OBJECTIVE: This research aims to provide a literature review study and an in-depth analysis to (1) investigate the procedure and roles of remote diagnosis in telemedicine; (2) review the technical tools and technologies used in remote diagnosis; (3) review the diseases diagnosed remotely in telemedicine; (4) compose a crossover taxonomy among diseases, technologies, and telemedicine; (5) present lists of input variables, vital signs, data and output decisions already applied in remote diagnosis; (6) Summarize the performance assessment measures utilized to assess and validate remote diagnosis models; and (7) identify and categorize open research issues while providing recommendations for future advancements in intelligent remote diagnosis within telemedicine systems.
METHODS: A systematic search was conducted using online libraries for articles published from 1 January 2016 to 13 September 2023 in IEEE, PubMed, Science Direct, Springer, and Web of Science. Notably, searches were limited to articles in the English language. The papers examine remote diagnosis in telemedicine, the technologies employed for this function, and the ramifications of diagnosing patients outside hospital settings. Each selected study was synthesized to furnish proof about the implementation of remote diagnostics in telemedicine.
RESULTS: A new crossover taxonomy between the most important diagnosed diseases and technologies used for this purpose and their relationship with telemedicine tiers is proposed. The functions executed at each tier are elucidated. Additionally, a compilation of diagnostic technologies is provided. Additionally, open research difficulties, advantages of remote diagnosis in telemedicine, and suggestions for future research prospects that require attention are systematically organized and presented.
CONCLUSIONS: This study reviews the role of remote diagnosis in telemedicine, with a focus on key technologies and current approaches. This study highlights research challenges, provides recommendations for future directions, and addresses research gaps and limitations to provide a clear vision of remote diagnosis in telemedicine. This study emphasizes the advantages of existing research and opens the possibility for new directions and smart healthcare solutions.
METHODS: The searches were completed in April 2024 using the databases PsycINFO, CINAHL Plus, MEDLINE, and Embase. Fifteen studies with a total of 1041 participants were included. These studies used quantitative measures to assess mania and depression in participants aged 50-98 with BD I or II. The studies' risk of bias was evaluated using the appropriate critical appraisal tools.
RESULTS: The Young Mania Rating Scale (YMRS) was the most commonly used measure of mania, while the Center for Epidemiologic Studies Depression Scale (CES-D) and the Hamilton Depression Rating Scale (HAM-D) were the most commonly used measures of depression. The pooled analysis revealed that older adult scores on the YMRS were relatively similar to younger cohorts in both euthymic and manic states. Variability in scores was seen across the depression scales.
LIMITATIONS: The review followed rigorous systematic processes. However, in some studies, the participant's mood state was unknown, possibly impacting their pooled scores on the measures.
CONCLUSIONS: The findings from the review add to our existing knowledge regarding the presentation of mania and depression in later life. There is still a great disparity in research developed for the older BD population. Large-scale studies are warranted to inform the development of tailored measures and interventions to improve the outcomes for this population.
STUDY DESIGN: The current case series is a retrospective review of historic cases accumulated from 3 different hospitals. Patients treated with denosumab for large or unresectable GCGC who subsequently underwent either surgical debulk or resection post drug treatment with histological tissue for assessment were included.
RESULTS: A total of 4 patients were included in this study. All cases showed radiographic response. However histological assessment identified giant cells in 3 of the 4 cases, 2 of which showed clinical recurrence. All cases demonstrated irregular woven bone formation toward the periphery of the lesion suggesting partial response.
CONCLUSIONS: The current case series provides some insight regarding the response of CGCG to denosumab and preliminary histopathological information toward the ongoing debate regarding the medical management of CGCG. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).
METHODS: A total of 381 children (mean age 9.7 [1.6] y, 57% girls) provided 24-hour wrist-worn GENEActiv accelerometry data which captured time spent for sleep, SB, light PA and moderate to vigorous PA (MVPA). Indicators of adiposity were derived from anthropometry and bioelectrical impedance analysis: body-mass-index-for-age, waist circumference, waist-to-height ratio, percent body fat, and body mass index. The composition of 4-part movement behaviors was expressed as isometric log-ratio coordinates which were entered into regression models. Isotemporal substitution analysis was used to assess changes in adiposity indicators when reallocating time between movement behaviors.
RESULTS: Relative to other movement behaviors, time spent on MVPA was significantly associated with waist circumference, waist-to-height ratio, percent body fat, and fat mass index. A 15-minute one-to-one reallocation from other movement behaviors to MVPA predicted lower body-mass-index-for-age (-0.03 to -0.11), smaller waist circumference (-0.67 to -1.28 cm), lower waist-to-height ratio (-0.004 to -0.008), percent body fat (-0.87% to -1.47%), and fat mass index (-0.23 to -0.42). Replacing SB and light PA with sleep or MVPA was associated with lower adiposity.
CONCLUSIONS: The overall composition of movement behavior was significantly associated with the adiposity of Malaysian schoolchildren. Promoting MVPA and sleep and reducing SB and light PA are important for prevention of childhood obesity.
METHOD: We conducted a qualitative case study evaluation in a general hospital in Saudi Arabia using interviews, observation, and document analysis from the perspectives of major MDI-EMR stakeholders, including healthcare providers, IT professionals and cybersecurity specialists.
RESULTS: The results showed the interplay among physical, technical and administrative security controls that maintained a secure posture of MDI-EMR. The effectiveness of security controls is highly influenced by the staff's cybersecurity awareness and training. The perceived effectiveness of security controls varied among users, with some expressing satisfaction with the ease of use and reliability, while others highlighting challenges such as password complexity and access procedures. Understanding these diverse perspectives is crucial for tailoring security measures to meet the needs of different stakeholders effectively.
CONCLUSION: Collaboration among the key stakeholders is crucial for implementing security controls for MDI-EMR. Balancing security measures with usability concerns is essential, as highlighted by challenges in implementing technical controls. A comprehensive approach encompassing physical, technical and administrative controls, continuous education and awareness initiatives are significant to empower staff in recognising and mitigating cyber threats effectively to safeguard medical data and ensure the integrity of healthcare systems.
METHODS: A 4-stage modified Delphi consensus method was used to engage 32 PEC experts from 12 Asian countries. Participants voted on 32 elements identified from a prior scoping review, focus group discussions, and survey. Each round of voting was conducted through an anonymous, web-based application and followed by face-to-face group discussions. The first two rounds aimed to answer, "Is the element important and feasible in a low resource setting?" The last two stages aimed to answer "Should this element be prioritized as core in the tool?" A thematic analysis of the recorded and transcribed discussions was used to identify participants' rationale for prioritization.
RESULTS: After four rounds of voting, 12 elements were identified as core elements: (1) dispatch assisted instructions, (2) protocols for screening, triage and destination, (3) medical direction, (4) standardized training programs, (5) minimum ambulance standards, (6) operational metrics, (7) quality assurance, (8) operational safety protools, (9) essential patient care documentation, (10) medical records management, (11) layperson awareness and education and (12) universal access emergency number. However, the participants decided to include all 32 elements in the tool grouped into broader categories by percent agreement for a tiered approach for early, intermediate, and advanced PEC systems. Rationales for prioritization included a need for focus on basic infrastructure and building resilience in resource-stretched systems.
CONCLUSIONS: Through a Delphi consensus process, stakeholders identified core elements for PEC systems in low resource settings. These findings will inform the development of a tool for quality assurance and monitoring in low resource settings in South and Southeast Asian countries.
RESEARCH DESIGN AND METHODS: 19,440 patients with T2D underwent structured evaluation utilizing the JADE platform with clinical outcomes data retrieved from territory-wide electronic medical records including inpatient, outpatient and emergency care. Two-part model was adopted to account for skewed healthcare costs distribution. Incremental healthcare costs associated with nine non-fatal diabetes complications and all-cause death were estimated, adjusted for demographic, clinical, lifestyle factors and comorbidities.
RESULTS: In this prospective cohort [mean ± SD age:59.9 ± 11.9 years, 56.6 % men, duration of diabetes:7.3 ± 7.5 years, HbA1C:7.5 ± 1.6 %] observed for 7 (interquartile range:4-9) years (142,132 patient-years), the mean annual healthcare costs, mainly due to inpatient cost, were USD$2,990 ± 9,960. Lower extremity amputation (LEA) (USD$31,302; 95 %CI: 25,706-37,004), hemorrhagic stroke (USD$21,164; 17,680-24,626), ischemic stroke (USD$17,976; $15,937-20,352) and end-stage disease (ESRD) (USD$14,774; 13,405-16,250) in the year of event incurred the highest cost. Residual healthcare costs in the post-event years were highest for ESRD, LEA, haemorrhagic stroke and incident cancer.
CONCLUSION: These comprehensive temporal healthcare cost estimates for diabetes-related complications allows the performance of long-term, patient-level, cost-effectiveness analyses on T2D prevention and treatment strategies relevant to an Asian and possibly global contexts. These may inform decision-makers on resource allocation aimed at reducing the burden of T2D and chronic diseases.
METHODS: Oxy-PICU was a pragmatic, multicentre, open-label, randomised controlled trial in England and Scotland. Eligible children were older than 38 weeks and younger than 16 years and had been admitted for emergency care in one of 15 participating PICUs, where they received invasive respiratory support for abnormal gas exchange. Participants were randomly assigned (1:1) to either a conservative oxygenation target (SpO2 88-92%) or liberal oxygenation target (SpO2 >94%). Survival status was assessed at 90 days and 1 year, and health-related quality of life (HRQoL), quality-adjusted life-years (QALYs), health-care costs, and incremental net monetary benefit were assessed at 1 year after the index hospital admission and randomisation. HRQoL was measured with age-appropriate Paediatric Quality of Life Generic Core Scales and mapped onto the Child Health Utility 9D index score. HRQoL and survival data were combined to construct QALYs. Costs at 1 year were derived from use of hospital, outpatient, and community health services. The trial was registered in the ISRCTN registry (ISRCTN92103439).
FINDINGS: 2040 children were enrolled between Sept 1, 2020 and May 15, 2022. 1868 (91·6%) children were included in the 90-day survival analysis; of these 930 (49·8%) had been assigned liberal oxygen and 938 (50·2%) conservative oxygen. 1867 (91·5%) children were included in the 1-year survival analysis; 930 (49·8%) had been assigned liberal oxygenation and 937 (50·2%) conservative oxygen. At 90 days, 35 (3·7%) patients in the conservative oxygenation group and 45 (4·8%) patients in the liberal oxygenation group had died (adjusted hazard ratio [aHR] 0·75 [95% CI 0·48 to 1·17]). By 1 year, 52 (5·5%) patients in the conservative oxygenation group and 66 (7·1%) patients in the liberal oxygenation group had died (aHR 0·77 [95%CI 0·53 to 1·10]). Overall, mean HRQoL, life-years, and QALYs at 1 year were similar in the two groups. The adjusted incremental effect on cost of conservative oxygenation versus liberal oxygenation was -£879 (95% CI -9036 to 7278), whereas the incremental difference in QALYs was estimated at 0·001 (-0·010 to 0·011), leading to an incremental net monetary benefit of £894 (-7290 to 9078) associated with conservative oxygenation relative to liberal oxygenation. These results did not vary by age (<12 months vs ≥12 months), comorbidity at baseline, age-adjusted heart rate, or haemoglobin level at admission and were robust to alternative assumptions.
INTERPRETATION: Compared with usual care (SpO2 >94%) for invasively ventilated children who are admitted as an emergency to a PICU, conservative oxygenation (SpO2 88-92%) was not associated with differences in longer-term survival, costs, or cost-effectiveness. Taken together with previous findings of Oxy-PICU that conservative oxygenation compared with liberal oxygenation leads to better patient-centred and parent-centred outcomes at 30 days, these findings support the use of conservative oxygenation targets for this population.
FUNDING: UK National Institute for Health and Social Care Research Health Technology Assessment Programme.
METHODS: Exosomes were isolated by ultracentrifugation and characterized using nanoparticle tracking analysis (NTA), scanning electron microscopy (SEM), and Western blot. The effect of exosomes in modulating monocyte phenotypes as well as cytokine secretion were further assessed in a co-culture condition using flow cytometry and ELISA accordingly.
RESULTS: Exosomes were identified as spherical particles with a size distribution ranging from 30 nm to 150 nm. These nanoparticles intensely expressed exosome protein markers including CD9, CD63, CD81, and HSP70. The expression of HLA-DR, CD14, and CD11b on monocytes decreased in the presence of exosomes after 24 h of incubation, regardless of the dose. Exosomes significantly induced the release of anti-inflammatory cytokines IL-1Ra in a time- and dose-dependent manner, while TNF-α secretion remains unchanged regardless of the presence or absence of exosomes.
CONCLUSION: This study highlights the immunoregulatory role of exosomes on monocytes, emphasizing the need for further studies into the underlying mechanism.