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Manager Zdravoochranenia 2022 #10
Published: 2022-10-13
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CONTENT OF THE ISSUE
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Categorization of the Higher Attestation Commission List and its place in the national system for evaluating the effectiveness of research and development
In 2022, Western countries imposed sanctions on the Russian scientific community, giving grounds to overestimate the paradigm of building an open global scientific system, proclaimed in Europe after the end of the Cold War. The main refrain of the new stage is the strict regulation of European values and transatlantic interests in the security of communications with Russia. The growing relationship between foreign policy and security policy marks a departure from the principles of scientific internationalism, therefore, a National System for evaluating the Effectiveness of scientific research and Development is being created in the Russian Federation. The methodology of creating
a sovereign system and the principles of forming a national “white list” of journals and/or scientific publishers, publications in which are taken into account when evaluating the activities of national organizations, collectives or individual scientists, are considered.
In order to increase the strictness of the selection of journals of the list of Higher Attestation Commission and the transparency of its replenishment procedures, the Ministry of Education and Science of Russia has developed a Methodology for ranking journals of the list of Higher Attestation Commission. Scientometric indicators are listed, on the basis of which an integral indicator of the “quality of the journal” is calculated for each scientific specialty.
The lists of peer-reviewed scientific journals are presented, in which the main scientific results of dissertations for the degree of candidate of science, for the degree of doctor of science, should be published, classified as K1, K2 and K3 in the scientific specialty 14.02.03 – Public health and healthcare (medical sciences). -
Features of the organization of work of paramedical personnel of emergency medical care in the conditions of COVID‑19
In recent years, the ambulance service in our country has been undergoing changes in the direction of reducing the number of stations, medical personnel, as well as persons who have been assisted on trips, which has increased the burden on this healthcare sector in the context of the spread of a new coronavirus infection.
The purpose of the study is to develop proposals to improve the organization of the work of the ЕMС in the conditions of the spread of a new coronavirus infection.
Materials and methods. To study the organization of work, information was copied from call cards (n=134 before the
pandemic, during the pandemic n=2058), the study of the frequency and validity of ЕMС calls was carried out using a developed questionnaire.
Statistical processing of the material was carried out using the Statistika 10.0 software package. Statistical differences were considered significant at p<0.05.
Results and discussions. It was found that in the conditions of the spread of a new coronavirus infection, the number of calls and the time spent on their full processing increased, and factors affecting the duration of the call were also identified. In addition, an increase in the number of unreasonable calls was detected and their causes were determined.
Findings. The developed proposals for improving the work of the ЕMС will reduce time losses when making a call and increase public awareness of the reasons for calling an ambulance -
Evolution of regional regulatory and legal acts concerning the organization and financings of high-tech medical care
Article represents the review of regulatory-legal base of the devoted organization of rendering and financial maintenance of high-tech medical care. Acts accepted both at a level of the Russian Federation as a whole, and in separately taken region are considered. Dynamics of variation of volumes and sources of financing of the given type of the help is traced. Data as about the solved problems in the organization of high-tech medical care, and about legal blanks in the legislation cite. The major factor preventing an increase of availability of high-tech medical care, it is considered deficiency of financing and imperfection of mechanisms of planning of volumes. Rendering of high-tech medical care due to the state sources of financing, requires perfection, especially concerning absence of the precise rules of a level co-financing. The decision of the given questions will assist as a result to growth of security of the population of Russia by high-tech medical care.
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Approaches to developing an information resource for managing patient flows in a medical organization during a global biological challenge (on the example of COVID-19)
Patient flow management in medical organizations and rational use of human, material, medical and technical resources during the period of global biological challenge are the key to the effective functioning of the health care system.
The formation of a set of indicators and criteria that allow the organization, planning and management of hospitalizations should be carried out with using of modern information aggregators integrated with medical information systems both at the level of a single hospital and in general across a network of medical organizations in the region that provide specialized medical care in hospitals.
Purpose of the study is to develop an information system architecture that allows assessing the level of use of the resources of a medical organization during a global biological challenge (on the example of COVID-19) and distributing patient flows depending on its current capabilities.
Materials and methods. Based on the data on the results of hospitalization of 7576 patients with COVID-19 in the Noginsk Central District Hospital, 6 consecutive stages of developing an information system were formed, including user stratification and determining roles and levels of access to information for them, classifying the resources of a medical organization, developing digital models of databases data, standardization and mapping of work processes in the structural divisions of the hospital, compiling a list of input (accounting) and output (reporting) indicators correlated with each other through the use of directories and registers, as well as on the basis of logical links.
Results. Digital layouts of 4 registration cards were developed (data of medical workers; data of patients, medical services provided to them and the time for their implementation; use of medical equipment and time spent on research; registration of hospitalizations in hospital departments), 10 reporting forms (on the activities of medical workers and medical services rendered by them; on the structure of hospitalized and diagnostic tests carried out by them; on the use of medical equipment; on hospitalizations and the use of hospital beds) and templates of analytical reports for making management decisions based on the data of reporting forms for 6 categories of users (for medical workers of the relevant structural units of the hospital heads of structural subdivisions, deputy heads of a medical organization and head of a medical organization, a specialist of a public authority of a constituent entity of the Russian Federation in the field of health protection).
Conclusion: The information resource proposed for development makes it possible to carry out a current assessment of the workload of medical workers and medical equipment, the employment of the bed fund, compliance with time parameters when performing standard operating procedures in the structural divisions of the hospital and ensure operational management of patient flows. -
Approaches to the study and development of corporate culture in a healthcare organization
Relevance. The N. V. Sklifosovsky Research Institute for Emergency Medicine is a leading multidisciplinary medical institution with a unique corporate culture. In its established work team, the heads of departments are carriers and indicators of values for the employees.
P u r p o s e . To study the values of the heads of departments.
M e t h o d s . Anonymous survey among two groups of heads: GrS (scientific departments) and GrC (clinical departments) using the methodology of assessing the value profile (questionnaires: SVS‑57, PVQ‑47) and labor motives (Martin-Ritchie questionnaire).
F i n d i n g s . The questionnaires were filled out by 25 heads, of which GrS – 11 people (44%), GrC – 14 (56%). According to the Schwartz questionnaire, in the GrS, “Self-Direction” was in the first place in the value profile rating, “Benevolence” was in the second place, “Security” was in the third, and in the GrC, “Security” was in the first place, “Benevolence” was in the second, “Self-Direction” was in the third. Regression analysis was carried out in the general group: clustering was determined by the indicator “Universalism” (0.13). Its strong correlation with “Security” was revealed (k=0.73, p<0.01). According to the Martin-Ritchie questionnaire, the main motivating factor for people is the feeling of their own relevance in interesting and socially useful activities.
In particular, the respondents for whom “Security” is not a priority want more recognition from other people than employees for whom “Security” is very important. The respondents ranking the “Security” value first prefer material incentives, but they also prefer to set challenging goals and achieve them.
C o n c l u s i o n s . In the rating of value orientations among the heads of scientific and clinical departments, there are divergent values of “Self-Direction” and “Security”, which increases the risk of professional burnout. The priority motives of mid-level executives were identified. The data obtained during the CC monitoring can be used for the development of communication strategies within the clinic (including in the distribution of functional responsibilities), as well as for image-building activities aimed at the external environment. -
The urgency of implementation of the refence center approach in pathology practice
The project to establish the reference center for addressing scientific-practice, organizational and methodological challenges of immunohistochemical, pathomorphological and molecular genetic laboratories and centers of data analysis and interpretation of radiological methods started in 2020 within the Department of fundamental pathology of Endocrinology research center. The present review focuses on the prospects of a concept of reference center with an emphasis on the current state of Russian pathology service.
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Peculiarities of system evaluation of polyclinics medical organization: optimization of availability by personnel
A model for the analysis of some indicators of a systemic assessment of the activities of a multidisciplinary medical organization is proposed: the integration of the indicator of staffing of a medical organization and the financial performance of medical organization is analyzed. The main performance indicators of the medical diversified organization are listed and the results of their correlation analysis with the indicators of the group of financial indicators are presented.
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Problems of medical support for persons over working age (by the example of the Republic of Tatarstan)
Currently, most countries are showing a demographic trend characterized by an increase in the number of older people. In Russia, there is also a significant aging of the population, in connection with which, the number of people older than working age seeking medical care is growing every year. At the same time, the need is growing not only for treatment and rehabilitation, but also for the prevention of diseases, the implementation of active longevity programs. All this emphasizes the relevance and necessity of high-quality and sufficient medical support for this category of people.
Purpose: to study the features of medical support for people older than working age on the example of the Republic of Tatarstan.
Materials and methods: the data of official statistics, including those of the Ministry of Health of the Republic of Tatarstan, were used in the work. Analytical, statistical, mathematical research methods were used.
Findings: To create optimal resource provision in the provision of medical care to people older than working age, it is necessary to: introduce new indicators of the state of health, increase the number of geriatricians, increase the number of geriatric beds, not reduce therapeutic beds, constantly increase the coverage of preventive medical examinations, medical examinations of people older than working age age, based on their share in the population structure (at least 25%). -
Mathematical prediction of the risks of iron deficiency in women
Purpose. Based on the study of medico-social, medico-biological and psychological factors, to assess the risks of iron deficiency in women. The results obtained will be used to develop a relevant program for the prevention of iron deficiency anemia and latent iron deficiency in primary health care.
Materials and methods. The medical and social study was conducted on the basis of the city polyclinics of Kazan, the samples included two groups of women: 394 patients with laboratory-confirmed iron deficiency, including its clinical manifestations, and 373 women with a confirmed absence of iron deficiency and without probable complaints. The following methods were used in the study: bibliographic, socio-hygienic, psychological testing, sociological, information-analytical, mathematical-statistical, organizational experiment.
Results. New data have been established on the factors affecting the volume of tissue iron stores in women: statistically significant associations of serum ferritin with sleep quality parameters and carbohydrate intake. The risks of iron deficiency anemia and latent iron deficiency were assessed, and subranges for individual risk groups were calculated.
Findings. Statistically significant associations were found in the ferritin-total protein model with late bedtime (p <0,001), discrete sleep patterns (p <0,001), situational anxiety (p <0,001), and daily sugar intake (p = 0,021). According to mathematical forecasting, the greatest influence on the development of IDA in women is “going to bed” (R=2,1). Women who go to bed after midnight and from 23.00 to midnight are at risk of iron deficiency anemia, the risk of which is 2 times higher than in women who fall asleep before 23.00. The probability of latent iron deficiency in women with a high level of personal and situational anxiety is 28–29 times higher than in women with a low level of anxiety (R=29,254 and R=28, respectively). -
Assessment of the economic burden of psoriasis in the republic of Bashkortostan
Psoriasis is one of the most common chronic dermatoses, leading to disability of patients. The damage from it is comparable to the damage from atrial fibrillation, lung cancer, breast cancer.
P u r p o s e of our study was to determine the economic burden of psoriasis in the Republic of Bashkortostan, depending on the volume of costs for different treatment options.
M a t e r i a l s a n d m e t h o d s . The paper calculates the economic burden of psoriasis in the Republic of Bashkortostan based on official data from the Medical Information and Analytical Center of the Republic of Belarus, the Territorial Compulsory Medical Insurance Fund of the Republic of Belarus and Bashkortostanstat for the period 2020-2021.
R e s u l t s . There is increase in the number of patients with psoriasis in the Republic of Bashkortostan for the period 2012-2021. The total economic burden of psoriasis in the Republic of Bashkortostan is 896970909,00 rubles in year (66055,7 rubles per patient), including: for all types of treatment, taking into account the funds of the patients themselves, 559028692,5 rubles are spent, for temporary disability benefits 300293897,6 rubles, disability benefits 37648318,9 rubles. The largest proportion of patients regularly treated for psoriasis are patients receiving therapy both in a hospital and in a polyclinic (42,1%). The allocated volumes of high-tech medical care, as well as genetically engineered biological therapy in the Republic of Bashkortostan are insufficient to provide all patients in need with these types of assistance. One third of patients with psoriasis (33,6%) do not seek treatment from dermatovenereologists.
C o n c l u s i o n . The results obtained indicate the need for further detailed study of the issue of economic costs associated with the prevalence of psoriasis in the Republic of Bashkortostan, the development of measures to reduce the incidence of the population, risk factors and relevant policy documents for the resource provision of medical care for patients. The medical, social and economic efficiency of the measures will be expressed by improving the quality of life of patients, reducing the economic damage from temporary disability and disability. -
Comparative assessment of adherence to vaccination of young mothers and medical university students
Vaccination is a proven tool for fighting infectious diseases. With the development of the pandemic, the relevance of vaccination prevention has significantly increased, and therefore the importance of considering aspects of vaccination among various population groups has increased. Of particular importance is the commitment to vaccination of medical university students, as future doctors on the one hand, and young mothers on the other.
P u r p o s e – identification of the peculiarities of adherence to vaccination of students of a separate medical university and young mothers of a certain territory to optimize the popularization of vaccination prevention.
M a t e r i a l s a n d m e t h o d s . A comparative study of vaccination adherence of 167 medical university students (average age 22,3±0,79 years) and 200 mothers aged 19 to 30 years (average age 23,5±5,1 years) living in Smolensk was planned and conducted. In the course of the study, statistical, analytical methods, and open online questionnaires were used.
R e s a l t s . The analysis of the results of the survey of young mothers and medical students indicates a generally positive attitude towards vaccination, the importance of which is understood by more than half of the respondents. Respondents of both groups are actively interested in the topic of vaccination prevention and would like to receive more information on this issue. The main source of information about vaccination in both young mothers and medical students are medical professionals. The majority of respondents of both sexes will vaccinate their children within the framework of the National Calendar of Preventive Vaccinations.
F i n d i n g s . It is necessary to strengthen the formation of commitment to vaccine prevention among medical students and young mothers.
This can be done by making changes in the educational structure; conducting webinars, seminars, conferences on immunoprophylaxis; development of informational materials for the population on vaccine prevention in the form of models, posters with the participation of students. It will be advisable to involve volunteers – medical students to speak to parents and peers on vaccination, as well as strengthening health education work among the population and talking to parents about the possible consequences of lack of vaccination. -
Issues of taxation of compensation payments for treatment of COVID-19 with personal income tax
Previously existing payments for the treatment of coronavirus infection (incentive payments, special social benefits) were not taxed on personal income. Therefore, the question naturally arises whether compensation payments to certain categories of persons at risk of contracting a new coronavirus infection are subject to taxation with this income. This problem is all the more urgent because, in accordance with the Tax Code, a number of types of compensation payments are exempt from taxation.
The article analyzes the positions of the tax authorities on the problem under consideration, taking into account judicial practice, and concludes that compensation payments related to the treatment of COVID‑19 are an element of remuneration, act as a form of compensation surcharges for work in harmful working conditions, and therefore are subject to personal income tax in a general manner.
