Regional Medical Institutions Research Articles

Important issues of professional burnout among hematologists and hematology department nursing staff during the COVID-19 pandemic

Background. Professional burnout (PB) among medical staff, namely hematologists, is of major importance, especially given the current shortage of personnel. It is of extreme value during the COVID-19 pandemic.Aim. To determine the degree of PB development among hematologists and nursing staff of hematological departments of federal and regional medical institutions in the context of the COVID-19 pandemic and to identify the associated factors.Materials and methods. The study was conducted in the period from July 2022 to September 2022 in the form of a onetime online survey of hematologists and nursing staff of hematology departments of federal and regional medical institutions in different cities of the Russian Federation. To interview specialists, a special checklist based on an Internet resource (Google forms) was used. It included burnout questionnaire Maslach Burnout Inventory (MBI) and questions related to factors that may be associated with the formation of PB. Statistical analysis included pairwise and multiple comparisons, as well as χ2 test, correlation and logistic regression analysis.Results. A total of 162 specialists took part in the online survey. More than half of the specialists (52 %) had high degree of emotional exhaustion, high level of depersonalization was detected in 39.5 % of specialists, and low level of personal accomplishment – in one third of specialists (32.1 %). It was shown that physicians, compared with nurses, had significantly higher indicators of PB. The level of problems for all PB components was significantly lower among specialists working in federal health facilities than among specialists working in regional clinics. The specialists who worked in the “red zone” showed a greater degree of emotional exhaustion and depersonalization than the specialists who did not work in the “red zone” during the pandemic. The formed PB syndrome was observed in 16 % of specialists, and its signs – in 42 %. The risk of PB was significantly greater in hematologists than in nurses, as well as among specialists with increased levels of depression and anxiety and dissatisfaction with the level of personal protective measures.Conclusion. The high importance of PB and the need for preventive measures among specialists of hematological centers and hematology departments in the Russian Federation is shown.

The incidence of Ph-negative chronic myeloproliferative neoplasms in Belarus

Introduction. Ph-negative myeloproliferative neoplasms (MPN) are chronic clonal disorders characterized by the proliferation of mature cells from one or more myeloid cell lines. These disorders include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF). The incidence of classical Ph-negative MPN varies significantly throughout the world. These differences may be due to geographical or population features, as well as due to differences in methods of diagnosis and recording. Aim: to determine incidence of Ph-negative MPN in Belarus. Materials and methods. Data on all cases of newly diagnosed Ph-negative MPNs (PV, ET and PMF) for 2014-2018 were collected from central regional medical institutions with a hematology specialization. Population epidemiological analysis of incidence was carried out by determining crude incidence rates per 100 000 population per year with distribution by genderand age groups at diagnosis, age-standardized rates, as well as average annual percent change. Results. The overall annual standardized incidence rate of classical Ph-negative MPN in Belarus was 1.96 (1.86–2.07), PV — 0.93 (0.86–1.01), ET — 0.63 (0.57–0.70) and PMF — 0.40 (0.36–0.45) per 100 000 population per year, respectively. The overall crude incidence rate was 3.26 (3.10–3.43) per 100 000 population. The crude incidence rates increased steadily with the increase in age of patients with a peak value of 12.78 (10.97–14.81) in the age group of 70–74 years. No significant changes were revealed in the overall incidence of the MPN and for each of the studied diseases separately during the study period. Conclusion. For the first time the nationwide features of incidence of the Ph-negative MPN in Belarus were estimated, which made it possible to provide substantial information for public health management. The incidence of MPN in Belarus is generally comparable to the levels determined in the analysis of the populations of other countries.

Public perception of the appropriateness of COVID-19 management strategies and level of disturbances in daily activities: A focus on educational level.

This study investigated the association between public perception of the appropriateness of management strategies implemented during the COVID-19 pandemic and the level of disturbances in daily activities reported by the general population. This cross-sectional study used Korea Community Health Survey conducted from August to November 2020. Public perception of COVID-19 management strategies included those implemented by the government (central, city or provincial, and administrative districts), the mass media, regional medical institutions, and neighbors. The subjective level of disturbances in daily activities was measured using a 0-100 numeric rating scale developed by Korea Disease Control and Prevention Agency. Multivariable linear regression analysis was used. A subgroup analysis was conducted based on education level. The present study analyzed 211,353 participants. Compared to individuals who perceived that the management strategies implemented during the pandemic was 'highly appropriate,' those who reported 'mediocre appropriateness' (β: -1.96, p-value: <0.001) or 'low appropriateness' (β: -3.60, p-value: 0.010) reported higher levels of subjective disturbances. The appropriateness of measures implemented by the mass media was associated with levels of subjective disturbances felt by individuals of lower education with statistical significance, whereas that applied by the mass media and the government were important in those with higher education. The findings suggest the importance of public perception of management strategies when implementing containment policies and minimizing its disturbances on daily lives is essential.

Experience of curation of patients with subarachnoid hemorrhage in the Krasnoyarsk Region using Regional Stroke Monitoring module

Objective: to evaluate the results of managing patients with subarachnoid hemorrhage in the Krasnoyarsk Region using the Regional Stroke Monitoring (RSM) module for the period 2014-2020. Material and methods. We analyzed 836 electronic applications from regional hospitals of the region in the RSM module for patients with subarachnoid hemorrhage for the period 2014-2020. Results. Over the seven-year period of work in the RSM module (2014-2020) it was possible to increase the number of patients with ruptured cerebral aneurysms transferred from the regions for surgery by 52.2% (from 88 patients in 2014 to 134 in 2020) and reduce the time from the admission of patients with subarachnoid hemorrhage to the regional medical institutions to their transfer to the regional vascular center for 1 day (from 1,5±0,6 days in 2014 to 0,6±0,5 days in 2020). Conclusion. In the geographically long Krasnoyarsk Region, where it is impossible to perform neurosurgical operations in most district hospitals, RSM module helps to track patients with aneurysm ruptures in real time and transfer them to the regional vascular center for surgical treatment in a timely manner, before the re-rupture or development of angiospasm.

Factors influencing the health satisfaction of users of public health and medical institutions in South Korea.

In this study, we investigated the health satisfaction levels of users of regional health and medical institutions in South Korea and the influencing factors. We included randomly selected 300 people with experience in using health and medical institutions from panel data targeting the entire nation. We used questionnaire (EQ-5D-5L) and sociodemographic characteristics to analyze the health satisfaction. EQ-5D-5L was used to measure health-related quality of life in five areas: mobility, self-management, daily activities, pain/discomfort, and anxiety/depression. Hierarchical linear regression analysis was performed in three steps to examine the factors influencing health satisfaction. The analysis showed that the health satisfaction was positively (+) correlated with monthly income, mobility, self-management, daily life, pain/discomfort, and anxiety/depression, and negatively (-) correlated with the number of chronic diseases and type of health insurance. The influencing factors in Step 1 and 2 were chronic diseases (β = -0.380, -0.385), respectively. The influencing factors in Step 3 were pain/discomfort (β = 0.202), anxiety/depression (β = 0.257), and the number of chronic diseases (β = -0.222). The current data suggested that regional health and medical institutions should focus their services on residents with chronic diseases. Moreover, they should expand physical activities to relieve physical pain or discomfort and provide services related to mental health. To accomplish these, we suggested that the government will need to promote post-service health checkup results as a key project, provide user-customized services, provide online services utilizing ICT, expanding the government's financial support, and building infrastructure.

Обзор работы государственной стоматологической службы Тверской области в 2021 году

Taking care of the health of the population of the Tver region is an important direction of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of the citizens of the Tver region, to increase the role of preventive care of dental diseases, to form a model of organization of the dental industry that ensures the availability and quality of dental care, to increase the efficiency of dental services, the volume, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science. The aim of the research is the analysis of the statistical data of the stomatological service of the state public health institutions of the Tver region. Materials and methods. Analysis of the statistical data reflecting demographic indexes, statistics of the stomatological service structure, staffing, distribution of dentists among the institutions of the Tver region, quality of dental care, the main indexes of the stomatological service of the Tver region, indexes of treatment and preventive work. Results. The present study is devoted to the analysis of the activity of state medical institutions of health care of the Tver region that provide dental care to the population of the Tver region. The indices of the provision of dentists in this region (not taking into account orthopedists and orthodontists) makes 3,82 posts for 10 thousand population (426,25 rates in total). Indicators of provision of the region’s population with dentists are 4,3 positions per adult population of the region. The deficit specialties have been revealed: pediatric dentists, orthodontists, in the regional institutions there is a shortage of orthopedists. The share of occupied staff positions in the specialty of pediatric dentistry was 49%, which reflects the need for training in this area. The difficulties in the organization of preventive examinations of the children’s population were revealed, and the low percentage of the examined persons. Conclusions. The municipal, district and regional medical institutions of health care rendering dental treatment to the population are functioning on the territory of the city of Tver and the Tver region in general. The statistical analysis has revealed a number of difficulties that require further action on the part of the medical community and public organizations. It is necessary to develop comprehensive measures to solve the shortage of pediatric dentists at the level of the Ministry of Health and educational institutions. The difficulties of preventive examinations among the population of different groups are highlighted. It is important to strengthen the preventive profile in order to reduce the cases of complicated caries, tooth extraction. Development of hygienic direction will increase awareness of the population about the peculiarities of dental and oral hygiene, methods of prevention and treatment of dental diseases.

1321MO Relevance index by cancer type: Trends and regional variation analysis, 2016-2020, Republic of Korea

In order to prepare a comprehensive healthcare system for cancer patients in the region, it is necessary to first prepare data on how cancer patients in the region use medical institutions. The data on cancer patients’ use of regional medical institutions will be useful in establishing plans to strengthen facilities and manpower for cancer patient care at medical institutions in the region. In this study, relevance index, which is a type of analysis indicator for medical service area, was analyzed for cancer diseases. Claim data from the Korean National Health Insurance Service were used for the analysis. Specifically, from 2016 to 2020, the inpatient and outpatient medical service use data of clinics, medical institutions, and public health institutions for medical or dental field were analyzed. The relevance index, which is the value obtained by dividing the amount of services used by medical institutions located in a specific area by the total medical services used by people living in a specific area, was measured by medical service type (outpatient and inpatient) and indicator type (number of patients and co-payments). Korea’s relevance index for cancer in inpatient treatment has hardly improved. In particular, the relevance index for cancer was highly variable by region. Seoul had the highest relevance index for cancer (5-year average 89.98%), while Gyeongsangbuk-do (5-year average 30.76%) had the lowest relevance index for cancer. “Bone and connective tissue cancer” (5-year average of 40.2%) had the lowest relevance index, while “Other neoplasms and unspecified cancers” (5-year average of 70.3%) had the highest relevance index. The relevance index for cancer in outpatient treatment tended to be higher than that in inpatient treatment. Furthermore, the relevance index for cancer based on co-payment tended to be lower than that based on the number of patients. In order to provide timely, effective, and patient-centered cancer treatment, it is necessary to have a comprehensive cancer treatment system in the region. The relevance index for each cancer type and year in Korea calculated in this study will be an important indicator to monitor in order to establish a comprehensive cancer treatment system in the region.

Organization of specialized assistance to the patients with seriously thermal burn in Primorsky region

The review examines the organization of specialized medical care for victims having burn injury in Primorsky Region. Thermal injury continues to occupy a significant place in the structure of domestic and industrial injuries in the Russian Federation. Every year, more than 300 calls about patients having thermal damage are received in Primorsky Region TCDM. For five years (from 2017 to 2021), specialists of the Primorsky TCDM made 178 visits to regional medical institutions, 160 seriously burned people were delivered to the specialized department by ground and air transport. There is still a need for round-the-clock collection of medical and sanitary information about the severely burned patients in medical institutions of Primorsky Territory and the organization of interaction with a specialized department. The Regional TCDM organized timely evacuation of patients having deep thermal traumas to the burn unit of FEDMC. It allowed performing surgical treatment tactics, including effective early removal of necrotic tissues. An analysis of appeals to the dispatcher's office of the Territorial Center for Disaster Medicine regarding severe thermal injury, as well as a statistical analysis of victims from remote areas of the Primorsky Territory delivered to the burn department in Vladivostok were conducted. It is emphasized that timely transportation of patients having severe burn injuries is the first step in the system of active treatment of victims which allows conducting early surgical treatment and reducing the number of complications, and improving treatment results.

Первая семилетка. Калмыцкое здравоохранение в 1959–1965 гг.

Introduction. The article analyzes the recovery period of Kalmykia’s healthcare system after the 1957 return of Kalmyk people from deportation. The chronological framework coincides with the first Soviet seven-year plan — from 1959 to 1965. Goals. The paper aims to examine actual conditions of the healthcare sector in Kalmykia during the period examined. Materials and methods. The work mainly explores archival documents from the National Archives of Kalmykia, it employs both general scientific (analysis, comparison) and special historical research methods. The historical systemic method makes it possible to reveal the relationship between government policy and the changes that took place in the republican healthcare. The quantitative (statistical) method and the chronological principle prove as instrumental in achieving objectives set forth. Results. After the restoration of autonomy, the healthcare system of the republic becomes part of national health services to build its work in accordance with certain federal regulations. The period witnesses the establishment of foundations for further development of Kalmykia’s healthcare, emergence of specialized medical aid, and opening of new medical institutions. The health budget of the republic and subsidization for the construction of a regional medical institutions network were increasing. Conclusions. The participation of the Government manifested in financial, material, technical support and staffing had a definitely positive effect on the development of the republic’s healthcare system and laid the foundation for its further growth.

Korean Society of Nephrology hemodialysis unit accreditation report (2016-2020) and future directions.

BackgroundPatients receiving hemodialysis have various complications with a high mortality rate and require specialized treatment at an institution equipped with an appropriate workforce, equipment, and facilities. The Korean Society of Nephrology (KSN) is conducting hemodialysis unit accreditation to manage the quality of hemodialysis institutions, present standard treatment guidelines, and establish a network between regional medical institutions for the safe treatment of hemodialysis patients. This study aimed to summarize the previous accreditation results and discuss future directions.MethodsAfter the proposal of hemodialysis unit accreditation in 2009, pilot projects were undertaken for hemodialysis units and dialysis subspecialist training hospitals in the metropolitan area for 5 years. Since 2016, five hemodialysis unit accreditation projects have been conducted.ResultsThe cumulative number of participating units was 599, and the number of accredited units was 473 (average accreditation rate, 79.0%). The participating units consisted of clinics (58.6%), non-university hospitals (28.2%), and university hospitals (13.2%). Overall, 92.4% of university hospitals, 81.2% of clinics, and 68.0% of non-university hospitals were accredited. Over 5 years, new units were added annually to apply for accreditation, and the rate of previous participants applying for reaccreditation was high (77.7%). However, considering that the total number of member institutions of the KSN is 637, the number of units with valid accreditation as of 2020 was low (267 [41.9%]).ConclusionThe efforts of the KSN and its members, as well as institutional support from the government, are required for quality management of hemodialysis units through hemodialysis unit accreditation.

Evaluation of Current Resources Available for Community-Based Cardiac Rehabilitation in Korea: A Nationwide Survey Study.

BackgroundIn Korea, the actual distribution of cardiac rehabilitation (CR) to the clinical field is insufficient due to the many barriers for cardiovascular patients to participate in CR. Community-based CR is a useful alternative to overcome these obstacles. Through a nationwide survey, we investigated the possibility of regional medical and public health management institutes which can be in charge of community-based CR in Korea.MethodsThe questionnaires on recognition of CR and current available resources in health-related institutions were developed with reference to the CR evaluation tools of York University and the International Council of Cardiovascular Prevention and Rehabilitation. The questionnaires were sent to regional public and private medical institutions and public health management institutions.ResultsIn total, 2,267 questionnaires were sent to 1,186 institutions. There were 241 and 242 responses from 173 and 179 regional private and public medical institutions, respectively. And a total of 244 responses were gathered from 180 public health management institutions. Although many institutions were equipped with the necessary facilities for exercise training, there were few patient-monitoring systems during exercise. Most institutions were aware of the need for CR, but were burdened with the cost of establishing personnel and facilities to operate CR.ConclusionMost regional medical, and public health management institutions in Korea are unprepared for the implementation of community-based CR programs. To encourage the utilization of such, there should be efforts to establish a national consensus.

성가롤로병원의 변혁적 리더십과 위기 극복

With the spread of coronavirus disease (COVID-19), the importance of local medical institutions’ infectious disease control and disaster response efforts has been emphasized. In particular, large regional medical institutions have played a pivotal role in responding to the outbreak. The purpose of this study is to examine how transformational leadership— with its four elements of idealized influence, inspirational motivation, intellectual stimulation, and individual consideration—affects hospital operations in addressing the crises. By performing qualitative research involving in-depth interviews on the transformational leadership and crises management capabilities of St. Carollo Hospital, which has grown from a small regional medical center to a large regional medical institution, this study aims to identify the role of transformational leadership in enabling a small clinic to develop and overcome challenges. The findings will have academic and practical implications and add to the current literature, which has focused mostly on large corporations and organizations.

Process Evaluation of the Regional Referral Clinical Pathway for Home-Based Palliative Care and Outreach Program: A Questionnaire Survey of the Medical Staff and Bereaved Families.

Background: The purpose of this study was to clarify how the Regional Referral Clinical Pathway for Home-based Palliative Care (RRCP-HPC) and an outreach program by a palliative care team (PCT) lead to an improvement in the outcome. Design and Methods: We conducted questionnaire surveys using the mailing method involving the regional medical staff involved in cancer patients introduced to the PCT of a single hospital, as well as bereaved families. The questionnaire was prepared through interviews with the medical staff and bereaved families. Subsequently, factor analysis was performed to identify factor structures and calculate the correlation coefficient with each outcome. Results: For the questionnaire survey involving the medical staff, responses were collected from 119 regional medical institutions and 84 regional medical staff. The response rate per institution was 51.3%. Similarly, for the questionnaire survey involving bereaved families, the response rate was 42.4%. For the survey involving the medical staff, 6 factors, such as “improved awareness of an interdisciplinary team,” were extracted. For the survey involving the bereaved families, 4 factors, such as “improvement of communications between patients and healthcare professionals,” were extracted. There were significant (≥moderate) correlations between these factors and all outcomes. Conclusion: In this study, we clarified the process of achieving palliative care until death at home without difficulties using the outreach program and RRCP-HPC. The results suggest the importance of improving communications. The outreach program and RRCP-HPC may have contributed to palliative care at home without difficulties through an improvement in communications.

Индивидуально-типологические особенности руководителей региональных медицинских учреждений санаторно-курортного профиля

Sanatorium complexes are a special direction related to the health care system, their heads are required to have specialized knowledge. However, there are different views on this, some experts believe that a professional manager can productively perform duties in an institution of any profile. Others believe that the head of a medical institution must have a medical education, otherwise difficulties may arise. Currently, there is a lack of research focused on the identification, assessment and consistency of personality traits with the direction of work. The article examines the individual-typological features of the heads of regional medical institutions of a sanatorium-resort profile. There were revealed clearly expressed individual-typological features that distinguish managers with medical education in cognitive, personal and motivational components from leaders of a different educational profile, which affects professional efficiency. Psychological basic features that determine the activity and behavioral activity of employees within the profession were identified. A formal-mathematical model has been developed, which makes it possible to comprehensively assess the level of effectiveness of professional management activities of managers. In addition, regional specificity was identified, which proves the influence of climatic and economic conditions on the mental and behavioral characteristics of a specialist.

The Health Care System of the Semipalatinsk Region of the Steppe Territory: Stages of Formation (60s of the 19th Century — the Beginning of the 20th Century)

On the basis of different sources, mainly annual regional statistical surveys, the stages of the formation of the health care system of the Semipalatinsk region of the Steppe Governor General are revealed. At the first stage, the end of the 60s — 80s of the 19th century, the accession of the Steppe Territory to the Russian Empire was completed. The integrating policy of this ethnoregion into the political-legal and socio-economic space of the empire was initiated. In the social sphere, it led to the creation of a health system. The procesas had a number of specific features due to the absence of zemstvos and zemstvo medicine and the predominance of Kazakh nomads in the ethnosocial structure of the region. Therefore, in contrast to the central regions of Russia, the development of the health care system in the Steppe Territory was dealt with by the provincial and regional administrations. The second stage (the end of the 80s 19th century — 1917) is associated with the beginning of the mass migration of peasant migrants from the European part of Russia to the Steppe Territory. This stage is characterized by the expansion of the network of regional and county medical institutions, the improvement of their material and technical base, the expansion of the specialization of practicing doctors, and the solution of the personnel problem.&#x0D; Also, at that stage, the system of management of medical institutions was improved and government organizations, for example, the Resettlement Department, were involved in solving problems related to health care services for the p opulation. In general, statistics show that by 1917 the quality of health care services and the percentage of population involvement remained at a low level.

Development and Validation of a Predictive Model for Severe COVID-19: A Case-Control Study in China.

Background: Predicting the risk of progression to severe coronavirus disease 2019 (COVID-19) could facilitate personalized diagnosis and treatment options, thus optimizing the use of medical resources.Methods: In this prospective study, 206 patients with COVID-19 were enrolled from regional medical institutions between December 20, 2019, and April 10, 2020. We collated a range of data to derive and validate a predictive model for COVID-19 progression, including demographics, clinical characteristics, laboratory findings, and cytokine levels. Variation analysis, along with the least absolute shrinkage and selection operator (LASSO) and Boruta algorithms, was used for modeling. The performance of the derived models was evaluated by specificity, sensitivity, area under the receiver operating characteristic (ROC) curve (AUC), Akaike information criterion (AIC), calibration plots, decision curve analysis (DCA), and Hosmer–Lemeshow test.Results: We used the LASSO algorithm and logistic regression to develop a model that can accurately predict the risk of progression to severe COVID-19. The model incorporated alanine aminotransferase (ALT), interleukin (IL)-6, expectoration, fatigue, lymphocyte ratio (LYMR), aspartate transaminase (AST), and creatinine (CREA). The model yielded a satisfactory predictive performance with an AUC of 0.9104 and 0.8792 in the derivation and validation cohorts, respectively. The final model was then used to create a nomogram that was packaged into an open-source and predictive calculator for clinical use. The model is freely available online at https://severeconid-19predction.shinyapps.io/SHINY/.Conclusion: In this study, we developed an open-source and free predictive calculator for COVID-19 progression based on ALT, IL-6, expectoration, fatigue, LYMR, AST, and CREA. The validated model can effectively predict progression to severe COVID-19, thus providing an efficient option for early and personalized management and the allocation of appropriate medical resources.

Activities of the ORT-OZE Committees: from the history of Jewish transnational philanthropy in 1920s – 1940s

The article examines activities of two large Jewish philanthropic organizations – the Union of Societies of Handicraft and Agricultural Work among Jews (ORT Union) and the Union of Societies for the Protection of the Health of the Jewish (OZE Union), that actively cooperated in the period between the First and Second World Wars. The main goal of cooperation between these organizations was to provide urgently needed assistance to the Jewish population of Eastern Europe, which was in a state of permanent crisis and therefore sought to emigrate to the more prosperous countries of Western Europe and to the United States. The author analyzes of previously unpublished archival sources and limited editions of the 1920s – 1930s shows how the ORT-OZE transnational network, which included the local branches, regional public committees, financial corporations, vocational and medical institutions, was able to function successfully, to mobilize all available resources for its constructive work and to conduct a number of social and educational programs directed toward rehabilitation of the Jewish emigrants, despite the difficult political situation in the world. The institutional ideologies of ORT and OZE played an important role in the success of these activities, due to which it was possible to overcome the mistrust between emancipated and religious Jews, between Westjuden and Ostjuden.

Experience in deployment and functioning of aeromobile hospital of Emercom of Russia when eliminating the consequences of biosocial emergency situations (in a coronavirus outbreak area)

Relevance. Based on the appeal of the Governor of the Murmansk region to the Operational Headquarters on preventing import and spread of a new coronavirus infection in Russia due to the aggravation of the epidemiological situation and in order to localize the spread of COVID-19, the Russian Emercom allocated forces and capabilities, including an airmobile hospital (AMH) and a temporary accommodation center, in the region. AMH was deployed at the industrial site of the Center for the construction of large-scale offshore facilities of NOVATEK-Murmansk LLC and subcontractors in Belokamenka village, where more than 10 thousand people worked and lived on a rotational basis.Intention. Summarize and analyze the experience of the AMH of Emercom of Russia under field conditions of an outbreak of the new coronavirus infection.Methodology. Daily reports on the activities of Emercom of Russia AMH were analyzed for the period from April 17, 2020 to June 12, 2020.Results and Discussion. Field camp deployment and functioning of Emercom of Russia AMH integrated into a regional medical and preventive institution are described. The data on admitted patients, scope and types of diagnostic tests are presented. It is shown that AMH as a separate outpatient diagnostic department of the Kolsky Central District Hospital should provide special and sanitary treatment, patient referrals and an algorithm of personnel activities, and also comply with antiepidemic measures. During the period of AMH activities in the field, 1678 shift workers got medical advice, 3086 diagnostic studies were carried out for shift workers and employees of the Emercom of Russia. COVID-19 was detected in 500 persons, including 328 cases of mild disease, 98 cases of moderate severity, and 74 severe cases, without case fatalities. The outbreak and spread of the new coronavirus (COVID-19) infection as an emergency in the subject of Russia and at the large industrial and construction site were brought under control.Conclusion. This experience will help improve the activities of the Emercom of Russia AMH under field conditions.

Using of telemedicine in treatment of severe community-acquired pneumonia in Krasnoyarsk state

Introducrion. Due to the peculiarities of the Krasnoyarsk krai (a huge territory, low population density, different levels of health development in the districts, personnel shortage), there is a need to increase the availability and quality of medical care to district patients. For this purpose, since 2016, the Regional telemedicine system has started functioning online monitoring for patients with severe pneumonia, which provides full-fledged curation of patients from all over the region.Objective. To evaluate the results of RTS monitoring of patients with severe pneumonia.Materials and methods. 770 cases of severe community-acquired pneumonia registered in RTS from 2016 to 2018 were analyzed. Statistical data processing was performed using variational statistics using the “Excel-7” software package. For all values, the minimum significance level (p) of 0.05 was taken into account.Results. The risk factor for severe flow was male. Among comorbid diseases, cardiovascular and bronchopulmonary diseases, diabetes, alcoholism and HIV infection prevailed. The lack of flu vaccination in 97% of patients increased the number of deaths by 4.5 times. The greatest need for consultation arose in the Central district hospitals of low capacity. The majority of patients are registered in the system on the first day of hospitalization and are consulted by a pulmonologist of the Regional clinical hospital within 2 hours. Air ambulance of the Regional clinical hospital evacuated 174 patients, the need for flights decreased by 3.5 times. The main mistakes of district hospitals in the management of patients were the irrational selection of antibacterial drugs, the volume of detoxification therapy, the late start of antiviral therapy and ventilators, and the lack of prescription of anticoagulants.Conclusions. Along with the presence of comorbidities, the outcome of the EAP is affected by the quality of medical care, which depends on the professional training of medical workers, continuity in the work of regional medical institutions and air ambulance, which causes difficulties, given the specifics of the region. RTS allows you to solve this problem at minimal cost.

Prevalence and risk factors of sarcopenia in community-dwelling older adults visiting regional medical institutions from the Kadoma Sarcopenia Study

This study aimed to investigate risk factors for sarcopenia in community-dwelling older adults visiting regional medical institutions. We retrospectively analyzed medical records of 552 participants (mean age: 74.6 ± 6.7 years, males 31.3%) who underwent body composition evaluation between March 2017 and December 2018 at one of 24 medical institutions belonging to the Kadoma City Medical Association in Japan. We collected the participant’s characteristics and laboratory data. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019. Sarcopenia, including severe sarcopenia, was detected in 22.3% of all participants, 17.3% of men, and 24.5% of women; rates increased with age. Multivariate logistic regression analysis revealed age (odds ratio [OR]: 2.12; 95% confidence interval [CI] 1.20–3.75), obesity (OR: 0.15; 95% CI 0.07–0.32), hypertension (OR: 0.44; 95% CI 0.25–0.76), certification of long term care (OR: 3.32; 95% CI 1.41–7.81), number of daily conversations (OR: 0.44; 95% CI 0.25–0.77), and malnutrition (OR: 2.42; 95% CI 1.04–5.60) as independent predictors of sarcopenia. Receiver operating characteristic curve analysis demonstrated that the cut-off for daily conversations defining sarcopenia was 4.8 persons. The prevalence of sarcopenia in this study was 22.3%. Besides traditional risk factors for sarcopenia, the number of daily conversations was an independent factor.