1. VASCULAR RECONSTRUCTION DURING KIDNEY TRANSPLANTATION FOR PREVENTING COMPLICATIONS
Batsaikhan B ; Erdenesaikhan M ; Bayan-Undur D ; Nyamsuren D ; Jambaljav L ; Tumurbaatar B
Journal of Surgery 2016;20(2):50-55
Introduction: This article provides areview about techniques and pitfalls of arterialand venous reconstruction during kidneytransplantation. Main reasons of our clinicalstudy are to evaluate vascular variationsof kidney, posttransplantation vascularcomplication incidence and present status ofsurgery outcome.This retrospective researchbased on cross-sectional assessmentofconsecutive 102 kidney transplantation cases,which performed from 2006 to 2015 at theFirst Central Hospital of Mongolia.Materials and methods: Statisticalprocessing andanalysis on posttransplantionpatient history data are made byMicrosoftExcel, SPSS19.0software.Results: Despite rising technicaldifficulties caused by vascular variations,pelvic and inguinal morphology of recipientand the existence of multiple renal arterieskidney transplantation is a safe and highlyefficient procedure.On this article wereexplained 44 kidney transplantation caseswith reconstruction using microvasculartechniques to reconstruct renal arteriesand veins. About 10 different kinds ofreconstructions were done in our practice.Due to investigation of consecutive 102kidney transplanted recipients, 24,51% had avascular anatomical variations. And describedabout 44 vascular reconstructions used inour hospital in case of vascular variations.According to the lit., vascular complicationsranges from 1 to 16%. In our hospital,vascularcomplication of kidney transplantation withmultiple vessels is 4,0-12,0%. Also, incidenceof vascular complication in group with singlevessels from 1.3 to 2.6% and in group withmultiple vessel 4 to 12%.Even it is highcomparing with other international articles;it’s almost in same results. But lymphaticcomplication is higher than others; it showsneeds of careful and accurate dissection ofrecipient site anastomosing vessels.Conclusion: Multiple renal graft’sveselshave been associated with a higher rateof vascular complications, including arterialstenosis and lymphorrhea. It shows needs ofcareful and accurate dissection of recipientsite anastomosing vessels.
2.Current status of Cancer Incidence and Mortality, mean annual 2008-2012 in Mongolia
Undarmaa T ; Tubshingerel S ; Erdenechimeg S ; Badamsuren TS ; Tumurbaatar L
Mongolian Medical Sciences 2016;177(3):25-37
National cancer center of Mongolia has responsibility to produce National cancer registry annual reportwhich is collected cancer reports from primary, secondary and tertiary level of government hospitals andprivate hospitals, laboratories. MCR and indicators of incidence and mortality are important for planningand evaluation of all levels for cancer control, primary prevention, diagnosis, treatment, rehabilitation.ObjectiveThe aim of this study was to determine ASR and ASMRs of cancer incidence and deaths in Mongoliafrom 2008 to 2012 for comparing the results of data.Material and MethodsData on new cancer cases diagnosed in 2008-2012 in permanent residents of Mongolia, collected bycancer registry of the National Cancer Center, were used for the analysis. Incidence and mortality rateswere calculated as mean annual numbers per 100,000 residents. ASRs (Age-standardized incidencerate) and ASMRs (Age-standardized mortality rates) were calculated by the direct method from agespecificincidence and mortality rates, weighted to the World Population standard.ResultsFirst five most frequent cancers (liver, stomach, lung, esophagus, cervix uteri) comprise 76% of all newcancer cases.In males, the most frequent cancer site was liver, followed by stomach, lung, esophageal, colon andrectal cancer. In females, liver is in the first place, followed by stomach, cervical, lung, esophagealcancer.Mean annual crude incidence rate of all cancer sites was 155 per 100 000 population,in males 165, infamale 165 in 2008-2012 years.During this period, mean annual age-standardized incidence rate of all cancer sites was 218,3 per 100000 population, for male 258.9 in female 188.1with higher percentage of men.As we age, morbidity of the cancer increases approximately 2 fold in both sexes and also study revealsmen has more tendency to have cancer than women
3.Result to assess management capability of maternity hospitals
Batbold Ts ; Tumurbaatar L ; Munkh-Erdene L
Innovation 2020;14(1):44-48
Background:
Healthcare organizations are successfully implementing quality management
system by forming legal entity, administration’s structure, arrangement and developing healthcare
organization’s structure, arrangement, functional standard, clinical guideline, rule and employee’s
moral principles. Implementation of accreditation system into healthcare organizations is proof
of accepted standard application. However, the results of healthcare paradigm shift outcome
is insufficient. Also researchers, citizens and policy makers commented that quality and access
of healthcare service began to worsen compared with previous degree of development.
Management capability index presents management assessment by score, assesses outcome of
organizational functions and give chance to measure capability of management.
Methods:
This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital
and Khuree Maternity Hospital. The study involved 480 employees of above-mentioned hospitals.
The study used 9 chapter and 90 criteria that was used in over 30 Mongolian Governmental
Organizations for capability assessment to determine management capability index of Maternity
Hospitals, using Cross-Sectional study method. In the study, a questionnaire with 90 questions
including organization management capability 9 chapters which are organizational goal and task,
leadership skill in organization, worthwhile structure and arrangement, organization’s motivation
and leverage, organization’s relationship and collaboration, organizational culture, resource
utilization, knowledge and innovation, organizational productivity, quality and performance was
used. Organizations capability index was estimated by assessment of each questions in scores 1
to 5.
Results:
Total 480 employees consisting of 220 employees working at Urguu Maternity Hospital,
125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity Hospital
filled the questionnaire. 46 administration officials, 75 doctors, 208 nurses and obstetricians,
105 caregivers and service assistants and 46 economic employees involved it. Organizational
management capability was 71.8, 73.6 and 93 respectively Urguu Maternity Hospital, Khuree
Maternity Hospital and Amgalan Maternity Hospital. It is obvious that there has necessity to
improve organizational knowledge, innovation, resource utilization, behavior, culture and activate
their organization. In result of studying doctors, nurses, obstetricians and other employee’s work
task management, there has relatively little difference of management capability index with
0-3.9% between Urguu Maternity Hospital and Khuree Maternity Hospital while management
capability index of Amgalan Maternity Hospital had difference with 14.7-20.1%. In the work task
questionnaire analysis, no difference was noted but administrative officials and service assistants
gave high assessment for organizational management. Regression analysis was used to assess the
relationship between management capability assessment of doctors, nurses, obstetricians and
other employee of Maternity Hospitals and the result was p<0.001 and r=0.89. It represented the
presence of strong association between those.
Conclusions
Management capabilities of Urguu and Khuree Maternity Hospitals which don’t
implement the quality management system have difference from Amgalan Maternity Hospital’s
management capability. All participants of Amgalan Maternity Hospital implementing quality
management system gave same assessment for their organizational management capability
index regarding of differences of work tasks.
4.Study of staff employee’s satisfaction
Batbold Ts ; Tumurbaatar L ; Munkh-Erdene L ; Erkhembaatar T
Mongolian Medical Sciences 2020;193(3):22-27
Introduction:
Studies in many countries have found that the satisfaction of medical workers is closely linked to the
quality and efficiency of medical services, as well as the satisfaction of patients. Satisfied employees
will bring about satisfied clients. The satisfaction of employees remains a key factor linking the
internal management and external management of an organisation. The World Health Organization
(WHO) Global strategy on human resources on health workforce 2030 sets out the policy agenda to
ensure a workforce that is ft for purpose to attain the targets of the Sustainable Development Goals
(SDGs). Motivation of health care workers can initiate them to exert and maintain an efort towards
organizational goals. Motivation depends up on many factors, and job satisfaction is one of the most
important factors. Healthcare is a service industry where the overall service experience is important
for customer satisfaction and quality of care (even if in different extents according to the professional
at stake) and that the literature has been bringing about the pertinence of such a holistic approach,
this research was conducted within this perspective. Likewise, it is also known that there is close
correlation between the job satisfaction of health care staff and the total quality of health services.
Different groups have reported differences between the job satisfaction of doctors and that of other
health providers. Various satisfaction levels of health care workers, including general practitioners,
nurses and midwives, have been reported previously.
Materials and Methods:
This study was performed at the Amgalan Maternity Hospital, Urguu Maternity Hospital and Khuree
Maternity Hospital The study involved 480 employees of above mentioned hospitals. The short
form of the Minnesota Satisfaction Questionnaire, with 20 items, was used to examine satisfaction
with professional life. The self-administered questionnaire was distributed to all people at their
workplaces. Responses of 4 (satisfied) or 5 (very satisfied) were classified as ‘satisfied’, those of 1
(very dissatisfied) or 2 (dissatisfied) as ‘dissatisfied’.
Results:
The study recruited total 480 employees consisting of 220 employees working at Urguu Maternity
Hospital, 125 employees of Khuree Maternity Hospital and 135 employees of Amgalan Maternity
Hospital. 46 administration officials, 75 doctors, 208 nurses and obstetricians, 105 caregivers and
service assistants and 46 economic employees involved it. In table, 87.1% of total employees of
maternity hospitals were female and 12.9% were male. While there had significantly difference for
gender, occupation type and worked year in this sector and workplace between 3 maternity hospitals
(p<.001), age and education level had no significantly difference between these 3 groups. The
proportion of health care staff satisfied with their work was 80.7%. The chance to tell people what
to do’ and ‘Being able to do things that do not go against my conscience’, and mostly dissatisfied
with ‘The working conditions’ and ‘My pay and the amount of work I do’. There was no significant
difference between satisfaction scores of health care staff according to age, gender, marital status, and
experience of profession. When the 20 items constituting job satisfaction were examined specifically,
the satisfaction score showed a difference related to profession. The midwives’ satisfaction score
was significantly lower than that of the others. In table 4, to assess employee’s satisfaction of each
maternal hospital: While the minimum satisfaction was assessed by employees of Urguu maternity
hospital whether salary is equal for work performance, the maximum satisfaction was assessed by
employees of Amgalan maternity hospital under scope of consistent workplace at 93.9 percent.
Conclusion
Maternity satisfy external and internal factors of employees are influenced. Maternity is
different, depending on the satisfaction of other working areas of employment.
5.The treatment outcome оf the patients with infectious keratitis
Undarmaa T ; Tumurbaatar B ; Burenjargal P ; Bayarmaa E ; Sayamaa L
Innovation 2021;14(1-Ophthalmology):26-31
Background:
Infectious keratitis is a disease caused by inflammation, infection, and other
ocular damage to the outer and other deep layers of corneal epithelium. It is a major cause of
monocular blindness and visual disability worldwide regardless of age and gender. Therefore, we
aimed to determine the clinical features and risk factors of infectious keratitis among Mongolians
and to identify the causative microorganism and compared them with the treatment results.
Methods:
We collected the data of 149 patients who diagnosed as infectious keratitis at the
Ophthalmology Department of the First State Central Hospital in 2017-2020 and using a case series
model of descriptive study. Statistical analysis was calculated using Stata14 software.
Results:
The majority of patients in our study were male, with a male-to-female ratio is 2.1:1. The
cause of infectious keratitis were categorized and eye injury-induced keratitis accounted for the
highest percentage of 38.3% (n=57), with the majority being men 73.7% (n=42) (p=0.028). As for the
type of treatment, antibacterial drugs 103 (69.1%) and evisceration 27(45%) predominate.
Conclusion
Our study shows that the majority of infectious keratitis in Mongolia is due to trauma
in male patients. Forty-five percent of all surgeries involve evisceration surgery, which reduces the
client's quality of life.
6.The evaluation of immunosuppressive regimens in kidney transplant Mongolian recipients
Sarantsetseg J ; Byambadorj B ; Byambadash B ; Munkhjargal B ; Tumurbaatar B ; Jambaljav L ; Bayan-Undur D ; Ganbold L ; Chuluunbaatar D ; Oyunbileg B ; Batbaatar G ; Munkhbat B ; Nyamsuren D
Health Laboratory 2019;9(1):21-27
Background:
However kidney transplantation has being performed in Mongolia since
2006, because of pre-transplant sensitization, ABO incompatibility, hepatitis B and C virus
activation many patients are taken kidney transplantation in abroad. The transplantation
centers use own immunosuppressive regimens.
Objective:
Our aim was to assess the immunosuppressive regimens efficacy and toxicity
in kidney transplant Mongolian recipients.
Methods:
We analyzed data from 96 adult kidney transplant recipients who had taken
kidney transplantation in different transplant centers from August 2006 through January
2014. There were 3 kinds of regimens Group I Simulect induction with standard triple
/FK506/CyA+MMF/AZA+steroid/, Group II Campath-1H induction with CNI monotherapy
and Group III Campath-1H induction with standard triple /FK506/CyA+MMF/AZA+steroid/.
We retrospectively collected the post-transplant first two years serum creatinine. The study
was performed in 2014. The questionnaire was taken and blood samples collected for
determination of tacrolimus through level and for other laboratory tests. The primary end
point was the first two years serum creatinine, the secondary end points included rejection
episodes, blood through level of tacrolimus and some laboratory findings.
Results:
The post-transplant first two years serum creatinine levels were significantly
different in 3 groups. Group III showed similar results compared to Group I. There was not
enough data of biopsy proven acute rejection episodes however group II said more
rejections occurred. However participants said that rejection occurred in 15 (15.6%) biopsy
was done only 3 (3.1%) cases. Blood through level of tacrolimus was significantly different
in three groups. Some laboratory findings showed different between three groups.
Conclusions
A regimen of Campath-1H induction with CNI monotherapy (Group II) may
be advantageous for short-term renal function and cost effective but there were more
rejection complications and increased creatinine. The regimen of Campath-1H induction
11 with standard triple (Group III) may be advantageous for long-term renal function, allograft
survival, but there should consider about infection complications and polycythemia.
Simulect induction with standard triple could be best choice but transplantations were
performed in experienced centers. The study enrolled few cases and cases which were
performed at the beginning of transplant program so many things could influence on the
result. The study was compared beginner transplant center with experienced centers.
Longitudinal cohort study needed in the future.