CONTENT OF THE ISSUE
Review of lean practices in clinical laboratories
The main role of clinical laboratory diagnostics is to obtain reliable, reproducible and timely results that help to make the right clinical decisions. As the literature review shows, there are a number of common problems for many clinical laboratories, such as: long turnaround times, high laboratory costs for consumables, insufficient level of satisfaction with quality of services received by patients and high number of complaints. The use of lean manufacturing can be one way of solving these problems.
Purpose of the study is to summarize and analyze the literature regarding the application of lean manufacturing in clinical laboratories.
Materials and methods. A literature review was performed using the following abstract databases: Web of Science, Scopus, PubMed, ScienceDirect, Mendeley, and NCBI. The depth of the search according to the time parameter had no limitations. The following keywords were used as search markers: “lean management”, “lean thinking”, “lean six sigma”, “lean tools”, “healthcare”, “health services”, “clinical laboratory”. More than 100 publications were analyzed, from which 28 most representative studies were selected.
Results. The implementation of lean production methods provides a reduction in turnaround time, costs and errors in the clinical laboratory, reduces the contamination of biological material at the preanalytical stage and reduces waiting time for services and, as a consequence, reduces the number of patient complaints.
Conclusion. The above results indicate that lean production methods can be used in laboratories to solve frequently occurring problems and demonstrate the effectiveness of their application in clinical laboratories.
Application of the VALS and the laddering techniques at shared decision-making
Patients values are fundamental in the process of health decision-making. The use of PROMs is often difficult in routine clinical practice, which requires the search for simpler methods of determining the patients values, where psychographic segmentation and laddering are one of those.
The aim of the study was to improve the process of shared-decision-making in patients with non-melanoma skin cancer using the VALS segmentation and the laddering technique.
Materials and methods. An inclusive, incomparable, prospective, long-term multicenter cohort study of the use of the laddering technique and the VALS technique was conducted in 158 patients (154 (97%) with basal cell skin cancer, 4 (3%) squamous cell skin cancer; 129 (82%) patients with stage I–II diseases, 17 (11%), with IV – 12 (7%); 56 (35%) – men, 102 (65%) – women.
The results of psychographic segmentation showed: the clinical result of the procedure is important for 96% (n=152), the safety of treatment and adverse reactions – for 91% (n=143), the cosmetic result – for 46% (n=73), convenience and flexibility of the treatment schedule – for 36% (n=57), the painlessness of the treatment procedure – for 34% (n=54), the ability to lead a habitual lifestyle during treatment – for 23% (n=36), the comfort of the treatment procedure – for 14% (n=22), the financial costs associated with treatment – for 9% (n=14), preservation of organ function after treatment – for 3% (n=5).
Conclusions. The method of psychographic segmentation can be adapted to the tasks of communication between the doctor and the patient. The scope of application of the VALS methodology and the laddering technique can be considered situations when a doctor is unable to use validated quality of life questionnaires due to limited resources or the absence of such questionnaires.
Clinical aspects of medical-social examination of tuberculosis in adults
The epidemiological situation with tuberculosis in the Russian Federation in the current socioeconomic conditions continues to be quite tense. In addition to all kinds of introductions from practicing physicians to combat tuberculosis, a significant contribution comes from the activities of administrative bodies aimed at creating and implementing new draft laws on disability related to tuberculosis, including methods of social expertise and safety, various support measures for disabled citizens, and methods of rehabilitation for persons with a disability group assigned.
All persons with tuberculosis are guaranteed the right to a medical and social expert evaluation. In connection with the release of the new order, there are actual data, which require attention not only of social security workers, but also of medical personnel.
P u r p o s e : to reveal actual aspects of medical and social examination for tuberculosis in adults.
Methods. Regulatory documents on social security of population were analyzed and the main reasons influencing the expert evaluation and decision of commission for medical and social protection in tuberculosis in adult stratum of population were singled out.
R e s u l t s a n d d i s c u s s i o n . As of January 1, 2020, Order No. 585n of the Ministry of Labor and Social Protection of the Russian Federation of August 27, 2019, came into force. “On the classifications and criteria used in the implementation of medical and social expert assessment of citizens by federal state medical and social expert assessment institutions. The expert evaluation for tuberculosis is based on an analysis of the totality of persistent impairments of body functions, containing significant clinical components, due to the pathological process and the severity of restrictions to vital functions, which are affected by the localization and prevalence of the specific process, the degree of activity, MBT sensitivity to antituberculosis drugs, the nature of complications and the possibilities of surgical treatment. Presence or absence of mycobacterial discharge in a patient is one of the major criteria
of therapy efficacy and favorable prognosis.
C o n c l u s i o n . The medical and social expert evaluation is an important component in the evaluation of a person’s state of health, in the assignment of a disability group, and in the analysis of the leading medical criteria, which characterize the degree of restriction of vital functions. The aspect of reviewing normative-legal acts concerns not only employees of social protection, but also acting clinicians for a better understanding of all the socio-economic consequences assigned when making this or that diagnosis.
Disability of the population due to tuberculosis remains a relevant area of analysis, requiring attention from both a clinical and legal perspective.
Child mortality in different countries during the COVID‑19 pandemic
At the beginning of the pandemic, COVID‑19 deaths were relatively higher among older children than in younger age groups, although there was a high likelihood of life-threatening cases of COVID‑19 in children with underlying medical conditions. Low child mortality from COVID‑19 is attributed by the authors of the study to the use of protective measures by children from high-risk groups and isolation measures. However, the COVID‑19 pandemic has led to serious disruptions in the work of health services in various countries, to interruptions in the provision of maternal and child health services (medical examinations, vaccinations, prenatal and postnatal care, and others), to a shortage of medical personnel.
Purpose: to analyze the data of scientific studies on the characteristics of child mortality in various countries with the allocation of risks in the system of maternal and child health care.
Materials and methods: bibliographic and analytical methods were used in the work.
Findings: Premature newborns are particularly vulnerable to the COVID‑19 pandemic, especially in low- and middle-income countries where the impact of health system failures is significant. Restrictions during the COVID‑19 pandemic exacerbate the risks of stillbirth, including delayed delivery. The drop in preterm birth rates seen in high-income countries is attributed by researchers to the indirect effects of the response to the COVID‑19 pandemic, and data on stillbirths are not taken into account, which may make it difficult to explain the decline.
Telemedicine as a tool for inter-regional remote interaction with specialized medical organizations of the subjects of the Russian Federation: experience of the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution». Russian Ministry of Health
At present, the possibility of providing qualified medical care anywhere in the world has become a reality thanks to the development of telemedicine technologies. The development and improvement of telemedicine technologies is due to the regulatory and legal regulation and implementation of the national project «Health Care», which was developed on the basis of the Presidential Decree № 204 of 07.05.2018 «On the national goals and strategic objectives of the Russian Federation for the period until 2024». (hereinafter – the Decree of the President of the Russian Federation of 07.05.2018 № 204) .
The National Medical Research Centers (NMRCs) were tasked with organizing advisory and methodological expert support for specialized regional medical organizations of the 3rd level of RF subjects. Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» supervises ophthalmological service of 8 subjects of the Russian Federation: Nizhny Novgorod, Kirov, Ulyanovsk regions, Republics of Mordovia, Udmurtia, Mari-El, Tatarstan and Chuvashia. The article presents the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine technologies to improve the provision of specialized, including high-tech medical care in the profile «Ophthalmology». Over the 3-year period of operation, the number of requests for telemedicine consultations at the «doctor-physician» level has increased significantly. In addition, from January 2021, Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» provides consultative
care at the «doctor-patient» level.
Purpose of the study is to present the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine consultations (TMC) performed using the «Telemedicine consultations» component of the federal electronic registry subsystem of the unified state information system in healthcare (USGISZ FER TMC component) from 2019 to 2021 and the «MEDTERA Telemedicine» unified secure technological platform from 2021.
Material and Methods. Telemedical consultations on the basis of the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» are performed by highly qualified specialists – heads of the departments, research workers, leading specialists in different fields of ophthalmology. Telemedical consultations at the «doctor-physician» level are performed as follows: at the initial stage, a request for a consultation is received from specialized medical organizations of the subjects of the Russian Federation, which is processed by the employees of the Department of Telemedical Consultations. Information about the request is registered in the database, its profile is evaluated, as well as the quality, completeness and relevance of the data of the attached medical documentation. For real-time consultation «doctor-patient» through video or audio conferencing, the patient makes an independent appointment for a convenient date and time with a particular specialist.
Results. During 3 years of the TMC functioning at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» the number of requests for telemedicine consultations at the “doctor-physician” level in the field of ophthalmology from 8 subjects of the Russian Federation of the Volga Federal District is progressively increasing. The bulk of telemedicine consultations are scheduled requests. During the 3-year period of telemedicine consultations at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» there were 94 TMK from the Republic of Tatarstan, 79 TMK from the Chuvash Republic, 61 TMK from the Republic of Mariy-El, 53 TMK from the Republic of Udmurtia, 46 TMK from the Kirov region, 37 TMK from the Nizhny Novgorod region, 36 TMK from the Ulyanovsk region, 23 TMK from the Republic of Mordovia.
Findings. Summarizing the results of the analysis of the structure of telemedicine consultations performed using the IGISZ FER TMC component, it can be summarized that the IGISZ FER TMC component is a convenient, effective tool, which allows to comply with the Russian legislation in conducting telemedicine consultations, as well as to analyze the structure of telemedicine consultations conducted with its use.
Scales and tests for evaluating the effectiveness of telerehabilitation of stroke patients
This article provides international scales and tests used in the telerehabilitation of stroke patients. The practical value of the work lies in the fact that, based on the analysis of international scientific articles published on the basis of randomized clinical trials, scales and tests used in telerehabilitation are given.
The results of this study can be used by healthcare professionals, doctors and medical workers to organize telerehabilitation of post-stroke patients under Russian conditions, as well as in clinical trials. The article may be useful to scientific and academic staff, resident doctors and other specialists who are dealing with digital rehabilitation of neurological patients or conducting research.
Implementation of SCORE calculator into the medical information system of the primary care
In the Russian Federation, disease prevention in primary care is a priority area of medical care for the adult population. An automated assessment of the risk of death from cardiovascular disease can be an auxiliary preventive tool if integrated intoa medical information system.
P u r p o s e o f t h e s t u d y – to substantiate the automation of the process of assessing the risk of death from cardiovascular diseases over the next 10 years using the SCORE scale at the level of a city hospital.
M a t e r i a l s a n d m e t h o d s . The study was carried outat the State Budgetary Medical Institution of Arkhangelsk region “Arkhangelsk City Clinical Hospital № 7”. The completeness and quality of electronic patient records were assessed. The SCORE calculator was integrated into the examination protocol for primary care physicians. The effects of the innovation on the completeness and quality of electronic patient records were assessed.
R e s u l t s a n d d i s c u s s i o n . Among the served population aged 40 to 79 years, any information on risk factors for cardiovascular diseases was reflected in 28,7% of electronic patient records. Data on all variables used to assess the risk on the SCORE scale (gender, age, systolic blood pressure, smoking, cholesterol level) were present for 20,8% of the patients. The introduction of the SCORE automated calculator into the examination protocol of a general practitioner and a cardiologist made it possibleto increase the completeness of data on cardiovascular disease risk factors used for the risk assessment on the SCORE scale to 97,4%.
C o n c l u s i o n s . The introduction of the SCORE automated calculator has significantly increased the completeness of data on the main risk factors for cardiovascular diseases in patients’ electronic patient records. The innovation makes it possible to reduce labor costs forestimatingthe risks, allowsmore effective identification of persons subject to dispensary observation.
Ten years of law enforcement of Federal Law No. 323-FZ dated 21.11.2011 “On the basics of public health protection in the Russian Federation”: controversial issues, gaps, prospects
Federal Law No. 323-FZ of 21.11.2021 “On the Fundamentals of Public Health Protection in the Russian Federation”, adopted in 2011 and entered into force in 2012 (323-FZ) is a key federal law regulating the healthcare sector.
The authors, through content and retrospective analysis, deductive method, method of generalization of judicial practice, conducted a comprehensive study of the application at the 10–year turn of the basic law in the healthcare system of the Russian Federation – 323- FZ. In the article, the authors analyzed the subject of legal regulation of the 323-FZ, the conceptual apparatus enshrined in 323-FZ, the principles of health protection, considered the ratio of the legal statuses of the patient and the medical worker, touched upon aspects of paid medical services. The problems in the implementation of the 323-FZ are also analyzed, the existing legal uncertainties of its enforcement are discussed.
According to the results of the study, the authors conclude that it is necessary to consolidate the most complete guarantees of the realization of rights, both for patients and for medical workers, aimed, inter alia, at reducing the risks of conflicts between the patient and the doctor, regulating economic relations in health care. In this connection, it is necessary to carry out work on the timely completion of this law.
Issues of introduction of electronic personnel document management in medical organizations
Informatization is gradually spreading to all new areas of labor relations. Therefore, it is logical to switch from the transfer to electronic form of individual documents (electronic sick leave, electronic workbooks, etc.) to the comprehensive automation of the entire personnel document flow.
The proposed material presents an analysis of changes in labor legislation devoted to this area.
Management in healthcare
Manager of heath care consults
Questions and answers