Applications of Telehealth in the practice, upgrading of knowledge, and communication of physicians with their colleagues and patients in Canada was explored in this study. The research used exploratory-grounded theory to investigate the opinions of practicing clinicians regarding the use of Telehealth. The study involved conducting semi-structured interviews with physicians who were using or might in the future use Telehealth in their practice. This study was designed to assess the major advantages and shortcomings that Telehealth has to offer in the field of medicine. The research found that clinicians predominantly had a very positive view of Telehealth, although some minor concerns were expressed with respect to the use of Telehealth in private offices and the home (rather than in the hospital). The data indicated that Telehealth can improve overall patient care by bettering the speed and accuracy of communication and diagnosis and the subsequent treatment of patients, saving physicians and patients time and money, reducing waiting lists, aiding the environment, reducing emergency visits and hospitalizations, addressing shortages of physicians (particularly in rural areas), increasing access to specialists, and enabling convenient distance education. These are just some of the many benefits of Telehealth which outweigh its disadvantages. This study also was designed to extract clinicians’ opinions on avenues for improving Telehealth, which thus led to implications for future research. Barriers to the use of Telehealth were found to include concerns about security and IT support, lack of public knowledge of Telehealth’s existence, and installation and maintenance costs for the necessary equipment in the private sector. The study suggests that Telehealth will become more widely available and accessible to the general public. The study also proposes that, through increased governmental support and funding, Telehealth should be advertised and promoted, researched in more depth (in part, to discourage misconceptions regarding Telehealth), collaborated on by stakeholders, and expanded. / Graduate

O objetivo do presente trabalho de pesquisa é reduzir o nível de atenção requerido para o uso do sistema Borboleta por meio de reconhecimento de fala na navegação através das funcionalidades do sistema, permitindo ao profissional dar maior atenção ao paciente. A metodologia de desenvolvimento do projeto inclui uma revisão bibliográfica para definir o estado da arte da área, uma pesquisa sobre o software disponível para reconhecimento de fala, uma coleta de dados dos comandos do sistema em português brasileiro para treinar e testar o sistema, uma etapa de projeção e desenvolvimento para definir a arquitetura de integração com o Borboleta, e uma fase de testes para medir a precisão do sistema e seus níveis de usabilidade e aceitação por parte do usuário. / The current document presents research that addresses the goal of reducing the user attention level required by Borboleta operation by providing speech recognition capabilities to augment navigation through the software functions, allowing the professional to pay more attention to the patient. The project methodology is composed of a bibliography revision to establish the state-of-the-art of the field, a review of available speech recognition software, data collection of Brazilian utterances to train and test the system, a design and development stage that defined the system architecture and integration with Borboleta and a testing process to measure the system accuracy, its usability and acceptance level.

Grâce au progrès de la médecine et à l’essor des technologies, l’espérance de vie ne cesse de progresser, cette augmentation s’accompagnant d’une apparition de besoins spécifiques pour les seniors. Sachant que huit français sur dix souhaitent continuer à vivre à domicile en cas de perte d’autonomie, équiper les seniors d’une solution de suivi de leur état de santé à distance pourrait le leur permettre et ce dans de bonnes conditions. Dans ce contexte, nous avons identifié trois verrous que nous avons cherché à lever au cours de cette thèse. Le premier concerne l’interopérabilité des capteurs de santé qui se trouve mise à mal par l’adoption massive des protocoles propriétaires par les fabricants. Pour y remédier, nous proposons une passerelle facilitant la communication avec les capteurs de santé, qu’ils soient médicaux ou de bien-être, en faisant abstraction des multitudes de protocoles de communication propriétaires et standards. Le deuxième obstacle concerne l’erreur de mesure due à la manipulation d’un capteur de santé par des personnes non initiées en absence d’un professionnel de santé. Nous illustrons cette problématique à travers l'exemple d'un tensiomètre de poignet pour lequel nous proposons une méthode permettant de guider l’utilisateur dans son bon positionnement en respectant les recommandations des fabricants grâce à l'apport d'une montre connectée. Le dernier challenge a trait à la question de la multimodalité et plus précisément à la contextualisation de la mesure. Il s'agit ici de la fusion de données provenant d’un ensemble d’objets connectés dans un système de télésuivi décliné sous l'angle de la prise de la tension artérielle dans l'objectif de placer l’usager en situation d'effectuer une mesure de tension conforme aux recommandations des sociétés savantes. L'expérimentation qui a été conduite a permis d’évaluer l’acceptabilité du système proposé. / Thanks to medical progress and new technologies, life expectancy is growing continuously leading to the emergence of specific needs for elderly. With eighty percent of French willing to keep living at home even with loss of autonomy, offering a remote health monitoring system would allow them to do so in good conditions. In this context, we identified three challenges. The first one concerns health sensors interoperability which is declining because of proprietary protocols largely adopted by manufacturers in their products. To deal with this issue, we propose a middleware that simplifies the communication with the multitude of protocols, proprietary and standard, to improve interoperability with both medical and wellness devices. The second challenge reports to reliability and more particularly to measurement errors due to device handling by the user in absence of clinician. We illustrate this point with a wrist blood pressure monitor and propose a method that guides the user in properly positioning the device thanks to a smartwatch. The last challenge relates to multimodality and more precisely to the measure contextualization. It consists of combining different types of data from a set of sensors in a health monitoring system to ensure that blood pressure is measured in compliance with learned societies recommendations. The experiment we have conducted allows to evaluate the users' acceptability of the proposed solution.

Esta pesquisa analisou as concepções, expectativas e vivências dos docentes, discentes e residentes médicos, frente à proposta pedagógica da disciplina optativa Telessaúde do curso de medicina da Universidade federal do Tocantins - UFT, como uma estratégia inovadora de formação de recursos humanos em saúde. Para o alcance dos objetivos propostos utilizou-se uma metodologia quali-quantitativa por meio de estudo exploratório e descritivo, utilizando análise documental, estudo de caso e um instrumento de percepção atitudinal do tipo Likert, que foi aplicado aos docentes, preceptores e discentes dos cursos da saúde (medicina, enfermagem e nutrição), jornalismo e ciências da computação da Universidade Federal do Tocantins que cursaram a disciplina Optativa Telessaúde no período de 2011 a 2014. Foram distribuídos 30 instrumentos, com 28 asserções cada, randomizadas por cinco dimensões: A disciplina optativa Telessaúde como programa estimulador da inovação curricular; A disciplina optativa Telessaúde como ferramenta qualificadora da gestão em saúde (redes de atenção); A disciplina optativa Telessaúde como ferramenta contributiva na fixação médica no Tocantins; A disciplina optativa Telessaúde como ferramenta contributiva no fortalecimento da Educação Permanente em Saúde – EPS; A disciplina optativa Telessaúde como ferramenta de estímulo a interprofissionalidade. Nenhuma asserção foi perdida no processo de validação quanto à dispersão, evidenciando uma ótima validação de conteúdo. A confiabilidade foi testada pela fórmula de Spearman – Brown usando o método teste – reteste com R = 0,97, pelo teste de homogeneidade com p-valor de 0,032 e ANOVA com p –valor de 0,059, o que configurou excelente densidade estatística para os resultados encontrados. Todas as dimensões ficaram em zona de conforto. A análise dos dados permite a sustentação de que aspectos inovadores foram identificados na construção e desenvolvimento da referida disciplina tais como: assertividade na escolha dos conteúdos, uso adequado de metodologias ativas de ensino-aprendizagem bem como das TICs. Algumas dificuldades foram identificadas como número insuficiente de docentes, pouca participação dos preceptores apontando para a necessidade de aprimoramento da integração ensino-serviço e por último eventuais dificuldades na conectividade. Este estudo traz subsídios para avanços na referida disciplina à luz dos princípios da inovação pedagógica, aprendizagem significativa e interprofissionalidade. / This research analyzed the conceptions, expectations and experiences of the teachers, students and medical residents, forefront of the pedagogical proposal of the optional discipline Telehealth from the Medicine´s course of the Federal University of Tocantins, like an innovative strategy of training human resources in health. To reach the proposed objectives was used a methodology qualitative and quantitative through exploratory and descriptive study, using document analysis, case study and an attitudinal perception instrument like Likert, that was applied to teachers, preceptors and students of health courses (medicine, nursing and nutrition), journalism and computer science at the Federal University of Tocantins who attended the optional discipline Telehealth in the period 2011 to 2014. 30 instruments were distributed, with 28 statements each, randomized for five dimensions: the optional discipline telehealth as a stimulator of curriculum innovation program; the optional discipline telehealth as health management tool qualifying (care networks); the optional discipline telehealth as contributory tool in the medical setting in Tocantins; the optional discipline telehealth as contributory tool in the strengthening of Continuing Health Education; the optional discipline telehealth as a stimulus tool inter professionalism. No proposition had been lost in the validation process on dispersed, showing a great validation of content. The reliability was tested by the Spearman – Brown´s formula using the test-retest method with R = 0,97, by the test homogeneity with p-value 0,032 and ANOVA with p-value 0,059, which sets great statistical density for the founded results. All dimensions were in the comfort zone. The data analysis allows the support that innovative aspects have been found in the construction and development from said subject such as: assertiveness in the choice of contents, proper use of teaching and learning active methodologies well as the TIC´s. Some difficulties have been identified as insufficient number of teachers, low participation of preceptors pointing to the need to improve the teaching-service integration and lastly any difficulties in connectivity. This study provides subsidies for advances in the discipline in the light of the principles of pedagogical innovation, meaningful learning and inter professionalism.

Esta pesquisa teve por objetivo avaliar um website com informações da área de Fonoaudiologia com enfoque em Doença de Parkinson. Foi elaborado um website contendo informações sobre a temática, com linguagem simples, clara e objetiva, com conteúdos concisos, embasados em livros, artigos indexados em bases de dados e manuais sobre a temática. A elaboração do website seguiu as etapas: análise e planejamento, modelagem, implementação e avaliação. Foram convidados avaliadores que fizeram parte das seguintes categorias: idoso (I), cuidador de idoso (CI) e fonoaudiólogo (F). Os grupos preencheram um formulário online com informações sobre identificação, frequência de uso da internet e nível de escolaridade. A amostra foi composta por 45 participantes sendo a maioria do sexo feminino (64,4%), sendo 15 idosos (média etária 68,13 anos), 15 cuidadores de idosos (média etária de 32,20 anos) e 15 fonoaudiólogos (média etária de 26,13 anos). A análise estatística foi realizada por meio do teste Kruskal-Wallis e Coeficiente de Correlação de Spearman. O conteúdo do website foi avaliado como adequado com maior classificação no submenu S4 (84%) e menor nos submenus S5 e S8 (77%). A comparação entre os 3 grupos das notas atribuídas ao conteúdo pelo teste de Kruskal-Wallis não mostrou diferença estatisticamente significante entre eles em nenhum dos submenus. Houve correlação significativa foi do grupo fonoaudiólogo no submenu S3, em relação ao tempo (p=0,006) e idade (p=0,014) com as notas atribuídas. O Coeficiente de Correlação de Spearman deu negativo implicando que quanto maior a idade e o tempo de formado do fonoaudiólogo, menores foram as notas atribuídas no submenu S3. Conclui-se que os conteúdos elaborados fundamentados em literatura científica, compondo um website de fonte de consulta e de complementação de informações confiáveis sobre Doença de Parkinson. / This research aimed to evaluate a website with information from the field of Speech Therapy with a focus on Parkinson\'s Disease. A website containing information on the subject was developed with simple, clear and objective language, with concise content, based on books, articles indexed in databases and manuals on the subject. The preparation of the website followed the steps: analysis and planning, modeling, implementation and evaluation. The evaluators were invited to participate in the following categories: elderly (I), caregiver of elderly (CI) and speech therapist (F). The groups completed an online form with information on identification, frequency of internet use and level of education. The sample consisted of 45 participants, the majority being female (64.4%), 15 elderly (mean age 68.13 years), 15 elderly caregivers (mean age 32.20 years), and 15 speech pathologists (average age of 26.13 years). Statistical analysis was performed using the Kruskal-Wallis test and Spearman\'s correlation coefficient. The content of the website was evaluated as \"appropriate\" with higher ranking in sub-menu S4 (84%) and lower in sub-menus S5 and S8 (77%). The comparison between the 3 groups of grades attributed to the content by the Kruskal-Wallis test did not show a statistically significant difference between them in any of the submenus. There was a significant correlation between the speech-language pathologist group in submenu S3, in relation to time (p = 0.006) and age (p = 0.014) with assigned scores. Spearman\'s Correlation Coefficient was negative, implying that the higher the age and the training time of the speech-language pathologist, the lower the scores assigned in submenu S3. It is concluded that the contents prepared based on scientific literature, composing a source website for consultation and complementing reliable information on Parkinson\'s Disease.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Este estudo traz uma reflexão sobre os desafios de educação permanente dos Agentes comunitários de Saúde inseridos no projeto Telessaúde/Rio de Janeiro. Temos como objetivo geral discutir o processo de educação permanente desses colaboradores inseridos no Projeto Telessaúde, Núcleo Rio de Janeiro, ressaltando os usos reais e potenciais das ferramentas da educação à distância, na perspectiva da educação crítica. Os objetivos específicos são: descrever o perfil demográfico de utilização de ferramentas de educação permanente a distância de Agente comunitário de saúde (ACS) do Estado do Rio de Janeiro inseridos no Telessaúde RJ, segundo as regiões administrativas do Rio de Janeiro; descrever e analisar a participação dos ACS no Telessaúde RJ durante o ano de 2009 nas atividades de teleconferências; discutir, com base na participação dos ACS no Telessaúde RJ, o papel da mediação da internet e das ferramentas do Telessaúde RJ no seu trabalho, na perspectiva pedagógica crítica. A metodologia utilizada é quali-quantitativa, no intuito de descrever, quantificar e classificar os dados em relação aos ACS que estão inseridos no Telessaúde. A coleta de dados se deu a partir de um relatório das oficinas presenciais e da análise de 100 formulários preenchidos pelos ACS nos workshops realizados nas regiões administrativas do Rio de Janeiro e no registro de teleconferências. Resultados: o relatório das oficinas nos mostrou que os ACS vêem no Telessaúde não só um espaço para troca de experiências, mas também para a educação permanente em serviço. Foi evidenciando na análise dos formulários, que a faixa etária na amostra de 100 dos ACS é de 23 a 38 anos com 59 ACS. Além disso, observou-se que os ACS utilizam a internet diariamente, com predominância do vinculo empregatício por CLT, acessam SIAB e DATASUS com frequência, realizam trabalho multidisciplinar com médicos e enfermeiros, propõem temas para capacitações pelo Telessaúde, em relação à assistência às teleconferências de 555 ACS no ano de 2009. Concluímos que a inserção do ACS no Telessaúde, com vistas à educação permanente, é uma real possibilidade e o estudo nos mostrou que eles vêem esta proposta do Ministério da Saúde como inovadora e viável. / This study reflects on the challenges of continuing education for the staff of Community Health Telehealth, being part of the project in Rio de Janeiro. We have as a general objective: to discuss the process of continuing education for ACS inserted in Telehealth Project, Rio de Janeiro, emphasizing the uses, actual and potential tools of distance education from the perspective of critical education. Specific Objectives: to describe the demographic profile of usage of tools for lifelong learning at a distance of ACS of Rio de Janeiro RJ inserted in Telehealth, according to the administrative regions of Rio de Janeiro; to describe the participation of the ACS for the RJ Telehealth, in year 2009 as well as the activities of teleconferencing, to discuss, based on participation in the ACS Telehealth RJ, the mediating role of the Internet and RJ Telehealth tools in their work, the critical pedagogical perspective. The methodology is quali-quantitative, in order to describe, quantify and classify data in relation to the ACS that are inserted in Telehealth. Data collection took place from a report of the workshops, and the analysis of 100 completed forms by the ACS in workshops held in the administrative regions of Rio de Janeiro, and the record teleconferences. Results: related to the report of the workshops It showed us that they see the ACS Telehealth not only as a space for exchanging experiences, but as a space for continuing education in service. It was evident in the analysis of the forms in relation to age in the sample of 100 of these ACS were ranging from 23 to 38 years with 59 CHA, the ACS uses the Internet daily, with majority of employment contract by CLT, with access SIAB And DATASUS often perform multidisciplinary working proposes topics for training for Telehealth, and assists with the ACS conference of 555 in 2009. We conclude that the insertion of ACS in Telehealth, aiming at continuing education is a real possibility, and the study showed us that they see this proposal from the Ministry of Health as an innovative and viable.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social and communication deficits, as well as restricted, repetitive, and stereotyped behaviors, interests, and activities (American Psychiatric Association, 2013). Although important relationships have been shown and described among the issues of challenging behavior, parent stress, and parenting sense of competence for families of children with ASD, there is a shortage of intervention programs appropriately suited for families which target these issues. Some programs have been developed and tested, but none is directly applicable for the target population. This is notable because of the connections drawn in the literature between families of children with ASD and the issues of challenging child behavior, parent stress, and parent sense of competence. Additionally, access to ASD-trained clinicians and research supported delivery options for families in rural areas is severely limited. COMPASS for Hope (C-HOPE) is an 8-week parent intervention program that was developed with the option of telehealth or face-to-face delivery. This study examined an asynchronous group discussion board adaptation of C-HOPE, which was developed to further support underserved families. Three main hypotheses were made: (1) Parents will report less challenging child behaviors post-intervention; (2) Parents will report lower levels of stress post-intervention; and (3) Parents will report higher sense of competency post-intervention. With a small sample size of 10, paired-samples t-tests were conducted and effect sizes were calculated to compare the pre- and post-intervention scores for challenging child behavior, parent stress, and parenting sense of competence. There was a statistically significant difference in the scores for challenging child behavior pre-intervention (M = 146.40, SD = 35.36) and post-intervention (M = 123.10, SD = 28.35); t(9) = 3.05, p = 0.01. The effect size for this analysis (d = 0.73) was found to fall between Cohen’s (1988) convention for a medium (d = 0.50) to large (d = 0.80) effect. There was also a statistically significant difference in the scores for parent stress pre-intervention (M = 122.60, SD = 25.73) and post-intervention (M = 109.50, SD = 26.47); t(9) = 2.51, p = 0.03. There was a medium effect size for this analysis (d = 0.50). There was not a significant difference in the scores for parenting sense of competence pre-intervention (M = 55.20, SD = 17.59) and post-intervention (M = 50.50, SD = 17.51); t(9) = 1.11, p = 0.30. Additionally, treatment adherence and social validity for the intervention were acceptable. The implications of these findings are discussed.

The primary purpose of this study was to craft and validate a set of core competencies necessary for an e-Helper to possess. A review of the literature guided the creation of the initial competencies. Following expert review, the competencies were revised and formatted into an online survey which was sent to respondents in four target groups: (a) school administrators who had adopted telepractice as a service delivery model; (b) SLPs experienced in telepractice within a school setting; (c) current e-Helpers, and (d) scholars experienced in telepractice. Sixty percent (21 out of 35) of the competencies were rated as “important” by 76-100% of respondents. The remaining competencies could be more or less important dependent on workplace requirements.

Congestive heart failure (CHF) affects an estimated 5.1 million Americans over the age of 20. The purpose of this quantitative study was to determine whether there is a difference in the Quality of Life (QOL) for Congestive heart failure patients receiving care through telehealth compared to patients receiving face-to-face care (usual care). Guiding this project was the Self-Care Model of Chronic Illness because the primary outcome of the self-care model is illness stability, well-being, and quality of life. Seventy-seven veterans with Heart Failure (HF) from the Washington D.C. Veterans Affairs Medical Center (VAMC) participated in the project. Forty reported they were receiving telehealth and 37 reported that they were receiving face-to-face care. The average participant age was 67 years with a range of 44 to 93 years. Seventy-five of the participants were male and 2 were female. Sixty-four participants were Black and 12 were White. The Minnesota Living with Heart Failure (MLHF) questionnaire average score for the telehealth group was 49.4 (SD = 28.7) and the face-to-face care group was 37 (SD = 27.9). With equal variance assumed, there was no significant difference between MLHF scores in the telehealth group compared to the usual care group (t = -1.91, p > .05). Thus, opportunities for using telehealth without negatively affecting patient outcomes, such as QOL, are plausible. It can be concluded that providing services using home telehealth for HF patients may produce outcomes that are equivalent to those receiving traditional services.

Care Coordination Home Telehealth (CCHT) maintains a positive impact on the delivery of patient care in the primary care clinic at the Department of Veterans Administration Medical Center (VAMC). This quality improvement initiative targets patients with chronic conditions such as diabetes, hypertension, heart failure, and chronic obstructive pulmonary disease. These patient are frequently seen in the emergency room, and are often admitted to the hospital, where they saturate the outpatient clinics' waiting room with multiple walk-ins. CCHT has, to some extent, reduced walk-ins, emergency room visits, and hospitalization while minimizing the strain on access to care at the VAMC. Sustaining self-management skills of veterans with chronic conditions at the VAMC continues to impose challenges. In this project, retrospective data from 95 randomly selected charts reviewed during a 2-year period were used to compare hospitalizations, emergency room visits, and primary care visits. The findings of the study indicate veterans enrolled in Home Telehealth show positive social change. The social change is evidenced by change in behavior patterns, such as maintaining a healthy diet, performing daily physical activity, and compliance with medication administration. Enrolled veterans had better outcomes regarding hospitalization, emergency room visits, and primary care visits. The data highlighted the need for incorporating disease-specific protocols guiding care coordinators at first point of contact with the veteran patient. Following these protocols may enhance communication style that matches the patient's stage of behavioral change with interventions.