[The Medical Informatics in Health Care of Russia].

The article considers medical informatics in relationship with medical cybernetics. The necessity of its development as an independent scientific discipline is emphasized. The input into development of public organizations is evaluated. The practical implementation is demonstrated on the example of the Unified State Information System in health care and telemedicine.

Prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS in decision support of treatment children with severe mechanical trauma.

The aim of the present study is to assess a possibility and validity of prognostic scales ISS-RTS-TRISS, PRISM, APACHE II and PTS to be used for the automated calculation in decision support when treating children with severe mechanical traumas. The mentioned scales are used in the Hospital Information System (HIS) MEDIALOG. The retrospective study was conducted using clinical and physiological data collected at the admission and during the first 24 hours of hospitalization in 166 patients. Scales PRISM, APACHE II, ISS-RTS-TRISS were used for calculating the severity of injury and for prognosis in death outcomes. Scale PTS was used for evaluating the severity index only. Our research has shown that ISS-RTS-TRISS has excellent discrimination ability, PRISM and APACHE II prognostic scales have acceptable discrimination ability; moreover, they all have significant calibration ability. PTS scale has acceptable discrimination ability. It has been showed that automated calculation scales ISS-RTS-TRISS, PRISM, APACHE II and PTS are useful for assessing outcomes in children with severe mechanical trauma.

Teaching the "Medical Informatics" course in higher professional medical education of the Russian Federation.

The paper discusses methodological and organizational problems of teaching the "Medical Informatics" course in institutions of higher education of the Russian Federation.

[Diagnosis of the stage of adult respiratory distress syndrome in patients with peritonitis]. / Diagnostika stadii respiratornogo distress-sindroma vzroslykh u bolnykh peritonitom.

The respiratory function of the lungs was examined in 68 patients with diffuse peritonitis of different origin in the early postoperative period by laboratory, instrumental, and statistical methods and assessed by expert evaluation. The training sampling included 275 cases expertly classified as follows: health, stage I respiratory distress syndrome of adults (RDSAI), RDSAII, RDSAIII, and RDSAIV. Discriminant analysis was carried out fir the first four classes of patients. The best results were obtained when the following 6 variables were used: respiration rate, assessment of the irregularity of ventilation perfusion ratio (delta p/delta t), end-expiration maximal tension of carbon dioxide (FetCO2), resistance of the body site between the measuring electrodes in the course of tetrapolar chest rheography (Z), and arterial capillary blood pCO2 and pO2. The resultant discriminant functions permit the diagnosis of RDSA and help determine the stage of the syndrome development with a probability of at least 90%, which may be used clinically to validate the conclusion of a physician concerning correction of the treatment policy in this patient population.

[Automatic monitoring of the myoelectric activity of the small intestine in peritonitis]. / Avtomatizirovannyi kontrol' mioélektricheskoi aktivnosti tonkoi kishki pri peritonite.

To monitor small intestinal myoelectrical activity in patients with peritonitis, the authors used direct electromyography. While processing the electromyograms, they calculated the frequency and amplitude of complexes, the standard deviation of complex duration, the amplitude of spike potentials and spike activity. Data on 41 patients were analyzed by using statistical methods. Normal value ranges and their variations in good- and poor- prognosis peritonitis were established. The findings were used to develop an automatic system which may enter an electromyogram, process it in automatic and semi-automatic modes, store the numbered curve and calculations in special files, construct a chart of the power spectrum density of a signal by the fast Fourier transform.

[A system of patient monitoring at intensive gastrointestinal care units]. / Sistema monitoringa sostoianiia patsienta v otdelenii intensivnoi terapii gastroénterologicheskogo profilia.

The system is designed for the long-term monitoring of critical patients with acute abdominal abnormalities at the intensive care and resuscitation units. It ensures input and long-term storage of history, anthropometric, and clinical data and laboratory and instrumental findings. The system allows a physician to have both primary information on the patient and results from examinations of the patient's circulation, respiration, and acid-base balance. The patient's major homeostatic systems were studied by using the original algorithms developed by means of mathematical statistic methods and an expert approach. Conclusions are produced on the display screen and printer in textual and graphic forms. Presenting all qualitative information as linear trends and polar diagrams makes it possible to contract data for visual control. The system evaluates the patient's status through prediction of odds ratio of good and poor prognoses.

[Prognosis and daily evaluation of changes in the condition of patients with peritonitis]. / Prognoz i ezhednevnaia otsenka dinamiki sostoianiia bol'nykh s peritonitom.

The authors examined 159 patients with peritonitis (87 with the generalized form and 72 patients with the diffuse form) and conducted a statistical analysis of the findings. Quantitative and some qualitative parameters of the patients were studied. The Student and Wilcoxon criteria and the correlation and discriminant analysis were used in construction of the determinative rules. Two groups of discriminant functions were constructed to obtain the prognosis of the outcome of peritonitis in a patient with daily appraisal of the dynamics of changes in his condition. The first group of prognostic indices was obtained only from the qualitative data. The second group of "simplified" prognostic indices was constructed with the use of parameters which are used most frequently in the wide clinical practice. The quality of both groups of discriminant functions proved to be comparable, i. e. both sets of determinative rules may be used in medical practice to evaluate the condition of a patient with peritonitis and construct the prognosis of the outcome of the disease.

[Computer monitoring of hemodynamics during assisted circulation and extracorporeal detoxication in abdominal surgery]. / Monitorno-komp'iuternyi kontrol' sostoianiia gemodinamiki pri provedenii vspomogatel'nogo krovoobrashcheniia i ékstrakorporal'noi detoksikatsii v abdominal'noi khirurgii.

Basic central and regional hemodynamic parameters have been studied using a computer monitoring system in 57 patients with acute abdominal surgical diseases during special extracorporeal procedures. Indications for regional assisted circulation (RAC) as well as regularities in hemodynamic changes during and after procedures have been established. The data of monitoring have shown that RAC and RAC in combination with hemosorption have in most cases a marked favourable effect on abdominal hemodynamics: mesenteric and portal blood flow is increased and consequently total hepatic flow is activated. The flow of portal blood leads to an increase in central venous pressure. Unfavourable tendencies have been established in changes of central hemodynamics during the procedures. They are: calculated intervals of the rates of central venous pressure increment and cardiac output decrement. This made it possible to optimize the use of extracorporeal procedures in patients with such diseases.

[Monitoring and computer control of the status of the central and regional hemodynamics in patients with diffuse forms of peritonitis]. / Monitorno-komp'iuternyi kontrol' sostoianiia tsentral'noi i regionarnoi gemodinamiki u bol'nykh s rasprostranennymi formami peritonita.

Changes in basic central and regional hemodynamic parameters have been studied in 46 patients with diffuse peritonitis using an automated system of constant intensive circulation monitoring. It has been established that the type of circulation did not reflect the severity of the condition in patients with peritonitis, but a characteristic combination of central hemodynamic parameters makes it possible to assess compensatory reserves within each circulation type, as well as to identify unfavourable hemodynamic tendencies. Analysis of changes in the circulation parameters in the course of peritonitis development is necessary to predict the course of the disease and its outcome. There was a considerable difference in circulation parameters patterns of patients who recovered and died of the disease. The principal differences manifested on day 2 postoperatively. Abdominal hemodynamic changes are specific and characterize the severity of peritonitis beginning from the first day of observation.

[Status of the cardiovascular and respiratory systems during immunosorption]. / Sostoianie serdechno-sosudistoi i respiratornoi sistem pri provedenii immunosorbtsii.

Blood was perfused through 2 series connected columns during immunosorption. The first column contained a mixture of immunosorbent and activated carbon, the second activated carbon only. In most patients the perfusion time was 40 min, and the volume of perfused blood 2000 ml. The procedure was performed under the conditions of operative control over the state of the cardiovascular and respiratory system using a monitor-computer system KOMPAS-01 in order to follow 5 hemodynamics values and 10 values of external respiration. A considerable effect of the procedure on the patients' hemodynamic patterns was revealed during hemosorption. These changes manifested themselves mainly in a decrease in stroke volume, cardiac output and changes in rate of the heart beat. External respiration values were more stable.