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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
311

Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Pallesen, Lars-Peder, Winzer, Simon, Hartmann, Christian, Kuhn, Matthias, Gerber, Johannes C., Theilen, Hermann, Hädrich, Kevin, Siepmann, Timo, Barlinn, Kristian, Rahmig, Jan, Linn, Jennifer, Barlinn, Jessica, Puetz, Volker 04 June 2024 (has links)
Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT. Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call. Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call. Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.
312

Emergency visualized : exploring visual technology for paramedic-physician collaboration in emergency care

Maurin Söderholm, Hanna January 2013 (has links)
This thesis explores the potential of visual information and communication technologies (ICTs) for collaboration in emergency care. The thesis consists of four studies exploring future technology, 3D telepresence technology for medical consultation (3DMC), from several different methodological and analytical perspectives. Together the studies provide a broad view of the potential benefits, risks and implications of using visual technologies for collaboration in emergency care. The results show that paramedic-physician collaboration via 3DMC might have some benefits for patient care, both in the immediate patient care situation and beyond, for example, when coordinating transport and resources; improving understanding between different actors; and in developing paramedic competence and confidence in their skills. However, collaboration is heavily impacted by physicians’ and paramedics’ respective work practices which are situated in very different physical, professional and organizational contexts. Adding a visual dimension to this collaboration presents unique challenges for the overall design, development, implementation, and appropriation process. Thus, the thesis emphasizes the importance of understanding both the individual users as well as the complex overall image which, although often neglected or ignored, is crucial to understand when developing and introducing new technology that is successful and justified in the overall context while also being useful and meaningful for the individual users. / <p>Academic dissertation for the Degree of Doctor of Philosophy in Library and Information Science at the University of Gothenburg and the University of Borås to be publicly defended on Thursday 19 September 2013 at 13:15 in the auditorium at Simonsland, University of Borås, Skaraborgsvägen 3, Borås.</p>
313

The Importance of a Pictorial Medical History in Assisting Medical Diagnosis of Individuals with Intellectual Disabilities: A Telemedicine Approach

Bonanno, Grace 01 May 2015 (has links)
When face-to-face physical medical exams are not possible, virtual physical exams, in the form of a pictorial medical exam/history, can be substituted, and telemedicine can be the means to deliver these virtual exams. The goal of this work was to determine if presence in the form of a visual and/or pictorial medical history can be of benefit to clinicians in the diagnosis of medical conditions of individuals with developmental disabilities (DDs) and/or intellectual disabilities (IDs), in particular those who cannot, because of their cognitive and/or physical disabilities, verbally relate their illness to a clinician. Virtual exams can also be useful in cases where clinicians may need additional advice from fellow experts, especially if those experts are not physically present. A web-based telemedicine application used for treating persons with DD/IDs was developed. This application includes a visual medical history component incorporated into an electronic medical records application. The purpose is to allow the clinician to use an environment that integrates a written and visual representation of a patient’s medical history and physical findings to aid the clinician in determining a medical diagnosis. Twenty-two clinicians and five direct service aids of a New York State Developmental Disabilities Services Office facility, who deliver healthcare to DD/ID patients on a daily basis, accessed the telemedicine application instead of their traditional hardcopy/paper medical history when examining patients. A comprehensive survey was distributed to the clinicians to determine the effectiveness of the application as well as help answer the primary questions proposed by this research. The results of this study showed that presence in the form of a video medical history is preferred by clinicians rather than having just a written medical history of the patient. Clinicians felt the visual medical history component of the telemedicine application was useful and informative for delivering healthcare to individuals with DD/ID and enabled them in diagnosing a patient as well as lessened the need to transfer patients to the emergency room, resulting in a significant cost savings.
314

The development of a telemedicine service maturity model

Van Dyk, Liezl 12 1900 (has links)
Thesis (PhD)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: A telemedicine service is a healthcare service (-medicine) that is delivered over a distance (tele-). The interest in the potential of telemedicine to increase the quality, accessibility, utilization, e ciency and e ectiveness of healthcare services is fuelled by the rapid development of information and communication technology (ICT) and connectivity. Despite this potential, the success rate of telemedicine services disappoints. Many mistakes in the implementation of telemedicine services are repeated over and over again and best practices are not captured and replicated. This study responds to the need for reference models for the assessment and optimization of telemedicine services in a consistent, systematic and systemic way. Maturity models are reference models that describe typical patterns in the development of organizational capabilities and depict a sequence of stages towards the desired state. Many reference models exist that are applicable to telemedicine services, but none of these provide guidance for the optimization of services, like a maturity model does. Many maturity models exist within a health systems context, but none of these can be applied "as is" to telemedicine services. In this study an iterative top-down design approach is followed to develop a Telemedicine Service Maturity Model (TMSMM). This model facilitates the assessment of a telemedicine service on micro, meso, and macrolevel along all the domains that comprise the telemedicine health system. Sets of capability statements are de ned, which follow each other in a cumulative manner, hence providing a maturation path towards the desired maturity state. These sets of capability statements provide yardsticks according to which quantitative values are allocated to an intangible concept, such as maturity. Once an individual service is assessed, further actions towards the optimization of the service can be derived from these yardsticks. The multidimensional design of the TMSMM, as well as the fact that capability statements facilitate the consistent quanti cation of maturity, makes it possible to analyze the aggregated results of cohort of services. To accomplish this, principles of business intelligence and data warehouse design are applied together with online analytic processing (OLAP) procedures. The TMSMM addresses the previously unful lled need for a reference model to assess and optimize telemedicine services in a consistent, systematic and systemic way. This study spans several academic and professional domains and thereby contributes to the scienti c world of telemedicine and ehealth. / AFRIKAANSE OPSOMMING: 'n Telegeneeskunde diens is 'n gesondheidsdiens (-geneeskunde) wat oor 'n afstand gelewer word (tele-). Met die snelle ontwikkeling van inligtings-en kommunikasietegnologie hou telegeneeskunde die potensiaal in om die kwaliteit, toeganklikheid, benutting, doelmatigheid en doeltre endheid van gesondheidsdienste te verhoog. Ten spyte van hierdie potensiaal, stel die aantal onsuksesvolle telegeneeskunde dienste teleur. Heelwat foute in die implementering van telegeneeskundedienste word oor en oor gemaak, terwyl die beste praktyke nie vasgevang en herhaal word nie. Hierdie studie is onderneem in reaksie op die behoefte aan 'n verwysingsmodel vir die assessering en optimering van telegeneeskunde dienste op 'n konsekwente, sistematiese en sistemiese manier. Volwassenheidsmodelle is verwysingsmodelle wat tipiese patrone in die ontwikkeling van organisatoriese vermoeëns beskryf. Dit stip 'n aantal fases neer wat uiteindelik behoort te lei na die ideale organisatoriese toestand. Daar bestaan verskeie verwysingsmodelle wat van toepassing is op telegeneeskunde dienste, maar geeneen daarvan gee leiding met die oog op die optimering van die diens, soos in die geval van 'n volwassenheidsmodel nie. In hierdie studie word 'n iteratiewe van-bo-na-onder ontwerpsbenadering gevolg om 'n telegeneeskunde volwassenheidsmodel (TMSMM) te ontwikkel. Hierdie model fasiliteer die assessering van 'n telegeneeskunde diens op 'n mikro-, mesoen makrovlak en met betrekking to al die fasette waaruit 'n telegeneeskunde stelsel bestaan. 'n Aantal vermoeëstellings is gede nieer. Hierdie stellings volg op mekaar en akkumuleer om sodoende 'n volwassenheidspad na die verlangde toestand aan te dui. Hierdie vermoeëstellings verskaf maatstawwe waarvolgens kwantitiewe waardes toegeken kan word aan 'n ontasbare konsep, soos volwassenheid. Sodra 'n individuele diens geassesseer is, kan verdere aksies met die oog op die optimering van die diens afgelei word. Die multidimensionele ontwerp van die TMSMM, tesame met die feit dat die vermoeëstellings volwassenheid op 'n konsekwente manier kwanti seer, maak dit moontlik dat die data van 'n kohort dienste saamgevoeg kan word met die oog op analise. Beginsels van besigheidsintelligensie, datastoorontwerp asook aanlyn analitiese prosessering (OLAP) word hiervoor ingespan. Die TMSMM spreek tot die voorheen onvervulde behoefte aan 'n verwysingsmodel waarmee telegeneeskunde dienste geassesseer in geoptimeer word in 'n konsekwente, sistematiese en sistemiese manier. Hierdie studie strek oor verskeie akademiese en professionele domeine en lewer sodoende 'n bydrae tot die multidissiplinêre wetenskapswêreld van telegeeskunde en e-gesondheid.
315

A Theoretical Model for Telemedicine : Social and Value Outcomes in Sub-Saharan Africa

Kifle Gelan, Mengistu January 2006 (has links)
<p>The Sub-Saharan Africa (SSA) region is faced with limited medical personnel and healthcare services to address the many healthcare problems of the region. Poor health indicators reflect the overall decline in socio-economic development. Shortages of access to health services in the region is further complicated by the concentration of health services in urban areas, the region’s multiple medical problems (over 70% of HIV/AIDS cases in the world); and the brain drain phenomenon – it is estimated one-third of African physicians emigrate to North America and Europe. The result is that the SSA region is left with about 10 physicians, and 20 beds, per 100,000 patients. Telemedicine has been found to offer socio-economic benefits, reduce costs, and improve access to healthcare service providers by patients, but previous attempts to move various information technologies from developers in the industrial world to the developing world have failed because of a clear neglect of infrastructural and cultural factors that influence such transfers. The objective of this study is to address key factors that challenge the introduction of telemedicine technology into the health sector in SSA in particular, and by extension, other developing countries with similar socio-economic structures.</p><p>This research offers a distinctive perspective, focusing on visually-based clinical applications in the SSA region, and considerable attention to the national infrastructure and cultural impact of telemedicine transfer (social and value) outcomes. Two research models and its associated hypotheses are proposed and empirically tested using quantitative data collected from SSA physicians and other health professionals. The study also contributes to the ongoing debate on the potential of telemedicine in improving access and reducing costs. This research can help to understand the socio-economic impact of telemedicine outcomes in a comprehensive way. The finding from the survey shows the rapid advances in telemedicine technology specifically, visual clinical applications may become an essential healthcare tool in the near future within SSA countries.</p>
316

Sjuksköterskors erfarenheter av att arbeta i glesbygd med jour på distans. / Nurses ' experiences of working in a rural environment with on call at a distance

Lundholm, Ylva January 2017 (has links)
AbstractSyfte. Att: beskriva sjuksköterskors erfarenheter av att arbeta i glesbygd med jour på distans.Bakgrund. Jour på distans innebär att sjuksköterskor, med stöd av läkare på di-stans, omhändertar patienter med olika slags akuta symtom. Frånvaron av nationella studier, rörande sjuksköterskors erfarenhet av jour på distans i kombination med behovet av att hitta nya sätt att bedriva vård i glesbygd, borde medföra ett intresse för studien.Design: Deskriptiv intervjustudie med kvalitativ ansats.Metod. Intervjuer genomfördes med 9 sjuksköterskor, vilka arbetar vid 2 olika häl-socentraler belägna i nordligaste delen av Sverige. Intervjuerna genomfördes våren 2017. Materialet analyserades med kvalitativ innehållsanalys.Resultat. Analysen resulterade i de 4 kategorierna rollutveckling, fördelar för pati-enten, stöd samt osäkerhet. Sjuksköterskor beskriver sig ha ett arbete som på olika sätt medför rollutveckling. Fördelar för patinten framställs bestå av exempelvis mins-kat behov av resor samt möjlighet att få snabb bedömning utan att alltid behöva åka till sjukhus. Kategorin stöd belyser betydelsen av tillit från läkare och fungerande teknik. Sista kategorin påvisar att vissa situationer medför känslor av osäkerhet hos sjuksköterskan, som exempelvis när läkare har dålig kunskap om jour på distans.Slutsats. Resultatet påvisar att jour på distans, sett ur sjuksköterskornas perspektiv, är ett bra sätt att tillvarata befintlig personal och teknik i syfte att tillhandahålla vård under jourtid i glest befolkade områden. Arbete med jour på distans kräver sjukskö-terskor med god kunskap och erfarenhet och studien påvisar även betydelsen av ut-bildning samt stöd från läkaren.
317

Projeto Jovem Doutor: ações de educação em saúde voltadas à síndrome da apnéia e hipopnéia obstrutiva do sono / Young Doctor Project: health educational actions focused on the Obstructive Sleep Apnea-Hypopnea Syndrome

Corrêa, Camila de Castro 20 March 2014 (has links)
O Projeto Jovem Doutor propicia a transmissão de conhecimentos para jovens do ensino fundamental sobre diversos temas da saúde. A Síndrome da Apneia e Hipopneia Obstrutiva do Sono (SAHOS) deve ser destacada, uma vez que esse quadro clínico implica em consequências impactantes ao indivíduo, e que se estendem para a população em uma escala ampla, tendo como exemplos acidentes de trânsito e de trabalho. Sendo assim, o objetivo foi de implementar um modelo de educação em saúde sobre o tema da SAHOS, fundamentado na dinâmica do Projeto Jovem Doutor. Para isso, realizou-se a parceria com uma escola estadual interessada em participar da dinâmica. A pesquisa foi estruturada em três etapas: organização da estrutura básica e elaboração do material educacional (1ª etapa); aplicação do programa (2ª etapa) e avaliação do modelo de educação em saúde (3ª etapa). Para a elaboração do material educacional (aulas presenciais, cybertutor, banner e folder), realizaram-se buscas em bases de dados, selecionando conteúdos, simplificando e adequando o nível de legibilidade do texto, além de inserir ilustrações (1ª etapa). Na 2ª etapa, houve a participação de 5 alunos nas duas aulas presenciais, acesso ao cybertutor, atividade prática e por fim, executaram a ação social para a disseminação do conhecimento. Foram realizadas orientações sobre o tema por meio do banner, folder, telejornal, teatro de fantoches e jogo de mímica. Ao final da Feira Cultural, houve a multiplicação do conhecimento para 985 pessoas, dentre elas, pais, professores e alunos da escola, que receberam o conhecimento diretamente pelas ações sustentadas dos Jovens Doutores. Em relação à 3ª etapa, observou-se no questionário de investigação do conhecimento o aumento em média de acertos sobre o conteúdo teórico; no acesso ao cybertutor, verificou-se que 100% dos alunos realizaram os materiais complementares e na análise da pesquisa motivacional, foi possível verificar que o curso foi considerado um Curso Impressionante!. Portanto, um modelo de educação em saúde sobre SAHOS, fundamentado na dinâmica do Projeto Jovem Doutor foi implementado, verificandose êxito no seu desenvolvimento, no aspecto motivacional dos alunos e na disseminação do conhecimento. / The Young Doctor Project provides the transmission of new knowledge for elementary school kids about various health topics. The Obstructive Sleep Apnea- Hypopnea Syndrome (OSAHS) should be emphasized, once the disorder implies at impactful consequences for the individual and extends to the population in a large scale, as an example car and work accident. With that been said, this research aims the implementation of a health educational model about OSAHS based on the pattern of the Young Doctor Project. In order to this, a partnership with a public state school interested to participate of dynamic. This research was structured around 3 stages: organization of the basic structure and the educational material elaboration (1st stage); the program application (2nd stage); and an evaluation of the health educational model (3rd stage). To develop the educational material (class attendance, cybertutor, banner and folder), were made searches in databases, selecting content, simplifying and adjusting the text legibility, besides insert illustrations (1st stage). On 2nd stage, were involved 5 students in the two classes, accessed the cybertutor, practical activity, an also executed a social action in order to spread the knowledge. Orientations were made by banner, folder, TV newscast, pupet show and mime game. At the end the Cultural Fair, the dissemination of learning were spread to 985 people, including parents, teachers and students whose knowledge were sustained by the Young Doctors actions. At the 3rd stage, on the learning investigation questionary, were noticed an increase of right answers about the theory; at the cybertutor, 100% of the students realized the complementary material and at the motivational research, was possible to verify that the course was classified as Impressive course!. Therefore, a model of health education about OSAHS based on the Young Doctor Project pattern was implemented and it was verified its success at the motivational aspect such as at the spread of knowledge.
318

Odontogênese: construção e validação de um objeto de aprendizagem inovador / Odontogenesis: construction and validation of an innovative learning object

Chao, Rosângela Suetugo 05 December 2017 (has links)
Introdução: Há uma demanda social de produção de material educacional interativo, flexível e visualmente atrativo; que tenha fácil acesso, comunicação e veiculação por meio das mídias e da internet, e principalmente que possibilite a difusão do conhecimento. Objetivos: O presente estudo teve como objetivos a construção e validação de objeto de aprendizagem com uso de computação gráfica 3D sobre odontogênese. Método: Baseou-se nos princípios da educação de adultos e na aprendizagem significativa. A construção do objeto de aprendizagem partiu da revisão da literatura e da discussão com grupo de especialistas multiprofissional. A partir destes dados, foi construído um roteiro baseado em uma matriz de objetivos educacionais. Este roteiro direcionou uma produção intelectual em formato de vídeo. Para a validação dessa produção intelectual, foi construído um processo de revisão por pares com análise crítica e sistematizada aplicada a um conjunto de 22 professores e profissionais de expertise reconhecida na área e atuantes em várias universidades distribuídas pelo território brasileiro. Resultados: O objeto de aprendizagem sobre odontogênese incluiu um vídeo elaborado a partir da tecnologia de computação gráfica 3D e narração, com nove minutos de duração. A análise das respostas do grupo de validadores mostrou unanimidade de visão positiva em vários itens do instrumento de validação destacando as afirmativas relacionadas aos movimentos das cenas, entendimento de todas as fases da odontogênese, assim como o uso de imagens tridimensionais e animação auxiliaram o entendimento e aprendizado do tema. Foi considerada uma ferramenta útil para a prática, por trazer uma síntese de informações, condensando conceitos relevantes apresentados de forma dinâmica com propósito educacional. Além disto, foi considerado um objeto de aprendizado flexível por atender a diversos interesses de aprendizado, sendo adaptável a diferentes públicos e objetivos, podendo contribuir com a formação de estudantes, pós-graduandos e profissionais da área de saúde. Conclusão: O processo de validação contribui para o aprimoramento do objeto de aprendizagem considerado adequado, útil, inovador e flexível. De acordo com os validadores, ter contato com essa tecnologia durante suas graduações, teria facilitado o entendimento sobre odontogênese / Introduction: There is a social demand for the production of an interactive educational material, which is flexible and visual attractive; that has an easy access, communication, media and internet placement and primarily that makes the diffusion of knowledge possible. Objective: The aim of this study was the construction and validation of a learning object with the use of 3D computer graphics about odontogenesis. Method: It was based on adults\' education principals and on the significant learning. The construction of the learning object started on the literature review and the discussion with a group of multiprofessional specialists. From these data it was constructed a script based on an educational objectives matrix. This script has directed to an intellectual production in a video format. For the validation of this intellectual production, it was built a pair review process with a critical and systematized analysis applied to a set of 22 professors with expertise in the area and active in several universities distributed in the Brazilian territory. Results: The learning object about odontogenesis resulted a nine minute video elaborated with narration and 3D computer graphics technology. The analysis of the group of validators\' answers showed a positive view unanimity in several items of the validation instrument, highlighting the affirmations related to the movements of the scenes, understanding of all phases of odontogenesis, as well as the use of threedimensional images and animation that assisted the understanding and learning of the theme. It was considered a useful tool for the practice for bringing a synthesis of information, condensing relevant concepts presented dynamically for educational purposes. Furthermore, it was considered a flexible learning object for attending various learning interests, being adaptable to different publics and objectives; it could contribute with potenciality to undergraduate, for the learning of postgraduate students and health professionals. Conclusion: The validation process contributed to the improvement of the learning object that was considered adequate, useful, innovative and flexible. According to the validators, having contact with this technology during their graduation course would have facilitated odontogenesis understanding
319

Programa de seguimento semipresencial a novos usuários de prótese auditiva / Follow-up program for new hearing aid users: a combination of in-person and virtual assistance

Drobina, Eloá Francisco 22 January 2018 (has links)
Introdução: As consultas de seguimento com o profissional fonoaudiólogo após a aquisição da prótese auditiva são de extrema importância para a garantia da manutenção do uso com qualidade. As dificuldades enfrentadas pelos usuários no comparecimento ao serviço de saúde impedem que esse processo ocorra de maneira adequada e impactam negativamente no processo de reabilitação auditiva do indivíduo ocasionando, inclusive, o abandono do uso. A incorporação da teleconsulta nesses seguimentos seria uma solução para impedir a ocorrência de tal fato, por permitir que as intervenções de orientações e aconselhamentos sejam realizadas remotamente. Objetivos: desenvolver um programa de seguimento semipresencial para novos usuários de prótese auditiva e verificar sua aplicabilidade. Método: estudo prospectivo (exploratório), no qual dez indivíduos adultos novos usuários de prótese auditiva bilateral, pertencentes a um serviço público de saúde, foram avaliados e submetidos a uma consulta inicial, seguido pela teleconsulta e novamente avaliados numa última etapa presencial. As intervenções realizadas foram classificadas em primárias e secundárias. O questionário para avaliação da satisfação foi aplicado nas etapas presenciais e os dados obtidos pelos registros foram enviados para análise estatística descritiva. Resultados: todos os indivíduos necessitaram de pelo menos uma intervenção na consulta presencial inicial. A maioria esteve relacionada a orientações e aconselhamentos referentes ao uso e manuseio da prótese auditiva (consideradas intervenções secundárias). Na etapa da teleconsulta, todos os indivíduos precisaram de intervenções secundárias, diminuindo sua ocorrência na consulta presencial final. O questionário utilizado para verificar a satisfação apresentou média de escore global com valores de 5,7 na consulta presencial inicial e 6,1 na consulta presencial final, o que correspondeu à satisfação dos participantes. Todos os participantes atribuíram nota máxima ao programa desenvolvido, o que representou a \"muito satisfeitos\". Conclusão: O estudo traz contribuições para a área da Telessaúde em Fonoaudiologia, pois a utilização das teleconsultas permitiu a resolução de problemas secundários no processo de adaptação à prótese auditiva. Apesar dessa amostra ser reduzida, o estudo inicial foi satisfatório para a continuidade do programa demonstrado ser aplicável. Ainda estudos com maior amostra em diferentes populações são necessários com intuito de validar novos protocolos / Introduction: Follow-up visits with the audiologist after the hearing aid fitting process are critical to ensure the maintenance of quality use. The difficulties faced by users in adhering to sequential return visits directly affect this process in an inadequate way and negatively impact on individual auditory rehabilitation process, even causing the use abandonment. The inclusion of virtual assistance in these follow-ups would be a solution to avoid this situation, allowing interventions of orientations and counseling by remote consultation. Objectives: to develop a follow-up program combining face-to-face appointments and telehealth for new hearing aid users as well as verifying its applicability. Methods: prospective (exploratory) study evaluated ten new bilateral hearing aid users, seen in a public health service. The first and the last appointments were face-to-face and five followed-ups by virtual assistance. The required interventions were classified as primary and secondary. The questionnaire for satisfaction evaluation were applied during the face-to-face assessments and all registered data was sent for descriptive statistical analysis. Results: all study subjects required at least one intervention during the initial face-to-face visit. Most were related to provide informative counseling and to clarify new users\' doubts regarding the use of the hearing aid (considered secondary interventions). At telehealth assistance stage, all subjects required secondary interventions, reducing their occurrence in the final face-to-face assistance. The questionnaire used to verify the satisfaction showed an average overall score of 5.7 in initial stage and 6.1 in the final stage, which proved subjects\' satisfaction. All subjects attributed the maximum score to the developed program, which represented \"very satisfied\". Conclusion: The study contributes to Telemedicine, since the use of virtual assistance allowed the resolution of secondary problems in the hearing aid fitting process. Although this sample was reduced, the initial study was satisfactory for the continuity of this program which has been shown to be applicable. Further studies with larger samples in different populations are needed to validate new protocols
320

Teleaudiometria como método de triagem em escolares / Teleaudiometry as a screening method in school children

Botasso, Maíne 28 May 2014 (has links)
Introdução: Dados epidemiológicos sobre prevalência de perdas auditivas em países em desenvolvimento são insuficientes para o planejamento e execução de programas efetivos, visando à intervenção, prevenção e promoção em saúde. Além disso, ações de saúde na atenção básica, bem como nos serviços de média e alta complexidade não dão conta de atender ou mesmo conhecer a demanda, também pelo fato de existir um número limitado de profissionais da saúde que cuidam da audição. Dentro deste contexto, faz-se necessária a adoção de técnicas ou procedimentos acessíveis às áreas carentes do país, que não contam com recursos financeiros para a aquisição de tecnologia ou recursos humanos que possibilitem a identificação, o mais precoce possível, de grupos de risco para alterações auditivas. Com o avanço da tecnologia, métodos de triagem auditiva à distância são possíveis, inclusive como facilitadores em áreas onde não há especialistas. Sendo assim, a criação e validação de protocolos de teleaudiologia são fundamentais para que possam ser utilizados dentro de programas de saúde rotineiros. Objetivo: avaliar a acurácia e a viabilidade de execução da teleaudiometria, comparando-a à audiometria por varredura, tendo como padrão ouro a audiometria tonal, em escolares do ciclo I do ensino fundamental. Método: Participaram do estudo 243 escolares, sendo 118 meninos e 125 meninas, com idade média de 8,3 anos. Foram realizados os seguintes procedimentos: triagem por teleaudiometria com fones TDH39, com software que avalia a audição automaticamente nas frequências de 1000, 2000 e 4000 Hz a 25 dBNA, triagem por varredura audiométrica em cabina acústica (nas frequências de 1000, 2000 e 4000 Hz a 20 dBNA) e pesquisa dos limiares auditivos por meio de audiometria tonal em cabina acústica (nas frequências de 500, 1000, 2000 e 4000Hz). Resultados: Verificou-se que não existe associação entre os resultados normais e alterados nos testes auditivos e a variável sexo. Das 243 crianças que realizaram a audiometria tonal, 195 apresentaram limiares auditivos normais. Para a audiometria por varredura, 209 passaram e para a teleaudiometria, 188 passaram. Sendo assim, a habilidade diagnóstica dos métodos de triagem foi avaliada, encontrando-se os seguintes valores para teleaudiometria / audiometria por varredura: sensibilidade - 58% / 65%, especificidade - 86% / 99%, valor preditivo positivo - 51% / 91%, valor preditivo negativo - 89% / 92%, acurácia - 81% / 92%. A teleaudiometria e a varredura apresentaram concordância moderada pelo coeficiente Kappa. Além disso, foi avaliada a possibilidade diagnóstica de execução da teleaudiometria realizada em série ou em paralelo com a imitanciometria, indicando que a aplicação destes métodos em série melhora a especificidade e a aplicação dos testes em paralelo melhora a sensibilidade. Conclusão: Embora a audiometria por varredura apresente valores de sensibilidade e especificidade maiores, a teleaudiometria mostrou confiabilidade e viabilidade como método de triagem auditiva em escolares. Além disso, a teleaudiometria apresenta vantagens de aplicação em áreas remotas, onde não existe a disponibilidade de profissionais especializados e equipamentos específicos, o que pode reduzir custos em programas de triagem auditiva / Introduction: Epidemiological data on the prevalence of hearing loss in developing countries are insufficient for the planning and execution of effective programs, aimed at intervention, prevention and health promotion. In addition, health actions in primary care, as well as secondary and tertiary services are not enough to meet or even know the demand; this also occurs because there is a limited number of health professionals who care for the hearing. Within this context, it is necessary to adopt accessible techniques or procedures for the underserved areas of the country, that do not have financial resources for the purchase of technology or human resources to enable the identification, as early as possible, of risk groups for hearing disorders. With the advance of technology, distance hearing screening methods are possible, working as facilitators in areas where there are no experts. Thus, the creation and validation of teleaudiology protocols are essential so that they can be used in routine health programs. Objective: To evaluate the efficacy and feasibility of the teleaudiometry, comparing it to the sweep audiometry, considering pure tone audiometry as the gold standard, in school children of the first cycle in elementary school. Method: 243 students participated in this study, 118 boys and 125 girls, mean age 8.3 years. The following procedures were performed: teleaudiometry screening with TDH39 headphones and software that automatically evaluates hearing at the frequencies of 1000, 2000 and 4000 Hz at 25 dBHL, sweep audiometry screening in acoustic booth (at the frequencies of 1000, 2000 and 4000 Hz at 20 dBHL) and hearing thresholds search using pure tone audiometry in acoustic booth (at the frequencies of 500, 1000, 2000 and 4000 Hz). Results: It was found that there is no association between normal and abnormal results in hearing tests and the gender variable. Of the 243 children who underwent pure tone audiometry, 195 had normal hearing thresholds. For the sweep audiometry, 209 children passed the screening, and 188 passed the teleaudiometry. Therefore, the diagnostic capacity of the screening methods was evaluated, verifying the following values: for teleaudiometry / sweep audiometry: sensitivity - 58% / 65%, specificity - 86% / 99%, positive predictive value - 51% / 91%, negative predictive value - 89% / 92%, accuracy - 81% / 92%. The teleaudiometry and the sweep audiometry showed moderate agreement using the Kappa coefficient. Furthermore, the diagnostic possibility of performing teleaudiometry in series or in parallel with imitanciometry was evaluated, indicating that the application of these methods in series improves specificity and the application of parallel testing improves sensitivity. Conclusion: Although the sweep audiometry presented higher sensitivity and specificity values, teleaudiometry showed reliability and feasibility as a hearing screening method in school children. Moreover, teleaudiometry has application advantages in remote areas, where specialized professionals and specific equipment are not available, which can reduce costs in hearing screening programs

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