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Resultados 1 - 20 de 37
1.

Health Sensors, Smart Home Devices, and the Internet of Medical Things: An Opportunity for Dramatic Improvement in Care for the Lower Extremity Complications of Diabetes.

J Diabetes Sci Technol; 12(3): 577-586, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-29635931

RESUMEN

OBJECTIVE: The prevalent and long-neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. With the rise of the Internet of medical things (IoMT), along with smart devices, the med-tech industry is on the cusp of a home-care revolution, which could also create opportunity for developing effective solutions with significant potential to reduce DFU-associated costs and saving limbs. This article discusses potential applications of IoMT to the DFU patient population and beyond. METHODS: To better understand potential opportunities and challenges associated with implementing IoMT for management of DFU, the authors reviewed recent relevant literatures and included their own expert opinions from a multidisciplinary point of view including podiatry, engineering, and data security. RESULTS: The IoMT has opened digital transformation of home-based diabetic foot care, as it enables promoting patient engagement, personalized care and smart management of chronic and noncommunicable diseases through individual data-driven treatment regimens, telecommunication, data mining, and comprehensive feedback tailored to individual requirements. In particular, with recent advances in voice-activated commands technology and its integration as a part of IoMT, new opportunities have emerged to improve the patient's central role and responsibility in enabling an optimized health care ecosystem. CONCLUSIONS: The IoMT has opened new opportunities in health care from remote monitoring to smart sensors and medical device integration. While it is at its early stage of development, ultimately we envisage a connected home that, using voice-controlled technology and Bluetooth-radio-connected add-ons, may augment much of what home health does today.
2.

Optimizing Tailored Communications for Health Risk Assessment: A Randomized Factorial Experiment of the Effects of Expectancy Priming, Autonomy Support, and Exemplification.

J Med Internet Res; 20(3): e63, 2018 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-29496652

RESUMEN

BACKGROUND: Health risk assessments with tailored feedback plus health education have been shown to be effective for promoting health behavior change. However, there is limited evidence to guide the development and delivery of online automated tailored feedback. OBJECTIVE: The goal of this study was to optimize tailored feedback messages for an online health risk assessment to promote enhanced user engagement, self-efficacy, and behavioral intentions for engaging in healthy behaviors. We examined the effects of three theory-based message factors used in developing tailored feedback messages on levels of engagement, self-efficacy, and behavioral intentions. METHODS: We conducted a randomized factorial experiment to test three different components of tailored feedback messages: tailored expectancy priming, autonomy support, and use of an exemplar. Individuals (N=1945) were recruited via Amazon Mechanical Turk and randomly assigned to one of eight different experimental conditions within one of four behavioral assessment and feedback modules (tobacco use, physical activity [PA], eating habits, and weight). Participants reported self-efficacy and behavioral intentions pre- and postcompletion of an online health behavior assessment with tailored feedback. Engagement and message perceptions were assessed at follow-up. RESULTS: For the tobacco module, there was a significant main effect of the exemplar factor (P=.04); participants who received exemplar messages (mean 3.31, SE 0.060) rated their self-efficacy to quit tobacco higher than those who did not receive exemplar messages (mean 3.14, SE 0.057). There was a three-way interaction between the effect of message conditions on self-efficacy to quit tobacco (P=.02), such that messages with tailored priming and an exemplar had the greatest impact on self-efficacy to quit tobacco. Across PA, eating habits, and weight modules, there was a three-way interaction among conditions on self-efficacy (P=.048). The highest self-efficacy scores were reported among those who were in the standard priming condition and received both autonomy supportive and exemplar messages. In the PA module, autonomy supportive messages had a stronger effect on self-efficacy for PA in the standard priming condition. For PA, eating habits, and weight-related behaviors, the main effect of exemplar messages on behavioral intentions was in the hypothesized direction but did not reach statistical significance (P=.08). When comparing the main effects of different message conditions, there were no differences in engagement and message perceptions. CONCLUSIONS: Findings suggest that tailored feedback messages that use exemplars helped improve self-efficacy related to tobacco cessation, PA, eating habits, and weight control. Combining standard priming and autonomy supportive message components shows potential for optimizing tailored feedback for tobacco cessation and PA behaviors.
3.

Reporting bias inflates the reputation of medical treatments: A comparison of outcomes in clinical trials and online product reviews.

Soc Sci Med; 177: 248-255, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28190628

RESUMEN

OBJECTIVES: People often hold unduly positive expectations about the outcomes of medicines and other healthcare products. Here the following explanation is tested: people who have a positive outcome tend to tell more people about their disease/treatment than people with poor or average outcomes. Akin to the file drawer problem in science, this systematically and positively distorts the information available to others. METHOD: If people with good treatment outcomes are more inclined to tell others, then they should also be more inclined to write online medical product reviews. Therefore, average treatment outcomes in these reviews should be more positive than those found in randomised controlled trials (RCTs). Data on duration of treatment and outcome (i.e., weight/cholesterol change) were extracted from user-generated health product reviews on Amazon.com and compared to RCT data for the same treatments using ANOVA. The sample included 1675 reviews of cholesterol reduction (Benecol, CholestOff) and weight loss (Orlistat) treatments and the primary outcome was cholesterol change (Bencol and CholestOff) or weight change (Orlistat). RESULTS: In three independent tests, average outcomes reported in the reviews were substantially more positive than the outcomes reported in the medical literature (η = 0.01 to 0.06; p = 0.04 to 0.001). For example, average cholesterol change following use of Benecol is -14 mg/dl in RCTs and -45 mg/dl in online reviews. CONCLUSIONS: People with good treatment outcomes are more inclined to share information about their treatment, which distorts the information available to others. People who rely on word of mouth reputation, electronic or real life, are likely to develop unduly positive expectations.
4.

A Web-Disseminated Self-Help and Peer Support Program Could Fill Gaps in Mental Health Care: Lessons From a Consumer Survey.

JMIR Ment Health; 4(1): e5, 2017 Jan 19.
Artículo en Inglés | MEDLINE | ID: mdl-28104578

RESUMEN

BACKGROUND: Self-guided mental health interventions that are disseminated via the Web have the potential to circumvent barriers to treatment and improve public mental health. However, self-guided interventions often fail to attract consumers and suffer from user nonadherence. Uptake of novel interventions could be improved by consulting consumers from the beginning of the development process in order to assess their interest and their preferences. Interventions can then be tailored using this feedback to optimize appeal. OBJECTIVE: The aim of our study was to determine the level of public interest in a new mental health intervention that incorporates elements of self-help and peer counseling and that is disseminated via a Web-based training course; to identify predictors of interest in the program; and to identify consumer preferences for features of Web-based courses and peer support programs. METHODS: We surveyed consumers via Amazon's Mechanical Turk to estimate interest in the self-help and peer support program. We assessed associations between demographic and clinical characteristics and interest in the program, and we obtained feedback on desired features of the program. RESULTS: Overall, 63.9% (378/592) of respondents said that they would try the program; interest was lower but still substantial among those who were not willing or able to access traditional mental health services. Female gender, lower income, and openness to using psychotherapy were the most consistent predictors of interest in the program. The majority of respondents, although not all, preferred romantic partners or close friends as peer counselors and would be most likely to access the program if the training course were accessed on a stand-alone website. In general, respondents valued training in active listening skills. CONCLUSIONS: In light of the apparent public interest in this program, Web-disseminated self-help and peer support interventions have enormous potential to fill gaps in mental health care. The results of this survey can be used to inform the design of such interventions.
5.

Mobile applications for obesity and weight management: current market characteristics.

Int J Obes (Lond); 41(1): 200-202, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27780974

RESUMEN

Mobile-Health (mHealth) is the fastest-developing eHealth sector, with over 100 000 health applications (apps) currently available. Overweight/obesity is a problem of wide public concern that is potentially treatable/preventable through mHealth. This study describes the current weight-management app-market. Five app stores (Apple, Google, Amazon, Windows and Blackberry) in UK, US, Russia, Japan and Germany, Italy, France, China, Australia and Canada were searched for keywords: 'weight', 'calorie', 'weight-loss', 'slimming', 'diet', 'dietitian' and 'overweight' in January/February 2016 using App-Annie software. The 10 most downloaded apps in the lifetime of an app were recorded. Developers' lists and the app descriptions were searched to identify any professional input with keywords 'professional', 'dietitian' and 'nutritionist'. A total of 28 905 relevant apps were identified as follows: Apple iTunes=8559 (4634, 54% paid), Google Play=1762 (597, 33.9% paid), Amazon App=13569 (4821, 35.5% paid), Windows=2419 (819, 17% paid) and Blackberry=2596 (940, 36% paid). The 28 905 identified apps focused mainly on physical activity (34%), diet (31%), and recording/monitoring of exercise, calorie intake and body weight (23%). Only 17 apps (0.05%) were developed with identifiable professional input. Apps on weight management are widely available and very popular but currently lack professional content expertise. Encouraging app development based on evidence-based online approaches would assure content quality, allowing healthcare professionals to recommend their use.
6.

Consumers' Patient Portal Preferences and Health Literacy: A Survey Using Crowdsourcing.

JMIR Res Protoc; 5(2): e104, 2016 Jun 08.
Artículo en Inglés | MEDLINE | ID: mdl-27278634

RESUMEN

BACKGROUND: eHealth apps have the potential to meet the information needs of patient populations and improve health literacy rates. However, little work has been done to document perceived usability of portals and health literacy of specific topics. OBJECTIVE: Our aim was to establish a baseline of lung cancer health literacy and perceived portal usability. METHODS: A survey based on previously validated instruments was used to assess a baseline of patient portal usability and health literacy within the domain of lung cancer. The survey was distributed via Amazon's Mechanical Turk to 500 participants. RESULTS: Our results show differences in preferences and literacy by demographic cohorts, with a trend of chronically ill patients having a more positive reception of patient portals and a higher health literacy rate of lung cancer knowledge (P<.05). CONCLUSIONS: This article provides a baseline of usability needs and health literacy that suggests that chronically ill patients have a greater preference for patient portals and higher level of health literacy within the domain of lung cancer.
7.

Construct Validity of the eHealth Literacy Scale (eHEALS) Among Two Adult Populations: A Rasch Analysis.

JMIR Public Health Surveill; 2(1): e24, 2016 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-27244771

RESUMEN

BACKGROUND: The Internet has become a ubiquitous venue for information seeking, especially for health information. Public health practitioners have noticed the promise and potential of the Internet, however, little is known about individuals' skills of their eHealth literacy. The eHealth Literacy Scale, eHEALS, was designed to measure perceptions of individuals' eHealth literacy skills. OBJECTIVE: The objective of the study was to examine the psychometric validity and reliability of the eHEALS with two adult populations using the Rasch Model. METHODS: A college-aged sample and an Internet-based sample (Amazon's MTurk) were recruited to complete the eHEALS, demographic questions, and a health literacy scale. Using WINSTEPS and SPSS, unidimensionality, item fit, rating scale, item hierarchy, person ability-item match, and reliability were analyzed, compared, and contrasted against each sample and to other samples found in the literature. RESULTS: An exploratory factor analysis supported unidimensionality in both samples. More than 90% of respondents from both samples fit the model. No items were outright misfitting. Both samples separated into three distinct groups. CONCLUSIONS: Based on the results, the eHEALS is a reliable and consistent measurement tool for a college sample and an Internet-based sample. As these individuals are most likely to use the Internet as a health resource, it is necessary to learn and know their skills versus perceiving that they can critically and successfully navigate the Internet. Further analyses are necessary to ensure that the eHEALS can serve as a standard eHealth literacy measure for public health.
8.

Conceitos fundamentais e ética em telemedicina

Recurso Educacional Abierto en Pt_BR | CVSP - Brasil | ID: cvsp-brasil--oai:ares.unasus.gov.br-acervo:ARES-3274

RESUMEN

Orientações sobre conceitos fundamentais e ética em telemedicina e telessaúde
1
Universidade do Estado do Amazonas
9.

Retinal diseases in a reference center from a Western Amazon capital city / Doenças retinianas em um centro de referência de capital estadual na Amazônia Ocidental

Einstein (Säo Paulo); 13(4): 530-534, Oct.-Dec. 2015. tab
Artículo en Portugués | LILACS | ID: lil-770494

RESUMEN

ABSTRACT Objective To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. Methods Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. Results A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. Conclusion Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.
RESUMO Objetivo Descrever as doenças de retina encontradas em pacientes que aguardavam tratamento para doenças retinianas em um hospital terciário de Rio Branco, Acre, Brasil. Métodos Foi realizado um exame oftalmológico compreendendo biomicroscopia com lâmpada de fenda, mapeamento de retina e ultrassonografia ocular. Os pacientes foram classificados de acordo com o status fácico e a doença retiniana que acometia o olho de maior gravidade. Resultados Foram atendidos 138 pacientes. A média de idade foi de 51,3 anos. A distribuição de diabetes foi de 35,3% e de hipertensão arterial foi de 45,5%. Catarata esteve presente em pelo menos um dos olhos em 23,2%. Tiveram o exame da retina possibilitado 129 pacientes. As principais doenças retinianas detectadas foram descolamento de retina regmatogênico (n=23; 17,8%) e retinopatia diabética (n=32; 24,8%). Dos 40 pacientes avaliados em função do diabetes, 13 (32,5%) apresentavam retinopatia ausente ou estágios iniciais de retinopatia e necessitavam apenas de acompanhamento. Conclusão A principal doença retiniana foi a retinopatia diabética, uma causa de cegueira evitável que pode ser acompanhada à distância, nos estágios iniciais, por meio de estratégias de telemedicina. A telemedicina pode ser uma importante ferramenta no acompanhamento de doenças retinianas em localidades remotas no Brasil.
Biblioteca responsable: BR1.1
10.

Allowing Physicians to Choose the Value of Compensation for Participation in a Web-Based Survey: Randomized Controlled Trial.

J Med Internet Res; 17(7): e189, 2015 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-26223821

RESUMEN

BACKGROUND: Survey response rates among physicians are declining, and determining an appropriate level of compensation to motivate participation poses a major challenge. OBJECTIVE: To estimate the effect of permitting intensive care physicians to select their preferred level of compensation for completing a short Web-based survey on physician (1) response rate, (2) survey completion rate, (3) time to response, and (4) time spent completing the survey. METHODS: A total of 1850 US intensivists from an existing database were randomized to receive a survey invitation email with or without an Amazon.com incentive available to the first 100 respondents. The incentive could be instantly redeemed for an amount chosen by the respondent, up to a maximum of US $50. RESULTS: The overall response rate was 35.90% (630/1755). Among the 35.4% (111/314) of eligible participants choosing the incentive, 80.2% (89/111) selected the maximum value. Among intensivists offered an incentive, the response was 6.0% higher (95% CI 1.5-10.5, P=.01), survey completion was marginally greater (807/859, 94.0% vs 892/991, 90.0%; P=.06), and the median number of days to survey response was shorter (0.8, interquartile range [IQR] 0.2-14.4 vs 6.6, IQR 0.3-22.3; P=.001), with no difference in time spent completing the survey. CONCLUSIONS: Permitting intensive care physicians to determine compensation level for completing a short Web-based survey modestly increased response rate and substantially decreased response time without decreasing the time spent on survey completion.
11.

Retinal diseases in a reference center from a Western Amazon capital city.

Einstein (Sao Paulo); 13(4): 530-4, 2015 Oct-Dec.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-26761550

RESUMEN

OBJECTIVE: To describe retinal diseases found in patients who were waiting for treatment at a tertiary care hospital in Rio Branco, Acre, Brazil. METHODS: Patients underwent slit lamp biomicroscopy, dilated fundus exam and ocular ultrasound. Patients were classified according to phakic status and retinal disease of the most severely affected eye. RESULTS: A total of 138 patients were examined. The mean age was 51.3 years. Diabetes was present in 35.3% and hypertension in 45.4% of these patients. Cataract was found in 23.2% of patients, in at least one eye. Retinal examination was possible in 129 patients. The main retinal diseases identified were rhegmatogenous retinal detachment (n=23; 17.8%) and diabetic retinopathy (n=32; 24.8%). Out of 40 patients evaluated due to diabetes, 13 (32.5%) had absent or mild forms of diabetic retinopathy and did not need further treatment, only observation. CONCLUSION: Diabetic retinopathy was the main retinal disease in this population. It is an avoidable cause of blindness and can be remotely evaluated, in its initial stages, by telemedicine strategies. In remote Brazilian areas, telemedicine may be an important tool for retinal diseases diagnosis and follow-up.
12.

Telegenetics: application of a tele-education program in genetic syndromes for Brazilian students

J. appl. oral sci; 22(6): 477-483, Nov-Dec/2014. tab, graf
Artículo en Inglés | LILACS | ID: lil-732579

RESUMEN

With the high occurrence of genetic anomalies in Brazil and the manifestations of communication disorders associated with these conditions, the development of educative actions that comprise these illnesses can bring unique benefits in the identification and appropriate treatment of these clinical pictures. Objective The aim of this study was to develop and analyze an educational program in genetic syndromes for elementary students applied in two Brazilian states, using an Interactive Tele-education model. Material and Methods The study was carried out in 4 schools: two in the state of São Paulo, Southeast Region, Brazil, and two in the state of Amazonas, North Region, Brazil. Forty-five students, both genders, aged between 13 and 14 years, of the 9th grade of the basic education of both public and private system, were divided into two groups: 21 of São Paulo Group (SPG) and 24 of Amazonas Group (AMG). The educational program lasted about 3 months and was divided into two stages including both classroom and distance activities on genetic syndromes. The classroom activity was carried out separately in each school, with expository lessons, graphs and audiovisual contents. In the activity at a distance the educational content was presented to students by means of the Interactive Tele-education model. In this stage, the students had access a Cybertutor, using the Young Doctor Project methodology. In order to measure the effectiveness of the educational program, the Problem Situation Questionnaire (PSQ) and the Web Site Motivational Analysis Checklist adapted (FPM) were used. Results The program developed was effective for knowledge acquisition in 80% of the groups. FPM showed a high satisfaction index from the participants in relation to the Interactive Tele-education, evaluating the program as "awesome course". No statistically significant differences between the groups regarding type of school or state were observed. ...
Biblioteca responsable: BR1.1
13.

Rapid grading of fundus photographs for diabetic retinopathy using crowdsourcing.

J Med Internet Res; 16(10): e233, 2014 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-25356929

RESUMEN

BACKGROUND: Screening for diabetic retinopathy is both effective and cost-effective, but rates of screening compliance remain suboptimal. As screening improves, new methods to deal with screening data may help reduce the human resource needs. Crowdsourcing has been used in many contexts to harness distributed human intelligence for the completion of small tasks including image categorization. OBJECTIVE: Our goal was to develop and validate a novel method for fundus photograph grading. METHODS: An interface for fundus photo classification was developed for the Amazon Mechanical Turk crowdsourcing platform. We posted 19 expert-graded images for grading by Turkers, with 10 repetitions per photo for an initial proof-of-concept (Phase I). Turkers were paid US $0.10 per image. In Phase II, one prototypical image from each of the four grading categories received 500 unique Turker interpretations. Fifty draws of 1-50 Turkers were then used to estimate the variance in accuracy derived from randomly drawn samples of increasing crowd size to determine the minimum number of Turkers needed to produce valid results. In Phase III, the interface was modified to attempt to improve Turker grading. RESULTS: Across 230 grading instances in the normal versus abnormal arm of Phase I, 187 images (81.3%) were correctly classified by Turkers. Average time to grade each image was 25 seconds, including time to review training images. With the addition of grading categories, time to grade each image increased and percentage of images graded correctly decreased. In Phase II, area under the curve (AUC) of the receiver-operator characteristic (ROC) indicated that sensitivity and specificity were maximized after 7 graders for ratings of normal versus abnormal (AUC=0.98) but was significantly reduced (AUC=0.63) when Turkers were asked to specify the level of severity. With improvements to the interface in Phase III, correctly classified images by the mean Turker grade in four-category grading increased to a maximum of 52.6% (10/19 images) from 26.3% (5/19 images). Throughout all trials, 100% sensitivity for normal versus abnormal was maintained. CONCLUSIONS: With minimal training, the Amazon Mechanical Turk workforce can rapidly and correctly categorize fundus photos of diabetic patients as normal or abnormal, though further refinement of the methodology is needed to improve Turker ratings of the degree of retinopathy. Images were interpreted for a total cost of US $1.10 per eye. Crowdsourcing may offer a novel and inexpensive means to reduce the skilled grader burden and increase screening for diabetic retinopathy.
14.

Efetividade das práticas de Teleducação por Webconferência no combate à dengue no Estado do Amazonas, Brasil / Effectiveness of practices for Web Conferencing Teleducation to combat dengue in the State of Amazonas, Brazil

J. health inform; 6(1)jan.-mar. 2014. tab, graf
Artículo en Portugués | LILACS | ID: lil-718865

RESUMEN

Objetivo: Verificar a efetividade das webconferências educativas na prevenção e combate à dengue, ao compará-las com a modalidade presencial de educação em saúde. Métodos: Participaram da pesquisa 50 alunos do 3º ano do ensino médio de escola pública do município de Itacoatiara, distante 300 quilômetros de Manaus, capital do estado do Amazonas. Os participantes foram divididos em dois grupos, sendo que o primeiro grupo participou de palestras presenciais e o segundo grupo participou de palestras por webconferência sobre o tema da prevenção e combate à dengue. Foram aplicados testes pré e pós-exposições e calculados os índices de rendimento de ambos os grupos. Resultados: Verificou-se que o grupo que participou das webconferências obteve rendimentos pós-teste de 82,8% e o outro grupo obteve rendimento de 78,6%. Conclusões: A Telessaúde, por meio de webconferência possui efetividade no processo de educação em Saúde e, uma vez utilizada em escala, pode contribuir com eficácia para o combate e prevenção da dengue no estado do Amazonas...
Objective: To determine the effectiveness of educational web conferences in preventing and combating dengue by comparing them with the face modality of health education. Methods: Participants were 50 students of the 3rd year of high school to public school in Itacoatiara, distant 300 km from Manaus, capital of Amazonas state. The participants were divided into two groups: the first group participated in lectures and the second group attended lectures by web conference on the topic of prevention and fight against dengue. Tests were performed before and after exposures and calculated the rates of return of both groups. Results: It was found that the group who participated in the web conferencing earned income post-test 82.8% and the other group received 78.6% yield. Conclusions: Telehealth through web conferencing has effectiveness in the process of health education and once used scale, can contribute effectively to the fight and prevention of dengue in the state of Amazonas...
Objetivo: Determinar la eficacia de la educación mediadas por conferencias web en la prevención y la lucha contra el dengue mediante la comparación con la modalidad presencial de la educación sanitaria. Métodos: Los participantes fueron 50 estudiantes del 3er año de la escuela secundaria a la escuela pública de Itacoatiara, ciudad distante 300 kilómetros de Manaus, capital del estado de Amazonas. Los participantes fueron divididos en dos grupos: el primer grupo participó en conferencias presenciales y el segundo grupo asistió a conferencias web sobre el tema de la prevención y lucha contra el dengue. Las pruebas se realizaron pré y post-exposición con el fin de calcular el rendimiento de ambos grupos. Resultados: Se encontró que el grupo que participó en la conferencia web tuvo um rendimento posterior a las pruebas de el 82,8% y el otro grupo recibió un rendimiento del 78,6%. Conclusiones: Telemedicina a través de conferencias web tiene eficacia en el proceso de educación para la salud y una vez aplicada en escala, puede contribuir eficazmente a la lucha y prevención del dengue en el estado de Amazonas...
Biblioteca responsable: BR1.2
15.

Telegenetics: application of a tele-education program in genetic syndromes for Brazilian students.

J Appl Oral Sci; 22(6): 477-83, 2014 Nov-Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25591016

RESUMEN

With the high occurrence of genetic anomalies in Brazil and the manifestations of communication disorders associated with these conditions, the development of educative actions that comprise these illnesses can bring unique benefits in the identification and appropriate treatment of these clinical pictures. Objective The aim of this study was to develop and analyze an educational program in genetic syndromes for elementary students applied in two Brazilian states, using an Interactive Tele-education model. Material and Methods The study was carried out in 4 schools: two in the state of São Paulo, Southeast Region, Brazil, and two in the state of Amazonas, North Region, Brazil. Forty-five students, both genders, aged between 13 and 14 years, of the 9th grade of the basic education of both public and private system, were divided into two groups: 21 of São Paulo Group (SPG) and 24 of Amazonas Group (AMG). The educational program lasted about 3 months and was divided into two stages including both classroom and distance activities on genetic syndromes. The classroom activity was carried out separately in each school, with expository lessons, graphs and audiovisual contents. In the activity at a distance the educational content was presented to students by means of the Interactive Tele-education model. In this stage, the students had access a Cybertutor, using the Young Doctor Project methodology. In order to measure the effectiveness of the educational program, the Problem Situation Questionnaire (PSQ) and the Web Site Motivational Analysis Checklist adapted (FPM) were used. Results The program developed was effective for knowledge acquisition in 80% of the groups. FPM showed a high satisfaction index from the participants in relation to the Interactive Tele-education, evaluating the program as "awesome course". No statistically significant differences between the groups regarding type of school or state were observed. Conclusion Thus, the Tele-Education Program can be used as a tool for educational purposes in genetic syndromes of other populations, in several regions of Brazil.
16.

Diagnóstico por Teledermatologia em paciente do Alto Rio Solimões: um caso de escabiose crostosa / Diagnosis by Teledermatology of a patient from the Alto Solimões River: a case of Crusted Scabies / Diagnóstico por Teledermatología en paciente del Alto Río Solimões: un caso de Escabiosis Costrosa

Rev. bras. med. fam. comunidade; 8(27): 127-131, abr./jun. 2013.
Artículo en Portugués | LILACS-Express | ID: biblio-880906

RESUMEN

A Teledermatologia estuda o uso das tecnologias de telecomunicação e informática na assistência dermatológica sem a atuação presencial do especialista. Neste trabalho, é relatado o processo diagnóstico de um caso de escabiose crostosa (sarna norueguesa) em paciente idoso da região do Alto Rio Solimões, por meio de recursos de Teledermatologia. Além disso, os autores discutem os avanços dessa tecnologia que possibilita a assistência a distância para comunidades ribeirinhas e indígenas, sobretudo em áreas isoladas da Amazônia Legal, nas quais inúmeras doenças são negligenciadas e subdiagnosticadas.
Teledermatology uses telecommunication technology and informatics on dermatologic practice without the presence of a specialist. This paper describes the diagnostic process of a Crusted Scabies (Norwegian Scabies) case in an elderly patient from the Alto Solimões River region using teledermatology resources. Moreover, the authors discuss the progress of these technologies, which allow healthcare assistance for those living in remote indigenous and riverine communities, particularly in isolated areas of the Legal Amazon where many diseases are neglected or underdiagnosed.
La Teledermatología usa las tecnologías de las telecomunicaciones y de la informática para dar asistencia dermatológica sin la presencia de un especialista. Este artículo describe el proceso de diagnóstico de un caso de escabiosis costrosa (sarna norueguesa) en un paciente anciano de la región del Alto Rio Solimões, a través de recursos de la Teledermatología. Además, los autores discuten los avances de estas tecnologías que permiten llevar asistencia médica a las comunidades costeras e indígenas remotas, especialmente a aquellas de zonas aisladas del Legal Amazon, en las cuales numerosas enfermedades son negligenciadas y subdiagnosticadas.
Biblioteca responsable: BR1931.9
17.

Web 2.0-based crowdsourcing for high-quality gold standard development in clinical natural language processing.

J Med Internet Res; 15(4): e73, 2013 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-23548263

RESUMEN

BACKGROUND: A high-quality gold standard is vital for supervised, machine learning-based, clinical natural language processing (NLP) systems. In clinical NLP projects, expert annotators traditionally create the gold standard. However, traditional annotation is expensive and time-consuming. To reduce the cost of annotation, general NLP projects have turned to crowdsourcing based on Web 2.0 technology, which involves submitting smaller subtasks to a coordinated marketplace of workers on the Internet. Many studies have been conducted in the area of crowdsourcing, but only a few have focused on tasks in the general NLP field and only a handful in the biomedical domain, usually based upon very small pilot sample sizes. In addition, the quality of the crowdsourced biomedical NLP corpora were never exceptional when compared to traditionally-developed gold standards. The previously reported results on medical named entity annotation task showed a 0.68 F-measure based agreement between crowdsourced and traditionally-developed corpora. OBJECTIVE: Building upon previous work from the general crowdsourcing research, this study investigated the usability of crowdsourcing in the clinical NLP domain with special emphasis on achieving high agreement between crowdsourced and traditionally-developed corpora. METHODS: To build the gold standard for evaluating the crowdsourcing workers' performance, 1042 clinical trial announcements (CTAs) from the ClinicalTrials.gov website were randomly selected and double annotated for medication names, medication types, and linked attributes. For the experiments, we used CrowdFlower, an Amazon Mechanical Turk-based crowdsourcing platform. We calculated sensitivity, precision, and F-measure to evaluate the quality of the crowd's work and tested the statistical significance (P<.001, chi-square test) to detect differences between the crowdsourced and traditionally-developed annotations. RESULTS: The agreement between the crowd's annotations and the traditionally-generated corpora was high for: (1) annotations (0.87, F-measure for medication names; 0.73, medication types), (2) correction of previous annotations (0.90, medication names; 0.76, medication types), and excellent for (3) linking medications with their attributes (0.96). Simple voting provided the best judgment aggregation approach. There was no statistically significant difference between the crowd and traditionally-generated corpora. Our results showed a 27.9% improvement over previously reported results on medication named entity annotation task. CONCLUSIONS: This study offers three contributions. First, we proved that crowdsourcing is a feasible, inexpensive, fast, and practical approach to collect high-quality annotations for clinical text (when protected health information was excluded). We believe that well-designed user interfaces and rigorous quality control strategy for entity annotation and linking were critical to the success of this work. Second, as a further contribution to the Internet-based crowdsourcing field, we will publicly release the JavaScript and CrowdFlower Markup Language infrastructure code that is necessary to utilize CrowdFlower's quality control and crowdsourcing interfaces for named entity annotations. Finally, to spur future research, we will release the CTA annotations that were generated by traditional and crowdsourced approaches.
18.

Système de télé-expertise échographique temps réel et de télédiagnostic échographique temps différé. Étude pilote au Togo. / [System of telesonography with synchronous teleconsultations and asynchronous telediagnoses (Togo)].

Med Sante Trop; 22(1): 54-60, 2012 Jan-Mar.
Artículo en Francés | MEDLINE | ID: mdl-22868727

RESUMEN

INTRODUCTION: Ultrasonography is an important nonirradiating diagnostic medical imaging procedure, frequently used, especially in urgent circumstances. This relatively inexpensive noninvasive examination makes it possible to diagnose disorders in various parts of the human body, by examining, for example, the abdomen and pelvis, the cardiovascular system, and the muscles and joints. Ultrasound is also an operator-dependent examination, in that the quality of the result depends on precision in the manipulation of the probe. Unfortunately, many small medical centers and isolated sites do not have an appropriate well-trained sonographer to perform initial evaluations, and an untrained operator cannot capture the appropriate echographic views required for a safe diagnosis of current patients, even with realtime vocal guidance (personal data). The lack of experienced physicians or qualified technicians means that diagnostic ultrasound is not always accessible to patients for rapid examination worldwide, especially in Africa, Amazonia or near the North or South Poles. This situation has led to the development of a new concept of telemedicine: telesonography, with a remote ultrasound diagnosis either in real time (synchronous) or delayed (asynchronous; store-and-forward). These systems of real-time telesonography and data transmission require expensive and complex technology with sophisticated equipment not available in many developing countries. The purpose of this study is to design a low-cost real-time system of telesonography for teleconsultations with experts and a delayed telediagnostic mode between isolated peripheral hospitals and a University Hospital center (UHC). METHODS AND MATERIALS: An IP camera and an internet video server were installed in a geographically isolated site equipped with an ultrasound machine and an operator with basic training in its use. Synchronous teleconsultation (second-opinion diagnosis) is possible via internet with a UHC expert. If no ultrasound operator is available at the isolated center, volume capture-and-store software is used. Later on, the UHC expert uses Echo-Cnes 3D software to reconstruct the organs scanned. The expert can then navigate within the reconstructed volume and display any plane. Volume capture is performed by tilting (± 40°) to both sides vertically to the skin. To locate the probe on the organ acoustic window, the novice operator uses acoustic window mapping designed by our laboratory (UMPS-Tours). The system was tested between the Tsévié regional hospital in Togo (40 km from Lomé, Togo, and 4500 km from Tours, France) and the UHC at Lomé and the Trousseau UHC in Tours. RESULTS: With an average internet connection of 2 Mbps, the quality of transmission of the background video and ultrasound sequence videos from Tsévié towards Lomé was satisfactory (16 images/s) with a maximal transmission delay of 1.5 s (almost in real time). A video conference between the Trousseau UHC in Tours, the UHC Campus in Lomé and the Tsévié Hospital was possible and the bandwidth allowed the Lomé experts (radiologists) to perform real-time telesonography with very satisfactory results (ultrasound diagnoses obtained) for abdominal (n = 5), pelvic (n = 3), obstetric (n = 2), prostate (n = 2) and mammary (n = 2) ultrasound, both normal and pathological. Because the doctors at Tsévié had minimal experience with ultrasound, complete ultrasound diagnoses were obtained by combining remote voice instruction for image capture and full diagnosis by Echo-Cnes. Asynchronous telediagnosis was also performed with Tsévié operators who lacked ultrasound expertise but could perform the required tilt movements (after 3 training sessions). The expert at Trousseau UHC performed real-time telesonography with the Tsévié Hospital for two cases requiring abdominal images and another viewing of the prostate. He also performed asynchronous reconstruction of the abdominal organs with Echo-Cnes. A demonstration seminar of our platform was organized successfully for 2 days during the 9(th) Congress of the French-speaking Black Africa Society of Radiology (SRANF in French) held from 4 till 6 May 2011 at the hotel EDA OBA. During this seminar, 4 ultrasound teleconsultations were performed from the hotel by eminent African radiologists. DISCUSSION AND CONCLUSION: This preliminary study, although limited in the number of patients, allowed us to assess the technical features of our telesonography system. Togo, a developing country with a very modest infrastructure for information and communication, was an ideal site for a first test of this platform. Our system of remote ultrasound requires the local patient center to be equipped simply with a 2D ultrasound machine. The cost is quite low, in comparison to the asynchronous techniques requiring 3D devices. The high cost of 3D or 4D ultrasound machines and their fragility make it difficult to install them at the isolated sites and was a serious obstacle in the development of this system. If the center already has a 2D device and a computer, the cost to equip it with the remaining communications materials is 1,500 €. The experience in Togo clearly highlighted the possibility of teletraining and complete teleradiology with our system. The next stage of this work will seek to validate the results of this preliminary experience on a larger sample with more precise assessment criteria in 2012. The results will allow the widespread dissemination and routine use of this system in developing countries.
19.

Analysis of cloud-based solutions on EHRs systems in different scenarios.

J Med Syst; 36(6): 3777-82, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22492177

RESUMEN

Nowadays with the growing of the wireless connections people can access all the resources hosted in the Cloud almost everywhere. In this context, organisms can take advantage of this fact, in terms of e-Health, deploying Cloud-based solutions on e-Health services. In this paper two Cloud-based solutions for different scenarios of Electronic Health Records (EHRs) management system are proposed. We have researched articles published between the years 2005 and 2011 about the implementation of e-Health services based on the Cloud in Medline. In order to analyze the best scenario for the deployment of Cloud Computing two solutions for a large Hospital and a network of Primary Care Health centers have been studied. Economic estimation of the cost of the implementation for both scenarios has been done via the Amazon calculator tool. As a result of this analysis two solutions are suggested depending on the scenario: To deploy a Cloud solution for a large Hospital a typical Cloud solution in which are hired just the needed services has been assumed. On the other hand to work with several Primary Care Centers it's suggested the implementation of a network, which interconnects these centers with just one Cloud environment. Finally it's considered the fact of deploying a hybrid solution: in which EHRs with images will be hosted in the Hospital or Primary Care Centers and the rest of them will be migrated to the Cloud.
20.

A PACS archive architecture supported on cloud services.

Int J Comput Assist Radiol Surg; 7(3): 349-58, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-21678039

RESUMEN

PURPOSE: Diagnostic imaging procedures have continuously increased over the last decade and this trend may continue in coming years, creating a great impact on storage and retrieval capabilities of current PACS. Moreover, many smaller centers do not have financial resources or requirements that justify the acquisition of a traditional infrastructure. Alternative solutions, such as cloud computing, may help address this emerging need. METHODS: A tremendous amount of ubiquitous computational power, such as that provided by Google and Amazon, are used every day as a normal commodity. Taking advantage of this new paradigm, an architecture for a Cloud-based PACS archive that provides data privacy, integrity, and availability is proposed. The solution is independent from the cloud provider and the core modules were successfully instantiated in examples of two cloud computing providers. Operational metrics for several medical imaging modalities were tabulated and compared for Google Storage, Amazon S3, and LAN PACS. RESULTS: A PACS-as-a-Service archive that provides storage of medical studies using the Cloud was developed. The results show that the solution is robust and that it is possible to store, query, and retrieve all desired studies in a similar way as in a local PACS approach. CONCLUSION: Cloud computing is an emerging solution that promises high scalability of infrastructures, software, and applications, according to a "pay-as-you-go" business model. The presented architecture uses the cloud to setup medical data repositories and can have a significant impact on healthcare institutions by reducing IT infrastructures.
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