RESUMO
Objectives: To describe the development of a protocol and practical tool for the safe delivery of telemental health (TMH) services to the home. The COVID-19 pandemic forced providers to rapidly transition their outpatient practices to home-based TMH (HB-TMH) without existing protocols or tools to guide them. This experience underscored the need for a standardized privacy and safety tool as HB-TMH is expected to continue as a resource during future crises as well as to become a component of the routine mental health care landscape. Methods: The authors represent a subset of the Child and Adolescent Psychiatry Telemental Health Consortium. They met weekly through videoconferencing to review published safety standards of care, existing TMH guidelines for clinic-based and home-based services, and their own institutional protocols. They agreed on three domains foundational to the delivery of HB-TMH: environmental safety, clinical safety, and disposition planning. Through multiple iterations, they agreed upon a final Privacy and Safety Protocol for HB-TMH. The protocol was then operationalized into the Privacy and Safety Assessment Tool (PSA Tool) based on two keystone medical safety constructs: the World Health Organization (WHO) Surgical Safety Checklist/Time-Out and the Checklist Manifesto.Results: The PSA Tool comprised four modules: (1) Screening for Safety for HB-TMH; (2) Assessment for Safety During the HB-TMH Initial Visit; (3) End of the Initial Visit and Disposition Planning; and (4) the TMH Time-Out and Reassessment during subsequent visits. A sample workflow guides implementation. Conclusions: The Privacy and Safety Protocol and PSA Tool aim to prepare providers for the private and safe delivery of HB-TMH. Its modular format can be adapted to each site's resources. Going forward, the PSA Tool should help to facilitate the integration of HB-TMH into the routine mental health care landscape.
Assuntos
Serviços de Saúde do Adolescente/organização & administração , COVID-19 , Serviços de Saúde da Criança/organização & administração , Protocolos Clínicos/normas , Serviços de Assistência Domiciliar , Serviços de Saúde Mental/organização & administração , Segurança do Paciente , Privacidade , Telemedicina , Adolescente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Redes de Comunicação de Computadores/normas , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Serviços de Assistência Domiciliar/ética , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/tendências , Humanos , SARS-CoV-2 , Telemedicina/ética , Telemedicina/métodos , Estados UnidosRESUMO
Blockchain is a shared distributed digital ledger technology that can better facilitate data management, provenance and security, and has the potential to transform healthcare. Importantly, blockchain represents a data architecture, whose application goes far beyond Bitcoin - the cryptocurrency that relies on blockchain and has popularized the technology. In the health sector, blockchain is being aggressively explored by various stakeholders to optimize business processes, lower costs, improve patient outcomes, enhance compliance, and enable better use of healthcare-related data. However, critical in assessing whether blockchain can fulfill the hype of a technology characterized as 'revolutionary' and 'disruptive', is the need to ensure that blockchain design elements consider actual healthcare needs from the diverse perspectives of consumers, patients, providers, and regulators. In addition, answering the real needs of healthcare stakeholders, blockchain approaches must also be responsive to the unique challenges faced in healthcare compared to other sectors of the economy. In this sense, ensuring that a health blockchain is 'fit-for-purpose' is pivotal. This concept forms the basis for this article, where we share views from a multidisciplinary group of practitioners at the forefront of blockchain conceptualization, development, and deployment.
Assuntos
Tecnologia Biomédica , Redes de Comunicação de Computadores , Atenção à Saúde/tendências , Sistemas de Informação Administrativa , Informática Médica , Tecnologia Biomédica/métodos , Tecnologia Biomédica/organização & administração , Tecnologia Biomédica/tendências , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/normas , Redes de Comunicação de Computadores/provisão & distribuição , Redes de Comunicação de Computadores/tendências , Data Warehousing/métodos , Data Warehousing/tendências , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Processamento Eletrônico de Dados/métodos , Processamento Eletrônico de Dados/organização & administração , Processamento Eletrônico de Dados/tendências , Utilização de Equipamentos e Suprimentos/organização & administração , Utilização de Equipamentos e Suprimentos/tendências , Ensaios de Triagem em Larga Escala/normas , Humanos , Sistemas de Informação Administrativa/normas , Sistemas de Informação Administrativa/tendências , Informática Médica/métodos , Informática Médica/organização & administração , Informática Médica/tendências , Prontuários Médicos/normasAssuntos
Redes de Comunicação de Computadores , Segurança Computacional , Gestão de Riscos , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Redes de Comunicação de Computadores/instrumentação , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/normas , Segurança Computacional/normas , Equipamentos e Provisões/normas , Humanos , Informática Médica/instrumentação , Informática Médica/organização & administração , Informática Médica/normasAssuntos
Diagnóstico por Imagem/tendências , Sistemas Automatizados de Assistência Junto ao Leito/tendências , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/normas , Redes de Comunicação de Computadores/tendências , Segurança Computacional/tendências , Análise Custo-Benefício , Diagnóstico por Imagem/economia , Diagnóstico por Imagem/instrumentação , Diagnóstico por Imagem/métodos , Equipamentos e Provisões/economia , Equipamentos e Provisões/normas , Troca de Informação em Saúde/normas , Humanos , Sistemas Automatizados de Assistência Junto ao Leito/economia , Sistemas Automatizados de Assistência Junto ao Leito/organização & administração , Sistemas Automatizados de Assistência Junto ao Leito/normasAssuntos
Necessidades e Demandas de Serviços de Saúde , Bombas de Infusão/tendências , Software , Redes de Comunicação de Computadores/organização & administração , Redes de Comunicação de Computadores/normas , Redes de Comunicação de Computadores/tendências , Segurança Computacional/normas , Segurança Computacional/tendências , Troca de Informação em Saúde/normas , Troca de Informação em Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Bombas de Infusão/normas , Assistência ao Paciente/instrumentação , Assistência ao Paciente/normas , Assistência ao Paciente/tendências , Telemedicina/instrumentação , Telemedicina/organização & administração , Telemedicina/normas , Telemedicina/tendências , Dispositivos Eletrônicos Vestíveis/normas , Dispositivos Eletrônicos Vestíveis/tendênciasAssuntos
Redes de Comunicação de Computadores/instrumentação , Redes de Comunicação de Computadores/normas , Análise de Falha de Equipamento/métodos , Análise de Falha de Equipamento/normas , Equipamentos e Provisões/normas , Guias como Assunto/normas , Valores de Referência , Processamento de Sinais Assistido por Computador/instrumentação , Avaliação da Tecnologia Biomédica/métodos , Avaliação da Tecnologia Biomédica/normas , Estados Unidos , Tecnologia sem Fio/instrumentação , Tecnologia sem Fio/normasAssuntos
Redes de Comunicação de Computadores/organização & administração , Acessibilidade aos Serviços de Saúde , Telemedicina/organização & administração , Redes de Comunicação de Computadores/normas , Controle de Custos , Georgia , Necessidades e Demandas de Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Telemedicina/normasRESUMO
INTRODUÇÃO A modernização da Medicina permitiu uma maior interação entre a equipe médica e o paciente. O desenvolvimento tecnológico, principalmente na comunicação, permitiu a criação de novos aparelhos, como smartphones e tablets. A disseminação destes aparelhos e o desenvolvimento de aplicativos permitiram o uso destes na Medicina, sendo um meio rápido de acesso a informação, diagnóstico, acompanhamento de pacientes, simulações cirúrgicas, orientações, livros eletrônicos e informações sobre a patologia, e na conduta terapêutica e cirúrgica. Este estudo é uma revisão para identificação dos aplicativos sobre cirurgia plástica nestes aparelhos: smartphones e tablets. MÉTODOS: Foram pesquisadas, na língua inglesa, as bases de aplicativos google play® e apple store®, encontradas disponíveis até junho de 2014. Foram encontrados, inicialmente, 588 aplicativos relacionados à cirurgia plástica. Com base na descrição dos aplicativos, estes foram classificados quanto a gratuidade, área de atuação, base em que o aplicativo foi encontrado e utilização. RESULTADOS: Após utilização de critérios, foram encontrados 19 aplicativos, dos quais 11 relacionados à simulação cirúrgica, cinco à avaliação clínica e três sobre microcirurgia e retalhos. Quanto ao acesso, 12 eram gratuitos e sete pagos. Quanto à base de aplicativos, 11 eram exclusivos da apple store®, dois exclusivos da android® e seis encontrados em ambas. CONCLUSÃO: Existem atualmente cerca de 600 aplicativos relacionados à cirurgia plástica, porém apenas cerca de 20 destes apresentam aplicabilidade clínica. É necessário o desenvolvimento da acessibilidade através desses aplicativos em outras línguas, facilitando o uso destes em outros países.
INTRODUCTION The modernization of medicine allowed a greater interaction between medical teams and patients. Technological development, especially in the field of communication, has led to the creation of new devices such as smartphones and tablets. The widespread popularity of these devices and the development of applications have allowed their use in medicine, being quick means of accessing information, diagnosis, patient follow-up, surgical simulations, guidelines, electronic books and information on pathological conditions, and therapeutic and surgical procedures. This study is a review of the applications of smartphones and tablets in plastic surgery. METHODS: The application stores Google Play® and Apple Store® in English were assessed until June 2014. Initially, 588 applications related to plastic surgery were found. Based on their descriptions, the applications were classified according to cost, area of operation, store in which the application is made available, and use. RESULTS: After applying the exclusion criteria, 19 applications were selected, of which 11 were related to surgical simulations; five, to clinical evaluations; and three, to microsurgery and flaps. With regard to access, 12 were free and seven were paid. Of these applications, 11 were exclusive to the Apple Store®, two were exclusive to Android®, and six were available in both. CONCLUSION: Approximately 600 applications related to plastic surgery have been developed, but only about 20 of these have clinical applicability. The development of these applications in other languages is needed, facilitating their use in other countries.
Assuntos
Humanos , História do Século XXI , Cirurgia Plástica , Tecnologia , Estudo de Avaliação , Telefone Celular , Aplicativos Móveis , Acesso à Internet , Tecnologia/métodos , Redes de Comunicação de Computadores , Redes de Comunicação de Computadores/normas , Redes de Comunicação de Computadores/ética , Telefone Celular/normas , Telefone Celular/ética , Aplicativos Móveis/normasRESUMO
On the basis of Evalvid tool integrated in NS2 (Network Simulator version 2), the paper gets new set of tools, myEvalvid, to establish the simulation and evaluation platform for multimedia transmission. Then the paper investigates the effects of various influence factors when multimedia information is transmitted in the network and the relationships among these factors. Based on the analysis, the paper gets different evaluation models, respectively. In this paper, we study the impact on performance of several basic source and network parameters of video streams, namely, GOP (Group of Pictures) pattern, compression quantitative parameters, packet length, and packet error rate. Simulation results show that different parameters lead to different distortion levels which are calculated according to the reconstruction images at the receiver and the original images. The experimental results show that the video transmission and quality evaluation model we designed can evaluate multimedia transmission performance over complex environment very well.
Assuntos
Redes de Comunicação de Computadores/organização & administração , Simulação por Computador , Multimídia/normas , Redes de Comunicação de Computadores/normas , Estudos de Avaliação como Assunto , Modelos Teóricos , Processamento de Sinais Assistido por ComputadorRESUMO
Vehicular ad hoc networks (VANETs) are emerging as new research area and attracting an increasing attention from both industry and research communities. In this context, a dynamic resource allocation policy that maximizes the use of available resources and meets the quality of service (QoS) requirement of constraining applications is proposed. It is a combination of a fair packet scheduling policy and a new adaptive QoS oriented call admission control (CAC) scheme based on the vehicle density variation. This scheme decides whether the connection request is to be admitted into the system, while providing fair access and guaranteeing the desired throughput. The proposed algorithm showed good performance in testing in real world environment.
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Redes de Comunicação de Computadores/normas , Modelos Teóricos , Alocação de Recursos , Algoritmos , Humanos , Controle de QualidadeRESUMO
Medical device interoperability has been identified as a key way of decreasing healthcare costs while improving patient care. 1 This has led to a shift toward placing more medical devices onto information technology (IT) networks. However, placing medical devices onto an IT network may lead to additional risks to safety, effectiveness and security of the devices, the network, and the data. ANSI/AAMI/IEC 80001-1 addresses the roles, responsibilities, and activities that need to be carried out when managing these risks. In this article, we describe an exercise undertaken to assess the medical IT network risk management practice implemented within a hospital to control risk associated with a clinical information system (CIS). The level of compliance with the 80001-1 standard was determined using an assessment framework developed by the Regulated Software Research Centre. The purpose of this exercise was to test and inform the development of an assessment method that is part of the assessment framework for this standard. The exercise also sought to identify how the management of such an existing CIS project meets the requirements of 80001-1.
Assuntos
Engenharia Biomédica/normas , Redes de Comunicação de Computadores/normas , Guias de Prática Clínica como Assunto , Gestão de Riscos/normas , Gestão da Segurança/normas , Estados UnidosRESUMO
Distance has been one of the basic factors in manufacturing and control fields, and ultrasonic distance sensors have been widely used as a low-cost measuring tool. However, the propagation of ultrasonic waves is greatly affected by environmental factors such as temperature, humidity and atmospheric pressure. In order to solve the problem of inaccurate measurement, which is significant within industry, this paper presents a novel ultrasonic distance sensor model using networked error correction (NEC) trained on experimental data. This is more accurate than other existing approaches because it uses information from indirect association with neighboring sensors, which has not been considered before. The NEC technique, focusing on optimization of the relationship of the topological structure of sensor arrays, is implemented for the compensation of erroneous measurements caused by the environment. We apply the maximum likelihood method to determine the optimal fusion data set and use a neighbor discovery algorithm to identify neighbor nodes at the top speed. Furthermore, we adopt the NEC optimization algorithm, which takes full advantage of the correlation coefficients for neighbor sensors. The experimental results demonstrate that the ranging errors of the NEC system are within 2.20%; furthermore, the mean absolute percentage error is reduced to 0.01% after three iterations of this method, which means that the proposed method performs extremely well. The optimized method of distance measurement we propose, with the capability of NEC, would bring a significant advantage for intelligent industrial automation.
Assuntos
Algoritmos , Artefatos , Redes de Comunicação de Computadores/instrumentação , Transdutores , Ultrassonografia/instrumentação , Ultrassonografia/métodos , Calibragem , Redes de Comunicação de Computadores/normas , Desenho de Equipamento , Análise de Falha de Equipamento , Ultrassonografia/normasRESUMO
The best way to ensure patient safety is to eliminate errors. To avoid errors and resulting harm from medical devices, there are rules and laws in Germany to ensure a certain quality and process [1,2]. This does not cover scenarios where devices are connected to a data network, forming a medical IT network. Arising risks need to be addressed by operating organizations, such as hospitals. International standard IEC 80001-1 offers a process for this and defines roles and responsibilities [3]. The aim of our study was to assess the application of risk management for a small initial project. We studied a daisy chain of medical devices connected to the IT network. The number of involved proprietary protocols and interface-definitions complicates the risk management, if just for the number of involved manufacturers. Identified risks could all be addressed and did not block the setup's deployment. Risk management creates an extra effort, but can reduce harm and potential financial liabilities. We can recommend starting with small projects to familiarize with the process.
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Redes de Comunicação de Computadores/instrumentação , Redes de Comunicação de Computadores/normas , Bases de Dados Factuais/normas , Segurança de Equipamentos/normas , Equipamentos e Provisões/normas , Gestão de Riscos/normas , Gestão da Segurança/normas , Guias como Assunto , Internacionalidade , Gestão de Riscos/métodos , Integração de SistemasRESUMO
The COST Action IC0604 "Telepathology Network in Europe" (EURO-TELEPATH) is a European COST Action that has been running from 2007 to 2011. COST Actions are funded by the COST (European Cooperation in the field of Scientific and Technical Research) Agency, supported by the Seventh Framework Programme for Research and Technological Development (FP7), of the European Union. EURO-TELEPATH's main objectives were evaluating and validating the common technological framework and communication standards required to access, transmit and manage digital medical records by pathologists and other medical professionals in a networked environment. The project was organized in four working groups. orking Group 1 "Business modeling in pathology" has designed main pathology processes - Frozen Study, Formalin Fixed Specimen Study, Telepathology, Cytology, and Autopsy -using Business Process Modeling Notation (BPMN). orking Group 2 "Informatics standards in pathology" has been dedicated to promoting the development and application of informatics standards in pathology, collaborating with Integrating the Healthcare Enterprise (IHE), Digital Imaging and Communications in Medicine (DICOM), Health Level Seven (HL7), and other standardization bodies. Working Group 3 "Images: Analysis, Processing, Retrieval and Management" worked on the use of virtual or digital slides that are fostering the use of image processing and analysis in pathology not only for research purposes, but also in daily practice. Working Group 4 "Technology and Automation in Pathology" was focused on studying the adequacy of current existing technical solutions, including, e.g., the quality of images obtained by slide scanners, or the efficiency of image analysis applications. Major outcome of this action are the collaboration with international health informatics standardization bodies to foster the development of standards for digital pathology, offering a new approach for workflow analysis, based in business process modeling. Health terminology standardization research has become a topic of high interest. Future research work should focus on standardization of automatic image analysis and tissue microarrays imaging.
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Redes de Comunicação de Computadores/normas , Registros Eletrônicos de Saúde/normas , Informática Médica/organização & administração , Telepatologia/normas , Comportamento Cooperativo , Europa (Continente) , Humanos , Agências Internacionais , Informática Médica/instrumentaçãoRESUMO
BACKGROUND: The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1) develop a detailed quality assessment tool to analyze quality of expert answers, 2) evaluate the intra- and inter-rater agreement of this tool, and 3) explore changes in the quality of expert answers over the time frame of the project. METHODS: The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer. RESULTS: A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232 ± 0.036, p < 0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105 ± 0.024, p < 0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time. CONCLUSIONS: The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within ECORN-CF, the tool will help ensure that CF patients all over Europe have equal possibility of access to high quality expert advice on their illness.
Assuntos
Redes de Comunicação de Computadores/normas , Fibrose Cística , Sistemas Inteligentes/instrumentação , Garantia da Qualidade dos Cuidados de Saúde/métodos , Encaminhamento e Consulta , Projetos de Pesquisa/normas , Inquéritos e Questionários/normas , Bélgica , Competência Clínica , Interpretação Estatística de Dados , Europa (Continente) , Guias como Assunto , Humanos , Internet , Idioma , Manuais como Assunto , Países Baixos , Variações Dependentes do Observador , Projetos Piloto , Reprodutibilidade dos TestesRESUMO
BACKGROUND: Telemedicine has been used for many years to support doctors in the developing world. Several networks provide services in different settings and in different ways. However, to draw conclusions about which telemedicine networks are successful requires a method of evaluating them. No general consensus or validated framework exists for this purpose. OBJECTIVE: To define a basic method of performance measurement that can be used to improve and compare teleconsultation networks; to employ the proposed framework in an evaluation of three existing networks; to make recommendations about the future implementation and follow-up of such networks. METHODS: Analysis based on the experience of three telemedicine networks (in operation for 7-10 years) that provide services to doctors in low-resource settings and which employ the same basic design. FINDINGS: Although there are many possible indicators and metrics that might be relevant, five measures for each of the three user groups appear to be sufficient for the proposed framework. In addition, from the societal perspective, information about clinical- and cost-effectiveness is also required. The proposed performance measurement framework was applied to three mature telemedicine networks. Despite their differences in terms of activity, size and objectives, their performance in certain respects is very similar. For example, the time to first reply from an expert is about 24 hours for each network. Although all three networks had systems in place to collect data from the user perspective, none of them collected information about the coordinator's time required or about ease of system usage. They had only limited information about quality and cost. CONCLUSION: Measuring the performance of a telemedicine network is essential in understanding whether the network is working as intended and what effect it is having. Based on long-term field experience, the suggested framework is a practical tool that will permit organisations to assess the performance of their own networks and to improve them by comparison with others. All telemedicine systems should provide information about setup and running costs because cost-effectiveness is crucial for sustainability.
Assuntos
Redes de Comunicação de Computadores/normas , Avaliação de Programas e Projetos de Saúde/métodos , Telemedicina/normas , Redes de Comunicação de Computadores/economia , Redes de Comunicação de Computadores/estatística & dados numéricos , Análise Custo-Benefício , Coleta de Dados , Humanos , Satisfação do Paciente , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Fatores de TempoRESUMO
In this article, we present the design and implementation of a regional ocular telehealth network for remote assessment and management of diabetic retinopathy (DR), including the design requirements, network topology, protocol design, system work flow, graphics user interfaces, and performance evaluation. The Telemedical Retinal Image Analysis and Diagnosis Network is a computer-aided, image analysis telehealth paradigm for the diagnosis of DR and other retinal diseases using fundus images acquired from primary care end users delivering care to underserved patient populations in the mid-South and southeastern United States.