[The results of clinical application of the mesh with anti-adhesive fluoropolymer coating in laparoscopic intraperitoneal repair of primary ventral hernia]. / Rezul'taty klinicheskogo primeneniya setchatogo endoproteza s antiadgezivnym ftorpolimernym pokrytiem pri laparoskopicheskoi intraperitoneal'noi plastike pervichnykh ventral'nykh gryzh.

OBJECTIVE: The purpose of the study was to evaluate the results of using fluoropolymer-coated mesh during intraperitoneal onlay mesh hernia repair in patients with primary ventral hernias. MATERIAL AND METHODS: The multicenter, non-randomized, controlled clinical study included 88 patients of both sexes who were operated on using a laparoscopic approach using the IPOM technique for a primary ventral hernia. The duration of observation ranged from 3 to 12 months. In the main group, 48 patients received fluoropolymer-coated meshes (Ftorex). A comparison was made with a retrospective group of 40 patients who were treated with anti-adhesive collagen-coated meshes (Parietene composite, Parietex Composite, Symbotex). RESULTS: The number of early and late postoperative complications in the groups did not have significant differences, at the same time, their number was lower in the group of patients in whom fluoropolymer-coated meshes were used. Most of the complications corresponded to Clavien-Dindo class I and II and did not pose a significant threat to health. There were no recurrences of hernias observed in patients included in the study. There were slightly more adhesions in the fluoropolymer-coated mesh group (35.4% vs. 25.0% in the collagen-coated mesh group). The quality of life of patients in the study groups did not differ. CONCLUSION: In laparoscopic IPOM hernia repair fluoropolymer-coated meshes are not inferior in effectiveness and safety to traditionally used collagen-coated meshes and can be recommended for use in patients with primary ventral hernias.

[The analysis of medical personnel potential of stomatological service of the Subject of the Russian Federation considering its private sector].

The approaches to analysis of medical personnel of stomatological service continue to be based on principles formed in relation to state health care system that makes it difficult to objectively assess situation due to increasing proportion of specialists employed in its private sector. The study, targeted to comprehensive comparative analysis of stomatological medical personnel of state and private medical organizations in the Irkutsk Oblast, for the first time made it possible to assess provision of population of large region and its municipalities with stomatologists, considering specialists employed in private medical organizations, in dynamics and in context of separate specialties. The decrease in provision of population with stomatologists in state medical organizations by 12.3% in 2019-2023 against the background of its increase in private ones by 14.5% was revealed. In 2023, 50.5% of stomatologists were concentrated in private sector of stomatological service and 30.8% in state sector. Yet another 18.7% combined their work in medical organizations of both types. The stomatologists employed in private sector of stomatological service were mainly concentrated in metropolises, especially in regional center, where their provision exceeds average regional level by 2.6 times.

[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%).

Development of a two-channel system for monitoring the mirror elements of the Millimetron space observatory.

The paper presents the results of the development of an onboard two-stage telescope monitoring (control) system of the Millimetron space observatory. A 3D laser scanner is used for the preliminary inspection of the reflector elements, and an image analyzer based on the Foucault knife method is used for the final one. The results of the calculation and modeling of the monitoring system for tuning the telescope elements into space are presented. The signals formed in the system are calculated, including using data on the actual shape of the manufactured mirror elements. Estimates of the expected measurement accuracy are given, and the test results of the developed system are presented.

[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.

Degree of improving TMS focality through a geometrically stable solution of an inverse TMS problem.

The Transcranial Magnetic Stimulation (TMS) inverse problem (TMS-IP) investigated in this study aims to focus the TMS induced electric field close to a specified target point defined on the gray matter interface in the M1HAND area while otherwise minimizing it. The goal of the study is to numerically evaluate the degree of improvement of the TMS-IP solutions relative to the well-known sulcus-aligned mapping (a projection approach with the 90∘ local sulcal angle). In total, 1536 individual TMS-IP solutions have been analyzed for multiple target points and multiple subjects using the boundary element fast multipole method (BEM-FMM) as the forward solver. Our results show that the optimal TMS inverse-problem solutions improve the focality - reduce the size of the field "hot spot" and its deviation from the target - by approximately 21-33% on average for all considered subjects, all observation points, two distinct coil types, two segmentation types, two intracortical observation surfaces under study, and three tested values of the field threshold. The inverse-problem solutions with the maximized focality simultaneously improve the TMS mapping resolution (differentiation between neighbor targets separated by approximately 10 mm) although this improvement is quite modest. Coil position/orientation and conductivity uncertainties have been included into consideration as the corresponding de-focalization factors. The present results will change when the levels of uncertainties change. Our results also indicate that the accuracy of the head segmentation critically influences the expected TMS-IP performance.

[Efficiency of the Decision-Making Module in the Personalized Choice of an Anticoagulant].

Aim        To evaluate the effectiveness of the decision-making module in selecting an oral anticoagulant for patients with atrial fibrillation.Material and methods        638 patients with atrial fibrillation aged 68.2±4.5 years were evaluated. The CHA2DS2-VASc, HAS-BLED, and 2MАСЕ scales, the creatinine clearance calculator, and the Morisky-Green questionnaire were used.Results   311 (48.75 %) patients had paroxysmal atrial fibrillation, 138 (21.6%) had persistent atrial fibrillation, 44 (22.7%) had long-standing persistent atrial fibrillation, and 145 (22.7 %) had permanent atrial fibrillation. Mean CHADS2­VASc scale score was 4.82; НAS-BLED scale score was 2.9; 2MACE score was 2.28; and compliance score was 3.52. 172 (26.9 %) patients were treated with rivaroxaban; 166 (26 %), with apixaban; 84 (13.2 %), with dabigatran; 210 (32.9 %), with warfarin; and 6 (1 %), with acetylsalicylic acid.Conclusion            The developed decision-making module is based on scientific justification of personalized selection of the oral anticoagulant and updates the knowledge on major issues of prescription.

Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction.

Aim      To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods  The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion      REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.

[Modern minimally invasive technologies in spine surgery]. / Sovremennye maloinvazivnye tekhnologii v khirurgii pozvonochnika.

The number of spine surgeries has been annually increasing all over the world. It is associated with high incidence of spinal degenerative diseases, vertebral traumas and different tumors. Minimally invasive surgical techniques are being developed in spine surgery considering extended surgical procedures, long hospital-stay and disability period. These techniques minimize surgical trauma, shorten hospital-stay and disability period.

[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.

[Clinical features of BPPV and their influence on the choice of the doctor's tactics]. / Dobrokachestvennoe paroksizmal'noe pozitsionnoe golovokruzhenie: osobennosti klinicheskoi kartiny i ikh vliyanie na vybor taktiki vracha.

OBJECTIVES: BPPV is the most common cause of recurrent vertigo. Except vertigo attacks main clinical symptoms of BPPV can include autonomic symptoms and imbalance, which sometimes complicate the diagnosis of BPPV.Purpose To evaluate clinical symptoms and management of patients with BPPV before the setting of correct diagnose. MATERIAL AND METHODS: A total of 640 patients (504 (78.8%) women) aged from 20 to 86 years old, mean age 56.43±0.54 years with BPPV were included and diagnosed by roll and Dix-Hallpike tests. Among them 144 (22.5%) patients were inpatient and 496 (77.5%) patients were outpatient. The detailed patient intake comprised the disease onset, the type of dizziness, vertigo triggers, autonomic symptoms, similar attacks in the past and previously made definite diagnosis of BPPV. The period from the appearance of the first symptoms to the correct diagnosis was assessed. RESULTS: The majority of patients (75.3%) consult a neurologist at the initial visit. Only 30.6% of patients had a correct diagnosis within a week of the onset of the disease. Initial BPPV symptoms included persistent dizziness that increased with head turns (38.8%), nausea and vomiting (21.6%), significant increase in blood pressure (13.4%), persistent imbalance while walking (73.4%). Inpatients more frequently had constant continuous dizziness, high blood pressure, severe nausea and vomiting, and the onset of symptoms in the morning when getting out of bed (p<0.05). CONCLUSION: Initial BPPV symptoms may be similar to other diseases. Focusing on medical history and complaints leads to frequent diagnostic errors, unnecessary hospitalization and prolonged treatment of patients. Positional tests are necessary for the correct diagnosis of BPPV.

[Minimally invasive ventral hernia repair: apply or save?] / Maloinvazivnye tekhnologii v gerniologii: primenyat' nel'zya ekonomit'.

Treatment of patients with ventral hernias remains one of the most pressing problems of abdominal surgery. Surgeons are trying to find a «gold standard¼ for the treatment of this pathology. Great hopes are placed on minimally invasive techniques, however, due to their high cost, they do not yet find mass distribution in everyday practice. In our opinion, this is short-sighted. We tried to analyze the feasibility of using minimally invasive techniques in the treatment of patients with ventral hernias of various locations, from the position of clinical and economic efficiency.

[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.

[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.

[Clinical and psychological features in patients with incident and recurrent cases of benign paroxysmal positional vertigo]. / Kliniko-psikhologicheskie osobennosti patsientov pri vpervye voznikshikh i retsidiviruyushchikh pristupakh dobrokachestvennogo paroksizmal'nogo pozitsionnogo golovokruzheniya.

OBJECTIVE: To assess the clinical and psychological features in patients with incident and recurrent posterior canal BPPV. PATIENTS AND METHODS: The study included 47 patients (mean age 49.1±10.9 years; 12.8% of men and 87.2% of women) with idiopathic BPPV, posterior canal. According to the anamnesis, the patients were divided into two groups: 27 (57.4%) patients with incident BPPV (iBPPV) and 20 (42.6%) patients with recurrent BPPV (rBPPV). All patients were treated with repositioning Epley and/or Semont maneuvers until resolution of canalolithiasis. After that, clinical and psychological testing was immediately carried out, including short version of Vertigo Symptom Scale (VSS), Dizziness Handicap Inventory (DHI), Visual analogue scale (VAS) for fear of vertigo spells, Depersonalization-Derealization Inventory (DDI), Social Readjustment Rating Scale (SRRS) of Holmes and Rahe, Anxiety Sensitivity Index (ASI), Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ). RESULTS: Patients with rBPPV compared with iBPPV had more severe symptoms of dizziness according to DHI (p=0.02) due to a functional and emotional subscales, as well as a more pronounced feeling of fear according to VAS (p=0.01). The data obtained on the remaining scales and questionnaires did not show statistically significant differences between the groups. The revealed results may indicate a greater predisposition of patients with rBPPV to the development of a special kind of mental disorders - functional dizziness or persistent postural-perceptual dizziness, which requires additional study and development of preventive measures.

[The experience of development of partnership between science and health care institutions in resolving issues of circulatory system diseases].

In Russia, the process of clustering institutions at the regional level is evolved. The analysis of scientific publications revealed only several examples of efficiently functioning medical clusters. As a rule, the publications present problems or projects and perspectives of development of medical clusters. At that, no information is available concerning organizational mechanisms integration of institutions. Purpose of the study is to evaluate the results of partnership between institutions of science and practice in resolving strategic health problems related to diseases of blood circulatory system. Materials and methods. The study applied such methods as monographic approach, data derivation, statistical technique, logical and system analysis. Results. The partnership between scientific and educational institutions and practical health care organizations was analyzed on the example of the system of medical care of circulatory system diseases organized in the Kemerovo region. The effective functioning of such a partnership is based on seven integration principles. Thus, the number of treated patients increased by 7.1% from 2011 to 2018. At the same time, the number of beds decreased by 9.2%. As a result, bed turnover increased by 18.1% over this period. The work of X-ray surgery service almost doubled the rate of percutaneous coronary interventions in case of acute coronary syndrome (from 22.0% in 2011 to 42.7% in 2018). The main organizational basics of successful cooperation of institutions are succession and interdependency in work of physians and departments, joint environments of quality management, knowledge management and personnel training, shared management of research and medical activity, common production and information environment, corporate culture and traditions.