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Healthcare costs continue to climb around the globe. The advent of the internet of things has the potential to revolutionize the traditional paper-based healthcare treatment through the access of real-time patient data and remote patient monitoring. Connected healthcare, particularly for chronic sufferers, enables improved patient care and encourages patient self-management while at the same time lowering costs.
Telehealth takes a lot of forms these days. Virtual visits with a health care provider can take place by video, phone or text, or via the Web or a mobile app. The one commonality: You get to consult a doctor from your home, the office, Starbucks or anywhere with a wifi or mobile connection.
These appointments can be quick, and save you from having to schlep across town and sit in a waiting room, leafing through year-old Time magazine articles, as prelude to every visit with a doc.
There's no debating that telehealth appointments can be convenient — and potentially even life-saving for people who live in remote areas. But are they also cheaper than in-person visits, as the telehealth companies claim? Not necessarily, according to a study published this month by the RAND Corporation, in the journal Health Affairs.
WHEN someone goes into cardiac arrest, survival depends on how quickly the heart can be restarted. Enter Amazon’s Echo, a voice-driven computer that answers to the name of Alexa, which can recite life-saving instructions about cardiopulmonary resuscitation, a skill taught to it by the American Heart Association.
Artificial intelligence is already making inroads into the NHS and could have profound effects on the medical workforce
Advances in clinical uses of artificial intelligence (AI) could have two profound effects on the global medical workforce.
AI, which mimics cognitive functions such as learning and problem-solving, is already making inroads into the NHS. In north London it is piloting use of an app aimed at users of the non-emergency 111 service, while the Royal Free London NHS foundation trust has teamed up with Google’s DeepMind AI arm to develop an app aimed at patients with signs of acute kidney injury. The hospital claims the project, which uses information from more than 1.6 million patients a year, could free up more than half a million hours annually spent on paperwork.
AI raises the prospect of making affordable healthcare accessible to all. According to the World Health Organisation, 400 million people do not have access to even the most basic medical services. Hundreds of millions more, including many in the world’s most advanced countries, cannot afford it. A key factor driving this is the worldwide shortage of clinical staff, which is getting worse as populations grow.
Health care, like many industries, places great emphasis on innovation. In just the past decade, we have moved rapidly from paper medical records to electronic ones and web portals that let information pass seamlessly between health systems and patients at the touch of a finger. Smartphone apps, wearables, medical devices, and other gadgets that promise to improve health are being developed at an ever faster pace. These developments often come from companies and startups that are relatively new to health care.
eMarketer has significantly revised its estimates of wearable usage downward for the entire forecast period, due to the Apple Watch’s failure to generate mass appeal. By 2020, only around on in five US adults—54.9 million—will use a wearable device on a monthly basis.
And most aren’t very likely to purchase one soon.
For marketers, the wearables user base is intriguing but not truly viable yet. “Marketers are interested in innovative wearables-based campaigns as well as basic notifications,” said Nicole Perrin, author of a new eMarketer report on wearables. “But they don’t see the technology in place yet to unlock wearables’ full potential for brands.”
NHS England is working with Google and Bing to increase the visibility of NHS content online and the forthcoming NHS app store.
Via VAB Traductions
Patient expectations about the power of digital health records are well ahead of the ability of healthcare providers to keep up, according to a new survey.
The report, by Transcend Insights, Humana’s population health management company, found that a vast majority of patients (97 percent) believe it is important for any health institution, regardless of type or location, to have access to their full medical history in order to deliver high-quality care.
Young people may be turning away from traditional sites of politics, but that does not mean that they are apolitical. In a recent co-authored article, Ariadne Vromen argues that Facebook is an important site of political engagement for youth in the UK, US and Australia.
There can be little doubt that the institutions and practices of modern representative government have been subject to growing disillusionment from young citizens. A reluctance to vote at elections, join political parties or have a high regard for their politicians, all suggest that many young people are turning away from formal politics in many countries. Instead, engagement in alternative or new forms of political participation point to the possible displacement of traditional models of representative democracy as the dominant cultural form of engagement, by approaches increasingly characterized through networking practices.
Via Pierre Levy
In the recent issue of the American Journal of Bioethics, the target article addresses the ethics of finding participants for clinical trials on social media sites. The authors, from Harvard Law School and Harvard Medical School, analyzed the particular ethical issues that occur in the online setting compared to in-person recruitment and provide practical recommendations for investigators and Institutional Review Boards (IRBs).
Less than 5% of patients with cancer participate in clinical trials, and most publicly funded cancer trials in the US fail to enroll sufficient numbers of patients to generate reliable results.1 For patients who do participate in clinical trials, they may not be representative of the population of individuals with cancer – participation is particularly low among older individuals and those in some racial and ethnic groups.2
Barriers to clinical trial participation were discussed at December’s American Society of Hematology (ASH) annual meeting. In a special-interest session on social media and clinical trials, the use of Twitter for clinical trial recruitment was discussed by a panel that included several clinicians and a patient advocate. The other session was an industry/advocacy forum on creating a diversified clinical trial and included the patient point of view.
Patient Perspective on Barriers to Trial Participation
Jennifer Ahlstrom, Founder, Myeloma Crowd, Salt Lake City, Utah, presented the patient perspective at the social media session. Ms. Ahlstrom says that trying to enroll in a clinical trial is “labor intensive” for patients who don’t feel well, are scared and think they may be dying and don’t know what their options are. “That’s a hard time to make decisions,” she said.
She was diagnosed in 2010 with multiple myeloma and assumed after her initial treatment she would join a clinical trial because of recurrence. She searched clinicaltrials.gov and discovered over 450 open myeloma trials.
“I didn’t understand any of the drug names, what they did, what they were for, even the standard therapies.” She called 8 facilities to learn about their clinical trials and got a call back from two.
“The process is not patient-centered,” she said. “You have to really fight to get into clinical trials and [it’s] a big reason patients don’t join.”
Ms. Ahlstrom said another reason patients don’t join clinical trials is that their doctor doesn’t refer them, whether it’s because they don’t want them to go outside their practice or they just don’t know what clinical trials are open at other facilities.
To inform other patients with myeloma about clinical trials, she started an online radio show, Myeloma Crowd Radio, which features hour-long interviews with investigators, asking them to explain their research and clinical trials, including the rationale and eligibility in patient-friendly language.
To date, 95 shows have been produced and archived, and are available as audio files and transcripts to a million listeners and readers.
Her Myeloma Crowd website shares news about trials, and its SparkCures tool allows patients to access information about vetted clinical trials that would be appropriate for them.
Barriers for Minorities
On the topic of increasing clinical trial diversity, Cheryl A. Boyce, Patient Ambassador, Columbus Ohio, said, “the efficacy of a drug is really important for anyone who has an active disease process. And with many drugs I’m not sure what the efficacy is for people who are African American. So, the diversity issue is of critical importance.”
She used the Tuskegee Study of Untreated Syphilis in the Negro Male — now referred to as the US Public Health Service Study3 — and the more recent experiences of Henrietta Lacks, whose tumor was the source of the widely-used HeLa cells,4 as examples of how things can go very wrong for people of color.
She said that many people in African American communities have heard those stories, and find it difficult to put trust in researchers who don’t look like them, or understand the cultural context of their belief systems. The underrepresentation of people of color as clinical investigators works against clinical trial recruitment.
Twitter as a Recruitment Aid
With Twitter, Michael A. Thompson, MD, PhD, Aurora Health Care, Milwaukee, Wisconsin, pointed out that pharmaceutical companies can tweet links to publicly available clinical trial information, e.g., if it is on clinicaltrials.gov, and suggested including the NCT number for tracking.
However, additional content not publicly available would probably require institutional review board approval to disseminate. He suggested pharmaceutical companies could use Twitter to follow conversations, e.g., those occurring at medical meetings, but not use it to promote their booths at those meetings.
The FDA has developed draft guidances to present information on drugs and devices using internet and social media platforms with character space limitations, i.e., Twitter,5 as well as a guidance for correcting third-party misinformation about drugs and devices.6
In general, information distributed by pharma on social media is subject to the same regulations that apply to distribution by any other means.
Joseph Mikhael, MD, Mayo Clinic Cancer Center, Phoenix, Arizona, acknowledged that many patients who may be eligible for clinical trials may not be on social media, but that often their family members or caregivers are. However, some patients will never be on Twitter, so other means of patient contact will be needed.
“Recruiting underrepresented minorities in clinical trials remains a grave challenge in medicine, and the use of social media might help by broadening the scope of information about clinical trials and research in general,” he said.
Dr. Thompson offered that a search of hashtags associated with ASH and the American Society of Clinical Oncology (ASCO) meetings allowed him to locate an appropriate local trial for a patient.
Ultimately it seemed that social media might be more useful for providers than patients.
Ms. Ahlstrom said that The Myeloma Crowd has run live patient meetings that were highly technical. This year they are producing pilot meetings for the minority community that are more basic, and have the theme of 5 steps to getting the best myeloma outcome.
One of those steps is to be aware of clinical trials.
Ms. Ahlstrom said, “I think one key thing is that the minority communities need to understand why knowing more is in their self-interest. It truly means longer life, which we want everyone to have.”
Ms. Boyce will be helping The Myeloma Crowd to identify topics that will apply to minority communities. She noted that the Intercultural Cancer Council has identified barriers to participation by underrepresented populations in clinical trials, and published policy recommendations several years ago.7
She said, “We know what we need to do; we just haven’t found the political will to do it. We’re better at planning than at implementing.”
Recommendations include removing barriers like lack of transportation or insurance, having awareness and education campaigns, addressing mistrust and language barriers, recruiting minority investigators, and encouraging referrals to clinical trials.
“If clinical trial participation is truly a priority in this country, we have to find a way to bring policy makers, industry, clinicians and community advocates together to figure out what parts of current policy are contradictory and serve as barriers themselves before we ever engage people. Every role should be defined and what support services are necessary to overcome barriers,” Ms. Boyce said.
She envisions a national education campaign that could even include information on cereal boxes and milk cartons, so the public will learn about clinical trials and research long before they may ever need to think about their own participation.
The Role of Advocacy Organizations
Daniel Auclair, PhD, VP, Multiple Myeloma Research Foundation (MMRF), Norwalk, Connecticut, said that patient advocacy groups can help break through barriers such as distrust toward pharma companies sponsoring trials and of the clinical trial process more generally.
Advocacy organizations may be able to provide better education about clinical trials to both clinicians and patients as well as devise personalized approaches to engage specific patient communities.
He noted that the Multiple Myeloma Research Foundation (MMRF) (like other advocacy foundations) has a personalized clinical trial matching tool that is more patient-friendly and has more patient-specific information than that on clinicaltrials.gov, as well as a patient call center staffed 7 days a week around the clock.
Dr. Auclair said they need to go to patients “on their turf, in their terms.” Patients who have been in clinical trials can serve as patient ambassadors to bring information to their community to learn more about trials.
Patients need to be active participants and they need to be supported so they can participate in clinical trials because “clinical trials test new drugs and new drugs save lives,” he concluded.
Ms. Ahlstrom, Ms. Boyce, and Dr. Auclair all noted that when African Americans, who have fared poorly in the past, have improved access to treatment, they may do better than others with myeloma, probably due to lower-risk genetic abnormalities.
Dr. Auclair said that myeloma has been the “poster child” for disparities, as African Americans have 2 to 3 times the rate of myeloma as other populations.
If the results of small studies showing they fare as well or better with treatment were replicated in larger studies, those data could support the entire population receiving treatment.
Dr. Auclair said that one reason clinical trial enrollment may be higher in other areas, e.g., Europe, is that the healthcare system tightly regulates the availability of drugs. The only way patients may have access to the newest agents is if they participate in clinical trials.
“Especially in this climate, more than ever, we may want to think about the access issues and the socioeconomic issues. We don’t know where the system is going but it may become a little more like in Europe, where going onto clinical trials will be a way where you can access these drugs that you can access now, but may not be able to access in the near future. I think clinical trials may become more important in the future than they are now,” he said.
Where do you turn for meaningful stats on your social media marketing?
ResearchKit, Apple’s proprietary medical research system, just received some encouraging news as to its accuracy and reliability.
A team of researchers from the Icahn School of Medicine at Mount Sinai analyzed data pulled from the Asthma Mobile Health Study, a research program that relies on a ResearchKit-powered app called Asthma Health. The researchers found that the data from the program, which was first launched in March 2015, was found to be in line with existing medical studies on asthma patients, according to results published in Nature Biotechnology.
More healthcare providers are turning to Apple products to help patients access medical records and improve engagement, a shift that is likely to grow given the company’s expanding interest in the healthcare industry. Health systems like Cedars-Sinai Health System in Los Angeles, Parkview Medical in Colorado and Ochsner Medical Center in New Orleans are integrating iPads and Apple Watches into their system, giving patients new insight into their care by allowing them to easily access and transport their medical records.
How many lives are worth protecting with the added expense of a physician in person?
Telemedicine is often in the news and until recently I had only casually glossed over the latest articles. The details I paid little attention to, but the headlines I would remember. “Great for rural areas” I would read! “Extend physician reach!” “Get specialists to greater numbers of patients with unique conditions!”
As a nearly graduated anesthesia resident in a large city with an abundance of doctors, I didn’t think telemedicine would have much impact on my future. None of the above headlines applied. However, I would be surprised one morning to wake up to an email that roughly said: “Thank you for your service to our patients in the past, but we will now be covering your position with telemedicine doctors, effective (nearly) immediately.”
Background: The goal of this research was to compare the self-reported estimates of daily physical-activity data provided to the Healthy People 2020 research team via a telephone survey to the mobile fitness app real-time reporting of physical activity using Twitter.
Methods: The fitness tweet classification data set was collected from mobile fitness app users who shared their physical activity over Twitter. Over 184 days, 2,856,534 tweets were collected in 23 different languages. However, for the purposes of this study, only the English-language tweets were analysed, resulting in a total of 1,982,653 tweets by 165,768 unique users. The information and data gleaned from this data set, which reflected 184 days of continuous data collection, were compared to the results from the Healthy People survey, which were compiled using telephone interviews of self-reported physical activity from the previous week.
Results: The data collected from fitness tweets using the five mobile fitness apps suggest lower percentages of people achieving both the 150 to 300 and 300+ min levels than is reflected in the Healthy People survey results. While employing Twitter and other social media as data-collection tools could help researchers obtain information that users might not remember or be willing to disclose face-to-face or over the telephone, further research is needed to determine the cause of the lower percentages found in this study.
Conclusions: Though some challenges remain in using social media like Twitter to glean physical-activity data from the public, this approach holds promise for yielding valuable information and improving outcomes.
Medtech startup AliveCor announced this morning it has pulled in $30 million from Omron Healthcare and the Mayo Clinic and is launching an artificially intelligent stroke prevention platform for doctors called KardiaPro.
AliveCor already has an FDA-cleared mobile app called Kardia to accompany its $99 standalone EKG reader device. However, a partnership last year with the Mayo Clinic involving 4,500 patients for a major study on stroke prompted the company to build the new platform, which is a premium offering for doctors who want to monitor the EKG readouts of patients at potential risk for stroke or other heart-related diseases.
In Italia la velocità di connessione internet cresce lentamente, lasciando il Paese nella parte bassa della classifica europea e mondiale. A dirlo è il "Rapporto sullo stato di internet" elaborato da Akamai e relativo al quarto trimestre 2016. Dall'indagine emerge che in Italia la velocità media di connessione è pari a 8,7 Megabit al secondo (Mbps). Il dato segna un incremento rispetto agli 8,2 Mbps del trimestre precedente, ma porta il Paese a scendere ancora nella classifica mondiale posizionandosi 58/o, e rimanendo 28/o in Emea (Europa, Medio Oriente e Africa).
In Europa 27 dei 31 paesi esaminati hanno una velocità media superiore ai 10 Mbps, con la Norvegia che mantiene il primo posto grazie ai suoi 23,6 Mbps. L'Italia, fanalino di coda, continua a precedere solo Croazia, Grecia e Cipro.
Nurses, Midwives and Allied Health Professionals (NMAHP) are raising their digital
game. Are you looking to develop your leadership skills to influence the use of
technology for the benefit of staff and patients? If so, flick through this magazine
to find out more about the programme and what some of the participants of the
NMAHP eHealth Leadership programme have been doing.
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