Medical Provision Research Articles

Adaptations to comprehensive abortion care during the COVID-19 pandemic: case studies of provision in Bolivia, Mali, Nepal, and the occupied Palestinian territory

The COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as “interlocutors” between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.

Almajiranci: A Challenge to Human Security in Northern Nigeria

The study is meant to examine Almajiranci and its challenges to human security in Northern Nigeria. Three objectives were set to be achieve through answering of three research questions. The study is purely qualitative using descriptive survey design with a sample size of 44 respondents. The targeted respondents are; parents of Almajirai, Almajirai and their teachers (mallams) as well as members of the public within the study area who have good awareness of Almajiranci. Convenient or purposeful sampling was used. Two local government areas were selected with 24 respondents each. Interview was used as the instrument for data collection and data analysis was done through transcription, coding and the use of themes and sub-themes for detail explanation of each research question. The findings of the study revealed that, there is no extension of Boko Haram in Almajiri Qur’anic Schools in Sokoto state, similarly, the Almajiris have vehemently reject any move for them to join Boko Haram activities but some are involved in area boyism in the state and others are involved in anti-social activities but yet some are exempted. Based on this study the causes of Almajiris involvement in anti-social activities are; Almajiris’ parents, lack of food and medical care provision for the Almajiris, getting contact with bad people, lack of good care and control from the mallam. Government and custodian (mallams) of Almajiri Qur’anic School should be vigilante and extra careful with visiting clerics who deliver lectures on religious ideology. Mallams should be mandated to take good care of all their Almajiris as good guardians of the children. Similarly, mallam should only admit Almajiris that they can take good care of their morality. To enforce these and put control in the system government should establish an agency for Almajiri Education in Sokoto state or a unit or department in Ministry for Arabic and Islamic Education.

МЕДИКО-САНІТАРНЕ ЗАБЕЗПЕЧЕННЯ ЗАСУДЖЕНИХ ДО ПОЗБАВЛЕННЯ ВОЛІ В УКРАЇНІ

At the current stage of its development, according to official data the Ukrainian state annually passes thousands of citizens through prisons, while a large part of all convicts experience a complex of certain rights restrictions while serving sentences related to deprivation of liberty. However, according to the existing doctrine of criminal-legal influence, it is considered that legal restrictions alone will not help to achieve the goal set before the punishment, therefore, convicts also have a significant range of various rights. One of these rights enshrined in Part 1 of Article 107 of the Criminal and Executive Code of Ukraine (hereinafter the Criminal Code of Ukraine) is the receipt of medical care and treatment, including paid medical services at the expense of personal funds or funds of relatives and friends in health care institutions who have a license from the Ministry of Health of Ukraine and are not assigned to the central executive body that implements state policy in the field of execution of criminal punishments. Deficiencies in the medical and sanitary support of convicts can significantly worsen their quality of life and lead to negative consequences for their health. Here are some of the possible disadvantages: limited access to medical care, i.e. convicts may face difficulties in accessing medical care due to limited resources, overcrowding of medical facilities or lack of qualified medical professionals; insufficient medical equipment, i.e. the lack of modern medical equipment and devices can complicate the diagnosis and treatment of those affected; an insufficient number of medical personnel, i.e. a lack of qualified medical specialists, can lead to underestimation and incorrect treatment of the medical problems of convicts; insufficient hygiene conditions, that is, inadequate conditions for personal hygiene can lead to the spread of infections and other diseases among convicts; lack of psychiatric care, i.e. necessary psychiatric care may be limited or unavailable, resulting in undertreatment of mental illness; lack of prevention programs, that is, lack of prevention programs can contribute to the spread of diseases among convicts; disproportionate access to medication ie inmates may have limited access to necessary medication due to financial or organizational constraints; lack of proper conditions for patients, i.e. Important conditions for the treatment of patients (for example, isolation, compliance with the hospital regime) may not be sufficiently provided; insufficient medical monitoring, i.e. the absence of a system of permanent medical monitoring can lead to underestimation and insufficient response to the medical conditions of convicts; unqualified medical care, i.e. insufficient level of professional training of medical personnel can lead to errors in diagnosis and treatment. Optimizing the medical and sanitary provision of residents is an important task to ensure their comfort and safety. Here are some suggestions that can help improve this situation: provision of high-quality medical care, i.e., to promote access of residents to high-quality medical services, including specialist consultations and treatment; creation of specialized medical centers, i.e. in the audience area, you can create medical centers or entire medical units, equipped with the necessary devices and medical equipment; development of prevention and education programs, i.e. organization of informational seminars, trainings and other forms of education, aimed at raising awareness among residents about health, hygiene and preventive measures. Implementation of modern technologies, that is, the use of telemedicine and other innovative technologies for remote consultations and diagnostics; creation of medical databases, i.e. keeping detailed medical statistics and analysis to improve medical care for the elderly; optimizing the transportation system, i.e. ensuring convenient and safe transportation of inmates to medical facilities in case of need; involvement of volunteers and specialists, i.e. involvement of medical specialists and volunteers to provide assistance and support to the elderly; development and implementation of evacuation plans, i.e. development of detailed evacuation plans and actions in case of emergency situations that may arise during the audience; creating comfortable conditions, i.e. providing a sufficient number of sanitary facilities, hygiene equipment and the possibility of cooking; coordination with public health services i.e. cooperation with public health authorities to ensure an effective response to the needs of residents. These suggestions can help create a safer and more comfortable environment for attendees and ensure their health and well-being during events or activities. Key words: medical and sanitary care of convicts, medical support and treatment, deprivation of liberty, legal protection, international standards for the treatment of prisoners.

Three ways of organising general practitioner’s medical services in sheltered housing. A qualitative study

Objective Explore care providers’ experiences with the organisation of the medical services for residents in round-the-clock staffed sheltered housing. Design Qualitative study and thematic analysis of individual interviews after strategic sampling of participants. Setting Round-the-clock staffed sheltered housing in seven municipalities, inhabited by various user groups, and GPs in various locations in Norway. Subjects In-depth interviews with 18 participants: 11 managers or employees in sheltered housing and seven GPs. Main outcome measures Main themes and subthemes reporting participants’ experiences of medical provision to sheltered housing residents. Results Three main models of organizing medical services for round-the-clock staffed sheltered housing were identified: (i) the ‘multiple GP’ model, where each resident has their own individual GP; (ii) the ‘single GP’ model, where all residents in the sheltered housing have one common GP; (iii) the ‘hybrid’ model, where a few dedicated GPs follow up the residents. Conclusion Residents in round-the-clock staffed sheltered housing constitute a varied group that generally has substantial medical assistance needs. Given that many residents lack autonomy to manage their own care needs and make decisions, models with fewer GPs like models ii and iii seem to provide a better medical professional offer. Moving towards such an organising of the medical services for sheltered housing residents could have implications for GPs’ workload and competence needs. Future studies are needed to test models and assess implications.

Comparison of medical care needs and actual care in German and Dutch nursing home residents: A cross-sectional study conducted in neighboring European countries

ObjectiveAssessing and comparing characteristics of German and Dutch nursing homes, their residents as well as residents’ medical care needs and the actual provision of care. MethodsTwo surveys were conducted among 600 randomly selected nursing homes each from Germany and the Netherlands. Questionnaires were mailed in May 2022. Responses were compared between German and Dutch respondents. ResultsWe received 199 German (response: 33.2%) and 102 Dutch questionnaires (response: 17.0%). Residents’ characteristics were comparable in both countries. While German nursing homes rated residents' general medical care needs higher than Dutch facilities (87.9% vs. 78.4%), the reverse was true for dental care needs (81.4% vs. 71.1%). For all 4 medical specialties surveyed, German nursing homes saw a need for treatment more frequently than Dutch facilities, e.g., 48.3% vs. 11.7% for neurology. In addition, Dutch nursing homes significantly more often considered general practitioners/elder care physicians (GPs/ECPs) to be able to cover these needs. The number of GP/ECP contacts per resident per year was similar in both countries (Germany: 26.5; Netherlands: 28.7). Almost all Dutch facilities had permanently employed allied health professionals (e.g. physiotherapists), whereas this was rarely the case in Germany. ConclusionsWe observed large differences in nursing home residents’ medical care. It appears that GPs/ECPs in the Netherlands cover needs deemed to require specialist consultations in Germany. Some differences between countries can possibly be explained by system-cultural differences. Future studies should therefore look closely at the process of medical care provision and its quality in nursing homes in both countries.

Работа Оперативно-распорядительной службы Департамента здравоохранения г.Москвы в условиях пандемии Covid-19 в 2020–2022 гг.

Summary. The aim of the study is to analyze the effectiveness of the Operations and Management Service (OMS) of Moscow Department of Health under the conditions of pandemic COVID-19 in 2020-2022. Materials and research methods. Materials of the study were statistical data on the activities of the Operations and Management Service for oral appeals of citizens and rapid response in 2020-2022: reporting forms of the Operations and Management Service (OMS) of Moscow Department of Health, containing data on the daily monitoring of the work of paramedics on the reception and transfer of calls; daily reports on the work done, as well as regulatory legal acts on the issues of medical provision for the population. Applied research methods were statistical and analytical. Results of the study and their analysis. The experience of work of the Operations and Management Service (OMS) of Moscow Department of Health during the pandemic COVID-19 in 2020-2022 is presented. By the example of the work of the Operations and Management Service (OMS) of Moscow Department of Health the importance of partnerships that ensure smooth operation of medical organizations of Moscow to provide timely medical care in an emergency epidemiological situation is revealed.

Development of civil opinion regarding legal relations in the field of medical care in independent Ukraine

The article analyzes the development of civil opinion regarding legal relations in the field of medical care provision in Ukraine during the period of independence. It is noted that civilistic thought refers to the set of ideas (concepts, views) of experts in the field of civil law (both scholars and practitioners) regarding the legal essence of legal relations in the field of medical care provision.It is emphasized that comprehensive research on legal relations in the field of medical care provision in Ukraine only began in the early 2000s. At this stage, unlike the Soviet period, the topic of contractual regulation of civil relations in the healthcare sector comes to the forefront, which was influenced by the development of contractual institutions of civil law, particularly contractual obligations for the provision of medical services.Specifically, the research directions of the independence period were: studying the legal nature of legal relations in the field of medical care provision; analyzing the concept and characteristics of civil legal relations in the field of medical care provision; researching the grounds for the emergence of legal relations regarding the provision of medical care; analyzing the object and subject of civil legal relations in the field of medical care provision; peculiarities of civil liability for harm caused by improper provision of medical care, and so on.In addition, attention is drawn to the fact that the opportunities for in-depth scientific research on specific relevant directions in this field are currently difficult due to the Russian armed aggression in Ukraine, which began on February 24, 2022, and has negatively affected all areas of society and the state, including the provision of medical care. At the same time, it is noted that considering the conditions of wartime, there is a need for scientific substantiation in new directions, namely: legal aspects of the implementation of legal relations in the provision of medical care in the context of armed conflicts, peculiarities of the legal status of patients and medical workers in conditions of war, legal aspects of preserving medical confidentiality, and so on.It is concluded that due to Ukraine’s declaration of the irreversibility of its European and Euro-Atlantic course at the constitutional level, today, in difficult wartime conditions, national private law, including civil legal relations in the provision of medical care, must develop in the context of European integration processes, taking into account progressive foreign experience in this field in national legislation.

Digitalization in mental health care. New opportunities for specialists and patients

Digitalization – is one of the most promising trends of the healthcare system transformation, including mental health care. Telemedicine opportunities allow to improve health care system, to resolve the problem of the qualified specialist’s deficit and provide the remote territories with appropriate medical care, it also provides education possibilities for the mental health specialists from all over Russia offering continual training opportunities. Digital technologies can help substantially improve the science data collection in the field of mental health, remote access ensures patient enrollment from the different regions of the country, it allows to make the measures in the typical patient’s environment, data accumulated with the help of digital assistants open the new possibilities in the study of mental disorders. Digital behavior and behavior in the digital environment became the new research objectives in the field of mental health. Problem internet use with the behavior addiction development is in the research focus of the researchers aimed to elaborate early intervention and prevention programs. The use of the computerized programs, gamification, VR and mobile apps possibilities should become the essential part of the medical care provision in the field of mental health with the hybrid models implementation where the patient will have the option to choose individualized treatment program with the optimal ratio between digital and classic treatments options. Digital technologies should take their place in the prevention and mental health sustenance in the nearest future.

Insulinoma: analysis of prevalence and incidence in the world

BACKGROUND: Currently, there are no data on the prevalence and incidence of insulinoma in Russia. The published world data on the epidemiology of the tumor are largely variable. Thus, it is important to systematize information on the prevalence and incidence of insulinoma in the world, including in Russia. AIM: To assess the prevalence and incidence of insulinoma in the world.TASKS Analysis of literature data.Analysis of the database of the Endocrinology Research Centre.MATERIALS AND METHODS: To implement Task 1, an analysis of foreign and Russian articles published in the PubMed and eLIBRARY.RU databases from 1927 was carried out until June 1, 2023, including the following keywords: «Insulinoma», «Epidemiology», «Frequency», «Incidence», «Nationwide», «Database». Based on the obtained results, an analysis of the prevalence and incidence of insulinoma in the world and in Russia was made. To implement Task 2, the analysis of patient records and the electronic database of the Endocrinology Research Centre was carried out.RESULTS: Based on data in individual countries the prevalence and incidence of insulinoma for the world population amounted to: an average of 16.4 per 1 million population and 0.9 per 1 million population per year, respectively. If extrapolating the world data, the number of patients with insulinoma in Russia can be 1066–2362 and 72–173 new cases are diagnosed annually (11.9 per 1 million population and 0.9 per 1 million population per year, respectively). The largest number of patients with insulinoma in Russia was recorded in the Endocrinology Research Centre and amounted to 275 cases for the period 2006–2022.CONCLUSION: In the Russian Federation, it is important to create a register of patients with insulinoma on the basis of the existing electronic database of the Endocrinology Research Centre in order to obtain accurate information about the current needs of patients with insulinoma in medical care and drug provision, as well as to conduct full-fledged scientific research.

Optimizing Healthcare Delivery: Analyzing the Relationship Between Inpatient Medical Record Return Time and Service Effectiveness at Ciremai Hospital

The medical record installation must maintain medical records correctly and appropriately, including the return of medical records. According to the Ministry of Health (2006), the standard for returning inpatient medical records is ≤ 2x24 hours after completion of treatment. Meanwhile, the standard of service effectiveness in the form of time for providing outpatient medical records according to Kepmenkes number 129 of 2008 is ≤ 10 minutes. The purpose of the study was to determine the relationship between inpatient medical record return time and service effectiveness. The research method used is quantitative with a cross-sectional design. The population is 220 medical records of post-inpatient patients who are controlled outpatients at Ciremai Hospital during January 2022. The total sample is 145 using the Slovin formula with the purposive sampling technique. Univariate analysis using frequency distribution and bivariate analysis using the Spearman rank correlation test are used because the data is not normally distributed. The results show that the average time to return inpatient medical records is 115,86 hours, the fastest time is 24 hours, and the longest time is 360 hours. The average service effectiveness in the form of outpatient medical record provision was 222,26 minutes; the fastest time was 3 minutes; and the longest time was 710 minutes. The Spearman rank correlation coefficient is 0,418 with a p-value of 0,000 ≤ 0,05. The conclusion is that there is a relationship with moderate correlation strength between inpatient medical record return time and service effectiveness, with a value of 0,418.

Military welfare history: what is it and why should it be considered?

Military welfare is a major yet abstract sub-field of warfare studies and warfare history, which interrogates the multitude of welfare, care, medical provisions and social policies that have existed at different times and within different social and political spaces relative to and for the benefit of armed forces personnel and their families or dependents. As a scholarly project military welfare history is both well developed and still evolving. It comprises a substantive community of scholars who have produced a robust body of literature. Yet, despite all of the scholarship that has existed since the 1960s, and more especially since the 1990s, military welfare history remains estranged from mainstream warfare history. Thus, it is the purpose of this special edition to encourage transformation in three ways: firstly, by highlighting or reacquainting a cross-section of scholars with the existence of this diverse but exclusive sub-field of warfare and welfare history that has existed as long as warfare itself; secondly, by highlighting the diversity of recent and current scholarship in this sub-field, and thirdly, by highlighting the existence of an academic network that has the explicit purpose of bringing together scholars in this diverse sub-field.

MEDICAL PROVISION FOR PRISONERS IN PRISONS ON BELARUSIAN LANDS IN THE LATE XIX – EARLY XX CENTURIES

Based on the study of archival data, the procedure for medical provision of prisoners in places of imprisonment on Belarusian lands after the prison reform of 1879 is being investigated. A set of measures is being determined, adopted by the General Prison Administration to improve the provision of medical care to convicts in prison hospitals in the late XIX – early XX centuries – increased funding for medical support, the construction of prison hospitals, the recruitment of medical personnel in penitentiary institutions, the implementation of measures to combat infectious diseases. The importance of this activity is assessed, and determine the results of the measures taken, as well as problematic issues of medical provision of prisoners in penitentiary institutions in Belarus at the beginning of the 20th century.

The effectiveness of the organization and specific prevention of Rh-conflict during pregnancy

AIM: The aim of the study was to evaluate the effectiveness of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.
 MATERIALS AND METHODS: To achieve the goal, an algorithm for managing pregnancy in Rh-negative women was developed, complex antenatal and postpartum prophylaxis of primary isoimmunization with anti-Rh0(D) immunoglobulin was carried out, and its effectiveness was evaluated in 37 women who gave birth to Rh-positive newborns. If antibodies to the Rh0(D) antigen were not detected, then at 28 weeks pregnant women were administered human immunoglobulin anti-Rh0(D) at a dose of 1500 IU (300 g). Anti-Rh0(D) antibody titer was monitored every 23 weeks before delivery. Mothers were re-introduced with human anti-Rh0(D) immunoglobulin at a dose of 1500 IU (300 g) within 2472 hours after the birth of an Rh-positive child. 6 months after delivery, the antibody titer to the Rh0(D) antigen was re-determined.
 RESULTS: After the introduction of domestic human immunoglobulin anti-Rh0(D), side effects and allergic reactions were not registered. All 37 (100%) women were delivered at term, of which 7 (18.9%) were delivered abdominally. All newborns were born with an Apgar score of 89 without hemolytic disease. The titer of antibodies to the Rh0(D) antigen was negative in 24 (64.9%) women 6 months after delivery. 13 (35.1%) mothers had a post-vaccination antibody titer not higher than 1 : 2, which is allowed by the instructions for the anti-Rh0(D) human immunoglobulin preparation. They tested negative again 12 months after delivery.
 CONCLUSION: The results of the study showed a rather high efficiency of the organization and medical provision of complex specific antenatal and postpartum prevention of primary isoimmunization with domestic anti-Rh0(D) immunoglobulin in Rh-negative women.

Do Primary Healthcare Facilities in More Remote Areas Provide More Medical Services? Spatial Evidence from Rural Western China

Primary healthcare institutions (PHIs) in China have experienced a sizable decline in medical services in recent years. Despite the large regional disparities in China, there is a lack of evidence on the differential patterns of medical services offered by PHIs, especially from a spatial perspective. This study examines whether residents in more remote areas use more medical services offered by township healthcare centers (THCs), a main type of PHIs. Linking medical visits to 923 THCs in a western Chinese province in 2020 with the driving time and geographic coordinates from the Gaode map, a leading map navigation provider in China, we applied a multilevel linear model and a geographically weighted regression to examine spatial heterogeneity in medical service utilization. We showed that a one-hour increase in the shortest driving time between THCs and the local county hospitals was associated with an average 6% increase in THCs outpatient visits and a 0.6% increase in THCs inpatient visits. Our findings suggest that THCs located in more remote areas provided more medical services, especially outpatient services. This study may improve our understanding of the spatial disparity in medical services provision for THCs in western China. We suggest that more attention should be paid to enhance the quality of THCs in remote areas, which deserve a higher priority in the process of improving the quality of primary healthcare. Health policymaking in developing regions such as western China should take geographic factors into account.

The organization of medical equipment provision to the armed forces of the russian federation in the first decade of the 21st century

ABSTRACT. This article presents the activities of the medical service in organizing the provision of medical equipment to the troops (forces) of the Russian Federation in the first decade of the 21st century. It reflects the main stages of development of the pharmaceutical industry in the post-default state of the economy and the emergence of new mechanisms and forms of interaction with transnational pharmaceutical companies. The article showcases the positive features and shortcomings of implementing programs for additional drug provision and ensuring the population has access to necessary drugs. Additionally, it discusses the reorganization of the medical service of the Armed Forces of the Russian Federation as part of a large-scale reform of the military organization. The organizational and staffing changes in the military administration of the medical service, pharmaceutical organizations of the Ministry of Defense of the Russian Federation, and medical supply units are represented, highlighting their reorganization and restructuring by the end of the 2000s during the ongoing modernization of the Russian Federation Armed Forces. The article also describes the three-level system of medical supply of troops (forces) that developed after modernization. The leading role of the Department of Military Medical Supply and Pharmacy of the Kirov Military Medical Aca demy and the Center for Pharmacy and Medical Equipment in updating the regulatory legal framework for the medical supply system for troops (forces) is discussed. Their activities of these entities during the modernization of the medical supply system for troops (forces) to create key regulatory legal acts such as orders and directives of the Minister of Defense of the Russian Federation and official documents as part of research work are disclosed. Finally, the article provides a list of normative legal acts and service documents developed during this period, which regulate various aspects of activities related to providing military equipment to the troops (forces) and have been updated and harmonized with the legislation of the Russian Federation, is given.

Content of the contract as a type of employment contract

The current state of legal regulation of mandatory and additional terms of employment contracts and contracts in Ukraine has been studied and its shortcomings have been identified. It has been specified that a rather long legislative uncertainty regarding mandatory and additional terms of an employment contract and the current conflict of legislation on this issue have led to the existence of different positions in the science of labour law regarding the terms of an employment contract. Scientists’ views on the essence of the content of an employment contract have been analysed.
 It has been proven that the terms of the employment contract should be considered the terms that are drawn up by its parties. Traditionally, such conditions in labor law are divided into mandatory and additional. The terms of the employment contract are recognized as mandatory, without which the content of the employment contract or contract cannot be considered concluded. Those without which the conclusion of an employment contract or contract is possible are considered additional.
 Mandatory and additional terms of the contract have been defined. Mandatory terms of the contract are: place of work; labor function; the moment of the start of the work and the duration of the contract; rights and duties; terms and amount of remuneration; financial support of the employee; labor organization; responsibilities of the parties; terms of termination of the contract. Additional terms of the contract are: term and conditions of the trial; non-disclosure of commercial secrets and other legally protected information; frequency and duration of professional training, retraining and advanced training of the employee; improvement of working conditions, industrial life and recreation; medical and sanatorium provision; social and household benefits and social and cultural services. There is a well-founded need to supplement the Code of Labor Laws of Ukraine with Article 21-2 “Content of the employment contract and contract”, in which mandatory and additional conditions of the employment contract and contract shall be established.

Trends in patients' behavior for cancer care and the number of registered cancer cases in Ehime Prefecture during the coronavirus disease pandemic.

The coronavirus disease (COVID-19) pandemic has reduced diagnosed cancer cases worldwide. This study aimed to elucidate the recovery of cancer care from the COVID-19 pandemic in Ehime Prefecture, Japan. This study collected data from the hospital-based cancer registry (HBCR) as well as the number of outpatients, medical information provision fee payments (MIP2) and second opinion patients (SOP) from the Council of Ehime Cancer Care Hospitals (ECCH). Then cancer care and patient requests for hospital transfers before and during the COVID-19 pandemic were analysed. The HBCR from the ECCH comprises >80% of cancer cases in Ehime Prefecture. In 2020, the numbers of all registered cases, first-line treatment cases and cases detected by cancer screening in the HBCR decreased from those in 2018-2019. In 2021, they increased to almost the same levels as those in 2020. In contrast, the number of registered patients that changed hospitals (hospital-change cases) after first-line treatments, patients who lived outside the metropolitan area of Ehime but registered in metropolitan hospitals, MIP2 and SOP remained low in 2021 after decreasing in 2020. Furthermore, the monthly numbers of hospital-change cases, MIP2 and SOP were significantly smaller in 2021 than in 2018-2019 (Wilcoxon rank sum test). The assessed indicators suggest that the decreased patients' behavior to further cancer care had not returned to pre-pandemic levels by 2021. Hence, psychological measures in society to prevent self-restraint in patients and support for the caregivers of the patients who have some problems visiting the hospital are necessary.

Artificial intelligence in orthopaedics: can Chat Generative Pre-trained Transformer (ChatGPT) pass Section 1 of the Fellowship of the Royal College of Surgeons (Trauma & Orthopaedics) examination?

Chat Generative Pre-trained Transformer (ChatGPT) is a large language artificial intelligence (AI) model which generates contextually relevant text in response to questioning. After ChatGPT successfully passed the United States Medical Licensing Examinations, proponents have argued it should play an increasing role in medical service provision and education. AI in healthcare remains in its infancy, and the reliability of AI systems must be scrutinized. This study assessed whether ChatGPT could pass Section 1 of the Fellowship of the Royal College of Surgeons (FRCS) examination in Trauma and Orthopaedic Surgery. The UK and Ireland In-Training Examination (UKITE) was used as a surrogate for the FRCS. Papers 1 and 2 of UKITE 2022 were directly inputted into ChatGPT. All questions were in a single-best-answer format without wording alterations. Imaging was trialled to ensure ChatGPT utilized this information. ChatGPT scored 35.8%: 30% lower than the FRCS pass rate and 8.2% lower than the mean score achieved by human candidates of all training levels. Subspecialty analysis demonstrated ChatGPT scored highest in basic science (53.3%) and lowest in trauma (0%). In 87 questions answered incorrectly, ChatGPT only stated it did not know the answer once and gave incorrect explanatory answers for the remaining questions. ChatGPT is currently unable to exert the higher-order judgement and multilogical thinking required to pass the FRCS examination. Further, the current model fails to recognize its own limitations. ChatGPT's deficiencies should be publicized equally as much as its successes to ensure clinicians remain aware of its fallibility.

The development of medical tourism in conditions of globalization health care

The article considers impact of process of health care globalization on development of medical tourism. The main trends in health care that drastically changes the situation in conditions of COVID-19 pandemic and implementation of digitization are presented. The normative legal base in force regulating medical services export is analyzed. The study of conditions of development of medical tourism in Russia is carried out. The directions of development of medical services export in modern conditions are considered. The enumeration of issues of global health care is formed. It is accepted to consider health care sector as a part of economics that is most isolated and attached to place of rendering and consumption of services. The outbreak of COVID-19 pandemic and active implementation of digital technologies into processes of organization of health care and medical care provision launched transformation and urged globalization. The conclusion is drew that actual society exists in epoch of globalization and digitization of health care sector. Nowadays, borders of states are not insurmountable obstacle for patients in need of high-tech medical care. The world market of medical tourism demonstrates trend to continuous growth and development permitting largest medical clusters to compete for attention of patients. The purpose of the study is in considering directions of development of medical tourism under the influence of process of health care globalization in modern society.

Problems and prospects of medical provision for military personnel with COVID-19 in the conditions of medical insurance

To date, the treatment of patients with COVID-19, which caused an unprecedented pandemic in 2019–2023, remains difficult. Military personnel of the Armed Forces of Ukraine during conscription, when returning from business trips and vacations (especially those who are in the incubation period or are asymptomatic) can bring COVID-19 into the unit and cause an outbreak of the disease.
 The purpose of the work was to conduct an analysis of the existing models of the functioning of insurance medicine in some countries in the world and in Ukraine for their further possible application in the system of medical support of the Armed Forces; factors and conditions affecting the course of the disease on COVID-19 were additionally studied.
 The main preventive measures against the spread of COVID-19 among military personnel are compliance with sanitary standards, control of disease symptoms and timely vaccination or revaccination. In the treatment of patients with COVID-19, depending on the conditions of stay and the severity of the disease, the following groups of drugs are used: analgesics and antipyretics, rehydration, antiviral, antibacterial and antifungal, low molecular weight heparins, systemic corticosteroids and vitamins, which military personnel receive free of charge. The creation of an effective system of insurance medicine in Ukraine should provide for the possibility for servicemen of the Armed Forces of Ukraine to receive medical care in any health care facility, regardless of departmental subordination, by creating an electronic medical card of a serviceman, which will be included in the electronic health care system of Ukraine.
 The conducted studies make it possible to draw a conclusion about the need for improvement and further development of the scientific and practical foundations of systematic research in the military medical service of the Armed Forces of Ukraine, improving the quality and efficiency of medical support for servicemen, introducing modern approaches and methods of making sound management decisions on issues of protection and prevention of proliferation COVID-19.