Совершенствование оказания медицинской помощи пациентам с ОНМК с применением стандартов JCI. Первые результаты

AIM OF THE STUDY To compare the dynamics of thrombolytic therapy effectiveness in patients with stroke after the reorganization of medical care using JCI standards.MATERIAL AND METHODS In 2022, a new system for routing patients with stroke at the level of the emergency department was introduced in the Emergency Care Hospital; and 976 patients with the diagnosis of brain infarction were treated. The analysis of the results was carried out by comparing the mortality rates from ischemic stroke, the number of thrombolytic therapies and procedures of mechanical methods of revascularization, as well as the indicators “Door-CT”, “DoorNeedle”, “Door-Opening” for 2021 and 10 months of 2022.RESULTS After the introduction of the new routing system for patients with stroke at the emergency department level, there appeared the first positive results. Thus, the mortality rate from brain infarction in 10 months of 2022 decreased by 5.6% compared to 2021. The number of thrombolytic therapies performed increased by 5.2%, and mechanical revascularization procedures by 1.62% over the same period, while the “Door-CT” indicator decreased by 27 minutes, “DoorNeedle” by 22 minutes, “Door-Opening” by 31.6 minutes.CONCLUSIONS The immediate results of the introduction of the new patient routing system at the level of the emergency department have proved successful, primarily due to the significant reduction in the mortality rate of patients with cerebral infarction by 5.6%. However, the process requires further investigation and has application points for further improvement.ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить динамику эффективности проведения тромболитической терапии у пациентов с острым нарушением мозгового кровообращения (ОНМК) после реорганизации медицинской помощи с применением стандартов JCI.МАТЕРИАЛ И МЕТОДЫ В ГАУЗ РТ «БСМП» в 2022 г. внедрена новая система маршрутизации пациентов с ОНМК на уровне приемного отделения и пролечены 976 пациентов с диагнозом «Инфаркт мозга». Анализ полученных результатов проводили путем сравнения показателей летальности от ишемического инсульта, количества проведенных тромболитических терапий и процедур механических методов реваскуляризации, а также показателей «Дверь–КТ», «Дверь–Игла», «Дверь–Раскрытие» за 2021 г. и 10 месяцев 2022 г.РЕЗУЛЬТАТЫ После внедрения новой системы маршрутизации пациентов с ОНМК на уровне приемного отделения с применением стандартов JCI имеются первые положительные результаты. Так, летальность от инфаркта мозга за 10 месяцев 2022 г. снизилась на 5,6% в сравнении с 2021 г. Количество проведенных тромболитических терапий увеличилось на 5,2%, а процедур механических методов реваскуляризации — на 1,62% за аналогичный период, в то время как показатель «Дверь–КТ» снизился на 27 минут, «Дверь–Игла» — на 22 минуты, а «Дверь–Раскрытие» — на 31,6 минуты.ЗАКЛЮЧЕНИЕ Непосредственные результаты внедрения новой системы маршрутизации пациентов на уровне приемного отделения являются успешными, в первую очередь за счет значимого снижения летальности пациентов с инфарктом мозга на 5,6%. Однако процесс требует дальнейшего исследования и имеет точки приложения для дальнейшего улучшения

Комплексное лечение больных раком прямой кишки с синхронными отдаленными метастазами

Objective: to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer.Materials and methods. We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy.Results. The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3.Conclusion. Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications.Цель исследования — изучить непосредственные и отдаленные результаты хирургического, комбинированного и комплексного лечения больных метастатическим раком прямой кишки.Материалы и методы. Данная работа основана на ретроспективном анализе проспективно собранной базы данных результатов лечения больных раком прямой кишки, которым проводилось хирургическое, комбинированное (операция и химиотерапия) и комплексное (химиолучевая терапия, операция и химиотерапия) лечение в проктологическом отделении ФГБУ«Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России в период с 1999 г. по июнь 2015 г. Исследуемые параметры включали общую выживаемость, частоту послеоперационных осложнений, частоту послеоперационной летальности, частоту осложнений химиолучевой терапии.Результаты. Всего в исследуемые 3 группы вошло 366 пациентов. Общая 2-летняя выживаемость в 3-й группе (комплексное лечение) составила 83 % по сравнению с 40 % в 1-й и 2-й группах, медиана выживаемости — 43 мес по сравнению с 18 мес во 2-й группе и 14мес в 1-й группе, частота послеоперационных осложнений — 19 % в 1-й группе, 13,4 % — во 2-й, 15,1 % — в 3-й. Послеоперационная летальность (1,1 %) зафиксирована только в 3-й группе.Выводы. Комплексный подход лечения позволяет значительно увеличить показатели общей выживаемости больных метастатическим раком прямой кишки без повышения риска послеоперационных осложнений

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Comprehensive treatment of rectal cancer patients with synchronous distant metastases

Objective: to analyze short-term and long-term outcomes of surgical, combination, and comprehensive treatment in patients with metastatic rectal cancer.Materials and methods. We performed a retrospective analysis of prospectively collected data on the outcomes of rectal cancer patients receiving surgical, combination (surgery + chemotherapy), or comprehensive (chemoradiotherapy + surgery + chemotherapy) treatment in the Department of Proctology at the N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, between 1999 and 2015. We assessed overall survival, frequency of postoperative complications, postoperative death rates and frequency of complications associated with chemoradiotherapy.Results. The study included 366patients that were divided into 3 groups according to the treatment strategy. The 2-year survival rate was 83 % in group 3 (comprehensive treatment) vs 40 % in groups 1 and 2. Median survival was 43 months in group 3 compared to 18 and 14 months in groups 2 and 1 respectively. The number of postoperative complications was 19 %, 13.4 %, and 15.1 % in groups 1, 2 and 3 respectively. There was one postoperative death (1.1 %) in group 3.Conclusion. Comprehensive treatment significantly improves overall survival of rectal cancer patients without increasing the risk of postoperative complications