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1.
Multimedia | Recursos Multimídia | ID: multimedia-9884

RESUMO

A AMHB agrade a participação dos doutores: Dr. Carlos Michaelis: Advogado Especialista em Direito Médico, consultor em telemedicina e Assessor do CREMESP. Dr.Sílvio Eduardo Valente: Médico, advogado e perito Médico. Doutor em Biodireito pela USP. Presidente da comissão de Direito Médico da OAB-SP (2014-2018).


Assuntos
Consulta Remota/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Promoção da Saúde , COVID-19/prevenção & controle
2.
BMC Med Inform Decis Mak ; 22(1): 206, 2022 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918702

RESUMO

BACKGROUND: Peripheral artery disease (PAD) is a cardiovascular disease that can be improved by risk factor modification. Mobile health (mHealth) intervention is an effective method of healthcare delivery to promote behavior changes. An mHealth platform can encourage consistent involvement of participants and healthcare providers for health promotion. This study aimed to develop an mHealth platform consisting of a smartphone application (app) synchronized with a wearable activity tracker and a web-based portal to support exercise intervention in patients with PAD. METHODS: This study was conducted based on an iterative development process, including analysis, design, and implementation. In the analysis phase, a literature review and needs assessment through semi-structured interviews (n = 15) and a questionnaire-based survey (n = 138) were performed. The initial prototype design and contents were developed based on the users' requirements. In the implementation phase, multidisciplinary experts (n = 4) evaluated the heuristics, following which the mHealth platform was revised. User evaluation of the usability was performed by nurses (n = 4) and patients with PAD (n = 3). RESULTS: Through the development process, the functional requirements of the platform were represented through visual display, reminder, education, self-monitoring, goal setting, goal attainment, feedback, and recording. In-app videos of exercise and PAD management were produced to provide information and in-app automatic text messages were developed for user motivation. The final version of the platform was rated 67.86 out of 100, which indicated "good" usability. CONCLUSIONS: The mHealth platform was designed and developed for patients with PAD and their healthcare providers. This platform can be used to educate and promote individualized exercise among patients with PAD.


Assuntos
Aplicativos Móveis , Doença Arterial Periférica , Telemedicina , Exercício Físico , Humanos , Doença Arterial Periférica/terapia , Telemedicina/métodos , Design Centrado no Usuário
3.
Front Public Health ; 10: 862065, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35923965

RESUMO

Metabolic diseases are a global rising health burden, mainly due to the deleterious interaction of current lifestyles with the underlying biology of these diseases. Daily habits and behaviors, such as diet, sleep, and physical exercise impact the whole-body circadian system through the synchronization of the peripheral body clocks that contribute to metabolic homeostasis. The disruption of this system may promote the development of metabolic diseases, including obesity and diabetes, emphasizing the importance of assessing and monitoring variables that affect circadian rhythms. Advances in technology are generating innovative resources and tools for health care management and patient monitoring, particularly important for chronic conditions. The use of mobile health technologies, known as mHealth, is increasing and these approaches are contributing to aiding both patients and healthcare professionals in disease management and education. The mHealth solutions allow continuous monitoring of patients, sharing relevant information and data with physicians and other healthcare professionals and accessing education resources to support informed decisions. Thus, if properly used, these tools empower patients and help them to adopt healthier lifestyles. This article aims to give an overview of the influence of circadian rhythms disruption and lifestyle habits in the progression of metabolic diseases while also reviewing some of the mobile applications available to monitor lifestyle behaviors and individual chronobiology. Herein is also described the design and development of the NutriClock system, an mHealth solution developed by our team to monitor these variables.


Assuntos
Doenças Metabólicas , Telemedicina , Ritmo Circadiano , Humanos , Estilo de Vida , Monitorização Fisiológica
4.
Health Promot Int ; 37(3)2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35913900

RESUMO

To address current trends in poor health-seeking behaviour and late cancer diagnosis in many low- and middle-income countries, like Uganda, it is important to explore innovative awareness building interventions. One possible intervention is a common digital format, an interactive voice response (IVR) system, which is suitable for individuals with low technological and reading literacy. It is increasingly acknowledged that developing digital interventions requires co-creation with relevant stakeholders and explication of program developers' assumptions, to make them effective, sustainable, and scalable. To this end, we sought to develop an initial program theory for a co-created IVR system for cancer awareness in Uganda. Utilising principles of the realist approach, a qualitative exploratory study was conducted through seven focus group discussions (FGDs) with people living with cancer (PLWC), health workers, and policy makers. Thematic analysis of the transcripts resulted in the emergence of four major themes. Through all themes the most consistent finding was that myths, misconceptions, and misinformation about cancer were related to every aspect of the cancer journey and influenced the experiences and lives of PLWC and their caregivers. Participants were positive about the potential of an IVR system but also had reservations about the design and reach of the system. The resulting initial program theory proposes that a context-specific IVR system has the potential to improve awareness on cancer, provided attention is given to aspects such as language, message framing, and accuracy.


Assuntos
Neoplasias , Telemedicina , Grupos Focais , Humanos , Idioma , Pesquisa Qualitativa
5.
PLoS One ; 17(8): e0269477, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35913933

RESUMO

OBJECTIVE: The objective of this study was to assess the potential of the use of asynchronous tele-expertise (ASTE) to provide prenatal diagnosis from a medical and economic point of view. POPULATION: Patients screened by a midwife at a primary center. METHODS: A technical and clinical evaluation was conducted retrospectively, and a cost minimization study compared asynchronous tele-expertise to face-to-face consultations that would have been performed without ASTE. MAIN OUTCOME MEASURES: In our study we assessed the feasibility of ASTE, what were the origins of the requests for expertise, whether patients need to be moved and the reasons for doing so, and the costs of tele-expertise and conventional consultation. RESULTS: In this retrospective analysis 322 advices from 260 patients were interpreted remotely via a platform. The results revealed a 90.68% feasibility of transmitting in a satisfactory and interpretable way ultrasound images and videos via the tele-expertise platform (292/322 files). In our series, asynchronous analysis allowed the required physician to make an accurate diagnosis and identify 74 (28.5%, 95% CI [23% -33.9%]) pregnancies associated with malformations and rule out abnormalities in 186 (71.5%, 95% CI [66.1% -77%]) of the cases. The ASTE was not associated with face-to-face consultations for 72.7% (189/260) of the patients, who without moving, were able to have access to a precise diagnosis by ruling out the presence of anomalies in 163/189 of these patients and confirming them in 26/189 patients. The practice of ASTE would result from a societal point of view, an average saving of 61.8% (€ 120.57) per patient compared to a face-to-face consultation. CONCLUSION: The use of asynchronous tele-expertise (ASTE) using fetal ultrasound, is feasible and may contribute to increased diagnostic accuracy while generating a significant reduction in costs for society.


Assuntos
Diagnóstico Pré-Natal , Telemedicina , Redução de Custos , Feminino , Humanos , Gravidez , Encaminhamento e Consulta , Estudos Retrospectivos , Telemedicina/métodos , Ultrassonografia
6.
BMC Res Notes ; 15(1): 269, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35915505

RESUMO

OBJECTIVES: The COVID-19 pandemic in Australia disrupted usual clinical training placements for naturopathic students. An innovative, remote Telehealth clinic was developed and implemented. This pilot study evaluates student and educator learning and teaching experiences in Telehealth. A survey assessed Likert and qualitative written responses to student and staff interaction with the Telehealth clinic. RESULTS: Nine student and 12 educator responses were included in the analysis. All students positively rated Telehealth training resources and the educator support provided. Students rated the Telehealth learning experience as 'very good' (78%) or 'good' (22%) with educator ratings of 'very good' (67%) or 'good' (33%). Thematic analysis of student written responses showed increased client diversity, collaboration, peer learning, increased feedback, and improved digital and technology skills. Virtual physical examination and infrastructure limitations were reported as Telehealth clinical practicum challenges. Naturopathic Telehealth clinic practicum is a valuable alternative to in-person clinical practicums for Australian students. It enhances student collaboration and peer learning. Challenges of technology, infrastructure and incorporating Telehealth in curriculum may be barriers to implementation of Telehealth. However, Telehealth is an important clinical training option to prepare student practitioners for contemporary professional practice if in-person consultation is prohibitive, such as during the COVID-19 pandemic.


Assuntos
COVID-19 , Telemedicina , Austrália/epidemiologia , COVID-19/epidemiologia , Humanos , Pandemias , Projetos Piloto
7.
Ideggyogy Sz ; 75(7-08): 265-273, 2022 Jul 30.
Artigo em Húngaro | MEDLINE | ID: mdl-35916613

RESUMO

Background and purpose: COVID-19 has made providing in-person care difficult. In most countries, including Hungary, telemedicine has partly served as a resolution for this issue. Our purpose was to explore the effects of COVID-19 on neurological care, the knowledge of neurology specialists on telemedicine, and the present state of telecare in Hungary, with a special focus on Parkinson's disease (PD). Methods: Between July and October 2021, a nationwide online survey was conducted among actively practicing Hungarian neurology specialists who were managing patients with PD. Results: A total of 104 neurologists were surveyed. All levels of care were evaluated in both publicly funded and private healthcare. Both time weekly spent on outpatient specialty consultation and the number of patients with PD seen weekly significantly decreased in public healthcare, while remained almost unchanged in private care (p<0.001); higher portion of patients were able to receive in-person care in private care (78.8% vs. 90.8%, p<0.001). In telecare, prescribing medicines has already been performed by the most (n=103, 99%). Electronic messages were the most widely known telemedicine tools (n=98, 94.2%), while phone call has already been used by most neurologists (n=95, 91.3%). Video-based consultation has been more widely used in private than public care (30.1% vs. 15.5%, p=0.001). Teleprocedures were considered most suitable for monitoring progression and symptoms of Parkinson's disease and evaluating the need for adjustments to antiparkinsonian pharmacotherapy. Conclusion: COVID-19 has had a major impact on the care of patients with PD in Hungary. Telemedicine has mitigated these detrimental effects; however, further developments could make it an even more reliable component of care.


Assuntos
COVID-19 , Doença de Parkinson , Telemedicina , COVID-19/epidemiologia , Humanos , Hungria/epidemiologia , Neurologistas , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapia , Telemedicina/métodos
8.
J Gerontol Nurs ; 48(8): 52-56, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914080

RESUMO

The current article provides an overview of an interprofessional service-learning course that became virtual in the setting of the coronavirus disease 2019 pandemic. Telehealth video technologies were used to build an intergenerational, virtual classroom and increase engagement of older adults with interdisciplinary health professional students. The virtual classroom involved group health education sessions, individualized Medicare wellness visits, and a clinical huddle. The course addressed the public health need for reliable health information during the early days of the pandemic, social connection, and meeting the educational goals for health care students and older adults in a novel virtual setting. Lessons learned for the interdisciplinary team and for engaging older adults included the need for preparation reading, team building exercises, training videos, and telehealth competency checklists. Beyond the pandemic, adoption of virtual methods enables hybrid approaches to interprofessional education and builds competencies for delivery of telehealth and computer-based visits in professional practice settings. [Journal of Gerontological Nursing, 48(8), 52-56.].


Assuntos
COVID-19 , Telemedicina , Idoso , Humanos , Educação Interprofissional , Relações Interprofissionais , Medicare , Pandemias , Estados Unidos
9.
Health Aff (Millwood) ; 41(8): 1136-1138, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914196

RESUMO

Regulatory flexibility by US states and territories during the COVID-19 pandemic rapidly facilitated the practice of medicine across state lines by physicians and other health care professionals, both in person and via telehealth, and greatly expanded access to care. Policy makers and health care leaders at the state and federal levels need to better understand which of these efforts (temporary expedited licenses, licensing waivers, interstate licensure compacts, and data credentialing platforms) worked well, under which circumstances, and how they might complement one another to facilitate more rapid and widespread adoption of measures to improve access to care in times of crisis and beyond. Lessons learned during this global public health crisis should better inform the nation's emergency preparedness efforts ahead of the next calamity.


Assuntos
COVID-19 , Telemedicina , Acesso aos Serviços de Saúde , Humanos , Licenciamento , Pandemias/prevenção & controle
10.
Health Aff (Millwood) ; 41(8): 1125-1132, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914197

RESUMO

New Jersey's COVID-19 Temporary Emergency Reciprocity Licensure program provided temporary licenses to more than 31,000 out-of-state health care practitioners. As one of the first COVID-19 hot spots in the US, New Jersey is uniquely positioned to provide insights on enabling an out-of-state health care workforce through temporary licensure to address critical, ongoing concerns about health care workforce supply. In January 2021 we surveyed New Jersey temporary licensees. We analyzed more than 10,000 survey responses and found that practitioners who used the temporary license originated from every state in the US, provided both COVID-19- and non-COVID-19-related care, served a combination of new and existing patients, conversed with patients in at least thirty-six languages, and primarily used telehealth. Findings suggest that temporary licensure of out-of-state practitioners, along with telehealth waivers, may be a valuable, short-term solution to mitigating health care workforce shortages during public health emergencies.


Assuntos
COVID-19 , Telemedicina , Humanos , Licenciamento , New Jersey , Recursos Humanos
11.
Health Aff (Millwood) ; 41(8): 1139-1141, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35914201

RESUMO

In response to COVID-19, many states increased their supply of health care workers, using emergency policies to remove barriers such as state licensure requirements. The experience in New Jersey suggests that most health care workers who obtained a temporary license, including physicians, nurses, and mental health providers, provided care for existing patients for COVID-19- and non-COVID-19-related conditions, mostly through telehealth. State variation in licensure requirements, as well as scope of practice, may be a barrier to patients having flexible, accessible, and continuous care. As states emerge from the pandemic, emergency policies that expand health workforce supply by removing these state-level barriers should be made permanent.


Assuntos
COVID-19 , Telemedicina , Mão de Obra em Saúde , Humanos , Pandemias , Estados Unidos , Recursos Humanos
12.
Soins ; 67(864): 44-46, 2022 Apr.
Artigo em Francês | MEDLINE | ID: mdl-35914881

RESUMO

Driven by public health policies since 2009, telemedicine has experienced an exceptional development during the health crisis. Unfortunately, this practice remains limited for private nurses, reducing an impact that could be more important than it is in terms of quality of care and services rendered to patients.


Assuntos
Serviços de Assistência Domiciliar , Telemedicina , Humanos
13.
S Afr J Commun Disord ; 69(2): e1-e10, 2022 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-35924605

RESUMO

BACKGROUND:  The coronavirus disease 2019 (COVID-19) presented and highlighted new and unanticipated challenges to the provision of clinical services, raising an urgency for the application of different models of service delivery, including tele-audiology. In many tele-audiology encounters, a site facilitator is needed at the patient site to help with the hands-on aspects of procedures, and the implications of this requirement are significant for the resource-constrained African context. OBJECTIVES:  The aim of this scoping review was to investigate published evidence on training provided to patient site facilitators (PSFs) for tele-audiology application to guide the South African audiology community in tele-audiology application initiatives. METHOD:  Electronic bibliographic databases including Science Direct, PubMed, Scopus MEDLINE and ProQuest were searched to identify peer-reviewed publications, published in English, between 2017 and 2021 related to training of PSFs. The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were followed during the screening process as well as for illustrating the process. RESULTS:  Findings are discussed under four key themes: (1) type of tele-audiology and the implications thereof, (2) length of training and its implications, (3) diversity in the range of PSFs used and its implications for the training, and (4) heterogeneity in the training. CONCLUSION:  The findings highlight important considerations for tele-audiology application within the African context, specifically decision-making around who can serve in the role of PSFs, as well as content and nature of training required, with implications for policy and regulations as well as human resource strategy. These findings are important for the COVID-19 pandemic era and beyond.


Assuntos
Audiologia , COVID-19 , Telemedicina , Audiologia/métodos , Humanos , Pandemias/prevenção & controle , África do Sul , Telemedicina/métodos
15.
PLoS One ; 17(8): e0272605, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35930556

RESUMO

Telehealth services may improve access to care, but there are concerns around whether availability of telehealth may increase care utilization. We assessed whether usage of telehealth was associated with differential primary care utilization at a large, urban public healthcare system. Using electronic health record data from 23 primary care clinics, we categorized patients as telehealth users and non-users. Then, we compared the number of visits per patient between groups using Welch's t-tests while stratifying by comorbidity count. We used multivariable Poisson regression to test for associations between telehealth usage and visit count while controlling for other demographic factors. Compared with telehealth non-users, telehealth users had approximately 1 more primary care visit per patient over the year regardless of comorbidity count or other patient characteristics. Availability of telehealth services may be associated with increased primary care utilization in a safety-net setting, though further research on outcomes, costs of care, and patient and clinician experiences is needed to better inform decisions regarding provision and reimbursement of telehealth services.


Assuntos
Telemedicina , Comorbidade , Humanos , Atenção Primária à Saúde
16.
17.
Perm J ; 26(2): 54-63, 2022 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-35933666

RESUMO

Introduction The COVID-19 pandemic drove rapid, widespread adoption of telehealth (TH). We evaluated surgical telehealth utilization and outcomes for newly diagnosed breast cancer patients during the initial pandemic period. Methods We identified patients with breast cancer diagnosed March 17, 2020 through May 17, 2020 who underwent surgery as the initial treatment. Clinicodemographic characteristics were collected. Initial consultation types (office, telephone, or video) were categorized. Outcomes included time to consultation, surgeon touchpoints, time to surgery, surgery types, and reexcision rates. Continuous variables were compared using Mann-Whitney tests or t-tests, and categorical variables were compared using χ2 or Fisher's exact tests. Results Of 158 patients, 56% had initial telehealth consultations (21% telephone, 35% video) and 42% did not have a preoperative physical examination. Age, race/ethnicity, and stage distributions were similar between initial visit types. Median time to consultation was lower in the initial telehealth group than the office group (6 days vs 9 days, p = 0.01). Other outcomes (surgeon touchpoints, time to surgery, surgery type, reconstruction) were similar between visit types. We observed higher reexcision rates in patients with initial telehealth visits (20% telehealth vs 4% office, p = 0.01), but evaluation was limited by small numbers. The reexcision rate was 13% for patients with telehealth visits and no preoperative physical exam. Discussion During the initial pandemic period, the majority of new breast cancer patients had an initial telehealth surgical consultation. Office and telehealth consultation visits had comparable numbers of postconsultation surgeon touchpoints and most outcomes. Our findings suggest that telehealth consultations may be feasible for preoperative breast cancer consultations.


Assuntos
Neoplasias da Mama , COVID-19 , Telemedicina , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pandemias , SARS-CoV-2 , Telemedicina/métodos
19.
PLoS One ; 17(8): e0271766, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35925980

RESUMO

Ideally, a patient's response to medication can be monitored by measuring changes in performance of some activity. In observational studies, however, any detected association between treatment ("on-medication" vs "off-medication") and the outcome (performance in the activity) might be due to confounders. In particular, causal inferences at the personalized level are especially vulnerable to confounding effects that arise in a cyclic fashion. For quick acting medications, effects can be confounded by circadian rhythms and daily routines. Using the time-of-the-day as a surrogate for these confounders and the performance measurements as captured on a smartphone, we propose a personalized statistical approach to disentangle putative treatment and "time-of-the-day" effects, that leverages conditional independence relations spanned by causal graphical models involving the treatment, time-of-the-day, and outcome variables. Our approach is based on conditional independence tests implemented via standard and temporal linear regression models. Using synthetic data, we investigate when and how residual autocorrelation can affect the standard tests, and how time series modeling (namely, ARIMA and robust regression via HAC covariance matrix estimators) can remedy these issues. In particular, our simulations illustrate that when patients perform their activities in a paired fashion, positive autocorrelation can lead to conservative results for the standard regression approach (i.e., lead to deflated true positive detection), whereas negative autocorrelation can lead to anticonservative behavior (i.e., lead to inflated false positive detection). The adoption of time series methods, on the other hand, leads to well controlled type I error rates. We illustrate the application of our methodology with data from a Parkinson's disease mobile health study.


Assuntos
Medicina de Precisão , Telemedicina , Causalidade , Humanos , Modelos Lineares , Smartphone
20.
Soins Gerontol ; 27(156): 23-26, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35926969

RESUMO

The Ti-Sage mobile geronto-psychiatry team provides semi-emergency care in the Sud Bretagne public mental health establishment sector. The system favours fluidity and responsiveness. Requests can be made by telephone without filling in a form. The multidisciplinary team assesses the disorders, directs and ensures follow-up as close as possible (living and care areas), quickly (within forty-eight hours), with the aim of forging links and avoiding inappropriate hospitalisations. Interventions are carried out in all the geriatric care structures in the area, by visit or telemedicine. The team works in a network to coordinate care with care partners and offer support to carers.


Assuntos
Serviços Médicos de Emergência , Telemedicina , Idoso , Hospitalização , Humanos , Titânio
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