20TH ANNIVERSARY OF SCIENTIFIC CLINICAL CENTER OF MINERS HEALTH PROTECTION
Federal Scientific Clinical Center of Miners’ Health Protection,
Leninsk-Kuznetsky, Russia
Federal Scientific Clinical Center of Miners’ Health Protection was built in Leninsk-Kuznetsky in 1993. Its purpose is rendering of specialized medical aid for workers of mining enterprises of Kuzbass and for their families.
Scientific Clinical Center of Miners’ Health Protection is the biggest medical facility in Russia, where the best domestic and foreign practice of decrease of morbidity in residents of mining industry regions is insistently performed.
This big, multidisciplinary, specialized medical scientific and educational institution is the exclusive coordinating center in Kuzbass, which provides realization of medical, scientific research and methodic programs oriented to increase of efficiency of treatment of miners and their families, retirees, extensive support and treatment of children, increase of professional level of medical staff and realization of scientific research projects.
The center includes 26 clinical departments with 840 beds, the polyclinics for adults and children with 1000 visits, the occupational pathology center, instant readiness teams of the regional center of disaster medicine, the prosthetics department and the anatomic pathology department.
More than 1600 persons work in the center, among them 214 doctors (11 doctors with PhD degree, 3 – with professor degree, 32 – candidate of medical science), 675 nurses, and 50 specialists with higher technical education.
Annually the polyclinics of the center register more than 500,000 visits, among them more than 4,000 miners and more than 9,000 children; 15,000 workers have periodical medical examinations; 5,000 workers of mining industry have profound health examination; 50 visits of mining industry enterprises, more than 60,000 miners had consultations; the decrease of morbidity by 15 % was achieved. 20,000 patients had in-patient treatment; among them, 4,500 workers of mining enterprises, 6,000 children. More than 10,000 operations were performed, including 2,000 high tech surgeries.
The center is the training facility with chairs of postgraduate education “Integrative traumatology” and “Occupational pathology” by Kemerovo State Medical Academy.
During the whole period of the center activity the great attention is given to the high level of its technical infrastructure. Using of progressive high technologies is the main principle of the collective work.
Since 1994 Federal Scientific Clinical Center of Miners’ Health Protection in association with the Presidium of the Siberian Department of Russian Academy of Medical Science and Kuzbass Scientific Center is realizing the scientific research program oriented to solvation of medical biological problems which are actual for Siberia.
The main directions of the scientific studies of the center were and remain the questions of organization of the monitoring system of health of mining industry workers, development of new methods for diagnostics and treatment of polytrauma, cardiovascular and bronchoalveolar systems and occupation pathology in miners.
Within the scope of the main directions the work is performed oriented to three complex fundamental and applied scientific research topics:
1. Development of new organizational technologies of medical aid rendering and effective ways of diagnostics, treatment and rehabilitation in polytrauma (#01200903895 from 2009.06.18);
2. Study of pathogenetic mechanisms of formation and development of new methods for diagnostics, treatment and prevention of the most common diseases in pediatric and adult population (#01200903894 from 2009.06.18);
3. Optimization of the system of prophylactic measures for professional and industry-conditioned diseases in mining industry workers (#01200903896 îò 2009.06.18).
In the clinic the new technologies were developed and implemented which passes evaluation and showed high clinical efficiency.
The center successfully implements the high tech treatment methods into the daily practice, with using of the last achievements in science and engineering.
Scientific Clinical Center is the biggest medical facility in Kuzbass, which purposefully is engaged in development of the system of organization of specialized medical aid with consideration of mappable routes of transport of victims to multidisciplinary facilities, as well as development of effective methods of diagnostics, treatment and rehabilitation of patients with polytrauma.
For the first time ever in Russia on the base of Federal Scientific Clinical center of Miners’ Health Protection the system of special medical aid rendering was developed and implemented which is meant for victims with polytrauma in conditions of the large industrial region of Siberia, which includes the complex of medical diagnostic measures at pre- and hospital stages with consideration of the mappable routes of transport of patients to medical multidisciplinary facilities, effective methods of diagnostics, treatment and rehabilitation.
The main conceptions of medical aid rendering in polytrauma are maximal fast transport of victims by transportation teams to medical facility where all types of diagnostics, intensive care, surgical treatment and special rehabilitation are performed.
At that, success in polytrauma treatment is conditioned by changes in system of organization of medical aid, development of effective methods for assessment of state severity, diagnostics, treatment and rehabilitation. The algorithm of staged management of patients with polytrauma is offered.
Using of principles of emergent surgical treatment in polytrauma includes: high priority conduction of surgical treatment of dominating injury which is dangerous for patient’s life; maximally possible conduction of surgical interventions in skeletal trauma of shockogenic pattern; reducing time of surgery conduction.
At the base of the center the medical transport teams of constant readiness are organized which are the part of the regional service “Disaster medicine” and perform one of the stages of treatment of patients. They participate in mitigation of consequences of serious disaster in mines and transport miners almost from all places of disaster with roof collapse, rock bursts and gas explosions (Ulyanovskaya, Yubileynaya, Raspadskaya mines et al.). During a year the teams have more than 400 trips for victims in different places of the region.
Transportation by the specialized medical transport teams resulted in decrease of time of transport of patients to specialized center that allowed to prevent admission to hospitals of lower level, as well as to increase the efficiency of prehospital treatment.
Therefore, for the first time ever the systems of specialized aid rendering with pattern “hospital – specialized medical facility” (“clinic-clinic”) were developed and implemented, with consideration of the mappable routes of transportation by the medical transport of the center; the new diagnostic and curative measures for pre-hospital and hospital stages were optimized and implemented; the methods of assessment and prediction of pathologic process course were developed; there was a research of pathologic mechanisms of development of pyoinflammatory and regenerative restorative processes in the posttraumatic period with aim of substantiation of the new methodologic approach to prevention of development of septic complications; the methods of surgical treatment of locomotorium diseases were developed and improved; the low invasive technologies for injuries and internal organ diseases were implemented; the effective programs of rehabilitation measures were developed.
The indications and tactics of emergent surgical treatment of patients were defined with compliance of injury severity, complications of severe traumatic brain injury, respiratory distress syndrome, conduction of replantation of detached limbs, knee and hip joint endoprosthesis, as well as endoprosthesis and plastics of hand joints and fingers. The methods of endoscopic neurosurgery, surgical methods of treatment of hydrocephaly, intracranial cysts in children and adults, sparing methods of surgical treatment of crush injuries and brain compressions, the pathogenetic approach to cranial defects closing with new technologies, surgery of degenerative diseases and spine and spinal cord injuries are implemented into daily practice.
The offered optimized complex organizational and medical diagnostic system of medical assistance realization in polytrauma with implementation of the new medical technologies and approbation at the center base in Kuzbass allowed to achieve the positive outcomes in 90 % of the cases, to reduce the time of in-hospital treatment by 2 %, to substantially reduce the mortality from polytrauma (two times, up to 15 %), and to decrease the primary disability by 20 %.
Within the scope of the research “The new methods of diagnostics and treatment of patients with polytrauma” 7 PhD dissertations and 18 candidate dissertations were defended, 39 patents of Russian Federation were received, 356 printed works were published including 66 in the central press and 6 in the foreign press. The monographies “Polytrauma” (2003), “Polytrauma. Septic complications” (2005), “Polytrauma. Emergency aid and transportation” (2008) were published. 12 methodic recommendations were approved. On the basis of the center two offsite meetings of the Presidium of the Siberian Department of Russian Academy of Medical Science were conducted which were dedicated to the problem of polytrauma (September, 2008, April, 2012).
The pathogenetic mechanisms of development of cerebral and cardiovascular pathology in young people were studied. The identified particularities of metabolic and rheologic disorders in ischemic stroke and myocardial infarction in individuals at the age of up to 50 form the basis for realization of complex approach to prophylactic and therapeutic strategy of these diseases. The parameters were separated which allow to assess the severity degree and possible functional outcome of ischemic stroke in patients at the age younger 50 (homocysteine in the first case, fibrinogen and homocysteine in the second one). The obtained data can be used in further for evaluation of risk degree and prediction of development of cerebral and cardiovascular pathology in young individuals, as well as for development of programs of individual prophylactic procedures.
The center of occupational pathology continues to work in observation and treatment of patients with vibration disease, to develop new diagnostic methods and treatment of dust pathology in miners.
The method of profound professional health examinations at the mining enterprises of Kuzbass is widely implemented in the center. Besides the precise study of morbidity in mining industry workers the workshop service provides conduction of complex medical examinations for miners suffered from different diseases, with consideration of professional signs. The teams of doctors visit the mining enterprises for profound examination of employees. The annual percent of coverage of periodical medical examination of mining industry workers is 98.8 %. In comparison to the similar mining enterprises which are not in the servicing area of the center the 15 % decrease of morbidity is achieved.
The program for provision of quality of medical aid was developed and implemented, the quality expertise department was organized that allowed to decrease the financial losses associated with medical causes from 3 % with compulsory medical insurance to 0.04 % with voluntary health insurance.
The system of personalized provision of patients with pharmaceuticals was developed, implemented and is constantly improved. It allowed to control using of drug therapy in concordance with medicamentary form and to save 20 % of funds.
The informative system of the center was significantly modified, the new computers meeting the modern requirements were installed in the departments of the center. The presence of the own web-site gave opportunity to the patients to receive at home any free information of any direction in the work of the doctors.
The system of quality management was developed and implemented which is applied to rendering of emergency and planned in-hospital and ambulatory polyclinic medical aid in compliance with the requirements of the international standard ISO 9001:2008. The correspondence certificate, the registration number # ROSS RU. IF09.K00006.
On the basis of the center 11 PhD dissertations and 74 candidate ones were realized and defended, 6 monographs, more than 4,500 scientific works were published, 135 Patents of Russian Federation were received, 16 All-Russian scientific practical conferences were organized and conducted in cooperation with the Presidium of the Siberian Department of Russian Academy of Medical Science. The materials of the conferences were published in the view of the annual Collections of conference materials (ISBN 978-5-904-430-18-4).
From 2006 the reviewed scientific practical journal “Polytrauma” is published trimonthly. On the February, 19, 2010 according to the decision of State Commission for Academic Degrees and Titles the journal was included into the “List of the leading reviewed scientific journals and publications in which the main scientific results of PhD and candidate of medical science dissertation have to be published”.
The center is the training base with the chairs of postgraduate education “Integrative traumatology” and “Occupational pathology” by Kemerovo State Medical Academy. The chairs were created in 1998 for realization of postgraduate education for doctors of Russia and CIS who have specializations in traumatology, orthopedics, complementary medical subjects and occupational pathology.
For education of students the chair has all necessary: the well-equipped clinic, the experienced teaching staff, the library.
The employees of the chair are the authors of 5 monographs, 420 publications, 60 Patents of Russian Federation. More than 400 doctors finished their education during the years of the work of the chair.
The web-site of the center (www.mine-med.ru) is constantly improved and renewed, with the aim of informing about multifunctional medical, practical, scientific research, pedagogic and organizational activity of the center. The catalogue “Scientific clinical Center of Miners’ Health Protection by Minenergo of RF” was published.
It is necessary to note that in the society the number of individuals is increasing who wish to receive effective medical aid in comfortable conditions. We developed the program oriented to improvement of stay of the patient in the hospital: reconstruction of wards, organization of individual nutrition for patients, branded overalls, staff discipline, adherence to the standards of ethics and deontology etc.
Preservation of innovative development of science and practice, traditions of high level of services, constant striving to get higher for one step compared to the past achievements from year to year present the characteristics which relate the center to the range of the leading health care facilities of the region.