Tıp Bilişimi

EnglishTürkçe

BÖLÜM


DOI :10.26650/B/ET07.2021.003.28   IUP :10.26650/B/ET07.2021.003.28    Tam Metin (PDF)

Teletıp, Uzaktan Hasta Yönetimi ve İmplante Kalp Destek Cihazları

Nilgün Bozbuğa, Ömer Ali Sayın

Teletıp, sağlık alanında bilişim teknolojilerinin desteğiyle hastaların vital parametrelerinin sağlık kuruluşuna gerçek zamanlı olarak dijital aktarımı ile uzaktan hasta yönetimi sistemidir. Teletıp, izlem halindeki hastaların acil tanı ve tedavi gerektiren sağlık hizmetine ihtiyaç duymaları halinde, acil servis iletişimleri ve triyaj işlemlerinin daha kuruma başvurmadan çok hızlı başlatılmasını sağlaamaktadır. Teletıp multidisipliner çalışma takımı tarafından uygulanması gereken bir süreçtir. Sağlık kurumları üzerinde hasta yükünü azaltmakta ve kronik hastalıkların evden izlenmesi, tedavi edilebilmesi, rehabilitasyonu mümkün hale gelmektedir. Uzaktan hasta yönetiminde, hasta verilerinin gerçek zamanlı olarak sağlık görevlilerine iletilmesinde nesnelerin interneti ve merkezi karar destekli uzaktan hasta takip sistemleri kullanılmaktadır. Kablosuz iletişim teknolojilerinin oldukça gelişmiş olduğu günümüzde, kronik hastalıklarda uzaktan hasta takip sistemlerinin kullanılması sağlık alanında köklü değişikliklere yol açmaktır. Uzaktan hasta yönetimi, hasta bakım ve takibinin hastane ortamından çıkartılıp hastanın kendi evine taşınması anlamına gelmektedir. Böylelikle hastalar kendi hastalıkları hakkında bilgi ve farkındalık sahibi olmakta, kendi bakımını ve sağlık kontrollerini yapabilmektedir. e-Sağlık yöntemleriyle yapılan uzaktan hasta yönetimi klinik etkinlik ve finansal verimlilik koşullarının yanı sıra, güvenilir karar verme süreçleriyle sağlıkta hakkaniyetin gerçekleştirilebilmesini desteklemektedir. Kronik, ilerleyici bir hastalıkla yaşamak zorunda olan hastaların yaşam kalitesini sürdürme çabası yalnızca kendilerini değil aynı zamanda yakın çevrelerini ve ulusal sağlık ekonomisini de yakından ilgilendirmektedir. Kalp yetmezliği ülkemizde ve tüm dünyada giderek artan sıklığı ve yaygınlığı nedeniyle önde gelen kronik sağlık sorunlarından biri olarak önemini korumaktadır. Kalp yetmezliği, artmış morbidite, mortalite ve düşük hayat kalitesiyle sağlık sistemlerine önemli bir mali yük oluşturan kronik hastalıklardan biri olup uzun hastane yatışlarından da sorumludur. İleri kalp yetmezliği sorununu çözmek ve yaşam kalitesini iyileştirmek üzere klinik bakım ve tedavi hizmetinde yeni yaklaşımlar, ileri bilimsel ve yeni teknolojik uygulamalar ortaya koyulmaktadır. Bu amaçla son yıllarda teletıp ve uzaktan hasta yönetimi, kardiyovasküler hastalıkların tanısında, takibinde ve tedavilerinin yönlendirilmesinde giderek daha fazla kullanılmaya başlamıştır. Medikal tedaviye yanıtsız son dönem kalp yetmezliği hastalarında ventrikül destek cihazları yoğun olarak kullanılmaya başlanmıştır. Bu cihazlar özellikle kalp nakli bekleyen aday hastalarda, bekleme sürecinde ölüm oranlarını azaltma ve bu süreci daha güvenli, uç organlarda hasar oluşmaksızın atlatmaları için kullanılmaktadır. Teletıp yazılımları ve uzaktan hasta yönetimi sistemleri ventrikül destek cihazları takılmış hastalarda özellikle taburculuk sonrası bakım konusunda yoğunlaşmaktadır. İleri kalp yetmezliğinde uzaktan takip sisteminin mortalite ve morbidite üzerine olumlu etkisi olduğu görülmektedir.


Anahtar Kelimeler: Teletıp, telesağlık, uzaktan hasta yönetimi, kalp yetmezliği, implante cihazlar, kalp destek cihazları
DOI :10.26650/B/ET07.2021.003.28   IUP :10.26650/B/ET07.2021.003.28    Tam Metin (PDF)

Tele-Medicine, Remote Patient Management and Implanted Heart Support Devices

Nilgün Bozbuğa, Ömer Ali Sayın

Tele-medicine is a remote patient management system with the real time digital transfer of vital parameters of patients to the health care institution with the support of information technologies in health. It provides emergency communication and triage procedures to be performed very quickly if patients in follow-up need health care services along with urgent diagnosis and treatment. Tele-medicine is a process that should be performed by a multidisciplinary work team. Its application decreases the patient burden of health institutions, and makes it possible to monitor, treat, and rehabilitate in chronic diseases from home. Internet of Things and remote patient tracking systems with central decision support are used to transmit patient data to health care providers in real time. Today, wireless communication technologies are highly developed, and the use of remote patient monitoring systems in chronic diseases causes radical changes in the field of health. Remote patient management means taking patient care and follow-up out of the hospital environment and moving it to the patient’s own home. In this way, patients have information and awareness about their own diseases, and can perform their own care and health checks. Remote patient management with e-health methods supports the achievement of equity in health with reliable decisionmaking processes as well as clinical effectiveness and financial efficiency conditions. The effort of patients who have to live with chronic disease to maintain the quality of life concerns not only themselves but also their close environment and national health economy. Heart failure maintains its importance as one of the leading chronic health problems in Turkey and worldwide because of its increasing frequency and prevalence. It is one of the chronic diseases that cause an important financial burden to health systems with heart failure, increased morbidity, mortality, and low quality of life, and is also responsible for long hospitalizations. New approaches, advanced scientific and new technological applications in clinical care and treatment services are introduced to solve the problem of advanced heart failure and improve the quality of life. For this purpose, tele-medicine and remote patient management have been increasingly used in the diagnosis, follow-up, and treatment of cardiovascular diseases in recent years. Ventricular support devices have been used intensively in patients with end-stage heart failure who do not respond to medical treatment. These devices are used especially for candidate patients who are waiting for a heart transplant to reduce the mortality rates during the waiting period and to survive this process more safely without suffering any damage to the end organs. Tele-medicine software and remote patient management systems focus especially on post-discharge care in patients with ventricular support devices. It is observed that the remote monitoring system in advanced heart failure has a positive effect on mortality and morbidity.


Anahtar Kelimeler: Tele-medicine, tele-health, remote patient management, heart failure, implantable devices, heart support device

Referanslar

  • Abraham WT, Adamson PB, Bourge RC, et al. (2011). Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet 377: 658-666. google scholar
  • Adamson PB, Abraham WT, Bourge RC, et al. (2014). Wireless pulmonary artery pressure monitoring guides management to reduce decompensation in heart failure with preserved ejection fraction. Circ Heart Fail 7: 935-944. google scholar
  • Adibi, S. (2015). Mobile Health A Technology Road Map, Springer International Publishing. Doi. 10.1007/978-3-319-12817-7 google scholar
  • Arhete, L. E., Erasmus, R. (2016) “Healthcare Service Delivery: A Literature Review”, International Association for Management of Technology IAMOT 2016 Conference Proceedings, pp 487-505. google scholar
  • Atlas of e-Health country profiles: theuse of e-Health in support of universal health coverage:based on thefin-dings of thethird global survey on e-Health 2015. google scholar
  • Bartoli CR, Vessels KM, McCants KC. (2013). Increased intrathoracic impedance may predict adverse events in LVAD patients. J Card Surg 28: 616-618. google scholar
  • Boogerd EA, Arts T, Engelen LJ, Van de Belt TH. (2015) “What is eHealth”: Time for an Update? JMIR Res Protoc 12; 4(1): e29. doi:10.2196/resprot.4065 google scholar
  • Boothroyd LJ, Lambert LJ, Sas G, Guertin JR, Ducharme A, Charbonneau E, Carrier M, Cecere R, Morin JE, Bo-gaty P. (2013). Should eligibility for heart transplantation be a requirement for left ventricular assist device use? Recommendations based on a systematic review. Can J Cardiol. 29(12): 1712-1720. google scholar
  • Bozbuğa N. (2019). Mantık ve Tıpta İnovasyon. IX. Mantık Çalıştayı Kitabı (Ed: Kamer V). Mantık Derneği Yayınları, İstanbul. google scholar
  • Bozbuğa, N. (2020). COVID-19’da Kalp ve Damar Cerrahisi. Türkiye Klinikleri 37(1): 49-55. google scholar
  • Casida JM, Aikens JE, Craddock H, Aldrich MW, Pagani FD. (2018). Development and feasibility of self-ma-nagement application in left-ventricular assist devices. ASAIO J 64: 159-167. google scholar
  • Chaudhry SI, Mattera JA, Curtis JP, et al. (2010). Telemonitoring in patients with heart failure. N Engl J Med 363: 2301. google scholar
  • Clarke A, Pulikottil-Jacob R, Connock M, Suri G, Kandala NB, Maheswaran H, Banner NR, Sutcliffe P. (2014). Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure: Analy-sis of the British NHS bridge to transplant (BTT) program. Int J Cardiol 171(3): 338-345 google scholar
  • Cleland JG, Swedberg K, Follath F, et al. (2003). The EuroHeart Failure survey programmea survey on the quality of care among patients with heart failure in Europe. Part 1: Patient characteristics and diagnosis. Eur Heart J 24: 442-463. google scholar
  • Critoph C, Green G, Hayes H, et al. (2016). Clinical Outcomes of Patients Treated with Pulmonary Vasodilators Early and in High Dose After Left Ventricular Assist Device Implantation. Artif Organs 40: 106-114. google scholar
  • Eckman PM, John R. (2012). Bleeding and thrombosis in patients with continuous-flow ventricular assist de-vices. Circulation 125: 3038. google scholar
  • Global Diffusion of e-Health: Making Universal Health Coverage Achievable. Report of the Third Global Survey on e-Health. Geneva: World Health Organization; 2016. Licence: CC BY-NC-SA 3.0 IGO. google scholar
  • Guglin M, George B, Branam S, et al. (2016). CardioMEMS™ in LVAD Patients: A Case Series.. Available online: http://uknowledge.uky.edu/cgi/viewcontent. cgi?article=1056&context=vad, google scholar
  • Hindricks G, Taborsky M, Glikson M, et al. (2014). Implant-based multiparameter telemonitoring of patients with heart failure (IN-TIME): a randomised controlled trial. Lancet 384: 583-590. google scholar
  • Hollander JE, Carr BG. (2020). Virtually Perfect? Telemedicine for Covid-19. N Engl J Med 2020 Mar 11. [Epub ahead of print], doi:10.1056/NEJMp2003539. google scholar
  • Ho KK, Pinsky JL, Kannel WB, Levy D. (1993). The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 22(4): A6-A13. google scholar
  • Hohmann S, Veltmann C, Duncker D, König T, Berliner D, et al. (2019). Initial Experience with Telemoni-toring in Left Ventricular Assist Device Patients J Thorac Dis 11(Suppl 6): S853-S863. doi: 10.21037/ jtd.2018.10.37. google scholar
  • http://www.alerevadcare.com/ google scholar
  • https://www.alere.com/content/dam/web/alere-com/products/inratio2/docs/23691_revA_Alere%20INR2%20Cleaning_PI%202012%20Aug7.pdf google scholar
  • https://www.cardiovascular.abbott/us/en/hcp/products/heart-failure/cardiomems-hf-system.html google scholar
  • http://www.coaguchek.co.uk/coaguchek_hcp/en_GB/home/products/pro_II_system.html google scholar
  • https://diagnostics.roche.com/us/en/coaguchek-hcp-home.html google scholar
  • https://www.medtronic.com/us-en/healthcareprofessionals/products/cardiac-rhythm/managing-patients/infor-mation-systems/carelink-network.html google scholar
  • Hutchinson J, Scott DA, Clegg AJ, Loveman E, Royle P, Bryant J, Colquitt JL. (2008). Cost-effectiveness of left ventricular-assist devices in end-stage heart failure. Expert Rev Cardiovasc Ther 6(2): 175-185. google scholar
  • Inamdar AA, Inamdar AC. Heart Failure: Diagnosis, Management and Utilization. Journal of Clinical Medicine DOI:10.3390/jcm5070062 google scholar
  • Inglis SC, Clark RA, McAlister FA, Ball J, Lewinter C, Cullington D, Stewart S, Cleland JG. (2010). Structured telephone support or telemonitoring programmes for patients with chronic heart failure. Cochrane Database Syst Rev 8:CD007228. google scholar
  • Jayaram NM, Khariton Y, Krumholz HM, et al. (2017). Impact of Telemonitoring on Health Status. Circ Car-diovasc Qual Outcomes 10. google scholar
  • Kato TS, Schulze PC, Yang J, et al. (2012). Pre-operative and post-operative risk factors associated with neuro-logic complications in patients with advanced heart failure supported by a left ventricular assist device. J Heart Lung Transplant 31:1. google scholar
  • Khush KK, Zaroff JG, Nguyen J, Menza R, Goldstein BA. (2015). National decline in donor heart utilization with regional variability: 1995-2010. Am J Transplant 15(3): 642-649. doi: 10.1111/ajt.13055. Epub 2015 Feb 10. google scholar
  • Klersy C, De Silvestri A, Gabutti G, et al. (2009). A metaanalysis of remote monitoring of heart failure patients. J Am Coll Cardiol 54: 1683-1694. google scholar
  • Koehler F, Winkler S, Schieber M, et al. (2010). Telemedical Interventional Monitoring in Heart Failure (TIM-HF), a randomized, controlled intervention trial investigating the impact of telemedicine on mortality in ambulatory patients with heart failure: study design. Eur J Heart Fail 12: 1354. google scholar
  • Maor E, Perry D, Mevorach D, Taiblum N, Luz Y, Mazin I, et al. (2020). Vocal Biomarker Is Associated with Hospitalization and Mortality Among Heart Failure Patients. J Am Heart Assoc 9(7): e013359. google scholar
  • Masoudi FA, Balillie CA, Wang Y, et al. (2005). The complexity and cost of drug regimens of older patients with heart failure in the United States, 1998-2001. Arch Intern Med 165: 2069-2076. google scholar
  • Neyt M, Van den Bruel A, Smit Y, De Jonge N, Erasmus M, Van Dijk D, Vlayen J. (2013). Cost-effectiveness of continuous-flow left ventricular assist devices. Int J Technol Assess Health Care. 29(3): 254-260. google scholar
  • Ong MK, Romano PS, Edgington S, et al. (2016). Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients with Heart Failure: The Better Effectiveness After Transition -- Heart Failure (BE-AT-HF) Randomized Clinical Trial. JAMA Intern Med 176: 310. google scholar
  • Pare G, Janna M, Sicotte C. (2007). Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 14: 269-277. google scholar
  • Polisena J, Tran K, Cimon K, et al. (2010). Home telemonitoring for congestive heart failure: a systematic review and meta-analysis. J Telemed Telecare 16: 68. google scholar
  • Reiss N, Schmidt T, Boeckelmann M et al. (2018). Telemonitoring of Left-Ventricular Assist Device Pa-tients-Current Status and Future Challenges. J Thorac Dis 10(Suppl 15): S1794-S1801. doi: 10.21037/ jtd.2018.01.158. google scholar
  • Reiss N, Wegner KK, Hoffmann JD, Schulte Eistrup S, Boeken U, Morshuis M, Schmidt T. (2019). Requirements for a Telemedicine Center to Monitor LVAD Patients. Stud Health Technol Inform 260: 146-153. google scholar
  • Rogers JG, Bostic RR, Tong KB, Adamson R, Russo M, Slaughter MS. (2012). Cost-effectiveness analysis of continuous-flow left ventricular assist devices as destination therapy. Circ Heart Fail 5(1): 10-16 google scholar
  • Sakhi R, Theuns DAMJ, Bhagwandien RE, Michels M, Schinkel AFL, Szili-Torok T, Zijlstra F, Roos-Hesselink JW, Yap SC. (2018). Value of implantable loop recorders in patients with structural or electrical heart dise-ase.J Interv Card Electrophysiol. 52: 203-208. google scholar
  • Sara JDS, Maor E, Borlaug B, Lewis BR, Orbelo D, Lerman LO, Lerman A. (2020). Non-invasive vocal bio-marker is associated with pulmonary hypertension. PLoS One 15(4): e0231441. google scholar
  • Shaw, T., McGregor, D., Brunner, M., Keep, M., Janssen, A., Barnet, S. (2017). What is e-Health? Development of a Conceptual Model for e-Health: Qualitative Study with Key Informants. J Med Internet Res 19(10): e324. doi:10.2196/jmir.8106. google scholar
  • Singhvi A, Trachtenberg B. (2019). Left Ventricular Assist Devices 101: Shared Care for General Cardiologists and Primary Care. J Clin Med. 18; 8(10): 1720. doi: 10.3390/jcm8101720 google scholar
  • Tsukui H, Abla A, Teuteberg JJ, et al. (2007). Cerebrovascular accidents in patients with a ventricular assist device. J Thorac Cardiovasc Surg 134: 114. google scholar
  • Vollmann D, Nagele H, Schauerte P, et al. (2007). Clinical utility of intrathoracic impedance monitoring to alert patients with an implanted device of deteriorating chronic heart failure. Eur Heart J 28: 1835-40. google scholar
  • Volterrani M, Sposato B. (2019). Remote monitoring and telemedicine. Eur Heart J Suppl 21(Suppl M): M54-M56. doi: 10.1093/eurheartj/suz266. google scholar
  • Virani SA, Sharma V, McCann M, Koehler J, Tsang B, Zieroth S. (2018). Prospective evaluation of integrated device diagnostics for heart failure management: results of the TRIAGE-HF study. ESC Heart Fail 5: 809-17. google scholar
  • Walter C, Fischer F, Hanke JS, Dogan G, Schmitto JD, Haverich A, Reiss N, Schmidt T, Hoffmann JD, Feldmann C. Infrastructural needs and expected benefits of telemonitoring in left ventricular assist device therapy: Results of a qualitative study using expert interviews and focus group discussions with patients. International Journal of Artificial Organs https://doi.org/10.1177/0391398819893702 google scholar


PAYLAŞ




İstanbul Üniversitesi Yayınları, uluslararası yayıncılık standartları ve etiğine uygun olarak, yüksek kalitede bilimsel dergi ve kitapların yayınlanmasıyla giderek artan bilimsel bilginin yayılmasına katkıda bulunmayı amaçlamaktadır. İstanbul Üniversitesi Yayınları açık erişimli, ticari olmayan, bilimsel yayıncılığı takip etmektedir.