Cicero Inacio da Silva

O uso da telepsicologia expandiu-se durante a pandemia de COVID-19, revelando limitações técnicas e éticas nas plataformas generalistas utilizadas para atendimentos clínicos. Este relato de pesquisa descreve o desenvolvimento e avaliação da V4HPsi, uma plataforma específica para teleatendimento psicológico, que incorpora recursos como blockchain, transcrição automática e avatar em Libras. Foram realizadas entrevistas cognitivas com 18 psicólogas(os) e estudantes de psicologia, aplicando o protocolo think-aloud para identificar potencialidades e limitações. A análise temática apontou pontos fortes como usabilidade intuitiva, funcionalidades direcionadas à saúde mental e percepção de segurança. Entre as barreiras, destacaram-se layout, uso em dispositivos móveis, transparência na gestão de dados e integração com outras ferramentas clínicas e administrativas. Também emergiram oportunidades de desenvolvimento para novas soluções, como integração com sistemas públicos de saúde, recursos voltados à infância e adolescência e maior automação. Os achados reforçam a relevância de soluções digitais adaptadas às demandas da psicologia e construídas com participação dos usuários.

Background Ultrasound (US) is increasingly used as the first-line imaging modality for the diagnosis of midgut volvulus, but may be non-diagnostic in some cases. Objective To determine the frequency and factors associated with non-diagnostic US for each midgut volvulus and malrotation in a multi-institutional sample. Materials and methods We conducted a retrospective multi-institutional study of children (age 0-18 years) who underwent US to evaluate for midgut volvulus and malrotation between January 1, 2018, and June 30, 2021, and had an available reference standard of one of the following: upper GI series, CT/MRI, surgery, or, for volvulus, clinical follow-up at 30 days or greater. Blinded review of US images was performed by a single radiologist at each institution. When available, radiographs acquired ≤3 h from the US were reviewed for bowel gas pattern. After blinded review, original ultrasound reports were classified as diagnostic or non-diagnostic for midgut volvulus and malrotation. Stepwise logistic regression identified the most important predictors of non-diagnostic US. Results In total, 637 patients were imaged for midgut volvulus and 311 for malrotation. Based on original report review, non-diagnostic proportions of examinations for volvulus and malrotation were 13.5% (86/637) and 25.7% (80/311), respectively. Based on blinded review, non-diagnostic proportions of examinations for volvulus and malrotation were 17.3% (110/637) and 37.6% (117/311), respectively. Of the patients with US considered non-diagnostic for volvulus by original reports, 2.3% (2/86) were subsequently found to have volvulus. Among patients with non-diagnostic US for volvulus by blinded review (n=110), none was found to have volvulus. Gaseous dilation with elongation of bowel on radiography was the single best predictor of a non-diagnostic US in blinded interpretation for volvulus and malrotation (OR=8.2 and 9.2; 95%CI 3.7-19.8 and 1.7-89.4, respectively) and in original radiology reports for volvulus (OR=4.5; 95%CI 2.2-9.5). Conclusion A small fraction of a multi-institutional sample of US for midgut volvulus was non-diagnostic; however, assessment of malrotation without volvulus is associated with a higher frequency of non-diagnostic examinations. Dilated bowel gas pattern on radiography is the strongest predictor for a non-diagnostic US, although it does not necessarily preclude a diagnostic exam.

Os festivais de cinema estão entre os eventos culturais mais atingidos pela pandemia da Covid-19. No entanto, graças ao streaming, os festivais obtiveram resultados surpreendentes de audiência, rearticulando suas formas de realização. Quais configurações os festivais têm assumido no sentido de contornar a pandemia com recurso às tecnologias de streaming? A partir de pesquisas em catálogos, websites e entrevistas com curadores, este artigo apresenta de forma descritiva os arranjos tecnológicos e os formatos propostos por diversos festivais nacionais e internacionais durante a pandemia, num esforço de cartografia qualitativa nãoexaustiva. Refletindo sobre os novos elementos de articulação, é sugerida uma tipologia das estratégias adotadas pelos festivais em função do uso do streaming, resumidas em cinco modalidades: 1) estratégias tradicionalistas; 2) estratégias híbridas; 3) estratégias miméticas; 4) estratégias integralmente on-line e; por fim, 5) estratégias nostálgicas. O artigo também observa as relações entre os festivais de cinema e a cidade, refletindo sobre o deslocamento da situação “evento” para a situação streaming, sobre os efeitos do hic et nunc, discutindo as consequências desse deslocamento no que se refere ao convívio com as plataformas online como novos “agentes” dos festivais. Ao longo do artigo, reflete-se sobre os efeitos desse convívio, os processos de democratização e possíveis desdobramentos dessa relação.

Background Follow-up scoliosis radiographs are performed to assess the degree of spinal curvature and skeletal maturity, which can be done at lower radiation exposures than those in standard-dose radiography. Objective Describe and evaluate a protocol that reduced the radiation in follow-up frontal-view scoliosis radiographs. Materials and methods We implemented a postero-anterior lower dose modified-technique for scoliosis radiography with task-based definition of adequate image quality and use of technique charts based on target exposure index and patient’s height and weight. We subsequently retrospectively evaluated 40 consecutive patients who underwent a follow-up radiograph using the modified-technique after an initial standard-technique radiograph. We evaluated comparisons of proportions for subjective assessment with chi-squared tests, and agreements of reader’s scores with intraclass correlation coefficients and Bland–Altman plots. We determined incident air kerma, exposure index, deviation index/standard deviation, dose-area product (DAP), and effective dose for each radiograph. We set statistical significance at PPP2 (Pacceptable or above. All modified-technique measurements obtained inter- and intra-observer correlation coefficient agreements of 0.86 (“Good”) or greater. Conclusion Substantial dose reduction on follow-up scoliosis imaging with existing radiography units is achievable through task-based definition of adequate image quality and tailoring of radiation to each patient’s height and weight, while still allowing for reliable assessment and reproducible measurements.

BACKGROUND AND PURPOSE: The frequency and utility of gadolinium in evaluation of acute pediatric seizure presentation is not well known. The purpose of this study was to assess the utility of gadolinium-based contrast agents in MR imaging performed for the evaluation of acute pediatric seizure presentation. MATERIALS AND METHODS: We identified consecutive pediatric patients with new-onset seizures from October 1, 2016, to September 30, 2021, who presented to the emergency department and/or were admitted to the inpatient unit and had an MR imaging of the brain for the evaluation of seizures. The clinical and imaging data were recorded, including the patient’s age and sex, the use of IV gadolinium, and the underlying cause of epilepsy when available. RESULTS: A total of 1884 patients were identified for inclusion. Five hundred twenty-four (28%) patients had potential epileptogenic findings on brain MR imaging, while 1153 (61%) patients had studies with normal findings and 207 (11%) patients had nonspecific signal changes. Epileptogenic findings were subclassified as the following: neurodevelopmental lesions, 142 (27%); intracranial hemorrhage (traumatic or germinal matrix), 89 (17%); ischemic/hypoxic, 62 (12%); hippocampal sclerosis, 44 (8%); neoplastic, 38 (7%); immune/infectious, 20 (4%); phakomatoses, 19 (4%); vascular anomalies, 17 (3%); metabolic, 3 (<1%); and other, 90 (17%). Eight hundred seventy-four (46%) patients received IV gadolinium. Of those, only 48 (5%) cases were retrospectively deemed to have necessitated the use of IV gadolinium: Fifteen of 48 (31%) cases were subclassified as immune/infectious, while 33 (69%) were neoplastic. Of the 1010 patients with an initial noncontrast study, 15 (1.5%) required repeat MR imaging with IV contrast to further evaluate the findings. CONCLUSIONS: Gadolinium contrast is of limited additive benefit in the imaging of patients with an acute onset of pediatric seizures in most instances.

O presente artigo analisa e apresenta os projetos realizados pelos grupos de pesquisa ligados ao Departamento de Oftalmologia, ao Núcleo Telessaúde Brasil Redes, da Universidade Federal de São Paulo (Unifesp) e ao grupo de pesquisa do Laboratório de Artes Cinemáticas e Visualização (LabCine – labcine.com).. Em um segundo momento, o artigo também propõe avaliar aplicações atuais e futuras no campo da videocolaboração relacionadas à utilização de ambientes de streaming baseados em vídeo para as denominadas “teleconsultorias síncronas”, que são processos de apoio à decisão na área da saúde que utilizam recursos de chat de vídeo entre dois profissionais de saúde aplicadas à Atenção Primária em Saúde.

Background: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. Methods: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system. Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. Discussion: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).