΠ· ΡΡΠ΅Π΄Π½Π΅ΠΉ ΡΡΠΌΠΌΡ ΠΊΠ²Π°Π΄ΡΠ°ΡΠΎΠ² ΡΠ°Π·Π½ΠΎΡΡΠ΅ΠΉ ΠΌΠ΅ΠΆΠ΄Ρ ΡΠΎΡΠ΅Π΄Π½ΠΈΠΌΠΈ NN-ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»Π°ΠΌΠΈ ΠΌΠ΅Π½Π΅Π΅ 18 ΠΌΡ (Ρ = 0,0037) ΠΈ Π²ΡΡΠΎΠΊΠΎΡΠ°ΡΡΠΎΡΠ½ΠΎΠ³ΠΎ ΡΠΏΠ΅ΠΊΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠ° ΠΌΠ΅Π½Π΅Π΅ 770 ΠΌΡ (p = 0,0001) ΡΠ°Π·Π²ΠΈΠ²Π°Π»ΠΈΡΡ ΠΏΠ°ΡΠΎΠΊΡΠΈΠ·ΠΌΡ ΠΠ’Π. ΠΠ½ΠΎΠ³ΠΎΡΠ°ΠΊΡΠΎΡΠ½ΡΠΉ ROC-Π°Π½Π°Π»ΠΈΠ· ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π», ΡΡΠΎ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎ-Π΄ΠΈΠ°ΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΈΠ½Π΄Π΅ΠΊΡ (Ρ = 0,0185) ΠΈ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠ΅ ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΠ΅ NN-ΠΈΠ½ΡΠ΅ΡΠ²Π°Π»ΠΎΠ² (Ρ = 0,0370) ΡΠ²Π»ΡΡΡΡΡ Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΠΌΠΈ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠ°ΠΌΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ’Π. Π Π°ΡΡΠ΅Ρ ΠΏΡΠ΅Π΄ΡΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠ½ΠΎΠΉ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ’Π ΠΏΠΎ Π΄Π°Π½Π½ΠΎΠΉ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΌΠΎΠ΄Π΅Π»ΠΈ Π²ΡΡΠ²ΠΈΠ», ΡΡΠΎ ΠΏΡΠΈ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠΈ ΠΊΠΎΡΡΡΠΈΡΠΈΠ΅Π½ΡΠ° Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΠΈ Π±ΠΎΠ»Π΅Π΅ 0,5613 Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘ ΡΠ°ΡΠ΅ ΡΠ°Π·Π²ΠΈΠ²Π°Π»ΠΈΡΡ ΠΏΠ°ΡΠΎΠΊΡΠΈΠ·ΠΌΡ ΠΠ’Π (AUC = 0,890; Ρ = 0,0001).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π‘Π½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΠ‘Π ΠΌΠΎΠΆΠ΅Ρ ΡΠ»ΡΠΆΠΈΡΡ ΠΏΡΠ΅Π΄ΠΈΠΊΡΠΎΡΠΎΠΌ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ’Π Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘. Π‘ΠΎΠ²ΠΌΠ΅ΡΡΠ½ΠΎΠ΅ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΠ‘Π ΠΈ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΠΈ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΡΠΈΡΠΎΠ²Π°ΡΡ Π³ΡΡΠΏΠΏΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠΈΡΠΊΠΎΠΌ Π²Π½Π΅Π·Π°ΠΏΠ½ΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠΈ
Π‘ΠΎΡΠΈΠ°Π»ΡΠ½ΠΎ-Π³ΠΈΠ³ΠΈΠ΅Π½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ ΡΡΠ»ΡΠ³ Π² ΡΠ΅Π»ΡΡΠΊΠΈΡ ΡΠ°ΠΉΠΎΠ½Π°Ρ Π’ΠΎΠΌΡΠΊΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ
Results of out-departments expertise revealed that medical service quality in rural areas of theTomskregion is worse than in municipal hospitals. The causes of such discrepancy is non-complete examination and wrong diagnosis. Patientsβ assessment of medical service quality is highly controversial: 72% of patients noted improving of treatment results but only 42% of patients considered their treatment results to be satisfactory.The leading factors of supplying quality of medical service in the rural health care are presence of modern diagnostic tools in rural hospitals (9.2β9.7 marks), and increasing of specialistsβ quality of work (8.0β9.5 marks). In addition, medical institutionsβ chiefs note the role of financial independence of the physician β in-chief (9.5 marks) and medical insurance companies experts note increasing out-departmental control (9.5 marks).Π£ΡΠΎΠ²Π΅Π½Ρ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ Π² ΡΠ΅Π»ΡΡΠΊΠΈΡ
ΡΠ°ΠΉΠΎΠ½Π°Ρ
Π’ΠΎΠΌΡΠΊΠΎΠΉ ΠΎΠ±Π»Π°ΡΡΠΈ ΠΏΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ Π²Π½Π΅Π²Π΅Π΄ΠΎΠΌΡΡΠ²Π΅Π½Π½ΠΎΠΉ ΡΠΊΡΠΏΠ΅ΡΡΠΈΠ·Ρ Π½ΠΈΠΆΠ΅, ΡΠ΅ΠΌ Π² Π³ΠΎΡΠΎΠ΄ΡΠΊΠΈΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡΡ
. ΠΡΠΈΡΠΈΠ½Π°ΠΌΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΡΠ²Π»ΡΡΡΡΡ Π½Π΅ΠΏΠΎΠ»Π½ΠΎΠ΅ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈ Π½Π΅ΠΏΡΠ°Π²ΠΈΠ»ΡΠ½Π°Ρ ΠΏΠΎΡΡΠ°Π½ΠΎΠ²ΠΊΠ° Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π°. ΠΡΠ΅Π½ΠΊΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΎΠΉ ΠΏΠΎΠΌΠΎΡΠΈ ΡΠ²Π»ΡΠ΅ΡΡΡ Π² Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΡΠΎΡΠΈΠ²ΠΎΡΠ΅ΡΠΈΠ²ΠΎΠΉ: 72% ΠΎΠΏΡΠΎΡΠ΅Π½Π½ΡΡ
ΠΎΡΠΌΠ΅ΡΠΈΠ»ΠΈ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ Π² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΡ, Π½ΠΎ Π»ΠΈΡΡ 42% ΡΠ΄ΠΎΠ²Π»Π΅ΡΠ²ΠΎΡΠ΅Π½Ρ Π΅Π³ΠΎ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎΠΌ, ΠΏΡΠΈ ΡΡΠΎΠΌ ΡΠΎΠ»ΡΠΊΠΎ 12% ΠΈΠ· ΠΈΡ
ΡΠΈΡΠ»Π° ΠΎΡΠΎΡΠΌΠΈΠ»ΠΈ ΠΏΡΠ΅ΡΠ΅Π½Π·ΠΈΠΈ Π΄ΠΎΠΊΡΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΠΎ.ΠΠ΅Π΄ΡΡΠΈΠΌΠΈ ΡΠ°ΠΊΡΠΎΡΠ°ΠΌΠΈ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ ΠΊΠ°ΡΠ΅ΡΡΠ²Π° ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΡΠ»ΡΠ³ Π² ΡΠ΅Π»ΡΡΠΊΠΎΠΌ Π·Π΄ΡΠ°Π²ΠΎΠΎΡ
ΡΠ°Π½Π΅Π½ΠΈΠΈ ΠΏΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ°ΠΌ ΡΠΊΡΠΏΠ΅ΡΡΠ½ΠΎΠΉ ΠΎΡΠ΅Π½ΠΊΠΈ ΡΠ²Π»ΡΡΡΡΡ ΡΠ»Π΅Π΄ΡΡΡΠΈΠ΅: ΠΎΡΠ½Π°ΡΠ΅Π½ΠΈΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΌ Π»Π΅ΡΠ΅Π±Π½ΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΎΠ±ΠΎΡΡΠ΄ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ (9,2β9,7 Π±Π°Π»Π»Π°) ΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΠΊΠ²Π°Π»ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ² (8,0β9,5 Π±Π°Π»Π»Π°). ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, ΡΡΠΊΠΎΠ²ΠΎΠ΄ΠΈΡΠ΅Π»ΠΈ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΡΡΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠΉ ΠΎΡΠΌΠ΅ΡΠ°ΡΡ ΡΠΎΠ»Ρ ΡΠΈΠ½Π°Π½ΡΠΎΠ²ΠΎΠΉ ΡΠ°ΠΌΠΎΡΡΠΎΡΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π³Π»Π°Π²Π½ΠΎΠ³ΠΎ Π²ΡΠ°ΡΠ° (9,5 Π±Π°Π»Π»Π°), Π° ΡΠΊΡΠΏΠ΅ΡΡΡ ΡΡΡΠ°Ρ
ΠΎΠ²ΡΡ
ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈΡ
ΠΎΡΠ³Π°Π½ΠΈΠ·Π°ΡΠΈΠΉ β ΡΡΠΈΠ»Π΅Π½ΠΈΠ΅ Π²Π½Π΅Π²Π΅Π΄ΠΎΠΌΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ (9,5 Π±Π°Π»Π»Π°)