Vol 15, No 4 (2016)

Goal: The pilot project to organize or conduct performance improvement of existing structural units in specific hospitals Russia to provide rehabilitative care for patients with cardiovascular disease (CVD) in three stages under the current "Procedure for the provision of medical care for patients in medical rehabilitation", to introduce in practice these units proven science-based approaches, forms and methods of cardio-rehabilitation, and try to create some patients routing algorithm. Material and methods: The pilot project includes 17 hospitals out of 13 subjects of the Russian Federation. To analyze the effectiveness of organizational models cardiorehabilitation in hospitals have been developed unified special cards that allow to evaluate the appropriate order on the medical rehabilitation provided rehabilitation assistance to cardiac patients, a multidisciplinary team involved in the provision of rehabilitation assistance, staffing, and equipping the facility. Special cards consisted of three sections, each of which allows you to evaluate the effectiveness of each of the three stages cardiorehabilitation: I stage - the unit intensive care unit (BRIT), and a specialized cardiology department, II of phase -stationary kardioreabilitatsionnoe department, III stage - patient department karidioreabilitatsii. The article presents the results of three years of analysis January 2013 through December 2015.. Results: The pilot project was organized kardioreabilitatsionnaya help stage I in 10 hospitals, II stage - in 10 hospitals and III stage 7 hospitals. By 2015, virtually all hospitals to provide assistance kardioreabilitatsionnoy were formed multidisciplinary team consisting of a cardiologist, cardiologist, rehabilitator, doctor medical physical culture (physical therapy), physical therapy instructor-methodologist, psychotherapist, clinical psychologist, physiotherapist. They were provided and equipped with facilities to practice physical therapy, room for educational schools. Home rehabilitation process BRIT has reduced the patient’s stay in the bed of 0.7 days (2013 to 2015), and for one day in the cardiology department. On average, 67% of AMI patients were translated into Phase II cardiorehabilitation in which they have become increasingly involved in physical rehabilitation program, which is based on a classic exercise therapy, dosage walking in the room, physical training (PT) on simulators. All hospitals were organized educational school for patients actively pursued discussions with the relatives. Special complexity of the project has caused the organization phase III cardiorehabilitation. The project is currently ongoing. Conclusion: The analysis of three years of organizing the three-step system kardioreabilitatsionnoy help AMI patients considering the use of staffing, equipment and methods according to the current regulatory legislation has shown a significant increase in recreational activities created by multidisciplinary teams in all three stages of cardio-rehabilitation, increasing the number of used rehabilitation methods and improve the quality of their performance, as well as He demonstrated the safety of the proposed principles of physical rehabilitation according to Russian clinical guidelines "AMI with ST-segment elevation ECG: rehabilitation and secondary prevention" in the proposed organizational models cardiorehabilitation.

The purpose of this article is to discuss issues related to the physical rehabilitation of patients with paroxysmal atrial fibrillation (AF) on the example of the case. The article examines a patient with paroxysmal AF after radiofrequency ablation of pulmonary veins (RFA), the last physical rehabilitation program, an evaluation of its impact on the course of the phase transition, physical performance (FRS), motor activity (DA) and blood biochemical parameters, such as the lipid profile blood markers of inflammation and fibrosis.

In patients with consequences of ischemic (30 pers., 34-71 years) and post-traumatic stroke (10 people, 16-55 years), were examined at different times after disease and after surgery on the bones of the cranial vault, the dynamics of blood flow velocity at middle cerebral arteries (MCA). The flow velocity in the MCA of the affected side during the first months after a stroke, patients of both groups were reduced. By the end of the year rate in both groups approached the level of conventional norms, and then began the "negative phase" (NP) of blood flow velocity, from which patients with consequences of ischemic stroke during the subsequent 4 years were observed output, and in patients with consequences of traumatic brain injury, there was a restoration of the level indicator. After surgery on the bones of the skull, patients of both groups noted the repetition ratio of the flow velocity. The yield of NF was observed only in the group of patients with consequences of traumatic brain injury.

The analysis of a possibility of various methods of diagnosis of an essential hypertension at the pilots undergoing medical examination in the conditions of a hospital is presented in article, actions for early diagnostics, prophylaxis of progressing of an essential hypertension and medical rehabilitation of pilots with the revealed disease are offered. A research objective was studying of opportunities of the modern methods of diagnosis of a hypertension at pilots and development of the system of their medical rehabilitation. 109 pilots with the diagnosis an essential hypertension aged from 25 up to 57 years shared in a research, the control group was made by 35 patients aged from 36 up to 57 years having a hypertension which activity is not bound to flight work. It is established that among pilots the diagnosis the idiopathic hypertensia for the first time is established in 15,3±7,7 years after the beginning of flight work while in control group in 23,5±5,6 years that is a consequence of influence of adverse factors of professional flight activity, infectious, toxic, metabolic, a stress - induced vegetative dysfunctions. Disease duration at the pilots recognized waste to flight work made 5,56±1,75 years, at middle age at the time of write-off from flight work -39,7 years. Selection of risk groups on an idiopathic hypertensia among aircrew with the functional disorders from cardiovascular system, and also application of methods of early diagnosis of a hypertension, including in an army link, with the subsequent verification of the diagnosis at a stationary stage to or during the stationary medical and flight examination allows to reveal a disease on an incipient state, and also will provide well-timed holding medical and rehabilitation actions for aircrew for the purpose of preservation of their professional longevity.

The article is devoted to the justification of the need for inclusion in the tactics of examination and treatment of patients with MVP psychodiagnostics and psychological counseling, and in case of detection of risk factors for worsening clinical manifestations PMK - psychotherapy, aimed at helping patients in understanding the psychological mechanisms of the clinical picture of the disease; recognition training ability, differentiation and emotion understanding and accompanying cognitive processes; development of the capacity for reflection, as well as expansion of the range in use emotion regulation strategies. The problem of regulation of the contribution to the pathogenesis of emotional disorders clinical PMK. Details discussed various strategies of emotion regulation, analyzed their usability patients with MVP. The data of the experiment on simulation of emotional stress, which revealed that the "stressful" situations, patients with MVP both psychological and physiological characteristics different from those of healthy individuals. It has been shown that individuals with MVP, while in principle available to them structurally complex and effective strategies for regulating emotions, significantly more often than healthy study participants resorted to repression of emotion, and that they choose emotion regulation strategies as a whole, they are ineffective in overcoming the emotional tension.

Early postoperative rehabilitation of patients with cholelithiasis is directed on the prevention of progressing of a disease and decrease in risk of development the postcholecystectomy violations. Use in complex rehabilitation of mineral waters, magnetolaser and EHF-therapy allows to receive positive dynamics in the form of considerable improvement and normalization of kliniko-laboratory indicators, increase of adaptation possibilities and normalization of the psycho-vegetative status of an organism. It provides high therapeutic effect (94,7%) which is interfaced to features of the carried-out rehabilitation that bases necessity introduction of the developed technology in practice of recovery treatment of patients with cholelithiasis at an early postoperative stage.

The article is devoted to explaining the need for the development and implementation of complex rehabilitation programs for families bringing up children with burn injuries. Such programs should include psychological support not only for the child but also for his family. Based upon the experience of foreign research and theoretical concepts of Russian psychology (Vygotsky - Luria - Zeigarnik school), article show the feasibility of participation of parents and other members of the family of a sick child in rehabilitation programs. This participation is important both for their own psychological well-being, and for the effective treatment and recovery of the child. In addition to general ideas about the psychological rehabilitation from medical point of view, we describe the theoretical foundations that exist in Russian psychology, which can and should be used to develop such integrated programs. The features of the social situation of development and their role in the formation of adequate ideas about the disease in children and their parents are described. The relationship between these concepts and the degree of adherence and successful socialization of the child is shown. We analyzed the model of pediatric medical traumatic stress that is used for building a complex family rehabilitation programs abroad, and discussed the possibility of introducing similar model in Russia. The article highlights the main objectives and directions of the psychological work in the department of burn injury and proved theoretical and practical importance of these tasks.