Submitted by Fabio Sobreira Campos da Costa (fabio.sobreira@ufpe.br) on 2016-06-14T14:29:57Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) trab_mestrado_daniel_telediagnostico.pdf: 1048169 bytes, checksum: 7ff9a35dbc7feae74298370779c671ec (MD5) / Made available in DSpace on 2016-06-14T14:29:57Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) trab_mestrado_daniel_telediagnostico.pdf: 1048169 bytes, checksum: 7ff9a35dbc7feae74298370779c671ec (MD5) Previous issue date: 2009-08-31 / Objetivo: Pernambuco atualmente oferece poucas unidades especializadas em estomatologia. O objetivo do presente trabalho foi desenvolver e verificar a funcionalidade de um sistema de telediagnóstico de doenças orais no estado de Pernambuco. Métodos: Quinze computadores e a mesma quantidade de câmeras digitais foram distribuídos em centros secundários de saúde onde Cirurgiões-Dentistas foram encorajados a visitarem um website e enviarem imagens dos seus pacientes que apresentassem lesões orais para avaliação à distância por dois profissionais com experiência em estomatologia. Um formulário de feedback com opiniões dos dentistas e pacientes também foi enviado. Resultados: Entre 325 pacientes, 313 (96,31%) acharam o procedimento de tirarem fotos de suas bocas bastante confortável, 265 (81,5%) ficaram satisfeitos em ver o interior de suas bocas e 288 (88,62%) acharam o procedimento útil no entendimento dos seus problemas clínicos. Foi estabelecida uma concordância entre os avaliadores e um correto diagnóstico final em 195 (60%) casos. Em 98 (30,16%) casos somente um avaliador acertou a hipótese diagnóstica sugerida à distância. Em 26 (8%) dos casos nenhum avaliador acertou o diagnóstico. 94,44% dos cirurgiões-dentistas consideraram que o auxílio do centro de referência contribuiu para os seus conhecimentos em relação à desordem/doença e acreditaram que o processo de telediagnóstico evita um encaminhamento desnecessário do paciente Conclusão: o telediagnóstico de doenças orais provou ser um modo viável de se evitar algum encaminhamento desnecessário de pacientes. / Objective: Pernambuco, located in Northern Brazil currently offers few oral medicine specialized units. Based upon this, the aim of the present study was to develop and verify the functionality of a telediagnosis system of oral diseases in Pernambuco state. Methods: fifteen computers and the same amount of digital cameras were distributed to secondary health care centers. Dentists were then encouraged to visit a website and send pictures of their patients who presented oral lesions. A feedback form with dentists and patients opinions was also sent. Results: Among 325 patients, 313 (94.3%) found the procedure of recording images of their mouth very comfortable, were happy to view the inside of their mouths 265 (81,5%), and found the procedure generally useful in understanding their clinical problem (288 out of 325 individuals (88%). In 195 (60%) of the instances an agreement between examiners and a correct final diagnosis was established; only one consultant made a correct diagnosis in 104 of the cases (32%); and neither consultants established a correct diagnosis in only 26 cases (8%). 94,44% of dentists considered that the help of a specialized center contributed to the improvement of their knowledge concerning oral diseases and believed that the telediagnosis system avoided unnecessary referrals. Conclusion: telediagnosis of oral diseases proved a feasible way of avoiding some unnecessary referrals.

Earlier identification of autism allows for interventions to begin during toddlerhood. Literature suggests that parents are an important part of very early intervention and specific goals have indicated that they are important to progress. The use of telemedicine may increase access to interventions. The purpose of the study was to evaluate a parent-toddler training program that targeted social-communication skills and incorporated a telemedicine component. Measures included parent teaching targets, child attending, vocal requesting, and coordinated joint attention and the parent's response to coordinated joint attention. Results indicate that parent teaching increased, child attending and vocalizations increased, child coordinated joint attention increased, and the parent's response to coordinated joint attention was primarily social in nature. Analysis of the home observations indicates that direct in home observations or teleconference observations neither under or overestimated behaviors. The results are discussed in the context of teaching and feedback delivery and selection of teaching targets.

This study aimed to create a holistic understanding of the physician experience in relation to telemedicine. This study examined a Tele-NICU and a Tele-ER program at a large metropolitan pediatric specialty hospital with a Level IV NICU that provides telemedicine consults to 16 remote sites across Texas. Twenty-four semi-structured interviews were conducted with physicians and nurses at remote hospitals, physicians who provide consultations from the pediatric specialty hospital, and managers of the tele-specialty programs. These interviews were coded using the consolidated framework for implementation science to contextualize program strengths and weaknesses and reviewed to make recommendations for future program development. Remote site participants reported that the programs are useful when they are in need a second opinion and providing reassurance to patient's families. Barriers to program use include issues with the tele-carts, insurance acceptance, and hesitation to request a consult. Study findings demonstrate the need to treat each tele-specialty programs as independent to suit the differing needs of both remote sites and the consulting physicians. This study demonstrates the importance of understanding physician's perspectives, culture, and the role of hospital settings in telemedicine program acceptance and refutes telemedicine as a monolithic solution to limited healthcare access.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Soft skills / Revisón por pares

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Within the deaf population, an extreme mental health professional shortage exists that may be alleviated with videoconferencing technology – also known as telehealth. Moreover, much needed mental health education within the deaf population remains largely inaccessible. Researchers have forewarned that the deaf population may remain underserved if significant changes do not take place with traditional service delivery methods. The goal of this study was to evaluate the efficacy of telehealth in teaching psychoeducational objectives, with special emphasis given to its application to the deaf population. The results of this study indicate that telehealth can be considered to be an efficacious and cost effective option in delivering health care to the deaf population. Results also indicate participant satisfaction with the technology.

Saudi Arabia is among the countries that have very high prevalence rates of diabetes and hypertension, with prevalence rates of almost 18% and 25%, respectively. The majority of patients with diabetes and hypertension fail to manage their diseases and to show up for their follow up appointments. Mhealth technology is among the interventions that have been recently adopted to overcome these issues and improve the quality of healthcare services. This study aims to evaluate the effectiveness of a mobile phone application named diabetes and hypertension application (DHA Tracking) to promote adherence for patients with diabetes and hypertension in Mecca, Saudi Arabia. The proposed intervention was designed to promote adherence via two features, namely, refill medication reminder (RMR) and doctor appointment reminder (DAR). The third feature, which is managing the number of unnecessary visits, was covered by the cumulative blood sugar test (Hemoglobin A1c) for patients with their doctors. The study examined the difference in adherence level before the intervention and after the intervention with samples of n = 199 and n = 165 for diabetes and hypertension, respectively. The mhealth intervention was found to have significant effects on both the refill medication reminder and the doctor's appointment reminder. Also, it was found that the intervention was efficient in reducing the number of unnecessary follow-up visits to around 20%. This study supports the evidence in the literature on the effectiveness of mhealth in promoting adherence to medication for patients with chronic diseases in the developing countries and specifically in Saudi Arabia. Positive social change that may result from this study is for better management of chronic disease symptoms and increase the awareness of using mhealth applications. This would improve the quality of life for patients, their families, and the community.

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Adverse events and medical errors plague the healthcare system. Hospital acquired infections and teamwork are some of the biggest contributor to these adverse outcomes. In an effort to mitigate these problems, administrators and clinicians alike have developed mechanisms, such as telemedicine. However, little research has been conducted investigating the role of telemedicine on teamwork -- a fundamental component of quality patient care. The purpose of this study is to gain a better understanding of the impact of telemedicine on teamwork behaviors and subsequent teamwork attitudes and cognitions during a common medical task, rounds within the Trauma-Intensive Care Unit. To this end, rounds were conducted with and without telemedicine. During this 60 day period, 16 clinicians completed three surveys and 34 rounds were video recorded. The results of this study suggest that the relationships between teamwork attitudes, behaviors, cognitions, and outcomes are differential impacted under conditions with and without telemedicine. More specifically, telemedicine is associated with an increase in attendance and communication density. Meanwhile, it does not significantly impact teamwork attitudes or cognitions. The primary implications of these findings indicate that telemedicine is not the solution for improving all teamwork elements but yet it is not a complete detriment either

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