KIEV LEFT BANK NEUROCENTRE WITH MEDICAL REHABILITATION
HISTORY OF NEUROLOGICAL AND NEUROSURGICAL SERVICE DEVELOPMENT
The neurological department of the Kyiv City Clinical Hospital No. 1 for 30 beds was opened in 1958 during the management of the hospital of the Honored Doctor of Ukraine VF Onischenko. The first head of the department was the candidate of medical sciences L.K. Firsunin. Among patients, 90% were patients with pathology of the peripheral nervous system, 8% - patients with damaged vessels of the brain and spinal cord, while the rest 2% referred to the patients with other diseases of the nervous system.
In 1978 the office expanded to 60 beds. There were 3 doctors of the neurologist working in the department. The office was located in a 9-storey building, where there was no cargo lift and patients had to be carroed with hands. The patients with severe disorders were in the intensive care department where equipment was very primitive - an oxygen pillow, a device for artificial ventilation of lungs and an electrocardiogram.
The department carries out planned treatment of patients, provided urgent assistance to residents of Darnytsky and Kharkiv districts, as well as residents of the city. Since 1989 -1990, it has been an increase in the number of patients with vascular pathology of the nervous system up to 50% of the total number of patients. At that time, the hospital had few auxiliary methods of examination and had to use the services of the City Diagnostic Center.
Since 1986, the department was headed by a highly qualified neuropathologist, a doctor of the highest category - N.V. Kucherenko. Due to its organizational skills and professionalism, the office becomes one of the best in the city.
Since 1987, the hospital was headed by a deputy of the Kyiv City Council, the Honored Doctor of Ukraine, the candidate of medical sciences Salut M. Yu. Due to his efforts the construction of a 9-story chamber building started.
In connection with the constant and significant increase in the number of patients with vascular pathology of the brain and spinal cord, in 1994, they opened the second neurological department for 60 beds. The total number of neurological beds in the hospital increases to 130.
Due to the introduction in 1995 of the diagnostic center with the most modern methods of research (magnetic resonance and computed tomography, doppler of the head vessels and neck of the dysplasia, reoencephalography, electroencephalography, echoencephalography, rheovasography), it is possible to use the most advanced research methods from neuropathologists and neurosurgeons and more purposefully to treat.
For further improvement and efficiency of the organization of medical care and rehabilitation for patients with cerebrovascular disorder, reduction of disability and mortality rates, as well as in accordance with the order of the Ministry of Health of Kyiv No. 584 of December 27, 2002, the Kyiv Left Bank Neuro Center for medical rehabilitation under the Kyiv City Clinical Hospital # 1. The head of the neurocenter was the candidate of medical sciences, a neurosurgeon doctor O. Goncharuk. Today, the Kyiv Left Bank Neurological Center for Medical Rehabilitation is a medical and preventive, scientific and organizational-methodical center that provides highly qualified specialized medical care to patients with diseases of the nervous system.
The Kyiv Left Bank Neurocentre with medical rehabilitation is today a medical and preventive, scientific and organizational-methodical center that provides organization of providing highly qualified specialized medical care to patients with diseases of the nervous system of Darnytsky, Dniprovsky and Desnianskyi districts.
The main tasks of the Neuro Center are:
• provision of urgent and planned highly skilled, specialized medical and preventive, diagnostic and consultative assistance to patients with systemic and organ function disorders as a result of acute cerebrovascular disease and other pathology of the nervous system;
• implementation of advisory and organizational-methodical assistance at the level of modern methods of diagnosis and treatment of nervous system disorders;
• provision of sequential stage treatment of neurological and neurosurgical patients, both at the Neurocenter level and interaction between different medical institutions;
• timely hospitalization and in-patient treatment for neurological patients;
• introduction of new methods of diagnostics, treatment and rehabilitation of patients;
• studying and generalizing the achievements of world science, developing forecasts of the health of the population on cerebrovascular pathology and its complications;
• conducting scientific research in the field of neurology;
• complete or partial recovery of the patient's health;
• implementation of measures for the improvement of professional qualifications of doctors and medical staff in accordance with the established procedure;
• participation in organization and carrying out of sanitary-educational work on prevention and control of vascular diseases of the nervous system and their complications;
• introduction of new methods for the rehabilitation of patients;
• use of standards of diagnostic and treatment process in rehabilitation care for patients;
• development of technology for the rehabilitation process;
• cooperation with the City Neurological Center, the City Center for Neuro-Rehabilitation and the "October" sanatorium.
Hospitalization in the neurocenter is conducted on the following indicators:
In the ward of intensive care subject:
1.1. Patients who entered the hospital in the first 6 hours after the development of acute cerebrovascular accident, regardless of severity, nature and localization. If necessary, urgent neurosurgical help patients are transferred to the neurosurgical department.
1.2. Patients with acute cerebrovascular accident who have been admitted to hospital for more than 6 hours from the time of stroke, if:
- violations of consciousness to coma level;
- concomitant acute cardial pathology (myocardial infarction, acute subendocardial ischemia, acute cardiac arrhythmias or intracardiac conduction, heart failure);
- epileptic seizures;
- violation of swallowing;
- Decompensation of diabetes mellitus;
- acute occlusion hydrocephalus, regardless of the level of consciousness disturbance (prior to consultation of the neurosurgeon).
1.3. Patients with secondary deterioration of the condition or development of complications during the acute period of stroke (up to 21 days) in the absence of coma;
1.4. Patients with other urgent neurological conditions:
- acute neuroinfections (not belonging to the group of contagious and especially dangerous);
- epileptic status or epileptic attacks often repeated (serial);
- with acute inflammatory demyelinating polyneuropathy of Guillain-Barrй and other polyneuropathies, complicated by violations of vital functions;
- neuromuscular diseases with violations of vital functions.
2. medical rehabilitation is acceptable for
2.1. Patients with consequences of acute cerebrovascular accident (ischemic or hemorrhagic genesis) on the background of arterial hypertension, cerebral vascular arteriosclerosis, vasculitis of different etiologies for a favorable rehabilitation prognosis within a period not exceeding 1 year of stroke, as well as the effects of other acute neurological and neurosurgical diseases.
2.2. Consequences of the transmitted craniocerebral injury.
2.3. Consequences of peripheral nervous system transmitted diseases.
2.4. Consequences of transmitted neuroinfections in compliance with the following criteria for the selection of patients for medical rehabilitation:
2.4.1. General somatic:
- stability of the general condition, sufficient competence of the somatic sphere, which can not be an obstacle for carrying out rehabilitation measures (absence of critical fluctuations of blood pressure, blood glucose level, decompensation of internal organs and systems, epileptic and other paroxysmal conditions, etc.);
- availability of sufficient level of self-service and ability to travel (no less than 45 meters on an equal plane);
- The maximum age for referral of patients 65-70 years.
- unchanged state of consciousness;
- lack of psychosomatic changes in personality, disorders of mind and memory, complications of orientation that impede the process of rehabilitation;
- motor deficit with a direct indicator for rehabilitation, but the absence of any arbitrary movements has a poor rehabilitation outlook;
- imbalance and coordination that prevent rehabilitation measures;
- sensory deficiency, as well as vision disorders within the limits that do not complicate rehabilitation;
- apathy phenomena that do not interfere with communication with others;
- absence of severe pain syndrome.
3. In the department of neurology with neurosurgical beds are subject to:
3.1. Patients with a neurological profile who are sent from the outpatient clinic network for orders, as well as by self-report and which do not fall under the criteria of hospitalization in the chamber of intensive care and medical rehabilitation, namely:
- patients with dyscirculatory encephalopathy and chronic insufficiency of cerebral blood circulation;
- patients with vasculitis, rheumatic musculature;
- patients with diseases of the autonomic nervous system;
- brain injuries, spinal and spinal traumas, traumas of peripheral nerves and their consequences;
- patients with cancer diseases of the nervous system;
- patients with neurological manifestations of degenerative-dystrophic diseases of the spine;
- patients with congenital malformations of the nervous system;
- patients with epileptic syndromes;
- patients with functional disorders of the nervous system.
Distribution, high mortality and disability of the population as a result of cerebrovascular diseases and their most severe manifestation - stroke put prevention and treatment of these diseases in one row with the most urgent medical and social problems. In this regard, the target regional program "Neurology" had been published in Kyiv during 1998-2010 years.
Employees of the Neuro Center take an active part in the main lines of the Program. This is primarily the provision of phased, qualified medical assistance with the use of modern methods of diagnosis and treatment in patients with cerebrovascular diseases and acute neurological pathology. Patients with a cerebral coma, epistatus are hospitalized in a ddepartment of intensive care, where 5 beds for neurological patients are allocated. For further treatment patients are transferred to the Chamber of Intensive Care of the Department of Neurology with cerebrovascular pathology and medical rehabilitation.
Twenty-four-hour service and treatment of severe patients is conducted in the department of intensive care. Patients are constantly under surveillance of anesthesiologist, neurologist and other medical staff, as well, they are able to consult with appropriate specialists if necessary.
In the future patients are transferred to neurological and rehabilitation beds, where the following stages of restorative treatment are carried out.
COMPOSITION AND STRUCTURE OF THE CENTER
Today, the Kiev Left Bank Neurocentre with medical rehabilitation includes a department of neurology (60 beds) with neurosurgical beds (10 beds), a department of neurology with cerebrovascular pathology and medical rehabilitation of 60 beds (including 6 beds of the intensive care room and 30 beds of medical rehabilitation) and an advisory department with traction methods of treatment.
Director of the Neurocentre - Doctor of Medical Sciences, Neurosurgeon - Oleksandr Goncharuk. After graduation from the Kiev Medical Institute (1991), he worked as a neurosurgeon of the Institute of Neurosurgery and the Regional Clinical Hospital
for a while. Since 1997 he has worked in KMKL №1. He deals with the problem of regeneration of peripheral nerves in unsatisfactory conditions, performing modern neurosurgical operations. In 2002, I participated in the International Congress of Neurosurgeons, held in Australia. And in 2002-2003 he was trained in France and Germany.
DIRECTIONS TO ACTIVITIES OF NEURO CENTER:
The main activities of the Neuro Center are:
1. Immediate hospitalization and high-quality treatment of neurological and neurosurgical patients;
2. Conservative and operative treatment of patients with cerebrovascular diseases, injuries of the brain and spinal cord, inflammatory and demyelinating diseases of the nervous system;
3. Participation in conferences, clinical conferences;
4. Participation in the examination of temporary incapacity for sick, the elaboration of labor recommendations, the need for reorganization into other areas of work, temporary referral of MSEC patients.
The high quality of diagnostics is provided with the modern equipment. Computer tomography, magnetic resonance imaging, ultrasound dopplerography, electrophysiological methods of diagnosis (electroencephalography, rheoencephalography, electromyography) work in the hospital.
Consultative and therapeutic work is carried out by highly skilled specialists under the direction of the Chief Neurosurgeon of the Health Ministry of Ukraine, Corresponding Member of the Academy of Medical Sciences of Ukraine E.G.Pedachenko. According to the agreement between the hospital and the Institute of Neurosurgery, the leading specialists of the Institute of Neurosurgery named after Academician AP are involved in the advisory and treatment work. Romodanov AMS of Ukraine and Department of Neurology, KMAPO.
Neurocenter involves complex neurosurgical interventions.
The rational structure of the neurocenter, cooperation with other structural departments (reanimation and intensive care department, diagnostic center) allows to bring the neurosurgical and neurological help to patients as close as possible, as well, it gives a possibility to accelerate. Close interaction with the department of restorative treatment brings opportunity to organize an effective rehabilitation. All this confirms the feasibility of the existence of neurological and neurosurgical medical associations.
Perspective directions in the work of the neurocenter are:
1. Introduction and development of modern mini-invasive neurosurgical technologies.
2. Application of thrombolysis in the treatment of ischemic brain lesions.
3. Operative intervention on the main arteries of the head.
4. Further improvement of medical and diagnostic measures in patients with demyelinating diseases and other viral lesions of the nervous system.
5. Improvement of methods of rehabilitation of patients with neurovascular pathology.
Goncharuk Oleg Aleksandrovich
Honored Doctor of Ukraine, Professor Director of the Kyiv Left Bank Neurocentre
with medical rehabilitation of Kyiv city Clinical Hospital No. 1
Kiev street Kharkiv highway 121