[The confidence limits of self-education of medical workers in matters of competences to provide quality and safety].

The article considers possible risks according analysis of comprehension by workers of necessary competencies ensuring quality and safety of medical activities at performing their duties as well as assessment of factors affecting completeness of choice. It is proposed to apply corporate training as component targeted to improving quality and safety of medical activities by addressed training of necessary competencies within the framework of continuous medical education, supplementing existing self-education.

[Evidence-based proposals for improving the Zemsky Doctor program].

Currently, more and more attention is paid to the shortage of medical staff in rural and remote areas. In order to ensure the staffing of medical institutions with workers in rural areas, in the regions one-time compensations are paid as part of an event called "Zemsky Doctor". However, "Zemsky Doctor" has shown a fading effect over the years of implementation, including due to the unwillingness of medical students to participate in this program. The purpose of the work is to identify the attitude of students of medical universities to participation in the "Zemsky Doctor" program and develop measures to increase the attractiveness of the program. To achieve the goal of the study, we conducted a survey of 250 medical students from all over Russia, interviews with medical students, with medical staff, including former and current participants. The novelty of the work lies in the study of the attitude of current and potential participants in the program in order to develop proposals for its improvement. To improve the program, it is necessary to choose the term for concluding the contract, differentiate payments depending on the distance from the regional center, create an information site, defer the army for the duration of the contract.

[The export of medical services as a driver of development of the National system of quality management and safety а medical activities].

The article presents definition of concepts of exporting medical services in foreign and Russian practice. It includes overview of the elements of strategy of developing export of medical services (within the framework of the National project "Health Care"). The article considers the need to develop marketing strategy, information exchange system and conditions ensuring compliance of medical services with high standards of quality and safety of medical activities at the national level. The perspective direction development of the quality and safety system in Russia during implementation of the Federal project "Development of export of medical services" through improving the efficiency of medical organizations and their accreditation is determined.

[The increasing of awareness of patients and medical personnel of security issues: the results of questionnaire survey within the framework of the World Patient Safety Day in the Russian Federation].

The specially developed questionnaires on the basis of the WHO materials developed for the World Patient Safety Day were applied in sociological survey of patients and medical workers. The sampling included 3946 respondents (1747 patients and 2199 medical workers). The study was carried out to establish awareness about course of treatment and medications taken, communication with the attending physician and nurse, involvement in decision-making regarding treatment and care provided, clinical decision-making, interaction with patients, informing patients on prescribed drugs and their possible adverse reactions.

[The quality and safety of rendering emergency and urgent medical care in hospitals].

The article presents the results of external auditing on the section "The organization of emergency and urgent medical care in hospital. Organization of admitting office functioning" in 30 medical organizations of the Russian Federation based on "The proposals (practical guidelines) of Roszdravnadzor for organizing internal quality control and safety of medical activity in medical organization (hospital)". The level of compliance with requirements of the Proposals is determined. The complex and structural problems of organization of rendering of emergency and urgent medical care.

Effects of home reading training on reading and quality of life in AMD-a randomized and controlled study.

BACKGROUND: Age-related macular degeneration (AMD) causes reading impairment, reduced quality of life (QoL), and secondary depression. We have shown that support with magnifying aids improved reading speed (RS), emotional and cognitive status, and QoL. The present study investigates whether additional reading training (RT) (after adapting to appropriate visual aids) can further improve vision rehabilitation. METHODS: Patients with dry AMD were randomly assigned to 2 groups. The primary RT group (P-RTG, n = 25) trained with sequentially presented text (RSVP), and the control group (CG, n = 12) performed placebo training (crossword puzzles) and later crossed over to RT, so that altogether 37 participants performed reading training. Patients trained at home on a PC for 6 weeks. RS was assessed during reading printed paragraphs of text aloud. Using a scanning laser ophthalmoscope, we examined fixation stability and preferred retinal locus (PRL) for fixating a cross, as well as PRL and eye movements during reading single words. We assessed emotional status by Montgomery-Åsberg Depression Rating Scale (MADRS), cognitive status by dementia detection test ( DemTect ) and QoL by Impact of Vision Impairment (IVI) profile. Visual acuity and magnification requirement were examined by standard procedures. All variables were measured before and after placebo training, before and after RT, and after 6 weeks without training (follow-up). RESULTS: RS improved significantly in the P-RTG during RT, but not in the CG during placebo training. The effect remained stable at follow-up. Fixation performance and eye movement variables did not change. Emotional status (MADRS) improved in P-RTG during RT and showed a significant difference of the change of scores between the 2 groups. Complete IVI scores improved significantly during RT and remained stable. CONCLUSION: The results indicate that patients with AMD, who already use magnifying aids, benefit from additional RT and that it can contribute in preventing depression and improve QoL. TRIAL REGISTRATION: The study was registered at the German Clinical Trials Register (DRKS00015609).

[Monitoring of adverse event triggers as a tool for managing the medical care quality at a neurosurgical clinic. Invitation to the discussion]. / Monitoring triggerov neblagopriiatnykh sobytii kak instrument upravleniia kachestvom meditsinskoi pomoshchi v neirokhirurgicheskoi klinike. Priglashenie k diskussii.

Management of the healthcare quality and safety is one of the priorities of state policy for protecting health of Russian citizens. We describe modern technologies for managing the quality of medical care and patient safety based on a systematic approach. Potential applications of these technologies in neurosurgical practice are defined. Quantitative, qualitative, and basic indicators are proposed for evaluation of outcomes (results) as part of implementation of an integrated quality management system in neurosurgical practice.

[Educational internet resources for doctors' training in diving medicine.]

The article covers analysis and systematization of major internet resources used to train high qualified professionals with higher medical education for competent and successful education of doctors in speciality 31.08.27 Diving medicine.

[The Results of Self-Assessment by Medical Organizations Their Correspondence to Proposals (Practical Recommendations) of the Roszdravnadzor Concerning Organization of Internal Control of Quality and Safety of Medical Activity].

The article presents the analysis of the results of internal audits (self-rating) in medical organizations implemented on the basis of Proposals (practical guidelines) of the Roszdravnadzor concerning organization of inner control of quality and safety of medical activities in medical organization (hospital). The self-rating was implemented by the medical organizations themselves according the common criteria of the Proposals as provided the following plan: planning of self-rating, collection and processing of data, application of self-rating, analysis of obtained results, preparation of report. The article uses the results of self-rating of medical organizations corresponding to following criteria: profile of activity-multi-field hospital-number of beds more than 350-state property. The self-rating was implemented according to 11 basic parts of the Proposals. The criteria were developed for every part. The evaluation lists developed on the basis of the given Proposals permitted to medical organizations to independently establish problems in their activities. Within the framework of implemented self-rating medical organizations mentioned the directions of activity related to personnel management, identification of personality of patient, support of epidemiological and surgical safety as having significant discrepancies with the Proposals and requiring implementation of improvement measures.

[INDIVIDUAL APPROACH TO THE USE OF MEDICATIONS TO NORMALIZE SITUATIONAL ANXIETY UNDER THE PSYCHO-EMOTIONAL STRESS].

Analysis of archival data revealed subsidence of situational anxiety accompanying work under psycho-emotional stress after administration of pharmacologically different psychotropic agents, such as stimulant mesocarb, nootropic and anxiolytic fenibut, tranquilizer fenazepam and alpha-adrenoblocker proroxan. Effectiveness of pharmacological anxiety control was dependent on individual sensitivity to these agents. Prescription of the medications with allowance for the factor reduced group-average levels of situational anxiety in 1.3 to 72 times.

[HEALTH PREDICTION INDICES OBTAINED WITH LOW-DOSE COMPUTER TOMOGRAPHY SCANS].

Purpose of the investigation was to make prognostic estimations of reductions in somatic morbidity and temporal disability, and tumor pathology using low-dose computer tomography (CT) scans and to compare with standard protocols. Mean effective radiation doses were determined based on the results of 1627 diagnostic CT investigations made in 2012-2014 at the Treatment and Rehabilitation Center of the Russian Ministry of Health. Low-dose CT scans of the head and thoracic, abdominal and small pelvis organs were obtained on a GE Discovery CT750 HD, and with the help of the ASIR and MBIR algorithms of iterative reconstruction. In comparison with a standard dose, a single CT scan with a dose reduced by 10-12 mSv predicts a decrease in total morbidity by 0.84-5.52% and temporal disability by 0.55-1.65% per 100 employees over a year; total risk of tumors and genetic effects reduced in 5 to 10 times, which may be equal to 40-90 cases per 100,000 of 30 y.o. males.

[Evaluation of active equipment protecting distal parts of hands and feet against cold].

Experimental studies covered thermoregulatory reactions of feet and hands, when using equipment protecting distal parts of hands and feet and using "active" heating (electric heating and thermochemical heater). Findings are that "active" heaters with output range 4-8 watt, as electrically heated inserts in gauntlets and welts, at air temperatures of -5 to -10 degrees C maintained average skin temperature of hand at 17-20 degrees C; using "active" heaters with output of 12 watt increased heat insulation of gauntlets and shoes up to 0.609-0.609 degrees C x m2/watt--that enables to conduct averagely hard work at cold climate up to 2 hours in all climate regions--IA (special), IB (climate zone IV), II (climate zone III) and III (climate zone II). Using 2 thermochemical heaters in gauntlets prevented local cooling, and heat insulation of the gauntlets therefore increased 1.6 times--that enables to widen temperature range of safe usage of equipment protecting hands against cold up to climate region II (climate zone III) during continuous physical work of average hardiness in cold climate up to 2 hours.

[Substantiation of optimum condition of parainfluenza-3 virus cultivation for production of vaccines on the finite cell line].

Research is performed for investigation of cultivation peculiarities of virus parainfluenza-3 on different cell cultures and optimization of methods of virus infection of these cultures with PI-3 virus in the process of development of vaccines. Influence of a seed lot on the formation rate of a cellular monolayer of continuous cell cultures PT-80, LEK, KSTand T-1 is defined, it is established that the seed lot of 250,000 cells in 1 ml provides optimum concentration for formation of a full monolayer within the time limits of 48-72 hours. The most sensitive cell cultures (PT-80) for cultivation of parainfluenza-3 virus are selected; an optimal CCID of virus PI-3(0,1 TCD/ml), whereby we can observe the maximal accumulation of a virus within 2-4 day after infecting cell cultures, is defined.

[Experience with selenium used to recover adrenocortical function in patients taking glucocorticosteroids long].

AIM: To study the effect of selenium on adrenocortical function in patients taking glucocorticosteroids (GCS) long. SUBJECTS AND METHODS: The study included 56 patients who had been long taking oral GCS for the underlying disease. Adrenocortical function was evaluated by a short synacthen test; adrenal insufficiency (mean cortisol level 8.2 microg/dl) was identified in 52 patients. A study group of patients (n = 35) was given selenium 200 microg/day. A control group (n = 17) with the detected adrenal insufficiency did not take it. All the patients (n = 52) continued to receive standard therapy for the underlying disease, including oral GCS. RESULTS: Adrenal function was reexamined 6 months later; the two paired-samples t-test indicated a statistically significant increase in cortisol levels up to 23.20 +/- 4.2 microg/dl (p < or = 0.05) in the patient group receiving selenium in addition to the basic therapy. In the control group, the function did not recover (cortisol levels were 8.6 and 9.8 microg/dl at baseline and at 6 months, respectively; p < or = 0.05). CONCLUSION: The experience with selenium 200 microg/day given long to patients with adrenal insufficiency caused by the long-term use of GCS shows that the agent is effective in recovering adrenocortical function.

[Methods of evaluation of efficiency of laboratory animals in the experimental influence of pathogenic and extreme factors].

In the experimental study of various environmental factors that negatively impact on the functional state of the organism of military, an important component is the assessment of performance. To this end, studies in laboratory settings that simulate the main types of human actions--mainly physical or mainly mental. In the described complex techniques used to simulate the performance of separate elements of the targeted actions of a man in experiments in small (mice, rats) and large (dogs, monkeys) laboratory animals under the effect of investigated factors. As a result of this approach, obtained in experiments with complex methodologies formed a dose-time dependence of efficiency of animals may be used, taking into account interspecies extrapolation regularities as a rapid assessment for predicting effects in humans from exposure to adverse factors studied.

[Emotional burnout syndrome and pedagogical styles in teachers of a medical high school].

The study involved 20 teachers of medical institutions who gave consent to be examined for emotional burnout syndrome (EBS). Diagnosis of moderate EBS was confirmed by relevant clinical tests and analysis of pedagogical communication style in 30% of the participants. The pedagogical style of teachers exhibiting no signs of burnout is characterized by personality-oriented model of communication with differential attitudes toward students and active interaction with them. Teachers presenting with EBS relied on the disciplinary model of communication prevailed by authoritarian and dictatorial behaviour lacking communicability and flexibility; these persons showed pronounced hyperreflexia.

[Effectiveness of new preventive means for maintaining the functional state of organism in air operators].

The study was designed to assess the psycho-physiological and immune status in 60 male aviation specialists aged 24-45 years given biologically active food additives "Intra" and "Adaptol" It was shown that regular consumption of these additives promoted mobilization of functional reserves of the organism, improved time-related activity of nervous processes, increased lability of the central part of the visual analyzer, and improved results of subjective assessment of postural equilibrium control. Results of the study indicate that food additives "Intra", "Adaptol" possess immunocorrective potential and may be used to restore functions of various organs and their systems in a human operator under extreme conditions.

LC-MS/MS analysis of epoxyalcohols and epoxides of arachidonic acid and their oxygenation by recombinant CYP4F8 and CYP4F22.

CYP4F22 and CYP4F8 are expressed in epidermis, and mutations of CYP4F22 are associated with lamellar ichthyosis. Epoxyalcohols (HEETs) and epoxides (EETs) of 20:4n-6 appear to be important for the water permeability barrier of skin. Our aim was to study the MS/MS spectra and fragmentation of these compounds and to determine whether they were oxidized by CYP4F22 or CYP4F8 expressed in yeast. HEETs were prepared from 15-hydroperoxyeicosatetraenoic acid (15-HPETE), 12-HPETE, and their [(2)H(8)]labeled isotopomers, and separated by normal phase-HPLC with MS/MS analysis. CYP4F22 oxygenated 20:4n-6 at C-18, whereas metabolites of HEETs could not be identified. CYP4F8 formed omega3 hydroxy metabolites of HEETs derived from 12R-HPETE with 11,12-epoxy-10-hydroxy configuration, but not HEETs derived from 15S-HPETE. 8,9-EET and 11,12-EET were also subject to omega3 hydroxylation by CYP4F8. We conclude that CYP4F8 and CYP4F22 oxidize 20:4n-6 and that CYP4F8 selectively oxidizes 8,9-EET, 11,12-EET, and 10,11R,12R-HEET at the omega3 position.

Inference of Boolean networks under constraint on bidirectional gene relationships.

The coefficient of determination (CoD) has been used to infer Boolean networks (BNs) from steady-state data, in particular, to estimate the constituent BNs for a probabilistic BN. The advantage of the CoD method over design methods that emphasise graph topology or attractor structure is that the CoD produces a network based on strong predictive relationships between target genes and their predictor (parent) genes. The disadvantage is that spurious attractor cycles appear in the inferred network, so that there is poor inference relative to the attractor structure, that is, relative to the steady-state behaviour of the network. Given steady-state data, there should not be a significant amount of steady-state probability mass in the inferred network lying outside the mass of the data distribution; however, the existence of spurious attractor cycles creates a significant amount of steady-state probability mass not accounted for by the data. Using steady-state data hampers design because the lack of temporal data causes CoD design to suffer from a lack of directionality with regard to prediction. This results in spurious bidirectional relationships among genes in which two genes are among the predictors for each other, when actually only one of them should be a predictor of the other, thereby creating a spurious attractor cycle. This paper characterises the manner in which bidirectional relationships affect the attractor structure of a BN. Given this characterisation, the authors propose a constrained CoD inference algorithm that outperforms unconstrained CoD inference in avoiding the creation of spurious non-singleton attractor. Algorithm performances are compared using a melanoma-based network.

[Surveillance for avian influenza virus in synanthropic birds during epizootic and postepizootic periods on the south of west Siberia].

Results of virologic examination of synanthropic birds procured on the south part of West Siberia during epizootic in autumn 2005 and during postepizootic period (winter 2005-2006) are presented. During epizootic period one strain belonging to H4 subtype of hemagglutinin, which was not highly pathogenic, was isolated from a magpie. During postepizootic period influenza A viruses in synanthropic species were not found.