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THE END OF DISABILITY Eliza Strickland IEEE Spectrum June 2014 IS 376 December 2, 2014 TELEMEDICINE With high-speed broadband communications, medical professionals can provide assistance without being physically present. Medical implants use wireless communications through body area, personal area, local area, and wide area networks. A technician operates ophthalmic equipment in rural India, and a counselor follows up with patients based on the diagnosis provided by a doctor at the remote base hospital. Robot surgery in remote communities, war zones, and disaster-stricken areas. IS 376 The End of Disability Page 2 EXPERT SYSTEMS Consulting with medical experts, software engineers develop a program that taps into the expert knowledge to determine probabilities for certain symptoms and test results yielding specific diagnoses and treatments. 1) Patient’s name: ** PT538 2) Age: ** 34 YEARS 3) Sex: ** MAEL -MALE 4) Race: ** CAUCASIAN Please supply one answer under each heading. If your response is not understood, you will be prompted by the standard questioning method. Please enter the results of positive cultures using the following table. site culture date date method of number collected positive collection (urine, sputum only) 5)**DONE Please enter the results of pending cultures in the following table. site culture stain date method of number examined positive collection (urine, sputum only) 6)** CSF 1234 30-Jan-77 YES stain of morphology smear [type DONE if no organism was seen on the smear] 7)**DONE IS 376 19) Does PT538 have any cutaneous lesions or rash on physical examination? ** NO 20) Does PT538 have evidence of ocular nerve dysfunction? ** NO 21) Is PT538 a compromised host (e.g. alcoholic, sicklecell-disease, immunosuppressed)? ** YES 22) Is PT538 immunosuppressed (e.g. corticosteroid therapy, cytotoxic drug therapy, radiation therapy, leukemia, lymphoma)? ** NO 23) For how many days has PT538 had abnormal neurologic signs? ** 7.2 HOURS 24) For how many days has PT538 had neurologic symptoms? ** 1 DAYS 25) Has PT538 had recent evidence of tender or enlarged salivary glands? ** NO 26) Has PT538 been exposed to any contagious disease recently (e.g. meningococcal disease, mumps)? ** NO Please enter CSF findings in the following table CSF Percent Protein CSF Peripheral WBC PMN Glucose Glucose 27)** 100 99 280 5 UNKNOWN The End of Disability My therapy recommendations will be designed to treat for organisms that either are very likely or, although less likely, would have a significant effect on therapy selection if they were present. It is important to cover for the following probable infection(s) and associated organism(s): INFECTION-i1s MENINGITIS + <ITEM-l>E .COLI [from clinical evidence only] + <ITEM-2>P SEUDOMONAS-AERUGINOSA [from clinical evidence only] + <ITEM-3>KLEBSIELLA-PNEUMONIAE [from clinical evidence only] + <ITEM-4>D IPLOCOCCUS-PNEUMONIAE [from clinical evidence only] [REC-1] My preferred therapy recommendations as follows: In order to cover for Items <1 2 3 4>: Give the following in combination: 1) AMPICILLIN Dose: 3.5g (28.0 ml) q4h IV [calculated on basis of 50 mg/kg] 2) GENTAMICIN Dose: 119mg (3.0 ml, 80mg/2ml ampule) q8h IV [calculated on basis 1.7 mg/kg plus consider giving 5 mg q24h Intrathecal Comments: Monitor serum concentrations Since high concentrations of penicillins can inactivate Aminoglycosides, do not mix these two antibiotics in the same IV bottle. Page 3 MEDICAL DATABASES While medical records are still primarily stored on paper, an increasing percentage are stored electronically. IS 376 • Huge IT Expense • Huge Paper Storage Expense • Ease of Data Retrieval • Ease of Data Entry • Simultaneous Access from Multiple Locations • Resistant to External Tampering • Medical Errors Due to Software Glitches • Medical Errors Due to Illegible Writing The End of Disability Page 4 PRIVACY CONCERNS With the development of remote access to electronic medical information, concerns have arisen about the privacy of one’s medical records. In 1996, Congress passed HIPAA, the Health Insurance Portability and Accountability Act, which requires that special care be taken with the following information available to health providers: • • • • • • • • Names Addresses (City, County, Street, Zip Code) Dates (Birth, Death, Admission, Discharge) Phone or Fax Numbers Online Addresses (E-Mail, IP, URLs) Numbers (Social Security, Account, License, Health Plan, Medical Record) Biometric Identifiers (Fingerprints, Retina Scans, Voiceprints, Photos) Individually Identifiable Health Information HIPAA does not protect your medical data from: • Insurance Companies (even if you pay for the procedures yourself) • Marketing Firms (as long as it sounds like treatment, e.g., diabetes magazines) • Law Enforcement (in some cases, without a warrant) IS 376 The End of Disability Page 5 PANDEMIC TRACKING One strong motivation for converting to electronic health records is the need to track pandemics like H5N1 (avian flu) and SARS (severe acute respiratory syndrome). Communication between health providers and local and state authorities is rather ad hoc and primitive, often dependent on written records and forms, telephone calls, and faxes. A fully automated system, which monitors 911 calls, pharmacy sales, school absenteeism, etc. has been proposed as an effective way to track pandemics, but… …the expense of converting to EHR and the potential privacy concerns tend to deflate such efforts. IS 376 The End of Disability Page 6 ROBOTIC PROSTHETICS Microelectronics and biosensors combine to place intelligence in replacement body parts. Fluid vibrations are used to detect rough surfaces. Perceived pressure varies with the touched locations. Small conductive devices detect touched hot objects. IS 376 The End of Disability Page 7 BIONIC LIMBS Standard artificial limbs only return about half of the energy supplied to them by the user, resulting in awkward and uncomfortable gaits. Newer bionic systems return 100% of the energy of a biological limb while accommodating for real time terrain changes, thus normalizing the individual's gait dynamics. This lower-leg system translates approximately 250 data points per step through algorithms and circuit boards that tell an actuator to retract or extend. When the actuator retracts, it pulls the series spring up, similar to the loading of a catapult. At the end of step, the actuator retracts further and the spring releases stored energy, emulating the action of the calf muscles and Achilles tendon. IS 376 The End of Disability Page 8 PACEMAKERS A pacemaker is a device that is surgically implanted in the chest in order to control abnormal heart rhythms (arrhythmia). Single lead pacemakers connect the generator and the lower right chamber of the heart (the right ventricle). Double lead pacemakers connect the generator, the right ventricle, and the upper right chamber of the heart (the right atrium). In 2008, researchers at the University of Massachusetts Amherst were able to wirelessly hack into a pacemaker, reprogramming it to shut down and to administer potentially fatal jolts of electricity. IS 376 Pacemakers are programmed in one of two ways: • Demand pacing – Heart rhythm is monitored and electronic pulses are transmitted only if the heart beats too slow or misses a beat. • Rate-responsive pacing – The heart rate is sped up or slowed down depending on current activity levels. The End of Disability Page 9 MEDICAL IMAGING Being able to see into a human body without invasive surgery assists in medical diagnosis without the danger of infection. Ultrasound Like the sonar of bats, ultrasound produces images by transmitting sound and then analyzing the returning echo to determine the size, shape, and consistency of organs, tissues, and vessels. IS 376 Computerized Tomography Magnetic Resonance Imaging CT scans produce a volume of data about bodily structures, based upon their ability to block a projected X-ray beam. MRI scans align the magnetization of some of the body’s atoms with a powerful magnetic field, applies radio frequency fields to systematically alter that alignment, and then scans the resulting magnetic field to produce an image of that part of the body. The End of Disability Page 10 DEEP BRAIN STIMULATION Deep Brain Stimulation (DBS) is under study for the treatment of numerous brain diseases. From psychiatric disorders, such as depression and obsessivecompulsive disorder, to neurodegenerative ailments, such as Parkinson’s and Alzheimer’s, … … the insertion of electrical probes to either stimulate or inhibit neuronal activity is proving effective in reducing symptoms. The trick is finding the right target. IS 376 The End of Disability Page 11 THE BRAIN INITIATIVE In 2013, President Obama announced the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative, a collaborative effort between the NIH, the NSF, DARPA, and the FDA to explore how the human brain encodes, stores, and retrieves vast quantities of information, and to shed light on the complex links between brain function and behavior. IS 376 The End of Disability Page 12 PHOTOGRAPHING THOUGHTS Using functional MRI scans of test subject brains while watching movies, UC Berkeley scientists have been able to roughly reconstruct images of what the test subjects are watching by analyzing the brain activity itself. IS 376 The End of Disability Page 13 SURGERY SIMULATORS Data from CT and MRI scans are used to produce a 3D virtual world of the patient’s anatomy, and special gloves connected to motion sensors and haptic feedback devices are used to teach a surgical trainee how to perform particular surgeries without endangering actual patients. Virtual Laparoscopic Liver Surgery Virtual Eye Surgery IS 376 Virtual Intestinal Surgery Virtual Brain Surgery The End of Disability Virtual Endonasal Sinus Surgery Virtual Open Heart Surgery Page 14 DRUG IMPLANTS Implantable drug-delivery devices merge microfluidics with flexible microelectromechanical systems to replace pills, which, due to their long travel through the bloodstream, must sometimes be prescribed at near-toxic levels. IS 376 The End of Disability Page 15