Background. The effective development of healthcare and, in particular, clinical medicine, increasingly depends on the unique medical technologies and modern equipment used. Therefore, in order to form a competitive healthcare system in a megapolis, it is important to introduce a management mechanism that allows constant monitoring of emerging new technologies and a comprehensive assessment of their impact on changing the quality of medical care, assessing their contribution to public health, that is, creating a “technological funnel” for the healthcare system. Purpose. The purpose of  this study is to identify the urgent problems in the analysis and comprehensive assessment of new medical technologies and determine the possible mechanisms for their introduction into clinical practice. Materials and methods. The methodology of this work is to study the literature and research of the most successful practices of introducing new medical technologies (on the example of the capital’s healthcare), study the opinions of the population and healthcare professionals based on the analysis of social networks. Results. Based on the systematization of information obtained by the authors in the course of the study, authors identified the most important new medical technologies for the population and health care professionals, which, in their opinion, have changed the landscape of the capital’s health care for the better. Authors determined significant criteria for improving the efficiency of the health care system through the search, comprehensive assessment and scaling of innovative practices in clinical medicine. Discussion. The creation of a «technological funnel» in the health care system of the capital makes it possible to conduct comparable research on the quality of medical care provided with many countries of the world. In addition, the constant search and comprehensive assessment of new medical technologies, potentially suitable for implementation in city clinics, can significantly influence the improvement of the quality of medical care provided to the population. Conclusion. Solving the problems associated with the optimization of search processes, comprehensive assessment, unification of the processes of introducing new medical technologies, can significantly improve the quality of medical care, as well as affect the contribution of health care to the health of citizens. At the same time, such studies require careful research and search for approaches that meet modern realities.

Background. The increase in the number of diagnosed strokes in children, significant distinctive features and complexity of diagnosis, treatment and prevention of cerebrovascular diseases in children compared with adults, the impossibility of direct extrapolation of therapeutic recommendations from adult practice to pediatrics required the creation of specialized primary centers of pediatric stroke in Russia. Purpose. The purpose of this article is to describe the experience of organizing a Center for the treatment of children and adolescents with cerebrovascular diseases (hereinafter referred to as the Center) on the basis of the multidisciplinary pediatric hospital of the Morozovskaya Children’s City Clinical Hospital of Moscow Healthcare Department, the introduction of modern methods of diagnosis and treatment of strokes in pediatrics, the organization of preventive measures, maintaining the city register of children’s stroke, coordinating the provision of medical care to children with cerebrovascular diseases at various levels in the city of Moscow. Materials and methods. The presented experience of organizing and operating the Center covers the period from 2014 to 2019. Researchers used descriptive, statistical, and comparative analysis to demonstrate the Center’s performance and justify proposed improvements in diagnostics, management of pediatric patients with cerebrovascular disease, and relapse prevention. Results. In the course of the organization and operation of the Center, there was assessed the frequency of children’s strokes in the city: in 2015 – 6.59 cases per 100 thousand of the child population of Moscow; in 2016 – 6.51 per 100 thousand; in 2017 – 6.43 per 100 thousand and in 2018 – 5.86 per 100 thousand. There were improved: the diagnostics of cerebrovascular pathology and its algorithm, modern reperfusion methods of treatment (thrombolysis, thromboextraction) were introduced into practice, outpatient observation. The equipment and trained specialists concentration on the basis of the Center allowed the creation of the Center «full cycle». Maintaining the city register of pediatric stroke made it possible to compare Russian data with those available in the literature and to establish international cooperation with the International Pediatric Stroke Organization. Conclusion. The establishment of the Center is an important example of interdisciplinary interaction in pediatrics. The City Register of Pediatric Stroke will make it possible to assess the problem of childhood stroke in Moscow. The accumulated organizational, medical and diagnostic, scientific, international and educational experience of the Center can be introduced in other regions of the Russian Federation to improve the provision of medical care to children and to solve the most important problem - preserving the health of the country’s child population.

Background. One of the tasks of the state policy in the field of health care is to improve the quality of medical services for the population, to increase the requirements for the competencies of medical personnel, on the results of whose activities public health depends. In this regard, the efficiency of organizing the processes of basic training and retraining (additional education) of doctors acquires a special role. Purpose. Revealing urgent problems of professional training of doctors for the capital’s health care. Materials and methods. Sociological research in the form of a series of expert interviews. Results. On the basis of the systematization of the information obtained by the authors in the course of the study, imperfections in the organization of the educational process in obtaining higher medical education are determined. Discussion. Professional training of doctors is a dynamically developing system, the effectiveness of which ultimately affects the quality of medical services provided to the population. Conclusion. Solving the problems associated with improving the content of curricula in medical universities, organizing the educational process and monitoring knowledge requires careful research and search for approaches that meet modern realities.

Background. The main controversial technical issues of pancreas transplantation are kinds of diverting pancreatic secret from the transplanted organ, as well as methods of its arterial reconstruction to ensure adequate and full blood supply of the graft. The article describes our experience in introducing two new technical variants of pancreas transplantation into clinical practice: with stump-free duodenal drainage and with its isolated blood supply by the splenic artery. Materials and methods. Our proposed operation with stump-free duodenal drainage of pancreatic secret using the button-technique method allows to minimize complications caused by duodenal injury and to reduce the antigenic load. The hardware method of forming the intestinal anastomosis allows to create a uniform compression along the line of anastomosis, provides strength and tightness of the seam, accurate tissue comparison, and the ability to adjust the closure of the brackets contributes to reliable hemostasis of tissues of different thickness. Results. The modified technique of pancreas transplantation with isolated blood supply through the splenic artery can be used both when it is impossible to perform the generally accepted arterial reconstruction of the graft, and as a routine procedure, since adequate and sufficient hemoperfusion of all pancreatoduodenal graft’s parts with its isolated blood supply through the splenic artery is justified and possible due to the presence of a developed system of collaterals between the splenic and superior mesenteric arteries.

The aim of this pilot non-interventional observational research was to assess the prevalence of adverse events associated with the use of antimicrobial drugs in children with cystic fibrosis, including the situations with the absence of the expected therapeutic effect in terms of clinical manifestations at the stage of hospital treatment. The observation group included 15 patients with cystic fibrosis hospitalized at the Morozovskaya Children’s City Clinical Hospital of Moscow Healthcare Department from 12.12.2019 to 30.03.2020. In the article there was carried out the analysis of the safety of antimicrobial drugs use by all children hospitalized with cystic fibrosis. During the study period, there were no serious adverse events caused by the use of all drugs. Adverse events were reported in 3 out of 15 patients included in the observational study with the use of 4 drugs. Thus, in our study the frequency of adverse events connected with the use of antimicrobial drugs by the patients with cystic fibrosis is 11.8%, which does not exceed the rates for the general population of patients receiving antimicrobial drugs registered for medical use in the United States and the European Union (according to experts 14-20 %). During the observation period in hospital of patients with cystic fibrosis, there was no established fact of pharmacotherapy ineffectiveness. This pilot non-interventional observational study has serious limitations for analysis, therefore, in accordance with letter of the Federal Service for Surveillance in Healthcare (04/01/2020 № 02-17376/20), based on the results of a meeting at the Federal State Budgetary Scientific Institution “Moscow State Scientific Center named after Academician N.P. Bochkov» federal medical institutions providing medical care to children with cystic fibrosis continue to implement the program for monitoring the effectiveness and safety of antibacterial drugs used in patients with cystic fibrosis during hospitalization on permanent basis.

Background. The article is dedicated to the study of native and international robotic surgery development as a revolutionary treatment technology. The article reveals the essence and advantages of surgical treatment using robots. The data provided indicate insufficient growth of the world market for robotic
surgery, segmentation by country (in favor of highly developed countries) and monopolization. Materials and methods. The article is structured in theses with infographics, giving a complete picture of the main aspects. Results. The data analysis helped to identify the main trends and problems of robotic technologies market in surgery. The key issue is the difference between the number of operations that can be possibly performed in robotic surgical technologies and their actual number. Based on the results of the analysis, there were formed promising directions and tasks for the development of robotic surgery and possible approaches to their implementation. In this study there were discussed the possibilities of training doctors and the prospects of the Russian robotic-assisting complex, as well as the paradoxical situation in the world of robotic surgery. The paradox is that despite the low level of market development, growing number of research works in the field of robotic-assisted surgery, its proven therapeutic efficacy and the high demand from behalf of the population and the surgical community, still there are problems that cannot be solved for the next 5-10 years. With a focus on the abdominal area, these problems are: high expenses; limited functionality of the robot; the lack of qualified doctors, training problems; unprofitable implementation of robotic surgery for clinics (in the business aspect). The development and implementation of robotic surgical techniques and technologies in Russia can significantly increase the availability and quality of medical care, and greatly advance the implementation of some projects in healthcare. At the same time, Moscow can initiate the development of robotic surgery in the country and in the world. Conclusion. It is important to fit the new surgical robots into the healthcare system, especially in terms of costs, and perform a large number of surgeries to increase payback. This requires the development and launch of the federal program “Robot surgery”.

Background. Modern digital technologies use can solve many problems of Russian healthcare system. The digital medicine development should be accompanied by the informatization of all participants of the process of providing medical services. Analysis and assessment of the changes taking place in society and in the health care system itself in digitalization terms are necessary for making effective management decisions aimed at improving the population health. Purpose. The purpose of this study is to analyze the digital medicine state and prospects for the development. Materials and methods. The analysis of foreign and domestic literature on digital medicine was used to identify current trends in this area and the variety of technologies used. The data analysis from public opinion polls gave an idea of the main problems of Russian healthcare. The study of Internet resources, like information and discussion platforms for medical professionals, as well as survey data, made it possible to identify the main aspects of the informatization process in the healthcare system. Results. There were highlighted: the main advantages of information technologies use in the healthcare sector, the priority areas for the digital medicine short term
development, the level of understanding of telemedicine among healthcare workers, the main areas of discussion regarding digital medical technologies, as well as important problems, risks and trends in this area. Conclusion. The authors identified eight promising areas for the digital medicine short term development. The study of Internet resources has shown that medical social networks are an important channel for healthcare informatization, including professional adaptation, especially of young specialists, to work with new technologies. The Internet also allows physicians to expand their professional
capabilities with the help of software products for laboratory research, diagnosis and treatment. All participants of the medical and related industries are actively entering the digitalization process, striving to create a unified system for electronic data exchange. The main problem that slows down
the development of digital medicine in Russia and which needs to be addressed at the state level is ensuring data security. A key measure to solve this problem is informatization about digital health opportunities through social media. At the content creation level there must be built trust to this channel.

Purpose. Many aspects of the health care system effective functioning depend on the level of trust in it. The purpose of this work is to study and summarize the research of native and foreign scientists on the topic of trust in the health care system in order to identify the context and methodological approaches to the study of trust. Materials and methods. The author used in the review the method of systematic review of publications based on strict criteria for selecting publications of individual homogeneous original studies. The search was carried out in the bibliographic databases PubMed, Google Scholar. The author included in the review articles that mentioned trust in the health system as part of their research objectives or questions. No reports published in peer-reviewed literature were analyzed. Results and discussion. There are three positions to consider trust from: trust in the personality of a medical worker (interpersonal); institutional trust in medical organizations; trust in the health care system as a whole (systemic). Several studies have looked at trust in the context of public trust in health care. Within the health care system, there are processes of transfer of trust from an individual to an institution and back. Institutional trust has a significant impact on the formation of interpersonal trust. No causal relationship has been established about the impact of trust on treatment outcomes, and patient distrust of healthcare providers can have detrimental health consequences. The degree of trust in the health care system is different in various categories of citizens. Conclusion. The review revealed that there is no sufficiently accurate, theoretically substantiated and empirically verified definition of trust; trust studies are scattered and built around different definitions. The terms are used interchangeably between studies with the same focus and are not clearly defined and distinct. A variety of tools used to measure trust, the use of different concepts, a significant variation in the choice of the subject and object of empirical research, different methodological foundations of research make it difficult to compare and generalize research data, therefore, for further understanding, study, assessment and conduct of empirical research, a theoretical basis of trust is needed.

Background. The demand for transplants leads to an increase in the demand for donor organs and as the result to their shortage all over the world. The United States is one of the world leaders in the number of donors and organ transplants. The article presents the results of an analysis focused on finding ways to improve the efficiency of the American donation and transplantation system. Purpose. The aim of the study is to analyze the organizational and legal components of the United States organ donation and transplantation system and identify possible ways to reform it. Materials and methods. The study carries out informational analysis and assessment of the effectiveness of the US donation and transplantation system based on the available official statistics for the period from 1991 to 2019, the results of the simulation of the application of the presumption of consent to posthumous donation, regulatory legal acts, insurance programs and scientific research of foreign and Russian scientists in the transplantation field. Results. A statistical data comparison showed that, despite the significant success of the United States in the development of donation and transplantation, there is a growing shortage of donor organs in the country, as in the whole world. The results of the analysis identified promising directions for reforming the donation and transplantation system in order to increase its effectiveness. There is great potential for increasing the supply of donor organs by the possible transition of the United States from the model of requested consent to the presumption of consent for posthumous donation. Centers for the procurement of donor organs have the least efficiency in the US organizational model of donation and transplantation. The financial vulnerability of living donors and organ donor recipients requires attention, because insurance programs do not cover their expenses, incl. on immunosuppressive drugs, due to the gap between the standards of care for organ donor recipients and the policies of insurance companies. The ongoing support measures for living donation are clearly insufficient. Conclusion. The directions of the US donation and transplantation system reforming identified in the course of the study require further elaboration and discussion in American society, the adoption of new regulatory legal acts, the development of new rules for the work of the system participants, adjustments to the assessment procedure, funding and support at the state and international level. Only a set of organizational, legal, financial and stimulating measures will help to increase the number of donor organs and the number of transplants.

The multidisciplinary team (MDT) conference has evolved as an essential instrument in the optimal management of a complex patient in the era of ever-changing medical knowledge. MDT discussions may improve the quality of diagnosis and treatment as well as provide an additional formal opportunity for collaboration among colleagues. MDT conference has become the standard of care and decision making tool in oncology. Such meetings include medical staff from all oncology-related services, and the decision is encouraged to be supported by the principles of evidence-based medicine. This paper provides an overview of the goals, pitfalls, and general recommendations for holding a productive MDT discussion.