Medical Issues Associated with Winter Survival Training

INTRODUCTION: During active phases of manned spaceflight there is a possibility of a spacecraft landing at any point traversed by its orbital path on the Earth. Survival training after emergency landing is an important and vital part of pre-mission preparations. In this paper we analyze medical issues associated with winter survival training in marshy and forested terrain.METHODS: From 2011 to 2019, 50 International Space Station crews participated in winter survival training. Crewmembers included Roscosmos, NASA, CSA, ESA, and JAXA astronauts, spaceflight participants, and instructors. Medical protocols and training final reports were analyzed for conditions and medical events.RESULTS: The health status of crewmembers during training was nominal. Temperature sensation was reported as comfortable or moderately cold during daytime and moderately cold or cold during nighttime. SpO2 (blood oxygen saturation) and heart rate recorded during training did not exceed normal values. SpCO (blood carbon monoxide saturation) generally was within normal limits. All participating crewmembers lost some bodyweight, from 0.15.5 kg (average 2.1 kg). Over the course of winter survival training there were 32 medical and environmental events requiring medical intervention. For two of the crewmembers requiring medical intervention, training was subsequently canceled.DISCUSSION: Winter survival training has successfully prepared spaceflight crews for the possibility of off-nominal landings in challenging terrain under adverse conditions. As this training involves high fidelity flight-like survival equipment and assigned flight crewmembers, the medical problems described here should closely reflect type and prevalence of events during an actual contingency scenario.Kireev KS, Grishin AP, Dowell GL. Medical issues associated with winter survival training. Aerosp Med Hum Perform. 2021; 92(8):676680.

Reliability Aspects in E-Health Pilot Experimentations

In many experimental research projects on e-health that make use of smart technologies (like Internet of Things and Artificial Intelligence), it is common (and good) practice to organize experimental pilot studies aimed at validating the proposed protocols and solutions. Such an experimentation however, is at the boundary of different disciplines, involve humans and it typically addresses a wide range of stakeholders (including medical specialists and patients). Furthermore, it is also dependent on several user-related aspects like acceptance, usability, ethics and on the specific common practices of the applicative domain. It is clear that this scenario poses several challenges that go beyond the typical challenges of experimentations that just focus on technology. The collection of requirements, for example, needs to address a variety of stakeholders, and in some cases the interaction with some of them must be mediated. The development of the required technology itself may be constrained by ethical requirements, and the planning of the pilot should also address the validation of the medical practice in the use of the developed technology and not just the validation of the technology itself, a fact that makes the technological design blurred with the development of the medical practice. Finally, the pilot themselves are exposed to human factors due to the involvement of end users. All these aspects may, in the end, impact on the reliability of the entire pilot. Taking inspiration from a recently concluded project comprising a relatively long experimental pilot that involved technologies developed on-purpose, humans and medical protocols, this keynote discusses the reliability issues arose during the pilots and their impact on the final evaluation of the project results.

Pszichoszomatikus tünetek és betegségek: a medicina vakfoltja

Összefoglaló. Bevezetés: A pszichoszomatikus medicina területéhez tartozó betegek ellátása rossz hatásfokú. Ez egyaránt jelentős terhet jelent a betegek és az egészségügy számára. Célkitűzés: A pszichoszomatikus tünetek és betegségek megjelenésének és ellátási ajánlásainak vizsgálata az irányadó hivatalos szakmai anyagban. Módszer: Az adatgyűjtés időpontjában elérhető 531 Szakmai irányelvből annak a 134 dokumentumnak a részletesebb elemzése, amelynek témájában pszichoszomatikus tünetek/betegségek gyakoribbak. Ebből 39 egyértelműen pszichoszomatikus vonatkozású anyag tartalmi vizsgálata, továbbá a Szakmai Kollégiumok listáján szereplő három pszichiátriai szakterület összes (26) szakmai irányelvének hasonló szempontú értékelése. Eredmények: A megvizsgált irányelvek töredéke tartalmaz csupán a pszichoszomatikus tünetképzésre, illetve kezelésre, megelőzésre vonatkozó megállapítást. A releváns témájú irányelvekben szereplő diagnosztikai utalások aránya: direkt 10,25, indirekt forma 23,7, a terápiás ajánlások között direkt 25,64, indirekt forma 15,38%. A megelőzésre vonatkozóan alig (5,12%-ban) szerepel említés, a pszichés betegségek egyidejű fennállásának esélyére is mindössze 10,25%-ban történik megállapítás. A szorongásos zavarok befolyásáról kevesebb, mint minden harmadik irányelv számol be (30,76%). A pszichiátriai irányelvek között pszichoszomatikus betegségekre vonatkozóan nincs célzott szakmai irányelv. Következtetés: A pszichoszomatikus medicina a hatékony betegellátás követelményeit meghatározó szakmai irányelvekben elégtelen arányban jelenik meg. Okait szemléleti zavarokban, a pszichiátriai szakmai konszenzus és a szakmaközi együttműködés hiányosságaiban kell keresni. Mind a vonatkozó kutatásokban, mind az irányelvek fejlesztése során erőfeszítéseket kell tenni a fentiek miatt kallódó nagy betegpopuláció hatékonyabb ellátása érdekében. A szerző javaslatot tesz a szükséges konkrét lépésekre. Orv Hetil. 2021; 162(7): 252–261. Summary. Introduction: The care of patients with psychosomatic disorders has bad efficacy. It beards hard both for the patients and the health care providers. Objective: Review of presentrecommendations for psychosomatic symptoms and illnesses in the recent Hungarian medical protocols. Method: A detailed evaluation of 134 medical protocols from altogether 531 protocols with closer connection with psychosomatic disorders were carried out, their diagnostic and therapeutic recommendations were analyzed. Further review of 39 (of the 134)directly related to psychosomatics was done. Investigation of psychiatric protocols for the same aspects was carried out, as well. Results: Only a small part of the protocols contain recommendations for psychosomatic disorders. Ratios of their presence: diagnostic – direct 10.25, indirect 23.7, therapeutic – direct 25.64, indirect 15.38%. Efforts for prevention are only in 5.12% of the materials and 10.25% of the protocols mention a possible dual nature of the given clinical manifestation. Anxiety disorders occur only in 30.76%. Psychiatric protocol directly aiming psychosomatic problems is lacking. Conclusion: Presence of psychosomatic medicine in clinical guidelines defining the conditions of successful care of patients is practically minimal. Possible explanations: confusion in approaches, lack of consensus among the psychiatric institutions, and deficiency of interdisciplinary cooperation. Both in relevant clinical research and in development of medical protocols common additive efforts are necessary for achieving a more successful care of high numbers of patients presently neglected because of the mentioned causes. Author advises some concrete steps for the solution. Orv Hetil. 2021; 162(7): 252–261.

Symptom Tracking and Experimentation Platform for Covid-19 or Similar Infections

Remote symptom tracking is critical for the prevention of Covid-19 spread. The qualified medical staff working in the call centers of primary health care units have to take critical decisions often based on vague information about the patient condition. The congestion and the medical protocols that are constantly changing often lead to incorrect decisions. The proposed platform allows the remote assessment of symptoms and can be useful for patients, health institutes and researchers. It consists of mobile desktop applications and medical sensors connected to cloud infrastructure. The unique features offered by the proposed solution are: (a) dynamic adaptation of Medical Protocols (MP) is supported (for the definition of alert rules, sensor sampling strategy and questionnaire structure) covering different medical cases (pre- or post-hospitalization, vulnerable population, etc.), (b) anonymous medical data can be statistically processed in the context of the research about an infection such as Covid-19, (c) reliable diagnosis is supported since several factors are taken into consideration, (d) the platform can be used to drastically reduce the congestion in various healthcare units. For the demonstration of (b), new classification methods based on similarity metrics have been tested for cough sound classification with an accuracy in the order of 90%.

A COVID-19 Multipurpose Platform

<b><i>Background:</i></b> Contactless symptom tracking is essential for the diagnosis of COVID-19 cases that need hospitalization. Indications from sensors and user descriptions have to be combined in order to make the right decisions. <b><i>Methods:</i></b> The proposed multipurpose platform Coronario combines sensory information from different sources for a valid diagnosis following a dynamically adaptable protocol. The information exchanged can also be exploited for the advancement of research on COVID-19. The platform consists of mobile and desktop applications, sensor infrastructure, and cloud services. It may be used by patients in pre- and post-hospitalization stages, vulnerable populations, medical practitioners, and researchers. <b><i>Results:</i></b> The supported audio processing is used to demonstrate how the Coronario platform can assist research on the nature of COVID-19. Cough sounds are classified as a case study, with 90% accuracy. <b><i>Discussion/Conclusions:</i></b> The dynamic adaptation to new medical protocols is one of the main advantages of the developed platform, making it particularly useful for several target groups of patients that require different screening methods. A medical protocol determines the structure of the questionnaires, the medical sensor sampling strategy and, the alert rules.

SARS-COV-2: Learning the Lessons from our Experiences, A Critical and Personal Review

The aims and objectives of this paper is to question established scientific thinking and medical protocols surrounding SARS-COV-2, stimulate debate, and consider alternative and more effective ways of screening and treating the severely affected patients which improve therapeutic outcomes and thereby reduce the complexity and cost of treating infected SARS-COV-2 patients. The paper argues that national quarantine or lockdown strategies among countries (as a preventive approach) exhibit many shortcomings and are based on a set of erroneous assumptions which enables the independently minded to consider alternative diagnostic and/or therapeutic strategies e.g. to quarantine only the ‘at-risk’ groups; which could be significant in the future. It raises for discussion a number of pertinent points e.g. (i) that the virus affects different patient groups in different ways; (ii) that the most severely affected who are at risk of death is currently the vast minority of the population, in particular those who are diabetic, obese and immunosuppressed; (iii) that chasing the virus using ‘test and trace’ methods should be augmented by advanced, remote screening methods to determine those in the most ‘at-risk’ groups who should be quarantined; and (iv) reviews the fundamental limitations of seeking only drug-based solutions instead of considering and focussing upon scientifically sustainable solutions based upon an understanding of the fundamental chemistry of biology.

RESEARCH ON THE EFFECTIVENESS OF THE INTRODUCTION APPROACH ON STUDENTS WITH MEDICAL PROTOCOLS

The aim of the investigation is by conducting a survey and analysis of the percentage of students with medical reports, to assess the effectiveness of the approach introduced. We have monitored the relative proportion of students with medical protocols to determine the effectiveness of an introduced approach. The study was conducted with 4194 students – 1624 men and 2570 women from the Faculty of Economics, the Faculty of Veterinary Medicine and the Faculty of Agriculture at Trakia University. Applied are the following methods: Theoretical analysis; Comparative analysis of percentages; Graphic analysis. We conducted monitoring, analysis and evaluation for 19 academic years of the relative proportion of students with medical protocols. The results confirm categorically effectiveness of the approach to students with medical protocols.