Том 65, № 2 (2021)

Introduction. So far, there is no reliable scientific basis for forecasting and preventing pandemics. Around the world, there is public dissatisfaction with the authorities’ insufficiently prompt and effective actions to prevent the spread of Сovid-19. 

The purpose of the study is the formulation a significant problem of the complexity and effectiveness of the operational protective measures for the health and life of the population from COVID-19 in other epidemics and pandemics.

Material and methods. Based on the application of a systematic approach and the international methodology for the policy analysis, the author proposes the structuring of the emergency measures and the subjects of the socio-psychological factors analysis of the epidemics and the pandemics to determine a system of the quantitative indicators and the monitoring of the situation. 

Results. During the epidemics and the pandemics, it is necessary to take emergency measures and also to strive to prevent them based on an in-depth study of the causal relationships, in particular, the risks of the recurrence as a result of the increased traffic flows, urbanization, agricultural intensification, environmental degradation and the continued development of new species biological weapons. 

Discussion. Among the topical areas, it should be attributed the application of the restrictive measures both on the international and domestic air travel; the limiting the increase in population density in large cities with a focus on the standards of «social isolation»; more the adequate environmental protection, the reducing the risk of the infection transmission from the animals to the humans; the reduction of people infections with nosocomial infections. 

Conclusion. The author proposes to significantly restructure the analytical and other functions of the operational protection of the population health and life during epidemics and pandemics.

Introduction. Positive long-term system experience of development and functioning of information technologies in health care should find application in modern information systems. 

The purpose of the study is to justify the principles of improving the efficiency of the use and creation of information resources in health and medicine based on previous experience. 

Methods. The system approach’s methodology combines the methods of system, graphical and statistical analysis used in the study, methods of expert assessments, empirical modeling, epidemiological, socio-hygienic, and other methods. Identifying the main problems of Informatization, evaluating and analyzing approaches to creating information systems, including interdepartmental ones, are solved.

Results. The main problems of informatization of the current stage are identified. The principles of increasing the efficiency of using and creating information resources in healthcare and medicine are justified. The analysis of previously applied principles and methodological approaches to creating information systems is carried out. That is, the experience is evaluated. The study outlines the ways of development and principles of improving the efficiency of using information resources, in particular, through in-depth analysis and modeling of information from multi-year databases.

Discussion. The functioning of the “Health Protection” system makes it possible to increase the efficiency, reliability, and completeness of the use of information on the state of morbidity, disability, and mortality of the population and the environment. The fact that the system is interdepartmental allows improving the existing assessment methods, analysis, and control of the population’s quality of medical care and environmental safety.

Conclusion. The study results emphasize the need to apply and develop similar approaches at the current informatization stage in the health care system.

Introduction. Clinical trials (CTs) are the footing foundation of evidence-based medicine. In Russia many aspects of CT implementation remain unexplored; one of them is the attitude of Russian society. 

Aims. This study aims to determine the knowledge and perception of CTs by potential participants. Analysis of the perception of CTs through the eyes of patients: CTs – is it a benefit or an unjustified risk?

Materials. The primary method of research was a questionnaire. A total of 488 anonymous, voluntary surveys of patients from hospitals in Tomsk were studied.

Results. More than half of the respondents heard about CTs, while the primary source of information was the media. The participants adequately assess the importance of conducting CTs to develop medicine and medical care for society. The primary goal of CTs is to determine the effectiveness and safety of drugs, and respondents regard their engagement as an opportunity to contribute to the development of science. The primary motivating factor in participating in CTs is receiving treatment for an incurable disease and observing conditions by a qualified doctor. The central negative aspect is the possibility of causing a risk to own health. The questionnaire demonstrated the need and importance of all points of informed consent. Several questions concerned the public attitude to researchers. According to patients, medical researchers arouse trust and confidence in altruistic motives during the CTs.

Conclusion. This study revealed a low interest of Russians in participating in CTs, except for personal benefit. The behavior of the doctors, the ability to convey reliable information to the patient to adequately assess benefits and possible risks play an important role in deciding on the involvement of patients in the CTs. The results of this work will allow us to adapt the process of organizing CTs to the needs of patients in the local context.

Introduction. The planning of funding in the public health system and specifically in cancer care remains a challenge for the medical community. Some issues of cancer cost analysis are still not entirely resolved.

Aims. To review the options for analysis of direct cancer costs based on registered follow-up data. 

Methods. The targeting and consensus search methodology was applied to collect the relevant papers from PubMed, Cochrane, E-library (RSCI). 

Results and Discussion. The following options have been identified: 1) using incidence data; 2) using prevalence data; 3) system net and total costs approach; 4) phase approach; 5) cost estimation using censored data. The incidence costs are related to the time of diagnosis. The prevalence costs represent the costs over a fixed calendar period. The net costs can be calculated by subtracting the mean costs across non-cancer patients from the total mean costs across comparable cancer patients. Total costs are defined as the summated costs for cancer patients regardless of whether they are associated with cancer or not. Phase analysis is a variant of estimates based on morbidity data and includes identifying specific periods from the diagnosis when the costs significantly change. Cost estimation using censored data provides for the application of mathematical modeling methods.

Conclusion. The availability of combined cost analysis methods makes it possible to obtain a comprehensive economic assessment for cancer treatment approaches.

Introduction. Children’s preventive healthcare legislation in noncommunicable diseases strictly determines departments’ interaction: there is a distinction in responsibilities, functions, and work standards for public health services and educational institutions. However, it is hard to distinguish which department or institution is responsible for preventive healthcare implementation in practice. This topic shows a lack of understanding of how to segregate responsibilities, establish effective communication channels, and create audit standards for preventing noncommunicable diseases and health literacy. 

Our aim was to analyze the legal, practical, and social aspects of preventive healthcare. 

Materials and methods. We studied correspondences in legal regulations and real-life healthcare activities, examined morbidity cases and affecting factors, and evaluated parental attitudes towards Russia’s preventive healthcare system. We surveyed national, sectoral, and regional statutory regulations. Regarding current laws, we analyzed children physical examination data (form № 030-ПО/о-12 (2017), form № 030-ПО/о-17 (2018)). We also questioned parents about children’s preventive healthcare and healthy lifestyle (1320 participants). All empirical data was collected in the 2017-2018 years in Moscow. 

Results. As a result, inconsistencies in the legal regulations and practical realization of preventive healthcare activities have been found. The critical problem is that there were no adequate implementation mechanisms, no standard criteria, and control methods for specific healthcare events. There was a difference in statutory healthcare activities, treatment as it is, and parental expectations (the most noticeable discrepancies were in the healthcare sphere): there is a noticeable growth of children morbidity; parents mostly feel themselves dissatisfied with the healthcare system. 

Conclusion. It is vital to develop control and implementation mechanisms of national legal regulations, 
to adapt them in regional preventive healthcare programs, considering region peculiarities.

The development of clinical thinking and the improvement of medical care largely depend on doctors and society’s attitude to medical errors. A balanced, rational perspective to medical errors is critical with an understanding of the main aspects of medication errors. The paper presents two important aspects of the problem of medical errors – their probability and, in a sense, their routine, as well as the role of collective relationships in shaping an objective attitude of doctors to errors.

The article argues that the correct action of a doctor does not mean that they are unmistakable. The factors that determine the complexity of medicine are listed.

The actual and ambiguous effectiveness of the medicine is considered.

It is argued that the development of evidence-based medicine is evidence of the relativity of knowledge in medicine. The basic variants of the relationship of doctors in the collective are given. The role of collegiality in improving the professional experience and quality of medical care is specified.

It has been shown that the absence of objective criteria of guilt or innocence of a doctor in error exacerbates the problem of errors. It emphasizes the flaw of equating all errors with misconduct and the unilateralism of such an approach in preventing mistakes. A vicious circle is presented, where the traditionally negative attitude towards doctors who made a mistake ultimately leads to concealment of errors, a decrease in the number and quality of error analysis, stagnation in the development of clinical thinking, an increase in the number of errors and, accordingly, the legal tightening of demand for medical errors.

The article explains the development and functioning of an essential military component - medical support wartime - evacuation system. Describes the concept of conservative evacuation, developed in the Russian army at the beginning of the last century, shows the military medical services’ efforts to expand military health care and improve the system of evacuation during World War I. It is noted that, despite significant efforts, the evacua-tion remained the weakest part of Russian military medicine and does not reflect the scale of sanitary losses.