Asunto(s)
Publicaciones Periódicas como Asunto , Urología , Brasil , Humanos , Telemedicina/tendenciasRESUMEN
The aim of this paper is to present the evolution of Digital Health (DH) in Brazil, in relation to the adoption of DH as a basis for the development of public policies, with a focus on improving the delivery of health care to patients and expanding its coverage. Data from the ICT in Health survey from the Regional Centre for Studies on the Development of the Information Society (Cetic.br) were analysed. The main challenges identified are related to gaps in patient information, which requires interaction between different facilities and to more complex functionalities related to guidelines and guidance in patient care.
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Telemedicina , Brasil , Humanos , Telemedicina/tendencias , Atención a la Salud , Registros Electrónicos de Salud , Salud DigitalRESUMEN
This article explores telecare from telehealth developments and the recent acceleration of the digital health transformation caused by the COVID-19 pandemic, focusing on the Brazilian Unified Health System (SUS). It addresses terminological issues, the scope of actions, the potential use for healthcare, and constraints and contingencies for telecare in Brazil, focusing on teleconsultations and interactions between health professionals and patients. Finally, it presents a set of propositions for the development of telecare policies and practices in Brazil, considering SUS principles, in two central themes: organizational political guidelines and operational propositions to organise services and healthcare delivery. The importance of clarifying the scope and limits of new technologies is highlighted in the attempt to avoid idealizations with proposed solutions to complex health problems. Telecare solutions should be compatible with SUS principles and with the recommended model of care, with the healthcare network coordinated and organised by primary care, ensuring access to health services and integrated and quality healthcare for the Brazilian society.
O artigo explora a teleassistência a partir dos desenvolvimentos da telessaúde e da aceleração da transformação digital na saúde provocada pela pandemia de COVID-19, com foco no Sistema Único de Saúde (SUS). Aborda questões terminológicas, escopo de ações, potencialidades do uso para atenção à saúde e condicionantes e contingências para a utilização da teleassistência no Brasil, concentrando-se nas teleconsultas e nas interações entre profissionais de saúde e pacientes. Por fim, apresenta um conjunto de proposições para o desenvolvimento das políticas e práticas de teleassistência no Brasil, tendo em vista os princípios do SUS, organizados em dois eixos estratégicos centrais: diretrizes político organizacionais e proposições operacionais e de organização dos serviços e do cuidado. Destaca-se a importância de ponderar e elucidar os alcances e os limites das novas tecnologias para evitar idealizações e deslumbramentos com suas propostas de solução para os complexos problemas de saúde. As soluções de teleassistência devem ser compatíveis com princípios e diretrizes do SUS e com o modelo de atenção preconizado, que prevê a organização da rede a partir da atenção primária, para garantir acesso, integralidade e qualidade da atenção à saúde para a sociedade brasileira.
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COVID-19 , Atención a la Salud , Accesibilidad a los Servicios de Salud , Programas Nacionales de Salud , Atención Primaria de Salud , Telemedicina , Brasil , Telemedicina/organización & administración , Telemedicina/tendencias , Humanos , COVID-19/epidemiología , Atención a la Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Política de Salud , Calidad de la Atención de SaludRESUMEN
Abstract Cardiovascular diseases are the leading cause of death in the world. People living in vulnerable and poor places such as slums, rural areas and remote locations have difficulty in accessing medical care and diagnostic tests. In addition, given the COVID-19 pandemic, we are witnessing an increase in the use of telemedicine and non-invasive tools for monitoring vital signs. These questions motivate us to write this point of view and to describe some of the main innovations used for non-invasive screening of heart diseases. Smartphones are widely used by the population and are perfect tools for screening cardiovascular diseases. They are equipped with camera, flashlight, microphone, processor, and internet connection, which allow optical, electrical, and acoustic analysis of cardiovascular phenomena. Thus, when using signal processing and artificial intelligence approaches, smartphones may have predictive power for cardiovascular diseases. Here we present different smartphone approaches to analyze signals obtained from various methods including photoplethysmography, phonocardiograph, and electrocardiography to estimate heart rate, blood pressure, oxygen saturation (SpO2), heart murmurs and electrical conduction. Our objective is to present innovations in non-invasive diagnostics using the smartphone and to reflect on these trending approaches. These could help to improve health access and the screening of cardiovascular diseases for millions of people, particularly those living in needy areas.
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Inteligencia Artificial/tendencias , Enfermedades Cardiovasculares/diagnóstico , Triaje/tendencias , Diagnóstico por Computador/métodos , Diagnóstico por Computador/tendencias , Teléfono Inteligente/tendencias , Triaje/métodos , Telemedicina/métodos , Telemedicina/tendencias , Aplicaciones Móviles/tendencias , Teléfono Inteligente/instrumentación , Telecardiología , COVID-19/diagnósticoRESUMEN
In this consensus statement, we provide updated recommendations on multiple sclerosis (MS) management during the COVID-19 crisis and the post-pandemic period applicable to neurology services around the world. Statements/recommendations were generated based on available literature and the experience of 13 MS expert panelists using a modified Delphi approach online. The statements/recommendations give advice regarding implementation of telemedicine; use of disease-modifying therapies and management of MS relapses; management of people with MS at highest risk from COVID-19; management of radiological monitoring; use of remote pharmacovigilance; impact on MS research; implications for lowest income settings, and other key issues.
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COVID-19/epidemiología , COVID-19/terapia , Internacionalidad , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/terapia , Guías de Práctica Clínica como Asunto/normas , Manejo de la Enfermedad , Humanos , Pandemias/prevención & control , Farmacovigilancia , Telemedicina/normas , Telemedicina/tendenciasRESUMEN
La digitalización de la historia clínica, documento indispensable en la atención de salud y que posee carácter legal, es uno de los focos de atención en la e-Salud. El sistema XAVIA HIS compuesto por módulos que informatizan los procesos e interconectan las diferentes áreas de una institución hospitalaria, posee como atributo fundamental, una historia clínica electrónica única por paciente. Esta se compone por documentos basados en el estándar HL7-CDA. Sin embargo, el sistema XAVIA HIS presenta algunas limitantes en la interacción con otras aplicaciones que gestionen la información de salud. En el trabajo se presentan las modificaciones a realizar al Sistema de Información Hospitalaria XAVIA HIS para mejorar la capacidad de gestión de las historias clínicas electrónicas del sistema. Se realizó un análisis de la literatura disponible sobre la gestión de las HCE y se evaluó el mecanismo que emplean sistemas homólogos nacionales e internacionales. Para guiar el desarrollo de la propuesta se empleó la metodología AUP-UCI; UML se empleó para el modelado de los artefactos de ingeniería y BPMN como lenguaje de notación para los procesos de negocio. Las modificaciones que se presentan, le permitirán al sistema XAVIA HIS interactuar con sistemas externos que generen documentos HL7-CDA. Adicionalmente, se añaden funcionalidades para mejorar la impresión de documentos clínicos que se exportan, así como la generación de resúmenes de la historia clínica(AU)
One of the e-Health approaches is the digitalization of the medical record, an essential document in health care and with a legal character. The XAVIA HIS system, made up of modules to manage the processes and interconnect the different areas of a hospital institution, has as a fundamental attribute, a unique electronic medical record per patient. It is made up of documents based on the HL7-CDA standard. However, the XAVIA HIS system presents some limitations to interaction with other applications also managing health information. This paper presents the new features and changes to be made to the Hospital Information System XAVIA HIS to improve the electronic medical records management of the mentioned system. An analysis of the available literature on EHR management was carried out and the mechanism used by national and international counterpart systems was evaluated. To guide the development of the proposal, the AUP-UCI methodology was used; UML was used for modeling the engineering artifacts and BPMN as a notation language for business processes. The modifications that are presented will allow the XAVIA HIS system to interact with external systems which also generate HL7-CDA documents. Additionally, functionalities are added to improve the printing of clinical documents that are exported, as well as the generation of summaries of the medical record(AU)
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Humanos , Programas Informáticos , Telemedicina/tendencias , Registros Electrónicos de Salud , Estándar HL7/normasRESUMEN
The COVID-19 pandemic contributed to the worldwide implementation of telemedicine because of the need for medical care for patients, especially those with chronic diseases. This perspective paper presents the current situation of telemedicine in Peru, showing advances in regulation, cases of successful implementation, and the current challenges. Access to health should be available to all, and more efforts need to be implemented to offer access to the internet to achieve high-quality telemedicine to all the vulnerable groups in Peru.
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COVID-19/epidemiología , Accesibilidad a los Servicios de Salud , SARS-CoV-2 , Telemedicina , Enfermedad Crónica , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Acceso a Internet , Perú/epidemiología , Telemedicina/normas , Telemedicina/tendenciasRESUMEN
BACKGROUND: Due to the lockdown and quarantines caused by the COVID-19 pandemic, the need to study and use telepractice for providing speech pathology interventions for children with cleft palate has arisen. OBJECTIVE: To carry out a systematic review of the use of telepractice during the COVID-19 pandemic for providing speech pathology interventions for Spanish-speaking children with cleft palate. METHODS: In July and August 2020, the authors searched the electronic databases Medline, LILACS, SciELO, and the Cochrane Library using the following keywords in English (MeSH): Cleft palate combined with Early intervention, Speech therapy, Rehabilitation of speech and language disorders, Speech production measurement, Speech articulation tests and Telemedicine. Original articles were selected and analyzed, complemented by an analysis of flowcharts and recommendations by the GES Clinical Guide of Cleft Lip and Palate of Chile's Government and the authors' expert opinions. RESULTS: A total of 2680 articles were retrieved, of which 23 were critically analyzed and used to adapt the early stimulation, evaluation, and treatment of children with CP to speech therapy telepractice at the Gantz Foundation, a Hospital in Santiago de Chile. LIMITATIONS: Only three researchers carried out a quick review, which limited the depth of individual analysis of the studies included. Also, the suggestions and material presented should be evaluated in future investigations. CONCLUSION: This systematic review provides useful guidelines for providing speech pathology interventions through telepractice for children with cleft palate. Audiovisual materials seem to be extremely useful for families receiving the interventions. The use of interactive videos for Spanish-speaking children and educational videos for parents is manifest.
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COVID-19 , Labio Leporino , Fisura del Paladar , Patología del Habla y Lenguaje , Telemedicina/tendencias , Niño , Chile , Labio Leporino/terapia , Fisura del Paladar/complicaciones , Control de Enfermedades Transmisibles , Humanos , Pandemias , HablaRESUMEN
Objetivo: Comparar estrutura e processo de trabalho na Atenção Básica para implantação da teleconsulta médica em municípios de diferentes regiões e portes populacionais (mil habitantes: <25; 25-100; >100). Métodos: Estudo transversal, com análise descritiva e bivariada, sobre dados de 2017-2018, para avaliar disponibilidade de computador com internet, câmera, microfone e caixa de som, e processo de trabalho das equipes (utilizar Telessaúde, central de regulação e fluxo de comunicação). Resultados: Analisadas 30.346 UBS e 38.865 equipes, a presença de equipamentos para teleconsulta entre UBS variou de 1,2% em municípios grandes do Norte a 26,7% em municípios pequenos do Sul. O processo de trabalho variou de 10,7% em municípios pequenos do Norte a 39,5% em municípios grandes do Sul. Comparados ao Sul, municípios médios do Norte (OR=0,14 - IC95% 0,11;0,17) e do Nordeste (OR=0,21 - IC95% 0,18;0,25) tiveram menores chances de dispor dos equipamentos necessários. Conclusão: Significativas desigualdades regionais recomendam investimentos em Saúde Digital.
Objetivo: Comparar estructura y proceso de trabajo en atención primaria para implementar la teleconsulta médica en municipios de diferentes regiones y tamaños (mil habitantes: <25; 25-100; >100). Métodos: Estudio transversal, con análisis descriptivo y bivariado, datos de 2017-2018 para evaluar la disponibilidad de computadora con internet, cámara, micrófono, altavoz y proceso de trabajo (uso de Telesalud, centro de regulación central y flujo de comunicación). Resultados: Se analizaron 30.346 unidades y 38.865 grupos. La presencia de equipos de teleconsulta osciló entre 1,2% en los grandes municipios del Norte y 26,7% en pequeños municipios del Sur. El proceso de trabajo osciló entre 10,7% en pequeños municipios del Norte y 39,5% en grandes municipios del Sur. En comparación con el Sur, municipios medianos del Norte (OR=0,14 - IC95% 0,11;0,17) y Nordeste (OR=0,21 - IC95% 0,18;0,25) tenían menos probabilidades de contar con los equipos necesarios. Conclusión: Existe la necesidad de inversiones en Salud Digital, con desigualdades regionales relevantes.
Objective: To compare the structure and the work process in Primary Care for implementing medical teleconsultation in municipalities in different regions and with different population sizes (<25,000; 25,000-100,000; >100,000 inhabitants). Methods: Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of computers with internet access, webcam, microphone, speaker, as well as to assess the work processes (use of Telehealth, service supply and demand control center, and communication flow). Results: 30,346 primary health centers and 38,865 teams were evaluated. Presence of teleconsultation equipment in the health centers ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. Established work process ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium-sized municipalities in the North (OR=0.14 - 95%CI 0.11;0.17) and Northeast (OR=0.21 - 95%CI 0.18;0.25) regions were less likely to have the necessary equipment. Conclusion: Significant regional inequalities call for investments in Digital Health.
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Atención Primaria de Salud/organización & administración , Telemedicina/tendencias , Consulta Remota/organización & administración , Brasil , Centros de Salud , Estudios de Factibilidad , Salud Pública/tendencias , Estudios TransversalesAsunto(s)
Humanos , Lactante , Preescolar , Niño , Adolescente , Grupo de Atención al Paciente , Unidades de Cuidado Intensivo Pediátrico/organización & administración , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Telemedicina/tendencias , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/estadística & datos numéricosRESUMEN
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.
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Atención a la Salud/tendencias , Atención Primaria de Salud/tendencias , Telemedicina/normas , Brasil/epidemiología , Gobierno Federal , Personal de Salud , Política de Salud/tendencias , Humanos , Política , Política Pública , Telemedicina/tendenciasRESUMEN
The coronavirus pandemic (COVID-19) brought up discussions about improvements in both primary healthcare and hospital care in Brasil. In addition, the use of information and communication technology tools has become more prominent in the transmission of health information to patients remotely. Through content dissemination actions for professionals and direct guidance to users, remote telehealth/telemedicine services offer qualified actions that can reduce unnecessary referrals and decrease the flow of patients in health units. Information and communication technologies are allies in the fight against COVID-19.
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Infecciones por Coronavirus/epidemiología , Difusión de la Información/métodos , Neumonía Viral/epidemiología , Telemedicina/tendencias , Betacoronavirus , Brasil , COVID-19 , Humanos , Pandemias , SARS-CoV-2RESUMEN
The COVID-19 pandemic has generated a revolution of such magnitude that no aspect of human life will be the same from now on. The provision of health services and health education are not unrelated to this new normality imposed by the disease, and its consequences have been reflected in the need to use protocols and resources based on virtuality that most of us had not valued in their real dimension. Telehealth and telemedicine will be basic tools for professionals and teachers and it is our obligation to know them, apply them, and innovate to adapt to this reality.
La pandemia de COVID-19 ha generado una revolución de tal magnitud que ningún aspecto de la vida del ser humano será igual a partir de ahora. La prestación de los servicios de salud y la educación en salud no son ajenas a esta nueva normalidad impuesta por la enfermedad, y sus consecuencias se han visto reflejadas en la necesidad de utilizar protocolos y recursos basados en la virtualidad que la mayoría no habíamos valorado en su real dimensión. La telesalud y la telemedicina serán herramientas básicas para profesionales y docentes y es nuestra obligación conocerlas, aplicarlas e innovar para adaptarnos a esta realidad.
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Betacoronavirus , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Telemedicina/tendencias , COVID-19 , Colombia/epidemiología , Confidencialidad , Infecciones por Coronavirus/prevención & control , Educación a Distancia , Programas de Gobierno , Instituciones de Salud , Accesibilidad a los Servicios de Salud , Humanos , Difusión de la Información , Pandemias/prevención & control , Neumonía Viral/prevención & control , Utilización de Procedimientos y Técnicas , SARS-CoV-2 , Telemedicina/métodos , Telemedicina/organización & administración , Telemedicina/estadística & datos numéricos , Universidades , Recursos HumanosRESUMEN
Hygienic and sanitary measures and social distancing policies implemented during the new coronavirus disease - COVID-19 - pandemic have altered the care and follow-up provided by healthcare professionals for patients with chronic diseases, including patients with epilepsy (PWEs). Telemedicine has become a solution for the healthcare of PWEs in many developed countries. In this short communication, we trace a particular perspective for the application of telemedicine for PWEs undergoing ketogenic diet (KD) treatment, considering the social and economic difficulties faced by healthcare teams in resource-poor countries, such as Brazil. During the pandemic, financial strain was the main impediment to following KD. The pandemic increased socioeconomic insecurity and access to KD-related products, as well as increasing anxiety in 71% of PWE, impacting their KD treatment follow-up. The challenges of telemedicine in Brazil include not only social and economic issues but also access to food, healthcare services, and education for the population, in addition to digital inclusion.
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COVID-19/epidemiología , Dieta Cetogénica/tendencias , Epilepsia Refractaria/dietoterapia , Epilepsia Refractaria/epidemiología , Programas Nacionales de Salud/tendencias , Telemedicina/tendencias , Adulto , Brasil/epidemiología , Dieta Cetogénica/métodos , Femenino , Humanos , Masculino , Pandemias , Telemedicina/métodos , Resultado del TratamientoRESUMEN
SUMMARY The coronavirus pandemic (COVID-19) brought up discussions about improvements in both primary healthcare and hospital care in Brasil. In addition, the use of information and communication technology tools has become more prominent in the transmission of health information to patients remotely. Through content dissemination actions for professionals and direct guidance to users, remote telehealth/telemedicine services offer qualified actions that can reduce unnecessary referrals and decrease the flow of patients in health units. Information and communication technologies are allies in the fight against COVID-19.
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Humanos , Neumonía Viral/epidemiología , Telemedicina/tendencias , Infecciones por Coronavirus/epidemiología , Difusión de la Información/métodos , Brasil , Infecciones por Coronavirus , Pandemias , BetacoronavirusAsunto(s)
Automonitorización de la Glucosa Sanguínea/tendencias , COVID-19/epidemiología , Países en Desarrollo , Diabetes Mellitus/epidemiología , Educación del Paciente como Asunto/tendencias , Telemedicina/tendencias , Automonitorización de la Glucosa Sanguínea/economía , COVID-19/economía , Diabetes Mellitus/sangre , Diabetes Mellitus/economía , Humanos , Pandemias , Educación del Paciente como Asunto/economía , Telemedicina/economíaRESUMEN
PURPOSE: The purpose of the study was to describe epileptologists' opinion on the increased use of remote systems implemented during the COVID-19 pandemic across clinics, education, and scientific meetings activities. METHODS: Between April and May 2020, we conducted a cross-sectional, electronic survey on remote systems use before and during the COVID-19 pandemic through the European reference center for rare and complex epilepsies (EpiCARE) network, the International and the French Leagues Against Epilepsy, and the International and the French Child Neurology Associations. After descriptive statistical analysis, we compared the results of France, China, and Italy. RESULTS: One hundred and seventy-two respondents from 35 countries completed the survey. Prior to the COVID-19 pandemic, 63.4% had experienced remote systems for clinical care. During the pandemic, the use of remote clinics, either institutional or personal, significantly increased (pâ¯<â¯10-4). Eighty-three percent used remote systems with video, either institutional (75%) or personal (25%). During the pandemic, 84.6% of respondents involved in academic activities transformed their courses to online teaching. From February to July 2020, few scientific meetings relevant to epileptologists and routinely attended was adapted to virtual meeting (median: 1 [25th-75th percentile: 0-2]). Responders were quite satisfied with remote systems in all three activity domains. Interestingly, before the COVID-19 pandemic, remote systems were significantly more frequently used in China for clinical activity compared with France or Italy. This difference became less marked during the pandemic. CONCLUSION: The COVID-19 pandemic has dramatically altered how academic epileptologists carry out their core missions of clinical care, medical education, and scientific discovery and dissemination. Close attention to the impact of these changes is merited.