远程医疗最新文章合辑
The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.
To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.
This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.
The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV1%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV1/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV1%pred, FEV1/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV1%pred, FEV1/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV1%pred, FEV1/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .
The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.
In China, the overall prevalence and incidence of cardiovascular disease (CVD) continues to increase, and the mortality rate from CVD in rural areas has exceeded that in urban areas recently. Remote ECG-based screening for CVD risk is a beneficial supplement for CVD risk screening in primary hospitals, but there are many difficulties during its implementation, which mainly include the following aspects: how to improve the awareness and credibility of remote ECG-based screening for CVD risk and sense of gain in residents? How to incentivize primary physicians to actively participate in the screening? How to improve insufficient management ability and experience of primary physicians who can only provide single screening and communication services? How to build a collaborative mechanism between primary and higher level hospitals involved in delivering referral services, and to provide continuous services by establishing multiple teams consisting of screening team, diagnosis team, evaluation team, treatment team and follow-up management team? To address these issues, we invited a group of experts to attend discussions, in which the following recommended solutions were put forward: using various resources rationally and efficiently; strengthening the division of labor and cooperation between team members to improve hierarchical diagnosis and treatment; giving full play to the capacities of nursing and public health teams to develop different screening programmes; strengthening the technical support of experts from higher level medical institutions for primary doctors, and increasing the social benefits of primary hospitals; carrying out workplace training to improve the professional level of primary care workers; integrating Internet technologies into primary care to enable referrals; building a big data database of cases; constructing medical and health groups with clear defined division of labor and cooperation.
Obstructive sleep apnea (OSA) is a high prevalent chronic disease that may lead to many complications, and cause great potential harm to health. Epidemiological studies have showed that OSA is closely related to the development of various cardiovascular diseases. There are about 66 million patients with moderate to severe OSA in China, but 80% of potential OSA patients have not been diagnosed and treated in time. OSA is mainly diagnosed and treated in a hospital-based sleep center currently, as the process is time-consuming and laborious, which may be lead to a delay in diagnosis and treatment of many patients. Supported by the development of Internet of Things, Internet technologies and other emerging technologies, remote medicine has been increasingly used in the diagnosis and management of chronic diseases owing to its advantages of easy access, interactivity, high efficiency, resource sharing, service continuity and without space-time constraints. Our center has initially built a management system for remote diagnosis and treatment of OSA, but its clinical efficacy and economic value need to be further verified. We designed a randomized controlled trial protocol to assess whether the clinical benefits of the low-cost remote healthcare model are similar to those of the traditional healthcare model by comparing them in terms of clinical efficacy and health economic benefits, hoping to provide a reference for the efficient use of medical resources and further promotion of remote diagnosis and treatment of chronic diseases.
Scoliosis is a common abnormal curvature of the spine. Patients with mild scoliosis are usually treated with outpatient physiotherapy, but satisfactory efficacy is associated with appropriate treatment time and frequency. The efficacy of offline physiotherapy may be affected by limited medical resources and patients' treatment time and geographical location. Remote rehabilitation may save patients' treatment time and increase the geographical accessibility of physiotherapy, making the therapy more simple and convenient.
To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis (AIS) .
Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine, Tianjin Hospital from September 2020 to September 2021, and divided into three groups according to patients and their parents' selection of treatment: online group (n=18), combined group (n=20) and offline group (n=20). The online group received WeChat- and Tencent Video-based physiotherapeutic scoliosis specific exercise (PSSE), the combined group received both outpatient and WeChat- and Tencent Video-based PSSE treatment, and the offline group received outpatient PSSE treatment. Data of three groups were collected, including the main curve Cobb angle, coronal balance (CB), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, sagittal vertical axis (SVA), angle of axial trunk rotation (ATR), parietal vertebra rotation (Raimondi), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), muscle activation rate (MAR) on both sides of paraspinal vertebrae, root mean square ratio (RMSR) of paraspinal muscles on both sides of paraspinal vertebrae, and the score of SRS-22 before and after treatment.
The main curve Cobb angle, TK, SVA, ATR, Raimondi, SS, MAR on paraspinal vertebrae, RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups (P<0.05). Specifically, the combined group was superior to the other two groups in improved ATR and treatment satisfaction. The combined group had significantly improved main curve Cobb angle after treatment than the online group. The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group (P<0.05) .
In mild AIS patients, remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve, improve sagittal abnormality of spine, abnormal posture and vertebral rotation, increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae. Moreover, the combined therapy also improved the quality of life.
Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it.
To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke.
In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke.
A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy.
TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.
Application of Artificial Intelligence Technologies in a Cloud-based Platform for ECG Analysis to Support the Diagnosis of a Critical Electrocardiography in Primary Care
The cloud-based platform for electrocardiography (ECG) analysis plays a supporting role in the prevention and treatment of cardiovascular diseases. During the construction of a cloud-based platform for ECG analysis, problems that should be focused and addressed are exploring ways to better use artificial intelligence (AI) technologies supporting ECG analysis, and improving the process and effectiveness of AI-aided diagnosis of a critical ECG.
To explore the use of AI technologies in a cloud-based platform for ECG analysis to support the diagnosis of a critical ECG in primary care.
The 12-lead resting ECGs (n=20 808) uploaded to Nalong Cloud-based ECG Analysis Platform by primary healthcare institutions were selected from June 2019 to June 2021. After being interpreted by AI-based algorithms and physicians, respectively, ECG findings were classified into critical group (critical ECGs) , normal group (normal ECGs) , and positive group (abnormal but not critical ECGs) . The results interpreted by the AI-based algorithm were compared with those interpreted by physicians (defined as the gold standard) to assess the diagnostic agreement and coincidence rate between AI-based and physician-based interpretations, and to assess the diagnostic sensitivity, and positive predictive value of AI-based interpretation. And the mean time for making diagnoses of three groups of ECGs was calculated.
By the AI-based interpretation, 619, 15 634 and 45 55 ECGs were included in the critical, positive, and normal groups, respectively. And by the physician-based interpretation, 619, 15 759 and 4 430 ECGs were included in the critical, positive, and normal groups, respectively. There was high agreement between AI-based and physician-based interpretation results of ECGs〔Kappa=0.984, 95%CI (0.982, 0.987) , P<0.001〕, with a diagnostic coincidence rate of 99.4%. The diagnostic sensitivity and positive predictive value of AI-based interpretation for ECGs was 99.4%, and 100.0%, respectively. The mean time for making diagnoses of critical ECGs, abnormal but not critical ECGs, and normal ECGs was statistically different (P<0.001) , the mean time of critical critical ECGs was shorter than normal ECGs and abnormal but not critical ECGs (P<0.001) .
AI technologies used in a cloud-based platform for ECG analysis could provide physicians with support for interpreting ECGs, which may contribute to improving the interpretation accuracy, optimizing the diagnostic process, shortening the time for diagnosing a critical ECG, and the treating of critical patients in primary care.
Application of Scatter Diagram in Prehospital Screening for Arrhythmia Using Single Lead，Wearable Remote ECG Monitoring System
Arrhythmia is a common cardiovascular disease, which has a range of transient or paroxysmal conditions. Arrhythmia easily occurs outside of the hospital, but signals of its onset often could not be captured by traditional ECG devices since they can not be worn at any time.
To assess the effect of applying scatter diagram in prehospital screening for arrhythmia via analyzing patients' data monitored by the single lead, wearable remote ECG monitoring system.
Participants (n=1 076) were primary care patients who were selected from Yinchuan from September 2018 to September 2019. All of them used single lead, wearable remote ECG monitoring system to monitor cardiac rhythms prehospitally when they had palpitation, dizziness, chest tightness, shortness of breath and other symptoms, and real-timely uploaded 24-hour ambulatory ECG data to be used for screen for arrhythmia by different approaches: approach A (diagnosis made using scatter diagram analysis by primary care physicians) , approach B (diagnosis made using scatter diagram analysis by physicians from Remote ECG Center, the First People's Hospital of Yinchuan) , and approach C (diagnosis made using scatter diagram analysis and ECG analysis by physicians from Remote ECG Center, the First People's Hospital of Yinchuan) . Prevalence and types of arrhythmia detected by these approaches and diagnostic coincidence rate of these approaches were analyzed. The sensitivity, specificity, positive and negative predictive values of approaches A and B were assessed with those of approach C as the gold standard.
(1) The frequencies of arrhythmias detected by approaches A, B and C were 1 301, 1 323, and 1 647, respectively. The types of arrhythmias detected by approaches A, B and C were 14, 14, and 15, respectively. And the prevalence of arrhythmias detected by approaches A, B and C were 80.9%, 81.2% and 87.5%, respectively. (2) The diagnoses made by approaches A and B were highly consistent〔Kappa=0.891, 95%CI (0. 711, 1.071) , P=0.617〕, and the diagnostic coincidence rate was 96.7%. The diagnoses made by approaches B and C were highly consistent〔Kappa=0.759, 95%CI (0.489, 1.029) , P<0.001〕, and the diagnostic coincidence rate was 93.6%. The diagnoses made by approach A were relatively consistent with those by approach C〔Kappa=0.692, 95%CI (0.392, 0.992) , P<0.001〕, and the diagnostic coincidence rate was 91.7%. (3) The sensitivity, specificity, positive and negative predictive values of approach A in diagnosing arrhythmia were 91.5%, 93.3%, 99.0% and 61.2%, and those of approach B were 92.8%, 99.3%, 99.9% and 66.3%.
Using scatter diagram in prehospital screening for arrhythmia through analyzing the monitoring results of single lead, wearable remote ECG monitoring system will contribute to the development of arrhythmia diagnosis and treatment in primary care, and the establishment of an arrhythmia prevention and treatment network with the participation of residents, primary care physicians and remote ECG center physicians.
目的 探讨云南省全科医生转岗培训远程教育的效果。方法 于2015年5月，采用分层随机整群抽样法，抽取云南省昆明市、玉溪市、普洱市、昭通市、红河州、临沧市6个州市参加2015年云南省全科医生转岗培训的学员作为调查对象。采用自行设计的《云南省全科医生转岗培训远程教育质量评价调查问卷》对学员进行现场调查。问卷内容包括：学员的基本情况、学员对远程教学效果的整体评价及学员对远程教学管理工作的整体评价。共发放问卷300份，回收有效问卷292份，有效回收率为97.3%。结果 68.8%（201/292）的学员认为远程培训整体效果好或很好；不同工作单位、文化程度、职称的学员对远程培训效果的整体评价间差异均无统计学意义（P＞0.05）。其中95.2%（278/292）的学员认为理论知识有提高或很大提高，89.7%（262/292）的学员认为临床实践技能有提高或很大提高；不同工作单位的学员对理论知识、临床实践技能的评价间差异均有统计学意义（P＜0.05）。学员对全科医疗的临床思维的好评率为95.5%（279/292），而对基层常见心理和精神问题、社区急危重症的识别及处理要点的好评率均为91.8%（268/292）。92.8%（271/292）的学员对远程教学管理整体工作满意或很满意；不同工作单位、文化程度、职称的学员对远程教学管理工作的整体评价间差异均无统计学意义（P＞0.05）。结论 云南省全科医生转岗培训的远程教育效果较好，但仍需严格学员选拔标准、按需培训、完善网络平台、加强过程管理。
远程医疗最新文章合辑
