Problemy tuberkuleza i boleznei legkikh最新文献

The authors studied the efficiency of material incentives in the amount of 300 rubles for each case to medical workers of the general health care network for early detection and to those of tuberculosis facilities for effective treatment us in 2001-2007. Due to the tuberculosis-controlling measures made in these years with the mechanism of material incentives to medical workers being introduced, the tuberculosis situation stabilized and the major epidemiological indices, such as morbidity, mortality, and prevalence, decreased by 1.3, 2.2, and 1.7 times, respectively. The higher fluorographic coverage of the population and the introduction of microscopy at the general health care facilities resulted in that the number of new cases of fibrocavernous tuberculosis from 5.6 to 0.7% and, on the contrary, the proportion of bacteria-excreting subjected among the new cases of pulmonary tuberculosis increased from 18.4% in 2000 to 45.2% in 2007 or by 2.5 times (p < 0.001). The results of treatment of the new cases became better. Thus, there were increases in the rate of bacterial discharging cessation from 67% in 2000 to 84.5% in 2007 (p < 0.001), that of cavity closure from 59% in 2000 to 75.2% in 2007 (p < 0.001), and that of transfer to diagnostic registration group III from 23.1% in 2000 to 32.4% in 2007 (p < 0.01). Thus, introduction of the material incentives to the medical workers of the general health care network and tuberculosis facilities had a positive impact on the quality of diagnosis and the efficiency of treatment in patients with tuberculosis.

The indices of life quality were estimated by the Seattle questionnaire in 140 patients aged 19 to 79 years who had chronic obstructive pulmonary diseases (COPD). The results of the study determined the lower life quality indices in patients with COPD according to a number of social factors: domicile, occupation, number of family members, living conditions, and medical care.

The paper analyzes the efficiency of vaccination and tuberculin diagnosis in the megapolis on the basis of official reporting forms Nos. 8 and 33 approved by the 11 November, 2005 Resolution of the Russian Statistics Agency and the Moscow tuberculosis monitoring system. It is concluded that refusals to undergo vaccination and tuberculin diagnosis may result in the system crisis of antituberculous care to the pediatric population. For the optimum solution of reducing the rate of refusals to take the drugs prescribed by a physician, the authors propose to use in pediatric antituberculous care the marketing methods that level off the responsibility of the parties in taking a decision whether a medical service is expedient. Under the marketing conditions of medical services, combating the foci of tuberculous infection should be a main line to reduce the prevalence of tuberculosis. Prevention of tuberculosis is most effective with the active interaction of medical services (pediatric phthisiological and primary pediatric care services) and society and with the needs being molded in it (as a market medical service) in the population.

The clinical and pharmacoeconomic effectiveness of the third-generation cephalosporin Ceftriabol versus the original drug Claforan in the treatment of varying community-acquired pneumonia was studied in 60 and 58 patients, respectively. The Russian third-generation cephalosporin Ceftriabol was shown to be as effective as Claforan in treating patients with community-acquired pneumonia. However, in addition to the main--therapeutic effect, Ceftriabol produces a certain economic gain.

The state-of-the-art of care given in the inpatient departments of tuberculosis facilities (TF) in the Kemerovo Region is analyzed. Large municipal TFs have been reorganized as interregional ones with their adjacent areas being assigned. Indications for hospitalization have been formulated. Continuous supply with antituberculous drugs (ATDs) is ensured. Strict monitoring of the use of each dose of ATDs has been made. Schools for tuberculosis patients have been set up. The posts of a psychologist and a social worker have been introduced. Compulsory hospitalization of bacteria-excreting patients is used by the decision of the court. As a result of the work done, queue to be admitted to the TFs of the Kemerovo Region has been eliminated; the treatment time has been optimized. The informative value of simple sputum smear microscopy against acid-resistant mycobacteria has significantly increased. The rate of premature treatment discontinuity has reduced. The efficiency of inpatient treatment has enhanced.

Visceral pleural pathomorpholodical changes were studied in 50 patients. Group 1 included 25 patients with isolated tuberculous pleurisy; Group 2 consisted of 7 patients with tuberculous exudative pleurisy in the presence of a specific process in the lung; a comparison group comprised 18 who had not died from diseases of the lung and pleura. The exudative productive type of specific pleural inflammation was prevalent in 15 (60%) and 4 (57.1%) patients, respectively. In Group 1, the pleural thickness was 144.0 +/- 3.3 microm, which was 8.3 times greater (p < 0.01) than that in the comparison group (17.35 +/- 4.78 microm). In Group 2, the visceral pleural thickness was 151.1 +/- 3.4 microm, which was 8.7 times greater (p < 0.01) than that in the comparison group and 1.05 times greater than that in Group 1. The study has established that in both Group 1 and Group 2, exudative pleurisy is accompanied by early visceral pleural fibrosing with a tendency to be more pronounced in Group 2 patients, which raises the question as to whether it is necessary to use resolution therapy at the early stages of treatment, to inject isoniazid lymphotropically, and to apply physical methods to prevent pleural cavity obliteration.