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The article describes the history of the creation of the Department of Family Medicine of the NWSMU named after I.I. Mechnikov, notes the role of international projects in its establishment and development of the main areas of activity. Examples of successful long-term cooperation are given, in particular, with the University of Iowa (USA). The main stages of the formation of teaching the specialty General Practice (Family Medicine) within the framework of professional retraining of primary health care doctors and residency are described. The importance of using various interactive technologies in the learning process is emphasized, including the development of skills in simulation conditions, which were introduced at the department long before their use in the process of accreditation of specialists. The features of teaching the discipline Polyclinic Therapy for the 6th year students of the medical faculty, as well as the experience of leading scientific research that was carried out by participants of the student scientific society are noted. The main directions of scientific research carried out at the department in recent years are described, aimed at a comprehensive study of the features of the management of elderly patients in general medical practice and the prevalence of chronic obstructive pulmonary disease (COPD) in St. Petersburg and Arkhangelsk. The role of international cooperation in the implementation of large-scale scientific projects, in particular with the Catholic University of Leuven (Belgium), is emphasized. The perspectives for the development of the Department of Family Medicine in the near future are outlined.

The article is devoted to the research of the development of motor skills of premature babies on the background of medical rehabilitation in an outpatient-polyclinic and the determination of the age standard (scale) for the development of motor skills of premature babies. The research includes 137 premature babies with the gestational age from 26 to 37 weeks, birth weight from 800 to 2600 grams. The main group of the research consisted of 117 premature babies who had already took a part in the early and complex rehabilitation, the control group which consisted 20 children who were included in the research because of a history of prematurity and who applied to the rehabilitation department with already established disabilities (the health status of premature babies in the control group was studied retrospectively). Premature babies in the control group began medical rehabilitation after 6 or more months of life and did not receive it in full. The assessment of the motor skills of premature babies was carried out in dynamics on the monthly basis. Of the 117 premature babies of the main group 2.5% had motor disorders that led to disability, the premature babies of the control group reached disability in 100% of cases. The research of motor development of premature babies revealed that with a delay in applying for medical rehabilitation, even for one day, the integrated indicator of the relative deviation of actual skills development from the standard increases by 0.9%.

The importance of studying the incidence of angina, methods of dealing with it, stems from the fact that among acute infectious diseases, angina is second only to influenza and catarrh of the upper respiratory tract.

Aim: to demonstrate the difficulties and timeliness of HIV diagnosis by primary care physicians, to carry out a clinical and epidemiological analysis of newly diagnosed cases of HIV infection. Materials and methods: The study evaluated the routing of diagnosis and analyzed the epidemiological and clinical and laboratory data of 85 patients with a newly diagnosed HIV infection hospitalized in the St. Petersburg Clinical Infectious Diseases Hospital named after S. P. Botkin during the period from November 2018 to October 2019. To confirm positive results, ELISA and western blot were used. Results: Among the observed patients, 71.3% were women and 28.7% were men. The average age was 39.3 2 years. Upon admission to the infectious diseases hospital with an established diagnosis of HIV infection, 49.5% were hospitalized in specialized departments (n = 42). Of them, nine (9) were referred by the polyclinic with an established diagnosis, in 20 patients the diagnosis was established in somatic hospitals, and emergency room doctors newly diagnosed HIV infection in 13 more patients. The remaining 50.5% (n = 43) were hospitalized in various departments with other diagnoses. Clinical and laboratory analysis of these patients showed that for the first time in life, an established diagnosis of HIV infection corresponded to both early (15.3%) and late (84.7%) stages of the disease with dominance of sexual transmission of the virus (43.6%). Conclusion: HIV infection at both early and late stages can manifest under the guise of various other diseases, which makes it necessary to expand testing of patients for HIV infection, including using rapid tests.

In this work, the author of the nine cases published by Professor Leopold (Volkmann's Vortrge, No. 333), the sewing of the retroflected uterus to the anterior abdominal wall attaches ten new ones, which were operated on during 1889 at the Dresden polyclinic.

Aim. To study the knowledge of clinical recommendations of the Ministry of Healthcare of the Russian Federation, acquired by doctors providing dispensary observation regarding contraindications to administration of antihypertensive drugs. Materials and methods. Questioning of 146 doctors, providing dispensary observation of adults using the standard questionnaire, containing 14 questions-tests. There was implemented the frequency analysis, calculation and comparison of the mean score, Median, Mode in relation to all the group and groups, singled out by the following two signs: work at the hospital for the recent 5 years and awareness of the content of clinical recommendations of the Ministry of Healthcare of RF. Correlation analysis between scores and age was conducted. Results. The mean score was 3.6 3.3 with maximum 14, Median 1, Mode 1. Nobody from respondents got the maximum score, the best result 12 scores was received by 0.7 % of respondents, 0 scores 3 %. No correlation between scores and age (r = 0.1, p = 0.4) was revealed. In the group of doctors, working at the hospital for the recent 5 years, during half a year the mean score 5.4 3.5 was significantly higher (t = 3.8, p = 0.001) than in the group of those who did not work 2.9 2.7. In the group of respondents, who indicated their knowledge of the content of clinical recommendations, the mean score 3.6 3.4 (t = 0.4, p = 0.89) did not significantly differ from the mean score 3.5 3.3 in the group of doctors who were not aware of clinical recommendations on arterial hypertension in adults. Conclusions. The knowledge of clinical recommendations, confirmed by the Ministry of Health of the Russian Federation, should be regularly estimated among the doctors, providing dispensary observation. Practice-oriented training of clinical recommendations is also needed.

The study confirmed that reproductive age patients with endometrial hyperplasia with initial severe hyperestrogenemia, autonomic regulation imbalance, and pronounced psychosomatic disorders as hormonal therapy showed marvelone in the prolonged mode, because in this case the gradient of estrogen incidence is smoother than during application depot forms of buserelin. In addition, the possibility of simplifying the algorithm for applying a verifiable clinical-psychological approach through the use of simple, automated physiological and psychodiagnostic research methods, which makes it possible to effectively use this algorithm in polyclinic conditions, is shown.

Aim. The research of the prevalence, nosological structure, clinical presentations, and pathogenetic features of different forms of coxal epiphyseal pathology including Meyer dysplasia in small children based on the results of clinical and instrumental observation on outpatient orthopedic admission. Material and methods. In 12,000 children from 0 to 5 years, an orthopedic examination was conducted with an assessment of external dysmorphogenetic signs of connective tissue dysplasia, an ultrasonic examination of hip joints, an in-depth X-ray examination. The step-by-step examination algorithm was structured and detailed according to the presence and severity of the coxal region pathology, childrens age. Conclusion. The combination of dysplastic phenotype with joints formation inhibition in children aged 1 year is a predictor of Mayers dysplasia and must be the reason for a detailed examination of the hip joints with use of visual diagnostic methods.

The article presents results of medical and sociological study carried out with purpose of exploring social characteristics of patients of municipal polyclinics in Rostov-on-Don. The derived results were compared with opinions of patients about their own health status, as well as with their perception of dispensarization. The results of the study demonstrated that mostly the patient of municipal polyclinic is characterized as woman (68.2%), aged 65 years and older (22.4%) or 18-25 years (19.1%), with higher education (51.1%) and married (55.9%). The social status of typical female patient of municipal polyclinic is worker (41.6%) or retired person (30.9%), considering her health condition to be rather poor than good (74.5%). The average rate of annual appealability to municipal polyclinic is 3.9 ± 0.3 times per year. At that, high level of patient compliance (78.6% and inadequate awareness of possibilities of dispensarization, including its purpose and tasks (only 24.7% passed dispensarization in 2018-2019) is established. The level of awareness of dispensarization program is related to age of patient (65 years and older), rate of visits to medical organization (municipal polyclinic), awareness of health maintenance and promotion.

Aim. To detect the most informative signs of connective tissue dysplasia (CTD) and develop the method for CTD express diagnosis in conditions of ambulatory and stationary traumatologo-orthopedic service. Materials and methods. Sixty practically healthy persons were examined. To diagnose the connective tissue pathology, there were used the criteria developed by S.K. Evtushenko (2002), T.Yu. Smolnova (2003) and T.I. Kartunova (2006). Eighteen the most informative criteria were chosen. Results. The paper is devoted to a widespread and yet not fully studied problem – the connective tissue dysplasia. The basic signs of this disease were analyzed. The most informative criteria of connective tissue dysplasia were singled out. Express test for primary diagnosis of this pathology in conditions of traumatologo-orthopedic service was offered. Conclusions. Express test of the state of connective tissue structure is simple to perform. It can be used to improve surgical aids in connective tissue dysplasia, when additional stabilization of loco motor system is required.

The article presents the main principles of lean manufacturing, experience and results of lean production launch in a large city outpatient clinic as part of the Ministry of Health pilot project “Lean outpatient clinic”. In the clinic, redistribution of space, optimization of e-document management and registry workflow were performed. It reduced queueing time and time of blood sampling, simplified arranging a visit to General practitioner and other physicians, increased time of doctor and patient interaction, which allowed to serve much more patients with the same amount of resources, save time of medical staff and patients, and increase their satisfaction.

The training manual is based on many years of experience in the practical application of reflexotherapy in outpatient settings. The article presents a structural analysis of diseases of children and adolescents receiving treatment in the reflexology room of a childrens polyclinic, which revealed a high level of pathology of the musculoskeletal system and connective tissue and a steady growth trend of this group of diseases. Pathogenetic justifications, indications and contraindications for the use of reflexotherapy in Pediatrics and in diseases of the musculoskeletal system in particular are given. Principal therapeutic approaches and treatment regimens for patients with obstetric hand paralysis, spastic torticollis, migraine, Perthes disease and traumatic limb injuries are considered. Recommendations on the organization of outpatient use of reflexotherapy in Pediatrics, the methods used and their instrumental support are formulated. The training manual is intended for doctors who specialize in reflexology, already practicing reflexologists, orthopedic traumatologists and physiotherapists.

The article presents the results of a retrospective study aimed at identifying exacerbations in outpatients with chronic obstructive pulmonary disease (COPD) during the previous 12 months. А telephone interview was conducted with 20 patients with COPD from the departments of general medical practice of three polyclinics in the Kalininsky district of St. Petersburg. The obtained data were compared with records in outpatient cards to determine the presence of registered cases of appeals to the polyclinic for exacerbation of the disease.7 patients (35%) were identified retrospectively using the questionnaire, which can be attributed to the phenotype of COPD with frequent exacerbations. Among them, five people were hospitalized in a hospital for exacerbation of COPD, and two patients had 2 or more exacerbations in an outpatient card that did not lead to hospitalization. In 5 patients (33%), among those who were not in hospital for an exacerbation of COPD for the previous 12 months, indirect signs of low self-esteem were revealed, indicating that it is necessary to raise awareness of the exacerbation of COPD and the education patients self-management skills. (For citation: Maliavko NS, Shatyi NO, Alagova EV, et al. Detection of exacerbactions of chronic obstructive lung disease in the ambulatory practice. Russian Family Doctor. 2018;22(1):18-22. doi 10.17816/RFD2018118-22).

One of the main tasks of the national healthcare is to increase the accessibility and quality of medical care to the population. One way of assessing the quality of care is to study patient satisfaction with medical care through sociological research. The degree of patient satisfaction reflects not only the social effectiveness of medical organizations, but also the work of all health systems. The bulk of medical care a child receives in the conditions of the polyclinic. Parents, being legal representatives of the child, can objectively assess the quality of medical care provided to them in the children's polyclinic, and, if necessary, protect his legitimate interests. With a view to identifying the main causes of the dissatisfaction of the child population of Saint Petersburg by the accessibility and quality of ambulatory-polyclinic care, the anonymous questionnaire of 1488 parents of children receiving the medical care in outpatient polyclinics was conducted. It found that in children's polyclinics parents often face difficulties when calling the doctor home, visiting a pediatrician and subspecialties doctor, passing medical examinations and procedures. Parents were not always satisfied with the preventive activities and sanitary and hygienic condition of the polyclinic. There are cases of inattentive and mistreatment by medical personnel. In General, over half (53.2%) parents have remained completely unsatisfied or not fully satisfied by the quality of provided ambulatory-polyclinic care.

Aim. To propose promising organizational and functional models of general medical practices in a city with the expansion of the functions of paramedical personnel. Methods. Analysis of the forms data of federal statistical observation in Russia and its subjects was carried out. The following research methods were used: content analysis, statistical method, direct observation, sociological method (questionnaire), functional organizational modelling. Results. The indicators of availability of general practitioners (family doctors) and nurses of a general practitioner in Russia and its subjects are presented. The main reasons for inhibiting the introduction of the institute of general medical practice in a city are revealed. The actual model of general medical practice in a medical organization is presented, that provides outpatient medical care, as well as prospective models of general medical practices, focused on the rational use of resources, including specialists with secondary-level medical education in accordance with their level of professional competence. Different variants of perspective models are discussed for general medical practice in the conditions of city policlinics serving the adult population and distinguished by the forms of work; (1) an independent appointment for patients with the general practitioner’s nurse is organized; (2) preliminary appointment for patients with general practitioner’s nurse together with a general practitioner; (3) independent, before-doctor appointment for patients with a medical assistant and a nurse of a general practitioner; (4) a complex team of general practice can include a medical register. Conclusion. The proposals on improving the organizational bases for the activities of general medical practices in a city were developed.

The peculiarity of the current stage of the development of medical and social expertise (MSE) is, first of all, the ratification of the Convention on the Rights of Persons with Disabilities in the Russian Federation. An attempt to ensure the participation of citizens with restrictions in activities in the civil, political, social and cultural life of the society required significant changes and additions to the regulatory and legislative framework of the Russian Federation that regulates various aspects of the life of Russian citizens. Changes in regulatory and legislative acts increase the role and importance of medical organizations in MSE in terms of establishing and formulating a medical diagnosis of the patient, determining the nature and persistence of disorders of the body’s functions, developing and implementing intra-institutional rehabilitation programs for people with disabilities. In this regard, it is important to take into account the readiness of medical organizations to respond promptly to changes in expert legislation and to make contributions into the provision of the continuity, consistency, succession and complexity of the expert - rehabilitation process. The purpose of this study was to identify the main trends in the work of disability evaluation boards of medical organizations on the example of a large hospital-polyclinic association for the referral of patients for MSE. It was succeed to clarify out that to date the procedure for referral citizens to MSE in the association is well managed, targeted at individuals, both of senior and middle ages and their need for examination, taking into account results of rehabilitation. During the period of observation, there was noted the gain in the number of people referred for MSE, mainly at the expense of persons referred for the reassessment, which is related both with the severity of the contingent appealing to the organization and using modern treatment technologies requiring a long rehabilitation period and with the accumulation of a contingent disabled people. Therefore, in examination persons of the older age group, the participation of geriatricians will probably be necessary.

The article presents the main characteristics of the medical personal of a typical city polyclinic, on the basis of which it is possible to get an idea about the quality of medical resources in primary health care. It was found that more than half of the physicians «treatment group» working in primary health care, do not have qualifying category (53,1%), despite the big experience of medical practice (14,7±12,1 years). The presence of the qualifying category does not always objectively reflect the quality of medical resources, as most physicians have great experience of practical work and highly appreciate their individual professional level. Activities of the medical personnel of polyclinics associ- ated with intense working conditions, due to the excessive number of the attached population for the primary health care, work without help of a nurse, remoteness of district territories and high need of the population of primary health care. The main factors that adversely affecting the preventive work with the population should include the intensity of outpatient reception, remoteness of district territories, insufficient study of the medical literature and rare visits to scientific conferences.

The problem of queues in polyclinics and hospitals is a deterrent to ensuring access to oncological care. In order to optimize anti-cancer control there were shortened timelines both for the diagnosis and the beginning of the specific treatment. Since 2012, in the Tomsk Regional Oncology Center a new concept of the polyclinic organization on the profile of «oncology» was formed. The key aspects of this concept were: 1) standardization of the medical staff work; 2) the rules for the routing of patients with the execution of the first medical appointment booking for visiting doctor through the registry, for the second visit - by an oncologist and with the differentiation of the streams of patients for medical care in the framework of MHI and medical services on a fee basis; 3) intensification of the provision with outpatient specialized care with the staff reinforcement: the regime of the polyclinic is organized in two shifts and 6 days a week, the number of doctors and nurses is increased by 60.8%, the number of medical registrars - by 7 times. To coordinate their work, the position of the senior medical registrator was introduced; 4) modernization of all workplaces of doctors, nurses, medical registrars with the provision of modern medical equipment, communications and information support; 5) logistics of the registry: the division of its zone into a «front office» - were the office-medical registrator communicates with patients only as «face-to-face» and «call center» - with a dialogue by phone. 6) quality control of the clinic work with evaluation of video and audio recordings of interaction between registrars and patients, visitors questioning. 7) the reform of the oncological consultation on an ongoing basis regulations; 8) increasing the comfort of waiting for patients with the organization of comfortable seats, coolers with glasses, air conditioners, corporate identity and logo. The result of the implemented activities was a reduction in the start of specialized treatment by 68.3%, increased coverage of antitumor therapy by 16.4%, including among rural residents. This contributed to the improvement of the situation in a number of indices: the increase in the share of early forms of malignant neoplasms, active detectability by 21.6% and 164.7%, respectively, a decrease in one-year mortality rate, neglect by 25.2% and 8.6%, respectively. Population satisfaction with the provision of cancer care increased.

Aim. The study of the structure of emergency outpatient adult visits in Naberezhnye Chelny. Methods. 2471 cases of primary outpatient visits for acute and chronic diseases of adult population of the city of Naberezhnye Chelny in 2011-2013 were analyzed. For statistical analysis of the data analysis of contingency tables with the assessment of statistical significance using Pearson criterion χ2 was used. The critical level of significance was set at p=0.05. Results. In the studied population 48.4% of primary outpatient visits were made by males and 51.6% - by females. In the general structure of visits patients aged 50 to 59 years were prevalent. Up to a quarter of the emergency outpatients noted the beginning of the disease on the weekends and holidays. The percent of visits to the polyclinic on weekends or holidays was extremely low (3.0% in the general structure of visits), while the highest rates of emergency visits to the polyclinic by adults were observed during the first half of the week. The highest number of primary emergency visits to the polyclinic among both males and females was on Mondays (28.8%). Conclusion. In the structure of visits made on Mondays and Tuesdays, the proportion of patients who became ill on weekends and holidays, amounted almost 30%.

Aim. To conduct comparative analysis of patients’ satisfaction with medical services in private and public health care institutions, considering satisfaction as a factor of improving competitiveness. Methods. Analysis of satisfaction with medical services in two medical institutions in Orel was performed by means of survey of 300 patients and analysis of web-based feedbacks. The obtained quantitative data were processed, grouped and presented as a result of statistical observation. Results. According to the results of the survey of clients of the medical center «Sakara» it was found that almost 100% of patients were satisfied with medical services, and according to the web-based feedbacks 59.1% of patients were not satisfied with the services and stuff attitude. In polyclinic №2 according to the results of the survey about 70% of the visitors were satisfied, and according to web-based feedbacks 78.8% are completely unsatisfied. It was revealed that over time consumers marked down their assessment and sometimes they even became reverse. In this regard we identified the primary level of satisfaction - satisfaction, and secondary level - contentment (discontent). Primary satisfaction and subsequent contentment of consumers with medical services do not coincide and are not consistent. The explanation of this result lies in specificity of medical services, their duration and uncertainty of outcome. In the market of medical services in Russia satisfaction doesn’t often transform into customer loyalty, and therefore is not a source of profit. Between the parameters of satisfaction and customer contentment there is a gap due to the current efficiency of services and customer expectations. Conclusion. Medical institutions should constantly analyze satisfaction and contentment of consumers for wider and more justified understanding of their behavior, preferences and expectations; identification of medical instituion problems and their timely correction is one of the most effective mechanisms to improve competitiveness.

Aim. To study medico-economic performance of outpatient and inpatient treatment of patients with chronic obstructive pulmonary disease (COPD) and bronchial asthma (BA) during emergency hospitalization and the influence of workshops on them.Methods. 75 case histories of patients with COPD and asthma treated in the department of internal medicine №1 of Kazan city polyclinic №3 were analyzed. Conventional clinical, pharmakoepidemiological, medico-economic methods of research, evaluation of quality of life and level of patient’s knowledge about the disease and statistical methods were used.Results. The study revealed that the number of ambulance calls in the groups undergoing training decreased significantly compared to the period before training. So, in the group taught at COPD workshop the number of ambulance calls decreased to 1.43 times, and in the group of BA workshop it decreased to 1.58 times. The change in the number of admissions and the number of ambulance calls causes leads to decreased health care costs for the treatment of patients with COPD and BA. The cost of outpatient treatment of 1 case of asthma (including personal patient’s expenses) is 2280.2 rubles. Average cost of 1 case of outpatient treatment of COPD is 3095.6 rubles. Training patients with asthma at asthma workshop resulted in saving health costs of 5593.512 rubles for each patient trained due to reducing the cost of inpatient treatment and emergency medical care. The effect of training of patients at COPD workshop resulted in saving health costs of 7180.78 rubles. The total amount of budget savings for the treatment of all cases of BA and COPD was 465 544.4 rubles.Conclusion. Influence of patients’ training at workshop resulted in saving costs of health care system and decreased number of ambulance calls.

During last five years there was increasing preterm infants, these children were born with a gestational age of 26 weeks and weighing 800 g, with severe combined pathology. Preterm infants came to the nearest polyclinics after the first stage of rehabilitation in hospitals. There are many questions how and when specialists should begin rehabilitation of such children. Specialists observes that is required an integrated approach to the rehabilitation of premature babies by analyzing the development of these children. Considering that children’s polyclinic allows monitoring children till 18 years of age, there is a possibility of observing and assisting these children during longer period. It is also very essential to realize that without an adequate intensive nursery care the negative consequences become irreversible for premature infants. Birth of a premature infant is a severe psychological stress for both parents. Often without completely realizing it, the family begins to live in conditions of high emotional stress. The department of medical rehabilitation must operate with the parents of a premature baby, in order to help them adapting to the new conditions of life. The task of differentiated medical and psychological rehabilitation can be fulfilled only by the district polyclinic in which the child will be observed until the age of 18. In the article considered features of modern rehabilitation of preterm infants in the in ambulatory-polyclinic service.

The article presents the results of determining the needs of a typical urban polyclinic in medical personnel in accordance with the recommended load standards 1 medical post. Show that the existing federal method has a number of drawbacks, since it ignores the differences in measuring units of the volume of medical care that can be calculated not only with a single visit, but finished case of treatment of the disease. In particular, according to the calculated data, made under the federal method, in an urban polyclinic should be cut 55 full-time medical posts because of their overabundance. However, in reality, for polyclinic is typical not surplus, but a deficit of medical personnel. This disagreement is due to the fact that 55,3% of the total number of visits took place during the year amounted to finished cases of treatment of the disease in accordance with the current standards of medical care. Therefore, at the present stage of development of human resources planning it is extremely important improvement of the federal method of calculating the needs of medical institutions in medical personnel due to the development of the correction coefficients, corrective statistics on the total number of visits for the year.

Infectious diseases are referred to as the most frequent and common diseases in our population, in children as well. Infectious pathology is often followed by the disorders in the organism structure and functions that requires medical rehabilitation measures. The purpose of this work is to prove the necessity of rehabilitation measures of certain level and form for those children who had different infectious diseases. The main research aim is to determine the organism disorders in its structure and functions in those children who recovered from infectious diseases according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). Materials and methods: there was performed the health assessment of 103 children who had been discharged from the infectious departments of Scientific Research Institute of Children’s Infections (Departments of Respiratory Infections, Intestinal Infections, Neuroinfections, and Hepatitis) according to the health domains of ICIDH. Results: according to the stage of the organism disorders by ICIDH there were determined five groups. More than 36 % of children from the groups 3, 4, and 5 required the second stage of rehabilitation measures at the polyclinic and rehabilitation departments of Scientific Research Institute of Children’s Infections. Conclusion: International Classification of Impairments, Disabilities and Handicaps (ICIDH) can be used to develop the reasoning of level and form of rehabilitation measures in every child who had an infectious pathology.

Research objective: increase of efficiency of secondary prevention of a myocardial infarction (MI) and rehabilitation of patients at an out-patient stage.Materials and methods: 164 patients of both floors with the transferred MI with enzymatic and endovascular restoration of a blood-groove of an ischemic myocardium are surveyed. The diagnosis of a MI is established according to standards of diagnostics of ESC/ACCF/AHA (European Society of Cardiology/American College of Cardiology Foundation/American Heart Association, 2007) also it is documented by an extract from the clinical record of office of medical institution where hospital treatment of the patient according to emergency indications was carried out. Patients were divided into 3 groups: the 1st (supervision with rehabilitation in out-patient conditions), the 2nd (rehabilitations in the round-the-clock specialized office), the 3rd (comparisons). To all patients continuous reception of pharmacological therapy according to standards of treatment of patients with the sharp coronary syndrome (SCS) was appointed; recommendations of the general character about healthy lifestyle observance are made; laboratory blood tests, electrocardiography and heart echocardiography, holter (daily) monitoring of the electrocardiogram, assessment of degree of heart failure on the scale of an assessment of a clinical state and the test of 6 minute walking, a commitment assessment to treatment with use of test of Moriski-Green, quality of life of patients with heart failure on the Minnesota questionnaire, episodes of repeated hospitalization concerning SCS and lethal outcomes are carried out. In addition to the 1st group of patients «Health school» and medical physical culture, the 2nd group - a rehabilitation course in specialized office of recovery treatment of City clinical hospital №19 were on an outpatient basis carried out.Results: on achievement of commitment to treatment, estimates of an average value of quality of life, episodes of repeated SCS, to reduction of weight of a functional class of heart failure indicators of patients of the 1st group surpassed data on patients of the 3rd group, but conceded to the 2nd.Conclusion. Use of rehabilitation actions at an out-patient and polyclinic stage of treatment of patients with transferred MI as element of secondary prevention of cardiovascular complications positively influence final points irrespective of a method of a myocardium revascularization.

One of the main tasks of the dental service is the maximum coverage of sanitation and preventive inspections of the population. National Population Census (2010) and the national epidemiological survey of dental population (2007-2008) showed 100% prevalence of dental caries in persons over 65 years, and nearly a third of the population (26,3%) live in the Russian countryside. To solve the problem of providing dental care to residents of remote areas where it is absent, organized a mobile dental office.

We investigated safety and efficacy of metformin and dietary product - jam laminaria, enriched with chromium, in integrated ambulatory treatment of patients with metabolic syndrome (MS). During the 6 months we observed 81 patients with MS, the average age of 50, 3 ± 1, 9 years old, who were divided into 3 comparable groups. Patients of the comparison group (n=30) with recommendations on modeling lifestyle and drug therapy of diseases; the first group of patients (n=31) was additionally appointed with metformin 1500-2000 mg/day, and patients in the second group (n=20) received dietary product 20 g/day. Surveillance in all groups of patients registered reduction of overweight, improved clinical and laboratory parameters, adaptive organism reserves and quality of life. The use of metformin and the dietary product in treatment of MS allowed to achieve a more pronounced positive dynamics in patients than in the comparison group.

In a cohort of 100 immunocompromised children aged 3 months to 12 years in continuous screening of saliva and urine with a qualitative polymerase chain reaction (PCR) assay DNA herpes virus 4, 5, 6, type (CMV, EBV, HHV-6) were verified in 76% of cases. DNA herpes virus type 6 was detected significantly more often (56%). On the material of the primary medical documentation and data of clinical and laboratory examination in conditions of a children's polyclinic there was performed the analysis of clinical and epidemiological risk factors for intrauterine infection (IUI), and clinical and laboratory markers of secondary immune deficiency (SID). It was made a suggestion about predominant vertical transmission of HHV-6 during the antenatal period. Based on 100 percent of detection of opportunistic herpes viral DNA in children aged 1-3 years the tactics of "antigenic sparing" in young children with SID was justified. To optimize the diagnostic measures in respect of immunocompromised children in conditions of a children's polyclinic the performance of a comprehensive screening PCR testing for HSV infections, including HHV-6, as well as immunological and bacteriological control is proposed.

In article the results of the analysis of a personnel potential on an example of children's out-patient-polyclinic establishments of Ryazan are resulted. The author had been studied the basic problems complicating activity of establishments of a primary link, and precisely – the provision by paediatricians, experts in the conditions of deficiency of financing under the given item of expenses, the dynamics of the quotient of pluralism, the level of a professional trainings of a medical personnel.

Patients with ischemic heart disease (IHD) with depressive RAS disabilities are a special group of dispensary observation with a higher risk of cardiovascular complications than patients without depression. Timely detection of depressive disorders in IHD patients, the study of psychosocial factors, along with the known factors of cardiovascular risk, are essential components of modern diagnostic, medical and rehabilitation programs for patients with comorbid pathology in the polyclinic.

The article gives examples of cases of subcutaneous dirofilariosis of clinical practice patient clinical management. The clinical cases are designed to focus the patient clinical profile to epidnastorozhennost against this parasitic disease, is rarely encountered in temperate climates.

In article problems on preservation of reproductive health of students of higher educational institutions in modern conditions are considered. Creation of regional interuniversity student's polyclinic Is offered. Its structure, principles of work and the basic directions of activity are considered

The urgency of increase of the efficiency of the dispensary account in establishments of an out-patient - polyclinic link is shown. New registration forms with a view of perfection of the statistical account of the dispensary supervision are offered. It promotes the improvement of interaction of narrow experts and local therapists of a territorial polyclinic and allows to define a priority of prophylactic medical examination on the nosology for the concrete patient.

Incidence should be considered as one of the most important indicators of health of the population. Since the 90’s of the last century, there is a number of negative trends in the health of children and teenagers such as the the steady increase in incidence rates of children in the Russian Federation, the increase in the number of chronic diseases and combined forms, increasing the number of children with disabilities. Growth of incidence is noted practically on all classes of diseases. The number of absolutely healthy children doesn’t exceed now 2–4%. In article the analysis of incidence of the children’s population according to negotiability to out-patient and polyclinic establishments of St. Petersburg is carried out.

The results of the polyclinic stage of rehabilitation of 295 patients with acute myocardial infarction are j given. The general number of days of temporary disablement (hospital, sanatorium, polyclinic stages) 112,66,92 - 151,212,64. As a result of the rehabilitation course 57 (40,1%) patients regained their ability to work, 35 (24,6%) patients restored partially their ability to work, 50 (35,4%) patients got disability the second group.

Favorable treatment outcomes (complete restoration of nerve and limb functions) were obtained in 80.3% of patients, which the authors regard as a result of early pathogenetic diagnosis and the use of complex pathogenetically based treatment developed by them. The proposed methods of treatment are applicable in a specialized neurological department of a polyclinic, as well as in a medical unit, which is much more economical than in a stationary setting.

After the introduction of anti-tuberculosis antibiotics and chemotherapy drugs into practice, the incidence of tuberculosis among the population began to decline rapidly. This was facilitated by a significant decrease in the massiveness of bacilli excretion in persons with open forms of the process under the influence of tuberculostatic therapy.

In 1976, in order to improve medical services for dispensary patients, a rehabilitation department was set up in the children's polyclinic, which serves 53,000 children, on the basis of physical therapy and physiotherapy departments. The department is equipped with light therapy (including a photarium), heat therapy, vitamin-oxygen cocktails, massages, an inhalatorium, a therapeutic gymnastics room, a therapeutic swimming pool and a room for teaching swimming to infants.

Compression-distraction osteosynthesis according to GA Ilizarov in outpatient settings has been used by us since January 1981 in the city hospital No. 3, which serves the complex of the Kama Automobile Plant and the Avtozavodskaya district of Brezhnev. The clinic has a well-equipped operating room and two sets of apparatus for osteosynthesis. We operate under local anesthesia. We use special supports for the osteosynthesis of the lower leg and humerus bones.

Dr. Aydarov's article correctly raises the question of the abnormal formulation of medical education in that part of it, which concerns outpatient surgery and purulent surgery in particular. The main forms of purulent surgical diseases should be studied in the third year in general surgery classes, the department of which should be provided with clinical beds and an outpatient clinic. Until recently, there was no such clinic in Kazan, just as there was no department or an outpatient clinic. Thus, teaching the basics of general surgery and, in particular, teaching students of purulent surgery stood on the wrong path of predominantly theoretical education. Until recently, there was no fixed polyclinic, where it would be possible to widely and correctly organize the teaching of 5th year students in outpatient and, in particular, purulent surgery.

In the vast majority of cases, we judge the life and creative work of our scientific institutions only by the individual works of their employees, scattered in various periodicals. Thanks to this, it is very difficult to get a clear idea of the scientific direction of this institution, the value of leadership and the scale of work.

(University News, Kiev. 1895, No. 9). The author gives not so much an account as an outline of the eight-year activity of his polyclinic in Kiev, in which he read lectures on the recognition of female diseases. During this time, 2881 patients visited the polyclinic

In our message, we would like to once again touch on the setting of teaching outpatient surgery to medical students, which, in our opinion, is not given enough attention in surgical departments. As a result of this, the graduated doctors, to whom, during their student course, clinicians willingly demonstrate gastric resections, bowel surgery, nephrectomies, know little about carbuncles, abscesses, panaritiums, etc. diseases. Meanwhile, these "minor diseases" are the main concern of polyclinic doctors and doctors of the periphery. Having not received sufficient practical training in the treatment of purulent inflammatory processes and, in particular, inflammatory processes of the fingers, young doctors are forced to gropingly understand these everyday, often complex diseases, which often lead to the loss of working capacity in case of improper treatment.