Training staff in personalized medicine implies modernisation of the traditional learning model that is to incorporate a curricular thread spanning all the stages (pre-university, undergraduate, post-graduate) of a doctor’s professional development.The article presents the experience of the Institute of Medical Education of The Almazov National Medical Research Centre in training personnel prepared to implement the principles of personalized medicine in domestic healthcare.

This article provides an overview of the use of gamification in teaching radiology to the generation Z medical students. It highlights the need to adapt medical education to the digital preferences of the new generation. The article emphasizes the importance of gamification in enhancing student motivation and improving the quality of education, and discusses the use of various gaming techniques, such us serious games and virtual reality-based games, as well as student radiology competitions. Current challengesof integrating gamification in the curriculum of medical universities are also discussed.

Background. The choice of an antiarrhythmic drug, proof of its effectiveness and safety in a short period of time in patients with non-coronary ventricular arrhythmia are the most pressing problems of practical arrhythmology. Objective. To resolve the issue of choosing an antiarrhythmic drug in patients with a mixed nature of ventricular arrhythmia, several ectopic foci, and to optimize further tactics for their management. Design and methods. Of 167 patients with ventricular arrhythmia distribution during periods of wakefulness who performed a stress test, 32 individuals with non-coronary arrhythmias of a mixed nature (by the participation of the autonomic nervous system) were selected. All patients underwent an acute pharmacological stress test with a beta-blocker. Antiarrhythmic therapy was selected under the control of multi-day ECG telemonitoring. Results. In the pretest of exercise tests, single ventricular parasystole was recorded in all 32 patients. In 3 patients, the arrhythmia persisted throughout the entire load, in 4 patients it progressed, in 25 patients the parasystole of the initial morphology disappeared, and at the peak of the load/early recovery period, arrhythmia of a different morphology appeared. Indications for drug treatment were determined for all patients with the choice of the drug after acute pharmacological tests. Then, therapy with two antiarrhythmic drugs was initiated using multi-day ECG telemonitoring, the purpose of which was to control the efficacy, safety, choice of doses and time of drug administration. On days 5–6, combination therapy was effective in 25 patients (78 %). Conclusion. With the help of stress tests, it is possible to accelerate not only the search for the cause of ventricular arrhythmia, but also the choice of a personalized method of treatment. Supplementing the examination with pharmacological tests allows predicting the result of combined antiarrhythmic therapy with a beta-blocker and a class IС drug with an anticholinergic effect.

Inflammatory changes in the myocardium create the prerequisites for the electrical instability of the myocardium, which can affect the ECG. It is promising to study relatively new electrocardiographic patterns: fragmentation of QRS (FQRS) and premature ventricular beats (FPVB) and early repolarization pattern (ERP) to improve the screening of patients with suspected myocarditis. Aim. To study FQRS, FPVB and ERP in patients with inflammatory changes in the myocardium. Material and methods. The study included 46 patients (78.3% male, 21.7% women) with suspected myocarditis. Age: median 47.5, quartile 37; 56.5. In all patients, the anamnesis, results of ECG, echocardiography, cardiac magnetic resonance imaging and endomyocardial biopsy were analyzed. Results. The patients were divided into three groups: the 1st – 20 patients with inflammatory and fibrotic changes in the myocardium, the 2nd – 20 patients with myocardial fibrosis without inflammatory, the 3rd – 6 patients without structural changes in the myocardium. FQRS in the 1st group was detected in 35% of the examined, in the 2nd – in 25%, in the 3rd – not registered. FPVB in the 1st group was determined in 55% of the examined, in the 2nd – in 30%, in the 3rd – in 33.3%. ERP in the 1st group was registered in 30% of the examined, in the 2nd group it was not detected, in the 3rd group – in 16.7%. FPVB and ERP were informative for the detection of inflammation (sensitivity – 57.9 and 85% respectively, specificity – 69.2 and 53.8% respectively). For the detection of fibrosis, FPVB proved to be the most informative (sensitivity – 80.0%, specificity – 59.1%). Conclusions. FQRS, FPVB, and ERP are significant ECG-markers for detecting both inflammatory changes in the myocardium and fibrosis. The use of these ECG-markers in routine clinical practice may have an impact on further management of patients with suspected myocarditis.

Russian Society of Cardiology (RSC) Developed with the special contribution of the Russian Functional Diagnostics Association, Russian Holter Monitoring and Non-invasive Electrophysiology Society, Russian Pediatric Cardiology Association.

Successful education of modern students requires great immersion of teachers in a process that is constantly changing, acquiring new properties, and meeting new challenges. So, digital technologies, online learning are already a natural communication environment, and students are motivated for self-development and self-expression. The traditions of the Russian medical school, together with modern trends in the development of education, create the prerequisites for the application of the most successful forms of education that develop the thinking and skills necessary for professional activity. In this article, the authors presented the experience of organizing training under the specialist’s program on the basis of the Department of Neurology and Psychiatry with the clinic of the Institute of Medical Education of the Federal State Budgetary Institution “Almazov National Medical Research Centre” of the Ministry of Health of the Russian Federation. Conclusions are formulated on the basis of the results of questioning teachers and students on the main characteristics of the educational process. The role of interactive and distance technologies is analyzed: online learning methods, video lectures, digital services, and other digital technologies. An analysis of the role of independent education, the most successful forms of knowledge testing, features of the development of communication skills, and the possibilities of mastering the competencies necessary for professional activity are presented. Separately, the interest of students in scientific work, the activity of participation in the student scientific club, the possibility of growth of interested students in professional and pedagogical aspects are analyzed. The presented data illustrated the success of the first experiment on the training of doctors on the basis of a scientific institution.

Aim. To study the relationship between a decrease in left ventricular (LV) ejection fraction (EF) and conventional electrocardiographic (ECG) signs associated with myocardial structure changes (pathological Q wave, ventricular arrhythmias), and relatively novel and less studied (fragmented QRS (fQRS), early ventricular repolarization (EVR)) and to evaluate their significance for identifying patients with mildly-reduced EF (mrEF).Material and methods. The study included 148 patients who were treated and examined at the Almazov National Medical Research Center. During the ECG analysis, fQRS, EVR, pathological Q wave, and ventricular arrhythmias (VAs) were assessed. Echocardiography data were analyzed. Statistical processing was carried out, including Fisher and chi-squared test, as well as correlation and ROC analysis.Results. Depending on the EF level, patients were divided into three groups: group 1 — patients with reduced EF (rEF) (<40%); group 2 — patients with mrEF (40-49%); group 3 — patients with preserved EF (pEF) (>50%). In the 1st group (with rEF), fQRS was registered in 16 (51,6%) patients, in the 2nd (with mrEF) — in 13 (44,8%), in the 3rd (with EF >50%) — in 16 (18,2%). Pathological Q wave was detected in the 1st group (rEF) in 20 (65%) patients, in the 2nd (mrEF) — in 10 (35%); in the 3rd (pEF) — in 15 (18%) (p<0,001). ROC analysis found that fQRS is more important for identifying patients with mrEF. In the 1st group (rEF), EVR was registered in 2 (6,5%) patients, in the 2nd (pEF) — in 2 (6,9%), in the 3rd (EF>50%) — in 11 (12,5%); the differences were not significant (p=0,5). The relationship of EVR, the number of PVCs and the presence of ventricular tachycardia with EF was not revealed.Conclusion. FQRS is significantly more often observed with a decrease in EF and may be a marker of an mildly-reduced EF. There were no significant correlations between EVR and EF. There was also no relationship between VAs and LV systolic dysfunction.

The aim of the study was to investigate the relationship between a decrease in the left ventricular ejection fraction (EF) and traditional ECG signs associated with structural changes of the myocardium (pathological Q wave, ventricular arrhythmias) and relatively new and poorly understood (fragmented QRS complex (fQRS), early repolarization pattern (ERP)) and evaluate their significance for identifying patients with mildly reduced EF (mrEF). The study included 148 patients who were treated and examined at the Almazov Medical Research Center. FQRS, ERP, pathological Q wave, and premature ventricular contractions (PVC) were described in the analysis of the ECG, and the results of echocardiography and statistical data were analyzed: Fisher’s test and chi-square, correlation analysis, and ROC analysis. According to the level of EF, patients were divided into three groups: group 1—patients with low EF (lEF) (less than 40%), group 2—patients with mildly reduced EF (mrEF) (40–49%); group 3—patients with preserved EF (pEF) (more than 50%). In the first group (EF), fQRS was registered in 16 (51.6%) patients, in the mrEF in 16 (18.2%). Pathological Q wave was detected in lEF in 20 (65%), in mrEF in 10 (35%), 15 (18%), in pEF in 15 (18%). The fQRS has been found to be more important in identifying patients with mrEF. In lEF in 2 (6.5%) patients, in mrEF in 2 (6.9%), in pEF in 11 (12.5%). There was no relationship between ERP, the amount of PVC, and the presence of ventricular tachycardia with EF. FQRS is significantly more common occurred with a decrease in EF and may be a marker of a mrEF. Thus, fQRS is associated with mrEF and pay close attention in routine clinical practice to identify patients at high risk of developing systolic dysfunction.

The aim of the study was to investigate the relationship between a left ventricular ejection fraction (EF) and ECG patterns associated with structural changes of the myocardium (pathological Q wave, fragmentated QRS complex (fQRS), early repolarization pattern (ERP).The study included 148.According to the level of EF, patients were divided into three groups: Group 1 -patients with low EF (lEF) (less than 40%), group 2 -patients with mildly reduced EF (mrEF) (40-49%); group 3 -patients with preserved EF (pEF) (more than 50%).In the 1st group (EF) fQRS was registered in 16 (51.6%)patients, in the mrEF -in 16 (18.2%).Pathological Q wave was detected in lEF in 20 (65%), in mrEF in 10 (35%), 15 (18%), in pEF in 15 (18%).The fQRS has been found to be more important in identifying patients with mrEF.In lEF in 2 (6.5%) patients, in mrEF -in 2 (6.9%), in pEFin 11 (12.5%).There was no relationship between ERP and EF.

Aim– to analyze the relationship between fQRS and myocardial fibrosis in CAD patients using SPECT. Material and methods.Retrospectively, we have analyzed the anamnesis and examinations of 116 patients with suspected coronary heart disease. The fQRS was assessed according to the criteria of Das M. et al., 2006, along with the presence of a pathological Q wave and a slow increase in the amplitude of the R wave. We analysed the transient myocardial ischemia and/or myocardial scarring using stress/rest SPECT with technetium-99m. Results.fQRS was significantly more frequently detected in patients with stable and partially reversible perfusion defects – 44.1% and 52.2%, respectively, versus 13.0% and 5.5% in patients without perfusion defects or with reversible perfusion defects, p 0.05. Among 28 patients with QRS fragmentation and myocardial fibrosis, 19 (67.8%) had classical signs of fibrosis on the ECG, 9 (32.1%) had no ECG-registered fibrosis but fQRS was detected. The sensitivity of fQRS marker in detecting myocardial fibrosis reached 84.4%, the specificity was 63.3%. Conclusion.fQRS complex is an informative marker for detecting myocardial scarring in patients with coronary artery disease. Analysis of fQRS in daily clinical practice may increase the diagnostic value of electrocardiography in the detection of fibrosis.

The materials highlight the experience of digital transformation and educational adaptation to the conditions of the novel coronavirus infection. The report presents new formats for organizing training sessions and practical training, tested in V.A. Almazov National Medical Research Center.

The article shows the need to include team simulation trainings directly at the workplace in the curriculum of existing medical institutions.

At the end of the last century and, especially, in the first two decades of the 21st century, a significant technological breakthrough took place in clinical laboratory diagnostics in Russia. The transition from manual techniques to high-tech and high-performance automated systems has changed the potential of laboratory medicine. The laboratory has become a high-tech, rapidly developing branch of medical organizations. Following the changes in technology, the range of diagnostic tests began to alter, while the list of laboratory tests available grew. These dynamics are growing every year. Simple routine techniques, practiced for all patients, are complemented by more specific tests. The place of conventional routine tests has been determined by many years of practical experience, while modern analyzers allow the use of tests with a high evidence value of recommendations, which, in the context of evidence-based medicine, enable the clinician to conduct a personalized diagnostic search. At the same time, in order to use all the possibilities of laboratory medicine, the discipline Clinical Laboratory Diagnostics should be included in educational programs at different stages of a doctor's training.

The organization of training for medical students from the point of view of the formation of an individual trajectory is important, taking into account the mastery of related competencies. There are certain mechanisms for the implementation of an individual educational trajectory, including the features of building an educational program and curriculum, tools for integration with scientific research, and practice of simulation training.

This article is devoted to the organization of the work of the Accreditation and Simulation Center of the Institute of Medical Education of the Almazov National Medical Research Centre during the primary specialized accreditation in the COVID-19 pandemic. Organizational solutions, technological processes and routing of accredited (308 people), support and technical personnel (98 people) and employees of the Accreditation and Simulation Center (14 people) and members of accreditation commissions (67 people) are presented to ensure infectious safety and the effectiveness of the face-to-face practice-oriented stage of accreditation.

We described key approaches to the realization of the pilot project, which is being carried out in Almazov National Medical Research Centre in order to implement basic medical education in close integration of science and education.

The aim of the study was the self-assessment by medical students of the level of IT competence and the identification of factors that influence this level. A survey of 52 2nd year students of the Faculty of Medicine was carried out. 42% of students plan to combine work as a medical practitioner and research. Self-assessment of competence in the field of information technology showed a good command of the search engines Google and Yandex, individual Microsoft Office applications, insufficient knowledge of Exell and Access. Selfassessment of competence is higher among students who plan to engage in research work.

The ongoing pandemic caused by virus SARS-CoV-2 encourages the search for ways to save the population. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. Since people first encountered this disease, it is being actively studied, and updating medical information is extremely valuable. The purpose of this review is to systematize the literature on the effect of SARS-CoV-2 on the cardiovascular system, focusing on changes in the surface electrocardiogram depending on the clinical course of the disease, the characteristics of the treatment and outcomes, and the possible identification of electrocardiographic predictors of complications, as well as sudden cardiac death in patients with non-coronarogenic syndromes with new virus infection (COVID-19).