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Clinical practice -- difficulties in the diagnostics 2014



A. Kircheva and S. Dimitrova
Department of Infectious Diseases, Epidemiology and Tropic Medicine,
Medical University "Prof d-r P. Stoynov" – Varna

Summary. Medical care is constantly improving, following the advancements in medicine and science. Hospitals changed from shelters and place of ‘last resort’ associated with poverty, infections and death to centers for specialized medical care and place where the technology advancements plays a huge role in the everyday practice. Nevertheless along with the needs and benefits for patients and society there are also some disadvantages which are point of research of many scientists, world health institutions along with suggestions and initiatives for safety medical care (WHO, World Alliance for Safer Health Care 27.10.2004). The aim of our research is to investigate in historic plan the development of hospital care, some of the problems concerning contemporary hospitals and the vision for the future through the prism of worldwide initiatives for safety medical care. We used the accessible historic documents representing the development of health care form antiquity to modern days, periodical reports from the World Health Organization (WHO) for safety medical care and the offered consensus solutions for organization, technological advancements and optimal hospital design. First hospitals – from shelters involved with care for the sick and suffering (Asclepios, Valetudinaria) pass through the test of the great pandemics evolving in places for isolation and finally emerging as the modern hospital structure with separate units delivering the best possible care. The benefits are followed along with some adverse events as for both patients and medical staff: health care-Associated Infections, complications during and after surgical interventions, rapidly growing multidrug resistance etc. In response of the world initiatives from WHO we considered specific benefits for implementation of some rules for working in high risk medical conditions and optimizing the hospital design. Hospitals are the backbone structures of the healthcare systems – they have to ensure at very high level safe medical care and diagnostics for the patients. Achieving work comfort for the medical personal and guaranteeing comfortable stay for the patients is critical for the modern vision and design of the hospital complex. Even the small changes in organization and performing medical activities based on international consensus could lower significantly the consequences for unwanted events associated with medical activities.

Key words: hospitals, safety medical care, health care-аssociated infections, surgical checklist
Address for correspondence: Dr. Anna Kircheva, MD, PhD, Department of Infectious Disease, Epidemiology and Tropic Medicine, Medical University, 55 Marin Drinov St., Bg ― 9000 Varna, tel.: 00359 052/6926 572, e- mail:

M. Becheva and N. Traykova
Medical College, Medical University – Plovdiv
Summary. The most common mechanism of clavicular fracture is a direct fall on the shoulder. We present a 28 year old patient with a fracture of the middle third of the clavicle in the result of a direct blow. The patient was treated conservatively by dressing type “Dezo” as the immobilization period for fractures of the clavicle lasted six weeks. Kinesitherapy took place in the early period after immobilization as procedures lasted eight days. Following a patokineziological analysis and identified rehabilitation potential kinesitherapy was appointed to the patient, including: physiotherapy, swelling reducing massage of upper arm, cryotherapy of the shoulder joint, passive movements of the shoulder girdle, active exercises to the horizontal level of the shoulder girdle, active-assisted exercises for abduction, minimal isometric contractions. The course of kinesitherapy had a good result in terms of functional recovery of upper limb movements. The patient increased both passive and active movements in the shoulder joint. The strength and endurance of the motor muscles of shoulder joint increased. Muscles of the scapula were stabilized. Paravertebral muscles force improved.
Key words: fracture, clavicle, кinesitherapy
Address for correspondense: Maria Becheva, MD, Medical College, Medcial University, 120 Bratya Buxton Blvd., Bg – 4004 Plovdiv, e-mail:

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