Untitled - Departamento de Informática em Saúde

Dear Colleague,
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The abstracts received by the 10 Congress Of the International Society of
Telemedicine and e-Health, the 2nd Congress of the Brazilian Council of
Telemedicine and e-Health and the 2nd Meeting of the Latin-American and
Caribbean Chapter of the American Telemedicine Association are edited in
this CD-ROM. They are published as they were sent; only a uniform layout
was given. An alphabetic sequence using the surname of the first author
was followed. Abstracts written in Portuguese and English were not
separated; whenever a choice was given the English version was used, as it
is the international language of Science. Whether it was a poster or oral
presentation is not indicated. An index was elaborated with all authors
linked to their contributions which we sincerely appreciated.
São Paulo, October 23, 2005
The Organizing Committee
Prezado Colega,
Os resumos dos trabalhos enviados para o 10º Congresso da Sociedade
Internacional de Telemedicina e Telessaúde, o 2º Congresso Brasileiro de
Telemedicina e Telessaúde e o 2º Encontro do Capítulo Latino Americano e
Caribenho da Associação Americana de Telemedicina estão reunidos neste
CD-ROM. Estamos publicando tal como foram recebidos, apenas
uniformizando o formato geral. A seqüência é alfabética sempre
considerando o sobrenome do primeiro autor. Não houve separação dos
resumos encaminhados em português e inglês; sempre que tivemos opção
usamos a versão inglesa por ser a língua internacional da ciência. O tipo de
apresentação, se pôster ou oral, não é indicado. Procuramos elaborar um
índice com todos os autores vinculados às suas contribuições que,
sinceramente, agradecemos.
São Paulo, 23 de outubro de 2005
A Comissão Organizadora
Abreu, I.M.
Batiz, M.G.
Carniglia, L.
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Carvalho, I.M.M.
Ajzen, S.
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Bedi, B.S.
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Bekteshi, F.
Carvalho, M.L.M.
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Bento, R.F.
Carvalho, R.S.
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Alencar, A.
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Alkmim, M.B.
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Almeida, A.L.
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Cassetti, I.
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Almeida, M.E.B.T.M.P.
Bhaskaranarayana, A.
Castilio, D.
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Böhm, G.M.
Cavalcanti, S.
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Borges, C.L.
Chao, LW
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Brady, P.
Chiari, J.P.
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Campelo, V.E.S.
Cogo, A.L.P.
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Alves, L.C.
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Alves, R.H.K.
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Alvin, F.B.
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Borghi, G.
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Andrade, V.G.
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Bossi, G.A.
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Andreazzi, D.B.
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Bossi, G.A.M.
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Atta, M.T.
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Brady, F.
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Azevedo, D.F.G.
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Azevedo, R.
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Barsottini, C.G.N.
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Conrado, M.A.
Filgueiras, T.
Guzovsky, P.A.
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Corrêa, F.G.C.
Fonseca, L.M.
Hammes, E.
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Dalpino, N. R. S.
Fortuin, J.B.
Holcomb, M.
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Daré Junior, S.
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Fregonara, M.
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Hovenga, J.S.
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Debbag, R.
Freitas, M.A.V.
Johnson, P.
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De-Lorme, P.
García, F.
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Diniz, C.G.P.
Garcia, G.B.
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Domingues, L.A.
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Gimenez, R.S.S.
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Jakobi, H.R.
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Jordanova, M.
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Judkins, D.
Gismondi, R.C.
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Juliani, M.C.M
Enrique S.
Godoy, I.
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Fernandes G.C.V.R.
Godoy, S.
Eisenstein, E.
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Ferreira E.G.P.
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Ferreira S.R.G.
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Godoy, S.C.B.
Junior, M.J.
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Kachienga, M.A.
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Grottone, G.
Kashiabara, J.A.
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Guerra, I. M.
Kelmer, S.
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Guimarães, E.M.P.
Kiefer, S.
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Ferreira, W.S.
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Festa C.N.
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Gundim, R.S.
Figueiredo, L
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Kurcgant, P.
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Gutierrez, M.A.
Latifi, R.
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Legramandi, D.B.
Merrell, R.C.
Neto, J.R.N
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Leite, M.M.J.
Messina, L.A.
Nobre, L.F.
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Lievens, F.
Miot, H.A.
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Nogueira, M.S.
Lombroso, F.
Molefi, M.
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Nunes, A.A.
Lopes, P.R.L.
Molefi, M.L.
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Machado, H.R.
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Ohl, R.
Monteiro, A.
Olurunju, S.
Monteiro, A.M.V.
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Paixão, M.P.
Mortara, A.M.
Pegoraro, C.N.
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Moshela, M.
Peixoto, F.C.
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Malmström, M.F.V.
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Mancini, F.
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Pereira, A. J.
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Mário Jr., M.J.
Múnera, L.E.S.
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Peres, H.H.C.
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Marta, S.N.
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Muja, S.H.
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Maia, C.C.A.
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Murthy, R.L.N.
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Petitet, A.
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Medeiros, R.
Nason, A.M.
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Pinheiro Neto, C.D.
Navarro Newball,
A.A.
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Melare, D.
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Melo, M.C.
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Pinto, V.C.
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Pires, F.S.
Mendes,I.A.C.
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Pisa, I.T.
Sachpazidis, I
Sequeira, E.
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Sakas, G.
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Ponokowski, P.
Salas, L.C.
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Porter, J.
Salvatore, P.
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Porter, J.M.
Santos, A.A.S
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Prudent, L.
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Sgavioli, C.A.P.P.
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Sigulem, D.
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Santos, A.F.
Reis, M.C.S.
Silva, A.P.S.S.
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Ribeiro, M.A.C.
Santos, D.T.
Silva, I.M.
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Richardson, R.J.
Santos, S.F.
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Ricur, G.
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Sakuno, T.
Rocha, G.Z.
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Soares, E.R.
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Soares, R.C.F.R.
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Sarkis, C.
Soares, S
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Roque, A.C.
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Satyamurthy, L.S.
Rosa, V.T.A.
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Sousa, R.M.
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Schaun, T.R.
Rossi, F.
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Souza, C.
Schor, P.
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Russomano, T.
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Scott, R.E.
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Souza, C.A.
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Sparenberg, A.L.F.
Vujacich, C.
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Young, E.
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Spiri, W.C.
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Wainer, J.
Sproule, K.
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Wangenheim, A.
Stamboulian, D.
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Weinstein, R.
Szabo, C.A.
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Whalen, E.
Szomorovszky, S.V.
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Williams, M.D.
Tachinardi, U.A.S.
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Zaldivar, R.
Thornby, D.
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Timm, R.
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Togashi, G.B.
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Trindade, M.A.B.
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Vazquez, L.
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Vélez Beltrán, J.A.
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Veronezi, M.C.
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Voegels, R.L.
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A DINÂMICA DE ENFERMAGEM EM SERVIÇO DE URGÊNCIAS COM
SISTEMA DE TELE-ECG DIGITAL NO SUL DO BRASIL
Soares, E. R.; Schaun, T.R.; Russomano, T.; Sparenberg, A.
Laboratório de Microgravidade/IPCT-Pontifícia Universidade Católica do
Rio Grande do Sul, Porto Alegre, RS, Brasil.
Associação Médica de São Lourenço do Sul, RS, Brasil
INTRODUÇÃO. Pequenas cidades e áreas rurais no Brasil são carentes de
cardiologistas, o que prejudica a análise de Eletrocardiogramas (ECGs),
especialmente os exames emergenciais. A transmissão em tempo real
(on-line) de ECGs permite o rápido estabelecimento de diagnósticos
cardiológicos.
MATERIAL E MÉTODOS. À partir de janeiro de 2000, a sala de urgências do
Hospital Santa Casa de Misericórdia de São Lourenço do Sul (HSCM-SLS),
RS, adotou um Sistema de Tele-ECG Digital (SED), o qual permite o
registro, a transmissão e análise em tempo real e o armazenamento dos
dados eletrocardiográficos. O SED inclui uma aparelho digital de ECG,
computadores, software de comunicação (pcANYWHERE, versão 10.5,
Symantec), modem ligado à linha fixa de telefonia e telefone celular
remoto (9600 bits/s). A equipe de enfermagem, a quem compete orientar
e treinar a realização dos exames, é composta por uma coordenação geral,
enfermeiras supervisoras de turno e técnicos e auxiliares de enfermagem.
RESULTADOS. No período de 17/11/2003 à 16/11/2004 foram analisados
604 exames, com tempo médio de transmissão e análise de 8,05 min (DP
1,6). A média etária foi de 58,7 anos. Na amostra, 321 (53.15%) pacientes
foram do sexo feminino e 283 (46.85%) do sexo masculino, incluindo 176
(29.14%) exames normais e 428 (70.86%) com diagnósticos
eletrocardiográficos patológicos.
CONCLUSÃO. O SED constitui-se em método de baixo custo e que permite
o diagnóstico precoce de urgências cardiológicas, trazendo
grande
benefício para a dinâmica do Serviço de Enfermagem, ao ser empregado
em cidade de pequeno porte.
[email protected]
[email protected]
INDICE/INDEX
A MODEL OF TELEHEALTH BETWEEN UNIVERSITY HOSPITAL
AND PRIMARY CARE SECTOR OF THE MUNICIPAL HEALTH
SYSTEM OF BELO HORIZONTE
Santos, A.F.; Alkmim, M.B.; Silva, I.M.; Souza, C.; Santos, S.F.;
Peixoto, F.C.; Bossi, G.A.; Alves, L.C..
Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas
Gerais, Brasil;
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brasil; Faculdade de Medicina da Universidade
Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil;
PRODABEL - Empresa de Informática e Informação do Município de Belo
Horizonte, Belo Horizonte, Minas Gerais, Brasil.
The BH TELEMED project is a Telemedicine and Telehealth project for
primary care, made for the family health teams in the city of Belo Horizonte
and financed by the @LIS line of the European Union and the Ministry of
Health. It interconnects the "Hospital das Clínicas"(HC) of the Federal
University of Minas Gerais(UFMG) and the Health Centers of the Municipal
Health Department through a long distance consulting system with
teleconsultations and specific theme discussions. Its objective is to
promote permanent in-service training and to improve the effectiveness of
the primary health network. The project is composed of Telemedicine,
Telenursing and Teleodontology activities. The body of Teleconsultants is
made up of 50 doctors, 10 nurses and 2 dentists of the UFMG. The defined
model is to carry out teleconsultations scheduled according to
spontaneous demand, discuss themes based on clinical cases and themes
programmed according to statistical data of specialised consultations. The
technology used is simple and not expensive (computers and webcams)
allowing a simultaneous on-line access of all the participating units, with
image, voice and/or chat interaction. In the first 15 months of the project
there was a gradual implementation of the system in 17 health centers,
development of the on-line module of the Teleconsulting Management
software, the interconnection of the network and the stabilisation of the
system. In the period 103 events were carried out (86 teleconsultations, 3
medical theme discussions, 4 telenursing sessions, 1 teleodontology
session and 7 international videoconferences) with the participation of 772
health professionals. The implemented model of Telehealth showed itself
effective in reducing the necessity of relocating patients to only 24% of
discussed cases, improving the resolution potential of the public health
system. Simultaneously it has been observed a progressive rise in the
participation of professionals in the clinical telesessions.
INDICE/INDEX
A MULTI-DIMENSION METHODOLOGY FOR ASSESSING,
EVALUATING AND COMPARING THE TELEHEALTH PROJECTS
Fregonara, M. (1); Borghi, G. (2)
(1)
Azienda Sanitaria Locale Provincia di Milano 3, Monza (Milan), Italy
(2)
Health General Direction - Lombardy Region, Milan, Italy
The telehealth projects receive mainly public funding, therefore
government agencies make careful economic assessment and impact
analysis of the investment expenditures and results. The Cost/Benefit
Analysis (CBA) investigates all the possible resources and estimated
effects derived by the introduction of technological innovations. The
comparison between resources (costs) and results (benefits) is used for
estimating the impact of telehealth projects, in order to choice the project
offering more net benefits among different solutions.
The main goal of the proposed method, based on six steps, is to overcome
the CBA limits enlarging its analysis parameters with a multi-dimensions
approach of assessing, evaluating, selecting and comparing the costs,
benefits and social impacts of telehealth projects in order to take a decision
about its outputs, resources and outcome. The first step identifies and
classifies all the information on the main assessment parameters for the
project analysis: costs, profits and impacts. The second step splits all the
resources within the project implementation phases: design, realisation,
activation, utilisation and divestment. The third step collects the data
within the aggregated macro-items in order to obtain an abstraction level,
but keeping a sufficient detail. The fourth step combines and classifies the
aggregated macro-items into the different project phases to obtain a
better ranking of the assessment parameters. The fifth step estimates the
balance of all the amount (costs and profits) and the outcomes (impacts)
for each project phases, in order to allow a specific or global evaluation.
The last step defines the metrics to support the decision about financing
the project, based on the previous steps.
This approach aims at estimating the global increase of health state
through the value of all the resources, costs, benefits and outcomes,
because all the main actors (patients, their family, physicians and
service organisations) attribute different values to these parameters.
The methodology is also focused on the project impact, measured
through the evaluation of costs and benefits, the assessment of possible
effects, included the intangible or social benefits for people and the
direct/indirect influences on the National Health Service budget.
The method acquires all the information needed to inquire into all the
complex impacts of telehealth projects from different perspectives:
patients' quality of life; care cost saving; modification of treatments;
equipment and supply costs; time of actors; improper admissions or
examinations. The method compares telehealth projects in order to both
“ex ante” (economic feasibility and realisation costs) and “ex post”
(benefits and general costs) or both “traditional” and “telematics”
processes, evaluates different workflows or solutions, analyses among
alternatives with potentially diverse global benefits, assesses different
organisation and management of health centres.
The method, tested in telecare, will fit also in different sectors of health:
teleeducation, telenursing, etc. Up to now, we are developing a software
tool for the evaluation of telehealth projects through the proposed
methodology, acquiring all the information needed to analyse a project
from all the different perspectives.
INDICE/INDEX
A SLIGHT SIGHT ON FRENCH TELEMEDICINE ADVENTURE : TWO
CONCRETE TELEMEDECINE APPLICATIONS
Petitet, A. - MD (AP)
CATEL , ISfTeH board member, CardioGap - Le Thor - France
FOREWORDS. On august , 13th , 2004 a very important event took place in
France: for the first time , the word: telemedicine was legaly inscribed in a
french law . That's means from now , telemedicine actions move from
"hunting stories" to pragmatic application tracks. This communication
reports two applications :
- 1. an international acute cardiac ischemia rescue network (before the
law).
- 2. an emergency network in a whole french district (after the law).
!- An international acute cardiac ischemia rescue network.
In 1998 , sanitary evacuations statistics showned to a french oil company
medical department for expatried workers the second place of suspected
acute myocardial infarction. The head of this medical departement decided
to improve the real documentation on time to better know the severity and
the potential level of emergency . It was decided to equip each site for
exploitation and/or prospection with a ECG recorder-transmitter all over
the world . 40 devices were active . The reception medical station for
reading , analysis and decision was first a North America call center , then
a french emergency hospital station . The network was working during 7
years . There were 35 "medical" calls : in 17 , ECG electric changes were in
favor of acute myocardial infarction or early ischemia ; in 18 , no real proof
of electric cardiac disorders . So the conclusion was:(1) in 17 , the quick
decision to treat then to transport patients to a well equiped hospital
concerning cardiac emergencies improve dramatically the quality of care
and first of all , the recovering ,(2) avoidance of unusufull sanitary
evacuation in 18 with a decreasing financial charge for this post. Today ,
after this positive experience , the company initiate local and regional
connections by telemedecine between its workers groups and agreed
hospital and clinics.
!- An emergency network in a whole french district.
The french emergency organisation is one of the best worlwide . It is
based on SAMU/SMUR on one hand , Firemen on the other hand. The
main principle is to have a medical inside the emergency car . But ,
several factors and also a large new pannel of types of transport have
changed the today conditions. In addition , more and more , the
medical teams out and in hospital need to work closely together and to
use for that the same objective documentation in real time.
There are 98 administrative french districts . One of them , an average one
, Vaucluse was chosen to be equiped by a multiparametric monitor able to
transmit continously data from the emergency car to the hospital station.
14 emergency cars are equiped . The device is able to collect biomedical
parameters as ECG 12, Sp0²,NIBP,Respiration, Capno and also to provide a
very complete electronic and evolutive patient dossier all over the
transportation. The sensor module and the tablet PC inside the car are
linked by bluetooth (no cables) . The tablet PC ,where all the data are
collected with e-PR, is linked with the hospital station by GPRS . Inside
hospital , the regulation station might be connected with a terminal in the
CCU for instance. All the screens of this netwoork show the same
documentation on the same time. More , there is a two ways messagerie
for exchanges between the mobil team and the hospital one. Numerous
advantages are done (1) no delay to drive the patient to the well adapted
hospital reception ,(2) interoperability between mobil emergency team
and hospital medical team , (3)help to the primary first aid or para-medics
team to improve the care under the medical management,(4) costs
effectivity by avoidance of wrong transportations,(5) better and more
accurate hospital reception ,(6) electronic objective documentation to be
stored for forward expectation , (7) a perfect common transmission tool
between SAMU/SMUR and Firemen . This is a pure concrete demonstration
of role of telemedicine in a daily sensible practice.
INDICE/INDEX
A SOCIAL PERSPECTIVE APPROACH ON TELEMEDICINE FOR
LAND MINES VICTIMS IN COLOMBIA
Vélez Beltrán, J.A. and Navarro Newball, A.A.
Colombian Telemedicine Centre, Cali-Colombia
KEYWORDS. Telemedicine, Land mines, Rehabilitation, Emergency,
Evacuation,
BACKGROUND. The Colombian territory has been seeded with more than
100.000 land mines and, 5.688 accidents and incidents and 3.263 victims
had been registered in 94% of the territory.
OBJECTIVE. The objective of this work is to create and to validate a set of
web-based interactive tools to support assistance of land mines' victims
and health care professionals in Colombia.
METHODS. The Web-based environment for land mines' victims support
follows an interdisciplinary and inter-institutional work and an object
oriented software methodology. Actually, the prototype of the environment
is under a technical validation which includes performance tests and
surveys.
RESULTS. At the moment there are three prototype web environments.
The emergency attention environment facilitates the communication
between health personnel attending the victim and specialists in trauma.
The rehabilitation environment allows the remote supervision of the
patient during the healing process, decreasing the number of required
displacements. The characterisation environment allows the search and
selection of trauma specialist. Also, a preliminary validation took place.
DISCUSSION. Even though the web based interactive tools show a high
level of interactivity, they must be enhanced in order to make them
friendlier. The access to the land mine victim's support environment is easy
as long as there is an Internet connection.
An educational cycle including a web based expert decision support system
(WEDS), a planning instrument, a video transmission and a simulator can
be extended in order to complement the tools.
The deployment of the proposed environment will cause a great social
impact.
[email protected]
[email protected]
INDICE/INDEX
A TELERADIOLOGIA SEM O PACS. O PROJETO
INTERINSTITUCIONAL ENTRE CENTRO DE ENSINO NACIONAIS
EM RADIOLOGIA PEDIÁTRICA.
Monteiro, A.
Faculdade de Ciências Médicas da UERJ.
A Faculdade de Ciências Médicas, entre os Projetos em Telemedicina, tem
desenvolvido Projetos de Teleintegração com outros centros de ensino,
nacionais e internacionais, com o objetivo de aperfeiçoamento, ensino,
pesquisa e assistência. Neste âmbito acadêmico destaca-se o Projeto
Interinstitucional em Radiologia Pediátrica pelo seu pioneirimo nesta linha
de pesquisa e assistência e, pela sua relevância no atendimento desta
população de crianças. Utilizando sistemas de videoconferências, com
conexões pela Rede de Internet via RNP, e também por ISDN, o Projeto já
agrega, até o presente, cinco pontos no nosso país. Na metodologia de
troca e envio de imagens têm-se adotado sistemas simples, tais como o
digitalizador de imagens, o progama Microsoft PowerPoint e o próprio uso
do negatoscópio, online. O propóstito desta forma simplificada de troca de
imagens pode ser resumido como um facilitador do processo de inclusão
entre diferentes centros de ensino. O público alvo tem sido de alunos da
graduação e da pós-graduação, lato e stricto-senso, além de médicos e
professores. O objetivo pricipal deste projeto é capacitar, de forma
atualizada, o médico-radiologista, e permitir a integração em projetos de
pesquisa multicêntricos.
Experiência do INCOR no desenvolvimento, implantação e
manutenção do PACS
Gutierrez, M.A.
Serviço de Informática,
Insituto do Coração do Hospital das Clínicas da Faculdade de Medicina
da USP.
O Instituto do Coração (InCor) tem envidado esforços para integrar
todas as informações clínicas dentro da Instituição. Nos últimos anos o
InCor implementou com sucesso um sistema para transmissão,
arquivamento, recuperação, processamento e visualização de Imagens
Médicas (PACS-InCor) e um Sistema de Informações Hospitalares (SI3)
que armazena as informações administrativas e clínicas. A integração
desses subsistemas forma o Prontuário Eletrônico do Paciente
(PEP).Institutos é também uma questão muito relevante.
INDICE/INDEX
ACTIVITIES OF THE TELEDENTISTRY CENTER
AT SACRED HEART UNIVERSITY
Sgavioli, C.A.P.P. 1; Veronezi, M.C.1.; Marta, S.N. 1; Carvalho, I.M.M.1;
Soares, S.1; Melare, D.1; Sequeira, E.2; Chao L.W.2
(1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline of
Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil.
The presence of new technologies requires new positions in the process of
learning and teaching.
Attempting to transform regular classes in a continuous process of
information, communication and investigation, where the knowledge can
be built through the balance of individual and group work, between
professor coordinator supporter and the active participation of students,
in this way Teledentistry was introduced at USC.
The current data available from ENADE on the students' access to
technology and number of professionals registered in the Federal Dental
Council, as well as the amount of dental courses existing in Brazil, show the
possibility of an increase in the activities of Teledentistry, increasing the
space and time in the access to permanent formation and education of all.
This opens the possibility of the University to assist dental professionals
working in places distant from the learning institutions and searching for
professional upgrade or a second professional opinion in diagnosis and
treatment planning.
The Dental Course of USC keeps a technical-scientific accord with the
Discipline of Telemedicine of FMUSP for utilization of the website “Medical
Digital Station” (www.estacaodigitalmedica.com.br). Online courses by
the “Cybertutor” Teleeducation environment; the “Virtual Ambulatory” for
Dentistry and also the creation of Cd-Roms within the Virtual Man Project
were developed.
Undergraduate and graduate dental students are using the whole material
produced so fat in the learning activities.
The Teledentistry at USC was developed because of the ability of the group
of people involved to make plans real, starting with ambitious dreams,
claiming to reach the entire community interested in the growth and
education in Dentistry.
INDICE/INDEX
ANALYSIS OF PARAMETERS OF MANAGEMENT IN THE
PROFESSIONAL QUALIFICATION DIRECTED TO THE
TECHNOLOGICAL INNOVATION IN HEALTH THROUGH THE USE
OF THE TELEMEDICINE
Borges, C. L.
Digital Radiology Observer - ORD
São Paulo / SP - Brazil
INTRODUCTION. The objective of this work is the analysis of management
parameters to be used in the professional qualification directed to the
technological innovation in Health through the use of resources of
Telemedicine. This exercise resulted in the construction of a pilot course
aiming to the specialized formation in area of administrative and
operational management of projects that involve digital technology in
departments of Radiology, to be offered by the Radiology Institute / USP in
partnership with the Radiology Department / UPenn, counting on the
contribution in services of Telemedicine Discipline / School of Medicine /
USP.
METHODOLOGY. The study consists of the analysis of the relevancy and
interrelation of values listed as necessary to the elaboration and
implementation of the course, as much in the basic infrastructure for
remote communication as in the logical sequence of
knowledge
absorption directed to the formation specialized in this sector. Functional
and administrative infrastructure aspects will be analyzed in the use of
resources of Telemedicine for remote communication with different types
of data (text, image and voice) guided to the professional qualification. In
the question of systematization of the knowledge absorption directed to
the technological innovation, parameters of efficiency will be evaluated
through use of relationary practical of the study divided in 06 sequential
discipline modules elaborated.
RESULTS AND CONCLUSION. The waited results of the analysis, when the
course on field, suggest the construction of a basic model of management
for use of Telemedicine in professional qualification directed to
technological innovation in Health.
INDICE/INDEX
APRENDIZAGEM AUXILIADA POR COMPUTADOR EM
OFTALMOLOGIA PARA PROFISSIONAIS DA SAÚDE NÃOESPECIALIZADOS
Grottone, G., Pisa, I.T., Lopes, P.R.L., Barsottini, C.G.N., Schor, P.,
Sigulem, D.
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
INTRODUÇÃO. A oftalmologia é uma especialidade de difícil aprendizado
para outros profissionais de saúde fora o médico-oftalmologista. Novos
métodos de ensino, baseados em auxílio informatizado, podem produzir
melhores resultados nesta tarefa. OBJETIVO. O objetivo deste trabalho é
desenvolver e validar um novo protocolo direcionado à consulta
oftalmológica por profissionais da saúde, utilizando elementos
computacionais e multimídia para auxiliar no ensino. MÉTODOS. Baseado
em uma lista de sinais e sintomas em oftalmologia, um novo protocolo foi
desenvolvido tomando como base a experiência obtida através de 10
alunos de medicina, que utilizaram diretrizes oftalmológicas préestabelecidas, testando suas dificuldades de aprendizagem. Antes do
atendimento com pacientes, foram reunidos e instruídos por um supervisor
quanto ao funcionamento de cada instrumento a ser utilizado na consulta
bem como seus possíveis resultados. Para cada bloco de informações, uma
nota entre 1 e 10 foi atribuída ao grau de dificuldade para fazer o exame e
interpretar os resultados gerados. RESULTADOS. Ao final de dois meses, o
protocolo final foi apresentado demonstrando suficiente informação para o
profissional de saúde ter uma ferramenta para decidir quais os pacientes
que necessitavam de atenção imediata de um especialista em
oftalmologia. CONCLUSÃO. Este é o primeiro passo para produzir um
programa de computador com a meta de poupar recurso em saúde,
distribuindo conhecimentos básicos e habilidades sobre cada especialidade
médica. Isso é de extrema importância quando pensamos em países em
desenvolvimento, onde o acesso ao médico especialista frequentemente é
dificultado por barreiras sócio-econômicas e geográficas.
Apresentação como POSTER
INDICE/INDEX
ASSESSMENT OF VIDEOCONFERENCE QUALITY FOR HEALTH
DISCUSSIONS BETWEEN LONG DISTANCE HOSPITALS
Campelo, VES; Pinheiro Neto, CD; Bento, RF; Wen, CL
Faculty of Medicine, University of Sao Paulo
INTRODUTION: The telemedicine system is a new way of medical practice.
It provides tools for patients' data retrieval and image data communication
between long distance hospitals on the information highway. Information
technology is now becoming the most popular technology every fields
should consider. To make telemedicine an effective medical practice it is
essential to become an easy technology and principally to show good
quality for data exchange.
OBJECTIVES: to assess the quality of videoconference in case discussions.
METHODS: a short questionnaire was administered to 20 otolaryngologists
(15 males/5 females) after two videoconferences between University of
Sao Paulo and Rio de Janeiro State University at a IP (internet protocol)
384Kbps conection. There were 13 ENT residents, 5 post-graduating
students and 2 Phd.
RESULTS: 65% of the interviewees considered that the images were good
and 70% answered that the audio was good. 75% said that image quality
didn´t hinde case comprehension. 65% considered that videoconference
is the best way to exchange experience between distant health groups, and
75% agree that it´s use will increase. 25% didn´t know that
videoconferences could be done using internet.
CONCLUSIONS: This telemedicine system showed its ability to improve the
way of patient information presentation and to access patient medical
records with good quality of image data communication.
INDICE/INDEX
AVALIAÇÃO DO PROGRAMA INTER-INSTITUCIONAL DE
TELEMEDICINA DA PÓS-GRADUAÇÃO DE RADIOLOGIA DA
UNIFESP, UFF, UERJ, USP
1
Lopes, P.R.L. ; Pisa, I.T.1; Ajzen, S.1; Santos, A.A.S 2; Gismondi, R.C.2
Monteiro, A.M.V.3; Machado, H.R.4; Ferreira, W.S. 4; Borges, C. L.5;
Sigulem, D.1
1
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2
Faculdade de Medicina - Universidade Federal Fluminense (UFF), Rio de
Janeiro, RJ, Brasil;
3
Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro
(UERJ), Rio de Janeiro, RJ, Brasil; 4 Faculdade de Medicina de Ribeirão Preto
- Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil; 5
Observatório de Radiologia Digital (ORD), São Paulo, SP, Brasil
INTRODUÇÃO. Programas de telemedicina inter-institucional podem
acelerar a colaboração entre grupos afins se em seu planejamento são
considerados aspectos sobre o objetivo dos parceiros, atividades práticas a
serem realizadas e parâmetros de avaliação pré-estabelecidos, entre
outros.
OBJETIVO. Este trabalho tem como objetivo descrever um modelo de
parametrização para avaliação na colaboração médica em programas de
telemedicina inter-institucionais.
METODOLOGIA. Considera-se o uso dos recursos de comunicação remota
na participação quinzenal de estudos de caso e qualificações de tese entre
os setores de pós-graduação das instituições supra citadas. Pretende-se
implementar uma métrica de avaliação para levantar resultados
relevantes sobre a qualidade da colaboração médica realizada,
considerando efetividade, segurança, praticidade e utilidade. Para
seguridade serão avaliados aspectos sobre a qualidade da imagem e
câmera, resolução espacial e cores, compressão, imagens necessárias no
processo, largura de banda e treinamento adequados. Para praticidade
serão avaliados aspectos sobre a organização do serviço, disponibilidade
dos equipamentos, competência para operação, financiamento e aspectos
legais. Quanto à utilidade serão considerados a melhoria da qualidade do
serviço, melhoria do bem-estar da população e custo-efetividade do
programa proposto.
RESULTADOS. Os resultados preliminares demonstram a importância de
realizar uma avaliação crítica da conectividade dos parceiros antes de
estabelecer os recursos que serão efetivamente empregados no
programa.
CONCLUSÃO. A partir desse modelo de avaliação torna-se possível
desenvolver um programa inter-institucional de telemedicina com
parâmetros para demonstrar a viabilidade financeira do projeto e sua
efetividade em relação ao processo em saúde em questão.
INDICE/INDEX
AVALIAÇÃO DO SITE ESCALA DE PESSOAL DE ENFERMAGEM
Juliani, M.C.M.*; Kurcgant, P.**
Faculdade De Medicina Da Unesp Botucatu/ Sp/ Br / Usp/ Sp
INTRODUÇÃO. O estudo, parte da tese de doutorado da autora, aborda o
resultado de avaliação de um site sobre escala de pessoal de enfermagem,
tema relevante no gerenciamento de recursos humanos de enfermagem,
em especial nas instituições de saúde que funcionam 24 horas. Cada
tecnologia modifica dimensões da nossa inter-relação com o mundo, da
percepção da realidade, da interação com o tempo e o espaço2.
OBJETIVO. Validar junto a experts da área de administração em
enfermagem e alunos de graduação o conteúdo do site desenvolvido.
METODOLOGIA. Uma vez produzido o site, a pesquisadora fez contato
com docentes das escolas públicas de graduação em Enfermagem do
estado de São Paulo que ministravam aulas na disciplina de Administração
em Enfermagem, portanto experts no tema do site e também com alunos
de graduação. A avaliação foi feita por meio de formulário eletrônico no
próprio site no final do ano 2002 e início de 2003.
RESULTADOS. Na somatória dos itens excelente e satisfatório, os
seguintes percentuais de aprovação: Design das Telas 88,45%, Velocidade
de Navegação 96.15%, Legislação (Aplicabilidade Profissão) 90.47%,
Legislação (Aplicabilidade Ensino) 95,23%, sendo a média de aprovação
para todos os itens avaliados (somando os critérios excelente e
satisfatório) de 85%.
CONSIDERAÇÕES FINAIS. Na interatividade deve-se considerar aspectos
cognitivos, emocionais e tecnológicos da aprendizagem1. O site foi
considerado de utilidade tanto para o ensino como para a profissão de
enfermagem e a avaliação significativa já que envolveu 30% dos docentes
das escolas públicas do estado de São Paulo, considerados experts na área
específica estudada.
BIBLIOGRAFIA. 1. Fainholc B. La tutoria en la educación a distancia:
problemas y recomendaciones. Tec Educ 1997; 25 (136/137): 39-41.
2. Moran JM. Novas tecnologias e o reencantamento do mundo. Tec Educ
1995; 23 (126): 24-6.
INDICE/INDEX
AVALIAÇÃO DO USO DO CYBERTUTOR COMO FERRAMENTA DE
ENSINO PARA ALUNOS DE GRADUAÇÃO EM ODONTOLOGIA
Legramandi, D.B.1; Veronezi, M.C.1; Pegoraro, C.N. 1; Domingues, L.A.1;
Carvalho, R. S. 1; Dalpino, N. R. S. 1, Sequeira, E. 2; Atta, M. T.1; Sgavioli,
C.A.P.P. 1
1- Universidade do Sagrado Coração Bauru S.P. Brasil. 2- Disciplina de
Telemedicina São Paulo S.P. Brasil.
O curso de Odontologia da Universidade do Sagrado Coração em acordo
com a Disciplina de Telemedicina/FMUSP-SP desenvolveu cursos online. As
instituições mantêm cooperação tecnocientifica para o conteúdo
Odontológico da Estação Digital Médica baseada na internet
(www.estacaodigitalmedica.com.br), site que contém um ambiente de
teleducação Cybertutor. Este tutor eletrônico é uma ferramenta interativa
que permite o aprendizado de conceitos teóricos num modelo
construtivista estimulando o desenvolvimento da cognição, capacidade de
expressão e síntese. Composto por um ambiente que contém fórum de
debates, tutorização on line, permite ao aluno participação com maior
discussão sobre o assunto e possibilita a verificação do aprendizado. Na
disciplina de Dentística, o curso no Cybertutor, Nomenclatura e
Classificação das Cavidades, foi utilizado com vinte alunos do segundo ano
de graduação em Odontologia para um primeiro contato com o conteúdo a
ser desenvolvido.
Este trabalho apresenta a avaliação dos alunos sobre o método interativo
empregado, assim como, a apreensão de conhecimentos dos mesmos.
Metade dos alunos teve um primeiro contato com a matéria pelo
Cybertutor e a outra metade, em aula expositiva. Na semana seguinte, as
turmas se inverteram, portanto todos os alunos tiveram contato com o
conteúdo pelos dois métodos. Para avaliar a apreensão do conhecimento,
os alunos passaram por uma avaliação dissertativa após cada etapa. Para
avaliar o método empregado responderam a um questionário elaborado
sobre o assunto.
Resultados obtidos a partir da avaliação aplicada mostraram que com
relação à apreensão do conteúdo, os dois métodos não apresentaram
diferenças significantes. Entretanto, o tempo gasto para que os alunos
entendessem o conteúdo sob a forma de aula tradicional foi
consideravelmente menor para o grupo que utilizou o Cybertutor
previamente à aula teórica. A avaliação dos alunos sobre o método
mostrou que todos o aprovaram como complemento da aula expositiva.
UTILIZATION OF THE CYBERTUTOR AS A TEACHING TOOL FOR
UNDERGRADUATE DENTAL STUDENTS
Legramandi, D.B.1; Veronezi, M.C.1; Pegoraro, C.N. 1; Domingues, L.A.1;
Carvalho, R. S. 1; Dalpino, N. R. S. 1, Sequeira, E. 2; Atta, M. T.1; Sgavioli,
C.A.P.P. 1
1- Sacred Heart University Bauru/SP Brazil. 2- Discipline of Telemedicine
São Paulo/SP Brazil.
The Dental School of Sacred Heart University, in collaboration with the
Discipline of Telemedicine of FMUSP-SP developed online courses.The
institutions keep a technical-scientific collaboration for the dental contents of
the internet-based Medical Digitalstation (www.estacaodigitalmedica.com.br)
,a website that contains the Teleeducation environment Cybertutor.This
electronic tutorial is an interactive tool that allows learning of theoretical
concepts in a constructive model, stimulating the development of cognition,
ability of expression and synthesis. Composed of an environment with a
forum of debates, and online tutorial, it allows participation of the student
with discussion on the subject and verification of learning. In the discipline of
Restorative Dentistry, the course on Cybertutor on the Nomenclature and
Classification of Cavities was used by twenty students of the second year of
dental school for a first contact with the content to be developed.
This paper presents the evaluation of the students on the interactive
method employed, as well as their acquisition of knowledge.
Half of the students had the first contact with the subject by the Cybertutor
and the other half in an expositive class. In the following week, the groups
were inverted, and thus all students had contact with the content by both
methods. To evaluate the acquisition of knowledge, the students
underwent an evaluation after each step. To evaluate the method, they
answered a questionnaire on the issue.
The results achieved in this evaluation revealed that, concerning the
acquisition of knowledge, both methods did not present significant
differences. However, the time spent by the students to understand the
content by the traditional method was considerably shorter for the group
using the Cybertutor before the theoretical lesson. The evaluation of
students on the method demonstrated that all approved it as a
complement to the class.
INDICE/INDEX
BUILDING AN INTERNATIONAL TELEHEALTH PROGRAM:
OVERCOMING BARRIERS INTERNALLY AND EXTERNALLY
Nason, A.M.
Johns Hopkins Medicine International, Baltimore, Maryland, USA
Johns Hopkins laboratories, classrooms and clinical units are centers of
learning for thousands of physicians, students and health professionals.
Johns Hopkins Medicine International (JHI) works with international
institutions, physicians and leaders to fulfill their needs for education and
training in their particular area of expertise by utilizing the subject matter
experts from one of the United States' premier academic institutions
Since 2001, JHI has taken steps to fulfilling this goal through the uses of
both 'hi-tech' and 'low-tech' telecommunications and telemedicine
technologies. With the changes in the world at that time, JHI felt it was
critical to remain local in a community without physically being present. It
is the philosophy of the JHI telehealth program that that the ability to
influence many is more powerful than treating one.
JHI and the Hopkins Office of Telemedicine have supported several
international initiatives of knowledge sharing through video conferencing
and e-learning formats. And while successful, all programs, regardless of
location, socio-economic status and culture, are faced with its pitfalls and
challenges.
This presentation will outline the successes of the JHI telehealth programs
(video education programs, telemedicine consultations), the results of our
successes (development of the Center for Clinical Global Health Education
and Johns Hopkins Medicine-Interactive), and the pitfalls we regularly run
into when establishing these programs.
INDICE/INDEX
BUSINESS PLAN AND OPERATIONAL PROTOCOLS TO ENSURE
SUSTAINIBILITY AND ACCEPTANCE OF TELETRAUMA PROGRAM
1
2,3
1
2
2
Judkins D.; Latifi R.; Whalen E.; Williams M.D.; Porter J.M.
1
University Medical Center, 2Department of Surgery, Trauma and Critical,
the University of Arizona, and 3Arizona Telemedicine Program, Tucson,
Arizona, U.S.A.
BACKGROUND. Technological advances and experience gained with
routine telemedicine services and networks have made possible
implementation of the teletrauma as an integral part of modern trauma
care. However, although this is an optimal solution for providing trauma
expertise to a remote location for trauma resuscitation, there is a concern
of sustainability of such programs and acceptance by hospitals and
healthcare providers in their daily practice.
METHODS. A successful program requires careful planning, a highlysophisticated telemedicine network, technical support on a 24 hour basis,
and a well-developed business plan, with a detailed operational procedure
manual. This document needs to be created with input from each member
of the multidisciplinary team, as it represents a new paradigm providing
telemedicine services for trauma and emergency care.
RESULTS. To insure program sustainability, we created an operational
document using a business model that includes an executive summary,
vision and objectives, products, current and future services, and step-bystep operations. This was done based on market analysis, developmental
strategy, and predictions of cost- effectiveness of the program. The
operational procedures consist of how to operate the telemedicine system,
how to initiate and complete teletrauma resuscitation based on ATLS
protocols, trouble-shooting and avoiding system failures, staffing and
scheduling, documentation and maintaining a database.
CONCLUSIONS.
A successful teletrauma program requires a good
business plan, defined operational procedures, and input and acceptance
by all stakeholders.
INDICE/INDEX
CEDECEM: A TELEMEDICINE PROGRAM APPLIED TO DISTANCE
MEDICAL EDUCATION AND SECOND OPINION CONSULTATION
IN INFECTIOUS DISEASES AND PERINATOLOGY IN ARGENTINA.
Debbag R., Enrique S., Cassetti I., Vazquez L., Vujacich C., García F.,
Sarkis C., Carniglia L., Prudent L., Stamboulian D.
FUNCEI, Buenos Aires, Argentina.
BACKGROUND:
CEDECEM is a Telemedicine program in Argentina
providing medical education courses (ME) and second opinion
consultations (SOC) in Infectious Diseases and Perinatology to public
hospitals (PH).
METHODS: CEDECEM was started in April 2002. Each beneficiary hospital
received a computer and Internet connection.
A specially designed
secure web site (www.funcei.org.ar/cedecem) gives health care
professionals (HCP) access to ME and SOC. Courses deal with Infectious
Diseases in Adults (A), Pediatrics (P) and Perinatalogy (Pe) for physicians
and Hospital Infection Control (HIC) for nurses. Each course lasts 2 years,
arranged in 8 modules. HCPs also receive a printed manual, on site
tutorial meetings and multiple choice online evaluations per module. SOC
have no time limit and they are only answered online.
RESULTS: Up 01/31/05, 6,223 HCP from 25 PH and 3 medical stations in
the Argentine Antarctic Territory received ME and access to SOC (3,144
Nurses and 3.079 Physicians: A 1,356, P 873 and Pe 619). 72% of the
physicians and 85% of the nurses were satisfactory evaluated. 2,089 SOC
were answered (A 862; P 718, Pe 509) in 42 hours average time. The most
frequent SOC were related to clinical and laboratory diagnostic problems,
use of antibiotics and epidemiological aspects.
CONCLUSIONS: CEDECEM has created a network for scientific exchange
among HCP from PH in Argentina, who usually have difficulties to access
ME and SOC mainly due to distance and economic factors.
This
telemedicine model with over 3 years' experience in Argentina may be
replicated in other countries, particularly in Latin America.
INDICE/INDEX
CREATION OF THE TELEMEDICINE LEAGUE OF THE FACULTY OF
MEDICINE OF THE UNIVERSITY OF SÃO PAULO.
Rocha GZ, Daré Junior S, Azevedo R, Fernandes GCVR, Chao LW
Discipline of Telemedicine of the Faculty of Medicine of the University of São
Paulo.
Students of the Faculty of Medicine of the University of São Paulo
(FMUSP) have a long tradition in organizing academic leagues of
extension of university services to health care. The Telemedicine
Discipline of the FMUSP wanted to extend its activities to the
undergraduates of the university. We have proposed this through the
creation of an interdisciplinary academic league. In order to do that
we gave an introductory course about the scene and the concepts of
telemedicine and the results of the practice of telemedicine in
Brazil; we included an electronic test and a personal interview. A
proposed Statute of the Telemedicine League was the source for the
description of the organization and of the functioning of the league.
The introductory course was ministered by 12 speakers during 7
expositive classes, a workshop and a debate. The attendance was
composed of students of engineering (1), dentistry (1), medicine (14),
biomedical informatics (16), nursing (12) and physiotherapy (1) and of
2 medical doctors and 4 lecturers. Of the 37 attendants 14 took the
electronic test. The league was formed with 16 graduate students:
medicine (8), nursing (7) and physiotherapy (1). The league was
organized in 4 groups of tasks, in monthly turns: tele-education,
tele-assistance, iconography and teleconference and a permanent group
for the application of tele-assistance in social university extension.
CONCLUSION: the first academic league of telemedicine in Brazil was
formed; the selection through electronic tests was adequate. This first step
is characterized by interest only graduate students of the health in
integrating this league.
INDICE/INDEX
DESENVOLVIMENTO DE CD ROM EM IMUNIZAÇOES
Juliani, C.M.C.M.*; Godoy, I*; Spiri, W.C.*; Diniz, C.G.P.**; Alvin, F.
B.**; Togashi, G.B.**; Alencar, A.**
Faculdade De Medicina Da Unesp Botucatu/ Sp/ Br
INTRODUÇÃO. O tema imunização é relevante na formação do profissional
de saúde. O produto CD ROM em Imunizações foi desenvovido por um
grupo de alunos de graduação em enfermagem da Faculdade de Medicina
da UNESP em conjunto com três docentes que orientaram a organização e
operacionalização do trabalho. Embora a tecnologia seja apenas um
aspecto do processo pedagógico, seu desenvolvimento torna-se
apropriado ao atual estágio de desenvolvimento tecnológico. Mais que a
tecnologia, o que facilita o processo de ensino-aprendizagem é a
comunicação autêntica do professor, e estabelecimento de relações de
confiança com os alunos2.
OBJETIVO. oferecer recurso tecnológico-pedagógico com conhecimentos
técnico - científicos dos imunobiológicos.
METODOLOGIA. As etapas de desenvolvimento passou pela escolha dos
conteúdos, desenho de mapas conceituais, produção das imagens, que
foram produzidas pelo grupo através de fotografia digital realizadas no
serviço de saúde no momento de realização das ações de imunização com
apoio do Núcleo de Educação a Distância (Nead) da FMB Unesp, edição e
revisão do CD ROM para publicação.
RESULTADOS. O produto final CD ROM permite difusão do conhecimento,
oportunidade de acesso em diversos locais, possibilidade da utilização do
recurso na educação a distância, clareza na transmissão da informação
dado que as técnicas, procedimentos, vacinas e insumos foram
fotografados in loco nas situações reais de atendimento no serviço.
CONSIDERAÇÕES FINAIS. A formação dos profissionais necessita
incorporar todos os avanços científicos e tecnológicos. Além da
instrumentalização técnica, é necessário o compromisso ético-político de
socializar o conhecimento e as informações na tentativa de tornar o mundo
humano1.
BIBLIOGRAFIA. 1. Ferreira NSC. Tecnologia educacional e o profissional no
Brasil: sua formação e a possibilidade de uma cultura humana. Tec Educ
1998; 26 (141): 26-9.
2. Moran JM. Mudar a forma de aprender e ensinar com a Internet. In:
Ministério da Educação (BR). Secretaria de Educação à Distância. Salto
para o futuro: TV e informática na educação. Brasília (DF); 1998.
INDICE/INDEX
DISPONIBILIZAÇÃO DE GUIAS DE CONDUTA E DIAGNÓSTICO
BASEADOS EM FLUXOGRAMAS DE OFTALMOLOGIA ATRAVÉS DE
DISPOSITIVOS MÓVEIS E TECNOLOGIA WEB
Pinto, V. C.; Pisa, I. T.; Lopes, P.R.L.; Barsottini, C.N.; Schor, P.
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
INTRODUÇÃO. O uso de guias de conduta tem demonstrado nos últimos
anos de vital importância para organizar e efetivar maior qualidade nos
processos de assistência em saúde. Em particular, guias de conduta se
mostram úteis no auxílio da prática médica e no diagnóstico para clínicos
gerais e generalistas em oftalmologia. OBJETIVO. Esse trabalho tem como
objetivo disponibilizar guias de conduta e diagnóstico baseadas em
fluxogramas de oftalmologia direcionadas a clínicos gerais e generalistas
de modo a categorizar doenças a partir de sinais e sintomas.
METODOLOGIA. Pretende-se desenvolver uma solução tecnológica para
diagnostico médico através da usabilidade da informação categorizada em
situações reais e simulada por meio do uso de guias de condutas. Esses
guias serão ofertados para uso através de dispositivos móveis e
plataforma web. Serão realizadas pesquisas no Departamento de
Oftalmologia da UNIFESP a partir de fluxogramas pré-estabelecidos na
literatura e opinião de especialistas.
RESULTADOS. A avaliação será realizada de modo quantitativo através de
testes paramétricos e qualitativos usando o padrão NBR/ISO 9241 de
qualidade, que esclarece os benefícios de medir usabilidade em termos de
desempenho e satisfação do usuário. Finalmente espera-se obter com
esta solução uma medida efetiva da melhoria na atenção a saúde.
CONCLUSÃO. Espera-se contribuir com uma solução tecnológica avaliada
quantitativamente e qualitativamente que auxilie clínicos gerais e
generalistas na utilização de guias de conduta em oftalmologia na
assistência médica.
INDICE/INDEX
EDUCAÇÃO A DISTÂNCIA UMA PROPOSTA DE ATUALIZAÇÃO
PERMANENTE EM MASTOLOGIA EXPERIÊNCIA COM BIÓPSIA DO
LINFONODO SENTINELA
Kelmer, S.; Fonseca, L.M.
UFRJ, FM Departamento de Radiologia
Rio de Janeiro Brasil
INTRODUÇÃO. Projeto de Mestrado - Criação, aplicação e avaliação do
curso de atualização em mastologia na técnica da Biópsia do Linfonodo
Sentinela no Câncer de Mama , na modalidade educação a distância
mediada pela internet.Trata-se de uma técnica simples e recente,
reconhecida pela sociedade médica internacional como imprescindível,
mas ainda pouco difundida no nosso meio. Este curso terá um público-alvo
composto por médicos-especialistas em Medicina Nuclear, Radiologistas,
Ginecologistas, Mastologistas e Cirurgiões Oncológicos. O curso estará
sendo ministrado pela Internet nos meses de outubro e novembro(2005),
a avaliação será composta de uma prova presencial a ser realizada em
dezembro/2005 na UFRJ.
Aos alunos que obtiverem rendimento
satisfatório será oferecida uma experiência prática, estes poderão
acompanhar um procedimento de detecção e retirada do Linfonodo
Sentinela em cirurgia de câncer de mama no Hospital Clementino Fraga
Filho (UFRJ) ou no Hospital Fernandes Figueira.
MÉTODOS. Para a elaboração do conteúdo do curso foi formada uma
parceria com a EAD/ENSP-FIOCRUZ , apropriando o conteúdo a didática da
modalidade a distância. Foi formada uma parceria com uma empresa
privada do setor de informática que vem fornecendo equipe de webdesigner, ferramentas tecnológicas (Ambiente Virtual de Aprendizado)
apropriadas para o aprendizado interativo via Internet e suporte de rede. A
divulgação e acreditação do curso serão realizados pela Sociedade
Brasileira de Mastologia.RESULTADOS. O curso será avaliado por diversas
óticas: pelo rendimento acadêmico dos alunos na prova presencial; a
análise das dificuldades e das soluções encontradas para a transformação
digital do conteúdo do curso, sobre o aspecto didático-pedagógico da
modalidade à distância, da implementação e do decorrer do curso
propriamente dito na Internet.
CONCLUSÕES. Espera-se contribuir com este piloto para a divulgação da
eficácia da educação médica permanente via Internet.
Email para contato: [email protected]
INDICE/INDEX
EDUCAÇÃO EM SERVIÇO POR VIDEOCONFERÊNCIA
Godoy, S.; Mendes, I.A.C.; Nogueira, M.S.
Escola de Enfermagem de Ribeirão Preto-USP
Realizou-se um treinamento sobre o conteúdo de administração de
injetáveis pela via intramuscular na região ventroglútea entre auxiliares de
enfermagem de um hospital escola do interior do estado de São Paulo.
Teve como objetivo incentivar a utilização da região citada. Utilizou-se
tecnologia de videoconferência para interligar um laboratório de ensino de
uma escola de enfermagem estadual ao referido hospital. Foram
ministradas aulas sobre o conteúdo utilizando-se a referida tecnologia e
realizado treinamento em situação simulada. Os 32 auxiliares de
enfermagem foram avaliados quanto a aquisição de habilidade intelectual
e motora, bem como avaliaram a utilização da videoconferência como
ferramenta para o ensino em serviço. Os resultados apontam que a
maioria dos auxiliares de enfermagem obtiveram bom desempenho na
realização do procedimento em situação simulada. A videoconferência se
mostrou um bom meio para a realização de educação em serviço. Os
participantes do estudo sugeriram ainda que para os treinamentos futuros
sejam disponibilizados materiais para apoio ao aprendizado em outros
formatos.
INDICE/INDEX
ESTABLISHMENT OF A PIONEER DIGITAL TELE-ECG SYSTEM IN
SOUTHERN BRAZIL
Sparenberg, A.L.F.; Russomano, T.; Azevedo, D.F.G.
Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil Medical
Society of São Lourenço do Sul, RS, Brazil
INTRODUCTION. A lack of medical specialists in remote areas of Brazil can
delay the diagnosis and the adequate management of diseases. A pioneer
Telemedicine Program was established in southern Brazil in the area of
cardiology (Digital Tele-ECG System, DES).
METHOD. DES allows electronic data transmission to and interpretation by
a remote cardiologist. An urban and a rural hospital in Sao Lourenco do Sul
city and an outpatient unit in Turucu city employed the DES in Jan 2000,
Jan 2001 and June 2003, respectively. DES includes a digital ECG machine,
standard computers, a modem connection, internet facilities,
telecommunication software and fixed or mobile phones.
RESULTS. A total of 1063 tele-ECGs were performed in the three locations
in 1 year: 622 via online and 441 via e-health. The time between data
transmission and analysis was 8.1 min and up to 24h for the online and ehealth tele-ECGs. 604 online tele-ECGs (97.1%) were performed at the
urban hospital. The results showed that 71.2% (443 out of 622) of the
online tele-ECGs presented important ECGs alterations, including 66
(14.9%) ECGs with acute signs of myocardial ischemia and 39 ECGs
(8.8%) with S-T elevation myocardial infarction.
CONCLUSION. The low cost of DES make it useful and appropriate for small
cities and rural areas of developing countries where cardiologists and
radiologists are not available for on-site consultation. DES has promoted a
significant improvement in the acute management of patients in remote
areas, with a consequent decrease in the morbidity and mortality rates
from cardiovascular diseases.
e-mail: [email protected]
e-mail: [email protected]
INDICE/INDEX
ESTABLISHMENT OF A PIONEER TELE-X RAY SYSTEM IN
SOUTHERN BRAZIL
Sparenberg, A.L.F.; Russomano, T.; Hammes, E.; Abreu, I.M.;
Szomorovszky, S.V.; Freitas, M.A.V.; Timm, R.
Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil Medical
Society of São Lourenço do Sul, RS, Brazil
BACKGROUND. A lack of medical specialists in remote areas of Brazil can
delay the diagnosis and the adequate management of several medical
conditions. A pioneer Telemedicine Program has been started recently in
southern Brazil in the area radiology (Tele-x ray or DEX) as an attempt to
overcome this situation.
METHODS. DEX includes an x-ray facility, a viewing box, a digital camera,
standard computers, a 3:1 Mitchell algorithm compression protocol using
the Easy Thumbnails software and Internet access. The system allows data
to be recorded, transmitted and stored. A remote specialist performs the
data analysis via either fixed or mobile phone, using specific
telecommunication softwares and web based transmission.
Results: Sixty chest x-rays were randomly selected at the urban and rural
hospitals of Sao Lourenco do Sul for a preliminary evaluation of DEX. A
remote radiologist of each health care unit received 30 chest x-rays via ehealth transmission for later analysis. The x-rays were transmitted via
Internet after being compressed. Lung and heart variables were compared
using the on-site and remote interpretation. There was an 81.7%
agreement (n=49) between the on-site and remote interpretation. Only
27.3% (3 out of 11) of the misinterpreted x-rays were related to a lack of
identification of pathological abnormalities. In eight remotely interpreted
x-rays (72.7%) additional information regarding signs of cardiac and
pulmonary alterations were found.
CONCLUSION. The low cost, the high quality and the “user friendly” aspect
of DEX make it appropriate for remote areas of developing countries where
radiologists are unavailable.
e-mail: [email protected]
e-mail: [email protected]
INDICE/INDEX
ETAPAS DE IMPLEMENTAÇÃO DO PACS NA ÁREA MÉDICA
Pereira, A. J.
INRAD, Hospital das Clínicas da Faculdade de Medicina da USP.
A instalação de um sistema PACS/RIS em uma instituição é muito mais que
apenas a implantação de um sistema de informações, são necessárias
várias etapas preliminares para a definição de vários processos e
necessidades do departamento e da instituição.
Antes de tudo, a implementação destes sistemas tratam-se de uma
mudança de filosofia e fluxo de trabalho que pode impactar toda a
instituição.
A maneira que com que o sistema e implementado pode acarretar no
completo fracasso do projeto, devendo, desta forma ser cuidadosamente
planejado e estruturado, desta forma evitam-se imprevistos devido a
super e sub dimensionamento da solução.
Destacam-se também no projeto a importância de uma correta avaliação
dos impactos tomando assim as medidas preventivas e corretivas
adequadas, provendo aos usuários do sistema uma base de treinamento e
suporte sólida e adequada as suas necessidades.
INDICE/INDEX
ETHICAL EVALUATION OF MEDICAL TELECONSULTATIONS
PERFORMED BY THE BHTELEMED PROJECT
Souza, C.; Alkmim, M.B.; SANTOS, AF.; Melo, M.C.; Silva, I.M.; Bossi,
G.A.; e Santos, S.F.
Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brasil; Hospital das Clínicas da Universidade
Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Secretaria
Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas Gerais,
Brasil; PRODABEL - Empresa de Informática e Informação do Município
de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil.
.
INTRODUCTION. Different from modern medical science, which has been
shaped by a strong ethical tradition, Telemedicine as a new activity has
controversial ethical and legal aspects which need to be analysed and
discussed. The Brazilian Federal Council of Medicine (CFM), through the
resolutions 1643/2002 and 1639/2002 established ethical criteria for
Telemedicine and digital medical records. However, considering the
relevance of Telemedicine and its certain expansion, it is strongly
recommended to carry out studies regarding ethical aspects of its practice.
The objectives of this study were to: 1- Detect ethically vulnerable
moments of the teleconsultations; 2- Analyse technological safety
solutions and the confidentiality adopted by the system; 3- Establish an
ethical commitment of all the actors involved in the process.
METHODOLOGY. Seventy-six Teleconsultations were evaluated, with
emphasis given to the vulnerability of the patient's privacy and
confidentiality and in the safety offered by the system of Teleconsulting.
RESULTS. Two weak points of the system were detected and will be
corrected: A formal absence of “informed consent” and the formal
absence of a term of commitment regarding confidentiality, signed by nonmedical actors. However, the system was considered safe in relation to
data and network access.
CONCLUSIONS. The BH TELEMED project, analysed from an ethical point
of view, showed itself adequate and in condition to reach high levels of
excellence within ethical standards, confidentiality, privacy, and with safe
reproduction of medical data.
INDICE/INDEX
EXPERIÊNCIA DO INCOR NO DESENVOLVIMENTO, IMPLANTAÇÃO
E MANUTENÇÃO DO PACS
Gutierrez, M.A.
ServiÇO de InformÁTica, Insituto do CoraÇÃO do Hospital das
ClÍNicas da Faculdade de Medicina da USP.
O Instituto do Coração (InCor) tem envidado esforços para integrar todas
as informações clínicas dentro da Instituição. Nos últimos anos o InCor
implementou com sucesso um sistema para transmissão, arquivamento,
recuperação, processamento e visualização de Imagens Médicas (PACSInCor) e um Sistema de Informações Hospitalares (SI3) que armazena as
informações administrativas e clínicas. A integração desses subsistemas
forma o Prontuário Eletrônico do Paciente (PEP). O InCor é um dos seis
Institutos que compõem o Hospital das Clínicas da Universidade de São
Paulo. Como cada um dos Institutos possui o seu próprio sistema de
informações, a troca de informações entre os Institutos é também uma
questão muito relevante. Este trabalho apresenta a experiência no
desenvolvimento de um Prontuário Eletrônico funcional e completo, que
inclui controle de acesso, exames laboratoriais, imagens (estáticas,
dinâmicas e 3D), laudos, documentos e mesmo sinais vitais de tempo real.
Esta apresentação pretende discutir também a modelagem e implantação
do PACS-InCor. Para a visualização das imagens, foi implementado um
visualizador DICOM, que permite a manipulação de imagens estáticas e
dinâmicas, em uma taxa de até 30 quadros por segundo. Uma versão
reduzida e simplificada, denominada “miniWebPACS”, foi disponibilizada
para a comunidade no endereço http://www.sourceforge.net. Além desse
desenvolvimento, também procurou-se integrar os equipamentos médicos
que não possuem capacidade para transmitir informações em formato
digital. Para tanto, um produto tecnológico foi desenvolvido para integrar
dezenas de equipamentos de ultra-som, utilizados na rotina de exames de
ecocardiografia, os quais não apresentavam capacidade para transmitir
imagens médicas em formato digital para o PEP. O produto desenvolvido
permitiu a integração destes equipamentos, reduzindo sobremaneira o
investimento necessário para a atualização do parque tecnológico da
Instituição. Atualmente, um volume superior a 2,5TB de imagens DICOM já
foi armazenado utilizando a arquitetura proposta. Diariamente, o PACSInCor armazena mais de 5GB de dados e tem uma quantidade de acessos
superior a 300 usuários. O sistema de armazenamento permite uma
visibilidade de seis meses para acesso imediato e mais de dois anos para
acesso automático utilizando unidades robotizadas de fitas de alta
velocidade (Jukebox).
INDICE/INDEX
GESTÃO DE FATORES DETERMINANTES DA SUSTENTABILIDADE
EM SERVIÇOS DE TELEMEDICINA
Gundim, R.S., Chao, L.w.
Faculdade Medicina USP - Disciplina Telemedicina
INTRODUÇÃO: O uso da Telemedicina para fins assistenciais e
educacionais, em um país com as dimensões do Brasil, quando bem
planejado, facilita ações de prevenção de doenças e promoção da saúde. O
entendimento adequado sobre os fatores envolvidos na sustentabilidade
da implantação da telemedicina poderá ajudar a evitar perda de
investimentos. A abordagem sob o foco da Gestão e da Logística de
Recursos, a fim de detectar os fatores potencializadores e limitadores à
implementação de Centros de Telemedicina (CTMs) em unidades básicas
de saúde, instituições e hospitais universitários permitirá avaliar os fatores
determinantes para o sucesso e continuidade de CTMs dentro do realidade
nacional.
OBJETIVOS: 1) Desenvolver critérios de mensuração de fatores
determinantes de sustentabilidade em relação à implementação e CTMs.
2)Identificar e quantificar os fatores que determinam riscos de insucesso
para telemedicina. 3) Sistematizar e Correlacionar os valores dos índices
com o desempenho dos CTMs ativos.
MÉTODO: Pesquisa de campo em distintas regiões do Brasil, através de
fichas de avaliação. A base conceitual para a determinação dos indicadores
de sustentabilidade estará baseada no Balanced ScoreCard (BSC) uma
metodologia de gestão estratégica em que os objetivos da empresa, são
estabelecidos e monitorados pela definição de indicadores de performance,
que devem ser estabelecidos a partir de situações sob as perspectivas:
econômicas, cliente, processos internos, aprendizado e desenvolvimento.
JUSTIFICATIVA E RELEVÂNCIA: Nota-se que o sucesso dos CTMs está
claramente associado a uma gestão integrada dos fatores humanos,
tecnológicos, financeiros e institucionais. A identificação precoce dos
fatores desfavoráveis do ambiente de implementação de CTMs permite
desenvolver ações de formação e motivação das pessoas, correção e
adequação do ambiente para a melhor incorporação da tecnologia e a
desejada continuidade.
Dada a importância estratégica da telemedicina e a inexistência de um
instrumento que auxilie os gestores na detecção de ambientes maduros
para implantação de programas desta natureza encontra-se relevância da
execução deste estudo. O resultado poderá servir de apoio à tomada de
decisão, pública ou privada, mensurando e indicando quais são as
condições mínimas adequadas para a implementação de CTMs, evitando
perdas de recursos.
INDICE/INDEX
GUIAS DE CONDUTA PARA PROGRAMAS DE TELEMEDICINA E
TELESSAÚDE DO OBSERVATÓRIO DE TELEMEDICINA DA
UNIFESP
Sousa, R.M.; Pisa, I.T.; Lopes, P.R.L.; Barsottini, C.G.N.; Gimenez,
R.S.S.; Sigulem, D.
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil
INTRODUÇÃO. O Setor de Telemedicina da UNIFESP está desenvolvendo
um Observatório de Telemedicina destinado a acompanhar a evolução da
área no país, bem como das tecnologias que podem ser empregadas para
auxiliar na colaboração entre profissionais da saúde. Por se tratar de novos
métodos, requer maior atenção aos profissionais que precisam de
orientação para a utilização das ferramentas envolvidas. OBJETIVO. Os
guias são desenvolvidos para orientar usuários de programas de
telemedicina e telessaúde a realizar reuniões síncronas a distância de
maneira eficaz e efetiva.
MÉTODOS. Para seu desenvolvimento foi necessária uma revisão
bibliográfica sobre os diversos temas relacionados, como telemedicina,
videoconferência, tecnologias e padrões, aplicações na área de saúde e
demais aplicações de suporte. Após essa pesquisa foi estudada a melhor
forma de apresentar as informações geradas em relação à sua estrutura e
conteúdo. O texto criado foi dividido em pequenas unidades que podem
ser agrupadas em diferentes formas, sendo passiveis de localização
através de busca por palavras-chave. A forma de armazenamento em
banco de dados permite que informações sejam alteradas a qualquer
momento, o que facilita sua constante atualização.
RESULTADOS. Com oito meses de trabalho, a versão beta 0.2 do guia está
disponibilizada na web, em fase de ajustes e revisão. Deverá ter sua
versão final até novembro de 2005, quando será gerada uma versão
impressa.
CONCLUSÕES. A oferta de guias de conduta em telemedicina e telessaúde
pode acelerar a aderência dos profissionais da saúde na colaboração
médica através do uso de tecnologias de informação e comunicação.
INDICE/INDEX
HARNESSING THE EHEALTH EXPERIENCE FROM AROUND THE
WORLD TO CREATE THE GLOBAL EHEALTHY CITIZEN
Richardson, R. J.
Imperial College, London, UK
INTRODUCTION. The healthcare environment is changing rapidly away
from a healthcare delivery model which has been configured to make it
easier for the provider and is infrastructure dependent - towards a new
healthcare model which will be truly citizen centric and patient friendly.
METHODS. eHealth plays a pivotal role in facilitating this transformational
change and provides the platform for the delivery models of the future. New
applications and interfaces are being developed - such as on hand held
devices and PDAs - to make the access of healthcare information and services
both ubiquitous and easy to utilise and eHealth and telemedicine allows the
specialist skills normally locked inside individual hospitals and clinics - to
become widely distributed to the community and across national and
international boundaries. There are many examples of eHealth in practice
from around the globe and these now need to be evaluated independently
and the best and most user friendly examples need to be identified and
brought to the attention of decision makers responsible for effecting the
healthcare transformation in their own countries. This paper will address
these issues with examples of eHealth "best practice" from around the world
|
INDICE/INDEX
HOME OR HOSPITAL IN HEART FAILURE
Johnson P.; Mortara A.M*; Ponokowski P.
Centre for Ehealth, John Radcliffe Hospital, Oxford, * Foundatzione S
Maugeri, Montescano, Italy. ~ Military Hospital, Wroclow, Poland for the
HHH Consortium
Home telemonitoring of cardiovascular and respiratory parameters have
been evaluated in the management of congestive heart failure (CHF).
Associated respiratory disorder, chiefly Cheyne Stokes Respiration (CSR)
occurs in 50% of CHF patients and seriously affects mortality and
morbidity, is the focus of this report.
The HHH study is a RCT in Italy, Poland and UK enrolling 450 CHF patients
(LVEF <35%, NYHA II-IV) and enrolment NICRAM (blind) with 2 arms
(usual clinical practice and home-care strategy) studied over a 12 month
period. NICRAM is the 24-hr telemonitoring of respiration, heart rate
rhythm and activity using new methods of data transmission and analysis.
Prognostic prediction, patient QOL, self-care, and cost-effectiveness in
three European countries will be assessed. A clinical assessment, ECG,
Echocardiogram, and Quality of Life questionnaire were performed at
baseline, 4 and 12-months and composite measure of patient well-being
(death, hospital bed days, symptom score and quality of life).
INDICE/INDEX
HOMEM VIRTUAL DA HANSENÍASE UMA ESTRATÉGIA PARA
AUMENTAR A PROCURA POR DIAGNÓSTICO E TRATAMENTO
Trindade M.A.B.1, Wen C.L.1, Festa C.N.1, Andrade V.G.2, Soares
R.C.F.R.3
1
Faculdade de Medicina da Universidade de São Paulo, 2Organização
Panamericana de Saúde, 3Ministério da Saúde do Brasil
INTRODUÇÃO: A hanseníase doença infecciosa crônica é um problema de
saúde pública brasileiro. O Brasil está após a Índia em número de casos
registrados e é o quinto país na taxa de detecção de casos novos. A
divulgação dos principais sinais e sintomas, manchas dormentes e do
tratamento gratuito visa estimular a população a procura por diagnóstico e
tratamento colaborando para quebrar a cadeia de transmissão e prevenir
incapacidades. Com este intuito elaboramos o vídeo a ser apresentado
utilizando novas tecnologias aplicadas na Telemedicina
MATERIAL E MÉTODOS: Para elaboração do vídeo foi utilizado material
iconográfico do Projeto Homem Virtua da Telemedicina sob a
orientação
da
Dermatologia
da
FMUSP, com assessoria e
financiamento da OPAS/OMS e distribuição pelo Ministério da Saúde
como patrimônio da população brasileira, em especial para Unidades
Básicas de Saúde , Unidades Escolares do Ensino Fundamenta
RESUMO: Esta apresentação pretende divulgar material desenvolvido com
novas tecnologias para realçar os sinais e sintomas iniciais da hanseníase
mancha e/ou área anestésica que, se não tratada na fase inicial, poderá
ser transmissível e causar incapacidades físicas. É informado que o
tratamento é gratuito, possibilita a cura da doença, e é realizado na UBS de
mais fácil acesso.
CONCLUSÃO: O vídeo Homem Virtual da Hanseníase concebido com
material iconográfico pretende ser uma estratégia para aumentar a
procura da população geral por diagnóstico e tratamento.
email: [email protected]
INDICE/INDEX
INDIAN INITIATIVES AND EXPERIENCES IN TELEMEDICINE FOR
SPECIALITY HEALTHCARE DELIVERY TO THE RURAL AND
REMOTE POPULATION - A DEVELOPING COUNTRY MODEL
Satyamurthy LS, Murthy RLN & Bhaskaranarayana. A
Indian Space Research Organisation (ISRO), Bangalore, Karnataka, India
India is the 7th largest country in the world with an area of 3.2 million
square kilometers and one Billion plus population. While a vast majority of
India's population lives in the rural areas, 75% of the qualified doctors
practice in urban areas. Noting this important dichotomy, especially the
Urban/Rural Health Divide, the Indian initiatives in
Telemedicine/Telehealth was started in the year 2001 and primarily
spearheaded by the Indian Space Agency ISRO.The focus of this
endeavour has been on providing technology and connectivity for
Healthcare Delivery in terms of the services for Tele-consultation and
treatment between Remote/Rural District Hospital and Super Speciality
Hospital, Continuing Medical Education (CME) including training of Doctors
and Paramedics, Mobile Telemedicine for Rural Health camps especially for
Ophthalmology and Community Health and ICT related to Primary
Healthcare. For implementing this daunting task, an integrated approach
of technology development, standards and cost effective systems were
evolved in association with the various Government/NGO Agencies,
Speciality Hospitals and the Industry, including introduction of innovative
insurance schemes for the rural population.Presently ISRO's Telemedicine
Network consists of 135 Hospitals 105 Remote/Rural/District
Hospitals/Health Centres connected to 30 Super Speciality Hospitals
located in major cities.ore than 50000 patients have been provided with
Tele-consultation and treatment. A private impact study conducted on one
thousand patients treated through Telemedicine network revealed that
there was a cost saving of 81%. This experience is set to enter operational
arena for a sustainable business model to facilitate public/private
partnership involving insurance industry for long-term sustainability.
The paper discusses the initiatives, the major thrust areas,
technology and utilisation aspects, the road map and the vision for future
development of an operational Telemedicine network in the country.
INDICE/INDEX
INTERACTIVE CASE DISCUSSION: AN OTOLARYNGOLOGY ELEARNING PROGRAM BASED ON PROBLEMS
Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RF
Faculty of Medicine, University of São Paulo
We have developed an integrated e-learning model using interactive
software. The model is divided into two parts: (1) A software distributed on
Cds, and (2) An internet website. The Cd is based on case reports and the
user need to evaluate the case step-by-step. The progress in the program
depends on the answer of some questions about the case. All the questions
have explanations. After case resolution, the user may assess literature
review and specialists comments about the topics. In the internet
interface, the user needs to complete an interactive test. Threedimensional (3-D) animated models are used to improve learning,
principally about anatomy and pathophysiology. The first CD is about
sudden hearing loss and others subjects will be assessed quarterly. The
interactive case discussion seems to be a good alternative as a e-learning
program and is focused on individual learning.
INDICE/INDEX
INTEGRATING TELE-NURSING AND TELE-HEALTH WITH HEALTH
INFORMATICS: NEED FOR STANDARDIZATION TO ACHIEVE
SEMANTIC INTEROPERABILITY AND IMPROVE PATIENT SAFETY.
Professor Hovenga, J.S. RN, PhD, FCHSE, FRCNA, FACHI, MACS
Program Director, Health Informatics, Head, School of Information
Systems
Faculty of Informatics and Communication - Central Queensland
University, Australia.
Making the best possible use of available technologies to safely deliver
quality health services requires every nation to establish a framework that
will enable health professionals and health information systems to
communicate with each other in a timely and reliable manner. Such a
framework consists primarily of the adoption of any number of agreed
standards but also on agreed policies and methods of operation. This
creates a new national health information environment facilitating all
appropriate stakeholders (users) to find, request, retrieve and provide
relevant patient records, data, information and knowledge rapidly and
accurately subject to patient authorization where relevant. Such an
approach takes advantage of significant investments made in the
acquisition of telecommunication and information technologies nationally
and by many health care providers within the country. Nurses represent
the largest group of organised health professionals in most countries.
Nurses play a critical role in creating an effective health care information
infrastructure via clinical nursing documentation and health information
systems. In many instances nurses make recommendations regarding the
purchase of systems or have responsibility for their implementation.
Nurses need to be educated such that there is a sizable national capacity of
nurses able to significantly contribute to the establishment and adoption
of the desired national framework as well as the necessary standards,
policies and methods of operation. This presentation intends to explore
opportunities and barriers for nurses to contribute to the creation of an
effective national health information framework that will enable the
integration of tele-nursing and tele-health with health and nursing
informatics for the purpose of improving patient safety and the quality of
nursing service delivery in any health care setting. It will conclude with
some ideas on how to make the most of these opportunities and to
overcome the barriers.
[email protected]
http://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/
[email protected],
http://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/
INDICE/INDEX
ISfTeH AND THE ROLE OF INTERNATIONAL ORGANISATIONS
AND INSTITUTIONS
Lievens, F. 1, 2 Jordanova, M. 2,3
1
ISfTeH, Zurich, Switzerland; 2Med-e-Tel, Luxembourg, G. D. of
Luxembourg
3
Institute of Psychology, Bulgarian Academy of Science, Sofia, Bulgaria
The aim of this presentation is to briefly present ISfTeH close and fruitful
collaboration with various international organisations and institutions such
as WHO, UNOOSA, ITU, EC, etc. Tremendous efforts were made by the
ISfTeH Board to establish and develop these partnerships, contributing as
such to fulfil its mission of promoting and supporting Telemedicine/eHealth
activities worldwide and to be recognized as an umbrella for national
Telemedicine and eHealth organisations. ISfTeH is truly the United Nations
in Telemedicine/eHealth.
On the other hand, close contacts with international bodies are a must for
ISfTeH to comply with its engagements towards its members and act as:
- Moderator in all aspects of healthcare: delivery, science, education,
business, etc,
- Feeder for projects and information,
- Assistant in the set up of new national Telemedicine/eHealth associations.
INDICE/INDEX
LAUNCH OF @HEALTH: A VIRTUAL COMMUNITY FOR
APPLICATIONS OF E-HEALTH TECHNOLOGIES IN EUROPE AND
LATIN AMERICA
VÉLez BeltrÁN, J.A.; Navarro Newball, A.A.; Salvatore, P.; Salas, L.C.
Colombian Telemedicine Centre - Cali, Colombia
CIAOTECH Srl - Roma, Italia
KEYWORDS. Community, Telehealth, Telemedicine, Information Society.
OBJECTIVE. The overall objective of the envisaged specific support action
“@HEALTH" is to enable European and Latin American researchers, policy
makers and other relevant players operating in the field of e-health to
access and exchange knowledge, skills, technologies and facilities through
the development of an e-health virtual community.
METHODS. The project´s methodology includes the following phases:
Phase I: Mapping competences, players, and resources in Europe and Latin
America related to e-health applications and technology.
Phase II: Setting up the virtual community web portal.
Phase III: Awareness creation action.
Phase IV: Dissemination and exploitation: web actions, e-newsletters,
press releases, and participation in international conferences and
seminars.
RESULTS. As a specific support action the project will not directly lead to
scientific results, but it will stimulate the achievement of specific scientific
objectives in emerging e-health applications and enabling technologies
oriented to: professional networking; integration of the clinical care
process management; provision of web-based health information and
healthcare, including remote monitoring and patient care.
At the moment, @HEALTH is built upon a consortium including European
and Latin American research organisations representing the top level
competences in the e-health sector, and a team of experts having
successfully carried out direct experiences in the development of
international research and technology transfer networks.
already exist at the practice, program, and policy levels. Can global ehealth contribute to the process? The simplistic response is absolutely.
Global e-health has the potential to address causes of inequality directly,
and thereby address inequity indirectly. For example, small area variation
across subgroups of practitioners may be identified as a factor contributing
to inequality. A variety of e-learning options exist (training, mentorship,
continuing education) that, if determined to be appropriate, can be
implemented through specific voluntary or mandatory educational
(practice), training (program), or standardisation (policy) interventions.
But issues also arise. For example, e-health has the potential to exacerbate
as well as ameliorate inequality to broaden the 'digital divide' (and other
divides). Poorer people are generally most in need of healthcare support,
yet they are the group least likely to have access to rapidly advancing
technological solutions. Our challenge is to identify, develop, and apply
culturally appropriate, broadly available e-health solutions, and to
concurrently develop the population and professional skills necessary to
use them. In this regard, global e-health alone will not suffice. To impact
other determinants that affect individual and population health, such as
literacy and employment skills, it will be necessary to develop initiatives
that work in concert, developing e-learning and e-business opportunities
concurrently with e-health applications. To achieve this, a systematic
approach is required. One that includes: identification of the magnitude of
health gradients, needs and readiness assessment, determination of
whether e-health is a viable option, and finally implementing and
assessing the impact of any global e-health solution.
Such a process would be equally applicable and valuable to developing
countries as to developed countries, but the context and solutions would
be different. Applying this approach will allow appropriate e-health
solutions to be applied in reducing inequality and inequity wherever it is
found, and thereby help level the playing field for the health of the world's
population.
INDICE/INDEX
MODELO DE EDUCAÇÃO À DISTÂNCIA EM HANSENÍASE
VOLTADO PARA REDE DE DETECÇÃO DE CASOS E
DIAGNÓSTICO.
Paixão M.P., Miot H.A., Chao L.W.
Disciplina de Telemedicina da Faculdade de Medicina da USP.
O Brasil é atualmente o segundo país em maior número de casos de
hanseníase no mundo. A maior concentração dos casos ocorre na região da
Amazônia legal, onde fatores como extensão geográfica e dificuldades de
acesso dificultam o atendimento de saúde às populações isoladas, que é
agravado pela heterogeneidade de distribuição de médicos e de
dermatologistas. O uso de telemedicina pode auxiliar no reconhecimento
de casos de hanseníase e permite criar uma rede de teletriagem através da
implementação programas de prevenção e educação continuada à
distância.
Este projeto de pesquisa tem por objetivo desenvolver ambiente de
educação à distância para treinamento em identificação clínica de
hanseníase, e avaliar o impacto dele como recurso para formação de uma
rede de triagem à distância através de ambulatório virtual, com: (a)
criação de curso de treinamento para não-médicos, voltado para o
reconhecimento de sinais suspeitos de hanseníase; (b) criação de cursos
de capacitação e de atualização à distância em hanseníase para médicos
generalistas e envolvidos com o Programa de Saúde da Família (PSF); (c)
estruturação de ambiente de segunda opinião (online e offline) em
hanseníase; (d) avaliação do potencial impacto da teleducação na
formação de profissionais não-especialistas.
Os participantes envolvidos no projeto serão médicos generalistas e
indivíduos não-médicos que tenham contato com grande número de
indivíduos. Serão oferecidos para os sujeitos da pesquisa cursos de
capacitação e de atualização para médicos, e curso de treinamento para
não-médicos. Serão feitas avaliações pré-treinamento e após este, através
de formulário padronizado, de forma a permitir avaliar o impacto do uso
dessa técnica. Todo o processo será feito remotamente dentro do ambiente
virtual do Cybertutor (tutor eletrônico), onde serão inseridas as
informações e implementados recursos educacionais.
Na última fase esse projeto possibilitará a integração com a assistência
remota à paciente, possibilitando a emissão de segunda opinião nos
casos com dificuldades diagnósticas ou terapêuticas. Representará,
portanto, importante recurso auxiliar na assistência à distância.
INDICE/INDEX
NEXT GENERATION BROADBAND AND WIRELESS NETWORKS TO
SUPPORT ADVANCED TELEMEDICINE APPLICATIONS
Szabo, C.A.
Budapest University of Technology and Economics, Budapest, Hungary
Development of telecommunications networks has been and partially is
technology-driven. This was particularly true for the years of telecom
boom in late 90s. Telecom operators and also, to some extent, public
entities such as municipalities laid down a large amount of optical cables
and equipment. As a result, multiple terabits of bandwidth was deployed in
the core part of the networks, which is to a large extent unused even today.
On the other hand, telcos did not pay too much attention to providing high
speed access to customers, especially to residents and non-profit
organizations such as health care institutions, except the widespread
deployment of ADSL which is the only “broadband” technology deployed
worldwide. (However it only provides data rate of about one Mbps and
besides does it in an asymmetric way, offering much less in the uplink
direction.)
After the recent downturn of the telecom industry, operators started to be
much more customer and service oriented. The new direction of “Next
Generation Networks” is no longer just a technology development: moving
to IP-based communications serves the needs of applications and services
in many ways. In the wireless/radio area, the term “Beyond 3G” means no
longer a specific new technology, on the contrary, it means a combined use
of a variety of existing and emerging wireless access technologies, to
achieve the objective of being “always best connected”, together with IP as
the universal platform here, too.
What can all this bring to the telemedicine world? Actually, a lot and not
only increased bandwidth. Telemedicine applications do indeed need
bandwidth, as for example transmission of uncompressed radiology
images with a reasonable delay need 10 Mbps or more and this
bandwidth has to be delivered to the end user no matter whether it is
an office in a hospital or the medical specialist's home. Telemedicine
applications can benefit from the recent developments and emerging
telecommunication technologies in many additional ways. Rural and
underserved areas can be covered, the growing populations of seniors
can be monitored at their homes, the quantity of medical errors can be
reduced and, in general, the effectiveness of health care services can be
increased.
Third generation cellular networks provide considerable data rates which
makes it possible to access to and exchange medical data in a global
environment. New high speed wireless technologies offer tens of Mbps
within the medical enterprise or within a metropolitan area. The new
wireless MAN technology can be deployed not only by service providers but
also by communities or groups of non-profit organizations such as
hospitals, due to the liberalization of the corresponding frequency bands.
New personal area communication technologies such as Bluetooth plus
information collecting and monitoring devices (intelligent cameras and
RFIDs, as examples) offer the right technology background for home
health care applications.
The paper gives an overview of the state-of-the art and emerging
communication solutions that are of primary importance for telemedicine
applications, for non-communications specialists. The overview will focus
on next generation broadband and wireless networking technologies and
solutions that could support advanced existing and emerging telemedicine
applications. First, the requiremements of telemedicine applications are
outlined, including bandwidth, response time, loss, pervasiveness,
mobility, security and privacy, payment, user devices, management. Then
an overview of relevant optical and wireless broadband technologies will be
given, focusing mainly on wireless solutions for providing telemedicine
services in metropolitan, local and personal enviroments. Regarding
wireless, the combined and flexible use of different wireless technologies
(WLAN, WiMAX, Bluetooth, 2.5G/3G cellular) will be emphasized, with
vertical handover among them as the application scenarios require. The
technology discussion will be accompanied with case studies of systems
deployed or planned in Europe.
[email protected]
INDICE/INDEX
OBJETOS EDUCACIONAIS: APLICAÇÃO NO ENSINO DE
FUNDAMENTOS DE ENFERMAGEM
COGO ALP; SILVA APSS; ALVES RHK.
Laboratório de Ensino Virtual Enfermagem, Escola de Enfermagem
Universidade Federal do Rio Grande do Sul
Porto Alegre RS Brasil
Introdução: Entende-se por objetos educacionais ou de aprendizagem os
recursos de multimídia que possibilitem interatividade para apoiar as
práticas de ensino-aprendizagem através das tecnologias da informação e
da comunicação. Possui como características a reusabilidade,
adaptabilidade, acessibilidade, ser autoexplicável e estar disponível em
repositório de objetos. O desenvolvimento de objetos educacionais sobre
temas de fundamentos de enfermagem tem sido uma das atividades
realizadas pelo Laboratório de Ensino Virtual Enfermagem, e a descrição
deste projeto é o objetivo deste trabalho. Métodos: As fases de
desenvolvimento envolvem desenho da estrutura do recurso educativo,
desenvolvimento dos objetos educacionais empregando softwares
Macromedia Flash MX®, Adobe Photoshop® e CorelDRAW®, implementação
e avaliação do material produzido.
Resultados: Os materiais
desenvolvidos referem-se às temáticas: administração de medicamentos,
balanço hídrico, curativos, oxigenoterapia, punção venosa, sinais vitais,
sondagens nasogástrica, nasoentérica, vesicais. Estes objetos são
constituídos de hipertexto, botões explicativos sobre os conceitos centrais,
imagens digitais demonstrando os procedimentos “passo-a-passo”, links
para conteúdos complementares e ao final de cada objeto, é
disponibilizado exercícios de revisão de conteúdo. Também encontram-se
em fase de desenvolvimento animações (jogos educativos) sobre
montagem de material para realização de procedimentos; passagem de
cateter de oxigênio e de sondas (SNG e SNE); punção venosa periférica.
Conclusões: Pretende-se avaliar os objetos apresentados junto aos
acadêmicos de enfermagem, quanto a interação e os níveis de
compreensão que os mesmos propiciam; e a adequação dos conteúdos
junto a especialistas. Os objetos educacionais desenvolvidos poderão ser
compartilhados com a comunidade de enfermagem a partir de sua
disponibilização em repositório.
Apresentação em Pôster
Contato: Ana Luísa Petersen Cogo
Rua Sacadura Cabral,130/202 Porto Alegre-RS-Brasil
CEP 90690-420
Fone: 51- 33165353
Email- [email protected]
INDICE/INDEX
OVERVIEW OF E-HEALTH PROJECTS IN SOUTH AFRICA
Fortuin, J.B.; Molefi, M.
Telemedicine Lead Programme, Medical Research Council, South Africa
BACKGROUND. Many challenges affect South African health care delivery
and too highlight a few they include: (i) lack of accessibility to primary
health care facilities and specialist hospitals, and (ii) the cost associated
with accessing specialist and specialist hospitals. E-Health has proven to
be successful in many developed countries this still has to be proven in
developing countries.
AIM. To identify E- Health projects in South Africa in which the
Telemedicine Lead Programme, Medical Research Council is directly
involved and use information gathered to make recommendations in terms
of E-Health applications in developing countries.
METHODS. We identified all implemented and operational E-Health
projects. The following breakdown of each project was requested: (i) aim
and objectives, (ii) target group, (iii) results \outcomes.
RESULTS. Four projects were identified, the projects included:
1.
Mindset Health Channel
2. Teledermatology
3. Teleradiology Project
4. Primary Health Care Testbed Project
CONCLUSION. South Africa has successfully implemented E-Health
projects over the past few years with very little infrastructure. Many
lessons have been learnt during this time. The success of the projects
includes the use of simple technology to deliver health care to under
resourced areas at a distance. The challenges include cost, support and
maintenance at sites, capacity development and sustainability. To address
the above issues there needs to be collaboration with industrialised
countries and research initiatives (i.e. evaluation of E-Health) needs to be
implemented.
INDICE/INDEX
PARAMETRIZAÇÃO DO USO DE INDICADORES NA GESTÃO DO
CONHECIMENTO EM SAÚDE PÚBLICA ATRAVÉS DA PRÁTICA DE
E-LEARNING
Tachinardi, U. A. S.; Borges, C. L.; Almeida, A. L.; Guerra, I. M.; Pires,
F. S.
Secretaria de Estado da Saúde de São Paulo
São Paulo / SP - Brasil
INTRODUÇÃO. Este trabalho tem como objetivo a parametrização do uso
de indicadores na gestão do conhecimento em Saúde Pública através da
prática de compartilhamento de conhecimento remoto em educação
continuada. A análise de valores a serem computados será viabilizada pela
implementação de projeto de E-learning pela Secretaria de Estado da
Saúde de São Paulo, em convite à colaboração acadêmica/operacional
direcionado a instituições reconhecidamente atuantes em projetos de
infra-estrutura tecnológica neste setor: Universidade de São Paulo (USP) Faculdade de Medicina/Disciplina de Telemedicina e Escola
Politécnica/Laboratório de Arquitetura e Redes de Computadores,
Universidade Federal de São Paulo (UNIFESP) - Departamento de
Informática em Saúde, Universidade Estadual Paulista (UNESP), Biblioteca
Virtual em Saúde (Bireme) e Fundação Vanzoline.
METODOLOGIA. O estudo metodológico se identifica na análise relacional
de valores a serem utilizados como indicadores na gestão do conhecimento
e as diferentes formas de aproveitamento dos recursos obtidos pelos
procedimentos envolvidos com a aprendizagem remota. Serão avaliados
em sua capacidade de geração e utilização de indicadores relacionais os
procedimentos de estabelecimento de padrões de comunicação, sistemas
e conexões, controle de avaliação, capacitação à distância, emissão de
certificação digital, administração de conteúdo, acervo bibliográfico,
integração e extração de dados, controle e auditoria de processos,
divulgação do conhecimento, comunicação on-line e desenvolvimento de
linhas de pesquisa.
RESULTADOS E CONCLUSÃO. Os resultados esperados pela
parametrização, viabilizada pós-implantação do Projeto E-learning
SES/SP, levam à construção de um modelo de utilização de indicadores na
gestão do conhecimento em Saúde Pública, auxiliando o Estado na gestão
administrava da informação.
INDICE/INDEX
PARTNERSHIP BETWEEN MEDICAL MISSIONS FOR CHILDREN
WORLDWIDE NETWORK AND THE STATE UNIVERSITY OF RIO DE
JANEIRO, MEDICAL SCHOOL/ FCM-UERJ.
Eisenstein, E.1; Monteiro, AMV1; Gismondi, RC1; Mário Jr, MJ1, Brady, P
; Brady, F.
The State University of Rio de Janeiro, Medical School. FCM-UERJ1,
Medical Missions for Children2
Purpose: Medical Missions for Children (MMC) is an American NGO,
dedicated to serving the medical needs and care of catastrophically ill
children in underserved U.S. and international communities.
Methods: MMC provides medical content through its Global Telemedicine
and Teaching Network™ (GTTN)
a real-time, interactive, satellite
broadcast technology and Internet-based communications platform.
Presently, MMC's network encompasses 36 pediatric healthcare facilities in
Latin America, Africa, India, and Eastern Europe and facilitates the
treatment of 1,500 children each month and since 1999, has helped nearly
23,500 children, all over the world.
The Medical School of the State of Rio the Janeiro is the country
representative for Medical Missions in Brazil
Results: Continuous education through videoconferencing has been done
using satellite broadcast technologies and Internet 2. Therefore ongoing
MMC-GTTN has provided access to cutting-edge research, new treatment
protocols, and diagnostic techniques by a network of pediatric specialists
in mentor and reference hospitals.
Conclusion: For more information, connect http://www.mmissions.org.
or http://www.lampada.uerj.br/telemedicine.
Congresso | Instruções para apresentação de trabalhos
Apresentação de trabalhos oral, vídeo ou pôster
Data limite de envio: 10 de agosto de 2005.
Idiomas Oficiais: Inglês e ou Português*.
O título do trabalho deverá ser em letras maiúsculas
Na linha seguinte o(s) nome(s) do(s) autore(s), sobrenome e iniciais
dos nomes.
Sublinhar o nome do apresentador.
Na linha seguinte indicar a instituição ou empresa, cidade, estado e
país.
Antes do corpo do trabalho deixar uma linha em branco e, depois,
mencionar introdução, métodos, resultados e conclusões.
Fonte: times new roman, 12, espaço simples.
Número de palavras do corpo do trabalho: até 250.
Formato Word.
Enviar para o e-mail: [email protected]
Não serão aceitos trabalhos por fax.
Anotar sua preferência de apresentação
( ) Oral ( ) Vídeo ( ) Pôster
* Trabalhos enviados em português não serão publicados nos Anais do
X Congresso da ISFT mas nos Anais do II Congresso do CBTms.
Atenção:
1) Só serão aceitos trabalhos de autores (pelo menos 1) inscritos no
congresso;
2) A comissão cientifica poderá selecionar seu trabalho para
apresentação em categoria diferente da de sua escolha.
3) Para receber a confirmação de aceitação do seu trabalho, informar
nome, endereço e e-mail.
INDICE/INDEX
REDE CATARINENSE DE TELEMEDICINA - RESULTADOS,
TECNOLOGIA E PERSPECTIVAS
Wangenheim, A e Nobre, LF
Projeto Cyclops UFSC e Coordenação de Telemedicina - Secretaria de
Estado da Saúde de Santa Catarina
O Governo do Estado de Santa Catarina e o Projeto Cyclops da UFSC estão
implantando em Santa Catarina a Rede Catarinense de Telemedicina RCTM. A RCTM é uma iniciativa pioneira de oferta de serviços de
Telemedicina em larga escala integrada à rotina clínica para usuários do
Sistema Único de Saúde - SUS. Para tanto está sendo implantada a
disponibilização e interiorização de equipamentos de eletrocardiografia e
radiologia em todo o Estado, conectados através de uma rede específica a
centros de diagnóstico regionais em hospitais específicos do Estado, além
de um Centro de Telediagnóstico em construção em Florianópolis. Os
equipamentos conectados à RCTM localizam-se desde em Postos de Saúde
e pequenos hospitais do Interior até grandes Hospitais Regionais do
Interior que fornecem exames para uma região e possuem déficit de
pessoal qualificado para realização de laudos. Os exames estão sendo
realizados por técnicos qualificados disponíveis localmente e o serviço de
laudo é fornecido por médicos qualificados que realizam os laudos à
distância utilizando workstations especialmente desenvolvidas a providas
de recursos de análise de imagens e sinais, desta forma reduzindo-se
drasticamente o trânsito de pacientes, aumentando-se a oferta por
otimização das capacidades e reduzindo-se tanto custos operacionais
diretos como custos materiais e humanos provenientes da demora no
atendimento e no fornecimento de resultados de exames. A RCTM se
baseia em uma tecnologia DICOM e um portal Web específicos
desenvolvidos pela a UFSC especialmente para este fim. Na palestra a ser
apresentada vamos descrever a tecnologia desenvolvida, detalhar a
filosofia operacional e apresentar os resultados obtidos até o momento.
INDICE/INDEX
SALA DE LAUDOS VIRTUAL
Nobre, L.F.
Cyclops, Universidade Federal de Santa Catarina.
"Sala de Laudos Virtual" é uma ferramenta integrada ao sistema "CMS Cyclops Medical Station", voltado para a área da teleradiologia,
desenvolvida pelo Projeto Cyclops da UFSC, que oferece aos médicos
recursos de estação radiológica DICOM e provimento de laudos em
formato DICOM Structured Report. Seu principal objetivo é acessar
informações de exames de imagem no padrão DICOM 3.0, compartilhar
estas imagens, e criar um canal de comunicação através das tecnologias
de voz sobre IP e compartilhamento de interface de edição e análise de
imagens radiológicas através de um protocolo de serviços especialmente
desenvolvido. Esta solução permite a criação de um ambiente colaborativo
entre médicos localizados à distância, utilizando a Internet para a
discussão de casos e elaboração conjunta de laudos e diagnósticos. O
ambiente da Sala de Laudos Virtual oferece aos médicos visualização de
imagens, aplicação de algoritmos de processamento de imagens, além de
edição e realização de anotações em conjunto sobre as imagens
compartilhadas. Com esta tecnologia, é possível a utilização de conexões
de rede IP de largura de banda limitada para o compartilhamento e
discussão de exames radiológicos com alta qualidade de imagem, sem a
perda de parâmetros diagnósticos em relação àquelas obtidas através do
uso de equipamentos de videoconferência tradicionais.
INDICE/INDEX
SATELLITE BASED TELEMEDICINE APPLICATION IN AMAZON
AREA
Sachpazidis, I.
Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283,
Darmstadt, Germany
INTRODUCTION. Access to medical care is sometimes very difficult to be
reached from people living in rural and underserved areas. This problem is
very well known in rural areas in Brazil. Citizens have no access to health
care. They have to travel hundred of kilometers to receive a medical
diagnosis. In this paper we will propose a medical network based on stateof-the-art medical applications that address the problems of providing
health care from a distance. Additionally, we are going to show
preliminarily results of the first year of the system deployment and
utilization in undeserved regions in Brazil. In the current paper we are
going to describe a medical network deployed in Amazon area of Para state
in Brazil.
MATERIALS AND METHODS. Proving medical services to remote areas in
Amazon, satellite communication is vital. AmerHis [1] is an advanced
communication payload, based around the Alcatel 9343 DVB On-Board
Processor, carried by the AMAZONAS satellite of Hispasat. This processor
has the capacity to provide the demodulation, decoding, switching,
encoding and modulation for the four transponders on Amazon region.
Each Ku-band transponder covers one of the four geographical regions
served by the satellite, namely: Europe, Brazil, North and South America.
AmerHis offers broadband interconnectivity to users anywhere within the
four geographical areas covered by Amazonas.
Furthermore, besides the communication over satellite a medical
application need to be deployed. This application called TeleConsul,
developed by Fraunhofer IGD and MedCom GmbH, in Germany.
TeleConsult [2] platform provides physicians with a wide spread of
functionalities. For example, the doctors working with it are able to make
notes on the digital medical image and send it to the expert doctor. This
could happen either in offline-mode (messages will be sent at a favorable
date and time, for example during the night) or in online-mode (real-time
tele-consultation).
Presently, there are two Excellence Hospital Centres in Brazil that compose
the T@lemed Project [3]: Santa Casa Hospital, in Porto Alegre, Rio Grande
do Sul, and FAHUCAM, in Vitória, Espírito Santo.
The current network is extended to Amazon areas in Para states. The state
of Pará presents the rate of general mortality of 3,65 deaths in 1.000
inhabitants. The main reasons are the following:
blood circulation diseases
birth associated diseases
breath associated diseases
infectious diseases
external causes
The children mortality is about 20 to 49 cases in 1.000 inhabitants. Some
common diseases: diarrhea, malaria, tuberculosis, typhoid, hepatitis,
leptospirosis, yellow fever, tetanus.
It's estimated that 35% to 40% of the total medical cost of the cities are
expended in treatments in other urban centers. Besides that, there is a
great difficulty in the human resources availability in remote areas where a
large part of the population lives in poverty. The high complexity medical
services are totally concentrated in Belém area.
REFERENCES. [1] http://www.esa.int/esaTE/SEMJPRL26WD_index_0
[2] Kontaxakis, G., Walter, S. and Sakas, G. (2000) “EU-TeleInViVo: an
integrated portable telemedicine workstation featuring acquisition,
processing and transmission over low-bandwidth lines of 3D ultrasound
volume images”, Information Technology Applications in Biomedicine:
Proceedings of IEEE EMBS International Conference, p. 158 163.
[3] http://www.alis-telemed.net
E-mail: [email protected]
INDICE/INDEX
SISTEMA DE APOIO À DECISÃO PARA AVALIAÇÃO POSTURAL
Mancini, F.1; Pisa, I.T.1; Lopes, P.R.L. 1; Barsottini, C.G.N. 1; Roque, A.C.2
1
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil; 2
Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (FFCLRP) Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil
INTRODUÇÃO. A avaliação postural é uma ferramenta fundamental no
diagnóstico do alinhamento dos segmentos corporais de um indivíduo.
Porém, uma deficiência dessa área é não haver uma descrição detalhada
do alinhamento postural da população brasileira ou parte dela.
OBJETIVO. Este trabalho tem por objetivo apoiar diretamente o
diagnóstico do alinhamento dos segmentos corporais de um indivíduo, a
partir da classificação de padrões sobre avaliação postural, e utilizando-se
desta classificação, desenvolver um sistema de apoio à decisão médica.
METODOLOGIA. Um projeto de pesquisa, patrocinado pelo CNPQ,
intitulado Software Gratuito Para Avaliação Postural com Tutoriais
Científicos e Banco de Dados, tem como um dos objetivos criar um
repositório de dados sobre avaliação postural, armazenando uma coorte da
população brasileira. Utilizando-se deste repositório, ferramentas de
análise estatística semi-paramétrica de dados, como redes neurais
artificiais, realizam mapeamentos não-lineares de dados, podendo
reconhecer padrões entre um conjunto de variáveis de entrada. Ou seja,
redes neurais artificiais podem agrupar em classes padrões referentes ao
alinhamento postural da população brasileira, com base no mapeamento
de dados armazenados no repositório de dados sobre avaliação postural.
RESULTADOS. Este trabalho resulta em um sistema de apoio à decisão
médica, a partir do algoritmo gerado pela classificação de padrões sobre
avaliação postural de cidadãos brasileiros, acoplado ao Software Gratuito
Para Avaliação Postural. CONCLUSÃO. O desenvolvimento deste trabalho
apoiará ao diagnóstico do alinhamento dos segmentos corporais de um
indivíduo, pois a utilização deste sistema de apoio à decisão colabora
diretamente com a prática clínica.
INDICE/INDEX
SISTEMA DE TELEDUCAÇÃO À DISTÂNCIA VOLTADO A
EDUCADORES FÍSICOS
Corrêa, F.G.C.; Chao, L.W.
Faculdade de Medicina da USP. São Paulo, SP. Brasil
Em resumo este trabalho apresenta um projeto que relata um sistema de
educação à distância destinado a educadores físicos, objetivando
promover a continuidade do seu processo formativo, e tendo como
conteúdo, conceitos e aplicações de metabologia, nutrição, fisiologia do
exercício e treinamento em atividade física, possuindo como ferramentas
de ensino o tutor eletrônico de ensino à distância conhecido como
cybertutor, iconografias em três dimensões de partes da anatomia do
corpo humano relevante a este processo de aprendizagem (homem
virtual) e vídeos de apoio ao conteúdo proposto no cybetutor.
Todas as ferramentas utilizadas neste projeto focam a prática da atividade
física com qualidade e todo o universo que a norteia, e o conteúdo inserido
no cybertutor é a “chave mestra” para o desenvolvimento harmonioso
deste processo, pois trata de conceitos e aplicações de conteúdos que são
diariamente aplicados no desenvolvimento de sua profissão e é a base para
o desenvolvimento das demais ferramentas, já o homem virtual é uma
tecnologia inovadora que proporciona melhor entendimento do conteúdo
através dos recursos da terceira dimensão (3D) e os vídeos de apoio que
são inserções áudio-visuais colocadas no decorrer das aulas, através de
ícones de acesso nas páginas do cybertutor, e que tem como objetivo
principal à fixação do conteúdo proposto no tutor eletrônico através de
informações novas ou complementos dessas informações.
Para utilização deste projeto o usuário receberá login e senha para acesso
ao cybertutor e um kit de material no qual estarão os discos com os vídeos
o homem virtual, e todo manual explicativo.
INDICE/INDEX
SIX YEARS OF TELEMEDICINE AT HOSPITAL SÍRIO-LIBANÊS:
EXPERIENCE REPORT.
Gundim, R.S.
Instituto de Ensino e Pesquisa Hospital Sírio-Libanês (IEP/HSL)
São Paulo Brasil
INTRODUCTION. The Service of Telemedicine was implemented in
October 1999 as an initiative of both the Oncology Center and the
Directory of Hospital Sírio-Libanês, and it was designed to fulfill two
objectives: Assistance ( International Second-Opinion ) and
Educational/Scientific (Lectures, Case Studies and Distance Education).
OBJECTIVE. The purpose is to report the experience of the Telemedicine
Service at IEP/HSL from 1999 to 2005.
METHOD. This is a retrospective study to examine the most relevant
aspects such as technologies, statistics and the outstanding points of the
activities.
RESULTS. Telemedicine at IEP/HSL started with a videoconferencing
system and several pertinent peripherals. In 1999, with the mentioned
structure, the International Second-Opinion Program was implemented in
collaboration with the MSKCC (1) 42 cases, parallel to the scientific
meetings 52 ones. In 2001, 41 videoconferences were held to exchange
experiences, broadcast lectures and develop long distance congresses. At
the same year it was the unique content source of medical update at the
recently founded IP-TV via satellite
157 transmitions. Currently it
develops a collaborative network to train people from the North and
Northern areas of Brazil, and search for partnership with other
Telemedicine Centers as of FMUSP (2), UFSC (3), UNIVAP (4), among
others. The presented statistics refer to the six years period.
CONCLUSION. This experience shows that financial, technological,
scientific and institutional sustainability should be based on the
investments in technology, communication and cooperation among
institutions. A collaborative action enhances the structuring of
telemedicine programs, contributes to the dissemination of best practices
and to the quality of health assistance.
Acronyms:
1 - MSKCC Memorial Sloan-Kettering Cancer Center of New York
2 - FMUSP Faculty of Medicine of The University of São Paulo
3 - Federal University of Santa Catarina
4 - Vale do Paraíba University
INDICE/INDEX
TELEASSISTÊNCIA E TELEEDUCAÇÃO EM HANSENÍASE: COMO
UMA ESTRATÉGIA DE PROGRAMA EM SAÚDE
1,4
1
1
2
Trindade M.A.B. , Festa C.N. , Wen C.L. Andrade V.G. , Soares
R.C.F.R.3, Carvalho M.L.M.4, Ferreira S.R.G.5, Almeida M.E.B.T.M.P.6
Médicos das Unidades Básicas de Saúde5: Manso VLS, Yamashitafuji
TMT, Souza LR, Trindade RA, Silva AA, Macedo RLC, Fukada M, Ribeiro
LA
Faculdade de Medicina da Universidade de São Paulo1, Organização
Panamericana de Saúde2, Ministério da Saúde3, Secretaria Estadual da
Saúde de São Paulo4, Secretaria Municipal da Saúde de São Paulo5,
Pontífice Universidade Católica-SP6.
INTRODUÇÃO: Para aumentar as oportunidades de diagnóstico e
tratamento, está sendo realizado um projeto piloto para Validação do
Diagnostico Virtual da Hanseníase na FMUSP-SP com a participação da
OPAS/OMS, Ministério da Saúde e Secretaria da Saúde do Município e do
Estado de São Paulo, os quais estão catalisando esta iniciativa de utilizar
ferramentas da Telemedicina e Teleducação como uma estratégia do
programa da hanseníase, um problema de saúde publica brasileiro.
MATERIAL E MÉTODOS: Foram selecionadas 8 unidades sanitárias das
diferentes regiões do município de São Paulo referência de tratamento em
hanseníase. Nos casos suspeitos de hanseníase, os médicos destas UBS
preenchem um formulário clínico, fotografam as lesões e as enviam via
Internet ao Ambulatório Virtual, e também encaminham o paciente ao
Ambulatório do HCFMUSP para avaliação presencial, sendo o padrão ouro e
o teste o exame virtual enviado pela UBS. Planeja-se que até outubro cerca
de 100 casos serão analisados sistematicamente e os resultados serão
apresentados.
Resumo: Esta apresentação visa mostrar a implantação de um serviço que
utiliza novas tecnologias na rede pública de saúde como uma estratégia de
programa de saúde.
CONCLUSÕES: Se os dados mostrarem que o diagnóstico virtual é um
método que auxilia o diagnóstico da hanseníase, o Ambulatório Virtual
será ampliado para outras regiões como uma das estratégias do Programa
da Hanseníase.
INDICE/INDEX
TELECONFERENCES IN PEDIATRIC RADIOLOGY- A BRAZILIAN'S
NETWORK.
1
Monteiro, A.M.V. ; Junior, M.J.1; Santos, A.A.S.2; Neto, J.R.N.3;
Cavalcanti, S.3; Sakuno, T.4, Nobre, L.F.N.4; Filgueiras, T5.
State University of Rio de Janeiro- UERJ1, Fluminense Federal UniversityUFF2, IMIP-PE3, Federal University of Santa Catarina-UFSC4, Federal
University of Minas Gerais-UFMG5._ BRAZIL.
PURPOSE. To provide continuous pediatric radiology education among
Medicals Schools and to centers over far distances.
METHODS. Network teleconferences by electronically transmitting
radiographic patient's images or power point presentations, session
consultative and second opinion session by using ISDN or Internet II.
RESULTS. The majority of the physicians were satisfied with the
videoconference format, presenters and content. The consultations and
discussions became more dynamic and organized. The medical and postgraduated students were more interested due to the new methodology and
new researchs have been discussed.
CONCLUSIONS. This pilot study in Brazil demonstrated that it is possible to
engage Medical Schools in pediatric-radiology rounds by videoconference.
Therefore, ongoing assessment of the use of videoconferencing for
continuing education and the development of professional communities of
practice is warranted to evaluate the impact of telehealth initiatives in
our country.
INDICE/INDEX
TELECONFERÊNCIA COMO FERRAMENTA PARA DISCUSSÃO
CLÍNICA ENTRE GRUPOS MÉDICOS À DISTÂNCIA
Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RF
Universidade de São Paulo (FMUSP)
Introdução: Compartilhar informações independentemente da
localização dos usuários tem se tornado possível graças às modernas
técnicas de telemedicina e abre novas dimensões para procedimentos
diagnósticos e terapêuticos. Teleconferências realizadas entre centros de
atenção à saúde de localidades distantes permitem maior integração e
troca de conhecimentos que ajudam na resolução de casos difíceis e no
estabelecimento de condutas. Objetivo: Descrever a experiência da
Divisão de Otorrinolaringologia da USP com as discussões interativas via
teleconferência. Material e Métodos: Foram desenvolvidas reuniões via
IP (Internet Protocol) à 384 Kbps, bimestralmente em 2005, com a UERJ
para discussão de casos clínicos. Utilizando conexão via ISDN (intergrated
services digital network), a uma velocidade de 384 Kbps, foram realizadas
teleconferências para discussão com a Mc Gill University (Canadá) em
2005. Utilizou-se equipamento do modelo Tandberg 6000 no ponto local.
Resultados: Após vários testes, 384 Kbps foi definido como a velocidade
padrão em que as imagens de alta definição e vídeos pudessem ser
transmitidos com boa qualidade. A transmissão via ISDN à 384 Kbps
mostrou uma estabilidade melhor do que a conseguida via IP a uma
mesma velocidade. Após testes em horários variados, observou-se que a
transmissão via IP tinha comprometimento da qualidade nos horários de
maior congestionamento na rede, mas apresentava uma ótima qualidade
nos demais horários. O custo da conexão via IP mostrou-se muito menor
do que o necessário para conexão via ISDN. Conclusão: A teleconferência
mostrou-se uma ferramenta viável e de boa qualidade para a discussão de
casos e troca de experiências entre grupos médicos sem a necessidade de
deslocamento dos participantes.
Opção recomendada: Apresentação POSTER VERSÃO INGLÊSA DO
RESUMO
INDICE/INDEX
TELEDENTISTRY AN EXPERIENCE USINGTHE INTERNET.
Sequeira E.1; Chao L.W.1; Sgavioli,C.A.P.P2.; Carvalho I.M.M.2
(1) Discipline of Telemedicine, Medical School, University of São Paulo,
São Paulo, Brazil. (2) Dental School, Sacred Heart University, Bauru,
São Paulo, Brazil.
In the health field, the technology helps to stimulate the student and the
professional to improve their knowledge in a dynamic way. Supported by
interactive resources and modernization of educational contents,
students, professors and dental practitioners can use the benefits of
technology to improve the quality of services provided to the population
and professional improvement. Following the models developed and
applied by the Discipline of Telemedicine of University of São Paulo, in 2004
and 2005, academic-scientific partnerships were established with dental
schools, which allowed application of technology-based educational
models, consolidating the Teledentistry in Brazil. By educational and
technological support, professionals and students may learn at any time
and place according to their dedication and availability. The Discipline of
Telemedicine has tools as the “Cybertutor”, a Teleeducation environment,
where the educational contents and the learning object “Virtual Man
Project” are designed and applied, in which anatomic structures, threedimensional physiologic movements (height, width and volume),
biomechanics, ultrastructures and temporal evolution are visualized by
modernization of iconographies. Two titles were developed in Dentistry:
temporomandibular joint and tooth structure. The Teledentistry facilitates
the transmission, diffusion and exchange of information, being essential to
support the professionals assisting the population.
INDICE/INDEX
TELEHOME MONITORING AVAILABLE TECHNOLOGIES
Guzovsky, P.A. (MD)
Medical Director - Panmédica Negócios Hospitalares Ltda..
São Paulo, S.P., Brasil.
INTRODUCTION. The World Wide Web and the Telecom companies
globalization, allowed several different approaches to Health, which
originated the term Telemedicine.
CONCEPT. One of the Telemedical areas refers to Monitor Patients at
distance.
Nowadays, an ideal format to the technologies would be:
user friendly devices
- connection through Telephone lines.
- Wireless reception and transmission.
- Miniaturization.
- Possibility to communicate with Sound and/or Imaging.
- Privacy
INDICATIONS. Several Telehome monitoring indications where already
published or presented, among them:
AIDS
Arterial Diseases
Autism.
Chronic Obstructive Pulmonary Disease
Congestive Hearth Failure
Continuous Education for Patients
Dermatology
Diabetes
General Rehabilitation.
Geriatrics Cognitive Disturbances.
Hypertesion
Medical evaluation
Medication
Mental Health
Obesity.
Oncology
Pain management
Post Trauma.monitoring
Post-operative
Sleeping diseases.
Tecnologies:
*Hardware:
Coagulometer
Digital Camera
EKG
Expirometer
Glucosemeter
Hearth rate
Oximeter
Scale
Sphigmomanometer
Thermometer
*Software:
- Web-based electronic medical records.
- Case management.
*Conectivity:
- Telephony (POTS)
- Broadband: DSL/Cable modem
- Others.
CONCLUSION. The available technology is enough to implement several
telemedical projects and Industry is already investing in more efficient
Softwares, to better manage the information gathered.
Propedeuthics as we knew from the past changed by opening to
modernization and the Classical Clinical Observation together with the
technological evolution, is bringing an infinity of advantages, which at the
end, targets the Individual well being.
INDICE/INDEX
TELE-MEDICAL COLLABORATION PLATFORMS DEPLOYED IN
RURAL AND UNDERSERVED AREAS IN LATIN AMERICA
Sachpazidis,I.; Kiefer², S.; Ohl, R.; Messina, L. A.; Sakas1 G.
Fraunhofer Institute for Computer Graphics, Dpt. Cognitive Computing
and Medical Imaging, Frauhoferstr 5, D-64283, Darmstadt, Germany;
Fraunhofer-Institut Biomedizinische Technik, Ensheimer Straße 48,
66386 St. Ingbert, Germany; MedCom Gesellschaft für medizinische
Bildverarbeitung mbH, Rundeturmstr. 12, 64283 Darmstadt, Germany;
Messina Ltda, Vitoria Brazil
KEYWORDS. Telemedicine, computer supported collaborative work
(CSCW), teleconsultation, virtual private networks (VPN), Instant
Messaging.
ABSTRACT.
T@LEMED project introduces an e-health model to the
provision of health services in strongly underserved regions in Colombia
and Brazil. The implementation of this model is supported on current
telehealth technologies as well as on evidence based medicine. The target
clinical applications include typical infectious diseases for the region such
as malaria, and general ultrasound applications such as pregnancy control,
urology and cardiovascular diagnosis.
In Colombia two telehealth networks will be established that provide
teleconsultation services to low level healthcare centres in rural and
remote regions for the early diagnosis and treatment of malaria and other
infectious diseases. The networks link experts in Cali and Bogota with lowlevel healthcare facilities in endemic, underserved regions at the Pacific
Coast and in the Amazons region. The expert will evaluate diagnostic
information such as microscopic images, medical device data and case
reports in order to advice the local healthcare staff in diagnoses and
treatment of the infected patients. As the technical backbone an extended
version of the telehealth platform TOPCARE is used, that has been
developed by Fraunhofer Institute IBMT and the Greek partners ICCS and
Datamed in the context of the European Commission's research and
development programme Technologies for the Information Society.
In Brazil teleconsultation services for medical ultrasound examinations
such as OB/Gyn, pregnancy control, urology and cardiovascular
diagnosis are implemented for rural hospitals in Brazil by using the
teleimaging platform, called TeleConsult, developed by Fraunhofer
Institute IGD and the German partner Medcom GmbH. TeleConsult
provides a wide spread
of possibilities. It is able to acquire ultrasound images from an ultrasound
device, to enrich a given image material with additional informations and
to send it as a message to distant expert doctors connected to the medical
network over Internet. With the help of TeleConsult two leading hospitals
of Brazil; Santa Casa Hospital in Porto Alegre and the Hospital of the
Federal University of Espirito Santo provide telediagnostics and treatment
advices to rural hospitals and health centres.
T@LEMED project has been funded by @LIS: Alliance for the Information
Society, European Union
Further information can be found at project's web site: http://www.alistelemed.net
E-mail: [email protected]
INDICE/INDEX
TELEMEDICINA, O PRÓXIMO PASSO: A AVALIAÇÃO DO IMPACTO
SÓCIO-ECONÔMICO?
Medeiros, R.1; Wainer, J.2
1
Pós-graduando do Departamento de Informática em Saúde (DIS) da
Universidade Federal de São Paulo/Escola Paulista de Medicina
(UNIFESP/EPM), Professor Convidado do DIS/EPM; Brasil.
RESUMO. Este artigo apresenta um resumo da pesquisa realizada sobre
quatro projetos de telemedicina implantados no Brasil dois em Hospitais
Privados e, dois ligados a Universidade Públicas. Nosso objetivo era o de
encontrar resultados e evidências do impacto sócio-econômico
conquistado com a telemedicina. A incorporação da avaliação como
prática sistemática nos diversos níveis dos serviços de saúde poderia
propiciar aos seus gestores as informações requeridas para a definição de
estratégias de intervenção e melhorias no sistema de saúde (entendendo
aqui a telemedicina como uma técnica de intervenção).
Partimos da premissa de que os projetos de telemedicina só deveriam ser
aprovados se estivessem acompanhados de um estudo rigoroso de
viabilidade de médio e longo prazo, de um plano de evolução (da
qualidade, dos custos, de acessibilidade e de aceitabilidade), além de
sistema adequado e efetivo de difusão dos resultados, portanto, um
contínuo processo avaliativo. Os impactos que deveriam ser avaliados,
estão relacionados: a) impacto no processo clínico; b) na saúde do
paciente; c) na acessibilidade ao sistema de saúde; d) econômico e, por
fim e) impacto na aceitabilidade do sistema de saúde.
A primeira constatação foi de que, ainda que a telemedicina tem trazido
avanços para o debate nacional e crescimento dos sistemas de saúde, não
há estudos ou avaliações dos projetos com qualidade e em número
suficientes que garanta os benefícios potenciais da telemedicina e, por
conseguinte, que possa produzir estimativas confiáveis dos seus
verdadeiros benefícios.
A segunda constatação é que, as relações entre as práticas e as
necessidades de saúde podem ser apreendidas a partir de duas vertentes
principais. A primeira delas consiste na busca dos seus significados
econômicos, políticos e ideológicos, bem como da especificidade dessas
relações em sociedades concretas. A segunda diz respeito à capacidade
das práticas modificarem uma dada situação de saúde, atendendo ou não
às necessidades de saúde de determinada população, ou seja, refere-se à
discussão sobre suas características e seus efeitos. A telemedicina, neste
sentido, surge como uma destas práticas que pode promover esta
mudança, porém ainda não é esta a realidade encontrada, ou seja, não há
mudanças concretas mapeadas e avaliadas.
INDICE/INDEX
TELEMEDICINA, UMA REALIDADE QUE O SUS, NO MUNICÍPIO DE
SÃO PAULO, SÓ CONHECERÁ EM 2010!!!
Medeiros, R.1; Wainer, J.2
1
Pós-graduando do Departamento de Informática em Saúde (DIS) da
Universidade Federal de São Paulo/Escola Paulista de Medicina
(UNIFESP/EPM), Professor Convidado do DIS/EPM; Brasil.
RESUMO. Falar em implantar sistema de informação no setor público não é
algo fácil, e em se tratando da rede de Saúde do Município de São Paulo as
dimensões assumem proporções sem precedentes conhecidas, em função
da sua complexidade.
O grande desafio colocado ao município de São Paulo foi e está, em
planejar e executar um projeto, que desse conta da informatização das
suas Unidades a saber 386 Unidades básicas de Saúde, 98 Ambulatórios
Especializados, 49 Policlínicas e 11 Ceccos.
Diante deste cenário, uma das primeiras tarefas foi à escolha de uma
metodologia para seleção do sistema e mecanismos de implantação que
atendesse as prioridades político-administrativa do município. O resultado
deste processo, concluiu com o desenvolvimento compartilhado com a
iniciativa privada, norteado por premissas definidas centralmente (SUS)
que determinaram o desenvolvimento do Projeto de Implantação do
Sistema de Informação do município de São Paulo SIGA-Saúde
Assim, o objetivo deste artigo é, apresentar ao leitor o processo iniciado
em 2004, como o mesmo foi estruturado e quais os próximos passos, dado
que não podermos afirmar que esta encerrado. Apresentaremos também,
que a SMS-SP, privilegiou a utilização de conceitos, métodos, fóruns,
equipamentos, recursos humanos e infra-estrutura já exSistentes na área
de Treinamento e Capacitação dos seus colaboradores internos e do
Ministério da Saúde MS, para a implantação do sistema. O artigo encerra
com a constatação de que, o município de São Paulo, dado o atual cenário,
terá condição de falar e investir em telemedicina somente a partir de 2010
e, de forma complementar apresentar as oportunidades para
desenvolvimento da telemedicina no município.
INDICE/INDEX
TELEMEDICINE: A PERSPECTIVE FOR RONDÔNIA'S HEALTH
Jakobi, HR
Secretaria de Estado de Saúde de Rondônia CEREST/RO
A powerful technological tendency is coming up, and will affect in a
reversible way the medical practice. That is about Telemedicine, which are
the technologies of telecommunication use to the interaction between
health professionals and patients, in order to execute medical actions at
distance. This will be a meaningful gain to the Amazon Region health,
especially to our RondÔNia state, connecting remote places to the most
advanced hospitals in the country and world, transmitting images,
conferences, surgeries and other procedures which require the
performance of experts in many different areas of health. Telemedicine can
be thE most viable technical and economical solution to change the present
deficient condition of the ambulatory and hospital medical services in our
state. Its implantation and implementation in many regions, micro regions
and in the municipal districts of RonDÔNia will generate a great potential to
improve the health service to the population, increasing intensively the
effectiveness of the health system, reducing the continental distances and
the operational expenses. Patients will be able to have their infirmiTy
diagnosed and treated in a faster way, causing less dislocation and
suffering, better medical resolution and, consequently, reduction of the
sequel rates. The technology analyzed in this study confirm that is
extremely important and a great need to the Health professional staff to
execute their daily tasks, concerning to the medical service to patients at
distance, even if they are not in person in their offices and surgery rooms.
The telemedicine contributes also to the formation, improvement and
continUous preparation of the health professionals and the education of the
population. The study demonstrates clearly that the infrastructure of the
state presents very polarized aspects: while usufruct, for example, of a
complete optical fiber to its fixed telEphonic communication, and on the
other hand it lacks of highways with pavement and concrete bridges in
many of its roads, making some municipal districts become isolated some
time of the year, all of them are important as a way of flowing off the
agriculture production and sick people; it has only 4% of basic sanitation in
their homes, but it is assisted by cable TV and satellite. But what is essential
to be understood is that Telemedicine is not only technology and new
equipments but also a procedure that requires a lot of relevant
organizational changes of the health service to be explored. There is
evidence that Rondônia is very well served of necessary infrastructure to
the Telemedicine achievement, being necessary only to have political
determination and a Plan of Action in Telemedicine of Rondônia that has as
a priority such technology. It is concluded that the technology of access
utilization already existing (satellite, optical fibre and telephony), and a
specific investment in hardware, software and peopleware will enable the
Telemedicine project in our state.
INDICE/INDEX
TELEMEDICINE IN INDIA: STANDARDISATION ISSUES AND
INITIATIVES
Bedi, B.S.
Senior. Director, Department of IT, Ministry of Communication &
IT,
New Delhi, India.
ABSTRACT. India today has more than one billion population that is
predominantly rural and distributed in distant geographical locations.
Telemedicine assumes special significance for India considering 70% of
the population lives in rural areas whereas about 90% of Secondary and
tertiary health care facility are city based. Having the technical and
medical expertise capability to offer quality healthcare to remote areas, a
number of telemedicine centers have been set up and are also being
planned across the country. To streamline establishment of Telemedicine
centers and services, need for a set of standards and guidelines was felt.
Through efforts of a specialized Technical Working Group, set up by
Department of IT, Govt. of India, a nucleus framework of recommended
guidelines and standards for practice of Telemedicine in India has been
drawn up. The recommendations provide for setting up a Telemedicine
center based on standards for systems, telemedicine software,
connectivity, data exchange, etc. These are vital issues to be considered at
this stage when Telemedicine activity is expanding rapidly in India and
interoperability among diverse systems becomes a crucial factor for
providing flexibility of multiple specialist consultations to Telemedicine
nodes.
The recommendations have been disseminated among various
stakeholders who have evinced keen interest. In addition to bringing
awareness among various stakeholders and policy makers, it is also
provides guidelines for judicious adaptation of Telemedicine at different
levels of existing landscape of health care delivery system prevailing in
India. Majority of the vendors and Telemedicine solution providers in India
have adopted the key recommendations making possible interoperability
between diverse systems.
Steps to take forward the present initiative of standardization activity in
Telemedicine in India are also underway.
INDICE/INDEX
TELEMEDICINE IN OTOLARYNGOLOGY CONTINUOUS MEDICAL
EDUCATION
Campelo, VES; Chiari, JP; Voegels, RL; Wen, CL; Bento, RF
Faculty of Medicine - University of São Paulo
OBJECTIVES: describe a continuous educational program using a synchronic
internet transmission of a course produced by Otolaryngology Department of
University of Sao Paulo (USP).
MATERIAL AND METHODS: this program is based on video streaming
transmission of the Otolaryngology Extension Curse of USP. There are four
remote centers (Campinas-SP, Santos-SP, Brasilia-DF, Salvador-BA)
connected above 512Kbps broadband internet connection. The class
transmission is acessed in a internet site (http://netsim.fm.usp.br/teleotorrino)
and the user has two speed options: 100 and 300 Kbps. The students in the
remote centers can ask questions using a chat, and the teacher answers online
using the video streaming transmission. This improves the course interactivity
with remote user participation.
DISCUSSION: nowadays, one of the principal educational focus is the
development of continuous programs that permit medical knowledge
updating. This is difficult to be achieved by traditional methods, principally
in the smallest cities, due to the shortage of human resources and the
necessity of people dislocation. That project allows the transmission of
expert classes to some remote points with appropriate quality, using a low
cost and world-wide technology. Another advantage of the method is the
experience exchange between the distant groups.
CONCLUSION: video-streaming interactive based courses seems to be an
efficient alternative in the development of continuous educational medical
programs.
INDICE/INDEX
TELEMEDICINE IN PERMANENT MEDICAL TRAINING: AN
INTERNATIONAL CO-OPERATION EXPERIENCE BETWEEN
UNIVERSITY HOSPITALS CONNECTED TO PRIMARY CARE
Alkmim, M.B.; DE-Lorme, P.; Santos, A.F.; Silva, I.M.; Souza, C.;
Santos, S.F.; Peixoto, F.C.; Bossi, G.A.M.
Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo
Horizonte, Minas Gerais, Brasil; Faculdade de Medicina da Universidade
Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Centre
Hospitalier Universitaire de Rouen, Rouen, Normandie, France;
Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, Minas
Gerais, Brasil; PRODABEL - Empresa de Informática e Informação do
Município de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil
The Telehealth and Telemedicine Nucleus of the “Hospital das Clínicas”
(HC) of the Federal University of Minas Gerais(UFMG) promotes
videoconferences with the “Centre Hospitalier Universitaire” (CHU) of
Rouen, France, within an international co-operation agreement. Six
medical specialities joined the program, carrying out clinical case
discussions and exchanging experiences between the two institutions. The
BH TELEMED project integrates these activities, as a telehealth project
aimed at primary care for the family health teams, which links Health
Centers from the Municipal Health Department of Belo Horizonte to the
“Hospital das Clínicas” through a system of long distance consulting. With
the integration of the used technologies, it becomes possible to connect
doctors from the family health teams, in their work environment, to French
and Brazilian specialists. International communications between the
CHU/Rouen and the HC/UFMG are made through videoconferences using
high bandwidth networks: RNP2 (MG/Brazil), RedClara (Latin America),
GÉANT and RENATER (Europe). Local communications between HC/UFMG
and health centers are made using computers, webcams and the network
BH2 connection with the Municipal Computer network. Initially, in 2004,
was established a simultaneous transmission to the CHU/Rouen and the
health centers of the 1st Franco-Brazilian Medical Journey that took place in
Belo Horizonte. From 2005 on, periodic clinical sessions made through
videoconferences were structured in each speciality. There were 232
french and brazilian health professionals participating in the four events
that took place. The interaction through Telemedicine between the national
and international academy and primary care allows an unique form of
permanent medical training, with doctors being trained in their own work
environment, adding quality to the public health system.
INDICE/INDEX
TELEMICROBIOLOGIA: AVALIAÇÃO DO USO DE IMAGENS
DIGITAIS EM BACTERIOSCOPIAS.
Andreazzi, D.B.; Rossi, F.; Rosa, V.T.A.; Chao, L.W.
Hospital das Clínicas de São Paulo-LIM-03;
Disciplina de Telemedicina-FMUSP, São Paulo-SP, Brasil.
INTRODUÇÃO: A bacterioscopia pelo método de Gram reflete
características morfotintoriais importantes que podem auxiliar em
diagnósticos precoces. A sistematização do diagnóstico através do uso de
imagens de bacterioscopias geradas com máquina digital diretamente da
ocular do microscópio e encaminhadas por email abre a possibilidade de
diagnósticos à distância bem como o acesso a segunda opinião em tempo
reduzido com relevante custo-benefício.
MÉTODOS: 53 lâminas de materiais clínicos diversos foram analisadas por
dois microbiologistas (M1 e M2). M1 fez as leituras por microscopia
convencional (MC) e fotografou 5 campos relevantes gerando imagens
digitais (ID) enviadas a M2 para leitura à distância. Para esclarecimento
das discrepâncias uma terceira leitura foi realizada por M2 por MC com
conhecimento dos resultados das leituras anteriores (leitura padrão).
As ID foram capturadas com lâminas focadas sob a lente objetiva de 100x e
ocular de 10x (aumento de 1000x), câmera Sony Cybershot Dsc-W5 com
objetiva de macro, 3.2 megapixels, JPEG.
RESULTADOS: 19% das lâminas (10/53) foram excluídas da análise devido
a impossibilidade do diagnóstico por ID, sendo que 8% (4/53) das imagens
apresentaram falta de foco e definição e, 11% (6/53), presença de material
de fundo protéico que impediu a visualização das estruturas. O índice de
compatibilidade (IC) entre a leitura de M1 por MC e M2 por ID foi de 81%.
As discordâncias observadas foram avaliadas através da comparação dos
resultados com a leitura padrão. O IC entre as leituras de M1 por MC x
padrão foi de 93% (40/43). Das 3 lâminas discordantes observou-se 4
diferenças na identificação morfológica das estruturas relacionados a cocos
Gram-positivos (1/4), diplococos Gram-negativos (1/4), leveduras (1/4) e
a associação fuso-espiralar (1/4).
INDICE/INDEX
TELENURSING: PERMANENT TRAINING FOR PRIMARY CARE
PROFESSIONALS IN THE CITY OF BELO HORIZONTE
Guimarães, E.M.P.; Godoy, S.C.B.; Santos, S.F.; Nunes, A.A; Ribeiro,
M.A.C; Maia, C.C.A.; Reis, M.C.S.
Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais,
Brasil
This is an intervention project of which take part the "Clínicas" Hospital and
the College of Nursing of the UFMG, together with the Assistance
Management sector of the Municipal Health Department of Belo
Horizonte/MG, within a permanent training program, all of which are part
of the activities of the TeleHealth BH TELEMED project. The proposal is
based on carrying out long distance training sessions for the nursing teams
of the basic care units of the city. The technology used is simple,
computers, webcams and a communication software. Seventeen points
have been installed in primary care units which can be connected on-line
simultaneously. The TeleNursing sessions are scheduled beforehand,
announced in the participating units, the confronted themes are selected
by the professionals according to problems faced in daily practice. During
the presentations, doubts are explained live by the person ministering the
conference or by chat in an absolutely interactive process. Since the
beginning of the activities, five meetings took place with an increasing
participation of the nursing professionals of the primary units, a total of
241 individuals, that generally approved the used methodology. The
obtained results achieved the goals established by the project and show
that the use of long distance training is the most appropriate methodology
to be implemented in the permanent training of the nursing team,
considering the opportunity to discuss daily work processes and to
overcome the limitations of participation in training activities that require a
physical presence inside traditional educational places, that is, outside
their work place and hours.
INDICE/INDEX
TELERADIOLOGY: IMAGING STRATEGIES AND PERSPECTIVES.
Santos D.T.1, Sequeira E.2, Chao L.W.2
1
Department of Radiology, College of Dentistry, University of São Paulo,
São Paulo, Brazil. 2 Department of Pathology, Telemedicine Discipline,
College of Medicine, University of São Paulo, São Paulo, Brazil.
The last few years have witnessed an increasing trend for secondary
opinion interpretation services from medically less developed countries to
centers of excellence. Teleradiology comprise the use of
telecommunications and teletechnologies to deliver services to who are
located in a different place from the radiologist, for purposes of
interpretations and/or consultation. At present, international telemedicine
and teleradiology represent a premium service, usually only available to
wealthier people from those countries with less well developed health
services. The premise is that telemedicine and teleradiology opinions may
prevent unnecessary foreign travel by the patient to the centre of
excellence. Often a diagnosis that has been made in the original country
can be validated by the centre of excellence, thereby reassuring both the
local physician and the patient. If an alternative diagnosis is suggested,
treatment options can be suggested to the local physician who may also
prevent the patient from traveling outside of their own country. The role of
radiologist specialists can be enhanced from providing interpretations for
diagnostic studies to supply advice on patient care and work-up.
Teleradiology allows greater efficiency with sharing of services among
institutions, greater standardization and reproducibility. The development
as evidence-based health care is a new approach to this practice, where
transdisciplinary collaboration is necessary through radiological practice,
education, and research.
INDICE/INDEX
TELERADIOLOGY EXPERIENCE USING INTERNET AND
WAVELET COMPRESSION
Souza C.A. (*), Conrado M.A.
Grupo Norteimagem Rio de Janeiro - Brazil
The authors describe a solution that implements a secure teleradiology
environment using Internet transmission and wavelet compression
algorithms. The studies are acquired from different modalities, lossless or
lossy compressed and dynamically stored in a central repository. There are
Dicom and non-Dicom modalities, and different specialties (MR, CT, US,
CR).
The system is designed to allow authorized physicians and technicians to
send and receive imaging studies from geographically distributed facilities,
and review also at home/office, in order to provide specialty consultations
and interpretations, regardless of distance or physical location.
In each point there is at least one off-the-shelf computer, configured as a
'special workstation', with many features: thumbnail display of image
series; support of color images and manipulation capabilities such as
synchronized series scrolling, windowing/leveling, panning, zooming, line
measurement, image flipping, rotating, and inverting; display/hide image
text; JPG and BMP image exporting; automatic presets for CT and MR.
The physician can filter the work list (by study Id, date, modality, patient,
facility) and the selected exams are downloaded and can be reviewed. Once
the interpretation is completed, the radiologist can create a report, save the
results and synchronize with the server. The reports can be printed directly
in each facility.
The teleradiology solution is in use by a consultant group, integrating 5
radiology departments in small hospitals and outpatient clinics.
INDICE/INDEX
TELE-OPHTHALMOLOGY: REACHING-OUT FOR OUR PATIENTS.
Ricur, G.; Zaldivar, R.; Batiz, MG
Instituto Zaldivar. Mendoza, Argentina.
BACKGROUND: Emerging technologies in communications are essential
tools in healthcare, especially in countries were distances and easy
accesses to qualified services are important barriers for patients. In this
project coined FOCUS, our main objectives were to link our national and
international branches, have real-time transactions between them, and
offer added-value eye care services for our patients.
METHODS: We developed a hybrid telecommunication network involving IP
and ISDN connectivity, with several real-time applications: Electronic
medical records (EMR) dataware house, intranet, voice over IP telephone
system (VoIP), security system, videoconferencing system, as well as our
institutional website. All these applications were used to enhance the
communication of both personnel and patients, and increase our outreach.
RESULTS: At present, we have effectively linked two of the three branches.
The applications are based on our workflow, and run with their respective
backup contingency plans in parallel. We are in the process of educating all
the users, both in the institution as well as in the community.
CONCLUSIONS: We now have different means of communicating ourselves
within our organization and with our patients, which enables us to be more
productive and efficient in providing high quality eyecare service,
regardless of the distances. Although they have proven to be innovating
and promising, cost-effectiveness has still to be demonstrated.
INDICE/INDEX
THE ROLE OF DISRUPTIVE TECHNOLOGY IN REDEVELPMENT OF
MEDICAL SYSTEMS: TELEMEDICINE OF KOSOVA AS AN EXAMPLE
1, 2
2
2
3
Latifi R, Muja Sh, Bekteshi F, Merrell RC.
1. The University of Arizona, Department of Surgery, Trauma and
Critical Care, Tucson, Arizona, USA; 2.Telemedicine Center of Kosova,
Prishtina, Kosova; 3. Medical Informatics and Technology Applications
Consortium, Virginia Commonwealth University, Richmond, Virginia
BACKGROUND: The medical system of Kosova, a region currently governed
by the United Nations and protected by NATO, was largely destroyed
by1999, from Serbian forces, leaving behind severely damaged medical
facilities and infrastructure. The telemedicine project was initiated to
support, supplement and guide educational programs, and development of
medical personnel in the region. Although seen as disruptive technology,
telemedicine has become an import element in providing information
resources for medical education programs within Kosova's medical system
through regional and collaboration international. MATERIALS AND
METHODS: Since its inauguration, Telemedicine Center of Kosova (TCK),
on December 10, 2002, has concentrated its activities in creation of
infrastructure, human capacity, clinical protocols, information resources,
electronic library, and continuing medical education through regional and
international collaboration. Fifty-four-thousand visits have been registered
at the TCK by 1885 medical students and nearly 3000 doctors, nurses and
other healthcare providers of the region. TCK has become virtual classroom
of Kosova's medical system. As of march of 2005, 43 regional and
international conferences have taken place at the TCK, including live
broadcasts of complex surgical procedures. TCK has planted the seeds of
medical information technology, and now is seen as champion of change and
hope in a region devastated by war and neglect.
CONCLUSION: Telemedicine may be regarded as a disruptive technology
in well-developed and functional medical systems. However, when the
disruption is war, natural or man made disaster; telemedicine can be an
expedient way to achieve the goal of independent medical care when there
is an acute need of recovery and redevelopment.
INDICE/INDEX
THE ROLE OF TELECARE IN THE PREVENTION AND SELF
MANAGEMENT OF CHRONIC DISEASES
Johnson, P.
Telecare and Maternal Infant Research Centre, John Radcliffe Hospital,
Oxford
In the UK the Wanless review spelt out the need for a National Program for
Information Technology NPfIT enabling a population to adopt a fully
engaged scenario which meant the public using IT to self care; without this
the NHS was unsustainable. The NPfIT (now called Connecting for Health),
a major commitment to an expert patient program (EPP) (Stanford
University) that identifies generic features of chronic diseases and the
Kaiser Permanente chronic diseases severity pyramid by primary care
could enable a radical change in healthcare. Innovative primary care teams
have linked with social services and local authorities to utilise telecare to
transform chronic disease management. Telecare combines health
information, assistive technology as well as vital signs monitoring.
Assistive technology is already being implemented for frail elderly patients
with memory deficits by social services and intermediate care services to
facilitate independent living through existing social alarm call services.
However, this holistic strategy 'competes' with an inefficient costly hospitalbased specialist NHS model. How may these new and old service models be
reconciled?
Poor lifestyle and chronic diseases are increasing, especially for those
socially disadvantaged. Nearly 1/3rd of the population now lives with a long
term condition, a minority of who are diagnosed early or managed
optimally.
Many years of experience using continuous physiological recording in
applications from antenatal care, through infancy to chronic conditions
such as COPD, heart failure and sleep disorders has demonstrated that a
combination of ECG heart rate variability (HRV), breathing (chest and
abdomen ), and activity recorded over 24 hour periods is powerful generic
diagnostic tool. It is an accurate individual guide to autonomic nervous
system function, a risk stratifier for death and morbidity in many chronic
diseases, and diagnostic of sleep-related cardiorespiratory disorder which
complicates many chronic diseases (20% of diabetes, COPD to > 50 % of
patients with CHF and hypertension). HRV has been increasingly used as an
effective biofeedback tool in stress management programs (e.g.
www.HeartMath.com ) which can reverse cardiovascular disease and as a
marker of risk reduction and improvement of disease control.
The generic clinical value of these measurements has led to the inclusion of
suitable sensors into a wireless garment that can be easily worn by public
and patients alike wherever they are in the community. The advent of blue
tooth and GPRS mobile telephony has radically changed the scale and cost
of providing a telecare service across the community. Blue tooth
connectivity for an increasing number of individual sensors, such as oxygen
saturation, blood pressure, means that additional measurements can be
added as required using a mobile MDA platform to investigate and manage
specific conditions. Experience using these continuous self monitoring
technologies is that patients are compliant (90% of self made recordings
are successfully completed) and develop more ownership of their clinical
data
The real challenge is how to package the results in a positive informing
manner so that more people will understand and value engaging in healthy
lifestyles. Equally health professionals in established health services where
health promotion and risk reduction have not been priorities have to make
radical changes in their knowledge base and practice. Innovative use of the
internet, proving to be a powerful data acquisition tool and information
resource, will be required to enable full advantage of the potential for self
monitoring on a community wide scale.
INDICE/INDEX
THE USE OF TELEMEDIA INTERVENTION IN THE FIGHT AGAINST
HIV/AIDS: IS IT WORKING?
Molefi, M.L.; Kachienga, M.A.; Olurunju, S.; Moshela, M.
Medical Research Council South Africa
Telemedicine Lead Programme
METHODOLOGY. The Mindset Health Channel that has been disseminating
HIV/AIDS information via satellite is one amongst the few in the African
content. This project is available in about 100 health facilities in South
Africa. An evaluation of the broadcast HIV/AIDS content was conducted to
test the effectiveness of this intervention. Questionnaires, interviews and
observations were conducted amongst 167 participants/patients
comprising of 2 groups - experimental and control, attending 4 healthcare
facilities in 3 provinces in South Africa. The participants were exposed to
different content. The Control - viewed a normal drama series of daily life
while the Experimental watched a programme that focused on HIV/AIDS
treatment and management. Data was analyzed using content, thematic
analysis and descriptive analysis using statistics (STATA 8).
RESULTS. The preliminary results showed that the intervention was found
acceptable in terms of attitudinal and possible behavioral change. Positive
results were noted with respect to understating the key medication areas
such as (a) common side effects of the antiretroviral medication, (b) CD4
cell count and (c) willingness to disclose to family members. However there
was marginal change in knowledge of the respondents on (a) why ARVs
should be taken for life, (b) adherence and effects of not taking the pills and
(c) unwillingness to disclose one's status to the community and to a spouse.
CONCLUSION. Findings showed that there is evidence of positive change
as results of this kind of programme however interpreting the side effects is
still low. Stigma continues to be a major hindrance in HIV/AIDS disclosure.
email [email protected]
INDICE/INDEX
THE VIDEOCONFERENCE AS AN EDUCATIONAL STRATEGY TO
TEACH NURSING
Leite M. M. J.; Peres H.H.C.; Kashiabara J. A.
Nursing School of USP / Professional Orientation Dept, San Paulo/SP,
Brazil
The videoconference is an interaction among people in real time and among
distant places. It has the purpose to communicate and it allows the use of
sound, texts and images. It is considered a technology that is very similar to
the traditional class, once it permits the interaction between the teacher
and the students in real time. The aim of this study is to report the use of the
videoconference as a strategy to teach the discipline Nursing Management
III in the nursing graduation course of the Nursing School of USP (EEUSP).
It is supported by the infrastructure of the discipline Telemedicine in the
Medical School of USP This discipline is taught during the seventh semester,
it has 315 hours and there are ninety students participating in it. The
practicing fields were the School Hospital of USP, the Clinicas Hospital of the
Medical School of USP and the School Health Center Samuel B. Pessoa.
Seven meetings were done through videoconference connecting the three
practicing fields. The students and the nurses made presentations with
contents related to the management of the material, structure and human
resources. At the end, the teachers gave a short speech about the themes
discussed. Through the videoconference the students were given the
opportunity to experience a new educational technology and they could
also identify the possibilities and difficulties related to this strategy that
brings a new educational space to the discipline Management in Nursing.
The videoconference contributes to the interaction among the practicing
fields and it allows the teachers, students and nurses to exchange
experiences, which facilitates the learning process and it can also be
combined with other educational methods like person to person and
through distance..
e-mail: [email protected]
INDICE/INDEX
THE VIRTUAL WORLD IS REALLY VIRTUAL?
Böhm, GM
(Faculty of Medicine, University of São Paulo, Brazil)
The real challenge of Telemedicine and e-Health is to guess what is going to
happen in the future and how far this future is. Thus, for example, there are
some doubts about surgery at distance whether it shall be an exception or a
medical routine; however in the field of image diagnosis it is quite possibly
that there will be nothing else but Telemedicine in a future that may be
tomorrow. At present, almost everywhere whenever telediagnosis,
teleassistance, tele-anything is mentioned some problems crop up:
technical difficulties, economical burdens, legal and ethical aspects,
patient-physician relationship and cultural aspects (exchange the real by
the virtual world). The first mentioned problems are practically solved:
Telemedicine is technically possible from a hospital localized in Washington
DC to a mighty aircraft-carrier navigating in the Persian gulf; Telemedicine
cost/benefit ratio is positive; Telemedicine's legal and ethical aspects have
been studied and there are solid rules in many developed countries; the
patient-physician relationship is a fundamental issue and it has a lot to do
with the cultural aspects, however it must be always remembered that as
virtual medical assistance is better than none. But it must be recognized
that the main cultural difficulty of Telemedicine: its virtual stigma.
IN THIS LECTURE the virtual aspects of the real world or, if somebody
prefers, the reality of the virtual world, shall be discussed. It is generally
recognized that cardiologists make unmistakable diagnoses by looking the
electric signs of the heart. Is the examination of an electrocardiogram real?
Are histopathological images less virtual when observed through a
microscope than when analyzed on the screen of a computer? To see or
listen something through a man made device is so much virtual than if an
image or sound comes from a source directly in our eyes or ears? Most
people accept that a binocular and a microphone belong still to the real
world and the TV and cellular phone do not. But why? Is there any logic in
this acceptance or it is only a superficial impression? Is the world less real
to a bat than to a rat? The main question is whether there exists a real
boundary between real and virtual. It is my personal opinion that the Real x
Virtual problem is an ephemeral one; for the generation born digital it will be
non existent and Telemedicine shall be part of our daily routine; it will be no
more virtual than diagnosis through an electrocardiogram or to speak over
a phone.
INDICE/INDEX
TOWARDS THE ENHANCEMENT OF A WEB ENVIRONMENT FOR
SURGICAL SKILLS TRAINING ON OTOLARYNGOLOGY (WESST OT)
Navarro Newball, A. A.- MSc1,2; Vélez Beltrán, J. A.- MD2,1; Múnera,
L.E.S3.- PhD; Garcia, G. B.- PhD4
1. Pontificia Universidad Javeriana, Cali; 2. Colombia.Colombian
Telemedicina Centre, Cali Colombia; 3. Universidad Icesi, Cali
Colombia; 4. DITEC, Universidad de Murcia, Spain.
KEYWORDS. surgery, simulation, virtual reality, otolaryngology,
telemedicine
INTRODUCTION. WESST OT's was designed to allow the practice of the
Functional Endoscopic Sinus Surgery (FESS). The objective of the advances
presented here is to enhance WESST OT in terms of realism, performance
and functionality.
METHODS. A collaborative, inter-institutional and interdisciplinary work and
a modular approach has been followed under an object oriented
methodology.
RESULTS. Results are listed next:
A stereopsis module was created aimed to provide 3D visualisations.
A human systems module was created for the study of the anatomy used.
A surgical tools module was created which allows the design of instruments.
A surgical table was designed to allow the use of the instruments designed
using the surgical tools module.
A help system was implemented.
Validations were done through the application of surveys in a medical
community and performance was measured.
The simulator was analysed from the technical and pedagogical point of
view.
The GOMS model for graphic interface efficiency measurement was applied.
A strategy for the WESST OT validation in a Latin American network was
designed.
WESST OT is being extended with the use of a virtual reality glove, since it is
a more natural interface.
The co-ordination and the spatial positioning skills are under development.
DISCUSSION. WESST OT demonstrates that cutting edge technologies like
virtual reality can be used in Latin America via Internet; However, it requires
further enhancement which increases its usefulness.
Modular engineering not only contributes in the enhancement process of
WESST OT but also, the modular developments have shown to be usable
independently.
INDICE/INDEX
TRANSFORMING GOLDEN HOUR TO GOLDEN MINUTES FOR
TRAUMA AND EMERGENCY CARE USING TELETRAUMA SYSTEM
1,2
1
2
3
Latifi, R.; Porter, J.; Holcomb, M.; Sproule, K.;
3
Young, E.; 3Thornby, D.; 2Weinstein, R.
1
Department of Surgery, Trauma and Critical Care Section,
University of Arizona, 2Arizona Telemedicine Program, Tucson,
Arizona, and 3Southeast Arizona Medical Center, Douglas, Arizona,
USA
BACKGROUND. Recent technological developments have made
possible the implementation of teletrauma, telepresence, and
teleresuscitation as integral part of modern trauma care.
MATERIALS AND METHODS. The University Medical Center (UMC) in
Tucson Arizona, USA, is the only Level I trauma center in the Southern
Arizona and treats 4500-5000 trauma patients a year from all southern
Arizona, northern Mexico, and other neighboring states. In
collaboration with the existing network of Arizona Telemedicine
Program (T1 line), the UMC has embarked on establishing the Southern
Arizona Teletrauma (SATT) Program in attempt to narrow the gap of
trauma and emergency care of patients in rural Arizona and to ensure
telepresence of trauma surgeons 24/7 in all emergency rooms in the
region. Using Vitel Net TM Teletrauma system for audio, video and
electronic medical records transmission, Teletrauma system at the UMC
has been active since November 21, 2004. The policies and procedures,
educational programs and the protocols have been created and
implemented to ensure standardization of the consultations and
teleresuscitation. RESULTS. The initial experience with teletrauma in
saving lives, managing critically ill and injured trauma patients at the
rural site, or safely transferring when needed, and reducing the overall
cost of trauma care has been rewarding and very successful. The
acceptance by trauma surgeons, referring physicians, nurses, and
other providers, as well as patients, has been excellent. Other clinical
specialties are making preparations and creating protocols to use the
system as well. The telepresence of trauma surgeon, through the
teletrauma system is being used to identify knowledge gaps and the
needs for instituting new outreach educational programs.
CONCLUSION. Telepresence for trauma resuscitation can be performed
successfully and safely using telemedicine principles, when guided by a
trauma surgeon. This has transformed the trauma concept of golden
hour to the golden minutestrauma surgeon. This has transformed the
t ra u m a c o n c e p t o f g o l d e n h o u r t o t h e g o l d e n m i n u t e s .
INDICE/INDEX
UTILIZATION OF WEB-BASED TELECARE IN DENTISTRY
Marta S.N.1; Sgavioli C. A. P.P.1; Sequeira E.2; Veronezi M.C.1;
Chao, L.W. 2; Ferreira E.G.P.1
(1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline of
Telemedicine, Medical School, University of São Paulo, São Paulo, Brazil.
The web-based telecare (cyberclinic) for consultation purposes in Dentistry
aims at integrating resources to promote the learning and professional
updating during clinical practice, allowing its utilization in several areas of
the country as a tool for support to interconsultation, in family health
programs, basic health centers, health campaigns and as a tool for long
distance triage. Developed by the discipline of Telemedicine of the Medical
School of USP, with support of the Teledentistry Sector of Universidade do
Sagrado Coração (USC), the system presents several modules: for sending
and evaluation of clinical cases; diagnostic support and updating of the
professional; drug bank with drug interactions; epidemiological surveillance
data collection. As a pioneer system in the field of Dentistry, besides
utilization with undergraduate and graduate students, USC has also
established partnerships with some institutions, such as Health Secretariat
of Bauru, APCDBauru, and APAE-Jaú, and attempted to regulate its
utilization with CRO-SP. The following was performed: 1) 6 trainings for
utilization of the tool with students and partner institutions; 2) at APAE-Jaú:
reformatting of records, base don the clinical form proposed in the
cyberclinic and presential examination of the 50 students of the institution,
which in the future will allow co-validation of the data sent by web; 3)
submission of 20 cases among the professors registered, which allowed
correction of some failures and improvement of the system. Its large scale
utilization will be a resource for updating and close contact between former
students and teaching centers of excellence, to benefit the patients.
INDICE/INDEX
“VIRTUAL CONSULT”
Ricur, G.; Zaldivar, R.; Batiz, M. G.
Instituto Zaldivar. Mendoza, Argentina.
BACKGROUND. The new cyber era has enhanced global communication and
provided new opportunities for accessing medical care and knowledge. IP
and video-conferencing technologies have brought together both patients
and doctors regardless of their distances. The objective of our project was
to provide eye care services, both online and thru video-conferencing
systems between our branches, enhancing our patient outreach.
METHODS. Thru a hybrid telecommunication network, involving IP/ISDN
connectivity and videoconferencing systems, our patients had the chance
to either consult our specialists online or be examined at our telemedicine
suite in Buenos Aires by the consultants in Mendoza. These virtual
ophthalmic consultations were analyzed retrospectively measuring the
impact of the use of these new technologies with protocols designed
specifically for this project.
RESULTS. Since its implementation, 5707 online consultations have been
registered and 267 teleconsults (video-conference) have been performed
between Buenos Aires and Mendoza.
CONCLUSIONS. Information and telecommunication technologies play a
key role in this new digital era. They have enabled the medical community
to enhance its outreach. Nevertheless, regardless of the tools used, virtual
consultations are ordinary consultations: physically different but ethically
the same. Further development of standards and guidelines are required to
help maintain virtual consultations safe from the never-ending growth of
emerging technologies.
INDICE/INDEX
VIRTUAL MAN PROJECT IN DENTISTRY
Soares, S 1; Sequeira, E. 2; Malmström, M.F.V. 1; Castilio, D.1;
Chao, L.W.2
1- Dentistry course, Sacred Heart University, Bauru, São Paulo, Brazil.
2- Discipline of Telemedicine, Medical School, University of São Paulo,
São Paulo, Brazil.
The Virtual Man Project of Discipline of Telemedicine from São Paulo
University, based on the concepts of learning objects, makes images with
movements of high visual and didactic quality, developed by collaboration
between health specialists and digital design professionals. In Dentistry,
two titles were prepared up to 2005: Temporomandibular Joint and Tooth
Structure, made by an association of the Discipline of Telemedicine FMUSP
and Sacred Heart University. After selection of a topic, an educational guide
is developed and scientific bases are searched for construction of each
image. The digital designers of the Discipline of Telemedicine FMUSP
transform the information in graphic representation. The threedimensional images (height, width and volume) allow visualization of
anatomic structures with physiologic or pathologic movements. The
possibility of three-dimensional visualization, establishment of anatomic
correlations, utilization of transparency resources, subtraction (exclusion)
and inclusion of functional dynamics, transforms the “Virtual Man”
generated model in an absolutely new way of transmitting a large amount
of information in a short time, increasing the educational efficiency. After
conclusion of the work, these images are used to help the learning of
students and training of professionals. The perception of students and
professors of USC in relation to this tool was positive. The development of
modern iconographic resources facilitates the education.
INDICE/INDEX
(1)
WEB-BASED FRAMEWORK FOR MANAGING THE OFFICIAL
MEDICAL CHECKS
Fregonara M. (1), Lombroso F.(1)
Azienda Sanitaria Locale Provincia di Milano 3; Monza (Milan); Italy
One of the purposes of the Italian Local Health Authority (LHA), for
territorial health and social services, is to execute the Official Medical
Checks (OMC) asked by private and public Companies on sick employees
suspected of fraudulent ill-health. The LHA must guarantee that an OMC is
performed by an official Medical Examiner (ME) within two days. There is a
complex workflow to manage in terms of bureaucracy and health problems.
The present project aims at creating a web-based framework to fully
manage the OMC workflows and to realise a database of all linked
information (organisation, healthcare, administrative and repayment).
The framework replaces the paper-based procedures with a similar process
supported by information and communication technologies. The framework
architecture is fully web-based, developed with web-programming
languages, organised in three layers technology and divided into three
networks: Internet connects the Companies; Extranet connects the MEs;
Intranet connects all the LHA operators.
A Company can request an OMC on its employees among the citizen in the
LHA database, via Internet. The framework certifies the correctness of the
personal data by verifying it in the register of births. The LHA operator
accepts the request and appoints it to the nearest ME where the employee
lives. The framework automatically assigns a Medical Check ID (MCI) and
sends to the Company an email, confirming the acceptance of the request,
and to the selected ME an email and a SMS (Short Message System) with all
the OMC information (personal data, address, MCI, etc). After the visit the
ME inserts, via Extranet, all the sanitary and operative information
(diagnosis, healthcare status, employee presence at home, etc). The
framework automatically sends to the Company an email containing the
results of the OMC request. Then a LHA operator inserts the administrative
information for the ME charge and for the repayment by the Company.
The Companies can verify, via Internet, anytime the workflow status of
all their requested OMCs, the LHA operators can check, via Intranet, the
status of all the OMC workflows and its related information, and also all
the MEs can verify, via Extranet, their assigned OMCs and related
information.
information. Other framework features are the complete integration with
the LHA Account Software, so the OMC repayment information and the ME
charge are immediately processed, and the management, analysis and
reporting of all the health OMC data. Particular care has been devoted in the
framework to the safeguard of the citizen' privacy.
Since summer 2004, the framework is running successfully (31655 requests
by 6372 Companies for 24013 employees) for submitting OMC requests, for
global managing of its workflows and for analysing all its information
(organisational, administrative, healthcare and repayment). The proposed
framework represents a demonstrator of a possible usage of ICT
technologies to improve and to spread health and social services.
INDICE/INDEX
LEVELLING THE PLAYING FIELD - THE ROLE OF GLOBAL E-HEALTH
IN ADDRESSING INEQUALITY AND INEQUITY
Dr. Scott, R.E.
President, Canadian Society of Telehealth Harkness Associate; Fulbright
New Century Scholar Alumnus
Given the networked nature of e-health (health informatics + telehealth),
the ultimate culmination of our individual and collective e-health related
activities will be to truly develop the entity of 'global e-health'. However, it is
already recognised that e-health represents both promise and peril as it is
applied in addressing various 'divides'. One such divide relates to the health
of individuals, and the health status of populations, which vary widely. A
number of factors contribute to this variation, including socio-economic
status, occupation, gender, age, ethnicity, culture, behaviour, geography,
healthcare practice ('small area variation'), healthcare administration,
disease prevalence, and poor global health information flow. When
significant imbalance occurs, such variation is often termed inequality or
inequity. These terms are sometimes used interchangeably, but their
differentiation is important. Inequality and equality have been described as
dimensional concepts that refer to measurable quantities. In contrast
inequity and equity are considered political concepts that express a moral
commitment to social justice. According to EQUINET, inequity in health is
“those differences in health status that are unnecessary, avoidable, and
unfair”. Inequality in healthcare is not an issue for developing countries
alone - a significant disparity has always existed in developed countries in
terms of geographic location. Those who live in an urban area have greater
and timelier access to healthcare services than do those in rural or remote
areas. The impact in terms of inequality and inequity - can be profound. The
situation is compounded in developing countries that must also struggle
with fundamentally poor healthcare infrastructure and funding constraints.
Opportunities to overcome, or at least minimise, sources of inequality and
inequity already exist at the practice, program, and policy levels. Can global
e-health contribute to the process? The simplistic response is absolutely.
Global e-health has the potential to address causes of inequality directly,
and thereby address inequity indirectly. For example, small area variation
across subgroups of practitioners may be identified as a factor contributing
to inequality. A variety of e-learning options exist (training, mentorship,
continuing education) that, if determined to be appropriate, can be
implemented through specific voluntary or mandatory educational
(practice), training (program), or standardisation (policy) interventions. But
issues also arise.
For example, e-health has the potential to exacerbate as well as ameliorate
inequality to broaden the 'digital divide' (and other divides). Poorer people
are generally most in need of healthcare support, yet they are the group
least likely to have access to rapidly advancing technological solutions. Our
challenge is to identify, develop, and apply culturally appropriate, broadly
available e-health solutions, and to concurrently develop the population and
professional skills necessary to use them. In this regard, global e-health
alone will not suffice. To impact other determinants that affect individual and
population health, such as literacy and employment skills, it will be
necessary to develop initiatives that work in concert, developing e-learning
and e-business opportunities concurrently with e-health applications. To
achieve this, a systematic approach is required. One that includes:
identification of the magnitude of health gradients, needs and readiness
assessment, determination of whether e-health is a viable option, and finally
implementing and assessing the impact of any global e-health solution.
Such a process would be equally applicable and valuable to developing
countries as to developed countries, but the context and solutions would be
different. Applying this approach will allow appropriate e-health solutions to
be applied in reducing inequality and inequity wherever it is found, and
thereby help level the playing field for the health of the world's population.
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