Whitney Palmer

Healthcare. Politics. Family.

Where EHRs Fall Short

Published on the Dec. 23, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

When electronic health records (EHRs) were first introduced, they were touted as being the answer to managing all patient data. An easy way to keep all medical data in one central location, accessible by all medical providers, and beneficial to patient care overall.

That was the initial intent, said Rena Zimmerman, MD, a radiation oncologist at Olympic Medical Center in Sequim, WA.

“Electronic health records should be intuitive to use, improve efficiency, reduce administrative responsibilities, not interfere with patient relationships, and be interoperable,” Zimmerman said. “They must be fully supported by your IT department, be completely secure, and improve patient outcomes and the health of the nation.”

But, that’s not what’s happened, she said at this year’s RSNA. Instead, EHRs are rife with challenges that make full, effective implementation difficult.

Medication Reconciliation: Under Meaningful Use guidelines, you’re required to review medication lists with 50% of your patients, including all prescription medications, herbal supplements, and over-the-counter medicines. Based on existing data, though, more than 60% of medical records contain errors of omission, addition, or both, even though providers have had several years to figure out how to manage medication records correctly.

“At this point, the learning curve isn’t the problem,” she said. “Most physicians feel the system is so cumbersome that they’ve sort of given up. There’s a belief that they don’t believe the medication record anyway, so they just put something, knowing that it’s probably not right.”

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/news/where-ehrs-fall-short

December 24, 2015 Posted by | Healthcare | , , , , , | Leave a comment

Teaching Radiologists to Be Business Leaders

Published on the Dec. 23, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Today’s radiologists do more than examine images and diagnose problems. They’re expected to understand revenue streams, keep up with coding and billing updates, and participate in mergers and acquisitions decisions.

But, currently, Falgun Chokshi, MD, MS, assistant professor of radiology and imaging services in the neuroradiology division at Emory Healthcare said at RSNA 2015 said, too few radiologists are prepared for these types of activities.

“Providing business leadership skills is a way to empower our trainees so they can go into a complex and very rapidly changing world of radiology and health care delivery and become active players,” he said. “These teachings provide valuable and necessary nonclinical tools, knowledge, and insight that have historically never been afforded in our training environment.”

The most effective way to impart this knowledge, he said, is to create a targeted curriculum and identify residents and fellows who could benefit from it the most. At Emory, this effort is known as P3R2 – Practice, Policy, and Professionalism for the Radiology Resident. Chokshi shared some lessons learned.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/rsna-2015/teaching-radiologists-be-business-leaders

December 24, 2015 Posted by | Education, Healthcare | , , , | Leave a comment

MYLES to Go

Published on the Dec. 18, 2015 Burroughs Wellcome Fund website

Asking Questions in the Great Smoky Mountains

By Whitney L.J. Howell

In the Great Smoky Mountains, Madison High School senior Chloe Schneider discovered something she never knew before. The mountains are home to a rich variety of snail species – but, some of them are in severe trouble.

Ordinarily, knowing details about the state’s mollusk population serves as a random bit of trivia for a party game. But, for Schneider, this knowledge was critical. Nearly 50 percent of North Carolina’s snails are endangered, but the ones in the Great Smokies are losing ground thanks to environmental changes.

The Millenial Youth Led Expedition (MYLES) of Science program showed the Marshall, N.C. native why it’s important to understand the impacts on the snails’ ecosystem.

“We could really tell how the acid rain has affected the environment and, how if we continue to have acid rain and pollution in the environment, that things will only get worse. Snails won’t be able to live in those areas anymore,” said Schneider, describing the work of her six-person team. “It’s crazy to see how much impact we have and how what we release into the environment can affect other species.”

MYLES, a Burroughs Wellcome Fund (BWF)-supported initiative, introduces high school students to science along the Appalachian Trail. BWF funded MYLES in 2013 with a nearly $60,000, three-year grant to support up to 100 participating students. Over the past two years, according to Dottie Shuman, Ph.D., MYLES grant administrator, surveys conducted at the beginning and end of each week-long program show the program meets BWF’s goal of fostering an augmented interest in and knowledge of science.

During six week-long summer expeditions, she said, students work alongside college-student guides and National Park Service (NPS) rangers, learning protocols and collecting data about the Western N.C. mountains to support long-standing NPS research projects. Students can also present their findings at scientific conferences throughout the school year.

“These students are excited about real science – testing hypotheses and setting up data collection,” she said. “They come back with knowledge about the natural resources at our fingertips, and they’re excited about protecting them.”

And, students don’t leave the program empty-handed – they take some scientific equipment with them. They carry hand lenses and water-test kits home to continue their investigations on their own.

In addition, according to NPS ranger and MYLES program staffer Susan Sachs, program staff hope students will leave MYLES thinking of science as a viable career option.

“A lot of times when students think of science, they think of lab coats and being indoors,” Sachs said. “We want to show them how we use science to study and protect the parks.”

To meet this goal, students participate in on-going NPS research into snail and salamander habitats and the outside influences affecting them. The six-person teams are also encouraged to form their own research questions and hypotheses, but all data gathered contributes to the investigations that have been active for at least a decade, Sachs said.

For example, this past summer, several teams examined how acid rain has impacted the mountain’s snail and salamander populations. Air quality in the area has improved over the past 10 years, but damaging rains still fall with greater amounts hitting the higher elevations, she said. Teams gathered data about soil pH and species diversity, compared it to historical data, and analyzed whether said diversity has increased or decreased over time. They determined, Sachs said, that fewer salamanders now live in the more highly-acidic, upper elevations.

“We use student data to look at salamander health. We might not notice the decline in population if we didn’t have the data students collect,” she said. “This way, we can monitor how changes in moisture and climate change affect these amphibians.”

Frequently, students take their new-found knowledge back into the high school classroom. In fact, two-time participant and high school junior Jalen Ward said hands-on experience with forming hypotheses and analyzing data has been helpful in his advanced placement science classes at Fike High School in Taylor, N.C. But, more importantly, he said, it’s impacted his future plans.

“I’d like to major in biology and maybe be a wildlife biologist working with North Carolina’s wildlife,” he said. “I enjoy the outdoors, so working with nature would be a way to do for a living what I already love to do.”
It’s that type of insight into the value of science as a career and forward-thinking that makes the MYLES program so important, Sachs said. It doesn’t take long for students to develop a deep appreciation for the significance of outdoor science and the opportunities for investigations it presents.

“After this program, science isn’t just something they learn in school. There’s a real value to it,” she said. “A lot students think we do a study and have answers. But, they learn that questions often only lead to more – and better questions.”

To read the story at its original location: http://www.bwfund.org/newsroom/awardee-profiles/myles-go

December 18, 2015 Posted by | Education, Science | , , , , | Leave a comment

Clusters of unvaccinated kids create WNC health time bomb

Published on the Dec. 16, 2015 Carolina Public Press website

By Whitney L.J. Howell

In the middle of Western North Carolina sits one of the state’s most potentially dangerous time bombs. And, at any given moment, under the right circumstances, it could go off.

Despite North Carolina’s requirements that school-age children have up-to-date vaccinations before starting kindergarten, 5 percent of Buncombe County’s kindergarten population remained unvaccinated for the 2014-15 school year. Statistics for the 2015-16 school year are not yet available.

According to Dr. Jennifer Mullendore, medical director for Buncombe County Health & Human Services, the percentage is higher than previous years and is six times the state average.

With up to 20 percent of each of the county’s schools allowed to be unvaccinated, the possibility exists for a significant public-health crisis, she said.

“We’re holding our breath, waiting for an outbreak,” she said.

“We’re fortunate the measles outbreak in California (in April) didn’t make it here. Next time, we might not be that lucky.”

Exemptions

In North Carolina, a child can remain unvaccinated for two reasons: a medical exemption and a religious opt-out. Based on N.C. Department of Health & Human Services statistics, out of

Buncombe’s 2,488 kindergarteners, one has a medical exemption, including a waiver from a healthcare provider, and 125 opted out for religious reasons. Or at least that’s officially what they claim. The state does not offer a philosophical exemption, even though that’s exactly what some anti-vaccination groups in Buncombe Cuonty have advocated. It’s likely that not all “religious” waivers are faith-based.

Upon kindergarten enrollment, parents must present schools with their child’s official immunization record. Schools keep these records on file, including any medical or religious exemptions. Children without exemptions have 30 days to provide proof of immunization or they aren’t allowed to return to school.

In addition to Buncombe County, Polk County and Transylvania County round out top three WNC locales with the highest non-vaccinated rates, reporting 4.71 percent and 2.89 percent non-vaccinations, respectively.

Henderson County has the second highest total number of children without vaccinations — with one medical waiver and 14 religious exemptions. However, because this is a relatively large county for WNC, it’s rate is not especially out of the range seen in most counties across the state.

Elevated sickness

Although no widespread outbreaks have occurred, Buncombe frequently experiences a higher-than-average incidence of pertussis, also known as whooping cough, a highly contagious respiratory disease known for uncontrollable, violent coughing that makes it hard to breathe.

Despite being preventable with a vaccine, in 2014, Mullendore said, the county had 65 reported cases. Only Duplin County, a rural county near the coast known for its pig farms, had more with 138 cases.

There were 782 cases of whooping cough reported statewide in 2014.

But, knowing the reasons behind the high non-vaccination rate is difficult, Mullendore said.

“We suspect immunizations have done a great job keeping people healthy for 50-plus years, and people don’t have context for why immunizations are important,” Mullendore said.

“People who grew up in the 1960s had friends and family who died from diseases that we have vaccines for now. Younger people raising kids now never saw that, so we’ve lost that perspective.”

Immunizations for North Carolina’s children are free through the Vaccines for Children program, even for uninsured individuals. It’s possible, though, other factors that typically limit access to healthcare are also at play, including cultural or language barriers that make it difficult to take advantage of healthcare services, and, in this case, a low level of education about vaccines.

Tara Rybka, public health educator with the Transylvania County Public Health Department, said that although it’s never been directly connected to a lack of immunization, transportation difficulties frequently play a role in limiting access to healthcare services in counties like hers.

Herd sensitivity

In many cases, Mullendore said, parents research vaccines on their own, trusting potentially non-vetted, online sources rather than asking their pediatrician or other healthcare provider for information about possible risks and benefits associated with vaccinating their children. Some choose not to vaccinate based on their online findings, leaving the overall community more vulnerable to preventable disease.

Doing so is particularly dangerous, said Noel Brewer, associate professor of health behavior at the University of North Carolina at Chapel Hill Gillings School of Global Public Health.

Vaccines provide herd immunity, he said, protecting the vaccinated and sheltering those who can’t receive vaccines due to conditions that compromise their immune systems, such as cancer.

On the flip side, however, non-vaccination can also create herd sensitivity, a phenomenon that gives rise to more severe cases of disease as individuals get sick at older ages.

Since most people are vaccinated, the risk of herd sensitivity might not seem too bad. But Brewer said this perception is misleading.

“Herd sensitivity is worse than people think,” he said. “Birds of a feather flock together, so those who are unvaccinated tend to stay together. But, you never have a pocket where 95 percent of people are vaccinated. It’s usually spread out to 80 percent or it can fall to 50 percent. These are the places that are vulnerable to outbreak and the spread of disease.”

Vaccination foes

Even with the risks of non-vaccination publicized throughout the healthcare community, Buncombe County has a relatively active anti-vaccine cohort, including Moms Against Mercury.

Based in Leicester, this organization, which did not return calls for comment, publicizes and supports the belief that mercury present in vaccines adversely affects the nervous system.

In recent years, the group has held six rallies, lobbying against the use of vaccines in their current forms.

According to the Centers for Disease Control & Prevention (CDC), though, the type of mercury used in vaccines – ethylmercury – is metabolized and cleared from the body far faster than the type of mercury – methylmercury – present in some types of fish. Consequently, CDC data states, ethylmercury is far less likely to be harmful.

Educating the public

County health officials are working to combat anti-vaccine efforts, Mullendore said. Last year, the Department of Health & Human Services worked with healthcare and childcare providers to expand educational services around the facts and benefits of vaccinating children.

Rather than targeting staunch anti-vaccine proponents who tend to dig their heels in when faced with information that contradicts their beliefs, health officials are reaching out through public forums to parents who are curious about vaccines. The effort could ultimately influence those who are on the fence about whether to vaccinate to proceed with immunizations.

Jennifer Garrett, director of nursing with Macon County Public Health also suggested holding school-based vaccination clinics to reach students who aren’t yet vaccinated. Macon’s health officials also reach out via phone to non-compliant parents to set up appointments for children to be vaccinated.

Ultimately, though, UNC’s Brewer said, the onus is on parents in communities with unvaccinated children to take steps that will side-step exposure to preventable disease. When children are sick, keep them home from school, he said, and know which pediatricians still choose to treat children who don’t have current vaccinations.

And, Brewer added, public health officials should continue to push for more widespread vaccinations.

“Getting information into the hands of those who are vaccinated can be helpful,” he said.

“More information needs to come from educators and physicians in the community. Not everyone will want to vaccinate, but more people are open to it than we currently believe.”

To read the story at its original location: http://www.carolinapublicpress.org/23894/clusters-of-unvaccinated-kids-create-wnc-health-time-bomb

 

December 18, 2015 Posted by | Family, Healthcare | , , , , , , , , , , , , | Leave a comment

How to Make the Most of Radiology Training

Published on the Dec. 11, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Residency is an intense time in the career for any radiologist. There’s much to learn and practice. Finding ways to do it all well can be an intimidating task. And, doing so can be particularly challenging if you don’t get the right guidance.

At this year’s RSNA, Rachel Nelson, MD, senior radiology resident and former chief resident at the Medical University of South Carolina, had advice for how residents can best navigate – and maximize – their training.

“Residency is daunting and difficult from the moment you first walk through the door,” Nelson said. “You need to know the tools you can use and find the support along the way to make the four-to-six years go smoothly.”

• Foundation: When you begin residency, she said, focus on developing the skills you need that will help you with advanced learning as you progress.

• Anatomy: In many ways, radiology is applied anatomy. Learn what normal – and the variations of normal – look like so you can identify when something is wrong. Focus on understanding how normal outcomes present on each modality.

• Pathology: Once you’ve mastered anatomy, she said, move on to pathology and pathophysiology. It’s important for you to be able to recognize what condition or problem you’re dealing with so you can provide better information to referring physicians and surgeons. Understanding the pathology can also better position you to help the patient achieve his or her “new normal.”

• Physics: You don’t need to be a physics expert, Nelson said, but it’s a field that’s fundamental to radiology. Educate yourself on some of the basics, learn how an X-ray is made, and study the Compton Effect. Not only will this knowledge help you when you’re studying for your board exams, but it will also be useful as you begin working with more advanced modalities.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/rsna-2015/how-make-most-radiology-training

December 11, 2015 Posted by | Healthcare | , , , , , , | Leave a comment

The challenges of healthy aging

Published in the Fall 2015 University of North Carolina at Chapel Hill Gillings School of Global Public Health Carolina Public Health Magazine

By Whitney L.J. Howell

Globally, the number of people 60 years old and older is growing exponentially. By 2050, these individuals will constitute nearly one-quarter of the world’s population.

Identifying strategies that will allow adults to age safely and with good quality of life, to maintain their abilities and safeguard their independence is vital – and is a high priority at the UNC Gillings School of Global Public Health.

“People are aging – me included – and we need a plan to help them live fully,” says Julie MacMillan, MPH, managing director of the School’s Research and Innovation Solutions office. “At the Gillings School, through strong collaborations, we want to create opportunities for people to live as healthfully and independently as possible.”

School leaders take a three-pronged approach to meeting those needs, including innovation, evaluation and education. Partnerships through the Gillings Global GatewayTM (sph.unc.edu/global-health) offer support.

Evaluation

Identifying needs is a first step, MacMillan says.

Peggye Dilworth-Anderson, PhD, professor of health policy and management, collaborates with UNC and Cambridge University (U.K.) colleagues to reduce later-life dementia risks. Using community-based participatory research, her team explores relationships between cognitive health, protective factors and modifiable risk factors to help develop cognitive, health-sustaining interventions that can be used with vulnerable groups of older adults in the U.S. and U.K.

Dilworth-Anderson is a venerated national leader in aging issues, having served as a Presidential appointee on the White House Conference on Aging Advisory Committee (2002-2005), president of the Gerontological Society of America (2009-2010) and appointed member of the Institute of Medicine’s Forum on Aging, Disability and Independence (2012- 2014). In October 2015, she was invited by AARP, in partnership with AgeUK (ageuk.org.uk), to serve a two-year term on the governance committee of the new Global Council on Brain Health (aarp.org/gcbh). The committee includes physicians, scientists, policy experts and others who will recommend best practices regarding brain health maintenance.

Funding for some of the UNC-Cambridge initiative was provided by Drs. Dennis and Mireille Gillings. Dennis Gillings, PhD, CBE, appointed by U.K. Prime Minister David Cameron as World Dementia Envoy, leads a global council to raise funds for research toward a cure for Alzheimer’s disease and other dementias.

Wayne Rosamond, PhD, epidemiology professor at the Gillings School and adjunct professor of emergency medicine in the UNC School of Medicine, identifies ways emergency medicine services (EMS) staff can communicate with hospitals while en route. These strategies could ensure immediate availability of emergency department resources, personnel and scanning equipment, of special importance in situations such as stroke, in which a few minutes can make a big difference in prognosis. Steve Marshall, PhD, epidemiology professor and director of the UNC Injury Prevention Research Center, and Jason Franz, PhD, biomedical engineering assistant professor, study factors that contribute to adult falls.

Epidemiology postdoctoral fellow Vineet Menachery, PhD, is using a recent National Institute on Aging award to support his research on the SARS coronavirus. He is identifying changes in immune response in the context of aging that could modify treatment of older adults who develop respiratory infections, a leading cause of death in that population.

Innovation

The Global Aging and Technology Collaborative aims to promote innovation and collaboration with global partners, says Heather Altman, MPH, project manager for the collaborative and doctoral candidate in the School’s Executive Doctor of Public Health program. The group leverages the expertise of more than 100 interdisciplinary researchers, practitioners and entrepreneurs to adopt creative, affordable and practical solutions that enhance quality of life and support people’s ability to age at home and in their communities. Altman is also Carol Woods Retirement Community’s community connections director, a long- held position that inspires and continues to enrich her work in aging at the UNC Gillings School.

With the help of a career development award from the UNC Institute on Aging, Altman is evaluating a tool that will help leaders assess the livability of their communities for older adults.

Education

Gillings School students also learn about older adults’ challenges, including food insecurities, by working with Amanda Holliday, MS, RD, clinical assistant professor of nutrition and licensed dietitian/nutritionist.

“Living older with chronic conditions has a nutritional component,” Holliday says. “Independence is intertwined with food. We need to consider how each person will manage his or her own nutrition if s/he wants to stay at home.”

Holliday’s students investigate older adults’ struggles in several ways. They complete daily living activities in a suit that impairs hearing and eyesight. Holliday also connects students with alumni living abroad to learn how other societies care for older adults, and she helps them secure study-abroad opportunities focused on aging, such as with the National Health Service’s Universal Malnutrition Screening Initiative, in England.

Overall, MacMillan says, the School prepares students to be leaders in a number of public health arenas. “When our students get excited, they’re a powerful force, no matter what challenge they take on,” she says. “They always make us think – and make us stronger. I’m particularly proud of our students who seek solutions for the challenges of aging, because they will make a difference in all our lives – and eventually, in their own.”

To read the article at its original location: http://sph.unc.edu/cphm/the-challenges-of-healthy-aging/

December 11, 2015 Posted by | Education, Healthcare | , , , , , , , , | Leave a comment

Official Research Arm of the Women’s Football Foundation

Published in the Fall 2015 University of North Carolina at Greensboro Research Magazine

By Whitney L.J. Howell

It’s no secret that playing football puts players at risk for sustaining a concussion. Research on this topic has accelerated over the past decade, with most work focusing on male players. But women play collision football too, and their numbers are growing.

This rise has researchers asking whether women experience concussions differently and if they need different assessments, treatments, and guidelines. Dr. Donna Duffy and her colleagues are trying to find these answers. It’s imperative, she says, because female football players are just as physical as their male counterparts while facing a high risk of injury.

This year, UNCG became the official research arm for the Women’s Football Foundation, or WFF. With WFF support, Duffy and her collaborators want to investigate whether female collision sport athletes have different normal neurocognitive and neuromotor performance. She also wants to determine whether women’s performance drops after sustaining a concussion, how long those changes will last, and whether there are any long-term effects.

“We have a real opportunity to work with the Women’s Football Foundation in their overarching goal to improve the safety of women’s football — to make it safer and to address issues that haven’t otherwise been looked at,” says Duffy, who is also director of UNCG’s Program for the Advancement of Girls and Women in Sport and Physical Activity. “We hope that our work will inform players, coaches, and league stakeholders.”

Ultimately, Duffy hopes to create sex-specific guidelines for when players can return to the game. The researchers also want to craft returnto-work recommendations to ensure that working-age women don’t return to a full workday before they’re healthy enough.

Most current women’s sports research focuses on contact sports, such as soccer or lacrosse, where concussions happen by accident. Duffy’s research is different, highlighting concussions from collision football that result from intentional, aggressive contact. In many instances, concussions in women are blamed on weaker neck muscles, but that assumption doesn’t hold true among female football players, Duffy says. Other factors contribute. For example, she says, pilot data collected from videotaping games of 50 women on two football teams in North Carolina — the Durham Phoenix and the Charlotte Queens — showed that most women play more than one position. This increases time spent on the field and risk of injury.

Duffy’s team assessed the players’ neurocognitive and neuromotor functions at the start, middle, and end of the season, with additional assessments of players diagnosed with a concussion. This year, the researchers plan to gather data from five more teams. All results will be collected in a database and used to determine whether any neurocognitive and neuromotor changes are related to concussion, as well as how collisions that don’t result in diagnosed concussions can impact cognitive function.

Duffy and her team also conducted a women’s health survey with 30 out of the 31 WFF teams. Approximately 700 women answered questions that touched on biological and psychosocial issues women in sports face, including how women portray and negotiate their femininity when not playing a sport. The survey gathered data about a player’s individual and family injury history and broached questions of equity and how women have been treated in their roles as female collision sport athletes.

When all the research is merged, Duffy says, a new picture of female athletes will emerge. “We’re looking to debunk the myths about the stereotypical understanding of what female athletes look like and are built like.”

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2015/12/onlinefall2015.pdf

December 9, 2015 Posted by | Education, Healthcare | , , , , , , , , | Leave a comment

International Voice

Published in the Fall 2015 University of North Carolina at Greensboro Research Magazine

By Whitney L.J. Howell

Women in Sport and Physical Activity Journal — the world’s only peer-reviewed journal dedicated to highlighting issues facing women and girls in sports — now resides at UNCG.

The university’s Department of Kinesiology manages and publishes the journal with Dr. Diane Gill as editor-inchief and Dr. Donna Duffy as managing editor. The publication was acquired for $1 from the National Association for Girls and Women in Sports.

The association asked UNCG to acquire the journal, Duffy says, because of the school’s history as a women’s college. Fusing UNCG’s expertise with women’s sports and the journal’s focus will significantly further what is known about how women play and the challenges they face.

“Purchasing and publishing the journal has elevated our status and the visibility of the program. We have a presence on the international stage,” says Duffy. “We’ll be helping women in sports, physical activity, recreation — in anything where movement is involved.”

In addition to continuing the journal online, UNCG has also resurrected the print version of the journal. After hosting a women’s hockey team from Pakistan, Duffy learned that slow Internet speeds and government controls in some countries significantly limited journal access. Providing print copies circumvents that problem.

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2015/12/onlinefall2015.pdf

December 9, 2015 Posted by | Education, Healthcare | , , | Leave a comment

Movement for Health: Setting the pace nationally in kinesiology

Published in the Fall 2015 University of North Carolina at Greensboro Research Magazine

By Whitney L.J. Howell

Ever since its early days, UNCG has had a strong reputation for excellence in sports, sports medicine, and movement-related health. Today’s kinesiology department has not let that legacy fade. Instead, the faculty are picking up the mantle and carrying it to exciting new places.

Maintaining optimal movement is crucial at any age. It’s vital that we know what impacts motion, how we can preserve it, and — in the worst case scenarios — how to recapture it after injury. Unexpectedly, the big answers aren’t coming in the form of little pills or injections. They’re taking shape as high-tech solutions merged with interventions based on personal physical effort.

At every turn, UNCG is leading the charge not only for the healthy to hold onto their capabilities, but for the injured and cognitively-impaired to reclaim their abilities as well.

Virtual Reality — Not Just For Video Games Anymore

If you walk into Dr. Chris Rhea’s research lab, you might think you’ve walked onto an animated movie set or into the planning stages for video game graphics. At any given point, there’s likely someone covered in reflective dots, walking on a treadmill, or being filmed by a 3D high-definition camera that records the body as a stick figure.

But what you’re really seeing is novel, state-of-the-art research into how individuals who’ve suffered a stroke or had an amputation might learn to reclaim their normal walking patterns.

Rhea’s lab is one of roughly 10 nationwide contributing to this type of research. The main tool supporting his work is virtual reality, or VR. VR itself isn’t new, but it’s just now being applied to this type of medical research, making Rhea’s investigations groundbreaking.

To help individuals who’ve suffered strokes, Rhea pairs the treadmill with a complicated mathematical pattern recognition algorithm and a software program. The software measures the body’s angles, trunk rotation, and limb symmetry to record exactly what the walker does and then runs that data through the algorithm.

Doing so creates an objective, baseline assessment, he says, that is used to build an avatar, which is projected on a split-screen alongside the participant’s walking pattern. Individuals use the avatar as a guide, trying to copy its movements to retrain their bodies into healthy walking patterns.

“Most healthy people have a range of movements within certain signatures, but if you get outside that range, it increases your risk for an injury due to a fall. That’s what we see with stroke patients,” he says. “The software and algorithms give us a quantitative way to measure walking patterns in different clinical populations and help them make changes.”

So far, Rhea’s team has mostly tested this technique with undergraduate students — approximately 600. But nearly 100 participants recruited from local doctors’ offices have contributed as well.

Rhea also works with individuals with amputations, but in a slightly different way. Working closely with clinicians, he and his students designed a VR program that helps these individuals learn how to walk with prosthetic devices without falling. Input from the community clinicians who treat these individuals frequently is critical, he says, to creating a program that pushes a participant’s abilities without exhausting him or her too quickly.

These participants wear a headset, called the Oculus Rift, which simulates a walk through the woods or down a street, so individuals can move at their own pace. Obstacles appear at intermittent times and heights, and participants must navigate around or over them to successfully complete the task.

“The goal with this project is to see if we can train these individuals in a virtual environment to step over objects,” Rhea says. “And can they transfer that ability to the real world?”

As with the research with stroke patients, the lab is still finetuning this technique, using undergraduate students to tweak the methods. It won’t be ready for clinical use until the team has identified which programs are most effective and efficient.

The wait, though, has its benefits. Over the next few years, Rhea’s VR rehabilitation advancements will likely be more affordable and accessible for the broader clinical community. Not only is the software required to run the programs rapidly becoming open-source, meaning it’s freely available to anyone, but the Oculus Rift headset the participants with amputations use to simulate walks is much cheaper than similar equipment purchased in previous years. For example, when Rhea’s group purchased a VR headset in 2011, its price tag was $37,000. Today, the smaller, more portable Oculus Rift exists for a fraction of the cost — $350.

Rhea’s lab has also invested in a new omnidirectional, lowfriction, bowl-shaped treadmill called the Virtuix Omni that is roughly half the size of a standard treadmill. When paired with the lower-cost Oculus Rift, the $500 Virtuix creates an effective rehabilitation system for less than $1,000, well within the budgets of most clinics.

Other elements of Rhea’s work have applications far outside the traditional clinic. With $1 million in funding from the U.S. Department of Defense, his team is designing a smartphone-based app to test whether soldiers injured in the field have sustained a concussion severe enough to be removed from duty.

“This research is important because concussion can range from mild to severe, with the mild version being more difficult to detect — yet it could still have serious implications on balance and cognitive ability,” he says. “There’s not really a good way to test in the field for mild concussions. But the last thing you want is someone with a concussion making life-and-death decisions for themselves or their entire unit.”

Time available to test whether a soldier has sustained a concussion is limited in a combat zone, and usually a combat medic, not a doctor, is the only medical personnel available. Consequently, the military needs an easy-to-use, accurate tool that can diagnose concussion severity within minutes. Rhea’s team is using existing smartphone technology to create one.

Most smartphones contain accelerometers, devices that detect speed, as well as orientation changes. That means they can pick up on subtle balance shifts, Rhea says, making them perfect tools for concussion diagnosis. A field medic can simply Velcro a smartphone with this app to the injured soldier’s thigh and have him or her walk in place for two minutes while the phone collects data on acceleration and side-to-side movements. After 15 seconds of analysis, a green, yellow, or red light will appear, signaling whether the soldier should be removed from duty and given medical attention.

This app could also be useful on the sidelines of high school and college football games, he adds.

Rhea’s team is currently collecting data from and testing the app with civilian patients, some who are healthy and some concussive, as well as with healthy and concussive military personnel. He hopes to have a perfected app to the Department of Defense in less than two years.

Exercise for a Lean, Strong Mind

Physical activity has always been important to Dr. Jennifer Etnier, but she never wondered about how it might impact mental capacity and thought processes until her parents repeatedly asked her to help program their VCR to record football games. Her mother eventually grasped the concept, but her father never did.

“I wondered if there were differences in older adults’ ability to learn and retain novel tasks and whether exercise and physical activity influenced that,” says Etnier. “Can exercise and physical activity help preserve cognitive ability into advanced age?”

To date, that answer has been unclear. Being able to say “yes” could make it easier to motivate older adults to exercise more — if they’re concerned about maintaining their cognitive capacity. Now, Etnier is beginning to do just that. Initial results from her two-year National Institutes of Health-funded research study show staying active can safeguard mental capabilities. In fact, that benefit extends all the way down to school-age children.

To delve into how exercise impacts cognitive performance, Etnier and her team have designed studies with older adults, college students, and elementary pupils.

With adults, Etnier explores whether exercise can safeguard mental faculties of individuals at genetic risk for Alzheimer’s disease. In her study, 54 adults between ages 50 and 65 exercised three times weekly (walking and strength-training). They also completed cognitive evaluations at the study’s start, at four months, and at eight months. The evaluations included recalling words from a list of 15 words read aloud and a Stroop test, where a participant must say the color of ink a word is written in instead of reading the word itself.

Everyone benefited.

“Overall, the group showed improvement in cognition associated with physical activity. This suggests that even those with a genetic risk will receive the benefit,” Etnier says. “It’s very exciting to see how long-lasting these benefits are — could we, perhaps, delay the effects of Alzheimer’s so that someone will die of other causes?”

Her team is also analyzing participants’ blood samples to examine brain-derived neurotrophic growth factor, a protein that is simultaneously responsible for strengthening synapses in the brain and pruning those the brain no longer uses. If physical activity is increasing production of this protein, the researchers may have identified one of the pathways by which physical activity is affecting cognition.

It’s clear, though, she says, that not all exercise is created equal. There could be a sweet spot — an optimal duration and intensity that evokes the best response. Working with UNCG undergraduates, she found those factors do matter, as does the timing of exercise relative to a mental task.

Participating students reviewed a 15-word list and recited the words after three 30-minute sessions on the treadmill at low, medium, and maximum capacity. They then returned 24 hours later to repeat the same word list. The students repeated the activity as a whole five times. Based on their performance, Etnier found that moderate and maximal exercise offered the greatest short-term benefits, but maximum exertion prompted the best performance the next day.

Etnier found further evidence of the importance of timing when studying children in the second, fourth, and sixth grades. Her team tested students after they exerted their maximum effort to complete a one-mile run (fourth and sixth graders) or an eight-minute run (second graders). Half of the children tested reviewed a 15-word list before the run, and half reviewed the word list after the run. They returned and were tested on their word recall 24 hours later. Those who ran prior to hearing the list remembered more words than those who ran after.

“Historically, there have been teachers who were afraid that if students exert themselves highly that it would hurt their academic performance,” she says. “We found that they actually performed better when they ran just before being asked to memorize the words than when they didn’t.”

These findings, she says, support the inclusion of physical education sessions early within the school day.

ACL Injury — Female Hormones At Fault?

Researchers have known for decades that women are more likely than men to suffer injury to the anterior cruciate ligament (ACL) — the ligament responsible for stabilizing the knee during jumping, landing, pivoting, and changing speeds. But the reasons behind this difference are still fuzzy.

Dr. Sandra Shultz has been at the forefront of these investigations since the late 1990s, looking specifically at how hormones might affect knee laxity in women.

“We’ve learned that laxity varies greatly among men and women,” Shultz says. “Women naturally have greater laxity than men. That’s important because research shows that greater laxity increases the risk of injury.”

Laxity refers to the amount of existing ligament looseness. With knees, laxity impacts stability. People with greater laxity tend to land more stiffly, and the knee collapses inward. Injuries occur when the force of impact on the knee overwhelms what the ACL can handle — often, the ligament just isn’t strong enough.

Shultz is investigating the potential for hormones to influence that laxity. Past research has shown that more injuries occur during the first half of a woman’s menstrual cycle compared to the second. Shultz’s team hypothesized that the reason might lie in fluctuations in estrogen, progesterone, testosterone, and possibly relaxin, the hormone most responsible for ligament laxity during pregnancy.

To test these changes, the team gathered blood samples from female undergraduate students, measuring their knee laxity on the same days the samples were drawn. They then identified the days of minimum and maximum laxity in each female’s cycle. On those days, subjects were asked to perform a landing maneuver while the researchers measured their lower extremity movement patterns. As expected, on days of maximum laxity, subjects exhibited movement patterns that are associated with a higher risk for injury.

The researchers assessed each subject’s hormone levels and other blood markers on days of minimum and maximum laxity. What they found? Not only do hormone changes correlate with changes in observed laxity, they also correlate with changes in collagen metabolism — in a way that can alter the makeup and structural integrity of soft tissue. These changes most likely contribute to a structurally weaker ligament and render the knee less mechanically stable at certain times of the month.

Dr. Randy Schmitz, Shultz’s colleague, is also adding to what researchers know about ACL injury and recovery. He’s following women who’ve had surgery for ACL injury to observe how their knee cartilage changes in the six months post-operation. He wants to know whether those early changes can predict how the subjects will walk over time. Such knowledge could impact rehabilitation. Figuring out better ways to treat or possibly prevent ACL injuries in females is critical, Shultz says, because the impact is lifelong. The majority of ACL injuries happen between ages 14 and 15, and arthritis sets in within 10 years to 15 years. That means injured young women can have arthritic knees — and face a future of knee replacements — by age 30.

Having a greater understanding of the variability of who’s at risk will help Shultz and her team better understand who to target for intervention.

“These injuries add up to missed time in sports and activities and an increase in potential long-term complications,”Shultz says. “Ultimately, we want to understand what factors increase knee laxity, and then determine if laxity can be changed or not through prevention and strengthening, since some evidence suggests that more muscle mass around the knee is associated with less knee joint laxity.”

Taken together — and individually — the ongoing work inside labs led by Rhea, Etnier, Shultz, and Schmitz continues to move the needle in the right direction for what we know about healthy movement and how the human body and brain can help themselves. Over time, their investigations hold great promise for combatting and, potentially, preventing and conquering some of the most common causes of impaired motion that both men and women face.

To read the article at its original location: http://research.uncg.edu/wp-content/uploads/2015/12/onlinefall2015.pdf

December 9, 2015 Posted by | Education, Healthcare | , , , , , , , , , , , , , , , | Leave a comment

Radiologist’s Guide to Informed Patient Consent

Published on the Dec. 8, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

CHICAGO — One of the most important issues facing radiology – both diagnostic and interventional – is informed patient consent, Stuart G. Silverman, MD, Harvard Medical School professor of radiology and director of abdominal imaging and intervention at Brigham and Women’s Hospital, said at RSNA 2015.

Along with colleagues, Silverman published a study in the Journal of Vascular Interventional Radiology November issue that discussed how vital informed patients are.

“Informed consent requires patient involvement, and this will happen even more so in the future,” he said. “Patients must understand their condition and the procedure, and they must also understand the benefits and risks presented by any proposed procedure.”

And securing proper informed consent means covering three key aspects. The interaction must be patient-centered, legally-sound, and quality-driven.

Patient-centered
Before presenting a patient with a written consent form and asking for a signature, take the time to get to know him or her. Learn what a patient believes about a procedure and what the desired outcome is. Explain the procedure fully, but be prepared to close the conversation without a consent signature.

“Consent is a collaborative goal, and a patient must know you’re working together to meet his or her wants,” Silverman said.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/rsna-2015/radiologists-guide-informed-patient-consent

December 8, 2015 Posted by | Healthcare | , , , , , | Leave a comment

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