[FUNCTIONAL DIAGNOSTICS FOR THE NEEDS OF MEDICAL AND SOCIAL EXAMINATION OF THE RUSSIAN FEDERATION].

The problems of licensing and licensing control of medical activities in the Russian Federation are related to the fundamental responsibility of healthcare - to comply with federal standards of safety, quality and accessibility. The introduction of special diagnostic equipment into the activities of the institutions of medical and social expertise of the Russian Federation and the obligation to use it for expert needs from 2022 has become the time to answer the questions: what are the safety and quality requirements when carrying out work using special diagnostic equipment; whether the organizational and managerial schemes of the activities of institutions of medical and social expertise should change; whether this is a new level of development of medical and social expertise or an expansion of the competencies of functional diagnostics; Are we standing at the origins of a new type of medical activity, and is there much new in this? Answers to these questions should not be expected from the future, putting at risk, in a period of uncertainty and searching for solutions, the life and health of patients, but it is advisable to look in the history of domestic medicine and science, their best practices, adapting them to the strict compliance with the legal field of our country today today.

[Analysis of medical records as an element of quality control and safety of medical activities]. / Analiz meditsinskoi dokumentatsii kak element kontrolya kachestva i bezopasnosti meditsinskoi deyatel'nosti.

OBJECTIVE: Studying the issue of quality control and safety of medical activities. MATERIAL AND METHODS: The analysis of domestic literature on the quality of filling out medical documentation has been carried out. RESULTS: A dental patient's medical record (ICSD) is not only the most important legal document, but also a certain indicator of the level of professional competence of a dentist. To find out all sorts of reasons that led to professional errors and adverse consequences after the provision of dental care, a thorough study and general analysis of medical documentation is of great importance, the maintenance and correct execution of which is also necessary for solving a number of other, including legal issues. The most common drawbacks in the design of a dental patient's medical record have been identified, which indicates a decrease in the quality of medical care provided to patients. CONCLUSION: At the moment, there are still unresolved issues related to complete completion of medical documentation. When analyzing the literature, we did not find a purposeful study of the medical history of a dental patient during surgical treatment, which requires further research.

[Qualification requirements for the re-delegation of medical activities to nursing professionals (with extended competencies)]. / Qualifikationsbedarf für Pflegefachpersonen (mit erweiterten Kompetenzen) bei einer Aufgabenneuverteilung ärztlicher Tätigkeiten.

BACKGROUND: For many years, the redistribution of tasks and thus a transfer of medical activities to nursing professionals with extended competencies has been discussed in Germany and is currently being regulated by the federal government. OBJECTIVES: The aim of this study was to record the opinions of GPs and nurses on the qualification requirements for possible delegable and substitutable medical activities to nurses using the example of outpatient dementia care. METHOD: In the context of a quantitative survey, the qualification requirements for the delegation of 30 different activities to nurses were collected from primary care physicians and nurses. A total of 1,634 questionnaires was distributed. The response rate was 28.0 % (primary care physicians: n=225, and nursing specialists: n=232). The analyses were carried out descriptively using SPSS software (version 25, IBM Corp., 2017). RESULTS: 45.1% of the respondents said they needed additional qualification prior to such a task transfer. This need primarily relates to further training (37.3%). Those seeking a university education (36.2%), will either pursue a Bachelor's (15.6%) or a Master's degree (20.6%) to obtain the necessary qualification. CONCLUSION: The results of this study can help define the activity profiles of academically qualified nursing professionals and inform the development of curricula for their university education. Furthermore, they will support the further development of the legal framework.

[The evaluation of compliance of medical activity to established requirements: organizational and technological support].

The ongoing process of reforming national health care system determines associated search for systems of adequate decision-making based on comprehensive and objective analysis of activities of sector objects. The results of many years research demonstrate that one of the most effective such systems is system of assessing compliance of medical activities with established requirements. It is a methodology that permits to implement systematic comprehensive analysis of health care objects and make necessary decisions on its basis. This approach is extremely important for improving control and authorization-based mechanisms, justifying necessary resource support and developing comprehensive programs of development of isolated institutions, services and industry as whole. The term "conformity assessment" was introduced for the first time in the Federal Law № 184 of 27.12.2002 "On Technical Regulation". The given law defines concept of conformity assessment as direct or indirect compliance with requirements imposed on the object. The concept presented in this law regulates industrial activity to objects and subjects of technical regulation. It is this ideology that became a basis of actual study, in which methodology and organizational technology was developed and experimentally tested to assess compliance of medical organizations and individual health services with requirements established by current legislation. Within study framework, development and experimental testing of system of assessing compliance of medical activities with requirements of regulatory documents was carried out. The object of the study was medical organizations and their structural divisions.The significant increase was established in specially developed integral compliance coefficients for studied objects for 2016-2020: from 76.5% to 82.0% for a number of medical profiles selected for the study and from 72.0% to 78.0% for medical organizations. The data obtained indicate that on the basis of a set of balanced indices, administration of monitoring objects made adequate management decisions.

[The normative legal regulation of quality management and medical activities security in conditions of application "regulatory guillotine"].

The term "regulatory guillotine" means analysis of all existing normative legal acts in order to understand their compliance with modern requirements. If these regulations meet the requirements, then the rules remain; if not, they must either be canceled and new regulation to be elaborated or corresponding changes must be implemented to current regulation. To resolve this problem, the government of the Russian Federation decided to implement the "regulatory guillotine" procedure. The main task of this procedure is to completely replace the entire array of norms that establish mandatory requirements with new ones by January 1, 2021. This will reduce administrative burden on business and increase level of security for consumers of various services. The same work is applied to the standards regulating management of quality and safety of medical activities. The article analyzes normative legal acts that regulate quality and safety management of medical activities, as well as new normative legal acts that are already accepted but still are not entered into force.

THE EXPERIENCE OF LEGAL AND ORGANISATIONAL ARRANGEMENTS FOR MILITARY MEDICAL ACTIVITIES IN THE DEFENCE FORCES (USING FRANCE, GERMANY AND UKRAINE AS EXAMPLES).

OBJECTIVE: The aim: To identify and establish the basics of organizational and legal support for military medical activities performed by the Defense Forces of France, Germany, and Ukraine, to make a comparative legal analysis of these principles in order to select the best practices that could be adopted by the forces of modern states. PATIENTS AND METHODS: Materials and methods: This study is based on regulatory instruments of England, France, Germany, the United States, and Ukraine. The following methods are used in the article: comparative-legal, comprehensive and analytical ones. CONCLUSION: Conclusions: The study confirmed the importance of the legal and organizational framework of military medical activities to ensure the proper medical support of the troops. It includes 1) legal principles as key imperative requirements imposed on the operation of the military health services system; 2) legal foundations for the activities of the military medical services; 3) institutional arrangement.

[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.

[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.

El principio de confianza como criterio delimitador de la responsabilidad penal de los médicos / O princípio da confiança como critério delimitador da responsabilidade penal dos médicos / The principle of reliance as a criterion for delimiting the criminal responsibility of physicians

Resumen: En el presente artículo el autor analiza los presupuestos y límites del principio de confianza como criterio de concreción del cuidado debido exigible a los médicos. Para ello, se distingue entre división horizontal y vertical del trabajo. En el ámbito de la división horizontal, se destaca la relevancia que tiene una clara delimitación de ámbitos de responsabilidad para la vigencia del principio de confianza. En el plano de la división vertical, se explica la delegación de actividades médicas en enfermeras y auxiliares paramédicos (contemplada en el inc. 2º del art. 113 del Código Sanitario), así como los deberes de elección, instrucción y supervigilancia que han de cumplirse para que los facultativos puedan confiar en la correcta ejecución de las tareas delegadas.

Resumo: No presente artigo o autor analisa os pressupostos e limites do princípio da confiança como critério de materialização do cuidado devido exigido dos médicos. Para isso se distingue entre divisão horizontal e vertical do trabalho. No âmbito da divisão horizontal se destaca a relevância que tem uma clara delimitação de âmbitos de responsabilidade para a vigência do princípio da confiança. No plano vertical se explica a delegação de atividades médicas para enfermeiras e auxiliares paramédicos (contemplada no parágrafo 2º do artigo 113 do Código Sanitário), assim como os deveres de eleição, instrução e supervigilância que se tem de cumprir para que os médicos possam confiar na correta execução das tarefas delegadas.

Abstract: In the present article, the author analyzes the pre-requisites and boundaries of the principle of reliance as a criterion for determining the due care that can be demanded from physicians. For that purpose, a distinction is made between horizontal and vertical division of labour. Regarding horizontal division, the relevance of a clear delimitation of scopes of responsibility for the principle of reliance to apply is highlighted. Regarding vertical division, an explanation about delegation of medical activities to nurses and paramedic auxiliaries (contemplated in indent 2 of article 113 of the Sanitary Code) is offered, as well as one about the duties of selection, instruction and supervision that must be fulfilled for the physicians to be allowed to trust in the correct execution of the delegated tasks.

A Research on the Shamanistic Medical Activities as Seen in the Recipes for Fifty-two Ailments Written in the Mawangdui Silk Manuscript.

The main thesis of this research is to discuss the shamanistic medical activities as seen in the Recipes for Fifty-two Ailments written in the Mawangdui Silk Manuscript, to corroborate them with handed-down literature and other underground written attestations in early China, and to inquire its characteristics. In the Eastern Zhou dynasty, medicine already emerged with specialized and professional properties, but did not disengage from the ideology of shamanism in Eastern Zhou society. In other words, the shamanistic treatment of diseases was one of the most important works of shamans because the specialized knowledge of medical treatment always interlaced with superstitious and mediumistic treatment methods. This article examines the details of shamanistic medical activities, for example, the 'zhuyou', the 'zhuyichuxiong', curing maggots activities, and so on, by analyzing the Recipes for Fifty-two Ailments written in the Mawangdui Silk Manuscript. The origin and development of this early Chinese medical treatment had an influence on ancient Korea, Japan, and other places. Through this research, we can learn more about the initial development stage of the early traditional medicine in ancient societies of East Asia.

Specification and Description Language of Medical Activities.

Modern health care management takes place in organizations and institutions that are becoming more and more complex. The management of these institutions requires broad clinical and business administrative knowledge, but also excellent scientific skills. The scope of our study, presented in this paper, is to emphasis the management of medical activities. Based on set theory and scientific management of work, we developed a method called Specification and Description Language of Medical Activities (SDLMA) that can monitor performance, and can provide instructions to ensure the most efficient ways of working.

[ZHANG Zhongyuan (), President of Imperial Academy of Medicine in the Qing Dynasty].

The Imperial Academy of Medicine (IAM) was the central medical administrative authority, responsible for the promulgation and implementation of national medical policies. It also was the medical educational institution that trained physicians. The imperial government isolated the physicians at the IAM from the outside world. Therefore, records about them are rare. By studying official archives such as Juezhi Quanlan 《》, Jinshen Quanshu 《》 and Qing Dynasty Imperial medical archives, etc, we provide a brief biography of Zhang Zhongyuan, the last chief administrator of the IAM, and present his rise from the lowest rank of physician to chief administrator. We also discuss his medical activities, diagnosis and treatments for the Imperial family, especially for Empress Dowager Cixi () and Emperor Guangxu (), as well as the management and reforms he advocated for the IAM. Through an analysis of the case of Zhang Zhongyuan, we can have a glimpse of the real life of imperial physicians.

[Legislative regulatory framework for medical care quality and safety control]. / Normativnaia pravovaia baza, reglamentiruiushchaia kontrol' kachestva i bezopasnosti meditsinskoi deiatel'nosti.

The paper presents the analysis of legislative and regulatory framework for the control of the quality and safety of medical activities. Legislative and regulatory framework requires mandatory internal control of the quality and safety of medical activities and dictates its structure. In the development of the internal control of the quality and safety of medical activities there is, however, a need to consider medical and social, legal, organizational, ethical and economic issues.

[Delegation of medical activities in acute pain therapy]. / Delegation ärztlicher Tätigkeiten in der Akutschmerztherapie.

Acute pain management is an interprofessional and interdisciplinary task and requires a good and trustful cooperation between stakeholders. Despite provisions in Germany according to which medical treatment can only be rendered by a formally qualified physician ("Arztvorbehalt"), a physician does not have to carry out every medical activity in person. Under certain conditions, some medical activities can be delegated to medical auxiliary personnel but they need to be (1) instructed, (2) supervised and (3) checked by the physician himself; however, medical history, diagnostic assessment and evaluation, indications, therapy planning (e.g. selection, dosage), therapeutic decisions (e. g. modification or termination of therapy) and obtaining informed consent cannot be delegated. With respect to drug therapy, monitoring of the therapy remains the personal responsibility of the physician, while the actual application of medication can be delegated. From a legal perspective, the current practice needs to be stressed about what is within the mandatory requirements and what is not when medical activities are delegated to non-medical staff. The use of standards of care improves treatment quality but like any medical treatment it must be based on the physician's individual assessment and indications for each patient and requires personal contact between physician and patient. Delegation on the ward and in acute pain therapy requires the authorization of the delegator to give instructions in the respective setting. The transfer of non-delegable duties to non-medical personnel is regarded as medical malpractice.

[Hope as psychological resource for nurturant professionals (medicine case study)].

INTRODUCTION: In the article, the issues concerning hope, which is one of the most important resources for specialists of many nurturant professions, are observed. The theoretical analysis of hope and its categorization from the perspective of subjective and resource-based view is given. The special scientific and practical interest to human subjective and personal resources is determined by their unique role not only in human life support, but also in overcoming hard situations and extreme obstacles, including crisis situations in professional activity, with the example of the profession of a doctor. The aim of the empirical research is studying the correlation between hope and such manifestations of subjective regulations medical practice as inner subjective control and failure avoidance motivation. MATERIALS AND METHODS: 120 doctors (60 men and 60 women) working in St. Petersburg hospitals took part in the research. Several research methods were used, such as 'Resource map' application form, R. Snyder's hope scale adapted by K. Muzdybayev, 'Subjective control level' method by E. Bazhin, E. Golynkina and L. Etkind, 'Failure avoidance motivation' method by T. Ehlers. RESULTS: Doctors think that Hope and Optimism are among important components of their professional practice, together with willing features helping them to reach their goals (such as persistence, patience, eagerness, insistence and endurance) and such personal qualities as self-assuredness, motion control in different situations, ability to solve hard problems. According the data of correlation and regression analyses, the anticipation that hope is determined by high level of inner control locus and low failure avoidance motivation (responsibility for patients' lives) within medical practice. CONCLUSIONS: Most doctors have average or high level of hope, which lets determine this personal disposition quality as one of the important ones for this profession. Being the positive result of professional practice and not depending on the doctors' sex and specialization, hope is linked to achievement drive and most rates of inner locus control. Obtained results can be used for psychodiagnostics and development of such psychological results as faith, hope and optimism, helping to keep nurturant professionals' mental health.

On the problems of infringement on patients' privacy in medical activities / 医学研究生学报

In the recent years,infringement on patients' privacy in medical activities is drawing wider attention.In medical practice there exit some common phenomena of this kind,such as some medical staff spreading the information of medical record to irrelevant people,going beyond their duty to pry into or deliberately disclose patients privacy,intentionally harass of directly intrude upon patients' private parts,etc.These problems can be gradually reduced or avioded by strengthening medical staff's awareness of self-discipline,offering related education and advice to patients,and perfecting relevant laws and regulations.

Approaches and Methods for Medical Staff to Avoid Professional Risks in Clinical Practice / 中国医学伦理学

Empirical research showed that when medical disputes arise,the emergence of that damage must be due to the fault of either party,while everyone ignored the unforeseen,difficult-to-prevent and ubiquitous occurrence of medical professional risk,and the fact that the professional risk can also occur when no party makes mistake in medical events.It is of particular importance to explore ways to avoid medical professional risks,to allow medical staff in a safer,less risk condition,and meanwhile throw themselves wholeheartedly into the cause of life-saving career.