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2022 ◽  
Vol 22 (1) ◽  
Author(s):  
José María Pego-Reigosa ◽  
Carlos Peña-Gil ◽  
David Rodríguez-Lorenzo ◽  
Irene Altabás-González ◽  
Naír Pérez-Gómez ◽  
...  

Abstract Objective To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. Methods The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. Results The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). Conclusion A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.


Iproceedings ◽  
10.2196/35438 ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. e35438
Author(s):  
Juan Carlos Palazón Cabanes ◽  
G Juan Carpena ◽  
L Berbegal García ◽  
T Martínez Miravete ◽  
B Palazón Cabanes ◽  
...  

Background Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. Objective This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. Methods We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. Results We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. Conclusions TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome. Conflict of Interest None declared.


2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Eduardo Alfredo Schäefer ◽  
Elisa Sousa Carmona ◽  
Gabriela Pereira Mehret ◽  
Karina do Valle Marques ◽  
Mayara Lucia Webber ◽  
...  

The dissection belongs to the medical teaching-learning process since ancient times. However, due to the generalization of the practice, the demand for corpses increased so that control of their origin was lost several technological tools are used in the learning of human anatomy, such as anatomical tables and 3D printed organs, which are complementary to a good practice in the field of health. This study report an experience of four medical students performing a practical dissection immersion in neuroanatomy, as well as their perceptions about the evolution of knowledge of the brain structural characteristics. In a maximized perception, it was felt the need to combine ways to teach neuroanatomy in order to unite the theory with the real perception of the organs, enabling an anatomical and physiological understanding close to reality. The use of anatomical atlases in drawings or photographed images is the most traditional study tool and with technological development, digital tools have been gaining ground in this educational scenario. However, the oldest way to study anatomy, visual exploration and dissection of the human body, will always make a great contribution to the study of neuroanatomy. Nonetheless, access to biological materials, for well-founded ethical reasons, is becoming increasingly rare, that is why students who experience these experiences are able to transform the knowledge obtained from unique opportunities into teaching materials accessible to academics in the health area.


Author(s):  
Alexis Oliva ◽  
Néstor Armas ◽  
Sandra Dévora ◽  
Susana Abdala

Abstract This study is an evaluation of prescription opioid use on the island of La Gomera, a mainly rural area, during the period 2016–2019 at various levels. Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses per 1,000 inhabitants/day (DID) and by the number of units sold per 1,000 inhabitants and year (units sold). This provided an island total of La Gomera’s overall prescription of opioids and its rate of change, as well as differences in prescribing at the municipal and health area level. Tramadol with acetaminophen and tramadol in monotherapy were the most consumed by “units sold” parameter, which accounted for 69.48% and 18.59% of the total. The situation was similar for DID, although with lower percentages, but a significant increase was observed in the use of fentanyl and buprenorphine, around 15% in each case. The balance between the uses of weak or strong opioids was different in La Gomera compared to that of Spain as a whole. In Spain, almost 70% of the prescriptions were for weak opioids compared to 58.67% in La Gomera. Fentanyl was the most used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera, buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in prescription opioid use are most likely explained by prescriber characteristics, whereas the population age, socioeconomic status, or living in rural/urban area are not decisive determinants.


2021 ◽  
Author(s):  
Juan Carlos Palazón Cabanes ◽  
G Juan Carpena ◽  
L Berbegal García ◽  
T Martínez Miravete ◽  
B Palazón Cabanes ◽  
...  

BACKGROUND Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. OBJECTIVE This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. METHODS We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. RESULTS We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. CONCLUSIONS TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome.


BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052817
Author(s):  
Alexis Sentís ◽  
Marcos Montoro-Fernandez ◽  
Evelin Lopez-Corbeto ◽  
Laia Egea-Cortés ◽  
Daniel K Nomah ◽  
...  

ObjectivesTo describe the epidemiology of sexually transmitted infections (STIs), identify and characterise socio-epidemiological clusters and determine factors associated with HIV coinfection.DesignRetrospective population-based cohort.SettingCatalonia, Spain.Participants42 283 confirmed syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum cases, among 34 600 individuals, reported to the Catalan HIV/STI Registry in 2017–2019.Primary and secondary outcomesDescriptive analysis of confirmed STI cases and incidence rates. Factors associated with HIV coinfection were determined using logistic regression. We identified and characterized socio-epidemiological STI clusters by Basic Health Area (BHA) using K-means clustering.ResultsThe incidence rate of STIs increased by 91.3% from 128.2 to 248.9 cases per 100 000 population between 2017 and 2019 (p<0.001), primarily driven by increase among women (132%) and individuals below 30 years old (125%). During 2017–2019, 50.1% of STIs were chlamydia and 31.6% gonorrhoea. Reinfections accounted for 10.8% of all cases and 6% of cases affected HIV-positive individuals. Factors associated with the greatest likelihood of HIV coinfection were male sex (adjusted OR (aOR) 23.69; 95% CI 16.67 to 35.13), age 30–39 years (versus <20 years, aOR 18.58; 95% CI 8.56 to 52.13), having 5–7 STI episodes (vs 1 episode, aOR 5.96; 95% CI 4.26 to 8.24) and living in urban areas (aOR 1.32; 95% CI 1.04 to 1.69). Living in the most deprived BHAs (aOR 0.60; 95% CI 0.50 to 0.72) was associated with the least likelihood of HIV coinfection. K-means clustering identified three distinct clusters, showing that young women in rural and more deprived areas were more affected by chlamydia, while men who have sex with men in urban and less deprived areas showed higher rates of STI incidence, multiple STI episodes and HIV coinfection.ConclusionsWe recommend socio-epidemiological identification and characterisation of STI clusters and factors associated with HIV coinfection to identify at-risk populations at a small health area level to design effective interventions.


Author(s):  
Denisse Parra-Giordano ◽  
Denisse Quijada Sánchez ◽  
Patricia Grau Mascayano ◽  
Daniela Pinto-Galleguillos

Background: The concept of Quality of Work Life (QWL) has been built multidimensionally through social reproduction; it is impacted by the perceptions of each individual and by the relationship between workers and the work environment. Objective: to analyze the Work Process and QWL of assisting nurses in public health. Methods: Research in a critical paradigm, descriptive, exploratory with a qualitative approach. The population corresponds to Nurses who work in care work. Semi-structured guiding questions were applied and were analyzed with content analysis. Results: seven participants declared female; all Chilean; seven are young adults; six singles; only one has children, and one has a person dependent on her care; six are heads of household, and five receive help with housework. All have a nursing degree, five have a diploma, but none have a postgraduate. Work Process has three subcategories: work object, instrument, organization, and work conditions; the QWL category has six subcategories: definition and perception of QWL, QWL potentiating factors, QWL exhausting factors, QWL improvement strategies, the emotional burden associated with QWL, and Health problems. Conclusions: In this way, the lifestyle built by the assistance in the health area has repercussions on the quality of life and health in general.


Conjecturas ◽  
2021 ◽  
Vol 21 (6) ◽  
pp. 410-426
Author(s):  
Isabela Miranda Gonçalves ◽  
Brenda Chayná do Nascimento Pereira ◽  
Cassiane Nogueira Santos ◽  
Shirley Maria de Araújo Passos ◽  
Waldeyde Oderilda Magalhães dos Santos ◽  
...  

The present work is an integrative review that aims to answer the following guiding question: how is virtual reality being applied as an educational technology in the health area? The databases used for the search were Pubmed, Virtual Health Library (VHL) in the health area, IEEEXplore and ACM Digital Library in the technology area. For this work, the following inclusion criteria were established: studies on the use of simulators as educational technology; free access articles; be available online in full; be in Portuguese and / or English; published from 2015 to 2020. Articles of literature review, dissertations, theses and editorials were excluded. A total of 1,563 articles were obtained, of which 21 went on to descriptive analysis. Most of the articles came from the Pubmed database, fourteen, six articles were added from the VHL and only one study was included from the ACM. The discussion of the results emerged from two categories: Characterization of the use of virtual reality in the area of health and Considerations on the applicability of virtual reality in the area of health. As a contribution, this review may serve as a guide for the expansion of virtual reality, while pointing out the potential and weaknesses of its use as training technology in the health area.


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