Archive for month: August, 2020

SpiroCall enables patients to measure lung function over a phone call. It is designed to work with any type of phone around the world, not just smartphones.
Most people in the developing world who have asthma, cystic fibrosis or other chronic lung diseases have no way to measure how well their lungs are functioning outside of a clinic or doctor visit. But many do have access to a phone, though it may be a 10-year-old flip phone or a communal village landline instead of the latest app-driven smartphone.
That’s why University of Washington computer science and engineering and electrical engineering researchers have developed SpiroCall, a new health sensing tool that can accurately measure lung function over a simple phone call.
A paper to be presented shows that SpiroCall’s results came within 6.2 percent of results from clinical spirometers used in hospitals and doctor’s offices, meaning it meets the medical community’s standards for accuracy.
‘We wanted to be able to measure lung function on any type of phone you might encounter around the world – smartphones, dumb phones, landlines, pay phones,’ said Shwetak Patel, Washington Research Foundation endowed professor of computer science & engineering and electrical engineering at the UW. ‘With SpiroCall, you can call a 1-800 number, blow into the phone and use the telephone network to test your lung function.’
In 2012, researchers from the UW’s UbiComp Lab introduced SpiroSmart – which lets people monitor their lung function by blowing into their smartphones.
The patients take a deep breath in and exhale as hard and fast as they can until they can’t exhale any more. The phone’s microphone senses sound and pressure from that exhalation and sends the data to a central server, which uses machine learning algorithms to convert the data into standard measurements of lung function.

University of Washington http://tinyurl.com/hgpmr2u

Agfa HealthCare has joined the Watson Health medical imaging collaborative, a global initiative comprised of more than fifteen leading health systems, academic medical centres, ambulatory radiology providers and imaging technology companies. The collaborative aims to bring cognitive imaging into daily practice to help doctors address breast, lung, and other cancers; diabetes; eye health; brain disease; and heart disease and related conditions, such as stroke.
Members of the collaborative plan to put Watson to work to extract insights from previously invisible’ unstructured imaging data and combine that with a broad variety of data from other sources. In doing so, the efforts may help physicians make personalized care decisions relevant to a specific patient while building a body of knowledge to benefit broader patient populations. This information may include data from electronic health records, radiology and pathology reports, lab results, doctors’ progress notes, medical journals, clinical care guidelines and published outcomes studies.
Initial plans include training Watson and evaluating potential new offerings in a variety of patient care environments ranging from stand-alone ambulatory settings to integrated health delivery networks. The aim in doing so is to gather data based on diverse real-world experience and to share findings to inform how the medical community might reduce operational and financial inefficiencies, improve physician workflows, and adopt a patient-focused approach to improving patient care and outcomes.
‘With an ability to draw insights from massive volumes of integrated structured and unstructured data sources, cognitive computing could transform how clinicians diagnose, treat and monitor patients,’ said Anne Le Grand, vice president of Imaging for Watson Health. ‘Through IBMs medical imaging collaborative, Watson may create opportunities for radiologists to extract greater insights and value from imaging data while better managing costs.’
James Jay, Vice President Imaging IT and Integrated Care Solutions businesses at Agfa HealthCare, elaborates: ‘We are very excited about the opportunity to collaborate with IBM and Watson. Healthcare systems are under enormous pressure to improve productivity; our combined expertise has the capability to harness the untapped power of technology to deliver the gains that have so far only been achieved in isolated use cases. Together we will look for ways to advance our customers’ ability to leverage the analytics power of Watson united with our own Enterprise Imaging platform, to assure that the right knowledge is available, at the right time, to help diagnose and treat their patients. We will be diving into specific use cases to turn the power of big data into real, tangible applications focused on specific improvements in either speed or accuracy of decisions.’
Watson is the first commercially available cognitive computing capability representing a new era in computing. The system, delivered through the cloud, analyses high volumes of data, understands complex questions posed in natural language, and proposes evidence-based answers. Watson continuously learns, gaining in value and knowledge over time, from previous interactions. In April 2015, the company launched IBM Watson Health and the Watson Health Cloud platform. The new unit will help improve the ability of doctors, researchers and insurers to innovate by surfacing insights from the massive amount of personal health data being created and shared daily. The Watson Health Cloud allows this information to be de-identified, shared and combined with a dynamic and constantly growing aggregated view of clinical, research and social health data.

http://tinyurl.com/hxnrlns

Surgical teams from the UK-based charity Healing Little Hearts are using the NanoMaxx point-of-care ultrasound to help accelerate recoveries and improve outcomes for pediatric patients with congenital heart defects. Healing Little Hearts provides life-saving heart operations to babies and children across India who would not otherwise have access to treatment, as well as helping to develop local pediatric surgical programmes. Dr Sanaulla Syed, a pediatric cardiac anesthetist with the charity, commented: ‘Obtaining vascular access in small children can be difficult, and the availability of point of care ultrasound systems has revolutionized this practice. As the technology has improved, this has led to other applications, and we now use ultrasound for a range of diagnostic applications before, during and after cardiac surgery. Ultrasound-guided regional anesthesia – specifically bilateral paravertebral blocks – can also significantly reduce the amount of opiates required for surgery, considerably shortening post-operative recovery times and offering improved analgesia.’

www.sonosite.com

The microbiome of patients admitted to the intensive care unit (ICU) at a hospital differs dramatically from that of healthy patients, according to a new study. Researchers analysing microbial taxa in ICU patients’ guts, mouth and skin reported finding dysbiosis, or a bacterial imbalance, that worsened during a patient’s stay in the hospital. Compared to healthy people, ICU patients had depleted populations of commensal, health-promoting microbes and higher counts of bacterial taxa with pathogenic strains – leaving patients vulnerable to hospital-acquired infections that may lead to sepsis, organ failure and potentially death.
What makes a gut microbiome healthy or not remains poorly defined in the field. Nonetheless, researchers suspect that critical illness requiring a stay in the ICU is associated with the loss of bacteria that help keep a person healthy. The new study, which prospectively monitored and tracked changes in bacterial makeup, delivers evidence for that hypothesis.
‘The results were what we feared them to be,’ says study leader Paul Wischmeyer, an anesthesiologist at the University of Colorado School of Medicine. ‘We saw a massive depletion of normal, health-promoting species.’
Wischmeyer notes that treatments used in the ICU – including courses of powerful antibiotics, medicines to sustain blood pressure, and lack of nutrition – can reduce the population of known healthy bacteria. An understanding of how those changes affect patient outcomes could guide the development of targeted interventions to restore bacterial balance, which in turn could reduce the risk of infection by dangerous pathogens.
Previous studies have tracked microbiome changes in individual or small numbers of critically ill patients, but Wischmeyer and his collaborators analysed skin, stool, and oral samples from 115 ICU patients across four hospitals in the United States and Canada. They analysed bacterial populations in the samples twice – once 48 hours after admission, and again after 10 days in the ICU (or when the patient was discharged). They also recorded what the patients ate, what treatments patients received, and what infections patients incurred.
The researchers compared their data to data collected from a healthy subset of people who participated in the American Gut project dataset. (American Gut is a crowd-sourced project aimed at characterizing the human microbiome by the Rob Knight Lab at the University of California San Diego.) They reported that samples from ICU patients showed lower levels of Firmicutes and Bacteroidetes bacteria, two of the largest groups of microbes in the gut, and higher abundances of Proteobacteria, which include many pathogens.
Wischmeyer was surprised by how quickly the microbiome changed in the patients. ‘We saw the rapid rise of organisms clearly associated with disease,’ he says. ‘In some cases, those organisms became 95 percent of the entire gut flora – all made up of one pathogenic taxa – within days of admission to the ICU. That was really striking.’ Notably, the researchers reported that some of the patient microbiomes, even at the time of admission, resembled the microbiomes of corpses. ‘That happened in more people than we would like to have seen,’ he says.
American Society of Microbiology http://tinyurl.com/hz98ug9

Over sedation among critically ill adult patients in intensive care units has been shown to be associated with longer duration of ventilation, longer hospital stay and adverse patient outcomes, such as withdrawal and delirium. Daily sedation holds have been shown to mitigate many of these problems. However, the evidence in the critically ill pediatric population is not well established. Vet et al. have conducted a multicentre randomized control trial among intensive care units in the Netherlands comparing protocolized sedation (PS) to protocolized sedation with daily sedation interruptions (PS+ DSI).
There was no difference between groups in ventilator-free days. The cumulative drug doses did not significantly differ between the two groups. The need for intermittent bolus administration in the DSI + PS group counterbalanced the reduction in continuous sedation. The essence of DSI is to minimize sedation use. The authors argue that protocolized management in control arm may have minimized sedation such that it negated any potential beneficial effect in the treatment arm. However, not all studies demonstrate a benefit in protocolized sedation practice. Furthermore, the expected mean number of ventilator-free days in the sample size calculation was lower than observed in the study, likely due to the selection of relatively more stable patients.
The authors also discuss the increased mortality among the treatment group. This is most likely to represent a type 1 error. No explanation for the increased deaths was found by independent review, and similar studies do not demonstrate a similar finding. Furthermore, the authors claim that the ‘timeframe between active participation in the study and death makes a causal relationship unlikely’.
In the PS group, there were significantly more re-intubations compared to the PS +DSI group (9 vs. 2, p = 0.03). The authors suggest that patients in the DSI + PS group were possibly more alert and therefore extubation may have been more successful. However, relatively small numbers make it difficult to be certain.
There are two previous studies of DSI in pediatric populations. Both show shorter durations of mechanical ventilation, shorter ICU stays and less use of sedatives. However, protocolized sedation was not used in the control arm of one study and the primary pathology among patients in the other study was very different (with a predominance of neurological as opposed to respiratory illness).
It is difficult to draw any firm conclusions from this study based on the small number of patients enrolled. However, it raises a number of important issues, including the difficulty in recruiting patients in pediatric ICU studies. A pragmatic protocol, which may allow a greater proportion of screened patients to be enrolled, may benefit future studies.

European Society of Intensive Care Medicine http://tinyurl.com/hsajzzt