Legislative framework of the Russian Federation. Examination room

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ORDER of the Ministry of Health of the Russian Federation dated 12-09-97 270 ON MEASURES TO IMPROVE THE ORGANIZATION OF ONCOLOGICAL CARE TO THE POPULATION (2019) Relevant in 2018

REGULATIONS ON THE EXAMINATION OFFICE OF AN OUTPATIENT POLYCLINIC INSTITUTION

1. Examination room<*>is organized in accordance with the established procedure in an outpatient institution, as an independent unit or structural unit of this institution and operates in the mode of an institution.

2. The office is located in a separate room with good lighting, equipped with special equipment and tools.

3. Work in the office is carried out by an average medical worker who has undergone special training in oncology and has an appropriate certificate.

4. Management and control over the activities of the office, the work and level of professional training of specialists is carried out by the head of the structural unit, which includes the examination room, in his absence - the deputy chief physician for medical work.

5. The methodological management of the work of the office is carried out by the district oncologist, and in the absence of such, by the oncologist of the territorial oncological dispensary.

6. The office carries out:

Pre-medical survey of patients;

Conducting a preventive examination of patients who applied for the first time during the year to an outpatient clinic for the early detection of chronic, precancerous and neoplastic diseases of visible localizations;

It is mandatory to take smears from the cervical canal and cervix from all women who contact the office and send them to the cytology laboratory for examination;

Referring persons with identified pathology to the appropriate specialist to clarify the diagnosis and organize treatment;

Accounting and registration of ongoing preventive examinations and results of cytological studies according to established forms of primary medical documentation;

Carrying out sanitary educational work among citizens visiting the clinic.

Note:

Preventive examination of women includes examination of the skin and visible mucous membranes, examination and palpation of the mammary glands, examination and palpation of the thyroid gland, examination and palpation of the abdomen, peripheral lymph nodes, speculum examination of the cervix and vagina, bimanual examination of the uterus and appendages, digital examination of the rectum intestines for women over 40 years of age and in the presence of complaints.

Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the external genitalia, the area of the mammary glands, thyroid gland, abdomen, peripheral lymph nodes, digital examination of the rectum and the prostate gland.

Head of Department
medical organization
assistance to the population
A.I.VYALKOV
Head of Department
maternal and child health
D.I.ZELINSKAYA

Nevertheless, the role of some environmental and internal factors that directly affect the development of cervical pathology has already been firmly defined. It has been proven that precancer, and subsequently cervical cancer, is formed against the background of benign (non-tumor) disorders of the stratified squamous epithelium (erosion, polyps, leukoplakia), against their background, true precancerous diseases - dysplasia, as well as initial forms of cervical cancer can develop. But the key concept in the etiology of the pathogenesis of dysplasia and cervical cancer is undoubtedly the viral hypothesis. The WHO fact sheet dated 07/09/96 officially confirmed that HPV is the cause of cervical cancer. A common feature of diseases of the breast and cervix is a long course and the presence of foci of atypical tissue growth from which cancer can arise.

Job responsibilities

Conduct an examination of all women who applied for the first time during the year to the clinic, regardless of age and nature of the disease.
Refer women with identified pathology or suspected disease to an obstetrician-gynecologist.
Provide the office with the necessary instruments and medications.
Observe the principles of deontology in your work.
Participate in carrying out sanitary education work among women.
Systematically improve their skills by studying the relevant literature, sites in conferences, seminars.
Submit timely reports on the work done to the medical statistics office.
Maintain necessary office medical documentation.

Attention

The midwife in the examination room uses all available examination methods: questioning, inspection, palpation, bimanual examination, cytological examination. These methods do not compete with each other, but complement each other. Careful examination, oncological alertness and knowledge allow the midwife to detect precancerous diseases and cancer.

Important

Before the examination, the midwife conducts a survey, paying attention to menstrual irregularities, the presence and appearance of pain and atypical bleeding during the intermenstrual period and during menopause. When examining the mammary glands, you can identify cracks, weeping, retraction of the nipples, asymmetry of the mammary glands; upon palpation - a formation in the form of a dense node, enlargement of the axillary lymph nodes. An important stage in the work of a midwife in the examination room is a gynecological examination.

Info

Bibliographic description: Pipko O. G. [Text] // New tasks of modern medicine: materials of the III International. scientific conf. (St. Petersburg, December 2014). - St. Petersburg: Zanevskaya Square, 2014. - pp. 5-7. - URL https://moluch.ru/conf/med/archive/153/6693/ (access date: 04/20/2018). If women between 30 and 50 years of age could be persuaded to undergo screening after 3 to 4 months, one could be confident that advanced forms of cancer would not exist, that surgery would provide the greatest benefit, and that recurrences would become rare.

V. F. Snegirev Cancer is a serious disease that claims many lives. Treating cancer is challenging and often causes poor outcomes because the disease is detected too late.

The role of the midwife in the examination room in the early detection of cancer

State Budgetary Institution "Republican Oncology Dispensary"
Operating procedure of the examination room
The role of the midwife in the examination room in the early detection of cancer
How to write an examination by a midwife in an examination room

State Budgetary Institution "Republican Oncology Dispensary" I. General part The main tasks of the midwife in the examination room are the early detection of gynecological, pre-tumor and cancer diseases of the female genital organs and other visible localizations (skin Lips, mammary glands) among visitors to the clinic from among the population living in the area where the clinic operates , as well as workers and employees of attached enterprises.
If a malignant neoplasm is suspected, an examination room alert form is filled out and sent to the primary oncology department. Analysis of the work of examination rooms in city clinics. Tver revealed the following results: 2400 women were examined in patients in the age group up to 30 years and 30–40 years for breast diseases (0.8%); cervix (1.0%); in the group from 50–60 years old and 60–70 years old, diseases of the mammary glands (6.2%); cervix (0.4%). All patients were referred for further examination. The number of cases of breast disease (75%) of the total number examined among the unorganized population is noteworthy.
This fully confirms that preventive examinations performed by a midwife at the outpatient stage have an important role in identifying patients with various pathological conditions.

How to write an examination by a midwife in an examination room

The listed locations of precancerous conditions of the breast and cervix are easily accessible for examination. This is a real prerequisite for detecting cancer at the earliest stages of development. Most cancer patients could be cured if the disease could be diagnosed early and treatment started immediately.

The reason why patients seek medical help late is the absence of pronounced clinical symptoms in the early stages of the disease, an inattentive and negligent attitude towards their health. The question arises of how to capture a malignant tumor during a period when it does not manifest itself in any way. The answer is clear - it is necessary to ensure active detection of malignant tumors by conducting preventive examinations among people who feel practically healthy.

Timely detection and treatment of patients in the early stages of the disease still remains an urgent task for the country's oncology service. Every year, the world experiences an increase in the incidence of cancer. In recent years, the number of cancer cases has increased to 14.1 million cases; deaths increased to 8.2 million.

Between 2008 and 2012, 32.6 million patients were diagnosed with cancer. According to world statistics, breast cancer ranks first among cancer diseases in women - 16% of all cancer cases. 1,250,000 cases of breast cancer are diagnosed annually. Breast cancer is the most common cause of death in women with cancer (522,000 cases).

Today, every fourth woman with cancer suffers from breast cancer.
The midwife of the examination room in her activities is guided by this Regulation, the Regulations on the examination room for women and other official documents, as well as orders and instructions of higher organizations and officials. II. Job responsibilities.2.1. The main task of the midwife in the women's examination room is to conduct a preventive examination of women. In accordance with the main task, the midwife carries out: 2.2. Collecting an obstetric and gynecological history and recording it in the anamnestic chart.2.3.
Examination of all women over 18 years of age who applied for the first time during the year to an outpatient clinic. 2.4. Examination of the skin, palpation of the mammary glands, referral of women over 35 years of age to mammography once every 2 years.2.5. Bimanual vaginal examination, examination of the cervix in speculums, in girls over 15 years of age - digital examination through the rectum (according to indications). 2.6.

Women's examination rooms began to be created in the Russian Federation from the early 60s of the twentieth century; they are structural divisions of clinics. Thanks to their activities, the proportion of actively identified malignant pathology of the cervix among all registered patients reached 40%. According to federal reports, there are 3,174 examination rooms operating in Russia.

The main task of the midwife in the examination room is to examine women in order to identify tumor and pre-tumor diseases. These are mainly people from the unorganized population, which is especially important, since among them there are often elderly and elderly women, especially at risk of cancer. The examination rooms are staffed by experienced, specially trained midwives who participate in regular training.
Appendix N 17 to the Order of the Ministry of Health of the USSR dated May 30, 1986 N 770 SAMPLE JOB DESCRIPTION FOR A MIDWIFE IN THE WOMEN'S EXAMINATION ROOM OF THE PREVENTION DEPARTMENT (OFFICE) OF OUTPATIENT POLYCLINIC INSTITUTIONS (UNITS) I. General provisions.1.1. A person with secondary medical education is appointed to the position of midwife in the women's examination room in accordance with the current rules for admission to medical practice.1.2. The midwife is hired and fired by the head of the medical institution.1.3. The midwife in the women's examination room reports to the head nurse of the prevention department and works under the general supervision of the head. department of prevention and methodological guidance of an obstetrician-gynecologist.1.4.
Rights. The midwife of the women's examination room has the right: 3.1. Require those undergoing preventive examination and junior office staff to comply with internal regulations. 3.2. Consult an obstetrician-gynecologist.IV. Responsibility.4.1. The listed locations of precancerous conditions of the breast and cervix are easily accessible for examination. This is a real prerequisite for detecting cancer at the earliest stages of development. Most cancer patients could be cured if the disease could be diagnosed early and treatment started immediately. The reason why patients seek medical help late is the absence of pronounced clinical symptoms in the early stages of the disease, an inattentive and negligent attitude towards their health.

Approximate position

On the organization of the work of the examination room of an outpatient clinic in the Irkutsk region

Chapter 1. General provisions

1. This Approximate Regulation determines the organization of the activities of the examination room of an outpatient clinic in the Irkutsk region.

2. An examination room is created in an outpatient clinic to conduct a preventive examination of citizens, the initial division of citizens into healthy ones and those requiring examination on suspicion of a precancerous disease or a malignant tumor of external localization and their referral with identified diseases for further examination and rehabilitation to doctors of relevant specialties.

^ Chapter 2. Functions of the examination room

3. The examination room carries out:

A) pre-medical survey of patients

Note :

Before starting to examine the patient, the medical professional conducts a brief survey, paying attention to the appearance of weakness, fatigue, loss of appetite, pain in the abdomen or lumbar region, or in the mammary gland. The appearance of these signs may indicate cancer of the stomach, ovaries and breast in a woman, etc.

The medical worker finds out whether the patient has “wounds” in the mouth, sharp edges of broken teeth that injure the tongue and mucous membrane of the oral cavity; are there any increasing birthmarks or moles, skin ulcerations; Is there any discharge from the nipples? During the survey, attention should be paid to disturbances in the menstrual cycle in women, the presence and appearance of pain and atypical bleeding during the intermenstrual period and during menopause. The presence of constipation is also noted, alternating constipation with diarrhea, mucus and blood discharge from the rectum, an increase in the abdomen, and a decrease in the amount of urine.

When conducting a survey in the clinic, the medical worker in the examination room enters the obstetric and gynecological history into the anamnestic chart;

B) conducting a preventive examination of patients who applied for the first time during the year to an outpatient clinic for the early detection of chronic, pre-tumor and tumor diseases of visual localizations

Note :

Preventive examination of men includes examination of the skin and visible mucous membranes, examination and palpation of the external genital area, breast area, thyroid gland, abdomen, peripheral lymph nodes, digital examination of the rectum and prostate area;

C) mandatory collection of smears from the cervical canal of the cervix from all women who contact the office and sends them to the cytology laboratory for examination (material for examination is collected with special cervix brushes)

Note :

For examination, the patient must undress completely.

^ Oral examination . The examination begins with the oral cavity. Using a spatula, examine the mucous membranes of the lips, cheeks, gums, and tongue. To examine the tongue, take its tip with a gauze pad and pull it outward. The purpose of the examination is to detect leukoplakia, cracks, and ulcerations of the mucous membrane.

Leukoplakias appear as white, rough plaques or dense white plaques that rise above the surface of the smooth, pink mucosa. More often they are located on the mucous membrane of the cheeks. Cracks and ulcerations occur on the lateral surfaces of the tongue, on the red border of the lower lip closer to the corner of the mouth, as well as in those areas of the oral mucosa that are constantly injured by the sharp edges of broken teeth and poorly fitted dentures. Easy vulnerability and bleeding of these areas is suspicious for the presence of precancerous diseases.

^ Examination of the skin . The medical worker sequentially examines the skin of the face, head, neck, torso and extremities in order to identify pigmented warts and nodular formations, ulcerations.

You should pay attention to the presence of long-term hyperemic areas of the skin with a rough surface and a tendency to ulceration, which are located in areas of the body exposed to irritating factors: friction with the edges of clothing, exposure to sunlight, chemicals, etc. Over time, nodular and warty formations may appear in these places. The most common location of precancer and cancer is the skin of the face.

A great danger for the presence of a malignant pigmented tumor of the skin - melanoma - are dark and bluish-purple spots and nodular formations that rise above the surface of the skin, prone to enlargement and ulceration. Such formations are often found on the skin of the abdomen, back, and lower extremities.

^ Palpation of lymph nodes . The healthcare professional palpates the peripheral lymph nodes in sequence: cervical, supraclavicular, axillary and inguinal. Palpation of the cervical and supraclavicular lymph nodes is carried out with the patient standing or sitting. In this case, the medical worker stands behind the patient. Palpation is carried out with both hands, with four fingers of each hand examining the cervical and supraclavicular areas, and the thumbs are located on the lateral surfaces of the neck. Palpation of the axillary lymph nodes is performed separately on each side. In this case, the medical worker stands in front of the patient, placing her hand on his shoulder from the examination side. The inguinal lymph nodes are palpated with the patient lying on the couch.

Normally, small lymph nodes of elastic consistency can be detected. Lymph nodes are a barrier to the spread of the malignant process. In them, metastases of tumors of various localizations can be detected first. Lymph nodes affected by metastases are dense, often immobile formations of varying sizes. In some cases, enlarged lymph nodes may be a manifestation of lymphogranulomatosis or leukemia - systemic diseases that affect the entire lymphatic system.

^ Palpation of the thyroid gland . Palpation of the thyroid gland can be done while standing in front or behind the patient. When the medical worker is positioned behind the patient, palpation is carried out with both hands, four fingers of both hands, with the thumbs located on the lateral surfaces of the neck. When the medical worker is positioned in front of the patient, palpation is performed with the thumbs of both hands, while the remaining fingers are located on the lateral surfaces of the neck. During palpation, the patient should be asked to make a swallowing movement. This clearly reveals the size and consistency of the thyroid gland.

The thyroid gland is located at the level of the laryngeal cartilages and normally does not contain compactions or tumor formations. In the presence of precancerous diseases and tumors, diffuse or local compaction and asymmetry of the gland are noted due to an increase in its right or left lobe.

^ Examination of the mammary glands . Examination of the mammary (breast) glands includes examination and palpation of them. When a medical professional examines the mammary glands, the patient should raise his hands and place them behind his head. Pay attention to the size and shape of the mammary (mammary) glands, the condition of the skin, nipples, and areola. Each gland is examined separately by placing the patient in a semilateral position and asking him to raise his arm. Changes are easier to detect when comparing one gland with another. Normally, the mammary (breast) glands have the same size and shape. The nipples are on the same line. Cracks, weeping, crusts, retraction and fixation of the nipple, skin resembling a lemon peel should be considered as signs of a malignant disease.

Palpation of the mammary (mammary) glands is always carried out in two positions of the subject: standing and lying down. They pass a “flat” palm over the mammary (breast) gland and feel it with their fingers to identify lumps and nodes in the breast tissue.

You need to feel the mammary (breast) glands carefully, sequentially examining each area. It is more convenient to examine large saggy breasts in a lying position, turning the patient slightly, first on one side and then on the other. By lightly pressing on the nipple, the healthcare professional should determine whether there is any abnormal discharge from the nipple.

Normally, the mammary glands are soft and do not contain any lumps. Malignant tumors are defined as dense, well-demarcated nodules or indurations without clear boundaries, often accompanied by nipple retraction and skin fixation. With proper palpation, tumors up to 1 cm in size can be detected. For large mammary (breast) glands, in which it is difficult to detect a tumor by palpation, it is advisable to refer the patient for mammography (ultrasound).

^ Examination and palpation of the abdomen . Examination of the abdomen is carried out with the patient standing and lying down, palpation is carried out while lying on the couch. You should pay attention to the size and shape of the abdomen, and the condition of the navel. An enlarged abdomen and its flattened shape may be signs of ascites. Upon palpation, tumor formations can be detected in the upper or lower abdomen, as well as in the navel area.

^ Examination of female genital organs . On a gynecological chair in good lighting, the vulvar mucosa is examined. Palpation of the external genital organs is also carried out. A whitish color and dryness of the vulvar mucosa with a tendency to form cracks, as well as atrophy of the labia minora, are characteristic of kraurosis. Leukoplakia is detected in the form of white, rough plaques and plaques. These changes in the vulvar mucosa are considered precancerous diseases. Ulceration of the mucous membrane with thickening of the tissue may be a sign of vulvar cancer.

^ Inspection using mirrors . The cervix is exposed with Sims spoon-shaped speculums and elevators. During examination, the size, shape of the cervix, the condition of its mucosa and the mucous membrane of the vaginal walls are determined. The presence of a border or foci of hyperemia around the external os of the cervix is designated as “erosion.” The detection of white plaques and plaques indicates leukoplakia. Upon examination, formations resembling cauliflower, characteristic of cervical cancer, may be detected.

^ Taking smears for cytological examination . During the examination of the cervix, smears are taken for cytological examination. From all women, regardless of the condition of the cervical mucosa, smears are taken using the superficial scraping method, which is performed with an Eyre spatula. The Eyre spatula is inserted with a longer “horn” into the cervical canal, and a circular movement is made with the spatula in a clockwise direction. Taking material from the cervix should be gentle, without traumatizing the tissue. The resulting material is applied in a thin layer to one glass slide and evenly distributed over the surface with the same spatula. An air-dried smear indicating the woman’s name with a formalized referral must be sent to the cytology laboratory on the same day.

^ Bimanual gynecological examination . During a two-manual gynecological examination, the midwife should pay attention to the size and shape of the cervix, its density, size, shape, consistency and mobility of the uterus, the position of the uterus in the pelvis; the condition of the appendages, the presence of seals and tumors near the walls of the pelvis.

An enlarged and dense consistency of the cervix, displacement of the uterus towards one of the pelvic walls and limited mobility, shortening and thickening of the vaginal vaults may be signs of cervical cancer. An enlarged uterus and an uneven, knotty surface are usually characteristic of fibroids. Tumor formations in the area of the appendages and in the posterior vaginal fornix are always suspicious for the presence of ovarian cancer.

^ Examination of the rectum. Digital examination of the rectum is mandatory when examining patients in the examination room. It can be performed with the patient positioned on a gynecological chair (couch). For rectal examination, a fingertip is used, which is placed on the index finger. Any changes in the intestinal wall - compactions, nodular formations, as well as traces of blood on the glove, should be regarded as a serious pathology suspicious for cancer;

D) referral of patients with identified pathology to a medical specialist to clarify the diagnosis and organize treatment

Note :

If the patient has not had a chest x-ray or fluorography performed in the current year, the medical professional will give him a referral for a fluorographic examination.

The task of a medical professional is not to establish an accurate diagnosis of the disease. He should only suspect pathology and refer the patient to a doctor for an in-depth examination.

If there are pathological changes in the female genital organs, the patient is referred for further examination to the antenatal clinic. If pathology of the skin, oral cavity, thyroid gland, lymph nodes, mammary (breast) gland and rectum is detected, the medical worker refers patients for examination to a surgeon at a city (district) clinic. Having discovered obvious tumor formations of any organ, a medical professional must refer the patient directly to an oncologist (to an oncology clinic). In the referral issued to the patient, the medical professional indicates the presumed diagnosis for targeted further examination, as well as the address of the institution where the patient is referred. To ensure that the patient independently requests additional examination, it is necessary to clearly explain the importance of qualified medical supervision.

A medical worker must know exactly which medical institution needs to send a patient with a particular pathology for further examination, and who in this institution is responsible for this section of work;

E) accounting and registration of ongoing preventive examinations and results of cytological studies according to established forms of primary documentation

Note :

The results of the examination are recorded in the daily intake log. The following columns are filled in the log: serial number on the day of admission, last name, first name, patronymic of the patient, age, address. In the following columns, the results of the examination of all localizations to be examined in the examination room are noted; skin, oral cavity (this includes examination of the lower lip and tongue), lymph nodes, thyroid gland, mammary (mammary) glands, genitals and rectum. Separate columns are allocated for marking the taking of smears from the cervix, the tentative diagnosis of a medical worker and the specified (medical) diagnosis.

Patients who have been examined in the examination room, if there is no pathology, are given a coupon indicating the date of the examination, which the patient must present to the doctor or the receptionist for pasting into the outpatient card. If a pathology is detected, it is advisable to mark the ticket in red.

Registration of the results of preventive examinations should be reflected in the file cabinet. The fundamental importance of the card index in recording the results of the inspection is that it allows:

A) visually control the number of women who were examined out of the total number of those subject to examination;

B) actively call women for preventive examinations and at the same time regulate the flow of attendance in the examination room;

C) monitor and compare the results of annual preventive examinations using maps to identify visual locations of cancer.

The examination room file is created based on a list of women 30 years of age and older living in the clinic’s service area and subject to examination. Lists are compiled by local nurses or the medical community in contact with the prevention department. The cards are stored in the examination room in special boxes or cabinets, arranged by area in alphabetical order. Checking the payroll and replenishing cards for women over 30 years of age should be carried out annually.

Cards are divided into two main groups:

A) cards of patients who were not examined this year;

B) cards of those who were examined this year.

It is advisable to divide the cards of examined patients into two groups:

A) cards of those who have no pathology identified;

B) cards of those who have been diagnosed with pathology.

In this group, cards with a verified, “clarified” diagnosis are highlighted. When cancer is detected, they are marked in red.

At the beginning of each year, all cards should be listed under the heading "to be examined", with the exception of cards of those patients who have previously been diagnosed with cancer. These patients are subject to observation by an oncologist.

Using a card index, a medical worker monitors patients' visits to the examination room. In case of a bad visit, he informs the local doctor about this and invites patients for examination by phone or postcard. In such cases, the active call is recorded on the front side of the card.

At the end of the working day, a summary of the work done is compiled based on the cards.

The records of patients whose pathology was not detected during examination are transferred to the group of those who underwent examination in the current year. In these cards, after receiving the conclusion from the cytological laboratory, a note is made on the results of the study.

If a pathology is detected, the card is moved to a special box. Using these cards, the medical worker controls the patients' visits to the doctor. After the doctor has clarified the diagnosis, the final diagnosis is written on the front side of the card. If patients live in the clinic's service area but are not registered in the card index, the medical worker must fill out cards for them. The results of the examination of women under 30 years of age are recorded in a journal.

A referral for cytological examination during the initial preventive examination is issued on a white form, and for repeated examinations - on a colored form. A repeat preventive examination is considered to be an examination performed one year after the initial one.

The result of the cytological analysis comes from the laboratory to the examination rooms, and medical workers mark it in the card of the examination room (if there is a card index) or in a journal.

If the answer is “erosion”, “inflammation”, “mild dysplasia”, “moderate dysplasia” and other non-tumor processes, the conclusion is sent by a medical professional to the antenatal clinic. With a cytological conclusion of “severe dysplasia”, “suspicion of cancer” and “cancer”, the tests are transferred from the examination room to the antenatal clinic or oncologist (to the oncology clinic). Cytological conclusions “cytogram without features” are transferred by a medical worker to the clinic’s reception desk for inclusion in outpatient records;

E) carrying out sanitary educational work among citizens visiting an outpatient clinic

Note :

To do this, local doctors and specialists of various profiles at appointments, as well as in lectures and conversations for the population on various issues, should explain to patients the importance of preventive examination in the examination room in view of the asymptomatic course of initial malignant tumors and precancerous diseases, the treatment of which prevents the development of cancer. An important role in explanatory work about the importance of preventive examinations belongs to the employees of the office for promoting a healthy lifestyle, the prevention department (office) of outpatient clinics.

It is advisable to highlight the tasks and meaning of the work of the examination room in a health education bulletin, which is posted on the floor of the clinic where the main appointment is conducted. In the hallways of the clinic, on the tables there should be reminders and brochures about the early diagnosis of cancer and the appointment of an examination room.

^ Chapter 3. Organization of work of the examination room

4. The examination room is located in a separate room with good lighting, equipped with equipment and tools in accordance with the equipment standard.

5. Activities in the examination room are carried out by an average medical worker who has a diploma and certificate in the relevant specialty and has been trained in oncology.

7. To ensure maximum preventive examination of patients, the examination room should operate throughout the full working day of the outpatient clinic, i.e. in two shifts.

In the staffing schedule of an outpatient clinic, it is recommended to provide for two rates of medical workers who should work in shifts.

8. Preventive examination in the examination room should be widespread.

9. Management and control over the activities of the examination room is carried out by the head of the structural unit that includes the examination room, and in his absence - by the deputy chief physician for medical affairs.

The methodological management of the work of the office is carried out by the district oncologist, and in his absence, by the oncologist of the oncology clinic located on the territory of the municipality of the Irkutsk region.

10. Attendance in the examination room is ensured by:

A) the availability in the outpatient clinic of information about the need for a preventive examination in the examination room, for which notices about the need for examination should be posted in an accessible place (next to the registry, in the self-registration room, in the prevention department and in the halls where patients are waiting to see a doctor) in the examination room, its location and opening hours;

B) obligatory referral of patients of an outpatient clinic to an examination room (registration workers, the prevention department, local doctors and doctors of various specialties are recommended to refer all patients (women 18 years of age and older) who initially applied to an outpatient clinic in the examination room for examination current year; district nurses and nurses working with doctors of various specialties when preparing outpatient cards for appointments must pay attention to the presence of a mark on the examination in the examination room and send patients who do not have such a mark in the outpatient card to the examination room);

C) actively calling patients for examination in the examination room.

11. In order to control attendance and workload of the examination room:

A) statisticians of an outpatient clinic once a quarter provide the manager with information on the number of patients who initially applied and compare it with the number of patients examined in the examination room (the percentage of those examined from the number of first-time visitors characterizes the coverage of patients with preventive examinations in the examination room);

B) employees of the registry and the office for centralized registration of the annual medical examination of the prevention department of an outpatient clinic institution once a year check the referral of patients to the examination room based on the marks in the outpatient cards and the dates of application to the outpatient clinic institution);

C) the head of the department (office) for outpatient prevention
the outpatient facility monthly checks the documentation of the examination room;

D) the manager (chief physician or his deputy for medical affairs) weekly hears information from local doctors about sending patients to the examination room in the districts.

^ Chapter 4. Populations of patients to be examined

12. The risk of developing malignant tumors of all locations increases with age. However, it should be remembered that in patients under 30 years of age, pretumor and background diseases are often found, and malignant tumors can also occur. Therefore, at present, patients over 18 years of age are subject to referral to the examination room.

Particular attention should be paid to attracting to the examination elderly women who are under dispensary observation in this outpatient clinic for various somatic diseases: hypertension, diabetes mellitus, glaucoma, chronic gastritis, etc. This contingent of women, due to their age, decreased reactivity organism and disturbances of hormonal and metabolic processes are most at risk for the occurrence of malignant tumors.

13. Patients with acute processes, severe pain, high fever, and diseases requiring emergency care should not be sent to the examination room. Such patients should undergo examination in the examination room after acute symptoms have subsided and the temperature has dropped. Women who are being treated by a gynecologist and who refuse to visit the examination room must submit a corresponding certificate.

^ Chapter 5. Clarification of diagnoses (reconciliation of identified pathology)

14. The effectiveness of the examination room is assessed based on the final diagnoses. Clarification of diagnoses (reconciliation of identified pathology) is carried out by a medical worker in the examination room once a month. To do this, the medical worker compiles a list of patients with identified pathology, indicating the last name, first name, patronymic, age and address, as well as the intended diagnosis established by the medical worker in the examination room (including cytology) and leaves room for entering a more precise diagnosis.

15. The lists include women:

A) with suspicion of malignant neoplasms of various localizations;

B) with precancerous diseases, targeted and diffuse compactions in the mammary (breast) glands of “mastopathy”, leukoplakia of the oral cavity, rectal polyps; in women, “erosion” of the cervix, polyps, leukoplakia, kraurosis of the vulva, tumor-like formations of the uterine appendages (“cysts”);

B) with benign tumors; uterine fibroids, lipomas of any location, enlarged thyroid gland.

16. Lists are compiled separately for patients referred to the antenatal clinic or to doctors at an outpatient clinic (surgeon or oncologist). If patients are sent directly to the oncology clinic, a separate list is also compiled for them.

17. The lists of identified pathologies do not include patients registered at the antenatal clinic or being treated for precancerous diseases or benign tumors.

18. Lists of women with identified pathology are transferred to the antenatal clinic to the senior midwife, men - to the oncology office of the outpatient clinic.

The list is a document that ensures continuity between the medical worker in the examination room and the doctors conducting further examination and treatment of patients in need. In order to timely call the patient to the antenatal clinic, outpatient clinic or oncology clinic, these lists must be transmitted at least once a month. No later than a month later, when submitting the next new list, the medical worker must receive the previous one indicating the final diagnoses.

19. Medical institutions that have received lists of patients from the examination rooms assigned to them are obliged to involve the patients indicated in the list for further examination and sanitation as soon as possible. By the end of the month, the date of the patient’s request for further examination and the updated diagnosis should be included in the list. By the end of the year, all patients referred by a medical worker in the examination room for further examination must be further examined and sanitized.

20. Actively attracting patients for further examination, patronage, telephone calls, as well as entering updated diagnoses into the lists of the examination room kept by the senior midwife and oncologist are the responsibility of medical workers in the local network. The same applies to additional examination of patients referred to an outpatient clinic to a surgeon, oncologist or to an oncology clinic.

21. It is necessary to provide patients who independently apply to a antenatal clinic or outpatient clinic in the direction of an examination room with a doctor’s appointment on the day of application.

22. The doctor must:

A) carefully examine such a patient;

B) if indicated, provide them with the necessary examination;

C) in the absence of pathology, reassure the patient without undermining the authority of the medical worker in the examination room, and emphasize the need for preventive examinations in the future;

D) note in the outpatient card that the patient was referred from the examination room.

23. Based on the final medical diagnoses, as well as his own documentation, once a month, a medical worker in the examination room summarizes the digital results of the work performed, indicating the number and age composition of those examined (primary and repeat), the number of cytological studies performed, while the number of patients with different pathological conditions are indicated only for specified diagnoses.

When drawing up a report, it is also necessary to indicate the number of patients with identified pathology who were left without further medical examination. The medical worker in the examination room checks the requests of patients referred to them to specialists according to the lists submitted to them at the antenatal clinic, outpatient clinic, and oncology clinic.

24. Quarterly, the medical worker in the examination room draws up a report on all indicators for the head of the outpatient clinic and the district oncologist. Issues regarding the operation of the examination room should be discussed twice a year at medical and nursing conferences.

^ Chapter 6

25. An analysis of the work of the examination room is carried out jointly with the head of the outpatient clinic, an obstetrician-gynecologist and an oncologist of the district or region.

26. To characterize the work of the examination room, it is recommended to use the following indicators:

A) attendance examination room, which is expressed by the number of patients examined during the reporting period and depends on the daily load of the examination room. If all modern requirements for the work of a medical worker in an examination room are met, the standard of work for a medical worker is calculated at the rate of 5 people per hour. When analyzing attendance, you should pay attention to the age composition of patients examined in the examination room, given that malignant tumors occur mainly in patients 30 years of age and older;

B) an important indicator of the work of the examination room is the ratio, expressed as a percentage, of the number of patients examined by a medical worker in the examination room to the number of patients who first applied to the outpatient clinic in the current year. In addition, it is important to define preventive screening coverage in the examination room of patients 30 years of age and older living in the service area of the outpatient clinic;

IN) volume of use of the cytological method is determined by the percentage of women from whom smears for cytological examination were taken during examination to the total number of those examined. This indicator to a certain extent characterizes the quality of the examination, since cytological examination helps to identify early forms of cervical cancer;

D) an important indicator of the performance of both the examination room and the medical institutions where patients are sent for further examination is the percentage of patients involved in further examination, since this indicator ultimately determines the results of the examination room;

D) an indicator of the qualifications of medical workers examination rooms can serve percentage of confirmed or changed diagnoses . If there are a large number of unfounded referrals of patients for further examination or omissions in the diagnosis of malignant tumors, the question of increasing the professional knowledge of the medical worker should be raised;

E) the main criterion for the operation of the examination room is detection of precancerous diseases and cancer . This indicator is expressed by the percentage of patients with precancerous diseases and cancer of various localizations identified in the examination room during the reporting period, in relation to all patients who underwent examination;

G) another important indicator of the operation of the examination room is percentage of active cancer detection , which is determined by the number of patients identified in the examination room in relation to all patients with cancer of a given localization, registered for the first time in the current year.

^ Chapter 7. Training and advanced training of medical workers in examination rooms

27. The quality performance of examination rooms depends on the experience of the medical worker, his special knowledge and oncological alertness. Therefore, in order to conduct a qualified, meaningful and targeted preventive examination, medical workers in examination rooms must undergo preliminary training in a specialized oncological institution.

28. It is advisable to carry out primary training in the form of a five-day seminar with lectures on the diagnosis of cancer of various visual localizations, in an examination room with a demonstration of patients of the corresponding profile and examination techniques. This form of primary training, despite the short duration, is more effective than the presence of medical workers at the workplace in an oncological institution. Both forms of training can be used to improve health care workers in examination rooms.

29. Training at a seminar or on the job does not exclude the need to improve the knowledge of health workers on a daily basis. An oncologist or oncogynecologist of a district or region should conduct methodological classes with medical workers in examination rooms to discuss diagnosis, examination, results and shortcomings of work. At these classes, it is advisable to instruct medical workers in examination rooms to prepare reports on various topics, and invite doctors of various specialties as co-speakers. It is advisable to periodically conduct a “School of Excellence” on the basis of the best institutions in the region.

30. Along with increasing professional knowledge, medical workers in the examination room must master the basics of medical deontology. Medical workers need to be daily taught responsibility for the work they do, a conscientious attitude to work and a polite, attentive and caring attitude towards patients.

This is a medical premises as part of a medical center, antenatal clinic, and clinic. The purpose of his work is to provide diagnostic, therapeutic and preventive assistance to girls, young women, and women. It is usually equipped with modern equipment, which allows for high-level diagnosis and treatment of gynecological diseases. Modern chairs, electrically adjustable chairs, create comfort for both the patient and the doctor.

The main task of the women's examination room at the clinic is to conduct a preventive examination. Particular attention should be paid to attracting elderly patients to the examination who are at risk of developing malignant tumors and who are under dispensary observation in this clinic for various somatic diseases. Patients with acute processes, severe pain, or high fever should not be sent to the examination room; with diseases requiring emergency care. Women who are being treated by a gynecologist and who refuse to visit a gynecological examination room must submit a corresponding certificate.

EQUIPMENT AND EQUIPMENT

2. Medical couch

3. Sighting lamp

4. Colposcope

5. Germicidal lamp

6. Gynecological instruments

7. Medicines and drugs

COMPOSITION OF THE GYNECOLOGIST'S OFFICE

Its main components are a room for a consultative conversation and the examination room itself - the examination room. In the consultation room, a preliminary conversation between the doctor and the patient takes place, collecting anamnesis, filling out an outpatient card, drawing up an examination and treatment plan. After a preliminary consultation, further examination is carried out by a gynecologist in the examination room.

In the examination room they do (subject to conditions, depending on the type of medical institution):

general medical examination (weighing, measuring height, measuring blood pressure, temperature, examining the mammary glands),
full gynecological examination,
taking tests (smears, PCR, cultures, cytology, biopsy),
colposcopy,
insertion and removal of the IUD,
therapeutic manipulations (treatment of the cervix, removal of condylomas, sanitation of the vagina, etc.).

Examination rooms. Their types and tasks

The main task of examination rooms is to conduct a preventive examination of men over 30 years of age, and women over 18 years of age (due to the high percentage of inflammatory and background gynecological diseases in this age group) for the purpose of early detection of malignant tumors and precancerous diseases of visual localizations (external genitalia , mammary gland, thyroid gland, rectum, lips, oral organs, skin, peripheral lymph nodes). These organs are accessible to inspection and palpation, and can also be examined using the cytological method. Tumors of external localizations, which can be detected during preventive examinations, account for 30% of all malignant tumors in people of both sexes and almost 40% in women. The recommended frequency of visiting the examination room for women is once every 2 years, for men - once every 3 years.

Preventive examination of women in the examination room includes the following examination methods: examination, palpation, blood pressure measurement, instrumental method, bimanual examination, digital examination of the rectum for women over 40 years of age and in the presence of complaints, cytological examination of smears from the cervix and cervical canal.

Preventive examination of men in the examination room includes the following examination methods: examination, palpation, blood pressure measurement, digital examination of the rectum and prostate area for men over 30 years old.

The role of examination rooms in the early diagnosis of cancer

In order to have excellent health, it is important to visit doctors not only during illness, but also for preventive purposes.

In our country, there are examination rooms for both women and men, staffed by specially trained medical workers. The State Budgetary Institution “Polyclinic No. 6 of Grozny” has organized an examination room for women, but men can also get the necessary advice here.

The main task of the examination rooms is to conduct preventive examinations of men over the age group of 30 years, and women over 18 years of age (which is due to the high percentage of inflammatory and background gynecological diseases in this age group) for the purpose of early detection of malignant tumors and precancerous diseases of visual localization.

Your skin will be examined for the presence of age spots and tumor formations; oral cavity; The lymph nodes; thyroid and mammary glands; genitals and rectum. The use of the cytological method (taking smears for oncological pathology) for diagnosis makes it possible to identify precancerous diseases in the early stages, when there are no visible manifestations yet.

Tumors of external localizations, which can be detected during preventive examinations, account for 30% of all malignant tumors in both sexes and almost 40% in women.

I would especially like to draw attention to women who do not work and are not sent for medical examinations every year, since a passive attitude and unreasonable personal disinterest in maintaining their health sometimes leads to disastrous results. After all, cancer can be suspected even in the absence of complaints from the patient. The purpose of the examination room is not to make an accurate diagnosis, but to suspect changes in the body in time and schedule additional examination with the right specialist, which must be completed in the near future. Sometimes loss of time leads to irreversible processes.

In women under 30 years of age, malignant tumors form relatively rarely, but erosions, leukoplakias, cervical dysplasia, ovarian cysts, nodular formations in the mammary glands, and so on often occur. Over the course of a year, up to 80% of women who consider themselves healthy are examined in the examination room of the clinic, and 2-3% of them are diagnosed with these diseases. Doctors call them precancerous because cancer often develops against their background, because this does not happen in healthy tissues. By eliminating these diseases in a timely manner, the occurrence of a malignant tumor can be prevented. This means that the most reliable method of cancer prevention is the identification and timely treatment of precancerous diseases.

Cancer is a serious and insidious disease. It’s insidious because its obvious symptoms appear only when it is already difficult to treat. But in women, tumors often develop in the mammary glands, thyroid gland, genitals, rectum, that is, organs that can be examined and examined using relatively simple methods. And this makes it possible to detect the disease at the earliest stages of development, when complete cure is possible. Experience in the fight against cancer indicates that the noted successes in cancer treatment have been achieved not only by improving treatment methods, but also as a result of improving methods for detecting cancer at an early stage of the disease and reducing the time elapsed from diagnosis to treatment.

A 30-year-old patient was referred from the examination room to a surgeon with suspected rectal cancer. The surgeon confirmed the diagnosis, but the woman did not show up for the next appointment for a referral to the oncology clinic, and did not apply for a whole year. As a result, the disease began to progress and entered stage IV. But all this could have been avoided: the woman would have been operated on and would have lived a full life, since the disease can be cured in the early stages. What a pity that our fear and various prejudices prevent us from making the right decision during an important period for us.

Another example: a woman was sent to the examination room by the reception staff without any complaints. The office midwife did not detect any visible painful changes in the examined organs. However, smears taken from the cervix gave reason to suspect cancer. Following a signal from the examination room, an examination was carried out, as a result of which cervical cancer was discovered at stage zero. The woman underwent treatment on time and maintained her health. And there are many examples when early forms of a particular disease were discovered in examination rooms.

Many women refuse to go to the examination room, citing the fact that they had an ultrasound. But this examination method does not give a complete picture of the condition of the cervix, since smears are not taken during it. And you should not be offended by the registrars when they insist on visiting the examination room. First of all, this is done in the interests of the woman herself. Therefore, every woman from 18 years of age must undergo a preventive examination in an examination room once a year.

Dear women!
When visiting the clinic, do not forget to visit the examination room!