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    Received 26.11.2012

    Mediko-biologicheskie i sotsial'no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh [Medical-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2013. N 1. Pp. 24–27.



    Soroka A.K. Ratsional'nye podkhody k diagnostike ranenii i travm zhivota v ogranichennykh usloviyakh okazaniya meditsinskoi pomoshchi [Rational approaches to the diagnosis of injuries and abdominal trauma in the limited health care settings]
    Naval Clinical Hospital (Russia, 690005, Vladivostok, Ivanovskaya Str., 2)
    Soroka Anatoly Konstantinovich – PhD Med. Sci, Head of Emergency Surgery Department, Naval Clinical Hospital (Russia, 690005, Vladivostok, Ivanovskaya Str., 2); e-mail: navidoc@mail.ru
    Abstract. Based on a study of 166 medical records, the analysis of the diagnostic efficiency of the clinical, laboratory, instrumental and operational methods of diagnosis of internal injuries in abdominal trauma was performed in patients admitted to the Naval Hospital (Vladivostok) in 2000–2010. A rational (rationalis – reasonable) approach to damage diagnostics using "direct" laparoscopy is proposed when general anesthesia and other instrumental methods of examination are not available.

    Keywords: injuries, abdominal trauma, laparoscopy, celiocentesis.
    References

    1. Abdullaev E.G., Babyshin V.V., Khodos G.V. Videolaparoskopiya v diagnostike i lechenii povrezhdenii zhivota [Videolaparoscopy in the diagnosis and treatment of injuries of the abdomen]. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2007. P 1. Pp. 6. (In Russ.)

    2. Gnatyuk B.M., Surovikin D.M. Punktsionnaya diagnostika zakrytoi travmy zhivota [Puncture diagnosis closed abdominal trauma]. Aktual'nye voprosy sovershenstvovaniya diagnostiki i lecheniya [Topical issues of improving diagnosis and treatment]. Leningrad. 1987. Vol. 2. Pp. 43–45. (In Russ.)

    3. Gumanenko E.K. Aktual'nye problemy khirurgii povrezhdenii [Actual problems of damage surgery]. Khirurgiya povrezhdenii mirnogo i voennogo vremeni: materialy simpoziuma [Damage surgery in peacetime and wartime: proceedings of the symposium]. Moskva. 2001. Pp. 19–21. (In Russ.)

    4. Molitvoslovov A.B. [et al.]. Diagnostika povrezhdenii zhivota pri sochetannoi travme [Diagnosis of abdominal injuries with associated trauma]. Khirurgiya. Zhurnal im. N.I. Pirogova. [Surgery. Zhurnal imeni N.I. Pirogova]. 2002. N 9. Pp. 22–26. (In Russ.)

    5. Alimov A.N. [et al.]. Optimizatsiya khirurgicheskoi taktiki i perspektivy endokhirurgii v lechenii sochetannoi i izolirovannoi travmy zhivota [Optimization of surgical tactics and endosurgery prospects in treatment of combined and isolated abdominal trauma]. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2005. N 1. Pp. 171–172. (In Russ.)

    6. Sitnikov V.N. [et al.]. Primenenie videolaparoskopii v diagnostike i lechenii koloto-rezanykh ran perednei bryushnoi stenki [Videolaparoscopy application in the diagnosis and treatment of stab wounds of the anterior abdominal wall]. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2005. N 1. Pp. 138–139. (In Russ.)

    7. Gumanenko E.K. [et al.]. Problemy dogospital'noi pomoshchi pri tyazheloi sochetannoi travme [Problems of prehospital care in severe concomitant injury]. Vestnik khirurgii imeni I.I. Grekova [Surgery Herald named after I.I. Grekov]. 2003. Vol. 162, N 4. Pp. 43–48. (In Russ.)

    8. Rozanov V.E., Snegur A.V., Slavinskaya O.M. Diagnosticheskaya i lechebnaya videolaparoskopiya pri zakrytoi travme organov bryushnoi polosti [Diagnostic and therapeutic videolaparoscopy in the closed trauma of the abdominal cavity]. Endoskopicheskaya khirurgiya [Endoscopic surgery]. 2005. N 1. Pp. 115. (In Russ.)

    9. Skorodumov A.V., Shirokov D.M. Ul'trazvukovaya diagnostika zakrytoi sochetannoi abdominal'noi travmy, soprovozhdayushcheisya shokom [Ultrasound diagnosis of abdominal trauma combined closed accompanied shock]. Sochetannaya i mnozhestvennaya mekhanicheskaya travma (klinika, diagnostika i lechenie): sbornik nauchnykh trudov [Combined and multiple mechanical trauma (symptoms, diagnosis and treatment): collection of scientific papers]. Sankt-Peterburg. 1997. Pp. 94–100. (In Russ.)

    10. Tsybulyak G.N., Sheyanov S.D. Raneniya i travmy zhivota: sovremennaya diagnostika i novye podkhody v lechenii [Injury and abdominal trauma: modern diagnosis and new treatment approaches]. Vestnik khirurgii imeni I.I. Grekova [Surgery Herald named after I.I. Grekov]. 2001. Vol. 160, N 5. Pp. 81–88. (In Russ.)

    11. Boyarintsev V.V., Suvorov V.V., Markevich V.Yu. [et al.]. Endovideokhirurgiya v voenno-polevoi khirurgii [Endovideosurgery in field military surgery]. Voenno-meditsinskii zhurnal [Military medical journal]. 2006. N 9. Pp. 45–52. (In Russ.)

    12. Sementsov V.K. [et al.]. Endoskopicheskaya khirurgiya v diagnostike i lechenii sochetannoi travmy grudi i zhivota [Endoscopic surgery in the diagnosis and treatment of concomitant injuries to the chest and abdomen]. Tikhookeanskii meditsinskii zhurnal [Pacific Medical Journa]. 2006. N 1. Pp. 95–96. (In Russ.)

    13. Livingston D.H., Tortella B.J., Blackwood J. The role of laparoscopy in abdominal trauma. J. Trauma. 2002. Vol. 33, N 3. Pp. 471–475.

    14. Marks J.M., Youngelman D.F., Berk T. Cost analysis of diagnostic laparoscopy vs laparotomy in the evaluation of penetrating abdominal trauma. Surg. Endosc. 1997. Vol. 11, N 3. Pp. 272–276.

    15. Leppaniemi A. [et al.]. The role of laparoscopy in blund abdominal trauma. Ann. of Med. 1996. N 6. Pp. 483–489.

    Received 10.12.2012

    Mediko-biologicheskie i sotsial'no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh [Medical-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2013. N 1. Pp. 27–31.



    Ravodin R.A., Rezvantsev M.V. Intellektual'nye sistemy podderzhki prinyatiya reshenii kak instrument profilaktiki vrachebnykh oshibok [Intellectual decision-making support systems as an instrument for medical errors prevention]
    The Kirov Military Medical Academy (Russia, 194044, Saint-Petersburg, Academica Lebedeva Str., 6)
    Ravodin Roman Anatol'evich – PhD Med. Sci., Lecturer, Department of Skin and Venereal Diseases. Kirov Military Medical Academy (Russia, 194044, Saint-Petersburg, Academica Lebedeva Str., 6); e-mail: rracad@mail.ru;

    Rezvantsev Mikhail Vladimirovich – PhD Med. Sci., Deputy Head of Education-methodic Department of the Kirov Military Medical Academy (Russia, 194044, St. Petersburg, Аcademica Lebedeva Str., 6); e-mail: rmvnb@mail.ru


    Abstract. The article concerns the state of medical errors problem in Russia and abroad. As one of the ways to escape them, the authors offer using intellectual decision-making support systems. Definition of such systems is given and their medical use is justified. The various options of clinical application of such systems are presented and their efficiency is analyzed.

    Keywords: medical decision-making support systems, intellectual information systems, medical errors.
    References

    1. Andreichikov A.V., Andreichikova O.N. Intellektual'nye informatsionnye sistemy [Intelligent information systems]. Moskva. 2006. 424 p. (In Russ.)

    2. Barbinov V.V. Ekspertnye sistemy v dermatogistopatologii (inzheneriya znanii v komp'yuternykh tekhnologiyakh prepodavaniya i diagnostiki [Expert systems in dermatohistopathology (knowledge engineering in computer technology of teaching and diagnostics]. Sankt-Peterburg. 1998. 40 p. (In Russ.)

    3. Bogdanov V. Letal'naya khalatnost' [Lethal negligence]. Rossiiskaya gazeta [Russian newspaper], 6.11.2008. (In Russ.)

    4. Gavrilova T.A., Muromtsev D.I. Intellektual'nye tekhnologii v menedzhmente: instrumenty i sistemy [Intelligent technologies in management: tools and systems]. Sankt-Peterburg. 2007. 488 p. (In Russ.)

    5. Innovatsionnyi meditsinskii server Diagnoz.ru [Innovative Medical Diagnoz.ru server]. URL: http://www.diagnos.ru. (In Russ.)

    6. IT – soobshchestvo dolzhno osoznat', chto rabota vracha – ne «business process», a «brain process» [IT - community should realize that the work of a doctor – not «business process», and «brain process»]. Vrach i informatsionnye tekhnologii [Physicians and IT]. 2007. N 6. Pp. 4–11. (In Russ.)

    7. Kilikovskii V.V., Olimpieva S.P. Tekhnologiya sozdaniya komp'yuternykh konsul'tativnykh ekspertnykh sistem dlya intellektual'noi podderzhki prinyatiya meditsinskikh reshenii [technology of creating computer advisory expert systems for intellectual support of medical decisions]. Vrach i informatsionnye tekhnologii [Physicians and IT]. 2004. N 9. Pp. 22–27. (In Russ.)

    8. Kobrinskii B.A. Sistemy podderzhki prinyatiya reshenii v zdravookhranenii i obuchenii [Decision support systems in health and education]. Vrach i informatsionnye tekhnologii [Physicians and IT]. 2010. N 2. Pp. 39–45. (In Russ.)

    9. Kruglyi stol Komissii Obshchestvennoi palaty Rossiiskoi Federatsii po okhrane zdorov'ya, ekologii, razvitiyu fizicheskoi kul'tury i sporta «Rol' patologoanatomicheskoi sluzhby v povyshenii kachestva meditsinskoi pomoshchi v Rossiiskoi Federatsii» ot 17.03.2011 [Roundtable of Comission on health, environment, development of physical culture and sports at the Public Chamber of the Russian Federation: "The role of pathology services to improve the quality of medical care in the Russian Federation" dated 17.03.2011]. URL: http://www.oprf.ru/ru/press/news/2011/newsitem/8712. (In Russ.)

    10. Luk'yanov I.V. Ekspertnaya sistema diagnostiki i vybora taktiki lecheniya u bol'nykh s dobrokachestvennoi giperplaziei predstatel'noi zhelezy [Expert system for diagnosis and choice of treatment strategy in patients with benign prostatic hyperplasia]. Moskva. 2001. 19 p. (In Russ.)

    11. Luchikhin L.A. Vrachebnye oshibki kak sledstvie nekotorykh ob"ektivnykh prichin [Medical errors as a result of some objective reasons]. Vestnik otorinolaringologii [Otorhinolaringology Herald]. 2008. N 1. Pp. 8–10. (In Russ.)

    12. Pashinyan A.G. Analiz professional'nykh oshibok i defektov okazaniya dermatovenerologicheskoi pomoshchi [Analysis of professional errors and defects of rendering dermatovenereological assistance]. Vestnik dermatologii i venerologii [Herald of dermatology and venereology]. 2004. N 4. Pp. 24–26.

    13. Pashinyan A.G., Elistratova I.V., Arutyunyan G.B. Ekspertiza vrachebnykh oshibok v dermatovenerologii [Examination of malpractice in dermatovenereology.]. Vestnik dermatologii i venerologii [Herald of dermatology and venereology]. 2007. N 4. Pp. 23–25. (In Russ.)

    14. Popov V.E. Organizatsionnye tekhnologii i sistemnyi analiz upravleniya samostoyatel'noi podgotovkoi studentov (na primere kadrovoi optimizatsii v dermatovenerologii) [Organizational technologies and systems analysis of managing independent training of students (by example of staffing optimization in dermatovenereology)]. Moskva. 2006. 38 p. (In Russ.)

    15. Semak A.E. [et al.]. Prognozirovanie insul'tov s pomoshch'yu ekspertnoi sistemy [Prediction of stroke by using an expert system]. Insul't [Stroke]. 2006. N 17. Pp. 37–41. (In Russ.)

    16. Rigel'man R. Kak izbezhat' vrachebnykh oshibok. Kniga praktikuyushchikh vrachei [How to avoid medical errors. Book for practitioners]. Moskva. 1994. 204 p. (In Russ.)

    17. Ulumbekova G.E. Dostupnost' i kachestvo meditsinskoi pomoshchi v Rossiiskoi Federatsii. Metody otsenki i sravnenie pokazatelei s raznymi stranami [Availability and quality of medical care in the Russian Federation. Methods of evaluation and comparison of indicators with different countries]. Menedzhment kachestva v sfere zdravookhraneniya i sotsial'nogo razvitiya [Quality management in health and social development]. 2011. N 4. Pp. 36–44. (In Russ.)

    18. Shchipskii A.V., Afanas'ev V.V., Zubkova Yu.A. Informatizatsiya zdravookhraneniya. Original'nyi opyt sozdaniya intellektual'noi ekspertnoi sistemy [Computerization of Health. Experience in creating original intellectual expert system]. Rossiiskii stomatologicheskii zhurnal [Russian journal of dentistry]. 2009. N 1. Pp. 42–45. (In Russ.)

    19. Asanov A.A., Larichev O.I., Naryzhnyi E.V., Strakhov S.I. Ekspertnaya sistema dlya diagnostiki lekarstvennykh otravlenii [An expert system for the diagnosis of drug poisoning]. Sed'maya natsional'naya konferentsiya po iskusstvennomu intellektu (KII-2000) [Seventh National Conference on Artificial Intelligence (CAI-2000)]. Moskva 2000. Pp. 708–716. (In Russ.)

    20. Dohler F. [et al.]. A cellular neural network based method for classification of magnetic resonance images: towards an automated detection of hippocampal sclerosis. J. Neurosc. Methods. 2008. Vol. 170, N 2. Pp. 324–331.

    21. Tzallas A.T. [et al.]. Automatic seizure detection based on time-frequency analysis and artificial neural networks. Comput. Intell. Neurosc. 2007. Аrt. 80510. Doi: 10.1155/2007/80510.

    22. Brennan T.A., Leaps L.L., Laird N. Incidence of adverse events and negligence in hospitalized patients: results of the Harvard Medical Practice Study. New England J. of Med. 1991. Vol. 324, N 6. Pp. 370–377.

    23. Liew P.L. [et al.]. Comparison of artificial neural networks with logistic regression in prediction of gallbladder disease among obese patients. Dig. Liver dis. 2007. Vol. 39, N 4. Pp. 356–362.

    24. Dayer C. GPs face escalation litigation. BMJ. 1999. Vol. 318. Pp. 830.

    25. Garg A.X. [et al.]. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes. JAMA. 2005. Vol. 293, N 10. Pp. 1223–1238.

    26. Hunt D.L. [et al.]. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA. 1998. Vol. 280, N 15. Pp. 1339–1346.

    27. Medical malpractice systems around the globe: examples from the US- tort liability system and the Sweden- no fault system. World Bank. Washington : DC, 2003. 31 p.

    28. Bassi P. [et al.]. Prognostic accuracy of an artificial neural network in patients undergoing radical cystectomy for bladder cancer: a comparison with logistic regression analysis. BJU Int. 2007. Vol. 99, N 5. Pp. 1007–1012.

    29. Standing Committee of the Hospitals of EU. The quality of health care/hospital activities: Report by the Working Party on quality care in hospitals of the subcommittee on coordination. EU, September 2000.

    30. Kohn L.T. [et al.]. To err is human: building a safer health system. Washington. 2000. 312 p.

    31. Vincent C., Neale C., Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ. 2001. Vol. 322. Pp. 517–519.

    Received 15.01.2013

    Mediko-biologicheskie i sotsial'no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh [Medical-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2013. N 1. P. 32–38.



    Sleptsova S.S., Rakhmanova A.G., Zholobov V.E. Formirovanie organizatsionnoi modeli okazaniya pomoshchi bol'nym s khronicheskimi virusnymi gepatitami v Respublike Sakha (Yakutiya) [Formation of the organizational model of care for patients with chronic viral hepatitis in the Republic of Sakha (Yakutia)]
    The North-Eastern Federal University named after M.K. Ammosov

    (Russia, 677000, Republic of Sakha (Yakutia), Yakutsk, Belinsky Str., 58);



    Pavlov First Saint Petersburg State Medical University

    (Russia, 197022, St. Petersburg, L'va Tolstogo Str., 6/8)


    Sleptsova Snezhana Stepanovna – PhD Med. Sci., Head of the the course of infectious diseases, the North-Eastern Federal University named after M.K. Ammosov (Russia, 677000, Republic of Sakha (Yakutia), Yakutsk, Belinsky Str., 58); e-mail: sssleptsova@yandex.ru;

    Rakhmanova Aza Gasanovna – Dr. Med. Sci., Prof. of Infectious Diseases and Epidemiology Chair with HIV medicine Class of Pavlov First Saint Petersburg State Medical University (Russia, 197022, St. Petersburg, L'va Tolstogo Str. 6/8); e-mail: aza.rakhmanova@gmail.com;

    Zholobov Vladimir Evgen'evich – Dr. Med. Sci. of Pavlov First Saint Petersburg State Medical University (Russia, 197022, St. Petersburg, L'va Tolstogo Str. 6/8), e-mail: gve@kzdrav.gov.spb.ru
    Abstract. In the Republic of Sakha (Yakutia), chronic viral hepatitis is frequently registered, along with its remote adverse outcomes. Large-scale vaccination against hepatitis B will help considerably reduce the number of patients with liver cirrhosis and liver cancer associated with HBV infection. Established risk factors for the development of primary liver cancer in the Republic are as follows: the indigenous nationality; male gender; replicative activity of B, C and D viruses; increased aldehyddehydrogenase/ alcoholdehydrogenase ratio in the blood. Organizational model of rendering aid to patients with chronic viral hepatitis in the Republic of Sakha (Yakutia) has been developed.

    Keywords: viral hepatitis, primary liver cancer, risk factors, Republic of Sakha (Yakutia).
    References

    1. Abdurakhmanov D.T. Khronicheskii gepatit B i D [Chronic hepatitis B and D]. Moskva. 2010. 288 p. (In Russ.)

    2. Alekseeva M.N. Virusnye gepatity v Respublike Sakha (Yakutiya) [Viral hepatitis in the Republic of Sakha (Yakutia)]. Sankt-Peterburg, 2002. 37 p. (In Russ.)

    3. Aprosina Z.G. Khronicheskii aktivnyi gepatit kak sistemnoe zabolevanie [Chronic active hepatitis as a systemic disease]. Moskva. 1981. 190 p. (In Russ.)

    4. Blyuger A.F., Novitskii I.N. Prakticheskaya gepatologiya [Practical Hepatology]. Riga. 1984. 405 p. (In Russ.)

    5. Blyuger A.F. Sovremennye problemy klinicheskoi gepatologii [Modern problems of clinical hepatology]. Zhurnal mikrobiologii, epidemiologii i immunobiologii [J. of Epidemiology and Microbiology, Immunology]. 1987. N 11. Pp. 51–59. (In Russ.)

    6. Ivanov P.M. [et al.]. Gepatologiya Severa [Hepatology of the North]. Yakutsk. 2012. 304 p. (In Russ.)

    7. Maksimov G.N. Rodnaya Yakutiya: priroda, lyudi, prirodopol'zovanie [Native Yakutia: nature, people, nature management]. Ed. M.Yu. Prisyazhnyi. Yakutsk. 2003. 168 p. (In Russ.)

    8. Pokrovskii V.I., Onishchenko G.G., Cherkasskii B.L. Aktual'nye napravleniya sovershenstvovaniya profilaktiki infektsionnykh boleznei [Topical areas of improved prevention of infectious diseases]. Epidemiologiya i infektsionnye bolezni [Epidemiology and infectious diseases]. 2000. N 1. Pp. 4–7. (In Russ.)

    9. Rakhmanova A.G. Yakovlev A.A., Vinogradova E.N. Khronicheskie virusnye gepatity i tsirroz pecheni [Chronic viral hepatitis and cirrhosis: a guide for physicians.]. Sankt-Peterburg. 2006. 413 p. (In Russ.)

    10. Rakhmanova A.G., Yakovlev A.A. Khronicheskie virusnye gepatity i VICh-infektsiya [Chronic viral hepatitis and HIV infection]. Sankt-Peterburg. 2011. 164 p. (In Russ.)

    11. Sleptsova S.S. Kliniko-epidemiologicheskie osobennosti virusnogo gepatita B v Respublike Sakha (Yakutiya) [Clinical and epidemiological features of hepatitis B virus in the Republic of Sakha (Yakutia)]. Sankt-Peterburg. 2003. 24 p. (In Russ.)

    12. Shakhgil'dyan I.V., Mikhailov M.I., Onishchenko G.G. Parenteral'nye virusnye gepatity (epidemiologiya, diagnostika, profilaktika) [Parenteral viral hepatitis (epidemiology, diagnosis, prevention).]. Moskva. 2003. 384 p. (In Russ.)

    13. Barazani Y., Hiatt J.R., Tong M.J. [et al.]. Chronic viral hepatitis and hepatocellular carcinoma. World J. Surg. 2007. Vol. 31. Pp. 1245–1250.

    14. Chu C.M. Natural history of chronic hepatitis B virus infection in adults with emphasis on the occurrence of cirrhosis and hepatocellular carcinoma. J. Gastroenterol. Hepatol. 2000. Vol. 15. Pp. 25–30.

    15. Lai E.C., Lau W. Y. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005. N 3. Pp. 210–215.

    16. Tsai J.F. [et al.]. Hepatitis B and C virus infection as risk factors for Liver cirrhosis and cirrotic hepatocellular carcinoma: a case control – study. Liver. 1994. Vol. 14. Pp. 98–102.

    Received 23.01.2013


    Mediko-biologicheskie i sotsial'no-psikhologicheskie problemy bezopasnosti v chrezvychaynykh situatsiyakh [Medical-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2013. N 1. Pp. 38–41.



    Prokhorova O.V., Dorofeichik-Drygina N.A. Nekotorye aspekty sostoyaniya tkanei parodonta u pozharnykh MChS Rossii s zabolevaniyami zheludochno-kishechnogo trakta [Some aspects of the state of the periodontal tissues in the Russian EMERCOM firefighters with diseases of the gastrointestinal tract]
    The Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia

    (Russia, 194044, Saint-Petersburg, Academica Lebedeva Str., 4/2)


    Prokhorova Ol'ga Viktorovna – PhD Med. Sci., dentist, the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (Russia, 194044, Saint-Petersburg, Academica Lebedeva Str., 4/2); e-mail: Olga-dent@mail.ru;

    Dorofeichik-Drygina Nadezhda Alekseyevna – dentist of Medical Center; e-mail: drygina.nadezhda@ yandex.ru;

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