The assessment of physicians' and senior medical students’ knowledge in the field of communityacquired pneumonia: preliminary results of the KNOCAP-II project (2017-2019)

Внебольничная пневмония (ВП) относится к одной из самых актуальных проблем современной медицины. На сегодняшний день ВП занимает 4 место в структуре смертности (после сердечно-сосудистых, цереброваскулярных заболеваний и злокачественных новообразований) и 1 место среди всех смертей от инфекционных заболеваний. Цель – оценка уровня знаний врачей терапевтического профиля и студентов старших курсов медицинских вузов в вопросах ведения пациентов с ВП. В рамках многоцентрового исследования KNOCAP (полное название проекта – «The assessment of physician and students’ knowledge of community-acquired pneumonia basics») представлены результаты анонимного проспективного опроса по оценке знаний и предпочтений врачей терапевтического профиля и студентов старших медицинских курсов в вопросах ведения пациентов с ВП. По итогам первого периода проекта (2017-2019 гг.) получены и проанализированы результаты анкетирования 588 врачей терапевтического профиля и 394 студентов-медиков из 17 центров России, Украины и Кыргызстана. За основу взят метод анонимного анкетирования, для чего была разработана оригинальная анкета на основании актуальных клинических рекомендаций. Наибольшие сложности вызвали следующие вопросы: сроки проведения повторного рентгенологического исследования при положительной динамике лечения, выбор основного диагностического признака при ведении пациента с ВП, указать типовые ошибки фармакотерапии ВП и выбор стартовой антимикробной терапии у пациентов с факторами риска и без них. В целом исследование показало значимое несоответствие знаний в вопросах ведения пациентов с ВП актуальным клиническим рекомендациям 2010 г. и проектом новых клинических рекомендаций 2018-2019 гг. В настоящее время существует необходимость в повышении уровня знаний и совершенствовании профессиональной деятельности врачей терапевтического профиля и студентов старших медицинских курсов, так как проведенный многоцентровой срез знаний и предпочтений специалистов во многих вопросах выявил их недостаточный уровень для корректного ведения пациентов с ВП. Community-acquired pneumonia (CAP) is one of the most relevant problems of modern medicine. Today, CAP takes 4th place in the structure of mortality (after cardiovascular, cerebrovascular diseases and malignant neoplasms) and 1st place among all deaths from infectious diseases. The aim of the study is to assess the level of general physician’ and senior medical students’ basic knowledge in CAP treatment. The article represents the results of anonymous prospective surveys within the framework of the second stage of KNOCAP multi-centered research project (full name of the project «The assessment of physician’ and students’ knowledge of community-acquired pneumonia basics») aimed at accessing the knowledge and preferences of doctors and students on the fundamental issues in diagnosis and treatment of community-acquired pneumonia. The survey conducted in 2017-2019 involved 588 physicians and 394 students from seventeen Russian, Kyrgyzstan and Ukrainian centers. The method of anonymous questioning was used in this study, for which an original questionnaire was developed on the basis of current clinical recommendations. The following fundamental questions caused the greatest difficulties in the respondents: terms for a repeated X-ray examination in positive dynamics of CAP treatment, the choice of main diagnostic criteria of CAP, the choice of the typical mistakes of CAP treatment, the choice of the initial antimicrobial therapy. In general, the respondents’ knowledge in CAP patients’ management deviates significantly from the current clinical guidelines, as of 2010, and from the new clinical guidelines draft, 2018-2019. Currently, there is a need to increase the level of knowledge and improve the professional activities of therapists and senior medical students, as a multicenter section of the knowledge and preferences of specialists in many issues revealed their insufficient level for the correct management of patients with CAP

SOCIAL CONTEXT AS A CATALYST FOR THE EVOLUTION OF REALIZED UTOPIAN MODEL OF URBAN MORPHOSTRUCTURE: THE CASE OF TOGLIATTI, RUSSIA

Proceedings of the XXV ISUF International Conference “Urban Form and Social Context: from Traditions to Newest Demands” (Krasnoyarsk, July 5–9, 2018)The article describes the role of social context in the evolution of a realized urban utopia’s morphostructure. Using the case of Togliatti, which is a typical Russian large single-industry city, the evolution of its morphostructure is investigated - from the utopian model of the industrial center, with its features of Le Corbusier’s “Radiant City”, to the modern pluralistic, polyfunctional city. The problems, which have been revealed in process of the functioning of this realized Soviet city utopia, are considered. Avtozavodskiy District of Togliatti is a large industrial area of the city, and its morphostructure reflects the functional workflow of the “ideal socialist city”, which was proposed by N.A. Milyutin in the 20-30ies of the 20th century. Under the supervision of B.R. Rubanenko, V.A. Shkvarikov, Yu. P. Bocharov in 1967-1968, under optimal geodemographic conditions, a regular urban grid-frame was laid. The functional structure of the grid is represented only by transport, and the main frame functions are redirected to the fabric, which is characterized by self-sufficiency, homogeneity and immanent intolerance to social context. Thus, the city’s layout was a system which, on the one hand, fully answered the ideal concept of a modernist city, built in accordance with the Athenian Charter principles, and on the other hand, contradicted the idea of the city as a concentrated environment. The solution which will help to overcome the critical condition of Togliatti lies in the field of generating new utopias. A team of young architects proposed a utopia, which they called “New Togliatti”. It is based on the concept of a macro frame, which will integrate the structures of both the historically established urban grids and of Avtozavodskiy District. The essence of the new concept was the replacement of redundant conceptuality with contextuality, in accordance with the new paradigm formed by socio-ecological thinking model