Multidisciplinary Hospital Research Articles

The burden of a new coronavirus infection in a Children’s multidisciplinary hospital in St. Petersburg 2020–2021

Objective: To describe the burden of COVID-19 in a children’s multidisciplinary hospital for two years of the pandemic, taking into account of age, severity of the disease, the spectrum of underlying conditions and the intensive care need.Methods: An assessment of 6048 cases of COVID-19 in patients under 18 years of age hospitalized from March 26, 2020 to December 31, 2021 was carried out. The diagnosis was confirmed by PCR on an outpatient basis or after hospitalization with the help of diagnostic kits registered in the Russian Federation. The features of the work of a children’s multidisciplinary hospital in new conditions, the dynamics of hospitalization, age characteristics and new coronavirus (CV) infection severity in the pandemic development process are presented. The analysis of the underlying condition’s structure depending on the severity of the disease, as well as the need and volume of therapy in the intensive care unit. The frequency and main characteristics of children’s multisystem inflammatory syndrome (MIS-C) in hospital conditions, long-term PCR positivity and its effect on the duration of inpatient treatment of children have been established.Results: The spread of SARS-COV-2 in St. Petersburg required a radical change in the work of the children’s multidisciplinary hospital. During the two years of the pandemic, four waves of hospitalization of children with new CV were revealed, differing in duration, intensity, and frequency of lung damage, but having no significant differences in the proportion of severe forms of the disease (1.7-2.8% of cases). Intensive therapy was required in 3.6% of cases, of which only 1/3 was due to the severe course of COVID-19 with a lung lesion volume of up to 100%. In 1/3 of cases, patients had risks of developing severe forms and in 1/3 – other pathology. Severe course of new CV was significantly more often accompanied by the need for respiratory support, anticoagulants and anti-inflammatory therapy. Contributing factors of severe forms and unfavorable outcomes were: pathology of the central nervous system, genetic diseases and malformations, obesity, as well as chronic bronchopulmonary pathology. Mortality in the hospital was recorded only among children with severe underlying conditions (0.1% of cases). D-MVS was registered significantly more often in boys (7 out of every 10 patients), accounting for 1.2% of cases of hospitalization of children with new CV over the entire period. Convalescent PCR-positivity in the outcome of COVID-19 was detected in 1/3 of children, significantly more often during the autumnwinter waves of the pandemic and among patients of high school age.Conclusion: New CV is gradually strengthening its position in the structure of acute respiratory pathology in children. Some of SARS-COV-2 infection cases is accompanied by extensive lung damage, as well as severe systemic inflammation independently or in the other infectious diseases structure, induction of the debut of various somatic pathology is not excluded. The presented data confirm the need for increased attention at high risk of adverse respiratory diseases outcomes children. All severe cases of COVID-19 in children require a personalized approach, taking into account the existing background diseases and possible options for the progression of the process. MIS-C should be considered as a systemic inflammatory response syndrome within the framework of an infectious disease of various etiologies, differentiated with Kawasaki disease and the debut of systemic diseases. The long-term PCR-positivity in the outcome of COVID-19 requires further study to address the need and nature of therapy in order to prevent further spread of infection in the population.

Development of a quality assessment tool for pharmacy and therapeutics committees and subsequent pilot testing

Pharmacy and therapeutics committees (PTCs) are multidisciplinary hospital teams responsible for rational medication use. We aimed at developing and piloting an assessment tool for their operating quality.We conducted a scoping...

Evaluation of hemostasis clinical and laboratory indicators of patients with stroke and coronavirus infection (COVID-19) on the basis of a multidisciplinary hospital in the period of its conversion to an infectious diseases hospital

Introduction. The COVID-19 impact on hemostasis of stroke survivors with community-acquired pneumonia is an urgent problem. The aim of the study is to analyze the features of clinical and laboratory parameters in cerebral stroke combined with community-acquired pneumonia caused by the SARS-Co-V-2 virus. Materials and methods. The instrumental and laboratory examination results of 88 patients aged 73.0 (12.3) years in the acute period of stroke with community-acquired viral pneumonia symptoms were analyzed. The present study included 39.8 % (n=53) male and 60.2 % female (n=35) with duration of diagnosed infectious disease less than 7 days. The symptoms of cerebral stroke were compared with the results of laboratory testing of the hemostasis system, lipid metabolism, and the activity of the systemic inflammatory response. The severity of lung tissue damage and the outcomes of the diagnosed changes were assessed. Results. All patients had mild or moderate COVID-19. In 87.5 % (n=77) cases unspecified (40.2 %, n=31), cardioembolic (36.4 %, n=28), lacunar (3.9 %, n=3) and atherothrombotic (19.5 %, n=15) ischemic stroke subtype was diagnosed. Focal ischemia lesion in the left middle cerebral artery (LMCA) territory was detected in 45.6 % (n=35), in the right middle cerebral artery (RMCA) territory in 41.6 % (n=32). Manifestations of hemorrhagic stroke were noted in 12.5 % (n=11) with signs of parenchymal hemorrhage in 54.5 % (n=6), ventricular hemorrhage in 27.3 % (n=3), subarachnoid hemorrhages were noted in 18.2 % (n=2). The indicators of the coagulation system in terms of the number of platelets corresponded to 251.3 (90.7); the APTT value was in the range of 29.2 (26.7 33.0) (s); the INR parameter was 1.16 (1.05 1.25); the value of prothrombin ( %) corresponded to the value of 85.9(23.4). Conclusion. We do not observe the great disorders of haemostasis in the most acute period of the stroke. When combined with COVID-19 the most common stroke is ischemic stroke. The stroke survivors with the community-acquired pneumonia caused by SARS-CoV-2 laboratory tests show that increase of inflammatory markers are above the reference range.

Resolution of HCM phenotype and CHF following CMOP protocol in a cat with large cell lymphoma and suspected cardiac involvement

AbstractA 10‐year‐old female desexed domestic shorthair cat was diagnosed by the regular veterinarian with large cell splenic lymphoma in June 2020. A splenectomy was performed; however, complications postoperatively and the owner's willingness to pursue chemotherapy resulted in the patient being referred to the oncology department of a local multidisciplinary specialist hospital. At referral, a hypertrophic cardiomyopathy (HCM) phenotype was diagnosed post an episode of dyspnea. The patient was treated with CMOP (cyclophosphamide, mitoxantrone, vincristine and prednisone) chemotherapy, resulting in remission of the lymphoma and the HCM phenotype. Twenty‐one months out from treatment, the patient was still in remission with no evidence of heart disease.

Organization of accelerated recovery and early rehabilitation of surgical patients within the framework of the service of anesthesiology and resuscitation: literature review

Accelerated recovery after surgery, according to publications, has been developed since 1980 and is a multimodal strategy aimed at reducing the physiological response to surgical trauma, rapid recovery and early discharge of the patient. This study aimed to analyze the feasibility of introducing a methodology for accelerated recovery of the patient after surgery and early discharge from the surgical hospital. A study of the literature and formulation of a theoretical algorithm for the implementation of the process of accelerated recovery after surgery or fast track. According to publications, accelerated recovery from surgery has been developed since 1980 and is a multimodal strategy intended to reduce the physiological response to surgical trauma and accelerating recovery and early discharge of the patient. This concept consists of scientifically based approaches to the perioperative and postoperative management of surgical patients and represents a radical revision of the established traditional approach. Solving organizational issues of implementing the fast track concept in multidisciplinary hospitals in our country is a key factor toward wider dissemination and implementation of accelerated recovery after surgery.

Features of the organization of medical care for patients with skin cancer using radiation therapy

BACKGROUND:Malignant skin diseases occupy the 2ndplace in the frequency of prevalence after breast cancer. Basal cell carcinoma of the skin (basal cell carcinoma of the skin) is most often diagnosed, its share is 6080% of all malignant skin diseases. Squamous cell skin cancer is much less common and accounts for 1825%. The annual increase in cancer incidence with localization of the process on the skin is from 3 to 10%.
 AIM: This study aimed to investigate the features of the organization of medical care for patients with skin cancer using radiation therapy in Moscow and to develop recommendations for its improvement.
 MATERIALS AND METHODS: Analysis of the results of treatment with short-focus radiation therapy of 461 patients with skin cancer in a large multidisciplinary hospital was carried out.
 RESULTS: The health status of patients with skin cancer was studied, in which 88.0% of cases had basal cell skin cancer, and 12.0% had squamous cell skin cancer; 90.1% of these patients were over 50 yr old. Medical care was provided in the radiotherapy department. The condition of patients after a course of short-focus radiation therapy allowed to obtain a positive cosmetic effect, and relapses occurred in 3.0% of patients. Measures have been identified to improve the organization of medical care for patients with skin cancer and to improve the quality of treatment results.
 CONCLUSION: The most effective strategy for the treatment of skin cancer with the best cosmetic result is to accelerate the process of determining treatment methods before the start of radiation therapy and conducting short-focus radiation therapy four times a week.

Pharmacotherapy in a Multidisciplinary Paediatric Hospital: Polypharmacy and Drug–Drug Interaction Risk Illustrated with a Clinical Case

Nowadays, the problems caused by polypharmacy are recognised and widely discussed in the medical community. Multimorbidity, which is not uncommon in paediatric practice, comes with an increase in the number of prescriptions and necessitates an active search for tools to reduce the potential risk and frequency of adverse drug–drug interactions in paediatric patients.The aim of the study was to use a clinical case to illustrate the need for monitoring, including laboratory monitoring of pharmacokinetic parameters, during concomitant therapy in paediatric practice.Materials and methods: the study consisted in a retrospective analysis of the archived medical records of an 11-year-old child with nephrotic syndrome associated with a concomitant tuberculous process who had been receiving inpatient treatment with immunosuppressants at the Russian Children’s Clinical Hospital from May to July 2018.Results: the prescription of cyclosporine for nephrotic syndrome entailed monitoring of plasma drug levels for potential pharmacokinetic interactions with the medicinal products used to treat the concomitant disease. The monitoring revealed an interaction between cyclosporine and rifampicin at the level of biotransformation. An adjustment of the concomitant therapy (discontinuation of rifampicin) allowed for achieving the target blood cyclosporine concentration, decreasing proteinuria and hypercholesterolemia, and increasing the blood total protein level in the child, which indicated the effectiveness of the ongoing treatment for the chief complaint.Conclusions: the data obtained suggest that laboratory monitoring of pharmacokinetic parameters in paediatric polypharmacy can increase the effectiveness of therapy and prevent adverse reactions and irrational combination of medicinal products.

Novel coronavirus pandemic and burnout of healthcare workers

Introduction. The novel coronavirus pandemic has a serious impact on the psychological health of healthcare workers. The purpose of the study is to investigate the syndrome of emotional burnout among medical workers. Materials and methods. Groups of medical workers in COVID hospitals (n=201), groups of medical workers in multidisciplinary hospitals (n=195), groups of outpatient medical workers (n=186), as well as a control group (n=190) were studied. Results. According to the Maslach Burnout test, group of medical workers of COVID-hospitals; a group of medical workers of the outpatient level a group of medical workers of multidisciplinary hospitals who provide medical care in their main profile have a significant increase in the indicators of “exhaustion” and “depersonalization” and a significant decrease in the indicator “reduction of personal achievements” compared with the control group. Medical workers of COVID-hospitals have significantly higher indicators of “emotional exhaustion” and “depersonalization” compared to medical workers of multidisciplinary hospitals (p≤0.001) and medical workers of outpatient clinics (p≤0.001). Medical workers in COVID hospitals have a significantly lower indicator of “reduction in personal achievements” compared to medical workers in general hospitals and outpatient clinics (p≤0.001). Limitations. As limitations, the following were identified: assessment of the dynamics of the burnout syndrome in future employees of COVID-hospitals, outpatient clinics and inpatients in the course of increasing seniority rises; assessment of the dynamics of the burnout syndrome in future specialists of COVID hospitals, outpatient clinics and hospitals, depending on the ongoing psychological and pharmacological correction. Conclusions. A comparative assessment revealed medical workers in COVID hospitals to have significantly higher rates of “emotional exhaustion”, “depersonalization” and lower values of the indicator “reduction of personal achievements”, compared with medical workers of multidisciplinary hospitals and outpatient clinics.

Индекс лекарственной устойчивости как критерий эффективности внедрения стратегии контроля антимикробной терапии

To assess the changes in the drug resistance index (DRI), a composite measure that combines the level of resistance of individual pathogens with the extent of antimicrobial drugs consumption in a multidisciplinary hospital, after implementation of the antimicrobial stewardship program (AMSP) and during COVID-19 pandemic.

Assessment of Microbiological Environment and the Level of Antibiotic Resistance in a Multidisciplinary Hospital

The objective: to determine the incidence and drug sensitivity of the main pathogens causing community-acquired and nosocomial infections in patients staying in a multidisciplinary hospital.Subjects and Methods: a retrospective study of the microbiological population in patients of a multidisciplinary hospital was carried out. The period over 3 years was assessed. 3,954 samples of biological materials from various sites were studied.Results: gram-positive bacteria prevailed in the general structure of microbial environment of patients – Staphylococcus aureus (28%), and Enterococcus faecalis (10%), as well as gram-negative – Escherichia coli (26%), and Klebsiella pneumoniae (13%). The majority of non-fermenting gram-negative microorganisms isolated from patients in the intensive care unit demonstrated multiple resistance and quantitatively prevailed over those in surgery units. The spectrum of antibiotic susceptibility of microorganisms of the same species isolated from patients of therapy and surgery departments differed.

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.

O11 - A Vision for Women

To provide a contemporary, evidence based and consumer driven maternity service that ensures each woman achieves her optimal outcome. Australian healthcare services measure the quality of their maternity care via clinical outcomes e.g. Perinatal statistics, Healthcare Acquired Conditions (HAC’s) and Clinical Indicators. The increasingly broad variation in maternal demographics between health services Australia wide make accurate benchmarking difficult e.g. rates of obesity, assisted fertility, maternal age >35 years and poor education and socio economic status. A Tertiary maternity service in NSW reviewed how women Australia wide measure their healthcare during pregnancy, labour and birth. The search identified that the factors that are important to women do not correlate with the priorities of health care services. The maternity service responded by reviewing how it would provide maternity care through a different lens. Core business was no longer ‘4000 births’ per annum but became the creation of ‘4000 mothers’ per annum. The team ensured that the evidence based strategies that impact physical birth outcomes were in place and aligned with evidence e.g. models of care, medical and non-medical interventions and provision of information. However a new approach saw the hospital team aligned in their language, energy and actions when interacting with the woman. This approach brought a new philosophy and energy to the team, impacting the emotional outcome for each woman following her birth experience. Obstetric interventions have been increasing nationwide for a number of decades with no demonstrated improvement in outcomes and in some cases a deterioration e.g. increasing rates of postpartum haemorrhage. An alternate strategy was required that would engage both women, medical and midwifery clinicians and optimise each woman’s pregnancy and birth outcome. A multidisciplinary hospital team aligned in their vision and belief resulting in the creation of strong and confident mothers…. ‘this is the moment I dreamed about’.

Patients with Cardiac Implantable Electronic Device Undergoing Radiation Therapy: Insights from a Ten-Year Tertiary Center Experience.

Background: The number of patients with cardiac implantable electronic devices (CIEDs) receiving radiotherapy (RT) is increasing. The management of CIED-carriers undergoing RT is challenging and requires a collaborative multidisciplinary approach. Aim: The aim of the study is to report the real-world, ten-year experience of a tertiary multidisciplinary teaching hospital. Methods: We conducted an observational, real-world, retrospective, single-center study, enrolling all CIED-carriers who underwent RT at the San Raffaele University Hospital, between June 2010 and December 2021. All devices were MRI-conditional. The devices were programmed to an asynchronous pacing mode for patients who had an intrinsic heart rate of less than 40 beats per minute. An inhibited pacing mode was used for all other patients. All tachyarrhythmia device functions were temporarily disabled. After each RT session, the CIED were reprogrammed to the original settings. Outcomes included adverse events and changes in the variables that indicate lead and device functions. Results: Between June 2010 and December 2021, 107 patients were enrolled, among which 63 (58.9%) were pacemaker carriers and 44 (41.1%) were ICD carriers. Patients were subjected to a mean of 16.4 (±10.7) RT sessions. The most represented tumors in our cohort were prostate cancer (12; 11%), breast cancer (10; 9%) and lung cancer (28; 26%). No statistically significant changes in device parameters were recorded before and after radiotherapy. Generator failures, power-on resets, changes in pacing threshold or sensing requiring system revision or programming changes, battery depletions, pacing inhibitions and inappropriate therapies did not occur in our cohort of patients during a ten-year time span period. Atrial arrhythmias were recorded during RT session in 14 patients (13.1%) and ventricular arrhythmias were observed at device interrogation in 10 patients (9.9%). Conclusions: Changes in device parameters and arrhythmia occurrence were infrequent, and none resulted in a clinically significant adverse event.

Establishing midwife-led continuity of care interventions in perinatal mental health in high-risk pregnancies: a best practice implementation project.

The current best practice implementation project aimed to improve the quality of continuity of care and emotional well-being in women with high-risk pregnancies. Perinatal mental health disorders, such as perinatal depression and anxiety, are considered major health issues and are associated with poor maternal and neonatal outcomes. Women with high-risk pregnancies are considered a group of women with a substantial vulnerability and the value of continuity of care is vital in this group. The current project used the pre-post implementation clinical audit following the JBI Evidence Implementation framework. A baseline audit and a follow-up audit were conducted involving 120 high-risk pregnant women in a hospital's obstetric unit. An intervention was performed establishing a midwife consultation and a referral circuit for the different healthcare professionals. A screening was performed through several validated questionnaires. To reflect the continuum of care, three topics were selected, including antenatal psychosocial assessment, intrapartum care and postpartum depression assessment, with a total of 10 criteria. The baseline audit results showed 0% compliance in all the criteria since the proposed standards of care did not exist before the audit. After the implementation of the strategies, the compliance achieved 100% in all audit criteria. A multidisciplinary hospital guideline was established for standardized care and mental well-being care for high-risk pregnant women. Follow-up in the mental health of pregnant women is insufficient. Improving emotional well-being in pregnancy should be a target of clinical practice. More national and international guidelines to assess mental well-being during pregnancy and the postpartum period should be developed.

Management of community-acquired pneumonia in adults with type 2 diabetes mellitus in a multidisciplinary hospital

Community-acquired pneumonia (CAP) is a common acute infectious disease in adults. Diabetes mellitus (DM) increases the incidence of CAP and worsens the prognosis. In this regard, the assessment of the current practice of CAP management in patients with concomitant DM and its compliance with clinical guidelines is of great interest.Purpose. To study the current practice of CAP treatment in adult patients with concomitant type 2 DM in a multidisciplinary hospital and evaluate its compliance with the national clinical guidelines.Methods. A cross-sectional observational study was carried out in a pulmonology department of a republican clinical hospital. The study recruited adult patients with a confirmed diagnosis of CAP and previously diagnosed type 2 DM. For each case, demographic characteristics, the severity of CAP, the presence and nature of complications, systemic antibiotic therapy (ABT) and compliance with 16 quality indicators (QI) were recorded. The quality indicators described the adequacy of examination, treatment and secondary prevention of CAP in the presence of concomitant DM. QIs were chosen based on the national clinical guidelines for CAP and algorithms for specialized medical care for patients with DM.Results. Altogether, 48 patients with the average age of 63.9 ± 10.5 years were enrolled. 81% of patients had mild CAP. The severity criteria were assessed in 60% of the patients, prognosis – in 17% of the patients. X-ray examination, pulse oximetry and complete blood count were performed on time in 100% of the cases. A total of 19% of patients had a culture of respiratory specimens. A blood culture was performed in 11,11% of the cases of severe CAP (SCAP). Rapid urine tests for pneumococcal and legionella antigens have not been used. Glycemia was monitored daily in 27% of the patients. ABT was initiated on time in 100% of the patients.Conclusion. Low adherence to many QIs, insufficient control of glycemia and correction of sugar-lowering therapy in the treatment of hospitalized patients with CAP and concomitant type 2 DM were observed, which can worsen clinical outcomes.

Analysis of the structure of drug prescriptions in patients with arterial hypertension and atrial fibrillation in conditions of comorbidity and their compliance with the STOPP/START criteria

Background. Arterial hypertension (AH) is often associated with type 2 diabetes mellitus (DM2), is one of the leading modifiable risk factors for cardiovascular disease, atrial fibrillation (AF), chronic kidney disease (CKD). Progression of renal dysfunction is a powerful predictor of the onset of AF in patients with high blood pressure. Irrational prescription of drugs is a risk factor for adverse drug reactions, which is especially important for elderly patients and leads to an increased risk of adverse clinical outcomes.Objective. To analyze the concordance of pharmacotherapy with the STOPP/START criteria in comorbid elderly patients with AH and combined DM2, CKD and AF treated in a multidisciplinary hospitals.Design and methods. Included data from medical records of 1600 patients aged ≥ 65 years with AH and/or AF admitted to multidisciplinary hospitals in Moscow from July 1, 2018 to June 30, 2019. Patients were divided into two groups — (1) AH in combination with AF (n = 822, women — 73%, median age 87 [79; 90]) and (2) control group (n = 778, women — 79,9%, median age 78 [71; 85]) Evaluation of the appointment of drugs was made according to the “STOPP/START” criteria.Results. The number of patients who were not prescribed the recommended drugs was statistically significant (p < 0,001) and higher in the AH + AF group (785 people, 95,5%) compared to the control group (623 people, 80,1%). The number of patients who were prescribed potentially non-recommended drugs was similarly statistically significant (p < 0,001) higher in the AH + AF group (439, 53,4%) compared to the control group (328, 42,2%). The most common START criteria were: 1. Statins with a documented history of coronary, cerebral or peripheral vascular disease (in the AH + AF group — 672, 81,8% of the number of patients in the group; in the control group — 464, 59,6%; p < 0,001) 2. Clopidogrel in patients with ischemic stroke or a history of peripheral vascular disease (c respectively, 324, 39,4% and 237, 30,5%; p < 0,001) 3. Warfarin/direct oral anticoagulants in AF (in the group AG + FP — 294, 35,8%). The most common STOPP criteria were: 1. Drugs that can increase constipation in chronic constipation, if there is a more suitable alternative (in the AH + AF group — 160, 19,5% of the number of patients in the group; in the control group — 47,6%; p < 0,001). 2. Drugs with anticholinergic activity in chronic constipation (respectively, 111, 13,5% and 74, 9,5%; p = 0,013). 3. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with hyperkalemia (respectively, 26, 3,2 % and 94, 12,1%; p < 0,001). Similar results were obtained in the analysis of subgroups of AH + AF with concomitant DM2, CKD and without them.Conclusions. The results obtained dictate the need to optimize pharmacotherapy in elderly and very old patients with AH and comorbidities in a hospital setting. In practice, START criteria are more common than STOPP, that is, in reality, the necessary drugs are often not prescribed where they are indicated and drugs with an unfavorable safety profile are prescribed relatively rarely in elderly and senile patients.

Pre-sterilization cleaning of medical devices in central sterilization department of multidisciplinary hospital

The reprocessing of multiple-use medical devices (MD) is an integral part of anti-epidemic (preventive) measures aimed at interrupting the transmission routes of infectious diseases in the sterilization departments of medical organizations. One of the key issues in the treatment of medical devices is their pre-sterilization cleaning, carried out manually or mechanized. A number of factors affect the operation of washer disinfection machines (WD), related both to the WD itself and to the process of placing MD in them for processing. Disinfection of MD in WD in all cases, from the point of view of ISO standards, is preferable to chemical disinfection. Ultrasonic cleaning of simple medical products makes it possible to clean them effectively.

Pharmacoeconomic features of increased costs of direct-acting and oral anticoagulants in a multidisciplinary hospital in 2019–2021

The purpose of the work is to analyze the costs of direct-acting anticoagulants and oral anticoagulants from the total cost of medicines by years in a multidisciplinary hospital, as well as to calculate the cost of a daily prophylactic dose of drugs on the example of apixaban and sodium heparin.

Pharmacoeconomic features of increased costs of direct-acting and oral anticoagulants in a multidisciplinary hospital in 2019–2021

The purpose of the work is to analyze the costs of direct-acting anticoagulants and oral anticoagulants from the total cost of medicines by years in a multidisciplinary hospital, as well as to calculate the cost of a daily prophylactic dose of drugs on the example of apixaban and sodium heparin

Evaluation of the Efficacy and Safety of Initial Empirical Antibiotic Therapy for Community-Acquired Pneumonia in Middle-Aged People

β-lactam antibiotics, including cephalosporins, are the drugs of choice for empirical antibiotic therapy (ABT) in patients with community-acquired pneumonia. Unreasonable and irrational use of antibiotics leads to an increased risk of adverse reactions, contributes to the growth of antibiotic resistance.The aim of the study was to analyse data on the efficacy and safety of initial empirical ABT using cephalosporins for community-acquired pneumonia in middle-aged patients of multidisciplinary hospitals in Moscow.Materials and methods: the authors analysed 177 archived medical records of the patients admitted to three multidisciplinary hospitals (I.V. Davydovsky City Clinical Hospital, City Clinical Hospital 52 and City Clinical Hospital 4) in Moscow from 2017 to 2019 and prescribed mono- and/or combination therapy including a cephalosporin antibiotic as a starting therapy for community-acquired pneumonia. The initial ABT was considered effective if a patient’s body temperature normalised within 48–72 h following initiation of treatment and safe if no adverse reactions developed during the period of inpatient treatment.Results: the combination of ceftriaxone and azithromycin was the most frequently prescribed ABT regimen; its effectiveness was 71.9%. Ceftriaxone monotherapy was the second in frequency of prescription; its effectiveness amounted to 77.2%. The third regimen included cefotaxime and azithromycin and was effective in 70% of cases. The patients who needed a change in initial ABT had a significantly higher incidence of developing severe community-acquired pneumonia and complications. The study results indicate that the structure of comorbidity did not affect the effectiveness of initial empirical ABT. Streptococcus pneumoniae was found to be the most common causative agent of community-acquired pneumonia in the studied population (44.8% of cases). Only 13% of the patients faced adverse reactions associated with the use of antibiotics as part of the initial empirical ABT; the most common were leukopenia and diarrhoea.Сonclusions: the results of the study indicate the feasibility of mono- and/or combination ABT including a cephalosporin antibiotic as a starting empirical therapy for community-acquired pneumonia due to its effectiveness and favourable safety profile.