Departmental Hospitals Research Articles

Hospital Facilities of the Mid-19th — Early 20th Centuries: Kirensky Hospital of Irkutsk Welfare Board

By the middle of the 19th century departmental hospitals have gained a predominant position in the network of medical institutions in Russia. The introduction of strict regulation of the activities of public charity hospitals, uniform catalogs of medicines, limits on expenses for medicines and other attributes of hospital life make it possible, using the example of one hospital, in our case, the Kirensky Civil Hospital of the Irkutsk welfare board, to give an idea of the main directions of their “financial and economic activities”. As such, the study examined the maintenance of the hospital’s economic infrastructure and financial support for the care of patients. The study analyzed paperwork documentation, which made it possible for the first time to introduce data on the volume of food rationing for patients, to provide a description of hospital premises with detailed parameters and functional purposes. As a result of the study, the author concluded that the economic activities of administrative hospitals in the mid-19th — early 20th centuries was a priority direction (compared to medical activities) and included solving a wide range of problems, despite the fact that the costs of maintaining the hospital facilities fell entirely on the Irkutsk public charity, reflecting the main feature of “departmental medicine”.

Mapping, profile and training of immunization stakeholders, Benin, 2020

The Benin Immunization and Logistic Directorate commissioned this study to provide evidence-based data to improve the performance of the Expanded Programme on Immunization. The objectives were to identify immunization stakeholders, describe their profile, their geographical distribution and determine their training needs. In December 2020, we conducted a census of Benin's immunization stakeholders via their administrative files and telephone interviews. The data were collected in each departmental directorate and health zone by focal points using an Excel® grid. The authorizations of the ethics and personal data protection committees were obtained. We identified 3, 893 immunization workers, 39 years old on average, 66% of whom were women, 53% were health care assistants, 77% were vaccinators, and 56% were government contract workers. About 96% of them worked in peripheral centers. Approximately 56% were untrained and 14% had been untrained for more than 5 years. More than half of the actors were not trained for their function. The proportion of actors needing training was estimated at 70%. The training needs were at least 72% in the departmental hospitals, zone hospitals and health centers. 98% of actors reported a need for training, including immunization (74%), vaccine management (69%), cold chain (61%), monitoring (61%), and maintenance (47%). The predominance of nurses' aides and women and the low proportion of trained personnel among immunization workers were also observed in other sub-Saharan African countries. Benin's Immunization and Logistics Directorate should mobilize sufficient resources to strengthen the technical capacities of the majority of immunization stakeholders.

Neural tube defects: Prevalence, mortality, and maternal characteristics in two departmental hospitals in the northwestern region of Nicaragua, 2006-2018.

Congenital anomalies are the fifth most common cause of neonatal mortality in Nicaragua, and neural tube defects (NTDs) are the most common of all cases of lethality associated with a birth defect. Prevalence and mortality estimates are needed to propose effective intervention strategies that prevent NTDs over time. A cross-sectional study was carried out in northwestern Nicaragua from January 2006 to December 2018. All cases of NTDs (anencephaly, spina bifida, and encephalocele) were registered in hospital surveillance systems, and the medical histories of the mothers and newborns were reviewed. Prevalence was calculated by considering the number of live births and stillbirths older than 20 weeks of gestation with NTDs, divided by the total number of live births and stillbirths in each study year. Neonatal mortality rate (NMR) for NTD, and case fatality for spina bifida was calculated. Two hundred fifty cases of NTDs were identified from 178,498 deliveries (177,316 live births and 1,182 stillbirths). The prevalence of NTDs during this time period was 14.01 (95% CI: 12.27-15.74) per 10,000 births. The prevalence of spina bifida (n = 140), anencephaly (n = 97), and encephalocele (n = 13) was 7.84, (95% CI: 6.54-9.14), 5.43 (95% CI: 4.30-6.45), and 0.73 (95% CI: 0.33-1.12) per 10,000 births, respectively. Mothers with fetus or newborns affected with NTDs did not use folic acid prior to conception, and 11% experienced periods of hyperthermia during the first trimester of pregnancy. NMR for NTDs was 0.55 per 1.000 livebirths. Case fatality for all NTDs and for spina bifida were 55% and 18%, respectively. The prevalence and mortality of NTDs in the northwestern region of Nicaragua present peaks and troughs during the study period. Spina bifida was the most frequent type of NTD. We believe that these findings could be of use by health policy makers to strengthen the primary prevention of NTDs in the region through the monitoring of the food fortification policy and folic acid supplementation to women of childbearing age. Additional etiologic studies of NTDs should be considered to identify additional prevention measures.

Early Referral to an ALS Center Reduces Several Months the Diagnostic Delay: A Multicenter-Based Study.

Objective: To analyze those factors contributing to the diagnostic delay in ALS.Methods: Consecutive ALS patients were categorized as those studied in departmental hospitals and those studied in a referral ALS center. Demographic and clinical variables, together with data of the diagnostic pathway were collected. Multivariable models were used to assess their effect in the time between symptoms onset and the first neurologist visit (time symptoms-neurologist), in the time between the first neurologist visit and the diagnosis (time neurologist-diagnosis) and in the diagnostic delay.Results: 166 ALS patients with a median diagnostic delay of 11.53 months (IQR: 6.68, 15.23) were included. The median diagnostic delay was 8.57 months (5.16, 11.61) in the referral center vs. 12.08 months (6.87, 16.8) in departmental centers. Bulbar onset, fast progression rate, upper motor neuron predominant phenotype and an early referral to the neurologist were associated with a shorter time between symptoms–neurologist. Being studied in a referral center was associated with a shorter time between neurologist–diagnosis. Comorbidities, familial ALS, bulbar onset, early referral to the neurologist and being studied in a referral center were associated with a shorter diagnostic delay. For patients studied in departmental hospitals, fast progression rate was also strongly associated with a shorter time between neurologist–diagnosis and diagnostic delay.Conclusion: Unmodifiable factors (comorbidities, familial ALS, bulbar onset, and progression rate) as well as modifiable factors (early referral to the neurologist and the evaluation in an ALS referral center) have an independent effect in the diagnostic delay. The universalization of ALS Units is probably the most efficient measure to reduce the diagnostic delay.

Epidemiology of snakebites in El Salvador (2014–2019)

This study describes the basic epidemiological features of snakebites in El Salvador for the period 2014–2019 on the basis of data provided by the national system of information on morbidity and mortality (Sistema de Morbi-Mortalidad via Web, SIMMOW) of the Ministry of Health of El Salvador. The total number of cases per year ranged from 161 (2017) to 215 (2016). Incidences ranged from 2.52 cases to 3.38 cases per 100,000 population per year, corresponding to the years 2017 and 2016, respectively. Five deaths were recorded in the six-year period, four in 2015 and one in 2016, for a case fatality rate of 0.44%. Snakebites peaked during the rainy season (May to November) and mostly affected people in the age groups of 10–30 years. The male/female ratio was 1.59. The Departments (local political units) showing the highest number of cases were Santa Ana, Libertad, Chalatenango, Sonsonate, and La Unión. Most cases were attended at departmental and regional hospitals (second level of attention). The incidence and mortality due to snakebite envenoming in El Salvador are the lowest reported for Central America. This may be related to the fact that Bothrops asper, the medically most important snake species in the region, is not distributed in El Salvador, where the rattlesnake Crotalus simus predominates.

Methodological basis for assessing the quality and effectiveness of endodontic dental care at the present stage

The article presents the results of the implementation of the method of internal quality control of medical care in the dental treatment-and-prophylactic institution. A methodology for assessing the quality and effectiveness of endodontic treatment of teeth with pulpitis and periodontitis is described. It was noted that competent implementation of internal quality control of endodontic care allowed departmental hospitals to increase its effectiveness a year later in the treatment of complicated forms of single-root, two and three root teeth, respectively, to 77.8%, 60.7% and 60.6% of cases with pulpitis and, respectively, up to 69.2%, 75.0% and 65.6% of cases with periodontitis.

HISTORY (STAGES) OF DEVELOPMENT OF THE MEDICAL SERVICE OF THE MINISTRY OF INTERIOR AFFAIRS OF RUSSIA

Relevance . The history of the medical service of the Ministry of Internal Affairs (MIA) of Russia is presented in domestic publications unsystematically. Intention. To present the stages of development of the medical service of the MIA of Russia. Methods. Domestic publications on the development of the medical service of the MIA were studied based on the Russian National Library and the Russian Scientific Citation Index of the Scientific Electronic Library. Results and discussion. To eliminate medical consequences of the mass epidemics and according to the Edict of the Empress Catherine II dated August 12, 1775, the Moscow Chief Policeman was instructed to «establish a special hospital and almshouse under the authority of the local police.» The opening ceremony of the Catherine’s Hospital took place on June 19, 1776. By 1810–1811, the structure of the main ministries and departments was basically formed in the Russian Empire. The central agency for managing medical and pharmacological activities was the Medical Department of the Ministry of Internal Affairs and its Medical Council, which carried out medical and sanitary control. Locally, there were administrations with subordinate county and city doctors as part of police institutions. Much attention was paid to the creation and development of hospitals personally by the Minister of Internal Affairs Count V.P. Kochubey. By 1855, there were 533 hospitals in Russia with 18,866 beds, although the status of the clinics was considered unsatisfactory due to a lack of funds, medicines and medical personnel. After October 1917 the medical service of the police (as rear units of the army) was carried out by agencies of the Chief Sanitary Directorate of the Workers ‘and Peasants’ Red Army. By order of the Chief of the Main Directorate of the Militia of the People’s Commissariat of Internal Affairs of the RSFSR No. 314 / s of October 12, 1921, «reception rooms» were organized within the departments to provide medical assistance to personnel and to carry out sanitary and preventive measures. Later in 2007, it was the day of October 12 that was declared the Day of Medical Service of the Ministry of Internal Affairs of Russia. In 1992, on the basis of the Medical Directorate of the Ministry of Internal Affairs of the USSR, the Medical Directorate of the Ministry of Internal Affairs of Russia was created, and since 2011 – the Medical Support Department of the Department for Material-Technical and Medical Support of the Ministry of Internal Affairs of Russia. In the medical institutions of the Ministry of Internal Affairs of Russia, about 2.3 million people are serviced, 28.9 % of them are employees of internal affairs agencies, 7.8 % – servicemen and employees of the Federal Service of National Guard troops, 5.4 % – employees of the Federal Service for the Execution of Sentences, 4 % – employees of the State Fire Service of the Ministry of Emergency Situations of Russia. Annually more than 186 thousand patients receive medical care in departmental hospitals, more than 13 million medical visits are conducted in outpatient departments. С onclusion. Positive trends in the development of departmental health in recent years make it possible to predict stable health indicators in employees of the Ministry of Internal Affairs of Russia in the near future.

Before and after the earthquake: a case study of attrition from the HIV antiretroviral therapy program in Haiti

Background On January 12, 2010, a devastating 7.0 magnitude earthquake struck the West Department of Haiti, killing more than 200,000 people and injuring or displacing many more. This disaster threatened continuity of HIV care and treatment services. Objectives This case study examined the effect of the devastating 2010 earthquake in Haiti on attrition from the HIV antiretroviral therapy (ART) program. Design The study triangulated retrospective data from existing sources, including: 1) individual-level longitudinal patient data from an electronic medical record for ART patients at two large public sector departmental hospitals differently affected by the earthquake; and 2) aggregate data on the volume of HIV-related services delivered at the two hospitals before and after the earthquake. Methods The study compared ART attrition and service delivery in Jacmel, a site in the ‘very strong’ zone of earthquake impact, and in Jérémie, a site in the ‘light’ zone of earthquake impact. The analysis used time-to-event analysis methods for the individual-level patient data, and descriptive statistical methods for the aggregate service delivery data. Results Adjusted ART attrition risk was lower at the hospital in Jacmel after vs. before the earthquake (HR=0.51; p=0.03), and was lower in Jacmel vs. Jérémie both before (HR=0.55; p=0.01) and after the earthquake (HR=0.35; p=0.001). The number of new ART patient enrollments, new HIV patient registrations, and HIV clinical visits dropped notably in Jacmel immediately after the earthquake, but then rapidly rebounded. On average, there was no change in new ART enrollments per month after vs. before the earthquake at either site. Conclusion These findings underscore the resilience of Haitian ART providers and patients, and contribute evidence that it is possible to maintain continuity of ART services even in the context of a complex humanitarian crisis.

Nicaraguan Surgical and Anesthesia Infrastructure: Survey of Ministry of Health Hospitals

Developing countries have surgical and anesthesia needs that are unique and disparate compared to those of developed countries. However, the extent of these disparities and the specific country-based needs are, for the most part, unknown. The goal of this study was to assess the surgical capacity of Nicaragua's public hospitals as part of a multinational study. A survey adapted from the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical care was used to study 28 primary, departmental, regional, and national referral hospitals within the Ministry of Health system. Data were obtained at the national and hospital levels via interviews with administrators and surgical and anesthesia chiefs of services. There are 580 obstetrician/gynecologists (OB/GYN), 1,040 non-OB/GYN surgeons, and 250 anesthesiologists in Nicaragua. Primary, departmental, regional, and national referral hospitals perform an annual average of 374, 4,610, 7,270, and 7,776 surgeries, respectively. All but six primary hospitals were able to perform surgeries. Four hospitals reported routine water shortages. Routine medication shortages were reported in 11 hospitals. Eight primary hospitals lacked blood banks on site. Of 28 hospitals, 22 reported visits from short-term surgical brigades within the past 2 years. Measurement of surgical outcomes was inconsistent across hospitals. Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.

ALGORITHM OF REHABILITATION AND REGENERATIVE TREATMENT IN DEPARTMENTS AND SPECIALIZED CENTER OF DEPARTMENTAL HOSPITAL

The article analyses the stages and tasks of rehabilitation and regenerative treatment of patients at the hospital stage in specialized center established on the basis of departmental hospitals. The scheme of the organization of medical-rehabilitation procedures is given.

Relevance of a database for monitoring a cooperative paediatric nephrology project in Nicaragua

Sirs, Many leading international scientific societies [European Society of Paediatric Nephrology (ESPN), International Society of Nephrology (ISN), International Pediatric Nephrology Association (IPNA), Latin American Pediatric Nephrology Association (ALANEPE) and others] and a significant number of pediatric nephrologists have contributed to the growth of our knowledge in the field of pediatric nephrology in developing countries over recent years [1–4]. Since 2000, we have been participating in a cooperative project in Nicaragua [5] with the aims of developing a tertiary pediatric nephrology centre in Managua (renal biopsies, dialysis and living donor transplantations) and a web network that links this centre and six Departmental hospitals in order to share diagnostic and treatment protocols and improve the early diagnosis and treatment of children with kidney and urinary tract diseases (KUTDs). The project includes the regular recording of the clinical data of all inand outpatients aged <19 years, for which an ad hoc computerised database was established in 2002 to contain basic demographic data, the diagnosis, the clinical course (cured, on or lost to follow-up, deceased), and annual creatinine clearance values or the type of renal replacement therapy (RRT) of patients with chronic renal failure (CRF; CrCl <75 ml/min/1.73 m). The data are regularly sent to the coordinating centre in Milan and discussed by e-mail or during meetings held twice a year in Nicaragua. As of December 2008, the data of 3376 children had been entered in the database, including 193 with CRF (Fig. 1). Analysis of the 56 deceased patients revealed that 95% had died during stage IV or V CKD according to the National Kidney Foundation (NKF) classification: 43% before RRT program was started in Managua (up to 2004), 22% while on RRT and 32% without starting RRT (for social problem). Although the project had undoubtedly improved the treatment of children with CRF by providing previously unavailable diagnostic and therapeutic resources, such as RRT, this was still a high rate of CRF-related mortality. The large number of children lost to follow-up or not entering the RRT programme was clearly not only due to limited medical facilities, but also to factors that could only be partially addressed by a simple cooperative project: logistics (distance from hospitals and the lack of transportation infrastructures), social problems (health education) and the families’ economic priorities [6]. An epidemiological analysis of the Departments fully covered by the project (61% of the country’s pediatric population) also indicated a lower incidence and prevalence of CRF than those reported in the ITALKID Italian Registry of CRF [7] (9.29 vs. 12.1 patients/year per million of the age-related population, and 40.3 vs. 74.7 patients per million of the age-related population, respectively), which was used for comparative purposes because of its similar patient selection and inclusion criteria. These data suggested that many G. Marra (*) :A. Edefonti Pediatric Nephrology and Dialysis Unit, Clinica Pediatrica G. e D. De Marchi, Fondazione O.M. Policlinico Mangiagalli e Regina Elena, Via Commenda 9, 20122 Milan, Italy e-mail: gimarra@hotmail.com

Combined Primary Subintimal and Endoluminal Angioplasty for Ischaemic Inferior-limb Ulcers in Diabetic Patients: 5-year Practice in a Multidisciplinary ‘Diabetic-Foot’ Service

This study aims to assess the patency, the clinical success and the limb-salvage rates of combined subintimal (SA) coupled to endoluminal angioplasty (EA) as the initial treatment of ischaemic inferior-limb ulcers in diabetic patients and to study the influence of other concurrent factors in the tissue-healing process. Since September 2002 until December 2007, a consecutive series of 176 limbs with manifold ischaemic wounds in 161 diabetic patients were treated by associated multilevel angioplasties in a multidisciplinary 'diabetic-foot team' (a third-line diabetic-care institution integrating two departmental hospitals). There were 98 associated SA with EA procedures, 26 re-vascularisations by single SA technique and 52 others including selective multilevel EAs that were retrospectively reviewed. The mean follow-up period was 22.1 months (in the range of 1-50 months) by clinical and duplex evaluation (every 6 months). The initial technical success was noted in 149 limbs (84%). For the single or associated SA procedures, 102 of 124 procedures were successful (82%) and 145 of 150 of the miscellaneous EAs (96%) evinced an equally favourable outcome. The 27 initially failed endovascular procedures (22 SA and five EA) required 16 surgical re-vascularisation, eight adjuvant endovascular procedures besides three amputations. A total of 21 secondary and five tertiary angioplasties were equally necessary during the entire follow-up period of these patients. The 30-day survival rate was 99% (one patient died from myocardial infarction). In a intention-to-treat analysis, the cumulative primary and secondary patencies at 12, 24, 36 and 48 months were 62%, 45%, 41% and 38%, together with 80%, 69%, 66% and 66%, respectively. The aggregate clinical success rates at the same intervals were 86%, 77%, 70% and 69%, while the corresponding limb-salvage proportions showed 89%, 83%, 80% and 80%, respectively. The primary patency was negatively affected at 1 and 4 years by the length of the occluded segment (>10 cm) and the end-stage renal disease (ESRD) (p<0.0001). The limb-salvage rates were unfavourably influenced at the same periods by the extent of tissue defects (>3 cm), the ESRD and the presence of osteomyelitis. In addition, at 4 years, the age (>70 years), the accompanying peripheral neuropathy, the bedridden status and the presence of cardiac failure (left ventricular ejection fraction (LVEF)<30%) appeared equally as negative predictors (p<0.0001) for wound healing and limb rescue. Primary angioplasty represents a low aggressive and efficacious method to improve the healing process in diabetic ischaemic ulcers. However, beyond appropriate re-vascularisation, even repetitive if necessary, achieving satisfactory limb-salvage rates probably implies a multidisciplinary control of the presenting risk factors for wound healing as well.

Book Review: The Australian health care system

THIS IS THE THIRD edition of one of the seminal local texts on the Australian health care system. Over the last seven years, this text has proved a basis for helping students, casual readers and health professionals understand Australia?s sometimes difficult to understand health care system. The text is divided into ten chapters that deal with key aspects of Australia?s health care system, namely: � Frameworks for analysis � The Australian population and its health � Financing health care � The health workforce � Departmental and intergovernmental structures � Hospitals � Public health � Primary and community care � Pharmaceuticals � Policy challenges for the Australian health care system. There are several key reasons why this text has been widely used in the past and will continue to be of value well into the future. The author has been able to accurately describe the complexities of the Australian health care system in an easily digestible way. This is a feat in itself and worthy of praise. There is an appropriate use of tables and figures to support the written content. Finally, the author provides excellent conclusions that bring together the salient points and issues in each chapter. The publisher promotes that this edition includes new material on health workforce, patient safety and medical and health insurance. The Australian health care system delivers on this claim, providing useful insights and a deeper understanding of the issues that confront the future direction and delivery of health services in this country. This text is a useful addition to any library as well as a staple for students needing to more clearly understand the complexities and challenges of the Australian health care system. My only suggestion is that the text could have been enhanced by the inclusion of revision or reflective questions at the end of each chapter. In summary, a must-have as part of a good health-related library.

Health Conditions in Guatemala

IN a recent message to the National Legislative Assembly, General Jorge Ubico, the president of Guatemala, gives the following details concerning health conditions in that country during 1939. 324,031 treatments were given to 67,371 malaria patients, 85,407 persons were treated for intestinal parasites, 2,486 dysentery cases received 13,123 treatments, 4,073 onchocerciasis patients were treated, 64,640 treatments for venereal disease were administered and 250 women were given 7,725 examinations. There were mild epidemics of whooping cough, diphtheria, measles and typhoid fever. The country has seventeen departmental hospitals, which cared for 48,815 persons.