Нrodzinskyі V. Clinical organizing model of medical aid to women of reproductive age with acute non-obstructive pyelonephritis

The dissertation is devoted to the improvement of the quality in rendering the specialized aid to the women of reproductive age (WRA) with acute non-obstructive pyelonephritis (ANP) in the aspect of preventing from the development, unfavorable course of a disease, and the optimal choice of tactics for managing the patients. The studies were performed on the retrospective and prospective followings up. The first ones were presented by all cases of hospitalizations (during 2003 - 2012) of women with ANP by means of deep study of medical reports of women at reproductive age (1844 and 1263, respectively). The long-term follow and division in two 5-year periods allowed to substantiate the possible conclusions about specificity in hospitalization and intensity of changes. Besides, a great number of unfavorable factors in development and course of disease was revealed. The prospective study presented 183 WRA with ANP who had received the stationary treatment in 2013. There was proved the possible increase among the hospitalized women with ANP (by 43.7%), the tempo of which became slower with years (24.0% and 18.1% by periods of study); among them, the reproductive age constituted 66.8 - 69.7% with similar dynamics (25.0% and 9.0%). The seasonal peculiarities were revealed. The social spectrum of the most vulnerable category of WRA was defined. There was proved the cause-and-effect relation between the character of course of ANP and preconditions of its development. On the grounds of the revealed risk factors of development and unfavorable course of disease (26 factors, 104 indications), after evaluation of their informative meaning, the prognostic chart was elaborated. It became the basis for the proposed method to single out three risk groups, which served as an instrument to choose the tactics for managing the patients, and also the key element of the proposed conceptual model of prophylactics against development and unfavorable course on ANP in WRA. By the results of the expert assessment and partial implementation (2014-2015) was proved the efficacy of the proposed innovations.