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1.
Esc. Anna Nery Rev. Enferm ; 26(spe): e20210179, 2022. ilus
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1292850

RESUMO

Objetivo: O estudo objetivou compreender as repercussões da pandemia da Covid-19 no cuidado de lactentes prematuros, na perspectiva de mães e profissionais de saúde. Método: Foram realizadas entrevistas semiestruturadas nos meses de junho e julho de 2020, por meio de ligação telefônica, com 14 mães e quatro profissionais de saúde do serviço de follow-up de uma maternidade pública da Paraíba, Brasil. Resultados: A partir da análise temática indutiva, os impactos da pandemia no cuidado ao lactente nascido prematuro, foram: sobrecarga e afastamento dos profissionais dos serviços de saúde, desativação temporária da unidade mãe canguru, descontinuidade da assistência ao prematuro, medo materno de expor a criança à Covid-19 e baixa condição socioeconômica. Foram elencadas estratégias de enfrentamento para o cuidado dos lactentes durante a pandemia, como: maior espaçamento das consultas, acompanhamento por meio telefônico e cumprimento das medidas de biossegurança. Conclusão e implicações para a prática: A pandemia exigi adaptações na assistência, tornando necessárias novas formas de cuidado a essas crianças, como exemplo, as consultas de acompanhamento remotas, a fim de garantir o seu direito à vida e saúde


Objective: The study aimed at understanding the repercussions of the Covid-19 pandemic in the care of premature infants, from the perspective of mothers and health professionals. Method: Semi-structured interviews were conducted in the months of June and July 2020, over the telephone, with 14 mothers and four health professionals from the follow-up service of a public maternity hospital in Paraíba, Brazil. Results: From the inductive thematic analysis, the impacts of the pandemic on the care of premature infants were as follows: overload and distancing of health service professionals, temporary deactivation of the Kangaroo mother unit, discontinuity of care for the premature infant, maternal fear of exposing the child to Covid-19 and low socioeconomic status. Coping strategies for the care of infants during the pandemic were listed, such as: greater spacing between consultations, phone follow-up and compliance with biosafety measures. Conclusion and implications for the practice: The pandemic required adaptations in care, which make new forms of care necessary for these children, such as remote follow-up consultations, in order to guarantee their right to life and health


Objetivo: El estudio tuvo como objetivo comprender las repercusiones de la pandemia de Covid-19 en la atención de bebés prematuros, desde la perspectiva de las madres y los profesionales de la salud. Método: Se realizaron entrevistas semiestructuradas en los meses de junio y julio de 2020, por medio de llamadas telefónicas, a 14 madres y cuatro profesionales de la salud del servicio de seguimiento de una maternidad pública en Paraíba, Brasil. Resultados: A partir del análisis temático inductivo, los efectos de la pandemia en la atención de bebés prematuros fueron los siguientes: sobrecarga y distanciamiento de profesionales de los servicios de salud, inhabilitación temporal de la unidad Madre Canguro, discontinuidad de la atención al bebé prematuro, miedo materno a exponer al niño al Covid-19 y nivel socioeconómico bajo. Se enumeraron estrategias de afrontamiento para la atención infantil durante la pandemia, tales como: mayor intervalo entre consultas, seguimiento telefónico y cumplimiento de medidas de bioseguridad. Conclusión e implicaciones para la práctica: La pandemia requirió adaptaciones en la atención, que hacen necesarias nuevas formas de atención para estos niños, como las consultas de monitoreo remoto, para garantizar su derecho a la vida y a la salud


Assuntos
Humanos , Feminino , Lactente , Adulto , Pessoa de Meia-Idade , Recém-Nascido Prematuro/crescimento & desenvolvimento , Pessoal de Saúde , Serviços de Saúde Materno-Infantil , COVID-19 , Cuidado do Lactente , Mães , Carga de Trabalho/psicologia , Consulta Remota , Pesquisa Qualitativa , Cobertura Vacinal , Medo , Método Canguru , Higiene das Mãos , Distanciamento Físico , COVID-19/prevenção & controle
2.
Acta Med Indones ; 53(3): 352-359, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34611077

RESUMO

BACKGROUND: COVID-19 is an infectious disease that is easily widespread and has clinical manifestations as mild, moderate, or severe disease. COVID-19 patients are required to be isolated during treatment to reduce transmission. This can cause anxiety and depression, which in turn worsens the patient's illness. Providing supportive psychotherapy can help provide a feeling of safety, comfort and calm for patients. The choice of method in providing supportive psychotherapy can be done online/teleconsultation or internet-based. This clinical review aims to determine the effect of online teleconsultation or internet-based psychotherapy on COVID-19 patients. METHODS: A systematic search was performed using online databases, such as PubMed, Cochrane, EBSCO/CINAHL and ProQuest. The identified articles were screened using eligibility criteria. There were 2 studies (Zhou et al, and Wei et al) which were analyzed critically using the Newcastle Ottawa Scale. RESULTS: Both studies showed that management of psychotherapy through teleconsultation or internet-based on COVID-19 patients can help relieve the patient's psychological symptoms. Zhou et al studied 63 suspected COVID-19 with 23.8% (n = 15) having a Hospital Anxiety Depression Scale (HADS) score of 8 or more. There was a significant decrease in HADS-A nxiety (HADS-A) scores (p <0.01) and HADS-Depression (HADS-D) scores (p <0.01) in 15 patients, and from the overall HADS scores (p < 0.01). Wei et al. Showed 17-HAMD and HAMA scores in the online psychological intervention group also showed a significant reduction in symptoms of depression and anxiety compared to controls. CONCLUSION: Psychotherapy through online teleconsultation or internet-based on COVID-19 patients can help relieve symptoms of anxiety and depression and teleconsultation and also effective in dealing with psychological complications in patients with COVID-19.


Assuntos
Ansiedade , COVID-19/psicologia , Depressão , Intervenção Baseada em Internet , Psicoterapia/métodos , Consulta Remota/métodos , Ansiedade/etiologia , Ansiedade/terapia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Depressão/etiologia , Depressão/terapia , Humanos , SARS-CoV-2
3.
Torture ; 31(1): 37-52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606476

RESUMO

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Assuntos
COVID-19/epidemiologia , Relações Médico-Paciente/ética , Refugiados/psicologia , Consulta Remota/ética , Telefone , Tortura , Humanos , Anamnese , Pandemias , Exame Físico , SARS-CoV-2 , Reino Unido/epidemiologia
5.
Online braz. j. nurs. (Online) ; 20(supl.1): e20216462, 09 setembro 2021. tab
Artigo em Inglês, Espanhol, Português | LILACS, BDENF - Enfermagem | ID: biblio-1292444

RESUMO

OBJETIVO: identificar as intervenções de enfermagem realizadas por teleconsulta ao idoso e seu cuidador no Serviço de Atenção Domiciliar (SAD) na pandemia da COVID-19. MÉTODO: estudo transversal das intervenções de enfermagem realizadas com 140 idosos e 106 cuidadores, no município de São Gonçalo-RJ. Para tanto, elaborou-se um instrumento semiestruturado fundamentado nos diagnósticos de enfermagem Síndrome do Idoso Frágil, Risco de contaminação e Tensão do papel do cuidador da Taxonomia da NANDA-I, intervenções e atividades de enfermagem NIC e no Protocolo de Manejo Clínico do Coronavírus (COVID-19), na Atenção Primária à Saúde do Ministério da Saúde. RESULTADOS: em 66,4% dos casos houve mudança na rotina para se adequar ao cuidado do idoso, sem diferença significativa para os idosos com mais de 85 anos; 53,6% tiveram dificuldades em manter o isolamento social e 49,3%, em realizar cuidados de higiene. Em 95,7%, a intervenção realizada foi "ensinar ao idoso e cuidador estratégias de manutenção dos cuidados de saúde para diminuir a contaminação". CONCLUSÃO recomenda-se o uso do telecuidado associado às visitas que se tornaram excepcionalidade na pandemia, dando continuidade ao cuidado no SAD, que auxilia na manutenção da capacidade funcional do idoso, no estresse do cuidador, e na adoção de medidas de isolamento social.


OBJECTIVE: to identify the nursing interventions performed by telenursing to the elderly and their caregivers in the Home Care Service (SAD) during the COVID-19 pandemic. METHOD: cross-sectional study of nursing interventions performed with 140 elderly and 106 caregivers, located in the city of São Gonçalo, in the state of Rio de Janeiro. Therefore, a semi-structured instrument was developed based on the nursing diagnosis of Frailty Syndrome, Risk of contamination, and Caregiver role strain of the NANDA-I Taxonomy, NIC nursing interventions and activities, and on the Coronavirus Clinical Management Protocol (COVID-19) in the Primary Health Care of the Ministry of Health. RESULTS: in 66.4% of the cases, there was a change in the routine to suit the care of the elderly,with no significant difference for the elderly over 85 years old; 53.6% had difficulties in maintaining social isolation, and 49.3% in performing hygiene care. In 95.7%, the intervention performed was "teaching the elderly and caregivers about health caremaintenance strategies to reduce contamination". CONCLUSION: the use of telecare associated with visits that became an exception during the pandemic is recommended, providing continuity of care in the Home Care Service. These strategies help to maintain the functional capacity of the elderly, to control the stress of the caregivers, and to adopt measures of social isolation.


OBJETIVO: identificar as intervenções de enfermagem realizadas por teleconsulta ao idoso e seu cuidador no Serviço de Atenção Domiciliar (SAD) na pandemia da COVID-19. MÉTODO: estudo transversal das intervenções de enfermagem realizadas com 140 idosos e 106 cuidadores, no município de São Gonçalo-RJ. Para tanto, elaborou-se um instrumento semiestruturado fundamentado nos diagnósticos de enfermagem Síndrome do Idoso Frágil, Risco de contaminação e Tensão do papel do cuidador da Taxonomia da NANDA-I, intervenções e atividades de enfermagem NIC e no Protocolo de Manejo Clínico do Coronavírus (COVID-19), na Atenção Primária à Saúde do Ministério da Saúde. RESULTADOS: em 66,4% dos casos houve mudança na rotina para se adequar ao cuidado do idoso, sem diferença significativa para os idosos com mais de 85 anos; 53,6% tiveram dificuldades em manter o isolamento social e 49,3%, em realizar cuidados de higiene. Em 95,7%, a intervenção realizada foi "ensinar ao idoso e cuidador estratégias de manutenção dos cuidados de saúde para diminuir a contaminação". CONCLUSÃO: recomenda-se o uso do telecuidado associado às visitas que se tornaram excepcionalidade na pandemia, dando continuidade ao cuidado no SAD, que auxilia na manutenção da capacidade funcional do idoso, no estresse do cuidador, e na adoção de medidas de isolamento social.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Saúde do Idoso , Cuidadores , Consulta Remota , Telenfermagem , COVID-19 , Serviços de Assistência Domiciliar , Estudos Transversais
6.
PLoS One ; 16(9): e0257458, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34591886

RESUMO

BACKGROUND: The COVID-19 pandemic has sparked a surge in the use of virtual communication tools for delivering clinical services for many non-urgent medical needs allowing telehealth or telemedicine, to become an almost inevitable part of the patient care. However, most of patients with vascular disease may require face-to-face interaction and are at risk of worse outcomes if not managed in timely manner. OBJECTIVE: We aimed to describe the utilization of telemedicine services in the outpatient vascular surgery clinics in a tertiary hospital. METHODS: A retrospective analysis of data on all vascular outpatient encounters during 2019 and 2020 was conducted and compared to reflect the pattern of practice prior to and during the COVID-19 pandemic. RESULTS: The study showed that 61% of the total patient encounters in 2020 were reported through teleconsultation. Females were the majority of patients who sought the virtual vascular care. Consultations for the new cases decreased from 29% to 26% whereas, the follow-up cases increased from 71% to 74% in 2020 (p = 0.001). The number of procedures performed in the vascular outpatient clinics decreased by 46% in 2020 when compared to 2019. This decrease in procedures was more evident in the duration from February 2020 to April 2020 in which the procedures decreased by 97%. The proportion of procedures represented 22.6% of the total encounters in 2019 and 10.5% of the encounters during 2020, (p = 0.001). CONCLUSIONS: Teleconsultation, along with supporting practice guidelines, can be used to maximize the efficiency of care in vascular surgery patients during the pandemic and beyond. Adoption of the 'hybrid care' which combines both virtual and in-person services as an ongoing practice requires evidence obtained through audits and studies on patients and healthcare providers levels. It is essential to establish a clear practice that ensures patient's needs.


Assuntos
Consulta Remota , Procedimentos Cirúrgicos Vasculares , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Catar/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária
7.
Dermatol Clin ; 39(4): 599-608, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34556249

RESUMO

The accelerated implementation and use of teledermatology during the coronavirus disease 2019 pandemic has met with successes and challenges. This review explores how telemedicine was used in dermatology before the pandemic, the regulatory adaptions made in response to the pandemic, and the effectiveness of the rapid implementation of teledermatology during the coronavirus disease 2019 pandemic, and, finally, how teledermatology has expanded in response to the pandemic. This review examines lessons learned and how teledermatology's reliance on digital technologies might paradoxically exacerbate health care disparities, and finally, considers the future outlook.


Assuntos
COVID-19/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Telemedicina/estatística & dados numéricos , Dermatologia/organização & administração , Humanos , Consulta Remota/estatística & dados numéricos , Índice de Gravidade de Doença
8.
Ir Med J ; 114(7): 403, 2021 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-34520346

RESUMO

Introduction Remote consultation is of growing in importance and gaining popularity in both primary and secondary healthcare settings. Reduced necessity for a physical presence of the patient within the healthcare setting is of particular benefit in the current COVID-19 era. It is also of benefit to a diverse group of patients, for example: those who are geographically distant from the base hospital, those suffering from mobility issues or chronic illness, those who require chaperoning as well as those with limited access to transport. We have developed guidelines for the use of the medical telecommunications platform, Attend Anywhere, which has been utilised across the English and Scottish National Health Services, as well as with the Australian Health service, and is now available in Health Service Executive (HSE) settings. Herein we describe and recommend a process that we have found helpful, and we propose guidelines on how a Health Care Worker (HCW) might consider approaching a virtual consultation when initiating and safely executing a patient encounter on Attend Anywhere, in a secure and efficient manner. The guidelines were created following review of the literature on previous experience by others with this software, as well as recent guidance published by the Irish Medical Council. A proportion of this guidance is transferable to other platforms. Methods We also undertook a short survey of our patients and physicians in Sligo University Hospital, who used Attend Anywhere over a six-week period to gauge their satisfaction levels with the experience., We estimated distance that our patients would have travelled for their appointment had the traditional face-to-face consultation been carried out. We noted whether we considered the medium appropriate for the patient consultations. Results 53 patients took part and satisfaction was rated from satisfied to very satisfied on a 3-point scale for all stakeholders. In addition, we found that remote consultation, when compared to face-to-face consultation, alleviated an average of 144km of unnecessary travel per appointment. Remote consultation was deemed appropriate in all cases and no rescheduled face-to-face appointments were required due to failure of the consultation due to difficulties encountered. Conclusion The authors recommend the implementation of the described guidance, with suggested Checklist, Information leaflet and Consent form, as a means of ensuring the confidentiality of the consultation and to ensure that processes are adhered to that optimise protection for both the patient and the clinician, while reducing the burden of attendance to the healthcare location.


Assuntos
COVID-19/epidemiologia , Dor Crônica/diagnóstico , Dor Crônica/terapia , Consulta Remota/organização & administração , Tecnologia de Sensoriamento Remoto/métodos , Austrália , Humanos , Programas Nacionais de Saúde , Manejo da Dor , Satisfação do Paciente , Pesquisa Qualitativa , Telecomunicações/organização & administração , Tecnologia sem Fio
10.
J Med Internet Res ; 23(9): e19232, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34533461

RESUMO

BACKGROUND: Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. OBJECTIVE: This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. METHODS: Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. RESULTS: Of the 54 patients who were randomized, 29 (54%) received remote consultations, and 25 (46%) received usual care (recruitment rate: 54/203, 26.6%). The crossover between study arms was high (13/29, 45%). A total of 129 appointments were completed, with 63.6% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that-according to patients-remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. CONCLUSIONS: Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. TRIAL REGISTRATION: ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2953-4.


Assuntos
COVID-19 , Transplante de Fígado , Consulta Remota , Estudos de Viabilidade , Hospitais , Humanos , Pandemias , SARS-CoV-2 , Medicina Estatal
11.
S Afr Fam Pract (2004) ; 63(1): e1-e6, 2021 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-34476964

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented international emergency, resulting in a need to adapt the existing healthcare systems, in order to enable ongoing patient care despite the current disruptions. Telemedicine may be a viable option to continue hospital workflow, however there are barriers to its implementation. We set out to establish what barriers might exist and to assess the viability of teleclinics within the province KwaZulu-Natal (KZN), as perceived by doctors. METHODS: This was a quantitative, observational, survey-based study targeted at medical doctors working in both the public as well as the private healthcare sector in University of KwaZulu-Natal (UKZN). RESULTS: One hundred and forty-seven (147) responses were included. The majority (86%) of respondents felt that telemedicine could provide a useful means to continuing hospital workflow, however, only 47% believed that it was a viable option for their unit. The major barrier identified was a feeling that doctors would-be at-increased medico-legal risk. Only 38.4% of doctors were familiar with the Health Professions Council of South Africa (HPCSA) guidelines on telemedicine usage. Other major barriers included: doctors feeling uncomfortable with not seeing a patient in person or not being able to perform a thorough physical examination. Other reasons identified as potential barriers were doctors foreseeing difficulty in accessing patient medical records and the absence of available systems to order investigations without the patient being physically present. CONCLUSION: Telemedicine is currently not widely utilised in KZN; although most doctors were of the opinion that it could be a useful tool in order to continue the workflow during the pandemic. The major barrier identified were issues surrounding medico-legal coverage.


Assuntos
Atitude do Pessoal de Saúde , Corpo Clínico Hospitalar/psicologia , Consulta Remota/métodos , Telefone , COVID-19/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Responsabilidade Legal , Masculino , Registros Médicos , Pandemias , Guias de Prática Clínica como Assunto , SARS-CoV-2 , África do Sul/epidemiologia
12.
J Med Internet Res ; 23(10): e31374, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34516389

RESUMO

BACKGROUND: Scotland-a country of 5.5 million people-has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. OBJECTIVE: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. METHODS: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. RESULTS: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. CONCLUSIONS: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.


Assuntos
COVID-19 , Consulta Remota , Antropologia Cultural , Humanos , Pandemias , SARS-CoV-2
14.
Int J Med Inform ; 155: 104589, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34592540

RESUMO

BACKGROUND: During the COVID 19 pandemic, direct-to-consumer telehealth (DTC) services allowed patients real-time virtual access to healthcare providers, especially those with an established relationship. In Colombia, this care modality was implemented between 2019 and 2020, under national considerations, it was implemented for outpatient care in a highly complex university hospital in Cali, Colombia. METHODS: A descriptive study with prospective information collection was used to describe the implementation of the outpatient teleconsultation care model for patients. We constructed the clinical and process indicators with which we evaluated the model. FINDINGS: A total of 56,560 patients from our institution were treated by virtual outpatient consultation during the first nine months of the health emergency declared by COVID 19 in Colombia. The strategy made it possible to achieve coverage more significant than 100% in Cali and the departments of Colombia. Attention by teleconsultation was 19% of the total ambulatory care. The effectiveness in carrying out scheduled teleconsultations had an overall result of 91.5%. The accessibility results demonstrated the need to strengthen connectivity and accessibility to payments and strengthen technology adoption in the institution, health personnel, and patients. INTERPRETATION: Implementing an outpatient teleconsultation model allowed the continuity of the management with comprehensive coverage nationwide from a highly complex hospital in southwestern Colombia. The indicators' analysis should help strengthen the policies of access to telemedicine, especially with the consequences of the pandemic in low- and middle-income countries. Latin American evidence is necessary to establish the safety profile of telemedicine and the costs associated with the provision.


Assuntos
COVID-19 , Consulta Remota , Assistência Ambulatorial , Colômbia/epidemiologia , Hospitais , Humanos , Pandemias , Estudos Prospectivos , SARS-CoV-2
15.
BMC Med Inform Decis Mak ; 21(1): 245, 2021 08 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419027

RESUMO

BACKGROUND: To enhance teleconsultation management, demands can be classified into different patterns, and the service of each pattern demand can be improved. METHODS: For the effective teleconsultation classification, a novel ensemble hierarchical clustering method is proposed in this study. In the proposed method, individual clustering results are first obtained by different hierarchical clustering methods, and then ensembled by one-hot encoding, the calculation and division of cosine similarity, and network graph representation. In the built network graph about the high cosine similarity, the connected demand series can be categorized into one pattern. For verification, 43 teleconsultation demand series are used as sample data, and the efficiency and quality of teleconsultation services are respectively analyzed before and after the demand classification. RESULTS: The teleconsultation demands are classified into three categories, erratic, lumpy, and slow. Under the fixed strategies, the service analysis after demand classification reveals the deficiencies of teleconsultation services, but analysis before demand classification can't. CONCLUSION: The proposed ensemble hierarchical clustering method can effectively category teleconsultation demands, and the effective demand categorization can enhance teleconsultation management.


Assuntos
Consulta Remota , Análise por Conglomerados , Humanos
16.
J Binocul Vis Ocul Motil ; 71(3): 110-117, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34348581

RESUMO

BACKGROUND: The coronavirus (COVID-19) global pandemic has been a poignant reminder of the value of telehealth services to deliver care, especially as a means of reducing the risk of infectious disease transmission caused by close personal contact, decreasing unnecessary travel for medical consultations, and limiting the number of individuals in waiting rooms. The role of telehealth in ophthalmology has historically been limited to store-and-forwarding of images, much like what is used in radiology. PATIENTS AND METHODS: Remote evaluation using two-way audio-video communications over the initial 10-week period of clinic shutdowns. Visual acuity (VA) measurement was attempted using a printed single surrounded HOTV or Snellen chart. The VA measurement of fellow eyes was compared to the prior in person clinical visit. External and strabismus examinations were also conducted. RESULTS: Fifty-eight patients were evaluated with a mean age 12.5 years (range 5 months to 82 years). Twenty of 58 (34%) were younger than 5 years of age. Reasons for evaluation were strabismus in 26 patients (45%), refractive error in 25 (43%), and amblyopia in 10 patients (19%). Recognition visual acuity was obtained in 69% (40 of 58), including every patient older than 5 years of age. Nine children from 2 to 5 years of age (mean 3 years) were unable to perform HOTV VA testing. Of nine children unable to do complete VA testing, five had been premature and seven had developmental delay. There was a mean bias of -0.12 logMAR in favor of the prior in office test in the right eyes of 21 non-amblyopic patients. The 95% limits of agreement between the in-person visit and the subsequent telehealth video visit logMAR VA were +0.20 logMAR upper limit, -0.44 logMAR lower limit. CONCLUSIONS: Telehealth video visits provided basic ophthalmic information in patients who are physically incapable to come to the office, leading to improved triage. Vision could be tested remotely in young children, but we found substantial variability in the measurement of clinically normal eyes. Improvements in the reliability of at-home visual acuity testing are needed.


Assuntos
COVID-19/epidemiologia , Consulta Remota/métodos , SARS-CoV-2 , Estrabismo/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Atropina/administração & dosagem , Criança , Pré-Escolar , Óculos , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Antagonistas Muscarínicos/administração & dosagem , Oftalmologia/métodos , Pediatria/métodos , Consulta Remota/organização & administração , Privação Sensorial , Estrabismo/fisiopatologia , Estrabismo/terapia , Estados Unidos/epidemiologia , Testes Visuais/métodos , Acuidade Visual/fisiologia
17.
PLoS One ; 16(8): e0249872, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34347779

RESUMO

This paper analyzes the application of various telemedicine services in Gansu Province, China during the COVID-19 epidemic, and summarizes the experiences with these services. In addition, the satisfaction levels of patients and doctors with the application of telemedicine in COVID-19 were investigated, the deficiencies of telemedicine in Gansu were determined, and recommendations for modification were proposed. Coronavirus Disease 2019 (COVID-19) has broken out in China, and Gansu Province in Northwest of China has not been spared. To date, there are 91 local COVID-19 cases and 42 imported cases. 109 hospitals were selected as designated hospitals during the COVID-19 outbreak, and most of them were secondary hospitals. However, it was unsatisfactory that the ability of medical services is relatively low in most of secondary hospitals and primary hospitals. Therefore, we helped the secondary hospitals cope with COVID-19 by means of remote consultation, long-distance education, telemedicine question and answer (Q&A). Our practical experience shows that telemedicine can be widely used during the COVID-19 epidemic, especially in developing countries and areas with lagging medical standards.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Telemedicina/organização & administração , China/epidemiologia , Surtos de Doenças , Educação à Distância/organização & administração , Educação à Distância/estatística & dados numéricos , Educação Médica Continuada/métodos , Educação Médica Continuada/organização & administração , Educação Médica Continuada/estatística & dados numéricos , Educação Continuada em Enfermagem/métodos , Educação Continuada em Enfermagem/organização & administração , Educação Continuada em Enfermagem/estatística & dados numéricos , Epidemias , Geografia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Relações Médico-Paciente , Consulta Remota/instrumentação , Consulta Remota/métodos , Consulta Remota/organização & administração , Consulta Remota/estatística & dados numéricos , SARS-CoV-2/fisiologia , Software , Telemedicina/instrumentação , Telemedicina/métodos
19.
Undersea Hyperb Med ; 48(3): 263-278, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34390631

RESUMO

Submariners face many challenges. For example, they "live where they work" and can be called to duty anytime. They have limited access to open space, natural settings, fresh air, fresh food, sunlight, privacy, exercise, and outside communication. They support a wider range of missions than occur aboard most other Navy vessels. At sea or on shore, submariners work long hours under conditions with little margin for error. They may traverse remote or disputed areas of the ocean far from rescue assets, and must remain vigilant for potential encounters with hostile forces, onboard fires, anomalies in the breathing atmosphere, leaks, undersea collisions, or radiation exposures. If any of these factors cause casualties, the Independent Duty Corpsman (with intermittent advice from shore-based medical personnel), must be ready to provide aid as long as necessary. The challenges of submarine service led to the growth of the unique field of submarine medicine, which has maintained an excellent record of health and safety. This review introduces the field of submarine medicine as practiced in the U.S. Navy, describing its major concerns, giving an overview of the operation of a submarine medical department, and identifying several medical gaps that researchers are working to fill. Submarine medicine already has a stellar record in terms of radiation and atmospheric safety and has made strides in fatigue management. Ongoing work will deliver improved psychological screening and support tools. This report summarizes developments in these and other areas of submarine medicine.


Assuntos
Atenção à Saúde , Militares , Navios , Medicina Submarina , Poluição do Ar em Ambientes Fechados/prevenção & controle , Atenção à Saúde/métodos , Fadiga/complicações , Humanos , Saúde Mental , Síndrome Metabólica/diagnóstico , Militares/psicologia , Doenças Profissionais/complicações , Doenças Profissionais/prevenção & controle , Doenças Profissionais/terapia , Exposição Ocupacional , Exposição à Radiação , Consulta Remota , Medicina Submarina/educação , Medicina Submarina/métodos , Transporte de Pacientes/métodos , Estados Unidos , Local de Trabalho
20.
Ann R Coll Surg Engl ; 103(8): 561-568, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34464563

RESUMO

BACKGROUND: The COVID-19 pandemic and the eventual national lockdown in the UK brought a halt to the face-to-face outpatient appointments at most NHS hospitals. Owing to this, clinicians have had to switch to other means of consultation, to maintain continuity of care. This survey was done to see how surgeons perceive telemedicine as part of their surgical consultations. METHODS: A questionnaire was piloted and re-designed following which an improved questionnaire was circulated among all users of telemedicine in surgical specialties through social media platforms. The results were analysed using smart survey software. RESULTS: Seventy per cent of the respondents had never used telemedicine before the COVID-19 pandemic. Three-quarters of the respondents found difficulty in assessing patients preoperatively. A significant proportion were worried about confidentiality and data security. The other concerns expressed were difficulty in building a rapport and the absence of a legal framework to support the surgeons in the transition. Despite some concerns, most of them were in favour of using telemedicine in the future with some improvements. CONCLUSION: As the pandemic prevented people from attending face-to-face appointments, remote consultations were stepped up to help overcome the difficulties. Screening services were suspended and treatment accumulated. Telemedicine will be a corner-stone service as healthcare systems attempt to tackle this backlog. The already existing software need to be further explored. Future studies must address the use of telemedicine in preoperative consultations. Regulatory bodies must ensure that there is adequate legal framework in place so that clinicians continue to embrace telemedicine.


Assuntos
Atitude do Pessoal de Saúde , Consulta Remota , Cirurgiões , COVID-19 , Segurança Computacional , Confidencialidade , Estudos Transversais , Humanos , Pandemias , Inquéritos e Questionários , Reino Unido
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