Сибирский государственный медицинский университет, г. Томск РЕЗЮМЕ В представленном обзоре рассматриваются особенности функции внешнего дыхания у пациентов с распространенной патологией -ожирением. Ожирение оказывает комплексное воздействие на все органы и системы организма. В последние годы было проведено достаточно много исследований с целью оценки состояния функции внешнего дыхания при ожирении. Обобщая результаты проведенных на данный момент исследований, можно сделать вывод, что ожирение влияет на функцию внешнего дыхания, в том числе и у больных бронхолегочными заболеваниями, усугубляя их проявления.

Introduction. The problem of access to medical care remains extremely relevant in many countries in the world nowadays. In this context, it is advisable to optimize patients’ flow, that is, primary and repeated admissions and appointments for preventive and medical care purposes, and information. The document titled “The Standard for Organizing Outpatient Care in the Tomsk Region” was developed to solve this problem in the region. The document regulates the organizational features of providing medical care to the residents in state polyclinics. The document addresses the following: service parameters, issues of routing patient flows, and the procedures for organizing workplaces and specialists’ behavior.Objective. To evaluate the effectiveness of the solutions proposed in “the Standard for Organizing Outpatient Care in the Tomsk Region” for routing patient flows in outpatient clinics.Material and Methods. The effectiveness of measures was evaluated for 35 medical organizations with outpatient departments based on the temporal changes in eight indicators in 2018–2019.Results and discussion. Except for the percentage of children who passed preventive examination out of the number of children subject to preventive examination, positive dynamics were observed for all study parameters. First of all, this observation suggests the adequacy of proposed solutions from the perspective of the health care system, and secondly, it indicates their acceptance by the patient community. However, the extent of growth/decline is extremely uneven depending on the medical organization, which requires further research.Conclusion. Standardization of patient flow routing within the state regional health system through the issuance of appropriate orders and further monitoring of their implementation is an effective way to increase the medical care availability.

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The Declaration on Patient-Oriented Healthcare of theTomsk Region was accepted by the medical and patient communities on August 24, 2018. It was the first document of its kind in Russia. It was created based on several elements: modern international experience in the field of protection of patients’ and medical workers’ rights, particular qualities of Russian legislation, principles of humanistic medicine, and broad analysis of specific complaints from patients of regional public health institutions in the Tomsk region. The reason to create the Declaration was the necessity to build a healthcare system in which both medical staff and patients comply with such principles as mutual respect, choice and responsibility, involvement, accessibility, and openness. The document explains the need for constant adherence to these principles for the effectiveness of treatment, the protection of the individual, professional dignity, and equality.