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Objective:To look for the problems faced in the construction of the tele-critical care system, explore the framework of construction of the tele-critical care system, and verify the application effects of the established tele-critical care system.Methods:Through literature review and on-site investigation and demonstration, the causes affecting the construction of the tele-critical care system were explored. Through on-site investigation of the actual situation of the critical care department in relevant hospitals, arguing and choosing intended intensive care unit (ICU) and cooperative third-party communication and equipment companies, and through the Internet of Things and 5G communication technology, a tele-critical care system with the core hospital of the group as the center and the member institutes within the group as the nodes was built. Via the established tele-critical care system, activities such as tele-monitoring, visual remote ward rounds, remote consultation, remote teaching were carried out to verify the functions of the system.Results:The insufficient cognition of relevant personnel, tele-medicine practice certification requirements, information security issues and the barriers of equipment information integration were the main causes affecting the construction of tele-critical care system. There were five parts in the tele-critical care system architecture foundations, including bed unit equipment and audio and video information collection system, lossless and secure transmission of collected information, real-time display of information in the remote center, real-time staff interaction between the centre and the nodal hospitals, and information cloud storage. It has been verified that patients' diagnostic and treatment information can be transmitted safely, losslessly and in real-time by a special line through private 5G network. Through this system, real-time and stable upload of audio and video information of patients and application information of monitors, ventilators and infusion work stations can be achieved; combined with tele-conference connections to conduct two-way communication with local medical staff, real-time tele-monitoring, visual remote ward rounds, remote consultation, remote teaching and other functions can be achieved.Conclusion:The tele-critical care system we established is feasible to construct within the medical group and can safely and effectively realize the functions of real-time tele-monitoring, visual remote ward rounds, remote consultation, and remote teaching.
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@#AIM: To analyze the demands, consultation patterns and contributing factors of the patients involved in the ophthalmic on-line consultation during the COVID-19 epidemic to provide reference for the optimization of the ophthalmic online health care system.<p>METHODS: Prospective observational study. The patients using “expert online consultation” provided by the Zhongshan Ophthalmic Center from February 1 to March 15, 2020 were enrolled. The baseline characteristics were analyzed. For the patients with repeated consultation, we randomly selected the same amount of patients with single consultation as comparison. The baseline characteristics, consultation purposes, disease types, and number of combined eye diseases between the patients with single and repeated consultation were compared, and the contributing factors of patients'consultation pattern were analyzed with statistical test and regression model.<p>RESULTS: The “expert online consultation” provided 9 831 consultations during the study, 3 919 of which were single consultation while 5 912 of which came from the repeated consultations of 1 967 patients. 1 967 patients with single consultation were randomly selected and compared with the repeated inquirers. The main consultation purposes in the both groups were “return visit”(59.7%, 64.9%). There was no significant difference in age and gender distribution between the patients with single online visit and repeated online visits(<i>P</i>=0.897, 0.482). Compared with the patients with single visit, the patients with repeated visit were less with the purpose of “new-onset discomfort”, more with the purpose of “return visit” and “follow-up after surgery”, more with ocular surface, fundus and uveal diseases, and more with two or more combined eye diseases. Regression analysis showed that the patients with ocular refractive issues tended to have a single consultation, while the patients inquired on previous eye disease and surgery, with fundus or uveal disease tended to have repeated consultations. The number of repeated visits for the patients with diagnosed ophthalmopathy and ophthalmic surgery was higher than that for the patients with new-onset discomfort; the number of repeated visits was lower for the patients with lens and anterior segment diseases, and was higher for the patients with ocular surface diseases.<p>CONCLUSION: During the COVID-19 epidemic, the main purpose of on-line ophthalmic consultation was return visit for the diagnosed eye diseases. Type of eye disease, consultation purpose and number of combined ophthalmopathies all affected whether the patients repeated the consultation and the repeated times. The arrangement of ophthalmologists in different sub-specialties should be adjusted according to the patients' needs and their consultation patterns.
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INTRODUCCIÓN: La rehabilitación y las acciones de terapia física se han ido adaptando a la era de la telesalud, permitiendo aumentar la accesibilidad y mejorar la continuidad de la atención en poblaciones con discapacidades y alejadas geográficamente. En la actualidad, y debido a expansión de la infección por SARS-CoV-2, muchos profesionales han debido adaptar su trabajo a una modalidad de telerehabilitación, por lo que es necesario acceder a la mejor evidencia disponible de manera resumida y oportuna. Es en este contexto que se ha desarrollado el presente protocolo, con el objetivo de evaluar la efectividad de la telerehabilitación como estrategia de atención en terapia física para diferentes condiciones, poblaciones y contextos. MÉTODO Y ANÁLISIS: Se conducirá una revisión global o revisión de revisiones, en un formato de revisión rápida siguiendo las recomendaciones PRISMA-P. Se incluirán revisiones sistemáticas de diferentes condiciones, poblaciones y contextos, donde la intervención a evaluar es la telerehabilitación en terapia física. Los desenlaces de interés a considerar son la efectividad clínica dependiendo de la condición específica, la funcionalidad, calidad de vida, satisfacción, adherencia y seguridad. Se realizará una búsqueda en las bases de datos MEDLINE/PubMed, EMBASE y Cochrane Library. La selección de los estudios será realizada en duplicado con resolución de discrepancias por un tercer revisor. La extracción de datos y la evaluación del riesgo de sesgos serán realizadas por un revisor con verificación no independiente de un segundo revisor. Los hallazgos serán reportados cualitativamente a través de tablas y figuras. ÉTICA Y DISEMINACIÓN: Se considera el cumplimiento de los principios éticos del valor de la pregunta de investigación, rigor metodológico, investigadores científicamente cualificados, evaluación independiente del protocolo y publicación puntual y precisa de los resultados. Se espera publicar la revisión completa en al menos un artículo y los resultados se difundirán ampliamente en diversos niveles de decisión.
INTRODUCTION: Rehabilitation and physical therapy have been adapting to the telehealth era, increasing accessibility and improving the continuity of attention in geographically remote populations with disabilities. Due to the spread of infection by SARS-CoV-2, many professionals have had to adapt their work to telerehabilitation practices, which require the best evidence at short notice and in summarized form. In this context, this protocol has been developed to evaluate the effectiveness of telerehabilitation as a care strategy in physical therapy for different conditions, populations, and contexts. METHOD AND ANALYSIS: An overview will be carried out in the format of a rapid review. It will include systematic reviews of different conditions, populations, and contexts, where the intervention to be evaluated is telerehabilitation by physical therapy. The outcomes considered will be clinical effectiveness depending on the specific condition, functionality, quality of life, satisfaction, adherence, and safety. A search will be carried out of the MEDLINE/PubMed, EMBASE, and Cochrane Library databases. Studies will be selected in duplicate with any discrepancies resolved by a third reviewer. Data extraction and risk of bias assessment will be carried out by a reviewer with non-independent verification by a second reviewer. The findings will be reported qualitatively by tables and figures. ETHICS AND DISSEMINATION: The principles of the value of the research question, the methodological rigor, scientifically qualified investigators, an independent evaluation of the protocol, and timely and accurate publication of the results will be complied with. The complete review will lead to the publication of at least one article, and the results will be widely disseminated at various levels of decision-making.
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Humans , Physical Therapy Modalities , Pandemics/prevention & control , Telerehabilitation/methods , COVID-19/prevention & control , Quality of Life , Research Design , Treatment Outcome , Systematic Reviews as Topic , COVID-19/epidemiologyABSTRACT
Objective This study was aimed to evaluate the remote real-time transmission 12-lead electrocardiogram system on door-to-balloon time in patients with ST-segment elevation myocardial infarction.Methods We retrospectively analyzed the consecutive patients with STEM I who had accepted primary percutaneous coronary intervention (PCI) in the chest pain center of our hospital from February 2012 to July 2012.The study group consisted of patients with pre-hospital ECG,while the control group included patients without pre-hospital ECG,Their door-to-balloon time and door-to-catheter room time,mortality w ere compared.Results Totally 60 consecutive patients who had received primary PC I for STEMI were evaluated.Among them,35 patients were hospitalized with pre-hospital ECG while the other 25 patients without ECG.The Pre-hospital ECG was associated with a significautly shorter median door-to-balloon time (38 min vs.94min;P ＜0.01),The proportion of patients received balloon dilation within the guidelinerecommended 90 min timeframes Was significantly higher in pre-hospital ECG group than in non pre-hospital ECG group (94.6％ vs.60％;P =0.001).No difference was observed in mortality between the two groups (5.7％vs.4％;P ＞ 0.05),Significant difference was seen in the median hospital time in study group (5 compared with control group (7day) (5 day vs.7 day;P ＜ 0.01).Conclusions The remote real-time transmission 12-lead electrocardiogram system is associated with a significantly shorter door-to-balloon time in STEMI patients.The remote real-time transmission 12-lead electrocardiogram system is recommended in patients suspected STEMI.
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Objective To evaluate the pre-hospital diagnostic reliability of real-time tele-transmission of 12-lead electrocardiogram of patients with ST-segment elevated acute myocardial infarction (STEMI).Methods The 12-lead electrocardiogram was simultaneously recorded with real-time tele-transmission system and a conventional electrocardiograph in 40 STEMI cases.The width and amplitude of each wave,the deviated amplitude of ST-segment in the same leads were compared by t-test and rank-sum test.Results There were no statistical differences in the width and amplitude of P wave,QRS wave and t wave as well as the deviated altitude of ST-segment between the two separate electrocardiographs (P ＞0.05).There was a significant positive correlation between the two ECG devices in respect of ST-segment elevated altitude (r =0.912,P =0.000).The differential ability of ST-segment elevation between two separate ECG devices kept highly consistent (Kappa value:0.976).Conclusions Real-time tele-transmission of 12-lead electrocardiogram is reliable for the pre-hospital diagnosis of STEMI.
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Objective To investigate the cost-effect of tele-wound treatment platform with cellular phone terminator and traditional outpatient treatment on chronic lower limb ulcers in remote district.Methods Thirty seven cases with chronic lower limb ulcers from the key hospitals in the district of west Hunan Province were collected by cluster sampling,and randomly divided into the intervention group (25 cases)and the control group (12 cases).They chose remote wound treatment platform intervention with cellular phone terminator and traditional dressing change in clinic.All patients received a 1.5-year follow-up,or cure and amputations were set as the endpoint of the study.The cost-effect,including the incidence of complications in the course of treatment,number of switches,treatment time,the cost of treatment,as well as medical human resources consumption was analyzed and compared between the two groups.Results The incidence of complications in the course of treatment in the intervention was (76.0％) significantly lower than the control group(91.7％).There was a significant increase in the dressing times and the duration of treatment; and there was no significant difference in the cost of treatment and medical human resources consumption between two groups.Conclusions Compared to the traditional outpatients wound treatment,the multimedia message-based tele-wound treatment platform unlikely increased medical human resources consumption and the cost of treatment,and may reduce the incidence of complications and the treatment time.
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Regional Medical Information System has been the objective of the construction of medical informatization. With HL7 and DICOM applied, this paper presents a tele-medical information-sharing platform based on PACS and HIS. Then the general scheme is put forward from such aspects as medical image storing center, copy import system for medical image data, tele-consultation center, disparate data source middle-ware transponder based on HL7 and clinical rounds system based on NC wireless network.