Digital Medicine Research Articles

BRACETS: Bimodal repository of auscultation coupled with electrical impedance thoracic signals

Background and Objective: Respiratory diseases are among the most significant causes of morbidity and mortality worldwide, causing substantial strain on society and health systems. Over the last few decades, there has been increasing interest in the automatic analysis of respiratory sounds and electrical impedance tomography (EIT). Nevertheless, no publicly available databases with both respiratory sound and EIT data are available. Methods: In this work, we have assembled the first open-access bimodal database focusing on the differential diagnosis of respiratory diseases (BRACETS: Bimodal Repository of Auscultation Coupled with Electrical Impedance Thoracic Signals). It includes simultaneous recordings of single and multi-channel respiratory sounds and EIT. Furthermore, we have proposed several machine learning-based baseline systems for automatically classifying respiratory diseases in six distinct evaluation tasks using respiratory sound and EIT (A1, A2, A3, B1, B2, B3). These tasks included classifying respiratory diseases at sample and subject levels. The performance of the classification models was evaluated using a 5-fold cross-validation scheme (with subject isolation between folds). Results: The resulting database consists of 1097 respiratory sounds and 795 EIT recordings acquired from 78 adult subjects in two countries (Portugal and Greece). In the task of automatically classifying respiratory diseases, the baseline classification models have achieved the following average balanced accuracy: Task A1 - 77.9±13.1%; Task A2 - 51.6±9.7%; Task A3 - 38.6±13.1%; Task B1 - 90.0±22.4%; Task B2 - 61.4±11.8%; Task B3 - 50.8±10.6%. Conclusion: The creation of this database and its public release will aid the research community in developing automated methodologies to assess and monitor respiratory function, and it might serve as a benchmark in the field of digital medicine for managing respiratory diseases. Moreover, it could pave the way for creating multi-modal robust approaches for that same purpose.

Modern capabilities of digital pancreatology

Personalized medicine requires the integration and analysis of vast amounts of patient data in order to provide a personalized approach. Digital pancreatology and Pancreomics facilitate personalized recommendations in the diagnosis and treatment of pancreatic diseases by analyzing data using machine learning methods to exploit the potential of this data in a similar way to Pathomics, Radiomics, and Genomics.
 The aim of this article is to present a brief overview of the modern capabilities of digital medicine for the diagnosis and treatment of various pancreatic diseases.
 The studies included in the review demonstrate the promising results of machine learning technologies that can both facilitate clinical prediction and decision-making and be used to interpret clinical laboratory, radiological, and endoscopic images in pancreatology and medicine in general.
 Digital pancreatology and Pancreomics may be promising concepts for the analysis and prediction of the course of pancreatic diseases in the contemporary digital era.

Libros de texto para el éxito académico: el Programa Institucional de la Facultad de Medicina

This article describes the process for the publication of textbooks created expressly specifically for the degree of general practitioner of the Faculty of Medicine (FacMed) of the UNAM. This program was created in 2016 as an initiative of Dr. Fajardo Dolci, with the objective of promoting an editorial program for the elaboration of books of the academic programs of the FacMed. It includes the chronology of publications on: El razonamiento clínico en la era de la medicina digital, Informática biomédica II, La medicina en la historia, Competencias digitales básicas para el médico general, Informática biomédica I, Morfología humana, El aprendizaje de la farmacología a través de ejercicios (Clinical Reasoning in the era of Digital Medicine, Biomedical Informatics II, Medicine in History, Basic Digital Skills for the General Practitioner, Biomedical Informatics I, Human Morphology and Learning Pharmacology through Exercises). The situation of the delivery of copies and the fund for student scholarships is globally contained; the access, use and sale of the works of said program; as well as the projects that are in transit with an upcoming appearance. Keywords: Textbooks; electronic books; educational innovation; didactic resources; higher education

Ethics for Digital Medicine: A Path for Ethical Emerging Medical IoT Design

We reflect on the ethical challenges facing digital medicine. We discuss the perils of ethical oversights in medical devices, and the role of professional codes and regulatory oversight toward the ethical design, deployment, and operation of digital medicine devices that safely and effectively meet the needs of patients.

Digital Human Modeling and Medicine [Book review

Digital Human Modeling and Medicine [Book review

BEST PRACTICES FOR THE APPLICATION OF TELEMEDICAL TECHNOLOGIES IN THE RUSSIAN FEDERATION AND ABROAD

The article analyzes the literature sources of the most promising areas of the development of informatization of health care systems in Russia and abroad. The World Health Organization and the International Telecommunication Union have noted, that for healthcare, digital systems are not only vital, but simply inevitable. Today, more than half of the underdeveloped and developing countries use telemedicine technologies, including using in emergency situations. It is actively gaining momentum in development and is being improved with infocommunication technologies.
 Purpose of the study. Analysis of the most promising directions for the development of healthcare informatization in Russia and abroad, taking into account the strategic importance of combating chronic non-communicable diseases.
 Material and methods. An analytical study that systematizes international and Russian experience in the application of telemedicine technologies.
 Results of the discussion. According to WHO forecasts, at present, not only in the Russian Federation, but throughout the world, there is a tendency towards population aging, which by 2050 will be more than 22%. This leads to demand growth for medical services. The development of digital mobile medicine (mHealth) is gaining popularity around the world, due to the shortage of medical personnel, the wide geographical spread of the population, the inaccessibility of medical care and the high cost of treatment
 Conclusion. The development and application of digital mobile medicine in the healthcare system has being contributed significantly to reducing the burden of non-communicable diseases, both from a medical and economical point of view.

Attitude of doctors and patients of the central district hospital to using digital health technologies (based on the results of a medical and sociological study)

Objective: to study the attitude of doctors and patients of the central district hospital to the use of digital medicine technologies. Material and methods. The study was conducted by a questionnaire survey. 43 doctors and 213 patients of the central district hospital were asked to assess the possibilities of digital tools in solving health problems, the degree of use of Internet platforms in the process of doctor-patient interaction, the level of influence of the Internet on patients' adherence to doctor's recommendations. Results. Only 14.0% of doctors and 5.2% of patients believe that digital technologies can help solve the problem of staff shortage. Currently, 65.1 % of doctors and 23.9% of patients use digital technologies in communication in the doctor-patient system. 55.8% of doctors stated the desire of patients to get information about treatment in Internet sources, but 97.7% of patients trust doctors more than recommendations on the Internet. Among the possible ways of using digital technologies in medicine, patients see the design of referrals (61.0%), prescriptions (50.2%), temporary disability sheets, certificates (29.6%). Conclusions. Most representatives of both the medical community and patients do not see digital technologies as a way to radically solve the problems of personnel shortage in rural areas: only 32.6% of doctors and 19.7% of patients consider it possible to increase the availability of medical care through telemedicine, only 23% of patients considered remote consultations to be in demand. First of all, the prospects of digitalization of healthcare, according to patients, are associated with the optimization of the issuance of documents in the provision of medical care.

The concept of responsible artificial intelligence as the future of artificial intelligence in medicine

Active deployment of artificial intelligence (AI) systems in medicine creates many challenges. Recently, the concept of responsible artificial intelligence (RAI) was widely discussed, which is aimed at solving the inevitable ethical, legal, and social problems. The scientific literature was analyzed and the possibility of applying the RAI concept to overcome the existing AI problems in medicine was considered. Studies of possible AI applications in medicine showed that current algorithms are unable to meet the basic enduring needs of society, particularly, fairness, transparency, and reliability. The RAI concept based on three principles accountability for AI activities and responsibility and transparency of findings (ART) was proposed to address ethical issues. Further evolution, without the development and application of the ART concept, turns dangerous and impossible the use of AI in such areas as medicine and public administration. The requirements for accountability and transparency of conclusions are based on the identified epistemological (erroneous, non-transparent, and incomplete conclusions) and regulatory (data confidentiality and discrimination of certain groups) problems of using AI in digital medicine [2]. Epistemological errors committed by AI are not limited to omissions related to the volume and representativeness of the original databases analyzed. In addition, these include the well-known black box problem, i.e. the inability to look into the process of forming AI outputs when processing input data. Along with epistemological errors, normative problems inevitably arise, including patient confidentiality and discrimination of some social groups due to the refusal of some patients to provide medical data for training algorithms and as part of the analyzed databases, which will lead to inaccurate AI conclusions in cases of certain gender, race, and age. Importantly, the methodology of the AI data analysis depends on the program code set by the programmer, whose epistemological and logical errors are projected onto the AI. Hence the problem of determining responsibility in the case of erroneous conclusions, i.e. its distribution between the program itself, the developer, and the executor. Numerous professional associations design ethical standards for developers and a statutory framework to regulate responsibility between the links described. However, the state must play the greatest role in the development and approval of such legislation. The use of AI in medicine, despite its advantages, is accompanied by many ethical, legal, and social challenges. The development of RAI has the potential both to solve these challenges and to further the active and secure deployment of AI systems in digital medicine and healthcare.

Validation of collaborative cyberspace virtual reality oculometry enhanced with near real-time spatial audio

Currently, most medical image data, such as optical coherence tomography (OCT) images, are displayed in two dimensions on a computer screen. Advances in computer information technology have contributed to the growing storage of these data in electronic form. However, the data are usually processed only locally on site. To overcome such hurdles, a cyberspace virtual reality (csVR) application was validated, in which interactive OCT data were presented simultaneously to geographically distant sites (Lucerne, London, and Barcelona) where three graders independently measured the ocular csVR OCT diameters. A total of 109 objects were measured, each three times, resulting in a total of 327 csVR measurements. A minor mean absolute difference of 5.3 µm was found among the 3 measurements of an object (standard deviation 4.2 µm, coefficient of variation 0.3% with respect to the mean object size). Despite the 5 h of online work, csVR was well tolerated and safe. Digital high-resolution OCT data can be remotely and collaboratively processed in csVR. With csVR, measurements and actions enhanced with spatial audio communication can be made consistently in near real time, even if the users are situated geographically far apart. The proposed visuo-auditory framework has the potential to further boost the convenience of digital medicine toward csVR precision and collaborative medicine.

COMPARISON STUDY FOR 24H AMBULATORY BLOOD PRESSURE MEASUREMENT (ABPM) WITH BIOBEAT PATCH ABPM® CUFFLESS WEARABLE DEVICE IN SUBJECTS WITH DIFFERENT BODY MASS INDEX

Objective: ABPM blood pressure measurement is a widely used method for the diagnosis and management of hypertension. In the era of digital medicine, the creation of some photoplethysmographic wearable sensors can allow to overcome the technical difficulties and procedural complexity that limit the use of ABPM-cuff systems. The purpose of the study is to validate whether the ABPM Biobeat cuffless patch improves the management of hypertensive patients and also to evaluate the degree of satisfaction through the measurement of the Customer Satisfaction Score (CSAT) both in patients and healthcare personnel. Design and method: We enrolled 30 patients, divided into two groups. For both groups, BP was monitored for 24 hours with traditional and wireless wearable systems and satisfaction questionnaires were administered. Subsequently, subgroups of analyzes will be extrapolated by isolating the obese group: patients who used the larger cuff with arm diameter 42 cm, compared to those of normal weight. will also be addressed to operators questioned on the applicability of calibrated versus non-calibrated and self-wearable devices by the patient independently compared to those who necessarily have to go to the clinic. The clinical data and the variables measured in the study groups were compared using the Bland Altman plot to indicate the level of agreement between the different measurement methods and between observers measuring the same phenomenon. At the end of the procedure we administered a customer satisfaction questionnaire for users and operators. Results: the data analysis highlighted an adequacy of the wearable patch for the number of valid measurements performed in 24 hours. There was improved accuracy of the wearable system in detecting values exceeding 130 mmHg for SBP and 89 mmHg for PAD. The satisfaction regarding the wearability of the BioBeat Patch ABPM system was also significant. Conclusions: The extremely encouraging results obtained with this preliminary pilot study allow us to continue enrolling other subjects in order to have a significant sample size.

CancerX: A national public-private partnership to boost innovation in the fight against cancer.

e13637 Background: In early 2022, President Biden reignited the Cancer Moonshot, setting new national goals to cut the death rate from cancer by at least 50% over the next 25 years and improve the experience of people and their families living with and surviving cancer. In its first year, the reignited Cancer Moonshot announced over 25 new programs, policies, and resources in pursuit of these goals. In February 2023, to mark the one-year anniversary of the new national goals, the Cancer Cabinet – the expert and interagency body responsible for setting the Cancer Moonshot agenda across government agencies – announced three new actions, including the launch of CancerX - a public-private partnership (PPP) to act as a national accelerator to boost innovation in the fight against cancer. Methods: Leveraging foundational work of Moffitt Cancer Center, the U.S. Department of Health and Human Services (HHS), the Digital Medicine Society (DiMe), and Moffitt Cancer Center have come together to establish and lead CancerX as an open, collaborative public private partnership effort to rapidly accelerate the pace of cancer innovation in the US. This builds on momentum of prior successful multi-stakeholder collaborations led by these founders to advance digital innovation to reduce the incidence and burden of cancer for all people. This multi-stakeholder success will characterize CancerX, with additional organizations driving innovation in the fight against cancer participating across initiatives. Results: To speed the development and optimize the impact of innovative solutions across the continuum of cancer care – including prevention, detection, treatment, and transitions in care – CancerX is comprised of three key initiatives: 1) Pre-competitive evidence generation: a rolling series of multi-stakeholder efforts will develop evidence, best practices, toolkits, and value models to drive the success of the mission. 2) Accelerator: This program will provide mentorship, education, and exposure to funding and clinical partnership opportunities to a start-up cohort aligned with the mission. 3) Demonstration projects: These implementation projects will pilot novel, mission-aligned approaches to demonstrate their value and sustainability for scale to drive broad adoption. Conclusions: CancerX provides a structure for organizations whose missions are aligned with the Cancer Moonshot goals to rapidly advance innovative solutions for success at scale. Through a multi-pronged approach focused on 1) commoditizing best practices and aligning incentives, 2) coordinating access to research, mentorship, resources, and other collaborative opportunities, and 3) demonstrating success in practice to drive broad adoption, this PPP will reduce the incidence and burden of cancer for all people.

Advancing digital innovation to improve equity and reduce financial toxicity in cancer treatment.

e18644 Background: The global burden of cancer is set to increase by more than 60% (to 29.4 million cases) by 2040 . Certain subgroups of patients experience avoidable disparities in access to specialized cancer treatment and discrepancies in clinical outcomes following treatment. The risk of financial toxicity following a cancer diagnosis is also not equally distributed . These disparities in cancer disease burden, treatment, and the risk of financial toxicity have the potential to be disintermediated by digital innovation. Methods: The Digital Medicine Society and Moffitt Cancer Center are co-hosting a pre-competitive collaboration to define the value of digital innovation in cancer treatment, address methodological and implementation gaps, and develop best practices for equitable adoption of digital health technologies at scale in precision oncology. We undertook a landscape review to identify and prioritize causes of disparities and financial toxicity and to benchmark the clinical, engineering, and implementation science dimensions relevant to enhanced digital innovation in cancer treatment. We convened and synthesized information from an expert roundtable which focused on challenges preventing the effective implementation of digital solutions as well as the infrastructure, payment, policy, and regulatory changes needed to promote equity and address financial toxicity with digital health tools. Results: We outline the value of digital innovation in cancer treatment and present consensus-based recommendations from workgroup convening about how digital health tools can be implemented to: Reduce costs associated with advanced cancer treatment and ameliorate disparities in cancer burden by equitably supporting early detection and cancer prevention   Advance precision oncology, minimize the costs of delays in accessing the right care and ensure that the best outcomes are available to all cancer patients  Reduce disparities in access by extending the best specialist expertise and clinical trial opportunities to all cancer patients . Conclusions: Innovative digital approaches have yet to be applied at scale to minimize the burden of financial toxicity to patients with cancer and to reduce healthcare access and outcomes disparities. The delivery of high-quality precision cancer care for all patients depends on our collective ability to increase access to specialized care, harness flows of existing patient data and the power of decentralized clinical trials, and reduce the impact of social determinants of health on patient outcomes. There is substantial opportunity to leverage the results of this landscape review and convening to 1) build impact models that articulate the value of implementing fit-for-purpose digital solutions to promote equity and reduce financial toxicity, and 2) develop implementation toolkits for the equitable and effective deployment of those solutions.

Digital health, digital medicine, and digital therapeutics in cardiology: current evidence and future perspective in Japan.

Ten years passed since Japan set out the Action Plan of Growth Strategy that declared the initiatives of digitalization for medicine, nursing care, and healthcare to achieve the world's most advanced medical care. The initiatives formed the foundation of the Japanese national strategy and have been continuously refined, resulting in the current environment of digital health and digital medicine. Digital health-related terminologies are organized, such as "digital health," "digital medicine," and "digital therapeutics" (DTx), as well as several common digital technologies, including artificial intelligence, machine learning, and mobile health (mHealth). DTx is included in mHealth and is a novel disease treatment option. Also, this article thoroughly describes DTx in Japan and compares it with those in the US and Germany, the leading countries in digital health-related policies, regulations, and their development status. In Japan, two of three DTx applications that have been approved and reimbursed by the Ministry of Health, Labor, and Welfare are explained in detail in relation to cardiovascular medicine. When added to a standard smoking cessation program, the DTx system for nicotine dependence significantly improved the continuous abstinence rate. Moreover, the DTx for hypertension together with the guideline-based hypertension management was effective in patients aged 65 years or younger who were diagnosed with essential hypertension without antihypertensive agents, and it was also found to be cost-effective. DTx in cardiovascular medicine, with consideration on safety, efficacy, and cost-effectiveness, could be widely used not only through basic experiments and clinical studies but also through social implementation.

Transformasi UMKM Melalui Strategi Digitalisasi Marketing Guna Meningkatkan Ekonomi Kreativ Desa Sengon Kabupaten Jombang

The SRI IBU herbal medicine MSME located in RT32/RW02, Sengon Village, Sengon Krajan, Jombang has a fairly good background in business activities. This product is marketed in liquid form and lasts only one week, so the marketing process must be immediate and a matter that requires attention. In addition, the herbal medicine production business is still managed traditionally without good business management and business planning. Even though it is done traditionally, its production has expanded to sub-districts and cities. However, the distribution permit for the product and its quality have not been tested, so this herbal medicine can only be marketed through private orders. So far there has been no real effort to fulfill the wishes of the local people in the target locations. Even though it requires direct information about how to utilize this based herbal medicine, community service is carried out through Digital Marketing education (socialization) and SRI IBU herbal medicine development training. The purpose of this activity is to provide knowledge and efforts to improve products and their marketing. The processing of various medicinal plants into herbal medicine provides an opportunity for added value so that it is possible to have an economic impact if it is marketed seriously by the target community.
 
 Keywords: Digital Marketing, MSMEs, Sengon.

Urology 2030: Why it is key to promote digitisation in urology today to maintain medical care in the future - an expert consensus

Due to demographic change associated with an increase in patient numbers as well as the existing shortage of medical personnel, the German healthcare system will face a major challenge in patient care. In order to maintain high-quality patient care at a high level, the digitisation of urology should be driven forward promptly and forcefully as digital applications such as online appointment scheduling, video consultations, digital health applications (DiGAs) and others could significantly improve treatment efficiency. The long-planned introduction of the electronic patient record (ePA) will hopefully accelerate this process, and medical online platforms could also become a permanent part of new treatment methods, which could emerge from the urgently needed structural change towards more digital medicine, including questionnaire-based telemedicine. This transformation, which, already today, is urgently needed in the healthcare system, must be demanded and promoted by service providers, but also by policymakers and administration, in order to achieve the positive development of digitisation in (urological) medicine.

Introducing patient-centric electronic medicine leaflets in the European Union

Despite numerous advances in their content and structure over recent years, paper information leaflets for medicines are often hard to read for people with visual impairments, contain a lot of technical information, and people suffering from chronic conditions may find it challenging to identify all side-effects or dangers of taking a drug in their situation. Likewise, for people already taking different drugs, identifying contraindications may be time-intensive and easily overlooked, posing a risk for affected patients. Electronic product information (ePI), or eLeaflets, provide an opportunity for improvements in how patients interact with the information provided. We summarise opportunities of ePI and experiences from a co-creation process of such an app together with patients as part of the Pharmaledger project and put it into context of the current policy environment in the EU in light of EMA’s key principles for the adoption of ePI in medicine. While more patient-friendly information remains a significant ask, ePI has the potential to make leaflets easier and quicker to read through search and zoom functions, provide a safe digital medicine cabinet employing blockchain technology, enables patients to identify falsified product boxes, receive real-time updates when a product expires or is being recalled by the manufacturer, and potentially even include a reminder function to increase adherence. We present a potential research agenda across disciplines for interested researchers. While many welcome the benefits of ePI, we urge policymakers to keep in mind that some groups, specifically people with low technical literacy, should not be left without alternatives. We recommend early initiatives to ensure a widespread understanding of how ePI works across populations while also taking this opportunity to use new insights to improve leaflets on paper.

GPU accelerated digital twins of the human heart open new routes for cardiovascular research

The recruitment of patients for rare or complex cardiovascular diseases is a bottleneck for clinical trials and digital twins of the human heart have recently been proposed as a viable alternative. In this paper we present an unprecedented cardiovascular computer model which, relying on the latest GPU-acceleration technologies, replicates the full multi-physics dynamics of the human heart within a few hours per heartbeat. This opens the way to extensive simulation campaigns to study the response of synthetic cohorts of patients to cardiovascular disorders, novel prosthetic devices or surgical procedures. As a proof-of-concept we show the results obtained for left bundle branch block disorder and the subsequent cardiac resynchronization obtained by pacemaker implantation. The in-silico results closely match those obtained in clinical practice, confirming the reliability of the method. This innovative approach makes possible a systematic use of digital twins in cardiovascular research, thus reducing the need of real patients with their economical and ethical implications. This study is a major step towards in-silico clinical trials in the era of digital medicine.

A Digital Lifestyle Program for Psychological Distress, Wellbeing and Return-to-Work: A Proof-of-Concept Study

ObjectiveTo demonstrate proof-of-concept for a chatbot-led digital lifestyle medicine program in aiding rehabilitation for return-to-work. DesignRetrospective cohort study with pre-post measures. SettingCommunity setting, Australia. Participants78 adult participants (mean age 46 years, 32% female) with an active workers’ compensation claim (N=78). InterventionsA 6-week digital lifestyle medicine program led by an artificially intelligent virtual health coach and weekly telehealth calls with a health coach. Main Outcome MeasuresAdherence (% program completions) and engagement (% of daily and weekly sessions completed), changes in depression, anxiety and distress (K10), psychological wellbeing (WHO-5), return-to-work confidence and anxiety and change in work status. ResultsSixty participants completed the program (72%), with improvements in psychological distress (P≤.001, r=.47), depression (P<.001, r=.55), anxiety (P<.001, r=.46) and wellbeing (P<.001, r=.62) were noted, as well as increased confidence about returning to work (P≤.001, r=.51) and improved work status (P≤.001). Anxiety about returning to work remained unchanged. Participants completed an average of 73% of daily virtual coach sessions and 95% of telehealth coaching sessions. ConclusionsArtificial intelligence technology may be able to provide a practical, supportive, and low-cost intervention to improve psychosocial outcomes among individuals on an active workers’ compensation claim. Further, controlled research is needed to confirm these findings.

Hygiene as a science in modern clinical therapeutic practice: from observation to digitalization (part two)

Building on the global medical historiography, this review attempts to demonstrate the continued interest and involvement of doctors in investigation of the influence of environmental factors, their epidemiological and pathological aspects, on life expectancy and health of human beings, as well as to cover the most significant domestically developed prevention measures applicable in everyday life, during epidemics and against occupational hazards. We have also attempted to outline the history of interinfluence of the two medical specializations, including the new round of their transformation as they merge into the digital reality of today. The review shows that when medicine, as science and trade, in Russia was going through its establishing phases in Russia, the prominent Russian experts underscored the need for integrated application of therapeutic and hygienic approaches, development of the most effective combination thereof with the aim of qualitative improvement of public health care. The article considers the historical prerequisites for development of the system of preventive and anti-epidemic measures, which are the key safeguards against diseases, and development of the hygiene, including occupational hygiene, from the moment of inception to the age of digital medicine we live in currently.

SP-0182 Quo Vadis? from pioneering experiences to digital medicine in the treatment of rectal cancer

SP-0182 Quo Vadis? from pioneering experiences to digital medicine in the treatment of rectal cancer