Health Care "Telepresence Robot" to aid high dependency care at Northern Ireland Hospital

A Northern Ireland Health Trust is the first in the UK to use a robot which allows intensive care specialists from one hospital to remotely assess patients in another.

The 'telepresence' robot enables doctors to examine and interact with patients in different locations.

It will be used at Daisy Hill Hospital in County Down.

Stormont Health Minister Edwin Poots said the new technology would create an "effective hospital network".

The robot has the ability to transmit heart and breath sounds and it is hoped it will prevent the need to transfer patients to intensive care in some cases.

It enables Dr Charles McAllister, based at Craigavon Area Hospital in County Armagh, to speak to staff and patients at a bedside in the Southern Trust in Newry more than 20 miles away.

"It means that although there are no intensivists on site in Daisy Hill Hospital, it means there will be 24/7 access to the intensivists on the Craigavon site to give advice and support on any patients in a high dependency unit or throughout the hospital," he said.

"You can get a huge amount of information via the robot.

"You can get real time information from the monitor, you can see the patient up close in high definition and look at all the charts and observations.

"There is also a facility for listening to the patient's lungs and heart through a stethoscope at the back of the robot."

More about "Telepresence" and robots, here.

Electronic 'tattoos' to monitor vital signs

Once a patient has left hospital, how can doctors track his or her physical condition? Conventional technology is too bulky or obtrusive, but rub-on electronics that stick to the skin like a temporary tattoo could revolutionise medical monitoring.

When doctors need to keep watch on someone's bodily systems, from the heart's beat to the brain's activity, they have to use bulky electronic devices and attach electrodes to the skin with sticky gel.

"These are useful in some clinical settings, but in the real world they restrain movement and cause irritation to the skin," says John Rogers at the University of Illinois at Urbana-Champaign.

To avoid restricting movement, Rogers's team have given their new "epidermal electronics" the flexibility, elasticity and density of skin.

A tattoo you won't regret (Image: John A. Rogers/Science)

They took the silicon and gallium arsenide typically used to build transistors, diodes and resistors, and fashioned it into wires just a few nanometres thick, each bent into the shape of a tiny meandering river. The meanders can stretch and contract to give electronics constructed from them a degree of flexibility which matches that of skin.

The researchers then took circuits made from the wires and put them on a thin patch of rubber. Finally, they embedded the rubber in a water-soluble protective sheet of plastic, creating a patch around 40 micrometres thick. This patch can then be applied to the skin like a temporary tattoo: it is placed on the skin, rubbed with a wet finger to dissolve the protective sheet and left to dry.
Tech style

The nifty "tattoo" is kept in place by the weak intermolecular forces that are at play whenever two surfaces come together. Because the circuit is soft and stretchy enough to conform to the skin's texture, the contact between the two surfaces is good enough to keep the device in place for several days.

For the style-conscious patient, it can even be combined with a conventional temporary tattoo (see video above) – although until a wireless transmitter can be incorporated into the design, the temporary tattoo must still be wired to a computer.

In a preliminary study, the group put patches on the throats of volunteers. The thin electronics could detect the electrical changes beneath the skin associated with muscle movements as the volunteers spoke.

The signals were then sent through a computer algorithm, which could differentiate the signals associated with different words and allow the volunteers to control a video game with spoken commands.

The first generation of medical patches can monitor electrophysiological signals associated with the heart, other muscles and brain activity. But in future people may benefit from patches that go beyond this passive role, says Rogers.

"We can also use the device to stimulate muscle contractions," he says – although this work, achieved in rats, has yet to be published.

The patches are "a beautiful example of the novel applications than can be enabled by building electronic systems on non-conventional substrates", says Ali Javey, an electronic engineer at the University of California, Berkeley. "This is truly exciting work," he adds.

Journal reference: Science, DOI: 10.1126/science.1206157

Alternative Energy - Lipo-diesel illegal in some states

In November 2008 the Beverly Hills surgeon Craig Alan Bittner suddenly closed his thriving liposuction practice and fled to South America. Why? Bittner had been using the extracted fat of patients as "lipo-diesel" to fuel the SUVs of himself and his girlfriend, and was therefore violating state laws on medical waste.

Lose That Weight Now! You know you want to.

Here is some good advice from another doctor who is on the cutting edge in the treatment of obesity, Dr Phil.

He talks to patients about how their weight is contributing to medical problems and encourages them to aim for a modest weight loss by making simple changes such as cutting out fruit juices and Cola or other high-calorie beverages and walking in five- to 10-minute increments several times a day. "I encourage patients to lose 5% to 10%, see where they are and then try for another 5% to 10%," he says.

He and his staff, which includes other physicians, dietitians and behavioural psychologists, insist that patients keep good food journals, which the health professionals review. "A lot of time they aren't eating the wrong foods, but they are just eating too much," he says.

Most 90% of people can lose weight with diet, exercise and behaviour modification. The longer people keep food logs, the better they do, he says. When people get off track, it's because they are often no longer keeping food journals and they're not being weighed weekly.

He believes primary-care doctors could make great strides in helping patients lose weight by inviting them to come into the office every week to be weighed: "That helps keep them focussed and accountable."

Achieving steady weight loss is not easy, because it means a change in your lifestyle or behaviour and most patients know it, he says. "Despite some patients being prompted and guided to do all the right things, their minds are completely resistant to the necessary behavioural change required, and therefore they experience less or no weight loss."

Questions: When is the best time to go under the Knife?

Questions

1. Is it safer to have elective surgery first thing in the morning rather than in late afternoon, when doctors and nurses might be tired?



2. For the same reason, is it smarter to schedule surgery earlier in the workweek than later?



3. Is it better to avoid having elective surgery in July and August, when a new crop of residents has just started training?



4. Also, is it foolish to have elective surgery when the moon is full and, tradition has it, people can go a little off-kilter?

Answers

No, no, no and no, according to a Cleveland Clinic study that found timing isn't anything, at least when it comes to elective coronary bypass surgery.

The authors of the study, published today in the journal Anesthesiology, write that they decided to focus on elective heart bypass surgery because, thanks to "well-established protocols (for bypass surgery), there is much less variability than with other procedures." Plus, they write, "hospitals closely track morbidity and mortality for this operation", which is very encouraging. I am presuming that this is in an attempte to reduce it.

Daniel Sessler, an anesthesiologist who chairs the Cleveland Clinic's department of outcomes research, says he and his co-authors hope to examine whether timing affects other types of elective surgery, but they expect to find the same thing.

The researchers analysed the results of 18,597 elective bypass surgeries at the Cleveland Clinic from 1993 to 2006. Most were performed between 7 a.m. and 5 p.m. on weekdays. None of the time factors — hour, day, month or phase of moon — made any difference in the outcomes of the operations.

"Fatigue is well-known to impair performance," Sessler says, citing its role in plane and car crashes. "It's highly plausible that fatigue would impair the performance of medical personnel."

But, he says, just because doctors or nurses are fatigued and make mistakes doesn't necessarily mean patients suffer. "Hospitals have extensive systems in place to minimize the consequences of any error," he says.

I hope this has answered some of your questions but I suspect it may have raised a few more!