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Archive for the ‘medicine’ Category

Blood glucose peripheral for iPhone/iPod touch

Thursday, May 17th, 2012

As reviewed by Iltifat Husain, MD, in the iMedicalApps blog, the iBGStar Blood Glucose monitoring system by Sanofi US, approved for use in Europe over a year ago, recently received approval for use in the U.S. It connects to an iPhone or iPod touch and allows persons with diabetes to monitor their blood glucose (BG) levels using the accompanying test strips, and review the results using the accompanying app. Dr. Husain gives it high praise for its ease of use, wide availability and seamless integration. Also, the mobile app can be used without the peripheral for those who meticulously track their own BG levels. Finally, the app’s analytics feature allows patients to email their physicians detailed BG reports, broken down in a variety of areas, which may improve communication about, and management of, this chronic condition.

The biggest drawback is price: $99 at the online Apple Store (or local Apple Store), and $75 online or at your local Walgreens for the peripheral, and it includes 50 initial test strips. Additional strips are $65 per 50 online through Walgreens. The app is free, and the manufacturer does offer a program to reduce the cost for the strips, down to about $20.

But the real test is whether or not it helps people achieve better glycemic control. Husain points out that while some evidence exists to support the claim that mobile devices help with glycemic control, a full clinical trial is needed to test the effectiveness of this device, perhaps in comparison with other devices as well.

Are you a person with diabetes who uses this or another mobile device to track your BG levels? Does it help improve your success at glycemic control? What strengths and weaknesses does your system have? Tell us about it!

Tags: blood glucose monitoring, diabetes, glycemic control, iPhone, iPod touch
Posted in iPhone, medicine, mobile | No Comments »

Testing interpretation accuracy of ECG readings sent via cellphone camera

Wednesday, May 16th, 2012

Shortening the time from collecting data on a patient to implementing treatment could help save lives. If a cardiologist is not locally available to interpret an ECG readout, would sending an image via cellphone to another specialist work as well as reading a paper printout? As reported on the iMedicalApps blog, researchers from Basxkent University in Turkey conducted a study to “evaluate the accuracy of diagnosing abnormal 12 lead ECGs.” They compared three groups:

Cardiologists interpreting ECGs from paper
Emergency room doctor interpreting from paper, and
Cardiologist interpreting from mobile device

The first group made fewer major mistakes than the other two groups, as was expected. However, there was no statistically significant difference between the second and third groups. This suggests that “sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure,” and could be a helpful aid in cardiology consultation. In practical terms, an ER physician working in a rural or remote area could consult with a cardiologist in a larger metropolitan area, and get a faster second opinion before proceeding with treatment. And while the iMedicalApps author points out that it would, indeed, be interesting to see this repeated with higher-resolution phone cameras, this technology could be implemented now, and begin helping to save lives sooner. While telemedicine cannot be a permanent substitute for in-person care, it could save lives in an emergency.

Reference:

Bilgi, M., Gulalp, B., Erol, T., Gullu, H., Karagun, O., Altay, H., & Muderrisoglu, H. (2012). Interpretation of electrocardiogram images sent through the mobile phone multimedia messaging service. Telemed J E Health, 18(2), 126-131. doi: 10.1089/tmj.2011.0108

Tags: ECG, mobile medical technology, telecardiology, telemedicine
Posted in medicine, mobile | No Comments »

Jargon-free doctor-patient communication: Ask Me 3

Thursday, May 3rd, 2012

Beginning in medical school, healthcare professionals are trained in medical jargon that serves as a shorthand for concise communication with colleagues and coworkers about patients they serve. Practically speaking, it is a “language” all its own that physicians (with 20 years of education) not only use, but assume patients understand as well. Yet the average patient does not have this level of education, and need health information provided at a lower level, anywhere from 8th grade on down. As one physician blogger noted:

Health care professionals must become “medically bilingual,” that is, learn to speak both medical jargon and plain language. I like to ask myself, “How would I explain this to my mother?”

When a physician is explaining her/his findings and recommendations, if the patient does not understand, he/she may not even ask for clarification out of fear of appearing ignorant. While medical schools are working to train doctors to speak using everyday language, patients can take some simple steps to avoid making this mistake: ask three simple questions:

What is my main problem?
What do I need to do?
Why is it important for me to do this?

And if your physician answers in a way that is confusing or loaded with unintelligible jargon, stop her/him and ask for them to explain in simpler language.

The National Patient Safety Foundation (NPSF) created the Ask Me 3^TM patient education program “to promote communication between health care providers and patients in order to improve health outcomes.” When patients clearly understand health information and instructions, they make fewer mistakes and can better manage their own healthcare. The NPSF offers patient brochures and other reference materials, and created this video to assist in improving patient-doctor communication.

While it is important that patients ask questions, and doctors answer using understandable language, it is also important to acknowledge that the current health system does not reward physicians for taking time to speak with patients. Regulation needs to be enacted or changed so that physicians can be reimbursed by health insurance, Medicare, Medicaid and other plans for the time spent. It will likely save the system money in the long run as well.

What other steps can be taken to improve doctor-patient communication? Tell us about it!

Tags: doctor-patient communication, health literacy, patient safety
Posted in health literacy, information literacy, medicine | No Comments »

Addressing health literacy gaining traction

Thursday, April 26th, 2012

As mentioned previously, health literacy is “the ability to get information, understand it, and use information to lower risk and better health.” People “with low health literacy are more likely to report poor health, have an incomplete understanding of their health problems and treatment, and are at greater risk of hospitalization” (Pawlak, 2005). Many organizations, groups and political entities are seeking to address this issue. This weekend, Iowa will host its first health literacy conference, “Health Literacy in Iowa: Partnering to Change Research into Action” (Villanueva-Whitman, 2012).

Looking for resources to improve health literacy and communication at your medical practice? The Health Literacy section of the AMA’s website toolkits, patient safety tip cards, and other resources to assist providers. Also, the Agency for Healthcare and Research Quality (AHRQ) of the U.S. Department of Health and Human Services has resources for addressing health literacy and cultural competency.

What tools have you found helpful in improving patient health literacy? Tell us about it!

Reference:

Pawlak, R. (2005). Economic considerations of health literacy. Nurs Econ, 23(4), 173-180, 147.

Villanueva-Whitman, E. (2012). Communication is key to better health care Retrieved April 26, 2012, from http://www.DesMoinesRegister.com/article/20120410/LIFE/304100053

Tags: conferences, health literacy, resources, toolkits
Posted in health information, health literacy, medicine | No Comments »

Doctor’s Toolbag: an evidence based clinical decision support app

Wednesday, April 25th, 2012

As reviewed recently in iMedicalApps, the BMJ Group has created The Doctor’s Toolbag, an iPhone app designed to assist doctors in following clinical prediction rules for diagnosis and prognosis. contains information on 74 common clinical prediction tools, along with evidence summaries for each tool with links to the relevant literature. It can be customized to provide one-click access to your most-frequently used tools, and has an adjustable font size to make reading easier on the iPhone’s small screen. It costs $6.99, plus an update subscription of $14.99 for one year.

Do you use an app or other software to assist in making clinical decisions? What do you like and dislike about it? Tell us!

Tags: clinical decision support app, medical mobile apps, mobile medical apps
Posted in medicine, mobile | No Comments »

Breast cancer online decision tool

Tuesday, April 24th, 2012

According to JAMA, a women’s lifetime risk of contracting breast cancer is 1 in 8, and the presence of a particular mutation “in breast cancer susceptibility gene 1 or 2 (BRCA1/2) significantly increases the risk of breast and ovarian cancer.” The Cancer Institute at Stanford has developed an online tool for helping women with this genetic mutation evaluate her risks and benefits for different interventions. It is not intended to replace proper medical care, but instead to “inform discussion between providers and patients about options for reducing cancer risk.”

When talking about cancer or any other life-threatening medical condition, numbers about risk, results, etc. can begin to blur for any patient. Having a tool like this to provide a clear visualization can help any woman and her doctor think through medical decisions more carefully. The website does note that the calculations this tool is based on ” calculations result from a computer simulation model, not a clinical trial.” Long-term validation studies of this tool are needed to confirm its accuracy.

But a woman facing important decisions about breast cancer risk and prevention needs the best information available now, and this tool appears to be a good way to help visualize the risks and benefits of treatment options and timing, in consultation with a physician. And being online, rather than in print, it is free and immediately available. Kudos to Standford for developing this important resource!

Tags: absolute risk, BRCA, breast cancer, gene mutation, online decision tool
Posted in health information, medicine | 1 Comment »

Catching up: a few select article of note

Monday, April 23rd, 2012

This past week a number of articles worth noting have been posted, and rather than devote an entire post to each one, I will offer a summary and encourage readers to visit ones that interest them.

First, the Center for Health Literacy Promotion Blog has a great story about “Esther,” a woman in the 1830′s whom the author calls “ahead of her time.” Too sick a 21 to help on the family farm or marry, she became a servant in a convent. When she became too sick to work there, she was sent home, where she founded a school, taught others to be teachers (who then started other schools), and broke social norms of the time to teach boys and girls together. At age 40, she and her teachers were recognized by the Catholic Church, becoming the Order of the Sisters of Saint Anne. While it may seem far afield to mention religious education in this context, closing words from the post make it a bit more relevant:

Aunt Esther was born two hundred years ahead of her time. Today her vision of literacy as the foundation for health, an escape route from poverty and the key to the advancement of women and society is an idea whose time has come. She inspires my work at the intersection of health and literacy.

The second item worth noting is a wiki created by researchers at the University of Michigan that is a catalog of more than 100 medical devices and technologies that can be used in poorer areas of the world. Example include:

Pedal-powered nebulizer for asthma treatments
Using a hand-cranked salad spinner as a centrifuge for blood samples
Small, wax-filled sleeping bags that could be used to keep premature babies warm

Finally, an article in the Wall Street Journal asks some challenging questions about mobile devices and the future of medicine. In short, with all of the add-ons that are being created for smartphones, how will this transform the practice of medicine? The author offers these examples:

You can get an add-on to a smartphone which does eye refraction and then texts [the prescription] to get your glasses made. If you’re an optometrist, you might be worried about that. Or you can get your skin lesion scanned and get a text back quickly that there’s nothing to worry about. If you’re a dermatologist, that’s a big part of your practice. You will be able to take a DNA sequence on a USB port and pop it into your smartphone and get data out of it. It just goes on and on.

For patients that live a distance from a specialist in one area of medicine or another, online appointments could be used to maintain communication and improve patient outcomes. And many yet-to-be-invented uses of technology will radically alter how medicine is practiced. Yet medicine, as a profession, is slow to change. Will technology change that, or will it leave traditional medicine behind?

What do you think of these different stories and what they have to offer? Tell us!

Tags: health care for the poor, health literacy, inexpensive medical technology, mobile medical technology, story, wiki
Posted in general interest, information literacy, medicine, technology | No Comments »

University of Chicago Hospital iPad program appears highly successful

Wednesday, March 28th, 2012

According to a recent post on iMedicalApps:

Recently, physicians at the University of Chicago published a research letter in the Archives of Internal Medicine detailing their experience with the routine use of iPads by internal medicine residents during their regular duties.

What they documented was that use of the mobile device was objectively associated with faster order entry after patient admission and the subjective assessment that it saves up to one hour per day for each resident.

Prior to initiating the program, investigators wisely met with hospital IT to determine their concerns and set up rules for usage of the devices. After initially having residents individually install apps via their own iTunes accounts, it was decided to work through a third-party vendor to standardize the devices — in this case, working with a company called Mobile Iron. Additional security protections included an eight-digit alphanumeric screen lock code (instead of the standard four-digit numeric code), and setting the iPads to automatically erase themselves after five unsuccessful attempts to log-in.

A great deal of interest has been generated since the research letter was published, and the authors plan to share what they’ve learned at conferences and workshops. In addition, the local ABC Television station did a segment on this event, which you can see below.

Have you used an iPad or other tablet computer in a medical setting? How did it work for you? Tell us about it!

Tags: iPad, mobile medical computing, research, University of Chicago
Posted in medicine, technology | 2 Comments »

Helping young cancer patients cope: Re-Mission video game

Tuesday, March 27th, 2012

As reported in the iMedicalApps blog, the non-profit organization HopeLab has created a video game with the goal of helping young people cope with the daily regimen required to fight cancer. Re-Mission features a nanobot (microscopic robot) named Roxxi that “travels through the bodies of patients with different kinds of cancer and battles the disease itself as well as treatment side effects” (from iMedicalApps).

The challenges faced by young people with various forms of cancer are difficult, to say the least: taking a variety of medications such as antibiotics, antiemetics, stool softeners, plus eating healthy when peers and the culture surrounding them are enjoying copious amounts of junk food. Roxxi the nanobot powers-up by following a real-life cancer regimen, and then she sets off to battle cancer.

Does this virtual-ly active role in battling cancer translate into increased motivation and empowerment for the young person playing it? According to a 2008 randomized control trial published in the journal Pediatrics, this video game intervention “significantly improved treatment adherence and indicators of cancer-related self-efficacy and knowledge in adolescents and young adults who were undergoing cancer therapy.”

For those who enjoy them, video games provide hours of satisfying play and escape from day-to-day challenges. A recent study examining the brain activity of patients who played this game provides a glimmer of how it translates into better adherence to the regimen necessary to battle cancer. Using functional magnetic resonance imaging technology to observe the reward circuits in their brains, 57 patients were assigned to either play or watch the Re-Mission video game. The result, as reported in a press release:

“Active involvement in video game play sparks positive motivation in a way that watching and hearing information does not,” said Steve Cole, Ph.D., Vice President of Research and Development at HopeLab, professor of medicine at the University of California, Los Angeles, and co-author of the article. “All participants in the study received the same information. It was the active participation in gameplay that made the big difference in motivation. This study helps refine our ‘recipe for success’ in harnessing the power of play in the service of health.”

Many libraries have embraced gaming as a way to connect to patrons. Imagine a library with a collection of video games with the artistry of the biggest sellers that promoted healthy living, and help young people cope with life’s challenges. Such an image gives this librarian hope that we might begin reversing the epidemics of obesity and other preventable diseases in this country.

Have you or someone you know played Re-Mission? What other health-inspiring video games would you like to see? Tell us about it!

Tags: cancer, childhood cancer, HopeLab, positive motivation, Re-MIssion, regimen, reward circuits in the brain, video games
Posted in medicine, research, technology | No Comments »