Teleconsulta síncrona na especialidade de estomatologia

Orientador: Prof. Dr. Cassius Carvalho Torres PereiraDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Odontologia. Defesa : Curitiba, 29/07/2019.Inclui referênciasResumo: A teleassistência é a vertente da Teleodontologia que possibilita o suporte, direcionamento ou supervisão a cirurgiões-dentistas em áreas sem acesso a especialistas. Por meio da transmissão de informações em relação ao diagnóstico e tratamento de lesões orais, a estratégia evita deslocamentos desnecessários e favorece o diagnóstico precoce nos casos de malignidade. O objetivo deste estudo foi avaliar a viabilidade, acurácia e satisfação do paciente em relação à teleconsulta síncrona em Estomatologia, por meio de videochamadas em um aplicativo de smartphone. Indivíduos com lesões orais encaminhados para atendimento especializado foram avaliados pessoalmente por um cirurgião-dentista generalista que realizou fotografias das lesões com um smartphone. As imagens foram enviadas por um aplicativo de mensagens instantâneas a um especialista em Estomatologia, com quem iniciou-se uma chamada de vídeo no mesmo aplicativo. Após entrevistar o paciente, o especialista formulou uma hipótese diagnóstica e sugestões para o manejo do caso. Ao final da consulta, o teleconsultor avaliou a qualidade das imagens e da conexão à internet durante a chamada. Além disso, o participante respondeu a um questionário sobre a experiência do atendimento à distância. Em seguida, um segundo especialista, cego para a primeira avaliação, examinou pessoalmente a lesão bucal e definiu um diagnóstico, que foi considerado como padrão-ouro. Trinta e três indivíduos, de 25 a 83 anos, apresentaram 41 lesões orais. A duração média das teleconsultas foi de aproximadamente 10 minutos. Em 92,7% dos casos houve conformidade entre o telediagnóstico e o padrão-ouro, atingindo um coeficiente de concordância "quase perfeito" (k = 0,922). Os homens avaliaram melhor o modelo do que as mulheres (p = 0,02), bem como pacientes que experimentaram conexão boa e razoável durante a teleconsulta (p = 0,03). Os resultados sugerem que a teleconsulta síncrona pode fornecer diagnóstico remoto confiável por meio do suporte aos profissionais de saúde da atenção básica no manejo das lesões orais, com boa aceitação entre os pacientes.Abstract: Teleassistance is the Teledentistry section that enables the support, direction or supervision of dental surgeons in areas without access to specialists. Through the transmission of information regarding the diagnosis and treatment of oral lesions, the strategy avoids unnecessary displacements and favors the early diagnosis in cases of malignancy. The aim of this study was to evaluate the feasibility, accuracy, and satisfaction of the patient in relation to synchronous teleconsultation in oral medicine, through video calls in a smartphone application. Individuals with oral lesions referred for specialized care were evaluated in person by a generalist dentist who took photographs of the lesions with a smartphone. The images were sent through an instant messaging application to a specialist in oral medicine, with whom a video call was initiated in the same application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for the case management. At the end of the consultation, the teleconsultant evaluated the quality of the images and of the internet connection during the call. In addition, the participant responded to a questionnaire about the experience of distance care. Then a second specialist, blind to the first assessment, examined the oral lesion in person and defined a diagnosis, which was considered as the gold standard. Thirty-three individuals, aged from 25 to 83 years, presented 41 oral lesions. The average duration of teleconsultations was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the gold standard, reaching an "almost perfect" agreement coefficient (k = 0.922). Men evaluated the model better than women (p = 0.02), as well as patients who experienced good and reasonable connection during teleconsultation (p = 0.03). The results suggest that synchronous teleconsultation can provide reliable remote diagnosis by supporting health care professionals in basic care in the management of oral lesions, with good acceptance among patients

Designing Cost-Effective Telemedicine Camps for Underprivileged Individuals in Less Developed Countries: A Decomposed Affordance-Effectivity Framework

Free telemedicine camps (telecamps) are emergent joint initiatives of healthcare organizations, national and local governments, and not-for-profit nongovernmental organizations (NGOs) with the goal of alleviating the health divide for underprivileged individuals in rural areas of less developed countries. Our study seeks to understand the effectiveness of physician-patient communication at telecamps with several salient characteristics: rural underprivileged patients, physicians in remote cities, and frugal telemedicine technology—specifically, videoconferencing—deployed in Hospitals on Wheels and appropriated by operators. We adopt a multiple-actor perspective, propose a decomposed affordance-effectivity framework, and combine variance and process perspectives to examine the phenomenon of interest. We collaborated with Apollo Hospitals, a leading hospital system in India, and collected multisource data from two major telecamps in rural South India. Based on an analysis of survey data from 216 telecamp participants through a variance perspective, we found support for the fit of patient-perceived media richness with two contingency factors—(1) disease diagnostic complexity and (2) patient healthcare needs fulfillment—in influencing patient satisfaction with teleconsultation. Based on an analysis of 46 sessions of teleconsultation video archives through a process perspective, we found that technology appropriation is realized through verbal and nonverbal communication events between patients and physicians, with on-site operators playing multiple roles that serve as “compensatory user effectivity.” Our findings yield theoretical and practical implications for how effective telemedicine encounters using frugal technologies can be designed in combination with other cost-effective support personnel resources to broaden healthcare access for underprivileged individuals in less developed countries and, more broadly, to actualize technology affordances in use situations involving multiple actors

The Comprehensive Cancer Center

This open access book provides a valuable resource for hospitals, institutions, and health authorities worldwide in their plans to set up and develop comprehensive cancer care centers. The development and implementation of a comprehensive cancer program allows for a systematic approach to evidence-based strategies of prevention, early detection, diagnosis, treatment, and palliation. Comprehensive cancer programs also provide a nexus for the running of clinical trials and implementation of novel cancer therapies with the overall aim of optimizing comprehensive and holistic care of cancer patients and providing them with the best opportunity to improve quality of life and overall survival. This book's self-contained chapter format aims to reinforce the critical importance of comprehensive cancer care centers while providing a practical guide for the essential components needed to achieve them, such as operational considerations, guidelines for best clinical inpatient and outpatient care, and research and quality management structures. Intended to be wide-ranging and applicable at a global level for both high and low income countries, this book is also instructive for regions with limited resources. The Comprehensive Cancer Center: Development, Integration, and Implementation is an essential resource for oncology physicians including hematologists, medical oncologists, radiation oncologists, surgical oncologists, and oncology nurses as well as hospitals, health departments, university authorities, governments and legislators

Telemedicine

Telemedicine is a rapidly evolving field as new technologies are implemented for example for the development of wireless sensors, quality data transmission. Using the Internet applications such as counseling, clinical consultation support and home care monitoring and management are more and more realized, which improves access to high level medical care in underserved areas. The 23 chapters of this book present manifold examples of telemedicine treating both theoretical and practical foundations and application scenarios

Primary Health Care

This book presents examples from various countries about the provision of health services at the primary care level. Chapters examine the role of professionals in primary healthcare services and how they can work to improve the health of individuals and communities. Written by authors from Africa, Asia, America, Europe, and Australia, this book provides up-to-date information on primary health care, including telehealth services in the era of COVID-19

Telehealth in the developing world

Co-published with the Royal Society of Medicine Pres

Diabetes in sub-Saharan Africa: from clinical care to health policy.

Rapid demographic, sociocultural, and economic transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs) in sub-Saharan Africa. The impacts of these transitions and their health and economic consequences are evident. Whereas, in 1990, the leading causes of death in sub-Saharan Africa were HIV/AIDS, lower respiratory infections, diarrhoeal diseases, malaria, and vaccine-preventable diseases in children, in more recent years, cardiovascular diseases and their risk factors are replacing infectious diseases as the leading causes of death in this region, and rates of increase of cardiovascular risk factors are predicted to be greater in sub-Saharan Africa than in other parts of the world. Thus, sub-Saharan Africa—which contains a high proportion of the world\u27s least developed countries—will face the multifaceted challenge of dealing with a high burden of infectious diseases and diseases of poverty, while also addressing the increasing burden of cardiovascular disease and its risk factors. At present, many of the health systems in sub-Saharan Africa struggle to cope with infectious diseases. Meeting the goals of the UN high-level meeting on NCDs (to reduce premature mortality from NCDs by 25% by 2025) and Sustainable Development Goals (SDGs; to reduce premature mortality from NCDs by a third by 2030) requires a coordinated approach within countries, which starts with a firm consideration of disease burden, needs, and priorities