TY - JOUR AU - Kitsiou, Spyros AU - par， Guy AU - Jaana, Mirou PY - 2015 DA - 2015/03/12 TI -家庭远程监护干预对慢性心力衰竭患者的影响:系统评价的概述乔- J地中海互联网Res SP - e63六世- 17 - 3 KW -家里遥控KW -远程医疗KW -远程医疗KW -远程监控KW -远程咨询KW -心脏衰竭KW -慢性病KW -病人护理的连续性KW -生理监测KW -动态监测KW -家庭护理服务KW -审查千瓦伞审查KW -系统回顾KW -荟萃分析AB -背景:人们对家庭远程监护对慢性心力衰竭(HF)患者的影响越来越感兴趣，这导致了针对相同或非常相似的研究问题的系统综述数量的增加，同时也增加了不一致的发现。系统评价的范围、分析方法和方法学质量的差异会造成很大的混乱，使政策制定者和临床医生难以获取和解释现有证据，也使研究人员难以了解现有文献中存在的知识空白。目的:本综述旨在收集、评估和综合来自多个系统综述的关于慢性心力衰竭(HF)患者家庭远程监测干预有效性的现有证据，为政策制定者、从业者和研究人员提供信息。方法:在MEDLINE、EMBASE、CINAHL和Cochrane图书馆进行全面的文献检索，以确定1996年1月至2013年12月发表的所有相关的同行评议的系统综述。使用明确的关键词和纳入标准对评论进行搜索和筛选。使用标准化表格提取数据，并使用AMSTAR(评估系统评价的方法学质量)工具对纳入的评价的方法学质量进行评价。为所有感兴趣的主要结果构建了结果摘要表，并使用GRADE(推荐、评估、发展和评价等级)系统根据结果对证据质量进行分级。进行事后分析和亚组荟萃分析，以进一步了解系统综述中包括的各种类型的家庭远程监控技术以及这些技术对临床结果的影响。 Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4%-6.5% and 3.7%-8.2%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (≤28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95% CrI 0.42-0.89) and HR 0.67 (95% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. SN - 1438-8871 UR - //www.mybigtv.com/2015/3/e63/ UR - https://doi.org/10.2196/jmir.4174 UR - http://www.ncbi.nlm.nih.gov/pubmed/25768664 DO - 10.2196/jmir.4174 ID - info:doi/10.2196/jmir.4174 ER -