Care For Medical Conditions Research Articles

Issues of Readiness of Nursing Personnel to Provide Medical Care in Conditions of Mass Admission of Victims in Emergency Situations to Medical Organizations

Issues of Readiness of Nursing Personnel to Provide Medical Care in Conditions of Mass Admission of Victims in Emergency Situations to Medical Organizations

THE START SORTING SYSTEM AND THE NURSE’S PARTICIPATION IN ITS IMPLEMENTATION

Introduction. This article highlights the problem of organizing the sorting of patients during mass admission to medical institutions and providing emergency medical care. The role of the nurse in conducting triage and providing emergency care at the early hospital stage is within the framework of limited resources. The urgency of working out the response protocol in the event of an emergency. The aim of the study – to determine the role of the nurse in the triage and provision of emergency care at the early hospital stage within the framework of a limited resource. To establish the relevance of the use of the START medical triage system in the practical activities of a nurse. The relevance of working out the response protocol in the event of an emergency among nurses. The main part. The medical triage system START (Simple Triage and Rapid Treatment) is an effective tool for organizing and accelerating the process of correct routing of patients in mass cases and crises when resources are limited and medical needs are high. Medical triage criteria also include signs of primary medical examination. As their professional responsibilities expand, nurses can use the ABCD algorithm to assess the patient’s condition. Knowledge of the principles of this medical triage system, the ability to provide emergency medical care, evenly and effectively distribute resources, follow the instructions of the coordinating physician, describe medical documentation, and label the patient’s category have become the duties of nurses due to the increasing frequency of emergencies. Conclusions. The START (Simple Triage and Rapid Treatment) triage system is used for prompt and efficient selection of victims during emergencies. The role of the nurse in this process is extremely important. First of all, the nurse must have skills in the application of the START triage technique and an understanding of its basics. During triage, the nurse can quickly assess the condition of each victim, determine the category, and assign the appropriate color tag. Provision of emergency medical care in conditions of limited resources, coordination, and reporting for further organization of medical care are key elements in the formation of nursing competence during triage. Using the principles of medical triage can help optimize treatment and save more lives in emergencies.

Organization of the specialized medical care in conditions of limited resources (military status) (on the example of the provision of nephrology aid in Ukraine)

The paper considers the features of the provision of pediatric and adult nephrology medical care during martial law in Ukraine from February 2022 to May 2023. The influence of military stages on the nephrology care are presented, territorial zones during the conflict are highlighted, event tracks are shown. Separately, the activity of the Ukrainian Association of Nephrologists/Ukrainian Association of Pediatric Nephrologists, new opportunities for integrating nephrology into the system of medical knowledge are considered. Along with the negative trends, positive results were revealed that made it possible to move forward in the system of specialized medical care, namely an increase in transplant activity, a wider use of “long” treatment regimens with rituximab, and the use of digital kidney biopsy. Statistical data, SWOT analysis at the stages of the military conflict are given, an analysis is presented for refugees who left for the European Union to receive kidney replacement therapy. The enormous role of humanitarian programs for maintaining the structure of nephrological care in Ukraine is emphasized. The accumulated experience is unique and can serve as material for the analysis of similar situations in the world in the future.

Организация оказания медицинской помощи пострадавшим при чрезвычайных ситуациях в лечебных медицинских организациях Федерального медико-биологического агентства. Сообщение 1

Summary. The aim of the study is to examine and to analyze infrastructure of medical treatment organizations of the Federal Medical and Biological Agency (FMBA of Russia) in relation to their preparedness to deal with the most likely emergency situations in the facilities and territories served by FMBA of Russia. Materials and research methods. The subject of the study is the system of medical treatment organizations of FMBA of Russia, their capabilities to provide medical care to victims in various emergencies at facilities and territories served by FMBA of Russia. The objects of the study are structure of regular beds in medical treatment organizations, staffing of their departments with medical specialists and a number of other indicators. The division of medical treatment organizations into levels was made irrespective of their location and without reference to federal districts. Linking the conditions of medical treatment organizations functioning to the specifics of the enterprise or territory served, was not carried out. Analytical, sociological (method of expert evaluation) and statistical research methods were used during the study. The materials of the study are Federal Laws, Resolutions of the Government of the Russian Federation, regulatory and methodological documents of FMBA of Russia, as well as scientific publications on the topic of the study. A card containing 75 questions and 187 sub-questions was developed to survey the state of infrastructure and capabilities of medical treatment organizations of FMBA of Russia to provide medical assistance and medical evacuation of patients and victims in emergencies. Results of the study and their analysis. We studied and analyzed 66 cards submitted by the surveyed medical treatment organizations, whose share in the total number of medical treatment organizations administered by the Russian Federal Medical and Biological Agency was 47%. In 16 medical treatment organizations (22.6%) there were no documents regulating their activities in preparation for work to eliminate medical and sanitary consequences of emergencies, which indicates a low level of preparedness of these organizations. The number of beds deployed in the specialized departments of medical treatment organizations of all levels corresponded to the staff list. Additional beds for providing medical care to patients and victims of emergencies can be deployed according to the profiles for which medical treatment organization is specialized for. In some medical treatment organizations it is planned to increase the bed fund by 2-4 times in case of mass admission of patients and victims in emergencies. Medical specialists in almost all organizations are not fully staffed — in day-to-day activities their deficit is compensated by the increased load on working specialists. If it is necessary to provide medical care in conditions of mass influx of patients and victims of emergencies, this situation will lead to an increase in time for triage and for therapeutic and diagnostic activities, as well as to a significant reduction in volume of medical care provided.

COVID-19 impact on hospitalization outcomes of patients with circulatory system diseases

Background: The study is devoted to the impact of a new coronavirus infection in combination with other diseases on the hospitalization outcomes. Features of mortality in the population during COVID-19 pandemic, including from blood circulatory system diseases, have been studied. However, there are few studies based on the large amount of data on the cases and outcomes of providing specialized hightech medical care to patients with cardiovascular diseases (CVD) and concomitant diagnosis of COVID-19.Objective: The analysis of impact of a new coronavirus infection on the outcomes of hospitalization for circulatory system diseases.Material and methods: Information about more than 350 thousand cases of hospitalization of patients with blood circulatory system diseases in the context of the COVID-19 pandemic has been analyzed, of which in 1875 cases a concomitant diagnosis of COVID-19 was established. The sources of information are the depersonalized registers of compulsory health insurance accounts. For assessment of the obtained data methods of descriptive statistics, simple (unweighted) arithmetic mean values, mean values, specific weights of indicator values, a mean square (standard) deviation from mean values were used. The analysis and descriptive part of the work were carried out by means of the Microsoft Excel spreadsheet software package.Results: The outcomes of hospitalization of patients with suspected or confirmed diagnosis of COVID-19 were significantly worse than in other patients. Moreover, the frequency of lethal outcomes increases significantly in correlation with the age of patients and does not depend on the choice of treatment method – surgical or therapeutic.Conclusion: COVID-19 significantly complicates provision of medical care in conditions of the round-the-clock hospital for blood circulatory system diseases. The risks of surgical interventions for circulatory system diseases in combination with COVID-19 are as high as with the use of therapeutic technologies. It is necessary to unify the indications and contraindications to surgical treatment of conditions related to acute coronary syndrome in cases of the presence of such concomitant pathology as COVID-19.

Anxiety in healthcare workers during the COVID-19 pandemic

Aim to study the manifestation of situational anxiety symptoms in medical personnel working on the front lines with patients with COVID-19, and medical personnel working in other areas of medicine, in the context of the coronavirus pandemic.
 Material and methods. The survey and analysis were conducted among the following groups: Group 1 medical workers of COVID-19 specialty hospitals providing medical care to patients with COVID-19 (n=201); Group 2 medical workers of multidisciplinary hospitals providing medical care in their main profile, working in the "normal mode" and periodically identifying patients with the disease of the new coronavirus infection COVID-19 (n=195); Group 3 outpatient medical workers providing medical care in conditions of an increased epidemic threshold for SARS, influenza and a new coronavirus infection COVID-19 (n=186). The control group included employees of engineering, technical and economic specialties, not related to the work in medical organizations (healthy). To study the components of situational anxiety in medical workers, the methodology "Use of the Integrative Anxiety Test (ITT)" was used.
 Results. For all components, the indicators were significantly higher in the group of medical workers of COVID-19 hospitals compared to other groups. Among healthcare workers in COVID-19 hospitals, the index of "alarming assessment of prospects" prevails. In medical workers of multidisciplinary hospitals, the "asthenic component" indicator prevails. Among outpatient medical workers, the "phobic component" indicator prevails.

Integrative level of anxiety in medical workers during the COVID-19 pandemic

The integrative level of anxiety in medical workers during the COVID-19 pandemic has been analyzed. The purpose of the study is to investigate the features of the manifestation of situational anxiety in medical personnel working on the front line with COVID-19 patients and in those working in other areas of medicine during the coronavirus pandemic. Research methods: to study the components of situational anxiety in medical personnel, the methodology «Application of an Integrative Anxiety Test» was used. Research results. Among medical workers of COVID hospitals providing medical care to patients with COVID-19, the «alarming outlook assessment» indicator prevails. The medical workers of hospitals providing medical care in their main profile, working in the «usual mode» and periodically identifying patients with the novel coronavirus infection COVID-19, are dominated by the «asthenic component» indicator. In outpatient medical workers providing medical care in conditions of an increased epidemic threshold for SARS, influenza and the novel coronavirus infection COVID-19, the «phobic component» indicator prevails.

The development of organization of population medical care in conditions of digitization of public health.

The article discusses two main problems of organizing medical care in national health care of Russia: medical and social monitoring of morbidity and mortality; key performance indices of public health in the Russian Federation. Methodologically, the article is based on interdisciplinary scientific approach that allows to study medical, social and economic components of public health, considering observed trends: digitalization of health care and epidemic of new coronavirus infection. Based on statistical analysis of open data on morbidity and mortality of population in the Russian Federation over past few years, results were obtained indicating that collection of medical statistics is not built consistently that medical care in health care is not organized sequentially as cycle or process, but is presented in fragments. This leads to the fact that rural population has very limited access to multidisciplinary and high-tech medical services, and in structure of mortality there is high gender bias (males die more often than females in same classes of causes). Based on identified problems, two organizing solutions are proposed. The first solution is to create, on the basis of the Ministry of Health Care of Russia, special portal for complete, reliable and up-to-date medical statistics, which will be generated and processed using Big Data technologies. The second solution consists in transition from fragmentation to systematic organization of medical care in the "education and prevention-treatment-rehabilitation" continuum, while for each stage special set of key performance indices is established that allows to solve the tasks of improving public health, but also to develop harmonized social and economic public policy.

Medical workers during the pandemic of the new coronavirus infection COVID-19 and risk factors for professional burnou

The article presents the results of a questionnaire survey of medical workers. The questionnaire allows you to assess the attitude of medical workers to the situation related to the new coronavirus infection. A survey was conducted of 186 outpatient medical workers providing medical care in conditions of an increased epidemic threshold for ARVI, influenza and the new coronavirus infection COVID-19 aged 25 to 64 years and 195 medical workers of hospitals providing medical care in their main profile, working as usual and periodically identifying patients with COVID-19 between the ages of 25 and 64. The data obtained indicate the emergence of new factors associated with the new coronavirus infection, which may affect the «emotional burnout» in medical workers.

Анализ качества оказания медицинской помощи в специализированной офтальмологической клинике в условиях пандемии новой коронавирусной инфекции COVID-19

The purpose of article was to study quality of planned medical care in conditions of reprofiling around the clock inpatient care into outpatients care in the Khabarovsk branch of the Eye Microsurgery Federal State Institution (the Khabarovsk branch) during pandemic of the novel coronavirus disease COVID-19. Due to unfavorable epidemic situation in the world and high risk of transmission of infection to patients and medical staff, the Khabarovsk branch was re-profiled from around the clock inpatient care into outpatients care. This form of specialized ophthalmic care has proven to be in high demand. It contributes to increasing the availability of planned specialized care. The percentage of complications from treatment performed predominantly in a day hospital (0.3% in 2021) does not exceed the number of complications from treatment performed in around the clock inpatient care before the COVID-19 pandemic. Practice has shown that in order to minimize the risks of complications during treatment in outpatients care hospital, a more thorough approach to patient preparation is required. Keywords: number of hospital beds, around the clock inpatient care, outpatients care, complications, re-profiling of hospital.

Principles of care for adolescent girls with eating disorders and body disturbances disorders: lessons from the COVID-19 pandemic

The pandemic of the new coronavirus infection (COVID-19) has contributed to an increase in problems related to eating behavior and body image in the population. Various risk factors that have become relevant due to changes in the usual lifestyle have significantly affected the frequency of eating disorders in the adolescent population. This necessitated the adapting of new strategies for providing medical care in conditions of limited personal contact.The aim of the work is the methodological substantiation and systematization of modern approaches to the prevention and treatment of eating disorders, body image disorders and risk factors associated with them in adolescents in the conditions of the COVID-19 pandemic.Materials and methods. The methodological basis of the work is a comprehensive analysis of modern medical and social approaches and recommendations on the organization of assistance to adolescents with eating disorders and body image disorders, with a description of personal experience of using various interventions on an outpatient basis during the pandemic.Results: Prevention and treatment of eating disorders and body image disorders in adolescents during the pandemic should be aimed at specific risk factors those have proved to be the most relevant in connection with restrictive measures: involvement in body image-related social media content and active use of the media; reduction of physical activity with simultaneous increase in access to food; social isolation and reduction of social support; restriction of access to qualified care. The most reasonable approaches during the pandemic are the approaches focused on the family of a teenager using, if possible, remote forms of assistance.Conclusions: Currently, there are no norms and standards in the organization of assistance to adolescents with eating disorders and body image disorders in the pandemic context. However, the analysis of the implemented approaches aimed at various risk factors of these disorders will allow the use of the most effective preventive and therapeutic practices in the future.

Theory of hibernament ensembles and the possibility of its use to ensure life activity for extremal impacts

The possibility of efficient use of the theory of hibernation ensembles to ensure vital activity in extreme conditions is considered. Hibernation ensembles are strictly selected sets of tools, among which are special combinations of pharmacological preparations and hypostabilizers, respiratory mixtures different in gas composition, controlled hypothermia, etc., which, when coordinated, cause the formation of a special state of the body, referred to as «hypobiosis and cryobiosis» or artificial hibernation. The data of experimental studies on changes in the body’s resistance to the extreme effects of gamma radiation, to acute hypobaric hypoxia and to flight overloads under conditions of artificially induced hibernation are generalized to determine the possibility of using the theory of hibernation ensembles while ensuring vital activity under extreme influences. It is shown that under the influence of vegetotropic agents against the background of hypothermia, the metabolic processes slow down significantly and the organism of warm-blooded animals begins to acquire ambient temperature. The condition that occurs in this case is accompanied by an increase in the body’s resistance to extreme factors, such as acute hypobaric hypoxia, deep hypothermia, exposure to ionizing radiation, toxic lesions, massive blood loss, pain shock, etc. This area of research is of particular relevance for the development of methods for long-term life support person in extreme conditions, with severe injuries and in the provision of medical care in conditions of mass admission victims, since it provides a reserve of time necessary for organizing the safe transportation of victims to the places of specialized and high-tech medical care, that is, actually providing medical care at a later date.

Medical Assistance to Migrants on their Way to Siberia in 1906—1914

The issue of the activity of the system of medical and paramedic travel migrant station in Siberia during the Stolypin agrarian reform is considered in the article. The author has made a general review of the historiography of the issue, showing its insufficient study and controversial nature. The object of the research is medical assistance to peasants-migrants in 1906-1914. Legislative and regulatory sources on the sanitary legislation of Russia at the beginning of the XX century are analyzed. It is concluded that the system of measures developed by the state was designed to prevent the spread of epidemics by migrants to areas of agrarian colonization. The reasons that impeded the effective operation of this system were identified. It is proved that, despite the existing shortcomings, during the period of the Stolypin resettlements, the state as a whole was able to cope with the provision of medical care to the migrants during their travelling. The author comes to the conclusion about the social nature of medical assistance to migrants. The relevance of the work is due to the need to use historical experience both in the field of state regulation of migration processes and in the provision of medical care in conditions of increased epidemiological danger. The importance of research on this topic is determined, firstly, by the growth in the dynamics of migration processes in the modern world; secondly, the relevance of using the historical experience of providing medical care to migrants in a pandemic.

Termination in integrated primary care behavioral health.

Termination with patients in integrated primary care behavioral health (IPCBH) is driven by elements that are present in other psychotherapies but more strongly emphasized under the primary care model. All treatments are, by design, time limited, and require transparent communication and almost immediate preparation for termination. Because treatment occurs within a primary care relationship, however, termination conveys a different message than it does in other settings-the conclusion of an episode, but not of a treatment relationship. As with primary care for medical conditions, the expectation is that the patient may return to treatment in the future to address new problems or recurrence of the previously treated condition, possibly making the brevity of treatment episodes more acceptable. This article discusses the process of termination in IPCBH and indicates with a case example how conversations around termination evolve throughout the brief treatment process. Suggestions for addressing termination in IPCBH are adapted from the literature on termination in more traditional psychotherapies. There is currently no published research on termination in the IPCBH setting, and research is needed to clarify how termination discussions affect treatment outcomes and patient satisfaction. As IPCBH models become more common, the meaning of termination in psychotherapy may change, with decreasing emphasis on the dyadic relationship of an individual therapist and patient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

On methods of evaluation and calculation of production potential of medical organization providing specialized medical care in conditions of around-the-clock hospital

The article presents basic methods of assessing and calculating production potential of medical organization. providing specialized medical care in round-the-clock hospital. The described techniques are used to develop standards of provision of medical care as part of territorial program of state guarantees of free medical care for citizens and to improve organizational processes of provision of medical car that allows to more efficiently apply available resources of medical organization.

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

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

Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

The Medical Care of Patients with Chronic Dermatitis in Conditions of General Medical Practice

The morbidity of chronic dermatitis continues to be permanently high in Russia, Europe and USA. the development of dermatitis is impacted by heredity, diseases of internal organs, environment. The medical social significance of dermatitis is high. The exacerbation of this disease results in deterioration of life quality of patients, emotional stress, decreasing of working capacity. Besides, special target financial expenses are required too. The interaction between primary medical care physicians and dermatologists plays significant role in treatment of dermatitis. To increase quality of medical care to patients with chronic dermatitis development and amelioration is needed concerning new models and principles of organization of treatment and diagnostic processes in the system of out-patient medical care in conditions of development of medical practice. The results of sociological survey of general practitioners were used to evaluate completeness of physicians implementing their function during management of patients with skin diseases. more than a half of physicians always prescribe to patients' examination prior to referral to dermatologist and one third of physicians always independently prescribe a treatment. Only one third of respondents declare confidence in independent diagnostic and treatment of patients with skin diseases. At that, more than two third of physicians being uncertain in diagnostic and treatment of patients, nevertheless are engaged in that. Therefore, nowadays general practitioners incompletely implement their functions in case of visit of patients with skin diseases.

Некоторые актуальные кадровые вопросы в период структурных изменений в амбулаторно-консультативном отделении крупной городской больницы

The purpose of this article was the analysis of some personnel problems during the period of
 structural changes in the outpatient consulting department of a large urban hospital. For the analysis of the statistical
 indicators, the followings methods were used: historical, sociological, statistical, mathematical, regulatory,
 timing method. The results show that the structural changes in the outpatient consulting department will inevitably
 lead to increased staff turnover, to reduce the indicators in staffing levels. This can reduce the quality and
 availability of medical care. Large medical institution is able to rapidly adapt to some transformations due to the
 greater amount of resources and opportunities.
 Conclusion. To improve the quality and accessibility of medical care in conditions of financing deficiency,
 an organization of specialized outpatient care is more appropriate in the outpatient consulting department,
 which is part of a multiprofile hospital.

Social and Economic Impact of Epilepsy on Nigerian Women (P01.048)

Objective: To determine the social and economic impact of epilepsy on Nigerian women. Background Previous reports indicated that women with epilepsy (WWE) experienced stigma and social marginalization than men with epilepsy or non-disabled women. We sought to assess the social and economic impact of epilepsy on Nigerian women. Design/Methods: The study is a cross-sectional survey of 63 WWE and 69 age - matched women who seek care for medical conditions that were not associated with epilepsy or stigma. A structured questionnaire was verbally administered to all the participants and information on demographic characteristics, education, employment status, housing and environmental quality, food security, health care use, personal safety and perceived stigma were obtained. The data was collated and analyzed with the did of SPSS 15.0 software (Chicago IL) Results: The WWE have fewer years of formal education than the control subjects (p 0.05). Physical abuse, sexual abuse and transactional sex were not uncommon among the WWE. WWE also had a high mean perceived stigma score. Conclusions: WWE have poorer social and economic status than women with non-stigmatized medical conditions. There is also reduced personal safety and high perceived stigma among WWE in this study. Disclosure: Dr. Sunmonu has nothing to disclose. Dr. Komolafe has nothing to disclose. Dr. Fabusiwa has nothing to disclose. Dr. Afolabi has nothing to disclose. Dr. Komolafe has nothing to disclose.