[The formation of organizational structures coordinating manpower policy in health care of the subject of The Russian Federation].

Nowadays, development of organizational structures coordinating personnel policy in health care of the Subjects of the Russian Federation is relevant. The purpose of the study was to investigate feasibility, scientifically substantiate and implement at the level of the subject of the Russian Federation measures developing organizational structures to coordinate participants of personnel policy in health care. According to 88.5% of interrogated experts, insufficient interaction between participants of personnel policy in health care is a significant cause of problems of medical personnel in the Irkutsk Oblast. About 81.1% of respondents consider overall efficiency of interaction between participants as low. The survey permitted to study main directions and degree of interaction between participants of personnel policy in Oblast health care. At that, 82.8% of respondents indicated that intensification of low interaction requires development of special organizational structure. The obtained results permitted to formulate proposals concerning organization in the Irkutsk Oblast of Medical Council under the Governor and in its structure working group on personnel policy in health care. The corresponding methodological support was developed.

[The sociological assessment of motives of job placement and professional adaptation of graduates of medical university in primary health care section].

The task of increasing staffing of physicians in primary health care level is resolving by accreditation of medical workers. The sociological assessment of motives of employment and professional adaptation of graduates of medical university who started to work as district therapists and pediatricians after undergoing primary accreditation was carried out. Only about 7% of graduates initially wished to work as district physicians. The most frequent reasons of employment were to get additional points for admission to residency (18%) and need in financial resources (18%). The analysis of professional plans of respondents testifies intention of every second to leave primary medical care to work in specialty received in residency. The seven out of ten respondents noted insufficient scope of necessary clinical knowledge and practical skills, lacking of effective measures for professional adaptation, including internship and supervision.

[The analysis of readiness of young specialists to self-dependent work in primary health care section].

At the present time, about 20% of graduates of medical universities after initial accreditation are employed as district physicians. The purpose of the study was to investigate readiness of graduates of medical university to work as district physicians after primary accreditation. The analysis was based on results of sociological survey of immediate supervisors of graduates. The interviewed heads of departments assess as relatively low level of practical training of graduates (3.8 points out of 5) and their readiness to independent work as district physicians (41.2%). The scarcity of implementation of the most effective measures for professional adaptation of novice district physicians, including paid mentoring (5.0%) and internship (1.7%) is established too. According to survey results, for training of district physicians, the most appropriate is to revive such previous forms of training in national system of higher medical education as internship (21.2%) and subordination (50.6%).

[The evaluation of efficiency of accreditation of graduates of medical universities as a measure supporting increase of numbers of physicians in primary health care section].

One of the most important tasks in transition to primary accreditation of health care professionals is increasing manning of primary health care section. It is achievable at the expense of opportunity for graduates of medical universities to find employment as district physicians and pediatricians without residency training. The purpose of the study was to assess impact on increasing of number of physicians of primary health care section of their admission to professional activities after primary accreditation. The study was carried out in the Irkutsk State Medical University provided objective quantitative evaluation of this occurrence. It was revealed that only every fifth graduate in specialty "General Medicine" and "Pediatrics" is employed as district physician, in half of cases combining this work with residency training, that subsequently results in leaving primary health care section. Only one out of ten continues to work in this position during 3-5 years.

[The sociological aspects of medical employee turnover].

The level of development of human resources in health care is determined by a number of factors, among which an important place belongs to turnover of medical staff. The turnover, or the process of unscheduled dismissal of staff, negatively affects functioning of the organization in any field, including health care. Although the analysis of staff turnover is widely applied in various fields of activity, relatively few studies are related to problems of assessing causes of this phenomenon in health care. The purpose of the study was to assess the characteristics and causes of turnover of medical staff in state medical organizations of the Irkutsk Oblast. The detailed information about the respondents obtained in the study made it possible to get a concept of intensity and characteristics of turnover of physicians and medical nurses, and to study causes of dismissal of respondents from their previous employment as well as causes that influenced current employment and to assess content and effectiveness of measures of professional adaptation and social support of hired specialists.

[The evaluation of personnel progression in state medical organizations of the Irkutsk Oblast].

The medical personnel reallocation is the most important resource to ensure sustainable functioning and development of medical organizations and health care system as a whole. The purpose of the study was to assess reallocation of medical personnel of state medical organizations in the subject of the Russian Federation exemplified by the Irkutsk Oblast in 2015-2019. The study permitted to test approaches to application of methods for analysis of reallocation of medical personnel in respect of physicians. The results contribute to development of measures targeted to prevent and to reduce the medical personnel turnover and to increase efficiency of human resources management in health care.

[About experience of developing concept of personnel policy in health care at the level of the subject of the Russian Federation].

The personnel policy is one of priority areas of developing national health care. Its effective implementation requires evidence-based development of relevant program documents, the most important of which is the Concept of health care personnel policy that currently exists only in a number of regions of the Russian Federation. In this regard, the purpose of the study was to develop approaches to scientific justification and development of the Concept of health care personnel policy at the level of region of the Russian Federation, as exemplified in the Irkutsk oblast. The article describes progress of this large-scale and lengthy study, its main results included. The developed approaches resulted in comprehensive organizational technology of development corresponding Concept. The results of this experience can be implemented in other regions of the Russian Federation. Therefore, it is of scientific and practical interest for all potential developers of similar program documents and wide range of specialists in health care organization.

[The comparative evaluation of policy documents of the Russian Federation concerning personnel policy in health care].

Nowadays, in Russia number of problems is present in effective personnel policy in health care. The National Concept of personnel policy in health care (2002) expired in 2010 and no new one was developed. However, corresponding program documents were adopted at the level of subjects of the Russian Federation. The purpose of study was to compare evaluation of program documents of subjects of the Russian Federation related to issues of personnel policy in health care. The continuous sampling technique was applied to study these documents, which were valid in the territories of all subjects of the Russian Federation in 2002-2019. The comparative assessment was performed. It is demonstrated that the most informative document in this area is only the corresponding specialized Concept. However, this document was adopted only in 8.2% of the subjects of the Russian Federation, and they were valid only in two subjects. The concepts of health care development in the subjects of the Russian Federation, addressing medical personnel policy were adopted in 44.7% of the subjects of the Russian Federation. However, these legal documents operate only in 15.3% of territories. At the same time, the availability of appropriate specialized program document is a prerequisite of development of coherent and effective medical personnel policy in health care at all its levels.

[The comparative analysis of training of paramedical personnel on the territory of the subjects of the Russian Federation of the Siberian Federal Okrug].

The comparative analysis of training of nursing staff in the territories of subjects of the Russian Federation, included in the Siberian Federal Okrug was implemented, based on data of the federal statistical monitoring of corresponding educational organizations in 2018. The analysis of calculated indices permitted to identify uncoordinated nature of provision of nursing staff and volumes of its training at the level of number of subjects of the RF on the territory of the Siberian Federal Okrug, and group them according to combination of level of the given indicators. The assessment was implemented concerning validity of manpower policy in the case of nursing staff in territories of mentioned regions. The study results permitted to determine role and place of the analyzed regions in training of nursing personnel considering groups of criteria characterizing training activities, infrastructure of educational organizations, financial economic aspects of implementation of educational process and employment of graduates with nursing education. The mentioned results are the basis for further research on issues of education of nursing staff at the level of particular subjects of the Russian Federation, analysis of indices in dynamics, factors determining level of development of manpower potential of medical organizations and other elements of scientifically grounded manpower policy in health care sector.

Light-Emitting Halide Perovskite Nanoantennas.

Nanoantennas made of high-index dielectrics with low losses in visible and infrared frequency ranges have emerged as a novel platform for advanced nanophotonic devices. On the other hand, halide perovskites are known to possess high refractive index, and they support excitons at room temperature with high binding energies and quantum yield of luminescence that makes them very attractive for all-dielectric resonant nanophotonics. Here we employ halide perovskites to create light-emitting nanoantennas with enhanced photoluminescence due to the coupling of their excitons to dipolar and multipolar Mie resonances. We demonstrate that the halide perovskite nanoantennas can emit light in the range of 530-770 nm depending on their composition. We employ a simple technique based on laser ablation of thin films prepared by wet-chemistry methods as a novel cost-effective approach for the fabrication of resonant perovskite nanostructures.

Nanoscale Generation of White Light for Ultrabroadband Nanospectroscopy.

Achieving efficient localization of white light at the nanoscale is a major challenge due to the diffraction limit, and nanoscale emitters generating light with a broadband spectrum require complicated engineering. Here we suggest a simple, yet highly efficient, nanoscale white-light source based on a hybrid Si/Au nanoparticle with ultrabroadband (1.3-3.4 eV) spectral characteristics. We incorporate this novel source into a scanning-probe microscope and observe broadband spectrum of photoluminescence that allows fast mapping of local optical response of advanced nanophotonic structures with submicron resolution, thus realizing ultrabroadband near-field nanospectroscopy.

[The personified accounting and intra-team distribution of the workload of pathologists, by using a procedure for their work quota setting]. / Personifitsirovannyi uchet i vnutribrigadnoe raspredelenie nagruzki vrachei-patologoanatomov na osnove ispol'zovaniia metodiki normirovaniia ikh truda.

The paper considers approaches to applying the methods for setting work quotas in pathologists for the personified accounting and intra-team distribution of their workload. These approaches include an algorithm and all necessary formulas for the calculation of the relevant indicators that make it possible to use the methods for work quota setting. The essence of the proposed approaches is demonstrated with a specific example.

[The sociological evaluation of commitment to treatment in re-hospitalized patients].

The article presents the results of sociological assessment of commitment to treatment of repeatedly hospitalized patients in hospitals of the Irkutsk Oblast and the Republic of Buryatia, that permitted to study their medical and social characteristics, the level of awareness of their own health, their diseases and methods of their treatment are presented. Sampling was preceded by the selection of respondents with the support of experts that reduced the impact on the study results of various factors, along with commitment to treatment, which determines the effectiveness of the treatment process (effective treatment methods for the relevant nosology, quality of medical care, etc.). The reasons for re-hospitalization were studied. The factors resulting in incomplete implementation and rejection of medical recommendations, as well as factors contributing to increased commitment to treatment were analyzed. It was established that three out of four respondents are not committed to therapy, respondents were poorly informed about the normal and their own most important indices of their health. Only one out of five of respondents indicated that they comply with medical recommendations in fullness. The main reasons for commitment to treatment are the factors that are managed by the health care system: detailed information about the disease and prescribed treatment, attention given by the doctor to their patients in accordance with their needs.

[The Complex Evaluation of Labor Migration of Graduates of Medical University as an Important Factor of Formation of Personnel Potential of Regional Health Care System].

On the basis of educational activities in the Irkutsk State Medical University, an assessment of directions and intensity of labor migration of medical graduates, started their professional activities in 2013-2017. The originally developed statistical tool was applied in scientific analysis of various educational and professional trajectories of graduates, from admission to the university to professional employment. It is established that only 34.9% of graduated physicians returned to their area of residence after completion of education, while 65.1% of graduates changed their place of residence after completion of education. These facts make it possible to consider higher medical education as a powerful mobilization factor for young specialists. The main direction of labor migration of University graduates of in 2013-2017 was Irkutsk (21.8%). The migration of graduated physicians reflects impact of urbanization processes. The directions and intensity of labor migration of young specialists graduated from University in the context of municipal formations of the Irkutsk region made it possible to obtain detailed information concerning the role of particular territories of the Oblast in development of human resources potential of the regional health care system.

[Work quota setting and man-hour productivity estimation in pathologists]. / Normirovanie truda i otsenka trudozatrat vrachei patologoanatomicheskikh otdelenii.

The paper considers the development and current state of the regulation of work quota setting and remuneration in pathologists. Reasoning from the current staff standards for morbid anatomy departments (units), the authors present a method to calculate the load of pathologists. The essence of the proposed method is demonstrated using a specific example.

[The Integral Evaluation of Level of Qualification of Physicians in the Irkutskaia Oblast].

The originally developed technique of integral evaluation of level of qualification of physicians is applied for establishing the level of the given criterion in municipal physicians of the Irkutskaia oblast. The levels of criterion in 2005-2015 were calculated. The results are ranked on the level of criterion. The integral evaluation was implemented to particular medical specialties and subsequent ranking of obtained results was made.

[The Sociological Aspects of Development of Organization and Enhancement of Quality of Hospital Medical Care of Patients with Tuberculosis].

The specially developed questionnaire on studying opinions of physician-phthisiatrician concerning hospital medical care of patients with tuberculosis was applied to survey sampling of 58 physicians phthisiatricians. The questions of questionnaire related to analysis of efficiency of hospital treatment of patients with tuberculosis, satisfaction with consultative and diagnostic activities, support with pharmaceuticals, discovering measures permitting to increase commitment of patients to treatment in conditions of hospital.

[The role and place of high-dose immunosuppressive therapy and autologous transplantation of hematopoietic stem cells for autoimmune diseases].

AIM: To determine the possible boundaries of high-dose immunosuppressive therapy and autologous hematopoietic stem cell transplantation (HDIT-autoHSCT) for autoimmune diseases (AUDs), such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS). SUBJECTS AND METHODS: A long-term trial was conducted at one center to evaluate the efficiency and safety of HDIT-autoHSCT in patients with AUDs. The previous standard therapy was noted to be resistant or lowly effective. The age of 10 patients with systemic connective tissue diseases was 27.6±2.8 years; the pre-HDIT-autoHSCT disease duration was 5.9±1.3 years; the median posttransplantation follow-up was 39.3 months. The age of 49 patients with MS reached 34.9±1.33 years; the pretransplantation disease duration was 8.4±0.69 years; the median post-HDIT-autoHSCT follow-up was 42 months. The efficiency of transplantation was evaluated on the basis of clinical findings, by using scales, laboratory tests, and magnetic resonance imaging. Pretransplantation conditioning was carried out according to the protocols: a) BEAM + antilymphocyte globulin (ALG); b) fludarabine + melphalan + ALG. No fatal outcomes due to a transplant procedure were observed. RESULTS: Overall 5-year survival after transplantation was 80% for systemic connective tissue diseases and 95% for MS; 5-year progression-free survival rates were 30% in the RA and SLE groups and 45% in the MS group. HDIT-autoHSCT turned out safe and reduced the activity of the process and further disease progression for a long period of time, as confirmed by regression of clinical symptoms and/or status stabilization in 9 patients with SLE or RA and in all patients with MS. CONCLUSION: The favorable factors associated with the results of transplantation are age younger than 35 years in collagenoses with their short-term duration and moderate signs; age younger than 40 years in MS with a disease duration of less than 10 years and expanded disability status scale scores of not more than 6.5. Of importance are functional system scores, duration of first remission, and an index of disease progression in different types of MS.

Dynamic polarization flip in nanoripples on photoexcited Ti surface near its surface plasmon resonance.

Both normal and abnormal sub-100-nanometer ripples (wavenumber ∼10 µm(-1)) were separately observed on Ti surfaces excited by linearly polarized IR femtosecond laser pulses at lower and higher fluences. Numerical modeling of dispersion curves for surface plasmon-polaritons on the photoexcited Ti surfaces demonstrates its surface plasmon resonance with the peak wavenumber ∼8 µm(-1) spectrally tuned by prompt surface optical response, prompt surface charging, and pre-oxidation, with normal/abnormal nanoripples appearing at its red/blue shoulders, respectively.

Flash-imprinting of intense femtosecond surface plasmons for advanced nanoantenna fabrication.

In this work, we demonstrate an all-laser method of fabrication of optical nanoantennas (ONAs) with an additional coupling/focusing diffractive element. This method is based on double-shot femtosecond laser nanoablation of a thin supported metallic film, inducing a sequence of electrodynamic (surface plasmon-polariton [SPP] excitation and interference), thermal (melting, ablation and ultrafast cooling), and hydrodynamic processes. In particular, the thermal and hydrodynamic processes are important for ONA formation after the first laser shot, while second spatially shifted laser shot via an induced SPP wave results in a radial surface grating near the nanoantenna. Such gratings provide efficient coupling between incident laser radiation and SPP waves, thus significantly improving the ONA efficiency.