Large Medical Organizations Research Articles

Risk of COVID­-19 Infection among Employees of a Large Anti­tuberculosis Institution in Moscow: Survey Results

Relevance. Studying the experience of working under the conditions of COVID-19 allows us to more effectively assess the functioning of anti-epidemic measures in the event of the occurrence or threat of new pandemics, including those caused by new pathogens. The risk of contracting COVID-19 among employees of medical organizations is higher compared to the rest of the population of the metropolis, which determines the need to develop additional measures in medical organizations to protect workers. Timely assessment of risks and preventive measures during a pandemic allow building a system to protect medical institutions from various biological threats when providing medical care. Aim. Assessment of the risks of contracting COVID-19 among employees of a large anti-tuberculosis medical organization in a metropolis. Materials & Methods. A survey of employees of a large anti-tuberculosis medical organization in Moscow was conducted. The survey was conducted on 46 key questions of epidemiological history, compliance with the requirements of the sanitary and anti-epidemic regime, alleged sources of infection, prognostic risks of the occurrence and course of COVID-19. During the period from August 1 to October 1, 2022, 1225 employees of the institution were surveyed (43.8% of the total number). The survey was conducted on a voluntary basis and was anonymous. When answering questions, participants provided information about demographic factors (age, gender), place of actual residence, the fact of contracting a new coronavirus infection, frequency of laboratory testing for SARS-CoV-2, immunization against COVID-19, possible places of contact with patients with COVID-19, the use of personal protective equipment (PPE) at home and at work, the regular use of skin antiseptics, as well as other information that allowed us to establish the risks of infection of workers at home and at work. To assess the risks of infection, respondents were divided into two groups depending on the presence of a positive test for SARS-CoV-2 (group I) or its absence (group II) as of October 1, 2022. The material for testing was nasal/oropharyngeal swabs. The research of employees was carried out on the basis of the laboratory of the anti-tuberculosis medical organization, as well as in other accredited laboratories of the metropolis using the molecular genetic method, and since February 2022 also using the express method that determines the SARS-CoV-2 antigen. Results. Among the survey participants and according to the questionnaire data, 797 employees suffered from the new coronavirus infection COVID-19, and 138 (17.3%) of them had repeated cases of the disease. Factors that increase the risk of COVID-19 among personnel of anti-tuberculosis medical organizations directly involved in the fight against the new coronavirus infection have been identified. The results of the study demonstrated that important factors influencing the incidence of workers were the frequency of examination for COVID-19, the regular use of skin antiseptics, contact with sources of infection, the use of glasses for vision correction, the use of public transport and eating at work. Conclusion. The need to study the risks of contracting COVID-19 among employees of medical organization and, based on them, develop a set of additional anti-epidemic protection measures was confirmed.

Etiology of community-acquired pneumonia in children and adults based on 2015–2022 bacteriological and molecular genetic studies

The data on etiology of community-acquired pneumonia (CAP) remain contradictory, which is often assessed only according to bacteriological studies coming to a conclusion about the low frequency of major main pathogenStreptococcus pneumoniaеisolation. At the same time, there are very few observations of parallel examination of patients with CAP simultaneously by bacteriological and molecular genetic methods. There are no observations on the etiology of CAP in the long-term dynamics. The aim of the work is to analyze the etiology of CAP in children and adults based on 2015–2022 bacteriological and molecular genetic studies. The etiology of pneumonia was assessed using the data on posterior pharyngeal wall washes from 418 children and 483 adults hospitalized with a primary diagnosis of CAP at two large Perm medical organizations in 2015–2022. The samples were examined by the bacteriological method and polymerase chain reaction using commercial test systems with the amplifier “CFX96” (Bio-Rad, USA). The results showed thatS. pneumoniaе, despite implementing decreed vaccinations against pneumococcal infection, it remains the leading causative agent of CAP in both children and adults. The 2015–2022 frequency of pneumococcal discharge according to bacteriological studies was 9.7 per 100 examined, according to molecular genetic studies — 48.5 per 100 examined among children and adults in the study area. According to 2021–2022 vs 2015–2017 bacteriological studies, the frequency ofStaphylococcus aureusexcretion among children increased significantly, andS. pneumoniaеincreased among adults. According to the results of molecular genetic studies among children and adults, no significant changes in the etiology of CAP were found. In 2021–2022, SARS-CoV-2-positive vs SARS-CoV-2-negative patients with CAP infected had higher rate of isolatedS. aureus,KlebsiellapneumoniaеandHemophilus influenzae, i.e., those pathogens whose number increased in the long-term follow-up observations.

ВОЗМОЖНОСТИ ОПТИМИЗАЦИИ ЗАТРАТ НА ЛЕКАРСТВЕННОЕ ОБЕСПЕЧЕНИЕ ПАЦИЕНТОВ ЗА СЧЕТ ЦЕНТРАЛИЗОВАННОГО РАЗВЕДЕНИЯ ПРОТИВООПУХОЛЕВЫХ ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ

The high level of costs for chemotherapy of malignant neoplasms requires the search for new solutions to reduce the cost of treatment. Centralized dilution of drugs is one of the most optimal solutions to this problem. But making such a decision requires a rather laborious calculation of the expected economic effects. The purpose of the study was to substantiate the economic benefits of centralized dilution of chemotherapeutic drugs in the regional oncological hospital. As materials, we took into account the number of spent 62 injectable forms of antitumor drugs in the departments of the Sverdlovsk Regional Oncological Dispensary, information on the implementation of 2098 chemotherapy regimens, acts on the disposal of unused drug residues, state contracts for the supply of drugs in 2022-2023. Methods of economic and mathematical analysis, modeling of economic situations with calculation of economic indicators were used to determine direct absolute and relative losses during the disposal of drug residues, as well as calculation of prevented economic damage. As a result, indicators were developed to determine the economic efficiency of the centralized drug dilution: the specific drug weight in the prescribing lists, absolute and relative financial losses, loss reduction coefficient. The relationship between the frequency of prescriptions and the potential for possible savings due to rational utilization of drug residues has been established. The average level of relative drug losses after the introduction of centralized drug dilution was 0.09% in 2023 against 5.54% of losses in 2022. The economic feasibility of using centralized drug dilution in large medical organizations is substantiated. The introduction of a centralized drug dilution in the Sverdlovsk Regional Oncology Dispensary prevented more than 20 million rubles of economic damage per month.

Analysis of the health status of medical workers based on the results of mandatory periodic examinations

Objective: to analyze the results of periodic medical examinations of employees of a large medical organization in dynamics, according to the final acts. Materials and methods: the research material was the final acts (2019–2021), compiled based on the results of periodic medical examinations of employees of the Novosibirsk Regional Clinical Hospital of War Veterans (Novosibirsk Regional Clinical Hospital of War Veterans). For the analysis, data on the structure of diseases for 2019–2021 were also used, with which medical workers underwent treatment courses in the day hospital of the hospital. Results: in just 3 years, 546 hospital employees under-went periodic medical examination, 489 of them women. The results of the studies have shown that in the dynamics of three-year follow-up, the number of persons subject to additional examination, treatment and dispensary observation has sharply increased, which may indicate a certain effectiveness of PMT. The detectability of chronic somatic diseases according to the results of the PMT has increased by more than 10 times in dynamics. 69 medical workers underwent treatment courses on the basis of the GNOCGV day hospital for 3 years. Of these, 22 medical workers were treated and rehabilitated in a day hospital with the consequences of a new COVID-19 coronavirus infection. Conclusion: when analyzing the final acts based on the results of the PMOS of GNOCGV employees for the period from 2019 to 2021, it was found that the efficiency and quality of inspections has increased dramatically.

Influenza Vaccination Among Pregnant Women: Self-report Compared With Vaccination Data From Electronic Health Records, 2018-2020 Influenza Seasons.

Having accurate influenza vaccination coverage estimates can guide public health activities. The objectives of this study were to (1) validate the accuracy of electronic health record (EHR)-based influenza vaccination data among pregnant women compared with survey self-report and (2) assess whether survey respondents differed from survey nonrespondents by demographic characteristics and EHR-based vaccination status. This study was conducted in the Vaccine Safety Datalink, a network of 8 large medical care organizations in the United States. Using EHR data, we identified all women pregnant during the 2018-2019 or 2019-2020 influenza seasons. Surveys were conducted among samples of women who did and did not appear vaccinated for influenza according to EHR data. Separate surveys were conducted after each influenza season, and respondents reported their influenza vaccination status. Analyses accounted for the stratified design, sampling probability, and response probability. The survey response rate was 50.5% (630 of 1247) for 2018-2019 and 41.2% (721 of 1748) for 2019-2020. In multivariable analyses combining both survey years, non-Hispanic Black pregnant women had 3.80 (95% CI, 2.13-6.74) times the adjusted odds of survey nonresponse; odds of nonresponse were also higher for Hispanic pregnant women and women who had not received (per EHR data) influenza vaccine during current or prior influenza seasons. The sensitivity, specificity, and positive predictive value of EHR documentation of influenza vaccination compared with self-report were ≥92% for both survey years combined. The negative predictive value of EHR-based influenza vaccine status was 80.5% (95% CI, 76.7%-84.0%). EHR-based influenza vaccination data among pregnant women were generally concordant with self-report. New data sources and novel approaches to mitigating nonresponse bias may be needed to enhance influenza vaccination surveillance efforts.

The Impact of Immunization with Anti-Coronavirus Vaccines on the Incidence of COVID-19 in Employees of a Large Tuberculosis Institution in Moscow

Relevance. Employees of a TB facility are a high-risk group for the incidence of COVID-19 due to their involvement in the detection and treatment of a new coronavirus infection, so vaccination of staff should play a significant role in their protection against a new coronavirus infection. Aim. Analyze the incidence of COVID-19 in employees of a large TB medical organization in a big city before and after mass immunization with anti-coronavirus vaccines. Materials & Methods. An analysis was made of the incidence of a new coronavirus infection COVID-19 among employees of the Moscow Research and Clinical Center for Tuberculosis Control during April 1, 2020–September 30, 2021, considering two periods of nine months in 2020 (2771 employees) and 2021 (2845 employees) and taking into account the data on the implementation of the first and second vaccinations carried out during the study period. Calculation of the average weekly and annual incidence per 1000 employees was carried out taking into account the different time spent by employees "at risk of getting sick". The incidence rate was calculated both for the entire study period as a whole and for weeks of high risk of COVID-19 incidence in the population of Moscow with an indicator of 500 or more per 100,000 population. Results. A comparative analysis of the incidence of COVID-19, registered from April 1, 2020 to October 1, 2021, was carried out among the average number of 2808 employees of the leading anti-TB institution in Moscow, taking into account vaccination. During the period under review, a total of 35.5% of employees in the institution fell ill and the annual incidence of staff was 177.4 per 1000 employees. 5.7% [95% CI 4.4–7.4%] of previously ill employees had a recurrence of the disease. Being unvaccinated until September 2020 and limitedly vaccinated until July 2021, the staff of the Center was massively immunized from July to August 2021 – up to 86.0% of the institution's staff by the end of the observation period. Based on the calculation of the weekly number of disease cases and of not yet ill persons among fully vaccinated, vaccinated with one drug, not vaccinated and previously ill, the incidence in these groups was compared, taking into account the time at risk of disease before a new case of COVID-19 was registered. For periods of high monthly incidence of the city's population (above 500 per 100 thousand), the annual notification rate of the unvaccinated was 2.8 times higher than that of the fully vaccinated (408.2 and 144.0 per 1000 people, RR = 2.8 [95% CI: 2.0–4.0]). The notification rate among those vaccinated with only one component of the two-component vaccine was 1.5 times higher than among those who were not vaccinated (271.5 and 409.2 per 1000 people. RR = 1.5 [95% CI: 1.04–2.2]). The probability of getting sick in fully vaccinated people was significantly higher than in those who previous infected with SARS-CoV-2 (144.0 and 78.0 per 1000 people, RR = 1.9 [95% CI: 1.1–3.1]). Conclusions. The obvious effectiveness of vaccination has been confirmed, including among the personnel of medical organizations directly involved in the fight against a new coronavirus infection.

P539 COVID-19 is Associated with Long-term Elevated Fecal Calprotectin Levels in Patients with Crohn’s Disease but not in Ulcerative Colitis

BackgroundData regarding the long-term effects of COVID-19 on patients with Inflammatory bowel disease is scarce. Fecal calprotectin (FC) correlates with IBD clinical and endoscopic activity. We compared fecal calprotectin levels between patients with COVID-19 to a control group tested negative to SARS-CoV-2.MethodsWe gathered data from a large health medical organization in Israel of insured individuals who underwent a SARS-COV-2 PCR test from March 1, 2020, to December 31, 2020. Among patients with IBD, data regarding fecal calprotectin taken 30–365 days before SARS-CoV-2 testing was gathered. We compared fecal calprotectin levels taken at least 30 days following COVID-19 infection to those who tested negative.Results1924 Crohn’s disease (CD) patients and 949 Ulcerative Colitis (UC) patients were tested for SARS-CoV-2. 322 (16.7%) were tested positive in the CD group and 114 (13.7%) in the UC group.Pre-COVID-19 calprotectin levels did not show statistically significant differences between patients who ended up testing positive for SARS-CoV-2 and those who tested negative in CD (377 ±759.08 vs. 451.84±869, p-value = 0.4) and in UC (466.93±766.69 vs. 617.91 ±1243.99 p-value=0.37). Post-COVID-19 fecal calprotectin was higher among patients with CD who were tested positive than those who tested negative for SARS-CoV-2 (617.42±832.68 vs. 355.94±1207.46, p value=0.04). In a multivariate linear regression controlling for age, gender, BMI, smoking status, and pre-COVID-19 fecal calprotectin, SARS-CoV-2 positivity was associated with higher fecal calprotectin levels (p value=0.03). In contrast, there was no statistically significant change in fecal calprotectin levels among patients with UC and SARS-CoV-2 positivity (547.2±1089 vs.458.32± 689 p value=0.9). In a 2:1 propensity score-matched cohort (n=264), calprotectin levels were higher among patients with CD who suffered from COVID-19 compared to controls (657.64 vs. 384.94 p-value = 0.03)ConclusionPatients with CD who had COVID-19 have higher FC levels compared to similar CD patients who did not have COVID-19. This finding was not found in patients with UC.

Educating Community Health Professionals About the Health-Related Effects of Climate Change Through ECHO Telementoring.

Introduction:Climate change is a global public health emergency causing extensive morbidity and mortality worldwide. Although most large medical organizations endorse the need to train health care professionals in climate change, such trainings are not readily available.Methods:This article describes the results of an 8-week, 75-min per week, Climate Change and Human Health ECHO (CCHH ECHO) synchronous telementoring course for post-licensure health professionals. The primary goals were: to increase knowledge, self-efficacy, and communication skills. Participants were eligible to receive up to 10 h of no-cost continuing education credits and a certificate for completing the program.Results:The 8-week course included 625 unique participants from 25 countries. An interprofessional group of clinicians, health professionals, and educators included: 130/28% PhD, 92/20% MD/DO, 52/12% RN/NP/PA, 50/11% MPH. The prospective survey demonstrated a significant improvement in knowledge, confidence, attitudes (P < .001) and communication skills (P = .029) at 3 months post course.Conclusions:The climate crisis is a public health emergency, and health professionals worldwide are considered the most trusted source of health information. Training current and future health professionals regarding the health-related effects of global warming is vital. The CCHH ECHO may be a successful model to facilitate knowledge transfer and promote communication skills between subject matter experts and course participants.

Incidence of COVID-19 in outpatient healthcare workers

Currently, work in any medical organization carries a risk of coronavirus infection, and, first of all, this applies to medical organizations dealing with the treatment of patients infected with coronavirus. Medical workers are a group at increased risk of infection with the SARS-CoV-2 virus in the provision of medical care in modern conditions, which determines their incidence of COVID-19 [1-3]. The aim of the study is to explore the prevalence of cases of COVID-19 infection in medical workers providing medical care on an outpatient basis. Materials and methods. The analysis of the incidence of COVID-19 medical workers in one of the large medical organizations of the Samara region during the period of the pandemic was carried out. The medical staff of the medical organization includes 207 doctors. There are 11 subdivisions in the structure of the medical and prophylactic institution. Research methods: content analysis of the modern regulatory framework (2020-2021), statistical, expert. For the period from May 2020 to March 2021 71 cases of infection of medical workers on an outpatient basis with SARS-CoV-2 were identified, of which 32 doctors (45%) and 39 people (55%) nurses. Based on the results of the expert assessment, the insurance nature of the infection case was established in 50 people (70%). Among the medical and nursing categories of medical workers, the largest number of cases was made by doctors and nurses of primary contact - specialists of the district service: general practitioners (40%), pediatricians (32%), doctors - obstetricians-gynecologists (12%), nurses adults (76%) and children (20%) polyclinic departments. A third of health workers received inpatient treatment for severe COVID-19, an average of 60 days. Conclusion. Medical workers are a risk group of COVID-19 who need support measures, since the possibility of occupational infection has been sufficiently proven, and the risk probably depends on the work performed and the conditions of direct contact of medical personnel, which requires further study in the current persisting epidemic conditions.

Speaking to the Heart of Our Patients: An Empathic Communication Education Initiative.

Communicating with empathy is a critical skill within the nurse-patient relationship and a driver of a positive patient experience. Staff at a large midwestern medical organization identified an education-based communication improvement strategy to address a gap within its patient experience data. An evidence-based empathic communication education framework was developed and delivered to more than 8,400 nurses and allied health staff. Posteducation sustainment strategies were included within the framework to support ongoing concept mastery and practical application. A multilevel evaluation strategy was used to measure the education's impact from both a learner and patient perspective. Evaluations demonstrated the chain of impact from reaction, learning, behavior, and results, indicating the education improved staff members' ability to communicate empathically, contributing to an increase from baseline in communication-related patient experience data. [J Contin Educ Nurs. 2021;52(7):319-325.].

COVID-19 in healthcare workers (literature review and own data)

Introduction. Health care workers are at risk of infection with the SARS-CoV-2 virus. However, many aspects of the professionally conditioned COVID-19 are still poorly understood. The aim of study is to conduct a brief review and analysis of scientific data on the prevalence, features of clinical and laboratory COVID-19 syndromes in medical professionals. To evaluate the structure of post-COVID syndrome in health care workers who are observed in a large multidisciplinary medical organization that has a center for occupational pathology. To present the current state of the problem of examination of the connection of COVID-19 with the profession and admission to work in conditions of high risk of SARS-CoV-2 infection. Materials and methods. At the first stage, a brief review of the literature on the problem of COVID-19 in health care workers was performed, at the second - a single-center observational prospective study of COVID-19 convalescents. The main group consisted of health care workers (n=203), the comparison group - people who do not have occupational health risks (n=156). The groups were comparable in demographic characteristics. The work experience of the medical staff was 15 (5; 21) years. Of the participants in the main group, 20.2% worked in hospitals, and 79.8% in outpatient institutions. Three of the participants (1.5%) were employees of specialized COVID hospitals. Doctors were 25.6%, secondary medical personnel - 51.7%, junior medical and technical personnel - 22.7%. A severe form of COVID-19 was suffered by 25 (12.3%) people, after the artificial ventilation of the lungs (AVL) - two participants. The observation time is 60 days. Statistical analysis included standard methods of descriptive statistics, determination of relationships by the method of logistic regression. The significance level is p&lt;0.05. Results. Most of the known data on COVID-19 in health care workers is obtained in cross-sectional studies. The possibility of occupational infection has been sufficiently proven. The risk probably depends on the work performed and is higher in conditions of direct contact of medical personnel with adults, potentially infected patients, but not in a specialized hospital. It is possible that the course of COVID-19 in health care workers differs from the general population of patients there is evidence of a greater frequency of weakness and myalgia. Studies of the features of post-COVID syndrome in health care workers in available sources could not be identified. According to the results of their own research, health care workers who had experienced COVID-19 had a higher frequency of central thermoregulation disorders, arrhythmias, heart failure, panic attacks and depression. Conclusions. Health care workers are at risk of COVID-19. Professionally conditioned post-COVID syndrome is characterized by the frequency of violations of the central mechanisms of thermoregulation and arrhythmias. COVID-19 in health care workers meets the definition of occupational disease.

New technologies in complex of measures of nonspecific prophylaxis of healthcareassociated infection

Introduction. Preventive maintenance is of great importance for the prophylaxis of healthcare-associated infection (HAI). Material and methods. An assessment of the interventional cleaning program of the epidemiologically significant units of a large medical organization was based on the data of marks erasure control, microbiological studies, a survey of employees of the insourcing department. Results. In 2017, the Center began implementing an intervention program for outsourcing, which began with the creation of the Department of sanitary services (DSS), which took over the functions of cleaning the premises, as well as providing departments with the necessary disinfectants, detergents, and cleaning products. Before the implementation of this intervention program, the staff was trained in the form of theoretical classes (lectures with the display of training videos, presentations). Practical skills were developed directly in the workplace. The interventional insourcing program showed a 1.28-fold decrease in microbial contamination of surfaces in high-epidemiological risk departments. As a result, the consumption of disinfectant was reduced by more than 5 times. The satisfaction of the sanitary service Department operators with the introduction of the new method was more than 90%. Conclusion. The implemented intervention program allowed not only to improve the quality of cleaning, but also to change the attitude of patients, medical personnel, and the administration to the institution of cleaning by the forces of the medical organization itself.

Radiation-hygienic assessment of modern medical technologies

Introduction. Currently, modern medical radiation technologies, including the use of radiopharmaceuticals, are becoming more widely used. At the same time, it should be noted that these technologies themselves have undergone a significant evolution towards improving their radiation safety. But while radiation technologies have been steadily improving, approaches to controlling and regulating activities with ionizing radiation sources remain highly conservative. In law enforcement practice, this approach leads more and more to excessive requirements that are not justified for the basic principles of radiation safety - rationing, justification, optimization. This paper substantiates the ways to improve the issues of regulation and regulation of activities using modern radiation technologies Purpose of research. Conducting radiation and hygiene assessment of working conditions in PET centers and developing proposals for improving regulatory requirements, taking into account the features of modern technologies Material and methods. Protocols of industrial radiation control, results of own research of effective equivalent doses, equivalent doses for the skin and lens of the eye by thermoluminescent dosimetry, timekeeping of the working time of the PET center staff were used. Results. As part of the work, the results of industrial radiation monitoring of the PET- center of a large medical organization were analyzed. It is shown that the annual radiation doses are within no more than 1/3 of the dose limit for limited personnel, most of whom receive less than 5 mS per year. The data of our research carried out based on the scientific LRC of the Department of radiochemistry of the Lomonosov Moscow State University are in good agreement with the data of the medical institution. Conducting time-lapse studies allowed us to conclude that the time of direct exposure of personnel is significantly less than the standard values provided for by regulatory documents, and the dose rates for many operations can not correspond to the values regulated by these documents. It is shown how a safe technology can relate, on formal grounds, to “highly dangerous”, which is a significant modern contradiction in the field of regulating activities with radiation sources. Conclusion. An important factor in ensuring radiation safety is the identification of critical groups of personnel, the most exposed organs, and tissues, taking into account the annual activity consumed. The standardized dose rate criteria laid down in regulatory documents do not provide for the use of indicators of the actual workload (time of exposure). It is necessary to introduce appropriate changes to the normative documents.

Analysis of Current Practices of Organizing the Export of Medical Services in the United Kingdom, Italy, South Korea and China

Aim of the study. Analysis of medical tourism’s organizational features based on the example of the large medical organizations in the United Kingdom, South Korea, Italy and China. Materials and methods. The data were collected by the authors by interviewing the heads of medical organizations and their deputies in the United Kingdom, South Korea, Italy and China (3–4 respondents per medical organization) using the developed questionnaire to identify the main mechanisms and tools for organizing the export of medical services. SWOT-analysis (Strengths; Weaknesses; Opportunities; Threats) was performed in order to comprehensively evaluate the received information. Results. Along with weaknesses and threats that slow down the development of medical services exports, strengths (internal factors) and opportunities ( external factors) that contribute to the development of medical tourism were also identified: the widespread popularity of the brand of medical organizations abroad which is associated with the provision of premium medical services; versatility and ability to conduct high-tech surgical operations; the presence of a separate premium class building and an international department for working with foreign patients and promoting a medical organization in the world market; well-established business relationships with assistance companies; foreign medical personnel who speak foreign languages and possess necessary skills to treat foreign patients; developed electronic medical care system; developed system of quality control of medical care; the presence of branches in other countries; the presence of a medical visa in the system of legislation; established cooperation with many countries at the embassy level; state licensing and accreditation for the provision of medical services to foreign citzens; the availability of a state website on the provision of medical assistance to foreign citizens; the possibility of the age of value added tax. Conclusion. We identified main patterns in the organization of export of medical services that can be applied to develop this direction in medical organizations of the Russian Federation during the analysis the strengths and weaknesses of four large medical organizations abroad, as well as external factors that affect the work of these medical organizations.

Working conditions and health of doctors of a large medical organization

The assessment of working conditions and morbidity with temporary disability of doctors of a large multidisciplinary hospital, questioning of doctors to assess the relationship between the level of health of doctors and their attitude to the preservation of their own health. Programs of health protection of doctors and the organization of their medical care and health saving are developed.

398. Description of a Large Pediatric Lyme Arthritis Cohort in an Endemic Region

BackgroundIn endemic areas, Lyme arthritis (LA) is a leading cause of joint swelling. Due to the shared inflammatory nature and common clinical features, acute LA is often misdiagnosed as septic arthritis (SA) while recurrent disease is at times difficult to differentiate from other causes of chronic arthritis. In Minnesota, there has been a steady increase in cases of Lyme disease. This has not been met by a clear guideline and there is no consensus for the management of pediatric arthritis. In this context, we sought to characterize the epidemiology and clinical presentation of a large local cohort.MethodsThis is a retrospective review of medical charts from children with confirmed LA, presented at a large academic medical organization in the Upper Midwest between January 2011 to December 2017. Demographic, clinical, and laboratory data were collected and analyzed.ResultsLyme arthritis was confirmed in 109 children. Acute presentation was more common (67) while the rest (42) had either persistence or reoccurrence of symptoms [Figure 1]. Elevated inflammatory markers and synovial pleocytosis were common, unlike fever and refusal to bear weight which were seen occasionally [Figure 2]. Seasonal distribution and the clinical setting for initial presentation as well as admissions are summarized in Figure 3. The knee was involved in all but 2 patients, both had acute monoarthritis (elbow and hip) [Figure 4].ConclusionLA causes a spectrum of disease, is seen year round, and across the clinical setting continuum. Acute knee monoarthritis is the most common presentation (54% in our cohort) and is often misdiagnosed as SA leading to unnecessary hospitalizations and aggressive interventions. This occurs more frequently at the ED setting and for children with significant synovial pleocytosis. When evaluating a child with arthritis, laboratory findings are none specific and should be used in caution. Pediatric providers in endemic regions, especially those in primary, hospital, or emergency care must be familiar with the clinical presentation and have a high index of suspicion for LA in order to prevent mismanagement. Disclosures All authors: No reported disclosures.

The impact of adoption of a new urate-lowering agent on trends in utilization and cost in practice.

ObjectivesChanges in treatment choice of therapy and size of treated population that can lead to under- or overestimate of payer’s budget are less likely to be reassured after reimbursement adoption of a new drug. The aim of this study was to evaluate the effects of febuxostat introduction and the modifications in its insurance coverage on the utilization and expenditure of urate-lowering therapy (ULT).MethodsElectronic medical records for adults patients prescribed any ULT during 2010–2015 was derived from the largest medical organization in Taiwan. Aggregated estimates of ULT use and costs were assessed per 3-month and per patient per month (PPPM). Factors associated with total ULT expenditure were assessed using a time series design with factored Autoregressive Integrated Moving Average (ARIMA) models.ResultsULT prevalent users increased 34.1% from 2010 to 2015 and a 123% increase in total ULT expenditure. Numbers on allopurinol and sulfinpyrazone both declined 31%, and on benzbromarone and febuxostat gradually increased to 38.21% and 22.89% of all users in 2015. Insurance payments PPPM ($4.44 to $9.22) and total monthly ULT cost ($32,946 to $ 85,732) growth more than doubled in 6 years, trend changes generated mostly by individuals switching to febuxostat.ConclusionsULT use moved to favor benzbromarone and febuxostat; greater expensive uptake for febuxostat led to a rapid rise in ULT cost. Marginal values of increasing access to febuxostat for asymptomatic hyperuricemia should be focus on future studies to facilitate drug prices negotiation and ensure appropriate ULT use.

Comparison of the Effects of Denosumab and Alendronate on Cardiovascular and Renal Outcomes in Osteoporotic Patients.

A correlation between impaired bone metabolism, chronic kidney disease, and cardiovascular diseases (CVD) has been suggested. This study aimed to compare the effects of denosumab and alendronate, two anti-resorptive agents, on cardiovascular and renal outcomes in osteoporotic patients. Propensity score-matched cohort study comparing denosumab to alendronate users between January 2005 and December 2017 was conducted from a large medical organization in Taiwan. Risks of CVD development and renal function decline were estimated using Cox proportional hazard regression. A total 2523 patients were recruited in each group. No significant difference in cardiovascular events was found between the two groups over a 5-year study period. Stratified analysis results showed that denosumab was likely to exert protective effects against composite CVD in patients with medication possession rate ≥60% (adjusted hazard ratio (AHR), 0.74; p = 0.0493) and myocardial infraction (AHR, 0.42; p = 0.0415). Denosumab was associated with increased risk of renal function decline in male patients (AHR, 1.78; p = 0.0132), patients with renal insufficiency (AHR, 1.5; p = 0.0132), and patients with acute kidney injury during the study period (AHR, 1.53; p = 0.0154). Conclusively, denosumab may exert cardiovascular benefits in patients with good adherence but may have renal disadvantages in certain conditions and thus must be used with caution.

Utility of human leukocyte antigen-B*58: 01 genotyping and patient outcomes.

Human leukocyte antigen (HLA-B*58:01) allele screening before allopurinol administration is recommended to prevent gene-mediated severe cutaneous adverse reactions (SCARs). The objective of the analysis was to examine the clinical utility and effects of HLA-B*58:01 genotyping on patient's outcomes in a practice setting. The electronic medical records covering diagnosis, laboratory results, and prescription dispensing for patients who were newly treated with allopurinol or tested for HLA-B*58:01 were obtained from a large medical organization in Taiwan between 2010 and 2014. The uptake of HLA-B*58:01 testing, incidence of allopurinol-associated SCAR, and changes in urate-lowering agent utilization were assessed. A total of 17 532 allopurinol new users were identified from 2010 to 2014, and the HLA-B*58:01 test was ordered for 2844 (21.76%) of 13 069 new users when available between 2011 and 2014 in the study. The allopurinol-related SCAR events decreased from 0.21% (22/4460) to 0 (0/2167) after the introduction of HLA-B*58:01 testing, accompanied by a gradual increase from 8% (326/4207) to 31% (674/2167) in genotype testing rate. However, the HLA-B*58:01 testing performed before allopurinol prescription was 60.34%, and ~40% of patients were tested after already taking allopurinol. A shift from allopurinol to other urate-lowering agent regimens appeared among new allopurinol users. HLA-B*58:01 test was associated with the prevention of allopurinol-induced SCAR. The clinical utility of genotype testing may not be consistent with recommendations for testing, and treatment alternatives are a competitive intervention associated with effective implications in a real-world setting.

Некоторые эпидемиологические аспекты инфекций мочевыводящих путей на примере крупных стационаров Алтайского края

Urinary tract infections (UTIs) are among the most common infectious diseases in outpatient and inpatient practice. to analyze some epidemiological aspects of UTIs in large hospitals of the Altai Territory (AK) for 2007-2017 yy. a retrospective analysis of UTI incidence, including acute and chronic pyelonephritis, acute and chronic cystitis in the AK for 2007-2017, as well as in large medical organizations (MO) AK (KGBUZ "Altai regional hospital for war veterans" and KGBUZ. "Regional clinical hospital") was done. The main uropathogens in patients who were treated in the MO of AK were determined and the sensitivity of isolated microorganisms to antimicrobial drugs and disinfectants was analyzed. a knowledge of the modern structure of uropathogens and systematic analysis of their sensitivity to antimicrobial drugs is of outmost practical importance and ensures a timely and individualized approach to the empirical antibiotic therapy even before the results of urine culture are known as well as allows to select proper disinfectants in the MO.