Резюме. У статті розглядається дуже важливе питання інтеграції онлайн-навчання у вищих навчальних закладах. У зв’язку із розвитком пандемії задля забезпечення карантинного режиму усі навчальні заклади було переведено в режим онлайн-навчання з використанням онлайн-платформ, таких як ZOOM, Microsoft TEAMS, Google Classroom та інші. Проаналізувавши світовий досвід навчання у різних університетах, зокрема і в медичному університеті, ми побачили, що у Європі наші колеги-викладачі давно практикують змішаний тип навчання. А саме: частина лекцій та семінарських занять, усі домашні завдання, атласи, книги, відеоматеріали та відеолекції студент отримує у своєму особистому кабінеті або класі (який знаходиться на серверах університету). Викладачі мають доступ до цих особистих кабінетів та можуть відстежувати прогрес студентів, а саме: кількість опрацьованого матеріалу, чи переглянуті відео повністю, чи здані домашні завдання, чи вирішені тести. Практична частина, а саме відпрацювання певних навиків, які є необхідними кожному студенту-медику у своїй майбутній медичній практиці, відбувається циклом у різних відділеннях та лікарнях. Така схема змішаного навчання дозволяє студентові опрацьовувати теоретичний матеріал у зручний для нього час. Українські університети до періоду пандемії були виключно на офлайн формі навчання. І, на жаль, в умовах жорсткого карантину, реалізувати змішану форму навчання вкрай важко, зважаючи на певні загальнодержавні обмеження. Існувала така ймовірність, що студенти-медики продовжать навчання онлайн з осіннього семестру. Було б доцільно з боку керівництва першочергово провести детальний та ретельний інструктаж щодо освоєння онлайн-платформ для якісного проведення пар, лекцій чи семінарських занять.

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

Currently, the elderly and senile account for 10 to 25% of all hospitalized for acute calculous cholecystitis. High operative-anesthetic risk, concomitant diseases and low resistance to surgical trauma are the cause of high frequency of postoperative complications and fatalities in this category of patients. In recent years, a reduction in postoperative mortality in acute cholecystitis, which is currently 0.28-2.9%, with gangrenous cholecystitis, it is higher to 17.8%. The aim of the study is to analyze and develop a rehabilitation program in the postoperative period in elderly and senile patients after surgery with acute calculous cholecystitis. Materials and methods We conducted an analysis of surgical treatment of 53 elderly and senile patients with acute calculous cholecystitis. In all patients, this diagnosis was confirmed intraoperatively and histologically. The age of all patients ranged from 61 to 89 years (mean 72.4 ± 8.7 years). Among the examined sick men there were 12 (22.6%), women - 41 (77.4%). The main criteria for assessing and creating a rehabilitation program in patients after surgery with acute calculous cholecystitis were the following processes: improving the general condition of patients, restoring intestinal motility, restoring or improving all impaired cardiovascular and respiratory functions, prevention of general complications (cardiovascular, respiratory, urinary, digestive and other systems), local (from the wound), normalization of blood parameters, One of the important components of successful surgical treatment of patients in the postoperative period is the timely restoration of respiratory, cardiovascular, digestive system after surgery. a guarantee of prevention of probable postoperative complications which are formed in the first 3-5 days after surgery. Objectives of the rehabilitation program in the early postoperative period in elderly and senile patients with acute calculous cholecystitis: to reduce the impact of drugs and accelerate the excretion of toxic substances from the body; restore adequate respiration and oxygen saturation; improve external respiration function, bronchial patency and bronchial drainage function; stabilize central hemodynamics to reduce peripheral circulatory disorders; prevent complications from the gastrointestinal tract, thromboembolic complications; prevent complications from the postoperative wound. Conclusions: Development of a rehabilitation program is a mandatory component in operated patients. Particular attention is paid to elderly and senile patients, who require a set of rehabilitation measures to be minimal, but sufficient to restore lost or reduced body functions in the early postoperative period, but at the same time, it should not exceed the patient's capabilities and ensure maximum efficiency. restoration. Start a rehabilitation program (breathing exercises, kinesiotherapy, massage, inhalation in combination with physiotherapy procedures) should be 12 - 16 hours after surgery. Prospects for further development Continue to develop a rehabilitation program for elderly and senile patients, taking into account the functional capabilities of the body in the long period of rehabilitation.

The history of the development of occupational therapy from the beginning of its establishment due to changes in different views of the formation of the essence of occupational therapy intervention is considered in the article. However, mostly occupational therapy as a separate specialty was formed after the Second World War, when society faced the problem of a large number of young people who became disabled as a result of hostilities, and the urgent need for their rehabilitation. These people needed to be re-taught both self-care and social adaptation, as such people often developed depression, which complicated not only the possibility of their recovery, but also the lives of relatives and friends of such patients. In 1952, the World Organization of Occupational Therapists was established, and in 2016 its members became representatives of 92 countries. There is a wide network of centers and a large number of occupational therapists in Western Europe, the United States and Canada. In Ukraine, occupational therapy as a separate specialty appeared at the beginning of the XXI century, as a separate specialty "physical therapy and occupational therapy" in Ukraine registered since 2015, the first master's program for students majoring in "occupational therapy" in Ukraine introduced at the Ukrainian Catholic University, later the training of occupational therapists began in other Ukrainian universities, including Ivano-Frankivsk National Medical University and the National Medical University named after Bogomolets. The Ministry of Health of Ukraine also recommended to involve students majoring in "Physical Rehabilitation" and "Physical Therapy, Occupational Therapy" in the practice of hospitals in Ukraine. Modern views on occupational therapy are based on a scientifically sound level and cover the main areas of human life: "man, environment, occupation." Training of occupational therapists in Ukraine should be carried out taking into account all requirements and standards, this will promote the formation of highly qualified specialists, and practical experience and research in this field will in the future develop occupational therapy at a professional level. Occupational therapy techniques in habilitation and rehabilitation - is the development, restoration and maintenance of functional capabilities of the child, which are necessary to perform important actions. Occupational therapy is used in various spheres of human life and is an important part of modern rehabilitation programs. The history of occupational therapy is a constant change in the system of views on the essence of occupational therapy, which goes hand in hand with scientific and technological progress, social events and the challenges they cause. The modern development of occupational therapy is important, scientifically sound, based on evidence-based practice, and covers the main areas of human life - Man-environment, occupation. Training of occupational therapists in Ukraine should be carried out taking into account all the characteristics of modern occupational therapy, which will promote the formation of highly professional specialists, and the accumulated experience of practical and scientific activities in this field of knowledge in the future will certainly enrich world science.