ObjectiveTo assess the effects of the Coronavirus disease 2019 (COVID-19) epidemic on patients with infantile epileptic spasms syndrome and their parents through an online questionnaire survey.MethodsThis study was a cross-sectional study conducted from May to June 2022. The questionnaire focused on seizure attacks, medical visits, and the mental health assessment of parents. ResultsA total of 67 patients with infantile epileptic spasms syndrome were included in this study. During the epidemic, 25.37% of the patients experienced increased spasms, and 73.13% of the patients had limited commercial availability of anti-seizure medications, mainly vigabatrin and clobazam. All patients had difficulty seeking medical services, and about 73.13% of them used telemedicine service. In addition, 31.34% of parents felt anxious, and 73.14% had different degrees of depressive symptoms. ConclusionThe difficulty in seeking medical services, limited commercial availability of anti-seizure medications, and the anxiety and depressive states of parents during the COVID-19 pandemic aggravate the difficulty in management of patients with infantile epileptic spasms syndrome. Improvement of the health care system and medication management strategy, as well as reasonable use of telemedicine service, may help solve this problem.
Objective To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as “Xinjiang Region”) in diagnosing fundus diseases. MethodsThe three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. ResultsAll the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination (P＜0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance (P＜0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance (P＜0.05). There was no significant correlation (P＞0.05) between the improvement of diagnostic level of participating physicians and educational background (Rho=0.07), professional title (Rho=0.13), age (r=0.20), and working time of ophthalmofundus disease specialty (r=0.26).ConclusionsRelying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.
ObjectiveTo systematically evaluate the effects of telemedicine on the management of warfarin therapy.MethodsWe searched PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, Wanfang Database (from inception to February 2020) and conducted retrospective literature searching to identify studies about the management of warfarin using telemedicine intervention techniques. R language software was used to evaluate the efficacy and safety of telemedicine on warfarin management.ResultsA total of 7 239 articles were retrieved, and 12 articles were finally included according to inclusion and exclusion criteria, totaling 8 112 patients, including 3 726 patients in the intervention group and 4 386 patients in the control group. The results of meta-analysis showed that there was a statistical difference in the accurate international normalized ratio (INR) treatment target range time ratio between the intervention group and the control group (MD=6.52, 95%CI 2.13 to 10.92, P<0.01, I2=89%). The incidence of bleeding events (RR=0.61, 95%CI 0.46 to 0.81, P=0.97, I2=0%) and the incidence of thromboembolic events (RR=0.50, 95%CI 0.29 to 0.85, P=0.63, I2=0%) were not statistically different between the two groups. ConclusionExisting evidence indicates that telemedicine management has a benefit in anticoagulant efficacy compared with conventional anticoagulant management in patients with thrombotic diseases, but there is no statistical difference in safety. Limited by the quantity and quality of the included studies, the above conclusion needs to be verified by more high-quality studies.
The increasing prevalence of the aging population, and inadequate and uneven distribution of medical resources, have led to a growing demand for telemedicine services. Gait disturbance is a primary symptom of neurological disorders such as Parkinson’s disease (PD). This study proposed a novel approach for the quantitative assessment and analysis of gait disturbance from two-dimensional (2D) videos captured using smartphones. The approach used a convolutional pose machine to extract human body joints and a gait phase segmentation algorithm based on node motion characteristics to identify the gait phase. Moreover, it extracted features of the upper and lower limbs. A height ratio-based spatial feature extraction method was proposed that effectively captures spatial information. The proposed method underwent validation via error analysis, correction compensation, and accuracy verification using the motion capture system. Specifically, the proposed method achieved an extracted step length error of less than 3 cm. The proposed method underwent clinical validation, recruiting 64 patients with Parkinson’s disease and 46 healthy controls of the same age group. Various gait indicators were statistically analyzed using three classic classification methods, with the random forest method achieving a classification accuracy of 91%. This method provides an objective, convenient, and intelligent solution for telemedicine focused on movement disorders in neurological diseases.
Recently, with the development of technology, the 5th generation mobile communication technology (5G) is developing day by day. Mobile medical industry has a huge market in our country. As a strategic emerging industry in China, 5G will focus on the medical care industry, enhance the service quality of medical care, enable innovative applications and services, and make the medical industry more digital, networked and intelligent. 5G has an epoch-making significance for improving the quality of health monitoring and self-care ability, and promoting medical care development. Therefore, this paper introduces the definition, advantages, and significance of 5G and its application status in medical care, in order to lay a foundation for promoting the deep integration of 5G and medical care.
ObjectivesTo systematically review the efficacy of telemedicine on blood glucose level and pregnancy outcomes in patients with gestational diabetes mellitus.MethodsThe Cochrane Library, PubMed, Web of Science, CINAHL, Scopus, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on efficacy of telemedicine on blood glucose and pregnancy outcomes in patients with gestational diabetes from inception to January 1st, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, and then meta-analysis was performed by RevMan 5.3 software.ResultsA total of 10 RCTs involving 1 267 patients were included. The results of meta-analysis showed that there were no statistical significances in fasting blood glucose (MD=−0.34, 95%CI −1.62 to 0.93, P=0.60), HbA1c (MD=−0.22, 95%CI −0.61 to 0.17, P=0.27), gestational age at delivery (MD=0.03, 95%CI −0.13 to 0.19, P=0.72), premature rate (OR=0.52, 95%CI 0.26 to 1.01, P=0.05), caesarean delivery rate (OR=0.87, 95%CI 0.57 to 1.31, P=0.51), infant birth weight (MD=13.01, 95%CI −45.75 to 71.78, P=0.66), large for gestational age rate (OR=1.16, 95%CI 0.83 to 1.62, P=0.40), pre- eclampsia/pregnancy induced hypertension rate (OR=1.04, 95%CI 0.52 to 2.09, P=0.91), neonatal hypoglycaemia rate (OR=1.21, 95%CI 0.75 to 1.95, P=0.44) and neonatal jaundice rate (OR=1.09, 95%CI 0.59 to 2.00, P=0.78) between telemedicine management and outpatient follow-up of gestational diabetes mellitus. However, the telemedicine management group had lower 2h postprandial blood glucose (MD=−3.45, 95%CI −5.53 to −1.37, P=0.001).ConclusionsThe current evidence shows that telemedicine management of gestational diabetes mellitus achieves similar efficacy and safety in blood glucose level and pregnancy outcomes as outpatient follow-up. Due to limited quality and quantity of the included studies, more high quality studies are required to verify the above conclusions.