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Introduction. The article presents a comparison of simulation models for financing an inpatient emergency department and a therapeutic department using the example of an emergency therapeutic flow of patients.The objective was to analyze the economic aspects in an inpatient emergency department for the treatment of emergency therapeutic conditions such as hypertension.Methods and materials. Based on a retrospective analysis of the flow of incoming patients for emergency and urgent indications, a simulation model of the load and economic calculations of the work of the inpatient emergency department was developed.Results. According to the results of the study, it was revealed that with a three-fold increase in the flow of patients entering the department, the inpatient emergency department copes with this flow more effectively in comparison with the therapeutic one. Despite this funding, the medical institution receives significantly less.Conclusion. Based on the study, the need to create a special tariff plan for the work of such units as the inpatient emergency department was identified, because the capacity in this department is many times greater.

Background. The severe course of parenteral viral hepatitis and their further chronicity are associated with the presence of immunodeficiency disorders, frequency of which increases significantly in harsh climate. The article discusses the spread of parenteral viral hepatitis in the Arctic zone of the Republic of Sakha (Yakutia) and the issues of organizing medical care for patients with chronic viral hepatitis at the regional level.The aim of the study. To analyze the incidence rates of parenteral viral hepatitis in the Arctic regions of Yakutia in order to improve the health care system using the example of remote areas of hard access.Methods. The work uses materials from official statistics of the territorial department of Rospotrebnadzor for the Republic of Sakha (Yakutia) for 2000–2022 and information from the “Chronic viral hepatitis in the Republic of Sakha (Yakutia)” register. Results. In the Arctic regions of Yakutia, problems are observed in chronic forms of viral hepatitis B, C and D, as well as in their outcomes, such as cirrhosis and liver cancer, leading to early disability and mortality. In the general structure, hepatitis B infection prevails, which indicates the presence of family foci of infection. All this requires a complex of not only therapeutic, but also advanced anti-epidemiological measures.Conclusion. The difficult epidemiological situation regarding parenteral viral hepatitis, caused by extreme natural and climatic conditions, genetic characteristics of the indigenous population and the lack of medical institutions specializing in the treatment of chronic viral hepatitis, dictates the need to strengthen systematic on-site monitoring studies and telemedicine consultations in the Arctic zone of Yakutia. Thanks to this, residents of hard-to-reach areas of the Arctic zone of the Republic of Sakha (Yakutia) will be able to receive targeted subsidized care for the treatment of chronic hepatitis without traveling to Yakutsk.

Introduction. The relevance of conducting this study is determined by the necessity to create organizational conditions and optimize the clinical-diagnostic aspect of medical care for patients with traumatic brain injury (TBI) and acute stroke. This aims to improve patients' quality of life by enhancing the effectiveness of medical care provision in Ukraine. This improvement is based on identifying the causes and analyzing deficiencies in medical care for these conditions. The aim of the research is to investigate the specificity of deficiencies in providing medical care to patients with isolated traumatic brain injury and acute hemorrhagic stroke due to the rupture of cerebral arterial aneurysms based on a retrospective analysis of medical documentation, as well as the results of patient treatment in cases of discrepancies between clinical and forensic diagnoses concerning the primary, concomitant diseases, and their complications. Materials and methods. Clinical assessment of the results of providing care to patients with traumatic brain injury and stroke was conducted through a retrospective analysis of medical documentation of patients who were hospitalized with these pathologies. The applied methods include clinical and laboratory investigations of homeostasis and metabolism parameters, and instrumental techniques. Results. In the identified influence of the timing of the operation (within the first few days) and the breakthrough of blood in the subarachnoid space of the brain, including with intracranial hemorrhage as a result of a re-rupture of a cerebral arterial aneurysm, on the risk of lethal outcomes of surgical treatment, a rationale for searching ways to optimize therapeutic tactics in this category of patients was provided. This includes identifying defects and shortcomings in the organizational aspect of medical care. Conclusions. Based on the analysis and identification of the most informative factors influencing the results of surgical treatment of cerebral aneurysms, a prediction system has been developed that allows calculating the probability of its outcome. The application of the forecast is advisable to consider in the prevention and timely detection of possible deficiencies in providing medical care to patients with stroke.

The article presents a review in the form of theoretical knowledge and critical understanding of cognitive premises, value formations and ideas about law, conceptualized in the chapter "Ethical and legal foundations of medical triage standards in the Russian military medical service" in the book "Lack of resources in an unfavorable environment: an ethical study principles of medical triage and procedures for providing medical care", published in 2023 by the Springer publishing house (Switzerland). The authors note that the reviewed chapter of the monograph is of theoretical, empirical and practical interest for researchers in healthcare organization, including in conditions of armed (military conflicts), philosophers, lawyers, as well as medical and legal students. This interest is due to the fact that the author of the chapter under review successfully managed to describe, justify and reveal the substantive characteristics of the ethical and legal foundations of medical triage in the activities of the Russian military medical service. Cognitive, legal, informational, value and prognostic aspects are the obvious advantages of the chapter under review, which will contribute to its popularization among readers.

Introduction The purpose of this cross-sectional study was anamnestic evaluation of the treatment performed in patients with GMFCS levels I, II, III spastic cerebral palsy and to assess their motor status, quality of life and anatomical disorders in the lower extremities in the age range from 17 to18.5 years. Material and methods A cross-sectional study was conducted in patients with spastic types of cerebral palsy at the age of 17‑18.5 years. The completeness and consistency of previous treatment (according to medical documentation), motor abilities, quality of life, radiographic anatomy of the lower extremities were studied. Results We selected 73 patients meeting the inclusion criteria out of 201 cases. Insufficient systematic implementation of complex therapeutic measures was revealed, which was reflected in a high rate of orthopedic interventions (93.1 %). Fibromyotomies, triceps lengthening surgeries performed at an early age (6-7 years) contribute to the development of an iatrogenic crouch gait pattern, a decrease in motor abilities and quality of life by the age of 17-18 years. The probability of maintaining a positive result and improving motor ability by the end of the childhood period is significantly higher in the subgroup of multilevel orthopedic interventions than in patients after fibromyotomies or who did not undergo orthopedic treatment; the differences are significant as the chi-square test for binary samples shows (p = 0.012). Conclusions The severity of impairment of motor abilities, quality of life, incidence of the crouch gait pattern in patients with spastic types of cerebral palsy are close between subgroups at the time of transition to adult medical and diagnostic institutions. The quality of life and motor status after multi-level intervention improves and remains stable by the end of the childhood. Early surgical interventions for lengthening the triceps, fibromyotomy reduce motor potential in the long term, cause the development of the iatrogenic crouch gait pattern, and decrease the quality of life of adolescents with mild neurological disorders.

The COVID-19 pandemic had a serious impact on global health and showed that the current state of most health systems in the world was not ready for such an emergency. During the pandemic, the provision of specialized planned medical care to patients with chronic diseases was suspended, and therefore telemedicine technologies for remote monitoring of patients began to be actively used in many countries of the world. In the Russian Federation, leading experts have issued organizational and methodological recommendations for the management of patients with diabetes and other chronic diseases during the COVID-19 pandemic. The measures taken by the government to provide medicines and prevent COVID-19 infection have allowed many patients with diabetes to observe a self-isolation regime. Meanwhile, there are data on the negative impact of self-isolation on the general condition of patients for various reasons: a decrease in the level of self-control and physical activity, a reduction in the volume of planned specialized medical care. Telemedicine technologies in the Russian Federation have been successfully used for remote monitoring of patients with mild and moderate severity of COVID-19. Currently, the widespread use of telemedicine and modern digital technologies, which proved their effectiveness during the pandemic in the treatment and control of diabetes, has not yet reached an optimal level. This review examines the possibilities of using telemedicine technologies for patients with diabetes, analyzes the experience of foreign countries and the Russian Federation in managing patients with diabetes during a pandemic, and analyzes the effectiveness of management measures to provide medical care to patients with diabetes.

Introduction. This article presents the experience of five years of using simulation modeling to optimize work in the field of healthcare organization. Works are considered on the example of organizing the process of a three-level system for organizing emergency medical care in the regions, and examples of the practical application of computer modeling to improve the work of an inpatient emergency department are presented.The objective was to study various methods and approaches to the implementation of simulation modeling used in practice in the healthcare system. Consider the possibilities of simulation modeling on the FlexsimHC platform.Methods and materials. The analysis of methods and software used to create a simulation model in the healthcare sector was carried out. The main possibilities of using process modeling on the FlexsimHC platform were considered on the example of designing work inside and outside the hospital.Results. After a series of experiments in the virtual space, the data obtained were put into practice. On the example of the completed project of the simulation model of the region, a real way to optimize the emergency medical care in the region was proposed. Experiments were also carried out on models of an inpatient emergency department, the results of which revealed ways to optimize the workflow aimed at reducing the duration of stay inside the department, at an adequate distribution of patient flows, allowing timely implementation of all necessary medical and diagnostic measures without additional burden on medical personnel.Conclusion. Simulation modeling is the key to solving the logical problems of modern planning, allowing to reduce the risks of logistics errors in real time.

These recommendations were approved at the meeting of the Samara regional branch of the Society of Transplantologists, protocol № 6, 2022. They contain recommendations for the actions of health authorities at the beginning of multiorgan transplantation programs.

The commentary critically analyzes the strategy proposed by the authors of the article for performing osteosynthesis and describes the system of care for patients with fractures in Moscow. Operating rooms are divided into planned and emergency. And they, in turn, are divided into conventional and hybrid, in which it is simultaneously possible to perform endoscopic, endovascular, and open surgery. Surgeries are performed in order of priority. Highest priority: extra-focal fixation of limb bones and/or pelvis with ex-fix devices; surgery on extremities with impaired blood supply in the distal parts; decompressive fasciotomies with simultaneous external fixation of fragments in ex-fix devices with suspected formation of compartment syndrome; surgeries performed in patients with severe combined or multiple trauma. High priority: open fractures of type 3A and 3B according to the Gustillo classification, requiring primary surgical treatment of wounds and external fixation; closed unstable fractures.

Objective: description of the current problems concerning the development and conducting of a protocol of clinical approbation (CA) of methods of prevention, diagnosis, treatment and rehabilitation to optimize the implementation of innovative medical technologies in practical health care through CA.Material and methods. The review of the legislative framework governing CA and analysis of the proceedings of CA issues strategic session were carried out, management decisions to improve the effectiveness of CA were proposed. Analysis of legal acts stipulating the notion and status of CA was performed. The study included orders of the Ministry of Health of the Russian Federation, which established regulations on the organization of CA, the CA protocol templates, etc. Methodological materials, review articles on the organization of health care in the Russian Federation selected from various open sources were studied. The basis for making management decisions on improving the quality of CA procedure was formed by the participants of the CA issues strategic session which had been initiated by the Center for Healthcare Quality Assessment and Control.Results. Based on the results of the strategic session and the analysis of legal acts, current issues related to CA regulation, such as lack of СА coordination and research publications, poor methodological quality of clinical and economic evaluations within CA, promotion of innovation through CA were identified. The developed managerial decisions on improvement of CA and promotion of innovations in practical health care were presented.Conclusion. Current legal acts regulating CA activities should be updated with a view to establishing a transparent system of clinical and economic evaluations of new and innovative methods for making an informed decision to include them in clinical guidelines and routine clinical practice. It is proposed to legally assign the functions of CA coordinator to the federal medical development organizations. Regarding the promotion of innovative technologies in practical health care, it is advisable to create a system for the introduction of innovations, including taking into account conducting CA.

The article is devoted to investigate and interpret the contents and correlation for the concepts of "medical care" and "medical service" in the context of public healthcare. Here, we demonstrate the defective features of the Russian legislation regarding accepting the necessary legal definitions for such concepts. At the same time, while performing a comprehensive formal legal analysis and applying interpretation by analogy, we provide generalizations allowing to understand the essence of the concepts analyzed as well as their inter-relationship. We interpret two definitions for the concept of "medical service", and envision that medical care vs. medical service is an ontological unit of a more general and higher level. Understanding the differences in the definitions of "medical care" and "medical service", demonstrated in the article, will be useful to healthcare organizers.

The Objectivewas to discuss various aspects (organizational, diagnostic, therapeutic and socio-ethical) of care for patients with surgical complications of lung cancer and the role of thoracic surgeon in the management of these patients. Different problematic issues of the management of patients with surgical complications of lung cancer (pneumothorax, pulmonary hemorrhage, paracancrotic abscess, pleural empyema) directed to the department of general thoracic surgery are presented. Various aspects of the management of patients with surgical complications of lung cancer are considered: organizational, diagnostic, therapeutic, social and ethical. The implementation of the presented aspects requires the training of specialists: thoracic surgeons in oncology and the technique of interventions, taking into account the principles of oncological radicalism, oncologists in the features of infectious postoperative complications. Improving the treatment and diagnostic approach in this category of patients will extend the life of those of them in whom radical surgical, chemotherapeutic and radiation treatment is impossible. Recognition of patients as palliative does not mean the cessation of emergency measures to save them from life-threatening complications. The problem can be solved with the participation of thoracic surgeons, oncologists, healthcare organizers.

Introduction. The economic aspects of providing cancer care to the public attract increasing attention of scientists, economists, physicians and other healthcare professionals. Currently, the healthcare economics of oncological institutions is defined as part of the national economy that implements cancer care programs and provide a wide range of medical and pharmaceutical services to the public.Aim. The study was conducted as part of the program for improvement of financial spending in order to facilitate cancer care for Moscow residents. The aim of this study was to identify the crucial areas of the cost analysis and thus improve the public health service.Materials and methods. We used the methodology of targeted and consistent search of the literature. The data search and analysis was carried out using the US National Medical Library (PubMed database), National Electronic Library (e-LIBRARY, Russia), and other Internet resources. Whenever possible, articles on the most common and socially significant types of cancer (breast, colon, prostate, lung etc.) were selected. In addition, we focused on significant studies conducted either on the national or international level.Results and discussion. In principle, the structure of total costs is determined by the health policy regarding the cancer care system. Six main areas of oncological care that require careful economic analysis have been identified: those are prevention, oncoscreening, diagnosis, treatment, rehabilitation, and palliative care. In order to implement the economic goals of the healthcare system, the cost of cancer treatment should be discussed. The relevant programs are expected to be based on 1) prevalence and incidence; 2) impact on health; 3) results of the integrative methodological approach to cancer treatment; 4) implementation of comprehensive measures of medical and social assistance; 5) use of financial mechanisms and their impact on economic indicators.Conclusion. The set of measures related to the direct costs as identified in this study include the development, planning and provision of cancer care. These specific features of the direct cost analysis are important for organizing medical care in oncological institutions.

The commentary discusses the advantages and disadvantages of the model proposed by the authors of the article for performing osteosynthesis for urgent indications within 24 hours after the patients admission to the hospital, and also focuses on the need for comprehensive assessment of treatment outcomes and financial costs of the healthcare system. The determination of indications for emergency osteosynthesis and the identification of patients groups depending on the pattern and localization of the fracture are also important issues in justifying the shortening of the time before surgery. It is necessary to justify the priority localization of fractures for urgent fixation based on the analysis of the authors own experience and literature data. Changes in the system of emergency trauma care will require a revision of the standards of staffing and financing in the system of compulsory medical insurance. Therefore, the commentary emphasizes the expediency of a preliminary assessment of the new model effectiveness in some medical institutions by comparing it with the traditional system.

The health care system is a state institution that implements the constitutional right of citizens to health and medical care. It is part of the legal framework, and in case of unfavorable outcomes or the consequences of the medical process, law enforcement and judicial authorities may be involved. Sudden and rapid onset death is difficult categories to accurately establish and evaluate. Having sufficient clarity in medical terminology, these categories are not clearly represented in the legal system. Consequently, when the question regards responsibility of the doctor for one or another adverse outcome in case of quick, sudden death, there are a number of qualification difficulties. There is an inconsistency between medical and legal terminologies. Complex approach to the problem analysis contributes to the systematization of knowledge and experience in this field. The article provides an example of legal proceedings in such course of events. We emphasize the need for coordination of medical and legal terminologies.

The article suggests the reasons for the delayed help-seeking in patients with acute coronary syndrome in terms of individualization of work. For analysis, the approach of narrative medicine was used, that is, a way to conceptualize medical situations using the methods of the humanities, or rather, to understand the disease as an event in the patient’s life — his biographical narrative. These categories are important both from the standpoint of ethics and patient orientation, and from the standpoint of health improving through education of the population. A number of attitudes are shown that lead to delay in help-seeking: rigidity of thinking, unwillingness to cause discomfort, atypical manifestations, distrust of medicine and the unknown medical process. In general, the inclusion of a disease in the biographical process occurs through denial of the disease, distrust of medicine and/or healthcare, procrastination. As a solution of these problems, an assessment of the general informational background of patients as society participants and education depending on the social category, is proposed.

The aim of this study is to examine cohort structure of patients with proximal femoral fractures (PFF) and estimate an average annual demand in emergency surgical treatment for St. Petersburg adult population with mentioned diagnosis. Material and methods. The authors examined case histories and radiographs of 1412 adult patients with proximal femur fractures admitted to three St. Petersburg large general hospitals during one year. Analysis was done using statistical and expert evaluation methods.Results. Cohort structure of patients with PFF demonstrated the following distribution: female – 71,7%, male – 28,3%; Patients of elderly group prevailed: 70 years and older – 70,6%, 60–69 years old – 12%, 50–59 years old – 10,8%; Retirees with various disability status – 80%. Injury structure showed prevalence of femoral neck fractures –52%, pertrochanteric fractures represented 42%, subtrochanteric fractures – 5%. 11,3 days was the average time span from injury till surgery. The authors separately estimated urgent surgical treatment demand for patients with femoral neck fractures and patients with trochanteric fractures. Consequently, both groups results were summed up to generate the total average annual demand for emergency operative treatment for PFF which for adult population of St. Petersburg amounted to 4098 interventions, meaning one surgery per one thousand of adults.Conclusions. Absence of a common consistent approach to treatment of patients with proximal femur fractures as well as significant variance among St. Petersburg hospitals in respect of material, technical and staff resources result in a situation when not every patient with PFF undergoes surgical treatment. There is a strong need to develop and regulate implementation of a standardized treatment algorithm for such injuries, to improve infrastructure and resources of St. Petersburg general hospitals as well as to continuously monitor quality of medical treatment for patients with PFF.

Introduction: Chronic obstructive pulmonary disease (COPD), usually in advanced stages, is associated with high mortality, being the third leading cause of death worldwide. In the Netherlands, care delivery to patients with COPD has become a focus of the regional medical community, since the COPD death rates in this country are higher than the European Union average. However, between 2011 and 2021, the number of people with COPD (under follow-u by general practitioners) decreased. The experience of this country is interesting, as a large set of measures to improve the situation has been developed and implemented in this region. The purpose of the study was to analyze the experience of the Netherlands in organizing medical care for COPD in primary care settings., Material and Methods: The search for scientific literature sources was carried out using the PubMed database and Google system. The search time horizon equaled to 5 years., Results: In the Netherlands, in the system of care delivery to patients with COPD, primary care settings are heavily burdened. The article summarizes approaches to identify COPD risk factors, summarizes current clinical recommendations as of December 2022, and highlights findings of the study on medical digital platforms with the potential to organize continuous monitoring of patients. The paper exemplifies criteria for assessing the treatment quality in specialized care settings, including primary care., Discussion: It is assumed that the most effective measure to further improve efficacy of COPD treatment is the introduction of remote digital medical devices. A possible integration of the updated standards and quality indicators into digital services will further strengthen the concept of continuous automated remote monitoring of COPD patients. Evidence-based selection and introduction of effective digital solutions into current practice will improve quality of care delivery to patients.

Screening or its synonym medical check-up is the result of a health indicator, representing results of a medical examination and an effective tool of disease prevention. The concept of the term screening in European countries implies active detection of a disease or a premorbidity in people who are considered or consider themselves healthy. Medical check-up is a set of measures that includes preventive medical examination and additional methods of examinations conducted in order to assess the state of health and carried out in relation to certain groups of the population. The study and analysis of the international screening model and experience of its implementation, its role in the system of primary health care, including rehabilitation, is very important in terms of shaping public health at the international level. The article discusses regional trends in screening (medical check-up) and issues related to the conceptual and methodological aspects of medical check-up organization in the context of public health and prevention of risk factors. The data were searched in Scopus Web of Science, MedLine, the Cochrane Library, PubMed.