Organizational aspects of neurorehabilitation at the outpatient stage

The study was aimed to evaluate the effectiveness of IRP implementation in patients of a specialized clinic providing long-term care to neurological and neurosurgical patients. Material and methods. The study was conducted in 2020-2021. on the basis of the MC "Expert Health" (Odessa, Ukraine). 83 patients undergoing neurorehabilitation program were examined. The correspondence of the fulfillment of key rehabilitation tasks in terms of time and quality was assessed. Additionally, the level of motivation and compliance of the patient was assessed using the MOT-Q questionnaires (for patients with previous TBI (n = 13), SRMS (for patients with stroke (n = 54) and with SRQ-E (for patients with other types of neurological pathology (n = 16). The overall level of compliance was assessed using the General Rehabilitation Adherence Scale (GRAS). The level of safety was assessed according to the following criteria: the presence of FAST certificates for personnel, a system for monitoring vital functions, equipment and consumables for the provision of emergency care. Statistical processing was carried out by methods of variance and correlation analysis, using the MedCalc 1.3 software. Results. There were not recorded any significant violations of safety principles in the provision of rehabilitation assistance in the certification of personnel according to FAST. The frequency of detecting cases of improper implementation of IRP did not exceed 6.0% (5 cases out of 83 analyzed). When assessing the relationship between the effectiveness of IRP and the level of compliance, a strong positive correlation was found - r = 0.78 Conclusion. 1. Provision of rehab services for neurological patients in the long term requires coordination of the actions of specialists at the intra-, inter-, and transdisciplinary levels. 2. A necessary condition for the functioning of a multidisciplinary team in the provision of rehabilitation care is certification of staff in the BLS systems - for allied health specialists and ACLS for physicians. 3. The effectiveness of IRP depends on the patient's compliance level (r = 0.78). 4. For the continuity of the rehabilitation process, it is necessary to involve relatives and facilitate their training in the basics of "home" rehabilitation

STRUCTURE OF ANXIETY DISORDERS IN PATIENTS WITH CHRONIC MIGRAINE AND ABDOMINAL OBESITY

Introduction. In Ukraine, on average, 30% of people are obese and 25% are overweight. In parallel with the increase in the number of overweight patients, the percentage of people with migraine is increasing. The prevalence of migraine is high, it affects 12-15% of the population. Both diseases negatively affect not only the function of internal organs, but also the nervous-psychological state of patients, leading to anxiety and depressive disorders. The aim of the study was to analyze the features of the structure of anxiety disorders in obese patients with chronic migraine. Materials and methods: 180 patients (90 women and 90 men) were examined and divided into two clinical groups: 1st group – 60 persons with chronic migraine with an average BMI=23.5.8±1.10 kg/m2; 2nd group – 60 obese patients with chronic migraine, BMI=34.6±1.42 kg/m2. The control group consisted of 60 patients without a headache and with averange BMI=19.5±0.7 kg/m2. The ICHD-3 criteria were used to diagnose migraine. The DSM-5 criteria were used to diagnose anxiety disorders. The patient's level of anxiety was measured using Taylor Manifest Anxiety Scale (TMAS). Statistical processing was performed using dispersion and correlation analysis. Results: Phobic anxiety disorders were in 1.5 times more common in 2nd group patients (c2=9.81, p<0.001) than in 1st group patients; panic disorder was in 1.8 times more frequent in 2nd group (c2= 11.99, p<0.001) than in the 1st group, generalized anxiety disorder was in 2 times (c2=13.08, p<0.0001) less common in patients with chronic migraine than in comorbid patients. The total number of patients with anxiety disorders in patients with chronic migraine on the background of abdominal obesity was twice folds higher (c2=20.93, p=0.00001) than in 1st group patients. Conclusions: the presence of concomitant abdominal obesity in patients with chronic migrane, not only increases the total number of anxiety disorders, but also affects their structure. Therefore, in addition to basic anti-migraine therapy, non-medicinal therapy in the form of a balanced diet, an individual exercise program and 10-12 sessions of cognitive-behavioral therapy (CBT) should be supplemented for the treatment of such patients

Identifying Ionic and Electronic Charge Transfer at Oxide Heterointerfaces

The ability to tailor oxide heterointerfaces has led to novel properties in low-dimensional oxide systems. A fundamental understanding of these properties is based on the concept of electronic charge transfer. However, the electronic properties of oxide heterointerfaces crucially depend on their ionic constitution and defect structure: ionic charges contribute to charge transfer and screening at oxide interfaces, triggering a thermodynamic balance of ionic and electronic structures. Quantitative understanding of the electronic and ionic roles regarding charge-transfer phenomena poses a central challenge. Here, the electronic and ionic structure is simultaneously investigated at the prototypical charge-transfer heterointerface, LaAlO3/SrTiO3. Applying in situ photoemission spectroscopy under oxygen ambient, ionic and electronic charge transfer is deconvoluted in response to the oxygen atmosphere at elevated temperatures. In this way, both the rich and variable chemistry of complex oxides and the associated electronic properties are equally embraced. The interfacial electron gas is depleted through an ionic rearrangement in the strontium cation sublattice when oxygen is applied, resulting in an inverse and reversible balance between cation vacancies and electrons, while the mobility of ionic species is found to be considerably enhanced as compared to the bulk. Triggered by these ionic phenomena, the electronic transport and magnetic signature of the heterointerface are significantly altered

Structural transformations and adsorption properties of PtNi nanoalloy thin film electrocatalysts prepared by magnetron co-sputtering

This is the final peer-reviewed manuscript accepted for publication in Electrochimica Acta Citation of the published version is: Electrochimica Acta 251, 427–441 (2017

States of Pt/CeO2 catalysts for CO oxidation below room temperature.

CO molecules can be efficiently oxidized over Pt/CeO2 catalysts, but the stability and reactivity of different states of Pt in the catalysts are still unclear. Here we combine experimental and computational methods to characterize Pt/CeO2 catalysts subjected to reductive and oxidative pre-treatments and exposed to CO oxidation reaction conditions. Particles of metallic Pt, known to be catalytically active at elevated temperature, are shown to be precursors for the formation, under operando conditions, of more stable PtOx particles that enable CO oxidation below room temperature. These PtOx particles are also similarly stable to - but more active than - atomically dispersed Pt2+ species. The results and approaches presented in this study illustrate the complex response of catalytic materials to reaction conditions and pave the way for future efforts to improve Pt/CeO2 and similar catalysts using dedicated pre-treatment strategies

Post-stroke depression: predictors and prophylaxis

The purpose of the study was to evaluate the effectiveness of prevention of post-stroke depression in patients with acute cerebrovascular accident It was shown that the incidence of PID in patients with ischemic stroke exceeds 30%. In assessing the role of various risk factors among the examined patients with PID, the prevalence of male patients (OR = 1.3 (1.1-1.5)), under the age of 55 (1.7 (1.3-1.9 )), with indications in the history of episodes of depression in the past (1.6 (1.4-1.8)), as well as alcohol abuse (1.2 (1.0-1.3)). In 31 (58.5%) there was a localization of focal ischemia in the frontal lobe of the dominant hemisphere. The use of both SIRS and an antidepressant with multimodal effect - vortioxetine was sufficiently effective in PID, but vortioxetin showing the best results - from 8,80,1 points to 6,20,1 points. The paper considers the expediency of the use of vorothoxetine in order to prevent PID in patients with ischemic stroke

Metal-support interaction and charge distribution in ceria-supported Au particles exposed to CO

Understanding how reaction conditions affect metal-support interactions in catalytic materials is one of the most challenging tasks in heterogeneous catalysis research. Metal nanoparticles and their supports often undergo changes in structure and oxidation state when exposed to reactants, hindering a straightforward understanding of the structure-activity relations using only ex situ or ultrahigh vacuum techniques. Overcoming these limitations, we explored the metal-support interaction between gold nanoparticles and ceria supports in ultrahigh vacuum and after exposure to CO. A combination of in situ methods (on powder and model Au/CeO2 samples) and theoretical calculations was applied to investigate the gold/ceria interface and its reactivity toward CO exposure. X-ray photoelectron spectroscopy measurements rationalized by first-principles calculations reveal a distinctly inhomogeneous charge distribution, with Au+ atoms in contact with the ceria substrate and neutral Au0 atoms at the surface of the Au nanoparticles. Exposure to CO partially reduces the ceria substrate, leading to electron transfer to the supported Au nanoparticles. Transferred electrons can delocalize among the neutral Au atoms of the particle or contribute to forming inert Auδ− atoms near oxygen vacancies at the ceria surface. This charge redistribution is consistent with the evolution of the vibrational frequencies of CO adsorbed on Au particles obtained using diffuse reflectance infrared Fourier transform spectroscopy

НАВЧАННЯ В ІНТЕРНАТУРІ ЗА ФАХОМ “НЕВРОЛОГІЯ”: СУЧАСНІ ТЕХНОЛОГІЇ ТА ПЕРСПЕКТИВИ ЇХ ЗАСТОСУВАННЯ

The aim of the work – to assess the prospects for the use of modern information technologies in internship in the field of Neurology. The main body. An analysis of the application of information technologies in the teaching of professional disciplines to interns, specializing in Neurology is conducted. The main forms are programmed control tools, electronic textbooks, teleconferencing, multimedia simulation technologies, electronic educational materials distribution, electronic medical records templates for patients’ management and the use of electronic repositories. BODY INTERACT ™ technology provides the opportunity to integrate into the process of learning the latest advances in medicine and information technology, developing learning concepts and sharing experiences through real clinical situations, creating a foundation for the culture of open communication and collaboration. Academic success of interns during the monitoring period on interim controls corresponded to the median 4 (3; 4), in the final – 4 (3; 5). The results of the survey showed an increase in the interest of interns in the use of information technology in the teaching of professional disciplines. At the Department of Neurology of the Odesa National Medical University, at all stages of the interns’ training, the means of programmed control are actively used. The expediency of regular review of educational programs for the training of interns in the specialty of Neurology is shown considering the possibilities of modern information technologies. Conclusion. Taking into account the priorities of interns training in the field of Neurology with the wide introduction of modern information technologies, it allows to improve theoretical knowledge and practical skills, to optimize the interaction in the format of multidisciplinary team with specialists of other specialties.Мета роботи – оцінка перспектив застосування сучасних інформаційних технологій при навчанні в інтернатурі за фахом “Неврологія”. Основна частина. Проведений аналіз застосування інформаційних технологій у викладанні фахових дисциплін лікарям-інтернам, що займаються за спеціальністю “Неврологія”. Основними формами є засоби програмованого контролю, електронні підручники, телеконференції, застосування мультимедійних симуляційних технологій, розсилки навчальних матеріалів в електронному вигляді, електронні шаблони медичної документації для курації пацієнтів та використання електронних репозиторіїв. Технологія BODY INTERACT ™ надає можливість інтеграції у процес вивчення новітніх досягнень медицини та інформаційних технологій, розробки навчальних концепцій та обміну досвідом через реальні клінічні ситуації, створюючу основу для культури відкритих комунікацій і співробітництва. Академічна успішність інтернів упродовж періоду спостереження на проміжних контролях відповідала медіані 4 (3;4), на кінцевих – 4 (3;5). Результати опитування показали зростання зацікавленості інтернів у застосуванні інформаційних технологій при викладанні фахових дисциплін. На кафедрі неврології Одеського національного медичного університету на всіх етапах підготовки інтернів активно застосовуються засоби програмованого контролю. Показана доцільність регулярного перегляду навчальних програм для навчання лікарів-інтернів з фаху “Неврологія” з урахуванням&nbsp; можливостей сучасних інформаційних технологій. Висновок. Врахування пріоритетів підготовки лікарів-інтернів за фахом “Неврологія” із широким впровадженням сучасних інформаційних технологій дозволяє вдосконалити теоретичні знання та практичні навички, оптимізувати взаємодію у форматі мультидисциплінарної команди з фахівцями інших спеціальностей

ДОГОСПІТАЛЬНА МЕДИЧНА ДОПОМОГА ПРИ ГОСТРИХ ПОРУШЕННЯХ МОЗКОВОГО КРОВООБІГУ. ПЕРШІ РЕЗУЛЬТАТИ РЕФОРМИ НА ПРИКЛАДІ ОДЕСЬКОЇ ОБЛАСТІ

Purpose: to evaluate the effectiveness of the provision of prehospital care for stroke in the context of reforming the national health system using the example of the Odesa region. Materials and Methods. A retrospective analysis of the activities of emergency medical care was carried out in 2016–2018 (before the implementation of the reform) and in 2018–2019. Results. The analysis showed that on average, (1160±29) patients were hospitalized in the region every year through the EMC system, which is 47.7 cases per 100.000 population. The mean age of patients hospitalized for EMC was (62.6±3.8)&nbsp;years, with a gender ratio of 1/1.2 with a slight male predominance. The largest number of stroke cases was recorded in summer (61.4 %). About 25–30 % of emergency medical care calls are not completed by the hospitalization of a stroke patient. The reasons for refusal are related to the wish of the patient or his relatives to be treated on an outpatient basis (13.5 %), the presence of physicians or medical professionals among the relatives (11.7 %), lack of funds (18.9&nbsp;%), family circumstances (6.3 %), the general serious condition of the patient (4.5 %). After the introduction of the new concept of emergency care, the number of hospital refusals in the presence of stroke decreased by 2.5 times, the number of patients admitted to the hospital within the therapeutic window increased by 36.3 %. The experience of creating regional clinical and transport protocols for maximum time reduction and optimal treatment at all stages of care is discussed. Сonclusion. The implementation of the reform improved the quality of pre-hospital care for stroke, the number of refusals from hospitalization in the presence of stroke decreased by 2.5 times, the number of patients admitted to the hospital within the therapeutic window increased by 36.3 %. The problem of unreasonable refusals of patients with stroke and their relatives from urgent hospitalization remains crucial. The introduction of standardized operating procedures for the provision of prehospital care aimed at reducing the time for patients transportation to the hospital is discussed.Мета: оцінити ефективність надання догоспітальної допомоги при інсульті в контексті реформування національної системи охорони здоров’я на прикладі Одеської області. Матеріали і методи. Здійснено ретроспективний аналіз діяльності екстреної медичної допомоги (ЕМД) у 2016–2018 рр. (до впровадження реформи) та в 2018–2019 рр. Результати. Проведений аналіз показав, що в середньому щороку в області через систему екстреної медичної допомоги госпіталізували з інсультом (1160±29) пацієнтів, що становить 47,7 випадку на 100 000 населення. Середній вік госпіталізованих пацієнтів становив (62,6±3,8) року, при гендерному співвідношенні 1/1,2 із незначним переважанням чоловіків. Найбільшу кількість випадків гострих порушень мозкового кровообігу (ГПМК) зафіксовано влітку (61,4 %). Близько 25–30 % викликів екстреної медичної допомоги не завершуються госпіталізацією хворого з інсультом. Причини відмови пов᾽язані з бажанням хворого або його родичів лікуватися амбулаторно (13,5 %), наявністю серед родичів лікарів або середніх медичних працівників (11,7 %), браком коштів (18,9 %), сімейними обставинами (6,3 %), загальним тяжким станом хворого (4,5 %). Після введення у дію нової концепції екстреної медичної допомоги кількість відмов від госпіталізації за наявності інсульту зменшилася у 2,5 раза, кількість пацієнтів, яких доставили до лікарні в рамках терапевтичного вікна, зросла на 36,3 %. Обговорюють досвід створення регіональних клінічних та транспортних протоколів для максимального скорочення часу і забезпечення оптимального лікування на всіх етапах медичної допомоги. Висновки. Впровадження реформи покращило якість догоспітальної допомоги при інсульті, так кількість відмов від госпіталізації за наявності інсульту зменшилася в 2,5 раза, кількість пацієнтів, яких доставили до лікарні в рамках терапевтичного вікна, зросла на 36,3 %. Залишається актуальною проблема необґрунтованих відмов пацієнтів із ГПМК та їхніх родичів від термінової госпіталізації. Обговорюють впровадження стандартизованих операційних процедур надання догоспітальної допомоги, спрямованих на зменшення часу транспортування пацієнтів до стаціонару

Позитивистская парадигма в эколого-гигиенических исследованиях

Проанализирована роль позитивистской парадигмы в эколого-гигиенических исследованиях. На примере исследований по изучению влияния условий проживания на репродуктивное здоровье населения показана приоритетность количественного подхода и необходимость учета вопросов интерпретации качественных данных на этапе сбора и формирования массива данных.There is analysed the role of positivistic paradigm in ecological and hygienic researches. As the template of the research on the impact of living conditions on the population reproductive health the priority of quantitative approach and the necessity of the regard for the issues of data interpreting on the stage of collecting and forming data bases in shown