Medical Institutions Research Articles

Cultural, demographic, and other non-demographic factors associated with cancer genetic counseling patients' appointment accompaniment preferences in the United States.

Although the presence of companion(s) in a genetic counseling session can positively influence session dynamics, research has found that some patients prefer to attend their appointments alone. To date, no studies have examined patient accompaniment preferences across different cultural groups in the context of genetic counseling. This quantitative study aimed to identify factors associated with individual preferences in accompaniment at cancer genetic counseling appointments in a sample (N = 130) of Hispanic/Latine (n = 29) and non-Hispanic/Latine White (n = 101) participants at a large academic medical institution. Variables examined included demographics, horizontal and vertical collectivism, and Hispanic and American acculturation. A link to an online questionnaire was emailed to patients who met four criteria: (1) identified as either Hispanic/Latine or non-Hispanic/Latine White; (2) had attended a cancer genetic counseling appointment at UCLA Health to discuss genetic testing options between October 2020 and December 2022; (3) were at least 18 years of age at the time of their appointment; and (4) indicated they were comfortable reading in Spanish or English; responses were anonymous. Logistic regression analyses identified four significant variables in the model associated with accompaniment preferences: individuals with at least one parent born outside of the US, those who attended their appointment in-person, and those with a higher horizontal collectivism score were less likely to want to attend their cancer genetic counseling appointment alone, while the converse was true among those with a higher American acculturation score. These findings highlight cultural and demographic factors that are associated with patient accompaniment preferences unrelated to ethnicity, indicating genetic counselors should not make assumptions regarding accompaniment preferences based solely on cultural or racial/ethnic background. Genetic counselors should incorporate this understanding when assessing patients' accompaniment preferences.

Выстраивание механизма внутренних коммуникаций участников закупочного процесса государственного учреждения здравоохранения.

The relevance of the work is determined by the need to optimize the procurement process in state medical institutions to improve the quality and efficiency of medical services provided. The subject of the study is the socio-economic interactions between participants in the procurement process, including preparation, implementation, and monitoring of procurement agreements. The purpose of the study is to identify and systematize the main problems in the field of procurement activities of public medical institutions and develop proposals for solving them based on the principles of cost-effectiveness, transparency and fairness. Materials and methods. The study includes a comprehensive analysis of current regulations governing procurement activities, as well as a study of the experience of implementing procurement procedures in medical institutions. Methods of comparative analysis, systematization and synthesis of the obtained data are used to identify key problems and challenges. Results. The work identified the main problems associated with the procurement process in medical institutions, including shortcomings in the regulatory framework, lack of a clear distribution of responsibilities between participants in the process and ineffective management decisions. Proposals were developed to optimize the procurement process, including adapting procurement models to the size and specificity of the activities of institutions, improving the documentation of the distribution of responsibilities and using digital technologies to improve the monitoring and management of procurement. Conclusions. Optimization of the procurement process in state medical institutions requires a comprehensive approach, including improving the legislative framework, enhancing interaction between structural units, and applying modern technologies to increase transparency and efficiency of procurement activities. These measures will not only help eliminate existing problems but also ensure higher quality and availability of medical services. Application of results. The results of the work can be applied in the healthcare system at the level of state medical institutions for the development and implementation of effective procurement models. They can also be used in the development of regulatory documents regulating procurement in the healthcare sector, as well as in the educational process for training specialists in procurement and logistics management in medical institutions.

Federated semi-supervised representation augmentation with cross-institutional knowledge transfer for healthcare collaboration

In the healthcare field, cross-institutional collaboration can fasten medical research progress. Vertical federated learning (VFL) addresses data heterogeneity across multiple medical institutions while ensuring medical data privacy, thereby enhancing the accuracy of disease diagnoses and treatments. However, traditional VFL only benefits from aligned samples, thereby limiting its applicability due to constrained sample sizes, and a large amount of non-aligned data remains untapped, resulting in wasted data. To exert full leverage on the value of all data obtained from medical institutions, this paper proposes a federated healthcare collaborative framework based on semi-supervised representation augmentation mechanism with cross-institutional knowledge transfer (CrossKT-FRA). Specifically, the developed method comprises three steps. First, the federated representations of shared data (aligned data) among medical institutions are extracted through efficient vertical federated representation learning (FRL) methods. Second, the federated knowledge contained in federated representations and potential labels derived through recurrent learning assist local shared data representations in performing supervised augmented learning. Finally, the federated knowledge is transferred indirectly from the representation augmentation module for shared data to the unsupervised representation augmentation module for local private data (non-aligned data). The experimental results show the effectiveness of the proposed knowledge transfer mechanism, whether applied independently or used to enhance VFL on medical datasets. Our findings contribute to a deeper theoretical understanding of VFL, further facilitating the utilisation of high-value medical data. By promoting cross-institutional and cross-disciplinary collaboration in healthcare data sharing, our study enhances the quality efficiency of medical services, thereby accelerating the development of interdisciplinary medical research. Code is available at https://github.com/LieLieLieLieLie/CrossKT-FRA.

Meteorological parameters and hospital-acquired falls—A multicenter retrospective study based on 10 years of adverse events reporting system data

Objective and RationaleHospital-acquired falls are common and serious adverse events in medical institutions, with high incidence and injury rates. Studying the occurrence patterns of hospital-acquired falls is important for preventing falls in hospitalized patients. However, the effect of meteorological factors on hospital-acquired falls has not been elucidated. Therefore, this study explored the impact of meteorological parameters on hospital-acquired falls in Chongqing, China, and provided new ideas for the clinical prevention of falls in patients. MethodsCorrelation analysis and distributed lag nonlinear models were employed to analyze the relationship between 3,890 cases of hospital-acquired falls and meteorological data in 13 hospitals in 11 districts and counties in Chongqing from January 2013 to April 2023. ResultsThe number of hospital-acquired falls demonstrated a nonlinear correlation with the daily average relative humidity and negatively correlated with sunshine duration; however, temperature, air pressure, and wind speed were not correlated. Compared to the reference humidity (87%), the immediate effects of daily average relative humidity (65–68% and 90–97%) increased the risk of hospital-acquired falls on the same day (relative risk [RR]:1.027–1.243). When the daily average relative humidity was 95–97%, lags of 0–1 d and 8–12 d had greater effects on falls (RR:1.073–1.243). The daily average relative humidities of 62–74% and 91–97% were statistically significant at cumulative relative risk (CRR)of 4, 7, 10, and 14 d with a cumulative lag (CRR: 1.111–4.277). On sex and age stratification, the lag and cumulative effects of relative humidity more significantly impacted falls in women and patients aged ≥65 years. ConclusionDaily average relative humidity had a nonlinear correlation and lag effect on hospital-acquired falls; therefore, medical institutions should pay attention to the effect of relative humidity on hospital-acquired falls in patients, especially old and female patients.

Impact of National Centralized Drug Procurement policy on chemical pharmaceutical enterprises' R&D investment: a difference-in-differences analysis in China.

This study aimed to evaluate the impact of the National Centralized Drug Procurement (NCDP) policy on chemical pharmaceutical enterprises' R&D investment and provide references for improving NCDP policy design and encouraging innovation in the pharmaceutical industry. Using the panel data of 102 Shanghai and Shenzhen A-share listed enterprises from 2016 to 2022 under the chemical pharmaceutical classification of Shenwan in Wind database as the research sample, this study developed difference-in-differences (DID) models on bid-winning and bid-non-winning enterprises, respectively, to evaluate the impact of NCDP policy on their R&D investment. In addition, this study tested the heterogeneity of bid-winning enterprises based on the bid success rate, the decline of drug price, and enterprise size. The NCDP policy could encourage chemical pharmaceutical companies to increase R&D investment, but the low bid success rate and excessive drug price reduction would reduce their R&D enthusiasm, especially for small- and medium-sized enterprises. It is suggested that the NCDP policy should be further improved: first, revise the bidding rule of the NCDP policy and increase the bid success rate so that more enterprises can win bids, and second, to solve the problem of excessive drug price reduction, evaluate the rationality of bid-winning prices, and introduce a two-way selection mechanism between medical institutions and supply enterprises. Integrate pharmacoeconomic evaluation into the NCDP rules to form a benign competition among enterprises. Third, attention should be paid to supporting policies for small- and medium-sized enterprises. By increasing procurement volume, shortening payment time limits, and increasing the proportion of advance payments, enterprises' cash flow shortages can be alleviated, thus achieving fairness and inclusiveness in the implementation of the NCDP policy.

Comparison of adverse events following the second/third dose of BNT162b2 in a medical institute in Japan

BackgroundVaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are crucial for ending the pandemic of coronavirus disease 2019 (COVID-19). Currently, the cumulative effect of booster shots of mRNA vaccines on adverse events is not sufficiently characterized. MethodsA survey-based study on vaccine adverse events was conducted in a Japanese medical institute after the third dose of Pfizer BNT162b2. Adverse events were grouped using network analysis, and a heteroscedastic probit model was built to analyse adverse events. ResultsThere were two main clusters of adverse events, systemic and local injection site-associated events. Subject background and the experience of previous vaccine-related adverse events were variably associated with the occurrence and intensity of adverse events following the third dose. Among adverse events, only lymphadenopathy increased prominently following the third dose, while the largest increase in other systemic adverse events occurred generally following the second dose. ConclusionsThe effect of repeated booster vaccines on the frequency and intensity of adverse events differs depending on the kind of adverse event.

Robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy with bladder cuff excision for upper tract urothelial carcinomas: Preliminary experience

ObjectiveTo present a modified technique for robot-assisted laparoendoscopic single-site retroperitoneal nephroureterectomy (RLESS-RNU) with bladder cuff excision and evaluate its effectiveness as a minimally invasive approach for managing upper tract urothelial carcinoma (UTUC). MethodsFifteen patients who underwent RLESS-RNU for UTUC between April 2020 and June 2021 were reviewed by our medical institution (The Second Affiliated Hospital of Nanjing Medical University), from our prospectively maintained institutional database. The da Vinci® Xi system (Intuitive Surgical, Sunnyvale, CA, USA) was utilized for surgical procedures on all patients. An in-depth analysis was conducted on their baseline demographic characteristics, pathological factors, and perioperative details. The complete surgical process and details are elaborated. ResultsThe median age of 15 patients was 67 years. The final pathology demonstrated 46.67% (7/15) patients with the pT1 stage or lower and 46.67% (7/15) with the pT3 stage; one patient could not undergo pathological staging because of preoperative chemotherapy. The perioperative outcomes revealed that the mean operative time was 185 (standard deviation [SD] 23.05) min. The time for the trocar placement including primary docking was 15 (SD 0.85) min and the time of second docking was 8 (SD 0.52) min. The median of estimated blood loss was 55 mL. The mean drainage tube duration and postoperative stay were 7.50 days and 11.00 days, respectively. After a mean follow-up period of 24.20 months, the relapse-free survival rate was 86.67%. Two patients experienced disease progression; one patient exhibited multifocal evidence of non-muscle invasive bladder cancer, and another patient developed systemic recurrence. ConclusionsThis study demonstrates the modified technique for RLESS-RNU is safe and satisfactory for UTUC.

Professor Nikolaos Louros, a concerned scientist in twentieth-century Athens

The personal papers of Nikolaos Louros present an invaluable source of information on Louros’s place in the medical, social, cultural and political history of twentieth-century Greece. A royalist, liberal and keen observer of scientific and social developments, he participated actively in the shaping of the country’s post-war progress in medical education, institutions and ideas.

Understanding Research Ethics: Perspectives of Faculty and Postgraduate Students in Medical and Dental Professional Institutions

Understanding Research Ethics: Perspectives of Faculty and Postgraduate Students in Medical and Dental Professional Institutions

High-risk HPV Prevalence Estimates among Older Patients: Implications for Cervical Cancer Screening Programs

Background: Due to the heterogeneity of existing studies and wide range of human papilloma virus (HPV) prevalence in India, further research into the incidence of HR-HPV and its spectrum of genotypes is essential to develop screening policies. This study aimed to determine the incidence and demographic distribution of HR-HPV among cisgender female patients attending a tertiary care facility in North India. Materials and Methods: This study was conducted in the Department of Obstetrics and Gynaecology, SGRR Institute of Medical and Health Sciences, Dehradun, India. HPV-DNA test results of 653 female patients were assessed for HR-HPV positivity, genotyping, and age-based differences via Chi-square analysis. Results: Overall prevalence of HR-HPV was 4.90%, HPV-16 was 1.37%, HPV-18 was 0.76%, and HPV non-16,18 was 2.7%. In patients ≤ 50 years, prevalence of HPV-16 was 0.97%, HPV-18 was 0.38%, and HR-HPV non-16,18 was 2.71%. In patients > 50 years, prevalence of HPV-16 was 2.89%, HPV-18 was 2.17%, and HR-HPV non-16,18 was 2.89%. The difference in the prevalence of HPV-16,18 between patients ≤ and > 50 years was found to be highly statistically significant (P = 0.007485). The difference in the prevalence of total HR-HPV between patients ≤ and > 50 years was not found to be statistically significant (P = 0.059905). Conclusion: Our study’s finding of higher HR-HPV positivity rates in patients > 50 years emphasizes the need for continued HR-HPV-DNA-based screening of this cohort. With widespread use in post-menopausal patients, HPV screening can serve as an important armamentarium in the fight against cervical cancer.

Referral Patterns to an Ophthalmic Outpatient Clinic in a Tertiary Eye Care Center in Iraq

Purpose: We aim to conduct a comprehensive review of outpatients at a tertiary ophthalmology clinic to evaluate various aspects including the spectrum of eye disorders, referral patterns, reasons for referral, and patient self-assessment, with a particular focus on self-referrals. Study Design: A cross-sectional study. Place and Duration of Study: Ibn Al-Haitham Teaching Eye Hospital from April to May, 2023. Methods: Referral letters were grouped into the primary health center (PHC), secondary hospital, internal referral and private clinic. Referral letter quality was assessed based on clinical information and particular request. Results: A total of 1367 individuals aged 40.8 ± 22.17 years were eligible for study. There were 19.2% referrals form PHC, 18.4% from secondary hospitals, 10.7% from private clinics, 3.3% were internal referrals, 37.2% were self-referred and 11.3% had medical or surgical follow-up. Blurred vision was the predominant complaint of 677 (51.6%) patients. Out of 659 referral letters, 25% scored two essential information items, 5.2% scored three, and only 0.8% scored four items. The majority (97.2%) of letters provided specific requests. Among all, 26.3% of PHC, 38.2% of hospitals, 34.9% of private clinics, 21.7% self-referred and 51.1% of internally referred patients considered their situations difficult. Conclusion: Majority of cases seen in ophthalmology tertiary centers consist of common conditions that could be effectively managed by PHCs and general hospitals. Improved referral standards for specialized medical institutions may reduce tertiary hospital over population.

Investigation on Infection Management in 156 Primary Medical Institutions

Objective: It's to understand and analyze the current status of nosocomial infection management in primary medical institutions. Methods: Through on-site investigation and analysis, the existing problems in nosocomial infection management in primary hospitals were identified, and countermeasures were analyzed and explored. Results: Effective management of infections in primary hospitals requires attention from hospital leadership, leveraging the role of infection management personnel, strict adherence to various systems, norms, and national standards, and ensuring the active participation of personnel to ensure smooth progress in infection management at the grassroots level. Conclusion: Primary hospitals should enhance infection control, focusing on establishing systems, providing training, standardizing operations, and implementing comprehensive monitoring. This is crucial for the survival and development of hospitals.

Effectiveness of organizational and legal measures and new practices to against HIV infection in the Novosibirsk region

The purpose of the study: to study the effectiveness of organizational and legal measures and new practices to against HIV infection introduced in the Novosibirsk region in 2019–2022.Materials and methods. The study was conducted on the basis of the State Medical Institution of the NGO «City Infectious Clinical Hospital No. 1», a division of the Center for the Prevention and Control of AIDS.Results. By Order of the Ministry of Health of the Novosibirsk Region No. 3429 of 10/15/2019, mandatory HIV screening was provided for all hospitalized with unknown HIV status during the year, which significantly increased the coverage of HIV screening. In 2019–2022, an AIDS Center information system was introduced for all patients with HIV infection admitted to inpatient treatment: 6,938 notifications were sent to the AIDS Center. Of the 2,717 patients who required measures to increase the level of adherence and involvement in ART, 18.9% of patients resumed ART after the measures taken; 36.5% started taking ART for the first time. The order of the State Medical Institution of the Infectious Clinical Hospital № 247 «On the organization of family support in the department «Center for the Prevention and Control of AIDS» dated 02.08.2021 provides the principle of monitoring the whole family with one doctor, which improves the adherence of children and parents to ART. For 4 months of functioning of family support, the share of parents receiving ART and having a high commitment increased from 15.5% to 77.3%. Among 45 children who had a previously determined level of HIV RNA viral load on the background of ART, 20% (9 abs.) registered an undetectable level of viral load for 3 months, and 13.3% (6 abs.) – for 2 months.Conclusion. The organizational and legal measures implemented in 2019–2022 in the Novosibirsk region and new practices to combat HIV infection have shown high efficiency: the coverage of dispensary observation of patients with HIV infection increased from 79.3% to 86.5%, and the coverage of antiretroviral therapy – from 74.5% to 85.2%.

Intravenous Methadone versus Intrathecal Morphine as Part of an Enhanced Recovery After Cardiac Surgery (ERACS) Protocol on Postoperative Pain and Outcomes: A Retrospective Cohort Study

ObjectiveEvaluate the effect of intravenous (IV) methadone versus intrathecal morphine (ITM) within an Enhanced Recovery After Cardiac Surgery (ERACS) pathway on postoperative pain and outcomes (length of hospital stay, postoperative complications) after cardiac surgery. DesignRetrospective cohort study. SettingTwo tertiary academic medical institutions within the same health system. ParticipantsEligible 289 adult patients undergoing elective cardiac surgery with an enhanced recovery pathway from January 2020 through July 2021. InterventionsPatients were administered ITM (0.25mg) or IV methadone (0.1mg/kg) if ITM was contraindicated. All patients were enrolled in an ERACS pathway utilizing current Enhanced Recovery After Surgery society guidelines. Measurements and Main ResultsPrimary outcome measures included postoperative pain scores and opioid consumption measured as oral morphine equivalents (OMEs). We analyzed patient demographics, procedural factors, intraoperative medications, and outcomes. Adjusted linear mixed models were fit to analyze associations between intervention and pain outcomes. ITM was associated with decrease in pain scores on postoperative day 0 after adjusting for clinical variables (average marginal effect, 95% confidence interval; 0.49 (0.002, 0.977), p=0.049). No difference in opioid consumption could be demonstrated between groups after adjusting for postoperative day and other variables of interest. ConclusionsITM when compared to IV methadone was associated with decrease in pain scores without any difference in opioid consumption after elective cardiac surgery. Methadone can be considered as a safe and effective alternative to ITM for ERACS protocols. Future large prospective studies are needed to validate this finding and further improve analgesia and safety.

Investigation on Infection Management in 156 Primary Medical Institutions

Objective: It's to understand and analyze the current status of nosocomial infection management in primary medical institutions. Methods: Through on-site investigation and analysis, the existing problems in nosocomial infection management in primary hospitals were identified, and countermeasures were analyzed and explored. Results: Effective management of infections in primary hospitals requires attention from hospital leadership, leveraging the role of infection management personnel, strict adherence to various systems, norms, and national standards, and ensuring the active participation of personnel to ensure smooth progress in infection management at the grassroots level. Conclusion: Primary hospitals should enhance infection control, focusing on establishing systems, providing training, standardizing operations, and implementing comprehensive monitoring. This is crucial for the survival and development of hospitals.

DETERMINATION OF SATISFACTION OF STUDENTS OF III-VI COURSES PURCHASE OF PRACTICE AT THE CLINICAL BASES OF DEPARTMENT I IN THE UNIVERSITY CLINIC OF NMU NAMED AFTER O. O. BOHOMOLTSA

Background. Every year in the developed countries of the world, more and more attention is paid to the analysis of patient satisfaction with medical institutions, the list of offered medical services and the quality of their provision. However, an equally important aspect of improving the system of medical institutions should be considered to be the study of the level of satisfaction of medical students with taking practical classes on the basis of health care institutions. Such a judgment is based on the fact that students of medical educational institutions are future employees of the system of health care institutions and it is they who will have to work on improving this system in the future. Aim: to find out the degree of quality of educational services provided by students of the III-VI courses of the National Medical University named after O. O. Bogomolets by determining the level of satisfaction of education seekers regarding the acquisition of knowledge and the development of practical skills at the clinical bases of the departments and at the University Clinic of NMU. Materials and methods. The study was based on a survey of students of the III-VI courses regarding the completion of practical classes at the clinical bases of the departments and at the University Clinic of the National Medical University named after O. O. Bogomolets. The purpose of the survey was to establish the level of satisfaction of education seekers with the acquired knowledge and developed practical skills. The methods of the conducted research, in addition to questionnaires, were comparison, specification, and systematic analysis. Results. 444 respondents took part in the survey - students of the III-VI courses in the specialties "Medicine", "Medicine", "Pediatrics", "Dentistry" of the first-third medical and dental faculties. At the first stage, attention was focused on comparing the number of people in groups when working with medical equipment during practical classes at the clinical bases of the departments and the University Clinic. As a result of the comparison, no statistically significant difference was found in the number of people in the groups when working with medical equipment during practical classes at the clinical bases of the departments and at the University Clinic (p=0.941 according to the T-Wilcoxon test). The second and third stages mainly concerned the analysis of evaluation of the University Clinic. At the second stage, attempts were made to reveal the relationship between the number of people in groups while working with medical equipment during practical classes at the University Clinic and their grades. The third stage of research revealed the difference in the results of the answers of students of the III-IV and V-VI courses. Conclusion. Almost all respondents provided answers to 13 questions of the questionnaire, only a small percentage of respondents did not provide answers to the last 2 questions. The numerical indicators of the answers showed a big difference between positive and negative feedback about the general impressions of the internship at the University Clinic (Questions I-III of the questionnaire). As a result of the comparison between the work with medical equipment at the clinical bases of the departments and at the University Clinic, no statistically significant difference in the number of people in the groups was found (p=0.941 according to the T-Wilcoxon test). Students and 6th year students were recognized as the most active in the positive evaluation of the level of satisfaction with the internship. In general, almost all comments and suggestions of respondents of all courses and specialties pointed to the need to increase practical classes and practical hours of working with medical equipment.

Collaborating for success: empowering medical professionals through interprofessional education

Interprofessional education (IPE) refers to training activities to foster collaborative learning among students from different healthcare professions with the intention to augment the quality of patient care activities. Interprofessional education has been linked with significant impact and accounts for significant benefits that it adds to patient care, healthcare professionals, and even the healthcare delivery system as a whole. Medical institutions that are planning to introduce interprofessional education within their settings must adopt a structured framework to ensure effective delivery of IPE that can train students to develop the required set of skills and competencies that are essential for patient-centered practice. A wide range of challenges has been identified that can impact the implementation of effective IPE in a medical college. There is an immense need to overcome these challenges to facilitate IPE by creating an enabling environment that supports interprofessional collaboration. In conclusion, interprofessional education has a special place in the medical education delivery, as it has the potential to encourage collaborative practice, patient-centered care, and effective teamwork among different types of healthcare professionals. Thus, it is the need of the hour that each medical institution should explore opportunities for interdisciplinary learning and adequately prepare their students for the complexities of modern healthcare.

의료사고에 있어 과실범의 양형판단과 특수성

Many people receive treatment at the hospital to cure the disease. However, medical accidents that have been damaged by doctors' negligence or hospital errors often occur. It is not an exaggeration to say that the victim is suffering damage in various directions as the burden of proof is left to the victim (patient) for the damage caused by such a medical accident. In addition, our criminal law is so-called 'justifiable act (Article 20), so even if the result is not good, it is considered to be a reason for illegal sculpture. However, if it does not fall under the grounds for illegal sculpture, punishment is made according to the law of the negligent offender. Negligence offenders are weaker in illegality than intentional offenders, and the Korean Criminal Law also requires that negligence offenders be punished only when there are separate provisions (Article 14). If a constituent requirement result occurs due to medical negligence, the legal principles of negligence offenders may be applied, and as mentioned, negligence offenders are subject to punishment only when there are separate constituent requirements, so the criteria for punishment are not clear. Accordingly, it seems necessary to set the criteria for determining sentencing. In Japan, many discussions began to take place on the sentencing of medical accidents at medical institutions and academic societies in the wake of the Fukushima Prefectural Ono Hospital case regarding criminal responsibility for medical accidents. In this situation, many precedents related to medical accidents have been accumulated in Japan. Regarding the liability of negligent offenders, it is necessary to review the aspect of negligence, the duty of care, and the contents of negligence, and in relation to sentencing, it is necessary to review what factors are necessary for determining sentencing. However, in the case of medical accidents, they are considered negligent offenders, and the criteria for determining sentencing have not been clearly established, so it seems necessary to review them. Therefore, this paper examined similar accident cases among medical accident cases in both countries so that they can be compared. As a result, common factors to be taken into account were found along with the situation of medical accidents, and this confirmed that there was a tendency to be different from sentencing judgments in other negligence crimes, especially general occupational negligence and injury crimes. Most medical accidents were sentenced to probation except for fines, and imprisonment or higher was extremely rare. In addition, with regard to the imposition of punishment, Korea and Japan seem to have strong preventive and educational aspects as a function of punishment rather than the imposition of retributive sentences. In this paper, we reviewed the criteria for sentencing judgment based on medical accident cases in Korea and Japan, and based on this, we hope that it will be of great help in discussing sentencing in future medical accident related cases.

KINETIC MODELLING OF BIOCHEMICAL REACTIONS USING MATHСAD ANALYTICAL TOOLKIT

Background. The study of the kinetics of biochemical reactions provides a better understanding of how biological processes occur in living organisms. Understanding the peculiarities of such reactions is important for the development of new technologies, in particular for the production of biologically active substances and for the synthesis of drugs. A powerful tool for solving problems in biochemical reaction kinetics is mathematical modelling, which can be carried out using computer mathematical systems, in particular the MATHCAD analytical toolkit. Aim: to substantiate the feasibility and effectiveness of using the MATHCAD analytical toolkit to solve problems of kinetic modelling of biochemical reactions in pharmaceutical research, and to review the capabilities of MATHCAD for computer modelling in pharmacy. Materials and methods. In the context of studying the rate of enzymatic reactions and developing models, such as the Michaelis-Menten model, to describe reactions in which enzymes catalyze the transformation of substrates, the use of a computer mathematical system (CMS) is considered. CMS is a software package and environment for performing mathematical computations, modelling and visualization. The possibilities of using the MATHCAD system to create mathematical models of biochemical reactions based on kinetic equations are demonstrated. This involves the creation of differential equations describing changes in reagent concentrations over time. These equations were solved using numerical methods in MATHCAD. In addition, the results obtained are visualized using 3D graphics in MATHCAD. The stages of using the MATHCAD analytical toolkit in the kinetic modelling of biochemical reactions have been determined. Results. The use of MATHCAD in the kinetic modelling of biochemical reactions is effective for the study of: (1) the kinetics of enzymatic reactions, e.g. reactions in which an enzyme catalyzes the conversion of a substrate into a product; (2) biochemical reactions that take place in reaction vessels in which reagents mix and interact; (3) modelling of reactions in reaction vessels based on the solution of differential equations of reaction kinetics; (4) the effect of inhibitors or activators on enzymatic reactions; (5) scenarios of interaction of reagents to determine changes in the kinetics of reactions that occur when different active substances are introduced; (6) kinetics of biochemical reactions in cases where reactions are accompanied by diffusion of reagents through membranes or other semi-permeable barriers; (7) modelling the effect of diffusion processes on the kinetics of biochemical reactions; (8) models describing the kinetics of decomposition of substances, for example the decomposition of biologically active compounds in the body or in the environment; (9) predicting the effect of changes in the conditions of the reaction medium (temperature, pH, concentration of reagents) on the kinetics of biochemical reactions. It is substantiated that model descriptions of the kinetics of biochemical reactions are important for forming an understanding of the functions of biological systems, including metabolism, enzymatic reactions, and other physiological phenomena. Tools have been used to visualize the modelling results in the form of three-dimensional MATHCAD graphics, which improves the understanding of the reaction mechanism and allows a more thorough analysis of its kinetics. Conclusion. MATHCAD provides an optimized environment for kinetic modelling of biochemical reactions through its ergonomic interface. Particular advantages are the ability to work with symbolic expressions and to use a wide range of built-in functions and tools for exploring mathematical models and visualizing results. The obtained results may be important both for further scientific pharmaceutical research and for implementation in the training of future Masters of Pharmacy in the discipline of "Computer Modelling in Pharmacy" in higher medical education institutions.

The Appeal of the Adult and Elderly Population to the State Dental Clinic

The main form of providing dental care to the population remains the provision of access assistance. Its proper organization makes it possible to increase the volume and, to a certain extent, the quality of dental care to the population. The aim of the work was to determine the volume of visits of the adult and elderly population to the GBU RO «SP» in Rostov-on-Don in the period from 2021 to 2023. Materials and methods. The study was conducted on the basis of the GBU RO «Dental Clinic» in Rostov-on-Don. A retrospective analysis of patient attendance at the medical surgical and orthopedic departments of the polyclinic was conducted based on the results of annual reports of medical organizations. Results. The number of visits by the elderly population aged 60 years and above in the study period 2021–2023 is on average 26 %, the ratio of primary visits to repeated visits is on average within 1:2.7. The share of preferential visits decreased by 2.4 % compared to 2021. Conclusions. Public dental clinics are competitive with private medical institutions.