Oral cancer diagnosis communication: Impact of an educational intervention using the SPIKES protocol.

OBJECTIVE: This study evaluated the influence of a single educational intervention on the perception and knowledge of strategies for communicating oral cancer diagnoses. METHODS: A educational intervention, 72 dentists and 41 dental undergraduates participated in the 'Maio Vermelho Project', a continuing education activity. Participants completed a 14-question online questionnaire concerning their experiences and perceptions of delivering difficult news. The educational intervention featured an interview illustrating the SPIKES protocol, broadcast on YouTube. RESULTS: Participants had a mean age of 40 years. A minority (21.2%) had encountered or experienced communicating an oral cancer diagnosis. Exposure to lectures on this topic during their education was uncommon (22.1%) but more prevalent among students. After the intervention, confidence in communicating a cancer diagnosis (29.2%) and addressing the patient's family (30.1%) in line with the SPIKES protocol increased. CONCLUSION: A training deficit persists in delivering cancer diagnoses, highlighting the need for educational interventions to empower students and professionals in this critical procedure. Integration of this topic into the dental undergraduate curriculum is imperative. CLINICAL RELEVANCE: Effectively communicating a cancer diagnosis poses challenges to healthcare professionals, impacting treatment outcomes. Implementing educational interventions ensures that professionals are well prepared to navigate this complex task, ultimately improving patient care.

Doubts about the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service.

This cross-sectional study aims to describe doubts regarding the diagnosis and treatment of syphilis in pregnancy among primary care professionals in a telehealth service. All teleconsultations (TCs) offered through TelessaúdeRS-UFRGS to primary health care (PHC) services in the state of Rio Grande do Sul between 2018 and 2021 involving syphilis in pregnancy were included. A total of 356 (TCs) were analyzed. The main doubts about syphilis during pregnancy raised by primary care professionals were related to the need for retreatment (35%), diagnostic definition (23%) and initial treatment (16%). In addition, 95% of TCs were suitable for diagnosing and treating syphilis based on the 2020 Brazilian Ministry of Health guideline. This study suggests that TCs can identify failures in the diagnosis and treatment of public health problems and support decision making in PHC involving syphilis in pregnancy.

Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions?

In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.

Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service.

Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.

Clinical Features Associated with the Demand of In-Person Care by Dermatologists: An Observational Cross-Sectional Study.

Background: The factors necessitating the need for referrals for in-person evaluations by a dermatologist are not adequately understood and have not been studied using automated text mining so far. The objective of this study was to compare the prevalence of required in-person dermatologist care in the presence or absence of certain clinical features. Methods: Observational cross-sectional study of 11,661 teledermatology reports made from February 2017 to March 2020. Results: The need for dermoscopy was associated with a 348% increase in the possibility of referral for in-person dermatologist evaluations (prevalence ratio [PR]: 4.48, 95% confidence interval [CI]: 4.17-4.82). Infectious diseases were associated with a 64% lower possibility of referral (PR: 0.36, 95% CI: 0.30-0.43). Discussion: Some lesions and poorly documented cases are challenging to assess remotely. This study presents a different approach to research more detailed data from teledermatology reports, using text mining, and points out the risk magnitude for demanding dermatologic in-person care of which feature analyzed. As limitations, the variables related to lesion location, size, and extension were not analyzed and the dictionaries used were originally in Brazilian Portuguese. Conclusions: Teledermatology seems sufficient for the management of 75% of clinical cases, especially acute in young patients with inflammatory or infectious lesions. Referrals for in-person dermatologist consultations were not only strongly associated with the need for dermoscopy, but also for therapeutic reasons like surgical procedures, phototherapy, and the use of some systemic medications.

An international planetary health for primary care massive open online course.

In this Viewpoint we argue that primary care practitioners should receive professional education in how to directly respond to planetary health challenges. We reflect on the provision of a massive open online course (MOOC) on planetary health for primary care practitioners in the context of existing training programmes. We describe the construction, delivery, and certification of a Global South-originated MOOC and explain aspects of its rhizomatic learning theory. We share baseline information and preliminary findings collected on the initial cohort of participants, including their profiles and previous knowledge about planetary health. We suggest that this MOOC is an appropriate response to planetary health challenges, and argue that cost-free, accredited planetary health education for primary care practitioners should be provided as a public good that also fulfils individual professionals' entitlement to quality education and continuing professional development.

Distance learning course improves primary care dentists' diagnosis and self-efficacy in the management of oral lesions.

Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

[TeleOftalmo: strategy to expand the offer of ophthalmologic telediagnostics for primary healthcare in the Southern Brazil]. / TeleOftalmo: estratégia de ampliação da oferta de telediagnósticos oftalmológicos para a atenção primária à saúde no Sul do Brasil.

The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.

O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.

La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.

Oral Medicine Experience and Attitudes Toward Oral Cancer: An Evaluation of Dentists Working in Primary Health Care.

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Telemedicine Versus Face-to-Face Care in Ophthalmology: Costs and Utility Measures in a Real-World Setting.

OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.

Distance learning course improves primary care dentists' diagnosis and self-efficacy in the management of oral lesions

Abstract Oral cancer represents a public health issue because of its high mortality rate, resulting mainly from diagnostic delays. Insufficient training in oral diagnosis is usually perceived by dentists. Distance learning could be used as an auxiliary tool to bridge that gap. This study evaluated the impact of a distance learning course on oral mucosal lesion diagnosis offered to public healthcare dentists. Participants of an online course answered a pretest/posttest comprising clinical images of 30 clinical cases. Participants were questioned about the diagnosis and informed their decision on the cases (referring the cases to a specialist or managing them themselves), as a parameter of perceived self-efficacy. A total of 442 dentists enrolled in the course. Their pass rate was 97%. Classification of the nature of the lesions, diagnostic hypotheses, sensitivity, and specificity improved by 13.4%, 10.0%, 13.4%, and 6.6%, respectively (p<0.01, Wilcoxon test). Regarding management, there was a 16.6% reduction in the intention to refer cases, while confidence in the diagnosis of benign lesions increased by 40%. A distance learning course may be useful in continuing education actions for primary care dentists, improving their diagnostic abilities and encouraging them in the management of oral lesions. Moreover, this strategy could contribute to disseminating knowledge to remote regions, particularly among primary health care professionals.

TeleOftalmo: estratégia de ampliação da oferta de telediagnósticos oftalmológicos para a atenção primária à saúde no Sul do Brasil / TeleOftalmo: strategy to expand the offer of ophthalmologic telediagnostics for primary healthcare in the Southern Brazil / TeleOftalmo: estrategia de ampliación de la oferta de telediagnósticos oftálmicos en la atención primaria de salud en el sur de Brasil

O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.

The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.

La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.

Teaming-up nurses with ophthalmologists to expand the reach of eye care in a middle-income country: Validation of health data acquisition by nursing staff in a telemedicine strategy.

Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.

Eighteen years in two days: the next steps for remote consultation in Brazil / Dieciocho años en dos días: los próximos pasos para la consulta remota en Brasil / Dezoito anos em dois dias: os próximos passos para a consulta remota no Brasil

This is an opinion article that aims to support the Disease caused by the New Coronavirus of 2019 (COVID-19) post-pandemic regarding the regulation of care through digital resources. Through a literature review, an attempt was made to conceptualize remote consultation and to survey both the historical evolution of technological appropriation by health and the regulation on the subject. Texts covering the pre-pandemic and pandemic periods in Brazil, the United States, the European Union and Australia were evaluated. We tried to highlight the main fallacies, sophisms and dissensions that orbit the theme, as well as the real points where there is a need for greater commitment for decision makers: data security and privacy, reimbursement parity and interstate licensing. It is concluded that the technological appropriation by health has divided the world into at least three segments: those that maintained the autonomy of professionals and patients; those who retarded technological advancement through bureaucracy; and those who forbade advances. The pandemic has generated positive reallocations among these groups and there is a need to refine progress and avoid setbacks.

Este es un artículo de opinión que tiene como objetivo apoyar la discusión pospandémica de la Enfermedad causada por el Nuevo Coronavirus de 2019 (COVID-19) en cuanto a la regulación de la atención a través de recursos digitales. A través de una revisión de la literatura, se intentó conceptualizar la consulta remota y relevar tanto la evolución histórica de la apropiación tecnológica por parte de la salud como la regulación sobre el tema. Se evaluaron los textos que cubren los períodos prepandémico y pandémico en Brasil, Estados Unidos, la Unión Europea y Australia. Intentamos resaltar las principales falacias, sofismas y disensiones que orbitan el tema, así como los puntos reales donde existe la necesidad de un mayor compromiso de los tomadores de decisiones: seguridad y privacidad de los datos, paridad de reembolso y licencias interestatales. Se concluye que la apropiación tecnológica por parte de la salud ha dividido al mundo en al menos tres segmentos: los que mantenían la autonomía de profesionales y pacientes; los que retrasaron el avance tecnológico a través de la burocracia; y los que prohibieron los avances. La pandemia ha generado reasignaciones positivas entre estos grupos y es necesario perfeccionar el progreso y evitar retrocesos.

Este é um artigo de opinião que objetiva subsidiar a discussão pós-pandemia da Doença causada pelo Novo Coronavírus de 2019 (COVID-19) a respeito da regulamentação do atendimento por meio de recursos digitais. Buscou-se, por meio de revisão de literatura, conceituar a consulta remota e fazer um levantamento tanto da evolução histórica da apropriação tecnológica pela saúde como da regulamentação sobre o tema. Foram avaliados textos cobrindo os períodos pré-pandêmico e pandêmico no Brasil, Estados Unidos, União Europeia e Austrália. Procurou-se evidenciar as principais falácias, sofismas e dissensos que orbitam o tema, bem como os reais pontos onde há necessidade de maior empenho para os tomadores de decisão: segurança de dados e privacidade, paridade de reembolso e licenciamento interestadual. Conclui-se que a apropriação tecnológica pela saúde dividiu o mundo em pelo menos três segmentos: os que mantiveram a autonomia de profissionais e pacientes; os que retardaram o avanço tecnológico por meio de burocracia; e os que proibiram os avanços. A pandemia gerou realocações positivas entre esses grupos e existe a necessidade de refinar avanços e evitar retrocessos.

The management of COVID-19 cases through telemedicine in Brazil.

In Dec 2020 Brazil became one of the worldwide epicenters of the COVID-19 pandemic with more than 7.2M reported cases. Brazil has a large territory with unequal distribution of healthcare resources including physicians. Resource limitation has been one of the main factors hampering Brazil's response to the COVID-19 crisis. Telemedicine has been an effective approach for COVID-19 management as it allows to reduce the risk of cross-contamination and provides support to remote rural locations. Here we present the analyses of teleconsultations from a countrywide telemedicine service (TelessáudeRS-UFRGS, TRS), that provides physician-to-physician remote support during the COVID-19 pandemic in Brazil. We performed a descriptive analysis of the teleconsultation incoming calls and a text analysis from the call transcripts. Our findings indicate that TRS teleconsultations in Brazil experienced an exponential increment of 802.% during a period of 6 days, after the first death due to COVID-19 was reported. However, the number of teleconsultations cases decreased over time, despite the number of reported COVID-19 cases continuously increasing. The results also showed that physicians in low-income municipalities, based on GDP per capita, are less likely to consult the telemedicine service despite facing higher rates of COVID-19 cases. The text analysis of call transcripts from medical teleconsultations showed that the main concern of physicians were "asymptomatic" patients. We suggest an immediate reinforcement of telehealth services in the regions of lower income as a strategy to support COVID-19 management.

The Role of Telehealth in the Covid-19 Pandemic: A Brazilian Experience. / O Papel da Telessaúde na Pandemia Covid-19: Uma Experiência Brasileira.

SARS-CoV-2, the virus that causes Covid-19, is the third coronavirus to cause severe disease in humans and to spread globally in the past two decades. In this context, several national public health departments, including the Brazilian Ministry of Health, highlighted what was, until then, considered a support service to the health system: telehealth and telemedicine. We intend to present the actions carried out by a national telehealth service in Brazil, both as a Primary Health Care (PHC) support service to professionals and to patients, as well as discussing the potential to reorganize a health system. This is a prevalence study that summarizes the measures adopted by Brazilian Telehealth Center from the 9th to the 27th epidemiological weeks of 2020 to support the health services of the Brazilian Unified Health System (SUS). There was an increase of 76.8% in the demand for telephone teleconsultations during the evaluated period compared to the same period in 2019, with 28.8% of the entire demand arising from doubts related to Covid-19. The Covid-19 pandemic demanded a quick response, with the organization of materials about the disease, a new team to carry out telemonitoring and teleconsultation activities, in addition to the creation of a manual for teleconsultations in Primary Health Care.

O SARS-CoV-2, vírus causador da Covid-19, é o terceiro coronavírus a causar doença grave em humanos e que apresentou disseminação global nas duas últimas décadas. Nesse contexto, diversos departamentos nacionais de saúde pública, entre eles o Ministério da Saúde do Brasil, trouxeram destaque àquilo que era, até então, considerado um serviço de apoio ao sistema de saúde: a telessaúde e a telemedicina. Pretendemos apresentar as ações realizadas por um serviço nacional de telessaúde no Brasil, tanto no suporte aos profissionais de saúde da Atenção Primária à Saúde quanto a pacientes, além de discutir o potencial de reorganizar um sistema de saúde. Estudo de prevalência que sumariza as ações de telemedicina adotadas pelo TelessaúdeRS-UFRGS no período da 9ª à 27ª semana epidemiológica de 2020 para apoio aos serviços de saúde do Sistema Único de Saúde (SUS). Houve aumento de 76,8% da demanda de teleconsultorias telefônicas no período avaliado em comparação com o mesmo período em 2019, sendo 28,8% dessa demanda total decorrente de dúvidas relacionada à Covid-19. A pandemia por Covid-19 demandou rápida resposta com a organização de materiais sobre a doença, uma nova equipe para execução das atividades de telemonitoramento e teleconsultas, além da elaboração de um manual para teleconsultas na Atenção Primária à Saúde.

Social Distancing, Mask Use, and Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Brazil, April-June 2020.

We assessed the associations of social distancing and mask use with symptomatic, laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection in Porto Alegre, Brazil. We conducted a population-based case-control study during April-June 2020. Municipal authorities furnished case-patients, and controls were taken from representative household surveys. In adjusted logistic regression analyses of 271 case-patients and 1,396 controls, those reporting moderate to greatest adherence to social distancing had 59% (odds ratio [OR] 0.41, 95% CI 0.24-0.70) to 75% (OR 0.25, 95% CI 0.15-0.42) lower odds of infection. Lesser out-of-household exposure (vs. going out every day all day) reduced odds from 52% (OR 0.48, 95% CI 0.29-0.77) to 75% (OR 0.25, 95% CI 0.18-0.36). Mask use reduced odds of infection by 87% (OR 0.13, 95% CI 0.04-0.36). In conclusion, social distancing and mask use while outside the house provided major protection against symptomatic infection.

O Papel da Telessaúde na Pandemia Covid-19: Uma Experiência Brasileira / The Role of Telehealth in the Covid-19 Pandemic: A Brazilian Experience

Resumo O SARS-CoV-2, vírus causador da Covid-19, é o terceiro coronavírus a causar doença grave em humanos e que apresentou disseminação global nas duas últimas décadas. Nesse contexto, diversos departamentos nacionais de saúde pública, entre eles o Ministério da Saúde do Brasil, trouxeram destaque àquilo que era, até então, considerado um serviço de apoio ao sistema de saúde: a telessaúde e a telemedicina. Pretendemos apresentar as ações realizadas por um serviço nacional de telessaúde no Brasil, tanto no suporte aos profissionais de saúde da Atenção Primária à Saúde quanto a pacientes, além de discutir o potencial de reorganizar um sistema de saúde. Estudo de prevalência que sumariza as ações de telemedicina adotadas pelo TelessaúdeRS-UFRGS no período da 9ª à 27ª semana epidemiológica de 2020 para apoio aos serviços de saúde do Sistema Único de Saúde (SUS). Houve aumento de 76,8% da demanda de teleconsultorias telefônicas no período avaliado em comparação com o mesmo período em 2019, sendo 28,8% dessa demanda total decorrente de dúvidas relacionada à Covid-19. A pandemia por Covid-19 demandou rápida resposta com a organização de materiais sobre a doença, uma nova equipe para execução das atividades de telemonitoramento e teleconsultas, além da elaboração de um manual para teleconsultas na Atenção Primária à Saúde.

Abstract SARS-CoV-2, the virus that causes Covid-19, is the third coronavirus to cause severe disease in humans and to spread globally in the past two decades. In this context, several national public health departments, including the Brazilian Ministry of Health, highlighted what was, until then, considered a support service to the health system: telehealth and telemedicine. We intend to present the actions carried out by a national telehealth service in Brazil, both as a Primary Health Care (PHC) support service to professionals and to patients, as well as discussing the potential to reorganize a health system. This is a prevalence study that summarizes the measures adopted by Brazilian Telehealth Center from the 9th to the 27th epidemiological weeks of 2020 to support the health services of the Brazilian Unified Health System (SUS). There was an increase of 76.8% in the demand for telephone teleconsultations during the evaluated period compared to the same period in 2019, with 28.8% of the entire demand arising from doubts related to Covid-19. The Covid-19 pandemic demanded a quick response, with the organization of materials about the disease, a new team to carry out telemonitoring and teleconsultation activities, in addition to the creation of a manual for teleconsultations in Primary Health Care.

Ophthalmic image acquired by ophthalmologists and by allied health personnel as part of a telemedicine strategy: a comparative study of image quality.

OBJECTIVES: This study evaluates the quality of ophthalmic images acquired by a nurse technician trained in teleophthalmology as compared with images acquired by an ophthalmologist, in order to provide a better understanding of the workforce necessary to operate remote care programs. METHODS: A cross-sectional study was performed on 2044 images obtained from 118 participants of the TeleOftalmo project, in Brazil. Fundus and slit-lamp photography were performed on site by an ophthalmologist and by a nurse technician under the supervision of a remote ophthalmologist. Image quality was then evaluated by masked ophthalmologists. Proportion of suitable images in each group was compared. RESULTS: The proportion of concordant classification regarding quality was 94.8%, with a corrected kappa agreement of 0.94. When analyzing each type of photo separately, there was no significant difference in the proportion of suitable images between on-site ophthalmologist and nurse technician with remote ophthalmologist assistance for the following: slit-lamp views of the anterior segment and anterior chamber periphery, and fundus photographs centered on the macula and on the optic disc (P = 0.825, P = 0.997, P = 0.194, and P = 0.449, respectively). For slit-lamp views of the lens, the proportion of suitable images was higher among those obtained by an ophthalmologist (99.6%) than by a technician (93.8%, P < 0.01). CONCLUSIONS: Ophthalmic photographs acquired by a trained technician consistently achieved >90% adequacy for remote reading. Compared with ophthalmologist-acquired photos, the proportion of images deemed suitable achieved a high overall agreement. These findings provide favorable evidence of the adequacy of teleophthalmological imaging by nurse technicians.

Protocol for a randomized clinical trial: telephone-based psychoeducation and support for female informal caregivers of patients with dementia / Protocolo para ensaio clínico randomizado: psicoeducação por telefone e apoio para cuidadoras informais femininas de pacientes com demência

OBJECTIVE: The burden felt by informal caregivers of patients with dementia is a source of physical, emotional, and financial problems. Face-to-face interventions for caregivers have accessibility limitations that may prevent them from receiving adequate care. Telehealth tools can be a solution to this problem. We will compare a telephone psychoeducational and support intervention protocol to usual care for informal female caregivers of patients with dementia treated at Brazilian specialized outpatient clinics. METHODS: In this single-blind randomized clinical trial, the intervention group will receive one weekly call for 8 weeks that addresses issues such as disease education, communication with the patient, and problematic behaviors. The control group will receive printed material on problematic behaviors in dementia. The primary outcome will be the difference in caregiver burden between baseline and 8 weeks, which will be assessed by blinded investigators through the Zarit Burden Interview scale. Caregiver burden at 16 weeks after baseline, depression, anxiety, and quality of life at 8 and 16 weeks are secondary outcomes. CONCLUSIONS: We expect the intervention to reduce caregiver burden. These results could lead to public health programs for improving dementia care in lower-middle-income countries. Ethics and dissemination: This trial was approved by an independent ethics committee. The results will be published in an international peer-reviewed medical journal. Trial registration number: NCT03260608

OBJETIVO: A sobrecarga sentida por cuidadores informais de pacientes com demência é uma fonte de problemas físicos, emocionais e financeiros. As intervenções face a face para cuidadores apresentam limitações de acessibilidade que podem impedilos de receber cuidados adequados. As ferramentas de telessaúde podem ser uma solução para esse problema. Comparamos um protocolo de intervenção psicoeducacional e de apoio por telefone ao tratamento usual para cuidadoras informais de pacientes com demência tratados em ambulatórios especializados. METODOLOGIA: Será realizado um ensaio clínico randomizado simples-cego. Durante 8 semanas, o grupo de intervenção receberá uma ligação semanal abordando questões como educação sobre a doença, comunicação com o paciente e comportamentos problemáticos. O grupo controle receberá material impresso sobre comportamentos problemáticos na demência. O resultado primário será a diferença na sobrecarga da cuidadora entre o ponto de partida e oito semanas, que será avaliada por pesquisadores cegos com a escala Zarit Burden Interview. Sobrecarga da cuidadora em dezesseis semanas após o início do estudo, depressão, ansiedade e qualidade de vida após oito e dezesseis semanas são resultados secundários. CONCLUSÕES: Esperamos que a intervenção reduza a sobrecarga da cuidadora. Esses resultados podem levar a programas de saúde pública para melhorar o tratamento da demência em países de renda médiabaixa. Ética e divulgação: Este estudo foi aprovado por um comitê de ética independente. Os resultados serão publicados em uma revista médica internacional revisada por pares. Número de registro do teste: NCT03260608.