Dear Colleague, - Unifesp

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Transcript of Dear Colleague, - Unifesp

Page 1: Dear Colleague, - Unifesp
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Dear Colleague,

The abstracts received by the 10 Congress Of the International Society ofTelemedicine and e-Health, the 2 Congress of the Brazilian Council ofTelemedicine and e-Health and the 2 Meeting of the Latin-American andCaribbean Chapter of the American Telemedicine Association are edited inthis CD-ROM. They are published as they were sent; only a uniform layoutwas given. An alphabetic sequence using the surname of the first authorwas followed. Abstracts written in Portuguese and English were notseparated; whenever a choice was given the English version was used, as itis the international language of Science. Whether it was a poster or oralpresentation is not indicated. An index was elaborated with all authorslinked 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 SociedadeInternacional de Telemedicina e Telessaúde, o 2º Congresso Brasileiro deTelemedicina e Telessaúde e o 2º Encontro do Capítulo Latino Americano eCaribenho da Associação Americana de Telemedicina estão reunidos nesteCD-ROM. Estamos publicando tal como foram recebidos, apenasuniformizando o formato geral. A seqüência é alfabética sempreconsiderando o sobrenome do primeiro autor. Não houve separação dosresumos encaminhados em português e inglês; sempre que tivemos opçãousamos a versão inglesa por ser a língua internacional da ciência. O tipo deapresentação, se pôster ou oral, não é indicado. Procuramos elaborar umíndice com todos os autores vinculados às suas contribuições que,sinceramente, agradecemos.

São Paulo, 23 de outubro de 2005

A Comissão Organizadora

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Abreu, I.M.

Ajzen, S.

Alencar, A.

Alkmim, M.B.

Almeida, A.L.

Almeida, M.E.B.T.M.P.

Alves, L.C.

Alves, R.H.K.

Alvin, F.B.

Andrade, V.G.

Andreazzi, D.B.

Atta, M.T.

Azevedo, D.F.G.

Azevedo, R.

Barsottini, C.G.N.

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Batiz, M.G.

Bedi, B.S.

Bekteshi, F.

Bento, R.F.

Bossi, G.A.M.

Brady, F.

Brady, P.

Borghi, G.

Campelo, V.E.S.

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Bhaskaranarayana, A.

Böhm, G.M.

Borges, C.L.

Bossi, G.A.

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Carniglia, L.

Carvalho, I.M.M.

Carvalho, M.L.M.

Carvalho, R.S.

Cassetti, I.

Castilio, D.

Cavalcanti, S.

Chao, LW

Chiari, J.P.

Cogo, A.L.P.

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Conrado, M.A.

Corrêa, F.G.C.

Dalpino, N. R. S.

Daré Junior, S.

Debbag, R.

De-Lorme, P.

Diniz, C.G.P.

Domingues, L.A.

Eisenstein, E.

Enrique S.

Fernandes G.C.V.R.

Ferreira E.G.P.

Ferreira S.R.G.

Ferreira, W.S.

Festa C.N.

Figueiredo, L

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Filgueiras, T.

Fonseca, L.M.

Fortuin, J.B.

Fregonara, M.

Freitas, M.A.V.

García, F.

Garcia, G.B.

Gimenez, R.S.S.

Gismondi, R.C.

Godoy, I.

Godoy, S.

Godoy, S.C.B.

Grottone, G.

Guerra, I. M.

Guimarães, E.M.P.

Gundim, R.S.

Gutierrez, M.A.

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Guzovsky, P.A.

Hammes, E.

Holcomb, M.

Hovenga, J.S.

Johnson, P.

Jakobi, H.R.

Jordanova, M.

Judkins, D.

Juliani, M.C.M

Junior, M.J.

Kachienga, M.A.

Kashiabara, J.A.

Kelmer, S.

Kiefer, S.

Kurcgant, P.

Latifi, R.

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Legramandi, D.B

Leite, M.M.J.

Lievens, F.

Lombroso, F.

Lopes, P.R.L.

Machado, H.R.

Maia, C.C.A.

Malmström, M.F.V.

Mancini, F.

Mário Jr., M.J.

Marta, S.N.

Medeiros, R.

Melare, D.

Melo, M.C.

Mendes,I.A.C.

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Artigo 1Merrell, R.C.

Messina, L.A.

Miot, H.A.

Molefi, M.

Molefi, M.L.

Monteiro, A.

Monteiro, A.M.V.

Mortara, A.M.

Moshela, M.

Muja, S.H.

Múnera, L.E.S.

Murthy, R.L.N.

Nason, A.M.

Navarro Newball,A.A.

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Neto, J.R.N

Nobre, L.F.

Nogueira, M.S.

Nunes, A.A.

Ohl, R.

Olurunju, S.

Paixão, M.P.

Pegoraro, C.N.

Peixoto, F.C.

Pereira, A. J.

Peres, H.H.C.

Petitet, A.

Pinheiro Neto, C.D.

Pinto, V.C.

Pires, F.S.

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Pisa, I.T.

Ponokowski, P.

Porter, J.

Porter, J.M.

Prudent, L.

Reis, M.C.S.

Ribeiro, M.A.C.

Richardson, R.J.

Ricur, G.

Rocha, G.Z.

Roque, A.C.

Rosa, V.T.A.

Rossi, F.

Russomano, T.

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Sachpazidis, I

Sakas, G.

Salas, L.C.

Salvatore, P.

Santos, A.A.S

Santos, A.F.

Santos, D.T.

Santos, S.F.

Sakuno, T.

Sarkis, C.

Satyamurthy, L.S.

Schaun, T.R.

Schor, P.

Scott, R.E.

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Sequeira, E.

Sgavioli, C.A.P.P.

Sigulem, D.

Silva, A.P.S.S.

Silva, I.M.

Soares, E.R.

Soares, R.C.F.R.

Soares, S

Sousa, R.M.

Souza, C.

Souza, C.A.

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Sparenberg, A.L.F.

Spiri, W.C.

Sproule, K.

Stamboulian, D.

Szabo, C.A.

Szomorovszky, S.V.

Tachinardi, U.A.S.

Thornby, D.

Timm, R.

Togashi, G.B.

Trindade, M.A.B.

Vazquez, L.

Vélez Beltrán, J.A.

Veronezi, M.C.

Voegels, R.L.

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Vujacich, C.

Young, E.

Wainer, J.

Wangenheim, A.

Weinstein, R.

Whalen, E.

Williams, M.D.

Zaldivar, R.

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A DINÂMICA DE ENFERMAGEM EM SERVIÇO DE URGÊNCIAS COMSISTEMA 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 doRio 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 decardiologistas, 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 diagnósticoscardiológicos.MATERIAL E MÉTODOS. À partir de janeiro de 2000, a sala de urgências doHospital Santa Casa de Misericórdia de São Lourenço do Sul (HSCM-SLS),RS, adotou um Sistema de Tele-ECG Digital (SED), o qual permite oregistro, a transmissão e análise em tempo real e o armazenamento dosdados 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 celularremoto (9600 bits/s). A equipe de enfermagem, a quem compete orientare treinar a realização dos exames, é composta por uma coordenação geral,enfermeiras supervisoras de turno e técnicos e auxiliares de enfermagem.

No período de 17/11/2003 à 16/11/2004 foram analisados604 exames, com tempo médio de transmissão e análise de 8,05 min (DP1,6). A média etária foi de 58,7 anos. Na amostra, 321 (53.15%) pacientesforam do sexo feminino e 283 (46.85%) do sexo masculino, incluindo 176(29.14%) exames normais e 428 (70.86%) com diagnósticoseletrocardiográficos patológicos.CONCLUSÃO. O SED constitui-se em método de baixo custo e que permiteo diagnóstico precoce de urgências cardiológicas, trazendo grandebenefício para a dinâmica do Serviço de Enfermagem, ao ser empregadoem cidade de pequeno porte.

RESULTADOS.

[email protected]@hotmail.com

INDICE/INDEX

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A MODEL OF TELEHEALTH BETWEEN UNIVERSITY HOSPITALAND PRIMARY CARE SECTOR OF THE MUNICIPAL HEALTH

SYSTEM OF BELO HORIZONTESantos, 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 UniversidadeFederal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil;

PRODABEL - Empresa de Informática e Informação do Município de BeloHorizonte, Belo Horizonte, Minas Gerais, Brasil.

The BH TELEMED project is a Telemedicine and Telehealth project forprimary care, made for the family health teams in the city of Belo Horizonteand financed by the @LIS line of the European Union and the Ministry ofHealth. It interconnects the " "(HC) of the FederalUniversity of Minas Gerais(UFMG) and the Health Centers of the MunicipalHealth Department through a long distance consulting system withteleconsultations and specific theme discussions. Its objective is topromote permanent in-service training and to improve the effectiveness ofthe primary health network. The project is composed of Telemedicine,Telenursing and Teleodontology activities. The body of Teleconsultants ismade up of 50 doctors, 10 nurses and 2 dentists of the UFMG. The definedmodel is to carry out teleconsultations scheduled according tospontaneous demand, discuss themes based on clinical cases and themesprogrammed according to statistical data of specialised consultations. Thetechnology used is simple and not expensive (computers and webcams)allowing a simultaneous on-line access of all the participating units, withimage, voice and/or chat interaction. In the first 15 months of the projectthere was a gradual implementation of the system in 17 health centers,development of the on-line module of the Teleconsulting Managementsoftware, the interconnection of the network and the stabilisation of thesystem. In the period 103 events were carried out (86 teleconsultations, 3medical theme discussions, 4 telenursing sessions, 1 teleodontologysession and 7 international videoconferences) with the participation of 772health professionals. The implemented model of Telehealth showed itselfeffective in reducing the necessity of relocating patients to only 24% ofdiscussed cases, improving the resolution potential of the public healthsystem. Simultaneously it has been observed a progressive rise in theparticipation of professionals in the clinical telesessions.

Hospital das Clínicas

INDICE/INDEX

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A MULTI-DIMENSION METHODOLOGY FOR ASSESSING,EVALUATING AND COMPARING THE TELEHEALTH PROJECTS

Fregonara, M. (1) (2)

(1)

(2)

; Borghi, G.Azienda Sanitaria Locale Provincia di Milano 3, Monza (Milan), Italy

Health General Direction - Lombardy Region, Milan, Italy

The telehealth projects receive mainly public funding, thereforegovernment agencies make careful economic assessment and impactanalysis of the investment expenditures and results. The Cost/BenefitAnalysis (CBA) investigates all the possible resources and estimatedeffects derived by the introduction of technological innovations. Thecomparison between resources (costs) and results (benefits) is used forestimating the impact of telehealth projects, in order to choice the projectoffering more net benefits among different solutions.The main goal of the proposed method, based on six steps, is to overcomethe CBA limits enlarging its analysis parameters with a multi-dimensionsapproach of assessing, evaluating, selecting and comparing the costs,benefits and social impacts of telehealth projects in order to take a decisionabout its outputs, resources and outcome. The first step identifies andclassifies all the information on the main assessment parameters for theproject analysis: costs, profits and impacts. The second step splits all theresources within the project implementation phases: design, realisation,activation, utilisation and divestment. The third step collects the datawithin the aggregated macro-items in order to obtain an abstraction level,but keeping a sufficient detail. The fourth step combines and classifies theaggregated macro-items into the different project phases to obtain abetter ranking of the assessment parameters. The fifth step estimates thebalance 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 financingthe project, based on the previous steps.This approach aims at estimating the global increase of health statethrough the value of all the resources, costs, benefits and outcomes,because all the main actors (patients, their family, physicians andservice organisations) attribute different values to these parameters.The methodology is also focused on the project impact, measuredthrough the evaluation of costs and benefits, the assessment of possibleeffects, included the intangible or social benefits for people and thedirect/indirect influences on the National Health Service budget.

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The method acquires all the information needed to inquire into all thecomplex 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 orexaminations. 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 amongalternatives with potentially diverse global benefits, assesses differentorganisation 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 softwaretool for the evaluation of telehealth projects through the proposedmethodology, acquiring all the information needed to analyse a projectfrom all the different perspectives.

INDICE/INDEX

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A SLIGHT SIGHT ON FRENCH TELEMEDICINE ADVENTURE : TWOCONCRETE TELEMEDECINE APPLICATIONS

Petitet, A. - MD (AP)CATEL , ISfTeH board member, CardioGap - Le Thor - France

FOREWORDS. On august , 13 , 2004 a very important event took place inFrance: for the first time , the word: was legaly inscribed in afrench law . That's means from now , telemedicine actions move from"hunting stories" to pragmatic application tracks. This communicationreports two applications :- 1. an international acute cardiac ischemia rescue network (before thelaw).- 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 companymedical department for expatried workers the second place of suspectedacute myocardial infarction. The head of this medical departement decidedto improve the real documentation on time to better know the severity andthe potential level of emergency . It was decided to equip each site forexploitation and/or prospection with a ECG recorder-transmitter all overthe world . 40 devices were active . The reception medical station forreading , analysis and decision was first a North America call center , thena french emergency hospital station . The network was working during 7years . There were 35 "medical" calls : in 17 , ECG electric changes were infavor of acute myocardial infarction or early ischemia ; in 18 , no real proofof electric cardiac disorders . So the conclusion was:(1) in 17 , the quickdecision to treat then to transport patients to a well equiped hospitalconcerning cardiac emergencies improve dramatically the quality of careand first of all , the recovering ,(2) avoidance of unusufull sanitaryevacuation in 18 with a decreasing financial charge for this post. Today ,after this positive experience , the company initiate local and regionalconnections by telemedecine between its workers groups and agreedhospital and clinics.

- An emergency network in a whole french district.The french emergency organisation is one of the best worlwide . It isbased on SAMU/SMUR on one hand , Firemen on the other hand. Themain principle is to have a medical inside the emergency car . But ,

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several factors and also a large new pannel of types of transport havechanged the today conditions. In addition , more and more , themedical teams out and in hospital need to work closely together and touse 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 totransmit continously data from the emergency car to the hospital station.14 emergency cars are equiped . The device is able to collect biomedicalparameters as ECG 12, Sp0²,NIBP,Respiration, Capno and also to provide avery complete electronic and evolutive patient dossier all over thetransportation. The sensor module and the tablet PC inside the car arelinked by bluetooth (no cables) . The tablet PC ,where all the data arecollected with e-PR, is linked with the hospital station by GPRS . Insidehospital , the regulation station might be connected with a terminal in theCCU for instance. All the screens of this netwoork show the samedocumentation on the same time. More , there is a two ways messageriefor exchanges between the mobil team and the hospital one. Numerousadvantages are done (1) no delay to drive the patient to the well adaptedhospital reception ,(2) interoperability between mobil emergency teamand hospital medical team , (3)help to the primary first aid or para-medicsteam to improve the care under the medical management,(4) costseffectivity by avoidance of wrong transportations,(5) better and moreaccurate hospital reception ,(6) electronic objective documentation to bestored for forward expectation , (7) a perfect common transmission toolbetween SAMU/SMUR and Firemen . This is a pure concrete demonstrationof role of telemedicine in a daily sensible practice.

INDICE/INDEX

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A SOCIAL PERSPECTIVE APPROACH ON TELEMEDICINE FORLAND MINES VICTIMS IN COLOMBIA

Vélez Beltrán, J.A.

[email protected]@colombiantelemed.org

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 than100.000 land mines and, 5.688 accidents and incidents and 3.263 victimshad been registered in 94% of the territory.OBJECTIVE. The objective of this work is to create and to validate a set ofweb-based interactive tools to support assistance of land mines' victimsand health care professionals in Colombia.METHODS. The Web-based environment for land mines' victims supportfollows an interdisciplinary and inter-institutional work and an objectoriented software methodology. Actually, the prototype of the environmentis under a technical validation which includes performance tests andsurveys.RESULTS. At the moment there are three prototype web environments.The emergency attention environment facilitates the communicationbetween health personnel attending the victim and specialists in trauma.The rehabilitation environment allows the remote supervision of thepatient during the healing process, decreasing the number of requireddisplacements. The characterisation environment allows the search andselection of trauma specialist. Also, a preliminary validation took place.DISCUSSION. Even though the web based interactive tools show a highlevel of interactivity, they must be enhanced in order to make themfriendlier. The access to the land mine victim's support environment is easyas 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 canbe extended in order to complement the tools.The deployment of the proposed environment will cause a great socialimpact.

INDICE/INDEX

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A TELERADIOLOGIA SEM O PACS. O PROJETOINTERINSTITUCIONAL ENTRE CENTRO DE ENSINO NACIONAIS

EM RADIOLOGIA PEDIÁTRICA.

Experiência do INCOR no desenvolvimento, implantação emanutenção do PACS

Monteiro, A.Faculdade de Ciências Médicas da UERJ.

A Faculdade de Ciências Médicas, entre os Projetos em Telemedicina, temdesenvolvido 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 ProjetoInterinstitucional em Radiologia Pediátrica pelo seu pioneirimo nesta linhade pesquisa e assistência e, pela sua relevância no atendimento destapopulação de crianças. Utilizando sistemas de videoconferências, comconexões pela Rede de Internet via RNP, e também por ISDN, o Projeto jáagrega, até o presente, cinco pontos no nosso país. Na metodologia detroca e envio de imagens têm-se adotado sistemas simples, tais como odigitalizador de imagens, o progama Microsoft PowerPoint e o próprio usodo negatoscópio, . O propóstito desta forma simplificada de troca deimagens pode ser resumido como um facilitador do processo de inclusãoentre diferentes centros de ensino. O público alvo tem sido de alunos dagraduação e da pós-graduação, lato e stricto-senso, além de médicos eprofessores. O objetivo pricipal deste projeto é capacitar, de formaatualizada, o médico-radiologista, e permitir a integração em projetos depesquisa multicêntricos.

Gutierrez, M.A.Serviço de Informática,

Insituto do Coração do Hospital das Clínicas da Faculdade de Medicinada USP.

O Instituto do Coração (InCor) tem envidado esforços para integrartodas as informações clínicas dentro da Instituição. Nos últimos anos oInCor implementou com sucesso um sistema para transmissão,arquivamento, recuperação, processamento e visualização de ImagensMédicas (PACS-InCor) e um Sistema de Informações Hospitalares (SI )que armazena as informações administrativas e clínicas. A integraçãodesses subsistemas forma o Prontuário Eletrônico do Paciente(PEP).Institutos é também uma questão muito relevante.

online

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INDICE/INDEX

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ACTIVITIES OF THE TELEDENTISTRY CENTERAT SACRED HEART UNIVERSITY

Sgavioli, C.A.P.P. ;

www.estacaodigitalmedica.com.br

1 Veronezi, M.C. .; Marta, S.N. ; Carvalho, I.M.M. ;Soares, S. ; Melare, D. ; Sequeira, E. ; Chao L.W.

(1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline ofTelemedicine, Medical School, University of São Paulo, São Paulo, Brazil.

The presence of new technologies requires new positions in the process oflearning and teaching.Attempting to transform regular classes in a continuous process ofinformation, communication and investigation, where the knowledge canbe built through the balance of individual and group work, betweenprofessor 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 totechnology and number of professionals registered in the Federal DentalCouncil, as well as the amount of dental courses existing in Brazil, show thepossibility of an increase in the activities of Teledentistry, increasing thespace and time in the access to permanent formation and education of all.This opens the possibility of the University to assist dental professionalsworking in places distant from the learning institutions and searching forprofessional upgrade or a second professional opinion in diagnosis andtreatment planning.The Dental Course of USC keeps a technical-scientific accord with theDiscipline of Telemedicine of FMUSP for utilization of the website “MedicalDigital Station” ( ). Online courses bythe “Cybertutor” Teleeducation environment; the “Virtual Ambulatory” forDentistry and also the creation of Cd-Roms within the Virtual Man Projectwere developed.Undergraduate and graduate dental students are using the whole materialproduced so fat in the learning activities.The Teledentistry at USC was developed because of the ability of the groupof people involved to make plans real, starting with ambitious dreams,claiming to reach the entire community interested in the growth andeducation in Dentistry.

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ANALYSIS OF PARAMETERS OF MANAGEMENT IN THEPROFESSIONAL QUALIFICATION DIRECTED TO THE

TECHNOLOGICAL INNOVATION IN HEALTH THROUGH THE USEOF THE TELEMEDICINE

Borges, C. L.Digital Radiology Observer - ORD

São Paulo / SP - Brazil

INTRODUCTION. The objective of this work is the analysis of managementparameters to be used in the professional qualification directed to thetechnological innovation in Health through the use of resources ofTelemedicine. This exercise resulted in the construction of a pilot courseaiming to the specialized formation in area of administrative andoperational management of projects that involve digital technology indepartments of Radiology, to be offered by the Radiology Institute / USP inpartnership with the Radiology Department / UPenn, counting on thecontribution in services of Telemedicine Discipline / School of Medicine /USP.METHODOLOGY. The study consists of the analysis of the relevancy andinterrelation of values listed as necessary to the elaboration andimplementation of the course, as much in the basic infrastructure forremote communication as in the logical sequence of knowledgeabsorption directed to the formation specialized in this sector. Functionaland administrative infrastructure aspects will be analyzed in the use ofresources of Telemedicine for remote communication with different typesof data (text, image and voice) guided to the professional qualification. Inthe question of systematization of the knowledge absorption directed tothe technological innovation, parameters of efficiency will be evaluatedthrough use of relationary practical of the study divided in 06 sequentialdiscipline modules elaborated.RESULTS AND CONCLUSION. The waited results of the analysis, when thecourse on field, suggest the construction of a basic model of managementfor use of Telemedicine in professional qualification directed totechnological innovation in Health.

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APRENDIZAGEM AUXILIADA POR COMPUTADOR EMOFTALMOLOGIA PARA PROFISSIONAIS DA SAÚDE NÃO-

ESPECIALIZADOSGrottone, 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 aprendizadopara outros profissionais de saúde fora o médico-oftalmologista. Novosmétodos de ensino, baseados em auxílio informatizado, podem produzirmelhores resultados nesta tarefa. OBJETIVO. O objetivo deste trabalho édesenvolver e validar um novo protocolo direcionado à consultaoftalmológica por profissionais da saúde, utilizando elementoscomputacionais e multimídia para auxiliar no ensino. MÉTODOS. Baseadoem uma lista de sinais e sintomas em oftalmologia, um novo protocolo foidesenvolvido tomando como base a experiência obtida através de 10alunos de medicina, que utilizaram diretrizes oftalmológicas pré-estabelecidas, testando suas dificuldades de aprendizagem. Antes doatendimento com pacientes, foram reunidos e instruídos por um supervisorquanto ao funcionamento de cada instrumento a ser utilizado na consultabem como seus possíveis resultados. Para cada bloco de informações, umanota entre 1 e 10 foi atribuída ao grau de dificuldade para fazer o exame einterpretar os resultados gerados. RESULTADOS. Ao final de dois meses, oprotocolo final foi apresentado demonstrando suficiente informação para oprofissional de saúde ter uma ferramenta para decidir quais os pacientesque necessitavam de atenção imediata de um especialista emoftalmologia. CONCLUSÃO. Este é o primeiro passo para produzir umprograma de computador com a meta de poupar recurso em saúde,distribuindo conhecimentos básicos e habilidades sobre cada especialidademédica. Isso é de extrema importância quando pensamos em países emdesenvolvimento, onde o acesso ao médico especialista frequentemente édificultado por barreiras sócio-econômicas e geográficas.

Apresentação como POSTER

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ASSESSMENT OF VIDEOCONFERENCE QUALITY FOR HEALTHDISCUSSIONS BETWEEN LONG DISTANCE HOSPITALS

Campelo, VES; Pinheiro Neto, CD; Bento, RF; Wen, CLFaculty 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 communicationbetween long distance hospitals on the information highway. Informationtechnology is now becoming the most popular technology every fieldsshould consider. To make telemedicine an effective medical practice it isessential to become an easy technology and principally to show goodquality 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 ofSao Paulo and Rio de Janeiro State University at a IP (internet protocol)384Kbps conection. There were 13 ENT residents, 5 post-graduatingstudents and 2 Phd.RESULTS: 65% of the interviewees considered that the images were goodand 70% answered that the audio was good. 75% said that image qualitydidn´t hinde case comprehension. 65% considered that videoconferenceis the best way to exchange experience between distant health groups, and75% agree that it´s use will increase. 25% didn´t know thatvideoconferences could be done using internet.CONCLUSIONS: This telemedicine system showed its ability to improve theway of patient information presentation and to access patient medicalrecords with good quality of image data communication.

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AVALIAÇÃO DO PROGRAMA INTER-INSTITUCIONAL DETELEMEDICINA DA PÓS-GRADUAÇÃO DE RADIOLOGIA DA

UNIFESP, UFF, UERJ, USPLopes, P.R.L.1 1 1 2 2

3 4 4 5

1

1 2

3

4

5

; Pisa, I.T. ; Ajzen, S. ; Santos, A.A.S ; Gismondi, R.C.Monteiro, A.M.V. ; Machado, H.R. ; Ferreira, W.S. ; Borges, C. L. ;Sigulem, D.Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil;

Faculdade de Medicina - Universidade Federal Fluminense (UFF), Rio deJaneiro, RJ, Brasil;Faculdade de Ciências Médicas - Universidade Estadual do Rio de Janeiro

(UERJ), Rio de Janeiro, RJ, Brasil; Faculdade de Medicina de Ribeirão Preto- Universidade de São Paulo (USP), Ribeirão Preto, SP, Brasil;Observatório de Radiologia Digital (ORD), São Paulo, SP, Brasil

INTRODUÇÃO. Programas de telemedicina inter-institucional podemacelerar a colaboração entre grupos afins se em seu planejamento sãoconsiderados aspectos sobre o objetivo dos parceiros, atividades práticas aserem realizadas e parâmetros de avaliação pré-estabelecidos, entreoutros.OBJETIVO. Este trabalho tem como objetivo descrever um modelo deparametrização para avaliação na colaboração médica em programas detelemedicina inter-institucionais.METODOLOGIA. Considera-se o uso dos recursos de comunicação remotana participação quinzenal de estudos de caso e qualificações de tese entreos setores de pós-graduação das instituições supra citadas. Pretende-seimplementar uma métrica de avaliação para levantar resultadosrelevantes sobre a qualidade da colaboração médica realizada,considerando efetividade, segurança, praticidade e utilidade. Paraseguridade serão avaliados aspectos sobre a qualidade da imagem ecâmera, resolução espacial e cores, compressão, imagens necessárias noprocesso, largura de banda e treinamento adequados. Para praticidadeserão avaliados aspectos sobre a organização do serviço, disponibilidadedos equipamentos, competência para operação, financiamento e aspectoslegais. Quanto à utilidade serão considerados a melhoria da qualidade doserviço, melhoria do bem-estar da população e custo-efetividade doprograma proposto.RESULTADOS. Os resultados preliminares demonstram a importância derealizar uma avaliação crítica da conectividade dos parceiros antes deestabelecer os recursos que serão efetivamente empregados noprograma.

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CONCLUSÃO. A partir desse modelo de avaliação torna-se possíveldesenvolver um programa inter-institucional de telemedicina comparâmetros para demonstrar a viabilidade financeira do projeto e suaefetividade em relação ao processo em saúde em questão.

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AVALIAÇÃO DO SITE ESCALA DE PESSOAL DE ENFERMAGEMJuliani, M.C.M.*; Kurcgant, P.**

Faculdade De Medicina Da Unesp Botucatu/ Sp/ Br / Usp/ Sp

OBJETIVO

METODOLOGIA

RESULTADOS.

INTRODUÇÃO. O estudo, parte da tese de doutorado da autora, aborda oresultado 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. Cadatecnologia modifica dimensões da nossa inter-relação com o mundo, dapercepção da realidade, da interação com o tempo e o espaço .2

. Validar junto a experts da área de administração emenfermagem e alunos de graduação o conteúdo do site desenvolvido.

. Uma vez produzido o site, a pesquisadora fez contatocom docentes das escolas públicas de graduação em Enfermagem doestado de São Paulo que ministravam aulas na disciplina de Administraçãoem Enfermagem, portanto experts no tema do site e também com alunosde graduação. A avaliação foi feita por meio de formulário eletrônico nopróprio site no final do ano 2002 e início de 2003.

Na somatória dos itens excelente e satisfatório, osseguintes percentuais de aprovação: Design das Telas 88,45%, Velocidadede Navegação 96.15%, Legislação (Aplicabilidade Profissão) 90.47%,Legislação (Aplicabilidade Ensino) 95,23%, sendo a média de aprovaçãopara todos os itens avaliados (somando os critérios excelente esatisfatório) de 85%.CONSIDERAÇÕES FINAIS. Na interatividade deve-se considerar aspectoscognitivos, emocionais e tecnológicos da aprendizagem . O site foiconsiderado de utilidade tanto para o ensino como para a profissão deenfermagem e a avaliação significativa já que envolveu 30% dos docentesdas escolas públicas do estado de São Paulo, considerados experts na áreaespecífica 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 Educ1995; 23 (126): 24-6.

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AVALIAÇÃO DO USO DO CYBERTUTOR COMO FERRAMENTA DEENSINO PARA ALUNOS DE GRADUAÇÃO EM ODONTOLOGIA

Legramandi, D.B.

www.estacaodigitalmedica.com.br

1; Veronezi, M.C. ; Pegoraro, C.N. ; Domingues, L.A. ;Carvalho, R. S. ; Dalpino, N. R. S. , Sequeira, E. ; Atta, M. T. ; Sgavioli,

C.A.P.P.

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 acordocom a Disciplina de Telemedicina/FMUSP-SP desenvolveu cursos online. Asinstituições mantêm cooperação tecnocientifica para o conteúdoOdontológico da Estação Digital Médica baseada na internet( ), site que contém um ambiente deteleducação Cybertutor. Este tutor eletrônico é uma ferramenta interativaque permite o aprendizado de conceitos teóricos num modeloconstrutivista estimulando o desenvolvimento da cognição, capacidade deexpressão e síntese. Composto por um ambiente que contém fórum dedebates, tutorização on line, permite ao aluno participação com maiordiscussão sobre o assunto e possibilita a verificação do aprendizado. Nadisciplina de Dentística, o curso no Cybertutor, Nomenclatura eClassificação das Cavidades, foi utilizado com vinte alunos do segundo anode graduação em Odontologia para um primeiro contato com o conteúdo aser desenvolvido.Este trabalho apresenta a avaliação dos alunos sobre o método interativoempregado, assim como, a apreensão de conhecimentos dos mesmos.Metade dos alunos teve um primeiro contato com a matéria peloCybertutor e a outra metade, em aula expositiva. Na semana seguinte, asturmas se inverteram, portanto todos os alunos tiveram contato com oconteúdo pelos dois métodos. Para avaliar a apreensão do conhecimento,os alunos passaram por uma avaliação dissertativa após cada etapa. Paraavaliar o método empregado responderam a um questionário elaboradosobre o assunto.Resultados obtidos a partir da avaliação aplicada mostraram que comrelação à apreensão do conteúdo, os dois métodos não apresentaramdiferenças significantes. Entretanto, o tempo gasto para que os alunosentendessem o conteúdo sob a forma de aula tradicional foiconsideravelmente menor para o grupo que utilizou o Cybertutorpreviamente à aula teórica. A avaliação dos alunos sobre o métodomostrou que todos o aprovaram como complemento da aula expositiva.

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UTILIZATION OF THE CYBERTUTOR AS A TEACHING TOOL FORUNDERGRADUATE DENTAL STUDENTS

Legramandi, D.B.

SP

1; Veronezi, M.C. ; Pegoraro, C.N. ; Domingues, L.A. ;Carvalho, R. S. ; Dalpino, N. R. S. , Sequeira, E. ; Atta, M. T. ; Sgavioli,

C.A.P.P.1- Sacred Heart University Bauru/ Brazil. 2- Discipline of TelemedicineSão Paulo/SP Brazil.

The Dental School of Sacred Heart University, in collaboration with theDiscipline of Telemedicine of FMUSP-SP developed online courses.Theinstitutions keep a technical-scientific collaboration for the dental contents ofthe internet-based Medical,a website that contains the Teleeducation environment Cybertutor.Thiselectronic tutorial is an interactive tool that allows learning of theoreticalconcepts in a constructive model, stimulating the development of cognition,ability of expression and synthesis. Composed of an environment with aforum of debates, and online tutorial, it allows participation of the studentwith discussion on the subject and verification of learning. In the discipline ofRestorative Dentistry, the course on Cybertutor on the Nomenclature andClassification of Cavities was used by twenty students of the second year ofdental school for a first contact with the content to be developed.This paper presents the evaluation of the students on the interactivemethod employed, as well as their acquisition of knowledge.Half of the students had the first contact with the subject by the Cybertutorand the other half in an expositive class. In the following week, the groupswere inverted, and thus all students had contact with the content by bothmethods. To evaluate the acquisition of knowledge, the studentsunderwent an evaluation after each step. To evaluate the method, theyanswered a questionnaire on the issue.The results achieved in this evaluation revealed that, concerning theacquisition of knowledge, both methods did not present significantdifferences. However, the time spent by the students to understand thecontent by the traditional method was considerably shorter for the groupusing the Cybertutor before the theoretical lesson. The evaluation ofstudents on the method demonstrated that all approved it as acomplement to the class.

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BUILDING AN INTERNATIONAL TELEHEALTH PROGRAM:OVERCOMING BARRIERS INTERNALLY AND EXTERNALLY

Johns Hopkins Medicine International, Baltimore, Maryland, USANason, A.M.

Johns Hopkins laboratories, classrooms and clinical units are centers oflearning for thousands of physicians, students and health professionals.Johns Hopkins Medicine International (JHI) works with internationalinstitutions, physicians and leaders to fulfill their needs for education andtraining in their particular area of expertise by utilizing the subject matterexperts from one of the United States' premier academic institutionsSince 2001, JHI has taken steps to fulfilling this goal through the uses ofboth 'hi-tech' and 'low-tech' telecommunications and telemedicinetechnologies. With the changes in the world at that time, JHI felt it wascritical to remain local in a community without physically being present. Itis the philosophy of the JHI telehealth program that that the ability toinfluence many is more powerful than treating one.JHI and the Hopkins Office of Telemedicine have supported severalinternational initiatives of knowledge sharing through video conferencingand e-learning formats. And while successful, all programs, regardless oflocation, socio-economic status and culture, are faced with its pitfalls andchallenges.This presentation will outline the successes of the JHI telehealth programs(video education programs, telemedicine consultations), the results of oursuccesses (development of the Center for Clinical Global Health Educationand Johns Hopkins Medicine-Interactive), and the pitfalls we regularly runinto when establishing these programs.

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BUSINESS PLAN AND OPERATIONAL PROTOCOLS TO ENSURESUSTAINIBILITY AND ACCEPTANCE OF TELETRAUMA PROGRAM

1 2,3 1 2 2

1 2

3

Judkins D.; ; Whalen E.; Williams M.D.; Porter J.M.University Medical Center, Department of Surgery, Trauma and Critical,the University of Arizona, and Arizona Telemedicine Program, Tucson,

Arizona, U.S.A.

BACKGROUND. Technological advances and experience gained withroutine telemedicine services and networks have made possibleimplementation of the teletrauma as an integral part of modern traumacare. However, although this is an optimal solution for providing traumaexpertise to a remote location for trauma resuscitation, there is a concernof sustainability of such programs and acceptance by hospitals andhealthcare providers in their daily practice.METHODS. A successful program requires careful planning, a highly-sophisticated telemedicine network, technical support on a 24 hour basis,and a well-developed business plan, with a detailed operational proceduremanual. This document needs to be created with input from each memberof the multidisciplinary team, as it represents a new paradigm providingtelemedicine services for trauma and emergency care.RESULTS. To insure program sustainability, we created an operationaldocument using a business model that includes an executive summary,vision and objectives, products, current and future services, and step-by-step operations. This was done based on market analysis, developmentalstrategy, and predictions of cost- effectiveness of the program. Theoperational procedures consist of how to operate the telemedicine system,how to initiate and complete teletrauma resuscitation based on ATLSprotocols, trouble-shooting and avoiding system failures, staffing andscheduling, documentation and maintaining a database.CONCLUSIONS. A successful teletrauma program requires a goodbusiness plan, defined operational procedures, and input and acceptanceby all stakeholders.

Latifi R.

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CEDECEM: A TELEMEDICINE PROGRAM APPLIED TO DISTANCEMEDICAL 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 Argentinaproviding medical education courses (ME) and second opinionconsultations (SOC) in Infectious Diseases and Perinatology to publichospitals (PH).METHODS: CEDECEM was started in April 2002. Each beneficiary hospitalreceived a computer and Internet connection. A specially designedsecure web site (www.funcei.org.ar/cedecem) gives health careprofessionals (HCP) access to ME and SOC. Courses deal with InfectiousDiseases in Adults (A), Pediatrics (P) and Perinatalogy (Pe) for physiciansand Hospital Infection Control (HIC) for nurses. Each course lasts 2 years,arranged in 8 modules. HCPs also receive a printed manual, on sitetutorial meetings and multiple choice online evaluations per module. SOChave no time limit and they are only answered online.RESULTS: Up 01/31/05, 6,223 HCP from 25 PH and 3 medical stations inthe Argentine Antarctic Territory received ME and access to SOC (3,144Nurses and 3.079 Physicians: A 1,356, P 873 and Pe 619). 72% of thephysicians and 85% of the nurses were satisfactory evaluated. 2,089 SOCwere answered (A 862; P 718, Pe 509) in 42 hours average time. The mostfrequent SOC were related to clinical and laboratory diagnostic problems,use of antibiotics and epidemiological aspects.CONCLUSIONS: CEDECEM has created a network for scientific exchangeamong HCP from PH in Argentina, who usually have difficulties to accessME and SOC mainly due to distance and economic factors. Thistelemedicine model with over 3 years' experience in Argentina may bereplicated in other countries, particularly in Latin America.

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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 LWDiscipline of Telemedicine of the Faculty of Medicine of the University of SãoPaulo.

Students of the Faculty of Medicine of the University of São Paulo(FMUSP) have a long tradition in organizing academic leagues ofextension of university services to health care. The TelemedicineDiscipline of the FMUSP wanted to extend its activities to theundergraduates of the university. We have proposed this through thecreation of an interdisciplinary academic league. In order to do thatwe gave an introductory course about the scene and the concepts oftelemedicine and the results of the practice of telemedicine inBrazil; we included an electronic test and a personal interview. Aproposed Statute of the Telemedicine League was the source for thedescription of the organization and of the functioning of the league.The introductory course was ministered by 12 speakers during 7expositive classes, a workshop and a debate. The attendance wascomposed of students of engineering (1), dentistry (1), medicine (14),biomedical informatics (16), nursing (12) and physiotherapy (1) and of2 medical doctors and 4 lecturers. Of the 37 attendants 14 took theelectronic test. The league was formed with 16 graduate students:medicine (8), nursing (7) and physiotherapy (1). The league wasorganized in 4 groups of tasks, in monthly turns: tele-education,tele-assistance, iconography and teleconference and a permanent groupfor the application of tele-assistance in social university extension.CONCLUSION: the first academic league of telemedicine in Brazil wasformed; the selection through electronic tests was adequate. This first stepis characterized by interest only graduate students of the health inintegrating this league.

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DESENVOLVIMENTO DE CD ROM EM IMUNIZAÇOES

procedimentos

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 profissionalde saúde. O produto CD ROM em Imunizações foi desenvovido por umgrupo de alunos de graduação em enfermagem da Faculdade de Medicinada UNESP em conjunto com três docentes que orientaram a organização eoperacionalização do trabalho. Embora a tecnologia seja apenas umaspecto do processo pedagógico, seu desenvolvimento torna-seapropriado ao atual estágio de desenvolvimento tecnológico. Mais que atecnologia, o que facilita o processo de ensino-aprendizagem é acomunicação autêntica do professor, e estabelecimento de relações deconfiança com os alunos .OBJETIVO. oferecer recurso tecnológico-pedagógico com conhecimentostécnico - científicos dos imunobiológicos.METODOLOGIA. As etapas de desenvolvimento passou pela escolha dosconteúdos, desenho de mapas conceituais, produção das imagens, queforam produzidas pelo grupo através de fotografia digital realizadas noserviço de saúde no momento de realização das ações de imunização comapoio do Núcleo de Educação a Distância (Nead) da FMB Unesp, edição erevisão do CD ROM para publicação.RESULTADOS. O produto final CD ROM permite difusão do conhecimento,oportunidade de acesso em diversos locais, possibilidade da utilização dorecurso na educação a distância, clareza na transmissão da informaçãodado que as técnicas, , vacinas e insumos foramfotografados nas situações reais de atendimento no serviço.CONSIDERAÇÕES FINAIS. A formação dos profissionais necessitaincorporar todos os avanços científicos e tecnológicos. Além dainstrumentalização técnica, é necessário o compromisso ético-político desocializar o conhecimento e as informações na tentativa de tornar o mundohumano .BIBLIOGRAFIA. 1. Ferreira NSC. Tecnologia educacional e o profissional noBrasil: sua formação e a possibilidade de uma cultura humana. Tec Educ1998; 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. Saltopara o futuro: TV e informática na educação. Brasília (DF); 1998.

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DISPONIBILIZAÇÃO DE GUIAS DE CONDUTA E DIAGNÓSTICOBASEADOS EM FLUXOGRAMAS DE OFTALMOLOGIA ATRAVÉS DE

DISPOSITIVOS MÓVEIS E TECNOLOGIA WEBPinto, V. C.; .; 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 últimosanos de vital importância para organizar e efetivar maior qualidade nosprocessos de assistência em saúde. Em particular, guias de conduta semostram úteis no auxílio da prática médica e no diagnóstico para clínicosgerais e generalistas em oftalmologia. OBJETIVO. Esse trabalho tem comoobjetivo disponibilizar guias de conduta e diagnóstico baseadas emfluxogramas de oftalmologia direcionadas a clínicos gerais e generalistasde modo a categorizar doenças a partir de sinais e sintomas.METODOLOGIA. Pretende-se desenvolver uma solução tecnológica paradiagnostico médico através da usabilidade da informação categorizada emsituações reais e simulada por meio do uso de guias de condutas. Essesguias serão ofertados para uso através de dispositivos móveis eplataforma web. Serão realizadas pesquisas no Departamento deOftalmologia da UNIFESP a partir de fluxogramas pré-estabelecidos naliteratura e opinião de especialistas.RESULTADOS. A avaliação será realizada de modo quantitativo através detestes paramétricos e qualitativos usando o padrão NBR/ISO 9241 dequalidade, que esclarece os benefícios de medir usabilidade em termos dedesempenho e satisfação do usuário. Finalmente espera-se obter comesta solução uma medida efetiva da melhoria na atenção a saúde.CONCLUSÃO. Espera-se contribuir com uma solução tecnológica avaliadaquantitativamente e qualitativamente que auxilie clínicos gerais egeneralistas na utilização de guias de conduta em oftalmologia naassistência médica.

Pisa, I. T

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EDUCAÇÃO A DISTÂNCIA UMA PROPOSTA DE ATUALIZAÇÃOPERMANENTE EM MASTOLOGIA EXPERIÊNCIA COM BIÓPSIA DO

LINFONODO SENTINELA

UFRJ, FM Departamento de RadiologiaRio de Janeiro Brasil

Kelmer, S.; Fonseca, L.M.

INTRODUÇÃO. Projeto de Mestrado - Criação, aplicação e avaliação docurso de atualização em mastologia na técnica da Biópsia do LinfonodoSentinela no Câncer de Mama , na modalidade educação a distânciamediada 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-alvocomposto por médicos-especialistas em Medicina Nuclear, Radiologistas,Ginecologistas, Mastologistas e Cirurgiões Oncológicos. O curso estarásendo ministrado pela Internet nos meses de outubro e novembro(2005),a avaliação será composta de uma prova presencial a ser realizada emdezembro/2005 na UFRJ. Aos alunos que obtiverem rendimentosatisfatório será oferecida uma experiência prática, estes poderãoacompanhar um procedimento de detecção e retirada do LinfonodoSentinela em cirurgia de câncer de mama no Hospital Clementino FragaFilho (UFRJ) ou no Hospital Fernandes Figueira.MÉTODOS. Para a elaboração do conteúdo do curso foi formada umaparceria com a EAD/ENSP-FIOCRUZ , apropriando o conteúdo a didática damodalidade a distância. Foi formada uma parceria com uma empresaprivada do setor de informática que vem fornecendo equipe de web-designer, ferramentas tecnológicas (Ambiente Virtual de Aprendizado)apropriadas para o aprendizado interativo via Internet e suporte de rede. Adivulgação e acreditação do curso serão realizados pela SociedadeBrasileira de Mastologia.RESULTADOS. O curso será avaliado por diversasóticas: pelo rendimento acadêmico dos alunos na prova presencial; aanálise das dificuldades e das soluções encontradas para a transformaçãodigital do conteúdo do curso, sobre o aspecto didático-pedagógico damodalidade à distância, da implementação e do decorrer do cursopropriamente dito na Internet.CONCLUSÕES. Espera-se contribuir com este piloto para a divulgação daeficácia da educação médica permanente via Internet.

Email para contato: [email protected]

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EDUCAÇÃO EM SERVIÇO POR VIDEOCONFERÊNCIAGodoy, S.; Mendes, I.A.C.; Nogueira, M.S.

Escola de Enfermagem de Ribeirão Preto-USP

Realizou-se um treinamento sobre o conteúdo de administração deinjetáveis pela via intramuscular na região ventroglútea entre auxiliares deenfermagem de um hospital escola do interior do estado de São Paulo.Teve como objetivo incentivar a utilização da região citada. Utilizou-setecnologia de videoconferência para interligar um laboratório de ensino deuma escola de enfermagem estadual ao referido hospital. Foramministradas aulas sobre o conteúdo utilizando-se a referida tecnologia erealizado treinamento em situação simulada. Os 32 auxiliares deenfermagem foram avaliados quanto a aquisição de habilidade intelectuale motora, bem como avaliaram a utilização da videoconferência comoferramenta para o ensino em serviço. Os resultados apontam que amaioria dos auxiliares de enfermagem obtiveram bom desempenho narealização do procedimento em situação simulada. A videoconferência semostrou um bom meio para a realização de educação em serviço. Osparticipantes do estudo sugeriram ainda que para os treinamentos futurossejam disponibilizados materiais para apoio ao aprendizado em outrosformatos.

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ESTABLISHMENT OF A PIONEER DIGITAL TELE-ECG SYSTEM INSOUTHERN BRAZIL

Sparenberg, A.L.F.; Russomano, T.; Azevedo, D.F.G.

Microgravity Laboratory/IPCT-PUCRS, Porto Alegre, RS, Brazil MedicalSociety of São Lourenço do Sul, RS, Brazil

INTRODUCTION. A lack of medical specialists in remote areas of Brazil candelay the diagnosis and the adequate management of diseases. A pioneerTelemedicine Program was established in southern Brazil in the area ofcardiology (Digital Tele-ECG System, DES).METHOD. DES allows electronic data transmission to and interpretation bya remote cardiologist. An urban and a rural hospital in Sao Lourenco do Sulcity 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 locationsin 1 year: 622 via online and 441 via e-health. The time between datatransmission and analysis was 8.1 min and up to 24h for the online and e-health tele-ECGs. 604 online tele-ECGs (97.1%) were performed at theurban hospital. The results showed that 71.2% (443 out of 622) of theonline 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 smallcities and rural areas of developing countries where cardiologists andradiologists are not available for on-site consultation. DES has promoted asignificant improvement in the acute management of patients in remoteareas, with a consequent decrease in the morbidity and mortality ratesfrom cardiovascular diseases.

e-mail: [email protected]: [email protected]

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ESTABLISHMENT OF A PIONEER TELE-X RAY SYSTEM INSOUTHERN 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 MedicalSociety of São Lourenço do Sul, RS, Brazil

BACKGROUND. A lack of medical specialists in remote areas of Brazil candelay the diagnosis and the adequate management of several medicalconditions. A pioneer Telemedicine Program has been started recently insouthern Brazil in the area radiology (Tele-x ray or DEX) as an attempt toovercome this situation.

METHODS. DEX includes an x-ray facility, a viewing box, a digital camera,standard computers, a 3:1 Mitchell algorithm compression protocol usingthe Easy Thumbnails software and Internet access. The system allows datato be recorded, transmitted and stored. A remote specialist performs thedata analysis via either fixed or mobile phone, using specifictelecommunication softwares and web based transmission.

Results: Sixty chest x-rays were randomly selected at the urban and ruralhospitals of Sao Lourenco do Sul for a preliminary evaluation of DEX. Aremote radiologist of each health care unit received 30 chest x-rays via e-health transmission for later analysis. The x-rays were transmitted viaInternet after being compressed. Lung and heart variables were comparedusing the on-site and remote interpretation. There was an 81.7%agreement (n=49) between the on-site and remote interpretation. Only27.3% (3 out of 11) of the misinterpreted x-rays were related to a lack ofidentification of pathological abnormalities. In eight remotely interpretedx-rays (72.7%) additional information regarding signs of cardiac andpulmonary alterations were found.

CONCLUSION. The low cost, the high quality and the “user friendly” aspectof DEX make it appropriate for remote areas of developing countries whereradiologists are unavailable.

e-mail: [email protected]: [email protected]

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ETAPAS DE IMPLEMENTAÇÃO DO PACS NA ÁREA MÉDICAPereira, 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 queapenas a implantação de um sistema de informações, são necessáriasvárias etapas preliminares para a definição de vários processos enecessidades do departamento e da instituição.Antes de tudo, a implementação destes sistemas tratam-se de umamudança de filosofia e fluxo de trabalho que pode impactar toda ainstituição.A maneira que com que o sistema e implementado pode acarretar nocompleto fracasso do projeto, devendo, desta forma ser cuidadosamenteplanejado e estruturado, desta forma evitam-se imprevistos devido asuper e sub dimensionamento da solução.Destacam-se também no projeto a importância de uma correta avaliaçãodos impactos tomando assim as medidas preventivas e corretivasadequadas, provendo aos usuários do sistema uma base de treinamento esuporte sólida e adequada as suas necessidades.

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ETHICAL EVALUATION OF MEDICAL TELECONSULTATIONSPERFORMED 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, BeloHorizonte, Minas Gerais, Brasil; Hospital das Clínicas da Universidade

Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; SecretariaMunicipal de Saúde de Belo Horizonte, Belo Horizonte, Minas Gerais,

Brasil; PRODABEL - Empresa de Informática e Informação do Municípiode Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil.

.INTRODUCTION. Different from modern medical science, which has beenshaped by a strong ethical tradition, Telemedicine as a new activity hascontroversial ethical and legal aspects which need to be analysed anddiscussed. The Brazilian Federal Council of Medicine (CFM), through theresolutions 1643/2002 and 1639/2002 established ethical criteria forTelemedicine and digital medical records. However, considering therelevance of Telemedicine and its certain expansion, it is stronglyrecommended to carry out studies regarding ethical aspects of its practice.The objectives of this study were to: 1- Detect ethically vulnerablemoments of the teleconsultations; 2- Analyse technological safetysolutions and the confidentiality adopted by the system; 3- Establish anethical commitment of all the actors involved in the process.METHODOLOGY. Seventy-six Teleconsultations were evaluated, withemphasis given to the vulnerability of the patient's privacy andconfidentiality and in the safety offered by the system of Teleconsulting.RESULTS. Two weak points of the system were detected and will becorrected: A formal absence of “informed consent” and the formalabsence of a term of commitment regarding confidentiality, signed by non-medical actors. However, the system was considered safe in relation todata and network access.CONCLUSIONS. The BH TELEMED project, analysed from an ethical pointof view, showed itself adequate and in condition to reach high levels ofexcellence within ethical standards, confidentiality, privacy, and with safereproduction of medical data.

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EXPERIÊNCIA DO INCOR NO DESENVOLVIMENTO, IMPLANTAÇÃOE 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 todasas informações clínicas dentro da Instituição. Nos últimos anos o InCorimplementou com sucesso um sistema para transmissão, arquivamento,recuperação, processamento e visualização de Imagens Médicas (PACS-InCor) e um Sistema de Informações Hospitalares (SI ) que armazena asinformações administrativas e clínicas. A integração desses subsistemasforma o Prontuário Eletrônico do Paciente (PEP). O InCor é um dos seisInstitutos que compõem o Hospital das Clínicas da Universidade de SãoPaulo. Como cada um dos Institutos possui o seu próprio sistema deinformações, a troca de informações entre os Institutos é também umaquestão muito relevante. Este trabalho apresenta a experiência nodesenvolvimento de um Prontuário Eletrônico funcional e completo, queinclui 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 implantaçãodo PACS-InCor. Para a visualização das imagens, foi implementado umvisualizador DICOM, que permite a manipulação de imagens estáticas edinâmicas, em uma taxa de até 30 quadros por segundo. Uma versãoreduzida e simplificada, denominada “miniWebPACS”, foi disponibilizadapara a comunidade no endereço . Além dessedesenvolvimento, também procurou-se integrar os equipamentos médicosque não possuem capacidade para transmitir informações em formatodigital. Para tanto, um produto tecnológico foi desenvolvido para integrardezenas de equipamentos de ultra-som, utilizados na rotina de exames deecocardiografia, os quais não apresentavam capacidade para transmitirimagens médicas em formato digital para o PEP. O produto desenvolvidopermitiu a integração destes equipamentos, reduzindo sobremaneira oinvestimento necessário para a atualização do parque tecnológico daInstituição. Atualmente, um volume superior a 2,5TB de imagens DICOM jáfoi armazenado utilizando a arquitetura proposta. Diariamente, o PACS-InCor armazena mais de 5GB de dados e tem uma quantidade de acessossuperior a 300 usuários. O sistema de armazenamento permite umavisibilidade de seis meses para acesso imediato e mais de dois anos paraacesso automático utilizando unidades robotizadas de fitas de altavelocidade (Jukebox).

3

http://www.sourceforge.net

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GESTÃO DE FATORES DETERMINANTES DA SUSTENTABILIDADE

EM SERVIÇOS DE TELEMEDICINA

Faculdade Medicina USP - Disciplina TelemedicinaGundim, R.S., Chao, L.w.

INTRODUÇÃO: O uso da Telemedicina para fins assistenciais eeducacionais, em um país com as dimensões do Brasil, quando bemplanejado, facilita ações de prevenção de doenças e promoção da saúde. Oentendimento adequado sobre os fatores envolvidos na sustentabilidadeda implantação da telemedicina poderá ajudar a evitar perda deinvestimentos. A abordagem sob o foco da Gestão e da Logística deRecursos, a fim de detectar os fatores potencializadores e limitadores àimplementação de Centros de Telemedicina (CTMs) em unidades básicasde saúde, instituições e hospitais universitários permitirá avaliar os fatoresdeterminantes para o sucesso e continuidade de CTMs dentro do realidadenacional.OBJETIVOS: 1) Desenvolver critérios de mensuração de fatoresdeterminantes de sustentabilidade em relação à implementação e CTMs.2)Identificar e quantificar os fatores que determinam riscos de insucessopara telemedicina. 3) Sistematizar e Correlacionar os valores dos índicescom o desempenho dos CTMs ativos.MÉTODO: Pesquisa de campo em distintas regiões do Brasil, através defichas de avaliação. A base conceitual para a determinação dos indicadoresde sustentabilidade estará baseada no (BSC) umametodologia de gestão estratégica em que os objetivos da empresa, sãoestabelecidos 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.

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JUSTIFICATIVA E RELEVÂNCIA: Nota-se que o sucesso dos CTMs estáclaramente associado a uma gestão integrada dos fatores humanos,tecnológicos, financeiros e institucionais. A identificação precoce dosfatores desfavoráveis do ambiente de implementação de CTMs permitedesenvolver ações de formação e motivação das pessoas, correção eadequação do ambiente para a melhor incorporação da tecnologia e adesejada continuidade.Dada a importância estratégica da telemedicina e a inexistência de uminstrumento que auxilie os gestores na detecção de ambientes madurospara implantação de programas desta natureza encontra-se relevância daexecução deste estudo. O resultado poderá servir de apoio à tomada dedecisão, pública ou privada, mensurando e indicando quais são ascondições mínimas adequadas para a implementação de CTMs, evitandoperdas de recursos.

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GUIAS DE CONDUTA PARA PROGRAMAS DE TELEMEDICINA ETELESSAÚDE DO OBSERVATÓRIO DE TELEMEDICINA DA

UNIFESPSousa, R.M.; Pisa, I.T.; ; 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 desenvolvendoum Observatório de Telemedicina destinado a acompanhar a evolução daárea no país, bem como das tecnologias que podem ser empregadas paraauxiliar na colaboração entre profissionais da saúde. Por se tratar de novosmétodos, requer maior atenção aos profissionais que precisam deorientação para a utilização das ferramentas envolvidas. OBJETIVO. Osguias são desenvolvidos para orientar usuários de programas detelemedicina e telessaúde a realizar reuniões síncronas a distância demaneira eficaz e efetiva.MÉTODOS. Para seu desenvolvimento foi necessária uma revisãobibliográfica sobre os diversos temas relacionados, como telemedicina,videoconferência, tecnologias e padrões, aplicações na área de saúde edemais aplicações de suporte. Após essa pesquisa foi estudada a melhorforma de apresentar as informações geradas em relação à sua estrutura econteúdo. O texto criado foi dividido em pequenas unidades que podemser agrupadas em diferentes formas, sendo passiveis de localizaçãoatravés de busca por palavras-chave. A forma de armazenamento embanco de dados permite que informações sejam alteradas a qualquermomento, o que facilita sua constante atualização.RESULTADOS. Com oito meses de trabalho, a versão beta 0.2 do guia estádisponibilizada na web, em fase de ajustes e revisão. Deverá ter suaversão final até novembro de 2005, quando será gerada uma versãoimpressa.CONCLUSÕES. A oferta de guias de conduta em telemedicina e telessaúdepode acelerar a aderência dos profissionais da saúde na colaboraçãomédica através do uso de tecnologias de informação e comunicação.

Lopes, P.R.L.

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HARNESSING THE EHEALTH EXPERIENCE FROM AROUND THEWORLD TO CREATE THE GLOBAL EHEALTHY CITIZEN

.

Richardson, R. J.Imperial College, London, UK

INTRODUCTION. The healthcare environment is changing rapidly awayfrom a healthcare delivery model which has been configured to make iteasier for the provider and is infrastructure dependent - towards a newhealthcare model which will be truly citizen centric and patient friendly.METHODS eHealth plays a pivotal role in facilitating this transformationalchange and provides the platform for the delivery models of the future. Newapplications and interfaces are being developed - such as on hand helddevices and PDAs - to make the access of healthcare information and servicesboth ubiquitous and easy to utilise and eHealth and telemedicine allows thespecialist skills normally locked inside individual hospitals and clinics - tobecome widely distributed to the community and across national andinternational boundaries. There are many examples of eHealth in practicefrom around the globe and these now need to be evaluated independentlyand the best and most user friendly examples need to be identified andbrought to the attention of decision makers responsible for effecting thehealthcare transformation in their own countries. This paper will addressthese issues with examples of eHealth "best practice" from around the world|

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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 theHHH Consortium

Home telemonitoring of cardiovascular and respiratory parameters havebeen 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 andmorbidity, 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 monthperiod. NICRAM is the 24-hr telemonitoring of respiration, heart raterhythm and activity using new methods of data transmission and analysis.Prognostic prediction, patient QOL, self-care, and cost-effectiveness inthree European countries will be assessed. A clinical assessment, ECG,Echocardiogram, and Quality of Life questionnaire were performed atbaseline, 4 and 12-months and composite measure of patient well-being(death, hospital bed days, symptom score and quality of life).

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HOMEM VIRTUAL DA HANSENÍASE UMA ESTRATÉGIA PARAAUMENTAR A PROCURA POR DIAGNÓSTICO E TRATAMENTO

Trindade M.A.B.

[email protected]

1, Wen C.L. , Festa C.N. , Andrade V.G. , SoaresR.C.F.R.

Faculdade de Medicina da Universidade de São Paulo, OrganizaçãoPanamericana de Saúde, Ministério da Saúde do Brasil

INTRODUÇÃO: A hanseníase doença infecciosa crônica é um problema desaúde pública brasileiro. O Brasil está após a Índia em número de casosregistrados e é o quinto país na taxa de detecção de casos novos. Adivulgação dos principais sinais e sintomas, manchas dormentes e dotratamento gratuito visa estimular a população a procura por diagnóstico etratamento colaborando para quebrar a cadeia de transmissão e prevenirincapacidades. Com este intuito elaboramos o vídeo a ser apresentadoutilizando novas tecnologias aplicadas na Telemedicina

E MÉTODOS: Para elaboração do vídeo foi utilizado materialiconográfico do Projeto Homem Virtua da Telemedicina sob aorientação da Dermatologia da FMUSP, com assessoria efinanciamento da OPAS/OMS e distribuição pelo Ministério da Saúdecomo patrimônio da população brasileira, em especial para UnidadesBásicas de Saúde Unidades Escolares do Ensino FundamentaRESUMO: Esta apresentação pretende divulgar material desenvolvido comnovas tecnologias para realçar os sinais e sintomas iniciais da hanseníasemancha e/ou área anestésica que, se não tratada na fase inicial, poderáser transmissível e causar incapacidades físicas. É informado que otratamento é gratuito, possibilita a cura da doença, e é realizado na UBS demais fácil acesso.

CONCLUSÃO: O vídeo Homem Virtual da Hanseníase concebido commaterial iconográfico pretende ser uma estratégia para aumentar aprocura da população geral por diagnóstico e tratamento.email:

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MATERIAL

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INDIAN INITIATIVES AND EXPERIENCES IN TELEMEDICINE FORSPECIALITY HEALTHCARE DELIVERY TO THE RURAL ANDREMOTE POPULATION - A DEVELOPING COUNTRY MODEL

Satyamurthy LS, Murthy RLN & Bhaskaranarayana. A

Indian Space Research Organisation (ISRO), Bangalore, Karnataka, India

India is the 7 largest country in the world with an area of 3.2 millionsquare kilometers and one Billion plus population. While a vast majority ofIndia's population lives in the rural areas, 75% of the qualified doctorspractice in urban areas. Noting this important dichotomy, especially theUrban/Rura l Hea l th D iv i de , the Ind ian in i t i a t i ves inTelemedicine/Telehealth was started in the year 2001 and primarilyspearheaded by the Indian Space Agency ISRO.The focus of thisendeavour has been on providing technology and connectivity forHealthcare Delivery in terms of the services for Tele-consultation andtreatment between Remote/Rural District Hospital and Super SpecialityHospital, Continuing Medical Education (CME) including training of Doctorsand Paramedics, Mobile Telemedicine for Rural Health camps especially forOphthalmology and Community Health and ICT related to PrimaryHealthcare. For implementing this daunting task, an integrated approachof technology development, standards and cost effective systems wereevolved in association with the various Government/NGO Agencies,Speciality Hospitals and the Industry, including introduction of innovativeinsurance schemes for the rural population.Presently ISRO's TelemedicineNetwork consists of 135 Hospitals 105 Remote/Rural/DistrictHospitals/Health Centres connected to 30 Super Speciality Hospitalslocated in major cities.ore than 50000 patients have been provided withTele-consultation and treatment. A private impact study conducted on onethousand patients treated through Telemedicine network revealed thatthere was a cost saving of 81%. This experience is set to enter operationalarena for a sustainable business model to facilitate public/privatepartnership 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 futuredevelopment of an operational Telemedicine network in the country.

th

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INTERACTIVE CASE DISCUSSION: AN OTOLARYNGOLOGY E-LEARNING PROGRAM BASED ON PROBLEMS

Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RFFaculty of Medicine, University of São Paulo

We have developed an integrated e-learning model using interactivesoftware. The model is divided into two parts: (1) A software distributed onCds, and (2) An internet website. The Cd is based on case reports and theuser need to evaluate the case step-by-step. The progress in the programdepends on the answer of some questions about the case. All the questionshave explanations. After case resolution, the user may assess literaturereview and specialists comments about the topics. In the internetinterface, the user needs to complete an interactive test. Three-dimensional (3-D) animated models are used to improve learning,principally about anatomy and pathophysiology. The first CD is aboutsudden hearing loss and others subjects will be assessed quarterly. Theinteractive case discussion seems to be a good alternative as a e-learningprogram and is focused on individual learning.

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INTEGRATING TELE-NURSING AND TELE-HEALTH WITH HEALTHINFORMATICS: NEED FOR STANDARDIZATION TO ACHIEVE

SEMANTIC INTEROPERABILITY AND IMPROVE PATIENT SAFETY.Professor RN, PhD, FCHSE, FRCNA, FACHI, MACS

Program Director, Health Informatics, Head, School of InformationSystems

Faculty of Informatics and Communication - Central QueenslandUniversity, Australia.

Making the best possible use of available technologies to safely deliverquality health services requires every nation to establish a framework thatwill enable health professionals and health information systems tocommunicate with each other in a timely and reliable manner. Such aframework consists primarily of the adoption of any number of agreedstandards but also on agreed policies and methods of operation. Thiscreates a new national health information environment facilitating allappropriate stakeholders (users) to find, request, retrieve and providerelevant patient records, data, information and knowledge rapidly andaccurately subject to patient authorization where relevant. Such anapproach takes advantage of significant investments made in theacquisition of telecommunication and information technologies nationallyand by many health care providers within the country. Nurses representthe largest group of organised health professionals in most countries.Nurses play a critical role in creating an effective health care informationinfrastructure via clinical nursing documentation and health informationsystems. In many instances nurses make recommendations regarding thepurchase of systems or have responsibility for their implementation.Nurses need to be educated such that there is a sizable national capacity ofnurses able to significantly contribute to the establishment and adoptionof the desired national framework as well as the necessary standards,policies and methods of operation. This presentation intends to exploreopportunities and barriers for nurses to contribute to the creation of aneffective national health information framework that will enable theintegration of tele-nursing and tele-health with health and nursinginformatics for the purpose of improving patient safety and the quality ofnursing service delivery in any health care setting. It will conclude withsome ideas on how to make the most of these opportunities and toovercome the barriers.

,

Hovenga, J.S.

[email protected]://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/[email protected]://infocom.cqu.edu.au/Staff/Evelyn_Hovenga/

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ISfTeH AND THE ROLE OF INTERNATIONAL ORGANISATIONSAND INSTITUTIONS

Lievens, F. Jordanova, M.ISfTeH, Zurich, Switzerland; Med-e-Tel, Luxembourg, G. D. of

LuxembourgInstitute of Psychology, Bulgarian Academy of Science, Sofia, Bulgaria

The aim of this presentation is to briefly present ISfTeH close and fruitfulcollaboration with various international organisations and institutions suchas WHO, UNOOSA, ITU, EC, etc. Tremendous efforts were made by theISfTeH Board to establish and develop these partnerships, contributing assuch to fulfil its mission of promoting and supporting Telemedicine/eHealthactivities worldwide and to be recognized as an umbrella for nationalTelemedicine and eHealth organisations. ISfTeH is truly the United Nationsin Telemedicine/eHealth.On the other hand, close contacts with international bodies are a must forISfTeH 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.

1, 2 2,3

1 2

3

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LAUNCH OF @HEALTH: A VIRTUAL COMMUNITY FORAPPLICATIONS OF E-HEALTH TECHNOLOGIES IN EUROPE AND

LATIN AMERICAVÉLez BeltrÁN, J.A.; Navarro Newball, A.A.; Salvatore, P.; Salas, L.C.

Colombian Telemedicine Centre - Cali, ColombiaCIAOTECH 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, policymakers and other relevant players operating in the field of e-health toaccess and exchange knowledge, skills, technologies and facilities throughthe 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 LatinAmerica 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 andseminars.RESULTS. As a specific support action the project will not directly lead toscientific results, but it will stimulate the achievement of specific scientificobjectives in emerging e-health applications and enabling technologiesoriented to: professional networking; integration of the clinical careprocess management; provision of web-based health information andhealthcare, including remote monitoring and patient care.At the moment, @HEALTH is built upon a consortium including Europeanand Latin American research organisations representing the top levelcompetences in the e-health sector, and a team of experts havingsuccessfully carried out direct experiences in the development ofinternational research and technology transfer networks.

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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 variationacross subgroups of practitioners may be identified as a factor contributingto inequality. A variety of e-learning options exist (training, mentorship,continuing education) that, if determined to be appropriate, can beimplemented 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 exacerbateas well as ameliorate inequality to broaden the 'digital divide' (and otherdivides). Poorer people are generally most in need of healthcare support,yet they are the group least likely to have access to rapidly advancingtechnological solutions. Our challenge is to identify, develop, and applyculturally appropriate, broadly available e-health solutions, and toconcurrently develop the population and professional skills necessary touse them. In this regard, global e-health alone will not suffice. To impactother determinants that affect individual and population health, such asliteracy and employment skills, it will be necessary to develop initiativesthat work in concert, developing e-learning and e-business opportunitiesconcurrently with e-health applications. To achieve this, a systematicapproach is required. One that includes: identification of the magnitude ofhealth gradients, needs and readiness assessment, determination ofwhether e-health is a viable option, and finally implementing andassessing the impact of any global e-health solution.Such a process would be equally applicable and valuable to developingcountries as to developed countries, but the context and solutions wouldbe different. Applying this approach will allow appropriate e-healthsolutions to be applied in reducing inequality and inequity wherever it isfound, and thereby help level the playing field for the health of the world'spopulation.

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MODELO DE EDUCAÇÃO À DISTÂNCIA EM HANSENÍASEVOLTADO 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 dehanseníase no mundo. A maior concentração dos casos ocorre na região daAmazônia legal, onde fatores como extensão geográfica e dificuldades deacesso dificultam o atendimento de saúde às populações isoladas, que éagravado pela heterogeneidade de distribuição de médicos e dedermatologistas. O uso de telemedicina pode auxiliar no reconhecimentode casos de hanseníase e permite criar uma rede de teletriagem através daimplementação programas de prevenção e educação continuada àdistância.

Este projeto de pesquisa tem por objetivo desenvolver ambiente deeducação à distância para treinamento em identificação clínica dehanseníase, e avaliar o impacto dele como recurso para formação de umarede de triagem à distância através de ambulatório virtual, com: (a)criação de curso de treinamento para não-médicos, voltado para oreconhecimento de sinais suspeitos de hanseníase; (b) criação de cursosde capacitação e de atualização à distância em hanseníase para médicosgeneralistas e envolvidos com o Programa de Saúde da Família (PSF); (c)estruturação de ambiente de segunda opinião ( ) emhanseníase; (d) avaliação do potencial impacto da teleducação naformação de profissionais não-especialistas.Os participantes envolvidos no projeto serão médicos generalistas eindivíduos não-médicos que tenham contato com grande número deindivíduos. Serão oferecidos para os sujeitos da pesquisa cursos decapacitação e de atualização para médicos, e curso de treinamento paranão-médicos. Serão feitas avaliações pré-treinamento e após este, atravésde formulário padronizado, de forma a permitir avaliar o impacto do usodessa técnica. Todo o processo será feito remotamente dentro do ambientevirtual do Cybertutor (tutor eletrônico), onde serão inseridas asinformações e implementados recursos educacionais.Na última fase esse projeto possibilitará a integração com a assistênciaremota à paciente, possibilitando a emissão de segunda opinião noscasos com dificuldades diagnósticas ou terapêuticas. Representará,portanto, importante recurso auxiliar na assistência à distância.

online e offline

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NEXT GENERATION BROADBAND AND WIRELESS NETWORKS TOSUPPORT ADVANCED TELEMEDICINE APPLICATIONS

Szabo, C.A.Budapest University of Technology and Economics, Budapest, Hungary

Development of telecommunications networks has been and partially istechnology-driven. This was particularly true for the years of telecomboom in late 90s. Telecom operators and also, to some extent, publicentities such as municipalities laid down a large amount of optical cablesand equipment. As a result, multiple terabits of bandwidth was deployed inthe 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 highspeed access to customers, especially to residents and non-profitorganizations such as health care institutions, except the widespreaddeployment of ADSL which is the only “broadband” technology deployedworldwide. (However it only provides data rate of about one Mbps andbesides does it in an asymmetric way, offering much less in the uplinkdirection.)After the recent downturn of the telecom industry, operators started to bemuch more customer and service oriented. The new direction of “NextGeneration Networks” is no longer just a technology development: movingto IP-based communications serves the needs of applications and servicesin many ways. In the wireless/radio area, the term “Beyond 3G” means nolonger a specific new technology, on the contrary, it means a combined useof a variety of existing and emerging wireless access technologies, toachieve the objective of being “always best connected”, together with IP asthe universal platform here, too.What can all this bring to the telemedicine world? Actually, a lot and notonly increased bandwidth. Telemedicine applications do indeed needbandwidth, as for example transmission of uncompressed radiologyimages with a reasonable delay need 10 Mbps or more and thisbandwidth has to be delivered to the end user no matter whether it isan office in a hospital or the medical specialist's home. Telemedicineapplications can benefit from the recent developments and emergingtelecommunication technologies in many additional ways. Rural andunderserved areas can be covered, the growing populations of seniorscan be monitored at their homes, the quantity of medical errors can be

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reduced and, in general, the effectiveness of health care services can beincreased.Third generation cellular networks provide considerable data rates whichmakes it possible to access to and exchange medical data in a globalenvironment. New high speed wireless technologies offer tens of Mbpswithin the medical enterprise or within a metropolitan area. The newwireless MAN technology can be deployed not only by service providers butalso by communities or groups of non-profit organizations such ashospitals, due to the liberalization of the corresponding frequency bands.New personal area communication technologies such as Bluetooth plusinformation collecting and monitoring devices (intelligent cameras andRFIDs, as examples) offer the right technology background for homehealth care applications.The paper gives an overview of the state-of-the art and emergingcommunication solutions that are of primary importance for telemedicineapplications, for non-communications specialists. The overview will focuson next generation broadband and wireless networking technologies andsolutions that could support advanced existing and emerging telemedicineapplications. First, the requiremements of telemedicine applications areoutlined, including bandwidth, response time, loss, pervasiveness,mobility, security and privacy, payment, user devices, management. Thenan overview of relevant optical and wireless broadband technologies will begiven, focusing mainly on wireless solutions for providing telemedicineservices in metropolitan, local and personal enviroments. Regardingwireless, the combined and flexible use of different wireless technologies(WLAN, WiMAX, Bluetooth, 2.5G/3G cellular) will be emphasized, withvertical handover among them as the application scenarios require. Thetechnology discussion will be accompanied with case studies of systemsdeployed or planned in Europe.

[email protected]

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OBJETOS EDUCACIONAIS: APLICAÇÃO NO ENSINO DEFUNDAMENTOS DE ENFERMAGEMCOGO ALP

Introdução:

Métodos:

Resultados:

Conclusões

; SILVA APSS; ALVES RHK.Laboratório de Ensino Virtual Enfermagem, Escola de Enfermagem

Universidade Federal do Rio Grande do SulPorto Alegre RS Brasil

Entende-se por objetos educacionais ou de aprendizagem osrecursos de multimídia que possibilitem interatividade para apoiar aspráticas de ensino-aprendizagem através das tecnologias da informação eda comunicação. Possui como características a reusabilidade,adaptabilidade, acessibilidade, ser autoexplicável e estar disponível emrepositório de objetos. O desenvolvimento de objetos educacionais sobretemas de fundamentos de enfermagem tem sido uma das atividadesrealizadas pelo Laboratório de Ensino Virtual Enfermagem, e a descriçãodeste projeto é o objetivo deste trabalho. As fases dedesenvolvimento envolvem desenho da estrutura do recurso educativo,desenvolvimento dos objetos educacionais empregandoMacromedia Flash MX , Adobe Photoshop e CorelDRAW , implementaçãoe avaliação do material produzido. Os materiaisdesenvolvidos referem-se às temáticas: administração de medicamentos,balanço hídrico, curativos, oxigenoterapia, punção venosa, sinais vitais,sondagens nasogástrica, nasoentérica, vesicais. Estes objetos sãoconstituídos de hipertexto, botões explicativos sobre os conceitos centrais,imagens digitais demonstrando os procedimentos “passo-a-passo”,para conteúdos complementares e ao final de cada objeto, édisponibilizado exercícios de revisão de conteúdo. Também encontram-seem fase de desenvolvimento animações (jogos educativos) sobremontagem de material para realização de procedimentos; passagem decateter de oxigênio e de sondas (SNG e SNE); punção venosa periférica.

: Pretende-se avaliar os objetos apresentados junto aosacadêmicos de enfermagem, quanto a interação e os níveis decompreensão que os mesmos propiciam; e a adequação dos conteúdosjunto a especialistas. Os objetos educacionais desenvolvidos poderão sercompartilhados com a comunidade de enfermagem a partir de suadisponibilização em repositório.

softwares

links

® ® ®

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Apresentação em Pôster

Contato: Ana Luísa Petersen CogoRua Sacadura Cabral,130/202 Porto Alegre-RS-BrasilCEP 90690-420

Fone: 51- 33165353Email- [email protected]

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OVERVIEW OF E-HEALTH PROJECTS IN SOUTH AFRICAFortuin, J.B.; Molefi, M.

Telemedicine Lead Programme, Medical Research Council, South Africa

BACKGROUND. Many challenges affect South African health care deliveryand too highlight a few they include: (i) lack of accessibility to primaryhealth care facilities and specialist hospitals, and (ii) the cost associatedwith accessing specialist and specialist hospitals. E-Health has proven tobe successful in many developed countries this still has to be proven indeveloping countries.AIM. To identify E- Health projects in South Africa in which theTelemedicine Lead Programme, Medical Research Council is directlyinvolved and use information gathered to make recommendations in termsof E-Health applications in developing countries.METHODS. We identified all implemented and operational E-Healthprojects. The following breakdown of each project was requested: (i) aimand objectives, (ii) target group, (iii) results \outcomes.RESULTS. Four projects were identified, the projects included:1. Mindset Health Channel2. Teledermatology3. Teleradiology Project4. Primary Health Care Testbed ProjectCONCLUSION. South Africa has successfully implemented E-Healthprojects over the past few years with very little infrastructure. Manylessons have been learnt during this time. The success of the projectsincludes the use of simple technology to deliver health care to underresourced areas at a distance. The challenges include cost, support andmaintenance at sites, capacity development and sustainability. To addressthe above issues there needs to be collaboration with industrialisedcountries and research initiatives (i.e. evaluation of E-Health) needs to beimplemented.

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PARAMETRIZAÇÃO DO USO DE INDICADORES NA GESTÃO DOCONHECIMENTO EM SAÚDE PÚBLICA ATRAVÉS DA PRÁTICA DE

E-LEARNINGTachinardi, 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 usode indicadores na gestão do conhecimento em Saúde Pública através daprática de compartilhamento de conhecimento remoto em educaçãocontinuada. A análise de valores a serem computados será viabilizada pelaimplementação de projeto de E-learning pela Secretaria de Estado daSaúde de São Paulo, em convite à colaboração acadêmica/operacionaldirecionado a instituições reconhecidamente atuantes em projetos deinfra-estrutura tecnológica neste setor: Universidade de São Paulo (USP) -Faculdade de Medicina/Disciplina de Telemedicina e EscolaPolitécnica/Laboratório de Arquitetura e Redes de Computadores,Universidade Federal de São Paulo (UNIFESP) - Departamento deInformática em Saúde, Universidade Estadual Paulista (UNESP), BibliotecaVirtual em Saúde (Bireme) e Fundação Vanzoline.METODOLOGIA. O estudo metodológico se identifica na análise relacionalde valores a serem utilizados como indicadores na gestão do conhecimentoe as diferentes formas de aproveitamento dos recursos obtidos pelosprocedimentos envolvidos com a aprendizagem remota. Serão avaliadosem sua capacidade de geração e utilização de indicadores relacionais osprocedimentos de estabelecimento de padrões de comunicação, sistemase conexões, controle de avaliação, capacitação à distância, emissão decertificação digital, administração de conteúdo, acervo bibliográfico,integração e extração de dados, controle e auditoria de processos,divulgação do conhecimento, comunicação on-line e desenvolvimento delinhas de pesquisa.RESULTADOS E CONCLUSÃO. Os resultados esperados pelaparametrização, viabilizada pós-implantação do Projeto E-learningSES/SP, levam à construção de um modelo de utilização de indicadores nagestão do conhecimento em Saúde Pública, auxiliando o Estado na gestãoadministrava da informação.

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PARTNERSHIP BETWEEN MEDICAL MISSIONS FOR CHILDRENWORLDWIDE 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

: Medical Missions for Children (MMC) is an American NGO,dedicated to serving the medical needs and care of catastrophically illchildren in underserved U.S. and international communities.

: MMC provides medical content through its Global Telemedicineand Teaching Network™ (GTTN) a real-time, interactive, satellitebroadcast technology and Internet-based communications platform.Presently, MMC's network encompasses 36 pediatric healthcare facilities inLatin America, Africa, India, and Eastern Europe and facilitates thetreatment of 1,500 children each month and since 1999, has helped nearly23,500 children, all over the world.The Medical School of the State of Rio the Janeiro is the countryrepresentative for Medical Missions in Brazil

: Continuous education through videoconferencing has been doneusing satellite broadcast technologies and Internet 2. Therefore ongoingMMC-GTTN has provided access to cutting-edge research, new treatmentprotocols, and diagnostic techniques by a network of pediatric specialistsin mentor and reference hospitals.

: For more information, connect http://www.mmissions.org.or http://www.lampada.uerj.br/telemedicine.

Purpose

Methods

Results

Conclusion

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Congresso | Instruções para apresentação de trabalhos

10 de agosto de 2005

Atenção:

Apresentação de trabalhos oral, vídeo ou pôster

Data limite de envio: .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 iniciaisdos nomes.

Sublinhar o nome do apresentador.

Na linha seguinte indicar a instituição ou empresa, cidade, estado epaís.

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:Não serão aceitos trabalhos por fax.

Anotar sua preferência de apresentação( ) Oral ( ) Vídeo ( ) Pôster

* Trabalhos enviados em português não serão publicados nos Anais doX Congresso da ISFT mas nos Anais do II Congresso do CBTms.

1) Só serão aceitos trabalhos de autores (pelo menos 1) inscritos nocongresso;

2) A comissão cientifica poderá selecionar seu trabalho paraapresentação em categoria diferente da de sua escolha.3) Para receber a confirmação de aceitação do seu trabalho, informarnome, endereço e e-mail.

[email protected]

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REDE CATARINENSE DE TELEMEDICINA - RESULTADOS,TECNOLOGIA E PERSPECTIVAS

Wangenheim, A e Nobre, LFProjeto 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 estãoimplantando em Santa Catarina a Rede Catarinense de Telemedicina -RCTM. A RCTM é uma iniciativa pioneira de oferta de serviços deTelemedicina em larga escala integrada à rotina clínica para usuários doSistema Único de Saúde - SUS. Para tanto está sendo implantada adisponibilização e interiorização de equipamentos de eletrocardiografia eradiologia em todo o Estado, conectados através de uma rede específica acentros de diagnóstico regionais em hospitais específicos do Estado, alémde um Centro de Telediagnóstico em construção em Florianópolis. Osequipamentos conectados à RCTM localizam-se desde em Postos de Saúdee pequenos hospitais do Interior até grandes Hospitais Regionais doInterior que fornecem exames para uma região e possuem déficit depessoal qualificado para realização de laudos. Os exames estão sendorealizados por técnicos qualificados disponíveis localmente e o serviço delaudo é fornecido por médicos qualificados que realizam os laudos àdistância utilizando workstations especialmente desenvolvidas a providasde recursos de análise de imagens e sinais, desta forma reduzindo-sedrasticamente o trânsito de pacientes, aumentando-se a oferta porotimização das capacidades e reduzindo-se tanto custos operacionaisdiretos como custos materiais e humanos provenientes da demora noatendimento e no fornecimento de resultados de exames. A RCTM sebaseia em uma tecnologia DICOM e um portal Web específicosdesenvolvidos pela a UFSC especialmente para este fim. Na palestra a serapresentada vamos descrever a tecnologia desenvolvida, detalhar afilosofia operacional e apresentar os resultados obtidos até o momento.

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SALA DE LAUDOS VIRTUALNobre, 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 médicosrecursos de estação radiológica DICOM e provimento de laudos emformato DICOM Structured Report. Seu principal objetivo é acessarinformações de exames de imagem no padrão DICOM 3.0, compartilharestas imagens, e criar um canal de comunicação através das tecnologiasde voz sobre IP e compartilhamento de interface de edição e análise deimagens radiológicas através de um protocolo de serviços especialmentedesenvolvido. Esta solução permite a criação de um ambiente colaborativoentre médicos localizados à distância, utilizando a Internet para adiscussão de casos e elaboração conjunta de laudos e diagnósticos. Oambiente da Sala de Laudos Virtual oferece aos médicos visualização deimagens, aplicação de algoritmos de processamento de imagens, além deedição e realização de anotações em conjunto sobre as imagenscompartilhadas. Com esta tecnologia, é possível a utilização de conexõesde rede IP de largura de banda limitada para o compartilhamento ediscussão de exames radiológicos com alta qualidade de imagem, sem aperda de parâmetros diagnósticos em relação àquelas obtidas através douso de equipamentos de videoconferência tradicionais.

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SATELLITE BASED TELEMEDICINE APPLICATION IN AMAZONAREA

Sachpazidis, I.Fraunhofer Institute for Computer Graphics, Fraunhoferstr. 5, D-64283,

Darmstadt, Germany

INTRODUCTION. Access to medical care is sometimes very difficult to bereached from people living in rural and underserved areas. This problem isvery well known in rural areas in Brazil. Citizens have no access to healthcare. They have to travel hundred of kilometers to receive a medicaldiagnosis. In this paper we will propose a medical network based on state-of-the-art medical applications that address the problems of providinghealth care from a distance. Additionally, we are going to showpreliminarily results of the first year of the system deployment andutilization in undeserved regions in Brazil. In the current paper we aregoing to describe a medical network deployed in Amazon area of Para statein Brazil.MATERIALS AND METHODS. Proving medical services to remote areas inAmazon, satellite communication is vital. AmerHis [1] is an advancedcommunication payload, based around the Alcatel 9343 DVB On-BoardProcessor, carried by the AMAZONAS satellite of Hispasat. This processorhas 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 regionsserved by the satellite, namely: Europe, Brazil, North and South America.AmerHis offers broadband interconnectivity to users anywhere within thefour geographical areas covered by Amazonas.Furthermore, besides the communication over satellite a medicalapplication 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 offunctionalities. For example, the doctors working with it are able to makenotes on the digital medical image and send it to the expert doctor. Thiscould happen either in offline-mode (messages will be sent at a favorabledate and time, for example during the night) or in online-mode (real-timetele-consultation).

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Presently, there are two Excellence Hospital Centres in Brazil that composethe T@lemed Project [3]: Santa Casa Hospital, in Porto Alegre, Rio Grandedo Sul, and FAHUCAM, in Vitória, Espírito Santo.The current network is extended to Amazon areas in Para states. The stateof Pará presents the rate of general mortality of 3,65 deaths in 1.000inhabitants. The main reasons are the following:

blood circulation diseasesbirth associated diseasesbreath associated diseasesinfectious diseasesexternal causes

The children mortality is about 20 to 49 cases in 1.000 inhabitants. Somecommon 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 areexpended in treatments in other urban centers. Besides that, there is agreat difficulty in the human resources availability in remote areas where alarge part of the population lives in poverty. The high complexity medicalservices 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: anintegrated portable telemedicine workstation featuring acquisition,processing and transmission over low-bandwidth lines of 3D ultrasoundvolume 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]

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SISTEMA DE APOIO À DECISÃO PARA AVALIAÇÃO POSTURALMancini, F.1 1 1 1 2

1 2; Pisa, I.T. ; Lopes, P.R.L. ; Barsottini, C.G.N. ; Roque, A.C.

Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brasil;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 nodiagnóstico do alinhamento dos segmentos corporais de um indivíduo.Porém, uma deficiência dessa área é não haver uma descrição detalhadado alinhamento postural da população brasileira ou parte dela.OBJETIVO. Este trabalho tem por objetivo apoiar diretamente odiagnóstico do alinhamento dos segmentos corporais de um indivíduo, apartir da classificação de padrões sobre avaliação postural, e utilizando-sedesta classificação, desenvolver um sistema de apoio à decisão médica.METODOLOGIA. Um projeto de pesquisa, patrocinado pelo CNPQ,intitulado Software Gratuito Para Avaliação Postural com TutoriaisCientíficos e Banco de Dados, tem como um dos objetivos criar umrepositório de dados sobre avaliação postural, armazenando uma coorte dapopulação brasileira. Utilizando-se deste repositório, ferramentas deanálise estatística semi-paramétrica de dados, como redes neuraisartificiais, realizam mapeamentos não-lineares de dados, podendoreconhecer padrões entre um conjunto de variáveis de entrada. Ou seja,redes neurais artificiais podem agrupar em classes padrões referentes aoalinhamento postural da população brasileira, com base no mapeamentode dados armazenados no repositório de dados sobre avaliação postural.RESULTADOS. Este trabalho resulta em um sistema de apoio à decisãomédica, a partir do algoritmo gerado pela classificação de padrões sobreavaliação postural de cidadãos brasileiros, acoplado ao Software GratuitoPara Avaliação Postural. CONCLUSÃO. O desenvolvimento deste trabalhoapoiará ao diagnóstico do alinhamento dos segmentos corporais de umindivíduo, pois a utilização deste sistema de apoio à decisão colaboradiretamente com a prática clínica.

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SISTEMA DE TELEDUCAÇÃO À DISTÂNCIA VOLTADO AEDUCADORES FÍSICOSCorrêa, 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 deeducação à distância destinado a educadores físicos, objetivandopromover a continuidade do seu processo formativo, e tendo comoconteúdo, conceitos e aplicações de metabologia, nutrição, fisiologia doexercício e treinamento em atividade física, possuindo como ferramentasde ensino o tutor eletrônico de ensino à distância conhecido comocybertutor, iconografias em três dimensões de partes da anatomia docorpo humano relevante a este processo de aprendizagem (homemvirtual) e vídeos de apoio ao conteúdo proposto no cybetutor.Todas as ferramentas utilizadas neste projeto focam a prática da atividadefísica com qualidade e todo o universo que a norteia, e o conteúdo inseridono cybertutor é a “chave mestra” para o desenvolvimento harmoniosodeste processo, pois trata de conceitos e aplicações de conteúdos que sãodiariamente aplicados no desenvolvimento de sua profissão e é a base parao desenvolvimento das demais ferramentas, já o homem virtual é umatecnologia inovadora que proporciona melhor entendimento do conteúdoatravés dos recursos da terceira dimensão (3D) e os vídeos de apoio quesão inserções áudio-visuais colocadas no decorrer das aulas, através deícones de acesso nas páginas do cybertutor, e que tem como objetivoprincipal à fixação do conteúdo proposto no tutor eletrônico através deinformações novas ou complementos dessas informações.Para utilização deste projeto o usuário receberá login e senha para acessoao cybertutor e um kit de material no qual estarão os discos com os vídeoso homem virtual, e todo manual explicativo.

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SIX YEARS OF TELEMEDICINE AT HOSPITAL SÍRIO-LIBANÊS:EXPERIENCE REPORT.

( )

( )( ).

Acronyms:

Gundim, R.S.Instituto de Ensino e Pesquisa Hospital Sírio-Libanês IEP/HSL

São Paulo Brasil

INTRODUCTION. The Service of Telemedicine was implemented inOctober 1999 as an initiative of both the Oncology Center and theDirectory of Hospital Sírio-Libanês, and it was designed to fulfill twoobjectives: Assistance International Second-Opinion andEducational/Scientific Lectures, Case Studies and Distance EducationOBJECTIVE. The purpose is to report the experience of the TelemedicineService at IEP/HSL from 1999 to 2005.METHOD. This is a retrospective study to examine the most relevantaspects such as technologies, statistics and the outstanding points of theactivities.

Telemedicine at IEP/HSL started with a videoconferencingsystem and several pertinent peripherals. In 1999, with the mentionedstructure, the International Second-Opinion Program was implemented incollaboration with the MSKCC (1) 42 cases, parallel to the scientificmeetings 52 ones. In 2001, 41 videoconferences were held to exchangeexperiences, broadcast lectures and develop long distance congresses. Atthe same year it was the unique content source of medical update at therecently founded IP-TV via satellite 157 transmitions. Currently itdevelops a collaborative network to train people from the North andNorthern areas of Brazil, and search for partnership with otherTelemedicine Centers as of FMUSP (2), UFSC (3), UNIVAP (4), amongothers. The presented statistics refer to the six years period.

This experience shows that financial, technological,scientific and institutional sustainability should be based on theinvestments in technology, communication and cooperation amonginstitutions. A collaborative action enhances the structuring oftelemedicine programs, contributes to the dissemination of best practicesand to the quality of health assistance.

1 - MSKCC Memorial Sloan-Kettering Cancer Center of New York2 - FMUSP Faculty of Medicine of The University of São Paulo3 - Federal University of Santa Catarina4 - Vale do Paraíba University

RESULTS.

CONCLUSION.

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TELEASSISTÊNCIA E TELEEDUCAÇÃO EM HANSENÍASE: COMOUMA ESTRATÉGIA DE PROGRAMA EM SAÚDE

Trindade M.A.B.1,4 1 1 2

3 4 5 6

5

1

2 3

4 5

6

, Festa C.N. , Wen C.L. Andrade V.G. , SoaresR.C.F.R. , Carvalho M.L.M. , Ferreira S.R.G. , Almeida M.E.B.T.M.P.

Médicos das Unidades Básicas de Saúde : Manso VLS, YamashitafujiTMT, Souza LR, Trindade RA, Silva AA, Macedo RLC, Fukada M, Ribeiro

LAFaculdade de Medicina da Universidade de São Paulo , Organização

Panamericana de Saúde , Ministério da Saúde , Secretaria Estadual daSaúde de São Paulo , Secretaria Municipal da Saúde de São Paulo ,

Pontífice Universidade Católica-SP .

INTRODUÇÃO: Para aumentar as oportunidades de diagnóstico etratamento, está sendo realizado um projeto piloto para Validação doDiagnostico Virtual da Hanseníase na FMUSP-SP com a participação daOPAS/OMS, Ministério da Saúde e Secretaria da Saúde do Município e doEstado de São Paulo, os quais estão catalisando esta iniciativa de utilizarferramentas da Telemedicina e Teleducação como uma estratégia doprograma da hanseníase, um problema de saúde publica brasileiro.MATERIAL E MÉTODOS: Foram selecionadas 8 unidades sanitárias dasdiferentes regiões do município de São Paulo referência de tratamento emhanseníase. Nos casos suspeitos de hanseníase, os médicos destas UBSpreenchem um formulário clínico, fotografam as lesões e as enviam viaInternet ao Ambulatório Virtual, e também encaminham o paciente aoAmbulatório do HCFMUSP para avaliação presencial, sendo o padrão ouro eo teste o exame virtual enviado pela UBS. Planeja-se que até outubro cercade 100 casos serão analisados sistematicamente e os resultados serãoapresentados.Resumo: Esta apresentação visa mostrar a implantação de um serviço queutiliza novas tecnologias na rede pública de saúde como uma estratégia deprograma de saúde.CONCLUSÕES: Se os dados mostrarem que o diagnóstico virtual é ummétodo que auxilia o diagnóstico da hanseníase, o Ambulatório Virtualserá ampliado para outras regiões como uma das estratégias do Programada Hanseníase.

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TELECONFERENCES IN PEDIATRIC RADIOLOGY- A BRAZILIAN'SNETWORK.

Monteiro, A.M.V.1; Junior, M.J. ; Santos, A.A.S. ; Neto, J.R.N. ;Cavalcanti, S. ; Sakuno, T. , Nobre, L.F.N. ; Filgueiras, T .

State University of Rio de Janeiro- UERJ , Fluminense Federal University-UFF , IMIP-PE , Federal University of Santa Catarina-UFSC , Federal

University of Minas Gerais-UFMG ._ BRAZIL.

PURPOSE. To provide continuous pediatric radiology education amongMedicals Schools and to centers over far distances.

METHODS. Network teleconferences by electronically transmittingradiographic patient's images or power point presentations, sessionconsultative and second opinion session by using ISDN or Internet II.RESULTS. The majority of the physicians were satisfied with thevideoconference format, presenters and content. The consultations anddiscussions became more dynamic and organized. The medical and post-graduated students were more interested due to the new methodology andnew researchs have been discussed.CONCLUSIONS. This pilot study in Brazil demonstrated that it is possible toengage Medical Schools in pediatric-radiology rounds by videoconference.Therefore, ongoing assessment of the use of videoconferencing forcontinuing education and the development of professional communities ofpractice is warranted to evaluate the impact of telehealth initiatives inour country.

1 2 3

3 4 4 5

1

2 3 4

5

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TELECONFERÊNCIA COMO FERRAMENTA PARA DISCUSSÃOCLÍNICA ENTRE GRUPOS MÉDICOS À DISTÂNCIA

Campelo, VES; Wen, CL; Pinheiro Neto, CD; Figueiredo, L; Bento, RFUniversidade de São Paulo (FMUSP)

Compartilhar informações independentemente dalocalização dos usuários tem se tornado possível graças às modernastécnicas de telemedicina e abre novas dimensões para procedimentosdiagnósticos e terapêuticos. Teleconferências realizadas entre centros deatenção à saúde de localidades distantes permitem maior integração etroca de conhecimentos que ajudam na resolução de casos difíceis e noestabelecimento de condutas. : Descrever a experiência daDivisão de Otorrinolaringologia da USP com as discussões interativas viateleconferência. : Foram desenvolvidas reuniões viaIP (Internet Protocol) à 384 Kbps, bimestralmente em 2005, com a UERJpara discussão de casos clínicos. Utilizando conexão via ISDN (

a uma velocidade de 384 Kbps, foram realizadasteleconferências para discussão com a Mc Gill University (Canadá) em2005. Utilizou-se equipamento do modelo Tandberg 6000 no ponto local.

Após vários testes, 384 Kbps foi definido como a velocidadepadrão em que as imagens de alta definição e vídeos pudessem sertransmitidos com boa qualidade. A transmissão via ISDN à 384 Kbpsmostrou uma estabilidade melhor do que a conseguida via IP a umamesma velocidade. Após testes em horários variados, observou-se que atransmissão via IP tinha comprometimento da qualidade nos horários demaior congestionamento na rede, mas apresentava uma ótima qualidadenos demais horários. O custo da conexão via IP mostrou-se muito menordo que o necessário para conexão via ISDN. A teleconferênciamostrou-se uma ferramenta viável e de boa qualidade para a discussão decasos e troca de experiências entre grupos médicos sem a necessidade dedeslocamento dos participantes.

Opção recomendada:

Introdução:

Objetivo

Material e Métodos

Resultados:

Conclusão:

Apresentação POSTER VERSÃO INGLÊSA DORESUMO

intergratedservices digital network),

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TELEDENTISTRY AN EXPERIENCE USINGTHE INTERNET.Sequeira E.1; Chao L.W. ; Sgavioli,C.A.P.P .; Carvalho I.M.M.

(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 theprofessional to improve their knowledge in a dynamic way. Supported byinteractive resources and modernization of educational contents,students, professors and dental practitioners can use the benefits oftechnology to improve the quality of services provided to the populationand professional improvement. Following the models developed andapplied by the Discipline of Telemedicine of University of São Paulo, in 2004and 2005, academic-scientific partnerships were established with dentalschools, which allowed application of technology-based educationalmodels, consolidating the Teledentistry in Brazil. By educational andtechnological support, professionals and students may learn at any timeand place according to their dedication and availability. The Discipline ofTelemedicine has tools as the “Cybertutor”, a Teleeducation environment,where the educational contents and the learning object “Virtual ManProject” are designed and applied, in which anatomic structures, three-dimensional physiologic movements (height, width and volume),biomechanics, ultrastructures and temporal evolution are visualized bymodernization of iconographies. Two titles were developed in Dentistry:temporomandibular joint and tooth structure. The Teledentistry facilitatesthe transmission, diffusion and exchange of information, being essential tosupport the professionals assisting the population.

1 2 2

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TELEHOME MONITORING AVAILABLE TECHNOLOGIESGuzovsky, P.A. (MD)

Medical Director - Panmédica Negócios Hospitalares Ltda..São Paulo, S.P., Brasil.

INTRODUCTION. The World Wide Web and the Telecom companiesglobalization, allowed several different approaches to Health, whichoriginated the term Telemedicine.CONCEPT. One of the Telemedical areas refers to Monitor Patients atdistance.Nowadays, an ideal format to the technologies would be:

user friendly devicesconnection through Telephone lines.Wireless reception and transmission.Miniaturization.Possibility to communicate with Sound and/or Imaging.Privacy

INDICATIONS. Several Telehome monitoring indications where alreadypublished or presented, among them:AIDSArterial DiseasesAutism.Chronic Obstructive Pulmonary DiseaseCongestive Hearth FailureContinuous Education for PatientsDermatologyDiabetesGeneral Rehabilitation.Geriatrics Cognitive Disturbances.HypertesionMedical evaluationMedicationMental HealthObesity.OncologyPain managementPost Trauma.monitoringPost-operative

-

-

-

-

-

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Sleeping diseases.

Tecnologies:*Hardware:

CoagulometerDigital CameraEKGExpirometerGlucosemeterHearth rateOximeterScaleSphigmomanometerThermometer

*Software:- Web-based electronic medical records.- Case management.*Conectivity:- Telephony (POTS)- Broadband: DSL/Cable modem- Others.CONCLUSION. The available technology is enough to implement severaltelemedical projects and Industry is already investing in more efficientSoftwares, to better manage the information gathered.Propedeuthics as we knew from the past changed by opening tomodernization and the Classical Clinical Observation together with thetechnological evolution, is bringing an infinity of advantages, which at theend, targets the Individual well being.

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TELE-MEDICAL COLLABORATION PLATFORMS DEPLOYED INRURAL AND UNDERSERVED AREAS IN LATIN AMERICASachpazidis,I.; Kiefer², S.; Ohl, R.; Messina, L. A.; Sakas G.

Fraunhofer Institute for Computer Graphics, Dpt. Cognitive Computingand 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), InstantMessaging.ABSTRACT. T@LEMED project introduces an e-health model to theprovision of health services in strongly underserved regions in Colombiaand Brazil. The implementation of this model is supported on currenttelehealth technologies as well as on evidence based medicine. The targetclinical applications include typical infectious diseases for the region suchas malaria, and general ultrasound applications such as pregnancy control,urology and cardiovascular diagnosis.In Colombia two telehealth networks will be established that provideteleconsultation services to low level healthcare centres in rural andremote regions for the early diagnosis and treatment of malaria and otherinfectious diseases. The networks link experts in Cali and Bogota with low-level healthcare facilities in endemic, underserved regions at the PacificCoast and in the Amazons region. The expert will evaluate diagnosticinformation such as microscopic images, medical device data and casereports in order to advice the local healthcare staff in diagnoses andtreatment of the infected patients. As the technical backbone an extendedversion of the telehealth platform TOPCARE is used, that has beendeveloped by Fraunhofer Institute IBMT and the Greek partners ICCS andDatamed in the context of the European Commission's research anddevelopment programme Technologies for the Information Society.In Brazil teleconsultation services for medical ultrasound examinationssuch as OB/Gyn, pregnancy control, urology and cardiovasculardiagnosis are implemented for rural hospitals in Brazil by using theteleimaging platform, called TeleConsult, developed by FraunhoferInstitute IGD and the German partner Medcom GmbH. TeleConsultprovides a wide spread

1

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of possibilities. It is able to acquire ultrasound images from an ultrasounddevice, to enrich a given image material with additional informations andto send it as a message to distant expert doctors connected to the medicalnetwork over Internet. With the help of TeleConsult two leading hospitalsof Brazil; Santa Casa Hospital in Porto Alegre and the Hospital of theFederal University of Espirito Santo provide telediagnostics and treatmentadvices to rural hospitals and health centres.T@LEMED project has been funded by @LIS: Alliance for the InformationSociety, European UnionFurther information can be found at project's web site: http://www.alis-telemed.net

E-mail: [email protected]

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TELEMEDICINA, O PRÓXIMO PASSO: A AVALIAÇÃO DO IMPACTOSÓCIO-ECONÔMICO?

Medeiros, R.1 2

1; Wainer, J.

Pós-graduando do Departamento de Informática em Saúde (DIS) daUniversidade Federal de São Paulo/Escola Paulista de Medicina

(UNIFESP/EPM), Professor Convidado do DIS/EPM; Brasil.

Partimos da premissa de que os projetos de telemedicina só deveriam seraprovados se estivessem acompanhados de um estudo rigoroso deviabilidade de médio e longo prazo, de um plano de evolução (daqualidade, dos custos, de acessibilidade e de aceitabilidade), além desistema adequado e efetivo de difusão dos resultados, portanto, umcontínuo processo avaliativo. Os impactos que deveriam ser avaliados,estão relacionados: a) impacto no processo clínico; b) na saúde dopaciente; c) na acessibilidade ao sistema de saúde; d) econômico e, porfim e) impacto na aceitabilidade do sistema de saúde.A primeira constatação foi de que, ainda que a telemedicina tem trazidoavanços para o debate nacional e crescimento dos sistemas de saúde, nãohá estudos ou avaliações dos projetos com qualidade e em númerosuficientes que garanta os benefícios potenciais da telemedicina e, porconseguinte, que possa produzir estimativas confiáveis dos seusverdadeiros benefícios.A segunda constatação é que, as relações entre as práticas e asnecessidades de saúde podem ser apreendidas a partir de duas vertentesprincipais. A primeira delas consiste na busca dos seus significadoseconômicos, políticos e ideológicos, bem como da especificidade dessasrelações em sociedades concretas. A segunda diz respeito à capacidadedas práticas modificarem uma dada situação de saúde, atendendo ou nãoàs necessidades de saúde de determinada população, ou seja, refere-se àdiscussão sobre suas características e seus efeitos. A telemedicina, nestesentido, surge como uma destas práticas que pode promover estamudança, porém ainda não é esta a realidade encontrada, ou seja, não hámudanças concretas mapeadas e avaliadas.

RESUMO. Este artigo apresenta um resumo da pesquisa realizada sobrequatro projetos de telemedicina implantados no Brasil dois em HospitaisPrivados e, dois ligados a Universidade Públicas. Nosso objetivo era o deencontrar resultados e evidências do impacto sócio-econômicoconquistado com a telemedicina. A incorporação da avaliação comoprática sistemática nos diversos níveis dos serviços de saúde poderiapropiciar aos seus gestores as informações requeridas para a definição deestratégias de intervenção e melhorias no sistema de saúde (entendendoaqui a telemedicina como uma técnica de intervenção).

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TELEMEDICINA, UMA REALIDADE QUE O SUS, NO MUNICÍPIO DESÃO PAULO, SÓ CONHECERÁ EM 2010!!!

Medeiros, R.1 2

1; Wainer, J.

Pós-graduando do Departamento de Informática em Saúde (DIS) daUniversidade 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 éalgo fácil, e em se tratando da rede de Saúde do Município de São Paulo asdimensões assumem proporções sem precedentes conhecidas, em funçãoda sua complexidade.O grande desafio colocado ao município de São Paulo foi e está, emplanejar e executar um projeto, que desse conta da informatização dassuas Unidades a saber 386 Unidades básicas de Saúde, 98 AmbulatóriosEspecializados, 49 Policlínicas e 11 Ceccos.Diante deste cenário, uma das primeiras tarefas foi à escolha de umametodologia para seleção do sistema e mecanismos de implantação queatendesse as prioridades político-administrativa do município. O resultadodeste processo, concluiu com o desenvolvimento compartilhado com ainiciativa privada, norteado por premissas definidas centralmente (SUS)que determinaram o desenvolvimento do Projeto de Implantação doSistema de Informação do município de São Paulo SIGA-SaúdeAssim, o objetivo deste artigo é, apresentar ao leitor o processo iniciadoem 2004, como o mesmo foi estruturado e quais os próximos passos, dadoque 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 áreade Treinamento e Capacitação dos seus colaboradores internos e doMinistério da Saúde MS, para a implantação do sistema. O artigo encerracom 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 2010e, de forma complementar apresentar as oportunidades paradesenvolvimento da telemedicina no município.

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TELEMEDICINE: A PERSPECTIVE FOR RONDÔNIA'S HEALTHJakobi, HR

Secretaria de Estado de Saúde de Rondônia CEREST/RO

all of them are important as a way of flowing off theagriculture production and sick people; it has only 4% of basic sanitation intheir homes, but it is assisted by cable TV and satellite. But what is essentialto be understood is that Telemedicine is not only technology and newequipments but also a procedure that requires a lot of relevantorganizational changes of the health service to be explored. There isevidence that Rondônia is very well served of necessary infrastructure tothe Telemedicine achievement, being necessary only to have politicaldetermination and a Plan of Action in Telemedicine of Rondônia that has asa priority such technology. It is concluded that the technology of accessutilization already existing (satellite, optical fibre and telephony), and aspecific investment in hardware, software and peopleware will enable theTelemedicine project in our state.

A powerful technological tendency is coming up, and will affect in areversible way the medical practice. That is about Telemedicine, which arethe technologies of telecommunication use to the interaction betweenhealth professionals and patients, in order to execute medical actions atdistance. This will be a meaningful gain to the Amazon Region health,especially to our RondÔNia state, connecting remote places to the mostadvanced hospitals in the country and world, transmitting images,conferences, surgeries and other procedures which require theperformance of experts in many different areas of health. Telemedicine canbe thE most viable technical and economical solution to change the presentdeficient condition of the ambulatory and hospital medical services in ourstate. Its implantation and implementation in many regions, micro regionsand in the municipal districts of RonDÔNia will generate a great potential toimprove the health service to the population, increasing intensively theeffectiveness of the health system, reducing the continental distances andthe operational expenses. Patients will be able to have their infirmiTydiagnosed and treated in a faster way, causing less dislocation andsuffering, better medical resolution and, consequently, reduction of thesequel rates. The technology analyzed in this study confirm that isextremely important and a great need to the Health professional staff toexecute their daily tasks, concerning to the medical service to patients atdistance, even if they are not in person in their offices and surgery rooms.The telemedicine contributes also to the formation, improvement andcontinUous preparation of the health professionals and the education of thepopulation. The study demonstrates clearly that the infrastructure of thestate presents very polarized aspects: while usufruct, for example, of acomplete optical fiber to its fixed telEphonic communication, and on theother hand it lacks of highways with pavement and concrete bridges inmany of its roads, making some municipal districts become isolated sometime of the year,

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TELEMEDICINE IN INDIA: STANDARDISATION ISSUES ANDINITIATIVES

Senior. Director, Department of IT, Ministry of Communication &IT,

New Delhi, India.

Bedi, B.S.

ABSTRACT. India today has more than one billion population that ispredominantly rural and distributed in distant geographical locations.Telemedicine assumes special significance for India considering 70% ofthe population lives in rural areas whereas about 90% of Secondary andtertiary health care facility are city based. Having the technical andmedical expertise capability to offer quality healthcare to remote areas, anumber of telemedicine centers have been set up and are also beingplanned across the country. To streamline establishment of Telemedicinecenters and services, need for a set of standards and guidelines was felt.

Through efforts of a specialized Technical Working Group, set up byDepartment of IT, Govt. of India, a nucleus framework of recommendedguidelines and standards for practice of Telemedicine in India has beendrawn up. The recommendations provide for setting up a Telemedicinecenter based on standards for systems, telemedicine software,connectivity, data exchange, etc. These are vital issues to be considered atthis stage when Telemedicine activity is expanding rapidly in India andinteroperability among diverse systems becomes a crucial factor forproviding flexibility of multiple specialist consultations to Telemedicinenodes.

The recommendations have been disseminated among variousstakeholders who have evinced keen interest. In addition to bringingawareness among various stakeholders and policy makers, it is alsoprovides guidelines for judicious adaptation of Telemedicine at differentlevels of existing landscape of health care delivery system prevailing inIndia. Majority of the vendors and Telemedicine solution providers in Indiahave adopted the key recommendations making possible interoperabilitybetween diverse systems.

Steps to take forward the present initiative of standardization activity inTelemedicine in India are also underway.

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TELEMEDICINE IN OTOLARYNGOLOGY CONTINUOUS MEDICALEDUCATION

:

:

:

Campelo, VES

http://netsim.fm.usp.br/teleotorrino

; Chiari, JP; Voegels, RL; Wen, CL; Bento, RFFaculty of Medicine - University of São Paulo

OBJECTIVES describe a continuous educational program using a synchronicinternet transmission of a course produced by Otolaryngology Department ofUniversity of Sao Paulo (USP).MATERIAL AND METHODS: this program is based on video streamingtransmission of the Otolaryngology Extension Curse of USP. There are fourremote centers (Campinas-SP, Santos-SP, Brasilia-DF, Salvador-BA)connected above 512Kbps broadband internet connection. The classtransmission is acessed in a internet site ( )and the user has two speed options: 100 and 300 Kbps. The students in theremote centers can ask questions using a chat, and the teacher answers onlineusing the video streaming transmission. This improves the course interactivitywith remote user participation.DISCUSSION nowadays, one of the principal educational focus is thedevelopment of continuous programs that permit medical knowledgeupdating. This is difficult to be achieved by traditional methods, principallyin the smallest cities, due to the shortage of human resources and thenecessity of people dislocation. That project allows the transmission ofexpert classes to some remote points with appropriate quality, using a lowcost and world-wide technology. Another advantage of the method is theexperience exchange between the distant groups.CONCLUSION video-streaming interactive based courses seems to be anefficient alternative in the development of continuous educational medicalprograms.

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TELEMEDICINE IN PERMANENT MEDICAL TRAINING: ANINTERNATIONAL CO-OPERATION EXPERIENCE BETWEENUNIVERSITY 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, BeloHorizonte, Minas Gerais, Brasil; Faculdade de Medicina da UniversidadeFederal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; CentreHospitalier Universitaire de Rouen, Rouen, Normandie, France;Secretaria Municipal de Saúde de Belo Horizonte, Belo Horizonte, MinasGerais, Brasil; PRODABEL - Empresa de Informática e Informação doMunicípio de Belo Horizonte, Belo Horizonte, Minas Gerais, Brasil

The Telehealth and Telemedicine Nucleus of the “(HC) of the Federal University of Minas Gerais(UFMG) promotesvideoconferences with the “ (CHU) ofRouen, France, within an international co-operation agreement. Sixmedical specialities joined the program, carrying out clinical casediscussions and exchanging experiences between the two institutions. TheBH TELEMED project integrates these activities, as a telehealth projectaimed at primary care for the family health teams, which links HealthCenters from the Municipal Health Department of Belo Horizonte to the“ ” through a system of long distance consulting. Withthe integration of the used technologies, it becomes possible to connectdoctors from the family health teams, in their work environment, to Frenchand Brazilian specialists. International communications between theCHU/Rouen and the HC/UFMG are made through videoconferences usinghigh bandwidth networks: RNP2 (MG/Brazil), RedClara (Latin America),GÉANT and RENATER (Europe). Local communications between HC/UFMGand health centers are made using computers, webcams and the networkBH2 connection with the Municipal Computer network. Initially, in 2004,was established a simultaneous transmission to the CHU/Rouen and thehealth centers of the 1 Franco-Brazilian Medical Journey that took place inBelo Horizonte. From 2005 on, periodic clinical sessions made throughvideoconferences were structured in each speciality. There were 232french and brazilian health professionals participating in the four eventsthat took place. The interaction through Telemedicine between the nationaland international academy and primary care allows an unique form ofpermanent medical training, with doctors being trained in their own workenvironment, adding quality to the public health system.

Hospital das Clínicas”

Centre Hospitalier Universitaire”

Hospital das Clínicas

st

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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 refletecaracterísticas morfotintoriais importantes que podem auxiliar emdiagnósticos precoces. A sistematização do diagnóstico através do uso deimagens de bacterioscopias geradas com máquina digital diretamente daocular do microscópio e encaminhadas por email abre a possibilidade dediagnósticos à distância bem como o acesso a segunda opinião em temporeduzido com relevante custo-benefício.MÉTODOS: 53 lâminas de materiais clínicos diversos foram analisadas pordois microbiologistas (M1 e M2). M1 fez as leituras por microscopiaconvencional (MC) e fotografou 5 campos relevantes gerando imagensdigitais (ID) enviadas a M2 para leitura à distância. Para esclarecimentodas discrepâncias uma terceira leitura foi realizada por M2 por MC comconhecimento dos resultados das leituras anteriores (leitura padrão).As ID foram capturadas com lâminas focadas sob a lente objetiva de 100x eocular de 10x (aumento de 1000x), câmera Sony Cybershot Dsc-W5 comobjetiva de macro, 3.2 megapixels, JPEG.RESULTADOS: 19% das lâminas (10/53) foram excluídas da análise devidoa impossibilidade do diagnóstico por ID, sendo que 8% (4/53) das imagensapresentaram falta de foco e definição e, 11% (6/53), presença de materialde fundo protéico que impediu a visualização das estruturas. O índice decompatibilidade (IC) entre a leitura de M1 por MC e M2 por ID foi de 81%.As discordâncias observadas foram avaliadas através da comparação dosresultados com a leitura padrão. O IC entre as leituras de M1 por MC xpadrão foi de 93% (40/43). Das 3 lâminas discordantes observou-se 4diferenças na identificação morfológica das estruturas relacionados a cocosGram-positivos (1/4), diplococos Gram-negativos (1/4), leveduras (1/4) ea associação fuso-espiralar (1/4).

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TELENURSING: PERMANENT TRAINING FOR PRIMARY CAREPROFESSIONALS IN THE CITY OF BELO HORIZONTE

Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais,Brasil

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.

This is an intervention project of which take part the " " Hospital andthe College of Nursing of the UFMG, together with the AssistanceManagement sector of the Municipal Health Department of BeloHorizonte/MG, within a permanent training program, all of which are partof the activities of the TeleHealth BH TELEMED project. The proposal isbased on carrying out long distance training sessions for the nursing teamsof the basic care units of the city. The technology used is simple,computers, webcams and a communication software. Seventeen pointshave been installed in primary care units which can be connected on-linesimultaneously. The TeleNursing sessions are scheduled beforehand,announced in the participating units, the confronted themes are selectedby the professionals according to problems faced in daily practice. Duringthe presentations, doubts are explained live by the person ministering theconference or by in an absolutely interactive process. Since thebeginning of the activities, five meetings took place with an increasingparticipation of the nursing professionals of the primary units, a total of241 individuals, that generally approved the used methodology. Theobtained results achieved the goals established by the project and showthat the use of long distance training is the most appropriate methodologyto be implemented in the permanent training of the nursing team,considering the opportunity to discuss daily work processes and toovercome the limitations of participation in training activities that require aphysical presence inside traditional educational places, that is, outsidetheir work place and hours.

Clínicas

chat

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TELERADIOLOGY: IMAGING STRATEGIES AND PERSPECTIVES.Santos D.T.1, Sequeira E. , Chao L.W.

Department of Radiology, College of Dentistry, University of São Paulo,São Paulo, Brazil. 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 secondaryopinion interpretation services from medically less developed countries tocenters of excellence. Teleradiology comprise the use oftelecommunications and teletechnologies to deliver services to who arelocated in a different place from the radiologist, for purposes ofinterpretations and/or consultation. At present, international telemedicineand teleradiology represent a premium service, usually only available towealthier people from those countries with less well developed healthservices. The premise is that telemedicine and teleradiology opinions mayprevent unnecessary foreign travel by the patient to the centre ofexcellence. Often a diagnosis that has been made in the original countrycan be validated by the centre of excellence, thereby reassuring both thelocal physician and the patient. If an alternative diagnosis is suggested,treatment options can be suggested to the local physician who may alsoprevent the patient from traveling outside of their own country. The role ofradiologist specialists can be enhanced from providing interpretations fordiagnostic studies to supply advice on patient care and work-up.Teleradiology allows greater efficiency with sharing of services amonginstitutions, greater standardization and reproducibility. The developmentas evidence-based health care is a new approach to this practice, wheretransdisciplinary collaboration is necessary through radiological practice,education, and research.

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TELERADIOLOGY EXPERIENCE USING INTERNET ANDWAVELET COMPRESSION

Souza C.A. (*), Conrado M.A.Grupo Norteimagem Rio de Janeiro - Brazil

The authors describe a solution that implements a secure teleradiologyenvironment using Internet transmission and wavelet compressionalgorithms. The studies are acquired from different modalities, lossless orlossy compressed and dynamically stored in a central repository. There areDicom and non-Dicom modalities, and different specialties (MR, CT, US,CR).The system is designed to allow authorized physicians and technicians tosend and receive imaging studies from geographically distributed facilities,and review also at home/office, in order to provide specialty consultationsand 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 imageseries; support of color images and manipulation capabilities such assynchronized series scrolling, windowing/leveling, panning, zooming, linemeasurement, image flipping, rotating, and inverting; display/hide imagetext; 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. Oncethe interpretation is completed, the radiologist can create a report, save theresults and synchronize with the server. The reports can be printed directlyin each facility.The teleradiology solution is in use by a consultant group, integrating 5radiology departments in small hospitals and outpatient clinics.

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TELE-OPHTHALMOLOGY: REACHING-OUT FOR OUR PATIENTS.; Zaldivar, R.; Batiz, MG

Instituto Zaldivar. Mendoza, Argentina.

BACKGROUND: Emerging technologies in communications are essentialtools in healthcare, especially in countries were distances and easyaccesses to qualified services are important barriers for patients. In thisproject coined FOCUS, our main objectives were to link our national andinternational branches, have real-time transactions between them, andoffer added-value eye care services for our patients.METHODS: We developed a hybrid telecommunication network involving IPand ISDN connectivity, with several real-time applications: Electronicmedical records (EMR) dataware house, intranet, voice over IP telephonesystem (VoIP), security system, videoconferencing system, as well as ourinstitutional website. All these applications were used to enhance thecommunication 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 respectivebackup contingency plans in parallel. We are in the process of educating allthe users, both in the institution as well as in the community.CONCLUSIONS: We now have different means of communicating ourselveswithin our organization and with our patients, which enables us to be moreproductive and efficient in providing high quality eyecare service,regardless of the distances. Although they have proven to be innovatingand promising, cost-effectiveness has still to be demonstrated.

Ricur, G.

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THE ROLE OF DISRUPTIVE TECHNOLOGY IN REDEVELPMENT OFMEDICAL SYSTEMS: TELEMEDICINE OF KOSOVA AS AN EXAMPLE

1, 2 2 2 3Latifi 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 ApplicationsConsortium, Virginia Commonwealth University, Richmond, Virginia

BACKGROUND: The medical system of Kosova, a region currently governedby the United Nations and protected by NATO, was largely destroyedby1999, from Serbian forces, leaving behind severely damaged medicalfacilities and infrastructure. The telemedicine project was initiated tosupport, supplement and guide educational programs, and development ofmedical personnel in the region. Although seen as disruptive technology,telemedicine has become an import element in providing informationresources for medical education programs within Kosova's medical systemthrough regional and international. MATERIALS ANDMETHODS: Since its inauguration, Telemedicine Center of Kosova (TCK),on December 10, 2002, has concentrated its activities in creation ofinfrastructure, human capacity, clinical protocols, information resources,electronic library, and continuing medical education through regional andinternational collaboration. Fifty-four-thousand visits have been registeredat the TCK by 1885 medical students and nearly 3000 doctors, nurses andother healthcare providers of the region. TCK has become virtual classroomof Kosova's medical system. As of march of 2005, 43 regional andinternational conferences have taken place at the TCK, including livebroadcasts of complex surgical procedures. TCK has planted the seeds ofmedical information technology, and now is seen as champion of change andhope in a region devastated by war and neglect.CONCLUSION: Telemedicine may be regarded as a disruptive technologyin well-developed and functional medical systems. However, when thedisruption is war, natural or man made disaster; telemedicine can be anexpedient way to achieve the goal of independent medical care when thereis an acute need of recovery and redevelopment.

collaboration

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THE ROLE OF TELECARE IN THE PREVENTION AND SELFMANAGEMENT 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 forInformation Technology NPfIT enabling a population to adopt a

which meant the public using IT to self care; without thisthe NHS was unsustainable. The NPfIT (now called Connecting for Health),a major commitment to an expert patient program (EPP) (StanfordUniversity) that identifies generic features of chronic diseases and theKaiser Permanente chronic diseases severity pyramid by primary carecould enable a radical change in healthcare. Innovative primary care teamshave linked with social services and local authorities to utilise telecare totransform chronic disease management. Telecare combines healthinformation, assistive technology as well as vital signs monitoring.Assistive technology is already being implemented for frail elderly patientswith memory deficits by social services and intermediate care services tofacilitate independent living through existing social alarm call services.However, this holistic strategy 'competes' with an inefficient costly hospital-based specialist NHS model. How may these new and old service models bereconciled?Poor lifestyle and chronic diseases are increasing, especially for thosesocially disadvantaged. Nearly 1/3 of the population now lives with a longterm condition, a minority of who are diagnosed early or managedoptimally.Many years of experience using continuous physiological recording inapplications from antenatal care, through infancy to chronic conditionssuch as COPD, heart failure and sleep disorders has demonstrated that acombination of ECG heart rate variability (HRV), breathing (chest andabdomen ), and activity recorded over 24 hour periods is powerful genericdiagnostic tool. It is an accurate individual guide to autonomic nervoussystem function, a risk stratifier for death and morbidity in many chronicdiseases, and diagnostic of sleep-related cardiorespiratory disorder whichcomplicates many chronic diseases (20% of diabetes, COPD to > 50 % ofpatients with CHF and hypertension). HRV has been increasingly used as aneffective biofeedback tool in stress management programs (e.g.

) which can reverse cardiovascular disease and as amarker of risk reduction and improvement of disease control.

fullyengaged scenario

rd

www.HeartMath.com

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The generic clinical value of these measurements has led to the inclusion ofsuitable sensors into a wireless garment that can be easily worn by publicand patients alike wherever they are in the community. The advent of bluetooth and GPRS mobile telephony has radically changed the scale and costof providing a telecare service across the community. Blue toothconnectivity for an increasing number of individual sensors, such as oxygensaturation, blood pressure, means that additional measurements can beadded as required using a mobile MDA platform to investigate and managespecific conditions. Experience using these continuous self monitoringtechnologies is that patients are compliant (90% of self made recordingsare successfully completed) and develop more ownership of their clinicaldataThe real challenge is how to package the results in a positive informingmanner so that more people will understand and value engaging in healthylifestyles. Equally health professionals in established health services wherehealth promotion and risk reduction have not been priorities have to makeradical changes in their knowledge base and practice. Innovative use of theinternet, proving to be a powerful data acquisition tool and informationresource, will be required to enable full advantage of the potential for selfmonitoring on a community wide scale.

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THE USE OF TELEMEDIA INTERVENTION IN THE FIGHT AGAINSTHIV/AIDS: IS IT WORKING?

CONCLUSION

email [email protected]

Molefi, M.L.; , M.A.; Olurunju, S.; Moshela, M.Medical Research Council South Africa

Telemedicine Lead Programme

METHODOLOGY. The Mindset Health Channel that has been disseminatingHIV/AIDS information via satellite is one amongst the few in the Africancontent. This project is available in about 100 health facilities in SouthAfrica. An evaluation of the broadcast HIV/AIDS content was conducted totest the effectiveness of this intervention. Questionnaires, interviews andobservations were conducted amongst 167 participants/patientscomprising of 2 groups - and , attending 4 healthcarefacilities in 3 provinces in South Africa. The participants were exposed todifferent content. The Control - viewed a normal drama series of daily lifewhile the Experimental watched a programme that focused on HIV/AIDStreatment and management. Data was analyzed using content, thematicanalysis and descriptive analysis using statistics (STATA 8).RESULTS. The preliminary results showed that the intervention was foundacceptable in terms of attitudinal and possible behavioral change. Positiveresults were noted with respect to understating the key medication areassuch as (a) common side effects of the antiretroviral medication, (b) CD4cell count and (c) willingness to disclose to family members. However therewas marginal change in knowledge of the respondents on (a) why ARVsshould 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.

. Findings showed that there is evidence of positive changeas results of this kind of programme however interpreting the side effects isstill low. Stigma continues to be a major hindrance in HIV/AIDS disclosure.

Kachienga

experimental control

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THE VIDEOCONFERENCE AS AN EDUCATIONAL STRATEGY TOTEACH NURSING

Leite M. M. J.; 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 amongdistant places. It has the purpose to communicate and it allows the use ofsound, texts and images. It is considered a technology that is very similar tothe traditional class, once it permits the interaction between the teacherand the students in real time. The aim of this study is to report the use of thevideoconference as a strategy to teach the discipline Nursing ManagementIII in the nursing graduation course of the Nursing School of USP (EEUSP).It is supported by the infrastructure of the discipline Telemedicine in theMedical School of USP This discipline is taught during the seventh semester,it has 315 hours and there are ninety students participating in it. Thepracticing fields were the School Hospital of USP, the Clinicas Hospital of theMedical School of USP and the School Health Center Samuel B. Pessoa.Seven meetings were done through videoconference connecting the threepracticing fields. The students and the nurses made presentations withcontents related to the management of the material, structure and humanresources. At the end, the teachers gave a short speech about the themesdiscussed. Through the videoconference the students were given theopportunity to experience a new educational technology and they couldalso identify the possibilities and difficulties related to this strategy thatbrings a new educational space to the discipline Management in Nursing.The videoconference contributes to the interaction among the practicingfields and it allows the teachers, students and nurses to exchangeexperiences, which facilitates the learning process and it can also becombined with other educational methods like person to person andthrough distance..

e-mail:

Peres H.H.C.;

[email protected]

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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 tohappen in the future and how far this future is. Thus, for example, there aresome doubts about surgery at distance whether it shall be an exception or amedical routine; however in the field of image diagnosis it is quite possiblythat there will be nothing else but Telemedicine in a future that may betomorrow. 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 bythe virtual world). The first mentioned problems are practically solved:Telemedicine is technically possible from a hospital localized in WashingtonDC to a mighty aircraft-carrier navigating in the Persian gulf; Telemedicinecost/benefit ratio is positive; Telemedicine's legal and ethical aspects havebeen studied and there are solid rules in many developed countries; thepatient-physician relationship is a fundamental issue and it has a lot to dowith the cultural aspects, however it must be always remembered that asvirtual medical assistance is better than none. But it must be recognizedthat the main cultural difficulty of Telemedicine: its virtual stigma.IN THIS LECTURE the virtual aspects of the real world or, if somebodyprefers, the reality of the virtual world, shall be discussed. It is generallyrecognized that cardiologists make unmistakable diagnoses by looking theelectric signs of the heart. Is the examination of an electrocardiogram real?Are histopathological images less virtual when observed through amicroscope than when analyzed on the screen of a computer? To see orlisten something through a man made device is so much virtual than if animage or sound comes from a source directly in our eyes or ears? Mostpeople accept that a binocular and a microphone belong still to the realworld and the TV and cellular phone do not. But why? Is there any logic inthis acceptance or it is only a superficial impression? Is the world less realto a bat than to a rat? The main question is whether there exists a realboundary between real and virtual. It is my personal opinion that the Real xVirtual problem is an ephemeral one; for the generation born digital it will benon existent and Telemedicine shall be part of our daily routine; it will be nomore virtual than diagnosis through an electrocardiogram or to speak overa phone.

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TOWARDS THE ENHANCEMENT OF A WEB ENVIRONMENT FORSURGICAL SKILLS TRAINING ON OTOLARYNGOLOGY (WESST OT)

Navarro Newball, A. A.- MSc ; Vélez Beltrán, J. A.- MD ; Múnera,L.E.S .- PhD; Garcia, G. B.- PhD

1. Pontificia Universidad Javeriana, Cali; 2. Colombia.ColombianTelemedicina Centre, Cali Colombia; 3. Universidad Icesi, Cali

Colombia; 4. DITEC, Universidad de Murcia, Spain.

KEYWORDS. surgery, simulation, virtual reality, otolaryngology,telemedicineINTRODUCTION. WESST OT's was designed to allow the practice of theFunctional Endoscopic Sinus Surgery (FESS). The objective of the advancespresented here is to enhance WESST OT in terms of realism, performanceand functionality.METHODS. A collaborative, inter-institutional and interdisciplinary work anda modular approach has been followed under an object orientedmethodology.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 designedusing the surgical tools module.A help system was implemented.Validations were done through the application of surveys in a medicalcommunity and performance was measured.The simulator was analysed from the technical and pedagogical point ofview.The GOMS model for graphic interface efficiency measurement was applied.A strategy for the WESST OT validation in a Latin American network wasdesigned.WESST OT is being extended with the use of a virtual reality glove, since it isa more natural interface.The co-ordination and the spatial positioning skills are under development.DISCUSSION. WESST OT demonstrates that cutting edge technologies likevirtual reality can be used in Latin America via Internet; However, it requiresfurther enhancement which increases its usefulness.Modular engineering not only contributes in the enhancement process ofWESST OT but also, the modular developments have shown to be usableindependently.

1,2 2,1

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TRANSFORMING GOLDEN HOUR TO GOLDEN MINUTES FORTRAUMA AND EMERGENCY CARE USING TELETRAUMA SYSTEM

1,2 1 2 3

3 3 2

1

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3

TM

Latifi, R.; Porter, J.; Holcomb, M.; Sproule, K.;Young, E.; Thornby, D.; Weinstein, R.

Department of Surgery, Trauma and Critical Care Section,University of Arizona, Arizona Telemedicine Program, Tucson,

Arizona, and Southeast Arizona Medical Center, Douglas, Arizona,USA

BACKGROUND. Recent technological developments have madepossible the implementation of teletrauma, telepresence, andteleresuscitation as integral part of modern trauma care.MATERIALS AND METHODS. The University Medical Center (UMC) inTucson Arizona, USA, is the only Level I trauma center in the SouthernArizona and treats 4500-5000 trauma patients a year from all southernArizona, northern Mexico, and other neighboring states. Incollaboration with the existing network of Arizona TelemedicineProgram (T1 line), the UMC has embarked on establishing the SouthernArizona Teletrauma (SATT) Program in attempt to narrow the gap oftrauma and emergency care of patients in rural Arizona and to ensuretelepresence of trauma surgeons 24/7 in all emergency rooms in theregion. Using Vitel Net Teletrauma system for audio, video andelectronic medical records transmission, Teletrauma system at the UMChas been active since November 21, 2004. The policies and procedures,educational programs and the protocols have been created andimplemented to ensure standardization of the consultations andteleresuscitation. RESULTS. The initial experience with teletrauma insaving lives, managing critically ill and injured trauma patients at therural site, or safely transferring when needed, and reducing the overallcost of trauma care has been rewarding and very successful. Theacceptance by trauma surgeons, referring physicians, nurses, andother providers, as well as patients, has been excellent. Other clinicalspecialties are making preparations and creating protocols to use thesystem as well. The telepresence of trauma surgeon, through theteletrauma system is being used to identify knowledge gaps and theneeds for instituting new outreach educational programs.CONCLUSION. Telepresence for trauma resuscitation can be performedsuccessfully and safely using telemedicine principles, when guided by atrauma surgeon. This has transformed the trauma concept of goldenhour to the golden minutestrauma surgeon. This has transformed thetrauma concept of golden hour to the golden minutes.

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UTILIZATION OF WEB-BASED TELECARE IN DENTISTRYMarta S.N.1; Sgavioli C. A. P.P. ; Sequeira E. ; Veronezi M.C. ;

Chao, L.W. ; Ferreira E.G.P.(1) Sacred Heart University, Bauru, São Paulo, Brazil. (2) Discipline ofTelemedicine, Medical School, University of São Paulo, São Paulo, Brazil.

The web-based telecare (cyberclinic) for consultation purposes in Dentistryaims at integrating resources to promote the learning and professionalupdating during clinical practice, allowing its utilization in several areas ofthe country as a tool for support to interconsultation, in family healthprograms, basic health centers, health campaigns and as a tool for longdistance triage. Developed by the discipline of Telemedicine of the MedicalSchool of USP, with support of the Teledentistry Sector of Universidade doSagrado Coração (USC), the system presents several modules: for sendingand evaluation of clinical cases; diagnostic support and updating of theprofessional; drug bank with drug interactions; epidemiological surveillancedata collection. As a pioneer system in the field of Dentistry, besidesutilization with undergraduate and graduate students, USC has alsoestablished partnerships with some institutions, such as Health Secretariatof Bauru, APCDBauru, and APAE-Jaú, and attempted to regulate itsutilization with CRO-SP. The following was performed: 1) 6 trainings forutilization of the tool with students and partner institutions; 2) at APAE-Jaú:reformatting of records, base don the clinical form proposed in thecyberclinic 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 allowedcorrection of some failures and improvement of the system. Its large scaleutilization will be a resource for updating and close contact between formerstudents and teaching centers of excellence, to benefit the patients

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“VIRTUAL CONSULT”Ricur, G.; Zaldivar, R.; Batiz, M. G.

Instituto Zaldivar. Mendoza, Argentina.

BACKGROUND. The new cyber era has enhanced global communication andprovided new opportunities for accessing medical care and knowledge. IPand video-conferencing technologies have brought together both patientsand doctors regardless of their distances. The objective of our project wasto provide eye care services, both online and thru video-conferencingsystems between our branches, enhancing our patient outreach.METHODS. Thru a hybrid telecommunication network, involving IP/ISDNconnectivity and videoconferencing systems, our patients had the chanceto either consult our specialists online or be examined at our telemedicinesuite in Buenos Aires by the consultants in Mendoza. These virtualophthalmic consultations were analyzed retrospectively measuring theimpact of the use of these new technologies with protocols designedspecifically for this project.RESULTS. Since its implementation, 5707 online consultations have beenregistered and 267 teleconsults (video-conference) have been performedbetween Buenos Aires and Mendoza.CONCLUSIONS. Information and telecommunication technologies play akey role in this new digital era. They have enabled the medical communityto enhance its outreach. Nevertheless, regardless of the tools used, virtualconsultations are ordinary consultations: physically different but ethicallythe same. Further development of standards and guidelines are required tohelp maintain virtual consultations safe from the never-ending growth ofemerging technologies.

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VIRTUAL MAN PROJECT IN DENTISTRYSoares, S 1; Sequeira, E. ; Malmström, M.F.V. ; Castilio, D. ;

Chao, L.W.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 PauloUniversity, based on the concepts of learning objects, makes images withmovements of high visual and didactic quality, developed by collaborationbetween health specialists and digital design professionals. In Dentistry,two titles were prepared up to 2005: Temporomandibular Joint and ToothStructure, made by an association of the Discipline of Telemedicine FMUSPand Sacred Heart University. After selection of a topic, an educational guideis developed and scientific bases are searched for construction of eachimage. The digital designers of the Discipline of Telemedicine FMUSPtransform the information in graphic representation. The three-dimensional images (height, width and volume) allow visualization ofanatomic structures with physiologic or pathologic movements. Thepossibility of three-dimensional visualization, establishment of anatomiccorrelations, 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 amountof information in a short time, increasing the educational efficiency. Afterconclusion of the work, these images are used to help the learning ofstudents and training of professionals. The perception of students andprofessors of USC in relation to this tool was positive. The development ofmodern iconographic resources facilitates the education.

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WEB-BASED FRAMEWORK FOR MANAGING THE OFFICIALMEDICAL CHECKS

Fregonara M. , Lombroso F.

One of the purposes of the Italian Local Health Authority (LHA), forterritorial health and social services, is to execute the Official MedicalChecks (OMC) asked by private and public Companies on sick employeessuspected of fraudulent ill-health. The LHA must guarantee that an OMC isperformed by an official Medical Examiner (ME) within two days. There is acomplex workflow to manage in terms of bureaucracy and health problems.The present project aims at creating a web-based framework to fullymanage the OMC workflows and to realise a database of all linkedinformation (organisation, healthcare, administrative and repayment).The framework replaces the paper-based procedures with a similar processsupported by information and communication technologies. The frameworkarchitecture is fully web-based, developed with web-programminglanguages, organised in three layers technology and divided into threenetworks: 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 theLHA database, via Internet. The framework certifies the correctness of thepersonal data by verifying it in the register of births. The LHA operatoraccepts the request and appoints it to the nearest ME where the employeelives. The framework automatically assigns a Medical Check ID (MCI) andsends 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 allthe OMC information (personal data, address, MCI, etc). After the visit theME inserts, via Extranet, all the sanitary and operative information(diagnosis, healthcare status, employee presence at home, etc). Theframework automatically sends to the Company an email containing theresults of the OMC request. Then a LHA operator inserts the administrativeinformation for the ME charge and for the repayment by the Company.The Companies can verify, via Internet, anytime the workflow status ofall their requested OMCs, the LHA operators can check, via Intranet, thestatus of all the OMC workflows and its related information, and also allthe MEs can verify, via Extranet, their assigned OMCs and related

(1) (1)

(1) Azienda Sanitaria Locale Provincia di Milano 3; Monza (Milan); Italy

information.

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information. Other framework features are the complete integration withthe LHA Account Software, so the OMC repayment information and the MEcharge are immediately processed, and the management, analysis andreporting of all the health OMC data. Particular care has been devoted in theframework to the safeguard of the citizen' privacy.Since summer 2004, the framework is running successfully (31655 requestsby 6372 Companies for 24013 employees) for submitting OMC requests, forglobal managing of its workflows and for analysing all its information(organisational, administrative, healthcare and repayment). The proposedframework represents a demonstrator of a possible usage of ICTtechnologies to improve and to spread health and social services.

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LEVELLING THE PLAYING FIELD - THE ROLE OF GLOBAL E-HEALTHIN 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 relatedactivities will be to truly develop the entity of 'global e-health'. However, it isalready recognised that e-health represents both promise and peril as it isapplied in addressing various 'divides'. One such divide relates to the healthof individuals, and the health status of populations, which vary widely. Anumber of factors contribute to this variation, including socio-economicstatus, occupation, gender, age, ethnicity, culture, behaviour, geography,healthcare practice ('small area variation'), healthcare administration,disease prevalence, and poor global health information flow. Whensignificant imbalance occurs, such variation is often termed inequality orinequity. These terms are sometimes used interchangeably, but theirdifferentiation is important. Inequality and equality have been described asdimensional concepts that refer to measurable quantities. In contrastinequity and equity are considered political concepts that express a moralcommitment to social justice. According to EQUINET, inequity in health is“those differences in health status that are unnecessary, avoidable, andunfair”. Inequality in healthcare is not an issue for developing countriesalone - a significant disparity has always existed in developed countries interms of geographic location. Those who live in an urban area have greaterand timelier access to healthcare services than do those in rural or remoteareas. The impact in terms of inequality and inequity - can be profound. Thesituation is compounded in developing countries that must also strugglewith fundamentally poor healthcare infrastructure and funding constraints.Opportunities to overcome, or at least minimise, sources of inequality andinequity already exist at the practice, program, and policy levels. Can globale-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 variationacross subgroups of practitioners may be identified as a factor contributingto inequality. A variety of e-learning options exist (training, mentorship,continuing education) that, if determined to be appropriate, can beimplemented through specific voluntary or mandatory educational(practice), training (program), or standardisation (policy) interventions. Butissues also arise.

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For example, e-health has the potential to exacerbate as well as ameliorateinequality to broaden the 'digital divide' (and other divides). Poorer peopleare generally most in need of healthcare support, yet they are the groupleast likely to have access to rapidly advancing technological solutions. Ourchallenge is to identify, develop, and apply culturally appropriate, broadlyavailable e-health solutions, and to concurrently develop the population andprofessional skills necessary to use them. In this regard, global e-healthalone will not suffice. To impact other determinants that affect individual andpopulation health, such as literacy and employment skills, it will benecessary to develop initiatives that work in concert, developing e-learningand e-business opportunities concurrently with e-health applications. Toachieve this, a systematic approach is required. One that includes:identification of the magnitude of health gradients, needs and readinessassessment, determination of whether e-health is a viable option, and finallyimplementing and assessing the impact of any global e-health solution.Such a process would be equally applicable and valuable to developingcountries as to developed countries, but the context and solutions would bedifferent. Applying this approach will allow appropriate e-health solutions tobe applied in reducing inequality and inequity wherever it is found, andthereby help level the playing field for the health of the world's population.

INDICE/INDEX

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