The document discusses medical rehabilitation, including its goals of recovering patients' functional abilities and work capacity. It describes the three periods of rehabilitation: early, late, and readaptation. Early rehabilitation focuses on diagnosis, treatment and lifestyle changes. Late rehabilitation uses physical therapy and exercises. Readaptation takes place at resorts or specialized centers using rehabilitation methods to restore work ability. The principles of rehabilitation emphasize early treatment, continuity of care, and a comprehensive individualized approach.

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Theme 5. Out of hospital (therapeutic) medical aid delivery in a case of the
most widespread therapeutic diseases.
1. A family can have a positive or negative influence on mental or physical
health of all its members. What are the main functions of family in this case?
Point and explain.
The main functions of a family in response to this statement.
1. Family is a primary source which forms a certain( healthy or unhealthy)
lifestyle .
A behavioral model is made by a family because its members, as a rule , lead the
same life style, have the same harmful habits (for example, smoking, drug and
drug abuse)
 parents’ behavior greatly influence on their kids’ health and behavior .For
example, as for teenagers, whose parents smoke , start smoking five times
more often than ones whose parents don’t smoke.
 smokers often marry to smokers and if they give up smoking they give up
smoking they usually do it simultaneously . Smokers who are married to non-
smoking partners often give up smoking
 family members usually have similar eating habits. So, such problem as
overweight ,first of all, should be considered within the bounds of a family.
Moreover , if one member of a family is on a diet it has an influence on meal of
all the family. For example, the prevention of the development of
cardiovascular disease of one member of a family is accompanied by change of
life style of all family.
2. Family can be a source of stress or social support. The most of family troubles
which caused any health problems are connected with family problems. However,
there lots of examples when a family support had a rehabilitation influence
injuries.
on patients who suffered sever diseases or injuries.
# The children from bad families have a higher index of streptococcic pharyngitis
and other respiratory pathology.
# The death of one partner of a couple or their divorce are closely connected with
health deterioration. There are more indexes of death among divorced men or
widowers in comparison with married ones. It is connected with depression as well
as with immune protection decrease.
# Children and their number are one of the conditions of the adequate support in
old age.
3. The patients objective symptoms can have adaptive function within a family.
2. How a family doctor must estimate the family relations and their influence on
the duration of the clinical course and the process of recovery of the patient?
(principles which are directed towards the family and health research within a
family).
1 Medicogenetic consultation. The ideal genogram includes the genetic
information( heredity diseases and genetic risks) and psychosocial information.

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2. Interviewing the patients with a purpose to clear up psychosocial and family
problems .For example:
#Has anybody from your family ever got the same problem?
#What do the members of your family connect this problem with?
# Who in you family is worried about this problem most of all?
# Do you connect your disease ( or its symptoms ) with your family problems?
# Do you think you family influence on the process of your recovery?
3. Involving members of a family to visit a family doctor everyday. A family
doctor usually meets the members of patient’s family when they accompany him to
see a doctor. More often the patients who should be accompanied are children,
teenagers and elderly people.
3. The functional clinical syndromes in the family doctor’s practice :causes,
characteristics, kinds and treatment.
The cause of functional syndromes - dysfunction of the vegetative nervous
system which happens on the background of chronic stress, overstrain,
intoxication(smoking), in a case of nidus of chronic infection (antritis, caries,
genitor-urinary diseases). The syndromes are characterized with a great number of
indefinite complaints (pains, unpleasant feelings, depression etc. in the lots of
organs and organism systems. Although, there aren’t any essential changes in lots
of these organs .
The kinds of functional syndromes:
Gastroenterology - Gastrooesphageal reflux, no-ulcer dyspepsia, irritable colon
syndrome.
Gynecology - Chronic pain in small pelvis, premenstrual syndrome.
Rheumatology - Fibromialgia
Cardiology - Non-cardiac retrosternal pain
Psychiatry - somatovisceral syndrome
The treatment of functional syndromes: calming medicines of different origin
(glycine, herbal preparats, tranqulizers).
4. What does the outpatient treatment mean? Name the indications and
contrindications to it.
The outpatient treatment is the medical aid delivery to the patients who
come to the medical establishment. The outpatient treatment is such kind of
treatment which is given at home or at the medical establishment.
Indication. If the patient is:
 sick
 poisoned
 injured
 pregnant

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 after having an abortion at the early stage of pregnancy
However, his state of health doesn’t require :
 supervision all day long;
 Isolation;
 using intensive methods of treatment( reanimation).
Contrindication. If the doctor thinks that the patient should
# be supervised all day long
# be given the intensive treatment
# be isolated ( in a case of epidemics) , because the patient has:
• an acute form of disease,
• exacerbation of a chronic disease ,
• the trauma of the middle or heavy degree of severity,
• the pathology of pregnancy, partus, abortion,
• newborn
5. What does the temporary, constant or long term incapacity mean? What does
the incapacity of work examination mean? What are the GP’s duties in
conformity with medical and social examination (MSE) activities ?
The temporary incapacity for work is a state of health if the changes which
happened to health don’t allow to do his usual working activity for sort period of
time;
The constant (stable) incapacity for work means such state of health if the
changes which happened to health don’t allow the patient to do his previous
professional duties and the patient has to be registered as a disable person.
The long term incapacity for work is considered when it has been continuing for
about 4 months. despite on all intensive methods which have been use during the
period or longer than 5 months during the year with breaks( in a case of
tuberculosis 10-11 month).
The duties of incapacity for work expert committee:
 to determinate the date and fact of the temporary or stable incapacity for work
of workers and employees. It means any doctor being in extreme situation
even he isn’t able to estimate the severity of clinical situation and diagnose
the illness certainly must clear it up and form it in accordance to the law.
 in a case of temporary incapacity for work a doctor must recommend a the
patient the conditions of work in response of his job and help him if a patient
is able to do the simple work.
 in a case of incapacity for work if the patient isn’t able to do the simple work
a sick leave is formed(SL)
 in a case of stable incapacity for work the patient is sent for examination of
medical and social experts committee so called MSEC
The doctors duties of MSE:
1. To determinate the fact of temporary incapacity for work including the
information about examination and character of work and also he must record this

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fat and give a sick leave within 6 days ( 3 days twice). In a case of epidemics or if
the disease is connected with epidemics ( for example flue) , in accordance to the
order of the Ministry of health Care of Ukraine and regional council these periods
can be prolonged to 10 days (5 days twice)
2. In the definite period of time ( no longer than 3 days for one occasion or 6 days)
to send a patient to decide a question of his further treatment and prolonging the
action of his SL
3. In a case of indications (signs of stable incapacity for work) to send a patient to
MSEC.
4. To provide the necessary treatment, moreover, the doctor: a) examines the
patient; b) diagnosis, c) analyses the stage of morphological and functional
changes and their connection with the severity disease; d) learns the certain
conditions of the patient’s work.
5. To give the patients relatives a sick leave for looking after the patient .Giving
the SL with a period of treatment longer than 6 days is allowed only with the chief
of the medical establishment permission .
6. To fix in the primary medical documents a form of established anamnesis and
objective facts, a number of SL the date when it was given and the next visit.
6. What is the and medical and social expert commission? What is their
structure and functions?
Medical and social expert commission (MSEC):
1. In Ukraine the expert examination of long term or stable(constant) incapacity
for work caries out by (MSEC).
2. MSEC consists of doctors which belong to the Health Care system but who are
not object to the Health Care bodies , they are subordinated to the Social
Security bodies.
3. The commissions include three doctors-experts (a therapeutist, a surgeon,
a neuropathologist) , the specialist social rehabilitation ( an expert in
rehabilitation), psychologist and the representative of social insurance
company(fund) in a case of accident at the working place or occupational
disease. The commissions of much higher level (regional, republic) include four
doctors-experts and also a lawyer and an economist. One of the doctors who is
a member of MSEC is appointed to be ahead of this commission. The head of
commission organizes its work and is responsible for practical activity of
MSEC and its quality.
Aims and purposes:
1. To determinate if it is true stable (constant) or long term incapacity for
work .
# people who apply to MSEC break their health , they have health problems
which can be resulted by diseases, injuries or congenital and limit their life
activity , also people who have rights to get social maintains .

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# the expert examination of MSEC is carried out at the medical establishment
where the patient is attached to or at the place of his treatment, patient must
show his passport or another document which identify a person and referral.
# If the patient is not able to come to MSEC place, he is examined at home or
at the inpatient hospital where he is cured.
# the expert examination which is carried out by MSEC must not be longer than
seven days.
# If MSEC does not resolve to prolong time of temporary incapacity for work
the validity of SL is dated by the date when the patient has been examined
byMSEC.
2. The patient is registered as a disable person in conformity with the trade
union bodies.
7. How many disability groups? What are the criteria for being registered as a
disable person belonging to a certain disability group?
The patient is registered as a disable person if his health failures or functional
disturbance don’t allow to do his occupational duties, and despite on adequate
treatment tent to be stable(constant).
 Disability group III is given in a case of considerable work capacity
decrease, when the patient has to be transferred to another working place and it
follows by sizable qualification and salary decrease .
 Disability group II is given if there are evident functional and organ
disturbance which don’t allow to work but the patient doesn’t need follow-up.
 Disability group I is given if the patient isn’t able to serve himself and
constantly needs help, follow-up and supervision even he has a rest of work
capacity in special conditions.
1. MSEC set the cases of disability: general, occupational, occupational
invalidism or childhood disability, disability as a result of the defense of state or in
the performance of his official or civic duty if it is approved with a document.
Case of disability:
 it is considered to be the disability as a result of general disease if it has
happened to the patient during his working activity but is isn’t connected with
work, army, childhood (before 15 years old) or off-the-job injury .
 it is considered to be the disability as a result of occupational disease if the
patient has been regularly under influence of the harmful factors which are
connected with his occupational activity during the long period of time. The
disease is considered to be occupational which is caused by one common
occupational aggressive factor. The occupational disease s given in
accordance to the resolution of MSEC.
 it is considered to be the occupational invalidism on the grounds of act about
the accident at the working place or judgment .
 the childhood disability is the disability preceding working age( before 15
years old)
2. MSEC sets the date of disability.

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It means the time when it happened to the patient, for example, during the time of
work, on his way to or from his working place.
3. MSEC gives people who have been registered as disabled or have incapacity for
work the health certificates and individual rehabilitation programs. MSEC
creates the individual rehabilitation program for each disabled person in response
to the individual rehabilitation program with the participation of the doctor in the
charge of the case at the medical-preventative establishment which should be used
by the patient.
4. MSEC recommends the patients who have the rest of work capacity to study,
re-qualification , means of transportation etc.
5. The resolution of MSEC can be disproved in legal form .
8. The temporary incapacity for work. Name the indications to sick- leave
certificates. In what cases can it be given?
- the temporary incapacity for work is approved with sick-leave another
documents are inadmissible. Except for: pupils, students military men and in
a case of off-job-injury which are approved with the certificate of medical
establishment for the first 5 days of incapacity for work.
- SL is given by doctors sometimes by junior medical workers who have a
special permission of the regional Health Care council.
- the private clinics don’t give SL
- in a case of the temporary incapacity for work SL are given by the doctors at
outpatient hospitals or medical units.
- In a case of tuberculosis, venereal disease and mental disease the GP give
the SL no longer than for three days !!! with further referral to the specialist
with a purpose of examination and treatment .In other case the SL are given
for the whole of treatment till the patients recovery or the he will be
registered as a disabled person.
- The patients who have been sick for a long period of time are sent to MSEC
not later than after 4 months since the moment of incapacity for work within
the year .The SL can be prolonged if there is a resolution of MSEC
- The doctors who work at the medical units give the SL in accordance to
general grounds.
- The junior medical workers who work at the medical units give release
from work certificate within the time of their working day (shift) ,they must
record the patients complaints and the urgent steps which have been taken
on the other side of…If the patient isn’t able to start working next day he is
given a sick live since the time date which is pointed in the release from
work certificate.
- The patients who have been sick for along time or are often sick get SL from
the doctor who is attached to them after DCC examination,
- The doctor in the charge of case give the SL for nursing no longer than for
three days and in the case of quarantine the SL is given by the
epidemiologist, in a case of his absence it is given by the doctor in charge of
the case or sanitarian doctor for the period of quarantine.

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- The SL for nursing isn’t given if there is a place for the patient in the
inpatient hospital but the patient or his relatives refuse ,if the chronic patient
needs nursing out of exacerbation.
9. What does the medical rehabilitation mean? What are its periods and
terms? What are the principles and components ?
Medical rehabilitation is a complex of health-improving measures which are
aimed at the patient’s recovery , renewing of his functional abilities and work
capacity, returning the disabled people for work.
It is very important for successful rehabilitation to start rehabilitation measures
as soon as it possible during the time of active treatment. The rehabilitation must
be consequent and onward at all its stages.
There are three periods of rehabilitation
1. The early rehabilitation (stabilization): it is a modern diagnostics and early
intensive treatment, regime and diet.
2. Late rehabilitation (mobilization) treatment at the rehabilitation
departments of inpatient or outpatient hospitals, physical therapy, remedial
gymnastics, reflex therapy.
3. Readaptation at the resorts, specialized rehabilitation centers,
preventoriums, with using mentioned above factors of rehabilitation and
technical methods aimed at renewing the patient’s work capacity .
IHCO determinates the rehabilitation as a process which purpose is to prevent
disability during the time of treatment and to help the patient to reach the
maximum mental, occupational, social and economical full value he will be
able to have within the bounds of his illness.
The principles of rehabilitation :
 The early diagnostics of disease , the active treatment with taking steps of
rehabilitation :
 The integrity of treatment and rehabilitation;
 Continuity , consequence and advancing movement of rehabilitation at all its
stages;
 The complex approach to the rehabilitation of the patient or the disabled
person byusing all its kinds ;
 creation of a complex plan of rehabilitation measures taking into
consideration the individual peculiarities of disease,
 changing the patient’s mental orientation;
 comeback the patients and disabled people to work, the rational organizing
of their work in conformity with their functional abilities.
The stages of rehabilitation are:
1. Outpatient hospital or outpatient room of GP with constant supervision of
the patient
2. Inpatient hospital to reach the stabilization of disease ;
3. The medical rehabilitation at the hospital; scientific research institute ;

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4. Local sanatorium;
5. Sanatorium-preventorium.
The conception of rehabilitation includes not only the medical part, it also includes
the psychological and occupational part (which is connected with patient’s
preparing to continue his work and possible re-qualification). It also includes the
social rehabilitation which is especially important for the patient who is limited in
his movies because of his artificial limbs to overcome the feeling of social
inferiority. If the patient is a teenage, it is very important to provide pedagogical
rehabilitation which includes studying at the special boarding schools.
9. Formulate the program of out of patient therapeutic aid delivery in the case
of the most widespread therapeutic diseases according to such plan: the
primary prophylaxis, the second prophylaxis and clinical examination,
treatment and rehabilitation measures, medicinal rehabilitation, social and
vocational rehabilitation, health resort treatment.
9.1 Chronic form of ischemic heart disease.
9.2. Hypertesive disease (HD)