These are the slides from my talk at the 4th Annual Putting Patients First Conference in Mumbai.
If god were to manifest the world using technology, he would first create something like social media. Conceptually provide technology with the ability to understand the thoughts of a population
SocMed leaves behind the old model of 1-to-1 communication – “talking to someone over the phone” Enables one-to-many communication (via blogs or microblogging) or many-to-many communication (discussion forums, social walls). Now anyone can setup an online community site/portal to represent a small or big offline community.
Further, anyone can setup an online site related to a treatment, a disease, a doctor, a drug , a concept or anything and see it grow into a popular site which in effect is simply the manifestation of a community which exists/ed but which no one ever knew of.
The central theme of personalized medicine is the premise that an individual’s unique physiologic characteristics play a significant role in both disease vulnerability and in response to specific therapies.
The major goals of personalized medicine are therefore to predict an individual’s susceptibility to developing an illness, achieve accurate diagnosis, and optimize the most efficient and favorable response to treatment. The goal of achieving personalized medicine in psychiatry is a laudable one, because its attainment should be associated with a marked reduction in morbidity and mortality.
In this review, we summarize an illustrative selection of studies that are laying the foundation towards personalizing medicine in major depressive disorder, bipolar disorder, and schizophrenia. In addition, we present emerging applications that are likely to advance personalized medicine in psychiatry, with an emphasis on novel biomarkers and neuroimaging.
Excerpt From the Conclusion:
The prospect of personalized medicine in psychiatry more or less reflects ideals still largely unrealized. Currently, the field is at the information-gathering infancy stage.
The greatest progress can be expected at the intersections of the categories described above, such as gene × environment and genes × biomarkers, which will poise psychiatry to make biological system-based evaluations. Furthermore, some of the emerging applications, including imaging genomics, strengthen our conviction that the future for personalized medicine is highly promising.
A protein in the central nervous system could provide a useful tool for diagnosing concussions and allow doctors to assess when it is safe for athletes to return to competition.
Swedish researchers have found, through examining studies in sporting injuries, that a protein in the central nervous system could provide a tool for diagnosing concussions. They published their results in JAMA Neurology.
Previous studies have measured changes in the levels of protein biomarkers present in cerebrospinal fluid or blood in athletes who participate in contact sports.
Certain biomarkers - neuron-specific enolase, S-100 calcium-binding protein B, neurofilament light and total tau (T-tau) - have been shown to increase in boxers, correlating with the number and severity of head blows received. After a rest from boxing, these biomarkers return to normal levels.
With his Google Glass, Stanford University physician Dr. Homero Rivas pinpoints a target on the skin of an anatomical human model.
The surgeon and his assistant then direct their Glass at the target to reveal an augmented reality display on their screens. To their eyes, looking through the Glass, they can see the procedure illustrated step by step with images superimposed over the skin of the model.
Stanford University live-streamed that demonstration to physicians around the world. It wasn’t a particularly complicated procedure, but it was one of the first times that augmented reality has been introduced to Glassware for the benefit of surgeons.
“You don’t need to go in blind anymore,” said Dr. Rivas in an interview with VentureBeat following the demonstration.
“Now, we have an educated impression of where a mass is. We can better understand exactly where to make an incision so we can create less trauma.”
Current controversy surrounding health domains is rooted in the Internet’s growing importance as a health information source. In 2013, the International Telecommunication Union estimated that 38.8% (2.7 billion) of the world’s population used the Internet. Many of these users are seeking important health information online. In the United States, surveys report 72% of online adults accessed the Internet to find health information primarily on the subjects of diseases and treatments . Other regions, including the European Union and emerging markets, have also shown marked increases in online health information seeking and self-diagnosing behavior.
The importance of establishing an inclusive yet reliable presence for health information online is critical to future global health outcomes given the growing importance of the health Internet. However, .health and many other health-related gTLDs are now on sale to private sector entities that largely permit open and unrestricted use. Yet, the globalized nature of the Internet, the public health need for privacy, security, and quality health information, and the rapid expansion of online health technologies demonstrate a critical need to ensure proper governance of future health domains. Focusing on the public good can be a first and crucial step to ensure an accurate, reliable, and evidence-based online presence for health for this generation and the next.
If genomes are going to revolutionize personalized medicine, the first step will be sequencing the genome accurately.
It bears repeating just how far this tech has come: the price of sequencing a genome is rapidly coming down, as is the time it takes to do a sequence. It’s getting so easy that the price point is already well within the means of many middle class Americans, and the technology might soon prove useful enough to save lives. Proponents say that, in the future, personalized medicine will allow doctors to determine the specific genetic variants that predispose their patients to certain diseases, which will then help doctors to devise individualized—and more effective—treatments.
But with roughly six billion base pairs in the human genome, creating a truly accurate gene sequence is no easy task. Even the best sequencing techniques can have an error rate around 1 percent, which adds up to hundreds of thousands of errors. When diseases depend on single nucleotide insertions or changes, those errors can mean the difference between a misdiagnosis and an accurate one.
A group of researchers with the US government’s National Institute of Standards and Technology is trying to solve that problem with a program called Genome in a Bottle. With academic and commercial partners, the group is trying to create what is essentially one “perfect” human genome that can be a reference for sequencing labs. Though every genome is different, the places where sequencing errors most commonly happen are fairly well understood, and by comparing one sequence with a reference genome, doctors and researchers would be able to tell if they’ve made a mistake.
“We’re sitting here with billions of data pairs—it boggles the mind try to get that much information accurately determined,” said Marc Salit of NIST’s Genome Scale Measurements Group. “Even when we think we’re getting it right, a few missing bases or additional ones can make a huge difference.”
Salit and his colleague, Justin Zook, recently published a study in Nature Biotechnologydiscussing their solution to the problem. According to Salit, by sequencing the same genome many times and comparing the base pairs, they can create a reference that is much more accurate than what we already have.
Though the industry has made outstanding progress in adopting EMRs, the practice of data acquisition from patients remains cloudy.
A recommendation from the HITSC Meaningful Use Workgroup would require practices with electronic health records (EHRs) to allow 10 percent of patients to report PGHD electronically.
If approved in meaningful use stage 3, the final stage of HealthIT.gov’s EHR incentive program, it could push hospitals to incorporate patient-generated data.
This requirement may seem like a relatively simple intervention, but the ramifications are quite significant. If clinical decision-making is made on the basis of data supplied by patients and documented in the EMR, how can clinicians be sure that such data is complete, correct and valid? And will clinicians like me learn to rely on it, or will we disregard it due to concerns about its validity or barriers to integrating it into care flow?
Furthermore, if a patient is in control of her health data entry, who is ultimately responsible for its completeness and accuracy — the patient or the clinician?
Incorporating biometric data into the EMR, an exciting prospect, is even more complex. Though clinicians are quite familiar with data entry from FDA-approved medical devices such as blood glucose meters, pacemakers and pulmonary function units, data from a myriad of consumer-driven health devices (Fitbit and others) will soon seek to flex their way into EMRs.
Patients clearly value these data; a recent Pew Research report noted that 60 percent of adults claim to track their exercise routine, weight or diet, meaning providers have some catch-up to do in order to meet patients halfway. Some health systems, such as Partners HealthCare, have already been experimenting with the incorporation of PGHD from remote devices into the EMR, and other institutions should follow.
Consumer health data devices are moving ahead at a staggering pace, and while the health care system can’t quite keep up, strategic planning should be happening now.
Despite the challenges, incorporating PGHD is a necessary evolutionary step for health care. Intelligently designed, well-executed systems that fully incorporate and display PGHD in a meaningful way will improve shared decision-making and enable patients as active care partners. Keen clinicians and patients will stay closely tuned to the numerous transformations to come.
Rather than your average bowl of Lucky Charms, these are three-dimensional cell cultures that can be generated by a new digital microfluidics platform from researchers at U of T’s Institute for Biomaterials and Biomedical Engineering (IBBME).
Published this week in Nature Communications, the tool can be used to study cells in cost-efficient, three-dimensional microgels. This may hold the key to personalized medicine applications in the future.
“We already know that the microenvironment can greatly influence cell fate,” saidIrwin A. Eydelnant (IBBME PhD 1T3), recent doctoral graduate from IBBME and first author of the publication. “The important part of this study is that we’ve developed a tool that will allow us to investigate the sensitivity of cells to their 3D environment.”
“Everyone wants to do three-dimensional (3D) cell culture,” explained co-authorAaron Wheeler (IBBME), Professor and Canada Research Chair in Bioanalytical Chemistry at IBBME, the Department of Chemistry, and the Donnelly Centre for Cellular and Biomolecular Research (DCCBR) at the University of Toronto.
“Cells grown in this manner share much more in common with living systems than the standard two-dimensional (2D) cell culture format.” But more naturalistic, 3D cell cultures are a challenge to grow.
Wearables may be the tech du jour, but the next generation of devices and services needs to focus more on keeping users engaged in the long-term. These three factors, based on behavioral science, can help them do just that.
1. Habit formation. Sustained engagement depends on a device or service’s ability to help the user form and stick with new habits. Wearable devices have the potential, all too often unrealized, to make the process of habit formation more effective and efficient than ever before. The best engagement strategies for wearables move beyond just presenting data (steps, calories, stairs) and directly address the elements of the habit loop (cue, routine, reward), triggering the deep-seated psychological sequences that lead to the establishment of new habits.
2. Social motivation. To sustain engagement beyond the initial habit formation, a device or service must be able to motivate users effectively. Social connections are a particularly powerful source of motivation that can be leveraged in many creative ways. In addition to using social connections to influence behavior, social media and networking sites can be exploited to alter habits for positive outcomes.
3. Goal reinforcement. To achieve sustained engagement, a user also needs to experience a feeling of progress toward defined goals. Research shows that achieving several smaller goals provides the positive momentum necessary for achieving bigger goals. Wearable products and services that help people experience continuous progress can do so, for example, through real-time updates that are powered by big data and insights. Facilitating personal progress in this way leads to improved health, user satisfaction and long-term sustained engagement.
“If you’re dealing with a disease like cancer that can be arrived at by multiple pathways, it makes sense that you’re not going to find that each patient has taken the same path” - John McDonald, a professor in the School of Biology at the Georgia Institute of Technology in Atlanta.
If a driver is traveling to New York City, I-95 might be their route of choice. But they could also take I-78, I-87 or any number of alternate routes. Most cancers begin similarly, with many possible routes to the same disease. A new study found evidence that assessing the route to cancer on a case-by-case basis might make more sense than basing a patient’s cancer treatment on commonly disrupted genes and pathways.
The study found little or no overlap in the most prominent genetic malfunction associated with each individual patient’s disease compared to malfunctions shared among the group of cancer patients as a whole. “This paper argues for the importance of personalized medicine, where we treat each person by looking for the etiology of the disease in patients individually,” said McDonald,
“The findings have ramifications on how we might best optimize cancer treatments as we enter the era of targeted gene therapy.”
The research was published February 11 online in the journal PANCREAS and was funded by the Georgia Tech Foundation and the St. Joseph’s Mercy Foundation.
In the study, researchers collected cancer and normal tissue samples from four patients with pancreatic cancer and also analyzed data from eight other pancreatic cancer patients that had been previously reported in the scientific literature by a separate research group.
McDonald’s team compiled a list of the most aberrantly expressed genes in the cancer tissues isolated from these patients relative to adjacent normal pancreatic tissue.
The study found that collectively 287 genes displayed significant differences in expression in the cancers vs normal tissues. Twenty-two cellular pathways were enriched in cancer samples, with more than half related to the body’s immune response. The researchers ran statistical analyses to determine if the genes most significantly abnormally expressed on an individual patient basis were the same as those identified as most abnormally expressed across the entire group of patients.
The researchers found that the molecular profile of each individual cancer patient was unique in terms of the most significantly disrupted genes and pathways.
The Oral-B SmartSeries 7000 can do plenty of things that normal toothbrushes can't.
The 7000 is about the same size and weight as any other fancy electric toothbrush, and is compatible with other old Oral-B brush heads.
It's handsome enough, but really: it's a toothbrush, not a fashion statement.
Anyway, as soon as the toothbrush and your phone have forged a connection over Bluetooth, firing up the 7000 will start a countdown to oral cleanliness in the companion smartphone app.
You (or your dentist, if you're the responsible type) can add and tweak those timers as desired, though the default timer will have you scrubbing different areas of your mouth for two minutes.
In case the sheer boredom of brushing your teeth for that long is too much to bear, you can also thumb through a stream of news articles or local weather reports (no, really) to help you hang in there. Turns out, just furiously mashing those bristles into your teeth isn't great either, so the timer will blink red if you're pressing too hard.
Oh, but the fun doesn't end once you're gleaming. The 7000 sends over your personal brushing data to the app, where it's turned into pretty graphs and accolades for prolonged brushing. Your dentist can specify certain areas you should focus on while brushing too, which appear during the countdown to keep you moving in all the right ways.
And if you don't have a dentist to meet regularly? The app will find and list local ones.
The U.S. Patent and Trademark Office just granted Apple a patent for a new kind of biometric sensor that, unlike other wearables we've seen so far, connects to you via your ear. The patent applies to a sensor that can be embedded in a pair of earbuds or headphones, which then hoovers up wearer data like heartbeat, body temperature, or even how much you're perspiring when you hit the gym.
How the sensor intends to do that, however, isn't explicitly outlined in the filing. AsAppleInsider first pointed out, U.S. patent #8,655,004 concerns a "sports monitoring system for headphones, earbuds and/or headsets" to be used "during exercise or sporting activities." Originally filed in 2007, the patent suggests Apple has apparently been experimenting with new ways to cull together biometric data for quite some time now.
Imagine going to the doctor with an infection and being sent home with a course of drugs. Unknown to your doctor you actually have two infections. If you take the drugs will the other infection go away by itself? What if you take the drugs and the other infection gets worse? This quandary faces those treating patients with multiple infections.
A new study led by former University of Sheffield PhD student Dr Emily Griffiths, in collaboration with the universities of Edinburgh, Liverpool and Zürich, has taken a novel approach to understanding this problem, shedding light on how multiple parasites interact within humans.
The study compiled a list of many of the parasites that infect humans, another list of the parts of the body consumed by each parasite, and also information about how the immune system responds to each parasite. This information was used to construct a large network of multiple infections in humans - a bit like a food web of infections inside the human body.
Building this network revealed some previously unknown patterns, something that could pave the way for new treatment strategies which help tackle multiple infections. For example, groups of parasites often share similar parts of their host, and these groups are prime candidates for coordinated treatment.
Dr Griffiths, who carried out the research during her PhD in the Department of Animal and Plant Sciences at the University of Sheffield, said: "After studying the fascinating range of hundreds of different infections that can occur in the same person at the same time, we've shown that we could better treat patients if we know what parasites are eating inside our bodies.
"Our web has revealed the ways hundreds of parasites could live together, which means that we can develop new coordinated treatments that help fight more than one infection.
As the number of self-tracking health and fitness tools available to consumers continues to climb, a persistent question has been whether the data they collect might be useful to health researchers. Along with that: Are people who self-track comfortable sharing their data with researchers?
A new, must-read report from San Diego’s California Institute for Telecommunications and Information Technology (Calit2), funded by the Robert Wood Johnson Foundation, explores these and other questions.
Based on a survey with hundreds of self-trackers, a majority — 57 percent — said one critical assurance they would need before agreeing to make their self-tracked, personal health data available to researchers was that their privacy would be protected. More than 90 percent also said it was important that their data remained anonymous. Respondents said they’d be more comfortable sharing data if they knew it was only going to be used for “public good” research.
One open-ended survey that the report’s researchers posed to self-trackers found that 13 percent of respondents specifically mentioned an aversion to commercial or profit-making use of their data, according to the report. One respondent wrote: “It depends who gets it. Research using these data will be instrumental in the future of personal predictive services, but also for that reason are likely to be exploited by marketers and the politically short-sighted. Thus I would like transparency for who has access to my data.”
Among the almost 100 health researchers interviewed for the report, 46 percent said that they had already used self-tracking data in their research previously. Some 23 percent reported that they had already worked with digital health companies that offer apps or devices to consumers to track their health.
Overall, the researchers interviewed for the report were “generally enthusiastic” about the prospect of using self-tracking data in the future — 89 percent agreed or strongly agreed that such data would prove useful to their research efforts. Almost all of those researchers surveyed said that kind of data could answer questions that other data could not.
A newly published Apple patent application that details ways to improve a wrist-based pedometer could represent another piece of evidence pointing to an iWatch.
The application, “Wrist Pedometer Step Detection,” came out of the U.S. Patent and Trademark Office today. This is part of the standard patent process toward issuance. It details ways to improve step detection when someone is wearing a pedometer on a wrist.
In the patent application’s implementation, the pedometer might be able to “automatically determine that the pedometer is being worn on a user’s wrist.”
Pedometers, the application points out, are often attached to a user’s trunk – on the waist or pants or shirt pocket. A commonly used algorithm to measures steps, however, doesn’t work as well when the pedometer is on a wrist, because the arm’s movement can interfere with the measurement of acceleration.
Apple’s patent application would overcome this by filtering the measured movement or inferring steps from previous measurements, leading to more accurate step counts and distance estimation. Additionally, the document notes, “users do not have to specify where the pedometer is being worn” because the software will compensate.
Online quizzes that predict when you’re going to die were popular for a while, but now there is an actual test that could uncover your expiration date. 17,000 samples of blood from Finland and Estonia were tested to uncover which of 100 biomarkers were present in people that died within five years. Researchers turned up four specific biomarkers linked to a higher risk of dying from heart disease, cancer, and other illnesses.
The four culprits responsible for early death include albumin, alpha-1-acid glycoprotein, citrate, and the size of low-density lipoprotein particles. Albumin has already been linked to early death in the past, but the other three have been under the radar until now. Scientists made sure there there were no other contributing factors either, such as old age, obesity, cholesterol levels, or alcohol use, amongst others.
The buzz about 3D printing can at times give the impression that the technology is a panacea that makes all manufacturing cheaper. The truth is 3D printing has one very specific use case: It makes prototypes and custom, one-of-a-kind items cheaper and faster to make.
Medicine would seem like a prime beneficiary of this technology, potentially using 3D printing to provide patients with custom-made implants and stents. Yet, to date, medical researchers have focused on the most ambitious goals for the technology, such as replacement organs printed from a patient’s own stem cells, which need years of development before they reach average patients.
Recently, a somewhat more modest medical device — and one that could find its way relatively quickly into treatment protocols — was created using 3D printing. Researchers Igor Efimov from Washington University in St. Louis and John Rogers from University of Illinois at Urbana-Champaign used MRI and CT scans of rabbit and human hearts to 3D-print custom-fitting flexible mesh sacs that fit each heart perfectly and stayed in place as it beat.
“Each heart is a different shape, and current devices are one-size-fits-all and don’t at all conform to the geometry of a patient’s heart,” said Efimov.
Inside its fabric, the mesh can also hold sensors that monitor for signs of trouble and deliver electrical pulses, if needed. The sensors are embedded in the fabric using technology similar to what Google has said it will use in sugar-monitoring contact lenses, only more nuanced.
Doctors can position the sensors or electrodes more precisely using the wrap than by attaching them directly to the heart with sutures or adhesives, Efimov and Rogers state in a recent paper in Nature Communications. They demonstrate in the paper that sensors attached to the mesh (or multifunctional integumentary membrane) accurately measure temperature, mechanical strain and pH, and could deliver pulses of electricity.
Depending on the sensors used, the heart wrap could improve treatments for a range of disorders; it could also be used to deliver medication directly to where its needed. But the device was conceptualized specifically to treat ventricle deformities and arrhythmias. The arrhythmia atrial fibrillation affects about 4 million Americans; patients often undergo a surgery that destroys the heart’s own drummer, the atrioventricular node, and subsequently receive a pacemaker.
Researchers and collaborators of the Soh lab at UC Santa Barbara have developed an implantable device to monitor real time concentrations of medications in the blood. The device, called the MEDIC (Microfluid Electrochemical Detector for In Vivo Concentrations), aims to address an increasingly identified problem in medicine – that people metabolize and respond to the same medication at the same dose in very different ways.
A great deal of focus has been on identifying genetic polymorphisms and other markers that can be used to identify patients who are either resistant to certain medications or at risk for adverse effects – think HLA typing prior to initiating Tegretol therapy.
The device itself consists of a chamber through which a constant stream of the patient’s blood runs. At the base of the chamber, small sensing molecules called aptamers bind the drug molecules. Once the drug molecule is bound to the aptamer, a tiny jolt of current is sent to an external device so the drug concentration can be calculated.
The researchers have overcome the problem of particles in natural blood sticking to and coating the sensor by adding a buffer layer to the chamber.
This device aims to open new opportunities into the personalization of medicine.
Sustained engagement is emerging as the key challenge for companies developing wearable devices and complementary services. What these companies may not be aware of is the importance of habit formation, social motivation, and goal reinforcement. These three factors, drawn from behavioral science, contain the secrets to successful wearable products and related services that get used and deliver real value.
A failure to engage
A surprising percentage of devices in the market fail to achieve even short-term engagement for many users because they suffer from one or more fatal user experience flaws.
Product design teams typically work toward nine baseline criteria that must be met to drive initial adoption and use: selectability, design, out-of-box experience, fit/comfort, quality, user experience, integration ability, lifestyle compatibility, and overall utility.
Many current devices fail on one or more of these criteria by breaking, failing after a shower, pulling the hairs off your arm, running down quickly, or being a pain to sync with your smartphone. Sadly, the growing number value-added services designed to exploit the data these wearables provide and their open APIs also suffer from similar problems with user experience.
Beyond traditional design criteria
However, even if these criteria are satisfied, they are not sufficient to drive long-term use. Traditional product design criteria are only part of the key to developing successful wearable products and services.
Devices and services that help wearers change their habits also promote sustained behavior change and lead to long-term health. Behavioral science offers three other critical factors that can lead to the development of successful wearable products and related services.
Key factor #1: habit formation
Sustained engagement with a wearable device or complementary service depends on its ability to help the user form and stick with new habits. Psychologists define habits as automatic behaviors or routines that are triggered by situational cues, which are then followed by some form of reward. Habits have three key components: cues, routines, and rewards. The best wearable devices have the potential to make the process of habit formation more effective and efficient than ever before.
Key factor #2: social motivation
Sustained engagement beyond initial habit formation with a wearable device or complementary service depends on its ability to motivate users effectively. Social connections are a particularly powerful source of motivation that can be leveraged in many creative ways. In addition to using social connections to influence behavior, social media and networking sites can be exploited to alter habits for positive outcomes. This includes the communication of social norms through “postings” or “sharing” of thoughts, pictures, and comments with one another.
Key factor #3: goal reinforcement
To achieve sustained engagement, a user needs to build on these habits and social motivation to experience a feeling of progress toward defined goals. Research shows that achieving several smaller goals provides the positive momentum necessary for achieving bigger goals. Wearable products and services that help people experience continuous progress can do so, for example, through real-time updates that are powered by big data and insights. Facilitating personal progress in this way leads to improved health, user satisfaction, and long-term, sustained engagement.
Pilots, astronauts and workers in other high-risk industries follow rigorous safety checklists to help them avoid hazards. Checklists have shown potential to reduce risk in health care, too, but the challenge is figuring out how to incorporate them into physicians’ and nurses’ work flow.
A Stanford team has built a solution: an automated checklist that pulls data directly from patients’ electronic medical records and pushes alerts to caregivers. The checklist, and a dashboard-style interface they used to interact with it, caused a three-fold drop in the rates of a serious type of hospital-acquired infection, the team found. The work has just been published in Pediatrics.
From our press release about the study:
“Electronic medical records are data-rich and information-poor,” said Natalie Pageler, MD, the study’s lead author. Often, the data in electronic medical records is cumbersome for caregivers to use in real time, but the study showed a way to change that, said Pageler, who is a critical care medicine specialist at the hospital and a clinical associate professor of pediatrics. “Our new tool lets physicians focus on taking care of the patient while automating some of the background safety checks.”
Working in the pediatric intensive care unit at Lucile Packard Children’s Hospital Stanford, the researchers focused on bloodstream infections that occur via central lines, which are catheters inserted in major veins. The automated alerts were designed to help physicians and nurses follow an established set of best practices for caring for central lines. For example, alerts were generated when the dressing on a patient’s central line was due to be changed.
The drop in the rate of central line infections – from 2.6 to 0.7 infections per 1,000 days of central line use – not only protected patients from harm; it also saved money. The team estimated that the savings in the pediatric intensive care unit were about $260,000 per year.
Next, the researchers hope to adapt the automated checklists to other uses, such as helping to guide the recovery of patients who have received organ transplants.
A chance connection over the internet has spawned multiple efforts to provide 3D printed hands at an extremely low cost.
Around the world, there are people who have lost all or part of their hand, or were born without one. There are also people and institutions with 3D printers. Pair the two, and you can print a custom mechanical hand for $20-150 — thousands less than the typical prosthetic.
e-NABLE, which functions through a website, Facebook page and Google+ page, stepped up to connect the two after site founder Jon Schull came across work by American prop maker Ivan Owen, who made a metal mechanical hand for South African carpenter Richard Van As. Van As had lost four of his fingers in a carpentry accident.
Owen was then contacted by a mother whose 5-year-old son needed a hand. He again made a metal hand for the boy. But then he turned to 3D printing. MakerBot gave both Owen and Van As a 3D printer.
The pair developed a 3D printed hand for the boy and then posted the design to Thingiverse, where anyone could download and print it.
Van As and Owen’s efforts toward developing 3D printed hands live on via the Roboand project, which has created more than 200 hands and now branched into prosthetic fingers and arms. But Schull was interested in connecting people who needed hands with individual makers and institutions that had 3D printing skills, but potentially idle printers.
He started a Google+ page, and then a Facebook page and website. More than 300 makers make their services available to people who contact e-NABLE about a hand. Just a quick scroll through posts on the Facebook page reveals many, many people who have a use for a hand.
“I see e-NABLE as a crowd-sourced pay-it-forward network for design, customization and fabrication of all sorts of assistive technologies,” Schull told Rochester Institute of Technology, where he is a researcher. “This is a scalable model that could go way beyond 3D printed prosthetic hands.”
Today in the highly digital world that we have come to live in, the experience has to be extended to the consumer’s devices: namely mobile phones, tablets and personal computers delivered on the backbone of the World Wide Web.
So in this era where consumers have come to expect more from their brands, are patients correct in demanding a better user experience from their care providers?
Healthcare organizations are aware of this expectation and they are also aware that physicians and their allied co-workers need a better medium to communicate and collaborate among them. This not only leads to a better experience for all but also is critical as hospitals continue to drive better clinical outcomes.
One of the aspects of digital engagement is providing an exceptional web experience, whether it is providing physicians with real time data and reports on the cases they are following or engaging patients with education that can help them manage their health better.
The digital experience can help in achieving the following
1) Provide a platform for better collaboration between physicians. Also this helps in increasing consultations between experts who are not necessarily collocated but still need a visual to make a better diagnosis.
2) Accentuates the sharing of information between hospitals and even between various departments of the same hospital.
3) Leveraging the existing hospital information to give a visual picture to the patients on education and how they can leverage the hospital and its facilities to the best of its ability.
4) Running extensive 360 degree programs involving various departments like surgery, nutrition and physiotherapy.
5) Providing a mechanism for better healthcare management.
Now that kids are using 3D printers to build their own new limbs, a group of Philadelphia doctors is exploring how to use the technology to build kid-sized devices.
A group of pediatric specialists at Children’s Hospital of Philadelphia want to find out how 3D printing can be used to create customized devices for the complex needs of its pediatric patient populations.
One frustration of pediatrics is that it tends to be an area overlooked by medical device companies. Children represent a relatively small market that doesn’t lend itself to mass production. Adapting adult medical devices for children can be problematic. But when you factor in subtle developmental differences, that can make it more complicated to find the best medical device for children.
Dr. Jorge Galvez, an anesthesiologist at CHOP and a professor of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania, talked about the group at the kickoff of DreamIt Venture’s new program with CHOP. It began collaborating with University of Pennsylvania engineering students Nicholas McGill and Michael Rivera after they won a challenge by the Society for Technology in Anesthesia.
The annual contest this year turned its attention to 3D printing applications. It sought ideas for applying the technology to developing a Williams intubating airway that could be adjusted based on measurements from a CT or MRI scan. That particular technology is especially useful for a pediatric hospital because there’s a need for specialized devices for children with variations in the shapes of their airways.
Galvez said the idea is that the 3D printing think tank would develop applications for the technology across different pediatric specialties. Among the specialties represented in the group are cardiology; anesthesiology; ear, nose and throat; and orthopedics. “There’s a lot of low-hanging fruit in this area, such as customized prosthetics,” said Galvez. “The challenge is not about using the printer, but having the knowledge and expertise to know what the needs of each specialty are.”
The idea is that as the practice of 3D printing becomes more mature, customized devices could be developed more rapidly.
How can health information exchange lead to savings? A case study by Western New York’s clinical information exchange HEALTHeLINK claims more than a million dollars could have been saved by avoiding unnecessary CT scans. And patients stand to benefit as well.
“These findings demonstrate the value an HIE provides by reducing the number of unnecessary tests which saves time, money and radiation exposure to our patients,” HEALTHeLINK chairman Dr. David Scamurra said in a public statement.
Using a sample of patients having received more than one CT scan during six-month period — sometime between July 1 , 2011 and Dec. 31, 2014) — the study broke duplicate scans into three categories: known (3,361), inconclusive (1,878), and unknown (885). Known studies were removed and the remaining 2,763 CT scans deemed to potentially unnecessary duplicative tests.
Based on the findings, an overwhelming majority of duplicative CT scans (90%) were the result of orders made by physicians who either never (0 queries) or infrequently (1-499 queries) used the HEALTHeLINK patient query function, the virtual health record (VHR).
What’s more, the use of VHR could have prevented 48.2 percent of duplicate CT scans from being performed based on the patients having consented to their information being available for HIE and their data being searchable by HEALTHeLINK users.
The study also shows that hospital-based physicians were the most frequent users of CT scans and the greatest source of duplicate scans, representing more than 95 percent of those deemed potentially unnecessary.