The way to determine the condition of the fruit of the female health workers
The invention relates to medicine, namely to Perinatology, and can be used to determine the status of the fetus of female health workers. Conduct scoring risk factors for perinatal pathology. As risk factors use of socio-biological maternal factors, namely, age of mother, years of experience in the profession, the job profile, the rate of occupational hazards, physical and gynecological indexes, the number of complications during pregnancy. Assessment of the status of the fetus carried out on the basis of the magnitude of the index of biophysical profile of the fetus (Z), which is calculated by the formula: Z=1,29·x1+15,31·x2+3,24·x3+0,77·x4+3,44·x5+0,9·x6, where x1 is the age of the mother, full of years; x2 - profile work, with x2=1 for therapist, x2=2 for nurses therapeutic profile, x2=3 for the surgeon, x2=4 for nurses surgical profile; X3 is the number of complications during pregnancy, x4 - somatic index, equal to the number of diseases, X5 - pelvic index, number of diseases, X6 is an indicator of occupational hazards, equal to, respectively: X6=a-0.73+5U2or 11.3 at+13 when x2=1 or 2; the s 5-9 years 3 - 10-14 years 4 over 14 years, and with the Z-index for more 54,18 assess the condition of the fetus as abnormal or questionable. The method improves the possibility of primary prevention, aimed at reducing the complications of pregnancy. 3 tab., 1 Il.
The invention relates to medicine, specifically, Perinatology, and for the study of the influence factors of the labour process on the fetus in utero women health workers and can be used for prediction and prevention of reproductive health, taking into account age-and-sex and professional features.
It is known that the medical workers is characterized by significant mental, moral, and ethical voltage, smart load, requires a large amount of operational and long-term memory, sometimes enormous physical strength and endurance, contains the elements of creativity and is associated with responsibility for the health and the lives of others. In addition, the very hospital environment is a complex of adverse factors affecting the body of the medical staff: uncomfortable microclimate impacts the nicknames health women, the majority of which is in the reproductive age and plans to have children.
It is noted that health care workers significantly more often than in the control group meets autonomic dysfunction, hepatitis, tuberculosis, and complications of pregnancy and childbirth (Kosarev centuries of Professional health workers. - Samara: Perspective, 1998. - 198 (C)
It was also established that the pathology of pregnancy and childbirth in women surgical profile found in 2.4 times more often than women in the control group (Kobozev N. In., Kiseleva T. A. Peculiarities of pregnancy and childbirth doctors surgery // occupational Hygiene and professional diseases - 1981. No. 6 - N-14-16).
It is authentically established that the adverse production factors directly associated with the occurrence of malformations of the fetus. Typically, these factors are divided into 3 main groups: socio-economic, which include maternal age, profession, occupation, maternal factors - various contributing factors to maternal health, including, pathology of pregnancy, bad habits, comorbidities and the third group of factors include data about the physiological condition of the fruit.
what if the adverse reactions to the influence of harmful factors of the working environment and working process. Forecasts are known to have been built with the aid of mathematical models, based on the use of probabilistic characteristics frequency of adverse reactions, which should reflect the impact of the whole range of influencing factors.
Studied qualitative analysis of disease patterns of health workers relative to other categories of workers (Kosarev centuries of Professional health workers. - Samara: Perspective, 1998. - 198 S.; Korotich L. P. Results and tasks of scientific research on the issue of "Work and health health workers" // occupational Medicine and prom. ecology - 1998. No. 8. - S. 35-39).
Known way to assess somatic health care workers with the consideration of regional factors (Lastovo E. C. Regional problems of protection of medical workers in the Primorsky territory: author. dis. Kida. the honey. Sciences. - Vladivostok, 2000. - S. 26).
Currently developed and used way of assessing the working conditions of health workers according to the degree of harmfulness and danger, on the basis of "Hygienic assessment criteria and classification of working conditions in terms of harmfulness and danger factors of production environment, severity and intensity of the work prozesky workers classified as harmful - 3 class, characterized by the presence of harmful factors in excess of hygienic standards and adverse effects on the body working and/or its offspring. According to the degree of exceeding the hygienic standards and intensity changes in the body running this class is divided into 4 degrees of harm.
At the same time, information about the total quantitative assessment of the impact of occupational hazards on women's reproductive health - medical personnel in the literature could not be found. Among the various manifestations of the adverse impact of production factors on the body of working women are of special importance in the distant effects, and primarily in the form of infringement of processes of reproduction, which can be considered as a sensitive indicator of the negative impact of harmful factors.
In most cases, the approach to predict the risk of perinatal pathology based on scoring of risk factors, which include different layout of the socio-biological, obstetric, extragenital complications of pregnancy, assessment of fetal status and others. When the pleasant outcome, at 5-9 - average and up to 4 - low.
The most developed are the evaluation methods, based on the physiological characteristics of the fetus, while the problem of quantitative estimation of the influence of external factors, namely, the socio-biological parent of the factors of the working environment and working process of reproduction and the health of the offspring remains at the present time because of its complexity practically unresolved.
The most common way to assess the condition of the fetus in normal midwifery practice is expressed in points indicator biophysical profile of the fetus (FFT), which includes assessment of the following physiological parameters: the tone of the fetus, its motor and respiratory activity, heart rate and its variability, blood flow in the umbilical arteries, the amount of amniotic fluid, the degree of maturity of the placenta, and so on, and use the data actresslove test (nst) and ultrasound scan (ultrasound). Such a study allows us to accurately assess the condition of the fetus on the size of the received points.
There is a rating scale FFT by F. A. Manning (Manning FA, Morrison I, Lange IR, et al., Fetal assessment based on fetal biophysical profile scoring: experience in 12,620 referred high-risk pregnancies. I Perinatal and PCT. The method is based on the fact that during hypoxia the fruit loses some behavioural characteristics in the reverse order of how they were acquired during development. In addition to indicators of acute hypoxia, we also evaluate the amount of amniotic fluid, reflecting chronic hypoxia, the development of the nervous system of the fetus, tone, movement, breathing movement, the reactivity of the cardiac rhythm, the sequence at the deterioration of the fruit.
While FFT is defined as the sum of the scores for respiratory movement (MDC), the movement of the fetus, the tone of the fetus, the reactivity of the fetus (gastrectomy test) and the amount of amniotic fluid. Each indicator is assessed as either normal (2 points), or pathological (0 points). At 10-8 points conclude the normal condition of the fetus and low risk of chronic hypoxia. At 6-4 points - signs of chronic hypoxia and 0-2 - severe chronic hypoxia.
Known rating scale FFT on A. Vintzileos (Vintzileos, A. M., W. A. Campbell, Ingardia C. J., The fetal biophysical profile and its predictive value. Obset Gynecol 1983; 62: 271-274), which in the assessment of the FFT include non-reactive test nst, MDC, locomotor activity, the tone of the fetus, the amount of amniotic fluid, the degree of maturity of the placenta. All these indicators are scored. Evaluation scale Clitheroe, at 6-7 is questionable and the number of points is less than a 5 - pathological. This method of evaluation is considered as the closest to the claimed.
However, this method, like the previous one, due to the use of quite a large number of instrumental parameters, including a mandatory ultrasound, which both objective and subjective reasons, it is not always possible, feasible and justified from the medical point of view, takes a lot of time, money and does not take into account the influence of socio-biological maternal factors on the fetus of female health workers.
The objective of the invention is to develop a fast and gentle way to determine the condition of the fruit of the female health workers on the basis of the magnitude of the index of biophysical profile of the fetus, taking into account the socio-biological maternal factors.
The problem is solved by a method for determining the status of the fetus of female health workers, including scoring risk factors for perinatal pathology, which use socio-biological maternal factors, namely, age of mother, years of experience in the profession, the job profile, the rate professional who NKU status of the fetus carried out on the basis of the magnitude of the index of biophysical profile of the fetus (Z), obtained by the formula (1)
Z=1,29· x1+15,31· x2+3,24· x3+0,77· x4+3,44· x5+0,9· x6 (1),
where x1 is the age of the mother, full of years; x2 - profile work, with x2=1 for therapist, x2=2 for nurses therapeutic profile, x2=3 for the surgeon, x2=4 for nurses surgical profile, X3 is the number of complications during pregnancy, x4 - somatic index, number of diseases, X5 - pelvic index, number of diseases, X6 is an indicator of occupational hazards, equal to, respectively,
X6=a-0.73+5U2or 11.3 at+13, when x2=1 or 2
X6=and-0.6+6,5, if x2=4,
where I=1, 2, 3 or 4 - indicator related groups: 1 - work experience 1-4, 2 - work experience 5-9 years, 3-10 - 14, 4 - over 14 years, and with the Z-index for more 54,18 assess the condition of the fetus as abnormal or doubtful.
To solve the problem of quantitative determination of the influence of socio-biological maternal risk factors on the fetus of female health workers have observed and full clinical examination of the groups of female health workers during pregnancy and childbirth 428 (main group), women - not from medical profile at therapeutic (317) and surgical (111); specialty doctors (220) and nurses (208), for typing indicator “profile”, the following indices: 1 physician, 2 - nurses therapeutic profile, 3 - doctor - surgeon, 4 - nurses surgical profile; work experience in the profession, highlighting four related groups: group 1 - work experience 1-4 (169); group 2 - work experience 5-9 years (101); group 3 - work experience 10-14 years (106); group 4 - work experience of over 14 years (52). The division into related groups carried out under the Leadership of R. 2.2.755.-99.
A survey of women in study and control group included data from clinical and laboratory examinations before and during pregnancy, obstetrical and gynecological survey, inspection specialists: therapist, ENT, ophthalmologist, dentist, neurologist, cardiologist, and evaluation of indicators of working conditions, the results of the questionnaire and history since childhood. In addition, for every woman main and control groups was assessed health status of the fetus on the biophysical profile A. Vintzileos.
Assessment of newborn children was carried out according to performance: the period of gestation, body weight at birth, body length, head circumference, district surveillance were 63 children from a group of women health workers and 65 children from the control group.
Assessment of working conditions of female health workers was carried out on the basis of Guidance P2.2.755-99. For each woman was determined in the workplace, the degree of harmfulness of working conditions according to the following criteria: the severity of the labour, work intensity, microclimate, lighting, e/m radiation, noise, chemical factor, aerosols fibrogenic action, biological. Introduced the concept of "indicator occupational hazards", which is a proxy indicator for integral evaluation of working conditions, which is calculated as follows. If any of the above factors working conditions there is harm, it is assigned 1 point, otherwise - 0. The points on nine factors hazard summarized and got the integral indicator of privrzenost for each of the respondents were women.
To assess physical health of the women introduced a measure of “somatic index, in which each disease is estimated at 1 point, and the total amount of points is a somatic index.
Similarly, somatic introduced a “gynecological index” is the number of gynecological diseases, as well as “indicator slozhnie women during pregnancy.
Assessment of fetal wellbeing of the fetus in pregnant women was carried out according to the method of A. Vintzileos. Used 6 biophysical parameters (FFT) fruit: indicators actresslove test (nst), respiratory movements of the fetus (MDC), the motor activity of the fetus (WCT), the tone of the fetus, the amount of amniotic fluid (ALE) and the degree of maturity of the placenta (NWS). Each parameter FFT fruit was assessed by the number of points. The scale consisted of 0, 1, 2 points for each topic. The resulting amount of points allowed to evaluate the fetus in utero. While the total score 10-12 points was considered normal, and 8-9 points - satisfactory, 6-7 points is doubtful 5 points or less pathological.
Implementation actresslove test was performed using kardiomonitornym research, other biophysical parameters (DDP, DAP, TA, ALE, AW) was determined by ultrasound scanning in real time scale.
Cardiotocographic study was performed using the apparatus “Partocoder-200 in position pregnant on your side before, during and after an ultrasound scan within 30 minutes.
The echography was performed using the apparatus Aloka - 1100 Flexus” working in the real scale of urzy data.
The mathematical analysis of pregnancy and childbirth on the basis of the data collected observations allowed us to establish a statistically significant increase in the number of complications during pregnancy, childbirth, women health workers in comparison with the control group and obsevational data. Particularly noticeable increase in complications of pregnancy, childbirth, women health care workers who have a certain experience.
To identify the correlation of somatic pathology, complications of pregnancy, childbirth, characterized by clinical and laboratory examination of women in study and control group, job profile, experience and work environment factors used criterion Chi-square. At the same time also compared the health outcomes of women health workers between subgroups.
Observations were grouped into classes. All n observations was divided into intervals. The number of observations in the interval is equal to the number caught in this interval of observations. Then build an additional table of frequencies falling observations in each interval and compared by the formula:
where k is the number of the e respectively.
On the basis of statistical analysis (correlation analysis, comparison of two samples by student's criterion, the comparison of the distributions of the frequencies of occurrence of the Chi-squared) of all collected original data observations revealed that there is no significant difference among different subgroups of women health workers and the effects on health of born children (table 1). When the division of professional status (/x - a surgeon, a/t - a physician, m/x - surgical nurse profile, m/t nurse therapeutic profile) determined the percentage of variance generative health women health workers depending on the professional status. The significance of differences among groups was tested using the criterion of “Chi-squared”.
The values of Chi-square (Hi2) considerably exceed the table for the 99% significance level (the last line). This indicates significant differences in the working conditions of doctors-surgeons and physicians, and surgeons and nurses and surgeons. The physicians and nurses therapists significant difference even on a smaller, 95% significance level, but different nurses have different profile (99 cases) and doctors (95 cases) and depends not only on the job profile, but from the age of the mother. On gynecological morbidity differences between samples was not detected, which indicates the similarity of gynecological condition, regardless of profession. The index, which in all cases are different infants and children medical professionals, is a biophysical profile of the fetus, which significantly depends on the profile and work experience.
Using the approximation of the data by the method of least squares was established according to that best describes the dynamics of the integral index of occupational hazards from experience, presented in the graphs (see the drawing), which shows the maximum values of the occupational hazards of women health workers depending on the profile and professional experience: a physician; a nurse-therapist; physician - surgeon; d - nurse-surgeon; X6 - point occupational hazards, R - coefficient of determination.
Shown in the graphs of the values of R2characterize the accuracy of the approximation. The smaller the residual sum of squares over the total sum of squares, the more the value of the coefficient of determination R, which shows how good the provided graphs (see drawing (a-d) shows changes in the maximum values of privrzenost in each relevant subgroup depending on experience. The obtained results clearly show that health care workers therapeutic profile maximum rate of privrzenost is 6-5 points. And in the early years it is higher, with work experience 5-9 years reduced to 5, with experience in 10-14 years old again increases and then decreases. The difference between privrzenost is only one point, and on the basis of a two-sample test by student's criterion we can say that this reduction is not statistically significant. The situation is different in workers surgical profile. The surgeon observed increase in the degree of privrzenost with experience, i.e., with the accumulation of experience and qualifications. Nurses surgeons greatest privrzenost observed in younger related group 1-4 years, i.e., the main burden falls on nurses aged 21-25 years.
On the basis of P2.2.755-99 compared and subsequent qualification occupational hazards, determining the degree of occupational hazards for the claimed method from 0 to 4 points as valid, 4-7 - harmful and above 7 points - dangerous.
Thus, the normal level for fascia and work experience, and point the index privrzenost (X6) depending on the profile of the medical worker is determined by the following formulas:
for doctors and nurses therapeutic profile
X6=a-0.73+5U2or 11.3 at+13;
for physicians surgical profile
for nurses surgical profile
where I=1, 2, 3 or 4 - indicator related groups: 1 - work experience 1-4, 2 - work experience 5-9 years, 3-10 - 14, 4 - over 14 years.
It is known that the environment in which the development of the fetus, has a number of features, due to the dependence of all its physiological functions from the flow of metabolic processes in the placenta and the mother's body. Survival and fetal development is possible only when strictly defined parameters of the internal environment that is significantly different from the respective indicators when the Autonomous existence of the child. Determining the status of the fetus during pregnancy is of great importance, as the pathology leading to perinatal morbidity and mortality often occurs in the antenatal period. In complicated pregnancy in the main parts of a functional system mother - placenta - fetus poeticheskogo factor.
When the FFT analysis of the fetus groups of women health workers we found that FFT fetuses of pregnant women health workers and the control group differed significantly (table 2). So, the normal level of the FFT in pregnant women health care workers met significantly less than in the control group (p<0,001).
A satisfactory indicator of the FFT of the fetus was diagnosed in General, 34.5% of pregnant women health care workers.
Doubtful FFT met in 32.9% of women (significantly more frequently than in the control group). Pathological indicator FFT was detected in 18.6% of pregnant women of the main group. In the control group questionable and pathological assessments FFT was not observed.
Normal assessment FFT doctors met more frequently than the average medical personnel, as well as women's therapeutic profile compared with surgery (p<0,001).
The highest percentage of satisfactory ratings FFT was observed in nurses (56,9%) compared with doctors and women therapists compared with surgeons. Dubious indicator FFT doctors significantly more frequently encountered than the average medical pelicana experience changed assessment FFT of the fetus in pregnant women medical workers. So, a normal score FFT of the fetus in women - health care workers with 1-4 years of professional work was 20.7%, then with increasing experience, the percentage of normal assessments were decreased in all groups, this figure was met significantly less than in the control group. When a satisfactory assessment of the FFT of the fruit of the maximum percentage was observed at 1-4 years of professional work, which is significantly higher than that in the control. When you experience more than 5 years normal assessment FFT fetal met significantly less than in the control group. Doubtful and pathological evaluation of FFT in control are not met. When you experience 5-9 years had the highest rate of dubious FFT evaluation of the fetus (54,4%). Pathological evaluation of the FFT of the fetus in pregnant women health workers were observed in all groups, the maximum number was when you experience 10-14 years.
Using Hi2 test was revealed heterogeneity of the distributions of frequencies of observations on the biophysical profile of the fetus (table 3). The resulting value,2as in the comparison group of doctors and nurses significantly exceeds the tabular value of2is 38,38, and the children of nurses 46,34 respectively. That allows you to note the significant difference in the biophysical profile of child health workers in 99%. This difference may also be due to the different working conditions of mothers.
Thus, a study of the status of the fetus in pregnant women health care workers revealed the prevalence of questionable and pathological assessments of biophysical profile in comparison with the control. The greatest intensity changes detected in women, doctors surgery. Figure doubtful and pathological assessments have increased by 32.7% and 34.4%, respectively.
The indicators of physical development of newborns allow in combination with other to assess the possible adverse effects of work environment factors parents on the health of the offspring.
Assessment of physical development of groups of newborns were carried out on the basis of anthropometric data, which was obtained by independent measurements. The obtained data were evaluated by tables centi is her groups corresponded to the professional affiliation of the mother. When comparing gestational age at birth of children in the study and control groups revealed that in the main group of children born in the period from 32 to 37 weeks, more than in the control. Compared the frequency distribution of children according to gradations within each indicator.
From the obtained results, “Chi-square” test established that there are no significant differences between children of different sub-groups of health workers on Apgar scale, physical and psychological development of children (the calculated values of2do not exceed the tabular values for the appropriate number of degrees of freedom).
Thus found that working conditions have an impact on the physical health of mothers, as well as indirectly on the offspring, and the duration of work in harmful conditions exacerbates the effect on the offspring.
All calculations were performed using the application program Statistica. The classification procedure was based on the determination of the biophysical profile of the fetus, i.e., the variable to which were found functional connectivity profile of work, occupational hazards, somatic and generative health matter. In the analyzed sample biophysical profile is drawing up a classification function was created “training” sample boundary indicators biophysical profile of the fetus is normal and the pathological. The rest of the data carried in the control group used for evaluation of the adequacy of the constructed classification functions.
The classification function is a linear equation, the so-called prognostic index. Procedure classification of new patients was as follows: the vector x=(x1... ..,x3) belongs to the group with abnormal if the value of the classification function more prognostic index, and normal - otherwise, i.e., the selected variables and coefficients, in which the probability of misclassification is minimal.
Originally analyzed a set of variables and a subset on which you can build the “best” split into groups. The contribution of each variable was estimated using ratios of total and partial lambda of Wilks and F - statistics. The value of the F statistic used to test the hypotheses H0:2=0, i.e. that between groups no differences. This criterion was allocated the variable for which there was the greatest difference, and at each step of the procedure was considered the conditional distribution of each variable, not included in the subset, given in the more control, the variable was included in the classification function, if not - it was not a significant variable to predict. After an exhaustive search of all variables allocated subset, which built the “best” division group “pathology” - “norm”. The accuracy is determined by the significance level for the F - statistics (in our case 0,05).
Through step-by-step selection of the 95 factors according to the criteria of F-statistics of the coefficients of full and partial lambda of Wilks at the first stage were selected two variables, which carry out the separation performance FFT on normal and pathological, namely, the profile and professional harm. However, this function accurately allocates pathology, but not accurate enough estimates of healthy children. For more accurate estimates used 6 variables: the job profile and privrzenost, and advanced physical and gynecological index, a scoring rate of pregnancy complications, and maternal age. The higher the value, the more abnormalities observed in these categories. Although the introduction of these variables somewhat deteriorates the accuracy of determining the actual pathology, but increases the overall accuracy. According to this model pravilnoy “norm-pathology” depending on the profile, age and health of the mother is
z=1,29· x1+15,31· x2+3,24· x3+0,77· x4+3,44· x5+0,9· x6 (1),
where x1 is the age of the mother, full of years; x2 - profile work (x2=1 for therapist, x2=2 for nurses therapeutic profile, x2=3 for the surgeon, x2=4 - for nurses surgical profile, X3 is the number of complications during pregnancy, x4 - somatic index, number of diseases, X5 - pelvic index, number of diseases, X6 is an indicator of occupational hazards, equal to, respectively,
X6=-0,u+u to 11.3 at+13, when x2 = 1 or 2 for the doctor and nurses therapeutic profile;
X6=0,4+3,5, when x2=3 for the doctor of surgical profile;
X6=and-0.6+6,5, when x2=4 for nurses surgical profile
where y is the indicator related group is equal to 1 if the work experience 1-4, y=2 - experience 5-9 years, y=3 - experience 10-14 years and y=4 - with the experience of over 14 years.
An example of estimating biophysical profile of the fetus on a specific clinical case.
Female B., age 31, married. The physician profile (x2=1), work experience 7 years (y=2 related group). Diagnosis: pregnancy 31-32 weeks. Burdened obstetric history. Sachetana The history of life: urolithiasis, chronic pyelonephritis in the next 5 years, increasing to 2 times a year, the treatment of chronic tonsillitis in the last 9 years, sanitized, anemia 1 degree identified for the 1st month before pregnancy, treatment is not received. Tuberculosis, hepatitis b, C, Hbs negative. Allergic history: drug allergies to drugs penicillin, manifests itself in the form of urticaria.
Gynecological history: menstruation at the age of 13, was established immediately, after 28 days, 5 days, painless, moderate. Disorders of the menstrual cycle was not. Chronic adnexitis, after an abortion, the treatment received. This pregnancy 3. The first delivery is urgent, without complications in 1996. The baby was born weighing 3600 grams, length 52 see Healthy.
During this pregnancy: registered in female consultations with 14 weeks. In 16 weeks yeast colpitis. At 25 weeks - the threat of termination of pregnancy, 28 weeks OG - eclampsia, treatment received.
To calculate a prognostic index biophysical profile of the fetus, you need to know: maternal age - 31, job profile - 1 (physician), somatic index - 3, gynecological index - 2, number of exacerbations during pregnancy - 2 and professional harmfulness - 5.
Z=1,h+15,h+0,9x5+0,h+3,h+3,h=75, is provedenii ultrasound was given conclusion: progressive uterine pregnancy 31 - 32 weeks, pelvic diligence, hfpn, the intrauterine development of the fetus 1-2 degrees. Oligohydramnios. Assessment actresslove test 1 score, respiratory movements of the fetus of 1 point, the tone of the fetus of 1 point, the volume of amniotic fluid - 1 point, the degree of maturity of the placenta - 0 points. Evaluation of FFT on A. Vintzileos - 5 points - pathological, i.e., defined by the coincidence of prediction by the proposed method with the data of instrumental study. The woman assigned to treatment according to the conventional scheme.
The ability to quickly determine the status of the fetus in pregnant women medical professional lets you implement rational tactics of pregnancy, to choose the best method of prevention, aimed at reducing the frequency of complications during pregnancy, especially in case of impossibility to carry out an ultrasound examination.
The criterion for early diagnosis, predicted violations of women's reproductive health - health workers can serve as an indicator of occupational hazards for women health care workers associated with socio-economic and maternal factors.
The proposed method for the rapid diagnosis of the status of women health workers who substantially increase the prevent the occurrence of various pathological conditions in children through early preventive measures for female physicians.
The way to determine the condition of the fruit of the female health workers, including ball assessment of risk factors for perinatal pathology, characterized in that as risk factors use of socio-biological maternal factors: maternal age, work experience in the profession, the job profile, the rate of occupational hazards, physical and gynecological indexes, the number of complications during pregnancy and assessment of the state of the fetus carried out on the basis of the magnitude of the index of biophysical profile of the fetus (Z), which is calculated by the formula (1)
where x1 is the age of the mother, full of years;
x2 - profile work, with x2=1 for therapist, x2=2 for nurses therapeutic profile, x2=3 for the surgeon, x2=4 for nurses surgical profile;
X3 - the number of complications during pregnancy;
x4 - somatic index, equal to the number of diseases;
X5 - pelvic index, the number of diseases;
X6 is an indicator of occupational hazards, respectively
X6=a-0.73+5U2 and when Z > 54,18 assess the condition of the fetus as abnormal or doubtful.
and when Z > 54,18 assess the condition of the fetus as abnormal or doubtful.
FIELD: medicine, clinical toxicology.
SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.
EFFECT: higher accuracy of prediction.
2 ex, 3 tbl
SUBSTANCE: method involves studying blood samples with venous blood mixed with vital stain like methylene blue. Degree of vital stain absorption by erythrocytes is determined by applying photocolorimetry. The value drop being more than 25%, extracorporal detoxication is to be predicted as ineffective.
EFFECT: simplified method.
SUBSTANCE: method involves evaluating prognostic signs and calculating their prognostic weight. Consciousness disorders and diagnosis set at prehospital stage are used as the prognostic signs. Calculations are carried out from formula: lethal outcome %= -15.99+19.1•C+14.7•DS-2.79•C•DS, where C is the ranged consciousness disorder degree, DS is the diagnosis set prehospital stage. The higher is the value, the higher is lethal outcome probability.
EFFECT: accelerated and simplified prognosis method.
SUBSTANCE: method involves evaluating proliferating processes by calculating index of positive cell nuclei (Ki-67). The Ki-67 value being from 6 to 16%, erosive ulcerating stomach lesions accompanied by stomach hemorrhage and hemorrhagic shock is to be predicted. The value being from 17 to 30%, erosive ulcerating stomach lesions without hemorrhage is to be predicted.
EFFECT: high accuracy of prognosis.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with differential diagnostics of prostatic cancer and other prostatic diseases at the stage of primary inspection. The method includes the detection of PCA and calculation of probability coefficient for prostatic cancer (PCC) by the following formula: where e - the foundation of natural logarithm (e=2.718…), PCA - the level of total blood PCA in ng/ml, V - patient's age in years. At PCC value being above 0.2 one should diagnose prostatic cancer and to establish final diagnosis one should perform polyfocal prostatic biopsy. The method enables to increase accuracy of diagnostics at decreased number of unjustified prostatic biopsies.
EFFECT: higher efficiency of diagnostics.
SUBSTANCE: method involves determining homeostasis values and absolute number of neutrophils and lymphocytes in particular. Low neutrophil number being determined in a child during a number of years and low number of lymphocytes in the persons from the nearest child surrounding, the persons are to be examined for given psychosomatic pathology availability with following medical treatment to be applied to eliminate the detected pathology and to normalize homeostasis values and lymphocyte number among others.
EFFECT: enhanced effectiveness of prophylaxis.
SUBSTANCE: method involves measuring radio signals and low frequency spectra of signals emitted by oral cavity organs and tissues in maxillofacial area. Decoding and comparison of the spectra to healthy organs and tissues spectra is carried out. Then, modulated information signals in infra-low frequency bandwidth corresponding to healthy organs and tissues signals are applied. Low frequency radio signals and spectra are measured. Treatment with modulated signals in infra-low frequency bandwidth is applied directly to organ or its location zone via skin.
EFFECT: enhanced effectiveness in diagnosing and treating oral cavity organs and tissues in maxillofacial area.
5 cl, 3 tbl
FIELD: medical engineering.
SUBSTANCE: device has bottom and cover joined in inseparable way so that no chance is available to mismatch covers belonging to different containers. The bottom and internal part of cover are lined with sponge so that the allergenic disks are kept in uniformly wetted state. Grate with holes is attached to lower sponge, the holes narrowing downward as cones so that the allergenic disks are kept in stable vertical position.
EFFECT: simplified access to disks using forceps; excluded misidentification risk.
5 cl, 6 dwg
FIELD: medicine, operative gynecology.
SUBSTANCE: at final stage of laparoscopic operation for 5-7 min one should introduce 16 U lidase in 1 ml 2%-lidocaine solution into uterine mesentery from both sides, and then, by not removing a needle - a half of single dose of antimicrobial preparation in 1 ml 2%-lidocaine solution, then in postoperational period - an antimicrobial preparation applied during laparoscopy lymphotropically under mucosa of lateral vaginal arch from both sides for 5-7 d once daily and one antimicrobial preparation - intravenously for 5-7 d, moreover, as antimicrobial preparations one should apply gentamicin, metrogyl and other preparations permitted for intravenous application. The present innovation stimulates lymphatic drainage in area of inflammation and activates interstitial humoral transport of antimicrobial preparations that, in its turn, favors complete sanitation of inflammation foci and prophylaxis of disease relapses.
EFFECT: higher efficiency of therapy.
1 cl, 1 ex
SUBSTANCE: method involves applying biological indicator as mixture composed of 0.1% aqueous solution of amino acids: leucine, glycine, proline, serine, phenylalanine, histidine, oxyproline, arginine, glutamic amino acid and aspartic amino acid, 0.5% aqueous solution of neuromediators like dopamine and histamine, 12% aqueous solution of magnesium sulfate in proportion of amino acids : neuromediators : magnesium sulfate = 4:1:5. Indicator kept on neck surface in thyroid gland projection during 3-5min. It is dried at T=+35-40°C, studied in polarized light with quartz compensator. Columnar, columnar-and-striated, sheaf-like crystals and discharged polygonal variegated chambers being observed, thyroid gland hyperfunction is to be diagnosed.
EFFECT: high accuracy of diagnosis.