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Wearable dynamic electrocardiogram monitor-based screening for atrial fibrillation in the community-dwelling elderly population 基于可穿戴动态心电图监测仪的社区老年人心房颤动筛查
Pub Date : 2024-02-01 DOI: 10.1016/j.ceh.2024.03.001
Lili Wei , Enyong Su , Jianfang Xie , Wangqiong Xiong , Xiaoyue Song , Junqiang Xue , Chunyu Zhang , Ying Hu , Peng Yu , Ming Liu , Hong Jiang

Background

Atrial fibrillation (AF) is a major public health problem with high rates of morbidity, disability and mortality, especially in the elderly population. This study explored the diagnosis and treatment status of AF in adults aged ≥65 years in the community through wearable dynamic electrocardiogram (ECG) monitoring.

Methods

We conducted a cross-sectional study in 4 random communities within the Qingpu district of Shanghai, China. Between January 1, 2020 and June 30, 2022, the ECGs of 3852 adults aged 65 years or older were examined through wearable dynamic ECG monitoring. Data from 3839 participants were ultimately analyzed. Multivariate logistic regression was used to determine the independent predictors of AF.

Results

Wearable dynamic ECG monitoring detected AF in 360 elderly people, 78 of whom were diagnosed with AF for the first time. Multivariate logistic regression analysis revealed that snoring, renal dysfunction, coronary heart disease and high CHA2DS2-VASc score were independent risk factors for AF. Among patients with unknown AF, 68 (87.20 %) met the criteria for anticoagulant therapy based on the CHA2DS2-VASc score. Only 4 (5.88 %) patients were taking anticoagulants. Of the patients with a clear history of AF, 249 (84.98 %) needed an anticoagulant strategy, but only 18 (7.23 %) took oral anticoagulants.

Conclusion

Many elderly people have silent AF, and wearable dynamic ECG monitoring can be used to screen for AF effectively.

背景心房颤动(房颤)是一个重大的公共卫生问题,发病率、致残率和死亡率都很高,尤其是在老年人群中。本研究通过可穿戴动态心电图(ECG)监测,探讨了社区中年龄≥65 岁成年人心房颤动的诊断和治疗状况。在 2020 年 1 月 1 日至 2022 年 6 月 30 日期间,我们通过可穿戴动态心电图监测对 3852 名 65 岁或以上的成年人进行了心电图检查。最终分析了 3839 名参与者的数据。结果可穿戴动态心电图监测仪检测出 360 名老年人患有心房颤动,其中 78 人是首次诊断出心房颤动。多变量逻辑回归分析显示,打鼾、肾功能不全、冠心病和 CHA2DS2-VASc 高分是房颤的独立危险因素。在不明房颤患者中,68 人(87.20%)符合根据 CHA2DS2-VASc 评分进行抗凝治疗的标准。只有 4 例(5.88%)患者正在服用抗凝药物。在有明确房颤病史的患者中,有 249 人(84.98%)需要采取抗凝策略,但只有 18 人(7.23%)服用口服抗凝药。
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引用次数: 0
Expert consensus on the evaluation and management of high-risk indeterminate pulmonary nodules 高风险不确定肺结节评估和管理专家共识
Pub Date : 2024-02-01 DOI: 10.1016/j.ceh.2024.01.002
Yang Dawei , Stephan Lam , Kai Wang , Zhou Jian , Zhang Xiaoju , Wang Qi , Zhou Chengzhi , Zhang Lichuan , Bai Li , Wang Yuehong , Li Ming , Sun Jiayuan , Li Yang , Fengming Kong , Haiquan Chen , Ming Fan , Xuan Jianwei , Fred R. Hirsch , Charles A. Powell , Bai Chunxue

Background

The most effective method for improving the prognosis of lung cancer is the application of low-dose computed tomography (LDCT) for pulmonary nodule screening in populations at high risk. Timely diagnosis and treatment of early-stage lung cancer can contribute to higher long-term survival rates. However, it remains difficult to differentiate malignant from benign pulmonary nodules measuring 8–15 mm, and avoid overtreatment on the one hand and delayed diagnosis on the other hand. In this consensus paper, we aimed to clarify the definition of “high-risk indeterminate pulmonary nodules (IPNs)” and discuss appropriate evaluation and management to facilitate timely diagnosis of lung cancer to improve lung cancer outcome. Direction for future research was discussed.

Methods

A multi-disciplinary panel of doctors and IT experts from Asia, Canada and the U.S. were invited to participate. Published evidence and consensus guidelines were used to develop this consensus was clarified. Their evaluation and management were discussed.

Findings

The experts believed that the prevalence of pulmonary nodules was very high, and it that was difficult to diagnose early-stage lung cancer due to the small size of the nodules, often leading to delayed diagnosis or overtreatment. To address this issue and to improve long-term outcome, the panel considered important to revise the classification of high-risk IPNs, (1) as pulmonary nodules that cannot be clearly diagnosed with non-surgical biopsy procedures, but is highly suspicious for early-stage lung cancer. The panel also recommends the most responsible should arrange imaging evaluations and follow-ups, taking new technologies into account. Artificial intelligence (AI) assessment based on the Medical Internet of Things (MIoT) can be combined with expert opinion to form a human–computer multidisciplinary team (MDT) that can fully implement the three core procedures of the MIoT, namely, comprehensive perception, reliable transmission, and intelligent processing. This will help to upgrade the non-standard diagnosis and treatment, the so-called “handicraft workshop model”, to a modern assembly-line model that meets international standards. The MIoT technology, which has the potential to realize “simplification of complex problems, digitalization of simple problems, programming of digital problems, and systematization of programming problems”, can promote the homogeneous evaluation of pulmonary nodules by enhancing both the sensitivity and the specificity of detecting early-stage lung cancer, in order to avoid delayed diagnosis and overtreatment.

Conclusion

To optimize the evaluation of early-stage lung cancer, and to avoid delayed diagnosis and overtreatment, it is necessary to propose and promote the concept of “high-risk IPNs”. The application of current technologies, AI, and a human–computer MDT, will facilitate improvement

背景 改善肺癌预后的最有效方法是在高危人群中应用低剂量计算机断层扫描(LDCT)进行肺结节筛查。早期肺癌的及时诊断和治疗有助于提高长期生存率。然而,要区分 8-15 毫米大小的恶性和良性肺结节,一方面要避免过度治疗,另一方面又要避免延误诊断,这仍然是一个难题。在这篇共识论文中,我们旨在明确 "高风险不确定肺结节(IPNs)"的定义,并讨论适当的评估和管理,以促进肺癌的及时诊断,从而改善肺癌的预后。我们邀请了来自亚洲、加拿大和美国的多学科医生和 IT 专家参加。在达成共识的过程中,使用了已发表的证据和共识指南。结果专家们认为,肺结节的发病率非常高,而且由于结节较小,很难诊断出早期肺癌,这往往会导致延误诊断或过度治疗。为解决这一问题并改善长期预后,专家小组认为修订高危 IPN 的分类非常重要,(1) 高危 IPN 是指无法通过非手术活检程序明确诊断,但高度怀疑为早期肺癌的肺部结节。专家小组还建议,考虑到新技术,最有责任心的人应安排影像学评估和随访。基于医疗物联网(MIoT)的人工智能(AI)评估可与专家意见相结合,组成人机多学科团队(MDT),全面实现医疗物联网的三大核心程序,即全面感知、可靠传输和智能处理。这将有助于把不规范的诊疗,即所谓的 "手工作坊模式",升级为符合国际标准的现代化流水线模式。MIoT技术具有实现 "复杂问题简单化、简单问题数字化、数字化问题程序化、程序化问题系统化 "的潜力,可通过提高早期肺癌检测的灵敏度和特异性,促进肺结节的同质化评估,避免延误诊断和过度治疗。当前技术、人工智能和人机 MDT 的应用将促进结节评估的改进,将当前类似于手工作坊式生产的诊断和治疗模式转变为符合国际标准的现代化流水线模式,并最终带来更好的预后。
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引用次数: 0
Wearable electronic devices in the intensive care units 重症监护室中的可穿戴电子设备
Pub Date : 2024-02-01 DOI: 10.1016/j.ceh.2024.02.001
Jiahuan Chen , Weipeng Jiang , Yuanlin Song

In the realm of intensive care medicine, wearable electronic devices have emerged as a highly promising field, driven by advancements in mobile, intelligent, and personalized healthcare. They are defined as devices that can be worn directly on the body, offering portable services by actively recording physiological parameters and metabolic status, providing index monitoring, clinical diagnosis, and disease treatment. This review specifically highlights the utilization of wearable devices in intensive care units within the field of intensive care medicine, anticipating their future applications.

在重症监护医学领域,在移动、智能和个性化医疗保健的推动下,可穿戴电子设备已成为一个极具发展前景的领域。可穿戴设备的定义是可直接穿戴在身上的设备,通过主动记录生理参数和代谢状态,提供指数监测、临床诊断和疾病治疗等便携式服务。本综述特别强调了可穿戴设备在重症监护医学领域的重症监护病房中的应用,并对其未来的应用进行了展望。
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引用次数: 0
Hybrid approach of type-2 fuzzy inference system and PSO in asthma disease 哮喘病中的 2 型模糊推理系统和 PSO 混合方法
Pub Date : 2024-01-11 DOI: 10.1016/j.ceh.2024.01.001
Tarun Kumar , Anirudh Kumar Bhargava , M.K. Sharma , Nitesh Dhiman , Neha Nain

This research work presents a hybrid approach combining a type-2 fuzzy inference system with particle swarm optimization (PSO) to develop a type-2 fuzzy optimized inference system, specifically tailored for asthma patient data. Addressing the inherent uncertainty in medical diagnostics, this model enhances traditional type-1 fuzzy logic by incorporating ambiguity into linguistic variables and utilizing type-2 fuzzy if-then rules. The system is trained to minimize diagnostic error in asthma disease identification. Applied to a dataset comprising eight medical entities from asthma patients, the model demonstrates substantial accuracy improvements. Numerical computations validate the system, showing a decrease in error rate from 1.445 to 0.03, indicating a significant enhancement in diagnostic precision. These results underscore the potential of our model in medical diagnostic problems, providing a novel and effective tool for tackling the complexities of asthma diagnosis.

这项研究工作提出了一种混合方法,将第二类模糊推理系统与粒子群优化(PSO)相结合,开发出一种专门针对哮喘患者数据的第二类模糊优化推理系统。针对医疗诊断中固有的不确定性,该模型通过将模糊性纳入语言变量并利用第二类模糊 "如果-那么 "规则,增强了传统的第一类模糊逻辑。该系统经过训练,能最大限度地减少哮喘疾病识别中的诊断错误。该模型应用于由哮喘患者的八个医疗实体组成的数据集,其准确性有了大幅提高。数值计算验证了该系统,显示错误率从 1.445 降至 0.03,表明诊断精确度显著提高。这些结果凸显了我们的模型在医疗诊断问题上的潜力,为解决复杂的哮喘诊断问题提供了一种新颖而有效的工具。
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引用次数: 0
Post pandemic analysis on comprehensive utilization of telehealth and telemedicine 大流行后对远程保健和远程医疗综合利用的分析
Pub Date : 2023-12-09 DOI: 10.1016/j.ceh.2023.12.002
Hamunyare Ndwabe, Arindam Basu, Jalal Mohammed

The existing global health crisis characterized by limited resources, including health personnel, has prompted the adoption of telemedicine and telehealth, especially in the post-pandemic era. The COVID-19 pandemic accelerated the adoption of these technologies, and as the world navigates beyond the crisis, it is essential to assess the extent of utilization of telehealth and telemedicine. This review study aims to assess the extent to which teleservices have been implemented worldwide across different continents. Peer-reviewed telehealth and telemedicine articles were reviewed across Web of Science, Scopus, Cochrane Library and Pubmed/Medline databases. The exclusion criteria comprised all articles published before 1 December 2019, any other databases, duplicates, and grey literature. The inclusion criteria for this study encompassed articles published on or after December 1, 2019. This timeframe allowed us to focus on the pandemic and post-pandemic era. A total of 381 publications were identified for inclusion, which were screened based on reviewing the titles, abstracts and full-text content down to 102 relevant articles. Utilization trends were identified amongst the different countries across the continents, and these were classified into advanced, developed, developing and emerging adoption stages. The respective characteristics utilized in differentiating these adoption stages were identified, encompassing the inclusivity of teleservices in administration, disease diagnosis, treatment, patient follow-ups, pharmacy services and electronic health records transversely. According to this review, of the countries surveyed (n = 77), (n = 27) 13.8 % are at an advanced adoption stage, (n = 20) 10.3 % are at a developed level, (n = 24) 12.3 % are at the developed stage, and (n = 6) 3 % are at the emerging stage, as percentages of all the countries in the world (N = 195). In conclusion, this study demonstrated the extent to which various nations have adopted telehealth and telemedicine from the onset of the COVID-19 pandemic to 2023.

当前全球卫生危机的特点是资源(包括卫生人员)有限,这促使人们采用远程医疗和远程保健,特别是在大流行后的时代。COVID-19 大流行加速了这些技术的应用,随着全球走出危机,有必要评估远程保健和远程医疗的利用程度。本综述研究旨在评估各大洲在全球范围内实施远程服务的程度。我们在 Web of Science、Scopus、Cochrane Library 和 Pubmed/Medline 数据库中查阅了同行评议的远程保健和远程医疗文章。排除标准包括 2019 年 12 月 1 日之前发表的所有文章、任何其他数据库、重复文章和灰色文献。本研究的纳入标准包括 2019 年 12 月 1 日或之后发表的文章。这一时间范围使我们能够关注大流行和大流行后的时代。共确定了 381 篇可纳入的出版物,并在审阅标题、摘要和全文内容的基础上筛选出 102 篇相关文章。确定了各大洲不同国家的使用趋势,并将其分为先进、发达、发展中和新兴采用阶段。在区分这些采用阶段时,还确定了各自的特点,包括远程服务在行政管理、疾病诊断、治疗、病人随访、药房服务和电子健康记录方面的横向包容性。根据这项研究,在接受调查的国家(总数=77)中,13.8%的国家(总数=27)处于高级采用阶段,10.3%的国家(总数=20)处于发达水平,12.3%的国家(总数=24)处于发达阶段,3%的国家(总数=195)处于新兴阶段。总之,本研究展示了从 COVID-19 大流行开始到 2023 年各国采用远程保健和远程医疗的程度。
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引用次数: 0
Research progress of MIoT and digital healthcare in the new era 新时代物联网与数字医疗的研究进展
Pub Date : 2023-12-03 DOI: 10.1016/j.ceh.2023.11.004
Peizhi Tao, Na Liu, Chunling Dong

Medical Internet of Things (MIoT) and Digital healthcare have long since ceased to be separate entities. Cross-fertilisation of MIoT-based digital medical treatment models is the way forward. However, few studies discuss the development of MIoT and Digital healthcare in clinical practice. This paper reviews the research progress of MIoT and Digital healthcare in related fields.

医疗物联网(MIoT)和数字医疗早已不再是独立的实体。基于工业物联网的数字医疗模式的交叉融合是未来的发展方向。然而,很少有研究讨论临床实践中工业物联网和数字医疗的发展。本文综述了工业物联网和数字医疗在相关领域的研究进展。
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引用次数: 0
Concept and prospect of the Human-Computer Multi-Disciplinary team (MDT) in pulmonary nodule evaluation 肺结节评估中人机多学科小组(MDT)的概念和前景
Pub Date : 2023-12-01 DOI: 10.1016/j.ceh.2023.11.003
Li Yang , Dawei Yang , Man yao , Chunxue Bai

Lung cancer is the leading cause of cancer-related deaths worldwide. Early diagnosis and treatment play a crucial role in improving the prognosis for lung cancer. However, the issue of overtreatment and delayed diagnosis remains prevalent due to the considerable limitations of manual film review in facilitating early detection and treatment of lung cancer. In recent years, artificial intelligence (AI) has emerged as a valuable tool for clinicians to screen and evaluate benign and malignant pulmonary nodules, offering numerous advantages. Nevertheless, the sensitivity and specificity of AI are neither sufficient to completely replace medical experts nor capable of assuming direct responsibility for clinical diagnosis and treatment.

Therefore, we propose the concept of a Human-Computer Multi-Disciplinary Team (MDT), which involves collaborative decision-making between human physicians and AI systems. The human-computer MDT approach in pulmonary nodule evaluation presents a novel model for diagnosis and treatment, leveraging the respective strengths of human expertise and AI capabilities. This review provides an overview of the background, medical application, advantages and limitations, future trends, and reporting format of the Human-Computer MDT in pulmonary nodule evaluation.

Its aim is to explore standardized methods for enhancing early diagnosis in lung cancer. With the rapid advancement of AI and the field of meta-cosmic medicine, human-computer MDT are expected to become more widespread and play an important role in the implementation of the Healthy China 2030 plan, particularly in improving primary medical care in the future.

肺癌是全球癌症相关死亡的主要原因。早期诊断和治疗对改善肺癌预后起着至关重要的作用。然而,过度治疗和延迟诊断的问题仍然普遍存在,因为人工胶片检查在促进肺癌的早期发现和治疗方面存在相当大的局限性。近年来,人工智能(AI)已成为临床医生筛查和评估良性和恶性肺结节的宝贵工具,具有许多优势。然而,人工智能的敏感性和特异性不足以完全取代医学专家,也无法直接承担临床诊断和治疗的责任。因此,我们提出了人机多学科团队(MDT)的概念,其中涉及人类医生和人工智能系统之间的协作决策。人机MDT方法在肺结节评估中提供了一种新的诊断和治疗模式,利用了人类专业知识和人工智能能力的各自优势。本文综述了人机MDT在肺结节评估中的背景、医学应用、优点和局限性、未来趋势以及报告格式。其目的是探索提高肺癌早期诊断的标准化方法。随着人工智能和元宇宙医学领域的快速发展,人机MDT有望得到更广泛的应用,并在“健康中国2030”规划的实施中发挥重要作用,特别是在未来改善基层医疗保健方面。
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引用次数: 0
Expert consensus on the “Digital Human” of metaverse in medicine 专家就元宇宙医学中的 "数字人类 "达成共识
Pub Date : 2023-12-01 DOI: 10.1016/j.ceh.2023.11.005
Dawei Yang , Mengting Sun , Jian Zhou , Yeting Lu , Zhenju Song , Zhihong Chen , Dong Yang , Xueling Wu , Haiyan Ge , Yuming Zhang , Chengshi Gao , Jianwei Xuan , Xiaoying Li , Jun Yin , Xiaodan Zhu , Jie Liu , Hongyi Xin , Weipeng Jiang , Ningfang Wang , Yuan Wang , Chunxue Bai
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引用次数: 0
Feasibility, safety and tolerability of CT-guided percutaneous thermal ablation in COPD with malignant pulmonary nodules CT引导下经皮热消融治疗慢性阻塞性肺疾病合并恶性肺结节的可行性、安全性和耐受性
Pub Date : 2023-12-01 DOI: 10.1016/j.ceh.2023.12.001
Min Ao , Yunjiu Hu , Mi Zhou , Junhao Mu , Weiyi Li , Jing Liu , Xiaohui Wang , Li Yang

For early-stage non-small cell lung cancer, surgical resection was used as the first treatment. However, approximately 20% of patients were not suitable for surgery due to severe comorbidities. We verified the feasibility, safety, and tolerability of percutaneous thermal ablation for patients of chronic obstructive pulmonary disease (COPD) with peripheral high-risk pulmonary nodules in the real world. The patients with peripheral high-risk pulmonary nodules ineligible or unwilling to undergo surgery who were ineligible or unwilling tosurgery underwent CT-guided thermal ablation in our hospital from January 1st, 2019 to May 31th, 2022 were retrospectively collected, and divided into COPD and non COPD group. Incidence, severity, risk factors of complications between in different severity of COPD and non-COPD group were compared. A total of 216 high-risk were enrolled, including 73 in COPD group and 143 in the non-COPD group. The average age, male gender, MMRC score, size of nodules, incidence of confirmed pathological diagnosis, and pneumothorax after thermal ablation were higher in the COPD group than in the non-COPD group. COPD was the only independent risk factor for pneumothorax after ablation. The incidence of pneumothorax increased with the severity of COPD, but no statistical significance. Compared to the baseline, the MMRC score was significantly increased in the COPD group, but there was no significant difference in the discharge time and hospitalization expenses between the COPD patients with or without pneumothorax. CT-guided percutaneous thermal ablation is a safe and feasible therapy for different severities of COPD with high-risk pulmonary nodules, and it is well-tolerated without increasing medical burden.

对于早期非小细胞肺癌,手术切除是首选治疗方法。然而,由于严重的合并症,大约20%的患者不适合手术。我们在现实世界中验证了经皮热消融治疗慢性阻塞性肺疾病(COPD)伴周围高危肺结节患者的可行性、安全性和耐受性。回顾性收集2019年1月1日至2022年5月31日在我院行ct引导热消融术的不适合或不愿意手术的外周高危肺结节患者,分为COPD组和非COPD组。比较不同严重程度COPD组与非COPD组的并发症发生率、严重程度及危险因素。共有216名高风险患者入组,其中慢性阻塞性肺病组73名,非慢性阻塞性肺病组143名。COPD组的平均年龄、男性、MMRC评分、结节大小、病理确诊发生率、热消融后气胸发生率均高于非COPD组。COPD是消融术后气胸的唯一独立危险因素。气胸发生率随COPD严重程度的增加而增加,但无统计学意义。与基线相比,COPD组MMRC评分显著升高,但合并气胸和不合并气胸的COPD患者出院时间和住院费用无显著差异。ct引导下经皮热消融对于不同严重程度的COPD合并高危肺结节是一种安全可行的治疗方法,且耐受性良好,不增加医疗负担。
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引用次数: 0
Enhancing Parkinson’s disease identification using ensemble classifier and data augmentation techniques in machine learning 利用机器学习中的集成分类器和数据增强技术增强帕金森病的识别
Pub Date : 2023-11-20 DOI: 10.1016/j.ceh.2023.11.002
Mohammed Muzaffar Hussain , D. Weslin , S. Kumari , S. Umamaheswari , K. Kamalakannan

Parkinson’s disease (PD) is a devastating neurological syndrome that affects millions of people worldwide. For the successful treatment and control of PD, it is essential to detect it early and diagnose it accurately. Machine learning (ML) algorithms have shown promising results in identifying PD based on various clinical and non-invasive measures. This paper proposes an ensemble classifier-based method to identify PD using ML algorithms. We consider two classes of PD, namely, healthy controls and PD patients. Our approach involves the use of feature selection, feature extraction, and classification techniques to develop a robust and accurate model. We use a dataset that includes clinical measures and necessary features from patients with PD and healthy controls. Our outcomes demonstrate the effectiveness of the proposed method in accurately identifying PD and highlight the importance of ML algorithms in assisting with early detection and diagnosis of PD.

帕金森病(PD)是一种毁灭性的神经系统综合症,影响着全世界数百万人。早期发现和准确诊断PD是成功治疗和控制PD的关键。机器学习(ML)算法在基于各种临床和非侵入性措施识别PD方面显示出有希望的结果。本文提出了一种基于集成分类器的PD识别方法。我们考虑两类PD,即健康对照和PD患者。我们的方法包括使用特征选择、特征提取和分类技术来开发一个鲁棒和准确的模型。我们使用的数据集包括PD患者和健康对照的临床测量和必要特征。我们的结果证明了所提出的方法在准确识别PD方面的有效性,并强调了ML算法在协助PD早期检测和诊断方面的重要性。
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引用次数: 0
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Clinical eHealth
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