Medical Care Practices Research Articles

“Economic migrants will anyway be deported soon”. Negotiating access and deservingness of refugees

Abstract Background Conflicting rationales permeate the European discourse on refugee migration: inclusiveness and human rights clash with xenophobia and aims to protect territory and wealth. Against this backdrop, health care access for newly arrived refugees in many European countries is restricted. The legal frame in Germany allows for extended restrictions as well as inclusive health care. While vague legal formulations create uncertainties regarding entitlements, they allow for discretionary decisions by a plethora of health care and government actors. Methods An ethnographic field study in two German refugee outpatient clinics including participant observation and interviews with 29 members of health care, administrative, social work and interpreting staff was conducted. By means of a qualitative content analysis we explored prioritisation criteria and negotiations about service provision to refugees by street-level decision-makers. Results Medical decision makers adopted government criteria to increase the chances of success of requests for reimbursement. We could identify various non-medical criteria, like asylum status and logistics impacting on access to care. Political and societal discourses seeped into discussions on granting or denying medical services: Medical and government decision-makers reflected on prospects of staying associated with the countries of origin of asylum seekers and illegitimate motives for flight, such as poverty, while negotiating what services should be provided to whom. Conclusions The vagueness of legal concepts allows for the implementation of restrictions based on non-medical grounds in practice, that would contradict international conventions if included in the legal norm unambiguously. In the face of contradictory imperatives, the state has chosen to leave policymaking to practitioners. They are in danger of being instrumentalized as agents of migration control, exclusion and deterrence, which raises practical and ethical questions. Key messages • Legal uncertainty leads to inconsistent medical care practices, that can exacerbate health inequities. • Health professionals have to be made aware of their responsibility as gate keepers to the medical system for refugees, so they cannot be politically instrumentalized as agents of migration control.

How Do Physicians Frame Medical Information in Talks With Their Patients? An Inductive Microanalysis.

During medical consultations, physicians need to share a substantial amount of information with their patients. How this information is framed can be crucial for patient understanding and outcomes, but little is known about the details of how physicians frame information in practice. Using an inductive microanalysis approach in the study of videotaped medical interactions, we aimed to identify the information frames (i.e., higher-level ways of organizing and structuring information to reach a particular purpose) and the information-framing devices (i.e., any dialogic mechanism used to present information in a particular way that shapes how the patient might perceive and interpret it) physicians use spontaneously and intuitively while sharing information with their patients. We identified 66 different information-framing devices acting within nine information frames conveying: (1) Do we agree that we share this knowledge?, (2) I don't like where I (or where you are) am going with this, (3) This may be tricky to understand, (4) You may need to think, (5) This is important, (6) This is not important, (7) This comes from me as a doctor, (8) This comes from me as a person, and (9) This is directed to you as a unique person. The kaleidoscope of information-framing devices described in this study reveals the near impossibility for neutrality and objectivity in the information-sharing practice of medical care. It also represents an inductively derived starting point for further research into aspects of physicians' information-sharing praxis.

Vertical integration of general practices with acute hospitals in England: rapid impact evaluation.

Vertical integration means merging organisations that operate at different stages along the patient pathway. We focus on acute hospitals running primary care medical practices. Evidence is scarce concerning the impact on use of health-care services and patient experience. To assess the impact of vertical integration on use of hospital services, service delivery and patient experience and whether patients with multiple long-term conditions are affected differently from others. Rapid, mixed methods evaluation with four work packages: (1) review of NHS trust annual reports and other sources to understand the scale of vertical integration across England; (2) development of the statistical analysis; (3) analysis of national survey data on patient experience, and national data on use of hospital services over the 2 years preceding and following vertical integration, comparing vertically integrated practices with a variety of control practices; and (4) focus groups and interviews with staff and patients across three case study sites to explore the impact of vertical integration on patient experience of care. At 31 March 2021, 26 NHS trusts were in vertically integrated organisations, running 85 general practices across 116 practice sites. The earliest vertical integration between trusts and general practices was in 2015; a mean of 3.3 practices run by each trust (range 1-12). On average, integrated practices have fewer patients, are slightly more likely to be in the most deprived decile of areas, are more likely to hold an alternative provider medical services contract and have worse Quality and Outcomes Framework scores compared with non-integrated practices. Vertical integration is associated with statistically significant, modest reductions in rates of accident and emergency department attendances: 2% reduction (incidence rate ratio 0.98, 95% confidence interval 0.96 to 0.99; p < 0.0001); outpatient attendances: 1% reduction (incidence rate ratio 0.99, 95% confidence interval 0.99 to 1.00; p = 0.0061), emergency inpatient admissions: 3% reduction (incidence rate ratio 0.97, 95% confidence interval 0.95 to 0.99; p = 0.0062) and emergency readmissions: 5% reduction (incidence rate ratio 0.95, 95% confidence interval 0.91 to 1.00; p = 0.039), with no impact on length of stay, overall inpatient admissions or inpatient admissions for ambulatory care sensitive conditions. The falls in accident and emergency department and outpatient attendance rates are temporary. Focus groups and interviews with staff (N = 22) and interviews with patients (N = 14) showed that with vertical integration, health service improvements are introduced following a period of cultural interchange. Patients with multiple long-term conditions continue to encounter 'navigation work' choosing and accessing health-care provision, with diminishing continuity of care. In the quantitative analysis, we could not replicate the counterfactual of what would have happened in those specific locations had practices not merged with trusts. There was imbalance across three case study sites with regard to staff and patients recruited for interview, and the latter were drawn from patient participation groups who may not be representative of local populations. Vertical integration can lead to modest reductions in use of hospital services and has minor or no impact on patient experience of care. Our analysis does not reveal a case for widespread roll-out of the approach. Further quantitative follow-up of the longer-term impact of vertical integration on hospital usage and more extensive interviewing of patients and their carers about patient experiences of navigating care. This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (BRACE Project no. 16/138/31) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 17. See the NIHR Journals Library website for further project information.

Patients’ rights in physicians’ practice during Covid-19 pandemic: a cross-sectional study in Romania

BackgroundAlthough the Covid-19 epidemic challenged existing medical care norms and practices, it was no excuse for unlawful conduct. On the contrary, legal compliance proved essential in fighting the pandemic. Within the European legal framework for the pandemic, patients were still entitled to be treated equally, by a specialized physician, with the possibility of seeking a second medical opinion, in a confidential setting, following prior and informed consent. This study examines physicians’ practices regarding patients’ rights during the Covid-19 pandemic and the effects of age, experience, and specialty on physicians’ behavior and preferences. Additionally, it explores the nexus of malpractice complaints, malpractice fear, and legal compliance.MethodsA cross-sectional study was conducted on a convenience sample of attending physicians and general practitioners to assess compliance with patients’ rights regulations. Respondents were physicians practicing in private and public settings in Southwestern Romania from July 2021 to May 2022.Results396 attending physicians and 109 general practitioners participated in the research. Attending physicians acknowledged patients’ rights in 55.7% of statements, while general practitioners showed a slightly higher level of compliance at 59.9%. Emergency and Anesthesia and Intensive Care physicians showed the lowest compliance. There were no significant behavioral differences based on physicians’ age, years in practice, work sector, or location. However, when faced with the question of prioritizing treatment for patients with similar medical conditions, 46.2% of attending physicians reported favoring the younger patients. This preference was common among physicians under 39. Additionally, over half of the attending physicians reported working outside their area of expertise due to staff shortages. Malpractice fear was high among physicians, although unrelated to patients’ claims, legal compliance, or working outside the scope of practice. It resulted in pressure and behavioral changes.ConclusionAdherence to patients’ rights was low during the Covid-19 pandemic. Physicians could benefit from educational and administrative support to ensure better legal compliance. Further research is needed to determine if this behavior persists beyond the pandemic context.

Private practice groups and medical care centers in Germany: afactual analysis of the current situation

Medical care centers (MCCs) are an important part of the German health care system and offer awide range of outpatient medical services. In recent years, the discussion about medical care centers has increased significantly and is largely emotional and interest-driven. The aim of this article is to provide afactual analysis of the current situation of MCCs in Germany and the role of private equity practice groups.

Models for Delivering Weight Management in Primary Care: Qualitative Results from the MOST Obesity Study.

Obesity is a leading cause of morbidity and mortality in the United States (US). Primary care medical practices can educate patients about the health effects of obesity and help patients with obesity lose and manage their weight. However, implementation of weight management in primary care is challenging. We sought to examine how practices that implement weight management services do so feasibly. Multiple methods including site visits, observations, interviews, and document reviews were utilized to identify and learn from primary care practices located across the US. A qualitative multidimensional classification of empirical cases was performed to identify unique delivery features that were feasible to implement in primary care. Across 21 practices, 4 delivery models were identified: group, integrated into standard primary care, hiring an "other" professional, and using a specific program. Model characteristics included who delivered the weight management services, whether delivered to an individual or group, the types of approaches used, and how the care was reimbursed or paid. Most practices integrated weight management services and primary care delivery, although some created specific carve-out programs. This study identified 4 models that may serve to overcome challenges in delivering weight management services in primary care. Based on practice characteristics, preferences, and resources, primary care practices can identify a model for successfully implementing weight management services that best fits their context and needs. It is time for primary care to truly address obesity care as the health issue it is and make it a standard of care for all patients with obesity.

Development of tuberculosis surgical service in Primorsky krai

To the 65th anniversary of the thoracic department of the Primorsky Regional Tuberculosis DispensaryThe paper reviews the main stages of the sixty-five-year history of the Thoracic Surgical Department of Primorsky Krai TB Dispensary. During this time, the department has handled all the difficulties of establishing the TB service, turning it to a platform for mastering new technologies in close cooperation with leading research institutions of Russia. Due to high professionalism and considerable efforts of managers, doctors and whole staff, the department is rapidly developing in the field of practical medical care and scientific work. All these historical chapters are inextricably interlinked with people whose respectful work and personal talents serve as an example for new generations of specialists.

Clinical trials of innovative technology of intraosseous access to the human circulatory system in the provision of emergency medical care

The article presents the results of clinical trials of innovative technology of intraosseous access to the human circulatory system in the provision of emergency medical care in the Belgorod region. 32 cases of the use of a domestic device for intraosseous access of UVK M for the treatment of patients with urgent conditions who had difficulties performing puncture / catheterization of veins were studied. The data on the high social and economic efficiency of intraosseous access technology in the practice of emergency medical care are presented.

Differences in Cannabidiol-Related Attitudes and Practice Behaviors Between U.S. Primary Care Physicians Practicing in a Single Health Care System Across States With and Without Marijuana Legalization.

Introduction: Dramatic shifts in marijuana laws, along with federal deregulation of hemp with the 2018 Farm Bill, have resulted in increased availability and use of cannabidiol (CBD) supplements throughout the United States (US). Given the rapid increase in CBD use in the U.S. general population, in this study, we aim to characterize primary care physician (PCP) attitudes and practice behaviors and to assess whether differences in provider attitudes and behaviors vary as a function of marijuana legalization (ML) status in the state of practice. Materials and Methods: Data are from an online provider survey on CBD supplement-related attitudes, beliefs, and behaviors administered to 508 PCPs as part of a larger mixed methods study. Participating PCPs were recruited from the Mayo Clinic Healthcare Network and provided medical care in primary care settings across four U.S. states (Minnesota, Wisconsin, Florida, and Arizona). Results: The survey response rate was 45.4% (n=236/508). According to providers, CBD was frequently brought up in PCP settings, typically by patients. PCPs were generally hesitant to screen for or discuss CBD with their patients and identified multiple barriers to open patient-provider dialogue about CBD. PCPs practicing in states that had passed ML were more receptive to patients using CBD supplements, whereas PCPs practicing in states that had not passed ML were more concerned about CBD-related side effects. Regardless of state ML status, most PCPs did not feel that they should be recommending CBD supplements to their patients. Most PCPs reported believing that CBD was unhelpful for most conditions for which it is marketed, with chronic non-cancer pain and anxiety/stress being exceptions. PCP respondents generally felt that they had insufficient knowledge/training around CBD. Conclusions: Results from this mixed methods study show that PCPs practicing in the U.S. rarely screen for or discuss CBD use with their patients and report several barriers to engage in proactive CBD-focused practice behaviors. Furthermore, survey results show that some PCP attitudes, practice behaviors, and barriers vary as a function of state ML status. These findings may guide medical education efforts and inform primary care practice modifications aimed at enhancing screening and monitoring of patient CBD use by PCPs.

A Survey of Personal Health Habits, Wellness, and Burnout in Practicing Orthopaedic Surgeons—Are We Taking Care of Ourselves?

The personality traits of those who become orthopaedic surgeons may also lead to overwork, work-life balance issues, and burnout. Health and wellness practices of orthopaedic surgeons have not been widely explored. This study evaluated the personal health habits, wellness, and burnout of practicing orthopaedic surgeons in the United States. An anonymous self-assessment survey was completed by 234 practicing orthopaedic surgeon alumni from two large residency programs. The survey assessed exercise habits according to Centers for Disease Control and Prevention recommendations, compliance with preventive medical care practices according to the United States Preventive Services Task Force, prioritization of occupational wellness strategies, and the presence of burnout via an adapted Maslach Burnout Inventory. Survey responders' mean age was 52 years, 88% were male, and 93% had a body mass index <30 kg/m2. Surgeons were stratified according to practice type, years in practice, and subspecialty. Among orthopaedic surgeons, compliance with aerobic and strength exercise recommendations was 31%. Surgeons in academic practice were significantly (P = 0.007) less compliant with exercise recommendations (18%) compared with private (34%) or employed (43%) practicing surgeons. Most (71%) had seen their primary care provider within 2 years and were up to date on age-appropriate health care screening including a cholesterol check within 5 years (79%), colonoscopy (89%), and mammogram (92%). Protecting time away from work for family/friends and finding meaning in work were the most important wellness strategies. The overall burnout rate was 15% and remained not significantly different (P > 0.3) regardless of years in practice, practice type, or subspecialty. This survey study identifies practicing orthopaedic surgeons' health habits and wellness strategies, including limited compliance with aerobic and strength exercise recommendations. Orthopaedic surgeons should be aware of areas of diminished personal wellness to improve quality of life and avoid burnout.

Beating the clock: Reduced time to first antibiotic dose administration following an audit and feedback intervention

ObjectiveQuality improvement interventions and policy revisions have been shown to improve clinical practice and patient outcomes. This study evaluated an intervention to shorten the time from the first antibiotic dose ordering to its administration in patients hospitalised with bacterial infections. MethodsAn intervention consisting of a weekly email report to nurse and physician leaders in hospital departments was introduced. The report included the percentage of patients who received their first antibiotic dose within 3 hours and details of those who did not. Interrupted time series analysis was used to compare the delay between the order and administration of antibiotics in various wards (surgical and medical) and daily nursing shifts. ResultsThe total number of orders pre-intervention and post-intervention was 58 320 and 52 127, respectively. The most protracted delays were observed during the morning shift in the surgical and medical wards (161 and 100 minutes, respectively). Comparing the pre- to post-intervention time to the first antibiotic dose (TTFAD), a reduction in the morning shift was noted both in the surgical wards (87 minutes, 55%) and medical wards (37 minutes, 37%) and with a preserved trend (P < 0.001). The slope's angle before and after the intervention was not affected. ConclusionUsing an audit and feedback automatic weekly report significantly reduced TTFAD in hospitalised patients. This intervention proved to be simple and sustainable over time. Raising staff awareness of current medical care practices is an effective way of improving performance.

Traditional knowledge in medicinal plants and intermedicality in urban environments: a case study in a popular community in southern Brazil

Background: Ethnobotanical studies have demonstrated the ability of different social groups to maintain and diversify plant knowledge in urban environments. This study characterizes the traditional knowledge about medicinal plants in a popular community in Porto Alegre metropolitan city, Brazil. Methods: Semi-structured interviews were carried out with 28 people, four of whom were healers. Data were collected regarding the uses, ways of obtaining the plants, the origin of the interviewees and their knowledge. The mentioned species value of relative importance was calculated. Relationships between traditional and scientific medical knowledge (intermedicality) were characterized and discussed. Results: The study identified a total of 237 plant species, most of them native to Brazil. The family with the highest number of representatives was Asteraceae (38), followed by Lamiaceae (17). Native and ritualistic species showed high values of relative importance. The main form of learning found was vertical, with mothers and grandmothers being the main ones responsible for teaching. Traditional knowledge is influenced by scientific medical care practices and the most significant use of herbs refers to the digestive system, followed by the respiratory system. The collection is the leading way of obtaining the plants. Conclusions: The high number of species used, and the substantial knowledge repertoire, reflect the local sociocultural and environmental diversity and the vital role of women and healers in producing and transmitting this knowledge. Deepening ethnobotanical studies with healers and women is a way of enhancing traditional medicines in urban environments. Keywords: urban ethnobotany, ethnomedicine, native species, ritualistic use, urbanization

The current status of medical care for myotonic dystrophy type 1 in the national registry of Japan.

Myotonic dystrophy (DM) is a systemic disease with multiple organ complications, making the standardization of medical care a challenge. We analyzed data from Japan's national registry to clarify the current treatment patterns and demographic features of Japanese DM patients. Using the Japanese National Registry of Muscular Dystrophy (Remudy), we analyzed medical care practice for the multisystemic issues associated with adult DM type 1 patients, excluding congenital DM. We included 809 patients with a median age of 44.2 years. Among these patients, 15.8% used ventilators; 31.7% met the index considered at risk for sudden death due to cardiac conduction defects (PR interval over 240 milliseconds or QRS duration over 120 milliseconds) and 2.8% had implanted cardiac devices. Medication for heart failure was prescribed to 9.6% of patients. Overall, 21.2% of patients had abnormal glucose metabolism, of whom 42.9% were treated with oral medications. Among the oral medications, dipeptidyl peptidase-4 inhibitors were the most common. Cancers were observed in 3.7% of the patients, and endometrial and breast cancers were dominant. Mexiletine was prescribed for myotonia in 1.9% of the patients, and only 1% of the patients received medication for daytime sleepiness. This study shows difference in treatment patterns for DM1 in Japan compared with other countries, such as lower rates of use of implantable cardiac devices and higher rates of ventilator use. These data may be useful in discussions aimed at standardizing medical care for patients with DM.

The Practice of Online Medical Care at Juntendo Hospital in Response to the Coronavirus Pandemic

The Practice of Online Medical Care at Juntendo Hospital in Response to the Coronavirus Pandemic

MEASURING PATIENT EXPERIENCE OF ORAL HEALTH CARE: A CALL TO ACTION

Surveys to measure patients' experiences of health care are common practice in general medical care to improve patient centered care. However, such questionnaires are not consistently used to capture the patient's experience of oral health care. Because patient experience is an important component of oral health care, there is an urgent need to measure it in the oral health care setting. The purpose of this article is to illustrate the need for patient experience measurement in oral health care, highlight the challenges such measurement in this setting faces, and provide a set of next steps to advance care experience measurement for dental patients. We conducted a comprehensive review of the literature examining patient experience measurement in medical and oral health care. This focused on studies aimed at understanding the current measurement landscape and existing measurement tools. We also gathered additional information and perspectives through discussions with key informants and stakeholders. There is a critical need for patient experience measurement in oral health care. To develop a program to measure patient experiences of oral care, the following should be done: (1) convene stakeholders and get their buy-in; (2) develop a patient experiences of oral health conceptual framework; (3) develop a survey tool that captures key aspects of patient experiences of oral health; (4) pilot the survey tool; (5) assess the survey tool...s psychometric properties; and (6) refine and finalize the survey tool. To advance the measurement of the quality of oral health care, we outline a stepwise methodology that captures dental patient experiences of oral health care.

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

The Medical Metaverse, Part 1: Introduction, Definitions, and New Horizons for Neuropsychiatry.

의료행위의 규율목적과 전문직업성과의 조화를 위한 해석과제

In this study, it is reviewed the historical origins and requirements of medical practices governed by the concept of over-regulation and so-called ‘health and sanitation risks’, after examining the national regulations on medical practices derived from the concept of medical law, Based on these discussions, it is trying to make a critical examination of the trend toward expansion of the medical practice concept, unlike the medical indication and treatment purpose, which are the requirements for traditional medical practice, from the perspective of the doctor's professionalism, the concept of ‘general public health risk’ is used for the purpose of medical administration to provide practical medical care. In this regard, it presents a critical stance against precedents that recognize the medical act of tattooing.&#x0D; In addition, with respect to the collection of unjust enrichment from medical care benefits under the National Health Insurance Act, we are looking into recent cases that a medical institution may not be denied under the National Health Insurance Act if it is recognized that the essential elements of medical practice are in place and that the doctor has provided actual medical treatment.&#x0D; In particular. this study reviews the extent to which the doctor's discretionary power and right to treat have an impact in the area of tattooing and collection of unfair profits under the Health Insurance Act and civil liability, divided into individual areas. In the field of civil liability, it is also interpreted from this point of view as the strengthening of the duty of care guidance, which is an essential element of medical practice, or the duty of guidance and explanation suggested by precedents. And it reviewed the degree to which the discretionary power and treatment right of doctors affect.&#x0D; Finally, it is not desirable for the necessary legal control over medical care to completely expand the relationship between doctors and patients into legal norms. It is concluded that it is necessary to seek harmony with professionalism.

Implementation of the principles of the scientific concept “Medicine of borderline states” regarding donosological diagnosis and overcoming the risks of health deterioration in student youth

Today, the methodological basis of disease pre­vention among various categories of the population, including students, is an innovative area of medical science and health care practice, namely medicine of borderline conditions. The development of a system of prenosological diagnosis of pathological conditions in young students and their hygienic correction for disease prevention are important both from a scientific and practical point of view. The study was conducted in the conditions of a natural experiment on the basis of three types of educational institutions, at the place of study of representatives of both sexes aged 14 to 23 years, adolescents and yound adults. In order to achieve the relevant objectives, the study used the following methods: analytic addressed at the study of educational programs, curricula, schedules, profile and regulatory documents; sanitary-hygienic; psychophysiological; psychological, statistic. Set of risk factors related to the educational process among young people studying in three types of educational institutions – secondary educational institutions, higher educational institution, Professional Agrarian Lyceum was analyzed. It is established that unfavorable living conditions affect donosological mental states of asthenic, hypochondriac and depressive nature.

A fact‐finding survey of medical care provided to neuromuscular disease patients at the National Center of Neurology and Psychiatry in Japan

AbstractSubjectThe aim of the present study was to conduct a fact‐finding survey of medical care practices that are provided to neuromuscular diseases (NMDs) patients and to identify the placement rate and timing of implementation for each of the diseases.MethodAll 3756 NMD patients who were admitted to the Neurology ward between April 2015 and March 2020 were included. This was a retrospective survey of specific medical care practices (percutaneous endoscopic gastrostomy (PEG) and tracheotomy) implemented.ResultsThe results showed that 325 patients (8.7%) had PEG placements, and 78 patients (2.1%) had tracheotomies. When the course of each disease from onset to medical care was examined, the diseases for which medical care was received soon after onset were MND, MSA, DLB, and progressive supranuclear palsy, whereas muscular dystrophy, myopathy, and Parkinson's disease (PD) were diseases with a relatively long time between disease onset and medical care. Discussion: In conducting the fact‐finding survey on medical care practices for NMD, the following were taken into consideration: (i) difficulty in conducting the investigation due to NMD being a rare disease; (ii) existence of a difference in age of onset and progression of the diseases; and (iii) differences in treatment environments due to disparities in treatment policies among medical institutions providing medical care and local support systems.ConclusionsThe course of medical care provision for NMD patients varied depending on the disease, and the difference in the time course of progression of symptoms greatly impacted patients' decision making.

The State of Military Medicine during the Russian Civil War

Along with the analysis of military strategy and tactics and of the ideological component of the struggle, the history of the Russian Civil War can also be studied with regard to the supporting factors in the opposing camps. The present article is based on the study of sanitary-medical services of the Red Army and the armies of the White Movement. Under war conditions, the boundary between military and civil medicine was blurred, as we are talking about a domestic war that coincided with several major epidemics. The personnel as well as the organizational forms and practices of medical care went back to the experiences of World War I. At the outbreak of the war the armed formations competed with each other to attract specialists to their ranks. Members of the medical community thus had to decide which side to serve - a choice that some made consciously and others situationally. At the beginning of the war, the Whites had an advantage regarding medical personnel; by the end of the war, the Bolsheviks had managed to rectify this situation. The Whites adopted the experience of World War I, assigning public organizations a special role in supplying the army. The Reds, in contrast, sought to match the revolutionary spirit of the era by encouraging initiative. This they combined with a fairly tight control of their services, creating a centralized system from the outset. The analysis of how the warrying parties organized their military medical-sanitary services can thus add new insights to our understanding of why the Bolsheviks achieved victory in the Civil War.