Introduction. Adolescence involves active personality formation and a variety of social networks. The educational environment has a significant impact and can predict the development of somatoform diseases. The assessment of the eating behaviour of high school students allows timely identification and prevention of adverse changes in the psyche, which has an impact on the formation of the mental and physical components of the quality of life of adolescents. Object. To study the peculiarities of eating behavior of senior schoolchildren and their dependence on physical development. Materials and methods. The study includes students of grades 8–11. Total 152 people. All teenagers passed an anonymous questionnaire. The questionnaire consisted of the questionnaire «Eating Attitudes Test» (EAT-26). Anthropometric data, physical health indicators and incidence of acute and chronic diseases were additionally determined. The statistical processing of the material was carried out using the application package IBM SPSS Statictics 26. When assessing the relationships between the factors, the one-factor variance analysis of ANOVA with determination of the level of reliability and significance of indicators was used. Results. The evaluation of the data revealed a correlation of sex and scales such as aspiration to lean, bulimia and body dissatisfaction. Among females, the walling levels are statistically higher (Scale 1: Pr = 0.091; Scale 2: Pr — 0.016; Scale 3: Pr = 0.039) compared to males. Age is associated with scales of body dissatisfaction, perfectionism and distrust in interpersonal relationships. It is revealed that the older the teenager, the higher the wallein in these scales. High values of wallets in each scale were from 14.3% to 28.1%. Conclusion. Adolescents experience high expectations, feelings of loneliness, insecurity and inability to control their own lives. The group at risk is the female students in high school.

Introduction. A common type of palliative intervention is the imposition of nutritional fistulas for enteral nutrition in dysphagia. The operation of choice is gastrostomy, in which the gastric stage of digestion is preserved. This is more physiological and reduces the risk of developing dumping syndrome and metabolic disorders that can develop with the introduction of nutrition into the jejunum directly. Ejunostomy is applied when gastrostomy is technically impossible due to damage to the stomach, or as a stage in another operation. The infrequent use of jejunostomy leads to a lack of awareness among medical professionals about the specifics of care and nutrition through jejunostomy, which differ significantly from the standard recommendations for gastrostomy. The aim is to study. Offer advice on care and nutrition through the jejunostomy. Materials and Methods. The recommendations are based on literature data and the clinical experience of the authors who perform these operations, teach patients and their relatives care, nutrition through the jejunostomy, and manage these patients at the outpatient stage. The results and their discussion. The article provides recommendations for the care of jejunostomy, depending on the type of jejunostomy and feeding tube. The technique of feeding through the jejunostomy is described in the details, while an original method for the slow introduction of the nutrient mixture in the absence of special systems for drip nutrition is proposed. General recommendations on the selection of a nutrient mixture for feeding through the jejunostomy are given. Conclusion. Fistula care and feeding of patients with jejunostomy are differ from similar activities carried out in patients with gastrostomy. The proposed article will improve the orientation of medical workers in the problem and may serve as the beginning of the development of domestic recommendations for the care of the fistula and nutrition of patients with jejunostomy.

Head and neck cancer can be invasive into the upper parts of the gastrointestinal tract which stop passing of food to complete dysphagia. If radically remove of the tumor is impossible, various palliative operations are used to provide patients with enteral nutrition. The purpose of the work is to offer an affordable method of minimally invasive gastrostomy, alternative to puncture techniques. Material and methods. An analysis of the nutrient fistula formed during puncture gastrostomy was carried out. A literature review has been carried out to search for minimal approaches in volume and trauma and minimally invasive gastrostomy through minilaparotomy has been developed, which allows to provide depleted patients with nutrition at the proper level if it is impossible to apply percutaneous endoscopic methods. These clinical examples prove the advantages of the proposed access and similarity to prototypes of puncture methods. There is no register of patients who have gastrostomy in the Russian Federation, at the request of the St. Petersburg Territorial CMI Fund received data on patients treated in city hospitals and tariffs corresponding to the correction of dysphagia in cancer patients. These data made it possible to assess the prevalence and preferred methods of gastrostomy, as well as the structure of the pathology that causes dysphagia. Results. Cross-cut puncture methods of gastrostomy is low traumatic surgery in exhausted patients and provide a feeding tube of the required diameter. The pressure method of fistula formation does not cause technical difficulties and can be supplemented by gastropexia. Most patients with dysphagia have a thin anterior abdominal wall, which determines the need for minimal gastrostomy through a minilaparotomy approach, in which the traumatic formation of the nutrient fistula does not exceed the puncture methods of gastrostomy. A clinical example of a patient hospitalized in the surgical department of a multidisciplinary hospital for emergency indications diagnosed with oropharyngeal cancer, a condition after hemiglossectomy with a reconstructive-plastic component, resection of oral bottom tissues, edge resection of the lower jaw with chin flap plasty, fascial-case excision of neck fiber and radiation therapy is given. Tumor progression. Dysphagia 3 Art. Kahexia. Tracheophageal fistula? Histological conclusion: squamous cell keratinizing cancer G1. This patient was successfully performed an operation according to the proposed method with gastrostomy tube 20 Fr. On the 10th day after the operation, the stitches were removed, the patient received adequate nutrition through gastrostomy, discharged in satisfactory condition for 10 ОРИГИНАЛЬНЫЕ СТАТЬИ ГОЛОВА И ШЕЯ РОССИЙСКИЙ ЖУРНАЛ Том 12, №1 – 2024 outpatient treatment. No postoperative complications were identified, the gastrostoma functioned, a balanced diet was provided. The patient received symptomatic therapy at the place of residence, was observed for two months. Conclusion. Minimal gastrostomy through minilaparotomy in its invasiveness approaches puncture percutaneous gastrostomy, is characterized by simple technique and high availability. This method can be offered to patients with a thin anterior abdominal wall if other minimally invasive methods are not available. Злокачественные новообразования головы и шеи могут распространяться на верхние отделы желудочно-кишечного тракта и препятствовать прохождению пищи до полной дисфагии. При невозможности радикального удаления опухоли применяют различные паллиативные операции, которые позволяют обеспечить больных энтеральным питанием. Цель работы предложить доступный способ малоинвазивной гастростомии, альтернативный пункционным методикам. Материал и методы. Проведен анализ питательного свища, сформированного при пункционной гастростомии. Выполнен обзор литературы для поиска минимальных по объему и травматичности подходов и разработана малоинвазивная гастростомия через минилапаротомию, позволяющая обеспечить истощенных больных питанием на должном уровне при невозможности применить чрескожные эндоскопические методики. Приведенные клинические примеры доказывают преимущества предложенного доступа и схожесть с прототипами пункционных методов. Учитывая, что реестра пациентов, перенесших гастростомию в Российской Федерации, нет, по запросу в Санкт-Петербургский Территориальный фонд обязательного медицинского страхования получены данные о пролеченных в стационарах города пациентах и тарифах, соответствующих коррекции дисфагии у онкологических больных. Приведенные данные позволили оценить распространенность и предпочтительные способы гастростомии, а также структуру патологии, вызывающей дисфагию. Результаты. Чрескожные пункционные методики гастростомии обеспечивают низкую травматичность операции у истощенных больных и обеспечивают постановку питательной трубки необходимого диаметра. Прижимной способ формирования свища не вызывает технических трудностей и может быть дополнен гастропексией. Большинство пациентов с дисфагией имеют тонкую переднюю брюшную стенку, что определяет необходимость выполнения минимальной гастростомии через минилапаротомный доступ, при котором травматичность формирования питательного свища не превышает таковой при пункционных методах гастростомии. Приведен клинический пример пациента, госпитализированного в хирургическое отделение многопрофильного стационара по экстренным показаниям с диагнозом рак ротоглотки, состояние после гемиглоссэктомии с реконструктивно-пластическим компонентом, резекцией тканей дна полости рта, краевой резекцией нижней челюсти с пластикой подбородочным лоскутом, фасциально-футлярного иссечения клетчатки шеи и лучевой терапии. Прогрессирование опухоли. Дисфагия 3 ст. Кахексия. Трахеопищеводный свищ? Гистологическое заключение: плоскоклеточный ороговевающий рак G1. Данному больному успешно выполнена операция по предложенной методике с гастростомической трубкой 20 Fr. На 10-е сутки после операции швы сняты, больной получал адекватное питание через гастростому, выписан в удовлетворительном состоянии на амбулаторное лечение. Послеоперационных осложнений не выявлено, гастростома функционировала, сбалансированное питание обеспечено. Пациент получал симптоматическую терапию по месту жительства, наблюдался в течение двух месяцев. Заключение. Минимальная гастростомия через минилапаротомию по своей инвазивности приближается к пункционной чрескожной гастростомии, отличается простой техникой и высокой доступностью. Данный способ может быть предложен пациентам с тонкой передней брюшной стенкой при недоступности других малоинвазивных методик

Dysphagia as a symptom of dysfunction of the digestive system occurs in patients with various pathologies and in severe cases requires the formation of a nutrient fistula. The presence of a stoma is a source of additional pathological changes. Changes in the microbiota of gastrostomy patients is an issue that is practically not covered in the scientific literature. The purpose of the study is to determine characteristic changes in the microbiota of the oral cavity, stomach and intestines caused by nutritional stoma and their clinical significance. Materials and methods. The study included 20 children fed through a gastrostomy tube and 10 children fed by mouth. Group 1 consisted of patients with a gastrostomy installed in less than 1 year, group 2 - in periods of more than 1 year, group 3 - children without gastrostomy. All patients underwent a standard examination in a gastroenterological hospital and 16S rRNA sequencing of aspirates from 3 biotopes - mouth, stomach and intestines. An assessment of physical development and bioimpedance measurements was carried out, and a group of patients with sarcopenia was identified. Results. In all three biotopes of patients with gastrostomies, a pronounced disturbance of microbiological homeostasis was found. In the oral cavity, the number of anti-carious microorganisms is reduced and, on the contrary, the level of periodontogenic strains is increased. This fact is the cause of the occurrence of comorbid conditions and requires the appointment of local therapy with probiotic strains approved for use. Changes in the gastric microbiome after gastrostomy placement are characterized by a high degree of H. pylori contamination against the background of a decrease in anti-inflammatory protection. Determining the level of bacteria of the genera Prevotella, Parabacteroides, Porphyromonas in the stomach can become a marker of concomitant chronic inflammatory changes in the mucous membrane of the upper gastrointestinal tract, a high risk of developing peptic ulcers and its complications. The state of the gut microbiome correlates with underweight, BMI, proportion of fat mass and active cell mass. The development of sarcopenia in gastrostomy patients is one of the possible dangerous comorbid conditions, one of the diagnostic criteria of which is a decrease in the level of Phylum Fusobacteriota bacteria.

Introduction. Restoration of nutrition in patients with nutritional deficiency hospitalized in intensive care units is a complex process due to the high risk of the development of refeeding syndrome. Refeeding syndrome is insufficiently studied in children not only with regard to pathogenesis and intensive care, but also with regard to its influence on the further development of the child.Materials and methods. A non-systematic review of literature sources was performed. Domestic publications were searched in the database on the eLibrary website, foreign publications were searched in PubMed, Google Scholar, Cophrane Library, Cyberleninka, ResearchGate databases in the period 2017–2024. 73 full-text publications describing risk factors, peculiarities of mechanisms of refeeding syndrome development in children, clinical picture and methods of intensive therapy were analyzed.Results. The review analyzed and systematized the stratified risk factors, peculiarities of pathogenesis and clinical picture of refeeding syndrome in children depending on developing metabolic disorders. The connection of refeeding syndrome on the progression of nutritional deficiency is shown. The main methods of intensive therapy, including nutritional support for patients with high-risk and developed refeeding syndrome are determined.Conclusion. Currently, there is no unambiguous definition and diagnostic criteria for refeeding syndrome in children. Timely intensive therapy in cases of refeeding syndrome development allows to correct nutritional deficiency, to increase the survival rate of patients, can influence further growth and development of the child.

Research of personal maturity allows to determine the resources of professional responsibility in the development of the doctor’s competencies, which is especially important during the period of adaptation to the new conditions of learning in the first year. Mature person due to developed qualities achieves better results in a short time and effectively interacts with other people. Purpose of the study is to determine the indicators of personal maturity of students enrolled in the first year in 2023. Materials and methods. The Department of General Medical Practice conducted a survey of students enrolled in the first year in 2023. Total 396 persons: 313 women and 83 men. The average age of the respondents was 18,18±1,71 years. The study used the Hilbuch method to assess the level of personal maturity in general and its components. Results. The high level of unsatisfactory indicators of both personal maturity in general and its components was revealed, among which the worst results were noted when assessing the relationship of freshmen to their «I» (74.8% to 63.9% for females and males respectively). The medians of most indicators were not satisfactory. There are no statistically significant differences by sex, but the median sense of relationship to his «I» was significant among female respondents. Findings. The low level of personal maturity of students was revealed with no motivation and undetermined life attitudes in the absence of the ability to psychological intimacy with other people, which can become a psychological barrier to the development of professional competencies and communication in medical professions. Components of personal maturity, sense of civic responsibility and «I»-concept must be formed at the initial stage of learning, using all the possibilities of educational work and psychological support for freshmen.

The article presents the accumulated experience of using minimal gastrostomy through minilaparotomy, which allows us to consider these methods of forming a nutritious fistula as an alternative to puncture gastrostomy in conditions of import substitution and possible unavailability of the necessary imported consumables.

Наиболее распространенным видом паллиативной помощи при дисфагии является наложение искусственных питательных свищей. При этом операцией выбора считается гастростомия, которой посвящено большое количество публикаций. Еюностомия выполняется значительно реже и меньше освещена в литературе. В статье представлен обзор литературы, отражающий эволюцию еюностомии как паллиативной операции для обеспечения энтеральным питанием при дисфагии. The most common type of palliative care for dysphagia is the imposition of artifi cial nutritional fi stulas. In this case, the operation of choice is considered to be gastrostomy, to which a large number of publications are devoted. Jejunostomy is performed much less frequently and is less covered in the literature. The article presents a review of the literature refl ecting the evolution of jejunostomy as a palliative operation to provide enteral nutrition for dysphagia.

The known negative consequences of intensive care unit stays, summarized as the post-intensive care syndrome (PICS) and including swallowing disorders (dysphagia) are also encountered in pediatric practice.Materials and methods. The non-systematic review of literature sources was carried out. Domestic publications were searched in the database on the elibrary website, foreign publications – in PubMed, Google Scholar, Cichrane Library, Cyberleninka, ResearchGate databases in the period of 1990–2023. When analyzed for the query «Dysphagia in Children», 1,496 results were found, «Post-intensive care syndrome in children» – 82 results. We analyzed 142 full-text publications describing the causes, mechanisms, and clinical presentation of dysphagia in children whose swallowing disorders occurred after hospitalization in intensive care units or were associated with severe somatic diseases.Results. The review analyzes the causes, features of diagnosis and treatment of dysphagia in pediatric patients with PIСS. 5 groups of causes in the structure of PIСS that can lead to the development of dysphagia were considered: infectious-trophic, vegetative-metabolic, neuromuscular, emotional-cognitivecomplications and decreased quality of life compared to the premorbid level. Complications associated with the development of dysphagia lead to increased length of stay in intensive care and hospitalization, lead to the development of malnutrition, aspiration pneumonia and other complications. The mechanisms of dysphagia development in children in intensive care units were analyzed. The main ways of dysphagia progression in pediatric practice are determined.Conclusion. Clarification of the causes and understanding of the mechanisms of dysphagia development in conjunction with the implementation of rehabilitation programs can contribute to the improvement of clinical outcomes in children who have undergone a critical condition in the immediate post-discharge period and in the future.

Introduction. There is no separate register of patients with dysphagia who need an artificial nutritional fistula and enteral nutrition. The situation can be indirectly judged by the data of the information system of the city multidisciplinary hospital in which these operations are performed.The purpose and objectives of the study. To study the structure of nosology, the order of hospitalization of patients with dysphagia and the ways of applying nutritional fistulas in the city multidisciplinary hospital of St. Petersburg.Material and methods. The data of the St. Petersburg municipal hospital № 26 information system of cases of gastrostomy and eunostomy in 2021 are analyzed.Results and discussion. In 2021, artificial nutritional fistulas were applied to 62 patients aged from 20 to 83 years, 63.1±12.64 years in average. In 49 (79.0%) hospitalized patients, the cause of dysphagia was malignant tumors that had already been diagnosed earlier. In 10 (16.1%) cases, patients underwent percutaneous endoscopic gastrostomy using the pull method, while dysphagia was of a functional nature and was a complication of non-tumor diseases. The patients operated by this method were aged from 20 to 80 years, 53.4±20.08 years in average. The imposition of an artificial nutrient fistula through laparotomy was performed in 52 (83.9%) patients aged 43 to 83 years, 64.94±9.90 years in average. All the patients of this group were older than patients, received puncture gastrostomy under the control of an endoscope (p<0.05).Conclusion. It is necessary to determine the tactics of monitoring of patient with dysphagia and resolving the issue of timely hospitalization for gastrostomy. Planned hospitalization for palliative intervention before the appearance of signs of decompensation of the general condition and obstruction of the upper digestive tract, will allow performing minimally invasive and, as a consequence, low-traumatic puncture methods of gastrostomy.

В статье проанализированы сроки госпитализации, проведения лечебно-диагностических мероприятий в стационаре и морфологические изменения удаленных червеобразных отростков у больных острым аппендицитом, пролеченных в Санкт-Петербургском научно-исследовательском институте скорой помощи им. И.И. Джанелидзе в 2017 году. Эти показатели могут служить объективными критериями качества оказания медицинской помощи у больных острым аппендицитом. The article analyzes the timing of hospitalization, therapeutic and diagnostic measures in the hospital and morphological changes in remote аppendix in patients with acute appendicitis treated at the St. Petersburg research Institute of emergency care I.I. Dzhanelidze in 2017. These indicators can serve as objective criteria for the quality of medical care in patients with acute appendicitis.

Introduction. The question of selecting the optimal diameter of gastrostomic tubes for enteric feeding remains unresolved. The aim of the study is to justify the choice of tube diameter for enteric feeding by studying deposits on the inner wall. Materials and Methods. A model for the introduction of specialized enteric and blender food through a tube at a temperature ranging from 36° to 40 °C has been developed. Polyvinylchloride probes with a length of 110 cm and an outer diameter ranging from 10 to 30 Fr with a step of 2 Fr are used as nutrient tubes. An imitation is performed nourishment 5 times a day for 300 ml for 30 days. After simulation, the probe’s internal clearance will wash 150 ml of water with a temperature of 37 °C, dried. At the beginning and end of the experiment, weighing and measuring the length of the probe was carried out. The results and their discussion. The specialized feed caused a blockage of 10 and 12 Fr probes, which were removed by washing 150 ml of water. There was no significant change in the mass of probes after the enteric feeding, indicating minimal sediments on the inner surface. The blending caused a blockage of probes 10, 12 and 14 Fr in diameter. Probes 10 and 12 Fr in diameter could not be recovered from washing with water. The power deposition on the inner walls of the probes was visually determined. No significant changes in the length of the probes were observed during the experiment. However, the change in the mass of probes after the blender feed is statistically larger than after the specialized one (p<0.001, Mann-Whitney criterion). Conclusion. It is advisable to use gastrostomic tubes with a diameter of 14-18 Fr to feed specialized mixtures. 18-24 Fr diameter tubes should be used when using a blender supply.

Gastrostomy is used to feed palliative patients with dysphagia. Currently, the preference is given to percutaneous puncture methods of gastrostomy, which do not require general anesthesia. Percutaneous puncture techniques are possible only if the patency of the upper parts of the digestive tract still exists for the «pull method» and can require additional X-ray irradiation in case of the «push method». These operations require expensive disposable kits, which affects the prevalence and availability of the technique. Therefore, the use of an alternative minimally invasive gastrostomy through minilaparotomy is justified. Minimal-invasive pressure gastrostomy is known for a long time, and in combination with small access, it can be successfully used to provide nutrition for palliative patients with dysphagia. Most patients with dysphagia have a thin anterior abdominal wall, which allows using minimal access. It is important to choose the right place of the incision so that access is in the area of the formation of the fistula. To obtain additional diagnostic information one can use a radiography of the abdominal cavity, which shows the gas bubble of the stomach, and other high-tech methods: ultrasound, spiral computed tomography, etc. At the same time such patients do not require general anesthesia, it is possible to perform the operation under a local anesthesia. The article provides a detailed description of the technique of minimal invasive laparotomy gastrostomy and two clinical observations of palliative patients who underwent this operation.

Optimization the work of a pediatrician on outpatient appointment, using the principles of lean- technologies in healthcare. A training center for studying of lean technologies in healthcare has been created at the St. Petersburg State Pediatric Medical University. The purpose of the Center is training doctors and nurses using the lean technology tools, for example, on a simulated clinic in which similar medical processes are simulated like in real clinics. The implementation of the tasks is achieved by conducting business games and factory process in medicine consisting of three stages with the subsequent identification the problems of the primary admission and the optimization the work of specialists. After each round, a debriefing was conducted and medical losses were identified with suggestion for improvement of quality in treatment and examination. Repeated repetition of identical processes in simulated conditions allows to identify losses at all stages of medical care. The training of doctors and nurses in children’s clinics is traditionally carried out at the workplace. Improving the quality and ensuring the availability of medical care to the population determines the necessity to optimize the doctor’s work at the initial appointment in the clinic. The conducting factory process in medicine on the early stages allows to reveal of the lack of a single view about the current and target state of the process, mapping techniques and types of losses and, of course, optimization opportunities. When the factory was re-conducted by similar specialists, the time of admission for children was reduced from 12 to 4 minutes, which allowed to take more time for each patient by optimization the work of doctors and nurses. During the action of factory processes, the waiting time for reception in the hall was also observed. Thus, by redistributing the responsibilities and functions of nurses, it was possible to obtain waiting times in the line, reduced from 45 to 20 minutes for each patient. The learning of lean technologies tools in a simulated clinic helped to understand process optimization skills to use the knowledge in practice. Using the factory processes and business games in a simulated clinic and the integrated implementation of lean technology tools allowed us to optimize the conditions for the effective and high-quality work of medical staff in clinics and, as a result, to improve the quality of medical care for the patients.

To work out the skill of assessing physical development and nutritional status of children and adolescents in various ways, to carry out comparative analysis of methods. Questionnaire data of patients examined in the office of a doctor – a nutritionist with various disorders of nutritive status – 101 people. Anthropometry was performed, physical development was evaluated by the WHO Anthro program, using centyl tables, and the impedance method (body composition). Statistical analysis, which included parametric statistics methods as well as r-Spearman rank correlation, was performed using Statistics 23.1 software. Physical development of children is a marker of adequacy of nutrition, and affects adaptation, severity of pathological processes, rate of recovery, effectiveness of therapy, terms of hospitalization. Not enough teaching time is devoted to the study and training of nutrition status assessment skills in various ways. The skill of evaluation of physical development (FR) and nuthritical status (NS) was worked out on the questionnaire data of specific patients. The results of the programme WHO Antro assessment, the centyl tables and the impedance data were compared in 101 patients with eating disorders (54 boys), from 2 m.o to 17 y.o (average 8.5 y.o) Malnutrition 30%, severe malnutrition – 6% cases. Obesity revealed 39% kids. The results of the WHO Antro assessment, the percentile tables and the impedance data were compared. Direct correlation links between the child ‘s percentile weight corridor, the WHO Antro (z-score), and the percentage of deficiency or excess of fat and active cell mass are obtained (p=0.05). The child ‘s percentile growth corridor and body mass index also correlates with the growth z- scor, fat, and active cell mass percent according to body impedance (p=0.05). The skill of assessing physical development and nuthritical status by students can be formed using simulation technologies. Physical development, as well as the nuthritical status of the child, can be investigated by the WHO Antro program using a computer application, or by using technologically complex equipment – impedance, or manually – with the help of centyl tables. Deviations of nutritive status from physiological norm are determined by all proposed methods.

The OBJECTIVE was to create a simulator for practicing manual skills of performing percutaneous endoscopic gastrostomy (PEG).METHODS AND MATERIALS. A patient simulator has been developed. It has a mouth, oropharynx, removable esophagus, stomach, and anterior abdominal wall that allows performing all stages of the operation. To objectify tension force of the gastrostomy tube during fixation and transmitting the proper manual sensations, a measuring device – bezmen was used. Initially, we used a single-use gastrostomy kit Freka PEG, FR 20 for the simulation. It increased the cost of the simulation. Therefore, instead of disposable kits, the Pezzer catheter No. 24 with a developed metal coneshaped tip was used as a gastrostomy tube (patent RU 2669483, 11.10.2018). Simulation was performed with reusable surgical instruments. At the final stage, an additional external pressure plate and a connector with a cover were used.RESULTS. The developed method of simulation training for PEG imposition allows performing all stages of endoscopic gastrostomy imposition. The simplicity of manufacturing and the possibility of replacing worn elements allows multiple implementation of the method. Using reusable instruments and a Pezzer catheter with a designed reusable tip increases the cost-effectiveness of training. The use of a measuring device allows to convey the necessary sensations of tension of the gastrostomy tube during fixation with an external pressure plate, corresponding to the sensations in real clinical simulation.CONCLUSION. The developed method of training for PEG imposition with the simulator allows to effectively work out manual skills and reduce the risk of iatrogenic complications during surgery on the patient.

Статья посвящена обучению иностранных студентов в медицинском вузе, которые приехали из разных уголков планеты с целью получения качественного медицинского образования. Стоит отметить, что обучение иностранных студентов в университете не на их родном языке доставляет некие трудности в восприятии обучающимися информации, что в последствие приводит к недостаточному усвоению учебной программы и, как следствие, к некачественному образованию. Необходимо устранить языковой барьер, чтобы обучение для иностранных студентов стало понятным. Также большое значение в обучении имеет мотивация, без которой студенту будет учиться очень тяжело. Ведь когда есть мотивация, есть стремление к какой-либо цели и тогда студент сделает все возможное, чтобы ее добиться.