Multidisciplinary Organization Research Articles

Віддалені наслідки COVID-19 (огляд літератури)

COVID-19 is a new especial coronavirus infection that differs from other seasonal respiratory viral infections and can cause damage to many organs and body systems with long-term consequences. In typical cases, the acute period of the disease lasts up to 2 weeks, the recovery period increases to 6 weeks in 35% of patients, and it is observed for months in some patients. Respiratory symptoms (in >50% of patients), 35% - cardiac and 13% - neuropsychiatric symptoms are the most common after COVID-19. The main factors in the pathogenesis of COVID-19 are: block of ACE2 receptors by coronavirus; inadequate response of the immune system to infection (“cytokine storm”) with macrophage hyperactivity syndrome and simultaneous suppression of key parts of the immune system; the development of vasculitis with hypercoagulability and damage to many organs (extrapulmonary systemic hyperinflammation syndrome) with endothelial dysfunction, which may be an important factor in the severity and duration of COVID-19 symptoms. Organizing pneumonia with impaired diffusion of gases is the most common lung injury after COVID-19. Up to 30% of hospitalized patients show signs of myocardial damage. Often pathology of the central nervous system is observed due to potential direct and indirect mechanisms of damage, kidney pathology is too. SARS-CoV-2 may be a trigger for Kawasaki disease. The difficulty of further monitoring of patients with long-term consequences of COVID-19 is due to the need for specialists from various medical specialties and a multidisciplinary organization that would adequately meet today's needs. The long-term effects of COVID-19 continue to be studied. No conflict of interests was declared by the author.

Особенности системной оценки деятельности многопрофильной медицинской организации: оптимизация обеспеченности кадрами

A model for the analysis of some indicators of a systemic assessment of the activities of a multidisciplinary medical organization is proposed: the integration of the indicator of staffing of a medical organization and the financial performance of medical organization is analyzed. The main performance indicators of the medical diversified organization are listed and the results of their c orrelation analysis with the indicators of the group of financial indicators are presented.

Change management in hospitals: A way to learn from climate change

Resolutely a complex and multidisciplinary organization, the hospital is undergoing several inevitable changes. Faced with so many changes and the risk of disappearing, it must transform, rethink and redefine its structures and strategies. Given this, change management is a critical factor in the success of organizational transformation strategies. In this respect, several change management practices have been proposed. Although applicable to any organization, these models and approaches require a perfect understanding of the reality of hospitals, as a change in hospitals is laborious and complicated. The change process in hospitals is still strongly marked by several constraints that handicap the management of change and make it challenging to implement changes. Rightly so, change management in a hospital may be hampered by technological, regulatory, organizational, managerial, or human resource constraints. Change management promotes continuous improvement where each actor must be considered a factor in the transformation of the hospital organization. To achieve this, the path to be followed must include more interaction and questioning, which encourage the learning of actors for the benefit of a learning hospital.

Cardiogenic shock code 2023. Expert document for a multidisciplinary organization that allows quality care

Despite the efforts made to improve the care of cardiogenic shock (CS) patients, including the development of mechanical circulatory support (MCS), the prognosis of these patients continues to be poor. In this context, CS code initiatives arise, based on providing adequate, rapid, and quality care to these patients. In this multidisciplinary document we try to justify the need to implement the SC code, defining its structure/organization, activation criteria, patient flow according to care level, and quality indicators. Our specific purposes are: a) to present the peculiarities of this condition and the lessons of infarction code and previous experiences in CS; b) to detail the structure of the teams, their logistics and the bases for the management of these patients, the choice of the type of MCS, and the moment of its implantation, and c) to address challenges to SC code implementation, including the uniqueness of the pediatric SC code. There is an urgent need to develop protocolized, multidisciplinary, and centralized care in hospitals with a large volume and experience that will minimize inequity in access to the MCS and improve the survival of these patients. Only institutional and structural support from the different administrations will allow optimizing care for CS.

Factors associated with reluctancy to acquire COVID-19 vaccination: A cross-sectional study in Shiraz, Iran, 2022.

Vaccination is a crucial action that can end the COVID-19 pandemic and reduce its detrimental effect on public health. Despite the availability of various vaccines, this study was conducted to better understand the factors behind individuals refusing to get vaccinated. The current cross-sectional study was conducted with individuals above 18 years of age in Shiraz, Iran, who were eligible but refused to receive the COVID-19 vaccination. Demographic features and factors related to their hesitancy and willingness to participate in the vaccination program were recorded in a questionnaire. Out of 801 participants in the current study, 427 (53.3%) were men, with a mean age of 37.92 years (± 14.16). The findings revealed that 350 (43.7%) participants claimed the side effects of the vaccine outweigh the benefits as one reason for their reluctance toward COVID-19 vaccination, followed by the unknown efficacy of vaccines (40.4%) and a lack of trust in vaccine companies (32.8%). Ensuring the safety of the vaccine (43.7%) and verifying its effectiveness (34.5%) were the most prevalent factors behind participating in the vaccination program. Those who reported their socio-economic status as low were significantly reluctant toward vaccination because of a self-presumption of high immunity (p-value < 0.001), the unclear efficacy of vaccines (p-value < 0.001), the side effects outweighing the benefits of vaccines (p-value < 0.001), distrust of vaccine companies (p-value < 0.001), usage of mask, gloves, and sanitizers (p-value < 0.001), contradictory speech of health authorities regarding vaccines (p-value = 0.041), and the unavailability of trusted vaccines (p-value = 0.002). It should also be noted that participants reported a greater likelihood to obtain information about vaccination reluctance from family and friends (p-value <0.001) and complementary medicine professionals (p-value <0.001). Avoiding vaccination is an undeniable public and individual health concern in Iran, as demonstrated in the current study. Concern about vaccine efficacy and side effects is the most reported cause of vaccination reluctance among individuals, which could be altered by emphasizing mass education and averting an infodemic by forming dedicated multidisciplinary organizations.

Exploring patient’s experience and unmet needs on pregnancy and family planning in rare and complex connective tissue diseases: a narrative medicine approach

ObjectiveThe aim of this work is to explore patient’ unmet needs of rare and complex rheumatic tissue diseases (rCTDs) patients during pregnancy and its planning by means of the narrative-based...

Working conditions and their hygienic assessment in multidisciplinary medical organizations

At present, one of the main tasks of the state and society is preservation and strengthening of the health of the able-bodied population. Employees of medical organizations are exposed to the combined effects of a significant number of harmful production and professional factors. In particular, the factors of the working environment include biological, chemical, and physical factors, while those of the labor process involve tension and severity. Therefore, the study of working conditions of medical personnel is a priority in occupational health. The purpose of the study is to analyze the working conditions of employees of medical organizations and iden tify priority production-related and occupational pathologies arising from the impact of unfavorable production and occupational factors in order to develop preventive measures. Materials and methods. The object of the study was 1,443 reports of the special assessment of working conditions. We carried out our own studies of the parameters of the microclimate and lighting in the premises: the number of measurements was 5,398, measurements were carried out in 60 premises of medical organizations, and 727 air samples were taken to determine the microbial load. Results. According to the studies of the conditions and nature of work at the workplaces of medical workers in the examined medical organizations and according to the results of a special assessment of working conditions and our own research, the conditions corresponded to a harmful class of 1–3 degrees and of the 4th degree for workers of the oncological hospital. The level of maximum microbial load in the doctors' lounges and nursing rooms increased by the middle of the work shift and remained high until the end of the working day. Since the air movement speed in the studied rooms was very low, this criterion may be a risk factor for aggravation of the course of general somatic pathologies and, as a result, the development of work-related morbidity in medical workers. It can also be noted that fungi were found in 100 % of samples, with their number decreasing by the end of the work shift, while the number of the genus Staphylococcus representatives, on the contrary, tended to increase by the end of the working day. Conclusion. According to the results of the special assessment of working conditions, the conditions and nature of the labor of medical workers in the studied medical organizations corresponded to the harmful class of 1–4 degrees. The 4th degree of the 3rd class of working conditions was due to the personnel’s work with cytostatic drugs. Microclimatic parameters corresponded to hygienic standards (at low air speeds). Fungi and representatives of the genus Staphylococcus were found in 100 % of air samples. A detailed study of the species identification of micromycetes in the indoor air showed that the number of Penicillium and Aspergillus micromycetes significantly exceeded the number of other species.

THE RESULTS OF THE ANALYSIS OF THE COMPOSITION OF PATIENTS HOSPITALIZED IN THE DEPARTMENTS OF SURGICAL AND THERAPEUTIC PROFILE OF MULTIDISCIPLINARY MEDICAL ORGANIZATIONS

Relevance. Currently, more attention is being paid to improving the quality of drug provision for multidisciplinary medical organizations. An objective analysis of factors, including the analysis of the structure of the composition of patients hospitalized in multidisciplinary medical organizations, is of great importance. Aim. To analyze the composition of patients hospitalized in the departments of therapeutic and surgical profile of multidisciplinary medical organizations. Materials and methods. Materials: statistical reports, journals of the movement of medicines and prescribing lists of medical histories of patients examined by multidisciplinary medical organizations, as well as data on standards of medical care and clinical recommendations. Methods: retrospective analysis, methods of comparison, correspondence, etc. Results. This article presents the results of the analysis of the morbidity structure of patients hospitalized in surgical and therapeutic departments of multidisciplinary medical organizations of the research base, which revealed that the most common diseases in these multidisciplinary medical organizations are respiratory diseases (Class X), circulatory system (Class IX) and digestive organs (Class XI). The analysis of the categories of the most common classes of diseases according to ICD-10 in each multidisciplinary medical organization showed the most common nosological forms in each category of ICD-10. For example, in the structure of diseases under the headings of Class I "Infectious and parasitic diseases" in all multidisciplinary medical organizations, the research base showed the predominance of the following nosological forms: chickenpox (B01) and acute intestinal infections caused by unidentified infectious agents (A09). Conclusion. To improve the quality of medical care, special attention should be paid to the compliance of the drug provision of multidisciplinary medical organizations with the structure of the morbidity of patients admitted to it.

Comparative analysis of actual and normative consumption of infusion solutions in multidisciplinary medical organizations

Objective: to carry out a comparative analysis of the actual consumption of infusion solutions in multidisciplinary medical organizations and the quantities of infusion solutions calculated on the basis of the generated database to determine the need for infusion solutions of each specific multidisciplinary medical organization. Materials and methods: statistical reports, journals of the movement of medicines and prescribing lists of medical histories of patients examined by multidisciplinary medical organizations, as well as data on standards of medical care and clinical recommendations were used as research materials. In the course of the study, methods of retrospective analysis, comparison, correspondence, etc. were used. Results: a comparative analysis of the data on the actual consumption of infusion solutions and the projected need for infusion solutions in multidisciplinary medical organizations, calculated using the generated database to determine the need for infusion solutions, showed an excess (in some cases, significant) of the actual consumption of 0.9% sodium chloride and 5% dextrose solutions in all surveyed multidisciplinary medical organizations compared to with regulations, regulated standards of medical care and clinical recommendations. Conclusions: in order to optimize the provision of infusion solutions to multidisciplinary medical organizations and, accordingly, to increase the effectiveness of medical care, it is important to use data on the structure of patients of multidisciplinary medical organizations and the most common nosological forms, as well as regulatory and reference information on the drug provision of patients with the most common nosological forms of diseases when predicting the need.

The main results of the analysis of the structure of consumption of infusion solutions in physical and cost terms in multidisciplinary medical organizations

Objective: to analyze the structure of consumption of infusion solutions in physical and cost terms in multidisciplinary medical organizations of the research base. Materials and methods: calculation of relative and average values, structural and functional analysis, system analysis, retrospective analysis, comparison method, correspondence. Results. As a result of the analysis of the structure of the consumption of infusion solutions by the main groups in multidisciplinary medical organizations of the research base, it was revealed that the largest share in the actual consumption of infusion solutions in kind are the groups of infusion solutions «Regulators of water-electrolyte and acid-base balances» and «Hemodynamic infusion solutions», which is explained by their significance for the provision of medical care in hospital conditions and the need for their appointment for a large number of patients of multidisciplinary medical organizations. As a result of the analysis of the structure of consumption of infusion solutions in value terms, we identified the main groups of infusion solutions that account for the greatest financial burden of multidisciplinary medical organizations of the research base, as well as the rating of the main groups of infusion solutions in the structure of consumption in value terms of multidisciplinary medical organizations. Conclusions. As a result of the analysis of the actual consumption of infusion solutions in kind, a significant predominance of the groups «Regulators of water-electrolyte and acid-base balances» and "Hemodynamic infusion solutions" was revealed. The analysis of the structure of infusion solutions consumption in value terms showed that the largest share in total infusion solutions consumption is also occupied by the groups of infusion solutions «Regulators of water-electrolyte and acid-base balances», "Other infusion solutions" and «infusion solutions for parenteral nutrition».

IMPROVING THE ASSESSMENT OF THE COMPETITIVENESS OF THE STRUCTURAL UNITS OF A SPORTS ORGANISATION

The article is devoted to improving the assessment of competitiveness sectors of multi-profile sports organization. The factors identified as a result of the comparative analysis, served as the basis for building an additive model to assess the competitiveness of separate, structural units of the sports organization. The main goal of building an additive model is the effective distribution of the financial resources of the sports organization between separate, structural subdivisions, professional clubs, regional offices and athletes representing nonteam sports. To build a model it is proposed to use factors (attributes) that reflect the specifics of sports organizations and take into account the indicators of financial and economic activity. The application of the additive model by sports managers in their professional activities requires legal justification in the local documents of the sports organization. The apodictic nature of the model is due to the objective, reliable data that are involved in the calculation. The integration of sports performance, results and accounting data in the model contributes to the smoothing of imbalances and improve the efficiency of the distribution of financial resources between the sectors of a multidisciplinary sports organization.

Features of providing medical care to patients with extensive high-voltage electric burns

Electrical injuries are a serious problem around the world. Patients with extensive, high-voltage electric burns belong to the group of severely burned. Timely and adequate treatment, which includes intensive anti-shock measures in the first days after injury, with simultaneous active surgical tactics, is decisive for saving life for such victims. The provision of specialized, high-tech medical care for these complex patients is optimal in conditions of a burn department / center of a multidisciplinary medical organization. However, knowledge of the basic principles of providing emergency and urgent medical care to victims with electrical trauma even before admission to the burn hospital is the key to their further successful treatment.

Safe launch of a robotically assisted mitral valve repair program in a single center: experience of initial 20 cases under the Center for Minimally Invasive Surgery.

Robotically assisted mitral valve repair was approved by the Japanese government in April 2018. However, understanding robotic surgery involves steep learning curves of surgeons and dedicated cardiac teams. The Center for Minimally Invasive Surgery (CMIS) of Tottori University Hospital is a multidisciplinary organization established in 2011 with seven surgical departments. In this study, we report strategies for improving the safety of robotic surgery in the CMIS and early results of robotic mitral valve repair at our hospital. We reviewed the first 20 patients who underwent robotic primary mitral valve repair, including concomitant procedures, from October 2019 to September 2021 under the supervision of the CMIS. Before starting the program, the CMIS requires setting console time limit to 180min and implementing risk management strategies through simulation training for various mechanical failures. Mitral valve repair was completed in all patients. There was no in-hospital or 30-day mortality. No conversion to median sternotomy was necessary. The analysis of mitral pathology revealed 1 case of functional mitral regurgitation, 12 cases of posterior lesions, 3 cases of anterior lesions, 3 cases of bileaflet lesions, and 1 case of commissural lesion. The average cross-clamp time was 133 ± 27min. Sixteen cases had trace mitral regurgitation postoperatively, and 4 cases had mild mitral regurgitation. The median (interquartile range) postoperative hospital stay was 10 (8.5-12.5) days. Robotically assisted mitral valve repair was performed safely with assistance from the multidisciplinary CMIS, and the early results were satisfactory without compromising clinical outcomes.

Preface

1st International Conference on Environmental Engineering and Green Technology -ICEEGT’22 held during April 5 & 6, 2022. ICEEGT’22 is a meeting place for Environmental Engineering and Green Technology specialists from academia and industry.The main purpose of the conference is to promote innovative research in environmental engineering and green technology. In addition, researchers, developers, engineers, students, and practitioners will be better able to share scientific knowledge. The annual conference will focus on environmental science and development, as well as other connected themes.Yazhli Global Multidisciplinary Research Organization (YGMRO), Tamilnadu, India, and Mizan-Tepi University, Ethiopia, are co-hosting the conference. The summit was intended to provide a scholarly forum for the exploration of environmental issues, sustainable development, environmental food & agricultural and green technology.List of Chief Patron, Patron, Chair, Editors, Steering Committee and Speakers are available in this pdf.

Mentorship in the Field of Aging: Purposes, Pivots, and Priorities

The Gerontological Society of America (GSA) is a multi-disciplinary organization dedicated to advancing the field of aging and improving the lives of older adults. With a long-standing commitment to mentorship and career development, this article focuses on GSA’s Mentoring Consultancies and Career Conversations events and their pivot to meet the needs and demands of current and future gerontologists amid the COVID-19 pandemic. This article provides a description of these events in the context of planning, content, and member engagement. Recommendations are provided to other organizations seeking to enrich their membership through mentorship and career development activities.

Barriers and facilitators in the implementation of a telemedicine-based outpatient brain tumor surgery program.

Despite growing evidence on the benefits of outpatient oncological neurosurgery (OON), it is only performed in a few specialized centers and there are no previous descriptions of established OON programs in Europe. Moreover, increasing application of telemedicine strategies, especially after the start of the coronavirus disease 2019 (COVID-19) pandemic, is drastically changing neurosurgical management, particularly in the case of vulnerable populations such as neuro-oncological patients. In this context, the authors implemented an OON program in their hospital with telematic follow-up. Herein, they describe the protocol and qualitatively analyze the barriers and facilitators of the development process. An OON program was developed through the following steps: assessment of hospital needs, specific OON training, multidisciplinary team organization, and OON protocol design. In addition, the implementation phase included training sessions, a pilot study, and continuous improvement sessions. Finally, barriers and facilitators of the protocol's implementation were identified from the feedback of all participants. An OON protocol was successfully designed and implemented for resection or biopsy of supratentorial lesions up to 3 cm in diameter. The protocol included the patient's admission to the day surgery unit, noninvasive anesthetic monitoring, same-day discharge, and admission to the hospital-at-home (HaH) unit for telematic and on-site postoperative care. After a pilot study including 10 procedures in 9 patients, the main barriers identified were healthcare provider resistance to change, lack of experience in outpatient neurosurgery, patient reluctance, and limitations in the recruitment of patients. Key facilitators of the process were the patient education program, the multidisciplinary team approach, and the HaH-based telematic postoperative care. Initiating an OON program with telematic follow-up in a European clinical setting is feasible. Nevertheless, it poses several barriers that can be overcome by identifying and maximizing key facilitators of the process. Among them, patient education, a multidisciplinary team approach, and HaH-based postoperative care were crucial to the success of the program. Future studies should investigate the cost-effectiveness of telemedicine to assess potential cost savings, from reduced travel and wait times, and the impact on patient satisfaction.

P45 OUTCOME AFTER ACUTE TYPE A AORTIC DISSECTION: THE ROLE OF AN AORTIC TEAM AND AN AORTIC REGIONAL NETWORK

Abstract Background The outcome of acute type–A aortic dissection (A–AAD) repair is strictly related both to surgical factors and patient conditions. Improvement in surgical experience and in diagnosis and treatment protocols could significantly increase survival for patients affected by A–AAD. The aim of this study was to assess the impact on patients outcomes of a standardized integrated surgical approach and of a regional aortic hub and spokes network. Materials and Methods From 2004 to 2021, a total of 258 patients underwent repair of A–AAD. In 2010 in our Institution was created the Aortic Team, with cardiac surgeons dedicated on the treatment of aortic pathologies, while in 2017 was created a regional aortic network between hub and spokes in order to standardize the diagnosis and treatment algorithm. Thus, patients were distributed among three periods: 2004–2010 (Era 1, n = 90), 2011–2016 (Era 2, n = 87), and 2017–2021 (Era 3, n = 81). Results Baseline demographic characteristics of the groups were similar. Compared to Era1 and Era2, clinical status at time of operation was better in Era3, because of less rates of malperfusion (16% vs 11% vs 4%, p = 0.01) and hemodynamic compromise (34% vs 38% vs 22%, p = 0.07). Patients of Era 3 were less likely to Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while femoral artery was mainly cannulated in Era 1 (91%) (p &amp;lt; 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); (p &amp;lt; 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) (p &amp;lt; 0.01). Frozen elephant trunk was mainly performed in Era 3. Operative mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 (p = 0.07, p = 0.03 between Era 1 and Era3). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Patients of Era 3 received less re–exploration for bleeding (p = 0.02) and less high inotropic support (p = 0.04). Conclusions With increasing experience and a more aggressive approach, including total arch replacement, repair of A–AAD can be more tailored to patients conditions, being performed with low operative mortality in many patients. Moreover, patient care and treatment by a multidisciplinary regional organization allows faster diagnosis and effective clinical stabilization allowing to further improve early and late outcomes.

Cited Reference Analysis in a National Laboratory to Assess Journal Usage*

Librarians at a large, federally funded, multidisciplinary research organization sought to assess the value provided by the library’s collections. One method for capturing this value includes determining how well their library’s collections meet researcher needs, as expressed by the materials those researchers choose to cite in the production of new scholarly communications. A cited reference analysis was performed on the publications originating from the institution to provide the necessary data for the assessment, as well as to aid in the creation of a core list of journals which will inform future collection development efforts. This paper fills a gap in the library and information science literature by addressing the citation behaviors of researchers at a large multidisciplinary government research facility, a setting that has not been examined previously.

Scoping the psychological support practices of Australian health professionals working with people with primary brain tumor and their families.

ObjectivesThis study aimed to scope the psychological support practices of Australian health professionals providing supportive care to adults with primary brain tumor.MethodHealth professionals from multidisciplinary organizations and cancer support services completed an online survey focused on psychological support for people with brain tumor (PwBT) and family members, and perceived barriers or gaps in support provision.Results107 professionals, mainly from psychology (45%), nursing (20%), and social work (10%) backgrounds, completed the survey. Scope of practice differed according to discipline, with psychologists and nurses most likely to screen for psychological distress (71%–76%), and psychologists more typically providing at least one psychological support session (78%). Psychologists were more likely to screen for cognitive impairment (31%), whereas nurses and social workers more commonly provided family‐based support (62%–73%). Psychological support was more frequently provided in the long‐term management phase (78%) than early post‐diagnosis/treatment (45%). System‐level barriers to accessing psychological support were most frequently identified, which included limited resources and funding, insufficient staff time, lengthy waitlists and costs, poor service coordination, and lack of staff with brain tumor‐specific training.ConclusionsThe provision of psychological support for PwBT varies according to discipline, setting and management phase. Further research on different models of psychosocial care is needed to inform strategies to address organizational and policy factors impacting professionals' scope of practice.

Strategy for a safe environment. Prevention fallsin a multidisciplinary medical organization

The aim of the study is the professional activity of a nurse in the prevention of falls in patients in a multidisciplinary hospital. Results. Literature sources on the problem of falls in a multidisciplinary hospital are analyzed; a practical study was conducted on the organization of the activities of nursing staff, aimed at preventing falls in patients in a multidisciplinary hospital; systematized a set of preventive measures to prevent falls in patients in a multidisciplinary hospital. Conclusion. The paper systematizes information on preventive measures taken by nursing staff in order to prevent falls and injuries of patients in a multidisciplinary hospital.