Врачебная оценка тяжести состояния больных с артериальной гипертонией и ее связь с частотой обращения за медицинской помощью по экстренным показаниям. Результаты исследования АФИНА
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
The ECG features analysis in a patient born in 1946 led to repeated statement of misdiagnosis, particularly of myocardial infarction. About 2,500 patients’s ECGshave been analyzed for the three-year period of the patient’s observation. A Fourier analysis of the spectra of the ECGs of the patient 2506 allowed to assume that there exists an additional leading center in his myocardium, with a variable start phase of the myocardium relative to the phase of the fundamental frequency of contractions of the myocardium. Experimental confirmation of this hypothesis is in particular; found in the patient jump-like transition from synchronous phase daily changes in the function dynamics of the P wave width and the PQ segment to the antiphase ones, which reflects the change in the conditions for triggering the process of myocardial contraction. As a result, the coupling of the two leading frequencies of the myocardium, with a variable phase shift of the triggering, can be expressed both in the extra systoles appearance as well as in unusual cardio cycles not coinciding in the form and phase of cardio cycles of a single ECG. Cluster analysis of the entire set of collected patient’s ECGs in the similarity of their forms revealed 18 separate clusters of similarity. While cluster analysis of the ECG samples in other 4857 patients in most cases led to the identification of only one cluster characteristic for a certain patient’s ECG form. Mathematical modeling of the proposed hypothesis about the presence of more than one leading center of myocardial triggering which resulted in getting model patterns of split ECGs, qualitatively corresponding to the split forms of ECGs observed in the studied patient, confirmed its validity.
The mass application of mobile cardiographs already leads to both explosive quantitative growth of the number of patients available for ECG study, registered daily outside the hospital (Big DATA in cardiology), and to the emergence of new qualitative opportunities for the study of long-term oscillatory processes (weeks, months, years) of the dynamics of the individual state of the Cardiovascular system of any patient.
The article demonstrates that new opportunities of long - term continuous monitoring of the Cardiov ascular system state of patients ' mass allow to reveal the regularities (DATA MINING) of Cardiovascular system dynamics, leading to the hypothesis of the existence of an adequate Cardiovascular system model as a distributed nonlinearself - oscillating system of the FPU recurrence model class . The presence of a meaningful mathematical model of Cardiovascular system within the framework of the FPU auto – recurrence , as a refinement of the traditional model of studying black box, further allows us to offer new computational methods for ECG analysis and prediction of Cardiovascular system dynamics for a refined diagnosis and evaluation of the effectiveness of the treatment.
The article includes the observation of the cloud services and technologies usage. The article contains a review of mathematical analysis of cardiac information using cloud technology, which produces storage, analysis and forecasting on the basis of owned data. In addition, the authors consider the possibility of integrating cloud technologies with external systems. The massive use of mobile devices for the removal of the electrocardiogram (ECG) leads to a quantitative increase of the patients number available for ECG investigation. Thus, there are new opportunities to research the oscillatory processes of long-term dynamics of the individual state of the cardiovascular system (CVS) of any patient. The article demonstrates new opportunities the long-term continuous monitoring of the patients CVS, which allows identifying regularities of the dynamics of the CVS. Also this article comprises the observation of the existence of an adequate model of CVS as a distributed nonlinear self-oscillating system of the class model returns the Fermi-Pasta-Ulam (FPU).
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.