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Mattos SDS, Moser LRDN, Diogenes TCP, Severi R, de Araújo JSS, Albuquerque FCDL, Tavare TR, Mourato FA. Echocardiography Learning by Pediatricians While Screening Congenital Heart Disease with the Aid of Telemedicine. Telemed J E Health 2020; 26:1449-1454. [PMID: 32212988 DOI: 10.1089/tmj.2019.0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Congenital heart disease (CHD) affects 1% of all newborns and is a major public health problem. Most children with CHD benefit from early diagnosis to optimize management. However, in many places there are no specialized professionals to do so. Introduction: A screening method for CHD was developed between two states in Northeast Brazil. It was based upon the performance of an echocardiogram by local pediatricians with support of pediatric cardiologists through telemedicine. Objective: To determine if the continuous performance of examinations together with online supervision increased the level of understanding of the pediatricians about the echocardiograms. Methods: Pediatricians received online support to perform echocardiograms for 7 years (2012-2018). Although the project aimed to teach them to acquire images and send to the cardiologists for analysis and interpretation, they were encouraged to describe their own diagnostic impressions. The level of agreement between pediatricians and cardiologists was calculated. Results: A large number (n = 3,951) echocardiograms was analyzed. From them, 2,818 were classified as abnormal, inconclusive, or normal by both the pediatricians and the cardiologists. The 7-year analysis demonstrated an overall agreement of 63.7%. As for the final diagnosis, it was possible to compare 1,457 echocardiograms. The combined analysis of the 7 years demonstrated agreement in 62.2%. Discussion: The screening of CHD under online support led to more in-depth learning of echocardiography by the pediatricians. This approach potentialized the accuracy of the screening through the years. Conclusion: By enrolling in a telemedicine-based screening program, the pediatricians' degree of understanding of echocardiography increased considerably.
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Mattos SDS, Mourato FA, de Araújo JSS, Moser LRDN, Hatem TDP, Albuquerque FCDL, Mariano NNDS, Gomes RGS. Impact of a Telemedicine Network on Neonatal Mortality in a State in Northeast Brazil. Popul Health Manag 2018; 21:517. [PMID: 30156467 DOI: 10.1089/pop.2018.0087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sandra da Silva Mattos
- 1 Círculo do Coração de Pernambuco, Recife, Brazil .,2 Laboratório de Imunopatologia Keizo Asami (LIKA) , Recife, Brazil
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Mattos SDS, Hazin SMV, Regis CT, Soares de Araújo JS, Albuquerque FCDL, Moser LRDN, Hatem TDP, Gomes de Freitas CP, Mourato FA, Tavares TR, Gomes RGS, Severi R, Santos CR, Ferreira da Silva J, Rezende JL, Vieira PC, de Lima Filho JL. A telemedicine network for remote paediatric cardiology services in north-east Brazil. Bull World Health Organ 2015; 93:881-7. [PMID: 26668441 PMCID: PMC4669725 DOI: 10.2471/blt.14.148874] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/16/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022] Open
Abstract
Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.
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Affiliation(s)
- Sandra da Silva Mattos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Cláudio Teixeira Regis
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | | | | | - Thamine de Paula Hatem
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Felipe Alves Mourato
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Thiago Ribeiro Tavares
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Rossana Severi
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Cícera Rocha Santos
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | | | - Juliana Landim Rezende
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - Paulo Coelho Vieira
- Círculo do Coração de Pernambuco, Av. Portugal, 163 Paissandu, Recife PE, CEP 52010-010, Brazil
| | - José Luiz de Lima Filho
- Laboratório de Imunopatologia Keiso Asami, Universidade Federal de Pernambuco, Recife, Brazil
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