Interview with FKKU honorary vice-president Boris Palamar. The capital city health department will be headed by the head physician of the hospital of the Dniprovsky district Monitoring the effectiveness of medicines

Moskovsky Boris Ivanovich - sniper of the 1095th Infantry Regiment (324th Infantry Division, 50th Army, 2nd Belorussian Front), corporal - at the time of presentation for awarding the Order of Glory 1st degree.

Born on March 31, 1924 in the village of Ogaryshevo, Povodnevskaya volost, Myshkinsky district, Yaroslavl province (now Myshkinsky district, Yaroslavl region) in a peasant family. Russian. In 1936 he graduated from the 4th grade. He worked as a photographer's apprentice in the artel in the city of Rybinsk.

In July 1943 he was drafted into the Red Army by the Rybinsk district military commissariat. Since August 1943, he participated in battles with the invaders on the Bryansk, Belorussian 2nd and 3rd Belorussian fronts. The entire combat path was in the ranks of the 1095th Infantry Regiment of the 324th Infantry Division.

In October 1943 and near Smolensk and in February 1944 near Mogilev he was wounded, he always returned to duty. In the spring of 1944, the division fought defensive battles in the upper reaches of the Dnieper River in the Mogilev region of Belarus. Here Corporal Moscow proved to be an excellent sniper.

For a short period from May 7 to June 10, 1944, when the regiment was on the defensive, Corporal Moscow destroyed 11 enemy soldiers with fire from a sniper rifle.

By order of units of the 324th Infantry Division dated June 12, 1944 (No. 94 / n), Corporal Boris Ivanovich Moskovsky was awarded the Order of Glory 3rd degree.

On June 27, 1944, parts of the division went on the offensive during the Belarusian operation. The division successfully crossed the Dnieper, during July-August 1944 advanced through the territory of Belarus, participated in the destruction of the Minsk grouping of the enemy. In these battles, Corporal Moskovsky acted in a mobile pursuit unit of the enemy, destroyed 25 enemy soldiers with sniper fire.

On July 3, 1944, in a battle near the village of Zorka (Minsk region, Belarus), when repulsing an enemy counterattack with sniper fire, he hit 12 Nazis and 6 horses.

By order of the troops of the 50th Army of August 4, 1944 (No. 439), Corporal Moscow Boris Ivanovich was awarded the Order of Glory, 2nd degree.

On July 26, near the city of Bialystok, he was seriously wounded in his left hand. After recovery, he returned to his regiment. Since January 1945, he participated in the East Prussian operation, the destruction of the Heilsberg enemy grouping. FROM

During the period of offensive battles in East Prussia from January 21 to March 5, 1945, Corporal Moskovsky, following in combat offensive units, advanced in front of infantry battle formations and suppressed enemy firing points and destroyed snipers with sniper fire. During the specified period of fighting in East Prussia, he exterminated 29 enemy soldiers and officers from a sniper rifle. In total, by that time, on his personal sniper account, there were already 76 destroyed soldiers and officers of the enemy. He was presented for awarding the Order of Glory 1st degree.

In April 1945, he participated in the assault on Koenigsberg, ended the war on the coast of the Frichess Huff Bay.

By decree of the Presidium of the Supreme Soviet of the USSR of June 29, 1945, the corporal was awarded the Order of Glory, 1st degree. He became a full cavalier of the Order of Glory.

In December 1945, the foreman of Moscow was demobilized.

Lived in the city of Saratov. He worked as a concrete worker in SMU No. 1. He died on October 8, 1990. He was buried at the Elshansky cemetery in the city of Saratov.

He was awarded the Order of the Patriotic War 1st degree, Order of Glory 1st (06/29/1945), 2nd (08/04/1944) and 3rd (06/12/1944) degrees, medals.

A street in the Volzhsky district of the city of Saratov is named after him.

Work on bugs
- in the biographical directories of the Ministry of Defense of the Russian Federation of 2000 and 2010, he is still listed as alive.

Recently, a seminar was held in Kyiv on the introduction of a formulary system for providing medical institutions with medicines. This topic was devoted to, published in No. 28 (249) of the Weekly APTEKA.

Among the medical institutions in Kyiv, which have already introduced some elements of the formulary system, is the Kyiv City Clinical Hospital No. 3 (KGKB No. 3). The APTEKA weekly correspondent asked Boris Palamar, chief physician of this hospital, to talk about his experience in using the formulary system for the purchase and use of medicines.

FORM IMPLEMENTATION - THE DIRECTION OF THE TIME

We learned about the formulary system after attending a seminar organized in the summer of 1999 as part of the Rational Pharmaceutical Management project, says B. Palamar. - By the way, the management of the clinic even earlier intuitively came to the understanding that such a system is necessary. After all, the hospital has to work in conditions of constant insufficient funding, so it is necessary to approach the purchase of drugs for the treatment of patients with special care.

First of all, we analyzed the list of drugs used in the hospital and divided them into two categories - the so-called general ones (which are used in all departments) and special ones, used mainly by narrow specialists (drugs for the treatment of diseases of the cardiovascular system, etc.) . From this list, groups of priority ones (corresponding to the “group of vital drugs” according to the Rational Pharmaceutical Management project), necessary and those whose presence would be desirable (“secondary”) were identified. The knowledge acquired at the seminar helped to systematize our independent developments and turn them into a full-fledged form.

FIRST FORM

Created in 1999 in KGKB No. 3, the first version of the formulary included 67 names of drugs in the form of an injection solution and 32 drugs in the form of tablets. Priority ("vital") in this list were 12 essential drugs. These are drugs that the patient, even with a strong desire, will not be able to buy at the pharmacy: oxygen, nitrous oxide, necessary for anesthesia, narcotic analgesics, as well as sterile material used in surgical operations. Antibiotics, including 1–2 modern antibacterial agents, in particular carbapenems, were classified as essential drugs. The hospital always has a small supply of such drugs. This is due to the fact that the Republican Center for Intensive Care for Sepsis has been opened on the basis of Clinical Hospital No. 3. Seriously ill patients from all over Ukraine come here, and modern medicines are required for their treatment. In addition to antibiotics, this important group includes such drugs that are widely used in all departments of the hospital (analgesics, antispasmodics), and used in specialized departments (infarction, cardiology, pulmonology, hemodialysis). Of course, the availability of only these drugs does not allow for the full treatment of a patient entering the clinic on a planned basis, - B. Palamar notes, - but they make it possible to provide the necessary assistance to patients entering the hospital on an urgent basis.

In fact, almost all the funds allocated to the hospital are spent on the purchase of so-called emergency medicines.

WHAT IS THE BUDGET AND FORM

In the first half of 2000, the hospital's formulary was expanded to 112 drugs (37 in the form of tablets, the rest in the form of injections).

However, in the second half of the year, funding for KGKB No. 3 was reduced by about one third compared to the first half of the year, and the drug formulary had to be reduced. - Today we buy 59 types of medicines, - says B. Palamar. This number of medicines is clearly not enough, but thanks to the procurement form, the most necessary drugs have been selected.

PURCHASING DRUGS: PRICE AND AGAIN PRICE

The formulary committee set up in the hospital, which included the deputy chief physician for economics, the chief accountant, the chief nurse of the hospital, and the head nurses of the departments, studied the proposals of more than 150 drug supply companies. The main criterion for selecting suppliers was the price of the drugs they offered. As a result, about 30 companies were selected that offered medicines entered in the formulary at the lowest prices. It should be noted that the hospital management tries to purchase all drugs on a prepaid basis, but in cases where it is impossible to calculate the exact number of drugs for emergency care in advance, payment is made upon delivery.

The hospital has developed good partnership relations with the Kyiv-based Pharmacia JSC, which always “enters” the position of the hospital and, in case of urgent need, supplies the necessary drugs on a deferred payment basis.

For us, even a seemingly insignificant difference in price is important, since with large volumes of purchases this allows us to save significant funds, - notes the chief physician of KGKB No. 3, - and use them to purchase additional medicines. Some wholesale companies offer us drugs at prices 10–15% lower than those of manufacturing plants. This is very beneficial for the hospital.

WE BUY UKRAINIAN.
BUT NOT ALWAYS

Most of the modest hospital budget is spent on the purchase of domestically produced drugs and medical products, although the quality of cheaper Ukrainian products sometimes leaves much to be desired. For example, a hospital was forced to stop purchasing x-ray film from the Svema factory after several batches were found to be of poor quality.

IS THE "IDEAL FORM" POSSIBLE?

It is difficult to say how many drugs should be in the "ideal" formulary in order to be able to fully meet the needs of the clinic in medicines, says B. Palamar. - Probably, there will never be such a form, because by definition it is already restrictive. The main task of the formulary today is to help choose the most necessary drugs for the purchase and use, and at the lowest price.

MONITORING THE EFFICACY OF MEDICINES

Clinical Hospital No. 3 has already started implementing a system for evaluating the effectiveness of the drugs used. Under the guidance of prof. A. Treshchinsky wasp the effectiveness of antibiotics is monitored. This makes it possible not only to select the medicines necessary for the patient strictly individually, to significantly increase the effectiveness of therapy, but also to reduce the cost of treatment.

The case, which was told by the chief physician of hospital No. 3, fully confirms this. A patient was admitted to the Republican Center for Intensive Care for Sepsis, who had previously been prescribed 12 antibacterial drugs for a total of UAH 20,000, but his condition did not improve.

Correctly selected antibiotic by the doctors of the clinic (at the required dose and exposure) allowed this patient, as they say, to put on his feet, and the cost of antibiotic therapy was 1800 UAH. For rational treatment, it is necessary to rationally approach the issue of providing medical institutions with medicines. The path to this, according to B. Palamar, lies only through monitoring the effectiveness of drugs.

GENERIC GENERIC DIFFERENCE

Specialists working in the hospital note that the same generic drug from different manufacturers very often differs significantly in its effectiveness. For example, it was noted that the therapeutic effect and severity of side effects of each of the 4 gentamicin preparations from different manufacturing companies are not the same.

Unfortunately, due to insufficient funding, the hospital is forced to buy the cheapest drugs, including gentamicin, but in the future it is planned to make purchases based mainly on the efficiency / price indicator. This is the next step in the introduction of the formulary system in the clinical hospital No. 3 in Kyiv. For this, data obtained from monitoring the effectiveness of drugs are needed.

Sergei Pavlovich
Photo by Evgeny Krivsha

Q. The place of sport in your life?

P. For as long as I can remember, I have always been involved in sports. As a child, when I lived in the regional center, there were no specialized sections, and I went in for various sports of a general physical direction. Later I began to seriously engage in boxing (more than 6 years), and now I go to Sportlife with pleasure. I do sports all the time, it's a way of life.

Q. Were there any interesting situations related to sports?

P. I want to tell a story that, from my point of view, has a certain underlying reason, when I entered the Kirov Military Medical Academy in Leningrad, I knew that the formation of courses takes place in 3 types of armed forces - missile, flight and underwater. The commission decided that I, as a good athlete - a boxer, would take a worthy place on a submarine, and I was unanimously sent to the submariners. I categorically objected, and not finding understanding, I packed my things and left "in English" through the fence. So much for sports, although this is not a positive example. But, of course, this is a joke.

Q. How did you get into Kyokushin Karate?

P. Having perfectly mastered the technique of working with my hands, I always wanted to attack and defend myself with my feet. My friend Grisha Shishkovsky introduced me to Sasha Huseynov about 10 years ago, and I began to go to the gym to train. Thanks to these trainings, I improved my footwork technique and got a good hand-foot mix. Already working as the head physician of the hospital, I somehow met a guy whom I didn’t recognize at first, but after he reminded me of how I worked with him in sparring, I realized that my efforts were wasted.

Q. What section of the National Kyokushin Karate Federation do you lead?

P. For more than ten years I have been helping to provide medical support for competitions of various levels, from urban to European Championships. In addition, I communicate very closely with the leaders of the Kyokushin Federation Bliznyuk Stanislav. I believe that this is a real athlete who, with his perseverance and work, went to the goal and is now rightfully the first in Kyokushin in Ukraine.

Many thanks to you Boris Ivanovich for your contribution to the development of Kyokushin in Ukraine.