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Showing posts with label McMaster. Show all posts
Showing posts with label McMaster. Show all posts

Monday, August 8, 2022

What is health journalism?

According to wikipedia that there are not many courses or career paths specifically on medical journalism, but it is hard to imagine that this field is not going to expand in future.

Recently the McMaster Daily News  reported on a YouTube channel called ViolinMD created by Dr. Siobhan Deshauer. She was a fifth year medical resident (recently finished residency successfully) but has been vlogging about her experience quite frequently since she started residency. She was a graduate of the Michael G. DeGroote school of medicine, which is why you can get a BA in music (violin) and still get into a medical school like McMaster. In one of the episodes she mentions "medical journalism" as she did a stint doing such for ABC news as a consultant on their medical news team. I can't recall that specific episode  - because I have watched so many of them -  but we can imagine that one of the reasons she got that consultancy work was because of her creative media skills vlogging her real lived experience on the front lines.

In Canada one of the most famous medical journalists might be Andre Picard, health columnist for the Globe and Mail. His recent book "Neglected No More:The Urgent Need to Improve the Lives of Canada's Elders in the Wake of a Pandemic", shed a lot of light on the state of long term care in the Canadian system.

There is a health column in the New York times called "Diagnosis" written by Lisa Sanders MD, who used write scripts for the TV Series House. I watched the TV documentary version of it about solving rare medical mysteries, like it is detective work.  Of course there are the likes of Sanjay Gupta, Chief Medical Correspondent for CNN, etc.

There are also investigative journalism books that really delve into medical issues. Michael Pollan wrote "How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence" which is a master study of psychedelics research. The book by author  James Nestor called "Breath: The New Science of a Lost Art" is a pioneering investigation into the new research and evidence on human breathing and the effect on our overall health. It is fascinating to see how these science minded though "non-health practitioners" explore these fields so relevant to medical well being.  There are many more books by journalists that explore medical and health issues. 

An area tangential to all this are the scientists who study the reporting of health information in various media looking for evidence of factual inaccuracy, let alone stories that create false hope or deceive the public. Timothy Caulfield is famous for debunking the myths and misconceptions, and the McMaster Health Forum has an evidence based health research group focusing on policy decision making for various health topics of concern.

Monday, March 23, 2020

Anxiety about coronavirus can increase the risk of infection — but exercise can help

Anxiety about coronavirus can increase the risk of infection — but exercise can help



Stress about the coronavirus pandemic can actually increase your risk of infection, but exercise can alleviate the immune system’s stress response. Above, a lone jogger in Ottawa, on March 17, 2020. THE CANADIAN PRESS/Adrian Wyld
Jennifer J. Heisz, McMaster University
Worried about COVID-19? You may be putting yourself at undue risk, because chronic anxiety suppresses the immune system and increases our risk for infection.
The psychological impact of the COVID-19 pandemic is causing incredible distress. I ran into a friend at the grocery store the other day. She was wiping down her cart with antiseptic. Under normal circumstance, this behaviour would seem bizarre, but in the current COVID-19 climate, it has become acceptable.
Although it is important to be prepared during this pandemic, we do not need to panic. Physical activity can help protect the immune system from the effects of stress.

Fear of the unknown

As an associate professor in the department of kinesiology at McMaster University, I direct a team of researchers in the NeuroFit Lab, where we’ve shown that psychological distress can compromise mental health.
Anxiety about the unknown (such as our risk of COVID-19) can hyperactivate the fear centre in the brain called the amygdala. In terms of evolution, this is one of the oldest parts of the brain and its operations are quite primitive; it acts like a trigger-happy alarm that interfaces with the stress system to keep our body and mind on high alert for as long as we are feeling anxious. Research shows that the mere suggestion of danger, even if it never is experienced, is enough to trigger the amygdala and activate the stress response. This is what keeps people awake at night, lying in bed worrying about COVID-19.
The problem is that chronic activation of the stress systems can damage our cells and upset many of the body’s functions. Our immune system bears the brunt. Although psychological stress is not pathogenic per se, the damage it causes to the body’s cells triggers an immune response that makes us more susceptible to a foreign pathogen. This may increase our risk for infection with SARS-CoV-2, the coronavirus that causes COVID-19.

Worried sick

The immune system acts like border security, patrolling the body for cells that are foreign and harmful to it. It works a lot like the Nexus or Global Entry programs for pre-approved travellers; anyone enrolled in the program has their iris scanned to quickly confirm their identity for fast border crossing. But instead of iris scanning, the immune system scans the outer surface of a cell for its biological passport, or what scientists call a motif.
The body’s cells have a motif (a “self” motif) that’s different from the “non-self” motif of foreign cells and pathogens, like SARS-CoV-2. This non-self motif is known as a pathogen-associated molecular pattern (PAMP).


Concerns about COVID-19 led crowds to stock up on supplies. Here, people line up at a Costco in Ottawa on March 13, 2020. THE CANADIAN PRESS/Justin Tang

Another type of motif is the “damaged self” motif, known as a damage-associated molecular pattern, or DAMP. This motif is expressed by a damaged or dying cell that no longer serves the body. Stress damages the body’s cells, transfiguring self motifs into damaged self motifs. This elevates inflammation throughout the body in a similar way as if it were infected. This response, in the absence of an actual infection, is called a sterile immune response.
Chronic over-worrying about COVID-19 can intensify our vulnerability to viruses by creating an imbalance in immune function. This is because the immune system reacts to multiple breaches in immunity in a similar way that airport security reacts to multiple breaches in safety, by escalating the response. Think back to how vigilant airport security became after 9/11, implementing the strictest screening procedures for all passengers and luggage.

Read more: Coronavirus weekly: expert analysis from The Conversation global network

Excessive anxiety about COVID-19 can trigger an immune response that increases inflammation and readies the immune system’s equivalent of special forces, known as inflammasomes. If SARS-CoV-2 acts like other viruses, then upon infection the inflammasomes will be called to action to escalate inflammation even further. But too much inflammation does more harm than good; it deregulates immune function, increasing our risk of a viral infection.
My lab recently demonstrated how quickly our health declines under chronic stress. We tracked sedentary but otherwise healthy students during the weeks leading up to their final exams, and we observed how six weeks of stress gave rise to the symptoms of depression.

Resisting the effects of anxiety

What can we do to prevent panic and bolster immune protection?
Physical activity can protect your body from chronic stress-induced inflammation.
In our study, during that same stressful six-week period, we enrolled some of the students in a new exercise program in which they cycled on a stationary bike at moderate intensity for approximately 30 minutes, three times per week. Moderate intensity exercise is about 40 per cent of maximum workload: the point at which someone can still talk, but can’t sing.
Blood samples were collected to track changes in inflammation. Although the exercisers were exposed to the same psychological stressors as the sedentary students, their inflammation remained low and their mood remained high with no increase in symptoms of anxiety or depression.
But the intensity of the exercise mattered. Higher intensity exercise was not as effective at protecting mental health or reducing inflammation. The vigorous nature of the intense exercise may have exacerbated an already stressed-out system, especially in individuals who were not accustomed to exercise.
The key take-away from our research: a brisk walk, jog or bike ride can help keep you calm and healthy during these uncertain times so you can be prepared without the panic.The Conversation
Jennifer J. Heisz, Associate Professor in Kinesiology and Associate Director (Seniors) of the Physical Activity Centre of Excellence, McMaster University
This article is republished from The Conversation under a Creative Commons license. Read the original article.

Saturday, December 16, 2017

The Future of eHealth

A Health Research Methology graduate course in the MSc eHealth program at McMaster University has a class on the future of ehealth. It was one of my favourite classes when I was a student 8 years ago, and I was asked to be the tutorial facilitator for it for the past several years. Part of the course content was a video scenario of what a future patient physician encounter will look like.  I will embed the video I just found on Youtube:

The encounter is very humanistic in spite of the technology and involves a lot of artificial intelligence in the form of voice interaction. There is also plenty of newer user interfaces - transparent augmented reality medical records - and instant appointment and medical record searching.

Another article to read for that class is by Vannevar Bush called "As We May Think", written in July 1945. Dr. Bush was the Director of Scientific Research and Development for the United States Government. He writes about something he calls a "memex" which would be very much like the computers we are using today.  At that time, there was an explosion of scientific knowledge around the world but there was no way to organize that knowledge or search on it. It is an interesting article to read if you try to imagine what someone writing the article today would have to say about technology or medicine 70 years from now, and actually coming to close to painting an accurate picture about it. If technology is changing exponentially, will that even be possible?

The explosion of knowledge has continued since then and we collect, distribute and analyze it daily as it arrives in our twitter and facebook feeds. A lot of the information that can be gleaned about the future of eHealth is thus kind of "grey literature" and not something that you can search and find on PubMed. These days I find viewing video stories on futurism.com the best ways I know to become excited about the future. "The pull of the future is greater than the push from the past" - I am still trying to find out which famous philosopher or scientist said that.

Here are just a few of the sources suggestive of the future of eHealth that I have been following with interest.  The first is Ray Kurzweil and his Accelerating Intelligence website.  Ray is a computer scientist and inventor who believes in transhumanism and indefinite life extension.  His group is always following the latest scientific advances and inventions of all kinds, and not just ones related to health technology. For example, I just read today a story they posted about a new kind of RFID tag for patients. This tag:
The RFID tags measure internal body motion, such as a heart as it beats or blood as it pulses under skin. Powered remotely by electromagnetic energy supplied by a central reader, the tags use a new concept called “near-field coherent sensing.” Mechanical motions (heartbeat, etc.) in the body modulate (modify) radio waves that are bounced off the body and internal organs by passive (no battery required) RFID tags.

The modulated signals detected by the tag then bounce back to an electronic reader, located elsewhere in the room, that gathers the data. Each tag has a unique identification code that it transmits with its signal, allowing up to 200 people to be monitored simultaneously.

A recent news feed I have been following is the Medical Futurist, Dr. Bertalan Mesko. Recently Dr. Mesko has had some involvement consulting with the Government of Canada, as you may read in his article: "Canada Brings Automation to Healthcare: An Example for Governments to Follow". Really worth following on Twitter or Facebook.

Another group that is interesting, but they are more about the current state and the breaking trends of Medicine and eHealth, is the Exponential Medicine group lead by Dr. Daniel Kraft- a part of the Singularity University. Similarly, there is the ongoing work and research of Dr. Eric Topol. Most of the students in my eHealth class that I was facilitating hadn't even heard of Dr. Topol so I was a bit taken aback.

In short, if you are not interested in the future of eHealth, I don't think there is any way that one would appreciate the changes that are currently going on.  In fact, the guest lecturer at the McMaster future of eHealth class, Dr. Ted Scott, Vice President Research & Chief Innovation Officer, did not talk about the future so much as he did about current innovations that are starting within the Hamilton Health Sciences. And this just made me think of something I learned when I was a student of anthropology many years ago, that yesterday's pseudo-science and magic is todays science.


Friday, February 24, 2017

The myUHN Patient Portal - Infoway Award Winner


The myUHN patient portal has won a second place award from a Canada Health Infoway contest. Here is the presentation they gave:
 http://imaginenationchallenge.ca/wp-content/uploads/2017/02/myUHN-Patient-Portal.pdf

Their infographic on the uptake of the portal is very impressive by the numbers - numbers which have been suggested as viable in research on patient portals (They didn't mention concern for the security of personal health information):
 http://www.uhn.ca/corporate/News/Documents/myUHN_infographic.pdf

The pilot study is over and a full launch began January 30, 2017. It is expected that 250,000 patients will register for it in 2017! Very, very interesting that the portal is integrated into all stages of the clinical experience and by all personnel.

Based on my research on patient portals this looks to be the very promising. Sunnybrook Hospital myChart was also a great pioneer in this area and they have taken a page from their book. It also appears to be an ideal integration solution that I think would work best for a healthcare system.

But what about primary care? Is there an API for that? And why are family docs still so worried about liability or whatever for using a PHR?

Looking closer at myUHN it is very much just a portal or window on the hospital EHR, with a limited but very useful and important set of interaction tools. It is not a personal health record where one can self-report and journal one's health, as is the one developed by McMaster Family Medicine, now called KindredPHR.

If I get sick, I am going to Toronto and the UHN:
 http://www.uhn.ca/PatientsFamilies/myUHN







Friday, March 4, 2016

Health Informatics is Coming to Hamilton

More than several news stories are reporting about Health Informatics projects coming out or going into Hamilton in the last week or so. The first story was about CareKitHealth, which was a start-up company at The Forge and McMaster Innovation Park. This story broke for me when I read that the company was bought by the British Columbia based mHealth group Moseda.

The second story that really caught the attention of all Hamiltonians was IBM moving into six floors of the seemingly derelict Stelco Tower. The reason why is to do Health Informatics research. I would really like to find out what kind of Health Informatics research IBM will do there but it sounds like Watson Big Health Data Analytics to me. There will probably be many jobs and co-op opportunities for McMaster and Mohawk Health Informatics students, as IBM is partnering with Hamilton Health Sciences.

Then to top that off McMaster Health Sciences researchers scored a very large grant and funding:
A Hamilton team of researchers led by McMaster is receiving a total of $12.3 million to advance a remote monitoring and care system, called SMArTVIEW, for post-operative patients.
The Canadian Institutes for Health Research (CIHR) today announced a $750,000 grant for the project through its eHealth Innovation Partnership Program (eHIPP).
An additional $11.6 million of in-kind support is coming from industry and other partners for the development and testing of the SMArTVIEW technological system that could save people facing life-threatening complications after surge
See more at: http://dailynews.mcmaster.ca/article/innovations-in-wireless-patient-monitoring-and-care-attract-federal-support/ 
Now every time I hear about another Health Hackathon I wish I could have participated more!












Research






March 3, 2016

Innovations in wireless patient monitoring and care attract federal support

A Hamilton team of researchers led by McMaster is receiving a total of $12.3 million to advance a remote monitoring and care system, called SMArTVIEW, for post-operative patients.
The Canadian Institutes for Health Research (CIHR) today announced a $750,000 grant for the project through its eHealth Innovation Partnership Program (eHIPP).
An additional $11.6 million of in-kind support is coming from industry and other partners for the development and testing of the SMArTVIEW technological system that could save people facing life-threatening complications after surgery.
Tens of thousands of seniors undergo cardiac and vascular surgeries in Canada and the United Kingdom each year, but studies have measured chronic postoperative pain in up to 40 per cent of patients at three months after surgery and hospital readmission at up to one in five patients.
Current systems for monitoring those patients after surgery are “inadequate,” says Michael McGillion. An associate professor of the School of Nursing, McGillion is principal investigator for the project. Co-principal investigator is P.J. Devereaux, professor of clinical epidemiology and biostatistics and medicine for McMaster’s Michael G. DeGroote School of Medicine.
With SMArTVIEW, a wireless information system connects specially-trained nurses to patients through tablets and other wireless devices. The nurses will monitor patients remotely and keep track of vital signs and provide education to improve patients’ recovery.
THE SMArTVIEW stands for TecHnology Enabled remote monitoring and Self-MAnagemenT: VIsion for patient EmpoWerment.
The research, to take place in Ontario and the U.K., will focus on remote, continuous monitoring and recovery support for eight weeks post hospital discharge. Several studies over four years will measure the effectiveness and efficiencies.
The Hamilton-based research team includes members of McMaster, Hamilton Health Sciences, the Population Health Research Institute and Mohawk College, along with members from the University of Toronto and Coventry University in the U.K.
“With SMArTVIEW and this research, we’ll be able to move from futuristic concepts to real-life care that’s in widespread use, based on evidence of real-world impact,” said McGillion.
“We are fortunate to be working with drivers of eHealth innovation including our lead technology partner, Philips Canada, along with QoC Health, a patient-engagement platform; XAHIVE, a secure communications service, and mPath, a mobile application developer.
“Looking ahead, we have the opportunity to reduce the global risk of serious complications following cardiac and vascular surgery by making continuous patient monitoring and virtual support, from hospital to home, a reality.”
The CIHR eHIPP was established to identify patient-oriented eHealth solutions that will improve health outcomes, patient experience and lower health costs, as well as foster partnerships between researchers and industry.
- See more at: http://dailynews.mcmaster.ca/article/innovations-in-wireless-patient-monitoring-and-care-attract-federal-support/#sthash.DYvts11Q.g8hE1sD3.dpuf

Research






March 3, 2016

Innovations in wireless patient monitoring and care attract federal support

A Hamilton team of researchers led by McMaster is receiving a total of $12.3 million to advance a remote monitoring and care system, called SMArTVIEW, for post-operative patients.
The Canadian Institutes for Health Research (CIHR) today announced a $750,000 grant for the project through its eHealth Innovation Partnership Program (eHIPP).
An additional $11.6 million of in-kind support is coming from industry and other partners for the development and testing of the SMArTVIEW technological system that could save people facing life-threatening complications after surgery.
Tens of thousands of seniors undergo cardiac and vascular surgeries in Canada and the United Kingdom each year, but studies have measured chronic postoperative pain in up to 40 per cent of patients at three months after surgery and hospital readmission at up to one in five patients.
Current systems for monitoring those patients after surgery are “inadequate,” says Michael McGillion. An associate professor of the School of Nursing, McGillion is principal investigator for the project. Co-principal investigator is P.J. Devereaux, professor of clinical epidemiology and biostatistics and medicine for McMaster’s Michael G. DeGroote School of Medicine.
With SMArTVIEW, a wireless information system connects specially-trained nurses to patients through tablets and other wireless devices. The nurses will monitor patients remotely and keep track of vital signs and provide education to improve patients’ recovery.
THE SMArTVIEW stands for TecHnology Enabled remote monitoring and Self-MAnagemenT: VIsion for patient EmpoWerment.
The research, to take place in Ontario and the U.K., will focus on remote, continuous monitoring and recovery support for eight weeks post hospital discharge. Several studies over four years will measure the effectiveness and efficiencies.
The Hamilton-based research team includes members of McMaster, Hamilton Health Sciences, the Population Health Research Institute and Mohawk College, along with members from the University of Toronto and Coventry University in the U.K.
“With SMArTVIEW and this research, we’ll be able to move from futuristic concepts to real-life care that’s in widespread use, based on evidence of real-world impact,” said McGillion.
“We are fortunate to be working with drivers of eHealth innovation including our lead technology partner, Philips Canada, along with QoC Health, a patient-engagement platform; XAHIVE, a secure communications service, and mPath, a mobile application developer.
“Looking ahead, we have the opportunity to reduce the global risk of serious complications following cardiac and vascular surgery by making continuous patient monitoring and virtual support, from hospital to home, a reality.”
The CIHR eHIPP was established to identify patient-oriented eHealth solutions that will improve health outcomes, patient experience and lower health costs, as well as foster partnerships between researchers and industry.
- See more at: http://dailynews.mcmaster.ca/article/innovations-in-wireless-patient-monitoring-and-care-attract-federal-support/#sthash.DYvts11Q.g8hE1sD3.dpuf

Research






March 3, 2016

Innovations in wireless patient monitoring and care attract federal support

A Hamilton team of researchers led by McMaster is receiving a total of $12.3 million to advance a remote monitoring and care system, called SMArTVIEW, for post-operative patients.
The Canadian Institutes for Health Research (CIHR) today announced a $750,000 grant for the project through its eHealth Innovation Partnership Program (eHIPP).
An additional $11.6 million of in-kind support is coming from industry and other partners for the development and testing of the SMArTVIEW technological system that could save people facing life-threatening complications after surgery.
Tens of thousands of seniors undergo cardiac and vascular surgeries in Canada and the United Kingdom each year, but studies have measured chronic postoperative pain in up to 40 per cent of patients at three months after surgery and hospital readmission at up to one in five patients.
Current systems for monitoring those patients after surgery are “inadequate,” says Michael McGillion. An associate professor of the School of Nursing, McGillion is principal investigator for the project. Co-principal investigator is P.J. Devereaux, professor of clinical epidemiology and biostatistics and medicine for McMaster’s Michael G. DeGroote School of Medicine.
With SMArTVIEW, a wireless information system connects specially-trained nurses to patients through tablets and other wireless devices. The nurses will monitor patients remotely and keep track of vital signs and provide education to improve patients’ recovery.
THE SMArTVIEW stands for TecHnology Enabled remote monitoring and Self-MAnagemenT: VIsion for patient EmpoWerment.
The research, to take place in Ontario and the U.K., will focus on remote, continuous monitoring and recovery support for eight weeks post hospital discharge. Several studies over four years will measure the effectiveness and efficiencies.
The Hamilton-based research team includes members of McMaster, Hamilton Health Sciences, the Population Health Research Institute and Mohawk College, along with members from the University of Toronto and Coventry University in the U.K.
“With SMArTVIEW and this research, we’ll be able to move from futuristic concepts to real-life care that’s in widespread use, based on evidence of real-world impact,” said McGillion.
“We are fortunate to be working with drivers of eHealth innovation including our lead technology partner, Philips Canada, along with QoC Health, a patient-engagement platform; XAHIVE, a secure communications service, and mPath, a mobile application developer.
“Looking ahead, we have the opportunity to reduce the global risk of serious complications following cardiac and vascular surgery by making continuous patient monitoring and virtual support, from hospital to home, a reality.”
The CIHR eHIPP was established to identify patient-oriented eHealth solutions that will improve health outcomes, patient experience and lower health costs, as well as foster partnerships between researchers and industry.
- See more at: http://dailynews.mcmaster.ca/article/innovations-in-wireless-patient-monitoring-and-care-attract-federal-support/#sthash.DYvts11Q.g8hE1sD3.dpuf

Research






March 3, 2016

Innovations in wireless patient monitoring and care attract federal support

A Hamilton team of researchers led by McMaster is receiving a total of $12.3 million to advance a remote monitoring and care system, called SMArTVIEW, for post-operative patients.
The Canadian Institutes for Health Research (CIHR) today announced a $750,000 grant for the project through its eHealth Innovation Partnership Program (eHIPP).
An additional $11.6 million of in-kind support is coming from industry and other partners for the development and testing of the SMArTVIEW technological system that could save people facing life-threatening complications after surgery.
Tens of thousands of seniors undergo cardiac and vascular surgeries in Canada and the United Kingdom each year, but studies have measured chronic postoperative pain in up to 40 per cent of patients at three months after surgery and hospital readmission at up to one in five patients.
Current systems for monitoring those patients after surgery are “inadequate,” says Michael McGillion. An associate professor of the School of Nursing, McGillion is principal investigator for the project. Co-principal investigator is P.J. Devereaux, professor of clinical epidemiology and biostatistics and medicine for McMaster’s Michael G. DeGroote School of Medicine.
With SMArTVIEW, a wireless information system connects specially-trained nurses to patients through tablets and other wireless devices. The nurses will monitor patients remotely and keep track of vital signs and provide education to improve patients’ recovery.
THE SMArTVIEW stands for TecHnology Enabled remote monitoring and Self-MAnagemenT: VIsion for patient EmpoWerment.
The research, to take place in Ontario and the U.K., will focus on remote, continuous monitoring and recovery support for eight weeks post hospital discharge. Several studies over four years will measure the effectiveness and efficiencies.
The Hamilton-based research team includes members of McMaster, Hamilton Health Sciences, the Population Health Research Institute and Mohawk College, along with members from the University of Toronto and Coventry University in the U.K.
“With SMArTVIEW and this research, we’ll be able to move from futuristic concepts to real-life care that’s in widespread use, based on evidence of real-world impact,” said McGillion.
“We are fortunate to be working with drivers of eHealth innovation including our lead technology partner, Philips Canada, along with QoC Health, a patient-engagement platform; XAHIVE, a secure communications service, and mPath, a mobile application developer.
“Looking ahead, we have the opportunity to reduce the global risk of serious complications following cardiac and vascular surgery by making continuous patient monitoring and virtual support, from hospital to home, a reality.”
The CIHR eHIPP was established to identify patient-oriented eHealth solutions that will improve health outcomes, patient experience and lower health costs, as well as foster partnerships between researchers and industry.
- See more at: http://dailynews.mcmaster.ca/article/innovations-in-wireless-patient-monitoring-and-care-attract-federal-support/#sthash.DYvts11Q.g8hE1sD3.dpuf

Saturday, December 19, 2015

Fall Prevention - From the Optimal Aging Portal

I volunteer with McMaster Family Medicine in the Tapestry program. We visit seniors who have volunteered to be in this research study. We bring an iPad and take a health survey. We also ask if they want to sign in to the McMaster Personal Health Record, which is integrated into the OSCAR EMR.  Many of the clients we have met have had falls.

Just saw this article on the McMaster Optimal Aging Portal about fall prevention. Because I have practiced Tai Chi for more several decades, and because I value the work of the Portal and the plain language systematic reviews and evidence based research they present to the public, I will post this here. It would be great if more people, both citizens and health professionals, could subscribe to the Portal.

Steady on your feet: New ways to improve balance and avoid falls


Dec 18, 2015
When it comes to keeping your feet safely on the ground – metaphorically and literally – it’s all about balance. But like many other things we take for granted when we’re young (strength, endurance, bone density, a full head of hair...) our sense of balance declines as we age. That’s one reason why older adults are at greater risk of falling and potentially becoming seriously hurt or even dying as a result (1).

Past research has shown that regular physical activity can help prevent falls, particularly when it includes exercises and movements designed to improve balance (2). Tai Chi for example, is recommended for its various benefits, including improving strength and balance through slow, controlled movements (3,4).

But if Tai Chi isn’t for you, there are other options you many want to consider. One recent systematic review of six studies measured the benefits of Pilates, a mind-body exercise program that has been popular since the early 20thcentury. Like Tai Chi, it involves controlled movements and concentrates on flexibility, strength, posture and breathing (5). Each study included older adult participants who took part in group Pilates sessions. The exercises varied (mat exercises as well as exercises using elastic bands, weights or other equipment), and included at least 2hrs of Pilates each week. The study participants were compared with a control group who kept up their usual daily activities but did not take Pilates.

Another emerging form of balance training that is gaining attention for its novel approach is “perturbation-based balance training” or balance recovery training. It focuses on improving people’s reaction time and helping them better recover from a loss of balance (6). Training can include equipment (such as moving platforms), or manual interference (such as nudges by a therapist) to enhance your ability to react and stop yourself from falling.

A recent systematic review of eight randomized controlled trials examined whether perturbation-based balance training lowers the risk for falls in older adults as well as people with neurological disorders such as Parkinson’s disease (6). More than 400 people between the ages of 50 and 98 took part in perturbation-based balance training and were compared with those in control group who participated in other types of balance enhancing exercises.

What the research tells us

Both Pilates and perturbation-based balance training appear to be promising strategies for helping older adults avoid falls and the resulting serious consequences.

Despite limitations in the quality of the Pilates studies the results suggest that Pilates is a promising way to help improve balance (5). So far the evidence on perturbation-based balance training is also encouraging: participants completing the training reported fewer falls and were less likely to fall, compared with those in the control groups (6). Further research is needed but there is cautious optimism that this approach may help people react and recover their balance more quickly so that a slip or trip doesn’t necessarily have to end in a fall.

Not sure which balance training exercises are best for you? Ask your doctor or physical therapist, or give these activities a try! At the same time, be aware of hazards and take the necessary precautions (e.g. good lighting, clear pathways, secure handrails etc.) so that you remain surefooted and safe as you enjoy an active lifestyle (7).


The Bottom Line

  • Older adults have a greater chance of falling and experiencing serious injury or even death.
  • Exercises aimed at improving balance have been shown to help prevent falls.
  • Initial studies of Pilates exercises (involving controlled movements to build flexibility, strength and posture) suggest it has the potential to improve balance.
  • Balance-recovery training aims to improve reaction time after a loss of balance and also appears to help lower risk of falls.
  • More high quality studies are needed to learn more about the benefits of Pilates and balance-recovery training.

References

  1. Centers for Disease Control and Prevention (CDC). Falls among older adults: an overview. [Internet] 2012. [cited Dec 2015] Available from: http://www.cdc.gov/homeandrecreationsafety/falls/adultfalls.html.
  2. Gillespie LD, Robertson MC, Gillespie WJ et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; 9:CD.007146.
  3. Mat S, Tan MP, Kamaruzzaman SB, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015; 44:16-24.
  4. Leung DP, Chan CK, Tsang HW, et al. Tai chi as an intervention to improve balance and reduce falls in older adults: A systematic and meta-analytical review. Altern Ther Health Med. 2011; 17:40-48.
  5. Barker, AL, Bird M, Talevki J. Effects of Pilates exercise for improving balance in older adults: A systematic review with meta-analysis. Arch Phys Med Rehabil. 2015; 96:715-723.
  6. Mansfield A, Wong JS, Bryce J et al. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Phys Ther. 2015; 95:700-709.
  7. Public Health Agency of Canada (PHAC). You Can Prevent Falls. Ottawa, Canada. [Internet] 2011. [cited Dec 4, 2015] Available from: http://www.phac-aspc.gc.ca/seniors-aines/publications/public/injury-blessure/prevent-eviter/index-eng.php 



AUTHOR DETAILS

Optimal Aging Portal Blog Team

The latest scientific evidence on this topic was reviewed by the McMaster Optimal Aging team. Blog Posts are written by a professional writer, assessed for accuracy by Dr. Maureen Dobbins, an expert in interpreting and communicating the scientific literature, and edited by a professional editor. There are no conflicts of interest.

Wednesday, July 1, 2015

Fitbit and Personal Health Informatics

A surprise gift for father's day was a Fitbit ChargeHR. The HR stands for Heart Rate, that measures beats per minute (BPM). It doesn't measure blood pressure, and I don't think any device like this on the wrist will be able to do that soon. I have been counting my walking distances, steps up stairs, calories and sleep activity for about a week now. It feels good to have entered the world of the "quantified self "and big data personal health informatics at more than just a theoretical level, as I have been doing on this blog for the past 4 years. I actually have a blog post about Fitbit from 3 years ago <here>!

The data is sent wirelessly to a small "dongle" on my MacBook anytime I am within 20 feet of it. I was surprised to see how this data easily integrated with Telus (Microsoft) Health Space (Healthvault) from the Fitbit.com login settings account. The power of the API is truly awesome.

As I knew before when I was looking at reviews for smart watches, the Fitbit ChargeHR is not a great watch for telling the time. However, one advantage is I find myself saving a lot of time by not looking at my watch to find out what time it is so often. All in all, I find myself wanting to wear it more than the old watch.

Sleeping with the watch is perfectly unobtrusive. There are continual double green sensor lights flashing for the BPM readings but it is hidden under the wrist. At a different viewing angle you can see the green lights. Double tapping at night will illuminate the clock (and day of the month) but during the day it is very difficult to see the digital time in glare of light of day. When you wake in the morning, sleep activity data is automatically transmitted to the MacBook or the Fitbit app on the iPad. via the dongle. The sleep data is a bit hard to interpret. Did I really only get 5 hours sleep? Anyway, I am starting to make some sense of the times I may have been awake or restless.

If you set a goal for 10,000 steps it will buzz on your wrist when you achieve the goal. You are also sent an email congratulating you, which is repeated in the weekly email data digest updates. I tracked food consumption for data on calories, sodium levels, etc. for a few days, and this is very interesting information for me. Since I have not really changed weight since I was a teenager, I don't really have any weight goals, but I know I can align readings from the gym equipment which tracks BPM and calories burned with the Fitbit. When I am not going to the gym, I can utilize those readings. But like I said, watching calories burned is not a science I follow much because of my metabolism.

Even though the data is integrated into the Telus HealthSpace, which is a free personal health record if you have a Microsoft login, I still don't find myself using the personal health record that much (yet). I also have a McMaster PHR (former MyOSCAR) and a Health and Wellness Companion PHR through my employer's health insurance company, in both of which I have just stepped into the shallow end of the pool. I tend to keep a Word document log and paper file of health related events a lot more. If the PHR was integrated with our family health team, I am sure I would use it more.

So, I think we are still a way off from wider adoption of personal health records as integrated tools for the physician's electronic medical record. A lot depends on more research, and of course evolving software breakthroughs like APIs. I am a community volunteer with the McMaster University Family Medicine TAPESTRY program, and I can see first hand the uptake on PHRs and how much education and training is required before they are being used effectively. On our visits to seniors in our communities we also help promote the use of the McMaster PHR. Like any technology, and the toothbrush comes to mind, use comes from developing good habits, as well as promotion from health care professionals.

Because we have entered a digital culture, many people will be entering a personal health record, not through their family medicine clinic, but through some form of personalized health informatics, like Fitbit data, or smart phone apps. There will be a point when physician medical practices will want to buy into accessing or making that data available.


Friday, September 27, 2013

eHealth Sources of Wellness

Disclaimer: opinions expressed here do not necessarily represent the policy of McMaster University, where I am employed.

I was checking the student wellness website at McMaster and immediately saw the eHealth application and benefit. First, there was a list of apps for smartphones on wellness and fitness <here>. Since I don't have a smartphone I can't testify about the worth of these apps. All I know is that everybody (and their dog) these days you see on the street is staring more at a phone than anything else in the environment. McMaster's employees website also have excellent resources for health and wellness, part of that movement toward corporate wholeness and a healthy workplace.

Another one of the great resources I found on the McMaster website was a link to a depression symptom checker. Now, that is the sort of thing you can find on some of the major consumer health websites, but this depression checklist was very good - had received research testing, face validity, evaluation etc. Problem is, I can't find the link to it now, but it was kind of like this one < here >. Maybe that is why people use the common consumer health websites - stuff is easy to find there. The thing is, if depression is part of ones' own personal health inventory, these should be integrated into one's personal health record, which should be easy to find, and accessed as often as one uses a tooth brush.

Should a personal health record also include apps and records for wellness and fitness, and counselling resources, and yoga videos, dental x-rays, MMR shots, etc.? Yes I think they should. This was also a question I once asked the late Kevin Leonard at a health informatics conference. At that time people at the conference were thinking mostly about personal health records as portal views of the physician's electronic medical record. Kevin thought everything related to one's health should be accessible in a electronic health record. Dr. Leonard was one of the leading advocates for personal wellness in the age of electronic health records. When I learned that he died of complications from pneumonia and that he had Crohns, I can understand more his personal mission. Why can't there just be One Record? < Patient Destiny >







Thursday, May 9, 2013

Consumer health information discoveries

I have been finding a lot of consumer health information websites, both local and international - a whole bunch of them - and I think it all started when I went to the announcement yesterday for the CISCO/McMaster University Professorship in Integrated Health Biosystems, as well as a Research Chair in Bioinformatics. This doesn't have a consumer health informatics label on it, but should have a Big Data one and be a separate post. Patients come into it when data from clinical trials will finally not go to waste but will be cross-linked with research databases to be put to use for medical research. If personal health records ever catch on, and patients consent to have data (whether de-identified or not - but probably de-identified) used for research, this would also be a mine of information as the original vision for PHR was to include genomic records, the intent being the development and perfection of personalized medicine.

This made me think of Dr. Danny Sands who teaches Medical Informatics at Harvard and is working for CISCO. He had a presentation at a conference (AHIC) where I was also delivering my first student paper presentation. Anyway, I read Danny's bio at CISCO which lead me to a blog he participates in called e-patients.net. It has interesting links to the Society for Participatory Medicine, and the Journal of same.

Impressed with that find, I came across by happenstance the meforyou.org website - a website that can cure you. For some reason this site reminded me about some research and journal articles I read, on how intercessory prayer doesn't work scientifically speaking.  It is a website inspired by Facebook new media but created by U of San Francisco:

UC San Francisco is the only university exclusively focused on human health. For 150 years, we've tackled the world's most vexing health issues, from diabetes and malaria to AIDS and cancer. We are driven by the idea that when the best minds come together, united by a common cause, great breakthroughs can be achieved. Because we believe it is perhaps the greatest single breakthrough that can be achieved, we have committed ourselves thoroughly to the realization of precision medicine. We began this movement knowing that we could not do it alone, and continue assured that we will do it together. Join us.

And then I found this surprising and local "searchless" health information website - hi - consumerhealthinfo.ca (a URL I wished I could have claimed). You can't not appreciate the layout, and user interface (think old people with no time to read extensively.) I think Dr. Mike Evans  ( Dr. Mike Evans curates the best health information found online. ) contributes to this site which lead me to his blog and website, which is simply brilliant, and this viral video!




And finally after this amazing journey just seemed to be beginning, Dr. Evans recommended the ultimate consumer health informatics website NHS.UK  I had recently read on a Yahoo website the UK's National Health Service was in the top ten biggest employers in the world! Well, a lot of them were busy preparing this website, and I relish reading their entire medical encyclopedia someday.

Wednesday, December 19, 2012

p value less than 0.05



I received an email about a Research Integrity conference and checked out the keynote speakers. One of them was Dr. John Ioannidis. This lead to me to what I discovered was one of the most cited research papers out there "Why Most Published Research Findings are False". This article touched off a nerve or two in me, and eventually I will try and read it to at least a level of comprehension, because it is very mathematical. What struck me was the hypothesis that:

Several methodologists have pointed out [9–11] that the high rate of nonreplication (lack of confirmation) of research discoveries is a consequence of the convenient, yet ill-founded strategy of claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically for a p-value less than 0.05.

I took courses in health research methodology and was taught how to read medical literature and the p value inherent in most of the journal articles always confused me.  I still don't know the significance of the p value, but this I know: it is not good if family doctors, relying on evidence- based medicine to prescribe innovative therapeutic drugs, are relying on these articles' conclusions and p values for their predictive value to help me. They should be relying on the gold standards of medical evidence: systematic reviews and meta-analysis - the highest forms of "unbiased" research. Atlantic magazine has a great article "Lies, Damn Lies, and Medical Science" (in plain English) about Ioannidis and this medical dilemma.

If you want to check out why I might be confused by what a p value is, check out this definition in wikipedia:


In statistical hypothesis testing, the p-value is the probability of obtaining a test statistic at least as extreme as the one that was actually observed, assuming that the null hypothesis is true.[1] One often "rejects the null hypothesis" when the p-value is less than the significance level α (Greek alpha), which is often 0.05 or 0.01.
Although there is often confusion, the p-value is not the probability of the null hypothesis being true, nor is the p-value the same as the Type I error rate.[2] A Type I error in statistics is the incorrect rejection of the null hypothesis. In this case the hypothesis was correct but wrongly rejected. In a Type II error, however, the null hypothesis was not rejected despite being incorrect. This results in the failure of rejection of incorrect assumptions.


The best place to learn about all of this is in one of the classics of evidence-based medicine by one of the authors who coined the term "evidence-based medicine", Dr. Gordon Guyatt, who teaches and does research at McMaster University:

Users' Guides to the Medical Literature: Essentials of Evidence-Based Clinical Practice, Second Edition (Jama & Archives Journals) by Gordon Guyatt, Drummond Rennie, Maureen Meade and Deborah Cook (May 21, 2008)



Thursday, December 13, 2012

Another McMaster Study about Health IT: The Renaissance Version!

So, I enjoy reading posts on the Kevin Pho MD newsletter, and I am not even an MD. The ehealth stories are often very interesting, like the one I am posting here. Now this article has 3 main characters:

1. The article by James Salwitz entitled "Why IT is the core of the healthcare renaissance".
2. An article mentioned by Dr. Salwitz by Stephen Soumeri and Ross Koppel on the online Wall Street Journal called "A Major Glitch for Digitized Health-care Reform".
3. A paper by McMaster University researchers entitled "The economics of health information technology in medication management: a systematic review of economic evaluations".

Please draw your own conclusions! My conclusion would be that the McMaster researchers uncovered a need for better economic assessments of healthcare technology, in order to really make a realistic appraisal. And I agree with Dr. Salwitz that looking back 5 decades is too long.

And this isn't the only research that has cast aspersions on the benefits of eHealth technology. A study on PLOS last year, that was almost polemical in tone, blew the doors off of that "The Impact of eHealth on the Quality and Safety of Health Care: A Systematic Overview"
"http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000387



Why IT is the core of the healthcare renaissance


Why IT is the core of the healthcare renaissance
Warning!  I am a practicing doctor who sees real patients using an electronic medical record (EMR).  My sole agenda is to provide the best patient care.  I have no financial stake in information technology (IT).  However, unlike the editorial board at the Wall Street Journal, Mr. Stephen Soumerai of Harvard or Mr. Ross Koppel of the University of Pennsylvania, I have actually used digital patient records for over a decade and I have news for them;  EMRs work.
In a reactionary opinion in the WSJ entitled “A Major Glitch for Digitized Health-Care Records,” the authors expanded to the point of silliness the conclusions of a review of healthcare IT by McMaster University.  The McMaster analysis abstracts data from 36000 studies over five decades of healthcare IT and concludes that computerization has yet to save dollars nor improve health care.  WSJ editorialists proposed that the concept of a common medical database has “already failed” as is “common knowledge.”  While they portend to “fully share the hope” in the success of a computerized healthcare system they express doubt as to “why are we pushing ahead to digitalize.”
The question is so ridiculous as to barely require an answer.  We are pushing ahead to digitalize because the healthcare industry, which is 18% of our GDP, is the last major industry to go electronic.  Despite how critical medicine is to our citizen and nation’s vitality, health care is most often documented with paper and ink.  Can you imagine any other industry where this would be acceptable?  Would you go to a bank where they use a hand-written ledger?  Travel on an airplane without GPS, fly by wire technology or a minimum of three computers?  Do you yearn for rotary phones?  Credit cards left paper money behind decades ago and will soon move on to the next phase, pay by smart-phone. The world is digital and one of the core problems with medical care is its failure to follow.
The average doctor writes his notes on parchment and scribbles orders on contact paper.  He wastes time writing prescriptions by hand that cannot be read and will produce unneeded drug interactions and side effects.  The data on billions of health care events cannot be mined, monitored, analyzed or improved, because it is not digital.   Millions of hours are wasted, billions of dollars vanish and tens of thousands die because of preventable medical complications, the result of massive variation in quality and safety.  We are doomed because we cannot access or evaluate most medical care data; “If you can not measure it, you can not manage it.”
Taking health digital is key to fixing and affording care.  Standard, unified medical records will significantly decrease the risk of providing unneeded or dangerous medical care.  Massive efficiencies will result by reducing duplication, speeding communication and reduction in waste (and fraud).  Critical improvements will follow the use of guidelines to study clinical databases and drive quality. This means that whether one lives in Manhattan, in the mountains of Tennessee or potentially deep in Africa, the finest care will be possible.
How do I know this to be true?  Our practice of seven doctors and three nurse practitioners was an early EMR adapter.  We put in our first basic system in 2000, upgraded three times and have been fully electronic for four years.  This has resulted in marked efficiencies and obvious quality improvement. Encrypted electronic records cannot be lost, are unlikely to be stolen and are always available from anywhere.  Ordering tests is instantaneous, as is reviewing results, organizing treatments, scheduling appointments or communication with outside health providers. On the cost side we reduced non-clinical staff by more than 50% and in an account receivable analysis our billing cycle dropped more than 60% and bad debt fell to low single digits.
Today in the office, I saw four new patients.  Without assistance of clerical staff and without leaving my desk I reviewed their entire surgical, laboratory, pathological, and radiologic records.  By the time, I entered the room to meet each of them a significant part of their medical history was entered into our EMR, based on outside records, so that the care and observations of previous doctors was not forgotten. Half way through each visit documentation of their history and physical exam was complete, leaving more time to talk with each patient.  Tests were ordered, treatments scheduled, disability letters printed, medications e-scripted, instructions created and follow-up appointments setup.  The patients were given codes to electronically access their records from home.  Letters were sent online to referring doctors, as well as any clinicians we were consulting in that patient’s care.  Billing was complete before each patient got to the parking lot.  Such is the power, efficiency and quality of electronic medical records.
This is just the beginning.  Although EMRs now provide assistance with basic medical care, such as scheduling flu shots, identifying drug interactions, and health screening reminders, future systems will use academic information to assist the doctor in making diagnoses and planning treatments.   Seamless with the EMR will be computer augmentation to create differential diagnoses and recommend treatment alternatives.  In oncology alone there are almost 50,000 articles published each year; Artificial intelligence integration with the clinical EMR will help every doctor penetrate that massive database on a continuous basis as it applies to individual patients.
So, why does the McMaster study not show this obvious benefit? It comes to four factors. The first is the “five decades” of study reviewed by the Canadian authors.  Since most doctors did not start adapting EMRs until 3 years ago, that leaves 57 months of irrelevant data.  Second, we have not reached the critical mass to achieve broad system efficiencies, as hospitals and doctors are still figuring out how to incorporate the technology into their daily practice, and less than 50% of health care providers have converted to EMRs.   Third, we do not yet have a universal common database for medical records. This is a complex technological step, which has been achieved in major industries such as banking, but still must be assembled in medicine.  Finally, as was correctly stated in the WSJ op-ed piece, present EMRs are cumbersome, immature, and several generations short of perfection.  However, these are expected problems when implementing disruptive evolving technology in the complex changing health market. Challenge is a weak argument for giving up and bringing back the fountain pen.
I am not certain what the goal of Sommeri and Koppel was in writing this piece, they offer nothing but “hope.”  The WSJ has been a strong supporter of business technology leading the drive towards quality, and has long recognized the positive contribution of IT to industry.   Those of us in the trenches, putting EMRs in place, ironing out the kinks, know that electronic medical records are now and they are the future.  With IT at the core of the healthcare renaissance we can make medicine cost efficient, producing quality second to none.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.
Image credit: Shutterstock.com