SCIENTISTS have made fresh in roads in the use of electronic gadgets
to improve health care services with a new application that turns any
smart-phone into portable medical diagnostic device, small wireless
pacemaker that is save and effective in early testing, and electronic
medication alerts designed with provider in mind that reduces
prescribing errors.
A pacemaker is a small device that’s placed in the chest or abdomen to help control abnormal heart rhythms.
Indeed, a recently developed mobile phone application could make monitoring conditions such as diabetes, kidney disease, and urinary tract infections much clearer and easier for both patients and doctors, and could eventually be used to slow or limit the spread of pandemics in the developing world.
The app, developed by researchers at the University of Cambridge, accurately measures colour-based, or colorimetric, tests for use in home, clinical or remote settings, and enables the transmission of medical data from patients directly to health professionals.
Also, according to a small study in the American Heart Association journal Circulation, a new small, wireless self-contained pacemaker appears safe and feasible for use in patients.
Lead author of the study and director of the Cardiac Arrhythmia Service at Mount Sinai Hospital in New York City, United States, said Dr. Vivek Y. Reddy, said: Although traditional pacemakers pose minimal risk, patients are still vulnerable to some short- or long-term complications.”
Those complications can stem from the pulse generator implanted under the skin of the chest, where infections or skin breakdown can occur, and particularly from the leads, or wires, that run from the generator through a vein to the heart. Leads can break, dislodge or contribute to a vein blockage.
However, the new pacemaker has no leads- its pulse generator lies within the unit in the heart – and is placed without the need for surgery.
At six millimeters in diameter and about 42 millimeters long, the wireless device is smaller than a triple-A battery. It is faster and easier to implant than traditional pacemakers, Reddy said, and it’s programmed and monitored similarly.
According to a study published online in the Journal of the American Medical Informatics Association, changing how medication alerts are presented in electronic medical records resulted in safer prescribing, increased efficiency and reduced workload for health care providers who placed drug orders.
A human factors engineer, Dr. Alissa L. Russ, who led the study said: “The VA electronic medical record system is one of the most widely used and respected EMR systems in the country. This EMR is used by providers at over 150 VA hospitals. We are looking at ways to improve the alert system for these providers and for patient care.”
Russ is a Richard Roudebush Veterans Affairs Medical Center research scientist, a Regenstrief Institute investigator and an adjunct assistant professor with the Purdue College of Pharmacy.
In this simulation study, investigators used knowledge from other industries and applications, such as the design of road signs and medication warning labels, to redesign medication alerts, such as drug allergy and drug-drug interaction warnings. Several changes were incorporated, including the use of concise language and a table-like format to help providers scan for information quickly.
Indeed, the decentralization of healthcare through low-cost and highly portable point-of-care diagnostics has the potential to revolutionize current limitations in patient screening. However, diagnosis can be hindered by inadequate infrastructure and shortages in skilled healthcare workers, particularly in the developing world.
Overcoming such challenges by developing accessible diagnostics could reduce the burden of disease on health care workers.
Due to their portability, compact size and ease of use, colorimetric tests are widely used for medical monitoring, drug testing and environmental analysis in a range of different settings throughout the world. The tests, typically in the form of small strips, work by producing color change in a solution: the intensity of the colour, which is produced determines the concentration of that solution.
Especially when used in a home or remote setting however, these tests can be difficult to read accurately. False readings are very common, which can result in erroneous diagnosis or treatment. Specialized laboratory equipment such as spectrophotometers or test-specific readers can be used to automate the readouts with high sensitivity, however these are costly and bulky.
The new app, Colorimetrix, makes accurate reading of colorimetric tests much easier, using nothing more than a mobile phone. The app uses the phone’s camera and an algorithm to convert data from colorimetric tests into a numerical concentration value on the phone’s screen within a few seconds.
After testing urine, saliva or other bodily fluid with a colorimetric test, the user simply takes a picture of the test with their phone’s camera. The app analyses the colors of the test, compares them with a pre-recorded calibration, and displays a numerical result on the phone’s screen. The result can then be stored, sent to a healthcare professional, or directly analyzed by the phone for diagnosis.
The app can be used in home, clinical, or resource-limited settings, and is available for both Android and iOS operating systems. It has been shown to accurately report glucose, protein and pH concentrations from commercially-available urine test strips without requiring any external hardware, the first time that a mobile phone app has been used in this way in a laboratory setting. Details were recently published in the journal Sensors and Actuators B: Chemical.
Beyond laboratory applications, the app could also be used by patients to monitor chronic conditions such as diabetes, or as a public health tool, by enabling the transmission of medical data to health professionals in real time.
“This app has the potential to help in the fight against HIV, tuberculosis and malaria in the developing world, bringing the concept of mobile healthcare to reality,” said Ali Yetisen, a PhD student in the Department of Chemical Engineering & Biotechnology, who led the research. “By quickly getting medical data from the field to doctors or centralized laboratories, it may help slow or limit the spread of pandemics.”
In addition to medical applications, the researchers are planning to publicly release the app so that it can be used for other colorimetric tests such as laboratory kits, veterinary diagnostics and environmental screening tools.
“This app can substitute for laboratory equipment, saving money to clinics and research institutions,” said Dr Leo Martinez, who developed the app.
The team is planning to use the app for clinical testing of kidney function and infections in clinical testing at Addenbrooke’s Hospital.
The app is the result of a collaboration between researchers from the Department of Chemical Engineering & Biotechnology, and the Department of Engineering.
The app is currently available for research purposes via the website: www.colorimetrix.com.
Reddy said: “While a much larger study is required to prove this, one may expect the leadless pacemaker to be associated with less chance of infection and lead-related problems such as lead fracture. Overall, the self-contained pacemaker is a paradigm shift in cardiac pacing.”
The study, called LEADLESS, was conducted in 33 Caucasian patients, average age 77, two-thirds men, at two hospitals in Prague and one in Amsterdam. The self-contained pacemaker was successfully implanted in 32 patients, or 97 percent. Ninety-four percent were free of complications through the three-month study period, the researchers reported.
The new device is a self-modulating pacer guided into place using a catheter inserted in the femoral vein and is affixed to the heart in the right ventricle, the same place a standard lead would be located. The device is for patients who require single-chamber pacing, or roughly 20 percent to 30 percent of U.S. and European patients who need pacemakers. Patients who need dual-chamber pacing would still require traditional pacemakers, according to Reddy.
Among the study’s 33 patients, one suffered complications during the procedure and underwent emergency surgery but later died after suffering a stroke.
After three months, the new pacemakers were functioning well, the researchers found. They are continuing to track the patients and expect to report longer-term outcomes later this year. Meanwhile, Reddy said, a much larger study at multiple U.S. locations that will include longer-term follow-up is under way.
Meanwhile, some of the redesigned alerts also presented more detail, such as a patient’s previous symptoms and lab results, so providers did not have to search for this information elsewhere in the patient’s electronic medical record. In addition to adopting safer prescribing practices, doctors, nurse practitioners and clinical pharmacists reported higher satisfaction with the redesigned display and the quality of the information presented.
These types of design changes can help providers pay attention to alerts and may reduce some aspects of alert fatigue, according to Russ.
The investigators used methods developed in human factors engineering to study the alerts and found that prescribers who participated in the simulation sometimes inadvertently canceled a medication when they thought they were ordering it- or, vice versa, unintentionally ordered a drug, depending on the alert design. These findings have not previously been reported for medication alerts. All patients in the study were fictitious, allowing researchers to safely test the design changes.
The study authors noted that good alert design may offer better cognitive support during busy patient encounters and may help providers extract information quickly, while a poor design may cause prescribers to prematurely dismiss alerts. They also found that repeating alerts in the same ordering session for a given patient did not substantially reduce prescribing errors.