1 / 51

Smiling Heart App - Simplifying Diagnosis of Critical CHD

The Smiling Heart App is a user-friendly tool designed to aid in the clinical recognition and diagnosis of critical congenital heart disease (CHD). It utilizes a two-step simplified approach and an integrated diagnostic tool to facilitate early referral and treatment. With features like symptom assessment, pulse oximetry screening, and echocardiography support, the app is aimed at healthcare workers, parents, and general physicians to improve detection rates and reduce infant mortality.

valeriem
Download Presentation

Smiling Heart App - Simplifying Diagnosis of Critical CHD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Navaneetha Sasikumar  MD(Ped), DM(Cardiology) Fellowship in Ped, Adult Congenital & Structural Heart Disease Interventions ; (University of Toronto, Canada) Paediatric Cardiologist, MCH Kottayam

  2. Outline • Background , why an app • About The Smiling Heart App • How to utilize the app • Limitations and Future plans

  3. Background • Targeting treatment of critical CHD -> Decrease in IMR • Organized System in place for appropriate , timely treatment (most difficult) • Timely Diagnosis and referral from the periphery becomes the Rate limiting step

  4. Background - Approaches for improving CHD detection rates • Pulse oximetry - Leaves out the left to right shunt lesions • Large group, important contributor to mortality in the 1st year • Need of a more inclusive approach -> BUT ALSO one thats easy to understand, remember and reproduce

  5. SYNDROMIC APPROACH to aid clinical recognition of CRITICAL CHD • Hypoxia , not responding to o2 • Shock , not responding to fluid /inotropes • heart failure • combination of above • asymptomatic patient with an abnormal 4 limb SPO2 screen

  6. Abnormal Pulse Oximetry Screen Clinical Suspicion

  7. HOW TO FORMULATE A WORKING DIAGNOSIS ? WHO WILL DO THAT ?

  8. HOW TO FORMULATE A WORKING DIAGNOSIS ? Echocardiography WHO WILL DO in the periphery ?

  9. Sometimes two people need to fall apart to realize how much they need to get back together !!!!! Paediatrician: “Mere paas clinical details details hai; ECG hai , X Ray hai, SPO2 screen hai, tere paas kya hai?” Cardiologist: “Mere paas Echo Hai!”

  10. Who will do that ? • Paediatrician/ Neonatologist • Trained Echocardiography Technicians and remote reporting of images - More money and effort

  11. HOW TO REACH A WORKING DIAGNOSIS ?

  12. The two -step Simplified (SYNDROMIC - PACCA) approach to diagnose critical CHD Step -1 Identify the Clinical Syndrome of Presentation

  13. The two -step Simplified (SYNDROMIC - PACCA) approach to diagnose critical CHD Step -2 Performing an ACRONYM Based (PACCA) Targeted Echocardiography using Basic views

  14. Building capacity based even on a simplified approach -what appears simple to a professional might not be simple for a beginner Mental models Differ

  15. Mental models Differ

  16. Make pulse oximetry screen easy and widely available Recruit as many forces as possible to suspect CCHD Provide continuous training and support (24*7) Train Paediatricians & neonatologists in Echocardiography

  17. Is there a comprehensive way of doing it all ?

  18. Reachable 24*7 availability Versatile User Friendly

  19. Suspecting CCHD: Once the whole process is simplified; and available as an APP • Parents • Grass root / healthcare workers in the field • Family doctors / General Physicians - PHC /CHC

  20. Parents / Family • Check Symptoms using symptom tool • Read and understand about CHD and pulse oximetry • Find help for treatment

  21. Parents / Family - Symptom assessment tool

  22. Grass root/Field healthcare workers/General practitioners • Check Symptoms - Clinical Tool • Prompts to Refer timely

  23. Paediatricians and Neonatologists • those not using echocardiography - Clinical Tool • for those with basic training in echocardiography :Echo integrated Diagnostic tool for reaching a provisional diagnosis to facilitate early referral • Support/ Interaction

  24. Clinical Tool

  25. Clinical Tool - BASIC Qs - essentially stimulates to think and look for clinical features

  26. Pulse Ox Tool - AAP Algorithm

  27. Pulse Ox Tool - AAP Algorithm - asks to repeat if needed

  28. Pulse Ox Tool - AAP Algorithm

  29. Portable pulse oximeter for neonates / infants Locally Modified from the commercially available finger pulse oximeter

  30. App can be an aid for training healthcare workers to obtain an accurate Pulse oximetry reading - Challenging task About Pulse Oximetry

  31. Formulated based on the two step SYNDROMIC - PACCA approach Uses clinical information , X ray , ECG findings to balance the inexperience with echocardiography Echo-Integrated Diagnostic Tool

  32. AIM - Help reach a working / provisional diagnosis for timely referral Echo-Integrated Diagnostic Tool

  33. Equipped with Readily available resource documents for quick referrals Echo-Integrated Diagnostic Tool

  34. Forces to think at each step and thus rule out / rule in important points of evaluation Echo-Integrated Diagnostic Tool

  35. Asks to look for certain findings on echo, based on clinical presentation Echo-Integrated Diagnostic Tool

  36. If the input fits into a particular CCHD, the app suggests the probable diagnosis and advises to refer early for treatment Echo-Integrated Diagnostic Tool

  37. If inputs do not match classic presentation / conflicting data are entered, the app prompts to refer early for expert opinion Echo-Integrated Diagnostic Tool

  38. How to utilize the app • Home based / community based care for neonates and infants • Healthcare field workers can do pulse ox check using the portable pulse oximeter and the pulse ox tool for all neonates at home • They can turn to the app for quick reference to do it the proper way

  39. How to utilize the app • Healthcare field workers can do a periodic “smiling heart symptom check” - at home ; at least once within the first 2-3 months of age • Doctors at PHC /CHC / Immunization clinics can use the clinical tool for a “smiling heart check” at first immunization visit

  40. How to utilize the app • If home checks are based on The APP; monitoring whether the job was done or not would be easy ; that will ensure accountability • E health is on the horizon - data can be transferred from the app to electronic health records of each patient

  41. How to utilize the app • Paediatricians and neonatologists, (after a basic training in echocardiography) can open the echo-integrated tool; follow the prompts and reach a provisional diagnosis of critical CHD , stabilize and refer early

  42. Limitations • Man /Woman cannot be replaced by a machine - Not an alternative to evaluation by trained paediatrician / paediatric cardiologist - ONLY FOR SCREENING PURPOSE

  43. Future • Check the tool algorithms in practical setting and modify if needed • Add videos to the echo integrated tool once the tool algorithm proves itself • Test utility by pilot projects in few districts and compare performance with non app using districts • Very open to Any other suggestions

  44. Acknowledgement Dr Harapriya B, Paediatric Cardiologist , MIOT , Chennai Mr Bertrand Russel Technical Lead, X-Value Technologies, Chennai

  45. Thank you for your patient listening

  46. Limitations The app and tools are for specific purposes: (a)the clinical tool and symptom evaluation tool are for non sick babies at home / during a well baby/vaccination contact with healthcare system (although an attempt is made to incorporate danger signs, particularly in neonates) (b) the echo integrated approach is ONLY for screening for critical CHDs for EARLY REFERRAL PURPOSE; it cannot compare itself with a detailed echocardiography by a trained paediatric cardiologist based on the classic segmental analytic approach

More Related