Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.042-048 meta

Abstract

Purpose is to develop and test an approach to the improvement of automated electrocardiogram (ECG) computer analysis systems, which increases physician productivity.

Materials and methods. The existing prototype of the ECG computer analysis system developed by the authors is used as materials. Dynamic time warping (DTW) method, as well as structural and object-oriented software development techniques were used.

Results and discussion. The main idea of improving automated computer-assisted ECG analysis systems is to provide the doctor with convenient software tools that allow you to: set various templates for QRS complexes; select templates and automatically find QRS complexes in ECG that are most similar to the selected template. The main result of the work is an algorithm that allows to quantify the degree of similarity of a QRS complex isolated from an ECG and a given pattern. The algorithm is based on the DTW method. The proposed improvement was tested when modifying the existing ECG computer analysis system. As a result of the modification, convenient interactive tools were added to the system, which allow the doctor to navigate the QRS complexes while viewing the ECG, taking into account their degree of similarity to the selected template. This gave the doctor the opportunity to quickly assess the patient’s condition and make a conclusion.

Conclusion. The proposed approach allows you to modify the automated computer-aided analysis of the ECG in order to increase the productivity of the doctor.

Keywords

ECG, ECG annotation, QRS complexes, method DTW, automated ECG computer analysis system.

For citations

Muromtsev V.V., Nikitin V.M., Efremova O.A., Kamyshnikova L.A. Approach to Improving the Automated System Computer Analysis of the Electrocardiogram. Medical Technologies. Assessment and Choice. 2019; 2(36): 42–48.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.035-041 meta

Abstract

The concept of a unified territorial approach to improving the quality and safety of medical activities (QSMA) in the Republic of North Ossetia – Alania through the implementation of the «Quality Management and Safety Program of Medical Activities» (Program) and the creation of the «Road Map» is disclosed in present article. The main leitmotif of it is to consistently increase the information-legal, educational-motivational, clinical, control-administrative and organizational components of a systematic approach to improving QSMA in all medical institutions (MI) of the region. The program is designed to create conditions for the formation of a new type of MI in the framework of the implementation of the national «Healthcare» project in the region and the training of specialists – QSMA managers.

Keywords

quality management, safety, medical activity, unified approach, program.

For citations

Karsanov A.M., Astakhova Z.T., Gogichaev T.K., Tuaeva I.B., Remizov O.V. The Concept of a Single Territorial Approach to Improving the Quality and Safety of Medical Activities on the Example of the Republic of North Ossetia – Alania. Medical Technologies. Assessment and Choice. 2019; 2 (36): 35–41.

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.024-034 meta

Abstract

Government spending are the basic of the health economics of any developed countries. We are overwhelmingly confident that an increase in the financing of the health care system makes it possible to improve the population’s access to medical care, which, accordingly, it is reflected on an increasing quality of life and its duration. Undoubtedly, investments in the healthcare industry should lead to the creation of new jobs, the development and introduction of advanced medical technologies and innovative drugs into clinical practice. In recent years, in the Russian Federation, there has been a positive trend in the volume of funds allocated by the state to protect public health. The article is devoted to the study of possible factors causing this growth. The authors made an attempt to answer the questions whether the increase in health care costs is due only to the political will of decision makers at the federal level, whether unhealthy lifestyles of the country’s citizens affect health care costs, which primarily depend on the costs of health care resources and others. To answer these questions, the authors analyzed the behavior of individual indicators reflecting health care expenditures and population health indicators for the Russian Federation in comparison with the countries of the Organization for Economic Development and Cooperation (OECD) – Australia, Canada, Denmark, France, Germany, Japan, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA.

Keywords

health care costs, GDP share for health care, per capita health care costs, quality of care, expensive medical technologies, five-year survival, tobacco use, obesity.

For citations

Kuftova Y.V., Obukhova O.V., Bazarova I.N. Growth of Health Costs: Myths and Reality. Medical Technologies. Assessment and Choice. 2019; 2 (36): 24–34.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.050-055 meta

Abstract

Introduction. Modern health care is a leader in the social sector in terms of the number of public-private partnership projects. Monitoring of the implementation of strategic projects proves that the targets on the key indicators of the road map are reached. However, experts give a negative assessment
of the availability and quality of medical care.

Methods. The article describes the experience of using the balanced scorecard as an instrument for linking the key health care indicators and performance indicators of individual health facilities. Principles underlying cohesion and balance of the separate elements of the system are justified. Methods for identifying a statistically significant causal relationship between indicators are analyzed. A general model for the assessment of the attainment of the strategic goals by taking into account the three-level healthcare system is proposed.

Results. The presented details on the structure of indicators could be used by managers of health facilities for the development of their own strategies. The article concluded that further specification on the methodology of obtaining objective information to assess the success in health care strategic management is necessary.

Keywords

strategic management; efficiency; a health facility; evaluation; factors; balanced scorecard.

For citations

Dvojnikov S.I., Arhipova S.V. To the Problem of Increased Efficiency in Health Care Strategic Management. Medical Technologies. Assessment and Choice. 2019; 1(35): 50–55.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.043-049 meta

Abstract

The European region WHO policy on the prevention of non-communicable diseases, and also the development of national efforts to combat non-communicable diseases in the Russian Federation, are considered in the article. The strategic directions in the evolvement of the prevention of non-communicable diseases are described from the middle of the XX century until now. The relevance of scheduled preventive activities with the population and identification of effective ways to implement the prevention strategies, to diagnose at earlier stages and to reduce the impact of behavioral risk factors for the non-communicable diseases are justified. The need for further developments in the work on the formation of a healthy lifestyle, active involvement of each individual in the process of the formation of a responsible attitude to the health are proved.

Keywords

prevention of non-communicable diseases, risk factors, health promotion, the formation of a healthy lifestyle.

For citations

Zadvornaya O.L., Borisov K.N. Development of Prevention Strategies for Non-Communicable Diseases. Medical Technologies. Assessment and Choice. 2019; 1(35): 43–49.

Issue № 1 | 2019 (35)

DOI: https://doi.org/10.31556/2219-0678.2019.35.1.032-042 meta

Abstract

Clinical Decision Making Support Systems (CDMSS) are becoming increasingly popular in the wake of the introduction of information technology in medicine and the development of medical information systems. The potential benefits of using the CDMSS are forcing you to look for ways to create such a system that would allow you to solve not only clinical problems, but also analytical ones, planning tasks, training medical personnel, and digging new knowledge in medicine. It has been almost 50 years since the creation of the first MYCIN CDMSS, but the developers of such systems, the systems that provide intellectual support for clinical decision-making (ICDMSS), still face the problems of imitating reflexion and building an adequate inference machine that would provide the doctor with detailed explanations regarding proposed options for further action. This article is devoted to describing the experience of developing an algorithm for the operation of the solver of ICDMSS for diagnosing angina, which using mathematical methods would allow adequately evaluating the options offered to the doctor, as well as explaining them in detail using custom user stories.

Keywords

Angina pectoris, clinical decision making support systems, CDMSS, solver algorithm.

For citations

Kiselev K.V., Noeva E.A., Vyborov O.N., Zorin A.V., Potekhina A.V., Osyaeva M.K., Martynyuk T.V., Zarubina T.V. Development of a Reasoning Solver Algorithm for Instrumental Diagnostics of Angina Pectoris in Intelligent Clinical Decision Support System. Medical Technologies. Assessment and Choice. 2019; 1(35): 32–42.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.019-024 meta

Abstract

Taking into consideration growing attention to oncological problems in Russia concerns about statistical recording of malignant neoplasms are becoming important. The main sources of information on prevalence and morbidity of malignant neoplasms are discussed in the article. They are cancer registries, forms of federal statistical monitoring and registers of medical bills of medical care provided. The exhaustiveness of the data collection for specified sources are evaluated. Assessment is done to estimate the compliance of the data collected in Russia with recommendations of the International Agency for Research on Cancer. Improvements in statistical recording of malignant neoplasms were proposed including use of modern information technologies.

Keywords

oncology, malignant neoplasms, statistical recording, morbidity, cancer registry.

For citations

Semakova E. V., Ledovskikh Y. A., Tishkina S. N., Zheleznyakova I. A., Gerasimova K. V. Statistical Recording of Malignant Neoplasms in Russian Federation: Current Situation and Main Areas for Improvement. Medical Technologies. Assessment and Choice. 2018; 4(34): 19–24.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.028-035 meta

Abstract

The paper considers the issues of funding of medical organizations rendering outpatient primary medical care, and the assessment of availability of medical care for population depending on the financial resources of medical organizations.

Keywords

performance audit, medical organization, signed population, unique patients, compulsory medical insurance, capitation fee.

For citations

Budarin S. S., Elbek Yu. V. The Analysis of the Resources Used for the Activities of Outpatient Medical Organizations at the Level of Primary Medical Care. Medical Technologies. Assessment and Choice. 2018; 3(33): 28–35.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.036-041 meta

Abstract

The article highlights the history and stages of the formation of the «maxillofacial surgery» profile in the Moscow region. The structure of the service is currently examined in detail according to the new distribution of interterritorial municipal associations. This structure includes 5 specialized highgrade profile hospitals in 8 interterritorial municipal unions. The data on the hospital fund of hospital beds are given. According to the latest statistical data, resources indicators of the doctors of medical department maxillofacial surgeons are presented in comparison with other regions of the Russian Federation. Also in the article the scheme of routing of patients from the dentist of an out-patient reception of a medical institution to the maxillofacial surgeon MONIKI is indicated. The issue of interaction between treatment and prophylactic institutions of the dental profile with in-patient hospitals in the field of maxillofacial surgery is considered. In conclusion, priority directions for the improvement of the profile service in maxillofacial surgery in the Moscow region are formulated.

Keywords

maxillofacial surgery, the medical aid organization, routing patients, the rate of availability of maxillofacial surgeons.

For citations

Sipkin A. M., Kryazhinova I. A., Lapshin V. P. Priorities for Maxillofacial Surgery Improvement in the Moscow Region. Medical Technologies. Assessment and Choice. 2018; 3(33): 36–41.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.042-048 meta

Abstract

High urgency of healthcare informatization and features of the organization of medical and diagnostic process allow searching for the ways of maintenance of medical activity information support. One of such ways is the development of clinical decision support systems based on knowledge. Among the forms of knowledge representation, a semantic network is distinguished, structurally repeating the model of graph databases that have the necessary advantages for working with knowledge.

Purpose of the study. Development of the knowledge base architecture of the clinical decision support system for the instrumental diagnosis of angina pectoris based on the ontological approach, using a graph database.

Materials and methods. Extraction of concepts related to the diagnosis of angina pectoris was carried out from clinical recommendations concerning stable ischemic heart disease. The primary accumulation of knowledge and grouping of concepts by types was carried out in MS Excel; the elaboration of the types of connections between the highlighted concepts was carried out in the ARIS Express program. To form the knowledge base, a Neo4j graph database was used.

Results. From the clinical recommendations with the help of cardiologists, 401 root concepts and 619 synonyms were extracted, which were grouped by type of diagnosis, synonym, clinical sign, diagnostic test, diagnostic sign, laboratory test, medical personnel, location of the study. The groups of concepts were linked by means of links: parent-child, synonym, concomitant pathology, clinical sign, diagnostic sign, indication for the study, place of the study, person conducting the study, person interpreting the results of the study, person taking biomaterial sampling. To indicate the characteristic values, the graph database was used to fill the attributes of nodes and links, which made it possible to reduce the dimension of the graph. The created knowledge base was twice validated for the completeness and adequacy of solutions offered to the doctor using depersonalized electronic medical records of patients. The first validation returned incomplete compliance with appointments from electronic medical records, which made it necessary to refine the filling of the database with new knowledge. New knowledge was added to the database without the need to modify its architecture, after which the re-validation returned a complete match between the proposed and the actual assignments.

Conclusion. The use of clinical decision support systems based on the ontological approach using graph databases can be promising in terms of providing speed and explaining the proposed assignments. Properly organized architecture allows you to scale the knowledge base, and graph database features allow you to reduce the dimensionality of the graph, simplifying the work with knowledge.

Keywords

angina pectoris, clinical decision support systems, CDSS, ontology, clinical recommendations.

For citations

Kiselev K. V., Noeva E. A., Vyborov O. N., Zorin A. V., Potekhina A. V., Osyaeva M. K., Shvyrev S. L., Martynyuk T. V., Chazova I. E., Zarubina T. V. Development of Knowledge Base Architecture for Clinical Decision Support System Based on Graph Database. Medical Technologies. Assessment and Choice. 2018; 3(33): 42–48.