Methodological approaches to the organization of internal control of the quality and safety of medical activity in a medical organization

The modern stage of functioning of domestic health care is characterized by the formation of regulatory and legal requirements for the system of internal control of quality and safety of medical activity.One of the tasks of internal control of quality and safety of medical activity is to ensure and assess the compliance of medical care provided by medical workers to the criteria for assessing the quality of medical care, as well as to consider the reasons for non-compliance of medical care provided to these criteria. Requirements to quality criteria, procedures for assessing the quality of medical care, compliance with the established procedure of medical records maintenance and development of measures to eliminate and prevent violations are established by various regulatory documents. At the same time, of great importance for a medical organization is not only the fulfillment of requirements in the field of quality control and safety of medical activity, but also the introduction of an effective system of internal control of quality and safety of medical activity, based on regulatory and legal requirements and giving real results.It determines the necessity of creating in a medical organization the system of collection and analysis of quality data and development of internal documents, establishing the processes of quality control and assessment of medical care, the methodology of selecting medical documentation for control and assessment of the quality of medical care, as well as the requirements to the results of analysis and documenting of decisions made.The article presents the experience of Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivian on the creation of a system for collecting and analyzing data on the quality of medical care and making management decisions to eliminate and prevent nonconformities, which operates within the framework of the quality management system of medical care of the institute

Highly Luminescent Salts Containing Well-Shielded Lanthanide-Centered Complex Anions and Bulky Imidazolium Countercations

In this paper, we report on the syntheses, structures, and characterization of four molten salts containing imidazolium cations and europium(III)- or terbium(III)-centered complex anions. In the complex anions, the lanthanide centers are wrapped by four pseudodiketonate anionic ligands, which prevent them from contacting with high-frequency oscillators and allow them to show intense characteristic europium(III) or terbium(III) emission, small line widths, high color purity, high quantum yields (30−49%), and long decay times (\u3e2 ms)

Beringian Standstill and Spread of Native American Founders

Native Americans derive from a small number of Asian founders who likely arrived to the Americas via Beringia. However, additional details about the intial colonization of the Americas remain unclear. To investigate the pioneering phase in the Americas we analyzed a total of 623 complete mtDNAs from the Americas and Asia, including 20 new complete mtDNAs from the Americas and seven from Asia. This sequence data was used to direct high-resolution genotyping from 20 American and 26 Asian populations. Here we describe more genetic diversity within the founder population than was previously reported. The newly resolved phylogenetic structure suggests that ancestors of Native Americans paused when they reached Beringia, during which time New World founder lineages differentiated from their Asian sister-clades. This pause in movement was followed by a swift migration southward that distributed the founder types all the way to South America. The data also suggest more recent bi-directional gene flow between Siberia and the North American Arctic

Многоуровневые инъекции ботулинического токсина типа А (Абоботулотоксина) при лечении спастических форм детского церебрального паралича: ретроспективное исследование опыта 8 российских центров

Background: The contemporary application of Botulinum toxin A (BTA) in cerebral palsy (CP) implies multilevel injections both in on-label and off-label muscles. However, there is no single international opinion on the effective and safe dosages, target muscles, and intervals between the injections.Objective: Our aim was to analyze the Russian multicenter independent experience of single and repeated multilevel injections of Abobotulinum toxin А in patients with spastic forms of CP.Methods: 8 independent referral CP-centers (10 hospitals) in different regions of Russia. Authors evaluated intervals between the injections, dosages of the BTA for the whole procedure, for the body mass, for the each muscle, and functional segment of the extremities.Results: 1872 protocols of effective BTA injections (1–14 repeated injections) for 724 patients with spastic CP were included. The age of the patients was between 8 months to 17 years 4 months at the beginning of the treatment (with a mean of 3 years 10 months). Multilevel BTA injections were indicated for the majority (n = 634, 87.6%) of the patients in all the centers. The medians of the dosages for the first BTA injection were between 30–31 U/kg (500 U), the repeated injections doses up to 45 U/kg (1000 U) (in most centers). The median intervals between the repeated injections were 180–200 days in 484 (66.9%) patients and 140–180 days in 157 (24.7%) patients. In 2 centers, children with GMFCS IV–V were injected more often than others.Conclusion: Multilevel BTA injections were indicated for the most patients. The initial dose of Abobotulinum toxin A was 30–31 U/kg. The repeated injections dose could increase up to 40 U/kg. The repeated injections were done in 140–200 days after the previous injection.Современная концепция ботулинотерапии при детском церебральном параличе (ДЦП) предлагает использование многоуровневых инъекций в расширенное число мышц. Однако по-прежнему отсутствует консенсус относительно выбора оптимальных доз, мышц и интервалов между инъекциями.Цель исследования: изучить российский опыт применения однократных и повторных многоуровневых инъекций абоботулотоксина при лечении спастичности у пациентов с ДЦП.Методы: в ретроспективном исследовании проанализирован опыт ботулинотерапии при ДЦПв 8 специализированных центрах России. Изучали протоколы клинически эффективных инъекций. Оценивали общие дозы препарата БТА, дозы на единицу массы тела пациентов, на всю инъекционную сессию и отдельные мышцы, а также интервалы между инъекциями.Результаты: изучено 1872 протокола клинически эффективных инъекций, всего от 1 до 14 повторных инъекций, сделанных 724 пациентам в возрасте от 8 мес до 17 лет 4 мес (медиана возраста на момент первой инъекции БТА — 3 года 10 мес) на момент начала ботулинотерапии. Большинство пациентов (n = 634; 87,6% инъекций) получили многоуровневую ботулинотерапию. Во всех центрах при первичных инъекциях БТА медиана доз находилась в пределах 30–31 Ед/кг массы тела (общая — 500 Ед). При повторных инъекциях в большинстве учреждений максимальные дозы превышали 45 Ед/кг (1000 Ед). Средние интервалы между повторными инъекциями колебались в пределах 140–180 сут для 157 (24,7%) и 180–200 сут для 484 (66,9%) пациентов. В 2 из 8 центров пациенты с наиболее выраженными двигательными нарушениями (GMFCS IV–V) требовали более частых повторных инъекций БТА.Заключение: в специализированных центрах большинству пациентов с ДЦП ботулинотерапию проводили по многоуровневой схеме. Общая доза абоботулотоксина при первичных инъекциях составляла 30–31 Ед/кг; при повторных инъекциях она могла быть увеличена до 40 Ед/кг и более. Вопрос о повторном проведении инъекции БТА рассматривался в интервале 140–200 сут после предшествующей инъекции