BHS Connect https://bhsconnect.net Fri, 31 Jul 2020 17:08:55 +0000 en-US hourly 1 https://wordpress.org/?v=5.5.2 https://bhsconnect.net/wp-content/uploads/2018/08/bhs-logo-111x111-100x100.png BHS Connect https://bhsconnect.net 32 32 MyDirectives Mobile App – iMedicalApps https://bhsconnect.net/mydirectives-mobile-app-imedicalapps/ Fri, 31 Jul 2020 17:08:55 +0000 https://bhsconnect.net/mydirectives-mobile-app-imedicalapps/ Bring Your Advanced Directives Anywhere with This Mobile App and Website Despite universal recommendations from numerous healthcare groups, most people lack an advance care plan. One study cited only approximately 25% of adults in the HealthStyles Survey had completed one. Additionally, the lack of an advance care plan leads to unwanted care, in another study,...

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Bring Your Advanced Directives Anywhere with This Mobile App and Website

Despite universal recommendations from numerous healthcare groups, most people lack an advance care plan. One study cited only approximately 25% of adults in the HealthStyles Survey had completed one. Additionally, the lack of an advance care plan leads to unwanted care, in another study, 25% of patients cited unwanted care. Many patients and providers simply don’t fully understand what is/isn’t an advance care plan. They are not simply DNR/DNI orders, a living will, or POLST or similar medical orders. These advance care plans comprise statements of patients’ wishes at the end of life, CPR desires, care at home/hospice, organ donation, etc. 

MyDirectives first launched their companion app for iOS in 2015. Not sure how we missed it! 

Their website and app can be used separately, but ideally they should be together. The website is probably the best place to start, but I did my plan on the app first, then went to the website to fill it out more completely. The website discusses the goals of “create, update, and share”. This way a user can immediately complete and sign a valid advance care plan and share it with their family, friends, and healthcare providers. Any updates made in the app or on the website seamlessly sync with one another and with the Apple Health app. The app allows the user to digitally sign the plan, make a video of your wishes, use photos and videos to confirm your identity, share the Advance Care plan with others via email, text, QR reader, show on iPhone lock screen, etc. The multimedia components of the website and app are outstanding. A truly polished product–and completely free!

Evidence-based medicine

The app takes the “best practices” in advance care planning and guides the user in the creation of a valid document signed by the user. The primary website provides even more care plan options to create a truly state-of-the art advance care plan. The app doesn’t cite any evidence, per se, but the overall concept of “create, update, share” has good face-validity. Getting more patients to make these plans before a crisis would be truly invaluable. 

Who would benefit from this App?

Any patient or healthcare provider of patients with chronic medical diseases, terminal illnesses, geriatric patients, but really virtually any/every patient would benefit from having a signed and portable advance care plan. 

Price

o Free

Likes

  • Slick user interface that uniquely combines website data, Apple Health Data, and other content from the iPhone, and user input
  • Makes completing an advance care plan “easy” and portable
  • Outstanding multimedia functionality for signing advance care plan, recording video plan/comments, etc

Dislikes

  • Not all information can be completed (at least some of the most detailed questions) on the app and requires use of the website.
  • The directions and details are more robust on the website than within the app.
  • Not available for Android

Overall

An outstanding, useful, and creative app that brings advance care planning to mobile devices. The app works best when combined with the free MyDirectives.com website, but can stand on its own. The syncing between the two as well as Apple Health are seamless and instantaneous. I am so impressed with the detailed information that can be imported from the iPhone into the app (pictures, contact information, medical information, videos, etc.). This app deserves the praise and awards it has won as so many of our patients (and ourselves) could benefit from the website/app. Recommended most highly. Needs an Android version.

Overall Score

o 5.0 stars

User Interface

o 5.0 stars

Very intuitive interface with step-by-step instructions. The primary MyDirectives.com website is even easier to use and both sync back/forth with any updates/changes. Submenus include directions and the app easily uploads pictures, contact info, records video advance care plan comments, etc. 

Multimedia Usage

o 5.0 stars

App includes syncing with Apple Health, the MyDirectives website, healthcare plans, sharing of documents with healthcare agents, contacts, family, etc. The app allows for recording of video documents, digital signature, QR sharing, etc. 

Price

o 5 stars

App and website are both free.

Real World Applicability

o 5.0 stars

For all patients and providers of any age, but especially for those with chronic diseases and geriatric patients, the MyDirectives website and companion app are the perfect one-two punch for completing quality advance care planning. The app works well enough on its own, but really needs the complete documents completed online. Seamless syncing between the website, app and Apple Health are a nice bonus. The app still could be improved with more information within the app to avoid needing the website for some critical information such as life support and CPR as well as an Android version. 

Device Used For Review

o iPhone 11 Pro running iOS 13.6

Available for Download for iPhone and iPad. Not available for Android at this time.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.

       

 

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The real time health system: adapting healthcare to the new normal https://bhsconnect.net/the-real-time-health-system-adapting-healthcare-to-the-new-normal/ Thu, 30 Jul 2020 18:22:20 +0000 https://bhsconnect.net/the-real-time-health-system-adapting-healthcare-to-the-new-normal/ Right now, in the midst of a pandemic, our healthcare system is struggling with uncertainty – some might even say chaos – as it tries to stem the tide of infections that are sweeping across the nation. The COVID-19 pandemic demonstrates, vividly, that our healthcare system is unsuited to delivering systemic services to preempt, intervene...

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Right now, in the midst of a pandemic, our healthcare system is struggling with uncertainty – some might even say chaos – as it tries to stem the tide of infections that are sweeping across the nation. The COVID-19 pandemic demonstrates, vividly, that our healthcare system is unsuited to delivering systemic services to preempt, intervene and mitigate health crises affecting the general population.

It’s a problem as old as organized medicine, and we have yet to effectively harness the collective resources of healthcare to optimize human and physical assets, eliminate the frictions, and introduce the efficiencies that remove gaps in care and uneven outcomes. The solution set is going to require a departure, maybe a divorce, from traditional care delivery, and a pivot towards a data driven, real time health system.

U.S. healthcare has reached an inflection point – accelerated by COVID-19, in which the industry’s’ brick-and-mortar, encounter based business model is being extended and magnified by technology-inspired care innovation.

Pandemic aside, that transformation is largely a consumer driven phenomenon: Consumers have grown accustomed to the convenience of real-time access to people, process, information and transactions from any location and any connected device, and healthcare is no exception. In growing numbers, consumers expect greater engagement in decisions about their health, and connectivity to their care team beyond the encounter.

For both payers and providers, the challenge is to define and deliver this higher order of clinical value to the new healthcare consumer– conveniently, and beyond the boundaries of the traditional provider -patient relationship. A further wrinkle is the introduction of value-based care – allowing the consumer a greater voice, and greater choice, in the services and the sources of their care.

The common thread running through all these consumer expectations is clinical information – data that is captured and aggregated from any stakeholder, including the patient, normalized regardless of structure, analyzed, translated into actionable information, and delivered into a shared record.

In practical terms, the heart of healthcare consumerism is the patient experience – the range of interactions between the patient and their touchpoints of care – their health plan, inpatient and outpatient, office and virtual encounters, home based, portals and social media. And it’s not just about fluid access or a retail level of convenience – it’s about immediate, fully informed clinical decision making. The clinical capability that addresses this right here, right now patient dynamic is the Real Time Health System.

RTHS describes healthcare systems in which stakeholders share, adopt, and apply medical knowledge in real time. The RTHS value prop: if we can collect data, analyze it, and get it to providers quickly, we can improve care, accelerate workflows, streamline business processes, and better balance resources with demand.

The RTHS is characterized by curated, comprehensive clinical data – sourced and shared between all of healthcare’s stakeholders and delivered in real time to the patient record and the decision makers who can deliver informed care as a result.

But beyond data sharing, RTHS impacts the speed and clinical expediency of data, and through applications like AI and population health, allows healthcare’s decision makers to deliver precision medical care.

The key ingredient of the RTHS is data interoperability – defined by HIMSS as “the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

Interoperability involves the bilateral sharing of clinical information, including medical records, laboratory results, clinical summaries, medication lists, and much more. It achieves this level of data access and transparency by establishing a common data lexicon that enables the interpretation, and delivery of relevant clinical information regardless of format, platform, or vendor.

The grand vision of healthcare interoperability is to remove the structural, technical, and cultural divisions that prevent transparent clinical data exchange among every stakeholder in the care continuum.

Foremost among interoperability solutions is Fast Healthcare Interoperability Resources, or FHIR, a set of HL7 sponsored standards that facilitate the exchange of health information through connected, independent systems. FHIR provides consistent data formats, elements, and an application programming interface to connect health information across different health systems, payers, practices, pharmacies, and consumers.

Ultimately, FHIR creates a common language where any clinical system can connect and share data. A few examples of FHIR in practice include the DaVinci project, a private sector initiative working to help payers and health care providers positively impact clinical quality, cost and care management outcomes by facilitating the adoption of FHIR data standards.

The CARIN Alliance is a multi-sector collaborative that promotes the ability of consumers and their authorized caregivers to gain digital access to their health information via open APIs (APIs provide the means for disparate applications and systems to communicate with each other). In the public sector, CMS has created Blue Button, a system that enables Medicare beneficiaries to view online and download their own personal health records.

Additionally, there are collaborative interoperability alliances like SHIEC (HIEs), DirectTrust (HISPs), the Sequoia Project (nationwide interoperable health information exchange), and the Discover Alliance (multi sector).

These initiatives share the common goal of delivering a dashboard style, consolidated patient record on any connected device, from any qualified source, and will provide a trove of research and best practice information to members of the care team, including providers, payers, pharmacy, and consumers.

If interoperability is the vehicle that enables the RTHS, then clinical data tools – tools that capture, analyze, and transmit data from all points of the healthcare compass – are the fuel. These tools include:

  • Population health envisions the health outcomes of a group of individuals, including the distribution of outcomes within the group. Groups can be defined by geography, but also by other demographics such as employees, ethnicity, disabled persons, prisoners, or any social structure. Employing RTHS resources, Population health tools aggregate broad patient data from multiple health venues, and action is directed at the health of an entire population, or sub-population, rather than individuals. In the era of value-based care, that means taking clinical and even financial responsibility for managing the overall health of a defined population and being accountable for the health outcomes of that population.
  • Virtual health encompasses a catalog of digital and telecommunication technologies used to deliver on demand health care, including telemedicine, remote patient management, virtual visits and virtual assistants, and self-care. It includes tools such as wearables and home-based monitors, virtual reality and portals that collectively enable continuous monitoring, recording, and sharing of clinical data. As a component of the RTHS, Virtual health captures and makes usable clinical data between (or in lieu of) visits, and by removing the physical barriers to care, shifts the focus of care from reaction to prevention and wellness. 
  • Patient-generated health data describes data that is recorded and shared by patients, their family members, or caregivers in the management of health conditions. Patient-reported outcomes measures can help patients and providers monitor the results of an encounter or treatment. For Providers, PGHD is a useful tool in monitoring overall health and well-being, and early detection of potential health conditions.
  • Artificial intelligence and analytics describes algorithms and software that enable the extraction of actionable insights from sets of patient data sourced from patient claims, pharmaceutical and research and development data, clinical data collected from electronic health records, and patient generated data. Taken a step further, AI and predictive analytics uncover previously unseen data patterns that can be used to improve clinical decisions and treatment protocols. Through tools like AI and predictive analytics, the RTHS can anticipate and intervene in health issues at their onset – or even before they occur.

Clinical data, captured from any source, distilled, evaluated, analyzed, translated into actionable information, and delivered in real time within the patient record, is the bonding agent of patient engagement and the RTHS.

But the value of RTHS stretches beyond the use of digital tools to compile and share data. It combines digital and telecommunication technologies to create a continuous connection between patients, physicians, and other caregivers. And by combining technologies, health care stakeholders can more effectively coordinate patient care and optimize the patient experience.

RTHS is emblematic of sweeping changes that are redefining the terms and tools of healthcare. As value-based care takes hold, clinical decisions based on episodes of care will be replaced by the continuous capture and sharing of patient data.

Isolated snapshots of patient health will be replaced by a holistic, 360-degree, real time view of the patient, and the role of the patient will be elevated from bystander to fully engaged member of the care team. And with health crises apparent (like opioid abuse) or immediate (like COVID-19), the RTHS isn’t just aspirational, it’s critical.

Rick Krohn, principal at HealthSense, is an expert in connected health. He is the author of more than 100 articles and three HIMSS books detailing healthcare innovation.

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Why did Lifespan Health face such a stiff HIPAA penalty for a stolen laptop? https://bhsconnect.net/why-did-lifespan-health-face-such-a-stiff-hipaa-penalty-for-a-stolen-laptop/ Wed, 29 Jul 2020 14:00:00 +0000 https://bhsconnect.net/why-did-lifespan-health-face-such-a-stiff-hipaa-penalty-for-a-stolen-laptop/ The United States Department of Health and Human Services recently reached an agreement with Lifespan Health System Affiliated Covered Entity in which Lifespan agreed to pay HHS Office for Civil Rights $1,040,000 and adopt a corrective action plan in the wake of a data breach that exposed over 20,431 patients’ protected health information. The breach...

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The United States Department of Health and Human Services recently reached an agreement with Lifespan Health System Affiliated Covered Entity in which Lifespan agreed to pay HHS Office for Civil Rights $1,040,000 and adopt a corrective action plan in the wake of a data breach that exposed over 20,431 patients’ protected health information.

The breach occurred when an employee’s unencrypted laptop was stolen which contained electronic protected health information – including patients’ names, medical record numbers, demographic information and medication information.

On the surface this settlement, like many other OCR settlements, may seem harsh when looking at only the amount of money vis-a-vis the number of patients affected. In the world of HIPAA breaches, and data breaches in general, 20,431 affected individuals is not a large breach. And for a stolen laptop? Laptops get stolen everyday, right?

It has become quite common for those who find themselves in the crosshairs of an HHS investigation to say that the agency acts too harshly and that the money HHS is fining companies would be better spent on those companies’ security practices.

Unfortunately, those who feel this way do not understand what OCR and most other regulatory agencies are trying to accomplish – which leads to the key takeaway from this settlement.

HHS is trying to get companies to comply with the law and, more broadly, their obligation to protect the sensitive information that people have entrusted to them. We have handled numerous cases where it could have imposed penalties on companies but did not because it was clear that the companies were being diligent and were trying to get it right.

They may not have gotten it right. There may have been breaches that exposed patients’ information. But they were trying.

Now, looking at the agency’s actions through this lens, consider the following details HHS provided about the Lifespan ACE case:

  • “OCR’s investigation determined that there was systemic noncompliance with the HIPAA Rules including a failure to encrypt ePHI on laptops after Lifespan ACE determined it was reasonable and appropriate to do so.”
  • “OCR also uncovered a lack of device and media controls, and a failure to have a business associate agreement in place with the Lifespan Corporation.”

“‘Laptops, cellphones, and other mobile devices are stolen every day, that’s the hard reality. Covered entities can best protect their patients’ data by encrypting mobile devices to thwart identity thieves,'” said OCR Director Roger Severino in a statement about the case.

Mistakes happen every day. Everyone understands that when it comes to cybersecurity there is no such thing as being completely “secure.”

But, when an entity recognizes that it has significant vulnerabilities that are likely to lead to the compromise of the privacy of people’s sensitive information, they have to take it seriously and act diligently in mitigating those vulnerabilities. They have to try to get it right. If they don’t make a good-faith effort, they will likely pay a price for it when something bad happens.

Shawn Tuma is a partner at Spencer Fane LLP, in the firm’s Dallas office, representing a wide range of clients across the U.S. and globally in dealing with cybersecurity, data privacy, data breach and incident response, regulatory compliance, computer fraud related legal issues and cyber-related litigation.

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Tiny 3D Printed Cubes Serve as Scaffolding for Broken Bones https://bhsconnect.net/tiny-3d-printed-cubes-serve-as-scaffolding-for-broken-bones/ Tue, 28 Jul 2020 21:12:29 +0000 https://bhsconnect.net/tiny-3d-printed-cubes-serve-as-scaffolding-for-broken-bones/ A good deal of orthopedic bone repair surgeries involve injecting powders or pastes, to serve as scaffoding, into fractures. Now a collaboration between scientists at Oregon Health & Science University (OHSU), University of Oregon, New York University, and Mahidol University in Thailand has led to the development of a Lego-like 3D printed scaffolding system that...

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A good deal of orthopedic bone repair surgeries involve injecting powders or pastes, to serve as scaffoding, into fractures. Now a collaboration between scientists at Oregon Health & Science University (OHSU), University of Oregon, New York University, and Mahidol University in Thailand has led to the development of a Lego-like 3D printed scaffolding system that may turn out to be much easier to use and clinically more effective for treating complex bone fractures.

The tiny 3D printed cubes, which are only 1.5 mm on each side, are designed to hold onto gels seeded with growth factors that are chosen to promote the growth of nearby cells. Healthy new cells can settle onto the scaffolding created by the cubes, and the cubes can be stuck together in all kinds of ways.

These cubes were already tried as an agent to help repair the bones of rats and compared to existing scaffolding materials, demonstrating that the cubes lead to the production of three times as many blood vessels nearby. Moreover, both soft and hard tissue are able to take advantage of the new scaffolding and make home within it.

“Our patent-pending scaffolding is easy to use; it can be stacked together like Legos and placed in thousands of different configurations to match the complexity and size of almost any situation,” in a press release said Luiz Bertassoni, Ph.D., the team leader and associate professor at OHSU.

“The 3D-printed microcage technology improves healing by stimulating the right type of cells to grow in the right place, and at the right time,” added study co-author Ramesh Subbiah, Ph.D., a postdoc at OHSU. “Different growth factors can be placed inside each block, enabling us to more precisely and quickly repair tissue.”

It is now hoped that the technology will prove itself on larger animals and then in humans, and that it may one day help lead to the development of large 3D printed organs and tissues.

Study in Advanced Materials: 3D Printing of Microgel‐Loaded Modular Microcages as Instructive Scaffolds for Tissue Engineering

Via: OHSU

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Augmented Reality Telemedicine Shown to be Effective for Battlefield https://bhsconnect.net/augmented-reality-telemedicine-shown-to-be-effective-for-battlefield/ Tue, 28 Jul 2020 16:43:18 +0000 https://bhsconnect.net/augmented-reality-telemedicine-shown-to-be-effective-for-battlefield/ July 28th, 2020 Medgadget Editors Emergency Medicine, Military Medicine, Public Health, Space Medicine, Surgery, Telemedicine A team of researchers from Purdue University and the Indiana University School of Medicine has recently developed and now demonstrated, in realistic simulations, a telemedical augmented reality system that can be used in very difficult and stressful situations. Called System...

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A team of researchers from Purdue University and the Indiana University School of Medicine has recently developed and now demonstrated, in realistic simulations, a telemedical augmented reality system that can be used in very difficult and stressful situations. Called System for Telementoring with Augmented Reality (STAR), it allows remote clinicians, such as surgeons, to guide military medics, paramedics, and others in how to perform emergency procedures.

The STAR system revolves around an augmented reality headset that’s worn by the person on the scene. Video from a forward facing camera on the headset is transmitted in real time to a remote clinician who can annotate the scene using a touchscreen tablet. The annotations immediately appear in the view of the person taking care of the stricken patient and where the clinician wanted them to. This allows for a precise explanation of what needs to be performed and where.

The system was just tested with a variety of volunteers in a simulated battle-like environment. Subjects were asked to perform a cricothyroidotomy, an incision that creates a patent airway at the neck when the regular breathing pathway is obstructed, while being distracted by the sounds of gunshots, helicopters, explosions, and actual smoke. The performance of the participants was compared with that of those who received clinical guidance using only voice, without the benefit of augmented reality. The volunteers did much better using the STAR system, performing the cricothyroidotomies faster and more correctly than those who only heard voice instructions.

The system is still in a prototype stage, as it will need to be integrated into a more robust headset than that used now. Nevertheless, the majority of the technology is pretty much ready for use in a variety of scenarios including space flight, military, and remote medicine.

More info: System for Telementoring with Augmented Reality (STAR)

Study in npj Digital Medicine: Evaluation of an augmented reality platform for austere surgical telementoring: a randomized controlled crossover study in cricothyroidotomies

Flashback: Augmented Reality System Helps Military Surgeons Treat Wounded Warriors

Via: Purdue

Medgadget Editors

Medical technologies transform the world! Join us and see the progress in real time. At Medgadget, we report the latest technology news, interview leaders in the field, and file dispatches from medical events around the world since 2004.

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MedBikini and the Moving Target of Medical Professionalism https://bhsconnect.net/medbikini-and-the-moving-target-of-medical-professionalism/ Mon, 27 Jul 2020 17:12:45 +0000 https://bhsconnect.net/medbikini-and-the-moving-target-of-medical-professionalism/ A study published in the Journal of Vascular Surgery last week line itemed the apparent transgressions of a group of surgical trainees. The study, Prevalence of unprofessional social media content among young vascular surgeons, cited breaches of professionalism including wearing swimwear (medbikini), drinking alcohol, profanity and commenting on controversial social topics. Their criteria for unprofessional...

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A study published in the Journal of Vascular Surgery last week line itemed the apparent transgressions of a group of surgical trainees. The study, Prevalence of unprofessional social media content among young vascular surgeons, cited breaches of professionalism including wearing swimwear (medbikini), drinking alcohol, profanity and commenting on controversial social topics. Their criteria for unprofessional were based on previously published studies from as recent as 2017.

As news got out medtwitter had its own 2020 cancel culture moment under the hashtag MedBikini with thousands of tweets showcasing the unprofessional elements identified in the study.

Then bending to post-publication review, the study was retracted on the basis of its methodology and concerns for bias. In their retraction statement the editors made a commitment to improve the diversity of their editorial board. The study, of course, is worth a peek. This tweetorial from a resident within the program that generated the paper offers one individual’s view of the study.

A few thoughts about early missteps of the paper its dramatic public response.

Digital culture and the moving target of professionalism

The faulty foundation of this paper is its failure to understand the standards of medicine’s digital culture. The assumptions about alcohol, bathing suits, language and the public discussion of controversial subjects reflect dated standards about how doctors engage and communicate in a global community. 

And so this paper is something I might have seen a decade ago when the medical world was petrified that Twitter might be used to share pictures of doctors in bikinis.

Times, of course, have changed.

Early on physician behavior on social media was framed in the IRL world of the doctor. At the time ideas about how a doctor should look and even act online reflected a dated construct about physicians — a neutral, buttoned-down appearance like you’d find in a 1975 hospital directory. As part of this carefully constructed social image, things outside professional life were supposed to stay in a walled garden that patients couldn’t see. This was described as dual citizenship in the early social media medical literature (2011).

Hard separation of professional and personal presence gave way to the idea that dual citizenship is probably more fantasy than reality. In fact, our ability to engage on a global network and even create our own media has started a kind of revolution in transparency among doctors. This opening of the white coat has created a window into our personal lives. It’s generally been a good thing but the smudging of personal/professional boundaries has created challenges when trying to draw lines around professionalism.

More recently the role of the public physician has evolved to include political action and social justice advocacy. The passionate beliefs of some have realigned standards of conduct and even the language used by health professionals. Words once identified as unprofessional have been described by some as the ‘new vernacular’ (I’ll add that my view on language is evolving from when I first wrote about it a year ago). And so physician professionalism has to be considered in context of time, place and purpose.

So it may be that the starting point involving dated standards of physician behavior may be where the study got off to a rough start.

MedTwitter’s strong libertarian bias

The social response with #medbikini serves as a great example of the fiercely independent mindset baked in to medicine’s online culture.

And it makes sense. For many of us our voice and online presence represent the last piece of personal control in a world gone actively managed. But honestly this core libertarian bias has been evident since the earliest days of Twitter. In my many discussions about professionalism and boundaries, my peers are less inclined to discuss their limits as much as the boundless potential of their personal platform and voice. I also fit in with this strong feeling of independence with my voice.

Bowing to the physician mob

While my concern with this study is its failure to recognize the standards of how responsible physicians use social media in 2020, my greater concern is with the vitriolic response by the medical community. A response disproportionate to the author’s missteps. For sure this study was tone deaf — and this is not the first time we’ve seen this in social media study design. And we can debate where on the vast landscape of gender-based transgressions against doctors this study stands.

This situation reminds me of last year’s public evisceration of a team of Korean physicians who published a paper demonstrating competence with intubation by female physicians. It was intended to dispel a locally ingrained belief about gender and competence. In a impulsive display of mob arrogance initiated by select American physicians who had their sensibilities threatened by the title of the paper, the cultural context of the study was completely overlooked. The public apology forced on the young researchers where there was zero wrongdoing was painful to watch. The apologies that followed from those who misunderstood the paper and created the mess were rare (the worst perpetrators tried, after the fact, to walk back their concerns as ‘issues with the methods’). After the virtual assault everyone just went about their business — the lives of a female medical student and her mentor irreversibly scarred.

It’s always helpful to hear from the people behind these events. Here is the apology from Erica L. Mitchell, one of the authors of the Journal of Vascular Surgery paper. As you read it remember that behind the medbikini hashtag are real people like you and I who may not always get it right. I know I didn’t get it right when I first saw the event trending.

Wrongs must be corrected, for sure. But these surgeons, and none of our colleagues in the future who believe to be working in good faith, deserve to be treated like this.

More than ever we need time to think

While the mainstream media reported on the spectacle that medtwitter created, a few friends reached out to ask me when I might weigh in. I suggested I needed a couple of days to think it through. I was concerned about what had happened.

When writing about the fantasy of the perfect quick comeback Seth Godin recently suggested, As the world keeps getting faster, there’s actually a shortage of thoughtful, timeless ideas that are worth sharing an hour or a week later.

In this age of rage there are times when we need to pull back, pause, think for a bit, and hopefully offer some grace to those of us who don’t have it just right.


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Vagus Nerve Stimulator Gets FDA Emergency OK for Asthmatics with COVID https://bhsconnect.net/vagus-nerve-stimulator-gets-fda-emergency-ok-for-asthmatics-with-covid/ Mon, 27 Jul 2020 14:37:40 +0000 https://bhsconnect.net/vagus-nerve-stimulator-gets-fda-emergency-ok-for-asthmatics-with-covid/ July 27th, 2020 Medgadget Editors Cardiology, Critical Care, Emergency Medicine, Medicine, Neurology, Pain Management, Public Health People stricken with COVID-19 exhibit a wide range of symptoms. Some are barely affected while others suffer dire consequences. People with asthma are in particular danger, as SARS-CoV-2 is a respiratory virus that can make breathing even more difficult....

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People stricken with COVID-19 exhibit a wide range of symptoms. Some are barely affected while others suffer dire consequences. People with asthma are in particular danger, as SARS-CoV-2 is a respiratory virus that can make breathing even more difficult. Now, the FDA has issued an Emergency Use Authorization for the gammaCore Sapphire CV non-invasive vagus nerve stimulator (nVNS) to help adult asthmatics with COVID-19 (or those suspected of being infected) overcome difficulties breathing when drugs are not appropriate or are insufficient.

The gammaCore stimulator has been approved as a treatment option for migraines and cluster headaches (see flashbacks below), but it was initially researched as a way for treating reactive airway diseases such as asthma. The new Emergency Use Authorization, in a way, validates that research. “Results from prior pilot studies that evaluated gammaCore for the acute treatment of asthma support our belief that nVNS may provide much needed relief to patients who are experiencing asthma-related breathing difficulty, which can be particularly debilitating in patients with COVID-19,” said Peter Staats, MD, Chief Medical Officer of electroCore. Potentially this may lead to the vagus nerve stimulator being used more widely for asthma and other reactive airway diseases.

Flashbacks: Transcutaneous Vagal Nerve Stimulation, for Airway Diseases and Migraines; Vagus Nerve Stimulation for the Masses: Interview with electroCore CEO J.P. Errico; gammaCore Personal Non-Invasive VNS Cleared for Episodic Cluster Headaches; gammaCore Sapphire Helps Control Migraines and Cluster Headaches: Now Available in U.S.

Product page: gammaCore…

Via: electroCore

Medgadget Editors

Medical technologies transform the world! Join us and see the progress in real time. At Medgadget, we report the latest technology news, interview leaders in the field, and file dispatches from medical events around the world since 2004.

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Digital Guide Dog for Blind People https://bhsconnect.net/digital-guide-dog-for-blind-people/ Fri, 24 Jul 2020 16:20:30 +0000 https://bhsconnect.net/digital-guide-dog-for-blind-people/ July 24th, 2020 Medgadget Editors Informatics, Rehab Guide dogs can be incredibly helpful, letting blind people maintain a level of independence that would be difficult without their loyalty. However, guide dogs require a huge amount of training and, because they’re dogs, are not practical for every blind person. Now, a student at Loughborough University in...

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Guide dogs can be incredibly helpful, letting blind people maintain a level of independence that would be difficult without their loyalty. However, guide dogs require a huge amount of training and, because they’re dogs, are not practical for every blind person. Now, a student at Loughborough University in England has designed a concept handheld device that can do some of the tasks of a guide dog.

The electronic tool is called Theia and it features gyroscope-based technology to pull the user in the correct direction. This is similar to how many virtual reality controllers work, but the direction of the pull would be decided using a mapping system that takes into consideration the ease and safety of a given path and other matters important to blind people.

The guidance system doesn’t need to make any sounds to let the user know how to proceed, and is therefore quite discreet. There shouldn’t be much of a learning curve when using the Theia as it’s expected to be completely intuitive.

The project is in its early stages still, but an initial prototype has been built. There’s a still a lot to do to integrate Lidar (laser-based distance measurement), mapping, and guidance capabilities into the device, but guidance capabilities in particular may not be too challenging since many similar systems, such as Google Maps, may be modified to control the Theia.

Prototype of the Theia device

Here’s a video presenting the Theia:

Via: Loughborough University…

Medgadget Editors

Medical technologies transform the world! Join us and see the progress in real time. At Medgadget, we report the latest technology news, interview leaders in the field, and file dispatches from medical events around the world since 2004.

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Spinal Cord Stimulators Give Robotic Prostheses a Sense of Touch https://bhsconnect.net/spinal-cord-stimulators-give-robotic-prostheses-a-sense-of-touch/ Wed, 22 Jul 2020 19:45:34 +0000 https://bhsconnect.net/spinal-cord-stimulators-give-robotic-prostheses-a-sense-of-touch/ Upper arm prostheses that give their users a sense of touch have been developed in the past (see flashbacks below). These require careful surgical placement of electrodes near the remaining nerves within the stump and precise stimulation of said nerves. Now researchers at the University of Pittsburgh have achieved a remarkable feat of using existing...

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Upper arm prostheses that give their users a sense of touch have been developed in the past (see flashbacks below). These require careful surgical placement of electrodes near the remaining nerves within the stump and precise stimulation of said nerves. Now researchers at the University of Pittsburgh have achieved a remarkable feat of using existing spinal cord stimulators, usually used to treat chronic pain, to produce a sense of touch in the missing limbs of amputees. This can certainly be used to give upper arm prostheses the ability to produce sensory feedback, giving patients a natural way to feel what they interact with.

The new technique relies on existing implantation methods that are performed thousands of times each year in major hospitals. “What’s unique about this work is that we’re using devices that are already implanted in 50,000 people a year for pain — physicians in every major medical center across the country know how to do these surgical procedures — and we get similar results to highly specialized devices and procedures,” said Lee Fisher, the senior author of the study, in a press release.

Published in journal eLife, the researchers implanted Infinion electrode leads from Boston Scientific near the spinal cords, above the nerve roots that relay sensations from the arm, of four volunteers and connected them to Nano 2+Stim stimulators from Ripple, Inc. The stringy electrodes that have multiple stimulation points were then energized, in different spots, with signals that are usually sent to tackle pain. This immediately produced different sensations that seemed to come from the volunteers’ missing arms.

With a bit of experimentation and fine tuning, the researchers were able to reliably produce a feeling of touch in different parts of the phantom arms and hands. In three of the four volunteers, the researchers were able to generate highly localized sensations that were only felt in individual fingers or spots on the palm of the hand. “I was pretty surprised at how small the area of these sensations were that people were reporting,” said Fisher. “That’s important because we want to generate sensations only where the prosthetic limb is making contact with objects. The researchers followed their study subjects for a month following implantation, showing that even after natural movement of the electrodes the stimulation continued to do its trick.

This technology is applicable even for amputees that lost the entire arm and those that have seriously damaged nerves near the stump, as the stimulation happens at the spine. There’s still a good deal of work to make all this clinically practical, including actually implanting not just the electrode leads but the stimulators as well, reducing the amount of tingling and other stray sensations that the participants felt, and better targeting the affected nerves.

Here’s a video profiling one of the study participants and her experience with the new technology:

Study in journal eLife: Sensory restoration by epidural stimulation of the lateral spinal cord in upper-limb amputees

Flashbacks: World’s Most Advanced Prosthetic Now With Sense of Touch; Smart Electronics Bring More Realistic Sense of Touch to Prosthetic Devices; Case Hand Prosthesis With Sense of Touch Allows Amputees to Feel; Woman Using Powered Prosthetic With Sense of Touch in Everyday Life; Prosthetic with Sense of Touch Lets Patients Know Its Location; Electronic Skin for Prosthetic Hands Lets Amputee Feel Touch, Pain; Highly Compliant, Ultra Sensitive Electronic Skin to Give Prostheses a Sense of Touch

Via: University of Pittsburgh

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Failing States of health – How broader collaboration can bring us closer to the future of health https://bhsconnect.net/failing-states-of-health-how-broader-collaboration-can-bring-us-closer-to-the-future-of-health/ Wed, 22 Jul 2020 07:08:28 +0000 https://bhsconnect.net/failing-states-of-health-how-broader-collaboration-can-bring-us-closer-to-the-future-of-health/ While the COVID-19 pandemic has seen some countries respond well to the ongoing health crisis for their own populations, it has also – despite decades of increasing and accelerating globalisation – shown how quickly countries can turn inwards. As countries around the world entered states of emergency and enacted extraordinary measures to contain the spread of COVID-19, they have in many instances also reverted to a ‘city-state’ logic, strictly limiting their attention...

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While the COVID-19 pandemic has seen some countries respond well to the ongoing health crisis for their own populations, it has also – despite decades of increasing and accelerating globalisation – shown how quickly countries can turn inwards. As countries around the world entered states of emergency and enacted extraordinary measures to contain the spread of COVID-19, they have in many instances also reverted to a ‘city-state’ logic, strictly limiting their attention within their borders and not daring to opt into common solutions that very likely would have been better, which will be discussed in more detail at the HIMSS & Health 2.0 European Digital Event in September.

Disappointingly, our leaders and international political institutions have both failed to stand together and provide strong frameworks for collaboration throughout the COVID-19 crisis, while other organisations and actors like businesses and researchers have in many ways worked to intensify and deepen cross-border collaboration. As we look cautiously to the end of the first wave of the crisis in some parts of the world, we must consider how sustainable these cross-border relationships are, who can and should take the lead in defending and cultivating them, and what benefits they can provide for the future of healthcare – particularly in relation to the emerging personalised health paradigm. Given the recent experience, the notion that states will lead this charge may be met with a degree of scepticism. 

The nation state as a ‘work in progress’

We should have in mind that the nation state and the Westphalian – i.e., nation state – system are social constructs that can be dated back to the 1648 Peace of Westphalia, but in reality only begin to manifest as we know them today in the wake of World War II with decolonisation and the establishment of the United Nations. This is to say that the constructs we expect so much of are quite new and not very stable. 

The pandemic suggests that the fragile system of fragmented nation states may not be equipped to handle a world that is becoming exponentially more connected. A rethinking of this system, especially as it relates to health, is overdue.

We know that as a global community we need to deliver on a better vision for healthcare in the wake of COVID-19. Doing this will require a great deal of adaptive and transformative thinking – to the extent that we need to consider if it is not states, but certain non-state actors, organisations and citizens that are best equipped to develop the framework for this vision, with the states instead playing a supporting role further down the line.

Affirming health as a global challenge and the 90/10 model 

A crucial step in delivering on a better vision for health is building a global consensus around the notion that health is indeed a global challenge for which we are all responsible, not simply an obligation of individual nation states that often lack the capacity to deliver adequate care on a national and local level. A practical point of departure in this effort could be reaffirming and expanding the mandate of UN Sustainable Development Goal 3, which aims to ensure healthy lives and promote wellbeing for all at all ages. By leveraging an existing global consensus with lessons from COVID-19, proactive leaders can help propel a more robust, global vision for health that emphasises equity, outcomes, and evidence-based decision making instead of vague guarantees and legislative or regulatory benchmarks. By encouraging and empowering leaders and decision-makers outside of the state, the close cross-border collaboration that is fundamental to achieving SDG 3 may be within reach sooner than we think.

To clarify, this is not to say that states cannot or will not be crucial to the improvement of health in the long-term. While states have struggled to work adaptively and collaboratively in the midst of the pandemic, it is clear that states are drawing much-needed lessons from the harrowing experience of the past few months. Although more diverse constellations of actors and organisations have shown an ability to work more flexibly throughout the crisis – perhaps because they are not nearly as encumbered by slow and complicated political processes – than states and state institutions, states can still play an invaluable role as conveners and agenda setters if the sufficient institutional learning takes place in the wake of the crisis.

At the same time, taking a broader global approach to health that welcomes a more diverse swathe of private contributors should also entail a stronger commitment to supporting developments that are useful for and accessible by the vast majority of people, not just the wealthiest segments of the population. This approach is what we at the Copenhagen Institute for Futures Studies have termed the ‘90/10 logic’, a mindset that advocates investing in and developing solutions that can improve health outcomes and wellbeing for all, including the other 90% of the population rather than just the top 10%. Supporting solutions that emphasise equality, equity and utility is another area to which states can contribute as regulators.

The Humanome: The fruit of cross-border collaboration in personalised health

At the Copenhagen Institute for Futures Studies, we have been continuously monitoring challenges, opportunities, and developments in the ongoing transition towards more personalised and preventive approaches to health and healthcare. On this basis, we have also envisioned what increased cross-border collaboration in health could produce in the future. At CIFS, we have developed a concept known as the ‘Humanome’ together with other Nordic stakesholders in Nordic Health 2030, in which we propose as an ideal model for personalised health, and which will be explored in greater depth at the HIMSS & Health 2.0 European Digital Event.

The Humanome (see illustration below) is a concept that gives a holistic picture of an individual’s health. It is based on data from both public and private sector sources, which all influence personal health. These data fall into different categories of conditions and influences on health and are to a varying degree fixed or changeable. Some of the data span over multiple categories, illustrated by the gradients in the model. ​ 

The Humanome requires a transformative new way of approaching health and how we work together. Some conditions that are needed to realise the Humanome are increased trust, interoperable standards, cross-border collaboration, dynamic data models, and an emphasis on prevention as service on the path towards better quality of life and wellbeing.

The outermost layer of the Humanome is the ‘data control and contracts’ category, which has to do with how data is handled by individuals, public and private institutions and actors, as well as the infrastructures that allow for the storage and transfer, and sharing of data. The building represents the hospital and established health system which holds medical records containing all the traditional clinical, biobank, health records and relevant data on health production. ​ ​

As a tool for organising and identifying relationships and patterns in health-relevant information, the Humanome qualifies people to make informed decisions and enables conscious interactions regarding their health based on real-time, real-world data over their lifespan.

​As the Humanome is founded on and, indeed, entirely dependent upon cross-border collaboration, dynamic sharing of information, new kinds of public-private partnerships, and a preventive health mindset, it is a model that is built for a world in which the burden of disease is becoming more diversified and in which health both transcends national borders and is increasingly individualised. The Humanome is, therefore, a model for the future of health.

Hear more from HIMSS Future50 leader, Bogi Eliasen, at the HIMSS & Health 2.0 European Digital Event taking place 7-11 September 2020.

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