Anti-depression video game and patient-specific screening. Best doctors tell about their work

June 21
Healthcare

This year, six teams of medical organisations of the Moscow Healthcare Department have been awarded by the Moscow Government for medical achievements. Doctors were given RUB 1 million for the best scientific and practical developments and innovative projects. Mos.ru article tells about their contribution to medicine development, sustaining and saving patients' lives.

Early cancer diagnosis 

Team of the Scientific and Practical Clinical Centre for Diagnostics and Telemedicine Technologies were awarded for the development and implementation of low-dose CT lung cancer screening. The method allows detecting tumour foci sized 6 mm and more and thus diagnose the disease at its early stages.

Experts have also proved that artificial intelligence can be used to control the screening quality. The program analyses the screening texts and finds possible errors in reports. In addition, these images are used to train artificial intelligence algorithms. At the same time, CT scans are connected to the unified radiological information system that enables experts to observe the screening process and helps doctors to avoid errors.

Sergei Morozov: "We are able to detect lung cancer at early stages by 40 percent more often now".

Director of the Scientific and Practical Clinical Centre for Diagnostics and Telemedicine Technology

"Until recently, it was practically impossible to detect lung cancer at its early stage. Usually the disease was diagnosed at the third or fourth stages, when the tumour is virtually inoperable. Thanks to CT, we can now screen people without symptoms and detect cancer at its early stage, when the tumour can be treated with minimally invasive surgery and radiotherapy. The method preserves both the patient's life and its quality.

The results of recent studies prove that screening of patients at risk (people over 55 years and with over 30 years of smoking experience), lung cancer mortality rate can be reduced. This is a great achievement.

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This screening method has been developed by our team. To do this, we needed not only the equipment for the research, but also experts to interpret the results, and the information system connected to all clinic scanners. Thanks to it, we can see now all the research results, assess their quality, re-check polyclinic doctors' diagnoses,  with description templates helping to automate the process.

We have proved that early stage (stage 1 and 2) lung cancer is diagnosed by 40 percent more often now. These are figures that not achieved in any region of Russia. Over the two years of the project, lung cancer mortality rate among screened patients has decreased by 70 percent. That's really impressive: we have now a new early cancer detection mechanism. The earlier the tumour is detected, the easier and cheaper it is to treat. The quality of a patient's life is also preserved. Thanks to the treatment methods Moscow has now, a patient undergoing chemotherapy or radiotherapy can live a long life at various lung cancer stages, continue to engage in favourite occupation, and go in for sports. It depends on a patient's willpower and his or her disposition to treatment success.

But we are determined to continue our development and now we plan to integrate speech recognition technology into Moscow Unified Radiologic Information System  and Unified Medical Information and Analytical System, to create standardised data sets for training and testing artificial intelligence algorithms.

We also plan to expand the screening program. Muscovites who have reached the age of 55 will be notified that it is time to be screened for lung or breast cancer or the coronary calcium amount. We will send them invitation to screening via SMS, messenger or e-mail. Thus, we will determine those who really need screening. This is what we call patient-specific medicine.

Low-dose CT screening of lung cancer is available at 10 polyclinics. In the future, we expect to scale the method to all Moscow medical institutions. The screening programs are in demand in many regions of Russia: we have been approached by chief expert oncologists and radiologists, representatives of regional ministries to help in calculation of cost effectiveness indicators and determining necessary resources to launch it. Professional community realises that the introduction of screening programs helps reduce cancer mortality rate.

When every minute counts: emergency care for ischemic stroke patients 

Scientific group of employees of Davydovsky Municipal Clinical Hospital, Clinical Medical Centre of the Yevdokimov Moscow State University of Medicine and Dentistry, and Federal Centre for Cerebrovascular Pathology and Stroke Treatment have been awarded for the endovascular care system for ischemic stroke patients. Stroke treatment centres have been opened in Moscow, where patients are provided 24/7 assistance.

Yelena Vasilyeva: "Hundreds of saved patients"

Chief Cardiologist, Chief Physician of Davydovsky Municipal Clinical  Hospital

"In 2015, there were first international studies held that showed that endovascular care is the most efficient way to treat ischemic stroke patients. Out treatment methods have been promptly introduced into Class I European Storke Organisation Guidelines, which is quite rare. At the same time, we have joined the whole world in arranging the system of such assistance. To implement this program, the Moscow Healthcare Department has formed a working group managed by Professor Alexander Shpektor, where me and Moscow Chief Neurologist Nikolai Shamalov, Chief External Emergency Medical Care Expert Nikolai Plavunov, Chief External X-Ray Endovascular Diagnostics and Treatment Specialist Dmitry Skrypnik have developed the ischemic stroke care system.

Ischemic stroke occurs when one of the major arteries supplying the brain gets blocked by a blood clot. The blood flow is disturbed, the brain parts supplied with this artery start to die off. This can result in paralysis and speech disorders, and in the worst case scenario it ends in death.

A blood clot blocking a large artery must be removed as soon as possible, only then a patient gets a chance that the necrosis will not occur or will be minimal. In endovascular treatment, special tools are used to remove a blood clot from brain vessels.

The treatment is highly efficient. Should a surgery be successful, a person is able to recover speech and can move within a few hours. There are hundreds of saved patients. Without this method, the most seriously ill patients either died or became disabled for life.

Moscow boasts now a unique patient care system, due to active engagement of ambulance specialists (managed by Nikolai Plavunov) and the existing endovascular care system for heart attack patients. Among the available infarction vascular treatment centres, we have chosen those having at least two angiography machines. We have also trained endovascular specialists with extensive experience in the heart attack treatment. Thanks to this, nine 24/7 stroke treatment centres are now open. They boast coordinated work of neurologists, cardiologists, imaging specialists (CT and MRI diagnostics) and endovascular treatment.

The system is to be further expanded. I believe that the number of patients who underwent the surgery is to increase by at least five times in the near future.

Overtake the diver and fight depression: new mental health treatments

The award for the introduction of new technologies in diagnosing and treating brain disorders has been received by the team of Solovyov Scientific and Practical Psychoneurological Centre, Buyanov Municipal Clinical Hospital, Clinical Medical Centre of the Yevdokimov Moscow State University of Medicine and Dentistry and Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences (RAS). The specialists have conducted comprehensive studies in borderline mental disorders and epilepsy, and developed treatment algorithms. The practice includes advanced techniques, such as biological feedback, transcranial direct current stimulation, as well as gravitational medicine methods.

Renat Akzhigitov: "After our treatment course, almost 90 percent of patients return to work"

Deputy Director for the Medicine of the Solovyov Scientific and Practical Psychoneurological Centre

"We focus primarily on borderline mental disorders: depression, panic attacks, insomnia and other widespread disturbances. If timely and properly treated, patients recover and live a productive life. Our contribution to this work has been appreciated by such a high reward, as we have developed a multidirectional complex of therapy measures that has effect on not only mental health, but the entire body as well. If a patient has any concomitant somatic disorders, we treat them, too.

To treat mental disorders, we use not only drugs and psychotherapy, although we cannot do without it. We also use a wide range of non-medicinal methods and technologies, such as biofeedback, transcranial direct current stimulation and magnetic brain stimulation, neurofitness, aqua aerobics and much more. In a fairly short time, we are able to achieve very good results.

Biological feedback (BFB) is a special software that registers physiological parameters of a human body: pulse rate, heart rate, blood pressure, galvanic skin reaction. These parameters reflect the state of the autonomic nervous system, which regulates unconscious processes (blood pressure surges, sweating etc.). We say "I feel cold sweat or chills", "my heart is pounding", "blood rushes to my face". These are manifestations that cannot be consciously slowed down or activated.

The biofeedback technique is based on a software registering parameters and then displaying a corresponding image. It may be some landscape or a kind of video game. Or a diver controlled by a patient who swims at a certain speed. The more tense a person feels, the slower the diver's speed is, while the system-controlled diver swims at an average speed. If a person feels anxious, he or she lags behind the computer diver, but should a patient relax, he or she overtakes the diver. Or, let us take a picture of nature: if a person is tense, he or she sees a fuzzy image. The more the patient relaxes, the sharper and more beautiful this picture becomes.

Thanks to this technique, a person starts to realise how to relax, to regulate these seemingly uncontrolled body functions. As a result, a patient copes better with various life situations, depressions, anxiety and emotions.

Transcranial direct current stimulation and magnetic stimulation are two seemingly different methods, but they are very similar indeed. This is the effect of either a magnetic field or a certain frequency current on the brain points responsible for the emotional state, ability to concentrate, coordination,  quick response and so on. This effect is healing, it regulates and brings the brain's activity back to normal. Thanks to these methods, a patient needs less drugs to take and can achieve a positive effect in a shorter time.

We have been actively cooperating with the Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science. Now comprehensive studies are conducted to find neurochemical or neurophysiological causes of depression or other disorders. Translational stress reactivity and depression studies are carried out  on mice at labs.  Scientists record changes at the biochemical level responsible for stress and reaction development, the intensity of its expression, and the threshold when it becomes painful.

Treatment results of borderline mental disorders are difficult to quantify. There are no biological markers that, like a blood test, would show, for example, a decrease in the level of a parameter from 100 to 50. As a rule, a doctor and a patient assess it at the sensation level. That is, how a patient feels, how he or she perceives things and copes with life situations.

Should people of employable age without disabilities address us, almost 90 percent of patients return to work after our treatment. The rest of patients cannot return to work due to some concomitant somatic disorders.

On average, present day population is getting older, people live longer nowadays. At the same time, the older the person, the more various chronic diseases he or she suffers from facilitating people's depression, anxiety and insomnia. Older people make up the majority of our patients.

Thanks to the upgrading carried out by the Moscow Healthcare Department, our centre is very well equipped now, and we can treat both mental and somatic disorders.

Epileptology is an important area of our work. This is also a borderline field of medicine that at different times engaged psychiatrists and neurologists. Present day medicine is well developed in terms of epilepsy treatment, modern drugs provide proper control of seizures, promote achieving partial or almost complete remission. However, in some cases, despite of an appropriate treatment, the so-called therapy resistance persists. It means that a patient still has epileptic seizures. When all conservative treatments have been applied, neurosurgical intervention is required. It is a brain surgery to remove epileptogenic lesion or to cut off certain paths responsible for seizure activity.

Neurosurgeries are quite successful; they are widely used all over the world. In Moscow, the program of neurosurgical epilepsy treatment launched a few years ago. Our Director Professor Alla Gekht and Head of the  Moscow Clinical Centre of Yevdokimov Moscow State University of Medicine and Dentistry academician Vladimir Krylov have established the Association of Medical Organisations with the best routing. A patient, who has come to visit a district neurologist, is sent to a district epileptologist, who will do his or her best to achieve improvements in a conservative way. Should these measures turn to be ineffective, the doctor sends the patient to the neurosurgeon.

The program is becoming increasingly prevalent, with EPI Kuskovo school arranged, attended by neurologists, epileptologists and neurosurgeons from all regions of Russia. This experience is to be widely spread  throughout the country. This practice has proved to be quite successful. In general, about 80-90 percent of  patients who underwent surgery have their epileptic seizures stopped, they now can live a productive life.

Strokes are another large-scale and grievous problem, as there are too many of them, and nowadays they affect people at an earlier age. Our centre admits patients with good rehabilitation potential for treatment. To restore lost or reduced functions, we use axial loading suits. This technology came from space medicine. When cosmonauts return to the Earth and get used to gravity once again, they have to wear such a suit,  with a special system of springs that affect all muscle groups.

Naturally, we are determined to continue our development and research. Annually, we hold scientific and practical conferences, invite scientists, including experts from abroad. Our employees attend various conferences, including international ones. We believe that we will be able to develop the  machine learning and the  biological markers' search technology to some extent. It will allow us to diagnose mental disorders at the earliest stages. It will enable us to prevent the development of severe conditions. The sooner we identify the disease and start treatment, the better the results achieved.

Source: mos.ru

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