远程皮肤病会诊对不同级别皮肤科医师诊断疾病作用的对比

发布时间：2018-06-22 05:11

本文选题：远程医学 + 远程皮肤病学　；参考：《郑州大学》2010年硕士论文

【摘要】： 背景和目的远程医学(telemedicine)是一种应用现代电子通讯技术来实现专业医学信息交流的新型医学工具,它既可以应用于医生和病人之间也可以应用于两个远距离的医疗机构之间。皮肤病学是最有可视特征的一门医学学科,很多皮肤病仅根据皮损的形态学即可作出准确诊断,正是这一点使它成为现代远程医学技术的最佳对象。做为远程医学的一个分支,远程皮肤病学(teledermatology)已经在许多研究中证明了它的可行性和可靠性。它的技术系统包括实时视频会议系统和存储并转发系统(SAF系统),后者一般通过e-mail或者网站传发。相比前者,SAF系统比较快速而且成本低廉。远程皮肤病学在很多方面得以应用,如可直接向病人提供诊断和治疗服务,或者向首诊医生提供二次诊断服务等。我国幅员广阔,医疗水平在大城市和农村或边远地区间有明显的区域性差别,同时我国皮肤病病人数量众多。促进远程皮肤病学的发展利于提高我国皮肤病学术水平、弥补我国皮肤病学水平的地域性差异,以及推进我国的皮肤科事业健康发展。目前关于远程皮肤病学的研究仍然需要我们做更多的随机控制实验和模拟研究需要去证明远程皮肤病学是一个有前景和节约成本的学科。本研究中,我们收集郑州大学第一附属医院皮肤科门诊需做组织病理的皮肤病病人50例,旨在讨论远程皮肤病学对不同级别医师诊断疾病的价值。方法 1.连续收集自2009年3月24日至2009年6月25日郑州大学第一附属医院皮肤性病科门诊50例患有皮肤病并需做组织病理的患者。分别由主任医师和主治医师独立给予面对面诊断并记录为第一诊断。采集病人病史,给病人皮损图像拍照,收集病人组织病理结果,排除不合格病例。把病人图片和临床资料(不包括病理资料)上传至皮肤科网站http://www.telederm.org进行远程会诊。主任医师和主治医师根据会诊结果再分别给出病人诊断结果并记录为第二诊断。两位医师在诊断时均不参考病理资料。 2.统计指标：以组织病理和临床诊断结合做出的诊断为金标准,首先分别统计主任医师和主治医师的第一诊断和第二诊断的正确率。然后对主任医师第一诊断和第二诊断的正确率差异性、主治医师第一诊断和第二诊断正确率差异性、主任医师和主治医师第一诊断正确率的差异性、主任医师和主治医师第二诊断正确率的差异性分别进行统计学比较。 3.统计学处理：利用Microsoft Office 2007的Excel录入记录的内容,使用SPSS16.0统计软件进行统计学分析。诊断差异性的比较采用McNemar检验,取检验水准α=0.05。结果 1.入选病例38例,主任医师第一诊断和第二诊断正确例数分别为35(92.11%)和36(94.74%),主治医师第一诊断和第二诊断正确率分别为15(39.47%)和34(89.47%)。 2.与金标准对比,主任医师第一诊断和第二诊断的正确率没有差异(χ2=0,P0.999),主治医师第一诊断比第二诊断的正确率低(χ2=17.05,P0.001),主任医师比主治医师的第一诊断正确率高(χ2=18.05,P0.001),主任医师和主治医师的第二诊断正确率没有差异(χ2=0.5,P=0.500)。结论 1.主治医师独立诊断的正确率没有主任医师高 2.通过远程皮肤病会诊,临床经验较少的主治医师诊断疾病的正确率能和主任医师相媲美。 3.远程皮肤病学能很好的帮助低年资皮肤科医师对疾病的诊断,而对主任医师,远程皮肤病学在其熟悉领域发挥的作用不大。
[Abstract]:Background and Purpose

Telemedicine is a new type of medical instrument that uses modern electronic communication technology to realize the communication of professional medical information . It can be applied between doctors and patients . It can be applied between doctors and patients . Dermatology is one of the most visible features . Many skin diseases can be diagnosed accurately according to the morphology of lesions , which makes it the best object of modern telemedicine technology .

As a branch of telemedicine , teleology has proved its feasibility and reliability in many studies . Its technical system includes real - time video conference system and storage and forwarding system ( SAF system ) . Compared with the former , the SAF system is fast and cost - effective .

In this study , we collected 50 cases of dermatological patients in the Department of Dermatology of the First Affiliated Hospital of Zhengzhou University in order to discuss the value of remote dermatological on the diagnosis of diseases at different levels .

method

1 . Continuous collection of 50 patients with skin diseases and histopathological changes from Mar . 24 , 2009 to June 25 , 2009 in the Dermatology Department of the First Affiliated Hospital of Zhengzhou University . The chief physician and the attending physician independently gave face - to - face diagnosis and recorded as the first diagnosis . The patient ' s medical history was collected , and the patient ' s skin loss image was taken to take pictures . The patient ' s pathological results were collected . The patient ' s picture and clinical data ( excluding pathological data ) were uploaded to the dermatologist ' s website at http://www.teleder.org.

2 . Statistical indices : The first diagnosis and the second diagnosis rate of the chief physician and the attending physician were statistically compared with the diagnosis based on the combination of histopathological and clinical diagnosis . Then , the difference of the first diagnosis and the second diagnosis of the chief physician , the difference between the first diagnosis and the second diagnosis rate of the chief physician , the difference of the first diagnosis accuracy rate between the chief physician and the attending physician , and the difference of the second diagnosis accuracy rate between the chief physician and the attending physician were statistically compared .

3 . Statistical treatment : Using Excel in Microsoft Office 2007 , statistical analysis was performed with SPSS 16.0 statistical software . The comparison of diagnosis was performed by McNemar , and the test level was 伪 = 0.05 .

Results

1 . The correct number of first and second diagnoses were 35 ( 92.11 % ) and 36 ( 94.74 % ) , respectively , and the first and second diagnoses were 15 ( 39.47 % ) and 34 ( 89.47 % ) respectively .

2 . Compared with the gold standard , there was no difference between the first diagnosis and the second diagnosis of the chief physician ( 蠂 2 = 0 , P 0 . 999 ) . The first diagnosis of the physician was lower than that of the second diagnosis ( 蠂2 = 17.05 , P0.001 ) . The first diagnosis rate of the physician was higher than that of the primary doctor ( 蠂2 = 18.05 , P0.001 ) . There was no difference in the second diagnosis accuracy rate between the chief physician and the attending physician ( 蠂2 = 0.5 , P = 0.500 ) .

Conclusion

1 . The correct rate of independent diagnosis by the attending physician is not higher than that of the chief physician

2 . Through remote skin disease consultation , the correct rate of diagnosing the disease by the attending physician with less clinical experience is comparable with that of the chief physician .

3 . Remote skin disease can help the low - aged dermatologist to diagnose the disease , while the role of the physician in the field of remote skin disease is not great .
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R751

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