Multidisciplinary Hospital Research Articles

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

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

Procalcitonin-Guided Management and Duration of Antibiotic Therapy in Critically Ill Cancer Patients With Sepsis (Pro-Can Study): A Randomized Controlled Trial.

To evaluate the effect of procalcitonin-guided management on the duration of antibiotic therapy in critically ill cancer patients with sepsis. Randomized, controlled, single-blinded trial. A comprehensive multidisciplinary cancer hospital in Jordan. Adults with cancer treated in the ICU who were started on antibiotics for suspected infection, met the SEPSIS-3 criteria, and were expected to stay in the ICU greater than or equal to 48 hours. Patients were randomized to the procalcitonin-guided or standard care (SC) arms. All patients had procalcitonin measured daily, up to 5 days or until ICU discharge or death. For the procalcitonin arm, a procalcitonin-guided algorithm was provided to guide antibiotic management, but clinicians were allowed to override the algorithm, if clinically indicated. In the SC arm, ICU clinicians were blinded to the procalcitonin levels. Primary outcome was time to antibiotic cessation. We also evaluated the number of antibiotic-free days at 28 days, hospital discharge, or death, whichever came first, and antibiotic defined daily doses (DDDs). We enrolled 77 patients in the procalcitonin arm and 76 in the SC arm. Mean age was 58 ± 14 (sd) years, 67% were males, 74% had solid tumors, and 13% were neutropenic. Median (interquartile range [IQR]) Sequential Organ Failure Assessment scores were 7 (6-10) and 7 (5-9) and procalcitonin concentrations (ng/mL) at baseline were 3.4 (0.8-16) and 3.4 (0.5-26), in the procalcitonin and SC arms, respectively. There was no difference in the median (IQR) time to antibiotic cessation in the procalcitonin and SC arms, 8 (4-11) and 8 (5-13), respectively (p = 0.463). Median (IQR) number of antibiotic-free days were 20 (17-24) and 20 (16-23), (p = 0.484) and total DDDs were 1541.4 and 2050.4 in the procalcitonin and SC arms, respectively. In critically ill cancer patients with sepsis, procalcitonin-guided management did not reduce the duration of antibiotic treatment.

ANTIBACTERIAL THERAPY IN SEPSIS PATIENTS

Today, sepsis, the cause of which is purulent-inflammatory processes of soft tissues, accounts for more than 45% of cases. In most multidisciplinary hospitals, the frequency of gram-positive and gram-negative sepsis is approximately the same. Antibacterial therapy (ABT) is the most important component of the complex therapy of sepsis, and early adequate empiric ABT leads to a decrease in mortality and the frequency of complications. ABT of sepsis at the beginning of treatment, in most cases, is empirical in nature, but it should be remembered that taking the material for microbiological research must be done before the start of antibacterial therapy! According to the principles adopted in the guideline "Sepsis - 3", the use of antibiotics for the treatment of sepsis is a necessary component, the effectiveness of which cannot be doubted. It should be remembered that a delay in the appointment of an antibacterial drug to patients with sepsis and septic shock for 1 hour leads to an increase in the risk of death of the patient by 7,6%. Empiric ABT should be initiated with a broad-spectrum regimen of one or more antibiotics in patients with sepsis or septic shock to cover all possible pathogens (including bacterial, possibly fungal, or viral). Empiric ABT should be narrowed after identification of the pathogen and determination of its sensitivity and/or when adequate clinical improvement is registered. There are no indications for long-term systemic antibacterial prophylaxis in patients with severe forms of inflammatory conditions of non-infectious origin (for example, severe pancreatitis, burns). Measurement of procalcitonin levels can be used to shorten the duration of antibacterial therapy in patients with sepsis. Rapid interpretation of the severity of the infectious process can be performed using ACCP/SCCM sepsis diagnostic criteria, organ dysfunction criteria (gSOFA, SOFA, MODS) or rapid procalcitonin test. Microbiological diagnosis of sepsis is the main factor in prescribing adequate ABT regimens. In the case when the same microorganism is released from the probable source of infection and from the peripheral blood, its etiological role in the development of sepsis should be considered as evidential. The standard for testing blood for sterility is the collection of material from two peripheral veins with an interval of up to 30 minutes, while blood from each vein must be collected in two vials. It is not permissible to take blood from the catheter! Building an ABT algorithm taking into account the etiology and characteristics of resistance of microorganisms to antibacterial drugs is the most optimal approach. Тoday, the optimal regimen of empiric ABT of sepsis with PON is carbapenems - as drugs that have the widest spectrum of action and to which the lowest level of resistance is observed among intra-hospital strains of gram(-) bacteria. In some cases, an alternative to carbapenems is cefepime, ceftaroline, protected by antipseudomonas β-lactams (cefaperazone/sulbactam, piperacillin/tazobactam) and "respiratory" fluoroquinolones. In cases of ineffectiveness of the indicated regimens of ABT, the feasibility of additional appointment of glycopeptides (vancomycin, teicoplanin or linezolid), as well as systemic antimycotics (fluconazole) should be evaluated. The latter should also be prescribed after 7-10 days after the start of ABT in a prophylactic dose of 150 mg per week.

Ensuring medication safety on the case of a multidisciplinary hospital

The article discusses the process of management and control in matters of ensuring medication safety at the Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan. Registration of adverse drug reactions is a mandatory measure for monitoring the safety of pharmacotherapy.

Orbital injuries: aspects of forensic medical examination in assessing the severity of harm caused to human health

Background: Forensic examination plays a key role in establishing the severity of injuries, especially of orbital trauma, which can lead to serious consequences, including vision loss. Examination of forensic reports associated with orbital trauma provides valuable information about the nature of the injuries, their prevalence, and factors influencing the severity of the injury. Aim: Analysis of the possibilities of an interdisciplinary approach based on the presence of a full ophthalmological status and computed tomography data of the skull in conducting a forensic medical examination of living persons and in the final qualification of the degree of harm to health in orbital injuries. Materials and methods: An analysis of 37 completed forensic medical examinations of living persons with orbital injuries who were treated in multidisciplinary hospitals in Moscow was carried out. The forensic medical examination was carried out in the Bureau of Forensic Medical Examination of the Moscow Health Department. In 23 cases, the ophthalmological status was assessed at periods from 1 week to 6 months after the injury. In all cases (n = 37; 100%), computed tomography of the facial and cerebral skull was performed. The age of the victims at the time of injury ranged from 12 to 82 years (average 39.7 ± 9.2 years). There were 29 adults among the victims (78.3%), 8 children (21.6%). In terms of gender distribution, there was a significant male predominance — 27 men (73%) versus 10 women (27%). Results: According to the results of the analysis of forensic medical reports, polytrauma with the simultaneous presence of several severe injuries to various organs and systems, combined with orbital trauma, was recorded in 12 victims (32.4%). A combination of traumatic brain injury and orbital injury without involvement of other organs and systems was detected in 9 victims (24.3%), isolated orbital trauma — in 13 people (35.1%), isolated injury of two orbits simultaneously — in 3 victims (8.1%). From the conclusions of forensic experts, it follows that in 89% of cases, the bone walls of the orbits, formed by the frontal, ethmoid and sphenoid bones, as well as the upper jaw, were damaged, which could subsequently lead to damage to the globe, optic nerve and other orbital structures. Damage to the soft tissue of the orbits with globe contusion was noted in 11% of cases. In 3 cases (n = 3; 8.1%), moderate harm to health was determined based on significant persistent loss of general ability to work. In 14 cases (n = 14; 37.8%), it was not possible to focus on the acuteness of the injured globe before the traumatic episode, due to the fact that the victims had no documented visits to an ophthalmologist before the injury. Conclusions: To objectively assess of the orbital trauma and determine the degree of harm to human health, it is necessary to have a full ophthalmological status, including such clinical and instrumental criteria as visual acuteness, presence or absence of ophthalmoplegia and globe dystopia, as well as computed tomography data of the skull, which must be presented in the primary medical documentation.

Identifying Locations Where Self-Reported Dizziness Occurs In Patients With Vestibular Disorders In A Day Hospital Setting

Abstract Background World falls guidelines recommended that where vestibular issues are identified such as Benign Paroxysmal Positional Vertigo (BPPV), therapeutic interventions should always be sought, as potential benefits to health-related quality of life are high (Montaro-Odasso et al., 2022). Identifying potential BPPV in older adults, however, can be challenging, as many older adults experience BPPV as vague unsteadiness rather than dizziness, leading to under diagnosis of the condition (Li et al., 2023). This audit aimed to identify the locations where patients with self- reported dizziness and falls experienced dizziness, and if they subsequently were diagnosed with vestibular disorders. If potential high-risk locations for experiencing dizziness with vestibular issues are identified, this may aid in the timely identification of vestibular disorders. Methods A retrospective chart audit was undertaken in a multidisciplinary day hospital setting, where patients aged 75 years and older attend for assessments. Paper charts of patients discharged from the day hospital between January and March 2024 were reviewed. A Microsoft excel sheet was used to track data. Data on self-reported dizziness and falls as well as the location of dizziness occurring was gathered. Results A total of 103 patient charts were reviewed. Of those, 39 reported experiencing dizziness, with 90% of those patients also reporting a history of falls. 18 of these patients were subsequently diagnosed with vestibular disorders. 78% of patients diagnosed with BPPV reported experiencing dizziness getting out of bed or in their bedroom with 28% also reporting dizziness on getting up from a chair. However, 100% of patients with dizziness and falls without vestibular disorders reported dizziness on getting out of their bed. Conclusion People with all cause dizziness reported dizziness on getting out of bed. Based on the results of this audit, vestibular screening is not aided by questions surrounding location of dizziness occurring.

Morning conference in the therapeutic clinic: importance in the professional education of young specialists

The article discusses a morning conference in a multidisciplinary therapeutic hospital as one of the effective and concentrated forms of professional education and the formation of clinical thinking among young specialists. The department's staff members' own experience of conducting morning conferences at a multidisciplinary hospital is presented. Among the many functions of the morning conference, emphasis was placed on the educational role in the process of training clinical residents and senior medical students. The role of duty was discussed with the presentation of the results at the morning conference, the possibility of analyzing lethal outcomes, clinical and anatomical comparison, and deontological aspects.

Specific features of anesthesia management in a patient with a transplanted heart

Background. The number of heart transplant patients makes 1 per 100,000 in the Russian Federation, 1.2 per 100,000 population in the Tambov Region. The medical community is poorly informed about the specific features of managing such patients during non-cardiac surgical interventions. The article presents a case report of the management of a patient with a transplanted heart undergoing surgery for acute appendicitis. Preoperative preparation, anesthesia management, surgery, and postoperative care and rehabilitation were provided taking into account the presence of a transplanted heart in the patient, according to the Guidelines developed by the experts of the V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs where the heart transplant had been performed to the patient, and standard clinical recommendations.Case Report. An 18-year-old patient diagnosed with acute phlegmonous appendicitis with a heart transplanted in 2021 for dilated cardiomyopathy underwent laparoscopic appendectomy 3 years after heart transplantation. Anesthesia was provided taking into account the presence of a denervated donor heart, a high risk of myocardial ischemia and heart ailure (low cardiac output syndrome), and the need for a timely correction of hypovolemia and hypotension. Anesthesia management was a general combined multicomponent anesthesia.Conclusion. This clinical case has shown the possibility of providing medical care to a patient with a transplanted heart at a modern level in an urban multidisciplinary hospital. Non-cardiac surgery was performed in accordance with recommendations of specialists of V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs and clinical recommendations in order to achieve optimal results and the fastest possible rehabilitation in the postoperative period.

Причины обращения за психологической помощью в стационаре скорой помощи

<p>Psychological assistance to patients in an emergency multidisciplinary hospital is increasingly relevant due to the influence of mental disorders and emotional maladjustment on treatment, the patient’s internal perception of their illness, and adherence to treatment. Since hospitalization is inherently a stressful factor that can contribute to the development of anxiety and depressive symptoms, psychological support for patients and often their loved ones is an integral part of the treatment process. However, studies on the emotional state of patients at the time of hospitalization are limited and primarily focus on assessing the level of current stress. Patients admitted to the hospital often experience symptoms of emotional maladjustment long before hospitalization, which can significantly impact their adaptation to the hospital environment and the treatment process as a whole. This article analyzes the reasons for seeking psychological help during hospitalization in an emergency hospital and examines the relationship between these reasons and the level of emotional maladjustment. The analysis of primary issues was conducted by coding each case according to the most prominent problem presented. A total of 379 consultations were analyzed, identifying problems associated with psychological distress. The sample consisted of 122 men and 257 women, with an average age of 50 years. Also, some patients completed the Hospital Anxiety and Depression Scale (HADS), including 30 men and 50 women. The results of the study showed that one of the most common reasons for seeking psychological help was related to situational reactions to stress. However, the majority of patients in this group did not have elevated scores on the Hospital Anxiety and Depression Scale. In addition, a significant percentage (37% of all consultations) of patients were referred for psychological consultation due to emotional problems that had been present before hospitalization. Notably, patients in this group were most often among those with clinically significant levels of anxiety and depression. The data obtained may indicate that the main reason for the deterioration of the emotional state at the time of hospitalization is not hospitalization itself, but problems that the patient has encountered outside the hospital walls.</p>

Detection of anticoagulant medication errors by triggers

Medication errors can cause preventable adverse events. For example, inappropriate use of anticoagulants (AC) can result in bleeding and thromboembolic complications. Detection and analysis of AC medication errors allow to reveal deficiencies in the safety systems in healthcare organizations. The study was aimed to develop a method of systematic detection of anticoagulant medication errors for consequent audit, analysis and development of medication safety improvement measures. The study was conducted in the multidisciplinary hospital and included 4924 patients admitted from January 2019 to December 2021 who received AC. Three laboratory triggers (international normalized ratio ≥4, serum creatinine ≥133 μmol/l, and glomerulofiltration rate <30 ml/min/1.73 m2) helped to reveal 4304 cases. Their matching with patient's data helped to develop combined triggers. Two clinical pharmacologists reviewed all cases identified by combined triggers for checking medication errors. The trigger was considered positive when anticoagulant medication error was detected in the history selected by combined trigger. Of the 4924 patients 253 (5.3%) were selected by combined triggers. Combined trigger allowed to reduce the amount of medical health records audit by 97.3%. Medication errors were detected in 137 patients. Positive predictive value of selected combined triggers varied from 0 to 63.9%. Aggregated positive predictive value of all combined triggers amounted to 54.2%. AC medication errors were detected in 2.8% patients. Method of systematic detection of AC medication errors using combined triggers in all hospitalized patients receiving AC allowed to reveal typical medication errors for consequent analysis and elaboration of measures to reduce preventable patient harm in healthcare settings.

Audit of the Quality of Emergency and Emergency Care for Children in a Multidisciplinary Hospital Using Simulation Technologies

Currently, on the basis of the Order of the Ministry of Health of the Russian Federation dated 07/31/2020 No.785n, the Ministry of Defense must conduct an audit of the quality and safety of medical activities. The audit should include not only an assessment of theoretical knowledge, but also the level of proficiency using simulation technologies. An audit was conducted on the indicators of emergency and emergency care for children in the Ministry of Defense. The audit results allowed: to improve approaches to providing emergency care to children; to form an effective trajectory for training specialists; to implement trainings; to obtain data on the survival of skills; to work out an audit algorithm.

Разработка системы управления конфликтами в отделении реанимации и интенсивной терапии многопрофильного стационара с помощью LEAN-технологий: пилотное исследование.

Objective: to develop and evaluate the effectiveness of a conflict management system using the example of the intensive care unit of a multidisciplinary hospital Materials and methods. The study was conducted on the basis of City Clinical Hospital No. 1 named after. N. I. Pirogov, resuscitation and intensive care units in 2023. The study included 74 department employees‑42 medical (34 male (80.9%) and 8 female (19.1%), and 47 nursing staff: 12 male (25.3%) and 35 female (74.5%). In order to identify the presence of conflict situations (incidents), their causes and factors provoking them, questionnaires were developed: questionnaire 1—initial assessment (input) and questionnaire 2—assessment of the results of the proposed conflict management model. analysis of operational activities, a Gantt chart was drawn up for medical and paramedical personnel, a comparative and statistical analysis of the results was performed and an algorithm for making management decisions was developed. Results. A tool for identifying conflict situations in a universal electronic form has been created. According to the survey results: conflicts do occur, they are regular, and the participants in the conflicts are department employees. The main cause of conflicts is the conditions of daily operating activities and non-compliance with ethical and deontological standards. Losses in the provision of medical care were identified and assessed: defects in the provision of medical care (defects); waiting is the time before the provision of medical services; untapped potential of employees; transport losses. An algorithm for managing conflicts and preventing future incidents has been developed and implemented. Conclusions. The study demonstrated the need for clear organization of operational activities; formation of protocols for improving professional competencies; formation of a motivational system; creation of an information analytical system for control and monitoring of current processes.

Peptidergic and adenosinergic drugs administration to comatose patients caused by alcohol consumption on early hospital period

Introduction. Medical care for patients diagnosed with the toxic effect of ethanol (according to ICD-10 code T51.0) it turns out to be in specialized toxicological centers or in emergency departments of multidisciplinary hospitals. The purpose of this study was to study the effectiveness of the drug моликсан® (molixаn) at different levels of medical care for patients diagnosed with the toxic effect of ethanol. Material and method. 128 patients were included in the study, of which 76 patients were taken to the emergency department of St. Petersburg State Medical Institution "Alexandrovskaya Hospital" and 52 patients were taken to the intensive care unit No. 11 of the St. Petersburg Scientific Research Institute of Emergency Medicine named after I.I. Dzhanelidze. All patients met the inclusion criteria: age 18–60 years; impaired consciousness of alcoholic genesis 21–30 points on the Glasgow–Pittsburgh coma scale (PBSS: Pittsburg Brain Stem Score, Kelsey S.F., et al. 1991); ethanol concentration in the blood is more than 2.5%. 72 patients were included in the моликсан® group, 56 patients in the Placebo group. Results. The use of the drug моликсан® has a positive effect on the dynamics of restoring the level of consciousness, which is reflected in higher values of the Glasgow–Pittsburgh scale after 1, 3 and 6 hours from the start of therapy (p&lt;0.01), reducing the period of stay of the patient in a coma from 150 [75; 178] minutes to 60 [50; 161.5] minutes (p&lt;0.05) and restoration of consciousness to a clear level after 3.5± 0.3 hours (p&lt;0.05).It was also revealed, that in the group of patients using моликсан®, normalization of heart rate (p&lt;0.05) and a decrease in the frequency and severity of tremor (p&lt;0.05) were noted. The hepatoprotective efficacy of моликсан® was shown, which manifested itself in a decrease in ALT, AST, GGTP, alkaline phosphatase, total and direct bilirubin (p&lt;0.001). Limitations. The clinical efficacy of моликсан® in the toxic effects of severe ethanol was carried out in patients with depression of consciousness and elevated levels of ALT, AST, GGTP, alkaline phosphatase, total and direct bilirubin, which indicated the presence of alcoholic hepatopathy. Conclusion. The conducted study showed the expediency of using моликсан® at a dosage of 3.0 mg/kg intravenously with the toxic effect of ethanol of moderate and severe severity of the disease.

CONSIDERATION OF MORPHOLOGICAL-FUNCTIONAL CHANGES IN THE COMPONENTS OF CALOT’S TRIANGLE IN ACUTE CHOLECYSTITIS AND THEIR INFLUENCE ON THE SPECIFIC LAPAROSCOPIC CHOLECYSTECTOMY TECHNIQUE IN PATIENTS WITH ACUTE CHOLECYSTITIS

From 2018 to 2023, a study was conducted on 89 (100%) patients operated on for acute cholecystitis in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care.The goal is to study the clinical features of acute cholecystitis based on the results of surgical treatment in the general surgery department of a multidisciplinary district hospital for intensive care.Materials and methods. From 2018 to 2023, 89 patients who underwent surgery for acute cholecystitis were studied in the surgical department of the Storozhynets Multidisciplinary Hospital for Intensive Care. Clinical, laboratory, instrumental examinations, and surgical treatment were performed on 89 patients of various age groups (from 18 to 74 years) with manifestations of acute cholecystitis. The patients were divided into two groups. The diagnosis was confirmed clinically, laboratory, by instrumental methods, intraoperative examination, and histological study of the removed specimens. The state of changes in peripheral blood was assessed: the number of erythrocytes, hemoglobin content, number of leukocytes, leukocyte formula, erythrocyte sedimentation rate, and leukocyte intoxication index according to the Kalf-Kalif formula. Statistical processing of the material was performed using the t-test with the determination of the probability corresponding to the Student's t-criterion. When performing statistical processing, the arithmetic mean (M) and the reliability of differences in study results (p) relative to the indicators of different groups were calculated. The results were considered reliable when the confidence coefficient was less than or equal to 0.05.Results. The results of our laparoscopic cholecystectomies for grade I and II (moderate) severity of acute cholecystitis (according to the International Classification) showed a quantitative advantage in prioritizing the laparoscopic method of surgical intervention. However, in the presence of a purulent-inflammatory process in the hepatobiliary zone, priority is given to performing cholecystectomy by the "open method," involving highly experienced surgeons in the surgical team. This option of cholecystectomy is advisable mainly for severe acute cholecystitis (stage III of the pathological process) with a purulent-necrotic process in the hepatobiliary zone detected at the preoperative stage and in the case of peritonitis. Contraindications for laparoscopic cholecystectomy include chronic duodenal obstruction, gangrenous-perforative cholecystitis, and diffuse peritonitis. Considering the features of surgical tactics for treating acute cholecystitis confirms the need for its differentiated determination based on already developed tactical and therapeutic recommendations, the effectiveness of which is evidenced by the accumulated experience of the international school of surgeons and confirmed by our clinical results.Conclusions. 1. Laparoscopic cholecystectomy is currently performed for both chronic and acute cholecystitis. 2. The most optimal time for performing "laparoscopic cholecystectomy" is the first two days from the onset of the inflammatory process in the gallbladder. 3. Performing laparoscopic cholecystectomy considering anatomical landmarks according to the recommendations for "safe cholecystectomy" by Steven Strasberg (1992, 1995 - SVS) and Gary G. Wind (1999) is an effective component of successful laparoscopic cholecystectomy for chronic cholecystitis and in the early stages of acute inflammatory processes in the gallbladder. 4. For acute destructive cholecystitis, the "elephant trunk" technique is practically preferred.

Medical аnd еconomic аspects оf the use of vacuum therapy for esophageal injures

Background. Currently, endoscopic vacuum therapy (EVT) with an efficiency of up to 90% or more is actively used in the treatment of esophageal injuries. At the same time, the economic assessment of the advantages of minimally invasive methods has not been studied enough. Aim. To Analysis of the economic component of EVT for esophageal injuries in comparison with classical interventions (thoracotomy, esophageal extirpation) in a regional multidisciplinary hospital. Materials and methods. The analysis of the economic component of EVT in comparison with classical interventions was carried out by retrospectively examining the medical records of 43 patients. The cost of treatment in the comparison groups was estimated by including the cost of the patient's stay in the hospital and the direct costs of intervention. Results. The conducted statistical analysis showed significant differences in the groups with a strong dependence of the cost of treatment on the patient's stay in the intensive care units and the direct costs of open surgery. Conclusion. The use of minimally invasive and modern EVT methods for esophageal injuries can significantly shorten the patient's hospital stay. Compared to traditional surgical approaches, this approach allows for a reduction in the financial aspect by more than two times.

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.