[The expert questions in practice of rheumatologist].

The rheumatic diseases are a source of serious medical, psychological, social problems both for individual and society. This pathology is characterized by: wide prevalence, often early onset, continuously progressive course. All this is resulted in at first regular episodes of temporary disability and later to disability. Even timely and adequate therapy provide no guarantee for absence of disease progression in all patients. The rheumatologist is to know both clinical guidelines and legislative acts regulating issues of determining disability. The characteristic of The medical social expertise and all processes related to referral of patient, examination, decision-making are characterized by strict compliance with legislative acts which detail all these steps are spelled out in detail. Actually, the legislation of the Russian Federation includes orders and resolutions by the Ministry of Health and the Ministry of Labor and Social Protection which are significant both for employees of bureau of medical social expertise and for physicians (including rheumatologists) of ambulatory polyclinic institutions and hospitals. The awareness about these laws is detailed in professional standards for various specialties.

[The population health in The Russian Federation and the Republic of Uzbekistan: a comparative analysis].

The epidemiological monitoring of morbidity, mortality and disability is one of the important mechanisms of studying population health. The purpose of the study is to carry out comparative analysis of health status of population of the Russian Federation and the Republic of Uzbekistan. MATERIALS AND METHODS: The demographic indicators as well as indicators of morbidity, mortality and disability of adult population of the Russian Federation and the Republic of Uzbekistan in 2010-2020 were analyzed. The statistical, analytical and mathematical methods were applied. The statistical significance of differences in relative values was calculated using the Student's coefficient and was considered as significant at p<0.05 and t>2. THE RESULTS: During the study period, an increase in population size of the Russian Federation and the Republic of Uzbekistan was established. The population age structure was of regressive type in the Russian Federation and of progressive type in Uzbekistan. In the Russian Federation, significant decrease of natality up to 12.8% and statistically significant increase of mortality up to 34% occurred. The natural population loss in the Russian Federation raised three-fold. In the Republic of Uzbekistan, there was statistically significant increase both of natality and mortality indicators up to 11% and of positive values of natural population growth by 14% (p<0.03). In the Russian Federation, there is statistically significant (p<0.006) decrease of indicator of primary disability from 7.7 cases per 1000 of population in 2010 to 5.6 cases in 2020. In the Republic of Uzbekistan, significant increase (p<0.009) of indicators of primary disability from 0.1 cases per 1000 of population to 2.2 cases per 1000 of population was established. THE CONCLUSION: The different types of population in the Russian Federation (regressive) and in the Republic of Uzbekistan (progressive) predetermine differences in demographic indicators of both countries. The high level of mortality and increasing of morbidity of circulatory system and neoplasms in both countries justify need in improving measures of primary and secondary prevention at the state level.

[The role of medical marketing in implementation of projects of value-orientated health care].

The modern health care is characterized by value-oriented approach. The changes in health care policy shifted research focus on studying patient behavior and emphasized role of marketing targeted on patients. The study of patient values is area of research going beyond the scope of medicine. The active interaction with consumer through analysis and prognostication is daily component of professional activity of marketer.The purpose of the study is to describe main methods of implementing value-orientated approach, to determine required competencies in implementation of projects of value-oriented health care and to value role of marketer in projects realization.The analysis of main techniques and methods of value-orientated approach and necessary competences was carried out. On the basis of the professional standard of marketer, possible areas of interdisciplinary interaction of specialists are identified. The important role in development of value-oriented health care belongs to studies of patient behavior and one's values system that requires good awareness of methodology of such studies. The competencies of marketer are required for implementing value-oriented health care projects: pricing, patient journey mapping, operational efficiency increasing, development of patient commitment to treatment, decision making about treatment shared with patient, quality assessment of medical services. The delegation to marketers part of tasks in implementation value-oriented health care projects will relieve medical personnel, improve quality of substantiation of projects implementation and increase persuasiveness of arguments at the expense of narrow specialization knowledge and competences in marketing.

[The comparative analysis of professional standards of specialists with higher and secondary medical professional education].

In 2020, the Mintrud of Russia approved a number of professional standards for specialists with secondary professional medical education. The implementation of professional standards is called to actualize outdated normative base concerning functions of medical workers, including assurance of separation of labor functions and actions of physicians and medical nurses, facilitation of development of job descriptions, and minimizing number of conflicts that occur during process of work activities at personnel functions crossing. The medical organization, focusing on requirements established by professional standards, can more competently develop personnel policy, make timely changes in staff list, establish progressive remuneration system. In this regard, it is useful to learn to what extent approved professional standards facilitate solution of practical problems of medical organizations.The article presents results of comparative analysis of three pairs of professional standards for paramedical personnel and specialists with higher education in comparable specialties. Certain contradictions and inaccuracies were esnablished too.

[The increasing of role of paramedical personnel under application of remote ultrasound studies].

The ultrasound studies are highly informative diagnostic methods. The modern ultrasound devices can be applied as component of mobile telemedicine systems that can significantly increase availability of medical care. However, application of ultrasound scanners requires inclusion of ultrasound diagnostics specialist in the medical team that is not always nor possible or appropriate. In the modern regulatory legal base, transfer of certain functions of ultrasound diagnostics specialist to average medical staff is not provided. The article considers issue of genuine development and testing method of implementation of ultrasound examinations by paramedical personnel under remote control of physician. Two organizational models were tested within the framework of organizational experiment. In the first model, physician monitored progress of examination by telemedicine monitor and, if necessary, directed actions of medical nurse. In the second model, the nurse independently obtained images of patients' organs, and physician according received visual information formulated final conclusion. The organizational experiment included patients with pathology of abdominal cavity, retroperitoneal space and lower limb arteries. Results. On the basis on results of 156 examinations, time-consuming analysis was performed, and effectiveness of developed methods was evaluated. The proposals were proposed to include additions into professional standard of ultrasound diagnostics nurse and to substantiate the need of altering the training programs for paramedical personnel.

And What About the Pharmacist?

In the Netherlands, euthanasia has been decriminalized. Termination of life on request and assisted suicide are criminal offences under Dutch law; but if physicians comply with the due care requirements of the Euthanasia Act and report their actions in the manner prescribed by law, they will not be prosecuted. One of the requirements relates to the act of euthanasia itself. If this is to be performed with due medical care, the physician relies on the services of a pharmacist. However, the responsibilities of the pharmacist with respect to euthanasia are not laid down in law. At present, Dutch pharmacists have to make do with professional rules that do not offer adequate solutions for the problems that may arise when euthanasia is performed.

[The development of the system of continuous medical education under the present-day conditions]. / Razvitie sistemy nepreryvnogo meditsinskogo obrazovaniia v sovremennykh usloviiakh.

The authors consider the selected stages in the development of the system of continuous medical education in the field of forensic medicine and forensic medical expertise as well as the contribution of the Department of Forensic Medicine of N.I. Pirogov Russian National Research Medical University to its practical implementation. The relevant conceptual problems and topical issues are discussed together with certain approaches to their solution.

[Training of dentists in public healthcare in accordance with professional standards]. / Osobennosti podgotovki vrachei-stomatologov po obshchestvennomu zdorov'iu i zdravookhraneniiu v sootvetstvii s polozheniiami professional'nogo standarta.

For the purpose of studying the possibility of labor functions development for public health and healthcare during training in the educational organizations the comparative analysis of provisions of the professional standard with the materials stated in textbooks and national manuals of the corresponding profile was carried out. It was found that in the development of Federal state educational standards of higher education in dentistry (specialization level), updating educational methodological publications on dentistry and public health, the formation of a unified database of evaluation tools for accreditation of specialists and obtaining or confirming qualification categories, it is necessary to take into account the content of labor functions of the professional standard in each discipline.

[Public healthcare responsibilities of ophthalmologists according to professional regulations]. / Funktsii vracha po organizatsii oftal'mologicheskoi pomoshchi v sootvetstvii s polozheniiami professional'nogo standarta.

Modern public healthcare practices are constantly being improved by the medical community, which involves approval and implementation of professional standards such as including public health activities in the responsibilities of medical specialists. To understand how well such skills can be mastered by the specialists, we have conducted a comparative analysis of ophthalmologist qualifications found in the most often used guidelines and textbooks. With logical, analytical and hypothetical analysis, books and guides published before 2018 were found to have insufficient coverage of the public health responsibilities. Improvement of the public healthcare in terms of professional standards is an important course of development for the medical field. The continued work on Russian Federal State Educational Standard (Higher Education) for Ophthalmology - index number 31.08.59 - should include actualization of educational materials with modern public health notions, development of a universal learning evaluation database for specialist accreditation, as well as evaluation tools for the obtainment and confirmation of their qualification. The professional standards for ophthalmologists should fully account for the job responsibilities they acquire. Training of ophthalmologists in the public healthcare should utilize the following textbooks published in 2018: 'Organization of medical aid in the Russian Federation' under the editorship of V.A. Reshetnikova, 'Healthcare and public health' under the editorship of G.N. Tsarik, and 'Public health and healthcare' by V.A. Medic.

Analysis of survey for implementation of professional standards of reference intervals in routine biochemistry laboratories / 临床检验杂志

Objective To investigate the implementation of professional standards for reference intervals in routine biochemistry laboratories.Methods The relevant data of reference intervals from different laboratories including upper and lower limits,sources of reference intervals,verification and grouping rules,etc was submitted by using the software of interval quality assessment (EQA) via WEB application.The background monitor saved all the data as Microsoft Excel 2007 documents.The implementation of reference intervals of professional standards for decreed 18 routine biochemical tests was analyzed.Results The proportion of laboratories in which the reference intervals were derived from professional standards increased largely in 2016 compared with those in 2014.The data of 2016 showed that the reference intervals derived from professional standards were verified in 58.9％ to 67.5％ of laboratories before they were used in clinical diagnosis.The grouping rules for reference intervals in most laboratories (59.1％ to 83.3％) were in accordance with professional standards,except for individual items,including urea (43.4％),creatinine (40.1％) and alkaline phosphatase (35.8％).There were significant differences for the upper and lower limits of the most items between the laboratories using professional standards and those without using professional standards (P ＜ 0.05),except for some items,including lower limit value of kalium,upper limit of phosphorus,upper limit of amylase,upper limit of aspartate aminotransferase and lower limit of ferrum.There was no significant difference in most items between the the upper and lower limits of the reference intervals in the laboratories using professional standards and the reference intervals defined by professional standards,except for individual items,including upper limit of total protein,lower and upper limit of creatine kinase,upper limit of urea and upper limit of creatinine (P ＜ 0.05).Conclusion The implementation of reference intervals from professional standards in most routine biochemistry laboratories could not be satisfactory.Only a small part of laboratories used the professional standards,and the reference intervals of professional standards,were not verified before use in quite a part of laboratories.

[The clinical laboratory diagnostic as a part of clinical medicine.]

The rapid development of laboratory technologies and their translation directionality permit developing principles of personified medicine. The article considers new paradigm of manpower policy for developing necessary level of clinical laboratory consultation.

Active surveillance for prostate cancer: a legal perspective.

Active surveillance (AS) for prostate cancer (PCa) has become a viable management strategy for men with low-risk PCa. With AS being offered more often and more patients being included in AS studies, the aim of this paper is to describe AS from a legal perspective. What might be pitfalls in the management strategy that urologists should be aware of? In order to construct an answer to our research question, a patient from the Prostate cancer Research International: Active Surveillance (PRIAS) study will be used as an example. In the methods section, first some information on the PRIAS study is given. Then a PRIAS case will be described after which the Dutch legal framework will be set-out. Finally, the Dutch legal framework will be applied to the PRIAS case to find what would happen if that particular patient would file a complaint. On the basis of the analysis we can conclude that urologists that offer AS should be aware of the information that they provide to patients when entering AS but also during follow-up. It is furthermore important that urologists act in line with their medical professional standards. Therefore it is advised that urologists follow the progress that is made within the field of AS carefully, as the field is moving rapidly.

The meaning of medical professionalism for the faculty members of medical school and university hospitals in Korea

The medical professionalism for faculty members of medical schools has some different implication from other medical professions. They have to work as educator, researcher, and manager as well as clinician. The professionalism of each duties has its own uniqueness, which sometimes causes a conflict between them. Therefore, the faculty members of medical schools have to harmonize their different tasks and duties each other, looking after the professional development through the professional life.