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The CMG Voice

Kids with cerebral palsy may benefit from using exoskeletons to help them walk

Posted Wednesday, September 6, 2017 by Tyler Goldberg-Hoss

You may recall the paraplegic man wearing an exoskeleton kicking a soccer ball to begin the 2014. For some time now, exoskeletons have been researched to aid adults with spinal cord injuries or other paralysis walk again.

A recent study looked at exoskeletons for children, specifically those born with cerebral palsy. Cerebral palsy, or CP, is a neurologic disorder caused by a brain injury that occurs while the child’s brain is being developed. It often refers to the loss of impairment of motor function which accompanies such a brain injury.

Many children with CP walk with a crouch gait. Over time, it gets more difficult to walk, and half of all people with CP end up wheelchair bound by the time they are adults.

The study hoped to see whether the use of an exoskeleton may improve a child’s crouch gait. The results were mildly encouraging, as 6 of the 7 participants saw improvements in their gait. The hope is that, by using the exoskeletons, including outside the lab, gaits will improve and allow children increased mobility as they age.

For a more in depth look at this new research, including a video showing the improved gait of one participant using an exoskeleton, read this:

Robotic exoskeletons show promise as tool to help kids with cerebral palsy walk easier

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Does Tele-Medicine Really Work in Primary Care?

Posted Thursday, August 31, 2017 by Gene Moen

We have several blogs discussing the advent of tele-medicine, which can mean anything from remote reading of radiology films to ”virtual” medical visits via a computer. The latter aspect seemed to offer a great deal of promise, because it would encourage preventive medicine by making it easier for patients to bring their medical concerns or problems to their physician without the delays occasioned by setting up an actual visit. And doctors would spend less time in responding to those concerns. It seemed to offer great promise to both patients and their doctors.

A recent study in Management Science questions whether those assumptions are working out. It found that e-visits are leading to more office visits and more phone consultations, and more physician time spent in providing care, and less income to physicians. Study leader Hassam Barfa, PhD, of the University of Wisconsin School of Business, noted that encouraging patients to reach out to their physician, even with minor problems, put doctors in a bind. Health care providers felt that ignoring the signal was a risk, so more patient visits were set up that were not actually needed.

The study used five years of data from a large health care system with multiple hospitals. Over 140,000 patient encounters were included in the study. The results were surprising to many: office visits after online contact with physicians increased by 6%. Physicians were spending an extra 45 minutes more on those visits each month.

Critics of the study, including the president of the American Telemedicine Association, said the findings did not include many patients who benefited by the experience, and actual patient improvement in health was not studied. From a business viewpoint, observers are considering various pricing mechanisms, such as a subscription fee for electronic access, or even a charge for each individual “visit.” One commentator said that tele-medicine has the potential to change the way primary care medicine is practiced: “Think Uber versus taxis, or what Amazon has done to purchasing products.” But much of that promise is yet to be realized.

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Rock tops the list of musical genres surgeons prefer in the Operating Room

Posted Monday, August 28, 2017 by Tyler Goldberg-Hoss

In slightly lighter “news” than usual, a recent Spotify survey found that surgeons prefer Rock and Roll over other types of music when they are performing surgery.

Rock was named as the most popular genre by 49% of surgeons, followed closely by pop and classical music. Fewer surgeons preferred jazz and R&B.

Said one surgeon: “listening to rock puts me in a comfortable place so my full attention is on my patients. I listen to bands from my youth and the feeling of nostalgia brings me to a calm, focused place.”

Some top rock songs include: Rock You Like a Hurricane (Scorpions); Sweet Child O’ Mine (Guns N’ Roses); Just What the Doctor Ordered (Ted Nugent); Break on Through (To the Other Side) (The Doors); and Paint It Black (The Rolling Stones).

Surprisingly, The Beatles “Dr. Robert”, Montey Crue’s “Doctor Feelgood”, and Robert Palmer’s “Bad Case of Loving You” did not make the cut.

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Do Standard Antibiotics Work For All Adult Pneumonia Patients?

Posted Friday, August 25, 2017 by Gene Moen

Our firm has recently seen in increase in cases where healthy adults in the 50-60 year age group had flu-like symptoms, then rapidly developed pneumonia, and then died shortly afterwards from sepsis. Our experience, of course, doesn’t necessarily reflect the actual statistics of this phenomenon. But a recent article pointed out that studies show that one in four adults who have community-acquired pneumonia receive appropriate standard antibiotics but do not respond to the treatment. As in the cases we reviewed, they then end up in the ER and are hospitalized.

Current treatment generally follows guidelines from the American Thoracic Society and the Infectious Disease Society of America, which were published in 2007. But the article contends that “large scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.”

There are data in the medical literature that points out that risk factors for treatment failure are known: older patients, and those with certain co-morbidities. Age-related differences in treatment outcome are significant. Patients over the age of 65 are twice as likely to be hospitalized even after antibiotic treatment for pneumonia, even when other risk factors are included in the analysis.

As a result of this data, many physicians are now recommending more aggressive antibiotic therapy for older patients. Somewhat surprisingly, the recent study also found substantial regional variations in treatment outcomes, although the reasons for this are not clear. Finally, it found that patients with co-morbidities such as COPD, cancer, and diabetes, were not being treated with combination antibiotic therapy or respiratory fluoroquinolones, as the guidelines recommend.

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A New Kind Of Tele-Medicine: Diabetic Retinal Exams

Posted Monday, August 21, 2017 by Gene Moen

In past blog posts we have discussed the advent and growth of tele-medicine. Routine doctor visits can now be done on someone’s laptop computer, with face-to-face contact with the doctor. Now, a new form of tele-medicine is being developed: tele-retinal imaging technology. This new form of screening is important for those who have diabetes and are at risk of diabetic retinopathy. This condition can develop slowly over a period of years, and often a patient does not seek specialized ophthalmology exams until the damage is already significant and more difficult to treat.

Under the procedure being developed, the doctor uses a special nonmydriatic camera in a primary care clinic, and the ophthalmologist in a remote setting can examine the retinas of the patient. The special cameras make fundus photography far more patient-friendly by eliminating the need for bright lights and dilating drops. In turn, eliminating the 30-minute wait for the pupil to dilate and the time for the eye to adjust following a flash of light speeds the exam. This further benefits the patient and saves time for the practitioner and office staff, an important feature in the managed care environment. This feature also is helpful with glaucoma patients for whom dilation is contraindicated.

Preliminary testing was done at three outpatient clinics serving uninsured and minority populations, and an outpatient pharmacy setting in an urban setting. Retinopathy was identified in about 22% of participants, with most cases being in the earliest stages of the condition. In addition, other ocular findings occurred in about 44% of patients. The need for this kind of primary care exam is greatest in areas where a trip to an ophthalmologist may involve significant travel and in areas where there is a shortage of ophthalmologists and thus long delays in scheduling exams. But it will take time to educate patients about this new procedure. Researchers also found that too many participants who had retinopathy findings did not follow up with the comprehensive care needed to prevent vision loss.

One problem is the lack of infrastructure to manage patients who have worrisome findings. As one researcher said “There is no benefit gained if a patient is detected with [retinopathy] but has no place to turn to have it treated.” As with all new technologies in medicine, there is also a cultural barrier that has to be overcome. Another of the researchers summed it up: “We know that [retinopathy] screening programs can save sight, but what we don’t know is whether these programs can be implemented in a culturally appropriate fashion within the US health system, in a manner where patients would be highly likely to be adherent to follow recommendations for follow-up care.”

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