Organizational problems and possible ways of its resolve when providing emergency surgical care to patients with comorbid status in a highly specialized medical institution

Purpose of the study. To demonstrate the difficulties of objective interpretation of providing medical care to patients with critical limb ischemia.Materials and methods. The results of treatment of more than 29 thousand patients of one of the highly specialized medical organizations of St. Petersburg were studied, in which the main activity of the staff is the examination of patients with surgical infection of soft tissues (particularly, the critical limb ischemia).Results. It has been ascertained that, despite the unconditional success of providing medical care to patients with critical limb ischemia, a high frequency of unsatisfactory treatment results for this category of patients remains (in 2017, among 685 patients of the specialized department of the highly specialized medical organization, the proportion of cases of performing high amputations of limbs and mortality, respectively, was 11,7% (80) and 2,6% (18)). It has been demonstrated on clinical examples that the pronounced comorbidity of critical limb ischemia patients and the severity of their general condition (combined with organizational difficulties in providing them with providing medical care in conditions of highly specialized medical organization) contribute to the formation of complications (up to lethal outcomes) of not only the underlying, but also concomitant diseases. Difficulties in providing medical care of adequate quality in life-threatening conditions for patients of highly specialized medical organization in cases of critical limb ischemia necessitate a wider interaction between specialists in narrow and multidisciplinary hospitals as part of the emergency surgery service.Conclusion. When creating specialized medical centers outside of multidisciplinary medical institutions, the possibilities should be provided for the regulated involvement of highly professional consultants with a reasonable algorithm for routing patients in cases of the need for their emergency re-hospitalization to other medical institutions

Influence of Bi Substitution with Rare-Earth Elements on the Transport Properties of BiCuSeO Oxyselenides

In this study, we demonstrate that introduction of rare-earth elements, R = La or Pr, into the Bi-O charge reservoir layer of BiCuSeO leads to an increase of both the charge carrier concentration and the effective mass. Although the charge carrier mobility slightly decreases upon Bi3+ to R3+ substitution, the electronic transport properties are significantly improved in a broad temperature range from 100 to 800 K. In particular, the electrical resistivity decreases by 2 times, while the Seebeck coefficient drops from 323 to 238 μV K-1 at 800 K. Thus, a power factor of nearly 3 μW cm-1 K-2 is achieved for Bi0.92R0.08CuSeO samples at 800 K. Meanwhile, a noticeable decrease of the lattice thermal conductivity is observed for the substituted samples, which can be attributed to the enhanced point defect scattering mostly originating from atomic mass fluctuations between R and Bi. Ultimately, a maximum zT value of nearly 0.34 at 800 K is obtained for the Bi0.92La0.08CuSeO sample, which is ∼30% higher than that of pristine BiCuSeO