Journal of the Asian Medical Students Association
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Telemedicine Approaches on Blood Glucose Control in Women with Gestational Diabetes Mellitus: A Systematic Review from Randomized Controlled Trials
Full text linkABSTRACT
Introduction: Telemedicine interventions amongst studies showed great potential in improving gestational diabetes mellitus (GDM) management. It has facilitated and allowed the patients to get closer treatment, such as blood glucose monitoring and glycemic control. Considering current situation, further studies are required to assess the intervention effects in relation to another outcomes parameter being examined.
Objective: The aim of this systematic review is to evaluate the role of telemedicine in controlling blood glucose level of patient with GDM.
Method: A systematic review of randomized controlled trials was undertaken by searching on 5 databases. Risk of bias was assessed in selection, performance, detection, attrition, and outcome reporting using Review Manager 5.4.1 tools. We analyzed the blood glucose level as primary outcome and secondary outcomes, such as maternal and neonatal assessment and its significancy.
Result: We identified 6 randomized controlled trials studies in total. There are 830 participants with GDM recruited (443 patients as intervention groups and 387 patients as control groups). Results analysis indicate the effectiveness of telemedicine approaches to control blood glucose level in patients with GDM shows significantly in three studies included (P<0.05), also shows positive improvements in the observed secondary outcomes. We recommend further studies in larger populations where the prevalence of GDM is still high and remain unresolved. Therefore, if it is implemented properly in the future, the risk of loss of complications can be prevented.
Conclusion: The implementation of blood glucose telemonitoring can be promisingly an acceptable and effective tool for sustainable blood glucose control and its maintenance for GDM patients, especially who are facing difficulty to access conventional health care regularly.
Keywords: gestational diabetes mellitus, telemedicine, blood glucos
Current Legal Regulation on Telemedicine Service in Mongolia
Full text linkIntroduction
Even though a policy for regulating telemedicine was established in Mongolia in 2008, it was not implemented until COVID-19. As a result of pandemics’ indirect impact, telemedicine applications are being rapidly developed, but Health Law and Health Service Law do not include the legally permissible range in telemedicine. Thus, it is necessary to establish legal regulation when it comes to preventing illegal services and penalizing the legal entity or organization who are responsible.
Method:
We analyzed and did a comparative study of legal documents of the countries with the most advanced technological development and telemedicine service, which includes the Republic of Korea, the People’s Republic of China, Japan, Malaysia, Australia and the Russian Federation.
Findings:
In international countries, telemedicine is regulated by legal policies. If an organizer or legal entity uses it without permission or violates the law in any way, it is written to be settled by the Law of Infringement or Criminal Law.
Proposed Solution:
To amend the definition of the term “3.1.26 Telemedicine” in Health Law of Mongolia, “13.1.3 Telemedicine service” in Health Service Law of Mongolia;
To legitimize penalties for violating the law, harming human health, and make individuals take their responsibilities in the Criminal Law of Mongolia; and
To add articles for conflict and violation penalties in Mongolian Law of Infringement.
Conclusion:
Although technology and telemedicine knowledge, sufficiency is scarce in our countries' citizens and healthcare services, it will soon be an essential part of healthcare services in the future. Therefore, it is appropriate to regulate it by specific law
The Impact of Technology-Based Interventions on Informal Caregivers of Persons with Dementia: A Systematic Review
Full text linkIntroduction: Poised to revolutionise healthcare, ‘telemedicine’ is the new buzzword disrupting the global healthcare industry. Increasingly, telehealth services are being integrated into our everyday care. Yet, there is a lack of consensus regarding the efficacy of telehealth interventions in improving the wellbeing of caregivers of patients with dementia (PwD).
Objective: To systematically review current literature on the efficacy of telehealth interventions in improving caregiver well-being and (2) explore possible interventions that would improve its efficacy.
Method: The review was conducted in accordance with the PRISMA guidelines. All studies that reported on the outcomes of telemedicine interventions targeted at the informal caregivers of PwD were included.
Results: A total of 4176 participants across 32 RCTs were included in our analysis, with 2243 participants in the intervention arm. Overall, a statistically significant improvement in caregiver self-efficacy and caregiver gain was observed together with a significant reduction in anxiety. Telemedicine was also noted to have modest but non-significant effects on improving caregiver stress, QoL and social support. No consensus was reached with respect to caregiver burden and depression. Additionally, telehealth interventions were not found to have an effect on emotional well-being and psychosocial distress.
Conclusions: Telehealth is not a panacea for the concerns of caregivers. A non-specific, ‘one-size-fits-all’ approach is neither sustainable nor effective in improving caregiver well-being. Given how the efficacy of telehealth interventions as well as the recommended approach remains unclear, further large-scale longitudinal studies involving novel telehealth interventions are recommended to delineate the most effective intervention, or combination of interventions that promotes caregiver well-being
Telehealth Interventions for Improving Anti-Retroviral Therapy Retention of HIV Infected Mothers and Preventing Mother-to-Child Transmission: A Systematic Review
Full text linkIntroduction
The increasing prevalence of HIV and its effect on pregnancy has prompted several innovations to enhance testing & treatment of the mother, prevention of mother-to-child transmission (PMTCT), and increase early neonatal testing, telehealth interventions such as Short Message Service (SMS), and telephonic counselling being one of them. Owing to the variety of interventions being tested and outcomes being analysed, it is imperative to systematically review the available evidence to reach a conclusion regarding the applications of tele-health in this field.
Objective
To assess the effectiveness of tele-health interventions in improving Anti-Retroviral Therapy (ART) retention and preventing mother-to-child transmission (PMTCT) in HIV-infected pregnant females.
Methodology
Pubmed (n=12) and ClinicalTrial.gov (n=2) were searched for randomised controlled trials with keywords “Telehealth”, "HIV in pregnancy", "HIV infected pregnant females/women", Antiretroviral Therapy retention" and "preventing mother-to-child transmission" in various combinations and imported to EndNote X9 Library. Duplicates and Protocol publications (n=6) were removed. Completed trials conducted with HIV infected pregnant females (>=18 years of age) between 14 & 36 weeks of gestation having received tele-health interventions compared against routine care controls were screened by title, abstract and full text (n=8-2=6). n=3 studies analysing the outcome of ART retention and PMTCT were included in this review.
Result
A total of 3 studies (N = 3681 participants) comparing telehealth interventions - SMS-based reminders, and counselling calls were studied. n=2 (N = 2857 participants) studies reported statistically significant improvement in ART retention and PMTCT relative to regular care. n=1 (N = 824 participants) did not report any statistically significant improvement in HIV outcomes but concluded an improvement in initiation of postpartum contraception. n=3 studies excluded from the review due to a different outcome measure reported significant improvement in early Ante-natal CD4 testing, STI prevention, Breastfeeding and early neonatal HIV testing after telehealth interventions.
Conclusion
Existing evidence supports that individualised counselling delivered through SMS and telephonic conversation may provide significant benefits in retaining HIV-infected mothers and preventing mother to child transmission of HIV. The current study shall form the basis for future research
Traditional Mongolian Mana-4, Norov-7 Medicine Used in the Treatment of COVID-19 Infection: A Comparative Study
Full text linkIntroduction
Due to the global outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic, many countries took explicit measures. As for Mongolia, we implemented policies such as strictenining quarantine, disseminating the infection prevention and control guidelines by social media, and using traditional herbal medicine for treatment. However, studies considering the benefits of this treatment were insufficient and misuse was common amongst citizens. Therefore, studying accurate results regarding these issues is necessary.
Objective
We aimed to study the effects of using traditional Mongolian medicine, such as Mana-4 and Norov-7, by themself or in combination with conventional medicine in the treatment of Covid-19 pandemics.
Method
185 recovered COVID-19 patients from six districts of general hospitals in Ulaanbaatar were randomly selected as participants. The permission and questionnaires were obtained through Google form and the questionnaire was developed based on the “Traditional Mongolian medicine Guidelines'' and “COVID-19 Clinical Guidelines” issued by the Ministry of Health of Mongolia.
Result
69.7% of the participants used traditional Mongolian herbal medicine. The group that had both traditional medicine and European treatment recovered the quickest and 41,9% of them improved in a week (p <0.001). 89.7% of the total participants had frequent symptoms such as sore throat, nasal congestion, and dry cough. 57.1% of those who used the traditional treatment, the symptoms decreased 1.7 times than the other groups (p <0.05). Furthermore, the ones that took the traditional medicine inappropriately recovered 3.5 times slower than the group that used it appropriately (p<0.05).
Conclusion
In this study, it could be concluded that the recovery rate is faster when using traditional Mongolian medicine Mana-4, Norov-7, and non-traditional medicine together. Therefore, traditional medicine ought to be used in a broad spectrum with appropriate, convenient, and cost-effective methods
Possible Correlations between Social Media, Search Engines and the Covid-19 Pandemic
Full text link1. Introduction Since December 2019, coronavirus has been raging around the world. It can be assumed that most people rely on internet technologies to get or share information about the Covid-19 pandemic. The information spreading can strongly influence people’s behavior and responses to the countermeasures deployed by governments.2. Objective The study investigates the implications of trends in keyword search and possible factors of internet users' preferences regarding pandemic-related information sources.3. Method First, Google Trends was used to analyze the trends in searching Covid-19-related topics. The results from Taiwan, the USA, and worldwide were compared. Current events, updates on confirmed cases, and daily vaccinations were mapped onto the data of searching trends. Second, an online questionnaire was distributed to explore internet users’ behavior of using search engines and social media to receive Covid-related information. Based on the valid responses, factors that arguably contribute to people’s choices of information sources were discussed.4. Result Social media and search engines are people’s main sources of information but used in different conditions. Whether the sources are reliable is concerned. Therefore, people prefer official websites or accounts.Search trends on Google indicate that the outbreak of Covid-19 raised people’s awareness and that people were in need of masks to protect themselves. The data of daily confirmed cases and daily vaccinations are mostly consistent with the search trends of their related topic. Most major related events and countermeasures by governments reflect on the search trends in each topic. In large-scale area are too many variables influencing the search trends.5. Conclusion Search engines and social media are both used in getting Covid-related information but in different conditions based on their distinct properties. In addition, search trends of pandemic-related topics can in a way reflect people’s responses to the pandemic, current events, and governments’ policies.
 
Assessment of Telemedicine Coverage and Factors Affecting its Utilization Among Medical Practitioners in India
Full text linkIntroduction
"Telemedicine" literally means "remote healing." It encompasses health care delivery, education, research, health surveillance, and public health promotion. Cell phone and internet use have become practically universal as wireless broadband technology has evolved. India's 12-week curfew during the COVID-19 outbreak limited access to healthcare. As a policy reaction, India's Ministry of Health and Family Welfare established first telemedicine guidelines. However, the views of Indian medical practitioners around the use of telemedicine need to be captured for the effective implementation.
Objectives
The primary objective is to determine the proportion of Indian doctors using telemedicine. The secondary objective is to study the feasibility and factors affecting telemedicine use in India from the medical practitioners' perspective.
Methodology
This research uses a sequential explanatory mixed-methods approach. A probability proportionate to the population sampling was done (openEpi) for 384 doctors at cluster level distribution across India to gather the quantitative data. For a deeper understanding of the feasibility and factors affecting the use of telemedicine, in-depth interviews were done with 30 doctors across the country using purposive sampling. Data will be analyzed using RStudio.
Results
As per the pilot study in 35 doctors, 57.16% use some form of telemedicine in their practice. The data collection for the main phase of the study shall end by 15th June. The analysis shall be presented following the completion of the data collection phase. The transcripts are also under analysis phase.
Conclusion
Based on our interim analysis of data we conclude that telemedicine can make healthcare more accessible and egalitarian in India. Guidelines must be expanded to address concerns around limited internet access, weak telecom infrastructure, widespread adoption of telemedicine and the need to rapidly train the Indian doctors in telemedicine. Addressing these challenges can make telemedicine equitable
The Effect of the COVID-19 Pandemic on Mental Health of Indian Medical Professionals & the Relevant Role of Health Communication
No full textTitle:
Effect of the COVID-19 Pandemic on Mental Health of Indian Medical Professionals & the Relevant Role of Health Communication
Introduction:
The COVID-19 Pandemic has affected the Mental Health of many more than it has infected; Medical healthcare professionals being especially vulnerable.
This study targets medical professionals divided into 3 categories: Senior/ experienced doctors, Junior Residents/ Interns and Paramedical staff
Subjects in each category were asked the same questions relevant to the Pandemic and its effect on their lives.
The Objectives included To identify the population among medical professionals most stressed due to the Covid-19 pandemic; To Identify the reasons of stress; To Analyze the different effects of stress- both personally & professionally; To recommend solutions to reduce the stress levels & to Identify the role of health communication in decreasing stress levels.
Method:
A Sample size of 200 medical professionals across India was chosen;
About one-third of the sample size representing each category.
A survey was conducted over 3 months using a standardized questionnaire.
The results were systematically analyzed.
Results :
About one-third (34.2 %) of the medical professionals perceived increased stressed due to various reasons during the COVID-19 Pandemic; majority being medical Interns.
Health of Family(60%) and Viral Exposure (39%) were perceived as the commonest causes of increased stress
Anxiety(55%) & Sleep disturbances(43%) were the commonest effects on personal health.
The professional lives of 33.5% were negatively affected whereas 13.5% people were dutifully motivated towards their profession.
Adequate PPE supplies were considered the most significant intervention to reduce stress levels by most (81%).
The following measures can help reduce stress levels significantly among medical professionals :
Adequate supply of PPEs, Work division at Hospital duties, Decreasing non emergency patient load, Increasing salaries & A good health communication system
 
Contact Tracing System in Taiwan during Covid-19
Full text linkIntroduction
As Covid-19 swept across the globe in early 2020, Taiwan was one of the first few countries that have deployed a contact tracing system to help stem the spread of the novel coronavirus. Despite being excluded from the World Health Organization, resulting in a blockade of crucial and timely information, the government still flourished in tackling the outbreak clusters.
Objective
This study aims to determine how such a system can address the pandemic problem effectively. Undoubtedly, availing of the aforementioned technology at such a large scale without trial and error resulted in room for improvements. Therefore, this study examines the crucial concerns and impacts of this system.
Method
By snowball sampling, an investigation through an online Google Forms questionnaire was distributed to Taiwanese and foreigners who have been in Taiwan for over the past twelve months. Semi-structured interviews were conducted with 10 participants from various stakeholders to probe and further explore topics regarding the issue. Via cross-sectional data analysis, the results showed that the dominant concern from all age groups is related to the invasion of data security and privacy.
Result
Our analysis has shown that the relatively high government satisfaction and societal trust of the public have pushed the positive social outcomes, like the willingness and self-discipline of people. Such cooperation has contributed to the crackdown of Covid-19.
Conclusion
Epidemic prevention in the use of data and technology for the public's good versus privacy protection is never a closed-ended question. Law enforcement and enhancement should be taken into account when designing and wielding any systems in contact tracing. Government should also be more transparent on any future usage or process of the data collected. Regardless, the results of the contact tracing system in Taiwan could be proudly declared as successful, and stand out as exemplars for the test-trace-isolate structure in pandemic response.
 
Prognostic Value of Early Stage Biomarkers on COVID-19 Severity: A Systematic Review and Meta-Analysis
No full textBackground: The surge in morbidity and mortality rate of COVID-19 is happening worldwide. Identifying COVID-19 severity prognosis in patients at an early stage became imperative as it could help to monitor and prevent disease progression towards severe form.
Purpose of Study: To comprehend the variation and profile of specific biomarkers to have the preferred modality to monitor the severity outcomes of COVID-19. Furthermore, this study is expected to help the clinicians to identify the probability of disease progression towards severe in COVID-19 patients on admission.
Methods: This study was reported based on criteria from PRISMA. The literature search was conducted in databases such as MEDLINE, Scopus, and ScienceDirect. RevMan 5.4 were used to provide pooled estimates for standardized mean differences with 95% confidence intervals. Random effect model was used based on heterogeneity level. Risk of Bias was assessed for each study using QUIPS tools.
Results: Fifty studies were included in the qualitative synthesis and twenty three from it were included in the quantitative meta-analysis. These studies consist of a total of 12720 cohort size, 2965 and 9755 for severe patients and non-severe patients respectively. Plasma suPAR (pooled SMD = 1.54, 95% CI = 0.85-2.22, p <0.0001), serum KL-6 (pooled SMD = 1.21, 95% CI = 0.85-1.57, p <0.00001), and SP-D (pooled SMD = 1.75, 95% CI = 0.79-2.70, p = 0.0003) were shown to have significantly high prognostic value for COVID-19 severity.
Conclusion: This study provides evidence that plasma suPAR, serum KL-6, and SP-D can be used as an excellent early stage biomarkers for COVID-19 severity.
Keywords: COVID-19, Biomarker, Severity, Prognosi