Publications by authors named "Magdala de Araújo Novaes"

14 Publications

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Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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http://dx.doi.org/10.1055/s-0041-1726484DOI Listing
April 2021

Advances in obstetric telemonitoring: a systematic review.

Int J Med Inform 2020 02 7;134:104004. Epub 2019 Oct 7.

Center of Medical Sciences, Federal University of Pernambuco, UFPE, Brazil; Telehealth Center, Clinical Hospital, Federal University of Pernambuco, UFPE, Brazil. Electronic address:

Background: Obstetric telemonitoring can improve gestational care, reducing the need fortravel, and can be used in different contexts to enable early detection of complications and prevention of intercurrences, providing local intervention before hospitalization.

Objective: This paper aims to identify advances, contributions and limitations of obstetric telemonitoring using mobile technologies.

Methods: A systematic review was performed on the Pubmed, Medline, LILACS, Cochrane, Scielo, Embase, ACM Surveys, and IEEE databases, from 2008 to 2018. PRISMA and CASP were used to analyze methodological rigour.

Results: 26 papers were included. The majority of the studies related to pregnant women, prenatal care, high-risk pregnancies and homecare. Only 2 articles related to postpartum and none related to delivery. Among the technological resources, the articles presented smartphone applications, which interact with external telemonitoring devices (such as electrodes attached to the body and thermometers) or request information about maternal and / or fetal health status. Based on those devices, decision-making by health professionals is more reliable, since data is obtained by digital devices that have a greater accuracy. The variety of studies is enormous and achieve promising results. However, there are still important gaps to be addressed. Many studies only cover isolated aspects of maternal health, e.g. blood pressure, which somehow limits clinical decision-making. All authors have described concerns about usability, but not all of them had actually performed usability tests. Interventions through obstetric telemonitoring can be applied to a wide range of domains, at various levels of healthcare complexity. There are still few investments in studies in developing countries, where maternal and fetal morbidity and mortality are higher.

Conclusion: The area of obstetrical telemonitoring has a great potential for contributing with better gestational outcomes, early detection of complications, prevention of intercurrences, providing local intervention even before hospitalization. Development of obstetric telemonitoring systems wich collect complete obstetric parameter integrated with the periods of childbirth and postpartum is recommended.
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http://dx.doi.org/10.1016/j.ijmedinf.2019.104004DOI Listing
February 2020

Improving Education of Medical Students Through Telehealth.

Stud Health Technol Inform 2019 Aug;264:1917-1918

Telehealth Center, Clinics Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil.

Telehealth can be used in medical education to promote teaching-service integration as a low-cost solution to broaden the field of medical practice, especially in rural areas of low and middle-income countries. This article presents our experience in the use of telehealth to broaden the practice field of medical students. In 2017, two itinerants' actions were carried out in municipalities in the state of Pernambuco. In both actions, 396 patients were assisted by a team of professionals, teachers and students in various specialties, with emphasis on mental health and dermatology. 9 students experimented with the use of an electronic patient record system, telehealth platform and a mobile application for tracking of disorders and diseases. The students reported high satisfaction with digital distance practices, and the enrichment of their learning. This digital approach to medical education has fostered greater collaboration among students, faculty and staff, teaching students the skills necessary for their future digital practices.
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http://dx.doi.org/10.3233/SHTI190712DOI Listing
August 2019

Prototype of Care Application for Obstetric Telemonitoring of Hypertensive Syndromes in High Risk Pregnancy.

Stud Health Technol Inform 2019 Aug;264:1769-1770

Telehealth Center, Clinics Hospital, University Federal of Pernambuco, Recife, Pernambuco, Brazil.

This article describes the development of a prototype application for obstetric telemonitoring of hypertensive syndromes during pregnancy. A workflow was elaborated with the conduct for gestational hypertensive syndromes. Subsequently, prototyping was performed using Balsamiq. The prototype presents daily monitoring of blood pressure, signs and symptoms, displays accompanying charts, and generates alerts when there are changes to more or less the normal values, which are sent to the pregnant woman and the health professional.
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http://dx.doi.org/10.3233/SHTI190639DOI Listing
August 2019

An Obstetric Application Architecture for Information, Diagnosis and Control of Diabetes in High Risk Pregnancy.

Stud Health Technol Inform 2019 Aug;264:778-782

Telehealth Center, Clinical Hospital, Federal University of Pernambuco, Recife, Pernambuco, Brazil.

Hyperglycemia associated with pregnancy has been related to several unfavorable perinatal outcomes, as well as to the increase of incidence on future complications. Thus, the diagnosis of hyperglycemia in the pregnancy-puerperal context should be a global health concern. This article presents the development of a mobile application prototype which informs, imparts accurate diagnosis and provides tools for obstetric telemonitoring in women with pregnancy associated diabetes. After detailed analysis of the proposals for a new diagnostic strategy considering possible scarcity of resources, key elements were selected and inserted into the prototype, in order to cater for the most aspects and make it as thorough as possible. The application has been adapted to the Brazilian reality, however, having adjustments in compliance with international protocols, it has the potential to be used worldwide.
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http://dx.doi.org/10.3233/SHTI190329DOI Listing
August 2019

Providing Telehealth Services to a Public Primary Care Network: The Experience of RedeNUTES in Pernambuco, Brazil.

Telemed J E Health 2016 08 8;22(8):694-8. Epub 2016 Mar 8.

1 Telehealth Center, Clinics Hospital, Federal University of Pernambuco , Recife, Brazil .

Background: Information technologies have been applied in primary care domains to improve the delivery of health services. This article reports the telehealth network experience in Pernambuco, Brazil.

Materials And Methods: Five different data sets were used, one by each service and the structural aspects of the network, collected from 2008 until August 2015. The data include solicited themes for educational activities, users' evaluation of services, numbers of sites, municipalities participating, participants in tele-education activities, teleconsultations, telediagnosis, and remote screenings. The analysis was done in absolute and percentage values using Microsoft Excel (version 2007).

Results: The indicators show high utilization of tele-education resources, followed by the teleconsultation service. The synchronous modality was the most used and the general clinical question was the most frequent type of question. Nurses are the professional category that most used the teleconsultation services (36%). Telediagnosis of electrocardiography has growth utilization, overcoming teleconsulting more recently. The satisfaction rate was 89%, and 68.5% of professionals changed their planning to patients' referrals to specialists.

Conclusions: Telehealth has been considered effective since it avoids inappropriate referrals of the patient and provides continuous actualization to health professionals. Our results provide evidence of the feasibility and importance of using telehealth as a tool to ensure the universality, equality, and completeness in the health system.
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http://dx.doi.org/10.1089/tmj.2015.0209DOI Listing
August 2016

[Analysis of the implementation of the TeleHealth Program in Pernambuco State, Brazil: a case study].

Cad Saude Publica 2015 Nov;31(11):2379-89

Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil.

The Network of TeleHealth Centers (RedeNutes) is part of the TeleHealth Brazil Program and conducts activities for the Family Health Strategy through the telecare and teleeducation services. The objective of this study was to evaluate the degree of implementation of RedeNutes in six municipalities (counties) in Pernambuco State. This was an evaluation study analyzing implementation in the second component, referring to analysis of the impact of implementation on the observed effects, backed by the multiple case study strategy. The analysis involved the manager, municipal, and global dimensions and their components: planning, development, portal, telecare, and teleeducation. In the Manager dimension, the degree of implementation was considered implemented; in the Municipal and Global dimensions, partially implemented; in the TeleCare component it was not implemented. In conclusion, TeleHealth can help improve comprehensive healthcare for the assisted population, but it requires overcoming problems with adherence to the intervention, especially in TeleCare.
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http://dx.doi.org/10.1590/0102-311X00125914DOI Listing
November 2015

A Comparison between LMS tools to support e-health educational activities.

Stud Health Technol Inform 2015 ;216:1125

Núcleo de Telessaúde, Hospital das Clínicas, Federal University of Pernambuco, Recife, PE, Brazil.

The objective of this study is to understand how a Learning Management System (LMS) plataform is used in a telehealth center to support two virtual learning enviroments focused on the education of the healthcare professionals and the students of a medical schoool. The study outcome is expected to provide indications towards choosing a better LSM for the telehelath center to support their educacional activities.
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March 2016

Validation of Minimum Data of Archetyped Telehealth Clinical Report for Monitoring Prenatal Care.

Stud Health Technol Inform 2015 ;216:64-8

Telehealth Center of Pernambuco, Federal University of Pernambuco (NUTES/ UFPE), Pernambuco, Brazil.

Studies on the validation of minimum data sets from international information standards have drawn the attention of the academic community to the identification of necessary requirements for the development of Electronic Health Records (EHRs). The primary motivation of such studies is the development of systems using archetypes. The aim of this study was to validate the minimum data set that should be used when constructing an archetyped EHR for prenatal care applications in telehealth. In order to achieve this, a data validation tool was built and used by nine expert obstetricians. The statistical analysis employed was the percentage of agreement and the content validity index. The study was conducted in three steps: 1) Literature review, 2)Instrument development, and 3) Validation of the minimum data set. Of the 179 evaluated pieces of data, 157 of them were validated to be included in the archetyped record of the first prenatal consultation, while 56 of them were allocated for the subsequent consultation record. The benefit of this research is the standardization (data validation for an archetyped system) of prenatal care, with the perspective of employing, both nationally and internationally, an archtyped telehealth system.
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March 2016

Representing second opinion requests from primary care within the Brazilian tele-health program: international classification of primary care, second edition.

Stud Health Technol Inform 2013 ;192:1190

School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.

Standardization of second opinion question-answer pairs with a classification system can be used to facilitate data sharing and reuse. The Brazilian telehealth program faces the problem of representing biomedical knowledge from the primary care second opinion demands generated by rural health care teams. The objective is to determine if one of the medical classification systems has a superior ability to standardize Portuguese-language second opinion question-answer pairs. Data from 2,638 second opinions from 2010 were randomly reduced to a 264 question-answer pair data set. The semantic meaning of the question-answer pairs was manually assigned to an International Classification of Primary Care, Second edition (ICPC2) code. Eight question-answer pairs did not contain sufficient medical semantic meaning to allow for mapping to an ICPC2 code; 53 question-answer pairs did contain sufficient medical semantic meaning for mapping, however an appropriate ICPC2 code did not exist; and 203 question-answer pairs did contain sufficient medical semantic meaning for mapping to an ICPC2 code. A review of the literature indicates that there is no baseline to compare the 77% success rate against.
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April 2015

A telehealth strategy for increasing adherence in the treatment of hypertension in primary care.

Telemed J E Health 2013 Apr 19;19(4):241-7. Epub 2013 Mar 19.

Nephrology Division, Hospital das Clínicas, Federal University of Pernambuco, Recife, Pernambuco, Brazil.

Objective: This study describes and analyzes a telehealth strategy for Family Health Teams (FHTs) providing primary care services. This strategy aimed to increase the adherence to the treatment of hypertension.

Subjects And Methods: We conducted a before-after study that enrolled 21 professionals and 502 hypertensive patients in two of the Family Health Units connected to our Telehealth Center Network. Seminars addressing the treatment adherence of hypertension were offered by Web conferences, for a period of 6 months, to the FHTs. The adherence to antihypertensive drugs, low salt diet, and physical activity was measured by specific questionnaires. The rates of adherence were assessed before and after a continuing education program (CEP). After the telehealth intervention, 17 professionals and 465 patients were re-evaluated.

Results: The participation in the question and answer session, after the seminar, was significant. The qualitative evaluation of the sessions by FHTs showed 87.5% of great/good. There was a trend toward a greater critical understanding of the results and targets set for the team, although at insignificant levels. The rates of adherence to antihypertensive medication, physical activity, and sodium control, before and after the CEP, were 37.8% versus 46.7% (p<0.004), 90.3% versus 89.9% (p=0.90), and 92.2% versus 96.3% (p<0.001), respectively.

Conclusions: The adherence to antihypertensive drugs and low salt diet improved after the CEP. Preliminarily, this telehealth strategy suggests a positive impact on hypertensive patients.
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http://dx.doi.org/10.1089/tmj.2012.0036DOI Listing
April 2013

Designing human centered GeoVisualization application--the SanaViz--for telehealth users: a case study.

Technol Health Care 2012 ;20(6):473-88

Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68164, USA.

Background: Public health data is typically organized by geospatial unit. GeoVisualization (GeoVis) allows users to see information visually on a map.

Objectives: Examine telehealth users' perceptions towards existing public health GeoVis applications and obtains users' feedback about features important for the design and development of Human Centered GeoVis application "the SanaViz".

Methods: We employed a cross sectional study design using mixed methods approach for this pilot study. Twenty users involved with the NUTES telehealth center at Federal University of Pernambuco (UFPE), Recife, Brazil were enrolled. Open and closed ended questionnaires were used to gather data. We performed audio recording for the interviews. Information gathered included socio-demographics, prior spatial skills and perception towards use of GeoVis to evaluate telehealth services. Card sorting and sketching methods were employed. Univariate analysis was performed for the continuous and categorical variables. Qualitative analysis was performed for open ended questions.

Results: Existing Public Health GeoVis applications were difficult to use. Results found interaction features zooming, linking and brushing and representation features Google maps, tables and bar chart as most preferred GeoVis features.

Conclusions: Early involvement of users is essential to identify features necessary to be part of the human centered GeoVis application "the SanaViz".
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http://dx.doi.org/10.3233/THC-2012-0697DOI Listing
May 2013

A human centered GeoVisualization framework to facilitate visual exploration of telehealth data: a case study.

Technol Health Care 2012 ;20(6):457-71

Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA.

Purpose: Public health data is typically organized by geospatial units. Routine geographic monitoring of health data enables an understanding of the spatial patterns of events in terms of causes and controls. GeoVisualization (GeoVis) allows users to see information hidden both visually and explicitly on a map. Despite the applicability of GeoVis in public health, it is still underused for visualizing public health data. The objective of this study is to examine the perception of telehealth users' to utilize GeoVis as a proof of concept to facilitate visual exploration of telehealth data in Brazil using principles of human centered approach and cognitive fit theory.

Methods: A mixed methods approach combining qualitative and quantitative assessments was utilized in this cross sectional study conducted at the Telehealth Center of the Federal University of Pernambuco (NUTE-UFPE), Recife, Brazil. A convenient sample of 20 participants currently involved in NUTES was drawn during a period of Sep-Oct 2011. Data was gathered using previously tested questionnaire surveys and in-person interviews. Socio-demographic Information such as age, gender, prior education, familiarity with the use of computer and GeoVis was gathered. Other information gathered included participants' prior spatial analysis skills, level of motivation and use of GeoVis in telehealth. Audio recording was done for all interviews conducted in both English and Portuguese, and transcription of the audio content to English was done by a certified translator. Univariate analysis was performed and means and standard deviations were reported for the continuous variables and frequency distributions for the categorical variables. For the open-ended questions, we utilized a grounded theory to identify themes and their relationship as they emerge from the data. Analysis of the quantitative data was performed using SAS V9.1 and qualitative data was performed using NVivo9.

Results: The average age of participants was 28 years (SD=7), a majority of them were females and 100% were professionals with graduate degrees. The users had diverse backgrounds including nursing, computer science, biomedical informatics, statistics, dentistry, administration and engineering. The users had varied roles and responsibilities, used computers frequently but only 5% of them were familiar with GeoVis. Google maps were the most common GeoVis application that the users were familiar with. Despite having minimal spatial skills, there was a strong motivation and relevance among the telehealth users to use GeoVis to facilitate visual exploration of telehealth data for better informed decision making. Results also showed that of the 60% participants with no GeoVis familiarity; 33% had moderate to large data exploratory role, 83% had no spatial skills but 58% preferred analyzing both spatial and temporal dimensions of the data. Majority of the participants agreed to have maps as the first choice to represent the data as it will be able to display the events both in place and time.

Discussion: The results demonstrate a potentially growing need for the use of GeoVis applications to evaluate telehealth data. Understanding of user needs is essential to ensure that the technology is appropriately functional and will be useful to complete the tasks.
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http://dx.doi.org/10.3233/THC-2012-0683DOI Listing
May 2013

Experiences on the use of a second opinion software for the primary care.

AMIA Annu Symp Proc 2005 :889

Grupo de Tecnologias da Informação em Saúde (TIS), Núcleo de Telesaúde (NUTES), Universidade Federal de Pernambuco(UFPE), Hospital das Clínicas, Cidade Universitária, Recife-PE, Brasil CEP 50.670-420.

This article describes the experience on the implantation and use of a Internet telehealth system for the primary care public service in the state of Pernambuco in Brazil. This system was designed to face several problems on the delivery of healthcare to people living in remote and/or poor areas.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560663PMC
February 2007