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1.
Neurodegener Dis Manag ; 11(1): 77-82, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33172353

RESUMO

Aim: To examine whether two existing cognitive screeners might be adapted for telephone administration by omission of item content requiring visual cues or assessment. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke's Cognitive Examination (MACE) and Free-Cog were used to derive scores for 'Tele-MACE' and 'Tele-Free-Cog'. Results: As in the index study, both Tele-MACE and Tele-Free-Cog proved sensitive for dementia diagnosis. Tele-MACE had a better balance of sensitivity and specificity than observed with MACE. Tele-MACE was sensitive for mild cognitive impairment diagnosis, whereas Tele-Free-Cog was more specific for mild cognitive impairment. Conclusion: Existing cognitive screeners may be adapted for telephone administration. Such developments may prove necessary in the COVID-19 era as remote rather than face-to-face cognitive assessment increasingly becomes the established norm.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Testes Neuropsicológicos/normas , Telemedicina/normas , Telefone , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade
2.
Am J Kidney Dis ; 77(1): 142-148, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33002530

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic, technological advancements, regulatory waivers, and user acceptance have converged to boost telehealth activities. Due to the state of emergency, regulatory waivers in the United States have made it possible for providers to deliver and bill for services across state lines for new and established patients through Health Insurance Portability and Accountability Act (HIPAA)- and non-HIPAA-compliant platforms with home as the originating site and without geographic restrictions. Platforms have been developed or purchased to perform videoconferencing, and interdisciplinary dialysis teams have adapted to perform virtual visits. Telehealth experiences and challenges encountered by dialysis providers, clinicians, nurses, and patients have exposed health care disparities in areas such as access to care, bandwidth connectivity, availability of devices to perform telehealth, and socioeconomic and language barriers. Future directions in telehealth use, quality measures, and research in telehealth use need to be explored. Telehealth during the public health emergency has changed the practice of health care, with the post-COVID-19 world unlikely to resemble the prior era. The future impact of telehealth in patient care in the United States remains to be seen, especially in the context of the Advancing American Kidney Health Initiative.


Assuntos
Comitês Consultivos/normas , Hemodiálise no Domicílio/normas , Falência Renal Crônica/epidemiologia , Nefrologia/normas , Sociedades Médicas/normas , Telemedicina/normas , Comitês Consultivos/tendências , Hemodiálise no Domicílio/tendências , Humanos , Falência Renal Crônica/terapia , Nefrologia/tendências , Sociedades Médicas/tendências , Telemedicina/tendências , Estados Unidos/epidemiologia
3.
Psychiatr Serv ; 72(1): 86-88, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32781927

RESUMO

To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.


Assuntos
Coleta de Dados , Pesquisa sobre Serviços de Saúde/organização & administração , Serviços de Saúde Mental/organização & administração , Assistência Centrada no Paciente/organização & administração , Psiquiatria/organização & administração , Melhoria de Qualidade/organização & administração , Telemedicina/organização & administração , Coleta de Dados/normas , Pesquisa sobre Serviços de Saúde/normas , Humanos , Ciência da Implementação , Serviços de Saúde Mental/normas , Organizações , Assistência Centrada no Paciente/normas , Psiquiatria/normas , Melhoria de Qualidade/normas , Participação dos Interessados , Telemedicina/normas
4.
Psychiatr Serv ; 72(1): 100-103, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32811284

RESUMO

Because of the COVID-19 pandemic, many mental health care services have been shifted from face-to-face to virtual interactions. Several health policy changes have influenced telehealth uptake during this time, including changes in technology, Internet connectivity, prescriptions, and reimbursement for services. These changes have been implemented for the duration of the pandemic, and it is unclear if all, some, or none of these new or amended policies will be retained after the pandemic has ended. Accordingly, in the wake of changing policies, mental health care providers will need to make decisions about the future of their telehealth programs. This article briefly reviews telehealth policy changes due to the COVID-19 pandemic and highlights what providers should consider for future delivery and implementation of their telehealth programs.


Assuntos
Prescrições de Medicamentos , Seguro Saúde , Serviços de Saúde Mental , Telemedicina , Continuidade da Assistência ao Paciente , Prescrições de Medicamentos/normas , Humanos , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/organização & administração , Seguro Saúde/normas , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/normas , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Telemedicina/normas , Estados Unidos
5.
J Nerv Ment Dis ; 209(1): 49-53, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003053

RESUMO

The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.


Assuntos
Atitude do Pessoal de Saúde , Serviços de Saúde Comunitária , Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental , Aceitação pelo Paciente de Cuidados de Saúde , Telemedicina , Serviços de Saúde Comunitária/economia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/normas , Telemedicina/economia , Telemedicina/organização & administração , Telemedicina/normas
6.
BMC Med Inform Decis Mak ; 20(1): 324, 2020 12 07.
Artigo em Inglês | MEDLINE | ID: mdl-33287815

RESUMO

BACKGROUND: Home telemonitoring is a promising approach to optimizing outcomes for patients with Type 2 Diabetes; however, this care strategy has not been adapted for use with understudied and underserved Hispanic/Latinos (H/L) patients with Type 2 Diabetes. METHODS: A formative, Community-Based Participatory Research approach was used to adapt a home telemonitoring intervention to facilitate acceptability and feasibility for vulnerable H/L patients. Utilizing the ADAPT-ITT framework, key stakeholders were engaged over an 8-month iterative process using a combination of strategies, including focus groups and structured interviews. Nine Community Advisory Board, Patient Advisory, and Provider Panel Committee focus group discussions were conducted, in English and Spanish, to garner stakeholder input before intervention implementation. Focus groups and structured interviews were also conducted with 12 patients enrolled in a 1-month pilot study, to obtain feedback from patients in the home to further adapt the intervention. Focus groups and structured interviews were approximately 2 hours and 30 min, respectively. All focus groups and structured interviews were audio-recorded and professionally transcribed. Structural coding was used to mark responses to topical questions in the moderator and interview guides. RESULTS: Two major themes emerged from qualitative analyses of Community Advisory Board/subcommittee focus group data. The first major theme involved intervention components to maximize acceptance/usability. Subthemes included tablet screens (e.g., privacy/identity concerns; enlarging font sizes; lighter tablet to facilitate portability); cultural incongruence (e.g., language translation/literacy, foods, actors "who look like me"); nursing staff (e.g., ensuring accessibility; appointment flexibility); and, educational videos (e.g., the importance of information repetition). A second major theme involved suggested changes to the randomized control trial study structure to maximize participation, including a major restructuring of the consenting process and changes designed to optimize recruitment strategies. Themes from pilot participant focus group/structured interviews were similar to those of the Community Advisory Board such as the need to address and simplify a burdensome consenting process, the importance of assuring privacy, and an accessible, culturally congruent nurse. CONCLUSIONS: These findings identify important adaptation recommendations from the stakeholder and potential user perspective that should be considered when implementing home telemonitoring for underserved patients with Type 2 Diabetes. TRIAL REGISTRATION: NCT03960424; ClinicalTrials.gov (US National Institutes of Health). Registered 23 May 2019. Registered prior to data collection. https://www.clinicaltrials.gov/ct2/show/NCT03960424?term=NCT03960424&draw=2&rank=1.


Assuntos
Assistência à Saúde Culturalmente Competente/organização & administração , Diabetes Mellitus Tipo 2 , Promoção da Saúde/métodos , Hispano-Americanos/psicologia , Monitorização Ambulatorial/métodos , Aceitação pelo Paciente de Cuidados de Saúde , Telemedicina/métodos , Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 2/terapia , Estudos de Viabilidade , Grupos Focais , Disparidades em Assistência à Saúde , Humanos , Entrevistas como Assunto , Projetos Piloto , Pesquisa Qualitativa , Telemedicina/normas , Populações Vulneráveis
7.
Ann Agric Environ Med ; 27(4): 680-688, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33356078

RESUMO

INTRODUCTION AND OBJECTIVE: The aim of the study is to discuss the legal framework for telemedicine services in Poland, and to present telemedicine solutions used in selected European countries. MATERIAL AND METHODS: The analysis of legal cts was chosen as a research method in order to determine legal possibilities for medical professionals to use telemedicine services. A literature review was undertaken to demonstrate the possibilities of telemedicine as used in the United Kingdom, Germany, Norway, The Netherlands and Sweden. RESULTS: The Act on the professions of a doctor and a dentist states that the doctor and the dentist can perform their profession via ICT systems or communication systems. The doctor is obliged to practice in accordance with current medical knowledge and available methods. 'Available methods' include considering information and communication measures that may allow prevention, recognition or treatment. The Act on the profession of a nurse and a midwife states that the nurse and midwife perform the professions using current medical knowledge and the mediation of ICT systems or communication systems. Thus, the legislator has clearly authorized persons performing these professions to provide services in the field of telemedicine. However, despite the existence of a legal basis for using telemedicine, its development in Poland is not as high as in the United Kingdom, Germany, Norway, The Netherlands or Sweden. CONCLUSIONS: The legislator gradually introduces legal solutions necessary for the development of telemedicine services, although the pace of these changes, as well as building the technical infrastructure that is the basis for the proper provision of telemedicine services, are too slow.


Assuntos
Odontólogos/legislação & jurisprudência , Tocologia/legislação & jurisprudência , Enfermeiras e Enfermeiros/legislação & jurisprudência , Médicos/legislação & jurisprudência , Telemedicina/legislação & jurisprudência , Comunicação , Polônia , Telemedicina/normas
8.
J Prim Care Community Health ; 11: 2150132720985055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33372570

RESUMO

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing "Telemedicine-National guidelines," approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.


Assuntos
/epidemiologia , Responsabilidade Legal , Telemedicina/organização & administração , Doença Crônica , Comunicação , Confidencialidade , Humanos , Pacientes Internados , Itália/epidemiologia , Modelos Organizacionais , Pacientes Ambulatoriais , Telemedicina/legislação & jurisprudência , Telemedicina/normas
9.
Adv Chronic Kidney Dis ; 27(5): 390-396, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33308504

RESUMO

The coronavirus (coronavirus disease-2019) pandemic has changed care delivery for patients with end-stage kidney disease. We explore the US healthcare system as it pertains to dialysis care, including existing policies, modifications implemented in response to the coronavirus disease-2019 crisis, and possible next steps for policy makers and nephrologists. This includes policies related to resource management, use of telemedicine, prioritization of dialysis access procedures, expansion of home dialysis modalities, administrative duties, and quality assessment. The government has already established policies that have instated some flexibilities to help providers focus their response to the crisis. However, future policy during and after the coronavirus disease-2019 pandemic can bolster our ability to optimize care for patients with end-stage kidney disease. Key themes in this perspective are the importance of policy flexibility, clear strategies for emergency preparedness, and robust health systems that maximize accessibility and patient autonomy.


Assuntos
Política de Saúde , Falência Renal Crônica/terapia , Nefrologia , Diálise Renal/métodos , Telemedicina/métodos , Instituições de Assistência Ambulatorial , Anastomose Cirúrgica , Artérias/cirurgia , Implante de Prótese Vascular , Centers for Medicare and Medicaid Services, U.S. , Segurança Computacional , Assistência à Saúde/métodos , Assistência à Saúde/normas , Planejamento em Desastres , Acesso aos Serviços de Saúde , Soluções para Hemodiálise/provisão & distribução , Hemodiálise no Domicílio/métodos , Hemodiálise no Domicílio/normas , Humanos , Organização e Administração/normas , Autonomia Pessoal , Equipamento de Proteção Individual , Garantia da Qualidade dos Cuidados de Saúde , Mecanismo de Reembolso , Diálise Renal/instrumentação , Diálise Renal/normas , Telemedicina/normas , Estados Unidos , Veias/cirurgia
11.
J Vasc Nurs ; 38(4): 176-179, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33279106

RESUMO

Coronavirus disease of 2019 poses significant risks for patients with vascular disease. Telemedicine can help clinicians provide care for patients with vascular disease while adhering to social-distancing guidelines. In this article, we review the components of telemedicine used in the vascular medicine practice at the Vanderbilt University Medical Center. In addition, we describe inpatient and outpatient diagnosis-based algorithms to help select patients for telemedicine versus in-person evaluation.


Assuntos
/prevenção & controle , Cardiologia/normas , Assistência à Saúde/normas , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Telemedicina/normas , Cardiologia/métodos , Assistência à Saúde/métodos , Humanos , Serviços Preventivos de Saúde/métodos , Telemedicina/métodos , Tennessee
12.
Neurosurg Focus ; 49(6): E13, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33260126

RESUMO

OBJECTIVE: Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS: This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS: During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS: Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/psicologia , Pessoal de Saúde/psicologia , Procedimentos Neurocirúrgicos/psicologia , Satisfação do Paciente , Telemedicina , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/normas , Atitude do Pessoal de Saúde , Feminino , Pessoal de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/normas , Telemedicina/normas , Adulto Jovem
13.
Neurosurg Focus ; 49(6): E11, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33260128

RESUMO

OBJECTIVE: The ongoing coronavirus disease 2019 (COVID-19) pandemic has considerably affected the delivery of postoperative care to patients who have undergone deep brain stimulation (DBS) surgery. DBS teleprogramming technology was developed and deployed in China before the COVID-19 outbreak. In this report, the authors share their experiences with telemedical DBS treatment of patients with psychiatric disorders during the COVID-19 outbreak. METHODS: Four patients (2 with obsessive-compulsive disorder, 1 with major depressive disorder, and 1 with anorexia nervosa) underwent DBS surgery at Ruijin Hospital and received continuous postoperative DBS telemedicine case management from January 2020 to July 2020. DBS teleprogramming, individualized psychological support, and medical consultations were provided via the authors' DBS telemedicine platform, which also incorporated a synchronous real-time video communication system. RESULTS: Forty-five DBS telemedicine sessions were conducted; there was no unexpected loss of network connection during the sessions. Of these, 28 sessions involved DBS teleprogramming. Adjustments were made to the stimulation voltage, frequency, pulse width, and contact site in 21, 12, 9, and 9 sessions, respectively. Psychological support and troubleshooting were provided during the remaining telemedicine sessions. Modest to substantial clinical improvements after DBS surgery were observed in some but not all patients, whereas stimulation-related side effects were reported by 2 patients and included reversible sleep and mood problems, headache, and a sensation of heat. CONCLUSIONS: DBS telemedicine seems to offer a feasible, safe, and efficient strategy for maintaining the delivery of medical care to psychiatric patients during the COVID-19 outbreak. The authors propose that implementation of a comprehensive DBS telemedicine system, which combines DBS teleprogramming with psychological counseling, medical consultations, and medication prescriptions and delivery, could be an efficient and effective approach to manage the mental health and quality of life of patients with psychiatric disorders during future local or global public health crises.


Assuntos
Anorexia Nervosa/cirurgia , Estimulação Encefálica Profunda/métodos , Transtorno Depressivo Maior/cirurgia , Transtorno Obsessivo-Compulsivo/cirurgia , Telemedicina/métodos , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/psicologia , Estimulação Encefálica Profunda/normas , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/psicologia , Seguimentos , Humanos , Transtornos Mentais , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , Estudos Retrospectivos , Telemedicina/normas , Resultado do Tratamento
14.
Neurosurg Focus ; 49(6): E3, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33260133

RESUMO

The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.


Assuntos
/normas , Mão de Obra em Saúde/normas , Procedimentos Neurocirúrgicos/normas , Guias de Prática Clínica como Assunto/normas , Centros de Atenção Terciária/normas , /cirurgia , Lista de Checagem/normas , Lista de Checagem/tendências , Mão de Obra em Saúde/tendências , Humanos , Índia/epidemiologia , Procedimentos Neurocirúrgicos/tendências , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/tendências , Telemedicina/normas , Telemedicina/tendências , Centros de Atenção Terciária/tendências
15.
Actas urol. esp ; 44(10): 644-652, dic. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-195507

RESUMO

INTRODUCCIÓN: La telemedicina ofrece un soporte clínico remoto utilizando herramientas tecnológicas. Puede facilitar la atención médica al tiempo que reduce las visitas innecesarias a la consulta. La pandemia COVID-19 ha provocado un cambio brusco en nuestra práctica urológica diaria convirtiéndose en algo muy necesario el acto de la teleconsulta. OBJETIVO: Proporcionar recomendaciones prácticas para el uso efectivo de herramientas tecnológicas en telemedicina. MATERIALES Y MÉTODOS: Se realizó una búsqueda en la literatura en la plataforma Medline hasta abril de 2020; seleccionamos los artículos más relevantes relacionados con «telemedicina» y «trabajo inteligente» que podrían proporcionar información útil. RESULTADOS: La telemedicina se refiere al uso de la información electrónica y a las herramientas de telecomunicaciones para proporcionar apoyo clínico remoto a la atención médica. El trabajo inteligente es un modelo de trabajo que utiliza tecnologías nuevas o existentes para mejorar el rendimiento. La telemedicina se está convirtiendo en una herramienta útil y necesaria durante la pandemia COVID-19 e incluso más allá de la misma. Es hora de que formalicemos y demos el lugar que se merece a la telemedicina en nuestra práctica clínica y es nuestra responsabilidad adaptar y conocer todas las herramientas y posibles estrategias para su implementación de una manera óptima, garantizar una atención de calidad a los pacientes y que dicha atención sea percibida por pacientes y familiares como de alto nivel. CONCLUSIONES: La telemedicina facilita la atención clínica urológica especializada a distancia y resuelve problemas como las limitaciones en la movilidad o el traslado de los pacientes, reduce las visitas innecesarias a las clínicas y es útil para reducir el riesgo de transmisión viral de la COVID-19


INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine» and «smart working» that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pandemias , Betacoronavirus , Telemedicina/organização & administração , Telemedicina/normas , Urologia/métodos , Poluição do Ar/prevenção & controle , Agendamento de Consultas , Confidencialidade , Técnicas de Diagnóstico Urológico , Registros Eletrônicos de Saúde , Urologia/organização & administração , Urologia/normas , Consentimento Livre e Esclarecido , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Sociedades Médicas , Triagem/métodos , Europa (Continente)/epidemiologia
17.
Arch Soc Esp Oftalmol ; 95(12): 586-590, 2020 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33160746

RESUMO

BACKGROUND: To report a pilot experience of telemedicine in ophthalmology in open-care modality (i.e. direct video call), in a confinement period due to the COVID-19 pandemic. METHODS: Descriptive study of the demographic and clinical characteristics of patients attended in a 10-week confinement period. Reported satisfaction of the participating patients and doctors was evaluated through an online survey. RESULTS: In the 10-week period, 291 ophthalmologic telemedicine consultations were performed. The main reasons for consultation were inflammatory conditions of the ocular surface and eyelids (79.4%), followed by administrative requirements (6.5%), non-inflammatory conditions of the ocular surface (5.2%), strabismus suspicion (3.4%) and vitreo-retinal symptoms (3.1%). According to previously defined criteria, 22 patients (7.5%) were referred to immediate face-to-face consultation. The level of satisfaction was high, both in doctors (100%) and in patients (93.4%). CONCLUSIONS: Open-care modality of telemedicine in ophthalmology during the pandemic period is a useful instrument to filter potential face-to-face consultations, either elective or emergency, and potentially reduce the risk of COVID-19 infection.


Assuntos
/epidemiologia , Oftalmologia/estatística & dados numéricos , Pandemias , Quarentena , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Oftalmopatias/diagnóstico , Oftalmopatias/tratamento farmacológico , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Oftalmologia/normas , Oftalmologia/tendências , Satisfação do Paciente , Projetos Piloto , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/normas , Telemedicina/tendências , Fatores de Tempo , Adulto Jovem
18.
PLoS One ; 15(11): e0242869, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33237947

RESUMO

This study characterized the evolution of Brazilian public telemedicine policy in the Brazilian Unified Health System for 30 years from 1988 to 2019 by analyzing its legal framework. We identified 79 telemedicine-related legislations from the federal government (laws, decrees, and ordinances) and 31 regulations of federal councils of health professionals. Three historical phases were established according to the public policy cycle, and material was classified according to the purpose of the normative documents. The content analysis was based on the advocacy coalition framework model. Of the federal legislations, 8.9% were for the Formulation/Decision-Making phase, 43% for the Organization/Implementation phase, and 48.1% for the Expansion/Maturation phase of telemedicine policy in Brazil. The Federal Council of Medicine was the most active in standardizing telemedicine and was responsible for 21 (67.7%) regulations. The first legislations were passed in 2000; however, the coalitions discussed topics related to telemedicine and created their belief systems from the 1990's. The time cycle which included formulation and decision making for Brazilian telemedicine policy, extended until 2007 with the creation of several technical working groups. The expansion and maturation of telemedicine services began in 2011 with the decentralization of telemedicine policy actions across the country. Telemedicine centers which performed telediagnosis influenced the computerization of primary health care units. We conclude that Brazilian telemedicine field has greatly grown and changed in recent years. However, despite the proliferation of legislations and regulations in the period studied, there is still no fully consolidated process for setting up a wholly defined regulatory framework for telemedicine in Brazil.


Assuntos
Assistência à Saúde/tendências , Atenção Primária à Saúde/tendências , Telemedicina/normas , Brasil/epidemiologia , Governo Federal , Pessoal de Saúde , Política de Saúde/tendências , Humanos , Política , Política Pública , Telemedicina/tendências
19.
J Speech Lang Hear Res ; 63(12): 3982-3990, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33186507

RESUMO

Purpose There has been increased interest in using telepractice for involving more diverse children in research and clinical services, as well as when in-person assessment is challenging, such as during COVID-19. Little is known, however, about the feasibility, reliability, and validity of language samples when conducted via telepractice. Method Child language samples from parent-child play were recorded either in person in the laboratory or via video chat at home, using parents' preferred commercially available software on their own device. Samples were transcribed and analyzed using Systematic Analysis of Language Transcripts software. Analyses compared measures between-subjects for 46 dyads who completed video chat language samples versus 16 who completed in-person samples; within-subjects analyses were conducted for a subset of 13 dyads who completed both types. Groups did not differ significantly on child age, sex, or socioeconomic status. Results The number of usable samples and percent of utterances with intelligible audio signal did not differ significantly for in-person versus video chat language samples. Child speech and language characteristics (including mean length of utterance, type-token ratio, number of different words, grammatical errors/omissions, and child speech intelligibility) did not differ significantly between in-person and video chat methods. This was the case for between-group analyses and within-child comparisons. Furthermore, transcription reliability (conducted on a subset of samples) was high and did not differ between in-person and video chat methods. Conclusions This study demonstrates that child language samples collected via video chat are largely comparable to in-person samples in terms of key speech and language measures. Best practices for maximizing data quality for using video chat language samples are provided.


Assuntos
Transtornos da Linguagem/diagnóstico , Testes de Linguagem/normas , Medida da Produção da Fala/normas , Telemedicina/normas , Linguagem Infantil , Pré-Escolar , Estudos de Viabilidade , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Ensaios Clínicos Controlados não Aleatórios como Assunto , Reprodutibilidade dos Testes , Inteligibilidade da Fala , Medida da Produção da Fala/métodos , Telemedicina/métodos
20.
Eur Rev Med Pharmacol Sci ; 24(21): 11402-11408, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33215462

RESUMO

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic. PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation. RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year. CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.


Assuntos
Assistência ao Convalescente/métodos , Infecções por Coronavirus/prevenção & controle , Hemodiálise no Domicílio/normas , Falência Renal Crônica/terapia , Pandemias/prevenção & controle , Diálise Peritoneal/normas , Pneumonia Viral/prevenção & controle , Assistência ao Convalescente/normas , Betacoronavirus/patogenicidade , Cuidadores/psicologia , Controle de Doenças Transmissíveis/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Seguimentos , Hemodiálise no Domicílio/efeitos adversos , Hemodiálise no Domicílio/psicologia , Humanos , Educação de Pacientes como Assunto , Diálise Peritoneal/efeitos adversos , Diálise Peritoneal/psicologia , Peritonite/epidemiologia , Peritonite/etiologia , Relações Médico-Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/normas , Autogestão/psicologia , Telemedicina/normas , Resultado do Tratamento
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