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Can an app save stroke patients when there’s no neurologist? ICMR explores

Sep 06, 2022

NEW DELHI: Can an app-based service become a viable option for managing stroke cases in hospitals where there are no neurologists available? 

Astudy funded by the Indian Council of Medical Research (ICMR) is being conducted in 22 district hospitals across several states in India to assess this. It is led by experts from 12 nodal centres including AIIMS Delhi, PGIMER Chandigarh and NIMHANS Bengaluru among others. 

In this study, the physicians at district hospitals will get the option to connect with a neurologist sitting in the nodal centres via a mobile-based app called ‘SMART INDIA App’. 

The moment a patient comes to the hospital with an acute stroke patient, the resident or physician can log in to the app and share baseline information about the patient with the nodal neurologist. 

Together, they can discuss and decide how to manage acute stroke and then initiate the process of tele-rehabilitation. This will involve interaction between the physician and a physiotherapist sitting in AIIMS or other nodal institutions on how to rehabilitate the patient. 

According to an article published recently in the Annals of Indian Academy of Neurology, the outcome of such an exercise will be decided upon the recovery of the patient over the next three months. 

In countries such as China, which face a similar shortage of neurologists in many parts of the country, the stroke physician model is being tried to tide over the crisis. It refers to a process wherein the physicians in rural centres are provided training on how to manage acute stroke cases. 

In the ICMR-funded study, officials said, the stroke physician model will also be attempted so as to compare which one of the two – telestroke model or the stroke physician model — leads to better outcome. “We hypothesise that the ‘low-cost Telestroke model (app-based service)’ is superior to the 'stroke physician model” to deliver optimal acute stroke care delivery,” say researchers. 

India sees 1. 5 million stroke cases every year. However, the country has only one neu- rologist per 1. 25 million population. A tele-stroke facility, if successful, can help local physicians save lives by timely medical intervention based on expert advice, doctors say. 

“The tele-stroke arm harnessing the power of information technology via a smartphone app enables the physician at the district hospital to engage in a real-time consultation with a stroke neurologist. The App allows the physician to transmit valuable patient data, including CT scans, critical for making timely clinical decisions in patient management,” the AIAN article says. 

According to Dr Kameshwar Prasad, former head of neurology at AIIMS and the current director of the Rajendra Prasad Institute of Medical Sciences, Ranchi, timely medical intervention can save many stroke patients from death and permanent disability. Stroke is a disease that affects the arteries leading to and within the brain. It occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts (or ruptures). When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it and brain cells die. Dr Prasad saiid timely administration of drugs to dissolve the clot can save many such patients. “Some patients may also benefit from minimally invasive surgery to remove the blood clot,” he added. 

Dr Shamsher Dwivedee, chairman of neurosciences division at VIMHANS Nayati hospital said sensitisation about stroke symptoms such as sudden weakness on one side of the body, slurring of speech or a sudden trouble seeing in one or both eyes is equally important. "Often, people fail to recognise the symptoms and associate it with a stroke, leading to delayed intervention. Even when the patient reaches a hospital, there are times when a CT scan and other imaging tests needed to assess the damage caused due to stroke takes too long. All this needs to be straightened to save lives,” he said. A stroke, sometimes called a brain attack, occurs when a clot blocks blood supply to part of the brain or when a blood vessel in the brain bursts. Intervention includes administering clot buster drugs or removing the clot and providing supportive care among others. 

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