Hospital infections: the problems and ways to resolve them]

The authors present the critical analysis of the existing situation in the spread of purulent septic infections in surgical hospitals of the USSR and the state of epidemiological surveillance. Considering this situation to be highly unfavorable, the authors propose a number of urgent organizational measures (the inclusion of hospital epidemiologists into the medical staff of large clinics, the system of training in this problem). The article deals with the specific features of the epidemiological process in purulent septic infections and the main principles of the organization of the epidemiological surveillance system for this group of infections.     

Prevention of epidemiological consequences during an extreme situation caused by the natural disaster in the Republic of North Ossetia-Alania

Information on the organization of interaction between different services responsible for restoration works, sanitary cleaning, disinfection under the conditions of the emergency situation is presented. The activity of the sanitary and epidemiological services in the areas in the Republic of North Ossetia-Alania, affected by high flood, is described. Measures aimed at the epidemiological surveillance of acute enteric infections, the control of the quality of drinking water and foodstuffs, the bacteriological study of material samples taken from humans, vaccinal and phage prophylaxis have taken an important place in the work of the institutions of sanitary and epidemiological surveillance. As the result of all these measures the sanitary and epidemiological service has managed to prevent the aggravation of the sanitary and epidemiological situation in the republic.     

Organization and execution of surveillance of the sanitary and epidemiologic situation under conditions of the emergency situation of a natural character

The data on the work of the formations and institutions of the sanitary and epidemiological service of the Republic of North Ossetia-Alania under the conditions of the emergency situation of the natural character (high floods) in June 2002 and the liquidation of its consequences are presented. Experience in ensuring the interaction between the formations of the sanitary and epidemiological service on the problems connected with the realization of the epidemiological surveillance in the territories affected by the natural calamity is described.     

Epidemiological situation on tularemia in the regions of Stavropol Territory affected by flood

The data obtained in the analysis of the epidemiological situation in tularemia in the zone of inundation in the Stavropol Territory in 2002 are presented. The current systematic epidemiological surveillance, as well as the data of urgent epizootological and epidemiological survey in the zone of inundation permitted the objective prognostication of the situation in tularemia and formed the basis for the rational planning and realization of prophylactic measures.     

Significance of epidemiological analysis for the development of epidemiology

The significance of epidemiological analysis for the study of the epidemic process is substantiated. The historical stages of the development of the doctrine on the epidemic process along with the role of epidemiological analysis in social and hygienic monitoring and epidemiological surveillance from the viewpoint of systemic approach are presented. The conclusion has been made on the necessity of the development of the systemic methodology of controlling the epidemic process and the sanitary and epidemiological situation.     

An analysis of the seasonal rise in hepatitis A morbidity at a children's center and ways to improve the sanitary epidemiologic surveillance for this infection among organized preschoolers

The spread of hepatitis A in children's institution occurred through everyday contacts, the boundaries of the focus of infection embraced the whole institution, and the active detection of the prevailing subclinical forms of the disease proved to be possible by means of virological and biomedical tests. The enhancement of the effectiveness of clinical and epidemiological surveillance by its orientation to the control of the spread of this infection through water and everyday contacts, the rational organization of sanitary, microbiological and serological studies, the development of criteria of epidemiological safety of children's institutions is proposed.     

Pulse electrophoresis of serogroup A streptocci isolated in Moscow

Pulse electrophoresis of group A streptococci (GAS) isolated in 1998 - 2004 in Moscow from patients during outbreaks of tonsillitis in child institutions, military unit and also from sporadic cases in children and adults was performed. During analysis of 48 strains 16 pulse electrotypes were recognized. These data allow to consider that in different child institutions (and other groups) accumulation and spreading of most adapted to such environment variants of GAS are take place and population structure of GAS in such institutions is unique on molecular and other characteristics. This study showed that complex typing of GAS (use of pulse electrophoresis and PCR for detection of erythrogenic toxins A and C) will help to improve molecular-epidemiologic surveillance for streptococcal group A infection, development of recommendations on reduction of morbidity from this infection and also to decrease risk of its severe forms, complications and mortality.     

Morbidity in sexually transmitted infections in the Republic of North Ossetia-Alania and the improvement of epidemiological surveillance

The present situation in sexually transmitted diseases (STD) in the Republic of North Ossetia-Alania is characterized as unfavorable. Morbidity in different nosological forms has been found to show different tendencies. The causes of elevated morbidity in STD observed in recent years have social, economic, psychological, ethical and moral, rather than medical character. The main trends in the improvement of epidemiological surveillance on STD have been determined.     

Complex method for epizootiological and epidemiological surveillance

A complex method for the epizootological and epidemiological surveillance of a number of bacterial and viral infections on the territories inside and outside their natural foci has been developed. The investigation techniques are described and the data on the isolation rate of each causative agent in different geographical zones are presented. In the natural foci of plague and tularemia, as well as on the territories outside such foci, the causative agents of intestinal yersiniosis, pseudotuberculosis, salmonellosis, erysipeloid, staphylococci and streptococci, arena- and arboviruses have been isolated from the rodents and ectoparasites under study. The results of this investigation suggest that the method may be recommended for use in medical institutions dealing with the problems of infections originating from natural foci.     

The status of the morbidity and the main trends in the improvement of the epidemiological surveillance of sexually transmitted infections in the city of Moscow

The present situation in sexually transmitted diseases (STD) is regarded as unfavorable. Differing tendencies in morbidity levels for various nosological forms have been established. The continuing growth of syphilis morbidity among children is considered to be specially alarming, and an increase in the number of cases of congenital syphilis is noted. The reasons of the growth of STD morbidity have not only medical, but mainly socio-economical, psychological, ethical and moral character. The main trends in the improvement of epidemiological surveillance on STD have been determined.     

Current epidemiological surveillance of tuberculosis

Some present-day specific epidemiological, microbiological and clinical features of tuberculosis are presented. A variant of the epidemiological surveillance morbidity scheme, comprising 3 blocks, viz. information, analysis and management, is proposed. In the information block the basic data necessary for epidemic analysis is listed, while the diagnostic block contains the stage-by-stage analysis of the information block data. In the block of management decisions the main directions of the tuberculosis prophylaxis interventions are listed.     

Epidemiologic situation in the quarantine of natural focal infections in the Southern Federal District

Materials on the situation in quarantine natural focal infections (anthrax, plague, tularemia, brucellosis, leptospirosis, etc.) in the Southern Federal District are presented. Experience in the provision of the epidemic safety in the above-mentioned diseases, based on the systematic surveillance on the activity of epizootological factors on the territory of the natural foci of infections, are described. The causes of the possible aggravation of the epidemiological situation in a number of nosological forms in connection with changes in natural and socio-economic factors are given. The results of the realization of regional programs, making it possible to improve the system interaction between the administrative territories, services and departments aimed at ensuring the epidemiological safety of the region, are shown.     

Community surveillance of complications after hernia surgery.

OBJECTIVE--To assess the effect of a programme of postoperative community surveillance on the rate of detection of wound complications after operation for inguinal hernia. DESIGN--Prospective audit of wound complications including complications recorded in case notes and those discovered by community surveillance. SETTING--Academic surgical unit of three consultant surgeons. PATIENTS--510 patients undergoing elective inguinal hernia repair between June 1985 and August 1989. RESULTS--The wound infection rate recorded in the hospital notes was 3% compared with 9% when additional information was obtained from community surveillance. Wound complications were detected in 143 (28%) patients by community surveillance compared with a complication rate of 7% in the case records for the same patients. CONCLUSIONS--Wound complications are common after clean surgery in patients discharged home early. Complication rates are a reflection not only of the standards of surgical practice but also the rigour with which they are sought. Before national comparative audit data are published the method of collection must be standardised. For short stay surgery this should include meaningful community surveillance.     

医疗投诉管理模式的探析

规范医疗投诉管理日益成为医疗机构改善与提高医疗服务质量的目标之一。将对我国现阶段5种较为普遍的医疗投诉管理模式的基本情况、特点以及适应范围进行分析,为各医疗机构建立和完善医疗投诉管理制度提供借鉴。     

国外诊断相关组付费制度与医疗服务质量关系研究述评

通过理论分析和文献综述,介绍此付费制度与医疗服务质量关系的研究现状,探讨了一些国家通过引入医疗机构提供能力、医疗服务质量评价标准及全面质量管理观念等措施,对制度进行改良的实践效果,对我国医疗付费制度的改革和优化具有重要的启示意义。     

Preventive oncologic check-ups in the District Sumperk, 1975-1986: the description of a database

From 1975 through 1986, repeated preventive oncologic check-ups were carried out in the District Sumperk. In the course of the check-ups, 49,426 persons were examined. The examinations were aimed at surveillance of initial stadium of cancers as well as at detection of other serious chronic diseases. The results of the check-ups form a large database suitable for a number of epidemiological analyses. In this article, methods of the data collection are described, individual data items are characterized and their summary is presented in tables. Utilization of the database is proposed in specified types of epidemiological studies.     

The theory and practice of an epidemic control service for the population

The data on the epidemic-control medical care of the population of the Kuznetsk coal fields and on the creation of the specialized system of the epidemiological surveillance of influenza, measles, viral hepatitis, hospital infections are presented. The possibility of using the theory of the self-regulation of the epidemic process in practical work is discussed.     

Tratamiento de los adenomas hipofisarios clínicamente no funcionantes

Clinically nonfunctioning adenomas are the most frequent pituitary macroadenomas in adults. These tumors are characterized by the absence of detectable hormonal hypersecretion and are diagnosed when compression symptoms or hormonal deficiencies occur. The treatment of choice of macroadenomas is surgery, but tumoral resection is often incomplete or the patient develops tumoral recurrence. Medical therapy has been shown to produce modest tumoral reduction in some patients. Postoperative irradiation should be considered in patients with large tumoral remnants or enlargement of remnants during follow-up. Stereotactic radiotherapy has been developed to diminish the long-term complications of radiotherapy. Microadenomas tend to remain small and surveillance alone is recommended. The present article reviews the results of medical, surgical and radiation treatments.     

Complications in surgery: root cause analysis and preventive measures

Patients expect to receive quality medical care by relying on the concepts of evidence-based medicine. This quality care is expected to be provided at decreased costs for payors, some of whom have stopped reimbursement for cases involving "reasonably preventable" surgical complications. The purpose of this article is to introduce root cause analysis as a tool for identifying the causes of surgical complications. The authors also discuss preventive measures, such as improved communication, checklists, reporting systems, and the use of evidence-based medicine, that have been implemented to decrease surgical complications. These preventive measures can be used alone or together to decrease complications and improve overall patient care.     

The Danish Registry for Plastic Surgery of the Breast: establishment of a nationwide registry for prospective follow-up,quality assessment,and investigation of breast surgery

Although numerous epidemiologic studies have examined the long-term safety of silicone breast implants during the past decade, there is a relative lack of surveillance data on short-term health effects and complications following cosmetic surgery of the breast. The Danish Registry for Plastic Surgery of the Breast, established in May of 1999, provides plastic surgeons with a nationwide system for the collection of preoperative, perioperative, and postoperative data on women undergoing breast implantation, breast reduction, or mastopexy. The purpose of the Registry is to examine short-term and, eventually, long-term local complications and possible health effects, and to contribute to an ongoing evaluation of surgical results and surveillance of the products. Furthermore, the Registry will allow the identification of new areas for research into cosmetic and reconstructive breast surgery. Women accepting registration in the Danish Registry for Plastic Surgery of the Breast complete a self-administered questionnaire focusing on medical history and demographic and behavioral factors. Preoperative blood samples are drawn for storage. Surgical data, postoperative results, and complications are registered following surgery and at postoperative visits. Currently, registration has been initiated at 24 private and public clinics, representing more than 80 percent of the plastic surgery clinics in Denmark. As of November of 2001, a total of 1472 women with breast implants and 560 women with breast reduction were included in the Registry. These figures are expected to increase annually by 1000 women undergoing breast implantation and 500 women undergoing breast reduction or mastopexy. The authors present their experience of establishing the first nationwide comprehensive clinical-epidemiologic database and biological bank for cosmetic and reconstructive surgery procedures.