Федеральное государственное бюджетное учреждение «Российский ордена Трудового Красного Знамени научно-исследовательский институт травматологии и ортопедии имени Р.Р. Вредена» Министерства здравоохранения Российской Федерации, Санкт-Петербург В современном мире, где стремительно развиваются трёхмерные технологии, использование только стандартных протоколов планирования и выполнения эндопротезирования коленного сустава является недостаточным. Двухмерность в предоперационном планировании влечет за собой проекционное искажение, что в конечном итоге отразится на расчетах, а следовательно, может негативно повлиять на результаты оперативного лечения в целом. Цель. Усовершенствовать способ предоперационного планирования и выполнения эндопротезирования коленного сустава с использованием методики индивидуального 3D-моделирования и прототипирования индивидуальных резекционных блоков, основанного на совмещении данных КТ и МРТ. Материалы и методы. В рамках данного исследования рассматривались 30 пациентов в возрасте 58-75 лет. Исследование проводилось на компьютерном томографе «Toshiba Aquilion 64» и на магнитно-резонансном томографе «Magnetom Avanto 1.5T Tim I-Class» по специально разработанным протоколам. Выполнялось индивидуальное 3D-моделирование и прототипирование анатомических моделей коленного сустава на 3D-принтере Picaso 250 Prо, а также прототипирование индивидуальных резекционных блоков на 3D-принтере Objet Eden 260. Результаты. В работе представлена разработанная авторская методика нового предоперационного 3D-моделирования эндопротезирования коленного сустава. Выводы. Созданный авторами статьи индивидуальный протокол виртуального предоперационного планирования позволил учитывать индивидуальные антропометрические показатели и особенности каждого пациента, позволяя подобрать необходимые размеры компонентов коленного сустава и учесть опилы бедренной и большеберцовой костей.

The article presents results of cohort epidemiological studies conducted in the period from 2001 to 2010 among the indigenous population residing in Chukotka (ChAO) and Nenets (NAO) autonomous districts. The aim was to document temporal changes in blood concentrations of persistent contaminants that caused the serious health concern from the first Arctic Monitoring and Assessment Program (AMAP) survey in 2001 “Persistent toxic substances, food security and indigenous peoples of the Russian North”. In monitored indigenous cohorts there have been measured blood concentrations of persistent contaminants including polychlorinated biphenyls (28/31; 52; 99; 101; 105; 118; 128; 138; 153; 156; 170; 180; 183 and 187); hexachlorocyclohexane (α, β, γ - isomers of HCH); oxychlordane (trans chlordane, cis-chlordane); DDT (2,4 DDE; 4,4 DDE; 2,4 DDD; 4,4 DDD; 2,4 DDT; 4,4 DDT); hexachlorobenzene (HCB); heptachlor; dieldrin; mirex; toxaphene (Par 26, the Par 50, the Par 62); PBDEs (28; 47; 100; 99; 153; 154; 183); metals (Cd, Pb, Hg). During 2003-2004 there was implemented a set of measures for the disposal and detoxification of local sources of persistent pollutants and reduction of the risk of associated health effects that had been recommended by the international AMAP expert panel. As a result of 2010 study a significant reduction in the average serum concentrations of DDT and DDE 4.4, as well as blood concentrations of lead was found to occur, they were observed only in men living in NAO. Changes in concentrations of a number of other persistent toxic substances (PTS) although show a tendency to decrease, but these changes failed to reach the level of statistical significance. The mean annual incidence rates of diseases associated with harmful impact of PTS, in particular, cancer, endocrine system diseases, congenital malformations, and immunodeficiency, unlike most of the other classes of diseases in the population showed a clear trend towards to the increase in the period of observation. Conclusion. The results obtained did not allow to confirm the sufficient effectiveness of implemented measures for the rehabilitation of residential areas both in Chukotka and NAO. The period of re-measuring blood concentrations of PTS was assumed not be appropriate due to longer half-life of many PTS studied. The health importance of long-range transboundary transport of PTS is likely to be also underestimated especially due to the observed high contamination of migrating of commercial species of wild birds, fish and marine animals that make up a significant part of the traditional diet of indigenous peoples of the North. There is need for the improvement of national biomonitoring as well as information systems for appropriate assessment, prediction and management of health risks associated with long-range biotransportation of PTS into the arctic food chains.

The existing classifier of qualifications appears to be replaced by professional standards (PS) for specialists of preventive medicine, approved by the order of the Ministry of labor of RF № 399n from 25.06.2015. This is a multifunctional regulatory document setting requirements for the content, quality and conditions of the work, qualifications and competencies, professional education and training for skills required to meet this qualification, as well as a description of the ethical standards that are obligatory for the acceptance and respect of all members of the professional community. The standard includes the main type of professional activity of specialists of preventive medicine direction - ensuring sanitary and epidemiological welfare of the population and protection of consumers, identifies summarized working functions and corresponding qualification levels for the specialist, as well as requirements for education and practical activities which are necessary for their implementation. For the each working function included into the standard there are identified required knowledge and skills. The Federal educational-methodical Association in the field of the science of health and preventive medicine prepared a new educational standard in which the professional tasks and competences of the future specialist were both harmonized with the labor functions described in the standard and aligned with the major employer of graduates - Federal Service on Surveillance for Consumer rights protection and human well-being. Conclusion. The implementation of the professional standard provides a number of advantages for specialists of preventive medicine, its employers and professors of universities. Continuous updating of professional standards will allow to assess the quality and level of employee competencies, mainstream vocational training programs at all levels, aimed at creating and improving the professionalism of preventive medicine direction.

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The article presents the results of determining the needs of a typical urban polyclinic in medical personnel in accordance with the recommended load standards 1 medical post. Show that the existing federal method has a number of drawbacks, since it ignores the differences in measuring units of the volume of medical care that can be calculated not only with a single visit, but finished case of treatment of the disease. In particular, according to the calculated data, made under the federal method, in an urban polyclinic should be cut 55 full-time medical posts because of their overabundance. However, in reality, for polyclinic is typical not surplus, but a deficit of medical personnel. This disagreement is due to the fact that 55,3% of the total number of visits took place during the year amounted to finished cases of treatment of the disease in accordance with the current standards of medical care. Therefore, at the present stage of development of human resources planning it is extremely important improvement of the federal method of calculating the needs of medical institutions in medical personnel due to the development of the correction coefficients, corrective statistics on the total number of visits for the year.