Sleep Profile Followup

The sleep profile quiz, if you’re interested!

http://www.bbc.co.uk/science/humanbody/sleep/profiler/

 

Resurrecting PowerPoint in Medical Education

I recently visited one of my teachers from high school and was greatly amused to see her teaching class from an archaic overhead projector.  I did not understand why, in a world with so much innovative technology, she had opted to use such outdated equipment. The experience caused me to ponder the extent to which technology has become integrated in our culture, and how this has affected the increasing role of multimedia software in education.

pvsp

Tools like PowerPoint, podcasts, video tutorials, etc., offer new and innovative teaching methods and possibilities. As a result, these technologies are used so frequently that it has become almost more unusual for a professor NOT to use some sort of multimedia tool in conjunction with their lecture. PowerPoint, especially, has become a popular multimedia resource for professors because of its ease of access and ability to streamline information into bullet-pointed lists.

While the software offers a variety of options for presenting and configuring information in many different ways, most professors still opt for the classic bullet-point format. We have all had that professor who lectures quickly, flipping through plain slides overloaded with text, resulting in a mad rush to record the information. Ultimately, this leads to confusion and the propagating of washed-out expressions and bored students.  Sadly this detrimental practice is so common that researchers have named the phenomenon, “death by PowerPoint.”

badpowerpointnews1

If this is the case, then how is the use of PowerPoint as an educational tool any better than my teacher’s antiquated, boring overhead projector?

Medical education provides an extremely high stress environment where students must learn enormous amounts of information in a limited amount of time. In such a high-stake atmosphere, improvements in the effectiveness of educational tools like PowerPoint could have a massive effect on the education of our country’s upcoming physicians.

So, are there ways to improve the use of PowerPoint and other multimedia tools to make them better resources for imparting information to students?

Fig2

Example of Adapted Powerpoint Slide

Research done by Richard E. Mayer has directly addressed many of these questions. Mayer has established a number of theories and principles regarding design and implementation strategies of multimedia educational materials through his work with evidence-based education materials. Both his and supporting research has shown that incorporation of Mayer’s multimedia design strategies involving college-level students showed increases in short-term retention of information. In addition, current research has shown that incorporation multimedia (similar to Mayer’s design) led to an increase in the short-term retention of information by medical students.

Preliminary evidence has shown that PowerPoint and its use can be redeemed, but still leaves many questions unanswered:

(1) Is there a possibility of improving multimedia presentation to improve long-term information retention?

(2) Do the use of multimedia tools improve student’s ability to incorporate information into a clinical setting?

 

Sources:

Mayer, R. Multimedia Learning, 2nd edn. Cambridge: Cambridge University Press 2009.

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The Risk That Comes With Too Many Choices

It’s hard to believe that there were no health apps over a decade ago and now new apps are being created everyday, with thousands being created every year. When researching diabetes-tracking applications for our project, I searched diabetes in the iTunes App store and I was given 968 results. When faced with so many choices, we often become overwhelmed and don’t make smart decisions. Barry Schwartz, author of the “Paradox of Choice” summarizes the risk that comes with too many choices by saying:

            “When people have no choice, life is almost unbearable. As the number of available choices increases…the autonomy, control, and liberation this variety brings are powerful and positive. But as the number of choices keeps growing, negative aspects of having a multitude of options begin to appear. As the number of choices grows further, the negatives escalate until we become overloaded. At this point, choice no longer liberates, but debilitates.”

choices

source: trulyheal.com 

 

When making a decision on which app to download, we end up relying on information given to us on app reviews or by the price of the app and while this information is useful, it can often be misleading. While an app might be expensive, it perhaps would better suit the users needs than the free app. And while one app works for someone else, every patient has different treatment plans and goals. In the worst scenario, the user becomes so overwhelmed that they don’t end up downloading an app at all. Here are some tips for making a informed decision when choosing an app:

  • Ask your doctor- Although not all physicians will know of useful applications, a physician that is familiar with treating patients with diabetes will probably have heard positive reviews of certain apps. Also, since your physician is familiar with your treatment plan, they will be better able to recommend an app suited to you then some random guest review on iTunes. Also, as the use of health apps becomes more common, physicians are becoming more aware of the variety of apps out there. One diabetes treatment app (BlueStar) even requires a prescription from your doctor!
  • Don’t solely focus on price- While it is often our natural inclination to download the free app, the one that costs $1.99 might be ten times better. This isn’t to say that price is correlated with quality of app, just try to focus on the features of the app instead of the price (as long as the price is reasonable).
  • Focus on the features most important to you- We can be tempted to download an app that offers the most features, but this type of app is often hard to navigate and confusing. Depending on your condition, choose the top three features you want in an app. For example, some diabetes patients want an extensive nutrition tracking feature while others are not interested in this feature. Once you narrow down your priority features, choosing an app will become easier.

Even though making a choice may be difficult, most of the health apps on the market will enable you to take better control of your health and will end up making it easier to manage your condition.

A Path to Quicker Innovation: A Boon for Medicine

For anyone that has any experience trying to create and commercialize a medical device one of the most challenging, frustrating, and intimidating obstacles is obtaining FDA approval. It’s complicated, it’s expensive and more than anything it’s LONG.

There are currently a number of different ways that someone can obtain FDA approval. The two most common are the 510(k) pathway and the Premarket Approval (PMA) pathway.

The 510(k) is a pathway that can only be followed by devices that can prove they are substantially similar to a pre-existing device on the market. In doing so, devices that pass by FDA approval through the 510(k) do not have to undergo clinical trial for approval. (Although for more complicated devices trials are also necessary to show validation to the market). Most Class I and Class II devices are approved using this pathway.

However, for inventors and companies with groundbreaking technology that is not similar the PMA pathway is often the only option. This is an extremely stringent and time consuming process that is often an enormous barrier to entry for startups.

An expedited pathway to approval called the FDA Fast Track Development Program has existed for a few years in the pharmaceutical industry that can accelerate approval time  to only 60 days. Drugs that offer solutions to unmet needs are appropriate for this program like novel cancer drugs.

But for some reason no such equivalent has existed for medical devices. Well hopefully the wait is over.

Just yesterday the FDA announced proposed the Expedited Access Premarket Approval Application, a program for medical devices that will help new and novel technology that is needed by patients and the medical community to obtain faster FDA approval.

Technology has been growing at an incredibly rapid pace, and technological marvels are all around you. Unfortunately, the medical environment has been resistant to change and slow to evolve. Part of that has always been the huge obstacle associated with FDA approval.

Hopefully, this new process will make things a little bit easier. 

http://www.reuters.com/article/2014/04/22/us-fda-medicaldevice-idUSBREA3L10120140422

SAM App Review Revisited

http://sam-app.org.uk/

Just For Fun: Clinical Trials Email Digests

Source: Wikipedia

Source: Wikipedia

In order to tackle the problem of low clinical trial accrual, my group has decided to work on designing the general solution of a Clinical Trials Navigator (CTN). While I am satisfied with this as a good general solution, there are other specific solutions that could be beneficial. Especially being a computer science major who loves to build software, I can’t help but toy with these other solutions. So just for fun, I will change gears and write a slightly more technical blog post that describes the architecture for a solution that I would like to implement in the future (when I have time!).

The idea is a service that sends patients email digests for new trials that are relevant to them. A digest contains a simple list of potential clinical trials that the patient might qualify for, and is interested in. The flow of the application is described below.

Basic Architecture

Digest Diagram

The use case for a user is that they register online for the digest service and choose the corresponding types of trials that they would be interested in. After this simple registration, the user does not have to initiate any more contact with the service. From the user’s perspective, digests with aggregated clinical trials information will come in at a fairly steady pace. This saves the patient from the headache of sifting through trials themselves.

But how does the user receive this neat packaged digest of relevant clinical trials? The solution I have thought up is simple:

  1. The listing of all clinical trials on clinicaltrials.gov is freely available and is updated every day. The end goal is to detect new trials, so what we will do is index all current trials, and then check every day to see if there are non-indexed trials (which means they are new).

  2. When new trials are added, we check against our database of registered users to check whether or not the trials would be relevant. If they would be, then we make a note to include the trial in the user’s next digest.

  3. Once a digest has reached a tipping point (a point where any more trials would clutter the digest) or a time of inactivity (below the tipping point, but there are trials that are getting stale), then we send the user the email digest.

  4. In the email the user has the option to unsubscribe themselves from the digest.

 

Although this solution does not help patients who are not already engaged patients, I hope that it might help those who are not against the idea of trials, but have not the energy, time, or knowledge to sift through trials online.

 

Increasing the Scope of mHealth: Telemedicine Behind Bars

Screen Shot 2014-04-23 at 2.32.46 PM

In designing mHealth solutions, one of the most important initial steps is identifying the target population. Asking “Who will benefit?” is one of the best ways to kick-off a successful, targeted mHealth campaign. To do this, we spend time gathering statistics about how many people own mobile phones, who owns smartphones, who texts, who tweets, and who talks. As we narrow down our target population to a specific subset, certain groups will inevitably be left out. One such population, is the incarcerated.

While inmates are not generally allowed access to mobile phones, mobile health, specifically telemedicine, holds a lot of promise in improving healthcare among this population. In December 2013, mHealth News reported that the Louisiana Department of Corrections (DOC) was planning to increase the use of telemedicine in their prisons three-fold as the primary healthcare delivery system for its inmates. By collaborating with AMD Global Telemedicine Inc—the leading Telemedicine Encounter Management Solutions supplier—the DOC hopes to serve over 50,000 inmates. Prior to this innovation, handcuffed prisoners had to be transported 150 miles by bus to reach the nearest healthcare facility, where all prisoners had to remain until everyone had been seen.

By establishing a telemedicine infrastructure—training doctors and healthcare professionals and purchasing video and medical equipment—inmates can be screened for the few that need face-to-face interaction, while the others can be seen virtually from the prison. With the technology provided by AMD, up to 15 patients can be seen by a single physician in just four hours. In addition to increasing productivity and tailoring care, the increased use of telemedicine is also cost-effective. Using telemedicine will greatly reduce transportation costs and payment for personnel who need to be transported from the prison. Additionally, the DOC is receiving additional funding from the state, which will allow it to pay for the aforementioned training and purchases.

Telemedicine is also especially valuable because it provides an opportunity for the consolidation of medical information through the digital interface. An article in PRWEb covering this telehealth development describes the program’s capacity to “deliver live medical images from connected medical devices and scopes, real-time video from an examination camera, and the ability to view patient documents and vital signs data all in the same online platform.” Furthermore, patients can use telemedicine to access physicians of 16 different medical specialties, including primary care, neurology, and endocrinology.

Telemedicine provides a very promising avenue for using media and digital technology to reach underserved populations. The incarcerated community is oftentimes overlooked for many medical innovations. However, this is one valuable opportunity in which such innovations can, and most likely will, be both highly useful and significantly impactful. While it is simple enough to design media solutions for educated professionals, the potential of mHealth is much more expansive, and should be utilized in as many ways as possible.

 

http://www.mhealthnews.com/news/telemedicine-behind-bars-prison-mobile-mHealth?page=0

http://www.prweb.com/releases/2014/02/prweb11575342.htm

Artificial Intelligence and Healthcare

I’m taking a philosophy class that touches a lot upon what cognition really means. Which led me to thinking – if we’re becoming closer and closer to developing artificial intelligence that rivals human intelligence, could we develop artificial intelligence to solve problems within healthcare?

Solutions are already in the works. A 2013 study from Indiana University showed that artificial intelligence machines were able to diagnose and reduce the cost of healthcare better than physicians by 50%! Using 500 randomly selected patients from that group for simulations, the two compared actual doctor performance and patient outcomes against sequential decision-making models, all using real patient data. They found great disparity in the cost per unit of outcome change when the artificial intelligence model’s cost of $189 was compared to the treatment-as-usual cost of $497.

However, one problem with replacing physicians with artificial intelligence may be the possibility of removing the doctor-patient relationship from the equation and undermines the importance of human relationship in the treatment process.

We are reaching a time in our society that we are slowly developing the tools needed to create intelligent beings that could solve problems. But a key distinction so far is that our goals in artificial intelligence have always been to create something as good or better than an average human.

But what if we switched that around? What if our goal was actually to create an artificial intelligence that had a problem itself? For example, could we develop an artificial intelligence that thinks like a patient in order to understand patient behavior?

There are plenty of virtual reality programs that exist for doctors to test their skills on surgery on specific parts of the human body, and now we know artificial intelligence could even replace doctors in diagnosis, but could there be one day be an artificial intelligence modeled after a sick person – an intelligent agent that may not be biologically (mainly because if it’s a robot it may not be made of biological parts) sick but we install a state of mind into it that would make it behave as it was sick? I’m talking about creating a robot patient who we would somehow program into thinking it has cancer, and doctors could be able to talk to the robot and it would respond and behave the same way as a cancer patient. It would be a great tool for doctors to understand patient behavior and how to meet their needs relationally, and I can see the uses it may have in studying psychology and philosophy as well.

As a Cognitive Science major, I can’t help but wonder since scientists, philosophers, and engineers have not been able to agree on an exact theory and replica of an artificial intelligence that represents a normal, healthy human, then how much harder would it be to create an accurate artificial intelligence that is a replica of someone who is sick.  After all, to model something that we might called defective, do you need to have a complete understanding of the original, non-defective object first?

Another complication would be distinguishing whether we could create a patient based on what is called “weak artificial intelligence” vs. “strong artificial intelligence”. Weak artificial intelligence is being able to create a machine that behaves intelligently, but strong artificial intelligence is creating a machine that can actually think. The current goal of researchers is to create strong artificial intelligence, which is why you have supercomputers like Watson who apparently can solve problems and answer questions by finding the information on its own. So if we even were able to create a machine that can behave like a patient, would it be because it has weak or strong artificial intelligence?

I believe there are many factors to consider both in philosophy and in technology before this possibility could ever be achieved. But for now, perhaps the best way to understand patient behavior is to communicate with the patient.

 

Medical Communication in a World of Cyber Dust

Many of the applications that are being developed as part of this class have run into the same dilemma: how can we have doctors communicate with patients in a HIPAA compliant and secure environment? There are secure doctor networks like Doximity, and in my last post I mentioned an idea for a secure patient doctor portal based on Doximity.

Well here’s another option. Cyber Dust.

Cyber Dust (http://cyberdust.com/) is a Mark Cuban backed startup that is described as “Whatsapp meets Snapchat”. The mobile application allows members to communicate with one another in a secure environment in which all messages are automatically and permanently erased after 30 seconds.

The impetus for this technology has absolutely nothing to do with medicine. Cuban talks about situations like Alex Rodriguez’s incriminating text messages that were part of the case leading to his history making MLB ban; private discussions he wanted to have with investors without worrying about the SEC prying; and confidential discussions between clients and lawyers.

With current text messaging however that just isn’t a reality; cyber dust allows individuals to communicate without leaving a digital footprint.

The common denominator here is that all of these conversations were supposed to be confidential, which is exactly what communication between doctors and patients is supposed to be. So then could Cyber Dust be modified in a way that facilitates secure patient doctor communication?

I see a lot of promise in the idea. But there is also a risk. Without a digital footprint it could be hard to hold doctors accountable.

I guess the real question for patients, doctors, Cyber Dust, and Mr. Cuban is do the benefits outweigh the risks? 

Developing SciFi: The Medical Tricorder

Have you heard of the medical Tricorder? It’s the fictional device used in the Star Trek universe to instantly diagnose disease without any invasive procedures. This space gadget seems like it could be pretty useful, but it isn’t real. Or is it?

In 2011, a non-profit organization focusing on technological development, X Prize, and the wireless telecommunication company, Qualcomm, organized the Qualcomm Tricorder Competition, inviting scientists world wide to turn the fictional medical Tricorder device into the next real health-tech breakthrough. The winner is to develop a hand held device that will diagnose patients better than or equal to a panel of board certified physicians.

The ultimate goal of this competition is to develop a device that will provide instantaneous medical feedback for an individual’s health status without any invasive procedures or trip to healthcare facilities. This, in theory, would give individuals direct access to health data as well as full control over how, when, and where they receive care.

This science fiction idea seems radical in that it is trying to condense the entire primary care physician’s job into one handheld device. With the development of devices such as the lab-on-a-chip, maybe the technology does exist that this device may not completely be out of reach. However, is it right to outsource such a huge task to a little phone screen? Even if such computerized devices give rise to better diagnostic outcomes than the 55% (as reported by the Qualcomm competition website) met by human physicians, is it right to shrink medicine down to statistics and algorithms?

Of course, even if this device is to be made, more invasive procedures will probably continue to be done in hospital – but that being said, I would like to believe that there is more to medicine than just providing a diagnosis. The new technology (again, in theory) will be able to gather health metrics to raise concerns for a specific diagnosis, but full patient context should be understood before making health decisions.

The medical tricorder may be perfected to be used as a supplementary medical device for those willing to purchase such a device – but this should never replace a doctor’s visit. The organizers for this competition provide the rationale that people more often than not must seek a healthcare professional in order to receive any type of direct medical care, creating an inefficient healthcare system that is out of reach for those who actually need it.

Although the concern brought up by the Qualcomm and X Prize is certainly valid, creating technology to replace doctors to an extent seems to be a bit extreme. Many studies have definitely shown evidence that increased physician-patient interaction correlate with better outcomes. Just from personal experience in research, I have seen the large positive placebo effect on patients just from being able to talk to a professional.

Patients who are going to the doctor out of concern for personal well-being are going to go to the doctor regardless of what a machine tells them. Those that are going to be persuaded not to go are those that probably wouldn’t have gone unless the symptoms were truly bothersome anyway – so in a sense – we aren’t really getting anywhere with this.

Sometimes, what the patient needs is genuine attention from the HCP, not an analysis of story-less numbers and figures. Technology can always be a great supplement, fulfilling biological human needs, but not enough to fulfill personal human needs.

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