EVALUATION OF INDICATORS CHARACTERIZING INPATIENT SURGICAL CARE DELIVERY TO OLDER PATIENTS IN THE RUSSIAN FEDERATION

2021 ◽  
Vol 67 (5) ◽  
pp. 5
Author(s):  
S.I. Shlyafer ◽  
◽  
I.B. Shikina ◽  
Keyword(s):  
Postoperative Complications ◽  
Older Patients ◽  
Care Delivery ◽  
Postoperative Mortality ◽  
Surgical Care ◽  
Fold Increase ◽  
High Tech ◽  
Number Of Patients ◽  
The Russian Federation ◽  
High Technologies

Significance: Population ageing challanges the majority of the world including the Russian Federation. Older people are more subject to operative interventions, including high tech interventions. The purpose of the study is to analyze indicators characterizing the level of surgical care deivery to older patients in the Russian hospitals in 2011-2019. Material and methods. Indicators characterising surgical care delivery in hospitals were analyzed including: the number of patients operated; the number of operations performed, including high tech interventions; the number of deaths after surgery, including after high tech interventions; frequency of postoperative complications; postoperative mortality among older patients (women - 55 years and older, men - 60 years and older). The authors used data of the federal statistical observation form No. 14 "Information onabout performance of units of medical organizations providing inpatient medical care" for the period from 2011 to 2019. Statistical (calculations of extensive and intensive indicators) and analytical methods were applied. Results. The share of older patients out of all patients operated in 2019 in the Russian hospitals equalled to 35.2% (vs 23.1% in 2011), including high tech interventions (18.9% of all operations). Conclusion: among older patients the study has identified: an 18.8% increse in the number of patients discharged from hospitals; a 5.6% increase in the number of patients operated; a 63.5% increase in the number of operations in the hospital, including a 2.6 fold increase in the number of operations using high technologies; a 73.4 % increase in the number of operated patients who died in the hospital; including a 3.8 fold increase in the number of patients died after operations using high technologies; postoperative mortality rate of patients increased from 2.21 to 2.39%. The rate of postoperative complications associated with all operations decreased from 1.06 to 0.64%, including decrease from 1.74 to 0.97% in postoperative complications associated with operations using high technologies.

Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

2021 ◽  
pp. 000313482199506
Author(s):  
Youngbae Jeon ◽  
Kyoung-Won Han ◽  
Won-Suk Lee ◽  
Jeong-Heum Baek
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Postoperative Complications ◽  
Postoperative Mortality ◽  
Nonsurgical Treatment ◽  
Perioperative Outcomes ◽  
Rank Test ◽  
Kaplan Meier ◽  
Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

scholarly journals Treatment of patients with malignant lymphoproliferative diseases in the Russian Federation: analysis of the data from 75 regions

2019 ◽  
Vol 11 (4) ◽  
pp. 3-15
Author(s):  
G. R. Hachatryan ◽  
T. S. Teptsova ◽  
V. A. Lemeshko ◽  
N. Z. Musina
Keyword(s):  
Medical Care ◽  
Russian Federation ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
High Tech ◽  
Lymphoproliferative Diseases ◽  
Number Of Patients ◽  
Icd 10 ◽  
The Russian Federation ◽  
Specialized Institutions

The aimis to analyze the medical records of patients with malignant lymphoproliferative diseases (LPD) in the Russian Federation in 2016- 2017.Materials and methods. Treating physicians in 75 regions of the Russian Federation were asked to fill the survey questionnaire containing 9 types of malignant LPDs (according to the ICD-10 classification). The questions covered the epidemiology of LPD (prevalence, resistant forms, relapses and mortality), the existence of specialized institutions and beds, the costs of medical care in patients with malignant LPD, and the financial support of pharmacotherapy in these patients during their hospital stay.Results. We found that the most common malignant LPD in 2016-2017 was Hodgkin’s lymphoma (73.5 and 73.4%, respectively). The prevalence of resistant forms and recurrences of malignant LPD over this period accounted for 6.8% of the total patient population. In 2017, the number of patients who died was 7.5% less than that in 2016. There are 815 and 1,763 specialized institutions of the oncology and hematology profiles that provide medical care to children and adult patients, respectively. Among the malignant LPDs, the highest costs of drug therapy in 2016 pertained to lymphosarcoma, and in 2017 – to Hodgkin’s lymphoma. In the system of compulsory health insurance (OMC), the largest spending for both adult and pediatric patients in 2016 and 2017 was accounted for Hodgkin’s lymphoma; a similar result was obtained for the cost of therapy based on high-tech medical care.Conclusion. In 2017, the total number of patients with malignant LPD in the Russian Federation increased by 2.65% as compared to 2016, while the proportion of primary LPD decreased by 1.2%. In 2017, the total costs of drug supply in patients with malignant LPD in the RF increased by 55.35% as compared with 2016.

scholarly journals The rationale for dislocation of interregional specialized surgical care centers for children in the Russian Federation

2020 ◽  
Vol 10 (3) ◽  
pp. 263-274
Author(s):  
Vladimir M. Rozinov ◽  
Dmitriy A. Morozov ◽  
Sergey A. Rumyantsev ◽  
Nikolay N. Vaganov ◽  
Vladimir I. Petlakh ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Medical Care ◽  
Russian Federation ◽  
Current System ◽  
Surgical Care ◽  
Federal District ◽  
Urgent Care ◽  
High Tech ◽  
Universal Method ◽  
The Russian Federation

Introduction. In Russia, there is a need to reorganize the system of providing specialized surgical care to children, primarily in emergency and urgent care and in remote, sparsely populated, and hard-to-reach areas. This need is evidenced by the significant persisting disparities in the mortality rate in the countrys various regions. Purpose of the study. This study aims to provide multifactorial substantiation of the expediency, profile, and location of specialized (surgical) interregional centers (MRC), including high-tech, medical care for children, by the priority profiles of activity, about medical organizations of the federal districts (FD) of Russia. Materials and methods. The study design included a two-level (regional and federal) system of professional expertise and justification in terms of the profile, location, and area of responsibility of the MRC in the federal district of the country. At the regional level, Delphi technology was implemented with a mathematical and statistical analysis of 103 expert opinions from 85 constituent entities of Russia, the result of which activities priority profiles were substantiated (newborn surgery, neurosurgery, thoracic surgery, oncology, combustiology) and patient routing preferences. At the second stage of the work, with the involvement of federal experts, the SWOT analysis technology was implemented as a universal method of strategic planning, with the justification of the location and number of MRCs in individual FD of the country, about specific medical organizations where they are based. For an objective (quantitative) assessment of the provision of the Federal District of Russia with the MRC of specialized medical care for children according to the established profiles of activity, we have proposed a calculated indicator the regional contingency coefficient (CRC), representing the ratio of two uniformly calculated values the number of MRCs and regions in a particular Federal District, or the country as a whole. Results. The consolidated position of federal experts regarding the location of the MRC was formulated according to the established profiles of activity about FD and specific medical organizations in the Russian Federation constituent entities. The cattle in the profile of the activity of neonatal surgery was 0.14, and about neurosurgery, thoracic surgery, and oncology, respectively, 0.12, 0.11, and 0.11 for Russia as a whole. The lowest (0.09) cattle in the country characterized the situation with the combustiology profile. In the overwhelming majority (76.0%), the location of the MRC is tied to the administrative centers of the Federal District or cities of federal significance. Among the 50 MRCs of all priority profiles, 43 (86%) were potentially designated by experts based on multidisciplinary pediatric medical organizations. Discussion. The effectiveness of the MRC functioning is due to the organization of medical and evacuation support for children with diseases and injuries. The development of consultative and resuscitation centers in the primary hospital structure is promising. Its functionality, along with remote counseling, treatment, and evacuation activities, includes monitoring the condition of sick and affected children at the place of primary hospitalization. An alternative is a presence on the clinical base of the MRC of a structural unit or a branch of the regional center for emergency medical care and disaster medicine. Conclusion. Overcoming the inequality in the availability and quality of medical care for children in certain FD and regions of Russia is necessary to reorganize the current system of staged medical care. Optimal logistics of medical and evacuation support for specialized patients and injured people include the MRC as a collector for children in need of specialized care, including high-tech medical care, with the implementation of the predominant principle of evacuation of oneself.

scholarly journals Predicting the Ophthalmic Surgical Backlog as a Result of the COVID-19 Pandemic: A population-based study and microsimulation model to inform surgical recovery plans

2021 ◽  
Author(s):  
Tina Felfeli ◽  
Raphael Ximenes ◽  
David MJ Naimark ◽  
Philip L Hooper ◽  
Robert J Campbell ◽  
...  
Keyword(s):  
Care Delivery ◽  
Surgical Care ◽  
Wait Time ◽  
Recovery Phase ◽  
Population Based ◽  
Microsimulation Model ◽  
Ophthalmic Surgery ◽  
Population Based Study ◽  
Number Of Patients ◽  
Future Outcomes

AbstractBackgroundJurisdictions worldwide ramped down ophthalmic surgeries to mitigate the effects of coronavirus disease 2019 (COVID-19), creating a global surgical backlog. We sought to predict the long-term impact of COVID-19 on ophthalmology surgical care delivery.MethodsThis is a population-based study and a microsimulation model for predicting future outcomes. Provincial administrative data from January 2019 to November 2020 was used to estimate the decline in surgical volumes during the COVID-19 pandemic. For the post-pandemic recovery phase, we estimated the resources required to clear the backlog of patients accumulated on the waitlist since the pandemic.ResultsA total of 56,923 patients were on the waitlist in the province of Ontario awaiting non-emergency ophthalmic surgery as of March 15, 2020. The number of non-emergency surgeries performed in the province decreased by 45-98% between March to May 2020 compared to the same months in 2019. By 2 years and 3 years, the overall estimated number of patients awaiting surgery grew by 129% and 150%, respectively. The mean wait time for patients for all subspecialty surgeries increased to 198.49 days (SD 81.38) in March 2021 compared to 94.41 days (SD 97.42) in 2019. The provincial monthly additional resources required to clear the backlog by March 2023 was estimated to be 26% (3,538 additional surgeries).DiscussionThe magnitude of the ophthalmic surgical backlog from COVID-19 has important implications for the recovery phase. The estimates from the surgical database and microsimulation modelling can be adapted to other jurisdictions to assist with recovery planning.

The application of a simplified system of criterions for audit to improve paediatric cardiologic and paediatric cardiac surgical care: evidence from a regional approach in Hungary

2006 ◽  
Vol 16 (2) ◽  
pp. 128-134
Author(s):  
Gabor Mogyorosy ◽  
Tunde Karacsonyi ◽  
Eva Szucs ◽  
Laszlo Kiraly ◽  
Tamas Kovacs ◽  
...  
Keyword(s):  
Cardiac Disease ◽  
Postoperative Mortality ◽  
Surgical Care ◽  
Routine Data ◽  
International Standards ◽  
Invasive Treatment ◽  
Access To Treatment ◽  
Cardiac Malformations ◽  
Timely Diagnosis ◽  
Number Of Patients

Aims:To evaluate the quality of cardiac and surgical care provided for children with congenital cardiac malformations in the eastern county of Hungary.Methods:We used the method of clinical audit based in selection of criterions, developing five such criterions concerning timely diagnosis, access to treatment, and outcome. To examine compliance with these criterions, we analysed retrospectively the routine data relating to children living in Hajdu-Bihar County. The period of observation lasted from January, 1994, until December, 2001, and was divided into two epochs in order to evaluate any changes over time.Results:In the first epoch, 28 infants, representing 0.1% of all newborns, died of congenital cardiac disease, with one of the malformations being recognised post mortem. In the second epoch, 21 infants died, representing 0.09% of newborns. In this group, each malformation was diagnosed before death. In each period, 6 infants died without having undergone cardiac surgery, and having no other non-cardiac disease. The overall postoperative mortality was 9.2% for the first period, and 4.6% for the second. The number of patients waiting for non-urgent repair had reduced significantly by the end of the second epoch.Conclusions:The results show that the timely diagnosis of congenital cardiac malformations is in line with accepted international standards. Conversely, the access to invasive treatment was limited over the period of observation, albeit that the waiting list was reduced significantly by the end of the second epoch. The postoperative mortality for those suffering congenital cardiac malformations is also comparable with international standards, except for mortality during infancy for treatment of complex anomalies. Our audit highlights the need for surgical repair of the more complex malformations during infancy.

Military service suitability among young men

2021 ◽  
Vol 16 (3) ◽  
pp. 105-109
Author(s):  
V.K. Sevostyanov ◽  
◽  
S.N. Makhmudova ◽  
A.Z. Bikmaeva ◽  
S.L. Balashov ◽  
...  
Keyword(s):  
Russian Federation ◽  
Military Service ◽  
Medical Information ◽  
Young Men ◽  
Fold Increase ◽  
Healthcare Services ◽  
Pediatric Care ◽  
Service Category ◽  
Number Of Patients ◽  
The Russian Federation

Objective. To analyze main chronic diseases in 16-year-old boys and assess their significance in terms of military service. Materials and methods. In this observational cohort study, we analyzed medical records of 315 young men residing in Moscow. We used forms No 025/u ‘Medical outpatient card,’ and No. 112/u ‘Information on child development’ and their digital analogues (Unified Medical Information and Analytical System of Moscow). To identify dynamic changes in the structure of morbidity, we used the results of medical examinations of young men from the Central Military District (n = 239) for 2015, provided by the Ministry of Defense of the Russian Federation. Data analysis was performed using the Statstica 6.0 software; we used the methods of descriptive statistics and Z-test. Differences were considered significant at р < 0.05. Results. More than one-third of participants (34.3%) were suitable for military service (Category A); 33% had minor limitations/were temporarily unsuitable for military service (Category B); 21% of young men had limited suitability for military service/were temporarily unsuitable for military service (Category C); 3.2% of participants were temporarily unsuitable for military service; 8.5% of participants were absolutely unsuitable for military service. Over 5 years, the structure of morbidity among young men of pre-conscription and military age has changed significantly: the number of patients with the most common pathologies making men unsuitable for military service (diseases of the musculoskeletal system and diseases of the eye and adnexa) has increased dramatically (a 3-fold and 7-fold increase, respectively). Conclusion. The simple information and analytical model proposed in this study allows the assessment of the dynamics of defense potential formation in the Russian Federation, as well as the evaluation of the effectiveness of pediatric care. Our findings suggest that it is necessary to perform a more thorough, early, timely examination of adolescents, correct their lifestyle, control the implementation of medical measures, increase the coverage of healthcare services for male children and adolescents. Keywords: military service, morbidity among adolescents, categories of suitability, medical examination.

The aspects of the innovation of the military-industrial complex and its significance for the national security of Russia

2020 ◽  
Vol 10 (1) ◽  
pp. 15-20
Author(s):  
Irina Orlova ◽  
Artem Sukharev ◽  
Maria Sukhareva ◽  
Mikhail Deikun
Keyword(s):  
National Security ◽  
Systematic Approach ◽  
Defense Industry ◽  
World Market ◽  
Modern World ◽  
High Tech ◽  
Industrial Complex ◽  
Military Industrial Complex ◽  
The Russian Federation ◽  
The Military

The main objective of the article is to substantiate a systematic approach to the introduction of all types of innovations in the development of the military-industrial complex of the Russian Federation. The relevance of the study is due to the fact that in the modern world it is especially important to ensure the national security of the country and the defense industry plays a crucial role in this. At the same time, one cannot but note the importance of the defense industry in the production of high-tech civilian products and dual-use products, which enhances the country's competitiveness in the world market. In addition, the relevance of the topic is due to the presence of rather serious problems in the Russian defense industry, which require immediate resolution. The article uses the methodology of structurally functional analysis, the institutional approach and the method of comparative assessments. The authors conclude that technological innovation alone will not be able to achieve strategic results for ensuring national security, only in conjunction with organizational, product, social and marketing innovations, the domestic defense industry is able to solve its tasks.

Medical Care for Children with Cancer in the Donetsk People’s Republic: Results of an Ecological Study in 2014–2017

2018 ◽  
Vol 5 (3) ◽  
pp. 145-154
Author(s):  
M. Yu. Rykov ◽  
I. N. Inozemtsev ◽  
S. A. Kolomenskaya
Keyword(s):  
Medical Care ◽  
Pediatric Patient ◽  
Ecological Study ◽  
Medical Service ◽  
Care Delivery ◽  
Benign Tumors ◽  
High Tech ◽  
Malignant Neoplasms ◽  
Children With Cancer ◽  
Patient Capacity

Background.Analysis of medical care delivery for children with cancer in armed conflict is highly important because the high-tech treatment in this context is extraordinary difficult and challenging task. Objective. Our aim was to analyze the morbidity and mortality rates in children with malignant tumors, to assess the pediatric patient capacity and medical service density in the Donetsk People’s Republic.Methods.The ecological study was conducted where the units of analysis were represented by the aggregated data of the Republican Cancer Registry on the number of primary and secondary patients with malignant and benign tumors, the deceased patients in the DNR in 2014–2017, pediatric patient capacity, and medical service density.Results.The number of pediatric patient capacity for children with cancer was 10 (0.27 per 10,000 children aged 0–17), pediatric patient capacity for children with hematological disorders — 40 (1.37 per 10,000 children aged 0–17). The treatment of children with cancer was performed by 5 healthcare providers: 1 pediatric oncologist (0.02 per 10,000 children aged 0–17), 3 hematologists (0.08 per 10,000 pediatric population aged 0–17), and 1 practitioner who did not have a specialist certificate in oncology. Morbidity rate for malignant neoplasms from 2014 to 2017 decreased by 25% (in 2014 — 9.6 per 10,000 children aged 0–17; in 2017 — 7.2). In the morbidity structure, the incidence proportion of hemoblastoses was 68.4%, brain tumors — 2.6%, other solid tumors — 29%. The death rate due to malignant neoplasms decreased by 37% (in 2014 — 2.7; in 2017 — 1.7).Conclusion.Low levels of the incidence rate and pattern of morbidity indicate defects in the identification and recording of patients. This explains the performance of the bed: low average bed occupancy per year and low turnover. For a reliable analysis of mortality statistical data is not available: in 2014–2015 only the number of in-hospital deceased patients is presented. Limited data is due to the lack of reliable patient catamnesis which is explained by the high rate of population migration. 

World experience in using the program-targeted planning methods for high-tech industry development

2020 ◽  
Vol 19 (9) ◽  
pp. 1723-1735
Author(s):  
A.Yu. Pronin
Keyword(s):  
Russian Federation ◽  
Technological Development ◽  
High Tech ◽  
Economic Activities ◽  
High Tech Industry ◽  
Industry Development ◽  
Foreign Countries ◽  
Planning Methods ◽  
The Russian Federation ◽  
Development Objectives

Subject. The article investigates the program-targeted planning methodology, which is implemented in the Russian Federation and leading foreign countries, for high-tech industry development. Objectives. The aim is to identify the specifics of program-targeted planning for the development of high-tech industries, to shape programs and plans for innovative development in the Russian Federation and leading foreign countries. Methods. The study employs general scientific methods of systems analysis, including the statistical and logical analysis. Results. I reviewed methods of program-targeted planning, implemented by the world’s leading countries (the Russian Federation, United States of America, France, Great Britain, Netherlands, Norway, Japan, Canada), in the interests of the development of various high-tech sectors of the economy. The study established that the methodology of program-targeted management is an effective tool for resource allocation by various types of economic activities in accordance with national priorities. I developed proposals by priority areas for improving the methodology for program-targeted planning and management in the Russian Federation in modern economic conditions. Conclusions. The findings and presented proposals can be used to improve methods for program-targeted planning to develop high-tech sectors of the economy; to design various long-term programs and plans, reducing the risk of their implementation; to determine the ways and methods of sustainable socio-economic and innovative and technological development of the world's leading economies.

Digital tax: an instructive foreign experience

2020 ◽  
pp. 69-87
Author(s):  
K.S. Teteryatnikov ◽  
S.G. Каmolov ◽  
D.A. Blashkina
Keyword(s):  
Russian Federation ◽  
High Tech ◽  
Digital Products ◽  
Tax Reforms ◽  
Goods And Services ◽  
Russian Economy ◽  
Internet Users ◽  
The Usa ◽  
On Line ◽  
The Russian Federation

The article is meant to analyze current problems and prospects for the development of effective tax policy as part of digital transformation of Russian economy. Introduction of a digital tax and the consequences of the digital tax reforms in the EU, the USA and OECD countries are highlighted. The necessity of qualitative transformation of the tax system of the Russian Federation in response to modern challenges is substantiated, taking into account the changes of the Tax Code of the Russian Federation adopted at the end of July 2020. The authors suggested their own concept of a digital tax and the prospects for its adoption in Russia, and consider it inappropriate to impose taxes on Internet users who do not use the Internet for business. Today, the main focus should be made on creating and testing effective technologies that allow on-line monitoring the tax basis of digital economy entities, taking into account the cross-border movement or use of digital products (goods and services). In addition, it would be extremely important to provide for a potential tax exemption for part of the profits of international ICT companies that are received on the territory of the Russian Federation and reinvested in joint with Russian companies projects in the high-tech for civil purposes area.

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