Primary Medical Care Research Articles

A Bayesian analysis integrating expert beliefs to better understand how new evidence ought to update what we believe: a use case of chiropractic care and acute lumbar disc herniation with early surgery.

A Bayesian approach may be useful in the study of possible treatment-related rare serious adverse events, particularly when there are strongly held opinions in the absence of good quality previous data. We demonstrate the application of a Bayesian analysis by integrating expert opinions with population-based epidemiologic data to investigate the association between chiropractic care and acute lumbar disc herniation (LDH) with early surgery. Experts' opinions were used to derive probability distributions of the incidence rate ratio (IRR) for acute LDH requiring early surgery associated with chiropractic care. A 'community of priors' (enthusiastic, neutral, and skeptical) was built by dividing the experts into three groups according to their perceived mean prior IRR. The likelihood was formed from the results of a population-based epidemiologic study comparing the relative incidence of acute LDH with early surgery after chiropractic care versus primary medical care, with sensitive and specific outcome case definitions and surgery occurring within 8- and 12-week time windows after acute LDH. The robustness of results to the community of priors and specific versus sensitive case definitions was assessed. The most enthusiastic 25% of experts had a prior IRR of 0.42 (95% credible interval [CrI], 0.03 to 1.27), while the most skeptical 25% of experts had a prior IRR of 1.66 (95% CrI, 0.55 to 4.25). The Bayesian posterior estimates across priors and outcome definitions ranged from an IRR of 0.39 (95% CrI, 0.21 to 0.68) to an IRR of 1.40 (95% CrI, 0.52 to 2.55). With a sensitive definition of the outcome, the analysis produced results that confirmed prior enthusiasts' beliefs and that were precise enough to shift prior beliefs of skeptics. With a specific definition of the outcome, the results were not strong enough to overcome prior skepticism. A Bayesian analysis integrating expert beliefs highlighted the value of eliciting informative priors to better understand how new evidence ought to update prior existing beliefs. Clinical epidemiologists are encouraged to integrate informative and expert opinions representing the end-user community of priors in Bayesian analyses, particularly when there are strongly held opinions in the absence of definitive scientific evidence.

Social Determinants of Health and Language and Academic Outcomes in Pediatric Cochlear Implantation: A Systematic Review and Meta-Analysis.

Cochlear implants can restore sound and enable speech and language development for children with severe to profound sensorineural hearing loss. Long-term outcomes of pediatric cochlear implant recipients are variable. Although the association between social determinants of health (SDH) and pediatric cochlear implant outcomes has been explored, the strength of this association has not been quantitatively synthesized in the literature. To determine the association of SDH with language and academic outcomes in pediatric cochlear implant recipients. In August 2023, the following databases were searched: Embase.com, Ovid MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Cumulated Index to Nursing and Allied Health Literature Plus, APA PsycINFO, and ClinicalTrials.gov. Following duplicate exclusion of 8687 results, 5326 records were finalized. Abstract screening, full-text review, and risk of bias assessment was performed by 1 to 2 reviewers. Articles were included if an effect size for an SDH variable that was associated with measures of language, communication, reading, academics, and quality of life was reported. A random-effects meta-analysis was performed, with standardized regression coefficients measuring the relative direction and magnitude of a variable association with the outcome of interest. Of 5326 articles, 40 articles that included a total of 3809 children were included in the systematic review; 20 articles that included a total of 1905 children were included in the meta-analysis. Parental involvement, education level, and low socioeconomic status were moderately to strongly associated with language outcomes (β = 0.30; 95% CI, 0.13-0.48; β = 0.45; 95% CI, 0.29-0.62; β = -0.47; 95% CI, -0.83 to -0.10, respectively). Known determinants of language outcomes, such as the age of cochlear implantation and duration of cochlear implant use, demonstrated moderate to no associations with language outcomes (β = -0.30; 95% CI, -0.43 to -0.17; β = 0.19; 95% CI, -0.26 to 0.63, respectively). The results of this systematic review and meta-analysis suggest that SDH are associated with childhood language development and academic achievement. In addition to efforts to expedite cochlear implant placement in eligible children, optimal outcomes may be achieved with interventions centered on the child's home, primary medical care, and school environment.

PROBLEMS OF THE ORGANIZATION OF THE STATE POLICY OF THE PROVISION OF MEDICAL SERVICES BY THE PRIMARY LINK OF MEDICAL AID IN UKRAINE

The article highlights key issues related to management at the level of primary health care in Ukraine. The focus is on aspects such as the growing role of primary care. Primary care is the foundation of the health care system, providing a patient's first contact with health services, prevention, diagnosis and treatment. It is especially important in the conditions of limited financial resources to continue the reforms of the medical industry in Ukraine. The article raises the issue of the availability of medical care: the relevance of management problems is due to uneven access to medical services in rural areas and remote regions. Improving the management of the medical field is necessary to overcome these difficulties. The article examines current problems in the field of primary medical care and ways to overcome them through the reform of state policy in the field of health care. The authors explore key challenges facing primary care, including insufficient funding, lack of qualified staff, uneven distribution of resources, and lack of effective governance mechanisms at various levels. Attention is paid to the issues of ensuring the availability of medical services, the quality of medical care and the implementation of new models of the organization of medical institutions. The article analyzes the reformative steps aimed at improving the functioning of the primary health care system, in particular, the introduction of family medicine and increasing the role of general practitioners. The role of state funding and the involvement of local communities in the management of medical institutions is considered separately. The conclusions emphasize the importance of improving the state's primary health care policy by strengthening financial support, infrastructure development, and improving the qualifications of medical workers to ensure a sustainable and effective health care system in Ukraine. The topic of economic challenges and management efficiency is interesting for analysis. Optimizing the use of financial resources requires their effective use, finding ways to increase the economic sustainability of healthcare institutions.

FREQUENCY OF INFECTIOUS AND NON-INFECTIOUS DISEASES DURING THE WAR IN UKRAINE BASED ON SOME PRIMARY MEDICAL CARE UNITS' DATA IN THE CHERNIVTSI REGION

Aim – to investigate the impact of the war in Ukraine and COVID-19 on the frequency of infectious (COVID-19, tuberculosis) and non-infectious diseases (hypertension (AH), diabetes mellitus (DM), obesity, thyroid pathology, chronic kidney disease (CKD)) according to data from primary health care units in Chernivtsi region..Material and methods. The statistical reports of Communal Non-commercial Enterprises (CNEs) "Kitsman Center of Primary Medical Care" of the Kitsman District Council and "City Polyclinic No. 1" of the Chernivtsi City Council for the years 2019-2023 with the number of observed population subject to medical care - 36,508 and 58,500, respectively, were analyzed.Results. During the COVID-19 pandemic (2021-2022), a surge in the incidence of tuberculosis was observed in separate communities, with an almost 7% increase per 100,000 residents in the Chernivtsi region as a whole (in 2022-2023), caused, in our opinion, by the war and an increased population migration. During the period of the COVID-19 pandemic and with the beginning of the full-scale invasion of the russian federation on the territory of Ukraine, a strict trend in the incidence of DM increase (mainly non-insulin-dependent) was established. The frequency of obesity in women increased as well by 17.5%, while in men, on the contrary, it decreased – by 17.42%. The frequency of diffuse goiter in the structure of thyroid diseases decreased by 3%, with a slight elevation in autoimmune thyroiditis.Conclusion. An obvious dependence of changes in the incidence of CKD and hypertension in linkage with the COVID-19 pandemic and the war in Ukraine was not established in the analyzed communities.

Медична освіта на тлі війни: приклад Каразінського університету

The article examines the global experience of the impact of military conflicts on medical education, with particular attention to the experience of Karazin University School of Medicine. It concludes that the impact of war on medical education is extremely negative and has always been characterized by interruptions or deterioration of learning conditions, its reorientation to meet war needs, the worsening physical and psychological state of students, and a decrease in the effectiveness of their learning. These factors pose a threat not only to education but also to the nation as a whole, as the decline in the quality of medical education creates a shortage of personnel in the healthcare system, which is critically needed during war and in post-wartime. Nevertheless, the Karazin University School of Medicine has met the challenges of wartime with dignity and managed to organize the education of medical students in both online and in-person formats, as well as to establish open courses for developing primary medical care skills for the wounded and those affected by the consequences of the war.

Реабілітація: історія формування, сучасна стратегія розвитку

The history and defined stages of the formation and development of rehabilitation care from the 19th century have been studied. to modern times. The formation of the methodology for the organization of rehabilitation assistance in national health care systems is shown. The logistics of the WHO’s initiatives regarding the recognition of rehabilitation assistance as the main direction of the development of medical service delivery systems have been studied. What is connected with the provision of human rights in the field of health, the achievement of health for all. The role of national governments, the responsibility of communities and the importance of primary medical care in ensuring the availability of rehabilitation care are shown. The main provisions of the WHO documents on the problem of rehabilitation are presented.

Community Paramedicine Program in Social Housing and Health Service Utilization

Community Paramedicine at Clinic (CP@clinic) is a chronic disease prevention program that decreases 911 calls for emergency medical services, but its wider system effects are unknown. To evaluate the effects of CP@clinic vs usual care on individual-level health service utilization outcomes. This open-label, pragmatic cluster randomized clinical trial evaluated all residents 55 years or older in 30 social housing buildings in Ontario, Canada, that had (1) a unique postal code, (2) at least 50 apartments, (3) 60% or more residents 55 years or older, and (4) a similar building for pairing (15 intervention and 15 control buildings, pair-matched randomization). The 12-month intervention had a staggered start date from January 1, 2015, to December 1, 2015, and ended between December 31, 2015, and November 30, 2016. Administrative health data analysis was conducted in May 2022. CP@clinic was a health promotion and disease prevention program led by specially trained community paramedics who held weekly drop-in sessions in social housing buildings. These paramedics conducted 1-on-1 risk assessments, provided health education and referrals to relevant community resources, and, with consent, sent assessments to family physicians. Control buildings received usual care (universal health care, including free primary and specialty medical care). Individual-level health service utilization was measured from administrative health data, with ED visits via ambulance as the primary outcome; secondary outcomes included ED visits for any reason, primary care visits, hospitalizations, length of hospital stay, laboratory tests, receipt of home care, transfer to long-term care, and medication initiation. Generalized estimating equations were used to estimate intervention effects on individual-level health service utilization, accounting for trial design and individual-level baselines. The 30 social housing buildings had 3695 residents (1846 control and 1849 intervention participants; mean [SD] age, 72.8 [9.1] years; 2400 [65.0%] female). Intention-to-treat analysis found no significant difference in ED visits by ambulance (445 of 1849 [24.1%] vs 463 of 1846 [25.1%]; adjusted odds ratio [AOR], 0.97; 95% CI, 0.89-1.05) but found higher antihypertensive medication initiation (74 of 500 [14.8%] vs 47 of 552 [8.5%]; AOR, 1.74; 95% CI, 1.19-2.53) and lower anticoagulant initiation (48 of 1481 [3.2%] vs 69 of 1442 [4.8%]; AOR, 0.68; 95% CI, 0.53-0.86) in the intervention arm vs the control arm. CP@clinic attendance was associated with higher incidence of primary care visits (adjusted incidence rate ratio, 1.10; 95% CI, 1.03-1.17), higher odds of receiving home care (AOR, 1.07; 95% CI, 1.01-1.13), and lower odds of long-term care transfers (AOR, 0.32; 95% CI, 0.13-0.81). In this cluster randomized clinical trial of CP@clinic, the intervention did not affect the rate of ED visits by ambulance; however, there were increased primary care visits and connections to home care services, which may have increased antihypertensive medication initiation and reduced long-term care transfers from social housing. Health policymakers should consider CP@clinic's impact as an upstream approach to improve care for older adults with low income. ClinicalTrials.gov Identifier: NCT02152891.

9376 Successful Implementation Of Continuous Glucose Monitoring In An Internal Medicine Residency Clinic

Abstract Disclosure: A.E. Manov: None. A. Donepudi: None. A.S. Dhaliwal: None. J. Tam: None. Y. Badi: None. M. Sharaf: None. R. Haddadin: None. A. Wang: None. K. Mefferd: None. Abstract In this 3-year retrospective observational cohort study, data from fifty-one patients with type 1 or type 2 Diabetes Mellitus (DM), receiving a minimum of 3-to 4 insulin injections per day, and self-monitoring their blood glucose (SMBG) 4-times a day, were derived from our internal medicine residency primary care clinic. The patients were equipped with a Continuous Glucose Monitoring (CGM) device that shared 24-hour glucose data with the clinic. They were assigned to members of our CGM team which included internal medicine or transitional year medical residents who functioned under the supervision of a board-certified endocrinologist. In consultation with our endocrinologist, the resident assessed the patients' glucose management data and adjusted their treatment regimens bi-weekly by calling the patients, and monthly by seeing them in the clinic. The rationale of the study which was confirmatory was to show that in the Internal Medicine Residency clinic in a project governed by the medicine residents, the CGM will lead to improvement in diabetes mellitus control compared to SMBG and this can be done not only in specialized endocrine clinics. The inclusion criteria for selecting the patients were as follows: Age-18-90, diagnosis of Type 1 or type 2 Diabetes Mellitus using 3-4 Injections of Insulin per day +/- other per oral antidiabetic medications and SMBG 4 times a day, HbA1c above 7% while using SMBG, patients who can use the CGM device and receive their primary medical care in our Internal medicine Residency clinic.To assess for differences in A1C, TIR, average blood glucose, percent of time spent in mild hypoglycemia, and percent of time spent in pronounced hypoglycemia, five paired t-tests were conducted. A Bonferroni correction set the new accepted alpha level at 0.01. Significant results from the study include a reduction of HbA1c from 9.9% to 7.6%, average blood glucose decrement from 242 mg/dL to 169 mg/dl, reduction of the incidence of mild hypoglycemia below 70 mg/dl to 54 mg/dl from 4.68% to 0.76% per day, and more pronounced hypoglycemia with glucose less than 54 mg/dl from 3.1% per day to 0.2% per day. We observed a significant increase in the time in the range of blood glucose from 33% to 67% per day. Furthermore, 9.5% of the patients in this study eventually discontinued daily insulin injections and continued treatment with oral diabetic medications with or without the use of injectable GLP-1 receptors once a week.This study affirms that CGM devices significantly improved glycemic control compared to SMBG, supporting its efficacy in optimizing glycemic control in real-world clinical practice. The results imply this can be accomplished in internal medicine residency clinics and not exclusively in specialized endocrine clinics. As far as we know, this is the first study of this kind in a residency clinic in the USA. Presentation: 6/1/2024

Experience of integrating lean technologies into the quality management system of a medical organization providing primary medical and sanitary care

Objective. To evaluate the effectiveness of implementation of lean production methods into the practical activity of primary health care on the example of the State Institution of Health Care «Saratov City Polycli nic № 2». Materials and methods. The study was divided into three stages: data collection through anonymous sociological surveys using phones or tablets, timing and improvement of the process, and a follow-up questioning of participants to assess their satisfaction. 296 residents of Saratov receiving primary health care at the polyclinic took part in the survey. The survey was conducted using a specially developed electronic questionnaire via Google Form. For mathematical processing, the results of the study were initially transferred into an electronic database; the results of the study were analyzed using the descriptive statistics method. Results. According to the survey, the majority of respondents are satisfied with the quality of outpatient medical care. This shows that organization of the medical care is focused on the patients` needs and desire to meet their demands. The organization of the front office and the premises of the polyclinic in accordance with the requirements for the new model of the organization providing primary medical care made it possible to achieve a high evaluation of the information stands and the waiting area. The study showed that ineffective organization of the registry office contributed significantly to the patients` low assessment. In our opinion, in order to solve the problem, it is necessary to optimize the work of the registry office by introducing modern technologies and equal distribution of duties among the employees. Conclusions. In order to improve the quality and accessibility of medical services, it is necessary to make certain changes in the organization of medical care. The level of patient satisfaction with the work of medical institutions may depend on various factors, such as waiting time for a doctor, the timing of medical services provision after the appointment, the availability of necessary diagnostic tests and specialists.

Generative Artificial Intelligence and Large Language Models in Primary Care Medical Education.

Generative artificial intelligence and large language models are the continuation of a technological revolution in information processing that began with the invention of the transistor in 1947. These technologies, driven by transformer architectures for artificial neural networks, are poised to broadly influence society. It is already apparent that these technologies will be adapted to drive innovation in education. Medical education is a high-risk activity: Information that is incorrectly taught to a student may go unrecognized for years until a relevant clinical situation appears in which that error can lead to patient harm. In this article, I discuss the principal limitations to the use of generative artificial intelligence in medical education-hallucination, bias, cost, and security-and suggest some approaches to confronting these problems. Additionally, I identify the potential applications of generative artificial intelligence to medical education, including personalized instruction, simulation, feedback, evaluation, augmentation of qualitative research, and performance of critical assessment of the existing scientific literature.

Improving Healthcare in South Texas Rural Communities: An Interprofessional Initiative for Primary Care Dental and Medical Residents.

To enhance primary care dentistry and medicine residents' didactic knowledge, communication skills to address patient's healthcare needs, and collaboration among healthcare professionals, while increasing confidence in integrating primary care skills into their clinical practice. An Interprofessional Education workshop was organized to enhance didactic knowledge and learning of 42 primary care dentistry (PCD) and family and community medicine (FCM) residents on topics including addressing facial and dental trauma in adults, managing patients with alcohol use and abuse, pain control and prescription opioid use in dentistry, and opioid use disorder and treatment. An online survey was administered before and after the workshop to assess changes in knowledge, confidence, and future intentions to incorporate targeted primary care skills learned during the workshop into clinical practice and to elicit residents' perceptions of workshop quality. Overall scale means were assessed by chi-square tests for knowledge scales and analysis of variance for confidence and career intentions scales, significance levels were set at 0.05. Pre-workshop assessments were completed by all attendees while post assessments received a response rate of 83.3%. Both PCD and FCM residents reported an increase in their knowledge (p<0.05) and confidence (p<0.05) in providing care for patients with facial/dental trauma, identifying signs of opioid abuse, addressing alcohol abuse, and understanding the referral processes following the workshop. While an overall increase was noted regarding intentions to incorporate skills learned during the workshop into practice by the PCD (pre-course=4.33, post-course=4.42) and FCM (pre-course=4.55, post-course=4.73) residents, the differences were not statistically significant differences. The interprofessional education workshop for PCD and FCM residents enhanced their knowledge, confidence, and future intentions to incorporate primary care skills into clinical practice and improve patient outcomes.

Об отдельных актуальных проблемах правового статуса врача и необходимости их законодательного решения.

Federal Law No. 323-FZ dated 11/21/2011 «On the Basics of Public Health protection in the Russian Federation» identifies two close, interrelated, but at the same time independent rights of a citizen: in article 21, the right to choose a doctor, taking into account the consent of a doctor, i. e. the right to choose any doctor at all and not only the attending physician, and in article 70 the patient’s right to choose the attending physician. At the same time, with the exception of the district service, the Basics do not disclose the mechanism for a citizen to choose a doctor, including a doctor, when providing him with primary specialized medical care and specialized medical care. This mechanism has not been disclosed in the procedures for providing medical care. In this regard, the authors proposed to supplement article 21 of the Fundamentals with instructions that the procedures for providing medical care, including the procedure for choosing a doctor by the patient. In addition, the publication noted that the absence of detailed and comprehensive medical care in the relevant procedures.

52116 Assessment of an Evidence-Based Dermatology Curriculum for Primary Care Medical Education

52116 Assessment of an Evidence-Based Dermatology Curriculum for Primary Care Medical Education

Impact of COVID-19 Epidemic on Morbidity and Mortality of Cancer Patients in the Ryazan Region

INTRODUCTION: In 2020, humanity faced a pandemic of a new infection a Severe Acute Respiratory Syndrome-related Corona Virus 2 (SARS-CoV-2) that had a significant impact on the economic, social, including medical, aspects of our life. Against the background of these changes, oncological diseases, like many other comorbid pathologies, seemed to fade into insignificance. But, as we understand, they have not lost their relevance, but only ‘retreated to the shadow’ for a while. Study of the basic statistical indicators used for evaluating the prevalence of cancer pathology and the results of the work of oncological service, helps analyze and understand the processes occurring in conditions of reorientation of medical measures for combating the pandemic. AIM: To study changes in the main indicators of the oncology service of the Ryazan region during the COronaVIrus Disease 2019 (COVID-2019) epidemic. MATERIALS AND METHODS: The main statistical indicators of morbidity, detestability and mortality from malignant neoplasms (MNs) in the Ryazan region were analyzed on the basis of statistical forms of federal statistical observation No. 7 (Form No. 7) ‘Record of MNs’, reports and data of cancer registry for 2012–2022. The most relevant statistical indicators were analyzed, data on most common and relevant tumor localizations were separately considered. RESULTS: At the height of COVID-19 pandemics in 2020–2021, a sharp reduction of the total number of identified MN cases was observed a seeming decline of ‘mortality’. At the same time, there was an increase in the proportion of patients with advanced IV stage pathology of lungs, stomach, and colorectal cancer, which, in turn, led in some cases to increase in one-year mortality, and to general increase in mortality among cancer patients. To note, despite a complicated situation associated with non-observance of the terms of the periodic medical examinations, reprofiling of a number of medical organizations and increased load on the primary medical care organizations, the oncology service of the Ryazan region showed a not that catastrophic impairment of the main statistical indicators, and of some of them a proportion of detection of early stages, results of treatment of tumors of visual localization even a positive dynamics. In 2022, officially registered cancer incidence rates in our region returned to previous values comparable to 2019. CONCLUSION: The experience of recent years should help in developing measures to prevent both the spread of similar epidemiological diseases and measures to prevent a decline of the quality of specialized medical care, in particular, in the field of oncology.

Analysis of the Current Situation and Optimization Strategies of Surgical Skill Training of Primary Orientation Training Residents

This paper analyzed the current situation of surgical skills training of grassroots orientation training residents, and found that there are deficiencies in training contents, faculty allocation, resource allocation and training evaluation. Given these problems, optimization strategies such as improving the training system, strengthening faculty, optimizing resource allocation and improving training evaluation are proposed. By strengthening the combination of theory and practice, improving the teaching ability of faculty, rationally utilizing and allocating resources, and building scientific evaluation system, the study aims to improve the surgical skills of primary care residents and enhance the service quality of medical care. This study provides valuable references for the talent training of primary medical and is of great significance in promoting the balanced development of primary medical care.

Ensuring Future Primary Care from a Municipal Perspective

In view of the continuing shortage of general practitioners, ensuring access to (primary) medical care close to home is also becoming increasingly important for local authorities. The aim of the present study was to analyse the current and future provision of primary care from the viewpoint of the municipalities in North Rhine-Westphalia (NRW). From the results, it should be possible to derive future health policy design of a needs-based primary care close to home. In an online survey in spring 2023, we surveyed the mayors or representatives of health departments of all 427 municipalities (396 cities and communities, 31 districts) in NRW in cooperation with the NRW Association of Cities and Municipalities, the NRW Association of Counties and the NRW Association of Cities. The items of the questionnaire (n=28) were developed on the basis of two other surveys on medical care in Lower Saxony and Baden-Württemberg, each with a municipal policy target group. They were tested in repeated pretests. In total, 192 municipalities participated in the survey (response rate: 45.0%). The majority of the municipalities (86.6%) considered the local provision of primary care to be (rather) not ensured within the next 10 years. The municipalities expressed the wish for more opportunities to exert their own influence (79.5% yes or rather yes), but nevertheless considered a stronger commitment, especially of the Associations of Statutory Health Insurance Physicians (85.4%), as well as an intensification of assumption of responsibility by the federal states (72.4%) to be necessary for ensuring primary care. The survey shows that municipalities are quite aware of the problem of future deficits in the supply of general practitioners at the local level. The results also indicate that, in view of increasing supply shortfalls, the municipalities see obligations for the Associations of Statutory Health Insurance Physicians and the federal states to take responsibility and to exert greater political pressure in the future. The municipal perspective is an essential building block in considerations of how primary care can be ensured in the future. The responsible stakeholders should therefore involve the municipal level in the planning and measures to secure primary care more closely than in the past.

Regional Experience of Using Artificial Intelligence Services in the Healthcare Sector of the Russian Federation in 2023

Background. The using of artificial intelligence (AI) in healthcare has particular importance for primary medical care. The market for AI in healthcare is actively developing, and Russian companies offer their products and services in this area. The federal project to create a single digital contour in healthcare includes the implementation of medical devices based on AI technology in healthcare of the regions of the Russian Federation. The AI services may or may not be medical devices. It is necessary to understand the organizational and economic effects for the healthcare system and a certain medical organization in order to select a service. There is no consolidation of regional experience on AI-enabled services in healthcare in the Russian Federation today. Aims — consolidation of experience in the using of the AI services in healthcare sector in the regions of the Russian Federation. Methods. We conducted an online survey of representatives of regional executive authorities and medical information and analytical centers in the regions of the Russian Federation through the “Yandex Forms” platform and also they were interviewed. Results. We surveyed 84 regions of the Russian Federation to consolidate the experience of using the AI services, and the information on Moscow was obtained from open sources. The analysis showed that the AI services that are not medical devices are more common than the AI services that are medical devices. Based on the results of the study, we have formed a classification of the AI services that are not medical devices used in healthcare in the Russian Federation, identified the reasons why, according to the regions, it is difficult to implement the AI services, as well as determined the conditions of use of the AI services that are not medical devices. Conclusions. On the basis of the study, we determined the algorithm for the implementation of the AI services in the Russian healthcare.

Ultrasound screening of thyroid pathology in primary medical care in Bulgaria

Thyroid diseases are common and, in most cases, can be safely and effectively detected and treated in primary medical care. This article aimed to analyze and evaluate the rate of thyroid ultrasonographic abnormalities in a primary medical care practice in Bulgaria. The research was conducted from 2016 to 2021. A random cohort of patients undergone annual preventive screening was included. Demographic information (age and sex) was collected. The descriptions of the ultrasonographic findings were standardized based on the following parameters: deviations in shape, size, position of the thyroid gland, deviations from normal parenchymal echogenicity (hyper-, hypo-, and heteroechogenic parenchyma), presence and size of detectable formations, and presence of calcifications. The total number of participants in this study was 3 178. Of these, 60% (1 907/3 178) were women and 40% (1 271/3 178) were men. The average age of participants was 40.1 &amp;plusmn; 11.3 years, and there was no significant difference between the males and females. Deviations from normal ultrasonographic findings were observed in 36.2% (1 151/3 178), with a frequency increasing with age. Detectable formations were seen in 19.7% (625/3 178) of the patients, and those larger than 1 cm accounted for 4.4% (139/3 178) of all cases and 22.2% of all formations (139/625). Calcifications were found in 0.5% (15/3 163). Over 1/3 of the performed thyroid ultrasounds revealed abnormalities. Thyroid ultrasonographic abnormalities were significantly more common in women compared to men, and their frequency increased with age.

Preventive Medical Examinations of Children’s Vision Functions as a Guarantee of Maintaining Ophthalmological Health

The objective: retrospective study of the dynamics of the prevalence of ophthalmic pathology and the effectiveness of preventive diagnostic examinations of visual functions in children of different age groups. Materials and methods. To conduct the study we used data from reporting forms 12, 14, 19 and 31-health from the official statistical reporting of the Center for Medical Statistics of the Ministry of Health of Ukraine. Construction of dynamic series for retrospective analysis and finding out the presence of established trends covered a 15-year research period from 2003 to 2017. During the research, such methods as medical-statistical one, content analysis, system approach and system analysis were used. Results. According to the results of the study, it was found that the prevalence of eye diseases and its accessory apparatus increases with the age of the child, having the lowest value in the age group of children 0–6 years old (3.0±0.685%) and the highest rate was in the age group of adolescents 15–17 years (8.0±0.651%). A comparison of the prevalence refractive errors values, in particular myopia, among preschool children according to the results of 2017 shows an increased indicator with the age of children by almost 10 times (p&lt;0.0001). A retrospective analysis of the formation of indicators dynamics of the visual impairment in children frequency detection in different ages revealed a tendency towards an increase in the values of the indicator in the age group of 7-year-old children and a significant increase in the age group of older adolescents (15–17 years) from 69.5 cases per 1000 examined children of this age in 2003 to 86.77 similar cases in 2017. Conclusions. The increasing prevalence of diagnosed disorders of visual functions among children who started school at the age of 7 years and school adolescents of 9-10 classes the expediency of paying attention to preventive diagnostic ophthalmological examinations and primary prevention measures among these age groups. Primary prevention, including the elimination of controlled risk factors for the development of visual impairments among the children’s population, is a necessary task, the implementation of which requires the combined efforts of all adults who are close to children, parents, teachers, doctors of all levels (primary and specialized ophthalmic) medical care.

Welfare and Self-development of Rural Doctors in China from the Perspective of Social Justice Study

Since the beginning of China's new medical reform, the government has issued several policies to promote the development of primary medical care. As an important subject of primary medical care, rural doctors have also received extensive attention on their welfare and self-development. At present, rural doctors in China have problems such as low salaries, imperfect pension security, and hindered development, which is not conducive to the balanced development of the medical industry. Making appropriate adjustments and improvements to the policy of rural doctors is conducive to strengthening the construction of rural medical care and reducing the loss of rural medical talents, thereby promoting social equity and enhancing social stability. Based on these, this paper puts forward the following suggestions. On the one hand, the government should ensure the relative fairness of policies, measure the economic level of various localities, formulate reasonable salary, social security, and promotion systems for rural doctors, rationally use policy tools, and increase supervision over policy implementation. On the other hand, it is necessary to give certain policy preferences to rural areas, issue subsidies to rural doctors, and increase capital investment in rural areas, to reduce the gap between urban and rural areas and promote the balanced development of medical services.