Category Archives: Technology

Medicine: Using Stem Cells To Treat Osteonecrosis

Daniel Wiznia, MD, an orthopaedic surgeon with Yale School of Medicine, is practicing a surgical technique designed to render 10% of hip replacements unnecessary. Regenerative properties from a patient’s own stem cells are responsible for regrowing bone, restoring blood flow, and being able to avoid further interventional surgery.

Osteonecrosis, also known as avascular necrosis, occurs in more than 20,000 Americans each year. As the condition progresses, bone cells known as osteoblasts become unable to repair themselves and sustain the integrity of the bone, and ultimately die. The bone deterioration leads to a decrease in blood flow to the area, further weakening the entire skeletal structure of the upper leg.

If unaddressed, the ball portion of the hip’s ball and socket joint will cave in on itself and collapse, requiring a total hip replacement. The fact that patients often receive this diagnosis during their 30s and 40s presents a particular challenge.

While the lifespan of hip prosthetics has dramatically increased in recent years, a patient who undergoes a total hip arthroplasty, or total hip replacement, at that age will almost certainly require a revision later in life. This redo of the same surgery at an older age comes with an entirely new set of risks and potential complications, making it that much harder to manage down the road.

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Telemedicine: UCM Digital Health Aids NY Hospitals

Telemedicine could soon offer relief local emergency rooms desperately need.

UCM Digital Health offers a digitally integrated, whole person health solution that provides patients with immediate access to care on their terms.

UCM combines a digital front door platform, multi-disciplinary team of providers, and a 24/7 telehealth triage, treatment, and navigation service to provide a range of patient services, including emergent and urgent care, primary and specialty care, behavioral health, and more. Care begins digitally and can seamlessly integrate across other points of care for a simple patient experience.

UCM brings together clinical expertise, advanced technology and compassionate care to offer powerful advantages for insurers, employers, patients and providers.

Artificial Intelligence: Its Benefits For Radiology

Using artificial intelligence in health care seems like a futuristic concept, but it’s something that’s being used now to complement the knowledge of doctors. Radiology was one of the first areas that saw a lot of AI applications.

Dr. Bradley Erickson, director of Mayo Clinic’s AI Lab, says in the case of radiology, machine learning is used to complete some of the more time-consuming work. Beyond that, the diagnostic capabilities of AI are what attracts a lot of the appeal. While imaging-related AI has seen a lot of advancements, Dr. Bhavik Patel, director of AI at Mayo Clinic Arizona, says the next step is looking at AI applications for preventive health and shifting the mindset from pipeline to platform thinking.

There are a broad area of applications (for AI), starting in radiology, but really spreading into the rest of the clinic, including cardiology and even pathology.

Colorectal Cancer: ‘Miss Rate’ Lowered 50% Using AI

“Colorectal cancer is almost entirely preventable with proper screening,” says senior author Michael B. Wallace, M.D., division chair of Gastroenterology and Hepatology at Sheikh Shakhbout Medical City in Abu Dhabi, United Arab Emirates, and the Fred C. Andersen Professor at Mayo Clinic in Jacksonville, Florida. “The substantial decrease in miss rate using AI reassures health care providers on the decreased risk of perceptual errors.”

The most relevant cause of post-colonoscopy colorectal cancer (CRC) is the miss rate of colorectal neoplasia — the rate at which neoplastic lesions are not detected in a screening or surveillance colonoscopy. Some studies suggest that 52% to 57% of post-colonoscopy CRC cases are due to missed lesions at patients’ colonoscopies. It’s estimated that 25% of neoplastic lesions are missed following screening colonoscopy.

Mayo Clinic Gastroenterology and Hepatology, in collaboration with colleagues from around the world, found that using artificial intelligence (AI) in colorectal cancer screening produced a 50% reduction in the miss rate for colorectal neoplasia. Results of the study were published in the July 2022 edition of Gastroenterology.

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Stroke Care: Deep Brain Stimulation ‘Pacemaker’ Restores Hand Movement

Deep brain stimulation for patients who experience a stroke.

Deep brain stimulation is a surgical procedure that involves implanting electrodes in the brain, which deliver electrical impulses that block or change the abnormal activity that cause symptoms. (Courtesy: Cleveland Clinic)

“He had limited use of his hand. It really wasn’t functioning,” explains Andre Machado, MD, PhD, who is Chairman of the Cleveland Clinic Neurological Institute. “He couldn’t do as much manual work, with both hands, and that was a limitation for his quality of life.”

For the study, Joe first underwent two surgical procedures — one to insert the DBS device under the skin of his chest, just below the collarbone, and the other, to implant the DBS electrode in a part of the cerebellum called the dentate nucleus. Once activated, the device, called an implantable pulse generator, serves as a specially-calibrated pacemaker for the brain, stimulating it to try and enhance motor rehabilitation.

COMMENTARY:

Many times in science, application precedes understanding. Deep brain stimulation, either by electrical or magnetic pulses is a good example.

It is not at all understood how the brain really works, much less how electrical and magnetic stimulation in the brain works. It may stimulate or slow down neural impulses, or interrupt the incoming signals or the outgoing messages. Are there any other possibilities?

At least it does work, Apparently.

One thing for certain is that deep brain stimulation is preferable to previous treatments, which produced small, destructive, irreversible lesions in the brain. At least these stimulations can be stopped if they don’t work.

I enjoyed this posting, since it reignited my interest in the cerebellum. This amazing Organ has more neurons than the rest of the brain combined, represented by innumerable small granule cells. I wasn’t even aware of the dentate nucleus, which is an island of cerebral cortex-like neurons in the white matter of the cerebellum. Apparently the action of the cerebellum is orchestrated through this and a couple of other islands of neurons. All of the coordination, movement, and thought processing accomplished in the cerebellum takes place through these nuclei.

It was also fascinating to learn of a patient who has complete lack of a cerebellum, and suffers only some mild incoordination and speech problems. Apparently, absent the cerebellum, the rest of the brain is largely capable of taking over the function of the missing cerebellum. Once the brain is formed, However, and dependent upon the cerebellum, damage to this organ causes a great deal of coordination, movement, and balance problems.

I’ll put another plug-in for sleep, diet and exercise, as well as being careful with your body. Prevention is far better than treatment.

—Dr. C.

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Telemedicine: New Survey Finds Virtual Care Is Now Mainstream Care Delivery

“Telemedicine is here to stay,” said Dr. Rahul Sharma, professor and chair of emergency medicine at Weill Cornell Medicine and co-author of a commentary on the results. “Health care organizations really need to think about the next steps regarding the future of virtual care, such as how we integrate it into our systems, and how to make sure we are meeting the needs of both our clinicians and our patients.”

The survey, conducted in March, polled members of NEJM’s Catalyst Insight Council who are clinicians, clinical leaders and executives in organizations that deliver care. The survey received 984 responses from around the world, 609 from the United States. Dr. Sharma, who is also emergency physician-in-chief at New York-Presbyterian/Weill Cornell Medical Center and executive director of the Center for Virtual Care at Weill Cornell Medicine, helped formulate the questions with his co-author Dr. Judd E. Hollander, senior vice president of health care delivery innovation at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia.

Of U.S. respondents, 71 percent reported that telemedicine has improved patient health, while a similar proportion said it provides at least moderate quality specialty or mental health care. For primary care, that share was 81 percent. When responses across all countries are included, the results differ only slightly from those of U.S. respondents.

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Technology: Smart, Voice-Assisted Operating Rooms

Are Amazon Alexa and Google Home limited to our bedrooms, or can they be used in hospitals? Do you envision a future where physicians work hand-in-hand with voice AI to revolutionize healthcare delivery? In the near future, clinical smart assistants will be able to automate many manual hospital tasks—and this will be only the beginning of the changes to come.

Voice AI is the future of physician-machine interaction and this Focus book provides invaluable insight on its next frontier. It begins with a brief history and current implementations of voice-activated assistants and illustrates why clinical voice AI is at its inflection point. Next, it describes how the authors built the world’s first smart surgical assistant using an off-the-shelf smart home device, outlining the implementation process in the operating room. From quantitative metrics to surgeons’ feedback, the authors discuss the feasibility of this technology in the surgical setting. The book then provides an in-depth development guideline for engineers and clinicians desiring to develop their own smart surgical assistants. Lastly, the authors delve into their experiences in translating voice AI into the clinical setting and reflect on the challenges and merits of this pursuit.

The world’s first smart surgical assistant has not only reduced surgical time but eliminated major touch points in the operating room, resulting in positive, significant implications for patient outcomes and surgery costs. From clinicians eager for insight on the next digital health revolution to developers interested in building the next clinical voice AI, this book offers a guide for both audiences.

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Smart Watches: New Heart Surgery Remote Monitors

Smartwatches just keep getting smarter: the latest versions can estimate your blood oxygen level and record an ECG (a measurement of your heart’s electrical activity). A new study suggests these sophisticated devices may provide a safe, accurate way to monitor people at home after they undergo a minimally invasive heart valve replacement procedure.

The study included 100 people who had a transcatheter aortic valve replacement, most of whom went home within a day or two after the procedure. All received a smartwatch that recorded their heart rate, steps, pulse, oxygen saturation, and an ECG measurement. During next 30 days, the smartwatch detected 29 of 38 heart-related problems — mostly heart rhythm abnormalities — among 34 participants.

The findings suggest that smartwatches could be an effective way to remotely monitor patients from home, say the authors, whose study was published March 29, 2022, in the Journal of the American Heart Association.

Technology: The Lancet Digital Health – July 2022

Covid-19: Can A Vaccine Be Developed That Lasts?

“Roughly two and a half years into the pandemic, White House officials and health experts have reached a pivotal conclusion about Covid-19 vaccines: The current approach of offering booster shots every few months isn’t sustainable.

Though most vaccines take years to develop, the Covid shots now in use were created in record time—in a matter of months. For health authorities and a public desperate for tools to deal with the pandemic, their speedy arrival provided a huge lift, preventing hospitalizations and deaths while helping people to escape lockdowns and return to work, school and many other aspects of pre-Covid life.”