Este trabalho descreve a trajetória percorrida desde a análise de requisitos até a configuração de todo o ferramental de software, hardware e de recursos humanos necessários para implantação de um sistema que comporte cursos a distância na Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP). É um dos resultados de extensas pesquisas realizadas desde 1998, quando Grupo de Estudos e Pesquisas em Comunicação no Processo de Enfermagem (GEPECOPEn) iniciou suas investigações relacionadas ao uso da videoconferência como ferramenta aplicada ao ensino e a pesquisa, com vistas ao aprimoramento da prática do profissional de saúde. A inclusão do tema plataforma de educação a distância foi o caminho natural de evolução das pesquisas, visto que é preemente a necessidade de oferecimento de alternativas inovadoras para a disseminação do conhecimento, dada a escassez de espaço físico, tempo e de recursos físicos e humanos. A opção pela adoção do software livre está em conformidade com as diretrizes propostas pela Universidade de São Paulo, do Estado e da União. A modalidade de educação feita a distância permite maior flexibilização das agendas de professores e alunos e amplia a capacidade de atendimento da demanda, que se mostra em crescimento constante.Os resultados deste trabalho originaram-se do processo de implantação do sistema e do oferecimento de um curso piloto para uma comunidade de alunos de curso de graduação em enfermagem da EERP/USP. Foram consideradas as etapas que precedem a implantação da plataforma de software até o estágio posterior ao oferecimento de um curso, quando então são analisados os dados obtidos do processo de acompanhamento do curso a distância. Como resultado do trabalho tem-se, portanto: o sistema implantado, o inventário do processo de implantação e o roteiro detalhado para criação do curso a distância na plataforma Teleduc. Este sistema implantado, juntamente com o roteiro, poderá ser utilizado por professores e outros profissionais para iniciar suas atividades neste ambiente virtual de ensino-aprendizagem. / This study describes the trajectory from the requirement analysis to the configuration of software and hardware tools and human resources needed to implant a distance course system at the University of São Paulo at Ribeirão Preto College of Nursing (EERP/USP). This is one of the results of extensive studies realized since 1998, when the Study and Research Group on Communication in the Nursing Process (GEPECOPEn) started its research on the use of videoconferencing as a teaching and research tool, with a view to improving health professionals’ practice. Including the subject of a distance education platform was part of this research’s natural course, considering the urgent need to offer innovative alternatives for knowledge dissemination, given the lack of physical space, time and physical and human resources. The choice of a free software is in accordance with the guidelines established by the University of São Paulo, the State and the Union. Distance education allows for greater flexibility in teachers and students’ agendas and expands the capacity to attend to a permanently increasing demand. The results of this work are based on the system implantation process and the offering of a pilot course to a group of undergraduate nursing students at EERP/USP. The steps preceding the implantation of the software platform until after the offering of a course are taken into consideration. Next, data obtained from the distance course process are analyzed. This work produced the following results: the implanted system, the implantation process inventory and a detailed script for the creation of a distance course in the Teleduc platform. In combination with the script, this implanted system can be used by teachers and other professionals to start their activities in this virtual teaching-learning environment.

A presente pesquisa tem por principal objetivo apresentar um panorama histórico da Clínica Psicológica \'Dr Durval Marcondes\' através da análise de seus prontuários clínicos, provenientes dos atendimentos realizados desde o seu início, em 1964. Para atingir tal objetivo, foram necessárias duas etapas distintas de trabalho: na primeira, realizada manualmente, procedeu-se a alocação física dos prontuários, o que viabilizou a construção da sede do arquivo com toda a sistematização necessária para a determinação de um acervo permanente. Na segunda, desenvolveu-se um projeto piloto que buscou inserir parte do acervo no PsicoUsp, software regularmente utilizado na CP desde 1999. Como resultado da segunda etapa do trabalho obteve-se a inclusão de dois novos campos ao PsicoUsp, inclusão esta que já está sendo utilizada rotineiramente, facilitando a comunicação entre os acervos permanente e corrente da CP. Também nessa fase, pode-se realizar uma análise de dados em quatro décadas de trabalho da CP, de 1964 a 2004, que buscou ilustrar, por exemplo, como se deu a distribuição de gênero e faixa etária nos atendimentos realizados, que tipo de trabalho foi desenvolvido com os clientes, quais os testes utilizados e em que freqüência. Ressalta-se que a análise aqui apresentada apenas ilustra a enormidade das informações que podem ser obtidas com esse acervo, salientando uma vez mais a importância para a CP, para o PSC e para o IPUSP da aquisição da sede do arquivo permanente. / The main objective of the present research is to show a historic perspective of \'Dr Durval Marcondes\' Psychological Clinic through the analysis of its clinical client records, coming from cases attended since its foundation, in 1964. In order to achieve this goal, two distinct work stages were necessary: first, the physical allocation of the client records, manually accomplished, which enabled the construction of the archives head office with the full systematization necessary to the formation of a permanent archive. Second, the development of a pilot project to insert part of the archive in PsicoUsp, a regularly used software in the PC since 1999. As a result of the second stage of the work, two new fields have been included in PsicoUsp and routinely used, simplifying the communication between permanent and current archives of the PC. Also in this stage, four decades worth of data were analyzed concerning the work of the PC between 1964 and 2004. This analysis tried to illustrate, for instance, how the distribution by gender and age was done; what kind of work was developed with the patients; which tests were made and how frequently. It must be emphasized that the present analysis only illustrates the immensity of information that can be obtained with this archive, stressing once more the importance to the PC, the PSC and the IPUSP of the setting of a permanent archive.

by Leung Wing-shan, Queenie. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (leaves 79-82). / Abstracts in English and Chinese. / Abstract --- p.iii / Acknowledgements --- p.v / Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Current Problem --- p.4 / Chapter 1.2 --- Research Proposal --- p.6 / Chapter 1.3 --- Research Target --- p.8 / Chapter 1.4 --- Thesis Overview --- p.9 / Chapter 2 --- Fuzzy Logic and Fuzzy Petri Net --- p.11 / Chapter 2.1 --- Background --- p.13 / Chapter 2.2 --- Fuzzy sets --- p.15 / Chapter 2.3 --- Operations on fuzzy sets --- p.18 / Chapter 2.4 --- Fuzzy logic --- p.20 / Chapter 2.5 --- Weighted Fuzzy Petri Net --- p.23 / Chapter 2.6 --- Fuzzy reasoning --- p.25 / Chapter 2.7 --- More about fuzzy logic --- p.29 / Chapter 2.8 --- Chapter Summary --- p.31 / Chapter 3 --- Dynamic Certainty Factor --- p.32 / Chapter 3.1 --- Definition --- p.32 / Chapter 3.1.1 --- Background --- p.33 / Chapter 3.1.2 --- Examples --- p.37 / Chapter 3.2 --- Advantages --- p.43 / Chapter 3.2.1 --- Best reasoning --- p.43 / Chapter 3.2.2 --- Independency --- p.46 / Chapter 3.2.3 --- Interaction effect --- p.49 / Chapter 3.3 --- Chapter Summary --- p.51 / Chapter 4 --- Experiment --- p.53 / Chapter 4.1 --- Transformation Definition --- p.54 / Chapter 4.2 --- Case Study --- p.61 / Chapter 4.2.1 --- Example 1 --- p.61 / Chapter 4.2.2 --- Example 2 --- p.63 / Chapter 4.3 --- Analysis --- p.65 / Chapter 4.3.1 --- Comparisons --- p.65 / Chapter 4.3.2 --- Discussion --- p.67 / Chapter 4.4 --- Chapter Summary --- p.68 / Chapter 5 --- Conclusion --- p.69 / Chapter 5.1 --- Final Summary --- p.69 / Chapter 5.2 --- Deficiency and Improvement --- p.71 / Chapter 5.3 --- Future Research Aspect --- p.73 / Appendix --- p.75 / Chapter A --- Data Details --- p.76 / Bibliography --- p.79

Submitted by Jonas Bianchi null (jonasbianchi@foar.unesp.br) on 2017-02-10T09:34:31Z No. of bitstreams: 1 BianchiJ.pdf: 8241431 bytes, checksum: c518c64d3206149062fef34dad2ea3f0 (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-02-14T18:27:57Z (GMT) No. of bitstreams: 1 bianchi_j_me_arafo.pdf: 8241431 bytes, checksum: c518c64d3206149062fef34dad2ea3f0 (MD5) / Made available in DSpace on 2017-02-14T18:27:57Z (GMT). No. of bitstreams: 1 bianchi_j_me_arafo.pdf: 8241431 bytes, checksum: c518c64d3206149062fef34dad2ea3f0 (MD5) Previous issue date: 2016-12-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O exame de tomografia computadorizada de feixe cônico (TCFC) tem sido utilizado amplamente na área clínica e científica médico/odontológica. Diversos softwares de diferentes fabricantes fornecem opções para processamento das imagens, segmentações e análises quantitativas tridimensionais. Um ponto que ainda gera controvérsias nessa área é a confiabilidade dos dados analisados computacionalmente devido às limitações dos algoritmos utilizados, complexidade da estrutura a ser avaliada, magnitude da mensuração, resolução espacial e variações nas metodologias de análises. Muitas dessas limitações são devidas as análises serem realizadas de formas não padronizadas e dependentes do operador. Deste modo, o objetivo geral do presente estudo foi desenvolver e validar um novo aplicativo para mensuração automática de deslocamentos ósseos a partir de TCFC de um crânio humano macerado. Para testar a confiabilidade do método, criamos um protótipo onde foram realizados deslocamentos físicos no crânio seguidos por exames de TCFC e realizamos os mesmos deslocamentos de forma virtual. As mensurações foram obtidas com base nos registros em maxila e na base do crânio por meio do nosso aplicativo e pelo 3D-Slicer, respectivamente. Além disso, realizamos uma análise visual após segmentação semiautomática por meio do ITK-SNAP para detecção do menor defeito ósseo em fragmento de osso bovino. Nossos resultados mostraram que as ferramentas testadas foram capazes de detectar deslocamentos físicos menores que a resolução espacial da imagem, sendo que os resultados foram comparáveis ao 3D-Slicer. Para os deslocamentos virtuais, foram obtidos resultados precisos, sendo que os deslocamentos foram limitados pela resolução da imagem. Além disso, observamos que a detecção e visualização de pequenos defeitos ósseos, mesmo que maiores do que a resolução espacial da imagem podem ser comprometidas pelo processo de segmentação da imagem. Concluímos que o aplicativo de análises automáticas desenvolvido é confiável para mensurações tridimensionais na área craniomaxilofacial. / Cone beam computerized tomography (CBCT) has been widely used in the clinical, scientific, medical and dental field. Various software from different manufacturers offer options for image processing, segmentation and quantitative analysis. One point that still generates controversy in this area is the reliability of the computer-analyzed data, because of the algorithms limitations, complexity of the structure to be assessed, magnitude of the measurement, spatial resolution and spatial variations in the records. Many of these limitations are caused by analyzes that are conducted in a non-standard form and highly dependent on the operator. Thus, the general objective of this study was to develop and validate a new application for automatic measurement of bone displacement from CBCTs of a macerated human skull. To evaluate our method’s reliability, we created a prototype where physical movements were performed in a human skull followed by CBCT examinations and performed the same movements virtually. Measurements were obtained from the records in jaw and skull base using our application and the 3D Slicer software, respectively. We also performed a visual analysis after the semi-automatic segmentation using the ITK-SNAP for detection of the lower bone defect in bovine bone fragment. Our results showed that we have succeeded in implementing our application of automatic analysis for three-dimensional measurements in the craniofacial area. The tools used in this study could detect physical displacements smaller than the spatial resolution of the image, and the results were comparable to the 3D Slicer software. For virtual displacements, precise results were obtained, and the movements were limited by the image resolution. Furthermore, we observed that the detection and visualization of bone defects in the bovine cortex, even higher than the spatial resolution of the image, can be compromised by the image segmentation process. We conclude that the automatic analysis derived from our developed application is reliable for three-dimensional measurements in the craniofacial area.

Pacientes críticos tratados em uma UTI comumente apresentam quadros severos de hiperglicemia. Estudos mostram que o controle da glicemia a níveis restritos leva à melhoria no prognóstico de tais pacientes. O controle glicêmico é feito através da medição freqüente da glicemia através de um exame de \"ponta de dedo\", aliada à infusão de insulina, numa atividade bastante trabalhosa para a equipe de enfermagem. Nos últimos anos, surgiram os primeiros sistemas comerciais de monitoramento contínuo de glicose para uso ambulatorial. Entretanto, há uma série de limitações que dificultam seu uso em uma UTI. No presente trabalho, foi desenvolvido um sistema de monitoramento contínuo de glicose para pacientes críticos hiperglicêmicos, batizado de vMonGluco. Esse sistema utiliza um monitor contínuo de glicose, disponível comercialmente, conectado a um palmtop, de forma a obter leituras de glicose em tempo real. Os dados coletados são enviados a um servidor seguindo a norma Health Level Seven (HL7). O servidor redireciona os dados a um monitor de beira de leito, disponibilizando as leituras de maneira prática. As informações também são armazenadas em um sistema de Prontuário Eletrônico do Paciente. Testes realizados em pacientes comprovaram a validade das leituras obtidas. Assim, com o presente trabalho, espera-se trazer uma contribuição prática e significativa no tratamento de pacientes críticos hiperglicêmicos. / Critical patients in an ICU usually experience severe hyperglycemia. Studies show that the control of glycemia to restricted levels can increase the prognosis of these patients. This control is usually done through the frequent reading of glycemia using a fingerstick test, together with the infusion of insulin, in a troublesome activity for the nursery team. In the last few years, the first commercial glucose monitoring systems for ambulatory use have been created. However, several difficulties limit its use in an ICU. In the present work, a continuous glucose monitoring system, named as vMonGluco, was developed. The system uses a commercially available continuous glucose monitor connected to a palmtop, in order to get glucose readings in real time. The collected data are sent to a server using the Health Level Seven (HL7) standard. The server redirects the data to a bedside monitor, so the readings can be accessed in practical way. The information is also stored in an Electronic Health Record system. Tests applied to patients showed the validity of the obtained readings. This way, with the present work, it is expected to bring a practical and significant contribution to the treatment of critical hyperglycemic patients.

ABSTRACT Clinical evidence technologies (CETs) are information sources derived from medical research literature that may assist health care providers in continued learning, decision-making, and patient care. Examples of CETs include: MEDLINE/PubMed and Cochrane Reviews, research journal literature, print and electronic medical texts, clinical topic summaries, guidelines, and interactive decision tools. Clinicians utilize CETs to find answers to questions that arise during patient care. However, it was unclear if CETs had a measurable impact on provider practice or patient outcomes. A literature review identified twenty-two articles evaluating CETs’ impact. Study designs included surveys, observational studies, randomized controlled trials and quasi-experimental methods. The review revealed mixed evidence of CET impact on provider-level outcomes such as improved diagnoses and treatments, and on patient level outcomes such as length of hospital stay and mortality. Additional research was needed to determine whether certain CETs or CET types have impact on patient care outcomes in clinically targeted areas. We conducted a cluster-randomized controlled trial (CRCT) to evaluate the effect of a dermatology-focused CET (VisualDx) when used by primary care providers. We found no difference in the patient skin disease outcomes of resolution of symptoms and return visits for the same problem in that trial. Thirty-two PCPs and 433 patients participated. In proportional hazards modelling adjusted for provider clusters, the time from index visit to skin problem resolution was similar in both groups (Hazard Ratio=0.92; 95% Confidence Interval (CI)=0.70, 1.21; P=0.54). Patient follow-up appointments did not differ significantly between groups (Odds Ratio=1.26; CI=0.94, 1.70; P=0.29). In a follow up mixed-methods study, we sought to understand why VisualDx did not make a difference. All CRCT provider participants were surveyed about their experience in the trial. VisualDx users (intervention arm) were interviewed about their experience using the CET. Ease of access and usefulness for patient communication facilitated successful use while irrelevant search results and use of other sources were barriers. Although PCPs reported benefits, they did not perceive the CET as useful often enough to motivate using it frequently or exclusively, thereby reducing the likelihood of it making a difference in the problem resolution and return appointment outcomes. There was no difference in skin problem resolution or number of follow-up visits when PCPs used VisualDx. PCPs did not perceive VisualDx as “useful” often enough for to use it frequently, or exclusively, thereby reducing the likelihood of this CET making a difference in patient-level outcomes.

Orientador: Ana Silvia Sartori Barraviera Seabra Ferreira / Resumo: De acordo com a OMS o termo Telemedicina pode ser definido como “a oferta de serviços ligados aos cuidados com a saúde, nos casos em que a distância é um fator crítico”. Ela pode ser utilizada em várias áreas como dermatologia, cardiologia, trauma, emergência, patologia, cirurgia, psiquiatria, radiologia. Já a Telessaúde é um termo mais amplo, envolvendo diferentes profissionais de saúde de áreas como enfermagem, fisioterapia, nutrição, psicologia. Devido à atual crise financeira do país, as características geográficas e dimensões territoriais, contrastes sociais, econômicos e culturais, existência de milhares de pessoas que vivem em locais de difícil acesso e distantes de unidades de saúde especializadas, o uso da tecnologia nas áreas da Telemedicina e Telessaúde mostra-se muito eficaz para a aproximação das populações localizadas em lugares remotos; integração de profissionais e pesquisadores; melhorias na gestão dos serviços de saúde e economia de gastos públicos. Assim, este estudo teve como objetivo descrever, por meio de um ebook, as ações das atividades e serviços de Telemedicina e Telessaúde desenvolvidas no Hospital das Clínicas e na Faculdade de Medicina de Botucatu da UNESP entre os anos de 2017 e 2018. Desta forma, este o estudo foi retrospectivo, caracterizando-se pela investigação e análise de atividades e serviços acontecidos entre os anos de 2017 e 2018, além de abranger reflexões e discussões sobre atividades e planejamentos futuros e desenvolvimento de dossi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: According to WHO the term telemedicine can be defined as "the provision of health care services in cases where distance is a critical factor." It can be used in several areas such as dermatology, cardiology, trauma, emergency, pathology, surgery, psychiatry, radiology. Telehealth is a broader term, involving different health professionals in areas such as nursing, physiotherapy, nutrition, psychology. Due to the country's current financial crisis, geographical characteristics and territorial dimensions, social, economic and cultural contrasts, existence of thousands of people living in difficult to reach places and away from specialized health units, the use of technology in the areas of telemedicine and telehealth are very effective for the approximation of populations located in remote places; integration of professionals and researchers; improvements in the management of health services and savings in public spending. The purpose of this study was to describe, through an ebook, the actions of the telemedicine and telehealth services and activities developed at the Hospital das Clínicas and at the Botucatu Medical School of UNESP between 2017 and 2018. Thus, this study was retrospective and characterized by the investigation and analysis of activities and services that took place between the years 2017 and 2018, as well as reflections and discussions on future activities and planning and development of dossier with the information and data raised during the research . Thus,... (Complete abstract click electronic access below) / Mestre

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives. The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare. An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts. In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.

Consumers face several challenges using the Internet to fill health-related needs. (1) In many cases, they face a language gap as they look for information that is written in unfamiliar technical language. (2) Medical information in social media is of variable quality and may be appealing even when it is dangerous. (3) Discussion groups provide valuable social support for necessary lifestyle changes, but are variable in their levels of activity. (4) Finding less popular groups is tedious. We present solutions to these challenges. We use a novel adaptation of topic models to address the language gap. Conventional topic models discover a set of unrelated topics that together explain the combinations of words in a collection of documents. We add additional structure that provides relationships between topics corresponding to relationships between consumer and technical medical topics. This allows us to support search for technical information using informal consumer medical questions. We also analyze social media related to eating disorders. A third of these videos promote eating disorders and consumers are twice as engaged by these dangerous videos. We study the interactions of two communities in a photo-sharing site. There, a community that encourages recovery from eating disorders interacts with the pro-eating disorder community in an attempt to persuade them, but we found that this attempt entrenches the pro-eating disorder community more firmly in its position. We study the process by which consumers participate in discussion groups in an online diabetes community. We develop novel event history analysis techniques to identify the characteristics of groups in a diabetes community that are correlated with consumer activity. This analysis reveals that uniformly advertise the popular groups to all consumers impairs the diversity of the groups and limits their value to the community. To help consumers find interesting discussion groups, we develop a system for personalized recommendation for social connections. We extend matrix factorization techniques that are effective for product recommendation so that they become suitable for implicit power-law-distributed social ratings. We identify the best approaches for recommendation of a variety of social connections involving consumers, discussion groups and discussions.

Magnetic resonance imaging (MRI) is a very versatile imaging modality which can be used to acquire several different types of images. Some examples include anatomical images, images showing local brain activation and images depicting different types of pathologies. Brain activation is detected by means of functional magnetic resonance imaging (fMRI). This is useful e.g. in planning of neurosurgical procedures and in neurological research. To find the activated regions, a sequence of images of the brain is collected while a patient or subject alters between resting and performing a task. The variations in image intensity over time are then compared to a model of the variations expected to be found in active parts of the brain. Locations with high correlation between the intensity variations and the model are considered to be activated by the task. Since the images are very noisy, spatial filtering is needed before the activation can be detected. If adaptive filtering is used, i.e. if the filter at each location is adapted to the local neighborhood, very good detection performance can be obtained. This thesis presents two methods for adaptive spatial filtering of fMRI data. One of these is a modification of a previously proposed method, which at each position maximizes the similarity between the filter response and the model. A novel feature of the presented method is rotational invariance, i.e. equal sensitivity to activated regions in different orientations. The other method is based on bilateral filtering. At each position, this method averages pixels which are located in the same type of brain tissue and have similar intensity variation over time. A method for robust correlation estimation is also presented. This method automatically detects local bursts of noise in a signal and disregards the corresponding signal segments when the correlation is estimated. Hence, the correlation estimate is not affected by the noise bursts. This method is useful not only in analysis of fMRI data, but also in other applications where correlation is used to determine the similarity between signals. Finally, a method for correcting artifacts in complex MR images is presented. Complex images are used e.g. in the Dixon technique for separate imaging of water and fat. The phase of these images is often affected by artifacts and therefore need correction before the actual water and fat images can be calculated. The presented method for phase correction is based on an image integration technique known as the inverse gradient. The method is shown to provide good results even when applied to images with severe artifacts.