State Regulation of Ensuring the Quality Medical Care During Martial Law in Ukraine: Lessons for the International Community.

Background: Nowadays, the quality of medical care and health care measures is considered the main target function of the health care system and at the same time the determining criterion for its activities. Objective: The article examines state regulation of medical care quality post- COVID and during martial law, identifying improvement areas. It emphasizes state roles in healthcare standardization, continuous feedback monitoring, and studying patient satisfaction. Interrelationships among Ukraine's state regulation mechanisms are determined, highlighting the need to enhance tools such as criteria and quality indicators for medical care assurance. Methods: The authors of this article utilize various scientific methods, including analysis, synthesis, induction, and deduction, as well as historical and legal, formal legal, and comparative legal methods to examine the state regulation of ensuring the quality of medical care during martial law in Ukraine. Results: The article considered the interrelationships of mechanisms and instruments of state regulation of quality assurance of medical care in Ukraine. Conclusions: The state should enhance medical care quality regulation, drawing on international experiences from the EU and the USA and adapting best practices to national circumstances. The resilience of the healthcare system depends on effective quality assurance, ensuring preparedness, stability, and ongoing improvement prospects.

Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic.

The COVID-19 pandemic has led to significant disruptions in various healthcare systems. In Romania, the elective procedures in the orthopedic and traumatology specialty were one of the most affected. The study aims to investigate the influence of the COVID-19 pandemic on patient perceptions of quality in these departments. Standardized assessment tools were used, which consist of satisfaction questionnaires addressed to patients in order to assess the quality of health services in orthopedics and traumatology departments. Thus, a retrospective study was conducted using satisfaction questionnaires addressed to patients admitted to the orthopedics and traumatology departments of the County Clinical Emergency Hospital Bihor between January 2019 and December 2022. Eight reports, based on 746 questionnaires conducted during the studied period, were evaluated. To gauge patient satisfaction, Likert scales featuring five response options were used. A total of 627 questionnaires were valid, the exclusion criteria being incomplete questionnaires (the patients did not respond on all questions, n = 119). Four domains were analyzed: demographic data, hotel conditions, quality of medical care, and overall satisfaction. Demographic data highlight that patients exhibited an equitable distribution across residences, with 50.2% hailing from urban locales, while 53.5% (n = 333) were female. Regarding the overall impression, in 2020, there was a decline in the top rating of 5 compared to 2019, dropping to just 45.10% from 53.45%. Scores of 4 increased to 41.83%, while scores of 3 stayed under 8.5%. Scores of 2 and 1 were negligible. In 2021 and 2022, we can observe a sustained increase in the number of patients who awarded 5 points for overall impression and a decrease in the number of patients who awarded 4 points compared to previous years. The maximum difference between 2020 and 2021 and the period before and after this period was 27.24% (p-value < 0.001). The results indicate that while overall impressions of the hospital remained positive throughout the studied period, there were notable fluctuations in satisfaction levels during the pandemic. Patient satisfaction with attending physicians dipped in 2020 from 86.70% to 77.78% but recovered by 2022. The same trend can be observed with nurses and caregivers, as well as hotel services, during this period. These findings underscore the importance of addressing patient concerns and improving the quality of care delivery, particularly during times of crisis.

Quality of care measurement for patients with ovarian cancer in Japan.

AIM: Quality of care is important to reduce disease progression, and improve both survival and quality of life. The Japan Society of Gynecologic Oncology has published treatment guidelines to promote standardized high-quality care for ovarian cancer in Japan. We developed quality indicators based on the guideline recommendations and used them on large datasets of health service use to examine the quality of ovarian cancer care. METHODS: A panel of experts developed the indicators using a modified Delphi method. Adherence to each indicator was evaluated using data from a hospital-based cancer registry of patients diagnosed in 2018. All patients receiving first-line treatment at participating facilities were included. The adherence rates were returned to participating hospitals, and reasons for nonadherence were collected. A total of 580 hospitals participated, and the study examined the care received by 6611 patients with ovarian cancer and 1879 with borderline tumors using 11 measurable quality indicators. RESULTS: The adherence rate ranged from 22.6% for "Estrogen replacement within 6 months of operation" to 93.5% for "Bleomycin, etoposide, and cisplatin for germ cell tumor more than Stage II." Of 580 hospitals, 184 submitted the reasons for nonadherence. CONCLUSIONS: The quality of ovarian cancer care should be continuously assessed to encourage the use of best practices. These indicators may be a useful tool for this purpose.

[Risk factors, treatment organization and quality indicators for chronic obstructive pulmonary disease in primary care settings: Dutch experience].

INTRODUCTION: Chronic obstructive pulmonary disease (COPD), usually in advanced stages, is associated with high mortality, being the third leading cause of death worldwide. In the Netherlands, care delivery to patients with COPD has become a focus of the regional medical community, since the COPD death rates in this country are higher than the European Union average. However, between 2011 and 2021, the number of people with COPD (under follow-u by general practitioners) decreased. The experience of this country is interesting, as a large set of measures to improve the situation has been developed and implemented in this region. The purpose of the study was to analyze the experience of the Netherlands in organizing medical care for COPD in primary care settings. MATERIAL AND METHODS: The search for scientific literature sources was carried out using the PubMed database and Google system. The search time horizon equaled to 5 years. RESULTS: In the Netherlands, in the system of care delivery to patients with COPD, primary care settings are heavily burdened. The article summarizes approaches to identify COPD risk factors, summarizes current clinical recommendations as of December 2022, and highlights findings of the study on medical digital platforms with the potential to organize continuous monitoring of patients. The paper exemplifies criteria for assessing the treatment quality in specialized care settings, including primary care. DISCUSSION: It is assumed that the most effective measure to further improve efficacy of COPD treatment is the introduction of remote digital medical devices. A possible integration of the updated standards and quality indicators into digital services will further strengthen the concept of continuous automated remote monitoring of COPD patients. Evidence-based selection and introduction of effective digital solutions into current practice will improve quality of care delivery to patients.

Comparative Analysis of Patient Satisfaction Surveys-A Crucial Role in Raising the Standard of Healthcare Services.

(1) Background: The study aimed to assess the patients' perception of the quality of the medical staff's care, the hotel's services, and the hospital's overall impression as well as to determine the best rating scale through a comparative analysis of patient satisfaction questionnaires. (2) Methods: A retrospective study was performed based on satisfaction questionnaires addressed to the patients hospitalized in the Orthopedics and Traumatology departments of the County Clinical Emergency Hospital Oradea between 2015 and 2019. Three different types of questionnaires were used during the study period, with the number of questions varying between 30 (variant A) and 37 (variant C). The evaluation was done using the Likert scales with three, four, or five answer variables. (3) Results: The items that we found to be present in all three categories of surveys and for which at least two different questionnaire variants used the Likert scales with various answer variables were chosen. In terms of the treatment given by the medical staff, hotel services, and the overall perception of the hospital, the patients perceive a higher level of quality. (4) Conclusions: The level of patient overall satisfaction or general impression about the hospital is strongly dependent on the quality of medical care provided by the doctors and the specific hotel conditions of the hospital. The quality assessment using the Likert rating scale with five binary variables is more accurate.

EXPERIENCE OF INTEGRATED MANAGEMENT OF PATIENTS WITH DIABETIC RETINOPATHY (EXAMPLE OF ANALYSIS OF PERFORMANCE INDICATORS OF A MULTI PROFESSIONAL HEALTHCARE FACILITY).

OBJECTIVE: The aim: Conducting an analysis of indicators of the dynamics and prevalence of the main classes of chronic non-infectious diseases of the contingent attached to a multidisciplinary health care institution of the population contingent, to determine the main predictive trends of morbidity for the formation of a strategy for the prevention of diabetes complications, in particular, one of the most dangerous complications - diabetic retinopathy. PATIENTS AND METHODS: Materials and methods: In our work, we used the bibliosemantic method and structural-logical analysis. During the research, we analyzed individual indicators of the health status of patients over 18 years of age, who are attached for medical care to the State Scientific Institution «Scientific and Practical Center of Preventive and Clinical Medicine¼ of the State Administrative Department. Our main focus is on the prevalence of diabetes and its complications. CONCLUSION: Conclusions: The stability of the dynamics of the general morbidity indicators for the most common nosological forms of diseases of the main rating classes of diseases indicates the effectiveness of measures for the prevention and early diagnosis of diseases among the attached contingent. The levels of coverage of dispensary supervision of patients of SIS «SPC PCP¼ SAD are quite high (more than 90%). Performing preventive dynamic observations of patients with diabetes and diabetic retinopathy and observing the basic principles of integrated management allows to improve the results of treatment and the prognosis of the course of the disease, because the onset of retinopathy often occurs without obvious symptoms. An important factor is the constant updating and implementation of medical and technological documents for the constant improvement of the quality of medical care.

A MEDICAL AND SOCIOLOGICAL STUDY AMONG DOCTORS ON THE MOTIVATIONAL COMPONENT OF ENSURING THE QUALITY OF MEDICAL CARE IN HEALTH CARE FACILITIES.

OBJECTIVE: Aim: To analyze the impact of medical reform on the motivational component of improving the quality of medical care in health care facilities in Sumy based on the results of a medical and sociological study of doctors. PATIENTS AND METHODS: Materials and Methods: The study involved 154 doctors working in inpatient and outpatient departments of health care facilities in Sumy. Sumy in June-August 2023. The study used a systematic approach, bibliosemantic, comparative and statistical analysis, and logical generalization. The data were processed and statistically analyzed using Google Forms and Microsoft Excel 2010 for Windows. RESULTS: Results: The study showed that 49 respondents (31.8%) are satisfied with the material and technical support at the workplace and working conditions. Almost all doctors (138 people (89.6%)) said that the actual amount of their salary does not correspond (partially or fully) to the workload at the workplace. Only 4.5% of them said that they receive extra payments for the quality of healthcare services, 21.4% of them said that they receive extra payments periodically, and 74.1% said that they do not receive extra payments at all. Despite the high level of workload and dissatisfaction with salaries, the majority of respondents (109 people (70.2%)) would not agree to change their profession to another one, even if the salary was higher. According to doctors, the most important incentives for improving the quality of healthcare services are: moral satisfaction from work and well-coordinated teamwork (76.6% of answers), financial incentives (74.7% of answers), opportunities for professional and career growth (48.7% of answers), respect from patients and society (46.8% of answers), and management recognition (13.6% of answers). CONCLUSION: Conclusions: The study has shown that today, in the context of health care system reform, there is practically no effective motivational component to improve the quality of health care in health care facilities in Sumy: 40.9% of people gave negative answers, 42.2% of people indicated only its partial existence. Regardless of the length of service, for all respondents, one of the most important motivational incentives is not only material but also moral factors and public recognition.

Dimensiones que caracterizan la lealtad de los clientes internos en servicios de salud

Introducción: La satisfacción de los integrantes de una organización de cualquier tipo y, en particular, de aquellas que prestan servicios médicos es un tema de mucho interés e importancia si de lograr altos niveles de satisfacción y, por ende, de lealtad de los pacientes y sus familiares se trata. Objetivo: Determinar las dimensiones y atributos para la satisfacción y lealtad del cliente interno en instituciones de salud en Barranquilla durante el año 2021. Método: Se realizó un estudio exploratorio descriptivo en instalaciones relacionadas con los servicios de salud en Barranquilla en 367 funcionarios (n=367) aunado con la revisión de la literatura correspondiente. Se aplicó un cuestionario con el fin de conocer las dimensiones y atributos antes mencionados. Los atributos fueron agrupados por eje de acuerdo a su mayor peso y sobre la base de esto fue definida el nombre de las dimensiones considerando diversos estudios realizados y la experiencia. Se realizaron pruebas para determinar fiabilidad y validez para la encuesta, así como pruebas de adecuación muestral. Se aplicó el análisis factorial y componentes principales. Resultados: El 79 % de la varianza total abarcó las dimensiones: trabajo en equipo, reconocimiento laboral, condiciones de trabajo y beneficios laborales. Se mostró una distribución de los atributos en las dimensiones capaz de explicar la situación en un alto nivel. Conclusiones: El cliente interno es factor clave en una organización, considerándose adecuados los atributos propuestos para la satisfacción y lealtad del mismo en instituciones de salud.

Introduction: Satisfaction of internal members of any organization, in particular those which provide medical services, is of a great interest and importance when it comes to achieve high levels of satisfaction and, therefore, loyalty of both patients and their families. Objective: To determine dimensions and attributes to get internal customer satisfaction and loyalty in health institutions in Barranquilla, throughout 2021. Method: An exploratory descriptive study was carried out in healthcare facilities in Barranquilla. The study was conducted in 367 health officials (n=367). Also it was carried out a review of related literature. It was applied a questionnaire to determine the dimensions and attributes. The attributes were grouped by axis according to those with widest impact and, based on this assess, the name of the dimensions was defined taken into account various previous studies and experiences. Factor and principal component analyses were applied. Results: The 79 % of the total variance covered the following dimensions: teamwork, job recognition, working conditions and work benefits. The attributes distributed in the dimensions can certify the high level found. Conclusions: The internal customer is a key factor in any institution, and the proposed attributes for customer satisfaction and loyalty in health institutions are considered adequate.

Introdução: A satisfação dos membros de uma organização de qualquer tipo e, em particular, daqueles que prestam serviços médicos é um tema de grande interesse e importância se pretendemos alcançar elevados níveis de satisfação e, portanto, de fidelização dos pacientes e seus parentes são tratados. Objetivo: Determinar as dimensões e atributos para a satisfação e lealdade do cliente interno em instituições de saúde em Barranquilla durante o ano de 2021. Método: Estudo descritivo exploratório realizado em instalações relacionadas a serviços de saúde em Barranquilla em 367 funcionários (n=367) juntamente com a revisão da literatura correspondente. Aplicou-se um questionário para conhecer as dimensões e atributos mencionados. Os atributos foram agrupados por eixo de acordo com seu maior peso e com base nisso foi definido o nome das dimensões considerando diversos estudos e experiências. Foram realizados testes para determinar a confiabilidade e validade da pesquisa, bem como testes de adequação da amostra. Aplicou-se análise fatorial e componentes principais. Resultados: 79% da variância total cobriu as dimensões: trabalho em equipe, reconhecimento do trabalho, condições de trabalho e benefícios do trabalho. Foi apresentada uma distribuição dos atributos nas dimensões, capaz de explicar a situação em alto nível. Conclusões: O cliente interno é um fator chave em uma organização, considerando adequados os atributos propostos para a satisfação e fidelização do mesmo nas instituições de saúde.

[THE NATIONAL PROJECT "HEALTHCARE" AND ITS IMPACT ON THE EXPORT OF THERUSSIAN MEDICAL SERVICES].

The article reports on the main directions of the national project "Healthcare", providing for the formation of a medical sector with hospitals and polyclinics fitted with modern equipment, online services for the convenience of patients and medical personnel and staffed with highly qualified medical personnel. The author analyses the factors influencing the development of medical tourism in the Russian Federation. Preserving the best traditions of medical practice and developing together with global trends in the field of health preservation, Russian medicine is becoming innovative. In order to solve the tasks set to expand the scope of medical care to foreign citizens, the federal project "Development of the export of medical services" is being implemented within the framework of the national project "Healthcare", which has already united 71 regions of the country. The purpose of this work is to identify the factors influencing the development of the export of the Russian medical services within the framework of the implementation of the national project "Healthcare". In conclusion, it is reported that the implementation of the project contributes to the inflow of investment funds into the national healthcare system, the promotion of the Russian medical centers and the creation of a positive image of the country abroad.

[IMPROVING THE ORGANIZATION OF LABOR AND THE QUALITY OF MEDICAL CARE AT PARAMEDIC AND OBSTETRIC STATIONS].

In the provision of primary health care to the rural population, the role of paramedic and obstetric stations (FAP) is great. The purpose of the study is to develop a system of measures aimed at improving the quality of medical care provided at paramedic and obstetric stations. The study was conducted in 2019-2020 on the basis of 26 FAP of 12 central district hospitals (CRH) of the Republic of Dagestan. The organization of labor of 26 paramedics and 26 midwives during 1740 hours was studied by the method of time-lapse observation. The content of 16511 visits by the FAP population was analyzed. The expert evaluation method studied the quality of medical care to 445 patients on 7 FAP. The main work of FAP paramedics accounts for 74.5%, and for midwives - 76.3% of all labor costs. A significant share in the cost structure is occupied by preventive (22.9% for paramedics and 27.8% for midwives) and diagnostic and therapeutic activities (17% and 15.6%). There are high costs for transitions and relocations (17.3% and 14.1%) and for working with documentation (13.7% and 14.5%). In the structure of visits by the population of paramedics and midwives of FAP, for reasons of the greatest proportion are visits with therapeutic and diagnostic purposes (37%), followed by visits for medical appointments (32.8%) and preventive (23.9%). The quality of medical care provided by paramedics to patients with therapeutic diseases was inadequate in 23.8% of cases. Every third (35.7%) patient was treated with FAP unreasonably. Out of the total number of patients who were treated unreasonably on FAP, according to experts, 62.5% had to be treated in the CRH, 34.8% - in the district hospital (outpatient clinic).

FEATURES OF SOCIAL DYSFUNCTION, ASSESSMENT OF LEVELS OF SOCIAL FRUSTRATION AND SATISFACTION WITH THE QUALITY OF MEDICAL CARE IN PATIENTS WITH SCHIZOPHRENIA ON THE BACKGROUND OF SOMATIC COMORBIDITY.

OBJECTIVE: The aim: To study the features of social dysfunction, assess the levels of social frustration and satisfaction with the quality of medical care in patients with schizophrenia on the background of somatic comorbidity. PATIENTS AND METHODS: Materials and methods: The study included 105 patients (55 women - 52.38% and 50 men - 47.61%) with a verified diagnosis of schizophrenia (F20.0-F20.3). The psychopathological condition of patients was assessed according to the "Positive and Negative Syndrome Scale" (PANSS). A special psychodiagnostic technique by L. I. Wasserman in the modification of V.V. Boiko was used to assess the level of social frustration. Peculiarities of social dysfunction were assessed based on the "Personal and Social Performance scale" (PSP). "The Health Resource Use Questionnaire" was used to obtain the information about the coverage of this patient with primary or specialized somatic care during the last three months. General and systematic examination of the patient was also performed, physical methods of diagnosis (palpation, percussion, auscultation) were applied, body mass index was calculated. Consultations of specialists, instrumental (ECG, ultrasound, Echo-CS, etc.) and laboratory diagnostic methods were prescribed depending on the detection or suspicion of concomitant somatic pathology. RESULTS: Results: The results showed significant social isolation of the respondents, their contacts were limited to communication with relatives and friends. This was confirmed by the data of social functioning on the PSP scale, according to which the most pronounced violations in the examined patients were found in the areas of "personal and social relationships", "socially useful activities, including work and study". It should be noted that the higher the rates of social dysfunction, the stronger the level of frustration (p<0.05). In particular, the low level of satisfaction with the field of medical services due to its inaccessibility, according to respondents, attracts attention. According to the relatives, the main reason for this restriction was the patients' lack of awareness of their condition, neglect and indifference. CONCLUSION: Conclusions: Further attention is required to develop strategies to improve comorbid treatment in the patients with schizophrenia regardless of whether this situation is the result of negative attitude of health professionals towards patients with mental illness, or the result of the patients' ignorance of their physical condition, or other factors.

[Medical expert evaluation of medical care for patients with musculoskeletal injuries]. / Mediko-ekspertnaya otsenka okazaniya meditsinskoi pomoshchi patsientam s travmami oporno-dvigatel'nogo apparata.

The objective of the study is to analyze 220 forensic medical examinations on criminal and civil cases and pre-investigation checks concerning the quality of emergency trauma care, involving an orthopedic traumatologist as a member of the expert panel. The main aspects of the forensic evaluation of medical care for patients with musculoskeletal injuries are described, including a thorough review of medical documentation data, completeness of past and present medical history in the medical records, injury mechanism, and completeness of the trauma course description in the medical records. The reasons for the forensic examinations, the causes of the main types of defects in medical care, and their relation to adverse outcomes were determined.

Assessment of the Level of Satisfaction with Medical Care of Patients Treated in Osteoporosis Clinics as an Indicator of the Quality of Medical Care.

The aims of this research are to assess the level of satisfaction with medical care among patients treated in osteoporosis clinics and to determine the relationship among the frequency of visits to the doctor, the duration of treatment, socio-demographic factors, and patient satisfaction with the medical care they receive. The study was conducted from August 2016 to July 2018 at osteoporosis clinics in eastern Poland. The study participants were 312 patients treated for osteopenia or osteoporosis. The authors utilized two research instruments: the PASAT POZ questionnaire and their own questionnaire. The results indicate that the duration of osteoporosis treatment is a factor that significantly influences the level of satisfaction with medical care: the longer the treatment time, the poorer the assessment of the clinic, and therefore, the lower the patient degree of satisfaction. Our analysis shows that women assess clinics more positively overall. Additionally, the higher the study participants' age, the lower the general assessment of the clinic. A further analysis showed that respondents in better financial situations and with higher levels of education tended to assess clinics more favorably. The Pareto-Lorenz analysis indicated that the key element in general assessments of specialist clinics is the doctor. It is advisable for health service providers to monitor the quality of health care they are providing and make improvements. Therefore, further research is needed, especially in relation to chronic diseases such as osteoporosis.

[Satisfaction with the quality of medical care of the mentally ill patients and its determining factors]. / Udovletvorennost' kachestvom meditsinskoi pomoshchi psikhicheski bol'nykh i faktory, ee opredelyayushchie.

OBJECTIVE: To study satisfaction with treatment as a predictor of compliance in patients with mental disorders prone to committing socially dangerous acts (SDA). MATERIAL AND METHODS: The study included 83 patients of a psycho-neurological institution prone to commit SDA. The comparison group consisted of 88 mental patients who were not inclined to commit SDA. The material was collected using the method of anonymous survey according to the «Questionnaire for the Study of Satisfaction of the Population with Inpatient Medical Care¼. To interpret the data, quantitative and qualitative indicators were calculated. RESULTS: Satisfaction with treatment in consumers of psychiatric services is high, reaching 96.4% (n=80) in the main group and 97.7% (n=86) in the comparison group. Doctors' knowledge (95.2%, n=79 and 97.7%, n=86) and the level of trust in them (86.8%, n=72 and 90.9%, n=80) received the highest share of positive assessments by the patients. However, patients who are prone to commit SDA rate lower both medical care in general (68.7%, n=57 vs. 90.9%, n=80) and its individual parameters. Thus, 71.1% (n=59) believe that the doctor does not perceive them as an independent person, does not devote enough time to them (41%, n=34). In the comparison group, there are fewer such answers (11.4%, n=10; 4.5%, n=4). Patients highly (89.2%, n=74 and 94.3%, n=83) rate the living conditions in the hospital.The perceived quality of medical care is influenced by three groups of factors: the characteristics of consumers of medical services, the possibilities for using health services, the assessed and perceived need for medical services. Equally important is the study of contextual factors in the use of mental health services. CONCLUSION: The formation of a trusting relationship between the patient and the doctor and ensuring the latter maintain medical secrecy contributes to strengthening social interaction and, as a result, reducing the feeling of coercion, increasing internal motivation and satisfaction with the quality of treatment.

[Features of assessing the quality of medical care for patients with chronic heart failure of older age groups (review).]

The review presents a literature analysis on the quality of medical care in general and the criteria for their assessment. The main discussion is conducted in several areas: what indicators are currently available; which of them can be used in elderly and senile age groups; what indicators should be used in this category of patients. Based on the review, it should be concluded, that the existing quality indicators do not reflect the specifics of providing care to elderly and senile people with chronic heart failure. It is concluded, that many issues have not yet been resolved and further research is needed on this issue. In our opinion, the assessment of the quality of medical care for chronic heart failure, primarily in elderly and senile patients, should be carried out taking into account age characteristics and using additional quality indicators, which should be introduced in a separate paragraph in the profile order.

[The medicinal support in palliative medical care: The review of normative legal acts].

The every patient, receiving palliative medical care, in case of pain syndrome requires specified medicinal therapy often with prescription of narcotic analgesics. The WHO developed the model lists of essential medications (differentiated for adults and children), including both drugs for treatment of the most symptoms in palliative care support and analgesics. The article presents the results of analysis of normative legal acts regulating medication support of citizens of the Russian Federation in case of palliative medical care applying both drugs treating main manifestations of diseases and arresting pain syndrome. It is established that all main aspects of activity are normative regulated (especially issues of population support with narcotic analgesics). No legal collisions revealed.

[THE QUALITY INDICATORS TO ASSESS THE PROSTATE CANCER RADIOTHERAPY PERFORMANCE (BRIEF REVIEW)].

INTRODUCTION: The radiation therapy (RT) plays a tremendous role in the consistent treatment of prostate cancer (PCa). The research ideas underpinning the wide implementation of innovative digitalized continuous (nonstop) dynamic auditing are coming true. Simultaneously, there are increasing challenges in selection of RT quality indicators. OBJECTIVE: to study the pivotal indicators for RT quality assurance in treatment of PCa and to highlight the breaking through developments securing the delivery of top-quality cancer care in radiation oncology units. MATERIALS AND METHODS: The literature search was performed in the PubMed database and the Google system. The inquiries included such terms as: "quality of care", "quality assessment criteria", "indicators", "prostate cancer" and "radiation therapy". A logical and semantic approaches were applicated to select the relevant scientific resources. RESULTS: In most relevant studies, the variations of the Delphi technique are used to choose the quality assessment criteria. The targeted research papers describe the development of QIs for assessing the quality of radiation therapy in patients with locally advanced PCa; a hierarchical list of QIs has been generated. The adequate registration of information has huge impact on quality assessment to draw the definitive thorough conclusions. DISCUSSION: The further improvement of Delphi technique may form one of pillars for the development of valuable RT quality measures. Considering the math aspects and the physical nature of RT, it seems being important to include the key opinion leaders in the field of clinical oncoinformatics, radiation informatics, and specialists from technical industries in the expert committees for the selection of RT QIs.

La mejora continua y la formación de médicos en la Facultad "Manuel Fajardo" de La Habana / Continuous improvement and physician formation in Manuel Fajardo School of Medical Sciences of Havana

Introducción: El proceso de mejora continua constituye hoy la piedra angular de los esfuerzos para gestionar la calidad en la formación de los profesionales. Objetivo : Evaluar el estado actual de la Facultad "Manuel Fajardo" para el desarrollo del proceso de autoevaluación de la carrera de Medicina con fines de mejora continua. Métodos: El grupo de estudio estuvo integrado por 57 profesores y 143 estudiantes de primero hasta sexto años en el período enero-marzo de 2020. Se seleccionó, para los estudiantes, una muestra estratificada por conglomerado; y para los profesores, una estratificada simple. Además, se realizó una investigación observacional, descriptiva, de corte transversal. Resultados: La calidad del proceso de formación tuvo una percepción diferente entre profesores y estudiantes. Más del 20 por ciento de los encuestados consideró como no satisfactoria la preparación del personal no docente y administrativo, y su incidencia en la formación del profesional; acerca de la organización docente, estos la valoraron en más del 30 por ciento como no satisfactoria. Casi el 30 por ciento de los profesores manifestó como medianamente satisfactoria o insatisfactoria la actividad investigativa y laboral de los estudiantes; y más del 20 por ciento de los estudiantes estimó que había dificultades en la aplicación de las estrategias curriculares. Conclusiones: Se constataron insuficiencias que limitaban el continuo desarrollo del proceso de formación(AU)

Introduction: The continuous improvement process is nowadays the cornerstone of efforts made to manage quality in the training of professionals. Objective: To assess the current state of Manuel Fajardo School of Medical Sciences regarding the development of the self-evaluation process in the medical major for the purpose of continuous improvement. Methods: The study group consisted of 57 professors and 143 students from first to sixth academic years, in the period from January to March 2020. A sample stratified by cluster was selected for the students; while, for teachers, the sample was chosen by simple stratification. In addition, an observational, descriptive and cross-sectional research was carried out. Results: The quality of the training process had a different perception between professors and students. More than 20 percent of the respondents considered as unsatisfactory the preparation of nonteaching and administrative personnel and its impact on professional training. Regarding organization of teaching, more than 30 percent rated it as unsatisfactory. Almost 30 percent of the professors stated that research and work activity of the students was moderately satisfactory or unsatisfactory, while more than 20 percent of the students estimated that there were difficulties in the application of curricular strategies. Conclusions: Insufficiencies were found that limited the continuous development of the training process(AU)

[The role of clinical recommendations in organization of medical care support].

In the Russian Federation, for long time legal uncertainty existed regarding relationship between the standards of medical care and clinical guidelines in organizing medical care support. In the actual legislation, there were no official definitions of concept "clinical guidelines". The obligation of of clinical guidelines implementation was limited by expertise of medical care quality. The article analyzes main stages of development and application of clinical guidelines regulation and their relationship with medical care standards as well. The special attention is paid to changes in regulatory legal acts establishing the clinical guidelines status and the new procedure of their development. The mechanisms of medical care quality control are evaluated. The particular attention is paid to the role of clinical guidelines in organization of population medicinal support.

[Foreign body in the esophagus as a reason to assess the medical aid quality during the forensic medical examination]. / Inorodnoe telo pishchevoda kak povod dlya ustanovleniya pravil'nosti okazaniya meditsinskoi pomoshchi pri proizvodstve sudebno-meditsinskoi ekspertizy.

THE AIM OF THE STUDY: Was to investigate in detail the case of a combination of esophageal injury and aortic aneurysm from the standpoint of the perspective of medical care. It was established that the circumstances of the improper provision of medical care in this case were the subjective nature in the form of insufficient and incorrect provision of it. It is shown that continuous training of doctors and mid-level medical workers within the continuing medical education is a gurantee of proper medical care.