May 29, 2009
Perspectives on Technology and Psychiatry
A couple of interesting pieces in the recent British Journal of Psychiatry. One, a book review entitled "Philosophical Perspectives on Technology and Psychiatry" and the other, correspondence that asks (is it) "Time to start taking an internet history?"
Philosophical Perspectives on Technology and Psychiatry
Edited by James Phillips.
Review: Callender The British Journal of Psychiatry.2009; 194: 573-574
(from the publishers description)
Our lives are dominated by technology. We live with and through the achievements of technology. What is true of the rest of life is of course true of medicine. Many of us owe our existence and our continued vigour to some achievement of medical technology. And what is true in a major way of general medicine is to a significant degree true of psychiatry. Prozac has long since arrived, and in its wake an ever-growing armamentarium of new psychotropics; beyond that, neuroscience promises ever more technological advances for the field.
However, the effect of technology on the field of psychiatry remains highly ambiguous. On the one hand there are the achievements, both in the science and practice of psychiatry; on the other hand technology's influence on the field threatens its identity as a humanistic practice. In this ambiguity psychiatry is not unique - major thinkers have for a long time been highly ambivalent and concerned about the technological order that now defines modern society. For the future, the danger is that the psychiatrically real becomes that which can be seen, the symptom, and especially that which can be measured. Disorders and treatments might become reduced to what can be defined by diagnostic criteria and what can be mapped out on a scale. This book exams how technology has come to influence and drive psychiatry forward, and considers at just what cost these developments have been made. It includes a range of stimulating and thought-provoking chapters from a range of psychiatrists and philosophers.
Oxford University Press
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Time to start taking an internet history?
Gary M. Cooney and Jane Morris
The British Journal of Psychiatry 2009 v. 194, p. 185.
Authors Cooney and Morris argue that our youth have increasingly turning to the internet to meet their educational, entertainment and social networking needs, and in times of emotional or psychological difficulty, they may likewise seek information online. Being able to access information, interact, and participate in fantasy, anonymously and without fear of repercussion, makes the web an obvious choice for young people who are reluctant to disclose their difficulties to parents or professionals. They point out the growing public concern over internet safety, particularly for young and vulnerable groups, who may access websites or online communities that promote suicide or self-harm and that "internet addiction" has been on the rise.
It is suggested that "eliciting a careful and sensitive internet history as part of routine psychiatric history taking may prove invaluable in assessing young people at risk of self-harm and suicide and in uncovering other aspects of psychopathology associated with excessive or unhelpful internet use. Above all, further research into the relationship between online activity and mental health among adolescents and the general population is crucial if we are to manage risks associated with internet use and also take advantage of potential benefits of new technologies."
References:
Cooney GM, Morris J. Time to start taking an internet history? Br J Psychiatry
2009; 194: 185.
Bell V. Online information, extreme communities and internet therapy: Is the
internet good for our mental health? J Ment Health 2007; 16: 445-57
May 27, 2009
To Boldly Go Where No Medical Response Has Gone Before
Sometimes science imitates science fiction. A new triage technology comes with a Star Trek twist, at the U.S. Department of Homeland Security’s Science & Technology Directorate (DHS S&T).
Even with today’s array of medical gadgets, evaluating who needs medical care at the scene of a disaster is still pretty much old-fashioned. An emergency responder bent over a victim, checks body temperature, heart rate, and muscle movement. Very much 'hands-on" and the entire process can take 3-5 minutes per person.
Because time is the most precious resource in a crisis, every second shaved can be a life-saver. With this in mind, the Science and Technology Directorate (S&T) is trying to make a revolutionary leap forward in triage. Why not 30 seconds per person? And why not from far away?
A new device resembling the medical diagnostic tool called the Tricorder from Star Trek, is being developed by the DHS S&T group in partnership with the Technical Support Working Group (TSWG), Boeing and Washington University’s School of Medicine in St. Louis. They call it the Standoff Patient Triage Tool (SPTT). Like the tricorder, SPTT takes key physiological readings necessary to any diagnosis —pulse, body temperature, respiration—from an injured person at a far distance. It’s triage at twenty paces. (actually from 5 to 40 feet away)
The magic behind SPTT is a technology known as Laser Doppler Vibrometry, which has been used in aircraft and automotive components, acoustic speakers, radar technology, and landmine detection. When connected to a camera, the vibrometer can measure the velocity and displacement of vibrating objects. An algorithm then converts those data points into measurements emergency medical responders can use in their rapid assessment of a patient’s critical medical conditions.
The goal is to develop a handheld unit about the size of a legal notebook and as a thick as a ream of paper. Achieving this will require further testing of optical stabilization technology to make sure the unit can function despite a responder’s arm and hand movements.
Besides providing accurate data, the SPTT can help overcome common human biases at an accident scene. According to the DHS S&T press release, "human nature is to pay attention to the person who is screaming and bleeding, but someone else with a less obvious internal injury may need to be the first priority. In the case of large-scale triage, it is not always the squeaky wheel that needs the grease. The SPTT may someday help first responders hear a lot more from their patients, and much more quickly."
With the help of Washington University, researchers have found that best place to capture strong readings vital signs is on the carotid artery, although strong signals have been obtained from the head, chest, abdomen, even a foot. Researchers are also testing whether readings could be taken when someone is lying in an awkward position, or wearing multiple layers of clothing. So far, the results are encouraging.
Despite its promise, the SPTT is not quite as a sophisticated as the tricorder. For instance, the tricorder was able to comprehensively diagnose obscure diseases. The standoff patient triage tool is a quantum leap forward for medical response, but the scope of science fiction remains the goal.
Press release from Department of Homeland Security’s Science & Technology Directorate
May 25, 2009
Evidence Supports Use of Technology-based Programs to Help Adults Quit Smoking
Available evidence supports the use of online or other computer-based smoking cessation programs for helping adults quit smoking, according to a meta-analysis of previously published studies appearing in the May 25 issue of Archives of Internal Medicine.
"Smoking is the single greatest cause of preventable disease and premature death," the authors write as background information in the article. Currently recommended smoking cessation strategies include individual or group counseling, medications and telephone quit-line counseling.
Faculty from the University of California, Berkeley, and the National Cancer Center, Goyang, South Korea, and colleagues identified 22 randomized controlled trials of Web- and computer-based programs published between 1989 and 2008. The trials included a total of 29,549 participants, 16,050 of whom were randomly assigned to a computer-based program and 13,499 to a control group. Ten studies used supplemental interventions—such as counseling, classroom lessons, nicotine replacement gum or patches, medication or quitlines—whereas 12 studies used Web- or computer-based programs alone.
When the results of the trials were pooled and analyzed, individuals assigned to use computer- or Web-based programs were about 1.5 times more likely to quit smoking than those assigned to control groups. Abstinence rates were higher among intervention groups than control groups after six to 10 months (11.7 percent vs. 7 percent) and 12 months (9.9 percent vs. 5.7 percent) of follow-up. The effects of these programs were similar to those of counseling interventions, the authors note.
"The stand-alone interventions had a significant effect on smoking cessation as well as on those that had supplemental interventions," the authors write. "However, compared with adults, these programs did not significantly increase the abstinence rate in adolescent populations." The findings imply that there is sufficient evidence to support the use of a Web- or computer-based smoking cessation program for adult smokers, and "as global Web users continue to increase, Web-based smoking cessation programs could become a promising new strategy that is easily accessible for smoke.
Archinves of Internal Medicine
May 21, 2009
Assets and Liabilities of Cloud Computing
A team of computer security experts at the National Institute of Standards and Technology (NIST) has released a working definition for cloud computing - a recent computer technique with potential for achieving significant cost savings and information technology agility.
The NIST cloud computing research team is studying cloud architectures, security and deployment strategies for the federal government. But its first task was to collaborate with industry and government to develop a working definition of cloud computing that will serve as a foundation for its research. The term "cloud computing" comes from the field's standard use of drawing the Internet as a cloud in diagrams.
The working definition of cloud computing described by NIST is "a pay-per-use model for enabling available, convenient and on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, services) that can be rapidly provisioned and released with minimal management effort or service provider interaction." The draft working definition also describes five key characteristics, three delivery models and four deployment models.
Since the federal government is considering cloud computing as a component of its new technology infrastructure, it is NIST's role to evaluate it and then promote its effective and secure use within government and industry by providing technical guidance and developing standards
Security is always a concern with any new computer approach, and this one is no different. According to cloud research team leader Peter Mell, "Cloud computing has both security advantages and disadvantages. The cloud computing model inherently promotes availability of services through its distributed architecture model. However, this same model presents data confidentiality and integrity challenges by pooling hardware resources for use by multiple parties."
The full working draft definition is available at http://csrc.nist.gov/groups/SNS/cloud-computing/index.html
Comments on the definition can be sent to cloud@nist.gov.
National Institute of Standards and Technology (NIST)
May 20, 2009
CCHIT releases ambulatory EHR, e-Rx criteria
The federally supported Certification Commission for Healthcare Information Technology has released its latest batch of final testing criteria for the 2009-10 certification cycle for electronic health-records systems used in ambulatory care, inpatient and emergency department environments as well as for stand-alone electronic-prescribing systems.
The commission also has released new criteria for testing add-ons to basic EHRs for use in the medical specialties of child health and cardiovascular medicine. The application dates for vendors to submit products for testing under the new criteria have not been set and testing under those new guidelines will be put on hold pending review of materials expected to be released by the Office of the National Coordinator for Health Information Technology at HHS, according to a CCHIT news release. The goal is to ensure the upcoming CCHIT testing rounds will be in conformance with the IT systems certification requirements of the American Recovery and Reinvestment Act of 2009, according to the release.
Source: CCHIT
May 14, 2009
Healthcare Technology Companies Launch National Physician Education Program on Stimulus and Electronic Health Records
"EHR Stimulus Alliance" which includes Allscripts, Cisco, Citrix, Dell, Intel, Intuit, Microsoft Corp., and Nuance, Will deliver education programs to physicians across the U.S.
Allscripts announced the formation of a coalition of technology innovation leaders who are partnering to educate 500,000 U.S. physicians about opportunities aligned with the American Recovery and Reinvestment Act (ARRA) of 2009. The Act details President Obama's plan to improve healthcare quality, safety and efficiency through the secure exchange of electronic health information and the adoption of Electronic Health Records (EHR) and associated technologies. By connecting physicians, hospitals, pharmacies, payers, public health organizations and other stakeholders across healthcare, information technologies such as the EHR can improve the management of chronic health conditions that account for about 75 percent of U.S. healthcare costs, and enhance the efficiency and effectiveness of U.S. healthcare.
Surveys indicate that, while large numbers of physicians are familiar with the basic tenets of the federal incentive program, many do not know the details, including how much money they are eligible to receive, when it will be allocated, how they can qualify, how to meet ARRA's requirements for information exchange, or the cost of implementing an Electronic Health Records. The EHR Stimulus Tour will provide the answers via executive briefings, roundtables, trade show presentations, webcasts, and local meetings bringing physicians together with Alliance experts and medical groups that have already successfully adopted Electronic Health Records.
Under the ARRA, the Centers for Medicare and Medicaid Services (CMS) will pay the incentives to physicians over five years, beginning in fiscal 2011. Physicians who have not adopted certified Electronic Health Record systems by 2014 will have their Medicare reimbursements reduced by 1 percent beginning in 2015; 2 percent in 2016; and by up to 3 percent in 2017 and thereafter. According to a Congressional Budget Office review of the law, the incentives will drive up to 90 percent of U.S. physicians to adopt Electronic Health Records in the next decade.
EHR Stimulus Page and Resource Center
Additional information on Alliance members and Press Release
May 12, 2009
Second Life Can Live Behind a Firewall
A few years ago when enterprises, governments, and educational institutions established their presence in Second Life, there was one piece of advice that we received consistently across the board, “The promise of virtual worlds is tremendous and the Second Life environment is great for some kinds of work. But, if you only had a behind the firewall solution, we could really incorporate virtual worlds into the core of our business.” Although Second Life is a safe place to work, many large enterprises and government institutions require complete control over their IT systems due to privacy and confidentiality concerns.
Acccordintg to Second Life, we’re pleased to share that the stand-alone version of Second Life solution is currently in the alpha phase. We have nine alpha installations in the field at organizations such as IBM, Naval Undersea Warfare Center (NUWC), New Media Consortium (NMC), Intel, and Northrop Grumman. And, we’re planning to go into a limited closed beta phase this summer with general availability later this year.
Source:
Thanks to BrianS's Twitter for this
May 09, 2009
IBM "Invents" 40-Minute Meetings
IBM has submitted for a patent with the US Patent Office for a 'System and Method for Enhancing Productivity.' They have come up with a way to increase productivity for organizations that hold numerous meetings a day. The invention consists of not permitting business meetings to be scheduled for a full hour during certain parts of the day. From the application, 'the observation is that if an hour were shorter, by a small amount, we would be more focused, and accomplish the same amount of work, but in less real time, thereby increasing productivity.'
The patent application states "a significant source of wasted time is the general predisposition to using integral units of time, based on hour or half hour increments. This is especially true of business meetings, which are invariably scheduled to last an hour. Meeting attendees will fill the full hour for which the meeting is scheduled regardless of whether the entire hour is necessary to address the business at hand. The result of this is that a meeting that could have taken less than an hour will end up wasting time due to the arbitrary hour-based scheduling paradigm."
Thus, 'the relatively shorter time intervals may force users in a collaborative system to exhibit greater efficiency. For example, with a relatively shorter scheduled time for a meeting, attendees of the meeting may be required to maintain greater focus in order to accomplish the goals of the meeting in the scheduled time. Similarly, the relatively shorter scheduled time may require more punctual arrival and greater preparation. For example, lateness in arriving at the meeting and lack of preparation may result in the inability to accomplish the goals of the meeting. With this knowledge, meeting attendees may make a greater effort to ensure that necessary goals can be accomplished within the relatively shorter time period scheduled for the meeting. Relatively longer time intervals may accommodate longer and/or more involved meetings.'
Sources:
May 06, 2009
Interactive Neuroanatomy Tool for iPhone
University of Pittsburgh biomedical engineering doctoral student, Richard Stoner, has put together a simple iPhone application that helps to locate and manipulate different views of the virtual 3D brain.
From the product website:
Cerebrii is an interactive neuroanatomy tool put together by a student for fellow neuroscience students and enthusiasts. Using simple controls, Cerebrii allows you to navigate through 12 functional layers of the brain and select any of the 200+ regions with a simple double-tap. A guided review mode is available to direct you through the 600+ questions ranging from simple identification to more in-depth physiologic functions. For an added challenge, the exam mode is available to test you on the information you've learned from the review. Thanks to its extensible design, the number of total questions will continue to grow with each future release of Cerebrii.
Cerebrii was inspired by Thomas Willis's Cerebri Anatome - one of classic collections in neuroanatomy history.
Anatomic regions covered:
* Cerebrum - lobes/gyri
* Cerebellum
* Midline structures
* Basal Ganglia
* Limbic System
* Cranial Nerves
* Visual System
* Ventricles
* Thalamic nuclei