Journal of the Asian Medical Students Association
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Risk and Protective Factors Associated with Nuclear Sclerotic Cataract among Adults: Systematic Review
Full text linkVisual impairment is currently suffered by 253 million people and lead to blindness in 15% of cases. Among them, cataract is the main cause in the world and Indonesia (52%), which could be prevented. Although actions have been taken in-order to manage cataract, the number is increasing 0.1% yearly, thus we conducted a systematic review of 11,377 subjects in 11 case-control studies from PubMed and EBSCOhost in-order to know the risk factors of nuclear sclerotic cataract (NSC), the most common cataract in the world, hence reduce incidence and prevalence of it and blindness. Full article study texts were assessed with STROBE’s criteria for further review. Within study, we concluded three preventable risk factors of NSC. Sunlight exposure which is gained by being outside for leisure (OR=1.45) or work (OR=1.75), could even elevates the risk up to 4.19 folds due to glycation process which occurs with the help of UV light. Diabetes is also linked, both acute (OR=1.66) and more dangerous chronic (OR=3.71) because of the retinopathy mechanism. Furthermore, alcohol (OR=1.18) and smoking (OR=5.44) are also responsible in elevating the risk. However, healthy diet with complete vitamins and low triglycerides, uric acid, and creatinine are proven to be able to cut the risk of NSC by half. Thus, we would like to increase awareness of primary health-care workers and community itself to educate the community about the risk factors of NSC in-order to reduce its incidence and prevalence rate as a step to achieve WHO’s “VISION 2020: The Right to Sight.
Review of the Telepathology Implementation for the Intraoperative Rapid Diagnosis in Japan
Full text linkIntroduction
Although the development of telepathology has made pathological diagnosis possible even in regions lacking pathologists, the information on the current evaluation and necessity of telepathology of intraoperative rapid diagnosis in Japan is insufficient. Thus, we compared and evaluated them based on previous studies.
Methods
We used the following items for evaluation: clinical needs, cost, training, targeted diseases, accuracy, time, diagnostic concerns, and equipment and system concerns. PubMed and Google Scholar were used to search previous articles using the following keywords [Japan], [telepathology], [intraoperative frozen section], [intraoperative rapid diagnosis], [pathologist shortage], [online training], and [AI].
Findings and Solution
Telepathology has been reported to be superior in terms of accuracy and time required, but it is not yet widespread in Japan. Concerns about implementing telepathology included increased workload for pathologists, specimen quality, and facilities' costs and safety. Reducing the workload of diagnosis by actively introducing artificial intelligence (AI) or enabling collaboration and communication among hospitals and facilities would help solve these issues. Since the investment in facilities is often costly, it is important to use AI and remote consultation following the characteristics of the patients in the region so that remote pathological diagnosis can be performed in any region of Japan, thereby improving the quality of medical care.
Conclusion
Telepathology has benefits for both the health care providers and patients, such as reducing the workload of pathologists and limiting the surgical range of the patient. The solutions from the evaluation of multiple aspects illustrated in this study can improve the quality of medical care in Japan and can also be applied overseas by promoting the introduction of remote pathological diagnosis accordance with the situations at each facility
Application of Traditional Chinese Herbal Medicine on the Prevention of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
Full text linkIntroduction
Disease outbreaks throughout history have taken its toll on the global population. Focusing on the most recent coronavirus disease-2019 (COVID-19) pandemic, scientists have been investigating viral mechanisms since the outbreak, with the aim of developing effective prevention and antiviral treatments. As the disease continues to rage on, the elimination of infection has been considered as an urgent issue.
Objective
Based on the traditional Chinese medicine (TCM) approach regarding COVID-19, we investigated the study of this pandemic from a different perspective. We aim to evaluate the effectiveness of TCM herbs as a SARS-CoV-2 prevention agent to furthermore open up more possibilities in regard to disease prevention and control.
Method
We closely exerted experiments with 18 TCM herbs for prevention of COVID-19 infection. The SARS-CoV-2 main protease (Mpro) functional assay concentrated on how these herbs inhibit the main protease in charge of virus replication. The viral pseudoparticle (Vpp) assay examined the activity of SARS-CoV-2 entry with the herbs infected with a pseudovirus.
Result
The experiments indicated that Forsythia suspensa (Lianqiao), Salvia miltiorrhiza (Danshen), and Scutellaria baicalensis (Huangqin) showed the greatest inhibition of the SARS-CoV-2 Mpro. while Scutellaria baicalensis (Huangqin) and Artemisia capillaris (Mieninchen) expressed suppression of SARS-CoV-2 entry.
Conclusion
Altogether, we showed that several TCM herbs turned out to be effective in Mpro targeting and SARS-CoV-2 Vpp inhibiting. We conclude that some of those TCM herbs might be possibly used to lower infection and prevent outbreaks. In terms of its application, while there are many aspects that need to be further investigated, the TCM herbs have shown their potential as preventive measures.
Diabetes Mellitus Control and Care in the COVID-19 Pandemic Quarantine in Mongolia: Retrospective Study
Full text linkIntroduction
Reduction in outpatient visits and laboratory testing during the Coronavirus Disease 2019 (COVID-19) pandemic has raised concerns about gaps in diabetes management and glycemic control.
Objective
We aimed to investigate the changes in the treatment and control of people with diabetes during the COVID-19 pandemic quarantine.
Method
106 glycemic control patients from three districts of six general hospitals in Ulaanbaatar were randomly selected as applicants, and permission and questionnaires were obtained through telephone contact. The questionnaire was developed based on the "Diabetes Guidelines" issued by the Ministry of Health of Mongolia. These findings include average blood glucose (BG) of fasting BG, 2-h postprandial BG, and bedtime to assess diabetes control. The main evaluation indicators included drug supply, shortage, and adherence to self-management behaviors.
Result
In total, 72.7% of participants were Type 2 Diabetes Mellitus (T2DM) and 83.3% of them were poorly controlled. 81.5% of the Type 1 Diabetes Mellitus (T1DM) participants had inadequate glycemic control. We retrospectively estimated the glycemic control using their previous HbA1c results. It shows that 70% and 72% of them were adversely controlled before the isolation although 79.7% of the respondents contacted their healthcare providers during the isolation period. All participants stopped treatment for an average of 50 ± 62.7 (p<0.05) days during the isolation period, 59% of which were due to drug supply and shortages, 41% due to isolation, and had to postpone. The average BG level before isolation was 8.4±6.9 mmol/l, the highest was 19.6±10.2 mmol/l, and during the isolation, the period was 8.9±5.3 mmol/l, the highest was 19.6±10.8 mmol/l. The maximum value is 50 mmol/l.
Conclusion
We need to develop telemedicine in Mongolia as a healthcare service. We conclude that glycemic control among patients with diabetes mellitus during quarantine is substandard
Tele-4-Life: An Application for Information Sharing among Healthcare Professionals and Referral Platform
Full text linkIntroduction Overtime doctors have been monitored in Thailand for many years and are most affected by human error communication when general doctors consult with specialists who must provide a large amount of patient data. Although nowadays telemedicine has become widespread, it rarely covers professional consultation before deciding to refer patients. Therefore, we create Tele-4-Life, a patient referral platform between specialists and doctors in local hospitals because we desire to develop a one-stop service application including a consultation process, for example, recording accuracy, file transfer, data storage, confidentiality, and referral form online.
Methods The use of telemedicine in Thailand, ThaiRefer, and in the USA, CarePICS, were searched on PubMed, Google Scholar, and other websites to study telemedicine errors and gather information to improve the life quality of physicians. This application is designed to solve problems that Thailand has not yet solved from a telemedicine perspective. Moreover, since it is a government app and acts as a one-stop service, so no information is leaked from the app.
Findings The following main factors are distinguished:
Miscommunication among physicians due to the overload of patient data.
Patient database confidentiality related to the data breach.
The delay of referral via the data provided by handwriting.
Proposed solutions Tele-4-Life integrates Thai patient database and brings the benefits of medical consultations with features as follows:
Laboratory examinations are accessible online in addition to the video call option between general physicians and specialists.
Providing online referral forms which could be accessed between hospitals.
The application could be regulated by Thai Ministry of Public Health.
Conclusion Implementation of Tele-4-Life in Thai healthcare system will improve the efficiency of patient care and minimize human error at multiple levels. When all required data are collected in one location, decision-making during treatment and referrals should be accelerated. Furthermore, it would alleviate the scarcity of medical professionals and equipment. Overall, this application aims to provide a sustainable solution for comprehensive patient care and patient database allocation
Insights from the Paralympic Experience on COVID-19 Infection Control Measures for People with Disabilities
Full text linkIntroduction
At the Tokyo Olympic Games, a measure called "bubble scheme" was taken for infection control, which focused on daily antigen testing, isolation, and avoidance of contact with the general public. At the Olympics, this infection control was considered to be effective, and the Paralympics followed the same approach.
Objective
In this study, we evaluated the effectiveness of the “bubble scheme” in COVID-19 control among the Paralympic Athletes. Based on the result, we discussed the importance of further support for people with disabilities.
Method
We searched the the website of the Japan Broadcasting Corporation NHK and Tokyo Metropolitan Government and identified the number of infected athletes in Tokyo during the period from August 17 to September 5 and from July 13 to August 8, when the Tokyo 2020 Paralympic and Olympic Games athletes' village was opening. We analyzed the collected data descriptively.
Result
The infection rates in Tokyo during the Paralympic and Olympic Games were 0.54% and 0.48%, respectively, while the infection rates among athletes were 0.30% and 0.25%, respectively. In both cases, the infection rates among athletes were lower than those in Tokyo. The infection rate among athletes was about 1.2 times higher in the Paralympics than in the Olympics.
Conclusion
Our research revealed that the “bubble scheme” was effective to prevent the spread of COVID-19 among the athletes, suggesting that the same method should be adopted in future mass gathering events. However, the measure could not completely prevent infection, and the infection rate was higher among the Paralympic athletes compared to the Olympic athletes, suggesting the need for more bespoke measures toward people with disabilities such as improving ventilation, providing free at-home covid test kits, enhancing remote support from healthcare workers
Current legal status and promotion of telemedicine in Thailand: A systematic review
Full text linkIntroduction: Telemedicine has been introduced in Thailand for a while. However, little information is available regarding how telemedicine is regulated and how the government currently supports it. Furthermore, there is no systematic review that directly addresses Thai telemedicine law.
Objective: This study aimed to collect and review progress in the use of telemedicine and current Thai legislation to promote the use of telemedicine in Thailand.
Method: A systematic literature review was conducted in Scopus and PubMed. Inclusion criteria were English-written articles published in the period 2000-2022 in the fields of medicine, health professions, computer science, and social sciences with accessible full-text. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 2020. The legal status and present situation of telemedicine in Thailand were also analyzed.
Result: A total of 4,796 records were identified after the initial search (Scopus 1,468 and PubMed 3,328). Twenty-six full-text articles fulfilled eligibility criteria, including the current Thai legislation. The results revealed that telemedicine was a potential strategy for healthcare delivery. Nonetheless, in Thailand it was still poorly developed and regulated. These studies suggest that 5 major factors need to be considered when promoting telemedicine as follows: cost effectiveness, information and communication technology (ICT) development, patient perception, health insurance coverage, and public-private sector partnership.
Conclusion: Telemedicine is an effective tool to deliver remote healthcare to patients. However, under the current situation, Thai legislation remains incomprehensible and unclear. Reviewing, updating, and implementing legislation and policies should be targeted to promote telemedicine in Thailand
A Systematic Review of Telemedicine in Burn Care over the Last Decade
Full text linkIntroduction: Technology has revolutionized medical care, allowing healthcare providers and patients to interact at distance and access greater expertise at lower cost. Burns, which relies heavily on visual assessment and multi-disciplinary teams, may benefit from telemedicine (TM). However, uptake and further barriers to development are unclear.
Objective: To assess the use of telemedicine in burn care in the last decade through a systematic review.
Methods: A PubMed search for (tele* AND burns) found 830 publications between 2010-2022. Paired abstract screening yielded 89 original research articles. Full-text review yielded 48, with 18 further excluded for non-English publication, no full text access, or study design. The remainder were assigned to at least 1 of 4 themes: cost-effectiveness (8), accuracy of diagnosis and triage (9), qualitative data (7), and practical challenges to implementation (8).
Results:
The cost-effectiveness of TM in burn care derived from accurate triage. 5 studies involved down-triage decisions for >50% patients, avoiding unnecessary transfers. Follow-ups were effective and satisfactory.
TM-supported diagnosis was more accurate for TBSA compared to depth, including in dark skin and >10% TBSA, though limited in non-expert groups. Only 4 of 9 papers included case-control assessments of accuracy. Triage decisions made via TM were generally upheld.
Qualitative opinions regarding TM are mixed. The benefits of reduced costs, access to expertise, and structured clerking providing education presented with concerns around redefined responsibilities, technological inadequacy, and difficulty providing moral support.
Technological difficulties presented the most significant challenge in implementing TM. Of 8 papers, 4 highlighted device or software inaccessibility creating delays or limiting image quality, while 2 noted unreliable internet connectivity. Other challenges included training required, financial reimbursement, and limited local resources.
Conclusion: TM shows promise in facilitating accurate, efficient, and satisfactory burns care. Further investigation into its quantitative impact and practical integration into effective care pathways is recommended
Improving the Quality of Virtual Medical Treatment & Medicine Delivery Experience in Taiwan through Telemedicine
Full text linkTelemedicine allows the running of certain health services through telecommunication technologies, regardless of time and distance, and minimises unnecessary contacts during pandemics. Despite the rapid development and the integrated technologies, Telemedicine in Taiwan did not truly come into service until early May 2022 when COVID-19 spread widely across the nation.
A survey was carried out to evaluate the degree of Telemedicine familiarity in Taiwan. Among 476 feedback, 35% of the participants were medical personnel and 65% were from the public. Data showed that about 48.5% considered themselves to be unfamiliar with Telemedicine and 25% believed that they have a good Telemedicine foundation. Only 8% of the participants claimed they have Telemedicine experiences. Two findings came to our attention when evaluating the causes of the data results. Firstly, not only do most of the Taiwan populace, the medical personnel show concerns about Telemedicine. The main reason is being unacquainted with the concepts behind it and the technologies involved. The second part moves on to the difficulty of delivering medicine to remote areas. The current practice of home delivery of medicine can only be executed by pharmacists. Consequently, the shortage of human resources has become a problem, much less the delivery to the remote regions. Thus, the following solutions have been suggested.
Solutions to the first issue:
Establishment of Professional Telemedicine departments
Telemedicine & Patience Safety Precautions
Solutions to the second issue:
Medicine delivered by the Third-party logistic industry
Set up Medicine Lockers
UAV delivery of medicine
Living in the post-pandemic era and beyond, Telemedicine is certainly becoming a leading trend. However, with an immaturely developed system, Taiwan is no doubt facing diverse obstacles when putting Telemedicine into service. Therefore, some feasible solutions are provided in this study, in the hope that Telemedicine can benefit more people
Post-implementation Evaluation of a Telehealth-Integrated Antenatal Care Model in Australia
Full text linkIntroduction (Aims and Problem Statement)
In response to the COVID-19 pandemic, the largest maternity provider in Melbourne, Australia implemented a world-first telehealth-integrated antenatal care schedule for both high- and low-risk pregnancies. Since the program has now been maintained for more than two years, clinical and economic evaluation is essential to guide its ongoing use.
Method
Clinical outcomes will be compared using time-series analysis and economic outcomes evaluated with a comparative cost analysis, for all booked births between 1st January 2018 – 22nd March 2020 (pre-telehealth cohort, n=20,031) and 25th April 2020 – 31st December 2021 (post-telehealth cohort, n=~16,500), allowing for a 1-month implementation period.
Findings
Analysis to date indicates comparable outcomes and service utilization between cohorts. No significant differences in adverse pregnancy outcomes including preeclampsia, fetal growth restriction and stillbirth were seen. The proportion of telehealth appointments increased from 0.06% pre-implementation to nearly 50% post-implementation, with no statistically significant differences in patient engagement. When surveyed, most multigravida women were satisfied with telehealth-integrated care, while primigravida women preferred more in-person appointments.
Telehealth may reduce healthcare costs, but its socioeconomic impact remains unclear as previous evaluations of smaller programs found either increased costs from added home monitoring, or cost savings from decreased travel. A cost analysis of this large-scale program is under way to clarify costs to funders and the affordability of the program.
Proposed solution(s)
We recommend:
Ongoing monitoring of clinical outcomes;
Further research into patient engagement and experience;
Robust economic evaluations to inform financial sustainability; and
Development of national Australian telemedicine standards for safety/quality.
Conclusion
The telemedicine-integrated model for antenatal care appears to be safe and acceptable. It may also be cost-saving, but ongoing research is needed to shape its future - optimizing the quality and value of pregnancy care, and ensuring sustainable, equitable and resilient healthcare systems