Clinical examination at FAPs
One of the most important types of preventive work is the assistant medical examination of the population.
main elements clinical examination are:
• active detection of patients with early stages of the pathological process;
• complete clinical examination;
• dynamic monitoring of the health condition;
• implementation of a complex of therapeutic measures, including outpatient treatment, hospitalization, spa treatment, diet meals, employment;
• familiarity with the working and living conditions in order to establish links between them and established disease, the development of measures to eliminate the harmful factors of environment and ensure the most favorable conditions for human life;
• propaganda among dispensary contingents nutrition regime of work and rest;
• periodic compilation of data on the effectiveness of prophylactic medical examination.
The objectives of the clinical examination are:
• identification and assessment of the health of everyone;
• ensuring improve the level and
• increasing the participation of different specialists and nurses in the clinical examination under the leadership of the district (the guild) physician;
• improving technical support annual inspections, and dynamic monitoring of public health with the use of automated systems;
• providing the necessary statistical accounting and reporting, transfer of information on the surveys and recreational activities for each person at his place of observation.
Preventive medical assistant should occupy 80% of the time.The most urgent issue for the emergence warning of diseases and their transition into the chronic form.
Under clinical examination refers to such a system of active measures, which ensures regular monitoring of health care workers for healthy children with conduct of appropriate preventive measures, early detection of diseases and their treatment until full recovery of function of the affected organ, healthier environment.The World Health Organization defines health as "a state of complete physical, mental and social well-being."Preventive medical examinations of the population are the initial stage of the system of follow-up.
population Clinical examination includes:
• annual inspections of physicians with nurses and conduct necessary laboratory diagnostic and functional studies;
• doobsledovanie need modern methods of diagnosis;
• the necessary therapeutic measures;
• dispensary observation of patients and persons with risk factors.
objectives of medical examinations are active detection in the general adult population and occupational diseases in their early stages;dynamic monitoring of the health status of persons exposed to adverse factors;detection of diseases, adverse flowing under the influence of certain factors, as well as diseases that can contribute to the development of occupational disease;determining deviations in terms of characterizing the physical development and the ability to work;development of recommendations aimed at improving the working conditions, the elimination or significant reduction of unfavorable factors of production;conducting individual therapeutic and preventive measures based on the results of medical examination for the purpose of restoration of the disturbed functions of the organism and disability cases.
preliminary medical examination to be children when taking them to the nursery, garden, school;pupils or students to enroll in technical schools and universities;teenagers get a job, as well as all persons coming to work in certain sectors of industry, agriculture, buildings, transport, catering and others.
Periodic medical examinations are carried out the above groups of people throughout the work for the dynamic monitoring oftheir health, ability to work and to ensure the conservation creative longevity.
Targeted medical examinations include detection of diseases, the most common and dangerous for disability and life. Tuberculosis, cancer, cardiovascular and other
In conducting mass medical examination arbitrarily allocate 2 stages: preparation and the actual work.
In the preparatory period is determined contingent of persons subject to routine inspections, date and place of inspections, create a team of doctors and nurses, and carried with them instructive and methodological meetings and seminars.Contingents of workers and employees, subject to preliminary and periodic inspections, indicating occupational hazard, establishes SES, and it, in writing on the approved form asks for lists of such persons from leaders of rural communities and businesses.Lists compiled in three copies (for the chief doctor of CDH, SES and the head of an agricultural enterprise);Head of Human Resources with the participation of an engineer for labor protection and safety endorse documents signed by their head of an agricultural enterprise, and stamped.At SES develop a schedule of preventive examinations, indicating the composition of the medical team and the volume of laboratory tests.Schedule inspections necessarily agree and argue with the management of rural settlements and agricultural enterprises and adjusted to each medical institution.
All physicals are divided:
• on preliminary;
second, or the actual working period is the immediate organization and carrying out medical examinations, and, as a rule, it starts from December to the beginning of the mass field work all the recreational activities have been completed.As CRH issued an order to the specific challenges faced by a team of doctors, appointed senior doctor (usually a physician).
Maintenance inspections can be carried out on the basis of CRH, district hospital, outpatient clinic.The medical team can go directly to the villages, lying on the FAP, in rooms specially adapted for inspections.The order, timing and responsible for the appearance on the inspection determined by the order of the head of the rural village.
paramedics and midwives at the exits of doctors to areas of a room, appropriate equipment, tools, specify the lists of persons subject to inspection, which helps physicians to reduce the loss of working time, more detailed study of the working conditions of specific occupational groups.
to attract people to participate in the examinations may be organized by radio transmission, publication in local newspapers, lectures, discussions, and individual invitations for apartments to patients sanitary activists and paramedics but compiled schedule.The responsibility for attendance on inspections of work lies with the heads of agricultural enterprises and trade union organizations.
After checkups up the final act for each enterprise.
Implementation of the annual medical examination of the entire population is provided in two stages.
In preparation for the introduction of the annual medical examination of personal account for all people living in the vicinity of the FAP service, in accordance with the "Regulations on the registration of the annual medical examination of the entire population."In rural areas, lists of inhabitants are nurses at the door-FAP rounds, they specify in rural and township administrations and transfer to the local hospital (clinic).
For a personal account of each resident nurses fill "Card account clinical examination 'and are numbered according to its medical card number ambulatory (form number 025 / y).After clarification of the composition of the population is "Maps clinical examination of accounting" is transmitted to the card index.
After the personal account of the total population are the following groups:
• Children 1st and 2nd year of life;
• preschool children in organized groups;
• Students up to 15 years;teenagers (pupils, students of vocational schools and secondary specialized educational institutions, working adolescents aged 15-17 years);
• invalids and participants of the Great Patriotic War, participants of the war in Afghanistan, the liquidators of the Chernobyl accident;
• are pregnant;
• industrial workers, construction, transport and communications;
• municipal workers, health-care, children, and other enterprises, organizations and institutions;
• machine operators, livestock, field crop, greenhouse workers and other agricultural workers;
• university students and students of secondary special educational institutions;
• personal pensioners health care in the health care facility;persons who are under medical observation;
• other populations are not included in the above list.
In the countryside (except regional centers and ascribed sites) recommended the following scope of surveys on the I stage of clinical examination.
1. Annual inspections pediatrician (in the absence of a pediatrician - a physician), a dentist (dentist).Pediatrician examines necessarily children of 1st and 2nd year of life, before entering school inspection produces pediatrician, neurologist and surgeon.
2. Nursing staff conducting anthropometric measurements, visual acuity, the definition of hearing, a preliminary assessment of the physical and neuropsychological development, takes the tuberculin test.
3. The following laboratory, diagnostic and instrumental examinations: blood tests (ESR, hemoglobin, white blood cells, red blood cells);general urine analysis;feces analysis on helminth eggs;measurement of blood pressure at age 7;Chest Photofluorography 13 years.
1. Annual inspections therapist, dentist, obstetrician-gynecologist (in his absence - the midwife), other specialists (if indicated).
2. Nursing staff, including FAP collects anamnesis specially developed questionnaire;anthropometric measurements;measurement of blood pressure;gynecological examination of women with smears (cytology);definition of visual acuity;tonometry (for persons older than 40 years);definition of hearing acuity, tuberculin skin test (adolescents aged 15-17 years).
3. Laboratory, diagnostic and instrumental examinations: blood tests (ESR, hemoglobin);urine sugar, urine protein (rapid method);ECG (after 40 years);chest x-rays (radiographs) annually;cytology smears with 18 years for women;mammography (flyuoromammografiyu) once every two years for women 35 to lay down.
volume of research carried out during the annual medical examination of workers in agriculture by main occupation, includes the following groups:
• machine operators;
• repair shops workers (fitters, turners, welders, battery attendant, blacksmiths and others.);
• livestock (milkmaids, herdsmen, hog woman, calf, etc.);
• poultry (attendant, operators, sorters eggs, slaughterhouses workers and others.);
• agronomists, plant protection, pesticides Warehouse, teplichnitsy, working in plant protection;
• workers covered ground (teplichnitsy, agronomists, etc.).
For each occupation by the order provided the identification of the etiological factor, experts examination (mandatory, if indicated), and laboratory tests, compulsory and indicated.
within the scope of medical examinations and diagnostic tests during pregnancy and the postpartum period includes the following nosologic forms: physiological pregnancy in healthy women (post-partum normal) - set the frequency of monitoring obstetrician-gynecologist, examinations by doctors of other specialties;The name and frequency of laboratory and other diagnostic studies;the main therapeutic event, hospitalization.
physiological pregnancy in healthy women.The frequency of observation obstetrician-gynecologist: during pregnancy of 14-15 times;after the first inspection of the turnout in 7-10 days with analyzes,
conclusion therapist and other professionals in the future in the first half of pregnancy - 1 time per month;after 20 weeks of pregnancy - twice a month;after 32 weeks of gestation - 3-4 times.
Inspections doctors of other specialties.GP - 2 times (at the first summons and the 32nd week of pregnancy), dentist, surgeon, neurologist, ophthalmologist - 1 times at the first appearance in the future by prescription, other experts - according to indications.
Name and frequency of laboratory and other diagnostic studies: a clinical analysis of the blood 2-3 times (at the first visit, when the term of 22 and 32 weeks of pregnancy);urinalysis (each visit);direct microscopic study of vaginal discharge (gonococci, trichomonas, fungi);blood group and Rh factor;when Rh-negative supplies - husband tested for group and Rh affiliation;a blood test for Wasserman - 2 times (at the first visit and 32 weeks of pregnancy);on the testimony - studies for toxoplasmosis, and others, visual acuity testing, audiometry, measurement of blood pressure, chest x-ray, ECG, colposcopy, tonometry eye pressure..
main therapeutic measures: Hygiene pregnant, work and rest, diet, psychoprophylactic preparation for childbirth, UV Oh, fortification, bandage.
Postpartum normal.The frequency of observation obstetrician - 2 times.First Inspection - 10-12 days after discharge from the hospital;final - 6-8 weeks after birth.
examined by a doctor other specialties: general practitioner, dentist, neurologist, surgeon, ophthalmologist (first inspection), or final inspection.
Name of laboratory and other diagnostic measures: external examination, measurement of blood pressure, visual acuity testing, audiometry, chest x-ray, ECG, colposcopy, tonometry eye pressure, blood and urine analysis.
main therapeutic activities: personal hygiene, care of the breasts, mode of work (home), rest, good nutrition, fortification, hygienic gymnastics, bandage.
clinical examination of the entire population of the territory served by the procedure, based on the allocation of 5 dispensary groups:
The dispensary work required phasing of follow-up.There are three stages.
1. Scheduling in conjunction with the annual examinations organized and unorganized population (I stage).
2. Identify contingent, subject to dispensary supervision (II stage).
3. Conducting an active dynamic monitoring, therapeutic and rehabilitation measures (III stage).
Group 1 - healthy persons subject to periodic inspections;
Group 2 - persons transferred from the third group taking into account the stage of stable compensation of the disease;
group 3 - patients with compensated disease course.This group includes also patients after acute diseases (infectious and non-infectious), about which they were on the short-term observation, and those at risk of developing chronic diseases as a result of repetitive acute pathological processes;
4th group - patients in stage subcompensation.In most cases, these patients are coming periodically flare-up, and they often lose the ability to work;