Game-based training method in diabetes school
SUBSTANCE: method involves training patients in groups formed with age, length of service and disease type taken into account. Treatment comprises basic training program including cognitive theoretical material combined with practical tasks. The following topics like digestion and metabolism; causes, pathogenesis and symptoms of diabetes mellitus; emergency states associated with diabetes mellitus; hypo- and hyperglycemia; self-control; compensated diabetes mellitus; physical activity during diabetes mellitus; diabetes mellitus complications; diabetes and alcohol; insulin preparations and insulin therapy are sequentially studied within a training course. Practical training includes training behavior under particular circumstances usable for training child skills and additional exercises given in facultative mode. Additional information is given for fixing the acquired skills by reviewing experience received in basic lessons. Fairy tales therapy is applied in tutorial process by letting children create fairy world of diabetes where they live and are able to rule over it. Art therapy is applied for creating disease image. Dance therapy is used for mastering historical events in diabetes mellitus development by staging those historical events.
EFFECT: enhanced effectiveness in preventing diabetes mellitus complications.
3 dwg, 1 tbl
The invention relates to medicine, namely to Pediatrics, and can be used in the rehabilitation of children with diabetes. Historically psychosomatic diseases include seven classic diseases: bronchial asthma, peptic ulcer of the duodenum and stomach, atopic dermatitis, ulcerative colitis, coronary heart disease, essential hypertension, rheumatoid arthritis and hypertension syndrome - the "Chicago seven", by F. Aleksander. Research in recent decades allow us to classify and diabetes to psychosomatic diseases, where the difficulties of life, negative emotions, mental overexertion are the impetus for its development.
Diabetes mellitus is a syndrome of chronic hyperglycemia and glycosuria, developing as a result of the impact of genetic and exogenous factors. He is due to absolute or relative deficiency of insulin in the body, leading to the violation of all types of metabolism, primarily of carbohydrate metabolism. Its consequence are pathological changes in various organs and tissues, manifested as diabetes complications: microvascular - retinopathy, neuropathy, nephropathy, macrovascular atherosclerosis.
Diabetes is prevalent in all countries of the world, according to who there are 150 million people with diabetes Diab is the fact. In the industrialized countries of America and Europe, the prevalence of this disease is 5-6% and is expected to further increase (Balabolkin M.I.,1998). Registered in Russia 15280 children with diabetes (Dedov I.I., 2002). Among the causes of death diabetes mellitus ranks third after cardiovascular diseases and cancer (Vaganova M.E. Ter-Minassian, 2000). Conducted epidemiological studies in the Arkhangelsk region showed an increase in the incidence of diabetes among the adult population 1.8 times over the period 1987-1997 years (Bannikova W., Zaroslikova L.A., 2000). The incidence of diabetes in children in the Arkhangelsk region is 20 to 100 thousand, which refers to the average values, slightly higher than the Russian (13.4 per 100 thousand) and the European average (12 per 100 thousand) indicators (Dedov I.I., 2000).
When was opened insulin, it seemed that the problem of diabetes resolved. But on this day the patient with diabetes is like a man going along a narrow path across the chasm. For it is terrible not only hypoglycemia, but other hazards of complications: blindness, kidney failure, diabetic foot (Dedov I.I., Suntsov SCI, 1997). The disease came into the house, changing not only the established order of life, the relations of others, but also the patient. Patients with diabetes have a very the earlier fixation installation disease, as evidenced by the work Martynenko A.A. (1975). This is due to the characteristics of the disease that requires the patient and his relatives deep understanding of the essence of pathology, care, patience and self-control. Ability to independently make decisions on aid, change of insulin dose, take responsibility for long-term outcomes of the disease. In this regard, the invaluable importance of proper installation of the patient to themselves and their disease. The doctor together with the patient should not only reduce blood sugar levels, but also to develop the patient's ability to manage diabetes, to adapt the patient, his relatives to a different way of life requires self-control. The key to good success in treatment is to educate the patient and his family in diabetic schools.
Information about the patient education met in the scientific literature in the early twentieth century. In 20-ies of XX century a separate diabetologists used patient education (Joslin in the United States, the Roma in Portugal, Lourens in the UK). The importance of teaching patients with diabetes mellitus was noted in 1919 Joslin in his book " A diabetes manual for the mutual use of doctor and patient" (Leont'ev A.B., 2002). In the late 20's-early 30-ies of the Carl Stole developed and promoted flexible insulin, which is now called intensified the Oh. The basis of therapeutic concept Stole was the requirement to seek compensation for metabolism using self-definitions glycosuria and short introduction of insulin before meals, depending on the result of determination of sugar content in the urine and the upcoming carb intake. Compliance with these rules required intensive training. The practice of education has assumed the character of an integrating part of the treatment of diabetes and were widespread. Beginning this was the work L.Miller, which proved that psychosocial and learning approach can assist in the treatment and reduce the rate of acute complications of diabetes (Dvoynishnikova O.M., Surkov E.V., Drobizhev M., 2003). Miller demonstrated the revolutionary possibilities of study patients. In his work he showed that after training, patients reduced the number of hospitalizations almost 5 times (Cherepanova S.V., Ivanov S.N., Rogalev A.A., 2001). Currently, training is basisty component of the treatment of patients with diabetes in many countries of the world. Created a number of international organizations involved in research in this area. In 1979, in Europe with the creation of the research group on teaching patients with diabetes mellitus - Diabetes Education Study Group (DESG), the European Association for the study of di is beta European Association for the Study of Diabetes (EASD). Its functions are to develop methods of diabetes management, distribution, training programs, creation of systems of long-term monitoring of patients with diabetes mellitus (Dvoynishnikova O.M., Surkov E.V., Drobizhev M., 2003). In Russia the most rapid development of this direction is received after the adoption of the world Health Organization in 1989, the St. Vincentsaa Declaration, which was an important milestone in the development of the system of medical care for patients with diabetes mellitus. Created a number of documents regulating the content of specialized programs in the field of chronic disease prevention and therapeutic education of patients. This is, for example, National standards for training programs in self-management of diabetes, developed by experts in this field with the support of the American diabetes Association; the Orders of the Russian Ministry of health No. 404 "on measures for realization of the Federal target program "diabetes" from 10.12.96 and №135 "On the standardized programs and visual AIDS for schools training of patients with diabetes from 06.05.97; Order of the Ministry of health of Russia №267 "On the development of diabetes care to the population of the Russian Federation to Annex 1 of the school education of diabetes patients from 16. 07. 01.
In the literature of recent years Shi, the eye has been discussing the methodology of the study patients. In Russia it is widely used training programs, developed by the staff of the Endocrinology research center RAMS using the principles of structuring proposed by Professor M. Berger (medical clinic of Düsseldorf University. Heinrich Heine) in accordance with who recommendations. Created training programs for patients with diabetes mellitus type 1 and 2, for children with diabetes and their parents, for patients with diabetes mellitus type 2 on insulinotherapy, pregnant women, patients with diabetes mellitus. They are all aimed at improving the quality of life of patients. For training, use both individual and group lessons. As shown by experience with patients with diabetes mellitus, group training is the most acceptable and effective. Such training creates favorable conditions both for the teacher and patients. A required component of the application of training programs is to evaluate their effectiveness. Numerous studies show the positive results of the training programs. In studies Kondratieva H. decreased glycated hemoglobin in children trained in the conditions of sanatorium to 10,86% (Kondratieff H., Kravets E.B., Samoilova YG, 2003). Reduced frequency of ketoacidosis 5-6 times in patients who have undergone training (Dolishny the ova O.M., Surkov E.V., Drobizhev M., 2003). Significantly reduced the percentage of hospitalizations due to decompensate and complications of diabetes, more than 50%, reduced the number of hypoglycemia and related admissions to hospital 2.5% after training in the "School of diabetes" (Cherepanova S.V., Ivanov S.N., Rogalev A.A., 2001). In the work of R. Rubin in 1989 marked improvement in the emotional background (reduction of anxiety, depression) in patients with diabetes mellitus. E. Bartlett conducted a cost-effectiveness analysis of study patients and came to the conclusion that on average, every dollar invested in educating patients, leads to savings of 3-4 dollars after training. However, in the row of the works noted the lack of effectiveness of training in diabetes mellitus. According to the materials of the program implementation St Vincentsaa Declaration of the European departments who and the International diabetes Federation only 20% of patients regularly reach normal levels of glycosylated hemoglobin after training. It has been shown that many educational programs that exist today, have a short effect (6 to 18 months). A single intensive one - or two-week programs have limited effect (Leont'ev A.V., 2003, Belikova T.V., One VI, Telegenic YU.N., 2001). Among the factors that reduce the effectiveness of the training process in Colodial", identify the following: extensive experience of diabetes is a factor of low efficiency of learning; overweight in adolescents with diabetes type 1 affects the learning process; conflicts in the family lead to inadequate control of diabetes and low levels of psychological adjustment to the disease, resulting in low efficiency of learning; depressed condition of the patient, increased anxiety reduce the effectiveness of the training. Among the positive factors on the learning process and the formation of motivation for self-control include: repeated, regular cycle training, support and active participation of the family of the patient in the monitoring of disease, and high average intelligence of the patient, the personal characteristics of the patient in the form of a personal locus of control over the disease (treatment is seen as the result of their own activities), group classes in combination with psychotherapy - have a positive effect on the learning process (Dvoynishnikova O.M., Surkov E.V., Drobizhev M., 2003; Leont'ev A.V., 2002).
Analogues's learning, which combines medical, social and psychological work, no. Learning in a playful and enticing form is not accidental. Firstly, the game is the form in which most can successfully learn the content, and secondly, it's an emotional support person boldog the child, facilitate adaptation to new conditions of life and providing psychological comfort, the third is an element of creative expression, independence and activity of the child among his peers. Voluntarily entering into the world of the game, the child reaches the result of learning and communication. " Easy childrens games deceptive, this phenomenon all know, but not all understand," PF the Kapterev. 's training is based on the fact that the game simulates the activity of a child in real life, and also allows you to play devised or desired reality. It has long been known that the game takes up a significant part of a child's life. In the 18th century Jean-Jacques Rousseau remarked: to learn and understand the child needs to watch his game. Unlike adults, for which the natural environment of communication is the language for the child's natural medium of communication is gaming activities. In a relatively safe situation of the game, in the state of relaxedness, modeled behaviors in the self-control, eating, trips to the country and so on the Game form the interest and desire of the child to learn and to perform actions aimed at the treatment of disease and prevention of complications, taking into account individual problems and characteristics of the child.
In the learning process actively using the following elements of psychotherapy:
Ska is cotherapy - treatment of fairy tales or the formation of links between the fabulous events and behavior in real life. This process of moving fabulous meanings in reality. With the help of a fairy tale to a child's easier to digest the material of the structure of the organs and their functions, especially for children of primary school age, the tale reveals the spiritual potential of the individual. The tale gently affects the child's behavior. Children are encouraged to create fabulous pancreas, fairy-tale world of the disease, the children created a fantastic world in which they live and can control them.
The art therapy - therapy visual arts (drawing, sculpting, mucosally), is used as a means of self-expression. Fine work not only develops visual and mechanical memory, but is used as a means of expression. Without words through creativity you can Express your emotions, feelings and difficulties. The purpose of creative expression, not in skill, but in the ability to do something differently. During creative activity has the effect of relaxation needed to further stress management. Drawing, in particular, reduces the internal resistance, promotes concentration on experiencing difficulties, and therefore improves their understanding (Sidorov P.I., Makarov V.I., Babikova IV, 2002). De the pits offered to make a collage with music, draw your illness, etc.
The dance therapy is used for the assimilation of historical moments in the development of diabetes, it is very difficult to attract the child's attention to the terse phrases, therapy, dance, dramatization of historical events allows you to combine mental training and physical with the positive influence of music on child (Belyavskaya Russia, having got, 1985).
The parents of the child are mandatory participants in the creative learning process. Helping the child to perform tasks, to draw, to reason and explain, they provide not only emotional balance in the family, but also build communication skills with a sick child.
If the training will be interesting and will take in the process the entire family, then it will be fruitful and effective. Good visual learning is the key to successful treatment of diabetes.
The purpose of the invention: prevention of complications of the disease.
This goal is achieved by the fact that when the game learning in the "School of diabetes" conduct group and individual game sessions, combining theoretical, practical, psychological and social sector jobs. The learning cycle consists of nine lessons with clear regulation of the volume and consistency. Classes include the task of understanding the nature of the disease, the patient's motivation for self-control and the installation fo the formation of adaptation in situations of illness, that in combination with traditional therapy increases the effectiveness of treatment and prevents complications.
The method is as follows.
Before and after cycle exercise testing to assess the level of awareness and residual knowledge about diabetes. Familiarity with theory takes into account the patient's age. Type of training: group training in groups of 7-15 people formed taking into account age, experience and type of disease. Types of classes: main (include cognitive theoretical material in combination with practical tasks), practical (assume the training of behavior in specific situations, necessary for the development of the skills of the child), additional (held in the form of optional courses, which provide additional information, fixed skills, repeats studied). All classes are conducted in the games accessible form, with a duration of 50 minutes. In the learning process consistently topics: digestion and metabolism; diabetes causes, pathogenesis, symptoms, emergencies in diabetes: Hypo - and hyperglycemia; self-covered diabetes; physical activity diabetes; complications of diabetes; nutritional planning in diabetes mellitus, diabetes is alcohol; insulin and insulin therapy; the final class. The training is conducted in the conditions of sanatorium or a special camp that allows you to create a flexible work schedule. In addition, such training does not exclude the child from the usual situation in a circle of peers, gives him the opportunity to implement acquired knowledge and skills without parental care. At the time of presentation of theoretical material with the help of poems, tales, stories, crossword puzzles are bright clear benefits: made of color and velvet paper, cardboard models of the organs of the gastrointestinal tract, kidneys, model figures, on which are superimposed the images, symbols, table games about diabetes with colorful drawings, depicted paints and markers on paper, puzzles of colored cardboard models of the pancreas in the form of Mukusalas, the layout of the insulin molecule of colored beads, colored card symbols, dominoes, aimed at learning, repetition and reinforcement of knowledge and skills. In the learning process actively used: tale therapy (children create a fantastic world of diabetes in which they live and can manage them); art therapy - therapy visual arts (drawing, sculpting, mucosally depict bodies, their structure, create the image of the disease); dance therapy is used for the assimilation of historical mo who develop diabetes (dramatization of historical events allows you to combine mental training and physical with the positive influence of music on children). During training, use of therapeutic exercise in the gym and in the pool, controlled grain units in the dining room, is the control of glycemia during the day, are tested to determine the characteristics of the child and the psychological state of the patient. In the process of performing tasks as encouraging the child receives monetary unit - shrinki. At the end of training on earnings he can get brochures, means self-control, etc.
An example of performing the method.
Lesson No. 1.
theme of the lesson: " Digestion and metabolism".
I. session Purpose: to Inform the patient about the process of digestion and metabolism.
II. Task classes:
1. To familiarize you with the process of digestion and metabolism.
2. To disassemble the structure and function of the pancreas.
3. To explain the importance and role of the hormone insulin in metabolism.
1. Visual aid "diabetes is a way of life."
2. Flannelgraph and layout of the gastrointestinal tract of man.
3. The layouts of the pancreas.
4. The layout of the molecules of the pancreas.
5. Puzzles (model liver)
6. Colored cards (traffic light)
7. Model helicopter
8. Paper, colored pencils, a watch with a second hand.
The algorithm does not work:
|1. Introductory word of the teacher, acquaintance||5 min|
|2. Input control||10 min|
|3. Explanation of material||25 min|
|4. Fastening material||10 min|
a) answer the questions on the digestive system
b) to call the authorities and in the figure, working in a team and independently.
d) image of the structure of the pancreas when working in a team.
e) collecting model of the liver (puzzles)
5. Homework 5 min
In the explanation of theoretical material is used
1. Under the microscope, the kids watch a microscopic slide of the pancreas, where do you find the Islands, and Into the cells.
2. Young children are encouraged fabulous pancreas (mucocele), with the size of the adult, where the head of the cap, body, visible tail and channels. All iron consists of Islands, and its eyes resemble the cells that produce insulin (read the tale of the pancreas). The fabulous layout of the pancreas presented in figure 1.
3. Demonstrates a volumetric model of the insulin molecule consists of two chains of amino acids represented by the beads, the number of beads equal to the number of amino acids in the chain (A chain - 21, circuit - 30 beads), between a circuit seinemaritime bridges in the form of beads of a different color and smaller size. The model of the insulin molecule are presented in figure 2.
4. The layout of the helicopter.
A peculiar mechanism, where the Windows are reminiscent of cells, the propeller blades - insulin, and fuel is glucose. For example, a helicopter shows the value of glucose and insulin. Without them, the movement and the mission is impossible (figure 3).
Fixation of the material.
Questions to freeze:
I. Test yourself, passing the bead on the layout of the digestive tract, answering the questions:
1. What happens to food in your mouth?
2. As the stomach digests food?
3. What distinguishes the gallbladder into the duodenum?
4. What is the pancreas?
5. What does the liver?
6. Where are absorbed nutrients?
7. What appears rectum?
8. What are the excretory organs you know?
II. The proposed figure, the child calls the authorities, are indicated by numbers. Other participants using traffic lights confirm the correctness of the answer. The correct answer is confirmed by a green signal, a wrong answer is red.
(The standard answer: 1 - the language; 2 - esophagus; 3 - stomach; 4, liver; 5 - gallbladder; 6 - intestines).
III. Children at will collect puzzles - the layout of the liver.
IV. Children are encouraged to split into two groups of an equal number of people. Issuing sheets of paper and colored pencils, participants draw faced the substance of the pancreas.
The winning team, quickly coped with the task and not making errors.
Winners earn credits - one sacharine.
- Children are encouraged to depict fairy-tale world of the pancreas.
Learn in your spare time with historical facts (in the final lesson, portraying the history of the development of diabetes - working with the teacher).
Examples of homework.
Example No. 1.
Agencia, 13 years; Mbarouk, 13 years. Was in the sanatorium "relations" with a diagnosis of diabetes mellitus type 1, subcompensated. Were on a mission to secure themes of diabetes, causes, symptoms of the disease.
The tale: "the Battle on the river pancreas".
Outside the city the stomach, where live cells digestion, the river and the pancreas. This river has many small Islands, named after the German pioneer of Langerhans. On the Islands live special people In and L cells, which are working day and night, maintaining normal fuel system - blood glucose. B - cells produce the hormone insulin, which causes the sugar to penetrate into the house, without heating them. In those days, when the stomach is a lot of glucose Into the cells work without rest, large portions deliver the insulin, thereby reducing sugar. Once at the river formed a mountain of sugar, the n from all sides came. B cells did not know what to do. Because stocks of insulin was becoming less and less, it was not enough.
Suddenly everything went dark, flashed zip - headache, 've got a thirst, a cloud appeared acetone, the body began to recede. But at 7 a.m. we received a new batch of artificial insulin, he made the sugar to enter and heat the house, leave their own standards. So, In cells overcome sugar.
Example No. 2.
Epistula, 14 years; Talkin,14 years. Was in a sanatorium with a diagnosis of diabetes mellitus type 1, subcompensated, within labile. Creative homework story about diabetes.
The tale: "planet of the pancreas.
Is there a planet pancreas. This planet consists of small islets of Langerhans. On each island live glucagon And insulin Century Life on these Islands was friendly. Glucagon and insulin communicated with each other gave each other space. And suddenly it was rush hour. Country and started a war between. The country And got up the immune system, was to destroy b - cells. When it was destroyed 90% of the population of b - cells, side And announced reconciliation. But developed diabetes. The planet was dark, rainy, covered with thick clouds of acetone. But glucagon could not exist without insulin. They began to look for insulin on other planets, to cover anity life. And so the pancreas has existed for many years. As soon as the clouds and the rain drips, glucagon looking for new insulin.
The proposed method of study approved from 124 people with diabetes type 1 and 4 children with diabetes mellitus type 2, aged 7 to 15 years (59 boys (46%) and 69 (54%) girls) in terms of the local sanatorium "relations". The most numerous group consisted of children from the cities of Arkhangelsk 42 people (33%) and Severodvinsk 49 children (38%), of the districts of the Arkhangelsk region 37 children (29%). The vast majority were children of school age to 68% (88 people), Junior high school students - 20% (26 people) and 6% (14 people) adolescents. More thanchildren disease duration was up to 5 years 54% (69 people), disease duration from 5 to 10 years had 34,2% (44 people), disease duration more than 10 years was noted in 5 children (4%). Most children had compensated carbohydrate metabolism 66,4% (85 people)to 33.6% (24 people) - subcompensated diabetes. The effectiveness of the training was evaluated by the following criteria: General health, the dynamics of body weight, blood glucose level, the level of knowledge before and after training. After training in 96,8% (124) were able to achieve compensation of carbohydrate metabolism. 24 days of observation in the face of physical load was 5 of hypoglycemia mild cases the AEB ketoacidosis was not. The input and output control test was performed in 20 children. To conduct classes at the "School of diabetes" the average level of knowledge amounted to 65% of children failed the test control, received a score of " poor", after the end of the session, all the children coped with the task, the average level of knowledge was - 84,2% - "good".
|Table No. 1|
|The effectiveness of the training's way in the "School of diabetes".|
|Score||Before class||After class|
|"excellent"||0||60% (12 persons)|
|"well - "||20% (4 persons)||25% (5 persons)|
|"satisfactory"||15% (3 persons)||15% (3 persons)|
|"unsatisfactory"||65% (13 persons)||0|
In a follow-up test control of residual knowledge level 1 year 11 people. The residual level of knowledge was 62%. Good "received - by 36.4% (4 people), "satisfactory" is 27.2% (3 people), "unsatisfactory" by 36.4% (4 people). During this period of severe hypoglycemia was not. 6 times decreased frequency of decompensation of diabetes mellitus, 1.6 times decreased hospitalizatio in the hospital due to decompensation in children, Arkhangelsk after training in this "School of diabetes". The results showed that after training, 's way at quite a high level. In comparison with the traditional presentation of the material according to Kondratieva H. 2000, where after training as "excellent" received 50% of the children in our scenario - 60%, "good" - 33%versus 25%, "satisfactory" - 17% of students against 15% 's way.
The data indicate the effectiveness of the gaming method of learning in the sanatorium. Offer's way of teaching children with diabetes provides psychological comfort a sick child, increases the level of literacy about the disease, forms the motivation for self-control and child adapts to different life conditions of the disease. This method allows you to unleash the creative potential of the child, allows the child to relax and to communicate freely among peers. In the content of the classes included examples from real situations, examples have specific actors that causes children the interest and trust of the child in the process of this method of learning takes responsibility for his condition and team members. This method is an alternative to the traditional "School of diabetes", allows you to upgrade classes based on the situation, allows for re qi the crystals to expand the horizons of knowledge. In the course of this training, the child is revealed as a person, samosovershenstvuetsya, to develop skills through emotional activities involving communication with parents and relatives, which allows to achieve the best results in the treatment of diabetes. In addition, it does not require significant costs associated with training of the patient.
Sources of information
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2. Balabolkin M.I., Klebanov E.M. Diagnosis and treatment of diabetes// diabetes. - 1999. No. 3. - page 11-17.
3. Balabolkin M.I. Endocrinology. M., 1998, 581 S.
4. Bannikova W., Zaroslikova L.A. features of the epidemiology of diabetes mellitus in the adult population of the Arkhangelsk region.// Human ecology. - 2000. No. 4. - p.27-29.
5. Belikova T.V., One VI, Telegenic YU. Materials of the IV all-Russian Congress of endocrinology. Coll., 2001.
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7. Birthe C. Olsen., Mortensen X. a Practical guide to the treatment of children and adolescents with diabetes. M., 2001, 55 S.
8. Dedov I.I., Kuraev TI, Peterkova VA diabetes mellitus in children and adolescents. M., 2002, 391 S.
10. Dvoynishnikova O.M., Surkov E.V., Drobizhev M. effectiveness of teaching patients with diabetes mellitus. // Problems of endocrinology. - 2003. - so 49. No. 5. - p.51-55.
11. The founder - Evstigneeva ETC. Workshop on fairytail therapy. SPb., 2000, s.
12. Zykova T.A., Savenko B.A. Diagnosis and classification of diabetes mellitus. Arkhangelsk. 2000, 30 S.
13. Zykova T. A., Savenko B.A. Quick reference diabetes. Arkhangelsk. 2000, 56 S.
14. Kogan A.G. Therapeutic pedagogy in children's sanatorium. L., 1977, 118 S.
15. Kondratiev H., Kravets E.B., Kalinin L.V. Rehabilitation of children with insulin-dependent diabetes mellitus in the local sanatorium. // Questions of balneology, physiotherapy and physical therapy. - 2000. No. 6. - p.46-48.
16. Lazarev, M. L. Program of health of children of preschool age. M., 1997, 374 S.
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19. I.A. Novikov Psychosomatic aspects of diabetes and the main directions of psychotherapeutic correction. Arkhangelsk. 1999, 27 S.
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21. On the development of diabetes care to the population of the Russian Federation: Ministry of health, 16.07. 2001.
22. Sibileva E.N., Startseva OG Manual of pediatric endocrinology. Arkhangelsk. 1994, 58 S.
23. Sidorov P.I., Makarov V.I. Rehabilitation of children with juvenile chronic arthritis. Arkhangelsk. 2002, 82 S.
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25. Cherepanova S.V., Ivanov S.N., Rogalev A.A. the Influence of teaching patients with diabetes mellitus on the development of complications according to OCB.// Bulletin of the SSMU. - 2001. No. 2. - p.101-103.
The way to prevent complications of diabetes, including the playful learning in the form of a game, characterized in that conduct training of patients in the groups formed with respect to the age, experience and type of disease, the course includes core classes, including cognitive theoretical material in combination with practical tasks in the learning process consistently topics: digestion and metabolism; diabetes causes, pathogenesis, symptoms, emergencies in diabetes: Hypo - and hyperglycemia; self-covered diabetes; physical activity diabetes; complications of diabetes; planning food with sugar is ω diabetes, diabetes and alcohol; insulin and insulin therapy, and practical sessions involve training of behavior in specific situations, necessary for the development of the skills of the child, and additional classes that are conducted in the form of an elective class that provides additional information, reinforcing skills, repeating studied in the main lesson in learning to use the tale therapy, in which children create a fantastic world of diabetes in which they live and can manage them, the art therapy to create an image of the disease and therapy dance, used for the assimilation of historical moments in the development of diabetes, by these dramatizations of historical events, all the lessons are conducted in the form of a game with a duration of 50 min, theoretical material is carried out with the help of poems, tales, puzzles, used bright clear benefits: made of color and velvet paper, cardboard models of the organs of the gastrointestinal tract, kidneys, model figures, on which are superimposed the images, symbols, table games about diabetes with colorful drawings, puzzles of colored cardboard models of the pancreas in the form of Mukusalas, the layout of the insulin molecule of coloured beads.
FIELD: medicine, psychotherapy.
SUBSTANCE: one should analyze anamnesis, perform rational psychotherapy and curative psychotherapeutic impact in patient's active state. Moreover, one should diagnose individual disadaptive cognitive-behavioral style of patient's psychological reactions to negative factors, with the help of which the patient process these negative factors, and, also, accompanying mimics and pantomimics. At the first stage of curative psychotherapeutic impact one should develop adaptive patient's integrative reactions to negative factors being contrast against disadaptive and being ahead by time of appearance with the help of a card, in the left side of which there is a text containing information on detected disadaptive cognitive-behavioral style, and in its right-hand part - text that contains opposite information about adaptive cognitive-behavioral style. Moreover, left-hand part should be deleted, patient should repeat it impressively, in one's mind, by imaging negative images along with mimics and pantomimics of disgust, and right-hand part should be spoken expressively loudly by strengthening it with positive images and combining it with adequate pronounced mimics and pantomimics. After learning the text one should cut the left-hand part of the card ff and throw and keep the right-hand part. At the second stage one should neutralize disadaptive cognitive-behavioral style with physical exercises, manipulations and pharmacological preparations that lead to negative feelings. At the third stage it is necessary to prepare a patient to apply developed adaptive integrative reactions under conditions of modeling the contact with negative factors with the help of successively performed visualization and role trainings. Therapy course consists of 7-10 seances of 1-2 h duration.
EFFECT: higher efficiency of therapy.
FIELD: medicine, anesthesiology, resuscitation.
SUBSTANCE: after introducing depolarizing myorelaxants, before the stage of intubation one should introduce additional quantity of brietal, its dosage being 0.45 mg/kg. The present innovation enables to provide stabilization of hemodynamic parameters.
EFFECT: decreased risk of introduced narcosis.
13 dwg, 1 tbl
SUBSTANCE: method involves selecting signals showing patient consciousness level and following evoked auditory potentials as responses to repeating acoustic stimuli, applying autoregression model with exogenous input signal and calculating AAI index showing anesthesia depth next to it.
EFFECT: quick tracing of unconscious to conscious state and vice versa; high accuracy of measurements.
9 cl, 3 dwg
FIELD: medicine; therapy of neurosis, psycho-emotional disorder, hypertension and cardiopathy of different etiology.
SUBSTANCE: method of correction of psycho-physical condition of patient during sleep is based upon simultaneous influence of light and sound signals during period of sleep when patient has dreams. Light signal pulses are used with frequencies within 0,5-3,5 Hz. Intensity of influence of sound signals is chosen in such a way not to interrupt physiological dream. Light and sound signal influence is carried out during time interval being equal to full cycle of change in dream phases. Effective working range of sound signals is chosen within 1000-4000Hz frequency range. As sound signals, different music melodies can be used. Device has timer, pulse light signal source to generate pulses at frequencies within 0,5-3,5 Hz, sound signal reproduction unit, decoder for conversing sound signals from digital form to analog on and light and sound signal control unit made for controlling level of sound signals and form of their amplitude modulation as well as for setting time intervals for generation of light and sound signals at different modes of influence. Device can additional have sound signal store unit made in form of re-recording removable digital unit. Light and sound signal control unit can be made for selection sound signals followed by fixing during period of influence. Sound signals reproduction unit loudspeaker can have effective frequency range of 1000-4000 Hz. Red color light signal source can be used as a light signal source.
EFFECT: widened store of aids and means for correction of psycho-physical condition of patient.
10 cl, 2 dwg
FIELD: medicine, physiotherapy.
SUBSTANCE: at the first stage, one should affect with magnetic field upon vertebral reflexogenic areas - volar surfaces - located at colored plates as straps. At the second stage, one should affect with magnetic field upon the area of vertebral column that helps to improve psychoemotional state in patients.
EFFECT: higher efficiency of therapy.
2 cl, 1 ex
FIELD: medicine, narcology.
SUBSTANCE: the present method deals with forming negative conditioned reflex to alcohol due to hypnosis, impact onto reflexogenic areas and coding. Moreover, all the stages of therapy should be carried out individually by applying nondirective psychotherapy at every stage by making samples for disgust or neutral attitude to alcohol. At the first stage of therapy, one should perform individual psychotherapy directed for positive formulation of positive therapeutic result by a patient. Then comes a seance of nondirective psychotherapy and placebo-procedure to detect alcoholic dosages. At the second stage, one should perform individual psychotherapy directed for revealing the perspectives of new behavior, again it is necessary to carry out the seance of nondirective psychotherapy. At the third stage, one should conduct the seance of individual psychotherapy to detect new feelings in a patient followed by the seance of nondirective psychotherapy. At the fourth stage, after carrying out the seance of nondirective psychotherapy one should teach a patient to apply autogenic training directed for maintenance of desired state: a patient has the task to use alcohol at the dosage indicated by a patient at the first stage of therapy. Next day, at the fifth stage of therapy, one should control patient's feeling followed by the séance of nondirective psychotherapy, coding the dosed alcohol intake at the dosage indicated by a patient at the first stage of therapy, due to hypnotic impact by applying an aggressive phonogram with possibility to remove the code by a patient himself/herself. Simultaneously, it is necessary to affect cerebral reflexogenic areas with impulse current and closed eyes with light impact, and, also, the impact with odor. Then comes the task for a patient to drink alcohol in the dosage indicated at the first stage of therapy for 2-4 mo and perform maintenance therapeutic seance and that of autogenic training. Moreover, reflexogenic impact should be performed for the following cerebral points: Bai-khuey, Bai-shen', Chen-lin, Nao-kun, Pan-lyan'-tsuan'. Code removal should be fulfilled due to an inert safe substance as a capsule or a tablet of strange shape and color. Seance of maintenance therapy and autogenic training should be carried out with the help of laser disc or audiocassette labeled with the same odor applied earlier during patient's coding.
EFFECT: higher efficiency of therapy.
3 cl, 3 ex
FIELD: medicine, psychotherapy.
SUBSTANCE: while analyzing patient's anamnesis and psychological peculiarities it is necessary to diagnose individual disadaptating cognitive-behavioral style by detecting peculiarities of its concepts, tendencies and associations to conduct rational psychotherapy. One should form the motivation to alternative behavior and hypnotherapy, moreover, to exclude possible resistance the procedure of hypnotizing should be suggested for a patients as exercises on creativity development. Moreover, at the first stage of hypnotherapy, a patient should be put into the stage of hypnotic trance due to tasks imitating creative self-studying and causing cognitive exhaustion and provoking the process of auto-suggestion of hypnotic phenomena. Out of them, the phenomena corresponding to the deepest stage of hypnotic trance should be induced with suggestion of support disappearance due to suggestion to imagine the light flow coming from beneath and replacing this support followed by visualization of more distanced images. At the second stage, one should perform hypnosuggestion of adaptive cognitive-behavioral style, for deepened curative impact it is useful to imitate the contact with patient's subconscious "ego" part by applying contact technique with touching patient's head with a hand and, due to earlier obtained diagnostic information. One should speak on behalf of subconsciousness on complete understanding the causes of present problems, agreement to refuse from disadaptating concepts and tendencies. Then one should finally fix adaptive cognitive-behavioral style by suggesting the patient to accept it completely. At the third stage one should perform dehypnotizing and fix curative information with patient's subconsciousness by causing amnesia of a seance. Therapy course includes 7-10 individual seances at duration of 1-2 h followed by dynamic survey. If necessary, one should fix the effect obtained due to maintenance seances. The method enables to overcome patient's latent resistance to the process of hypnotic induction to teach a patient to apply auto-hypnosis, meditation or deep relaxation.
EFFECT: higher efficiency of therapy.
SUBSTANCE: device comprises gaseous and/or colored insertions formed by additives, in particular potassium bicarbonate and/or rare-earth metal oxides.
EFFECT: enhanced efficiency of prevention and correction of psychogenic diseases.
SUBSTANCE: method involves specifying disease stage, determining suggestibility degree, programming on abstinence from alcohol consumption for a 6-12 months long period the patient determines on the own free will. Treatment is administered with bipolar electric asymmetric current pulses of 3-5 mA being applied on the background of relaxing melody later on in reanimation room. Assurance in overcoming difficulties of life and becoming free of alcohol addiction is suggested on this background. Placebo is concurrently intravenously administered as drop infusion imitating coding preparation as alcohol receptor blocker. Suggestive accentuation is concentrated on possible complications caused by alcohol consumption after introducing the preparation. The aversion against alcohol is invoked by making drop infusion of medicament mixture causing fever sensation and myorelaxation. The patient swallows 2-3 gulps of alcohol and the provoked responses are associated to them with a cause-effect relation like alcohol-bad health state and fixed with intramuscular placebo injection simulating oil code preparation.
EFFECT: enhanced effectiveness of treatment; prolonged remission period.
FIELD: medicine, psychotherapy, amending and medicinal psychology, in particular, treatment of neuroses and posttraumatic stress disturbances.
SUBSTANCE: method involves introductory stage including collection of data and analysis of anamnesis, social development and bringing-up conditions, children and parents relations, emotional response to stress of burned children; finding out trauma nature and start training lessons with child; establishing confidential relations and contact with child; providing diagnosis of psychological, physical and intellectual development of child; determining child's extent of readiness and form of participation in training, purpose of training; preparing playing zone with fire safe conditions; constructing and modeling together with child articles imitating match box and matches; measuring pulse rate; basic stage involving doing exercises using two construction-modeling articles simulating match box and matches by modeling controlled actions, namely,: taking match box from table by one hand, opening match box by other hand, withdrawing match from box and closing match box; turning match box so that its side surface is oriented upward; abruptly, with application of pressure, moving match against side surface of match box away from yourself; holding match in horizontal position for 10 s after ignition of match with gradual bringing of match holding time to 30 s; extinguishing fire; informing about function and designation of article while pointing out positive and negative features of "fire"; discussing feelings connected therewith and watching child's state by controlling his breath; creating "fairy" atmosphere of candle ignited by specialist upon receiving child's consent for switching and presence of negative stimulus-fire of candle during training; final stage involves confidence-conciliation agreement between specialist, parent and child and discussing observation of its terms; extinguishing candle fire; controlling child's pulse rate; providing similar manipulations by bringing burning match to candle fixed in holder; teaching safe blowing-in of flame at safe distance or by closing with cap; bringing burning match to piece of paper lying on tray and extinguishing flame by water; teaching more complicated actions to bring fire handling skills to automatic extent; controlling level of acquired knowledge in fire handling and approving child's actions by granting "diplomas" for successful results.
EFFECT: increased efficiency in forming stress-overcoming behavior, reduced traumatism and provision for recovering of motor function.
FIELD: medicine, psychiatry, psychotherapy.
SUBSTANCE: the present innovation deals with carrying out dietotherapy and psychotherapeutic impact in the course of group seances. Moreover, the main psychotherapeutic impact should be performed during two seances per 8 h each, each due to marathon technique under asthenization conditions, biorythmical misfunctioning and behavioral stereotypes. Motivation should be elaborated for patient's healthy nutrition along with self-confidence and belief into success. Program for losing body weight should be developed to visualize and concretize therapy. Diary for nutritive behavior should be written, psychological protection should be performed in case of affected dietary situation. After the main seances one should carry out psychotherapeutic impact during one seance of 3 h duration in 1 or 3 mo. During seances the results obtained should be fixed by discussing and excluding situations provoking obesity relapse. The method enables to prolong duration and stability of remission.
EFFECT: higher efficiency of therapy.
SUBSTANCE: the present innovation deals with the ways to treat alcoholism, narcomania, tobacco smoking, obesity, sexual disorders, gambling-mania and others. Videopicture contains either one or two additional exposures, the 25th and 26th, correspondingly, each of them contains verbal information of either prohibiting or encouraging character and depictive information that corresponds to the character of verbal information. Moreover, at first, it is necessary to show the 25th exposure only, then - the 25th and the 26th exposures together, then again - the 25th exposure only. Duration of seance for videopicture watching should last for about 20-40 min. The method enables to perform less severe impact upon a patient.
EFFECT: higher efficiency of therapy.
FIELD: medicine, in particular, narcology.
SUBSTANCE: method involves using computer as apparatus for displaying on monitor screen of brain colored images reflecting at least two states of brain: before coding by separating portions colored with yellow, green and blue colors and tints thereof reflecting increasing extent of brain affection, and after coding by separating big portion of bright-red color on the background of portions colored with yellow, green and blue colors and tints thereof, respectively; explaining to patient that portion of bright-red color is his dominant code resulted from treatment; before coding procedure, applying and fixing on patient's forehead electrodes simulating elimination of brain potentials; in the course of coding, exposing patient to light flashes with switched-off common illumination and to continuous acoustic signals generated by means of acoustic synthesizer; during coding procedure, exposing patient to light flashes issued from, for example, stroboscope, said light flashes being emitted at frequency of 1-3 Hz; providing immediate suggestion by means of microphone and telephone headsets electrically connected to microphone and secured on patient's head. Method allows preliminary treatment procedure to be avoided.
EFFECT: increased therapeutic effect.
4 cl, 3 dwg, 1 tbl
SUBSTANCE: method involves carrying out physiological examination with electroencephalogram recorded. Cognitive evoked potential method is additionally applied as neuropsychological examination for detecting hard and latent organic brain lesions causing central nervous system pathological disorders. An additional psychophysiological examination is carried out with vision analyzer test, visuomotor response test being applied for obtaining estimations of selection, discrimination, noise immunity and muscle endurance index, movement coordination, response to moving object and integral estimation of attention and ability for perceiving significant information, motor analyzer rapid response production estimation, estimation of nature of cardiovascular system response to given psychoemotional loading estimation. The examination is sequentially carried out as primary control when hiring personnel, as intermediate control in following a training course and emergency training. Psychological testing is of multi-purpose nature. To achieve it, a set reliable tests and methods of prognostic and substantial validity are applied, including intellect and project-building tests and standardized self-reports. When making decisions concerning professional validity based on test and examination results, risk group is selected from operation personnel.
EFFECT: enhanced effectiveness of occupational skill assessment.
FIELD: medicine, human weight correction.
SUBSTANCE: while elaborating self-realization formula a dietologist should develop weight correction mode for a patient during certain period of time without health deterioration. A psychotherapist should detect several targets for weight correction followed by psychotherapeutic seance by applying neurolinguistic programming. For this purpose, a patient should provide picturesque and detailed description of desirable function. Moreover, a psychotherapist detects positive, emotional and autonomic manifestations to form conditionally reflector relationship due to tactile contact. Under supervision of a psychotherapist due to suggestion technique a patient should imagine "a part of personality" responsible for weight correction. Then his psychotherapist has communication with mentioned "part of personality", arouses patient's attention to desirable result and fixes elaborated conditioned reflex. Then a psychotherapist illustrates communication with physical feelings that correspond to either negative or positive answer and their appearance in "a part of personality". At establishing tactile contact a psychotherapist suggests to choose new ways of behavior directed onto weight correction, obtains agreement from "a part of personality" to take care of this very function, which a psychotherapist should monitor by physiological manifestations and fix with conditioned tactile contact. A patient suggests new ways of alimentary behavior, analyze them and choose not less than 3 really achievable ones and "a part of personality" is responsible for automatic implementation of these new ways of alimentary behavior in patient's next life and at achieving positive answer from "a part of personality" sйance of psychotherapy should be finished by returning a patients into awakening state. Moreover, one should prescribe a diet at decreased caloricity of 800-900 kcal during the 1st mo, then - 1200 kcal for another month with subsequent achieving its value to correspond to normal body requirements. Psychotherapy lasts for 3-4 seances in 3-5 d at repeated maintenance therapy in a month, 1 seance. The method enables to achieve stable weight decrease during preset period of time for prolonged terms.
EFFECT: higher efficiency of weight correction.
1 cl, 1 ex
FIELD: medicine, anesthesiology, intensive therapy, surgery.
SUBSTANCE: the present innovation is suggested to correct anesthetic therapy in postoperational period. One should apply a modified visual-analog scale of pain on which patient should mark independently his (her) pain feelings by fixing them on vertical sections of the above-mentioned scale of pain every 2 h during the day, then doctor should plot an algogram of daily fluctuations of patient's pain feelings to analyze them for estimating the strength of pain feelings and adequacy of analgetic therapy conducted; and by taking into account the data obtained to conduct correction anesthetic program next day. The present innovation enables to adequately evaluate patient's pain feelings in postoperational period for subsequent performing adequate preventive analgetic therapy of pain syndrome, that, in its turn, enables to prevent pathological postoperational syndromocomplex.
EFFECT: higher efficiency of correction.
2 cl, 3 dwg, 1 ex
FIELD: medicine, cardiology.
SUBSTANCE: the present innovation includes hypolipidemic diet. Additionally, in the state of meditation one should induce the feeling of thermal disposition in intestinal area due to autosuggestion spirally starting from dextral ileal area and performing about 3-5 circles clockwise, only by narrowing the radius of movement towards navel's area, then about 3-5 circles clockwise by widening the radius of movement against initial circumference. Then one should similarly work with feelings of colic pains and cold. Moreover, autosuggestive impact should be carried out twice daily for 30-40 d, and then - once daily every other day to maintain cholesterol level at normal value. The method enables to treat hypercholesterolemia in patients despite cholesterol level.
EFFECT: higher efficiency of therapy.
1 cl, 1 tbl
FIELD: medicinal cosmetology.
SUBSTANCE: at first, one should perform target psychological tuning up for the work with a certain patient. Then, at the fist stage it is necessary to remove articular blocks, relax muscular-ligamentous apparatus of body joints with light swingings of patient's head and limbs. Moreover, one should apply long smoothing movements for limbs. The first stage should be finished with respiratory exercises. Then comes relaxing massage of jugular area and hands, plastic impact upon facial fasciae and muscles, massage of biologically active points and linear facial massage. Then one should do the complex of strengthening exercises for the neck and face. At the same time, one should concentrate patient's attention upon coming feelings in jugular and facial areas. Complex of strengthening exercises for the face and the neck should be performed every day. The present innovation enables to maintain daily tonicity of facial myofascial layer well.
EFFECT: higher efficiency.
1 cl, 4 ex
FIELD: medicine, thoracic surgery, anesthesiology.
SUBSTANCE: as non-narcotic medicinal preparation one should apply heparin to be introduced intratracheally at the dosage of 300-500 IU/kg, moreover, heparin should be introduced during the first 30 min after the operation is over. The present innovation enables to create prolonged anesthetizing effect in combination with prophylaxis of postoperational thrombohemorrhagic complications due to heparin capacity to be kept in the body due to its accumulation by mast cells at blockade of their fermentative activity followed by its gradual release into the blood.
EFFECT: higher efficiency.
1 cl, 1 ex, 3 tbl
SUBSTANCE: method involves doing complex of physical training exercises on the background of medical rehabilitation treatment. First, dominant hemisphere is determined. Next, exercises are done expanding in turn over higher and higher levels of the nervous system beginning from homolateral movements of extremities. Then, heterolateral movements are done with extremities: first, without crossing median line of the body and then with shoulder girdle rotation to one side and pelvic girdle to the opposite side ending in movements crossing the median line. Then, the heterolateral movements are combined with eye movements and functional loads upon the hemispheres. Infinity sign drawing is carried out in the air with the right hand, left hand and with both hands, following the imaginary drawings with eyes and transferring center of gravity from one leg to the other one. Then, symmetrical figures are drawn simultaneously using both hands. Then, autotraining exercises are done consisting in creating and fixing in memory image of both working hemispheres.
EFFECT: enhanced effectiveness of influence exerted to both hemispheres in activating interhemispheric links and restoring injured cortical functions.
8 dwg, 2 tbl