I Sverige har en rad olika mobila applikationer vuxit fram där patienter kan ställa frågor och konsultera läkare med hjälp av videobesök. Dessa typer av tjänster är i dagsläget menat att användas som ett substitut eller komplement till traditionella vårdbesök med syfte att avlasta sjukhus och tillgängliggöra vård. ​Ökade krav och nya behov har däremot skapat nya förväntningar på hälso- och sjukvårdstjänster och hur de ska tillhandahållas. Detta har lett till en debatt kring huruvida det är positivt för vården eller ej. Syftet med denna uppsats var att undersöka sjukvårdspersonals inställning till videobesök, samt vilka faktorer som är viktiga för att sjukvårdspersonalen ska acceptera ett sådant system. För att få en förståelse för detta genomfördes totalt sex intervjuer med sjukvårdare i Stockholm, Uppsala och Norrtälje. Intervjuer utformades och analyserades med hjälp det teoretiska ramverket, TAM, som ämnar förutse och förklara användares acceptans till system innan de har utsatts för det. Resultaten av undersökningen visar att det finns en positivitet och nyfikenhet hos respondenterna till videobesök i sig men en skepsis kring hur tekniken används idag - de ansåg ​att videobesök är ett viktigt verktyg som i dagsläget används på fel sätt. Utfallet av analysen ledde dock till ett annat resultat än det som empirin visade: ​acceptans och inställning hos respondenterna visade sig bero på mer på vilken kontext det används inom än demografiska faktorer. Validiteten av det teoretiska ramverket i relation till sjukvård är något som vidare bör diskuteras i framtida forskning. / During the past few years, there has been a increase of services which provide healthcare through mobile applications. These types of services are meant to be used as a complement to traditional health care with the purpose of relieving hospitals and making health care more accessible. An increase in demand has formed new expectations in health care and the way in which health care services are carried out. This has led to an ongoing debate where some argue that this is a positive development concerning the quality of care and others argue that it is not. The purpose of this study was to examine the attitudes of health care professionals toward mobile application based health care, as well as examine which factors are important in assuring that health care professionals accept such a system.Interviews with six different health care professionals in Stockholm, Uppsala and Norrtälje were carried out to gain knowledge in this subject. The interviews were developed and analysed using the theoretical framework, TAM, which aims to predict and explain user acceptance of systems that they have not yet been exposed to. The results of this study reveal a positivity and curiosity among the respondents towards video healthcare, but a skepticism of how the technology is being used today. They felt that it is an important tool which is being used in the wrong way. The outcome of our analysis show different results than our empirics imply. The acceptance and attitude among our respondents seem to depend more on which context it is being used in rather than demographic differences. The validity of our theoretical framework in the context of healthcare is something that should be further discussed in future studies.

Dans le domaine médical, la plupart des établissements (hôpitaux, cliniques, …) utilisent des applications distribuées dans le cadre de la télémédecine. Comme la sécurité de l’information est primordiale dans ces établissements,ces applications doivent pouvoir traverser les barrières de sécurité (passerelles sécurisées comme les proxies Web, les pare-feu, …). Le protocole UDP (User Datagram Protocol en anglais), qui est classiquement recommandé pour les applications de vidéo conférence ou toutes autres données soumises à la contrainte temps-réel, n’est pas utilisable par ces dispositifs de sécurité (sauf si des ports fixes sont explicitement configurés : ce qui est considéré comme une violation de sécurité au sein de ces établissements). Dans cette thèse, nous proposons une nouvelle plateforme appelée VAGABOND (Video Adaptation framework, crossing security GAteways, Based ON transcoDing) qui fonctionne de manière très efficace et originale sur la base du protocole TCP (Transmission Control Protocol). VAGABOND est composé de proxies d’adaptation,appelés des AP (pour Adaptation Proxy), qui ont été conçus pour prendre en considération les préférences utilisateurs des professionnels de santé, les hétérogénéités des périphériques,et les variations dynamiques de la bande passante dans un réseau. VAGABOND est capable de s’adapter tout aussi bien au niveau utilisateur qu’au niveau réseau. La loi binômiale et l’inférence bayésienne sur une proportion binômiale sont utilisées pour déclencher des adaptations de profils utilisateurs. Ainsi, nous souhaitons être plus tolérants aux fortes variations de la bande passante d'un réseau. Avec une précision plus fine et grâce à ces lois de probabilité,l'adaptation du profil utilisateur n'est déclenchée que lorsque des congestions réseau sévères surviennent.Enfin, TCP étant un protocole de transport fiable et en mode connecté,nous avons eu besoin de concevoir et d'utiliser de nouvelles stratégies d'adaptation intelligentes avec la transmission de données afin de faire face aux problèmes de latence et à la temporisation des sockets. / In the medical area, most of medical facilities (hospitals, clinics, ldots) use distributed applications in the context of telemedecine.As information security is mandatory, these applications must be able to cross the security protocols (secured gateways like proxies, firewalls, ldots). User Datagram Protocol (UDP), which is classically recommended for videoconferencing applications, does not cross firewalls or proxies unless explicitly configured fixed ports are declared. These fixed ports are considered as a security breach.In this thesis, we propose a novel platform called VAGABOND (Video Adaptation framework, crossing security GAteways, Based ON transcoDing) which works, in a very efficient and original way; on TCP (Transmission Control Protocol). VAGABOND is composed of Adaptation Proxies (APs), which have been designed to take into consideration medical experts videoconferencing preferences, device heterogeneities, and network dynamic bandwidth variations. VAGABOND is able to adapt itself at the user and network levels.The cumulative binomial probability law and the Bayesian inference on a binomial proportion are used to trigger user profile adaptations. In fact, we aim at being more tolerant to severe network bandwidth variations. With a finer precision and following these probability laws, user profile adaptation is only triggered when severe network congestions arise. However, as TCP is a reliable transport protocol, we needed to design and to employ new intelligent adaptation strategies together with data transmission in order to cope with latency issues and sockets timeout.

O Brasil conta com uma rede de atenção terciária razoavelmente bem equipada nos grandes centros urbanos e com a rede de atenção primária em fase de franca expansão na maioria dos municípios. Entre estes dois extremos do sistema de saúde há um hiato deixado pela inexistência, em grande parte das regiões distantes dos grandes centros, da atenção secundária, fato que gera a necessidade de grandes deslocamentos diários de pessoas para realização de consultas e exames de média complexidade. Objetivo: Comparar, do ponto de vista econômico, duas formas de assistência: a convencional que está em prática em todos os municípios do RS; e a modalidade com a descentralização do exame de espirometria com apoio da teleassistência. Método: Estudo de custo-minimização da implantação da espirometria descentralizada com apoio de teleconsultoria em município distante 50Km da Capital do Estado do RS e que encaminha todos os pacientes que necessitam deste exame. Este trabalho foi apresentado como dissertação de mestrado ao PPG em Epidemiologia da UFRGS. Resultados: Observou-se que em um ano gastou-se R$ 16.966,35 com o encaminhamento de pacientes para consulta e realização de espirometria comparado com o custo de R$ 15.150,00 para se implantar um espirômetro descentralizado. Na análise dos gastos individualmente encontrou-se uma economia de R$ 102,71 por paciente que realizar o diagnóstico e o tratamento na forma descentralizada. Conclusão: O menor custo da espirometria descentralizada, a redução dos deslocamentos rodoviários e a possibilidade de eliminar a demanda reprimida por este procedimento de média complexidade justificam sua implantação. / Brazil has a well organized tertiary care network in major urban centers and a growing primary care network in almost all municipalities. In between, a gap exists due to the virtual absence of specialists offering secondary care services outside of major metropolitan areas. This results in a daily pilgrimage of patients to receive specialist consultations and undergo exams of moderate complexity. Objective: To compare, from an economic viewpoint, two modes of care: the conventional one currently being practiced across the state of Rio Grande do Sul; against a modality of decentralized spirometry with interpretation using telemedicine. Methods: Cost-minimization study of the implementation of decentralized spirometry using telemedicine, taking as a model a municipality 50 km distant from the state capital which currently references all patients who need this exam. Results: In one year R$ 16,966.35 would be spent in referencing these patients compared with R$ 15,150.00 that would be spent with the implementation of decentralized spirometry. When costs are expressed per patient, we found a saving of R$ 102.71 for each patient who received decentralized care. Conclusion: The lower cost of decentralized spirometry coupled with the possibility of eliminating backed up demand for this moderate complexity procedure justify its implementation. / Telemedicina

Este estudo avaliou o potencial da Telemedicina como suporte complementar a assistência ambulatorial na monitoração de sintomas em pacientes com câncer avançado. Foram acompanhados 12 pacientes do ambulatório do Núcleo de Cuidados Paliativos do Hospital Universitário Pedro Ernesto (NCP-HUPE) de janeiro de 2011 a agosto de 2013. Mensalmente foram feitas consultas ambulatoriais pela médica e equipe multidisciplinar. Neste intervalo, os pacientes do domicilio, através de seus computadores pessoais se conectaram ao Laboratório de TeleSSaúde UERJ pelo serviço de webconferências interagindo com a mesma médica assistente do ambulatório. Os pacientes também tiveram acesso à médica por celular e email. A cada entrevista (presencial e remota) foi aplicada a Escala de Avaliação de Sintomas de Edmonton [Edmonton Symptom Assessment System (ESAS)], e coletado outros dados quanto a outras queixas biopsicossociais e espirituais, agravos à saúde, qualidade de áudio e vídeo da conexão, avaliação dos familiares com a Telemedicina e interferência da Telemedicina quanto ao local do óbito do paciente. Houve dificuldade na seleção dos pacientes, pois o HUPE é um hospital público cuja população assistida tem, caracteristicamente, baixa escolaridade, nível socioeconômico restrito e pouca habilidade com informática. O tempo médio de acompanhamento foi de 195 dias (DP 175,11; range: 11-553 dias). Todos receberam diagnóstico de câncer avançado e tinham dificuldades com locomoção. Sem dúvidas, a ESAS favoreceu a comunicação dos sintomas com os profissionais de saúde; porém, condições clínicas e controle dos sintomas singulares, avaliados em momentos distintos e sujeitos a influências diversas, impedem conclusões em relação às pretensas vantagens. Acompanhamento clínico, detecção de agravos à saúde e de sintomas físicos, psicossociais e espirituais foram possíveis de ser observados pela Telemedicina, confirmados e medicados nas consultas presenciais. A conexão para webconferência foi estabelecida por familiares, pois nenhum paciente operava computadores. O óbito domiciliar ocorreu em 41,67% e todos, mesmo os óbitos hospitalares, receberam suporte à distância do NCP. Durante o estudo foram feitos 305 contatos: 110 consultas presenciais a pacientes e familiares e 195 por Telemedicina (77 webconferências, 38 telefonemas e 80 emails). Todos os familiares referiram satisfação com o suporte oferecido. A Telemedicina permitiu maior acesso ao sistema de saúde (maior número de contatos), reduziu a busca por serviços de emergência, ajudou o controle dos sintomas e proporcionou orientações e segurança aos familiares. Este suporte favoreceu intervenções precoces e proativas e assistência continuada até o óbito. A Telemedicina demonstrou ser um bom adjuvante na monitoração e gerenciamento de sintomas de pacientes em cuidados paliativos em domicílio, não substituindo, mas complementando a assistência presencial. / This study assessed telemedicine potential as a complementary support to ambulatory care in monitoring symptoms in patients with advanced cancer. Twelve patients were followed up at the Palliative Care Nucleus ambulatory of the Pedro Ernesto University Hospital (NCP-HUPE) from January 2011 to August 2013. Monthly, assistance were made by physician and multidisciplinary team. Meanwhile, patients at home, with their personal computer connected to UERJ Telehealth Laboratory webconference service, interacting with the same ambulatory physician. Patients also had access to doctors cellphone and e-mail. At each interview (personal and remote) was applied the Edmonton Symptom Assessment System (ESAS), collected data on other biopsychosocial and spiritual complaints, health problems, audio and video quality connection, family's evaluation about Telemedicine and Telemedicine interference on patient's place of death. There was difficulty to select patients because HUPE is a public hospital whose population assisted has typically low educational and socioeconomic status, and restricted ability to deal with computers. The mean follow-up time was 195 days (SD 175.11; range: 11-553 days). All were diagnosed with advanced cancer and had transportation difficulties. There is no doubt that ESAS favored symptoms communication with health professionals; however, singular clinical conditions and symptom control assessed at different moments and subjected to many factors, preclude conclusions regarding alleged advantages. Clinical monitoring, detection of health problems and physical, psychosocial and spiritual symptoms were possible to be observed by Telemedicine, and were confirmed and treated at face-to-face consultations. Webconference connection was made by family members, because no patient operated computers. Death at home occurred in 41.67% and everyone, even the hospital deaths, received NCP support at distance. During the study was made 305 contacts; 110 face-to-face consultations to patients and families and 195 by Telemedicine (77 webconference, 38 telephone calls and 80 emails). Telemedicine allowed better access to health system (greater number of contacts), reduced search for emergency services, helped symptom control and provided orientations and reassurance to family members. This support favored early and proactive interventions and continuing assistance till death. Telemedicine has proved to be a good adjuvant in home monitoring and managing symptoms in palliative care patients, complementing face-to-face assistance, but not substituting it.

Abstract Introduction: The perception of quality of life (QoL) in patients with implantable cardiac devices including implantable cardioverter-defibrillators (ICD), followed by telemonitoring care (Home Monitoring HM), has recently become an extremely hot topic due to constantly increasing number of patients wearing these devices. This increase has resulted in an increased demand for safe, prompt, and more effective out-patient care. Methods: Our research was carried out between December 2016 and March 2017. A cohort of 150 consecutive patients with ICD, followed using the Home Monitoring system (HM+), and 150 consecutive patients with ICD, followed using conventional in-office check-ups (HM-), was retrospectively drawn from the Ceske Budejovice Hospital Patient Information System. A questionnaire, which specifically addressed QoL (EQ5D), level of anxiety and depression (HADS), and a custom questionnaire examining the relationship between patients and the HM system and telecare workflow, was sent out to all patients. Results: For the final statistical analysis, 91 (60.7%) and 104 (69.3%) of the questionnaires were used from the HM+ and HM- groups, respectively. Our results showed that the method of ICD device follow-up did not directly influence QoL. Our statistical comparison of the data did not show any difference between HM+ and HM- patients. A non-significant trend towards better QoL in HM+ compared to HM- patients was noted based on total QoL scores from the EQ5D questionnaire (68.6 ? 19 vs. 64.6 ? 16.5, p = 0.09). Regarding anxiety and depression, statistical testing also failed to find any difference between HM+ and HM- patients. However, more than half of the patients in both groups were in the "normal" population range with respect to anxiety and depression. The most striking difference between HM+ and HM- patients was noted in the preference for the type of follow-up: while 54.9% of HM- patients expressed an interest in remote follow-up and 45.1% said they preferred in-office check-ups, only 6.7% (p < 0.0001) of HM+ patients expressed an interest in switching to in-office check-ups with personal contact instead of remote monitoring. Willingness to partially cover the financial costs of telecare was similar in both groups. HM+ patients were more inclined to use remote ICD monitoring (p = 0.007) and had a more positive attitude toward the telecare approach overall, compared to HM- patients (p = 0.034). Conclusion: The method of device follow-up does not significantly affect QoL in patients with ICD devices, nor does it affect levels of anxiety and depression. Generally, patients with ICDs followed using the HM system were very satisfied with telecare and would prefer not to lose remote ICD monitoring. Although, the willingness to, at least partially, cover the costs of the HM system was limited and comparable to that of patients receiving conventional follow-up.

O Brasil conta com uma rede de atenção terciária razoavelmente bem equipada nos grandes centros urbanos e com a rede de atenção primária em fase de franca expansão na maioria dos municípios. Entre estes dois extremos do sistema de saúde há um hiato deixado pela inexistência, em grande parte das regiões distantes dos grandes centros, da atenção secundária, fato que gera a necessidade de grandes deslocamentos diários de pessoas para realização de consultas e exames de média complexidade. Objetivo: Comparar, do ponto de vista econômico, duas formas de assistência: a convencional que está em prática em todos os municípios do RS; e a modalidade com a descentralização do exame de espirometria com apoio da teleassistência. Método: Estudo de custo-minimização da implantação da espirometria descentralizada com apoio de teleconsultoria em município distante 50Km da Capital do Estado do RS e que encaminha todos os pacientes que necessitam deste exame. Este trabalho foi apresentado como dissertação de mestrado ao PPG em Epidemiologia da UFRGS. Resultados: Observou-se que em um ano gastou-se R$ 16.966,35 com o encaminhamento de pacientes para consulta e realização de espirometria comparado com o custo de R$ 15.150,00 para se implantar um espirômetro descentralizado. Na análise dos gastos individualmente encontrou-se uma economia de R$ 102,71 por paciente que realizar o diagnóstico e o tratamento na forma descentralizada. Conclusão: O menor custo da espirometria descentralizada, a redução dos deslocamentos rodoviários e a possibilidade de eliminar a demanda reprimida por este procedimento de média complexidade justificam sua implantação. / Brazil has a well organized tertiary care network in major urban centers and a growing primary care network in almost all municipalities. In between, a gap exists due to the virtual absence of specialists offering secondary care services outside of major metropolitan areas. This results in a daily pilgrimage of patients to receive specialist consultations and undergo exams of moderate complexity. Objective: To compare, from an economic viewpoint, two modes of care: the conventional one currently being practiced across the state of Rio Grande do Sul; against a modality of decentralized spirometry with interpretation using telemedicine. Methods: Cost-minimization study of the implementation of decentralized spirometry using telemedicine, taking as a model a municipality 50 km distant from the state capital which currently references all patients who need this exam. Results: In one year R$ 16,966.35 would be spent in referencing these patients compared with R$ 15,150.00 that would be spent with the implementation of decentralized spirometry. When costs are expressed per patient, we found a saving of R$ 102.71 for each patient who received decentralized care. Conclusion: The lower cost of decentralized spirometry coupled with the possibility of eliminating backed up demand for this moderate complexity procedure justify its implementation. / Telemedicina

Den psykiska ohälsan ökar internationellt och även i Sverige, samtidigt rapporteras den psykiatriska vården vara bristfällig på grund av sin låga tillgänglighet. Ett sätt att öka tillgängligheten av vården kan vara genom en smartphone-applikation. Men oavsett hur effektiv en app är, så tillför den ingenting om den inte används. Syftet med denna studie är därmed att utreda attityder till denna typ av digitalisering samt undersöka vilka appfunktioner som skulle möta psykiatripatienters behov. Studien baseras på kvalitativa intervjuer med personer som fått vård vid psykiatrin vid Akademiska sjukhuset i Uppsala och vi analyserar sedan empirimaterialet utifrån det teoretiska ramverket Technology Acceptance Model (TAM). Studiens resultat visar på att samtliga av de deltagande psykiatripatienterna har överlag positiva attityder till konceptet att använda appar vid vård av psykisk ohälsa. De positiva attityderna grundar sig dock på förutsättningen att en sådan app ska utgöra ett komplement till den psykiatriska vård som finns idag. Slutligen presenterar studien även att det tyder på att de funktioner som lämpar sig väl för att möta psykiatripatienters behov är sådana som tillgängliggör psykiatrin genom att förmedla information snarare än att erbjuda behandling genom mobilapplikationen. / Mental illness is increasing, both globally and in Sweden. Meanwhile it is reported that the psychiatric care is inadequate because of its low availability. A solution to this problem is to increase the availability of care through a smartphone application. But no matter how effective an app might be, it will not solve anything if it is not used. The purpose of this study is therefore to investigate attitudes towards this kind of digitalization and to examine what kind of app functions that can meet patients needs. The study is based on qualitative interviews with persons that have received care from the psychiatry at Akademiska sjukhuset in Uppsala, Sweden. Furthermore, we analyze the empirical material by using the theoretical framework Technology Acceptance Model (TAM). The results show that all of the participating patients generally have positive attitudes towards the concept of using apps for mental health care. Although, these positive attitudes require that a mental health app should be complementary to the psychiatric care available today, not replace it. Finally, the study also suggests that application functions that are well suited to meet the needs of the patients are those who make the mental health care more available by providing information rather than offering treatment through the application.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-02-15T12:04:15Z No. of bitstreams: 1 arquivototal.pdf: 2179152 bytes, checksum: f6a80c3412db9a464131b2373d2490d0 (MD5) / Made available in DSpace on 2016-02-15T12:04:15Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2179152 bytes, checksum: f6a80c3412db9a464131b2373d2490d0 (MD5) Previous issue date: 2014-10-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The use of Computer Graphics techniques in Telemedicine systems can enrich the streaming videos of surgeries, facilitating the understanding of patients' problems, improving communication between surgeons and the medical team and providing improvements in teaching and learning. The purpose of this work is to prepare and develop a strategy for recording 3D experience that simulates the anatomical structures of the human body, performed during a surgical transmission in real time. This multimedia experience generated by multiple streams of video, audio and 3D models is relevant to medical students that watch the transmission, both live and non-simultaneous form. In this scenario, emerges the need of a strategy to enable the recording of the 3D experience in the context of the Arthron tool, which already has modules that allows recording audio and video streams transmitted in real time surgeries, but not the 3D experience. Thus, a multimedia system can use the proposed strategy to record some extra content transmitted in real time that subsequently needs to be played again. With this strategy, we intend to make a larger amount of members of medical teams to have access to materials generated by multimedia streams in real time, providing an extensive training program, independent of geographical distances. / A utilização de técnicas de Computação Gráfica em conjunto com sistemas de Telemedicina pode enriquecer as transmissões de vídeos de cirurgias, facilitar o entendimento dos problemas dos pacientes, melhorar a comunicação entre os cirurgiões e toda a equipe médica e prover melhorias em relação ao ensino e à aprendizagem. O objetivo deste trabalho é elaborar e desenvolver uma estratégia para gravação e reprodução de conteúdo tridimensional que simula as estruturas anatômicas do corpo humano, utilizados durante uma transmissão cirúrgica em tempo real. A experiência multimídia gerada pelos múltiplos fluxos de áudio, vídeo e modelos 3D é de grande relevância para os estudantes de Medicina que acompanham a transmissão, tanto ao vivo quanto de forma não simultânea e subsequente ao procedimento cirúrgico. Diante desse cenário, surge a necessidade de uma estratégia para viabilizar a gravação da experiência 3D no contexto da ferramenta Arthron, que já possui módulos para gravação de áudio e vídeo de cirurgias transmitidas em tempo real, mas não abrangem a gravação da experiência tridimensional. Assim, um sistema multimídia poderá utilizar a estratégia proposta para gravar algum conteúdo extra transmitido ao vivo e que posteriormente necessite ser reproduzido. Com a estratégia proposta, pretende-se fazer com que uma maior quantidade de membros de equipes médicas possa ter acesso a materiais gerados através de fluxos multimídia em tempo real, promovendo uma ampla capacitação independente de distâncias geográficas.

This thesis deals with the development of novel haptic array system that can render distributed pressure pattern. The haptic devices are force feedback interfaces, which are widely seen from consumer products to tele-surgical systems, such as vibration feedback in game console, mobile phones, virtual reality applications, and daVinci robots in minimally invasive surgery. Telemedicine and computer-enabled medical training system are modern medical infrastructures where the former provides health care services to people especially in rural and remote places while the latter is meant for training the next generation of doctors and medical students. In telemedicine, a patient at a remote location consults the physician at a distant place through the telecommunication media whereas in computer enabled medical training system, physician and medical students interact with the virtual patient. The experience of physical presence of the remote patient in telemedicine and immersive interaction with virtual patient on the computer-enabled training system can be attained through haptic devices. In this work we focus on palpation simulation in telemedicine and medical training systems. Palpation is a primary diagnostic method which involves multi-finger, multi-contact interaction between the patient and physician. During palpation, a distributed pressure pattern rather than point load is perceived by the physician. The commercially available haptic devices are single and five point devices, which lack the face validity in rendering distributed pressure pattern; there are only a few works reported in literatures that deal with palpation simulation. There is a strong need of a haptic device which provide distributed force pattern with multipoint feedback which can be applied for palpation simulation in telemedicine and medical training purposes. The haptic device should be a multipoint device to simulate palpation process, an array device to render distributed force pattern, light weight to move from one place to another and finally it has to cover hand portion of physician. We are proposing a novel under-actuated haptic array device, called taut cable haptic array system (TCHAS), which in general is a m x n system, consist of m+n actuators to obtain m.nhaptels, that are multiple end effectors. A prototype of 3 x 3 TCHAS is developed during this work and detailed study on its characterisation is explored. The performance of device is validated with elaborate user study and it establishes that the device has promising capability in rendering distributed spatio-temporal pressure pattern.

Este estudo avaliou o potencial da Telemedicina como suporte complementar a assistência ambulatorial na monitoração de sintomas em pacientes com câncer avançado. Foram acompanhados 12 pacientes do ambulatório do Núcleo de Cuidados Paliativos do Hospital Universitário Pedro Ernesto (NCP-HUPE) de janeiro de 2011 a agosto de 2013. Mensalmente foram feitas consultas ambulatoriais pela médica e equipe multidisciplinar. Neste intervalo, os pacientes do domicilio, através de seus computadores pessoais se conectaram ao Laboratório de TeleSSaúde UERJ pelo serviço de webconferências interagindo com a mesma médica assistente do ambulatório. Os pacientes também tiveram acesso à médica por celular e email. A cada entrevista (presencial e remota) foi aplicada a Escala de Avaliação de Sintomas de Edmonton [Edmonton Symptom Assessment System (ESAS)], e coletado outros dados quanto a outras queixas biopsicossociais e espirituais, agravos à saúde, qualidade de áudio e vídeo da conexão, avaliação dos familiares com a Telemedicina e interferência da Telemedicina quanto ao local do óbito do paciente. Houve dificuldade na seleção dos pacientes, pois o HUPE é um hospital público cuja população assistida tem, caracteristicamente, baixa escolaridade, nível socioeconômico restrito e pouca habilidade com informática. O tempo médio de acompanhamento foi de 195 dias (DP 175,11; range: 11-553 dias). Todos receberam diagnóstico de câncer avançado e tinham dificuldades com locomoção. Sem dúvidas, a ESAS favoreceu a comunicação dos sintomas com os profissionais de saúde; porém, condições clínicas e controle dos sintomas singulares, avaliados em momentos distintos e sujeitos a influências diversas, impedem conclusões em relação às pretensas vantagens. Acompanhamento clínico, detecção de agravos à saúde e de sintomas físicos, psicossociais e espirituais foram possíveis de ser observados pela Telemedicina, confirmados e medicados nas consultas presenciais. A conexão para webconferência foi estabelecida por familiares, pois nenhum paciente operava computadores. O óbito domiciliar ocorreu em 41,67% e todos, mesmo os óbitos hospitalares, receberam suporte à distância do NCP. Durante o estudo foram feitos 305 contatos: 110 consultas presenciais a pacientes e familiares e 195 por Telemedicina (77 webconferências, 38 telefonemas e 80 emails). Todos os familiares referiram satisfação com o suporte oferecido. A Telemedicina permitiu maior acesso ao sistema de saúde (maior número de contatos), reduziu a busca por serviços de emergência, ajudou o controle dos sintomas e proporcionou orientações e segurança aos familiares. Este suporte favoreceu intervenções precoces e proativas e assistência continuada até o óbito. A Telemedicina demonstrou ser um bom adjuvante na monitoração e gerenciamento de sintomas de pacientes em cuidados paliativos em domicílio, não substituindo, mas complementando a assistência presencial. / This study assessed telemedicine potential as a complementary support to ambulatory care in monitoring symptoms in patients with advanced cancer. Twelve patients were followed up at the Palliative Care Nucleus ambulatory of the Pedro Ernesto University Hospital (NCP-HUPE) from January 2011 to August 2013. Monthly, assistance were made by physician and multidisciplinary team. Meanwhile, patients at home, with their personal computer connected to UERJ Telehealth Laboratory webconference service, interacting with the same ambulatory physician. Patients also had access to doctors cellphone and e-mail. At each interview (personal and remote) was applied the Edmonton Symptom Assessment System (ESAS), collected data on other biopsychosocial and spiritual complaints, health problems, audio and video quality connection, family's evaluation about Telemedicine and Telemedicine interference on patient's place of death. There was difficulty to select patients because HUPE is a public hospital whose population assisted has typically low educational and socioeconomic status, and restricted ability to deal with computers. The mean follow-up time was 195 days (SD 175.11; range: 11-553 days). All were diagnosed with advanced cancer and had transportation difficulties. There is no doubt that ESAS favored symptoms communication with health professionals; however, singular clinical conditions and symptom control assessed at different moments and subjected to many factors, preclude conclusions regarding alleged advantages. Clinical monitoring, detection of health problems and physical, psychosocial and spiritual symptoms were possible to be observed by Telemedicine, and were confirmed and treated at face-to-face consultations. Webconference connection was made by family members, because no patient operated computers. Death at home occurred in 41.67% and everyone, even the hospital deaths, received NCP support at distance. During the study was made 305 contacts; 110 face-to-face consultations to patients and families and 195 by Telemedicine (77 webconference, 38 telephone calls and 80 emails). Telemedicine allowed better access to health system (greater number of contacts), reduced search for emergency services, helped symptom control and provided orientations and reassurance to family members. This support favored early and proactive interventions and continuing assistance till death. Telemedicine has proved to be a good adjuvant in home monitoring and managing symptoms in palliative care patients, complementing face-to-face assistance, but not substituting it.