Military Medical Organizations Research Articles

Trends in changing the structure of anesthesia at the advanced stages of medical care in modern armed conflict

The objective was to analyze the structure of anesthesia provided to the wounded at the advanced stages of medical care in the active phase of hostilities.Materials and methods. A retrospective analysis of the medical data of anesthesia was performed. The data on the structure of anesthesia in military medical organizations of 1–3 levels in the zone of a special military operation for the period from 01.2023 to 07.2024 were analyzed.Results. In the structure of combat trauma, with the need for surgical intervention, gunshot wounds amounted to 85.2%, there was a predominance of combined (71.5%) and multiple (19.8%) wounds.The low proportion of combined general anesthesia and the lack of use of inhalation anesthesia at some stages is explained by the special conditions of care. Regional anesthesia (RA), including as part of combined anesthesia, in the structure of anesthesia at the stages of emergency specialized surgical care amounted to 34.5%, and at the stages of qualified surgical care – 25.4%. The lowest rates of RA use were at the stages of level 1, as well as at the stages of level 2 with a 100% flow of primary wounded.Conclusion. RA occupies a significant share in the structure of anesthesia at the military stages of medical evacuation; an increase in the frequency of its use is possible due to the introduction of ultrasonic navigation.

Methods for assessing the quality of medical care in Russia and abroad: formation and modern aspects

The study presents the results of the analysis of available literary sources covering the historical and modern aspects of assessing the quality of medical care in the healthcare systems of the Russian Federation and some foreign countries and shows the relevance and feasibility of improving the methodology for assessing the quality of medical care in the Armed Forces of the Russian Federation. At present, many methods are used for assessing the quality of medical care in the healthcare system of the Russian Federation; however, none of them contains an exhaustive set of criteria that would allow assessing the quality of medical care provided in full. In the Armed Forces of the Russian Federation, the methods used to assess the quality of medical care are also not perfect, which leads to a decrease in the effectiveness of management decisions and thereby a decrease in the effectiveness of military medical organizations and units. To this end, active development of assessment indicators and criteria for the quality of medical care, introduction of new assessment methods, including the use of automated data accounting and analysis tools, and improvement of the procedures and standards of medical care are necessary. The most promising area is the use of comprehensive methods for assessing the effectiveness and quality of medical care, which have recently become widespread. Their application provides comprehensive control over compliance with medical care requirements and allows us to investigate the conditions wherein it is indicated, assess the degree of patient satisfaction, and helps optimize the assessment procedure. In addition, to improve the effectiveness, continuity in the implementation of control measures performed at various levels both within the medical organization and with the participation of departmental and state control bodies must be ensured. To do this, close interaction of all control bodies must be organized, and their activities must be integrated into a single quality management system for medical care. The results of the assessment of the quality of medical care can help determine the main directions of the development of the medical and diagnostic process and optimize the work of medical personnel, which increases the importance of work aimed at improving the assessment methodology. In addition, the quality control of medical care in the Armed Forces of the Russian Federation must be further improved.

System for evaluating medical technologies in military healthcare

Modern challenges and threats, as well as unprecedented sanctions pressure on the Russian Federation, have contributed to the intensification of research both on the development of innovative medical technologies and on expanding the range of use of existing ones. At the same time, on the one hand, there is an increase in incoming proposals for the use of various medical technologies in military healthcare, and on the other hand, the need to ensure accessibility and improve the quality of medical care for military personnel and other cate- gories of assigned contingents is rapidly increasing. At the same time, in con- ditions of limited resources, the level of requirements for justifying the need to introduce one or another medical technology into the activities of military medical organizations and other medical units of the Armed Forces of the Rus- sian Federation naturally increases. All this predetermines the relevance of the development of a departmental system for assessing medical technologies for effective information support for making rational management decisions. The study examined the main directions of development of the medical tech- nology assessment system in military healthcare. In particular, goals and objectives are defined, the main aspects and possible forms of organizing a departmental system for assessing medical technologies are substantiated. The main elements of the basic model for assessing medical technologies in military healthcare are identified. In addition, the characteristics of the in- formation system for assessing medical technologies in military healthcare are given, its main components are given, as well as the expected effects of implementation. The implementation of the departmental concept for assessing medical tech- nologies in the main directions of development presented in the article on the basis of a specialized information system will not only help increase the availability of effective and safe medical technologies, but also the rational use of funds and other military healthcare resources. In addition, taking into ac- count the results of departmental assessment of medical technologies at the state level will serve as the basis for the formation of priority directions for the strategic development of the domestic medical and pharmaceutical industry in the interests of national defense and state security.

Deploying whole blood to the battlefield-The Israel Defense Forces Medical Corps initial experience during the 2023 war.

Military and prehospital medical organizations invest significant resources to advance the treatment of trauma patients aiming to reduce preventable deaths. Focus is on hemorrhage control and volume resuscitation with blood products, with adoption of Remote Damage Control Resuscitation (RDCR) guidelines. The Israel Defense Forces Medical Corps (IDF-MC) has been using tranexamic acid and freeze-dried plasma (FDP) as part of its RDCR protocol for more than a decade. In recent years, low-titer group O whole blood (LTOWB) has been integrated, on IDF evacuation helicopters and expanded to mobile ambulances, complementing FDP use in treating trauma patients in state of profound shock. During the war that erupted in October 2023, the IDF-MC made a decision to bring LTOWB forward, and to equip every combat brigade level mobile intensive care units with LTOWB, onboard armored vehicles. The goal was to make whole blood available as close as possible to the point of injury and within minutes from time of injury. We describe the IDF-MCs' efforts to bring LTOWB to the front lines and present four cases in which LTOWB was administered. All patients were young male, with significant blood loss following penetrating injuries. One patient died in the operating room, following hospital arrival and emergency thoracotomy. The others survived. Our initial experience with bringing LTOWB as close as possible to the point of injury during high intensity fighting is encouraging, showing patient benefit along with logistic feasibility. After action reports and data collection will continue.

Работа военной организации здравоохранения в условиях массового поступления раненых и пострадавших в мирное время (опыт принятия организационного решения)

Ongoing military conflicts, an increase in the number of vehicles on the roads, an increase in the intensity of combat training in the Armed Forces inevitably confront hospitals and military medical organizations with the need to work in conditions of mass influx of wounded. Lack of regulatory documents, feature of the organizational and staff structure and layout of emergency rooms of military healthcare organizations lead to the need for individual attitude to the organization of work in the mass casualty incidents. This article presents the experience of solving the problem of organization the work of a military clinical medical center in the conditions of a large number incoming wounded in a peacetime.

Epidemiological characteristics and risk factors of tuberculosis in women in military service

The aim of the research is comparative analysis of epidemiological characteristics and risk factors in the female service persons and their family members. Materials and methods. Monitoring data of tuberculosis among the service persons of the RF Armed Forces during the last 20 years and 100 medical histories of female patients, who received treatment in specialized military medical organizations in the period of 2012–2020 years have been analyzed. The patients were divided in two groups: the first group — 62 service women; the second group — 38 female family members of the service persons. The following aspects have been estimated: epidemiological and clinical characteristics of tuberculosis, the period of detection of the disease from the beginning of the military service, ways of the disease detection, the presence of risk factors, clinical manifestations and defects in the organization of anti-tuberculosis measures. Results. The incidence of tuberculosis in servicewomen was declining (as well as in the whole country) and amounted to 0.17 ‰ in 2020 year. The reduction of morbidity rate amounted to 60% in the period of 2012–2020. The planned fluorography has revealed 32.3% of infected patients in the first group and 36.8% — in the second group. Examination of patients with the symptoms suspicious of TB who sought medical care has revealed 54.8% of infected patients in the first group and 57.9% — in the second group. The risk factors of the TB incidence amounted to 27.4% in the first group and 23.7% — in the second group. Diagnostic defects occurred in 27.4% cases in group 1 and 34.2% in group 2. The violation of fluorography timing happened rather often. Conclusion. The rate of TB morbidity in female service persons has considerably decreased in the last 15 years. TB is mainly detected in servicewomen when the seek medical care due to symptoms similar to TB. Nearly the third part of TB infected servicewomen had risk factors. Diagnostic defects and dynamic monitoring defects occur with the same frequency among this population.

Implementing Project-Based Learning: the Experience of a Military Medical Educational Organization

Introduction. The implementation of project-based learning into programs of advanced professional education is one of the most relevant areas of development in the modern education system. Project-based learning significantly increases the efficiency of the educational process and the interest of students in the subjects studied and contributes to the development of their leadership qualities. The acquired skills can be successfully applied to professional activities.
 The article examines the successful implementation of project-based learning using the example of a military medical educational organization and determines positive aspects that can be used in other education sectors.
 The purpose of the study was to identify the advantages and disadvantages of project-based learning in comparison to traditional forms of education.
 Materials and methods. In the study, methods of sociological research were used. Students engaged in traditional and project-based learning were asked to fill out questionnaires. Then, a comparative content analysis was performed. Statistical processing and analysis of the data obtained were carried out.
 Results and discussion. The study of students' satisfaction with traditional and project-based learning showed that the second group had better motivation, higher interest in the subject, and a higher level of academic performance. The average academic performance score in the project-based groups was 4.8, while in the group of traditional education it was only 4.2.
 Conclusion. The implementation of project-based learning in academic departments is aimed at increasing students’ professional competencies, acquiring and improving additional professional skills, and creating and implementing innovative schemes that can be used later in a medical organization as independent projects.
 Project-based learning is more effective than traditional learning in terms of critical thinking, communication and organizational skills, and teamwork experience. The practice of analytical, strategic, and planning skills as a team is an important skill difficult to acquire in traditional training.

Predictors of death in seriously injured patients

The purpose of the study. To analyze the structure of the incoming flow in conditions of conducting large-scale military operations at the stage of emergency specialized surgical care and to determine the predictors of an unfavorable outcome in patients with severe combined wounds. Materials and methods. A retrospective cohort study of medical data was performed in seriously wounded during a special military operation who were admitted to the department of anesthesiology, intensive care and intensive care of a level 3 military medical organization with severe combined wounds and trauma in 45 seriously wounded. Depending on the outcome of treatment, the seriously injured and injured were divided into 2 groups: survivors (n=30, 66.6%) and deceased (n=15, 33.4%) within a 30-day period from the moment of injury. Results. In the structure of seriously injured people in need of resuscitation, gunshot wounds predominate 84.5% (fragmentation — 95.4%, bullet — 4.6%), surgical diseases account for 7.2% of cases, closed trauma occurs in 5.1% of cases, thermal lesions — 3.2%. Combined and multiple wounds were diagnosed in 96.2% of cases. Upon admission, the predictors of death are hypothermia (p-value=0.011), the time elapsed from injury to qualified surgical care (p-value=0.035), the severity of the condition on the APACHE II scale (p-value=0.047). During treatment at the stage of emergency specialized surgical care, the predictors of death are the laboratory assessment of total bilirubin (p-value=0.006), the SOFA scale (p-value=0.015), an increase in creatinine levels (p-value=0.018), the appearance of metabolic acidosis (p=0.022), an increase in the dose of norepinephrine (p-value=0.015).value=0.033), as well as an increase in potassium levels (p-value=0.041). Conclusion. The result of the study showed a high frequency of combined injuries admitted to the OARIT. The predictors of an unfavorable outcome at admission were hypothermia; the time elapsed from the moment of injury to the provision of qualified surgical care; the severity of the condition on the APACHE II scale. And during intensive therapy, the predictors were: an assessment on the SOFA scale, an increase in creatinine levels, total bilirubin, potassium levels and metabolic acidosis.

Drug provision model of patients based on an architectural approach in the context of digital transformation of military healthcare

According to architectural modeling (the architectural structure of an open group), typed blocks of elements forming the basic components or layers of the architecture of a military medical organization are considered, combined into six domains with a schematic representation as typical architecture. The rational allocation of layers, their contents, interrelations, and directions of development provide an opportunity to effectively manage the complex multidisciplinary military medical organization during digital transformation. For the introduction and implementation of digital solutions, the analysis of the creation of an integrated module of a single digital contour for managing medical property resources indicates the feasibility of substantiating and developing reference functional models according to a single standard for describing business processes and the need to choose the most optimal methodology and notation for modeling reference functional architectures of a military medical organization. In a comparative analysis of the selected notations according to reasonable criteria, the business process model and designations were determined as the optimal and universal description language that most fully meets the needs of functional modeling of the architecture of information systems for the subsequent automation and digitalization of the management of medical property resources in a military medical organization. The reference functional model of the information system for the management of medical property resources is presented by the description of the processes of drug provision of admitted patients, which is one of the main target areas of the military medical organization considering its state task. Moreover, a well-founded and developed standard functional architecture in the notation of the business process model and notation 2.0 is presented as interacting pools displaying the subjects (participants) of the process with the tasks assigned to them. The methods and methodological approaches presented in the article, as well as models of functional architectures for providing medicines to patients admitted to a military medical organization, can be used as a reference in the digital transformation of the management of medical property resources at various levels of military healthcare.

Peculiarities of functioning of the medical supply system for troops (forces) during the operation to force Georgia to peace in South Ossetia (august 7–12, 2008)

The activities of providing medical equipment to the troops (forces) participating in the operation to force Georgia to peace in South Ossetia (August 712, 2008) are presented. The functioning features of medical supply institutions and units on the eve and after the invasion of the military contingents of Georgia into South Ossetia are shown. The chronology of the activities of units and institutions of medical supply in the combat zone is outlined. The features of providing troops (forces) with medicines and blood products, disinfectants, and medical products are revealed. The purchase procedure, delivery routes, and creation of a reserve of the most demanded medical equipment, as well as the dispatch and repair of mobile medical equipment in preparation for an operation and during hostilities, have been determined. Owing to the professionalism of the medical service specialists of the Armed Forces of the Russian Federation at all levels of military healthcare, a grouping of forces and means were quickly developed, including medical supply units, and institutions. The functioning issues on the system of providing medical supply to troops (forces) are indicated, considering the negative impact of objective and subjective factors and the characteristics of measures to optimize it based on the experience of medical support for troops (forces) during the operation to force Georgia to peace. The implementation of research and development improve the regulatory legal framework relating to the use of narcotic drugs and psychotropic substances in combat conditions and the creation of modern models of complete and standard equipment: first-aid kits, medical bags, medical equipment sets, and medical, and styling sets. In general, organizing the provision of medical equipment to troops (forces) during the operation to force Georgia to peace in South Ossetia allowed the involved institutions and medical supply units to cope with the tasks. Medical supply specialists of all levels of military healthcare selflessly performed their professional duties. With their efforts, military medical organizations, formations, and military units were almost completely provided with medical equipment, which contributed to the timely and complete provision of medical care and treatment of the wounded (injured).

Organization of a system for providing medical care to patients with a new coronavirus infection in Central Clinical Hospital named after P.V. Mandrykа

The experience of organizing specialized care for patients with a new coronavirus infection on the basis of Central Military Clinical Hospital named after P.V. Mandrykа is summarized and analyzed.The purpose of the study is to give scientifi c substantiation and to develop organisational tips for the reorientation of the structural units of the hospital in order to create non-standard infectious diseases center. During the pandemic, the hospital operated under the conditions of a partial antiepidemic regime, which means the allocation of a “red zone” for patients with a new coronavirus infection on the hospital area, while maintaining the remaining area for providing emergency and planned medical care to persons of the dispensary group. A system of providing specialized medical care to patients with a new coronavirus infection with the established routing and algorithms was created in Central Medical Hospital named after P.V. Mandrykа.Conclusion. The system of medical care created in the hospital under the circumstances of the COVID-19 pandemic, made it possible to ensure the preservation of the ability to perform tasks for the intended purpose of monitoring and treatment of the attached military personnel contingent. The data obtained are the basis for the reorientation of the structure of the military medical organization and its units (without a need to increase personnel), ensuring the therapeutic and diagnostic process by functional zones and taking into account the possible occurrence of mass infectious diseases.

MEDICAL INFORMATION SYSTEMS IN MODERN CONDITIONS OF MILITARY MEDICAL ORGANIZATIONS' ACTIVITY (Regulatory framework and literature review)

MEDICAL INFORMATION SYSTEMS IN MODERN CONDITIONS OF MILITARY MEDICAL ORGANIZATIONS' ACTIVITY (Regulatory framework and literature review)

RESULTS OF THE CONFERENCE «PECULIARITIES OF NURSE TRAINING IN MODERN CONDITIONS»

In the present conditions, the need of society and modern healthcare system for highly qualified medical personnel is increasing, as well as the level of responsibility of medical workers to patients determine the need for continuous improvement of their professional knowledge and skills. These issues were discussed between the participants of the scientific and practical conference within the framework of a round table on the topic: “Peculiarities of nurses training in modern conditions”. The issues of advanced nurses training, the preparation of nurses for the accreditation procedure in modern conditions, as well as the implementation of standard operating procedures and the work of educational and methodological departments in military medical organizations of the Ministry of Defense of the Russian Federation were highlighted.

Assessment of risk factors for COVID-19 infection in personnel of military medical organizations

Relevance. Workers in medical organizations are at risk of developing occupational diseases, including coronavirus infection through frequent contacts with patients and colleagues in the course of their professional activities. Analysis of the causes of infection associated with the pathogen SARS-CoV-2 is the basis for development of preventive measures aimed at minimizing the risk of infection. Intention – development of the main directions for the prevention of COVID-19 morbidity among medical personnel based on a hygienic assessment of occupational risk factors. Methodology. An analysis of cases of a new coronavirus infection among employees of a military medical organization was carried out. An assessment was made of the factors that increase the risk of personnel infection, based on the study of materials from epidemiological investigations and the results of a survey. Results and Discussion. Research has identified factors that increase the risk of COVID-19. An analysis of the causes of the disease showed that in 60 % of cases, infection of personnel is associated with infection at the workplace (contacts with patients – 53.1 %, contacts personnel – 6.9 %), in 38.7 % of cases the cause was not established, in 1.3 % – contacts with sick relatives were registered. A number of specialists from certain professional groups have a higher incidence rate (traumatologists, surgeons, urologists, specialists who carry out sanitary and epidemiological surveillance). It was found that, regardless of the category of work and specialty, during the pandemic, the staff had contacts with sick patients – 78.2 %, contacts with sick colleagues – 53.7 %. Contacts with sick patients increased the risk of developing the disease (RR 1.26; 95 % CI: 1.02–1.55; p = 0.01). The required degree of personnel protection was not provided in this case, which affected the significance of the factor of violation of the rules for the use of PPE (RR 1.66; 95 % CI: 1.11–2.48; p = 0.006) in the risk of developing disease. At the same time, the involvement of personnel to the work in the “red zone” increased the likelihood of the disease (RR 2.98; 95 % CI: 1.24–7.17; p = 0.005). Conclusion. The conducted studies made it possible to establish differences in the level of potential risk for certain categories of medical specialists in non-infectious departments (traumatologists, surgeons, urologists; specialists in charge of sanitary and epidemiological surveillance) and to develop directions for preventive measures based on their analysis.

Peculiarities of the course of tuberculosis in military women and women – family members of military personnel

Relevance. It is noted that incidence of tuberculosis among population and the military increased with perfect regularity during wars and social upheaval. Therefore the health care system and the medical service of the Armed Forces of Russia should be ready for new challenges.Intention. To assess the characteristics of the course of tuberculosis in female servicemen and female members of military families, the specificity in the organization of specialized medical care for them and of treatment results.Methodology. According to the data of studied and analyzed medical documentation (medical histories, medical service reports), characteristic features of tuberculosis course in female servicemen and female members of military families (who were treated in tuberculosis military medical organization in the period of 2012 to 2021) have been revealed. The 1st group consisted of 62 female servicemen, the 2nd – of 63 female members of military families. Mathematical and statistical data processing was carried out using Statistica 22.0 application software packages.Results and Discussion. New cases of tuberculosis are detected among female military personnel every year. Statistically significant differences have been established in various age groups (p < 0.05), in groups with frequently detected disseminated tuberculosis (p < 0.05). Generalized forms of tuberculosis have been detected only in patients of the 2nd group; these patients were more often prescribed an individual course of treatment (p < 0.05). Tuberculosis pleurisy was significantly more common in 1st group (p < 0.05) due to the younger age of patients. Bacterial excretion was observed in 27.4 % of patients in 1st group and 34.9 % in 2nd group. The proportion of multidrug-resistant tuberculosis reached 9.7 %. As appears from the above, the patients of the 2nd group had clinically more severe forms of tuberculosis and the treatment have required more diagnostic effort and resources.Conclusion. Treatment efficacy in the 1st and 2nd groups was 100 and 93.7 %, respectively. Despite the effective course of treatment, 46.7 % of female servicemen cured of tuberculosis were subject to dismissal from the Russian Armed Forces.

Directions of the laboratory diagnostics improving of the socially significant hemocontact viral infections in the military medical organizations

In this study we have shown the relevance of the nucleic acid testing for the diagnosis of the human immunodeficiency virus infection and hemocontact viral hepatitis in the military medical organizations as well as the experience of majority of the foreign countries that actively apply modern molecular methodologies for the diagnosis of infectious diseases. The possibility of using the rapid tests, molecular biology techniques and an alternative carrier of the biological material the dry drop method, the potential of this method of biological material preparation in infectious diseases diagnostics in case of laboratory remoteness and for follow-up observation of patients with socially significant hemocontact viral infections is shown.
 New algorithm of human immunodeficiency virus infection laboratory testing using polymerase chain reaction as an expert test followed by methods of determination of recency of acquisition of human immunodeficiency virus antibodies especially in questionable laboratory result cases are proposed.
 Promising molecular genetic methods for implementation in laboratories in military medical organizations such as nester-polymerase chain reaction, loop-mediated isothermal amplification, digital polymerase chain reaction, mass spectrometry of polymerase chain reaction amplicons, Deoxyribonucleic acid sequence are observed. We have defined the main approaches to improve laboratory diagnostics of social significant hemocontact viral infections in military medical organizations: optimization of logistics of pre-analytical step with expansion of validated biomaterial samples storage and delivery methods (including dry drop); reduction in the duration of analytical phase through increase in the clinical use of polymerase chain reaction testing (including isothermic variant); improving the sensitivity and accuracy of serological and molecular diagnostics; development of validation methodology and laboratory tests results interpretation While ensuring military medical expertise. The necessity of specialists training in new diagnostics techniques and result interpretation, improving regulatory framework on examination and registration of human immunodeficiency virus positive military officers, determination of the legal status of cases with unfinished human immunodeficiency virus diagnostic process in order to ensure timely preventive and treatment care events and to objectify statistical recording of this category.

La prise en charge des troubles psychiques de guerre. Perspective historique au sein de la Société Médico-Psychologique

The first descriptions of post-traumatic psychic disorders date back to antiquity. Even though descriptions of a military medical organization have existed since the reign of the Roman emperor Trojan, it was not until the Renaissance in France that surgeons were systematically present on the battlefield. The first medical reports of war-induced mental disorders were, therefore, made by doctors and surgeons. This is how the syndrome of “le vent du boulet” or the nostalgia of imminent danger of the soldiers in battle is described in France by the surgeons of Napoleon's army. With the industrial disasters associated with railway accidents, the term traumatic neurosis appeared for the first time at the end of the 19th century. The publications of the société Médico-Psychologique created in 1847 by Jules Baillarger reflect the evolution of this new diagnostic category. In this article, we invite the reader on a historical journey through five periods beginning with the birth of the concept and its first clinical descriptions, up until the explosion of observations during the First World War. We see how the concept gradually acquired its autonomy both clinically: the association of recurrent memories of the event and the modification of the victim's personality rather than the decompensation of a previous pathology and sign of vulnerability or even moral weakness and on the etiological level: the progressive recognition of the preponderant role of emotion instead of concussion or confusion. Following the Second World War, the pathology of the deportees provides a new description of the concept. At that point, the recognition of the diagnosis of post-traumatic stress disorder within the DSM 3 due to the difficulties that Vietnam veterans experienced in re-entering society promoted the dissemination of the concept and its recognition within civil society. In France, the RER attacks of 1995 were the beginning of a real awareness on the part of public authorities of the need to deal with psychological injuries. Military psychiatrists then took the initiative and participated in the establishment of medico-psychological emergency cells following the model of the earlier “psychiatrie de l’avant”. They also argued for conducting immediate post-trauma debriefings by specialized interlocutors whereas this technique was controversial in Anglo-Saxon countries. They often offered a psychodynamic and comprehensive approach to the cases which was probably linked to the underlying issue of freeing oneself from the moral judgments often too present when describing the disorder during the First World War when each soldier counted for the country. Currently, the approach is evolving towards methods of integrative care provided by military and associative practitioners. The mentally disturbed soldier is accompanied in a process of re-insertion and rehabilitation just like the physically wounded soldier. These nuggets from the history of psychiatry show how the concept of post-traumatic war disorder, which seems so obvious today, evolved over time. If the final chapter remains to be written, we hope that additional studies on this matter will continue within the medico-psychological society, whose 170th anniversary we honor today and we wish to pay tribute to our masters who in particular have worked for the recognition and treatment of post-traumatic stress disorders.

Medical supply system peculiarities for the troops (force) during the Afghanistan territory armed conflict (1979–1989)

Medical service activity in organizing medical equipment provisions to a limited contingent of Soviet troops (forces) during the armed conflict in Afghanistan (19791989) was presented. It was established that thanks to the medical supply specialists competent work in the most difficult conditions in the shortest possible time during the creation and build-up of Soviet troops (forces) grouping, a medical supply system adapted to the specific conditions of activity was formed, functioning in three, largely isolated areas. The work medical supply units and institutions to provide troops (forces) with medical equipment during the armed conflict is shown, as well as the problematic issues of their functioning, which were successfully resolved thanks to the involvement of students from the faculty of Military Medical Academy named after S.M. Kirov. It reflects the priority tasks facing the medical supply system during the withdrawal period of a group of Soviet troops (forces) from Afghanistan, including providing local population assistance and its armed forces by transferring not only buildings, structures, medical service units, but also part of the medical property. The features of certain drug provision for the medical evacuation and military hospitals stages were presented, particularly injection and infusion solutions, as well as medical oxygen. The operational experience of the troops (forces) medical supply system during the armed conflict in Afghanistan was analyzed, and a number of contradictions were identified, which were later successfully eliminated. The medical supply specialists role was emphasized, whose professionalism and dedication made it was possible to solve all the tasks facing them in providing troops (forces) with medical equipment. In general, military units and military medical organizations that were part of a limited contingent of Soviet troops were provided with medical equipment within their actual need, which contributed to the timely provision of medical care and treatment of the wounded and sick, as well as maintaining a high level of the troops (forces) combat capability.

Оценка уровня готовности медицинских специалистов разных ведомств в составе нештатных формирований Службы медицины катастроф к ликвидации медико-санитарных последствий чрезвычайных ситуаций

The aim of the study was to investigate and to evaluate the readiness and job satisfaction rates of military medical specialists and civilian personnel of military medical organizations of the Russian Ministry of Defense of central and district subordination (MMO-MOD group), as well as the readiness and job satisfaction indicators of medical specialists from medical organizations of the Russian Ministry of Health and the Federal Medical and Biological Agency (MOH-FMBA group) within the non-staff units of the Disaster Medicine Service for medical and sanitary consequences of emergencies elimination activities. Materials and research methods. Materials of the study: sociological survey questionnaires of the non-staff medical specialists divided into 2 groups (MOH-FMBA group, n = 255; MMO-MOD group, n = 227). The following was assessed: general characteristics of a medical specialist, his/her professional activity at the main place of work and in the non-staff formations when working in high readiness and emergency modes; readiness of non-staff medical specialists to eliminate medical and sanitary consequences of emergencies. Research methods: analytical, logical, statistical (descriptive statistics, correlation and factor analysis). Results of the study and their analysis. Satisfaction with the work of all military medical specialists and civilian personnel of the Russian Ministry of Defense of central and district subordination, as well as medical specialists from medical organizations of the Ministry of Health and the Federal Medical and Biological Agency of Russia were noted. It is marked that among the factors influencing professional activity of medical specialists of different departments in non-staff formations the most important should be considered special training and provision of non-staff formations with medical and other material and technical equipment, readiness of non-staff formations when working in the mode of daily activity to perform tasks on purpose.

Experience of the army internship of military medical academy cadets on stomatology

BACKGROUND: An organized acquisition of practical skills at the military level, in the positions of dentists of a medical company (military medical organization), by cadets studying stomatology is relevant.
 AIM: The purpose is to highlight the tasks solved during the military training of cadets, the methodology of their implementation and the results achieved.
 MATERIAL AND METHODS: Cadets in their fifth year of the fourth pharmacy of the Faculty of Training Doctors for the Navy who were studying stomatology started their clinical practice (military internship). The departments of organization and tactics of the medical service, general and military epidemiology, general and military hygiene, military medical supplies, officials of the educational and methodological department, and representatives of the faculty took part in the preparation and conduct of the military internship. The training of cadets included the main provisions of methodological recommendations, documents worked out during the internship, and recommendations from representatives of departments focusing on certain profile issues.
 RESULTS: The cadets fully completed the military internship program in the stomatology specialty, received positive feedback from the commanders of military units, and successfully defended the reports on the work done. The survey showed that the cadets who were constantly located in remote military units managed to work out the largest number of manipulations, which allowed them to determine the real conditions of their future service. They were also most satisfied with the results of their practical work. The acquired knowledge enabled the cadets to adjust their theoretical training. The vast majority of cadets requested increasing the internship period to 4 weeks. All streams completed the internship without comments due to the responsible attitude of the internship managers and the assistance of officials of the medical service of the Western Military District and the Baltic Fleet.
 CONCLUSION: The military internship allowed the cadets to get acquainted with real military service, instilling a sense of pride in belonging to the Armed Forces of Russia. The experience gained allowed us to focus on planning internships in military units, whereas the number of cadets specializing in dentistry should be no more than two in one military unit. It is desirable to expand the geography of the internship. Thus, the duration of clinical practice was recommended to be at least 4 weeks. A more in-depth study of the documentation conducted in the dental office and as a part of the medical service is necessary. Publishing methodological recommendations on the organization of clinical practice (military internship) of cadets studying in the stomatology specialty is desirable.