[Effect of delayed coronary angioplasty after thrombolytic therapy on outcome of acute myocardial infarction].

Patients with acute myocardial infarction (n=161) were in random order divided into 2 groups: (1) those who received thrombolytic therapy (TT), (n=126), (2) those who received TT, optimized coronary angioplasty (TT+CA) on days 2-7 (n=35). During hospital period we assessed systolic and diastolic left ventricular (LV) function, content of cytokine tumor necrosis factor a (TNF a) and its soluble receptor type I (sTNF alphaR-I). Outcomes were registered after 1 year. By the end of hospital period group 2 had significantly higher LV ejection fraction, smaller left atrial dimensions, and lower pulmonary artery pressure. Zones of disturbances of local contractility were more rarely registered in this group. No significant differences were revealed between groups 1 and 2 in parameters of LV diastolic function, levels of TNF alpha and sTNF alphaR-I were revealed by the end of hospital period. After 1 year end point (cardiac death/reinfarction/revascularization) was noted in 47.5% of patients of group 1 and only in 20% of patients in group 2 (relative risk 0.48; 95% confidence interval 0.21-0.84, p=0.0035). Thus delayed CA after TT in acute myocardial infarction is an effective method of reperfusion therapy.

[Systemic analysis of the activities of the intensive care and resuscitation unit in a multi-profile hospital. 3. Evaluation of the effectiveness and decision making]. / Sistemnyi analiz deiatel'nosti otdeleniia intensivnoi terapii i reanimatsii mnogoprofil'noi bol'nitsy. Chast' III. Otsenka éffektivnosti i priniatie reshenii.

The third part of this analysis deals with assessment of the efficacy of the reanimation service by reviewing the data on total and specific mortality rates, the results in critical patients, and correlation of these values to similar values in the hospital. Conclusions and resolutions on further improvement of the department activities are presented.

[Systems analysis of activities of the intensive care and resuscitation department at a multidisciplinary hospital. II. Intensity of work and quality indicators]. / Sistemnyi analiz deiatel'nosti otdeleniia intensivnoi terapii i reanimatsii mnogoprofil'noi bol'nitsy. Chast' II. Intensivnost' truda i pokazateli kachestva.

The second part of the research is devoted to problems of the personnel labor load, to maintenance of reanimation asepsis, to analysis of the complications of intensive care, the causes and outcomes of these complications. A total system approach allows, as the authors believe, an objective assessment of the prerequisites of complications in expert evaluations.

[Systems analysis of activities of the intensive care and resuscitation department at a multidisciplinary hospital. I. Development of structure and function]. / Sistemnyi analiz deiatel'nosti otdeleniia intensivnoi terapii i reanimatsii mnogoprofil'noi bol'nitsy. Chast' I. Razvitie struktury i funktsii.

Using the suggested information mathematical model of reanimation activity, realized in an administrative computer program, the authors carry out a total system analysis of the activity of the intensive care and reanimation unit of a multi-discipline hospital in the town of Arkhangelsk. They discuss the problems of present-day equipment and modernization, formation of the patient populations, improvement of the resuscitation methods, and the policy of reanimation bed use. They recommend that along with the traditional activities, such department should take part in the prevention of grave states in inpatients of all departments of the hospital.