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WO2023163236A1 - Database integrating treatment/therapeutic systems, and method for implementing same - Google Patents

Database integrating treatment/therapeutic systems, and method for implementing same Download PDF

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Publication number
WO2023163236A1
WO2023163236A1 PCT/JP2023/007929 JP2023007929W WO2023163236A1 WO 2023163236 A1 WO2023163236 A1 WO 2023163236A1 JP 2023007929 W JP2023007929 W JP 2023007929W WO 2023163236 A1 WO2023163236 A1 WO 2023163236A1
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Prior art keywords
patient
treatment
assessment
disease
data
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PCT/JP2023/007929
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French (fr)
Japanese (ja)
Inventor
千草 下川
栄彦 中島
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ロゴスサイエンス株式会社
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Priority to JP2023534270A priority Critical patent/JP7391443B1/en
Publication of WO2023163236A1 publication Critical patent/WO2023163236A1/en

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems

Definitions

  • a doctor including a therapy provider, etc.
  • a patient a client, a user (user), etc.
  • an information processing terminal e.g., smartphone
  • an information processing network system e.g., the Internet
  • Patent Document 1 a technology (so-called “therapeutic application”) has been developed that allows a doctor and a patient to perform treatment without face-to-face contact via an information processing terminal and an information processing network system (e.g., Patent Document 1, Patent Reference 2).
  • Such technology allows for routine treatment, or treatment of patients living in depopulated or remote areas where access to medical facilities is difficult.
  • it is possible to improve the consultation rate even for patients who do not want to be treated by a specialist doctor or a specialist because they want to keep the fact that they are undergoing treatment confidential as much as possible for privacy reasons. be.
  • Patent Document 1 it is fundamental to perform the same treatment for all patients with respect to a specific disease.
  • CBT cognitive-behavioral therapy
  • process-based CBT process-based cognitive behavioral therapy
  • the present invention has been proposed in view of the above-described problems of the prior art, and includes a medical system that performs diagnosis, treatment, prevention, self-care, etc., using an information processing terminal and an information processing network system, a database that integrates the system, and a database that integrates the system. How to use it.
  • a cross-diagnostic assessment to assess how adaptively or maladaptically the patient is behaving to psychosocial problems, life adjustment, stress, etc., and/or Or, based on the results of a disease-specific assessment that assesses how adaptively or maladaptive the patient is to the symptoms characteristic of the disease, the patient
  • the purpose is to provide a system that provides optimal medical care (performs treatment) to patients, and a method for integrating data based on them and optimizing data analysis.
  • the plurality of types of application programs are programs for mental health care and/or treatment of psychogenic diseases, psychosomatic disorders, and stress-related disorders, and the common item is psychogenic disorders, psychosomatic disorders, and stress-related disorders.
  • the database system of (1) used for symptoms and conditions of psychogenic diseases, psychosomatic diseases, and stress-related diseases, characterized by items related to daily life data for (1).
  • the analysis block uses statistical analysis and AI to classify the user's psychogenic disease, psychosomatic disease, and stress-related disease symptoms and conditions according to the input from the application program.
  • the database system according to any one of (1) or (2) having (4) The database according to any one of (1) to (3), characterized in that it has a list showing correspondence between the type classification and the prescribed work, and the list is updated by the analysis block.
  • the common item is used in cognitive behavioral therapy
  • the system (100) of the present invention comprises: Having an information processing terminal (3) used by a patient, The server (10) It has a function to assess how adaptively or non-adaptive the patient is in response to psychosocial problems, life adjustment, stress, etc., using data from daily life.
  • a functional block (10A2: disease-specific assessment part) Analyzing the results of the assessment of the block (diagnostic cross-sectional assessment part 10A1 and/or disease-specific assessment part 10A2) (assessment of cross-diagnostic assessment part 10A1 and/or disease-specific assessment part 10A2) Characterized by having a block (10B: module selection part) having a function of classifying patients into a specific group (cluster or group) and selecting a treatment module corresponding (for example, linked) to the classified group there is
  • the system of the present invention preferably constitutes a platform having both a cross-diagnostic part and a disease-specific part.
  • the system (100) of the present invention has a server (10) functioning as a control device (1) and an information processing terminal (3) used by a patient, the server (10) It has a function to assess how adaptively or non-adaptive the patient is in response to psychosocial problems, life adjustment, stress, etc., using data from daily life.
  • a block (10B: module selection part) having a function of classifying patients into a specific group (cluster or group) and selecting a treatment module corresponding (linked) to the classified group.
  • the server (10) is composed of a computer or other information processing machine.
  • daily life data includes psychological data collected by asking various questions in daily life, heart rate, blood pressure, blood oxygen level, number of steps, walking speed, reaction speed, reflex speed, moving body Visual acuity, sleep duration and sleep quality (deep sleep, light sleep, etc.), activity level, activity range (action history: measured and acquired by GPS, etc.), physiological data such as blood sugar level, behavior data, emotion/mood data, nighttime Contains erection data. That is, daily life data includes psychological/behavioral/physiological data and self-monitoring data.
  • the system (100) of the present invention may include a device for acquiring daily life data (for example, an electronic device having an information processing function and a communication function such as a smart phone or a personal computer).
  • An information processing terminal (4) used by the medical institution can also be provided.
  • the method of the present invention is a method for executing the above-described system (the system according to any one of claims 1 to 3), while utilizing data under daily life to deal with psychosocial problems, life adjustment, stress, etc.
  • a step of assessing to what extent the patient can act adaptively or maladaptively to the symptoms characteristic of the disease (S6: Assessment of disease-specific assessment part 10A2)
  • the results of how adaptively or non-adaptively the patient behaves to the symptoms characteristic of the disease are also analyzed to classify the patients into specific populations (clusters or groups).
  • the present invention can be used to treat relationship problems with a spouse or partner, erectile dysfunction, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized anxiety, social anxiety, speech anxiety, specific phobia, and psychological disorders.
  • Post-traumatic stress disorder complex anxiety disorder, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle-related diseases, bipolar disorder, borderline personality disorder, attention-deficit/hyperactivity disorder, chronic or persistent pain , sexual dysfunction, relationship problems with a spouse or partner other than erectile dysfunction, alcoholism and other addictions, schizophrenia and other severe psychoses, generalized anxiety, social anxiety, speech anxiety and other Anxiety, specific phobia, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence), anti-aging, menopause, premenstrual syndrome (PMS), psychogenic visual disorder, dental treatment It is preferably applied to phobia, glossodynia, dental psychosomatic disease, body dysmorphia, and the like.
  • the classification of a specific group includes three indicators: "Psychological flexibility in ED" AFQ-ED, "Sexual communication with partner” SRQ , “General psychological flexibility” PFQ can be used.
  • the patient's treatment/behavior such as taking medicine is recorded, and the record is checked by the doctor on each date of the calendar. ) so that the doctor can check the record of each date on the calendar.
  • a medical examination including outpatient examinations and online examinations
  • work is determined.
  • assessment diagnosis cross-sectional assessment, disease-specific assessment
  • classification into a specific group based on cluster analysis can be performed, and a new set of work to be provided to the patient can be set.
  • the results of the assessment performed anew can also be used in medical examinations by doctors.
  • medical examinations by doctors, newly set treatment policies, drug prescriptions, work sets, and the like are recorded. It is also possible to change treatment policies, prescriptions, work contents, etc. in response to changes in daily life data and EMA without changing the specific group (for example, cluster 1) to which the patient belongs.
  • EMA specific group
  • a cross-diagnostic assessment is performed to determine how adaptively a patient can act in response to psychosocial problems, life adjustment, stress, etc. while utilizing data under daily life. It is possible to assess whether a person is acting in a non-adaptive manner or is acting maladaptically. Furthermore, disease-specific assessment makes it possible to assess to what extent the patient is behaving adaptively or maladaptively to the symptoms characteristic of the disease. . Based on these assessments, the optimal treatment module can be provided for that patient. In particular, we provide highly effective medical care (treatment, diagnosis, prevention, recurrence prevention, early detection, detection of coexisting diseases, etc.) and self-care for cases that cannot be improved by simply identifying and treating the disease.
  • the present invention focuses on the "process” instead of the "result".
  • the stage of the patient's psychosocial "process” progresses, and the mental Focus on whether or not the flexibility of If the stage of the psychosocial process progresses and the flexibility of the mind improves, new behavioral patterns are acquired and learned. It broadens the range of thinking, such as "It's okay to be with a partner," and "The relationship with a partner is not all about sexual intercourse.”
  • the present invention by providing an optimum treatment module and performing treatment by process-based CBT, it is possible to achieve a certain effect after customizing for each patient or for each type of disease.
  • Quantitative measures are then used to perform cross-diagnostic and disease-specific assessments and perform cluster analysis to optimize treatment. For example, relationship problems with a spouse or partner, erectile dysfunction, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized/social/speech anxiety, specific phobia, post-traumatic Stress disorders, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle-related diseases, bipolar disorder, borderline personality disorder, attention deficit/hyperactivity disorder, chronic or persistent pain, sexual dysfunction, erectile dysfunction Relationship problems with a spouse or partner other than alcoholism and other addictions, schizophrenia and other severe psychosis, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence) , anti-aging, menopausal disorders, premenstrual syndrome (PMS), psychogenic visual disturbances, psychosomatic dentistry, body dysmorphia, and the like.
  • relationship problems with a spouse or partner erectile dysfunction
  • the present invention it is also possible to assess multiple comorbid disease symptoms/states, and to propose or provide an optimal cross-diagnostic therapy. For example, in an application for psychogenic ED, it is possible to analyze comorbid tendencies such as depression, anxiety, and diabetes from the results of the assessment. Alternatively, multiple indefinite complaints can be used to assess menopausal disorders. Furthermore, by applying the present invention, if the patient can act adaptively to psychosocial problems, life adaptation, stress, etc., it will be possible to prevent infectious diseases such as coronavirus and to prevent post-corona anxiety. etc. is also applicable.
  • FIG. 1 is a functional block diagram showing an outline of a system according to an embodiment of the invention.
  • FIG. 2 is a functional block diagram of a server used in the embodiment;
  • FIG. 3 is a functional block diagram of the module selection part in FIG.
  • FIG. 4 is a functional block diagram of the patient-side electronic device used in the embodiment.
  • FIG. 5 is a functional block diagram of the medical institution side electronic device used in the embodiment.
  • FIG. 6 is a flowchart showing the first access in the control of the embodiment.
  • FIG. 7 is a flowchart for the second and subsequent accesses in the control of the embodiment.
  • FIG. 8 is a diagram showing an example of an integrated database.
  • FIG. 9 is a diagram showing data such as patients and evaluation values contained in the management server 931 of the treatment platform 901.
  • FIG. 10 is a diagram showing an example of cluster analysis using common parts.
  • FIG. 11 is a diagram showing a list of correspondences between types and prescriptions stored in the management server.
  • FIG. 12 illustrates the algorithm used in the Therapy App's compatibility routine.
  • FIG. 13 is a diagram showing an example of combination of therapeutic module assessment and therapeutic module of the present invention.
  • a system generally indicated by reference numeral 100 includes a server 10 (for example, a computer) including a control device 1 and a database 10F, an information processing terminal 3 used by a patient (information processing terminal on the patient side), and a medical institution. It has an information processing terminal 4 (information processing terminal on the side of the medical institution) that is used, and these are interconnected by, for example, an information processing network 20 (for example, a local area network or the Internet).
  • an information processing network 20 for example, a local area network or the Internet.
  • the details of the server 10 will be described later with reference to FIG. 2, but the control device 1 in FIG. 1 is a functional block comprehensively representing various parts in FIG.
  • the term "patient” as used herein means an individual who is aware that he or she may be suffering from psychogenic ED or the like and who is willing to seek treatment.
  • the term "patient” is not limited to those who are receiving treatment under the guidance of a doctor or other related parties at a medical institution, and is judged to be "healthy” by a third party. It can also include those who are Therefore, the information processing terminal 4 is not limited to medical institutions.
  • the information processing terminal 3 on the patient's side is a "device for acquiring daily life data", and is composed of an electronic device having an information processing function and a communication function, such as a smartphone or a personal computer (PC, personal computer). can do Alternatively, a wearable device or the like can be used as a device for acquiring daily life data.
  • Daily life data includes psychological data collected by having people answer various questions in their daily lives.
  • the information processing terminal 4 on the medical institution side can use an electronic device (for example, a PC) having an information processing function and a communication function, but it is also possible to use a smart phone.
  • the information processing terminal 3 (for example, a smartphone) on the patient side is not only used as a tool for accessing the server 10 via the line 3L and the network 20, but also used for cross-diagnostic assessment in the server 10. It also functions as a tool for measuring "daily life data" and transmitting it to the server 10 side.
  • the function of measuring daily life data and transmitting it to the cross-diagnosis assessment part of the server 10 is made possible by installing a dedicated application for executing such functions on the smartphone, which is the information processing terminal 3 on the patient side. Become.
  • the information transmission line 3L (which may be wired or wireless) connecting the information processing terminal 3 on the patient side and the network 20 is used for accessing the server 10.
  • patient information for example, medical history information corresponding to the patient ID
  • information on psychogenic ED treatment (disease education, treatment methods, medication history, etc.) information, information about process-based CBT, etc.) are stored.
  • the medical treatment in the medical history includes medical treatment via the information terminal and medical treatment at the medical institution.
  • a plurality of information processing terminals 3 on the patient side and a plurality of information processing terminals 4 on the side of medical institutions can be connected to the network 10 .
  • the database 10F is built in the server 10 together with the control device 1.
  • FIG. 10 is a functional block diagram.
  • the server 10 can be coupled with big data or a system 30 using big data. By combining with big data or a system 30 using big data, results of assessment and treatment module selection in the server 10, treatment status, etc. can be used as a part of big data, and can be obtained by using big data. The obtained knowledge can be used to improve the server 10 .
  • the server 10 in the system 100 according to the illustrated embodiment will now be described with reference to FIG. 2, which is a functional block diagram.
  • the diagnostic application (assessment module) and the treatment/prevention application (treatment module/evaluation module) are expressed as an integrated unit. module/evaluation module) are configured separately, and the treatment/prevention application (treatment module/evaluation module) prescribes (including cases where a doctor prescribes) based on the assessment results of the diagnostic application (assessment module) can be configured as
  • a server 10 (indicated by dashed lines in FIG. 2) has an assessment part 10A, a module selection part 10B, a treatment module part 10C, an evaluation part 10D and a login/authentication part 10H.
  • the illustrated embodiment constitutes a platform having both a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2.
  • the information transmission lines SL1, . . . may be wired or wireless.
  • the login/authentication part 10H corresponding to the entrance of communication from the patient-side terminal 3 to the server 10, when the ID and password are input from the patient-side information processing terminal 3, the patient is authenticated.
  • the login/authentication part 10H confirms the patient's legitimacy and reliability from previous data, and sends the authentication result (information indicating that the patient is a legitimate patient, not a fake) to the question part 10Q.
  • security measures such as patient spoofing prevention are implemented using known technology, for example.
  • Such security measures are applied to the login/authentication part 10H in the illustrated embodiment to protect the system 100 against patient impersonation and other fraudulent activities. If the accessor is an impersonator pretending to be a patient, the access is blocked in the login/authentication part 10H, and the transmission of information to the question part 10A and subsequent parts is blocked.
  • the login/authentication part 10H has a function of issuing, for example, a prescription ID and a password, and confirming the identity of a person (patient) who has accessed.
  • the number of times the system 100 is accessed and the period after the first access are appropriately set, and if the set number of times or period is exceeded, the system is deactivated. Alternatively, access can be restricted.
  • the system 100 can be configured so that the patient can access the system 100 again under the direction of the doctor in charge.
  • login authentication in addition to entering an ID and password, for example, if the information processing terminal 3 on the patient side is a smartphone or PC, the patient's face, voice (voiceprint ), the patient's retina, iris, etc. are photographed (obtained) with biometric information unique to the patient, and the biometric information is used to authenticate the patient, thereby preventing so-called "impersonation" and account transfer. , the reliability of the data input or obtained from the patient can be ensured.
  • the six adaptive behavioral assessments described above are based on one form of CBT, Acceptant and Commitment Therapy (ACT). Subjects who show the above-mentioned adaptive behavior to psychosocial problems, life adjustment, stress, etc. are healthy, have a high quality of life, have low stress, and are resistant to various diseases. It can be judged that the power is in a high state.
  • the assessment results in the cross-diagnostic assessment part 10A1 are sent to the module selection part 10B via the information transmission line SL5.
  • Cross-Diagnostic Assessment Part 10A1 does not assess for disease identification nor does it assess symptoms characteristic of disease. As described above, in the cross-diagnostic assessment part 10A1, while utilizing data under daily life, how adaptively the patient can behave in response to psychosocial problems, life adjustment, stress, etc.
  • the Cross-Diagnostic Assessment Part 10A1 enables us to understand the patient based on factors common to a variety of diseases, such as psychosocial problems, life adjustment and stress, and to understand the process. Based CBT is feasible.
  • Cross-diagnostic assessment Part 10A1 understanding the patient based on factors common to various diseases, such as psychosocial problems, life adjustment and stress, is one of the key features of the illustrated embodiment. This is a clear difference from conventional various medical applications (see, for example, Patent Documents 1 and 2).
  • Information on the subject who has completed the assessment in the cross-diagnostic assessment part 10A1 is sent to the disease-specific assessment part 10A2 via the information transmission line SL31.
  • Disease-specific assessment part 10A2 evaluates to what extent the target person (accessing user) is able to act adaptively or maladaptively to the symptoms characteristic of the disease. It has an assessment function and uses quantitative measurement indicators to perform assessment. For example, as maladaptive behavior, "Anticipation anxiety" that begins to think that sexual activity may fail, The self-concept that if you can't maintain an erection during sexual intercourse, you're finished as a 'man', "Attention control” where you are concerned about whether you can maintain an erection and cannot concentrate on sexual activity, "Interpersonal relationship” where the relationship does not go well due to concern about the evaluation from the partner, It assumes "avoidance behavior” such as not trying to engage in sexual activity.
  • maladaptive behaviors include: “Inactive”, being inactive and having a narrow range of activity “Rumination” to think over and over again about unpleasant events in the past “Cognitive bias” such as thinking about things to the extreme and denying everything with a small mistake It is assumed that "disability of social function", etc., which prevents people from interacting with others.
  • the disease-specific assessment part 10A2 if the subject is assessed for the above-described maladaptive behavior for symptoms characteristic of the disease, the subject's information is transmitted via the information transmission line SL4. , along with the assessments of the assessment parts 10A1 and 10A2 to the module selection part 10B.
  • the information of the subject who has completed the assessment in the cross-diagnostic assessment part 10A1, along with the results of the assessment in the cross-diagnostic assessment part 10A1, will be sent to the disease-specific assessment part via the communication line SL5. 10A2 and is sent to the module selection part 10B.
  • module selection part 10B statistical techniques (e.g., cluster analysis) are used to classify subjects into specific groups (or into clusters in the case of cluster analysis). , select the therapy module linked with the group or cluster.
  • the module selection part 10B has the function of selecting a treatment module based on the assessment result of the cross-diagnostic assessment part 10A1 and the assessment result of the disease-specific assessment part 10A2.
  • clusters of "acceptance”, “defusion”, “contact with the present moment”, “self as a point of view”, “clarification of values”, and “commitment” cluster 1 (lower than average scores for “acceptance” and “deffusion”), cluster 2 (lower than average scores for “contact with this moment” and “self as a point of view”) cluster 3 (values clarification, commitment below average), cluster 4 (acceptance, defusion, contact with the present moment, The score of "Self as a point of view” is lower than the average level).
  • the average level refers to the average point ⁇ 1 SD (standard deviation).
  • Cluster 1 anticipatory anxiety
  • cluster 2 higher than average scores for ⁇ anticipatory anxiety'' and ⁇ avoidance behavior''
  • cluster 3 higher than average scores for ⁇ self-concept'', ⁇ interpersonal It is classified into 4 clusters: the score of "relationship” is higher than the average level) and cluster 4 (the score of "interpersonal relationship” and "avoidance behavior” is higher than the average level).
  • Patients are classified into one of the above clusters from the results of the disease-specific assessment part 10A2 assessment.
  • cluster analysis is performed for each of the cross-diagnostic assessment part 10A1 and the disease-specific assessment part 10A2.
  • Cluster analysis may be performed by integrating the results of Then, the module selection part 10B selects a treatment module based on the cluster into which the patient is classified from the assessment result of the cross-diagnostic assessment part 10A1 and the assessment result of the disease-specific assessment part 10A2.
  • the number of clusters is 4, but in actual cluster analysis, the number of clusters can be subdivided from a few to 1000 or more for each individual by data analysis and customization of the treatment application. could be.
  • a platform having both a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2 is configured, so the system 100 is configured by separating the diagnostic application and the treatment/prevention application. Even in the case, for each cluster by cluster determination in the assessment part (assessment module) in the diagnostic app, automatically, the treatment module based on the results of the cross-diagnostic assessment and / or the results of the disease-specific assessment Based treatment modules are selected and ordered.
  • the selection and instruction of the treatment module are determined by the doctor based on the results of the assessment. Based on this, it is possible to manually select and instruct a treatment module.
  • the therapy module selected in the module selection part 10B is transmitted to the therapy module part 10C through the information transmission line SL6.
  • the module selection part 10B is a machine for transmitting the selected treatment module to the information processing terminal 3 on the patient side via an interface (not shown) and an information transmission line SL7.
  • the treatment module's treatment program (exercise, work, etc.), homework, useful information for treatment (tips), user statistics, etc. Part of the information such as data, user's usage status, and user's answer examples can be sent to the patient terminal 3 .
  • the treatment program can be executed in a place where the network environment is not available or offline.
  • the patient can still perform exercises, homework, and Some information such as useful information (Tips) for treatment, statistical data of users, usage status of users, examples of answers of users, etc. can be continuously executed and viewed offline, preventing interruption of treatment, In addition, it can be used to maintain the therapeutic effect and prevent recurrence even after the end of treatment.
  • useful information Teles
  • information such as offline exercises and workouts, homework, tips, user statistical data, user usage status, user response examples, etc. are not recorded by the system 100 as intervention records.
  • the state of psychogenic ED can be grasped, or if the state is improved, confidence can be gained by the improvement. can also be recovered.
  • RigiScan in which a wire is wrapped around the penis, or pants for erection measurement, which have a detection means such as a pressure sensor inside, can be used.
  • the therapy module part 10C has a function of executing the therapy module selected in the module selection part 10B to the patient or transmitting the therapy module selected in the module selection part 10B to the patient.
  • the treatment module implemented in part 10C of the treatment module is a cross-diagnostic intervention, in response to the results of the assessment of "psychological flexibility", a psychological intervention aimed at the learning/acquisition of healthy new behavioral patterns.
  • a cross-diagnostic intervention in response to the results of the assessment of "psychological flexibility", a psychological intervention aimed at the learning/acquisition of healthy new behavioral patterns.
  • “Attention training” aims to acquire flexibility of attention and release from self-focused cognitive processing through practice of paying attention to multiple sounds in various ways. By executing these treatment modules, it is expected that the adaptive behaviors included in the cluster will be promoted.
  • the execution of psychotherapy may be expressed as intervention for a patient.
  • a treatment module for psychogenic ED in disease-specific intervention, for each disease-specific scene, situation, etc., using techniques appropriate for each cluster, healthy and new behavioral patterns according to the disease Conduct psychological interventions aimed at learning/acquisition. For example, in the assessment of disease-specific assessment part 10A2, if the patient is classified as cluster 1 (“anticipatory anxiety” and “attention control” scores are higher than the average level), “sensory concentration training” is performed. do.
  • Treatment Module Part 10C it is possible to provide a treatment module using "virtual reality". For example, in the case of an anxiety patient, it is possible to make the patient experience "get on a train” (virtual reality experience) in virtual reality. In the illustrated embodiment, cross-diagnostic interventions take precedence over disease-specific interventions. However, there are also cases where it is not limited to this.
  • Treatment module part 10C provides homework to be performed by the patient corresponding to the classified clusters.
  • the treatment module part 10C selects homework, it can refer to homework that is stored in a storage device (database) not shown in FIG. 2 and linked to each treatment module.
  • Such homework is compiled in advance so that improvement of symptoms can be expected when the patient performs the homework, and the patient's independence can be improved.
  • "attention training” training is performed for about 15 minutes a day to pay attention to various sounds recorded in sound sources.
  • the treatment modules and treatment results performed in the treatment module part 10C are transmitted to the evaluation part 10D by the communication line SL8. Homework and its achievement may also be sent to Assessment Part 10D.
  • the evaluation part 10D has a function of evaluating the effect of treatment by the treatment module executed in the treatment module part 10C, and evaluates the effect of treatment according to a predetermined algorithm using an existing evaluation scale or the like.
  • the International Erectile Function Score IIEF
  • evaluation scale measuring index
  • severity classification is made from scale scores, and it is possible to evaluate the effect of treatment.
  • the tool rating scales or metrics are stored in the therapy module part 10D.
  • an evaluation scale or measurement index for each treatment module may be stored in a storage device (database) not shown in FIG.
  • the evaluation part 10D can then have the ability to provide such feedback to the patient (or physician).
  • the evaluation result of the therapeutic effect by the evaluation part 10D is transmitted to the information terminal 3 on the patient side through the information transmission line SL9.
  • a chatbot is used as a treatment module
  • the patient is presented with an evaluation of the treatment effect by the chatbot.
  • the evaluation content transmitted to the patient includes, for example, advice for improving symptoms.
  • the timing means and recording means for recording the time until inputting, the measuring means for measuring the heart rate and blood pressure, the state of the patient's pupil opening and closing means for measuring the direction of gaze and the number of blinks (for example, the camera of the patient-side terminal 3 if it is a smartphone or PC), means for measuring the number of breaths, means for measuring body temperature, or means for observing the complexion (For example, a camera of the patient-side terminal 3) is provided, and a device for monitoring objective information at the time of index input to measure and observe the accuracy of answers and the condition of the respondent is preferably provided.
  • Items to be monitored as the condition of the respondent include, for example, whether the respondent, the patient, has entered the measurement index inadvertently, whether the patient has entered false information to obtain the result of "improved", By inputting the measurement index, it is whether or not the patient is under stress, whether or not the patient is deep in thought, the patient's responsiveness, the patient's cognitive function, and the like. Such monitoring can be taken as a factor in cluster analysis.
  • a special filter or lens, etc. is attached to the camera, and the above-mentioned Monitoring can be done. Furthermore, it is possible to use a measuring device (not shown) for heart rate, blood pressure, etc., and an application. Furthermore, it is possible to acquire objective information of the respondent by wearing devices such as an odor sensor, an electroencephalogram sensor, and a cerebral blood flow sensor. As a result, it becomes possible to measure the mental and physical condition of the respondent and use it as a factor in cluster analysis. For example, if a headset-like device for measuring brain waves, cerebral blood flow, etc.
  • the evaluation part 10D if the therapeutic effect is not evaluated favorably, the evaluation result is sent to the module selection part 10B via the information transmission line SL10. If an unsatisfactory evaluation is received from the evaluation part 10D, the module selection part 10B determines that the proposed treatment module was less effective and selects and proposes a new treatment module.
  • the therapy module part 10C transmits (provides) the new therapy module to the patient, and the evaluation part 10D evaluates the therapeutic effect of the new therapy module.
  • the information terminal 3 on the patient side is connected to the cross-diagnostic assessment part 10A1 through an information transmission line SL12. As described above with reference to FIG.
  • the information processing terminal 3 on the patient side has the function of measuring the patient's "daily life data” and transmitting the cross-diagnostic assessment part 10A1. To do so, it sends the patient's "daily life data" to the cross-diagnostic assessment part 10A1 via communication line SL12. Also, the login/authentication part 10H is connected to the treatment module part 10C via an information transmission line SL12, and is connected to the evaluation part 10D via an information transmission line SL13. In the second and subsequent accesses from the patient (subject), as will be described later with reference to FIG. This is because there are both cases where it is confirmed whether or not there is. Next, referring to FIG. 3, the module selection part 10B will be described.
  • module selection part 10B selects a number of treatments based on the assessment results of the cross-diagnostic assessment part 10A1. Select modules and select several treatment modules based on the results of the assessment of disease-specific assessment part 10A2. In other words, multiple treatment modules are selected in the module selection part 10B based on the results of each of the cross-diagnostic assessment part 10A1 and the disease-specific assessment part 10A2.
  • module selection part 10B includes analysis block 10B1, classification block 10B2, linking block 10B3, and storage device 10B4.
  • the results of the assessment of the cross-diagnostic assessment part 10A1 are sent via communication line SL5 to the analysis block 10B1 of the module selection part 10B.
  • the results of the assessment of disease-specific assessment part 10A2 are then sent to analysis block 10B1 via information transfer line SL4.
  • the analysis block 10B1 has a function of performing cluster analysis on each of the assessment results of the cross-diagnosis assessment part 10A1 and the assessment results of the disease-specific assessment part 10A2.
  • Analysis block 10B1 analysis results based on the results of the assessment of the cross-diagnostic assessment part 10A1 are sent to the classification block 10B2 via the communication line SL22, and analysis of the analysis block 10B1 based on the results of the disease-specific assessment part 10A2 The results are sent to classification block 10B2 via communication line SL24.
  • the patient is classified into a predetermined cluster based on the results of the assessment of the patient's cross-diagnostic assessment part 10A1.
  • the patient is classified into a predetermined cluster based on the results of the patient's disease-specific assessment part 10A2 assessment.
  • the cluster information classified based on the results of the assessment of the cross-diagnostic assessment part 10A1 is sent to the linking block 10B3 via the communication line SL26 and classified based on the results of the assessment of the disease-specific assessment part 10A2.
  • the cluster information obtained is transmitted to the linking block 10B3 via the information transmission line SL28.
  • Information is stored in the storage device 40 that links the clusters to the therapy modules that are valid for the clusters.
  • the "linking information” may be a diagram or a function that associates the clusters with treatment modules effective for the clusters.
  • the "linking information” is transmitted to the linking block 10B3 via the information transmission line SL30, and effective treatment modules are determined for the clusters classified by the classification block 10B2.
  • the linking block 10B3 has the function of determining effective treatment modules for clusters into which patients are classified according to the "linking information".
  • the treatment modules that are effective for the clusters classified based on the results of the assessments of the cross-diagnostic assessment part 10A1 and the clusters that are effective for the clusters classified based on the results of the assessments of the disease-specific assessment part 10A2. Decide on a treatment module.
  • Cluster-effective treatment modules classified based on the results of the assessments of the cross-diagnostic assessment part 10A1 are sent to the treatment modules part 10C via communication line SL61, and based on the results of the assessments of the disease-specific assessment part 10A2.
  • the therapy modules that are valid for the clusters classified by are sent to the therapy module part 10C via communication line SL62.
  • the patient can be offered both a treatment module based on the results of the assessment of the cross-diagnostic assessment part 10A1 and a treatment module based on the results of the disease-specific assessment part 10A2.
  • both cross-diagnostic and disease-specific interventions are possible.
  • the information transmission lines SL61 and SL62 shown in FIG. 3 are comprehensively displayed as a single information transmission line SL6 in FIG.
  • Cluster analysis is exemplified here as a statistical method, but statistical methods other than cluster analysis can be used if patients (subjects) can be accurately classified and linked to appropriate treatment modules. can be adopted.
  • the patient can be offered both a treatment module based on the results of the assessment of the cross-diagnostic assessment part 10A1 and a treatment module based on the results of the disease-specific assessment part 10A2. Whether one of them is preferentially displayed on the patient-side information terminal 3 or both are displayed on the patient-side information terminal 3 at the same time can be configured to be appropriately settable.
  • a priority determination block 10R is provided in which the results of the interview and input in the question part 10Q, the results of the assessment of the cross-diagnostic assessment part 10A1, the results of the assessment of the disease-specific assessment part 10A2, etc.
  • the order determination block 10R decides whether to preferentially present to the patient a treatment module based on the assessment result of the cross-diagnostic assessment part 10A1, or whether to give priority to the patient based on the assessment result of the disease-specific assessment part 10A2. It has a function to determine whether the treatment module based on the treatment should be presented preferentially or both should be presented at the same time.
  • the priority determination block 10R transmits a control signal to the interface 10BIF of the module selection part 10B via the information transmission line SL32 to notify the patient-side information terminal 3 of the assessment of the cross-diagnostic assessment part 10A1.
  • whether the patient is presented with only the treatment module based on the assessment of the cross-diagnostic assessment part 10A1, or both treatment modules based on the results of the disease-specific assessment part 10A2 are presented to the patient, or both are presented to the patient at the same time. It is possible to appropriately set whether to present the information on the side information terminal 3 .
  • the patient in order to prevent a patient who is an application user from continuing to use the application and dropping out during treatment, the patient is requested to log in to the treatment application at an appropriate timing.
  • the system 100 has a function of sending a message (reminder notification) prompting the application (a function of activating the application at an appropriate timing).
  • a message for example, daily life data of a patient using the system 100 can be obtained, a therapeutic application can be immediately activated, and real-time assessment can be performed based on the daily life data. It is also possible to intervene immediately (real-time intervention) as a result of such real-time assessment.
  • the therapeutic app will be launched and assessments and other necessary measures will be taken. It is possible.
  • a patient with psychogenic ED is using a therapeutic app
  • check the keyword and schedule of the email received by the patient and if, for example, receives a date email from a partner, a therapeutic app is required. It judges that such an event has occurred, activates the treatment application, executes the necessary assessment, and sends a message prompting the patient to execute the necessary treatment module.
  • the patient is a chronic pain patient, detect that the patient has received a "picnic invitation email", activate the treatment application, perform the necessary assessment, send a message from the system 100 side, or A message can be sent that prompts the patient to perform the necessary treatment module.
  • rescue-like function means having a function (a so-called “rescue-like” function) that allows immediate assessment of the patient, or allows the patient to immediately execute treatment modules and tips.
  • rescue measures and functions for example, when the patient is ED, the necessary PDE5 inhibitor is prescribed when the partner contacts as described above but the patient does not have the PDE5 inhibitor It is conceivable to display the doctor's contact phone number.
  • the patient is ED and has been contacted by the partner but the patient does not have the PDE5 inhibitor, it is possible to pop up the countermeasures that were considered in advance (the countermeasures that the patient had set) in the treatment module. Conceivable.
  • a rescue button on the information processing terminal 3 on the patient side and operating the rescue button by the patient, the necessary treatment modules, exercises, and information can be immediately sent from the treatment application side in the event of the above-described situation. etc. is presented to the patient.
  • the patient may ask, "What if my partner dislikes me?" I am in a so-called “swallowed state of thought” due to the anxiety that
  • treatment modules and exercises are sent to the patient, allowing the patient to think that ⁇ it's not all about sex,'' or ⁇ I just want to enjoy meeting my partner.'' can help the patient get out of the state of being "swallowed up in thought" by anxiety.
  • the system 100 can be provided with a device having a function of transmitting messages such as reminders and encouragement to encourage the use of the therapeutic application periodically or irregularly at a fixed time. .
  • the ability to provide some reward to the patient for accessing the system 100 can be provided. Then, it is possible to provide a wearable device or the like having the above-described functions so as to increase motivation to access the system 100 and actively execute the treatment application, and continue treatment (treatment application It is possible to strengthen the "positive" behavior of continuing to use By exerting these functions, the patient's willingness to continue using the system 100 to access the system 100 and continue executing the treatment module is increased, and the patient does not access the system 100 during treatment (drops out during treatment). It is possible to suppress the situation and improve the therapeutic effect of the system 100 (or the effect of the therapeutic application). Regarding the timing of sending reminder notifications, is the patient active or inactive? information and whether the patient is mobile?
  • diabetes can coexist if the patient has ED.
  • the illustrated embodiment by measuring the patient's blood sugar level on a daily basis and generating an alert when it exceeds a predetermined value, it is possible to give the patient a sense of crisis and increase their motivation to continue treatment.
  • the illustrated embodiment performs cross-diagnostic assessment, which is effective when multiple diseases (diabetes, arteriosclerosis, etc.) are involved, as described above.
  • an appetite score that indicates changes in appetite is created to identify depression. be made recognizable by the patient.
  • the treatment module feedback such as "Good job!” It is possible to provide motivation for the patient to continue the action (treatment) by giving
  • the design/visual effects of visual information in the treatment application can be designed so that, for example, the background design can be selected so that it can be activated just by looking at it. .
  • Patients' respect for therapeutic apps also contributes to continuation of the app. Therefore, it is preferable that the design of the therapeutic application according to the illustrated embodiment be designed so that other people will not be able to recognize it.
  • the design is devised so that when viewed from the side, it looks like you are looking at your smartphone for business. Such a design solves the problem that the patient cannot continue using the medical treatment application because of "it would be embarrassing (if someone else knew that the medical treatment application was running)." And, for example, since the treatment of ED can be performed even in spare time other than at home, it becomes easier for the patient to continue the treatment using the treatment application.
  • a smart speaker is a speaker that has an AI assistant function that supports interactive voice operation, recognizes voice with a built-in microphone, searches for information, and operates linked home appliances. It also has a function of providing contents (Tips) for patients who access the system 100 to sequentially view videos, music, sounds, and other contents (for example, mindfulness meditation) related to or useful for treatment. equipment can be provided.
  • contents for patients who access the system 100 to sequentially view videos, music, sounds, and other contents (for example, mindfulness meditation) related to or useful for treatment. equipment can be provided.
  • Such content includes, for example, mindfulness meditation, scents, music, images, vibrations, information on preferred foods/meals, etc., and improves QOL, which is an indicator of therapeutic effects, duration, and satisfaction by using the five senses. bring.
  • QOL is an indicator of therapeutic effects, duration, and satisfaction by using the five senses. bring.
  • When performing the above-mentioned treatment module and exercise when moving the body according to the treatment application, combine with VR and AR, wear equipment for VR and AR when performing exercise, and enhance the feeling by VR and AR. can be done. This enhances the effectiveness of the therapy modules and exercises.
  • the work done with the patient's partner, the woman, and the content watched with the partner will raise the awareness of the partner (female) and promote the understanding and transfer of ED treatment. preferred.
  • a simple evaluation is performed for each exercise of the therapy module, and, for example, the patient's own evaluation is written in the "free description field". If such a mini-evaluation is fed back and the patient recognizes changes in the feedback, it is possible to show the patient the significance of moving toward the goal (e.g., the significance of performing exercise every day). . If it is possible to show such significance, for example, in the case of a patient with psychogenic ED, the patient's hope that ⁇ even if sexual activity is not going well, it is improving more than before,'' ) can be given. Additionally, giving patients meaningful feedback about their efforts toward their goals can increase their motivation to continue with the therapeutic app.
  • the illustrated embodiment focuses on the process rather than the "result.”
  • a patient with psychogenic ED for example, whether or not the patient's psychosocial process progressed and mental flexibility improved rather than whether or not the symptoms of "erection, no erection" improved. Focus on no. If the stage of the psychosocial process progresses and the flexibility of the mind improves, new behavioral patterns are acquired and learned. You can broaden your way of thinking by saying, "It's okay," and "The relationship with your partner is not all about sexual activity.”
  • the information processing terminal 3 on the patient side has a control block 3A, a display block 3B, an input block 3C, a memory block 3D and a communication block 3E.
  • the control block 3A has a function of executing control such as information processing in the information processing terminal 3 on the patient side.
  • the display block 3B has a function of displaying information to the user (patient) of the information processing terminal 3 on the patient side.
  • the input block 3C has a function of receiving information input by the user (patient).
  • the storage block 3D is composed of existing storage equipment, and stores a patient program denoted by reference numeral 3F for the information processing terminal 3 on the patient side. Although not explicitly shown, it is possible to use database 10F as storage block 3D.
  • the communication block 3E has a function of connecting with the network 20 through wired or wireless communication.
  • the information processing terminal 3 on the patient side is not particularly limited as long as it is an electronic device having an information processing function and a communication function.
  • the information processing terminal 4 on the medical institution side has a control block 4A, a display block 4B, an input block 4C, a storage block 4D and a communication block 4E.
  • the control block 4A has a function of executing control such as information processing in the information processing terminal 4 on the side of the medical institution.
  • the display block 4B has a function of displaying information to users of the information processing terminal 4 on the side of the medical institution (doctors, persons involved in the medical institution, etc.).
  • the input block 4C has a function of receiving information input by a doctor, a person involved in a medical institution, or the like.
  • the storage block 4D is composed of existing storage equipment, and stores a medical institution program denoted by reference numeral 4F for the information processing terminal 4 on the medical institution side. It is also possible to use the database 10F as the storage block 4D.
  • the communication block 4E has a function of connecting to the network 20 through wired or wireless communication.
  • websites outside the system such as anonymous patient associations, chat rooms, and BBSs, are connected to share the usage status and transitions of therapeutic applications in communities of patients suffering from the same disease. It is possible to view data relating to other users as statistical data.
  • a connectable website outside the system must meet the requirements as a medical device.
  • FIGS. 6 and 7 procedures for performing diagnosis, treatment, prevention, etc. (medical care) by the system 100 will be described.
  • the disease of a patient person concerned: user
  • FIG. 6 a patient accessing system 100 for the first time will be described.
  • step S1 it is determined whether or not the information processing terminal 3 on the patient side has logged in to the system 100, thereby determining whether the patient uses the system 100 or not.
  • step S1 if there is a login from the patient side ("Yes” in step S1), the process proceeds to step S2, and if there is no login, the process returns to step S1 (loop of "No" in step S1).
  • the login/authentication part 10H authenticates the identity of the patient who has accessed, for example, using the issued ID and password.
  • the number of times of access and the period after the first access are set for patients who are accessing multiple times, and if the set number of times or period is exceeded It is also possible to deactivate or restrict access.
  • biometric information specific to the patient such as the patient's face, voice (voiceprint), retina, iris, etc.
  • 3 is a smartphone or a PC
  • Acquisition of such biometric information is possible not only at the time of login but also at the time of inputting (acquiring) patient data.
  • step S2 when logged in by the patient, the patient is authenticated by the login/authentication part 10H based on the ID and password entered by the patient. Then, the process proceeds to step S3.
  • the patient authenticated in step S2 can immediately proceed to step S113 (described later) without executing step S3 and subsequent steps.
  • step S3 the accessing patient is asked to enter the chief complaint, current illness history, past history, etc. (intake information), and along with that, evaluation of psychogenic ED (for example, "When you start thinking that you will fail again, "I worry about maintaining an erection and cannot concentrate on sexual intercourse"), questioning based on operational diagnostic criteria (checklist questions) by simplified structured interview. Then, the process proceeds to step S4.
  • step S4 the cross-diagnostic assessment part 10A1 is used to determine how adaptively the patient can behave in response to psychosocial problems, life adaptation, stress, etc. while utilizing data under daily life, or Assess whether the user is acting adaptively and assess the psychological flexibility of the accessing user (patient: target person) (diagnostic cross-sectional assessment).
  • patient target person
  • cross-diagnostic assessment takes precedence over disease-specific assessment.
  • step S5 the presence or absence of disease-specific symptoms is determined in step S5 as a result of the input and interview in step S3. If there is no disease-specific symptom (No in step S5: for example, in the case of a healthy subject), the process proceeds to step S7.
  • step S6 the disease-specific assessment part 10A2 assesses whether or not the above-described skills are demonstrated for a specific disease (disease-specific assessment). After the disease-specific assessment of step S6, proceed to step S7.
  • analysis block 10B1 performs (for example) a cluster analysis on the results of the cross-diagnostic assessment, or (for example) performs a cluster analysis on the results of the disease-specific assessment.
  • step S8 in the classification block 10B2, based on the results of the cluster analysis, the patients are classified into the corresponding clusters based on the cluster analysis of the cross-diagnostic assessment, and the patients are classified into the corresponding clusters based on the cluster analysis of the disease-specific assessment. Sort into clusters.
  • cross-diagnostic assessment or disease-specific assessment for example, in the case of psychogenic ED, nine evaluation indices were conventionally used, but as a result of the inventor's research, cluster analysis in the case of psychogenic ED It has been found that it can be done using only three indices. The three indices are "psychological flexibility in ED" AFQ-ED, "sexual communication with partner” SRQ, and "general psychological flexibility” PFQ.
  • a linking block 10B3 determines (links to) the effective treatment modules for the classified patient clusters (step S9). Then, the process proceeds to step S10. Steps S7-S9 are executed in the module selection part 10B.
  • the patient decides whether or not to log out of the system 100 at this time. If the patient is satisfied with the treatment module presentation for the first access (Yes in step S10), the patient logs out and the first access ends for that patient. A case in which the patient accesses again (accesses for the second and subsequent times) will be described with reference to FIG. 7 .
  • step S11 the therapy module part 10C executes the therapy module selected in the module selection part 10B (step S11). The manner in which this is done depends on the contents of the therapy module. After execution, the process returns to step S10.
  • treatment programs exercises, work, etc.
  • homework tips, etc.
  • part of the information such as user statistical data, user usage status, and user response examples can be transmitted to the patient terminal 3 .
  • the patient can run a treatment program. Therefore, even if a problem occurs in the communication/network environment, or if the system 100 becomes inaccessible (deactivated) after the treatment is completed, the patient can still exercise or work (for example, Audio for attention training, etc.), homework, tips, user statistical data, user usage status, user response examples, etc., can be continued offline and interrupted treatment. can be used to maintain therapeutic effects and prevent recurrence.
  • Information such as exercises and workouts performed offline, homework, tips, user statistical data, user usage status, user response examples, etc.
  • step S11 the treatment module has been executed (step S11), the effect of the intervention is measured using cross-diagnostic (psychological flexibility) measures, cross-disease measures, existing evaluation scales, etc. (step S111: evaluation).
  • step S112 the effect of the intervention is measured using cross-diagnostic (psychological flexibility) measures, cross-disease measures, existing evaluation scales, etc.
  • step S112 feedback is provided to the doctor/patient (step S112).
  • the patient's daily life data can be obtained and recorded using the patient's terminal 3, wearable device, or the like.
  • step S112 by using emotion recognition AI based on facial expressions, it is possible to objectively judge the patient's emotions and the degree of stress.
  • the patient wears an earphone with a built-in pulse sensor, body temperature sensor, etc., even in an environment where the voice cannot be heard due to noise, it is possible to detect everyday data, especially voice and vibration such as pulse.
  • Data can be acquired under daily life.
  • body temperature data can also be obtained.
  • daily life data can be utilized to visualize the degree of "psychological flexibility” and "mindfulness” in acceptance and commitment therapy (ACT).
  • a sensor is attached to the chest of the patient to measure the heart rate, and LF / HF (ratio of low frequency LF and high frequency HF power: sympathetic and (indicating the overall balance of the parasympathetic nervous system) can be calculated to present the state of the autonomic nervous system.
  • LF / HF ratio of low frequency LF and high frequency HF power: sympathetic and (indicating the overall balance of the parasympathetic nervous system)
  • a known and commercially available sensor can be used as the sensor to be attached to the patient's chest.
  • the data measured by the sensor is transmitted as data to the information processing terminal 3 on the patient side and stored.
  • hormone/stress levels can be measured and used as an evaluation index as daily life data.
  • cortisol and amylase in saliva are measured by a sensor and transmitted as data to the information processing terminal 3 on the patient side.
  • the blood concentration of dopamine or serotonin can be measured by a sensor and transmitted to the information processing terminal 3 on the patient side to be used as an index of the effect of treatment.
  • Serotonin can also be measured by identifying alpha waves using an electroencephalograph.
  • cerebral blood flow can be measured as daily life data instead of electroencephalograms.
  • hyperactivity in the right frontal pole is associated with self-attention
  • a cerebral blood flow (NIRS) sensor it is possible to measure brain activity in the right frontal pole with a cerebral blood flow (NIRS) sensor and use it as an index of anticipatory anxiety and self-attention.
  • NIRS cerebral blood flow
  • physical quantities such as the number and frequency of conversations, the duration of the conversation, the amount of information in the conversation, and the amount of communication, which is the amount of information, can be measured with a smartphone (PCs and tablets can also be used), and used as data in daily life.
  • a method of measuring the amount of communication it is also possible to detect an IC chip incorporated in a device such as a smart phone, and automatically measure the number of times the device comes close to the IC chip and the time spent close.
  • digital biomarkers which are physiological data that can be acquired by wearable devices, etc., as data in daily life, it can be used to predict the onset of diseases, understand and manage conditions, etc., and improve the accuracy of assessment. can be improved.
  • it can be big data in algorithm development using machine learning and AI. By utilizing this big data, for example, using AI, it is possible to predict diseases, and it is also possible to construct preventive measures based on the prediction.
  • Interventions are then possible to prevent disease morbidity.
  • big data is analyzed with AI, and based on the analysis results, a therapeutic application with content that matches the individual patient's personality, degree of disease, etc. (content that suits each individual patient), that is, for each patient
  • the information processing terminal 3 for example, smart phone, PC, tablet, wearable device, etc.
  • the information processing terminal 3 can be provided with a function as a "life record table" for recording daily life data.
  • a life record table for recording daily life data.
  • the ecological instantaneous evaluation (EMA) method is based on heart rate, blood pressure, blood oxygen concentration, number of steps, sleep time and sleep quality (deep/light sleep, etc.), activity level, activity range (action history: For example, it is applied to physiological data such as measurement and acquisition by GPS) and blood sugar level.
  • the patient inputs the response of the measurement index (of the effect of the intervention).
  • the camera is used to measure the patient's pupil opening and closing, the direction of the line of sight, the number of blinks, the number of breaths and the body temperature, or the complexion. Objective information can be monitored at the time of index input.
  • the patient who is the respondent entered the measurement index carelessly It is possible to suppress inputting, stress, and the like.
  • heart rate, blood pressure, etc. can be measured.
  • the patient responds by voice, etc. the patient's voice is analyzed and judged by AI to determine whether the patient is seriously working on treatment, or the degree of seriousness of the patient ( It is possible to determine the patient's seriousness).
  • a device such as an odor sensor, an electroencephalogram sensor, a cerebral blood flow sensor, etc. is worn, objective information of the respondent is obtained by the sensor, the mental and physical state of the respondent is measured, and a cluster is obtained.
  • step S111 the patient can be automatically instructed to do homework (step S113).
  • step S113 the next intervention (access to the system 100) can be automatically proposed or instructed according to the evaluation after the intervention. This makes it possible to repeat the access until the problem is improved.
  • the patient who accesses the system 100 can sequentially watch videos, music, sounds, and other contents (eg, mindfulness meditation) related to or useful for treatment (Tips).
  • Tips offers content such as mindfulness meditations, scents, music, videos, vibrations, and information about preferred foods/diet. Such content brings improvement of QOL, which is an index showing therapeutic effect, its continuation, and degree of satisfaction, by using the five senses.
  • step S2 the patient who has been authenticated in step S2 can immediately proceed to step S113 and view the content.
  • step S113 the user logs out (step S114). After logging out, when actually going to the hospital, a medical examination/interview is performed by a doctor while referring to records of interventions and evaluations in the system 100 and acquired daily life data.
  • Steps S1 and S2 are the same as explained in FIG.
  • the login/authentication part 10H issues, for example, a prescription ID and password, and verifies the identity of the accessing patient.
  • step S13 the process proceeds to step S13, and steps S3, S4, and S6 (interview, cross-diagnostic assessment, and disease-specific assessment) described with reference to FIG. 6 are executed. Then, the process proceeds to step S14.
  • the patient authenticated in step S2 can immediately proceed to S113 (homework, tips) without executing step S3 and subsequent steps.
  • step S3 since it is expected that the content will be the same as that of the first access, it is possible to omit the input.
  • step S14 with reference to the interview, cross-diagnostic assessment, and disease-specific assessment, the assessment part 10D determines whether the patient is improving, cross-diagnostic (psychological flexibility) measures and cross-disease Objective measures measure the effectiveness of previous interventions. Also in step S14, the patient's terminal 3 or wearable device is used to acquire and record data under daily life, and the results of the effect measurement before and after the intervention are expressed in a report format using graphs, etc. It is possible to give feedback to the patient. If it is determined that the evaluation part 10D has improved (Yes in step S14), the process proceeds to step S15.
  • step S16 the treatment module presented on the previous access is executed.
  • steps S13, S14 and S16 are skipped after being authenticated in step S2. , it is possible to proceed immediately to step S16.
  • the module selection part 10B performs the first treatment. Other treatment modules selected in the access are suggested.
  • a new treatment module is proposed in the module selection part 10B based on the cross-diagnostic assessment and disease-specific assessment of step S13.
  • the patient chooses whether to log out of system 100 or not. If the user does not log out, the treatment module is continued (loop of No in step S17).
  • the patient logs out of system 100 and proceeds to step S18.
  • step S18 for example, in the evaluation part 10D, it is determined whether follow-up is necessary. At that time, in the evaluation part 10D, the possibility of recurrence is determined based on interviews, intakes, diagnostic cross-sectional assessments, and disease-specific assessments.
  • step S18 If there is a possibility of recurrence (Yes in step S18), after a predetermined period of time has elapsed, the system 100 accesses the information terminal on the patient side and conducts follow-up observation by interviewing predetermined items (step S19). ). Although not shown in FIGS. 6 and 7, it is also possible to periodically or irregularly send messages such as reminders and encouragement to encourage the use of the treatment application to the patient, and to apply game-like elements. is. Additionally, it is possible to reward the patient in some way for accessing the system 100 . Then, it is possible to increase the motivation to access the system 100 and actively execute the treatment application, and to strengthen the "positive" behavior of continuing treatment (continuously using the treatment application). be.
  • the patient's willingness to continue using the system (willingness to access the system 100 and continue executing the treatment module) is increased, and a situation in which the patient stops accessing the system 100 during treatment (drops out during treatment) is suppressed. and improve the therapeutic effect of the system 100 (or the effect of the therapeutic application).
  • treatment module treatment program: exercise
  • work homework, tips, evaluation, etc.
  • voice questions using smart speakers etc. It is configured to enable the patient to input, record, and respond to items read aloud, instructions, guidance, etc. by voice, and to exhibit a function that interacts with voice (interactive function). Is possible.
  • the server 10 can be customized to correspond to diseases, customized to correspond to applications on the patient side, and the like.
  • a known technique can be applied to the customization method.
  • the patient's treatment/behavior such as taking medication, is recorded, and the record can be checked by the doctor. The check can be performed via the information processing terminal 4 on the side of the medical institution, or can be directly checked by a doctor.
  • a calendar function is installed in the information processing terminal 3 on the patient side in order to record the patient's treatment/behavior. It is possible to configure so that action records (for example, records related to sexual activity in the case of an ED patient) can be entered.
  • a doctor can then check the records for each date in the calendar. Further, in the illustrated embodiment, a medical examination by a doctor (including the case where the patient visits a medical facility for examination, and the case where the examination is performed using the online function provided in the system 100) is performed every predetermined period (for example, two weeks). It is possible to determine a treatment policy, a prescription of drugs used for treatment, a set of works, etc., according to the situation of the patient. At that time, assessment (diagnostic cross-sectional assessment, disease-specific assessment) can be performed again, classification into a specific group based on cluster analysis can be performed, and work to be provided to patients can be newly set. Then, it is also possible to utilize the results of the newly executed assessment for medical examination.
  • Treatment policies, prescriptions, work contents, etc. can be changed in response to changes in daily life data and EMA without changing the specific group (for example, cluster 1) to which the patient belongs.
  • group for example, cluster 1
  • personalized treatment can be provided for each patient. This allows us to provide the best possible treatment.
  • medical examinations by doctors, newly set treatment policies, drug prescriptions, work sets, etc. can be recorded in the database 10F or the like. According to the system 100 of the illustrated embodiment, when treating a patient, it is possible to determine how adaptively the patient behaves with respect to psychosocial problems, life adjustment, stress, etc., while utilizing daily life data.
  • the optimal treatment module can be provided to the patient. Then, after executing the selected treatment module, the evaluation scale is applied to evaluate the treatment effect by evaluation part 10D, and the evaluation result is fed back to the patient, and if the treatment effect is not evaluated well, , the evaluation result is sent to the module selection part 10B, where a new treatment module is selected.
  • the patient's daily life data is acquired and recorded using the patient's terminal 3 or wearable device, etc., and the results of the effect measurement before and after the intervention are expressed in a report format using graphs, etc., and the doctor / patient
  • the illustrated embodiment which constitutes a platform that combines a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2, focuses on process rather than "results.” For example, in the case of a patient with psychogenic ED, whether or not the patient's psychosocial process has progressed and the flexibility of the mind has improved is more important than whether or not the symptom of "not being able to get an erection" has improved.
  • therapeutic effects can be exhibited for depression, anxiety, lifestyle-related diseases, chronic pain, sexual dysfunction, psychogenic erectile dysfunction (ED), various addictions, and the like.
  • therapeutic effects can be exhibited even when these diseases are complicated.
  • the system 100 of the illustrated embodiment if the patient can act adaptively to psychosocial problems, life adjustment, stress, etc., blood pressure is stabilized, blood flow is improved, and autonomy is achieved. Nerves are regulated and immunity is improved. Therefore, the system 100 of the embodiment having the server 10 as described above can also be applied to prevent infectious diseases such as coronavirus.
  • the illustrated embodiment can use quantitative metrics, objective monitoring methods, and cluster analysis, so it is possible to clearly explain the algorithm of the program to a third party, and actually It is easy to use as evidence by the results of Therefore, it becomes easy to prepare data necessary for various approvals.
  • the systems or methods according to the illustrated embodiments can be used by more than one person together. For example, partners of patients with ED and infertility (male, female), families and supporters of patients with depression and anxiety disorders share information and content necessary for treatment with patients, and exercise related to treatment modules. By working together with the patient, you can accompany the patient and deepen your understanding and practice of the disease and how to help.
  • the patient can actively participate in the decision of the treatment policy, receive treatment according to the decision (adherence), and improve the treatment effect.
  • the illustrated embodiment is merely an example and is not intended to limit the technical scope of the present invention.
  • the present invention may also be used to treat spousal or partner relationship problems, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized Anxiety, social anxiety, speech anxiety, specific phobia, post-traumatic stress disorder, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle diseases, bipolar disorder, borderline personality Disability, attention deficit/hyperactivity disorder, chronic or persistent pain, sexual dysfunction, relationship problems with a spouse or partner other than erectile dysfunction, alcoholism and other addictions, schizophrenia and other severe psychoses, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence), anti-aging, menopause, premenstru
  • two indicators “Leibovitz Social Anxiety Scale” LSAS-J and "General Psychological Flexibility” PFQ are used for classifying a specific group (cluster analysis), for example in the case of social anxiety. be able to.
  • a cluster analysis is performed based on the evaluation results of these indicators, and, for example, classification is performed into the following clusters.
  • Cluster 1 Extremely high standards (must speak perfectly fluently, must be seen as intelligent and witty)
  • Cluster 2 Conditional beliefs (If X, then Y) (If If I say something different, I'll be willing, I'll look bad if people notice that I'm anxious, people won't talk about me if they're not interested in me)
  • Cluster 3 Unconditional Belief ( I'm boring, I'm floating, I'm weird, I'm suspicious) Then, in the same way as the above-mentioned treatment application, the work corresponding to the above cluster is provided to the patient (integrated database of various applications)
  • FIG. 8 shows an example of the integrated database.
  • a treatment platform 901 an ED treatment application group 911, an anxiety disorder treatment application group 912, the Internet 950, a management server 931, and FIG. 8(B), a treatment platform 902 and an ED treatment application.
  • integration server 934 is included.
  • an example in which two therapeutic applications are included in the platform is shown as an example, but the number of therapeutic applications is not limited to this. Not only that, mental health care apps can also join the platform.
  • Each treatment application group includes an information processing terminal capable of executing each treatment application and a patient using the information processing terminal.
  • FIG. 8A shows a case in which a management server is provided to centrally manage a plurality of treatment applications
  • FIG. 8B shows a case in which a management server is provided for each treatment application.
  • There is provided an integrated server that controls the availability of The integrated server 934 for example, makes the common data of the management server 932 available in response to a call from the management server 933, or vice versa.
  • the common data of the management server 932 and the management server 933 are stored in the integrated server 934 so that the data of different management servers can be shared.
  • FIG. 9 shows data such as patients and evaluation values contained in the management server 931 of the treatment platform 901 .
  • reference numerals 101, 102, 103, 201, 202 indicate patient numbers
  • 101, 102 ⁇ are data obtained from users of ED treatment applications
  • 201, 202 ⁇ are users of anxiety disorder treatment applications
  • the indices and EMA data are merely examples, and may be configured to include other indices, EMA, and other data.
  • index A indicates the input result of a cross-diagnostic scale based on common cognitive behavioral therapy for multiple applications
  • index B indicates ED
  • index C indicates anxiety disorder.
  • EMA_A indicates the result of measuring body temperature as data under daily life
  • EMA_B indicates the result of measuring blood pressure as data under daily life.
  • the present embodiment is characterized in that the evaluation result of the index A, which is the common scale, is shared by both the ED treatment application and the anxiety disorder treatment application.
  • the present invention is characterized in that a common portion of data of applications having common data can be shared.
  • FIG. 10 shows an example of cluster analysis using common parts.
  • FIG. 10A shows an example of cluster analysis of the ED treatment application
  • FIG. 10B shows an example of cluster analysis of the anxiety disorder treatment application.
  • the index A and the index B are input to the patient via the patient's information processing terminal.
  • the management server calculates an evaluation result from the input.
  • the management server compares (1) type A when the evaluation result of index A is less than 30, and (2) further evaluation value of index B when the evaluation result of index A is 30 or more, and 40 If it is less than 40, it is classified as type C, and if it is 40 or more, it is classified as type D.
  • the patient inputs the index A and the index C via the patient's information processing terminal.
  • the management server calculates an evaluation result from the input.
  • the management server compares (1) type A when the evaluation result of index A is less than 30, and (2) further evaluation value of index C when the evaluation result of index A is 30 or more.
  • the threshold for cluster analysis of the evaluation values of index A can be changed according to the correlation between the evaluation result of index A and the type and therapeutic effect, such as changing the threshold from 30 to 35.
  • the threshold can be changed using the feedback results of both.
  • the amount of correlation data increases compared to the conventional case where the evaluation value threshold is changed based on the data for each application, and the numerical value can be further optimized.
  • the statistical analysis threshold is optimized simply from the viewpoint of common data and treatment effect. Relationships can also be analyzed, especially with the help of AI.
  • the statistical analysis also includes classification by AI.
  • FIG. 11 shows a list of correspondences between types and prescriptions stored in the management server. In the assessment block, symptoms and factors are categorized into types, and prescriptions (work) are provided according to this list.
  • FIG. 11 shows a list of correspondences between types and prescriptions stored in the management server. In the assessment block, symptoms and factors are categorized into types, and prescriptions (work) are provided according to this list.
  • 11(A) is a correspondence table of types originally stored in the management server and prescribed works.
  • type A modification will be described as a symptom (or factor) of a disease.
  • the types classified into type C, type D, type E, and type F are first referred to. If the evaluation value of index A is relatively high 25 to 30 and the therapeutic effect of type C and type E (both include work 3) is low, work for the group with high evaluation value of index A On the other hand, when type D and type E are compared and type D has a higher therapeutic effect, work 5 is judged to have a higher correlation with the high value of index A than work 3. , the correspondence table is updated as shown in FIG.
  • each type of prescription is made according to the updated correspondence table. However, it is also considered to return to the original if the treatment effect is reduced.
  • common work is provided according to the type of cognitive behavioral therapy, which is convenient because it facilitates correlation.
  • the management server has blocks and databases that perform assessment functions, but it is sufficient if any of the systems have these functions, for example, all functions are installed in smartphones.
  • these databases may be used as an integrated database.
  • a depressed patient has suicidal thoughts, it is dangerous to use the treatment app alone, and cooperation with treatment by a doctor is preferable.
  • Patients who have been depressed for more than two years should also be combined with drug therapy to improve cognitive distortions. If it is mild or moderate, treatment with a therapeutic app alone is effective, or if there are no mental symptoms due to an organic disease, the use of a therapeutic app cannot be expected to be effective. In this way, assessing the suitability of therapeutic applications is effective not only for depression, but also for all psychogenic and psychosomatic disorders, improving symptoms and ensuring treatment safety.
  • the system uses a depression scale provided in the database 10F (depression check simple depressive symptom scale (QIDS-J), 0-5 points, normal, 6-15 points, mild to moderate, 16 points or more, severe),
  • the Begg suicidal ideation scale (SSI) is read out and transmitted by the control device 1 to the information processing terminal 3 on the patient side.
  • FIG. 12 is a flow diagram of this suitability assessment.
  • depression is shown as an example in this example, it goes without saying that it can be applied to other diseases as well.
  • the control device 1 of the system presents QIDS-J, SSI, and depression history to the user via the user terminal, and when the user's answer is obtained, the result is transmitted to the control device 1 of the system.
  • the system recommends the user to see a medical institution.
  • the severity of depression will be determined based on the results of QIDS-J, and if it is mild or moderate, treatment will be started using the therapeutic app.
  • it is connected to a medical institution terminal (not shown) and online medical treatment is performed.
  • treatment modules consist of multiple categories (relaxation, stress management, improvement of cognitive distortion, improvement of symptoms). Offer a program.
  • modules for relaxation novel relaxation, abdominal breathing, visual imagery, etc.
  • modules that improve cognitive distortions polar bear experiments, cognitive restructuring methods, etc.
  • disease-specific treatment modules that improve symptoms (mind Fullness, biofeedback method, autonomic training method, music that regulates the autonomic nervous system, exercise, etc.), intervene not only in symptoms but also in the causes of psychogenic diseases and psychosomatic disorders, aiming for a complete cure, or
  • the aim is to improve the efficiency of treatment.
  • the system stores in the database 10F an entry list that records the correspondence between these modules for treatment, clusters by disease or assessment, and program sets for treatment corresponding to them.
  • treatment can be started using a treatment program set corresponding to the disease and the cluster based on the assessment result.
  • the categories included in the program and the treatment modules in the categories are set in advance based on treatment efficiency and the like, but they can be rearranged as described above.
  • the above example shows an example of a combination of a cross-diagnostic treatment module and a disease-specific treatment module. Needless to say, it can be designed as appropriate.
  • a treatment application requires a patient to perform a treatment module according to a predetermined treatment plan (program in the present invention) for a certain period of time.
  • a predetermined treatment plan program in the present invention
  • the treatment efficiency can be improved by performing character judgment on the patient and changing the input/output method, UI/UX, and treatment program according to the character judgment result.
  • a personality diagnosis test based on the "Big Five Theory", which is the most supported theory in psychological research, is conducted, and the treatment module is changed according to the personality.
  • this personality test may be performed prior to or after the cross-diagnostic and disease-specific assessments described above to further subdivide the clusters by personality.
  • the database 10F has a plurality of treatment program sets corresponding to clusters.
  • Abdominal Breathing which is also included in the same category, is not just a single treatment module, but a Big Five analysis, a visual-oriented, video-based module for extroverted and open users, or For those who are highly cooperative and sincere, we will provide modules that explain the same content in detail in sentences.
  • a plurality of types of modules expected to have the same effect in the same category are stored in the database 10F.
  • Treatment is realized by recording the corresponding relationship with the program set for use and providing the corresponding program set at the time of treatment. This can further improve treatment efficiency.
  • the correspondence in this list can also be updated according to the treatment results, and the correspondence can be corrected by AI.
  • FIG. 10 shows an example of functional modules of a treatment program provided by the treatment application system provided in the present invention.
  • the treatment program includes a cross-diagnostic assessment module and a disease-specific assessment module, the patients are clustered based on the patient's responses to the items for both assessments, and the It provides a cross-diagnostic treatment module and a disease-specific treatment module.
  • the treatment program includes only a disease-specific assessment module, the patients are clustered based on the patient's answers to the items for assessment, and the diagnostic cross-sectional treatment module and disease according to the cluster It provides a specific therapeutic module.
  • the treatment program includes only a cross-diagnostic assessment module, the patients are clustered based on the patient's answers to the items for assessment, and the cross-diagnostic treatment module and disease according to the cluster It provides a specific therapeutic module.
  • each functional module is completely included in the user's information processing terminal, and even if the user's information processing terminal operates stand-alone, each functional module is included in the server, and the user's information processing terminal connected to the server is included.
  • the information processing terminal can be realized by a device used only for display or input/output, or a device in which functional modules are divided into both the server and the user's information processing terminal.
  • Cross-diagnostic assessments and cross-diagnostic treatment modules are typically directed at psychiatric features across psychogenic and psychosomatic disorders, and disease-specific assessments and cross-diagnostic treatment modules are typically addressed. are directed to disease-specific symptoms such as, for example, insomnia, menstrual symptoms and ED. (app clipping) In this embodiment, sharing of scales will be described.
  • ED treatment application group 911, anxiety disorder treatment application group 912, and management server 931 in FIG. 8A treatment platform 901 will be described.
  • the management server 931 includes measures A, B, C, D, and E, for example.
  • Scales A and B are scales for cross-diagnostic assessment
  • scales C and D are disease-specific scales for treating ED
  • scale E is a scale for treating anxiety disorders.
  • Each treatment application 911, 912 accesses the management server 931 to perform assessment, and performs assessment using a predetermined scale required for each treatment.
  • each application had its own scale, so when the scale was updated, it was necessary to update the information for each downloaded application. is efficient because it only needs to update the scale on the server.
  • treatment is used, but this is not limited to treatment of disease, but naturally includes self-care, maintenance and improvement of mental health, etc.
  • patient also applies to healthy people. Needless to say, it also includes those who have some kind of mental disorder.
  • control device 3 patient-side information processing terminal (for example, smart phone) 4 Information processing terminal on the medical institution side (for example, PC) 10 Server 10A1 Cross-Diagnostic Assessment Part 10A2 Disease-Specific Assessment Part 10B Module Selection Part 10C Treatment Module Part 10D Assessment Part 10F Database 10H Login and Authentication Part 100 System

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Abstract

Provided are a treatment/therapeutic system in which an information processing terminal and an information processing network system are used, and a method using the treatment/therapeutic system, the method utilizing common evaluation data for a plurality of different treatment apps.　A database system comprises: a plurality of different types of application programs that use evaluation data having a common psychogenic disease/psychosomatic illness/stress-related disorder measure; a database in which common evaluation data acquired from the plurality of types of application programs can be integrated and utilized; and an analysis block that performs data analysis using integrated evaluation data of common items acquired from the plurality of types of application programs, and evaluation data of non-common items acquired from the plurality of types of application programs.

Description

医療・療法システムを統合するデータベース及びそれを実行する方法A database that integrates medical and therapeutic systems and a method for implementing it
　本発明は、情報処理端末（例えばスマートフォン）及び情報処理ネットワークシステム（例えばインターネット）を介して、医師（療法提供者等を含む）と患者やクライエント、ユーザ（利用者）等が直接面会することなく診断・治療・予防・再発防止・早期発見・合併している疾病の発見、セルフケア等を行うための医療・療法技術に関する。 In the present invention, a doctor (including a therapy provider, etc.), a patient, a client, a user (user), etc. directly meet via an information processing terminal (e.g., smartphone) and an information processing network system (e.g., the Internet). It is related to medical and therapeutic techniques for diagnosis, treatment, prevention, recurrence prevention, early detection, detection of coexisting diseases, self-care, etc.
　近年、情報処理端末及び情報処理ネットワークシステムを介して、医師と患者が直接面会することなく治療を行うための技術（いわゆる「治療用アプリ」）が開発されている（例えば、特許文献１、特許文献２）。
　そのような技術では、日常における治療、あるいは医療施設へ通うのが困難な過疎地や遠隔地に居住する患者の治療が可能である。また、プライバシーの関係で「治療を行っている」という事実を出来る限り秘匿したいという要請を有し、専門医師或いは専門家による治療を望まない患者であっても受診率を向上することが可能である。
　従来技術（例えば特許文献１）に係るシステムでは、特定の疾患に関して、全ての患者に対して同一の治療を行うことが基本であるが、心因性の疾患の場合、その症状をもたらす要因が、その患者に特有の認知・行動パターンに依存しているケースが多く、疾患に汎用的な治療を提供しても、十分な治療効果を得られないことが多い。
　ＣＢＴ（認知行動療法）は、身体疾患および心因性疾患・心身症・ストレス関連疾患への汎用性が高く、その治療効果が注目されている。ＣＢＴ、特にプロセスベースドＣＢＴ（プロセスに基づく認知行動療法）では、当該疾患に特徴的な症状の有無のみに着目するのではなく、心理社会的問題、生活適応やストレス等の様々な疾患に共通している要因に基づいて患者を理解していくことが重要である。そのためには、場合によっては、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメント（評定）すること、さらには当該疾患に特徴的な症状に対しても、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントすることが不可欠である。上記のような心理的なアセスメントを行うことで、その患者に最適な治療を実施することが可能となるが、従来技術（例えば特許文献１）では、係るアセスメントは行われていなかった。
　また、従来の医療用アプリ（例えば特許文献２）では、アセスメントする際に用いる患者データを蓄積し、そのデータに基づいて、アセスメントによる患者のタイプ分けを最適化することを教示していが、その最適化のためには膨大なデータが必要となる。 In recent years, a technology (so-called “therapeutic application”) has been developed that allows a doctor and a patient to perform treatment without face-to-face contact via an information processing terminal and an information processing network system (e.g., Patent Document 1, Patent Reference 2).
Such technology allows for routine treatment, or treatment of patients living in depopulated or remote areas where access to medical facilities is difficult. In addition, it is possible to improve the consultation rate even for patients who do not want to be treated by a specialist doctor or a specialist because they want to keep the fact that they are undergoing treatment confidential as much as possible for privacy reasons. be.
In the system according to the prior art (for example, Patent Document 1), it is fundamental to perform the same treatment for all patients with respect to a specific disease. However, in many cases, it depends on the cognitive and behavioral patterns unique to the patient, and even if a general treatment is provided for the disease, it is often not possible to obtain a sufficient therapeutic effect.
CBT (cognitive-behavioral therapy) has high versatility for physical diseases, psychogenic diseases, psychosomatic diseases, and stress-related diseases, and its therapeutic effects are attracting attention. CBT, especially process-based CBT (process-based cognitive behavioral therapy), does not focus only on the presence or absence of symptoms characteristic of the disease, but common to various diseases such as psychosocial problems, life adjustment and stress. It is important to understand the patient based on the underlying factors. To that end, depending on the situation, it is necessary to use data from daily life to assess the degree to which the patient can behave adaptively to psychosocial problems, life adjustment, stress, etc. In addition, to what extent the patient is able to act adaptively or maladaptively in response to the symptoms characteristic of the disease. Assessment is essential. By performing the psychological assessment as described above, it becomes possible to implement the most suitable treatment for the patient, but in the conventional technology (for example, Patent Literature 1), such an assessment is not performed.
In addition, a conventional medical application (for example, Patent Document 2) teaches that patient data used for assessment is accumulated, and based on that data, patient type classification is optimized through assessment. A huge amount of data is required for optimization.
特許第６３３９２９８号公報Japanese Patent No. 6339298 特願２０２１−１４２１６号広報Japanese Patent Application No. 2021-14216
　本発明は上述した従来技術の問題点に鑑みて提案されたものであり、情報処理端末及び情報処理ネットワークシステムによる診断・治療・予防・セルフケア等を行う医療システム及び当該システムを統合したデータベースとその利用方法である。具体的には、心理社会的問題、生活適応やストレス等に対して患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする診断横断的アセスメント、及び／又は、当該疾患に特徴的な症状に対しても患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする疾患特異的アセスメントの結果に基づいて、その患者に最適な医療を提供する（治療を実施する）システムと、それらに基づいたデータの統合と、データ解析の最適化を実行する方法の提供を目的としている。 The present invention has been proposed in view of the above-described problems of the prior art, and includes a medical system that performs diagnosis, treatment, prevention, self-care, etc., using an information processing terminal and an information processing network system, a database that integrates the system, and a database that integrates the system. How to use it. Specifically, a cross-diagnostic assessment to assess how adaptively or maladaptically the patient is behaving to psychosocial problems, life adjustment, stress, etc., and/or Or, based on the results of a disease-specific assessment that assesses how adaptively or maladaptive the patient is to the symptoms characteristic of the disease, the patient The purpose is to provide a system that provides optimal medical care (performs treatment) to patients, and a method for integrating data based on them and optimizing data analysis.
（１）共通する心因性疾患・心身症・ストレス関連疾患症状や状態に基づいて、複数のあるいは診断横断的な尺度を用いる、複数の異なる種類のアプリケーションプログラムと、
前記複数の種類のアプリケーションプログラムから取得される共通する尺度の評価データを統合して利用可能とされたデータベースと、
前記複数の種類のアプリケーションプログラムから取得された共通項目の統合された評価データと、前記複数の種類のアプリケーションプログラムから取得された非共通項目の評価データとを用いてデータの分析を行う分析ブロックと、を含むデータベースシステム。
（２）前記複数の種類のアプリケーションプログラムがメンタルヘルスケアおよび／または心因性疾患・心身症・ストレス関連疾患治療用のプログラムであり、前記共通項目が心因性疾患・心身症・ストレス関連疾患症状や状態に横断的な評価（及び日常生活下データ）に関する項目であり、前記非共通項目が特有の心因性疾患・心身症・ストレス関連疾患症状や状態の評価（及び特有の性疾患症状に対する日常生活下データ）に関する項目であることを特徴とする、心因性疾患・心身症・ストレス関連疾患症状や状態に関して用いられる（１）のデータベースシステム。
（３）前記分析ブロックは、前記アプリケーションプログラムからの入力に応じて、その利用者の心因性疾患・心身症・ストレス関連疾患症状や状態をもたらすタイプ分けを統計解析やＡＩを用いて行う機能を有する（１）または（２）のいずれかに記載のデータベースシステム。
（４）前記タイプ分けと処方されるワークの対応関係を示すリストを有し、前記リストが前記分析ブロックによって更新されることを特徴とする（１）ないし（３）のいずれかに記載のデータベースシステム
（５）前記分析ブロックによって、前記タイプ分けのアルゴリズムが更新されることを特徴とする（１）ないし（４）のいずれかに記載のデータベースシステム
（６）前記共通項目が、認知行動療法に基づく評価指標の尺度の評価である、（１）ないし（５）のいずれかに記載のデータベースシステム。
（７）　本発明のシステム（１００）は、
　患者に使用される情報処理用端末（３）を有し、
　前記サーバー（１０）は、
　日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする機能を有するブロック（１０Ａ１：診断横断的アセスメントパート）、及び／又は、当該疾患に特徴的な症状に対して患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする機能を有するブロック（１０Ａ２：疾患特異的アセスメントパート）と、
　前記ブロック（診断横断的アセスメントパート１０Ａ１及び／又は疾患特異的アセスメントパート１０Ａ２）のアセスメント（診断横断的アセスメントパート１０Ａ１のアセスメント、及び／又は、疾患特異的アセスメントパート１０Ａ２のアセスメント）の結果を分析して患者を特定の集団（クラスタ或いはグループ）に分類し、分類された集団と対応する（例えばリンク付けされた）治療モジュールを選択する機能を有するブロック（１０Ｂ：モジュール選択パート）を有することを特徴としている。
　本発明のシステムでは、診断横断的な部分と疾患特異的な部分とを併せ持つプラットフォームを構成していることが好ましい。
　或いは、本発明のシステム（１００）は、制御装置（１）として機能するサーバー（１０）と、患者に使用される情報処理用端末（３）を有し、前記サーバー（１０）は、
　日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする機能を有するブロック（１０Ａ１：診断横断的アセスメントパート）、及び／又は、当該疾患に特徴的な症状に対して患者がどの程度適応的に行動できているのか或いは非適応的に行動しているのかをアセスメントする機能を有するブロック（１０Ａ２：疾患特異的アセスメントパート）、または、
　前記ブロック（診断横断的アセスメントパート１０Ａ１及び／又は疾患特異的アセスメントパート１０Ａ２）のアセスメント（診断横断的アセスメントパート１０Ａ１のアセスメント、及び／又は、疾患特異的アセスメントパート１０Ａ２のアセスメント）の結果を分析して患者を特定の集団（クラスタ或いはグループ）に分類し、分類された集団と対応する（リンク付けされた）治療モジュールを選択する機能を有するブロック（１０Ｂ：モジュール選択パート）を有することを特徴としている。
　ここでサーバー（１０）としては、コンピュータその他の情報処理機械により構成される。
　そして、日常生活下データは、日常生活の中で様々な質問に答えてもらうことで収集する心理データや、心拍数、血圧、血中酸素濃度、歩数、歩行速度、反応速度、反射速度、動体視力、睡眠時間や睡眠の質（眠りが深い・浅い等）、活動量、行動範囲（行動履歴：例えばＧＰＳにより計測・取得）、血糖値等の生理データ、行動データ、感情・気分データ、夜間勃起データを含んでいる。すなわち、日常生活下データは心理・行動・生理データ、セルフモニタリングデータを包含する。
　また本発明のシステム（１００）において、日常生活下データを取得する装置（例えばスマートフォン、パーソナルコンピュータ等の情報処理機能及び通信機能を有する電子装置）を備えていてもよい。
　そして、医療機関側で使用される情報処理用端末（４）を備えることもできる。
　本発明では、日常生活下データを活用して、アクセプタンス＆コミットメント・セラピー（ＡＣＴ）における「心理的柔軟性」や「マインドフルネス」の程度を可視化することも出来る。
　本発明の方法は、上述したシステム（請求項１~３の何れか１項のシステム）を実行する方法において、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする工程（Ｓ４）と、前記ブロックのアセスメント（診断横断的アセスメントパート１０Ａ１のアセスメント）の結果を分析して患者を特定の集団（クラスタ或いはグループ）に分類し、分類された集団とリンク付けされた治療モジュールを選択する工程（Ｓ７~Ｓ９）を有することを特徴とする。
　本発明の方法においては、上記に加えて、当該疾患に特徴的な症状に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする工程（Ｓ６：疾患特異的アセスメントパート１０Ａ２のアセスメント）を備え、
　前記治療モジュールを選択する工程（Ｓ７~Ｓ９）では、当該疾患に特徴的な症状に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかの結果も分析して患者を特定の集団（クラスタ或いはグループ）に分類するのが好ましい。
　本発明は、配偶者またはパートナーとの関係性の問題、勃起障害、うつ病、強迫症、パニック症、広場恐怖症、全般性不安症や社交不安症やスピーチ不安、限局性恐怖症、心的外傷後ストレス障害、複合性不安障害、不眠症、過敏性腸症候群、摂食障害と肥満、肥満その他の生活習慣病、双極性障害、境界性パーソナリティー障害、注意欠如・多動症、慢性または持続性疼痛、性機能障害、勃起障害以外の配偶者またはパートナーとの関係性の問題、アルコール依存その他の各種依存症、統合失調症及び他の重度精神病、全般性不安症や社交不安症やスピーチ不安その他の不安症、限局性恐怖症、不妊症（男性、女性）、アトピー性皮膚炎、過活動膀胱（尿失禁）、アンチエイジング、更年期障害、月経前症候群（ＰＭＳ）、心因性視覚障害、歯科治療恐怖症、舌痛症、歯科心身症、醜形恐怖症等について適用することが好ましい。
　本発明の実施に際して、例えば心因性ＥＤの場合における特定の集団の分類（クラスタ分析）には、３つの指標「ＥＤにおける心理学柔軟性」ＡＦＱ−ＥＤ、「パートナーとの性に関するコミュニケーション」ＳＲＱ、「全般的な心理的柔軟性」ＰＦＱを用いることができる。
　本発明において、患者の服薬等の治療・行動を記録して、当該記録を医師がチェックカレンダーの各日付に患者の服薬（治療）の記録や、行動記録（例えばＥＤ患者であれば性行為に関する記録）を記載できるように構成し、カレンダーの各日付の記録を医師がチェックできるように構成するのが好ましい。
　また、所定期間（例えば２週間）毎に医師による診察（通院による診察、オンラインによる診察を含む）を行い、治療方針や治療に用いられる薬剤の処方、心理療法（以下ワーク）のセット等を決定することが出来る。当該診察に際して、改めてアセスメント（診断横断的アセスメント、疾患特異的アセスメント）を実行し、クラスタ分析に基づく特定の集団への分類を行い、患者に提供するワークのセット等を新たに設定することが出来る。改めて実行されたアセスメントの結果は、医師による診察において活用することも可能である。ここで、医師による診察、新たに設定された治療方針、薬剤の処方、ワークのセット等については、記録される。
　患者が属する特定の集団（例えばクラスタ１）を変更せず、日常生活下データ、ＥＭＡの変化に対応して、治療方針、処方、ワーク内容等を変更することも出来る。
　新たなワークを提供することにより、それぞれの患者にとって最適な治療を提供することが可能である。 (1) multiple different types of application programs that use multiple or cross-diagnostic scales based on common psychogenic, psychosomatic, and stress-related disease symptoms and conditions;
a database made available by integrating evaluation data of a common scale obtained from the plurality of types of application programs;
an analysis block that analyzes data using integrated evaluation data of common items obtained from the plurality of types of application programs and evaluation data of non-common items obtained from the plurality of types of application programs; , including database systems.
(2) The plurality of types of application programs are programs for mental health care and/or treatment of psychogenic diseases, psychosomatic disorders, and stress-related disorders, and the common item is psychogenic disorders, psychosomatic disorders, and stress-related disorders. Items related to cross-sectional evaluation (and daily life data) of symptoms and conditions, and evaluation of symptoms and conditions (and specific sexual disease symptoms) The database system of (1) used for symptoms and conditions of psychogenic diseases, psychosomatic diseases, and stress-related diseases, characterized by items related to daily life data for (1).
(3) The analysis block uses statistical analysis and AI to classify the user's psychogenic disease, psychosomatic disease, and stress-related disease symptoms and conditions according to the input from the application program. The database system according to any one of (1) or (2) having
(4) The database according to any one of (1) to (3), characterized in that it has a list showing correspondence between the type classification and the prescribed work, and the list is updated by the analysis block. System (5) The database system according to any one of (1) to (4), wherein the analysis block updates the typing algorithm (6) The common item is used in cognitive behavioral therapy The database system according to any one of (1) to (5), which is an evaluation of a scale of evaluation index based on.
(7) The system (100) of the present invention comprises:
Having an information processing terminal (3) used by a patient,
The server (10)
It has a function to assess how adaptively or non-adaptive the patient is in response to psychosocial problems, life adjustment, stress, etc., using data from daily life. Block (10A1: cross-diagnostic assessment part) and/or assess how adaptively or maladaptically the patient is behaving to the symptoms characteristic of the disease a functional block (10A2: disease-specific assessment part);
Analyzing the results of the assessment of the block (diagnostic cross-sectional assessment part 10A1 and/or disease-specific assessment part 10A2) (assessment of cross-diagnostic assessment part 10A1 and/or disease-specific assessment part 10A2) Characterized by having a block (10B: module selection part) having a function of classifying patients into a specific group (cluster or group) and selecting a treatment module corresponding (for example, linked) to the classified group there is
The system of the present invention preferably constitutes a platform having both a cross-diagnostic part and a disease-specific part.
Alternatively, the system (100) of the present invention has a server (10) functioning as a control device (1) and an information processing terminal (3) used by a patient, the server (10)
It has a function to assess how adaptively or non-adaptive the patient is in response to psychosocial problems, life adjustment, stress, etc., using data from daily life. Block (10A1: cross-diagnostic assessment part) and/or assess how adaptively or maladaptically the patient is behaving to the symptoms characteristic of the disease a functional block (10A2: disease-specific assessment part), or
Analyzing the results of the assessment of the block (diagnostic cross-sectional assessment part 10A1 and/or disease-specific assessment part 10A2) (assessment of cross-diagnostic assessment part 10A1 and/or disease-specific assessment part 10A2) It is characterized by having a block (10B: module selection part) having a function of classifying patients into a specific group (cluster or group) and selecting a treatment module corresponding (linked) to the classified group. .
Here, the server (10) is composed of a computer or other information processing machine.
In addition, daily life data includes psychological data collected by asking various questions in daily life, heart rate, blood pressure, blood oxygen level, number of steps, walking speed, reaction speed, reflex speed, moving body Visual acuity, sleep duration and sleep quality (deep sleep, light sleep, etc.), activity level, activity range (action history: measured and acquired by GPS, etc.), physiological data such as blood sugar level, behavior data, emotion/mood data, nighttime Contains erection data. That is, daily life data includes psychological/behavioral/physiological data and self-monitoring data.
In addition, the system (100) of the present invention may include a device for acquiring daily life data (for example, an electronic device having an information processing function and a communication function such as a smart phone or a personal computer).
An information processing terminal (4) used by the medical institution can also be provided.
In the present invention, it is also possible to visualize the degree of "psychological flexibility" and "mindfulness" in acceptance and commitment therapy (ACT) by utilizing daily life data.
The method of the present invention is a method for executing the above-described system (the system according to any one of claims 1 to 3), while utilizing data under daily life to deal with psychosocial problems, life adjustment, stress, etc. a step (S4) of assessing to what extent the patient can act adaptively or maladaptively, and the result of the assessment of the block (assessment of cross-diagnostic assessment part 10A1) are analyzed to classify the patients into a specific group (cluster or group), and a treatment module linked to the classified group is selected (S7 to S9).
In the method of the present invention, in addition to the above, a step of assessing to what extent the patient can act adaptively or maladaptively to the symptoms characteristic of the disease (S6: Assessment of disease-specific assessment part 10A2),
In the step of selecting the treatment module (S7 to S9), the results of how adaptively or non-adaptively the patient behaves to the symptoms characteristic of the disease are are also analyzed to classify the patients into specific populations (clusters or groups).
The present invention can be used to treat relationship problems with a spouse or partner, erectile dysfunction, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized anxiety, social anxiety, speech anxiety, specific phobia, and psychological disorders. Post-traumatic stress disorder, complex anxiety disorder, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle-related diseases, bipolar disorder, borderline personality disorder, attention-deficit/hyperactivity disorder, chronic or persistent pain , sexual dysfunction, relationship problems with a spouse or partner other than erectile dysfunction, alcoholism and other addictions, schizophrenia and other severe psychoses, generalized anxiety, social anxiety, speech anxiety and other Anxiety, specific phobia, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence), anti-aging, menopause, premenstrual syndrome (PMS), psychogenic visual disorder, dental treatment It is preferably applied to phobia, glossodynia, dental psychosomatic disease, body dysmorphia, and the like.
In the practice of the present invention, for example, in the case of psychogenic ED, the classification of a specific group (cluster analysis) includes three indicators: "Psychological flexibility in ED" AFQ-ED, "Sexual communication with partner" SRQ , “General psychological flexibility” PFQ can be used.
In the present invention, the patient's treatment/behavior such as taking medicine is recorded, and the record is checked by the doctor on each date of the calendar. ) so that the doctor can check the record of each date on the calendar.
In addition, a medical examination (including outpatient examinations and online examinations) is performed by a doctor every predetermined period (for example, two weeks), and treatment policies, drug prescriptions used for treatment, and psychological therapy (hereinafter referred to as work) sets are determined. can do At the time of the examination, assessment (diagnostic cross-sectional assessment, disease-specific assessment) can be performed again, classification into a specific group based on cluster analysis can be performed, and a new set of work to be provided to the patient can be set. . The results of the assessment performed anew can also be used in medical examinations by doctors. Here, medical examinations by doctors, newly set treatment policies, drug prescriptions, work sets, and the like are recorded.
It is also possible to change treatment policies, prescriptions, work contents, etc. in response to changes in daily life data and EMA without changing the specific group (for example, cluster 1) to which the patient belongs.
By providing new work, it is possible to provide optimal treatment for each patient.
　上述の構成を具備する本発明によれば、診断横断的アセスメントにより、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントすることが可能となる。
　さらに、疾患特異的アセスメントにより、当該疾患に特徴的な症状に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントすることが可能となる。これらのアセスメントに基づくことで、その患者に最適な治療モジュールを提供することが出来る。特に、疾患を特定して治療するだけでは改善しない事例に対して、極めて効果的な医療（治療、診断、予防・再発防止・早期発見・合併している疾病の発見等）、セルフケアを提供することが出来る。
　ここで本発明では、「結果」ではなく、「プロセス」に着目する。例えば、心因性ＥＤの患者であれば、「勃起しない」という症状（ここでの「結果」）が改善したか否かよりも、当該患者の心理社会的「プロセス」の段階が進み、心の柔軟性が向上したか否かに着目する。心理社会的的プロセスの段階が進み、心の柔軟性が向上すれば、新しい行動パターンの獲得、学習が行われたことになり、上述の心因性ＥＤの患者であれば、「勃起しなくとも大丈夫」、「パートナーとの付き合いは性行為が全てではない」というように考え方の幅が広がり、その結果、心因性ＥＤの改善・治癒や生活の質が向上する。
　本発明によれば、最適な治療モジュールを提供し以てプロセスベースドＣＢＴによる治療を実行することで、患者毎、或いは疾患の種類毎にカスタマイズした上で一定の効果を上げることが可能である。そして、量的測定指標を用いて診断横断的なアセスメント、疾患特異的なアセスメントを実行してクラスタ分析を行うことにより、治療の最適化が図られる。例えば、配偶者またはパートナーとの関係性の問題、勃起障害、うつ病、強迫症、パニック症、広場恐怖症、全般性不安症や社交不安症やスピーチ不安、限局性恐怖症、心的外傷後ストレス障害、不眠症、過敏性腸症候群、摂食障害と肥満、肥満その他の生活習慣病、双極性障害、境界性パーソナリティー障害、注意欠如・多動症、慢性または持続性疼痛、性機能障害、勃起障害以外の配偶者またはパートナーとの関係性の問題、アルコール依存その他の各種依存症、統合失調症及び他の重度精神病、不妊症（男性、女性）、アトピー性皮膚炎、過活動膀胱（尿失禁）、アンチエイジング、更年期障害、月経前症候群（ＰＭＳ）、心因性視覚障害、歯科心身症、醜形恐怖症等に対して、治療効果を発揮することが出来る。また、患者の自殺の防止にも効果的である。さらに、上述した疾患が合併していても治療効果を発揮することが出来る。
　そして本発明によれば、複数の合併する疾患症状／状態でのアセスメントも可能であり、最適な診断横断的治療法を提案或いは提供することが出来る。例えば、心因性ＥＤのアプリにおいて、抑うつ、不安、糖尿等の合併傾向もアセスメントの結果から分析することが出来る。或いは、複数の不定愁訴から更年期障害のアセスメントが出来る。
　さらに、本発明を適用することにより、心理社会的問題、生活適応やストレス等に対して、患者が適応的に行動できていれば、コロナウィルス等の感染症の予防や、アフターコロナの不安症等に対しても適用可能である。
　また、幹細胞を用いた再生医療や幹細胞の上清を用いた治療と、本発明の治療用アプリとを組み合わせ、併用することで、より高い治療効果が期待できる。
　それに加えて本発明によれば、量的測定指標や客観的なモニタリング手法、クラスタ分析を用いることが出来るので、第三者に対してプログラムのアルゴリズムを明確に説明することが可能であり、実際の結果による証拠とすることが容易である。そのため、各種承認に際して提出するべき必要な資料（客観的な証拠データや、それに用いられたシステムの説明等）の作製が容易である。
　本発明に係るシステム或いは方法は、複数名で一緒に使用することが可能である。そして、ＥＤや不妊症（男性、女性）の患者におけるパートナー、うつ病や不安障害の患者における家族や援助者等が、治療等に必要な情報やコンテンツを患者と共有し、治療モジュールに係るエクササイズを患者と共同で実行することで、患者と伴走することが出来て、疾患や、援助の仕方についての理解と実践を深めることが出来る。
　そして、患者が積極的に治療方針の決定に参加し、その決定に従って治療を受けること（アドヒアランス）が確立し、治療効果の向上を図ることが出来る。
　上述した様な作用効果を奏する本発明によれば、治療のパーソナライズ化を図ることが可能である。 According to the present invention having the above-described configuration, a cross-diagnostic assessment is performed to determine how adaptively a patient can act in response to psychosocial problems, life adjustment, stress, etc. while utilizing data under daily life. It is possible to assess whether a person is acting in a non-adaptive manner or is acting maladaptically.
Furthermore, disease-specific assessment makes it possible to assess to what extent the patient is behaving adaptively or maladaptively to the symptoms characteristic of the disease. . Based on these assessments, the optimal treatment module can be provided for that patient. In particular, we provide highly effective medical care (treatment, diagnosis, prevention, recurrence prevention, early detection, detection of coexisting diseases, etc.) and self-care for cases that cannot be improved by simply identifying and treating the disease. can do
Here, the present invention focuses on the "process" instead of the "result". For example, in the case of a patient with psychogenic ED, the stage of the patient's psychosocial "process" progresses, and the mental Focus on whether or not the flexibility of If the stage of the psychosocial process progresses and the flexibility of the mind improves, new behavioral patterns are acquired and learned. It broadens the range of thinking, such as "It's okay to be with a partner," and "The relationship with a partner is not all about sexual intercourse."
According to the present invention, by providing an optimum treatment module and performing treatment by process-based CBT, it is possible to achieve a certain effect after customizing for each patient or for each type of disease. Quantitative measures are then used to perform cross-diagnostic and disease-specific assessments and perform cluster analysis to optimize treatment. For example, relationship problems with a spouse or partner, erectile dysfunction, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized/social/speech anxiety, specific phobia, post-traumatic Stress disorders, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle-related diseases, bipolar disorder, borderline personality disorder, attention deficit/hyperactivity disorder, chronic or persistent pain, sexual dysfunction, erectile dysfunction Relationship problems with a spouse or partner other than alcoholism and other addictions, schizophrenia and other severe psychosis, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence) , anti-aging, menopausal disorders, premenstrual syndrome (PMS), psychogenic visual disturbances, psychosomatic dentistry, body dysmorphia, and the like. It is also effective in preventing patient suicide. Furthermore, therapeutic effects can be exhibited even when the above diseases are complicated.
According to the present invention, it is also possible to assess multiple comorbid disease symptoms/states, and to propose or provide an optimal cross-diagnostic therapy. For example, in an application for psychogenic ED, it is possible to analyze comorbid tendencies such as depression, anxiety, and diabetes from the results of the assessment. Alternatively, multiple indefinite complaints can be used to assess menopausal disorders.
Furthermore, by applying the present invention, if the patient can act adaptively to psychosocial problems, life adaptation, stress, etc., it will be possible to prevent infectious diseases such as coronavirus and to prevent post-corona anxiety. etc. is also applicable.
Further, by combining regenerative medicine using stem cells or treatment using the supernatant of stem cells with the therapeutic application of the present invention, a higher therapeutic effect can be expected.
In addition, according to the present invention, quantitative measurement indexes, objective monitoring methods, and cluster analysis can be used, so it is possible to clearly explain the algorithm of the program to a third party. It is easy to use as evidence by the results of Therefore, it is easy to prepare necessary materials (objective evidence data, description of the system used for it, etc.) to be submitted for various approvals.
A system or method according to the present invention can be used by multiple people together. Then, partners of patients with ED and infertility (male and female), families and supporters of patients with depression and anxiety disorders share information and content necessary for treatment with patients, and exercise related to treatment modules. By carrying out together with the patient, you can accompany the patient and deepen your understanding and practice of the disease and how to help.
Then, it is established that the patient actively participates in the decision of the treatment policy and receives the treatment according to the decision (adherence), and the improvement of the treatment effect can be achieved.
According to the present invention, which has the effects as described above, it is possible to personalize treatment.
図１は本発明の実施形態に係るシステムの概要を示す機能ブロック図である。
図２は実施形態で用いられるサーバーの機能ブロック図である。
図３は図２におけるモジュール選択パートの機能ブロック図である。
図４は実施形態で用いられる患者側電子装置の機能ブロック図である。
図５は実施形態で用いられる医療機関側電子装置の機能ブロック図である。
図６は実施形態の制御において、初めてアクセスした場合を示すフローチャートである。
図７は実施形態の制御において、二回目以降にアクセスした場合のフローチャートである。
図８は統合データベースの例を示した図である。
図９は治療用プラットフォーム９０１の管理サーバ９３１に含まれる患者と評価値等のデータを示す図である。
図１０は共通部分を利用したクラスタ分析の例を示す図である。
図１１は管理サーバに保存されている、タイプと処方の対応関係の一覧を示す図である。
図１２は治療用アプリの適合性ルーチンに用いるアルゴリズムを示す図である。
図１３は本発明の治療用モジュールのアセスメントと治療用モジュールの組み合わせ例を示す図である。 FIG. 1 is a functional block diagram showing an outline of a system according to an embodiment of the invention.
FIG. 2 is a functional block diagram of a server used in the embodiment;
FIG. 3 is a functional block diagram of the module selection part in FIG.
FIG. 4 is a functional block diagram of the patient-side electronic device used in the embodiment.
FIG. 5 is a functional block diagram of the medical institution side electronic device used in the embodiment.
FIG. 6 is a flowchart showing the first access in the control of the embodiment.
FIG. 7 is a flowchart for the second and subsequent accesses in the control of the embodiment.
FIG. 8 is a diagram showing an example of an integrated database.
FIG. 9 is a diagram showing data such as patients and evaluation values contained in the management server 931 of the treatment platform 901. As shown in FIG.
FIG. 10 is a diagram showing an example of cluster analysis using common parts.
FIG. 11 is a diagram showing a list of correspondences between types and prescriptions stored in the management server.
FIG. 12 illustrates the algorithm used in the Therapy App's compatibility routine.
FIG. 13 is a diagram showing an example of combination of therapeutic module assessment and therapeutic module of the present invention.
　（心因性疾患・心身症・ストレス関連疾患用の治療用アプリの例（ＥＤ治療用アプリ））
　以下、添付図面を参照して、本発明の実施形態について説明する。図示の実施形態では、プロセスベースドＣＢＴを心因性勃起障害（ＥＤ）患者の医療（治療、診断、予防・再発防止・早期発見・合併している疾病の発見等）、セルフケアに適用する場合について説明する。ただし、本発明は心因性ＥＤのみならず、他の性機能障害、配偶者またはパートナーとの関係性の問題、うつ病、強迫症、パニック症、広場恐怖症、全般性不安症や社交不安症やスピーチ不安、限局性恐怖症、心的外傷後ストレス障害、不眠症、過敏性腸症候群、摂食障害と肥満、肥満その他の生活習慣病、双極性障害、境界性パーソナリティー障害、注意欠如・多動症、慢性または持続性疼痛、性機能障害、勃起障害以外の配偶者またはパートナーとの関係性の問題、アルコール依存その他の各種依存症、統合失調症及び他の重度精神病、不妊症（男性、女性）、アトピー性皮膚炎、過活動膀胱（尿失禁）、アンチエイジング、更年期障害、月経前症候群（ＰＭＳ）、心因性視覚障害、歯科心身症、舌痛症、歯科恐怖症、醜形恐怖症等についても適用可能である。また、これらの疾患が合併していても適用可能である。
　図１において、全体を符号１００で示すシステムは、制御装置１とデータベース１０Ｆを含むサーバー１０（例えばコンピュータ）、患者に使用される情報処理端末３（患者側の情報処理用端末）、医療機関で使用される情報処理端末４（医療機関側の情報処理端末）を有しており、これらは例えば情報処理ネットワーク２０（例えばローカルエリアネットワーク或いはインターネット）により相互に接続されている。
　サーバー１０の詳細は図２を参照して後述するが、図１における制御装置１は、図２における各種パートを包括的に表示した機能ブロックである。
　ここで「患者」なる文言は、心因性ＥＤ等に罹患している可能性が有ることを自ら認識しており、且つ、その治療を行う意思のある個人を意味している。換言すれば、「患者」なる文言は、医療機関において医師、その他の関係者の指導により当該治療を行っている者のみに限定される訳ではなく、第三者が見れば「健常」と判断されるような者も包含し得る。したがって、情報処理端末４は医療機関に限定されない。
　図１において、患者側の情報処理用端末３は「日常生活下データを取得する装置」であり、例えばスマートフォン或いはパーソナルコンピュータ（ＰＣ、パソコン）等の情報処理機能及び通信機能を有する電子装置により構成することが出来る。或いは、日常生活下データを取得する装置として、ウェアラブル機器等を用いることも出来る。日常生活下データは、日常生活の中で様々な質問に答えてもらうことで収集する心理データを含む。また、例えば心拍数、血圧、血中酸素濃度、歩数、歩行速度、反応速度、反射速度、動体視力、睡眠時間や睡眠の質（眠りが深い・浅い等）、活動量、行動範囲（行動履歴：例えばＧＰＳにより計測・取得）、血糖値等の生理データ、行動データ、感情・気分データ、夜間勃起データも含んでいる。
　医療機関側の情報処理端末４は、情報処理機能及び通信機能を有する電子装置（例えばＰＣ）を利用することが出来るが、スマートフォンを利用することも可能である。
　ここで患者側の情報処理用端末３（例えばスマートフォン）はライン３Ｌ、ネットワーク２０を介してサーバー１０にアクセスするツールとして用いられるのみならず、サーバー１０における診断横断的アセスメントに役立てるため、患者の「日常生活下データ」を計測しサーバー１０側に送信するためのツールとしても機能する。日常生活下データの計測やサーバー１０の診断横断アセスメントパートへの送信という機能は、係る機能を実行するための専用アプリを、患者側の情報処理用端末３であるスマートフォンにインストールすることにより可能になる。
　そのような専用アプリをインストールする場合には、患者側の情報処理用端末３とネットワーク２０とを接続する情報伝達ライン３Ｌ（有線或いは無線の場合が存在する）は、サーバー１０にアクセスするためのアクセスラインであり、且つ、情報処理用端末３で計測した患者の日常生活下データをサーバー１０に送信するための情報伝達ラインでもある。
　サーバー１０におけるデータベース１０Ｆには、患者の情報（例えば患者のＩＤに対応させた診療履歴情報等）や心因性ＥＤ治療に関する情報（疾患に関する疾患教育、治療方法、服薬履歴を含むＰＤＥ５阻害薬に関する情報、プロセスベースドＣＢＴに関する情報等）が記憶されている。なお、診療履歴における診療には、情報端末を介しての診療及び医療機関での診療が含まれる。
　図１には示されていないが、複数の患者側の情報処理端末３及び複数の医療機関側の情報処理端末４をネットワーク１０に接続することも出来る。
　また、図１ではデータベース１０Ｆは制御装置１と共にサーバー１０に内蔵されている。ただし、データベース１０Ｆをサーバー１０とは別個に構成し、ネットワーク２０を介してサーバー１０に接続することも可能である。
　サーバー１０はビックデータ或いはビックデータを用いたシステム３０と結合可能である。ビックデータ或いはビックデータを用いたシステム３０と結合することにより、サーバー１０におけるアセスメントや治療モジュールの選択の結果、治療の状況等をビックデータの一部として活用出来ると共に、ビックデータを活用して得られた知見をサーバー１０の向上に役立てることが可能になる。
　図示はされていないが、上述のビックデータを活用して得られた知見、情報をＡＩ（人工知能）のアルゴリズム構築に取り入れ、ＡＩを用いた医療用アプリに発展させることも可能である。
　図示の実施形態に係るシステム１００におけるサーバー１０について、機能ブロックである図２を参照して説明する。
　図示の実施形態では、診断用アプリ（アセスメントモジュール）と治療・予防用アプリ（治療モジュール・評価モジュール）が一体に表現されているが、診断用アプリ（アセスメントモジュール）と治療・予防用アプリ（治療モジュール・評価モジュール）を別体に構成し、診断用アプリ（アセスメントモジュール）のアセスメント結果に対して、治療・予防用アプリ（治療モジュール・評価モジュール）が処方する（医師が処方する場合も含む）様に構成することが出来る。
　図２において、サーバー１０（図２では破線で示す）は、アセスメントパート１０Ａ、モジュール選択パート１０Ｂ、治療モジュールパート１０Ｃ、評価パート１０Ｄ及びログイン・認証パート１０Ｈを有している。明確には図示されていないが、図示の実施形態では、診断横断的アセスメントパート１０Ａ１と、疾患特異的アセスメントパート１０Ａ２とを併せ持つプラットフォームを構成している。
　また図２において、情報伝達ラインＳＬ１・・・は、有線のみならず、無線の場合もある。
　患者側端末３からサーバー１０への通信の入口に相当するログイン・認証パート１０Ｈでは、患者側の情報処理端末３からのＩＤ、パスワードが入力されると、当該患者の認証を実施する。ログイン・認証パート１０Ｈは、当該患者の正当性、信頼性を以前のデータを確認して、認証結果（偽物ではない正当な患者である旨の情報）を質問パート１０Ｑに送信する。
　明確に図示はされていないが、サーバー１０において、患者への成りすまし防止等のセキュリティ対策は、例えば公知技術を用いて実行されている。そして、係るセキュリティ対策は、図示の実施形態ではログイン・認証パート１０Ｈに施されており、患者への成りすまし、その他の不正行為に対してシステム１００を保護している。アクセスしてきた者が患者に成りすました偽者の場合には、ログイン・認証パート１０Ｈで当該アクセスを遮断し、質問パート１０Ａ以降への情報伝達を遮断する。
　ログイン・認証パート１０Ｈでは、例えば処方ＩＤとパスワードを発行し、アクセスしてきた者（患者）の本人確認を行う機能を有している。図示はされていないが、例えば患者本人の同意により、システム１００にアクセスする回数や最初にアクセスしてからの期間を適宜設定して、設定した回数や期間を超えた場合には非アクティベートすること、或いは、アクセスに制限を掛けることが可能である。後述するように、非アクティベートした場合でも、担当医師の指示により、患者が再びシステム１００にアクセスすることが出来る様に構成することが可能である。
　明確には図示されていないが、ログイン認証に際して、ＩＤとパスワード入力の他に、例えば患者側の情報処理端末３がスマートフォンやＰＣであればそのカメラ等を用いて、患者の顔、音声（声紋）、網膜、虹彩等を患者本人固有の生体情報を撮影（取得）して、当該生体情報を用いて本人認証を行い、以て、所謂「成りすまし」やアカウントの譲渡を防止することが出来て、患者から入力或いは取得されるデータの信頼性を確保することが出来る。ここで、上述した様な生体情報の取得はログイン時のみならず、患者のデータを入力（取得）する際であれば可能である。
　情報伝達ラインＳＬ１を介してログイン・認証パート１０Ｈに接続している質問パート１０Ｑでは、アクセスしてきた患者（対象者）に主訴、現病歴、既往歴等を入力せしめる。それと共に質問パート１０Ｑでは、心因性ＥＤの評価（例えば、「また失敗するのではないかと考え始めると、そのことで頭がいっぱいになる」、「勃起を維持できるのかが気になり、性行為に集中できない」）、及び心理的機能障害（精神症状）のまとまりを分類する基準（操作的診断基準）に基づいて、アクセスしてきた患者に対して問診を行う。具体的には、質問パート１０Ｑでは、例えば、心因性ＥＤの症状チェックリスト、及びＤＳＭ−５及びＩＣＤ−１０に準拠した精神疾患簡易構造化面接法によるチェックリスト形式の質問を、アクセスしてきた患者に対して実行する。
　アクセスしてきた患者の質問パート１０Ｑにおける入力や回答に基づき、特定の疾患が顕在しているか否かの判断や、リスクファクターの有無についての判断が可能になり、アセスメントパート１０Ａ１、１０Ａ２におけるアセスメントに役立てることが出来る。
　質問パート１０Ｑにおける入力や回答は、情報伝達ラインＳＬ２を介して診断横断的アセスメントパート１０Ａ１に送信される。
　診断横断的アセスメントパート１０Ａ１は、患者側の情報処理用端末３（日常生活下データを取得する装置）により取得された日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする機能を有しており、量的測定指標を用いてアセスメントを行う。例えば、適応的な行動として、
　不快な思考や感情を回避しないで、そのままにしておく「アクセプタンス」、
　考えと現実を区別して、不快な思考や感情にのみ込まれない「脱フュージョン」、
　目の前の現実への気づきを保持する「今、この瞬間との接触」、
　俯瞰的な視点から、自分自身が気づいていることに気づく「視点としての自己」、
　生きたい「生き方」を明確にする「価値の明確化」、
　生きたい「生き方」を追求する「コミットメント」等を想定している。
　心理社会的問題、生活適応やストレス等に対して、上述の適応的な行動をアセスメントすることにより、アクセスしたユーザー（患者：対象者）の心理的柔軟性をアセスメントする。上述の６つの適応的な行動のアセスメントは、ＣＢＴの一つであるアクセプタント＆コミットメント・セラピー（ＡＣＴ）に基づいて行われている。そして、心理社会的問題、生活適応やストレス等に対して、上述の適応的な行動が見られる対象者であれば、健康的であり、生活の質が高く、ストレスが低く、各種疾患に対する抵抗力が高い状態にあると判断できる。
　診断横断的アセスメントパート１０Ａ１でのアセスメント結果は、情報伝達ラインＳＬ５を介して、モジュール選択パート１０Ｂに送信される。
　診断横断的アセスメントパート１０Ａ１では疾患を特定するためのアセスメントはせず、疾患に特徴的な症状のアセスメントも行わない。上述した様に、診断横断的アセスメントパート１０Ａ１では、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントするからである。その様なアセスメントを行う結果、診断横断的アセスメントパート１０Ａ１では、心理社会的問題、生活適応やストレス等の様々な疾患に共通している要因に基づいて患者を理解することが可能であり、プロセスベースドＣＢＴが実行可能である。
　診断横断的アセスメントパート１０Ａ１で、心理社会的問題、生活適応やストレス等の様々な疾患に共通している要因に基づいて患者を理解することは、図示の実施形態における重要な特徴の一つであり、従来の各種治療用アプリケーション（例えば特許文献１、特許文献２参照）と明確に相違している点である。
　診断横断的アセスメントパート１０Ａ１でのアセスメントが終了した対象者の情報は、情報伝達ラインＳＬ３１を介して疾患特異的アセスメントパート１０Ａ２に送信される。
　疾患特異的アセスメントパート１０Ａ２は、対象者（アクセスしたユーザー）が、当該疾患に特徴的な症状に対して、どの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする機能を有しており、量的測定指標を用いてアセスメントを行う。例えば、非適応的な行動として、
　性行為に失敗するのではないかと考え始める「予期不安」、
　性行為中に勃起を維持できなければ、“男”として終わっていると感じる「自己概念」、
　勃起を維持できるのかが気になり、性行為に集中できない「注意制御」、
　パートナーからの評価が気になり、関係性が上手くいかない「対人関係」、
　性行為を試みようとしない「回避行動」等を想定している。
　また、うつ病の場合であれば、非適応的な行動として、
　非活動的であり、活動の幅が狭まっている「不活性」
　過去の嫌な出来事を繰り返し何度も考える「反芻」
　物事を極端に考え、少しのミスで全否定する等「認知の偏り」
　他人と関わらないようにしている「社会機能の障害」等を想定している。
　疾患特異的アセスメントパート１０Ａ２において、対象者が、疾患に特徴的な症状に対して、上述の非適応的な行動がアセスメントされたならば、情報伝達ラインＳＬ４を介して、当該対象者の情報が、アセスメントパート１０Ａ１、１０Ａ２のアセスメントと共に、モジュール選択パート１０Ｂに送信される。
　ここで、質問パート１０Ｑにおけるインテーク情報や問診の結果、対象者には特定の疾患の兆候が無い場合（例えば健常者である場合）は、図示の実施形態では疾患特異的アセスメントは行われない。その様な場合は、診断横断的アセスメントパート１０Ａ１でのアセスメントが終了した対象者の情報は、診断横断的アセスメントパート１０Ａ１でのアセスメントの結果と共に、情報伝達ラインＳＬ５を介して、疾患特異的アセスメントパート１０Ａ２をバイパスして、モジュール選択パート１０Ｂに送信される。また、質問パート１０Ｑにおけるインテーク情報や問診の結果、対象者が健常者であることが判明した場合には、診断横断的アセスメントパート１０Ａ１でアセスメントすることなく、対象者を健常者に相当するクラスタに分類することが可能である。
　図３を参照して説明する様に、モジュール選択パート１０Ｂでは、統計学的手法（例えばクラスタ分析）を用いて対象者を特定のグループに分類し（クラスタ分析の場合にはクラスタに分類し）、当該グループ或いはクラスタとリンク付けされた治療モジュールを選択する。換言すれば、モジュール選択パート１０Ｂは、診断横断的アセスメントパート１０Ａ１のアセスメントの結果、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて治療モジュールを選択する機能を有している。例えば、診断横断的アセスメントパート１０Ａ１のアセスメントにおいて、「アクセプタンス」、「脱フュージョン」、「今、この瞬間との接触」、「視点としての自己」、「価値の明確化」、「コミットメント」のクラスタとして、クラスタ１（「アクセプタンス」、「脱フュージョン」の得点が平均的な水準より低い）、クラスタ２（「今、この瞬間との接触」、「視点としての自己」の得点が平均的な水準より低い）、クラスタ３（「価値の明確化」、「コミットメント」の得点が平均的な水準より低い）、クラスタ４（「アクセプタンス」、「脱フュージョン」、「今、この瞬間との接触」、「視点としての自己」の得点が平均的な水準より低い）の４クラスタに分類する。なお、平均的な水準とは、平均点±１ＳＤ（標準偏差）を指している。診断横断的アセスメントパート１０Ａ１のアセスメントの結果から、上記のいずれかのクラスタに患者を分類する。
　心因性ＥＤでは、疾患特異的アセスメントパート１０Ａ２のアセスメントにおいて、「予期不安」、「自己概念」、「注意制御」、「対人関係」、「回避行動」のクラスタとして、クラスタ１（「予期不安」、「注意制御」の得点が平均的な水準より高い）、クラスタ２（「予期不安」、「回避行動」の得点が平均的な水準より高い）、クラスタ３（「自己概念」、「対人関係」の得点が平均的な水準より高い）、クラスタ４（「対人関係」、「回避行動」の得点が平均的な水準より高い）の４クラスタに分類する。疾患特異的アセスメントパート１０Ａ２のアセスメントの結果から、上記のいずれかのクラスタに患者を分類する。
　また、上述の例では、診断横断的アセスメントパート１０Ａ１、疾患特異的アセスメントパート１０Ａ２のそれぞれについてクラスタ分析を行っているが、診断横断的アセスメントパート１０Ａ１のアセスメントの結果及び疾患特異的アセスメントパート１０Ａ２のアセスメントの結果を統合して、クラスタ分析を行っても良い。
　そして、モジュール選択パート１０Ｂは、診断横断的アセスメントパート１０Ａ１のアセスメントの結果、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果から、患者が分類されたクラスタに基づいて、治療モジュールを選択する。
　なお、上述した例ではクラスタ数は４つであるが、実際のクラスタ分析では、データ分析及び治療用アプリのカスタマイズ化により、クラスタ数は数個から個人ごとに細分化し、１０００以上になることもあり得る。
　図示の実施形態では、診断横断的アセスメントパート１０Ａ１と、疾患特異的アセスメントパート１０Ａ２とを併せ持つプラットフォームを構成しているので、システム１００を診断用アプリと治療・予防用アプリとに分離して構成した場合においても、診断用アプリにおけるアセスメントパート（アセスメントモジュール）におけるクラスタ判定による各クラスタに対して、自動的に、診断横断的アセスメントの結果に基づく治療モジュール、及び／又は、疾患特異的アセスメントの結果に基づく治療モジュールが選択、指示される。ここで、診断用アプリと治療・予防用アプリとが一体に構成されたシステム１００においても、別体に構成されている場合においても、治療モジュールの選択、指示については、医師がアセスメントの結果に基づいて手動により治療モジュールを選択、指示することが可能である。
　モジュール選択パート１０Ｂで選択された治療モジュールは、情報伝達ラインＳＬ６により治療モジュールパート１０Ｃに送信される。
　モジュール選択パート１０Ｂは、図示しないインターフェース及び情報伝達ラインＳＬ７を介して、選択した治療モジュールを患者側の情報処理端末３に伝達する機．能を有している。すなわち、アセスメントの結果として患者のクラスタが判明して治療モジュールが提示されたならば、治療モジュールの治療プログラム（エクササイズやワーク等）、ホームワーク、治療に有用な情報（Ｔｉｐｓ）、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報の一部を患者側端末３に送信することが出来る。係る機能により、ネット環境が整っていない場所で、或いはオフラインで、当該治療プログラムを実行できる。そのため、例えば通信・ネット環境の不具合発生時や、治療が終了してシステム１００にアクセスできなくなった場合（非アクティベート化された場合）でも、当該患者は治療モジュールで行われたエクササイズやホームワーク、治療に有用な情報（Ｔｉｐｓ）、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報の一部を引き続きオフラインで実行・閲覧出来ることで、治療の中断を予防し、また治療終了後も治療効果の持続と再発予防に役立てることが出来る。
　ただし、オフラインで行われたエクササイズやワークアウト、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報について、介入の記録としてシステム１００側で記録されないので、適切な評価が出来なくなる可能性を防止するため、図示はされていないが、オフラインで行われたエクササイズやワークアウト、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報についてシステム１００側に送信する機能を有する様に構成することが可能である。
　ここで、患者が心因性ＥＤである場合に、上述した様なワークの一例として、例えば、公知の陰圧式勃起補助具（ＶＣＤ）を用いたワークがある。当該ワークはパートナー（配偶者等）と実践することが好ましく、性交が可能な程度に勃起した事実、性交が上手くできた事実は患者の自信の回復に好影響を及ぼす。また夜間の就寝中に勃起の状態を測定し、頻度や高度を記録し、その記録を確認することによって、心因性ＥＤの状態を把握、あるいは、状態が改善されていればその改善によって自信を回復することもできる。夜間勃起を測定するためには、陰茎にワイヤーを巻き付けるＲｉｇｉＳｃａｎや、内部に圧力センサ等の検出手段を有する勃起測定用のパンツなどを用いることができる。
　治療モジュールパート１０Ｃは、モジュール選択パート１０Ｂで選択した治療モジュールを患者に対して実行する、或いは、モジュール選択パート１０Ｂで選択した治療モジュールを患者に対して伝達する機能を有している。
　治療モジュールパート１０Ｃで実行する治療モジュールは、診断横断的な介入では、「心理的柔軟性」のアセスメントの結果に対して、健康で新しい行動パターンの学習／獲得を目指すための心理的介入を行う。例えば、診断横断的アセスメントパート１０Ａ１のアセスメントにおいて、クラスタ１（「アクセプタンス」、「脱フュージョン」の得点が平均的な水準より低い）に分類された患者であれば、「シロクマのエクササイズ」等を実施する。「シロクマのエクササイズ」とは、シロクマのことを一定時間考えないでおこうとすることで、不快な思考や感情を避けようとすることの不機能性を理解することを目的とする。クラスタ２（「今、この瞬間との接触」、「視点としての自己」の得点が平均的な水準より低い）に分類された患者であれば、「注意訓練」等を実施する。「注意訓練」とは、複数の音に様々な方法で注意を向ける練習を通して、注意の柔軟性を身につけ、自己注目的な認知処理から解放することを目的とする。これらの治療モジュールを実行することで、当該クラスタに含まれる適応的な行動が促進されることが期待できる。なお、本明細書において、心理療法の実行を、患者に対する介入と表現する場合がある。
　また、心因性ＥＤに対する治療モジュールとして、疾患特異的な介入では、各疾患に特有な場面、状況等に対して、各クラスタに適切な技法で、当該疾患に応じた健康で新しい行動パターンの学習／獲得を目指すための心理的介入を行う。例えば、疾患特異的アセスメントパート１０Ａ２のアセスメントにおいて、クラスタ１（「予期不安」、「注意制御」の得点が平均的な水準より高い）に分類された患者であれば、「感覚集中訓練」を実施する。「感覚集中訓練」とは、パートナーの身体に触れ合い、全神経を与えられた感覚に集中することを目的とする。クラスタ３（「自己概念」、「対人関係」の得点が平均的な水準より高い）に分類された患者であれば、「パートナーとの関係」を実施する。「パートナーとの関係」とは、性的関係を維持するために大切な、話し合いと妥協が可能な領域を見つけることを目的とする。
　治療モジュールパート１０Ｃにおいて、「仮想現実」を用いた治療モジュールの提供が可能である。例えば、不安症の患者の場合であれば、仮想現実により「電車に乗る」という体験（仮想現実上の体験）をさせることが出来る。
　図示の実施形態では、診断横断的な介入が疾患特異的な介入に優先する。ただし、それに限定されない場合も存在する。
　治療モジュールパート１０Ｃには、分類されたクラスタに対応して、患者が実行するべきホームワークが用意されている。治療モジュールパート１０Ｃがホームワークを選択するに際しては、図２では図示しない記憶装置（データベース）に記憶されており、治療モジュール毎にリンク付けされたホームワークを参考にすることが出来る。係るホームワークは、患者が実施すると症状の改善が期待でき、且つ、患者の主体性を向上させる様な内容に、予め編集されている。例えば、上述の治療モジュール「注意訓練」では、１日に１５分程度、音源に収録されている様々な音に対して注意を向けるトレーニングを行う。
　治療モジュールパート１０Ｃで実行した治療モジュールと治療結果は、情報伝達ラインＳＬ８により評価パート１０Ｄに送信される。ホームワーク及びその達成状況についても、評価パート１０Ｄに送信される場合もある。
　評価パート１０Ｄは、治療モジュールパート１０Ｃで実行した治療モジュールによる治療の効果を評価する機能を有しており、既存の評価尺度等を用いて、所定のアルゴリズムに従って治療の効果を評価する。例えば、心因性ＥＤでは、当該疾患に特徴的な症状である勃起機能の評価尺度（測定指標）として、国際勃起機能スコア（ＩＩＥＦ）を用いる。国際勃起機能スコアでは、尺度得点から重症度分類がなされており、治療の効果を評価することが可能である。ツールである評価尺度或いは測定指標は治療モジュールパート１０Ｄに記憶されている。或いは、図２では図示しない記憶装置（データベース）に治療モジュール毎の評価尺度或いは測定指標が記憶されていても良い。
　ここで、患者側の端末３やウェアラブル機器等を用いて患者の日常生活下データを取得して、記録し、治療前後の効果測定の結果をレポート形式にすることが可能である。そして評価パート１０Ｄは、患者（或いは医師）に対してその様なフィードバックを実行する機能を有することが可能である。
　評価パート１０Ｄによる治療効果の評価結果は、情報伝達ラインＳＬ９により患者側の情報端末３に送信される。例えば治療モジュールとしてチャットボットを用いた場合に、チャットボットによる治療効果の評価が患者に表示される。
　患者に送信される評価内容には、例えば、症状を改善するための助言等が含まれる。
　図示されていないが、治療の効果の測定指標の回答を入力するに際して、入力までの時間を記録するための計時手段及び記録手段、心拍数や血圧を測定する測定手段、患者の瞳孔開閉の様子や視線の向きや瞬きの回数を計測する手段（例えば患者側端末３がスマートフォンやＰＣである場合にはそのカメラ）、呼吸の回数の計測手段、体温の計測手段、或いは、顔色を観察する手段（例えば、患者側端末３のカメラ）を設け、指標入力時における客観的な情報をモニタリングして、回答の精度や回答者の状態を測定、観察する装置を設けていることが好ましい。
　回答の精度や回答者の状態を測定、観察する装置を設けることにより、回答の精度や回答者の状態を客観的にモニタリングすることが出来る。回答者の状態としてモニタリングする事項としては、例えば、回答者である患者が測定指標をいい加減に入力していないか、「改善された」という結果を得るために偽りの入力をしていないか、測定指標を入力することでストレスが掛かっていないか、深く考え込んでいるかどうか、患者の反応性、患者の認知機能等である。この様なモニタリングにより、クラスタ分析の際の要因として取り入れることが出来る。
　また、回答の精度や回答者の状態を測定、観察する装置として、患者側端末３としてのスマートフォンやＰＣのカメラを用いた場合、当該カメラに専用のフィルターやレンズ等を装着して、上述したモニタリングを行うことが出来る。さらに、心拍数、血圧等の計測装置（図示せず）やアプリケーションを使用することが可能である。
　さらに、匂いセンサー、脳波センサー、脳血流センサー等のデバイスを装着して回答者の客観的な情報を取得することが可能である。それにより、回答者の心身の状態を計測して、クラスタ分析の際の要因とすることも可能になる。そして、例えば脳波や脳血流等を測定するヘッドセット状のデバイス等を装着すれば治療の実感が高まり、治療効果がさらに向上する。
　評価パート１０Ｄにおいて、治療効果について良好な評価がされない場合には、その評価結果が情報伝達ラインＳＬ１０によりモジュール選択パート１０Ｂに送信される。評価パート１０Ｄからの良好ではない評価を受信した場合には、モジュール選択パート１０Ｂは提案した治療モジュールは効果が低かったと判断して、新たに治療モジュールを選択、提案する。治療モジュールパート１０Ｃは当該新たな治療モジュールを患者に送信（提供）し、評価パート１０Ｄは新たな治療モジュールによる治療効果を評価する。
　図２において、患者側の情報端末３は、情報伝達ラインＳＬ１２により、診断横断的アセスメントパート１０Ａ１に接続している。図１を参照して前述したように、患者側の情報処理用端末３は、患者の「日常生活下データ」を計測し診断横断的アセスメントパート１０Ａ１送信する機能を有しており、係る機能を実行するため、情報伝達ラインＳＬ１２を介して診断横断アセスメントパート１０Ａ１に患者の「日常生活下データ」を送信する。
　また、ログイン・認証パート１０Ｈは、情報伝達ラインＳＬ１２を介して治療モジュールパート１０Ｃに接続しており、情報伝達ラインＳＬ１３を介して評価パート１０Ｄに接続している。患者（対象者）からの２回目以降のアクセスでは、図７を参照して後述するように、先ず治療モジュールパート１０Ｃにアクセスして治療モジュールを実行する場合と、評価パート１０Ｄにアクセスして改善しているか否かを確認する場合の双方が存在するからである。
　次に図３を参照して、モジュール選択パート１０Ｂについて説明する。
　診断横断的アセスメントパート１０Ａ１と、疾患特異的アセスメントパート１０Ａ２とを併せ持つプラットフォームを構成する図示の実施形態では、モジュール選択パート１０Ｂでは、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づいて幾つかの治療モジュールを選択すると共に、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて幾つかの治療モジュールを選択する。換言すれば、診断横断的アセスメントパート１０Ａ１と疾患特異的アセスメントパート１０Ａ２の各々のアセスメントの結果に基づいて、複数の治療モジュールがモジュール選択パート１０Ｂにおいて選択される。
　図３において、モジュール選択パート１０Ｂは、分析ブロック１０Ｂ１、分類ブロック１０Ｂ２、リンク付けブロック１０Ｂ３、記憶装置１０Ｂ４を含んでいる。
　診断横断的アセスメントパート１０Ａ１のアセスメントの結果は情報伝達ラインＳＬ５を介して、モジュール選択パート１０Ｂの分析ブロック１０Ｂ１に送信される。そして疾患特異的アセスメントパート１０Ａ２のアセスメントの結果は情報伝達ラインＳＬ４を介して、分析ブロック１０Ｂ１に送信される。
　分析ブロック１０Ｂ１では、診断横断的アセスメントパート１０Ａ１のアセスメントの結果及び疾患特異的アセスメントパート１０Ａ２のアセスメントの結果の各々についてクラスタ分析を行う機能を有している。
　診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づく分析ブロック１０Ｂ１の分析結果は情報伝達ラインＳＬ２２を介して分類ブロック１０Ｂ２に送信され、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく分析ブロック１０Ｂ１の分析結果は情報伝達ラインＳＬ２４を介して分類ブロック１０Ｂ２に送信される。
　分類ブロック１０Ｂ２では、患者の診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づいて当該患者が所定のクラスタに分類される。同様に、患者の疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて当該患者が所定のクラスタに分類される。
　診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づいて分類されたクラスタの情報は情報伝達ラインＳＬ２６を介してリンク付けブロック１０Ｂ３に送信され、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて分類されたクラスタの情報は情報伝達ラインＳＬ２８を介してリンク付けブロック１０Ｂ３に送信される。
　クラスタと、当該クラスタに有効な治療モジュールとをリンク付ける情報が、記憶装置４０に記憶されている。当該「リンク付ける情報」は、クラスタと、クラスタに有効な治療モジュールとを関連付ける図表であっても良いし、関数であっても良い。
　リンク付けブロック１０Ｂ３には、情報伝達ラインＳＬ３０を介して、前記「リンク付ける情報」が伝達され、分類ブロック１０Ｂ２で分類されたクラスタに対して有効な治療モジュールが決定される。換言すれば、リンク付けブロック１０Ｂ３は、「リンク付ける情報」により、患者が分類されたクラスタに対して有効な治療モジュールを決定する機能を有している。
　リンク付けブロック１０Ｂ３では、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づいて分類されたクラスタに有効な治療モジュールと、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて分類されたクラスタに有効な治療モジュールとを決定する。
　診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づいて分類されたクラスタに有効な治療モジュールは情報伝達ラインＳＬ６１を介して治療モジュールパート１０Ｃに送信され、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づいて分類されたクラスタに有効な治療モジュールは情報伝達ラインＳＬ６２を介して治療モジュールパート１０Ｃに送信される。その結果、患者には、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づく治療モジュールと、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく治療モジュールの双方が提案可能である。換言すれば、診断横断的な介入と疾患特異的な介入の双方が可能である。
　図３で示す情報伝達ラインＳＬ６１、ＳＬ６２は、図２では単一の情報伝達ラインＳＬ６として包括的に表示されている。
　ここで、クラスタ分析が統計学的手法として例示されているが、患者（対象者）を正確に分類して、適切な治療モジュールとリンク付けできるのであれば、クラスタ分析以外の統計学的手法を採用することが出来る。
　上述した様に、患者には、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づく治療モジュールと、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく治療モジュールの双方が提案可能であるが、何れか一方を優先的に患者側情報端末３に表示するか、或いは、双方同時に患者側情報端末３に表示するかについては、適宜設定可能に構成することが出来る。
　例えば図３において、質問パート１０Ｑにおける問診、入力の結果、診断横断的アセスメントパート１０Ａ１のアセスメントの結果、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果等が入力される優先順位決定ブロック１０Ｒを設け、優先順位決定ブロック１０Ｒは入力された情報から、患者に対して、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づく治療モジュールを優先的に提示するべきか、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく治療モジュールを優先的に提示するべきか、双方を同時に提示するべきかを判断する機能を有している。それと共に、優先順位決定ブロック１０Ｒは、情報伝達ラインＳＬ３２を介してモジュール選択パート１０Ｂのインターフェース１０ＢＩＦに制御信号を送信して、患者側情報端末３に対して、診断横断的アセスメントパート１０Ａ１のアセスメントの結果に基づく治療モジュールを送信するか、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく治療モジュールを送信するか、双方を同時に送信するかを制御する機能を有している。
　その結果、患者に対して、診断横断的アセスメントパート１０Ａ１のアセスメントに基づく治療モジュールのみを提示するか、疾患特異的アセスメントパート１０Ａ２のアセスメントの結果に基づく治療モジュールの双方が提示するか、双方同時に患者側情報端末３に提示するかを適宜設定することが出来る。
　図示の実施形態において、アプリ利用者である患者がアプリを継続して使用し続け、治療途中で脱落することを防止するため、適正なタイミングで、当該患者に対して、治療用アプリへのログインを促すメッセージ（リマインド通知）をシステム１００側から発信する機能（適正なタイミングでアプリを起動する機能）を有している。
　例えば、システム１００を利用している患者の日常生活下データを取得して、直ちに治療用アプリを起動して、日常生活下データに基づいてリアルタイムにアセスメントを行うことが出来る。そして、係るリアルタイムで行われたアセスメントの結果として、直ちに介入すること（リアルタイム介入）も可能である。
　日常生活下データの数値で判断するのみならず、患者の日常において治療用アプリが必要になると予想されるイベントが発生した際に、治療用アプリを起動して、アセスメントその他の必要な措置を講じることも出来る。例えば心因性ＥＤ患者が治療用アプリを使用している場合において、当該患者が受信したメールのキーワードやスケジュールをチェックして、例えばパートナーからデートのメールを受信した場合に、治療用アプリが必要となるイベントが発生したと判断して、治療用アプリを起動し、必要なアセスメントを実行し、当該患者に必要な治療モジュールの実行を促す内容のメッセージを送信する。
　慢性疼痛の患者であれば、その患者が「ピクニックのお誘いメール」を受信したことを検出して、治療用アプリを起動し、必要なアセスメントを実行し、システム１００側からメッセージを送信し、或いは当該患者に必要な治療モジュールの実行を促す内容のメッセージを送信することが出来る。
　どの様なタイミングで患者に問題が起こっているのか？
　について、日常生活下データその他の患者のデータから治療者にフィードバックすることで、例えば、
　患者に問題が生じるのは朝昼夜の何れか？
　或いは、所定のケースで患者に問題が生じるのか？
　を決定することが出来る。すなわち、図示の実施形態に係るシステムで自動的に収集したデータの解析を進めることにより、患者に問題が生じるタイミング、換言すれば患者が最も治療用アプリを必要とするタイミング、を決定することが出来る。
　この様に、治療用アプリを起動するべき適正なタイミングを決定して、アプリにおいて必要な措置を講じることは、患者が治療モジュールの実行を緊急に必要とする場合（すなわち患者にとっての緊急時）に、当該患者に対して即時にアセスメントを実行し、或いは、当該患者が即時に治療モジュールやＴｉｐｓを実行できる機能（所謂「レスキュー的な」機能）を備えることを意味している。
　係るレスキュー的な措置や機能として、例えば患者がＥＤである場合に、前述したようなパートナーからの連絡があったがＰＤＥ５阻害剤が患者の手元に無い場合に、必要なＰＤＥ５阻害剤を処方する医師の連絡先電話番号を表示することが考えられる。
　そして、患者側の情報処理端末３にレスキューボタンを設置し、患者がレスキューボタンを操作することにより、上述した様な事態が生じた場合に直ちに治療用アプリ側から必要な治療モジュールやエクササイズ、情報等が患者に提示される。患者がＥＤであり、パートナーからの連絡があったがＰＤＥ５阻害剤が患者の手元に無い場合に、治療モジュールの中であらかじめ考えていた対策（本人が設定していた対策）をポップアップさせることが考えられる。
　そして、患者側の情報処理端末３にレスキューボタンを設置し、患者がレスキューボタンを操作することにより、上述した様な事態が生じた場合に直ちに治療用アプリ側から必要な治療モジュールやエクササイズ、情報等が患者に提示される。患者がＥＤであり、パートナーからの連絡があったがＰＤＥ５阻害剤が患者の手元に無い場合に、この様な状態では患者は「パートナーに嫌われたらどうしよう」、「性行為が失敗したらどうしよう」という不安により、いわゆる「思考に飲み込まれた状態」に陥っている。
　図示の実施形態において、治療モジュールやエクササイズが患者に送信され、患者が「性行為だけが全てではない」、「単純にパートナーと会うことを楽しめば良い」という様にも考えることができるようになれば、不安で「思考に飲み込まれた状態」から患者が抜け出すことが出来る。
　図示はされていないが、システム１００において、定期的に決めた時刻に合わせて定期或いは不定期に治療用アプリ使用を促すリマインド通知や励まし等のメッセージを送信する機能を有する装置を設けることが出来る。ゲーム的な要素を応用することも可能である。さらに、システム１００にアクセスすることについて患者に何かしらの報酬を与える機能を備えることが可能である。そして、システム１００にアクセスして治療用アプリを積極的に実行しようとする動機付けを高める様上記のような機能を有するウェアラブル機器等を備えることが可能であり、治療を継続する（治療用アプリを継続使用する）という「正」の行動を強化することが出来る。
　これ等の機能を発揮することにより、患者がシステム１００にアクセスして治療モジュールを実行し続けたいという継続使用の意欲を高めて、治療途中でシステム１００にアクセスしなくなる（治療途中で脱落する）事態を抑制し、システム１００による治療効果（或いは治療用アプリの効果）を向上することが出来る。
　リマインド通知の発信のタイミングについては、患者が活動しているか停止しているか？の情報と、患者が移動中であるか？在宅であるか？の情報（ステイタス管理）を管理して決定することが出来る。
　また、日常生活下データから、心拍安定時、患者が暇な時等にリマインド通知を発信することが出来る。
　さらに、患者側の情報処理端末３（例えばスマートフォン）の起動後（復帰後）は当該患者がスマートフォンに触れている可能性が高いので、その際にリマインド通知を発信することが出来る。
　図示の実施形態では、患者がアプリを継続して使用し続け、治療途中で脱落することを防止するために、患者自らが治療に取り組む、自ら治療に参加するという意思を強固にする（アドヒアランスを高める）ためのコンテンツを提供することが出来る。
　係るコンテンツとしては、疾患教育、治療法教育に係るコンテンツ等（例えば、ＡＣＴとは何かを説明するコンテンツ）がある。
　患者がアプリを継続して使用し続けるモチベーションを持続して、治療途中で脱落することを防止するためには、如何にして患者を治療用アプリにログインさせるかが重要である。そのため、図示の実施形態において、患者が好きな有名人のＳＮＳアプリ（例えば、Ｔｗｉｔｔｅｒ　Ｉｎｃ．の情報サービスである「Ｔｗｉｔｔｅｒ（登録商標）」）に当該患者がアクセスすると、（治療用アプリにログインする旨の）リマインド通知が発信される。
　或いはパートナーのＳＮＳアプリ（例えば、ＬＩＮＥ株式会社の情報サービスである「ＬＩＮＥ（登録商標）」等）に当該患者がアクセスすると、リマインド通知が発信される。
　さらに、患者が利用しているスマートフォンのその他のＳＮＳアプリ（例えば、Ｇｏｏｇｌｅ　ＬＬＣ．の動画共有サービスである「ＹｏｕＴｕｂｅ（登録商標）」等）の起動状況から、それにリンクしてリマインド通知を発信することが出来る。
　くわえて、ガイド役のパートナーキャラクターや自らのアバターを表示させて、あたかもアプリ内でコミュニケーションを行っているかのような親しみやすさを感じさせることや、そのキャラクターやアバターを選べたり、利用者の好みに合わせてカスタマイズしたりできるような機能を持たせることで、モチベーション維持と脱落防止に役立つ。
　患者側の情報処理端末３（例えばスマートフォン）から発生される警報（アラート）は、当該患者の問題意識を高め、治療継続の意欲を高めることが分かっている。
　例えば、患者がＥＤであると糖尿病は併発する恐れがある。図示の実施形態において、当該患者の血糖値を日常的に計測して、所定値以上となった場合にアラートを発生することにより、患者に危機感を与え、治療継続の意欲を高めることが出来る。上述した様に、図示の実施形態では診断横断的アセスメントを実行するので、上述した様に複数の疾病（糖尿病、動脈硬化、その他）が関連する場合に有効である。
　また、食事（食欲）と気分とは関連しており、抑うつ気味の時には食欲が変化（低下・増加）することに着目して、食欲の変化を示す食欲スコアを作成して抑うつ気味であることを患者自身が認識できるようにする。或いは、食事の写真をアップロードして食欲の変化を目視出来るようにして、抑うつ気味である場合に認識できる。
　上述した「正の行動強化」に関する行動分析学における理論として、行動の直後に「良いこと」、「嫌なことの消失」（報酬）があると、当該行動を続ける方向に作用するというものがある。ここで言う「直後」は６０秒以内であり、係る理論を「６０秒ルール」と表現することがある。この理論に基づいて、図示の実施形態において、治療モジュール、エクササイズを行った直後に「良く頑張りました！」等のフィードバック、ポイントが加算される、達成度が表示される、結果がグラフ表示される等を与えて、患者が行動（治療）を続ける動機付けを提供することが出来る。
　明確には図示されていないが、図示の実施形態では、治療用アプリのデザイン／ビジュアルに視覚情報による効果、見るだけで活性化する様に、例えばバックグラウトのデザインを選べる仕様とすることが出来る。
　また、治療用アプリに対して患者が敬意を持つことは、そのアプリを継続すること寄与する。そのため、図示の実施形態に係る治療用アプリのデザイン等については、周囲の人からそれと悟られないようにすることが好適である。例えば、心因性ＥＤの患者が治療用アプリを実行している最中に、第三者に見られたとしても、当該患者が恥ずかしい思いをしない様に、（ＥＤ治療用アプリを実行しているのだが）傍から見るとビジネスのためにスマホを見ている様に見える等の工夫がされたデザインであるのが好ましい。その様なデザイン等であれば、「（治療用アプリを実行していることが他人に知られてしまうと）恥ずかしい」という理由で患者が治療用アプリを続けられなくなるという問題が解消される。そして、例えばＥＤの治療を自宅以外の隙間時間でも実行できるので、患者が治療用アプリを用いた治療を継続し易くなる。
　診断横断的アセスメント、疾患特異的アセスメント、治療モジュール（治療プラグラム：エクササイズ、ワーク）、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報、評価等を実行するに際して、スマートスピーカー等を用いて、音声による質問項目の読み上げ、指示、ガイダンスその他に対して、患者が音声により入力し、記録し、応答すること等を可能にして、音声により相互に作用する機能（インタラクティブな機能）を具備する様に構成することが可能である。ここで、スマートスピーカー（ＡＩスピーカー）は対話型の音声操作に対応したＡＩアシスタント機能を持つスピーカーであり、内蔵されているマイクで音声を認識し、情報の検索や連携家電の操作を行う。
　また、システム１００にアクセスした患者に対して、治療に関連する或いは治療に役立つ動画や音楽、音声、その他のコンテンツ（例えばマインドフルネス瞑想）を順次視聴させるコンテンツ（Ｔｉｐｓ）を提供する機能を有する装置を設けることが出来る。係るコンテンツは、例えば、マインドフルネス瞑想、香り、音楽、映像、振動、好ましい食品／食事の情報等であり、五感を使うことにより治療効果とその持続、満足度を表す指標であるＱＯＬの向上をもたらす。
　上述した治療モジュール、エクササイズの実行に際して、治療用アプリに従って身体を動かす際に、ＶＲ、ＡＲと組み合わせ、エクササイズ実行の際にＶＲ、ＡＲ用の機器を装着して、ＶＲ、ＡＲにより実感を強めることが出来る。これにより、治療モジュール、エクササイズの効果が向上する。
　ここで、治療用アプリを実行するに際して、患者のパートナーである女性と一緒に行うワーク、パートナーと一緒に観るコンテンツは、パートナー（女性）の意識向上とＥＤ治療への理解と搬送を促すので、好適である。
　図示の実施形態においては、治療モジュールのエクササイズ毎に簡単な評価（ミニ評価）を実施しており、例えば、「自由記述欄」に患者自らの評価を記載する様に構成されている。その様なミニ評価をフィードバッグし、フィードバッグにおいて患者に変化を認識させれば、当該患者に対して目標に向かう意義（例えば、エクササイズを毎日実行していることの意義）を示すことが出来る。その様な意義を示すことが出来れば、例えば心因性ＥＤの患者であれば、「性行為が上手くいかない場合でも前進している、以前よりも改善されている」という希望を（当該患者に）与えることが出来る。
　さらに、得られるフィードバッグについて患者が意義を感じる様にして、目標に向かって取り組んだことに対するフィードバッグを行えば、患者が治療用アプリを継続する意欲を向上することが出来る。
　ここで、図示の実施形態では、「結果」ではなく、プロセスに着目している。心因性ＥＤの患者であれば、例えば、「勃起する、勃起しない」の症状が改善したか否かよりも、当該患者の心理社会的プロセスの段階が進み、心の柔軟性が向上したか否かに着目する。心理社会的プロセスの段階が進み、心の柔軟性が向上すれば、新しい行動パターンの獲得、学習が行われたことになり、上述の心因性ＥＤの患者であれば、「勃起しなくとも大丈夫」、「パートナーとの付き合いは性行為が全てではない」と考え方の幅を広げることが出来る。
　図４において、患者側の情報処理端末３は、制御ブロック３Ａ、表示ブロック３Ｂ、入力ブロック３Ｃ、記憶ブロック３Ｄ及び通信ブロック３Ｅを有している。
　制御ブロック３Ａは、患者側の情報処理端末３における情報処理等の制御を実行する機能を有している。表示ブロック３Ｂは、患者側の情報処理端末３の使用者（患者）に情報を表示する機能を有している。入力ブロック３Ｃは、使用者（患者）が入力した情報を受け付ける機能を有している。
　記憶ブロック３Ｄは既存の記憶用機器により構成され、患者側の情報処理端末３のために、符号３Ｆで示す患者用プログラムが記憶されている。明示されていないが、データベース１０Ｆを記憶ブロック３Ｄとして用いることが可能である。通信ブロック３Ｅは、有線或いは無線の通信により、ネットワーク２０と接続する機能を有している。
　患者側の情報処理端末３は、情報処理機能及び通信機能を有する電子機器であれば、特に限定はしない。ただし、昨今の普及を考慮すると、いわゆるスマートフォンの様な携帯型情報端末が好ましい。
　図５において、医療機関側の情報処理端末４は、制御ブロック４Ａ、表示ブロック４Ｂ、入力ブロック４Ｃ、記憶ブロック４Ｄ及び通信ブロック４Ｅを有している。
　制御ブロック４Ａは、医療機関側の情報処理端末４における情報処理等の制御を実行する機能を有している。表示ブロック４Ｂは、医療機関側の情報処理端末４の使用者（医師、医療機関の関係者等）に情報を表示する機能を有している。入力ブロック４Ｃは、医師、医療機関の関係者等が入力した情報を受け付ける機能を有している。
　記憶ブロック４Ｄは既存の記憶用機器で構成され、医療機関側の情報処理端末４のため、符号４Ｆで示す医療機関用プログラムが記憶されている。データベース１０Ｆを記憶ブロック４Ｄとして用いることも可能である。通信ブロック４Ｅは、有線或いは無線の通信により、ネットワーク２０と接続する機能を有している。
　明確には図示されていないが、システム外部のＷｅｂサイト、例えば匿名患者会、チャットルーム、ＢＢＳを接続して、同じ疾病に悩む患者同士のコミュニティで治療用アプリの使用状況や推移を共有し、他の使用者に関するデータを統計的なデータとして見る様にすることが可能である。ここで、接続可能なシステム外部のＷｅｂサイトは医療機器としての要件を満たす必要がある。
　この様なシステム外部のＷｅｂサイトと接続することにより、各種疾病の自助グループ（例えば薬物依存症患者のための自助グループ）に参加することと同等な効果を得ることが出来て、治療続行のためのモチベーションをあげることが出来る。
　次に、主として図６、図７を参照して、システム１００による診断・治療・予防等（医療）を実行する手順を説明する。図６、図７を説明するに際して、患者（当事者：ユーザー）の疾患が心因性ＥＤである場合を想定する。
　最初に図６を参照して、患者が初めてシステム１００にアクセスする場合を説明する。
　図６において、ステップＳ１では、患者側の情報処理端末３からシステム１００に対してログインされたか否かを判断し、以て、患者がシステム１００を利用するか否かを判断する。ステップＳ１において、患者側からログインがあった場合（ステップＳ１が「Ｙｅｓ」）はステップＳ２に進み、ログインがなければステップＳ１に戻る（ステップＳ１が「Ｎｏ」のループ）。
　図６では明示されていないが、ステップＳ１では、ログイン・認証パート１０Ｈにより、例えば発行されたＩＤとパスワードによりアクセスしてきた患者の本人確認を行う。図示はされていないが、複数回アクセスをしている患者に対してアクセスする回数や最初にアクセスしてからの期間（治療期間）を設定して、設定した回数や期間を超えた場合には非アクティベートすること、或いは、アクセスに制限を掛けることも可能である。
　また、図示されてはいないが、ログイン認証に際して、ＩＤとパスワード入力の他に、患者の顔、音声（声紋）、網膜、虹彩等を患者本人固有の生体情報を、例えば患者側の情報処理端末３がスマートフォンやＰＣであればそのカメラ等を用いて撮影（取得）して、当該生体情報を用いて本人認証を行うことが出来る。この様な生体情報の取得は、ログイン時のみならず、患者のデータを入力（取得）する際であれば可能である。係る生体情報を取得して患者本人の認証を行うにより、所謂「成りすまし」やアカウントの譲渡を防止することが出来て、患者から入力或いは取得されるデータの信頼性を確保することが出来る。
　ステップＳ２（患者からログインされた場合）では、ログイン・認証パート１０Ｈにより、患者側が入力したＩＤ、パスワードに基づいて患者の認証を行う。そしてステップＳ３に進む。
　図６では明示されていないが、ステップＳ２で認証された患者は、ステップＳ３以降を実行することなく、直ちにステップＳ１１３（後述）に進むことが可能である。
　ステップＳ３では、アクセスしてきた患者に主訴、現病歴、既往歴等（インテーク情報）を入力せしめ、それと共に、心因性ＥＤの評価（例えば、「また失敗するのではないかと考え始めると、そのことで頭がいっぱいになる」、「勃起を維持できるのかが気になり、性行為に集中できない」）、操作的診断基準に基づいて問診（例えば、ＤＳＭ−５及びＩＣＤ−１０に準拠した精神疾患簡易構造化面接法によるチェックリスト形式の質問）を実行する。そしてステップＳ４に進む。
　ステップＳ４では、診断横断的アセスメントパート１０Ａ１により、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントして、アクセスしたユーザー（患者：対象者）の心理的柔軟性をアセスメントする（診断横断的アセスメント）。図示の実施形態では、診断横断的アセスメントは疾患特異的アセスメントに優先して行われる。
　ステップＳ４の診断横断的アセスメントの後、ステップＳ５において、ステップＳ３における入力、問診の結果として、疾患特異的な兆候の有無を判定する。疾患特異的な兆候が無い場合（ステップＳ５がＮｏ：例えば健常者の場合）にはステップＳ７に進む。
　一方、疾患特異的な兆候があれば（ステップＳ５がＹｅｓ）、ステップＳ６に進む。
　ステップＳ６では、疾患特異的アセスメントパート１０Ａ２により、特定の疾患について上述したスキルが発揮されるか否かをアセスメントする（疾患特異的アセスメント）。
　ステップＳ６の疾患特異的アセスメントの後、ステップＳ７に進む。
　ここで、ステップＳ３において健常者であると判断された場合には、直ちにステップＳ７に進み、健常者に該当するクラスタに分類することも可能である。
　ステップＳ７では、分析ブロック１０Ｂ１において、診断横断的アセスメントの結果について（例えば）クラスタ分析を実行し、或いは、疾患特異的アセスメントの結果について（例えば）クラスタ分析を実行する。
　そしてステップＳ８では、分類ブロック１０Ｂ２において、クラスタ分析の結果から、診断横断的アセスメントのクラスタ分析に基づいて患者を該当するクラスタに分類すると共に、疾患特異的アセスメントのクラスタ分析に基づいて患者を該当するクラスタに分類する。
　診断横断的アセスメント或いは疾患特異的アセスメントにおいて、例えば心因性ＥＤの場合には、従来９つの評価指標を用いていたが、発明者の研究の結果、心因性ＥＤの場合におけるクラスタ分析は、３つの指標のみを用いて行うことが出来ることが判明した。当該３つの指標は「ＥＤにおける心理学柔軟性」ＡＦＱ−ＥＤ、「パートナーとの性に関するコミュニケーション」ＳＲＱ、「全般的な心理的柔軟性」ＰＦＱである。
　患者を該当するクラスタに分類したならば、リンク付けブロック１０Ｂ３において、分類された患者のクラスタに対して有効な治療モジュールを（リンク付けて）決定する（ステップＳ９）。そしてステップＳ１０に進む。
　ステップＳ７~Ｓ９は、モジュール選択パート１０Ｂにおいて実行される。
　ステップＳ１０において、（治療モジュールを決定された）当該患者は、この時点でシステム１００からログアウトするか否かを判断する。
　患者が、第１回目のアクセスとして治療モジュールの提示で満足するのであれば（ステップＳ１０がＹｅｓ）ログアウトして、当該患者について１回目のアクセスは終了する。当該患者が再度アクセスする（２回目以降のアクセスを行う）場合については、図７を参照して説明する。
　患者が治療モジュールの提示のみならず、提示された治療モジュールの実行を求めるのであれば（ステップＳ１０がＮｏ）、治療モジュールパート１０Ｃにより、モジュール選択パート１０Ｂで選択された治療モジュールを実行する（ステップＳ１１）。この実行の態様は、治療モジュールの内容により異なる。
　実行後、ステップＳ１０に戻る。
　図示されていないが、ステップＳ１１（及び図７を参照して後述するステップＳ１６）において、患者のクラスタに対応して提示された治療モジュールの治療プログラム（エクササイズやワーク等）、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報の一部を患者側端末３に送信することが出来る。患者側端末３に治療プログラム、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報の一部を送信することにより、ネット環境が整っていない場所で、或いはオフラインで、当該患者は治療プログラムを実行できる。そのため、例えば通信・ネット環境の不具合発生時や、治療が終了してシステム１００にアクセスできなくなった場合（非アクティベート化された場合）でも、当該患者は治療モジュールで行われたエクササイズやワーク（例えば注意訓練のための音声等）、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報の一部を引き続きオフラインで実行・閲覧することで治療の中断を防止し、また、治療効果の持続と再発予防に役立てることが出来る。
　オフラインで行われたエクササイズやワークアウト、ホームワーク、Ｔｉｐｓ、利用者の統計データ、利用者の利用状況、利用者の回答例等の情報について、介入の記録としてシステム１００側で記録されないため、適切な評価が出来なくなることを防止するために、オフラインで行われたエクササイズやワークアウトについてシステム１００側に送信することが可能である。
　治療モジュールを実行する際に、実行した治療モジュールの記録を音声入力可能に構成することが出来る。
　治療モジュールを実行したならば（ステップＳ１１）、診断横断的（心理的柔軟性）測定指標と疾患横断的測定指標、既存の評価尺度等により、介入の効果を測定する（ステップＳ１１１：評価）。介入の効果を測定した後、医師・患者に対してフィードバックする（ステップＳ１１２）。フィードバックに際しては、患者側の端末３やウェアラブル機器等を用いて患者の日常生活下データを取得して、記録することが出来る。これにより介入前後の効果測定の結果をグラフ等によりレポート形式に表現して、医師・患者に対してフィードバックすることが可能である。そして、所定の回数や期間毎に、治療モジュールと、それによる変化（介入による評価指標の変化、日常生活下データの変化等）が理解できるような報告（レポート）を作成して、医師や患者に提示することが出来る。
　フィードバック（ステップＳ１１２）に際して、「前回のワーク、エクササイズでは○○でした。」という様なメッセージを治療用アプリ側から患者に送信することが出来る。
係るメッセージを受信した患者は「自分のことを忘れていない」、「注目されている」という様な印象を持ち、係る印象は当該患者が治療用アプリを継続する意欲を高めることが出来る。
　また、フィードバック（ステップＳ１１２）に際して、表情による感情認識ＡＩを用いることにより、患者の感情やストレスの度合いを客観的に判断することが出来る。
　さらに、脈拍センサー、体温センサー等を内蔵したイヤホンを患者が装着すれば、雑音で音声が聞こえない環境下であっても、日常性下データ、特に脈拍の様に音声、振動により検出される日常生活下データが取得できる。同様に、体温のデータも取得できる。フィードバックに際しては、その様に取得された脈拍データや体温データにより、患者の感情変化やストレスを判定することが可能である。
　図示の実施形態において、日常生活下データを活用して、アクセプタンス＆コミットメント・セラピー（ＡＣＴ）における「心理的柔軟性」や「マインドフルネス」の程度を可視化することが出来る。
　日常生活下データとして、例えば、患者の胸部にセンサーを貼り付けて心拍を測定し、自律神経機能のバランスを示すパラメーターであるＬＦ／ＨＦ（低周波ＬＦと高周波ＨＦのパワーの比率：交感神経と副交感神経の全体のバランスを示す）を計算して、自律神経の状態を提示することが出来る。ここで、患者の胸部に貼り付けるセンサーとしては、公知、市販のものを使用することが出来る。当該センサーで測定されたデータは患者側の情報処理端末３にデータとして送信され、蓄積される。計測された心拍のデータから求めたＬＦ／ＨＦを、当該患者におけるＬＦ／ＨＦの傾向と比較することにより、当該時点における患者の自律神経のバランスに異常があるか否かを判定し、治療の効果を確認することが出来る。
　また日常生活下データとして、ホルモン／ストレスレベルを計測して評価指標に用いることが出来る。例えば唾液中のコルチゾール、アミラーゼをセンサーで計測して、患者側の情報処理端末３にデータとして送信する。或いは、センサーによりドーパミンやセロトニンの血中濃度を計測して患者側の情報処理端末３に送信して、治療の効果の指標とすることが出来る。セロトニンについては、脳波測定器を用いてα波を特定することにより計測することも出来る。
　ここで、日常生活下データとして、脳波に代えて脳血流を測定することが出来る。例えば、右前頭極の過活動が自己注目と関連するので、右前頭極の脳活動を、脳血流（ＮＩＲＳ）センサーにより計測して、予期不安や自己注目の指標とすることが可能であり、自意識過剰になっている状態をリアルタイムで検出することが可能である。
　さらに、会話の回数、頻度、会話を行った時間、会話における情報量の様な物理量及び情報量であるコミュニケーション量をスマートフォン（ＰＣ、タブレットでも可能）で計測して、日常生活下データとして用いることも出来る。コミュニケーション量の計測方法として、スマートフォン等のデバイスに組み込まれたＩＣチップを検知して、当該ＩＣチップと近接した回数、近接した時間を自動的に計測することも可能である。
　日常生活下データとして、ウェラブル機器等で取得することが出来る生理学的データであるデジタルバイオマーカーを取得し、蓄積することにより、疾患の発症予測や状態把握・管理等に利用し、アセスメントの精度を向上させることが可能である。そして、よりパーソナライズされた最適な治療法を提案／提供することが出来る。さらに、機械学習やＡＩを用いたアルゴリズム開発におけるビッグデータとなり得る。
　このビックデータを活用し、例えばＡＩを用いることにより、疾病の予測が可能であり、当該予測に基づいて予防対策を構築することも出来る。そして、疾病罹患を予防するための介入が可能である。或いは、ビックデータをＡＩで分析し、その分析結果に基づいて、個々の患者の個性、疾病の程度等に合致した内容（個々の患者に合った内容）の治療用アプリ、すなわち、患者毎にカスタマイズされたアプリを提供することが可能になる。
　ここで、患者側の情報処理端末３（例えば、スマートフォン、ＰＣ、タブレット、ウェラブルデバイス等）に日常生活下データを記録する「生活記録表」としての機能を持たせることが出来る。従来、患者は、紙媒体に日常生活下データを記録していたが、「生活記録表」に対して電子的に日常生活下データを記録することにより、スマートフォン、ＰＣ、タブレット、ウェラブルデバイス等を操作する平易性に起因して、日常生活下データをリアルタイムで記録することが可能になる。紙媒体に記録する場合、一定期間が経過した時点で当該期間の生活下データを纏めて記録する傾向があり、その結果、バイアスが掛かる可能性（事実や実際に感じたものとは異なる内容を紙媒体に記入する可能性）がある。患者側の情報処理端末３に日常生活下データをリアルタイムで電子的に記録することにより、その様なバイアスや虚記憶の想起を防止して、紙媒体への記録よりも適切で妥当な日常生活下データを保存することが出来る。
　上述した様に、本発明では、日常生活下データを活用して、アクセプタンス＆コミットメント・セラピー（ＡＣＴ）における「心理的柔軟性」や「マインドフルネス」の程度を可視化することが出来る。日常生活下データにおける心理データの例として、例えば、生態学的瞬間評価（ＥＭＡ）の手法を用いて、毎朝、毎晩、その時の気分や感情、思考をその場でその時その瞬間に回答してもらうことが挙げられる。その場でその時その瞬間に回答してもらう（リアルタイムに回答してもらう）ことにより、記憶にバイアスが掛かることを防止出来る。ここで、回答のタイミングとしては、「毎朝、毎晩」を例示したが、定時に限定される訳ではなく、一定の時間帯（例えば、朝は７時~８時、晩は１９時~２２時）の中でランダムにリマインダ通知が送信されることで、回答を促すことが出来る。
　なお、生態学的瞬間評価（ＥＭＡ）の手法は、心拍数、血圧、血中酸素濃度、歩数、睡眠時間や睡眠の質（眠りが深い・浅い等）、活動量、行動範囲（行動履歴：例えばＧＰＳにより計測・取得）、血糖値等の生理データにも適用される。
　ステップＳ１１１における評価に際しては、例えば、患者が（介入の効果の）測定指標の回答を入力するが、その際に、入力までの時間を記録し、心拍数や血圧を測定し、例えば患者側端末３がスマートフォンやＰＣである場合にはそのカメラを用いて患者の瞳孔開閉の様子や視線の向きや瞬きの回数を計測し、呼吸の回数や体温を計測し、或いは、顔色を観察して、指標入力時における客観的な情報をモニタリングすることが出来る。以て、回答の精度や回答者の状態を客観的にモニタリングして、例えば、回答者である患者が測定指標をいい加減に入力したことや、「改善された」という結果を得るために偽りの入力をすること、ストレスが掛かること等を抑制することが出来る。さらに、心拍数、血圧等を計測することが可能である。
　ここで、患者が音声により回答をした場合等において、ＡＩにより患者の音声を解析、判断して、患者が治療に真剣に取り組んでいるか否かを判定し、或いは、患者の真剣さの度合い（患者の本気度）を判定することが可能である。
　図示はされていないが、匂いセンサー、脳波センサー、脳血流センサー等のデバイスを装着し、当該センサーにより回答者の客観的な情報を取得し、回答者の心身の状態を計測して、クラスタ分析の際の要因とすることも可能である。
　ステップＳ１１１における介入後の評価に応じて、自動的に、患者に対してホームワークを指示することが出来る（ステップＳ１１３）。ステップＳ１１３においては、介入後の評価に応じて、自動的に、次回の介入（システム１００へのアクセス）を提案或いは指示することが出来る。これにより、改善するまでアクセスを繰り返す様にせしめることが出来る。また、ステップＳ１１３において、システム１００にアクセスした患者は、治療に関連する或いは治療に役立つ動画や音楽、音声、その他のコンテンツ（例えばマインドフルネス瞑想）を順次視聴することが可能である（Ｔｉｐｓ）。Ｔｉｐｓでは、マインドフルネス瞑想、香り、音楽、映像、振動、好ましい食品／食事の情報等のコンテンツを提供する。この様なコンテンツは、五感を使うことにより治療効果とその持続、満足度を表す指標であるＱＯＬの向上をもたらす。
　上述した通り、ステップＳ２で認証を行った患者は直ちにステップＳ１１３に進んで、コンテンツの視聴を行うことが出来る。
　ステップＳ１１３の後、ログアウトする（ステップＳ１１４）。ログアウト後、実際に通院する際には、システム１００における介入や評価の記録、取得された日常生活下データを（医師が）参照しつつ、医師による診察／面接が行われる。
　次に図７を参照して、２回目以降のアクセスの場合について説明する。
　ステップＳ１、Ｓ２は図６で説明したのと同様である。前述したように、ログイン・認証パート１０Ｈは、例えば処方ＩＤとパスワードを発行し、アクセスしてきた患者の本人確認を行う。図示はされていないが、例えば予め患者本人の同意を取り付けて、アクセスする回数や最初にアクセスしてからの期間（治療期間）を適宜設定して、設定した回数や期間を超えた場合には非アクティベートすることが可能である。非アクティベートしてシステム１００へのアクセスが出来なくなったとしても、担当医師の指示により、患者は再度システム１００にアクセスすることが可能である。
　そしてステップＳ１３に進み、図６で説明したステップＳ３、Ｓ４、Ｓ６（問診、診断横断的アセスメント、疾患特異的アセスメント）を実行する。そして、ステップＳ１４に進む。図示されていないが、ステップＳ２で認証された患者は、ステップＳ３以降を実行することなく、直ちにＳ１１３（ホームワーク、Ｔｉｐｓ）に進むことが可能である。
　ステップＳ３において、については第１回目のアクセスの際と同様な内容になると予想されるので、入力を省略することが可能である。
　ステップＳ１４では、問診、診断横断的アセスメント、疾患特異的アセスメントを参照して、評価パート１０Ｄは患者が改善しているか否かを判断し、診断横断的（心理的柔軟性）測定指標と疾患横断的測定指標により、以前の介入の効果を測定する。ステップＳ１４においても、患者側の端末３やウェアラブル機器等を用いて日常生活下データを取得して、記録して、介入前後の効果測定の結果をグラフ等によりレポート形式に表現して、医師・患者に対してフィードバックすることが可能である。
　評価パート１０Ｄで改善したと判断された場合には（ステップＳ１４がＹｅｓ）、ステップＳ１５に進む。
　改善していないと判断された場合には（ステップＳ１４がＮｏ）、ステップＳ１６に進む。ステップＳ１６では、前回のアクセスの際に提示された治療モジュールを実行する。
　図７では明示されていないが、図２を参照して説明したように、患者が直ちに治療モジュールの実行を望む場合には、ステップＳ２で認証された後、ステップＳ１３、Ｓ１４、Ｓ１６を飛び越えて、直ちにステップＳ１６に進むことが可能である。
　改善していないと判断された場合において（ステップＳ１４がＮｏ）、所定の期間や回数だけ選択された治療モジュールを繰り返していても改善しないと判断されれば、モジュール選択パート１０Ｂにおいて、第１回目のアクセスで選択されたその他の治療モジュールが提案される。
　或いは、ステップＳ１３の診断横断的アセスメント、疾患特異的アセスメントに基づいて、モジュール選択パート１０Ｂで新たに治療モジュールが提案される。
　ステップＳ１７では、患者はシステム１００からログアウトするか否かを選択する。ログアウトしない場合には治療モジュールを続行する（ステップＳ１７がＮｏのループ）。
　ステップＳ１５（ステップＳ１４がＹｅｓの場合）に、患者はシステム１００からログアウトして、ステップＳ１８に進む。
　ステップＳ１８では、例えば評価パート１０Ｄにおいて、経過観察が必要か否かを判断する。その際、評価パート１０Ｄでは、問診やインテーク、診断横断的アセスメント、疾患特異的アセスメントに基づいて、再発の可能性が判断される。そして、再発の可能性が有る場合（ステップＳ１８がＹｅｓ）、所定期間経過後、システム１００側から患者側の情報端末にアクセスして、所定事項の問診等により経過観察が実行される（ステップＳ１９）。
　図６、図７では示されていないが、患者に対して、定期或いは不定期に治療用アプリ使用を促すリマインド通知や励まし等のメッセージを送信すること、ゲーム的な要素を応用することも可能である。さらに、システム１００にアクセスすることについて患者に何かしらの報酬を与えることも可能である。そして、システム１００にアクセスして治療用アプリを積極的に実行しようとする動機付けを高め、治療を継続する（治療用アプリを継続使用する）という「正」の行動を強化することが可能である。
　これ等により、患者の継続使用の意欲（システム１００にアクセスして治療モジュールを実行し続けたいという意欲）を高めて、治療途中でシステム１００にアクセスしなくなる（治療途中で脱落する）事態を抑制し、システム１００による治療効果（或いは治療用アプリの効果）を向上する。
　図示はされていないが、診断横断的アセスメント、疾患特異的アセスメント、治療モジュール（治療プラグラム：エクササイズ）、ワーク、ホームワーク、Ｔｉｐｓ、評価等を実行するに際して、スマートスピーカー等を用いて、音声による質問項目の読み上げ、指示、ガイダンスその他に対して、患者が音声により入力し、記録し、応答すること等を可能にして、音声により相互に作用する機能（インタラクティブな機能）を発揮する様に構成することが可能である。
　また図示の実施形態においては、サーバー１０に対して、疾病に対応したカスタマイズ、患者側のアプリケーションに対応させるカスタマイズ等を行うことが可能である。カスタマイズの手法については、公知技術を適用可能である。
　明確には図示されていないが、図示の実施形態において、患者の服薬等の治療・行動を記録して、当該記録を医師がチェックすることが出来る。そのチェックは、医療機関側の情報処理端末４を介して行うことも出来るし、或いは直接、医師がチェックすることが出来る。
　患者の治療・行動の記録を行うために、図示の実施形態では、例えば、患者側の情報処理端末３にカレンダー機能がインストルールされ、カレンダーの各日付に患者の服薬（治療）の記録や、行動記録（例えばＥＤ患者であれば性行為に関する記録）を記載できるように構成することが可能である。そして、カレンダーの各日付の記録を、医師がチェックすることが出来る。
　また、図示の実施形態において、所定期間（例えば２週間）毎に医師による診察（患者が医療施設に通院して診察する場合、システム１００に設けられたオンライン機能による診察を行う場合を含む）を実行し、当該患者の状況に対応して、治療方針や治療に用いられる薬剤の処方、ワークのセット等を決定することが出来る。その際に、改めてアセスメント（診断横断的アセスメント、疾患特異的アセスメント）を実行し、クラスタ分析に基く特定の集団への分類を行い、患者に提供するワーク等を新たに設定することが出来る。そして、改めて実行されたアセスメントの結果を、診察に活用することも可能である。
　患者が属する特定の集団（例えばクラスタ１）を変更せず、日常生活下データ、ＥＭＡの変化に対応して、治療方針、処方、ワーク内容等を変更することが出来る。
　所定期間毎に医師による診察を行い、新たなワークを提供することにより、患者毎にパーソナライズされた治療を提供することが出来る。これにより、最適な治療を提供出来る。
　なお、医師による診察、新たに設定された治療方針、薬剤の処方、ワークのセット等については、データベース１０Ｆ等に記録することが出来る。
　図示の実施形態のシステム１００によれば、患者の治療に際して、日常生活下データを活用しながら、心理社会的問題、生活適応やストレス等に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする診断横断的アセスメントと、疾患の特定を行い、当該疾患に特徴的な症状に対して、患者がどの程度適応的に行動できているのか、或いは非適応的に行動しているのかをアセスメントする疾患特異的アセスメントの結果に基づいて、その患者に最適な治療モジュールを提供することが出来る。
　そして、選択された治療モジュールを実行した後、評価尺度を適用して治療効果の評価を評価パート１０Ｄにより実施し、評価結果を患者にフィードバックすると共に、治療効果について良好な評価がされない場合には、評価結果をモジュール選択パート１０Ｂに送信し、モジュール選択パート１０Ｂで新たな治療モジュールが選択される。例えば、疾患特異的アセスメントの結果に基づいて選択された治療モジュールには効果が低かった場合に、診断横断的アセスメントの結果に基づいて選択された治療モジュールを提案することが可能である。
　ここで、患者側の端末３やウェアラブル機器等を用いて患者の日常生活下データを取得し、記録して、介入前後の効果測定の結果をグラフ等によりレポート形式に表現して、医師・患者に対してフィードバックすることも可能である。
　診断横断的アセスメントパート１０Ａ１と疾患特異的アセスメントパート１０Ａ２とを併せ持つプラットフォームを構成する図示の実施形態では、「結果」ではなく、プロセスに着目する。例えば、心因性ＥＤの患者であれば、「勃起しない」という症状が改善したか否かよりも、当該患者の心理社会的プロセスの段階が進み、心の柔軟性が向上したか否かに着目する。心理社会的プロセスの段階が進み、心の柔軟性が向上すれば、新しい行動パターンの獲得、学習が行われたことになり、上述の心因性ＥＤの患者であれば、「勃起しなくとも大丈夫」、「パートナーとの付き合いは性行為が全てではない」と考え方の幅を広げることが出来て、その結果、心因性ＥＤが治癒される。
　そして図示の実施形態によれば、最適な治療モジュールを提供し以てプロセスベースドＣＢＴによる治療を実行することで、患者毎、或いは疾患の種類毎にカスタマイズした上で一定の効果を上げることが可能である。そして、診断横断的なアセスメント、疾患特異的なアセスメントが量的測定指標を用いて実行されてクラスタ判定を行われることにより、治療のパーソナライズ化、最適化が図られる。例えば、うつ病、不安症、生活習慣病、慢性疼痛、性機能障害、心因性勃起障害（ＥＤ）、各種依存症等に対して、治療効果を発揮することが出来る。また、これらの疾患が合併していても治療効果を発揮することが出来る。
　図示の実施形態のシステム１００を適用することにより、心理社会的問題、生活適応やストレス等に対して、患者が適応的に行動できていれば、血圧が安定し、血流が改善され、自律神経が調節されて免疫力が向上する。そのため、上述した様なサーバー１０を有する実施形態のシステム１００は、コロナウィルス等の感染症の予防に対しても適用可能である。
　それに加えて図示の実施形態では、量的測定指標や客観的なモニタリング手法、クラスタ分析を用いることが出来るので、第三者に対してプログラムのアルゴリズムを明確に説明することが可能であり、実際の結果による証拠とすることが容易である。そのため、各種承認に必要なデータを用意することが容易になる。
　図示はされていないが、図示の実施形態に係るシステム或いは方法を、複数名で一緒に使用することが可能である。例えば、ＥＤや不妊症（男性、女性）の患者におけるパートナー、うつ病や不安障害の患者における家族や援助者等が治療等に必要な情報やコンテンツを患者と共有し、治療モジュールに係るエクササイズを患者と共同で実行することで患者と伴走し、疾患や援助の仕方についての理解と実践を深めることが出来る。これにより、患者が積極的に治療方針の決定に参加し、その決定に従って治療を受けて（アドヒアランス）、治療効果の向上を図ることが出来る。
　図示の実施形態はあくまでも例示であり、本発明の技術的範囲を限定する趣旨の記述ではないことを付記する。
　例えば、図示の実施形態では主として心因性ＥＤ治療を例示しているが、本発明は、配偶者またはパートナーとの関係性の問題、うつ病、強迫症、パニック症、広場恐怖症、全般性不安症や社交不安症やスピーチ不安、限局性恐怖症、心的外傷後ストレス障害、不眠症、過敏性腸症候群、摂食障害と肥満、肥満その他の生活習慣病、双極性障害、境界性パーソナリティー障害、注意欠如・多動症、慢性または持続性疼痛、性機能障害、勃起障害以外の配偶者またはパートナーとの関係性の問題、アルコール依存その他の各種依存症、統合失調症及び他の重度精神病、不妊症（男性、女性）、アトピー性皮膚炎、過活動膀胱（尿失禁）、アンチエイジング、更年期障害、月経前症候群（ＰＭＳ）、心因性視覚障害、歯科心身症、醜形恐怖症等に対して、またこれらの疾患が合併していても適用可能である。
　そして図示の実施形態では、複数の合併する疾患症状／状態のアセスメントが可能であり、パーソナライズされた最適な診断横断的治療法を提案或いは提供することが出来る。例えば、心因性ＥＤのアプリにおいて、抑うつ、不安、糖尿等の合併傾向もアセスメントすることが出来る。或いは、複数の不定愁訴から更年期障害のアセスメントが出来る。
（心因性疾患・心身症・ストレス関連疾患用の治療用アプリの例（不安症治療用アプリ））
　システムの構成およびアセスメントの実施手順、ＥＭＡ等の情報の収集や、医師及び患者の情報のやり取りなどは前述の治療用アプリと同様に行うことができる。
　本発明の実施に際して、例えば社交不安の場合における特定の集団の分類（クラスタ分析）には、２つの指標「リーボヴィッツ社交不安尺度」ＬＳＡＳ−Ｊ、「全般的な心理的柔軟性」ＰＦＱを用いることができる。
　これらの指標の評価結果に基づいてクラスタ分析を行い、例えば、下記のクラスタに分類する。
　クラスタ１：極端に高い基準（完璧に流暢に話さなければならない、知的で気の利いた人に見られなければならない）、クラスタ２：条件付き信念（ＸであればＹとなる）（もし違うことを言ったらバカにされる、不安になっていることに気づかれると悪く思われる、私に対する興味がなければ人は自分のことを私に話さない）、クラスタ３：無条件の信念（私はつまらない、浮いている、変わり者である、私は怪しい）
そして、前述の治療用アプリと同様に上記クラスタに応じたワークが患者に提供される（各種アプリの統合データベース）
　図８に統合データベースの例を示した。図８（Ａ）において、治療用プラットフォーム９０１、ＥＤ治療用アプリ群９１１，不安障害治療用アプリ群９１２、インターネット９５０、管理サーバ９３１、図８（Ｂ）において、治療用プラットフォーム９０２、ＥＤ治療用アプリ群９１１，不安障害治療用アプリ群９１２、インターネット９５０、ＥＤ治療用アプリ９１１の管理サーバ９３２、不安障害治療用アプリ群９１２の管理サーバ９３３、管理サーバ９３２と管理サーバ９３３のデータを統合制御するための統合サーバ９３４が含まれる。ここで、例として二つの治療用アプリがプラットフォームに含まれる例を示したが、治療用アプリの数はこれに限定されるものではなく、また、共通のデータを含むものであれば治療用アプリだけでなく、メンタルヘルスケアアプリ等もプラットフォームに加入することができる。
　それぞれの治療用アプリ群には、それぞれの治療用アプリを実施可能な情報処理端末とそれを利用する患者等が含まれる。図８（Ａ）は複数の治療用アプリを集中して管理する管理サーバが設けられるケース、図８（Ｂ）は治療用アプリごとに管理サーバが設けられるケースで、それぞれの管理サーバの共通データを利用可能とする制御を行う統合サーバが設けられている。統合サーバ９３４は、例えば、管理サーバ９３２の共通データを管理サーバ９３３の呼び出しに応じて利用可能に、または、その逆に利用可能としている。あるいは、管理サーバ９３２と管理サーバ９３３の共通データを統合サーバ９３４に記憶するようにし、異なる管理サーバのデータを共有可能としている。
　図９には治療用プラットフォーム９０１の管理サーバ９３１に含まれる患者と評価値等のデータを示した。ここで、参照数字１０１，１０２，１０３，２０１，２０２は患者番号を示し、１０１，１０２~はＥＤ治療用アプリの利用者から取得したデータ、２０１，２０２~は不安障害治療用アプリの利用者から取得したデータを示している。指標やＥＭＡデータについては一例にすぎず、他の指標や、ＥＭＡ、その他のデータが含まれるように構成してもよい。図８に図示した場合においては、指標Ａが複数のアプリに関して共通の認知行動療法に基づく診断横断的な尺度の入力結果を示し、指標ＢはＥＤ，指標Ｃは不安障害症といった、それぞれの疾患に特有の尺度の評価結果を示している。また、ＥＭＡ＿Ａは日常生活下データとして体温を計測した結果、ＥＭＡ＿Ｂは日常生活下データとして血圧を計測した結果を示している。
　本実施例では、この共通の尺度である指標Ａの評価結果をＥＤ治療用アプリおよび不安障害治療用アプリの両者で共用することを特徴とする。従来はそれぞれのアプリごとにデータ管理が行われていたが、本発明は共通したデータを持つアプリのデータの共通部分を共用できるようにしたことを特徴とする。
　図１０は共通部分を利用したクラスタ分析の例を示す。図１０（Ａ）はＥＤ治療用アプリのクラスタ分析の一例、図１０（Ｂ）には不安障害治療用アプリのクラスタ分析の一例を示した。図１０（Ａ）に示した、ＥＤ治療用アプリでは、患者に対して指標Ａと指標Ｂの入力を患者の情報処理端末を介して則す。次に、管理サーバで入力から評価結果を算出する。続いて、管理サーバでは（１）指標Ａの評価結果が３０未満の場合はタイプＡと、（２）指標Ａの評価結果が３０以上の場合、さらに、指標Ｂの評価値を比較し、４０未満の場合はタイプＣと、４０以上の場合はタイプＤとタイプ分けする。図１０（Ｂ）に示した、不安障害治療用アプリでは、患者に対して指標Ａと指標Ｃの入力を患者の情報処理端末を介して則す。次に、管理サーバで入力から評価結果を算出する。続いて、管理サーバでは（１）指標Ａの評価結果が３０未満の場合はタイプＡと、（２）指標Ａの評価結果が３０以上の場合、さらに、指標Ｃの評価値を比較し、２０未満の場合はタイプＥと、２０以上の場合はタイプＦとタイプ分けする。
　ここで、指標Ａに基づいてタイプ分けされたタイプＡおよびタイプＢと、そのタイプに応じて処方されたその治療モジュール（ワーク）との治療効果のフィードバック結果を評価して、例えば、治療効果が低かった場合に、閾値を３０から３５に変えるなど、指標Ａの評価結果と、タイプと治療効果の相関関係に応じて指標Ａの評価値のクラスタ分析の際の閾値を変更することができる。ここで、タイプＡとタイプＢに処方されるワークが同一でなくても、類似したワーク等を処方されたものである場合、その閾値を双方のフィードバック結果を用いて変更することができる。つまり、従来のようにアプリごとのデータに基づいて評価値の閾値を変更する場合に比較して相関関係のデータ数が多くなり、数値をより最適化することができる。
　本実施例では単純に共通するデータと、治療効果の観点から、統計解析の閾値の最適化をすることを示したが、例えば、関連する診断横断的な指標に基づく尺度と、治療効果などの関係を、特にＡＩを利用して分析することも可能である。ここで、統計解析にはＡＩによる分類も含まれる。
　上述の実施例ではタイプ分け（パーソナライズ化）のクラスタ分析の最適化に異なる疾患に用いられる尺度の共通データを用いる例を示したが、それぞれのタイプへの処方の最適化に用いることもできる。図１１に管理サーバに保存されている、タイプと処方の対応関係の一覧を示した。アセスメントブロックで症状・要因のタイプ分けが行われ、この一覧に応じて処方（ワーク）が提供される。図１１（Ａ）は元々、管理サーバに記憶されていたタイプと処方されるワークの対応表である。ここで、疾患の症状（あるいは要因）としてタイプＡの修正を例として説明する。前述の図１０で示したタイプ分けが行われるケースで、タイプＣ、タイプＤ、タイプＥ、タイプＦにタイプ分けされたものをまず参照する。指標Ａの評価値が比較的高い２５~３０のもので、タイプＣとタイプＥ（いずれもワーク３が含まれる）の治療効果が低い場合、指標Ａの評価値が高い群に対してのワーク３との治療効果が低いとし、一方でタイプＤとタイプＥを比較した際にタイプＤのほうが治療効果が高いとき、ワーク３よりもワーク５のほうが指標Ａの高値と相関が高いと判断され、対応表が更新され図１１（Ｂ）のようにされ、以後、それぞれのタイプの処方は更新された対応表に従って行われる。ただし、治療効果が下がった場合に元に戻すことも検討される。本実施例では認知行動療法においてはタイプに応じて共通のワークが提供されるので相関がとりやすく都合がよい。
　上述の説明では、管理サーバにアセスメントの機能を果たすブロックやデータベース等を持つものとして説明をしてきたが、システムのいずれかにこれらの機能があればよく例えばすべての機能をスマホに搭載させるようにしてもよい。また、電子カルテや健康診断などのヘルスケアプラットホームのデータベースと連携させ、それらに含まれる検査結果や治療データや健康状態を個人のデータとして追加して、分析に用いても良い。これらに優位なデータを選択したりする観点からもＡＩを用いると都合がよい。また、これらのデータベースを統合データベースとして利用してもよい。
　心因性疾患・心身症・ストレス関連疾患は複数の心因性疾患・ストレス関連疾患を併発することが多く複数な疾患症状を横断する尺度でアセスメントすることが有用で、特に認知行動療法ではその症状をもたらす認知・行動様式を特定するために診断横断的な尺度の利用が極めて有用である。そしてその共通である尺度を共有することでさらに疾患の理解、治療を向上することができるという効果が得られる。
（ＡＩを使った指標の作成方法）
　指標に用いられる文言と、治療効果との相関関係から、実際に治療効果と相関関係の強い文言を選択することによって効果的な指標を作成することができる。この相関関係についてはＡＩを使って行うことができる。ここで、指標とは主に文言を使った指標を意図しているが、視覚や聴覚を使った評価尺度も指標に含まれる。
（治療用アプリの適合性ルーチン）
　治療用アプリは患者の症状により適合性が異なっている。例えば、うつ病の患者であれば、自殺願望がある場合、治療用アプリ単独での利用は危険を伴ない、医師による治療との連携が好ましい。また、２年以上うつ病を患っている患者は、認知の歪みを改善するためにも薬物療法との併用が望ましい。軽度あるいは中程度の場合は、治療用アプリ単独での治療が効果的である、あるいは、器質性の疾患で精神症状が全く出ていない場合には、治療用アプリの利用が効果が期待できない、といったように、治療用アプリの適合性をアセスメントすることはうつ病に限られず、すべての心因性疾患および心身症の症状の改善、治療の安全性のために有効である。システムはデータベース１０Ｆに備えられたうつ病の尺度（うつ度チェック　簡易抑うつ症状尺度（ＱＩＤＳ−Ｊ）、０−５点、正常、６−１５点、軽度から中程度、１６点以上、重度）、ベッグ自殺念慮尺度（ＳＳＩ）を読み出し、それを制御装置１が患者側の情報処理端末３に送信する。図１２はこの適合性アセスメントのフロー図である。この例ではうつ病を例に示したが他の疾患でも適用できるのは言うまでもない。この例では、システムの制御装置１がユーザー端末を介して、ＱＩＤＳ−Ｊ、ＳＳＩ、およびうつ病歴をユーザーに提示し、ユーザーの回答を得たら、結果をシステムの制御装置１へ伝送して、解析し、まずＳＳＩの結果から自殺リスクの高い場合はシステムはユーザーに対して医療機関の受診勧奨を行う。次に、自殺リスクが高くない場合は、ＱＩＤＳ−Ｊの結果によって、うつ病の重症度を判定し軽・中度の場合は治療用アプリでの治療を開始する。また、重度の場合は図示しない医療機関端末と接続し、オンライン診療を行う、ここで、うつ病歴が２年以上であると、オンライン診療によって処方された薬物と治療用アプリの併用での治療を行う。ここで、薬物の服用履歴や服用計画などの服薬管理、オンライン診療の治療効果や治療スケジュール管理等を治療用アプリのシステムで行っても良い。この適合性アセスメントを前述のアセスメントと組み合わせ、あるいはその前に行うことによって改善効率を上げることができる。本アセスメントの詳細な実施方法は前述のアセスメントの手順や、公知の情報端末とユーザの入出力方法を参考に実現することができる。
　（治療用アプリに基づくプログラム）
　現在、多く流通している治療用アプリやメンタルヘルスアプリはその症状のみに着眼し、例えば、イライラしているときにイライラを解消する音楽を聴くといった手段のみを提供しているものが多い。こういったアプリでは一時的に症状を改善できる可能性はあるが、症状の原因を解消することはできない。本発明では、心因性疾患および心身症は、その患者の生物心理社会的要因に基づくという知見に基づき、複数のカテゴリ（リラクゼーション、ストレスマネジメント、認知の歪み改善、症状改善）の治療モジュールからなるプログラムを提供する。たとえば、最初に、診断横断的な治療用モジュールである、リラクゼーションのモジュール（斬新的弛緩法、腹式呼吸法、視覚的イメージ法など）を提供する、次に、ストレスマネジメントを改善するモジュール（行動振る舞いを振り返るワークなど）、次に、認知の歪みを改善するモジュール（シロクマ実験、認知再構成法など）を提供する、最後に、疾患特異的な治療モジュールである、症状を改善するモジュール（マインドフルネス、バイオフィードバック法、自律訓練法、自律神経を整える音楽、エクササイズなど）を提供するといったように、症状だけでなく、心因性疾患および心身症の原因に介入し、根治を目指す、あるいは治療の効率改善を目指すものである。そのために、システムはデータベース１０Ｆにこれらの治療用のモジュールと、疾患あるいはアセスメントによるクラスタと、それらに対応した治療用のプログラムセットの対応関係を記録した入りストを記憶しており、患者と患者の情報処理端末とのアセスメントを行った後、疾患やアセスメント結果に基づくクラスタに対応した治療用のプログラムセットを用いて治療を開始することができる。プログラムに含まれるカテゴリと、カテゴリの中の治療モジュールとは、いずれかを用いるかはあらかじめ治療効率等に基づいて設定されているが、上述のように組み替えることも可能である。上述の例は、診断横断的な治療モジュールと疾患特異的な治療モジュールの組み合わせの例を示しているが、例えば、複数種類の疾患特異的な治療モジュールを用いるなど治療効率を考慮して組み合わせは適宜設計できることは言うまでもない。
　（性格の考慮）
　治療用アプリは患者に対してある一定期間、決められた治療計画（本発明ではプログラム）にしたがって治療モジュールを実施することを要求するものである。しかしながら、患者の性格やアプリへの慣れによってその実施状況は異なることが問題となる。そこで、患者に対して性格判断を行い、その性格判断結果によって入出力方法やＵＩ／ＵＸ、治療プログラムを変化させると治療効率が向上する。具体的には、例えば、心理学研究の中で最も支持されている「ビッグファイブ理論」に基づく、性格診断テストを行い、その性格に応じて治療用モジュールを変化させる。
　例えば、上述の診断横断的アセスメントや疾患特異的アセスメントに先立って、あるいはそののちにこの性格診断を行い、クラスタをさらに性格で細分する。データベース１０Ｆにはクラスタに応じた治療用のプログラムセットを性格に応じて複数持っている。例えば、同じカテゴリに含まれる腹式呼吸法についても一つの治療モジュールだけでなく、ビッグファイブ分析で、外向性および開放性が高いユーザー向けには、ビジュアルを重視した動画に基づくモジュールで、あるいは、協調性および誠実性が高いものに向けては同じ内容を文章で細かく説明したモジュールとして提供する。このように、同じカテゴリの同じ効果を期待したモジュールであっても複数種類のものをデータベース１０Ｆに記憶し、前述のようなリストで、アセスメントによるクラスタをさらに性格判断によって細分化したものと、治療用のプログラムセットとの対応関係の記録させ、治療時にその対応するプログラムセットを提供することで治療を実現する。これによってさらに治療効率を向上させることができる。このリストの対応関係も治療結果によって更新することも可能で、また対応関係をＡＩによって修正することもできる。本アセスメントの詳細な実施方法は前述のアセスメントの手順や、公知の情報端末とユーザの入出力方法を参考に実現することができる。ここでは性格の違いによって同じ効果を期待した、異なる表現型のモジュールを提供することを例示したが、例えば、文字表示のモジュールを音声提供のモジュールに代えるといった表現方法が変更される他のものでもよい（この場合はユーザの視聴覚の障害などに対応したものである）。こういった点で複数の自律神経を整えるための異なる楽曲を記憶するものとは異なっている。
　（治療用アプリ・システムの機能モジュール例）
　本件発明で提供される治療用アプリのシステムで提供される治療用プログラムの機能モジュールの例を示したものである。（ａ）は、治療用プログラムが診断横断的アセスメントモジュールおよび疾患特異的アセスメントモジュールを含み、双方のアセスメントのための項目の患者からの回答に基づいて患者のクラスタ分けを行い、そのクラスタに応じた診断横断的治療モジュールおよび疾患特異的治療モジュールを提供するものである。（ｂ）は、治療用プログラムが疾患特異的アセスメントモジュールのみを含み、アセスメントのための項目の患者からの回答に基づいて患者のクラスタ分けを行い、そのクラスタに応じた診断横断的治療モジュールおよび疾患特異的治療モジュールを提供するものである。（ｃ）は、治療用プログラムが診断横断的アセスメントモジュールのみを含み、アセスメントのための項目の患者からの回答に基づいて患者のクラスタ分けを行い、そのクラスタに応じた診断横断的治療モジュールおよび疾患特異的治療モジュールを提供するものである。（ｄ）は、アセスメントモジュールを含まずに診断横断的治療モジュールおよび疾患特異的治療モジュールを提供するものである。これらのモジュールはソフトウェアとして構成され、サーバやユーザの情報処理端末で実現されるが、ソフトウェアではなく、それぞれの機能を持つハードウェアの組み合わせによって構成しても良い。また、それぞれの機能モジュールは完全にユーザの情報処理端末に含ませ、ユーザの情報処理端末がスタンドアローンで動作するものでも、それぞれの機能モジュールがサーバに含まれ、そのサーバと接続されたユーザの情報処理端末は表示や入出力のみに使われるもの、あるいは、機能モジュールをサーバとユーザの情報処理端末の双方に分けて含まれるものなどで実現できる。診断横断的アセスメントや診断横断的治療モジュールは典型的には心因性疾患や心身症に横断的にみられる精神的な特徴に向けられたものであり、疾患特異的アセスメントや診断横断的治療モジュールは、例えば、不眠症、月経随伴症状やＥＤなどの疾患に特異的な症状に向けられたものである。
　（アプリ切り出し）
　本実施例では、尺度の共有について説明する。図８（Ａ）治療用プラットフォーム９０１における、ＥＤ治療用アプリ群９１１，不安障害治療用アプリ群９１２、管理サーバ９３１を用いて説明する。ここで、管理サーバ９３１に例えば尺度Ａ、Ｂ、Ｃ、Ｄ、Ｅが含まれている。この尺度Ａ、Ｂは診断横断的アセスメントのための尺度、尺度Ｃ、ＤはＥＤ治療用の疾患特異的な尺度、尺度Ｅは不安障害治療用の尺度である。それぞれの治療用アプリ９１１、９１２はアセスメントを実行するために、管理サーバ９３１にアクセスし、それぞれの治療に必要な所定の尺度を利用してアセスメントを行う。従来のアプリはそれぞれのアプリがそれぞれに尺度を備えていたので、尺度の更新が行われた場合にはそれぞれのダウンロードされたアプリ毎に情報を更新する必要があったが、本実施例の場合はサーバの尺度を更新するだけですむので効率が良い。
　いままで述べてきた例では「治療」という言葉を使っているが、これは疾患の治療に限られず、セルフケア、メンタルヘルスの維持改善なども当然含まれる、また「患者」という言葉は健常人でもなんらかのメンタルの不調を抱えるものも含むことは言うまでもない。 (Examples of therapeutic applications for psychogenic diseases, psychosomatic disorders, and stress-related disorders (ED therapeutic applications))
BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. In the illustrated embodiment, when process-based CBT is applied to medical treatment (treatment, diagnosis, prevention, recurrence prevention, early detection, detection of coexisting diseases, etc.) and self-care for patients with psychogenic erectile dysfunction (ED) explain. However, the present invention covers not only psychogenic ED but also other sexual dysfunctions, spousal or partner relationship problems, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized anxiety disorder and social anxiety. Speech anxiety, specific phobia, post-traumatic stress disorder, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle-related diseases, bipolar disorder, borderline personality disorder, attention deficit/ Hyperactivity, chronic or persistent pain, sexual dysfunction, relationship problems with a spouse or partner other than erectile dysfunction, alcoholism and other addictions, schizophrenia and other severe psychoses, infertility (men, women) ), atopic dermatitis, overactive bladder (urinary incontinence), anti-aging, menopausal disorder, premenstrual syndrome (PMS), psychogenic visual disturbance, dental psychosomatic disease, glossalgia, dental phobia, dysmorphic phobia etc. is also applicable. Moreover, even if these diseases are complicated, it is applicable.
In FIG. 1, a system generally indicated by reference numeral 100 includes a server 10 (for example, a computer) including a control device 1 and a database 10F, an information processing terminal 3 used by a patient (information processing terminal on the patient side), and a medical institution. It has an information processing terminal 4 (information processing terminal on the side of the medical institution) that is used, and these are interconnected by, for example, an information processing network 20 (for example, a local area network or the Internet).
The details of the server 10 will be described later with reference to FIG. 2, but the control device 1 in FIG. 1 is a functional block comprehensively representing various parts in FIG.
The term "patient" as used herein means an individual who is aware that he or she may be suffering from psychogenic ED or the like and who is willing to seek treatment. In other words, the term "patient" is not limited to those who are receiving treatment under the guidance of a doctor or other related parties at a medical institution, and is judged to be "healthy" by a third party. It can also include those who are Therefore, the information processing terminal 4 is not limited to medical institutions.
In FIG. 1, the information processing terminal 3 on the patient's side is a "device for acquiring daily life data", and is composed of an electronic device having an information processing function and a communication function, such as a smartphone or a personal computer (PC, personal computer). can do Alternatively, a wearable device or the like can be used as a device for acquiring daily life data. Daily life data includes psychological data collected by having people answer various questions in their daily lives. In addition, for example, heart rate, blood pressure, blood oxygen concentration, number of steps, walking speed, reaction speed, reflex speed, dynamic visual acuity, sleep time and quality of sleep (deep/light sleep, etc.), amount of activity, activity range (action history) (for example, measured and acquired by GPS), physiological data such as blood sugar level, behavior data, emotion/mood data, and nocturnal erection data.
The information processing terminal 4 on the medical institution side can use an electronic device (for example, a PC) having an information processing function and a communication function, but it is also possible to use a smart phone.
Here, the information processing terminal 3 (for example, a smartphone) on the patient side is not only used as a tool for accessing the server 10 via the line 3L and the network 20, but also used for cross-diagnostic assessment in the server 10. It also functions as a tool for measuring "daily life data" and transmitting it to the server 10 side. The function of measuring daily life data and transmitting it to the cross-diagnosis assessment part of the server 10 is made possible by installing a dedicated application for executing such functions on the smartphone, which is the information processing terminal 3 on the patient side. Become.
When installing such a dedicated application, the information transmission line 3L (which may be wired or wireless) connecting the information processing terminal 3 on the patient side and the network 20 is used for accessing the server 10. It is an access line and also an information transmission line for transmitting the patient's daily life data measured by the information processing terminal 3 to the server 10 .
In the database 10F in the server 10, patient information (for example, medical history information corresponding to the patient ID) and information on psychogenic ED treatment (disease education, treatment methods, medication history, etc.) information, information about process-based CBT, etc.) are stored. The medical treatment in the medical history includes medical treatment via the information terminal and medical treatment at the medical institution.
Although not shown in FIG. 1, a plurality of information processing terminals 3 on the patient side and a plurality of information processing terminals 4 on the side of medical institutions can be connected to the network 10 .
Further, in FIG. 1, the database 10F is built in the server 10 together with the control device 1. FIG. However, it is also possible to configure the database 10F separately from the server 10 and connect it to the server 10 via the network 20. FIG.
The server 10 can be coupled with big data or a system 30 using big data. By combining with big data or a system 30 using big data, results of assessment and treatment module selection in the server 10, treatment status, etc. can be used as a part of big data, and can be obtained by using big data. The obtained knowledge can be used to improve the server 10 .
Although not illustrated, it is also possible to incorporate the knowledge and information obtained by utilizing the above-mentioned big data into the construction of AI (artificial intelligence) algorithms and develop them into medical applications using AI.
The server 10 in the system 100 according to the illustrated embodiment will now be described with reference to FIG. 2, which is a functional block diagram.
In the illustrated embodiment, the diagnostic application (assessment module) and the treatment/prevention application (treatment module/evaluation module) are expressed as an integrated unit. module/evaluation module) are configured separately, and the treatment/prevention application (treatment module/evaluation module) prescribes (including cases where a doctor prescribes) based on the assessment results of the diagnostic application (assessment module) can be configured as
In FIG. 2, a server 10 (indicated by dashed lines in FIG. 2) has an assessment part 10A, a module selection part 10B, a treatment module part 10C, an evaluation part 10D and a login/authentication part 10H. Although not explicitly illustrated, the illustrated embodiment constitutes a platform having both a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2.
In FIG. 2, the information transmission lines SL1, . . . may be wired or wireless.
In the login/authentication part 10H corresponding to the entrance of communication from the patient-side terminal 3 to the server 10, when the ID and password are input from the patient-side information processing terminal 3, the patient is authenticated. The login/authentication part 10H confirms the patient's legitimacy and reliability from previous data, and sends the authentication result (information indicating that the patient is a legitimate patient, not a fake) to the question part 10Q.
Although not clearly illustrated, in the server 10, security measures such as patient spoofing prevention are implemented using known technology, for example. Such security measures are applied to the login/authentication part 10H in the illustrated embodiment to protect the system 100 against patient impersonation and other fraudulent activities. If the accessor is an impersonator pretending to be a patient, the access is blocked in the login/authentication part 10H, and the transmission of information to the question part 10A and subsequent parts is blocked.
The login/authentication part 10H has a function of issuing, for example, a prescription ID and a password, and confirming the identity of a person (patient) who has accessed. Although not shown, for example, with the patient's consent, the number of times the system 100 is accessed and the period after the first access are appropriately set, and if the set number of times or period is exceeded, the system is deactivated. Alternatively, access can be restricted. As will be described later, even if the system is deactivated, the system 100 can be configured so that the patient can access the system 100 again under the direction of the doctor in charge.
Although not clearly illustrated, for login authentication, in addition to entering an ID and password, for example, if the information processing terminal 3 on the patient side is a smartphone or PC, the patient's face, voice (voiceprint ), the patient's retina, iris, etc. are photographed (obtained) with biometric information unique to the patient, and the biometric information is used to authenticate the patient, thereby preventing so-called "impersonation" and account transfer. , the reliability of the data input or obtained from the patient can be ensured. Acquisition of biometric information as described above is possible not only at the time of login but also at the time of inputting (obtaining) patient data.
In the question part 10Q, which is connected to the login/authentication part 10H via the information transmission line SL1, the accessing patient (subject) is asked to enter the chief complaint, current illness history, past history, and the like. Along with that, in question part 10Q, evaluation of psychogenic ED The patient is interviewed based on criteria for classifying clusters of psychological dysfunction (psychiatric symptoms) (operational diagnostic criteria). Specifically, in Question Part 10Q, for example, a psychogenic ED symptom checklist and a checklist-style question from the DSM-5 and ICD-10 compliant psychiatric brief structured interview were accessed. Perform on the patient.
Based on the input and answers in question part 10Q of the patient who accessed, it becomes possible to judge whether a specific disease is manifested and the presence or absence of risk factors, which is useful for assessment in assessment parts 10A1 and 10A2 can do
Inputs and answers in the question part 10Q are sent to the cross-diagnostic assessment part 10A1 via the information transfer line SL2.
In the cross-diagnostic assessment part 10A1, while utilizing the daily life data acquired by the patient's information processing terminal 3 (device for acquiring daily life data), psychosocial problems, life adjustment, stress, etc. On the other hand, it has a function of assessing to what extent the patient is acting adaptively or non-adaptively, and performs the assessment using a quantitative measurement index. For example, as an adaptive behavior,
“Acceptance,” in which unpleasant thoughts and feelings are not avoided, but left as they are
"Defusion", which separates thoughts from reality and does not get overwhelmed by unpleasant thoughts and emotions,
'Contact with the present moment' to maintain awareness of the reality in front of us,
From a bird's-eye view, "self as a point of view" to notice what you are aware of,
"Clarification of values" to clarify the "way of life" you want to live,
It envisions a "commitment" to pursue the "way of life" that you want to live.
By assessing the above-mentioned adaptive behavior against psychosocial problems, life adjustment, stress, etc., we assess the psychological flexibility of the accessing user (patient: target person). The six adaptive behavioral assessments described above are based on one form of CBT, Acceptant and Commitment Therapy (ACT). Subjects who show the above-mentioned adaptive behavior to psychosocial problems, life adjustment, stress, etc. are healthy, have a high quality of life, have low stress, and are resistant to various diseases. It can be judged that the power is in a high state.
The assessment results in the cross-diagnostic assessment part 10A1 are sent to the module selection part 10B via the information transmission line SL5.
Cross-Diagnostic Assessment Part 10A1 does not assess for disease identification nor does it assess symptoms characteristic of disease. As described above, in the cross-diagnostic assessment part 10A1, while utilizing data under daily life, how adaptively the patient can behave in response to psychosocial problems, life adjustment, stress, etc. This is because it assesses whether they are acting maladaptically. As a result of such an assessment, the Cross-Diagnostic Assessment Part 10A1 enables us to understand the patient based on factors common to a variety of diseases, such as psychosocial problems, life adjustment and stress, and to understand the process. Based CBT is feasible.
Cross-diagnostic assessment Part 10A1, understanding the patient based on factors common to various diseases, such as psychosocial problems, life adjustment and stress, is one of the key features of the illustrated embodiment. This is a clear difference from conventional various medical applications (see, for example, Patent Documents 1 and 2).
Information on the subject who has completed the assessment in the cross-diagnostic assessment part 10A1 is sent to the disease-specific assessment part 10A2 via the information transmission line SL31.
Disease-specific assessment part 10A2 evaluates to what extent the target person (accessing user) is able to act adaptively or maladaptively to the symptoms characteristic of the disease. It has an assessment function and uses quantitative measurement indicators to perform assessment. For example, as maladaptive behavior,
"Anticipation anxiety" that begins to think that sexual activity may fail,
The self-concept that if you can't maintain an erection during sexual intercourse, you're finished as a 'man',
"Attention control" where you are worried about whether you can maintain an erection and cannot concentrate on sexual activity,
"Interpersonal relationship" where the relationship does not go well due to concern about the evaluation from the partner,
It assumes "avoidance behavior" such as not trying to engage in sexual activity.
In the case of depression, maladaptive behaviors include:
"Inactive", being inactive and having a narrow range of activity
"Rumination" to think over and over again about unpleasant events in the past
"Cognitive bias" such as thinking about things to the extreme and denying everything with a small mistake
It is assumed that "disability of social function", etc., which prevents people from interacting with others.
In the disease-specific assessment part 10A2, if the subject is assessed for the above-described maladaptive behavior for symptoms characteristic of the disease, the subject's information is transmitted via the information transmission line SL4. , along with the assessments of the assessment parts 10A1 and 10A2 to the module selection part 10B.
Here, as a result of the intake information and medical interview in question part 10Q, if the subject has no symptoms of a specific disease (for example, if the subject is healthy), disease-specific assessment is not performed in the illustrated embodiment. In such a case, the information of the subject who has completed the assessment in the cross-diagnostic assessment part 10A1, along with the results of the assessment in the cross-diagnostic assessment part 10A1, will be sent to the disease-specific assessment part via the communication line SL5. 10A2 and is sent to the module selection part 10B. In addition, if it is found that the subject is a healthy person as a result of the intake information and interview in the question part 10Q, the subject is classified into a cluster corresponding to a healthy person without being assessed in the cross-diagnostic assessment part 10A1. It is possible to classify
As will be described with reference to FIG. 3, in module selection part 10B, statistical techniques (e.g., cluster analysis) are used to classify subjects into specific groups (or into clusters in the case of cluster analysis). , select the therapy module linked with the group or cluster. In other words, the module selection part 10B has the function of selecting a treatment module based on the assessment result of the cross-diagnostic assessment part 10A1 and the assessment result of the disease-specific assessment part 10A2. For example, in the assessment of Cross-Diagnostic Assessment Part 10A1, the clusters of "acceptance", "defusion", "contact with the present moment", "self as a point of view", "clarification of values", and "commitment" , cluster 1 (lower than average scores for “acceptance” and “deffusion”), cluster 2 (lower than average scores for “contact with this moment” and “self as a point of view”) cluster 3 (values clarification, commitment below average), cluster 4 (acceptance, defusion, contact with the present moment, The score of "Self as a point of view" is lower than the average level). In addition, the average level refers to the average point ±1 SD (standard deviation). Based on the results of the assessment in Cross-Diagnostic Assessment Part 10A1, the patient is classified into one of the above clusters.
In psychogenic ED, in the assessment of disease-specific assessment part 10A2, cluster 1 ("anticipatory anxiety , cluster 2 (higher than average scores for ``anticipatory anxiety'' and ``avoidance behavior''), cluster 3 (higher than average scores for ``self-concept'', ``interpersonal It is classified into 4 clusters: the score of "relationship" is higher than the average level) and cluster 4 (the score of "interpersonal relationship" and "avoidance behavior" is higher than the average level). Patients are classified into one of the above clusters from the results of the disease-specific assessment part 10A2 assessment.
In the above example, cluster analysis is performed for each of the cross-diagnostic assessment part 10A1 and the disease-specific assessment part 10A2. Cluster analysis may be performed by integrating the results of
Then, the module selection part 10B selects a treatment module based on the cluster into which the patient is classified from the assessment result of the cross-diagnostic assessment part 10A1 and the assessment result of the disease-specific assessment part 10A2.
In the above example, the number of clusters is 4, but in actual cluster analysis, the number of clusters can be subdivided from a few to 1000 or more for each individual by data analysis and customization of the treatment application. could be.
In the illustrated embodiment, a platform having both a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2 is configured, so the system 100 is configured by separating the diagnostic application and the treatment/prevention application. Even in the case, for each cluster by cluster determination in the assessment part (assessment module) in the diagnostic app, automatically, the treatment module based on the results of the cross-diagnostic assessment and / or the results of the disease-specific assessment Based treatment modules are selected and ordered. Here, in the system 100 in which the diagnosis application and the treatment/prevention application are configured integrally or separately, the selection and instruction of the treatment module are determined by the doctor based on the results of the assessment. Based on this, it is possible to manually select and instruct a treatment module.
The therapy module selected in the module selection part 10B is transmitted to the therapy module part 10C through the information transmission line SL6.
The module selection part 10B is a machine for transmitting the selected treatment module to the information processing terminal 3 on the patient side via an interface (not shown) and an information transmission line SL7. have the ability That is, if a cluster of patients is identified as a result of the assessment and a treatment module is presented, the treatment module's treatment program (exercise, work, etc.), homework, useful information for treatment (tips), user statistics, etc. Part of the information such as data, user's usage status, and user's answer examples can be sent to the patient terminal 3 . With such a function, the treatment program can be executed in a place where the network environment is not available or offline. Therefore, for example, even when a failure occurs in the communication/network environment, or when the treatment ends and the system 100 becomes inaccessible (in the case of deactivation), the patient can still perform exercises, homework, and Some information such as useful information (Tips) for treatment, statistical data of users, usage status of users, examples of answers of users, etc. can be continuously executed and viewed offline, preventing interruption of treatment, In addition, it can be used to maintain the therapeutic effect and prevent recurrence even after the end of treatment.
However, information such as offline exercises and workouts, homework, tips, user statistical data, user usage status, user response examples, etc. are not recorded by the system 100 as intervention records. , In order to prevent the possibility of not being able to make an appropriate evaluation, although not shown, offline exercises and workouts, homework, tips, user statistical data, user usage status, user It is possible to configure so as to have a function of transmitting information such as answer examples to the system 100 side.
Here, when the patient is suffering from psychogenic ED, an example of the work as described above is work using a known negative pressure erection aid (VCD). The work is preferably performed with a partner (spouse, etc.), and the fact that the patient has an erection to the extent that sexual intercourse is possible and the fact that sexual intercourse has been successful has a positive effect on the recovery of the patient's self-confidence. In addition, by measuring the state of erection at night while sleeping, recording the frequency and height, and confirming the record, the state of psychogenic ED can be grasped, or if the state is improved, confidence can be gained by the improvement. can also be recovered. In order to measure nocturnal erection, RigiScan, in which a wire is wrapped around the penis, or pants for erection measurement, which have a detection means such as a pressure sensor inside, can be used.
The therapy module part 10C has a function of executing the therapy module selected in the module selection part 10B to the patient or transmitting the therapy module selected in the module selection part 10B to the patient.
The treatment module implemented in part 10C of the treatment module is a cross-diagnostic intervention, in response to the results of the assessment of "psychological flexibility", a psychological intervention aimed at the learning/acquisition of healthy new behavioral patterns. . For example, in the assessment of cross-diagnostic assessment part 10A1, if the patient is classified as cluster 1 ("acceptance" and "deffusion" scores are lower than the average level), perform "polar bear exercise" etc. do. The "polar bear exercise" aims to understand the non-functionality of trying to avoid unpleasant thoughts and emotions by trying not to think about the polar bear for a period of time. If the patient is classified into cluster 2 (lower than average scores for "contact with this moment" and "self as a point of view"), "attention training" or the like is performed. "Attention training" aims to acquire flexibility of attention and release from self-focused cognitive processing through practice of paying attention to multiple sounds in various ways. By executing these treatment modules, it is expected that the adaptive behaviors included in the cluster will be promoted. In this specification, the execution of psychotherapy may be expressed as intervention for a patient.
In addition, as a treatment module for psychogenic ED, in disease-specific intervention, for each disease-specific scene, situation, etc., using techniques appropriate for each cluster, healthy and new behavioral patterns according to the disease Conduct psychological interventions aimed at learning/acquisition. For example, in the assessment of disease-specific assessment part 10A2, if the patient is classified as cluster 1 (“anticipatory anxiety” and “attention control” scores are higher than the average level), “sensory concentration training” is performed. do. "Sensory concentration training" is aimed at touching the partner's body and concentrating on the sense given with all nerves. If the patient falls into cluster 3 (higher than average scores for 'self-concept', 'interpersonal relationships'), 'relationship with partner' is performed. The 'partner relationship' aims to find areas of discussion and compromise that are important for maintaining a sexual relationship.
In Treatment Module Part 10C, it is possible to provide a treatment module using "virtual reality". For example, in the case of an anxiety patient, it is possible to make the patient experience "get on a train" (virtual reality experience) in virtual reality.
In the illustrated embodiment, cross-diagnostic interventions take precedence over disease-specific interventions. However, there are also cases where it is not limited to this.
Treatment module part 10C provides homework to be performed by the patient corresponding to the classified clusters. When the treatment module part 10C selects homework, it can refer to homework that is stored in a storage device (database) not shown in FIG. 2 and linked to each treatment module. Such homework is compiled in advance so that improvement of symptoms can be expected when the patient performs the homework, and the patient's independence can be improved. For example, in the above treatment module "attention training", training is performed for about 15 minutes a day to pay attention to various sounds recorded in sound sources.
The treatment modules and treatment results performed in the treatment module part 10C are transmitted to the evaluation part 10D by the communication line SL8. Homework and its achievement may also be sent to Assessment Part 10D.
The evaluation part 10D has a function of evaluating the effect of treatment by the treatment module executed in the treatment module part 10C, and evaluates the effect of treatment according to a predetermined algorithm using an existing evaluation scale or the like. For example, in psychogenic ED, the International Erectile Function Score (IIEF) is used as an evaluation scale (measuring index) for erectile function, which is a characteristic symptom of the disease. In the International Score for Erectile Function, severity classification is made from scale scores, and it is possible to evaluate the effect of treatment. The tool rating scales or metrics are stored in the therapy module part 10D. Alternatively, an evaluation scale or measurement index for each treatment module may be stored in a storage device (database) not shown in FIG.
Here, it is possible to acquire and record the patient's daily life data using the patient's terminal 3, wearable device, etc., and to put the results of the effect measurement before and after the treatment into a report format. The evaluation part 10D can then have the ability to provide such feedback to the patient (or physician).
The evaluation result of the therapeutic effect by the evaluation part 10D is transmitted to the information terminal 3 on the patient side through the information transmission line SL9. For example, when a chatbot is used as a treatment module, the patient is presented with an evaluation of the treatment effect by the chatbot.
The evaluation content transmitted to the patient includes, for example, advice for improving symptoms.
Although not shown, when inputting the response of the measurement index of the effect of the treatment, the timing means and recording means for recording the time until inputting, the measuring means for measuring the heart rate and blood pressure, the state of the patient's pupil opening and closing means for measuring the direction of gaze and the number of blinks (for example, the camera of the patient-side terminal 3 if it is a smartphone or PC), means for measuring the number of breaths, means for measuring body temperature, or means for observing the complexion (For example, a camera of the patient-side terminal 3) is provided, and a device for monitoring objective information at the time of index input to measure and observe the accuracy of answers and the condition of the respondent is preferably provided.
By installing a device for measuring and observing the accuracy of answers and the conditions of respondents, it is possible to objectively monitor the accuracy of answers and conditions of respondents. Items to be monitored as the condition of the respondent include, for example, whether the respondent, the patient, has entered the measurement index inadvertently, whether the patient has entered false information to obtain the result of "improved", By inputting the measurement index, it is whether or not the patient is under stress, whether or not the patient is deep in thought, the patient's responsiveness, the patient's cognitive function, and the like. Such monitoring can be taken as a factor in cluster analysis.
In addition, when using a smartphone or PC camera as the patient terminal 3 as a device for measuring and observing the accuracy of answers and the state of the respondent, a special filter or lens, etc. is attached to the camera, and the above-mentioned Monitoring can be done. Furthermore, it is possible to use a measuring device (not shown) for heart rate, blood pressure, etc., and an application.
Furthermore, it is possible to acquire objective information of the respondent by wearing devices such as an odor sensor, an electroencephalogram sensor, and a cerebral blood flow sensor. As a result, it becomes possible to measure the mental and physical condition of the respondent and use it as a factor in cluster analysis. For example, if a headset-like device for measuring brain waves, cerebral blood flow, etc. is worn, the real feeling of the treatment is heightened, and the therapeutic effect is further improved.
In the evaluation part 10D, if the therapeutic effect is not evaluated favorably, the evaluation result is sent to the module selection part 10B via the information transmission line SL10. If an unsatisfactory evaluation is received from the evaluation part 10D, the module selection part 10B determines that the proposed treatment module was less effective and selects and proposes a new treatment module. The therapy module part 10C transmits (provides) the new therapy module to the patient, and the evaluation part 10D evaluates the therapeutic effect of the new therapy module.
In FIG. 2, the information terminal 3 on the patient side is connected to the cross-diagnostic assessment part 10A1 through an information transmission line SL12. As described above with reference to FIG. 1, the information processing terminal 3 on the patient side has the function of measuring the patient's "daily life data" and transmitting the cross-diagnostic assessment part 10A1. To do so, it sends the patient's "daily life data" to the cross-diagnostic assessment part 10A1 via communication line SL12.
Also, the login/authentication part 10H is connected to the treatment module part 10C via an information transmission line SL12, and is connected to the evaluation part 10D via an information transmission line SL13. In the second and subsequent accesses from the patient (subject), as will be described later with reference to FIG. This is because there are both cases where it is confirmed whether or not there is.
Next, referring to FIG. 3, the module selection part 10B will be described.
In the illustrated embodiment comprising a platform that combines a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2, the module selection part 10B selects a number of treatments based on the assessment results of the cross-diagnostic assessment part 10A1. Select modules and select several treatment modules based on the results of the assessment of disease-specific assessment part 10A2. In other words, multiple treatment modules are selected in the module selection part 10B based on the results of each of the cross-diagnostic assessment part 10A1 and the disease-specific assessment part 10A2.
In FIG. 3, module selection part 10B includes analysis block 10B1, classification block 10B2, linking block 10B3, and storage device 10B4.
The results of the assessment of the cross-diagnostic assessment part 10A1 are sent via communication line SL5 to the analysis block 10B1 of the module selection part 10B. The results of the assessment of disease-specific assessment part 10A2 are then sent to analysis block 10B1 via information transfer line SL4.
The analysis block 10B1 has a function of performing cluster analysis on each of the assessment results of the cross-diagnosis assessment part 10A1 and the assessment results of the disease-specific assessment part 10A2.
Analysis block 10B1 analysis results based on the results of the assessment of the cross-diagnostic assessment part 10A1 are sent to the classification block 10B2 via the communication line SL22, and analysis of the analysis block 10B1 based on the results of the disease-specific assessment part 10A2 The results are sent to classification block 10B2 via communication line SL24.
In the classification block 10B2, the patient is classified into a predetermined cluster based on the results of the assessment of the patient's cross-diagnostic assessment part 10A1. Similarly, the patient is classified into a predetermined cluster based on the results of the patient's disease-specific assessment part 10A2 assessment.
The cluster information classified based on the results of the assessment of the cross-diagnostic assessment part 10A1 is sent to the linking block 10B3 via the communication line SL26 and classified based on the results of the assessment of the disease-specific assessment part 10A2. The cluster information obtained is transmitted to the linking block 10B3 via the information transmission line SL28.
Information is stored in the storage device 40 that links the clusters to the therapy modules that are valid for the clusters. The "linking information" may be a diagram or a function that associates the clusters with treatment modules effective for the clusters.
The "linking information" is transmitted to the linking block 10B3 via the information transmission line SL30, and effective treatment modules are determined for the clusters classified by the classification block 10B2. In other words, the linking block 10B3 has the function of determining effective treatment modules for clusters into which patients are classified according to the "linking information".
In linking block 10B3, the treatment modules that are effective for the clusters classified based on the results of the assessments of the cross-diagnostic assessment part 10A1 and the clusters that are effective for the clusters classified based on the results of the assessments of the disease-specific assessment part 10A2. Decide on a treatment module.
Cluster-effective treatment modules classified based on the results of the assessments of the cross-diagnostic assessment part 10A1 are sent to the treatment modules part 10C via communication line SL61, and based on the results of the assessments of the disease-specific assessment part 10A2. The therapy modules that are valid for the clusters classified by are sent to the therapy module part 10C via communication line SL62. As a result, the patient can be offered both a treatment module based on the results of the assessment of the cross-diagnostic assessment part 10A1 and a treatment module based on the results of the disease-specific assessment part 10A2. In other words, both cross-diagnostic and disease-specific interventions are possible.
The information transmission lines SL61 and SL62 shown in FIG. 3 are comprehensively displayed as a single information transmission line SL6 in FIG.
Cluster analysis is exemplified here as a statistical method, but statistical methods other than cluster analysis can be used if patients (subjects) can be accurately classified and linked to appropriate treatment modules. can be adopted.
As described above, the patient can be offered both a treatment module based on the results of the assessment of the cross-diagnostic assessment part 10A1 and a treatment module based on the results of the disease-specific assessment part 10A2. Whether one of them is preferentially displayed on the patient-side information terminal 3 or both are displayed on the patient-side information terminal 3 at the same time can be configured to be appropriately settable.
For example, in FIG. 3, a priority determination block 10R is provided in which the results of the interview and input in the question part 10Q, the results of the assessment of the cross-diagnostic assessment part 10A1, the results of the assessment of the disease-specific assessment part 10A2, etc. Based on the input information, the order determination block 10R decides whether to preferentially present to the patient a treatment module based on the assessment result of the cross-diagnostic assessment part 10A1, or whether to give priority to the patient based on the assessment result of the disease-specific assessment part 10A2. It has a function to determine whether the treatment module based on the treatment should be presented preferentially or both should be presented at the same time. At the same time, the priority determination block 10R transmits a control signal to the interface 10BIF of the module selection part 10B via the information transmission line SL32 to notify the patient-side information terminal 3 of the assessment of the cross-diagnostic assessment part 10A1. It has a function to control whether to transmit the treatment module based on the result, to transmit the treatment module based on the result of the disease-specific assessment part 10A2 assessment, or to transmit both at the same time.
As a result, whether the patient is presented with only the treatment module based on the assessment of the cross-diagnostic assessment part 10A1, or both treatment modules based on the results of the disease-specific assessment part 10A2 are presented to the patient, or both are presented to the patient at the same time. It is possible to appropriately set whether to present the information on the side information terminal 3 .
In the illustrated embodiment, in order to prevent a patient who is an application user from continuing to use the application and dropping out during treatment, the patient is requested to log in to the treatment application at an appropriate timing. The system 100 has a function of sending a message (reminder notification) prompting the application (a function of activating the application at an appropriate timing).
For example, daily life data of a patient using the system 100 can be obtained, a therapeutic application can be immediately activated, and real-time assessment can be performed based on the daily life data. It is also possible to intervene immediately (real-time intervention) as a result of such real-time assessment.
In addition to judging numerical values in daily life data, when an event that is expected to require a therapeutic app occurs in the patient's daily life, the therapeutic app will be launched and assessments and other necessary measures will be taken. It is possible. For example, if a patient with psychogenic ED is using a therapeutic app, check the keyword and schedule of the email received by the patient, and if, for example, receives a date email from a partner, a therapeutic app is required. It judges that such an event has occurred, activates the treatment application, executes the necessary assessment, and sends a message prompting the patient to execute the necessary treatment module.
If the patient is a chronic pain patient, detect that the patient has received a "picnic invitation email", activate the treatment application, perform the necessary assessment, send a message from the system 100 side, or A message can be sent that prompts the patient to perform the necessary treatment module.
When do patients have problems?
By providing feedback to the therapist from daily life data and other patient data, for example,
Is it morning, afternoon or night when the patient has problems?
Or will the patient have problems in a given case?
can be determined. That is, by proceeding with the analysis of data automatically collected by the system according to the illustrated embodiment, it is possible to determine the timing at which a problem occurs in the patient, in other words, the timing at which the patient most needs the treatment application. I can.
In this way, determining the appropriate timing to launch the therapy app and taking the necessary actions in the app can be done when the patient urgently needs to execute the therapy module (i.e., an emergency for the patient). In addition, it means having a function (a so-called “rescue-like” function) that allows immediate assessment of the patient, or allows the patient to immediately execute treatment modules and tips.
As such rescue measures and functions, for example, when the patient is ED, the necessary PDE5 inhibitor is prescribed when the partner contacts as described above but the patient does not have the PDE5 inhibitor It is conceivable to display the doctor's contact phone number.
By installing a rescue button on the information processing terminal 3 on the patient side and operating the rescue button by the patient, the necessary treatment modules, exercises, and information can be immediately sent from the treatment application side in the event of the above-described situation. etc. is presented to the patient. If the patient is ED and has been contacted by the partner but the patient does not have the PDE5 inhibitor, it is possible to pop up the countermeasures that were considered in advance (the countermeasures that the patient had set) in the treatment module. Conceivable.
By installing a rescue button on the information processing terminal 3 on the patient side and operating the rescue button by the patient, the necessary treatment modules, exercises, and information can be immediately sent from the treatment application side in the event of the above-described situation. etc. is presented to the patient. If the patient has ED and has been contacted by the partner, but the patient does not have a PDE5 inhibitor, in such a state, the patient may ask, "What if my partner dislikes me?" I am in a so-called "swallowed state of thought" due to the anxiety that
In the illustrated embodiment, treatment modules and exercises are sent to the patient, allowing the patient to think that ``it's not all about sex,'' or ``I just want to enjoy meeting my partner.'' can help the patient get out of the state of being "swallowed up in thought" by anxiety.
Although not shown, the system 100 can be provided with a device having a function of transmitting messages such as reminders and encouragement to encourage the use of the therapeutic application periodically or irregularly at a fixed time. . It is also possible to apply game-like elements. Additionally, the ability to provide some reward to the patient for accessing the system 100 can be provided. Then, it is possible to provide a wearable device or the like having the above-described functions so as to increase motivation to access the system 100 and actively execute the treatment application, and continue treatment (treatment application It is possible to strengthen the "positive" behavior of continuing to use
By exerting these functions, the patient's willingness to continue using the system 100 to access the system 100 and continue executing the treatment module is increased, and the patient does not access the system 100 during treatment (drops out during treatment). It is possible to suppress the situation and improve the therapeutic effect of the system 100 (or the effect of the therapeutic application).
Regarding the timing of sending reminder notifications, is the patient active or inactive? information and whether the patient is mobile? Are you at home? information (status management) can be managed and determined.
In addition, based on daily life data, reminder notifications can be sent when the heartbeat is stable, when the patient is idle, and so on.
Furthermore, since there is a high possibility that the patient is touching the smart phone after the information processing terminal 3 (for example, the smart phone) on the patient side is activated (after recovery), a reminder notification can be sent at that time.
In the illustrated embodiment, in order to prevent the patient from continuing to use the app and dropping out during treatment, the patient's own intention to work on the treatment and participate in the treatment by himself is strengthened (adherence It is possible to provide content for enhancing
Such content includes content related to disease education, treatment method education, etc. (for example, content explaining what ACT is).
In order to maintain the patient's motivation to continue using the application and prevent the patient from dropping out during treatment, it is important to have the patient log in to the treatment application. Therefore, in the illustrated embodiment, when the patient accesses an SNS app of a celebrity that the patient likes (for example, Twitter (registered trademark), which is an information service of Twitter Inc.), the patient accesses (meaning to log in to the treatment app ) reminder notification is sent.
Alternatively, when the patient accesses a partner's SNS application (for example, LINE (registered trademark), which is an information service of LINE Corporation), a reminder notification is sent.
Furthermore, from the activation status of other SNS applications on the smartphone used by the patient (for example, "YouTube (registered trademark)", which is a video sharing service of Google LLC.), to send a reminder notification linked to it. can be done.
In addition, by displaying a partner character who acts as a guide and your own avatar, you can feel familiarity as if you are communicating within the app, and you can select the character or avatar to suit your preferences. By providing a function that can be customized according to the situation, it is useful for maintaining motivation and preventing dropouts.
It is known that an alarm (alert) generated from the information processing terminal 3 (for example, a smart phone) on the patient side raises the patient's awareness of the problem and motivates the patient to continue treatment.
For example, diabetes can coexist if the patient has ED. In the illustrated embodiment, by measuring the patient's blood sugar level on a daily basis and generating an alert when it exceeds a predetermined value, it is possible to give the patient a sense of crisis and increase their motivation to continue treatment. . As described above, the illustrated embodiment performs cross-diagnostic assessment, which is effective when multiple diseases (diabetes, arteriosclerosis, etc.) are involved, as described above.
In addition, focusing on the fact that food (appetite) and mood are related, and that appetite changes (decreases/increases) when depressed, an appetite score that indicates changes in appetite is created to identify depression. be made recognizable by the patient. Alternatively, by uploading a picture of a meal and making it possible to see changes in appetite, it is possible to recognize when a person is depressed.
As a theory in behavior analysis regarding "positive behavioral reinforcement" mentioned above, there is a theory that if there is a "good thing" or "disappearance of an unpleasant thing" (reward) immediately after a behavior, it will act in the direction of continuing the behavior. be. "Immediately after" here means within 60 seconds, and this theory is sometimes expressed as a "60 seconds rule." Based on this theory, in the illustrated embodiment, the treatment module, feedback such as "Good job!" It is possible to provide motivation for the patient to continue the action (treatment) by giving
Although not clearly illustrated, in the illustrated embodiment, the design/visual effects of visual information in the treatment application can be designed so that, for example, the background design can be selected so that it can be activated just by looking at it. .
Patients' respect for therapeutic apps also contributes to continuation of the app. Therefore, it is preferable that the design of the therapeutic application according to the illustrated embodiment be designed so that other people will not be able to recognize it. For example, even if a third party sees a patient with psychogenic ED while running a treatment application, the patient will not feel embarrassed. It is preferable that the design is devised so that when viewed from the side, it looks like you are looking at your smartphone for business. Such a design solves the problem that the patient cannot continue using the medical treatment application because of "it would be embarrassing (if someone else knew that the medical treatment application was running)." And, for example, since the treatment of ED can be performed even in spare time other than at home, it becomes easier for the patient to continue the treatment using the treatment application.
Cross-diagnostic assessment, disease-specific assessment, treatment module (treatment program: exercise, work), homework, tips, user statistical data, user usage status, user response example information, evaluation, etc. When executing, using a smart speaker, etc., the patient can input, record, and respond to voice questions, instructions, guidance, etc. by voice, and interact with voice. It is possible to configure so as to have a function (interactive function) to Here, a smart speaker (AI speaker) is a speaker that has an AI assistant function that supports interactive voice operation, recognizes voice with a built-in microphone, searches for information, and operates linked home appliances.
It also has a function of providing contents (Tips) for patients who access the system 100 to sequentially view videos, music, sounds, and other contents (for example, mindfulness meditation) related to or useful for treatment. equipment can be provided. Such content includes, for example, mindfulness meditation, scents, music, images, vibrations, information on preferred foods/meals, etc., and improves QOL, which is an indicator of therapeutic effects, duration, and satisfaction by using the five senses. bring.
When performing the above-mentioned treatment module and exercise, when moving the body according to the treatment application, combine with VR and AR, wear equipment for VR and AR when performing exercise, and enhance the feeling by VR and AR. can be done. This enhances the effectiveness of the therapy modules and exercises.
Here, when running the treatment app, the work done with the patient's partner, the woman, and the content watched with the partner will raise the awareness of the partner (female) and promote the understanding and transfer of ED treatment. preferred.
In the illustrated embodiment, a simple evaluation (mini-evaluation) is performed for each exercise of the therapy module, and, for example, the patient's own evaluation is written in the "free description field". If such a mini-evaluation is fed back and the patient recognizes changes in the feedback, it is possible to show the patient the significance of moving toward the goal (e.g., the significance of performing exercise every day). . If it is possible to show such significance, for example, in the case of a patient with psychogenic ED, the patient's hope that ``even if sexual activity is not going well, it is improving more than before,'' ) can be given.
Additionally, giving patients meaningful feedback about their efforts toward their goals can increase their motivation to continue with the therapeutic app.
Here, the illustrated embodiment focuses on the process rather than the "result." In the case of a patient with psychogenic ED, for example, whether or not the patient's psychosocial process progressed and mental flexibility improved rather than whether or not the symptoms of "erection, no erection" improved. Focus on no. If the stage of the psychosocial process progresses and the flexibility of the mind improves, new behavioral patterns are acquired and learned. You can broaden your way of thinking by saying, "It's okay," and "The relationship with your partner is not all about sexual activity."
In FIG. 4, the information processing terminal 3 on the patient side has a control block 3A, a display block 3B, an input block 3C, a memory block 3D and a communication block 3E.
The control block 3A has a function of executing control such as information processing in the information processing terminal 3 on the patient side. The display block 3B has a function of displaying information to the user (patient) of the information processing terminal 3 on the patient side. The input block 3C has a function of receiving information input by the user (patient).
The storage block 3D is composed of existing storage equipment, and stores a patient program denoted by reference numeral 3F for the information processing terminal 3 on the patient side. Although not explicitly shown, it is possible to use database 10F as storage block 3D. The communication block 3E has a function of connecting with the network 20 through wired or wireless communication.
The information processing terminal 3 on the patient side is not particularly limited as long as it is an electronic device having an information processing function and a communication function. However, considering the recent spread, portable information terminals such as so-called smart phones are preferable.
In FIG. 5, the information processing terminal 4 on the medical institution side has a control block 4A, a display block 4B, an input block 4C, a storage block 4D and a communication block 4E.
The control block 4A has a function of executing control such as information processing in the information processing terminal 4 on the side of the medical institution. The display block 4B has a function of displaying information to users of the information processing terminal 4 on the side of the medical institution (doctors, persons involved in the medical institution, etc.). The input block 4C has a function of receiving information input by a doctor, a person involved in a medical institution, or the like.
The storage block 4D is composed of existing storage equipment, and stores a medical institution program denoted by reference numeral 4F for the information processing terminal 4 on the medical institution side. It is also possible to use the database 10F as the storage block 4D. The communication block 4E has a function of connecting to the network 20 through wired or wireless communication.
Although not clearly shown in the figure, websites outside the system, such as anonymous patient associations, chat rooms, and BBSs, are connected to share the usage status and transitions of therapeutic applications in communities of patients suffering from the same disease. It is possible to view data relating to other users as statistical data. Here, a connectable website outside the system must meet the requirements as a medical device.
By connecting to a website outside such a system, it is possible to obtain the same effect as participating in a self-help group for various diseases (for example, a self-help group for drug addicts), and to continue treatment. can give motivation.
Next, mainly referring to FIGS. 6 and 7, procedures for performing diagnosis, treatment, prevention, etc. (medical care) by the system 100 will be described. In describing FIGS. 6 and 7, it is assumed that the disease of a patient (person concerned: user) is psychogenic ED.
Referring first to FIG. 6, a patient accessing system 100 for the first time will be described.
In FIG. 6, in step S1, it is determined whether or not the information processing terminal 3 on the patient side has logged in to the system 100, thereby determining whether the patient uses the system 100 or not. In step S1, if there is a login from the patient side ("Yes" in step S1), the process proceeds to step S2, and if there is no login, the process returns to step S1 (loop of "No" in step S1).
Although not shown in FIG. 6, in step S1, the login/authentication part 10H authenticates the identity of the patient who has accessed, for example, using the issued ID and password. Although not shown in the figure, the number of times of access and the period after the first access (treatment period) are set for patients who are accessing multiple times, and if the set number of times or period is exceeded It is also possible to deactivate or restrict access.
Although not shown in the figure, when performing login authentication, in addition to entering an ID and password, biometric information specific to the patient, such as the patient's face, voice (voiceprint), retina, iris, etc., is stored on an information processing terminal on the patient's side, for example. If 3 is a smartphone or a PC, it is possible to photograph (acquire) using the camera or the like, and perform personal authentication using the biometric information. Acquisition of such biometric information is possible not only at the time of login but also at the time of inputting (acquiring) patient data. By acquiring such biometric information and authenticating the patient himself/herself, it is possible to prevent so-called "impersonation" and account transfer, and to ensure the reliability of the data input or obtained from the patient.
In step S2 (when logged in by the patient), the patient is authenticated by the login/authentication part 10H based on the ID and password entered by the patient. Then, the process proceeds to step S3.
Although not explicitly shown in FIG. 6, the patient authenticated in step S2 can immediately proceed to step S113 (described later) without executing step S3 and subsequent steps.
In step S3, the accessing patient is asked to enter the chief complaint, current illness history, past history, etc. (intake information), and along with that, evaluation of psychogenic ED (for example, "When you start thinking that you will fail again, "I worry about maintaining an erection and cannot concentrate on sexual intercourse"), questioning based on operational diagnostic criteria (checklist questions) by simplified structured interview. Then, the process proceeds to step S4.
In step S4, the cross-diagnostic assessment part 10A1 is used to determine how adaptively the patient can behave in response to psychosocial problems, life adaptation, stress, etc. while utilizing data under daily life, or Assess whether the user is acting adaptively and assess the psychological flexibility of the accessing user (patient: target person) (diagnostic cross-sectional assessment). In the illustrated embodiment, cross-diagnostic assessment takes precedence over disease-specific assessment.
After the cross-diagnostic assessment in step S4, the presence or absence of disease-specific symptoms is determined in step S5 as a result of the input and interview in step S3. If there is no disease-specific symptom (No in step S5: for example, in the case of a healthy subject), the process proceeds to step S7.
On the other hand, if there is a disease-specific symptom (Yes in step S5), the process proceeds to step S6.
In step S6, the disease-specific assessment part 10A2 assesses whether or not the above-described skills are demonstrated for a specific disease (disease-specific assessment).
After the disease-specific assessment of step S6, proceed to step S7.
Here, when it is determined that the subject is healthy in step S3, it is possible to immediately proceed to step S7 and classify the subject into a cluster corresponding to the healthy subject.
In step S7, analysis block 10B1 performs (for example) a cluster analysis on the results of the cross-diagnostic assessment, or (for example) performs a cluster analysis on the results of the disease-specific assessment.
Then, in step S8, in the classification block 10B2, based on the results of the cluster analysis, the patients are classified into the corresponding clusters based on the cluster analysis of the cross-diagnostic assessment, and the patients are classified into the corresponding clusters based on the cluster analysis of the disease-specific assessment. Sort into clusters.
In cross-diagnostic assessment or disease-specific assessment, for example, in the case of psychogenic ED, nine evaluation indices were conventionally used, but as a result of the inventor's research, cluster analysis in the case of psychogenic ED It has been found that it can be done using only three indices. The three indices are "psychological flexibility in ED" AFQ-ED, "sexual communication with partner" SRQ, and "general psychological flexibility" PFQ.
Once the patients have been classified into the appropriate clusters, a linking block 10B3 determines (links to) the effective treatment modules for the classified patient clusters (step S9). Then, the process proceeds to step S10.
Steps S7-S9 are executed in the module selection part 10B.
At step S10, the patient (for whom the therapy module has been determined) decides whether or not to log out of the system 100 at this time.
If the patient is satisfied with the treatment module presentation for the first access (Yes in step S10), the patient logs out and the first access ends for that patient. A case in which the patient accesses again (accesses for the second and subsequent times) will be described with reference to FIG. 7 .
If the patient desires not only the presentation of the therapy module but also the execution of the presented therapy module (No in step S10), the therapy module part 10C executes the therapy module selected in the module selection part 10B (step S11). The manner in which this is done depends on the contents of the therapy module.
After execution, the process returns to step S10.
Although not shown, in step S11 (and step S16 described later with reference to FIG. 7), treatment programs (exercises, work, etc.), homework, tips, etc., of treatment modules presented corresponding to clusters of patients. Part of the information such as user statistical data, user usage status, and user response examples can be transmitted to the patient terminal 3 . By transmitting a part of information such as treatment program, homework, tips, user statistical data, user's usage situation, user's answer example, etc. to the patient side terminal 3, , or offline, the patient can run a treatment program. Therefore, even if a problem occurs in the communication/network environment, or if the system 100 becomes inaccessible (deactivated) after the treatment is completed, the patient can still exercise or work (for example, Audio for attention training, etc.), homework, tips, user statistical data, user usage status, user response examples, etc., can be continued offline and interrupted treatment. can be used to maintain therapeutic effects and prevent recurrence.
Information such as exercises and workouts performed offline, homework, tips, user statistical data, user usage status, user response examples, etc. are not recorded by the system 100 as records of intervention. Exercises and workouts performed offline can be transmitted to the system 100 side in order to prevent such evaluation from becoming impossible.
When performing a therapy module, a recording of the therapy module performed can be configured to be audible.
Once the treatment module has been executed (step S11), the effect of the intervention is measured using cross-diagnostic (psychological flexibility) measures, cross-disease measures, existing evaluation scales, etc. (step S111: evaluation). After measuring the effect of the intervention, feedback is provided to the doctor/patient (step S112). When providing feedback, the patient's daily life data can be obtained and recorded using the patient's terminal 3, wearable device, or the like. This makes it possible to express the results of the effect measurement before and after the intervention in a report format in the form of graphs or the like, and provide feedback to doctors and patients. Then, for each predetermined number of times and period, we create a report that enables us to understand the treatment module and the changes (changes in evaluation indices due to intervention, changes in data in daily life, etc.), which are provided to doctors and patients. can be presented to
At the time of feedback (step S112), it is possible to send a message to the patient from the treatment application side, such as "The previous work and exercise was XX."
A patient who receives such a message has an impression that "I have not forgotten myself" and "I am being watched", and such an impression can increase the patient's motivation to continue using the therapeutic application.
In addition, in the feedback (step S112), by using emotion recognition AI based on facial expressions, it is possible to objectively judge the patient's emotions and the degree of stress.
In addition, if the patient wears an earphone with a built-in pulse sensor, body temperature sensor, etc., even in an environment where the voice cannot be heard due to noise, it is possible to detect everyday data, especially voice and vibration such as pulse. Data can be acquired under daily life. Similarly, body temperature data can also be obtained. For feedback, it is possible to determine emotional changes and stress of the patient from the pulse data and body temperature data thus obtained.
In the illustrated embodiment, daily life data can be utilized to visualize the degree of "psychological flexibility" and "mindfulness" in acceptance and commitment therapy (ACT).
As data under daily life, for example, a sensor is attached to the chest of the patient to measure the heart rate, and LF / HF (ratio of low frequency LF and high frequency HF power: sympathetic and (indicating the overall balance of the parasympathetic nervous system) can be calculated to present the state of the autonomic nervous system. Here, as the sensor to be attached to the patient's chest, a known and commercially available sensor can be used. The data measured by the sensor is transmitted as data to the information processing terminal 3 on the patient side and stored. By comparing the LF / HF obtained from the measured heart rate data with the LF / HF trend in the patient, it is determined whether there is an abnormality in the balance of the autonomic nerves of the patient at the time point, and treatment The effect can be confirmed.
In addition, hormone/stress levels can be measured and used as an evaluation index as daily life data. For example, cortisol and amylase in saliva are measured by a sensor and transmitted as data to the information processing terminal 3 on the patient side. Alternatively, the blood concentration of dopamine or serotonin can be measured by a sensor and transmitted to the information processing terminal 3 on the patient side to be used as an index of the effect of treatment. Serotonin can also be measured by identifying alpha waves using an electroencephalograph.
Here, cerebral blood flow can be measured as daily life data instead of electroencephalograms. For example, since hyperactivity in the right frontal pole is associated with self-attention, it is possible to measure brain activity in the right frontal pole with a cerebral blood flow (NIRS) sensor and use it as an index of anticipatory anxiety and self-attention. , it is possible to detect in real time the state of excessive self-consciousness.
In addition, physical quantities such as the number and frequency of conversations, the duration of the conversation, the amount of information in the conversation, and the amount of communication, which is the amount of information, can be measured with a smartphone (PCs and tablets can also be used), and used as data in daily life. can also As a method of measuring the amount of communication, it is also possible to detect an IC chip incorporated in a device such as a smart phone, and automatically measure the number of times the device comes close to the IC chip and the time spent close.
By acquiring and accumulating digital biomarkers, which are physiological data that can be acquired by wearable devices, etc., as data in daily life, it can be used to predict the onset of diseases, understand and manage conditions, etc., and improve the accuracy of assessment. can be improved. Then, it is possible to propose/provide more personalized and optimal treatment methods. Furthermore, it can be big data in algorithm development using machine learning and AI.
By utilizing this big data, for example, using AI, it is possible to predict diseases, and it is also possible to construct preventive measures based on the prediction. Interventions are then possible to prevent disease morbidity. Alternatively, big data is analyzed with AI, and based on the analysis results, a therapeutic application with content that matches the individual patient's personality, degree of disease, etc. (content that suits each individual patient), that is, for each patient It will be possible to provide customized applications.
Here, the information processing terminal 3 (for example, smart phone, PC, tablet, wearable device, etc.) on the patient side can be provided with a function as a "life record table" for recording daily life data. Conventionally, patients recorded data under daily life on paper media, but by electronically recording data under daily life on the "life record table", it is possible to use smartphones, PCs, tablets, wearable devices, etc. Due to the simplicity of operating the , it becomes possible to record real-time data under daily life. When recording on paper media, there is a tendency to collect and record living data for that period after a certain period of time has passed, which may result in bias may be filled out on paper). By electronically recording daily life data in the information processing terminal 3 on the patient's side in real time, such biases and recollections of false memories are prevented, and daily life is more appropriate and appropriate than recording on paper media. You can save the following data.
As described above, in the present invention, it is possible to visualize the degree of "psychological flexibility" and "mindfulness" in acceptance and commitment therapy (ACT) by utilizing daily life data. As an example of psychological data in daily life data, for example, using the method of ecological instant evaluation (EMA), ask people to respond to their moods, emotions, and thoughts at that moment on the spot every morning and every night. Things are mentioned. It is possible to prevent memory from being biased by asking questions to be answered on the spot at that moment (answered in real time). Here, "every morning, every night" was exemplified as the timing of answering, but it is not limited to a fixed time, but a certain time zone (for example, 7:00 to 8:00 in the morning, 19:00 to 22:00 in the evening) ), you can be encouraged to answer by randomly sending a reminder notification.
In addition, the ecological instantaneous evaluation (EMA) method is based on heart rate, blood pressure, blood oxygen concentration, number of steps, sleep time and sleep quality (deep/light sleep, etc.), activity level, activity range (action history: For example, it is applied to physiological data such as measurement and acquisition by GPS) and blood sugar level.
For the evaluation in step S111, for example, the patient inputs the response of the measurement index (of the effect of the intervention). When 3 is a smartphone or PC, the camera is used to measure the patient's pupil opening and closing, the direction of the line of sight, the number of blinks, the number of breaths and the body temperature, or the complexion. Objective information can be monitored at the time of index input. Therefore, by objectively monitoring the accuracy of the answers and the condition of the respondent, for example, the patient who is the respondent entered the measurement index carelessly, It is possible to suppress inputting, stress, and the like. Furthermore, heart rate, blood pressure, etc. can be measured.
Here, when the patient responds by voice, etc., the patient's voice is analyzed and judged by AI to determine whether the patient is seriously working on treatment, or the degree of seriousness of the patient ( It is possible to determine the patient's seriousness).
Although not shown in the figure, a device such as an odor sensor, an electroencephalogram sensor, a cerebral blood flow sensor, etc. is worn, objective information of the respondent is obtained by the sensor, the mental and physical state of the respondent is measured, and a cluster is obtained. It can also be used as a factor in analysis.
According to the evaluation after the intervention in step S111, the patient can be automatically instructed to do homework (step S113). In step S113, the next intervention (access to the system 100) can be automatically proposed or instructed according to the evaluation after the intervention. This makes it possible to repeat the access until the problem is improved. In addition, in step S113, the patient who accesses the system 100 can sequentially watch videos, music, sounds, and other contents (eg, mindfulness meditation) related to or useful for treatment (Tips). . Tips offers content such as mindfulness meditations, scents, music, videos, vibrations, and information about preferred foods/diet. Such content brings improvement of QOL, which is an index showing therapeutic effect, its continuation, and degree of satisfaction, by using the five senses.
As described above, the patient who has been authenticated in step S2 can immediately proceed to step S113 and view the content.
After step S113, the user logs out (step S114). After logging out, when actually going to the hospital, a medical examination/interview is performed by a doctor while referring to records of interventions and evaluations in the system 100 and acquired daily life data.
Next, with reference to FIG. 7, the second and subsequent accesses will be described.
Steps S1 and S2 are the same as explained in FIG. As described above, the login/authentication part 10H issues, for example, a prescription ID and password, and verifies the identity of the accessing patient. Although not shown in the figure, for example, with the consent of the patient in advance, the number of times of access and the period after the first access (treatment period) are appropriately set, and if the set number of times or period is exceeded It can be deactivated. Even if access to the system 100 becomes impossible due to deactivation, the patient can access the system 100 again under the direction of the doctor in charge.
Then, the process proceeds to step S13, and steps S3, S4, and S6 (interview, cross-diagnostic assessment, and disease-specific assessment) described with reference to FIG. 6 are executed. Then, the process proceeds to step S14. Although not shown, the patient authenticated in step S2 can immediately proceed to S113 (homework, tips) without executing step S3 and subsequent steps.
In step S3, since it is expected that the content will be the same as that of the first access, it is possible to omit the input.
In step S14, with reference to the interview, cross-diagnostic assessment, and disease-specific assessment, the assessment part 10D determines whether the patient is improving, cross-diagnostic (psychological flexibility) measures and cross-disease Objective measures measure the effectiveness of previous interventions. Also in step S14, the patient's terminal 3 or wearable device is used to acquire and record data under daily life, and the results of the effect measurement before and after the intervention are expressed in a report format using graphs, etc. It is possible to give feedback to the patient.
If it is determined that the evaluation part 10D has improved (Yes in step S14), the process proceeds to step S15.
If it is determined that there is no improvement (No in step S14), the process proceeds to step S16. At step S16, the treatment module presented on the previous access is executed.
Although not explicitly shown in FIG. 7, as described with reference to FIG. 2, if the patient wishes to immediately execute the treatment module, steps S13, S14 and S16 are skipped after being authenticated in step S2. , it is possible to proceed immediately to step S16.
When it is determined that there is no improvement (No in step S14), if it is determined that there is no improvement even if the selected treatment module is repeated for a predetermined period or number of times, the module selection part 10B performs the first treatment. Other treatment modules selected in the access are suggested.
Alternatively, a new treatment module is proposed in the module selection part 10B based on the cross-diagnostic assessment and disease-specific assessment of step S13.
At step S17, the patient chooses whether to log out of system 100 or not. If the user does not log out, the treatment module is continued (loop of No in step S17).
At step S15 (if step S14 is Yes), the patient logs out of system 100 and proceeds to step S18.
In step S18, for example, in the evaluation part 10D, it is determined whether follow-up is necessary. At that time, in the evaluation part 10D, the possibility of recurrence is determined based on interviews, intakes, diagnostic cross-sectional assessments, and disease-specific assessments. If there is a possibility of recurrence (Yes in step S18), after a predetermined period of time has elapsed, the system 100 accesses the information terminal on the patient side and conducts follow-up observation by interviewing predetermined items (step S19). ).
Although not shown in FIGS. 6 and 7, it is also possible to periodically or irregularly send messages such as reminders and encouragement to encourage the use of the treatment application to the patient, and to apply game-like elements. is. Additionally, it is possible to reward the patient in some way for accessing the system 100 . Then, it is possible to increase the motivation to access the system 100 and actively execute the treatment application, and to strengthen the "positive" behavior of continuing treatment (continuously using the treatment application). be.
As a result, the patient's willingness to continue using the system (willingness to access the system 100 and continue executing the treatment module) is increased, and a situation in which the patient stops accessing the system 100 during treatment (drops out during treatment) is suppressed. and improve the therapeutic effect of the system 100 (or the effect of the therapeutic application).
Although not shown, when performing cross-diagnostic assessment, disease-specific assessment, treatment module (treatment program: exercise), work, homework, tips, evaluation, etc., voice questions using smart speakers etc. It is configured to enable the patient to input, record, and respond to items read aloud, instructions, guidance, etc. by voice, and to exhibit a function that interacts with voice (interactive function). Is possible.
In the illustrated embodiment, the server 10 can be customized to correspond to diseases, customized to correspond to applications on the patient side, and the like. A known technique can be applied to the customization method.
Although not clearly illustrated, in the illustrated embodiment, the patient's treatment/behavior, such as taking medication, is recorded, and the record can be checked by the doctor. The check can be performed via the information processing terminal 4 on the side of the medical institution, or can be directly checked by a doctor.
In the illustrated embodiment, for example, a calendar function is installed in the information processing terminal 3 on the patient side in order to record the patient's treatment/behavior. It is possible to configure so that action records (for example, records related to sexual activity in the case of an ED patient) can be entered. A doctor can then check the records for each date in the calendar.
Further, in the illustrated embodiment, a medical examination by a doctor (including the case where the patient visits a medical facility for examination, and the case where the examination is performed using the online function provided in the system 100) is performed every predetermined period (for example, two weeks). It is possible to determine a treatment policy, a prescription of drugs used for treatment, a set of works, etc., according to the situation of the patient. At that time, assessment (diagnostic cross-sectional assessment, disease-specific assessment) can be performed again, classification into a specific group based on cluster analysis can be performed, and work to be provided to patients can be newly set. Then, it is also possible to utilize the results of the newly executed assessment for medical examination.
Treatment policies, prescriptions, work contents, etc. can be changed in response to changes in daily life data and EMA without changing the specific group (for example, cluster 1) to which the patient belongs.
By performing a medical examination by a doctor at predetermined intervals and providing new work, personalized treatment can be provided for each patient. This allows us to provide the best possible treatment.
It should be noted that medical examinations by doctors, newly set treatment policies, drug prescriptions, work sets, etc. can be recorded in the database 10F or the like.
According to the system 100 of the illustrated embodiment, when treating a patient, it is possible to determine how adaptively the patient behaves with respect to psychosocial problems, life adjustment, stress, etc., while utilizing daily life data. A cross-diagnostic assessment to assess whether or not the patient is acting maladaptically, and to identify the disease, and to what extent the patient is able to behave adaptively in response to the symptoms characteristic of the disease Or, based on the results of a disease-specific assessment that assesses whether the patient is behaving maladaptically, the optimal treatment module can be provided to the patient.
Then, after executing the selected treatment module, the evaluation scale is applied to evaluate the treatment effect by evaluation part 10D, and the evaluation result is fed back to the patient, and if the treatment effect is not evaluated well, , the evaluation result is sent to the module selection part 10B, where a new treatment module is selected. For example, it is possible to suggest a therapeutic module selected based on the results of a cross-diagnostic assessment when the therapeutic module selected based on the results of the disease-specific assessment was less effective.
Here, the patient's daily life data is acquired and recorded using the patient's terminal 3 or wearable device, etc., and the results of the effect measurement before and after the intervention are expressed in a report format using graphs, etc., and the doctor / patient It is also possible to give feedback to
The illustrated embodiment, which constitutes a platform that combines a cross-diagnostic assessment part 10A1 and a disease-specific assessment part 10A2, focuses on process rather than "results." For example, in the case of a patient with psychogenic ED, whether or not the patient's psychosocial process has progressed and the flexibility of the mind has improved is more important than whether or not the symptom of "not being able to get an erection" has improved. Focus. If the stage of the psychosocial process progresses and the flexibility of the mind improves, new behavioral patterns are acquired and learned. It is possible to broaden the range of thinking, such as "It's okay" and "The relationship with a partner is not all about sexual activity", and as a result, psychogenic ED can be cured.
According to the illustrated embodiment, by providing the optimal treatment module and performing treatment by process-based CBT, it is possible to achieve a certain effect after customizing for each patient or each type of disease. is. Then, cross-diagnostic and disease-specific assessments are performed using quantitative metrics to determine clusters, thereby personalizing and optimizing treatment. For example, therapeutic effects can be exhibited for depression, anxiety, lifestyle-related diseases, chronic pain, sexual dysfunction, psychogenic erectile dysfunction (ED), various addictions, and the like. In addition, therapeutic effects can be exhibited even when these diseases are complicated.
By applying the system 100 of the illustrated embodiment, if the patient can act adaptively to psychosocial problems, life adjustment, stress, etc., blood pressure is stabilized, blood flow is improved, and autonomy is achieved. Nerves are regulated and immunity is improved. Therefore, the system 100 of the embodiment having the server 10 as described above can also be applied to prevent infectious diseases such as coronavirus.
In addition, the illustrated embodiment can use quantitative metrics, objective monitoring methods, and cluster analysis, so it is possible to clearly explain the algorithm of the program to a third party, and actually It is easy to use as evidence by the results of Therefore, it becomes easy to prepare data necessary for various approvals.
Although not shown, the systems or methods according to the illustrated embodiments can be used by more than one person together. For example, partners of patients with ED and infertility (male, female), families and supporters of patients with depression and anxiety disorders share information and content necessary for treatment with patients, and exercise related to treatment modules. By working together with the patient, you can accompany the patient and deepen your understanding and practice of the disease and how to help. As a result, the patient can actively participate in the decision of the treatment policy, receive treatment according to the decision (adherence), and improve the treatment effect.
It should be noted that the illustrated embodiment is merely an example and is not intended to limit the technical scope of the present invention.
For example, although the illustrated embodiment primarily illustrates psychogenic ED treatment, the present invention may also be used to treat spousal or partner relationship problems, depression, obsessive-compulsive disorder, panic disorder, agoraphobia, generalized Anxiety, social anxiety, speech anxiety, specific phobia, post-traumatic stress disorder, insomnia, irritable bowel syndrome, eating disorders and obesity, obesity and other lifestyle diseases, bipolar disorder, borderline personality Disability, attention deficit/hyperactivity disorder, chronic or persistent pain, sexual dysfunction, relationship problems with a spouse or partner other than erectile dysfunction, alcoholism and other addictions, schizophrenia and other severe psychoses, infertility (male, female), atopic dermatitis, overactive bladder (urinary incontinence), anti-aging, menopause, premenstrual syndrome (PMS), psychogenic visual disorder, psychosomatic dentistry, dysmorphia, etc. It is applicable even if these diseases are complicated.
And, in the illustrated embodiment, assessment of multiple coexisting disease symptoms/conditions is possible, and personalized and optimal cross-diagnostic treatment can be suggested or provided. For example, in an app for psychogenic ED, co-morbid tendencies such as depression, anxiety, and diabetes can also be assessed. Alternatively, multiple indefinite complaints can be used to assess menopausal disorders.
(Examples of therapeutic applications for psychogenic disorders, psychosomatic disorders, and stress-related disorders (anxiety disorder treatment applications))
The configuration of the system, the procedure for performing the assessment, the collection of information such as EMA, and the exchange of information between doctors and patients can be performed in the same manner as in the treatment application described above.
In the practice of the present invention, two indicators "Leibovitz Social Anxiety Scale" LSAS-J and "General Psychological Flexibility" PFQ are used for classifying a specific group (cluster analysis), for example in the case of social anxiety. be able to.
A cluster analysis is performed based on the evaluation results of these indicators, and, for example, classification is performed into the following clusters.
Cluster 1: Extremely high standards (must speak perfectly fluently, must be seen as intelligent and witty), Cluster 2: Conditional beliefs (If X, then Y) (If If I say something different, I'll be ridiculed, I'll look bad if people notice that I'm anxious, people won't talk about me if they're not interested in me), Cluster 3: Unconditional Belief ( I'm boring, I'm floating, I'm weird, I'm suspicious)
Then, in the same way as the above-mentioned treatment application, the work corresponding to the above cluster is provided to the patient (integrated database of various applications)
FIG. 8 shows an example of the integrated database. In FIG. 8(A), a treatment platform 901, an ED treatment application group 911, an anxiety disorder treatment application group 912, the Internet 950, a management server 931, and FIG. 8(B), a treatment platform 902 and an ED treatment application. A group 911, an anxiety disorder treatment application group 912, the Internet 950, a management server 932 for the ED treatment application 911, a management server 933 for the anxiety disorder treatment application group 912, and an integrated control of the data of the management server 932 and the management server 933. integration server 934 is included. Here, an example in which two therapeutic applications are included in the platform is shown as an example, but the number of therapeutic applications is not limited to this. Not only that, mental health care apps can also join the platform.
Each treatment application group includes an information processing terminal capable of executing each treatment application and a patient using the information processing terminal. FIG. 8A shows a case in which a management server is provided to centrally manage a plurality of treatment applications, and FIG. 8B shows a case in which a management server is provided for each treatment application. There is provided an integrated server that controls the availability of The integrated server 934, for example, makes the common data of the management server 932 available in response to a call from the management server 933, or vice versa. Alternatively, the common data of the management server 932 and the management server 933 are stored in the integrated server 934 so that the data of different management servers can be shared.
FIG. 9 shows data such as patients and evaluation values contained in the management server 931 of the treatment platform 901 . Here, reference numerals 101, 102, 103, 201, 202 indicate patient numbers, 101, 102 ~ are data obtained from users of ED treatment applications, 201, 202 ~ are users of anxiety disorder treatment applications shows data taken from The indices and EMA data are merely examples, and may be configured to include other indices, EMA, and other data. In the case illustrated in FIG. 8, index A indicates the input result of a cross-diagnostic scale based on common cognitive behavioral therapy for multiple applications, index B indicates ED, and index C indicates anxiety disorder. shows the evaluation results of a scale specific to Further, EMA_A indicates the result of measuring body temperature as data under daily life, and EMA_B indicates the result of measuring blood pressure as data under daily life.
The present embodiment is characterized in that the evaluation result of the index A, which is the common scale, is shared by both the ED treatment application and the anxiety disorder treatment application. Conventionally, data management was performed for each application, but the present invention is characterized in that a common portion of data of applications having common data can be shared.
FIG. 10 shows an example of cluster analysis using common parts. FIG. 10A shows an example of cluster analysis of the ED treatment application, and FIG. 10B shows an example of cluster analysis of the anxiety disorder treatment application. In the ED treatment application shown in FIG. 10(A), the index A and the index B are input to the patient via the patient's information processing terminal. Next, the management server calculates an evaluation result from the input. Subsequently, the management server compares (1) type A when the evaluation result of index A is less than 30, and (2) further evaluation value of index B when the evaluation result of index A is 30 or more, and 40 If it is less than 40, it is classified as type C, and if it is 40 or more, it is classified as type D. In the anxiety disorder treatment application shown in FIG. 10B, the patient inputs the index A and the index C via the patient's information processing terminal. Next, the management server calculates an evaluation result from the input. Subsequently, the management server compares (1) type A when the evaluation result of index A is less than 30, and (2) further evaluation value of index C when the evaluation result of index A is 30 or more. If it is less than 20, it is classified as type E, and if it is 20 or more, it is classified as type F.
Here, the feedback results of the therapeutic effects of type A and type B, which are classified based on index A, and the treatment modules (work) prescribed according to the types are evaluated, and for example, the therapeutic effect is If it is low, the threshold for cluster analysis of the evaluation values of index A can be changed according to the correlation between the evaluation result of index A and the type and therapeutic effect, such as changing the threshold from 30 to 35. Here, even if the workpieces prescribed for type A and type B are not the same, but similar workpieces are prescribed, the threshold can be changed using the feedback results of both. In other words, the amount of correlation data increases compared to the conventional case where the evaluation value threshold is changed based on the data for each application, and the numerical value can be further optimized.
In this example, it was shown that the statistical analysis threshold is optimized simply from the viewpoint of common data and treatment effect. Relationships can also be analyzed, especially with the help of AI. Here, the statistical analysis also includes classification by AI.
In the above-described embodiment, an example of using common data of scales used for different diseases to optimize cluster analysis for classification (personalization) was shown, but it can also be used to optimize prescriptions for each type. FIG. 11 shows a list of correspondences between types and prescriptions stored in the management server. In the assessment block, symptoms and factors are categorized into types, and prescriptions (work) are provided according to this list. FIG. 11(A) is a correspondence table of types originally stored in the management server and prescribed works. Here, an example of type A modification will be described as a symptom (or factor) of a disease. In the case where the type classification shown in FIG. 10 is performed, the types classified into type C, type D, type E, and type F are first referred to. If the evaluation value of index A is relatively high 25 to 30 and the therapeutic effect of type C and type E (both include work 3) is low, work for the group with high evaluation value of index A On the other hand, when type D and type E are compared and type D has a higher therapeutic effect, work 5 is judged to have a higher correlation with the high value of index A than work 3. , the correspondence table is updated as shown in FIG. 11(B), and thereafter, each type of prescription is made according to the updated correspondence table. However, it is also considered to return to the original if the treatment effect is reduced. In the present embodiment, common work is provided according to the type of cognitive behavioral therapy, which is convenient because it facilitates correlation.
In the above explanation, we have explained that the management server has blocks and databases that perform assessment functions, but it is sufficient if any of the systems have these functions, for example, all functions are installed in smartphones. may In addition, it is also possible to link with databases of healthcare platforms such as electronic medical records and health checkups, and add test results, treatment data, and health conditions contained in them as personal data and use them for analysis. It is convenient to use AI from the viewpoint of selecting superior data for these. Also, these databases may be used as an integrated database.
Psychogenic diseases, psychosomatic disorders, and stress-related diseases often coexist with multiple psychogenic diseases and stress-related diseases. The use of cross-diagnostic scales is extremely useful for identifying cognitive and behavioral patterns that lead to symptoms. By sharing the common scale, the effect of further improving the understanding and treatment of diseases can be obtained.
(How to create indicators using AI)
From the correlation between the wording used for the index and the therapeutic effect, it is possible to create an effective index by selecting a wording that is actually strongly correlated with the therapeutic effect. This correlation can be done using AI. Here, the index is mainly intended to be an index using words, but the index also includes evaluation scales using visual and auditory senses.
(Therapeutic App Conformance Routine)
Applicability for treatment differs depending on the patient's symptoms. For example, if a depressed patient has suicidal thoughts, it is dangerous to use the treatment app alone, and cooperation with treatment by a doctor is preferable. Patients who have been depressed for more than two years should also be combined with drug therapy to improve cognitive distortions. If it is mild or moderate, treatment with a therapeutic app alone is effective, or if there are no mental symptoms due to an organic disease, the use of a therapeutic app cannot be expected to be effective. In this way, assessing the suitability of therapeutic applications is effective not only for depression, but also for all psychogenic and psychosomatic disorders, improving symptoms and ensuring treatment safety. The system uses a depression scale provided in the database 10F (depression check simple depressive symptom scale (QIDS-J), 0-5 points, normal, 6-15 points, mild to moderate, 16 points or more, severe), The Begg suicidal ideation scale (SSI) is read out and transmitted by the control device 1 to the information processing terminal 3 on the patient side. FIG. 12 is a flow diagram of this suitability assessment. Although depression is shown as an example in this example, it goes without saying that it can be applied to other diseases as well. In this example, the control device 1 of the system presents QIDS-J, SSI, and depression history to the user via the user terminal, and when the user's answer is obtained, the result is transmitted to the control device 1 of the system, After analysis, first, if the SSI results show that the risk of suicide is high, the system recommends the user to see a medical institution. Next, if the risk of suicide is not high, the severity of depression will be determined based on the results of QIDS-J, and if it is mild or moderate, treatment will be started using the therapeutic app. In addition, in the case of severe cases, it is connected to a medical institution terminal (not shown) and online medical treatment is performed. Here, if the history of depression is two years or more, treatment with drugs prescribed by online medical treatment and a treatment application will be performed. conduct. Here, drug administration management such as drug administration history and administration plan, treatment effect of online medical treatment, treatment schedule management, and the like may be performed by the treatment application system. This suitability assessment can be combined with, or preceded by, the previous assessment to improve efficiency. A detailed implementation method of this assessment can be realized by referring to the above-mentioned assessment procedure and a known information terminal and user input/output method.
(program based on therapeutic app)
Currently, many of the therapeutic applications and mental health applications that are widely distributed focus only on the symptoms, and many of them only provide means such as listening to music that relieves frustration when one is irritated. These apps may temporarily improve the symptoms, but they cannot eliminate the cause of the symptoms. In the present invention, based on the knowledge that psychogenic diseases and psychosomatic disorders are based on the patient's biopsychosocial factors, treatment modules consist of multiple categories (relaxation, stress management, improvement of cognitive distortion, improvement of symptoms). Offer a program. For example, first, we provide modules for relaxation (novel relaxation, abdominal breathing, visual imagery, etc.), which are cross-diagnostic therapeutic modules; behavioral reflection work, etc.), then modules that improve cognitive distortions (polar bear experiments, cognitive restructuring methods, etc.), and finally disease-specific treatment modules that improve symptoms (mind Fullness, biofeedback method, autonomic training method, music that regulates the autonomic nervous system, exercise, etc.), intervene not only in symptoms but also in the causes of psychogenic diseases and psychosomatic disorders, aiming for a complete cure, or The aim is to improve the efficiency of treatment. For this purpose, the system stores in the database 10F an entry list that records the correspondence between these modules for treatment, clusters by disease or assessment, and program sets for treatment corresponding to them. After performing the assessment with the information processing terminal, treatment can be started using a treatment program set corresponding to the disease and the cluster based on the assessment result. The categories included in the program and the treatment modules in the categories are set in advance based on treatment efficiency and the like, but they can be rearranged as described above. The above example shows an example of a combination of a cross-diagnostic treatment module and a disease-specific treatment module. Needless to say, it can be designed as appropriate.
(Consideration of personality)
A treatment application requires a patient to perform a treatment module according to a predetermined treatment plan (program in the present invention) for a certain period of time. However, there is a problem that the implementation status varies depending on the patient's personality and familiarity with the application. Therefore, the treatment efficiency can be improved by performing character judgment on the patient and changing the input/output method, UI/UX, and treatment program according to the character judgment result. Specifically, for example, a personality diagnosis test based on the "Big Five Theory", which is the most supported theory in psychological research, is conducted, and the treatment module is changed according to the personality.
For example, this personality test may be performed prior to or after the cross-diagnostic and disease-specific assessments described above to further subdivide the clusters by personality. The database 10F has a plurality of treatment program sets corresponding to clusters. For example, Abdominal Breathing, which is also included in the same category, is not just a single treatment module, but a Big Five analysis, a visual-oriented, video-based module for extroverted and open users, or For those who are highly cooperative and sincere, we will provide modules that explain the same content in detail in sentences. In this way, a plurality of types of modules expected to have the same effect in the same category are stored in the database 10F. Treatment is realized by recording the corresponding relationship with the program set for use and providing the corresponding program set at the time of treatment. This can further improve treatment efficiency. The correspondence in this list can also be updated according to the treatment results, and the correspondence can be corrected by AI. The detailed implementation method of this assessment can be realized by referring to the above-described assessment procedures and known information terminal and user input/output methods. Here, we have exemplified the provision of modules with different phenotypes, expecting the same effect depending on the difference in personality, but other modules that change the expression method, such as replacing the character display module with the voice provision module, can also be used. Good (in this case, it corresponds to the user's visual and auditory impairment). In this respect, it is different from memorizing different songs for adjusting multiple autonomic nerves.
(Example of a functional module of a treatment application system)
FIG. 10 shows an example of functional modules of a treatment program provided by the treatment application system provided in the present invention; FIG. In (a), the treatment program includes a cross-diagnostic assessment module and a disease-specific assessment module, the patients are clustered based on the patient's responses to the items for both assessments, and the It provides a cross-diagnostic treatment module and a disease-specific treatment module. (b), the treatment program includes only a disease-specific assessment module, the patients are clustered based on the patient's answers to the items for assessment, and the diagnostic cross-sectional treatment module and disease according to the cluster It provides a specific therapeutic module. (c), the treatment program includes only a cross-diagnostic assessment module, the patients are clustered based on the patient's answers to the items for assessment, and the cross-diagnostic treatment module and disease according to the cluster It provides a specific therapeutic module. (d) provides a cross-diagnostic treatment module and a disease-specific treatment module without including an assessment module. These modules are configured as software and realized by a server or a user's information processing terminal, but they may be configured by a combination of hardware having respective functions instead of software. Moreover, each functional module is completely included in the user's information processing terminal, and even if the user's information processing terminal operates stand-alone, each functional module is included in the server, and the user's information processing terminal connected to the server is included. The information processing terminal can be realized by a device used only for display or input/output, or a device in which functional modules are divided into both the server and the user's information processing terminal. Cross-diagnostic assessments and cross-diagnostic treatment modules are typically directed at psychiatric features across psychogenic and psychosomatic disorders, and disease-specific assessments and cross-diagnostic treatment modules are typically addressed. are directed to disease-specific symptoms such as, for example, insomnia, menstrual symptoms and ED.
(app clipping)
In this embodiment, sharing of scales will be described. ED treatment application group 911, anxiety disorder treatment application group 912, and management server 931 in FIG. 8A treatment platform 901 will be described. Here, the management server 931 includes measures A, B, C, D, and E, for example. Scales A and B are scales for cross-diagnostic assessment, scales C and D are disease-specific scales for treating ED, and scale E is a scale for treating anxiety disorders. Each treatment application 911, 912 accesses the management server 931 to perform assessment, and performs assessment using a predetermined scale required for each treatment. In the conventional application, each application had its own scale, so when the scale was updated, it was necessary to update the information for each downloaded application. is efficient because it only needs to update the scale on the server.
In the examples I have discussed so far, the word "treatment" is used, but this is not limited to treatment of disease, but naturally includes self-care, maintenance and improvement of mental health, etc. The word "patient" also applies to healthy people. Needless to say, it also includes those who have some kind of mental disorder.
　複数の種類の異なる治療用アプリの共用データ部分を統合したプラットフォームを構築する。さらに、共通データと患者に与える効果との相関関係を蓄積することによって、治療法の改善、新たな治療法の発見につなげることができる。 Build a platform that integrates the shared data parts of multiple types of different treatment apps. Furthermore, by accumulating correlations between common data and effects on patients, it is possible to improve treatment methods and discover new treatment methods.
１　　　制御装置
３　　　患者側の情報処理端末（例えばスマートフォン）
４　　　医療機関側の情報処理端末（例えばＰＣ）
１０　　サーバー
１０Ａ１　　　　診断横断的アセスメントパート
１０Ａ２　　　　疾患特異的アセスメントパート
１０Ｂ　モジュール選択パート
１０Ｃ　治療モジュールパート
１０Ｄ　評価パート
１０Ｆ　データベース
１０Ｈ　ログイン・認証パート
１００　システム 1 control device 3 patient-side information processing terminal (for example, smart phone)
4 Information processing terminal on the medical institution side (for example, PC)
10 Server 10A1 Cross-Diagnostic Assessment Part 10A2 Disease-Specific Assessment Part 10B Module Selection Part 10C Treatment Module Part 10D Assessment Part 10F Database 10H Login and Authentication Part 100 System

Claims (6)

  1. 　共通する心因性疾患・心身症・ストレス関連疾患の、複数のあるいは診断横断的な尺度を用いる、複数の異なる種類のアプリケーションプログラムと、
    　前記複数の種類のアプリケーションプログラムから取得される共通する尺度の評価データを統合して利用可能とされたデータベースと、
    　前記複数の種類のアプリケーションプログラムから取得された共通項目の統合された評価データと、前記複数の種類のアプリケーションプログラムから取得された非共通項目の評価データとを用いてデータの分析を行う分析ブロックと、を含むデータベースシステム。     multiple different types of application programs that use multiple or cross-diagnostic measures of common psychogenic, psychosomatic, and stress-related illnesses;
    a database made available by integrating evaluation data of a common scale obtained from the plurality of types of application programs;
    an analysis block that analyzes data using integrated evaluation data of common items obtained from the plurality of types of application programs and evaluation data of non-common items obtained from the plurality of types of application programs; , a database system including;
  2. 　前記複数の種類のアプリケーションプログラムがメンタルヘルスケアおよび／またはストレス関連疾患治療用のプログラムであり、前記共通項目が心因性疾患・心身症・ストレス関連疾患症状や状態に横断的な評価（及び日常生活下データ）に関する項目であり、前記非共通項目が特有の心因性疾患・心身症・ストレス関連疾患症状や状態の評価（及び特有の性疾患症状に対する日常生活下データ）に関する項目であることを特徴とする、心因性疾患・心身症・ストレス関連疾患症状や状態に関して用いられる請求項１のデータベースシステム。 The plurality of types of application programs are programs for mental health care and/or stress-related disease treatment, and the common item is a cross-sectional evaluation (and daily life) of psychogenic disease, psychosomatic disease, stress-related disease symptoms and conditions. The non-common items are items related to the evaluation of specific psychogenic disease, psychosomatic disease, stress-related disease symptoms and conditions (and daily life data for specific sexual disease symptoms). 2. The database system of claim 1 used with respect to psychogenic diseases, psychosomatic diseases, and stress-related disease symptoms and conditions, characterized by:
  3. 　前記分析ブロックは、前記アプリケーションプログラムからの入力に応じて、その利用者の心因性疾患・心身症・ストレス関連疾患症状や状態をもたらすタイプ分けを統計解析やＡＩを用いて行う機能を有する請求項１または請求項２のいずれかに記載のデータベースシステム。 According to the input from the application program, the analysis block has a function of classifying the user's psychogenic disease, psychosomatic disease, stress-related disease symptoms and conditions by using statistical analysis and AI. 3. The database system according to claim 1 or claim 2.
  4. 　前記タイプ分けと処方されるワークの対応関係を示すリストを有し、前記リストが前記分析ブロックによって更新されることを特徴とする請求項ないし請求項３のいずれかに記載のデータベースシステム。 4. The database system according to any one of claims 1 to 3, characterized by having a list showing the corresponding relationship between the typing and the work to be prescribed, wherein the list is updated by the analysis block.
  5. 　前記分析ブロックによって、前記タイプ分けのアルゴリズムが更新されることを特徴とする請求項１ないし請求項４のいずれかに記載のデータベースシステム。 The database system according to any one of claims 1 to 4, wherein the analysis block updates the typing algorithm.
  6. 　前記共通項目が、認知行動療法に基づく評価指標の尺度の評価である、請求項１ないし請求項５のいずれかに記載のデータベースシステム。 　The database system according to any one of claims 1 to 5, wherein the common item is an evaluation of an evaluation index scale based on cognitive behavioral therapy.
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