Diseño y Validación de una Aplicación Móvil, para el Diagnóstico de Anemia en Pre-Escolares. Estudio de Precisión Diagnóstica / Design and Validation of a Mobile Application for the Diagnosis of Anemia in Preschoolers. Diagnostic Accuracy Study

La anemia afecta a miles de niños. Para el diagnóstico se cuantifica la hemoglobina (Hb); técnica que no se encuentra al alcance de toda la población. Contar con un instrumento validado de fácil aplicación, puede ayudar al diagnóstico. El objetivo de este estudio fue validar una aplicación móvil (APP) para diagnosticar anemia en niños de 2 a 5 años, aplicable por padres o tutores. Estudio de validación de escalas. Mediante búsqueda bibliografía se recopilaron ítems y dominios relacionados con anemia en niños. Una vez reducidos, se construyó un cuestionario para pilotaje, con tres hematólogos pediatras. El resultado de este fue posteriormente validado por 22 expertos mediante aplicación de escalas tipo Likert. Los ítems validados, se contrastaron con la Hb de niños de 267 niños de 2 a 5 años de los andes ecuatorianos (2.560 msnm). Se determinó asociación de los ítems con Hb y con los resultados obtenidos y se construyó la APP. 14 ítems fueron analizados. Todos ellos puntuaron sobre la mediana de la distribución (35,5 puntos) y fueron valorados por, al menos el 50 % de los expertos. Se seleccionaron palidez palmar, astenia y sueño en horas no habituales. Todos mostraron asociación significativa con anemia (p<0,05), y fueron aplicados como preguntas a padres o tutores y contrastados con el valor de Hb. Sensibilidad y especificidad para palidez fue: 85,1 % y 85,0 %; astenia: 72,3 % y 87,7 %; sueño en horas no habituales: 68,1 % y 87,7 %; palidez más astenia o sueño: 95,7 % y 74,6 %; y debilidad más sueño: 92,5 % y 76,8 %. Se desarrolló y validó una APP para diagnóstico de anemia en niños de 2 a 5 años aplicable por padres o tutores.

SUMMARY: Anemia affects thousands of children, and to reach a diagnosis, hemoglobin (Hb) is quantified. This technique however, is not always accessible to the general population. Therefore, the availability of a validated instrument can be useful in the diagnosis. The aim of this study was to validate a mobile application (APP), to diagnose anemia in children from 2 to 5 years old, applicable by parents or guardians. Scale validation study. Through a bibliographic search, items and domains related to anemia in children were collected. Once reduced, a pilot questionnaire was constructed with three pediatric hematologists. The result was later validated by 22 experts through the application of the Likert-type scales. The validated items were contrasted with the Hb of children of 267 children from 2 to 5 years of age from the Ecuadorian Andes (2,560 meters above sea level). The association of the items with Hb and with the results obtained was determined, and the APP was constructed. 14 items were analyzed. All of them scored above the median of the distribution (35.5 points) and were valued by at least 50 % of the experts. Palmar pallor, asthenia, and sleep at unusual hours were selected. All showed a significant association with anemia (p<0.05) and were applied as questions to parents or guardians and contrasted with the Hb value. Sensitivity and specificity for pallor was: 85.1 % and 85.0 %; asthenia: 72.3 % and 87.7 %; sleep at unusual hours: 68.1 % and 87.7 %; paleness plus fatigue or sleepiness: 95.7 % and 74.6 %; and weakness plus sleep: 92.5 % and 76.8 %. An APP for the diagnosis of anemia in children from 2 to 5 years old applicable by parents or guardians was developed and validated.

Utilização de sensores inerciais no teste timed up and go: uma revisão narrativa / Use of inertial sensors in the timed up and go test: a narrative review

O teste funcional Timed Up and Go (TUG) é amplamente utilizado para avaliar o risco de queda, através do equilíbrio e mobilidade, por ser de fácil aplicação e boa reprodutibilidade na prática clínica. Porém, o TUG ainda possui algumas limitações, pois se concentra no tempo total em que o teste é realizado. Uma proposta de avaliação é através da utilização de sensores inerciais, baseados na tecnologia de sistemas microeletromecânicos, e vem sendo muito utilizados para análise do movimento humano. Logo, o objetivo desse estudo foi realizar uma revisão narrativa sobre o uso dos sensores inerciais nas medidas temporais e cinemáticas do TUG e suas subfases. Metodologia: Essa revisão narrativa foi realizada nas bases de dados PubMed, CENTRAL, BVS e PEDro, por meio do vocabulário MeSH entre o período de maio a junho de 2020. Os critérios de inclusão foram estudos que utilizaram sensores inerciais para avaliação de medidas temporais e cinemáticas do TUG e suas subfases. Resultados: Foram incluídos 11 artigos de um total de 2305 achados. Desses, 5 utilizaram os sensores de smartphones. Não houve padronização em relação à quantidade utilizada, nem à fixação e posicionamento. Os sensores conseguiram mostrar diferenças no TUG e suas subfases nas medidas temporais e cinemáticas nos diferentes grupos avaliados. Considerações Finais: Sensores inerciais são capazes de avaliar medidas temporais e cinemáticas do TUG e de suas subfases, mostrando serem ferramentas confiáveis. Entretanto, mesmo obtendo resultados satisfatórios, necessita-se de mais estudos abrangendo uma população maior.

The Timed Up and Go (TUG) functional test is widely used to assess the risk of falling through balance and mobility since it is easy to apply and presents good reproducibility in clinical practice. However, the TUG test still has some limitations, as it focuses on the total time the test is performed. A proposal for evaluation is the use of inertial sensors, based on the microelectromechanical system technology, which has been widely used for the analysis of human movement. Therefore, the objective of this study was to carry out a narrative review on the use of inertial sensors in the temporal and kinematic measurements of TUG and its subphases. Methodology: This narrative review was carried out in the PubMed, CENTRAL, BVS, and PEDro databases using the MeSH vocabulary between the period of May to June 2020. The inclusion criteria were studies using inertial sensors to evaluate temporal and kinematic measurements of the TUG and its subphases. Results: A total of 11 articles were selected from 2305 hits. From these, five (5) used smartphone sensors. There was no standardization regarding the quantity used, nor their fixation and positioning. The sensors were able to show differences in the TUG and its subphases in the temporal and kinematic measurements in the different groups evaluated. Final Considerations: Inertial sensors are capable of evaluating temporal and kinematic measurements of the TUG and its subphases, showing that they are reliable tools. Nevertheless, although satisfactory results were obtained, further studies are needed covering a larger population.

Herramientas tecnológicas para el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno / Technological tools for the control and follow-up of patients with respiratory diseases and oxygen support

El uso de las herramientas tecnológicas en salud permite llegar a puntos geográficos donde la medicina tradicional traza una brecha entre las instituciones de salud y los pacientes. Estas tecnologías pueden llegar a reducir las tasas de inasistencia médica, aumentar la adherencia al tratamiento y ayudar a garantizar la frecuencia apropiada de las visitas médicas. El presente trabajo se propuso realizar una revisión de la literatura sobre el control y seguimiento de pacientes con enfermedades respiratorias y soporte de oxígeno, a través de herramientas tecnológicas. Se realizó una búsqueda en las bases de datos Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, con descriptores tipo Medical Subject Headings (MeSH) y Descriptores en Ciencias de la Salud (DeCS). El análisis de la literatura se realizó por medio de los elementos Strobe, Amstar. A partir de los estudios incluidos en el análisis final se puede evidenciar que la tecnología móvil en salud se ha convertido en una herramienta de gran importancia en el seguimiento y control de pacientes con enfermedades respiratorias, lo cual proporciona en tiempo real datos que pueden ser usados para minimizar complicaciones y ampliar la oportunidad de atención con calidad en pacientes con problemas respiratorios. No obstante, es necesaria la realización de ensayos clínicos que determinen los beneficios clínicos, al utilizar las herramientas tecnológicas en esta área(AU)

The use of technological tools in health allows reaching geographical points where traditional medicine draws a gap between health institutions and patients. These technologies can reduce medical absence rates, increase adherence to treatment, and help ensure the appropriate frequency of medical visits. In the present work it was proposed to carry out a review of the literature on the control and follow-up in patients with oxygen and respiratory diseases through technological tools. A search was carried out in the databases Pubmed, Cochrane, Medline, Lilacs, Biomed, National Library, Science, with descriptors such as Medical Subject Headings (MeSH) and Descriptors in Health Sciences (DeCS). The analysis of the literature was carried out using the elements Strobe, Amstar. From the studies included in the final analysis, it can be evidenced that mobile health technology has become a very important tool in the monitoring and control of patients with respiratory diseases, which provides data in real time that They can be used to minimize complications and expand the opportunity for quality care in patients with respiratory problems, however, it is necessary to carry out clinical trials to determine the clinical benefits, when using technological tools in this area(SU)

Aplicaciones móviles para el estudio de la anatomía humana / Mobile applications for the study of human anatomy

RESUMEN: El aprendizaje a través de aplicaciones móviles (Apps) es un tema de gran importancia que está asociado a interactuar con la realidad virtual. Pese a la gran cantidad de Apps disponibles, no existe información suficiente que oriente acerca de la utilidad en la didáctica de la anatomía. Es por ello que este trabajo pretende evaluar el uso de aplicaciones móviles en el estudio de la Anatomía humana. Se realizó la búsqueda de aplicaciones para el estudio de la anatomía humana, utilizando las plataformas de descarga App Store y Google Play. Se jerarquizaron las Apps dando importancia a las que contaran con un mayor número de personas que la hubieran valorado y a la puntuación que le otorgaron sus usuarios. Se incorporaron Apps al estudio de la Anatomía humana en estudiantes de salud de universidades de la ciudad de Manizales (Colombia). Se aplicó un instrumento para evaluar la utilidad en el aprendizaje de las diferentes estructuras humanas. La búsqueda dio como resultado 113 aplicaciones, de las cuales 70 son gratuitas y 43 que tienen un costo para su descarga. De éstas, Anatomy quiz es la que más prefieren los estudiantes al momento de estudiar anatomía. La utilización de Apps para el estudio de la anatomía humana prepara a estudiantes para enfrentarse a una estructura real; se cuenta con especímenes ilimitados para una disección virtual y desarrolla habilidades espaciales. Conocer las Apps disponibles para estudio del cuerpo humano aporta a una mejor didáctica de la Anatomía.

SUMMARY: The learning through mobile applications (Apps) is a subject of great importance that is associated to interact with virtual reality. Despite the large number of Apps available, there is not enough information to guide the usefulness in the didactics of anatomy. That is why this work aims to evaluate the use of mobile applications in the study of human anatomy. Methods were sought for applications for the study of human anatomy, using the App Store and Google Play download platforms. Apps were prioritized giving importance to those that had a greater number of people who had valued it, and the score given by its users. Apps were added to the study of human anatomy in health students at universities in city of Manizales (Colombia). An instrument was applied to evaluate the usefulness in the learning of the different human structures. The search resulted in 113 applications of which 70 are free and 43 have a download cost. Of these, Anatomy quiz is the most preferred by students when studying anatomy. The use of Apps for the study of human anatomy prepares students to face a real structure; unlimited specimens are available for virtual dissection and to develop spatial skills. Knowing the Apps available for the study of the human body contributes to better didactics of anatomy.

Telemedicina en procesos de rehabilitación en pacientes con paraplejia bajo el contexto de Atención Primaria de Salud / Telemedicine in rehabilitation processes in patients with paraplegia under the context of Primary Health Care

Encontrar estrategias costo-efectivas para la rehabilitación y la educación del paciente con paraplejia, basado en sus necesidades, es menester para su abordaje integral, así como para la disminución de costos directos e indirectos. La telemedicina podría ser una herramienta adecuada. Este trabajo se propuso realizar una revisión crítica de la literatura sobre la utilidad de la telemedicina para la rehabilitación y el manejo del paciente con paraplejia, en el contexto de la Atención Primaria de Salud. Se realizó una búsqueda en las bases de datos PubMed, Medline y EMBASE, con descriptores tipo MeSH y DeCS. No se aplicó ningún filtro de temporalidad, idioma o grupo etario. Se reunieron 134 artículos. El criterio de búsqueda y de selección se basó en los elementos PICO. Luego del análisis de contenido de cada uno, se escogieron 29 artículos. El análisis crítico de la literatura se realizó por medio de los elementos PRISMA. La telemedicina y la telerrehabilitación son herramientas que pudieran ser útiles para pacientes parapléjicos o cuadripléjicos; sin embargo, no existe literatura ni evidencia sobre este tipo de intervenciones en esta población. Intervenciones en pacientes con enfermedades neurológicas diferentes a la paraplejia muestran que potencialmente la telemedicina podría tener beneficios y reducir costos en la rehabilitación. Las herramientas tecnológicas y de telemedicina en pacientes parapléjicos podrían favorecer potencialmente su rehabilitación y el uso eficiente de los recursos; no obstante, es necesaria la realización de estudios en el área, para determinar el beneficio real de la telemedicina como estrategia de Atención Primaria de Salud en el paciente con paraplejia y cuadriplejia(AU)

Finding cost-effective strategies for the rehabilitation and education of patients with paraplegia, based on their needs, is necessary for their comprehensive approach, as well as for the reduction of direct and indirect costs. The objective of this work was to perform a critical review of the literature on the usefulness of telemedicine for the rehabilitation and management of patients with paraplegia, in the context of Primary Health Care. A review of the literature in the PubMed, Medline and EMBASE databases was performed with MeSH and DeCS type descriptors. No filter of temporality, language or age group was applied. 134 articles were collected. The searching and selection criteria were based on the PICO elements; after the content analysis of each one, 29 articles were chosen. The critical analysis of the literature was carried out through the PRISMA elements. Telemedicine and telerehabilitation are tools that could be useful for paraplegic or quadriplegic patients; however, there is no literature or evidence on this type of interventions in this population. Interventions in patients with neurological diseases other than paraplegia show that telemedicine could potentially have benefits and reduce rehabilitation costs. The technological and telemedicine tools in paraplegic patients could potentially favor their rehabilitation and efficient use of resources; however, studies in the area are necessary to determine the real benefit of telemedicine as a care strategy primary health in the patient with paraplegia and quadriplegia(AU)

Telemedicina en cáncer: nuevas alternativas / Telemedicina in Cancer: new alternatives / Telemedicina no Câncer: novas alternativas

Introducción: El cáncer ha sido reportado como la segunda causa de muerte a escala mundial. Las tecnologías de la información y comunicación son una herramienta importante para mejorar el bienestar general de los pacientes oncológicos y apoyar su proceso de atención. Objetivo: El objetivo de este artículo es brindar información actualizada y estructurada de la telemedicina en el área de oncología y de las nuevas alternativas que existen en Colombia y en el mundo, mediante una revisión documental de la literatura. Metodología: Se realizó una búsqueda de la literatura mediante Pubmed, Scielo, Web of Science, Scopus, Sciencedirect, y metabuscadores como World Wide Science Startpage (Ixquick). Se revisaron artículos desde el 2002 hasta el 2018, y la estrategia de búsqueda incluyó términos MeSH como "e-health", "telemedicine" y "neoplasms". Resultados: Se reclutaron 67 artículos; se encontró que las principales aplicaciones de la teleoncología incluyen telediagnóstico, teleconsulta, teleeducación sanitaria y profesional, teleterapia y telerrehabilitación. Conclusiones: La teleoncología mejora la calidad de vida de los pacientes oncológicos y fortalece las herramientas académicas en los profesionales de salud, al mejorar la prestación de los servicios de salud.

Introduction: Cancer has been reported as the second cause of death worldwide, information and communication technologies are useful to improve the general well-being of cancer patients and support their attention process. Objective: The aim of this article is to provide updated and structured information on telemedicine in the area of oncology and the new alternatives that exist in Colombia and in the world, through a documentary review of the literature. Methodology: A literature search was carried out by Pubmed, Scielo, Web of Science, Scopus, Sciencedirect, and metasearch engines such as World Wide Science Startpage (Ixquick). Articles were reviewed from 2002 to 2018 and the search strategy included the MeSH terms such as "e-health", "telemedicine" and "neoplasms". Results: 67 articles were recruited and it was found that the main applications of teleoncology include telediagnosis, teleconsultation, health and professional teleeducation, teletherapy and telerehabilitation. Conclusion: Teleoncology improves the quality of life of cancer patients and strengthens the academic tools of health professionals improving the provision of health services

Introdução: O Câncer tem sido relatado como a segunda causa de morte em todo o mundo; as tecnologias de informação e comunicação são úteis para melhorar o bem-estar geral dos pacientes com Câncer e apoiar seu processo de. Objetivo: O objetivo deste artigo é fornecer informações atualizadas e estruturadas sobre telemedicina na área de oncologia e as novas alternativas existentes na Colômbia e no mundo, através de uma revisão documental da literatura. Metodologia: Uma pesquisa bibliofigura foi realizada pelos motores Pubmed, Scielo, Web of Science, Scopus, Sciencedirect e metassearch, como o World Wide Science Startpage (Ixquick). Os artigos foram revisados de 2002 a 2018 e a estratégia de pesquisa incluiu termos do MeSH como "e-health", "telemedicine" e "neoplasms". Resultados: foram recrutados 67 artigos e constatou-se que as principais aplicações da teleoncologia incluem telediagnóstico, teleconsulta, teleducação profissional e em saúde, teleterapia e telerreabilitação. Conclusão: A teleoncologia melhora a qualidade de vida dos pacientes com câncer e fortalece as ferramentas atenção acadêmicas dos profissionais de saúde, melhorando a prestação de serviços de saúde

Ferramenta computacional para avaliação de kerma no ar em aplicações de radioproteção em áreas de internação de pacientes: proposição de um método simples para avaliação experimental / Computational toolkit for evaluating air kerma with the purpose of radiation protection of hospital inpatients: proposal of a simple experimental evaluation method

OBJETIVO: Apresentar uma ferramenta de análise de dados que pode ser utilizada para proteção de pacientes e trabalhadores em áreas de uso de equipamentos móveis. MATERIAIS E MÉTODOS: Foi desenvolvida uma ferramenta, em planilha ativa Excel®, que utiliza medidas de exposição para gerar um banco de dados de fatores de forma e calcular o kerma no ar ao entorno de um leito. O banco de dados inicial foi coletado com três equipamentos móveis. Um espalhador não antropomórfico foi utilizado, sendo realizadas medidas de exposição em uma malha de (4,2 × 4,2) m², ao passo de 0,3 m. RESULTADOS: A ferramenta calcula o kerma no ar (associado à exposição de pacientes expostos e ao equivalente de dose ambiente) à radiação secundária. Para distâncias inferiores a 60,0 cm, valores acima do limite máximo de equivalente de dose ambiente definido para área livre (0,5 mSv/ano) foram verificados. Os dados coletados a 2,1 m foram sempre inferiores a 12% do referido limite. CONCLUSÃO: A ferramenta é capaz de auxiliar na proteção radiológica de pacientes e trabalhadores, quando associada à coleta de dados adequada, pois possibilita a determinação de áreas livres ao entorno de leitos em áreas onde equipamentos móveis geradores de radiação X são utilizados.

OBJECTIVE: To present a data analysis toolkit that may be utilized with the purpose of radiation protection of hospital inpatients and workers in areas where mobile apparatuses are used. MATERIALS AND METHODS: An Excel® ActiveSheet was utilized to develop a computational toolkit with exposure measurements to generate a database of shape factors and to calculate the air kerma around hospital beds. The initial database included data collected with three mobile apparatuses. A non-anthropomorphic phantom was utilized and exposure measurements were performed on a (4.2 × 4.2) m² mesh-grid at 0.3 m steps. RESULTS: The toolkit calculates the air kerma (associated with patients' radiation exposure and with ambient equivalent dose) under secondary radiation. For distances lower than 60.0 cm, values above the maximum ambient equivalent dose threshold defined for radiation free areas (0.5 mSv/year) were verified. Data collected at 2.1 m have always presented values lower than 12% of that threshold. CONCLUSION: The toolkit can aid in the radiological protection of patients and workers, provided it is combined with appropriate data collection, since it allows the determination of radiation free areas around beds in rooms where mobile X-ray apparatuses are utilized.