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Aim. To evaluate 24-month outcomes after hospital treatment of patients with coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. Two-year outcomes (2,2±0,5) after hospital treatment for COVID-19 were analyzed in 802 patients (mean age, 59,8±14,5 years, men, 51,0%). We assessed cases of death, non-fatal myocardial infarction (MI) and stroke, revascularization operations, hospitalizations, recurrent COVID-19, vaccination for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).Results. During the follow-up period, 49 (5,9%) patients died, while 7 (0,8%) patients had MI, 7 (0,8%) — stroke. In addition, 222 (26,7%) patients were hospitalized, of which 26 (3,1%) for COVID-19. Recurrent COVID-19 were revealed in 146 (17,6%) patients, while 414 (49,6%) patients were vaccinated for SARS-CoV-2. The factors of age and stay in the intensive care unit were significantly associated (p1/3 of deaths recorded in the first 3 months and >2/3 during the first year. Factors associated with death were age, male sex, and intensive care unit treatment during the hospitalization. The readmission rate was associated with older age and CVDs. The risk of repeated cases of COVID-19 was one and a half times higher in the presence of CVDs, but 2 times lower in those vaccinated for SARS-CoV-2 in the post- COVID-19 period.

Aim. To study the clinical and anamnestic characteristics, pharmacotherapy of cardiovascular diseases (CVD) and long-term outcomes in post-COVID-19 patients with cardiovascular multimorbidity (CVMM), enrolled in the prospective hospital registry.Material and methods. In patients with confirmed COVID-19 included in the TARGET-VIP registry, the CVMM criterion was the presence of two or more CVDs: arterial hypertension (AH), coronary heart disease (CHD), chronic heart failure (CHF), atrial fibrillation (AF). There were 163 patients in the CVMM group and 382 – in the group without CVD. The information was obtained initially from hospital history sheet, and afterwards – from a telephone survey of patients after 30-60 days, 6 and 12 months, from electronic databases. The follow-up period was 13.0±1.5 months.Results. The age of post-COVID patients with CVMM was 73.7±9.6 years, without CVD – 49.4±12.4 years (p0.05). There were higher rate of all-cause mortality among patients with CMMM (12.9% vs 2.9%, p

Aim. Based on the data from the register of patients with COVID-19 and community-acquired pneumonia (CAP), analyze the duration of the prehospital period, cardiovascular comorbidity and the quality of prehospital pharmacotherapy of concomitant cardiovascular diseases (CVD).Material and methods. Patients were included to the study which admitted to the FSBI "NMHC named after N.I. Pirogov" of the Ministry of Health of the Russian Federation with a suspected or confirmed diagnosis of COVID-19 and/or CAP. The data for prehospital therapy, information from medical histories and a patients’survey in the hospital or by telephone contact 1-2 weeks after discharge were study. The duration of the prehospital stage was determined from the date of the appearance of clinical symptoms of coronavirus infection to the date of hospitalization.Results. The average age of the patients (n=1130; 579 [51.2%] men and 551 [48.8%] women) was 57.5±12.8 years. The prehospital stage was 7 (5,0; 10,0) days and did not differ significantly in patients with the presence and absence of CVD, but was significantly less in the deceased than in the surviving patients, as well as in those who required artificial lung ventilation (ALV). 583 (51.6%) patients had at least one CVD. Cardiovascular comorbidity was registered in 222 (42.7%) patients with hypertension, 210 (95.5%) patients with coronary heart disease (CHD), 104 (91.2%) patients with atrial fibrillation (AF). The inclusion of non-cardiac chronic diseases in the analysis led to an increase in the total proportion of patients with concomitant diseases to 65.8%. Approximately a quarter of hypertensive patients did not receive antihypertensive therapy, a low proportion of patients receiving antiplatelet agents and statins for CHD was revealed – 53% and 31.8%, respectively, anticoagulants for AF – 50.9%.Conclusion. The period from the onset of symptoms to hospitalization was significantly shorter in the deceased than in the surviving patients, as well as in those who required ALV. The proportion of people with a history of at least one CVD was about half of the entire cohort of patients. In patients with CVD before COVID-19 disease, a low frequencies of prescribing antihypertensive drugs, statins, antiplatelet agents and anticoagulants (in patients with AF) were recorded at the prehospital stage.

Aim. To estimate the detection rate of heart failure (HF), using various diagnosis criteria, among patients aftr 12 months after hospital treatment for coronavirus disease 2019 (COVID-19).Material and methods. The study included 185 patients from the TARGET-VIP registry who came for a visit 12 months after hospitalization for COVID-19. To identify HF with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction (EF), the European Society of Cardiology (ESC) criteria (2016 and 2021) were used. To identify HF with preserved EF (HFpEF), we used the ESC criteria (2016 and 2021), as well as the 2018 Russian guidelines and H2FPEF score.Results. In the analyzed group, there were no patients with EF

Aim. To evaluate the medical treatment of patients with cardiovascular disease (CVD) during the first year of follow-up after hospitalization for coronavirus disease 2019 (COVID-19) in a prospective registry.Material and methods. The material for the study was obtained from the database of the TARGET-VIP inhospital registry. The registry included 1130 people. Of 863 patients discharged from the hospital with a diagnosis of COVID-19, 473 (548%) patients with CVD were selected, and 31 (40,8%) patients were selected from 76 patients in whom the diagnosis of COVID-19 was not confirmed with CVD.Results. At the stage of discharge from the hospital, the quality of therapy for CVD was insufficient on average, the frequency of proper prescriptions was 59,5%. During the first year, there was a significant trend towards a decrease in the prevalence of antihypertensive therapy for hypertension (p=0,018), anticoagulants for atrial fibrillation (p

The article is devoted to the scientific understanding of the practical aspects of receiving, customs declaration and use of humanitarian aid in the Russian Federation in the context of a pandemic of the new coronavirus infection COVID-19. The procedure for interaction of a medical organization as a recipient of humanitarian aid with executive authorities and international donors of gratuitous aid has been considered in detail and outlined. The rapid spread of the new coronavirus infection COVID-19 in the world did not provide an opportunity to prepare special measures to regulate legal relations within the framework of humanitarian assistance in the Russian Federation. At the same time, the receiving organization was faced with the task of promptly transferring humanitarian aid to the final recipients in order to prevent the spread of a new coronavirus infection in the Russian Federation. The authors studied the issues of receiving, declaring and transferring humanitarian aid to the final recipients in a pandemic COVID-19, identified collisions of existing legal norms and suggested possible options for improving the system for receiving and distributing humanitarian aid. The necessity of developing and adopting a normative act that comprehensively regulates the procedure for organizing, preparing and receiving humanitarian aid, the procedure for its acceptance with verification of the availability of quantity, compliance, labeling, packaging, technical documentation, as well as its compliance with other requirements, has been proved.The article substantiates expediency of the introduction of amendments to some norms of customs regulation, envisaging the possibility of transferring cargo placed under a special customs procedure to other persons according to the decision of the authorized executive body.The relevance and high practical significance of the article is caused by the need for the timely distribution of large volumes of humanitarian aid in order to effectively prevent and eliminate the consequences of emergencies.

Aim. To assess long-term outcomes within 12 months after hospital treatment of patients with coronavirus disease 2019 (COVID-19) as part of a prospective registry.Material and methods. Outcomes in the posthospital period were assessed in 827 patients diagnosed with COVID-19 (age, 58,0±14,8 years; men, 51,3%). For periods of 30-60 days, 6 and 12 months after discharge from the hospital, cases of death, nonfatal myocardial infarction (MI) and stroke, hospitalization, acute respiratory viral infections/influenza were assessed. The follow-up period was 13,0±1,5 months.Results. During the follow-up period, 35 (4,2%) patients died, 6 (0,73%) and 4 (0,48%) cases of MI and stroke were registered. In addition, 142 (17%) patients were hospitalized, while 217 (26,2%) patients had acute respiratory viral infections/ influenza. Factors of age and length of intensive care unit stay were significantly associated (p

Aim. According to hospital-based registry, to evaluate the age characteristics and prevalence of concomitant cardiovascular and non-сardiovascular diseases in patients hospitalized with COVID-19 during epidemic wave.Material and methods. The TARGET-VIP register included 1130 patients aged 57,5+12,8 years (men, 51,2%) hospitalized at the Pirogov National Medical and Surgical Center from April 6, 2020 to June 22, 2020 with COVID-19. Cardiovascular diseases (CVDs) were diagnosed in 51,6% of patients, non-сardiovascular chronic diseases — in 48,6%, while CVDs and/or non-сardiovascular chronic diseases — in 65,8% of patients.Results. The average age of patients significantly increased by an average of 0,77 years per week (p

Aim. To characterize patients admitted to hospital with suspected or documented COVID-19 infection and community-acquired pneumonia (CAP) and to assess the prevalence of concomitant cardiovascular, non-cardiac diseases, prehospital cardiovascular therapy and outcomes of in-hospital treatment.Material and methods. The TARGET-VIP registry includes patients admitted to the N. I. Pirogov National Medical and Surgical Center with suspected or documented COVID-19 infection and/or CAP for the period from April 6, 2020 to July 2, 2020. COVID-19 infection was diagnosed using polymerase chain reaction (PCR) tests and chest computed tomography (CT). Comorbid conditions and pre-hospital therapy were assessed.Results. A total of 1,130 patients were included in the registry (mean age, 57,5±12,8 years; men, 579 (51,2%)). Using PCR test, COVID-19 infection was established in 686 (60,7%) patients; using chest CT − 334 (29,6%) patients. The most numerous were the group with a combination of COVID-19 and CAP (n=662; 58,6%) and the group with CAP without positive PCR (n=402; 35,6%). The group of patients with COVID-19 without CAP was the smallest (n=24; 2,1%); in 3,7% of patients (n=42), CAP was not confirmed and PCR were negative. The proportion of people with cardiovascular diseases (CVD) according to the survey, in comparison with data of medical records, was higher by 2% (52,2 vs 50,2%); the proportion of persons with chronic non-cardiac diseases − higher by 6,7% (50,8 vs 44,1%). Among patients with CVD (n=598), compared with patients without CVD (n=532), following diseases was diagnosed significantly more often: diabetes (odds ratio (OR), 5,66; 95% confidence interval (CI), 3,52-9,12), respiratory disease (OR, 2.,7; 95% CI, 1,43-4,27), chronic kidney disease (OR, 3,32; 95% CI, 1,97-5,59), obesity (OR, 15,35; 95% CI, 6,62-35,59). Hospital mortality was 4,2% and significantly differs (4,7 times) in patients with and without COVID-19 according to PCR (6,6 vs 1,4%, p=0,0001), including among patients with CAP and positive or negative PCR (6,0 vs 1,2%, p=0,0002).Conclusion. COVID-19 infection was diagnosed in 60,7% of patients according to PCR and in 90,3% of patients according to the combination of PCR and chest CT. Among patients with CVD, the proportion of people with chronic noncardiac diseases was significantly higher (regardless of age and sex), in particular, with diabetes, chronic kidney disease and obesity. Questionnaires provided important data on the history of noncommunicable diseases and prehospital cardiovascular therapy. The mortality rate of patients with documented COVID-19 infection was 4,7 times higher than with undocumented.

Modeling the activity of medical institutions is one of promising lines in enhancing the organization of medical aid. However, its realization today is restricted by research work. The key reason is the difficulty of developing effective models in public health service and working with them, which is envisaged by a wide diversity of processes of medical services provided to the population. In the National Pirogov Surgery Center methods of modeling the patients' flow are introduced in the process of hospital management. The authors show results of the preparatory, analytical stage. Analysis of the data demonstrates that methods of the theory of mass service can be applied to processes of a big multi-profile medical institution and the quality of data in the medical information system provides an opportunity to use it for imitation modeling. Preliminary results of data preparation were given. It was shown that the complexity of collection, treatment and presentation of data is a strategic function, which can be compared to complexity of model development.

The article is dedicated to the description of the experience of automation of the processes of statistical reporting on salaries in Federal State Budgetary Institution «NationalPirogovMedicalSurgicalCenter» of Ministry of Health of theRussian Federationwith the use of information systems.According to the current legislation of theRussian Federation, within the framework of the successful implementation of the «Road Map» on a national scale, statistical information about salaries of employees of social institutions is collected in various sections of data reporting. It became necessary to develop a tool to promptly collect, process and analyze data on salaries to provide statistical information to social institutions.The purpose of this article is to familiarize oneself with the concept of multidimensional data representation and to structure information on multidimensional analytical reports within the framework of practical application for solving economic problems related to the formation of statistical reporting on salaries. The algorithm and the procedure for the formation of multidimensional analytical reports are described, both from the methodological and from the practical point of view. As a material for this study, the normative and legal acts of the Russian Federation, statistical and analytical materials of the section «Salaries of certain categories of workers in the social sphere and science» of the Federal State Statistics Service of the Russian Federation, scientific publications and articles of the periodical press, as well as the results of their own research were used.To facilitate the perception, special attention is given to the description of the basic concepts of multidimensional analytical reporting: measure, performance variables, value. The authors not only gave a definition of multidimensional analytical reporting, but also demonstrated a visual representation of the multidimensional information space of performance variables.Based on these definitions, the article describes the system for developing multidimensional analytical reporting, examines the stages of designing a multidimensional analytical representation of data, and demonstrates how to set up a multidimensional analytical report for building a multi-level hierarchy in accordance with pre-selected performance variables and dimensions.Methods of working with multidimensional analytical reporting are also described on the example of the implementation of the formation of the multidimensional analytical report «Statistical reporting on salaries» in the information system of the Federal State Budgetary Institution «NationalPirogovMedicalSurgicalCenter» of Ministry of Health of theRussian Federation.As a result, the effectiveness of multidimensional analytical reports for collecting, monitoring and analyzing statistical information on salaries was proved. Conducting in-depth analysis and evaluating the results of the implementation of salary targets are the basis for further modeling of the pay system and forecasting of financial results. Thus, the introduction of multidimensional analytical reporting made it possible to facilitate the labor-intensive process of making strategic management decisions by the administration of the institution.The authors concluded that the availability of such a tool in the healthcare system could help accelerating the operational processing of information for data analysis, as well as the generation of reports in various sections with an established depth of detail.

Objective: this article presents the analysis of treatment’s results, life’s quality and long-term postoperative period’s complications at using intestine segments for replacement plastic of bladder and ureter.Material and methods: this study included 122 patients with plactic by intestine segments at urology department of Pirogov National Medical & Surgical Center. At bladder’s reconstructive plastic we used Hautmann’s method (59 operations) and Reddy’s method (36 operations). At ureter’s reconstructive plastic we used method of ileoureteroplastic (all 27 operations). After operation, patients underwent urography with intravenous contrast, cystography for impermeability, anastomotic integrity and the lack of reflux. Evaluation of oncological and functional outcomes included clinical, laboratory and radiological diagnostic methods.Results: long-term results of intestinal grafts showed the highest level of life’s quality after ileoureteroplastic, the lowest level – after Reddy’s method of bladder’s plastic.Conclusion: postoperative results of intestinal segments at reconstructive plastic operations on the urinary tract analyzed and assessed.

Objective. Evaluate the change of etiological structure and clinical outcomes of bacteremia in surgical patients after the implementation the system of monitoring and control antibiotic resistance in a multidisciplinary hospital.Materials and methods. Interventional study with historical controls. The intervention: antibiotic stewardship program, including a group of experts on antimicrobial therapy, antimicrobial therapy and prophylaxis protocols, infection control, improving hospital bacteriological laboratory, educational programs, internal audit. Study onset: June 2013. Analysis of pre-intervention (Jan. 2011-June 2013) and intervention (July 2013-Dec. 2015) periods was carried out. We assessed incidence of bacteremia caused by methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), ESBL-producing Enterobacteriaceae, MDR Gram-negative nonfermenting bacteria (MDR-NFGB), incidence of candidemia, hospital length of stay (LOS) and mortality of surgical patients with bacteremia.Results. In the intervention period a significant decrease in the incidence of bacteremia caused by MDR-NFGB from 50 (14,8%) to 16 (4,7%), р

The purpose of the study is to assess the possibility of managing the antibiotic resistance level and consumption of antimicrobial agents in a hospital based on the analysis of the drug resistance index.Material and methods. The antibiotic consumption planning system was employed at the multidisciplinary surgical hospital based on the unified Registry of microorganisms (ROM). ROM included data on 25.581 strains obtained from patients with infections admitted to the intensive care units (ICU) and specialized departments. Protocols of empiric antimicrobial therapy and perioperative antibiotic prevention were developed. The ROMbased system allowed automated calculation of drug resistance indices for nosocomial microor ganisms. Data obtained during the preintervention period (2012) and intervention period, (2014—2015) were compared. Results. Decreases in the drug resistance indices for Pseudomonas aeruginosa from 0.721 in 2012 to 0.596 in 2015, Acinetobacter baumannii from 0.96 in 2012 to 0.889 in 2015, Klebsiella pneumoniae from 0.728 in 2012 to 0.595 in 2015 were achieved due to reduction of antimicrobial resistance, reduced consumption of III—IV generation cephalosporins and antipseudomonal carbapenems, and more frequent use of ertapenem for treatment of infections caused by Klebsiella pneumoniae. There was an increase in the drug resistance index of Escherichia coli from 0.325 in 2012 to 0.382 in 2015 due to increased consumption of protected penicillins and first generation cephalosporins for prevention in abdominal surgery and urology and increased pathogen resistance to these antibiotics.Conclusion. A development of a unified hospital ROM and application of the drug resistance index for math ematical modeling of the pathogens resistance level allows to perform timely monitoring of changes in antibiotic resistance of nosocomial microorganisms in ICU setting and other hospital departments and proper managinge the antibiotics prescription.

In the work are elucidates advanced approaches to local treatment of hepatic tumors. Such modalities as super-selective intra-arterial chemoembolization, cryoablation, laser and radio-frequency ablation, as well as most modern technique based on high intensity focused ultrasound (HIFU) for distant local tumor destruction are presented in a comparative format. A classification of local ablation techniques based on degree of invasiveness (factor of local tumor destruction) is proposed. The authors present through analysis of published data, describing benefits and disadvantages of all local ablation techniques, indications and contraindications, associated complications and long-term clinical outcomes.