Igor Efimov, PhD, at the School of Engineering & Applied Science at Washington University in St. Louis and an international team of biomedical engineers and materials scientists have created a 3-D elastic membrane made of a soft, flexible, silicon material that is precisely shaped to match the heart's epicardium, or the outer layer of the wall of the heart.
Current technology is two-dimensional and cannot cover the full surface of the epicardium or maintain reliable contact for continual use without sutures or adhesives.
Dr. David Blumenthal believes that “given its huge public health, research, safety and quality advantages, the digitization of health information is inevitable,” and he predicts that voice recognition and systems that enable patients and medical assistants to enter more data will transfer much of physicians’ digital burden.
Blumenthal also implied something that had occurred to me but that I’d preferred not to think about: part of my problem with computers is my age. Though I’m no Luddite, my younger colleagues are less troubled by screens than I am.
“For physicians of a certain generation,” Blumenthal told me tactfully, the current status of computers in medicine is “a painful interlude in an important historic process.”
The principal value added by most Class 2 and 3 medical devices, which are not mechanical things like structural prosthetics (e.g., knee replacement) or physical accessories (e.g., laser hand piece), is increasingly contained in the algorithms. The critical electro-mechanical infrastructure for algorithms, which used to be quite dear, has now become nearly a commodity with the proliferation of embedded systems for consumer use. There just never was sufficient volume for this to happen with just military and industrial use. The exact same thing is happening with sensors and sensor fusion techniques that permit extracting greater value from the sensed signals. The software tools, while still quite dear, for creating high reliability software systems are also coming down in price (sometimes to the price of almost free—check out www.sourceforge.com) and soon will be within reach of sole practitioners like myself. The ability to inexpensively create complex electro-mechanical parts (including 3-D printed circuit boards) using such techniques such as additive manufacturing, and within the decade self-organizing nanoscopic entities, will shift the real intellectual property values to algorithmic creations and innovations (including those algorithms driving the printers and nanobots). Math, physics, and high-quality software engineering will gain high perceived value! The forthcoming crop of healthcare professionals (physicians, nurses, pharmacists, etc.) grew up tech-savvy prior to choosing their profession–they will expect sophisticated HIT and will be greatly dissatisfied when they do not have it or have to struggle with it (e.g., HF/UX issues). Economic and competitive pressures in healthcare delivery, combined with the parallel new crop of tech-savvy managers and an emphasis on collective purchasing, will put downward pressure on medical device prices—meaning, at least from my perspective, that the cost of goods sold needs to decrease – which brings us back to the earlier point that the marginal cost of duplicating software is very low and the fixed cost, if distributed over a very large number of copies, can be made quite low as well.
The future of transplants seems to be in the 3D printing technology. During a pioneering research, Dr. Faiz Bhora of the Luke’s and Roosevelt Hospitals and his research team made a silicon trachea from biologic materials including stem cells.
The bioengineered organ was created in about 15 minutes and one of the most impressive properties is its capability to continue to grow along with the patient (so it will never need to be replaced).
Social environments allow healthcare professionals to disseminate health information, but not practice medicine, and interact with people, who may or may not be within a close enough geographical proximity to be a potential patient.
They also afford people the opportunity to importune healthcare professionals for medical advice, or to start personal relationships with them.
Anne Marie Cunningham (@amcunningham) writes:The focus on social media in the medical education literature has concerned threats to professionalismWhat does this research on online professionalism tell us about our deeper uncertainties about what it means to be a doctor in the 21st century? [Some commentators have] described the confusion between the various conceptions of professionalism, indicating that to some professionalism is an identity and set of values, whereas to others it is a set of attitudes and behaviours. Medical students also employ different discourses when considering professionalism with some focussing on more superficial aspects such as how they act or appear, whilst other students have more complex and embodied understandings. To some professionalism is an identity and set of values, whereas to others it is a set of attitudes and behaviours
Although there’s little hardcore evidence to date that mobile health technology will dramatically reduce U.S. healthcare costs, several thought leaders are optimistic.
Proponents like Eric Topol, MD, a cardiologist at Scripps Green Hospital in La Jolla, Calif., for instance, claims it will save billions.
In an interview published in MIT Technology Review, Topol pointed to inexpensive iPhone adds-ons that can serve as EKG monitors, and a mobile ultrasound device about the size of a smart phone that scans a patient’s heart chambers. This device, which resembles a flip phone and is made by GE, can be used for about 80 percent of U.S. scans, Topol claims. He charges nothing for such scans when done as part of a routine exam. Most doctors, he said, charge $600 to perform an ultrasound using a $350,000 machine.
3-D printing used to construct everything from art to toys to spare parts for the space station may one day produce human organs at a hospital near you.
The 20-year-old technology uses liquid materials that become hard as they print out three-dimensional objects in layers, based on a digital model. Current medical uses are in dentistry, for hard-material crowns, caps and bridges, as well as prosthetics. Last year, a 3-D printer was used to create a structure from moldable polymer that replaced more than 75 percent of a patient’s skull.
Now, Organovo Holdings Inc. is using 3-D printers to create living tissue that may one day look and act like a human liver, able to cleanse the body of toxins. Drugmakers and cosmetic companies already plan to use 3-D printed human tissue to test new products. Eventually, the technology may help reduce organ shortages and cut transplant rejections as patients receive new organs constructed from their own cells.
A bunch of researchers studying doctor jokes on Facebook, that’s who.
But it’s not all just for laughs. The Dartmouth Institute of Health Policy & Clinical Practice study published in the February edition of the Journal of Medical Internet Research is one of the first to look at social networking site conversations pertaining to health and medicine, according to a news release from the institute.
Over the last decade, the evidence has made it very clear that people who are not online are older, less educated, and more socially disadvantaged. Users of health and social care services are drawn heavily from these groups.
Whatever the cost savings to be made, health and social care managers have argued successfully that a significant proportion of their service users would simply not have access to the technology, or the necessary skills, to use online channels.
Things are changing however, and there is growing recognition that the time may now be right for the sector to start embracing digital working and channel shift with greater enthusiasm.
Technology has genuinely become available to almost everyone. Rapid take up of smartphones and tablets, and much greater access to free wi-fi and low cost broadband has meant that having no access to a PC, or affordable broadband is no longer the barrier it once was.
"My patient is a middle aged professional, with no symptoms what so ever.
He is fit and healthy, a non smoker, has good teeth, eats well and has no family history of arthritis or autoimmune disease. So why is he seeing a rheumatologist?
He’s concerned about some results he has received from a genetic screening test. The test results suggest that his risk of developing two autoimmune diseases – rheumatoid arthritis and Scleroderma, conditions I frequently treat, is increased.
I’m at a slight disadvantage as this is the first time I’ve had has to counsel a patient in this situation.
There’s an additional complicating factor.
The patient is me."
Andrew Spong's insight:
Never less than a joy to read. You're following Ronan already? Ah. Of course you are.
In recent years there has been growing interest in the potential of design approaches to transform health care.
There are many drivers for Health service reform; a rise of long term conditions, an aging population, a health service that has evolved to deliver acute care rather than primary care, reduced funding and increasing expectations from an increasingly informed population. These are some of the key challenges to society today, and ones that require a new way of thinking, a radical step change in the ways we deliver care, innovative approaches.
Having said this health service provision, or even more person-centred issues around health are by definition ‘wicked problems’, ones that there is no single correct response too. This is where we argue design’s strength lies, where we can draw on a tradition of creative and divergent thinking to address these fundamental and yet practical challenges to our societies’ health.
"Some patients mentioned that I often spent more time typing on a computer instead of talking to them.
Now I leave my laptop outside the exam room.
Unlike the intuitive ease of touch-based smartphones and tablets, electronic medical records are generally antiquated programs that are cumbersome to use. Providers often spend more time checking boxes with a mouse to satisfy onerous billing and administrative requirements that do little to help patients."
Andrew Spong's insight:
Interesting POV, but IMO the benefits of the EHR outweigh any potential shortcomings -- by a long way.
Dr. Eric Topol, the cardiologist and author who has built a reputation as an advocate for disruption in healthcare, is going to advise AT&T’s digital health division on its mobile health strategy. The telecommunications company has been adding mobile health tools as part of the AT&T ForHealth unit. Topol’s role won’t hurt in raising the company’s digital health unit, particularly as it gears up for the HIMSS conference later this month.
In the new role of Chief Medical Advisor, Topol will offer strategic guidance as the company adds mobile devices and mHealth products and services, according to a company statement. AT&T will apply Topol’s insights to enhance its current health IT solutions and improve consumer and enterprise adoption.
Top identified hazards in secondary care settings included:
Infusion pump medication errors
CT radiation exposure in pediatric patients
Data integrity failures in EHRs and other Health IT systems
Occupational radiation hazards in hybrid ORsInadequate reprocessing of endoscopes and surgical instrumentsNeglecting change management for networked devlices and systemsRisks to pediatric patients from 'adult' technologiesRobotic surgery complications due to insufficient trainingRetained devices and unretrieved fragments
There is a growing literature about physicians sharing personal information with their patients, something known as “physician self-disclosure” or “physician personal disclosure” In one study, investigators examining audio recordings of patient visits found that when general internists self-disclose patients report lower satisfaction, but when surgeons self-disclose patients report higher satisfaction.
An accompanying editorial suggested that some forms of self-disclosure may be useful while others may violate patient-provider boundaries. Another paper in which investigators observed physicians interacting with standardized patients concluded that there was no evidence of a positive effect of physician self-disclosure, that it could be disruptive, and that physicians should consider avoiding it. Physicians Danielle Ofri and Juliet Mavromatis explored their experiences with personal disclosures to patients in their recent blog posts.
I considered the pros and cons of disclosing details of my illness to my patient....