In this 4.5-minute video interview conducted at the 2011 meeting of the American College of Cardiology (ACC), Dr. Eric Silfen explains that there is an important new initiative to provide continuity of care after hospital discharge. The initiative, which is being promoted by the ACC and others, has been given the formal acronym of H2H, which stands for hospital to home care.

In this first part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the concept of ambient intelligence and discusses its many potential applications within society. Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

What is ambient intelligence and why is it potentially so important?
Prof. Verbeek: “Ambient intelligence is what we call ‘smart environment’. By combining ubiquitous computing and intelligent user interfaces, environments come about that can intelligently respond to people’s behavior. This is a very interesting new configuration of humans and technologies. Whereas the usual configuration is ‘use’ – human beings making use of technological artifacts – ambient intelligence evokes a configuration of ‘immersion’. Human beings are immersed in environments that actively engage with their activities and experiences.”

Two important papers on telemonitoring in patients with chronic heart failure (CHF) have been published in the past few months, providing new information on the potential application and benefits of such projects.

First, specialists from centers in Germany summarized the experiences and findings from seven different CHF telemonitoring projects in the country. These primarily regional projects, some of which remain ongoing, involve a total of 7,720 patients with CHF. The patient breakdown by disease severity (according to the New York Heart Association staging system) is 14.5% at stage I, 51.1% at stage II, 26.3% at stage III, and 6.6% at stage IV, and the typical variables being monitored include heart rate, ECG, blood pressure and/or body weight.

In this second part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the potential applications of ambient intelligence (introduced and discussed in general terms in part 1 of the interview) in healthcare.

Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

Email-based telemedicine reviewed
Researchers at the Centre for Online Health, at the University of Queensland, Australia, have summarized the evidence relating to email-based telemedicine in a newly published review paper. Their findings, based on an analysis of 185 published papers, include the observation that email-based telemedicine has a wide range of potential applications, in primary consultation, second-opinion consultation, telediagnosis (including applications in image-based specialties such as dermatology, pathology, wound care, and ophthalmology, where digital images can be attached to emails), and administration (such as referrals). They highlight the need in certain instances for tailored email software, rather than ordinary email, to support telemedicine services (Caffery LJ, Smith AC. Stud Health Technol Inform. 2010;161:20-34).

Two important papers on telemonitoring in patients with chronic heart failure (CHF) have been published in the past few months, providing new information on the potential application and benefits of such projects.

First, specialists from centers in Germany summarized the experiences and findings from seven different CHF telemonitoring projects in the country. These primarily regional projects, some of which remain ongoing, involve a total of 7,720 patients with CHF. The patient breakdown by disease severity (according to the New York Heart Association staging system) is 14.5% at stage I, 51.1% at stage II, 26.3% at stage III, and 6.6% at stage IV, and the typical variables being monitored include heart rate, ECG, blood pressure and/or body weight.

In this first part of a 2-part interview, Professor Peter-Paul Verbeek of the University of Twente, in Enschede, The Netherlands, talks to GetInsideHealth.com about the concept of ambient intelligence and discusses its many potential applications within society. Prof. Verbeek is professor of philosophy of technology at the University of Twente’s Department of Philosophy, and has written frequently on ambient intelligence and persuasive technology.

What is ambient intelligence and why is it potentially so important?
Prof. Verbeek: “Ambient intelligence is what we call ‘smart environment’. By combining ubiquitous computing and intelligent user interfaces, environments come about that can intelligently respond to people’s behavior. This is a very interesting new configuration of humans and technologies. Whereas the usual configuration is ‘use’ – human beings making use of technological artifacts – ambient intelligence evokes a configuration of ‘immersion’. Human beings are immersed in environments that actively engage with their activities and experiences.”

In October 2010 the University of Wisconsin Hospital and Clinics, in Madison, USA, announced the introduction of a new method for identifying patients. The SAFE system uses near-infrared radiation to scan and record the pattern of venous blood flow in the palm – a pattern that is unique to each person.

When registering on the system, patients place their hand on a SAFE scanner for less than a minute during which the pattern of blood flow in the palm is recorded. The scan is stored as digital numerical information, and not as an actual image. At subsequent visits patients provide their date of birth and have their palm scanned. Their identification is then confirmed in seconds, and the correct electronic medical record can be accessed.

Hospital-acquired infections – with pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, and Clostridium difficile – are well established as a leading cause of morbidity and mortality in many countries.

A recently published review paper (available free as a download with this article, see the details below) noted that hospital-acquired infection is one of the most common adverse events associated with healthcare in the USA, with approximately 2 million cases occurring every year. It has been estimated that these infections add US$ 17-20 billion to the annual costs of healthcare in the country. The WHO, meanwhile, has reported an overall prevalence rate of 8.7% in industrialized and developed nations.¹

The European Resuscitation Council (ERC) held its 10th scientific congress in Porto, Portugal, from 2-4 December, and GetInsideHealth.com was there. Here we present coverage of five sessions from the conference, covering topics ranging from including CPR in school curricula to emergency service planning for major sporting events such as the Olympic Games.

GetInsideHealth.com brings you a brief round-up of newly published research, and other healthcare news:

Assessing the use of radiotherapy for prostate cancer
Is radiotherapy for prostate cancer under- or over-used, compared with the level suggested by published evidence? Some answers have been provided by an analysis of the medical records of almost 130,000 patients with prostate cancer in Ontario, Canada and in the USA. Specialists used a criterion-based benchmark approach to estimate the need for radiotherapy (both external beam radiation and brachytherapy) and compared it with actual rates for Ontario and the USA. They found that the estimated and actual rates were similar for the USA.  In Ontario, however, there was a suggestion that radiotherapy was underutilized: the observed initial rate of radiotherapy was 28%, significantly lower than the predicted rate of 37.2%. (Kerba M,  et al. Clinical Oncol. 2010;22:801-9).

Wrist device aids telemonitoring in the elderly
Gerbovics [Austria] reported on the development and testing of a wrist-wearable prototype telemonitoring device, named the Health Data Hub. The device is intended for elderly people, and monitors the heart rate using pulse oximetry. Measurements are transmitted to a monitoring station, along with data on the context of the measurements (such as altimeter data indciating whether or not the patients is walking up stairs) in order to improve interpretation. An automatic alarm message is initiated if data indicate a worsening health status – this message can be sent to a dedicated monitoring center or to relatives. It is intended that the device will eventually also include temperature sensors, gyro sensors and acceleration sensors, and will use a touch display to request contextual information (such as whether the person is taking a walk, or making an unscheduled visit to their doctor). Tests are ongoing on the latest version of the device. Security and privacy still need to be addressed in order to guarantee the safe exchange of medical data.

What are the obstacles to implementing new information systems?
Advances in information technology have opened up the possibility of better healthcare at the primary, secondary, and tertiary level. However, obstacles may impede the implementation of potentially successful strategies in eHealth, unless they are identified and actively managed during early phases of implementation. Ryan [Australia] reported on the findings of an anonymous voluntary survey of 100 patients and 100 staff at a metropolitan tertiary center about the implementation of eHealth applications.

Opening address: telehealth “a global force in healthcare”
The Most Reverend Desmond Tutu [S. Africa], in his capacity as ambassador for eHealth for the International Society for Telemedicine and eHealth, opened this year’s conference remotely through a video message. He said the theme of the conference – “Telehealth for every nation, community and home” – highlighted the hope that telehealth would become “a global and a local force in healthcare, a worldwide unifying and enabling technology” with information and communications technologies being foremost in surmounting the challenges  associated with differing levels of healthcare access around the world.

The latest developments in telemedicine were discussed at the Global Telehealth 2010 conference held from 10-12 November in Fremantle, near Perth in Western Australia. This was the 15th international conference of the International Society for Telemedicine and eHealth, and also the first national conference of the Australasian Telehealth Society, which formed in 2008.

In this study, 47 women with a mean age of 58 years were evaluated with dual energy X-ray absorptiometry (DEXA) and CT screening. DEXA served as the reference standard for comparing QCT and a single trabecular measure of CT attenuation at L1 with CT colonography (CTC).

Dr. Moulik explains that current picture archiving and communications systems (PACS) already provide 3D images but in a limited form without stereoscopic viewing that provides visual depth. In addition to stereoscopic views, Dr. Moulik has been pursuing strategies to actually isolate organs within the image in order to move them independent of surrounding anatomy.

“This work is quite a novel approach in that success of screening is usually measured in terms of reduction in mortality from breast cancer,” said Nicholas Perry, MD, of The London Breast Institute, London, UK. “We are not aware of any other studies in this age group comparing success in terms of breast preservation,” he added.

In their study, Dr. Perry and colleagues compared mastectomy rates following breast cancer diagnosis at a UK center in women aged 40-50 with a prior mammogram within the previous year to those with longer interval or no previous mammography.

The study was performed by specialists at Hull Royal Infirmary, in Hull, UK, to explore the factors influencing the experience of patients undergoing interventional radiological procedures.  

The researchers sent out questionnaires to 315 patients undergoing interventional vascular procedures prior to treatment, immediately following treatment, as well as 4 weeks and 3 months after the procedure.

The questionnaires were aimed at surveying the patients’ understanding of the procedure, their level of anxiety, and the amount of pain they were experiencing. The latter was assessed using a visual analog scoring system (VAS). The short form 36 (SF 36) health survey questionnaire was used to evaluate quality of life changes associated with the procedure.

The study was conducted by researchers at Stanford University, Stanford, California, and involved a review of Medicare claims submitted between 1998 and 2005 for over 10 million people, focusing on the well-characterized patient group of older adults, who are most frequently imaged. The data were analyzed in two temporally differentiated cohorts: 1998-2001 (N = 5,267,230) and 2002-2005 (N = 5,555,345).

Dr. Michel and colleagues evaluated the accuracy of 4,879,715 preliminary radiological studies that were interpreted between 1/1/2007 and 12/31/2009. “Our study is the largest retrospective analysis of the accuracy of interpretation in a teleradiology practice,” Dr. Michel noted.

In an effort to help reduce similar errors in the future, Dr. Mansfield's team reviewed 656 radiological exams with delayed diagnoses that were collected from July 2002 to January 2010 at BAMC. Each case was reviewed by two radiologists and the diagnostic errors were classified based on the type of error.

Smallpox, measles, and typhoid are no longer the threat they once were. But according to a Philips-sponsored report by Marsh, the insurance broker and risk advisor, even in the twenty-first century other infectious diseases continue to emerge at a rapid pace—and frequently with significant human and financial costs.