Photo: Press service of the National Center for Medical Research LRC
As doctors around the world have pointed out, in recent years rehabilitation has become an important part of maintaining people’s health. And not only after obvious injuries or strokes, but also due to the consequences of the covid pandemic.
In our country there are many state multidisciplinary centers where, if necessary, all Russians with a compulsory health insurance policy have access to free comprehensive care, from surgery to rehabilitation. One of these institutions is the “Treatment and Rehabilitation Center” under the Ministry of Health of Russia. Its director, Doctor of Medical Sciences, Honored Doctor of Russia, Professor Sergei Tsarenko, explained which areas of rehabilitation are in greatest demand.
IMPORTANT ADDRESSES
– What areas of rehabilitation can you, director of the LRC Sergei Tsarenko, consider the most in demand?
– The greatest need in society is neurorehabilitation. Both after a stroke and after injuries: craniocerebral, spinal. This is in demand both in peacetime and now. Rehabilitation of injuries and operations of the musculoskeletal system and transplantation of artificial joints are in great demand. There are many of them: 4-5 thousand joint replacement surgeries are performed per year in our hospital alone. We keep the 20 percent of the most difficult cases and rehabilitate them at the expense of compulsory health insurance.
A current topic is the rehabilitation of oncology and cardiac patients. Rehabilitation of cardiovascular diseases, for example after the installation of stents, after severe myocardial infarctions accompanied by stents, is very important and we actively participate in this.
Rehabilitation after a mastectomy is also important. It is nothing new that women usually have big problems after removal of the mammary glands: lymphostasis, etc. To solve these problems there are techniques that we are already implementing. This is very relevant and we have good multilevel oncology care. Unfortunately, we cannot afford a massive influx of cancer patients: we have only 450 beds in the hospital, but as a methodological institution we are developing such rehabilitation.
Well, one cannot fail to mention the medical examination and rehabilitation of people who have recovered from Covid. The consequences here are very different: autoimmune processes, cardiovascular diseases, diabetes, kidney diseases. Any of the newly started diseases is a reason to evaluate the patient’s condition: what he is suffering from and what problems he potentially has.
I believe that rehabilitation should be integrated into the entire treatment process, starting during resuscitation and not ending after hospital discharge. This is patient activation, a well-known topic of the fast track, that is, the fast track. 10-15 years ago, post-surgical patients would lie down and be afraid to move because of the pain, but now there is a rule: in the hospital, in the first hours after a transplanted joint, they are lifted out of bed so that they adapt faster . . This applies to surgical and oncological operations, this applies to any postoperative period. And in our LRC early rehabilitation is very actively used. Early rehabilitation is especially important for those suffering from traumatic brain injuries or strokes – time is running out. And if the brain does not participate in external activity, then, like any unused organ, it recovers worse.
But rehabilitation is a cross-cutting story: it doesn’t end when a person enters the ward, and it shouldn’t end when they leave the medical center. Someone has to keep an eye on it, but in the regions there is a serious staffing problem when it comes to the rehabilitation components. Now we have a very interesting idea: a remote option to train said personnel. That is, we will prepare video materials, distribute them to the regions, and our consultants will train regional instructors.
Photo: Press service of the National Center for Medical Research LRC
– What rehabilitation methodologies will be adopted in the regions?
– It is not news to anyone that a state telemedicine system has already been established in the country, and we help in the most complex rehabilitation cases, provide consultations, etc. In addition, within the framework of our Petrovsky Locomotive project we plan to train not only anesthesiologists and resuscitators, but also rehabilitation specialists. Bring them to Moscow and train them, show them how and what is done. The time has passed when you wrote a manual, sent it out and everyone did it, it doesn’t work anymore. You have to bring the person closer to the patient, you have to show them everything, you have to captivate them. Then he will understand everything and do it. I see development in this direction.
WHAT IS THE MEANING OF MULTI-SPECIFICATION?
– I know that you have implemented a full course of oncological treatment. What does it mean?
– For any healthcare organization there is an obvious rule: in one place it is necessary to bring together the three components of oncological treatment: surgery, chemotherapy and radiological exposure. This approach is also determined by the procedure for providing medical care in case of cancer diagnosis, approved by the Ministry of Health. Obviously, in some situations, the main surgeon acts first, performs surgical manipulations, and then the tumor remnants are irradiated or treated with chemotherapy. In other situations, the opposite occurs: first it is irradiated, the tumor shrinks, becomes more sensitive to chemotherapy drugs, the patient is treated with chemotherapy and then the surgeon arrives. This is a mosaic, and all specialists are equal participants in the oncology consultation located in one location. The option of subcontracting one of them is not appropriate, nor is the option of excessive activity of the surgeon or chemotherapist. We need balance. And when everything is carried out in one institution, under the strict control of the oncology board and maintaining a balance between mutual interests and the interests of the cancer patient, success can be counted on. It is available at any decent cancer institution, including the LRC.
In general, I would like to note that versatility is an advantage of any institution, including our LRC. The presence of concomitant chronic diseases not related to the main diagnosis is not a problem for us, but a task. For example, when they come to us for cancer treatment and they need to place a stent in the heart so that the person can have surgery, this stent is placed. And then they will perform a planned surgical operation. And this story is not only therapeutic, but also rehabilitative.
Of course, you must understand that although we are a multidisciplinary institution, we cannot cover all topics. We do not have some therapeutic profiles, we are mainly a surgical clinic. We do not have people with kidney diseases, we do not treat hematological patients, post-burn patients. The main areas are surgery, oncology, rehabilitation, neurology.
LEARN ABOUT THE GENOME AND SUPPORT ATHLETES
First of all, the activities of any multidisciplinary medical institution are issues of providing medical care and rehabilitation. But scientific research is also carried out at the LRC, although there are no laboratories with white mice there. This is what Sergei Vasilievich Tsarenko says about these studies:
– One of the interesting topics that we are currently developing together with the Genetic Research Center of the Rosneft company is the Russian human genome. We are trying to study the genotype of people to obtain information about which of them has a certain predisposition to this or that type of disease treatment, that is, which patient will recover and for which there is a possibility that he will die for a long time and with difficulty. . Of course, we will not work alone, but with other hospitals, hospitals and institutions, so that there is greater coverage.
There is another important question: we have a large flow of people with joint replacement and we want to know which of them will visit us again in 3-5 years, when the parallel joint is symmetrically damaged. The information is important to plan our actions and plan federal health care resources. But I wouldn’t call it science, although it is a very important piece of research.
In addition, on the instructions of the Minister of Health of Russia Mikhail Albertovich Murashko, we are trying to collect information about Russian developers of various types of devices: implantable, rehabilitation, etc. We want to methodologically evaluate how useful this is, how close it is to real clinical practice, accumulate this information and transfer it to the government level, so that the emphasis is directed specifically at Russian developers.
And an equally important area in our activities – the training of sports instructors together with the Moscow Sports University. This is an important component because there are not enough instructors, although the importance of rehabilitation activities has increased, and this is a highly in-demand specialty. Athletes are people at risk, they are extremely burdensome and the examinations performed on them are usually formal. And there is information that this is also the cause of sudden deaths.
Photo: Press service of the National Center for Medical Research LRC
WILL THERE BE ANOTHER WAVE OF COVID?
– Finally, I can’t help but touch on the topic of COVID 19. Do you think another big wave is real or not?
– I can only assume what my friends, epidemiologists and virologists, believe: the probability of this happening is low due to the fact that the immune layer that we have been talking about for many years has been formed: someone has been sick, someone has vaccinated status. Now Covid has reached a point where weakened people become ill, as has always happened with viral infections. Very old, very young, with severe chronic hematological disease. They are very seriously ill and receive special care.
At the same time, we must be prepared for new respiratory pandemics. Sooner or later a situation like Covid is likely to occur. I don’t know if it will happen in 3 years, 5 or 10, but it can happen. Therefore, we must learn lessons from the past pandemic. The first lesson is that we will help on the basis of ordinary, not closed, hospitals, and it is necessary to create a clear system of hospitals at different levels. The second question: it must be understood that there will not be enough respiratory equipment, so a certain supply is needed, which is used sporadically: these are mechanical ventilation, means of high-flow oxygen supply, means of airway sanitization , evaluation of the patient’s condition and, of course, personal protective equipment. We need clear training of resuscitation personnel and staff pulmonologists who have experience in assessing the status of the lungs. A network of CT centers should be created, because computed tomography is the leading method for assessing not only the patient’s condition, but also classifying it according to the severity of the condition, according to the primary emergency of care, etc. Another problem is resistance to antibiotics. The mindset of outpatient physicians needs to be changed so that they do not prescribe antibiotics just in case. They quickly forgot about this, even though it was mentioned several times during Covid.
Many of these tasks have already been well developed by the Ministry of Health and the regions: infrastructure has been created, the necessary equipment has been installed, and organizational approaches have been introduced into the work of hospitals and specialists. The health system is now much better prepared for any infectious threat than before the pandemic.
THE NAIS IS OFFICIAL EDITOR ON NAIS NEWS