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Saeki M, Oyama S, Yoneda H, Shimoda S, Agata T, Handa Y, Kaneda S, Hirata H. Demonstration experiment of telemedicine using ultrasonography and telerehabilitation with 5G communication system in aging and depopulated mountainous area. Digit Health 2022; 8:20552076221129074. [PMID: 36262932 PMCID: PMC9575445 DOI: 10.1177/20552076221129074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/10/2022] [Indexed: 11/04/2022] Open
Abstract
Objective The challenges of an aging population worldwide are the increased number of people needing medical and nursing care and inadequate medical resources. Information and communication technologies have progressed remarkably, leading to innovations in various areas. 5G communication systems are capable of high-capacity, high-speed communication with low latency and are expected to transform medicine. We aimed to report a demonstration experiment of telerehabilitation and telemedicine using a mobile ultrasound system in a depopulated area in a mountainous terrain, where 32% of the population are 65 years or older. Methods At the core hospital, a physician or physical therapist remotely performed ultrasonography or rehabilitation on a subject in a clinic. Five general residents participated in the telerehabilitation as subjects. The delay time and video quality transmitted with 5G and long-term evolution (LTE) communication systems were compared. The physician or physical therapist subjectively evaluated the quality and delay of the transmitted images and subject acceptability. Results Of seven physical therapists, six and three responded that the video quality was "good" for telerehabilitation with 5G/4K resolution and LTE, respectively. Five physical therapists and one physical therapist reported that the delay time was "acceptable" with 5G/4K resolution and LTE, respectively. For telemedicine using a mobile ultrasound system, the responses for 5G were "the delay was acceptable" and "rather acceptable." In contrast, both respondents' responses for LTE were "not acceptable." Conclusions Multiple high-definition images can be transmitted with lower latency in telerehabilitation and telemedicine using mobile ultrasound imaging systems with a 5G communication system. These differences affected the subjective evaluation of the doctors and physical therapists.
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Affiliation(s)
- Masaomi Saeki
- Department of Hand Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan,Center for Advanced Medicine and Clinical Research,
Nagoya
University Hospital, Nagoya, Japan,Masaomi Saeki, Graduate School of Medicine,
Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
| | - Shintaro Oyama
- Department of Hand Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan,Medical IT center, Nagoya University
Hospital, Nagoya, Japan
| | - Hidemasa Yoneda
- Department of Hand Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
| | - Shingo Shimoda
- RIKEN Center of Brain Science-TOYOTA Collaboration Center, Nagoya,
Japan
| | - Tsukasa Agata
- Department of Medical Technology, Shinshiro Municipal
Hospital, Shinshiro, Japan
| | - Yutaka Handa
- Department of Medical Technology, Shinshiro Municipal
Hospital, Shinshiro, Japan
| | - Satoshi Kaneda
- Info-Future
Innovation Center, NTT Data Institute of Management
Consulting, Inc., Tokyo, Japan
| | - Hitoshi Hirata
- Department of Hand Surgery, Nagoya University Graduate School of
Medicine, Nagoya, Japan
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The Future of Clinical Trial Design: The Transition from Hard Endpoints to Value-Based Endpoints. Handb Exp Pharmacol 2019; 260:371-397. [PMID: 31707472 DOI: 10.1007/164_2019_302] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Clinical trials have been conducted since 500 BC. Currently, the methodological gold standard is the randomized controlled clinical trial, introduced by Austin Bradford Hill. This standard has produced enormous amounts of high-quality evidence, resulting in evidence-based clinical guidelines for physicians. However, the current trial paradigm needs to evolve because of the ongoing decrease of the incidence of hard endpoints and spiraling trial costs. While new trial designs, such as adaptive clinical trials, may lead to an increase in efficiency and decrease in costs, we propose a shift towards value-based trial design: a paradigm that mirrors value-based thinking in business and health care. Value-based clinical trials will use technology to focus more on symptoms and endpoints that patients care about, will incorporate fewer research centers, and will measure a state or consequence of disease at home or at work. Furthermore, they will measure the subjective experience of subjects in relation to other objective measurements. Ideally, the endpoints are suitable for individual assessment of the effect of an intervention. The value-based clinical trial of the future will have a low burden for participants, allowing for the inclusion of neglected populations such as children and the elderly, will be data-rich due to a high frequency of measurements, and can be conducted with technology that is already available.
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García-Altés A. [The introduction of technologies in health care systems: from saying to doing]. GACETA SANITARIA 2015; 18:398-405. [PMID: 15498411 DOI: 10.1016/s0213-9111(04)71851-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Health technology assessment (HTA) is a tool based on scientific evidence useful for making decisions about the introduction of technological advances in healthcare systems. However, there are multiple elements that influence the actual use of the results of HTA. These elements are related both to the characteristics of HTA and to the stakeholders involved -health professionals, politicians, and society. The aim of this article was to describe the main elements that influence the applicability of HTA in practice, as well as the use of HTA in clinical practice and health policy. METHODS A literature search was performed in PubMed. The references retrieved, as well as additional bibliography and gray literature dealing with different aspects of HTA practice identified from the references retrieved, were reviewed. The results are presented descriptively, with analysis of the studies grouped according to the various HTA-related topics. RESULTS Key elements that could be improved are standardization of the evaluation process, description of the organization's mission, prioritization of the technologies to be assessed, the clarity of the presentation of results, inclusion of values other than scientific evidence, such as social and cost-effectiveness values, and increased international coordination. CONCLUSIONS For many people, the rationale for HTA is its explicit role in decision making, despite its problems. The immediate future of HTA would seem to include making the assessment process explicit, and the inclusion of HTA in decision making. This entails prioritization of technologies, setting limits on resource allocation and interrelation with political processes.
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Affiliation(s)
- Anna García-Altés
- Fundación Instituto de Investigación en Servicios de Salud. Agència de Salut Pública de Barcelona. Barcelona. España
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Porzsolt F, Schreyögg J. [Scientific evidence and the cost of innovations in the health-care system]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2009; 104:622-630. [PMID: 19701733 DOI: 10.1007/s00063-009-1134-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 05/19/2009] [Indexed: 05/28/2023]
Abstract
When depicting the relationship between evidence and the cost of an innovation in the health-care system, the overall risks of assessment, the redistribution of risks in a regulated market, and the ethical consequences must first be taken into account. There are also evidence-based criteria and economic considerations which are relevant when calculating the cost of an innovation. These topics can indicate, but not exhaustively deal with the complicated relationship between scientific evidence and calculating the cost of an innovation in the health-care system. The following three statements summarize the current considerations in the continuing discussion of this topic: *Scientific evidence undoubtedly exists which should be taken into consideration when calculating the cost of an innovation in the health-care system. *The existing scientific evidence is, however, not sufficient to reach such a decision. Additional information about the benefit perceived by the patient is required. *No standardized method exists to measure this additional information. Therefore, a definition problem also exists in the health-care system when setting a price according to scientific evidence.
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Abstract
PURPOSE OF REVIEW The literature was reviewed to describe the role of gait analysis in the orthopaedic management of ambulatory children with cerebral palsy and examine the current best evidence to support these roles. RECENT FINDINGS Gait laboratory analysis is superior to visual or observational analysis of gait because it provides an objective record of gait that is able to quantify the magnitude of deviations of pathologic gait from normal and also explain these abnormalities. Recognizable gait patterns can be classified and used for making treatment decisions, the effectiveness of which can be assessed using gait analysis as a measure of gait outcomes. There are many sources of variability, however, including patients themselves, the gait laboratories and testing processes, interpretation of data and surgeons' surgical recommendations. SUMMARY Although gait analysis has been shown to alter decision making, there is little evidence that the decisions based on gait analysis lead to better outcomes. Consequently, clinical gait analysis remains controversial, with wide variation in the rates of utilization of gait analysis in the management of children with ambulatory cerebral palsy. The time is ripe for clinical trials and cohort studies to provide the evidence to establish the appropriate utilization of this technology.
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Affiliation(s)
- Unni G Narayanan
- Divisions of Orthopaedic Surgery and Population Health Sciences, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Kymes SM, Lee K, Fletcher JW. Assessing diagnostic accuracy and the clinical value of positron emission tomography imaging in patients with solitary pulmonary nodules (SNAP). Clin Trials 2006; 3:31-42. [PMID: 16539088 DOI: 10.1191/1740774506cn131oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Diagnostic tests, particularly diagnostic imaging modalities such as computed tomography (CT) and positron emission tomography (PET), have the potential to make important contributions to improved patient care and medical decision making. The expense of these tests is justified to the extent that they improve diagnostic and treatment decisions, and ultimately health outcomes. Clinical studies evaluating the accuracy of diagnostic tests and assessing their influence on decision making are essential to setting health policy and directing patient care. PURPOSE We present the design and participant baseline characteristics of the Department of Veterans Affairs Cooperative Study 027 (Prospective Study of the Diagnostic Accuracy of 18F-Fluorodeoxyglucose (FDG) - Positron Emission Tomography (PET) Imaging in the Management of Patients with Solitary Pulmonary Nodules (SNAP). METHODS SNAP is a prospective, multi-site diagnostic trial to evaluate the efficacy of PET and CT for characterizing solitary pulmonary nodules. The study incorporated an assessment of the impact of these imaging modalities on clinical decision making. RESULTS Between January 1999 and June 2001, 10 SNAP sites enrolled 532 participants with a mean age of 66 years (SD +/- 11.3), of whom 97.3% were male. A history of smoking was claimed by 93.6% of participants, with 45.7% of all participants smoking at time of enrollment. Those still smoking had an average exposure of 56.8 pack-years, while those who had quit smoking prior to enrollment had an exposure of 58.1 pack-years. LIMITATIONS The study design reduced most common biases, but some degree of selection bias and verification bias remained. We sought to minimize verification bias by use of a dual reference standard. CONCLUSION SNAP is a diagnostic test study that was designed to minimize bias and to assess a test's impact on clinical decision making, providing the kind of information most needed by clinicians and health policy makers.
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Affiliation(s)
- Steven M Kymes
- Washington University School of Medicine, Department of Ophthalmology and Visual Sciences, St Louis, MO, USA.
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García-Altés A, Ondategui-Parra S, Neumann PJ. Cross-national comparison of technology assessment processes. Int J Technol Assess Health Care 2004; 20:300-10. [PMID: 15446760 DOI: 10.1017/s0266462304001126] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:To compare methods and results among four health technology assessment organizations in different countries.Methods:All assessment reports published between 1999 and 2001 by VATAP (United States), NICE (United Kingdom), CCOHTA (Canada), and AETS (Spain), were reviewed. Detailed information about the organization, the technology assessed, the methods used, and the recommendations made were collected. A descriptive analysis of the variables, as well as comparisons of means and proportions, was performed.Results:Sixty-one reports assessing seventy-six technologies were published: nine (11.8 percent) by VATAP, thirty-nine (51.3 percent) by NICE, twenty (26.3 percent) by CCOHTA, and eight (10.5 percent) by AETS. A total of 64.5 percent of the technologies assessed were related to a high prevalence disease in the corresponding country. Most of the assessments addressed treatments (73.7 percent) and were mostly drugs (56.6 percent) and devices (23.7 percent). Most organizations used reviews of effectiveness and economic evaluations (64.5 percent), systematic reviews (21.1 percent), and original economic evaluations (36.7 percent). In 38.1 percent, the technology was recommended; the rest of the cases had no formal recommendations.Conclusions:Critical issues for future technology assessment efforts are making assessment processes more consistent, transparent, and evidence-based; formalizing the inclusion of economic and ethical considerations; and making more explicit the prioritization process for selecting technologies for assessment and reassessment.
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Abstract
Health technology assessment is the systematic and quantitative evaluation of the safety, efficacy, and cost of health care interventions. This article outlines aspects of technology assessment of diagnostic imaging. First, it presents a conceptual framework of a hierarchy of levels of efficacy that should guide thinking about imaging test evaluation. In particular, the framework shows how the question answered by most evaluations of imaging tests, "How well does this test distinguish disease from the nondiseased state?" relates to the fundamental questions for all health technology assessment, "How much does this intervention improve the health of people?" and "What is the cost of that improvement?" Second, it describes decision analysis and cost-effectiveness analysis, which are quantitative modeling techniques usually used to answer the two core questions for imaging. Third, it outlines design and operational considerations that are vital if researchers who are conducting an experimental study are to make a quality contribution to technology assessment, either directly through their findings or as an input into decision analyses. Finally, it includes a separate discussion of screening--that is, the application of diagnostic tests to nonsymptomatic populations--because the requirements for good screening tests are different from those for diagnostic tests of symptomatic patients and because the appropriate evaluation methods also differ.
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Affiliation(s)
- Jonathan H Sunshine
- Department of Research, American College of Radiology, 1891 Preston White Dr, Reston, VA 20191, USA.
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Morreim EH. From the clinics to the courts: the role evidence should play in litigating medical care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2001; 26:409-427. [PMID: 11330087 DOI: 10.1215/03616878-26-2-409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Lanzafame RJ. Clinicians, decisions, and technology in the 21st century. JOURNAL OF CLINICAL LASER MEDICINE & SURGERY 2000; 18:1-2. [PMID: 11189106 DOI: 10.1089/clm.2000.18.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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