ABSTRACT
The patients with aneurysm subarachnoid hemorrhage (aSAH) living in remote, inaccessible, rural areas cannot be provided with urgent neurosurgical care on the spot. They require medical evacuation (ME) to neurosurgical hospital. The purpose of the study was to investigate effect of complex (multi-stage) and simple (one-stage) logistic scheme of ME of patients in acute period of aSAH on the outcome of the disease. The retrospective analysis of results of surgical treatment in 145 patients with aSAH hospitalized in regional vascular center (RVC) in Yakutsk in 2017-2018 was carried out. The subjects were allocated into 3 groups: group 1 - patients from regions of the Republic of Sakha, who underwent ME to the RSC using simple transportation scheme; group 2 - patients from regions of the Republic of Sakha who underwent ME using complex transportation scheme; group 3 (control) - patients hospitalized from territory of Yakutsk. The RVC hospitalized 145 patients. The sanitary aviation delivered 91 (62.8%) patients from districts of the Republic to the RVC. The duration of time from the onset of disease to surgical treatment: in group 1-2 days; in group 2-4 days; in group 3, 2 days (p = 0.018). The frequency of re-rupture of cerebral aneurysm in the group 1 and group 2 did had no statistically significant differences (19,1% and 32.7%) (p = 0.142). Mortality: in group 1 7.1%; in group 2 8.2%; in group 3 7.4% and no statistically significant differences between groups 1 and 2 (p = 1,000), between groups 1 and 3 (p = 1,000) and between groups 2 and 3 (p = 0.886). When applying complex logistic scheme of ME, transportation over considerable distance does not deteriorated course of disease and results of surgical treatment of patients with aSAH in acute period of hemorrhage.
Subject(s)
Aneurysm, Ruptured , Intracranial Aneurysm , Subarachnoid Hemorrhage , Aneurysm, Ruptured/epidemiology , Aneurysm, Ruptured/surgery , Humans , Intracranial Aneurysm/surgery , Retrospective Studies , Subarachnoid Hemorrhage/epidemiology , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/surgery , Treatment OutcomeABSTRACT
The article considers issue of implementation of employment agreement by way of effective contract exemplified by the Yakutsk medical center of the Republic Sakha (Yakutia). The new job descriptions, criteria of effectiveness, ratings of implementation of functions of medical job position were developed. At that, mechanisms of registration and implementation of social guarantees in respect of health workers were proposed.
Subject(s)
Physicians/economics , Physicians/legislation & jurisprudence , Salaries and Fringe Benefits/economics , Salaries and Fringe Benefits/legislation & jurisprudence , Humans , SiberiaABSTRACT
The organization of medical care in the Central hospital of the department of Federal penitentiary service of Russia of the Republic of Sakha (Yakutia) was examined The analysis of morbidity of convicts was carried out. The activities concerning enhancement of quality of organization of medical care considering tendencies in health care are proposed.
Subject(s)
Criminals , Delivery of Health Care/organization & administration , Humans , RussiaABSTRACT
In the beginning of XX century health care of the Yakutskaya ASSR characterized by low level of development due to lacking and shortage of medical manpower, illiteracy of population in issues of prevention of various diseases. In those times, by virtue of timely applied new normative documents, health personnel training, organization of medical educational institution for Yakutia and preventive activities the first results in further development of obstetrics service were achieved. In the beginning of XX century in Yakutia high birth rate, high infant and maternal mortality were marked. The present study was carried out to analyze development of obstetrics service in Yakutskaya ASSR (at present the Republic of Sakha (Yakutia)). The study established that to the end of XX century birth rate decreased and extra genital morbidity increased. The indicators of perinatal and maternal mortality, quality indicators of dispensarization of pregnant women, prevention and diagnostic of diseases ameliorated. According implemented analysis no grounds are tracked to expect any increasing of birth rate. However, possibility is not inconceivable that in perspective percentage of women having two and more deliveries up to the end of reproductive cycle will decrease. The effectiveness of actual "stimlulating" measures of public policy will be under the threat in future because of "Russian cross" of 1996. In the Republic, aggregate birth rate level of 1.7 deliveries counting upon one woman has no perspective. The other mechanisms and public policy are needed to be worked out.
Subject(s)
Birth Rate , Maternal Health Services/organization & administration , Maternal Mortality , Adult , Female , History, 20th Century , Humans , Maternal Health Services/history , Pregnancy , Siberia/ethnology , USSR/ethnologyABSTRACT
In the Republic of Sakha (Yakutiya) a stable increase of indicator of birth rate was marked during 1990-2012. Against the background of increase of indicator of birth rate the indicator of maternal mortality has a positive tendency to decrease. During 1990-2012, indicator of maternal mortality decreased from 560.8 to 29.4 per 100 000 of born alive. In the structure of causes of maternal mortality the percentage of direct obstetric causes of death decreased i.e. toxicosis on 18%, bleeding on 82%, sepsis on 9.1%. During 2007-2012 no death case was detected. The increase of specific weight of unavoidable causes made up to 25% of obstetrical embolism, 5% in the structure of causes of maternal mortality was attached to extra-genital diseases in 2007-2012. The percentage of deceased because of complications of anesthesia increased (1.5-5%).
