Pre-accreditation Gap Analysis of Mongolian Laboratories / Эрүүл мэндийн лаборатори

Background@#Poor laboratory quality can lead to misdiagnosis and inappropriate treatment of patients. To demonstrate the quality and reliability of their services, medical laboratories seek accreditation to ISO 15189. We have initiated a project to assist laboratories in their efforts to obtain the accreditation. @*Goal@#Conduct a gap analysis of the status of preparedness of medical laboratories for accreditation.@*Materials and Methods@#Six laboratories are selected for participation in the project. In the first phase of the project, a gap analysis of the participant laboratories is conducted using an Excel program based on ISO 15189 requirements.@*Results@#The findings reveal that the participant laboratories are the strongest in Organization and management of laboratory, Quality of examination results, Personnel and facility management and in Laboratory information management. The majority of the laboratories are hospital based, and their organization and management are well established and functional mostly due to centralized administrative guidance. The concept of quality control is effectively adapted in medical laboratories, therefore ensuring the quality of examinations and the data management are usually in line with the requirements. Weaker areas include Evaluation and audits, and Document control. Even though the laboratories do conduct evaluations and control, they do not do it regularly and, most importantly, do not keep records routinely, which cause the higher gap rate.@*Conclusion@#Policies to meet ISO 15189 requirements are in place in the participant laboratories, but their documentation and records keeping are insufficient.

STUDY ON CHILDREN WITH CLEFTS, VISITED SPEECH THERAPY SESSIONS BETWEEN 2007-2012 / Шинэ санаа Шинэ нээлт

@#BACKGROUND. Congenital Cleft Lip and/or Palate (CL/P) is a common craniofacial birth defect and occurs 1 per 500-700 live births in average. Children with CL/P at a higher risk for speech/language problems due to the anatomical and structural differences in the oral and nasal cavities, Velopharyngeal Insufficiency causing speech disorders with articulation, phonation, and resonance, respectively. It leads to long-lasting adverse outcomes, influencing quality of life and causes obstacles in child’s socialization. Speech in 2007 Therapy team of School of Dentistry ( G. Ariuntuul , B. Bulgan, U. Azzaya, B. Batsukh, M. Bat-Erdene), Mongolian National University of Medical Sciences (MNUMS) (former Health Sciences University of Mongolia) established and successfully conducted a first clinical speech therapy sessions for children with clefts in Mongolia based on the Department of Oral and Maxillofacial Surgery (G. Ayanga et al.) of National Maternal and Children’s Health Center (NMCHC). Since 2012 the speech therapy team of School of Dentistry, officially transferred the equipped operating speech room to NMCHC and speech pathologist B. Bulgan, supervised and trained by Ariuntuul G. recruited by NMCHC for a full time position and working as a member of multidisciplinary team till present. OBJECTIVES. To assess and analyze registry data of children with clefts, visited speech therapy sessions of speech pathology team of School of Dentistry, MNUMS during 2007 through 2012. MATERIAL AND METHODS. Registry based retrospective study was conducted to obtain demographic and speech disorder related data of children with clefts, visited speech therapy sessions between 2012-2017 at the NMCHC. RESULTS. In total 203 participants are attended the speech therapy sessions: 103 male (51%), 100 female (49%). Out of total 203 children 144 (71%) had Cleft Lip and Palate (CLP), 44 had cleft palate only (22%), 15 had cleft lip (7%), respectively. Average age for primary cleft surgery was 1y13m, where as for secondary was 4y22m. CONCLUSION. For speech therapy session for children with clefts boys were dominant compared to girls (1:1.03). By the types of clefts children diagnosed with Cleft Lip and Palate was prevalent to attend treatment classes. There is a need in early CL/P diagnosis, using birth screening and furthermore, traning of speech therapists/pathologists are important for development of multidisciplinary team, surgery outcome and improvement of quality of life of children with clefts.

EVALUATION OF PRESCRIPTION INDICATORS AND CUSTOMERS’ KNOWLEDGE OF DRUG / Шинэ санаа Шинэ нээлт

@#BACKGROUND: The Mongolian National drug policy states, “The rational drug rehabilitation is one of the main goals of pharmaceutical care”. Recruitment and prescription medications are important issues for improving rational use of medicines. According to the recommendations of the World Health Organization (WHO), the status of rational use of medicines is assessed through the recipe by 10 criteria. The needs to study on rational drug use in hospitals of Ulaanbaatar and determining standard criteria for the proper use of drugs by recommendation of World Health Organization is the main justified issue of the study. @*METHODS@# In order to study the rational use of medicines, a single moment /descriptive/ research type was used. Recipes for 50 and 50 people who received prescription from pharmacy within 12 hospitals TFCHM, TSCHM, TTCHM, NCCD, NTaORC, NCMH, HCSKhD, HCChD, HCSBD, HCKhUD, HCBZD, HCBGD June 2017 in Ulaanbaatar, it was based on the WHO recommended methodology, a total of 600 clients, 600 recipes and 1249 medicines were selected and submitted to the conclusions. @*RESULTS@#The average number of medicines per minute was 2.08 ± 0.25, 45.2% in International Health Prescription were 42.6% antibiotics. According to a study on a contingency test, 85% did not have prescription signs, 38.8% without diagnostic prescription, 25% did not have physicians, and 48% did not have any medical information. The knowledge about the dose was 68.5% .@*CONCLUSION@#The results of the study were compared with the recommendations of the World Health Organization and the proportion of medicines included in the ICS list was lower than the recommendations of the World Health Organization list and the proportion of antibiotic drugs. The study found that 11 different incidents were encountered. Knowledge about medicines dose was 68.5%, compared to World Health Organization recommendations

VELOPHARYNGEAL FUNCTION FOLLOWING MONGOLIAN METHOD FOR PRIMARY PALATOPLASTY / Шинэ санаа Шинэ нээлт

The timing and technique for palatoplasty is very controversial, recent literature advocates for early repair, between six and eighteen months of age, facilitating normal speech and language development, and avoiding hearing loss. It is using three main kinds of techniques for palatoplasty in the worldwide, two flap pushback, Furlow double opposing z-plasty, and two-step palatoplasty.Cases presenting later in life to the Mongolian National Center for Maternal and Child Healthprovide Mongolian surgeons′ with the challenge of wider defects which are difficult to manage successfully using traditional palatoplasty techniques.Oro-nasal fistula formation is an one of most documented postoperative complication, and it`s rate is reported between 6-42,3% in the literature. In Mongolia patients often present in older than recommended age for palatoplasty,it provide surgeons with the challenge of managing wider defects, which have higher rates of fistula formation and wound dehiscence. There were 30% of ONF in our practice. So, in 2000 we established new modified Mongolian technique for primary palatoplasty for improved outcomes across all age groups. And ONF rate reduced from 30% to 5.9 % in our department. Objective: To determine velopharyngeal function after primary palatoplasty by Mongolian method in connective with age at repair and cleft type.In our study were included over four year’s old patients, who underwent primary palatoplasty by Mongolian method at the authors` centre. We excluded syndromic cases, and patients who had an oronasal fistula postoperatively, and no cooperation with speech therapist. This study, we use video records of nasopharyngeoscopy to evaluate for cleft lip and palate patient’s velopharyngeal function associated with type of clefts, the timing of palate repair and cooperation with speech therapist.There were included totally 28 patients who are 4-23 years old (mean age 10.2 years) at the time of study, were performed primary cleft palate repair by Mongolian technique at NCMCH. The mean age at palate repair was 38 months (14 months-18 years). Overall, 39.2% (11) of patients were performed palate repair at 18≥ months old and 60.8% (17) patients were operated palate repair at 18< months. In the first group, VPI was demonstrated 27,3%, and in the second group 41,2%. Also, there were demonstrated VPI for 66,7% of Veau 1 type, 45,5% of Veau 3 type, and only 10% of Veau 4 type, after Mongolian method. Better velopharyngeal result for Veau 4 type and wide cleft palate after Mongolian method than other types. We should continue this study in wider screen for recognition this results.