Организация медицинской помощи новорожденным с дыхательной недостаточностью

The most frequent causes of perinatal morbidity and mortality due to respiratory disorders are asphyxia, respiratory distress-syndrome, aspiration of amniotic fluid, and neonatal pneumonia. The article is based on an analysis of domestic and foreign experience of different medical facilities and discusses the main principles of organization of urgent care of newborns with respiratory failure who represent a great deal of newborn patients at intensive care units. About 90% of the newborns have a good prognosis under the adequate and timely medical care.Среди респираторных нарушений наиболее частой причиной перинатальной заболеваемости и смертности являются асфиксия, респираторный дистресс-синдром, аспирация околоплодными водами, неонатальные пневмонии. На основании анализа отечественного и зарубежного опыта работы учреждений различного уровня в статье изложены основные принципы организации неотложной помощи новорожденным с дыхательной недостаточностью, которые составляют большую часть пациентов отделений реанимации и интенсивной терапии новорожденных. При своевременной и адекватной помощи на всех этапах до 90% новорожденных имеют благоприятный прогноз

Original Russian Text © Ya

Assessing the economic efficiency of medical information technologies calls for a quantitative comparison of costs and results. If the required indicators can be obtained, the efficiency can be estimated using known methods of economic efficiency evaluation for investment projects The next step in coming closer to a solution for the above task is to analyze common approaches to evaluating the efficiency of information systems irrespective of their domain. We should note here the lack of methods reliable in terms of practical application. Practical designs are available only for particular cases where specific conditions related to the type and domain of information systems introduced are assumed. Since a unified approach to the evaluation of information technologies' economic efficiency is not available, special methods must be developed for information systems aimed at solving particular management problems, especially in medicine. Such methods are mostly of a heuristic nature and are based on the study of costs and economic effects after the introduction of information systems in a particular case. If the costs and effects of implementing such systems can be evaluated, it is possible to subsequently apply the above common approach to assessing the economic efficiency of investment projects. The preferred level in solving the problem of assessing the efficiency of medical information systems is hardly attainable; therefore, a positive achievement here would be revealing the positive effects of introducing a particular information system in which each effect is measured by specific quality parameters. The above deductive logic in the development of methods for evaluating the efficiency of medical information technologies is observed in the below analysis of the present state of studies in the topic in question. A General Approach to Evaluating the Economic Efficiency of Investment Projects. Universal methodological recommendations for evaluating the efficiency of investment projects contain general principles and are suitable only for the most typical industrial projects. These methodological recommendations point to the need for using special procedures to assess the economic effects derived from non-standard situations (e.g., in projects for developing science and technology and environmental projects), one sign that the above methodological techniques are aimed at application broader than just the manufacturing of commodities. Such techniques for assessing efficiency should define the preferred area for investing funds among all potential areas in industry, science, public medical, and so on. The same methodological guideline should enable us to compare the efficiencies of any nonstandard projects with those of industrial projects, since the same financial resources are invested in both categories of projects. One problem of evaluating the efficiency of information technologies is describing their effects, which are not revenues from sales of products output and thus differ from the effects of industrial investment projects. The existing methodical guidelines contain references to the probability of such situations. They underline especially that investment is made to acquire a benefit. The tern "benefit" is used to show that the purposes of investment projects are not limited to a net profit in sales, but can take on other forms, e.g., the saving of funds and the prevention of losses. Apart Abstract -The topic of how to assess the economic efficiency of medical information technologies in a model of the system of electronic medical records is considered in this paper. The paper also gives an analysis of foreign approaches that would be interesting to consider for application in Russian conditions to assess the economic benefits of introducing the above information system in inpatient and outpatient care facilities

Original Russian Text © Ya

Assessing the economic efficiency of medical information technologies calls for a quantitative comparison of costs and results. If the required indicators can be obtained, the efficiency can be estimated using known methods of economic efficiency evaluation for investment projects The next step in coming closer to a solution for the above task is to analyze common approaches to evaluating the efficiency of information systems irrespective of their domain. We should note here the lack of methods reliable in terms of practical application. Practical designs are available only for particular cases where specific conditions related to the type and domain of information systems introduced are assumed. Since a unified approach to the evaluation of information technologies' economic efficiency is not available, special methods must be developed for information systems aimed at solving particular management problems, especially in medicine. Such methods are mostly of a heuristic nature and are based on the study of costs and economic effects after the introduction of information systems in a particular case. If the costs and effects of implementing such systems can be evaluated, it is possible to subsequently apply the above common approach to assessing the economic efficiency of investment projects. The preferred level in solving the problem of assessing the efficiency of medical information systems is hardly attainable; therefore, a positive achievement here would be revealing the positive effects of introducing a particular information system in which each effect is measured by specific quality parameters. The above deductive logic in the development of methods for evaluating the efficiency of medical information technologies is observed in the below analysis of the present state of studies in the topic in question. A General Approach to Evaluating the Economic Efficiency of Investment Projects. Universal methodological recommendations for evaluating the efficiency of investment projects contain general principles and are suitable only for the most typical industrial projects. These methodological recommendations point to the need for using special procedures to assess the economic effects derived from non-standard situations (e.g., in projects for developing science and technology and environmental projects), one sign that the above methodological techniques are aimed at application broader than just the manufacturing of commodities. Such techniques for assessing efficiency should define the preferred area for investing funds among all potential areas in industry, science, public medical, and so on. The same methodological guideline should enable us to compare the efficiencies of any nonstandard projects with those of industrial projects, since the same financial resources are invested in both categories of projects. One problem of evaluating the efficiency of information technologies is describing their effects, which are not revenues from sales of products output and thus differ from the effects of industrial investment projects. The existing methodical guidelines contain references to the probability of such situations. They underline especially that investment is made to acquire a benefit. The tern "benefit" is used to show that the purposes of investment projects are not limited to a net profit in sales, but can take on other forms, e.g., the saving of funds and the prevention of losses. Apart Abstract -The topic of how to assess the economic efficiency of medical information technologies in a model of the system of electronic medical records is considered in this paper. The paper also gives an analysis of foreign approaches that would be interesting to consider for application in Russian conditions to assess the economic benefits of introducing the above information system in inpatient and outpatient care facilities

Early visual experience and its role in the development of a child

The function of the visual analyzer plays one of the leading roles in the development of the child. From the first days of a child’s life, vision is closely associated with touch, hearing, smell and other types of sensitivity. As a result, complex dynamic systems of connections are formed, which are the sensory basis of all mental activity and orientation of the child in space. Understanding the processes and creating optimal conditions for early neuro-sensory development is important both for caring for a healthy newborn and young child, and for organizing developmental care for premature and sick children in a hospital setting. The newborn is able to recognize contrasting images (faces and eyes), which are rounded and easier to observe, since their eye muscles have not yet had much practice in making sudden movements. The visual apparatus of a premature newborn has additional functional limitations and points of vulnerability. The article discusses aspects of the visual system in the neonatal period, with a more detailed analysis of the features associated with prematurity, describes the mechanisms explaining the negative impact on the processes of visual development of intense direct light, the absence of objects and patterns in focus, lack of attention (for example, sedation), lack of changes in the environment, lack of movement, complete darkness, or lack of adequate lighting on waking. A long period of nursing a premature baby in a hospital in the intensive care unit, in an incubator microclimate in compliance with a protective regime, the impossibility of full maternal care, and therefore in the absence of sensitive stimuli, falls on the most important period of the development of the nervous system. It is at this age that an adequate and timely start of neurosensory development is very important, in connection with which the need for research is increasing to determine the optimal start dates and methodology for early developmental care

Recommendations from a European Roundtable Meeting on Best Practice Healthy Infant Skin Care

Background European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. Methods The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. Results Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies’ skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. Conclusion Health care professionals can use these recommendations as the basis of their advice to parents

The use of computer vision technologies for an objective assessment of indicators of concentration of attention in newborns and infants with visual stimulation for the purpose of developmental care

Assessment of visual function in the first few days after birth is mainly limited to the study of eye movements, the ability to fix a gaze and follow an object. In order to determine how the child's gaze moves when looking at an object, how long it is fixed on the object, techniques are needed to record the movements of the eyeballs and determine the trajectory of the gaze. THE AIM OF THE study is to develop a method based on machine learning technology and computer vision for the automated analysis of eye movement and fixation of the gaze of a newborn and an infant during visual stimulation. MATERIAL AND METHODS: The proposed method includes video filming of newborns and children of the first year of life in hospital and outpatient. Video recordings from mobile phone cameras with a length of 15 s to 3 min were used as the initial data. Of the 150 videos of newborns, 73 videos were selected, of which 61 recordings of sufficient quality were selected, in which the child was recognized in at least 30% of frames. For each recording, a track was recorded of the state of the newborn during visual stimulation. Facial recognition was implemented using a widely used pre-trained model based on machine learning and ultra-precise networks. The algorithm for the study of eye movement includes searching for a face, determining the position of the head by the location of the eyes, nose, lips, searching for the eye zone, searching for the pupil, determining the relative and absolute direction of gaze. RESULTS AND DISCUSSION: A neural network was developed and trained for recognizing facial images of newborns and babies and for locating the eyes on a child's face. The method made it possible to obtain data on the direction of the child's gaze in real time using the camera of an ordinary smartphone or a simple web camera. Depending on the size of the displayed image and the distance to it, the system calculates the total time of concentration on the image, and also detects moments when the child is not interested in the image. CONCLUSION: The proposed method can be used to analyze the effectiveness of early visual stimulation in children, in the context of long-term effects on psychomotor and cognitive development, as well as to objectify data from various programs for early assessment of visual function in newborns and infants

Social and medical rehabilitation of military conflicts

The article describes the need for social and psychological assistance in the rehabilitation of military personnel who have been in military conflicts, the goals and ways to improve social and psychological and medical rehabilitation.В статье описывается необходимость социально-психологической помощи в реабилитации военнослужащих, побывавших в военных конфликтах, цели и пути оказания социально-психологической и медицинской реабилитаци

Оценка клинико-функционального состояния и качества жизни больных хронической обструктивной болезнью легких до и после комплексной медикаментозной терапии в амбулаторных условиях

A comparative randomised trial of fenspirid (Erespal) had been administered for 3 months together with bronchodilating and mycolytic drugs involved 45 patients with chronic obstructive pulmonary disease (COPD). Clinical status, forced expiratory values and quality of life (QoL) were studied using World Organization of Health questionnaire (W H O Q O L -100). Thirty four patients completed the examination (24 males and 10 females, the average age was 52.7±1.9 yrs). The comparative group included 25 healthy non-smokers. The trial demonstrated that the therapy resulted in improvement of QoL in physical and psychical health scales. The patients becam e more active, their sleep becam e better. Their attention was transferred from their physical status to the surroundings. The application of fenspirid (Erespal) facilitated the improvement in the forced expiratory values and ESR. The drug was well tolerated and caused only mild adverse effects which rates were equal to those in patients not received fenspirid. The results permit fenspirid to be included to modern treatment protocols for patients with mild to moderate COPD when combined with bronchodilators.В сравнительное рандомизированное исследование препарата фенспирид (эреспал), применявшегося в течение 3 мес в сочетании с бронхолитическими и муколитическими средствами, было включено 45 больных хронической обструктивной болезнью легких (ХОБЛ). Изучали клинический статус пациентов, параметры форсированного выдоха и качество жизни больных ХОБЛ с помощью опросника Всемирной организации здравоохранения W H O Q O L-100. Полностью обследование завершили 34 больных ХОБЛ (24 мужчин и 10 женщин), средний возраст которых составил 52,7±1,9 года. 25 здоровых не курящих людей составили группу сравнения. Проведенное исследование показало, что после лечения качество жизни (КЖ), оцененное по методике, рекомендованной ВОЗ, улучшилось по шкалам, отражающим физическое и психическое здоровье. Больные стали более активными, у них улучшился сон. Акцентуация была перенесена с собственного физического состояния на окружающую среду. Использование фенспирида (эреспал) в лечении больных ХОБЛ потенцировало улучшение параметров форсированного выдоха, нормализацию СОЭ. Препарат хорошо переносился, вызывал только легкие побочные реакции, которые встречались не чаще, чем у пациентов, не получавших фенспирид. Полученные данные позволяют рекомендовать включение фенспирида (эреспал) в современные протоколы лечения больных ХОБЛ при легком и среднетяжелом течении в сочетании с бронхолитическими препаратами

Goat’s milk-based formula when choosing artificial feeding for a newborn and a first-year baby

Mother’s milk is the most suitable product for feeding a newborn baby, its uniqueness is obvious. However, there are situations when breastfeeding is not possible at all or its volume is limited, so under certain circumstances mothers are forced to partially supplement or completely feed the child with an artificial formula. Although the composition of the ingredients in most modern formula feeds is similar, there are nevertheless differences in their composition and in the processing of the ingredients in the formula. In addition, the child may have individual taste preferences as well as unexpected negative reactions to any adapted milk formula. This review presents the achievements of recent years in creating adapted goat’s milk-based formulas for feeding newborns and first-year infants. Goat’s milk-based formulas have a number of advantages over cow’s milk-based formulas. One of the representatives of modern artificial formulas are those containing goat’s milk, which is characterized by low α-s1-casein genotype and high β-lactoglobulin content, which provides easier protein digestibility, contributes to more comfortable digestion and better absorption. Knowledge of the biological and nutritional value of goat milk, taking into account the peculiarities of the gastrointestinal tract of newborns and their needs, made it possible to develop and introduce into the goat’s milk-based formula the DigestX lipid complex, which is a complex of vegetable oils with a high content of palmitic acid in the sn-2-position in the triglyceride molecule, which is similar to breast milk. Goat’s milk, compared to cow’s milk, contains 4-6 times more oligosaccharides, which retain their beneficial properties in the production of artificial goat’s milk formula.Recent scientific literature data is presented, including that from the standpoint of evidence-based medicine, proving the effectiveness and safety of artificial goat’s milk-based formulas. The necessity of consulting mothers, psychological support and practical assistance not only in breastfeeding, but also in artificial feeding is substantiated

Assessment of the newborn status during the first home nursing visit: what should the pediatrician know?

The article details the pattern of a home nursing visit of a newborn. The authors advise when after birth the visit should take place and by whom, its purpose, the components of the newborn examination after discharge from maternity hospital, and recommendations for young parents