Archive

Monthly Archives: October 2014

Breakthrough as dead hearts are transplanted into patients

By Laura Donnelly, Reprinted from The Daily Telegraph

Three heart transplant patients have been successfully given organs that had stopped beating, a medical breakthrough that could dramatically increase the “donor pool” for such operations.

Donor hearts from adults usually come from those who are confirmed as brain-dead but whose hearts are still beating.

But a medical team in Australia has now revived and transplanted hearts that had stopped beating for up to 20 minutes. Two of the patients are recovering well while the third is in intensive care.

Heart surgery

The first said she felt a decade younger and was now a “different person”.

It is predicted the lives of 30 per cent more heart transplant patients could be saved using the “dead” heart procedure.

The operations were carried out at St Vincent’s Hospital in Sydney, Australia, by Professor Kumud Dhital.

Cardiologist Prof Peter MacDonald said the donor hearts were housed in a portable console dubbed a “heart in a box” where they were submerged in a chemical solution and connected to a sterile circuit which kept them beating and warm. He said: “In all our years, our biggest hindrance has been the limited availability of donor organs.” Prof Dhital said dead hearts had been used in the first wave of human heart transplants in the 1960s, with the donor and recipient in adjacent operating theatres. He said: “This co-location of donor and recipient is extremely rare in the current era, leading us to rely solely on brain-dead donors – until now.”

Prof Dhital said he “kicked the air” when the first surgery was successful. It was possible thanks to new technology, he said. “The incredible development of the preservation solution with this technology of being able to preserve the heart, resuscitate it and to assess the function of the heart has made this possible.” he said. The first patient to have the surgery was Michelle Gribilas. The 57-year-old Sydney woman was suffering from congenital heart failure and had surgery about two months ago.

She said: “I was very sick before I had it. Now I am a different person altogether. I feel like I am 40 years old. I am very lucky.”

The second patient, Jan Damen, 43, also suffered from congenital heart failure and had surgery about a fortnight ago. The father of three is still recovering at the hospital. He said: “I feel amazing. I am just looking forward to getting back out into the real world.”

The former carpenter said he often thinks about his donor. He said: “I do think about it, because without the donor I might not be here. I am not religious or spiritual but it is a wild thing to get your head around.”

The team has been working on the project for 20 years. Prof MacDonald said: “We have been researching to see how long the heart can sustain this period in which it has stopped beating.

“We then developed a technique for reactivating the heart in a so called heart in a box machine. To do that we removed blood from the donor to prime the machine and then we take the heart out, connect it to the machine, warm it up and then it starts to beat.”

The donor hearts were each housed in this machine for about four hours before transplantation. Prof MacDonald said: “Based on the performance of the heart on the machine we can then tell quite reliably whether this heart will work if we then go and transplant it. This breakthrough represents a major inroad to reducing the shortage of donor organs.”

Maureen Talbot, senior cardiac nurse at the British Heart Foundation, welcomed the “wonderful” development.

She also suggested that Britain needed to overhaul its organ donor procedure as less than a third of people were signed up as donors.

“We need the rest of the UK to follow Wales’s lead by introducing a soft opt-out system of organ donation where everyone is considered to be a donor unless they opt out,” she said.

Eastern Manitoba ERs plagued by doctor shortages

Reprint of article BY JERED STUFFCO ON OCTOBER 10, 2014 FOR THE MEDICAL POST online

A doctor shortage is crippling ER facilities in eastern Manitoba, forcing staff to scramble and send patients to other hospitals.

created a lot of anxiety

CBC reports here that “at least eight of the ten hospitals in the area don’t have enough doctors.”

Ambulance drivers have also reported long trips, according to the union representing the workers.

According to Michelle Gawronsky, who is president of the Manitoba Government and General Employees’ Union that represents emergency medical workers, patients should be upset.

“If I was having a heart attack, knowing that minutes count, I would be very concerned,” she said.

Meanwhile, Pinawa Mayor Blair Skinner said filling a doctor shortage is the top priority.

“It’s created a lot of anxiety, not knowing when the emergency room is going to be closed,” he said in the CBC article.

“People have considered moving away from the area because they are concerned about sustainable health care.”

Five things I wish I’d known before starting independent practice

Reprinted from the Medical Post
Out on your own, you realize you’ve been shielded from certain things during training, and being the perfect doctor is harder than you had thought
Written by Sarah Giles         on         October 20, 2014         for The Medical Post

1. The first two years  of practice would be  a steeper learning curve than medical school or residency

I remember the final three months of residency: I was ready to take on the world. I didn’t need my preceptors anymore—heck, after studying for my exams, I was more up-to-date on the guidelines than they were. And then suddenly I had graduated, my preceptors were gone and I realized the decisions truly stopped with me. While I wasn’t paralyzed with indecision, I was significantly slowed by self-doubt.

Once I started on my own, there was no longer someone sitting in the office with whom I could double-check the dose of common drugs and/or who could remind me to check for x, y and z. I quickly lost my cockiness and started spending significant portions of my evenings reading UpToDate.

2. Paperwork is daunting

While I had done a portion of the paperwork for some of my preceptors, I was never left to experience the true brunt of it. The paperwork generated in working up even a minor problem can be truly overwhelming. Every test I order either comes back to me three times or I spend a lunch hour trying to find a result that never came. Insurance forms, letters from lawyers, flu watch, policy changes that need to be reviewed . . . it never stops!

I wish I had appreciated what my preceptors were doing over their lunch hours and between patients. I was never taught how to deal with paperwork, but my locuming lifestyle meant I never fell behind in it. Whatever it takes, do not become one of those people who jeopardize patient care by failing to do their paperwork in a timely manner.

3. Certain patients  will be ridiculously demanding of your time

I was shielded from certain types of patients during my training. I remember having been a bit offended when a patient refused to see me, or my preceptor said, “Mr. X  is a bit difficult, I’ll see him.” I didn’t realize the truly demanding/actively psychotic patients rarely see the resident. And I didn’t realize how many minutes could be sucked up just having them walk through  the door!

4. I would do things I had sworn I’d never do

After years of watching preceptors cut the odd corner or occasionally give in to unrelenting pressure to prescribe an antibiotic for viral upper respiratory tract infections, I swore on my newly minted certification that I was going to be the best doctor. I was going to follow guidelines. I would swab every throat and wait for the lab results before giving antibiotics.

And I was wrong. I quickly came to realize that it is impossible to be the perfect doctor and that certain situations require that common sense and/or self-preservation trump guidelines. I also realized that some guidelines are largely pharma-ceutical industry-driven attempts to get us to treat more and more conditions that were once a part  of everyday life rather than  a disease. I imagine medicine to be a lot like parenting–—eventually we all find ourselves doing things we swore we’d never do.

5. There will be days when I don’t want to be a doctor anymore

Sometimes the responsibility of being a doctor is crushing. On a daily and sometimes even hourly basis we make decisions that can have a tremendous impact on our patients’ lives.

It is not easy to constantly make those high-stakes decisions: Do I spend $10,000 of the tax payers’ money to medevac this patient? Do I need to place this patient on a Form 1 or do I send him home with followup in the morning? But for every day when I no longer want to be a doctor, there are many where I realize I have the best job in the world.

I have the privilege of seeing people at both their best and worst. I help to shepherd people both into and out of the world. So, to the new graduates who just started independent practice—it’s not all going  to be flowers, pay cheques  and accolades, but it will be deeply fulfilling. Welcome to the work force!

Sarah Giles is a locum family physician in Ontario and  the Northwest Territories and  an aid worker with Médecins Sans Frontières.

Cell transplant allows paralyzed man to walk again, researchers say

Reprinted from CNN online.

By CNN Staff
updated 3:29 AM EDT, Thu October 23, 2014

A ground-breaking cell transplant has allowed a paralyzed man to walk again, researchers announced Tuesday.

Polish man Darek Fidyka, 38, had been left paralyzed from the chest down after a 2010 knife attack caused an 8mm gap in his spinal cord. An initial 13 months of rehabilitation followed by an additional 8-month program before the experimental treatment had not produced an improvement in his condition, researchers said.

But two years after the 2012 cell transplant he can walk with the aid of a Zimmer frame, also known as a walker.

Scientists at University College London (UCL) developed the treatment, which saw olfactory ensheathing cells (OECs) from the nose transplanted to Fidyka’s spinal cord. OECs are what allow the sense of smell to return when nerve cells in the nose are damaged.

Surgeons at Wroclaw University in Poland led by Dr Pawel Tabakow injected the OECs above and below Fidyka’s spinal cord gap, then used nerve tissue taken from his ankle to act as a bridge for spinal nerves to grow across, UCL said.

The underlying idea is ‘can we get something out of an area where repair works and transfer it into an area where repair doesn’t work and will it then cause a repair?.’   Geoff Raisman, UCL

Three months after the surgery, Fidyka’s thigh muscle began to grow and three months after that he started to walk with leg braces and the help of a physiotherapist, researchers said.

Being able to walk with a Zimmer frame or walker two years on, Fidyka said, was an incredible feeling.

“When you can’t feel almost half your body, you are helpless, but when it starts coming back it’s as if you were born again,” he said.

Bladder sensation and some sexual function have also returned, the UCL said.

UCL’s Professor Geoff Raisman discovered OECs in 1985 and headed the team whose research led to the breakthrough.

Previous studies have shown these cells to be popular candidatesfor research on repairing spinal cord injuries.

These are not the same cells like the controversial human embryonic stem cells used in the Geron Corporation’s 2010 trial in the United States. Before that trial was stopped due to funding issues, none of the patients enrolled were able to walk. A 2012 Swiss study launched by California-based StemCells Inc, led to some sensations returning in one patient.

Spinal ‘roadway’

In an interview with CNN’s Isa Soares, Raisman explained how his idea had developed.

“The problem with spinal injury is that nerve fibers are severed by the injury so that impulses that carry movement — the desire for movement — down from the brain to the body are cut off. Impulses carrying sensations up from the body to the brain are cut off,” he said.

Paralyzed man walks after cell treatment

 

“So, my idea, which I followed for many, many years, is that actually the nervous system is capable of repairing itself, actually the cut nerve fibers are capable of growing back — but they lack a pathway to cross the injury.

“So it’s as though a motorway has been damaged. The cars still know where they want to go, but there is no roadway for them to go across. Thinking that way, the question is — what could we use to make a bridge.

“Now, we don’t know how the bridge would work, we don’t understand the basis of this, so our idea was ‘is there somewhere else where nerve fibers are able to relay the road?’ and the only place we know is the olfactory system, the sense of smell.

“The underlying idea is ‘can we get something out of an area where repair works and transfer it into an area where repair doesn’t work and will it then cause a repair?.'”

Raisman compared the process to repairing a washed-out motorway.

“What you have to do is put a bridge across the injury. Exactly the same applies to the spinal cord — the nerve fibers which have been cut are trying to grow, they’re trying to find their way across.

“They can’t get across because there’s a damage, there’s scarring on either side — there are road barriers up. What we have to do is pull down those barriers and build a bridge along which they can grow.

“That’s what these cells are doing,” he said. The OECs carried out the same regenerative function for the nerve fibers of the spinal cord as they did for the olfactory system, he said.

But Raisman stressed that the procedure needed to be further developed: “Until we repeat this in a number more patients it’s just that one patient.”

‘Not convinced breakthrough’

Dr. Barth Green, Professor and Chairman of Neurological Surgery at University of Miami Health System echoed that sentiment.

“They’ve got one patient who did well and that’s a wonderful,” he told CNN but added that he was not convinced it was a breakthrough: “If you can’t reproduce it, it’s not real.”

Fidyka’s spinal cord had not been completely severed in the knife attack meaning — while he had an 8mm gap — 2mm of tissue remained, Green said.

Greene said laboratory studies had shown much more significant recovery in patients whose spinal cords were only partially severed.

He queried whether the rehabilitation Fidyka had had before the new treatment had been a factor in his recovery.

“The question is it all the physical therapy, or the cells he’s getting?” Green said.

“I’m not convinced that this is a breakthrough,” he said. “It definitely isn’t the answer for everybody — or even everybody with the same injury — until we have more examples with more than one patient.”

‘Provocative’

Edelle Field-Fote, PT, Ph.D., director of spinal cord injury research at Shepherd Center in U.S. city of Atlanta said the researchers’ findings were a “very provocative outcome.”

“If similar results are observed beyond this one patient, then bulbar olfactory ensheathing cells (OECs) would be a game-changer,” Field-Fote said.

“While prior (unsuccessful) studies used OECs harvested from the nasal mucosa (i.e., tissue in the nose), these OECs were harvested from the area where they grow — just below the brain.

“It is possible that obtaining these cells from their source using this more invasive approach made the difference, but it won’t be possible to know until results from more people are available.”

Field-Fote noted that Fidyka had also had scar tissue removed and that there had been documented cases where this process had resulted in improved function.

Funding

In a statement released by the UCL Tuesday, Raisman said the development of the technique was “immensely gratifying.”

“I believe we stand on the threshold of a historic advance and that the continuation of our work will be of major benefit to mankind. I believe we have now opened the door to a treatment of spinal cord injury that will get patients out of wheel chairs,” Raisman said. Researchers now need to develop the procedure to a point where it could be rolled out world wide, he said.

The research was funded by the UK Stem Cell Foundation andNicholls Spinal Injury Foundation (nsif).

Nsif was founded by David Nicholls after his son Daniel was instantly paralyzed after diving into a sandbank during a gap year in Australia in 2003.

“One of the most devastating moments a parent will ever experience is the sight of their son or daughter lying motionless in a bed and facing the reality that they may never walk again,” David Nicholls said in a statement on the development.

“The young man who was in the bed next to Dan in Australia, also paralyzed from the neck down, had parents who were so traumatized by the finality of their son’s condition that they came to visit him once and never came back,” he said.

“I promised Dan that I would not give up until a cure had been found. Professor Geoffrey Raisman and Dr. Pawel Tabakow’s breakthrough marks the first step.”

The full research paper is published in the medical journal “Cell Transplantation.”

 

Are family doctors cherry picking patients?

Reprinted from Healthy Debate

When Anne Lyddiatt’s family doctor retired, she went looking for a new one.  The Ingersoll, Ontario resident thought she’d found one for herself, her two daughters, and her granddaughter, and they filled out application forms with their health information. But only one of the four was accepted: the daughter who had no chronic conditions.

“When we went back [to hand in the forms], the receptionist said ‘I’m sorry, she’s the only one who fits our profile,” says Lyddiatt. “I knew [cherry picking] went on, but I didn’t realize the extent of it until then.”

Family doctors are allowed to screen patients based on their scope of practice. But they can’t refuse people because they’re low-income or have complex health problems.

Lyddiatt isn’t the only patient who feels she’s been treated improperly: in a 2011 discussion with 25 members of the Toronto Health Policy Citizens’ Council – led by Andreas Laupacis, Healthy Debate’s editor-in-chief – some members believed they personally, or friends and family members, had been inappropriately screened out of a doctor’s practice. A recent study in Canadian Family Physician spoke to 18 Ontarians who had lost their family physicians, and found that many were frustrated with the process of getting a new family doctor. One said “I felt like I was applying for a job …. I knew already that there could be issues in terms of if you have too many problems, or … the burden that you’re going to put on the practice.”

The College of Physicians and Surgeons of Ontario has received 90 complaints since it began tracking them in 2008, after developing its policy on the issue. That only includes those who’ve come forward officially; the actual incidence is probably higher. Ken Gardener, assistant registrar at the College of Physicians and Surgeons of Alberta, says, “I don’t think we get lots of complaints [about cherry picking], but I know that if you go down and talk to a number of physicians practicing at the front line, they’re certainly aware that some clinics do not comply [with the rules around it].”

The issue has caused a debate over the common introductory meeting – is it a way for family doctors to present their practice and look for fit, or an invitation for some doctors to screen for more time-consuming patients? And new funding models may reward cherry picking more than old fee-for-service ones did. So how pervasive is the issue, and what can we do to counter it?

Who does it affect?

Trevor Theman, registrar of the College of Physicians and Surgeons of Alberta, says he’s also heard complaints about cherry picking, often against those with complex medical issues. “Commonly it appears to be the more difficult patients, patients with multiple chronic diseases, with chronic pain, those who may have some drug seeking behavior, or patients with mental health conditions,” he says.

Research has also found discrimination against a different category of patients. Last year, Stephen Hwang, a physician and scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, studied the issue (Healthy Debate is also run out of the institute). Hwang looked at the effect socioeconomic and health status had on access to primary care physicians by having researchers call 375 family doctor’s offices in Toronto. They said they worked for a bank and had just been transferred to town, or that their welfare worker had told them to get a doctor, and also asked for regular check-ups or care for diabetes and back problems.

Contrary to popular perception, he found doctors actually were more likely to accept patients who needed more care, with 24% of those who said they had diabetes and back issues getting an appointment, versus 13% of those who only needed checkups. But there was a difference when it came to socioeconomic status: 37% of the callers who pretended to be bankers were accepted by family doctor versus  only 24% of welfare recipients. Often, the ones in a lower socioeconomic status would be told the doctor wasn’t accepting new patients.

“Working with people who are marginalized or disadvantaged, what they often say is, ‘I think I got treated differently because I’m poor,” says Hwang. He suspects physicians may turn down lower-income people because of the perception that they take more time and energy.

The guidelines

Both the Canadian Medical Association’s code of ethics and The Ontario Human Rights Code prohibit discrimination based on things such as age, race or gender. The College of Physicians and Surgeons of Ontario’s 2009 policy on new patients is even more explicit, stating that patients should be accepted based on who’s first. “Physicians who are able to accept new patients into their practice should use a first-come, first-served approach,” it reads.

The policy does make exceptions for doctors who have decided to limit their practice to a certain specialty, such as sports medicine, or patients doctors don’t think they have the skills to treat (though the Toronto citizens’ council raised concerns this might be used as a loophole). Another exception: physicians can prioritize the sickest. “You can choose on the basis of picking someone who is more urgent than the person in front of them,” says Marc Gabel, president of the College of Physicians and Surgeons of Ontario.

The College of Physicians and Surgeons of Alberta has similar guidelines. “A physician who is accepting patients on anything other than a “first come first served basis” must establish criteria for patient selection, based on matters relevant to the physician’s scope of medical practice,” it reads.

Screening meetings

The Ontario college’s guidelines recommend against introductory appointments, where family doctors meet with patients, explain the practice and hours of operation, and get a sense of the patient’s background. Hwang’s study looked at the rates of these introductory meetings – which he’s heard called “patient auditions.” It found in 9% of cases, patients were invited to one. “To me that’s kind of concerning, because [the CPSO] says in no uncertain terms you shouldn’t do that,” he says.

Those appointments are often where patients are rejected, says Theman, saying the College of Physicians and Surgeons of Alberta has had patients say they were explicitly told told they were too old or had too many conditions. However, he does believe meet-and-greets can be legitimate, when they’re used for a doctor who has a limited scope of practice or to clarify expectations between the physician and the patient.

Others also believe they have merit. The College of Family Physicians of Canada doesn’t have a policy surrounding patient screening, but believes that all family doctors need to be socially accountable. But Francine Lemire, executive director and CEO of the organization, believes that doesn’t mean they shouldn’t have introductory meetings, though they’re often precipated by an acute situation. “It offers an opportunity for us to communicate how the practice works, what our after-hours situation is, what the coverage for the practice is. We get appraised of their situation and can think through how is this practice going to be able to support them, and then they can also assess the same thing,” she says.

The College of Physicians and Surgeons of Alberta doesn’t discourage initial meetings, but believes that only the patient, not the physician, can look for fit (beyond the accepted exceptions). “If you have a meet and greet with a patient, then that is now your patient. You have established your relationship with that individual,” says Gardener.

Issues of compensation

The payment models for doctors may not be helping in Ontario, either. Capitation was introduced and has proven popular, with 4,000 of Ontario’s 9,000 family physicians on the system, which pays doctors per patient, per year, rather than per visit. “In the old traditional fee for service way of doing business, there wasn’t nearly as much incentive to cherry pick as there is with primarily capitation funding,” says Mark Dermer, a family doctor in Ottawa and author of Healthcare Insighter.

Under capitation, doctors get paid an adjusted rate depending on the patient’s age and gender – but not for how sick the person is. That means that physicians would be paid the same for a 40-year-old who came in once a year as for one who came in every month. “A payment system that creates sufficient incentive to cherry pick is flawed,” says Dermer.

Rick Glazier, senior scientist at the Institute for Clinical Evaluative Sciences, studied compensation and patient mix in a 2012 analysis. It found that doctors paid through capitation are more likely to be in suburban or rural areas, with patients who are healthier and richer. Those on fee-per-service are more likely to have lower income, less healthy patients. But those differences don’t necessarily mean doctors are cherry picking – rather, Glazier thinks those offices who would have benefited from capitation made the switch when it became available, and those who would have lost money stuck with the old fee-per-service program.

And the gap means the financial incentive to cherry pick is there. “The [patient] who never comes in is a winner financially, and the one who comes in all the time is a loser, financially” under the current system, Glazier says. He also has colleagues who began building practices from the ground up with Health Care Connect, which helps Ontarians find a family doctor and prioritizes those with complex health problems. “They’ve realized you can’t have an entire practice of those people, or you’ll have a third or half of the number that everybody else has [and make a lot less money],” he says.

The government has tried to address this problem by providing additional payments for illnesses such as diabetes, as well as services like prenatal care and smoking cessation. “They have recognized it as a problem… they are paying an acuity payment,” says Glazier. “They are attending to it, but so far it’s not anything like the size of the payment that would make you want to take on those patients.”

In the meantime, hopefully the ethical requirements of the profession are enough to keep doctors from screening out unhealthy or poorer patients. It’s important to treat everyone to maintain the public’s trust, says College of Physicians and Surgeons of Ontario’s Gabel. “Professionally we go into medicine to take care of people. Not to take care of only x or y, but to take care of the entire alphabet,” he says.

Family Medicine / GP – $100K Annual Guaranty for Family Physicians to Work in GTA

Job ID: 908

LOCATION ON, Canada PLACEMENT Permanent
START DATE 2014/10/07

This client has been operating physician practices as well as delivering community-based diagnostic imaging services in Ontario and the U.S. for over 25 years. With 13 locations in southern Ontario, serving over 200,000 patients annually, the most immediate need is for Family Physicians to join 3 existing practices in North York and downtown #Toronto. As a Family Physician practicing at one of these state-of-the-art medical facilities you can expect a complete turn-key set up and benefit from their long standing and proven experience in practice management, and the comprehensive integration of information technology and electronic medical record software.

Their goal is to set new standards in the delivery of comprehensive, efficient and cost-effective healthcare services with a commitment to high quality patient care and success.

This position is a combination of supervising stress tests and doing Family Practice. The stress tests will take a couple of hours/day and can be done in one time slot or mixed throughout your day as you see regular patients.  This is what the $100k/year guarantee covers.  The clinic will provide full support including advertising that a new physician is available and accepting new patients.  All the patients you see for family medicine will be billed on a fee-for-service basis with a competitive split.

Seize this opportunity to enjoy work life balance and a rewarding medical practice!

Qualifications: Preference given to candidates who are CCFP Certified or CCFP Eligible and hold ACLS certification or willing to obtain.

In accordance with immigration requirements, preference will be given to Canadian citizens or permanent residents of Canada.

Interested candidates, please contact: Hedi Cameron, Regional Manager, CanAm Physician Recruiting Inc. Office: 647-883-7185 E-mail: hcameron@canamrecruiting.com, www.canamrecruiting.com

Click link to go to CanAm Job Board – https://www.canamrecruiting.com/ViewJob.php?JobID=908

Star Trek’s Tricorder is materializing; RC Fellow is one of 10 finalists for an XPRIZE

Reprint from RCPSC Dialogue, Vol. 14, No. 10, October 2014

When Star Trek: The Original Series debuted in the late 1960s, it’s visionary tricorder — a portable device capable of scanning, sensing, computing and recording data — was the substance of dreams. Those dreams are quickly becoming a reality.

Sonny Kohli, MD, FRCPC, and his team at Cloud DX have been named one of 10 team finalists for the Qualcomm Tricorder XPRIZE®. This global competition, announced in 2012, will award 10 million in development money to the team that creates the best medical tricorder device, based on the prize parameters.

“I really view us as almost a David vs. Goliath because we’re a really small team, not a lot of money, but we managed to go from almost 300 teams down to 10,” said Dr. Kohli, team lead and attending physician in intensive care and Internal Medicine at the Oakville Trafalgar Memorial Hospital.

“I don’t know if we’ll win, but we’ve gone a long way.”

About the Qualcomm Tricorder XPRIZE

The teams face a challenging task. The Qualcomm Tricorder XPRIZE® is seeking a device that

  • is able to continuously monitor five health vital signs: heart rate, blood pressure, oxygen saturation, temperature and breathing rate.
  • can accurately diagnose 16 conditions — 13 required core conditions and a choice of three elective conditions that Dr. Kohli has broadly categorized as common ailments (e.g. bladder, ear or throat infections), chronic diseases (e.g. diabetes, high blood pressure, high cholesterol) and conditions significant in a global-context (e.g. tuberculosis and HIV).
  • can be used independent of a health care worker or health care facility.
  • does not exceed five pounds in weight.

 

Tricorder - 1

Tricorder – 1

(photo courtesy of Cloud DX)

Every team has a different approach to their solution and that diversity is encouraged. Throughout the competition, teams have had access to staff at the U.S. Food and Drug Administration (FDA) and user interface experts who have answered questions, provided basic training and general principles to guide the development of their devices. Ultimately, the goal is to award a device that meets the FDA’s rigorous safety standards, would be approved for home use, and able to provide a simple and valuable user experience.

tricorder_2

The difference is in the detail

When asked what makes Cloud DX’s submission different than those of the other nine finalists, Dr. Kohli points to blood pressure.

“All the other entries have very interesting pieces of the puzzle and they’re all exceptional in their own right, but the one thing that none of them have is the blood pressure figured out. Nobody else has a bona fide way to measure blood pressure that is already approved by the FDA — we do and we’re already selling that product [Pulsewave® Health Monitor].  We’re just taking that current technology and making it more portable and wireless.”

Pulsewave® is the foundation of Cloud DX’s “Vitaliti” XPRIZE® submission. It is a multi-function device and cloud diagnostic application capable of measuring and transmitting blood pressure, heart rate and other vital sign data from a wrist cuff to a personal computer, tablet or smartphone.

In addition to this wearable, wireless device, the other component of the team’s submission is a portable home-based lab. This kit will enable the diagnosis of conditions that require blood, urine or saliva samples or other simple diagnostic tests.

“The real challenge is teaching people how to monitor their health and doing it in a way that’s easy. Without question, there will be a little bit of education; but just like smartphones, eventually it became intuitive.”

The endgame

Dr. Kohli’s goal is widespread use of the Vitaliti device by as diverse people as a flight attendant, trying to determine if the plane needs to be grounded; individuals on a boat or camping in the woods; someone climbing Everest; someone working in a remote medical clinic; home care workers or outreach nurses in retirement or long-term care homes; or even parents at home.

“Ultimately, if we win or not is almost irrelevant to me; really, the goal is to get it to market so that one day people in Haiti and India, my mother, my wife — we’re all using this thing. That, to me, is the real prize.”

Dr. Kohli and his team are now building their prototype, before the final prize judging in fall 2015. The winning team is expected to be announced in January 2016.

Visit the XPRIZE® homepage for news and a competition overview. You can also visit the Cloud DX website to learn more about Dr. Kohli and his team’s device.

Cdn Medical Assoc. outlines complexity of legalizing assisted dying

by                     Pat Rich

10/16/2014

News Body

Expression of the many practical challenges involved in implementing a system of assisted dying that protects the vulnerable while allowing patient autonomy marked the Canadian Medical Association’s verbal submission to the Supreme Court of Canada earlier this week.

The Supreme Court met on Oct. 15 to hear the Carter case about whether the existing prohibition on assisted death in the Criminal Code of Canada is unconstitutional under the Canadian Charter of Rights and Freedoms.

“The CMA is intervening in this appeal to assist the court by providing a window into the diverse views expressed by its membership, and to highlight practical considerations that must be assessed if the law were to change,” said CMA President Chris Simpson in a release.

The Carter case began in 2011, when the BC Civil Liberties Association (BCCLA) joined Dr. William Shoichet, Gloria Taylor – who had an incurable, progressive disease – and the family of Kay Carter, who also had an incurable disease, to challenge the law against assisted dying.

In 2012, the B.C. Supreme Court ruled the Criminal Code of Canada provisions against assisted dying violated the rights of the gravely ill. The federal government appealed that decision, and the provincial Court of Appeal overturned the lower court ruling in October 2013 and upheld the ban, citing the 1993 case of Sue Rodriguez. The Supreme Court granted the BCCLA, the Carter family and others permission to appeal the case.

The CMA was one of many organizations to address the court during the day-long hearing; the Supreme Court is not expected to render a decision for several months.

Harry Underwood, CMA’s external counsel who made the oral submissions on behalf of the association, referenced the resolution adopted by the CMA in August supporting the right of all physicians, within the bounds of existing legislation, to follow their conscience when deciding whether or not to provide medical aid in dying. He noted that CMA was not appearing before the court to speak for or against a change in the law.

Underwood said the recent CMA policy resolution from General Council reflected an acknowledgment that the profession is divided on the question on professional and ethical grounds. Simpson said the revised CMA policy would “continue to reflect the ethical principles for physicians to consider in choosing whether or not to participate in medical aid in dying…

“Since euthanasia and assisted dying are illegal, we continue to advise our members not to participate in these activities (assisted dying),” said Simpson. But he stated the CMA recognizes assisted dying “is a societal issue and that it is society that will ultimately decide what will take place.”

In his oral presentation, Underwood discussed the practical challenges for physicians in assessing the competence of individuals to choose assisted death and to ensure they’re making an informed decision.

He said there is a “looming concern” such decisions may be made in the emergency room or other area of a hospital, when the patient is in crisis, rather than as the result of a full discussion between patient and family physician. Adding to this challenge, he said, some people do not have a family physician. Among those that do, many don’t have a long-term relationship with this physician, and in the present health care system many family doctors are not able to provide continuity of care when the patient is hospitalized.

Underwood noted the primary care environment in Canada is markedly different from those in Belgium and the Netherlands, where assisted dying is legal, because these countries are compact and homogeneous and many people have better access to family physicians .

Both Simpson and Underwood referred to the “patchwork” of palliative care services across this country, and the impact the lack of these services could have on a patient’s decision to avoid pain and suffering by choosing assisted death.

Underwood said that if the law is changed to permit assisted death, physicians who choose to participate and offer this service need legal protection. Those who choose not to participate also need their choice respected and protected. He also said institutional safeguards would be required to protect vulnerable individuals, and said Canada would not be able to simply adopt a system from another jurisdiction where assisted dying is legal.

Simpson noted that going forward, the CMA will continue to advocate and press for a pan-Canadian strategy on palliative care to ensure that Canadians have improved access to such services. The discussion around end-of-life care has cast into sharp relief the serious lack of palliative care in many areas, and Simpson said it is past time the shortage be addressed.

Forward any comments about this article to:cmanews@cma.ca.

Family Physician (2) A First-Rate Medical Career Opportunity in Western Canada

This is your chance to live in a Canadian city ranked among the best places to live in North America. It is a city with education and arts as the center of its cultural life, an outstanding place to raise a family, earn excellent income and enjoy a very comfortable lifestyle. Click on the link now – to apply – https://www.canamrecruiting.com/ViewJob.php?JobID=910