Vol 66, No 4 (2022)

Introduction. Measures implemented in the form of a project to change the activities of medical institutions are recognized as successful if, on the basis of intensive diagnostic and treatment methods, the maximum possible amount of medical care is provided in compliance with licensing requirements.

The purpose of the study was, taking into account the trends in the attitude of the population towards the activities of private medical institutions, to conduct not only an analysis of the activities carried out by the authorities and management to improve the model of the state medical institution, but also to identify possible problems that, against the background of optimizing the health system, can impede the successful implementation of appropriate management decisions.

Materials and methods. The material for the comparative analysis was the normative legal acts of state authorities and management bodies, as well as the results of measures taken in the Kemerovo region to optimize the regional health care system and the information obtained by questionnaire of patients of a private medical institution. The analysis database was created in the IBM SPSS Statistics 22 license statistical package. Statistical comparison of ordinal and qualitative traits in independent groups was carried out using the chi-square test (χ²) and the Z-test. Differences are statistically significant at the difference level p < 0.05.

Results. Patients who took part in the survey as respondents gave a higher rating to a private medical institution on the following indicators: management of work, quality of prescribed treatment, staff attitude to patients, waiting time for admission, sanitary condition of the institution, satisfaction with the quality of services. Differences are statistically significant.

Limitations. As part of the study of the results of the implementation of a new model of a medical institution providing primary health care in the context of optimizing the healthcare system, an analysis of regulatory documents on the problem under consideration and a survey of two hundred nineteen residents of Novokuznetsk who sought medical help at the clinic of Grand Medica LLC were carried out.

Conclusions. The conclusions contain not only an assessment of the declared level of the priority project being implemented, but also possible management decisions, the implementation of which will contribute to a positive change in the health system.

Compliance with ethical standards. The study does not require submission of the opinion of the biomedical ethics committee or other documents.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The author declares no conflict of interest.

Received: April 27, 2021
Accepted: May 25, 2021
Published: August 30, 2022

Purpose. Evaluation of the effectiveness of risk management for the occurence of cardiovascular diseases residents of municipal districts of the Republic of Tatarstan using the specialized software module “Cardiovascular Risk Management” in dynamics.

Materials and methods. The study was based on the cities of Zelenodolsk and Nizhnekamsk in the Republic of Tatarstan. The sample consisted of nine thousand seven hundre twenty-five residents of Nizhnekamsk (6332 (65.1%) women with an average age of 64.1 years, men — 3393 (34.9%) people with an average age of 62.7 years. 4175 people (including 2893 women aged of 63.3 years in average (69.3%), and 1282 men at the average age of 59.7 (30.7%) years. Information and software module “Cardiovascular Risk Management”, which is a medical software product aimed at managing an assessment of the risk of developing cardiovascular diseases in a particular patient and taking preventive measures.

Results. The most significant risk factors in residents of both districts were arterial hypertension. In the considered areas, a significant decrease in the severity of risk factors such as “systolic” and “diastolic” blood pressure, cholesterol and glucose levels in residents of the Zelenodolsk municipal district and a decline in the severity of one risk factor in the form of “diastolic” blood pressure in residents of the Nizhnekamsk municipal district were revealed in dynamics.

Limitations. 9725 people from two municipal districts of the Republic of Tatarstan took part in the study. The analysis of the effectiveness of the risk management for the occurrence of cardiovascular diseases was carried out. The age-gender distribution is representative of the demographic indicators of the region’s population.

Conclusion. The use of the information and software module “Cardiovascular Risk Management” allows effectively identifying existing risk factors in the population and carrying out timely preventive measures, as well as increase the efficiency and quality of the provision of medical and diagnostic assistance to the population living in remote areas of the subject of the Russian Federation.

Compliance with ethical standards. The study has the conclusion of the Local Ethical Committee Kazan State Medical University of Russia, protocol No. 7 dated July 20, 2022. The examination of the article on the study did not reveal any ethical violations. 

Contribution of the authors:
Garipov R.Z. — collection and processing of the material, statistical processing, writing a text.
Shulaev A.V. — research concept and design, writing a text.
Galimzyanov A.F. — research concept and design, collection and processing of the material.
Mortazina R.M. — editing.
Usmanova A.R. — statistical processing, editing.
Sadykov M.M. — editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: November 23, 2021
Accepted: December 13, 2021
Published: August 30, 202

Introduction. Breast cancer (BC) incidence is on the top positions among women cancer diseases. Medical care (MC) organization improvement to BC patients — an important problem of healthcare management.

Research purpose. To estimate the results of routing patients with suspected BC.

Methods. A cohort study conducted at the St. Petersburg Medical Information and Analytical Center from January 1, 2017 to December 31, 2019. Analysis the data on 14 629 BC suspected women, accumulated in the automatic accounting system “City register of routing maps” (AAS CRRM), considering the age and diagnostic timing.

Results. Interquartile range of patients waiting time to receive a level 1 oncologist consultation decreased from 1–8 to 1–3 days (p = 0.0000). In 2017–2019 yr. Patients with suspected BC were to wait 8 days to receive a level 2 oncologist consultation (p = 0.1629). Clinical diagnosis in suspected BC cases in St. Petersburg in 2017–2019 yr. was confirmed in 21 days (p = 0.5141).

Limitations. Cohort nature of the study.

Conclusion. The AAS CRRM use in BC suspected women allows better control MC providing and the timing of diagnosis of BC at all levels of medical care provision.

Compliance with ethical standards. The study does not require the submission of the biomedical ethics committee or other documents. 

Contribution of the authors:
Orlov G.M. — research concept and design, editing.
Romanenkov N.S. — research concept and design, collection and processing of material, writing the text, editing.
Alekseev P.S. — research concept and design, statistical data processing.
Movchan K.N. — research concept and design, editing.
Dolgov V.P. — compilation of the list of literature, editing.
Daryina M.G. — writing the text, compilation of the list of literature, statistical data processing.
Zharkov A.V. — writing the text, statistical data processing.
Yakovenko O.I. — collection and processing of material.
Gedgafov R.M. — collection and processing of material.
All со-authors are responsible for the integrity of all parts of the manuscript and approval of its final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: December 24, 2020
Accepted: February 24, 2021
Published: August 30, 2022

Introduction. One of the reasons for the increase in the prevalence and incidence of cancer is anthropogenic pollution of the environment. In the Republic of Bashkortostan, there are regions that clearly differ with the predominant concentration of certain types of industries, which form a kind of geochemical province. The study of the formation of cancer incidence in regions with different environmental situations is a prerequisite for corporate and regional programs for the prevention and public health care.

Purpose. To determine the epidemiological and dynamic features of the formation of cancer incidence in various ecological regions of the republic.

Materials and methods. The paper analyzes and summarizes materials from organizations and institutions of the Federal Service for Supervision in Protection of the Rights of Consumer and Man Wellbeing, the Ministry of Nature and Ecology, the Ministry of Health for 2002–2018.

Results. The level of cancer incidence in the Republic of Bashkortostan for 2002–2018 increased by 1.2 times (from 266.1 in 2002 to 329.3 in 2018 per 100 thousand population). The gain in the number of cancer patients occurred in all regions of the Republic in different ways, depending on their production and industrial orientation and environmental characteristics. Over all years of observation, the highest incidence rates are recorded among the population of cities in which petrochemical plants are located with an average annual level of 321.7‱, which is 30.8–36.4‱ higher than the national indicators. Cancer patients are registered in the region with large metallurgical production somewhat more often than in the Republic. Average annual levels in areas with the predominant development of oil production (290.5‱), mining production (253.0‱), agriculture (232.6‱) for 2002–2016 remain below the population indicator (285.3‱). Over following 2017–2018 years, in almost all of the above regions, the number of cancer patients continues to increase.

Limitations. The dynamics of the development of oncological morbidity for 2002–2018 in the Republic of Bashkortostan.

Conclusions. The revealed features of the dynamic development of oncological morbidity and the patterns of its formation in regions with different production and industrial development must be taken into account when developing comprehensive and corporate programs for protecting public health and preventing cancer.

Compliance with ethical standards. The study does not require the submission of the opinion of the biomedical ethics committee or other documents.

Contribution of the authors:
Karamova L.M. — research concept and design, collection and processing of material, writing the text, editing.
Gainullina M.K. — editing.
Basharova G.R. — collection and processing of material, writing the text.
Vlasova N.V. — collection and processing of material, compilation of the list of literature.
Khafizova A.S. — collection and processing of material.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest. 

Received: March 10, 2021
Accepted: March 30, 2021
Published: August 30, 2022

Introduction. An important principle of improving cardiovascular care is to increase the compliance of patients to optimal drug therapy.

Purpose. To identify compliance in patients with cardiovascular diseases to optimal drug therapy.

Materials and methods. Direct continuous questioning of patients with cardiovascular diseases (n = 1,018) was carried out using a modified Morisky D. questionnaire (1986). The survey was carried out by cardiovascular surgeons (n = 3) of the Central Clinical Hospital "Russian Railways Medicine". The degree of adherence of patients to the implementation of the recommendations of doctors at the stage of the initial interview and in 6 and 24 months was compared (p < 0.05).

Results. At the stage of the first consultation low compliance of patients to antihypertensive therapy (23.8%); high compliance to dual antiplatelet therapy was established in patients after endovascular arterials stenting (99%), anticoagulant therapy in patients with atrial fibrillation (86%) and hypoglycemic therapy in patients with diabetes (98%). After follow-up for six months, including the provision of endovascular and surgical care, compliance to optimal drug therapy in patients of all groups increased up to 99.9% (p < 0.05). After follow-up for 24 months, the compliance degree to antihypertensive and anticoagulant therapy slightly decreased to 93.8 and 97.5%, respectively (p > 0.05).

Limitations. To assess compliance to the recommendations of doctors, the results of outpatient follow-up of one thousand eighteen patients with cardiovascular diseases over two years were analyzed, which is a sufficient reference sample.

Conclusion. Compared with the initial consultation of patients, their compliance to optimal drug therapy increased during the 12 months of follow-up. Clinical management in the treatment-and-prophylactic process optimizes control over the effectiveness of the implementation of medical prescriptions, including self-control by patients of hemodynamic and other indicators. The formation of trusting relationships in the “doctor-patient” system is the most important principle of the continuity compliance of clinical management of the process of improving public health.

Compliance with ethical standards. The conduct of the scientific study was approved by the Ethics Committee of the Medical Institute of the Peoples’ Friendship University of Russia (PFUR), Protocol No. 9 dated June 9, 2022. Before the start of the study, patients gave written informed consent.

Contribution of the authors:
Goloshchapov-Aksenov R.S. —  the concept and design of the study, the analysis and statistical processing of the material, the correction of the text, the formation of tasks and conclusions.
Shaburov R.I. – the concept and design of the study, the formation of tasks, editing.
Rukodaynyy O.V. —  the concept and design of the study, the formation of tasks, editing, the formation of conclusions.
Starikov V.O. —  collection and processing of material, writing a text, compiling a list of references.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: March 01, 2021
Accepted: March 24, 2021
Published: August 30, 2022

The further development of Russian healthcare system requires a solution to the issue of forming a national system for managing of the quality and safety of medical activities. There is no consolidated opinion on the goals, objectives and indicators characterizing the activities of a high-quality national health system, which requires the study and additional analysis of foreign experience.

Purpose. Analysis of foreign experience in the development of the management system of the quality and safety of medical activities at the present stage.

In the systems PubMed, Web of Science, Science Direct by Elsevier, Research Gate, a systematic search, selection and subsequent analysis of publications reflecting international experience in the development of management system of the quality and safety of medical activities were carried out.

The modern paradigm of the development of management system of the quality and safety of medical activities consists in the harmonious implementation of scientifically based and generally recognized tools at the national level.

Modern healthcare faces challenges in four main areas: increasing the cost of medical services; dependence on technology; the need to reduce costs while continuously improving quality indicators; patients’ needs meeting. Most countries go through the professional model of quality management in health care, through the administrative model, to the formation of an industrial model, when solving these problems.

The industrial model completely corresponds to modern scientific ideas about management quality of medical care. Necessary condition for its implementation is a preliminary assessment of the industry’s readiness for innovations and a consistent policy in this area.

Contribution of the authors:
Kuchin N.E. — research concept and design, collection and processing of material, writing the text, compilation of the list of literature.
Tyukov Yu.A. — editing.
All authors are responsible for the integrity of all parts of the manuscript and approval of the manuscript final version.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest. 

Received: April 27, 2021
Accepted: May 19, 2021
Published: August 30, 2022

This article discusses the emergence of the idea of ​​Lend-Lease, as a method with the implementation of which, in conditions of force majeure, there was an opportunity to optimally solve important pressing problems. A fragment is given — the quintessence of the correspondence of the British Prime Minister Sir Winston Churchill, calling on the President of the United States of America Franklin Roosevelt and insisting on the need to introduce Lend-Lease. On the basis of archival documents and sources of literature, the role and share of medical products received during the Great Patriotic War in the USSR under Lend-Lease was established. The great importance of lend-lease is confirmed by a letter from F. Roosevelt dated November 4, 1941, addressed to Joseph Vissarionovich Stalin. The author discloses not the decisive, but significant, assistance provided in the provision of medicines, medical and sanitary products to the Soviet Union, especially over the first period of the war in 1941–1942, when some of the medical enterprises remained in the territories occupied by the Nazis. The largest number of deliveries was shown to be made by the United States of America, in comparison with the UK and Canada. The ways and logistics of incoming supplies are investigated. Products were proven to be received not free of charge, but under certain conditions. The USSR had to pay for the goods received until 2030. The Russian Federation, the legal successor of the USSR, managed to repay the debt in 2006. The role of public organizations that came to the aid of the Soviet people earlier than the governments of Western countries fighting Germany was emphasized. Behind the decisions taken on this issue, the policy of the Anglo-American allies in relation to the USSR, to the state, which must be helped in the fight against the common enemy, but in moderation, without strengthening its potential, is seen.

Contribution of the authors:
Serebryany R.S. — research concept and design, editing, approval of the final version of the article, responsibility for the integrity of all parts of the article.
Kamelskikh D.V. — idea of research, collection and processing of material, writing the text, compilation of the list of literature.
All co-authors approved the final version of the article and take responsibility for the integrity of all its parts. 

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: July 17, 2021
Accepted: August 29, 2021
Published: August 30, 2022