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Transcript of CONGESTIVE HEART FAILURE ANNA POLYNIKI MD ARISTOTLE UNIVERSITY OF THESSALONIKI SCHOOL OF MEDICINE...
![Page 1: CONGESTIVE HEART FAILURE ANNA POLYNIKI MD ARISTOTLE UNIVERSITY OF THESSALONIKI SCHOOL OF MEDICINE Professor: Dr. Ernest Carter. HOWARD UNIVERSITY COLLEGE.](https://reader036.fdocuments.in/reader036/viewer/2022081514/5697bffc1a28abf838cc1680/html5/thumbnails/1.jpg)
CONGESTIVE HEART FAILURE ANNA POLYNIKI MDARISTOTLE ARISTOTLE
UNIVERSITY OF UNIVERSITY OF THESSALONIKITHESSALONIKI
SCHOOL OF SCHOOL OF MEDICINEMEDICINE
Professor:
Dr. Ernest Carter.
HOWARD UNIVERSITY
COLLEGE OF MEDICINE
Director:
Dr. Celia Maxwell.
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INDEX1.INTRODUCTION
2.DEFINING TELEMEDICINE3.TELEMEDICINE APPLICATIONS
4.CONGESTIVE HEART FAILURE5.TELECARDIOLOGY IN CYPRUS
6.CONCLUSION
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1.INTRODUCTION
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2.DEFINING TELEMEDICINE
“Telemedicine is the use of electronic information and communication technologies to provide and support healthcare when distance separates the patient from the health care provider.”
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1.TIMELY2.COST-EFFECTIVE
3.CONVENIENT ACCESS TO QUILITY HEALTH CARE
SERVICES ACROSS DISTANCE
ADVANTAGES OF TELEMEDICINE
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1.Home health care for persons with chronic conditions
2.Transmission of diabetic patients’ glycose data from home
3.Transmission of ECG or EEG data4.Real-Time interactive orthopedic
examination and consultation5.Remote supervision of laparoscopic
surgical procedures6.Patient education
7.Diagnosis of an astronaut’s acute illness during space flight
3.TELEMEDICINE APPLICATIONS
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4.CONGESTIVE HEART FAILURE
Heart failure is a complex syndrome that results from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump.It has a major impact on longevity and quality of life.One to two percent of the general population of developed countries have heart failure, and the average age at diagnosis is 76 years.Although the steady rise in hospital admissions for heart failure has slowed recently, the management of heart failure still accounts for 1-2% of healthcare expenditure in countries in the developed world.Improvements in cardiac imaging and new biochemical assays have made diagnosis more straightforward.Major changes in treatment have resulted from a better understanding of the pathophysiology of heart failure and the results of large clinical trials.Improving outcomes now increasingly depends on improved communication between healthcare professionals, education of patients and carers and better chronic disease management.
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5.TELECARDIOLOGY IN CYPRUS
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PREVALENCE OF CONGESTIVE HEART FAILURE IN CYPRUS
0,87%
Department Internal Medicine-
Cardiologist
Specialized Cardiologist
Nicosia 12 32
Limassol 15 15
Larnaca 4 10
Pafos 1 8
Ammochostos 1 2
Total 33 67
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CYPRUS MAP
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Daily
Every 6 weeks
Every 2 weeks
BPHR
WEIGHT
Chronic Cardiac Patients
Primary Health Care Center
Nurse
WORKFLOW
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STABLE CONDITION
NOT STABLE3.Notifies nurse about
decisions
4.Nurse forwards patient doctor’s
orders
DETERIORATED CONDITION
STABLE CONDITION HOME
STABILIZED
CHANGE TREATMENT
1.Checks patient’s record2.Desides necessary follow-up
AMI
Cardiologist
WORKFLOW 1
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SEVERE CHEST PAIN
PATIENT’S CONFERMATION PAGE
CONDUCTS CLINICAL
EXAMINATION
RECORDS A RESTING ECG
MYOCARDICAL ENZYMES
Primary Health Care
Center
WORKFLOW 2
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1.Registration Information2.Administrative Data
3.Presenting Symptoms4.Diagnosis
5.Medication6.Specific Examinations
-ECG -ECHO cardiogram
-Laboratory Findings7.Demographics Page
PATIENT’S CONFIRMATION PAGE
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DEMOGRAPHICS PAGEAnatomical Characteristics:
1.Ascending Aorta2.Aortic Arch3.Aortic Valve4.Left Atrium
5.Left Ventricle6.Mitral Valve
7.Interatrial Septum8.Interventricular Septum
9.Tricuspid Valve10.Right Atrium
11.Right Ventricle12.Pulmonary Artery
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NO SUSPICION OF AMI
SUSPICION OF AMI
DEFINATELY AMI
STABILIZED HOME
REMOTE SITE
CONSULTANT SITE
2nd Interpretation of ECG is
Requested
ICU
Teleconsultation with a specialist cardiologist is
requested
DIAGNOSIS
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TRF is constructed, reviewed and
signed
CENTRAL HOSPITAL
Specialist Cardiologist
PROCEDURE
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1.Administrative Data2.Patient’s Demographics
3.Parts of Patient’s Medical History
4.Clinical Data -Blood Pressure -Laboratory Data
-Comments of Physician -Counter Indications for
Thrombolysis5.Sample Diagnosis
6.Treatment Plans for AMI
TELECONSULTATION REQUEST FORM
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Insufficient Data
Requests Additional Data
1.Follow-up ECG2.Old ECGs
Reviews
NO AMI
SUSPICION OF AMI
Sufficient Data
NO AMI
SUSPICION OF AMI
STABILIZED HOME
TELEMEDICINE VISITPROCEDURE
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A.SELECT MEDIALITY -Real-Time VideoTeleconferencing B.SCHEDULING -The patient -The local referring provider -The distant consultant provider C.EQUIPMENT SET-UP -Real-Time Consultation:Referring Site 1.The technician arrives at the bedside of the patient 2.Puts equipment in place, plags in power and telecommunications 3.Turns on and makes diagnostic peripherals ready for study 4.Starts software programs as needed 5.Checks: -peripherals as appropriate -cleans any patient-contact surfaces as needed 6.Dials consultant location for a test connection 7.Checks video quility 8.Checks audio quility and volume.Adjusts as needed 9.Checks “camera control” mode10.Hungs up test connection
PROCEDURE 1
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-After patient is in place and ready11.Dials consultant location and establishes contact12.Caps video camera to ensure patient’s privacy-Real-Time Consultation:Consultant Site13.Puts equipment in place, plugs in power and telecommunications14.Turns on power for all equipment15.Starts softaware programs as needed16.Checks availability of medical information17.Accepts test connection call from referring site18.Checks video quility19.Checks audio quility and volume20.Checks “camera control” mode21.Hungs up test connectionD.PATIENT PREPERATION1.Patient orrientation checklist2.Explains patient about3.Reassures patient that4.Requests written informed consent5.Describes cost6.Introduces both send and receive people
•Telemedicine concept•Reason for using it•Participating peolple•The expected interactive experience
•Wont be on television•Quility of care will be appropriate and safe•Most patients are satisfied•Will have privacy and confidentiality
PROCEDURE 2
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E.PROVIDER PREPERATION AT SEND/REFERRING SITE1.Assesses suitability of the patient2.Schedules patient3.Sends medical records of patient at Receive/Consultant Site4.Tests connections and peripheral devices5.Contacts consulting site to confirm readiness6.Completes patient’s orrientationF.PROVIDER PREPERATION AT RECEIVE/CONSULTANT SITE1.Confirms telemedicine visit is precisely scheduled2.Reviews medical records3.Receives test connect call from referring site.Checks audio/video settings4.Assures specialized cardiologist is available and located at receive stationG.REAL-TIME EXAMINATION1.Technician positions telemedicine stethoscope on patient’s chest as directed by the specialized cardiologist2.Technician establishes quility of sound3.Technician stores all heart sounds4.Technician positions ECHO transducer in the locations as directed by the specialized cardiologist
PROCEDURE 3
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5.Technician establishes quility of image with each position6.Technician stores all video images by ECHO7.Technician records an ECG8.Ends telemedicine encounter-Specialized cardiologist approves images/sounds-All data is transferred to specialized cardiologist-Telecardiology consultation records become part of patient’s electronic health care record-Both parties sign off (linkage is broken)9.Telemedicine encounter ends-Specialized cardiologist reviews and generates consult-Diagnosis-Treatment plan
NO AMI
AMI
CONSULTATION IS SEND TO GP
Specialized cariologist advises the GP to give patient thrombolytic
treatment
Requests ambulance/helicopter to
transfer patient to Central Hospital
PROCEDURE 4
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Patient is telemonitored so as the specialized
cardiologist will be alerted for possible arrythmias
ICU
CENTRAL HOSPITAL
TELEMONITORING
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H.WRAP-UP1.Patient wrap-up-Patient is invited to ask any questions-Briefly assessment of patient’s comfort level and satisfaction2.Provider wrap-up-Briefly assessment of the telemedicine visit by providers of both sitesI.DOCUMENTATION1.Patient’s charts are maintained by both sites2.Stored images are maintained at the end site but not necessarily at the receive site3.Assure appropriate payment4.Assure insurance reimbursementG.EQUIPMENT SHUT DOWN/ CLEANING/ STORAGE1.Exit any computer-based applications and shut down the computer in an olderly manner2.Turn off power and unplug equipment3.Disconnect and properly store peripheral devices4.Clean all devices involving patient contact per infection control protocols5.Store equipment in a secure area or lock the examination room
PROCEDURE 5
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GOAL
Enhancement Reliability of the
Telemedicine Systems
GOAL
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MEDICAL PERIPHERALS
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Operating System: MS Windows 95/98/NT 4.0/2000Processor: Pentium II - 300 MHz or higherRAM: 64 MB minimumSound Card(for use with Receive Software): Creative Labs SB Live! X-Gamer 5.1Creative Labs SB Live! MP3+ 5.1Creative Labs SB Live! Platinum 5.1Third Party Software Requirements (for IP transmission):E-mail:Outlook ExpressOutlook 97/98/2000Netscape 6Netscape Communicator 4.77Web Browser:Internet Explorer 4.0 or laterNetscape 6 or laterNetscape NavigatorNetscape Communicator 4.77 or laterSize: 26.4mm (1.04") H x 121mm (4.76") W x 201mm (7.91") L List Price : $2,995.00
Digital Electronic Stethoscope
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Length: 7.10" (180MM) Width: 5" Height: 1.3" (33mm) Weight: 0.84 lbs. (.038kg) Power / Electrical: 4 AA alkaline batteries Intended Use: Resting Electrocardiogram Anatomical Sites: Non-invasive device, 12-lead electrocardiogram Safety Characteristics: Patient electrically isolated from mains.Patient leakage current <10uA Ground leakage current <50uA ECG Acquisition: Simultaneous 12-lead Patient Connection: 10-lead patient cable with RFI filter, defibrillator protection and patient isolation.Input impedence >100 MohmFrequency response 0.05-110 HzSensitivity: 5, 10, 20mm/mVADC resolution 2.44uV/bit Analysis & Measurement: Telemed Electrocardiogram
List Price : $3,990.00
ECG
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CPU Hardware:
SmartProbe Connection: IEEE Standard 1394 - 6 pin (Firewire); In the Gateway, custom connection through the media bay.Processor: Pentium IIIProcessor Speed: 700 MgHz+Random Access Memory: 192 MB RAM minimum; (If running multiple diagnostic application on the same CPU, please consult AMD on RAM recommendations).Hard Drive: 10 GigabitRecommended Peripheral: Rewritable CD ROMSoftware:Microsoft Windows 2000 Professional
List Price : $26,000.00
Ultrasound
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Dimensions: 2.63" (66.7mm) H x 6.45" (163.7mm) W x 4.37" (111mm) D Weight: Approximately 0.860 lbs. (390g) Type: Oscillometric Measurement Range: 20-280mmHG (BP); 40-200 beats/minute (Pulse) +3mmHG or 2%, whichever is greater (BP); +5% (Pulse) Display: Digital, character height: 0.63" (16mm) Pressurization: Automatic, using a micropump Depressurization: Constant-Air-Release Valve System Deflation: Automatic exhaust Power source: Four AA batteries (1.5V each) Battery Life: Approximately 3 months with one use/day Telephone Connection: RJ-11
List Price : $450.00
Digital Blood Pressure Monitor
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General Examination Camera
Dimensions: 2.2"W x 3.7"D x 2.9"H Weight: .5 lbs.
Magnification: Auto-zoom from 1-50x. Polarization: Push-button
Zoom: Push-button Pixels: 410,000 from a 1/4" CCD
Horizontal Resolution: Greater than 430 lines
Signal to Noise Ratio: Greater than 48dB Output Signal: Composite and S-Video
Output Format: NTSC Integrated Freeze-frame: Push-button
Color Adjustments: Auto white balance ACC: Full iris control Lighting: Fluorescent
Operating Temperature Range: 0 degree C - 40 degree C
Operating Humidity: Less than 90% Power Consumption: 5W
Voltage Range: 110/220 VAC 10%, 50/60 Hz, or 12VDC
Lens: General purpose lens close focus, 50x polarized lens, and optional 200x polarized
contact lens
List Price : $5,490.00
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Dimensions: 6.5"(16.5 cm) H x 8.6"(21.8 cm) W x 5.0"(12.7 cm) L
Weight: 6 lbs. (2.8 kg) Blood Pressure Accuracy: Meets or exceeds SP10-
1992 AAMI standards Cuff Pressure Range: 0-300 mmHg
Pressure Preset Levels: 120,140,160,200,240 or 280 mmHg
Systolic Determination: Max: 250 mmHg; Min: 60 mmHg
Diastolic Determination: Max: 160 mmHg; Min 30 mmHg
Pulse Rate Determination: Max: 200 bpm; Min: 40 bpm
Temperature Accuracy: Meets or exceeds ASTM E112-86 standards
Temperature Determination: Normal and Monitor Mode, Max: 108.0 deg. F (42.2 deg. C); Min: 84.0
deg. F (28.9 deg. C) Power Requirements: N. American version: 120
VAC, 60 Hz. International version: 220-240 VAC, 50-60 Hz
Internal Battery: Lead Acid, with external recharger
List Price : $ 2,995.00
Vital Signs Monitor
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Telemedicine by definition involves a separation of distance and/or time between a patient and a diagnosing
physician.Some form of information is necessary to bridge the gap.And there are four primary modalities that are
used to carry out telemedicine: Phone and Fax, Store and Forward, Real Time Videoteleconferencing (VTC) and
Internet/Web-Based applications. The telecommunication system chosen for this project is already existing and
proven.The major effort will be put on the integration of the various components and the software designed for
increasing the functionality of the telemedicine encounter which is dependent on the transmission of information
from one location to another.The list below includes the telecommunication technologies that will be included in
our telemedicine environment.
TELECOMMUNICATIONS
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TELECOMMUNICATION TECHNOLOGIES
1.TELEPHONE2.FAX
3.INTERNET4.ELECTRONIC MEDICAL RECORD
5.PERIPHERAL EQUIPMENT CONNECTIONS6.BANDWIDTH
7.INTEGRATED PORTABLE DEVICE FOR TELEMEDICINE EMERGENCY
8.REAL TIME VTC9.TELEMEDICINE CONSULTATION
ROOM
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FINANCIAL
PROFIT=GROSS REVENUE-EXPENCESA=REMOTE SITEB=CORPORATE EXPENCESC=CONSULTANT SITE
•EXPENCES=A+B+C•GROSS REVENUE-(A+C)=NET REVENUE•NET REVENUE-B=PROFIT•GROSS REVENUE ≥(A+B+C)+10%(A+C)•PROFIT=10% (A+C)
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6.CONCLUSIONS
THE MEDICAL PROFESSION AND THE CHALLENGE
Telemedicine will be an integral part of Medicine in the forthcoming years.
• Distances between health care providers and patients will be eliminated.
• Health providers in a growing number of medical specialties, including, but not limited utilize Telemedicine: dermatology, oncology, radiology, surgery, cardiology, psychiatry and home health care.
• Cyprus, because of its small size, is not possible to have all the facilities to meet the health needs of the entire population, especially the needs in tertiary medicine therefore Telemedicine will be an essential element of the Medical Health Care System.
• Income>Expenditure.