ABSTRACT
This study investigated telemedicine reliability and usability in evaluating facial dystonia grading and treatment complications. Eighty-two telemedicine recordings from 43 adults with blepharospasm (12, 28%) and hemifacial spasm (31, 72%) were obtained (mean age 64.5 ± 9.3 years, 32 females [64%]). Two recorded in-hospital telemedicine visits were arranged with in-person visits at baseline and 4-6 weeks. After 8 weeks, neuro-ophthalmologists who performed the in-person visits re-evaluated the telemedicine video records. Intra-rater agreements in assessing spasm gradings were moderate (severity: kappa = 0.42, 95% confidence interval [CI] 0.21-0.62; frequency: kappa = 0.41, 95% CI 0.21-0.61) with substantial agreement in detecting lagophthalmos (kappa = 0.61, 95% CI 0.36-0.86). Adding symptoms to signs increased sensitivity and negative predictive value (NPV) in detecting lagophthalmos (67%-100% and 94%-100%) and drooping lips (38%-75% and 94%-96%), respectively. Thai version Telehealth Usability Questionnaire showed high mean usability score of 6.5 (SD 0.8) out of 7. Telemedicine could further be developed as an alternative platform to evaluate facial dystonia.
ABSTRACT
This cross-sectional validation study aimed to translate, cross-culturally adapt, and investigate the psychometric properties of a Thai version of the Telehealth Usability Questionnaire (T-TUQ). Two hundred and ten Thai participants, mean age of 61.2±15.2 years, were recruited from three specialty clinics: 50 (23.8%) hematology, 70 (33.3%) movement disorders, and 90 (42.9%) general neurology. The T-TUQ was translated from the original English version to produce a Thai language version. Back translation and pilot cognitive interviews were completed. All five subscales (usefulness, ease of use, effectiveness, reliability, and satisfaction) showed excellent internal consistency (alpha >0.80), displayed by Cronbach's alpha coefficient of 0.83, 0.94, 0.86, 0.83, and 0.92, respectively. For construct validity, exploratory factor analysis revealed two dimensions from eigenvalues and scree plot, defined as utility and accessibility subscales. In conclusion, the T-TUQ could be a reliable and valid instrument to evaluate the usability of telehealth with a Thai population.
ABSTRACT
BACKGROUND: The prevalence of hypertension and its associated complications are markedly growing. Most patients need more than one drug to achieve blood pressure (BP) target. However, most guidelines only focus on the first-line treatment. We conducted a meta-analysis to explore the benefits of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs) combined with calcium channel blockers (CCBs) on metabolic, renal, and cardiovascular outcomes in hypertensive patients. METHODS: A systematic literature search was conducted in MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov (until April 7, 2016) to identify randomized controlled trials (RCTs) comparing the benefits of ACEIs/ARBs combined with CCBs versus other dual or triple combinations on clinical outcomes in hypertensive patients. Random effects models were used to compute the weighted mean difference (WMD) for continuous variables. RESULTS: Sixty RCTs (48,913 patients) were identified. When compared with other combinations, the combination of ACEIs/ARBs and CCBs had comparable WMD of systolic as well as diastolic BP (73 study arms) but provided better benefits on metabolic parameters, such as HDL, FBS, HbA1C, and serum uric acid; renal functions, including serum creatinine and estimated glomerular filtration rate; and cardiovascular diseases, including reduction of all cardiovascular events, myocardial infarction, and syncope/hypotension. A significant increase of serum potassium was observed. CONCLUSION: The combination of ACEIs/ARBs with CCBs has superior benefits on metabolic, renal, and cardiovascular outcomes in hypertensive patients. Therefore, this combination should be considered whenever monotherapy does not achieve the guideline target.
