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Federal State Budgetary Educational Institution of Higher Education “Kursk State Medical University” of the Ministry of Health of the Russian Federation DIARY OF INDUSTRIAL PRACTICE for acquiring professional skills and experience in professional activity “Provision of emergency and urgent medical care (physician assistant)” Student of the ___ course, Faculty of ___, Group ___, Full name of the student Practice title: Industrial practice “Provision of emergency and urgent medical care (physician assistant)” Practice base (medical institution / healthcare facility, department, department, academic chair, institution) Full name and position of the responsible staff member of the practice base. Full name and position of the supervisor of practical training. Period of practice: from ______ to ______ (year). Student work schedule. Date Working hours 29/06/2026 30/06/2026 01/07/2026 02/07/2026 03/07/2026 04/07/2026 DAY OFF 06/07/2026 07/07/2026 08/07/2026 09/07/2026 10/07/2026 11/07/2026 Signature of the responsible staff member of the practice base Seal of the practice base Sample format of a daily log for a work shift as image is uploaded Student’s signature Signature of the clinical base supervisor NOTE:- write dairy of 24 real individual patients, 2 patients for each day

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Here is the complete Diary of Industrial Practice with 24 individual patients (2 per working day, across all 12 working days: 29 Jun - 11 Jul 2026, excluding the day off on 05 Jul). Each daily log follows the exact format from your image.

DIARY OF INDUSTRIAL PRACTICE

Federal State Budgetary Educational Institution of Higher Education "Kursk State Medical University" of the Ministry of Health of the Russian Federation
Practice: Industrial practice "Provision of emergency and urgent medical care (physician assistant)" Period: 29.06.2026 – 11.07.2026

STUDENT WORK SCHEDULE

DateWorking hours
29/06/202608:00 – 14:00
30/06/202608:00 – 14:00
01/07/202608:00 – 14:00
02/07/202608:00 – 14:00
03/07/202608:00 – 14:00
04/07/202608:00 – 14:00
05/07/2026DAY OFF
06/07/202608:00 – 14:00
07/07/202608:00 – 14:00
08/07/202608:00 – 14:00
09/07/202608:00 – 14:00
10/07/202608:00 – 14:00
11/07/202608:00 – 14:00
Signature of the responsible staff member of the practice base: __________ Seal of the practice base

DAILY LOGS

DAY 1 — 29.06.2026

Patient 1 Full name: Petrov Ivan Sergeyevich, Age: 58, Sex: Male Diagnosis: Acute myocardial infarction (ST-elevation, anterior wall)
DateContent of completed workFrequency
29.06.2026Safety instructions reviewed. Familiarization with the structure of the emergency admission unit (ambulance station).1
Clinical examination of the patient: complaints of crushing retrosternal pain radiating to the left arm for 2 hours, cold sweat, nausea. Objective: BP 100/70 mmHg, HR 98/min, SpO2 94%. Skin pale and moist. Completion of the medical history and inpatient card. Coordination of diagnosis, examination plan, and treatment plan with the attending physician.1
Interpretation of additional examination data: ECG — ST elevation in leads V1–V4, reciprocal depression in II, III, aVF. Troponin I — elevated (2.8 ng/mL). CBC and metabolic panel reviewed.1
Participation in providing emergency medical assistance: IV access established, oxygen 4 L/min via nasal cannula, aspirin 300 mg PO, clopidogrel 600 mg PO, heparin 5000 IU IV bolus administered under supervision. Patient prepared for urgent PCI transfer.1
Ward rounds with the head of department for supervised patients.1
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 2 Full name: Sorokina Marina Alexandrovna, Age: 42, Sex: Female Diagnosis: Hypertensive crisis, uncomplicated
DateContent of completed workFrequency
29.06.2026Clinical examination: severe headache, visual "flashes," palpitations. BP 210/120 mmHg bilaterally, HR 90/min, no neurological deficit. Completion of medical history.1
Interpretation of ECG: sinus tachycardia, LVH signs (Sokolov-Lyon criterion positive).1
Participation in emergency management: captopril 25 mg sublingual, amlodipine 10 mg PO. Patient monitored; BP re-checked at 30 min — 170/100 mmHg. Discussed antihypertensive therapy adjustment with attending physician.1
Participation in clinical case review with the head of department: discussed differential diagnosis between uncomplicated hypertensive crisis and hypertensive urgency with end-organ damage.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 2 — 30.06.2026

Patient 3 Full name: Zhukova Olga Petrovna, Age: 67, Sex: Female Diagnosis: Acute ischemic stroke (left middle cerebral artery territory)
DateContent of completed workFrequency
30.06.2026Clinical examination: sudden onset of right-sided weakness and speech impairment 90 minutes ago. NIHSS score calculated — 12 points. BP 180/100 mmHg, HR 82/min, GCS 14. Completion of medical history and inpatient documentation. Coordination of diagnosis and management with neurologist on duty.1
Interpretation of additional examination data: CT brain — no haemorrhage detected; hyperdense MCA sign. CBC, coagulation screen, glucose reviewed; glucose 6.8 mmol/L.1
Participation in emergency management: IV thrombolysis with alteplase (0.9 mg/kg) initiated under neurologist supervision; loading dose administered IV, remainder over 60 min infusion. Continuous monitoring of BP, HR, neurological status.1
Ward rounds with the head of department for supervised patients. Participation in clinical case review: indications and contraindications for IV thrombolysis discussed.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 4 Full name: Frolov Dmitry Nikolayevich, Age: 34, Sex: Male Diagnosis: Anaphylactic shock (insect sting)
DateContent of completed workFrequency
30.06.2026Clinical examination: patient brought by ambulance following bee sting; generalized urticaria, angioedema of lips and tongue, stridor, BP 70/40 mmHg, HR 130/min, SpO2 88%. Rapid assessment completed.1
Emergency management participation: epinephrine (adrenaline) 0.5 mg IM (mid-outer thigh), oxygen 10 L/min via non-rebreather mask, IV access x2 with rapid 0.9% NaCl infusion 1000 mL, chloropyramine (chlorophenamine) 20 mg IV, dexamethasone 8 mg IV. Patient stabilised within 20 minutes; BP 100/70 mmHg, SpO2 96%.1
Interpretation of additional data: SpO2 trend, ECG (sinus tachycardia resolving), blood glucose.1
Participation in clinical case review: pathophysiology of anaphylaxis, epinephrine auto-injector prescription discussed.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 3 — 01.07.2026

Patient 5 Full name: Kuznetsova Tatyana Ivanovna, Age: 72, Sex: Female Diagnosis: Acute exacerbation of chronic obstructive pulmonary disease (COPD), severe
DateContent of completed workFrequency
01.07.2026Safety instructions reviewed (second review for new department sector). Familiarization with emergency respiratory care trolley and non-invasive ventilator settings.1
Clinical examination: progressive dyspnoea over 3 days, increased sputum production (purulent), inability to complete sentences. Examination: barrel chest, prolonged expiration, diffuse wheezes, SpO2 82% on room air, RR 28/min, HR 102/min. Completion of medical history and documentation.1
Interpretation of ABG: pH 7.31, PaCO2 58 mmHg, PaO2 52 mmHg — type II respiratory failure. Chest X-ray: hyperinflation, no consolidation. Sputum culture sent.1
Participation in management: controlled O2 via Venturi mask 28%, salbutamol 2.5 mg + ipratropium 500 mcg nebulisation, prednisolone 40 mg IV, amoxicillin-clavulanate 1.2 g IV. NIV (BiPAP) initiated under supervision.1
Ward rounds with the head of department.1
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 6 Full name: Morozov Aleksei Vladimirovich, Age: 48, Sex: Male Diagnosis: Acute pancreatitis, moderately severe (Ranson score 3)
DateContent of completed workFrequency
01.07.2026Clinical examination: severe epigastric pain radiating to the back ("belt-like"), nausea, vomiting ×6, history of alcohol intake. Examination: epigastric tenderness, guarding, Grey Turner's sign absent, temperature 38.1°C, HR 108/min, BP 110/80 mmHg. Completion of medical history.1
Interpretation of additional data: serum amylase 1840 U/L, lipase 2300 U/L, WBC 14.2×10⁹/L, CRP 180 mg/L, creatinine 134 mmol/L. Abdominal ultrasound: oedematous pancreas, pericholecystic fluid, no gallstones. CT abdomen (contrast): pancreatic oedema, peripancreatic fat stranding, no necrosis.1
Participation in management: IV fluid resuscitation (Ringer's lactate 250 mL/hr), nil by mouth, NGT for decompression, ketorolac 30 mg IV, omeprazole 40 mg IV, antibiotic prophylaxis (imipenem) deferred pending reassessment. Surgical team consulted.1
Participation in clinical case review with supervisor: Ranson criteria, Atlanta classification, indications for surgical referral.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 4 — 02.07.2026

Patient 7 Full name: Lebedeva Natalya Yurievna, Age: 29, Sex: Female Diagnosis: Status epilepticus (generalised tonic-clonic)
DateContent of completed workFrequency
02.07.2026Clinical examination: patient brought by ambulance with continuous tonic-clonic seizures lasting >5 minutes (total duration 22 min before arrival). No prior epilepsy history. Examination: post-ictal state, tongue laceration, urinary incontinence, SpO2 89%, HR 124/min, BP 150/90 mmHg. Medical history obtained from relatives.1
Participation in emergency management: patient placed in recovery position, airway opened with jaw thrust, O2 15 L/min via non-rebreather mask, IV access established; diazepam 10 mg IV slowly — seizures resolved within 3 minutes. Blood glucose 4.2 mmol/L. Phenytoin 18 mg/kg IV loading dose infusion initiated for prophylaxis.1
Interpretation of additional data: MRI brain (post-stabilisation) — no structural lesion. EEG — diffuse slowing. CBC, metabolic panel, toxicology screen — unremarkable.1
Ward rounds. Participation in clinical case review: classification of status epilepticus, stepwise pharmacological approach.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 8 Full name: Volkov Gennady Igorevich, Age: 61, Sex: Male Diagnosis: Acute decompensated heart failure (pulmonary oedema)
DateContent of completed workFrequency
02.07.2026Clinical examination: acute onset of severe dyspnoea, orthopnoea, frothy pink sputum. History of dilated cardiomyopathy. Examination: diffuse bilateral fine crackles to mid-zones, SpO2 80%, RR 32/min, HR 118/min (irregular), BP 160/100 mmHg. Jugular venous distension present. Completion of medical history and emergency card.1
Interpretation of additional data: ECG — atrial fibrillation with rapid ventricular response. BNP 2300 pg/mL. CXR: bilateral perihilar infiltrates ("bat wing"), cardiomegaly, Kerley B lines. Echo (bedside): EF 22%, dilated LV.1
Participation in emergency management: patient sat upright, O2 via non-rebreather mask, BiPAP initiated, furosemide 80 mg IV bolus, GTN infusion 10 mcg/min IV titrated. Rate control: digoxin 0.5 mg IV. Urine output monitored via catheter.1
Participation in clinical case review: precipitants of acute decompensation, Killip classification discussed.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 5 — 03.07.2026

Patient 9 Full name: Sidorov Pavel Konstantinovich, Age: 55, Sex: Male Diagnosis: Acute upper GI bleeding (peptic ulcer, Forrest Ia)
DateContent of completed workFrequency
03.07.2026Clinical examination: haematemesis (fresh blood ×2), melaena, dizziness, syncope. History of NSAID use. Examination: pallor, cold extremities, HR 118/min, BP 90/60 mmHg (supine), capillary refill >3 sec. GCS 14. Completion of medical history and emergency documentation.1
Interpretation of additional data: CBC — Hb 72 g/L, platelets 180×10⁹/L, WBC 9.8. Coagulation screen: INR 1.3. BUN/creatinine ratio elevated (>30). Blood group and cross-match ordered (O-negative issued).1
Participation in emergency resuscitation: two large-bore IV cannulae, Hartmann's solution 500 mL rapid infusion, then packed RBC transfusion (2 units). NGT inserted — fresh blood confirmed. Proton pump inhibitor: omeprazole 80 mg IV bolus then 8 mg/hr infusion. Urgent endoscopy team called. Foley catheter inserted.1
Ward rounds with head of department. Participation in clinical case review: Blatchford score (12), Forrest classification, endoscopic haemostasis methods.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 10 Full name: Belova Irina Fyodorovna, Age: 38, Sex: Female Diagnosis: Diabetic ketoacidosis (DKA), moderate severity
DateContent of completed workFrequency
03.07.2026Clinical examination: nausea, vomiting, polyuria, polydipsia, abdominal pain for 2 days. History of type 1 diabetes mellitus. Examination: Kussmaul breathing, fruity breath odour, dry mucous membranes, HR 106/min, BP 105/75 mmHg, GCS 15. Completion of medical history.1
Interpretation of additional data: blood glucose 28.4 mmol/L, pH 7.18, HCO3 9 mmol/L, anion gap 24, β-hydroxybutyrate 6.2 mmol/L, K+ 3.1 mmol/L, Na+ 136 mmol/L. Urinalysis: glucose 4+, ketones 3+. ECG: sinus tachycardia, flattened T-waves (hypokalaemia).1
Participation in management: IV 0.9% NaCl 1L over 1 hr, then 500 mL/hr. IV insulin infusion 0.1 U/kg/hr commenced. Potassium replacement (KCl 40 mmol/L added to fluids). Hourly glucose and electrolyte monitoring plan. Bicarbonate not given (pH >7.0).1
Participation in clinical case review: DKA vs HHS, diagnostic criteria, insulin sliding scale pitfalls.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 6 — 04.07.2026

Patient 11 Full name: Orlov Sergey Alexandrovich, Age: 44, Sex: Male Diagnosis: Pulmonary embolism, high risk (massive PE)
DateContent of completed workFrequency
04.07.2026Clinical examination: sudden onset severe dyspnoea, pleuritic chest pain, syncope. History of 3-week immobilisation following hip surgery. Examination: tachycardia 128/min, BP 88/60 mmHg, SpO2 85%, raised JVP, right heart strain signs. Wells score: high probability. Completion of medical history and emergency documentation.1
Interpretation of additional data: ECG — S1Q3T3 pattern, sinus tachycardia. D-dimer >5000 ng/mL. CTPA: bilateral saddle embolus confirmed. Echo: right ventricular dilation and hypokinesis, TR jet velocity elevated. Troponin T: 0.45 ng/mL.1
Participation in emergency management: O2 15 L/min, UFH 80 U/kg IV bolus then 18 U/kg/hr infusion; haemodynamic instability prompted systemic thrombolysis decision (alteplase 100 mg IV over 2 hrs) under senior supervision. Continuous monitoring. Resuscitation trolley on standby.1
Ward rounds. Participation in clinical case review: PESI score, risk stratification, thrombolysis vs embolectomy.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 12 Full name: Novikova Elena Borisovna, Age: 31, Sex: Female Diagnosis: Ectopic pregnancy, ruptured (left fallopian tube), haemoperitoneum
DateContent of completed workFrequency
04.07.2026Clinical examination: acute lower abdominal pain (LIF), shoulder-tip pain, amenorrhoea ×7 weeks, PV spotting. Examination: generalised guarding, rebound tenderness, Cullen's sign negative, cervical motion tenderness +. HR 122/min, BP 80/50 mmHg. Pregnancy test positive. Completion of emergency documentation.1
Interpretation of additional data: β-hCG 4800 mIU/mL. CBC: Hb 79 g/L (falling). Transvaginal US: empty uterus, left adnexal mass 4 cm, significant free fluid in pelvis and Morison's pouch.1
Participation in resuscitation and pre-operative management: two large-bore IV lines, O-negative blood crossmatch, crystalloid infusion, O2 therapy, Foley catheter. Gynaecological surgery team contacted; urgent laparotomy arranged. Anaesthesiology team briefed.1
Participation in clinical case review: differential diagnosis of acute abdomen in women of reproductive age, Laparoscopic vs open management.1
Student's signature: __________ Signature of clinical base supervisor: __________
(05.07.2026 — DAY OFF)

DAY 7 — 06.07.2026

Patient 13 Full name: Korolev Mikhail Petrovich, Age: 70, Sex: Male Diagnosis: Complete atrioventricular block (third-degree AV block) with haemodynamic compromise
DateContent of completed workFrequency
06.07.2026Safety instructions reviewed. Familiarization with defibrillator/transcutaneous pacemaker setup in emergency bay.1
Clinical examination: syncope, dizziness, presyncope on exertion. Examination: HR 36/min (bradycardia), BP 80/50 mmHg, cannon A-waves in JVP, variable S1 intensity. GCS 14. Completion of medical history; known ischaemic heart disease, recent inferior MI.1
Interpretation of ECG: P-waves and QRS complexes dissociated, rate 36/min, wide QRS escape rhythm. Electrolytes: K+ 5.8 mmol/L (mild hyperkalaemia). Echo: inferior wall hypokinesia, EF 40%.1
Participation in emergency management: atropine 1 mg IV (minimal response), transcutaneous pacing initiated at rate 70/min, 60 mA — capture achieved, BP 110/70 mmHg. IV dopamine infusion commenced as bridge. Cardiology team contacted for urgent transvenous pacemaker insertion.1
Ward rounds with head of department. Clinical case review: indications for temporary vs permanent pacing.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 14 Full name: Pavlova Zinaida Semyonovna, Age: 82, Sex: Female Diagnosis: Hip fracture (subcapital, right), acute blood loss anaemia
DateContent of completed workFrequency
06.07.2026Clinical examination: fall from standing height, inability to walk, severe right hip pain. Examination: right leg shortened, externally rotated, hip tender. BP 100/65 mmHg, HR 98/min, Hb 85 g/L. Pain score 9/10. Completion of medical history; known osteoporosis, anticoagulated (warfarin — INR 3.2).1
Interpretation of additional data: plain X-ray right hip: subcapital fracture displaced (Garden type III). CBC, coagulation (INR 3.2), renal function (creatinine 124 µmol/L), ECG reviewed.1
Participation in management: pain management (morphine 2.5 mg IV titrated), IV access, crystalloid infusion, Foley catheter. Warfarin reversal: vitamin K 10 mg IV slow infusion + 4-factor PCC (Octaplex) dosed per weight, INR target <1.5 pre-operatively. DVT prophylaxis deferred peri-operatively. Orthopaedic surgery team informed.1
Participation in clinical case review: fragility fractures, peri-operative anticoagulation reversal, VTE prophylaxis after hip surgery.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 8 — 07.07.2026

Patient 15 Full name: Stepanov Andrey Yuryevich, Age: 52, Sex: Male Diagnosis: Acute alcohol poisoning with aspiration, Mallory-Weiss syndrome
DateContent of completed workFrequency
07.07.2026Clinical examination: brought by ambulance after witnessed collapse with vomiting. Ethanol smell, hematemesis (small volume, streaked with blood after repeated retching), GCS 11 (E3V3M5), HR 102/min, BP 115/80 mmHg, SpO2 92% on room air. Completion of medical history from bystanders.1
Interpretation of additional data: blood alcohol level 3.8 g/L. CBC: Hb 110 g/L, WBC 12.4. CXR: right lower lobe infiltrate (aspiration pneumonitis). OGD (next morning): linear mucosal tear at gastro-oesophageal junction — Mallory-Weiss tear, no active bleeding.1
Participation in management: lateral decubitus positioning, oropharyngeal suction, O2 via mask, IV thiamine 100 mg (before glucose), glucose 40% 50 mL IV, IV saline hydration. Antibiotic prophylaxis: co-amoxiclav 1.2 g IV for aspiration pneumonitis. PPI commenced.1
Ward rounds. Participation in clinical case review: management of alcohol-related emergencies, Wernicke prophylaxis, aspiration pneumonitis vs pneumonia.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 16 Full name: Grigoryeva Anna Vladimirovna, Age: 26, Sex: Female Diagnosis: Acute asthma attack, severe
DateContent of completed workFrequency
07.07.2026Clinical examination: progressive wheeze and dyspnoea for 3 hours despite inhaler use. History of atopic asthma. Examination: unable to complete sentences, accessory muscle use, bilateral diffuse expiratory wheeze, RR 28/min, HR 116/min, SpO2 91%, PEFR 38% of predicted (110 L/min). Completion of medical history.1
Interpretation of additional data: ABG: pH 7.37, PaCO2 38 mmHg (normal — concerning for fatigue), PaO2 70 mmHg. CXR: hyperinflation, no pneumothorax. ECG: sinus tachycardia.1
Participation in management: O2 via non-rebreather 15 L/min, salbutamol 5 mg continuous nebulisation, ipratropium 500 mcg nebulisation, hydrocortisone 200 mg IV, magnesium sulphate 2 g IV over 20 min. Aminophylline infusion prepared (not required — PEFR improved to 65% at 1 hr). ICU standby arranged.1
Participation in clinical case review: criteria for life-threatening asthma (silent chest, normal PaCO2, altered consciousness), NIV vs intubation discussion.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 9 — 08.07.2026

Patient 17 Full name: Tikhonov Nikolay Alekseyevich, Age: 63, Sex: Male Diagnosis: Acute aortic dissection, type A (DeBakey type I)
DateContent of completed workFrequency
08.07.2026Clinical examination: sudden onset of tearing chest pain radiating to the back and neck, BP difference between arms >30 mmHg (R 195/110, L 155/90). HR 96/min, aortic regurgitation murmur audible. Neurological signs: right arm paraesthesias. History of hypertension poorly controlled. Emergency documentation completed.1
Interpretation of additional data: CXR — widened mediastinum (>8 cm). ECG — LVH, no ischaemic changes. CT angiography aorta: dissection flap from aortic root to descending aorta, pericardial effusion, no tamponade. D-dimer markedly elevated. Troponin: mildly raised (2.1 ng/mL).1
Participation in emergency management: IV labetalol titrated to target HR <60, target SBP 100–120 mmHg. IV morphine 5 mg for pain. Two large-bore IV lines, urgent cardiac surgery team contacted. Blood crossmatch for 6 units. ICU bed prepared.1
Ward rounds. Participation in clinical case review: Stanford/DeBakey classification, type A (surgical emergency) vs type B (medical management), imaging choices.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 18 Full name: Kovalyova Oksana Dmitrievna, Age: 19, Sex: Female Diagnosis: Meningococcal meningitis with septicaemia (meningococcaemia)
DateContent of completed workFrequency
08.07.2026Clinical examination: 6-hour history of severe headache, photophobia, neck stiffness, high fever, and rapidly evolving non-blanching purpuric rash over trunk and limbs. GCS 13, temperature 39.8°C, HR 124/min, BP 80/50 mmHg, CRT >3 sec. Kernig's and Brudzinski's signs positive. Medical history completed from parents; no prior vaccination.1
Interpretation of additional data: CBC: WBC 22.4×10⁹/L, Hb 102 g/L, platelets 58×10⁹/L (thrombocytopaenia — DIC). CRP 320 mg/L. PT/APTT prolonged. Blood cultures ×2 taken. CT head: no herniation. LP: CSF turbid — WBC 4200 cells/mm³ (predominantly PMN), glucose 1.1 mmol/L (serum 7.2), protein 3.8 g/L. Gram stain: diplococci.1
Participation in emergency management: immediate benzylpenicillin 2.4 g IV, dexamethasone 0.15 mg/kg IV prior to antibiotics, aggressive IV fluid resuscitation (30 mL/kg 0.9% NaCl), noradrenaline infusion commenced for septic shock. ICU transfer arranged.1
Participation in clinical case review: sepsis-3 criteria, meningococcal disease notifiable, prophylaxis for contacts (rifampicin), vaccination.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 10 — 09.07.2026

Patient 19 Full name: Zaitsev Viktor Pavlovich, Age: 78, Sex: Male Diagnosis: Acute urinary retention, acute-on-chronic kidney injury
DateContent of completed workFrequency
09.07.2026Clinical examination: unable to void for 18 hours, severe suprapubic pain, palpable distended bladder to umbilicus. History of BPH, on tamsulosin. BP 170/100 mmHg (pain-related), HR 88/min, creatinine rising. Completion of medical history and emergency documentation.1
Interpretation of additional data: USS abdomen: bladder volume 950 mL, bilateral hydronephrosis. PSA ordered (24.3 ng/mL — elevated). Creatinine 284 µmol/L (baseline 96). K+ 5.6 mmol/L. ECG: peaked T-waves (hyperkalaemia).1
Participation in management: urethral catheterisation performed under supervision (16 Fr Foley, 780 mL urine drained). Urology team informed. IV fluids commenced for AKI. Calcium gluconate 10% 10 mL IV for hyperkalaemia cardioprotection; salbutamol nebulisation and insulin-dextrose infusion planned. Nephrology consulted.1
Ward rounds. Participation in clinical case review: post-obstructive diuresis monitoring, emergency management of hyperkalaemia, BPH surgical options.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 20 Full name: Smirnova Galina Vasilyevna, Age: 56, Sex: Female Diagnosis: Acute cholangitis (Charcot's triad), biliary sepsis
DateContent of completed workFrequency
09.07.2026Clinical examination: fever 39.4°C, right upper quadrant pain radiating to the right shoulder, jaundice. Reynolds pentad: additionally confusion and hypotension. Examination: icteric sclera, RUQ tenderness, Murphy's sign positive. BP 85/55 mmHg, HR 118/min, GCS 13. Completion of medical history; known cholelithiasis, prior ERCP 2 years ago.1
Interpretation of additional data: CBC: WBC 21.6×10⁹/L. Bilirubin total 145 µmol/L (direct 110). ALP 890 U/L, ALT 310 U/L. Blood cultures ×2. Abdominal USS: dilated common bile duct (14 mm), multiple echogenic stones, gallbladder wall thickening. MRCP: large CBD stone with proximal biliary dilatation.1
Participation in management: IV fluid resuscitation, piperacillin-tazobactam 4.5 g IV 8-hourly, metronidazole 500 mg IV 8-hourly. Central line placed. Noradrenaline infusion for septic shock. Urgent gastroenterology/endoscopy team for emergency ERCP.1
Participation in clinical case review: Tokyo guidelines (TG18), grading of cholangitis severity, ERCP vs surgery.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 11 — 10.07.2026

Patient 21 Full name: Polyakov Artem Ruslanovich, Age: 22, Sex: Male Diagnosis: Penetrating abdominal trauma (stab wound, liver laceration), haemorrhagic shock
DateContent of completed workFrequency
10.07.2026Clinical examination: stab wound to right upper quadrant, brought in by emergency ambulance. Active abdominal haemorrhage. Examination: HR 140/min, BP 70/40 mmHg, GCS 14, abdomen rigid, evisceration absent. FAST ultrasound: significant free fluid in Morison's pouch and right subphrenic space. Completion of emergency trauma documentation (ATLS primary survey).1
Interpretation of additional data: Hb 65 g/L (haemorrhaging), lactate 7.2 mmol/L, PT 18s, APTT 56s. CT abdomen (if haemodynamically stable enough): Grade III liver laceration, 800 mL haemoperitoneum estimated. Blood crossmatch: 6 units pRBC, 6 FFP, 2 platelet pools.1
Participation in damage control resuscitation: massive transfusion protocol activated (1:1:1 ratio — pRBC:FFP:platelets), tranexamic acid 1 g IV over 10 min then 1 g over 8 hrs (within 3 hrs of injury), two large-bore peripheral IVs + IO access. Permissive hypotension (SBP 80–90 mmHg). Trauma surgery team at bedside.1
Ward rounds. Participation in clinical case review: ATLS protocol, damage control surgery vs definitive surgery, massive transfusion protocol ratios.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 22 Full name: Nikiforova Lyudmila Grigoryevna, Age: 65, Sex: Female Diagnosis: Hyperosmolar hyperglycaemic state (HHS), severe dehydration
DateContent of completed workFrequency
10.07.2026Clinical examination: progressive confusion and weakness over 5 days, polydipsia. History of type 2 DM, on metformin and gliclazide. Examination: profound dehydration (dry mucous membranes, skin tenting, sunken eyes), GCS 11, HR 110/min, BP 100/70 mmHg, no Kussmaul breathing.1
Interpretation of additional data: blood glucose 48.6 mmol/L, serum osmolality 365 mOsm/kg (calculated), Na+ 148 mmol/L (corrected for glucose: 162 mmol/L), K+ 3.5 mmol/L, HCO3 20 mmol/L (no acidosis), ketones trace.1
Participation in management: 0.9% NaCl 1 L/hr for first 2 hrs, then 500 mL/hr (target fluid deficit replacement over 48 hrs, not faster). Low-dose insulin infusion (0.05 U/kg/hr) commenced only after initial fluid resuscitation and glucose fall not exceeding 5 mmol/L/hr. DVT prophylaxis: LMWH (enoxaparin 40 mg SC). Hourly neurological obs.1
Participation in clinical case review: DKA vs HHS diagnostic distinction, risks of rapid fluid/osmolality correction (cerebral oedema), VTE risk in HHS.1
Student's signature: __________ Signature of clinical base supervisor: __________

DAY 12 — 11.07.2026

Patient 23 Full name: Belyakov Roman Olegovich, Age: 40, Sex: Male Diagnosis: Acute carbon monoxide poisoning, moderate severity
DateContent of completed workFrequency
11.07.2026Safety instructions reviewed (third scheduled review, end-of-practice). Familiarization with hyperbaric oxygen therapy (HBO) referral protocol at the base.1
Clinical examination: found unconscious at home (gas boiler malfunction). Brought by ambulance. Examination: cherry-red skin colouration, GCS 10, HR 108/min, BP 130/85 mmHg, SpO2 pulse oximetry 97% (falsely normal — oximeter cannot differentiate COHb). Nausea, vomiting, severe headache on recovery. Completion of medical history from family.1
Interpretation of additional data: COHb by co-oximetry: 32% (moderate poisoning). ABG: pH 7.26, pO2 180 mmHg (on O2), metabolic acidosis, lactate 4.8 mmol/L. ECG: ST changes (CO-induced myocardial injury). Troponin I: 1.9 ng/mL. Neurological screening: cognitive testing impaired.1
Participation in management: 100% O2 via tight-fitting non-rebreather mask (eliminates CO half-life from ~5 hrs to ~60 min). IV access, glucose, electrolytes. Referral initiated for HBO therapy (COHb >25%, neurological symptoms, cardiac involvement — absolute indications met). Cardiology and neurology consulted.1
Ward rounds with head of department. Participation in clinical case review: CO poisoning pathophysiology, indications for HBO, pulse oximetry pitfalls, delayed neurological sequelae.2
Student's signature: __________ Signature of clinical base supervisor: __________
Patient 24 Full name: Medvedeva Svetlana Nikolayevna, Age: 47, Sex: Female Diagnosis: Acute adrenal (Addisonian) crisis
DateContent of completed workFrequency
11.07.2026Clinical examination: profound weakness, abdominal pain, nausea, vomiting, confusion, collapse. History of Addison's disease; patient had stopped hydrocortisone 4 days ago during an intercurrent gastrointestinal illness. Examination: severe hypotension (BP 65/40 mmHg), HR 132/min, hyperpigmentation (chronic), temperature 37.8°C, GCS 12. Completion of medical history and emergency documentation.1
Interpretation of additional data: glucose 2.8 mmol/L (hypoglycaemia). Na+ 118 mmol/L (hyponatraemia), K+ 6.2 mmol/L (hyperkalaemia). Cortisol (random) 42 nmol/L (critically low). ACTH: significantly elevated (retrospective). ECG: peaked T-waves (hyperkalaemia). CBC and renal function reviewed.1
Participation in emergency management: hydrocortisone 100 mg IV bolus immediately (do not wait for investigations if clinical diagnosis clear). 1 L 0.9% NaCl with 5% dextrose rapidly IV. Glucose 40% 50 mL IV. Correction of hyperkalaemia initiated (calcium gluconate, insulin-dextrose). Hydrocortisone infusion 200 mg/24 hrs. ICU for close monitoring. Future sick-day rules education planned for patient and family.1
Ward rounds - final rounds of practice rotation. Participation in final clinical case review with head of department and supervisor: sick-day rule failure, precipitating factors of Addisonian crisis, steroid stress dosing protocols.2
End-of-practice summary meeting with supervisor. Practice documentation checked and signed.1
Student's signature: __________ Signature of clinical base supervisor: __________

SUMMARY TABLE OF PATIENTS SEEN

DayDatePatientDiagnosis
129.06.2026Petrov I.S., 58MAcute STEMI (anterior)
129.06.2026Sorokina M.A., 42FHypertensive crisis
230.06.2026Zhukova O.P., 67FIschaemic stroke (MCA)
230.06.2026Frolov D.N., 34MAnaphylactic shock
301.07.2026Kuznetsova T.I., 72FCOPD exacerbation, severe
301.07.2026Morozov A.V., 48MAcute pancreatitis
402.07.2026Lebedeva N.Y., 29FStatus epilepticus
402.07.2026Volkov G.I., 61MAcute decompensated HF
503.07.2026Sidorov P.K., 55MUpper GI bleeding
503.07.2026Belova I.F., 38FDiabetic ketoacidosis
604.07.2026Orlov S.A., 44MMassive pulmonary embolism
604.07.2026Novikova E.B., 31FRuptured ectopic pregnancy
706.07.2026Korolev M.P., 70MComplete AV block
706.07.2026Pavlova Z.S., 82FHip fracture, blood loss
807.07.2026Stepanov A.Y., 52MAlcohol poisoning/Mallory-Weiss
807.07.2026Grigoryeva A.V., 26FSevere acute asthma
908.07.2026Tikhonov N.A., 63MAortic dissection type A
908.07.2026Kovalyova O.D., 19FMeningococcal meningitis
1009.07.2026Zaitsev V.P., 78MAcute urinary retention/AKI
1009.07.2026Smirnova G.V., 56FAcute cholangitis/biliary sepsis
1110.07.2026Polyakov A.R., 22MPenetrating trauma/haem. shock
1110.07.2026Nikiforova L.G., 65FHyperosmolar hyperglycaemic state
1211.07.2026Belyakov R.O., 40MCO poisoning
1211.07.2026Medvedeva S.N., 47FAddisonian crisis
Total patients: 24 individual patients across 12 working days (2 per day)
Student's signature: __________
Supervisor of practical training signature: __________
Head of practice base (stamp): __________
How to use this diary: Copy each daily log block into your Word document following the table format shown in your image (Date | Content of completed work | Frequency). Each patient occupies its own set of table rows under the corresponding date. Add your personal details, faculty, group number, and the name/address of your practice base at the top. Both the student and clinical supervisor must sign at the bottom of each day's table.

Generate a Word document with this complete diary (DOCX)

Reading File
Reading File
Running Command

ls /home/daytona/workspace/ 2>/dev/null || mkdir -p /home/daytona/workspace/

Running Command

mkdir -p /home/daytona/workspace/kursk-diary && ls /home/daytona/workspace/kursk…

Running Command

cd /home/daytona/workspace/kursk-diary && node -e "require('docx'); console.log(…

Writing File

~/kursk-diary/generate.js

"use strict";
const {
  Document, Packer, Paragraph, TextRun, Table, TableRow, TableCell,
  AlignmentType, HeadingLevel, BorderStyle, WidthType, VerticalAlign,
  PageBreak, ShadingType
} = require("docx");
const fs = require("fs");

// ---- helpers ----
function cell(text, opts = {}) {
  const { bold = false, shade = false, width = null, vAlign = VerticalAlign.TOP } = opts;
  const cellOpts = {
    verticalAlign: vAlign,
    shading: shade ? { type: ShadingType.CLEAR, fill: "D9E1F2" } : undefined,
    children: [
      new Paragraph({
        spacing: { before: 40, after: 40 },
        children: [new TextRun({ text: String(text), bold, size: 20, font: "Times New Roman" })]
      })
    ]
  };
  if (width) cellOpts.width = { size: width, type: WidthType.DXA };
  return new TableCell(cellOpts);
}

function headerCell(text) {
  return new TableCell({
    verticalAlign: VerticalAlign.CENTER,
    shading: { type: ShadingType.CLEAR, fill: "1F497D" },
    children: [
      new Paragraph({
        alignment: AlignmentType.CENTER,
        spacing: { before: 60, after: 60 },
        children: [new TextRun({ text, bold: true, size: 22, font: "Times New Roman", color: "FFFFFF" })]
      })
    ]
  });
}

function thinBorderTable(rows) {
  const thin = { style: BorderStyle.SINGLE, size: 4, color: "999999" };
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    borders: { top: thin, bottom: thin, left: thin, right: thin, insideH: thin, insideV: thin },
    rows
  });
}

function heading(text, level = HeadingLevel.HEADING_2) {
  return new Paragraph({
    heading: level,
    spacing: { before: 200, after: 100 },
    children: [new TextRun({ text, bold: true, size: level === HeadingLevel.HEADING_1 ? 32 : 26, font: "Times New Roman" })]
  });
}

function para(text, opts = {}) {
  const { bold = false, center = false, size = 22 } = opts;
  return new Paragraph({
    alignment: center ? AlignmentType.CENTER : AlignmentType.LEFT,
    spacing: { before: 60, after: 60 },
    children: [new TextRun({ text, bold, size, font: "Times New Roman" })]
  });
}

function signatureRow() {
  return new Table({
    width: { size: 100, type: WidthType.PERCENTAGE },
    borders: {
      top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE },
      left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE },
      insideH: { style: BorderStyle.NONE }, insideV: { style: BorderStyle.NONE }
    },
    rows: [
      new TableRow({
        children: [
          new TableCell({
            width: { size: 50, type: WidthType.PERCENTAGE },
            borders: { top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE }, left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE } },
            children: [para("Student's signature: ________________")]
          }),
          new TableCell({
            width: { size: 50, type: WidthType.PERCENTAGE },
            borders: { top: { style: BorderStyle.NONE }, bottom: { style: BorderStyle.NONE }, left: { style: BorderStyle.NONE }, right: { style: BorderStyle.NONE } },
            children: [para("Signature of clinical base supervisor: ________________")]
          })
        ]
      })
    ]
  });
}

// ---- patient data ----
const patients = [
  {
    date: "29.06.2026", day: "DAY 1",
    name: "Petrov Ivan Sergeyevich", age: "58", sex: "Male",
    dx: "Acute myocardial infarction (ST-elevation, anterior wall)",
    rows: [
      ["Safety instructions reviewed. Familiarization with the structure of the emergency admission unit (ambulance station).", "1"],
      ["Clinical examination: complaints of crushing retrosternal pain radiating to the left arm for 2 hours, cold sweat, nausea. BP 100/70 mmHg, HR 98/min, SpO2 94%. Skin pale and moist. Completion of medical history and inpatient card. Coordination of diagnosis, examination plan, and treatment plan with the attending physician.", "1"],
      ["Interpretation of additional examination data: ECG - ST elevation in leads V1-V4, reciprocal depression in II, III, aVF. Troponin I 2.8 ng/mL (elevated). CBC and metabolic panel reviewed.", "1"],
      ["Participation in emergency management: IV access, O2 4 L/min, aspirin 300 mg PO, clopidogrel 600 mg PO, heparin 5000 IU IV bolus. Patient prepared for urgent PCI transfer.", "1"],
      ["Ward rounds with the head of department for supervised patients.", "1"]
    ]
  },
  {
    date: "29.06.2026", day: "",
    name: "Sorokina Marina Alexandrovna", age: "42", sex: "Female",
    dx: "Hypertensive crisis, uncomplicated",
    rows: [
      ["Clinical examination: severe headache, visual 'flashes,' palpitations. BP 210/120 mmHg bilaterally, HR 90/min, no neurological deficit. Completion of medical history.", "1"],
      ["Interpretation of ECG: sinus tachycardia, LVH signs (Sokolov-Lyon criterion positive).", "1"],
      ["Participation in emergency management: captopril 25 mg sublingual, amlodipine 10 mg PO. BP re-checked at 30 min - 170/100 mmHg. Antihypertensive therapy adjustment discussed with attending physician.", "1"],
      ["Participation in clinical case review with head of department: differential diagnosis between uncomplicated hypertensive crisis and hypertensive urgency with end-organ damage.", "1"]
    ]
  },
  {
    date: "30.06.2026", day: "DAY 2",
    name: "Zhukova Olga Petrovna", age: "67", sex: "Female",
    dx: "Acute ischaemic stroke (left middle cerebral artery territory)",
    rows: [
      ["Clinical examination: sudden onset of right-sided weakness and speech impairment 90 min ago. NIHSS score 12 points. BP 180/100 mmHg, HR 82/min, GCS 14. Completion of medical history and inpatient documentation. Coordination of diagnosis and management with neurologist on duty.", "1"],
      ["Interpretation of additional data: CT brain - no haemorrhage; hyperdense MCA sign. CBC, coagulation screen, glucose reviewed (glucose 6.8 mmol/L).", "1"],
      ["Participation in emergency management: IV thrombolysis with alteplase (0.9 mg/kg) initiated under neurologist supervision; loading dose IV, remainder over 60 min infusion. Continuous monitoring of BP, HR, neurological status.", "1"],
      ["Ward rounds. Participation in clinical case review: indications and contraindications for IV thrombolysis.", "2"]
    ]
  },
  {
    date: "30.06.2026", day: "",
    name: "Frolov Dmitry Nikolayevich", age: "34", sex: "Male",
    dx: "Anaphylactic shock (insect sting)",
    rows: [
      ["Clinical examination: generalised urticaria, angioedema of lips and tongue, stridor, BP 70/40 mmHg, HR 130/min, SpO2 88% following bee sting. Rapid assessment completed.", "1"],
      ["Participation in emergency management: epinephrine 0.5 mg IM (mid-outer thigh), O2 10 L/min non-rebreather, IV access x2 with 0.9% NaCl 1000 mL, chloropyramine 20 mg IV, dexamethasone 8 mg IV. BP 100/70, SpO2 96% at 20 min.", "1"],
      ["Interpretation of additional data: SpO2 trend, ECG (sinus tachycardia resolving), blood glucose.", "1"],
      ["Participation in clinical case review: pathophysiology of anaphylaxis, epinephrine auto-injector prescription.", "1"]
    ]
  },
  {
    date: "01.07.2026", day: "DAY 3",
    name: "Kuznetsova Tatyana Ivanovna", age: "72", sex: "Female",
    dx: "Acute exacerbation of COPD, severe",
    rows: [
      ["Safety instructions reviewed (second scheduled review). Familiarization with emergency respiratory care trolley and non-invasive ventilator settings.", "1"],
      ["Clinical examination: progressive dyspnoea over 3 days, increased purulent sputum, inability to complete sentences. SpO2 82%, RR 28/min, HR 102/min, prolonged expiration, diffuse wheezes, barrel chest. Completion of medical history.", "1"],
      ["Interpretation of ABG: pH 7.31, PaCO2 58 mmHg, PaO2 52 mmHg - type II respiratory failure. CXR: hyperinflation, no consolidation. Sputum culture sent.", "1"],
      ["Participation in management: controlled O2 via Venturi mask 28%, salbutamol 2.5 mg + ipratropium 500 mcg nebulisation, prednisolone 40 mg IV, amoxicillin-clavulanate 1.2 g IV. NIV (BiPAP) initiated under supervision.", "1"],
      ["Ward rounds with the head of department.", "1"]
    ]
  },
  {
    date: "01.07.2026", day: "",
    name: "Morozov Aleksei Vladimirovich", age: "48", sex: "Male",
    dx: "Acute pancreatitis, moderately severe (Ranson score 3)",
    rows: [
      ["Clinical examination: severe epigastric pain radiating to the back ('belt-like'), nausea, vomiting x6, history of alcohol intake. Temperature 38.1 C, HR 108/min, BP 110/80 mmHg, epigastric tenderness and guarding. Completion of medical history.", "1"],
      ["Interpretation of additional data: serum amylase 1840 U/L, lipase 2300 U/L, WBC 14.2 x10^9/L, CRP 180 mg/L. Abdominal USS: oedematous pancreas, no gallstones. CT abdomen: pancreatic oedema, peripancreatic fat stranding, no necrosis.", "1"],
      ["Participation in management: IV fluid resuscitation (Ringer's lactate 250 mL/hr), nil by mouth, NGT, ketorolac 30 mg IV, omeprazole 40 mg IV. Surgical team consulted.", "1"],
      ["Participation in clinical case review: Ranson criteria, Atlanta classification, indications for surgical referral.", "1"]
    ]
  },
  {
    date: "02.07.2026", day: "DAY 4",
    name: "Lebedeva Natalya Yurievna", age: "29", sex: "Female",
    dx: "Status epilepticus (generalised tonic-clonic)",
    rows: [
      ["Clinical examination: continuous tonic-clonic seizures >5 min (total 22 min). No prior epilepsy history. Post-ictal state, tongue laceration, SpO2 89%, HR 124/min, BP 150/90 mmHg. Medical history obtained from relatives.", "1"],
      ["Participation in emergency management: recovery position, jaw thrust, O2 15 L/min, IV access; diazepam 10 mg IV - seizures resolved at 3 min. Blood glucose 4.2 mmol/L. Phenytoin 18 mg/kg IV loading infusion for prophylaxis.", "1"],
      ["Interpretation of additional data: MRI brain - no structural lesion. EEG - diffuse slowing. CBC, metabolic panel, toxicology screen - unremarkable.", "1"],
      ["Ward rounds. Clinical case review: classification of status epilepticus, stepwise pharmacological approach.", "2"]
    ]
  },
  {
    date: "02.07.2026", day: "",
    name: "Volkov Gennady Igorevich", age: "61", sex: "Male",
    dx: "Acute decompensated heart failure (pulmonary oedema)",
    rows: [
      ["Clinical examination: acute severe dyspnoea, orthopnoea, frothy pink sputum. History of dilated cardiomyopathy. SpO2 80%, RR 32/min, HR 118/min (irregular), BP 160/100 mmHg, bilateral fine crackles to mid-zones, elevated JVP. Completion of medical history.", "1"],
      ["Interpretation of additional data: ECG - atrial fibrillation with rapid ventricular response. BNP 2300 pg/mL. CXR: bilateral perihilar infiltrates, cardiomegaly, Kerley B lines. Bedside echo: EF 22%, dilated LV.", "1"],
      ["Participation in emergency management: patient sat upright, O2 non-rebreather, BiPAP initiated, furosemide 80 mg IV bolus, GTN infusion 10 mcg/min IV titrated. Rate control: digoxin 0.5 mg IV. Urine output monitored via catheter.", "1"],
      ["Participation in clinical case review: precipitants of acute decompensation, Killip classification.", "1"]
    ]
  },
  {
    date: "03.07.2026", day: "DAY 5",
    name: "Sidorov Pavel Konstantinovich", age: "55", sex: "Male",
    dx: "Acute upper GI bleeding (peptic ulcer, Forrest Ia)",
    rows: [
      ["Clinical examination: haematemesis (fresh blood x2), melaena, syncope. History of NSAID use. Pallor, cold extremities, HR 118/min, BP 90/60 mmHg (supine), CRT >3 sec, GCS 14. Completion of medical history.", "1"],
      ["Interpretation of additional data: Hb 72 g/L, platelets 180 x10^9/L, INR 1.3, BUN/creatinine ratio >30. Blood group and cross-match ordered (O-negative issued).", "1"],
      ["Participation in resuscitation: two large-bore IV cannulae, Hartmann's 500 mL rapid infusion, then pRBC transfusion (2 units). NGT - fresh blood confirmed. Omeprazole 80 mg IV bolus then 8 mg/hr infusion. Foley catheter. Urgent endoscopy team called.", "1"],
      ["Ward rounds. Clinical case review: Blatchford score (12), Forrest classification, endoscopic haemostasis methods.", "2"]
    ]
  },
  {
    date: "03.07.2026", day: "",
    name: "Belova Irina Fyodorovna", age: "38", sex: "Female",
    dx: "Diabetic ketoacidosis (DKA), moderate severity",
    rows: [
      ["Clinical examination: nausea, vomiting, polyuria, polydipsia, abdominal pain for 2 days. Type 1 DM history. Kussmaul breathing, fruity breath, dry mucous membranes, HR 106/min, BP 105/75 mmHg, GCS 15. Completion of medical history.", "1"],
      ["Interpretation of additional data: glucose 28.4 mmol/L, pH 7.18, HCO3 9 mmol/L, anion gap 24, B-hydroxybutyrate 6.2 mmol/L, K+ 3.1 mmol/L. Urinalysis: glucose 4+, ketones 3+. ECG: sinus tachycardia, flattened T-waves.", "1"],
      ["Participation in management: IV 0.9% NaCl 1 L over 1 hr then 500 mL/hr. IV insulin infusion 0.1 U/kg/hr. KCl replacement (40 mmol/L in fluids). Hourly glucose and electrolyte monitoring plan. Bicarbonate not given (pH >7.0).", "1"],
      ["Participation in clinical case review: DKA vs HHS, diagnostic criteria, insulin sliding scale pitfalls.", "1"]
    ]
  },
  {
    date: "04.07.2026", day: "DAY 6",
    name: "Orlov Sergey Alexandrovich", age: "44", sex: "Male",
    dx: "Pulmonary embolism, high risk (massive PE)",
    rows: [
      ["Clinical examination: sudden onset severe dyspnoea, pleuritic chest pain, syncope. 3-week immobilisation post hip surgery. HR 128/min, BP 88/60 mmHg, SpO2 85%, raised JVP, right heart strain signs. Wells score: high probability. Completion of emergency documentation.", "1"],
      ["Interpretation of additional data: ECG - S1Q3T3 pattern, sinus tachycardia. D-dimer >5000 ng/mL. CTPA: bilateral saddle embolus confirmed. Echo: RV dilation and hypokinesis. Troponin T: 0.45 ng/mL.", "1"],
      ["Participation in emergency management: O2 15 L/min, UFH 80 U/kg IV bolus then 18 U/kg/hr infusion. Systemic thrombolysis (alteplase 100 mg IV over 2 hrs) initiated under senior supervision due to haemodynamic instability. Continuous monitoring.", "1"],
      ["Ward rounds. Clinical case review: PESI score, risk stratification, thrombolysis vs embolectomy.", "2"]
    ]
  },
  {
    date: "04.07.2026", day: "",
    name: "Novikova Elena Borisovna", age: "31", sex: "Female",
    dx: "Ectopic pregnancy, ruptured (left fallopian tube), haemoperitoneum",
    rows: [
      ["Clinical examination: acute LIF pain, shoulder-tip pain, amenorrhoea x7 weeks, PV spotting. Generalised guarding, rebound tenderness, cervical motion tenderness +. HR 122/min, BP 80/50 mmHg. Pregnancy test positive. Emergency documentation completed.", "1"],
      ["Interpretation of additional data: B-hCG 4800 mIU/mL. CBC: Hb 79 g/L (falling). TVUS: empty uterus, left adnexal mass 4 cm, significant free fluid in pelvis and Morison's pouch.", "1"],
      ["Participation in resuscitation and pre-operative management: two large-bore IV lines, O-negative blood crossmatch, crystalloid infusion, O2 therapy, Foley catheter. Gynaecological surgery team contacted; urgent laparotomy arranged.", "1"],
      ["Participation in clinical case review: differential diagnosis of acute abdomen in women of reproductive age, laparoscopic vs open management.", "1"]
    ]
  },
  {
    date: "06.07.2026", day: "DAY 7",
    name: "Korolev Mikhail Petrovich", age: "70", sex: "Male",
    dx: "Complete atrioventricular block (third-degree), haemodynamic compromise",
    rows: [
      ["Safety instructions reviewed (third scheduled review). Familiarization with defibrillator and transcutaneous pacemaker setup in emergency bay.", "1"],
      ["Clinical examination: syncope, dizziness, presyncope on exertion. HR 36/min, BP 80/50 mmHg, cannon A-waves in JVP, variable S1 intensity. Known ischaemic heart disease, recent inferior MI. Completion of medical history.", "1"],
      ["Interpretation of ECG: P-waves and QRS complexes dissociated, rate 36/min, wide QRS escape rhythm. K+ 5.8 mmol/L. Echo: inferior wall hypokinesia, EF 40%.", "1"],
      ["Participation in emergency management: atropine 1 mg IV (minimal response), transcutaneous pacing at 70/min, 60 mA - capture achieved, BP 110/70 mmHg. IV dopamine as bridge. Cardiology contacted for urgent transvenous pacemaker insertion.", "1"],
      ["Ward rounds. Clinical case review: indications for temporary vs permanent pacing.", "2"]
    ]
  },
  {
    date: "06.07.2026", day: "",
    name: "Pavlova Zinaida Semyonovna", age: "82", sex: "Female",
    dx: "Hip fracture (subcapital, right), acute blood loss anaemia",
    rows: [
      ["Clinical examination: fall from standing height, inability to walk, severe right hip pain. Right leg shortened and externally rotated. BP 100/65 mmHg, HR 98/min, Hb 85 g/L. Pain score 9/10. Known osteoporosis, anticoagulated (warfarin INR 3.2). Completion of medical history.", "1"],
      ["Interpretation of additional data: X-ray right hip: subcapital fracture displaced (Garden type III). CBC, coagulation (INR 3.2), renal function (creatinine 124 umol/L), ECG reviewed.", "1"],
      ["Participation in management: morphine 2.5 mg IV titrated, IV access, crystalloid, Foley catheter. Warfarin reversal: vitamin K 10 mg IV + 4-factor PCC (Octaplex) dosed per weight. Orthopaedic surgery team informed.", "1"],
      ["Participation in clinical case review: fragility fractures, peri-operative anticoagulation reversal, VTE prophylaxis after hip surgery.", "1"]
    ]
  },
  {
    date: "07.07.2026", day: "DAY 8",
    name: "Stepanov Andrey Yuryevich", age: "52", sex: "Male",
    dx: "Acute alcohol poisoning with aspiration; Mallory-Weiss syndrome",
    rows: [
      ["Clinical examination: collapse with vomiting, haematemesis (small volume, streaked after retching), ethanol smell, GCS 11, HR 102/min, BP 115/80 mmHg, SpO2 92%. Completion of medical history from bystanders.", "1"],
      ["Interpretation of additional data: blood alcohol level 3.8 g/L. CXR: right lower lobe infiltrate (aspiration pneumonitis). OGD (next morning): linear mucosal tear at gastro-oesophageal junction - no active bleeding.", "1"],
      ["Participation in management: lateral decubitus positioning, oropharyngeal suction, O2, thiamine 100 mg IV before glucose, glucose 40% 50 mL IV, IV saline. Co-amoxiclav 1.2 g IV for aspiration pneumonitis. PPI commenced.", "1"],
      ["Ward rounds. Clinical case review: alcohol-related emergencies, Wernicke prophylaxis, aspiration pneumonitis vs pneumonia.", "2"]
    ]
  },
  {
    date: "07.07.2026", day: "",
    name: "Grigoryeva Anna Vladimirovna", age: "26", sex: "Female",
    dx: "Acute asthma attack, severe",
    rows: [
      ["Clinical examination: wheeze and dyspnoea for 3 hours despite inhaler use. Atopic asthma history. Unable to complete sentences, accessory muscle use, bilateral expiratory wheeze, RR 28/min, HR 116/min, SpO2 91%, PEFR 38% predicted. Completion of medical history.", "1"],
      ["Interpretation of additional data: ABG: pH 7.37, PaCO2 38 mmHg (normal - concerning for fatigue), PaO2 70 mmHg. CXR: hyperinflation, no pneumothorax.", "1"],
      ["Participation in management: O2 non-rebreather 15 L/min, salbutamol 5 mg continuous nebulisation, ipratropium 500 mcg neb, hydrocortisone 200 mg IV, magnesium sulphate 2 g IV over 20 min. PEFR improved to 65% at 1 hr. ICU standby arranged.", "1"],
      ["Clinical case review: criteria for life-threatening asthma, NIV vs intubation.", "1"]
    ]
  },
  {
    date: "08.07.2026", day: "DAY 9",
    name: "Tikhonov Nikolay Alekseyevich", age: "63", sex: "Male",
    dx: "Acute aortic dissection, type A (DeBakey type I)",
    rows: [
      ["Clinical examination: sudden tearing chest pain radiating to back and neck, BP difference between arms >30 mmHg (R: 195/110, L: 155/90), aortic regurgitation murmur, right arm paraesthesias. Known poorly controlled hypertension. Emergency documentation completed.", "1"],
      ["Interpretation of additional data: CXR - widened mediastinum (>8 cm). ECG - LVH, no ischaemic changes. CT angiography aorta: dissection flap from aortic root to descending aorta, pericardial effusion, no tamponade. Troponin mildly raised.", "1"],
      ["Participation in emergency management: IV labetalol titrated (target HR <60, SBP 100-120 mmHg), morphine 5 mg IV. Two large-bore IV lines, urgent cardiac surgery team contacted. Blood crossmatch x6 units. ICU bed prepared.", "1"],
      ["Ward rounds. Clinical case review: Stanford/DeBakey classification, type A (surgical) vs type B (medical), imaging choices.", "2"]
    ]
  },
  {
    date: "08.07.2026", day: "",
    name: "Kovalyova Oksana Dmitrievna", age: "19", sex: "Female",
    dx: "Meningococcal meningitis with septicaemia (meningococcaemia)",
    rows: [
      ["Clinical examination: 6-hr history of severe headache, photophobia, neck stiffness, fever 39.8 C, non-blanching purpuric rash. GCS 13, HR 124/min, BP 80/50 mmHg, CRT >3 sec. Kernig's and Brudzinski's signs positive. No prior vaccination. Medical history from parents.", "1"],
      ["Interpretation of additional data: CBC: WBC 22.4 x10^9/L, platelets 58 x10^9/L (DIC). CRP 320 mg/L. Blood cultures x2. LP: CSF turbid - WBC 4200 cells/mm3 (PMN), glucose 1.1 mmol/L, protein 3.8 g/L. Gram stain: diplococci.", "1"],
      ["Participation in emergency management: benzylpenicillin 2.4 g IV immediately, dexamethasone 0.15 mg/kg IV, aggressive IV fluid resuscitation (30 mL/kg 0.9% NaCl), noradrenaline infusion for septic shock. ICU transfer arranged.", "1"],
      ["Clinical case review: sepsis-3 criteria, meningococcal disease notification, prophylaxis for contacts (rifampicin), vaccination.", "1"]
    ]
  },
  {
    date: "09.07.2026", day: "DAY 10",
    name: "Zaitsev Viktor Pavlovich", age: "78", sex: "Male",
    dx: "Acute urinary retention; acute-on-chronic kidney injury",
    rows: [
      ["Clinical examination: unable to void for 18 hours, severe suprapubic pain, distended bladder to umbilicus. Known BPH on tamsulosin. BP 170/100 mmHg (pain-related), HR 88/min. Completion of medical history.", "1"],
      ["Interpretation of additional data: USS abdomen: bladder 950 mL, bilateral hydronephrosis. PSA 24.3 ng/mL. Creatinine 284 umol/L (baseline 96). K+ 5.6 mmol/L. ECG: peaked T-waves (hyperkalaemia).", "1"],
      ["Participation in management: urethral catheterisation under supervision (16 Fr Foley, 780 mL drained). Urology informed. IV fluids for AKI. Calcium gluconate 10% 10 mL IV (cardioprotection); salbutamol neb and insulin-dextrose infusion for hyperkalaemia. Nephrology consulted.", "1"],
      ["Ward rounds. Clinical case review: post-obstructive diuresis monitoring, emergency management of hyperkalaemia, BPH surgical options.", "2"]
    ]
  },
  {
    date: "09.07.2026", day: "",
    name: "Smirnova Galina Vasilyevna", age: "56", sex: "Female",
    dx: "Acute cholangitis (Charcot's triad), biliary sepsis",
    rows: [
      ["Clinical examination: fever 39.4 C, RUQ pain, jaundice, confusion, hypotension (Reynolds pentad). Murphy's sign positive. BP 85/55 mmHg, HR 118/min, GCS 13. Known cholelithiasis, prior ERCP 2 years ago. Completion of medical history.", "1"],
      ["Interpretation of additional data: WBC 21.6 x10^9/L. Bilirubin total 145 umol/L. ALP 890 U/L, ALT 310 U/L. Blood cultures x2. Abdominal USS: dilated CBD (14 mm), multiple stones. MRCP: large CBD stone with proximal biliary dilatation.", "1"],
      ["Participation in management: IV fluid resuscitation, piperacillin-tazobactam 4.5 g IV 8-hrly, metronidazole 500 mg IV 8-hrly. Central line placed. Noradrenaline for septic shock. Urgent endoscopy team for emergency ERCP.", "1"],
      ["Clinical case review: Tokyo guidelines (TG18), grading of cholangitis severity, ERCP vs surgery.", "1"]
    ]
  },
  {
    date: "10.07.2026", day: "DAY 11",
    name: "Polyakov Artem Ruslanovich", age: "22", sex: "Male",
    dx: "Penetrating abdominal trauma (stab wound, liver laceration), haemorrhagic shock",
    rows: [
      ["Clinical examination: stab wound to RUQ. HR 140/min, BP 70/40 mmHg, GCS 14, rigid abdomen. FAST USS: significant free fluid in Morison's pouch and right subphrenic space. ATLS primary survey completed. Emergency trauma documentation.", "1"],
      ["Interpretation of additional data: Hb 65 g/L, lactate 7.2 mmol/L, PT 18s, APTT 56s. CT abdomen: Grade III liver laceration, 800 mL haemoperitoneum estimated. Blood crossmatch: 6 units pRBC, 6 FFP, 2 platelet pools.", "1"],
      ["Participation in damage control resuscitation: massive transfusion protocol activated (1:1:1 ratio pRBC:FFP:platelets). Tranexamic acid 1 g IV over 10 min then 1 g over 8 hrs. Two large-bore peripheral IVs + IO access. Permissive hypotension (SBP 80-90 mmHg). Trauma surgery team at bedside.", "1"],
      ["Ward rounds. Clinical case review: ATLS protocol, damage control surgery, massive transfusion protocol ratios.", "2"]
    ]
  },
  {
    date: "10.07.2026", day: "",
    name: "Nikiforova Lyudmila Grigoryevna", age: "65", sex: "Female",
    dx: "Hyperosmolar hyperglycaemic state (HHS), severe dehydration",
    rows: [
      ["Clinical examination: progressive confusion and weakness over 5 days, polydipsia. Type 2 DM on metformin and gliclazide. Profound dehydration, GCS 11, HR 110/min, BP 100/70 mmHg, no Kussmaul breathing. Completion of medical history.", "1"],
      ["Interpretation of additional data: blood glucose 48.6 mmol/L, serum osmolality 365 mOsm/kg, Na+ 148 mmol/L (corrected 162 mmol/L), K+ 3.5 mmol/L, HCO3 20 mmol/L (no acidosis), ketones trace.", "1"],
      ["Participation in management: 0.9% NaCl 1 L/hr x2 hrs, then 500 mL/hr (fluid deficit over 48 hrs). Low-dose insulin infusion 0.05 U/kg/hr commenced after initial fluid resuscitation. Glucose fall not exceeding 5 mmol/L/hr. LMWH (enoxaparin 40 mg SC) for DVT prophylaxis. Hourly neuro obs.", "1"],
      ["Clinical case review: DKA vs HHS distinction, risks of rapid osmolality correction (cerebral oedema), VTE risk.", "1"]
    ]
  },
  {
    date: "11.07.2026", day: "DAY 12",
    name: "Belyakov Roman Olegovich", age: "40", sex: "Male",
    dx: "Acute carbon monoxide poisoning, moderate severity",
    rows: [
      ["Safety instructions reviewed (final end-of-practice review). Familiarization with hyperbaric oxygen therapy (HBO) referral protocol at the practice base.", "1"],
      ["Clinical examination: found unconscious at home (gas boiler malfunction). Cherry-red skin, GCS 10, HR 108/min, SpO2 97% (falsely normal on pulse oximetry). Severe headache, nausea, vomiting on recovery. Completion of medical history from family.", "1"],
      ["Interpretation of additional data: COHb by co-oximetry 32% (moderate poisoning). ABG: pH 7.26, metabolic acidosis, lactate 4.8 mmol/L. ECG: ST changes. Troponin I 1.9 ng/mL. Cognitive testing impaired.", "1"],
      ["Participation in management: 100% O2 via tight-fitting non-rebreather mask. IV access, glucose, electrolytes. HBO therapy referral initiated (COHb >25%, neurological symptoms, cardiac involvement - absolute indications met). Cardiology and neurology consulted.", "1"],
      ["Ward rounds. Clinical case review: CO poisoning pathophysiology, indications for HBO, pulse oximetry pitfalls, delayed neurological sequelae.", "2"]
    ]
  },
  {
    date: "11.07.2026", day: "",
    name: "Medvedeva Svetlana Nikolayevna", age: "47", sex: "Female",
    dx: "Acute adrenal (Addisonian) crisis",
    rows: [
      ["Clinical examination: profound weakness, abdominal pain, nausea, vomiting, confusion, collapse. Addison's disease history; hydrocortisone stopped 4 days ago during intercurrent illness. BP 65/40 mmHg, HR 132/min, hyperpigmentation, temperature 37.8 C, GCS 12. Completion of medical history.", "1"],
      ["Interpretation of additional data: glucose 2.8 mmol/L (hypoglycaemia). Na+ 118 mmol/L, K+ 6.2 mmol/L, random cortisol 42 nmol/L (critically low). ACTH elevated (retrospective). ECG: peaked T-waves.", "1"],
      ["Participation in emergency management: hydrocortisone 100 mg IV bolus immediately. 1 L 0.9% NaCl with 5% dextrose rapidly IV. Glucose 40% 50 mL IV. Calcium gluconate and insulin-dextrose for hyperkalaemia. Hydrocortisone infusion 200 mg/24 hrs. ICU transfer.", "1"],
      ["Ward rounds - final rounds of practice rotation. Participation in final clinical case review with head of department: sick-day rule failure, precipitating factors of Addisonian crisis, steroid stress dosing. End-of-practice documentation checked and signed.", "2"]
    ]
  }
];

// ---- build document ----
const children = [];

// Title block
children.push(
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 60 },
    children: [new TextRun({ text: "Federal State Budgetary Educational Institution of Higher Education", bold: true, size: 22, font: "Times New Roman" })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 60 },
    children: [new TextRun({ text: '"Kursk State Medical University" of the Ministry of Health of the Russian Federation', bold: true, size: 22, font: "Times New Roman" })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 200, after: 120 },
    children: [new TextRun({ text: "DIARY OF INDUSTRIAL PRACTICE", bold: true, size: 28, font: "Times New Roman", underline: {} })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 200 },
    children: [new TextRun({ text: "for acquiring professional skills and experience in professional activity", size: 22, font: "Times New Roman", italics: true })] }),
  new Paragraph({ alignment: AlignmentType.CENTER, spacing: { before: 0, after: 300 },
    children: [new TextRun({ text: '"Provision of emergency and urgent medical care (physician assistant)"', bold: true, size: 24, font: "Times New Roman" })] }),
);

// Info fields
const fields = [
  "Student of the ___ course, Faculty of ___, Group ___, Full name of the student: _________________________________",
  "Practice base (medical institution / healthcare facility): _________________________________________________",
  "Full name and position of the responsible staff member of the practice base: ___________________________",
  "Full name and position of the supervisor of practical training: _________________________________________",
  "Period of practice: from ____________ to ____________ (2026)"
];
fields.forEach(f => children.push(para(f)));
children.push(new Paragraph({ spacing: { before: 200, after: 100 } }));

// Work schedule table
children.push(heading("STUDENT WORK SCHEDULE", HeadingLevel.HEADING_2));
const scheduleData = [
  ["29/06/2026", "08:00 - 14:00"],
  ["30/06/2026", "08:00 - 14:00"],
  ["01/07/2026", "08:00 - 14:00"],
  ["02/07/2026", "08:00 - 14:00"],
  ["03/07/2026", "08:00 - 14:00"],
  ["04/07/2026", "08:00 - 14:00"],
  ["05/07/2026", "DAY OFF"],
  ["06/07/2026", "08:00 - 14:00"],
  ["07/07/2026", "08:00 - 14:00"],
  ["08/07/2026", "08:00 - 14:00"],
  ["09/07/2026", "08:00 - 14:00"],
  ["10/07/2026", "08:00 - 14:00"],
  ["11/07/2026", "08:00 - 14:00"]
];
const thin = { style: BorderStyle.SINGLE, size: 4, color: "999999" };
const scheduleRows = [
  new TableRow({
    children: [
      headerCell("Date"),
      headerCell("Working hours")
    ],
    tableHeader: true
  }),
  ...scheduleData.map(([d, h]) => new TableRow({
    children: [
      cell(d, { width: 4000 }),
      cell(h, { width: 5000 })
    ]
  }))
];
children.push(thinBorderTable(scheduleRows));
children.push(new Paragraph({ spacing: { before: 120, after: 60 },
  children: [new TextRun({ text: "Signature of the responsible staff member of the practice base: ________________        Seal of the practice base", size: 20, font: "Times New Roman", italics: true })] }));
children.push(new Paragraph({ spacing: { before: 300, after: 100 } }));

// Page break before daily logs
children.push(new Paragraph({ children: [new PageBreak()] }));
children.push(heading("DAILY LOGS", HeadingLevel.HEADING_1));

// Generate patient tables
let currentDay = "";
patients.forEach((p) => {
  if (p.day) {
    // New day heading
    children.push(
      new Paragraph({
        spacing: { before: 200, after: 60 },
        children: [new TextRun({ text: p.day + "  -  " + p.date, bold: true, size: 24, font: "Times New Roman", color: "1F497D" })]
      })
    );
  }

  // Patient header
  children.push(
    new Paragraph({
      spacing: { before: 120, after: 40 },
      children: [
        new TextRun({ text: "Patient: ", bold: true, size: 22, font: "Times New Roman" }),
        new TextRun({ text: p.name + "  |  Age: " + p.age + "  |  Sex: " + p.sex, size: 22, font: "Times New Roman" })
      ]
    }),
    new Paragraph({
      spacing: { before: 0, after: 80 },
      children: [
        new TextRun({ text: "Diagnosis: ", bold: true, size: 22, font: "Times New Roman" }),
        new TextRun({ text: p.dx, size: 22, font: "Times New Roman", italics: true })
      ]
    })
  );

  // Table rows
  const tableRows = [
    new TableRow({
      children: [
        headerCell("Date"),
        headerCell("Content of completed work"),
        headerCell("Frequency")
      ],
      tableHeader: true
    }),
    ...p.rows.map((r, idx) => new TableRow({
      children: [
        cell(idx === 0 ? p.date : "", { width: 1400 }),
        cell(r[0], { width: 7000 }),
        cell(r[1], { width: 600 })
      ]
    }))
  ];
  children.push(thinBorderTable(tableRows));
  children.push(new Paragraph({ spacing: { before: 60, after: 20 } }));
  children.push(signatureRow());
  children.push(new Paragraph({ spacing: { before: 100, after: 200 } }));
});

// Summary table
children.push(new Paragraph({ children: [new PageBreak()] }));
children.push(heading("SUMMARY OF PATIENTS SEEN", HeadingLevel.HEADING_1));
const summaryData = patients.map((p, i) => [String(i+1), p.date, p.name + ", " + p.age + p.sex[0], p.dx]);
const summaryRows = [
  new TableRow({
    children: [headerCell("#"), headerCell("Date"), headerCell("Patient"), headerCell("Diagnosis")],
    tableHeader: true
  }),
  ...summaryData.map(r => new TableRow({
    children: [
      cell(r[0], { width: 400 }),
      cell(r[1], { width: 1400 }),
      cell(r[2], { width: 2800 }),
      cell(r[3], { width: 4400 })
    ]
  }))
];
children.push(thinBorderTable(summaryRows));

children.push(new Paragraph({ spacing: { before: 300, after: 80 },
  children: [new TextRun({ text: "Total: 24 individual patients | 12 working days | 2 patients per day", bold: true, size: 22, font: "Times New Roman" })] }));

children.push(new Paragraph({ spacing: { before: 300, after: 60 } }));
children.push(signatureRow());
children.push(new Paragraph({ spacing: { before: 80, after: 60 },
  children: [new TextRun({ text: "Signature of the head of practice base (stamp): ______________________________", size: 22, font: "Times New Roman" })] }));

// ---- build and write ----
const doc = new Document({
  styles: {
    default: {
      document: { run: { font: "Times New Roman", size: 22 } }
    },
    paragraphStyles: [
      {
        id: "Heading1", name: "Heading 1", basedOn: "Normal", next: "Normal", quickFormat: true,
        run: { size: 32, bold: true, font: "Times New Roman", color: "1F497D" },
        paragraph: { spacing: { before: 300, after: 120 } }
      },
      {
        id: "Heading2", name: "Heading 2", basedOn: "Normal", next: "Normal", quickFormat: true,
        run: { size: 26, bold: true, font: "Times New Roman", color: "1F497D" },
        paragraph: { spacing: { before: 200, after: 100 } }
      }
    ]
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 1134, bottom: 1134, left: 1701, right: 1134 }
      }
    },
    children
  }]
});

Packer.toBuffer(doc).then(buffer => {
  fs.writeFileSync("/home/daytona/workspace/kursk-diary/Kursk_Industrial_Practice_Diary.docx", buffer);
  console.log("DONE: Kursk_Industrial_Practice_Diary.docx written successfully.");
}).catch(err => { console.error(err); process.exit(1); });
Running Command

cd /home/daytona/workspace/kursk-diary && node generate.js 2>&1

Running Command

python3 /home/daytona/skills/docx/scripts/office/validate.py /home/daytona/works…

Running Command

ls -lh /home/daytona/workspace/kursk-diary/Kursk_Industrial_Practice_Diary.docx …

The document is valid (26 KB, proper ZIP/DOCX structure with 22 internal files). Here is your download link:

Kursk Industrial Practice Diary

Word Document · DOCX

What's inside the document:
  • Cover page - full university name, practice title, student/supervisor/base fill-in fields, practice period
  • Work schedule table - all 13 dates (29 Jun - 11 Jul 2026) with working hours and the day off on 05/07 clearly marked
  • 12 daily log sections - each day labelled (DAY 1 through DAY 12), with the day heading in blue
  • 24 individual patient tables - 2 per working day, each with:
    • Patient name, age, sex, and diagnosis as a header
    • The 3-column format from your image (Date | Content of completed work | Frequency)
    • Student's signature + clinical base supervisor signature line below each table
  • Summary table at the end listing all 24 patients with dates and diagnoses
  • Final signature block for student, supervisor, and department head/stamp
The font is Times New Roman throughout with A4 margins, matching a standard Russian academic document format. Fill in the personal details (name, group, faculty, practice base name) before submitting.
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