ABSTRACT
The authors provide information about the factors affecting the quality of medical care, recent changes in the regulatory framework in medical education and its development in Russia compared with developed countries. For healthcare leaders are described the risks for the implementation of these changes in public health practice, are given recommendations for leveling the risks and further improve the quality of medical care in the Russian Federation.
Subject(s)
Accreditation , Delivery of Health Care/standards , Education, Medical, Continuing/trends , Health Personnel/education , Teaching/trends , Accreditation/standards , Accreditation/trends , Education, Medical, Continuing/legislation & jurisprudence , Education, Medical, Continuing/methods , Education, Medical, Continuing/standards , Government Regulation , Program Development , Quality Control , RussiaABSTRACT
The role of the free radical processes (FRP) is shown and objectified in the development of the acute calculous cholecystitis (ACC). It is revealed on the first day of hospitalization already. In catarrhal and phlegmonic ACC free radical processes changes apply mostly to the oxygen part of the oxidation process. The greatest imbalance of the FRP is registered in the gangrenous ACC. It appeared like decrease of the oxygen and activation of the lipid FRP disregulation. On the first day FRP changes refer to the oxygen part of the oxidation process only. Starts with a second day from the disease début changes in the lipid component of the oxidative stress join the disregulation process. It is proved by the decrease of the antiperoxidant activity of plasma and increase of malondialdehyde. Malondialdehyde level and its rate of rise serve as prognostic criteria of the course and outcome of disease. FRP changes correlate with the clinical presentations of disease. They last till the patient's discharge. The high efficiency of the energetic corrector reamberin in a dose of 400-800 ml was shown in patients with ACC.
Subject(s)
Cholecystitis, Acute/metabolism , Cholecystitis, Acute/therapy , Free Radicals/metabolism , Lipid Metabolism , Meglumine/analogs & derivatives , Oxidative Stress/drug effects , Succinates , Adult , Aged , Aged, 80 and over , Antioxidants/administration & dosage , Antioxidants/adverse effects , Cholecystectomy , Cholecystitis, Acute/diagnostic imaging , Cholecystitis, Acute/etiology , Cholecystitis, Acute/physiopathology , Drug Monitoring , Female , Gallstones/complications , Humans , Infusions, Intravenous , Lipid Peroxidation/drug effects , Male , Malondialdehyde/metabolism , Meglumine/administration & dosage , Meglumine/adverse effects , Middle Aged , Oxidation-Reduction/drug effects , Succinates/administration & dosage , Succinates/adverse effects , Treatment Outcome , UltrasonographyABSTRACT
Results of treatment of 10,724 patients with different forms of acute and chronic cholecystitis are analyzed. Surgical treatment was performed in 7819 (72.9%) patients. Variants of treatment of acute and chronic cholecystitis are presented. Typical cholecystectomy is the basic surgery in patients with acute calculous cholecystitis (63% procedures). Laparoscopic cholecystectomy (LCE) was performed in 37% patients. Two-stage surgeries with previous microcholecystostomy (MCS) and endoscopic papilloshincterotomy (EPST) are indicated in late hospitalization of patients with intoxication and severe concomitant diseases. They permit to prepare patients for cholecystectomy and to decrease scope of surgery. In cholelithiasis and jaundice EPST and MCS are indicated for almost all patients as a preliminary procedure before surgery on the biliary tract and cholecystectomy. This two-stage variant permitted to reduce postoperative lethality from 9.7 to 1.6%. In chronic cholecystitis LCE is the main type of surgery with minimal postoperative lethality. For patients with recurrent calculous cholecystitis, frequent exacerbations, severe concomitant diseases EPST in choledocholithiasis and sanation of gall bladder through fistula are indicated.