Catalyst Corner : January/February 2014

Medical Advances Continue to Amaze


Medscape ran a great article series last year on cutting-edge medical advances. Entitled “Science or Science Fiction: Cutting-Edge Medical Advances,” the series involved writers Bret S. Stetka, M.D., and Marrecca Fiore walking readers through 25 fascinating developments — from growing organs to brain transplantation — that were once only the content of science fiction movies. I thought ComputerTalk readers might enjoy learning about several of these developments. 

Prosthetics

Mind-controlled, robotic, and bionic technologies are being made with titanium and other new materials and allow users to truly restore mobility, even in the most challenging patients. They provide examples such as one quadriplegic who has been able to perform several daily living activities from her wheelchair and a paraplegic who was able to use a robotic exoskeleton to walk. 

Neuroscience

A new initiative was launched in 2013 called BRAIN. The project aims to map brain structure and activity in order to prevent and treat neurologic and psychiatric disorders. New techniques are allowing scientists to precisely control neuronal firing and to image intact neural networks. Brain/computer interfaces analyze brain waves and extract personal information, while software recognizes and records emotional states. Scientists are also exploring how to use external magnetic fields to treat brain disorders. Progress is being made on engineering transplantable living nerve tissue that may be used to regenerate or reconnect neurons, allowing brain transplantation someday.

Transplantation

Many other tissue types and organs have been successfully grown. Examples include a donor trachea, with stem cells used to prevent rejection and encourage tissue integration. Twelve tissue-engineered tracheas have now been transplanted. Skin replacements and rat kidney regeneration were successful, while work continues on liver, heart, bone, and muscle tissue. In 2012, scientists from the Netherlands announced that they had fitted a woman with an artificial jaw that was made on a 3-D printer using titanium powder fused together using lasers. This technology was combined with nanomaterials by NIH-funded scientists, allowing them to create functional ears that receive radio signals. Face, limb, and hand transplants are becoming far more common as well. In China, surgeons took a very different approach to tissue generation, growing an accident victim a new nose on his forehead to be surgically placed when complete. The surgeons used subcutaneous tissue expanders and stem cells harvested from the patient’s ribs to grow the nose. 

Robotics

The FDA approved the first remote-presence robot for use in hospitals. Made by the same company that makes the robotic vacuum, it allows doctors to monitor and interact with patients remotely. With regard to robotic surgery, costs and adverse events have led to a slowdown in the technology’s development. Google Glass is also being tested (see http://www.google.com/glass/start/what-it-does/). Wearing Google Glass, surgeons performed one of the first live surgeries watched in real time by medical students and faculty in a Google Hangout. Google Glass may be used in the future to help EMS personnel to access medical professionals elsewhere, for example, live-streaming patient vital signs and images to physicians en route to hospitals. 

Fecal Transplants and the Microbiome

At my alma mater, scientists have introduced fecal transplantation to successfully treat Clostridium difficile infections. C. difficile is a primarily hospital-acquired bacterial infection of the colon and kills more than 14,000 people in the United States every year. Fecal transplantation from healthy donors eradicates the infection in roughly nine out of 10 attempts by rebalancing intestinal flora. The procedure shows the importance of understanding our microbiome — the bacterial, viral, and fungal coinhabitants that are part of the immune system and help with physiologic and metabolic stability. The NIH’s Human Microbiome Project aims to characterize, sequence, and better understand how our microbial colonists affect our health. 

Smartphone Apps/Sensors

I have spoken at American Society for Automation in Pharmacy meetings about the burgeoning number of smartphone applications. Many contain sensors that are being used to diagnose and monitor heart disease, hypertension, diabetes, epilepsy, stroke, dementia, Parkinson’s disease, breast cancers, and sleep problems. Wearable sensors can be used to obtain real-time feedback for various therapies. High-tech pill boxes, smart blisters, and other ingestible sensors are being used to monitor medication adherence. Another new smartphone device combines inexpensive binoculars with the app to measure the eyes’ refractive error, which may allow patients to determine their own eyeglass prescription and order lower-cost glasses through online stores. 

Many of these advances will impact how our pharmacy systems may be designed in the future, especially integration with data from new devices and the ever-progressing smartphone.  Medscape Editor-in-Chief Eric J. Topol, M.D., notes “We will be able to monitor almost any physiologic metric with data going to our smartphone.” 

Videos for Brain Health

While many believe video games result in too much sedentary activity, positive uses have been found in the area of brain health. A recent study suggests that the right video games may have some benefit in elderly people, leading to improved short-term memory and long-term concentration.

Pharmacy-Based Testing

In other news, Palo Alto, Calif.-based Theranos is offering clinician-directed lab testing in Walgreens stores using a blood sample as small as a few drops or 1/1,000 the size of a typical blood draw. Samples are taken with traditional methods used in point-of-care testing. The plan is to provide physicians with the test results in hours, verses days. It is expected that insurers will cover “low-cost” tests. The inventor, and Theranos founder and CEO, is a 29-yearold Stanford University drop-out, Elizabeth Holmes. 

Many of these advances will impact how our pharmacy systems may be designed in the future, especially integration with data from new devices and the ever-progressing smartphone. I look forward to continuing to share new developments with ComputerTalk readers as they occur. CT 

Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, in Eagan, Minn. The firm provides consulting, research, and writing services to help industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@catalystenterprises.net.


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