STEREOFUNCTIONAL FEATURES OF MOTHER-PLACENTA-FETUS SYSTEM IN OPTIMIZATION OF COMPLEX TREATMENT OF THREATENING PRETERM LABOR

Purpose: improving the efficiency of complex treatment of threatened abortion.Materials and Methods: The study involved 299 primigravidas. The I clinical group consisted of 78 women with threatened miscarriage receiving combination therapy (standard medication and acupuncture). The II clinical group consisted of 76 women receiving combined medication and acupuncture to our improved method. In the III clinical group - 71 women with threatened miscarriage, which received only standard medical therapy. In the IV (control group) there were 74 pregnant women with physiological pregnancy.Results: It has been proven that the lateral stimulation of biologically active points of acupuncture taking into account the factor of placental laterality in the utero-placental-fetal complex initiate functional processes accompanied by an increase right asymmetry of utero-placental blood flow and uterine activity, and improvement of the fetus condition.Summary: We proved that in unilateral acupuncture impact to the placenta, processes of functional symmetry in the utero-placental-fetal complex in women with threatened termination of pregnancy are replaced by functional asymmetry of processes that improve the condition of the fetu

Персонифицированный учет затрат в управленческом учете медицинских организаций

In the modern economic conditions, the rational planning of costs and the complex process optimization are essential requirements to all organizations. Knowledge of costs is needed to correctly assess the economic performance of an organization. Competent and timely correction of tariffs for the obligatory medical insurance and rationalization of the requested financing of the medical organization depends on this assessment. In the present study, we analyze various methods of personalized cost accounting: the ratio of costs to charges (RCC); relative value unit (RVU); time-driven activity-based costing (TDABC), and the possibility of their adaptation to the specific needs of medical organizations. The personalized cost accounting incorporated into a medical information system allows for controlling, planning and carrying out a close internal management of financial activity. This function helps decision-makers: control the use of funds for medical care provision; increase the efficiency of management decisions; justify the prices of paid medical services; define the deficit and surplus work units; analyze the treatment cost for each patient, considering the diagnosis, method of treatment, age and other classification signs, including the reference to specialized departments; reduce the unnecessary “paper” work load on the medical personnel; model the future needs of the organization in accordance with the planned changes in the hospitalization policy; optimize, control and plan the budget with regard to the established standards of financial expenses. Implementation of this approach is expected to increase the work efficiency in most medical organizations and the entire healthcare system.В современных экономических условиях характерной чертой для всех организаций является рациональное планирование расходов и комплексная оптимизация процессов. Изучение затрат позволяет выработать правильную оценку уровня экономических показателей организации. От данной оценки зависит грамотная и своевременная корректировка тарифов обязательного медицинского страхования и обоснованность необходимого финансирования медицинской организации. В статье приводится анализ различных методов персонифицированного учета затрат: метода соотношения затрат к прибыли, метода единицы относительной стоимости, система учета затрат по видам деятельности и ее модификации Time-driven ABC (TDABS), а также возможность их адаптации для различных целей медицинских организаций. Система персонифицированного учета затрат, включенная в медицинскую информационную систему, позволяет оперативно контролировать, планировать и проводить внутренний финансовый контроль деятельности организации. Эта функция помогает лицам, принимающим решения в медицинской организации, в решении следующих задач: контроль использования средств на оказание медицинской помощи; усиление действенности и оперативности управленческих решений; обоснование цены платных медицинских услуг; определение дефицитных и профицитных отделений; анализ данных о стоимости случая лечения каждого пациента с учетом диагноза, метода лечения, возраста и других классификационных признаков, в т.ч. в разрезе профильных отделений; снижение «бумажной» нагрузки на медицинский персонал; моделирование будущих потребностей организации в соответствии с планируемыми изменениями структуры госпитализации; оптимизация расходов, контроль и планирование с учетом установленных нормативов финансовых затрат. Реализация данного процесса является актуальным и необходимым инструментом повышения эффективности деятельности, как самой медицинской организации, так и всей системы здравоохранения в целом

Seasonal periodicity of melatonin exchange and hormonal status of pregnant women in dependence on fetus sex

Objective: to study melatonin metabolism and hormonal status of pregnant women in different seasons of the year, depending on the sex of the fetus. Materials and methods: 538 women were examined at the time of physiological gestation of 37-40 weeks. The first group — 286 pregnant women with female fetuses and the second group — 254 pregnant with male fetuses. Estimation of the hormonal status included the determination of the level of cortisol, estradiol, adrenocorticotropic hormone, progesterone, testosterone in the blood and melatonin in the urine of pregnant women. Results: the level of 6-sulphatoxymelatonin in the morning urine, regardless of the sex of the fetus, was higher in the seasons of the year with the predominance of the dark time of the day. Absolute levels of 6-sulphatoxymelatonin in urine in all women in 37-40 weeks of gestation were the lowest in the light-saturated summer and spring months of the year, while in the winter period its parameters were maximal. Melatonin production was statistically significantly higher in pregnant women with female fetuses during the fall and winter periods of the year. Regardless of the time of the year, in pregnant women with female fetuses, the absolute levels of estradiol and progesterone were higher than in the case of the male fetus. The highest values in the case of the female fetus were noted in the spring. Testosterone production was significantly higher in pregnant women with male fetuses mainly in the spring season. Stress resistance of pregnant women was higher in the summer months. Depending on the “sex of the fetus” factor, stress hormones in the summer had the highest values in pregnant women with male fetuses. Conclusions: the sex of the fetus is a significant factor affecting the seasonal variability of melatonin production, sexual and stress hormones in pregnant women due to the formation of the specificity of the systemic signaling between the maternal and the fetal organism in the dynamics of pregnancy

THE EFFECT OF LIGHT DEPRIVATION ON FUNCTIONAL PROCESSES IN THE SYSTEM “MOTHER – PLACENTA – FETUS” IN CASE OF THREATENING PRETERM BIRTH AND ITS CLINICAL SIGNIFICANCE

Objective: to study the nature of uterine contractile activity, hormonal status, melatonin metabolism, blood flow in the uterine and fetal vessels, and the state of the fetus wellbeing before and after standard drug treatment and combination therapy involving the additional use of light deprivation. Materials and methods: a total of 547 women with threatening preterm birth were examined at 28 – 35 weeks of pregnancy. Among these, 198 pregnant women received standard therapy and 196 women received combined treatment, medical along with light deprivation. The control group consisted of 153 women with physiological pregnancy. We used cardiotocography to study the contractile activity of the uterus and the fetal cardiac rhythm, enzyme-linked immunosorbent assay methods to study the expression of hormones (ACTH, cortisol, progesterone, estriol, placental lactogen) in the blood and 6-sulfatoxymelatonin in the urine of pregnant women. Results: threatening preterm labor is accompanied by an increase in the level of generalized (bilateral) uterine activity, a decrease in the level of melatonin and an increase in the level of stress hormones. After using standard drug therapy, there is a suppression of any form of uterine activity, which leads to a deterioration of the fetus state in 30,2% of women, while combined therapy increases the level of melatonin, decreases the activity of stress-liberating subsystems of the mother’s body, and increases the level of right-sided uterine contractions that contribute to maintaining functional activity of the uteroplacental “pump”, contributing to the prevention of fetal distress. Conclusions: the studies indicate an improvement in the therapeutic effect with using light deprivation, as an additional method for tocolysis in women with the threat of premature birth

Daily periodicity of labor in pregnant women in physiological and complicated pregnancy depending on the sex of the fetus

Objective: the study aimed to reveal the daily periodicity of labor, the nature of melatonin metabolism, and the outcome of childbirth in women with a physiological and complicated pregnancy, depending on the sex of the fetus.Materials and methods: to study the chronophysiological characteristics of birth outcomes depending on fetal sex, 1 980 birth histories and stories of newborns were analyzed. The neonates were born between January 1 and December 31, 2016, in a maternity ward of the Federal State Budgetary Educational Institution of Higher Education “RostGMU” of the Ministry of Health of Russia. Melatonin production was identified by the level of urinary excretion of 6-sulfatoxymelatonin (6-SM) (its main metabolite) examining the morning portion of the urine of women by the ELISA method (at 8 am 3 ml of urine were collected in Eppendorf tube).Results: it was revealed that fetal sex modulated the activity of the central regulatory mechanisms responsible for the daily period functional processes in the female body and the initiation of labor. The largest number of spontaneous births by male fetuses occurred in the early evening before midnight when daily illumination was decreased, while the birth of girls was observed more often in the period from midnight to early morning. At the same time, mothers of boys had lower production of melatonin compared to that of girls’ mothers.Conclusions. The peculiarities of labor and birth complications associated with the sex of the fetus were identified

МЕТОДОЛОГИЯ ОЦЕНКИ ЭФФЕКТИВНОСТИ ИСПОЛЬЗОВАНИЯ КОЕЧНОГО ФОНДА МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ

Since recently, a number of normative legal acts aimed at increasing the salaries of medical professionals in the Russian Federation have been implemented. As these decisions are not supported by increasing the financial bases of medical organizations, those institutions may develop the accounts payable status. Under these conditions, the efficient usage of hospital beds may bring a financial relief to these medical institutions. The present study addresses the assessment of bed usage and suggests a well-rationalized set of methods to evaluate and characterize the bed usage efficiency. The main indicators of this efficiency are: the number of beds, the bed turnover, the number of hospitalized patients, the average length of hospital stay per patient per year, and the average bed occupancy per year. In this study, we analyze the available data on the hospital bed usage taken from the annual statistical information published by the Ministry of Health of the Russian Federation. Using the method of chain substitutions we have found ways to improve the quality of medical services and reduce economic losses in medical organizations. Our results recommend implementing periodical analysis of the hospital bed usage both in general and in specialized clinics. The results also suggest mobilizing more reserves to increase the performance of hospital bed usage, mainly by increasing the bed occupancy in specialized round-the-clock hospitals. It is recommended to conduct a comparative analysis of the planned vs factual bed usage, to restructure the hospital setting with a possible change in the number of specialized beds, to optimize the routing of patients when providing primary medical care, as well as routing the patients when providing emergency service including emergency specialized medical care.Основной причиной для разработки методологии оценки эффективности использования коечного фонда стала необходимость выполнения медицинскими организациями ряда нормативных правовых актов, направленных на повышение заработной платы сотрудникам учреждений бюджетной сферы, в условиях прежнего уровня финансирования, что способствует формированию и росту кредиторской задолженности учреждений. В статье рассмотрены методологические аспекты оценки использования коечного фонда медицинских организаций, выявлена обоснованная совокупность приемов и методов структуры оценочной деятельности. Основными показателями эффективности использования коек являются: количество коек, оборот койки, количество госпитализированных больных, средняя длительность пребывания пациента на койке в году (в днях), средняя занятость койки в году (в днях), среднее время простоя койки. С целью оценки возможностей метода оценки эффективности использования коечного фонда в статье произведены расчеты и сравнения результатов по основным показателям эффективности использования коек на основе открытых данных (ежегодная статистическая информация, публикуемая Минздравом РФ). На основании проведенного анализа использования коечного фонда методом цепных подстановок в целях совершенствования качества медицинского обслуживания и снижения экономических потерь в медицинских организациях рекомендуется проводить анализ и оценку эффективности использования коечного фонда как в целом, так и по отдельным профилям, использовать дополнительные резервы повышения интенсивности использования коечного фонда, главным образом, за счет повышения средней занятости коек по отдельным профилям круглосуточных коек стационара, проводить сравнительный анализ плановых и фактических показателей использования коечного фонда, уделять внимание структурной перестройке стационара с возможным изменением количества профильных коек, уделять внимание маршрутизации пациентов при оказании первичной медико-санитарной помощи, уделять внимание маршрутизации при оказании скорой, в том числе скорой специализированной, медицинской помощи

Обзор зарубежного опыта финансирования инновационных медицинских технологий

The article presents a review of the foreign approaches to the mechanisms of financing of medical help and innovative medical technologies with the description of the implemented financial mechanisms of stimulation of innovations in foreign systems of public healthcare. Since the system of payment for diagnosis-related groups (DRG) does not contribute to the implementation of innovations in the medical practice, the majority of countries apply additional mechanisms of financing of innovative technologies in public healthcare such as single and additional payments, and target financing that was initially not associated with a DRG model.В статье представлен обзор зарубежных подходов к механизмам финансирования медицинской помощи и применению инновационных медицинских технологий, с описанием используемых финансовых механизмов стимулирования инноваций в здравоохранении за рубежом. В связи с тем, что оплата по клинико-статистическим группам (КСГ) заболеваний не способствует внедрению инноваций в медицинскую практику, большинство стран применяют дополнительные механизмы финансирования инновационных технологий в здравоохранении, такие как отдельные и дополнительные платежи, целевое финансирование, изначально никак не связанные с моделью КСГ

Genetic and expression studies of SMN2 gene in Russian patients with spinal muscular atrophy type II and III

<p>Abstract</p> <p>Background</p> <p>Spinal muscular atrophy (SMA type I, II and III) is an autosomal recessive neuromuscular disorder caused by mutations in the survival motor neuron gene (<it>SMN1</it>). <it>SMN2 </it>is a centromeric copy gene that has been characterized as a major modifier of SMA severity. SMA type I patients have one or two <it>SMN2 </it>copies while most SMA type II patients carry three <it>SMN2 </it>copies and SMA III patients have three or four <it>SMN2 </it>copies. The <it>SMN1 </it>gene produces a full-length transcript (FL-SMN) while <it>SMN2 </it>is only able to produce a small portion of the FL-SMN because of a splice mutation which results in the production of abnormal SMNΔ7 mRNA.</p> <p>Methods</p> <p>In this study we performed quantification of the <it>SMN2 </it>gene copy number in Russian patients affected by SMA type II and III (42 and 19 patients, respectively) by means of real-time PCR. Moreover, we present two families consisting of asymptomatic carriers of a homozygous absence of the <it>SMN1 </it>gene. We also developed a novel RT-qPCR-based assay to determine the FL-SMN/SMNΔ7 mRNA ratio as SMA biomarker.</p> <p>Results</p> <p>Comparison of the <it>SMN2 </it>copy number and clinical features revealed a significant correlation between mild clinical phenotype (SMA type III) and presence of four copies of the <it>SMN2 </it>gene. In both asymptomatic cases we found an increased number of <it>SMN2 </it>copies in the healthy carriers and a biallelic <it>SMN1 </it>absence. Furthermore, the novel assay revealed a difference between SMA patients and healthy controls.</p> <p>Conclusions</p> <p>We suggest that the <it>SMN2 </it>gene copy quantification in SMA patients could be used as a prognostic tool for discrimination between the SMA type II and SMA type III diagnoses, whereas the FL-SMN/SMNΔ7 mRNA ratio could be a useful biomarker for detecting changes during SMA pharmacotherapy.</p

Совершенствование модели оплаты медицинской помощи при хроническом вирусном гепатите С в рамках реализации Программы государственных гарантий бесплатного оказания гражданам медицинской помощи на 2023 год и на плановый период 2024–2025 годов

Background. In 2021, new clinical guidelines for the treatment of chronic hepatitis C virus (HCV) in adults were published that did not contain interferon drug therapy regimens. Current therapy of chronic HCV is based on modern drugs of direct-acting antivirals (DAA). In this regard, the model of diagnosis-related groups (DRG) with the use of interferon-containing drugs as etiotropic therapy, which has been in effect until now, has lost its relevance and cannot be used to pay for cases of medical care for chronic HCV within the framework of the Program of State Guarantees of Free Medical Care to Citizens for 2023 and for the planning period of 2024–2025 (PSG). Objective: to improve the DRG model to pay for medical care for chronic HCV in a day hospital based on current clinical recommendations.Material and methods. Regulatory legal documents on the subject of the study, proposals and expert opinions of specialists, as well as feedback from public organizations, including patients, regarding the payment of medical care for chronic HCV, sent as part of a public discussion of the draft PSG, were studied. For the calculations were used: the current version of the clinical recommendations "Chronic viral hepatitis C"; impersonal personalized information of the database of registers of bills for payment for medical care for 2020–2021; the state register of manufacturers' maximum selling prices for medicines included in the list of vital and essential drugs.Results. A DRG model was developed to pay for medical care during drug therapy of chronic HCV, including for children. When calculating the model, the cost of medicines, patient days and the principles of accounting for the duration of hospitalization were updated.Conclusion. The developed DRG model to pay for medical care for chronic HCV in a day hospital with the use of drug therapy regimens with DAA recommended by clinical guidelines, including for children with HCV, contributes to improving the effectiveness of the system of payment for medical care provided as part of the implementation of the PSG and accessibility of medical care for this contingent of patients.Актуальность. В 2021 г. опубликованы новые клинические рекомендации по лечению хронического вирусного гепатита С (ХВГС) у взрослых, в которых отсутствуют интерфероновые схемы лекарственной терапии. Актуальная терапия ХВГС базируется на современных противовирусных препаратах прямого действия (ПППД). В этой связи модель клинико-статистических групп (КСГ) с применением в качестве этиотропной терапии интерфероносодержащих препаратов, действующая до настоящего времени, утратила актуальность и не может использоваться для оплаты случаев оказания медицинской помощи при ХВГС в рамках реализации Программы государственных гарантий бесплатного оказания гражданам медицинской помощи на 2023 год и на плановый период 2024–2025 годов (ПГГ).Цель: совершенствование модели КСГ заболеваний для оплаты медицинской помощи при ХВГС в условиях дневного стационара на основе действующих клинических рекомендаций.Материал и методы. Изучены нормативные правовые документы по теме исследования, предложения и экспертные мнения специалистов, а также отзывы общественных организаций, включая пациентские, в части оплаты медицинской помощи при ХВГС, направленные в рамках общественного обсуждения проекта ПГГ. Для проведения расчетов использовались: актуальная версия клинических рекомендаций «Хронический вирусный гепатит С», обезличенные персонифицированные сведения базы реестров счетов на оплату за оказание медицинской помощи за 2020–2021 гг., государственный реестр предельных отпускных цен производителей на лекарственные препараты, включенные в перечень жизненно необходимых и важнейших лекарственных препаратов.Результаты. Разработана модель КСГ заболеваний для оплаты медицинской помощи при проведении лекарственной терапии ХВГС, в т.ч. для пациентов детского возраста. При расчете модели актуализирована стоимость препаратов, пациенто-дня и принципы учета длительности госпитализации.Заключение. Разработанная модель КСГ для оплаты медицинской помощи при ХВГС в условиях дневного стационара с применением схем лекарственной терапии ПППД, предлагаемых клиническими рекомендациями, в т.ч. для детей с ХВГС, способствует повышению эффективности системы оплаты медицинской помощи, оказываемой в рамках реализации ПГГ, и доступности медицинской помощи для данного контингента больных