SPECIALIZED MEDICAL CARE — a type of the medical care provided by specialists doctors in the medical institutions or departments which are specially intended for this purpose with use of the special medical and diagnostic equipment, tools and the equipment.
Differentiation of medical science during its development and the specialization of medical business which is going deep on this basis involve changes in the organization of medical aid, in functions to lay down. - the prof. of institutions, their typification and structure. Quality of prevention, diagnosis and treatment of various diseases depends on extent of specialization, forms and methods of the organization of specialized types of medical aid.
In Russia S.'s development by m of the item proceeded very slowly, especially concerning the organization of specialized departments in to lay down. - the prof. institutions, despite aspiration of the advanced doctors to providing the population with medical assistance on various specialties.
Stationary S.'s emergence of m of the item in Russia belongs to the second half of 18 century when construction of large civil BCs where along with all-profile also a number of specialized departments was presented began. Then would begin to be created specialized, of to-rykh were organized by the first: psychiatric in 1808 (Moscow), eye in 1826 (Moscow), children's in 1834 (Moscow), etc. At the beginning of 19 century in out-patient clinics, in addition to «private» general practitioners, eye diseases specialists began to render medical aid, to obstetrics, tooth diseases. At the same time in 1913 specialized types of an ambulatory care appeared only in 16% of out-patient clinics, and in the others general practitioners worked. A number of specialized institutions of out-patient type in Russia was created on charitable means, e.g., in 1904 in Moscow the first out-patient clinic was open for TB patients, and by the beginning of World War I in the country there were 67 antitubercular out-patient clinics-gyupechitelstv existing generally on charitable means. The big role in S.'s development by m of the item in Russia was played by Pirogovsky congresses (see), already on the first of to-rykh in 1885 there took place meetings on 8 various sections.
Basic changes happened in the organization C. of m of the item after establishment of the Soviet power. Formation of a number of specialized types of medical aid was caused not only by development of science and practice, but also serious social problems — high rates of incidence and mortality of the population as the investigations heavy economic, a dignity. - a gigabyte. and other effects of the imperial mode, World War I and civil wars. E.g., from the very beginning of existence of the Soviet power for fight against infectious, venereal diseases, tuberculosis, etc. in nation-wide scale the relevant services, types of institutions (specialized-tsy, clinics) were created and the corresponding specialists doctors are trained.
Before the Great Patriotic War many issues of the organization C. of m of the item were resolved. In particular, in 1938 the task of providing the population with a specialized domiciliary care was set. The organization of specialized stationary departments in city would widely be developed and by 1941 only 2,7% of their number remained unspecialized.
In days of the Great Patriotic War S. of m of the item gained the further development in the organization of medical service of Red Army. The hospital network was organized not only on all-profile type (therapeutic, surgical, infectious, etc.), but also by the principle of the differentiated specialized treatment: for wounded in the head (including a maxillofacial profile), in a breast, a stomach, pelvic bodies etc. In 1942 the order of the People's commissar of health care of the USSR was issued, the Crimea ways of recovery of specialized hospital network were defined.
The IV Plenum of Hospital Council Narkomzdrava the USSR and Narkomzdra-va in 1943 indicated RSFSR the urgent need to correct shortcomings of business of preparation of medical shots on separate specialties, and then the order of the People's commissar of health care of the USSR on the organization of special departments and chambers for treatment of patients with a peptic ulcer, diabetes mellitus, etc. was issued. For the purpose of improvement of the management and upgrading of S. of m of the item the Institute of chief specialists of the ministries, regional, regional and nek-ry city public health departments was created (see. Chief specialist).
Especially intensively process of specialization of medical aid developed since 50th when surgical, and then and therapeutic types of the help began to be differentiated widely. S.'s development by m of the item was expressed not only in emergence of its new types, but also in development of new organizational forms of its rendering. The specialized centers for various profiles began to be created. Providing country people of extra hospital and stationary S. of m of the item was promoted by creation of network regional (regional, republican) to BC with advisory policlinics, and also the central regional BCs where specialized departments at least on 5 profiles were organized: therapies, to surgery, obstetrics and gynecology, pediatrics, infectious diseases. The network of regional and regional specialized clinics grew. Expansion of volume of the extra hospital specialized help to country people was promoted by the organization of the exit planned and advisory help by teams of specialists doctors.
The course towards further specialization of medical aid was defined by the Program of the CPSU and gained the development in the relevant decisions of the Central Committee of the CPSU and Soviet government, the orders M3 of the USSR. Questions of development of the specialized out-patient and polyclinic help found the reflection in the resolution of the Central Committee of the CPSU and Council of ministers of the USSR «About measures for further improvement of medical care and public health care of the USSR» (1960) and in the order of the Minister of Health of the USSR issued in the light of this resolution. In the order of the Minister of Health of the USSR «About a state and measures for further improvement of stationary service of the population of the USSR» (1963) the main directions of development of stationary medical aid were stated, of to-rykh integration of the existing BCs and construction of the new, more powerful hospital complexes necessary for expansion and S.'s improvement of m of the item were main. «About measures for further improvement of health care and development of medical science in the country» (1968) it was planned «to continue by the resolution of the Central Committee of the CPSU and Council of ministers of the USSR construction of large specialized and multi-field hospitals, policlinics, clinics to increase quality of specialized medical care and more stoutly to provide the population with all its types». The order of the Minister of Health of the USSR issued in the light of this resolution obliged bodies of health care to organize in 1971 — 1975 interrepublican, republican, interregional, regional, regional departments (centers) for a heart surgery, cardiology, vascular surgery, neurosurgery, nephrology, pulmonology, for treatment of patients with a myocardial infarction, with burns generally as a part of multi-profile BCs. It was indicated the need of development for the cities and areas which do not have independent specialized clinics, network of the relevant dispensary departments (offices) in policlinics. The medical and diagnostic centers of hospital and polyclinic type for separate types of S. of m of the item, the educational and scientific and practical centers began to be created. Considerable impact on development of specialized types of medical aid was exerted by orders of the Minister of Health of the USSR «About regular standards of medical and pedagogical personnel of city policlinics, medical and medical assistant's health centers» (1968) and «About the nomenclature of medical specialties and the nomenclature of medical positions in healthcare institutions» (1970). For S.'s improvement by m of the item to country people of M3 of the USSR approved «The provision on interdistrict specialized department» (1975). Streamlining of development of network of the institutions giving specialized help was promoted by orders of the Minister of Health of the USSR «About the approval of the nomenclature of healthcare institutions» (1978) and «About measures for improvement of the organization of work of out-patient and polyclinic institutions» (1981). Reflection of processes of specialization and integration in practical health care is improvement of organizational forms of specialized types of medical aid, creation of specialized offices, departments, consulting and diagnostic centers, rehabilitation departments and institutions, further development of staging in an eye for Him of medical aid etc.
During performance of these tasks it was considered that extent of specialization of medical aid is defined not only by differentiation of science and practice, but also real needs of the population for it in connection with the number of the contingents of patients of a different profile, character and structure of pathology, volume and forms of the medical help necessary for the patient, and equally economic and town-planning opportunities, perspectives of resettlement of inhabitants, etc.
Along with differentiation of medical science and practice also process of integration developed that was promoted considerably by construction of large multi-profile BCs, improvement of activity of doctors of various specialties, and also complexity and coordination of scientific research, development of approaches to comprehensive examination of the nek-ry contingents of patients, etc. Construction of large multi-profile and specialized BCs, BC of ambulance, clinics, etc. allows to create specialized departments in their structure and to create the centers of hospital and polyclinic type equipped with the most perfect equipment and provided with highly qualified personnel of specialists. The organization of the specialized centers provides the most rational use of bed fund, shots of specialists, the medical equipment, promotes professional development of medical personnel and quality of the medical aid by the patient rendered to them. In modern city the population would receive medical aid on all main specialties. A lot of work is carried out on further development and enlargement regional (regional, republican) the hospitals providing the population with specialized medical aid. Growth of security of the population of the USSR with the specialized hospital beds — see tab. 6 to St. Hospital, t. 3.
Dynamism of process of differentiation of S. of m of the item finds the reflection in improvement of normative indicators. So, in 1954 standards of need of the population for stationary medical aid were planned on 12 profiles of beds, and in 1982. The board of M3 of the USSR approved standards for 35 specialties, including differentiation of a therapeutic profile of beds on 9 specialties and surgical — on 12. Similarly differentiation of standards of need for the stationary help is approved also for the children's population. Standards for the out-patient and polyclinic help are recommended by 28 specialized types for adult population and by 25 types — for children's.
The tendency to specialization found the reflection and in development of service of emergency medical service (see) where cardiological, resuscitation, traumatologic, pediatric, antishock, toxicological and other specialized crews began to be created that promoted expansion of the volume of help given by doctors on site and in transit the patient in to lay down. - the prof. establishment, and also to increase in its quality. Enough in high gear the network of hospitals of emergency medical service develops (see Emergency medical service hospital), the main objectives to-rykh is rendering specialized emergency medical aid to the population.
The importance is attached to development of diagnostic and laboratory service where process of specialization is swept also up. Are constantly developed new medical d-iagnosticheskiye methods and the directions, new offices and laboratories are created.
S.'s development by m of the item is one of the most difficult sections demanding the corresponding conditions and organizational forms. Experience of the Soviet and foreign health care shows that highly skilled S.'s providing with m of the item requires rational placement of specialized offices, departments, institutions taking into account the principle of medical division into districts. At the same time it is necessary to provide a certain staging in rendering medical aid by doctors of the main and narrow specialties. S.'s development by m of the item in specific territories is based on the differentiated regularatory approach to formation of uniform functional and organizational structure of network to lay down. - the prof. of institutions during the saving the philosophy of the organization of the Soviet health care — territorial, providing availability of medical aid to all population.
The special role in S.'s development by m of the item belongs to chief specialists (to therapists, surgeons, pediatricians, obstetricians-gynecologists, etc.) the Ministries of Health, regional (regional, district) and city public health departments (see. Chief specialist). Their value in the village where the existing institute of chief specialists of the central regional BCs is an important link of a control system of health care is especially big. Chief specialists, to-rymi would be, as a rule, managers of departments central regional, except medical, carry out the large volume of work as organizers, consultants and methodologists of the relevant specialized services of the area.
Also attraction to work in policlinics and-tsakh as consultants of highly skilled research associates of research institutes and the faculty of medical in-t and in-t of improvement of doctors is of great importance for S.'s improvement by m of the item.
Specialization of medical aid among others put forward also a problem of preparation of the corresponding shots of specialists. The changes entered into the system of medical education (see) were caused by need of a combination of specialized preparation to all-medical education on a wide natural-science and social and hygienic basis. In the USSR the harmonious system of specialization and improvement of doctors is created, edges it is carried out institutes of improvement of doctors (see), faculties of improvement at medical in-ta, and also by primary specialization at large republican, regional, regional and city-tsakh, system of a clinical internship.
At different stages of development of the Soviet health care according to its tasks of public health care forms and methods of rendering to lay down were improved and improved. - the prof. of the help, however basic bases and socialist character its organization remained invariable thanks to what it is created and successfully the modern uniform system of the organization C. of m of the item functions. Specialization of medical aid, being process dynamic, in turn, exerts huge impact on development of all system of the Soviet health care, significantly supplementing first of all its preventive direction (see. Prevention , Prevention primary ). Evolution of organizational forms C. of m and. leads to emergence of new effective methods and prophylactics, diagnoses and treatments, to-rye can change radically established practices of health care, promote further development of science and medical aid to the population.
Specialized medical care in field conditions
Specialized medical care in field conditions — the highest type of medical aid which is fullestly using (in relation to field conditions) achievements of medical science in practice of stage treatment struck and patients with forces of the corresponding specialists in intended for this purpose specialized to lay down. institutions (departments) with special medical and diagnostic equipment.
As these stories of military medicine testify (see. Meditsina military ), specialization of medical aid in system of medical and evacuation providing Armed Forces (see System of medical and evacuation providing) was caused by differentiation of medical science, as a result the cut was allocated a number of the independent industries of clinical medicine. During war E. I. Smirnov expressed this pattern concerning the organization of the surgical help as follows: «since the maxillofacial surgery, neurosurgery, treatment of damage of bones of extremities and a chest cavity were allocated in independent disciplines, that situation for hospitals when each doctor-surgeon was a doctor for all wounded ceased to exist, and any wounded was a patient of any doctor-surgeon».
For the first time the attempt of specialization of medical aid by the wounded and patient was undertaken during the Russian-Japanese war of 1904 — 1905 when in the nek-ry reserve hospitals developed in the near back of field army (in Harbin), specialized beds for infectious, venereal, mentally sick, sick with diseases of an ear, throat and nose were allocated. During World War I of 1914 — 1918 the following step to the organizations C. of m of the item by the wounded and the patient was taken. Experience of expansion in 1916 of group of the hospitals and infirmaries intended for separate reception of various categories of wounded and patients, in particular, testifies to it. Medical aid in Lodz and Zhirardov at the initiative of H was so organized. N. Burdenko and in the 5th army near Dvinsk at the initiative of V. A. Oppel. Pointed out V. A the progressive nature of specialization of the surgical help to wounded. Opel: «My experience on various fronts — he wrote — takes to one N to the same conclusion: fractional surgical specialties shall exist, life develops them, means it is necessary to meet requirements of them, to help their development».
After Great October socialist revolution on the basis of achievements in development of the national economy, medical science and Soviet health care necessary premises for further development and improvement of system of medical and evacuation providing troops were created, an indispensable component a cut was specialization of medical aid and treatment of wounded and patients. The principles of stage treatment which developed by the beginning of the Great Patriotic War with evacuation to destination caused need of creation of specialized field and evacuation hospitals starting with army to lay down. institutions that was shown clearly by real check of these principles during combat operations of Red Army in the river Halkhin-Gol (1939) and the Soviet-Finnish conflict (1939 — 1940). On the eve of the Great Patriotic War the main directions of the organization of specialized medical aid were defined that found the reflection in «The collection of regulations on institutions a dignity. services of wartime» (1941). Specialization of field hospitals in an army link of medical service, to-rye on the organizatsionnoshtatny structure were «hospitals of general purpose», it was provided by the direction in specified hospital of the «special groups of medical strengthening» which were available in a separate company of medical strengthening (ORMU) of army — including neurosurgical groups, maxillofacial, eye, toksiko-therapeutic, etc. Also specialization of the evacuation hospitals included in structure of GB of army and evacuation points of the front was provided.
Extremely the adversity which developed as a result of sudden treacherous attack of fascist Germany to the USSR did not allow to organize S. of m of the item at the beginning of the Great Patriotic War of 1941 — 1945 in the volume stated above. However during war specialization of medical aid and treatment of wounded and patients was one of the most important directions of improvement of system of stage treatment with evacuation to destination and gained further development.
Performed management of medical service of Red Army a number of measures for streamlining of the organization C. of m of the item. In 1941 were entered into structure of medical service hospital for lightly wounded (see). Instead of the unified field mobile hospitals (FMH) in 1942 were created surgical field mobile hospital (see) and therapeutic field mobile hospital (see); three main types of specialized HPPG — for wounded in the head were defined; in a hip and large joints; in a breast and a stomach that was reached by strengthening of the specified hospitals by the corresponding specialized groups of structure of ORMU. For providing the correct organization C. of m of the item p the systematic highly skilled management it created institute of the chief, front and army specialists, and positions of specialists inspectors are entered into states of managements of all evacuation points. Thus, in the period of the Great Patriotic War the harmonious, evidence-based system C. of m of the item and specialized treatment of wounded and patients was created.
In post-war years on the basis of studying, the critical analysis and synthesis of the got experience there is a further development and S.'s improvement of m of the item. This process is promoted in many respects by development of network specialized to lay down. institutions and the centers in system of the Soviet health care, and also significant improvement of hardware specialized to lay down. institutions by the corresponding diagnostic and medical equipment.
Due to the acceptance on arms by the aggressive imperialistic countries of weapons of mass destruction it is necessary to expect new types of a fighting injury. The contingents of the m of the item struck, needing S. and specialized treatment, can have thermal and radiation defeats, defeats by neuroparalytic and psikhomimetichesky OV, toxins, etc. Emergence in an arsenal of the modern striking means nuclear weapon (see), toxic agents (see) and toxins caused allocation in structure of fighting sanitary losses (see) struck a therapeutic profile [e.g., radial illness (see)] and need to provide for these contingents of the m of the item struck the corresponding types with S.
As well as in the period of the Great Patriotic War, as a part of hospital bases are intended for S.'s rendering of m of the item and specialized treatment specialized hospital of two types: having constant (regular) specialization, e.g. infectious, neurologic, hospital for le ~ a cheniya lightly wounded, and strengthenings of hospitals of general purpose by specialized medical groups of structure, the group of specialized medical care (GSMC) specialized hospital, created in the way.
Specialized medical care in system of civil protection
struck and their hospitalization is supposed to carry out Specialized medical aid in to lay down. institutions hospital bases (see), developed in country zones (see. Health service of civil protection ). As a part of hospital base expansion of BC and departments of the following profiles is provided in them: neurosurgical, torakoabdo-minalny; for treatment of fractures of hip and wounds of large joints; traumatologic; burn; therapeutic (for treatment struck with a penetrating radiation, toxic agents, toxins, and also patients with somatopathies); infectious; psychoneurological; hospitals for treatment of lightly wounded, specialized children's departments. B-tsy combine in hospital collectors. Each hospital collector is calculated on reception struck on all main specialties. For ensuring carrying out the help by specialists doctors standard tool kits and the equipment are created.
See also Health care .
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E. A. Loginova, A. L. Lindenbraten; A.S. Georgiyevsky (soldier.), V. I. Mikhaylov, Yu. I. Tsitovsky (MSGO).