Doctoral Work Research Articles

НЕКОТОРЫЕ АСПЕКТЫ ДЕЯТЕЛЬНОСТИ ГОСУДАРСТВЕННОГО САНИТАРНОГО НАДЗОРА ПО УЛУЧШЕНИЮ СРЕДЫ ОБИТАНИЯ И ЗДОРОВЬЯ НАСЕЛЕНИЯ (ОБЗОР ЗА 1971-2018 ГОДЫ)

The purpose of this work was to consider the individual results of the activities of the state sanitary supervision (hereinafter - the state sanitary supervision) in the field of communal hygiene and occupational hygiene for 1971-2018, its role in ensuring the health of the population of Belarus. To achieve this goal, an analysis of the sanitary and epidemiological situation in the Republic of Belarus in 2000 and 2017 was carried out. The data of the statistical reporting of the Ministry of Health of the Republic of Belarus (hereinafter - the Ministry of Health of the Republic of Belarus) for 1974-2017 were studied. A retrospective analysis of the incidence of the population of the republic has been carried out. It has been established that the observance of sanitary legislation in the work of a sanitary doctor is the basis for the activity of a sanitary doctor at hygiene centers of any level. The scientific and legal approach in the presentation of requirements for the implementation of sanitary and anti-epidemic measures allows avoiding legal liability, ensures the fulfillment of orders from higher management, requests of interested organizations and individuals. Working with complaintsfrom the population, especially doctors on communal hygiene, takes up a significant part of the working time of specialists of hygiene and epidemiology centers at the district level (hereinafter referred to as the CGE paradise), stimulates the raising of questions about the elimination of identified legal shortcomings. More widespread introduction of sanitary and epidemiological audit is needed. The necessity of analyzing the state of health of the population when carrying out sanitary and anti-epidemic measures is substantiated, the difficulties of using such an assessment and the ways of its possible optimization are shown. The characteristic stages of the successful path to science of doctors of a sanitary-prophylactic profile have been formulated: study at a university (mastering a craft, profession); achieving excellence in the application of the acquired Significant results of progress in the field of hygiene of water supply, sanitation and labor hyena over the past 20-30 years are outlined. The necessity of analyzing the state of health of the population when carrying out sanitary and anti-epidemic measures is substantiated, the difficulties of using such an assessment and the ways of its possible optimization are shown.

How to understand modern digital technologies so as not to fall into the traps of cybercriminals and misinformation online

The digital world with all its gadgets, sites and useful services has become too comprehensive and comprehensive to fundamentally ignore it. The digital world offers significant opportunities for both individual users and institutions. Reforming the health care sector in Ukraine involves a significant emphasis on not using an increasing number of digital tools in the daily work of both medical institutions and doctors. Every day patients try to communicate with doctors through messengers, sending the latter their questions, test results, and other medical data. And although such online consultations are mostly not institutionalized, patients are primarily guided by the logic of convenience, accessibility and time saving, pressing the «send» button in the messenger to send a message to the doctor. At the same time, the use of digital technologies in health care is gaining more and more expressive forms due to the introduction of telemedicine, electronic prescriptions, or the availability of publicly available dashboards from the National Health Service. The dashboards contain arrays of data on the provision of medical services at the level of hospitals and the corresponding payments under contracts with the National Health Service. Access to all these benefits of the digital space requires at least a basic understanding of digital technologies to use them effectively. The article explains principals of digital literacy with emphasize on health care providers and explains how to understand modern digital technologies and not to fall into the traps of cybercriminals and misinformation online.

Nephrotic syndrome in the work of a family doctor

Nephrotic syndrome in the work of a family doctor

Educational interventions to ensure provision of doctors in rural areas - a systematic review.

Recruiting doctors in rural areas is challenging, and various educational interventions to ensure the provision of doctors in rural areas have been introduced in many countries. This study aimed to collect knowledge about the undergraduate medical education interventions that have been introduced in order to recruit doctors to rural areas, and the results of these interventions. We undertook a systematic search in the databases Cinahl, Eric, Medline and PsycInfo using the search words rural, remote, workforce, physicians, recruitment and retention. We included articles that met the following criteria: the educational interventions were clearly described, the study population consisted of medical graduates, and outcome measures included place of work (rural/non-rural) after graduation. The analysis included 58 articles and encompassed educational interventions in ten countries. There were five main types of interventions, often used in combination: preferential admission from rural areas, curriculum relevant to rural medicine, decentralised education, practice-oriented learning in rural areas, and compulsory service periods in rural areas after graduation. The majority of the studies (42) compared place of work (rural/non-rural) of doctors who had graduated with and without these interventions - only two of the studies reported non-significant differences in place of work. In 26 studies, the odds ratio for rural place of work was significant at a level of 5%, with odds ratios between 1.5 and 17.2. In 14 studies there were significant differences in the proportion with a rural/ non-rural place of work, with differences ranging from 11 to 55 percentage points. Changing the focus of undergraduate medical education towards the development of knowledge, skills and teaching arenas that equip doctors with competencies to work in rural areas has an impact on the recruitment of doctors in rural areas.

A study of attitudes among Polish dermatologists and dermatology trainees regarding modern technologies in medicine.

IntroductionDermatology offers great potential for the use of modern technologies such as remote online consultations, initial diagnostics via smartphone and computer applications, and artificial intelligence (AI)-based support for doctors.AimTo investigate the attitude of dermatologists to such technologies.Material and methodsThe participants completed a paper questionnaire comprising 16 questions regarding data such as age, gender and advancement in specialization, as well as views on the safety, benefits and future role of technologies such as AI and telemedicine in the future of medicine. The participants were chosen by snowball sampling. In total, 140 questionnaires were obtained; this was reduced to 90 by removing 50 respondents who were not familiar with term “telemedicine”. The obtained data were subjected to statistical analysis.ResultsThe prevailing opinion was that while AI will not be able to replace doctors in the future, it could be used to improve the skills of medical personnel. Among the possible applications of these technologies in medicine, most of the responses indicated disease prevention (32%) and education (26%). None of the participants indicated that telemedicine could completely replace the traditional visit to the doctor’s office.ConclusionsWhile the connection between medicine and modern technology is becoming stronger, most respondents believe that it is not possible for technologies such as AI or telemedicine to replace the work of human doctors.

Prevention of adverse events following the use of local anesthetics in traumatology and orthopedics

The article analyzes the frequency of development of adverse toxic reactions when using local anesthetics in the practice of an orthopedic traumatologist; based on the conclusions of commission forensic medical examinations conducted in the framework of criminal proceedings on the death of patients, the features of the onset of LAST syndrome are studied, which significantly increases the medical risk for the patient and the legal risk for the doctor. An analytical study of scientific publications on the possibilities of using the local anesthetic Articaine-Binergia 20 mg/ml in the daily work of both polyclinic and inpatient doctors to ensure the safety of medical activities was conducted.

Spiritual and religious competencies in psychology.

Religion and spirituality (R/S) are important aspects of human diversity that should be explicitly addressed in the field of psychology. The field has already included R/S in its definitions of multiculturalism, but while multicultural training is routinely included in doctoral level psychology course work and internship programs, it rarely includes specific training in R/S diversity. Polls of the American public indicate that religion and spirituality are important in most people's lives, and hundreds of studies demonstrate empirical links between R/S and psychological health and well-being. In clinical practice, there is evidence that clients would prefer to have their R/S addressed in psychotherapy. However, R/S issues are typically neither discussed in psychotherapy nor included in assessment or treatment planning. In research, religion and spirituality are often assessed with a single item on religious affiliation. Psychologists receive little or no training in R/S issues, in part because no agreed upon set of spiritual competencies or training guidelines exist. This article summarizes the rationale for including religious and spiritual competencies in psychology training and practice, reviews research establishing a set of religious and spiritual competencies (attitudes, knowledge, and skills) that we propose all psychologists should demonstrate, and provides practical recommendations for inquiring about religion and spirituality. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Ponencia y Reseña de los Sistemas Educativos como Insumo principal en las Gestiones Educativas Contemporáneas

This work was based on the different research proposes at the local and foreign level, analyzing how different educational systems have evolved at The Latin American and global context and how educational trends have been serving as the main input in the elaboration of the different action plans and institutional improvement plans in some educational entities of tertiary education , but which has been unknown to basic and middle education bodies in the management of teachers and teaching managers learning. It analyses characteristics of global trends focused on supranational entities and how ignoring them would be detrimental to the relevance of the new undergraduate, graduate and management documents of any university at the national level to generate policies and for management and research. This review was resolved as a doctoral course work and part of a broader process of reflection in educational management and research and its relationship to the relevance of the impact of education on social change and relevance in a much more competitive labor market.

Factors influencing Lithuanian researchers’ use of open access repositories as a publishing channel

The affordances of repositories for scientific information are emphasized in various international and national governmental and research financing documents. However, the researchers do not upload their full-text publications into the repositories as intensively as it is expected. The aim of the paper is to establish which factors and to what extent affect the intention of Lithuanian researchers to use open access repositories as a publication channel. The model of the theory of planned behaviour was employed to better understand the intentions of Lithuanian researchers to deposit their publications to research repositories. A representative questionnaire survey was carried out to collect the data. The 545 respondents of the survey were the Lithuanian researchers who have a doctoral degree and work at Lithuanian state universities or state research institutes. The obtained data were analysed using statistical analysis (correlation). The connections between intention to submit publications to open access repositories and attitudes, perceived norm, perceived control, past open access publishing behaviour, occupational and demographic characteristics were analysed. The study has identified the factors affecting the open access publishing behaviour of Lithuanian researchers and the strength of their influence with regard to it. It was found that the most significant factors which affect Lithuanian researchers’ intention to submit their publications to repositories are perceived norm, perceived control and past open access publishing behaviour. The age and seniority of researchers are also significant. Lithuanian researchers differ from the general context of open access publishing behaviour in that the influence of norms on the intention to submit publications to open access repositories is greater than that of researchers in other countries, and the attitudes, although positive, are less significant. The remaining factors are affecting their publishing behaviour similarly as in the studies from other countries. Lithuanian researchers representing social sciences and humanities are slightly more likely to submit publications to the repositories than researchers representing the natural science, medicine and technology.

Towards sustainable health - detection of tumor changes in breast histopathological images using deep learning

The paper presents issues related to methods used in breast histopathological images tumor changes detection. The problem is connected with sustainable health issues which focus on the improvement of health and better delivery of healthcare, rather than late intervention in disease, with resulting benefits to patients and to the environment on which human health depends, thus serving to provide high quality healthcare. The main purpose of the paper is to develop a model based on deep artificial neural networks for the cancer detection in histopathological breast images. The implementation of the proposed model fits in with the concept of sustainable health through the support of the work of doctors in their decisions, diagnosis and in the reduction of the human workload and time, which can be referred to improve the health services. Data set contains 277524 samples from 163 breast histopathological images taken with the WSI scanner. The model is based on a convolutional neural network in the ResNet-18 architecture, which consists of residual blocks. During the final validation on the test set, the network achieved an accuracy of 93.6% and a 87.3% sensitivity in the detection of cancer tissues. The overall performance of the model is characterized by an F1-score of 0.887. The obtained results indicate the possibility of using the system in clinical conditions.

Nasilje na radu nad ljekarima porodične medicine kao dio globalnog fenomena u sektoru zdravstva

Objective. Violence against healthcare workers is a significant global problem and is prevalent in both developed and underdeveloped countries. In the Republika Srpska, there is also a problem of violence against health workers and it occurs in the public and private health sector. Most attacks come from patients or their family members who have a mental illness or have harmful behavioral habits such as alcohol or drug abuse. Aim of the work is to examine the prevalence of violence at work against family medicine doctors, the most common forms of violence, the consequences of violence on the professional work of doctors, as well as prevention measures. Methods. The research was conducted in 16 health institutions in the Republika Srpska in the period from January to December 2018 according to the type of cross-sectional study on a randomized sample of 287 respondents, doctors who worked in the service of family medicine. The research instrument was a specially created questionnaire that was created for this research, and the obtained data were statistically processed in the program package SPSS 19. Results. Doctors of both sexes participated in the research, and the majority of respondents were women, 77,8% of them, while 22,2% were men. The majority of respondents are employed in public health care, 97,11% of them. Of the total number of doctors surveyed, 84,48% of them experienced violence at work during their working life. The analysis of the representation of certain types of violence showed that the most common form of violence is verbal violence in the percentage of 40,7%. A total of 73,62% of respondents believe that violence at work affects further professional work. Conclusion. Violence at work against family medicine doctors in Republika Srpska is significant. The most common forms of violence are verbal violence and rude or disrespectful behavior, and as the most important prevention measures, family medicine doctors point out a lower workload with the number of examinations, the introduction of stricter criminal liability for offenders and the introduction of the status of an official.

To the Ukrainian People – a Stable and Balanced Development (Historical and Analytical Essays: Rethinking the Past). Part 3. Retrospective of the Formation of Planning and Economic Independence at Different Levels of Management: Ideas, People, Destinies

The article reveals the results of rethinking the formation of planning and economic independence of enterprises, associations and industries of the national economy (with specification on the example of the coal industry of Ukraine) under the influence of the Interdepartmental Commission for the Implementation of New Systems of Planning and Management Organization of the State Plan of the Ukrainian SSR in 1976-1990. In the context of awareness of the provisions of the “three S” doctrine (Social forecasting, Social planning, Social management), the strategizing of stable human-centered development has been carried out. The need to finalize the 2011, 2017 and 2020 draft of the Law of Ukraine “On State Planning” as a basis for building the Planning Code of Ukraine is justified. The experience of formation of the Sector of problems of the efficiency of management of Economic Research Institute of the State Plan of the Ukrainian SSR for scientific and methodological support of the development for the years 1976-1980, 1981-1985, 1986-1990 of the Plan for improving the management of the branches of the national economy of the subdepartmental Government of the Ukrainian SSR circle of ministries and departments of the republic is given. Based on the substantiation of the planned mechanism of harmonization of public, collective and personal economic interests, the essence of the initiative scientific work of the Sector of the Management Effectiveness of Economic Research Institute of the State Plan of the Ukrainian SSR regarding the modeling of the programtarget indicative planning of the socially-oriented economy of the republic as part of USSR was revealed. An example of integrated design of a comprehensive effective and flexible management system of mines, coal plants, industry as a whole in the conditions of planning and economic independence of the Ukrainian SSR as part of the USSR is given. Considered, as an alternative to the current Anglo-Saxon model of an open market with free prices, the methodological provisions of the two-sector model of the mixed economy “Market-Plan”, which should be used to clarify and improve the current market model of the economy in Ukraine. The article pays attention to a real example of the selection and training of domestic management personnel with innovative ideas of state-building, based on the example of the scientific work of Doctor of Economics, Professor Stolyarov Vasyl Fedosiyovych in 1972-1994, from a full-time graduate student of the university to the director of the Economic Research Institute of the State Plan of the Ukrainian SSR. Formulated questions for public discussion in the Discussion Club of the Academy of Economic Sciences of Ukraine.

Оценка эффективности работы первичной медико-санитарной помощи менеджерами здравоохранения

Introduction. There is a need for a dynamic assessment of the quality of medical care in the context of the opinions of stakeholders.The purpose of the study is to assess the efficiency of the use of resources and the willingness to work of primary managers in the context of PHC organizations.Methods. The study was conducted using the original questionnaire developed by us for PHC managers based on the AGREE methodology to study the effectiveness of primary care according to PHC managers. The study included 232 PHC medical organizations in 17 regions of Kazakhstan. The data analysis was carried out taking into account the group correlation.Results. 1,754 respondents (managers) from medical organizations (city and district polyclinics) of 14 regions and three cities of republican significance of the Republic of Kazakhstan took part in the survey. Slightly more than half of the respondents (54.02%, n=948) work in city polyclinics. Women significantly predominate among the respondents (83.7%, n=1463). More than half of the respondents (57.13%, n=1002) are aged 40 to 60, and respondents aged 18 to 39 account for 37.91% (n=665). When conducting a correlation analysis of the data of the questionnaire of the managers-respondents, we found a fairly significant correlation between the criteria “age” and “manager's experience” (r=0.537, p≤0.01), “total experience” (r=0.770, p≤0.01), “duration of work in PHC institutions” (r=0.587, p≤0.01), “duration of work in the polyclinic” (r=0.456, p≤0.05)). In addition, the total experience of the specialist correlated strongly enough with the duration of work in PHC institutions (r=0.714, p≤0.05). Managers note the high efficiency of polyclinic management by the management (96%), the high level of knowledge of their professional duties by doctors (93%) and nurses (94%), the high level of interaction between doctors and nurses (94%), as well as the effective interaction of doctors and nurses with managers (96%). Managers also point out that it is easy for them to find solutions to problems that arise in the polyclinic (95%), as well as good interaction with supervising organizations (Department of Public Health, Ministry of Health) (91%).Conclusion. Managers of PHC organizations show a fairly high assessment of the effectiveness of the primary level of providing medical and preventive care in the Republic of Kazakhstan. At the same time, it should be borne in mind that as a polyclinic manager, it is necessary to have experience in PHC conditions and its duration. For the well-coordinated and effective work of the polyclinic, the coordinated work of doctors and secondary medical workers, as well as the rest of the institution's staff and sufficient equipment and medical products are necessary. In addition, the competence of nurses and their well-coordinated interaction depends on the competence of doctors.Keywords: healthcare, primary health care, manager, efficiency assessment.

SCIENTIFIC PALETTE OF UKRAINIAN LINGUIST NADIIA BOYKO: DECODE ATTEMPT

The article uses the metaphor of “scientific palette” to focus on the reception of the scientific work of Doctor of Philology, Professor Nadiia Ivanivna Boyko. Attention is focused on the innovative research of the famous Ukrainian linguist, summarized in the individual and collective monographs “Ukrainian Expressive Vocabulary: Semantic, Lexicographic and Functional Aspects” (2005), “Mythologemes in the Ukrainian Romantic Space” (2010), “Connotative Lexical Semantics: Intensive and Parametric Components” (2011), “Expressive Potential of Volodymyr Vynnychenko’s Idiolect: Lexical and Phraseological Components” (2017); “Expressive Semantics: Discursive Interpretation” (2018), educational, methodological and lexicographic works. Author summed up the results of the study of the semantic and functional peculiarities of the expresctive vocabulary of the Ukrainian literary language, the interpretation of the emotional and appraised shades, the signifi cance of the lexem in the dictionary and the ways of their implementation in the artistic language in the monograph “Ukrainian expressive vocabulary: semantic, lexicographic and functional aspects” (2005). In the monograph “Mythologems in the Ukrainian Romantic Space” (co-author – A.M. Kaidash, 2010) the theoretical principles of understanding the main categories of mythologems are substantiated on the rich factual material from the works of Ukrainian romantic writers. In the scientific work “Conotative lexical semantics: intensive and parametric components” (co-authored with T.L. Khomich, 2011), we discuss the theoretical foundations of studying the intensive and parametric components in the modern linguistic paradigm, the intensive and parametric components in the semantic structure of the connotated word, and about their interaction with other components of the semantics of the connotated lexical units. Monograph “Expressive potential of idiollect of Volodymyr Vynnychenko: lexical and phraseological components” (2017) by N.I. Boiko, L.I. Kotkova is a new comprehension of the linguistic and creative personality of Volodymyr Vynnychenko, which will stimulate the study of idiostyles of Ukrainian writers, comparative study of individually-authored pictures of the world. As a cursory review of N.I. Boyko’s work shows, her research potential is very powerful, and her scientific palette is rich and diverse. In her works, the linguist covers topical issues of the modern existence of language, she is attracted by the complex and unknown, which she manages to study and make close and understandable.

РАССТРОЙСТВА СНА У ВРАЧЕЙ КАК РЕЗУЛЬТАТ ПРОФЕССИОНАЛЬНО-ДЕТЕРМИНИРОВАННОГО ДЕСИНХРОНОЗА

Intervention in the sleep-wake cycle affects the physical and mental state of the body, the social and professional functioning of the doctor working at night shift. This article presents the results of a study conducted among 755 doctors, 446 of them work at night shifts (the main group), 309 don't work at night shift (the comparison group). Significantly worse results were obtained in the main group in relation to the comparison group with indicators of all Pittsburgh Insomnia Rating Scale (PIRS) subscales with a significant effect. Unmarried respondents of the main group showed significantly worse results on a number of PIRS subscales. In the comparison group, the differences in the PIRS subscales between married and unmarried respondents were statistically unreliable. Male respondents, who work at night shifts, are less vulnerable to such sleep disorders as falling asleep, the duration of sleep, the frequency of nighttime awakenings and the state of dissatisfaction of sleep's quality. The main group of respondents who had to work two consecutive night shifts during the month showed significantly worse results in a few PIRS subscales in relation to their colleagues who didn't have two or more consecutive night shifts. The obtained results allow for consider the doctors over 40 y.old and working at night shifts as more vulnerable to sleep disorders then their colleagues under 40. Respondents with morning and intermediate types of circadian rhythms are less vulnerable to circadian desynchronosis and showing the best results on the most PIRS subscales in relation to the respondents with an evening type of daily rhythm.

‘Kidney Health for All’ - Implications for India

‘Kidney Health for All’ - Implications for India

Medicolegal Issues with Reference to NDPS and MHCA in Management and Rehabilitation of Persons with Substance Use Disorders.

Medicolegal Issues with Reference to NDPS and MHCA in Management and Rehabilitation of Persons with Substance Use Disorders.

RISK FACTORS IN THE PROCESS OF EMPLOYMENT OF MEDICAL WORKERS OF THE DENTAL PROFILE

One of the most socially important types of work is the work of medical workers. Due to the presence of a significant number of harmful and dangerous factors, the medical profession is divided into a separate group, which in turn is characterized by unique aspects of work. The work of doctors and nurses of different specialties of the dental profile differs significantly in the density of the working day, the volume and nature of professional activities; responsibility for the life of the patient, which affects many physiological processes.
 The purpose. Assessment and comparative characterization of the presence of occupational risks in the dental field, which are daily exposed to factors of aggressive and dangerous nature, as well as the development of a set of preventive measures aimed at reducing occupational morbidity.
 Materials and methods. Hygienic research of working conditions of medical staff of the University Dental Clinic in the form of a questionnaire. Statistical analysis of data of special assessment of working conditions; sanitary and hygienic characteristics, acts, maps of cases of nosocomial diseases; laboratory and instrumental research conducted as part of production control; dosimetric control, air sampling with subsequent sowing on the nutrient medium of IPA.
 Results. It was found that in the studied premises, the total microbial count varied from 756 ± 0.8 CFU / 1m3 to 6497 ± 3.4 CFU / 1m3. In most medical institutions, the level of artificial lighting in the workplaces of medical workers was insufficient. The largest negative contribution was provided by such production factors as: labor intensity and intensity - 26.41%; physical: noise, vibration, non-ionizing and ionizing radiation - 25.32%; chemical - 12.77%. The total contribution of the main factors was 91.78%. Assessment of working conditions is based on hygienic criteria to assess the degree of deviations of the parameters of the production environment and labor process from the current hygienic standards, as well as after analysis and processing of data submitted by employees in the format of their questionnaires. In this regard, the distribution of harmful production factors and their degree of impact on the health of medical personnel was established with the help of multifactor analysis.
 Conclusions. Thus, the research interprets the results, which clearly in the format of a specific percentage, identify those factors that have a strong driving impact on the health of dental professionals. The most substantiated are such production factors as: chemical (exposure to drugs and chemicals), physical (noise and vibration, non-ionizing and ionizing radiation), the severity and intensity of the labor process, lighting (non-compliance with regulations for artificial lighting in the workplace) and microclimate and biological (work with biological, potentially contaminated material, samples, patients), non-ionizing and ionizing radiation, labor intensity (tension of the visual organs).

Клинические рекомендации МЗ РФ: готовы ли врачи их выполнять? Результаты интернет-опроса врачей

Introduction. Clinical guidelines are a collection of documents developed by professional communities and containing structured clinical information on etiology, pathogenesis, symptoms, methods of diagnosis, treatment and rehabilitation of patients. Medical spe- cialists of the Russian Federation are informed about the need to comply with the recommendations from January 1, 2022, and have completely different reactions to this fact. The purpose of the article is to analyze the results of an Internet survey of Russian doctors in their attitude to the necessity and possibility of following clinical guidelines. Materials and methods. In total, 2487 Russian doctors took part in the survey, which lasted from July 21, 21 to October 30, 21, who, after identification on the resources listed above, were asked questions with multiple answers: 1. Region of the doctor's work, 2. Medical specialty, 3. Do you think Russian doctors need clinical guidelines? 4. Should clinical guidelines be publicly available? 5. To what extent are you ready to apply the clinical guidelines? 6. Do you consider it permissible to include phytopreparations, dietary supplements in the national clinical guidelines? 7. Do you consider it permissible to mention the trade names of drugs in the clinical guidelines? 8. How often should clinical guidelines be updated? Results. The attitude of Russian doctors to clinical guidelines is heterogeneous - out of 2,487 respondents, 52.96% are ready to apply clinical guidelines in some typical cases, 33.78% are absolutely ready to follow clinical guidelines, 10.74% consider it rather unnecessary, and 3.18% categorically against clinical guidelines. 1237 (49.74%) survey participants believe that clinical guidelines must be in the public domain exclusively for doctors and / or medical professionals. 1250 (50.26%) specialists opposed open access, in particular, due to the inadmissibility of familiarization with the clinical guidelines of patients. Most of the survey participants of 1916 people (77.04%) consider it permissible to include phytopreparations and dietary supplements in clinical guidelines in the form of separate chapters, with a mention and references to clinical studies. Conclusions. The main barriers hindering the implementation of clinical guidelines into clinical practice are the level of equipment of medical facilities, lack of time due to staff shortages, availability of clinical guidelines, lack of awareness and disagreement of doctors with the content of clinical guidelines, and their low motivation. Clinical guidelines should be the "starting point" in decision-making, but unconditional implementation of clinical guidelines cannot be required in the current health care system and the lack of legal protection of doctors. The format for the application of clinical guidelines in the work of doctors requires legal elaboration, strict compliance with the International Classification of Diseases (ICD).

Corona.

Description We all are witnessing unprecedented pain and suffering, enduring unsurpassed tribulations. As a doctor working in an intensive care unit each day, I carry the burden of my patients and their families, my coworkers, my own family and friends. I never think about myself, the burden on my soul. Yet I believe there will be a better tomorrow. A new day, where COVID times will be remembered with tears in our eyes yet a comfort in our smile that it's past.