Problems of Social Hygiene,
Public Health and History of Medicine

The quality of medical care in a medical organization is largely determined by the effectiveness of its Head. The article looks at current regulatory acts, main factors of healthcare organization process in developed countries (France, Switzerland, Australia and South Korea) and methods for assessing the quality of health services. This work analyzes the world practice of appointment, functioning and activity effectiveness of the heads of healthcare system.

One of the urgent medical and social problems of modern society is the steady growth of auto-aggressive behavior and deliberate medication poisoning among adolescents and young adults. This investigation was held to optimize the provision of specialized medical care for acute deliberate self-poisoning in teenagers. We examined 498 patients admitted to the Toxicology Department of N. F. Filatov Children City Clinical Hospital No. 13 with a diagnosis of acute deliberate medication poisoning. The diagnosis was confirmed by chemical and toxicological urine test using thin-layer chromatography. From 2016 to 2018 the number of patients with deliberate medication poisoning increased by more than 2.5 times and amounted to 236 cases. Female patients were prevalent and accounted for up to 85% of cases. The leading position among medication self-poisoning is held by psychopharmacological drugs at 56%, in second place are non-steroidal anti-inflammatory drugs at 18.5%. The main causes of self-poisoning were social or family conflicts (47%), problems at school (35%), and Internet-related complaints (18%). The clinical manifestations of the disease in the acute period of chemical poisoning depended on the toxic agent and the dose taken. Psychological testing revealed a high level of neuroticism in 71% of adolescents, severe anxiety was observed in 57% of patients, and depression was diagnosed in 28% of cases. All patients were provided specialized medical care, including resuscitation, detoxification, and psychiatrist examination. Based on the accumulated clinical experience, an algorithm for managing adolescents with deliberate medication poisoning has been developed, which has reduced the number of repeated suicides by 1.8 times.

The study conducted in the framework of “Our Patient - Our Citizen” Project has examined methods and possibilities of rehabilitating mentally ill people who were prone to anti-social behaviors and have been committed to involuntary treatment. The research has introduced the criteria for identifying patients with high rehabilitation potential. The work has described methods and possibilities of their rehabilitation in hospital (training psychological programs, ergotherapy, art therapy, occupational therapy, etc.) and analyzed possibility of their outpatient implementation. Concrete examples of such successful rehabilitation have been considered. Financial value was determined.

Authors aimed to assess the correlation between the apparent diffusion coefficient (ADC of the tumor, ADC ratio) and final grade group (GG) after radical prostatectomy (RP), and to determine the threshold values of ADC for detecting clinically significant prostate cancer (PC) with subsequent evaluation in a prospective group. 118 patients with PC were included in the retrospective group. These patients underwent RP from 2012 to 2017 with preoperative 3 Tesla multiparametric MRI (mpMRT) with contrast enhancement in a single center. After analyzing all the MRI studies, the average values of tumor ADC and benign tissue ADC were calculated using the maps of ADC. The prospective part of the study included 60 patients with completed pre-biopsy mpMRI and subsequent RP from January 2018 to March 2019. The prospective part of the study demonstrated the effectiveness of applying the obtained diffusion coefficient thresholds. When used as a criterion for determining clinically significant prostate cancer (GG > 6), threshold value of ADC ratio had sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 84%, 91%, 87%, 94% and 78% respectively.

Authors considered the issue of regulatory support for dynamic control methodology concerning the performance efficiency of a head (head physician) of the medical organization of Moscow healthcare system. The regulatory framework for assessing the performance of managers in the public healthcare management system is described. The indicators for assessing the execution effectiveness of the state program “Development of Healthcare in the Russian Federation” and Moscow program “Development of Healthcare in Moscow (Capital Health)” are given. Authors analyzed recommendations of the federal executive authorities on the development of performance indicators of social organizations, as well as experience of their implementation by the constituent entities of the Russian Federation. Proposals to improve the system for assessing performance efficiency of head managers of medical organizations were developed.

The article deals with the actual problem of modern treatment of infant hemangiomas. The accumulated 10-year experience of using propranolol in 512 patients has shown its effectiveness and safety. The team of authors developed a protocol for managing patients with infantile hemangiomas of various localization at all stages of treatment. Special attention was paid to the cardiological aspect of patient monitoring using modern methods of instrumental diagnostics. Due to the clear application of the created protocol with the use of ultrasound control, in most cases, it was possible to achieve complete cure of this pathology, minimize incidence of undesirable effects and avoid the formation of relapses (rebound effect). The effectiveness of the developed algorithm of diagnosis and treatment is confirmed by both clinical results and the results of instrumental examinations.

The family form of giant cell reparative granuloma or cherubism is a rare benign lesion of the jaws which causes face deformation reminiscent of the cherubs portrayed in Renaissance art. Radical surgery, especially in children before puberty, is impossible or irrational, because it leads to disablement. For four years, a child with cherubism was undergoing an outpatient supervision in the Department of Maxillofacial Surgery in Russian Children Clinical Hospital. During the observation period it was noted that tumor masses were slowly progressing leading to exoorbitism. The child had a diagnosis histological verification; a treatment using human monoclonal antibodies to RANKL was developed, adapted and approved by the ethical committee. The clinical effect was observed from the third month of therapy - jaws corners sharpened, the volume reduced. The control biopsy material taken at the end of the 6-month course did not reveal any giant cells which meant complete pathomorphism. Computed tomography showed that at the end of the therapy bone density increased by 6-7 times in the affected zones and was additionally growing over the next 6 months of observation. Such dynamics allowed making effective contouring surgery of excessive bone tissues. Inoperable and early stages of cherubism require a combined treatment which includes a course of monoclonal antibodies followed by alendronic acid therapy that increases osteoblasts survival. After the treatment, if it is necessary to improve the appearance, contouring surgery of excessive bone tissue is performed

For the first time in Moscow and Russia, a program of selective lung cancer screening has been implemented with a comprehensive approach, including organizational, management, medical, technical and educational aspects and quality control. Unique ultra-low-dose protocols (ultra-LDCT) have been developed to implement the screening program. These protocols allow performing high-quality chest computed tomography for lung nodule detection with an effective dose of less than 1 mSv. The possibility of using neural networks (“artificial intelligence”) for quality control of screening results has been proven for the first time.

The article deals with methods of treating patients with bradyarrhythmias, life-threatening tachyarrhythmias and chronic heart failure with the use of implantable antiarrhythmic devices permanent pacemakers, cardioverter defibrillators, and cardio-resynchronizing systems. Methods of instrumental and electrocardiographic diagnosis acceptable for such patients are described. The work defines management approaches to these patients in the postoperative and subsequent periods of life.

The article presents modern technologies of medical rehabilitation of children operated for hydronephrosis. The importance of medical rehabilitation of children with hydronephrosis is associated with high incidence, possibility of developing chronic kidney disease, and early disability of these patients.After surgery on the ureter it is important to use medical rehabilitation technologies aimed at preventing urodynamics disorders of upper and lower urinary tract, and at stimulation of regenerative processes. In recent years, particular attention has been paid to high-intensity pulsed electromagnetic field therapy, which has a more significant and long-term stimulating effect compared to various types of electrical stimulation.Clinical studies were conducted in 80 children operated for hydronephrosis, aged 3 to 15. The main group consisted of 40 children who received high-intensity pulsed magnetic therapy, and 40 children were included in the control group (without physiotherapy). Basic treatment included uroseptics and exercise therapy.Effectiveness of the method was assessed using clinical, laboratory and ultrasound data, and Doppler ultrasound of the renal blood flow. The results of the study demonstrated the rationale of including high-intensity pulsed electromagnetic field therapy in medical rehabilitation of children operated for hydronephrosisThe positive effect of high-intensity pulsed electromagnetic therapy on the urodynamics of the urinary tract (reduction in the size of renal pelvis and calyx) and renal blood flow (restoration of blood flow to the renal cortex) were revealed. This method helped to reduce inflammation in the renal parenchyma (reduction of proteinuria, leukocyturia) in children operated on for hydronephrosis.A significantly higher effectiveness of medical rehabilitation with the use of high-intensity pulsed magnetic therapy was proved (87.5%).

The aim of this study is to improve the results of detection and treatment of patients with prostate cancer (PCa) in the Moscow. For this purpose, we performed our own clinical diagnostic, epidemiological, autopsy, experimental and comparative studies that emphasize the relevance of the stated subject in the study of the diagnosis and treatment of patients with PCa. Urology Department of A. I. Evdokimov Moscow State University of Medicine and Dentistry was at the forefront of the Men's Health program in Moscow and in early 2003 it was the first to have an office for early diagnosis of prostate diseases, as part of the Program. Over 20,000 patients were screened for PCa. For the first time in Russia, methods for the early detection of PCa were investigated on a cohort of Russian men using PCA3 and the Prostate Health Index. The role and significance of prostate saturation biopsy was examined. The investigation of aspects of the morphological assessment of prostate diseases formed the basis for the development of an electronic atlas of PCa images. A series of studies on various prostate visualization methods, including Histoscanning system and MRI, have been performed. A new minimally invasive method for the treatment of prostate cancer has been introduced - a robot-assisted radical prostatectomy and cryoablation. The concept of surgical treatment of localized forms of PCa has been developed and the factors predicting the success of treatment have been determined. This study is reflected in numerous publications both in Russia and abroad, in monographs and dissertations.

Comparative analysis of methods for preventing/stopping intraoperative hemorrhage during surgical delivery of patients with placenta accreta (temporary balloon-assisted occlusion of common iliac arteries, internal iliac artery ligation; uterine artery embolization - UAE) has shown that internal iliac artery ligation is not effective. UAE and especially balloon-assisted occlusion of common iliac arteries have demonstrated a significantly greater effect due to the temporary ‘devascularization’ of the uterine corpus. It has been proved that an innovative surgical technique - a lower segment Caesarean section (LSCS) significantly reduces intraoperative blood loss. The main purpose of an alternative uterus cut - anterior placenta previa preserving and bleeding absence before the child removal - has been achieved within all observations. LSCS has caused a significantly smaller (by 1.6 times) amount of intraoperative blood loss than the corporal one. Another innovative surgical technique is metroplasty. It entails removing placenta accreta areas from the uterus with subsequent restoration of the organ integrity.The authors have proved the necessity of autologous advance blood donation and hemodilution strategy, which was first implemented in Moscow Center for Family Planning and Reproduction, and after 2006 was used in all obstetric institutions in Moscow. This allowed reducing the number of blood donations up to 85% and additionally decreased transfusiological risks which is economically valuable as well.Improvement of diagnostic methods, operating techniques, hemostasis, blood volume redistribution and creating an algorithm on its basis has proved the possibility of implementing an organ-, life, health- and fertility preserving approach in cases of placenta accreta in patients with a scar on the uterus after cesarean section.The introduction of the enhanced principles of patient management with placenta accreta has significantly reduced the number of hysterectomies in Moscow (from 48 in 2007 to 8 in 2016), and during the last 2 years no patient with this complication has had a hysterectomy. 12 out of 85 patients who had deliveries in accordance with the developed algorithm, have realized their subsequent fertility.

The key role in healthy lifestyle (HLS) formation among the population belongs to medical specialists, who possess reliable scientific knowledge in this field. The effectiveness of spreading healthy living message is connected with organizational conditions: principles of segmentation and patient routing, role of non-physician staff, development of remote forms of work and staff training system. Much attention is given to healthy living attitudes among medical specialists. According to the conducted sociological study and review of foreign and national experience, the authors present practical recommendations which include organizational changes aimed at greater effectiveness of HLS promotion by healthcare professionals.

Authors considered the possibilities and limitations of EMIAS implementation in the laboratory service of the city of Moscow on the example of the development and implementation of an integrated Single Reference Laboratory Testing Directory (SRLTD). The article describes the analytical and methodological work performed to systematize the nomenclature when creating the directory. The advantages of SRLTD are assessed: new opportunities for further digitalization of the city’s laboratory service, streamlining of medical documentation, convenience in obtaining laboratory data from doctors and patients, and the expected economic effect.