Multidisciplinary Hospital Research Articles

Inhalational anaesthetic agent consumption within a multidisciplinary veterinary teaching hospital: an environmental audit

Inhalational anaesthetic agents are routinely used in veterinary anaesthesia practices, yet their consumption contributes significantly to greenhouse gas emissions and environmental impact. We conducted a 55-day observational study at a veterinary teaching hospital in Switzerland, monitoring isoflurane and sevoflurane consumption across small, equine and farm animal clinics and analysed the resulting environmental impact. Results revealed that in total, 9.36 L of isoflurane and 1.27 L of sevoflurane were used to anaesthetise 409 animals across 1,489 h. Consumption rates varied among species, with small and farm animals ranging between 8.7 and 13 mL/h, while equine anaesthesia exhibited a higher rate, 41.2 mL/h. Corresponding to 7.36 tonnes of carbon dioxide equivalent in total environmental emissions or between 2.4 and 31.3 kg of carbon dioxide equivalent per hour. Comparison to human anaesthesia settings showed comparable consumption rates to small animals, suggesting shared environmental implications, albeit on a smaller scale. This research highlights the importance of continued evaluation of veterinary anaesthesia practices to balance patient safety with environmental stewardship; potential mitigation strategies are explored and discussed.

Technological Checklist for Kidney and Liver Transplantation in a Multidisciplinary Hospital. Clinical Protocol

This clinical protocol delineates the technological requirements for performing kidney and liver transplantation procedures in a multidisciplinary hospital setting. The protocol has been developed based on clinical guidelines from leading international societies and has been approved by the Samara Regional Branch of the Interregional Public Organization "Society of Transplantologists" (Protocol No. 11 dated July 1, 2024). It is recommended for use in assessing a hospital's readiness to implement transplantation programs. The technologies specified in the protocol may be implemented either through the hospital's own resources or via agreements with other healthcare institutions or through outsourcing arrangements.

Diversity of streptococcus species isolated in the departments of purulent surgery and coloproctology of a multidisciplinary hospital and their antibiotic resistance

Diversity of streptococcus species isolated in the departments of purulent surgery and coloproctology of a multidisciplinary hospital and their antibiotic resistance

New technologies for organizing the work of middle and junior medical personnel

The article presents new technologies for organizing the work of nursing and junior medical personnel in an infectious diseases hospital. Methods for freeing nurses from functions unusual for them are described, and changes in the content of the activities of a nurse interacting with other departments of a multidisciplinary hospital are given.

Venous thrombosis and embolism in surgical hospital patients in the conditions of the COVID-19 pandemic

Background. Venous thrombosis and embolism are one of the main and most threatening complications in emergency abdominal surgery in the conditions of global pandemic caused by the SARS-CoV-2, which is constantly worsening the morbidity and mortality rates. Despite the accumulation of sufficient knowledge on the problem of venous thromboembolism in general, understanding the unique prothrombotic pathophysiology of the virus and its potentiation of the coagulation system in patients with COVID-19 remains at a suboptimal level. The purpose of the study is to assess the extent of venous thrombosis in patients undergoing emergency surgery for abdominal pathology with concomitant coronavirus disease and to determine the main measures to improve the effectiveness of prevention and treatment. Materials and methods. The results of the treatment of 3,476 patients in the Surgical center 1 of the CNPE of the Lviv Territorial Medical Union “Multidisciplinary Clinical Hospital of Intensive Treatment Methods and Emergency Medical Care” from April 2021 to March 2022 were analyzed, 89.3 % of them were hospitalized urgently. One hundred and fifty-nine (4.6 %) patients died, mainly from purulent-septic complications, multi-organ (primarily severe respiratory) failure and venous thrombosis and embolism. Results. Non-specific prevention of venous thrombosis and embolism was carried out in all patients. It consisted in elastic compression of the legs before transporting the patient to the operating room and early ambulation after surgery. Adequate analgesia and assistance from medical staff were considered an important component of motor activity recovery. Specific prevention of venous thrombosis was carried out by subcutaneous injection of low-molecular-weight heparins once or twice a day. With the beginning of the pandemic and a sharp rise of thromboembolic complications, a longer prophylaxis with increased dose and frequency of anticoagulant administration began to be used in clinical practice. Conclusions. Unresolved issues that stood in the way of optimizing the prevention of venous thrombosis and embolism in the clinic are the new challenges associated with the COVID-19 pandemic, insufficient alertness of doctors to the problem of thromboembolic complications, difficulties in objective assessment of the risk of deep vein thrombosis in the presence of many factors, absence of scales for evaluating the risk of venous thrombosis adapted to today’s conditions.

Gottron's carcinoid papillomatosis of the skin (clinical cases)

Gottron's carcinoid papillomatosis of the skin is a rare and little-studied disease. The number of available scientific publications does not exceed several dozens, in Ukraine, in the last ten years, 2 works devoted to this pathology have been published. However, in parallel with the increase in diagnostic capabilities in a multidisciplinary hospital, there are periodically cases of establishing a diagnosis: Gottron's carcinoid papillomatosis of the skin. The lack of a clear understanding of the diagnostic and treatment algorithm creates additional difficulties in the treatment of Gottron's carcinoid papillomatosis of the skin. The course and features of this disease, namely: the presence of various concomitant pathologies, duration and unsatisfactory results of treatment, low patient compliance, etc., make its study relevant. This prompts a more detailed study and analysis of cases of successful treatment. The purpose of our work was to analyze a clinical case of treatment of Gottron's carcinoid papillomatosis of the skin in a multidisciplinary hospital using a multidisciplinary team approach, as well as to summarize the data related to the incidence, features of the clinical course and treatment of this disease given in scientific publications. A clinical case of successful treatment of a patient with Gottron's carcinoid papillomatosis of the skin is presented, a model of the interaction of a vascular surgeon at the stage of restoring the patency of the main arteries and preservation of the limb, a surgeon of the purulent-septicsurgery department at the stage of local and systemic treatment, a pathologist at the diagnostic and post operative stage, and a dermatologist for improvement of topical exposure and ambulatory monitoring is shown. Therefore, the analysis of this clinical case convincingly testifies to the successful capabilities of a multidisciplinary hospital in the treatment of Gottron's carcinoid papillomatosis of the skin, which can be taken into account when determining the treatment tactics of this disease. Coverage of this and similar cases in scientific publications of this rare disease will improve clinician awareness and treatment outcomes.

Morning clinical conference in a therapeutic hospital: is it needed today?

The article presents the experience of the staff of the Department of Hospital Therapy conducting a morning conference on the clinical basis of therapeutic departments of a multidisciplinary hospital. The role and importance of the morning conference format in the organization of hospital work in several areas of activity are considered. The role of the conference moderator, the specifics of presenting the material in the reports of the doctor on duty, the possibilities of interdisciplinary discussion of various aspects of diagnosis and treatment in this format were discussed in more detail.

Prevalence of chronic kidney disease in patients with type 2 diabetes admitted to multidisciplinary hospitals: results of a prospective observational multicenter study (CREDO)

AIM: To assess the prevalence of chronic kidney disease (CKD), clinical and demographic characteristics and therapy profile in patients with type 2 diabetes admitted to multidisciplinary hospitals. CREDO (Cardio-REnal Diabetic cOmplications) trial was initiated for this purpose.MATERIALS AND METHODS: in a prospective observational multicenter study for the period from August 2022 to April 2023, data from 445 patients with type 2 diabetes hospitalized in multidisciplinary hospitals of the Moscow Department of Health were analyzed. The data was collected on a single visit. The design of the study did not involve any interventions in routine clinical practice, including the choice of a diagnostic or treatment method.RESULTS. The study included 445 patients with the main inclusion criteria — type 2 diabetes, age over 50 years, duration of diabetes more than 3 years. The prevalence of CKD was 90%, while in 43% the diagnosis of CKD was confirmed, in 43% it was detected for the first time, and in 7% the disease progressed. Patients with stage C2 and C3 (a and b), as well as with levels of A1 and A2 albuminuria, were most often identified. The percentage of patients in whom the albuminuria was not performed remained high — 46.2%. The highest incidence of CKD was observed in patients with inadequate glycemic control, having an HbA1c level of ≥9%. In the group with newly diagnosed CKD, sodium-glucose co-transporter-2 inhibitor (iSGLT-2) was received by 31.1% of patients, glucagon-like peptide-1 receptor agonists (GLP-1 RA) — 7.9% of patients. In the group with confirmed CKD — 30.7% and 9.4%, respectively.CONCLUSION: it has been shown that patients over the age of 50 with type 2 diabetes with a disease duration of more than 3 years are at a high risk of developing CKD — 90%. The results obtained convincingly confirm the possibility of detecting CKD and initiating nephroprotective therapy at the hospital stage.

Professional burnout and quality of life of nurses during the COVID-19 pandemic

Introduction. In the context of the COVID-19 pandemic, average medical workers turned out to be the most vulnerable category among medical workers in terms of professional stress, professional burnout, and a decrease in quality of life. Goal. To establish the features of professional burnout and the quality of life of MS in specialized COVID hospitals, multidisciplinary hospitals (MP hospitals), as well as polyclinics (PCs) during the pandemic of the new coronavirus infection COVID-19. Material and methods. The study was performed at the Department of Occupational Diseases and Clinical Pharmacology named after the Honored Scientist of the Russian Federation, Professor V.V. Kosarev of the Federal State Budgetary Educational Institution of the Ministry of Health of the Russian Federation and the Regional Center of Occupational Pathology of the Samara City Hospital No. 5. The following MS groups were examined: the first group consisted of nurses working in a COVID hospital (n=29); the second group consisted of nurses working in a multidisciplinary hospital (n=31); the third group consisted of nurses working in polyclinics (n=29); The fourth, control group (GC), included employees of engineering, technical and economic specialties that are not related in their field of activity to work in medical organizations (n=190). The assessment of professional burnout syndrome was carried out using the Maslach Burnout professional burnout assessment questionnaire, the V.V. Boyko questionnaire, the quality of life was determined using the SF-36 questionnaire. Results. It has been established that the work of MS during the COVID-19 pandemic is associated with the impact on medical workers of a number of specific risk factors related to the provision of medical care to infected patients, as well as with significant changes in work regarding aspects related to organization, safety, which contribute to an increase in the level of occupational stress, professional burnout, and a decrease in the quality of life. Conclusion. The work of MS in a COVID hospital, when compared with MS in hospitals, nurses working in polyclinics, is associated with an increase in the level of professional stress, the level of professional burnout. It is necessary to continue research on the emotional state of MS in order to timely carry out preventive treatment to preserve the health of this category of medical workers. Limitations of the study. The study has regional (Samara region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Compliance with ethical standards. The study was carried out within the framework of the complex topic of the Department of Occupational Diseases and Clinical Pharmacology named after Honored Scientist of the Russian Federation Professor V.V. Kosarev of the Federal State Budgetary Educational Institution of the Russian Ministry of Health of the Ministry of Health of the Russian Federation «A systematic approach to early diagnosis, prevention and prediction of the impact of low-intensity industrial factors on the health of workers» (state registration number AAAA18-118122190069-6, date registration on December 21, 2018). The study was approved by the local Ethics Committee of the Federal State Budgetary Educational Institution of the Russian Ministry of Health on 11/23/2021. Patient consent. Each participant of the study gave informed voluntary written consent to participate in the study and publish personal medical information in an impersonal form in the journal «Meditsinskaya sestra (The Nurse)»

О некоторых причинах госпитальной летальности при проведении интенсивной терапии пациентов с новой коронавирусной инфекцией COVID-19

Relevance. The outbreak of a new coronavirus infection showed the unpreparedness of the whole world to such an epidemic both from medical institutions and from organizations that evaluate the quality of medical care. Objective. To identify the main predictors affecting the hospital mortality in patients with COVID-19 during intensive care. Materials and methods. 93 patient's case histories of patients who were in in-patient treatment with the main diagnosis COVID-19, community-acquired double -sided polysegmental viral pneumonia, ARDS were subjected to analytical examination. The sample was carried out using the blind method for the period from April 01,2021 to October 31, 2021. Statistical processing was carried out using the Statistica 10.0 program (Windows) and using an online calculator located on the Internet resource at: https://medstatic.ru/calculators/calcrisk.html. Results. In this study, two main groups of predictors of the death of patients with COVID-19 are identified. The first group: the accompanying somatic pathology that was already in patients, and the second are intensive care defects that did not always occur due to the doctor’s poor quality performance of their professional duties. Conclusions. Currently, unquestioning execution of temporary methodological recommendations for the prevention, diagnosis and treatment of new coronavirus infection (COVID-19) is possible only in the conditions of multidisciplinary hospitals based on regional centers, where there are all the necessary resources, which leads to a reduction in cases of deaths among patients. Their poor performance somewhere in remote areas raises many questions.

Assessment of the levels of formation and leading components of the patient safety system of the anesthesiology and resuscitation service (message 2)

The objective was to assess the levels of formation and leading components of the patient safety system of the anesthesiology and resuscitation (A&R) service (department) of multidisciplinary hospitals.Materials and methods. Expert assessment of the patient safety system of the anesthesiology and resuscitation service (department) of 235 multidisciplinary hospitals, including the assessment of its level, leading components, and their structure in the overall sample. Expert assessment method. Statistical analysis of data distribution, Student’s t-test for independent samples of different sizes, correlation analysis.Results. It has been established that in the main part (38.3%) of multidisciplinary hospitals, the A&R service is at an average (sufficient) level of ensuring patient safety. 17% are at a high (organized) and highest (system-organized) level in terms of ensuring patient safety. A fairly large part (44.7%) is at a low (insufficient) and minimal (critical, extremely low) level of ensuring patient safety. At the same time, the level of ensuring patient safety in the A&R service of multidisciplinary hospitals is important and has a close but inverse relationship with the level of digitalization. Comparison of the severity of the five leading (main) components (criteria) for ensuring patient safety in the A&R service of multidisciplinary hospitals made it possible to assess the levels of their completeness and their structure and showed that in the general sample, the most pronounced criteria for ensuring patient safety were «Teamwork, staff expertise» and «Availability of medicines».Conclusion. The current state of the patient safety system of the A&R service of multidisciplinary hospitals is characterized by 5 levels and 5 leading (main) components, the expert assessment of which made it possible to distribute the A&R services of hospitals according to the indicated levels, identify the structure of their leading components an determine target areas for improving the patient safety system.

Principles of Organization of Multidisciplinary Clinics and Pain Treatment Centers (Literature Review and Own Experience)

Pain is one of the most important problems of modern medicine. The high prevalence of pain causes significant material and social losses. As an effective measure to solve this problem, the idea of organizing a network of pain treatment centers and clinics was put forward. The purpose of the work is to describe the structure of the organization of multidisciplinary clinics and pain treatment centers. The article discusses the basic principles of the organization of pain treatment centers and the system of analgesic care. An example of the work of the pain center on the basis of a multidisciplinary hospital (Volga District Medical Center of the FMBA of Russia) is given. The authors shared the structure and organization of the work of this pain treatment center. They also presented the results of his work. Currently, there are no specialized pain centers in Russia. Now in many cities of Russia there is a process of formation of analgesic care. However, this process faces a number of difficulties.

Correlation between Muscle Mass and Physical Activity Level in Older Adults at Risk of Falling: The FITNESS Study

BackgroundThe study investigates the correlation between muscle mass and physical activity level measured objectively and subjectively in older adults who fall or are at high risk of falling.MethodsFITNESS (Fall Interest to Target Newly Sarcopenic Society) is a multi-center (French university hospitals of Angers, Lille, Limoges and Orléans), cross-sectional, observational study of routine care within a French multidisciplinary hospital consultation. Inclusion criteria were ≥ 75 years old, living at home and consulting for fall or gait disorder. A standardized geriatric assessment, muscle mass evaluation by impedancemetry, physical activity by continuous actimetry (5 days) and Incidental and Planned Exercise Questionnaire (IPEQ) were performed at patient inclusion.Results170 people aged 75 and over were included in the FITNESS study (mean age 82.9 ± 4.7 years, women 72.9%). Muscle mass (whole body and lower limbs) correlated with active energy expenditure (AEE, ρ whole body = 0.32, p-value < 0.001; ρ lower limbs = 0.25, p-value = 0.003), but not with number of daily steps, nor with IPEQ score. Multivariate analysis of whole-body muscle mass showed a positive and significant association with AEE and albumin levels and for lower limb muscle mass, a positive association with AEE and Charlson.ConclusionThis study suggests that in the particular population of older adults who fall and/or are at high risk of falling, loss of muscle mass correlates with reduced physical activity. So subjects who fall or at high risk of falling constitute a special group for whom the fight against sedentary lifestyles and the maintenance of physical activity should be a dual priority.

Prospects for implementing regional project «Development of export of medical services in the Samara Region»

The article presents the data on the implementation of the regional project "Development of export of medical services in the Samara Region" based on the results of 2019-2023. The analysis of the main risk factors and the main hurdles that have arisen in recent years for the implementation of this project has been carried out. Using the case of a separate multidisciplinary hospital in the Samara Region, the analysis of indicators for hospitalization in a 24-hour hospital was carried out, taking into account the proportion of patients from other regions and foreigners. The main possible channels for attracting the flow of foreign patients to the Samara Region have been identified. Taking into consideration the analysis, the prospects for the implementation of the federal project at the regional level are determined.

Clinical and pharmacogenetic features of patients with upper gastrointestinal lesions at a multidisciplinary hospital: the role of nonsteroidal anti-inflammatory drugs.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed medications, buttheir use can be associated with a number of adverse reactions, including upper gastrointestinal lesions. The aim of the study was to identify clinical and pharmacogenetic factors associated with upper gastrointestinal lesions, including those linked to NSAIDs, in patients at a multidisciplinary hospital. The study included 92 patients (mean age 59.4±16.5 years; 47 women), who underwent esophagogastroduodenoscopy during inpatient treatment. Patients' intake of NSAIDs and gastroprotectors during the year before hospitalization was considered. Demographic, clinical, laboratory data of patients were compared between groups, including genotyping for CYP2C9*2 rs179985, CYP2C9*3 rs1057910, CYP2C8*3 rs11572080, CYP2C8*3 rs10509681, PTGS-1 rs10306135, PTGS-1 rs12353214, and PTGS-2 rs20417 using real-time PCR. In NSAIDs+ patients, PTGS1 rs10306135 AT+TT genotypes increased the chance of developing gastrointestinal complications by 5.4 times (95 % CI=1.30-22.27). In total sample, smoking (OR=3.12, 95 % CI=1.15-8.46), and alcohol intake (OR=4.09, 95 % CI=1.05-15.87) increased odds of gastrointestinal damage. In NSAIDs+ patients omeprazole, famotidine and both famotidine and omeprazole during the last year were as ineffective as not taking gastroprotectors; in total sample famotidine (OR=0.19, 95 % CI=0.04-0.93) and two gastroprotectors (OR=0.13, 95 % CI=0.02-0.75) reduced the chance of upper gastrointestinal lesions. Pharmacogenetic features of patients may significantly contribute to the development NSAIDs-induced upper gastrointestinal injuries.

Организация профилактических и противоэпидемических мероприятий в многопрофильном стационаре на современном этапе

The report was made at the Scientific and Practical Conference «Organization of Deratization Measures in Modern Conditions, Topical Issues of Disinfection Activities in the Conditions of Medical Organizations of Various Profiles,» held May 15–16, 2024 in St. Petersburg. The organization of timely preventive and anti-epidemic measures is one of the key components of the strategic task of health care to ensure the quality of medical care and create a safe environment for patients and medical workers in organizations engaged in medical activities. Infections associated with the provision of medical care (ISMP), including nosocomial infections (VBI), are the most important component of this problem due to the widespread, negative consequences for the health of patients, medical workers, as well as economic damage. Keywords: multidisciplinary hospital, disinfection activities, preventive measures, anti-epidemic measures, infections associated with the provision of medical care, nosocomial infections, microbiological monitoring, disinfectants, quality control of disinfection measures.

Опыт внедрения отдела профилактической дезинфекции в крупном многопрофильном стационаре. перспективы развития

The flock was prepared on the basis of a report made at the scientific and practical conference «Organization of deratization measures in modern conditions, topical issues of disinfection activities in the conditions of medical organizations of various profiles,» held May 15–16, 2024 in St. Petersburg. The interaction between the medical and non-medical units of the hospital, their well-coordinated work is one of the most important factors in the provision of high-quality medical care in a large multidisciplinary hospital. The implementation of preventive and anti-epidemic activities is often distributed among departments, and non-medical specialists do not always understand the need for these measures. To improve the quality of medical care and improve the interaction between services, a new department was introduced into the staff of a large multidisciplinary hospital – the department of preventive disinfection. Keywords: multidisciplinary hospital, preventive disinfection department, linen regime, disinfectants, disinfection, deratization, medical waste management, disinfection chamber, preventive activities, anti-epidemic measures, interaction between medical and non-medical units.

ОПЫТ ЛЕЧЕНИЯ ПАЦИЕНТОВ СО СВИЩАМИ ОБОДОЧНОЙ КИШКИ ДИВЕРТИКУЛЯРНОГО ПРОИСХОЖДЕНИЯ

Abstract. Introduction. In the 21st century, a massive increase was noted in the incidence of diverticular disease (DD) by more than 10 times with an increase in the frequency of its complications ranging from 5 to 25%. According to the literature, the colon fistulation frequency is 5-30%, over a half of such formations being colovesical fistulas. The problem of surgical approaches to the purulent-inflammatory complications of DD is far from being resolved. Despite the fact that diverticular disease is a benign pathology, inflammatory process often creates serious technical difficulties in surgery due to the violation of the anatomical relationship of the intestine with the surrounding organs, while surgeries often affect several organs with a high infection risk. Aim. Analysis of the results of the treatment of patients with diverticular colon fistulas in a specialized department of a multidisciplinary hospital. Materials and Methods. Treatment outcomes were analyzed retrospectively in 347 patients with diverticular colon disease complications for the period from 2013 to 2022. The study included 17 patients with diverticular fistulas: 14 (82.4%) patients with internal (intestinal-urinary (13) and intestinal-vaginal (1)) fistulas and 3 (17.6%) with external ones. Results and Discussion. The therapeutic and diagnostic algorithm for diverticular fistulas required a wide range of diagnostic methods and a multidisciplinary approach. Surgery remains the single treatment option for this pathology. The choice of the surgical procedure depended on the inflammatory process severity, its spread to the surrounding abdominal organs, and the largest diverticula accumulation in the gut. In the group of patients with intestinal-urinary fistulas, the resection was not limited to the removal of the colon segment only. In 9 (52.9%) cases, it was expanded to the anterior rectum resection due to the inflammation transition to its upper ampullary region. We are supporters of the one-stage surgical procedures with forming the primary anastomosis in patients with diverticular fistulas. We give preference to the Sigal-Ramazanov invagination anastomosis that allows avoiding the anastomosis due to creating a duplicate of the intestinal wall hiding the anastomosis zone. The paper identifies probable predictors of complicating diverticular disease with fistulation. Conclusions. Choosing the optimal treatment option for patients with diverticular disease complications is a difficult problem. It is better to operate on them in the coloproctology departments of multidisciplinary hospitals with the established good interaction among the members of a multidisciplinary team.

Intensive Multidisciplinary Feeding Day Programs in the United States: A Report Regarding the Treatment Landscape

Intensive multidisciplinary intervention is increasingly recognized as the standard of care for children with complex feeding problems. Much, however, remains unknown about this treatment model. This current qualitative, prospective study sought to identify intensive multidisciplinary day hospital programs operating in the US, describe the treatment approach, and summarize current capacity.

Thrombophilia’s in Patients with Diabetes Mellitus

A clinical case of severe manifestation of type 2 diabetes mellitus in a teenage boy with obesity and the development of severe ketoacidosis as part of multiple organ failure syndrome is described. Timely elimination of diabetic ketoacidosis, hemodialysis and complex therapy in a multidisciplinary hospital made it possible to improve the teenager’s condition and avoid death.