Academician Konstantin Lyadov. Academician Konstantin Lyadov will head the Stationary Medical Cluster. And in case of arthroplasty
E. Kryukova:
Hello, this is MediaDoctor, "Online reception", I'm on air, Ekaterina Kryukova. Today we have the Rehabilitation Day, in connection with which we gathered with Konstantin Lyadov, surgeon, oncologist, doctor of medical sciences, professor, academician of the Russian Academy of Sciences. Hello.
K. Lyadov:
Hello.
E. Kryukova:
Konstantin Viktorovich, let's figure out who a rehabilitation doctor is and why we need medical rehabilitation?
K. Lyadov:
You start with the hardest question. The name of the specialty changed quite often. And a rehabilitation doctor is probably a person who is responsible for ensuring that our patient, after surgery, after treatment, after some problems with which he ended up in the hospital or with which he came to an outpatient doctor, eventually returns maximally restored to normal life.
The ideal rehabilitation doctor is a generalist who understands how to restore the functions of the body as a whole. Since often a person comes with a specific problem, this problem is solved. But while solving this problem, others arise, since the operation leads to some complications. Treatment is complex, difficult, chemotherapy also leads to side effects on the body. And the rehabilitator must minimize the harmful effects of treatment and optimize the process of recovery of the body.
The ideal rehabilitation doctor is a generalist who understands how to restore the functions of the body as a whole
E. Kryukova:
Do I understand correctly that a rehabilitation doctor cannot graze each patient after each operation, ask how he is doing? That is, the issue of rehabilitation is decided at the level of the leadership of the clinic, the institution we are talking about?
K. Lyadov:
Rather, at the level of changing the perception of a doctor, specialist (neurologist, oncologist, gynecologist) about what rehabilitation is. When we meet with colleagues, give lectures, we ask who prescribes these methods of treatment, these are non-drug, and sometimes medication methods. We will refer you to an exercise therapy doctor or a rehabilitation specialist. And we are trying to explain that the attending physician is responsible for the treatment. Therefore, a gynecologist, urologist, oncologist, neurologist should know as much as possible the list of methods and the possibilities that are now available in order to restore the patient.
Why do I need physiotherapy in the intensive care unit? You come with some incomprehensible devices and drive over the patient's stomach, and we operated on him in general on a lung or on his legs. We say that when the patient is lying, his intestines do not work very well. And when the intestines are swollen, the lungs are compressed, the diaphragm rises. So he'll have congestive pneumonia. If we make sure that the intestines work well, the lungs will not be compressed.
And often even competent specialists have to explain that the human body is a very complex interconnected mechanism. And it is possible to act on completely, it would seem, unexpected moments in order to solve those problems that we are unsuccessfully trying to solve head-on. A rehabilitation doctor is such an integrative specialist who can approach the problem from different angles and offer a solution using a variety of methods.
Traditionally, the idea of rehabilitation is exercise therapy and physiotherapy. The main part is different types of training, simulators, mechanisms, this is everything that is not related to medicine. Nevertheless, we are actively using medications in order to restore the patient in order to prepare him for further treatment. And this is a completely different approach to man. That is, rehabilitation can be started at any time, and it is very difficult to finish it. Because when we go to the fitness center, we can say that we are doing rehab. When we bring a child who cannot concentrate on his studies, and our psychologists work with him in order to teach him to concentrate and not scatter attention (attention is now a very common problem), using rehabilitation techniques, electrical stimulation, biofeedback, using methods of any a certain correction, this is also rehabilitation, although this is a healthy child, he, in general, is not sick with anything. And when we go to the gym, we don't get sick either. But we can improve ourselves ad infinitum. And so is rehabilitation. It can start at any time: before surgery, during treatment, after an injury. And it is very difficult to finish it, because a person always wants to achieve some kind of ideal and become even better than he was before the operation. Therefore, the question here is not easy, and the answer can be quite vague, but, nevertheless, a rehabilitator is a person who looks at the patient as a whole, without isolating his individual diseases.
Rehabilitation can begin at any time: before surgery, during treatment, after an injury. And it is very difficult to finish it, because a person always wants to achieve some kind of ideal and become even better than he was before the operation.
E. Kryukova:
It seems to me that when a person finds himself in a situation where he needs an operation, the task of the entire medical team and staff is to make his life as easy as possible after the operation, shorten the post-rehabilitation period and any troubles associated with it, and take into account all the risks in advance.
K. Lyadov:
We often pay attention to the fact that this work begins before the operation. It begins when we see the patient and try to understand what else he has, besides the problem with which he came, how we should prepare his cardiovascular system, respiratory system, psychological characteristics for the operation. Because sometimes a person is more afraid than normal, and this also leads to sad consequences. It is better to operate on the day of the patient's hospitalization, there are no fears, there is no unnecessary hospitalization. It is very difficult to convince our colleagues, but more and more of our clinics come to the conclusion that the patient must be prepared, come in the morning and be operated on the same day. It is very difficult to convince the surgeon that the patient should be lifted as soon as he wakes up from anesthesia and allowed to walk. Because a whole complex of mechanisms is turned on here: both the proprioception mechanism and the mechanisms for turning on respiratory analyzers. We are accustomed to walking upright, we don't have to lie down. And if a person is stale even an extra day, then it is more difficult to restore him. It is difficult to convince our colleagues that as soon as a person comes to his senses, instructors of physical therapy in the intensive care unit come to him, lift him up and walk around the bed with him.
We are accustomed to walking upright, we don't have to lie down. And if a person is stale even an extra day, then it is more difficult to restore him
E. Kryukova:
Have you just described real-life, evidence-based recommendations?
K. Lyadov:
Really existing, scientifically substantiated methodology, and they are described in our monographs, and this has already been published in Russia and has been repeatedly discussed. But you still have to convince people that it is right and safe, because fears are present not only in patients, fears are also present in doctors, there are certain habits.
E. Kryukova:
Tell us more of these chips. You said that you need to get up quickly on the first day of hospitalization.
K. Lyadov:
You are probably familiar with the situation when you are told that you do not need to eat or drink before the operation, and preferably in the evening. And all over the world it is considered that this is wrong. And 2 hours before the operation, you must definitely drink a glass, 200 g, at least, sometimes a little more, depending on the weight, of a high-energy drink, either special or just sweet tea. Because then the brain is much easier to tolerate anesthesia. And the anesthesiologists say: "How to drink, he will vomit." We always have one and a half liters of liquid in our stomach on an empty stomach, from the fact that we drank 200 g of a sweet liquid, an energy liquid, it no longer became. But it is much easier for our brain, and it is much easier for our intestines, because the intestine does not like it when it does not receive nutrition, it starts to deflate, bacteria work there, and we get the same problems that I have already mentioned. We get a compressed diaphragm and lung problems. If this is an elderly person, and if he is a smoker, if it was already difficult for him to breathe, then now we have worsened it even more. Because of which? Because we are still talking about not eating or drinking on the day of the operation, under any circumstances. No, drink 200 g in 2 hours, and it will be better.
They say that before the operation you do not need to eat or drink. And all over the world it is considered that this is wrong. And 2 hours before the operation, you must definitely drink a glass of high-energy drink or sweet tea, because then the brain tolerates anesthesia much easier.
E. Kryukova:
The same with the enema, now they are trying to refuse.
K. Lyadov:
We don't, and you know there are no problems.
E. Kryukova:
All this is prejudice, or did it have some basis, some kind of sanitation of the intestines and adjacent organs, starvation, etc.
K. Lyadov:
You know, it is very difficult to answer this question, probably. We studied when it was mandatory, but new drugs for anesthesia appeared, new opportunities to quickly bring the patient out of anesthesia. Because now we can bring the patient out of anesthesia within seconds, it ends, and we can communicate with the patient and activate him. Probably, 50 years ago it was really impossible, if a person was taken out of anesthesia for 3-4 hours, one could hardly think that it could be activated so quickly. Everything is interconnected here: the advancement of medical technologies, and changes in methodological approaches, how to prepare a patient, how to operate him, what to do with him.
If we move to oncology, it is a completely different oncology. If we move to neurology, to recovery, absolutely amazing changes have occurred, and 10 years ago, when we were recovering patients, we were not using even 30% of what we use now. There simply weren't these devices, there weren't these technologies. They appeared, and other results appeared.
E. Kryukova:
We began to describe the Fast track a little, as I understand it.
K. Lyadov:
Yes, it's closer to surgery.
E. Kryukova:
What it is? A set of measures for what?
K. Lyadov:
This is a set of measures aimed at minimal trauma from any operation: gynecological, oncological, traumatological, any. Preparation, special approaches to the management of the patient already in the hospital itself. I have already said: hospitalization on the day of surgery, no fasting, no enemas, rapid activation of the patient, a number of recommendations for drug management. And our task is to make sure that the patient can go to the buffet on his own feet and have a snack in the evening after the operation. This is the ideal of Fast Track.
Our task is to make sure that the patient can go to the buffet on his own feet and have a snack in the evening after the operation.
E. Kryukova:
As for oncological diseases, chemotherapy, surgeries. You say that there are absolutely special measures and rehabilitation actions.
K. Lyadov:
Fortunately, oncology has changed. It became much easier for us, as rehabilitation specialists, as other operations began to appear. We tell patients all the time that there is no need to be afraid of treatment, fear of surgery, afraid to go to the doctor, because they have become different. Gone are breast cancer mutilation operations, large incisions are gone for the thyroid gland, we now do it through the armpits. Therefore, no cuts remain. Women do not go to the doctor because they are afraid of the incision, and they run their thyroid diseases to the stage when it is too late to deal with them.
The first to change were the technologies of operations, the technologies of anesthesia changed. But the process of cancer treatment itself has become longer, more effective, but, unfortunately, more painful for the patient. The successes of modern oncology are recognized by everyone, including surgeons, these are the successes of chemotherapy and radiation therapy. There are new targeted drugs that act directly on a specific tumor in a specific patient. But they are quite toxic to the body.
Earlier, when we talked about the rehabilitation of cancer patients, it was the fight against edema after the removal of the mammary gland, this is the care of stoma during major operations on the intestines. And now we are going to another, we are saying that we need to make sure that the patient can endure chemotherapy. The operation has already become less traumatic. But six courses before, six courses after, and if they are not done, there will be no effect, we will not be able to give this dose of the drug, which will allow us to kill cancer cells in the human body. And this is where we come in when we are engaged in the restoration of mood, the fight against nausea, depression, neuropathies. This word may not be very clear to a wide audience, but, unfortunately, it is a frequent consequence, a manifestation of chemotherapy complications, when sensitivity is lost. And nothing seems to be happening, but the person does not feel his fingertips, he cannot even take a cup, a toothbrush. Lose sensation in the legs. Everything is fine, but a person cannot get up, because he does not feel anything under him.
And when we began to develop a set of measures to combat these neuropathies, probably five or six years ago, it became clear that this is a problem that we will face more and more often. We have now come to a set of measures, as we have begun to figure out the mechanisms. There is a hypoxic mechanism, and a toxic mechanism, and an eating disorder, a metabolic mechanism. It plays a role here even when we inject drugs in order to nourish the nerves, we inject them, warming up the muscle, warming up the tissue, or we didn’t do it, and the drug didn’t reach the point, and we didn’t get a good effect.
The sequence of procedures is very important: when physiotherapy, when physiotherapy exercises, when inhalations and breathing exercises. Because they ask us: why? We explain: but you do not have enough oxygen, and in order for us to fight these consequences, we must fight hypoxia, hypoxic stress. This is the whole complex, which, in fact, is decided by a rehabilitation doctor, which allows us to restore a person in 3-4 days between chemotherapy courses and allow him to continue chemotherapy.
E. Kryukova:
Where is it best for us to establish such communication with a rehabilitation doctor? Can a person come by himself or is it better to stay in a hospital or sanatorium? What do you think is more efficient?
K. Lyadov:
If these are severe complications, then these are specialized centers. And rehabilitation is the same technological branch of medicine as cardiac surgery. If there are serious problems, then it is better to look for a specialized center that deals with these specific problems. It’s just that people who are recovering from some kind of back problems don’t do their head very well and don’t do oncology at all. That is, it is either a large multidisciplinary rehabilitation center that has specialists in these areas, or try to somehow convince their doctors that they also need to read books, listen to lectures and somehow try to help. It is not simple.
Rehabilitation is the same technological branch of medicine as cardiac surgery
E. Kryukova:
But at the same time, the highest goal of rehabilitation is to achieve patient independence.
K. Lyadov:
Achieve the highest quality of life. To make him feel as comfortable as possible and as comfortable as possible in society. So that it can exist independently, function. And even if problems remain, so that it is not a psychological problem for him. Because there are situations: a new joint is put in, it still doesn’t fit. You can’t get hung up on the fact that I want to be like 20 years ago, when I had my own. This means that we must convince you that we have achieved the maximum effect, you can do whatever you want, nothing hurts you, and this is wonderful.
E. Kryukova:
Let's talk a little about a heart attack, a stroke.
K. Lyadov:
Stroke, neurorehabilitation is, of course, a huge problem. Stroke, traumatic brain injury - very similar changes, a little more, a little less. The tissue of the brain is lost, the functions that have been familiar to a person since childhood are lost. And our task is to restore functions, but using the plasticity of the brain, using those parts of the brain that have never been responsible for this before. This is a very interesting task, it is neurorehabilitation. These are clearly rehabilitators, since intensive care doctors save lives, which is great, completely without irony. But then the next patients come, and the patient goes where? Moves into rehab. Something is done to him during intensive treatment in the intensive care unit.
E. Kryukova:
That is the state aid system.
K. Lyadov:
Of course, the first stage of rehabilitation is quite well, fortunately, worked out, it is really necessary.
E. Kryukova:
Without this, the patient will not be released, without the first stage?
K. Lyadov:
At the first stage, the maximum that could be done will be done. But what the result was, no one can say. Someone will have a wonderful one, and the patient will go home, the first stage was enough for him. Some need a second, some need a third. And here is the problem that still exists, where he will go to the second stage, and how he can be helped at this second stage after a stroke, after a traumatic brain injury.
E. Kryukova:
Can they do something wrong?
K. Lyadov:
We understand that the state system does not have enough funds for a long-term, serious rehabilitation of the second stage. A significant part manages to help. But if we are talking about serious consequences, unfortunately, this remains paid care and is produced in a very small number of centers in the country. I can be criticized, but I think that there won’t be even a dozen centers of serious neurorehabilitation that really deal with patients in extremely serious condition, but when the acute period has already passed. Functional disorders are so serious that we have to deal with everything in a complex way: both movement, and the urinary system, and the respiratory, nervous, and everything, everything, everything. This is a separate issue, a very difficult category of patients, and these types of rehabilitation are still paid.
If we are talking about serious consequences, unfortunately, this remains paid care and is produced in a very small number of centers in the country.
E. Kryukova:
Is it true that this cannot be completely delayed, for example, in a year we will no longer be able to work with the patient?
K. Lyadov:
It's better to start working right away, I repeat. But I do not agree that there is no effect in a year, two or even three. We very often see patients who decide to come to us and leave completely different, because we do not know much about our brain, that we have absolutely no idea how it can react to new rehabilitation methods. I repeat, there are new methods of stimulation, new methods of brain development, electrical stimulation of the brain, something that was not mentioned at all before.
E. Kryukova:
Tell me a little.
K. Lyadov:
Now the phrase Brain Fitness is very fashionable, when we train the brain with the help of special exercises and with the help of stimulation techniques, computer techniques, biofeedback techniques. In a healthy person, we can increase the amount of RAM very quickly. That is, after a 30-minute workout, you can take two pages and read them, immediately repeat them.
E. Kryukova:
What specialist is this?
K. Lyadov:
Rehabilitator, of course, as usual. But we say all the time that you have to train. When you go to fitness, you understand that you must repeat the exercises. It's the same with the brain. That is, the brain demonstrates the same things. We remember from school, if we repeat a poem over and over again, we train the brain, and we finally learn it by heart. Then time passes, we stopped training the brain, we forgot this poem. This suggests that the brain can be rehabilitated, it can be restored, and this does not depend on the duration of the injury. We can find those areas that will allow a person to feel much better and recover much better.
When you go to fitness, you understand that you must repeat the exercises. Same thing with the brain.
E. Kryukova:
But this should not be one specialist, it should be a neuropsychologist, a physiotherapist, something else like that.
K. Lyadov:
There is the concept of a multidisciplinary team. Of course, an exercise therapy doctor and, again, a rehabilitation specialist and a specialist doctor, a neurologist or an oncologist, if we are dealing with an oncological patient. The concept of a multidisciplinary team has existed for a long time in rehabilitation, when everyone enters the treatment process, joins the treatment process. But still, there is always someone who coordinates this treatment process. Let's call him a rehabilitator.
E. Kryukova:
Now our patients have made some progress, and when choosing an operation for themselves, they try to order a laparoscopic one. Do we always manage to meet the needs of the patient, and is this always appropriate? Again, touching on the Fast track, a quick way out of this state.
K. Lyadov:
You know, Fast track was developed by Dr. Kelet, as proof that by performing the operation perfectly, observing all the rules that we talked about, you can achieve the same results as with laparoscopic surgery, but with open surgery. He argued that it was much more important for the patient to follow all these rules aimed at his rapid recovery than one 10 cm or three 1 cm incisions.
E. Kryukova:
But we understand this, but the patient is capricious, for example, a woman does not want a scar, she wants a laparoscopy.
K. Lyadov:
He is not capricious, he does not want to. And she is absolutely right, she wants laparoscopically, so you need to try to meet her halfway. And now, in my opinion, most hospitals in our country, centers are equipped with laparoscopic equipment. Sometimes, if doctors are not proficient, they go for open surgery. I can't say it's bad. But I understand the patient, I understand the patient. Of course, at the first stage, recovery after laparoscopic surgery is much faster. And yet, in this regard, laparoscopic surgery is less traumatic, more gentle and more physiological than open surgery. But it happens differently. There are cases when it is not possible to do laparoscopically, and by the way, there are fewer and fewer of them. Technology is advancing rapidly, the da Vinci robot has appeared, 3D racks are appearing now, 4K racks are appearing. That is, entering the abdominal cavity, you can enlarge the image, you can see in such detail as you will never see in open surgery. These are all the advantages of laparoscopic surgery, and they are undeniable. Therefore, the choice is still up to the doctor, we try to follow the wishes of the patient.
My point is that laparoscopic surgery is less traumatic and it should be promoted and it should be developed. Although, I will repeat once again, if the doctor for some reason believes that the operation should be done openly, the patient needs to listen to the opinion of the doctor. The doctor's task is to make sure that this injury, this incision interferes with the patient's life as little as possible or interferes with his recovery after surgery. Thoracoscopic operations, this is a completely new word, when we operate on the lungs with instruments and punctures, recovery even with laparoscopic operations may not be as striking as with lung operations.
E. Kryukova:
Is it cancer surgery?
K. Lyadov:
The most different are, there are benign, emphysema, bullous emphysema. But still, traditional thoracic surgery involves large traumatic incisions along the intercostal spaces. These are difficulties with breathing, these are many, many problems, and they remain with a person, often for many years. Thoracoscopic surgery avoids this altogether. That is, there are things here when, if you can do a thoracoscopic, you need to go where it is done, and not stay where it is not done. Because here the efficiency, safety and benefits for the patient are even higher, perhaps, than in abdominal surgery.
If you can do thoracoscopic surgery, you need to go where it is done and not stay where it is not done. Because here the efficiency, safety and benefits for the patient are even higher than in abdominal surgery.
E. Kryukova:
Do we train laparoscopy doctors in medical institutions or is it a personal initiative, some courses, seminars, master classes?
K. Lyadov:
They teach, now there are a large number of simulation centers at medical universities, at the first medical institute, at the Botkin hospital.
E. Kryukova:
That is, who wants to do it without problems?
K. Lyadov:
And whoever wants, they guide, even if they don't want, they force them. The training of laparoscopic surgeons is quite active. Another thing is that all the same, the surgeon must specialize in something, because then the effectiveness of treatment will be much higher if he does not scatter and is engaged in some one direction. Let laparoscopic surgery, but bowel surgery or esophageal surgery, they still have a difference, and laparoscopic too. This is also a separate topic, not only for a rehabilitator, what is more effective, which specialist to choose, who to go to when decisions are made, to a generalist or to a person who deals only with such operations. I would probably choose someone who deals only with such operations.
E. Kryukova:
Logically. Konstantin Viktorovich, you are considered a pioneer in the region, that you brought new rehabilitation systems, you have long run a well-known rehabilitation center. I would like to ask you, in addition to some conceptual decisions, there were probably complex economic and organizational tasks, and did you have to make compromises in this sense?
K. Lyadov:
The main compromise, which was, or rather, the main problem, which was also a compromise, which we still have to make anyway, is still the organization of rehabilitation, its inclusion in the healthcare system and financing of this rehabilitation. Since we work in the system of state guarantees, we have prescribed free medical care. But, unfortunately, we cannot provide a number of things. By law, a person may want to receive paid assistance, but here, for example, it seems wrong to me when there is a person’s desire, whims, wishes, whatever. Yes, I know that I can get it somewhere, but I want to go there, I want to pay money and do it better, as it seems to me, or really. Unfortunately, the problem of rehabilitation is very long, it is very expensive, and the state cannot pay for it. When it is shown, it is needed, and there is no way to finance it, and you need to tell the person that you know, after all, you have to pay for it. It was like a problem for us 20 years ago, and yet we had to agree that this paid direction, unfortunately, remains the same now. Much has changed, the first stage has appeared, during the treatment they began to engage in rehabilitation measures. And here the merit of the Ministry of Health. But there is an objective situation.
E. Kryukova:
What is missing?
K. Lyadov:
There is not enough money to treat a small number of severe patients after a stroke, traumatic brain injury, some neurosurgical operations, some situations. They are relatively few, but they do exist. And while the compulsory medical insurance system is not engaged, there is no money yet. At one time there were federal quotas, then they were canceled during the time of the ministry of Golikova Tatyana Alekseevna. That is, before it was recognized that rehabilitation is a high-tech medical care. And it was very right, and it helped people a lot. The rehabilitation center, and our center, and the institute of neurology, and the center of the FMBA of the medical and biological agency could provide assistance to a very large number of patients and then send them to their place of residence for further treatment at a different level.
Over the past few years, rehabilitation has been withdrawn from the system of high-tech assistance and transferred to the compulsory medical insurance system. But the CHI is not unlimited, the CHI cannot close everything yet.
As for household things, organization, training, we were probably pioneers in that we were among the first to actively introduce multidisciplinary teams and understand that rehabilitation is the same direction as surgery, therapy or obstetrics and gynecology, that this is still a separate area that needs to be dealt with separately professionally. At the very beginning, sponsors helped us a lot, perhaps it would be more correct to say so, and most of the organizations that helped us, they did not wait for money, they did not ask for money back at all, they invested in new development.
Then there were no serious centers at all, we created a center according to the Western image, a multidisciplinary one. The only thing that differed from our Western colleagues was that they always specialized somewhat. And since we were federal, and the tasks were big, that is, we had both the musculoskeletal system, and neurorehabilitation, and urological, and gynecological. When colleagues came and said: why do you have so many things? Because we have a federal center, we have to deal with everything. But on the other hand, it was a great experience, and then people came to us to learn from our experience, and we communicate a lot with colleagues. And even now, when we are creating a new center, using the experience we have already gained, I do not see any global problems. The consciousness has already changed, 20 years ago there was no understanding that there is such a branch of rehabilitation, now no one even denies it.
Over the past few years, rehabilitation has been withdrawn from the system of high-tech assistance and transferred to the compulsory medical insurance system. But the OMS is not unlimited, the OMS cannot yet close everything
E. Kryukova:
It seems to me that only in extreme cases do our people remember this, and if a complex operation is ahead, they will most likely fly to Germany, Israel, if it concerns oncology.
K. Lyadov:
Still, the majority of our citizens will still remain treated in the country. And our task is to make sure that they do not regret it, so that people who come from Germany find out that the person who remained in Russia received the same assistance, and he was also rehabilitated. But it costs money, and in our country too.
E. Kryukova:
But after an operation that is not related to a stroke, state institutions will not help us in any way?
K. Lyadov:
After a stroke, they will help at the first stage not bad, and then too. The rates are very low, let's be completely frank. 18 days - 48.000 rubles, 50.000 rubles. 18 days of rehabilitation of the second stage, as a rule, is paid by the regional fund. 2000 rub. in a day. But of these, discard 1000 for food, for a bed, for other things. 1000 rub. per day, of which 300 rubles. you have to pay a salary. There is an instructor, and a physiotherapist, and a psychologist, and a neurorehabilitologist, and all of them will receive 300 rubles for this patient. in a day. Well, it is simply impossible to fulfill the volume that he needs. Something is being done, but not to the extent that is needed.
Another thing is that many of the patients do not need serious rehabilitation, they are slowly recovering at home. We are talking about those who are in need. We can provide at the highest level, cheaper than abroad, but still for the money. Rehabilitation, complex rehabilitation is still an expensive thing. And in Russia it is an expensive thing. It is effective, it allows you to get back on your feet, it allows you to return to life, and actually return to life.
We recently had a situation, here we are talking about how much it costs. The son of a man who had suffered a stroke came to us on the recommendation of our colleagues. A rather young man, on the background of hypertension, 50 years old, who worked actively, engaged in mental work. They were in one center, they were in another center, they went through everything that was supposed to be, and quite well. But then the opportunities allotted by the state ended, and the restoration did not come to an end. And the family had a dilemma: they give up everything, hire a nurse, he remains a severely disabled person, or there is a chance to try to bring him back to life after finding money. And when the son arrived, "Let's see the first stage, two weeks." Two weeks, then another two weeks, he stayed with us for three and a half months, it cost very good money, but he came back to life. And three months ago they were told that he would remain a severe invalid, chained to a bed and a nurse. Therefore, here the question is, is it worth it or not, you need to find money.
E. Kryukova:
Of course, it is worth and should be explained to people. Let's raise the issue of children's rehabilitation. It seems to me that our country is better with this, they are treated more responsibly and there are more existing options on the market.
K. Lyadov:
More charities that help. That is, we again return to the fact that after all this is an event that is financed by someone, somewhere by the state, somewhere by philanthropists, somewhere by parents.
Children's rehabilitation is also very diverse. There are children with cerebral palsy, this is one topic, complex, understandable, developed. There are some schemes, there are regional programs, in Moscow there is an excellent center for the rehabilitation of children with cerebral palsy. We work a lot with children and adults remotely, because then people stay at home anyway, and we help them with the help of the Internet, with the help of video cameras, our instructors watch how they work at home.
Right now, exactly the same program is underway, the equipment is brought home to children by the Department of Social Protection, children with disabilities, as a rule, cerebral palsy. And, of course, it is very important that they do the right thing, so that parents understand what can and cannot be done. That is, these programs have been worked out. We are trying with oncological rehabilitation, there are hematological patients, and a hospital, and the Dima Rogachev center, and sanatoriums, where these children later move and where they try to deal with and recover, on the one hand.
On the other hand, we pay very little attention to the prevention of childhood injuries and the recovery of children after injuries. We often encountered this in sports rehabilitation. Because the child can fall, it can break something, and the group, the section goes forward very quickly, that is, when he arrived there three months later, he had already lagged behind so much that they were no longer involved. It's not even that he's not promising anymore, they're just already throwing the ball into the ring, and he still remained at that stage when he only rolled him on the floor. And we try to help such kids, we work with them, bringing them to the level of the same readiness, in which there are children who have not had an injury. This is a separate topic of sports rehabilitation, because we must bring an athlete or a child, no matter who wants to play sports, to the level of sports readiness for sports events. This is also a separate topic, it is very important for children, children are so vulnerable, they are so worried when they later come to the section and find themselves out of work, which we also deal with, and this is an interesting, grateful topic.
Scoliosis, heart defects, recovery from heart defects, recovery from cardiac operations, many problems. But here, fortunately, charitable foundations help, we do a lot, we work a lot with foundations, more with neurological patients, but also with cardiological patients.
We pay very little attention to the prevention of childhood injuries and the recovery of children after injuries.
E. Kryukova:
Is it better for the consumer to contact highly specialized centers? With regards to adult rehabilitation, sports, children's rehabilitation, cerebral palsy and so on. Or are there centers that perfectly combine all of the above?
K. Lyadov:
You know, those who combine, not even 10, there are five of them in the country, and everyone knows them, we all know each other. Patients pass from us to colleagues, from colleagues to us. 4-5-6 centers, but this is not only Moscow, it is also Yekaterinburg, the center of Professor Belkin. But again, Yekaterinburg, the center of Professor Belkin, and we are no longer talking about specialized centers, because despite the presence of departments in regional and regional hospitals, these are not specialized centers. You still need to choose a center that deals, for example, with recovery after spinal surgery, if they do only this, they do it successfully, then you can safely go there.
E. Kryukova:
Your problem, in other words.
K. Lyadov:
Yes, this is your problem. But there is no need to go there with a urological problem or with the problem of recovery after a gynecological operation, this is the business of our multidisciplinary centers.
E. Kryukova:
And there should be a multidisciplinary team, preferably.
K. Lyadov:
Multidisciplinary, and there are not very many such centers.
E. Kryukova:
Thank you very much for a wonderful broadcast. The guest was Konstantin Lyadov, surgeon, oncologist, doctor of medical sciences, professor, academician of the Russian Academy of Sciences.
K. Lyadov:
E. Kryukova:
We discussed rehab, thank you, bless you, goodbye.
K. Lyadov:
Former General Director of the Federal State Budgetary Institution "Treatment and Rehabilitation Center" (LRC) of the Ministry of Health of the Russian Federation, academician Konstantin Lyadov, who left his post after the scandal with the admission of state officials to academicians, headed the Medsi Stationary Cluster - a project of the largest private network of clinics "Medsi Group of Companies". Together with Konstantin Lyadov, Tatyana Shapovalenko, who previously held the position of Deputy Director for Medical Work at the LRC, moved to Medsi.
At Medsi, Konstantin Lyadov will be involved in the development of the Medsi Stationary Cluster pilot project, in which it was decided to combine the Solyanka polyclinic, ambulance services, polyclinics in Shchelkovo, Stupino, Krasnogorsk, Otradnoy, Mitino, the Otradnoye Clinical Hospital and the Otradnoye Sanatorium .
Medsi expects that in this way it will be possible to form a full cycle of outpatient, inpatient and rehabilitation services within the network.
Following Konstantin Lyadov in Medsi passed about a hundred specialists from various fields of medicine, including Professor Tatyana Shapovalenko, who previously held the position of deputy director for medical work at the LRC. She is the author of numerous publications in domestic and foreign medical publications on the issues of restorative medicine and medical rehabilitation, and is also known as the host and chief physician of the TV series “Give Yourself Life” on the Rossiya TV channel dedicated to a healthy lifestyle. And about. Igor Nikitin, director of the LRC, claims that the number of employees who left for Medsi is much less: “To be absolutely precise, it is 20 people, of which only 6 are medical personnel. These are the official statistics of the personnel department of the LRC.”
The resignation of Konstantin Lyadov, who became an academician of the Russian Academy of Sciences, from the post of director of the FGBU LRC was known at the end of December 2016. Then the academician explained his decision by the unambiguous message of the country's leadership about the impossibility of combining leading government positions with membership in the Russian Academy of Sciences and scientific activities.
Russian President Vladimir Putin promised officials who became members of the Russian Academy of Sciences or were elected academicians at the end of October 2016. Thus, Alexander Fisun, head of the Main Military Medical Directorate of the Ministry of Defense, as well as Konstantin Kotenko, head of the Main Medical Directorate of the Office of the President of the Russian Federation, issued a presidential decree. Following them, at his own request, the director of the Department of Science, Innovative Development and Management of Medical and Biological Health Risks of the Ministry of Health, Sergei Rumyantsev.
Konstantin Lyadov was born in Moscow in 1959. He graduated from the First Moscow Medical Institute. THEM. Sechenov, and in 1997 he took the post of chief physician of the Moscow Central Clinical Basin Hospital. Then he became the executive director of the National Medical and Surgical Center. N.I. Pirogov. Since 2006, Konstantin Lyadov has been the head of the Medical and Rehabilitation Center of the Ministry of Health of the Russian Federation. Lyadov is the author of more than 300 scientific articles and 12 monographs.
JSC Medsi is one of the largest medical holdings in the Russian market of commercial medicine. The network includes 13 clinics in Moscow and the region, three clinical diagnostic centers in Moscow, seven regional clinics, three sanatoriums, an ambulance service, three wellness centers and 55 first-aid posts in the regions. In 2015, Medsi's revenue decreased by 15.7% to RUB 8.2 billion, with a net loss of RUB 127 million. With such indicators, the holding holds the second position in the TOP100 private multidisciplinary clinics of the Vademecum Analytical Center.
As Vademecum found out, Academician Konstantin Lyadov is leaving Medsi Group to pursue his own medical project. He intends to organize a hospital with a rehabilitation center called Lyadov's Clinics. The project investor will be the main owner of Pharmstandard, Viktor Kharitonin.
As Konstantin Lyadov told Vademecum, we are talking about creating a multidisciplinary clinic with a hospital and a rehabilitation center in Moscow. “The business model of the project takes into account the peculiarities of work in the CHI system. I sincerely believe that it is possible and necessary to provide medical care effectively within the framework of the state guarantees program, while not excluding paid services,” he explained.
The object under the Lyadov Clinics has already been selected. The area of the future medical center will be 14 thousand square meters. m. Lyadov refused to name the volume of investments in the project.
Currently, he is engaged in obtaining patents for new technologies for inpatient rehabilitation: “I hope we will be able to organize a full-fledged rehabilitation, keeping within the compulsory medical insurance tariffs that exist.” It is planned to scale this part of the project by selling the rights to use technologies to regional partners.
Earlier, Konstantin Lyadov presented a system for remote rehabilitation of patients at home under the supervision of a doctor - via telemedicine. This project, according to Vademecum, is already being tested in pilot regions.
Since February 2017, Konstantin Lyadov has been the head of the Otradnoye business unit at Medsi Group, which includes a multidisciplinary hospital and a number of polyclinics in Moscow and the Moscow region. He will continue to take part in the work of the group for some time - until the launch of a new project.
“The management of Medsi Group thanks Konstantin Viktorovich for the work done. In record time, including thanks to his participation, the clinical hospital on Pyatnitskoye Highway has become one of the leading assets of the network. Konstantin Viktorovich has assembled a unique team of specialists who will continue to work in the group. We consider it a logical and consistent step to create his own clinic,” Medsi commented on the departure of one of the group’s key managers.
“I believe that the project has prospects - Konstantin Lyadov has extensive experience in combining the sale of public and commercial services. By positioning the clinic as an inexpensive hospital, it is quite possible to get quotas for both operations and a basic set of rehabilitation care, and earn money by selling additional medical services,” says Vladimir Geraskin, managing partner of DMG.
Information about two new companies controlled by Konstantin Lyadov appeared in the Unified State Register of Legal Entities on June 15. These are the Lyadov Clinic Multidisciplinary Medical Center LLC and the Moscow Center for Rehabilitation Treatment LLC. In them, Lyadov owns 10% each, 90% each is owned by MIG LLC. This company is 70% owned by Viktor Kharitonin.
At the same time, MIG LLC registered several more companies - Innovation Clinic, Nuclear Medical Technologies, High Technologies, Clinic Group. The IPT Group, managing medical projects of Viktor Kharitonin, did not disclose the appointment of new legal entities.
Yesterday it became known that following the head of the Department of Affairs of the Prosecutor General's Office Alexey Staroverov in the case of the GTA gang, the head of the FGBU "Treatment and Rehabilitation Center" of the Ministry of Health of Russia, Corresponding Member of the Russian Academy of Medical Sciences Konstantin Lyadov, whose country house, like the prosecutor, was serviced by a participant in the murders of drivers in the Moscow region, was lit up. This native of Kyrgyzstan, Fazalidin Khasanov, who was in charge of weapons in the gang, was placed in jail by the Basmanny Court yesterday.The Main Investigation Department of the ICR accused Fazalidin Khasanov of committing crimes under Art. 105, Art. 209 and Art. 222 of the Criminal Code (murder, banditry and illegal arms trafficking). According to investigators, he was an active member of the GTA gang, organized by his countryman Rustam Usmanov.
The latter lived in the back room of a house in the village of Udelnaya, Ramensky District, registered in the name of the mother of the chief economic executive of the Prosecutor General's Office, Alexei Staroverov, and helped their housekeeper with the housework. Near the same utility room, Usmanov, who was shooting back from the special forces with a Walther pistol with a worn out number, was eliminated on November 6.
In relation to Mr. Staroverov, Vasily Piskarev, First Deputy Chairman of the ICR, following the results of the search, during which a weapon was found, opened a criminal case under Art. 222 of the Criminal Code, but Deputy Prosecutor General Viktor Grin recognized the relevant decision as illegal and unfounded.
The housekeeper, but already in the house of the physician Lyadov, turned out to be Fazalidin, a Kirghiz, bearing the same surname as the prosecutor's housekeeper, namely Khasanov. According to media reports, Mr. Lyadov previously lived in Udelnaya, and then sold a house there, buying a new one for his son in the Krasnogorsk region. Khasanov also moved there. As a result, he turned the utility room into a workshop for converting traumatic pistols into combat ones, from which murders were later committed in Moscow and the Moscow region. Spikes, the so-called goose paws, were also made there, which the criminals scattered on the tracks to stop the cars of their victims. In the workshop, according to the official representative of the TFR Vladimir Markin, a member of the gang, using a small lathe, even managed to make a sniper rifle. In total, more than 20 firearms and ammunition were seized from the gang's caches. The conducted examinations have already confirmed that the trunks were used to kill car owners.
Yesterday, the Basmanny District Court, having satisfied the petition of the ICR, arrested Fazalidin Khasanov for a month and a half - until December 22. Earlier, another member of the GTA, a native of Tajikistan, Abdumukim Mamadchonov, was identified in the pre-trial detention center, as well as an unnamed militant. Three more suspects are awaiting arrest. In total, the gang, according to Mr. Markin, included about a dozen militants - the detention of the rest is a matter of the near future.
The TFR noted that the members of the dangerous gang, liquidated by the Ministry of Internal Affairs and the FSB, carried out attacks solely for selfish purposes. "They killed indiscriminately, regardless of nationality and social status, often content with even small amounts of money that they found from the dead," Mr. Markin said. According to him, the versions that members of the GTA could commit crimes guided by national, religious or any other "disinterested motives" have not been confirmed.
In total, this gang has at least 14 murders, but the investigation does not exclude that other episodes may appear in the case.
Kommersant failed to get comments from Konstantin Lyadov. The Ministry of Health abstained from them.
