Provision Of Medical Assistance Research Articles

Сравнительная характеристика затрат рабочего времени врача-челюстно-лицевого хирурга, оказывающего помощь в стационарных условиях, в условиях организационного эксперимента.

In the system of organization of provision of specialized medical care on the profile of maxillofacial surgery there are significant changes in connection with the digitalization processes, the introduction of new medical-diagnostic technologies, the development of surgical interventions, that has a significant effect on the working time of the doctor – maxillofacial surgeon. Purpose of the study is to study the working time of the doctor-maxillofacial surgeon, who provides assistance in stationary conditions with the help of photochronometric measurements in dynamics before and after the introduction of organizational measures. Materials and methods. The study was carried out in 2018 and 2023, before and after the introduction of organizational measures, on the basis of the department of maxillofacial surgery of the Penza regional clinical hospital. N. N. Burdenko». Doctors-maxillofacial surgeons took part in the study. The following methods were used: analytical, photo-time, organizational experiment, statistical. In the course of the photo chronometric research, all activities were studied: main activity, document processing, support activities, work, other activities, personal time required, unencumbered time. Results and Discussion. Analysis of the data obtained showed that doctors-facial surgeons in 2018 conducted an average of 9.75+0.1 hours at the workplace, which is 1.95 hours above the norm. According to the results of the study the article reveals an imbalance of working time expenditure, significant time spent on unusual functions (provision of medical assistance in the reception department, completion of medical documentation)There’s a lot going on. Problems in the regulation of work of doctors-maxillofacial surgeons, as well as shortcomings in the organization of medical care on the profile of «maxillofacial surgery» were revealed as a result of the photochronometric researchIt was possible to identify the main directions for improving the provision of specialized assistance in the field of PF. After the behavior of organizational arrangements (change of localization of the department, staffing, new patient routing, strengthening of continuity) The results of a repeated photochromic study conducted in 2023 showed that the structure of the working time expenditure has changed significantly: the share of main activities has decreased from 61,46% in 2018 to 59.7% in 2023, the duration of work with medical documents increased from 16.3% to 20.1%, costs for support activities decreased from 14,63% to 7.6%, The cost of performance increased from 4.59% to 5.6%, personal time required increased from 0.86% to 2.0% respectively. In 2023 there is no open time (late to work). The organizational changes made have had a positive impact on the quantity of quality of the bed. The average duration of treatment in 2018 was 7.92 days, and in 2023–5.53 days. In 2018, the pre-operative bed day was 1.05 days, and in 2023–0.17 days, decreased by 6.2 times. Conclusions. It was found that the organizational changes, directly related to the opening of the regional center of maxillofacial surgery, allowed to change the routing of patients, improve the continuity with specialists of dental, traumatological, oncological, pediatric profile, rational use of personnel resources, provide assistance to children. The optimization of doctors’ activities has had a positive impact on the quantity and quality of the bed. A comparative description of the work time spent before and after the organizational experiment shows that the activity of the surgeonmaxillofacial round-the-clock hospital has changed significantly due to the reduction of the cost of performing unusual functions.

Посттравматичний вплив фосфорної зброї: від патогенезу до лікування

With the beginning of a full-scale war, the negative impact of harmful, dangerous substances due to the use of chemical, phosphorus bombs and other weapons, prohibited by the Geneva Convention, leads to unpredictable consequences for the health of combatants and the civilian population as well. Objectives of the study is to analyze injuries caused by white phosphorus of various types of phosphorus weapons, such as explosive weapons with a wide area of damage - mines, ammunition, long-range missiles; artillery, mortar shells, various types of grenades - in the conditions of the russian invasion of Ukraine. Materials and methods. The following methods were used when performing the work: content analysis, comparative analysis and systematization of the researched material. A study of scientific publications of domestic and foreign scientists was conducted using the PubMed and Google Scholar databases for the period 2001-2023. The results. Phosphorus munitions such as white phosphorus are known for their high effectiveness in combat operations, but their use leads to serious injuries and post-traumatic psychological changes. White phosphorus after a bomb explosion causes burns to the tissues of the human body, especially when in contact with burning material, as well as burns to the upper respiratory tract due to inhalation of smoke or gases released during combustion. The article analyzes the legal framework prohibiting the use of phosphorous ammunition in armed conflicts. Clinical cases of combined gunshot wounds of the limbs with a massive defect of soft tissues, gunshot fractures and the presence of multiple foreign bodies of metallic density due to the used phosphorous ammunition were considered. An analysis of scientific research by foreign scientists on this issue was carried out. The article presents the algorithms for providing first aid due to the effects of phosphorous ammunition, as well as the methodological recommendations of the Ministry of Health of Ukraine (Order of the Ministry of Health of Ukraine № 506 dated 20.03.2022) regarding the provision of medical assistance at the pre-hospital stage for burns, enteral poisoning, and eye contact phosphorus as a result of damage by the phosphorus component of the ammunition.

Парадигма розвитку медичного права в Україні

The article formulates the paradigm of the development of medical law in Ukraine, and also considers the constituent elements that form it. We believe that the legal relations included in the subject of medical law should be divided into two groups. The first group is represented by those relations that arise during the implementation of medical activities in the process of providing medical assistance. That is, the relationship between the doctor and the patient during the implementation of the first diagnostic, treatment and preventive measures. We believe that they are the basis of relations in the field of medicine. The second group of relations includes relations related to the provision of medical care, in particular, in the field of internal organization of the provision of medical services, mandatory medical insurance, control and supervision in the field of health care, licensing and accreditation of medical organizations, etc. We propose to call such relations organizational and legal in the field of medicine, since they are the basis of the emergence of relations in the process of implementing medical activities regarding the provision of medical assistance and ensure its quality provision. It is proved that medical law is an independent complex branch of law, which was formed on the border of profiling branches of law (which, in our opinion, are civil, administrative law, social security law), the subject of which is social relations that arise in the process of implementing medical activities in relation to provision of medical care and organizational and legal relations in the field of medicine. Their legal regulation is based on the combined (imperative-dispositive method). Thus, awareness of the independent sectoral affiliation of medical law will contribute to its further development, improvement of legal regulation of individual sectoral institutes, introduction of new mechanisms of protection and protection of the rights and interests of subjects in the field of health care.

ДЕЯКІ ПИТАННЯ ЗАБЕЗПЕЧЕННЯ ЖИТЛОМ ВНУТРІШНЬО ПЕРЕМІЩЕНИХ ОСІБ, ЯКІ ЗАХИЩАЛИ СУВЕРЕНІТЕТ, НЕЗАЛЕЖНІСТЬ ТА ТЕРИТОРІАЛЬНУ ЦІЛІСНІСТЬ УКРАЇНИ

The article examines the problems of provision of housing for internally displaced persons who defended the independence, sovereignty and territorial integrity of Ukraine and took a direct part in the anti-terrorist operation, ensuring its conduct, being directly in the areas of the anti-terrorist operation during its conduct, in the implementation of measures to ensure national security and defence, repelling and deterring the armed aggression of the russian federation in Donetsk and Lugansk regions, ensuring their implementation, being directly in the districts and during the implementation of the specified measures. The concept of an internally displaced person is defined. The directions of social security of internally displaced persons are characterized, namely: 1) provision of housing; 2) provision of medical assistance; 3) social welfare of children in matters of education and science; 4) provision of the entire complex of social and administrative services by state bodies; 5) assistance in the return of forced migrants to their place of residence in accordance with state registration; 6) provision of social benefits and social assistance. The group of persons who have the right to receive compensation for obtaining housing is determined. The normative acts regulating the procedure and conditions for providing monetary compensation to internally displaced persons who defended the independence, sovereignty and territorial integrity of Ukraine and took a direct part in the anti-terrorist operation, ensuring its implementation, being directly in the areas of the anti-terrorist operation during its implementation were analysed. It was concluded that the order and conditions, which determine the mechanism of providing subventions from the state budget to local budgets for payment of monetary compensation for obtaining housing for internally displaced persons who defended the independence, sovereignty and territorial integrity of Ukraine and took a direct part in the anti-terrorist operation, ensuring its implementation, being directly in the areas of the anti-terrorist operation during its implementation, in the implementation of measures to ensure national security and defence, repelling and deterring the armed aggression of the russian federation in Donetsk and Lugansk regions are imperfect and need to be improved. It is proposed to adopt a law that would approve the procedure and conditions for allocating subventions for providing monetary compensation for housing, since the process of preparing laws is more thorough, and the procedure for adopting a law by the highest collegial body of the legislative power is more democratic than the procedure for adopting by-laws. In this law, it is proposed to clearly define the concept of an authorized public authority and give an interpretation of this term. It is also proposed to normatively regulate the issue of receiving monetary compensation to those persons, whom it is intended to, but was not paid due to the occupation of their settlements after February 24th, 2022. Key words: internally displaced person, anti-terrorist operation, monetary compensation, subvention, right to housing.

Organization of Anti-Epidemiological Measures by Workers of Zemstvo Medicine in Russia at the end of the XIX – at the beginning of the XX century

Introduction. The bodies of zemstvo self-government, created in 1864 and gradually spreading throughout the territory of the Russian Empire, performed important social functions: the development of education, medicine, assistance in difficult circumstances (crop failure, fires), etc., and this activity was directed primarily on the peasant population. The prevention of epidemics and the provision of medical assistance in the event of their beginning were the most important areas of work of zemstvos. In the provinces, a district network of medical and paramedic points was created which constantly monitored the epidemiological situation in the villages, in a number of provinces special sanitary points were opened. The implementation of anti-epidemiological measures was carried out at the expense of the provincial zemstvo on the proposal of the governor. Special infectious barracks were opened to reduce the number of patients and for seriously ill patients during the epidemic. Employees of zemstvo hospitals carried out work in different directions: conducting explanatory conversations with the population about the observance of sanitary standards, the need for vaccinations for children, vaccinations (mainly for children), examination and prescribing treatment for patients, maintaining medical statistics. Such work yielded results: the number of epidemics and cases decreased, but it was impossible to prevent epidemiological diseases completely until 1917. Methods. The solution of the set research tasks was provided by a complex of interrelated theoretical (analysis of scientific literature, comparative analysis, comparison, generalization, systematization), empirical (study and generalization of sources) and hermeneutic methods. Results. Zemstvo medical activity from 1864 to the end of the 1870s only determined the directions of work, was inconsistent and in the field of combating epidemics was fragmented. In fact, the work was not limited to preventing epidemics but to eliminating those that had already broken out. The state did not provide special assistance to the zemstvos in this direction. Only in 1879, due to the strongest epidemic of diphtheria at the government level, “Mandatory rules on measures to prevent the development of infectious diseases” were introduced. In accordance with which, mandatory sanitary and police measures against the spread of these diseases began to be determined. Conclusion. The selfless work of zemstvo medical workers, the introduction of a system of measures to prevent diseases led to a reduction in both the number of epidemics and the number of cases, but it was impossible to eliminate the epidemics completely until 1917.

Клінічні аспекти діагностики та лікування внутрішньосуглобових переломів п’яткових кісток

В аналітичному огляді літератури розглянуті питання діагностики та лікування внутрішньосуглобових переломів п’яткових кісток. Висвітлені основні тенденції і напрямки діагностики та лікування: механогенез, сучасні класифікації, стандарти обстеження, можливості оптимізації надання медичної допомоги постраждалим із внутрішньосуглобовими переломами п’яткових кісток. У результаті проведеного аналізу встановлено, що існує проблема діагностики й якісного лікування внутрішньосуглобових переломів п’яткових кісток, яка потребує вирішення шляхом розробки, впровадження комплексних методик діагностики та лікування на засадах доказової медицини.

Організація медичної допомоги при подіях із масовим ураженням людей

Актуальність. Збільшення кількості надзвичайних ситуацій із масовим ураженням людей, зокрема через аварії на транспорті або терористичні напади, призводить до одночасного надходження значної кількості постраждалих осіб до закладів охорони здоров’я та потребує збільшення готовності системи охорони здоров’я до медичного реагування через постійний перегляд і опрацювання Плану реагування та взаємодії під час виникнення надзвичайних ситуацій і ліквідації їх наслідків. Під поняттям «події з масовим ураженням людей» (для закладу охорони здоров’я) у поданій статті розуміють ситуацію, через яку виникає невідповідність між одночасним надходженням значної кількості постраждалих і можливостями надання їм медичної допомоги без впровадження змін у повсякденні форми та методи роботи, на відміну від надзвичайної ситуації потреба залучення зовнішніх ресурсів закладом охорони здоров’я відсутня або мінімальна. Мета. Оптимізація інформаційного забезпечення системи управління медичною допомогою постраждалим при подіях із масовим ураженням людей. Матеріали та методи. Робота ґрунтується на власному досвіді організації та безпосередньому наданні медичної допомоги постраждалим при подіях із масовим ураженням людей і надзвичайних ситуаціях в Україні та за її межами, участі у міжнародних проектах і навчаннях, зокрема під егідою Європейської комісії гуманітарної допомоги та цивільного захисту. Під час проведення дослідження застосовано бібліографічний і семантичний методи пізнання. Узагальнено організаційні аспекти медичного забезпечення 46 випадків масового ураження людей, які відбулись у світі впродовж 1979–2015 рр., із них унаслідок терористичних нападів з використанням вибухових пристроїв — 33 (71,7 %), вогнепальної зброї проти незахищеного цивільного населення — 6 (13 %), пожежі в закладах відпочинку — 3 (6,5 %), сильнодіючих отруйних речовин — 2 (4,3 %) і внаслідок транспортних аварій — 2 (4,3 %). Результати. Організація медичної допомоги постраждалим внаслідок подій із масовим ураженням має ґрунтуватись на принципах 4С кризового менеджменту відповідно до введеного режиму функціонування органів і закладів охорони здоров’я. В системі охорони здоров’я України доцільно впровадити режими, що існують в країнах Європейського Союзу: 1) готовність до можливого надходження значної кількості постраждалих («зелений рівень»); 2) часткова мобілізація («жовтий рівень»); 3) повна мобілізації («червоний рівень»). Первинне медичне сортування постраждалих на догоспітальному етапі передбачає розподіл на дві основні групи: термінові та нетермінові. Нетермінових постраждалих слід доставити до лікарень, які географічно розташовано недалеко від місця події, але не до найближчого закладу, який має бути готовим до надання екстреної медичної допомоги терміновим хворим і тим, хто звернувся самостійно (самозвернення), кількість яких може суттєво перевищувати тих, кого доставлено бригадами екстреної (швидкої) медичної допомоги. До групи управління закладу охорони здоров’я включають відповідальних чергових — лікаря-хірурга та лікаря-анестезіолога. До форм інформаційного забезпечення системи управління надання медичної допомоги на догоспітальному етапу належать: 1) сили та засоби на місці події; 2) розподіл постраждалих на місці події; 3) потреба підсилення догоспітального етапу. На госпітальному етапі визначають можливості проведення хірургічних операцій та кількість вільних лікарняних ліжок: 1) операційний блок; 2) лікарняні ліжка. Висновки. В систему охорони здоров’я України при подіях із масовим ураженням людей доцільно впровадити відповідні рівні функціонування, що використовують в країнах Європейського Союзу. Перерозподіл наявних ресурсів охорони здоров’я при наданні медичної допомоги постраждалим при подіях із масовим ураженням людей на догоспітальному та госпітальному етапах критично важливе для збереження життя та здоров’я постраждалих. Управління надання медичної допомоги при масовому ураженні людей потребує відповідного інформаційного забезпечення догоспітального та госпітального етапів, впровадження галузевої та міжвідомчої взаємодії.

On the work of the medical team during the spring sowing season in 1932 at the "Jedalik" collective farm of the Nariman village council of the Aravan-Burin region Kir. YSSR

Plan: 1 / General characteristics of the collective farm, 2 / production plan, 3 / work of the health center: a / introduction of a minimum of sanitary, b / approaching first aid to the brigade, c / organization of sanitary posts, d / combating injuries and simulation and absenteeism, e / organization and assistance to a kindergarten and a playground, f / provision of medical assistance at a health center, the fight against smallpox.

Scientific potential of military medicine in the Great Patriotic War (1941–1945)

Reconstruction of the historical and scientific-practical heritage of the military-medical and scientific potential of the country during the Great Patriotic War is of enduring relevance. Already by 1940, more than 250 specialized scientific institutions were created in relation to theoretical, preventive and clinical medicine in which more than 21,000 scientific workers worked (of them 2394 doctors and 5025 candidates of sciences). During the war, the scientific potential of military medicine continued to be strengthened (4 academicians, 22 honored scientists, 275 professors, 556 associate professors, 306 doctors and 1199 candidates of sciences).
 The Military Medical Academy played an important role in solving scientific problems. Active scientific work continued not only in the departments and laboratories of the Academy, but also at the fronts. Scientists of the academy prepared many instructions and instructions on various issues of military medicine, which contributed to the improvement of the system of medical support for troops on the basis of military field medical doctrine. For the first time, methods have been developed for planning medical support for combat and issues of organizing medical support for army and front-line operations.
 The practical significance of the principles of the military field doctrine developed during the Great Patriotic War was repeatedly confirmed by the experience of medical support of Soviet troops during the war in Afghanistan, as well as in the provision of medical assistance during counter-terrorist operations in the North Caucasus (9 figs, bibliography: 5 refs).

Emergency responder and public health considerations for plastic sewer lining chemical waste exposures in indoor environments

The cured‐in‐place pipe (CIPP) manufacturing process is used to repair buried pipes, and its waste commonly discharged into the air can enter nearby buildings. Exposure can prompt illness and the need for medical care. A mass balance model was applied to estimate indoor styrene concentrations due to intrusion of CIPP emissions through plumbing under different bathroom ventilation conditions. To better understand building contamination and recommend emergency response actions, calculations to estimate chemical intrusion through plumbing were developed. Field reports and study calculations showed that contractor-applied external pressures during plastic manufacture have and can displace plumbing trap water seals. Modeled styrene vapor concentrations that entered the building (1, 300, 1000 ppm) were similar to those measured at CIPP worksites. Modeling revealed that in some cases, bathroom exhaust fan operation during a CIPP project may increase indoor styrene concentrations due to enhanced entrainment of styrene-laden air from the sink and toilet. However, styrene concentrations decreased with increasing air leakage across the bathroom door due to reduced suction from the plumbing system. CIPP waste discharge should be treated as a hazardous material release and can pose a threat to human health. Immediate building evacuation, respiratory protection, provision of medical assistance, source elimination, and building decontamination are recommended.

Дорожно-транспортный травматизм на федеральной автодороге в регионе с низкой плотностью населения: актуальность проблемы и пути её решения

The purpose of the study is to use the example of the Arkhangelsk region to identify conditions affecting the organization of medical care for victims of road accidents on the federal highway in a region with a low population density, and to determine the main directions of its improvement. Materials and research methods. Using the method of comparative analysis, the following review was carried out: review of the authors’ studies, the subject of which was the features of road traffic injuries on the federal highway M-8 «Kholmogory» within the Arkhangelsk region; review of domestic and foreign scientific research, review of regulatory documents on the provision of medical assistance to victims of road accidents. Scientific literature search was performed in eLibrary, PubMed, Scopus systems by keywords. Scientific articles published in 1990–2020 were selected for analysis. Using the method of an organizational experiment, a scientific substantiation of a set of measures to improve the efficiency of the provision of medical care in prehospital and hospital periods to victims of road traffic accidents at federal highway in regions of the Russian Federation with a low population density was carried out. Applying the method of system analysis, on the basis of the results of this study, conceptual provisions for a systemic register of health consequences of road accidents in the Russian Federation have been developed and scientifically substantiated. Research results and their analysis. The article describes road traffic injuries on the federal highway M-8 «Kholmogory» in the Arkhangelsk region. The factors that determine the effectiveness of the provision of medical care in prehospital and hospital periods to victims of road traffic accidents are considered. The ways of improving the provision of medical care to victims of road traffic accidents at federal highway in a region with a low population density are formulated and substantiated.

Samobójstwo wspomagane w prawie polskim oraz niemieckim. Uwagi na tle wyroku Federalnego Trybunału Konstytucyjnego

The article concerns the issue of admissibility of assisted suicide in Poland and Germany. The main research question is the possibility of accepting the right of an individual to commit suicide and to apply for help of the third party in this matter. The analysis of this issue has been made by comparing Polish and German regulations, with particular attention paid to the judgment of the Federal Constitutional Court issued in February 2020. The existence of the right to suicide would have to influence the perception of not only the suicide itself and the possible provision of medical assistance to persons committing a suicide attack, but also assisted suicide in form of providing resources or assistance to persons intending to commit suicide. Before the judgment was delivered, the legal assessment of such behaviour under German law depended on the relationship between the person who provided the assistance and the suicide - the institutions which provide assistance for suicide in an organised manner (for example the Swiss association „Dignitas”) were prohibited. In Poland, on the other hand, there is a dispute concerning the assessment of assisted suicide – part of the doctrine considers this to be an activity prohibited by Article 151 of the Polish Penal Code, while others considers that this provision does not apply to aid granted at the initiative of a future suicide. Therefore, the German experience is helpful in assessing the issue of admissibility of assisted suicide, especially discussion about the former regulation. The article presents criminal law regulations in both countries and an analysis of the adoption of the right to commit suicide in the Polish legal system.

Professional experiences of formal healthcare providers in the provision of medical assistance in dying (MAiD): A scoping review.

This scoping review describes the existing literature which examines the breadth of healthcare providers' (HCP's) experiences with the provision of medical assistance in dying (MAiD). This study employed a scoping review methodology: (1) identify research articles, (2) identify relevant studies, (3) select studies based on inclusion/exclusion criteria, (4) chart the data, and (5) summarize the results. In total, 30 papers were identified pertaining to HCP's experiences of providing MAiD. Fifty-three percent of the papers were from Europe (n = 16) and 40% of studies were from the USA or Canada (n = 12). The most common participant populations were physicians (n = 17) and nurses (n = 12). This scoping review found that HCPs experienced a variety of emotional responses to providing or providing support to MAiD. Some HCPs experienced positive emotions through helping patients at the end of the patient's life. Still other HCPs experienced very intense and negative emotions such as immense internal moral conflict. HCPs from various professions were involved in various aspects of MAiD provision such as responding to initial requests for MAiD, supporting patients and families, nursing support during MAiD, and the administration of medications to end of life. This review consolidates many of the experiences of HCPs in relation to the provision of MAiD. Specifically, this review elucidates many of the emotions that HCPs experience through participation in MAiD. In addition to describing the emotional experiences, this review highlights some of the roles that HCPs participate in with relation to MAiD. Finally, this review accentuates the importance of team supports and self-care for all team members in the provision of MAiD regardless of their degree of involvement.

The Provision of Medical Assistance to Victims of the Earthquake in Armenia (for the 30th Anniversary of the Tragedy)

Abstract. The article presents the organization of specialized medical care to patients with crush syndrome, acute liver and kidney failure (ALKF), and endotoxic shock, who suffered in the earthquake in Armenia, delivered via air ambulance to N.V. Sklifosovsky Research Institute. In the present report we defined characteristics of medical supplies, qualified and specialized treatment of patients with combined trauma.

Training students basis of first provision health care

It is known that in connection with the untimely provision of medical assistance in case of disasters, incidents, any events where there are victims, up to 30% of victims die in the first hour, up to 70% in 3:00, and up to 90% in 6:00. Usually the life and health of the victim depends on first aid by persons without special medical education.
 The high level of injuries is always alarming, therefore it is very important to be able to prevent injuries, and the ability to provide first-aid medical care is a necessary knowledge for all specialists – university graduates.
 First aid is a set of urgent measures taken in case of accidents and sudden illnesses aimed at terminating the harmful factor, eliminating life-threatening phenomena, alleviating suffering and preparing the victim to be sent to a medical institution.
 It is essential that each student be aware of the essence, principles, rules and sequence of first aid.
 The article is a brief guide to the first aid in emergency situations in different circumstances, and can also be used in the educational process to prepare students who do not have a medical education, but are required to be able to provide first aid.
 The solution of this problem requires the development and implementation of modern scientifically based information on injury prevention and untimely first aid. In order to increase the effectiveness of first aid, the article offers instruction on knowledge and skills, which is developed in accordance with the program of the course «Fundamentals of Medical Knowledge» and «The Course of Medical Training for Rescuers», which is approved by the Medical Directorate of Ukraine MSC, which should be laid out for students at the life safety basics classes.

Provision of medical assistance in dying: a scoping review

ObjectivesThe purpose of this study is to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of medical assistance in dying (MAID) in order...

LEGAL ASPECTS AND UNCONVENTIONAL METHODS OF CANCER TREATMENT

Background: The current legislation on the provision of medical assistance fixes the patient’s right to health care and medical assistance (Article 41 of the Constitution of the Russian Federation). Hence it follows that the patient has the opportunity to receive advice on the use of different treatment methods not only from his/her attending physician, but also from other doctors, to use available reference information, and to consider options for using methods of alternative medicine. Patients have the right to refuse treatment if they consider that the treatment options offered by the attending physician are inappropriate for them. Physicians have no right to treat patients without a patient’s informed consent. It is necessary to determine the actual legal model of the relationship between the attending physician and the patient, who may have different options for further treatment. The purpose of the study was to analyze the legislation on the protection of public health, which allows the attending physician to refuse further treatment of a patient, informing the chief physician about the reasons for the refusal. Results. In cases when cancer hospitals and centers refuse to treat patients who decline conventional cancer treatment and require alternative medicine instead, a signed mutual refusal of medical care is documented: the patient’s refusal of the treatment and the cancer institution’s refusal of the treatment options offered by the patient.

The provision of medical assistance in dying: protocol for a scoping review

IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive...

Analysis of catamnesis of combatants–pensioners of the Ministry of Internal Affairs with mental disorders

We analysed catamnesis of combatants and pensioners of the Ministry of internal Affairs (MIA) of Russia, dismissed in connection with the presence of mental disorder impeding further passage of service. It is shown that within three years after the dismissal of the combatants noted the negative clinical dynamics of mental state with a disability, the formation of a concomitant alcohol dependence. They have expressed social problems as divorce, do manual work low-skilled or do not work, which requires improved approaches to providing them with medical psychological and social assistance, with regular observation. The establishment of mental health Centers in the departmental regional health units of the Ministry of internal Affairs of Russia on the basis of existing centres of psychophysiological diagnostics, system-monitoring the mental state of the combatants with mental disorders and improve the quality of provision of medical assistance.

MEDICAL SERVICES OR MEDICAL CARE – AN URGENT ISSUE FOR PUBLIC HEALTH INSTITUTIONS

Purpose. To consider the relationship between the concepts of “medical service” and “medical care” in the work of public medical institutions, based on the analysis of normative legal documents of the modern period. Materials and methods. In the course of the research, more than 18 legal and regulatory documents that were published during the period from 1990 to 2017 were analyzed, an analysis of judicial practice and related literature sources (periodicals) was carried out. Results. The analysis made it possible to distinguish the stages in the development of the organizational and legal framework for the provision of paid medical services in the Russian Federation and the dynamics of the relationship between the terms “medical care” and “medical service”. It was revealed that the concept of “medical services” appeared much later and was associated with the development of paid medical services and the need to establish legal aspects of health care. The provision of medical assistance is regulated mainly by public law, and the provision of medical services is governed by private law. The term “medical care” is broader than the “medical service” from the standpoint of the social aspect. At the same time, the concept of “medical service” can be considered more widely than medical care in cases when it is not only about measures aimed at treating the patient, but also about providing additional services to the patient in the process of receiving medical care. Conclusion. Thus, we concluded that the categories of medical care and medical services should not be identified, but also not completely different concepts, but rather enter into a partial intersection relationship. The need to distinguish between the concepts of “medical care” and “medical service” is dictated not only by the category relations or opinion of the population and the medical community, but also by the need for legal support for the process of providing paid medical services with state-owned establishments.