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The CMG Voice

Intricate design, unsafe cleaning practices to blame for high rate of infected medical scopes

Posted Monday, April 30, 2018 by Tyler Goldberg-Hoss

In a recent paper published in the American Journal of Infection Control, 71% of reusable medical scopes tested at three major hospitals carried bacteria.

Scopes are medical devices used to look deep into areas of the body, including the colon, lung, and esophagus. Because such a high percentage of these scopes carry bacteria, considerable numbers of patients are harmed: 35 deaths since 2013.

These bacteria, including superbugs such as CRE and MRSA, are responsible for even more harm: around 2 millions Americans are made sick by such bugs, and overall 23,000 die.

Part of the problem is the design, and also the cleaning procedures of hospital staff often lacked. This includes using the same gloves when disinfecting the scopes multiple times, scopes stored in unsanitary conditions, and generally skipping steps in the cleaning process due to the need to rush between procedures.

Higher standards have been proposed to increase patient safety. This includes sterilizing all scopes using gas or chemicals, and concurrently redesigning scopes to withstand the stress of repeated sterilizations (or creating single use scopes).

Scopes – in all their forms – are terrific inventions that have saved countless lives and solved countless medical problems. It appears that, with a little tweaking, they can continue to be promoters of patient safety.

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New transport technology keeps livers warm and alive – not on ice in a cooler

Posted Thursday, April 26, 2018 by Tyler Goldberg-Hoss

As you may know, we as a society have not figured out the best system for organ transplantation. I have already written on the problem of too little organs and at least one solution for it. Additionally, some have advocated for legalizing the ability to sell your organs.

Within that context, medical researchers continue to find ways to make our organs last longer, make transplantation less necessary, and increase the likelihood that an organ will be viable for transplantation.

This includes hearts and now livers. A new study finds that instead of traditionally keeping livers “on ice” during the transport process, livers actually prefer to be warm.

The new technology, called an OrganOx device, replicates a liver’s normal environment, including keeping livers functioning during transport. This resulted, according to the study, in a greater chance the organ will actually be used in transplantation due to less injury to the liver as it “lives” outside the body.

You can read more about the results of the study here:

A ‘breakthrough in organ preservation’: Study shows keeping livers warm helps preserve them for transplant

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Radiologists watch out – Artificial Intelligence is coming

Posted Monday, April 23, 2018 by Tyler Goldberg-Hoss

Recently the FDA approved the marketing of a device that uses Artificial Intelligence (AI) to screen patients for the eye disease diabetic retinopathy.

The software, called IDx-DR, uses AI to analyze images taken of the retina. It is marketed toward health care professionals such as primary care doctors who may not normally be involved in the eye care of their patients.

Someone in the office takes a picture of the retina with a special camera. Then the images are uploaded to a server where the IDx-DR software is installed. Then IDx-DR does it’s thing. First, it determines whether the images are good enough quality to analyze. Next, if the images are good enough, it analyzes them, producing one of two results: either (1) “more than mild diabetic retinopathy detected: refer to an eye care professional” or (2) “negative for more than mild diabetic retinopathy; rescreen in 12 months.”

IDx-DR is not perfect: in the FDA study, it correctly identified more than mild diabetic retinopathy 87.4% of the time, and correctly identified those patients without more than mild diabetic retinopathy 89.5% of the time. However, considering how diabetic is the most common cause of vision loss among diabetics in the US, early detection of disease is important in halting its progress, and about ½ of all diabetics don’t see their eye doctors on a yearly basis. The software promises to improve detection and prevent vision loss for a significant number of people.

As an attorney who handles claims against medical providers, it will be important for any such provider to make sure each patient is appropriate for the screening software (some patients, such as those with underlying eye conditions, should not be screened with IDx-DR). And patients should be aware that the software is not perfect; they should go to their eye doctor if they begin having any vision symptoms.

Although this is a baby step in terms of using AI to screen for abnormalities in medical imaging, it does not take much effort to imagine AI interpreting x-rays and other imaging in the future. How long will it be before we are able to use our smartphones to take pictures of our bodies and allow AI to diagnose us?

You can read the FDA release here to learn more:

FDA permits marketing of artificial intelligence-based device to detect certain diabetes-related eye problems

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UberHealth launches. Perhaps more patients will make their medical appointments.

Posted Thursday, April 19, 2018 by Tyler Goldberg-Hoss

Nearly a year ago, I wrote about how, with the advent of ride sharing companies, some people have elected to use Uber or Lyft to take them to the Emergency Department instead of calling an ambulance.

It appears that Uber was paying attention. It has recently launched UberHealth, focused on helping patients get rides to medical appointments they might otherwise not make.

The UberHealth service is different than the traditional ride sharing apps in that the medical provider arranges the rides for the patient. The patient doesn’t need an app, or even a smartphone.

The benefit to the patient is obvious. For many, just getting to the doctor can be burdensome, particularly for those with limited means and/or without reliable transportation. This service will hopefully provide better access to healthcare.

For medical providers, this service aims to reduce the amount of no-shows, which cost providers money. In addition, with patients receiving better healthcare, hopefully they will in turn be healthier, and need less health care. Consider a patient who doesn’t make it to a doctor’s appointment, or fails to follow through on prescribed treatment plans, including physical or occupational therapy. That patient is less likely to have control over their medical condition, and more likely to need costly care in the future as a result.

You can read more about this new service here:

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Director of shuttered Seattle Pain Centers keeps license after clinics found to have caused or contributed to 16 deaths

Posted Monday, April 16, 2018 by Tyler Goldberg-Hoss

In September of 2016 I wrote about the suspension of Dr. Frank Li, director of a number of Seattle Pain Center clinics in the Puget Sound area.

Dr. Li’s medical license was suspended pending an investigation surrounding deaths associated with patients of his clinics. As a result, a number of opioid dependent patients were suddenly without a medical provider to prescribe them medication. Many scrambled to find other providers willing to do so, often encountering significant difficulty.

Recently, following the investigation conducted by the Washington Medical Commission, an agreement was reached whereby Dr. Li’s license remains suspended for at least another year. Further, once his license is reinstated, his ability to prescribe pain medication will be limited.

You can read a Seattle Times article on the recent agreement here:

In wake of deaths, Seattle-area pain doctor agrees to face a lifetime of restrictions

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