Regional Medical Institutions Research Articles

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.

Experience in Immunizing HIV-Infected Children against Pneumococcal Infection and Influenza

Relevance. The lethal outcomes of HIV infection are determined by secondary diseases, among which tuberculosis and pneumonia take the leading place. Vaccination is an important way to reduce and prevent the development of infectious diseases in both adults and children. Particular attention is paid to children with HIV infection, the incidence of which is much higher in comparison with children without HIV positive status. The purpose of the study was to study the effectiveness of the prevention of lower respiratory tract infections with pneumococcal and influenza vaccines in HIV-infected children. Materials & Methods. The material was data from medical records about HIV-infected children. The research method is visual using retrospective analysis. Results. Immunological indicators and the general health status of HIV-infected children were assessed during their registration with the regional AIDS center. Changes in the immunological status of patients under dynamic observation were described. The timing of vaccination was analyzed and a comparison was made with the development of bacterial diseases in HIV-infected children. Conclusions. A low incidence of bacterial infections and the absence of pneumococcal pneumonia in HIV-infected children were revealed. Vaccination against pneumococcal infection and influenza must be given to all HIV-infected children from the moment they are registered with a regional specialized medical institution.

INNOVATIVE MODELS FOR MANAGING THE PRIMARY HEALTH CARE SYSTEM (regional experience)

The article analyzes the practice of applying innovative models of primary health care system management in the framework of the Belgorod region project «Health Management». The special place is given to the evaluation of innovative models of primary health care organization on the Belgorod region’s territory. The experience of medical care for adults and children in urban and rural areas by general practitioners (family doctors) is presented. Changes in the structure of primary care physician admission in regional medical institutions are shown. The expediency of innovative modeling is confirmed by the presence of organizational and medical-demographic effects.

Productivity Growth in Chinese Medical Institutions during 2009–2018

China is the most populous nation and considerations of economic efficiency in the social sectors is important for maintaining the wellbeing of such a large population. This is especially true when gauging the performance of the healthcare sector treating the population. In this paper, we examine the total factor productivity (TFP) growth in Chinese medical institutions during the period 2009–2018, which experienced a systemic healthcare reform. In order to identify the contribution from each component of TFP indicators and from each provincial or regional medical institutions, a generalized decomposition of productivity gains is applied to analyze hospital operations based on an aggregate directional distance function (DDF). The results show that the annual average TFP growth rate in Chinese medical institutions is 1.87% that is mainly driven by technological progress (0.75%, per annum), while less contributed by technical efficiency change (0.65%, p.a.) and scale efficiency change (0.47%, p.a.). Disparities of provincial hospital performances are observed that may provide policy implications for decision makers.

Questionnaire survey on hepatitis B vaccine in clinics

We conducted a questionnaire survey on the status of implementation of hepatitis B vaccination and HBs antibody testing. It involved medical personnel covering 484 regional medical institutions in the Osaka Province. Results showed that the recognition rate was 30.1%, the hepatitis B vaccination implementation rate was 38.9%, and that of HBs antibody testing was 38.9%. Although 42.5% of the medical institutions had experienced needle-stick injuries, some medical institutions did not respond properly. The low implementation rate of hepatitis B vaccination and HBs antibody test could be explained by lack of recognition for hepatitis B infection control guidelines. Therefore, we can achieve a possible improvement in the control of infection in the Province, if sensitization programs on hepatitis B infection control are organized in the various regional medical institutions in order to provide adequate information and raise awareness on the importance of respecting these guidelines.

Improving the diagnosis, treatment and secondary prevention of stroke using a unified online system: primary vascular department - regional vascular center - family doctor

The introduction of the Stroke Platform (SP) in the Belgorod Region to improve the efficiency of diagnosis and care for patients with stroke. Stroke platform is a unified information platform that unites all stages of treatment of a patient with stroke, from the first symptoms to dispensary observation by a family doctor and control of targeted provision of medicines for the secondary prevention of vascular events. The SP includes 6 modules: the Central Archive of Medical Images or the Picture Archiving and Communication System (PACS) and connection to a single circuit of all CT devices of the regional medical institutions; Stroke register; secondary prevention register; routing bureau; statistics and analytics; COVID platform. The SP, as it develops, can be supplemented with those modules that are necessary to improve the quality and availability of patient care. More than 100 consultations of CT images are carried out monthly through the SP, the average response time is less than 10 minutes, 52 platform participants are in constant contact, all medical institutions of the region are connected. Five hundred and forty patients were consulted for 6 months of 2020. The share of hospitalizations in specialized departments increased to 97.6% versus 86.3%. The availability of high-tech medical care for patients with stroke has increased due to timely transfer to the district vascular center. Endovascular interventions for aneurysms and arteriovenous malformations, stenting of extracerebral arteries during dissection, mechanical thrombectomy from large arteries are performed. Mortality decreased from 19.7% (2019) to 17.6%. At the stage of outpatient follow-up, it is possible to obtain information about the range of those drugs that are prescribed to the patient for prophylaxis and are delivered to the target. The main feature of the SP is the speed and efficiency of making medical decisions, ergonomics and ease of interaction, a single workspace.

Role of galectins 1 and 3 in the recruitment of eosinophilic granulocytes into tumor tissue in gastric and colon cancers

Background: Gastric and colon tumors are often associated with eosinophilic infiltration of tumor tissue, the significance of which is still not entirely clear. The recruitment of eosinophils into the tissues can be in part regulated by galectins ― galactose-binding proteins which are expressed by a variety of tissues and are capable of exerting a broad range of effects.
 Aims: To evaluate the expression of galectin-1 and galectin-3 in tumor tissue, and gal-3 gene mRNA expression in blood eosinophils in patients with gastric and colon cancer with or without tissue eosinophilia.
 Materials and methods: The study included a total of 107 patients (84 males and 23 females, average age 60,9 6,8) with verified gastric cancer (52 persons) and colon cancer (55 persons), who underwent treatment or were registered at the dispensary at the regional medical institution Tomsk Regional Oncology Center (Tomsk, Russia). The control group consisted of 15 men and 11 women of comparable age. The materials of the research included samples of gastric and colon tumors obtained during surgery, and eosinophilic granulocytes isolated from whole blood by immunomagnetic separation. Galectin-1 and galectin-3 expression in tumor tissue was evaluated by immunohistochemistry. The expression of gal-3 gene mRNA in eosinophils was determined by real-time reverse transcription polymerase chain reaction. Statistical analysis of the results was carried out using the non-parametric Mann-Whitney U test for independent samples with Benjamini-Hochberg procedure for multiple comparisons, and the Chi-square Pearson criterion with Yates correction.
 Results: In patients with gastric cancer and colon cancer, regardless of the presence of tissue eosinophilia, low expression of galectin-3 in the tumor tissue and high expression of gal-3 gene mRNA in peripheral blood eosinophils were found. Gastric and colon cancer patients with eosinophilic infiltration of tumor tissue were characterized by low expression of galectin-1 within tumor cells (in 64.0% cases, 2 = 4.890, р = 0.029; and in 73.9% cases, 2 = 5.981, p = 0.031 respectively). There was a statistically significant connection between the level of galectin-1 expression by tumor cells and the presence of tissue eosinophilia both in gastric ( = 0.307) and colon cancer ( = 0.330).
 Conclusion: Low expression of galectin 1 and 3 by tumor cells in gastric and colon cancer with tissue eosinophilia indicates the lack of a significant effect of these proteins on the process of recruiting eosinophilic granulocytes into tumor tissue. Increased expression of galectin-3 in blood eosinophils in gastric and colon cancer is not associated with the presence of eosinophilic infiltration of tumor tissue.

Real-World Effectiveness and Safety of Nivolumab in Special Subgroups of NSCLC pts: A Multicenter-Retrospective Study

Abstract Background In December 2015, nivolumab was approved as treatment for previously treated NSCLC irrespective of PD-L1 expression or histology in Japan. There are few reports that include real-world data on large-scale cohorts of patients with special backgrounds from Japan. Method Data from patients who initiated nivolumab treatment from April 1, 2016 to December 31, 2016 were collected at 23 regional medical institutions across Japan. Here we report retrospective analysis of all 901 pts data and focus on effectiveness and safety in special subgroups of the Japanese NSCLC patients, from a multicenter, observational study; CA209-9CR (NCT03273790). Result Patients with EGFR mutations showed significantly shorter PFS as compared to EGFR wild-type patients. Among other special groups, 316 pts with high blood pressure, in which 272 pts was on antihypertensive, showed superior ORR as compared to 585 pts with normal pressure at baseline. Safety analysis showed higher pulmonary toxicity in patients with pulmonary infection at baseline and higher hepatotoxicity in a group of pts infected with hepatitis virus. In this presentation, further analysis on the other subgroups will be presented.

Real-World Effectiveness of Nivolumab by PD-L1 Expression in NSCLC pts in Japan: A Multicenter-Retrospective Study

Abstract Background Since its approval in December 2015, nivolumab has been widely used as a second-line treatment for non-small cell lung cancer (NSCLC) patients regardless of tumor PD-L1 expression or histology. However, the relationship between nivolumab effectiveness and PD-L1 expression using 22C3 PharmDx in the real-world setting is unclear. Methods Data from patient who initiated nivolumab treatment from April 1, 2016 to December 31, 2016 were collected at 23 regional medical institutions across Japan. Tumor PD-L1 expression was determined using PD-L1 IHC 22C3 PharmDx or 28-8 PharmDx assays. Here, we report the relationship between nivolumab effectiveness/safety and PD-L1 expression using 22C3 PharmDx, from a multicenter, observational study; CA209-9CR (NCT03273790). Results PD-L1 expression in 348 cases of NSCLC was determined using the 22C3 PharmDx assay. The propotion of cases with PD-L1 negative ( Conclusion These real-world data show relationship of nivolumab effectiveness and PD-L1 expression using 22C3 PharmDx.

Exploratory Analysis of Nivolumab Effectiveness with Lab Data in NSCLC pts in Japan: A Multicenter-Retrospective Study

Abstract Background In December 2015, nivolumab was approved for previously treated advanced NSCLC irrespective of PD-L1 expression or histology in Japan. Real-world data can provide insights beyond the clinical trial, and in this analysis we study a large Japanese patient cohort. Methods Data for 901 patients who initiated nivolumab treatment for advanced NSCLC from April 1, 2016 to December 31, 2016 were collected at 23 regional medical institutions across Japan, including clinical laboratory data before and all the available data during nivolumab treatment. Here we report an exploratory analysis on the association of nivolumab effectiveness with the clinical laboratory data of the Japanese advanced NSCLC patients from a multicenter, observational study; CA209-9CR (NCT03273790). Results Analysis on association of objective response rate (ORR) with each clinical laboratory data at baseline among responders and non-responders suggested that neutrophils, lymphocytes, neutrophil/lymphocyte ratio (NLR), albumin, sodium, CYFRA, and uric acid at baseline were associated with significantly improved ORR. Further analyses on those multiple factors are planned to identify associations with improved outcome of with nivolumab treatment beyond ORR.

Real-World Effectiveness and Safety of Nivolumab in NSCLC pts in Japan: A Multicenter-Retrospective Observational Study

Abstract Background In December 2015, nivolumab was approved as treatment for previously treated NSCLC irrespective of PD-L1 expression or histology in Japan. There are few reports that include real-world data on large cohorts of patients from Japan. Method Data from patients who initiated nivolumab treatment from April 1, 2016 to December 31, 2016 were collected at 23 regional medical institutions across Japan. Here we report a retrospective data analysis accessing effectiveness and safety of nivolumab in 901 Japanese NSCLC pts from a multicenter, observational study; CA209-9CR (NCT03273790). Result Among 901 pts, median age of the pts treated with nivolumab was 67 ys old and proportion of 75 ys or over was 19.8%. Pts with ECOG PS 0 or 1 account for 75.8%, and pts with SQ and adeno histology were 24.5% and 67.7%, respectively. Pts with EGFR mutation account for 12.9%. Median numbers of nivolumab dose was five and nivolumab was most frequently used at 2nd line (46.8%) and followed by at 3rd line (26.5%). Rate of 1 yr overall survival (OS) was 54.3% and, median PFS was 2.1 months and overall ORR was 20.6%. There was no significant difference in effectiveness among histology. Although there was no difference in effectiveness of nivolumab by age, ECOG PS status significantly influence effectiveness of nivolumab. Analysis is ongoing to access various factors that may be associated with the effectiveness of nivolumab. Overall irAE incidence for all grade and grade 3-4 will be reported as well as categorized irAE. Further analysis is planned for safety management of irAEs and prognosis. Conclusion The effectiveness and safety of nivolumab observed in real-world data from NSCLC patients in Japan was comparable to results observed in clinical trials. ECOG PS status was identified as a factor influencing effectiveness of nivolumab.

Building of Collaboration Between National Research Center of Pediatric Hematology, Oncology and Immunology, Professional Society and Medical Institutions in the Russian Federation: Unique Experience

Background and context: More than 4000 cases of pediatric cancer are registered in the Russian Federation annually. A well-functioning system of the centers and departments of pediatric, hematology and oncology required to obtain good treatment results. Features of the Russian Federation require close collaboration between Dmitry Rogachev Center, NSPHO and regional medical institutions. Aim: Development and implementation of the system of direct collaboration between Dmitry Rogachev Center, NSPHO and regional medical institutions for improvement of diagnostics, treatment and rehabilitation of children with hematologic and oncological diseases on the all territory of the Russian Federation. Strategy/Tactics: Dmitry Rogachev Center was set by the Ministry of Health of the Russian Federation as the National Center in charge of pediatric hematology and oncology. Thus, the collaborative initiatives between Dmitry Roigachev Center, NSPHO and regional medical institution were prioritized. Key points of the regional strategy are 24/7 telemedicine support for regional institutions, forming of database of centers and specialists based on NSPHO catalogue of institutions, usage of unique clinical guidelines and standards for all regions of Russia based on tandem agreements and continuous medical education and scientific work. Program/Policy process: To obtain above-mentioned goals, the following steps were made. Federal Center of Telecommunication for Children with hematologic and oncological diseases was founded. A special Web-based application was constructed for the forming of the database of the institutions (the base of this work is the 9 years experience of NSPHO in accumulating of data on centers and specialists on the Russian territory). More than 50 guidelines were prepared and approved for hematologic and oncological diseases treatment in children. Tandem agreements are signing now between Dmitry Rogachev Center, NSPHO and regional medical institutions. Different educational activities are available for specialists from all Russian regions (e.g., on-site seminars, online meetings, etc.). Outcomes: Regional network consists of 86 institutions in all Russian regions (about 3900 beds). During the test period of work of FCT in 2017 more than 5000 consultations were made. Estimated number for 2018 is 6000. All these institutions and specialists (1050) are included to the monthly updated database including the contact and other information. Approved guidelines updating periodically based on the results of multicenter studies. Nowadays more than 50 institutions signed the tandem agreements. These steps allowed to control all pediatric cancer cases in country. What was learned: Only scientific-based multicentre collaboration under the leadership of the National Center and strong national society with support of the government could lead to control of cancer cases and success in treatment. This experience could be used in other countries

Unknown pages of cardiovascular surgery history in Sakhalin Region (Surgeon Alfred Egorov)

The article is dedicated to the history of cardiac surgery in the Sakhalin Region, which over a 20-year period of its development has achieved much success and is now mastering open heart surgery, and to Sakhalin Chief Surgeon Alfred Egorov (1926–1996). Doctor A. Egorov was a great healthcare manager and a surgeon, Honorary Physician of Russian Federation, Member of the USSR and Russian Federation Surgical Society, who over a period of 1964–1986 made a major contribution to the development of anesthesia and surgical care in Sakhalin Region, while strengthening the material and technical facilities of regional medical institutions. The emphasis in the article is placed on Doctor A. Egorov’s role in the development of cardiovascular surgery and on the support that Novosibirsk Institute of Circulation Pathology (now Evgeny Meshalkin National Medical Research Center) has given in this process. As early as 1966 he introduced new methods of cardiac diagnostics and performed pioneer heart operations. His invention, a dilator of heart stenosed orifices (valvulotome), came into common use in heart surgery. It was A. Egorov who performed the first open heart surgery (February 1969) in the Far Eastern Region of Russian Federation.Received 21 May 2018. Revised 2 July 2018. Accepted 3 July 2018.Funding: The study did not have sponsorship.Conflict of interest: Author declares no conflict of interest.AcknowledgmentThe author expresses the gratitude to Oleg S. Egorov, Alfred V. Egorov’s grandson for access to the photos from their family archive.

Anxiety indicators for women in the postpartum period

Situations, which are dangerous and sad, provoke state anxiety (S-anxiety), but trait anxiety (T-anxiety) shows anxiety like person’s acquired behavioural disposition. The aim was to evaluate postpartum anxiety indicators of women that have had the vaginal birth and women that have had surgery in Riga regional medical institutions that provide obstetric services. Respondents – 100 women (50 – with vaginal birth; 50 – with caesarean section surgery) were surveyed by 2 instruments: the demographic survey and the state – trait anxiety inventory, STAI Form Y-1 (Spielberger et al., 1983, adapted in Latvian by Škuškovnika (2004). The results reflect the statistical difference between State anxiety indicators (S-anxiety) of women that have had the vaginal birth (M=35.38; SD= 9.98) and women that have had the surgery (M=37.20; SD= 9.41) was not found (p=0.304). Indicators of Trait anxiety (T-anxiety) show that there was not statistically significant (p=0.059) difference between women that have had the vaginal birth (M=36.92; SD= 7.81) and women that have had the surgery (M=39.24; SD= 7.56), however, it should be noted that the average anxiety scores were higher after surgery.

СУЧАСНІ РЕАЛІЇ ГЕПАТИТУ А У ЖИТЕЛІВ ЗАКАРПАТСЬКОЇ ОБЛАСТІ

Мета роботи – встановити реальну поширеність серопозитивності ГА методом виявлення anti-HAV IgG та співвідношення жовтяничних форм захворювання до стертих, атипових, безжовтяничних у жителів Закарпатської області.Пацієнти і методи. Дослідження наявності anti-HAV ІgG проводилось у 262 дорослих осіб, пацієнтів обласних лікувальних закладів. Цілеспрямоване опитування на наявність в анамнезі захворювання з ознаками жовтяниці проведено у 203 хворих Обласної клінічної інфекційної лікарні.Результати. Антитіла IgG до вірусу гепатиту А виявлено у 77,48 % обстежених. Частота знаходження їх залежала від віку та місця проживання і не залежала від статі: найменшою була у віці від 18 до 29 років і найбільшою у віці 60 років і більше (р<0,001); у жителів м. Ужгорода вірогідно меншою за жителів інших міст, сільських населених пунктів і жителів Закарпатської області в цілому (р<0,01-0,001). Висновки. Отримані результати свідчать про значну серопозитивність гепатиту А серед жителів Закарпатській області. Офіційно реєструється менше десятої частини хворих, які перенесли дане захворювання. Серед дорослого населення переважають безжовтяничні форми гепатиту А. Частота виявлення анамнестичних антитіл до гепатиту А залежить від віку та місця проживання обстежених.

Application of Image Cloud Platform in Hierarchical Hospital Visit

To achieve medical information sharing among different health institutes through constructing image cloud platform, thus establish a diagnosis and treatment system through long range image-viewing. Design and apply image cloud platform in Wuxi people's hospital and other 16 basal level health institutes. The goal of sharing the medical equipment and imaging diagnosis expert collaboration at the regional medical institutions was achieved through establishment of the platform. The establishment of such platform plays a positive role in balancing health resources, improves the level of basic-level hospital diagnosis and treatment and reduces medical cost.

An Analysis of the Awareness and Performance of Radiation Workers’ Radiation/Radioactivity Protection in Medical Institutions : Focused on Busan Regional Medical Institutions

An Analysis of the Awareness and Performance of Radiation Workers’ Radiation/Radioactivity Protection in Medical Institutions : Focused on Busan Regional Medical Institutions

Treatment of Psoriasis with Biologics in Cooperation with Regional Medical Institutions

Treatment of Psoriasis with Biologics in Cooperation with Regional Medical Institutions

Cost evaluation of clinical laboratory in Taiwan's National Health System by using activity-based costing.

To cope with the government's policies to reduce medical costs, Taiwan's healthcare service providers are striving to survive by pursuing profit maximization through cost control. This article aimed to present the results of cost evaluation using activity-based costing performed in the laboratory in order to throw light on the differences between costs and the payment system of National Health Insurance (NHI). This study analyzed the data of costs and income of the clinical laboratory. Direct costs belong to their respective sections of the department. The department's shared costs, including public expenses and administrative assigned costs, were allocated to the department's respective sections. A simple regression equation was created to predict profit and loss, and evaluate the department's break-even point, fixed cost, and contribution margin ratio. In clinical chemistry and seroimmunology sections, the cost per test was lower than the NHI payment and their major laboratory tests had revenues with the profitability ratio of 8.7%, while the other sections had a higher cost per test than the NHI payment and their major tests were in deficit. The study found a simple linear regression model as follows: "Balance=-84,995+0.543×income (R2=0.544)". In order to avoid deficit, laboratories are suggested to increase test volumes, enhance laboratory test specialization, and become marginal scale. A hospital could integrate with regional medical institutions through alliances or OEM methods to increase volumes to reach marginal scale and reduce laboratory costs, enhancing the level and quality of laboratory medicine.