1. No category

Aplikacje medyczne dla pacjentów. !
Monitoring pacjentów w warunkach
domowych dr n. med. Lukasz Koltowski
I Katedra i Klinika Kardiologii
Warszawskiego Uniwersytetu Medycznego
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Global Internet Device Sales 3,000 Units in millions
2,500 Tablets
2,000 1,500 Smartphones
1,000 500 Computers
0 2000 2001 2002 2003 *Source Gartner – May 2012 2004 2005 2006 2007 2008 2009 2010 2011 2012E 2013E 2014E 2015E 2016E 2 3. …choroby przewlekłe
Wg. WHO do roku 2050 blisko 30% populacji
będzie cierpiała z powodu chorób przewlekłych,
a liczba osób +65 wzrośnie o 86%
APLIKACJE MEDYCZNE
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
THE AUGMENTATION OF USUAL CARDIAC REHABILITATION WITH AN ONLINE AND SMARTPHONE-­‐BASED PROGRAM IMPROVES CARDIOVASCULAR RISK FACTORS AND REDUCES REHOSPITALIZATIONS (ACC Mar 2014) + risk factor recording
+ daily tasks related to risk factors
+ education on life style changes
+ chat with nursing team
Widmer R, et al ACC 2014; Abstract 925-­‐05 doi:10.1016/S0735-­‐1097(14)61296-­‐1 WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
THE AUGMENTATION OF USUAL CARDIAC REHABILITATION WITH AN ONLINE AND SMARTPHONE-­‐BASED PROGRAM IMPROVES CARDIOVASCULAR RISK FACTORS AND REDUCES REHOSPITALIZATIONS (ACC Mar 2014) Online/ smartphone-based
application [OSPA] (n=19)
Control group (n=18)
Rehabilitation
+ App Support:
daily tasks and entered risk factor
information (weight, blood pressure
(BP), glucose, lipids, physical
activity, and diet) at baseline and
throughout the program
no additional intervention
Changes in risk factors and re-­‐hospitaliza]ons/emergency department (ED) visits were assessed aaer 90 days. Widmer R, et al ACC 2014; Abstract 925-­‐05 doi:10.1016/S0735-­‐1097(14)61296-­‐1 WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Risk Factors
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Progress
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Tasks
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Results: risk factors at 90 days
•  Compared to the control group, patients in
the OSPA group had significant reductions
in weight (-4.1+1.1 kg, p=0.01) and !
BP (-7.9+5.4 mmHg, p=0.05). •  There was an inverse relationship between
OSPA usage and change in BP (r2=0.30,
p=0.04), and a positive relationship with diet
scores (r2=0.58, p=0.003). WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Results: rehospitalizations / ED visits !
at 90 days
P<0,05 The OSPA group showed a significantly lower rate of rehospitaliza]ons/ED visits (-­‐40%, p<0.05) Widmer R, et al ACC 2014; Abstract 925-­‐05 doi:10.1016/S0735-­‐1097(14)61296-­‐1 WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Czy mamy dowody naukowe?
PREWENCJA!
CUKRZYCA
WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
163 patients eligible for recruitment to the study met all
inclusion criteria:
•  Physician diagnosis of type 2 diabetes for ≥6 months;
•  Glycated hemoglobin ≥7.5% within 3 months;
•  Age 18–64 years.
Patients were excluded for any of the following:
•  Medicare or Medicaid beneficiaries;
•  Uninsured;
•  Insulin pump users;
•  Not currently managed by study physicians;
•  Pregnant;
•  Active substance, alcohol, or drug abuser (sober <1 year);
•  Psychotic or schizophrenic under active care;
•  Severe hearing or visual impairment; or
•  No Internet or e-mail access.
Source: Diabetes Care 34:1934–1942, 2011
Flowchart of enrollment and patient status (n = 163).
Quinn C C et al. Dia Care 2011;34:1934-1942
Prewencja powikłań w cukrzycy
Aplikacja BlueStar Diabetes:
-  Edukacja pacjenta
-  System wsparcia decyzji
-  Wyznaczanie czasu kontroli glikemii
-  Ustalanie dawkowania leków
Source: Diabetes Care 34:1934–1942, 2011
System wsparcia decyzji
Source: Diabetes Care 34:1934–1942, 2011
Wpływ intensywnej teleopieki
diabetologicznej na stężenie HbA1C
0.00%
-0.50%
-0.70%
Teleopieka:
-  Porada
-  Portal edukacyjny
-  Algorytm optymalizacji
farmakoterapii
-1.00%
p<0,001
-1.50%
-2.00%
HbA1C
-1.90%
Algorytm
optymalizacji
Grupa kontrolna
-1.90%
-0.70%
Source: Diabetes Care 34:1934–1942, 2011
“BlueStar App
received FDA
approval in 2010”
Source: http://www.slate.com
•  Failure of a free flap is almost always
caused by postoperative thrombosis of
the artery or vein
•  Clinical examination of the transplanted
tissue’s color, temperature, turgor, and
recapillarization continues to be the gold
standard of monitoring but requires a high
level of experience to be proficient
•  Early identification of vascular
compromise is imperative to maximize
successful outcome. Goal:
•  to compare the accuracy rate between remote smartphone
photographic assessments and in-person examinations for free flap
monitoring.
Microsurgery. 2011 Nov;31(8):589-95. doi: 10.1002/micr.20921. Epub 2011 Aug 24.
Goal:
•  to compare the accuracy rate between remote
smartphone photographic assessments and in-person examinations for free flap monitoring.
Microsurgery. 2011 Nov;31(8):589-95. doi: 10.1002/micr.20921. Epub 2011 Aug 24.
•  The accuracy rate was 98.7% and 94.2% for in-person
and smartphone photographic assessments,
respectively.
•  The time to decision of re-exploration 8 +/- 3 min in
smartphone group was statistically shorter than the
180 +/- 104 min in in-person group (p<0.01)
Microsurgery. 2011 Nov;31(8):589-95. doi: 10.1002/micr.20921. Epub 2011 Aug 24.
Portable mobile spirometer
Mobile App
MySpiroo advantages
MySpiroo size:
Usually competitors device size:
110 x 70 x 60 mm with mouthpiece
210 x 100 x 60 mm with mouthpiece
MySpiroo weight:
Usually competitors device weight:
80g
200g
MySpiroo working time:
Usually competitors device working time:
Patient: 56 days
Office: 45 hours (5,6 days)
Stand by: 120 days
Patient: 5-10 days
Office: 20 hours (2,5 day)
Stand by: 10 days
MySpiroo wake-up time:
Usually competitors device wake-up time:
60 ms
1-3 s
MySpiroo connectivity:
Usually competitors device connectivity:
Bluetooth 4.0
Bluetooth 2.0 or USB wire
MySpiroo advantages
Temperature-based Sensor*
*MySprioo is the only spirometer with temperature-based sensor
Podsumowanie
•  Aplikacje mobilne osiągnęły wysoki poziom
zaawansowania technologicznego by można je
było stosować w celu prewencji, diagnostyki i
leczenia chorób przewlekłych.
•  Dostępne dowody naukowe wskazują na
potencjalne korzyści kliniczne i ekonomiczne !
z automatyzacji i algorytmizacji opieki
medycznej.
•  Konieczne jest inicjowanie nowych badań w
obszarze zdrowia mobilnego. WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO
Blog dotyczący telemedycyny i mHealth (www.koltowski.com) WARSZAWSKIEGO UNIWERSYTETU MEDYCZNEGO