Medical Institutions Research Articles

Knee joint dislocations-Current epidemiology and treatment in Germany.

Knee joint dislocations, though rare, present significant challenges due to potential complications like vascular and nerve damage, and are known to be often linked to sports injuries, accidents and obesity. This study aims to analyse the epidemiology, incidence and treatment approaches for knee dislocations in Germany from 2019 to 2022. This retrospective cohort study utilized data from the German Institute for the Hospital Remuneration System to examine knee dislocation cases across German medical institutions. Patient data coded under International Statistical Classification of Diseases and Related Health Problems 10 for 'knee dislocation' enabled detailed analysis by age, sex and surgical procedures categorized by operation and procedure codes. The Patient Clinical Complexity Level (PCCL) assessed complication severity. Analysis of 1643 knee dislocation cases revealed an incidence rate of 0.44-0.54 per 100,000 inhabitants annually. During the years 2020 and 2021, there were fewer cases of knee dislocations. Male patients comprised 50%-56% of cases, with an average hospital stay of 11 days. Most cases were PCCL 0 (62%-72%) and predominantly affected patients aged 18-29 years. Anterior tibial dislocations were common among classified cases. Injuries included ligament ruptures, meniscus lesions and grade I soft-tissue injuries. Patients with pre-existing knee prostheses constituted 0%-16% annually. Treatment involved closed reduction, external fixation and surgeries like capsuloligamentous reconstructions and arthroscopic procedures. Revision knee arthroplasty was required in 2%-9% of cases, with obesity rates up to 7%. This study provides valuable insights into the epidemiology, incidence and treatment of knee dislocations in Germany, with a focus on demographic risk factors, treatment complexities and the impact of obesity and knee prostheses. The findings emphasize the importance of specialized care in larger hospitals, comprehensive management of concomitant injuries and the need for improved coding accuracy. Future research should aim to refine treatment protocols. Level III.

Smart control in healthcare

The author analyzes the prospects of SMART control in healthcare, which provides monitoring of the activities of state medical institutions included in the healthcare system of the Russian Federation, while minimizing the administrative burden. SMART control — “smart” control to prevent violations of budget legislation. It is planned to create a unified electronic system for generating accounting and reporting data for public finances by 2027. This will make it possible to consolidate accounting information about public finances, including in the healthcare system, and improve the efficiency and quality of management of public medical institutions. The connection to the GIS “Electronic budget” of medical organizations will allow to reorient mainly on the methods of preliminary control.

Interpretation of the key points of Regulation for Diagnosis and Treatment of Non-neonatal Tetanus (2024 Edition)

Non-neonatal tetanus is an acute, specific, toxic disease in patients over 28 days of age, characterized by continuous rigidity and paroxysmal spasms of the skeletal muscles throughout the body caused by the intrusion of Clostridium tetani through skin or mucosal membrane into the body and reproducing in anaerobic environments to produce exotoxins. The mortality rate of severe patients is close to 100% without medical intervention. Even with aggressive comprehensive treatment, the global mortality rate remains at 30%-50%, making it a potentially fatal disease. In order to standardize the diagnosis, treatment and prevention of non-neonatal tetanus, based on "Regulation for Diagnosis and Treatment of Non-Neonatal Tetanus (2019)", experts have revised this regulation according to clinical practice and recent research progress in this field to guide medical institutions in the prevention and control of non-neonatal tetanus. This article interprets the key points and basis for updating the 2024 edition regulation to guide clinical implementation and application.

The Change in Public Perception and Knowledge Acquisition Methods of Chronic Kidney Disease Among General Population in Okayama Prefecture, Japan

CKD public education plays a very important role in effective chronic kidney disease (CKD) countermeasure. We have been conducting CKD public education programs in Okayama Prefecture since 2007. Here, we aimed to examine the actual status of CKD perceptance and changes in CKD perceptance due to these education programs. The study was conducted on individuals who underwent health checkups at 12 medical institutions across five medical regions in Okayama Prefecture between 1 October and 30 November in 2015, 2019, and 2023. The results showed that overall CKD perceptance has improved over time (perceptance of “CKD” 4% to 7%, “chronic kidney disease” 27% to 34%, 2015 vs. 2023). “Chronic kidney disease” was more commonly recognized than “CKD”, and the elderly were more aware of the disease than younger people. The CKD perceptance improved across all age groups. However, the rate of CKD perceptance is still low, especially among young people. Previously, newspapers were the second most common resource of information about CKD after television. However, the Internet has recently replaced newspapers as the second most common source of information, especially among younger people. Understanding of the exact diagnosis of CKD also remains insufficient. It is necessary to continue more effective CKD public education programs through more intelligible terminology and information sources that match the demographics of target population.

Dementia severity and advanced pressure injury procedures and prognosis: A nationwide study in Japan.

In older adults, pressure injuries (PIs) are common and, despite advancements in PI care, are associated with increased complications in patients with dementia for whom standardized treatments are unavailable. Herein, we aimed to examine the influence of dementia status on the care practice pattern and healing outcomes for PI on discharge. This retrospective cohort study used data from the Diagnosis Procedure Combination database for 2014-2015 and the Annual Report for Functions of Medical Institutions and included patients aged ≥65 years. The DESIGN-R (depth, exudates, size, inflammation/infection, granulation, necrosis and rating) classification system was used to determine PI severity, and the Dementia Scale was used to assess dementia status. The measured outcomes included advanced PI care and healing upon discharge. Multivariable logistic regression, accounting for hospital-related clustering, was used to examine the association of dementia with these outcomes. Among 20 386 patients from 1198 hospitals included in the analysis, 32.5%, 20.1% and 47.3% had no, mild and severe dementia, respectively. After adjustment for patients' and hospital characteristics, compared with those without dementia, patients with severe dementia were significantly less likely to undergo advanced treatments, such as skin grafts (adjusted odds ratio [aOR], 0.62 [95% confidential interval [CI], 0.40-0.97]; P = 0.034) and flap surgeries (aOR, 0.57 [95% CI, 0.42-0.77]; P < 0.001), and had a reduced likelihood of PI healing (aOR, 0.80 [95% CI, 0.72-0.90]; P < 0.001). Severe dementia was associated with poor PI healing outcomes, indicating potential treatment disparities. Thus, PI treatment should be provided according to the severity of dementia. Geriatr Gerontol Int 2024; ••: ••-••.

An Analysis of Pediatric Ophthalmology Content on Instagram.

To analyze pediatric ophthalmology-related information on Instagram (Meta Platforms, Inc). A cross-sectional study queried 112 common eye terms and conditions from the American Association for Pediatric Ophthalmology and Strabismus website as hashtags on Instagram. A categorical classification system was used to analyze the top 9 posts per hashtag for likes, comments, views, and engagement level ratio (ELR). Posts were further characterized by author and content type. Analysis of the top 901 posts that met our inclusion criteria revealed a cumulative 424,608 likes, 15,793 comments, and 2,873,042 views. Authors had a total of 76,076,455 followers. Patients/families created the greatest number of posts (37.6%), followed by companies (20.2%), other (14.9%), medical organizations (12.3%), international ophthalmologists (6.1%), optometrists (5.9%), and American Board of Ophthalmology-certified ophthalmologists (3.0%). Content was mostly patient experience (42.4%), followed by educational (29.7%), self-promotional (13.5%), other (10.5%), and career-related (3.8%). Companies authored the highest number of educational posts (23.5%), followed by medical institutions (20.9%), other (19.4%), international ophthalmologists (13.8%), optometrists (13.4%), and American Board of Ophthalmology-certified ophthalmologists (4.5%) and patients (4.5%). Although pediatric ophthalmology content presented by board-certified ophthalmology Instagram authors had a greater number of followers than most other author categories, ophthalmologist authors on Instagram are still underrepresented. Additional research is warranted to help promote ophthalmologist-authored posts. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

A qualitative study of patient competence for patient engagement in their safety——from the perspective of nurses and patients

ObjectivesTo describe the essential competencies required for patient engagement in their own safety.MethodWe adopted a phenomenological approach in qualitative research to conduct semi-structured interviews with nurses (n = 14) and adult patients (n = 13) from different departments. By deeply exploring their experiences and feelings about patient engagement in patient safety, we sought to understand their views on the qualities that patients need to possess in order to participate in their own safety.ResultsFrom the interviews, we identified six major themes, including competence of information sharing, competence of taking patient engagement as responsibility and right, competence of making equal communication, competence of maintaining trust relationship with health personnels, competence of accepting non-punitive safety culture, need of resource support, five of them showed essential competences for patients and one of them showed patients’ need for promoting their engagement.ConclusionThe findings of this study show necessary competence and needs in patient engagement process of patient, offer a foundational reference for constructing a measurement tool for patient engagement in patient safety competence in the future, so that medical staff and patients can provide reference for the future targeted construction of patient competence improvement programs. At the same time, improving patient competence and engagement to better achieve safety goals requires the joint efforts of patients, medical staff, medical institutions, the government, and society.

Comprehensive validation of a compact laser speckle contrast imaging system for vascular function assessment: from the laboratory to the clinic.

Proper organ functioning relies on adequate blood circulation; thus, monitoring blood flow is crucial for early disease diagnosis. Laser speckle contrast imaging (LSCI) is a noninvasive technique that is widely used for measuring superficial blood flow. In this study, we developed a portable LSCI system using an 805-nm near-infrared laser and a monochrome CMOS camera with a 10 × macro zoom lens. The system achieved a high-resolution imaging (1280 × 1024 pixels) with a working distance of 10 to 35 cm. The relative flow velocities were visualized via a spatial speckle contrast analysis algorithm with a 5 × 5 sliding window. In vitro experiments demonstrated the system's ability to image flow velocities in a fluid model, and a linear relationship was observed between the actual flow rate and the relative flow rate obtained by the system. The correlation coefficient (R2) exceeded 0.83 for volumetric flow rates of 0 to 0.2 ml/min when channel widths were greater than 1.2 mm, and R2 > 0.94 was obtained for channel widths exceeding 1.6 mm. Comparisons with laser Doppler flowmetry (LDF) revealed a strong positive correlation between the LSCI and LDF results. In vivo experiments captured postocclusive reactive hyperemic responses in rat hind limbs and human palms and feet. The main research contribution is the development of this compact and portable LSCI device, as well as the validation of its reliability and convenience in various scenarios and environments. Future applications of this technology include evaluating blood flow changes during skin injuries, such as abrasions, burns, and diabetic foot ulcers, to aid medical institutions in treatment optimization and to reduce treatment duration.

PUBLIC ADMINISTRATION POLICY IN THE HEALTHCARE SECTOR UNDER MARTIAL LAW

The article analyzes the main directions of public administration in the field of health care of Ukraine during martial law. The main focus is on the adaptation of the legislative framework and the modernization of management approaches, which allow to ensure the effective functioning of the health care system in crisis situations. The issue of creating mobile medical teams and hospitals, which are the main tool for providing medical care in front-line and de-occupied areas, was considered. The contribution of international organizations to the support of the Ukrainian medical system in terms of supplying medical equipment, medicines and providing financial assistance is analyzed. The key normative legal acts, which were adopted from 2022 and contributed to the adaptation of the medical system to new challenges, were studied. Features of the functioning of the Resolution of the Cabinet of Ministers No. 302, No. 683, No. 1078 and others are given. Particular attention is paid to the digitization of health care, the implementation of electronic medical records in order to ensure the prompt provision of medical services. The problems of medical institutions in the front-line zones, including the destruction of more than 700 hospitals, and ways to solve the logistical problems of the supply of medicines were considered. A conclusion was made regarding the further development of public administration in the field of health care based on the integration of international and national resources, improvement of digital technologies and modernization of medical infrastructure. Ensuring adequate funding of the health care system, which includes the health insurance program, emergency and specialized medical care, is revealed, which is a priority in the 2023 budget. The article examines the influence of international humanitarian organizations on the support of the Ukrainian health care system in the conditions of military operations. The basis for the development of long-term strategies for the recovery of medical facilities after destruction and their equipment with modern technologies is proposed. Aspects of integration of digital solutions to ensure the continuity of medical services in the most difficult conditions have been studied.

Attitudes and awareness in autonomous decision on medical treatment or inclusion in clinical trials amongst Slovenian adolescents: an online survey

BackgroundIn Europe and elsewhere in the world, activities are taking place to improve the awareness of children and adolescents (hereinafter: adolescents) regarding their rights and obligations in autonomous decision-making about their own medical treatment and participation in clinical research.MethodsThe cross-sectional survey of adolescents was carried out using an anonymous online questionnaire. We obtained consent from the Commission of the Republic of Slovenia for Medical Ethics. Participating young people were invited through the network of primary and secondary schools, the Society of Dystrophy of Slovenia and through the dissemination of electronic messages. The online questionnaire was open from April 25 to May 6, 2023. Young people aged 13 to 20 joined the survey. The association between several factors and awareness of the minimum age limit was tested by univariate logistic regression. All statistical testing was performed at a significance level of 0.05.ResultsThe responses of 458 respondents were analysed, of which 281 were male. Only 8.3% of participating adolescents knew the age limit set by law for autonomous decision-making about medical treatment at 15 years old. Most answered that a medical institution should inform them about their rights (62.4%). Only 5.02% responded that they do not need their parents’ consent when making decisions; 2.6% of respondents answered that they autonomously decided to undergo treatment without their parents’ knowledge. The majority obtained information about treatment from a doctor (more than 70%); 42.8% were in favour of new forms of treatment, especially chronic patients (more than 70%); 44.8% had already heard about clinical research, most of them through the media (55.4%); 70% of the respondents answered correctly about making an autonomous decision about participation in research at the age of 18. About three-quarters (75.6%) of respondents who had heard of clinical research believe that an individual should be paid for participating.ConclusionsOur research showed insufficient awareness of the age limit of adolescents regarding medical treatment decisions and clinical research. The prevailing view is that health professionals should inform young people more about their rights. Most adolescents believe they should be paid to participate in clinical research.

National Health Insurance Claim of Pediatric Appendectomy With Mandatory Diagnosis-Related Group Payment System in Korea

IntroductionEnforcement of diagnosis-related group system for appendectomy under the National Health Insurance Service has gradually widened and since July 2013 it has been enforced in all medical institutions in Korea. We have analyzed Health Insurance Review & Assessment Service data to observe changes in claim patterns of pediatric appendectomy during this period. MethodsAll claims data for appendectomy of patients younger than 18 y from 2011 to 2015 were collected. We analyzed the following factors of all cases: age, gender, length of hospital stay, medical cost, method of insurance claim and region. ResultsA total of 112,143 claims were made for appendectomy during the study period. In that, 66,510 (59.3%) were boys and 45,633 (40.7%) were girls. Median length of stay was 5 d and median sum of reimbursement of each claim was 2,198,630 won. Annual number of claims for appendectomy showed a steady decline from 24,888 in 2011 to 19,070 in 2015. Median sum of reimbursement of each claim was 1,862,615, 1,975,500, 2,233,360, 2,376,700, and 2,468,000 won, respectively from 2011 to 2015. Reimbursement for complicated appendectomy increased from 4400 out of 24,888 cases (17.7%) in 2011 to 3865 out of 19,070 cases (20.3%) in 2015. Overall medical cost of all reimbursement for pediatric appendectomy increased from 46,113,202,580 to 47,572,253,300 won. ConclusionsFollowing the universal enforcement of the diagnosis-related group claim system for appendectomy by the National Health Insurance Service, we observed an increase in the median sum of reimbursement per claim and a rise in the rate of claims for complicated appendectomies. These changes were associated with an overall increase in national medical costs.

How do medical students perceive the role of artificial intelligence in management of gastroesophageal reflux disease?

Background Artificial intelligence (AI) has significantly revolutionized the diagnosis and treatment of various medical and surgical conditions, including gastroesophageal reflux disease (GORD). AI has the potential to enhance diagnostic and treatment capabilities, contributing to overall advancements in healthcare. The current study aimed to investigate the medical students’ views regarding the use of AI in GORD management. Methods An anonymous, self-administered questionnaire was distributed among undergraduate medical students of various grades within different national medical institutions. The questionnaire comprised three sections, addressing sociodemographic data, knowledge, and attitudes. Knowledge and attitudes were assessed through 5- and 7-item questionnaires, respectively. The knowledge scores constituted a scale of 0–5. This reflected varying levels of understanding. Categories include poor knowledge (two or less), moderate knowledge (three), and good knowledge (4 and 5). Attitudes were classified as negative, neutral, or positive based on 50% and 75% cutoff points, with scores below 50% indicating negative attitudes, 50–75% considered neutral, and scores above 75% reflecting positive attitudes. Results A total of 506 medical students participated, including 273 females and 233 males, with a ratio of 1.2–1. The majority fell within the age range of 20–26 years. Additionally, 388 participants (76.7%) reported grade point averages (GPAs) higher than 4. Regarding knowledge, 9% demonstrated a poor score of knowledge, while 33% had a moderate knowledge score. However, 65% of the participating students held a neutral attitude toward the role of AI in GORD management, with 6.9% expressing a negative stance on the matter. Conclusion Although AI is highly involved in GORD management, the study revealed that medical students and interns possess a limited perception of this emerging technology. This may highlight the necessity for active involvement in AI education within the medical curricula.

Цифровизация закупочного процесса как элемент управления медицинской организации

In modern conditions, digital technologies are penetrating into all spheres of life, and the healthcare industry is no exception. It is not individual medical services that compete in the market, but financial models. Therefore, those medical institutions that are able to quickly search, test and implement appropriate changes win. Digitalization tools and approaches help you learn to speak the language of value that is created for different target audiences, and regularly update the financial model of a medical institution. A significant stage in the activities of a public health institution is the procurement process. The purpose of the study is to identify the main aspects of building the procurement process of a public health institution through the prism of digitalization of this process within a medical institution. Materials and methods. The study includes the identification of factors that must be taken into account when forming a model of the procurement process; the stages of creating a digital model of the procurement process; the principles of implementing the procurement process project; substantiation of design decisions on information and software for the procurement process of a public health institution; the stages of developing an information system. Methods of structural, functional, information process, causal analysis and modeling are used. Results. The paper identified the main problems associated with the procurement process in medical institutions, including shortcomings in the regulatory framework, the lack of a clear distribution of responsibility between the participants in the process and the inefficiency of management decisions. To improve procurement monitoring and management, a proposal has been developed to optimize the procurement process through the use of digital technologies. Conclusions. The conducted research made it possible to identify the optimization of the procurement process in public medical institutions, which is associated with the use of a digital model of the procurement process. The scope of the results. The results of the work can be used in public medical institutions of various levels to develop and implement a system of digitalization of procurement activities within a medical organization. And also, when optimizing the procurement process in public medical institutions, when using a digital financial model of the procurement process, which has a number of beneficial advantages.

Prevalence and association of uncorrected refractive error among Chinese adolescents: a cross-sectional study.

Uncorrected refractive error (URE) is one of the main causes of visual impairments. URE may reduce interaction and learning in the classroom, leading to social isolation, irreversible amblyopia, lack of external knowledge, and restrictions on education and employment opportunities. Our aim was to investigate the prevalence and related factors of URE in adolescents using epidemiological surveys and questionnaire surveys related to lifestyle habits. A cross-sectional school-based study was conducted in Nantong, China, including adolescents 12-19 years of age from 16 schools. URE was defined as presenting visual acuity worse than 6/12 and improving to ≥ 1 lines after correction in either eye. Univariate and multivariate logistic regression analyses were used to investigate specific correlations between URE and related lifestyle parameters. Non-cycloplegic autorefraction was assessed for each adolescent. A total of 2,910 adolescents were analyzed, of which 50.3% (n = 1,465) were male, and 49.7% (n = 1,445) were female. The mean age was 15.23 ± 1.77 years. The overall prevalence of URE was 23.7%. The total prevalence of REC and eREC was 85.1% and 71.7%, respectively, and both of them showed an increasing trend with age (Ptrend = 0.018 and Ptrend = 0.019, respectively). A higher prevalence of URE was related to myopia, anisometropia, and increased daily use of electronic products. Timely visual examination by medical institutions, more extracurricular homework, and older age were protective factors for URE. Among the 689 adolescents with URE, 362 (52.5%) did not receive any refractive correction, and 327 (47.5%) used corrected glasses. URE was highly prevalent among adolescents in China. Myopia was the most important risk factor for URE. The impact of anisometropia and increased daily use of electronic devices on URE was significant. Timely visual examinations by medical institutions served as an effective protective factor against URE. Further research on adjusting intervention strategies is therefore needed to eliminate preventable visual impairments.

The Influence of Arrhythmia on the Outcomes of Pediatric Patients with Idiopathic Dilated Cardiomyopathy.

Children diagnosed with dilated cardiomyopathy (DCM) are at an increased risk of developing arrhythmias, which can significantly affect their overall prognosis. However, the implantation and effectiveness of implantable cardioverter-defibrillators (ICDs) pose challenges in the pediatric population. Therefore, it is crucial to determine the prevalence of arrhythmia-related death in pediatric patients with DCM. This study investigated the correlation between arrhythmias and mortality in pediatric patients with DCM. This retrospective cohort study examined children with idiopathic DCM referred to Rajaie Cardiovascular, Medical, and Research Institute in Tehran, Iran, from 2017 to 2023. All patients underwent a standard 12-lead electrocardiogram, 24-h Holter monitoring, cardiac magnetic resonance imaging, and echocardiography. Patient outcomes, including death, heart transplantation, and survival, were evaluated within one year of Holter monitoring. A total of 178 children (79 males) with a mean age of 83.06 ± 56.41months were included in the study. Overall, 72 deaths (40.4%) and 46 heart transplants (25.8%) were recorded and 60 patients (33.7%) survived. There was no significant association between patients' outcomes with ventricular arrhythmias, late gadolinium enhancement, corrected QT interval, and QRS interval prolongation; however, a significantly higher proportion of dead patients had abnormal heart rate variability (P = 0.034). Heart failure was the leading cause of death, with ventricular arrhythmia accounting for two out of 72 deaths. Both cases of ventricular arrhythmia were associated with severe cardiac dysfunction. Arrhythmia-related mortality is rare in children with idiopathic DCM, with severe heart failure being the primary cause of death in this population. Life-threatening arrhythmias primarily occur in DCM children with more compromised cardiac function.

Epidemiology, presentation, management and outcomes of patients with acute epiglottitis - A 10-year retrospective study based on a tertiary hospital in northern China.

This study aimed to explore the new clinical characteristics and trends of acute epiglottitis (AE) in northern China. A retrospective, observational study was conducted on patients diagnosed with AE between January 2014 and December 2023 at a single-center medical institution in northern China. The clinical profiles of patients with AE were investigated. This study encompassed 366 AE patients (M: F = 1.79:1). The average age of the patients was 47.31 ± 13.18 years, and 33.4% patients had comorbidities. Common initial symptoms: sore throat (93.17%), dysphagia (48.09%), fever (10.65%). Dyspnea reported in 14.48%. AE incidence rose annually over a decade, with mild seasonal variations.Laryngoscopy remains the primary means of confirming AE. Almost all patients received intravenous antibiotic therapy, and 98% of them were also treated with corticosteroids. Emergency airway intervention needed in 2.73% (cricothyroidotomy: 0.54%; tracheotomy: 2.19%). Among all patients, 353 (96.44%) had a good prognosis, 1 death (0.27%) from cardiopulmonary arrest during tracheotomy, 1 anoxic encephalopathy (0.27%) after tracheotomy in the emergency room due to intubation failure. The incidence rate of AE is on the rise. Even if airway intervention is rarely required, clinicians must maintain a high degree of vigilance and conduct early identification of risk factors and emergencies that could progress severe cases into life-threatening. Furthermore, the development of safe and efficacious management strategies is crucial to prevent catastrophic complications and safeguard patient lives.

Optimizing revision arthroplasty: the role of customized articulating spacers

Introduction The advancement of surgery is set against a backdrop of continuous development and surgical innovations have transformed the way clinical care is delivered. Revision surgery might be required to address complications of primary arthroplasty. The first stage of revision arthroplasty would involve removal of an implant and placement of an antibiotic-impregnated cement spacer to maintain the joint space and stability, prevent soft tissue retraction, provide local antibiotic release and preserve bone tissue for revision implantation at the final stage of revision. Custom-made articulating spacers are a promising tool for optimizing the first stage of revision arthroplasty.The objective was to summarize the current data and present comprehensive information about spacers used in two-stage revision arthroplasty including manufacturing techniques, physical and chemical properties, clinical applications, the possibility of customization within the first stage of revision arthroplasty, current and promising directions for research.Material and methods The original literature search was conducted on key resources including Scientific Electronic Library (www.elibrary.ru), the National Library of Medicine (www.pubmed.org), the Cochraine Library (www.cochranelibrary.com) between 2018 and 2023 using search words and phrases: total arthroplasty, complications, revision arthroplasty, articulating spacer, periprosthetic joint infection, additive manufacturing, 3D printing.Results A comparative analysis of factory supplied, home-made, dynamic and static spacer models showed that the choice of articulating spacers for revision arthroplasty of major joints is of great relevance. Advantages of factory-made spacers include standardized range of sizes, the reliability and availability for medical institutions. They are characterized by limited use in repair of severe bone defects.Discussion Custom-made articulating spacers enable specific tailoring to accommodate individual defects. Despite high expectations from custom-made spacers, development of optimal technologies for rapid prototyping is essential. Investments in research and development in this area have the potential to create innovative solutions that can significantly improve the results of revision arthroplasty.Conclusion The paper explores the importance of systemization of knowledge about spacers and the role of new research in improving the design and functionality. Progress in the field of materials science, additive technologies and a personalized approach to spacer manufacturing can expand possibilities of revision arthroplasty and the effectiveness. Personalized approaches and improved methods of local drug delivery that provide controlled release of antibiotics can improve the results of treatment of periprosthetic joint infections.

Assessment of the quality of life of GPs in situations of high epidemic risk

The purpose is to assess the characteristics of the decrease in the quality of life of GPs working in a specialized COVID-19 hospital, a multidisciplinary hospital, and a poly clinic during the pandemic of the novel coronavirus infection COVID-19, as well as early diagnosis, prediction, and prevention of a decrease in the quality of life in this category of medical workers. Material and research methods. The study was carried out on the basis of the Department of Occupational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation professor V. V. Kosarev, FSBEI HE Samara State Medical University of the Ministry of Health of the Russian Federation, and the Department of Occupational Pathology, Regional Center for Occupational Pathology of the Samara City Hospital No. 5. The study was carried out within the framework of a complex theme «Systematic ap proach to early diagnosis, prevention, and prediction of the impact of low-intensity pro duction factors on workers’ health» of the Department of Occupational Diseases and Clinical Pharmacology named after honored scientist of the Russian Federation profes sor V. V. Kosarev, FSBEI HE Samara State Medical University (state registration number AAAA-A18‑118122190069‑6, registration date — December 21, 2018). The study was approved by the local ethics committee of the FSBEI HE Samara State Medical University of the Ministry of Health of the Russian Federation on November 23, 2021. The study included the following groups of examined medical workers: group 1 consisted of physicians of internal medicine working in a COVID hospital (in the «red zone») (n = 111); group 2 included GPs working in a multidisciplinary hospital (n = 106); group 3 consisted of GPs working in a polyclinic (n = 102); group 4 was the control group (n = 190) comprising employees of engineering, technical, and economic specialties not relat ed to work in medical organizations (healthy). To assess the psychophysiological state and quality of life of medical workers during the pandemic of the novel coronavirus infection COVID-19, the SF-36 questionnaire [J. E. Ware, 1993], designed to study all components of the quality of life, was used. The obtained data were processed using the Statistica package from StatSoft (USA). Results. The professional activities of GPs providing medical care in the «red zone», mul  tidisciplinary hospitals, and clinics are associated with the exposure of physicians to a number of risk factors in the working environment and the labor process, related to the provision of regular or occasional care to infected COVID-19 patients, which, under con ditions of exposure to an increased level of occupational stress, leads to a decrease in the quality of life in these categories of health workers. The decrease in the quality of life among medical workers in medical institutions of various profiles during the pandemic of the novel coronavirus infection COVID-19 is due to the fact that health workers faced many additional difficulties during this period: sleep deprivation, stress, strain, and chronic fa tigue. Chronic fatigue can affect behavior, communication, learning, and decision-making, which overall leads to a decrease in the qualit y of life of medical workers. Conclusion. Thus, the obtained data indicate that when identifying risk factors for a de crease in the quality of life in medical workers working in situations of high epidemic risk, there is the need to use specialized rehabilitation measures with relaxation techniques, art therapy, as well as professional adaptation programs, physiotherapeutic techniques, such as electrosleep and reflexology, and, if possible, resort treatment in health care centers, local sanatoriums, etc. with visits to psychotherapy offices, as well as psychopharmaco logical medications.

Occupation and stress: professional burnout of GPs depending on the profile of the medical institution in situations of high epidemic risk

Introduction. In the context of the COVID-19 pandemic, medical workers turned out to be the most vulnerable category of the population in terms of the risk of developing psycho-emotional disorders. Objective. To establish the characteristics of the psycho-emotional state among general practitioners of COVID hospitals, multidisciplinary hospitals, and polyclinics during the COVID-19 pandemic. Material and methods. The study included: group 1 – general practitioners of COVID hos pitals (n=111); group 2 – internists of multidisciplinary hospitals (n=106); group 3 – GPs working in polyclinics (n=102); group 4 – control group (healthy) (n=190). The assess ment of professional burnout was carried out by means of the Maslach Burnout Inventory, developed by American psychologists C. Maslach and S.E. Jackson, in adaptation by N.E. Vodopyanova and E.S. Starchenkova, as well as using V.V. Boyko’s questionnaire. The study utilized an integrative anxiety test to investigate the formation of psycho-emotional disorders in internists during the pandemic of the novel coronavirus infection. The quality of life was determined by means of the SF-36 questionnaire. The processing of the ob tained data was carried out using the Statistica package from StatSof t (USA). Results. It has been established that the work of general practitioners during the COVID-19 pandemic was associated with the impact of occupational stress related to caring for in fected patients on medical workers, as well as with significant changes in work regarding aspects of organization and safety, which contributed to an increase in the levels of oc cupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Limitations of the study. The study has regional (Samara Region) and professional (in terms of detailing the working conditions in the studied comparison groups) limitations. Conclusions. The work of general practitioners of specialized COVID hospitals, internists of multidisciplinary hospitals, and GPs of polyclinics is associated with an increase in the levels of occupational stress, professional burnout, and anxiety, and a decrease in the quality of life. Notably, psychological changes are most pronounced in employees of specialized COVID hospitals. It is necessary to continue research on the emotional state of medical personnel in order to timely carry out preventive treatment to preserve the health of medical workers.

Comparison of the standardized incidence ratio of tuberculosis among workers at medical and educational institutions: a nationwide LTBI observational cohort study

BackgroundThe objective of this study was to determine the incidence of tuberculosis (TB) among workers at medical institutions based on interferon-gamma release assay (IGRA) and compare it with that of workers at educational institutions and the general population. MethodsFrom March 2017 to December 2020, we used a cohort of workers from medical and educational institutions in Korea, who underwent IGRA as part of a national screening program for latent tuberculosis infection (LTBI). After connecting to the National Health Insurance Service (NHIS) database to detect for any actual cases of active TB, we estimated standardized incidence ratio (SIR) and the expected number of cases to compare the incidence of TB with that of the general population. ResultsSignificant disparities in TB incidence were revealed among workers in medical and educational institutions, based on IGRA results, age, and occupation. Individuals positive for IGRA in medical institutions displayed substantially higher SIR for TB, 7.19 (6.15–8.41), compared to counterparts in educational institutions, 3.69 (3.02–4.51). Comparing by age group, we see that the SIRs are higher in younger age groups compared to older ones, with 37.30 (28.11–49.50) and 11.89 (7.28–19.41) for IGRA-positive medical and education workers under 30 years of age, respectively. In the results by occupation within the medical institutions, nurses had the highest SIR at 14.17 (11.14–18.04). ConclusionsHealthcare workers in medical institutions are more likely to develop actual TB after a positive result of LTBI screening in Korea. Intensive management and surveillance programs should be reinforced.