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The article addresses the issues in healthcare delivery and organization of public healthcare in the face of rapid advancements in digital technologies. The purpose of the study is to outline the legal challenges arising during the implementation of concepts such as digital health, e-health, mobile health as well as establishing the legal framework for electronic medical records and telemedicine, and certain types of innovative biomedical activities. The article illustrates the consistent impact of information and communication technologies on the interaction between patients and healthcare providers. It defines the legal framework for telemedicine and its transition to e-health. The study systematizes the particularities of legal regulations concerning both general electronic medical record and those developed by specialized medical organizations. It presents legal challenges related to data compatibility and potential cross-border exchanges. The concept of mobile healthcare is analyzed, with attention given to the risks associated with its development, notably threats to privacy and cybersecurity. The main directions of digital medicine and the challenges faced by modern legal regulations are summarized, including the use of big data, the integration of artificial intelligence, translational bioinformatics, gamification of various stages of medical care, etc. Additionally, the legal challenges arising from the use of big data and introduction of certain digital devices into medical practice are outlined, with special attention given to the brain-computer interface. Comprehensive recommendations for the improvement of healthcare legislation are presented.

Telehealth is a modern branch of medicine that provides affordable and high-quality healthcare. The doctor-patient communication during an online consultation is just as important as personal bedside communication. A telehealth doctor is a qualified specialist who is able to provide remote assistance to patients using a computer and telecommunication software. Telehealth is especially important to patients in remote or rural areas with limited access to medical service. The article describes the role of the communicative component in effective telehealth interaction. The authors studied various online telehealth services, i.e., the Gostelemed telehealth consultation service provided by state medical organizations, the Miracle Doctor multidisciplinary medical clinic, and the Capsa Healthcare mobile medical platform. The authors used the methods of data analysis, generalization, and classification, as well as terminological analysis of dictionary definitions, to study the basic principles of effective telehealth communication. They identified the provisions and means of effective verbal and non-verbal communication during online consultations. Telehealth proved to be an effective tool that improves the standards and accessibility of medical care, especially during pandemics or crisis. Effective telehealth communication promotes positive relations between patients and specialists.

Due to the increased pace of digitalization in all areas of life, including medicine, more citizens can receive qualified medical care. The period of the СOVID-2019 pandemic has clearly demonstrated that telemedicine is becoming a relevant area of medical practice. In particular, the role of online consultation in medical communication is significantly increasing. In this regard, medical network discourse becomes the focus of scholarly interest. Our research is aimed at verifying the scenario of medical consultations on medical online forums. The research material includes 5259 messages in Russian from 2018-2023 as part of 60 medical consultations on cardiology on rusmedserv Internet forum. The empirical study design included the collection and structuring of research material by means of corpus methods; the data were described, systematized and generalized; the qualitative interpretation of the data was carried out on the basis of the communicative and pragmatic method of analysis developed by Issers (2008). It was found that the dynamics and structure of medical consultations are generally maintained while a doctor and a potential patient are interacting through an Internet forum. The obtained data also confirm the findings presented in academic literature on “doctor - patient” communication via Internet forums. The results of the research contribute to the understanding of written medical Internet consultation proving that it unfolds inconsistently, but recurrently; the communication innovations mainly relate to the dynamics of communication scenario during medical Internet consultation deployment. The obtained results may contribute to the development of a more effective “patient - doctor” communication model focused on the mission of telemedicine.

Relevance. Healthcare today faces the inevitability of change as it faces a wide range of challenges in the face of complete uncertainty. Through effective change management, success can be achieved in states, globalization and complementarity. The scientific community recommends developing approaches to changes in management that focus on coordinated work in the field of healthcare of personnel, continuous training, exchange of experience, and professional development of medical personnel not only as specialists in the field of oncology, but also as successful managers. It is also necessary not to ignore social factors, namely the so-called “power of compassion”, which is expressed in the introduction and improvement of palliative care. The purpose of this article is to analyze the structure of management and organization of cancer care and proposals for improving the quality of treatment and care for cancer patients. This publication is devoted to a comprehensive analysis of the problems and prospects for the development of cancer care. Oncology is considered by us as one of the largest health problems. In this regard, ideas have been proposed on the need to modernize and optimize the processes of providing oncological care. According to the literature, important aspects in this process are the coordination of the actions of medical personnel, both doctors and nurses, and patients; their qualifications as oncology specialists and managers; provision and implementation of palliative care everywhere; quality control of provided medical services carried out directly by medical personnel. However, all of these components of the cancer care structure face the reality of a lack of actual time for medical personnel to train management skills, a lack of resources for regional health structures to implement palliative care and train staff in management skills. A positive aspect in this situation is the desire of the scientific community to improve itself and improve the skills of both oncologists and managers. Conclusion.The creation of specialized courses on management in the field of oncology and continuous international training through distance education and telemedicine is an important milestone in resolving these issues.

Telemedicine technologies are rapidly evolving, providing new opportunities for remote medical care, especially in areas with limited access to medical facilities. Developing a Medical Information System (MIS) for telemedicine is becoming a crucial task aimed at improving the quality of medical services, optimizing administrative processes, and enhancing the availability of qualified medical care for a broad range of patients, including those living in remote areas. This research paper provides a detailed analysis of existing methods and technologies in this field and proposes new, innovative approaches to addressing the current challenges associated with implementing MIS in practice. The findings may be useful for MIS developers and implementers, healthcare facility managers, and researchers involved in telemedicine and healthcare information technology. The proposed approaches and recommendations contribute to improving medical service delivery processes, increasing the overall effectiveness of telemedicine, and enhancing interactions between doctors and patients at all levels of medical care. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of telemedicine technologies in the provision of medical care is becoming a widespread phenomenon. The law is designed to regulate emerging social relations in order to prevent negative manifestations and organize their harmonious development. In the field of medicine, it is important to establish legal norms aimed at protecting and safeguarding the rights and legitimate interests of the patient, since fundamental natural human rights — the right to health care and life — are affected. The provision of a wide margin of discretion to those engaged in medical-legal relations may result in a significant violation of the constitutional right of a citizen to health. One of the principal applications of telemedicine technologies is remote consultation with the patient. AIM: The aim of the study was to review the current legal framework regulating remote patient consultations, identify problematic issues, and propose solutions to address these issues. MATERIALS AND METHODS: The materials of the present study are the Federal Law dated November 21, 2011 № 323-FZ “On the Fundamentals of Health Protection of Citizens in the Russian Federation”, Order of the Ministry of Health of the Russian Federation dated November 30, 2017 № 965n, Order of the Ministry of Health of the Russian Federation dated September 14, 2020 N 972n. The research methods are formal-legal, comparative-legal, as well as general scientific methods of cognition. RESULTS: The general legal regulation permits remote consultation with the patient in the absence of a face-to-face preliminary visit to the attending physician (Art. 36.2 of the Federal Law dated November 21, 2011 No. 323-FZ “On the Fundamentals of Health Protection of Citizens in the Russian Federation”). Nevertheless, the physician is constrained in his authority to prescribe treatment, modify previously prescribed therapy, or issue an electronic prescription. The result of such a consultation is a medical report. Should the physician determine that a face-to-face appointment is necessary, the patient may be advised to undergo preliminary examinations (clauses 47 and 48 of the Procedure for the Organization and Provision of Medical Care with the Use of Telemedicine Technologies, approved by Order of the Ministry of Health of the Russian Federation No. 965n dated November 30, 2017). Consequently, there are issues pertaining to the determination of the potential content of the medical report (clause 9 of the aforementioned Order). This affects the scope of liability, as the consulting physician is liable within the limits of the issued medical opinion. Furthermore, these provisions conflict with the requirements to indicate in the medical report reasonable conclusions about the presence (absence) of diseases, the presence of medical indications or medical contraindications for the use of methods of medical examination and (or) treatment, to determine the effectiveness and validity of therapeutic and diagnostic measures (paragraphs “b” and “c” of the Procedure for Issuing Certificates and Medical Reports by Medical Organizations, approved by Order of the Ministry of Health of the Russian Federation No. 972n dated September 14, 2020). CONCLUSIONS: The development of telemedicine necessitates the implementation of appropriate regulatory frameworks, as well as the resolution of existing gaps and conflicts. These include the absence of specific requirements pertaining to the content of a medical report issued within the context of remote consultation, as well as the definition of its legal significance. Concurrently, the Procedure for Issuing Certificates and Medical Opinions by Medical Organizations stipulates that a medical opinion may be provided upon the patient’s request. In contrast, the Procedure for Organizing and Providing Medical Care Using Telemedicine Technologies specifies that it is issued following a remote consultation. Furthermore, the correlation between a medical report and a consultation sheet remains undefined.

Background. According to various data, the prevalence of chronic non-communicable diseases among young people tends to increase. This is often due to lifestyle changes, increased stress factors, poor nutrition, low physical activity, bad habits, etc. It is known that the pathological effect of the main risk factors and the formation of diseases begins in adolescence and young age, and therefore, the development of a concept of their prevention is of particular interest for this particular population group. In this regard, early detection and diagnosis of chronic noncommunicable diseases play an important role in preventing their progression, improving the prognosis and quality of life of young patients. Identification of risk factors and determination of their severity at an early stage of the development of diseases allows them to begin their timely correction, which contributes to the prevention of complications. However, low health awareness and lack of medical literacy among this population group is an obstacle to the early detection of chronic noncommunicable diseases in young people. One of the key tools for early detection of chronic noncommunicable diseases in young people is screening aimed at identifying risk factors and primary signs of the disease in people without clinical manifestations. Screening can be carried out using various methods, including questionnaires. The introduction of automated screening diagnostic systems using artificial intelligence is of genuine interest among young people. Moreover, artificial intelligence technologies actively contribute to the creation of conditions for improving the quality of health services.Results. We have developed and tested a methodology for remote multidisciplinary questionnaire screening of chronic noncommunicable diseases for the first stage of medical examination of young people. The system has allocated a contingent of subjects with high, medium and low risk, and also helps to collect a preliminary medical history for each subject, which helps to improve the quality of medical decision-making and reduces its subjective component, thereby increasing the time for direct examination of the patient. Each subject received personalized medical recommendations on a healthy lifestyle, taking into account the identified risk factors and their severity.Conclusion. The present development of St. Petersburg programmers and doctors makes it possible to optimize the provision of medical and preventive care to the population and improve the quality of patient examination.

Forced distancing in the context of the COVID-19 pandemic has necessitated the transition of medical education to distance learning. The problem was exacerbated by the outbreak of full-scale hostilities, which necessitated further research in this area. The purpose of the study was to comprehensively review current scientific materials and consolidate existing knowledge on educational activities in obstetrics, gynaecology, and ultrasound diagnostics in the context of the coronavirus pandemic and full-scale hostilities. The following methods were used for the study: bibliographic, analysis, synthesis, induction, generalization, analogy, systematization, and categorization. The article presents a comprehensive analysis of the current literature on overcoming pedagogical challenges in the context of the COVID-19 pandemic and military operations through the achievements of distance education. The methodological foundations of distance education, the peculiarities of applying this practice in a pandemic and military operations, the similarities, and differences between them, especially in the context of obstetrics, gynaecology and ultrasound diagnostics, are considered. The connection between telemedicine and distance learning is presented both at the level of theory and practice. The practice of distance learning in obstetrics and gynaecology is compared with some other clinical disciplines. The result of the study was to solve the problem of the lack of a systematic view of the adaptation of the educational process to the conditions of a pandemic and military operations as emergency distance learning, rather than the classical practice of distance education, which contributes to the formation of an adequate assessment of pedagogical activities conducted in such conditions, in particular, in the field of obstetrics, gynaecology, and ultrasound diagnostics. The results of the study are of practical importance in the field of medical education, where they can be used to develop recommendations for the organization of training in obstetrics and gynaecology or other medical disciplines in conditions of forced distance learning

Introduction. The aim of the article is to analyze an extramural express consultation as a genre of oral medical discourse. New telemedicine technologies expand the forms of communication, it results in transformation of the dialogue between a doctor and a patient when communicating online, which requires linguistic research.Methodology and sources. The article is based on the main theses of the theory of speech genres formulated by M.M. Bakhtin, T.A. Van Dijk, O.B. Sirotinina, T.V. Shmeleva and others. The author has taken the scientific works on the study of speech genres of oral medical discourse as the methodological basis of the analysis. This includes the works of V.V. Zhura, E.A. Ponomarenko, M.I. Barsukova and others. The study applies methods of linguistic analysis of recorded online consultations for speech-genre characteristics of express consultations.Results and discussion. The article gives a description of an express consultation, including the following parameters: communicative goal, utterance content, speech roles of communicators, linguistic embodiment of the genre. The author pays special attention to doctor's communicative style and gives its assessment in terms of achieving communicative and consequently professional success. The author also describes a speech-genre scenario of a medical online consultation and a chain of communicative moves in a doctor's speech.Conclusion. The study shows that doctor's every speech act is specified by a complex system of communicative targets, primarily related to informative goals (requesting information from the patient and providing information in the form of an explanation and recommendation) and therapy goals to maintain a patient's psychological and emotional well-being. Communicators' speech behavior is regulated by the institutional roles of «an agent» and «a client» of an institution, native speakers having their own invariants. The utterance content is specified by a patient's specific complaint and is organized in accordance with the stages of a medical consultation. The study concludes that genre competence as a part of communicative competence in the form of online communication is the most important professional tool of a consulting specialist.

The aim – to evaluate the possibilities of long-term patch monitoring of the electrocardiogram (ECG) to determine gender and age characteristics of the frequency of detection of atrial fibrillation (AF). Materials and methods. A total of 1,123 patients participated in this 2-year (2021–2023) retrospective multicenter study. Long-term ECG monitoring was performed at the referral of internists and cardiologists of 30 health care institutions according to various clinical indications for this study. For long-term monitoring of the ECG, the innovative device «Mawi Heart Patch» was used – a disposable two-channel device with the possibility of continuous recording of the ECG for up to 7 days. The primary analysis of the records was carried out using Cardio.ai artificial intelligence algorithms, re-decryption and validation by certified doctors. Results. The average age of the study participants was (50.2 ± 16.65) years. There were 599 (53.3 %) women, 524 (46.6 %) men. The average time of ECG monitoring was (81.03 ± 18.5) hours, 74.35 % of the participants had continuous ECG monitoring for 3 days, 20.75 % for 4 days, and 2.58 % for 5 days. In total, AF was diagnosed in 7.93 % of patients, in particular, women and men were 6.51 % and 9.54 % respectively (p > 0.05). In elderly patients, AF was diagnosed statistically significantly more often than in middle-aged patients (18.5 and 3.6 %, respectively, p ˂ 0.001). Among all age groups, the highest frequency of detection of AF was in participants over 75 years old, compared to young (28.8 % vs 3.6 %, p ˂ 0.001) and middle-aged patients (28.8 vs 18.5 %, p ˂ 0.05). Conclusions. The study did not reveal a gender difference in the frequency of diagnosing AF. In patients over 50 years, a significant increase in the frequency of detection of AF was recorded, which tends to increase in the following age periods and reaches a maximum in long-livers (over 90 years). The use of long-term patch ECG monitoring in patients of older age groups expands diagnostic possibilities and makes it possible to prevent complications in time.

BACKGROUND: Despite its relevance and established efficiency, the third stage of cardiac rehabilitation (CR) lacks a universal solution. The longest rehabilitation period requires many resources and effort on the part of the healthcare system. Digital technologies rapidly developing and being introduced into medicine can significantly assist in organizing the CR process. The healthcare system is already mastered and actively adopting telemedicine technologies into daily practice. OBJECTIVE: We aimed to determine the patients’ preparedness for the upcoming surgical treatment of the chronic types of coronary artery disease to engage in remote cardiac rehabilitation programs using telemedicine technologies. MATERIALS AND METHODS: A study of 213 patients treated for artery disease and preparing for planned coronary bypass surgery was conducted. Gender, age, socioeconomic factors, and digital literacy were analyzed. The patients were offered one of two options for completing the third stage of CR: a standard option in which CR is performed under the supervision of a medical worker in a medical organization at the place of residence according to the recommendations received upon hospital discharge or an alternative in which CR is performed at home using remote monitoring under the supervision of specialists from the CR laboratory of the Research Institute for Complex Issues of Cardiovascular Diseases. Patients were divided into two groups based on their choice: those who agreed to participate in the outpatient stage of CR using telemedicine technologies (loyal patients) and those who refused to use telemedicine technologies (nonloyal patients). The factors indicating more loyalty were identified using survey data and correlation analysis, and a portrait of a patient eager to use remote rehabilitation programs was formed. RESULTS: Social factors, such as living in big cities (p 0.001) and having a spouse (p=0,030), were associated with increased loyalty to participating in CR via telemedicine technologies. Male gender (p 0.001), obesity (p 0.001), and smoking (p 0.001) were associated with the reluctance to participate in the alternative CR program. The education level (p=0.060) did not show a significant impact on the loyalty to use telemedicine technologies. CONCLUSION: 46% of patients were interested in using remotely controlled CR programs. The social factors determine the loyalty to telemedicine technologies in patients.

Infantile hemangioma (IH), a benign tumor of the vascular endothelium, is the most common type of vascular pathology of the infant’s skin, which grows and significantly increases in size mostly during the first 12 months of a child's life. Statistics indicate that IH affects up to 10% of newborns and children aged

In 1838 G. Rees, a doctor from London (Guy's Hospital), for the first time isolated excess sugar from the blood serum of a patient with diabetes mellitus. Diagnosis of diabetes mellitus gradually developed. The next step was the understanding that regular monitoring of glucose levels by the patient himself is an integral part of diabetes mellitus therapy. The starting point of the technology for self-monitoring of diabetes mellitus was the determination of the sugar content in urine using chemical reactions. The method had no great clinical significance, it only indicated a progressive disease. The first Dextrostix blood glucose test strip (Ames-Mile's laboratories) was introduced in 1964. In 1970, the first automated blood glucose analysis system, the Ames Reflectance Meter (ARM), was created. Over time, the technology has been improved, accuracy, visibility, comfort, and an individual approach to glucometry have been formed. A new chapter was the development of remote technologies and the possibility of remote monitoring. More advanced data processing is now available in tabular and graphical form, with the calculation of 7-, 14-, 30-, and 90-day average glycemic values. A promising direction is the introduction of artificial intelligence in the management of diabetes mellitus.

Introduction. Telemedicine is a new form of communication between a doctor and a patient. Of interest is the expediency of its use in the postoperative observation of patients. Aim. To analyze the possibility of optimizing the postoperative management of patients who underwent outpatient surgical treatment of VVLE using telemedicine. Materials and methods. The study was performed in two stages on patients with VVLE. At the first stage, a comparative prospective, randomized study of the main and comparison groups (50 patients C2 according to CEAP) in the early postoperative period was conducted. In the main group, telemedicine was used, in the comparison group – face-to-face examinations in the polyclinic. The frequency of complications associated with surgery, the frequency of acute respiratory infections and the time spent on a follow-up examination were compared. At the second stage, in 876 cases of telemedicine use in the postoperative period, the frequency and structure of complications requiring conversion to face-to-face examination were studied. Results. Significant differences between the compared groups were revealed by the frequency of acute respiratory infections and the time spent by the patient on a follow-up examination. The reasons for conversion from telemedicine to face-to-face examination: copious wetting of the bandage with blood, swelling and severe pain of the operated limb, hyperthermia are rare. Discussion. Most of the complications and side effects associated with surgical intervention registered in the study have characteristic specific manifestations: complaints and appearance, which allows them to be diagnosed through telemedicine. Conclusion. The use of telemedicine optimizes the postoperative period in patients with VVLE: the risk of infection with acute respiratory infections is reduced, the time of the doctor and the patient is saved, while there is no negative effect on the frequency associated with surgery.

Glaucoma is the top leading cause of ophthalmic-related disability in almost all Russian regions. It is a chronic lifelong disease which requires regular monitoring (once a year or more often) in a medical facility. Since the population is aging, the prevalence of glaucoma is steadily increasing, which hampers access to medical care. Advances in telecommunications and diagnostic technologies have given rise to programs of TV glaucoma, which are used to pass the basic glaucoma parameters on to a specialist working remotely for interpretation. The Federal Law No 242-FZ on telemedicine came into force on January 1, 2018, but the COVID-19 pandemic sped up the development of information technologies in medicine in general and telemedicine communication in particular. The review presents the data on TV glaucoma programs which point to their effectiveness and provides practical advice. Potentially, telemedicine can facilitate access to medical care. The analysis of the economic factors shows that remote consulting is more cost-effective than traditional face-to-face examination of the patient. TV glaucoma programs often help detect glaucomatous changes in the ONH, so more patients with suspicion of glaucoma are referred for screening.. Publications focused on the experience in using active programs contribute to their further development and introduction to the public health system, which will eventually facilitate the access to quality medical care for patients with glaucoma.

Currently, in the Russian Federation, much attention is paid to the introduction of artificial intelligence technologies into the healthcare system in order to improve the quality of medical care provided. The AI methods support the medical decision-making; it becomes possible to obtain a second opinion for a doctor when determining a diagnosis, which leads to a reduced risk of determining erroneous diagnoses (including missed pathologies). The development of high-tech medical care is a particularly relevant issue for medical institutions in the Arctic regions, which are geographically distributed and remote territories with hard natural and climatic conditions. The solution of this issue is designed to ensure natural sustaina-ble population growth in these regions and increase the life expectancy of the population of the Russian Arctic, including the indigenous peoples of the North. The article considers the positive experience of cooperation between Russian research centers, medical companies and higher educational institutions in the development and implementation of medical software products based on technologies and methods of artificial intelligence on the example of such Arctic territories of Russia as the Yamalo-Nenets Autonomous Okrug, the Republic of Sakha (Yakutia), the Murmansk Oblast, the Republic of Karelia and the Arkhangelsk Oblast.

BACKGROUND: The COVID-19 global pandemic exposed gaps in the treatment of common physical and mental disorders that had to do with things like lockdowns, poor convenience, fear of contracting COVID, and economic constraints. Hence, to address these treatment gaps while also limiting exposure to the COVID-19 infection, telemedicine in the form of telephone and internet consultations has increasingly become the recourse around the world. Our center adopted this trend and also launched a telepsychiatry initiative in order to better cater to the needs of patients with pre-existing mental health disorders and to ensure regular follow-ups and compliance with prescription regiments. AIM: The present study aimed to assess the level of patient satisfaction with the online psychiatric services/telepsychiatry. METHODS: The sample consisted of 100 patients with pre-existing mental health disorders. This was a cross-sectional study lasting 6 months. The DigiDoc app by Hospital Information Software (HIS) software, which is used to manage a patients appointment schedule, relevant clinical and lab details, along with follow-up prescriptions, was used to follow the selected patients for the purpose of this study. This software also provides a digital platform for video calls for online consultation. The Client Satisfaction Questionnaires-8 (CSQ-8) was employed to collect patient data for analysis. RESULTS: The mean total CSQ-8 score of the study sample was 21.015.80 (832), which corresponds to a low-to-moderate level of satisfaction with online psychiatric services/telepsychiatry. Most patients (45%) reported low satisfaction levels, followed by 37% who reported moderate levels of satisfaction. Only 18% of patients reported higher satisfaction with telepsychiatry. CONCLUSION: Despite the psychiatrists ability to provide adequate professional advice and psychoeducation through online psychiatric services, patients level of satisfaction proved moderate-to-low. This suggests a need to design standard protocols and guidelines in the search and provision of consultation services on online psychiatric service platforms that could help enhance patients levels of satisfaction.

BACKGROUND: The use of remote forms of mental health care has become widespread during the period of epidemiological restrictions due to the COVID-19 pandemic. Methodological and organizational issues remain insufficiently developed, including the level of equivalence of the use of telemedicine technologies in the diagnosis of autistic spectrum disorders. AIM: Study of the equivalence of diagnostic tools in the framework of telemedicine and face-to-face consultations in children with autistic spectrum disorders according to modern scientific literature. METHODS: A descriptive review of scientific studies published between January 2017 and May 2023 was carried out. The papers presented in the electronic databases PubMed, Web of Science, and eLibrary were analyzed. Descriptive analysis was used to summarize the obtained data. RESULTS: The conducted analysis convincingly indicates sufficient equivalence of remote tools used in different countries for level I screening, assessment scales, and structured procedures for diagnosing autistic spectrum disorders with a high level of specificity from 60.0 to 94.4%, sensitivity from 75 dog 98.4%, and satisfaction of patients and their legal representatives. CONCLUSION: The widespread use of validated telemedicine diagnostic systems in clinical practice contributes to the early detection of autistic spectrum disorders, increasing the timeliness and effectiveness of medical, corrective psychological, pedagogical, and habilitation interventions.

The article presents the results of a mixed empirical study carried out in 2020– 2021, which included semi-structured interviews with residents of large Russian cities (N = 90) and a telephone survey of residents of Saint Petersburg (N = 861). The focus of our attention is people’s experience of receiving remote medical consultations, the factors influencing it, as well as the attitudes that have developed towards this sort of assistance. The article aims at identifying possibilities and limitations of a new type of communication between doctor and patient, mediated by digital technologies. Based on the results of the research, conclusions about the prevalence of remote medical consultations, as well as how they are embedded in the everyday life of citizens and how they actualize important aspects of interaction with medical professionals were formulated. It was revealed that remote medical consultations in general need to be separated from telemedicine as one of its variants. According to the results of the study, 25.2% of respondents have communicated at least once with a doctor remotely. Typically such interaction occurs with “trusted” doctors — those with whom personal, and often repeated contact has proven to be effective, and can be initiated by both the doctor and the patient. The situation is different in the case of telemedicine, attitudes towards which can be explained by how the specifics of interaction in the doctor-patient system are perceived. The inability to provide a physical examination and difficulties in establishing personal contact are among the more significant reasons preventing the use of telemedicine. Since telemedicine involves contact with unknown doctors and is always initiated by the patient, the basis for resorting to it is not interpersonal trust in the specialist, but the presence of institutional trust in the healthcare system and a significant degree of patient autonomy. People who are aware that they have health problems and have a habit of taking care of themselves in various different ways, including by means of monitoring medical recommendations, are more likely to communicate remotely with a doctor. A higher level of income increases the chances of resorting to such consultations. Predictably, representatives of older age groups turned out to be in the outsider group.

Background. Currently, the mortality rate of pediatric patients due to injuries surpasses mortality from other causes worldwide. The selection and timely transfer of the injured to specialized clinics are crucial elements of the healthcare system. Telemedicine consultations (TMC) are considered by several authors as an effective means to enhance the quality of trauma care and optimize patient routing processes. Aim of the study was to analyze the results of urgent and emergent telemedicine consultations and hospitalizations based on telemedicine consultations for children with musculoskeletal injuries. Methods. TMC requests from 2020 to 2022 were analyzed. When evaluating TMC requests, attention was given to the type of request (planned, urgent, emergent), the region from which the request originated, and the correspondence of the request’s urgency category to the patient’s diagnosis. The study also involved an analysis of the injury structure, its severity according to the Injury Severity Score (ISS) at the time of trauma, and the timelines for requesting and transferring to the federal clinic from the moment of injury. Results. From 2020 to 2022, a total of 3745 requests for TMC were received. Among them, there were 572 urgent and emergent requests. A threefold increase in the number of TMC requests was observed over the span of three years. In the same period, 78 patients were transferred to the clinic. For 36 patients with combined and multiple injuries, the severity of trauma was assessed using the ISS scale. The average score was 31 (min 9; max 57). The average time for regional institutions to send a request from the moment of the patient’s hospitalization was 6.7 days. Hospitalization in the center’s clinic from the moment of injury was 10.3 days (min 1; max 58). Conclusion. The study revealed the following issues that need to be addressed through further organizational steps: a high percentage of mismatch between the type of request and the actual clinical picture, delayed consultations, prolonged medical evacuation, and organizational aspects of medical evacuation.

Diabetes mellitus is one of the most world’s common disease. Global digitalization reveals new opportunities in diabetes mellitus patient man-agement. Various applications and devices are currently available to improve patient’s glucose levels. Apart from continuous glucose monitoring devices traditional methods of blood glucose monitoring are widely used. The development of special applications and options for glucometers to connect with mobile devices essentially improved data analysis and allowed to improve treatment efficacy.

The COVID-19 pandemic had a serious impact on global health and showed that the current state of most health systems in the world was not ready for such an emergency. During the pandemic, the provision of specialized planned medical care to patients with chronic diseases was suspended, and therefore telemedicine technologies for remote monitoring of patients began to be actively used in many countries of the world. In the Russian Federation, leading experts have issued organizational and methodological recommendations for the management of patients with diabetes and other chronic diseases during the COVID-19 pandemic. The measures taken by the government to provide medicines and prevent COVID-19 infection have allowed many patients with diabetes to observe a self-isolation regime. Meanwhile, there are data on the negative impact of self-isolation on the general condition of patients for various reasons: a decrease in the level of self-control and physical activity, a reduction in the volume of planned specialized medical care. Telemedicine technologies in the Russian Federation have been successfully used for remote monitoring of patients with mild and moderate severity of COVID-19. Currently, the widespread use of telemedicine and modern digital technologies, which proved their effectiveness during the pandemic in the treatment and control of diabetes, has not yet reached an optimal level. This review examines the possibilities of using telemedicine technologies for patients with diabetes, analyzes the experience of foreign countries and the Russian Federation in managing patients with diabetes during a pandemic, and analyzes the effectiveness of management measures to provide medical care to patients with diabetes.

BACKGROUND: The use of telemedical technologies (TMT) is widespread in providing care to patients of various profiles. However, TMTs are hardly ever used in gastroenterology, despite the extensive digitalization of healthcare. Potential sites for the use of TMTs among gastroenterological patients were assessed. AIM: The study aimed to assess the effectiveness and benefits of TMTs in patients with digestive diseases. Patients with colorectal cancer (CRC): Screening and postoperative management. The TMT intervention increased the number of patients screened for CRC compared to standard face-to-face counseling. In addition, the quality of preparation for colonoscopy was higher in patients who interacted with the physician via TMTs compared to the control group. Most studies reported positive effects of TMTs on quality of life and physical activity in patients with CRC. However, the study by K. Beaver et al. showed that the incidence of CRC recurrence did not differ in the TMT and face-to-face groups. Patients with nonalcoholic fatty liver disease (NAFLD): Correction of lifestyle. When assessing the use of TMTs among NAFLD patients, a significant decrease in alanine aminotransferase and aspartate aminotransferase activity was found compared to that in face-to-face management. The results of the body mass index reduction are contradictory. The most pronounced tendency towards weight loss was observed with the telemedical follow-up of patients over a 6-month period. Patients with irritable bowel syndrome (IBS): Treatment and monitoring of symptoms. Two directions are distinguished in the treatment of IBS by ТМТs. The first is cognitive behavioral therapy (CBT). H. Everitt et al. showed clinically significant improvement in 72.8% of cases after 12 months of web-based CBT. The advantages of using telemedicine in the delivery of CBT include the geographical independence of the physician and the patient, personalization of treatment, and the possibility of ongoing support for the patient and his or her family. The second direction is the use of special diets, such as low-fermentable nutrient diets (FODMAP). Patients following the FODMAP diet supervised by the mobile app reduced symptom severity (odds ratio 55; 95% confidence interval 1198, p=0.01). Special mobile apps (IBS Constant Care) were used to monitor the condition of patients with IBS, which analyze input data and assess severity, providing information to both the patient and the physician. Patients with inflammatory bowel disease (IBD): Patient training and telemonitoring. The study by L. Pang et al. proved that the patients quality of life in the telemedicine intervention group was significantly higher (p=0.03). Another advantage of using TMTs is the provision of access to educational materials about IBD and the possibility of remote contact with the treating physician. The patients ability to obtain necessary information reduces the need for unplanned visits to medical facilities, thus reducing the cost of organizing medical care for patients with IBD. The degree of IBD activity and risk of recurrence and adherence to therapy did not differ significantly between the telemedicine intervention group and the standard face-to-face follow-up group. METHODS: A literature search relevant to the review was conducted in the PubMed database. The studies taken for assessment were those on the use of TMTs among patients with IBD, IBS, NAFLD, and CRC. TMTs were used to access educational information and dietary recommendations, provide information on lifestyle adjustments and physical activity, remind patients to take medicines, consult with physicians, and assess disease activity by completing online questionnaires. The various studies used text messaging, e-mail, mobile apps, websites, and videoconferencing apps as a means of communication. RESULTS: The use of telemedicine in the management of patients with digestive diseases showed high efficiency. TMTs contribute to: Improved quality of life in patients with digestive diseases. Increasing physical activity of patients with CRC and NAFLD. Improved quality of CRC screening. Maintaining remission of IBD and CRC as effectively as face-to-face monitoring. Moreover, the use of TMTs allows personalized treatment, ensures the ongoing support of the patient and his or her family by the medical staff, and provides patients with access to quality educational materials about the disease. CONCLUSIONS: Thus, the use of TMTs is promising in the treatment of digestive diseases and requires wider introduction into practice.

BACKGROUND: Chronic heart failure (CHF) is one of the leading causes of death. Telemedicine and remote monitoring (RM) are a way to increase life expectancy and quality of life in patients with CHF. Methods based on messengers familiar to patients promote adherence and do not require additional training. AIM: To compare quality of life and adherence to therapy in patients with CHF who were on RM using a chatbot compared to the standard follow-up (SFU) group for 3 months. METHODS: Patients with CHF on optimal drug therapy discharged from the hospital were included in the study. Comparison groups were formed according to the method of observation, particularly, RM and SFU. A chatbot was set up for patients in the RM group. Monitoring was done using a seven-question survey sent daily. The signs of decompensation (red flags [RF]) were increased edema, dyspnea, body weight 2 kg per week, and changes in individual parameters of heart rate and blood pressure. If a RF was detected, telephone contact was made, and the therapy was corrected if necessary. Quality of life was assessed according to the Minnesota Quality of Life Questionnaire for patients with CHF (highest, 0 points; lowest, 105 points), and adherence was assessed using the Adherence Scale of the National Society for Evidence-based Pharmacotherapy. RESULTS: A total of 60 patients were included in the study; 37 patients completed a 3-month follow-up. The RM group (n=17, 13 men, 76.5%; median age 61 [51; 62]) and comparison group (n=20, 14 men, 70%; mean age 64.98.9) were comparable according to the functional class (New York Heart Association), but differed in ejection fraction (42.813% versus 53.210.4% [p 0.05]). Adherence to the chat-bot was 67.2%. Adherence to therapy was not significantly different between the RM and SFU groups accounting for (17 [100%]) and (18 [90%], respectively, (p=0.62). In the RM group, RF was detected in 7 (41%) patients. Only one patient required correction of therapy. Patients in the RM group required no referral to a medical facility, whereas 2 patients in the SFU group required medical care. Quality of life was statistically significantly higher in the RM group, reaching 28.713.9 points compared to 37.717.9 points in the SFU group (p=0.04). CONCLUSIONS: After 3 months, patients in the RM group were committed to the chatbot, with adherence to therapy comparable to the SFU group. Quality of life was statistically significantly higher in the RM group. Patients in the RM group did not go to medical facilities, in contrast to the SFU group. The limitations of the study were the small sample size and short follow-up period. The results require further research to obtain additional data.

The social significance of telemedicine services is due to their effectiveness in combating the main challenges facing national health systems. The introduction of these services into medical care opens up new opportunities for cutting its costs and increasing accessibility, as well as reducing the risks inherent in the Russian healthcare system. The study aims to formulate proposals for regulating telemedicine services in the Russian Federation and identifying promising areas for their diversification. The theoretical framework includes the theories of servitization, digitalization and public health, as well as researchers’ views on health economics. The methods of comparative, system and functional analysis were used. The empirical evidence comes from the Organization for Economic Cooperation and Development, the Federal State Statistics Service of the Russian Federation, the Ministry of Health of the Russian Federation, and audit companies for the period of 2018–2022. Having analysed the global practice in forming and regulating the telemedicine market under healthcare digitalization, we emphasize the need to create a clear legislative framework, build intergovernmental relations, and exchange experience in this area. The research proposes a set of measures for developing these services, while taking into account the risks caused by the specificity of healthcare in Russia, i.e., the imperfection of national legislation, the lack of quality standards and clear rules for doctor-patient interaction. The authors’ recommendations provide for the use of economic, administrative, legal, information and communication methods for regulating telemedicine services. Realization of these recommendations will contribute to a more rational distribution of resources and effective implementation of health policy in accordance with national economic, financial and social interests.

Background. Medical care through telemedicine technologies for plasma cell tumors has been provided at the National Medical Research Center for Hematology since 2018. Patients are consulted at the “doctor–doctor” level in the field of “hematology”. Another important aspect of the application of telemedicine at the National Medical Research Center for Hematology is scientific, practical and educational activities aimed at developing remote interaction with medical institutions, developing ways to improve interaction with specialized medical organizations.Aim. To present the implementation of the main applications of telemedicine technologies on the example of paraproteinemic hemoblastoses.Materials and methods. From October 2018 to October 2022 the department of hematology and chemotherapy of paraproteinemic hemoblastoses with bone marrow and hematopoietic stem cells transplantation unit of National Medical Research Center for Hematology received 815 telemedicine requests (701 – primary, 114 – repeated). In 93.6 % of cases, telemedicine consultation was required for multiple myeloma, 2.6 % of requests included information about patients with solitary plasmacytoma, in individual cases, regional hematologists made inquiries about patients with plasma cell leukemia, plasmablastic lymphoma, Waldenstrom’s macroglobulinemia.Results. There has been an annual increase in the number of telemedicine consultations for multiple myeloma. Of the 73 participating regions, the most active were: Tambov Region, Altai Territory, Vladimir Region, Republic of Crimea, Republic of Buryatia, Krasnodar Territory, and Krasnoyarsk Territory. Most of the consultations are aimed at clarifying the tactics of treating multiple myeloma. In 20 % and 22 % of cases, first- and second-line therapy was recommended. In response to 21 % of requests, recommendations were given for the treatment of multiple myeloma complicated by double and triple refractoriness. In 14 % of requests, insufficient information content of medical documentation did not allow expressing an adequate opinion on the tactics of patient management. Hospitalization at the National Medical Research Center for Hematology for the purpose of autologous hematopoietic stem cells transplantation was recommended in 10 % of cases. An analysis of 4 % of telemedicine requests testified to the expediency of palliative treatment and local radiation therapy at the place of residence. The main disadvantages of requests are the lack of primary information when establishing a diagnosis and information on disease monitoring during therapy, as well as the presence of excessive information in medical records.Conclusion. An analysis of telemedicine consultations for paraproteinemic hemoblastoses over a 4‑year period indicates a high need for regional hematologists to discuss therapy tactics with doctors from the federal center. Through telecommunications between doctors of National Medical Research Center for Hematology and the region, in some cases, the full range of diagnostic and therapeutic measures is ensured, which contributes to improving the quality of medical care.

The purpose of the research is to look at the issues of legal regulation of information healthcare, consider the positive experience of international legal regulation to overcome legal gaps in digital healthcare, improve the quality of life of the population and the systemic functioning of information biomedicine based on the principles of mutually beneficial cooperation between Russia and foreign countries. It examines the historical aspects and modern trends of cross-border digital healthcare in accordance with international standards, positive and negative consequences of the information biomedicine impact on basic constitutional human rights and freedoms. The research analyzes national and international legislation, the main directions of constitutional regulation of digital biomedicine and proposes to create an effective mechanism for implementing national legislation on digital healthcare, based on the positive experience of international legal regulation and protection of basic constitutional human rights in order to prevent the use of ethically unacceptable methods. The following scientific methods have been applied in the research: theoretical, historical, empirical, classification and comparative legal analysis. The study identified the urgent need for holistic approach to transnational digital healthcare, characterized by integration of law and biomedicine, and constitutional regulation of the biomedical research approbation. It is worth mentioning that the practical research activities of medical professionals and lawyers are interrelated and require constant interaction and analysis of biomedical results and their legal justification. Therefore, the function of law is to regulate the limits of human intervention in information biotechnologies, identify and exclude all possible risks of approbation of scientific research and their results in the sphere of digital healthcare. The author believes that development of information biomedicine involves interplay of various spheres of knowledge based on scientific synergy of medical, legal, and ethical aspects, integration of interrelated legal and non-legal sciences. Given the importance of integrating the constitutional foundations of cross-border digital healthcare, the author proposes to create a single extraterritorial Concept of Transnational eHealth. It is essential to consider international experience in order to ensure proper protection of human rights in the sphere of information healthcare.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune rheumatic disease with joint damage and systemic manifestations, which worsens the quality of life and life expectancy, leading to disability in the absence of effective therapy at a young age. The goal of RA treatment is to achieve remission/low disease activity. Frequent monitoring of the disease is needed (every 13 months until the goal is reached, then every 36 months), which is not always possible due to remoteness of residence, financial capabilities of patients, and epidemic situation. Remote monitoring appears to be a possible solution to the problem; however, the effectiveness of telemedical technologies in the treatment of patients with RA is not sufficiently studied. AIM: To investigate the effectiveness of remote-control treatment of patients with RA of high and moderate activity using a chat-bot. METHODS: An algorithm for remote monitoring and communication with RA patients was developed. The chat-bot performs a survey every month and out-of-schedule when the patients condition worsens and provides the data to the doctor in a convenient form. Regular assessments of RA activity, functional impairment, and quality of life and correction of recommendations if necessary are made. All participants are coded, with only the doctor having access to personal data. In remote (60 patients) and traditional (30 patients) control groups, the time to remission/low disease activity will be compared. Adherence to the chat-bot and cost-effectiveness analysis will be studied. RESULTS: Twenty patients were trained on how to use the chat-bot and have been using the program for 2 months. The condition is monitored and online counseling is provided if necessary. Nineteen patients had no difficulties when working with the chat-bot. One patient needed a second consultation on how to use the chat-bot. Half of the patients were over 60 years old. Most patients prefer remote counseling to a face-to-face appointment. Patients report an improved understanding of the disease, treatment principles, and methods of self-assessment of the joint condition. Remote monitoring is planned to achieve stable control of RA activity by timely detection of exacerbations and therapy correction and assessment of the need for hospitalization, which will help to reduce the period of remission/low RA activity. The economic cost of treating RA is expected to be reduced. CONCLUSIONS: Remote monitoring using a chat-bot to improve the effectiveness of RA treatment is an important aspect of current rheumatology and a potential method for increasing the availability of medical care. The results may serve as a basis for further research on telemedical technologies and the development and application of personalized algorithms for monitoring, prevention, and treatment of patients with rheumatic diseases.

BACKGROUND: The COVID-19 worldwide pandemic enabled the expanded use of telemedical technologies in many areas of medicine. Remote consultations helped conserve medical resources and reduce the risk of spreading COVID-19 while preserving patients access to medical care. In addition, telemedicine played a role in caring for patients who live in remote regions. Other benefits include savings in transportation costs and travel time both for patients and caregivers. Telemedicine, together with remote health monitoring technologies, has high potential in developing a preventive healthcare system and increasing the accessibility of medical care and meets current challenges by improving healthcare quality and providing an individual approach to patients. In 2020, the Center of Telemedicine was created in the Republican Clinical Oncological Dispensary (RCOD) to organize and improve telemedical assistance to the population of the Republic of Bashkortostan in the oncology profile. AIM: To analyze telemedical consultations (TMCs) on oncology in the Republic of Bashkortostan for the period of 20202022. METHODS: Quantitative count and comparison of the TMCs conducted by the RCOD of the Ministry of Health of the Republic of Bashkortostan in 20202022 and sent to the National Medical Research Center (NMRC) were performed. The work on referrals to the NMRC for revision of examination results (computer tomography, magnetic resonance imaging, positron emission tomography/computed tomography, and histological examinations), obtaining a second opinion, and determining treatment tactics was organized. RESULTS: In 2020, 32,076 TMCs were conducted, while 225 TMCs were performed with the NMRC. In 2021, the RCOD conducted 52,139 TMCs (a 62% increase compared to 2020), whereas 473 TMCs took place in the NMRC (a 110% increase compared to 2020). During the 12 months of 2022, 57,456 TMCs were performed by RCOD staff (a 10% increase over the previous year), and 672 TMCs were conducted with the NMRC (a 42% increase compared to 2021). For feedback from referring medical organizations and monitoring and evaluating the quality of regional TMCs, conference calls were held with the Ministry of Health of the Republic of Bashkortostan, chief physicians, and oncologists of the Republic of Bashkortostan. CONCLUSIONS: TMCs allow for the rapid exchange of medical information, thereby reducing the time of diagnosis and timely prescription of treatment, the implementation of timely routing of patients and improving the quality and availability of medical care in the oncology profile in the Republic of Bashkortostan. The annual increase in the number of TMCs is due to the growing need for this type of specialized medical care in this profile.

Inflammatory bowel diseases (IBDs) represent a group of nosologies including Crohns disease and ulcerative colitis. These diseases lead both to the deterioration of the patients physical condition and to a pronounced decrease in the quality of life. Currently, healthcare costs of managing patients with IBDs are steadily increasing and are commonly associated with the need for examinations and therapy with expensive drugs and unplanned expenses of healthcare resources for unscheduled consultations, emergency hospitalizations, and surgical interventions. Deterioration of patients condition may be associated with self-cancellation of therapy after normalization of the state of health. The use of telemedical technologies (TMTs) is promising for maintaining remission of IBDs, improving adherence to therapy, and reducing the frequency of unscheduled visits to the clinic and the cost of treating IBD complications (including surgery). The efficiency and benefits of TMTs in patients with IBDs were assessed in comparison with standard face-to-face follow-up. A literature search relevant to the review was conducted in the PubMed database. Papers were selected that assessed the efficiency of telemedical interventions among patients with IBDs as compared to the standard face-to-face follow-up group. The evaluation criteria included the degree of the disease activity, risks of IBD recurrence, quality of life of patients, adherence to therapy, healthcare costs, and frequency of visits to healthcare facilities. Telemedical interventions were conducted using the Internet, mobile applications, various telemedical platforms, SMS messages, and phone calls. The telemedical follow-up groups received access to educational materials and online consultations with a specialist upon request and completed questionnaires to assess disease activity, adherence to therapy, and quality of life. The degree of IBD activity and risk of recurrence and the level of adherence to therapy did not differ significantly between the telemedical intervention and standard face-to-face follow-up groups. The study by L. Pang et al. showed that the patients quality of life in the group of telemedical intervention was significantly higher (p=0.03) [8]. Another advantage of using TMTs is the provision of access to educational materials about IBDs and the possibility of remote contact with the treating physician. The patients ability to obtain necessary information reduces the need for unplanned visits to medical facilities and the cost of organizing medical care for patients with IBDs. The use of TMTs allows to monitor IBD activity as effectively as face-to-face follow-up, improve the patients quality of life with IBDs, and reduce costs for organizing care for patients with these diseases by decreasing the frequency of unscheduled visits to the doctor and conducting unnecessary additional examinations.

The article explores the theoretical and applied aspects of providing medical services by means of telecommunication technologies. The state of development and application of telecommunication technologies in the market of medical services over the world and in Ukraine is described. The methods of telecommunications, which are used in the modern system of medical care, are systematized. The key levers of influence on the effectiveness of medical care of the population through the introduction of telemedicine technologies are defined. The principles and directions of interaction of counterparties through the procedure for the provision of medical services are identified. The factors of influence and indicators that ensure the effectiveness of the provision of medical services are studied. The levels of management in the provision of medical care through telecommunication technologies are outlined. The main forms of regulation of the process of primary health care in Ukraine are characterized. The essence of the key forms of interaction of doctor – patient on the basis of telemedicine is defined. The structure of telemedicine methods that will provide an integrated approach to improving the level of medical care in the regions of Ukraine is specified. The introduction of telecommunication methods into the management system of medical institutions is proposed. Approaches and means of using telemedicine tools are summarized, taking into account the current state of development of the social sphere in Ukraine. The conditions for further integration of telecommunication technologies into the process of medical care of the population are substantiated.

The article analyzes the possibility of the influence of telemedicine on the levels of systolic blood pressure in patients with type 2 diabetes mellitus in combination with arterial hypertension. The study involved 224 patients who were initially divided into 2 groups: group 1 (patients who refused to undergo structured training; n = 54) and group 2 (patients who underwent structured training; n = 170). Subsequently, the patients of group 2 were divided into two subgroups: group 2a, consisting of 109 patients who underwent structured training, but did not use feedback from the doctor every 2 weeks, carried out in the form of telemedicine; group 2b, consisting of 61 patients who underwent structured training and made contacts with a doctor every 2 weeks. In order to increase the effectiveness of training, family members of the patient living with him often also participated in the process. In some cases, group training was used (no more than 3 people in 1 group, taking into account age, psychological and intellectual compatibility). As a result of the study, it was found that in all three groups, the systolic blood pressure levels at the end of the study were lower than the baseline levels, and in all cases, the differences between the initial and final levels of this indicator were statistically significant. However, with the initial levels of systolic blood pressure not statistically significantly different from each other, the most optimal result was obtained in group 2b – 133.3 mm Hg. (95% CI 131.46; 135.14) and 2a – 133.7 mm Hg. (95% CI 132.25; 135.15). In group 2b, a more gradual decrease in systolic blood pressure was noted than in group 2a. In addition, there were also statistically significant differences in the incidence of systolic blood pressure < 130 mm Hg. at the end of the study between groups 1 and 2a (p < 0.0001) and the difference between the frequency of occurrence of systolic blood pressure < 130 mm Hg. at the end of the study between groups 1 and 2b (p < 0.001). According to the results obtained, it can be argued that structured learning made it possible to achieve a more effective reduction in the level of systolic blood pressure compared to unstructured, "sketchy" learning. The feedback system "patient-doctor" using telemedicine technologies, used to manage arterial hypertension in type 2 diabetes mellitus, made it possible to achieve a smoother decrease in systolic blood pressure levels, while maintaining the effectiveness of therapy.

AIM. To develop an original information technology for remote monitoring and to conduct a scientific justification for its use for monitoring and evaluating the motor regimen and the main physiological parameters of patients in a rehabilitation center. MATERIAL AND METHODS. The original architecture of the software and hardware complex was used (certificate of state registration of the computer program No. 2022611766 of February 1, 2022), allowing to the attending physician’s PC and wearable devices (smart watches) of the patient with the function of the 24-hour registration of motor activity and heart rate indicators of users. The study involved 21 patients, who underwent medical rehabilitation courses in a round-the-clock hospital. 11 patients underwent cardiorehabilitation programs for the diagnosis of chronic coronary heart disease, myocardial infarction in the past (I25.2 according to ICD-10); 10 patients due to a condition after COVID-19 (U09.9 according to ICD-10). RESULTS AND DISCUSSION. When comparing the motor characteristics of the 2 study groups, it was found that the average number of steps per day was 9004.6 in the group of patients with a diagnosis of I25.2, which equals the distance of 6.6±2.63 km, and 10072.4 steps per day and 7.45±3.12 km in the group with a diagnosis of U09.9, respectively (p

Introduction.Research is devoted to the modern initiative practices of using web resources, which surgeons use to build a career and advance in a professional environment or aim for self-training. A review of Russian-language sources showed that studies on the topic are almost absent. The work was based on the principles of pragmatic sociology and revealed structural and functional changes manifested in new ways to improve professional skills through the opportunities provided by digital technologies.Methodology and sources. The authors rely on systemic, structural-functional approaches and the methodology of the French school of pragmatic sociology to describe the changes that digital technologies bring to the social institution of medicine. Foreign sources show a high researchers' interest in this field. Foreign colleagues develop the topic of web resources used in the routine practice of a surgeon having regard to his / her specialization, goal setting, etc. The publication is based on a questionnaire survey of 252 surgeons and four indepth interviews.Results and discussion. Web resources and social media in the professional practice of doctors in general and individual specializations are at the initial stage of scientific and practical understanding of Russian sociology. Appealing to web resources to improve the professional level or prepare for surgery is part of the routine practice of surgeons. At the same time, surgeons lack technical and organizational support, the actual use of web resources is underestimated, and institutional web resources are less popular than specialized communities and individual social media channels. Conclusion. Russian surgeons act in a resource-constrained Internet technology environment in their working place, bound by the lack of technical capabilities for creating, storing, and distributing video archives, the lack of special tools, and, often, skills for editing and commenting on videos, operations, and maintaining social media. The professional representation of surgeons on web resources is their initiative, and videos of the surgical operation are uploaded spontaneously. The mastership of the surgeon and the quality of the surgical operation posted do not have institutionalized forms of regulation and evaluation by the professional community.

The COVID-19 pandemic in Poland lasted from March 2020 to May 2022. As a result of the new strain of the virus, it was necessary to change the way primary health care units work. In order to allow patients to interact with medical staff, teleconsultations were introduced. This was thought to reduce the spread of the virus and reduce the risk of contracting SARS-CoV-2. Many other countries have seen a reduction in in-person visits and an increase in online doctor consultations. The aim of the study was to examine the level of services provided by medical facilities, including efficiency, effectiveness and patient satisfaction. The survey, which included 246 people, showed that most respondents used remote visits during the pandemic and more than 50% of them believe that clinics were not adequately prepared for the epidemiological situation. Despite the rapid development of technology in the medical sector, patients still prefer the traditional form of medical consultation, which they argue is more accurate and insightful for the doctor during this type of visit.

A decade ago, telemedicine was considered a cumbersome and unattainable technology, but now the rapid development of telecommunications provides the basis for its dissemination as a reliable and useful direction in treatment. This method of medical care has recently begun to be used in Ukraine. Interventional neuroradiology is one of the most technologically advanced and leading areas of modern medicine with a wide range of tools for minimally invasive treatment of various vascular pathologies of the nervous system. Over the past 3 years, due to the restrictions associated with the COVID-19 pandemic, as well as the russian-ukrainian war, cooperation between specialists in this field has become much more complicated. And first of all it concerns the education of the specialists and the introduction of new methods of endovascular treatment in Ukraine. In such conditions, the integration of telemedicine into clinical practice is one of the priorities.

The purpose of this work is to study the process of telemedicine implementation in the context of digitalization of Kazakhstan to identify problems. Development of recommendations for solving these problems, both in the public and in the private sectors of medical services. The scientific significance of the work lies in the contribution of new knowledge on the issue of telemedicine in the example of Kazakhstan, since this issue has been underxplored. The results of this study can be used to further develop the digitalization process of healthcare in the Republic of Kazakhstan. A qualitative method is used, a semi-structured interview with experts in the field of telemedicine implementation was conducted. Atlas.ti software is used for data processing. As a result of the analysis of the interviews, the limitations and problems of the implementation of telemedicine in the country were identified, such as high costs for the provision of IT services and the quality of the Internet, as well as the government’s weak interest in cooperation with the private sector. However, despite these obstacles, the private sector is interested in implementing telemedicine. Analysis of world official data showed that the telemedicine market is growing rapidly, and there is a demand for consultations using telemedicine in the Kazakhstani market. Therefore, there is a need to develop this direction. Recommendations were offered to solve the problems of telemedicine implementation in Kazakhstan. Eliminating the identified problems can accelerate the process of healthcare digitalization, which is a contribution to the development of this area.

Objective: the rapid expansion of the use of telemedicine in clinical practice and the increasing use of Artificial Intelligence has raised many privacy issues and concerns among legal scholars. Due to the sensitive nature of the data involved particular attention should be paid to the legal aspects of those systems. This article aimed to explore the legal implication of the use of Artificial Intelligence in the field of telemedicine, especially when continuous learning and automated decision-making systems are involved; in fact, providing personalized medicine through continuous learning systems may represent an additional risk. Particular attention is paid to vulnerable groups, such as children, the elderly, and severely ill patients, due to both the digital divide and the difficulty of expressing free consent.Methods: comparative and formal legal methods allowed to analyze current regulation of the Artificial Intelligence and set up its correlations with the regulation on telemedicine, GDPR and others.Results: legal implications of the use of Artificial Intelligence in telemedicine, especially when continuous learning and automated decision-making systems are involved were explored; author concluded that providing personalized medicine through continuous learning systems may represent an additional risk and offered the ways to minimize it. Author also focused on the issues of informed consent of vulnerable groups (children, elderly, severely ill patients).Scientific novelty: existing risks and issues that are arising from the use of Artificial Intelligence in telemedicine with particular attention to continuous learning systems are explored.Practical significance: results achieved in this paper can be used for lawmaking process in the sphere of use of Artificial Intelligence in telemedicine and as base for future research in this area as well as contribute to limited literature on the topic.

BACKGROUND: Due to the gaming industrys rapid development, a large number of technical tools and technologies with unique characteristics have emerged. One of these technologies, which can be potentially used in medical diagnostics, is streaming (online streaming). By connecting an ultrasound scanner to a video capture system, it is possible to significantly expand the diagnostic devices functionality. AIM: To investigate the possibility of applying the gaming industrys information technology in telemedicine, like tele-ultrasound. MATERIALS AND METHODS: In this study, an ultrasound video image was captured using a video capture system developed for gamers. The video was obtained during brachycephalic arteries ultrasound in the following modes: greyscale B-mode, color duplex, and pulse Doppler mode. The examination was broadcast to a video streaming service in real time. RESULTS: An expert sonologist obtained optimal video image parameters and determined the minimum required video streaming settings for an adequate remote evaluation. The following video capture workstation settings are recommended: video, 1280720; 24 fps; H.264 encoder; bitrate, at least 350 Kbps. CONCLUSIONS: Using technical and software tools developed for video game streaming to provide tele-ultrasound is possible.

The steady growth and prevalence of chronic heart failure (CHF) leads to an increase in mortality, repeated hospitalizations and disability of the population. More than half of rehospitalizations are due to poor adherence to therapy, the impossibility of timely observation by a doctor, and inadequate patient education in the basics of self-control and self-help during and after discharge. In order to improve the quality of life of patients with CHF, reduce the frequency of readmissions and mortality, it is necessary to create programs to optimize outpatient care with the possibility of monitoring clinical indicators and timely correction of therapy, which can be done using digital technologies — mHealth. The ubiquity of mobile phones and portable gadgets is thought to make the introduction of remote monitoring software more affordable and cost effective. Thus, the purpose of the review is to collect and analyze the available literature data on the use of mobile technology programs for non-invasive remote monitoring of patients with CHF. Thus, studies investigating the impact of remote monitoring on the course of CHF have included widely varying patient cohorts using dissimilar devices with different support packages. Of course, the heterogeneity of both the sample and the methods used led to the inconsistency of the data obtained, the inability to compare and evaluate the results in full. Along with this, the inability to directly compare different methods of remote monitoring of patients with CHF determines the impossibility of choosing the most effective of them, which, in turn, dictates the need for standardization of methods according to, including the healthcare system in each individual country. Overall, mHealth applications offer a potentially cost-effective solution with continued access to symptom monitoring, encouraging patient engagement in self-care and self-monitoring, and improved outcomes over standard practice. While there is considerable evidence for the effectiveness of remote monitoring programs, many areas of uncertainty remain, and mobile phone interventions require further careful evaluation. Although the available data is insufficient to confirm the impact of mobile phone monitoring, it is clear that the potential is enormous.

Objective: to study the practice of organizing and conducting telemedicine consultations (TMC) of a rheumatological profile, their effectiveness and the main problems that arise during the implementation of this technique.Patients and methods. From June 2020 to December 2021, 102 rheumatological TMCs were performed at the «New Hospital» Medical Association in Yekaterinburg. Patients aged 18–82 years applied for TMC after a face-to-face examination and for the purpose of «pre-consultation». TMC included the following steps: familiarizing the doctor with previous medical reports and the results of examinations; video conference; preparation of final medical report. The Aibolit service and the «Medkarta» platform were used. After TMC, a survey of doctors and patients was conducted to identify the positive and negative aspects of this technique.Results and discussion. Most of the patients who applied for TMC suffered from diseases that required regular monitoring of disease activity (rheumatoid arthritis, psoriatic arthritis, systemic connective tissue diseases), as well as fibromyalgia. Leading reasons for seeking medical advice: exacerbation of the disease or new symptoms onset, the need for laboratory and instrumental monitoring and correction of therapy. The vast majority of patients (90.2%) received answers to all questions and 9.8% – to most of the questions. Doctors had technical problems in 34 (33.3%) cases, including 11 (10.8%) cases when they had to switch to another method of communication.Conclusion. TMK is a promising technique that can be useful and convenient for patients both now, during the COVID-19 pandemic, and in the future. Its main unresolved problems are the recognition of parity between TMK and face-to-face consultations and the improvement of technical conditions.

Telepsychiatric assistance in the “doctor-patient” format is at the stage of formation and requires the solution of legal, organizational and methodological issues. The aim of the study was to substantiate the methodology of telemedicine consultations of patients (legal representatives) in child psychiatry. Material and methods. The analysis of the results of 1129 telemedicine consultations (TMK) in the «patient-doctor» format for 559 patients aged 2 to 18 years was carried out. Results. Remote consultations have been tested for the entire spectrum of mental disorders in childhood and adolescence. During the primary patient-doctor TMK, a number of serious regulatory and technical limitations were identified. Repeated TMK «patient — doctor» in child psychiatric practice are defined as the most optimal and safe. There was a significant increase in the number of repeated TMKs and the expansion of the specialties of consultants during the period of restrictive measures in connection with the COVID-19 pandemic. The assessment of the effectiveness of TMK was carried out by means of a sociological survey (questionnaire) of doctors and patients (legal representatives). Conclusion. A methodology has been developed for organizing and conducting telemedicine consultations for patients under the age of 18 (legal representatives) in the field of psychiatry. A survey of beneficiaries recorded their high readiness and satisfaction with remote counseling. A survey of medical workers revealed a positive trend in attitudes towards carrying out TMK. The negative dynamics of the opinions of specialists in connection with the increase in the level of workload indicates the need for further organizational, methodological and educational work on the use of telemedicine technologies.

The article provides a review of legislative acts, scientific articles, conference papers devoted to the problems of clinical use of telemedicine counseling. The official regulations of interactive telemedicine, the portals used for this service, formats, modes, payment methods were in the focus of our research. We analysed several examples of the telehealth services provided in the Russian Federation and abroad. Thus, we managed to identify the factors that, according to expert opinion, limit the widespread implementation of telemedicine counseling in clinical practice. We also gave general evaluation of the prospects of using an endocrinologist's workstation for consulting outpatients with diabetes mellitus for remote "doctor patient" interaction and for clinical case teleconferences, as well as for integration of the formalized protocol, lying in the software basis, into fully functional medical and administrative information systems existing in the medical institution. A short example of the 3-year regular use of a workstation for admission of outpatients with diabetes mellitus in a city polyclinic illustrates the advantages of this method.

This work is devoted to development of automatic eye detection module. This is a part of a scientific study devoted to development of automatic strabismus detection information system, which will be applied in automated system of telemedical consultations. Telemedicine has great potential to reduce the growing demand for the diagnosis of ophthalmic diseases and is an effective method for timely detection of strabismus. The following tasks were solved to achieve the goal: training of eye detection model, development of an application programming interface for interacting with detection model, development of web interfaces for patient and administrator. The trained model can be used in various information systems that require eye detection functionality. Also, results can be applied to various studies that use the TensorFlow platform to detect single class objects. Presented architecture of interaction between detection model, application programming interface and web interfaces can be used in design and development of complex systems that include user interfaces and server-side computing. Purpose. Development of automatic module for eye detection in human face photo aimed at use in automated system of telemedical consultations. Methodology: programming and machine learning methods were used in the article. Results: automatic eye detection module for use in automated system of telemedical consultations was developed. Practical implications it is expedient to apply the received results for organization of automated telemedicine services and implementation in the developed information systems using telemedicine technologies.

Aim. Based on the results of a sociological survey of patients, to assess quality and availability of health care for cardiovascular diseases (CVDs) in 2020-2021 in the Russian Federation.Material and methods. In August-September 2021, 5159 patients with CVDs from 76 Russian regions were interviewed. Questionnaire (Google form) assessed the change in health care provision over the past two years, the availability of medicine provision, the prevalence and reasons for discontinuation of treatment, as well as the difficulties faced by patients.Results. Improvement in health care provision were assessed by 47,6% of the surveyed patients with CVD, worsening — by 16,6%, and 23,7% did not noted any changes. Improvements regarded diagnosis promptness (29%) and timeliness of treatment (28,5%), availability of subsidized medicines (25%) and better patient routing (21%). However, 37% of respondents did not see any improvements in health care system, or found it difficult to answer. The acute problem of access to diagnostics was considered by 24%, inaccessibility of subsidized medicines — by 17%. In addition, 24% of respondents had difficulties in obtaining specialized cardiology care in the polyclinic and 18% had difficulty in obtaining high-quality medical rehabilitation for CVD.Conclusion. In order to increase public satisfaction with the quality of care, public awareness on health maintenance and patients’ rights to receive care should be improved. In addition, possible barriers to obtaining health care should be eliminated, while consultative and diagnostic assistance and subsidized drug provision should be facilitated for receiving.

The article considers development of medical tourism as one of the significant areas of global market of services export. The historical stages of formation of medical tourism are described, starting from the end of the 19th century, as well as modern trends in its development due to economic, social and technological factors. The various approaches to definition of notion "medical tourism", its classification and comparative characteristics with medical and wellness tourism are presented. The conclusion is made about definitive creolization of the very notion of "medical tourism". The key factors and barriers affecting development of this industry are highlighted, including cost of medical services, quality of medical care, technological progress and communication barriers. The special attention is paid to role of accreditation, telemedicine and information communication technologies in ensuring competitiveness of countries in the medical tourism market. The forecast of further development of this sector in post-pandemic period is made. Its impact on transformation of national health systems is emphasized.

Unfavorable demographic trends give relevance to the search of possible directions for reducing the incidence rate, strengthening the health of citizens and increasing the life expectancy of the Russian population, which is one of the priority national tasks. The COVID-19 pandemic has greatly complicated the situation by increasing population decline and causing significant damage to its health. In this regard, the activation of health care resources is of particular importance, but no less important is the attitude of people themselves to their health, manifested in the way of life, various everyday practices of behavior.The purpose of the article is to analyze, on the basis of sociological data, the dependence of the state of health of citizens, their lifestyle, various behavioral practices associated with saving and promoting health, on the presence of a high level of education. The empirical basis of the study was formed by the results of an all-Russian sociological survey conducted in 2021. The results obtained allow us to assess the potential of higher education in increasing the desire of citizens of modern Russia for self-preserving behavior and a healthy lifestyle.The results of the study show that educational groups of different status have their own characteristics of propensity to various diseases, which, quite obviously, may be associated with the lifestyle of their representatives. According to the survey, people with higher education assess their health better, care more about it, express greater awareness of the factors that determine human health, interest in a healthy lifestyle, which is manifested in more active behavioral practices aimed at maintaining and strengthening own health.

Background: The prevalence of type 1 diabetes mellitus (T1DM) in childhood is increasing every year. Adolescence is the most challenging age for achieving optimal metabolic control of T1DM. Telemedicine has already been shown to be ­effective in children with the condition, but there are not enough studies in adolescents. The use of mobile apps may be associated with better glycemic control in patients with type 1 diabetes.Aims: To assess the effectiveness and safety of a model of medical care for adolescents with type 1 diabetes using remote counseling and a mobile application.Materials and methods: Were included adolescents aged ≥14 and 18 years with a T1DM duration> 3 months, a glycated hemoglobin level (HbA1c)> 7%. The duration of the study was 26 weeks. There were 3 face-to-face and at least 4 remote visits using a mobile application. All patients underwent standard examination and anthropometry, study of HbA1c, registration and analysis of indicators, assessment and correction of the treatment. The quality of life of adolescents was assessed at baseline and at the end of the study. Adolescents and physicians were interviewed about program evaluation.Results: 56 patients were included, 7 adolescents withdrew. HbA1c significantly decreased by the 12th week of the study (–0.3%; p = 0.005), by the end of the study the change in HbA1c was –0.5% (p

Background. Today, the development and widespread use of digital technologies in medicine is considered as one of the most promising mechanisms for optimizing costs and improving the efficiency of healthcare and the quality of life of the aging society.Objective: to study the experience of using telemedicine technologies for providing medical care in the health systems of different countries, including the Russian Federation.Material and methods. To obtain the necessary information, an overview of the most relevant studies published in Medscape, PubMed/ MEDLINE, ScienceDirect, Scopus, eLibrary, CyberLeninka databases, World Health Organization repository and open sources from Google and Yandex search, as well as relevant regulatory documents was carried out.Results. The experience of using telemedicine technologies for medical care in healthcare systems of different countries, including Russia, presented in the article, demonstrates both the advantages of these technologies, and the limitations for their use in healthcare.Conclusion. Despite all the undisputed advantages of telemedicine technologies, their development should not become an end in itself. The expediency of their use in each specific case of providing medical care and exclusively as another, additional tool to improve the quality and accessibility of medical care should be considered.

Purpose. Evaluation of the first experience in organizing systematic telemedicine consultations/conciliums between the national medical research center and medical organizations in the territory of the Far Eastern Federal District (FEFD) of the Russian Federation. Material and methods. The analysis of organizational and technical difficulties in creating of stable system of planned and unscheduled telecommunication events between the Khabarovsk branch of the Fyodorov Eye Microsurgery Federal State Institution (Khabarovsk branch) and assigned to it medical organizations of the 3rd level, providing ophthalmological care for patients from 8 administrative territories of the FEFD. Results. Organizational and methodological department was created in the Khabarovsk branch, which clarified and eliminated the factors that impeded of telemedicine consultations/conciliums for ophthalmologists of medical organizations of the 3rd level; a set of organizational measures was taken to register these medical organizations in the Federal Register of Medical Organizations, in the Unified State Information System in the Field of Healthcare; the equipment necessary for communication was purchased and technically prepared; methodological assistance was provided in setting up equipment in the regions, including on-site visits; backup connections of several providers have been created; an algorithm for preliminary notification of regional ophthalmologists about the knowledge transmission has been worked out; an organizational algorithm for forming a request for telemedicine consultations has been tested. For 2019–2020 the Khabarovsk branch conducted 32 knowledge transmissions, 560 telemedicine consultations on patients living in the FEFD. Conclusion. The introduction into the daily clinical ophthalmologists practice in the FEFD of system of periodic telecommunication events between the Khabarovsk branch and assigned medical organizations of the 3rd level after the elimination of organizational and technical difficulties showed a high demand, allowing consultations on patient management in accordance with modern standards of ophthalmological care.