Keyword: Patient

ABSTRACT: Objective: To evaluate the medical-organizational and clinical effectiveness of optimizing comprehensive diagnostics and follow-up care for patients with cervical intraepithelial neoplasia (CIN) through the introduction of a specialized digital module into the national Health Management Information System (HMIS/DHIS2) of the Republic of Tajikistan.
Materials and Methods: An analysis was conducted on the results of diagnosis, treatment, and dynamic follow-up of 542 patients with morphologically verified CIN1–3/Tis, aged 20 to 65 years, examined during 2023–2026. The main group using the digital system (n=82) was compared with a control group managed through paper-based documentation (n=460). The developed Digital Module for Early Diagnosis (DMED) of cervical cancer enabled the integration of 51 specialized cervical pathology units at district and city health centers, HPV diagnostics laboratories, cytology laboratories, and the State Institution "Republican Oncological Scientific Center" (ROSC). Time intervals for completing stages of medical care and the proportion of patients under follow-up care were assessed.
Results: The use of automatic tracking algorithms through the DMED for cervical cancer reduced the total diagnostic and treatment time interval (from abnormal visual screening through extended diagnostics to organ-preserving treatment with LEEP/cone biopsy) from 68.4 ± 5.2 to 21.2 ± 2.4 days (p < 0.001). The proportion of women lost to follow-up decreased from 34.2% to 6.1%. All 5 cases of invasive cervical cancer detected using the DMED were diagnosed at stage I of the disease.
Conclusion: The implementation of the DMED for cervical cancer optimizes the organization of gynecologic oncology care, eliminates lost links in patient referral pathways, and ensures a high level of monitoring of the health status of patients with precancerous pathology of the cervix.

ABSTRACT: Background: Internal quality control is an essential component of healthcare management aimed at ensuring compliance with established standards, identifying and eliminating deficiencies, improving clinical processes, and enhancing patient safety.
Objective: To evaluate the main activities and outcomes of the Medical Quality Control Service at the State Enterprise on the Right of Economic Management “Multidisciplinary Medical Center” of the Akimat of Astana.
Materials and Methods: The activities of the Quality Control Service in 2024–2025 were analyzed. Key areas included preparation for national accreditation, updating standard operating procedures, internal audits of medical records and clinical processes, identification of deficiencies, and analysis of complications and mortality.
Results: In 2024–2025, the Center successfully completed national accreditation. In 2025, more than 3,000 inpatient medical records and 1,500 day-care records were audited. Clinical processes in surgical and chemotherapy departments were regularly monitored. More than 40 mortality case reviews and 14 meetings of the Medical Quality Control Committee were conducted. Identified deficiencies were analyzed, followed by the development of corrective measures.
Conclusions: Systematic internal audits, process standardization, and analysis of healthcare deficiencies are important tools for quality assurance. The Quality Control Service contributes to identifying areas for improvement, implementing corrective measures, and maintaining compliance with established healthcare quality standards.

ABSTRACT: Surgery in metastatic cancer has been considered to have a limited role in the treatment of metastatic disease and has generally been reserved for palliative intent. However, as imaging, systemic therapy, surgical techniques, and understanding of the biology of cancer has improved, the role of surgery in the treatment of metastatic disease has evolved. This narrative review will discuss the current state of surgical therapy in metastatic cancer and the indications for such an approach. A discussion of the impact of reducing tumor burden, the concept of oligometastatic disease, and the role of host–tumor interactions will provide a basis for the discussion. The objectives of surgery have evolved from palliation to include longer survival and even potentially curative intent. The primary consideration in the decision to pursue surgical therapy for metastatic disease is proper patient selection, and this requires a thorough evaluation of disease and patient factors, as well as the integration of systemic therapy and other local therapies. While evidence is strongest for metastasectomy in colorectal cancer, there is growing evidence in breast cancer, renal cell carcinoma, lung cancer, and neuroendocrine tumors. As a general rule, the optimal management of metastatic cancer includes a combination of systemic and surgical therapies to maximize benefit for the patient. While there are limitations to the current role of surgical therapy in metastatic cancer, challenges including surgical morbidity, delays in initiation of necessary systemic therapy, and a paucity of high-quality evidence, proper patient selection remains the cornerstone to providing meaningful clinical benefit.

ABSTRACT: Posterior reversible encephalopathy syndrome (PRES) is a neurological condition characterized by seizures, encephalopathy, visual disturbances, and headache, often occurring in the context of hypertension and immunosuppressive therapy after solid organ transplantation. Although classically presenting with vasogenic edema in the parieto-occipital regions, atypical patterns may also occur. Here we report our experience with a case of cyclosporine-related PRES after liver transplant and summarize PRES clinical features through a literature review.
The case was a 53-year-old man who received a deceased donor liver transplant. His initial immunosuppressive therapy comprised cyclosporine/mycophenolate mofetil/prednisolone. Five months after transplantation, he was admitted to our center with altered mental status. The patient was diagnosed with PRES based on neurological symptoms and neuroimaging findings and recovered after switching from cyclosporine to everolimus. In addition, the lowering of blood pressure with drugs reported in the literature for use in PRES proved to be effective but challenging, requiring the use of multiple agents and only slowly leading to adequate control of hypertensive peaks. Nonetheless, hypertension management and supportive therapy allowed for a complete neurological recovery of the patient.
In conclusion, cyclosporine-associated PRES has a generally favorable prognosis with early diagnosis and prompt treatment, including altering or discontinuing CNIs and controlling blood pressure. CNI-associated PRES should be considered in patients exhibiting acute neurological symptoms after transplantation. Early diagnosis and immediate treatment are critical for a favorable prognosis.

ABSTRACT: Introduction: This study is aimed at assessing the operational efficiency of the admission department of the National Research Oncological Center (NROC) for the period from 2020 to 2024 with an emphasis on the impact of digitalization on patient management and workflow optimization. Telemedicine is a key tool for improving the availability and quality of medical care, especially for patients living in remote regions. In oncology, its importance is increasing due to the need for interdisciplinary interaction and quick routing of patients.
Methods: A retrospective analysis was conducted using internal hospital records, admission logs, and national healthcare regulations. Key performance indicators were assessed, including patient intake volume, processing time, and rejection rates. The impact of digital tools such as automated registration, routing algorithms, and remote clinical validation was examined.
Results: Patient visits increased from 5,664 in 2020 to 11,851 in 2024, while cancer-related hospitalizations rose from 1,477 to 6,102. The average waiting time for reception was reduced from 12 to 7 hours, and the processing time for documentation was reduced from 45 to 15 minutes. The introduction of digital solutions improved the accuracy of admission and reduced the number of inappropriate hospitalizations. Improvements in identifying clinical contraindications and infectious risks through remote screening technologies were also noted. The number of telemedicine consultations increased 3 times, especially in surgery and transplantology.
Conclusion: Digital transformation has significantly improved admissions efficiency, improving patient flow, reducing processing time and improving decision-making. Further development of digital infrastructure and staff competencies is recommended to ensure sustainable growth and quality of care in cancer care. The comprehensive implementation of telemedicine and interaction with air ambulance contribute to increasing the availability of cancer care, optimizing resources and reducing costs.