Impact of the Fourth Industrial Revolution on the Health Sector: A Qualitative Study

Objectives: The Fourth Industrial Revolution is changing the way health is understood, transforming the methods of treatment and diagnosis as well as the relationship between health professionals and patients and altering the management and organization of health systems. The main objective of this study was to explore the impact that the Fourth Industrial Revolution is having on the health sector. Methods: Conducting interviews consisting of four questions with 10 professionals who had experience working in the health sector to gain their insights and to obtain information to meet the general objective of the study as well as its specific objectives. Results: From the analysis of the respondents’ responses, it was possible to create five dimensions developed by the topics most addressed by respondents, namely, impact on healthcare efficiency and effectiveness, impact on government action, impact on human resources, impact on health system organization, and financial impact on the health sector. Conclusions: Although the Fourth Industrial Revolution is still at an early stage, it has been concluded that it is having a major positive impact on the health sector. For the effective and efficient implementation of these disruptive technologies, a global interaction between governments, health professionals, stakeholders, and society is essential to make this change possible.info:eu-repo/semantics/publishedVersio

A Quarta Revolução Industrial nos Sistemas de Saúde

Dissertação de Mestrado em Administração Pública na Especialidade de Administração da SaúdeCom este estudo pretendeu-se compreender como a implementação das tecnologias 4.0 está a afetar a estrutura e a organização dos sistemas de saúde. A Quarta Revolução Industrial está a mudar a forma como a saúde é entendida, transformando os métodos de tratamento e diagnóstico, os processos de gestão, bem como a relação entre profissionais de saúde, pacientes, governos e stakeholders do setor da saúde, impactando a estrutura e organização dos sistemas de saúde. Assim, para dar resposta à questão nuclear deste estudo, optou-se por um estudo exploratório descritivo de abordagem qualitativa, sendo elaboradas entrevistas semiestruturadas a personalidades nacionais e internacionais da área da saúde do setor e a stakeholders do setor da saúde, de forma a ter um conhecimento da sua perceção sobre a temática do estudo em causa. Os resultados do nosso estudo sugeriram que as tecnologias 4.0 atualmente implementadas no sector da saúde estão a permitir mudanças organizacionais e estruturais nos sistemas de saúde. Identificamos os fatores dificultadores e facilitadores da implementação de tecnologias provenientes da Quarta Revolução Industrial nos sistemas de saúde e observamos os efeitos das tecnologias 4.0, tanto na eficácia como na eficiência dos mesmos. Constatamos ainda que os governos estão a acompanhar a evolução da Quarta Revolução Industrial através de regulamentações e políticas que favorecem a introdução das tecnologias 4.0 nos seus sistemas de saúde. Por fim pudemos perceber que a implementação de tecnologias 4.0 nos sistemas de saúde está a trazer benefícios para o cidadão, dando-lhes uma maior acessibilidade aos mesmos e capacitando-os com um maior controlo da gestão do seu estado de saúde. Pelos resultados obtidos através da aplicação de entrevistas baseadas nos 8 objetivos específicos deste estudo, foi possível observar que as tecnologias 4.0 estão a ter um impacto na estrutura e organização dos sistemas de saúde.This study aimed to understand how the implementation of 4.0 technologies is affecting the structure and organization of health systems. The Fourth Industrial Revolution is changing the way health is understood, transforming treatment and diagnostic methods, management processes, as well as the relationship between health professionals, patients, governments and stakeholders in the health sector, impacting the structure and organization of health systems. Thus, to answer the nuclear question of this study, we opted for a descriptive exploratory study of qualitative approach, and semi-structured interviews were applied to national and international personalities and stakeholders of the healthcare sector, in order to have a knowledge of their perception about the theme of the study in question. The results of our study suggested that 4.0 technologies currently implemented in the healthcare sector are enabling organizational and structural changes in health systems. We identified the most difficult and facilitating factors of the implementation of technologies from the Fourth Industrial Revolution in health systems and observed their effects, both on their effectiveness and efficiency. We also found that governments are following the evolution of the Fourth Industrial Revolution through regulations and policies that favour the introduction of 4.0 technologies into their health systems. Finally, we could see that the implementation of 4.0 technologies in health systems is bringing benefits to the citizen, giving them greater accessibility and empowering them with greater control of the management of their health status. From the results obtained through the application of interviews based on the 8 specific objectives of this study, it was possible to observe that 4.0 technologies are having an impact on the structure and organization of health systems.N/

Difficulty and Facilitating Factors in the Implementation of 4.0 Technologies in Health Systems

The aim of this study was to understand which factors hinder and facilitate the implementation of 4.0 technologies in health systems.Thus, to answer the core question of this study, we opted for a descriptive exploratory study with a qualitative approach, with semi-structured interviews being carried out with national and international personalities in the health sector and stakeholders in the health sector, in order to have a knowledge of their perception on the subject of the study in question.The results of our study suggested that the implementation of 4.0 technologies in health systems has as hindering factors: lack of funding, lack of qualified human resources, the current structure of health systems and resistance to change by professionals and patients and as facilitating factors: cost reduction and interoperability policies in health systems

European Portuguese adaptation and validation of dilemmas used to assess moral decision-making = Adaptação e validação para português europeu de dilemas utilizados para avaliar a tomada de decisão moral

Abstract Objective To adapt and validate a widely used set of moral dilemmas to European Portuguese, which can be applied to assess decision-making. Moreover, the classical formulation of the dilemmas was compared with a more focused moral probe. Finally, a shorter version of the moral scenarios was tested. Methods The Portuguese version of the set of moral dilemmas was tested in 53 individuals from several regions of Portugal. In a second study, an alternative way of questioning on moral dilemmas was tested in 41 participants. Finally, the shorter version of the moral dilemmas was tested in 137 individuals. Results Results evidenced no significant differences between English and Portuguese versions. Also, asking whether actions are “morally acceptable” elicited less utilitarian responses than the original question, although without reaching statistical significance. Finally, all tested versions of moral dilemmas exhibited the same pattern of responses, suggesting that the fundamental elements to the moral decision-making were preserved. Conclusions We found evidence of cross-cultural validity for moral dilemmas. However, the moral focus might affect utilitarian/deontological judgments

Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and Methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.Introdução: A aprovação do tratamento endovascular para o acidente vascular cerebral isquémico obrigou à reorganização dos cuidados de saúde em Portugal. Os nove centros que realizam tratamento endovascular não estão distribuídos equitativamente pelo território, o que poderá causar acesso diferencial a tratamento. O principal objetivo deste estudo é realizar uma análise descritiva da frequência e métricas temporais do tratamento endovascular em Portugal continental e seus distritos. Material e Métodos: Estudo de coorte nacional multicêntrico, incluindo todos os doentes com acidente vascular cerebral isquémico submetidos a tratamento endovascular em Portugal continental durante um período de dois anos (julho 2015 a junho 2017). Foram colhidos dados demográficos, relacionados com o acidente vascular cerebral e variáveis do procedimento. Taxas de tratamento endovascular brutas e ajustadas (ajuste indireto a idade e sexo) foram calculadas por 100 000 habitantes/ano para Portugal continental e cada distrito. Métricas de procedimento como tempo entre instalação, primeira porta e punção foram também analisadas. Resultados: Foram registados 1625 tratamentos endovasculares, indicando uma taxa bruta nacional de tratamento endovascular de 8,27/100 000 habitantes/ano. As taxas de tratamento endovascular entre distritos variaram entre 1,58 e 16,53/100 000/ano, com taxas mais elevadas nos distritos próximos a hospitais com tratamento endovascular. O tempo entre sintomas e punção femural entre distritos variou entre 212 e 432 minutos. Conclusão: Portugal continental apresenta uma taxa nacional de tratamento endovascular elevada, apresentando, contudo, assimetrias regionais no acesso. As métricas temporais foram comparáveis com as observadas nos ensaios clínicos piloto

Análise das alterações prognósticas em pacientes oncológicos acometidos pelo COVID-19 / Analysis of prognostic changes in cancer patients affected by COVID-19

INTRODUÇÃO: A pandemia de COVID-19, causada pelo novo coronavírus (SARS-CoV-2), se tornou um problema de saúde pública mundial. Nesse cenário, a idade avançada, o sexo, o histórico de tabagismo e a presença de comorbidades, entre elas, o câncer, foram mostradas na literatura como fatores associados a piora no prognóstico da doença.OBJETIVO: Apresentar efeitos da infecção pelo SARS-CoV-2 em pacientes oncológicos, visando alterações prognósticas. MÉTODO:  Trata-se de um resumo baseado no método de revisão de literatura com exposição de evidências. A revisão foi realizada nos bancos de dados nacionais e internacionais, tais como Scielo e PubMed. RESULTADOS: Segundo 25 estudos a neoplasia que pior se relacionou com a COVID-19 foi a pulmonar. A vulnerabilidade decorrente do tratamento oncológico altera o prognóstico para pior, as alterações mielopoiéticas resultantes do recurso terapêutico em conjunto com alterações provenientes do próprio câncer podem minar o cenário imunológico necessário para o combate à infecção viral. Com isso, uma nova análise estima que ocorrerá um aumento de 20% na mortalidade de pacientes oncológicos na Inglaterra nos próximos 12 meses devido ao SARS-CoV-2, em relação a anos anteriores.CONCLUSÃO: Conclui-se que os pacientes oncológicos têm pior prognóstico, em relação à população geral, quando infectados pelo COVID-19