[The confidence limits of self-education of medical workers in matters of competences to provide quality and safety].

The article considers possible risks according analysis of comprehension by workers of necessary competencies ensuring quality and safety of medical activities at performing their duties as well as assessment of factors affecting completeness of choice. It is proposed to apply corporate training as component targeted to improving quality and safety of medical activities by addressed training of necessary competencies within the framework of continuous medical education, supplementing existing self-education.

[The development of diagnosis coding model by means of implementing automated system of coding support: The results of functional and cost analysis].

Actually, in many medical organizations there is an inexpedient structure of labor costs of medical workers, in many respects associated with large time spent on making up medical documentation. The very important aspect is proper formulation of clinical diagnosis and its coding according to the International Classification of Diseases of the 10th revision that in most cases is performed in tradition mode (so called manual coding). The article presents results of functional and cost analysis of application of automated system of coding support in various departments of the Medical Sanitary Unit of of the Ministry of Internal Affairs of Russia at the Moscow Oblast. The study established significant difference in time spent and cost of coding process before and after implementation of automated system. The automated coding of diagnosis permits to reduce six-fold time and cost of coding process, as well as up to 12.6% reduce number of coding errors. The results of functional and cost analysis serve as an objective justification of economic expediency of implementing automated system of diagnosis coding support in multidisciplinary hospital.

[The methodology of prognostication of severe exacerbation of bronchial asthma and asthmatic status].

The modes of predicting chronic non-infectious diseases in clinical practice remain actual issues for general practitioner. The methodology of predicting severe exacerbation of bronchial asthma and asthmatic status during therapeutic care rendering in out-patient conditions is proposed. The methodology comprises sequential assessment in patient availability of predictors of severe exacerbation of bronchial asthma and asthmatic status with further calculation of indices of information values of each of them separately and as well as accumulated information value to evaluate their cumulative effect.

[COVID-19 as a catalyst of development of telemedicine services to rural population].

The paper presents a review of publications concerning issues of development of telemedicine in rural health care of the USA during in conditions of COVID-19 pandemic and expediency of extensive application of telemedicine technologies during "post-COVID" period. The issues, aspects, prospects and required conditions for extensive diffusion of telemedicine services to the rural population are considered.

[The results of implementation of automated system of diagnosis encoding in multi-field hospital].

The common coding of main diagnosis (so-called "manual coding") is accompanied by quite many errors associated with inobservance of classification algorithm and subjective causes that in statistical morbidity and mortality data corruption. The article presents the results of implementing automated system of diagnosis coding by the ICD-10 in the departments of the Medicosanitary Unit of MVD of Russia in City of Moscow. The functional and time losses and the error rate were studied under manual coding and automated coding system. In case of common coding of complete clinical diagnosis of one discharged patient per day, it takes from 5 to 15 minutes, for coding diagnoses of all discharged patients - about 1 hour. The number of errors in common coding made up to 14.1% (n=2472) and in case of automated coding it made up to 1.5% (n= 63, p>0.05). The application of automated coding system in medical organizations ensures exact correspondence of clinical and statistical diagnosis, unifies wording of clinical diagnosis, minimizes subjective deviations from algorithm of the ICD-10.

[The analysis of concomitant pathology in ophthalmologic practice based on electronic medical records data].

The study substantiates possibility of using data retrieved from electronic medical records (EMR) for analyzing comorbidity under diseases of the eye and its adnexa. The purpose of the study is to analyze prevalence and evaluate risk of development of comorbidity in patients with ophthalmologic pathology, based on the data presented in EMR. The total number of patients included into comprised 12 120 individuals. The 653 diagnoses were established and 122 703 requests for medical care were registered. The calculation was applied concerning prevalence, comorbidity index, relative risk of comorbidity. The study established prevalence and level of relative risk of development of opportunistic diseases characteristic for senile cataract and glaucoma. The obtained data on comorbidity may testify in-depth mechanisms of interaction of diseases at cellular, protein or genetic levels. The understanding of mechanisms of interaction of main and concomitant diseases can result in development of new methods of diagnostic, treatment and prevention of diseases. Thus, establishment of glaucoma diagnosis can induce physician to look for possible presence or high probability of development of prostate neoplasm that implies periodic control of prostate-specific antigen. The presented results demonstrate how EMR data can be used to identify, estimate prevalence and risk of comorbidity and also reveals pathogenic mechanisms of interaction between primary and recurrent diseases that can be applied in clinical practice.

[The development of morbidity and mortality encoding in the system of the Ministry of Internal Affairs of Russia].

Despite attempts of improving actual system of morbidity and mortality accounting, the study research established significant real data distortion. These differences do not allow to assess in fullness complete picture of actual morbidity and mortality. Hence, improvement of approaches to increasing efficiency of indices data registration. The study was carried out in 2017-2019 on the bases of medical organizations of the Ministry of Internal Affairs of Russia. The study assessed quality of encoding of morbidity of 28 061 case histories/out-patient records. The size needed to obtain reliable results was determined using the Lopez-Jimenez formula. The statistical data was processed by MS Excel and Statistica-6 software. The most common errors were associated with non-rubricated and incorrectly rubricated diagnoses (53.2%, n = 2860). The second most common error in the structure of incorrectly formulated diagnosis was associated with using non-informative terms (14.6%, n = 785). The errors regarding non-observance of the ICD 10 revision requirements followed resulting in using and wordings not corresponding to modern classification (10.6%, n = 568). A number of errors was associated with unspecified localization of process (3.6%, n = 195) and other rarely occurring causes (2.6%, n = 139). The results of study permitted to conclude that one of the most promising directions of modernization of the encoding system is the automated encoding system.

[The export of medical services as a driver of development of the National system of quality management and safety а medical activities].

The article presents definition of concepts of exporting medical services in foreign and Russian practice. It includes overview of the elements of strategy of developing export of medical services (within the framework of the National project "Health Care"). The article considers the need to develop marketing strategy, information exchange system and conditions ensuring compliance of medical services with high standards of quality and safety of medical activities at the national level. The perspective direction development of the quality and safety system in Russia during implementation of the Federal project "Development of export of medical services" through improving the efficiency of medical organizations and their accreditation is determined.

[Phenomenon of unstable tcpO2 level in transcutaneous oximetry in patients with diabetes mellitus]. / Fenomen nestabil'nogo urovnia tcpO2 pri transkutannoi oksimetrii u bol'nykh sakharnym diabetom.

The back of the foot is a standard region for measuring transcutaneous oxygen tension (tcpO2) with a reliably determined threshold of ischaemia, but such measurement reflects blood supply of only a portion of angiosomes of the foot. Determining the reference values of tcpO2 in other regions of the lower extremity is of current importance. However, measuring the tcpO2 level on the plantar surface and in some other regions not uncommonly reveal a phenomenon of its steady decrease instead of formation of a plateau. The purpose of the present study was to analyse the frequency of the phenomenon of a steady decrease in ptcO2 level while performing transcutaneous oximetry in various zones of the lower extremity. We retrospectively analysed the results of a total of 160 measurements of tcpO2 in 35 patients with diabetes mellitus. The patients' mean age amounted to 68 (47-87) years, with the duration of diabetes mellitus averaging 14 (1-24) years. The male-to-female ratio was 60:40. Seventy-seven percent of patients had foot ulcers/wounds, 34% of patients had a history of previously endured revascularization. The examination was carried out in the dorsal, plantar, medial plantar regions of the foot, on the medial surface of the crus and in the subclavian region, using the TCM 400 monitoring device (Radiometer, Denmark). The measurements were performed by an experienced operator in strict accordance with the manufacturer's recommendations. We evaluated the average value of tcpO2 between the 15th and 19th minutes of measurement and the peculiarities of the tpcO2 curve (plateau/increase/decrease of the value) within this time interval. The mean tcpO2 value in the medial plantar region was significantly higher than that on the back of the foot: 34 (3-70) versus 22 (1-59) mm Hg, p=0.003. A portion of measurements demonstrated a steady decrease in the tpcO2 during the measurement up to the 40th minute. Complying with the stable plateau phase criteria we had developed were 92% of measurements in the subclavian region, 100% - in the middle third of the crus, 76% - on the back of the foot, 77% - in the medial plantar region and 43% - on the plantar surface of the foot. CONCLUSIONS: 1) the revealed phenomenon of a steady decrease of tcpO2 in some patients needs to be taken into consideration in clinical practice and deserves further study; 2) the nature of this phenomenon is unclear, with a possible effect of skin creams on the results of the measurements; 3) it is advisable to include into the functions of the devices for transcutaneous oximetry an algorithm for confirmation of the true phase of the plateau and calculation of the mean tcpO2 value for a chosen period; 4) despite the need for measurement of tcpO2 in the 'alternative zones' it is necessary to thoroughly study the reliability of the data in these zones and to determine the normal values of the parameter separately for each of them.

[The increasing of awareness of patients and medical personnel of security issues: the results of questionnaire survey within the framework of the World Patient Safety Day in the Russian Federation].

The specially developed questionnaires on the basis of the WHO materials developed for the World Patient Safety Day were applied in sociological survey of patients and medical workers. The sampling included 3946 respondents (1747 patients and 2199 medical workers). The study was carried out to establish awareness about course of treatment and medications taken, communication with the attending physician and nurse, involvement in decision-making regarding treatment and care provided, clinical decision-making, interaction with patients, informing patients on prescribed drugs and their possible adverse reactions.

[The labor standards of osteopath with regard to morbidity coding].

In the article the main planned normative documents on an osteopathy are considered, recommendations about commission of scheduling of number of positions of osteopathic doctors on the basis of the data which are available in statistics on incidence taking into account the available systemic defects of coding on ICD-10 are made.

[The re-engineering and financial cost analysis of administrative economic and managerial processes in medical organization].

The article presents substantiation of necessity and main directions of application of re-engineering of administrative economic and managerial processes in medical organization. The approaches to financial cost analysis of the mentioned processes are also considered. The proposed methodology is demonstrated on the example of management of industrial safety measures in medical organization.

[The Medical Sociological Monitoring as a Strategic Element of Management of Medical Care Quality].

The sociological survey of physicians and patients was carried out in the state and private sector of medical care services with the purpose of comparison of various defects of paper work and quality of provided medical services. The material of study consisted of the results of survey in state and private medical institutions of Moscow. The quality of medical paper work, satisfaction of patients with received discharge epicrisis, quality of paper work for expertise of medical commission, rate of detection of defects and breaches in medical paper work were evaluated. The study object included patients aged 18-94 years received hospital care in 2016-2017 and provided voluntary informed consent to participation in survey. The study results demonstrated that in state and private medical institutions patients in overall were satisfied both with quality of proposed services and informativeness of discharge epicrisis at discharge from hospital. A number of established defects in execution of discharge epicrisis negatively affect overall perception of applied treatment and force to apply additional efforts to visit medical institution iteratively with the purpose of elimination of defects of lexical character and lacking in documentation the results of implemented clinical instrumental analyses and consultations of adjacent specialists.

Prevalence and Prognostic Value of Depression and Anxiety in Patients with Diabetic Foot Ulcers and Possibilities of their Treatment.

BACKGROUND: Depression and anxiety can potentially influence treatment results of diabetic complications. OBJECTIVE: Of our study was to explore: (1) prevalence of these disorders in patients with diabetic foot ulcers (DFU); (2) possible risk factors of depression and anxiety; (3) possible links between ulcer treatment results and depression/anxiety status. METHODS: 285 outpatients with diabetes and foot or leg ulcers were tested for depression and anxiety with self-report scales: CES-D and the anxiety subscale from HADS. Ulcer treatment results, incidence of new ulcers and number of hospital admissions were assessed after 1.5 years of follow-up. RESULTS: Depression was detected in 110 patients (39%), anxiety in 103 (36%). Females had depression and anxiety more often than males (48% and 46% vs. 27% and 25% respectively). A combined score based on diabetes duration, insulin treatment, history of myocardial infarction, history of foot ulcers and recent foot surgery was higher in patients with than without depression (3.0 vs. 2.0, p=0.02). Every of these or other potential risk factors alone was not associated with depression or anxiety. Patients with depression did not demonstrate poorer prognosis except higher mortality in subgroup of severely depressed patients without ulcer history. For anxiety we got similar results as its presence strongly correlated with depression. CONCLUSION: The overall prevalence of depression and anxiety in DFU patients is compatible with other diabetic populations. Various parameters of ulcer severity and duration did not influence the probability of depression and anxiety occurrence. Depression in general was not associated with poorer ulcer treatment results.

[The Application of Expert Judgments under Work Quota Settings].

The article considers results of study concerning substantiation of standards of medical workers in children sanatoriums. The possibilities are demonstrated relating to possibility of application of expert estimate concerning scope of curative diagnostic measures at development of labor standards for these medical workers.

[The experience of functioning of diabetic retinopathy room of municipal medical institution].

The diabetic retinopathy rooms are relatively new interdisciplinary structure in the medical care system. The evaluation of sufficiency of the number of this type of medical service for all patients with diabetes mellitus is lacking. The article presents calculation of required number of diabetic retinopathy rooms based on analysis of actual normative base, epidemiological data and experience of functioning of such rooms kind of rooms in municipal medical institution. It is established that for the room assisting particular population of patients with diabetes mellitus workload in average makes up to 1.87 visits per patient annually. The structure and authorized number of diabetic retinopathy rooms specified by actual normative documents, can be considered as sufficient only under condition that primary screening of diabetic retinopathy will be implemented at least to certain percentage of patients by ophthalmologists outside diabetic retinopathy rooms. This condition is to be considered during development of routing of referral of patients with diabetes mellitus to diabetic retinopathy rooms and other ophthalmologists of polyclinic network for full coverage of patients with screening for retinopathy and other affections of organ of vision under diabetes mellitus.

[The problems of data reliability concerning results of treatment of syndrome of diabetic foot].

The article presents results of comparison of two techniques of evaluation of quality of treatment of complications in patients with diabetes mellitus i.e. cohort retrospective analysis and standard report of physicians of office of diabetic foot syndrome. The study demonstrated necessity of development of system of unified analysis of reports of physicians of office of diabetic foot syndrome permitting receiving more precise and reliable data concerning results of treatment of complications of diabetes mellitus and to avoid present decreasing of percentage of patients with positive result of treatment in annual report.

[The automatized lexical control of medical documents as an obligatory component of informatization of medical organizations].

The article considers issues of development and implementation of systems of lexical control of medical documents as a tool of increasing of quality of medical documents in conditions of electronic formation. The main characteristics of elaboration of the system of lexical control "Elex" and perspectives of its development are considered.

[THE IMPLEMENTATION OF PERSONAL CALENDAR OF PRESCRIPTIONS OF PATIENT UNDER REMOTE MONITORING].

The article considers issues of development and implementation of mobile application of patient within the framework of automated system of remote monitoring of human health indicators as a tool of increasing of quality of medical care of patients. The mechanisms of implementation of personal calendar of prescriptions of patient as one of the most important element of mobile application of patient are proposed.

[THE REMOTE MONITORING OF ARTERIAL PRESSURE AND RATE OF HEARTBEATS].

The article considers issues of necessity of development and implementation of remote monitoring of arterial blood pressure and rate of heartbeats as a mean of enhancing quality of medical care of patients. The main characteristics of development of specialized automated system as an integral component of the project is considered too.