Archives: 8/2006

5342135ss Clinics Employ Secret ShoppersAs we head into an era of “Pay for Performance” and “Personalized Care” (both of which mostly mean it’s time to shop around and pay your own way), savvy clinics have employed mystery shoppers: individuals posing as patients who are actually paid to evaluate their experience. Healthcare managers say the practice has paid off…

When James Loden, an ophthalmologist, recently peered into a patient’s eyes, he was evaluating her for laser surgery to correct her vision. But her eyes were sharp enough to have already scanned Dr. Loden’s Nashville, Tenn., office, noting a small water stain on the ceiling in the hallway, the technician’s missing name tag, and that exactly 55 minutes elapsed between when she came in the door and when she was seen.
After her appointment, she sat in her car and jotted down notes for her employer, Las Vegas-based Examine Your Practice, which then reported back to Dr. Loden on the experience.
“Perception is reality,” says Dr. Loden, who has made a number of changes in his practice based on reports from mystery shoppers. “The patient’s perception is all that really matters.”
Health-care facilities that use mystery shoppers say the reports have led to a number of changes in the patient experience, including improved estimates of wait times, better explanations of medical procedures, extended hours for hospital administration workers, escorts for patients who have gotten lost, and even less-stressful programming on the television in the waiting room.
To remember details while remaining undercover, shoppers resort to hiding tape recorders in their bags, jotting details down in appointment books or crosswords, and going to bathrooms to take notes.
Observations can range from the minor to the serious. Courtney Lee once posed as an uninsured patient for 24 hours on an inpatient unit at a Midwestern hospital for Indianapolis-based Perception Strategies mystery-shopping service. When she asked for an additional pillow, she says a nurse said to her, “Why don’t you have your husband or friend get you one from the dollar store?”

Interesting to see clinics opening up to this whole concept of “customer service.” Next thing you know they’ll be improving the food…
More from the Wall Street Journal‘s Startup Journal

42534132ed CAN: Computer Aided Nanodesign™MIT’s Technology Review has an interesting article about San Diego-based Accelrys Software Inc.’s efforts to develop better software to visualize and predict thhe behavior of nanomaterials. As we have covered before, there is a growing consensus that computer simulators will play a major role in moving nanotech forward.
So go ahead and check out Accelrys Software‘s nanotechnology page, as well as its Materials Studio® software page. Company says that Materials Studio software environment has “a proven track record of enhancing nanotechnology R&D in a plethora of applications, such as nanoelectronics, devices, displays, coatings, drug delivery and nanocomposite materials.”
MIT Technology Review article

This just to let you know that the FDA has announced the formation of a new level of bureaucracy.

The new task force is charged with determining regulatory approaches that encourage the continued development of innovative, safe and effective FDA-regulated products that use nanotechnology materials.
The task force will identify and recommend ways to address any knowledge or policy gaps that exist so as to better enable the agency to evaluate possible adverse health effects from FDA-regulated products that use nanotechnology materials. FDA will continue to address product-specific nanotechnology-related issues on an ongoing basis.
“As this exciting new area of science develops, FDA must be positioned to address both health promotion and protection challenges that it may present,” said Dr. von Eschenbach. “Through this task force, we are leveraging our expertise and resources to guide the science and technology in the development of nanotechnology-based applications.”

Press statement
Website

65454345sw The Saga of the Finger Saving SawStop
Stephen Gass invented a table saw system, the SawStop, which within 3 milliseconds can tell if something other than wood (your finger) is being cut, and stops the blade. To refresh your memory how the device works, check out our earlier post: SawStop: For Less Penetrating Trauma.
What’s interesting is that the power tool industry has been remiss to license this limb-saving technology…

One CEO, traveling to Gass’s barn-based headquarters, expressed the industry’s position in terms that shocked Gass. “We sat around a little table and he said, ‘You guys have got to understand. Nobody in this industry likes you,’” Gass recalls. “‘You’ve created a huge problem here.’”
As an attorney, Gass is sympathetic with the industry position. The prospect of implementing a new technology like SawStop raises the potential of investing frightening amounts of capital to re-tool existing production lines.
“It’s not a simple issue for the manufacturers,” he explains. “They have whole product lines of saws. Once the genie is out of the bottle, there’s a huge product liability problem for any manufacturer who doesn’t have this. People will ask, ‘Why didn’t you have this on the saw you sold to us?’”
Gass believes that the “use it at your risk” legal structure steals the motivation of saw manufacturers to adopt new safety technology. “What you have here is an economic disconnect,” Gass says. “The power tool companies are not paying for the injuries. You and I are paying in terms of medical premiums and workers’ comp. If the (power tool) industry had to pay, this technology would have been on those saws a long time ago.”
The power tool industry, however, has a very different view of the subject. Representatives cite a plethora of technical problems with SawStop technology, including too many “false positives” or “nuisance trips,” cost of replacement cartridges after the brake fires, and difficulties cutting conductive materials, such as moist wood. Moreover, they say, Gass is asking for an 8 percent royalty on each saw sold, a figure they describe as ridiculous.

Despite these challenges, the Consumer Product Safety Commision has sided with Gass…

Acting on a petition from Gass, engineers at the U.S. Consumer Product Safety Commission recommended that the government begin a “rulemaking process” that could result in mandatory safety standards for table saws. Days later, the agency’s commissioners shocked the power tool industry by concurring with the recommendation.

There’s no doubt this is excellent technology. However, it would also be unfortunate that the price of every table saw increase by $50 because regulators have decided to play nanny. Gass’s proposed royalties seem to be the biggest reason the industry has issues with his technology.
In this Medgadgeteer’s opinion, Gass’s argument about lack of liability and payment could save him yet. Why not show the technology to assorted insurance firms? Anyone insuring a wood shop with a table saw would demand the use of this technology. Seems like a less irksome method than running to the government to make your technology the law…
More from designnews.com
The SawStop product page

Airport%20Biometric%20Lie%20Detector Airport Biometric Station Screens for HostilityHostility detector. . .hmmm. . . I hope this can tell the difference between hostility aimed at airport personnel (armed with GEDs) and terrorist related hostility.

With one hand inserted into a sensor that monitors physical responses, the travelers used the other hand to answer questions on a touch screen about their plans. A machine measured biometric responses — blood pressure, pulse and sweat levels — that then were analyzed by software. The idea was to ferret out U.S. officials who were carrying out carefully constructed but make-believe terrorist missions.
The trial of the Israeli-developed system represents an effort by the U.S. Transportation Security Administration to determine whether technology can spot passengers who have “hostile intent.” In effect, the screening system attempts to mechanize Israel’s vaunted airport-security process by using algorithms, artificial-intelligence software and polygraph principles.
The people-based program — called Screening Passengers by Observation Technique, or SPOT — began undergoing tests at Boston’s Logan Airport after 9/11 and has expanded to about a dozen airports. Trained teams watch travelers in security lines and elsewhere. They look for obvious things like someone wearing a heavy coat on a hot day, but also for subtle signs like vocal timbre, gestures and tiny facial movements that indicate someone is trying to disguise an emotion.
More than 80% of those approached are quickly dismissed, he says. The explanations for hiding emotions often are innocent: A traveler might be stressed out from work, worried about missing a flight or sad because a relative just died. If suspicions remain, the traveler is interviewed at greater length by a screener with more specialized training. SPOT teams have identified about 100 people who were trying to smuggle drugs, use fake IDs and commit other crimes, but not terrorist acts.

Read more here. . .
(hat tip: Slashdot)

2343w2333 Wii Trauma Center: Second OpinionThe Journal of Surgical Endoscopy said it, the Journal of Endourology agreed and even the presitgious MSNBC published the data. Surgeons who play video games are better at laproscopic surgeries resulting in fewer movements, less mistakes and better patient outcomes. Until now only a lucky few young surgical residents had access to these digital surgical simulators. That was until Nintendo CEOs decided that average Joes should have equal access to hone their surgical skills.
We know very little about this new game for the upcoming Nintendo Wii platform, but so far we’re big fans of the title, which strikes just the right amount of dread and fear (narrowly beating out “Trauma Center: The Bounceback” and “Trauma Center: Patient is Well-Known to Staff with Frequent Visits for Same Complaint”). While we can’t imagine ever wanting to come home and play this game (we live it!) we can understand the appeal to pre-meds and children of physicians. Maybe, also, the anime nurses have some appeal to some obscure demographic that we wouldn’t really know about, why are you even asking?
From videogamesblogger:

Second Opinion will feature enhanced visuals (when compared to Under the Knife on DS), as well as voice acting. Additional surgeries will also be added, including heart transplants and broken bone procedures. And this time around, Atlus will offer three difficulty settings, an obvious response to complaints about Under the Knife’s inconsistent difficulty, which includes several near-impossible missions.

Available November 3

The bottom line is that surgery in the morning has less perioperative complications than in late afternoon.

Patients who undergo surgery late in the afternoon are more likely to experience unexpected adverse events related to their anesthesia than are patients whose operations begin in the morning, a new analysis by Duke University Medical Center researchers suggests.
In the more than 90,000 surgeries analyzed, only a small percentage of the adverse events reported actually caused harm to the patients, the researchers said. The vast majority of events involved such serious though lesser problems as those related to pain management requiring additional attention to patients’ pain and postoperative nausea and vomiting.
“This is one of the first studies to show that there is a difference in patient outcomes depending on the start time of surgery,” said Melanie Wright, Ph.D., a human factors specialist in the Duke University Human Simulation and Patient Safety Center. Human factors specialists study how people behave physically and psychologically in different environments. Previous studies, she said, have examined the effects on patient outcomes of such factors as fatigue, sleep deprivation and circadian rhythms among health care workers.
In addition to spotting problems related to anesthesia, Wright and her colleagues also found that surgery patients experienced a significant increase in “administrative delays” during late afternoon, which might contribute to the increase in adverse events that occur during this time. The delays included waiting for laboratory test results, doctors running late, transporters not being available to move patients and rooms not being ready on time.

Link to the story at Duke University Medical Center…

1254234213rf2 RF MicroChannel™ Technology
Israel21C profiles an innovative transdermal drug delivery system from a start up TransPharma Medical Ltd. Together with Teva Pharmaceutical Industries of Israel, the company is currently developing a proprietary transdermal hPTH (1-34) product to treat osteoporosis while eliminating the need for daily injections.
Here’s how the company’s RF-MicroChannel™ technology works:

A densely spaced array of microelectrodes is placed against the skin. A high frequency alternating current is transferred through each of the microelectrodes to create localized ablation of the skin cells in close proximity to the electrodes. This process takes only milliseconds and produces well-defined and completely safe RF-MicroChannels. The RF-MicroChannels penetrate only the outer layer of the skin, where there are no blood vessels or nerve endings. This means no pain or trauma to the skin.
1254234213rf1 RF MicroChannel™ TechnologyA typical TransPharma Medical RF-MicroChannel microelectrode array incorporates hundreds of microelectrodes, so that many parallel channels are created through the skin within a few seconds. This covers less than 1% of the total treated surface area…
The dimensions and density of the RF-MicroChannels are completely flexible, depending on the electronic and mechanical settings of the ViaDerm system. The drug delivery rate is determined by the size and number of channels created. These, in turn, are a function of the number and density of the activated electrodes and the current driven through them. The depth of a typical channel is less than 100 microns – large enough for even the largest drug molecules…
One of the primary difficulties in penetrating the skin is the very texture and nature of the skin tissue itself. This of course, varies among individuals. TransPharma Medical’s proprietary microelectrode array design, which adapts to variations within and between treatment sites, addresses these variations. This design is essential for the formation of RF-MicroChannels that have a consistent, well controlled depth, so that the drug reaches the subcutaneous capillary bed without unnecessary trauma to the inner skin layers.
RF-MicroChannel Technology offers more therapeutic opportunities than existing technologies under development due to the following:

  • RF-MicroChannels are created within milliseconds, with no resulting skin trauma or pain.
  • Uniformity of RF-MicroChannels through all skin types is fully controlled by a unique feedback mechanism, offering precise and reproducible drug delivery.
  • The size and density of RF-MicroChannels enable delivery of relatively high doses of drugs, which could not previously be delivered transdermally.
  • RF-MicroChannels can be used to deliver a wide variety of molecules through the skin. Other active technologies impose limitations as to molecule size, formulation or dose.
  • RF-MicroChannels formed in the skin remain open for a relatively long time, up to and exceeding 24 hours. This enables sustained-release drug delivery to maintain constant drug blood levels and improved compliance.
  • More from the company…

    pr virtual1 1 Minimally Invasive Surgery Digital SimEngineers from the Rensselaer Polytechnic Institute, in cooperation with Harvard Medical School, Albany Medical Center, and the Massachusetts Institute of Technology, are developing a novel type of surgical simulator for surgeons training in minimally invasive surgery. The haptics (i.e. sense of touch) used in the simulator are based on a computerized algorithm called Point-Associated Finite Field:

    “The sense of touch plays a fundamental role in the performance of a surgeon,” De said. “This is not a video game. People’s lives are at stake, so when training surgeons, you better be doing it well.” [Suvranu De is an assistant professor of mechanical, aerospace, and nuclear engineering and director of the Advanced Computational Research Lab at Rensselaer --ed.]
    In a paper published in the June/July issue of the journal Presence, the researchers describe their new computational technique, and beginning in the summer of 2006 the work will be supported by a $1.4 million, four-year grant from the National Institutes of Health (NIH)…
    Surgical simulators — even more than flight simulators — are based on intense computation. To program the realism of touch feedback from a surgical probe navigating through soft tissue, the researchers must develop efficient computer models that perform 30 times faster than real-time graphics, solving complex sets of partial differential equations about a thousand times a second, De said.
    The major challenge to current technologies is the simulation of soft biological tissues, according to De. Such tissues are heterogeneous and viscoelastic, meaning they exhibit characteristics of both solids and liquids — similar to chewing gum or silly putty. And surgical procedures such as cutting and cauterizing are almost impossible to simulate with traditional techniques.
    pr virtual3 Minimally Invasive Surgery Digital SimTo overcome these barriers, De’s group has developed a new computational tool called the Point-Associated Finite Field (PAFF) approach, which models human tissue as a collection of particles with distinct, overlapping zones of influence that produce coordinated, elastic movements. A single point in space models each spot, while its relationship to nearby points is determined by the equations of physics. The localized points migrate along with the tip of the virtual instrument, much like a roving swarm of bees.
    This method enables the program to rapidly perform hundreds of thousands of calculations for real-time touch feedback, making it superior to other approaches, according to the researchers. “Our approach is physics-based,” De said. “The technologies that are currently available for surgical simulation are mostly graphical renderings of organs, and surgeons are not very happy with them.” And the same physics-based technology can be used to model blood flow and the generation of smoke during cauterization, which is often used to burn tissue and stop hemorrhaging.
    The researchers are currently using video images of actual surgical procedures to enhance the visual realism of their computer-generated scenarios, and they are performing experiments on human cadavers to evaluate the mechanical properties of human organs. These experiments are taking place at Albany Medical Center in collaboration with Tejinder Paul Singh and Leon Martino, and also at Connecticut-based U.S. Surgical, a manufacturer of wound closure products and advanced surgical devices.

    Link