Remote monitoring of patients with chronic heart failure using blood pressure telemonitoring and ECG

Introduction. Remote monitoring of patients with chronic heart failure seems to be very promising in connection with a possible decrease in mortality as a result of the use of telemedicine technologies in the treatment of chronic heart failure (CHF). Materials and methods. Remote monitoring of the health of 997 patients with confirmed diagnoses of circulatory diseases complicated by CHF, aged 18 to 74, inclusive, living in rural areas, mainly in remote and hard-to-reach settlements of Uvatsky, Vagaysky, Nizhnetavdinsky, Tobolsky and Yarkovsky, was carried out. districts of the Tyumen region. Results. We studied the results of remote monitoring of blood pressure and ECG in 997 patients with chronic heart failure in rural areas for 24 months using various models of telemedicine support. In the «home» monitoring group (n = 316), patients independently recorded and broadcast blood pressure and ECG data; in the «office» monitoring group (n = 681), the same studies were performed by medical workers. Additionally, the presence or absence of patient complaints about the state of health at the time of the research was recorded. Conclusions. The organization and conduct of remote monitoring of the health status of patients with CHF using teleAP and teleECG in the «home» self-registration mode has an advantage over the implementation of such monitoring in a medical organization, which is reflected in a statistically significant decrease in the need for hospitalizations.

Healthcare in the smartphone: the situation in Russia

The purpose of the study was to analyze the popularity of mobile applications for health care in Russia. Material and methods. The app stores «App Store» of Apple and «Google Play Store» of Google were studied for comparative analysis. In case of The App Store we analyzed the categories «Medicine and Health and Fitness», in the Google Play Store – the categories «Medicine», «Motherhood and Childhood» and «Health and Fitness». The total amount of applications was 231. The reviewed applications were grouped into several groups and ranked in descending order of popularity. Results. The most popular applications by the number of downloads were applications from the group «Fitness and healthy lifestyle»: by individual positions – more than 1,2 billion. installations. On the second place was the group «Women's Health» with more than 285 million installations. The highest ratings of applications in the context of groups were received by services related to pregnancy control, evaluation of fetal and child development, as well as services for determining the symptoms of diseases. Conclusions. Thus, the most popular content for health care is the analysis of physical activity, regular diagnostics of the state of the body, monitoring of women's health indicators and monitoring the course of pregnancy, children's health.

Distance form of acceptance and commitment therapy for chronic insomnia minimization

Introduction. For the last year chronic insomnia is one of the most widespread sleeping disorders among the population in general. About 30-54% of population report about symptoms of insomnia and about 27% of them comply with diagnosis criteria of chronic insomnia. The aim of this article is to introduce Russian specialists to specificity of application of acceptance and commitment therapy in the treatment of chronic insomnia. Results. In this article for the first time, we show the limitations of distance forms of the ‘first’ and the ‘second’ wave cognitive behavioral therapy in the treatment of chronic insomnia. The aims, therapeutic targets, forms of holding acceptance and commitment therapy for chronic insomnia (ACT-I) are described in this paper. Transdiagnostic approach for support of patients with chronic insomnia is detailed on the example of integrative distance protocol of acceptance and commitment therapy with CBT-I by M. Chapoutot and L. Peter-Derex. This approach increases adherence to treatment, provides good remission and reduces the risks of uncontrolled using of hypnotic drugs, decreases insomnia symptoms and improves the quality of patient’s life. There is presented the innovated form of distance psychological examination of patients suffering from chronic insomnia and the accent is made on the features of somatic and cognitive hyperexcitation, mental flexibility and ability to suppress chronic disadaptive thoughts. We demonstrated specificity, efficiency and limitations of acceptance and commitment distance therapy existing in foreign practice and aimed for minimization of chronic insomnia in the structure of depression and chronic pain syndrome by P. Lappalainen et al. Conclusions. Current distance protocols of acceptance and commitment therapy for treatment of chronic insomnia in the structure of depression and pain syndrome demonstrate efficiency in increasing in sleep quality and duration, and also in decreasing of dysfunctional beliefs and attitudes related to sleep. Furthermore, therapy decreases symptoms of depression and significantly influences on thoughts suppression.

Economic aspects of telemedicine

Introduction. For the recent years telemedicine (TM) has been actively integrated into daily life, and its growth was especially significant during COVID-19 pandemic. However, its economic component has its own specificities depending on the health financing system. The aim of this article is to analyze reasons of economical inefficiency of TM technologies in different health financing systems and to determine its further development path in economic terms. Results. It’s not justified to expect cost reduction of health care after integrating TM technologies into medical practice. In private health-care system TM technologies in the form of TM consultation aren’t cost-effective for beneficiaries. Representatives of private clinics use TM as a part of lead generation. From private clinics’ point of view, it’s cost-effective to use distant monitoring technologies integrated into programs of patients’ management. It’s economically appropriate to apply all varieties of TM including TM consultation on the voluntary health insurance (VHC) system. However, due to the low prevalence of VHC in Russia we can’t expect significant growth of TM in Russia based on using this sector. Conclusions. TM technologies require financing in its formative stage, implementation, development and further functioning phases.

библиоVirtual reality (VR) in clinical medicine: international and Russian experience

Introduction. This article reviews an application of highly technological methods of virtual reality (VR) in clinical practice based on various studies and experiments of foreign and Russian researchers in recent years. The aim of this review is to demonstrate application of virtual reality technologies for further transformation of classical medicine into digital one. Materials and methods. There is significant growth of interest in the use of VR in medicine. Particularly, only in PubMed library such dynamics can be traced by using key words «VR technology in medicine»: in 2017 year there were 58 articles, in 2018 – 65, in 2019 – 106, in 2020 – 127, and currently in the first half of 2021 year there are already 145 articles. For this paper 37 articles from international journals and 28 from Russian ones were selected. The accent was made on the usage of VR technologies in different fields of clinical medicine, education of medical staff and patients. Results. In this paper we described wide range of experiments on using VR technologies during various medical manipulations such as diagnosis, planning of surgical interventions, cognitive therapy, pain management, preventing medicine and conservative treatment. Examples of successful clinical management of patients during rehabilitation and health maintaining were shown. Medical fields where VR is currently widely used were chosen, promising directions for further research were indicated. We also described opportunities of VR application for teaching medical staff. Conclusion. Nearly all researchers who applied virtual reality (VR) in clinical practice have come to similar conclusion. This innovative tool is a breakthrough in medicine and it has high potential for using it by physicians, patients and health care organizers. Authors have articulated issues which should be managed for further successful introduction VR technologies into modern clinical practice.

Rating of artificial intelligence startups: prospects for healthcare in Russia

Nowadays the work of the healthcare system tends to be based on the care about patient and one of the main goals is to reduce the cost of the service price. One of the steps to reach this goal is to adapt the work of the entire system to the current realities. In all market segments any optimization is based primarily on competent management. If it is necessary to neutralize economic losses, the solution is to work with big data using the machine learning, as well as in healthcare. The market of artificial intelligence (AI) in healthcare includes predictive analytics, image analysis and digital diagnostics. AI in the healthcare contributes to the optimization of the work of all medicine, from the assessment of laboratory parameters to the analysis of the workload of medical institutions. The top 10 of AI companies includes those from all segments of the market in the healthcare. At the same time, the first place is taken by the Webiomed project, which represents the predictive analytics sector. The second and third places are taken by companies offering products in the field of image analysis – Botkin.AI and Celsus, respectively. It should be noted that, according to the special developed criteria, representatives of the digital diagnostics segment are only at the 8th and 9th places. Based on the current data it becomes clear that nowadays the most promising companies representing the AI segments in healthcare are predictive analytics. At the same time, taking into account the analytical forecasts of the market size, there is a prospect for the predictive analysis segment, compared to the digital diagnostics image analysis segments.

Remote medical consultations for patients: what has changed in Russia in 20 years

Introduction. 2020 has sparked explosive growth in telemedicine, especially remote patient consultation and remote patient monitoring techniques. Materials and methods. The authors analyzed data from 169 articles from Pubmed and 47 articles from Elibrary.ru, 117 analytical reviews of Internet resources, Federal Laws on the keywords «remote patient consultation», «mobile applications for patients», «telemedicine», «pandemic». For this publication, 49 publications were selected, as well as the authors' own opinions and experiences. Results. Today remote consulting in Russia is used in the case of an initial consultation – a preventive appointment, referral to clinics, obtaining a second medical opinion with the possibility of prescribing additional examinations. Over the past 20 years, there has been an active growth in the development of remote consultations, long-term monitoring of patients' health, the introduction of mobile applications for monitoring vital signs of the body. An important point is the legal regulation of the provisions on the use of telemedicine technologies, however, it remains imperfect and requires improvement. The COVID pandemic has become a driver for the development of TM technologies in the state healthcare system. Conclusions. TM has transformed from conventional consultations to long-term (continuous) monitoring of health status using medical devices, which can be considered one of the most promising new areas with clinical efficacy. TM technologies are gradually becoming a familiar tool in clinical practice and may become routine for doctors and patients even after the end of the pandemic.

Weaknesses of artificial intelligence in medicine

Introduction. Recently, a large number of intelligent systems have begun to appear that are used to support medical decision- making – «artificial intelligence in medicine». Material and methods. The author of the publication also works on the issues of making medical decisions, and, being a doctor himself, in the course of his work and existing practice, discovered a number of important issues that he considered necessary to share with the professional community. Results. In some cases, the demonstration of the successful operation of the software in the declared characteristics (sensitivity, specificity) occurs only in the «reliable hands» of the developers and on the data that underlie the software. When attempting to demonstrate performance in clinical situations, the claimed characteristics are often not achieved, so the clinical community that must use this AI-based solution does not always form a favorable opinion. The author considers various types of errors that can be fatal in making medical clinical decisions – distortion of primary medical knowledge, lack of knowledge or inaccurate knowledge about the subject area, social distortions. Conclusions. When developing solutions based on AI, it seems important to keep the above points in mind for both developers and users.

Remote cognitive behavioral therapy for tinnitus and Meniere's disease

Introduction. Telemedicine for tinnitus and Meniere's disease can be implemented at various stages: diagnosis, initial clinical and psychological assessment, long-term follow-up and online support, cognitive-behavioral therapy protocols with support for virtual reality and mobile applications. Material and methods. A search, analysis and systematization of literature was carried out in the PubMed, e-library and Google Scholar databases using the keywords «cognitive-behavioral therapy», «Meniere's disease», «monitoring», «tinnitus» – a total of 117 sources, of which for writing the article were selected 16. Theses and their abstracts, as well as conference abstracts were excluded from the analysis. Results. The article describes the structure, specificity, forms and effectiveness of the use of distance cognitive-behavioral therapy protocols in audio-vestibular rehabilitation using the example of chronic tinnitus (tinnitus), hyperacusis and Meniere's disease. The mental phenotypes of patients with tinnitus are highlighted, which makes it possible to build a personalized approach to treatment that reduces the risks of developing a refractory course. The psychotherapeutic strategies used in the treatment of tinnitus are systematized. The tactics of remote clinical and psychological examination of patients with tinnitus to identify psychotherapeutic targets are presented. Conclusions. Cognitive behavioral therapy (CBT) has been shown to be moderately effective in reducing noise-induced irritation and stress in these patients. Distance learning CBT protocols are currently being viewed as an «alternative» to face-to-face treatment.

Evolution of dynamic bioradiotelemetry: key historical events

Introduction. The intensive development of medical science in the XX century required the development of fundamentally new approaches and methods for assessing body functions during free movements and various activities. This led to the emergence of dynamic biotelemetry via radio. Objective. To study the main points of the dynamic biotelemetry formation, characterizing the role and contribution of individuals and groups. Material and methods. The research are based on an evolutionary approach; methods of analysis, synthesis, systematization, as well as the problem-chronological method of historical knowledge are used. Results. The first system of biotelemetry via radio proposed by A.A. Yushchenko and L.A. Chernavkin in 1932. The system has been successfully tested in experimental physiology. Comprehensive development of technologies and methodology of bioteleme- try was carried out in the 1960-1970s by group led by V.V. Rosenblat. A classic "triad" of research objectives was form. The “triad” became the methodological basis of scientific research in the field of biotelemetry. In the course of hundreds researches (carried out using biotelemetry) in the field of normal and pathological physiology, a huge amount of new information has been accumulated. Methods of dynamic biotelemetry of V.V. Rosenblat are widely distributed throughout the world. Conclusions. Biotelemetry was very important for space exploration programs, physiological studies of athletes, as well as for occupational medicine. Thanks to this technology, new directions of knowledge have been form. Two key historical events that led to the development of biotelemetry happened in 1930-1932 and 1960-1970 years.