No 4 (2016)

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Articles
The comparative analysis of the psychoemotional and cognitive sphere of the schoolboys living in the territory of Moscow with different environmental conditions
Glebov V.V., Shastun S.A., Trifonova T.A.
Abstract
The study presents a comparative analysis of psycho-emotional and mental activity of junior schoolchildren living in Moscow with different environmental conditions. The study was conducted on a sample of 206 primary school children (students of the first grade), age 7,8-8,9 years old who attended primary schools located in different districts of the capital city - South-Western administrative district (SWAD) and South-Eastern administrative district (SEAD). Depending on environmental conditions (ecological and social) subjects were divided into 4 groups. The first subgroup of E1 schoolboys were under the influence of negative social factors (low socio-economic status family, single-parent families, and inharmonious child-parent relationships) and environment (air pollution, noise, industrial areas). The second subgroup E2 of schoolboys lived in ecologically adverse and favorable social environment (high socio-economic status of the family, a complete family, a harmonious parent-child relationship). The third subgroup E3 schoolboys lived in ecologically favorable and unfavorable social environment. The fourth group, conditionally designated as a control of schoolboys lived in a favorable ecological (lack of industrial zones, the forest zone) and the social environment. Comparative analysis of the investigated sub-groups of schoolboys confirmed the existence of differences in the indicators of the development of psycho-emotional and cognitive development of children living in different environmental conditions. Our study showed that in the SEAD, where the action of unfavorable physical environment has a stronger, more pronounced than the social environment psycho-emotional state, cognitive development and for the adaptation processes of schoolboys takes place with overvoltage functional systems. As a consequence of these impacts, affected-environmental conditions of the southeastern administrative area, the level of morbidity of children was higher than favorable in the South.
RUDN Journal of Medicine. 2016;(4):9-21
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Localization of biologically active substances in the structural of scin at the acupuncture points TR-20 in the morning and evening times
Lyubovtseva L.A., Aronina E.E., Lyubovtsev V.B., Lyubovtseva E.V.
Abstract
Dynamics of the content of biogenic amines in the structures of the acupuncture points of the skin at different times of the day is shown in article. Skin educations as epithelium, elastichesky fibers, the granular luminescing and corpulent cells of skin in the field of TR-20 acupuncture point at different times were for this purpose studied of days. Further, the statistical and correlation analysis of morphological and quantitative changes of catecholamines, serotonin, histamine and heparin in the skin structures is carried out.
RUDN Journal of Medicine. 2016;(4):22-29
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The structural-functional characteristics of myocardium in the experimental crush syndrome
Aznauryan A.V.
Abstract
The investigation of the pathogenesis mechanisms and the morphological manifestations of crush syndrome are still actual. There is still a persistent likelihood of occurrence of the situations that can possibly lead to the given pathology: the lesions as a rule gain an incremental character, and what is more, the developing crush syndrome in such cases occurs in its heaviest form. The exploited model of the experiment has enabled to mitigate CS; the lighter form of the syndrome has made the development of a more sustainable model of CS possible, which is proved by the morphological changes of myocardium.
RUDN Journal of Medicine. 2016;(4):30-36
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Innovative technologies in pelvic fractures management
Solod E.I., Lazarev A.F., Sagorodni N.V., Abdulchabirov M.A., Ovcharenko A.V.
Abstract
The article is based on our clinical experience and modern tendencies of development of minimally invasive surgery. It contains analysis of percutaneus osteosynthesis of pelvic fractures with various metal fixation devices. We analyzed 74 cases of pelvic fractures in which minimally invasive osteosynthesis was used. The patients underwent operative treatment with cannulated screws and new metal fixation devices - CITO screws. The innovative technology showed its high clinical efficiency, its advantages and weak points were analyzed. The majority of pelvic ring injuries are life-threatening and are often accompanied by fractures of other parts of the skeleton and injuries of internal organs. High quality operative treatment of pelvic fractures is often limited by severe general condition of patients and the necessity of simultaneous operative treatment of internal organs and injured parts of musculoskeletal system. Thus, on the one hand, it is necessary to provide high quality fixation of pelvic bone fragments, on the other hand, it is important to reduce surgical aggression during osteosynthesis. The most serious conditions are pelvic ring fractures associated with acetabular fractures, when there is need for intracapsular acetabular fracture stabilization for successful pelvic functional recovery. Acetabular fractures still remain one of the most crucial issues of modern traumathology. Disability, low life quality, hip arthroplasty are the main sequences of inadequate treatment of such fractures. Conservative treatment results in disability in 22-66.7% cases, that is 3 times more frequent compared to the level of disability after operative treatment (1, 2, 3). Only operative treatment makes it possible to achieve successful longtime functional recovery (4). Open reduction with internal fixation is associated with large surgical incision, massive intraoperative blood loss and high risk of infectious complications. The main recognized condition for bone fracture consolidation is intact blood supply of fragments, that is provided only by minimal surgical invasion (5, 6, 7, 8). Thus, development and implementation of implants and minimally invasive methods of bone fragments stabilization are main innovative tendencies of internal osteosynthesis development. The aim of our research was to develop minimally invasive osteosynthesis technologies and to invent a new metal fixation device.
RUDN Journal of Medicine. 2016;(4):37-46
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New aspects of the clinic, pathogenesis and treatment of algesis temporal-mandibular joint dysfunction syndrome in patients with psychoemotional disorders
Tatintsyan L.V.
Abstract
One of the problems brought to our attention was to study the effect of psycho-emotional state on the functional ability of the TMJ. In every separately taken case we focused our special attention on the roentgenological investigations for the structural changes of the temporal-mandibular joint. Either orthopantomo-graphy or computed tomography (CT) was mainly implemented One of the problems brought to our attention was to study the effect of psycho-emotional state on the functional ability of the TMJ. In every separately taken case we focused our special attention on the roentgenological investigations for the structural changes of the temporal-mandibular joint. Either orthopantomo-graphy or computed tomography (CT) was mainly implemented. High sensitivity of CT to the changes of the studied tissues is conditioned by the fact that unlike the ordinary roentgenological films these obtained images are not distorted b y applying other structures through which passes the X-ray bundle. One of the symptoms of TMJ dystrophy is the murmur in the joint area when opening and closing the mouth. Murmur recording is performed with the help of highly sensitive microphones attached on the surface of the skin in the joint area. The patient opens and closes the mouth at a maximum amplitude. The recording is carried out during 4 cycles and later the program analyzes by interpreting the obtained data. One of our brought up problems was to study the psycho-emotional status effect on the functional state of TMJ. Radiologic examinations, particularly CT was used to define organic-structural changes in the joint. We have modified and worked out a device for the determination of murmurs in TMJ pathologies, apparatus-electrosonography “Device for defining murmur in TMJ. Invention N.95 on 07.07.2015, which is portable, small with a corresponding (suitable) program that allows to define changes in TMJ dysfunctions during the very first approach. We think that this device will be widely used in clinical practice. Of the patients observed by us practically all of them had malocclusion, which makes us speak about the necessity to eliminate the causes preceding its development, i.e. to normalize the occlusive states and the psycho-traumatic stress-genic factor which will significantly increase the possibility to diagnose and treat painful dysfunction of TMJ.
RUDN Journal of Medicine. 2016;(4):47-53
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Clinical observation: polymyalgia rheumatica
Bychkova L.V., Kobelevskaya N.V., Vorontsova K.O., Kondratenko A.I., Overchenko T.U.
Abstract
Polymyalgia rheumatica - a rare disease diagnosis is difficult in the absence of specific laboratory indicators, as well as from the similarity of the clinical picture of such diseases as bilateral humeroscapular nodosa, polymyositis, periarteritis nodosa, cancer, multiple myeloma. In some cases, with high fever, rheumatic polymyalgia necessary to differentiate from sepsis or tuberculosis; when the articular syndrome, brucellosis, toxoplasmosis, arthritis of the jaw joint, the jaw and facial neuralgia. In laboratory indicators - signs of inflammation. Quick response to treatment with prednisolone (within 2-3 days) confirms the diagnosis.
RUDN Journal of Medicine. 2016;(4):54-59
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Comedication in the structure of drug burden in children in hospital
Gudkov R.A.
Abstract
Comedication is a reception of drug about the associated diseases. The concept of comedication reflects pharmacotherapy side of comorbidity and is a little-studied phenomenon in pediatric practice. This work shows the results of the study the prevalence and drug load patterns in hospitalized children with different levels of comorbidity. A total of 512 children aged 1 to 17 years who were hospitalized in the somatic department of the regional hospital. The analysis of case histories, outpatient cards and a survey of parents was performed. Three groups of patients were allocated: the first were children with isolated pathology (n = 155), the second - the children with two chronic disease (n 168) and the third - polypathy patients (n = 189). On average for the period of hospitalization children received 3,85 drugs. Five or more drugs received 18.8% of the patients. The average drug load in children with isolated pathology was 3,1; in children with two diseases - 3,72; with polypathy - 4,43. Admission drugs about concomitant diseases was recorded in the history of the disease in 11,7% of the surveyed children. Cases receiving medicinal products not listed in the history of the disease were detected in 17,6% of patients. In the structure comedication identified three options: a long reception of medicines on the associated chronic diseases (11,5%), episodic receiving medications for acute symptoms of any non-main disease (11,0%) and the reception of biologically active additives and other similar means of treatment and preventive orientation (9,2%). Children with polypathy had more comedication compared with patients who had one or two diseases.
RUDN Journal of Medicine. 2016;(4):60-67
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Prostate cancer. Principles of early diagnosis
Kostin A.A., Kulchenko N.G., Tolkachev A.O.
Abstract
Among the main methods of examination of prostate cancer: finger rectal examination, PSA test, ultrasonography of prostate, none possesses enough specificity and sensitivity. In our research, we used special statistic and mathematic processing (multifactor analysis and binary logic regression) of main prostate cancer symptoms, which allows to suspect Prostate Cancer with 97% accuracy and also reduce the incidence of prostate biopsy. The article presents a clinical example of early diagnosis of prostate cancer.
RUDN Journal of Medicine. 2016;(4):68-76
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Method of lower anterolateral resections on primary carcinoma of the subglottic larynx
Maktybaeva D.A.
Abstract
In our clinical materials among 533 patients with cancer of the larynx, laryngectomy were performed at 387 (73%) of cases, various kind of the organ-save operations - at 146 (27%) patients. In 4 cases malignancy tumors were located in subglottic larynx. In one cases at the T1 stages of the tumors confirmed by pathomorphologically among 4 patients the left lower anterolateral resections of the larynx with formations of the tracheostomy had done and preservation the vital functions of the larynx: respiration, separation, phonation. In other cases laryngectomy had been done.
RUDN Journal of Medicine. 2016;(4):77-80
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Markers of myocardial fibrosis in patients with ischemic cardiomyopathy and atrial fibrillation
Myasoedova E.I., Polunina E.A., Voronina L.P., Sevostyanova I.V.
Abstract
This paper studied the biochemical and functional indices of myocardial fibrosis in patients with ischemic cardiomyopathy and atrial fibrillation. In the group of patients with ischemic cardiomyopathy with sinus rhythm, the level of transforming growth factor-β1, the ratios of matrix metalloproteinase-1 and its inhibitor and volume fraction of interstitial collagen were significantly higher than in patients with permanent form of atrial fibrillation in this group (P = 0.041, P = 0.045, P = 0,038, respectively), which suggests the presence of processes of fibrosis and collapse in the extracellular matrix, while in patients with atrial fibrillation there is a slight predominance towards the latter.This leads to electrical heterogeneity of the myocardium, the increase in the speed of wave propagation of excitation and activation of ectopy, creates favorable conditions for the occurrence of atrial fibrillation in these patients.
RUDN Journal of Medicine. 2016;(4):81-86
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The optimising of neoadjuvant chemoradition methods of therapy in muscle-invasive bladder cancer
Nurgaliyev N.S.
Abstract
In this original paper presented main results of neoadjuvant chemotherapy and radiation of the muscle invasive bladder cancer. Authors analyzed results of preoperative therapy and radical cystectomy in depending of prognostic factors, such as age, sex, grade of histological differentiation, tumor size, stage of disease, and lymph nodes status. There were showed that neoadjuvant chemoradiation therapy in selected group of patients with muscle-invasive bladder cancer can affect overall survival and life expectancy, compared with only surgery.
RUDN Journal of Medicine. 2016;(4):87-94
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Prognostic opportunity neurological evaluation scale in patients with non infiltrative paraxial tumors in early period after posterior fossa surgery
Podlepich V.V., Shimansky V.N., Sokolova E.Y., Alexandrova E.V., Dolotova D.D., Masherov E.L., Lapteva K.N.
Abstract
For optimal airway protection in early postoperative period after fossa posterior surgery (PFS) necessary prognosis of neurological dynamic through neurological exam before operation. We performed Neurological Evaluation Scale (NES). The aim of our study was research possibility NES to predict brain stem deterioration in early postoperative period after PFS It was a prospective study during. It included 182 patients operated for fossa posterior tumors (FPT). Including criteria were age elder 18 years, operation in fossa posterior non infiltrative paraxial tumors. We examined all pts. before and after operation immediately after extubation in ICU. NES provide complex neurological estimation with emphasis of brain stem function. NES points after operation were subtracted from points before operation - AB-criterion (ABc). Positive ABc correspond augmentation neurological impairment. Negative or zero ABc correspond neurological improvement. All neurological symptoms were grouped in 7 NES blocks in conformity their relation with CNS. We divided all pts. in two group by ABc and revealed, that pts with positive ABc has reliability less NES points before operation, than pts. with negative or zero ABc. We found frequency of occurrence of each of the NES blocks in full neurologic status. We reveal more frequency of involvement the caudal stem in pts. with more NES points. We evaluate probability impairment or regression neurological symptoms by ABc with sensitivity 90,7% and specificity 95%. We created prognostic model, which could predict outcome in discharge from clinic in terms on NES blocks in early postoperative period.
RUDN Journal of Medicine. 2016;(4):95-102
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New psychoactive substances synthetic kannabinoids clinical and social aspects
Suvorov A.V., Larchenko A.V., Kaurov Y.V., Suvorov M.A.
Abstract
Work is devoted to the most actual problem of our time to impact of smoking mixes on a human body. It is shown that new psychoactive agents, synthetic kannabinoids as drugs are used relatively recently. The main mechanisms of impact on a human body are allocated. Selection of patients with the diagnosis sharp inhalation poisoning with smoking mixes for 2014 in the city clinic No. 33 toxicological center of Nizhny Novgorod is executed. The clinical picture and the main manifestations of inhalation poisoning with smoking mixes is described. As a result of work it is revealed that bulk of patients young people in an age interval from 11 to 30 years. Overdoses are most often connected with a variety of the applied smoking mixes and variations of doses from party to party. Pharmacological effects such as tachycardia can be connected with existence in composition of some mixes of a preparation klenbuterol. Communication between impact on CB2 receptors and existence of a fever and leykotsitoz in blood is found.
RUDN Journal of Medicine. 2016;(4):103-106
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The quality of life of patients after treatment of inguinal hernias by TAPP and TEP
Tarasenko S.V., Zaytsev O.V., Ahmedov S.I.
Abstract
A comparative analysis of the quality of life of patients in the late postoperative period after hernia repair methods TAPP and TEP. To study the quality of life questionnaire SF-used 36.Na based study found that the quality of life of patients after hernia repair method TEP is higher than after TAPP.
RUDN Journal of Medicine. 2016;(4):107-111
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The syndrome of enteral insufficiency at patients with acute pancreatitis
Taha H.D., Fedoseev V.A., Murav'ev S.Y., Budarev V.N.
Abstract
Schemes improvement of acute pancreatitis treatment requires a detailed study accompanying its pathological changes in the body. In our study, we carried out analysis for a number of parameters characterizing enteral insufficiency syndrome that develops regarding acute pancreatitis. At the same time a dependency between the enteral insufficiency syndrome severity and developing regarding an underlying disease of endogenous intoxication is identified , immunodeficiency.
RUDN Journal of Medicine. 2016;(4):112-117
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P-glycoprotein functional activity and expression in type 2 alloxan diabetes
Yakusheva E.N., Titov D.S., Popova N.M., Ryabkov A.N.
Abstract
On 16 Chinchilla rabbits males of breed with type 2 alloxan diabetes P-glycoprotein functional activity and expression was studied. The diabetes mellitus was modelled by intravenous administration of alloxan monohydrate in the citrate buffer. P-glycoprotein functional activity was assessed by pharmacokinetics of its probe substrate - fexofenadine after its single oral administration. P-glycoprotein expression was investigated by immunohistochemistry method. The inhibition of P-glycoprotein functional activity and expression was followed by decrease of postprandial insulin level and an insulinogenic index and increase of postprandial glucose level in a blood.
RUDN Journal of Medicine. 2016;(4):118-126
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Continuing education and accreditation of specialists organization of healthcare and public health
Abramov A.Y., Kicha D.I., Fomina A.V., Konovalov O.E., Rukodaynyy O.V., Makaryan A.S., Pachgin I.V., Ivanenko A.V.
Abstract
In the article discusses the issues and proposes mechanisms for continuous medical education and accreditation of specialists of the health care organization and public health/ Analyzes the difficulties of training and experience of the authors on the development of teaching materials, the introduction of distance education technologies, simulation tasks, the readiness of personnel to the accreditation function on the portal of Ministry of health of Russia.
RUDN Journal of Medicine. 2016;(4):127-134
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Experience of introduction of the standard of quality management of ISO-9001-2015 on the example of the medical center of Yakutsk
Borisova E.A., Lutskan I.P., Timofeev L.F., Stepanova M.A.
Abstract
In article the questions connected with introduction in activity of State Healthcare Institution of the ISO-9001-2015 standard of quality management (SQM) are considered, examples of administrative processes, control methods and indicators of an assessment of efficiency are offered. The work results in the field of the standard of quality management, achievement of target indicators are summed also up and problems and risks which the medical organization when using faces in the two work of SMK are reflected.
RUDN Journal of Medicine. 2016;(4):135-140
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Evaluation of the hospital rheumatology department procedural nurse activity in terms of the quality of life of patients
Breslavskaya E.S., Maksimenko L.V., Tadjieva A.V.
Abstract
The life quality of the patient, hospitalized in the rheumatology department, is determined not only by its functional abilities (especially musculoskeletal system), but also by mental comfort, that largely dependent on the adaptive capacity of the patient, surrounding situation, attitude of staff and awareness of the patient. The procedural nurse ranks the third place after the head of department and the attending physician, and in some groups is the leader by the importance for ensure the mental and physical comfort of the patient. Totally, self-rating of health is determined by the ability of self-weakness, duration of illness and frequency of panic disorder. The majority of patients evaluated their health as average (54%) or good (42%). The majority of patients (88%) are pessimistic about the forecasts of the disease. 46% of respondents believe that the disease will lead to the impossibility of self-service and 42% disability. However, more than half experiencing depressed psychoemotional state, physical weakness of the average level, more or less pronounced fatigue. Therefore, the activities of procedural nurses of rheumatology department of a hospital is extremely high for the quality of life of patients. The work of department procedural nurse, carrying out official duties, is regarded by patients as excellent or good, with the leading factors of an excellent rating is the inability of patients to self-care and the possibility of loss due to disease among patients. Between evaluations of medical services, professional level of medical personnel and work of procedural nurses a positive correlation was revealed, which is evidence of the importance of the work of nurses, including nurse procedural, for the perception of the patients of the health service as a whole. The evaluation of procedural nurse of the rheumatology department of the hospital, conducted by surveying patients and statistical processing of results, showed the high importance of procedural nurses work for the quality of life of patients exceeding the rating and occupational level of the rest of the nursing staff. Her work most highly valued by patients with potential or realized risk limits functionality and is a reserve of quality improvement of health services in general.
RUDN Journal of Medicine. 2016;(4):141-148
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Analysis of human potential of health care
Jidkova E.A., Fomina A.V.
Abstract
Improver effectiveness of health care system is pretty much determined by professional competence of staff, it also depends upon staff policy. The aim of the study is to conduct a statistical analysis of medical and nursing staff, changes in its number.On the basis of official statistics (form of State Medical Statistics № 30) the authors conducted a specific characteristic of medical and nursing staff in the health care system of Russian Railways. Analysis of quantitative composition of staffrevealed to staffing in a medical organizations.
RUDN Journal of Medicine. 2016;(4):149-151
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Health status and negotiability for medical care reserve officers and retired officers
Konovalov O.E., Popov A.V., Breusov A.V.
Abstract
In the course of the present study were conducted sociological survey 574 reserve officers and retired officers. Despite the relatively high subjective assessment of the health of the respondents they had different complaints about their state of health. These were mainly complaints of violations on the part of the circulatory system, musculoskeletal system, digestive organs and organs of sense (sight, hearing). Incidence rate was 203.9 per 100 respondents. At the same time at everyone were registered from 1 to 4 diseases, an average per person accounted for 2.13 of the disease. The analysis showed that there was a direct correlation of medium strength between the quantity of disease and the availability of disability in patients. It was found that 84% of respondents sought medical care at least once a year, and among them, 22.1% - at least once a half year. Nearly one-third (29.8%) of former military have transferred serious illness, injury and surgery operations. Over the past year 85.4% of respondents called for an ambulance, among them 23.5% did so every month.
RUDN Journal of Medicine. 2016;(4):152-157
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Decision-making methods on expediency of introduction of innovations in treatment and diagnostic process
Otstavnov S.S., Breusov A.V., Otstavnov N.S., Breusov R.A.
Abstract
The fact that each management solution is made with the lack of information defines the risk of making a wrong decision. Such decisions made by competent specialists in individual agencies as well as networks of health authorities can produce a strong effect on lives and health of patients. It explains the increasing topicality for defining methods and means of making reasonable decisions. In the article based on the analysis of normative documents, scientific and methodical literatures, with the interaction of experts in health services, such methods and means are described, analyzed and systemized. The research showed that using of each alternative (analysis of regulatory documents, expert survey, clinical and economic analysis) has its own advantages and disadvantages. And it depends on the case which method will be the most reasonable to use.
RUDN Journal of Medicine. 2016;(4):158-167
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The composition of adult patients discharged from hospitals and day hospitals Russia
Shlyafer S.I.
Abstract
The article presents the distribution of adult patients discharged from hospital and day hospitals by classes of diseases in the Russian Federation for 2005-2014. Marked a decrease in the number of patients discharged from hospitals with 211,9 to 205,6 per 1,000 adult population, the growth the number of adult patients discharged from the day hospital with 15,6 to 18,1 per 1000 adult population. The main reasons for the treatment of adult patients in hospitals and day hospitals were diseases of the circulatory system, the genitourinary system, the pregnancy, childbirth and the postpartum period, diseases of respiratory organs, digestion. It is shown that in the country for 10 years, the average length of stay of adult patients in the hospitals has decreased from 14,5 to 12,35 days, in day hospitals - from 12,0 to 10,3 days. The maximum duration of stay in adult patients - in hospitals and day hospitals identified in connection with mental disorders and behavioral disorders, some infectious and parasitic diseases.
RUDN Journal of Medicine. 2016;(4):168-177
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Abstract
RUDN Journal of Medicine. 2016;(4):178-183
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