Clinicians Archives - InnoHEALTH magazine

Artificial Intelligence Coming Big Way in Healthcare Sector

InnoHEALTH Magazine — Mon, 19 Nov 2018 10:13:51 +0000

Brig Arvind Lal, CMD of Dr Lal Path Labs, is a pioneer in bringing laboratory services in India at par with the western world. In 1977, he took charge of the medical diagnostics laboratory founded in 1949 by his late father. Under his expert guidance and leadership, the initiative has become one of the most reputed laboratories in Asia, having to its credit quality accreditations from various national and international bodies.

The critical care environment has undergone significant alterations in the past several years. This has happened because our lifestyles in the fast-paced lives of modern India are ensuring that most people, in the age group of 30-50 years are falling prey to life-threatening cardiac diseases and strokes, in addition to diabetes, hypertension, cancers, liver, kidney and lung diseases – these diseases being called Non-Communicable Diseases or NCDs. They are now responsible for killing more than 65% of our population says Dr Arvind Lal, known for his diagnostic labs across the country.

Flagging concerns on such trends, these patients need high-cost intensive care, be it for complications of heart attacks, strokes, diabetes, hypertension, cancer or lung diseases. This is where the importance of Point-of-care testing (POCT) comes in. It helps in almost diagnosing the patient instantly and improves the physician’s ability to take immediate corrective action and decreases hospital stay. One such test is Troponin – that has revolutionized cardiac care by diagnosing heart attacks or myocardial infarction.

This article is based on the keynote address on the occasion of 2nd Annual International InnoHEALTH Conference 2017 – ‘Transforming Healthcare Through Innovation’ in New Delhi, said there are numerous promising diagnostic technologies. The key message is that in a country where 70% of the population lives in rural surroundings, ‘it is our duty to rapidly adopt disruptive innovative affordable technologies including telemedicine. Thus, our underserved population would be able to avail of the best treatment possible and bring in massive visible change’. He said the importance of bringing quality healthcare needs no reminder and the time has come for India to change the direction of healthcare for the masses.

Healthcare is a right – and access to good healthcare should not depend on where one lives and how much he or she earns. But sadly, that is exactly what plagues India’s healthcare today, he lamented. India faces a severe shortage of both hard infrastructure and talent. With about one doctor and one functional bed per 1000 population, healthcare is truly underserved in India. Add to this the regional imbalances and variations in healthcare delivery. The healthcare infrastructure is skewed towards urban over rural India.

Although rural India accounts for about 70% of the population, it has less than one-third of the nation’s hospitals, doctors and beds, resulting in large disparities in health outcomes across urban and rural India. British Medical Journal (BMJ) has observed that there is a remarkable saving of lives in India if good healthcare facilities consisting of operation theatres, surgeons, anaesthetists, blood banks are available within 50 kilometres of the patient providing quality medical services within the ‘golden hour’.

Though there has been a sea change in the last five decades, India now needs to reinvent the field of diagnostics as laboratory tests are responsible for 70% of all clinical or medical decisions.

In today’s life where internet rules the roost, the patients have become very knowledgeable, thanks to the globalisation of healthcare, and are demanding very high-quality healthcare for themselves. They are insisting on a very wholesome and satisfying experience rather than being told that the ‘treatment is over’.

Soon, a time will come when the tests shall be ordered by the patients based on clinical history and clinical findings that shall be answered by an Artificial Intelligence (AI) application. Artificial intelligence has already found several areas in healthcare from the design of treatment plans to assist in repetitive jobs to medication management and drug designing. The most obvious application of artificial intelligence in healthcare is data management. Collecting it, storing it, normalizing it, tracing its lineage – it may well be the first step in revolutionizing the existing healthcare systems.

Recently, the AI research branch of the search giant, Google, launched its Google Deepmind Health project, which is used to mine the data of medical records in order to provide better and faster health services. The project is in its initial phase, and at present, they are working with Moorfields Eye Hospital of NHS Foundation Trust, UK to improve eye treatment.

Just a few years ago the patient after giving the sample used to come back in the evening to the lab to collect a physical copy of the test report. This was replaced by making the report available on the internet that could be downloaded by the patient in the comfort of his home. These days this has been further replaced by making available an App on his mobile phone wherein he can book an appointment for the sample to be collected at home and the report being later available on the same mobile App.

‘IBM Watson, whose headquarters I had the privilege of visiting a few months back in the Silicon Valley, is an AI-based engine that has launched its special program for oncologists to provide clinicians evidence-based treatment options. The program has an advanced ability to analyze the meaning and context of structured and unstructured data in clinical notes and reports in its encyclopedic memory that may be critical to selecting a treatment pathway’. IBM launched another algorithm called Medical Sieve. It is an ambitious long-term exploratory project to build a next-generation ‘cognitive health assistant’ that is able to analyze radiology images to spot and detect abnormalities faster and more reliably. This shall help radiologists in the future to look at the most complicated cases where human supervision is essential.

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‘Wearable Tech is another area which I am personally very excited about. It has the potential to change the world as it helps people understand their own bodies by using mass data collected on a daily basis. From fitness bands to smartwatches to eye based wearables, they are being adopted widely. Take the case of Zephyr’s Anywhere Bio Patch which is an FDA-approved, small device that is attached to a patient’s chest and monitors their vitals minute-by-minute and collects medical-grade data for doctors’ use. These devices will connect our organs digitally, enabling disease detection at very early stages. It has the potential to bring down cardiac and other deaths drastically. This offers immense potential to do remote testing, monitoring and thus assisting the doctor in timely treatment’.

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Point of Care Testing: Technological advancements in laboratory automation, including POCT, and initiatives to increase patient satisfaction are transforming the clinical laboratory market. POCT has come a long way from a handful of simple tests to a multibillion-dollar global market that holds great promise for the future. Not so long ago, laboratory data would often arrive at the bedside too late to be of significant use in the active, continuing care of critically ill patients. Now, most clinicians acknowledge that POCT is a prerequisite for early recognition of life-threatening conditions as they require that laboratory results are made available in real-time and, if possible, at the critically ill patient’s point of care. The College of American Pathologists defines POCT as tests designed to be used at or near the site where the patient is located, that do not require permanent dedicated space, and that are performed outside the physical facilities of the clinical laboratories.

Examples include kits and instruments that are hand-carried or transported to the vicinity of the patient for immediate testing at that site (e.g. capillary blood glucose) or analytical instruments that are temporarily brought to a patient care location (like operating room, intensive care unit). In many cases, the simplicity was not achievable until technologies developed that was simple and affordable. For example, various kinds of urine test strips have been available for decades, but portable ultrasonography did not reach the stage of being advanced, affordable and widespread until recently. Similarly, pulse oximetry can test arterial oxygen saturation in a quick, simple, non-invasive, affordable way today, but in earlier eras, this required an intra-arterial needle puncture and a laboratory test. Thus, over decades, testing continues to move toward the point of care.

The lab-on-a-chip (LOC) is another device that integrates one or several laboratory functions on a single integrated circuit (commonly called a “chip”) of only a few square centimetres to achieve automation and high throughput screening. Imagine that a patient comes to one of our 2,100 collection centres in the remote tier three or tier four towns in India with the high fever. We take a drop of blood from his finger and inform the clinician almost immediately that the patient is suffering from Chikungunya and not from Malaria or Typhoid, or Dengue fever or Japanese Encephalitis – all in a matter of minutes! The driving notion behind POCT is to bring the test conveniently and immediately to the patient. Needless to add, the patient’s data by POCT shall be made available to update the patient’s electronic health records (EHR).

Talking about POCT Instruments: Currently, two broad type of POCT instruments are available: Small benchtop analyzers (for example, blood gas and electrolyte systems) and handheld, single-use devices (such as urine albumin, blood glucose, and coagulation tests). Now let us talk about if POCT is Boon or Bane? The strong point of POCT is speed and the rapidity with which it shall save lives in emergencies. As India marches towards quality healthcare delivery, in course of time regulatory compliances shall have to be adhered to in the interest of the patient’s health.

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Stressful events can increase women's obesity

InnoHEALTH Magazine — Tue, 03 Apr 2018 08:33:59 +0000

Women who experienced one or more traumatic lifetime events or several negative events in recent years had higher odds of being obese than women who didn’t report such stress, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians.

“Little is known about how negative and traumatic life events affect obesity in women. We know that stress affects behaviour, including whether people under- or overeat, as well as neuro-hormonal activity by in part increasing cortisol production, which is related to weight gain,” said study senior author Michelle A. Albert, M.D., M.P.H., professor of medicine, cardiology, and founding director of the Center for the Study of Adversity and Cardiovascular Disease, at University of California, San Francisco.

Obesity, a preventable risk factor for cardiovascular and other diseases, impacts more than one-third of U.S. adults. According to the American Heart Association, nearly 70 percent of American adults are either overweight or obese. Women tend to live longer than men, putting especially obese, aging women at greater risk for disease, said study author Eva M. Durazo, Ph.D., a post-doctoral scholar at the NURTURE Center, Division of Cardiology, and UCSF said.

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The researchers studied the relationship between major life events and obesity in a group of 21,904 middle-aged and older women, focusing on women with the highest obesity prevalence. They defined obesity as having a body mass index (BMI) of 30 kg/m2 or higher. And, they measured the impacts of two types of stress: traumatic events, which could occur anytime in a woman’s life and includes events as death of a child or being a victim of a serious physical attack, as well as negative life events that had occurred in the previous five years of a woman’s life. Negative events included wanting employment but being unemployed for longer than three months or being burglarized.

Sleep deprivation may increase risk of cardiovascular disease in older women Older women who don’t get enough sleep were more likely to have poor cardiovascular health, according to preliminary research presented at the American Heart Association’s Scientific Sessions 2017. In the new study researchers considered sleeping at least two hours more during the weekend than on the weekday as a sign of being in state debt. Among the roughly 21,500 female health professionals between ages of 60 and 84 the research team followed, women who were in sleep debt were more likely to be obese and have hypertension. When taking into account socioeconomic status and sources of stress, such as negative life events and work-related stress that could also influence cardiovascular health, quality of sleep was still an important factor for good overall cardiovascular health. The results suggest that not getting enough sleep during the week might throw the body off and may increase risk of cardiovascular disease in older women.

NEARLY A QUARTER (23 PERCENT) OF THE WOMEN STUDIED WERE OBESE

Women who reported greater than one traumatic life event versus no traumatic life events had 11 percent increased odds of obesity;

The higher the number of negative life events reported by women in the last five years, the higher the tendency for increased odds of obesity. Specifically, women who reported four or more negative life events had a 36 percent higher risk of obesity, compared to women who reported no such events;

Among women who had higher levels of physical activity, there was a stronger association between increasing cumulative/chronic stress and obesity, though the reason for this finding remains uncertain.

“Our findings suggest that psychological stress in the form of negative and traumatic life events might represent an important risk factor for weight changes and, therefore, we should consider including assessment and treatment of psychosocial stress in approaches to weight management,” Albert said.

Because the study looks at the association between stressful events and obesity in a snapshot of time, future studies should look at the relationship longitudinally, following people for weight gain over time after life events have occurred, according to Albert.

“This is important work because women are living longer and are more at risk for chronic illnesses, such as cardiovascular disease. The potential public health impact is large, as obesity is related to increased risks of heart attack, stroke, diabetes and cancer, and contributes to spiraling healthcare costs,” Albert said.

Want to write for InnoHEALTH? send us your article at magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 2 Issue 1 (January to March 2017) – https://goo.gl/DEyKnw
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 4 (October to December 2017) – http://amzn.to/2B2UMLw
InnoHEALTH Volume 3 Issue 1 (January to March 2018) – https://goo.gl/fksdQx

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HEALTHY INTENTIONS FOR A HEALTHY WORLD

InnoHEALTH Magazine — Mon, 20 Nov 2017 06:10:32 +0000

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Professor Jeffrey Braithwaite is a leading health services and systems researcher with an international reputation for his work investigating and contributing to systems improvement. He has particular expertise in the culture and structure of acute settings, leadership, management and change in health sector organisations, quality and safety in health care, accreditation and surveying processes in international context and the restructuring of health services. In an exclusive interview with VIGYAN ARYA of InnoHEALTH he responds to the growing global concerns of health and medicare.

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Q1. What is the prime objective of the institute you are leading: Australian Institute of Health Innovations?

The Australian Institute of Health Innovation (AIHI) at Macquarie University conducts world-class research with national and international research communities, governments, policymakers, providers of health services, managers, clinicians, patients and the community. Our work underpins health reforms and systems improvement, providing new tools, perspectives and evidence to help stakeholders who are interested in making the health system more effective, efficient and productive. Our overarching aim is to produce new, high-quality research evidence to support change, prevention and improvement.in the Australian health system, and internationally.

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Q2. Could you share some of the achievements of the institute in the recent past?

As highlights of 2016, we are currently running over 77 different funded projects valued at almost $40 million, and participating in another 17 grants administered by other institutions worth a similar amount. Overall, we attracted new funding in 2016 valued in excess of $15 million. One notable milestone is that we secured the largest grant ever awarded to the Institute and the largest to Macquarie University in 2016: the NHMRC Partnership Centre in Health System Sustainability, valued at $10.75 million. In that project we are trying to create more sustainable systems of care.

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Q 3. The contributions of the institute (and yours) limited to Australia or its implications are international? Can you elaborate on it with some examples?

In 2015 Professor Enrico Coiera won the highest international award for digital health—the IMIA Francois Gremy Award of Excellence. He is a highly influential commentator on national e-health strategies, advocating strongly for rational policy making based on sound evidence. His work has translated into policy and practice changes for e-health safety, multiple patented inventions, as well as for a US-based consumer e-health start-up company. He is author of one of the earliest textbooks on health informatics, which is widely used internationally, translated into multiple languages and now in its 3rd edition. Professor Coiera is the lead researcher, along with colleague Dr Annie Lau, of healthy.me, a personal health management system.

Professor Johanna Westbrook is an elected a Fellow of the American College of Medical Informatics (AC MI) – one of only four Australians. In 2014 she was named Australian ICT professional of the year by the Australian Information Industry Association for her research contributions. In 2015 she was appointed as an Associate Editor of the Journal of the American Medical Informatics Association (JAMIA). She was also appointed Chair of the Deeble Institute Advisory Board by the Australian Healthcare and Hospitals Association in 2015. The Institute has a major focus on driving evidence-based health policy. In 2016 Johanna was elected by members to the Sax Institute Board. In 2016, Professor Westbrook was appointed by the Federal Minister for Health to the Board of the Australian Digital Health Agency and chairs the national Digital Health Quality and Safety Governance Committee.

Our landmark CareTrack Australia study revealed, in 2012, Australians receive “appropriate” healthcare in only 57 percent of consultations. A follow-up study to CareTrack Australia, “CareTrack Kids” will, for the first time, determine the percentage of healthcare encounters at which Australian children receive evidence- and consensus-based care for 16 paediatric conditions and examine the frequency and types of adverse events involving Australian children. We aim to deliver a range of important outcomes in this highly significant and overdue research. Led by Professor Jeffrey Braithwaite and Peter Hibbert, this research stream is building on CareTrack Australia’s findings to pilot new approaches to clinical standards and to explore digital platforms for their delivery. This stream aims to provide a new evidence base to reduce healthcare costs and improve care by helping clinicians deliver the right care at the right time to the right patients.

The Work Observation Method by Activity Timing (WOMBAT ) developed by Institute staff led by Professor Westbrook, and now used by over 30 research teams around the world, has produced new opportunities to undertake international collaborative studies. This measures how care is delivered using a hand held device, looking at how clinical care actually takes place.

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Q 4. Are there any biological/medicinal differences in the needs and concerns of original Aborigines in Australia and its broadly expat population?

Everyone deserves good care. Australia has been trying very hard in recent years to provide high quality services to Aboriginal and Torres Strait Islands populations. Many live in remote areas, and it has been hard to narrow the gap between the health status of those populations and other members of Australian society. Governments in Australia are making investments in this situation.

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Q 5. What is your institute doing to address the needs and concerns of Australian Aborigines, who are genetically distant from the rest of the Australian expat population?

While this is not our area of expertise, we strongly support colleagues who do research on these populations. This is very important work. Most of our studies include a wide range of patient groups including those from Aboriginal and Torres Strait Islander populations.

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Q 6. Can you highlight some of the achievements of the institute in Emotional Health sector since it invests a lot in resources in this field?

We are very interested in doing research with clinicians who are want to deliver the best care that resources permit to patients. We are also interested in ensuring that patients are involved in decisions about their care. We have done a great deal of work with both groups.

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Q 7. What, according to you, are going to be the biggest challenges for Australia and the world for securing a healthy society and combat future medical challenges?

To my mind, three things are important. One is digital health: ensuring we get the greatest advantage from investments in future e-health and information systems. The second is patient safety and quality of care. It is critical that we make further inroads into keeping patients safe and improving the quality of their care. In particular, we need to understand when things go right as well as when things go wrong. Third, we need to build sustainable health systems: ones that are built to last, and flexible enough that they can cope with future changes and innovations.

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Q 8. On personal front, where do you draw the line between medical marvels and miracles?

I don’t personally believe in miracles. I am very much appreciative, as a scientist, of the benefits to be gained by the application of evidence, science and technology to improve the health system for the benefit of our patients. This is the real marvel.I don’t personally believe in miracles. I am very much appreciative, as a scientist, of the benefits to be gained by the application of evidence, science and technology to improve the health system for the benefit of our patients. This is the real marvel.

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Q 9. What are your expectations from the global medical community and what direction would you see governments and people should invest in?

In my next edited book, involving care delivered to patients in 60 countries, I found four things that were success factors in improving care. One is to start with a pilot program, and then scale it up. A second is the importance of having good data on which to base decisions about systems and care. A third is to ensure that multiple stakeholders are involved in complex improvement initiatives. And a fourth is that the benchmark for improvement must be the patient, rather than other stakeholders’ views on the care we need to provide.

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Q 10. How do you see innovations of your country linked to Indian which is well known for frugal innovations, do you think some collaboration at working level to take it forward for benefit of both countries in view of two countries’ Prime Ministers have signed recently MoU of collaboration?

This is an excellent idea. India and Australia have many things to learn from each other, and have been friends for many years not just because of our shared interest in cricket and because of our ties as members of the Commonwealth. We are natural partners in ensuring a better health system for our respective countries, and teaching each other about innovative things we have done.

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Want to write for InnoHEALTH? send us your article at magazine@innovatiocuris.com

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