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Manager Zdravoochranenia 2022 #8
Published: 2022-08-28
614
CONTENT OF THE ISSUE
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Professional standards: the role and importance in ensuring the quality and safety of medical activities, the main tasks
The article deals into detail with the application of professional standards in the activities of medical organizations and in the training of medical personnel. The authors substantiate that the application of professional standards in the regulation of labor relations of medical workers, as well as in the development and implementation of both professional educational programs and additional professional programs is an essential tool for ensuring the quality and safety of medical activities. The main tasks facing today in the field of the application of professional standards, the implementation of which will contribute to improving the quality and safety of medical activities, are identified: the creation of legal mechanisms for the effective application of professional standards by educational organizations; ensuring continuity in the application of professional standards between the training of medical personnel and the regulation of labor relations in the process of medical activity; the need to constantly maintain professional standards up to date
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Multifactorial assessment of the capacity of the laboratory service of the region in the diagnosis of COVID‑19
The ubiquity of the new coronavirus infection contributed to the mobilization of all authorities, and a colossal burden fell on the health care system. An important stage in patient management is timely laboratory diagnostics, which allows you to adequately carry out medical and diagnostic, anti-epidemic and preventive measures. The integral indicator characterizing the readiness of the laboratory service to diagnose a new coronavirus infection is the capacity of the laboratory service. The material and technical base, personnel resources, labor organization, informatization exert their influence on the maximum design capacity of the laboratory, the current real productivity of the laboratory, the operational productivity of the laboratory. It was revealed that significant factors affecting the laboratory activity are the number of personnel, the presence of automatic nucleic acid isolation stations, and the number of amplifiers. Timely integrated material and technical support, qualified personnel are the basis for successful solution of the assigned tasks of laboratory diagnostics.
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Self-assessment of health and conditions for receiving medical care by residents of the Russian Federation
In the context of higher interest of healthcare executives in patient-centeredness, development of value-based healthcare and increasing public satisfaction with medical care, it is very important to have access to detailed information about how people evaluate the care provided, as well as to specify problems associated with receiving care. Such detailed information can provide directions for further development of organizational technologies and serve basis for developing management decisions.
T h e p u r p o s e of the study is to analyze results of sociological surveys of the Russian population on self-assessment of health and conditions for receiving medical care.
M a t e r i a l a n d m e t h o d s . The study used data available from the Rosstat (Federal State Statistics Service) official website – “Comprehensive monitoring over living conditions of the Russian population” (conducted in 2014, 2016, 2018 and 2020) in terms of questions related to receiving medical care by the survey respondents, based on a sample survey of representatives of various groups and population strata covering 10 thousand households. Analysis of the presented data was carried out using descriptive statistics methods by the following sections: respondents’ self-assessment of health, smoking and alcohol consumption, receiving outpatient care, receiving dental care, seeking emergency medical care, receiving inpatient care, non-care seeking if medical care is needed.
R e s u l t s . The share of those who rated their health as “excellent” and “good” has increased. It should be noted here that males were more optimistic in assessing their health status than females. The share of the respondents reporting a chronic disease diagnosed by a doctor decreased from 30.2% in 2014 to 27.2% in 2020. There is no significant difference between urban and rural population.
The share of non-smokers and those who have never smoked decreased from 63.5% in 2014 to 62.1% in 2020. The share of male alcohol consumers remained stable adding up to 70%, while the female share tended to increase from 49.5% in 2014 to 52.1% in 2020.
Assessment of an average time spent on making an appointment with a doctor in outpatient settings has not changed in dynamics and equaled to about 18 minutes. The share of those receiving timely medical care out of those applied for care increased from 92.6% in 2016 to 95.1% in 2020.
The share of those calling an ambulance tended to decrease: from 10.8% in 2014 to 10.1% in 2020. According to the surveys’ results, every year some 7–8% of the population receive specialized medical care in inpatient settings.
The analysis of cases of non–care seeking if medical assistance is needed showed a decreased share of such respondents: 33.6% in 2014, 33.0% in 2016, 34.5% in 2018, and 29.2% in 2020. The share of those failing to get to or experiencing difficulty getting to a health care facility equaled to 3.3%, 2.5%, 2.8% and 1.9%, respectively. 7.2% of the respondents had “no time” for care seeking in 2014, 8.2% in 2016 and 2018, and 4.7% in 2020. A significant decrease in this indicator is rather logical and unsurprising in the context of the pandemic caused by a new coronavirus infection.
C o n c l u s i o n s . From 2014–2020, self-assessment of health has improved; in general, males rate their health higher compared to females.
Men smoke 5 times more often than women. Generally, they start smoking during the teen years. As a positive trend, we can point out an increasing share of people who quit smoking.
Men drink alcohol 9 times more often than women. The share of the female alcohol consumers tends to increase.
Negative trends in care delivery are as follows: increased waiting time for emergency medical care; increased average number of days waiting for hospital admission; decreased share of those admitted to the hospital on the day of the visit.
Positive trends in care delivery include the following: decreased denials of outpatient care due to lack of necessary equipment or medicines, shorter lines in waiting premises to see a doctor; decreased offers of payed services; decreased waiting time for a doctor’s appointment; increased share of those receiving timely dental care.
A tendency among the respondents towards self-medication and not seeking medical care due to lack of time has decreased. -
The issue of age-related characteristics of the prevalence of diabetes mellitus among the population of various countries
Without interventions to halt the rise in diabetes, it is believed that by 2045 there will be at least 629 million people living with diabetes in the world. Currently, four out of five people with diabetes, approximately 80% of the world’s 463 million, live in lowand middle-income countries, and the incidence of diabetes is increasing in poorer, marginalized, socioeconomically vulnerable and indigenous communities. The prevalence of type 2 diabetes with onset in youth, defined as diabetes diagnosed before the age of 25, is increasing worldwide. It should be noted that type 2 diabetes, which occurs at a young age, most often manifests itself in the second decade of life. There are about 652 thousand children with type 2 diabetes in the world. It is estimated that there will be around 41,600 new cases of diagnosed type 2 diabetes in children and adolescents worldwide in 2021. Along with the increase in the prevalence of diabetes among children and adolescents, there is an increase in the incidence of pre-diabetes preceding the development of type 2 diabetes. They found an 8% risk of progression from pre-diabetes to type 2 diabetes over a 3-year period, confirming the importance of interventions to reduce obesity, pre-diabetes, and insulin resistance.
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Prediction of disease outcomes in patients with COVID-19 based on the EQ 5D 5L questionnaire
In order to provide effective medical care to patients with COVID-19 in hospitals, the disease outcome prognosis is of
considerable importance. The authors of the study suggested a relationship between health-related quality of life indicators and the outcomes of the disease of patients hospitalized because of COVID-19.
P u r p o s e . Retrospective study of the relationship between health-related quality of life in patients with COVID-19 on the first day of hospitalization with the outcomes of the disease in a hospital and at the stages of rehabilitation up to 180 days following the discharge to predict outcomes at the early stages of the disease.
M a t e r i a l s a n d m e t h o d s . The study was conducted at the “Kommunarka” Moscow Multidisciplinary Clinical Center of the Moscow City Health Department from March 2021 to April 2022. Data collection was carried out using a paper-and-pencil Russian version of the EQ-5D-5L questionnaire (Tracking Number: 41183), on the first day of admission of patients to the hospital. Additional patient data was extracted from electronic health records. Two types of EQ-5D-5L questionnaire results were evaluated: Index EQ and the Visual Analog scale (VAS) EQ. All calculations of the regression model were carried out using the R 4.2.1 language in the RStudio 2022.02.3 Build 492 software environment.
F i n d i n g s . In the obtained logistic regression model, the extremely high statistical significance of the variable “Index EQ” (p<0.01) was demonstrated, the greater the value of the variable “Index EQ” is, the less the probability of a fatal outcome is.
At the same time, there is no statistically significant relationship between the variable VAS EQ under study and the probability of a fatal outcome.
C o n c l u s i o n s . An extremely significant relationship between the calculated health-related quality of life index, Index EQ, and outcomes of COVID-19 when patients were admitted to the hospital was revealed, which makes it possible to use it as a predictor of disease outcomes at early stages. No significant relationship between the VAS EQ and the outcomes of the disease in patients with COVID-19 on the first day of hospitalization was revealed, which makes it impossible to use it as a predictor of disease outcomes at the early stages. Application of the health-related quality of life index, Index EQ can be used to make medical decisions in order to early predict tactics of patient management in hospital treatment and rehabilitation. -
Population and birth rates in assessing dynamic changes in the reproductive potential of the region
The article analyzes the dynamic changes in the main indicators of the reproductive potential of the region, such as the
number of female and male population of the region (on the example of the Republic of Dagestan), the structure of women by age groups and changes in the number of women of reproductive age, birth rates. The theoretical material for the study was legal documents and statistical collections, literary sources, as well as materials of statistical analysis of the demographic situation in the regions; in the course of the analysis, the following methods were used: study and generalization of experience, analytical, statistical.
M a t e r i a l s a n d m e t h o d s : bibliographic, sociological, statistical and analytical methods.
F i n d i n g s . The results of the study showed that the number of women in the age groups of 15–19 years and 20–24 years has noticeably decreased in the republic, in recent years the number of women in the age group of 25–29 years has been declining (after their stable growth in previous years), and negative changes in the structure of the number of women of young childbearing age may cause a decrease in the birth rate in the coming years, despite the still high level of large families. -
Organizational and legal issues of examination of minors in a gynecological hospital
The organizational and legal aspects of gynecological care for minors remain a matter of debate, and the indicated topic requires further detailed study. Due to the limited scope of work, not all relevant aspects on the issue under consideration are considered, but only issues of providing information about a minor to law enforcement agencies without the consent of the patient and her legal representative. The relevance of the study is largely due to the fact that the answer to the indicated questions causes difficulties not only among medical professionals, but also among lawyers.
The authors set out to substantiate the main features of the organization of gynecological care for minor patients, as well as provisions for the observance of their rights. To achieve the goal, the authors set the tasks of determining the legal status of minor patients of the gynecological hospital, the accompanying duties of medical workers and medical organizations, development of practical recommendations on the actions of a medical organization when examining a minor and establishing the fact of pregnancy, as well as interaction with law enforcement agencies.
The study materials were the provisions of regulatory legal acts in the field of health protection and ensuring the rights of minors, as well as judicial practice on the issue under study.
When conducting the study, the authors used general scientific and private scientific methods of cognition, such as analysis and synthesis, formal and legal, interpretations.
During the examination of a minor in a gynecological hospital, doctors face the need to ensure the rights of minor patients both to sexual inviolability, sexual freedom and the normal moral and physical development of the minor’s personality, as well as to ensure the protection of personal data and medical secrets. I correspond to these rights the obligations of medical workers and medical organizations not only to transfer information about the patient to law enforcement agencies in cases established by law, but also to comply with the requirements of the law on the protection of information constituting a secret protected by law.
As a result of the study, the authors came to the following conclusions. When establishing the fact of pregnancy of a minor or the entry of a minor into sexual intercourse (other sexual acts), if there are no sufficient grounds to believe that harm to her health was caused as a result of illegal actions, the medical professional (doctor) must explain to the minor (her legal representative) the possibility of transmitting relevant information to the internal affairs body; obtain written consent to the transfer of relevant information to the internal affairs body, which is stored in a medical organization; transfer relevant information to the medical officer responsible for timely informing the internal affairs bodies.
The results of the study can be used by gynecological hospitals and other medical institutions in organizing the provision of gynecological care to minor patients, interaction with the internal affairs bodies to protect the rights and legitimate interests of minors. -
About some methodological issues of remuneration of medical workers
The article discusses a number of methodological issues of remuneration that arose against the background of the suspension of special social payments for work with COVID‑19 and their replacement with compensation payments, as well as the postponement of pilot projects that were to be implemented in order to prepare for the introduction of a new system of remuneration for medical workers.
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Issues of changing labor relations in conditions of partial mobilization
The Presidential decree on partial mobilization addresses a wide range of issues requiring regulatory regulation. This publication examines a relatively narrow, but extremely important aspect concerning labor relations with the mobilized.
