scholarly journals Organizational problems and possible ways of its resolve when providing emergency surgical care to patients with comorbid status in a highly specialized medical institution

2020 ◽  
Vol 7 (2) ◽  
pp. 64-74
Author(s):  
I. M. Khokhlova ◽  
V. B. Kozhevnikov ◽  
K. N. Movchan ◽  
B. S. Artyushin ◽  
E. V. Bartashevich ◽  
...  
Keyword(s):  
Medical Care ◽  
Critical Limb Ischemia ◽  
Soft Tissues ◽  
Surgical Care ◽  
Limb Ischemia ◽  
Medical Organization ◽  
Surgical Infection ◽  
Results Of Treatment ◽  
Medical Institutions ◽  
Main Activity

Purpose of the study. To demonstrate the difficulties of objective interpretation of providing medical care to patients with critical limb ischemia.Materials and methods. The results of treatment of more than 29 thousand patients of one of the highly specialized medical organizations of St. Petersburg were studied, in which the main activity of the staff is the examination of patients with surgical infection of soft tissues (particularly, the critical limb ischemia).Results. It has been ascertained that, despite the unconditional success of providing medical care to patients with critical limb ischemia, a high frequency of unsatisfactory treatment results for this category of patients remains (in 2017, among 685 patients of the specialized department of the highly specialized medical organization, the proportion of cases of performing high amputations of limbs and mortality, respectively, was 11,7% (80) and 2,6% (18)). It has been demonstrated on clinical examples that the pronounced comorbidity of critical limb ischemia patients and the severity of their general condition (combined with organizational difficulties in providing them with providing medical care in conditions of highly specialized medical organization) contribute to the formation of complications (up to lethal outcomes) of not only the underlying, but also concomitant diseases. Difficulties in providing medical care of adequate quality in life-threatening conditions for patients of highly specialized medical organization in cases of critical limb ischemia necessitate a wider interaction between specialists in narrow and multidisciplinary hospitals as part of the emergency surgery service.Conclusion. When creating specialized medical centers outside of multidisciplinary medical institutions, the possibilities should be provided for the regulated involvement of highly professional consultants with a reasonable algorithm for routing patients in cases of the need for their emergency re-hospitalization to other medical institutions.

scholarly journals Acute appendicitis in children in the context of the new coronavirus infection (COVID-19)

2021 ◽  
Vol 25 (1) ◽  
pp. 25-28
Author(s):  
V. G. Svarich ◽  
I. M. Kagantsov ◽  
V. A. Svarich ◽  
E. G. Perevozchikov
Keyword(s):  
Postoperative Complications ◽  
Acute Appendicitis ◽  
Medical Care ◽  
Surgical Care ◽  
Komi Republic ◽  
Complicated Appendicitis ◽  
Surgical Department ◽  
Results Of Treatment ◽  
Significant Difference ◽  
Coronavirus Infection

Introduction. The first publications about acute appendicitis in the conditions of the new COVID-19 coronavirus infection have appeared. Most authors point to the increased time of seeking medical help in such patients and an increase in the level of postoperative complications.Material and methods. A retrospective study of 192 case histories of patients aged 3 to 17 years with various forms of acute appendicitis who were treated in the surgical Department of the Republican children’s clinical hospital in the period from 2019 to November 2020 was conducted. Children operated on during 2019 before the start of the new coronavirus pandemic were included in the first group (n = 114). Children operated on in 2020 after the development of a new coronavirus pandemic were included in the second group (n = 78).Results. The age of patients in both groups compared did not differ significantly. The course of the disease was within the average accumulated indicators and the terms of hospitalization did not change significantly. According to our observations, the time of admission to the surgical hospital from the time of the disease in the pre-coronavirus period and during it also did not differ significantly, which indicates that the same availability of medical care remains even during the epidemic. Our study also showed that the number of requests for complicated appendicitis in children during the COVID-19 epidemic even decreased, which ultimately led to a decrease in the level of postoperative complications. The study did not establish a significant difference between the main results of treatment of children with acute appendicitis before and during the new COVID-19 coronavirus infection. Only the level of postoperative complications significantly decreased in patients operated during the COVID-19 epidemic, which is associated with a lower admission of children with complicated appendicitis.Conclusion. With the onset of the pandemic, the organization of medical care for the child population with acute pathology in the Komi Republic did not change and did not have any restrictions, which made it possible to maintain the timely provision of surgical care to children with acute appendicitis at the proper level.

scholarly journals IMPROVING THE PROVISION OF SURGICAL CARE TO THE CIVILIAN POPULATION WITH GUNSHOT WOUNDS TO THE CHEST IN CONDITIONS OF LOCAL ARMED CONFLICT

2021 ◽  
Vol 22 (1) ◽  
pp. 70-75
Author(s):  
V. V. Masljakov ◽  
A. Р. Chuprina ◽  
К. G. Kurkin
Keyword(s):  
Medical Care ◽  
Armed Conflict ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Medical Personnel ◽  
City Hospital ◽  
Not Given ◽  
Civilian Population ◽  
Medical Institutions ◽  
The City

The aim of the study is to improve the organization and provision of surgical care to civilians with gunshot wounds to the chest in the context of armed conflict on the example of the Chechen campaign.Materials and methods. The work is based on the analysis of medical care provided to 106 wounded with gunshot wounds to the chest from the civilian population in the period from 1991 to 2000. Medical care was provided on the basis of the surgical hospital of the city hospital No. 9 in Grozny.Results and discussion. Found that providing medical care to wounded with gunshot wounds of the chest when massive flow in terms of actual hostilities rendered by the forces and means of civil hospitals, has a certain specificity. It is due to the fact that in such conditions, in contrast to military medical organizations, there are no stages of evacuation, often the wounded are delivered by non-specialized and unsuitable vehicles on destroyed roads, while they are not given or given insufficient pre-medical care. In such conditions, the workload of medical personnel of civil medical institutions associated with the provision of medical care increases. In this regard, in our opinion, it is necessary to develop measures aimed at improving the algorithm aimed at minimizing various errors that occur in civilian medical institutions during the mass admission of wounded. 

MODERN APPROACHES IN MANAGING WOUND DEFECTS IN CHILDREN WITH SURGICAL INFECTION

2020 ◽  
pp. 169-175
Author(s):  
Kuzmin A.I. ◽  
Munin A.G. ◽  
Zavyalkin V.A. ◽  
Barskaya M.A. ◽  
Terekhina M.I.
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Soft Tissues ◽  
Local Treatment ◽  
Wound Management ◽  
Innovative Technologies ◽  
Surgical Infection ◽  
Results Of Treatment ◽  
Inadequate Antibiotic Therapy ◽  
Good Cosmetic

The results of treatment of 57 children with wound defects of soft tissues that have appeared at the background of surgical infections of various origins have been analyzed. The causes of the wound defects formation were analyzed according to the T.I.M.E. system.[7,8,9]. While treating the wound defects the strategy of creating the conditions close to the ones in an acute wound was followed («Wound bed preparation») [7,8,11]. We used several types of debridement aimed at shortening the phases of the wound process with the following closure of the wound defects by different methods [1,2,5,7]. The assessment of the effectiveness of local treatment was carried out taking into account the nature and severity of the phases of the wound process by the method of clinical observation of the state of the wound (the severity of symptoms of inflammation, the nature and amount of exudate, the presence and appearance of granulations, the presence of signs of wound epithelialization and scarring, the size of the wound), microbiological, cytological and histology and research [10]. The study revealed factors that disrupt wound healing during primary surgical treatment, in the management of foci of surgical infection, in the management of postoperative wounds, in the treatment of pressure ulcers in children with neurological pathology. During the initial surgical treatment of the received wounds, its inadequacy was noted - the abandonment of necrotic, defective tissues, foreign bodies, the presence of an undiagnosed infection, the absence or inadequate antibiotic therapy, constant tension of the skin edges, impaired blood flow and innervation, inadequate sanitation and drainage. The use of modern innovative technologies in wound management reduces hospital stay, reduces the duration of the use of antibiotics and other medications, contributes to a good cosmetic effect. Application of the current innovative technologies in wounds treatment shortens the hospital stay, decreases the duration of the use of antibiotics and other medicines, and contributes to better cosmetics effects [1,4,6]. The current trends in wounds treating with the choice of local treatment according to the phases of the wound process are presented in this article. The methods of active wound defects therapy and different types of debridement considering their pros and cons are analyzed.

scholarly journals Long-Term Results of Treatment for Critical Limb Ischemia

2015 ◽  
Vol 8 (3) ◽  
pp. 192-197 ◽  
Author(s):  
Takuya Miyahara ◽  
Masamitsu Suhara ◽  
Yoko Nemoto ◽  
Takuro Shirasu ◽  
Makoto Haga ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Long Term Results ◽  
Results Of Treatment

scholarly journals Long-term Results of Treatment for Critical Limb Ischemia

2014 ◽  
Vol 54 (2) ◽  
pp. 5-11 ◽  
Author(s):  
Takuya Miyahara ◽  
Masamitsu Suhara ◽  
Yoko Nemoto ◽  
Takuro Shirasu ◽  
Makoto Haga ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Long Term Results ◽  
Results Of Treatment

ANALYSIS OF THE QUALITY OF MEDICAL CARE PROVIDED BASED ON INSURANCE SUPERVISORY

2020 ◽  
pp. 160-170
Author(s):  
Ольга Игоревна Муратова ◽  
Наталия Андреевна Матвеева
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Medical Insurance ◽  
Insurance Companies ◽  
Medical Services ◽  
Medical Organization ◽  
Medical Institutions ◽  
Quality Of Medical Care ◽  
The Russian Federation

Статья посвящена анализу качества медицинской помощи, оказываемой населению в рамках системы обязательного медицинского страхования (ОМС), на основе мероприятий страхового надзора над медицинскими организациями. Полис ОМС гарантирует пациентам доступность, качество и своевременность предоставления медицинских услуг. Проверка качества медицинской помощи производится путем осуществления экспертиз и контроля уполномоченными органами РФ по направлениям: законности работы медицинской организации, системности оказания медицинской помощи, результативности и своевременности проводимых мероприятий в рамках оказания медицинской помощи. Таким образом, страховой надзор за медицинскими организациями осуществляется путем соблюдения объема, сроков и условий оказания медицинской помощи, контроля качества медицинской помощи фондами обязательного медицинского страхования и страховыми медицинскими организациями в соответствии с законодательством Российской Федерации. Страховой надзор над медучреждениями осуществляется в рамках ОМС и включает следующие виды страхового надзора: медико-экономический контроль, медико-экономическая экспертиза и экспертиза качества медицинской помощи. Отличительной особенностью современного состояния системы страхового надзора за качеством оказываемой медицинской помощи в системе ОМС является его совершенствование на основе анализа удовлетворенности потребителей медицинских услуг, что позволяет выявить нарушения, которые допущены при оказании медицинской помощи. Причем эти мероприятия способствуют как повышению качества обслуживания застрахованных лиц, так и улучшению репутации медицинских организаций, что серьезно влияет на решения участников программы обязательного медицинского страхования. Повышение ответственности страховых компаний становится важным элементом модернизации системы ОМС. В этой связи актуальным является обеспечение эффективной работы страховых медицинских компаний и медицинских учреждений на принципах конкурентоспособности и повышения качества медицинской помощи, реализуемое с помощью механизмов ориентации на требования потребителей медицинских услуг The article is devoted to the analysis of the quality of medical care provided to the population within the framework of the system Compulsory health insurance (CHI), based on the measures of insurance supervisory over medical organizations. The CHI guarantees patients the availability, quality and timeliness of medical services. Quality control of medical care is performed by carrying out examinations and control by the authorized bodies of the Russian Federation in the following areas: the legality of the work of a medical organization, the consistency of medical care, the effectiveness and timeliness of measures taken within the framework of medical care. Thus, insurance supervisory of medical organizations is carried out by observing the scope, terms and conditions of medical care, and monitoring the quality of medical care by mandatory medical insurance funds and insurance medical organizations in accordance with the legislation of the Russian Federation. Insurance supervisory of medical institutions is carried out within the framework of the CHI and includes the following types of insurance supervisory: medical and economic control, medical and economic expertise and examination of the quality of medical care. A distinctive feature of the current state of the system of insurance supervisory over the quality of medical care in the CHI system is its improvement based on the analysis of satisfaction of consumers of medical services, which allows you to identify violations that have been committed in the provision of medical care. Moreover, these measures contribute both to improving the quality of care for insured persons and to improving the reputation of medical organizations, which seriously affects the decisions of participants in the compulsory medical insurance program. Increasing the liability of insurance companies is becoming an important element of the modernization of the CHI system. In this regard, it is important to ensure the effective operation of medical insurance companies and medical institutions based on the principles of competitiveness and improving the quality of medical care, implemented through mechanisms of orientation to the requirements of consumers of medical services

scholarly journals INTERREGIONAL CENTERS OF HIGH-TECH CHILDREN’S SURGERY – MORTGAGE OF ACCESSIBILITY AND QUALITY OF MEDICAL CARE FOR RUSSIAN CHILDREN

2018 ◽  
Vol 8 (3) ◽  
pp. 6-17 ◽  
Author(s):  
V. M. Rozinov ◽  
D. A. Morozov ◽  
S. A. Rumyantsev ◽  
N. N. Vaganov ◽  
D. R. Azovskiy ◽  
...  
Keyword(s):  
Medical Care ◽  
Information Exchange ◽  
Surgical Care ◽  
High Tech ◽  
Medical Evacuation ◽  
Medical Institutions ◽  
Quality Of Medical Care ◽  
Regional Centers ◽  
Surgical Conditions

The article starts with a summary of the international experience in making medical care both accessible and high quality for children with surgical conditions and trauma by concentrating patients in specialized trans-regional centers. The authors give results of the retrospective analysis of the reasons for failure when implementing the concept of trans-regional specialized medical care in the Russian healthcare system. The paper lists problems with legislative control over these aspects: supplying the centers with resources, medical evacuation processes, distribution of responsibility by areas, and the information exchange with local medical institutions (hospitals, clinics, etc). The article also illustrates similarities and differences on how the trans-regional centers for pediatric surgical care function inRussiaand in other countries. The authors outline high priority measures for creating trans-regional centers for specialized medical assistance for children inRussia. The systematic review includes 16 domestic and 28 foreign literature sources, 8 references to Russian laws and regulations. 

scholarly journals IMPLEMENTATION THE PRINCIPLES OF RECONSTRUCTIVE SURGERY WOUNDED WITH SOFT TISSUE DEFECTS AT THE IV LEVEL OF MEDICAL CARE

World Science ◽  
2020 ◽  
Author(s):  
Хоменко І. П. ◽  
Гуменюк К. В. ◽  
Король С. О. ◽  
Михайлусов Р. М. ◽  
Тертишний С. В. ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Medical Care ◽  
Soft Tissues ◽  
Surgical Care ◽  
Relative Number ◽  
Functional Results ◽  
Surgical Trauma ◽  
Soft Tissue Defects ◽  
Surgical Tactics ◽  
Tissue Defects

Resume. The experience of providing medical care during the anti-terrorist operation in eastern Ukraine has shown that in the structure of modern combat surgical trauma gunshot wounds with soft tissue defects are 64.9-68.2%, of which 36.4-37.5% small and medium, 28.5-30.7% are large and very large defects. Goal: To improve the results of surgical care for soft tissue defects by introducing differentiated surgical tactics for wound closure to each level. Material and methods. The total amount of the study was 136 wounded with shrapnel, bullet and explosive injuries from April 2014 to September 2018. Determination of surgical tactics for closing soft tissue defects was performed on the basis of metric classification, taking into account the area, volume and anatomical areas of the lesion. Results. The combination of metric characteristics of wound defects by area, volume and location of wounds in a single classification allowed to offer a comprehensive approach to sorting the wounded by the level of medical care and determine further reconstructive surgical tactics to close soft tissue defects. Conclusions. The introduction of differentiated surgical tactics in wounded with gunshot defects of the soft tissues at the all levels of medical care improved functional results: the proportion of satisfactory increased from 46.9% to 53.7%, the relative number of unsatisfactory decreased from 18.8% to 11.6%

The role of motivation mechanisms in increasing the efficiency of nursing staff management in a medical organization (literature review)

2021 ◽  
pp. 50-60
Author(s):  
Irina Nikolaevna Bogomolova ◽  
Sergey Ivanovich Dvoinikov
Keyword(s):  
Literature Review ◽  
Medical Care ◽  
Nursing Staff ◽  
Human Factor ◽  
Healthcare Professionals ◽  
Healthcare Management ◽  
Medical Organization ◽  
Critical Function ◽  
Medical Institutions

Motivating healthcare professionals is a critical function of healthcare management. Without solving the problems of motivation, it is impossible to really improve the quality and culture of providing medical care to the population, as well as to increase the efficiency of the activities of medical institutions and the industry as a whole on the basis of the competent use of all types of resources, material, financial and personnel. The use of motivation also helps to reduce the number of errors in work due to the human factor associated with its low level and with an insufficiently serious attitude to work.

scholarly journals Ways to reduce the frequency of high amputations, post-amputation complications and mortality in diabetic foot syndrome

2021 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
V. M. Bensman ◽  
A. G. Baryshev ◽  
S. N. Pyatakov ◽  
K. G. Triandafilov ◽  
V. N. Ponomarev ◽  
...  
Keyword(s):  
Critical Limb Ischemia ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Comparison Group ◽  
Lower Extremities ◽  
Limb Ischemia ◽  
Main Group ◽  
Diabetic Foot Syndrome ◽  
Wound Complications ◽  
Comparison Groups

Despite the success in treatment, currently 30.0% of patients with diabetic foot syndrome (DFS) still undergo high amputations with a mortality rate of up to 54.0–68.0 %. The causes of high low limb amputations in 28.0 % of patients are infection, and in 46.0 % – arterial insufficiency in the stage of critical limb ischemia.Objective: to improve the results of patients treatment by reducing the number of high amputations of the lower extremities, reducing the occurrence of complications and deaths of the disease.Materials and methods. To study the results of treatment of patients with DFS, they were divided into two comparison groups and two main groups. From 1982 to 2019, the frequency of amputations, mainly at the hip level, was 71.0 % (177 amputations in 248 patients). These patients formed the first comparison group of observations. The second comparison group (1988–1994) included 58.3 % of patients in whom amputations were performed according to more stringent indications (157 amputations in 269 patients). The first main group of observations (1995–2013) included 9.9 % of patients with DFS who were amputated only for wet gangrene, incurable critical limb ischemia, and infection with a systemic inflammatory response (130 amputations out of 1312 patients). In ischemia with preserved blood flow through the deep artery of the thigh, amputation of the lower leg was performed in a sequential-two-flap method with removal of the soleus muscle. Amputations were completed with the imposition of drainage removable muscle-fascial sutures. The second main group (2014) consisted of 11.4 % of patients who underwent amputations only for sepsis or wet gangrene (124 amputations in 1083 patients). The difference between the second main group and the first was the division of the high amputation intervention into 2 stages.Results. Comparison of the treatment results in the main groups and in the comparison groups revealed a 6-fold decrease in the number of high amputations (from 64.6 to 10.69 %) and a significant improvement in the main quality indicators. This concerns a 6-fold decrease in mortality, which was a consequence of the introduction of a two-stage tactic for high amputation treatment of the most severe patients and the limitation of indications for amputation of the hip. Using of removable drainage muscle-fascial sutures decreased postoperative wound complications from 51.9 to 13.0 %, and the number of re-amputations decreased in 17th times.Conclusion. Amputation of the lower extremities for irreversible critical limb ischemia can be performed with a decrease in TcP02 of the stitched stump tissues to no more than 30 mm Hg. Preserving the knee joint improves the possibilities of prosthetics, which allows older diabetics to lead an active life. Methods of performing parallel- or sequential-two-flap high amputation improve the conditions for cutting out racquet-shaped wound flaps, which provides free displacement of the soft tissues of the stump connected by removable drainage sutures.

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