*Natasza Blek1, Lukasz Szarpak2, Michalina Drejza3
The use of digital technologies in stroke management in the world: an analysis of examples
Technologie cyfrowe wykorzystywane w opiece nad pacjentami z udarami – analiza przypadków na świecie
1Institute of Neuroscience and Cybernetic Medicine, Faculty of Medicine, Lazarski University, Warsaw, Poland
2Lazarski University, Warsaw, Poland
3Reproductive And Sexual Health Research student, London School of Hygiene And Tropical Medicine, London, United Kingdom
Streszczenie
Celem tej publikacji jest zilustrowanie realistycznego potencjału technologii cyfrowych – aplikacji mobilnych, telemedycyny, zautomatyzowanych systemów analitycznych stosowanych w kilku kluczowych elementach zapobiegania i terapii udaru. Na podstawie danych Światowej Organizacji Zdrowia szacuje się, że udar był przyczyną 5,78 miliona zgonów na świecie w 2016 roku.
Baza PubMed została przeszukana pod kątem stosowanych metod cyfrowych w zapobieganiu i terapii udaru. Po wstępnym przeszukaniu identyfikowano kierunki dalszych poszukiwań w oparciu o najpopularniejsze słowa kluczowe odnoszące się do technologii cyfrowych.
Coraz więcej dowodów naukowych przemawia za skutecznością wykorzystania cyfrowych technologii w opiece nad pacjentem z udarem. Niestety, większość związanych z ucyfrowieniem opieki rekomendacji zawartych jest w wytycznych tworzonych przez towarzystwa amerykańskie, bez europejskiego czy polskiego odpowiednika. Wybrane technologie (zwłaszcza te umożliwiające prewencję pierwotną i wtórną) mogą być z łatwością zastosowane przez szerokie grupy pacjentów i pracowników ochrony zdrowia, potrzeba jednak szeroko zakrojonych kampanii informacyjnych, edukacji i rekomendacji w tym zakresie.
Summary
The aim of this publication is to illustrate the realistic potential of digital technologies – mobile applications, telemedicine, automated analysis systems applied in the several key elements in stroke patient management. According to data provided by WHO, it is estimated that strokes have caused 5.78 million deaths in 2016.
Review has been conducted searching for digital health technologies used for stroke management in PubMed database, and several references have been snowballed from the search terms.
More and more scientific evidence speak for the efficiency of using digital technologies in care of stroke patients. Unfortunately, most of the recommendations linked to digitalization of patient care are part of guidelines provided by American associations, with no European or Polish equivalents. The chosen technologies (and especially those making primary and secondary prevention feasible) can be easily applied by wide groups of patients and healthcare practitioners. However, more publicly targeted informational and educational campaigns are necessary, together with the development of specific recommendations.
INTRODUCTION
The World Health Organization (WHO) defines stroke as the “interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue” (1).
According to data provided by WHO, it is estimated that strokes have caused 5.78 million deaths in 2016, being the world’s second biggest killer (2).
Nowadays the majority of the strokes occurs in the younger age, unlike 30 years ago when they affected mostly people over 75 (3). The INTERSTROKE case-control study led in 32 nations around the world provided evidence that 10 risk factors represented 90% of the population-attributable risk for all stroke (4).
Guidelines written by The European Stroke Organisation (ESO) (5) distinguish a few key components to enhance stroke care:
1. Public Awareness and Education.
2. Primary Prevention.
3 Secondary Prevention.
4. Referral and Patient Transfer.
5. Emergency Management.
6. Stroke Services and Stroke Units.
7. Diagnostics.
8. General Stroke Treatment.
9. Specific Treatment.
10. Prevention and Management of Complications.
11. Rehabilitation.
In this paper the authors explore the most prominent developments in stroke care with a special focus on recent progress in the use of new and digital technologies. Multiple new definitions have been introduced to the public health domain. For instance, mHealth (mobile health) can be defined as a practice of medicine and public health services combined with the use of mobile devices (6). This term, however, is being replaced with broader term of “Digital Health” covering healthcare interventions delivered via digital technologies – telemedicine, Web-based strategies, e-mail, mobile phones, mobile applications, text messaging, and monitoring sensors (7). After a two-year process to update and standardize the typology, in December 2017 WHO released a revised classification scheme for digital health interventions, which “aims to promote an accessible and bridging language for health program planners to articulate functionalities of digital health implementations” (tab. 1) (8).
Tab. 1. Selected elements of stroke care according to ESO and the corresponding WHO digital health typology including examples
| Element of stroke care | Digital functionaity for addresing the health system challenge |
| Public awareness and education | 1.6.1. Client look-up of health information – mobile applications
2.8.1. Provide training content and reference material to healthcare provider(s) – mobile applications |
| Primary prevention | 4.1.4. Automated analysis of data to generate new information or predictions on future events – mobile applications
1.4.2. Self monitoring of health or diagnostic data by client – mobile applications |
| Secondary prevention | 1.4.3. Active data capture/documentation by client – mobile applications, wearable devices |
| Referral and patient transfer | 2.3.2. Provide checklist according to protocol – mobile applications
2.4.1. Consultations between remote client and healthcare provider – telemedicine
2.6.1. Coordinate emergency response and transport – telemedicine |
| Emergency management | 2.4.4. Consultations for case management between healthcare providers – telemedicine
2.8.1. Provide training content and reference material to healthcare provider(s) – mobile applications |
| Diagnostics | 2.7.2. Schedule healthcare provider’s activities – workflow management systems
4.1.4. Automated analysis of data to generate new information or predictions on future events – artificial intelligence system
2.4.3. Transmission of medical data (e.g. images, notes, and videos) to healthcare provider – telemedicine
2.4.4. Consultations for case management between healthcare providers – telemedicine |
| Rehabilitation | 2.4.1. Consultations between remote client and healthcare provider – telemedicine
1.4.2. Self monitoring of health or diagnostic data by client – virtual reality |
The aim of this publication is to illustrate the realistic potential of digital technologies – mobile applications, telemedicine, automated analysis systems applied in the several key elements in stroke patient management.
In addition, another at-desk review has been conducted searching for digital health technologies used for stroke management in PubMed database, and several references have been snowballed from the search terms.
REVIEW
Mobile applications
By 2019, the number of smartphone users is estimated to raise to 2.5 billion people. A little more than 36 percent of the total population is anticipated to possess and use a smartphone by 2018, up from around 10 percent in 2011 (9). Mobile applications can be used to raise awareness among patients and healthcare professionals, therefore reducing financial burden from numerous disorders.
Mobile applications – Public Awareness and Education
Several mobile stroke applications can increase stroke awareness and help to perform early detections on mild stroke symptoms.
Some of the existing mobile health awareness applications are designed to raise knowledge and awareness around stroke and its consequences, including FAST Test (10), The Mayo Clinic Acute Stroke Evaluation App (11), Stroke 119 (12).
Mobile applications – Emergency Management
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Piśmiennictwo
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