Organization of research activity in a polyclinic using medical information system

Introduction. The article considers an approach to organization of research activity using medical information system. Materials and methods. Authors carried out retrospective analytical cohort study of adults with temporary incapacity to work based on the data from the State Medical Institution Galichskaya District Hospital (Kostroma Region of the Russian Federation) for a period 2014–2019. Sampling was done using the medical information system. Results. As the medical information system has been operating for many years and is designed in the way that the key information gaps should be filled, we consider the results of our study on research activity in a polyclinic using medical information system successful. Discussion. The organization of research activity is discussed using results of an epidemiological study aimed at identifying the correlation between the incidence of acute respiratory diseases and further development of circulatory system diseases carried out in Galichskaya District Hospital.

Routing of pregnant women as one of the ways to reduce infant mortality

One of the most important tasks that healthcare providers face is to reduce infant mortality. The purpose of our study was to assess the effects of routing of pregnant women with preterm birth on the infant mortality rate. Materials and methods: оperating data of the Federal State Statistics Service (Rosstat), operational notifications about death of young children under the age of 1, monthly reports of obstetric hospitals subordinate to Moscow Healthcare Department, annual reports of hospital departments providing neonatal care in medical organizations of Moscow Healthcare Department, and statistical data analysis. Results and discussion. The infant mortality rate in Moscow has been declining in recent decades and has been less than 6‰ annually since 2016. The share of newborns with extremely low birth weight is insignificant in overall rate. At the same time, extremely low birth weight is one of the main causes of infant mortality. As this category of newborns requires specific care, it is better to deliver such babies in perinatal centers that provide high quality medical care. Within 5 years, the share of children with ELBW born in perinatal centers and specialized obstetric hospitals has almost doubled. At the same time, there is an increase in the survival rate of children with extremely low birth weight by the age of one year in obstetric hospitals. Conclusion. Well-planned routing of patient within the large system of obstetric hospitals in Moscow could reduce death rate, increase the survival rate of children with extremely low birth weight and contribute to reducing infant mortality in the region.

Some features of pre-trip medical examination

Pre-trip examinations of drivers are the basis of medical management system road safety. Pre-trip examinations should be optimized so as not to miss significant changes in the health status of workers and/or predict such changes. Authors propose to use a pulsogram to analyze parameters of heart rate variability during pre-trip examination of train crews.

System of providing cancer care in the Netherlands during COVID-19 pandemic: assessing the consequences of the first wave

The COVID-19 pandemic has had a huge impact on healthcare systems in many countries around the world, including the cancer care system in the Netherlands. During the first smart lockdown, the number of consultations by family physicians (general practitioners) decreased by 70%, and the number of referrals of patients to specialized centers (hospitals) decreased by 75 %. Since the 9th week of 2020, in which the first case of COVID-19 in the Netherlands was confirmed, there has been a marked decrease in the number of diagnosed oncological diseases. When compared with the first weeks of 2020, the number of diagnoses at the peak of the pandemic decreased by 20-4 0%. 20th week and onwards saw the recovery of the diagnostic system, although the number of detected cases of cancer remained low. Screening programs for breast, colon and cervical cancer have been suspended at 12th week of 2020. Further clinical studies are needed to identify the real effects of the pandemic on long-term outcomes (survival and quality of life) in cancer patients. It is important to remove unnecessary barriers for patients to seek care in primary health care and to ensure continued regular care during the pandemic.

Compliance with the mask regime and social distancing during a pandemic in the city: a factor of reducing external control and features of practices

Purpose of the study. Identification of the main characteristics of compliance with pandemic restrictions in public places during the easing of restrictions, e.g. the correlation of declarations of commitment to measures and the real behavior of the population. Material and methods. A sociological study was carried out using the method of standardized observation in the city of Moscow on July 15–25, 2020. Observation points in the metro, ground transport, shops of various price categories and shopping centers were selected. More than 16748 observations were made within the quantitative and qualitative stages. Results and discussion. A significant discrepancy (up to 4 times) between the declared adherence to masks (2 Moscow surveys was studied) and the real one was revealed, the possible reasons for this were considered (social desirability, questionnaire features, sampling shift). The approach to the survey data as indicators of adherence rather than behavior merics is proposed. The diversity and polarization of the practices of wearing masks and maintaining social distance — «positive» and «negative», formal and informal are under analysis. Possible factors of this diversity, features of practice in different places are considered. Observation groups are analyzed, both adherent to wearing masks (women, elder persons, migrants) and non-adherent (young adults, middle age men). The practice of situational social «mimicry» is described, when, under the guise of taking care of health, people wanted to get more comfortable travel conditions in transport.

Evaluation of the effectiveness of internal quality control of medical care during control and supervision activities in medical organizations

Introduction. Currently, medical organizations of Moscow Healthcare Department have a three-level system of internal control for assessing the quality and safety of medical activities. At the same time, insurance companies have adopted a logically consistent, alternating multi-level system of inspections (medical and economic control) and evaluations (medical and economic evaluation, quality of medical care evaluation). Methods, techniques, criteria and guidelines for external and internal control of the quality and safety of medical activities are different. In this regard, assessment of the effectiveness of internal quality control of medical care in medical organizations during control and supervision activities is an important task that requires an evidence-based decision. Objectives. To provide evidence for the effectiveness of assessment criteria when conducting internal quality control of medical care and to determine their impact on effective performance of medical organizations. Materials and methods. The authors studied the results of 10 inspections and 36 evaluations of regulatory and supervisory authorities (insurance companies, Federal Service for Surveillance in Healthcare (Roszdravnadzor), etc.) and systematized the reasons for applying deductions and penalties. We performed a comparative analysis with evaluation criteria used by the heads of structural divisions (departments, laboratories) of City Clinical Hospital named after brothers Bakhrushin of Moscow Healthcare Department, as well as other private medical organizations. Authors studied technical capabilities of various automated information systems (Megaclinic, Asklepius, Doctor’s Automated Workstation, EMIAS for polyclinics and hospitals, etc.). Results. Authors performed comparative analysis of criteria used in inspections and evaluations of external and internal control of the quality and safety of medical activities. Analysis showed that the currently used assessment criteria do not fully ensure fulfillment of requirements and guidelines, violation of which entails financial sanctions (deductions, fines). Conclusion. It is necessary to develop and implement methods for organizing and conducting internal control of quality and safety of medical activities to create «effective criteria» that will minimize financial sanctions (deductions, fines) applied during various inspections (evaluations) of control and supervisory authorities.

Treatment of children with Pierre Robin Syndrome

Introduction. Incidence of Pierre Robin sequence (PRS) according to different studies varies from 1:8500 to 1:30000 newborns. Swallowing dysfunction may lead to aspiration of food, saliva and gastric content, resulting in severe aspirational pneumonia. Obstructive sleep apnea (OSA) may be a life threatening condition for children with PRS and may cause death by asphyxia. Average mortality rate for PRS according to different studies is approximately 16 % and varies depending on several factors: number of patients in studies, severity of the condition, diagnostic methodologies and presence of associated syndromes in maxillofacial region. Mortality rate in severe PSR (especially associated PSR) is 41,4 %. Aside from high mortality, OSA contributes to the development of cardiovascular disease including pulmonary hypertension, which progresses more rapidly than in adults. OSA exacerbates existing comorbidities; in the absence of timely treatment sleep apnea leads to learning impairment and behavioral problems, developmental delay, failure to thrive. Methods. 80 children with PSR aged between 4 days and 1 year have undergone compression-distraction osteosynthesis (CDO). 48,8 % (39) of children were diagnosed with severe degree of OSAS, 35 % (28) had moderate degree, 16,3 % (13) had mild degree. Pretreatment diagnostics included standard set of examinations and specialist consultations. Special diagnostics included CT of head and neck, fiberoptic nasopharyngoscopy, examination by ENT specialist for the assessment of the degree of upper airways obstruction and exclusion of pathologies and anomalies of nasal cavity, pharynx, larynx and trachea, which also may be the cause for reduced airflow and upper airway obstruction (intubated children haven’t undergone these examinations). Photographs were taken and videos of clinical manifestations of airway obstruction during sleep were recorded. Blood gas tests were regularly taken; blood oxygenation levels were measured with a pulse oximeter. Polysomnography was performed, which allows for accurate and comprehensive evaluation of severity of OSA based on multiple parameters. Extra-cortical and external compression-distraction devices (CONMET, KLS Martin, Synthes) were used. Results. Good outcome was achieved in 90 % (72), satisfactory in 6,3 % (5) and negative in 3,8 % (3) of cases.

Bulletin of Clinical Studies in Q1 2021

Purpose. To evaluate clinical trials data since January 2021 till March 2021. Materials and methods. The information about clinical trial’s approvals from the state register of medicines of Russian Federation ministry of health website was used as the main source of the original data concerning clinical trials. The register contains all the information relating to clinical trials in Russian Federation. Results. Clinical trials data was analyzed by its type (international, local, bioequivalence), sponsorship (foreign, local), phases and disease areas. Separately COVID-19 clinical trials were considered. Conclusion. During the 2021 Q1 we can mark a clinical trail’s quantity growth (started ones) both in Russia and in Moscow in comparison with 2018-2020 similar periods, that is definitely a positive trend especially in COVID-19 pandemic circumstances. There is a significant growth of bioequivalence share in 2021 versus 2019-2020 in Moscow. Due to SARS-CoV-2 ongoing pandemic lots of related to SARS-СоV-2 treatment clinical trials started, which considerably increased the contagious diseases pool in clinical trials market structure. Totally 14 related to SARS-СоV-2 treatment trials started in Russia, including 5 ones held in Moscow Healthcare Department medical organizations.

Bendopnea as a risk factor for the incidence of COVID-19 in patients with CHF

Purpose. Analysis of the incidence of COVID-19 in patients from the register «Management of chronic patients with multiple diseases» with a previously established CHF diagnosis, depending on the presence or absence of a symptom of bendopnea. Materials and methods. Retrospective analysis of electronic outpatient records of 121 patients with CHF with and without bendopnea symptom, with an assessment of the incidence of COVID-19. For statistical processing of the data obtained, we used the R language and the RStudio software environment. Results. The average age of the patients was 74.38±9.83 years. Bendopnea symptom occurred in 60,3% (n = 73) of the studied patients. The incidence of COVID-19 was 14% (n = 17), of which 88% were patients with the symptom of bendopnea (p-value = 0.023, Х2 = 5.17). The chance of COVID-19 in patients with bendopnea was higher than in patients without symptom of bendopnea (OR 5.8 (1.2; 26.7), p = 0.013). Conclusion. The presence of a symptom of bendopnea in patients with CHF increases the risk of COVID-19. A statistically significant relationship was established between the presence of a symptom of bendopnea, the level of left ventricular ejection fraction and the incidence of COVID-19.

Teens in megacity: growing up online

Bulletin about results of Applied Research Conference dedicated to development of socio-psychological assistance to adolescents and their social environment in modern megacities. It targets practitioners and specialists involved in topical research in adolescence: psychologists, teachers, doctors, anthropologists, culturologists and sociologists.