遠距監測裝置對於中風發生成效之系統性回顧暨統合分析Remote Monitoring for the effectiveness of stroke A Systematic Review and Meta-Analysis

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2019-08-31 已刊登
新刊登 綜 整 預防/治療/介入類型

作  者

林惠庭 張家佩* 黃愉真

實證知識類別

A 類:實證健康照護綜整

PICO

治療/預防性問題

治療/介入措施

心血管系統 Cardiovascular Medicine & Hematology

科別

  • 遠距健康/遠距照護 Telehealth / Telenursing

中文關鍵詞

遠距監測 中風發生率

英文關鍵詞

Remote monitoring Stroke incidence

機構名稱

臺北市立萬芳醫院-委託財團法人臺北醫學大學辦理

申請單位

護理部

中文摘要

形成臨床提問:
在心律不整中心房纖維顫動(Atrial fibrillation, Af)發生容易產生中風機率增加,在臨床上發現Af大多是個案感覺有不適情形至門診就醫後發現,亦可能延遲就醫進而於其間有中風之風險;本研究目的透過系統性文獻回顧將遠距心電圖監測是否降低中風發生率,並做統合分析。
文獻搜尋的方法與分析:
本研究透過實證方法,設定PICO關鍵字,將關鍵字以照布林邏輯AND及OR的方式做聯集及交集,以PubMed, Embase, Cochrane, CINAHL, Airiti Library及臺灣博碩士論文共六個資料庫,搜尋2019年7月前之遠距監測系統(Remote Monitoring, RM)及中風發生率;使用EndNote X7逕行文獻篩選及管理。使用I²檢測研究間的異質性,用隨機效應做統合分析,計算中風發生率的勝算比(odds ratio, OR)。使用Review Manger (RevMan) 5.3統計軟體計算OR及95%信賴區間(95% Confidence interval, 95% CI),數據進行統合分析。
文獻的品質評讀:
共引用6篇文獻做統合分析,心電圖監測裝置包括有用永久性心臟節律器(Permanent pacemaker, PPM)、植入式去顫器(Implantable Cardioverter Defibrillator, ICD)及配戴型心電圖監測器(alivecor kardia monitor)。本文共搜尋到6篇符合條件之文章,依考科藍隨機對照試驗誤差風險評估(revised tool for Risk of Bias in randomized trials, RoB 2.0)之評析標準進行研究品質評價,其中五項評估皆為Low risk。
結論與建議:
本研究發現遠距心電圖監測裝置可以降低中風發生率,不同裝置類型進行個別的次群組分析皆未有顯著差異。遠距醫療可應用的場域愈來愈廣,不僅可克服地理障礙,亦成為提升照護效率與照護持續性的重要工具。冀望能透過早期發現進而早期治療,降低中風發生及傷害。

英文摘要

Ask an answerable question (PICO):
The study atrial fibrillation (Af) increase stroke . In the clinic, it is found that Af is mostly uncomfortable in the case and found in the outpatient clinic. It may also delay the medical treatment and the risk of stroke between them. The purpose of this study was to review whether remote monitoring reduces the incidence of stroke through a systematic review of the literature and to conduct an integrated analysis.
The Method and Analysis of Literature Review:
This study uses the empirical method to set the PICO keyword, and combines and intersects the keywords in the way of Buhlin logic AND and OR. There are six materials in PubMed, Embase, Cochrane, CINAHL, Airiti Library and Taiwan Master's thesis. The library searches for remote monitoring systems (RM) and stroke rates before July 2019; uses EndNote X7 to track and manage documents. I2 was used to detect heterogeneity between studies, and random effects were used for integrated analysis to calculate the odds ratio (OR) of the incidence of stroke. Data were analyzed using the Review Manger (RevMan) 5.3 statistical software calculation OR and 95% confidence interval (95% CI).
Critical Appraisal:
This systematic review and meta-analysis examined the of these six literatures . The remote monitoring device includes a permanent pacemaker (PPM), Implantable Cardioverter Defibrillator (ICD) and a wearable ECG monitor (alivecor kardia monitor). In this study, a total of six literatures were searched, and the evaluation quality of the Revised tool for Risk of Bias in randomized trials (RoB 2.0) was evaluated. Five of the evaluations were Low. Risk.The evidence level uses the Oxford centre for Evidence-based Medicine 2011 Levels of Evidence rating, both Level II.
Conclusions and Recommendations:
This study found that remote monitoring devices can reduce the incidence of stroke, but there is no significant difference in individual secondary group analyses between different device . The field of remote monitoring is becoming more and more applicable, which not only overcomes geographical obstacles, but also becomes an important tool for improving the efficiency of care and the continuity of care. It is hoped that early detection and early treatment can reduce the occurrence and damage of stroke.