Procurement Of Medicines Research Articles

Decision-making regulatory framework of the introduction of health technologies at the hospitals in Ukraine

The limited resources of the health care system and the COVID-19 pandemic encourage more rational and cost-effective administrative and clinical decisions. To achieve the best health care within available resources, the introduction of the most efficient technologies should be supported, considering organizational, social and ethical issues. Assessment of health technologies at different levels, namely national/regional and hospital, is becoming increasingly important. Adherence to cost-effective approaches to administrative and clinical decision-making will ensure the rational use of the state budget and improve clinical outcomes, improve the quality and life expectancy of patients.
 The purpose of the study was to analyze the current regulatory framework for the introduction of health technologies (medicines and medical devices) at the hospital level. During the research the methods of content analysis, historical, system-analytical, generalization was used.
 According to the analysis of the decision-making regulatory framework for the health technology’s introduction, it was drawn the next conclusions. The active HTA development in Ukraine is noted. In a short time, a legal framework for state HTA for medicines was created and approved, amendments were made to the Law of Ukraine ‘On Public Procurement’ and other Ukraine’s laws on medicine procurement under managed entry agreements, the further steps for development of the HTA ecosystem in Ukraine were identified.
 The legal framework for the circulation of medical devices needs to be updated in Ukraine, starting with technical regulations in accordance with EU regulations №745 and №746 and further approval of the Law on Medical Devices.
 Procedures for evaluation and selection of medicines and medical devices at the level of medical institutions are absent in Ukraine and require separate elaboration. The introduction of HB-HTA will help hospital managers to make independent, transparent, reasonable, and impartial management decisions on the selection of drugs and medical devices.
 The obtained results prove the need for further research of everyday decision-making practices on the introduction of health technologies at the hospitals, development of methodology for hospital-based HTA and update regulation of HB-HTA in the current legal framework of Ukraine.

Identification of Problems or Barriers in Medicine Procurement Process in Low- and Lower-Middle-Income Countries: A Narrative Review

Medicine procurement at LLMIC still becomes a challenge regarding to low medicine availability. There is no study yet that identifies the problems of medicine procurement at LLMIC countries so that it becomes the objective of this narrative review. PUBMED, Science Direct, Google Schoolar, PLOS from May 14th, 2021 to May 22nd, 2021 were used. The problems of procurement were found since the processes of selection, planning, and procurement. Factors of human resources, organization, management information system, and parties excluding health facilites (government, distributor, and pharmacy industry) also contribute to hinder the medicine procurement. The effort to solve this problem should include multisectors with the aim to strengthen the medicine management and the supply chain.
 Keywords: supply chain, developing countries, medicine management

Medicine Storage and Dispensing Facilities in Public Healthcare Pharmacies of Puducherry, India.

BackgroundLarge amounts of medicines are wasted during procurement, storage, distribution, and utilization. Proper procurement, storage, dispensing, and documentation of medicines are important aspects of pharmacy management. The World Health Organization (WHO) and the Indian Pharmaceutical Association (IPA) have developed guidelines for the storage and dispensing of medicines by pharmacists. This study was conducted to assess the storage and dispensing facilities of medicines in public healthcare pharmacies of Puducherry province in south India.MethodologyA one-time survey was conducted in 10 public healthcare pharmacies by filling the checklist which was prepared based on the WHO and IPA guidelines.ResultsFacilities such as adequate surface area, storage area, reception area, and availability of water supply in dispensing area were available in 90% of surveyed pharmacies. The most common system used for the arrangement of medicines was alphabetical order (70%). In 80% of pharmacies, a sufficient number of shelves was available for storage of medicine, and in 90% of pharmacies, shelves were properly labeled. None of the pharmacies had separate storage facilities for expired medicines and narcotic drugs.ConclusionsIn Puducherry, pharmacy services are provided by qualified and experienced pharmacists. Although most of the surveyed pharmacies had all the required infrastructure and equipment facilities, few pharmacies need to improve their facilities to promote good drug-dispensing practices.

POSA326 Cross-Border Collaboration to Support Pricing and Access for High-Cost, High-Value Therapies: A Review of Initiatives within Europe

Cross-border collaboration for the evaluation and procurement of medicines can be undertaken to pool expertise, minimise risk and increase bargaining power. This has become increasingly important in Europe to improve affordability and access to innovative therapies in areas of high-unmet need. This research aims to understand the rationale for collaboration across borders, outcomes of joint initiatives (and associated implications) and key success factors.

POSC215 Assessment of Tender Adjudication Criteria Among European and Leading Emerging Markets

Procurement of medicines through competitive bidding (tendering) is a common measure taken by governments to lower pharmaceutical expenditure. While tendering is used for the purchase of medicines with approved equivalents, their adjudication depends on product performance against tender criteria, with individual criterion weights varying by country/region. This research explores the criteria used by several countries to rate and adjudicate pharmaceutical tenders.

Phishing as a form of fraud identity theft in healthcare: Victimization during COVID-19 pandemic

The coronavirus pandemic affects all segments of human life around the world. Due to the risk to people's health, personal communication has been completely changed and most professional activities and contacts must take place in a cyber environment, with the help of computers and mobile telephony. On-line communication and the use of social networks undoubtedly represent a conditio sine qua non in a situation when compliance with numerous preventive measures are required, including the work from home, online teaching in schools, a ban on gatherings etc. The positive aspects of this kind of communication are undoubtedly obvious and necessary, but they also created new forms of victimization due to insecure protocols for sending e-mails, inadequate level of privacy protection, insufficient information security, the existence of so-called security holes and the use of the same devices and digital services for professional and private purposes. Hacking phishing activities during the pandemic mostly endangered the security of confidential data collected within medical information systems, educational institutions, and in the field of banking, when the user is expected to compromise his/her digital identity and publish his/her data. The subject of this paper is the presentation of some of the most common phishing activities and identity theft in the field of health care, provision of health services, procurement of medicines and vaccines against coronavirus, which have been recorded in the world since the beginning of the pandemic. The phishing activities that will be presented in this paper significantly contribute to the further spread of panic from the misuse of medical data of infected persons and their contacts. The paper aims to point out the most common forms of victimization that have appeared around the world, as a consequence of cyber security violations due to hacker attacks during the COVID- 19 pandemic. Special emphasis in the paper is on these ?pandemic? cyber dangers, as well as on the mechanisms for avoiding this type of victimization.

Routine medical check-up and self-treatment practices among population living in mountainous area of a tribal district of Odisha

Background: Self-treatment is recognized as one of the global public health issues. Geographical distance, constrained financial resources, and lack of awareness are the main barriers for people in remote areas to access health care. Self-treatment may also have risky consequences such as side effects and antibiotic resistance. It is assumed that the rate of self-treatment is high in the unreachable hilly tribal areas because of the geographical factor. Aim and Objective: The primary objective of the present study is to find out the prevalence and reason of self-medication, and the sources of drug information. The secondary objective is to assess the awareness of routine medical check-up among the tribal population of the hilly areas of the Koraput district of Odisha. Materials and Methods: A retrospective study was conducted after receiving clearance from the Institutional Ethical Committee, SLN MCH, Koraput. The study was conducted from February 2022 in some hilly villages near Koraput, which is a typical mountainous commune with the terrain divided by many mountains. Simple random sampling was done using computer software for selecting participants (sample size: 200). The participants were contacted and our interviewer visited door-to-door for face-to-face interviews. The research team developed a structured questionnaire to use in the face-to-face interviews. The questionnaire included questions about demographic characteristics, access to medical facilities, frequency of routine medical check-ups in the past 12 months, health information sources, and distance to the nearest health facility. A series of questions regarding self-treatment practices were also asked: Whether they had purchased any medication without prescription in the past 3 months, what the symptoms were, and what kind of medicines they bought, and the reasons they bought the medicines on their own. Results: The study found that prevalence of self-medication was 92 (46%, C.I. 95%). The majority of residents had self-medication when they suffered from common cold and cough (16% of participants), fever (8%), diarrhea (6%), body pain or myalgia (8%), and allergy (2%). The most prevalent groups of drugs used were antipyretics such as paracetamol (36%), antibiotics (30%), antihistamines (14%), and analgesics such as diclofenac and nimesulide (26%). The most common reason for choosing a local practitioner or private pharmacist and health worker was the subjects’ proximity to them. Of the self-medicated population in our study, 62% procured medicines from local practitioners, chemists, or health workers residing in their villages or nearby villages. Conclusion: Rational use of drugs requires that patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements for an adequate period of time and at the lowest cost to them and their community. Self-medication unfortunately does not follow the standard, scientific, and rational criteria. Due to self-medication quality of medicine, scientific, and rational procurement, rational prescription is always questionable.

Consumers' access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review.

Information about where medicines are in stock and how much they cost facilitates consumers’ timely access to affordable medicines by enabling price comparisons and the identification of stockists. Our aims were to: (1) Review how consumer access to price and availability information is engaged within the Medicine Access discourse and (2) identify factors associated with the existence of interventions that provide consumers with medicine availability and price information. We conducted two scoping reviews. We reviewed 26 medicine access and pharmaceutical system strengthening frameworks to assess how they conceptualise information access. We then reviewed four interventions that provide consumers with availability and price information to identify the factors associated with these interventions’ existence. We found that in the medical access discourse, information is mainly cast as helpful to entities that ensure medicine access for populations. Information as an enabler of medicine procurement for consumers/households is less emphasised. We then identified the following eight factors that facilitate consumer access to reliable medicine price and availability information: the recognition of a medicine access problem that can be mitigated by consumer access to information; cross-sectoral collaboration; the willingness of medicine sellers to disclose their inventory information; having information quality control measures; appropriate incentives for intervention adoption; enabling legal environments; systems of pooling information; and access to digital information technology infrastructure. We recommend that more theoretical and implementation attention ought to be directed at how medicine price and medicine availability information can empower individual consumers to make sound purchasing decisions.

Challenges of Guaranteeing Access to Medicines in Mexico: Lessons from Recent Changes in Pharmaceuticals Procurement

ABSTRACT During the last two decades, Mexico adopted policies intended to increase the efficiency and effectiveness of medicines procurement in its nationally fragmented health system. In this policy report, we review Mexico’s efforts to guarantee access to medicines during three national administrations (from 2000 to 2018), and then examine major health system changes introduced by the current government (2018–2024), which have created significant setbacks in guaranteeing access to medicines in Mexico. These recent changes are having important consequences in the levels of satisfaction of health care users and citizens, household expenditure on health, and health conditions. We suggest key lessons for Mexico and other countries seeking to improve pharmaceutical procurement as part of guaranteeing access to medicines.

TRIPS to Where? A Narrative Review of the Empirical Literature on Intellectual Property Licensing Models to Promote Global Diffusion of Essential Medicines.

Governed through the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) since 1995, the current medical R&D system requires significant trade-offs between innovation and high monopoly prices for patented drugs that restrict patient access to medicines. Since its implementation, few amendments have been made to the original TRIPS agreement to allow low- and middle-income countries (LMICs) to facilitate access by generic manufacturers through flexible provisions, such as compulsory licensing and parallel import. Although a useful policy tool in theory, the routine use of TRIPS flexibilities in LMICs in the procurement of new essential medicines (EMs) is regarded as a ‘last resort’ due to strong political response in high-income countries (HICs) and new trade agreements’ restrictions. In this context, access-oriented biomedical Public-Private Partnerships (PPPs) have emerged. More recently, leading multilateral health organizations have recommended different types of intellectual property (IP) interventions, voluntary biomedical patent pools, as strategies to reduce prices and increase the diffusion of novel EMs in LMICs. Nevertheless, the recent Ebola and COVID-19 outbreaks highlight growing concerns regarding the use of TRIPS flexibilities and the limited success of voluntary mechanisms in promoting access to medicines in the Global South amidst health crises. This review aims at describing the state-of-the-art empirical research on IP-related options and voluntary mechanisms applied by emerging PPPs to guarantee timely and affordable access to EM in LMICs and reflect on both models as access paradigms. Some suggestions are put forward for future research paths on the basis of these analyses and in response to contemporary debates on waiving key IP rights on COVID-19 therapies, diagnostics, and vaccines.

An Analysis of the Drug Distribution Model in the Public Health Services in Tamil Nadu

Based on the field work in Tamil Nadu, this article analyses the procurement and dissemination functioning of the Tamil Nadu Medical Services Corporation (TNMSC), including the problems faced by different stakeholders’ viz. doctors, patients and pharmaceutical companies and also the stakeholders outside Tamil Nadu. The Tamil Nadu model of procurement and distribution of medicines under TNMSC is acclaimed as a successful model for its centralized-swift actions. However there were some inconsistencies hampering TNMSC to remain a model as there were the no availability of drugs as per approved essential drugs list, shortage and incomplete availability of drugs, and a shift from centralized procurement to local purchase arrangement of some drugs across Tamil Nadu. It also observed not only the quantity, quality and number of drugs procured and distributed, not matching with the health need of patients, but also the doses are not effective. In order to do that there is a need to revamp its centralized procurement pattern and dissemination of drugs to various public health systems in Tamil Nadu. By doing this, it can avoid the high-cost private medicines being promoted even by government doctors, and truly make the public health system successful and a top model in this country.

Evaluating the implementation of the standard treatment guidelines (STGs) and essential medicines list (EML) at a public South African tertiary institution and its associated primary health care (PHC) facilities

BackgroundThe standard treatment guidelines (STGs) and essential medicines list (EML) were a policy option recommended in the National Drug Policy for South Africa in 1996 to address the irrational and bloated medicines procurement list. STGs/EML serve as a tool to promote cost-effective use of medicines; rational prescribing; and improve accessibility to medicines for all citizens. The purpose of this study was to evaluate the use and implementation of the STGs/EML by prescribers at a public tertiary institution and its associated Primary Health Care (PHC) facilities in the uMhlathuze subdistrict of KwaZulu Natal. The study aimed to provide feedback and to make recommendations to policy makers to improve the use and implementation of the STGs/EML and to inform National Health Insurance (NHI) policy development.MethodAn observational quantitative descriptive research design was used. A retrospective audit of prescriptions was conducted, and questionnaires were utilized to collect data from prescribers and the facilities to evaluate the utilization of the STGs/EML and the rational use of medicines. All descriptive analyses were presented as counts with percentages, and Fisher’s exact test was used to compare results. The data was summarized, reduced, and analysed using SAS statistics software.Results107 medical doctors (97%) responded to the questionnaire at hospital level and 98 nurses (98%) responded to the questionnaire at the PHC level. Results revealed that the majority of doctors, 94.4%, had access to the latest STGs/EML compared with only 41.8% of nurses. 70.3% and 78.3% of doctor’s and nurse’s prescriptions, respectively, adhered to the guidelines. 94.9% of nurses requested training on the use of STGs/EML as most of them had not received formal training on its use.ConclusionThis study showed suboptimal adherence to STGs/EML by all prescribers, in contrast to previous research amongst nurses when hardcopies were available. Training on the use of the STGs/EML is needed at PHC level and improved monitoring of STGs/EML compliance is necessary. This study may be replicated for a wider population to paint a national picture and to periodically assess the extent of the implementation of the STGs/EML.

Balance of digital transformation of the healthcare system on the example of vertically integrated medical information systems (VIMIS)

The change in demographic trends observed in most of the subjects of the Russian Federation in recent years has had an impact on the structure of morbidity. The increase in the morbidity of the population for certain classes of diseases required operational accounting and planning of increasing the corresponding health resources, procurement of medicines. National medical research centers are of fundamental importance in the management of the quality of medical care and the assessment of health resources. The lack of an effective control tool at national medical research centers for many years did not allow to increase the effectiveness of quality management of medical care. In 2019, the Ministry of Health of the Russian Federation created a modern mechanism for managing medical care in the main profiles throughthe use of vertically integrated medical information systems.The introduction of such information systems led to a search for a balance of interests of medical professionals who do not have the opportunity to spend a lot of time filling out various electronic documents and forms, as well as the interest of developers of information systems whose rigid algorithms had to be transformed into convenient and familiar business processes for doctors.The optimal solution proposed by the authors of this article is the use of regional specialized subsystems for disease profiles, which receive primary information about the case of treatment from various sources and automatically generate structured electronic medical documents.

Oncology calculator as a tool for optimizing drug provision for patients with malignant neoplasms in the subjects of the Russian Federation

Introduction. The increase in financial resources on the part of the state for the procurement of medicines for treating patients with malignant neoplasms makes the issue of calculation the need in medicinal preparations (MP) actual. The aim of the work is to develop a special tool (oncology calculator) that standardizes the method for determining the need for drugs and can calculate the need for medications for the treatment of malignant neoplasms in a particular constituent entity of the Russian Federation. Material and methods. To develop an oncology calculator, we analyzed the need for the drugs for the treatment of patients with the most common malignant neoplasms was analyzed based on current clinical guidelines approved and published on the Ministry of the Russian Federation website. The number of patients at each stage of a specific cancer was calculated. The frequency of application of a particular treatment regimen was calculated based on the approved standards of medical care for patients with cancer or from a project. The number of patients was calculated on the official statistics presented in the P.A. Hertsen Moscow Oncological Research Institute - branch of the Federal State Budgetary Institution “National Medical Research Center of Radiology” by the Ministry of Health of Russia. Results. We have developed a tool called the “Oncology calculator” that standardizes the methodology for determining the need of a constituent entity of the Russian Federation or a medical institution for drugs based on clinical guidelines, as well as facilitating the planning of the volume of medical care in the conditions of round-the-clock and day hospitals, and in the provision of medical care to patients with malignant neoplasms in outpatient settings. Conclusion. The existing approaches to calculating the need for drugs for the treatment of patients with cancer in the constituent entities of the Russian Federation are scattered, which leads to the ineffective use of funds from the federal budget, compulsory medical insurance funds, budgets of the constituent entities of the Russian Federation. A uniform approach to calculating the need for drugs to treat malignant neoplasms should be based on clinical guidelines containing drug regimens for treating patients.

European collaborations on medicine and vaccine procurement.

To ensure equitable access to medicines and vaccines, organizational efforts and purchase volumes have been pooled in joint procurements and negotiations for decades in some regions of the world, as well as globally through supranational procurement mechanisms. In Europe, countries started to collaborate on procurement and negotiations recently when it became increasingly difficult to ensure access to high-priced medicines, even in high-income countries. Two European country collaborations (the Nordic Pharmaceutical Forum and the Baltic Procurement Initiative) have successfully concluded at least one joint tender process for medicines and vaccines and the Beneluxa Initiative has concluded its first successful joint price negotiation. This article describes the experiences of these country collaborations. Challenges observed included: legal barriers; institutional and organizational differences between health-care systems in member countries; and the risk that suppliers will be reluctant to cooperate with country collaborations. Although these collaborations helped improve access to medicines and vaccines for the countries involved, in situations such as a global health crisis, larger-scale, more-inclusive initiatives are needed. In the current coronavirus disease 2019 (COVID-19) pandemic, COVID-19 Vaccines Global Access (COVAX) initiative established a global procurement mechanism to ensure the equitable distribution of COVID-19 vaccines globally. Despite differences in organization and scale, the European country collaborations and COVAX have some similarities: (i) their success depends on the increased purchasing power associated with pooled order volumes; (ii) expert knowledge and previous procurement experience is pooled; (iii) they perform other collaborative activities that go beyond procurement alone; and (iv) they actively involve external partners and stakeholders.

ANALISIS MANAJEMEN PENGELOLAAN OBAT PADA MASA PANDEMI DI PUSKESMAS SERING KECAMATAN MEDAN TEMBUNG

Drug management is a series of activities related to the aspects of planning, procuring, receiving, storing, destroying, controlling, recording and reporting drugs. During the Covid-19 pandemic, many activities were hampered, especially in drug management. This study aims to describe the management of drug management in the health center often in the sub-district of Medan Tembung. This type of research is descriptive research using a qualitative approach. The number of informants in this study were 3 people consisting of the head of the puskesmas, the person in charge of the pharmacy and the pharmacy staff. Data collection was carried out through in-depth interviews and direct observation. The results showed that the management of medicines had not been implemented properly in accordance with Permenkes number 74 of 2016 concerning standards of pharmaceutical services at Puskesmas. During a pandemic, the number of patient visits at the health center has often decreased drastically so that the planning and procurement of medicines that are prepared and available are many that are not used and even have expired in 2021. It can be concluded that the distribution and recording and reporting are in accordance with the drug management standards at the Puskesmas. However, planning, procurement and storage are not in accordance with existing standards. It is expected that the puskesmas will often pay attention to and follow the established management guidelines.

Risks of Corruption in the Context of Covid-19 Pandemic

orruption is a social evil that encroaches on certain human values, and various law enforcement agencies and institutions function to combat it. In many countries, the fight against organised crime, as well as crimes in the economic and financial spheres, is handled by various specialised law enforcement agencies. In addition, experts claim that the pandemic has negatively affected the situation with corruption around the world and COVID-19 is a challenge to the anti-corruption fight of each country. Available reports indicate that corruption is widespread throughout the COVID-19 response: from bribery in the procurement of tests, medicines, and provision of medical services for public procurement of medicines and general preparedness for emergencies. This situation has some shortcomings of a total crime prevention and may reduce the priority of the fight against corruption in the general list of combating economic crimes and organised crime. To provide effective counteraction against corruption-related crimes, it is rather important to find out the reasons for them and preconditions of their origin, especially their certain types which have spread during the pandemic. In this context, the research analysis of Ukrainian and foreign scientists from all the world is of particular importance. It will give us the possibility to justify, under modern conditions, the recommendations aimed at improving the drawing up of the content of administrative and criminal offences as well as administrative and criminal sanctions for corruption-related crimes.

The impact of the COVID-19 pandemic on the financial sector in medicine: features of centralized state procurement of drugs and medical devices in Ukraine for the period 2018-2021

ABSTRACT. Coronavirus disease (COVID-19) has deeply impacted the global health care system, and the redistribution of funding for medical care violated the prevention and treatment of chronic non-communicable diseases, including hypertension, tuberculosis, and HIV. In 2020, centralized state procurement of medicines in Ukraine was for the first time conducted via the online platform Prozorro. Of the 483 items planned to be purchased, 375 items (78 %) were successfully contracted. In the current 2021, tenders were announced for the purchase of 555 of 562 items. In most fields of medicine, the drugs to be purchased are 100 % covered by tenders. The lowest percentage of coverage is observed for pulmonary arterial hypertension (66.67 %).
 In today’s complex environment, not only COVID-19 should be actively combated, but other diseases should be also kept in mind when carefully planning the funding of various fields of medicine through the analysis of data from previous years. The money saved can be used to eliminate the consequences of the COVID-19 pandemic, and to purchase the necessary medicines. The creation of a single database of drug residues in medical institutions (chatbot in the Telegram messenger) can be called a positive innovation. Control of drug residues and their adequate redistribution makes it possible to rationally use this resource without spending money on unnecessary purchases.
 In general, despite the medical and financial impact of COVID-19, Ukraine’s healthcare system continues to withstand pressure and change for the better. Further improvement of the system of centralized procurement of medicines will be able to overcome the problem of lack of necessary drugs.

ФАРМАЦЕВТИЧЕСКИЙ РЫНОК КАРДИОПЛЕГИЧЕСКИХ СРЕДСТВ И ОСОБЕННОСТИ ИХ ПРИМЕНЕНИЯ В РОССИЙСКОЙ ФЕДЕРАЦИИ

Relevance. Surgical treatment of cardiovascular diseases with the use of artificial blood circulation is associated with the need to protect the myocardium. Various cardioplegic solutions are widely used in cardiac surgery to stop and protect the heart. Currently, a significant number of mixtures of drug solutions are used in "open" heart surgery. However, not all of them have been officially registered as cardioplegic solutions and not all have the appropriate indications in the instructions for medical use of the drug, which jeopardizes the safety and quality of medical care for patients. Goal. To study the pharmaceutical market of registered drugs for cardioplegia and to estimate the share of heart operations with the connection of artificial circulation performed without the use of officially registraited drugs for cardioplegia. Materials and methods. The following methods were used in the work: content analysis, statistical, marketing, graphic. The main information sources were: the State Register of Medicines; statistical indicators of surgical interventions in cardiac surgery, information on public procurement of medicines, instructions for the medical use of medicines, regulatory documents. Results. This study presents the results of a marketing analysis of the pharmaceutical market of drugs officially registered for cardioplegia. Three medicines have been registraited in Russia, which, in accordance with the instructions for use, can be used during surgical interventions in the quality of cardioplegic solutions. According to the ATC classification, all of them belong to the subgroup of the fifth level B05XA16 "Cardioplegic solutions". For the period 2018-2020. the volumes of purchases of cardioplegic solutions for the needs of medical organizations have been established and the volumes of drugs for surgical intervention in cardiac surgery during operations on the "open" heart have been determined. The comparison of morbidity rates and the estimated number of surgical interventions of the cardiac surgery service based on the data of public procurement of drugs for cardioplegia, revealed a discrepancy between the volumes of purchased cardioplegic solutions and the care provided. The data analysis shows that at least 23 thousand cardiac surgeries in Russia are performed annually without the use of registraited medicines for cardioplegia. Conclusion. When performing surgical interventions on an "open" heart with the connection of artificial blood circulation, it is necessary to use cardioplegic solutions that have an official indication in the instructions for medical use, in order to ensure the safety of patients and to perform medical interventions of appropriate quality.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.

The EU Response to COVID-19: From Reactive Policies to Strategic Decision-Making.