SANATORIUM SELECTION — set of the medical events held for detection of indications or contraindications to a resort therapy and also definitions of the place, a medical profile of sanatorium, duration and a season sanatorium or an out-patient resort therapy. The purposes C. - to. the lake — achievement of the best results of treatment and prevention of diseases, and also increase in efficiency of use of sanatorium network.
Dignity. - hens. treatment along with the polyclinic and stationary help is included into the general system successive to lay down. - the prof. of the actions directed to increase in level of health of the population. Therefore the choice in each separate case of character, the place and terms of treatment, a medical profile of sanatorium is important, to lay down. factors depending on a condition of the patient, a stage of development and features of disease, results of the treatment which is earlier received by it.
From the correct organization and quality of carrying out S. - to. lakes considerably depend both the direct, and long-term results a dignity. - hens. treatments. Accounting of short-term results dignity. - hens. treatments the doctor shall conduct a dignity. - hens. institutions, and the long-term results (duration and level of the reached medical and preventive effect) — the attending physician at the permanent address or works of the patient after his return from the resort or from local sanatorium. Data of such account can be used for S.'s improvement - to. lake and all dignity. - hens. affairs; besides, they are necessary for planning of the subsequent recreational actions concerning each patient.
The main maintenance of S. - to. the lake makes medical selection, i.e. establishment of indications to a dignity. - hens. to treatment. Medical selection is carried out on the basis of results of the previous medical observation which is earlier carried out polyclinic and hospitalization of the patient, and also this his inspections just before a trip to sanatorium. Depending on the medical indications established at the same time choose the resort (sanatorium) in the greatest measure answering to problems of treatment of this patient and suitable it on a territorial sign. At the same time consider existence in the resort (in sanatorium) mineral waters (see. Balneoterapiya ), to lay down. dirt (see. Mud cure ), local climatic conditions (see the Climatotherapy), a possibility of use physiotherapeutic (see. Fizioprofilaktika , Physical therapy ) and LFK-methods (see. Physiotherapy exercises as method ), etc.
Organization of sanatorium selection. Rules of medical selection of patients on a dignity. - hens. treatment are defined by the order M3 USSR coordinated with the All-Union Central Council of Trade Unions. Selection of patients is carried out by the attending physician and the managing department or the chief physician-tsy, policlinics, a clinic, clinic for women at the place of residence of the patient or MSCh of the industrial enterprise (organization) where it works.
At the direction on a dignity. - hens. treatment of the patient shall pass such researches as clinical blood test and urine, a chest fluoroscopy (if from the moment of the last X-ray analysis there passed 6 months and more), an electrocardiography, inspection in psikhonevrol. a clinic (in the presence in the anamnesis neuropsikhicheskrgkh frustration), women — inspection at the gynecologist (at the direction in sanatorium concerning any disease). At the basic or associated diseases of endocrine system, an eye, ENT organs, kidneys and urinary tract, generative organs, skin also the conclusion of the corresponding specialist is necessary. In some cases for specification of the diagnosis assessment of function of external respiration, a research of an eyeground, biochemical analyses, a reovazografiya are carried out (see. Reografiya ), etc. Results of researches and the conclusion of specialists are brought in a case history or the out-patient card.
At the solution of a question of the choice of this or that resort (sanatorium) and a type of treatment (sanatorium or out-patient), in addition to the diagnosis, it is necessary to consider a stage of a basic disease, existence or absence of associated diseases, extent of disturbance of functions of separate bodies and systems, ability of the patient to independent movement and self-service; at the same time conditions of a trip to the resort (distance, a type of transport, the number of changes) are taken into account not only medical factors and climatic characteristics of resorts, but also. Send to local sanatoria to hl. obr. seriously ill patients, but not needing a bed rest. Besides, treatment in local sanatoria is recommended to patients, the trip to-rykh to the remote resorts (especially with the klimatogeografichesky conditions differing from districts of full-time residence of patients markedly) can reflect adversely on a condition of their health. Resort out-patient treatment is recommended when the patient for health reasons does not need a sanatorium regime and constant medical observation.
In the presence of medical indications for treatment in the resort or in local sanatorium the attending physician issues to the patient the reference with the corresponding medical recommendations (the registration form No. of a 298-approved by M3 of the USSR on December 20, 1971) about what makes record in the history of a disease (the out-patient card). Period of validity of the reference — 2 months. It is the basis for issue of the permit to the patient with factory or local committee. For timely paperwork and arrival of the patient in sanatorium the permit is given to it by the trade-union organization not less than in 10 days prior to the start date of stay specified in it in the resort.
Having received the permit, the patient shall be to the attending physician who issued it the reference. If the permit corresponds to medical recommendations, the attending physician issues to the patient the medical record of the established sample (the registration form No. 298 approved by M3 of the USSR on December 20, 1971) signed with it together with the manager of department about what makes record in the history of a disease or the out-patient card. The medical record is valid within 2 months. The recommended resorts, a type of treatment (sanatorium or resort and out-patient), a profile of the recommended specialized sanatorium are specified in it (cardiological, neurologic etc.); results conducted analyses and researches are applied to it.
If the patient can acquire the permit in sanatorium or in boarding house with treatment or the voucher on resort out-patient treatment directly in the place of treatment, he receives the medical record, as an exception, without preliminary execution of the medical reference, but after obligatory inspection and establishment of medical indications for treatment in this resort or in local sanatorium.
In practice of S. - to. islands are cases of the unreasonable direction of nek-ry patients to resorts, stay on to-rykh for them contraindicated and leads to deterioration in health, an aggravation, weighting or the accelerated development of the basic or associated diseases, especially tuberculosis and tumors. Main reasons for it: insufficiently careful inspection of patients in to lay down. - the prof. institutions before the direction them on a dignity. - hens. treatment; errors of diagnosis; underestimation of associated diseases, disease severity, conditions of a trip to the resort (remoteness, changes), the wrong choice for treatment of season, climatic conditions etc.; insufficient awareness of doctors on indications and contraindications for a dignity. - hens. treatments in resorts of various types, and also about to lay down. factors of this or that resort and mechanisms of their action; violation of the rules of issue of permits by local and factory committees, and also other organizations and institutions (issue of permits without dignity. - hens. cards, according to expired maps, without the conclusion of the doctor in cards, without a profile of sanatorium).
Contraindications to stay of the patient in the resort are defined by the medical and consulting commission organized in each sanatorium or resort policlinic. The chairman of the commission is the chief physician of sanatorium (resort policlinic), members — the manager of department, the attending physician, and if necessary the consultant in the specialty. The commission establishes existence of contraindications for treatment in this resort and defines a possibility of leaving of the patient in the resort (in sanatorium), carrying out different types of treatment — climatic, medicinal etc. or need of its transfer in-tsu or returns to the residence. In the presence of contraindications the commission draws up the statement in a form No. 307 (the order M3 USSR No. 924 of December 20, 1971). The act is sent to the address of higher body of health care (regional, regional, city, regional public health department in the place of subordination to lay down. the establishment which gave a dignity. - hens. the card) or to the higher trade-union organization (republican, regional, regional, city or territorial council on management of resorts of labor unions) if the patient with existence of contraindications arrived because of the trade-union organization which incorrectly issued the permit for investigation and involvement of guilty persons to responsibility. Identification of contraindications for stay of the patient in sanatorium (in the resort) and adoption of the relevant decision no more than 5 days from the moment of its arrival shall be spent in time.
In case of need returns of the patient to the residence the chief physician of sanatorium or resort policlinic shall render the maximum assistance in acquisition of tickets, its delivery to the station or in the airport. Maintenance is provided to seriously ill patients. All expenses connected with evacuation and escort of the patient are made by sanatorium due to the establishment which gave a dignity. - hens. card. If contraindications to a resort therapy appeared during stay of the patient in the resort (an injury, an infection), expenses on evacuation of the patient are carried out by that spa facility where there is a patient.
Public health departments and councils of labor unions during the receiving from chief physicians of sanatoria or resort policlinics of the act of the wrong direction of the patient in sanatorium (to the resort) no more than report in a month about results of investigation and the taken measures concerning guilty persons in the institution which sent the act.
If in the specified time the corresponding letter from bodies of health care or trade-union bodies does not come to the address of the chief physician of sanatorium or resort policlinic, the last is obliged to notify on it republican (territorial) council for management of resorts of labor unions and the Ministry of Health of the federal republic for acceptance of the appropriate measures. Data on cases of the wrong direction of patients to resorts (in sanatorium) are fixed in the special magazine, to-ry is conducted in sanatoria and resort policlinics.
For S.'s improvement - to. islands carry out instructing of doctors to lay down. - prof. of institutions, direct them to short-term courses on professional development in the field, give lectures, conferences with involvement of specialists, provide to lay down. - prof. of establishment by necessary grants, methodical recommendations, analyze a dignity on the basis of acts. - hens. institutions cases of the wrong direction of patients in sanatorium.
The resolution of the Central Committee of the CPSU, Council of ministers of the USSR and the All-Union Central Council of Trade Unions «About measures for further improvement of sanatorium treatment and rest of workers and development of network of health resorts of labor unions» of January 7, 1982. To m3 of the USSR it is imputed a duty to increase the responsibility of doctors to lay down. - the prof. of institutions for quality of medical selection of persons for the direction on a dignity. - hens. treatment.
Management to lay down. - the prof. of institutions according to S. - to. the lake, and also control and its generalization are assigned to regional, city, regional (regional) public health departments and on managements (departments) to lay down. - the prof. of the help of the Ministries of Health of federal or autonomous republics. Responsibility for the organization, instructing and control over the implementation of rules C. - to. the island in to lay down. - the prof. institutions is assigned to deputy chief physicians on to lay down. parts, and at their absence — on heads of these institutions.
Features of sanatorium selection in sanatorium for teenagers. Selection of teenagers for a dignity. - hens. treatments are performed with obligatory participation of managers and doctors of teenage offices of policlinics taking into account the special indications and contraindications established to M3 of the USSR.
At the same time anatomo-physiological features of an organism of the teenager, a condition of his study, work and life are taken into account. Sanatoria of labor unions for teenagers are specialized according to structure of incidence among persons of this age. Issues of the direction of sick teenagers in sanatorium shall be resolved to lay down. - the prof. institutions together with the trade-union organizations and committees of Komsomol.
Features of sanatorium selection in children's sanatoria of system of the Ministry of Health. The order M3 USSR in 1970 defined the following medical profiles of sanatoria for treatment of children with diseases of not tubercular character: a) for patients with rheumatism; b) for children with disturbances of functions of the musculoskeletal device; c) for patients with diseases of a respiratory organs; d) for patients with diseases of the digestive system; e) for psychoneurological patients; e) for children with diseases of kidneys, urinary tract and disbolism; g) for children with skin diseases; h) for patients with osteomyelitis; i) for having infectious nonspecific (rhematoid) polyarthritis; j) for had dysentery.
To the children's sanatoria, the USSR M3 systems located out of resorts admit children aged from 1 up to 14 years inclusive, and to sanatoria in resorts — from 5 to 14 years inclusive. Children with disturbance of functions of a musculoskeletal system, including cerebral palsies, are sent to the sanatoria of the USSR M3 system located in resorts, C 3 up to 14 years in a dignity. - hens * institutions of system of labor unions — from 4 to 14 years, and system of education — - from 7 to 14 years.
Terms dignity. - hens. treatments are established by M3 of the USSR. The issue of need of extension of treatment for sanatorium is resolved intra turnaround manager - ache the medical commission and it is made out by the relevant act submitted to an operating controls, the sanatorium is subordinated to Krom.
Need of the direction of the sick child on a dignity. - hens. treatment is defined only by the attending physician children's to lay down. - the prof. of establishment. Before the direction to the sick child carry out to sanatorium, except necessary laboratory and functional researches, sanitation of the centers of an infection, deworming, antirecurrent treatment etc.
Selection of children on a dignity. - hens. treatment is performed by the regional, city, regional, regional, republican sanatorium selection commissions (SSC) organized at children's policlinics, clinics,-tsakh and also at regional, city, regional, regional public health departments, the Ministries of Health of the republic. SKOK is created according to the order of public health department or Ministry of Health of the republic as permanent body of a certain structure. The chairman of SKOK is the deputy chief physician for a medical part of children's policlinic, a clinic,-tsy or the regional, city, regional pediatrician of public health department. Members of SKOK are pediatricians and, according to a profile of sanatorium, specialists doctors: rheumatologists, neuropathologists, phthisiatricians, dermatologists, traumatologists. If necessary doctors and other specialties are attracted (surgeons, psychiatrists, otorhinolaryngologists, ophthalmologists, LFK specialists, radiologists, etc.). At selection of children local sanatoria in structure of the commission shall include the chief physician of this sanatorium.
Direct to SKOK of children with exchange a dignity. - hens. the card, to-ruyu the attending physician gives out to parents of the sick child.
At the direction of the child in sanatorium the following documents shall be processed: 1) exchange dignity. - hens. card with the conclusion dignity. - hens. the commissions (a form No. 298 — it is put.); 2) the certificate of the epidemiologist of lack of contact of the child with inf. patients at the place of residence and in child care facility; 3) the certificate of the dermatologist of absence at it contagious skin diseases; 4) the certificate of results of a research on a diphtheritic and dysenteric bacteriocarrier. School students shall have at themselves the characteristic from school and the diary if they are sent to sanatorium in school hours of year.
An order of medical selection in sanatorium of labor unions for parents with children. Such sanatoria (boarding houses) and sanatorium departments accept on treatment of children aged from 4 up to 14 years inclusive together with parents. At medical selection in a dignity. - hens. institutions of this type it is necessary to be guided by the medical indications and contraindications developed and approved by M3 of the USSR together with Central office on management of resorts of labor unions (1981). Councils for management of resorts of labor unions shall inform systematically to lay down. - the prof. of establishment who are carrying out medical selection on a dignity. - hens. treatment of children and adults, about location and a profile a dignity. - hens. institutions for parents with children.
The general medical indications and contraindications for sanatorium treatment
Indications and contraindications, to-rymi are guided at S. - to. lakes, are defined by M3 of the USSR and stated in relation to different classes and forms of diseases in the methodical instructions approved on February 22, 1978. The general indications and contraindications for the direction of patients to resorts, and then — indications and contraindications are included below at separate classes and forms of diseases with lists of the recommended domestic resorts.
The general indications
the General indications for a dignity. - hens. treatments are defined by hl. obr. its successive role generally to lay down. process and in prevention of diseases. Used at the same time natural to lay down. factors at a stage of a pre-disease promote the prevention of its development; at hron. diseases reduce number of a recurrence and aggravations, slow down a current patol. process; at a stage of medical rehabilitation accelerate and do fuller return of the patient to work and socially active life, reduce the level of disability and a lethality. Also conditions of stay in the resort, significantly different from a daily situation of work and life of the patient have important value. Along with balneoterapevtichesky, mud, climatic and other factors they act as the irritants which are positively influencing health. Therefore dignity. - hens. treatment should be considered shown if it is carried out timely — to such period of a disease when with the sufficient basis it is possible to expect a positive take of influence of resort factors and a sanatorium regime, and also at absence at the patient of acute displays of a disease or serious condition demanding treatment in a hospital.
The general contraindications
are not subject to treatment in sanatoria patients with diseases in an acute stage and with hron. diseases in a stage of an aggravation; patients acute inf. diseases before the termination of term of isolation; patients with a cachexia of any origin; patients with an echinococcosis; with often repeating bleedings; venereal diseases in acute or infectious stages; mentally sick, including addicts; patients with epilepsy; the patients needing hospitalization. Besides, are not subject to the direction on a dignity. - hens. treatment sick, not capable to independent movement and self-service, needing permanent special care. All malignant new growths are a contraindication for the direction on a dignity. - hens. treatment, however after radical treatment such patients at the general satisfactory condition can be sent to local sanatoria for an aftercare in the direction onkol. institutions. The direction of pregnant women at any duration of gestation to balneoterapevti-chesky and mud resorts is contraindicated, and since 26th week — to climatic resorts. It is also not necessary to direct pregnant women — inhabitants of flat areas to the mountain resorts located at the height more than 1000 m above sea-level. The direction in a dignity is contraindicated. - hens. institutions of not tubercular profile of TB patients in andto ktivny form.
In addition to the general indications and contraindications, at S. - to. lakes shall be considered the features connected with specifics of specific nosological forms.
Indications and contraindications for a dignity. - hens. treatments at specific forms of diseases are reconsidered now. The main data will be on this matter published in «Additional materials» of BME, t. 29.
On arrival in sanatorium (resort policlinic) of the patient shows the permit and the medical record (the last joins afterwards a case history). After primary survey by the attending physician of sanatorium or resort policlinic to the patient the resort book is issued, in to-ruyu enter the diagnosis and diagnostic and medical procedures appointed to it. Shows the resort book of the patient in balneofizioterapevtichesky both other medical and diagnostic departments of sanatorium or institutions of the resort. In it do marks about the adopted procedures and their portability.
Before an extract from sanatorium or resort policlinic the attending physician writes down in the resort book which is handed out to the patient, given about results of the carried-out treatment and the recommendation for a duty, food, physical culture and rest, of need of continuation of treatment about the residence etc. If it is necessary, in the book also the recommendation to the patient is made to be in the place of his residence or work to the attending physician; about same the doctor of sanatorium or resort policlinic shall inform the patient orally before an extract.
Duration dignity. - hens. treatments, designated in the permit, together with a trip to the resort and a way back there can be more labor issue of the patient. In these cases for full use of the permit to the patient in the place of paperwork before departure to sanatorium for missing days the leaf of disability is given. Such order is provided by the instruction of the All-Union Central Council of Trade Unions and the Narkomzdravy USSR «About an order of delivery insured sick-lists», approved by Council of People's Commissars of the USSR on August 14, 1937, with subsequent changes and additions (1955, 1970, 1971).
On the basis of these documents issue for a dignity. - hens. treatments it is provided for all term of treatment (term of the permit) and for the period of journey to sanatorium and back (taking into account the next and additional issues insured) if need a dignity. - hens. treatments it is established by the attending physician together with the manager of department or the chief physician and also if the permit is issued by factory, local committee or the higher trade-union organization at the expense of means of the state social insurance it is free or with payment of sick 30% of its cost. The same rule of issue of sick-lists affects in cases of the direction of patients an out-patient resort therapy according to permits (vouchers) received in the same order.
Similarly, but irrespective of who issued the permit and regardless of sources of its financing, issue for a dignity is made out. - hens. treatments by the patient with an active form of tuberculosis sent for treatment to tubercular sanatoria; to the working disabled people of the Great Patriotic War of I and II groups; to other disabled people of I and II groups of number of the servicemen who became disabled owing to wound, a contusion or a mutilation at protection of the USSR, or at execution of other obligations of military service or owing to the disease connected with stay at the front; to disabled people of I and II groups of number of command and ordinary structure of the Ministry of Internal Affairs which became disabled people owing to wound, contusions or mutilations received on duty.
If the worker or the employee who was already using issue receives the permit to a dignity. - hens. treatment and administration grants it leave for treatment without preservation of earnings, the sick-list is issued minus days of the next and additional issues, i.e. for the days lacking for use of the permit (including a trip to the place of treatment and back).
Sick-lists for a dignity. - hens. treatments, except for cases when the permit is issued in antitubercular sanatorium, register the medical and consulting commissions and where they are absent — the attending physician together with the chief physician.
At the request for the sick-list it is necessary to present: 1) permit; 2) an extract from the resolution of the trade-union organization on providing the permit to the patient at the expense of means of social insurance it is free or with payment of 30% of its cost; 3) certificate of administration of duration of the next and additional issues; 4) medical record.
At a dignity. - hens. treatment of TB patients sick-lists give out to them directly in sanatorium; the treating and chief doctors sign them. During the obtaining the sick-list in antitubercular sanatorium of the patient presents the direction to sanatorium and the certificate of administration of duration of the next and additional issues. Stay of patients in all specialized sanatoria, except antitubercular, over the term of the permit is allowed only if it by the time of the termination of term of stay in the resort was disabled owing to emergence at it an acute disease or an exacerbation of the main disease, at to-rykh its extract from sanatorium is contraindicated, and transfer in-tsu is inexpedient. Extension of stay in a dignity. - hens. establishment in a similar case it is made out by the sick-list signed by the commission as a part of the chief physician (chairman), the attending physician and, whenever possible, the consultant. In departmental a dignity. - hens. institutions extension of treatment and issue of the sick-list is made by the medical and consulting commission of the given establishment with participation of the attending physician, and in the absence of such commission — the chief physician territorial to lay down. institutions (-tsa, policlinic) and attending physician dignity. - hens. institutions.
In case of the temporary disability which came in a dignity. - hens. establishment and matched the period of the next or additional issue, the sick-list is issued for all days of temporary disability minus that time, on a cut the patient already has a sick-list issued in connection with the direction in given a dignity. - hens. establishment. For the days of temporary disability which matched issue without preservation of earnings, the sick-list is not issued.
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V. M. Bogolyubov.