July 01, 2009
Internet Filtering Can Hinder A Psychiatric Assessment
An interesting letter to the editor in the May-June Psychosomatics describes a case where a hospital’s Internet filtering system impeded a thorough assessment of a case that presented to the Emergency Department.
An 18 year old was brought to the ER by police for psychiatric evaluation after it was discovered that he had posted threats on a popular Internet social networking site. It included threats to kill the assistant principal of his school, other students, and himself. As the staff tried to view the threats, they were thwarted by the hospital’s Internet filtering system, which denied access to "Social Networking and Personal Sites." Hospital Information Technology personnel were unable to remove this filter, despite the clinical importance of doing so.
After several hours, a hospital computer far from clinical areas was identified that had an unrestricted access to the Internet; and it allowed access to the website. In addition to the threats, it revealed clear references to drug use. The patient was admitted to the psychiatry service.
In the discussion of the case, the authors describe how important social networking websites have become in peer to peer communication and the openness with which highly personalized information is presented. They point out that "as use of social networking sites becomes more common, the gathering of additional information during a psychiatric assessment may include viewing such online content produced by the patient." In this case, access to online content was crucial to the overall evaluation of the safety of this patient and the safety of others. The Internet with its expanding scope of accessible personal information, is rapidly becoming an important collateral source of information in a psychiatric assessment.
Use of Internet filters in hospitals can also become a restriction of educational content. "As professional organizations have begun posting various materials online, including videos of educational presentations, patient examinations, and self-assessment tests. If these are posted to sites that are flagged as inappropriate (e.g., a video posted on YouTube.com) they will be blocked, limiting access to an important educational resource."
The authors conclude that "Internet filtering systems, while intending to restrict recreational or inappropriate use of the Internet, may unintentionally serve as barriers to effective clinical information-gathering and educational material. Hospitals and organizations must carefully weigh the risks and benefits of instituting such measures. Mechanisms by which Internet filters can be overridden (perhaps with a recorded rationale) in cases of clinical or education import may be a useful compromise that should be further explored."
Psychosomatics 50:301-302, May-June
June 28, 2009
Virtual Hospital And Informed Consent
A key principle of informed consent is that the person understands the medical procedure. But what if a patient has a mental impairment and his doctor does not have time to ensure he understands the proposed treatment? A team of researchers at the Royal Sussex County Hospital in Brighton, England, believe that virtual environments might provide a solution.
They have designed a virtual version of the hospital and later this year will receive its first "patients," a group of 20 volunteers with learning disabilities who will visit it in order to be talked through the sort of treatment they might be offered if they really were patients.
The hospital is being built in Second Life. In the study, the subjects avatars will begin their journeys at a simulation of the Grace Eyre Foundation centre for adults with learning disabilities in Brighton, which they attend in real life. Local landmarks such as the town’s famous seaside pier will be used to help familiarise them with their surroundings before they arrive at a virtual version of the Royal Sussex. It will be hosted in a private part of Imperial College’s virtual postgraduate medical school in SciLands, a dedicated science and technology Second Life continent populated by around 30 universities, government agencies and museums. Once inside the hospital, the avatars will be directed to a waiting room. Then a virtual nurse will take them to a bed, where they will lie down to have virtual blood taken. A Second Life doctor will explain that they are about to have an anaesthetic. Meanwhile, a real person alongside the participant will answer any questions and, after the virtual visit is over, a psychologist will carry out "non-directive" interviews, a technique used by the police to encourage witnesses to choose what they want to talk about and to maximise recall.
If these interviews suggest the participants understood what was going on well enough to give informed consent, then the researchers plan to carry out a larger study, comparing their simulation directly with the standard method of obtaining consent face to face.
Source: The Economist
June 23, 2009
Brainwaves To Help Patients Communicate
Scientists at France's Institute for Health and Medical Research (Inserm) are using a system called OpenVibe to help sufferers of locked in syndrome and to develop understanding of the human mind.
The condition known as locked-in syndrome has many causes but in most cases it leaves its victims fully conscious but unable to move or speak. OpenVibe responds directly to the electrical activity of the brain rather than rely on a part of the patient's body that still moves. According to Olivier Bertrand from Inserm, "the main application of this technology is to provide some disabled people with a communication aid, especially those who have very severe motor disorders. Using their brain, which is still perfectly functioning, as a way to communicate is a big hope for them getting in touch with the rest of the world."
OpenVibe is based on a grid of letters - to choose a letter the computer looks at brain activity to note the column and the row the user is looking at within the grid - the choices flash on the screen. Thus by crossing the information of which row and which column have been flashed it signals which letter is desired. The process is still slow and painstaking but software that predicts the patient's words could one day speed it up
Virtual movements
Similar technology is also being used at France's digital technology research centre Inria to turn thought into action in the virtual world. Patients are asked to imagine they are moving their hands, which stimulates the part of the brain that commands such movements. The brain activity is detected by electrical sensors and the movements are carried out virtually.
According to the researchers, OpenVibe could in the future not only help locked-in patients, but also people in a coma. These patients are often perceived as being beyond reach in terms of communication. Mr Bertrand points out that "we always think they are not able to communicate or they are not able to understand what we are telling them, but there are some indicators now from neuroscience research that they could have a way to understand our talk. Probably their brains would be able to react to this, even though they are not able to move."
Communication between man and machine will continue to improve as scientists further their own understanding of the brain's capabilities. Neuroscience offers a glimmer of hope for patients cut off from the people nearest to them.
Source: BBC Technology
June 19, 2009
Software Program Prescribes Regimen For Jet Lag
Researchers at Brigham and Women's Hospital and the University of Michigan have developed a software program that prescribes a regimen for avoiding jet lag using timed light exposure. The method is described in an article published June 19 in the open-access journal PLoS Computational Biology.
According to the authors, jet lag, which includes trouble sleeping at night and difficulty remaining awake during the day, reflects a de-synchronization between the body's internal time clock and local environmental cues.
The program, which seeks to re-synchronize the body with its new environment, considers inputs like background light level and the number of time zones traveled. Then, based on a mathematical model, the program gives users exact times of the day when they should apply countermeasures such as bright light to intervene and reduce the effects of jet lag.
Timed light exposure is a well known synchronization method, and when used properly, this intervention can reset an individual's internal clock to align with local time. The result is more efficient sleep, a decrease in fatigue, and an increase in cognitive performance. Poorly timed light exposure can prolong the re-synchronization process.
Using their computational method, researchers simulated shifting sleep-wake schedules and the subsequent light interventions for realigning internal clocks with local time. They found that the mathematical computation resulted in quicker design of schedules and also predictions of substantial performance improvements. They were able to show that the computation provided the optimal result for timing light exposure to reduce jet lag symptoms.
"Using this computation in a prototyped software application allows a user to set a background light level and the number of time zones traveled to obtain a recommendation of when to expose a subject to bright light, such as the bright lights sometimes used to treat Seasonal Affective Disorder" said lead-author Dennis Dean. "Although this method is not yet available to the public, it has direct implications for designing schedules for jet lag, shift-work, and extreme environments, such as in space, undersea or in polar regions."
The goal of this research is to show how interventions can cut the number of days needed to adjust to a new time zone by half. The next phase of this research includes the addition of interventions such as naps, caffeine and melatonin to help the process of realigning the internal body clock while reducing decreased performance experienced during travel across time zones.
