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360 immersive Virtual Reality arrives to the Cathlab. Revamping Medical Education

March 31, 2015 Leave a comment

The implementation of augmented reality into the medical setting has been increasingly experimented with since the birth of the Google Glass explorer program.

The first publication analyzing the potential of such technology in different settings was done back in October 2013 “Wearable technology to improve education and patient outcomes in a cardiology fellowship program – a feasibility study” . Following this publication came the proof of concept on the application of Google Glass in a tele-mentoring scenario was published in JACC ““Tele-Mentoring”: An Interventional Procedure Using a Wearable Computer” in which google glass was used in a PFO Closure.

Since then questions have risen if the technology was truly ready for different implementation of glass. A recent publication “Accuracy of Remote Electrocardiogram Interpretation With the Use of Google Glass Technology” found glass not to be adequate for EKG interpretation. Which by the way I congratulate the authors on their effort, it is great to see more physicians exploring the incorporation of such technologies to improve the way we practice medicine. The truth it that the results were not surprising due to many variables but there are 2 which I consider most important 1) The need for millimetric assesment of EKGs 2) Google Glass is now “old” technology and its field of view is handicapped for such a task (Rumors have it that Google is likely already working on next gen). Another important point that this demonstrates is the rapid pace that technology has (following an exponential curve) and our slow implementation in the medical setting due to many restrictions.

Currently there are many other options more relevant than the first generation of Google Glass for such tasks. I have personally experienced Atheer Glasses, META Glasses, and most recently ODG which is used by the military and NASA. They are all great with tremendous potential and depending on the vision of the individual one can prove better suited than the other one. A company exploring this in a very interesting way is Vital Medicals. Implementing this uptodate technology is a whole different world when compared to Glass. For example, just by checking ODG’s Field of View (FOV) we see dramatic improvement with a Dual 720p 16:9 stereoscopic see-thru displays at 30fps (Full specs of ODG Glasses).

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Having said this, in addition to augmented reality we now have virtual reality. In my personal opinion, implementation of augmented reality is more challenging in the medical setting since it faces a lot of “hurdles” depending on how it is used. In the case of Virtual Reality things are different and the biggest potential for now, in addition to entertainment is education.

Last week we used COMPLETE 360 degree immersive technology for the first time in the Cathlab (maybe even in a medical procedure) to capture valuable education points; 1) Ultrasound Guided Access 2) Setting up and deploying a Medtronic CoreValve. At the moment can not disclose how this was done exactly, but just wanted to mention that VR is already being used in the medical setting.

My recommendation to everyone is start exploring Google Cardboard or Samsung Gear VR (YOU NEED A NOTE 4, this was the only reason I upgraded from my Note 3 and it is worth it!)

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CYBERHEART: The Future of Afib Ablation and more

November 16, 2014 Leave a comment

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Categories: Health, Mobilehealth, TechMed Tags: ,

Medical Records were not meant to be “Sugarcoated”

September 27, 2014 Leave a comment

I have spoken recently with several doctors that are changing the way they write their notes and thus relevant patient information. Why? Simple, a great thing is happening, patients are beginning to embrace digital health , learning more about their diseases/conditions and accessing, studying and understanding their medical records.

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Here is the kicker…Sometimes in life we hear others addressing personal issues that even though they are true, they are uncomfortable to hear. Some can easily ignore them, others may  feel insulted and/or aggravated. This is extremely important to YOU, yes you who is reading this, since you now  have easy access to your Medical records.

Medical records are not meant to be a story. They were not made to be easy on our ears. They are scientific data used to capture facts. They are the mixture of years of training, medical knowledge, experience, and a patient-doctor relationship.

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Why is this important?  A chart might say; Mr. X is a delightful, pleasant individual, who exercises daily and is very involved with his health. Fantastic right? Well yes but the opposite is true. Mr. X can also be obese 57 year old individual, with a 20 pack year history who is not compliant with his medications. Mr. X mentions that he has no money for his medications but yet he is able to buy  a pack a day of cigarettes. The latter, mentions facts that are not pleasant to hear but may be the truth.

I am now encountering physicians, being contacted by their patients, arguing that they do not appreciate being called obese in the note. They do not appreciate hearing that they are not compliant  when obviously they are not.  Since physicians do not want to aggravate more people then they reword or  simply refrain from placing particular information in the chart. Information that other physicians will find valuable because it can change the way they will address the case.

Bottom line is, when WE encounter this situation, before WE get angry we have to  reflect and ask ourselves, “Is this true?”

I have modified my lifestyle thanks to comments like this. Comments that were not easy to digest but the truth nonetheless.

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September 27, 2014

* EDIT1: If you would like to engage on a conversation regarding this post, it has been posted in reddit http://www.reddit.com/r/medicine/comments/2hkzag/are_we_entering_the_era_of_sugarcoating_medical/

* EDIT 2: Thanks to Dr. Jack Minas for sharing  “Interview with Eric Topol: Do Docs & Patients See Eye-to-Eye?” Interesting comment here “54% of patients say they own their medical records vs 39% of doctors who say they own them. Although there is confusion on the part of doctors and patients, but some medical associations are pretty clear that the records belong to physicians. Check this out: The Texas Medical Association states, “Although the medical record contains patient information, the physical documents belong to the physician. Indeed, the medical record is a tool created by the physician to support patient care and is an asset of the practice.”

The Exponential Regurgitation of Misinformation is real and dangerous

September 20, 2014 Leave a comment

As the adoption of Social Networks has increased over the last couple of years we have also witnessed a shift of the material that is posted and shared by individuals. Unless you go to reddit, in which Cat posts predominate (kidding btw I love reddit, recommend /r/science, futurology, technology). Many blogs out there tend to find an interesting article from a scientific journal one that is popular in the news and change the title to a “Sexy” provocative combination of words that will awaken an urge to click. Why? Because Clicks = traffic, Traffic = money from Ads.speaker-stop-vomiting-information.jpg-e1406587759559 copy

I will not mention blog names but you all know which they are. In many cases people retweet, re-share content without really reading the article. They get enamored by the sexy title and enjoy the likes, shares, retweets etc. In order not to spread  erroneous information, it is  extremely important, at least  in medical related material, to question and learn more before re-sharing and re-tweeting.

Thus -> The  Exponential Regurgitation of Misinformation Factor (ERoM Factor). Which addresses the number of times a trending topic has been posted without it being properly digested by the reader
0) User read scientific related data and agrees with the post.
1) Post impacting the individuals life or daily conversations
2) Post impacting the poster’s friends, family, acquaintances circles
3) Post impacting other individuals by the shares of his circles.

Hopefully your next science or medical shared posts have an EROM Factor of 0

TeleMentor gives procedure impacting advice to Interventional Cardiologist performing PFO closure through GoogleGLASS

November 26, 2013 2 comments

In the past, fellow GLASS Explorers like Rafael Grossman and Heather Evans have demonstrated how Google GLASS can help doctors obtain important recommendations from other experts via live-streaming.

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In a recent sequence of serendipitous events occurring at UAMS,  Dr. Eudice Fontenot, Pediatric Interventional Cardiologist from Arkansas Children’s Hospital provided valuable insight to a team of interventional cardiologists (Dr. Barry Uretsky, Dr. Abdul Hakeem and GLASS explorer Dr. Christian Assad-Kottner) who  performed  a Patent Foramen Ovale  (PFO) Closure

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PFO closures are usually performed in children and adolescents who have symptoms secondary to significant Right to Left shunts, in non-medical terms, significant non-oxygenated blood mixing with oxygenated blood.  On occasion, secondary to anatomical changes in adulthood, a PFO which was not significant can turn into a defect which needs correction. Such was the case we recently encountered. A PFO closure is not something performed frequently in adults, and an even an expert interventional cardiologist could have accumulated 25-50 cases through their career. Even though the procedure could have been done safely by the operator, we decided to contact a pediatric interventional cardiologist, who performs this procedure  more frequently.

 

Uretsky agreeing with Fontenot and retrieving amplatzer with Dr. hakeem. ThROUGHGLASS

This is where we saw an opportunity to  use of Google GLASS as a way of Livestreaming the procedure to the telementor and obtain his advice in real time. The next step was obvious, before anything, I spoke in detail with the patient (which by the way I will be disclosing his name soon because he wants me to do so as well as his family). I explained to him how we would use GLASS and Hangouts to stream the procedure to an expert who has abundant experience on PFO closures on children, and if needed he could instantly provide his advice. Needless to say, he understood the potential of such a dynamic and was excited to be part of it.

Nov 19 the procedure occurred. We initially had planned to stream the hangout to the tele-mentor at Arkansas Children’s Hospital, but due to heavily leaded walls in the catheterization lab affecting the current data connection, and GLASS being a beta-gadget, we decided to have the expert nearby in case we needed him.

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Patient was anesthetized, intubated, and  Transesophageal echocardiogram  performed to guide the implantation of the Amplatzer closure device. Shortly after, access was obtained with a femoral sheath and the device was inserted and advanced to the left atrium across the PFO. At this point in time, the interventional cardiology team spotted a mobile artifact within the tip of the amplatzer highly suggestive of thrombus. These images were transmitted live to the tele-mentor who agreed on the diagnosis and suggested at this point to retrieve the device to avoid the possibility of a thromboembolic event. When the device was retrieved, we confirmed our suspicion, a thrombus in the tip of the amplatzer was observed. The tele-mentor further guided us on how to flush the sheath and adequately clean the thrombus from the device. At this point in time we decided to end transmission and ask the tele-mentor to come to  the cath lab to provide further recommendations.  Soon after the device was reinserted, deployed with excellent angiographic, echocardiographic and physiologic results.  Procedure was a success and patient was subsequently discharged with adequate arterial oxygen saturation, effectively treating his problem.

After discussion with my colleague and Google GLASS pioneer Rafael Grossman MD, we agreed that this was the first time that the advice given by an expert through Google GLASS directly impacted and helped the decisions made in a medical procedure.

Example of looking at TEE monitor with GLASS to demonstrate quality

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AMplatzer deployed without complications

Whole story to be released soon via another source, with procedure pictures, names and more details

Twitter: https://twitter.com/Christianassad

Categories: Health, Social Media, TechMed

Are we protecting patient information more than the patient?

September 23, 2013 1 comment

We are living an era of disruption in which exponential technologies have the potential to change dramatically the way medicine is practiced but in order to do so certain regulations need to also do so.

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As other Medical Google GLASS explorers, I am disappointed and frustrated on the concern of incorporating such technology in a faster pace in the hospital. Yes, there are pros and cons but let me mention what is the most important pro, PATIENT OUTCOMES!

Every time I stumble with people asking me about what GLASS can do, I am happy to do so. In addition I tell them about my projects in medicine as well as how colleagues are using them in telemedicine and telementoring like Rafael Grossman. Needless to say they are all impressed. After talking with them I go ahead and describe a scenario.

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“Imagine you are in the cathlab or in the operating room and your doctor is performing a particular procedure.Suddenly he/she faces a situation in which he would like a second opinion from a colleague to make sure he is making the right call. In order to do this your doctor could use Google GLASS and communicate via HANGOUTS. Your information could be intercepted by wandering eyes in the transfer, but at the end your doctor will get relevant feedback. If this impacted your outcome, would you care about your privacy in this point in time?

So far, out of approximately 50 people I have asked this question, 100% said they could not care less. If this will help the doctor GO AHEAD! It is the patient’s data! Shouldn’t he/she decide how it is going to be used?

The reader may argue on this but, If I am the patient, and my doctor wants a second opinion from another doctor, and this implies him using google glass in a non secured network to impact outcome. I could not care less…

Thoughts?

Categories: Health, Social Media, TechMed

Installing Native Apps in Google Glass: The simple way

September 1, 2013 Leave a comment
8694573611_777ace4e4f_bOne of the coolest things in Google Glass right now is installing Native Apps. Some Glass explorers are not developers, and therefore do not know how to do this…Here is a simple set of instructions (made by an md 😉 to get you goingFirst Download ADB platform for NON-DEVELOPERS:
I. Non-Developers like me:http://esausilva.com/misc/android/platform-tools-osx.zip
If you are a developer… You dont need advice from a noob
II. Get Launchy.APK
http://www.androidfilehost.com/?fid=22979706399752795Do not get overwhelmed. It is easier than it looks…
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In order to get ADB to work you must go to terminal
1) Get info of location where you have adb (cd /Users/X-Tian/Desktop/adb)
2) To take make sure Glass is detected by your computer
a. type ./adb devices
3) To install something
a. ./adb install -r /(directory/theapplication you want to install.apk)
4) To see all the junk you have installed
a. type ./adb shell
b. pm list packages
5) If you want to uninstall something. Identify the package and the uninstall
a. ./adb uninstall (package name) ex (./adb uninstall crystalshopper.android)

More helpful info at:
http://songz.quora.com/How-to-run-Android-Apps-on-Google-Glass

Thanks to Cecilia Abadie for helping me out

AbRipper for Google GLASS

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Categories: Health, TechMed