伤口世界
- 星期二, 10 5月 2022
A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study
Agathe Leo´ n1*, Ce´ sar Ca´ ceres2 , Emma Ferna ´ndez1 , Paloma Chausa2 , Maite Martin3 , Carles Codina3, Araceli Rousaud4 , Jordi Blanch4 , Josep Mallolas1 , Esteban Martinez1 , Jose L. Blanco1 , Montserrat Laguno1 , Maria Larrousse1 , Ana Milinkovic1 , Laura Zamora1 , Neus Canal5 , Josep M. Miro´ 1 , Josep M. Gatell1 , Enrique J. Go ´ mez2 , Felipe Garcı´a1
1 Infectious Diseases Unit, Hospital Clinic, Institut d’Investigacions Biome`diques August Pi I Sunyer, University of Barcelona, Barcelona, Spain,
2 Bioengineering and Telemedicine Unit, Technical University of Madrid, Madrid, Spain,
3 Pharmacy Service, Hospital Clinic, Institut d’Investigacions Biome `diques August Pi I Sunyer, University of Barcelona, Barcelona, Spain,
4 Clinical Institute of Psychiatry and Psychology, Hospital Clinic, Institut d’Investigacions Biome `diques August Pi i Sunyer, University of Barcelona, Barcelona, Spain, 5Health Economics and Outcomes Research, IMS Health, Inc., Barcelona, Spain
Abstract
Background: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals.
Methodology: We developed a new internet-based home care model covering the entire management of chronic HIVinfected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out.
Findings: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels .90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care.
Conclusions: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. Trial Registration: Clinical-Trials.gov: NCT01117675.
Citation: Leo´n A, Ca´ceres C, Ferna´ndez E, Chausa P, Martin M, et al. (2011) A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study. PLoS ONE 6(1): e14515. doi:10.1371/journal.pone.0014515
Editor: Rupert Kaul, University of Toronto, Canada Received May 7, 2010; Accepted December 1, 2010; Published January 21, 2011
Copyright: © 2011 Leo ´n et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Dr. Leo ´n is supported by Contract CM06/00170 from the Institut de Investigacions Biome `diques August Pi I Sunyer and Fundacio ´ Clı´nic in collaboration with the Spanish Health Department. The role of Health Economics and Outcomes Research IMS Health in the study had been only to analyze the patients’ quality of life data. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: A Leo ´n, C Ca ´ceres, E Ferna ´ndez, P Chausa, M Martin, C Codina, A Rousaud, A Milinkovic, M Laguno, M Larrousse, L Zamora, and EJ Go ´mez have no potential conflicts of interests. Neus Canal is employed by a commercial company, Health Economics and Outcomes Research IMS Health. E Martinez, F Garcı´a, J Blanch and JL Blanco have received research grants from Abbott, Bristol-Myers Squibb, and Gilead Sciences. J Mallolas and JM Miro have received research grants from Abbott, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences and Roche. JM Gatell has received honoraria or research grants from Bristol-Myers Squibb, MSD, GlaxoSmithKline, Gilead Sciences, Tibotec, Roche, Boehringerngelheim, Abbott and Pfizer. This does not alter our adherence to all the PLoS ONE policies on sharing data and materials."
- 星期一, 09 5月 2022
Telemedicine and burns: an overview
B. Atiyeh, S.A. Dibo, and H.H.. Janom
Summary
Access to specialized burn care is becoming more difficult and is being restricted by the decreasing number of specialized burn centers. It is also limited by distance and resources for many patients, particularly those living in poverty or in rural medically underserved communities. Telemedicine is a rapidly evolving technology related to the practice of medicine at a distance through rapid access to remote medical expertise by telecommunication and information technologies. Feasibility of telemedicine in burn care has been demonstrated by various centers. Its use facilitates the delivery of care to patients with burn injuries of all sizes. It allows delivery of acute care and can be appropriately used for a substantial portion of the long-term management of patients after a burn by guiding less-experienced surgeons to treat and follow-up patients more appropriately. Most importantly, it allows better effective triage which reduces unnecessary time and resource demanding referrals that might overwhelm system capacities. However, there are still numerous barriers to the implementation of telemedicine, including technical difficulties, legal uncertainties, limited financial support, reimbursement issues, and an inadequate evidence base of its value and efficiency.
- 星期一, 09 5月 2022
Fast resuscitation and care of the burn patients by telemedicine: A review
Sima Ajami and Arezo Arzani-Birgani Additional article information
Abstract
Background:
In Iran, burns are the second most common cause of death, after traffic accidents in individuals under the age of 15 years. Many burned patients die or suffer injury due to lack of immediate care, so we need to use an alternative resuscitations to cure them immediately. Telemedicine describes the use of medical information exchanged from one site to another via electronic communications to improve patients’ health status and care. The aim of this study was to express the advantages of Telemedicine to resuscitate and care burn patients.
Materials and Methods:
This study was a narrative review. The literature was searched on fast resuscitation and care of the patients’ burn by telemedicine with the help of libraries, databases, and also searches engines available at Google, Google scholar, books and conference proceedings. In our searches, we employed the following keywords and their combinations: Telemedicine, Telecare, Burn, Burn patient, Air transport, Triage and Health Information Management in the searching areas of titles, keywords, abstracts and full texts.
Results:
In this study, more than 78 articles and reports were collected and 30 of them were selected based on their relevancy.
Conclusion:
Acute evaluation of burn patients can be performed by the telemedicine and it plays an important role in improving access to the required expertise, and raises physician confidence in treating burn patients. This can reduce under-triage or over-triage for air transport and finally lead to saving time and cost.
- 星期六, 07 5月 2022
Scar-free healing: from embryonic mechanisms to adult therapeutic intervention
Mark W. J. Ferguson1,2* and Sharon O’Kane2
1 UK Centre for Tissue Engineering, School of Biological Sciences, University of Manchester, 3.239 Stopford Building, Oxford Road, Manchester M13 9PT, UK
2 Renovo Limited, Manchester Incubator Building, 48 Grafton Street, Manchester M13 9XX, UK
In man and domestic animals, scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in adverse aesthetics, loss of function, restriction of tissue movement and/or growth and adverse psychological effects. Current treatments are empirical, unreliable and unpredictable: there are no prescription drugs for the prevention or treatment of dermal scarring. Skin wounds on early mammalian embryos heal perfectly with no scars whereas wounds to adult mammals scar. We investigated the cellular and molecular differences between scar-free healing in embryonic wounds and scar-forming healing in adult wounds. Important differences include the inflammatory response, which in embryonic wounds consists of lower numbers of less differentiated inflammatory cells. This, together with high levels of morphogenetic molecules involved in skin growth and morphogenesis, means that the growth factor profile in a healing embryonic wound is very different from that in an adult wound. Thus, embryonic wounds that heal without a scar have low levels of TGFβ1 and TGFβ2, low levels of platelet-derived growth factor and high levels of TGFβ3. We have experimentally manipulated healing adult wounds in mice, rats and pigs to mimic the scar-free embryonic profile, e.g. neutralizing PDGF, neutralizing TGFβ1 and TGFβ2 or adding exogenous TGFβ3. These experiments result in scar-free wound healing in the adult. Such experiments have allowed the identification of therapeutic targets to which we have developed novel pharmaceutical molecules, which markedly improve or completely prevent scarring during adult wound healing in experimental animals. Some of these new drugs have successfully completed safety and other studies, such that they have entered human clinical trials with approval from the appropriate regulatory authorities. Initial trials involve application of the drug or placebo in a double-blind randomized design, to experimental incision or punch biopsy wounds under the arms of human volunteers. Based on encouraging results from such human volunteer studies, the lead drugs have now entered human patient-based trials e.g. in skin graft donor sites. We consider the evolutionary context of wound healing, scarring and regeneration. We hypothesize that evolutionary pressures have been exerted on intermediate sized, widespread, dirty wounds with considerable tissue damage e.g. bites, bruises and contusions. Modern wounds (e.g. resulting from trauma or surgery) caused by sharp objects and healing in a clean or sterile environment with close tissue apposition are new occurrences, not previously encountered in nature and to which the evolutionary selected wound healing responses are somewhat inappropriate. We also demonstrate that both repair with scarring and regeneration can occur within the same animal, including man, and indeed within the same tissue, thereby suggesting that they share similar mechanisms and regulators. Consequently, by subtly altering the ratio of growth factors present during adult wound healing, we can induce adult wounds to heal perfectly with no scars, with accelerated healing and with no adverse effects, e.g. on wound strength or wound infection rates. This means that scarring may no longer be an inevitable consequence of modern injury or surgery and that a completely new pharmaceutical approach to the prevention of human scarring is now possible. Scarring after injury occurs in many tissues in addition to the skin. Thus scar-improving drugs could have widespread benefits and prevent complications in several tissues, e.g. prevention of blindness after scarring due to eye injury, facilitation of neuronal reconnections in the central and peripheral nervous system by the elimination of glial scarring, restitution of normal gut and reproductive function by preventing strictures and adhesions after injury to the gastrointestinal or reproductive systems, and restoration of locomotor function by preventing scarring in tendons and ligaments.
Keywords: wound healing; scarring; transforming growth factor beta; regeneration; skin pharmaceuticals; regenerative medicine
- 星期五, 29 4月 2022
Provider confdence in the telemedicine spine evaluation: results from a global study
Francis Lovecchio1 · Grant J. Riew2 · Dino Samartzis3,4 · Philip K. Louie5 · Niccole Germscheid6 · Howard S. An3,4 ·
Jason Pui Yin Cheung7 · Norman Chutkan8 · Gary Michael Mallow3,4 · Marko H. Neva9 · Frank M. Phillips3,4 ·
Daniel M. Sciubba10 · Mohammad El‑Sharkawi11 · Marcelo Valacco12 · Michael H. McCarthy13 · Melvin C. Makhni2 ·
Sravisht Iyer1
1 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
2 Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3 Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
4 The International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
5 Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
6 Research Department, AO Spine International, Davos, Switzerland
7 Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China
8 Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
9 Department of Orthopaedic and Trauma Surgery, Tampere University Hospital, Tampere, Finland
10 Department of Neurosurgery, Baltimore, MD, USA, John Hopkins University, Baltimore, MD, USA
11 Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, Egypt
12 Department of Orthopaedics, Churruca Hospital de Buenos Aires, Buenos Aires, Argentina
13 Indiana Spine Group, Carmel, IN, USA
Received: 22 September 2020 / Accepted: 27 October 2020 / Published online: 22 November 2020
© The Author(s) 2020
Abstract
Purpose To utilize data from a global spine surgeon survey to elucidate (1) overall confidence in the telemedicine evaluation and (2) determinants of provider confidence.
Methods Members of AO Spine International were sent a survey encompassing participant’s experience with, perception of,and comparison of telemedicine to in-person visits. The survey was designed through a Delphi approach, with four rounds of
question review by the multi-disciplinary authors. Data were stratified by provider age, experience, telemedicine platform, trust in telemedicine, and specialty.
Results Four hundred and eighty-five surgeons participated in the survey. The global effort included respondents from Africa (19.9%), Asia Pacific (19.7%), Europe (24.3%), North America (9.4%), and South America (26.6%). Providers felt that physical exam-based tasks (e.g., provocative testing, assessing neurologic deficits/myelopathy, etc.) were inferior to inperson exams, while communication-based aspects (e.g., history taking, imaging review, etc.) were equivalent. Participants who performed greater than 50 visits were more likely to believe telemedicine was at least equivalent to in-person visits in the ability to make an accurate diagnosis (OR 2.37, 95% C.I. 1.03–5.43). Compared to in-person encounters, video (versus phone only) visits were associated with increased confidence in the ability of telemedicine to formulate and communicate a treatment plan (OR 3.88, 95% C.I. 1.71–8.84).
Conclusion Spine surgeons are confident in the ability of telemedicine to communicate with patients, but are concerned about its capacity to accurately make physical exam-based diagnoses. Future research should concentrate on standardizing the remote examination and the development of appropriate use criteria in order to increase provider confidence in telemedicine technology.
Keywords Telemedicine · Spine surgery · Examination · International · Survey
- 星期五, 29 4月 2022
Designing Futuristic Telemedicine Using Artificial Intelligence and Robotics in the COVID-19 Era
Sonu Bhaskar, Sian Bradley, [...], and Maciej Banach Additional article information
Abstract
Technological innovations such as artificial intelligence and robotics may be of potential use in telemedicine and in building capacity to respond to future pandemics beyond the current COVID-19 era. Our international consortium of interdisciplinary experts in clinical medicine, health policy, and telemedicine have identified gaps in uptake and implementation of telemedicine or telehealth across geographics and medical specialties. This paper discusses various artificial intelligence and robotics-assisted telemedicine or telehealth applications during COVID-19 and presents an alternative artificial intelligence assisted telemedicine framework to accelerate the rapid deployment of telemedicine and improve access to quality and cost-effective healthcare. We postulate that the artificial intelligence assisted telemedicine framework would be indispensable in creating futuristic and resilient health systems that can support communities amidst pandemics.
Keywords: telehealth, digital medicine, pandemic (COVID-19), robotics, telemedicine, artificial intelligence, coronavirus disease 2019 (COVID-19)
