The authors describe a clinical diagnosis center working in close cooperation with a chair of therapy. Analysis of the activities of the center demonstrated the usefulness of medical divisions of such kind for practical health service, for it is at such diagnostic centers that profound examinations of patients, making use of present-day diagnostic methods, is possible at the preclinical stage. Such a possibility was offered to the residents of a large region who previously had to be hospitalized for this purpose. A diagnostic center brings evident economic benefit and is a clinic where physicians of primary health centers upgrade their knowledge and skills.
The paper presents an external respiratory failure (ERF) classification, a scientific rationale for its use in the clinical practice of departments of different profiles. The setting up of interclinical functional diagnostic laboratories and preventive health care facilities for the preclinical diagnosis of ERF is substantiated. The introduction of the classification of ERF into wide clinical practice is intended to form a social order for the design and purchase of diagnostic equipment for therapeutic-and-prophylactic institutions and to stimulate researches in clinical respiratory physiology, and to improve physicians' knowledge of this section of clinical science.
Due to the fact that modern digital fluorographic plants have been introduced into medical practice, it is necessary to elaborate new organizational and technological forms of work during fluorographic survey. For this, 1-2 Moscow okrugs completely equipped with digital fluorographic plants should be used to examine their actual capacities and on this basis to develop guidelines for detection of chest diseases by applying this new technological equipment. While organizing mass surveys by using digital fluorographs, it is necessary to take into account the definite conditions: health care facilities must be equipped with a uniform digital fluorograph; for continuity in work and information exchange, the software of all fluorographs must be unified within the city; a personified electronic fluographic card catalogue must be provided by identifying decreed contingents and tuberculosis risk groups; digital fluorographs must be fitted with the programmes that permit one to keep records and accounts in accordance with the approved official statistical forms; the database must be compatible in all users for prompt exchange of information on modem communication and for transmission of the results of a survey on diskette carriers; a fluorographic center wherein the fluorograms of individuals with suspected tuberculosis should be collected and deciphered (by modem communication or on diskette information carriers) must be set up on the basis of one of the tuberculosis dispensaries.
Restructuring the health care system and the epidemiological situation associated with tuberculosis result in an increased burden on the bacteriological laboratories (BLs) of tuberculosis facilities. At present, there are no statistical data that enable one to estimate the capacity of a laboratory service to assure the adequate quality and efficiency of bacteriological diagnosis. To assess the state of the headquarters BLs of tuberculosis facilities, the authors have worked out a questionnaire to glean necessary information on the activity of the laboratories to such an extent that suffices to reveal cardinal problems in the work of individual laboratories and the laboratory network as a whole. Out of the 48 questionnaires sent from the regional BLs, the data available from 22 laboratories that had fully answered all the questions were analyzed. The data obtained are referred to as of 2004, i.e. when the current antituberculous care projects were launched, which is of significance in organizing the monitoring of a laboratory service and in assessing the progress of the projects. The authors have identified the following cardinal problems: inadequate readiness of most laboratories to fully perform their incumbent functions; no coordination in providing data at the regional and federal levels; inefficient laboratory diagnosis that is associated with the disintegration of the curatorial institution, with neither reference relations no united external or internal quality control programs, with the lack of expertise and the undermanning of the laboratories, with the obsolete list of staff members and the obsolete standards for calculation of their loads, with the deterioration of a material and technical base, and with the unconformity of equipment to the state-of-the-art technologies. In order to solve the above problems, the authors offer a laboratory service monitoring system based on the proposed questionnaire, followed by the computerization of data collection and the compulsory supervision of regional laboratories by the officials of district and federal BLs.
Occupational bronchial asthma remains rather prevalent condition developing due to industrial allergens both of organic and inorganic origin. Diagnostic tool is a complex approach including study of occupational and allergologic anamnesis, immune and allergy status, respiratory volumes. Diagnosis leads to first therapeutic step--elimination of contact with occupational allergen. Treatment of occupational asthma includes inhalation steroids, beta 2-agonists, cholinergic antagonists, methylxanthines. Objective of this treatment is maximal control of the disease with minimal therapy facilities--these are contemporary ideas of medical management for such occupational patients.