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The goals and basic principles of the concept of value-based healthcare are described. The experience of participation of medical organizations of the Omsk Region in the implementation of the pilot project "Formation of models of primary care organization based on the principles of value-based healthcare" is analyzed. During the implementation of the project, 9 processes are researched and improved, key performance indicators are identified. It is concluded that the transition to value-based healthcare will improve the quality of medical care.

The item offers a view on psychological, ethical, and deontological aspects of pharmacists’ professional activities; there is also a view on substantial psychological features to be found in those employed in the area of pharmaceutical business, as well as the importance of such aspects for pharmaceutical care.

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Diabetes mellitus is a chronic, endocrine and socially significant disease in which blood sugar is higher than normal as a result of insufficient production of insulin in the body. One of the most serios complications of the disease is the so-called “diabetic foot”, manifested by injury to the limb and subsequent gangrene, amputation and high mortality. This causes permanent disability to the patient, associated with additional complications, reduced duration and quality of life. Treatment requires a multidisciplinary approach, and the team should include – endocrinologist, vascular surgeon, orthopedist, hydropodist, rehabilitator and nurse. Early diagnosis and limiting the influence of risk factors slows down the development of the disease and improves the prognosis of the patient's condition. Nurses carry out continuous monitoring and communication with the patient and his relatives. They must carry out control and training to limit the risk factors and exact compliance with the doctor's prescriptions, which helps to preserve the full lifestyle of the patient, both in the hospital setting and at home and in his social environment. In this context, the nurse's competencies are essential for the early detection and limitation of the factors for the development of the diabetic foot. Her full participation in the treatment team and proper training of patients and their relatives requires her certain knowledge and professional skills. The purpose of this work is to study the competencies of nurses in their participation in a team for the treatment of diabetic foot and to provide training to patients and their relatives to limit risk factors and maintain a normal lifestyle. The study was conducted through an anonymous survey among 32 nurses working in a vascular surgery unit. The research is aimed at analyzing their competencies for providing quality health care to patients with a diagnosis of diabetic foot, as well as their ability to properly educate the patient and his relatives to slow down the development of the disease and maintain a normal lifestyle. The majority of nurses are familiar with the disease diabetes and its complication "diabetic foot". The main guidelines in health care to limit risk factors include: diet, hygienic care and periodic examinations. To provide quality care and maintain a normal lifestyle for patients with a diagnosis of "diabetic foot", it is necessary to develop a health care algorithm in accordance with the specifics of the disease and the needs of the patient. Its successful implementation in practice depends on the competencies of the nurses and the ability of the medical institution to provide conditions for their development. [ABSTRACT FROM AUTHOR]

Patient satisfaction has been the focus of marketing and marketing research for the past two decades. The marketing of the patient-GP relationship aims at satisfaction, repetition of the use of medical services in pre-hospital care and current and future loyalty of patients based on offering the services sought by the target market and development of long-term patient relations programs. The aim of the present study was to study and analyze the degree of satisfaction of patients with medical care in primary outpatient care. An anonymous sociological survey was conducted among 128 health-insured patients in outpatient care in Haskovo. Issues related to the main reasons for choosing a general practitioner from patients, frequency and reasons for changing the GP, assessment of the organization and weaknesses in the activities of GPs are discussed and recommendations for the improvement of GP work are given. [ABSTRACT FROM AUTHOR]

Background: Over the last decade, there has been a growing worldwide interest in the process of communication in the doctor's office. Medical activity, among other things, is a specific social interaction. The patient's ability to choose his general practitioner (GP), attending physician, hospital, insurance fund, etc. is associated with the idea of the independence of the consumer of health services. Public opinion, public attitudes and assessments can become a reliable and effective tool for managing a variety of health activities. The aim of the present study is to investigate and analyze the degree of patient satisfaction with medical care in primary outpatient care and the availability of medical services in pre-hospital medical care. Material and methods: The methods used are: sociological - survey and statistical methods - alternative, variational, graphical analysis - to illustrate the results obtained. An anonymous sociological survey was conducted among 128 health insured patients in outpatient care in Haskovo. Results: The vast majority of respondents believe that the main thing in choosing a GP is the qualification of the doctor (33%), followed by personal impressions (23%) and recommendations from acquaintances (20%). 69% of the respondents state that there should be no restrictions when issuing a referral for a specialist. 31% are in favor of restricting the issuance of a referral to a specialist, and for most of them (55%) the reason is lack of funds. An insignificant part of the respondents (21%) connect the restrictions in the issuance of referrals with sufficient qualification of GPs. Most of the surveyed health insured persons (62%) prefer consultations with specialists in diagnostic-consultation centers (DCC). Discussion: A significant problem in the activities of GPs is the allocation of referrals for examinations of patients by a specialist, which is a prerequisite for interpersonal problems and conflicts between GPs and patients, subsequent change of doctor and even deterioration of the patient due to unrealized examination. at a specialist. The contact between family doctors and specialists is still not good enough. Conclusion: The multilateral problems in the activity of the general practitioner in our country should be the subject of increased attention by health policymakers, health managers and society. [ABSTRACT FROM AUTHOR]

The goal of the current study was to analyze additional costs for COPD patients, having one or more comorbidities related to the severity of COPD, type, and number of comorbidities. This is ambispective 1-year study (6 months prospective and retrospective observation), during which was collected information about the demographic of a representative cohort of 416 patients, COPD severity, comorbidities, health care resources used. Cost of health care resources was collected from officially available sources. The comorbid diseases are varying between 1 and 9. The higher is the number of comorbid conditions for patients in GOLD А (on average 3.69) and smaller if the same number for patients in GOLD В (on average 3.03). The highest is the number of prescribed medicines for comorbid conditions for patients in GOLD С (to 10 products). From the patient point of view, the costs are lower in COPD A group - average 20.05 BGN per patient per month, and higher for patients in GOLD C - average 27.88 BGN per patient per month. From the point of view of the payer the highest are the costs for COPD GOLD A - on average 27.17 BGN per patient per month, and lower are the costs for GOLD С - on average 13.09 BGN, per patient per month. Logically the number of comorbid conditions increase the cost for payer. The cost of COPD A group is more costly for the payer, probably due to specificity of the comorbid diseases. [ABSTRACT FROM AUTHOR]

Цель работы – обобщение научно- го представления об эпохальном пути становления доказательной медицины как успешной медицинской практики и обоснование методического подхода мировой успешной медицинской практики для врача и пациента в процессе опти- мизации медицинской помощи в условиях трансформации системы здравоохранения Украины, ее подготовки к рыноч- ным условиям. Материалы и методы исследования – выполнено описательное, сравнительное, ретроспективное, хро- нологическое исследование, с применением исторического, библиографического, историко-сравнительного, логико- аналитического методов, а также методов дедуктивного осведомления, аналогии, синхронизации, структурно- логического анализа с учетом принципов системности; материалом служили как отечественные, так и зарубежные науч- ные медицинские информационные источники различного генезиса, собранные при помощи электронной поисковой системы Google в соответствии с пакетом Microsoft Office 2016. Результаты. Впервые была сделана попытка системно- го научного обоснования эпохального пути становления доказательной медицины, что позволяет убедительно и в пол- ном обьеме осознать практикующему врачу актуальность мировой успешной медицинской практики в контексте эффек- тивности и безопасности медицинской услуги для пациента, пациенту – о ее качестве, безопасности, финансовой состоя- тельности и минимизации рисков в процессе лечения, а ученому – о повышении качества научных исследований. Выво- ды. Представленный эпохальный путь становления доказательной медицины, как успешной на сегодня в мире медицин- ской практики, в полной мере может способствовать успешной оптимизации системы медицинской помощи, путем по- вышения компетентности и гибкости практических действий врача как к медицинских инновациях доказательного соде- ржания, так и при их внедрении в процессе лечения, без понимания чего врач не в состоянии качественно проанализиро- вать научно-медицинскую информацию и поднять свой профессиональный уровень согласно европейскому стандарту.

Статья посвящена актуальным проблемам ятрогенной преступности в контексте современнойотечественной социально-правовой действительности. Причиной ятрогенных событий часто являются неосторожные действия медицинских работников, обусловленные преступной небрежностьюили преступным легкомыслием. Необходимость формирования современной уголовной политикии действенного механизма ее обеспечения опосредует целесообразность теоретического обоснования комплекса профилактических мер правового, социального, экономического характера, способных предупредить ятрогенные преступления. Анализ существующих правовых позиций позволяетпроследить дальнейшие исследовательские перспективы данной проблемы. Настоящее исследование содержит в себе перечень статей Уголовного кодекса РФ, по которым медицинских работниковпривлекают к уголовной ответственности, а также предложения по внесению отдельной статьи, которая бы предусматривала ответственность медицинских работников. Представлены материалы судебной практики, раскрывающие суть ятрогенных преступлений, анализ которой показывает, что ейявно не хватает глубокой теоретической базы для уголовно-правовой и криминалистической оценки сложных и труднодоказуемых в силу своей специфики преступлений.

The Declaration on Patient-Oriented Healthcare of theTomsk Region was accepted by the medical and patient communities on August 24, 2018. It was the first document of its kind in Russia. It was created based on several elements: modern international experience in the field of protection of patients’ and medical workers’ rights, particular qualities of Russian legislation, principles of humanistic medicine, and broad analysis of specific complaints from patients of regional public health institutions in the Tomsk region. The reason to create the Declaration was the necessity to build a healthcare system in which both medical staff and patients comply with such principles as mutual respect, choice and responsibility, involvement, accessibility, and openness. The document explains the need for constant adherence to these principles for the effectiveness of treatment, the protection of the individual, professional dignity, and equality.

В статье рассматриваются особенности положения пациента как получателя медицинской услуги; вопросы правового регулирования оказания медицинских услуг, договорные отношения. Также рассматриваются пути совершенствования законодательства в сфере оказания медицинских услуг. Причин этому несколько и их сложно отделить друг от друга – это и увеличение количества врачебных ошибок, и рост юридического правосознания населения и как следствие увеличения числа исков и требуемых сумм возмещения, это также и лояльность судов в отношении потерпевших и растущие присуждаемые суммы компенсаций. С одной стороны, перечисленные судебные аспекты деятельности лечебных учреждений можно рассматривать как факторы, влияющие на степень реализации рисков оказания некачественных услуг. По мнению автора, их необходимо рассматривать как отдельную группу рисков, поскольку лежащие в их основе явления, помимо прочего, будут приводить к предъявлению необоснованных чрезмерных претензий к медицинским организациям в случаях, когда их вина отсутствует. В этом случае реализация фактора риска может привести к возникновению проблем у клиники и тем самым перейдет из категории факторов риска в категорию опасностей. А значит, судебная практика требует отдельного внимания при организации системы управления рисками.

Функциональные расстройства пищевода являются конфликтогенными заболеваниями в силу особенностей возникновения и протекания, зачастую формирующих у пациента недоверие к рекомендациям врача гастроэнтеролога. Деструктивно завершенные конфликты с пациентом могут повлечь за собой проблемы психологического, общественного и правового характера. Конфликтологическая компетентность врача гастроэнтеролога и владение переговорными техниками повышает вероятность конструктивного разрешения противоречий. В статье описываются психологические причины конфликтного поведения пациента, понимание которых позволяет правильно интерпретировать его высказывания и сформулировать ответ, способствующий устранению противоречий. В статье также приведены способы аргументации, конструктивного реагирования на конфликтогенные высказывания и способы профилактики конфликтного поведения пациента. Кроме того, проанализированы примеры конфликтных высказываний врача и приведены более конструктивные альтернативы.

Статья посвящена освещению особенностей организации работы государственных стоматологических поликлиник в условиях распространения новой коронавирусной инфекции (Covid 19). Также представлен обзор законодательных актов и нормативных документов Российской Федерации, регулирующих функционирование стоматологической службы в период пандемии (Covid 19). Авторами обозначена проблема стабильного глобального роста заболеваемости новой коронавирусной инфекцией Covid 19 и связанные с этим трудности, которые возникают в системе здравоохранения и при оказании стоматологической помощи, в частности. В статье отмечена сложность принятия взвешенных и оптимальных решений по работе медицинских учреждений стоматологического профиля в кардинально изменившейся среде. Подчеркивается важная роль принятия административных мер по соблюдению инфекционной безопасности при оказании стоматологической помощи в условиях пандемии. Целью данной статьи является освещение специфики функционирования государственных стоматологических медицинских организаций в условиях распространения новой коронавирусной инфекции (Covid 19). Актуальность данной цели продиктована недостаточностью знаний о новом возбудителе, механизмах передачи от инфицированного к здоровому, тяжестью течения заболевания, наличием частых осложнений и т.д. Приведены рекомендации по внесению изменений в организацию оказания стоматологической помощи. Рассматриваются организационные аспекты, тактические модели реализации рекомендаций по профилактике заражения новой коронавирусной инфекцией (Covid 19) в государственных стоматологических поликлиниках. Авторами предлагается разработать и утвердить нормативные документы по соблюдению инфекционной безопасности медицинским персоналом в соответствии со спецификой стоматологического лечебного учреждения, объемов оказания стоматологической помощи.

Purpose. In article authors put the task to track process of transformation of the informed voluntary consent of the patient to medical intervention of the ethical theory in legal practice in a domestic health care system since the Soviet period to the present as the harmony of universal values and precepts of law can regulate at the same time not only behavior of the person within professional ethics, but also development of medical science. Methodology. To studying of this problem it was applied dialectic and comparative-historical methods of a research. Results. During the carried-out analysis of introduction in medical practice of the theory of the informed consent on a debatable basis in public and medical circles and also on the basis of consideration of the standard precepts of law regulating relationship the doctor patient in domestic medicine of the 20th century, authors have come to a conclusion about what, having got the first experience of legal regulation of the practician of consent of the patient to medical intervention only in modern Russia has been brought into accord with the international standards. Practical implications. Results of a research can find application not only in the field of bioethics and the medical right in medical and legal higher education institutions in the course of training, but also to become the basis for a separate study on the study and improvement of the legal framework of informed voluntary consent of the patient in the development of modern health care system.

Cardiovascular disease is a leading cause of morbidity and mortality. Angina pectoris (stable and unstable) is caused by the presence of atherosclerotic plaque located in one of the coronary arteries feeding the myocardium. This plaque narrows the lumen of the vessel, as a result of which less oxygen and nutrients reach the heart cells. Nursing care for these patients consists of accommodation in a suitable well-ventilated room, monitoring of somatic parameters every two hours, oxygen therapy, providing a suitable position for the patient in bed -- Fowler, providing adequate personal hygiene according to the patient's condition and creating positive emotional tone and limiting unpleasant experiences. The aim of the present study was to establish the presence of a pattern between gender, age, concomitant diseases and the emotional state of patients with angina. The presence of hypertension, time, location, intensity and duration of pain in these patients were explored. Material and methods: The study was conducted through an anonymous survey of 100 patients admitted for treatment in the intensive care unit of the Clinic of Cardiology at MHAT „Lozenets" -- Sofia, in 2019 and 2020. Results and discussion. The data from the study shows that all patients -- 100, receiving treatment in the intensive care unit of the Clinic of Cardiology at Lozenets Hospital in 2019 and 2020, were hospitalized under the Clinical Pathway No. 16 -- diagnosis and treatment of unstable angina pectoris/acute myocardial infarction without invasive examination and/or interventional treatment. The duration of treatment in the clinical pathway is three days, after which patients are discharged from the intensive care unit and transferred for treatment in the Cardiology Clinic. [ABSTRACT FROM AUTHOR]

The postoperative period in patients who have undergone heart surgery requires good preparation of the patient and his active participation in the treatment process, which continues at home. The postoperative period includes the time from the operation to the discharge of the patient from the hospital. Postoperative care is performed mainly during hospitalization, but the observation of the patient and care for his full recovery continue after discharge from the hospital ward. The main goal of the postoperative period is prevention and treatment of the pain syndrome, infusion therapy, adequate nutrition, care for the surgical wound, if necessary, fight the infection. In order to fully restore the patient's capacity, it is necessary to conduct rehabilitation, which aims to restore the physical, psychological and socio-economic functions of the patient. In this rehabilitation process, it is important to determine the place and importance of nursing care. Achieving good results in the postoperative period is possible by conducting a nursing assessment of care needs, developing a care plan and its implementation. The role of the nurse is primarily related to informing the patient about the risk factors and helping him to improve the quality of life. After hospitalization, it is important that a nurse with the appropriate professional qualification is actively involved in the care of the patient's home. The aim of the present study was to identify patients' need for training for care after cardiac surgery at home, their self-assessment in terms of adaptation and awareness, and the need for care after hospitalization. Material and methods: A questionnaire was developed and an anonymous survey of 100 patients who were hospitalized for cardiac surgery at the Hospital "Lozenets" -- Sofia, took place. The survey was conducted before their discharge from the hospital in the period 2019 -- 2020. In questioning of patients students majoring in "nurse" at the Faculty of Medicine, Sofia University „Sv. Kliment Ohridski", were included. Results: According to the data obtained, the survey included 60.00% of men and 40.00% of women who underwent surgical treatment at the Clinic of Cardiac Surgery of Hospital "Lozenets" -- Sofia. The average age of the surveyed men is 64 years, and of women -- 59 years. These results show that patients are almost equal in both sexes, with men predominating over women. Patient responses regarding the patient awareness of the risks and complications show that nearly half of the respondents were not informed about the risks and complications in the postoperative period. These results clearly indicate the need for training to inform patients in more detail and detail about the postoperative period in cardiac surgery. Patients find it difficult to adapt to the regimen that they are required to follow during the postoperative period. Only a quarter of the respondents indicated that they were fully informed about the care they had to take at home. At home, there are too many risk factors for the patient after heart surgery and he must be well prepared to cope with daily activities without disrupting the healing process and the rehabilitation process. Almost all patients accept the idea of consultation and care from a nurse at home. Discussion: The study confirms the need for training in home care for patients after heart surgery and the important role of nurses in this process. The health professional trains and helps the patient to acquire new skills for independent and dignified life during the treatment and after. An important element of training should be the different situations, in which the patient is trained in the decisions he has to make and in the behaviors and care that must be followed to avoid complications of a different nature. Patients find it difficult to adapt to the regimen they need to follow after heart surgery. The patient must have a positive attitude in order to mobilize and direct his efforts towards the proper conduct of the recovery. [ABSTRACT FROM AUTHOR]

An important priority in the healthcare sector is given to prevention and treatment of people with high risk of cardio-vascular diseases and one of the leading tasks in the activity of the general practitioners and specialists is the early discovery of the predisposition to such diseases. In the contemporary health systems, the foreground place and role of primary medical aid is unquestionable, officially recognized and acknowledged. In the present article the authors, considering the demographic status of the population in the province of Plovdiv, analyze the activity of the general practitioner (GP) and his team in the field of intra-morbidity prevention and clinical examination of people with high risk of cardio-vascular diseases. Quantitative indices (number of people, hospitalization, clinical examination), as well as qualitative indices (morbidity rate, lethal outcome) have been used. The following conclusions have been drawn: Plovdiv province is in a state of population decline. The number of people living in the cities increases at the account of those living in villages. The relative share of the people aged 65+ increases; The most frequent reason for appearance of disabilities are the diseases related to the blood circulation organs; In the structure of hospitalized patients, the first place is occupied by those suffering from diseases of the blood circulation organs; The main causes of deaths in 2018 in the province of Plovdiv remain the diseases of the blood circulation organs; The better the ratio between patients with socially significant diseases and those covered by clinical examinations, the lower death rate of the population. Intra-morbidity prevention is one of the contemporary activities, which has a significant influence on the efficiency of healthcare in general. Prevention and treatment of people with high risk of cardio-vascular diseases should be an important priority in the health sector. One of the leading tasks of the general practitioners and specialists is to discover at an early stage the predisposition to such diseases. [ABSTRACT FROM AUTHOR]

The article sets the goal of reviewing the levels of tolerance to medical workers and patients/clients in modern Russia in the recent decades, when the country went through a turbulent transitional period and reformed its health care system. Pointed out are the difficulties of such interactions; the conclusion is drawn on the necessity of inclusion into these relations of representatives of auxiliary professions - medical anthropologists and bioethicists. It is emphasized that in the recent years the service of prejudicial mediation was created in the country; it is expected to expand its activities to include the medical sphere, too. The researcher pays attention to the importance of education among medical workers and patients, as another side of their interactions. Denoting the necessity of additional training in the humanities for the medical students, the author provides information on the currently active schools of medical anthropology and bioethics, which regularly work, with support from volunteers, at the Institute of Ethnology and Anthropology (Russian Academy of Sciences, Moscow). [ABSTRACT FROM AUTHOR]

The didactic process in the higher school for preparation of specialists for regulated professions of ―Midwives‖ and ―Nurses‖, department of ―Health care‖, meets the needs of quality healthcare services in Bulgaria. It reaches the modern standards for developing professional competencies – a dynamic combination of knowledge, skills and values, that provide students‘ effective realization. According to the ―Regulations of Unified State Requirements‖ for obtaining higher education in the ―Nursing‖ and ―Midwifery‖ specialties, Bachelor educational – qualification degree, 50% of the education program is clinical and conducted in hospitals. The patient plays an important role in integrating the theoretical knowledge and applying it into a professional practice. The patient is referred to a subject, who is ―ill‖. Besides, the patient is also considered as a consumer, who needs quality healthcare services. The type, the stage, the degree and the course of the disease have influence on the educational process. While communicating with the patient and their relatives, students have to conform to the patient‘s temper, personality, social status, intellect, age, stage of the disease and other features, that affect the outcome of the disease. Participants in the didactic process – students, tutors, patients - are in complicated relationships. Each individual behavior affects the rest. The aim of the conducted didactic study was to examine and analyze the role of the patient in the midwifery and nursing education during their practical classes at the hospital. The methodology included documentary, sociological and statistical analysis. The respondents were divided into focus groups. The conclusion from the data analysis was that the patient played a significant role in the education and developed the required skills of the future profession. The patient is not always able to assist in the course of education. This puts to the test the student‘s motivation and emotional stability, especially of the first-year students. The patient is a challenge for the tutors in regards with planning, organization and realization of the education. By including a subject – subjective relations in the teaching process, the tutor gets an opportunity to transform the cognitive process into a personal one in a safe environment for the rest of the participants in the clinical education – the student midwives, nurses and the patient. [ABSTRACT FROM AUTHOR]

The skill to communicate is extremely important in every moment of human life. The interpersonal communication is a complex process that first takes place within the individual when he or she wishes to share his or her ideas with someone. The profession of the medical specialists is associated with intense communication activity and empathy. In the medical practice of the rehabilitation therapist, empathy requires an intellectual understanding of the patient, sharing his feelings, effective communication, and a positive attitude towards the patient. Mastering and applying the tools of communication in the medical practice have a favorable effect on the patient's behavior and support the patient. The effectiveness of communication depends on the extent to which the relationship between the rehabilitation therapist and the patient is built on the principles of collaboration, mutual respect and trust, empathy and responsibility. Empathic professional behavior extends the patient's understanding beyond the history and symptoms of his or her illness and is a prerequisite for achieving an effective therapeutic outcome. Communication is the activity of people for the purpose of developing psychological contact, characterized by the exchange of information, mutual understanding and empathy. Good communication is part of the role of the healthcare professional. When dealing with suffering people, it is important to support both the patient and his or her environment, and to overcome the health problem and its consequences more easily. The purpose of this study is to analyze the psychological aspects of communication and empathy in the work of the medical specialist - rehabilitation therapist. Conclusion: As a profession with a strong social element, it cannot be practiced without having theoretical knowledge and practical communication skills. Sick people are always looking for contacts with professionals, expecting human communication, understanding, sympathy, empathy and support. The effective communication and interaction are the main factors for achieving good therapeutic results. [ABSTRACT FROM AUTHOR]

In the modern health systems, the priority role of primary care is undeniable, officially recognized and accepted. A central figure in the system of primary care is the physician with a general profile. In this article the authors, considering the demographic status of the population in the region of Plovdiv, attempt to analyze the activities and human resources in the medical staff that operates primary healthcare services, where the main leading figure is the general practitioner. Quantitative and qualitative indicators have been used. Conclusions about the real situation and motivation for GPs to work have been included. [ABSTRACT FROM AUTHOR]

Empathy is a basic characteristic of the person's interpersonal communication ability. It improves the ability of people to understand others. It is defined as one of the main features in the theories of interpersonal communication. Empathy is an individual human quality that promotes good relationships between people. Empathy displayed during patient communication is one of the specific professional qualities of the health care professional. Many authors view empathy as contributing to positive development and relationships. The impact of empathy on relationships is mainly determined by three functions: 1. create supportive communication 2. create assisting and reassuring behaviours 3. increase the accuracy of reflective communication. These features are focused on the impact of empathic motivating communication with the other. Such communication strengthens relationships and increases their effectiveness. The manifestation of empathy as a social skill and personal quality is a prerequisite for fulfilling the human mission of healthcare professionals, including the intellectual understanding of the patient, the sharing of his feelings, the effectiveness of communication, and the positive attitude of the professional towards the patient. A good therapist can do just that - be the "healer medicine" for the patient. The summit therapist - patient relationship should be importing relief. This is exactly what M. Balint called the "healing medicine" - the security that you are the ones who will take care to relieve suffering and have the competence to deal with the disease. This most common form of psychotherapy is necessary for every patient. It uses professional attitude adapted to the individual needs and condition of the particular patient. Most patients have the irresistible need to be heard. Unfortunately, traditional skills for understanding, recognizing emotions and clarifying the patient's stories about the disease are at risk of devaluation. Many of the actions, manipulations and organization of care are experienced by patients as dehumanizing and punishing. Most healthcare professionals share the requirements of professional relationships - to set boundaries, to avoid forms of self-disclosure and attachment that could be misinterpreted by patients. In recent years, the selection of students in health care specialties has been substantially altered, and the personal motivation of those who want to care for sick and suffering people is a leading place. In order to reveal the problems in the education of students in terms of empathy, it is important to establish the degree of their professional development during the training. [ABSTRACT FROM AUTHOR]

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In the Republic of Tuva, people increasingly often appeal to various forms of traditional medical and preventive practices. In some cases, these practices even compete with Western medicine (biomedicine). The article is devoted to the study of the influence various traditional medical, preventive and shamanic practices, widespread in Tuva, have on the relationship between the doctor and the patient. Our study is based on the outcomes of a survey of 22 physicians of different medical specializations in the Republic of Tuva, as well as in the neighboring regions — the Republic of Khakassia, Altai and Krasnoyarsk regions – made in 2018. The opinions we have collected relate to various forms of traditional medical practices and folk healing common in the regions of Russia with considerable ethnic and cultural minority presence. Physicians agreed to participate in the survey upon condition of strict anonymity and used a variety of terms to refer to traditional medical and preventive practices or folk healing. All respondents hold that alternative methods of treatment are unjustified, while medical advice is seen as the only key priority in healthcare. All of them believe in "real" medicine. When asked to name the main reasons why patients go to healers, physicians named the lack of treatment effect in hospitals, poor quality of medical services provided there, territorial inaccessibility, high cost of paid services, cultural characteristics, family traditions and education in Tuva and nearby regions, etc. The general attitude of physicians to healers is skeptical, although some methods, such as herbal medicine, are not rejected outright. They also accept the use of such methods for themselves and their families, either at home or in specialized clinics. Widely different are the opinions of another group of physicians in Tuva – those who accept the special role of cultural traditions in healing, among other areas of human experience.

Напреенко А., Мишиев В.,Кашпор Е. История становления ТМО «Психиатрия» в г. Киеве Представлены данные про историю ТМО «Психиатрия» в г. Киеве. Уточнены и конкретизированы ключевые даты в истории становления психиатрии в г. Киеве. На основе анализа исторического опыта отображены основные стратегии и направления развития ТМО «Психиатрия» в г. Киеве. Ключевые слова:ТМО «Психиатрия» в г. Киев, Кирилловские учреждения, медперсонал, пациент, история психиатрии, история оказания медицинской помощи психически больным, научная деятельность. Napryeyenko Olexander, Mishyjev Vyacheslav, Kashpor Yevhen.THE HISTORY OF CLINIC "PSYCHIATRY" IN KYIV This article presents information of the historical way of TMA "Psychiatry" in Kyiv. It start TMA "Psychiatry" history since the creation of the necessary items for the functioning of the house for mentally sick persons in the territory of Kirillov Monastery (1803-1805). In our days, 2013 year by decision of the Kyiv City Council all specialized psychiatric clinics (except KMTSSPE) were joined into territorial medical association "Psychiatry" in Kiev. Association was held at the Kyiv city clinical psychoneurological hospital №1 with the same name: TMA "Psychiatry" in Kyiv. Clarified and specified key dates in the history of the development of psychiatry in Kiev. In the development of psychiatry it was decided to distinguish between pre-reform – “orders” period and post-reform or “provincial” period. For Kyiv mental hospital “provincial” period started only in 1904. By this time the hospital was run by “Prikaz opiky”. Seniors of this establishment cared a little for the psychiatric help in Kyiv. Meanwhile, provincial psychiatry successfully developed, the organization in Kiev was in distress. One of the serious shortcomings of this period was a constant discrepancy between budgeted allocations for the maintenance of the house for the mentally sick persons and the necessary costs for the actual number of patients, which was always far exceeded then the projected number of beds, and a mismatch between available area and the actual need for it. This created difficult conditions for patients, drastically worsened sanitary status of clinic. The situation in clinic for the mentally ill had not changed even with the introduction in 1904 of new rules of principal status as also upgrade it to "full provincial” in 1912. In such difficult situation was Psychiatric Hospital till 1921.After 1921 psychiatric help in Kyiv became better. During the time there were increased appropriations for the maintenance patients. Kirill hospital was the typical psychiatric hospital with the withdrawal from its territory somatic departaments. In period 1924 – 1933 clinic was completely rebuilt, expanded its economic base and medical work. In the case of health-improvement research, organization of hospitals and training doctors play an important role of the Department, working at the hospital. In 2000 it was accepted and confirmed the first Law of Ukraine" by Psychiatric care legal provision of mental health care within the standards of developed countries. The law defines the legal and organizational basis for this type of assistance based on the priority of individual rights. The importance of social issues in psychiatry increases grew up with the democratization of Ukrainian society. With the view to the full development of psychiatry it was provided, as its comprehensive integration of basic sciences (anatomy, physiology, biochemistry, medical psychology, etc.). Keywords: TMA "Psychiatry" in Kyiv, Kirill institutions, medical staff, patient, psychiatry, history, historical development providing medical aid, mentally ill, scientific activity.

Background: Thus far, the uptake of telehealth in Australia has been puzzlingly small in scale and sporadic in nature. This is particularly true of audiology. The current study aimed to investigate the satisfaction of clinicians and clients with audiology appointments in a trial of the telehealth mode. Material and methods: A mixed-methods study design was utilised involving surveys with all appointment participants and semi-structured post-appointment interviews with clients. Appointments were conducted with 11 individual clients; of these, 7 interviews were conducted. One audiologist and one allied health assistant were used for all appointments. Results: High satisfaction ratings overall were given by both clients (87.3% excellent) and the allied health assistant (74.4% excellent), whereas the audiologist consistently provided slightly lower levels of satisfaction (72.7% good). It was also found that the audiologist believed that teleaudiology increased the quality of care offered. Conclusion: By examining the perspectives of all key stakeholders, this study identifies a number of novel positive and negative aspects of a teleaudiology practice and offers suggestions for future implementation of such a program. [ABSTRACT FROM AUTHOR]

The purpose of the study is to investigate the opinion of the patients and their relatives (120) on various aspects related to the conduct of health education as an important function of the nurse of the general practitioner‘s team. An analysis of literary sources, documentary method and method of sociological interview is applied. A survey was performed in the period July-August 2018. The results reflect the opinion of the majority of the surveyed on the important role of the nurse working in the general practitioner‘s team in the health education process. The majority of respondents received training on issues related to the application of a proper treatment, the nutritional and motor regimens in managing chronic diseases and a very small part – about healthy lifestyle. According to most of the surveyed participants, most often the whole team is involved in the health education process – the general practitioner, the nurse, the patients and their relatives. [ABSTRACT FROM AUTHOR]

Copyright of Handel Wewnêtrzny is the property of Institute for Market, Consumption & Business Cycles Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

According to the Bulgarian National Statistical Institute, cardiovascular diseases, including acute myocardial infarction, hypertension and cerebrovascular disease, are the primary reason for death (67%) in Bulgaria for 2011. Reducing the risks of cardiovascular diseases and their secondary prophylactics -- prevention of acute cardiovascular accidents and adequate rehabilitation of the patient after such accident -- is a serious challenge before public healthcare. The purpose of the current study is to identify the risk factors to diet and lifestyle of patients with acute myocardial infarction (AMI) and within nursing to suggest communication strategies for secondary prophylactics. Materials and methods: 100 patients were interviewed -- 64 men (average age 67.7-12.7 years) and 36 women (average age 61.4-16.8), hospitalized in University Hospital „Lozenets", in the period 2016/2017. The questionnaire includes questions about accompanying illnesses, eating habits and behavior, smoking, alcohol consumption, and motor activity before the incident. Results and discussion: Hospitalization for AMI allows the identification of risk factors -- diet and lifestyle and build a training algorithm for modification of risk as an integral part of nursing care and all therapy of the patient. Conclusions: The study confirms the important role of overweight and obesity as risk factors for the development of cardiovascular diseases such as acute myocardial infarction, coronary heart disease, sudden cardiac death associated with reduced survival. The identification of individual risk factors and their modification can be adequately included in the daily algorithm of nursing care at acute myocardial infarction. [ABSTRACT FROM AUTHOR]

Myocardial infarction is one of the most severe forms of ischemic heart disease. It has great social significance due to the high disability and mortality it causes. The purpose of this study was to characterize the heart attack in patients with acute myocardial infarction and to identify information needs and training groups at risk. Materials and methods. A survey of patients with acute myocardial infarction, who received treatment at the clinic of Cardiology University Hospital „Lozenets" -- Sofia, took place. The study included 100 patients diagnosed with acute myocardial infarction for the period 2016-2017. Results and discussion. In the survey conducted, patients with AMI admitted to treatment in the hospital have raised some of the issues related to patients awareness of their illness as well as issues related to the experienced heart crisis -- description of the pain, clinical manifestations of the crisis, transportation to the medical establishment, etc. Conclusions. The results show that patients who have experienced acute myocardial infarction need to be informed and trained about the nature and location of pain in a heart attack. Preventive care is needed to address the risk groups of the population in terms of a healthy lifestyle. [ABSTRACT FROM AUTHOR]

The present study analyses the qualitative characteristics of the attitude of the Russian and international medical students to the patient. The peculiarities of the perception of the patient and the contact with him/her are revealed through interviewing students.