Outpatient Medical Rehabilitation Research Articles

Resources and activities of voivodeship occupational medicine centers in Poland during the COVID-19 pandemic

Voivodeship Occupational Medicine Centres (VOMC), being higher-level units towards basic units providing preventive care for employees in Poland, play a consultative, appeal, supervisory and registration role towards them. Additionally, they perform many other tasks specified in the Occupational Medicine Service Act, including conducting diagnostic and jurisprudential activities related to occupational diseases and postgraduate education in occupational medicine. The analysis covers data from 2017-2022 on VOMCs activities, derived from mandatory MZ-35 reporting. Over 6 years, the number of employed physicians at VOMCs decreased from 830 in 2017 to 820 in 2022, with >20% of employment contracts transitioning to other forms of cooperation. The number of employed nurses decreased from 375 to 342, and the number of psychologists from 86 to 82. During the 3 years of the pandemic (2020-2022), compared to 2017-2019, the consultative activity of VOMCs for basic units of occupational health service decreased by nearly 30%, while appeal and supervisory activities decreased by 15.2% and 15.8%, respectively. The number of individuals receiving outpatient medical rehabilitation for occupational pathology decreased by >32%, and the number of services provided for established occupational pathology decreased by >14%. The number of certifications for occupational diseases decreased from 3963 in 2019 to 3518 in the first year of the pandemic, then increased to 4145 in 2021 and 3990 in 2022. The COVID-19 pandemic had a significant impact on the functioning of VOMCs. Changes in specific areas of their judicial, consultative, appeal, supervisory, training and rehabilitation activities corresponded with the socio-legal changes observed between 2020-2022. The structure of employment at VOMCs and the scope of their tasks remained stable during the pandemic. The observed changes in employment of medical staff were in line with general trends in healthcare institutions and regional conditions. Med Pr Work Health Saf. 2024;75(4):367-381.

Pharmaco- and ozone therapy in outpatient medical rehabilitation programs for patients with chronic cerebral ischemia

Abstract. Purpose of the study. To evaluate the effectiveness of medical rehabilitation of patients with stage 1 chronic cerebral ischemia using ozone therapy in an outpatient setting. Material and methods. A randomized, prospective, single-center, open-label, controlled study was conducted on 80 patients with stage 1 chronic cerebral ischemia, who were divided into 2 groups by means of simple randomization: in the study group (SG/41 patients), the patients received rehabilitation in accordance with the federal clinical guidelines and intravenous ozone therapy; in the control group (CG/39 patients), the patients underwent only standardized treatment. The effectiveness of rehabilitation measures was monitored using validated rating scales, electroencephalography, and quality of life assessment. Results. The implementation of the medical rehabilitation program for patients with stage 1 chronic cerebral ischemia in an outpatient setting provides a significant reduction in pain (p < 0.01), correction of psycho-emotional and cognitive disorders (p < 0.01), normalization of lipid metabolism (p < 0.01), and improvement in quality of life (p < 0.01). The efficacy of the developed outpatient medical rehabilitation program for patients with stage 1 chronic cerebral ischemia was 85.4 %, and that of the standardized program — 77.0 %. Conclusion. Integrated pharmacotherapy and ozone therapy provide a significant increase in the effectiveness of medical rehabilitation of patients with chronic cerebral ischemia at the outpatient stage.

Frailty profile among elderly patients in the outpatient medical rehabilitation unit of RSUD Dr. Soetomo, Surabaya, during the period of march-august 2023

The prevalence of the elderly population is increasing, often accompanied by a rise in the prevalence of symptoms related to declining functions caused by the aging process. Findings from a study on frailty conducted in Surabaya's elderly community revealed that 36.7% of subjects were in a frail state, with a higher percentage of females (31.5%) being frail compared to males (5.2%). This indicates a significant prevalence of elderly individuals experiencing frailty syndrome. Consequently, this research aims to determine the incidence of frailty among the elderly in the Outpatient Medical Rehabilitation Unit of Dr. Soetomo Regional General Hospital during the period of March-August 2023. The research objective is to understand the frailty profile in elderly patients at the Outpatient Medical Rehabilitation Unit of Dr. Soetomo Regional General Hospital in Surabaya during the specified period. This study is a descriptive research type utilizing a cross-sectional survey method. Data processing involves computerized calculations using coding, entry, cleaning, and saving methods. Data analysis is conducted using descriptive methods, and the analyzed data will be presented through tables and diagrams to elaborate on the incidence of frailty in the Outpatient Medical Rehabilitation Unit of Dr. Soetomo Regional General Hospital during March-August 2023. The results of this study indicate a significant incidence of frailty among elderly patients in the Outpatient Medical Rehabilitation Unit of Dr. Soetomo Regional General Hospital in Surabaya during the specified period, categorized into three groups. The frailty category comprises 58.2%, the prefrailty category comprises 30.9%, and the robust category comprises 10.9%. The conclusion drawn from this research includes the characteristic data of elderly patients at the Outpatient Medical Rehabilitation Unit of Dr. Soetomo Regional General Hospital in Surabaya during March-August 2023, encompassing gender, age, frequency of visits, highest education level, body mass index (BMI), ability to perform daily physical activities, and comorbidities.

Standardization of rehabilitation medical cards for adult patients with musculoskeletal and peripheral nervous systems dysfunction

Currently, each rehabilitation institution solves the problem of registration of rehabilitation medical records empirically, based on the existing realities of a particular institution.
 The study examined the development of a medical history template for the in- and outpatient medical rehabilitation of patients with peripheral nervous system (PNS) and musculoskeletal system (MSA) dysfunction.
 The medical history template corresponded to the currently approved forms 003/y (Medical record for inpatient care) and 025/y (Medical record for outpatient care) but supplemented with chapters, allowing entry of information in accordance with the requirements of the Ministry of Health of the Russian Federation Order for medical rehabilitation of adults (No. 788n dated July 31, 2020). Additional chapters, forms, and appendices designed to include specific information about the rehabilitation process included the physical and rehabilitation medicine doctor examination list, multidisciplinary rehabilitation team members, examination lists, rehabilitation routing scale blank, list of MDRC discussions, individual patient management forms, standard rehabilitation discharge form, and list of rehabilitation quality criteria for adult patients with MSA/PNS dysfunction. Validated scales and test forms were also included.
 The unification of rehabilitation medical records for patients with MSA/PNS impairment makes it easier for the staff of the rehabilitation departments and centers to file medical records in accordance with the current legislation.

A modern approach to the rehabilitation of patients with fractures of the bones of the lower extremities

BACKGROUND: General injury rates tend to increase in most federal districts of Russia. The patients with fractures of the bones of the lower extremities reaches for 8.525% of the total number of patients with fractures. Fractures of the bones of the lower extremities are characterized by long period of reparation, persistent contractures, a violation of the congruence of the articular surfaces, and changes in the biomechanics of walking. Only full course of rehabilitation can eliminate the these complications and restore the previous motor activity.
 АIMS: The study aimed to analyze the structure of injuries in patients of the traumatology department and to present and the results of the recovery of patients with fractures of the bones of the lower extremities using and algorithm of organization of medical rehabilitation in the case study.
 MATERIALS AND METHODS: A retrospective analysis of statistical data on 995 patients of the traumatology department № 1 of the Kazan City Clinical Hospital, who underwent 981 operations, was carried out. Randomly selected two groups of patients ― I main (n=45) and II control (n=45). Patients of group II after the treatment at the trauma center underwent outpatient medical rehabilitation, group I received inpatient medical rehabilitation in the rehabilitation department of the Kazan City Clinical Hospital № 7. In a hospital setting, a comprehensive rehabilitation program included physiotherapy exercises, CPM-veloergometry, exercises on rehabilitation simulators, the PNF kinesiotherapy technique, etc.
 RESULTS: A more pronounced statistically significant positive dynamics at the end of the course of medical rehabilitation was noted in patients of group I (reduction of pain syndrome, increased joint mobility, degree of dependence on others, increased mobility index, the ability to dress independently, maintain body position in space, reduced dysfunction in lifting and carrying objects, walking disorders, and caring for body parts). The dynamics of motor function and psycho-emotional sphere also improved to a greater extent in patients of group I.
 CONCLUSIONS: The effectiveness of the presented algorithm of organization of medical rehabilitation of patients with fractures of the bones of the lower extremities is confirmed by the results of present study. It is revealed that patients in the I (main) group showed more significant improvement in functions, activity and participation, a decrease of disability, reduce of pain, anxiety and depression, as well as an increase of the level of quality of life compared to patients of group II (control), who did not receive comprehensive medical rehabilitation in the hospital (p 0.1).

Development of Practice Guidelines for Social Work in Medical Rehabilitation

Social work services are a major part of the treatment spectrum in medical rehabilitation. Given new demands and differences in the practical implementation of social work interventions, there is a need for good clinical practice standards of care. Therefore, practice guidelines (PG) for social work in medical rehabilitation facilities were developed. These are intended to support decision-making processes in interventions and give other professions working in rehabilitative care insight into the range of social work services. The PG were developed in a multi-stage process involving experts from social work practice. A national and international literature search was conducted on the current evidence on social work interventions in medical rehabilitation. In a survey of social work services in inpatient and outpatient medical rehabilitation facilities (all indications except addictive disorders, child/adolescent rehabilitation; Nmax=311), social workers were asked to provide information on current practice and their expectations towards the PG. On this basis, a preliminary version of the PG was modified and expanded in an expert workshop and evaluated in a second survey of social work services in rehabilitation facilities (Nmax=184). The results were discussed at a second workshop and on this basis the final PG version was prepared. The PG include information on framework conditions of social work in rehabilitation and on social diagnostics. At the center of the PG are frequent needs and problems of rehabilitation patients. These include work-related problems, social and financial problems, participation of persons with disability, and aftercare/follow-up. Each chapter provides information on needs assessment, the content and scope of suitable interventions, and additional materials and references. The PE are intended as a practical aid, based on both practical expertise and existing scientific evidence, to provide social work staff and other professional groups in rehabilitation with information on social work services and their implementation. The focus of the content reflects the expressed expectations of social services for PE.

Correlation Between Physical Activity, Body Composition, And Micronutrition Intake In Patients Of Knee Osteoarthritis At The Medical Rehabilitation Clinic, Fatmawati Hospital Jakarta In 2021

Background : Osteoarthritis (OA) is a degenerative joint disease associated with joint cartilage damage that usually occurs in the aging process. This study is to analyze the correlation between physical activity, body composition, and the micronutrients intake such as vitamin C, D, E, and Calsium the patients with knee OA at the Medical Rehabilitation Clinic (MRC) at Fatmawati Hospital, Jakarta in 2021.Methods: This is a cross sectional quantitative research. The samples were 45 patients who have been diagnosed with knee osteoarthritis in outpatient medical rehabilitation clinic at Fatmawati General Hospital Jakarta who met the inclusion criteria.Results : the results of statistical tests showed that there was a significant difference in the average percentage of body fat with the gradation of OA patients, p value = 0.004. However, there was no significant difference between the average physical activity score, and intake of macronutrients (energy, protein, fat and carbohydrates), BCAAs (arginine and histidine), and intake of micronutrients (vitamin C, vitamin D, vitamin D, vitamin E and Calcium)Conclusion: Percent body fat is the variable with the highest correlation among other factors.

O5-2 Tele-rehabilitation program ‘Funktionstraining-online' in people with Multiple Sclerosis - preliminary results of a first online survey

BackgroundIn 2019, the German Multiple Sclerosis (MS) Society was certified as a provider for ?Funktionstraining? (FT). FT is an exercise training program developed for people with disabilities or people at risk of disability, takes place weekly and is led by a qualified FT-therapist. It is prescribed by a physician (between 12 and 24 months) and is part of outpatient medical rehabilitation. Due to the COVID-19 pandemic, the tele-rehabilitation concept ‘Funktionstraining-online’ (FT-online) was developed for pwMS. This study examines the FT-online from a participants' point of view within an online survey.MethodsWe developed an online questionnaire that included data of sample characteristics, participants' experiences with FT-online in terms of usability and training content. Further, the survey captured the quality of FT-online and the FT-therapist and compared carefully FT-online with face-to-face training. The standardised questionnaires Self-Efficacy Scale - Short Form (ASKU), the Multiple Sclerosis Questionnaire for Physiotherapists MSQPT and the Fatigue-Questionnaire (WeiMuS) were included. The 103 interviewed people with MS (pwMS) participated in FT-online at least for three months.ResultsData analyses are in process. The response rate was 75% (n = 78). The analysed sample is 53.4±8.1 years old with a disease duration of 18±8.7 years (male=7, female=71). Preliminary results in the ASKU certify a low self-efficacy in the sample (2.25 ±0.67). Qualitative results show the advantages for FT-online in the independence of mobility and infrastructure, flexibility, compatibility within job and family, group feeling in times of social distancing and an increase in quality of life. The disadvantages described by the sample are mainly technical problems and lack of socialising. 35% (n = 27) participants experienced both: FT-online and face-to-face. 44.4% (n = 12) of this sample prefer FT-online, 33.3% (n = 9) prefer the face-to-face training course and 22.2% (n = 6) rate both kinds of training equal.ConclusionsThe implementation of FT-online was an important step to ensure the exercise-related physical activity in pwMS during the COVID-19 pandemic. The descriptive analyses show high potential for FT-online training in pwMS. We are aware of the bias in current data, because of the pandemic situation both the free choice of FT-offers and the pandemic circumstances held influence in study outcomes. First results lead to the conclusion that FT-online may be beneficial for a broad range of persons with neurologic diseases, movement disorders and fatigue episodes and should be considered for future medical rehabilitation.

Medical rehabilitation in patients with anal incompetence after surgery for stage IV hemorrhoids

To evaluate the outcomes of comprehensive rehabilitation in patients with AI after hemorrhoidectomy to improve quality of life after surgery. A retrospective study was carried out on 46 patients (mean age 53.8±15.4 years) after hemorrhoidectomy with fecal incontinence, 13 (28.3%) males and 33 (71.7%) females. The main group included 25 patients who received comprehensive rehabilitation, including biofeedback training and tibial neuromodulation (TNM) for 15 days. The control group consisted of 21 patients who received TNM at home also for 15 days. The severity of fecal incontinence was determined using the Wexner score. The functional state of the sphincter before and after surgery was assessed using the anorectal manometry (sphincterometry) (WPM Solar, the Netherlands). Comprehensive rehabilitation resulted in a statistically significant clinical improvement: a decrease in the Wexner score in both males and females. No significant differences in manometry results were observed: the anal sphincter tone increased by 16.0% in females and 10.6% in males, and contractility increased by 17.7% and 15.1%, respectively. Monotherapy with TNM in control group patients improved tone indices by 8.7% in females and 6.8% in males, and contractility by 6.2 and 5.4%, respectively, which was lower than in the main group. Contraindications to physiotherapeutic procedures based on electrical stimulation, extracorporeal magnetic stimulation, and magnetic translumbosacral neuromodulation determine the only possible choice of medical rehabilitation, which is the combination of biofeedback training and TNM (as superior to TNM monotherapy). If out-patient medical rehabilitation is not feasible, patients are recommended to complement the home course with a specially designed set of exercises for anal incontinence treatment.

Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome

To develop a new medical technology for the 3rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort. There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2. The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01). The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

Caregiver Depression Among Home-Bound Stroke Patients in an Urban Community.

IntroductionThe sudden undertaking of being a caregiver for a spouse or family member afflicted with a stroke can cause adverse psychological consequences. In Malaysia, the majority of stroke patients return home to be cared for by family members and continue rehabilitation as outpatients. In most local urban communities, the practice of shared caregiving is observed among stroke caregivers either out of necessity or familism. Sole or primary caregivers who share their homes with stroke patients would be more challenged physically and psychologically compared to secondary or joint caregivers. Sharing the caregiving responsibilities is believed to lighten the burden on primary caregivers. This study aims to determine the proportion and associated factors of depression among urban-dwelling caregivers of home-bound stroke patients receiving long-term care from a university-based primary care clinic.MethodologyA cross-sectional study involving 123 primary and secondary caregivers of stroke patients was conducted at Klinik Primer PPUKM Cheras (KPPC) and the outpatient Medical Rehabilitation Services Department Hospital Canselor Tuanku Muhriz (HCTM), Cheras Kuala Lumpur. A self-administered questionnaire comprising of sociodemographic characteristics, the Beck Depression Inventory-II (BDI-II), and the Multidimensional Scale of Perceived Social Support questionnaire (MSPSS) was used. The functional status of the stroke patients was assessed using the Modified Rankin Score (MRS).ResultsThe proportion of respondents with depression was 20.3% (n=25). Depression was associated with caregivers’ age (CI=42.23-50.09, p=0.016), presence of illness (p=0.001), and being a sole caregiver (p=0.001). There is also an association found between caregiver depression with longer duration post-stroke (CI= 12.75-16.13, p<0.001), longer time spent for caregiving (CI= 117.73-135.87, p=0.004), and more functionally dependant patients (p=0.002).ConclusionDepression affects one in five caregivers of home-bound stroke patients residing in the urban community. The primary care provider should be more vigilant in screening for depression, especially among caregivers who are from older age groups, have ongoing health problems, and are sole caregivers to patients who are functionally dependant.

CO-FLOW: COvid-19 Follow-up care paths and Long-term Outcomes Within the Dutch health care system: study protocol of a multicenter prospective cohort study following patients 2\u2009years after hospital discharge

BackgroundFirst studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID-19) causes severe physical, cognitive, and psychological impairments, which may affect participation and health-related quality of life (HRQoL). After hospitalization for COVID-19, a number of patients are referred to medical rehabilitation centers or skilled nursing facilities for further treatment, while others go home with or without aftercare. The aftercare paths include 1] community-based rehabilitation; 2] in- and outpatient medical rehabilitation; 3] inpatient rehabilitation in skilled nursing facilities; and 4] sheltered care (inpatient). These aftercare paths and the trajectories of recovery after COVID-19 urgently need long-term in-depth evaluation to optimize and personalize treatment. CO-FLOW aims, by following the outcomes and aftercare paths of all COVID-19 patients after hospital discharge, to systematically study over a 2-year period: 1] trajectories of physical, cognitive, and psychological recovery; 2] patient flows, healthcare utilization, patient satisfaction with aftercare, and barriers/facilitators regarding aftercare as experienced by healthcare professionals; 3] effects of physical, cognitive, and psychological outcomes on participation and HRQoL; and 4] predictors for long-term recovery, health care utilization, and patient satisfaction with aftercare.MethodsCO-FLOW is a multicenter prospective cohort study in the mid-west of the Netherlands with a 2-year follow-up period. Measurements comprise non-invasive clinical tests and patient reported outcome measures from a combined rehabilitation, pulmonary, and intensive care perspective. Measurements are performed at 3, 6, 12, and 24 months after hospital discharge and, if applicable, at rehabilitation discharge. CO-FLOW aims to include at least 500 patients who survived hospitalization for COVID-19, aged ≥18 years.DiscussionCO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases.Trial registrationThe Netherlands Trial Register (NTR), https://www.trialregister.nl. Registered: 12-06-2020, CO-FLOW trialregister no. NL8710.

Correlation Between Joint Position Sense, Threshold To Detection of Passive Motion of The Knee Joint And Walking Speed of Post-Stroke Patient

Background: Sensori motor dysfunction such as muscle weakness, impaired sensation, changes in muscle tone, reduced movement control are common in stroke patients. Locomotion function requires continuous afferent sensory input. Impairment of sensory function can hinder the ability to recruit muscles during walking. Patients generally walk slowly, cadence, step and stride length are shorter and the double phase of support increases. Goal: Analyzing the correlation between the propioceptive function of the knee joint and walking speed in post-stroke patients, who are treated at the Outpatient Medical Rehabilitation Clinic of RSU Dr.Soetomo Surabaya. Methode: An observational analytic cross sectional study, nine subjects measured walking speed (10MWT), joint position sense (JPS) and threshold to detetction of passive motion (TTDPM) of the knee joint, in the period March - November 2020.. Results: There is a moderate correlation between 10MWT and JPS 150 on the non-paretic side (r 0.676; p=0.045) and JPS 300 on the paretic side (r 0.668; p=0.049). And there is a strong correlation between 10MWT and JPS 600 on the paretic side (r 0.824; p=0.006). However, there is no significant correlation between 10MWT and TTDPM. Conclusion: There is correlation between the propioceptive function of the knee joint and the walking speed of post-stroke patients. The smaller the percentage of joint position error, the stronger the correlation with walking speed.

Age-specific rates of population requirements in outpatient medical rehabilitation

Improving organizational approaches of medical rehabilitation is one of the important directions in Russian healthcare system.Aim. To determine the age-specific rates of adult population requirements in outpatient medical rehabilitation in Russia.Material and methods. The article provides data on the estimated age-specific rates of population requirements in outpatient medical rehabilitation, determined by expected attendance of a rehabilitation physician by classes of diseases and individual diseases according to the ICD-10 codes. For the study, the adult population was divided into 6 age groups (18-29, 30-39, 40-49, 50-59, 60-69 and 70 and older). Medical experts, taking into account the stage of the disease and the severity of the patient’s condition, have developed indications for outpatient medical rehabilitation immediately after the treatment of acute conditions, exacerbation of chronic diseases, the consequences of injuries and operations. And also the type of rehabilitation (inpatient or outpatient) was determined. Taking into account these indications, competent experts decided on the need and duration of further medical rehabilitation of patients after hospitalization.Results. The age-specific rates of population requirements in outpatient medical rehabilitation were determined and analyzed. The number of visits to a rehabilitation physician was calculated according to the main classes and some individual diseases. The largest number of persons in need of outpatient medical rehabilitation naturally falls on the older age groups 60-69 years (3917,5 visits per 1000 population) and 70 years and older (4716,9 visits per 1000 population), while the smallest — the patients 18-29 years old (832,2 visits per 1000 population). This is due to the fact that in older age groups the number of diseases requiring outpatient medical rehabilitation both in inpatient and outpatient settings is increasing. In other age groups, the need for medical rehabilitation per 1000 population was as follows: 985,6 visits per year in the 30-39 age group; 1672,0 — in the 40-49 age group; 2713,1 — in the 50-59 age group.Conclusion. Based on the data obtained, the healthcare executive authorities in the subjects of the Russian Federation can calculate the population requirements in outpatient medical rehabilitation in region, taking into account age composition and the estimated number of visits to a rehabilitation physician by the adult population.

СОВРЕМЕННЫЕ СТАНДАРТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ВЕНОЗНЫХ ТРОФИЧЕСКИХ ЯЗВ НИЖНИХ КОНЕЧНОСТЕЙ

Today, a wide spectrum of surgical techniques for the treatment of patients with refractory persistent venous trophic ulcers of the lower extremities based on the generally accepted standard sare proposed. The main aim of surgical therapy is the elimination of the lower extremity venous refluxso that the solution of this problem significantly reduces the incidencerate ofrecurrent ulceration in comparison with the conservative therapy alone. In addition to classical varicose vein surgery, the current options of the endovenous interventions are available: endovenous laser ablation (EVLA), radiofrequency ablation (RFA), mechanochemicalablation(MOCA), foam sclerotherapy or cyanoacrylate embolization. The most preferable method of a local surgical correction of the refractory venous trophic ulcers is layer-by-layer dermatolypectomy (shave therapy) in combination with simultaneous autodermoplastywith free split perforatedcutaneousflap. The remote results with a healing rate of over 80% cannot be achieved with any other method. Subfascial endoscopic perforator surgery(SEPS) in the presence of an epithelialized or open trophic ulcer is used for correction of pathological venous refluxin the case when endovasal and minimally invasive techniques of obliteration cannot be applied. The shin fasciotomy is used to relieve pressure in the diagnosed muscle compartment. Lower extremity fasciotomy for acute compartment syndrome is currently performed in case of special indications for the treatment of deep transfascial necrosis, recurrence of trophic ulcers after shave therapy, severe calcification of the shin tissues and correction of chronic venous compartment syndrome. Apart from the optimal choice of surgical treatment the remote healing rates of venous trophic ulcers depend on standardized in-patient treatment and care for wound in the postoperative period, followed by outpatient medical rehabilitation.

Информационный софт-патронаж пациента после операции эндопротезирования тазобедренного сустава (предварительное сообщение)

Introduction The article considers the situation with modern user’s applications for patients in the post-operative period after surgical interventions, including total hip replacement. The main reasons for the emergence of a multidisciplinary field of a science, in particular between the medical and IT industries, were formulated. The aim of the study was to develop a technology for preventive analysis, control and management of patient actions at the stage of outpatient medical rehabilitation by developing and implementing a universal software platform of an application and a chatbot on a mobile device and PC. Material and methods The study presents a universal software platform on a mobile device and a PC, in which the doctor introduces personalized indications based on existing clinical recommendations that permit to target the patient's behavior in an expert-based vector of preventive measures. The paper presents the database scheme, usage scenarios, interface, and an example of a recommendation for a random patronage day. Results The comparative results in the aspect of complications in the patients who used the software product after discharge from the hospital with those in the patients without software patronage were analysed. The overall percentage of complications and of each specific one among them was significantly more frequent in the comparison group than in the observation group with IT-based support (р &lt; 0.001). Patient satisfaction with the app was studied based on an anonymous survey, and a high satisfaction rate was revealed. Discussion The introduction of the software product into clinical work in comparison with existing analogues provided better patients’ compliance, especially in older persons with cognitive comorbidity, to targeted behavioral information, prevention of non-compliance with the medication dosage regimen and mobile activity, thus improving the long-term treatment results in patients at the stage of the rehabilitation. Conclusion It has been concluded that the results of the study indicate the feasibility and clinical validity of the development and implementation of the application developed and of similar software products.

The effectiveness of the narcological service in the Russian Federation in terms of target indicators

The analysis of the effectiveness of the narcological services based on the primary and general incidence rates, as well as target indicators considered in the Health Care Development program, is presented. A decrease in both the general and primary incidence of mental and behavioral disorders associated with the use of psychoactive substances in 2013-2018 was revealed. This decrease can be explained by the increasing role of primary prevention and regulation of the consumption of psychoactive substances at the state level, as well as a change in the order of dispensary monitoring of persons with mental disorders and (or) behavior disorders associated with the use of psychoactive substances. An analysis of the target indicators characterizing the activities of the drug treatment service showed that remission rates among patients with alcoholism and drug addiction increase and remain above target values. At the same time, the proportion of patients with alcoholism and drug addiction hospitalized repeatedly during the year exceeds the target values and amounts to 26,3 and 28,2%, respectively. This fact may be associated with insufficiently effective continuity in the work of the outpatient and inpatient stages of treatment of patients with drug addiction and alcoholism. The shares of people included in outpatient and inpatient medical rehabilitation programs also increased - the growth was 5 and 5,7%, respectively. The effective work of the service, in terms of rehabilitation, is also indicated by the fact that the proportion of patients who successfully completed medical rehabilitation programs both in outpatient and inpatient settings tend to increase. In general, the incidence of drug abuse disorders and indicators characterizing the work of the drug treatment service are determined by the strong negative impact of drug addiction and alcoholism on the demographic and economic situation in society.

On the state of child health in Ekaterinburg based on results of prophylactic medical examinations

Morbidity parameters in children aged 0–17 years have been analyzed based on results of prophylactic medical examinations conducted in Ekaterinburg between 2013 and 2019. The prophylactic medical examination coverage of pediatric population, distribution among the health status groups and frequency of regular medical check-ups have been studied. In 2019 versus 2013, children aged 0–17 years demonstrated a 1.6-fold increase in overall morbidity, and 2.3-fold increase in primary-care morbidity. In 2013–2017, a higher level of overall morbidity was found in children aged 15–17 years compared to children 0–4 years of age, owing to the emergence of newly diagnosed diseases. It was noted than the most frequently diagnosed diseases included diseases of the musculoskeletal system and connective tissue, diseases of the eye and eye appendages, diseases of nervous system, digestive system, endocrine system, nutritional disorders and metabolic disorders. Each year, based on results of prophylactic medical examinations, the proportion of children for whom the outpatient examination has been recommended amounts to 9.5%, outpatient treatment to 35.0%, and outpatient medical rehabilitation to 9.3%. The fraction of healthy children as of 2019 was 23.1% of all examined children. In 2019 the coverage for medical check-ups at the health facilities was 605.6 per 1000 children, that is 1.8 times higher than that in 2013 (334,0 per 1000 children).

On the state of child health in Ekaterinburg based on results of prophylactic medical examinations

Morbidity parameters in children aged 0–17 years have been analyzed based on results of prophylactic medical examinations conducted in Ekaterinburg between 2013 and 2019. The prophylactic medical examination coverage of pediatric population, distribution among the health status groups and frequency of regular medical check-ups have been studied. In 2019 versus 2013, children aged 0–17 years demonstrated a 1.6-fold increase in overall morbidity, and 2.3-fold increase in primary-care morbidity. In 2013–2017, a higher level of overall morbidity was found in children aged 15–17 years compared to children 0–4 years of age, owing to the emergence of newly diagnosed diseases. It was noted than the most frequently diagnosed diseases included diseases of the musculoskeletal system and connective tissue, diseases of the eye and eye appendages, diseases of nervous system, digestive system, endocrine system, nutritional disorders and metabolic disorders. Each year, based on results of prophylactic medical examinations, the proportion of children for whom the outpatient examination has been recommended amounts to 9.5%, outpatient treatment to 35.0%, and outpatient medical rehabilitation to 9.3%. The fraction of healthy children as of 2019 was 23.1% of all examined children. In 2019 the coverage for medical check-ups at the health facilities was 605.6 per 1000 children, that is 1.8 times higher than that in 2013 (334,0 per 1000 children).

On the state of child health in Ekaterinburg based on results of prophylactic medical examinations

Morbidity parameters in children aged 0–17 years have been analyzed based on results of prophylactic medical examinations conducted in Ekaterinburg between 2013 and 2019. The prophylactic medical examination coverage of pediatric population, distribution among the health status groups and frequency of regular medical check-ups have been studied. In 2019 versus 2013, children aged 0–17 years demonstrated a 1.6-fold increase in overall morbidity, and 2.3-fold increase in primary-care morbidity. In 2013–2017, a higher level of overall morbidity was found in children aged 15–17 years compared to children 0–4 years of age, owing to the emergence of newly diagnosed diseases. It was noted than the most frequently diagnosed diseases included diseases of the musculoskeletal system and connective tissue, diseases of the eye and eye appendages, diseases of nervous system, digestive system, endocrine system, nutritional disorders and metabolic disorders. Each year, based on results of prophylactic medical examinations, the proportion of children for whom the outpatient examination has been recommended amounts to 9.5%, outpatient treatment to 35.0%, and outpatient medical rehabilitation to 9.3%. The fraction of healthy children as of 2019 was 23.1% of all examined children. In 2019 the coverage for medical check-ups at the health facilities was 605.6 per 1000 children, that is 1.8 times higher than that in 2013 (334,0 per 1000 children).