Purpose. To determine the dynamics of cardiovascular system function in individuals with acute calculous cholecystitis (ACC) after laparoscopic cholecystectomy (LCE) under the influence of physical therapy and occupational therapy at the acute, post-acute, and long-term stages of rehabilitation. Materials & Methods. The study involved 120 individuals aged 18-74 years with ACC after LCE. Participants were assigned to control and main groups by simple randomization using a lottery method according to age categories: 18-44 years (A1, A2), 45-59 years (B1, B2), and 60-74 years (C1, C2). Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), the six-minute walk test distance, and Borg scale scores were assessed. The rehabilitation program lasted 12 months and included aerobic and strength exercises, as well as health management. Statistical analysis was performed using IBM SPSS Statistics 23 with the Shapiro-Wilk W-test and Student’s t-test; differences were considered statistically significant at p<0.05. Results. Twelve months after LCE, statistically significant (p<0.05) decreases in SBP, HR, and Borg scale scores were found in the main groups (A2, B2, C2) compared with the previous examination and control groups. The six-minute walk test distance increased statistically significantly (p<0.05) in groups A2 and B2, indicating improved exercise tolerance. Conclusions. The combined use of physical therapy and occupational therapy after LCE has a positive effect on the functional status of the cardiovascular system, improves physical performance, and may contribute to reducing the risk of cardiovascular complications.

Purpose. To determine the dynamics of carbohydrate metabolism in individuals with acute calculous cholecystitis after laparoscopic cholecystectomy under the influence of physical therapy and occupational therapy. To perform a comparative analysis of the dynamics of insulin resistance at the acute, post-acute and long-term stages of rehabilitation. Material & Methods. The study included 120 people with acute calculous cholecystitis aged 18 to 74 years who underwent LHC. People received rehabilitation interventions for 12 months. The main strategies of physical rehabilitation for normalization of carbohydrate metabolism of people after LHC were: support (consultation), reduced energy consumption, healthy eating habits, regular physical activity (strength and aerobic exercise), sleep management, reduction of anxiety and depression. Statistical analysis. The obtained results were processed by mathematical statistics methods using the IBM SPSS Statistics 23 program. The input data were checked for normality of their distribution. For this, the Shapiro-Wilco W-criterion was used. For the indicators that corresponded to the normal distribution, the average (x̅), standard deviation (S) and standard error of the mean (m) was calculated. To assess the significance of the difference, in the presence of a normal distribution of research results, Student's t-test was used for dependent and independent samples; the difference was considered statistically significant at p<0,05. Results. The initial assessment of carbohydrate metabolism in individuals with acute calculous cholecystitis (ACC) demonstrated glucose levels within the normal range, but an increased HOMA-IR index. When assessing the dynamics of carbohydrate metabolism in individuals with ACC 1 month after LHC, no statistically significant (p>0.05) changes were found in the indices either in the control groups or in the main groups. One year after LHC, when assessing the dynamics of carbohydrate metabolism in the control groups according to ACC, no statistically significant (p>0,05) changes were found in any of the control groups. The HOMA-IR index in representatives of the control groups remained above the norm for a year. When assessing the dynamics of carbohydrate metabolism indices one year after LHC in representatives of the main groups with ACC, a statistically significant decrease (p<0.05) in fasting blood insulin and the HOMA-IR index was found in representatives of all main groups relative to the preliminary examination index and compared with the indices of the control groups. Conclusions. Such positive changes in the insulin resistance function one year after cholecystectomy in individuals who received rehabilitation interventions using our technology indicate that the system of exercises using strength exercises and cyclic aerobic exercises and lifestyle modification can influence carbohydrate metabolism even with unfavorable rehabilitation prognosis in individuals with signs of metabolic dysfunction after cholecystectomy. For a significant impact on carbohydrate metabolism in individuals after LHC, a one-month rehabilitation intervention is not enough; statistically significant dynamics in these functions were observed after 12 months of rehabilitation interventions.

Objectives. This study aimed to scientifically substantiate, develop and evaluate the effectiveness of including the BodyArt fitness method in the rehabilitation plan of female patients with cervicothoracic osteochondrosis in the phase of periodic maintenance rehabilitation. Material and Methods. The study involved 57 women who were randomly divided into a control group (CG, n = 27, age 49.3 ± 1.5 years) and a main group (MG, n = 30, age 50.1 ± 1.2 years) using the sealed envelope method. Inclusion criteria comprised females aged 40 to 60 years with a diagnosis of osteochondrosis of the cervicothoracic region (OCT), confirmed by instrumental methods (X-ray, CT or MRI), established at least one year before the onset of the study. Exclusion criteria were: acute pain, severe somatic pathology, fractures or tumors of the vertebrae. All participants provided written informed consent to be involved in the study. The CG underwent standard rehabilitation according to the hospital protocol (training — 30 min, 4-6 sessions; therapeutic gymnastics — 3 times a week for 1 hour; manual therapy — 6-8 sessions). The MG program included the BodyArt fitness method instead of standard exercises. The study spanned two rehabilitation cycles (28 days). To assess the effectiveness of the intervention, clinical and instrumental methods and scales were used (McGill Pain Questionnaire, MMT of the back and shoulder girdle muscles, cervical and thoracic spine mobility, Index of disability due to neck pain (Neck Disability Index, NDI)), as well as statistical methods. Results. In patients of the main group, after using BodyArt fitness, there was a significant decrease in pain intensity according to the results of the McGill Pain Questionnaire (MPQ) (p<0.01), an improvement in muscle strength (p<0.05),and an increase in the range of motion in the cervical and thoracic spine (p5). In particular, the NDI disability index decreased by 34.7% (p < 0.01). Conclusions. The findings revealed that incorporating BodyArt fitness into the physical therapy program is an effective means of rehabilitation for patients with cervicothoracic osteochondrosis, helping to reduce pain, improve spinal mobility and restore functional activity.

OBJECTIVE:Aim: To determine the dynamics of renewal of the function of external respiration in patients after laparoscopic cholecystectomy at the acute stage of rehabilitation under the influence of a rehabilitation program.PATIENTS AND METHODS:Materials and Methods: The study is randomized, simple with blinded assessors. The forced vital capacity (FVC, l), forced expiratory volume in the first second (FEV1, l) and peak expiratory flow rate (PEFR, l/s) were assessed. Spirometry was performed 120 patients on the first day of admission of patients to the surgical department for surgical intervention, on the second day and on the day of discharge. Methods of mathematical statistics: arithmetic mean (M) and standard error of the mean (}m), Student's t-test were calculated, differences at p<0,05 were considered statistically significant.RESULTS:Results: It has been established that laparoscopic cholecystectomy leads to a statistically significant decrease in the parameters of respiratory function in all age categories. More pronounced positive dynamics of respiratory function in the group of respiratory therapy. It was established that without respiratory therapy on the day of discharge there was no restoration (р<0.05) in groups of elderly patients of group of FVC l, FEV1 l, PEFR l/s; in middle-aged patients did no restoration FEV1, l, PEFR, l/s; in younger patients there was no recovery of FEV1, l.CONCLUSION:Conclusions: The results of the study indicate the effectiveness of the introduction of diaphragmatic breathing exercises in combination with early mobilization at the acute and subacute stages of rehabilitation in patients after laparoscopic cholecystectomy in order to restore the function of the respiratory system.

In the context of solving the tasks of inclusive education, the competencies of physical therapists and occupational therapists, defined by the Standard of Higher Education of the second (master's) level of higher education in the field of knowledge 22 Health care, specialty 227 Physical therapy, occupational therapy, in particular effective cooperation with all members of the multidisciplinary rehabilitation team and other health, education and social policy professionals involved in providing services to patients/clients. The purpose of the research is to reveal the content and tasks of physical therapy, occupational therapy in an inclusive educational space. In order to achieve the set goal, the following research tasks must be solved: to reveal the state of scientific study of the problem of using methods of physical therapy, occupational therapy in inclusive education; to analyze the task of the team of psychological and pedagogical support of a child with special educational needs; determine the types of health-preserving technologies in educational institutions with an inclusive form of education; to analyze the content, forms and methods of adaptive physical education in an inclusive educational space. Conclusions: The introduction of an inclusive form of education in Ukraine significantly actualized the need for the use of occupational therapy and physical therapy in corrective and developmental assistance for children with disabilities of different age and nosological groups. At the same time, the support of children with special educational needs in the implementation of the tasks of the individual development program by a multidisciplinary team of specialists in an inclusive educational space has become an important direction of ensuring their special educational needs. The use of various types of health-preserving technologies is an important condition for the effective functioning of inclusive education. In order to preserve, strengthen and increase the physical, mental and social health of pupils of inclusive groups of special education, such main groups of health-preserving technologies are used as: organizational-pedagogical, psychological-pedagogical and educational-educational. Organizational and pedagogical ones are used to determine the structure of the educational process, which is able to prevent overwork, hypodynamia, etc. Among the types of health-preserving technologies that are used in the inclusive educational space of primary schools, it is appropriate to single out: physical culture and health, medical and preventive technologies, and technologies for ensuring optimal mental and social health of preschoolers. The effectiveness of the introduction of AFV in the work with pupils of special educational institutions who have normative development and their peers with special needs of different nosological groups depends on ensuring an optimally favorable, barrier-free educational environment in special educational institutions. The results of AFV directly depend on taking into account and realizing the potential opportunities and needs of each child, individual characteristics, preservation and strengthening of his health. At the same time, it is necessary to take into account that regardless of the psychophysical development of preschoolers and their state of health, each of them has resource opportunities, the use of which can positively affect the quality of life.

Aim: To determine the effectiveness of the influence of the use of mineral medicinal water on the functional state of the liver of patients after laparoscopic cholecystectomy in a long period of rehabilitation in the conditions of the Morshynkurort health resort complex. Materials and Methods: An analysis of 100 medical records of patients after laparoscopic cholecystectomy who were undergoing rehabilitation at the Morshynkurort health resort complex in 2017 and 2018 was carried out. Medical records were selected by a randomized method using the Random Allocation Rule program. Blinded evaluators while processing medical records. The method of comparison of indicators of the functional state of the liver of patients before the beginning of rehabilitation and after its completion was carried out by the method of mathematical statistics – Student’s t-test. The studied parameters: total protein (g/l), thymol test (unit), total bilirubin (mkmol/l), activity of alanine transpeptidase (ALT, (units/hour • l)), aspartate transaminase (AST, (units/hour • l)), total cholesterol (mmol/l), triglycerides (mmol/l), blood glucose (mmol/l). All patients were examined before and after treatment. There was no dropout from the study among the surveyed. Results: Mathematical statistics revealed a significant (p <0,05) improvement in such indicators as: thymol test, alanine transpeptidase activity, total cholesterol. Conclusions: Hydrotherapy for 14 days MPO well No. 3-k and groundwater source No. 4 in Morshyn diluted to mineralization 3,0-3,4 g/dm³ at a long stage of rehabilitation leads to an improvement in liver function in patients after laparoscopic cholecystectomy.

Aim: Conduct an examination of patients after laparoscopic cholecystectomy (LCC) in the acute period of rehabilitation using the international classification of functioning (ICF). To analyze the functionality, activity, environmental factors in patients of this nosology, depending on age. Materials and Methods: The study included 382 patients with chronic calculous cholecystitis (CCC), who were in the surgical department. The assessors and patients were double-blinded during the interview, examination, and processing of the collected data. Performing the initial examination of patients, we used the ICF, formed a “Patient’s Functional Profile” map, in which the existing disorders in the functions of the body, body structures, activity and participation, environmental factors at the time of the initial survey, examination of the patient, as a rule, are available in patients after LCC on acute stage of rehabilitation. Results: It was found that in all groups there are dysfunctions, activities and participation of patients, the degree of impairment of which increases with age. The greatest degree of impairment was observed in elderly patients in the functions of muscle endurance, exercise tolerance and defecation functions. The environment of the clinic is positive for the stay after LCC of patients. A negative assessment of financial assets was in patients of retirement age. Conclusion: The use of a functional profile map of a patient after LCC with ICF with a scoring criterion makes it possible to establish the level of impairment of functioning, activity, participation, environmental factors and plan a rehabilitation program.

The article talks about the state of health of girls who receive higher education and engage in physical education in special medical groups according to medical instructions. The authors prove that the health of young people is an urgent problem and a subject of primary importance because it determines the future of the country, the gene pool of the nation, the scientific and economic potential of society. The article has a theoretical character, but for factual confirmation of its relevance in the Ukrainian region, we assessed the physical health of female students on the main indicators of the circulatory system, respiration and functional ability of the autonomic nervous system by conventional methods. The article makes general suggestions for preserving and strengthening the students' health, forming the value of health by reforming or choosing the educational technologies, which are adequate to the modern challenges of society and the needs of the students. The novelty and international significance of the article lies in the fact that for the first time such multifaceted factors of living health have been analyzed. It will contribute to a broader understanding of female students' physical health and issues, from demotivation and gender stereotypes, to the prospects of being healthy through physical education influences.

Aim: to determine the dynamics of the level of functioning of patients after laparoscopic cholecystectomy in the long-term rehabilitation period. Materials and Methods: 79 patients after laparoscopic cholecystectomy were included, double-blind survey on the presence of impairments in functioning, activity and participation using the ICF. Statistical methods: measurement of the median value (Me), upper and lower quartiles (25%; 75%). The Mann-Whitney U-test was used to compare independent samples; the Wilcoxon T-test was used for dependent samples. Results: under the influence of rehabilitation, positive dynamics in the state of the gastrointestinal tract and the gait activity of patients of group A were revealed after the implementation using a biomedical approach. The rehabilitation method of group B was based on the assessment of the patient’s functioning using the ICF and the organization of problem-oriented and aimed at achieving long- and short-term tasks with a patient-centered approach. to achieve improved functioning of gastrointestinal functions, general endurance, aerobic capacity, muscle strength and improved activities. Conclusions: the dynamics of the level of functioning and activity of patients after laparoscopic cholecystectomy in the long-term rehabilitation period was better in the group that used a biopsychosocial approach with the use of ICF.

The Aim is to determine the level of functional ability of abdominal muscles in patients of different ages after LCH in the long-term rehabilitation period. Materials and methods. Lovett's manual muscle testing (MMT) was performed on 113 patients after laparoscopic cholecystectomy (LCH), who were undergoing rehabilitation at the Morshyn kurort resort complex in 2020 and 2021. The average age of patients was 52,96±0,62 years. Patients were divided into 3 groups according to three age categories: group A - women aged 18 to 44 years (n = 14); group B - aged 45 to 59 years (n = 79); group C aged from 60 to 74 years (n = 20). Inclusion criteria: patients after LCH from 1 month to 1 year after surgery. Exclusion criteria: patients who have contraindications to testing: early postoperative period; pregnancy; severe circulatory failure, the presence of patients with neuropsychiatric pathology; peptic ulcer of the stomach and, or duodenum with bleeding, patients' refusal to participate in the study. Methods. Evaluators were blinded during testing. Methods of synthesis, analysis and mathematical statistics. Indicators under study: functional ability of torso flexion and rotation muscles. In order to assess the effect of LCH on the functional ability of the abdominal muscles, MMT was performed according to the Lovett method. The results of the study. The results of the assessment of the functional ability of the abdominal muscles of patients after LCH in the long term indicate a decrease in the strength of the abdominal muscles in patients of three groups. Analyzing the results, it was found that the functional ability to bend the torso was the best in the youngest group A 2.86 ± 0.20 points. Slightly lower level of torso flexion was in group B 2.44 ± 0.07 points and the worst in the oldest group C - 2.20 ± 0.11 points. A statistically significant difference was found between the three groups in this indicator. In all three groups, the level of functional flexion of the abdominal muscles of patients after LCH was low. However, it was found that in three age groups there is an asymmetry in the level of muscle strength - in all patients the muscles that perform the function of torso rotation on the right are weaker than the muscles on the left side. In all three groups, there was a greater statistically significant difference between the strength of the functional ability of the abdominal muscles to rotate on the left than on the right. This result indicates that even minor surgery with minor damage to muscle fibers and fascia reduces the functional capacity of the abdominal muscles. LCH leads to an asymmetry in the strength of the external and internal oblique muscles of the abdominal press - a statistically significant decrease in the functional state of these muscles on the right compared with the strength of the muscles on the left in all age groups. Conclusions. The low level of functional ability of the abdominal muscles of patients after LCH in the long term requires the inclusion in the protocols of rehabilitation physical therapy and occupational therapy. Accordingly, physical therapy and occupational therapy programs at this stage should include techniques to increase the strength of the abdominal muscles, due to the postponed surgery, recovery and improvement of motor capacity.

Most of the current programs of physical rehabilitation of students of a special medical group (hereinafter - SMG) are aimed only at a separate contingent depending on the type of nosology, which complicates the work of the teacher and reduces the effectiveness of classes for other students. In fact, no physical rehabilitation programs have been developed for female students who have the highest reproductive potential. Therefore, the creation of a rehabilitation program that will not only be able to cover students with various diseases, but will also be useful for the prevention of risk factors for chronic noncommunicable diseases (CHD) as the most acute demographic problem is relevant. The purpose of the study is to develop, scientifically substantiate and test the program of physical rehabilitation of students of a special medical group, taking into account motor disorders. The developed program of physical rehabilitation of SMG students taking into account motor impairments had a complex character and included the following elements: lifestyle modification, kinesitherapy (with stoppage of fitness yoga, functional training, aerobic training) (swimming, fitness, jogging, health) self-massage with the Lyapko applicator. The control group included 24 individuals, the experimental group consisted of two groups of 24 individuals. The following methods were used to solve the research tasks: analysis of scientific and special literature, surveys and questionnaires, pedagogical testing, methods of determining indicators of physical development, physical fitness and functional state of the organism, methods of mathematical statistics. After the implementation of the developed program of physical rehabilitation for female students, a decrease in the number and intensity of modified risk factors for CHD due to increased physical activity, reduction of bad habits was determined; reducing the number of complaints. Studies on the effectiveness of the program of physical rehabilitation of female students, taking into account motor impairments, tested on a sufficient number of female students of the special medical group, have confirmed data and can serve as a basis for practical implementation of this program.

The adolescents aged between 15 and 17 with postural disorders in the sagittal plane, who live in mountainous regions in the Carpathians, achieve less than their peers with similar postural disorders, who live in plain regions. The research aims to develop the comprehensive programme for correcting postural disorders in the sagittal plane among pupils, who live in mountainous regions in the Carpathians, using physical rehabilitation, and establish the links between empirical data of the experiment and neurosciences to develop methods of complex psychophysical and neurophysiological diagnostic and rehabilitation of adolescents with such disorders in further research. The research is based on a detailed observation of 319 adolescents aged between 15 and 17 from mountainous regions of the Ukrainian Carpathians and 94 pupils from plain regions with postural disorders in the sagittal plane. The research methods are the following: an analysis of the scientific and specialized literature; surveys and questionnaires; pedagogical tests; methods for determining the indicators of physical development, functional readiness and functions of the spine; methods of mathematical statistics, namely, the Ruffier-Dickson test, Otto test, Schober test, Thomayer test, Fleischmann test, Sedin test and spinal index, inclinometer measurements. The pupils who suffer from the stoop and round spine have shown a decrease in average values in the angles of lordosis and kyphosis curves; pupils who suffer from flat back – an increase in the angles of the sacral bone, lordosis and kyphosis curves; pupils who suffer from the round and concave back – a decrease in the angles of the sacral bone, lordosis and kyphosis curves. The implementation of the author’s programme for physical rehabilitation has made it possible to achieve a statistically significant improvement in most of the analyzed indicators. Finally, the article extrapolates the results of the experiment to their neurophysiological and neuromedical application in terms of enhancing anamnesis and taking into account post-correction data in subsequent medical treatment.

The article considers research methods and features of the functional state of the vestibular apparatus and vestibular disorders in children with sensorineural hearing loss. We used the methods of analysis, generalization and systematization of data from domestic and foreign literature sources on methods of studying the vestibular apparatus in children with sensorineural hearing loss. It was determined that the function of balance and coordination of movements is one of the most complex, and consists of several analyzers - visual, vestibular, proprioceptive and tactile. When studying the physical development of children with this pathology, attention is paid to the formation of the main static-dynamic and coordination capabilities according to the age of the child. In children with congenital sensorineural deafness, and especially double deafness, there are signs of vestibular insufficiency and impaired translational control, movement and gait. This affects the development of gross motor functions, such as sitting and walking, to a lesser extent affects fine motor skills, if there are no layers of other pathologies of the central nervous system. The pathological process in the auditory analyzer changes the function of the vestibular apparatus, due to their close location in the labyrinth and innervation by one cranial nerve, and in turn changes in the vestibular apparatus contribute to the formation of motor disorders. Therefore, we can observe a certain general principle of operation of the auditory and vestibular systems. At children who have low vestibular stability any turns, inclinations, sharp change of a direction of movement causes imbalance of coordination and balance of movements. All these delays in physical development, according to many authors, are cumulative in character and are caused by the hearing defect itself, insufficient information from the environment, difficulty expressing thoughts and desires verbally, as well as the state of the motor analyzer and vestibular activity. Children with hearing impairment have an insufficient level of coordination development, physical development, static and dynamic balance, spatial orientation. Researches of the vestibular apparatus, namely the functions of coordination and balance are carried out in several categories: the research of tonic vestibular reactions, coordination of movements and static and dynamic balance. Researches of tonic vestibular reactions are performed on the following tests: the test with outstretched arms, Vodak-Fisher test, pointing test Barani, finger-nose test, Holmagi test. Researches of static and dynamic equilibrium are carried out on the samples of Romberg, Grahe, Oppenheim, walking in a straight line. When analyzing these samples, we can talk about the degree of violation of coordination and stato-dynamic balance. As a result of vestibular compensation, children with sensorineural deafness can catch up with their peers with normal hearing with the help of visual and somato-sensory systems, pyramidal and extra-pyramidal systems.

The article substantiates the nature of conflict in educational institutions through the contradictions arising from differences in attitudes, interests, and aspirations and are perceived and evaluated by participants as incompatible with their own. According to the authors, this is mostly accompanied by attempts to force their own position and leads to psychological tension and confrontation. The types of pedagogical conflicts and the teacher’s role in conflict management in the educational institution arerevealed. The results of theoretical and empirical research of the strategy of student behavior in conflict situations are presented: competition, cooperation, compromise, avoidance, adaptation. 304 students from Ukrainian universities (control group –CG) and 297 persons (experimental group –EG) were involved in the experiment. It was researched that in conflict situations a third of students is inclined to cooperate (28.4% of CG students and 31.1% of EG), and almost as many (29.4% of CG respondents and 26.4% of EG) –to compromise. Thus, there is a group of educational process participants prone to avoidance or adaptation tactics, as well as the ability to compete and confront in a conflict situation. Emphasis is placed on the need to develop future skills to achieve mutual understandinginconflicts,totransfer the conflict from emotional to intellectual level, as well as the transformation of motives of confrontationinto motives for finding understanding to regulate relationships with others in various spheres of life.

In recent decades, scientists have been attracted by the idea of developing methods for targeted transport of drugs and diagnostic drugs directly into the area of inflammation. Experimental and single clinical studies have revealed high efficiency and prospects for targeted delivery of various drugs. Most known carriers have a number of disadvantages, both in the range and amount of drugs they can bind, and in their ability to prevent contact of transport drugs with healthy tissues. In addition, there are difficulties associated with the toxicity and immunogenicity of carriers, their availability, cost, complexity of preparation. Transport systems that use the body's own cells are the most advantageous in terms of biocompatibility. Among them, erythrocytes, platelets and leukocytes are used as vehicles. Currently, the most promising in terms of drug transport is the use of erythrocyte containers. Pharmacokinetic studies have shown that with this route of administration, the concentration of antibiotic in the bile in patients with inflammatory diseases of the biliary tract, 4.7 times higher than with other routes of administration, and their therapeutic activity is maintained for a much longer time. When the erythrocyte containers were applied topically, the antibiotic concentration in the wound and surrounding tissue was 10 times higher than that achieved by traditional soft tissue puncture. In order to prove the ability of erythrocyte containers to capture drugs and concentrate in the inflammatory focus in 10 patients with this pathology at the beginning of treatment was injected into the femoral artery 1% - 1 ml of nicotinic acid in 0.9% - 2 ml of saline, and the following day the same patient in the same dose it was administered in erythrocyte containers. The time of onset of the reaction and the duration of the drug were determined, taking into account subjective and objective data. The ability of erythrocyte containers to seize drugs is evidenced by the results obtained by us: with the introduction of nicotinic acid in its pure form, the reaction occurred after 115411 ± 0,0411and lasted 715211 ± 0,0311. Objectively, there was a gradual reddening of the face and mild hyperemia. With the introduction of erythrocyte containers with nicotinic acid, the reaction occurred through 214311 ± 0,0311 and lasted 1112411 ± 0,0211. Subjectively, patients were characterized by a milder course of the reaction. The development of granulation tissue in the wound with the introduction of erythrocyte containers with antibiotics began on day 8-9, and the marginal epithelialization - on day 10-12. In the control group, the appearance of granulation tissue and epithelialization in the wound were on 12-13 and 14-15 days, respectively.

The article deals with a very important issue of integrating online learning in higher education process. Due to the development of a pandemic to ensure a quarantine regime, all educational institutions were switched to online learning, using online platforms such as ZOOM, Microsoft TEAMS, Google Classroom, and others. After analyzing the world experience of studying at various universities, including medical ones, we noticed that in Europe, our fellow teachers have practised a mixed type of education for a long time. The student receives parts of lectures and seminars, all homework, atlases, books, videos and video lectures in his/her personal office or classroom (which is located on the servers of the university). Teachers have access to these personal offices, and can track students' progress, namely, the amount of material processed, whether videos have been viewed in full, whether homework has been passed, or tests have been solved. There is also a direct connection between the student and the teacher through this office. The practical part, namely the development of certain skills that are necessary for every medical student in their future medical practice, takes place in a cycle in different departments and hospitals. This scheme of blended learning allows the student to study theoretical material at a time convenient for him. At the same time, his practical skills are also practiced and the student receives quality education. Also, this method reduces the risk that the student will use someone else's homework, pretending to be his own. It is worth noting that the current generation, or children «Z», as they are called, have a well-developed «clip» thinking. This is a type of thinking that is adapted to excessive flow in the period of scientific and technological progress. This generation absorbs most of the information through photos and videos. After all, physiologically it is much easier for them. They learn new programs faster, adapt better to the flow of information, focusing on really important things. Therefore, for them, distance learning is more effective and more digitalized. It will also be reasonable to use as an alternative computer programs that visualize a particular type of disease and simulate a virtual patient. Such programs do not replace live communication and direct practice of a medical student; however, they promote the development of clinical thinking, better topic mastering and are a good alternative in a pandemic. Practical skills can be shown to students in the form of videos with the methodology of a particular skill. To practice it, the student can use relatives or, for example, roommates. Teaching the first-year or third-year courses, which master the basics of medical sciences, can also be made productive and informative. In addition to lecture materials and theoretical textbooks, 3D atlases of anatomy are also worth using in online teaching. Conclusions: After analyzing the data, we did not find obvious reasons that would prevent the full establishment of the distance learning process and provide comfort to teachers and students. Distance learning as a form of learning could be in the process of mastering the future profession. It is necessary to change the approach to the organization of distance learning and develop adaptive flexibility.

Резюме. В роботі проведено аналіз лікування ретроспективної групи пацієнтів з хронічним калькульозним холециститом в ранньому післяопераційному періоді. Щорічне зростання даної патології, яке в Україні складає 10 % від населення, змушує шукати нові підходи до лікування. Дослідження проводилося у рамках наукової роботи «Теоретико-методичні основи фізичної терапії хворих після лапароскопічної холецистектомії». Методи дослідження: Проведено ретроспективний аналіз 50 медичних карт пацієнтів із ХКХ, які знаходилися на стаціонарному лікуванні у хірургічному відділенні Івано-Франківської центральної міської клінічної лікарні протягом 2018 року. Метою дослідження є характеристика пацієнтів з хронічним калькульозним холециститом на стаціонарному етапі реабілітації з метою пошуку покращення та удосконалення засобів відновлення функцій організму на різних етапах післяопераційного періоду у хворих на ЖКХ після лапароскопічної холецистектомі. Всім хворим була проведена лапароскопічна холецистектомія. 1. Ретроспективний аналіз результатів хірургічного лікування хворих на хронічний калькульозний холецистит засвідчив, що при відсутності комплексу реабілітації, який не включений в протоколи, кількість ускладнень склала 34 %, а тривалість госпіталізації 3,76±0,28 дні. Незадовільні наслідки в ранньому післяопераційному періоді обумовлені відсутністю лікаря фізичної реабілітаційної медицини в лікувальному закладі, комплексу реабілітаційних заходів в протоколах, негативним впливом супутньої патології. Розробка, впровадження та чітке дотримання комплексу реабілітаційних заходів в подальшому сприятимуть скорішому відновленню пацієнта, зменшенню кількості ускладнень та скороченню терміну перебування у стаціонарі.

Резюме. Згідно з рекомендаціями ВООЗ сучасне реабілітаційне втручання повинне мати міждисциплінарний підхід. Останній підхід у реабілітації поступово впроваджується в систему охорони здоров`я введенням таких посад як лікар фізичної реабілітаційної медицини, фізичний терапевт, ерготерапевт, а із впровадженням у практику проблемно-орієнтованого підходу поки що складніше. Зустрічаються проблеми міждисциплінарної взаємодії спеціалістів. Відсутній пацієнтоцентричний, індивідуальний підхід у реабілітації. Не враховуються всі контекстуальні чинники пацієнта для встановлення цілей реабілітаційного втручання. Відсутня об’єктивна оцінка ефективності проведеного реабілітаційного втручання. Така ситуація не може сприяти покращенню реабілітаційної допомоги, у тому числі після лапароскопічної холецистектомії. У жодній стаціонарній карті немає шифр МКФ. Мета дослідження. Розглянути МКФ як інструмент формування цілей фізичної терапії хворих після лапароскопічної холецистектомії на різних етапах реабілітації та впровадження їх у хірургічну практику. Висновки: Проаналізовано чинну практику організації реабілітаційної допомоги на різних етапах (гострому, підгострому та довготривалому). У хворих після лапароскопічної холецистектомії виявлено повну відсутність використання класифікації МКФ. Спільне використання МКХ-10 та МКФ у хірургічній практиці дозволить доповнити одна одну, що підвищить якість надання послуг у галузі охорони здоров’я. Впровадження схем кодування полегшить роботу мультидисциплінарних команд, які займаються реабілітацією хірургічних пацієнтів. Починати потрібно із забезпечення інформаційними системами в охороні здоров'я з автоматизованими схемами кодування (для зменшення навантаження на медичний персонал та полегшення ведення медичної документації), оскільки практично таке кодування займає багато часу та потребує спеціальної підготовки медичного персоналу.

Резюме. Мета дослідження: провести аналіз методики реабілітації пацієнтів після холецистектомії на віддаленому етапі реабілітації у Відділенні «Санаторій «Лаванда»» санаторно-курортного комплексу «Моршинкурорт». Методи дослідження: аналіз методів реабілітації пацієнтів у Відділенні «Санаторій «Лаванда»» санаторно-курортного комплексу «Моршинкурорт» за 2017 та 2018 роки, синтезу та аналізу. У Відділенні «Санаторій «Лаванда»» проходять реабілітацію пацієнти у підгострому періоді після оперативних втручань на органах травлення (відділення на 60 ліжок). У 2018 році виписано 359 реабілітаційних хворих. Ваннами охоплено 331 хворого, тобто 92,7 %, по 8,6 процедур на хворого. Відпущено 2833 ванни. Лікувальні душі приймало 179 осіб, проведено 1510 процедур, по 8,4 процедур на хворого, охоплено 50,1 % хворих. 3,6 % хворих приймало місцевий висхідний душ та 5,6 % приймали душ Шарко, 97 % охоплено фізіотерапією. Найчастіше призначалась фітотерапія (47 %), магнітотерапія (59,9 %), лазеротерапія (10,6 %), СКТ (44,5 %), інгаляція (15,1 %), світлолікування (9,5 %), ультразвукова терапія (19,9 %), озекерітолікування (24,6 %), мікроклізми (67,5 %), кишкові зрошення (8,4 %), оксигенотерапія (25,5 %). Висновки. Кадрові, природні, матеріальні ресурси та лікувальна діяльність відділення свідчать про великий реабілітаційний потенціал даного закладу при різних соматичних захворюваннях. Проте у світлі реформ та нововведень, можливо, доцільно залучати у мультипрофесійну команду, яка здійснює реабілітаційний процес, також лікарів фізичної реабілітаційної медицини, а замість інструктора ЛФК ввести посаду фізичного терапевта, для застосування більш нових методів фізичної терапії з точки зору доказової медицини.