[Methodical approach to the construction of the index of doctors' confidence in their activities].

INTRODUCTION: The COVID-19 pandemic has demonstrated the importance of developing a state policy to increase the attractiveness of a doctor's work and counteract professional burnout. The trust of doctors in their work determines the state of human resources in the field of healthcare. The development of an approach to the organization of monitoring the trust of doctors will allow identifying organizations at an early stage in which there is a decrease in the confidence of doctors in their activities. The purpose of the study is to develop and test a methodological approach to calculating the index of trust of doctors. MATERIALS AND METHODS: To construct the index, a list of statements was developed that are applicable for a comprehensive assessment of the doctor's activities. The approbation of the developed approach was carried out as part of a pilot sociological study in which 346 doctors from different regions of Russia took part. The significance of the statements used in the assessment was confirmed by binary probit regression. RESULTS: The analysis made it possible to calculate the index of doctors' trust for the obtained sample, equal to 62,5%. The results of the study can be used to assess the attitude of doctors to their activities both at the regional level and at the level of individual organizations. The Ministry of Health of the Russian Federation can use the results obtained to develop approaches to increasing the attractiveness of the medical profession to increase the public health of Russia.

LEGAL CONFLICTS IN MEDICAL PRACTICE AND METHODS OF THEIR RESOLUTION.

OBJECTIVE: The aim: A theoretical and applied study of the essence of legal conflicts in the field of medical activity in order to determine the proper system of ways to protect the interests of patients, doctors and other participants in medical legal relations. PATIENTS AND METHODS: Materials and methods: Various methods of scientific knowledge make up the methodological basis of research. Thus, the comparative legal method was used to compare the features of the legal regulation of the rights protection of medical legal relations subjects in different countries. The essence and classification criteria of both legal conflicts and methods of protection in the field of medical activity were investigated with the help of a system-complex method. The following other methods were used in the study, in particular: formal-logical, dialectical, analysis and synthesis. CONCLUSION: Conclusions: The classification of dispute resolution methods in the aspect of medical activity indicates the possibility of distinguishing non-jurisdictional (self-defense) and jurisdictional (special, administrative, judicial protection) forms of patients' rights protection, as well as distinguishing two levels of such protection (pre-trial and judicial), each of which has its distinctive features and the patient himself is able to determine in what way and by what level to protect his rights. An important role in the conflict resolution in the field of health care is primarily played by the pre-trial protection, the defining features of which are the voluntary nature of conflict resolution, the availability, convenience and speed of dispute resolution as well as the possibility of compensation for the damage caused.

[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 medical activity and satisfaction of geriatric care of Mongolia residents.

Nowadays, process of aging of population covers all countries of the world. In current conditions, an important moment is increasing medical activity of elderly population and old persons. The purpose of the study is to investigate social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly residents of Mongolia. The sociological survey of 726 residents of Mongolia older than able-bodied age, 75 out of which were in nursing homes, was carried out using specially designed questionnaire that included questions on assessing medical activity and satisfaction with geriatric care. The negative correlation was established between good assessment of one's own health and age of respondents. The study revealed that 90.9% of respondents noted presence of chronic pathology, but only 21.1% of them were registered in dispensary. In age group under 65 years, 75.8% of persons capable to serving themselves made up 75.8% and in age group 75 years and older only 48.1%. The analysis established that 50.2% of elderly and senile persons consulted geriatrician, while 48.3% of those who did not consult this specialist were unaware of its existence. The number of cases of respondents visiting geriatric doctor in place of their residence was higher in cities. The respondents who received geriatric medical care were completely satisfied with it in 52.7%. The causes of dissatisfaction with geriatric medical care in aimags (regions) were inattentive attitude of medical staff, low effectiveness of treatment and insufficient availability of free provision of medications. The identified social hygienic characteristics of medical activity and satisfaction with geriatric care of the elderly and senile residents of Mongolia should be taken into account in developing measures to improve this type of care in Mongolia.

[Prevention of adverse events following the use of local anesthetics in traumatology and orthopedics]. / Profilaktika nezhelatel'nykh sobytii pri primenenii mestnykh anestetikov v travmatologii-ortopedii.

The article analyzes the frequency of development of adverse toxic reactions when using local anesthetics in the practice of an orthopedic traumatologist; based on the conclusions of commission forensic medical examinations conducted in the framework of criminal proceedings on the death of patients, the features of the onset of LAST syndrome are studied, which significantly increases the medical risk for the patient and the legal risk for the doctor. An analytical study of scientific publications on the possibilities of using the local anesthetic Articaine-Binergia 20 mg/ml in the daily work of both polyclinic and inpatient doctors to ensure the safety of medical activities was conducted.

[Lifestyle factors and medical activity of patients with COVID-19 treated on an outpatient basis using telemedicine technologies].

The aim of the study was to study the factorial conditionality of the state of health and the features of medical activity (MA) of patients with COVID-19 who were treated on an outpatient basis using telemedicine technologies. MATERIAL AND METHODS: The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records. RESULTS: It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001). CONCLUSION: The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.

Telemedicine services in the work of a doctor, dentist, nurse and midwife - analysis of legal regulations in Poland and the possibility of their implementation on the example of selected European countries.

INTRODUCTION AND OBJECTIVE: The aim of the study is to discuss the legal framework for telemedicine services in Poland, and to present telemedicine solutions used in selected European countries. MATERIAL AND METHODS: The analysis of legal cts was chosen as a research method in order to determine legal possibilities for medical professionals to use telemedicine services. A literature review was undertaken to demonstrate the possibilities of telemedicine as used in the United Kingdom, Germany, Norway, The Netherlands and Sweden. RESULTS: The Act on the professions of a doctor and a dentist states that the doctor and the dentist can perform their profession via ICT systems or communication systems. The doctor is obliged to practice in accordance with current medical knowledge and available methods. 'Available methods' include considering information and communication measures that may allow prevention, recognition or treatment. The Act on the profession of a nurse and a midwife states that the nurse and midwife perform the professions using current medical knowledge and the mediation of ICT systems or communication systems. Thus, the legislator has clearly authorized persons performing these professions to provide services in the field of telemedicine. However, despite the existence of a legal basis for using telemedicine, its development in Poland is not as high as in the United Kingdom, Germany, Norway, The Netherlands or Sweden. CONCLUSIONS: The legislator gradually introduces legal solutions necessary for the development of telemedicine services, although the pace of these changes, as well as building the technical infrastructure that is the basis for the proper provision of telemedicine services, are too slow.

[The methodical principles of quality management of medical activities on particular territory].

The article, on the basis of experience of development of the Republic's first territorial system of medical quality management, presents basic organizational systemic principles of building quality management of medical activity and organizational model of system functioning. The listing of criteria and indices of assessing effectiveness of territorial system of managing quality and safety of medical activity is presented too. The purpose of developing such a system is formulated. The evidence base for actuality and feasibility of its organization is presented.

[The integrated approach to implementation of expertise of medical interventions].

The article analyzes and systematizes legislative rules of the medical care quality expertise. The paramount place of clinical recommendations in development of legal acts regulating expertise and assessment of medical care quality, quality control and safety of medical activity is determined.

[The risk factors of health formation in urban and rural women].

The purpose of the study is the socio-hygienic characteristics of the lifestyle and living conditions of urban and rural women and the assessment of their importance in the formation of health. The materials of the study were: the number of newly registered chronic diseases for 5 years, the average number of complaints about diseases during the year, the results of the survey. A socio-hygienic study shows that among urban women there are more divorced women than among rural women, fewer widows, urban women have higher levels of education, more permanent jobs, low physical activity, etc. Rural women were distinguished from urban women by lower level of education, low medical activity, frequent alcohol consumption, lower income, etc. Among urban women, more than in the first health assessment group (18.4% of women), among rural women 14.6% and less than in the third health assessment group (30.2%). Among rural women, 36.0% were in the third health assessment group. It was found that the greatest impact on the health of urban women have irrational nutrition, low physical activity, low medical activity, harmful production factors, frequent stress at work and at home, on the health of rural women: low income, low medical activity, mainly physical labor, irrational nutrition, frequent alcohol consumption.

[The Medical Activity and Satisfaction of Population Need in Medical Care].

The article considers phenomenon of medical activity as a determinant of population demand for medical services and needs in medical care. The medical activity is determined as both a criterion of formation of health of patients by force of active using medical care and a criterion of efficiency of functioning of physicians in satisfaction of needs of patients in medical care. The results are presented related to phenomenon of medical activity using methodology of analysis of opinions of patients and level of medical care appealability of population. Medical activity of population and level of satisfaction of demand and needs in medical services is to be considered as an evidence of commitment of population to treatment and prevention. The investigation of these issues acquires particular specificity in conditions of health care system of large municipal agglomeration with developed network of medical organizations of budget insurance, departmental and private forms of property. In these conditions, patients and population are provided with various possibilities of choosing different forms and types of satisfaction of need in medical care independently of cause and motive of using it that is an advantage for implementing medical activity.

[On Methodology of Developing Action Algorithm of Hygienic Processing of Hands And Application of Medical Gloves].

The article substantiates actuality of working out methodology of development of action algorithm of hygienic processing of hands and application of medical gloves in medical organizations. The mechanism is presented concerning development of standard operational procedures most valuable from standpoint of quality and safety of medical care. The basic project of standard operational procedures "The order of implementing hygienic processing of hands and application of medical gloves for prevention of infections related to medical care provision". The order can easily be adapted for implementation in specific departments of medical organizations.

[The Actual Legal and Organizational Problems of Licensing of Military Medical Expertise].

The article presents analysis of problems of organization of functioning of military medical commissions in the light of implementation of complex of activities related to licensing of military medical expertise as a type of medical activity. The conceptual definitions and main legislative acts regulating procedures of licensing of the given type of expertise are considered. The characteristics of functioning of military medical expertise in actual conditions of Russia, including experience of Moscow and the Moskovskaia oblast are established.

[The Results of Self-Assessment by Medical Organizations Their Correspondence to Proposals (Practical Recommendations) of the Roszdravnadzor Concerning Organization of Internal Control of Quality and Safety of Medical Activity].

The article presents the analysis of the results of internal audits (self-rating) in medical organizations implemented on the basis of Proposals (practical guidelines) of the Roszdravnadzor concerning organization of inner control of quality and safety of medical activities in medical organization (hospital). The self-rating was implemented by the medical organizations themselves according the common criteria of the Proposals as provided the following plan: planning of self-rating, collection and processing of data, application of self-rating, analysis of obtained results, preparation of report. The article uses the results of self-rating of medical organizations corresponding to following criteria: profile of activity-multi-field hospital-number of beds more than 350-state property. The self-rating was implemented according to 11 basic parts of the Proposals. The criteria were developed for every part. The evaluation lists developed on the basis of the given Proposals permitted to medical organizations to independently establish problems in their activities. Within the framework of implemented self-rating medical organizations mentioned the directions of activity related to personnel management, identification of personality of patient, support of epidemiological and surgical safety as having significant discrepancies with the Proposals and requiring implementation of improvement measures.

Mutual Benefit and Win-win:the Economic Ethical Basis of Harmonious Physician-patient Relationship / 中国医学伦理学

It was undoubted that doctor-patient relationship was becoming more and more worse,and this condition lead the doctors,patients,governments feel ve ry awkward.Every related side would be Faliures.Nowadays,the tensional doctor patient relationsh i p is a result of improper value choice and institutional arrangement in the back ground of market economy and high technology development.Building a harmonious doctor patient relationship and become double win is a key issue to affect medical service.It needs government,hospital,doctor and patient to work together.Therefore,we should promote the harmony of doctor-patient relationship in the respects of value choice and institutional arrangement.The action of benefiting others at the medical market includes benefiting for others unselfish and benefiting for others for self under the condition of market economy.Seeking patients' interests even at the expense of the professionals' own interests is the most essential moral criterion and professional obligation.