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
3,000 Global Internet Device Sales 2,500 Units in millions 2,000 1,500 Tablets 1,000 Smartphones 500 Computers 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012E 2013E 2014E 2015E 2016E *Source Gartner May 2012 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
Quinn C C et al. Dia Care 2011;34:1934-1942 Flowchart of enrollment and patient status (n = 163).
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
0.00% -0.50% -1.00% -1.50% -2.00% Wpływ intensywnej teleopieki diabetologicznej na stężenie HbA1C -1.90% Algorytm optymalizacji p<0,001-0.70% Grupa kontrolna HbA1C -1.90% -0.70% Teleopieka: - Porada - Portal edukacyjny - Algorytm optymalizacji farmakoterapii 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: 110 x 70 x 60 mm with mouthpiece MySpiroo weight: 80g MySpiroo working time: Patient: 56 days Office: 45 hours (5,6 days) Stand by: 120 days MySpiroo wake-up time: 60 ms MySpiroo connectivity: Bluetooth 4.0 Usually competitors device size: 210 x 100 x 60 mm with mouthpiece Usually competitors device weight: 200g Usually competitors device working time: Patient: 5-10 days Office: 20 hours (2,5 day) Stand by: 10 days Usually competitors device wake-up time: 1-3 s Usually competitors device connectivity: 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