Download Goals and Objectives of sanitary and epidemic of the conditions of

MINISTRY of HEALTH UKRAINE
Higher state educational establishment of Ukraine
«Ukrainian medical stomatological academy»
“It is ratified"
on meeting of Department
of Accident Aid and Military Medicine
Manager of department
DMSc, Associate Professor Shepitko K.V.
29.08.2016
METHODICAL INSTRUCTION
FOR INDEPENDENT WORK OF STUDENTS
DURING PREPARATION TO PRACTICAL EMPLOYMENT
Goals and Objectives of sanitary and
epidemic of the conditions of natural and
man-made disasters. The concept of
quarantine and observation
Poltava-2016
1.Topic relevance
Timely providing oforganization of sanitary-hygienic and epidemic security
for population affected by natural, technological and social accidents and
organization of infection department in area of specially dangerous infections to
help restore the health of victims, their rapid return to normal life, the maximal
decrease of disability and mortality.
1. Educational objectives of the course are:
1. To be know following factors of epidemic area after situation accidents.
2. To calculate activity of epidemic center.
3. To be know the basic principles of emergency hygiene and preventive
measures in emergency situation.
4. To be knowkinds of epidemic situation in area of situation accidents.
5. To be able to organize medical care of population in conditions of
observations.
6. To be able to organize medical care of population in conditions of
quarantine.
3. Basic knowledge, abilities, practical skills required for studying of the
theme (interdisciplinary integration
Courses
Practical skills
1. Microbiology
1. To know the peculiarity of specially
dangerous infections and their agents.
2.Lawyer’s basis
2. To know main laws about organization of
sanitary-hygienic and epidemic security in
the cells of natural and man-made disasters.
3.Safety of life
functions
4. Latin language.
3. To usemain rules of people behavior during
specially dangerous infections.
4. To use the Latin terminology in situations
emergency.
4.1 Tasks for independent work during preparation to practical employment
Following factors of
- Presence in the areas of disaster unisolated sick
epidemic area after
situation accidents
among the affected population and the possibility of
spreading of agents;
- Affected, those that require hospitalization, are
evaluated in terms of risk of infection;
- Healthy population exposed to infectious patients and
require observation, measured in terms of risk of
infection;
- Environment, dangerous for human infection.
Determination of
activity of epidemic
centerafter situation
accidents
the maximum incubation period of infectious diseases
spread, is insufficient. At infection of patients with low
immunity second peak of infection may occur after 2-3
incubation period after the first due to the transfer
agent by persons who leaked asymptomatic infection.
The basic principles of
emergency hygiene and
preventive measures in
emergency situation
providing medical assistance to populations in areas of
disaster, prevention of appearance and spread of
infectious diseases.
The kinds of epidemic
situation in area of
situation accidents
there are favorable, unstable, unfriendly and unusual
Favourable condition
means infectious diseases in the population are missing
or there are not linked single cases.
Unstable state
among the population there are not some previously
recorded infectious diseases, there appear group
infections without further spread, i.e. no signs of the
epidemic.
Adverse condition
there are group infections with a tendency to their
further dissemination, or there appear isolated cases of
especially dangerous infectious diseases (plague,
cholera and others.).
The state of emergency
there is an epidemic or perceptible group lesions of
especially dangerous infectious diseases. At emergency
situation they conduct sanitary and epidemiological
intelligence of areas to determine the boundaries of
disease center and complex hygiene and preventive
measures in it.
Center of bacterial
infection
means cities, localities (place of temporary
accommodation of the population) or objects of the
economy that have undergone infection by bacterial
means.
Observation
is a system of restrictive measures, a number of
medical measures to prevent the spread of infectious
diseases and strengthen health surveillance.
Quarantine
means the system of government measures, including
regime-sealing, administrative and household, antiepidemic, sanitary and medical preventive measures to
localize and eliminate hotbeds of infectious diseases.
4.2. Questions:
1. Following factors of epidemic area after situation accidents.
2. Determination of activity of epidemic center after situation accidents.
3. The basic principles of emergency hygiene and preventive measures in
emergency situation.
4. The kinds of epidemic situation in area of situation accidents.
5. Quarantine. Definitions. Summary measures.
6. Observation. Definitions. Summary measures .
7. Emergency anti-epidemic commission, its structure and basic tasks.
4.2. Professional algorithms for forming practical skills and abilities:
1.To be know following factors of epidemic area after situation accidents.
2.To calculate activity of epidemic center.
3.To be know the basic principles of emergency hygiene and preventive measures
in emergency situation.
4.To be know kinds of epidemic situation in area of situation accidents.
5.To be able to organize medical care of population in conditions of observations.
6.To be able to organize medical care of population in conditions of quarantine.
5. Detailedtheme content:
Emergenciesrelatedtovarious types ofdisastersare a complexof sanitaryepidemiological andmedico-social problem and
applytospecifichealthobjectivestoprovideEmergency medical aid
(EMA)affectedandsanitary-epidemic support of the affected population.
Emergencies for sanitary epidemiological service are sudden, often
unexpected changes in the normal atmosphere, resulting from the disaster and its
consequences, which are characterized by numerous fatalities, widespread illness
and injury, a sharp deterioration of sanitary and epidemiological situation and
extremely difficult epidemiological situation. In such circumstances rapid changes
in the organization and the normal rhythm of the authorities, medical and health
agencies are required. In extreme situations timely managed preventive work and
prevention of deterioration of sanitary-epidemic state disaster areas bear particular
importance. Activities must comply with the conventional control system in
service of EMA in emergencies, it is important to consider the general principles of
preventive work, especially the hygienic state of the environment in various
disasters and their impact on multifactors of epidemic consequences.
In areas of natural disasters and other emergencies epidemic focus should be
regarded as the territory in which at some time and space people were infected by
pathogens and infectious diseases and they spread massively.
These limits define the following factors of epidemic area:
- Presence in the areas of disaster unisolated sick among the affected population
and the possibility of spreading of agents;
- Affected, those that require hospitalization, are evaluated in terms of risk of
infection;
- Healthy population exposed to infectious patients and require observation,
measured in terms of risk of infection;
- Environment, dangerous for human infection.
For determination of activity of epidemic center in the areas of disaster (at
various infectious diseases), the maximum incubation period of infectious diseases
spread, is insufficient. At infection of patients with low immunity second peak of
infection may occur after 2-3 incubation period after the first due to the transfer
agent by persons who leaked asymptomatic infection.
Therefore, in determining the timing of epidemic center it is necessary to
consider the presence of carrier. Each separately taken infectious disease among
different population groups in the same region of disasters is spread unequally.
The intensity of the origin and spread of infectious diseases is significantly
influenced by communal device and sanitary living conditions of people in disaster
areas and the locations of the evacuated population, and especially the
susceptibility of the organism of people to each of a particular disease in extreme
situations. The potential risk of human infection depends on municipal properties,
including:
-geographicalandclimatic conditions;
-economic resources, andsocioeconomicstatus;
- the level ofhygieneinthehome;
- medicalsurveillanceandprevention;
-drinking water andfood supply system;
- the system ofcleaningandsanitation;
-migration,contactwith animals;
-outbreaks ofinfectionsandepidemic diseases.
Infectious diseases are not peculiar to this area can be brought by visitors who
arrived and other members of groups. The mechanism of infection transmission
remains and acts in the centers for the duration of that pathogen survives in the
environment, and at the presence of infectious patients in an environment of the
affected population. At emergency situation there appear difficult sanitary
conditions that require conduction of skilled hygienic and preventive measures.
The basic principles of emergency hygiene and preventive measures in emergency
situation are based on universal principles of health care, providing medical
assistance to populations in areas of disaster, prevention of appearance and spread
of infectious diseases.
At the beginning of an emergency in a fast changing epidemiological situation
timely sanitary and epidemiological intelligence becomes very important, that is
quick information about the sources of infection and ways of its transmission.
According to the results of this intelligence of sanitary and epidemiological state of
emergency situation area can be rated as favorable, unstable, unfriendly and
unusual.
Favourable condition means infectious diseases in the population are
missing or there are not linked single cases.
Unstable state: among the population there are not some previously recorded
infectious diseases, there appear group infections without further spread, i.e. no
signs of the epidemic.
Adverse condition: there are group infections with a tendency to their further
dissemination, or there appear isolated cases of especially dangerous infectious
diseases (plague, cholera and others.).
The state of emergency: there is an epidemic or perceptible group lesions of
especially dangerous infectious diseases. At emergency situation they conduct
sanitary and epidemiological intelligence of areas to determine the boundaries of
disease center and complex hygiene and preventive measures in it.
Center of bacterial infection means cities, localities (place of temporary
accommodation of the population) or objects of the economy that have undergone
infection by bacterial means.
The boundaries of infection center in such cases are borders of the cities,
towns or individual objects of the economy. All measures of localization and
liquidation of infection by biological agents are carried out according to plan of
anti-bacterial protection that is developed by experts of sanitary-epidemiological
service in conjunction with members of the general medical network. Performance
and quality of work on localization and liquidation of centers largely depends on
timely preparation of plan of action.
In order to more differentiated approach to the implementation of these
measures specialized services are established: administrative, anti-epidemic,
quarantine, treatment and prevention and logistics. Management of services is the
responsibility of heads of the relevant departments. For each service there is a
defined list of specific tasks. The complex of specific activities is carried out
directly on the objects of the economy. Managers of facilities provide an epidemic
regime, including the decontamination area and production facilities, as well as a
full decontamination of workers and employees. These events are held by the
objects of forces that are prepared to work in the centers of accidents in advance.
In the general system of measures aimed at localization and liquidation of centers
of infectious disease leading place is given to quarantine (observation) measures.
Their organization and conduction is under the direction of the local
Emergencyanti-epidemiccommission. Carrying out quarantine measures is
conducted by all Ministries, agencies and organizations in accordance with the
plan of anti-bacterial protection of population. Quarantine regime is accompanied
by the simultaneous introduction of observation at all related to the quarantine area
of administrative areas. In imposing quarantine on large administrative and
industrial center area of the city and directly adjacent towns, related to local
transport, the total supply chain and trade and industrial activity are included into
quarantine area.
In terms of evacuation and dispersal of infection center outside the quarantine is
expanded to include settlements where the evacuated population is located. The
administrative area, where the quarantined focus of infection is located, and
settlements in connection with the separation in these population centers of
infection, is declared a quarantine area. Contaminated areas outside the settlements
is dangerous to people and animals in it. In this regard, the contaminated area must
be installed restrictive and warning signs, posts, and the epizootic and
epidemiological surveillance for a period of selfdecontamination.
Quarantine means the system of government measures, including regime-sealing,
administrative and household, anti-epidemic, sanitary and medical preventive
measures to localize and eliminate hotbeds of infectious diseases.
Introduction of mandatory quarantine includes the following main groups of
measures:
- Surrounding fire or its armed protection, putting in the focus of
commandant'sservice;
- Strict control over entry and exit of people and removal of property from the zone
of quarantine;
- Prohibition of travel by road transport through center of infection and stops
outside the designated areas for transit of railway and water transport;
- The creation of observatories and observation of the events of those who were in
the center of infection and dropped out outside the quarantine area;
- Restriction of communication between different population groups;
- Establishment of epidemic regime for the population of urban transport,
commercial networks and public catering, facilities of the economy depending on
the epidemiological situation, that is, the condition of continuity, the provision of
food supplies and manufactured goods of prime necessity of compliance with
epidemic regime;
- Sanitary inspection of food and drinking water;
- Establishment of a strict anti-epidemic mode of medical facilities;
- Activities for disinfection of environmental objects, industrial products, and
sanitization of the population;
- Carrying out emergency and specific prevention;
- Early detection of infectious patients, their isolation and hospitalization;
- The destruction of disease vectors (disinsection and disinfestations) - strict
control over the execution of people, enterprises, ministries and departments of the
rules of quarantine;
- Conducting sanitary-educational work among the population etc.
Environment (armed guard) of quarantined area is to ensure its isolation and
eliminate the spread of infection abroad. It is conducted by means of services and
public order in cooperation with the military units of Interior with participation of
the population. Along the perimeter of the main center of infection routes of
movement of people and transport are located security posts. Around the clock
patrols between posts, strict control over the movement of people between
different quarantined settlements is conducted, restrictive signs, signs are
established, put up posts on country roads, path, etc. To monitor the
implementation of the epidemic mode when leaving and entering of the population,
export and import of cargo checkpoints are established, including in its
membership sanitary control points (SCP).
Checkpoints as multi formation are created by executive committees of
administrative areas that meet on the basis of the administrative apparatus of city
and regional departments of various services. SCPs are deployed in the
transmission of checkpoints by forces and means of health care. Checkpoints are
deployed in towns on main routes, road, railway, water-near their crossing the
border quarantine zone, as well as at airports, and if necessary - within the
quarantine zone at the outputs of the center of infection. The main objective of
checkpoints is to monitor the implementation of access control procedure
established in accordance with preventive requirements. From the quarantine zone
it is allowed to export any goods in the presence of instruments of their
decontamination and safety. Exit of people from the zone of quarantine is solved in
the cases when necessary if they have a certificate of observation.
Import of cargo in quarantine area (for unloading places) is the strict
implementation of the rules of quarantine by persons accompanying cargo, and
transport teams. Individual experts and medical units bound for measures to
eliminate the infectious center, as well as those areas of quarantine, which are
resident in the territory, but left it to establish a quarantine are in the area of
quarantine freely allowed. Export of goods from the quarantine zone is conducted
after their decontamination. Instruments of disinfection of goods and their
harmlessness seem departments - the shipper.
Departure of persons who were temporarily in the quarantine zone (holidays,
business trips, etc..), is decided after observation. For this purpose by the Executive
Committee of People's Deputies of the pre-drafting plan observatories at the hotels,
hostels, rest homes are established, etc.
Medical surveillance is carried out in observatories during the period, equal to the
maximum incubation period of infectious diseases, about which the quarantine was
imposed. Observations are conducted by specially selected medical staff by
regional and departmental health authority. Before entering the observatory the
patients undergo medical examination at the observatory are inserted only healthy
people. Supply for observed patients is organized service trade and public catering
executive, and protection and respect for the service provided by public order.
After the observation the patients in an organize way are delivered to the airport or
train station to send in their neighborhood. When the cases of infectious diseases
among observed period of observation is extended accordingly. Entry into
quarantine zone permitted personnel groups and institutions and individual
professionals that are sent to assist in the elimination of infectious disease center.
In the quarantine area may be accepted also persons who permanently live in
settlements where the declared quarantine and those returning from vacations,
trips, etc., provided that they have documents. Persons entering quarantine zone
must have supporting documents to conduct vaccinations and emergency
prevention tools and customized products sewn.
At the sites of the economy that continue to operate under quarantine, introduced
preventive work, namely:
- protection of workers and employees from exposure to bacterial products;
- Early detection among workers and employees of infectious patients, their
immediate isolation and establishment of monitoring individuals who were in
contact with patients - activities for decontamination of the environment and
production facilities;
- Ensure timely conduction among workers and employees of preventive measures
(emergency prevention, vaccination, etc..)
- Disinfection of production, before removal from the quarantine zone with the
issuance of relevant documents about its safety;
- implementation by workers and employees established hygiene and preventive
policies.
With the introduction of quarantine consumer services - studios, hairdressers and
others – are temporarily closed. Shops, commercial base syllables with food and
other sales points close to the time of disinfection measures. Hours of operation of
these enterprises in the future are determined depending on the selected pathogen
and prevailing epidemic state. Public catering are transferred to service to
employees working shifts, serving groups, observatories, hospitals, etc.
Public transport quarantined cities will receive services workers that work shifts
and do not stop working in quarantine. Movement of long-distance buses between
different quarantined localities is usually stopped. Working hours of enterprises of
communication is set according to the epidemiological situation in the quarantined
city and towns all types of postal items (letters, packets, parcels, translations,
periodicals, etc.) are accepted and delivered without any restrictions. Acceptance
from people from quarantined area of postings, except telegrams to establish the
type of pathogen, is usually ruled out. The complex of anti-epidemic measures in
foci of infection disinfection areas, transportation, industrial and residential
buildings, water, food and feed, and items of care and their secretions are the most
important.
Disinfection in places the invention of infectious diseases in hospitals, the main
travelers highways, transport facilities of the economy that continue to work in the
center of infection is primarily carried out.
Decontamination of vehicles is done at stations of disinfection of transport
conducted in cleaning offices of garages, parks, stores, clothes, shoes and soft
inventory - at stations decontamination of clothing conducted at the laundries, dry
cleaners. Sanitary treatment population, workers and employees who work during
disasters, is in permanent or temporary flushing points that are deployed in a bath,
shower facilities.
Infected food should be promptly identified and utilized in non-food purposes or
disinfected. Decontamination of food is carried out depending on the type of
product. The most effective methods are boiling and autoclaving. Decontamination
of individual drinking water is done by boiling (45 min in spore forms of the
pathogen and 10 min – in vegetative). You can add one teaspoon of 3% hydrogen
peroxide or 10 drops perhydrol to 1 liter of water, or a pill hydroperite to 5 liters of
water and boil for 5 minutes. Adding pills pantothenatecide, aquacept to 1 liter of
water keeping exposure to 30 min. Large amounts of water is disinfected in rate of
50 mg of substance on l liter for 24 h and 100 milligrams of substance per 1 liter
with exposure for 1 h. Mine wells are disinfected by adding 80 g of perchloric
lime in 1 liter of water at 3 h exposure takes into account activity bleach.
Disinfection of epidemic center is conducted by special teams, consisting of
disinstructor, disinfector and two volunteers (sanitary activists). In the general
system of warning and preventive measures in case of largly contagious infectious
diseases emergency prevention is paid special attention.
Emergency prevention is a set of health measures carried out against people who
are exposed to infection by pathogens of dangerous infectious diseases, to prevent
the development of their infection. This measure is applied immediately - with the
advent of information on infection or disease threatening human infections, as well
as flares in the population of infectious diseases of unknown etiology.
Emergency Prevention is divided into general and special. General
Emergency Prevention is conducted to detect the type of pathogen that caused the
infection. Special Emergency Prevention id conducted after the detection of the
type of microorganism, its antibiotic sensitivity and confirmation of clinical
diagnosis of infectious patients. Universal emergency prevention is conducted with
antibiotics or chemotherapy of wide spectrum.
Duration of prophylaxis can be reduced to 2-3 days according to the results of a
specific indication. The duration of the special emergency prevention is set
including nosological forms of infectious disease (the term of the incubation
period), the properties of used antimicrobial agents, and prevention held before the
general emergency. Quarantine may be replaced by observation of such infectious
diseases as brucellosis, typhoid fever, rickettsiosis, deep mycosis, etc, i.e.
infections where a person is not a source of infection, or if found agents are not
related to especially dangerous infections. This replacement of quarantine regime
observation is made only after disinfection or self decontamination of objects of
the environment and complete sanitization of the population in the focus of
infection.
Observation is a system of restrictive measures, a number of medical measures to
prevent the spread of infectious diseases and strengthen health surveillance.
District principle of service for the population is preserved in the area of
quarantine, however, due to the sharp increase in workload, currently existing
medical areas are divided into smaller parts and micro districts. Each micro district
should have selected and adapted premises to contain at Emergency situations (ES)
offices of specialists in general medical network. At micro district in ES all work is
performed by medical team consisting of one doctor, 2 nurses and 2 disinfectors
and involving several volunteers (sanitary activists). The team is in charge for the
selected area with a population of 1000-1500 people. Brigade is provided with
material for guarding barrier for patients, drugs for emergency prevention,
pharmaceuticals, boilers, special forms, lists of serviced population. In order to
identify patients the medical team wards around the serviced micro districts 2
times a day with simultaneous conduct of thermometry, emergency prevention and
sanitary education. Work of the crew is conducted under strict anti-epidemic
regime. Personnel work under the supervision of a medical doctor. All crew
members are provided with a full set of protective clothing - suits plague. Each
team specifies each apartment lists the population living in the area, including
visitors.
Thermometry results are recorded in a special magazine. Data about
temperature measurements at residents in the morning and evening are recorded in
the temperature letter that is posted in doorways, on buildings, doors. This service
facilitates the work of medical personnel. At the end of the day each team fills a
special reporting form, which contains the following data: total number of
residents in micro districts, the number of persons covered by thermometry, the
number of persons with fever of unknown etiology, detection of patients with
typical symptoms of this nosological form, the number of hospitalized patients, the
number of patients left at home (specify reason), information on health and
educational work.
Transportation of infectious patients and persons with suspected infectious
disease is carried by special transport separately. The same machine can transport
patients with the same diagnosis. The patient is accompanied by a nurse, driver,
nurse and nurse-porter. They should be in protective clothing of appropriate type.
Nurse must have dishes to collect discharge the patient, underlay oilcloth,
disinfectant solution,necessary medicine to provide emergency aid, oxygen.
Ambulance vehicle after delivery of the patient in a hospital is disinfected by staff
receiving department. Disinfect sanitary transport entry is made in the book of
disinfection measures, and to route the letter put the stamp of spent
decontamination.
A. Tasks for self-education
1. As a result of Epidemiological and sanitary Intelligence and epidemiological
state of emergency region can be estimated as:
a). satisfactory
b). unsatisfactory
c). extremely difficult
d). extraordinary
2. For the implementation of measures to localize and eliminate the epidemic
center specialized services are created, including:
a). police
b). fire protection
c). Pharmacy Network
d).quarantine service
3. Sanitary control points are conducted by powers and means of:
a). armed forces
b). public safety
c). fire protection
d). health authorities
4. The main objective of checkpoints are:
a). emergency and specific prevention
b). early detection of infected people, their isolation and hospitalization
c). conduction of health and education work among the population
d). control over the implementation of access mode when leaving and entering of
population, export and import of cargo
5. Decontamination of individual drinking water supplies in the affected zone can
be made:
a). by boiling
b). defending
c). Filter
d). should not be done
6. Quarantine may be replaced by the following observation of infectious diseases:
a). cholera
b). plague
c). anthrax
d). brucellosis
7. In the area of quarantine medical point area:
a). preserved
b). divided into smaller points
c). combined into larger
d). district service principle is not preserved
8. Ambulance vehicle after delivery of the patient to hospital disinfected by:
a). receiving department
b). can not be disinfected
c). checkpoints
d). sanitary checkpoints
9. Rounds to each yard(apartment) in the area of quarantine are conducted:
a). every other day
b). 2 times a day
c).once a day
d). once a week
10. Members of the medical team that carry out the apartment rounds, are provided
with:
a). Combined masks
b). civilian gas masks
c). respirators
d). plague costumes
B. Tasks for final control of knowledge with answers:
Task №1. Organization of epidemic infectious hospital treatment is relied on:
a). chief physician of infectious hospital
b). chief nurse of infection hospital
c). Interior Ministry troops
d). units of the armed forces
Task №2. In the "clean" area of infectious hospital is located:
a). catering department
b). Department of pathologic anatomy
c).Clinical Laboratory
d).bacteriological laboratory
Task №3. In the "infected" area of infectious hospital is located:
a). pharmacy
b). dormitories for staff
c). administrative service
d). receiving and sorting office
Task №4. The composition of the train that carries the population evacuated from
center of natural disaster exposed to quarantine:
a). at the appearance of 10 infectious patients on the train
b). the appearance of five sick on the train
c). the appearance of 20 or more sick on the train
d). composition of the train carrying the evacuated population, should not be under
quarantine.
Task №5. Transportation of persons with suspected infectious disease quarantine
zone is:
a). in one machine can be transported patients with a diagnosis
b). in one machine can be transported patients with different diagnoses
c). infectious patients may not be transported
d). in one machine can carry only one patient
Task №6. Preparation of buildings for deployment in their time of infectious
hospitals is the responsibility of:
a). head physician of health care institutions
b). chief nursing of medical institutions
c). public safety
d). Police
Task №7. Adding pills pantotsydu to 1 liter of water for disinfection follows the
exposition:
a) .1 hour
b) .10 min
c) .30 min
g). 1 day
Task №8. Noncontagious and little contagious infections include:
a). plague
B). cholera
in). dysentery
g). botulism
Task №9. Largely contagious (especially dangerous) infections include:
a). botulism
B). brucellosis
in). plague
g). tularemia
Task №10. In micro area of quarantine zone work medical team consisting of:
a). 1st nurse and 1 doctor
b). 1 nurse and 1disinfector
c).1 doctor, 1 nurse and her 1 disinfector
d). 1 doctor, 2 medical nurses and 2 disinfectors involving several volunteers from
the public (health activists)
References literature
Basicreferences:
1.
Methodical development of practical training for students of 2nd year
stomatologydepartments: «Goals and Objectives of medical evacuation support
under conditions of natural and man-made disasters. Types and amounts of
aid. Medical triage ». Poltava, 2013 – 15ст.
Additionalreferences:
Methodical development of independent work for students of 2nd year
stomatology
departments:
«Preparationtopracticallessons
–
theoreticaltrainingandstudingofpracticalskills.Preparation to the final module
control».Poltava, 2013 – 14ст.
Guidelines prepared by:
PhD in Medical Sciences
Assistant Professor
V.V. Shevchenko