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Introduction: Telemedicine has gained significant attention as an effective means of providing health care remotely, particularly during the COVID-19 pandemic. Patient satisfaction is a critical aspect of implementing telemedicine, but we have no comprehensive understanding of satisfaction levels and the associated factors. The aim of this systematic review and meta-analysis was to assess patient satisfaction related to telemedicine consultations and to identify key factors influencing satisfaction levels. Results: The search yielded a total of 147 cross-sectional studies, of which 107 met the criteria for inclusion in the meta-analysis. Overall, patient satisfaction with teleconsultations was found to be high, with satisfaction levels ranging from 38 to 100 on a scale of 0 to 100. Only a small percentage (2.72%) of the studies reported satisfaction levels below 75%. Surprisingly, most studies used nonvalidated satisfaction questionnaires, which highlight the need for the development of standardized measurement instruments. Conclusions: This systematic review and meta-analysis provide evidence that patients generally exhibit high levels of satisfaction with telemedicine consultations. The use of nonvalidated satisfaction questionnaires in many studies, however, suggests a need for more standardized assessment tools. Factors such as the time interval between the consultation and the assessment were found to influence satisfaction levels. Understanding these factors can help health care providers improve telemedicine services and patient-provider relationships and optimize health care delivery in the context of telemedicine. Further research is warranted to develop validated satisfaction measurement instruments and explore any additional factors that influence patient satisfaction with telemedicine.
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COVID-19 , Satisfação do Paciente , Telemedicina , Humanos , SARS-CoV-2 , Inquéritos e Questionários , Consulta RemotaRESUMO
OBJECTIVE: To evaluate and compare the effectiveness and quality of standard face-to-face and teleaudiology hearing aid fitting follow-up consultations and blended services for adult hearing aid users. DESIGN AND STUDY SAMPLE: Fifty-six participants were randomly allocated to two equal groups, with equal numbers of new and experienced users. One standard and one teleaudiology follow-up consultation were delivered by an audiologist, the latter assisted by a facilitator. The order was reversed for the second group. Outcome measurement tools were applied to assess aspects of participants' communication, fitting (physical, sensorial), quality of life, and service. Cross-sectional and longitudinal outcomes were analysed. RESULTS: Most participants presented with moderate, sloping, and symmetrical sensorineural hearing loss. The duration of teleaudiology (42.96 ± 2.73 min) was equivalent to face-to-face consultations (41.25 ± 2.61 min). All modes of service delivery significantly improved outcomes for communication, fitting, and quality of life (p > 0.05). Satisfaction for both consultation modes was high, although significantly greater with standard consultations. The mode and order of delivery of the consultations did not influence the outcomes. CONCLUSION: Teleaudiology hearing aid follow-up consultations can deliver significant improvements, and do not differ from standard consultations. Blended services also deliver significant improvements. Satisfaction can be negatively impacted by technical or human-related issues.
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Auxiliares de Audição , Adulto , Estudos de Coortes , Estudos Transversais , Seguimentos , Humanos , Qualidade de Vida , Encaminhamento e ConsultaRESUMO
Although forest fires are indispensable for some ecosystems, they can have profound economic, environmental, and social implications, especially when they reach high intensities. There are two crucial factors in fighting forest fires: the availability of water resources and the service network. The objective of this study was to propose an alternative methodology for allocating water reservoirs to fight forest fires. The research was divided into three stages: zoning of fire risk, delimitation of viable areas for the implementation of water reservoirs, and determining strategic locations for reservoir allocation. The variables analyzed were land use and occupation, provision of watercourses, relief orientation, slope, proximity to roads, temperature, and precipitation. Fuzzy logic, Euclidean distance, and network analysis were used as the modeling techniques. Scenarios with all risk classes and only the high- and very high-risk classes were analyzed. A total of 66% of the area was represented by the low- and moderate-risk fire classes and 53.16% had a low potential for reservoir allocation, influenced by the low availability of water resources in the area. The proposed model efficiently allocated the water collection points in the different scenarios, and allowed the determination of the areas most susceptible to the occurrence of forest fires and the optimal locations for the installation of reservoirs, with the allocation of 21 water reservoirs to attend the areas of high- and very high-risk of occurrence of fires at a safe speed (40 km h-1) and 47 reservoirs to meet all risk classes at the same speed. The proposed methodology is feasible, applicable, and adjustable and can be implemented in other conservation units and areas of economic interest.
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Incêndios , Incêndios Florestais , Conservação dos Recursos Naturais , Ecossistema , Florestas , Árvores , ÁguaRESUMO
Users of cocaine and/or crack may present symptoms of dysphagia due to changes in anatomical structures caused by the use of these substances. The objective of this study was to investigate the presence of symptoms suggestive of dysphagia in users of cocaine and/or crack seeking treatment, as well as to investigate the quality of life of these individuals related to their swallowing condition. A cross-sectional study from September 2015 to December 2016, with 121 users of cocaine and/or crack, was conducted. 59 of them called a telemarketing service and 61 sought treatment at the Centro de Atenção Psicossocial Álcool e Drogas in Porto Alegre (Psychosocial Alcohol and Drug Center). Users were screened and asked to fill the Eating Assessment Tool questionnaire. Users who presented themselves at the center were submitted to the Tool Volume-Viscosity Swallow Test. Users with symptoms of dysphagia responded to the Quality of Life in Swallowing questionnaire. Of all the interviewees, 22.3% (n = 27) reported symptoms suggestive of dysphagia and 2% of the individuals, submitted to swallowing test, presented cough in the liquid consistency. The scores showed a negative impact on quality of life, mainly related to fatigue, sleep, feeding duration, and fear of eating. Significant numbers of users of cocaine and/or crack referred to symptoms suggestive of dysphagia and significant impairments in quality of life, which require specific care in feeding this population in order to assist in their rehabilitation.
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Transtornos Relacionados ao Uso de Cocaína/psicologia , Cocaína/toxicidade , Transtornos de Deglutição/psicologia , Qualidade de Vida , Adolescente , Adulto , Transtornos Relacionados ao Uso de Cocaína/complicações , Estudos Transversais , Transtornos de Deglutição/induzido quimicamente , Transtornos de Deglutição/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
The original version of this article unfortunately contained a mistake. The spelling of the Sheila Taminini de Almeida name was incorrect.
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Objective this study aimed to determine the thermal favorability for the oidium (Oidium caricae) and early blight (Asperisporium caricae) in areas of edaphoclimatic aptitude for the papaya (Carica papaya) in the Espírito Santo state, Brazil. The edaphoclimatic zoning was based on the overlapping of maps that characterize the average annual air temperature obtained by multiple linear regression, annual water deficiency calculated by the Thornthwaite and Matter method (1955) and favorable soil classes to the development of papaya. The results indicated that as regards the edaphoclimatic zoning for the papaya crop it was observed that 71.70% of the area is classified as apt for its development. In relation to agrometeorological favorability for the occurrence of fungal diseases, there was a favorability of 7.64% for the development without restrictions of the oidium and a predominance of 64,56% of favorability with thermal restriction. For the early blight fungus, it was observed that the zones of favorability without restriction correspond to 11.66% of the area apt for the papaya cultivation and that 55.13% of the area has favorability with restriction of humidity. The edaphoclimatic zoning for the papaya crop showed compatibility with the most productive areas of this crop in the state of Espírito Santo. The zoning of thermal favorability for the occurrence of papaya fungal diseases proved to be a valuable tool for studies of plant diseases, allowing the establishment of plans for the allocation of resistant varieties, in order to minimize the risks of loss of crop productivity due to the disease. This methodology presents potential to be used in other areas, cultures and phytopathological diseases.
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Ascomicetos/fisiologia , Carica/microbiologia , Doenças das Plantas/microbiologia , Agricultura , Clima , TemperaturaRESUMO
OBJECTIVES: The aim of this study was to assess the quality of and outline the differences among recommendations of published clinical practice guidelines (CPGs) for the management of bisphosphonate-associated osteonecrosis of the jaw. METHODS: We conducted a systematic literature search in PubMed, Cochrane, Embase, Web of Science, and Google web site. We selected CPGs supported by a nongovernmental organization or national institutes, related to bisphosphonate-associated osteonecrosis of the jaw in adults, in English language, and dated from January 2008 onward. The validity of each included CPG was appraised according to 2 validated appraisal tools for CPG that were independently used by 2 reviewers. RESULTS: We identified 724 articles, of which 13 were included based on our eligibility criteria. Most CPGs were of good quality based on the appraisal tools for CPGs used in this study. CONCLUSION: We did not find consensus on all the recommendations of the evaluated CPGs. Thus, each clinical case must be assessed individually, considering the risks and benefits on the proposed dental treatment.
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Osteonecrose da Arcada Osseodentária Associada a Difosfonatos , Osteonecrose , Adulto , Assistência Odontológica , HumanosRESUMO
Families of substance abusers may develop maladaptive strategies, such as codependency, to address drug-related problems. It is important for families to receive specialist treatment in order to contribute to the recovery process. The Tele-intervention Model and Monitoring of Families of Drug Users (TMMFDU), based on motivational interviewing and stages of change, aims to encourage the family to change the codependents' behaviors. A randomized clinical trial was carried out to verify the change in codependent behavior after intervention with 6 months of follow-up. Three hundred and twenty-five families with high or low codependency scores were randomized into the intervention group (n = 163) or the usual treatment (UT) (n = 162). After 6 months of follow-up, the family members of the TMMFDU group were twice as likely to modify their codependency behavior when compared to the UT group (OR 2.08 CI 95% 1.18-3.65). TMMFDU proved to be effective in changing codependent behaviors among compliant family members of drug users.
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Terapia Comportamental , Codependência Psicológica , Usuários de Drogas , Família/psicologia , Entrevista Motivacional , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Transtornos Relacionados ao Uso de Substâncias , Resultado do TratamentoRESUMO
OBJECTIVE: To systematically review randomized controlled trials that evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation aspects related to communication and swallowing functions. METHODS: A search was conducted on PubMed, Clinical Trials, Cochrane Library, and ASHA electronic databases. Studies were judged according to the eligibility criteria and analyzed by 2 independent and blinded researchers. RESULTS: We analyzed 9 studies: 4 about aphasia, 3 about dysphagia, 1 about dysarthria in Parkinson's disease and 1 about linguistic deficits in Alzheimer's disease. All aphasia studies used low-frequency rTMS to stimulate Broca's homologous area. High-frequency rTMS was applied over the pharyngoesophageal cortex from the left and/or right hemisphere in the dysphagia studies and over the left dorsolateral prefrontal cortex in the Parkinson's and Alzheimer's studies. Two aphasia and all dysphagia studies showed a significant improvement of the disorder, compared to the sham group. The other 2 studies related to aphasia found a benefit restricted to subgroups with a severe case or injury on the anterior portion of the language cortical area, respectively, whereas the Alzheimer's study demonstrated positive effects specific to auditory comprehension. There were no changes for vocal function in the Parkinson's study. CONCLUSION: The benefits of the technique and its applicability in neurogenic disorders related to communication and deglutition are still uncertain. Therefore, other randomized controlled trials are needed to clarify the optimal stimulation protocol for each disorder studied and its real effects.
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Transtornos da Comunicação , Transtornos de Deglutição , Espectrografia do Som , Acústica da Fala , Estimulação Magnética Transcraniana , Qualidade da Voz , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/reabilitação , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/reabilitação , Valores de Referência , Estatística como Assunto , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Emergency departments are challenging research settings, where truly informed consent can be difficult to obtain. A deeper understanding of emergency medical patients' opinions about research is needed. We conducted a systematic review and meta-summary of quantitative and qualitative studies on which values, attitudes, or beliefs of emergent medical research participants influence research participation. We included studies of adults that investigated opinions toward emergency medicine research participation. We excluded studies focused on the association between demographics or consent document features and participation and those focused on non-emergency research. In August 2011, we searched the following databases: MEDLINE, EMBASE, Google Scholar, Scirus, PsycINFO, AgeLine and Global Health. Titles, abstracts and then full manuscripts were independently evaluated by two reviewers. Disagreements were resolved by consensus and adjudicated by a third author. Studies were evaluated for bias using standardised scores. We report themes associated with participation or refusal. Our initial search produced over 1800 articles. A total of 44 articles were extracted for full-manuscript analysis, and 14 were retained based on our eligibility criteria. Among factors favouring participation, altruism and personal health benefit had the highest frequency. Mistrust of researchers, feeling like a 'guinea pig' and risk were leading factors favouring refusal. Many studies noted limitations of informed consent processes in emergent conditions. We conclude that highlighting the benefits to the participant and society, mitigating risk and increasing public trust may increase research participation in emergency medical research. New methods for conducting informed consent in such studies are needed.
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Ensaios Clínicos como Assunto/ética , Medicina de Emergência/ética , Opinião Pública , Sujeitos da Pesquisa/psicologia , Adulto , Altruísmo , Estudos de Avaliação como Assunto , Humanos , Consentimento Livre e Esclarecido/ética , Risco , Confiança/psicologiaRESUMO
FTIR spectroscopy and multivariate analysis were used in the chemical study of the terroirs of Coffea canephora. Conilon coffees from Espírito Santo and Amazon robusta from Matas of Rondônia, were separated by PCA, with lipids and caffeine being the markers responsible for the separation. Coffees from Bahia, Minas Gerais, and São Paulo did not exhibit separation, indicating that the botanical variety had a greater effect on the terroir than geographic origin. Thus, the genetic factor was investigated considering the conilon and robusta botanical varieties. This last group was composed of hybrid robusta and apoatã. The DD-SIMCA favored the identification of the genetic predominance of the samples. PLS-DA had a high classification performance regarding the conilon, hybrid robusta, and apoatã genetic nature. Lipids, caffeine, chlorogenic acids, quinic acid, trigonelline, proteins, amino acids, and carbohydrates were identified as chemical markers that discriminated the genetic groups.
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Coffea , Coffea/genética , Coffea/química , Cafeína/análise , Brasil , Café/química , LipídeosRESUMO
OBJECTIVES: This study aimed to ascertain utility and vision-related quality of life in patients awaiting access to specialist eye care. A secondary aim was to evaluate the association of utility indices with demographic profile and waiting time. METHODS: Consecutive patients that had been waiting for ophthalmology care answered the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The questionnaire was administered when patients arrived at the clinics for their first visit. We derived a utility index (VFQ-UI) from the patients' responses, then calculated the correlation between this index and waiting time and compared utility across demographic subgroups stratified by age, sex, and care setting. RESULTS: 536 individuals participated in the study (mean age 52.9±16.6 years; 370 women, 69% women). The median utility index was 0.85 (interquartile range [IQR] 0.70-0.92; minimum 0.40, maximum 0.97). The mean VFQ-25 score was 70.88±14.59. Utility correlated weakly and nonsignificantly with waiting time (-0.05, P = 0.24). It did not vary across age groups (P = 0.85) or care settings (P = 0.77). Utility was significantly lower for women (0.84, IQR 0.70-0.92) than men (0.87, IQR 0.73-0.93, P = 0.03), but the magnitude of this difference was small (Cohen's d = 0.13). CONCLUSION: Patients awaiting access to ophthalmology care had a utility index of 0.85 on a scale of 0 to 1. This measurement was not previously reported in the literature. Utility measures can provide insight into patients' perspectives and support economic health analyses and inform health policies.
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Qualidade de Vida , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Idoso , Visão Ocular/fisiologia , Listas de Espera , OftalmologiaRESUMO
INTRODUCTION: Telemedicine has shown promising results, allowing specialists to provide rapid and effective care in remote locations. However, to our knowledge, current evidence is not robust enough to prove the effectiveness of this tool. This cluster-randomized trial (CRT) aimed to evaluate the impact of telemedicine on clinical care indicators in pediatric intensive care units (PICUs). METHODS: An open-label CRT was conducted in 16 PICUs within the Brazilian public health system. The trial took place from August 2022 to December 2023 and compared an intervention group, which received telemedicine support, with a control group, which received usual PICU care. The primary outcome was the PICU length of stay. The main secondary outcomes were mortality rate and ventilator-free days. RESULTS: A total of 1393 participants were included, 657 in the control group and 736 in the intervention group. The mean PICU length of stay was 10.42 (SD, 10.71) days for the control group and 11.52 (SD, 10.80) days for the intervention group. The overall mean of ventilator-free days was 6.82 (SD, 7.71) days. Regarding mortality, 7.54% of participants died in total. No significant difference was found in the outcomes between the groups. CONCLUSION: Despite the potential benefits of telemedicine, its effective implementation in the Brazilian public health system faces considerable challenges, highlighting the continued importance of investigating and improving the role of telemedicine in pediatric critical care. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT05260710 and ReBEC - RBR-7×j4wyp.
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Brazilian coffee production relies on the cultivation of Coffea arabica and Coffea canephora. Climate change has been responsible for the decreasing yield of the crops in the country yet the associated microbial community can mitigate these effects by improving plant growth and defense. Although some studies have tried to describe the microorganisms associated with these Coffea species, a study that compares the microbiome on a wider spatial scale is needed for a better understanding of the terroir of each coffee planting region. Therefore, our aim was to evaluate the microbial communities harbored in soils and fruits of these Coffea species in four Brazilian floristic domains (Amazon, Atlantic Forest Caatinga, and Cerrado). One hundred and eight samples (90 of soil and 90 of fruits) were used in the extraction and sequencing of the fungal and bacterial DNA. We detected more than 1000 and 500 bacterial and fungal genera, respectively. Some soil microbial taxa were more closely related to one coffee species than the other species. Bacillus bataviensis tends to occur more in arid soils from the Caatinga, while the fungus Saitozyma sp. was more related to soils cultivated with C. arabica. Thus, the species and the planting region (floristic domain) of coffee affect the microbial composition associated with this crop. This study is the first to report microbial communities associated with coffee produced in four floristic domains that include sites in eight Brazilian states. Data generated by DNA sequencing provides new insights into microbial roles and their potential for the developing more sustainable coffee management, such as the production of biofertilizers and starter culture for fermentation of coffee cherries.
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Coffea , Microbiota , Café , Brasil , Microbiota/genética , SoloRESUMO
The objective of this study is to present the protocol of a cluster randomized clinical trial to be conducted through the TeleICU project - Qualification of Intensive Care by Telemedicine. The study will consist of a cluster randomized clinical trial, open label, in pediatric intensive care units, with an allocation ratio of 1:1, to compare the intervention group (support of Telemedicine for patients admitted to the pediatric intensive care unit) with a control group (pediatric intensive care unit usual care). The study proposed to select 16 pediatric intensive care units, including 100 participants per site, with a total of 1,600 participants. The intervention group will receive telerounds from Monday to Friday and will have specialists and continuing education activities available. The primary outcome measure will be the length of stay in the pediatric intensive care unit, defined as the difference between the date of discharge of the participant and the date of admission to the intensive care unit. The secondary outcomes will be mortality rate, invasive mechanical ventilation-free days, days using antibiotics, days using vasoactive drugs and days using sedoanalgesia. This study will be conducted in accordance with Resolution 466/12 of the National Health Council, with approval by the Research Ethics Committee of the institutions involved. The present study has the potential to reproduce studies on Telemedicine in intensive care and may make important contributions to care in intensive care units in Brazil and other settings. If Telemedicine shows positive clinical care results compared to conventional treatment, more pediatric patients may benefit. ClinicalTrials.gov registry: NCT05260710.
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COVID-19 , Telemedicina , Humanos , Criança , SARS-CoV-2 , Hospitalização , Unidades de Terapia Intensiva Pediátrica , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.
O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.
La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.
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Oftalmopatias , Oftalmologia , Telemedicina , Idoso , Brasil , Estudos Transversais , Oftalmopatias/diagnóstico , Feminino , Humanos , Masculino , Atenção Primária à SaúdeRESUMO
OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.
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Oftalmologia , Telemedicina , Brasil , Redução de Custos , Humanos , Qualidade de VidaRESUMO
The use of telemedicine in ICUs has grown and is becoming increasingly recognized. However, its impact on PICUs remains unclear. This systematic review and meta-analysis aimed to evaluate whether telemedicine in the PICU has the potential to improve clinical and non-clinical outcomes. PubMed, Scopus, LILACS, and CINAHL electronic databases were searched to identify studies that assessed the impact of telemedicine on clinical outcomes, with no publication date restrictions. The reference lists of the selected articles were hand-searched for additional studies that had not been identified by the initial electronic search. Studies were included if they had a cohort design, used telemedicine, were conducted in PICUs or specialized PICUs, and were published in Portuguese, English, or Spanish. Two groups of reviewers independently screened titles and abstracts for inclusion. The same group of reviewers independently assessed the full-text articles for eligibility and extracted the following information: telecommunication method, intervention characteristics, patient characteristics, sample size, and main results. Studies were meta-analyzed using a random-effects model to estimate the pooled prevalence of PICU mortality and length of PICU stay. Risk of bias was assessed using the Newcastle-Ottawa Scale. Of 2703 studies initially identified, 2226 had their titles and abstracts screened. Of these, 53 were selected for full-text reading, of which 10 were included and analyzed. The main results of interest were length of PICU stay, number of deaths or mortality rate, and satisfaction of health professionals and family members. The results of meta-analysis show that the mortality rate reduced by 34% with an increase of the length of PICU stay in the PICUs with the use of telemedicine. Family members and health professionals were satisfied with the use of telemedicine. Telemedicine has the potential to improve PICU outcomes, such as mortality rate and family and staff satisfaction. However, it extended length of PICU stay in the studies included in this systematic review.
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Telemedicina/métodos , Gerenciamento de Dados , HumanosRESUMO
Purpose of Review: To present the implementation of a telemedicine project (TeleICU) in pediatric intensive care units (ICU) throughout different Brazilian regions. Recent Findings: Although telemedicine in pediatric ICUs has shown evidence of benefit in numerous studies with potential to 18 mitigate existing disparities, in Brazil, its use is still under development. Brazil has several opportunities for implementing this resource since, according to the National Registry of Healthcare 20 Establishments (NRHE), there is a discrepancy in the density of pediatric intensive care physicians per patient and the availability 21 of pediatric ICU beds per number of inhabitants. Summary: Health technologies are being widely used to fill gaps in the healthcare system. Telemedicine has been an important tool to meet demands in intensive care units, especially the demand for specialized assistance. TeleICU is a Brazilian model of telemedicine that performs multidisciplinary telerounds in remote pediatric ICUs and develops continuing education activities for the healthcare teams. The project aims to systematize and to qualify care, as well as to reduce risks for patients admitted to pediatric ICUs engaged in the project. Preliminary results have demonstrated a positive impact regarding this approach, providing medical care to 6640 inpatients-day in two Brazilian pediatric ICUs, for 616 patients during 946 daily telerounds. Supplementary Information: The online version contains supplementary material available at 10.1007/s40124-021-00242-z.
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Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.