Reference information in integral anamnesis development

The article is devoted to semantic content of integral anamnesis - basic part of national integrated electronic health record. Integral anamnesis is a formalized set of the most important clinical data of a patient aimed at safety and continuous medical care both emergency and elective care. A short review of international projects of implementation and trans border exchange of key information about a patient is presented. Information content of integral anamnesis is presented which is developed in our country and includes 15 main sections: disability, benefits, social factors, addiction and occupational hazards, significant vital parameters, blood types and rhesus factor, pathological reactions, vaccination and immunization, epidemiological anamnesis, significant (dispensary) diseases, surgical interventions, medical devices and implants, pregnancies and deliveries, current medications and non-drug treatment. Administration, structure, problems, readiness of reference materials for coding of information presented in integral anamnesis are described. At the moment most of the necessary reference materials are finished and available on the portal of normative-reference information of the Ministry of Health of the Russian Federation (http://nsi.rosminzdrav.ru/): 20 basic and 7 additional ones. At the current stage it provides interoperability of medical information systems in integral anamnesis. Such time-consuming reference books as surgical interventions, instrumental diagnostic studies, federal reference book of medications are being actively developed. The section «Epidemiological anamnesis of a patient» stays practically unformalized. The first step in this direction is development of a reference book of immunobiological medications for specific prophylaxis, diagnosis and treatment. The aim of the study of semantic interoperability for integral anamnesis was reached by development of 27 reference books posted on the federal portal of normative-reference information of the Ministry of Health of Russia; the next stage should be development of technologies of formation and upgrade of the information of integral anamnesis

Differential Diagnosis of Jejunum and Ileum Tumours Based on Video Capsule Endoscopy Data Using Mathematical Analysis

Aim. The aim of this study was to develop an algorithm for identifying various types of jejunum and ileum tumour lesions based on video capsule endoscopy (VCE), which can be used by physicians in the process of decision making. Materials and methods. In the study, we analysed data on the examination and treatment of 65 patients (35 men and 30 women aged 18–80 years (mean age 46 ± 28 years)), who underwent VCE in the City Clinical Hospital No. 31 and in the Clinica K+31 during the period October 2008 — April 2017. The indications for VCE were a search for a reason of gastrointestinal bleeding, the anaemia of unknown etiology and suspected tumour of the small intestine. According to the VCE results, 181 cases of various changes in the jejunum and ileum were revealed. Each tumour object had been histologically verified before our study. Capsule endoscopy was performed using equipment produced by Olympus (Japan), MicroCam Intromedic (Korea), PillCam Given Imaging (Israel), OMOM Chongqing Jinshan Science & Technology (China).Results. Following expert interviews, 30 signs and their gradations were identified for assessing the type of lesion in the jejunum and ileum using video capsule endoscopy images. Among them, 8 were found to be statistically significant (affecting the division of objects into groups): patient gender, gut wall/lumen deformation, path of intestinal folds, polypoid changes, vascular pattern, mucosal regularity, mucosal lobulation and colour. Using a Bayesian heterogeneous diagnostic procedure and the calculation of diagnostic factors, a three-level algorithm has been developed for the differential diagnosis of jejunum and ileum lesions.Conclusions. The application of the proposed algorithm in clinical practice will not only allow the presence or absence of the jejunum or ileum tumour lesion to be verified, but also the type of this lesion to be determined with an accuracy of more than 86%. The developed diagnostic algorithm can support decision making by the clinician within the task of differentiating jejunum or ileum tumour lesions into three main types: benign epithelial tumours, benign non-epithelial tumours and malignant tumours. Differential diagnosis of the type of jejunum or ileum tumour lesion using the proposed diagnostic algorithm facilitates not only the development of a treatment tactic for managing such patients (dynamic observation, conservative therapy, operative treatment), but also the determination of terms (emergency, urgent, planned) and methods (endometrial luminal, laparoscopic, laparotomic) of surgical treatment

Differential Diagnosis of Jejunum and Ileum Tumours Based on Video Capsule Endoscopy Data Using Mathematical Analysis

Aim. The aim of this study was to develop an algorithm for identifying various types of jejunum and ileum tumour lesions based on video capsule endoscopy (VCE), which can be used by physicians in the process of decision making. Materials and methods. In the study, we analysed data on the examination and treatment of 65 patients (35 men and 30 women aged 18–80 years (mean age 46 ± 28 years)), who underwent VCE in the City Clinical Hospital No. 31 and in the Clinica K+31 during the period October 2008 — April 2017. The indications for VCE were a search for a reason of gastrointestinal bleeding, the anaemia of unknown etiology and suspected tumour of the small intestine. According to the VCE results, 181 cases of various changes in the jejunum and ileum were revealed. Each tumour object had been histologically verified before our study. Capsule endoscopy was performed using equipment produced by Olympus (Japan), MicroCam Intromedic (Korea), PillCam Given Imaging (Israel), OMOM Chongqing Jinshan Science & Technology (China).Results. Following expert interviews, 30 signs and their gradations were identified for assessing the type of lesion in the jejunum and ileum using video capsule endoscopy images. Among them, 8 were found to be statistically significant (affecting the division of objects into groups): patient gender, gut wall/lumen deformation, path of intestinal folds, polypoid changes, vascular pattern, mucosal regularity, mucosal lobulation and colour. Using a Bayesian heterogeneous diagnostic procedure and the calculation of diagnostic factors, a three-level algorithm has been developed for the differential diagnosis of jejunum and ileum lesions.Conclusions. The application of the proposed algorithm in clinical practice will not only allow the presence or absence of the jejunum or ileum tumour lesion to be verified, but also the type of this lesion to be determined with an accuracy of more than 86%. The developed diagnostic algorithm can support decision making by the clinician within the task of differentiating jejunum or ileum tumour lesions into three main types: benign epithelial tumours, benign non-epithelial tumours and malignant tumours. Differential diagnosis of the type of jejunum or ileum tumour lesion using the proposed diagnostic algorithm facilitates not only the development of a treatment tactic for managing such patients (dynamic observation, conservative therapy, operative treatment), but also the determination of terms (emergency, urgent, planned) and methods (endometrial luminal, laparoscopic, laparotomic) of surgical treatment