АКТУАЛЬНОСТЬ: Неинвазивная респираторная поддержка является неотъемлемым компонентом терапии дыхательной недостаточности у новорожденных. Метод nCPAP (nasal continuous positive airway pressure) рекомендуется в качестве стартового для респираторной поддержки недоношенных. Единого мнения относительно критериев проведения nCPAP новорожденным во время межгоспитальной транспортировки в литературе нет, а рекомендации носят эмпирический характер. ЦЕЛЬ ИССЛЕДОВАНИЯ: Изучить возможность проведения nCPAP на этапе предтранспортной подготовки и межгоспитальной транспортировки новорожденных. МАТЕРИАЛЫ И МЕТОДЫ: В когортное ретроспективное исследование включены данные 70 случаев эвакуации новорожденных, выполненных транспортной бригадой реанимационно-консультативного центра Областной детской клинической больницы Екатеринбурга в период с 1 июля 2014 г. по 31 декабря 2018 г. пациентам, находившимся на неинвазивной вентиляции (nCPAP) на момент осмотра реаниматолога транспортной бригады в исходной медицинской организации. Исходная выборка разделена на группу пациентов, транспортированных на вентиляции (n = 22), и группу пациентов, транспортированных на nCPAP (n = 47), одному пациенту прекращено проведение респираторной поддержки. РЕЗУЛЬТАТЫ: При анализе параметров респираторной поддержки на момент осмотра реаниматологом транспортной бригады наблюдали различия между группами по фракции кислорода во вдыхаемой смеси (34 [30–45] % и 30 [21–30] %, группа 1 и группа 2 соответственно, р = 0,002) и сатурационному индексу оксигенации (2,1 [1,6–2,6] и 1,53 [1,1–1,8], группа 1 и группа 2 соответственно, р = 0,001). Сатурационный индекс оксигенации обладает приемлемой предиктивной ценностью в отношении интубации трахеи на этапе предтранспортной подготовки (AUC 0,799 [0,682–0,917]). Во время транспортировки одному пациенту группы 2 потребовалось выполнить интубацию трахеи (2,1 [0,1–11,3]). При поступлении одному пациенту группы 2 потребовалось выполнить интубацию трахеи (2,2 [0,1–11,5] %), другая коррекция параметров неинвазивной поддержки пациентам группы 2 не потребовалась. ВЫВОДЫ: Основным критерием перевода на искусственную вентиляцию легких (ИВЛ) на этапе предтранспортной подготовки является зависимость от дополнительного кислорода при проведении nCPAP. Сатурационный индекс оксигенации (AUC 0,799 [0,682–0,917]) и отношение SpO2/FiO2 (AUC 0,803 [0,687–0,919]) обладают приемлемой предиктивной ценностью в отношении потребности в интубации трахеи. Вероятность перевода на ИВЛ во время транспортировки составляет 2,1 (0,1–11,3) %.

Introduction. Paracetamol (acetaminophen) is an over-the-counter analgesic and antipyretic drug, available in monoform and included in more than 200 combined drugs. Today, paracetamol is widely used in medicine, and therefore available in different age categories, including children from 0 to 18 years old, adults, the elderly and pregnant women.The aim is to systematize data on the epidemiology, diagnosis and treatment of paracetamol poisoning based on data from foreign and domestic literature.Materials and methods. Literary search on the platforms PubMed, Google Scholar, eLibrary.ru, CyberLeninka by keywords “paracetamol, acetaminophen, poisoning, epidemiology, hepatotoxicity, N-acetylcysteine”. Inclusion criteria: original, review articles, randomized and non-randomized clinical trials, meta-analyses and systematic reviews on the topic of paracetamol poisoning.Results and discussion. The literature review presents data on toxic effects, epidemiology, metabolism, and clinical picture; modern research on methods of diagnosis and treatment of paracetamol poisoning.Conclusions. Modern methods of diagnosing paracetamol poisoning allow us to focus not only on determining the concentration of the drug in the blood or the dose taken orally, as a decision-making tool. The development of new biomarkers of liver damage is a promising diagnostic tool, suggesting an “early warning” of potential liver damage.

A brief overview of the results of work in the field of “Devices, systems and technologies for medical purposes”, obtained with the direct participation of the authors of the article, is given. The results of the development and research in the field of modeling the effects of physical factors on the human body and digital processing of biomedical signals are presented. The principal aspects of the original systems of long-term monitoring of the human condition and control of the musculoskeletal system are presented.

The objective was to evaluate the clinical effectiveness of various surgical techniques for early stabilization of the rib cage in comparison with conservative treatment tactics. The authors attached great importance to the search for predictors of an unfavorable outcome in patients with severe combined trauma.Materials and methods. This multicenter, non-randomized, open, retro- and prospective cohort study included 65 patients with chest trauma. Pa tients were categorized into three groups depending on the technique of restoration of the disturbed thoracic skeleton. Group 1 included 19 patients with the age of 39.9 ± 2.4 years and severity of MODS-II scale 4.0 ± 0.6, ISS 24.1 ± 1.8 points. In this group, submersible constructs were used to restore sternal reconstruction. Group 2 included 24 patients aged 30.9 ± 2.4 years with MODS-II severity score of 4.3 ± 0.5, ISS 27.1 ± 1.0 points. The stabilization of the frame was carried out using the technique of fixation of the bones of the ribs and sternum with an external fixation device (AVF). Frame stabilization was performed according to the technique of fixation of rib and sternum bones with external fixation apparatus (EFA). Group 3 contained 22 patients aged 48.6 ± 2.9 years with severity of MODS-II scale 3.9 ± 0.3, ISS 24.3 ± 1.3 points and conservative treatment tactics.Results. The respiratory biomechanics parameters in groups 1 and 2 had no statistically significant differences after 24 hours of the surgical interven tion and stabilized the rib cage. The exception concerned increased CO2 accumulation and a distinct tendency to decrease lung tissue extensibility (Slang) in the group 1, which could indicate restriction of chest excursion. The analysis of correlation between clinical and laboratory parameters and lethal outcome indicated that unfavorable outcome was most closely related to prolonged prehospital time, initial severity of the condition according to SOFA and APACHE II integral scales, as well as to the development of acute kidney injury and uncompensated tissue hypoxia.Conclusion. The comparison of the three treatment methods showed that each of them has its own advantages: the technique of surgical treatment using submersible structures is characterized by the greatest aggressiveness for the victim, limits the excursion of the chest in accordance with the biomechanics of respiration, which contributes to the aggravation of tissue hypoxia, but reduces the duration of treatment and financial costs. The least expensive, but comparable in aggressiveness, is the method of hardware fixation. The most sparing for the patient, although lengthening the time of treatment and, accordingly, its cost, is the conservative method of management. Thus, the choice of surgical tactics is left to the attending physician and the patient.

INTRODUCTION: Noninvasive respiratory support is a crucial component of neonatal respiratory disorders therapy. The nCPAP (nasal continuous positive airway pressure) is recommended for respiratory support of a premature. There is no consensus on criteria for non-invasive respiratory support for newborns during transfer, the recommendations are empirical. OBJECTIVE: To study the possibility of using nCPAP during pre-transport preparation and transfer of newborns. MATERIALS AND METHODS: The cohort, retrospective study included data on 70 cases of newborns evacuation performed by the transport team (July 1, 2014 — December 31, 2018) to patients who were on nCPAP at the time of the transport team examination in the initial institution. The initial sample was divided into a group of patients transported on ventilation (n = 22) and a group of patients transported on nCPAP (n = 47), respiratory support was discontinued in one case. RESULTS: Statistically significant differences were observed between the FiO2 (34 [30–45] % and 30 [21–30] %, the first and second groups, respectively, p = 0.002) and the saturation index of oxygenation (2.1 [1.6–2.6] and 1.53 [1.3–1.8]) the first and second groups, respectively, p = 0.001). The saturation index of oxygenation has an acceptable predictive value for tracheal intubation during pre-transport preparation (AUC 0.799 [0.682–0.917]). During transfer, one patient of the second group required tracheal intubation (2.1 [0.1–11.3] %). Upon admission, one patient of the second was intubated (2.2 [0.1–11.5] %), no other correction of the parameters of noninvasive support was required for patients of the second group. CONCLUSIONS: The main criterion for intubation at the stage of pre-transport preparation is oxygen requirement during the nCPAP. The saturation oxygenation index (AUC 0.799 [0.682–0.917]) and the SpO2/FiO2 ratio (AUC 0.803 [0.687–0.919]) have an acceptable predictive value for tracheal intubation. The probability of intubation during transportation is 2.1 (0.1–11.3) %.

Introduction. Respiratory support remains the most common procedure performed by neonatal transport team specialists. Non-invasive ventilation is a very common method of respiratory support for newborns, reducing the incidence of chronic lung disease. However, the safety and efficacy of this type of support during transportation remain controversial. The aim of the work is to determine the current state of the problem of non-invasive respiratory support in newborns in the initial medical organization, at the stage of pre-transport preparation and during transportation. Materials and methods. Literature sources were searched and selected in PubMed and eLibrary. The following queries were used for the search: nasal continuous positive airway pressure, non invasive ventilation, neonate, newborn, patient transportation, transport, transfer. Types of studies considered: retrospective observational studies, prospective studies (randomized, quasi-randomized, non-randomized), systematic reviews, meta-analyses, clinical protocols. Depth of search − 20 years. The total number of publications included in the review was 61, including 29 studies directly related to the use of noninvasive ventilation in interhospital neonatal transport. Results and discussion. Non-invasive respiratory support is one of the priority and actively used methods of therapy of respiratory disorders of various genesis in neonatology. Nasal CPAP is used both independently and in conjunction with various methods of surfactant administration, reducing the risk of a combined outcome “death or chronic lung disease”. It is recommended both as a method of starting respiratory support and as an intermediate option to increase the probability of successful extubation. There is limited experience with non-invasive respiratory support during interhospital transport of neonates. The available studies suggest that when patients are selected rationally and reasonable criteria are applied to administer nCPAP en route, this method of respiratory support is safe, effective, maintains the benefits of spontaneous breathing, and reduces the duration of intensive care. The small number and poor design quality of studies in this direction do not allow at this stage to form evidence-based recommendations. Conclusion. Medical evacuation of newborns from 1−2 level institutions to level 3 organization with nCPAP is safe and has a number of potential benefits. Existing recommendations are empirical, and there are exceptionally few studies evaluating the validity of such recommendations.

BACKGROUND: The medical evacuation of premature newborns to institutions providing a higher level of medical care results in the reduction of death risk. The use of pediatric intensive care units in level 2 organizations for the hospitalization of newborns can be a potential solution to the lack of neonatal beds in level 3 institutions. AIM: This study aimed to determine the predictors of the re-evacuation of newborns from level 2 medical organizations to level 3 institutions. MATERIALS AND METHODS: This observational, cohort, retrospective study included data of 284 cases of the evacuation of newborns from level 1 and 2 medical organizations without a pediatric intensive care unit to level 2 medical organizations with a pediatric intensive care unit. The sample was divided into two groups: the first group included patients who received the necessary therapy in level 2 medical organizations and did not require further evacuation to level 3 (n = 261), and the second group included patients who required further transfer to level 3 (n = 23). Anamnesis data, nosological structure, respiratory support parameters, intensive therapy, and volume of pretransoport activities in the groups were analyzed. Methods of statistical analysis included median, interquartile range, proportion and its 95% CI, Fisher exact test, MannWhitney test, receiver operating characteristic analysis, and odds ratio. RESULTS: The predictor of the requirement for re-evacuation was birthweight (area under the curve [AUC] 0.658 [0.5220.795]). When only patients on a ventilator were included in the analysis, the saturation oxygenation index (AUC 0.730 [0.5790.863]) and the SpO2/FiO2 ratio (AUC 0.720 [0.5710.869]) have the maximum predictive value. CONCLUSIONS: Birthweight of 1390 g (AUC 0.658 [0.5220.795], sensitivity 0.348 [0.1530.542], and specificity 0.950 [0.9240.977]) is a predictor of the requirement for further evacuation of newborns from level 2 pediatric and neonatal intensive care units to a level 3 organization. For patients on a ventilator, such predictors included saturation oxygenation index 4.25 (AUC 0.730 [0.5790.863], sensitivity 0.471 [0.2330.708] and specificity 0.928 [0.8880.967]) and SpO2/FiO2 ratio 265.71 (AUC 0.720 [0.5710.869], sensitivity 0.588 [0.3540.822], and specificity 0.837 [0.7810.893]). However, the high negative and low positive predictive values for these parameters do not allow their solitary use when deciding about routing a newborn.

Introduction. Pre-transport preparation reduces the risks of deterioration when transporting a newborn. Correction of intensive care in the original medical organization may be an indicator of the need for the transport team to travel to the patient. Purpose of the study is to identify predictors of the need for correction of neonatal therapy during pre-transplant preparation. Materials and Methods. Data from all transport team departures of the neonatal intensive care and consultation center between July 1, 2014, and December 31, 2018 (n = 2029) were included in an observational, cohort, retrospective study. Two groups were identified: the first group (n = 502) – patients who underwent correction of intensive care, the second group (n = 1527) – newborns who did not require correction of the ongoing therapy before evacuation. Results. Statistically significant differences in the volume of intensive care administered at baseline medical organization, parameters of respiratory support were observed between patient groups. The oxygenation saturation index demonstrated good predictive properties regarding the need for correction of intensive care with an AUC ROC of 0.696 [0.662–0.730]. Logistic regression revealed the following reliable predictors of the need for therapy correction: Apgar score at 1 and 5 minutes, giving the patient respiratory support, SpO₂/FiO₂ ratio value, catecholamine infusion, and giving therapy in a Level 1 organization. Discussion. The identified predictors indirectly indicate the need for correction of intensive care, which is an argument in favor of an evacuation trip and can be a tool for determining the order of such trips. Conclusion. Predictors of the need to adjust the neonate's therapy include the need for respiratory support (EVI or pCPR), SpO₂/FiO₂ ratio, need for adrenaline or dopamine infusion, Apgar scores at 1 and 5 minutes, and therapy in a Level 1 medical organization.

BACKGROUND: Assessment of the clinical condition, prediction of risks and possible outcomes during the transfer of newborns remains an important part of the work of transport teams. Respiratory disorders remain a significant indication for transfer to medical organizations of a higher level of care. AIM: To study the predictive value of the parameters of respiratory support in newborns requiring medical evacuation for the outcomes of treatment. MATERIALS AND METHODS: The observational, cohort, retrospective study included data from neonatal to patients on ventilators (286 newborns) in the period from August 1, 2017 to December 31, 2018. Anamnesis parameters, intensive care volume, respiratory support settings, and assessments on scales (KSHONN, NTISS, TRIPS) were evaluated. Analyzed: 24-hours mortality, 7 days mortality, hospital mortality, air leakage syndrome. The assessment and comparison of the predictive value of the parameters in relation to the hospital outcomes was performed. RESULTS: The AUC ROC of SpO2/FiO2 for predicting 24-hours mortality was 0.984 [0.9661.000], which is significantly higher than the ROC of the saturation oxygenation index (AUC 0.972 [0.9490.995], p = 0.004). The area under the ROC of the 24-hours mortality on the TRIPS scale does not significantly differ from the saturation index of oxygenation (AUC 0.972 [0.9490.995], p = 0.113) and the mean airway pressure (AUC 0.943 [0.8841.000], p = 0.107). When predicting 7-day mortality, the saturation oxygenation index has AUC ROC (0.702 [0.5490.854]) significantly lower than AUC ROC for SpO2/FiO2 (0.762 [0.6380.887], p = 0.001). SpO2/FiO2 predicts total mortality with AUC ROC (0.759 [0.6770.841]). CONCLUSIONS: The mean airway pressure, saturation oxygenation index and SpO2/FiO2 have a high (AUC 0,9) predictive value for 24-hours mortality, while only SpO2/FiO2 reliably predicts total mortality with AUC ROC 0,7.

Introduction. The need for intensive care adjustments to be made by the transport team at the originating medical organization remains an important element of pre-transport preparation, being an indirect indicator that the level of care does not match the needs of the patient. The aim of the study is to identify factors associated with the need for therapy adjustments depending on the level of initial medical organization. Materials and methods. The one-stage, cross-sectional study included the data of visits of the neonatal transport team of the resuscitation and consultative centre of the Regional Children’s Clinical Hospital (Ekaterinburg) in the period 01. 07. 2014–31. 12. 2018 (n = 2029). The sample was divided into groups: the first group – patients from level 1 organizations (22.8 %, n = 462), the second group – patients from level 2 organizations without paediatric intensive care units (34.9 %, n = 709), the third group – patients from level 2 organizations with paediatric intensive care units (32.5 %, n = 659), the fourth group – patients from level 3 institutions (9.8 %, n = 199). Results. The need for therapy adjustment at baseline was dependent on the level of the institution, with a maximum in level 1 organizations and a minimum in level 3 organizations. The odds ratio of need for therapy correction for level 1 organizations compared to level 2 organizations with paediatric intensive care units was 1.4, 95 % CI [1.2–1.7], p = 0.002, and compared to level 3 organizations was 1.6, 95 % CI [1.2–2.3], p = 0.003. Multivariate analysis identified the following factors associated with the need to adjust therapy at the original facility: for level 1 facilities, respiratory support, dopamine administration; for level 2 facilities without paediatric intensive care units, respiratory support, dopamine and epinephrine infusion, sedation; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; for level 2 facilities with paediatric intensive care units, respiratory support, dopamine infusion; and for level 3 facilities with paediatric intensive care units, respiratory support, dopamine infusion. Discussion. The need for respiratory support and administration of catecholamines are indicators of the severity of the patient’s condition. Patients in low-acuity healthcare organizations require an increased level of care, regardless of the birth weight and gestational age of the newborn. Conclusion. Logistic regression analysis revealed factors associated with the need for therapy correction in patients in the initial medical organizations depending on their level. The following factors played a statistically significant role: respiratory support, sedation, intravenous infusion of catecholamines, patient weight.

Ensuring highly realistic simulation in training and assessing the clinical skills of healthcare professionals is one of the important tasks in the development of simulation technologies. Using the method of analyzing OSCE video fragments in the accreditation procedure, it was possible to consider the work of simulated / standardized patients when assessing communication skills in the accreditation procedure for healthcare professionals in the Russian Federation, as a condition for ensuring highly realistic simulation.

INTRODUCTION: Assessment of the patient’s condition and prediction of outcomes is critically important during pre-transport stabilization and remains the most complex challenges of the activities of transport teams. A significant variety of scales and different requirements for their application indicates that there is no consensus on the choice of a specific scale and predictive tool. OBJECTIVE: To study hospital outcomes in transported newborns, depending on the assessment on the TRIPS scale (Transport Risk Index of Physiological Stability for Newborn Infants). MATERIALS AND METHODS: The оbservational, cohort, retrospective study included data from 604 trips of the transport team to newborns consulted by resuscitation and consultative center from August 1, 2017 to December 31, 2018. The total sample was divided into groups depending on the assessment of the score, followed by a comparison of characteristics and outcomes in these groups. RESULTS: There is a significant difference in birth weight and gestational age between TRIPS groups. An increase in the TRIPS score in transported newborns is associated with an increased risk of death with a maximum relative risk of 21.4 (3.35–136.72) (between 6 and 1 groups). For other outcomes, there are significant differences between groups with minimum and maximum TRIPS scores. CONCLUSIONS: The TRIPS scale allows to stratify newborns requiring inter-hospital transportation by the risk of developing a fatal outcome and complications at the upcoming hospital stage.

Physicians must be competent communicators to effectively practice medicine, and communication is one of six required competencies identified by the Accreditation Council on Graduate Medical Education (ACGME). 1 Elements of competent communication are featured in four of the six ACGME competencies.The Association of American Medical Colleges (AAMC) also published recommendations for communication in the Medical School Objective Project, Paper III. 2 The National Board of Medical Examiners (NBME) is requiring Objective Standardized Clinical Examinations (OSCEs) to assess interviewing and communication skills.The Institute of Medicine, in its 2004 report, "Im-proving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula," names communication skills as one of six curricular domains. 3The strong agreement about the importance of competent communication in medical practice challenges medical educators to develop effective tools to determine competence.Assessing communication competence is complex.Skills that require performance are difficult to assess through disembodied means (such as written tests) but require in-vivo demonstration. 4 Further, competence is not defined solely by the presence or absence of specific behaviors but rather by the presence and timing of effective verbal and nonverbal behaviors within the context of individual interactions with patients or families. 5Effective communication includes the ability to adapt, to be responsive, and to manage self-awareness during the process of talking and listening.Additionally, effective communication is not only dependent on the observable behaviors of the physician but also on the behaviors and perceptions of patients.What constitutes effective communication in one setting or with

INTRODUCTION: In recent decades procedural sedation and/or analgesia (PS/PSA) have been widely used for diagnostic examinations and minimally invasive surgical interventions outside of the operating room. The recommendations for (PS/PSA) presented in the literature contain contradictory data related to indications, contraindications, baseline monitoring level, priority level and sedation protocols. OBJECTIVE: To perform an analysis of current practice guidelines, randomized clinical trials (RCTs), literature review and to systematize data on the potential use of sedatives and narcotic analgesics in procedural sedation. MATERIALS AND METHODS: PubMed, Medline, Embase, and eLibrary were searched for PS/PSA guidelines, RCTs, and articles. RESULTS: The literature review describes the levels of sedation in increase in difficulty and potential risk of complications. A comparative characteristic of first- and second-line drugs for sedation and anesthesia is presented. Minimum requirements for perioperative monitoring of vital signs, sedation and pain levels are formulated. CONCLUSIONS: The PS/PSA in a planned or emergency procedure provides safe, comfortable and successful performance of diagnostic examinations and mini-invasive surgical interventions. The principles of interaction and administration of sedatives with narcotic analgesics are the basis for the use of sedation regimens. The use of scales has important practical value for monitoring the dynamics of sedation levels and for more fine management of sedation doses. There are no absolute contraindications for PS/PSA. PS/PSA is a popular area of practice for the anesthesiologist and resuscitator today. The Russian Federation's lack of regulatory documents on PS/PSA makes it necessary to develop guidelines.

Objective. To identify predictors of newborn infants mortality before medical evacuation.Materials and methods. The observational, cohort, retrospective study included 564 newborns: 526 patients survived and 38 died after 604 visits of the resuscitation-consultation Center transport team (critical care transport — CCT team). Patient's anamnesis, objective data of a patient at the time of examination by CCT team, the volume of intensive care provided and treatment adjustments during preparation for the transfer, records of patient's monitored parameters and indicators of prognosis were analyzed.Results. Compared to survivors, non-survivors neonates exhibited significant increases in premature new-borns (gestation period <29 weeks in 55.26% vs 10.27% in survivors, P<0.001) and significantly increased need in a high-frequency ventilation (7.89% [1.66-21.38] vs 0.57% [0.12-1.66] in survivors, P=0.005), and in cate-cholamines support (use of adrenaline was 13.51% [4.54-28.77] in non-survivors vs 0.76% [0.21-1.94] in survivors, P<0.001). Both early and late neonatal infections predominated in non-survivors: ([26.32% [13.40-43.10] vs 8,75% [6,47-11,49, early infection, non-survivors vs. survivors, respectively, P=0.002) and (23.6% 8 [11.44-40.24] vs 10.46% [7.97-13.39], late infection, non-survivors vs. survivors, respectively, P=0.028). Significant differences in the fraction of inspired oxygen (30% [30-30] vs 45% [30-60], P<0.001), oxygenation saturation index (2.71 [2.54-3.03] vs 4.48 [2.55-7.67], P<0.001), and SpO2/FiO2 ratio (316.67 [313.33-320] vs 207.25 [151.67-313.33] P<0.001) were found between the groups of survived vs. non-survived neonates, respectively. Logistic regression model revealed following markers of neonatal mortality: birth weight, development of early and late neonatal infection, and the oxygenation saturation index.Conclusion. Low birth weight, development of early or late neonatal infection and an increase in the oxygenation saturation index are the risk factors of death in newborns requiring medical evacuation.

Purpose . To study the patient’s characteristics and hospital outcomes in subgroups depending on the PNCAS scale score. Material and methods. The cohort study included data from 604 trips of the transport team to newborns hospitalized in medical organizations of the Sverdlovsk region from August 1, 2017, to December 31, 2018. Median birth weight [IQR] 2515 [1600; 3275] grams, median gestational age [IQR] 36 [32; 38] weeks. The total sample was divided into subgroups depending on the assessment of the score, followed by a comparison of characteristics and outcomes in these subgroups. Results . There are significant differences in the structure of birth weight and gestational age, as the PNCAS score increases, there is a significant increase in the proportion of patients weighing less than 1000 grams and a decrease in the proportion of patients weighing 2500–3499 grams. The largest proportion of extremely premature newborns was observed in 6–8 points and 9–14 points subgroups, 30.16% and 24.00%, respectively. Assessment of the intensive care showed an increase in the proportion of patients requiring HFOV, dopamine and epinephrine infusion while increasing PNCAS score. Analysis of the outcomes showed a significant increase of mortality while increasing PNCAS score, 0.76% [0.02; 4.18] in the 0–2 points subgroup and 42.86% [21.82; 65.98] in the 9–14 points subgroup. There is also an increase in the proportion of patients who have formed severe IVH, 0.00% [0.00; 2.78] in the 0–2 points subgroup and 19.05% [5.45; 41.91] in the 9–14 points subgroup. A similar pattern is observed in the frequency of late onset sepsis. Conclusion . The PNCAS scale we studied demonstrates a reliable division of patients by severity and predicts the outcomes of the hospital stage of treatment.

Introduction. Despite all the advances in anesthesiology, postoperative pain syndrome remains a serious problem. The lowest satisfaction with postoperative pain relief was found among gynecological patients. For adequate anesthesia and relief of postoperative pain syndrome in gynecological patients, a clear understanding of the features of pain development is necessary. The purpose of the study: identification of mechanisms of development of postoperative pain syndrome in gynecological patients. Materials and methods. The search and analysis of literature sources in the databases Scholar Google, Cyberleninka, PubMed, by keywords: physiology of pain, postoperative pain in gynecology, pain syndrome after uterine surgery. Criteria for the inclusion of articles: compliance with the subject of the review and the relevance of the data. The search depth was 33 years. The review includes 59 literary sources. Results. The development of pain syndrome is influenced by pathophysiological mechanisms, such as: the formation of hyperalgesia zones, changes in estrogen levels, damage to nerve fibers and genetic factors. To assess the level of pain, specialized scales are used, such as YOURS, CRH, DN4 scale. Psychological factors have a great influence on the formation of postoperative pain. Namely, the level of anxiety and depression, the level of catastrophization of pain, coping strategies used, psychological stability. Conclusion. Postoperative pain syndrome in gynecological patients is associated not only with the physiological mechanisms of pain development, but also with psychoemotional factors. A multidisciplinary approach is needed to alleviate pain in gynecological patients, including not only adequate multimodal anesthesia and analgesia in the perioperative period, but also collaboration with clinical psychologists, psychotherapists, to evaluate and possible selection of psycho-social therapy.

Introduction. Medical evacuation of newborns in critical condition remains an important area of neonatal intensive care. The study of threat-metric tools for assessing severity during the inter-hospital transport phases is of considerable practical interest. The aim of the study was to determine the ability of the NTISS scale to predict neonatal outcomes during the pre-transplant preparation phase, depending on the score obtained. Materials and Methods The cohort study includes data from 604 visits of the resuscitation and consultative center (RSCC) transport team to newborns under remote monitoring by the RSCC between August 1, 2017, and December 31, 2018. Division of the total sample into subgroups according to the score on the studied scale, with subsequent comparison of characteristics and outcomes in these subgroups was performed. Results In the subgroup of patients with a score of 30 or more there was a significant predominance of children with a birth weight of less than 1000 grams (85.72 %); in the subgroup with a score of 0–9, children with a birth weight of more than 2500 grams accounted for 83.33 %. Similar patterns were observed in the analysis of gestational age. Analysis of the volume of intensive care indicates an increase in the proportion of patients requiring high-frequency ventilatory ventilation, dopamine and adrenaline infusion as the NTISS score increased. When analyzing outcomes in the overall sample, there was an increase in the proportion of fatal outcomes from 0.00 % to 75.00 % as the NTISS score increased. Discussion The NTISS scale, being a therapeutic profile instrument, divided the sample according to the need for intensive care, which was significantly associated with birth weight and gestational age. Thus, the observed differences in outcomes are a legitimate result of the prevalence of extremely premature infants at high NTISS scores. Conclusion The NTISS scale demonstrates a reliable division of patients by severity and predicts the outcomes of the hospital phase of treatment.