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.
June 14, 2009
The Social Life of Health Information
According to a report released by the Pew Research Center’s Internet & American Life Project and the California HealthCare Foundation, 61% of adults look online for health information. Of those, 59% have done at least one of the following activities:
* Read someone else's commentary or experience about health or medical issues on an online news group, website, or blog
* Consulted rankings or reviews online of doctors or other providers
* Consulted rankings or reviews online of hospitals or other medical facilities
* Signed up to receive updates about health or medical issues
* Listened to a podcast about health or medical issues
In addition, 20% of internet users who have looked online for health information, have actively contributed comments, reviews, and updates. they have for example:
* Tagged or categorized online content about health or medical issues
* Posted comments, queries, or information about health or medical matters in an online discussion, listserv, or other online group forum
* Posted comments about health on a blog
* Posted a review online of a doctor
* Posted a review online of a hospital
* Shared photos, videos or audio files online about health or medical issues
In sum, 37% of all adults have done at least one of the above activities.
"The Social Life of Health Information," report describes not only how American adults use the internet to gather and share health information, but also how the landscape has shifted in the last decade. In 2000, 46% of American adults had access to the internet, 5% of U.S. households had broadband connections, and 25% of American adults looked online for health information. Now, 75% of American adults go online, 57% of American households have broadband connections, and 61% of adults look online for health information. Further, many adults now have wireless access to the internet.
According to the report authors, "mobile access allows people to be 'always present' to each other and that seems to draw them into conversations about health. The early internet provided e-patients online tools that enabled research. Now the mobile, social internet enables connection and conversation."
Asked to assess the quality of their online health experiences, 60% of e-patients (42% of all adults) say they or someone they know has been helped by following medical advice or health information found on the internet. This represents a significant increase from a 2006 Pew report that found 31% of e-patients (25% of all adults) said that. Just 3% of e-patients say they or someone they know has been harmed by following medical advice or health information found on the internet, a number that has remained stable since 2006.
However, Americans’ longstanding practices of consulting a health professional, a trusted friend, or a wise family member persist as patients pursue good health. When asked which sources they turn to for assistance, the internet comes in third (tied with books) behind asking a health professional and talking with friends or family members.
Source:
The Pew Research Center's Internet & American Life Project
June 09, 2009
Games In Healthcare
The Fifth Annual Games for Health Conference will be held this week in Boston, MA. The conference will focus on the ways that videogames intersect with health and healthcare. The conference was started by the Games for Health Project in 2004 to gather together researchers, developers, health professionals and related stakeholders to share ideas, demos, and research concerning the use of videogames and their related technologies for use in health and healthcare.
Games for health have existed in several forms for quite some time. Many pioneers have achieved some success and the current generation of games and game consoles has seen an explosion in active games now used for fitness and some innovative efforts in physical therapy. The field of cognitive fitness and therapy with games is also booming. Many new pieces of science and new products are now entering the market to address developments in cognitive fitness and therapy. However, like the physical exergame field, the field of cognitive fitness is also having to sort out its science, impact gaps and sustainability.
The future of games for health goes way beyond just exergames, physical therapy, and cognitive fitness. The opportunities for games for health are broad. This year’s conference features a multitude of talks on related uses of games for epidemiology, multiple sclerosis, training, public health messaging, nutrition, child development and more.
Games are now considered Health 3.0 - where the idea of information therapy moves beyond textual based relationships. One of the things that will make games in healthcare different is already being seen. It is the notion that the mere act of playing creates a behavioral change as a byproduct of their consumption. Games bring traits to Health 2.0, and can take things to the next level by potentially improving motivation, enabling deeper emotional impact, and providing visualization and social experiences.
This year at Games for Health 2009 there are four key themes:
1. The heritage of games for health with talks from early pioneers in games for health, and prior art in games that covered health themes.
2. The current impact and research behind the two biggest first movers in games for health: exergaming, and cognitive health, with tracks devoted to each segment.
3. The impact gap between the potential reach of games for health and the actual impact it is or is not having due to the current structure of the field and the games themselves.
4. The future of the field at its broadest horizons and what can be done to see success in as many areas as possible.
Health touches many parts of life. Videogames are a medium we’re just beginning to understand as being very broad based.
Games for Health Website
Press releases
Article: Why Games Matter in Healthcare
The Serious Game Initiative
June 03, 2009
Workplace Survey Examines the Reputational Risk Implications of Social Networks
According to a 2009 Deloitte Ethics & Workplace survey, 60 percent of business executives believe they have a right to know how employees portray themselves and their organizations in online social networks. However, employees disagree, as more than half (53 percent) say their social networking pages are not an employer’s concern. This fact is especially true among younger workers, with 63 percent of 18-34 year old respondents stating employers have no business monitoring their online activity.
Interestingly enough, employees appear to have a clear understanding of the risks involved in using online social networks, as 74 percent of respondents believe they make it easier to damage a company’s reputation.
According to Deloitte's press release, "with the explosive growth of online social networks, such as Facebook and Twitter, rapidly blurring the lines between professional and private lives, these virtual communities have increased the potential of reputational risk for many organizations and their brands. While the decision to post videos, pictures, thoughts, experiences and observations is personal, a single act can create far reaching ethical consequences for individuals as well as employers. Therefore, it is important for executives to be mindful of the implications of this connected world and to elevate the discussion about the risks associated with it to the highest levels of leadership."
A mere 17 percent of executives surveyed say they have programs in place to monitor and mitigate the possible reputational risks related to the use of social networks. Additionally, while less than a quarter have formal policies on the medium’s use among their people, nearly half (49 percent) of employees indicate defined guidelines will not change their behavior online.
One-third of employees surveyed never consider what their boss or customers might think before posting material online. This fact reinforces the vulnerability that brands or companies can have as a result of the increased use of social networks. Sharon Allen, chairman of the board, Deloitte LLP, suggests that "as business leaders, it is critical that we continue to foster solid values-based cultures that encourage employees to behave ethically regardless of the venue."
Source: Deliotte Press Release
Transparency Matters: 2008 Ethics & Workplace Survey Results
Overview: 20-page PDF
Leadership Counts: 2007 Ethics & Workplace Survey Results
Overview; 20-page PDF
2009 Deloitte LLP Ethics & Workplace Survey
Overview; 17-page PDF
June 01, 2009
Online Cognitive Behavioral Therapy is Effective in Treating Chronic Insomnia
A study in the journal Sleep (June 2009), describes that online cognitive behavioral therapy (CBT) for chronic insomnia significantly improves insomnia severity, sleep quality, and daytime fatigue. Online treatment also reduces erroneous beliefs about sleep and pre-sleep mental arousal.
The study describes that 81 percent of treated participants (30 of 37) reported at least mild improvement in their sleep after completing the five-week program, including 35 percent (13 of 37) who rated themselves as much or very much improved. Thirty percent of treatment group completers were receiving an additional hour of sleep at the end of the program. Those who received treatment also developed healthier attitudes about sleep and were less likely to report having an overactive mind at bedtime.
The researchers, from University of Manitoba in Winnipeg, Canada, were surprised by the significance of the results in the absence of any ongoing support from a clinician. The treatment program consisted of psychoeducation about insomnia, information concerning sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy.
According to the authors, "although each segment of the CBT program is important, the cognitive therapy module was the most positively rated. This module was designed to help individuals to develop realistic expectations about sleep and the impact of sleep on next-day functioning while teaching a variety of strategies for coping with an overactive mind and worries."
The study involved 118 adults with chronic insomnia who were referred to a teaching hospital behavioral medicine sleep clinic or who had responded to a newspaper advertisement. Those included in the study were required to have high-speed Internet access and a home computer, as well as an insomnia complaint with daytime impairment occurring more than four nights a week for six months or longer.
Participants were randomly assigned to a treatment or wait-list group; those on the wait list were informed that they would receive access to treatment once their follow-up data was received, and they were asked to refrain from treatment-seeking during the course of the study. Individuals receiving treatment engaged in online CBT from home for five weeks with no clinician interaction. The online treatment used audiovisual clips as the main teaching component, downloadable mp3 files for relaxation training and PDF files for psychoeducation and cognitive therapy. Findings were based on self-reported data gathered from a post-treatment questionnaire packet and sleep diaries.
There was a 33-percent drop-out rate, and physician-referred participants were significantly more likely to drop out than community-recruited participants. According to the authors, the rate of attrition for North American in-person psychotherapy is 22 percent.
The authors state that most individuals could potentially benefit from online CBT for chronic insomnia, as the program has been used successfully by people ranging in age from 18 to 80 years. The researchers speculate that the program might also be helpful for teenagers.
Srouce:
Eurekalert
Cognitive Behavior Therapy Institute of Manitoba