[Organizing the medical care for the COVID-19 patients in non-infectious Moscow hospital: reassignment experience].

AIM: To present the results of work of National Medical Research Center of Treatment and Rehabilitation, reassigned for COVID-19 patients treatment during pandemic. Run-up methodology, procedures and working process organization are detailed. MATERIALS AND METHODS: 354 COVID-19 patients were treated from 13.04.2020 to 10.06.2020 [age 59 (470) years, 56% women, body mass index 28.5 (24.932.2) kg/m2]. Patients were admitted at 8 (611) day of sickness. In-hospital stay was 16 (1420) days. RESULTS: NEWS scale at the day of admittance was 2 (14); 2 (13) in patients discharged alive and 6 (47) in died patients, p=0.0001. So prognostic accuracy of NEWS scale was confirmed as very well (area under ROC-curve = 0.819). 69 patients (19.5%) were treated at intensive care department for 7 (413) days. 13 patients died, 11 of them had COVID-19 as direct or indirect cause of death. Total in-hospital mortality was 3.67%, in-hospital mortality of COVID-19 patients 3.1%. 17 healthcare workers (HCW), contacted with COVID-19 patients were infected (2.67%). 4 HCW, who had no direct contact with patients were also infected and 7 HCW were infected before the first patient was admitted. No one of them died. CONCLUSION: Complex tasks of healthcare organization during COVID-19 pandemic can be solved quickly with acceptable quality, characterized by low levels of patients; mortality and HCW infection.

[Clinical aspects of the service of acute postoperative pain treatment].

PURPOSE OF THE STUDY: To analyze work results of the service of acute postoperative pain treatment in the orthopedic hospital. DISIGN: Single-center retrospective observational cohort study. PATIENTS AND METHODS: We studied 1343 patients underwent total hip arthroplasty (64%), total knee arthroplasty (33%), and revision surgeries (3%). The average age of the patients was 59 ± 12 years, and body mass index was 30 ± 6. All patients received triple pain therapy in postoperative period which included pracetamol, NSA IDs or specific ciclooxygenase-2 inhibitor and epidural analgesia or peripheral blockade and patient controlled intravenous or epidural analgesia. The pain intensity was recorded four times a day--every 6 hours during 2 days after surgeries. RESULTS: All patients received oral or intravenous analgesics. 90% of patients received prolonged epidural infusion, 10%--prolonged block of the femoral nerve after total knee arthroplasty. Patient controlled analgesia was used in 6-10% of patients. Average pain intensity was 20 mm according to VAS. Pain intensity over 40 mm was observed in 8-13% of patients at 1st day after surgery and in 2-15% at 2nd day after surgery. Deep vein thrombosis was found in 5.7% of patients, and bleeding in 0.2%. Length of stay in a hospital after total hip arthroplasty and total knee arthroplasty was 6 ± 2 days and 10 ± 8 days after revision surgeries. CONCLUSIONS: The work of the service of acute postoperative pain treatment in the orthopedic hospital, the use of multimodal treatment protocols and mandatory clinical monitoring provide proper control of postoperative pain, patient satisfaction, and allow to accelerate early recovery and reduce the time of postoperative hospital stay after total replacement of large joints.