Vol 67, No 5 (2023)

Introduction. Nowadays standardization is a necessary tool for timely response to challenges and changes, the basis for the work on patient safety, contributes to the control of staff performance, minimizes the risks of medical care.

Objective. to reveal the managing and economic aspects of standardization of processes in the healthcare system and the correctness of the use of existing regulatory documents as an algorithm for the main processes at the level of structure, at the level of process, at the level of result.

Materials and methods. By conducting surveys and in-depth interviews, various opinions on the standards of medical care of various interviewed groups were collected: undergraduates of the HSE course “Management and Economics of Healthcare”, as well as groups of territorial fund of compulsory medical insurance medical experts and “high-level” experts.

Results. The materials of the sociological survey showed a lack of knowledge, uncertainty and unpreparedness of respondents on the application of standards in the planning and provision of medical care, which indicates a lack of understanding of the use of standardization mechanisms in improving medical care. At the same time, in-depth interviews with “high-level” experts show this management tool to operate.

Limitations. The research materials are limited to the results of a survey of two groups of respondents (78 people) conducted over the period from 09.2022 to 01.2023.

Conclusion. The standards can be successfully used in medical care planning, pricing, examinations, as well as training and training of medical personnel. In this regard, it should be concluded that there is a need for further training on the issues of professional development of a wide range of healthcare managers, as well as in the process of training specialists at all levels. As part of the recommendations, it is advisable to provide training for medical personnel on standardization issues, including connection with the examination of the quality and safety of medical care. To develop a methodological approach to improve and use the principle of standardization in the management and provision of medical care.

Compliance with ethical standards. the study was approved by the independent Ethics Committee of the N.A. Semashko National Research Institute of Public Health, Protocol No. 2 of 17/11/2021. All respondents signed an informed consent to participate in the study, and agreed to the publication of the results of sociological surveys.

Contribution of the authors:
Russkikh S.V. — the concept and design of the study, writing the text, compiling the list of references, collection and processing of material; statistical data processing;
Lindenbraten A.L. — concept and design of research, collection and processing of material;
Moskvicheva L.I. — writing the text, collecting and processing the material;
Vasilieva T.P. — concept and design of research;
Smbatyan S.M. — writing the text;
Gorbacheva N.А. — 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: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

Introduction. Despite the presence of positive trends in the provision of medical specialties, there are currently a number of personnel problems in both Russian and world health care. The experience of fighting against coronavirus has proved the importance of solving personnel problems in healthcare, strengthening medical personnel in particular.

Purpose. To assess the impact of the coronavirus pandemic on the number and structure of medical personnel in Moscow; to predict the number of medical personnel for a short-term period.

Material and methods. The methods of mathematical-statistical and empirical analyses are used. To analyze the composition of medical personnel, data from the forms of federal statistical observation No. 30 “Information about a medical institution” provided by medical institutions in Moscow for 2013–2022 were used. Changes in the structure were estimated using the Gatev coefficient, Salai and Ryabtsev indices. The quality of proposed one-factor model (t — time) for prediction is proven by Fisher’s F-test and Student’s t-test (95 CI%).

Results. During the pandemic, there was an outflow and shortage of doctors of certain specialties, which led to a huge overload of the remaining staff. As a result, the proportion of specialists under the age of 36 increased by 17.4%, and the number of therapists increased by 13.6%. The provision of doctors to the population in Moscow has increased by almost 5% over five years. By the end of 2023, the number of doctors of all specialties is expected to increase by 1.6–2.9%.

Limitations of the study. When studying the number and composition of medical personnel, data from 251 medical institution of Moscow during 2013–2022 was used which is a fairly informative sample.

Conclusion. The analysis showed a significant impact of COVID-19 on both the number and structure of medical personnel. There is a tendency to increase the number of doctors, and the enlargement of medical personnel is expected by the end of 2023.

Compliance with ethical standards. The study does not require the approval of the Biomedical ethics committee.

Contribution of the authors:
Karnafel A.A. — сollection and processing of material, statistical data processing research design, writing the text, complication of the list of literature;
Podchernina A.M. — research concept, approval of the manuscript final version.
All authors are responsible for the integrity of all parts of the manuscript.

Acknowledgment. The study had no sponsorship.

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

Received: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

Introduction. In multidisciplinary pediatric hospitals in Russia, the prerequisite for the formation of principles of antimicrobial therapy management as a medical technology, implemented with the participation of a clinical pharmacologist became possible on the basis of updated clinical and pharmacological tools proposed by the World Health Organization (WHO) in 2019.

Purpose. The project goal is to show the possibilities of control of antimicrobial therapy, as a medical technology in multidisciplinary children’s hospitals to improve adherence to domestic clinical recommendations in the actual clinical practice of implementing antibiotic therapy management programs in children on the profile of «Pediatrics».

Material and methods. The pilot scheme was implemented from 2019 to 2021 on the basis of the Morozov Children’s Clinical Hospital by methods of WHO AWaRe and points estimation of prevalence of antibiotic use according to WHO tool checklist in dynamics. Regulatory documents of medical organization (MO) were formed, which ensured transition from traditional to new approaches within 3 years from 2019 to 2021 to maintain clinical practice of antibiotic use based on clinical guidelines.

Results. A comparative study of clinical antibiotic use in children “before” the project in 2019 and “after” in 2021 showed a 2.7-fold decrease in antibiotic use by absolute DDDs from 65.99 in 2019 to 24.34 in 2021. DDDs per 100 p/d. By WHO AWaRe method for absolute values of antibiotics in the “Tolerance” category, a 2-fold decrease in consumption and a 5-fold decrease in consumption for absolute values of antibiotics in the “Control” category: in 2019. — 41.13% (abs. 27.55 PDT per 100 p/d) and in 2021. — 60.1% (abs. 4.64 PDT per 100 p/d). Consumption of “Reserve” category antibiotics by absolute values has not changed.

Limitations. This publication describes one medical institution in which this project was implemented, which somewhat reduces the value of the results obtained.

Conclusion. As a result of the implementation of the principles of managing antimicrobial therapy, this pilot project was able to reduce the irrational use of antibiotics in the pediatric hospital.

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

Contribution of the authors:
Vlasova A.V. — research concept and design of the study, collection and processing of material, writing the text;
Smirnova E.V. — statistical data processing, editing;
Volkova N.N. — compilation of a list of references;
Dymnova L.V. — editing, responsibility for the integrity of all parts of the article;
Romanova Yu.V. — collection and processing of material;
Rakhalina A.A. — collection and processing of material;
Sharshakova A.A. — collection and processing of material;
Angel A.E., Gorev V.V., Zhuravleva M.V. — approval of the final version of the article, responsibility for the integrity of all parts of the article.
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: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

Introduction. The policy and practice of the Russian healthcare system in the area of person-centered care aims to involve the patient in the treatment process with an individual approach to their needs and expectations. The quality of medical care is increasingly evaluated through the perception of the patient, his/her satisfaction. In this regard, the design of person-centered medicine is multi-dimensional, forming a partnership relationship between the parties involved — doctor, patient, health care provider — in making joint decisions.

The purpose of the study. Assessment of general practice (GP) through individual patient preferences in a multidimensional construct of satisfaction with the quality of care.

Material and methods. The international EUROPEP questionnaire was used. Statistical processing of the study materials was performed using Statistica 10 and SAS JMP 11.

Results. Statistically significant differences in respondents’ satisfaction depending on the age and gender (p < 0.0001) were revealed. The predominance of a positive opinion on the totality of all the analyzed criteria of satisfaction among female respondents is shown. At the same time male respondents gave positive estimation of quality of general medical practice only in such two groups of observation as in age category of 36–45 years old — 53.09 % and 66.67 % of persons older than 75 years old.

Research limitations. The research is limited to the survey of a certain number of patients of medical institutions in Moscow to assess the GP in terms of satisfaction with the quality of medical care provided.

Conclusion. New data have been obtained on different respondents’ perceptions of the quality of standardized medical care provided by GPs, and the assessment of satisfaction with its quality depending on the age and gender of the adult population. The satisfaction of male respondents with the quality of medical care was shown to be lower in all age groups except 53.09% (36–45 years) and 66.67% (over 75 years). Female respondents expressed satisfaction on the aggregate of all opinion-forming factors.

Compliance with ethical standards is based on the informed consent of the survey participants and approved by the minutes of the Local Ethics Committee of the FSBSI «N.A. Semashko National Research Institute of Public Health» (Protocol No. 2 of 17.05.2022).

Contribution of the authors:
Kuznetsova M.A. — concept and design of the study, collection and statistical processing;
Vasilyeva T.P. — consulting, editing;
Zudin A.B. — material systematization, editing;
Aksenova E.I. — consulting, editing;
Gruzdeva O.A. — organization of the study in medical organizations;
Kuznetsova K.Yu. — summarization, 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: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 202

A large fraction of adult patients has two or more chronic diseases (multiple chronic diseases, MCD). There are often questions about the quality and availability of medical care for patients with MCD, which could drastically be improved using information technologies (IT).

The purpose of this work was to study medical care management for MCD patients abroad using IT.

This study was carried out by searching the Google system and PubMed.

MCD patients are characterized by a high heterogeneity. Effective processing of the flow of medical information (electronic patient registers, digital medical records, scientific knowledge, etc.) is usually feasible with the help of artificial intelligence technologies and supercomputers. To improve health care delivery to adult MCD patients there are described three dimensions for the IT development including 1) development the algorithms to support clinical decision making; 2) coordination of medical care delivery; and 3) attainment of patient self-management.

The presented results confirm the important role of IT in medical care. The number of scientific reports devoted to this issue is growing. The use of IT in medicine demonstrates the promise of the principles of automated analysis and the provision of additional information directly at the point of care delivery. This can improve medical processes and, to some extent, clinical outcomes, including indicators of patients’ quality of life.

Conclusion. Additional studies based on data from real-life clinical settings are required to make a comprehensive assessment of the areas of IT applicability.

Contribution of the authors:
Kamynina N.N. — research concept and design, editing;
Andreev D.A. — material collection and processing, collection of literature data, compilation of the list of literature, writing the text;
Pakhuridze M.D. — material collection and processing, writing the text;
Sizov G.G. — material collection and processing.
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: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

Introduction. The performance of professional duties in stressful conditions leads to the emergence of low-adaptive forms of guilt in medical workers.

Purpose of the study is to identify the features of low-adaptive forms and guilt types in medical workers in the post-COVID period.

Material and methods. Eight hundred sixteen selected medical workers with pronounced maladaptive forms and guilt types participated in the study using questionnaires for measuring maladaptive forms and guilt types.

Results. Above average levels of guilt of comprehensive responsibility, survivor’s guilt, low-adaptive forms of guilt in general, moral norms were revealed. The average level of guilt in general, the guilt of self-hated, the guilt of separation, the guilt of the state, the guilt of the trait. There was established a high correlation between moral norms and the guilt of the survivor, the guilt of comprehensive responsibility and the general indicator of low-adaptive forms of guilt; noticeable connection: guilt of comprehensive responsibility and guilt-state, guilt-feature and general indicator of guilt; survivor’s guilt, guilt-feature and overall guilt score.

Limitations. The results of the study cannot be extrapolated to the professional profiles of all medical workers, since forms and types of guilt may be associated with other symptoms of post-traumatic stress.

Conclusion. The results of the study will allow healthcare managersorganizers to systematically monitor stressful working conditions in order to prevent and level them, as well as to implement the prevention of low-adaptive forms and types of guilt in medical workers to maintain and strengthen their professional health.

Compliance with ethical standards. Voluntary informed consent of the diagnostic participants was obtained (only adult respondents voluntarily participated in the survey, which is necessary and sufficient; the study was organized and conducted in accordance with the Code of Ethics on 14.02. responsibility, honesty).

Contribution of the authors:
Polyakova O.B. — concept and design of the study, collection and processing of material, writing text, compiling a list of references, statistical data processing;
Bonkalo T.I. — organization of research, scientific supervision, editing.
All authors — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

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

Received: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

Introduction. Even a decade ago, an increase in mortality from circulatory diseases (CVD) in Russia until 2050 was predicted, in parallel with an increase in number of people older than working age. The forecast did not materialize.

The purpose is to identify the relationship between the level and structure of mortality from CVD and the proportion of elderly people.

Materials and methods. Official Rosstat data on mortality in Moscow and the Russian Federation for period 1975–2019 were used. There was made a comparison of age patterns of mortality from CVD at the beginning and end of the analysed period in the country and in the capital separately for men and women. For simplicity of calculations, the trend in the gain in mortality with increasing age was approximated by an exponential function in the Microsoft Excel Software.

Results. Since 2003 to 2019 in the Russian Federation, mortality from CVD was found to decline among men and women by 2.0 and 2.2 times. In Moscow, with a 2.3- and 2.2-fold decrease in mortality from CVD. During this period losses fell as a result of premature death from CVD by 1.8 and 1.9 times in men and women, as well as in Moscow.

Limitations. The quality of analysed data is limited by quality of coding of the causes of death in different regions and by accuracy of estimate of age structure of the population in period between population censuses.

Conclusions. Demographic aging does not lead to an increase in the contribution of CVD to the mortality of the population. The decrease in mortality from CVD significantly contributes to the growth of life expectancy and is accompanied by an increase in the proportion of elderly people. Only during periods of increased mortality, the contribution of CVD to it is directly proportional to proportion of elderly people. Age structure of mortality from CVD indicates the need to strengthen measures to prevent mortality.

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

Contribution of the authors:
Sabgayda T.P. — research concept and design, collection and processing of research material, editing;
Evdokushkina G.N. — statistical data processing, text writing and editing;
Ivanova A.E. — research concept and design, collection and processing of research material, 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 interests. The authors declare no conflict of interest.

Received: June 22, 2023
Accepted: August 23, 2023
Published: November 3, 2023

The year 2022 marks the 120th anniversary of the death of Nikolai Nikolaevich Betling, one of the most prominent representatives of pre-revolutionary medicine in the Taurida Gubernia. For more than thirty years he was the head of the Taurida Gubernatorial Zemstvo Hospital, which he took over in a very difficult and crucial period — soon after it was transferred from the Prikaz Public Charity to the Taurida Gubernatorial Zemstvo. It was his efforts that laid the foundation for the development of not only the practical medicine of the region, but also the surgical research center of the Gubernia. For his outstanding contribution to medicine, Betling was awarded not only several orders, but also the title of honorary nobility, and after his death a street in Simferopol was named in his honour. However, over a century later, Betling’s legacy has been forgotten. Today Betling’s name is known only to some local historians and is practically not mentioned in scientific publications. The authors of the article analyzed pre-revolutionary literature sources and searched among archival documents, plans and photographs. Today, in the main building of the former hospital is a Department of Human Anatomy of Institute “Medical Academy named after S.I. Georgievsky”, where medical students of junior courses are trained. Resurrecting the memory of such figures of Medicine as Betling is a fertile ground for creating a sense of pride in the national history of Medicine among aspiring physicians.

Contribution of the authors:
Zvereva E.E. — research concept and design, material collection and processing, text writing;
Kutia S.A. — research concept and design, processing, editing.
All authors — approval of the final version of the article.

Acknowledgment. The study had no sponsorship.

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

Received: February 01, 2023
Accepted: April 12, 2023
Published: November 3, 2023