Objective. To characterize care to patients with AL amyloidosis in accordance with current regulations, to analyze survey data from medical specialists on modern care and to identify current issues in medical education regarding diagnosis and treatment of patients with paraproteinemic hemoblastosis. Material and methods. We analyzed regulatory documents and problematic issues in organization of care for patients with AL amyloidosis taking into account expert assessments from chief hematologists in constituent entities of the Russian Federation. Specialists in care for patients with AL amyloidosis were surveyed. Results. Regulatory acts governing care to patients with AL amyloidosis and status of hematologists as primary specialists for pathogenetic therapy were identified. Patient pathways issues were identified, and potential solutions were proposed (creation of regional regulatory documents regulating patient pathways to receive high-quality care). Survey of specialists identified the need for advanced professional program on organization of care, diagnosis and treatment of patients with AL amyloidosis. Conclusion. Improved treatment of patients with AL amyloidosis is possible in case of state funding for expensive diagnosis and therapy. Correct coding of AL amyloidosis cases will enable organization of a patient registry and outcome monitoring, reduce the period between diagnosis and treatment, as well as facilitate patient pathways. It is necessary to develop and implement advanced educational programs for diagnosis and treatment of AL amyloidosis with practice-oriented training for hematologists, pathologists, and specialists in laboratory testing. Multidisciplinary teams, including hematologist, nephrologist and cardiologist, should be formed to ensure timely diagnosis and treatment, including pathogenetic antitumor targeted therapy.
Objective. To analyze international approaches to assessing the labor complexity for different specialists with higher medical education (physicians). Material and methods. We performed a systematic searching and content analysis of foreign and national studies and documents devoted to labor complexity of different specialists with higher medical education (doctors). A group of experts among the authors of this study discussed and identified significant factors in assessing complexity. Results. There are 2 main systems to assess physician workload complexity in foreign countries. The first approach is based on analysis of «patient complexity» and includes number of comorbidities and prescribed medications, mental disorders, admission and redo admission rate, risk of mortality. The second approach involves assessing the overall workload, including work-related, mental, and emotional stress. After analysis of international and national approaches to assessing the labor complexity of medical stuff, specialists of the Center for Expertise and Quality Control of Medical Care developed a set of 8 factors for assessing the complexity of work of various doctors taking into account specifics of their professional activities. Conclusion. Analysis of international approaches to assessing the labor complexity of medical stuff underlies expert survey to rank various factors of work complexity relative to each other.
Objective. To evaluate economic significance of febrile neutropenia (FN) prophylaxis using granulocyte colony-stimulating factors (G-CSF) in oncology patients receiving antineoplastic drug therapy (ADT) within compulsory health insurance (CHI) system. Material and methods. We compared the total costs of CHI system when using two alternative G-CSF drugs (filgrastim 300 µg for 4 days and empegfilgrastim 7.5 mg once), direct costs of CHI system aimed at reimbursing hospitals for purchase of G-CSF and subsequent savings of CHI funds that could be spent on care for immediate and mid-term (up to 12 months) outcomes of prevented FN. Results. The estimated costs for prevention of FN determined by reimbursing purchase of a medicinal product and cost of care for FN and its consequences at the intermediate and final points of the study amounted to 43.81 billion rubles for filgrastim and 41.89 billion rubles for empegfilgrastim. The difference in such costs for empegfilgrastim (with complete abandonment of filgrastim) demonstrated savings for CHI budget in amount of 1.92 billion rubles/year or 16 071 rubles/year per a patient. Conclusion. Despite higher costs of empegfilgrastim, subsequent reduction of costs following more effective prevention of adverse outcomes will ensure a positive financial result for CHI system over a 12-month period.
Objective. A systematic review of studies on development, implementation and application of surgical safety checklists, as well as attitudes of healthcare workers towards ensuring safety using these checklists in the Russian Federation. Material and methods. The review included publications describing development and/or implementation and/or results of surgical safety checklists and/or attitude of healthcare workers towards surgical safety in the Russian Federation. We reviewed the PubMed, Google Scholar, eLibrary.Ru, CyberLeninka, Yandex (https://ya.ru/) and Google (https://www.google.ru/) platforms using the terms and phrases (in Russian and English) «surgical safety checklist» and «safe surgery checklist». No formal assessment of study quality was conducted. Results. This review indicates local use of surgical safety checklists in several Russian healthcare facilities. In some cases, lower complication rates and better process organization were reported. However, available data are limited in scope, not representative and characterized by low methodological quality (no control groups, standardized assessment criteria and long-term monitoring). Key barriers to checklist implementation include insufficient staff training and resistance from certain healthcare professionals. Successful integration requires educational initiatives and leadership support. Conclusion. Available data in Russia are limited and do not allow for general conclusions about effectiveness of checklists. This determines the need for further research with higher evidence level.
Objective. To assess the methodological quality of Russian clinical guidelines using standards developed by specialists at the Center for Expertise and Quality Control of Medical Care. Material and methods. A meta-epidemiological study included clinical guidelines for the treatment of children. These guidelines were published on the website of the Russian Ministry of Health and approved in 2024. Quality of guidelines was assessed in several stages. The first stage implied analysis of availability and completeness of information provided in section “Methodology of clinical guidelines”. The second stage assessed compliance of the stated development process with the actual one. All references included in abstracts of guidelines were checked for availability in appropriate databases and compliance with stated searching depth and appropriate publication type. Results. The study included 51 clinical guidelines. All guidelines provided information on methodology. However, comprehensiveness varied and was often insufficient. All guidelines did not provide criteria for inclusion of evidence sources or strategy for their searching and selection. Critical assessment of quality of sources was provided in only one-third of guidelines. Systematic and/or statistical methods of data analysis were not described in all guidelines. Assessment of compliance of the stated development process with the actual one was possible for only half of guidelines. The stated development process matched the actual one in none case. Conclusion. The recently approved Russian clinical guidelines are characterized by unsatisfactory methodological quality and do not comply with the stated development process.
