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  1. Article ; Online: Challenging the Dogma: Stage migration or negative lymph nodes, which of them is the main player on gastric cancer prognosis?

    Costa, P Matos da / Antunes, Cláudia / Lages, Patrícia / Rodrigues, Jéssica / Peyroteo, Mariana / Onofre, Susana / Lara Santos, Lúcio

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2024  Volume 50, Issue 6, Page(s) 108318

    Abstract: Expanding loco-regional nodes harvesting is expected to increase survival. This improvement may be associated to stage migration (SM). However, the great bulk of harvested lymph nodes observed in large dissections is negative. M&M: 830 patients who ... ...

    Abstract Expanding loco-regional nodes harvesting is expected to increase survival. This improvement may be associated to stage migration (SM). However, the great bulk of harvested lymph nodes observed in large dissections is negative. M&M: 830 patients who received R0 gastrectomy for adenocarcinoma were included. pN+ patients with <26 nodes (n = 209) were included for a simulation to "offer 26 nodes" - SM (proportional and exponential based) was simulated and analysed through machine learning algorithms. Overall Survival (OS), in native and simulated stages, were compared. OS of extended lymphadenectomies (pN+, D ≥ 26, n = 273) was compared with the simulated curves. OS of patients in the following dissection intervals of negative nodes were compared: <16 (n = 233), 16-25 (n = 258), ≥26 (n = 339). RESULTS: After simulation to 26 nodes (pN+, D < 26 patients, n = 209), staging was recomputed. OS of native vs simulated early-stages (I-II) and advanced stages (III) were not different (p > 0.05). OS of patients with lymphadenectomy (≥26) was better than simulated for early and advanced stages (p = 0.008; p = 0.005). OS of patients included in distinct intervals of negative lymph nodes were different (p < 0.001). These intervals were an independent prognostic factor (multivariate analysis). CONCLUSIONS: The influence of Stage Migration was null in this set of simulations and Will Rogers phenomenon was not observed. Extended dissection performed better in OS. But the influence of the number of negative nodes, even in large dissections, was highlighted. By emphasizing the role of negative nodes, we aim to facilitate more informed decision-making in management of gastric cancer patients, ultimately leading to improved treatment outcomes and patient care.
    Language English
    Publishing date 2024-04-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2024.108318
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Repeat cytoreduction with Hyperthermic Intraperitoneal chemotherapy in patients with peritoneal disease: A 5-year retrospective analysis.

    Mendes, João / Marques, Sónia / Peyroteo, Mariana / Lobo, Mercês / Sousa, Fernanda / Fernandes, Manuel / Videira, José Flávio / de Sousa, Abreu

    Surgical oncology

    2024  Volume 54, Page(s) 102078

    Abstract: Background: Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (CR-HIPEC) is a locorregional surgical therapy applied in patients with peritoneal-only metastatic disease of primary abdominal malignancies. Integrated in a multimodal ... ...

    Abstract Background: Cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (CR-HIPEC) is a locorregional surgical therapy applied in patients with peritoneal-only metastatic disease of primary abdominal malignancies. Integrated in a multimodal treatment, CR-HIPEC is associated with increased overall survival. In cases of peritoneal-site only relapse, it may be carried out more than once.
    Methods: Patients who received a CR-HIPEC between January 2016 and December 2020 at Instituto Português de Oncologia do Porto, Portugal were included in a unicentric, retrospective, observational study. Short- and long-term outcomes after surgery were analyzed.
    Results: In this period, 259 CR-HIPEC were performed on 248 patients. Of these, 31 were CR-HIPEC repeats, with 6 being the third HIPEC in the same patient. Of the 31 cases, 15 (48.4 %) had an appendicular origin. Mean PCI in re-HIPEC group was 10.6 (SD ± 7.1). No significant differences in baseline characteristics between the first and re-HIPEC groups were found, except for mean PCI, higher in the 1st HIPEC group (p = 0.047). In re-HIPEC group, major complications rate (CT-CAE 3-4) was 12.9 % (n = 4), without postoperative mortality. The 1st and re-HIPEC group had similar morbidity rates and hospitalization time. With a median follow-up time of 44 months, relapse rate after repeat CR-HIPEC was 45.2 % (n = 14), with a mean overall survival (OS) of 68.7 months and 5-year OS of 78 %.
    Conclusions: Repeat CR-HIPEC is a safe approach with an acceptable complication rate for its complexity, associated with a survival benefit in selected patients. It should be presented as a valid therapeutic option in recurrent peritoneal disease.
    Language English
    Publishing date 2024-04-15
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 1107810-8
    ISSN 1879-3320 ; 0960-7404
    ISSN (online) 1879-3320
    ISSN 0960-7404
    DOI 10.1016/j.suronc.2024.102078
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Impacts of public health and social measures on COVID-19 in Europe: a review and modified Delphi technique.

    Paulo, Marília Silva / Peyroteo, Mariana / Maia, Mélanie R / Pries, Cara / Habl, Claudia / Lapão, Luís Velez

    Frontiers in public health

    2023  Volume 11, Page(s) 1226922

    Abstract: Introduction: The emergence of the COVID-19 pandemic in early 2020 led countries to implement a set of public health and social measures (PHSMs) attempting to contain the spread of the SARS-CoV-2 virus. This study aims to review the existing literature ... ...

    Abstract Introduction: The emergence of the COVID-19 pandemic in early 2020 led countries to implement a set of public health and social measures (PHSMs) attempting to contain the spread of the SARS-CoV-2 virus. This study aims to review the existing literature regarding key results of the PHSMs that were implemented, and to identify the PHSMs considered to have most impacted the epidemiological curve of COVID-19 over the last years during different stages of the pandemic.
    Methods: The PHSM under study were selected from the Oxford COVID-19 Government Response Tracker (OxCGRT), supplemented by topics presented during the Rapid Exchange Forum (REF) meetings in the scope of the Population Health Information Research Infrastructure (PHIRI) project (H2020). The evidence- based review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify which reviews have already been published about each PHSMs and their results. In addition, two modified Delphi panel surveys were conducted among subject matter experts from 30 European countries to uphold the results found.
    Results: There were 3,212 studies retrieved from PubMed, 162 full texts assessed for eligibility and 35 included in this PHSMs summary. The measures with clearest evidence on their positive impact from the evidence-based review include social distancing, hygiene measures, mask measures and testing policies. From the modified Delphi panel, the PHSMs considered most significant in the four periods analyzed were case isolation at home, face coverings, testing policy, and social distancing, respectively.
    Discussion: The evidence found has significant implications for both researchers and policymakers. The study of PHSMs' impact on COVID-19 illustrates lessons learned for future pan- and epidemics, serving as a contribution to the health systems resilience discussion. These lessons, drawn from both the available scientific evidence and the perspectives of relevant subject matter experts, should also be considered in educational and preparedness programs and activities in the public health space.
    MeSH term(s) Humans ; Public Health ; COVID-19/epidemiology ; SARS-CoV-2 ; Delphi Technique ; Pandemics ; Europe/epidemiology
    Language English
    Publishing date 2023-08-31
    Publishing country Switzerland
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2711781-9
    ISSN 2296-2565 ; 2296-2565
    ISSN (online) 2296-2565
    ISSN 2296-2565
    DOI 10.3389/fpubh.2023.1226922
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Load adaptation through bone remodeling: a mechanobiological model coupled with the finite element method.

    Peyroteo, M M A / Belinha, J / Natal Jorge, R M

    Biomechanics and modeling in mechanobiology

    2021  Volume 20, Issue 4, Page(s) 1495–1507

    Abstract: This work proposes a novel tissue-scale mechanobiological model of bone remodeling to study bone's adaptation to distinct loading conditions. The devised algorithm describes the mechanosensitivity of bone and its impact on bone cells' functioning through ...

    Abstract This work proposes a novel tissue-scale mechanobiological model of bone remodeling to study bone's adaptation to distinct loading conditions. The devised algorithm describes the mechanosensitivity of bone and its impact on bone cells' functioning through distinct signaling factors. In this study, remodeling is mechanically ruled by variations of the strain energy density (SED) of bone, which is determined by performing a linear elastostatic analysis combined with the finite element method. Depending on the SED levels and on a set of biological signaling factors ([Formula: see text] parameters), osteoclasts and osteoblasts can be mechanically triggered. To reproduce this phenomenon, this work proposes a new set of [Formula: see text] parameters. The combined response of osteoclasts and osteoblasts will then affect bone's apparent density, which is correlated with other mechanical properties of bone, through a phenomenological law. Thus, this novel model proposes a constant interplay between the mechanical and biological components of the process. The spatiotemporal simulation used to validate this new approach is a benchmark example composed by two distinct phases: (1) pre-orientation and (2) load adaptation. On both of them, bone is able to adapt its morphology according to the loading condition, achieving the required trabecular distribution to withstand the applied loads. Moreover, the equilibrium morphology reflects the orientation of the load. These preliminary results support the new approach proposed in this study.
    MeSH term(s) Adaptation, Physiological ; Algorithms ; Animals ; Biomechanical Phenomena ; Biophysics ; Bone Remodeling/physiology ; Bone and Bones/physiology ; Computer Simulation ; Finite Element Analysis ; Humans ; Models, Biological ; Osteoblasts/physiology ; Osteoclasts/physiology ; Stress, Mechanical
    Language English
    Publishing date 2021-04-26
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 2093052-5
    ISSN 1617-7940 ; 1617-7959
    ISSN (online) 1617-7940
    ISSN 1617-7959
    DOI 10.1007/s10237-021-01458-0
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: A mathematical biomechanical model for bone remodeling integrated with a radial point interpolating meshless method.

    Peyroteo, M M A / Belinha, J / Natal Jorge, R M

    Computers in biology and medicine

    2020  Volume 129, Page(s) 104170

    Abstract: Bone remodeling is a highly complex process, in which bone cells interact and regulate bone's apparent density as a response to several external and internal stimuli. In this work, this process is numerically described using a novel 2D biomechanical ... ...

    Abstract Bone remodeling is a highly complex process, in which bone cells interact and regulate bone's apparent density as a response to several external and internal stimuli. In this work, this process is numerically described using a novel 2D biomechanical model. Some of the new features in this model are (i) the mathematical parameters used to determine bone's apparent density and cellular density; (ii) an automatic boundary recognition step to spatially control bone remodeling and (iii) an approach to mimic the mechanical transduction to osteoclasts and osteoblasts. Moreover, this model is combined with a meshless approach - the Radial Point Interpolation Method (RPIM). The use of RPIM is an asset for this application, especially in the construction of the boundary maps. This work studies bone's adaptation to a certain loading regime through bone resorption. The signaling pathways of bone cells are dependent on the level of strain energy density (SED) in bone. So, when SED changes, bone cells' functioning is affected, causing also changes on bone's apparent density. With this model, bone is able to achieve an equilibrium state, optimizing its structure to withstand the applied loads. Results suggest that this model has the potential to provide high quality solutions while being a simpler alternative to more complex bone remodeling models in the literature.
    MeSH term(s) Biomechanical Phenomena ; Bone Remodeling ; Bone and Bones ; Models, Theoretical ; Osteoblasts ; Osteoclasts
    Language English
    Publishing date 2020-12-08
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 127557-4
    ISSN 1879-0534 ; 0010-4825
    ISSN (online) 1879-0534
    ISSN 0010-4825
    DOI 10.1016/j.compbiomed.2020.104170
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  6. Article ; Online: Remote Monitoring Systems for Patients With Chronic Diseases in Primary Health Care: Systematic Review.

    Peyroteo, Mariana / Ferreira, Inês Augusto / Elvas, Luís Brito / Ferreira, João Carlos / Lapão, Luís Velez

    JMIR mHealth and uHealth

    2021  Volume 9, Issue 12, Page(s) e28285

    Abstract: Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving ... ...

    Abstract Background: The digital age, with digital sensors, the Internet of Things (IoT), and big data tools, has opened new opportunities for improving the delivery of health care services, with remote monitoring systems playing a crucial role and improving access to patients. The versatility of these systems has been demonstrated during the current COVID-19 pandemic. Health remote monitoring systems (HRMS) present various advantages such as the reduction in patient load at hospitals and health centers. Patients that would most benefit from HRMS are those with chronic diseases, older adults, and patients that experience less severe symptoms recovering from SARS-CoV-2 viral infection.
    Objective: This paper aimed to perform a systematic review of the literature of HRMS in primary health care (PHC) settings, identifying the current status of the digitalization of health processes, remote data acquisition, and interactions between health care personnel and patients.
    Methods: A systematic literature review was conducted using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify articles that explored interventions with HRMS in patients with chronic diseases in the PHC setting.
    Results: The literature review yielded 123 publications, 18 of which met the predefined inclusion criteria. The selected articles highlighted that sensors and wearables are already being used in multiple scenarios related to chronic disease management at the PHC level. The studies focused mostly on patients with diabetes (9/26, 35%) and cardiovascular diseases (7/26, 27%). During the evaluation of the implementation of these interventions, the major difficulty that stood out was the integration of information into already existing systems in the PHC infrastructure and in changing working processes of PHC professionals (83%).
    Conclusions: The PHC context integrates multidisciplinary teams and patients with often complex, chronic pathologies. Despite the theoretical framework, objective identification of problems, and involvement of stakeholders in the design and implementation processes, these interventions mostly fail to scale up. Despite the inherent limitations of conducting a systematic literature review, the small number of studies in the PHC context is a relevant limitation. This study aimed to demonstrate the importance of matching technological development to the working PHC processes in interventions regarding the use of sensors and wearables for remote monitoring as a source of information for chronic disease management, so that information with clinical value is not lost along the way.
    MeSH term(s) Aged ; COVID-19 ; Chronic Disease ; Humans ; Pandemics ; Primary Health Care ; SARS-CoV-2
    Language English
    Publishing date 2021-12-21
    Publishing country Canada
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 2719220-9
    ISSN 2291-5222 ; 2291-5222
    ISSN (online) 2291-5222
    ISSN 2291-5222
    DOI 10.2196/28285
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Predictive factors of non-sentinel lymph node disease in breast cancer patients with positive sentinel lymph node.

    Peyroteo, Mariana / Canotilho, Rita / Margarida Correia, Ana / Baía, Catarina / Ribeiro, Cátia / Reis, Paulo / de Sousa, Abreu

    Cirugia espanola

    2022  Volume 100, Issue 2, Page(s) 81–87

    Abstract: Introduction: Management of positive sentinel lymph node biopsy (SLNB) in breast cancer remains a matter of debate. Our aim was to evaluate the incidence and identify predictive factors of non-sentinel lymph node metastases.: Methods: Retrospective ... ...

    Abstract Introduction: Management of positive sentinel lymph node biopsy (SLNB) in breast cancer remains a matter of debate. Our aim was to evaluate the incidence and identify predictive factors of non-sentinel lymph node metastases.
    Methods: Retrospective review of all cN0 breast cancer patients treated between January 2013 and December 2017, with positive SLNB that were submitted to ALND.
    Results: Of the 328 patients included, the majority of tumors were cT1 or cT2, with lymphovascular invasion in 58.4% of cases. The mean isolated nodes in SLNB was 2.7, with a mean of 1.6 positive nodes, 60.7% with extracapsular extension. Regarding ALND, a mean of 13.9 nodes were isolated, with a mean of 2.1 positive nodes. There was no residual disease in the ALND in 50.9% of patients, with 18.9% having ≥4 positive nodes. In the multivariate analysis, lymphovascular invasion, extracapsular extension in SLN, largest SLN metastases size (>10 mm) and ratio of positive SNL (>50%) were independent predictors of non-sentinel lymph node metastases. These four factors were used to build a non-pondered score to predict the probability of a positive ALND after a positive SLNB. The AUC of the model was 0.69 and 81% of patients with score = 0 and 65.6% with score = 1 had no additional disease in ALND.
    Conclusion: The absence of non-sentinel lymph node metastases in the majority of patients with 1-2 positive SLN with low risk score questions the need of ALND in this population. The identified predictive factors may help select patients in which ALND can be omitted.
    Language English
    Publishing date 2022-02-03
    Publishing country Spain
    Document type Journal Article
    ISSN 2173-5077
    ISSN (online) 2173-5077
    DOI 10.1016/j.cireng.2022.01.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Protocol for a cluster randomised trial of a goal-oriented care approach for multimorbidity patients supported by a digital platform.

    Gil Conde, Margarida / Peyroteo, Mariana / Maria, Ana / Maia, Mélanie Raimundo / Gregório, João / Paulo, Marilia Silva / Alves, Marta / Papoila, Ana Luísa / Lapão, Luís Velez / Heleno, Bruno

    BMJ open

    2023  Volume 13, Issue 11, Page(s) e070044

    Abstract: Introduction: Health information systems represent an opportunity to improve the care provided to people with multimorbidity. There is a pressing need to assess their impact on clinical outcomes to validate this intervention. Our study will determine ... ...

    Abstract Introduction: Health information systems represent an opportunity to improve the care provided to people with multimorbidity. There is a pressing need to assess their impact on clinical outcomes to validate this intervention. Our study will determine whether using a digital platform (Multimorbidity Management Health Information System, METHIS) to manage multimorbidity improves health-related quality of life (HR-QoL).
    Methods and analysis: A superiority, cluster randomised trial will be conducted at primary healthcare practices (1:1 allocation ratio). All public practices in the Lisbon and Tagus Valley (LVT) Region, Portugal, not involved in a previous pilot trial, will be eligible. At the participant level, eligible patients will be people with complex multimorbidity, aged 50 years or older, with access to an internet connection and a communication technology device. Participants who cannot sign/read/write and who do not have access to an email account will not be included in the study. The intervention combines a training programme and a customised information system (METHIS). Both are designed to help clinicians adopt a goal-oriented care model approach and to encourage patients and carers to play a more active role in autonomous healthcare. The primary outcome is HR-QoL, measured at 12 months with the physical component scale of the 12-item Short Form questionnaire (SF-12). Secondary outcomes will also be measured at 12 months and include mental health (mental component Scale SF-12, Hospital Anxiety and Depression Scale). We will also assess serious adverse events during the trial, including hospitalisation and emergency services. Finally, at 18 months, we will ask the general practitioners for any potentially missed diagnoses.
    Ethics and dissemination: The Research and Ethics Committee (LVT Region) approved the trial protocol. Clinicians and patients will sign an informed consent. A data management officer will handle all data, and the publication of several scientific papers and presentations at relevant conferences/workshops is envisaged.
    Trial registration number: NCT05593835.
    MeSH term(s) Humans ; Quality of Life ; Multimorbidity ; Goals ; General Practitioners ; Caregivers ; Randomized Controlled Trials as Topic
    Language English
    Publishing date 2023-11-17
    Publishing country England
    Document type Clinical Trial Protocol ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2022-070044
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  9. Article ; Online: The role of Design Science Research Methodology in developing pharmacy eHealth services.

    Gregório, João / Reis, Lígia / Peyroteo, Mariana / Maia, Melanie / Mira da Silva, Miguel / Lapão, Luís Velez

    Research in social & administrative pharmacy : RSAP

    2021  Volume 17, Issue 12, Page(s) 2089–2096

    Abstract: The increasing focus on efficiency of care has prompted health systems to look for innovative solutions that yield maximum value for care. Integration of care and eHealth are seen as the most promising solutions in the high technological environment of ... ...

    Abstract The increasing focus on efficiency of care has prompted health systems to look for innovative solutions that yield maximum value for care. Integration of care and eHealth are seen as the most promising solutions in the high technological environment of the coming decades. Pharmacy services have been developed to a point where the face of community pharmacy has changed dramatically. Thus, service design and implementation has become an area of increased attention by Pharmacy practice researchers, and the arrival of eHealth concepts to Pharmacy is driving the need to find alternative ways to design new services. Moreover, known barriers and challenges remain when securing integration of pharmacy services with the health systems. In this paper, Design Science Research Methodology (DSRM), a user-centered alternative methodology to the design, development and implementation of health services, especially eHealth services, is presented. This alternative, originally from the Information Sciences field, has been adopted as a service design methodology in diverse settings, including health care. Here, case studies are used to explain how a DSRM process should be conducted in a health care setting, illustrating what methods to choose in each step of the process. Finally, the advantages of DSRM compared to other user-centered methodologies for service design are presented, hopefully prompting the discussion on the use of DSRM for the study of the implementation and sustainability of pharmacy services.
    MeSH term(s) Community Pharmacy Services ; Humans ; Pharmacies ; Pharmacy ; Research Design ; Telemedicine
    Language English
    Publishing date 2021-06-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2192059-X
    ISSN 1934-8150 ; 1551-7411
    ISSN (online) 1934-8150
    ISSN 1551-7411
    DOI 10.1016/j.sapharm.2021.05.016
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  10. Article ; Online: Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach.

    Lapão, Luís Velez / Peyroteo, Mariana / Maia, Melanie / Seixas, Jorge / Gregório, João / Mira da Silva, Miguel / Heleno, Bruno / Correia, Jorge César

    Journal of medical Internet research

    2021  Volume 23, Issue 8, Page(s) e24181

    Abstract: Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection.: Objective: ... ...

    Abstract Background: The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection.
    Objective: The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections.
    Methods: For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication.
    Results: The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction.
    Conclusions: Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.
    MeSH term(s) Aged ; COVID-19 ; Chronic Disease ; Humans ; Pandemics ; SARS-CoV-2 ; Telemedicine
    Language English
    Publishing date 2021-08-26
    Publishing country Canada
    Document type Journal Article
    ZDB-ID 2028830-X
    ISSN 1438-8871 ; 1438-8871
    ISSN (online) 1438-8871
    ISSN 1438-8871
    DOI 10.2196/24181
    Database MEDical Literature Analysis and Retrieval System OnLINE

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