Specialized Medical Care Research Articles

Vascular decompression with videoendoscopy as a treatment for glossopharyngeal nerve neuralgia: clinical case and literature review

The objective is to demonstrate the effectiveness of the vascular decompression with videoendoscopy in the treatment of classical glossopharyngeal nerve neuralgia by a clinical case and to summarize the literature data on this subject. Clinical case. In February 2020, a 56-year-old patient with a clinical picture of glossopharyngeal nerve neuralgia was admitted to the Research Clinical Center of Specialized Medical Care and Medical Technologies. The pain syndrome bothered about 3 years, constantly took carbamazepine at a dose of 1200 mg per day, amitriptyline 75 mg per day, clonazepam 2 mg per day without effect. After further examination and differential diagnosis of causal neuralgia of the glossopharyngeal nerve, a neurovascular conflict appeared between the glossopharyngeal nerve, the posterior inferior cerebellar and vertebral arteries. A good postoperative clinical result was obtained. An analysis of the available scientific literature on this problem is carried out.Results. After performing vascular decompression of the root of the glossopharyngeal and vagus nerves, pain completely regressed (BNI - I, VAS - 0). 6 months after surgery, there is no pain, the patient does not receive drug therapy. In the course of the analysis of available literature, the effectiveness of vascular decompression in the treatment of patients with classical neuralgia reaches 98 %.Conclusion. Given the low incidence of glossopharyngeal neuralgia, the correct diagnosis and the choice of an appropriate treatment method determine the outcome of the disease. The performed operation in the volume of vascular decompression of the glossopharyngeal nerve root with the use of videoendoscopy allowed to completely stop the pain syndrome.

Providing of a highly specialized medical care for servicemen of the Armed Forces of Ukraine by roentgen-endovascular interventional methods

Aim: to provide high-quality and full-fledged minimally invasive highly specialized medical care by X-ray endovascular methods, according to modern world standards, for the Armed Forces of Ukraine on all territories of the country and direct participants of combat operations in the context of Joint Forces Operation (JFO) in certain parts of Donetsk and Luhansk regions. Materials and methods. The provision of minimally invasive highly specialized medical care by X-ray endovascular techniques for servicemen of the Armed Forces of Ukraine in the conditions of JFO in certain parts of Luhansk and Donetsk regions and the National Military Medical Clinical Center of Kyiv (NMMCC) in critical internal bleedings, pathology and injuries of the main vessels, acute cardiovascular pathology over a period of 2018–2020 was analyzed: 1038 diagnostic coronary interventions to servicemen with acute coronary syndrome, 346 stenting of coronary arteries in an emergency, 36 – angioplasty of coronary arteries. A total of 296 interventions for pathology of the peripheral vascular system including combat trauma were performed. Transcatheter arterial embolization was performed for 100 patients with internal bleeding. An emergency care mechanism was implemented for patients with acute coronary syndrome in the Joint Forces Operation in certain parts of Donetsk and Luhansk regions. Results. The implementation of these methods of highly specialized care in the Armed Forces of Ukraine allowed to realize the standards of emergency care for acute coronary syndrome, the average time of “door – balloon” was 100 minutes (CI 95 %, 98–103 minutes, P < 0.05). In the conditions of JFO, care for patients with acute coronary syndrome, the interval “door – balloon” takes time from 2 to 12 hours (CI 95 %, 5.5–6.5 hours, P < 0.05), fatalities were absent. At transcatheter arterial embolization, technical success of arterial occlusion was 100 %. In the treatment of main vessels, the length of hospital stay after endovascular interventions was 1–18 days (CI 95 %, 1.96–2.51 days, P < 0.05). The main complications were postpuncture hematoma – 4.73 %, acute occlusion after intervention within 24 hours – 2.36 %, pseudoaneurysm – 0.68 %. Effective recanalization of the main blood flow was achieved in 262 cases (88.51 %). Conclusions. The implementation of X-ray endovascular techniques into the medical service of the Armed Forces of Ukraine allowed for providing high-quality highly specialized medical care directly to participants of Joint Forces Operation in certain parts of Donetsk and Luhansk regions in the shortest possible time.

Model and principles of organizing emergency specialized medical care for children at the stage of medical evacuation

Relevance. The problem of organizing specialized medical care in emergency forms for children is caused by three groups of reasons: the presence at the junction of several adult and pediatric medical specialties, the medical and geographical features of the country and the lack of a unified regulatory framework.Intention. To increase the availability of medical services and reduce regional inequality in their distribution. A model of organizing a single operational service of specialized medical care for children and the basic principles of its functioning on the territory of the Russian Federation are proposed.Methodology. Statistical data, features of legislation, ways of solving the problem in certain regions and the achievements of initiative groups of specialists are analyzed.Results and Discussion. Since 2000, the number of hospital beds for children, the number of emergency medical stations has decreased, and the number of diseases and conditions requiring specialized emergency care for children has increased. Infant mortality rates in remote and hard-to-reach regions exceed the national average by 1.5–2.6 times. At the same time, the current statistics of medical evacuations of children are not accurately reflected in any of the official sources. The regulatory framework for medical evacuation of children includes three “ Procedures for providing medical care “in the profile “ambulance”, “neonatology” and “obstetrics and gynecology” and Federal Law N 323. The law implies the presence of mobile teams in hospitals and departments of different profiles that are not related to each other, but there is no structure that unites them and analyzes the results of work at the federal level.Conclusion. To solve the problem, it is necessary to create a federal operational service and a “hotline” that can be contacted by any resident of the country, to form a federal medical register of critical conditions in children, to develop and implement common principles of diagnosis and treatment. The presented model and principles contribute to the development of a three-level system of emergency medical care and correspond to the goals and objectives of the Ministry of Health of the Russian Federation set out in Letter N 14-3/n/2-2339 of 20.03.2019.

The Study of the Awareness of Healthcare Workers on Organizational Aspects of Vaccination

Aim. To analyze the awareness of healthcare workers on the organization of vaccination.
 Materials and Methods. In 2018 – 2019 sociological survey was conducted among 1384 healthcare workers from 4 Ukrainian regions: 353 primary care physicians, 233 specialized medical care doctors, 88 healthcare managers, 700 nurses, and 10 others.
 Results. Gaps in the knowledge and beliefs of health professionals associated with the organization of vaccination were founded: less than half of the surveyed health workers understand that vaccination is carried out with any certified vaccine, regardless of the country of origin; a significant part of respondents tend to prescribe drugs not recommended by international guidelines (53.6%), antihistamines (15.9%) and anti-inflammatory (8.0%) drugs before vaccination; do not know about the possibility of doing several vaccinations in one visit (47.3%) and that the cold chain breach affects the effectiveness of the vaccine (52.4%). It was found that the most knowledgeable about the organization of immunoprophylaxis of the population are the health care managers and medical personnel who have passed special training on vaccination vs the least informed specialized medical care doctors.
 Conclusions. It is necessary to develop a set of scientifically based measures to improve the awareness of health professionals about the organization of vaccination in order to improve the coverage of the population with immunoprophylaxis.

ОПЫТ ПРИМЕНЕНИЯ КЛЕТОЧНОГО ЭНЕРГОПРОТЕКТОРА В КОМПЛЕКСНОМ ЛЕЧЕНИИ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК У ПОДРОСТКА С ОТРАВЛЕНИЕМ МЕТАМИЗОЛОМ НАТРИЯ

Every year, 1,700–1,850 pediatric patients apply to the Department of Toxicology of Filatov Children's City Clinical Hospital for specialized medical care. More than 56% of hospitalizations are caused by medicinal poisoning. One of the serious complications of drug intoxication is acute kidney injury (AKI). The incidence of AKI in acute chemical poisoning in childhood is from 10 to 57,6% according to various authors, therefore, the issues of effective treatment of AKI in the medical practice of doctor of any specialty are extremely relevant. The article presents the case of conservative treatment of AKI stage 3 according to the KDIGO classification in a teenager with metamizole poisoning, including inclusion of «Cytoflavin» cellular energy protector as a part of complex therapy. As a result of the treatment, the level of proteinuria and azotemia in the child has decreased. The rate of tuber filtration has increased from 20,0 to 62,4 ml/min/1,73 m2. Thus, the use of a cellular energy protector contributed to effective restoration of renal function.

Inappropriateness of Antibiotic Prescribing in Medical, Surgical and Intensive Care Units: Results of a Multicentre Observational Study.

The objectives of the present study were to provide a snapshot analysis of antibiotic appropriateness in two hospitals in Southern Italy in three specific areas, surgical, medical and intensive care, and to evaluate the risk factors associated with inappropriateness in antimicrobial prescriptions. We conducted a multicentre observational study in two hospitals in the Campania region. We collected data of all patients admitted on the day of evaluation to antibiotic therapy or prophylaxis through a case report form. The primary outcome was to assess the inappropriateness of antibiotic prescribing, related to the spectrum, dose, route of administration and duration of treatment—in particular, to assess whether there was a difference in the adequacy of the prescriptive practice in the medical, surgical and intensive sectors. Prescriptive inappropriateness was more frequently observed in surgical units (79.8% of the 104 antimicrobial prescriptions) than in medical units (53.8% of the 65 prescriptions, p = 0.0003) or in intensive care units (64.1% of the 39 prescriptions, p = 0.052). The reasons for the inappropriate antimicrobial prescriptions were similar in the three areas evaluated: antimicrobial unnecessary and antimicrobial not recommended were the most frequent reasons for inappropriateness. Not participating in an antimicrobial stewardship program (ASP) was identified as a factor associated with inappropriate antimicrobial prescriptions in medical and surgical units, but not in Intensive Care Units (ICUs). ASPs may enhance the appropriateness of antimicrobial prescriptions especially in medical and surgical units. In ICUs, specific programs able to limit empirical therapies and encourage the collection of microbiological samples may be useful to set up targeted therapies and to design antimicrobial protocols.

The Orthopedic Features in Children - Hockey Players

Hockey as a power and quite injury and dangerous sport, presents the children’s body with high requirements for general physical training and accompanying orthopedic pathology. These are the issues of providing high-quality specialized medical care in cases of injuries of young hockey players, orthopedic examinations and deciding on the admission to training and competitions of healthy and injured children and adolescents, along with adult professional hockey players, that are within the competence of doctors of orthopedic doctors of the SKA medical center.

THE RESULTS OF THE IMPLEMENTATION OF AN OPTIMIZED ROUTING SYSTEM FOR ADULT AND CHILD POPULATION WITH MAXILLOFACIAL REGION IN THE TERRITORY OF THE PENZA REGION IN 2020-2021.

The continuous increase in the incidence of the maxillofacial region, the peculiarities of the course and spread of the pathological process, actualize, in the context of the development of modern healthcare, the need for continuous improvement of the system of providing medical care to the population in the profile of "Maxillofacial surgery". Up-to-date patient treatment algorithms, a variety of medicines and equipment allow us to thoroughly improve the results of treatment of patients with maxillofacial pathology. However, the guarantee of the effectiveness of treatment is not only human resources, modern material and technical equipment, the development of the latest clinical recommendations for treatment and the creation of effective therapy, but also a clearly competently designed and built organization of the system of providing medical care to patients in the profile of "Maxillofacial surgery". The system of providing specialized, including high-tech, medical care is determined by the incidence, the level of development of medical care and its socio-economic feasibility. The development of maxillofacial surgery in the structure of the hospital of a multidisciplinary medical organization, the formation of outpatient clinics, the training of highly qualified personnel, the development of scientific directions, contribute to improving the quality of diagnosis, treatment and timely detection of pathology. Definitely, an important role is played by patient routing, which includes a step-by-step system of providing specialized medical care to patients with maxillofacial pathology. A systematic, step-by-step approach helps to achieve high-quality detection and treatment of diseases of the maxillofacial region, as well as reduces the frequency of complications. The stage-by-stage organization of the patient routing service, well-defined goals and objectives of each stage, and established medical organizations responsible for each stage make it possible to organize the provision of medical care to patients with maxillofacial pathology at the proper level.

Routing and Treatment of Patients with Hematogenous Vertebral Osteomyelitis on the Tyumen Region Example

Background. Currently, various algorithms of tactical classifications and treatment regimens for hematogenous vertebral osteomyelitis (HVO) are proposed. However, all proposed approaches are designed for the treatment of patients in specialized multidisciplinary clinics departments, although the initial treatment often occurs in municipal polyclinics, private medical centers and district hospitals. The question is what the appropriate scope of diagnostic and therapeutic measures in institutions with different material and resource bases and how to ensure continuity according to the existing three-level system of medical care remains open. The aim of this studyis to determine the probable routing and treatment options for patients with HVO on the example of the Tyumen region, depending on the existing three-level system of providing medical care to the population.Object and Methods.The current Orders of the Ministry of Health of the Russian Federation and the Resolutions of the Government of the Tyumen Region were studied, on which basis a three-level system of providing medical care to the population was organized and organizations providing emergency and elective medical care to patients with HVO were identified. The volume of medical and diagnostic measures in patients with HVO in institutions of various levels, as well as their routing to the regional clinical hospital No. 2 in case of impossibility or inexpediency of providing specialized medical care at the place of primary treatment, is analyzed on the example of the Tyumen region. The clinical material is presented by 267 patients with HVO who were treated in the Tyumen regional clinical hospital No. 2 from 2006 to 2019, 78.7% of whom were treated in the profile of traumatology and orthopedics, 18.7% — neurosurgery and 2.6% — surgery. Results.The list of medical institutions that provide emergency and planned care in traumatology and orthopedics, neurosurgery in the Tyumen region is defined, depending on the level of the institution and the available material and resource base. A block diagram is proposed that determines the scope of medical and diagnostic measures in institutions of I-III levels and specialized departments of multidisciplinary clinical hospitals. The principle of determining the patient profile (surgical, orthopedic, neurosurgical) depending on the type and severity of the inflammatory lesion according to the classification E. Pola (2017) is proposed.Conclusion. The need for effective use of medical and diagnostic resources starting from level I is determined by clear routing of the patient to ensure the continuity of medical care. A full-fledged diagnosis is possible in institutions not lower than the third level with the mandatory determination of the lesion type and the severity of the inflammatory process. HVO treatment is advisable in level III institutions, specialized departments of regional clinical hospitals and federal institutions.

Components of the Magnet® model provide structure for the future vision of nurse managers' work: A qualitative perspective of nurse managers.

To describe nurse managers' views of their work in the future. Ongoing reformation of health care organisations includes profound changes to nurse managers' work practices. A qualitative approach was applied to elicit views of nurse managers (n=133) from eight Finnish specialized medical care hospitals through one open-ended question about their future work in November 2019. The acquired data were subjected to inductive thematic content analysis. Four themes were identified in the nurse managers' responses, indicating that they anticipated: 1) a shift from hierarchical leadership to shared governance, 2) an increasing focus on proactive and systematic work, 3) development of evidence-based practices and 4) improvement in the attractiveness and effectiveness of the organisation. Nurse managers envisage their future work will follow the transformational leadership model. Shared governance and multidisciplinary team leading, with a stronger focus on proactive strategic planning will extend their power to influence decision-making. Administrative supporting systems will free more time from their daily routine work for interactions with staff. Clarification of the managers' job description along with administrative support systems is anticipated to strengthen leadership, facilitate management, enhance decision-making and increase the attractiveness and effectiveness of both health care organisations and nurse managers' work.

The means of optimization of medical care support of victims of road traffic accidents at the hospital stage: The publications review

The road traffic traumatism remains among the most actual medical social problems in Russia. The injured because of road traffic accidents suffer of predominant severe multiple and combined injuries (polytrauma) very often resulting in permanent disablement and lethal outcomes. The existing three-level system of traumatologic centers to supply specialized medical care of the injured in road traffic accidents demonstrates efficiency only on condition of observation of routing of patients. The new organizational approaches to specialized medical care to the injured at the hospital stage is needed for further decreasing of lethality and disability in group of victims of road traffic accidents.

Properties of the overall hospital Star Ratings and consumer choice.

To examine characteristics of the CMS Overall Hospital Quality Star Ratings related to their use by consumers for choosing hospitals. Observational study using secondary data analyses. Hospital Star Rating data reported in February 2019 and additional quality data from California and New York were used, with a mix of analytical approaches including descriptive statistics, correlational analysis, and Poisson regression models. The distribution of hospitals' Star Rating summary scores was tightly compressed, with no hospitals at or near the scores that would be obtained if a hospital were either best or worst across all quality domains. Hospitals did not consistently perform well or poorly across the range of measures and quality groups included in the Star Ratings. On average, for a given quality measure included in the Star Rating program, 12% of 1-star hospitals received top-quartile scores and 16% of 5-star hospitals received bottom-quartile scores. No significant associations were found between hospitals' overall Star Ratings and their performance on a set of condition-specific quality measures for hospitals in California and New York State. Hospitals' overall scores clustered in the middle of the potential distribution of scores; no hospitals were either best at everything or worst at everything. The Star Ratings did not predict hospital quality scores for separate quality measures related to specific medical conditions or health care needs. These 2 observations suggest that the Star Ratings are of limited value to consumers choosing hospitals for specific care needs.

Rehabilitation Route for a Child with Cerebral Palsy:
 the Experience of Chuvashia

The most common cause of neurological disability in childhood is cerebral palsy. The objectives of the treatment of children with cerebral palsy are the acquisition and maintenance of new motor skills; prevention of the development of contractures and other secondary orthopedic complications; decrease in the level of pain; improving the level of childcare. At the same time, the provision of treatment and rehabilitation assistance to children with cerebral palsy requires an integrated, systematic approach. The article describes the route of rehabilitation of children with cerebral palsy in the Chuvash Republic from the moment of diagnosis until reaching the age of 18. The study was carried out on the basis of an analysis of data from the regional register of children with cerebral palsy at all stages of treatment and rehabilitation (habilitation). The first stage includes the identification of risk groups for cerebral palsy, conservative, surgical specialized medical care. The register of children with cerebral palsy made it possible to keep records of patients at the stages of treatment and rehabilitation with an assessment of the results. At the second stage, high-tech conservative and surgical treatment is carried out. After operations, patients are sent for rehabilitation to a 24-hour hospital or to a Rehabilitation Center for Children (over 3 years, 1.5 thousand children were treated, 25.7% after operations). The third stage is organized at the outpatient clinic level and in specialized sanatoriums. For 20142018 the coverage of children with cerebral palsy with conservative treatment increased 1.9 times, with botulinum therapy 2.6 times, the proportion of those who received surgery decreased to 22.4%. 92.7% of patients of the Register are covered by conservative treatment. 33.3% of operated children were referred for sanatorium-resort treatment. The control section of the rehabilitation results showed an increase in the proportion of children with improved gait quality, the ability to stand independently, walk (with support), and an increase in the average level of physical activity. A multi-level system of interagency interaction in the provision of treatment and rehabilitation assistance to children with cerebral palsy in Chuvash Republic made it possible to ensure a sufficient amount of basic and availability of highly qualified medical care, effective management and control of the stages of rehabilitation.

Hospitalizations for COVID-19 in Poland: a study based on data from a national hospital register.

INTRODUCTION COVID‑19 has been identified by the World Health Organization as a pandemic. Poland introduced extensive antiepidemic measures relatively early in order to slow down the spread of the disease. OBJECTIVES The study aims to present recent data on COVID‑19 hospitalizations during the first months of the disease outbreak in Poland. PATIENTS AND METHODS This is a retrospective, population‑based study conducted using hospital discharge records that included a diagnosis of COVID-19. Data were obtained from the National Institute of Public Health, where they had been originally collected for a Polish hospital morbidity study. They included 8840 hospitalization records from the period between February and September 2020. RESULTS Overall, there were 8252 records of patients hospitalized for COVID‑19 for the first time, which accounted for 93% of all hospitalizations. The study group consisted of 4161 men (50.4%) and 4091 women (49.6%). Significantly more patients from urban than rural areas were hospitalized (21.8 per 100 000 vs 20.5 per 100 000; P <0.02). In the period subject to analysis, 1073 in‑hospital deaths were observed (13% of all patients), 965 of which occurred during first‑time hospitalizations (11.7% of all patients). In the study group, patients who died during hospitalization compared with those who survived hospitalization were significantly older, more frequently lived in urban areas, and had more comorbidities. CONCLUSIONS The findings of our study, especially the differences between survivors and nonsurvivors with COVID-19, may be helpful in recognizing patients requiring special medical care and preventive measures during hospitalization.

Are Researchers Addressing Cancer Treatment and Survivorship Among People With Intellectual and Developmental Disabilities in the U.S.? A Scoping Review.

People with intellectual and developmental disabilities (PWIDD) often encounter barriers in the health care system when seeking general and specialized medical care. Literature has shown that PWIDD experience a lack of proper screening for and prevention of cancer compared to the general population. However, less is known regarding the cancer care and survivorship of PWIDD, especially in the United States. In this review, we examine what is currently known about the primary, psychosocial, and palliative care of PWIDD diagnosed with cancer. Our analyses reveal an immediate need for improvement in caregiver support, collaboration among health care providers, and ethical approaches to information disclosure for this population, as well as the establishment of more reliable standards of care through additional research with PWIDD.

Technological Innovations Through Digital Service Design in Hospital Districts

The aim of the study is to describe and increase understanding about digital service design in creating technological innovations in Finnish hospital districts. The data was collected via an open questionnaire during March-August 2019 and analyzed using a combined thematic and narrative analysis. Three distinct themes arose from the research narratives: cooperation, development, and cost. First, the importance of cooperation in the early stages of the service design process, when new technological innovation ideas are developed, was emphasized. Second, the possibilities of digitalization and need for new innovations were taken into account in the development theme. Third, costs define the utilization of an innovation and guide its initial development. If savings and costs are in balance, technological innovations will move forward. Moreover, the findings show that technological innovations in hospital districts progress in a certain pattern, and the utilization of innovations come from the need and pressure to evolve. Keywords Adoption of Innovation, Deployment of Innovation, Digital Service Design, Rogers's Diffusion of Innovation Theory, Service Design, Service Innovation, Specialized Medical Care

The worms that invade your brain

IntroductionNeurocysticercosis is a parasitic infection of the central nervous system and caused by the pork tapeworm Taenia solium. Humans become infected after consuming undercooked food or water contaminated with tapeworm eggs, or through poor hygiene practices. The clinical manifestations of neurocysticercosis (NCC) largely depend on the number, type, size, localization, and stage of development of cysticerci, as well as on the host immune response against the parasite. Seizures are the most common manifestations of NCC (70–90%) of patients, followed by headache (38%), focal deficits (16%) and signs of intracranial hypertension (ICH) (12%), but psychiatric symptoms can also be seen.ObjectivesLiterature review on neuropsychiatric manifestations of neurocysticercosis, based on a clinical case.MethodsPubmed search using the keywords neurocysticercosis, psychiatric comorbidity, neuropsychiatric manifestations.ResultsWe present a clinical case of a 29-year-old male patient, with history of an epilepsy, that immigrated to Portugal with his family from Cape Verde for specialized medical care. He presented to the ER with an acute psychotic episode characterized by disorientation, persecutory ideation, psychomotor agitation and violent behavior. Brain CT scan showed multiple calcifications in cerebral parenchyma and CSF was positive for antibodies against T. solium.ConclusionsThe polymorphous symptomatology seen in NCC is mimicked only by neuro-tuberculosis and neurosyphilis in developing countries, and multiple sclerosis in the Western countries. Psychiatric symptoms are a part of the clinical presentation of infectious diseases. It is important to consider NCC in endemic areas presenting with psychiatric symptoms, especially those showing poor response to the standard treatment and in those with history of seizures.DisclosureNo significant relationships.

EPIDEMIOLOGICAL CHARACTERISTICS OF BREAST CANCER IN THE REPUBLIC OF MORDOVIA

The article analyzes the main epidemiological characteristics of breast cancer in the Republic of Mordovia in comparison with the Russian Federation. Based on the official accounting and reporting documentation for 2011-2019. the territorial and age-specific features of the incidence were determined, the structure of pathomorphological forms of breast cancer was assessed, the weighted average cost of providing specialized medical care for breast neoplasms in a hospital in the Republic of Mordovia was calculated. It has been shown that the incidence of breast cancer in the Republic of Mordovia for 2011-2019 increased, which corresponds to the all-Russian laws: 6.11 per 100 thousand women in the age group of women 25-29 years old to 213.14 in the age group 60-64 years. Infiltrating ductal carcinoma prevailed in the structure of the pathomorphological form of breast cancer among the inhabitants of the Republic - 58.8%. It has been shown that the cost of providing specialized hospital care for stage III breast cancer is 8 times higher than for stages I-II of breast cancer. Thus, the analysis showed that breast cancer is a serious medical and social problem, and effective treatment of the disease requires costly treatment in a specialized hospital, and the cost of drug therapy for the disease increases significantly at advanced stages.

Beginning to Find the Missing Piece: Social Determinants of Health as a Contributor to Disparities in Plastic Surgery.

At few times during recent history have social determinants of health been more glaring. Effects of the coronavirus disease of 2019 pandemic have accentuated existing sociodemographic disparities. Considering the tenets of medical ethics and the current social climate, including the Black Lives Matter movement, each medical discipline is called to examine barriers to equitable health care across racial, ethnic, and socioeconomic spectrums. Within the field of plastic surgery, our understanding of how poor social determinants contribute to disparities in surgical access and outcomes is incomplete, limiting our ability to develop targeted interventions. Social determinants of health are the conditions in which people are born, grow, live, work, and age, which are shaped by the distribution of economic resources and power. Factors such as socioeconomic status and stability, education, living environment, social support, and health care provider availability and cultural competency influence patient behaviors and health equity. These factors may account for a greater percentage of patients’ health outcomes than the specific medical care provided.1 Examples in Philadelphia are representative of many American metropolitan areas. Just 5 miles from Center City, the average life expectancy drops by 20 years as less affluent neighborhoods with greater minority representation are reached.2 Current and historical structural drivers of inequity may account for a greater proportion of Black and Hispanic patients facing unfavorable social determinants than do white patients.1 Slowed efforts in reducing school segregation have limited the well-known contributions of desegregation to improved health and well-being of minority students.3 People of color may be shown fewer properties when purchasing or renting homes.3 Despite declining unemployment rates for all races, income for indigenous, Black, and Hispanic people has only modestly improved, presenting difficulty for households to keep pace with rising living costs.1 These structural drivers shape patients’ health behaviors and approach to the health care system. Low health literacy, challenges with navigating the insurance and health care systems, medical distrust, and lack of transportation or childcare, in addition to geographic constraints, are barriers to using medical services, remaining in the system, and maintaining the actual quality of care.4 Implicit bias toward minority patients may compound existing issues by compromising communication and trust. Consider that minority patients are less likely to receive a referral for reconstruction after mastectomy, and more likely to be unaware of options for breast reconstruction.5 Or that Black and Hispanic patients are more likely to be referred later than white patients for the treatment of craniofacial conditions. Understanding that these observations likely influence outcomes is a first step in providing equitable care. As the majority of plastic surgical research on disparities has involved descriptive studies of breast reconstruction, a gap exists in developing subspecialty best practices. Culturally congruent programs are likely to have the greatest impact.5 We are called to deepen our knowledge of the barriers patients face, the discrepancies in care provided, and most importantly, the interventions that best promote equitable care. As plastic surgeons practice in diverse settings, understanding the social barriers that impact patient care is not only essential, it is our moral duty. DISCLOSURE The authors have no financial interest to disclose. No funding was received for this article.

Uniting the traumatological and orthopedical service of the country

On April 22, 1921, the Moscow Medical and Prosthetic Institute was founded. Nikolay N. Priorov (MD, PhD, professor, academician of the USSR Academy of Medical Sciences) was the founder and permanent leader of the institute for 40 years. In 1930, the facility was renamed into the Moscow Regional Institute of Traumatology, Orthopedics, and Prosthetics. Before World War II, in 1940, the institute became known as the Central Research Institute of Traumatology and Orthopedics, known as CITO as the leading national institution for traumatology and orthopedics. For a century, CITO employees has been conducting clinical, research, educational, and methodological activities providing comprehensive assistance in all regions of the country. In 2018, CITO was the first traumatological and orthopedics centers to be transformed into the Federal State Budgetary Institution National Medical Research Center of Traumatology and Orthopedics named after N.N. Priorov of the Ministry of Health of the Russian Federation which significantly increased the role of the institution in traumatology and orthopedics, especially managemental, analytical, educational, and methodological activities. The 15 clinical departments and various laboratories of the center conducted research work and provide specialized medical care, including high-tech traumatological, orthopedic, oncological, and neurosurgical patient care.