AbstractIntroduction. The work presents an analysis of certain juridical, theoretical and practical problems of organization of internal quality control of medical aid (hereafter referred to as IQCMA) from the moment of history taking and diagnostics till the end of the treatment (quality of technologies and of the results obtained). A model of IQCMA conditioned by the quality of technologies and the results obtained has been proposed.Objects of research. Laws, departmental regulatory acts of the Ministry of Health of the Russian Federation, of the Federal Statutory Health Insurance Fund, orders about IQCMA approved by the authorized bodies of the subjects of the Russian Federation.Methods. Hypothetico-deductive method, general logical methods and research techniques (analysis, synthesis, abstracting, generalization, induction).

Introduction. At the present time osteopathy is considered as a branch of official medicine. The experience accumulated by osteopaths has already proven the effectiveness of this treatment method. In the context of intensive development of the specialty it became necessary to justify scientifically organizational andЕ. Е. Петрова, И. Г. Юшмановmethodological approaches in osteopathic healthcare delivery. In order to do that it is relevant to carry out socio- hygienic analysis of osteopathic healthcare delivery to patients.The object of the researh. To study socio-hygienic aspects of osteopathic healthcare delivery in big cities on the basis of the medical information analysis.Methods. Socio-hygienic and organizational aspects of osteopathic healthcare appealability were studied on the basis of a sample of medical histories of 1 624 patients who received treatment in osteopathic clinics. Every 13th patient card was selected in random manner. The information about each patient was registered in a specially elaborated research protocol. 121 patient cards were examined. In order to hold content-analysis of the information about the clinics declaring osteopathic healthcare delivery in public sources of the Internet, a protocol («Clinic’s passport») for collecting and grouping the data was elaborated. In total 163 sites of clinics were examined.Results. In St. Petersburg 243 medical organizations (including organizations which have branches) and three nonmedical organizations declared osteopathic healthcare delivery. Medical organizations in most cases have osteopath’s consulting rooms (88 %). At the same time in 17,2 % of clinics which declare osteopathic healthcare delivery, there are no osteopaths.Conclusion. In order to regulate the services of osteopathic healthcare delivery it is necessary to establish licensing of osteopathic medical activity.

Introduction. Back pain is the most frequent problem related to the musculoskeletal system. Chronic pain influences on the somatic and psychoemotional constituent of the patient’s health. In recent times great attention has been paid to the socio-psychological consequences of the treatment, to the patient’s well-being and life quality. It is important to evaluate the influence of osteopathic treatment on the life quality of patients presenting chronic vertebrogenic pain syndrome.Research objectives. To evaluate the influence of osteopathic treatment on the life quality of patients presenting chronic vertebrogenic pain syndrome.Research methods. Two groups of 20 patients each were formed in random manner. Patients from both groups presented chronic vertebrogenic pain syndrome of different localization. They were 30-60 years old, average age was 43,9±2,7 years. The experimental group consisted of 20 patients who received osteopathic treatment in addition to the medicamentous therapy (pregabalin if necessary). The control group was treated according to the standard scheme: medicamentous therapy (muscle relaxants, pregabalin), physiotherapeutic treatment, massage, exercise therapy. Osteopathic treatment was held once in 10-14 days, each patient had 3-4 consultations. The intensity of the pain syndrome was measured according to the visual analogue scale. The evaluation of the life quality was held with the use of SF-36 questionnaire.Results. Patients who received osteopathic correction presented more important reduction of somatic dysfunctions as well as honestly significant reduction of the intensity of the pain syndrome and improvement of the life quality in comparison with the patients who received only medicamentous therapy.Conclusion. The use of osteopathic treatment in combined therapy of patients presenting chronic vertebrogenic syndrome improves the treatment efficacy.

This paper presents a review of publications dedicated to the complex clinical management of patients older than 75 years of age who have had fractures of the proximal femur and presented signs of osteoporosis. Descriptive and analytical methods were used in the research. The work with the publications was performed by entering the relevant MeSH terms and subheadings in the search systems of databases. The study found that most researchers think that this problem still needs to be studied in the context of the search for effective clinical management strategies, including the surgical treatment as early as possible and the prescription of medications which influence bone remodeling mechanisms.

He research provides an overview of studies on osteosynthesis of proximal femoral nail antirotation (PFNA) with augmentation in patients with fractures of the femur on the background of osteoporosis. Descriptive and analytical methods were used in the work. The search for publications was made in the databases: Google Scholar, e-Library and Medline, as well as in Cochrane Consort library with the use of MeSh terminology. At the present time in order to obtain full evidence base on the benefits of using PFNA with augmentation in osteosynthesis of hip fractures on the background of osteoporosis it is necessary to conduct randomized controlled trials, despite the obvious advantages of this technology.

Introduction. Intracranial hypertension is diagnosed in 80 % of mature and almost in 100 % of premature children. The child’s brain especially in the first year of life is very sensible to the hypoxia of different genesis. That is why early diagnostics and treatment of this type of pathology in newborns is very important. The justification of the use of osteopathic treatment of this pathology is of current interest.Research objectives. To find the possibilities of osteopathic correction of somatic dysfunctions in combined therapy of intracranial hypertension in children under one year of age.Research methods. The results of the treatment of the intracranial hypertension were compared in two groups of children. Children from group № 1 (15 children) received medicamentous therapy and osteopathic treatment, which included restoration of the kinetics of the elements of the craniosacral system. Children from group № 2 received only medicamentous therapy. The treatment outcomes were evaluated according to the changes of the neurologic status, which considered presence of general cerebral and focal symptoms, growth of head circumference in comparison with the age norm, intensification of vascular pattern on the skin of the head, separation of cranial sutures.Results. It was found that the number of somatic dysfunctions and complexes of symptoms was reduced in a statistically significant manner in the group of patients who received osteopathic treatment in comparison with the patients from the control group.Conclusion. The research showed that osteopathic correction is effective and can be widely used in combined therapy of intracranial hypertension.

The research realized on 20 6-12 month old premature babies (gestation period less than 34 weeks) presenting perinatal encephalopathy showed good potential of combined therapy, which included pathogenetically substantiated physiotherapy (medical massage course and therapeutic exercises) and osteopathic treatment.

Introduction. In order to improve the effectiveness of rehabilitation treatment of children presenting delayed motor development, it is important to observe how somatic and neurologic dysfunctions influence each other and how they affect on the formation of motor skills in children. It is of current interest to justify methods of osteopathic diagnostics of somatic dysfunctions which can impede normal development of a child and methods of correction of these somatic dysfunctions by osteopathic techniques.The aim of the research. To evaluate clinical effectiveness of osteopathic supervision of formation of motor skills in babies presenting delayed motor development on the background of the perinatal damage of the nervous system. Methods. 70 3-9 month old babies presenting consequences of cerebral hypoxia-ischemia of the first-second degree, delayed motor development (F82) took part in the research. The babies were evaluated before and after osteopathic correction. In order to evaluate changes in the neurologic state and motor development there were used special tables for evaluation of neurologic states and a point scale for evaluation of progress in motor development.Results. Structure of somatic dysfunctions in babies presenting delayed motor development on the background of perinatal damage of the nervous system was identified. On the global level rhythmogenic disorders of the cranial rhythmical impulse were predominant. On the regional level the most typical somatic dysfunctions for this pathology were: somatic dysfunctions of the head region (46 %), of the duramatral region (32 %). On the local level somatic dysfunctions of the craniosacral system were the most frequent: dysfunctions of certain bones and cranial sutures (96 %), intraosseous lesion (78 %). After osteopathic treatment the number of changes in neurologic state had a coefficient of contingency with the number of somatic dysfunctions found, which makes evident the presence of strong feedback.Conclusion. The results obtained permit to recommend the use of osteopathic treatment together with the neurologic treatment in rehabilitation of babies.

Introduction. Psychic retardation and its correction in children is an important problem in children’s psychoneurology. It is necessary to extend the variety of treatment methods, also by means of osteopathy. The analysis of the cardiac rhythm vaiability gives information about the functional state of the body and permits to follow its dynamics.Research objectives. Evoluate the influence of osteopathic treatment on the functional state of children presenting psychic retardation (according to the data of the spectral analysis of the cardiac rhythm variability). Research methods. An osteopathic evaluation and an analisys of the cardiac rhythm variability were held in a group of children presenting psychic retardation (31 boys aged from 5 to 7) before and after three osteopathic consultations. The statistical data processing was held with the use of the Wilcoxon test.Results. All the children presenting psychic retardation had somatic dysfunctions and tension of the body’s regulating systems (according to the evaluation of the data of the cardiac rhythm variability). After the course of osteopathic treatment on the background of correction of somatic dysfunctions all the children presenting psychic retardation showed decrease of the tension of the regulatory systems. The vegetative balance was achieved and the body’s adaptive capabilities improved.Conclusion. The results of the research permit to recommend the use of osteopathic techniques in combined therapy of children presenting psychic retardation, as well as the use of the analysis of the cardiac rhythm variability for evaluation of the effectiveness of osteopathic treatment.

The article presents the results of the evaluation and treatment of 30 women of intellectual labour in the period of the annual report submission. The most frequent somatic dysfunctions in women of intellectual labour were identified and analyzed. The effectiveness of general osteopathic treatment of neurotic states in women of intellectual labour during the period of the annual report submission was proven.

Introduction. Alteration of the mobility of the sternum, decrease of the external respiration functions are most often due to two groups of diseases: chronic obstructive lung disease and degenerative dystrophic diseases of the spinal column. Patients presenting degenerative dystrophic lesion of the spinal column often address to osteopaths and manual therapists. It is important to justify the most effective method of osteopathic correction in treatment of this type of patients.Research objectives. To evaluate the effectiveness of the sternum mobilization technique according to the lung capacity indices, peakfluorometric index, chest excursion.Research methods. Patients aged from 20 to 45 took part in the research. They were divided into two groups regardless of sex. There were 15 people in each group. All the patients had regional biomechanical disorder of the sternum from 1 to 3 points with predominant structural constituent and all of them complained of discomfort in the thoracic region. Osteopathic correction of patients from the first (experimental) group included sternum mobilization technique with the use of the recoil methods during the first and the second consultation. In the control group the sternum mobilization techniques were not realized. The evaluation of the treatment results was held on the basis of the analysis of the spirometry data. Indices of the chest excursion, lung capacity and peakfluorometric index were evaluated.Results. It was proven that the sternum mobilization technique is effective and demonstratively increases lung capacity and peakfluorometric index. At the same time the sternum mobilization technique is not effective in respect of the chest excursion volume.Conclusion. Sternum mobilization technique can be recommended for using in osteopathy and manual therapy in order to improve the restrictive lung function.

The article describes the somatic dysfunction as a unity of structure and function, which can have reversible or irreversible alterations. The possible mechanisms of development of somatic dysfunctions on the local and regional levels are considered. The pathogenesis of somatic dysfunctions is presented as chain of adaptive, compensatory and decompensatory responses.

Background. Trained practitioners claim to identify the specific direction of superficial or deep lymphatic circulation using a non-invasive technique called Manual Lymphatic Mapping (MLM). MLM is a recent advance in manual therapy, a component of Lymph Drainage Therapy / Osteopathic Lymphatic Technique.Objective. Assess the potential of trained practitioners to palpate superficial lymphatic flow.Method. Each practitioner mapped the sole of the foot of a healthy volunteer, a region never previously studied. The results of the mapping were compared between trained and untrained practitioners and physiologic lymph charts. Results. Trained practitioners ( n =393) provided significantly more correct mappings (correct answers - 245) than untrained practitioners ( n =411, correct answers - 11), |2=329,54, p <0,05 and OR =60,20, p <0,05.Conclusion. Trained practitioners, but not untrained practitioners, mapped pedal flow by palpation, consistent with standard physiologic lymphatic maps. Flow studies, by imaging in individual subjects mapped by palpation, must further test this finding.

The article presents a full analysis of the normative base, which regulates legal matters of the supplementary vocational education in the specialty «osteopathy». Types of responsibility of educational institutions for the infringement of rules of law during the organization of the teaching process are considered.