Using the Internet to Assist Japan

On March 11, 2011, Japan was struck by a 9.0 magnitude earthquake – the fourth largest in the world since 1900 - proceeded by a massive tsunami. Reports indicate that at least 550,000 people have been displaced, and at least 10,000 have lost their lives. In the hours and days following these disasters, individuals and organizations have utilized the Internet as a “virtual crisis center,” using websites particularly social networking sites, to share information and locate friends and family members.

According to Ezra Gottheil, an analyst at Technology Business Research, “Social communications, like Twitter, and social networking sites, like Facebook, are at their best when big news is breaking.” As seen following the recent earthquakes in Haiti and Chile, humanitarian aid organizations have used social networking websites to solicit donations. Individuals have also used the sites to share information about their experiences on the ground and reconnect with friends and family members. Online Social Media, an organization which tracks social media services, reported that just an hour after the earthquake hit Japan, Twitter was experiencing 1,200 tweets per minute, many of them containing hashtags related to the tragedy. Facebook was similarly flooded with posts, which students in the U.S. and Japan are working together to use to paint a picture of the extent of the tragedy.

Large corporations have also created portals to help individuals locate loved ones and provide information about where to obtain medical assistance, food, potable water, and shelter. Google’s Person Finder database, available in Japanese, English, Korean, Chinese, and Portuguese allows users to enter a name and search for missing persons or post updates about people who they know are safe. A local version of the crisis-mapping tool, Ushahidi, has also been created and put in place. Ushahidi allows individuals in Japan to text or input online the locations of trapped people or clinic locations which are then plotted on a map so that users can easily pinpoint where people may be trapped, dangerous areas that should be avoided, and locations where food and clean water can be obtained.

Patrick Meier, director of crisis mapping and new media at Ushahidi, notes that “Ten percent of this [sharing of information] is the technology, and the other 90 percent is the people…That’s truer and truer as the technology gets easier to use.” As technology use and adoption becomes more widespread, the use of technology during the rescue and recovery period is likely to increase. By utilizing existing information and communication technologies and developing new ones, outcomes following natural disasters can be improved.



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FEMA Online Guide to Disaster Preparedness

Mobile applications that can prepare you for or provide assistance in a disaster situation:

• American Red Cross: Shelter View (iPhone – Free)


• Disaster Readiness (iPhone - $0.99)


• Disaster Readiness (Android - $1.99)


• Pocket First Aid & CPR (iPhone - $3.99)


• Pocket First Aid & CPR (Android - $2.99)


• Emergency Radio (iPhone - $0.99)


• Scanner Radio Pro (Android - $2.99)

Mobile Medical Applications

The New York Times recently reported that “more human beings today have access to a cell phone than the United Nations says have access to a clean toilet.” Further reports indicate that there are an estimated 5 billion mobile phone users worldwide with three-quarters of these individuals in developing nations. Mobile broadband subscriptions are on track to surpass one billion by 2011, according to Ericsson, a provider of telecommunication and data communication systems worldwide. For healthcare providers in the developed world, smartphones and mobile devices have become increasingly common, and a reported 72 percent of physicians are utilizing smartphones personally and professionally. This global trend underpins the unprecedented potential of mobile applications to help bridge gaps in medical knowledge and address the lack of trained personnel at the point of care in underserved areas.

Experts note that the use of mobile applications can simplify the process of sharing clinical images and patient data for physicians consulting on a case and may be particularly helpful in rural and remote regions. To date, two mobile applications have been approved for use by the Food and Drug Administration (FDA) to improve the quality of care provided nationwide. The first, Mobile MIM, allows physicians to examine images of patient scans on iPhones or iPads. According to William Maisel, chief scientist and deputy director for science at the FDA’s Center for Devices and Radiological Health, Mobile MIM “provides physicians with the ability to immediately view images and make diagnoses” without requiring that they be near a workstation. Similarly, MobiUS, a simple medical ultrasound imaging system, which has also recently received FDA approval, can be used to simplify the ultrasound process. Requiring only an ultrasound wand and gel, and a smartphone, MobiUS increases the portability, affordability, and accessibility of this type of non-invasive medical imaging and can help improve the delivery of obstetric and gynecological care.

A number of other medical applications have been developed to aid in diagnosis and provide treatment recommendations. MedRed, an organization whose mission is to make medical knowledge accessible to patients and healthcare providers at the point of care, was recently awarded a contract from the Veterans Affairs Department to pilot a software tool aimed at helping healthcare providers more easily share new and innovative treatment strategies for veterans being treated for traumatic brain injury. The system, called Balto, provides for electronic data capture and exchange, and incorporates clinical decision support technology. Balto’s graphical user interface allows the user to enter patient signs and symptoms in a point-and-click fashion, and receive real-time diagnosis and treatment recommendations based on selected clinical guidelines embedded in the system.

The Coags Uncomplicated mobile application was also developed to assist in medical diagnosis, specifically for bleeding disorders, and allows physicians to input test results and receive a list of possible diagnoses. Mobile applications are in development to help diagnose a number of other potentially fatal conditions as well, including cancer. In addition to applications created for use by physicians, some aim to improve patient awareness and the ability to monitor one’s health. According to Kathleen Sebelius, Secretary of Health and Human Services (HHS), “People in communities can improve their healthcare if they just have the information to do it.” Among application created to allow patients to monitor their condition is Prostate Pal, a free iPhone application developed by urologist Dr. Ronald Yap. Designed to help men keep accurate health records and discuss symptoms with their doctors, Prostate Pal allows patients to track their fluid intake and output, and features a symptoms questionnaire from the American Urological Association. Other iPhone applications intended for consumer use, such as Wheelmap, depend heavily on user feedback and the sharing of information. Wheelmap tags places of interest on a map and shows the user the most wheelchair-accessible route. In addition, users are able to indicate how accessible locations are using a color-coding system, and can also rate the routes the application provides and suggest modifications.

The use of medical applications on cell phones, tablets, and personal computers can help to greatly improve the quality of care delivered worldwide. Clinicians and patients can utilize these innovative new tools to inform diagnosis and treatment decisions, share information about medical conditions, and track symptoms to ensure that medical knowledge is available at the point of care.


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FEMA Online Guide to Disaster Preparedness

Mobile applications that can prepare you for or provide assistance in a disaster situation:

American Red Cross: Shelter View (iPhone – Free)

Disaster Readiness (iPhone - $0.99)

Disaster Readiness (Android - $1.99)

Pocket First Aid & CPR (iPhone - $3.99)

Pocket First Aid & CPR (Android - $2.99)

Emergency Radio (iPhone - $0.99)

Scanner Radio Pro (Android - $2.99)

Inflammatory Bowel Disease

More than 1.5 million Americans – nearly one in every 250 people - are currently living with inflammatory bowel disease (IBD). IBD refers to two related but different diseases: Ulcerative Colitis and Crohn’s disease, which cause chronic inflammation of the intestinal tract. By increasing awareness about these conditions, research into new treatment options may be advanced, improving the lives of individuals with IBD.

Though the exact cause of the condition is not known, inflammatory bowel disease is thought to occur when the body’s immune cells attack the intestine. According to experts, there may be an initial trigger, such as an infection or something taken in from the diet or environment, that activates this immune response. IBD is frequently viewed a spectrum, as some patients exhibit symptoms associated with both UC and Crohn’s disease. The inflammation seen in Ulcerative Colitis (UC) occurs only in the large intestine (colon) and is limited to the inner lining of the intestinal wall. In contrast, Crohn’s disease can involve any portion of the intestinal tract from the mouth to the anus but is frequently confined to the terminal portion of the small intestine (ileum). While Crohn’s and UC affect different areas of the digestive system, both are marked by diarrhea, rectal bleeding, urgency to have bowel movements, abdominal cramps and pain, fever, and weight loss. In addition to painful and frequently debilitating symptoms, individuals with IBD can experience complications of their condition including bowel obstruction, ulcers, and malnutrition.
Treatment options for Crohn’s and UC are frequently limited to anti-inflammatory, immunosuppressant, and steroid-based medications. These medications are used to control acute attacks or “flare ups”, prevent repeated attacks, and help the colon and intestinal tract to heal. In addition, UC can sometimes be treated through surgical removal of the affected portion of the bowel, after which patients may require an ileostomy to allow waste to leave the body. Because Crohn’s disease frequently spreads deep into the layers of affected bowel and intestinal tissue, surgical removal of the affected regions is often not possible.
Experts continue to strive to identify new treatment options for individuals with IBD. New research suggests that while UC and Crohn’s affect a relatively high rate of individuals in the U.S., the conditions are extremely rare in the developing world. According to some experts, there may be a correlation between parasitic worm (helminth) infection – which is common in the developing world but not in the United States – and the number of patients presenting with UC. Though the practice is not recommended, Dr. Joel Weinstock, chief of gastroenterology at Tufts University Medical School, notes that some UC patients have seen relief from symptoms after ingesting the trichuris suis worm, a parasite that lives in the intestines of pigs. Researchers are also investigating the use of live bacterial cultures (probiotics), including a genetically altered version of the common bacteria Lactobacills acidophilus, which have been found to nearly eliminate colon inflammation in rodent studies.
While experts work to develop new treatments, individuals with IBD can manage their condition using medications and monitoring their diet to avoid foods that exacerbate their symptoms. Participating in support groups, either online or in person, can help some individuals with IBD learn more about their condition, ways to cope with it, and available treatment options.

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Finding Health Information Online

More than ever before individuals have begun turning to the Internet for health-related information, including information about specific conditions and medications. Though the wealth of information online allows patients the opportunity to be better informed and take a more active role in their care, not all information comes from reliable sources. While individuals should be encouraged to become informed about issues that affect their health and well-being, it is also important to ensure that they are able to identify information that is from a credible source.



The United Nations (UN) reports that approximately 1.8 billion people worldwide are now using the Internet. A recent survey which included over 12,000 individuals in 12 nations, found that individuals are looking online for health-related information more frequently than in previous years. Globally, 81 percent of individuals with Internet access use it to search for advice about health, medicines, or medical conditions. A reported 80 percent of Americans look online at least some of the time for health information, frequently to find information about a specific disease, a treatment procedure, or exercise and fitness. Nearly half of all Americans looking for health information online are attempting to self-diagnose a condition based on symptoms they are experiencing.

While some experts endorse the use of the Internet for patient self-education as it allows patients to play a more active role in their care, they stress the importance of verifying health information found online. A recent report from the London School of Economics indicates that the amount of health information available online is abundant, and its accessibility is increasing as personal computers, tablets, and smartphones become more common. David McDaid, senior research fellow at the London School of Economics, notes that only a reported one in four people validate the sources of information posted online. Further, Dr. Karthik Murugiah, author of a recent study on the use of YouTube to provide information on CPR techniques, states that without some type of verification of credentials of an individual posting health-related information online, there is a “risk of dissemination of incorrect information.” While some government and health-related organizations and medical associations do put information online, it is sometimes difficult for patients to separate these posts from less credible information when searching online.

Findings of another recent study show that a typical health-related search produced a list of 93 links, only about one-third of which were “relevant.” According to Eric Horvit an artificial intelligence researcher at Microsoft Research, “People tend to look at just the first couple results” of a Web search, resulting in what experts have termed “cyberchondria.” Dr. Brett Taylor, an emergency department pediatrician at the IWK Health Center in Helifax, notes that “Misinformation travels along exactly the same social pathways as accurate, useful knowledge.” Echoing this point, Dr. Jan Maurer, Vice President and Medical Director of Health Dialog, “Increased and easier access to online health information creates a double-edged sword,” as there is a benefit to the wide and varied health information available online, however it must be carefully scrutinized.

By helping patients to learn where to find credible health information, physicians can guide patients to more valuable search results. While some sites provide diagnostic tools which can be problematic if used improperly, others provide information that patients can access after they have received a diagnosis from their physician. There is a benefit to be seen by allowing patients to become better informed, and thus more involved in their healthcare decisions, provided steps are taken to insure that information is credible.

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On Robot-Assisted Surgery

In recent years, robot-assisted surgeries are becoming increasingly common, and researchers are working to develop new equipment and procedures. Study findings of robotic surgery procedures indicate that they ensure a high quality of care, and according to experts “Robots will not replace doctors but help them to perform to the highest standards.” Robots have now been employed during gynecological, urological, cardiac surgery, and general surgery procedures. Surgeons have also utilized these high-tech devices to perform gastric bypass surgeries, excise cancerous tumors from the head and neck, and deliver anesthesia. When used by surgeons with appropriate training, these devices may help to provide improved health outcomes and even deliver care remotely.

A reported 1,068 surgeries were completed in 2010 using the da Vinci Surgical System. In use at 852 hospitals across the United States, the da Vinci has become the most well-known of the surgical robots currently being utilized. The da Vinci allows for procedures to be conducted laparoscopically (using smaller incisions), resulting in faster healing, lower risk of infection, and quicker recovery. The da Vinci features a high-resolution camera that produces magnified 3D images and micro-instruments allow for the translation of a surgeon’s hand movements to smaller, more precise ones by the device’s four arms. As with any new procedure or medical equipment, surgeons and surgical staff must be trained properly to ensure that they are using the device effectively and some newer models of da Vinci Surgical Systems feature two sets of controls, allowing an opportunity for residents to safely receive hands-on training, or two surgeons to work simultaneously to complete a procedure.

Though robotic-assisted surgeries for certain types of tumors have been found to be as effective as other minimally invasive surgical techniques, experts note the importance of the surgeon having proper training on the device. Despite the increased precision made possible by magnified images and the dexterity of the machine’s tools, the robot is still “an instrument that is constantly being controlled by the surgeon,” according to Dr. Balasubramaniam Sivakumar, a general surgeon of 32 years and medical staff vice president at St. Joseph’s Hospital Health Center.

The da Vinci has been used in conjunction with other surgical robots, including the McSleepy, an anesthetic robot. According to Dr. TM Hemmerling, “Automated anesthesia delivery via McSleepy guarantees the same high quality of care every time it is used.” Success has also been noted in surgeries utilizing the SpineAssist, a small robotic arm coupled with a work station that allows surgeons to map out a patient’s spinal anatomy in advance of the procedure. Innovations in cardiac surgery have also been made thanks to tiny, jointed robots like the CardioArm, which provides greater precision than a flexible endoscope and is easy to control. Despite their potential benefit to patients, surgical robots are often quite costly and it is frequently cost-prohibitive to introduce them into clinics and hospitals. Though these devices could allow surgeons to complete procedures remotely, in medically underserved areas, surgical robots are often not available. With continued advancements in the field of robot-assisted surgery, the cost of the equipment may decrease and their availability may increase worldwide.



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Healthcare Shortages in the U.S.

In remote areas worldwide, the availability of trained medical personnel continues to be problematic, but new research shows that there are also shortages of healthcare providers in the United States. Recent reports indicate that approximately 65 million Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), defined as regions with 2,000 or more residents per primary-care doctor. A recent study in the journal Academic Emergency Medicine found that three-quarters of U.S. emergency department directors indicated that they did not have adequate on-call trauma surgeon coverage. In addition to a lack of emergency department personnel, some regions of the U.S. are experiencing shortages of ophthalmologists, pediatricians, nurses, and dentists, all of which result in a lack of quality healthcare services. Treatment outcomes can be improved by finding alternative means of ensuring that patients have access to specialty healthcare.

Nearly a quarter of the U.S. hospital emergency departments that participated in a recent study reported an increase in the number of patients who left the facility before being seen by a specialist. According to the study’s lead author Dr. Mitesh Rao, 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Further, more than 70 percent of participating emergency departments noted staff shortages in neurosurgery and hand surgery, and for patients with traumatic brain or hand injuries, the resulting delays in care could significantly increase the risk of lifetime disability, and according to Dr. Rao, the study’s lead author, “Transferring patients significant distances to an available specialist is sometimes the only option.”

In regions with a dearth of a particular type of medical professionals, availability of general treatment may also be significantly limited. Reports indicate that 14 of 81 counties in Kansas have no dentists, leaving residents with few options. Without appropriate dental care, patients’ risk of developing infections detrimental to the heart and lungs can increase, as can the risk of other conditions. Pediatricians and family care physicians are also lacking in some areas of the U.S. According to a recent study, nearly one million children live in areas with no local doctor. Nurses are also in short supply in many areas, and according to experts, by 2020 the nation will have 29 percent fewer nurses than are needed to provide care.

To ensure the provision of care to patients in areas that lack clinical staff, some experts suggest the use of telemedicine and remote screening programs. Through these programs, specialists can provide clinical advice to clinicians remotely and improve the level of care provided without requiring transport of the patient. Remote screening and diagnosis have been proven effective for diabetic retinopathy in areas where expert ophthalmologists are not available. Using a special camera, clinical staff and technicians captured a picture of a patient’s eye and send it to a trained professional. Eighty-three percent of individuals with retinopathy were diagnosed correctly using this remote screening technique regardless of the level of medical training of the individual taking the photograph. Teleradiology programs have also been implemented in some areas, a number of which are now utilizing fourth-generation wireless networks to allow radiologists to transfer images more and make preliminary evaluations more quickly.

Comprehensive telemedicine programs can help to ensure the delivery of specialty healthcare in underserved areas of the U.S. and worldwide. The iCons in Medicine program is an global telehealth and humanitarian medicine volunteer alliance that serves to connect volunteer healthcare providers with individuals and clinics requesting assistance on challenging cases. Membership in the iCons in Medicine network includes nearly 400 individuals in 12 countries around the world. These individuals represent 35 academic and medical centers, and include renowned experts in telemedicine, e-health, and global health disparities. Over 130 physicians with expertise in 35 medical specialties are available to respond to teleconsultation requests from individuals representing over 20 organizations in 10 countries. Through the use of telemedicine and remote diagnosis and screening programs, the delivery of specialty care in remote areas and treatment outcomes can be improved.



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On Polio Worldwide

Though cases of polio worldwide have been reduced by 99 percent since 1988, it continues to be a major public health concern in Afghanistan, India, Nigeria, and Pakistan. Recent outbreaks have also been seen in the Congo Republic. Vaccination programs have been put in place in the hopes of eradicating the disease, but according to experts, infection in even one individual can put an entire population at risk. Though previous vaccination efforts helped to reduce the number of cases in many regions, in Nigeria and some other African nations the social stigma and fear associated with vaccinations must be overcome. By utilizing a newly developed, more effective polio vaccine and working to educate individuals about the importance of getting vaccinated, it may be possible to meet the Global Polio Eradication Initiative’s (GPEI) goal of eradication polio worldwide by 2013.

Polio (poliomyelitis) is a contagious viral illness that, in its most severe form, can cause paralysis, difficulty breathing, and death. Often contracted through contact with the feces of an infected person, polio can be spread through contaminated food or water, and the risk of contamination is particularly in areas with poor sanitation. Though individuals of all ages can contract polio, children under five years of age, pregnant women, and individuals with weakened immune systems are even more vulnerable. Ninety-five percent of individuals infected with polio have no symptoms, and between four and eight percent experience minor, flu-like symptoms including fever, fatigue, and stiffness or pain in the back, neck, or limbs. Individuals with polio who show no symptoms or only minor symptoms may still spread the virus to others.

Though infection rates of non-paralytic and paralytic polio were significant in the 1950s in the United States and other areas worldwide, in recent years fewer than one percent of individuals who contract polio develop paralytic polio, the most serious form of the disease, which can lead to loss of reflexes, severe muscle aches and spasms, and paralysis. Paralytic polio can manifest in a variety of ways, and is classified by the areas of the body that are most affected. Spinal polio, the most common form of paralytic polio, attacks the motor neurons in the spinal cord and may cause paralysis of the muscles that control breathing and movement of the arms and legs. Bulbar polio affects the motor neurons of the brainstem, impacting an individual’s ability to see, hear, smell, taste, and swallow, and may also affect intestine, heart, and lung function. A combination of both, bulbospinal polio can lead to paralysis of the limbs, as well as affecting breathing, swallowing, and heart function.

The lack of a cure for polio and limited treatment options available underscore the need for effective vaccination campaigns. Inactivated polio vaccine (IPV), an injection given in the arm or leg, has been used in the United States since 2000. Most children in the U.S. are given four doses of IPV, which has been found to be 90 percent effective after two shots, and 99 percent effective after three. The oral polio vaccine (OPV) is used throughout much of the world, but may soon be replaced by the newly developed bivalent oral polio vaccine (bOPV). The bOPV contains two key strains of the virus and thus may provide improved inoculation results. In addition to efforts to increase vaccination rates, improved sanitation and education related to personal hygiene can help to reduce the spread of polio, as well as cholera and other water-borne illnesses.

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