Friday 20 January 2017
Tuesday 10 January 2017
David Haselwood | Fixation Patterns and Reading Rates in Eyes with Central Scotomas from Advanced Atrophic Age-related Macular Degeneration and Stargardt Disease
Purpose: To study fixation patterns and reading rates in eyes with central scotomas from geographic atrophy (GA) of age-related macular degeneration and to compare fixation patterns with those of patients with Stargardt disease.
Methods: Scanning laser ophthalmoscope analysis of fixation patterns in eyes with 20/80 to 20/200 visual acuity. Included were 41 eyes of 35 patients with GA and 10 eyes of 5 patients with Stargardt disease. The patients with GA also were tested for maximum reading rate, and the size of the areas of atrophy were measured by fundus photograph analysis.
Results: Sixty-three percent of GA eyes fixating outside the atrophy placed the scotoma to the right of fixation in visual field space, 22% placed the scotoma above fixation, and 15% placed it to the left, regardless of the laterality of the GA eye. Fixation was stable in subsequent years of testing for scotoma placement to the right of or above fixation. All GA eyes fixated immediately adjacent to the atrophy. In contrast, seven of ten eyes with Stargardt disease fixated at a considerable distance from the scotoma border, with the dense scotoma far above the fixation site in visual field space.
For the patients with GA, the maximum reading rate was highly correlated with size of the atrophic area, but not with age or visual acuity within the limited visual acuity range tested. There was a trend to more rapid reading with the scotoma above fixation and slower reading with the scotoma to the left.
Conclusion: There is a preference for fixation with the scotoma to the right in eyes with GA. Patients with Stargardt disease use different strategies for fixation, perhaps due to subdinical pathology adjacent to the atrophic regions.
The size of the atrophic area in GA plays the predominant role in reading rate for eyes that have already lost foveal vision.
David Haselwood | Visual Function Abnormalities and Prognosis in Eyes with Age-related Geographic Atrophy of the Macula and Good Visual Acuity
Purpose: Geographic atrophy (GA) may cause significant compromise of visual function, even when there still is good visual acuity (VA), because of parafoveal scotomas and foveal function abnormalities antedating visible atrophy. This study evaluates the visual function abnormalities at baseline and the 2-year worsening of VA and reading rate for eyes with GA compared with a group of eyes with drusen only.
Methods: Seventy-four eyes with GA and VA greater than or equal to 20/50 from a prospective natural history study of GA were included, as were 13 eyes with only drusen. Baseline visual function testing and 2-year VA and maximum reading rate are reported.
Results: The worsening of VA in decreased luminance and foveal dark-adapted sensitivity showed severe abnormalities for the GA group. Contrast sensitivity was significantly reduced for the eyes with GA. Half the eyes with GA, but none of the drusen eyes, had maximum reading rates below 100 words per minute. A scanning laser ophthalmoscope (SLO) measure of the scotoma near fixation combined with a measure of residual foveal function accounted for 54% of the variability in maximum reading rate in the eyes with GA.
Of 40 eyes with GA observed for 2 years, half lost greater than or equal to 3 lines of VA and one quarter lost greater than or equal to 6 lines. The nine eyes with drusen with follow-up had no significant change in VA. Low foveal dark-adapted sensitivity, SLO measures of the scotoma within 1° of fixation, and low maximum reading rate were statistically significant risk factors for doubling of the visual angle. Significant reduction in maximum reading rates at 2 years was present for the eyes with GA.
Conclusions: The eyes with GA with good VA have profound decreases in visual function, particularly in dim lighting and in reading. Half the eyes with GA had doubling in visual angle at 2 years after the baseline examination, whereas the drusen eyes remained essentially unchanged. Impaired visual function at baseline was predictive of an adverse outcome for the eyes with GA.
David Haselwood | Landmark-driven fundus perimetry using the scanning laser ophthalmoscope
PURPOSE: To present a new method of performing scanning laser ophthalmoscope perimetry that compensates for eye movements so that the correct retinal location is tested even if fixation changes. This allows for accurate testing of patients with central scotomas and for repeating testing longitudinally at the same retinal locations even if central fixation is lost. METHODS: The operator views the retina and selects a retinal landmark, such as a vessel bifurcation, that can be identified easily. A testing strategy is preselected, and the computer saves the landmark and stimulus coordinates. To present each stimulus, the operator positions a cursor over the retinal landmark, and the computer adjusts the site of presentation of the stimulus for any change in landmark position caused by an eye movement. At the conclusion of the testing, the results are displayed in the proper retinal location on a fundus image. RESULTS: Sixty-seven eyes with macular disease were tested with the landmark-driven method, using the same preplanned strategy for each eye for both a bright and a dim stimulus. There was a low rate of inconsistent points (seen with dim but not bright stimuli), and virtually all of these bordered a dense scotoma. Those eyes with more inconsistent points had a significantly greater percentage of dense scotoma points and significantly lower visual acuity. The technique significantly corrected error in retinal localization resulting from large eye movement. There is no significant rotation or magnification change during the procedure, so specifying the change in location of one landmark is sufficient to describe movement of the retina. The technique is rapid and easy to administer to elderly patients and to children. CONCLUSIONS: This technique allows for accurate and repeatable measures of retinal sensitivity in specific locations. It is useful in following change over time. It can be developed further to allow for fully automated, retinally correct testing. Read More..........
Monday 9 January 2017
David Haselwood | ECRI Institute Preps Hospital Leaders on Top 10 Technology Issues to Watch in 2017
PLYMOUTH MEETING, Pa., Jan. 9, 2017 /PRNewswire-USNewswire/ -- The new and emerging healthcare innovations of 2017 come with a lot of promises. And, just like every other year, hospital leaders must remain vigilant about what to bring into their hospitals—and what to keep out. However, separating the facts from the hype isn't easily done alone.
ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, announces the release of its annual Top 10 Hospital C-suite Watch List to help hospital leaders make tough decisions about new and emerging technologies in 2017 and beyond.
Available as a free public service, the list gives hospital leaders evidence-based perspectives on new and emerging innovations that promise to deliver safe and cost-effective patient care. Each entry includes actionable recommendations in a quick-glance "What to Do" section.
"As new technologies come and go, ECRI remains steadfast in its mission to keep healthcare leaders' technology decisions tethered to their patients' needs while keeping an eye trained on evidence-based research," says Diane C. Robertson, director of Health Technology Assessment Information Service, ECRI Institute.
In its 2017 list, ECRI Institute examines 10 topics poised to affect care delivery over the next 12-18 months:
- Liquid Biopsies: The New Wave of Genetic Testing?
- Opioid Addiction: Can Technology Predict Risks of Addiction and Relapse?
- The Belly of the Presurgery Beast: An Initiative to Improve Outcomes and Costs of Abdominal Surgery?
- Right-sizing Your Hospital: Is It Time to Refresh Your Purchasing and Implementation Processes?
- Seeing the Disinfecting Light: Will Compact Deep Ultraviolet-C LEDs Zap Disinfection Rates?
- Pepper, the Emotional Robot: Do You Have a Spot for Artificial Intelligence on Your 2017 Payroll?
- Robotic Surgery: Could a Pricey Patient-repositioning Table Improve Workflow and Outcomes?
- Adjusting the Endoscopy Picture: Is a New Imaging Technique a Better Way to Visualize Tissue Malignancies?
- Crohn's Disease: Will Immunotherapy and Stem Cell Therapy Rescue Patients with Moderate-to-Severe Symptoms?
- Sticking It to Diabetes: Will Novel Vaccines Prevent or Cure Type I Diabetes in Children and Adults?
"Navigating new technologies is one of the biggest challenges we hear about from hospital leaders," says Robert P. Maliff, director of Applied Solutions Group, ECRI Institute. "They simply can't afford to miss the mark on which clinical advancements to bring in to improve patient care."
The watch list draws upon ECRI Institute's nearly 50 years of experience evaluating and providing technical assistance on the safety, efficacy, and cost-effectiveness of health technologies. It reflects the unbiased, independent judgment of the Institute's multidisciplinary staff of clinical and technical researchers, engineers, risk management specialists, and healthcare planners and consultants.
ECRI Institute invites the press to learn more about the issues on this year's watch list by attending its media event, "Dismantling Device Dangers, Forecasting New Innovations," on Tuesday, January 31, at its headquarters in Plymouth Meeting, PA. Reporters will have the unique opportunity to interact with our health technology assessment, hospital consulting, patient safety, and medical device evaluation experts.
Professionals are also encouraged to join ECRI Institute's LinkedIn Group, "Emerging Healthcare Technologies in Patient Care," for further discussion of these topics.
David Haselwood | Rise of digital health technologies sparks urgent need for identity management, experts say
Consumers are becoming more concerned that the sharing of their personal and medical data by providers and other healthcare stakeholders will lead to security and privacy breaches, according to a recent study by Black Book Research.
Indeed, as electronic healthcare systems become more interoperable and as more digital patient information is collected and stored, the number of people and organizations trying to access this data – provider employees, colleagues, business partners, payers, pharmaceutical companies, and other healthcare stakeholders – has dramatically increased.
That reality has created an urgent need among healthcare providers for strong identity management.
“When we have users on our system, do we know if they’re the good guys or the bad guys?” asks Brian Decker, senior manager at Mayo Clinic and program manager for the clinic’s Identity Management Platform. “Who actually are users? Are they appropriate users? Who has access to what and why? Who’s accountable for our users’ access?”
The bottom line, Decker says, is “you’ve got to be sure the right people have the right access to the right things at the right time, and nothing else.”
What’s more, the emergence of digital technologies in healthcare, including electronic health records, revenue cycle management systems, connected health, cloud computing, and mobile devices and applications, necessitates a renewed focus on security, scalability, and improved experiences.
“Healthcare has gotten very complex, with lots of regulations and lots of changes,” said Munawwar Khan, senior principal healthcare consultant at Mayo Clinic. “As a result, not all vendor systems do everything, so health organizations have to purchase different apps or create their own.”
When that happens, Khan added, it can create a “black hole” within the organization that could lead to security vulnerabilities.
To avoid that black hole, Decker and Khan recommend identifying and implementing practical solutions for establishing an identity management program, instituting appropriate governance and creating organizational change management and communications challenges within the identity management operational infrastructure. Read More.......
David Haselwood | 10 health IT conferences you shouldn’t miss in 2017
From 3D printing to digital records, technology has changed the healthcare industry. If you want to keep up to date on the latest emerging trends in healthcare, there is no shortage of events that will keep you in the loop. Here are 10 health IT conferences you can't miss whether you're a doctor, nurse, health IT pro or C-Level executive.
SX Health & MedTEch Expo
Part of the popular annual SXSW festival, the SX Health & MedTech Expo focuses on latest technologies in healthcare. Covering everything from startups to large corporations, this conference offers the latest innovations and emerging trends in healthcare. While this year's speakers haven't been announced yet, past years have included Bakul Patel, associate center director for digital health at the FDA, and Stanford and Harvard trained physician-scientist, inventor and entrepreneur, Daniel Kraft from Singularity University.
The SX Health and MedTech Expo takes place during the SXSW festival between March 10 and 18 in Austin, Texas, and registration fees vary depending on what level badge you purchase.
TEDMED
Affiliated with the popular TED conference, best-known for its Ted Talks, TedMed operates under a similar format with a focus on healthcare innovation. The conference promises to bridge "the gap between science and the public," through shared stories that help "inform, inspire, engage and provoke action."
This year's TedMed conference takes place in Palm Springs, California, from November 1 to 3, and registration costs $3,450. However, if you register before January 15, you will receive $1,500 off the cost of the registration process.
iHealth 2017 Clinical Informatics Conference
The iHealth Clinical Informatics Conference, held by the AMIA, is targeted at clinicians and informatics professionals, with a focus on innovations with health data and mobile health initiatives. The iHealth 2017 Clinical Informatics Conference takes place in Philadelphia, from May 2 to 4 at the Lowes Philadelphia Hotel. Registration is currently open, and starts at $430 for students, $745 for members and $1,120 for nonmembers; rates go up if you register after March 15.
HIMSS Conference
Targeted at health IT professionals, executives, vendors and clinicians, the HIMSS17 conference promises to offer educational programs, keynote speakers, thought leader discussions, workshops and networking opportunities. This year's keynote speakers include Ginni M. Rometty, chairman, president and CEO of IBM as well as former speaker, John Boehner.
The 2017 HIMSS Annual Conference and Exhibition takes place in Orlando, Florida, in the Orange County Convention Center February 19-23.
Health 2.0
Health 2.0 conferences, areaimed at everyone from digital innovators to nurses to CIOs. These conferences focus on innovation, networking, emerging trends and you'll find no shortage of impressive keynote speakers at any event. You can find conferences in San Francisco and Santa Clara, California; Barcelona, Spain and Hyderabad, India. Dates and registration fees vary depending on the conference you choose. Unlike other annual conferences, you don't have to worry if you can't make one Health 2.0 event, because it's likely there is another just around the corner.
Connected Health Conference
Formerly the mHealth Summit, the Connected Health Conference heavily focuses on the digital aspect of healthcare and facilitating healthcare access around the globe. While the 2017 conference hasn't been announced just yet, last year's conference included the chief health officer at IBM, Kyu Rhee, and the vice president of digital health at Fitbit, Adam Pellegrini.
This year's Connected Health Conference doesn't have a date yet, but the last conference took place during December in Washington, D.C. The cost of registration will vary depending on how many sessions you choose to go to, how early you register and how many ad-on sessions you opt for. Read More......
David Haselwood | 2017: The Year Ahead in Healthcare Information Technology
Cybersecurity, analytics and population health have the attention and dollars of healthcare organizations, which also are beginning to invest in prescriptive analytics and artificial intelligence, a new Healthcare IT News survey finds.
The need for greater cybersecurity protection is sinking in. The desire to better understand mountains of untapped data is on the rise. And the necessity to start improving the health not just of patients but of whole populations is being taken quite seriously.
These are some of the conclusions from “2017: The Year Ahead in Health IT,” a new survey of healthcare organizations from Healthcare IT News. We polled 95 healthcare executives in October 2016.
Asked which technologies they are planning to upgrade in 2017, 52 percent of survey respondents said security, 51 percent analytics, 44 percent patient engagement, 44 percent population health, 31 percent EHRs, 24 percent remote patient monitoring, and 22 percent revenue cycle management.
“When you look at the quality programs and MIPS and MACRA, suddenly you are seeing a realignment of incentives where doctors are paid for wellness and quality as opposed to quantity,” he said. “Unless you are collecting data about patients across the population, it’s really hard to control expenses, enhance quality and improve workflow. EHRs were put in basically as dumb data communication systems without emphasis on exchange and workflow. But because of payment reform, we have incentives to do data exchange. Different things are bubbling to the top.”
One aspect of EHRs many healthcare organizations continue to work on is caregiver acceptance. Asked what actions will they take in 2017 to get more physicians and nurses to fully embrace EHR technology, 60 percent of survey respondents said integrate EHRs with other technologies that, for example, advance population health or best practices, 47 percent improve EHR system interfaces, 40 percent clearly show EHRs help the organization profitably manage value-based care, and 38 percent clearly show how the technology markedly reduces time spent on tasks outside of direct patient interaction.
The “2017: The Year Ahead in Health IT” survey found population health to be a high priority with a great many healthcare organizations. Asked if their organization plans to implement a population health system in 2017, 20 percent of survey respondents said yes, they are planning to deploy a new system, a big 42 percent said yes, they will be adding tools to existing systems, 9 percent said no, they have finished their population health project, and a significant 29 percent said no, population health is not in their plans for 2017. Read More......
David Haselwood | 9 Healthcare Predictions For 2017
Every year at Frost & Sullivan, the Transformational Health team brainstorm top predictions for the New Year to come. 2017 will definitely continue to be a year of tumultuous uncertainty and turbulence, but amidst this uncertainty we know for a fact that technology will continue to flourish and will have unprecedented impact on healthcare in terms of building some of the foundation blocks towards a connected home and healthcare ecosystem.
The following are our nine top predictions for healthcare for 2017:
Strong Push Toward Price Control And Transparency Measures Around Drugs
Public and political pressure on the control of surging drug prices, globally, will compel health authorities to bring transparency measures around drugs pricing, especially for some of the diabetes and cholesterol medicines where more low-cost generic competition is gaining market acceptance.
Blockchain Becomes One Of The Most Important Technologies In The Healthcare Industry
With the potential to change how healthcare information is stored, shared, secured and paid for, blockchain technologies have immense potential to tackle some of the biggest challenges in healthcare information management. Companies like Gem Health are among the few companies currently advocating the use and benefits of such a platform.
Artificial Intelligence (AI) Transforms Medical Imaging Informatics
As more and more experts and healthcare professionals find the usability of these AI systems as decision support tools and not decision makers, uptake of AI-enabled clinical decision support tools is expected to increase in the coming years. More particularly during 2017, AI will play a big role in diagnostic imaging by complementing radiologists with advanced interpretation and imaging informatics supports. Read More......
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