CHOLERA EPIDEMIC AND SOCIO-ECONOMIC REASONS OF THEIR DISTRIBUTION IN THE XIX CENTURY ACCORDING TO TAMBOV PROVINCE

The article examines the poorly studied topic of the influence of socio-economic causes on the occurrence and spread of mass infectious diseases on the example of cholera epidemics. The geographical scope of the study is limited to the territory of the Tambov province, as a typically agrarian with a predominantly rural population. Statistical materials presented by various collections on public health and medical services, as well as reviews of the Tambov province and reports of the Tambov City Council were taken as the main sources. A comprehensive analysis of the sources was carried out using both traditional scientific methods of research (system analysis, retrospective method, method of historicism, etc.) and modern methods, for example, the method of mathematical statistics. In the course of the work, the characteristics of the healthcare system of the studied region were given and the main factors that negatively affected the spread of cholera epidemics during the study period were identified. The author established a connection between the sanitary and hygienic situation and the spread of infections in rural and urban settlements of the Tambov province. As the main conclusion of the study, the author points to a combination of two main factors that negatively affected the sanitary situation in the province. This is a low level of literacy and cultural evelopment of the population combined with economic insecurity. With a shortage of doctors and unsettled zemstvo medical care, these factors contributed to the rapid spread of epidemics in the region.

1569 Paediatric Upper Limb Fracture Manipulation in A Children’s Emergency Department: Practice Changes During The COVID-19 Pandemic

Background Trauma theatre time is valuable and previous studies reported cost of £24.77/minute. BSUH Children’s emergency department (CED) guidelines were implemented in December 2016, allowing reduction of forearm and distal radius (DR) fractures in CED using 70% nitrous (N2O) sedation. Due to COVID-19 pandemic and the risks associated with aerosol generating procedures as well as staffing levels, CED shifted to using 50%N2O with or without intranasal fentanyl. Method Relevant fractures presenting to CED from Feb-Dec 2020 were identified and compared to previous years. Demographics, treatment modality, timings, and outcomes were reviewed for 275 patients. Results In 2017-2018, 56% were manipulated in CED under 70%N2O (compared to only 3% in 2016). The main barrier identified was shortage of doctors trained in sedation to supervise use of 70%N20. In 2020, 101 patients were suitable for manipulation in CED. 64 had DR fractures, 37 midshaft fractures, 65 were male. Mean age: 10 years. 92 patients (91%) were manipulated in CED/fracture clinic. One was under 70%N2O; the rest used 50%N2O with or without intranasal fentanyl. 8 (9%) had manipulation under GA. Of those manipulated in CED, 3 were re-manipulated in clinic for cast problems. A typical MUA takes 30minutes indicating a saving of £743 per case; therefore, £68,356 over the study period. Conclusions Paediatric upper limb fracture manipulation in CED under N2O is effective and provides significant cost savings. Due to changes related to COVID-19 pandemic, considerably more patients in 2020 were safely treated in CED/clinic. Using 50%N2O improves uptake due to lower staffing requirements.

Specialists with higher medical education on the labor market

Based on the weighted microdata of the 2019 Rosstat Labor Force Survey, it was examined how the labor strategies of doctors implemented at the microlevel affect the situation on the labor market on the whole. To do this, the author tried to find answers to the following questions: 1) how the potential of those who had higher medical education was used in terms of their involvement in economic activity, 2) what is the amount of those whose labor path ran within the field of their chosen profession, and who did not work in the specialty and 3) what are the reserves of the unemployed, which, under certain conditions, could be used. The analysis carried out from the perspective of not only the standard, but also the extended concept of labor force showed high involvement of this professionally qualified group in the economy. Specialists with diplomas from medical higher schools stood out sharply among other categories of specialists by their commitment to their initial choice of profession. Only a relatively small number of doctors changed the type of occupation. Young doctors (graduates of2016-2018) followed the same strategies Judging by the scale of the real and potential resources of medical specialists, there is no reason to say that they are available in any significant amount. In scientific and political circles it is widely discussed how to overcome the shortage of doctors. Underestimation of the rather rigid restrictions on inter-professional mobility in the field of medicine leads to an increase in the vulnerability of this group of highly qualified specialists in the labor market and, as a consequence, to professional burnout and a decrease in motivation to work, which is extremely dangerous in medical practice.

A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS

Background: The UK is experiencing a shortage of doctors. Consequently, the Medical Intern Programme, a unique two year programme consisting of an observership, four clinical rotations at the level of a foundation doctor within an NHS Trust and a postgraduate diploma from a university in the north of England, was set up to enhance the NHS workforce by facilitating the entry of international medical graduates into UK medicine via a supported transitional programme. We aimed to explore the experiences of the doctors enrolled on the Medical Intern Programme. Methods: Semi-structured interviews were conducted via the telephone with seven doctors enrolled on the programme. The interview guide was informed by the research questions and data were analysed using a thematic analysis. Results: We identified four themes that were important in the experiences of the doctors: preparing to work in the UK, feeling supported, weighing up the pros and cons of the programme and comparisons between countries. Conclusions: The Medical Intern Programme successfully facilitated international doctors' transition to the UK and working in the NHS. Support needs to be provided at the organisational, team and individual level including a period of observing and shadowing to enable the doctors to understand the systems and multidisciplinary team working in the NHS.

USING MACHINE VISION FOR FUNCTIONALITY EXPANSION OF MINI ROBOTS DECONTAMINATING MEDICAL PERSONNEL PREMISES IN CONDITIONS OF COVID-19 EPIDEMIC

In case of COVID-19 epidemic spread the requirements for protection of medical personnel were increased. This category of specialists has exposure of high risk of COVID-19, due to inevitable numerous contacts with infected persons.Because of this, existing practicable models of medical care are needed to be upgraded (Tavakoli, 2020). The emergency response path was implemented through the opening of new infectious hospitals, re-profiling clinics, as well as increasing workload on medical personnel. This approach is associated with the possible rapid drop-up of qualified medical specialists due to the illness, which is a strong limiting factor to respond to new threats of COVID-19 due to the risks of exhaustion of the human resource. In the worst scenario, a threat of collapse of the emergency and specialized medical care system due to peak load of severe patients under the shortage of doctors and support personnel. To prevent such an emergency, a complex of anti-epidemic events is provided, most of the purpose of interrupting infection contacts, isolation of the most vulnerable contingents, extended population testing for virus or contact with infected persons, this allows you to follow unwanted contacts with the subsequent mobility limitation.Digital monitoring technologies with digitization of incoming data of significant events played the increasing role in all these options. Today they are complemented by robotic supporting. Due to the high risk of the infection in the COVID-19 spread, including the intra-clinic infections, the requirements for reliable disinfection of closed premises intended for patients and medical personnel should be fulfilled. At the same time, the following circumstance should be taken into account. When these work-time activities are imposed on the employee who is forced to stay long in an infected air environment, he is subjected to additional impact of pathogenes. To reduce these threats, robotic support for the work for disinfection of premises with automated air environment control and tracing contacts.

Innovation in rural workforce strategies by a national surgical society

Health services exist to address the health needs of the community. But in Australia at present there are not enough detailed data to tell us to what extent, community by community, our highly regarded health system is meeting those needs. We know that demand for health care services is growing faster than the overall economy, and that we no longer have a general shortage of doctors, but most problematically there is a significant geographic maldistribution of those doctors away from rural and regional areas.iFor plastic surgery services, there is very little understanding of what the aggregate needs of rural communities are, or how these needs vary by community. We know by anecdote that there is significant inequity in plastic surgery services and that rural and regional locations often have unfilled positions and diminished services. We note that 80 per cent of specialist plastic surgeons live and work wholly within the five largest Modified Monash level 1 (MM1) Australian cities.1 Only 8.5 per cent of specialist plastic surgeons are permanently based outside those five cities. We also note that this is a more serious negative divergence than other comparable surgical specialties.While we briefly explore the basis for some ‘innovative’ solutions in this paper, we are constantly reminded that a prerequisite of any ‘solution’ should be an in-depth study of what Australian rural communities need or want in terms of plastic surgery services.

Personnel imbalance and ways to overcome it in the healthcare sector

The National Healthcare Project, which has been implemented in our country since 2019, includes eight federal projects aimed at developing individual elements of the industry. The federal project "Providing medical organizations of the healthcare system with qualified personnel" is the connecting link of all eight projects. It involves the elimination of the shortage of doctors and nurses in polyclinics, the staffing of medical workers by 95% and an increase in the number of doctors by 10% by the end of 2024. Without a sufficient number of specialists in the industry, its effective work is impossible. The surge in the incidence of coronavirus infection has become another challenge for the healthcare industry and exacerbated the problem of staff shortages. To solve the personnel problem, first of all, it is necessary to understand the reasons for the imbalance, to understand the incentives of young people who have just come to receive education and in the labor motives and doctors already working in the industry, to know the reasons that force them to leave the profession. The article presents the results of a study of factors-motivators of medical students, as well as medical workers.

The first military hospitals in Saint Petersburg

The documentary materials from the funds of the Russian State Archive of the Navy, other archives, published letters and documents of Peter the Great, his Daily Note and other sources about the history of the first military hospitals (infirmaries) of Saint Petersburg are studied. At the same time, the history of the first military hospitals is reflected against the background of the difficult events of the Northern War of 17001721, with which the establishment of hospitals for the Russian army and the navy and the development of military medicine are inextricably linked. The organization of military medicine became aggravated immediately with the outbreak of hostilities, with the first wounded and sick. The fight against the plague epidemic and other infections during the war, the shortage of doctors, healers, infirmaries, hospitals and their own national staff greatly complicated the provision of medical care. Numerous documents and facts prove that the events before 1715 can be attributed to the first stage in the development of military medicine in Saint Petersburg. It was established that in 1704 the issue of establishing a military land hospital in the northern capital was already discussed (Peter I, A.D. Menshikov, N.L. Bidloo); hospital), and the senior physician of the Navy Yang Govi served in it with zeal In 1713, by the decree of the Great Sovereign Y. Govi, he was appointed head of the Admiralty Hospital, doctors, apprentices and medical students in it. By that time, Dr. R. Erskine actually assumed the office of archiatrist (until 1712). A detailed statement of Lieutenant General R.V. Bruce on the number of sick and wounded who received medical care in hospitals and hospitals in Saint Petersburg from 1713 to 1715. The decree of Peter I on the construction of a complex of General hospitals with anatomical theaters on the Vyborgskaya side (1715) according to Dr. Areskins drawing, and the establishment of a medical school (until 1719) are the next stage in the development of military medicine in Saint Petersburg, prepared by all previous events.