副蛋白血症性造血细胞病患者远程医疗的特点

Q4 Medicine
M. V. Soloveva, M. Solovev, L. Mendeleeva
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引用次数: 0

摘要

背景。从2018年开始,国立血液学医学研究中心通过远程医疗技术为浆细胞肿瘤提供医疗服务。患者在“血液学”领域的“医生-医生”级别进行咨询。国家血液学医学研究中心远程医疗应用的另一个重要方面是开展科学、实践和教育活动,旨在发展与医疗机构的远程互动,发展改善与专业医疗组织互动的方法。以副蛋白血症性造血细胞病为例,介绍远程医疗技术的主要应用。材料和方法。2018年10月至2022年10月,国家血液医学研究中心骨髓及造血干细胞移植单元副蛋白血症性造血细胞病血液科及化疗科共收到远程医疗请求815次(701次为一次,114次为重复)。93.6%的病例需要远程医疗咨询多发性骨髓瘤,2.6%的病例需要包括孤立性浆细胞瘤患者的信息,个别病例中,地区血液科医生询问了浆细胞白血病、浆母细胞淋巴瘤、华氏大球蛋白血症患者的信息。多发性骨髓瘤的远程医疗咨询数量每年都在增加。在73个参与地区中,最活跃的是:坦波夫地区、阿尔泰地区、弗拉基米尔地区、克里米亚共和国、布里亚特共和国、克拉斯诺达尔地区和克拉斯诺亚尔斯克地区。大多数咨询的目的是澄清治疗多发性骨髓瘤的策略。在20%和22%的病例中,推荐一线和二线治疗。针对21%的请求,给出了双重和三重难治性多发性骨髓瘤的治疗建议。在14%的请求中,医疗文件的信息内容不足,无法对患者管理策略表达适当的意见。10%的病例被推荐到国家血液学医学研究中心住院进行自体造血干细胞移植。对4%的远程医疗请求的分析证实了在居住地进行姑息治疗和局部放射治疗的便利性。请求的主要缺点是在建立诊断时缺乏初级信息,在治疗期间缺乏疾病监测信息,以及医疗记录中存在过多信息。对4年期间的副蛋白血症性造血细胞病远程医疗咨询的分析表明,地区血液学家非常需要与联邦中心的医生讨论治疗策略。通过国家血液学医学研究中心的医生与该地区之间的电信,在某些情况下,确保了全面的诊断和治疗措施,这有助于提高医疗保健的质量。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Specifics of the telemedicine in patients with paraproteinemic hemoblastoses
Background. Medical care through telemedicine technologies for plasma cell tumors has been provided at the National Medical Research Center for Hematology since 2018. Patients are consulted at the “doctor–doctor” level in the field of “hematology”. Another important aspect of the application of telemedicine at the National Medical Research Center for Hematology is scientific, practical and educational activities aimed at developing remote interaction with medical institutions, developing ways to improve interaction with specialized medical organizations.Aim. To present the implementation of the main applications of telemedicine technologies on the example of paraproteinemic hemoblastoses.Materials and methods. From October 2018 to October 2022 the department of hematology and chemotherapy of paraproteinemic hemoblastoses with bone marrow and hematopoietic stem cells transplantation unit of National Medical Research Center for Hematology received 815 telemedicine requests (701 – primary, 114 – repeated). In 93.6 % of cases, telemedicine consultation was required for multiple myeloma, 2.6 % of requests included information about patients with solitary plasmacytoma, in individual cases, regional hematologists made inquiries about patients with plasma cell leukemia, plasmablastic lymphoma, Waldenstrom’s macroglobulinemia.Results. There has been an annual increase in the number of telemedicine consultations for multiple myeloma. Of the 73 participating regions, the most active were: Tambov Region, Altai Territory, Vladimir Region, Republic of Crimea, Republic of Buryatia, Krasnodar Territory, and Krasnoyarsk Territory. Most of the consultations are aimed at clarifying the tactics of treating multiple myeloma. In 20 % and 22 % of cases, first- and second-line therapy was recommended. In response to 21 % of requests, recommendations were given for the treatment of multiple myeloma complicated by double and triple refractoriness. In 14 % of requests, insufficient information content of medical documentation did not allow expressing an adequate opinion on the tactics of patient management. Hospitalization at the National Medical Research Center for Hematology for the purpose of autologous hematopoietic stem cells transplantation was recommended in 10 % of cases. An analysis of 4 % of telemedicine requests testified to the expediency of palliative treatment and local radiation therapy at the place of residence. The main disadvantages of requests are the lack of primary information when establishing a diagnosis and information on disease monitoring during therapy, as well as the presence of excessive information in medical records.Conclusion. An analysis of telemedicine consultations for paraproteinemic hemoblastoses over a 4‑year period indicates a high need for regional hematologists to discuss therapy tactics with doctors from the federal center. Through telecommunications between doctors of National Medical Research Center for Hematology and the region, in some cases, the full range of diagnostic and therapeutic measures is ensured, which contributes to improving the quality of medical care.
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