1993

1994

1996

1997

1998

Ophthalmology

• Extensive hands-on training that occurred in 1994 at Railway Hospital in the early detection of myopia and cataracts has led to a 40 percent increase in early detection and an estimated 20 percent decrease in disability associated with vision, resulting in increased worker productivity.
• According to statistics provided by the Railway Hospital in 1997, 1300 patients were diagnosed with cataracts, 125 extra-capsular procedures were performed, 102 intra-ocular lenses were implanted (resulting in restoration of full vision) and the phaco-emulsification system was used in 48 cases. In addition, 808 patients were diagnosed with glaucoma and 98 anti-glaucomatosis procedures were performed.

Surgical Services

• As a result of partnership training, physicians at Railway Hospital have performed over 270 cholecystectomies in 1998 and 1999, with no record of any infection complications. The average length of stay dropped to 3.5 days (compared with 10-11 days with traditional surgical cholecystectomy). As a result of the introduction of this new procedure, the total profit for the hospital amounted to approximately 10,000 Ukrainian Hryvnas (approximately 5,000 USD) by mid-1998 (the cost of one surgery was 750 Hrn).
• As a result of the partnership program in laparoscopy, the post-operative infection rate for laparoscopic cholesystectomies was reduced to 0.02 percent. The overall length of stay at the Railway Hospital has been reduced from 13.9 days in 1994 to 10.7 days in 1999. This is attributable in large part to the fact that the length of stay in the laparoscopic surgery department has been reduced from 12.5 to 5.0 days during the same period of time.
• Physicians at the Railway Hospital performed 420 gastroenterology procedures in 1996 and over 1000 procedures in 1998.
• As a result of the partnership program, clinical practice guidelines were developed and implemented on interventional therapy of cholecystitis have been introduced at the Railway Hospital.
• The Perinatal Center began performing Laparoscopically Assisted Vaginal Hysterectomy (LAVH) techniques in 1996. In the first year, ten procedures were performed with no conversion to open procedure.
• The Perinatal Center also introduced the following new technologies in the laparoscopy department in 1996: infertility diagnoses, tubal ligations, treatment of tubal pregnancies, minilaparotomy and cystectomies.
• As a result of the implementation of gynecological laparoscopy at the Perinatal Center, a significant cost savings has been noted by the partners. The average length of stay in the Gynecology Unit was 10.7 days in 1998; however, after gynecological laparoscopy the LOS is only 3.0 days. As the cost per patient is 46 Ukrainian Hryvnas (23 USD) per day, this represents a savings of approximately 354 Hryvnas (177 USD) per patient.
• As a result of the Partnership's work, the L'viv Regional Association of Endoscopists has been established.

Nursing

• As a result of the Nursing Learning Resource Center project, strong professional relationships were developed between the nurses at the Railway Hospital and the Perinatal Center.

Perinatal and Neonatal Care

• According to reports from the Perinatal Center, a number of reductions have been made with regard to the average length of stay (LOS). In the maternity unit, the average LOS decreased from 5.8 days in 1995 to 5.4 days in 1998. In 2000, the average LOS in the maternity unit was 6.7. The average LOS in the gynecology unit was reduced from 13.6 days in 1995 to 11 days in 2000. In addition, the LOS for women after a normal delivery was reduced to three days.
• The Perinatal Center also reported that perinatal mortality rates decreased from 27% in 1995 to 26% percent in 1998. In 1999 there were 92 cases of perinatal mortality registered, and in 2000 - only 36. Intra-natal mortality rates were reduced from 15.5% in 1995 to 14% in 1998. The mortality rate of full-term infants was also lowered in 1998 to 2% from a rate of 3% in 1995.
• A number of perinatal technologies were introduced at the Perinatal Center in 1996. These include amniocentesis, hysteroscopy, and ultrasound examination with the use of a transvaginal meter. In 1998, 10,000 sonograms and 4057 trans-vaginal sonograms were performed at the Perinatal Center. In 1999 and 2000 the total number of sonograms was 23,102 including 16,282 trans-vaginal sonograms.
• In 1996 the Perinatal Center began to provide services on an out-patient basis for laboratory examinations prior to surgery and treatment to women with gynecological diseases.
• A Ukrainian-American physician translated selected OB-GYN texts from English into Ukrainian. These translations were published in Ukraine and copies were provided to both partnership hospitals and the medical universities.
• According to the Ukrainian partners, the 1997 statistics in the neonatology department show a significant improvement over the previous year's statistics in a number of areas (see chart below).

  	1996	1997	1998*	1999*	2000*
  Number of Patients in the Intensive Care Unit	327	256	2456*	2245*	1380*
  Average Length of Stay (days)	6.08	5.40	6.8	6.8	6.9
  Early Neonatal Mortality	10.65%	6.9%
  Number of Lethal Cases	29	16
  Percentage of Lethal Cases	8.25%	6.9%	3.75%	4.1%	2.61%

  
  * For 1998 through 2000 - total number of patients in all neonatology departments

 
Infection Control

• The Perinatal Center educated all 14 of their units in the prevention of blood and fluid exposure. This training was given to 248 physicians, 332 nurses and 172 midwives . As a result of the infection control program, the incidence of nosocomial infections at the Perinatal Center was reduced by 15 percent in 1998, and in 199-2000 no cases of nosocomial infections were registerd at the Perinatal Center.
• Between 1997 and 1998, the number of complications due to infections at the Perinatal Center decreased in both the maternity and the gynecology units. In the maternity unit it decreased by 2.7 times and in the gynecology unit it was reduced by a factor of 2.7 by the year 2000.
• In 1997, the position of Infection Control Officer was added at the Railway Hospital. This individual is responsible for hospital-wide infection control and the quality improvement program. The hospital also created positions for and hired both an epidemiologist and a Deputy Head Physician for Epidemiology Control.

Information Services

• Partners developed computer centers in both NIS partnership hospitals and provided health care professionals with access to medical and nursing resources. Developed a computer center at the Medical University Library in collaboration with the Rotary Clubs of L'viv, Buffalo and Rotary International.
• The partnership developed a library at the Perinatal Center, including numerous donated texts and journals.

Hospital Administration

• The For-Profit Medical Services Department at the Railway Hospital facilitates the receipt of payment for medical services rendered. Revenues for these services total over $5,000 per month. In 1998 over 380 patients were admitted to the hospital through this department..Patients without any professional connection to the railway system may receive treatment at the railway hospital through this Department. As of mid-1999, the hospital had received approximately $17,000 for medical services provided to such patients. These revenues help to pay for hospital operations, patient meals, and pharmaceuticals and disinfectants. The hospital anticipates that within five years they will transition to a completely fee-for-service institution.
• The For-Profit Medical Services Department is responsible for creating contracts for medical services between the hospital and the patients. They have also facilitated contracts for medical services through domestic insurance companies and collaborated with insurance companies for medical services for foreigners. The department keeps records of all medical services provided as well as records of payment submitted by insurance companies and records of payments for medical services provided by Contract Agreements.
• A computerized database of all case histories was introduced at the Railway Hospital in 1998.
• In order to attract more patients and effectively manage financial resources, both hospitals' head physicians are developing billing, collection and cost containment strategies.

Perinatal Care/Laparoscopy

• An OB/GYN from the L'viv Perinatal Center received extensive hands-on training in advanced laparoscopic surgery, including laparoscopic-assisted vaginal hysterectomy at partnership institutions in Buffalo. The physician also received training-of-trainers instruction in advanced laparoscopic surgery. From 1999-2000 175 laparoscopies were performed at the Center, and only in 2.24% of cases complications were observed.
• US partners provided a course on colposcopy with slide presentations on cytology/pathology at both the Railway WWC and the Perinatal Center. The partners also provided demonstrations of how a comprehensive pap screening program can significantly improve their overall departmental and institutional programs. Fromn 1999-2000, the total number of colposcopies performed was 3563.
• The US partners through several exchanges provided training in clinical and academic instruction for premature labor, neonatal care, and gynecological laparoscopy. Gynecologists and neonatologists from the Lviv Perinatal Center received training in prenatal diagnostic testing, treatment in premature labor, neonatal care, and in management of pre-term birthing.

 
Women's Health

• An obstetrician/gynecologist from the Perinatal Center was a member of the Joint US-NIS Advisory Committee on Clinical Practice Guidelines. He played an active role in helping to assemble the recommendations and clinical practice guidelines to create the reference manual being used in each of the AIHA-sponsored Women's Wellness Centers. He also played a key role in various meetings and workshops regarding the effective implementation of the guidelines. A nurse from Millard Fillmore Hospital was a member of the committee which created the breast health section of the reference manual.
• During three partnership exchanges to L'viv, US partners worked with the WWC staff on breast health quality assurance, reviewed films, reviewed Ukrainian patients, diagnosis and treatment of breast lesions according to standards and protocols as well as to evaluate the radiology technologist's competencies and equipment maintenance. In 1998-2000 approximately 5,000 women received mammograms, 218 patients were diagnosed with breast cancer, in 88% breast cancer was detected on stages 1 and 2 of the disease.
• Partners from the L'viv WWC and Buffalo participated in a Breast Health Quality Assurance workshop held in L'viv. The workshop addressed the issues of early detection and diagnosis of benign and malignant tumors, positioning, and film processing, and mammography and sonography image analysis/film reading. After the workshop, US partners spent an additional week working on issues addressed at the workshop. In addition, a gynecologist from Buffalo worked with staff from the WWC to complete training in the area of sonography and colposcopy, including treatment with LEEP.
• By the year 2001 L'viv WWC was visited by 58,000 women, and approximately 7% of those were adolescent girls. In 2000, 62% of the patients came for preventive visits. The range of the Center's services includes prenatal care; STI screening, diagnostics and treatment; ultrasound diagnostics, colposcopy, cervical biopsy; mammography; laboratory services (blood and urine tests, cytology tests, cultures).
• The Center has a well developed system of patient education, including breast self-exam education, "Partnership in birth" program for couples, prevention of sexually transmitted diseases, menopause education, breastfeeding counseling.
• The staff of the Center includes 16 physicians , 10 nurses and a lab assistant. The Center is staffed with a psychologist that provides patient counseling. Hotline services at the Center were established in the summer of 2000. Hotline consultants received training organized by AIHA jointly with Winrock International.
• The establishment of WWC was supported by the community of the oblast and Railway administration, who invested almost 300,000 USD in its renovation and modeling.
• Lviv WWC works closely with the "Woman to Woman" center opened in Lviv by Winrock International as a part of a trafficking prevention project. At present the Lviv WWC serves as a referral clinic for the victims of women's trafficking.
• The specialists of the center provide extensive family planning services. Almost 75% of the patients are using some type of contraception. Almost 70% of women use condoms as a primary method, and 20% receive oral contraceptives.