Project

 

on rehabilitation of Beslan town residents

using latest DiViSy telemedicine technologies and equipment.

 

Purposes of the project. 2

Tasks to be solved within the project. 2

Main activities within the project. 2

Premises for the project implementation. 3

Works completed by the organizations of Community. 3

Information about some telemedicine consultations. 4

Conclusions: 7

The further development of the project. 7

Picture 1. 8

Picture 2. 9

Picture 3. 10

Picture 4. 11

 

 

Beslan-Moscow, 2004

Purposes of the project.

 

Establishing a standing system for medical, psychological and social rehabilitation of residents in the town of Beslan using the latest DiViSy telemedicine technologies. The system will not only provide for high efficiency of rehabilitation processes, but will become a framework for establishing similar systems in Moscow and other regions of Russia in case emergency situations come up.

Coordinators of project telemedicine consultation Beslan-Moscow are: DiViSy Group, Dr. V. Kazinov and Vladikavkaz Scientific Center of Russian Academy of Sciences, Dr. A. Kusraev.

 

Tasks to be solved within the project.

 

1. Rendering help to the doctors at the hospital in Beslan from the leading medical experts of institutes and clinics in Moscow in conducting medical and psychological rehabilitation of the town residents using DiViSy telemedicine technologies.

2. Remotely operated further training and medical consultancy rendered to doctors at the hospital of Beslan provided by institutes, health-care centers and clinics of Moscow.

3. Medical and psychological rehabilitation of patients who returned to the town of Beslan after treatment at institutes, health-care centers and clinics of Moscow. This rehabilitation is to be conducted with the remote participation of doctors who were directly involved in the treatment of those wounded and suffered while staying at Moscow clinics.

4. The project provides for working out the principles of setting up and operation of a similar system for Moscow and other regions of Russia in case emergency situations come up.

In view of the decision adopted by the Russian Federation Government on establishing a medical center of federal level in Beslan, all the solutions and technologies within this project will be reused in future for medical and social support to the citizens of Northern Caucasus by the specialists of the new health-care center.

 

Main activities within the project.

 

1. Conducting telemedicine consultancy sessions between doctors at the hospital of Beslan and doctors at leading medical institutes, health-care centers and clinics of Moscow.

2. Conducting rehabilitation sessions for the residents of Beslan staying temporarily on treatment at institutes, health-care centers and clinics in Moscow during audio-visual contacts with relatives in Beslan.

3. Conducting psychological rehabilitation sessions for the sufferers in Beslan with the remote participation of psychologists and psychotherapists at the institutes and health-care centers in Moscow.

4. Conducting medical and psychological rehabilitation of schoolchildren in Beslan through holding joint lessons between classes at schools of Beslan and Moscow.

5. Conducting medical and psychological rehabilitation of citizens in Beslan during remote sessions of cultural, educational and enlightening orientation, as well as remotely operated festivals and contests on various fields of life.

6. Establishing an organizational and financial scheme for deployment, arrangement and functioning of similar projects during liquidation of after-effects of terrorist acts and emergency situations in Russias regions.

Premises for the project implementation.

 

1. In Moscow, abundant organizational, scientific and technological experience of introduction and use of telemedicine technologies in the part of developing DiViSy telemedicine systems for rendering consultancy and remote learning has been accumulated.

2. In 1999-2001, a telemedicine network was established in Moscow, based optic lines. Its users are over 40 medical institutions of the Health Care Department in Moscow, Russian Academy of Medical Sciences and RF Ministry of Health Care.

3. At the hospital in Beslan, a telemedicine network has been set up with DiViSy TM21 systems introduced with the participation of the Vladikavkaz Scientific Center of Russian Academy of Sciences and DiViSy Group Companies.

4. During 2002-2004, experts in the DiViSy Group Companies, Vladikavkaz Scientific Center of Russian Academy of Sciences, and the Republican fund of obligatory medical insurance held a number of events aimed at training the health-care organizers and medical experts of the North Ossetia-Alania Republic to using telemedicine technologies in the clinical practice.

5. An informal Community of enterprises and organizations of Moscow and North Ossetia-Alania Republic was set up for the project implementation, comprising the following parties:

From the part of the North Ossetia-Alania Republic:

-         Vladikavkaz Scientific Center of Russian Academy of Sciences coordinator,

-         Republican fund of obligatory medical insurance,

-         Hospital in the town of Beslan,

The republican medical Academy and the republican Hospital are also assumed to take part.

From the part of Moscow city:

-         DiViSy Group (telemedicine technology and equipment) coordinator,

- Russian Academy of Medical Sciences with the subordinate organizations: Institute of Surgery named after A.V. Vishnevsky, Russian Academy of Medical Sciences; Institute of Neurosurgery named after N.N. Burdenko, Russian Academy of Medical Sciences; Institute of Social and Forensic Psychiatry named after V.P. Serbsky, Russian Academy of Medical Sciences;

-         Gascom OJSC satellite channel;

-         Comcor OJSC optic lines;

- Rostelecom OJSC is also assumed to take part, as well as the following medical institutions: Moscow Scientific Research Institute of Pediatrics and Pediatric Surgery at RF Ministry of Health Care, Moscow Scientific Research Institute of Pediatric Urgent Surgery and Traumatology, Institute of Cardiovascular Surgery named after A.N.Bakulev, as well as other medical institutions if necessary.

 

Works completed by the organizations of Community.

 

1. At the hospital in Beslan town, a local telemedicine network was set up, with DiViSy TM21 telemedicine systems installed, as well as medical and engineering personnel having undergone respective training. One DiViSy TM21 telemedicine system has been installed at the Medical Academy.

Contractors: DiViSy Group, Vladikavkaz Scientific Center of Russian Academy of Sciences, Republican fund of obligatory medical insurance, Hospital in Beslan.

 

2. The Yamal-24 satellite station and a 2 MB/s satellite communication link have been set up.

Contractors: Gascom OJSC, Vladicaucases Scientific Center of Russian Academy of Sciences, Republican fund of obligatory medical insurance, DiViSy Group, Hospital in Beslan.

 

3. Works on testing the fiber-optical telemedicine network of Moscow, additional connection of several medical institutions to the network, as well as commutation of the telemedicine network to the satellite communication channel have been conducted.

Contractors: DiViSy Group, Comcor OJSC, Gascom" OJSC, Department of Information Technologies at the Russian Academy of Sciences.

 

4. Works on testing the set up global telemedicine network have been conducted by medical institutes, health-care centers and clinics of Moscow.

Contractors: DiViSy Group, Comcor OJSC, Gascom" OJSC, Department of Information Technologies at the Russian Academy of Sciences.

 

5. Telemedicine systems DiViSy TM21 have been installed at the Institute of Surgery named after A.V. Vishnevsky, Russian Academy of Medical Sciences, at the Institute of Neurosurgery named after N.N. Burdenko, at the Institute of Social and Forensic Psychiatry named after V.P. Serbsky, Russian Academy of Medical Sciences, and Moscow Scientific Research Institute of Pediatric Urgent Surgery and Traumatology, with connection to the global telemedicine network implemented, and the required specialists having undergone respective training.

Contractors: DiViSy Group, Vladikavkaz Scientific Center of Russian Academy of Sciences, Department of Information Technologies at the Russian Academy of Sciences.

 

Information about some telemedicine consultations.

 

1. On 24 September 2004, a telemedicine session between the Hospital in Beslan and the Institute of Surgery named after A.V.Vishnevsky was held using DiViSy TM21 systems. From the part of the Hospital in Beslan, the following participants took part in the telemedicine session: Prof. V.N. Karginov, physician-in-chief; V.Ch.Baskaev, deputy physician-in-chief; chiefs of departments and leading doctors of the hospital; as well as the following project participants Prof. A.G.Kusrayev, Chairman of the Vladicaucasian Scientific Center at the Russian Academy of Sciences, and A.V.Pliev, chief of the IT department at Republican fund of obligatory medical insurance. From the part of Moscow city, the following persons took part in the telemedicine session Prof. D.D.Venediktov, head of the IT department at the Russian Academy of Medical Sciences, corresponding member of the Academy; Prof. O.V.Krastin, deputy director of the Institute of Surgery named after A.V.Vishnevsky; Prof. A.V.Pokrovsky, head of department at the Institute, academician of the Russian Academy of Medical Sciences; V.A.Kazinov, director general of DiViSy group of companies. During the telemedicine session, major organizational and methodological issues of the initial stage of the project implementation were discussed. Both parties noted to the vital importance of permanent operation of the project and its paramount significance for the rehabilitation of Beslan residents.

 

2. On 24 September 2004, upon completion of the telemedicine session, a telemedicine consultancy was rendered to two patients staying on treatment at the hospital in Beslan.

Consultation No.1. A woman of 30 years old, arrived with a mine/explosive injury, splinter wound in the neck, back, right ankle, first finger of the right hand. Rupture of the left eardrum. Brain shell shock, post contusion neuritis of the auditory nerve on the right. A splinter in the neck is 3 mm from the edge of the jugular vein. Recommendations from a vascular surgeon are needed.

Consultation No.2. A 20-year-old woman, at 24th week of pregnancy. Arrived with multiple missile wounds in the lower part of both legs. To remove the splinters, X-ray diagnostics contra-indicated during pregnancy is needed. What are the surgeons recommendations?

Academician A.V.Pokrovsky held both consultations. During the discussion of situations and examination of transmitted data, recommendations on further steps of physicians in charge were stated. Currently, based on the results of following the recommendations worked out in the course of telemedicine consultation, one of the lady patients is going to be sent to the Institute of Surgery for a surgical operation at the department of academician A.V.Pokrovsky.

 

3. On 28 September 2004, a telemedicine session was held from the Institute of Neurosurgery named after N.N.Burdenko with V.Ch.Baskaev, deputy physician-in-chief at the hospital of Beslan. From the part of the Institute, there were Ya.K.Gasanov, deputy director, and M.A.Shifrin, head of medico-mathematical laboratory. During the telemedicine session, issues of organizational and medical interaction were discussed. Currently, at the Institute of Neurosurgery there are 8 patients from Beslan staying on treatment. According to the agreement reached, a telemedicine session would be held on 30 September between deputy director of the Institute, corresponding member of Russian Academy of Medical Sciences, A.A.Potapov, and deputy physician-in-chief of the hospital in Beslan, V.Ch.Baskaev, with discussions of treatment progress for each patient.

 

4. During the first telemedicine consultations, deputy physician-in-chief of the hospital in Beslan spoke out a wish of holding otolaryngology consultations for patients at day-and-night and outpatient hospitals who suffered barotraumas. On 29 September 2004, such a consultation was held. From the part of the Moscow city, the head of otolaryngology, corresponding member of Russian Academy of Medical Sciences, professor G.Z. Piskunov, held the consultation. He consulted three complicated patients with barotraumas of various severities. During the consultations, images of endoscopic data of patients with results of graphic examinations were transmitted. From the part of hospital of Beslan, during the consultation there took part the head of otolaryngology department, N.I. Kulagin. Professor G.Z. Piskunov discussed the treatment progress for each sufferer in detail with doctor N.I.Kulagin, and in the course of consultations outlined the design of prosthetic eardrums, commented the technology of its installation and use. In view of the lack of otolaryngological surgery at the hospital in Beslan, an agreement was reached on that one of the lady patients would undergo surgical operation in Moscow at the G.Z. Piskunov clinic. Doctor N.I. Kulagin noted that these recommendations and methods of prosthetics and treatment would be extended to other patients of similar wounds. From the part of Beslan town, present were the minister of Health Care in the Republic of North Ossetia-Alania, Prof. A.V. Reutov, head of the Republican fund of obligatory medical insurance, Mr. T.M. Demurov, and chairman of the National Scientific Center, Mr. A.G. Kusrayev.

 

5. According to the preliminary agreement, on 30 September 2004 a telemedicine consultation was held between the deputy director of Institute of Neurosurgery and corresponding member of the Russian Academy of Medical Sciences, professor A.A. Potapov, and deputy physician-in-chief of the hospital in Beslan, V.Ch. Baskaev, with discussions of treatment progress for each patient staying at the Institute of neurosurgery. Professor A.A. Potapov informed V.Ch. Baskaev in detail on the progress and treatment and condition of each patient. An agreement was reached on that a telemedicine session with relatives in Beslan would be arranged for some patients.

 

6. At 01 October 2004 was telemedicine consultation from Institute of Social and Forensic Psychiatry named after V.P. Serbsky, Russian Academy of Medical Sciences. In this consultation toke part of director, the academician of Russian Academy of Medical Science T.B. Dmitrieva, the deputy director, professor Z.I. Kikelidze, and also of the assistant to the head physician of Beslan hospital V.Ch. Baskaev. During consultation both parties have expressed unanimous opinion on necessity of constant interaction with use of telemedical technologies. The academician of Russian Academy of Medical Science, professor T.B. Dmitrieva said that psychological rehabilitation of the citizens injured of act of terrorism has noted extreme importance of the telemedical project. Professor Kikelidze Z.I. has lead remote instructing on a question of interaction of administration of hospital and various religious faiths. All instructions were closely listened and accepted to performance by doctors of Beslan hospital.

 

7. At 03 October 2004 was a telemedicine consultation of adults and children suffering heart diseases. Telemedical consultation of leading experts of Institute of cardiovascular surgery by N.N. Bakuleva: Dr. Med. A.A. Svobodnov, and the doctor of functional diagnostics E. Tumeneva. During one session were consulted 6 patients, from which two children by age 2,5 months and 7 years. During consultations from Beslan hospital was ultrasonic research of heart of patients, which in real time was transferred to Moscow. On each patient recommendations of therapeutic or surgical character were given. In connection with absence cardiovascular in republic, the decision on realization of operations in Moscow is accepted.

After these consultations, was meeting of the patients who are taking place on treatment in institute of neurosurgery with relatives in Beslan.

 

8. At 04 October 2004 telemedical system DiViSy TM21 is established in the Moscow scientific research institute of urgent children's surgery and traumatology (the director of scientific research institute, professor L.M. Roshal). Professor L.M. Roshal has stated a wish that telemedical consultations were carried out not only with Beslan hospital, but also with children's clinical hospital in Vladikavkaz.

 

9. At 07 October 2004 in Presidium of the Russian academy of medical sciences was held conferences on the analysis of works of the telemedical project Beslan - Moscow. Doctors of hospital of have taken part in this conference within the framework of telemedical consultations. All participants of this conference note that this project is vital importance for processes rehabilitation of Beslan citizens.

 

10. At 14 October 2004 telemedicine consultation between the Moscow scientific research institute of urgent children's surgery and traumatology and clinical hospital of Beslan has taken place. On the part of Moscow consultation was carried out by professor Roshal L.M., on the part of Beslan the deputy minister of public health services - Tsidaeva T.I., the head physician of hospital have taken part in consultation Karginov V.P. managing faculty of obstetrics and gynecology of the North-Osetiya medical academy of Tsallagova L.V., the head physician of a maternity hospital 1 of Vladikavkaz Esaulova S.V., the head physician of a maternity hospital 2 of Vladikavkaz of Gasieva S.M. and the regional podiatrist of Right-bank regional clinical hospital Fedoseenko A.B. During consultation organizational questions of rendering of the medical and humanitarian help to injured children, questions of creation of the new medical center in Beslan, and also practical questions of children's public health services were considered. The parties have agreed upon the order of the further work on carrying out of telemedicine consultations and remote training on a direction of children's public health services.

 

11. On 25 October 2004, at the request of doctors of Republic North Ossetia-Alania Republic is lead lecture on gynecology from the Central clinical hospital of Ministry of Railways of the Russian Federation. Lecture professor A.L. Tikhomirov, and also doctors Central clinic of Ministry of Railways. At hospital of Beslan there were doctors-gynecologists of various hospitals RSO-A. During lecture unique operation on myoma embolisation of the uterus, lead under the x-ray control has been shown. The given medical direction is actual not only for doctors of hospital of Beslan, but also for doctors of other hospitals of republic.

 

Conclusions:

 

1. The telemedicine project Moscow-Beslan already in an initial stage has proved the importance and efficiency in business of rendering of medical aid and rehabilitation of inhabitants of Beslan. Up to now the project is realized only with use of financial assets of companies-participants of the project.

2. For maintenance of constant functioning the project his constant financing, at least within two years is necessary.

3. Within the framework of the given project it is expedient to carry out works on working off of principles of expansion and functioning of similar projects at occurrence of extreme situations in other regions of Russia or in other countries.

 

The further development of the project.

 

Now the first stage within the framework of which the information and communication environment of telemedicine consultations is created is realized, telemedicine systems DiViSy TM21 are established and principles of functioning of the project are fulfilled.

On results of performance of the first stage of the project, in view of the saved up experience and the formulated technical requirements, the question on creation of the integrated system for fast expansion of telemedicine consultations in conditions of liquidation of consequences of acts of terrorism and extreme situations in regions of Russia or in other countries should be considered. Such system can solve and other practical problems of removed medical diagnostics, rehabilitation and remote medical education. Within the framework of the centralized financing, the question on continuation of the given project and expansion of sphere of his use in educational, cultural and other directions of ability to live of the city of Beslan can be solved.

For this purpose it is necessary to perform additional works on creation of a communication network to Beslan with connection of schools, cultural and educational establishments, municipality and other organizations, to establish additional systems of remote education DiViSy ED21, DiViSy LC21 and others, in the given organizations, to develop a corresponding supply with information and professional educational techniques.

 

 

 

 


 

Picture 1.

Telemedicine Project Beslan-Moscow based DiViSy TM21.

Picture 2.

Telemedicine consultation of professor Piskunov G. by otolaryngology for patients with barotraumas using DiViSy TM21.

At the first picture consultation in process real endoscopic diagnostic of the ear path.

At the second picture scheme of artificial limb for eardrum.

 

Picture 3.

Telemedicine consultations of professor Roshal L.M. with group of doctors and heads of children's public health services North-Osetiya clinics and medical academy, and also medical institutions of Vladikavkaz and Beslan.

 

Picture 4.

Remote lecture of professor Tikhomirov A. by gynecology from Moscow to Beslan using DiViSy TM21.