Ethical problems in nursing teleconsultations for people living with HIV during the Covid-19 pandemic

OBJECTIVES

to understand the ethical problems experienced by primary health care nurses in using nursing teleconsultations for people living with the human immunodeficiency virus during the coronavirus pandemic.

METHODS

qualitative research, anchored in Constructivist Grounded Theory. Data was collected between July and September 2020, with 17 participants.

RESULTS

the first category highlights the ethical problems in conducting teleconsultations, managing high demand, communication barriers, and risks related to data security. The second emphasizes the potential of teleconsultations in communication and access, by generating changes in the work process and the use of protocols to guide clinical practice.

CONCLUSIONS

nurses' work in digital mode requires professional qualification, with a view to stimulating reflection on teleconsultation practice, ethical-moral deliberation and combating stigma, and also adopting data security-centered conduct.

Comparing wildlife habitat suitability models based on expert opinion with camera trap detections

Expert knowledge is used in the development of wildlife habitat suitability models (HSMs) for management and conservation decisions. However, the consistency of such models has been questioned. Focusing on 1 method for elicitation, the analytic hierarchy process, we generated expert-based HSMs for 4 felid species: 2 forest specialists (ocelot [Leopardus pardalis] and margay [Leopardus wiedii]) and 2 habitat generalist species (Pampas cat [Leopardus colocola] and puma [Puma concolor]). Using these HSMs, species detections from camera-trap surveys, and generalized linear models, we assessed the effect of study species and expert attributes on the correspondence between expert models and camera-trap detections. We also examined whether aggregation of participant responses and iterative feedback improved model performance. We ran 160 HSMs and found that models for specialist species showed higher correspondence with camera-trap detections (AUC [area under the receiver operating characteristic curve] >0.7) than those for generalists (AUC < 0.7). Model correspondence increased as participant years of experience in the study area increased, but only for the understudied generalist species, Pampas cat (β = 0.024 [SE 0.007]). No other participant attribute was associated with model correspondence. Feedback and revision of models improved model correspondence, and aggregating judgments across multiple participants improved correspondence only for specialist species. The average correspondence of aggregated judgments increased as group size increased but leveled off after 5 experts for all species. Our results suggest that correspondence between expert models and empirical surveys increases as habitat specialization increases. We encourage inclusion of participants knowledgeable of the study area and model validation for expert-based modeling of understudied and generalist species.

[Telephone assistance for neurological diseases: a systematic review]

INTRODUCTION AND OBJECTIVE

While part of the care for neurological patients is done by telephone, it is not well known what neurological diseases and which part of that care is provided by telephone. Our goal is to find it out through a bibliographic review.

MATERIALS AND METHODS

References on telephone care for neurological diseases accessible through the PubMed, Embase, and Cochrane platforms have been systematically reviewed, with an unspecified start date and up to March 2022. We found 618 references, and as 219 did not pass the exclusion criteria, 399 were finally included in the review.

RESULTS

Dementia is the area of neurology with more publications about its telephone assistance. It is followed by stroke, head trauma, multiple sclerosis, Parkinson's disease and movement disorders, epilepsy, neuromuscular disorders, and others.

DISCUSSION AND CONCLUSIONS

Dementias are the diseases with more bibliographic references on their telephone assistance despite not being the most prevalent. The telephone is frequently used to administer diagnostic scales or support caregivers and is particularly useful in diseases that limit mobility and attending a medical practice.

Clinical Features and Management of Patients Assessed by Cardiology Teleconsultation in the Brazilian Region with the Highest Number of Isolated Cities

BACKGROUND

Cardiovascular diseases are the leading cause of adult mortality. Geographically remote and low-income Brazilian regions lack specialized consultations. The telemedicine management of this population by cardiologists is not fully known.

OBJECTIVES

To analyze cardiology teleconsultation in the Brazilian region with the highest number of isolated cities.

METHODS

From February 2020 to October 2021, patients from the North Region of Brazil evaluated by local general practitioners were referred for cardiological evaluation by telemedicine. Referral reasons, demographics, clinical history, physical examinations, tests, medications, and prescriptions pre- and post-telemedicine were analyzed (p<0.05 was considered statistically significant).

RESULTS

We analyzed 653 patients. The attendance rate was 85.7% (53.1% female, mean age: 54.2±6.5 years). The main reasons for referral were cardiovascular symptoms (58.1%) and risk factors among asymptomatic patients (13.3%). Only 12.6% had a diagnosed disease. Most patients had regular physical examinations and electrocardiograms. Few had recent complementary tests. The prescription of angiotensin receptor blockers (ARBs), calcium channel blockers and statins was significantly increased, while that of digoxin, noncardiac beta-blockers and acetylsalicylic acid (ASA) was decreased at the first teleconsultation. Most of the tests requested were of low complexity and cost: electrocardiogram (28.2%), chest X-ray (14%), echocardiogram (64.5%) and blood tests (71.8%). For 2.1% of patients, interventions were indicated, and 8% were discharged after the first consultation.

CONCLUSION

On-demand cardiology teleconsultation contributes to heart disease treatment optimization. Most patients were referred with syndromic diagnoses without previous complementary tests. The specialist workup requested was usually available locally and at a low cost but precluded early discharge. Local training could optimize the referral.

Feasibility of telemedicine for patients with parkinsonism in the Brazilian public health system

BACKGROUND

Telemedicine for patients with parkinsonism is feasible, cost-effective and satisfactory. However, the feasibility of this modality of care for this subpopulation is not known in real-life scenarios of developing countries like Brazil.

OBJECTIVE

To evaluate the feasibility of telemedicine for patients with parkinsonism in a developing country.

METHODS

A cross-sectional study with patients with parkinsonism treated in the Brazilian public healthcare system. We included 130 patients, who were contacted by telephone; those who could be reached underwent a structured interview for data collection. The primary outcomes were the feasibility of teleconsultations and video consultations, but we also performed a logistic regression regarding the feasibility of a video consultation and associated factors.

RESULTS

Telemedicine was feasible and accepted by 69 (53.08%) patients regarding teleconsultations and by 50 (38.5%) patients regarding video consultations. Teleconsultations were feasible for 80.2%, and video consultations were feasible for 58.1% of the patients reachable through telephone calls. Having a higher family income was positively correlated with the feasibility for a video consultation while a negative association was observed regarding being married or in a stable union and having a low level of schooling.

CONCLUSIONS

A significant proportion of patients with parkinsonism in a developing country are unreachable, unwilling, or unable to participate in telemedicine. Among the reachable patients, feasibility is higher but still lower than what is reported in studies in developed countries. Family income, level of schooling, and marital status were associated with the feasibility of video consultations.

Telemedicine in neurology: advances and possibilities

BACKGROUND

Telemedicine develops from technology that offers opportunities for knowledge transfer and information sharing and allows the provision of health services at a distance.

OBJECTIVE

To evaluate the number of publications on teleneurology in the last two decades in PubMed and the available evidence on the use of this technology in neurological clinical conditions.

METHODS

A quantitative assessment of publications related to telemedicine and neurology in the last two decades. A search was performed on the PubMed database for the descriptors ("Telemedicine"[Mesh]) AND "Neurology"[Mesh]). A review of the articles retrieved on the topic was carried out to evaluate the innovation processes used and applications in various clinical conditions involving teleneurology.

RESULTS

The search performed on March 14th 2022 resulted in 229 publications involving the topic of telemedicine and neurology between 1999 and 2022. Since 2000, there has been an increase in publications related to this topic, with a peak of 71 articles published in 2020, the year in which the World Health Organization defined the COVID-19 pandemic status.

CONCLUSION

In the last two decades, teleneurology has been developing through the expansion of technological resources and the COVID-19 pandemic intensified this process. Different modalities of teleneurology are studied in several neurology subfields and include teleconsultation (between healthcare professionals or between healthcare professionals and patients), telerehabilitation, telemonitoring and tele-education. The advances achieved by teleneurology in this period encouraged technological innovations and health processes that developed opportunities to improve the care provided in a mechanism of constant evolution.

Telemedicine: contributions, difficulties and key factors for implementation in the prison setting

Information and communication technologies are transforming the way we understand health, via a hyper-connected world in which patients, professionals and society take on new challenges and roles. This change is creating an ecosystem called connected health, in which telemedicine acquires special importance when distance (not only geographical), is a critical factor. It can respond to financial, social or safety needs or questions of dignity, as is the case with prisoners when they are transferred handcuffed and under custody to hospitals. Bringing health services closer to patients who cannot autonomously travel contributes towards humanising healthcare. Tele-consultations, long-distance encounters between patients and health professionals, reduce the direct and social costs inherent to habitual clinical practice and are very highly valued by patients in prison. Despite its potential benefits in the prison setting, the implementation of telemedicine in Spain continues to be scarce and irregular, which, amongst other things, is due to a lack of awareness of this healthcare practice, the severe shortage of resources currently endemic to the prison health service system and the lack of interoperability solutions for clinical information between the healthcare administration and the prison health services, which unfortunately continue to depend on an organisation outside the healthcare ambit (the Ministry of Home Affairs), despite the legal provisions requiring them to be fully integrated into regional health services. The SARA (Administration Applications and Networks Systems) Network and the Reúnete© Service offer solid, secure, free technology is available to all prisons, to set in motion telemedicine programs at a nationwide level.

[Evaluation of the teleconsultation process from the perspective of the provider (Oaxaca Telehealth Program, Mexico)]

OBJECTIVE

Identify barriers to implementation of the teleconsultation process in order to develop strategies to improve the program's operation.

METHODS

A process evaluation strategy was used to study the implementation of the teleconsultation service. The program's operating manuals were compared with the qualitative and quantitative information compiled on the practical implementation of the teleconsultation process.

RESULTS

The factors reported as obstacles to the teleconsultation process were: slow Internet connection, the hours available to the public, the specialized services offered, and insufficient clinical history included in teleconsultation requests. It was determined that 60% of internal medicine patients received two or more teleconsultations in the study period, as did 44% of patients of the gynecology service. Four consulting medical units accounted for 75% of the teleconsultations and the rest were distributed among 12 medical units.

CONCLUSIONS

The barriers identified in the teleconsultation process mainly affect consulting physicians; even so, productivity is on an upward trend. Despite the existing barriers, it was determined that some patients receive follow-up through the program, which favors access to care. It is necessary to standardize implementation and to conduct subsequent research on patients' health condition.

[Evaluation of the teleconsultation process from the perspective of the provider (Oaxaca Telehealth Program, Mexico)]

OBJECTIVE

Identify barriers to implementation of the teleconsultation process in order to develop strategies to improve the program's operation.

METHODS

A process evaluation strategy was used to study the implementation of the teleconsultation service. The program's operating manuals were compared with the qualitative and quantitative information compiled on the practical implementation of the teleconsultation process.

RESULTS

The factors reported as obstacles to the teleconsultation process were: slow Internet connection, the hours available to the public, the specialized services offered, and insufficient clinical history included in teleconsultation requests. It was determined that 60% of internal medicine patients received two or more teleconsultations in the study period, as did 44% of patients of the gynecology service. Four consulting medical units accounted for 75% of the teleconsultations and the rest were distributed among 12 medical units.

CONCLUSIONS

The barriers identified in the teleconsultation process mainly affect consulting physicians; even so, productivity is on an upward trend. Despite the existing barriers, it was determined that some patients receive follow-up through the program, which favors access to care. It is necessary to standardize implementation and to conduct subsequent research on patients' health condition.