As dimensões continentais de alguns países e a distribuição heterogênea da rede hospitalar dificultam o acesso ao atendimento inicial adequado ao trauma de face principalmente aos pacientes residentes em regiões mais remotas. Um modelo de atendimento por telemedicina pode ser uma opção ao atendimento especializado presencial. Os objetivos deste trabalho são apresentar um modelo de atendimento por especialistas à distância, por meio de videoconferência utilizando-se smartphone, e analisar a concordância deste atendimento por telemedicina com o atendimento presencial, considerado padrão ouro. Cinquenta pacientes com trauma de face e suspeita de fratura de face (n=50) foram atendidos, por duas equipes independentes, uma presencialmente e outra por telemedicina. A equipe presencial, que era formada pela equipe de plantão de cirurgia plástica na unidade de emergência, prestou o atendimento à beira do leito (história, exame físico e análise de imagens por tomografia computadorizada). A equipe telemedicina, composta por um médico generalista atendendo à beira do leito, prestou atendimento em conjunto com um cirurgião plástico à distância através de videoconferência com um smartphone. Após cada atendimento as duas equipes responderam a um questionário, com informações sobre dados epidemiológicos, dados do exame físico, sobre indicações de tomografia computadorizada, achados radiológicos da tomografia e conduta. Os dados foram analisados e comparados quanto à concordância das respostas através da análise estatística kappa, cálculo de acurácia, especificidade e sensibilidade. A amostra estudada foi representativa e concordante com a literatura, com predomínio de homens jovens. Acidentes de trânsito e violência interpessoal foram os principais mecanismos causadores do trauma. A concordância das respostas para os achados de exame físico foi considerada substancial (kappa=0,720), para a indicação da tomografia computadorizada foi quase perfeita (kappa=0,957), para os achados na tomografia foi quase perfeita (kappa=0,899) e para definir a conduta também foi quase perfeita (kappa=0,891). A alta concordância dos achados radiológicos nas tomografias computadorizadas de face também foi observada ao se calcular os valores preditivo positivo (VPP=89,9%), preditivo negativo (VPN=99,3%), sensibilidade (94,2%), especificidade (98,8%) e acurácia (98,3%). O estudo concluiu que o modelo de atendimento ao trauma de face à distância por videoconferência via smartphone é factível, encontrando altos índices de concordância quando comparados ao atendimento padrão ouro presencial, sendo uma opção ao atendimento para a triagem de pacientes vítimas de trauma de face em áreas remotas que não têm à disposição o atendimento especializado presencial / The continental size of some countries and heterogeneous distributed hospital network prevent many patients who live in remote areas from getting adequate initial assessment of facial trauma. The author presents a model for trauma assessment through telemedicine, which may be an alternative to face-to-face specialized attending. The goals of this study are presenting a model for non-attending specialized assessment through video conference via smartphones, and analyzing a comparison between telemedicine and face-to-face management, the latter currently being the gold standard. Fifty patients with either a confirmed or suspected diagnosis of facial trauma (n=50) were evaluated by two teams of physicians, one face-to-face and the other one telemedicine-based. The face-to-face team, which was made up by the attending plastic surgery team in the emergency unit, attended the patients at the bedside (physical examination and CT-scan analysis). The telemedicine team was made up by an in-house general practitioner working together with an on-call plastic surgeon through videoconference via smartphones. After each evaluation, both teams answered a similar questionnaire, which contained data concerning the patient\'s epidemiology, physical examination, CT-scan indications and findings, and the treatment option to be followed. The data were analyzed and compared regarding the similarity of answers, with the use of kappa statistics and analysis of data accuracy, sensitivity and specificity. The sample studied was representative and consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The agreement of answers for physical examination findings was considered substantial (kappa=0.720). For CT-scan indications, it was considered almost perfect (kappa=0.957); for CT-scan findings, it was almost perfect (kappa=0.899); and for defining the treatment option, it was also almost perfect (kappa=0.891). High concurrency of face CT-scan findings was also observed after we calculated the positive predictive value (PPV=89.9%), negative predictive value (NPV=99.3%), sensitivity (94.2%), specificity (98.8%) and accuracy (98.3%). The study concluded that the model for non-attending assessment of facial trauma through video conference via smartphones is feasible, showing high concurrence rates when compared to gold-standard in-house assessment, thus being an option for first assessment of facial trauma patients who live in remote areas, where specialized medical teams are not available

As dimensões continentais de alguns países e a distribuição heterogênea da rede hospitalar dificultam o acesso ao atendimento inicial adequado ao trauma de face principalmente aos pacientes residentes em regiões mais remotas. Um modelo de atendimento por telemedicina pode ser uma opção ao atendimento especializado presencial. Os objetivos deste trabalho são apresentar um modelo de atendimento por especialistas à distância, por meio de videoconferência utilizando-se smartphone, e analisar a concordância deste atendimento por telemedicina com o atendimento presencial, considerado padrão ouro. Cinquenta pacientes com trauma de face e suspeita de fratura de face (n=50) foram atendidos, por duas equipes independentes, uma presencialmente e outra por telemedicina. A equipe presencial, que era formada pela equipe de plantão de cirurgia plástica na unidade de emergência, prestou o atendimento à beira do leito (história, exame físico e análise de imagens por tomografia computadorizada). A equipe telemedicina, composta por um médico generalista atendendo à beira do leito, prestou atendimento em conjunto com um cirurgião plástico à distância através de videoconferência com um smartphone. Após cada atendimento as duas equipes responderam a um questionário, com informações sobre dados epidemiológicos, dados do exame físico, sobre indicações de tomografia computadorizada, achados radiológicos da tomografia e conduta. Os dados foram analisados e comparados quanto à concordância das respostas através da análise estatística kappa, cálculo de acurácia, especificidade e sensibilidade. A amostra estudada foi representativa e concordante com a literatura, com predomínio de homens jovens. Acidentes de trânsito e violência interpessoal foram os principais mecanismos causadores do trauma. A concordância das respostas para os achados de exame físico foi considerada substancial (kappa=0,720), para a indicação da tomografia computadorizada foi quase perfeita (kappa=0,957), para os achados na tomografia foi quase perfeita (kappa=0,899) e para definir a conduta também foi quase perfeita (kappa=0,891). A alta concordância dos achados radiológicos nas tomografias computadorizadas de face também foi observada ao se calcular os valores preditivo positivo (VPP=89,9%), preditivo negativo (VPN=99,3%), sensibilidade (94,2%), especificidade (98,8%) e acurácia (98,3%). O estudo concluiu que o modelo de atendimento ao trauma de face à distância por videoconferência via smartphone é factível, encontrando altos índices de concordância quando comparados ao atendimento padrão ouro presencial, sendo uma opção ao atendimento para a triagem de pacientes vítimas de trauma de face em áreas remotas que não têm à disposição o atendimento especializado presencial / The continental size of some countries and heterogeneous distributed hospital network prevent many patients who live in remote areas from getting adequate initial assessment of facial trauma. The author presents a model for trauma assessment through telemedicine, which may be an alternative to face-to-face specialized attending. The goals of this study are presenting a model for non-attending specialized assessment through video conference via smartphones, and analyzing a comparison between telemedicine and face-to-face management, the latter currently being the gold standard. Fifty patients with either a confirmed or suspected diagnosis of facial trauma (n=50) were evaluated by two teams of physicians, one face-to-face and the other one telemedicine-based. The face-to-face team, which was made up by the attending plastic surgery team in the emergency unit, attended the patients at the bedside (physical examination and CT-scan analysis). The telemedicine team was made up by an in-house general practitioner working together with an on-call plastic surgeon through videoconference via smartphones. After each evaluation, both teams answered a similar questionnaire, which contained data concerning the patient\'s epidemiology, physical examination, CT-scan indications and findings, and the treatment option to be followed. The data were analyzed and compared regarding the similarity of answers, with the use of kappa statistics and analysis of data accuracy, sensitivity and specificity. The sample studied was representative and consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The agreement of answers for physical examination findings was considered substantial (kappa=0.720). For CT-scan indications, it was considered almost perfect (kappa=0.957); for CT-scan findings, it was almost perfect (kappa=0.899); and for defining the treatment option, it was also almost perfect (kappa=0.891). High concurrency of face CT-scan findings was also observed after we calculated the positive predictive value (PPV=89.9%), negative predictive value (NPV=99.3%), sensitivity (94.2%), specificity (98.8%) and accuracy (98.3%). The study concluded that the model for non-attending assessment of facial trauma through video conference via smartphones is feasible, showing high concurrence rates when compared to gold-standard in-house assessment, thus being an option for first assessment of facial trauma patients who live in remote areas, where specialized medical teams are not available

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

The current period of rapid technological change, particularly in the area of mediated communication, has combined with new philosophies of education and market forces to bring upheaval to the realm of higher education. Technical capabilities exceed our knowledge of whether expenditures on hardware and software lead to corresponding gains in student learning. Educators do not yet possess sophisticated assessments of what we may be gaining or losing as we widen the scope of distributed learning. The purpose of this study was not to draw sweeping conclusions with respect to the costs or benefits of technology in education. The researcher focused on a single issue involved in educational quality: assessing the ability of a student to complete a course. Previous research in this area indicates that attrition rates are often higher in distributed learning environments. Educators and students may benefit from a reliable instrument to identify those students who may encounter difficulty in these learning situations. This study is aligned with research focused on the individual engaged in seeking information, assisted or hindered by the capabilities of the computer information systems that create and provide access to information. Specifically, the study focused on the indicators of completion for students enrolled in video conferencing and Web-based courses. In the final version, the Distributed Learning Survey encompassed thirteen indicators of completion. The results of this study of 396 students indicated that the Distributed Learning Survey represented a reliable and valid instrument for identifying at-risk students in video conferencing and Web-based courses where the student population is similar to the study participants. Educational level, GPA, credit hours taken in the semester, study environment, motivation, computer confidence, and the number of previous distributed learning courses accounted for most of the predictive power in the discriminant function based on student scores from the survey.

Atualmente, novas alternativas para as redes de computadores estão surgindo, tais como ReMAVs (Redes Metropolitanas de Alta Velocidade), Internet2, RNP2 e Advanced ANSP (Academic Network at São Paulo). Neste novo cenário, alta largura de banda e qualidade de serviço são aspectos fundamentais. Tais redes têm como objetivo suportar o tráfego de áudio e vídeo em tempo real com qualidade, o que viabilizará o desenvolvimento de aplicações avançadas - por exemplo, aplicações de videoconferência - que exigem maiores capacidades das mesmas. Este projeto apresenta, na revisão bibliográfica, conceitos de videoconferência; suas principais características; e algumas considerações sobre os tipos de cenários e o ambiente dos participantes. Neste projeto foi realizada uma avaliação de sistemas de videoconferência baseando-se em parâmetros que foram estabelecidos de acordo com a recomendação ITU-T F.730. Com o desenvolvimento deste trabalho foi possível estabelecer e validar um conjunto mínimo de parâmetros para avaliação que poderá auxiliar na escolha de sistemas de videoconferência. / This project aims to present concepts of videoconference, some considerations about scenarios and environment for videoconference users, considered at the time of the evaluation. In this project was done an evaluation of videoconference systems based in parameters established under ITU-T F.730 recommendation. Futhermore, it was possible establishing and validating a minimum set of parameters for evaluation which is usefull to choose videoconference systems.

Thesis (Ph.D.)--Syracuse University, 2008. / "Publication number: AAT 3323039."

Thesis (doctoral)--Universität zu Köln, 2003. / Includes bibliographical references (p. 553-603).

Orientador: Elisabete Monteiro de Aguiar Pereira / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-18T08:31:53Z (GMT). No. of bitstreams: 1 Oliani_Gilberto_M.pdf: 991542 bytes, checksum: c724416be2629d51904a58e5828d3b44 (MD5) Previous issue date: 2011 / Resumo: Este trabalho objetivou pesquisar como ocorreu o processo de ensino e aprendizagem, com e por meio da videoconferência, durante o primeiro curso de mestrado stricto sensu semipresencial, ministrado na sala de videoconferências da Faculdade de Educação - FE da Unicamp, em 2006, com o Centro Federal de Educação Tecnológica - CEFET de Cuiabá por meio do Programa Minter. Participaram 10 professores da Unicamp: 06 ministraram aulas na FE e 04 em Cuiabá. Participaram 30 alunos: 20 assistiram aulas na sala de videoconferência da FE e 10 em Cuiabá. Adotamos a metodologia de pesquisa qualitativa e documental e usamos como instrumentos de análise: vídeos das videoconferências; relatórios durante videoconferências; relatórios de acessos dos alunos aos vídeos; questionários de alunos e professores. Visamos conhecer como professores e alunos consideram a educação semipresencial, como ocorre a interação professor-aluno, como professores atuam com o uso da videoconferência e reconhecer quais, as necessárias competências docentes, qual o impacto da tecnologia para o ensino semipresencial e as tecnologias a serem aprimoradas para a produção midiática e o uso em videoconferência. A análise demonstrou que a implantação de cursos com o uso da videoconferência demanda novas formas no processo de ensino e aprendizagem; que há necessidade do professor desenvolver competências pedagógicas, didáticas e técnicas para o ensino semipresencial com o uso da tecnologia; que é relevante o preparo dos conteúdos midiáticos apropriadamente. Acreditamos que o trabalho possa oferecer subsídios e diretrizes para a implantação de um Programa de Preparação de Professores, na Faculdade de Educação, para o uso da videoconferência em cursos semipresenciais. / Abstract: This study has aimed to investigate how took place the teaching and learning process, with and through videoconferencing during the first stricto sensu Masters blended course, taught in the videoconferencing room at the Faculty of Education - FE Unicamp in 2006 with the Federal Center for Technological Education - CEFET of Cuiabá, through Minter Program. We adopted a qualitative and documentary research methodology and used as analytical tools: recorded videoconferencing sessions; reports during videoconferences sessions; students reports regarding recorded videos, questionnaires received from students and teachers. We aimed to know how teachers and students see the semi-distance education, how the interaction between teacher and student happens, how teachers behave with the use of videoconferencing and to recognize which are the necessary teacher skills, what is the impact of technology to the semidistance education and the technologies to be improved to the mediatic production and the use in videoconferencing. The analysis has shown that the implementation of courses using videoconferencing demands new ways in the teaching and learning process; that the teacher needs to develop pedagogical, didatic and technical skills to the semi-distance education with the use of technology. We believe that this study can offer subsidies and guidelines to the implementation of a Teacher Preparation Program, in the Faculty of Education, to the use of videoconferencing in semi-distance courses. / Mestrado / Ensino e Práticas Culturais / Mestre em Educação

Abstract The background to this study was, firstly, the shortage of doctors in the remote areas in Finland and secondly, the possibilities to use new IT-technology to the organization of health care services. The aim was to find out whether it is possible to organize consultations between GPs and patients as remote work through the use of videoconferencing equipment. In literature the results of the studies on teleconsultations in remote areas have been positive in many specialties from the point of view of operating the system, patient satisfaction and costs. However few studies of teleconsultations are available in the area of general practice. The aims of this study were to identify the technical solutions what teleconsultation requires and to report on the implementation of the solutions and process of the teleconsultations. Two hypotheses were to be tested in the study: first that patients treated in the traditional way were more satisfied than teleconsultation patients: the second was that while a sizeable patient group could be treated remotely, teleconsultation would prove to be more expensive than the traditional consultation. The teleconsultation part of the study was organized so, that the patient and a trained nurse were in Puolanka Health Center and the GP in the city of Kajaani (100 kilometers away). The videoconferencing system worked on the LAN in the Kainuu area. The study group consisted of two random groups, 508 patient visits were treated as remote work and 490 visits were treated in the traditional way in Puolanka Health Center. In addition to the diary of technical problems and the patient satisfaction questionnaires the measures of the study were the analysis of success in the consultation and the account of the return consultations in the remote group. A part of consultations were videotaped and the success in transfer of information was analysed from those tapes. The cost of the consultation was calculated, and sensitivity analysis was used to examine the cost of teleconsultations for diabetic patients. The results indicated that with a local area network it is possible to build a well functioning, reasonably priced teleconsultation system. The patients were equally satisfied with the teleconsultation as with the traditional consultation. The transfer of information in teleconsultations was good enough to make reliable diagnoses. It is estimated that three out of four from a random population in general practice could be treated in teleconsultation. Although it is about 30% more expensive to treat patients by teleconsultation than by the traditional method, the advantages of the teleconsultation model are that it enables an efficient transfer of information and know-how regardless of distance, and that it enhances considerably the traditional scope of health care services. / Tiivistelmä Tutkimuksen lähtökohtana oli syrjäisten alueiden lääkäripula ja toisaalta telelääketieteen mukanaan tuomat mahdollisuudet järjestää palveluja uudella tavalla. Tarkoituksena oli selvittää, voidaanko lääkärin vastaanottopalveluita tuottaa etätyönä videoneuvottelujärjestelmää käyttäen. Kirjallisuuden mukaan tulokset monien erikoisalojen televideokonsultaatioista olivat myönteisiä toimivuuden, potilastyytyväisyyden ja kustannusten näkökulmista: mutta perusterveydenhuollon tutkimuksia etävastaanotosta ei löytynyt. Tutkimuksen tavoitteena oli selvittää millaisia teknisiä ratkaisuja etävastaanotto vaatii ja kuvata valitun järjestelmän toimivuus sekä etävastaanottotapahtuman kulku. Hypoteesissa oletettiin tavallisella vastaanotolla hoidettujen olevan hieman etä-vastaanotolla käyneitä tyytyväisempiä ja että merkittävä osa potilasjoukosta voidaan hoitaa etätyönä sekä että etävastaanottokäynti on kalliimpi kuin tavallinen vastaanottokäynti. Tutkimus toteutettiin siten, että etävastaanottotilanteessa potilas oli hoitajan kanssa Puolangan terveyskeskuksessa ja lääkäri Kajaanissa. Yhteys hoidettiin videoneuvottelujärjestelmällä, joka käytti Kainuun atk-alueverkkoa. Tutkimusjoukko koostui kahdesta satunnaistetusta ryhmästä, joista 508 vastaanottokäynnin ryhmä hoidettiin etätyönä ja toinen 490 käynnin ryhmä tavallisella vastaanotolla Puolangan terveyskeskuksessa. Mittareina käytettiin teknisten ongelmien päiväkirjaa ja potilastyytyväisyyskyselyä, vastaanoton onnistumisen arviointia ja etävastaanoton uusintakäyntien tarpeen selvitystä. Tiedon siirtymisen onnistumista tutkittiin siten, että analysoitiin joukko videonauhoitettuja vastaanottoja, laskettiin vastaanottokäyntien kustannukset ja tarkasteltiin herkkyysanalyysien avulla etävastaanottomallilla toteutetun diabetesetävastaanoton kustannuksia. Tuloksien mukaan on mahdollista rakentaa toimiva, kohtuuhintainen etävastaanottojärjestelmä, kun käytetään alueellista atk-verkkoa. Potilaat olivat vähintään yhtä tyytyväisiä etävastaanottoon kuin tavalliseen. Tiedon siirtyminen etävastaanotolla on riittävän hyvä luotettavien päätelmien tekemiseksi. Noin kolme neljäsosaa valikoimattomasta perusterveydenhuollon potilasjoukosta voitiin hoitaa etätyönä. Lääkärin oma arvio vastaanoton onnistumisesta oli kuitenkin parempi perinteisessä vastaanotossa ja etävastaanotolla jouduttiin määräämään hieman enemmän laboratoriokokeita. Kun etävastaanottomallia käytetään korvaamaan tavanomainen vastaanottotapa ilman toiminnallisia ja organisatorisia muutoksia, se on noin 30 % kalliimpi kuin tavanomainen. Etävastaanottomalli kuitenkin mahdollistaa tehokkaan tiedon ja osaamisen siirtymisen välimatkasta riippumatta ja luo edellytykset uudenlaisille tavoille organisoida terveydenhuollon palveluita.

Prior to the development of interactive television, schools that were either geographically isolated or financially restricted were often unable to provide courses that may have been essential for students. Interactive television has helped such school districts provide appropriate courses for their students. Because student self-efficacy is a significant indicator of student success, the relationship between distance learning and students' self-efficacy requires research. The problem of the study was to examine the impact of site location in a distance learning environment on student self-efficacy in Spanish instruction. The participants in this study were junior high school students enrolled in distance-learning Spanish classes at two junior high schools in a north central Texas independent school district. All of the students were taught by the same instructor. The age range of the students was from 11 to 14 years of age, and all students were in either the seventh or the eighth grade. Students took a modified version of the Motivated Strategies for Learning Questionnaire at the end of each treatment. Using the counterbalanced design, each subject was matched to themselves. T-tests for nonindependent samples were used to compare the two treatments. The findings indicate that there is no significant difference in the level of student self-efficacy by site location. The findings in this study support the use of distance learning as a medium for Spanish instruction at the junior high school level. Because of the strong statistical relationship between self-efficacy and student performance, teachers and administrators can reasonably believe that site location will not hamper their students' success.