Creating a Web Infrastructure for the Support of Clinical Protocols and Clinical Management: An Example in Teledermatology.

Introduction: We describe a teledermatology infrastructure, implemented as part of a statewide large-scale telemedicine network, designed to provide comprehensive support for examination and clinical management protocols, which includes telediagnostic and patient triage and referral. It was implemented as a web-based system and an associated mobile application that supports both the primary healthcare facility team and the specialist during the patient care process. Methods: We describe the process models, protocols and technology employed, and the requirements generated for their development. We also present the results and experiences gained in implementing the model. The teledermatology service was implemented in 313 primary healthcare facilities in 286 municipalities in the State of Santa Catarina, Brazil. This study covers the period from January 2014 to June, 2018. Results: During this period, the teledermatology infrastructure processed 83,100 teledermatology examinations, of which 75,832 were validated and employed for patient triage and clinical management. Teledermatology allowed 33,112 patients to avoid further referral and be treated locally. Of this cohort, 7,513 patients presented more complex dermatoses that could be treated at the primary care level using telehealth-supported clinical management. Conclusions: Results indicate that this model contributes not only to the resolution of cases at the primary care level but also to the progressive improvement of the technical quality of dermatological examinations performed by technical staff at the primary healthcare.

Design and methods of a randomized telehealth-based intervention to improve fitness in survivors of childhood cancer with exercise intolerance.

BACKGROUND: Exercise intolerance among childhood cancer survivors substantially increases risk for early mortality, reduced cognitive function, poor quality of life, emotional distress, and sub-optimal participation in social roles. Fortunately, exercise intolerance is modifiable, even among individuals with impaired cardiopulmonary and neuromuscular health. This study aims to evaluate the impact of tailored exercise intervention remotely supervised by fitness professionals in survivors with exercise intolerance. Telehealth-based delivery of the intervention aims to enhance uptake by removing the burden of travel and allowing participants to gain confidence with exercise and physical activity at home. METHODS: This is an ongoing single-blind, two-arm, prospective, clinical trial that will randomize 160 participants 1:1 to intervention (n = 80) and attention control (n = 80) groups. The intervention group receives an individually tailored exercise prescription based on results from baseline assessments performed remotely via a Health Insurance Portability and Accountability Act-compliant virtual platform and personal preferences for aerobic exercise. Each prescription includes aerobic and strengthening components designed to progress gradually to 150-300-min of moderate aerobic activity and twice weekly strengthening exercises over 20-weeks. The first two weeks are supervised for 6 sessions, tapering to twice/week for weeks 3-4, once/week for weeks 5-8, every other week for weeks 9-16 and once midway between weeks 17-20. The schedule is modifiable depending on participant need, adherence, and response to exercise. Each session is approximately one hour. CONCLUSION: This study tests the efficacy of an individually prescribed, virtually supervised exercise intervention on exercise intolerant childhood cancer survivors. CLINICALTRIALS: gov registration: NCT04714840.