Vol 1, No 4 (2019)

The article presents the results of the analysis of methods for assessing the effectiveness of project activities related to technical means of rehabilitation. Particular attention is paid to the competitive selection of projects, in the process of which the assessment methods used in specific organizations specializing in financing promising research and R&D projects, as well as their implementation in practice, are used. According to the results of the analysis, it was found that the key role, both in the course of competitive procedures and in assessing the interim and final results of project implementation, is assigned to a comprehensive expert method. The examination of projects is considered as the implementation of specialized assessment, analytical and / or research activities aimed at ensuring the development of recommendations regarding the feasibility of financing projects and their practical application, as well as forecasting effectiveness, taking into account the relevance in practice. The key subject of the assessment is the expert, to whom certain requirements are made, and a strictly formalized procedure for conducting examinations is established for him. Other individual methods were described (the procedure for selecting projects, the methodological substantiation of project examinations, the selection of experts, the organization and formation of the procedure for conducting examinations, the selection of criteria and indicators for evaluating a project, evaluating the effectiveness of a completed project), their strengths and weaknesses in the context were substantiated conclusions about the effectiveness of project activities in the field.

Purpose of the study. Based on the analysis of case histories to determine ways to improve the results of treatment of patients with hip fracture and reduce duration of rehabilitation period. Material and methods. From 2012 to 2018 in the emergency department of traumatology of the Sklifosovsky Clinical and Research Institute for Emergency Care were treated 865 patients with a hip fracture. For analysis of these patients they were divided into 2 groups. The control group consisted of patients who were treated from 2012 to 2016 - 569 patients. The main group - 296 patients treated from 2017 to 2018. Results. Preoperative hospital stay in the main group was reduced in the 2-fold. The number of non-operated patients was reduced by 2 times. It was increased in the number of hip arthroplasty from 46.3% to 53.0%. It reduces the average time of operation in bipolar arthroplasty from 65 to 48 minutes, in total arthroplasty - from 89 to 63 minutes. It reduces the average blood loss during arthroplasty from 626 ml to 277 ml. The preoperative thrombosis of the lower limbs was detected in 9% of primary and 15% of the control group. Number of bedsores decreased from 2.5% to 1.7% and reduced mortality from 3.3% to 1.3%. Conclusion. All patients with a suspected fracture of the proximal femur, regardless of age, should be admitted and examined. Indications for surgery are vital. The purposes of the examination of the patient are identifying ways to quickly patient's condition compensation. For the prevention of thromboembolic complications is necessary to perform venous ultrasound before and after the operation. Detection of floating thrombus in the veins of the lower extremities before surgery is an indication for surgical prophylaxis of thromboembolism. Diagnosing floating thrombus up to 5 cm in the postoperative period may be an indication for conservative treatment. Such measures as multimodal analgesia with combination of non-steroidal and opioid analgesics before and after operation, patient-controlled analgesia in the postoperative period, high volume surgical wound infiltration with a solution of local anesthetic during surgery allows to activate the operated patients for 1-2 days after hip replacement. Reducing the duration of the operation leads to reduction of blood loss during the arthroplasty by improving the surgical technique and intravenous tranexamic acid infusion.

Up to 1.5 million total hip arthroplasty is performed annually in the world. In Russia, at least 300 thousand patients a year need hip replacement surgery. High tissue invasiveness during surgical approaches presents special requirements for the rehabilitation process in the early postoperative period. Accelerating and making it more efficient is possible with the use of the least traumatic operating access. The purpose of the study is a comparative analysis of two models of the organization of rehabilitation in the postoperative period after hip arthroplasty: using standard Harding surgical access and the minimally invasive Rottinger access. Material of the study - patients operated on with standard Harding access (group I, n = 227) and front-external Rottinger access (group II, n = 266). Criteria for inclusion of patients in both groups are primary coxarthrosis without previous surgical interventions, exclusion criteria are connective tissue diseases, severe comorbidity. Group I patients underwent postoperative rehabilitation according to the standard protocol, group II - according to the rehabilitation concept "ERAS, fast-track". To assess the effectiveness of the rehabilitation at all stages in both groups, the rehabilitation potential was assessed on the rehabilitation routing scale (SRM), the dynamics of the pain syndrome on the visual analogue pain scale (VAS), the verticalization period was taken into account, the main assessment scales of the patient's motor functions and psychological status were used in hip arthroplasty: Harris scale, quality of life questionnaire (EQ - 5D), modified Rankin scale. Results and discussion. The proportion of hip arthroplasty using MIS access in the total number of operations increased from 0.7% in 2015 to 10.1% in 2018. The studied groups are comparable in terms of the ratio of men and women, average age, number of observations, BMI and the volume of blood loss. The surgeon duration and the duration of the stationary phase in group I exceeded the similar parameters of the II group. The modified Rankin scale at admission and discharge in all patients showed moderate disability, starting indicators and results after 3 months were more prosperous in group II. Both groups had an equivalent score on the Harris scale before surgery and after 3 months after it, more pronounced positive dynamics of the quality of life on the EQ-5D scale ("thermometer") was noted in group II. A decrease in pain after surgery compared with baseline, with regression to 0.8-1.0 points by 3 months after surgery, was noted in all patients. The assessment on the rehabilitation routing scale did not differ in both groups. At the stationary stage, group I patients walked with additional support on crutches (100%), group II - on a cane (92.5%). On long days 4-6, 82.8% of patients of group I and 91.7% of patients of group II passed long distances. At the end of stage I rehabilitation, 83.7% of group I patients and 92.5% of group II were sent to the outpatient rehabilitation stage, the rest were transferred to stage II of rehabilitation in a 24 - hour hospital. The third stage of rehabilitation, all patients went on an outpatient basis at the place of residence. At the follow-up stage, the data of a telephone survey of group II were analyzed (n = 68, 25.6% of the respondents). By 3 months, the Harris score exceeds 90 points, satisfaction with the operation is 97%. As a result of the use of surgical MIS access for hip arthroplasty, all patients had good rehabilitation indicators. Conclusions. The general approach to managing patients after hip arthroplasty is similar for all types of surgical access, however, MIS-access creates the most favorable conditions for the rehabilitation of patients in the early postoperative period: a positive attitude of the patient, reduced blood loss, reduced surgical incision, the possibility of early activation and transition to the general regime for 6-7 days. The results of the study showed the advantages of a model for the organization of rehabilitation in the postoperative period after hip arthroplasty using mini-invasive access over standard surgical access. Group II patients (MIS access) had a higher level of physical activity and a low level of pain in the early postoperative period.

The article analyzes the needs of the elderly and senile in medical and social assistance and rehabilitation. Some problems in solving medical and social problems of the studied category of persons are reflected. Measures are proposed to eliminate the causes that reduce the quality of life of the studied contingent. Attention is drawn to the need to simplify the examination procedure at the ITU bureau for elderly and senile people, both with a view to establishing a disability group, and for compiling an IPRA, including providing disabled people with technical rehabilitation equipment.

Temperature monitoring of the brain using radiothermometric technology allows you to assess the imbalance of the thermal balance of the brain, and the technique has shown the possibility and information content of its use in the diagnosis of cerebral lesions. In healthy individuals, at rest, the average temperature of the left (36.74 ± 0.37 ° C) and the right hemisphere (36.64 ± 0.32 ° C). In boxing athletes who received "planned" minor traumatic brain injuries after training sparring, the average temperature of the left (38.4 ± 0.28 ° C) and right temperature (38.2 ± 0.45 ° C), which is significantly elevated. Patients in chronic critical conditions showed a monotonous temperature distribution in the left (36.98 ± 0.18 ° C) and right hemispheres (36.88 ± 0.21 ° C). The temperature heterogeneity of the brain in this category of patients was less pronounced compared with healthy individuals, athletes after sports head injury.

Disorders of urination of an obstructive and irritative nature are found in almost all major diseases of the nervous system and their symptoms are largely reminiscent of dysuric disorders in the local pathology of the urethra and bladder. Proper diagnosis and timely treatment determine not only the quality of life, but sometimes the very life of patients. Only the combined efforts of neurologists and urologists in the framework of the clinical direction "Neurouroscience" allows us to timely diagnose the cause of urination disorders and carry out the necessary treatment and rehabilitation measures.

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