Posts Tagged medical

[WEB PAGE] AI could play ‘critical’ role in identifying appropriate treatment for depression

Male doctor discussing reports with patient at desk in medical office

Image credits: Wavebreak Media Ltd – Dreamstime

Published Tuesday, February 11, 2020

A large-scale trial led by scientists at the University of Texas Southwestern (UT Southwestern) has produced a machine learning algorithm which accurately predicts the efficacy of an antidepressant, based on a patient’s neural activity.

The UT Southwestern researchers hope that this tool could eventually play a critical role in deciding which course of treatment would be best for patients with depression, as well as being part of a new generation of “biology-based, objective strategies” which make use of technologies such as AI to treat psychiatric disorders.

The US-wide trial was initiated in 2011 with the intention of better understanding mood disorders such as major depression and seasonal affective disorder (Sad). The trial has reaped many studies, the latest of which demonstrates that doctors could use computational tools to guide treatment choices for depression. The study was published in Nature Biotechnology.

“These studies have been a bigger success than anyone on our team could have imagined,” said Dr. Madhukar Trivedi, the UT Southwestern psychiatrist who oversaw the trial. “We provided abundant data to show we can move past the guessing game of choosing depression treatments and alter the mindset of how the disease should be diagnosed and treated.”

This 16-week trial involved more than 300 participants with depression, who either received a placebo or SSRI (selective serotonin reuptake inhibitor), the most common type of antidepressant. Despite the widespread prescription of SSRIs, they have been criticised for their side effects and for inefficacy in many patients.

Trivedi had previously established in another study that up to two-thirds of patients do not adequately respond to their first antidepressant, motivating him to find a way of identifying much earlier which treatment path is most likely to help the patient before they begin and potentially suffer further through ineffectual treatment.

Trivedi and his collaborators used an electroencephalogram (EEG) to measure electrical activity in the participants’ cortex before they began the treatment. This data was used to develop a machine learning algorithm to predict which patients would benefit from the medication within two months.

The researchers found that the AI accurately predicted outcomes, with patients less certain to respond to an antidepressant more likely to improve with other interventions, such as brain stimulation or therapeutic approaches. Their findings were replicated across three additional patient groups.

“It can be devastating for a patient when an antidepressant doesn’t work,” Trivedi said. “Our research is showing that they no longer have to endure the painful process of trial and error.”

Dr Amit Etkin, a Stanford University professor of psychiatry who also worked on the algorithm, added: “This study takes previous research, showing that we can predict who benefits from an antidepressant, and actually brings it to the point of practical utility.”

Next, they hope to develop an interface for the algorithm to be used alongside EEGs – and perhaps also with other means of measuring brain activity like functional magnetic resonance imaging (functional MRI, aka fMRI) or MEG – and have the system approved by the US Food and Drug Administration.

 

via AI could play ‘critical’ role in identifying appropriate treatment for depression | E&T Magazine

, , , , , ,

Leave a comment

[White Book] White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – Full Text PDF

In the context of the White Book of Physical and Rehabilitation Medicine (PRM), this paper deals with the education of PRM physicians in Europe. To acquire the wide field of competence needed, specialists in Physical and Rehabilitation Medicine have to undergo a well organised and appropriately structured training of adequate duration. In fact they are required to develop not only medical knowledge, but also competence in patient care, specific procedural skills, and attitudes towards interpersonal relationship and communication, profound understanding of the main principles of medical ethics and public health, ability to apply policies of care and prevention for disabled people, capacity to master strategies for reintegration of disabled people into society, apply principles of quality assurance and promote a practice-based continuous professional development. This paper provides updated detailed information about the education and training of specialists, delivers recommendations concerning the standards required at a European level, in agreement with the UEMS rules of creating a Common Training Framework, that consists of a common set of knowledge, skills and competencies for postgraduate training. The role of the European PRM Board is highlighted as a body aimed at ensuring the highest standards of medical training and health care across Europe and the harmonization of PRM physicians’ qualifications. To this scope, the theoretical knowledge necessary for the practice of PRM specialty and the core competencies (training outcomes) to be achieved at the end of training have been established and the postgraduate PRM core curriculum has been added. Undergraduate training of medical students is also focused, being considered a mandatory element for the growth of both PRM specialty and the medical community as a whole, mainly in front of the future challenges of the ageing population and the increase of disability in our continent. Finally, the problems of continuing professional development and medical education are faced in a PRM European perspective, and the role of the European Accreditation Council of Continuous Medical Education (EACCME) of UEMS is outlined.

Download Full Text PDF

via White Book on Physical and Rehabilitation Medicine (PRM) in Europe. Chapter 9. Education and continuous professional development: shaping the future of PRM – European Journal of Physical and Rehabilitation Medicine 2018 April;54(2):279-86 – Minerva Medica – Journals

, , , , , , , ,

Leave a comment

[Abstract] Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion 

Abstract

Objective

To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain.

Design

Single-blind case series.

Setting

Three outpatient physical therapy clinics.

Participants

Patients with shoulder pain and limited AROM (N=69).

Intervention

Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder.

Main Outcome Measures

We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy.

Results

There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°.

Conclusions

A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects.

Source: Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion – Archives of Physical Medicine and Rehabilitation

, , , , , , ,

Leave a comment

[WEB SITE] Undergoing physiotherapy exercises from home now a reality for patients

SINGAPORE: Patients from two healthcare institutions across Singapore will be able to carry out physiotherapy exercises in the comfort of their own homes, after a national tele-rehabilitation pilot was launched on Friday (May 5) by Integrated Health Information Systems (IHiS).

IHiS, Singapore’s healthcare technology agency, developed the system together with T-Rehab, a start-up founded by researchers from the National University of Singapore (NUS). 

To use the service, patients open an app on an iPad – called Smart Health TeleRehab – and put on neck and limb sensors, depending on which part of the body they are exercising. The instructions are available in five languages: English, Mandarin, Bahasa Melayu, Tamil and Tagalog. 

Video demonstrations of the exercises prescribed by the therapists will then be played via the app. The therapist is able to customise the level of difficulty of each exercise, from the number of repetitions to the angle of each limb movement.

The patient’s movements are also recorded for the therapist to review, and to motivate the patient to complete his or her exercises, the system designed to have gaming elements. For instance, there are coloured bars to indicate if the patient has achieved the desired exercise angle, and a counter for the number of repetitions completed. 

After the patient completes the exercises, a record of the patient’s performance is sent to the therapist.

The service is available to those deemed suitable to perform physiotherapy exercises without the physical supervision of a physiotherapist. This includes those recovering from strokes, lower limb joint replacements and amputations, falls and fractures. 

It is currently offered by NTUC Health and TOUCH Home Care. Twelve other institutions including Ang Mo Kio-Thye Hua Kwan Hospital, Khoo Teck Puat Hospital, and the National University Hospital will provide the service by end-2017.

There are 200 sets of tele-rehabilitation equipment available, which is rented out to the healthcare institutions for a fee. IHiS hopes to get 1,000 patients on the programme by the end of the two-year pilot and currently has around 11 patients on the service since February this year, said Mr Chua Chee Yong, director of IHiS’ planning group.

OVERCOMING INCONVENIENCE, HIGH COSTS

This service comes two-and-a-half years after clinical trials were conducted by the researchers from T-Rehab. 

A total of 100 stroke patients were recruited from Ang Mo Kio-Thye Hua Kwan Hospital and the Singapore General Hospital since January 2014, said Dr Gerald Koh, an associate professor and the director of medical undergraduate education at Saw Swee Hock School of Public Health at NUS. He is one of the founders of T-Rehab. 

They chose to develop a tele-rehab system after an earlier study he conducted found that only two out of five patients wanted to continue with rehabilitation after discharge, he said. This is despite close to four out of five of them stating that rehabilitation was useful.

According to Dr Koh, many of them cited inconvenience, high costs and difficulty getting to the rehab centre without a caregiver as the main reasons why they stopped going for rehabilitation.

“The very reason why I need rehabilitation is the very reason why I can’t get to the day rehab centre three times a week,” Dr Koh said of the issue of immobility faced by patients. 

His study found that those who got therapy through tele-rehabilitation recovered as well as those who did their exercises with a therapist present. 

This new service, Dr Koh added, will help to boost rehabilitation participation rate and remove the barriers to carrying out physiotherapy and this will prevent their conditions from deteriorating further.

One of the early adopters of the system, TOUCH Home Care, found that the service benefits both patients and its healthcare workers since it implemented the system in March 2017.

For TOUCH Home Care, the price per session is still the same as a home visit at S$18. However, as the patient is able to carry out the exercises more frequently and at their own time, the hope is that he or she will recover faster and overall, fewer therapy sessions are required, said a physiotherapist at TOUCH Home Care Vivian Lim.

The operator’s therapists have also been more productive.

So far, they spend about 50 minutes on each tele-rehabilitation session, which include prescribing the exercise via the system, reviewing the elderly client’s exercise records and conducting video consultations or calling the patients to provide feedback. A home visit will typically take about 100 minutes, including time to travel from one home to another.

The sessions are not meant to substitute home visits entirely, said Ms Lim, but can replace some of the weekly sessions.

However, not all clients are able to benefit from the new service, as those with conditions such as chronic giddiness and seizures will not be able to perform their exercises without direct supervision, said Ms Rachel Lim, a senior occupational therapist from TOUCH Home Care. 

Some of the seniors also “lack confidence” in using technology, while others may not have the right caregivers at home. “There are some caregivers are also elderly who are frail (themselves), with sensory deficits…they can’t help put on the sensors,” said the occupational therapist.

TOUCH Home Care hopes to get 90 of its 300 clients using the remote rehabilitation tool by the end of this year. It now has seven on board.

MEETING SINGAPORE’S HEALTHCARE NEEDS

The tele-rehabilitation service was developed in light of Singapore’s healthcare landscape, said IHiS’ Mr Chua.

“Our growing ageing population (means) we have more aged elderly in the community… more healthcare workers, including our therapists, are also getting older,” he said. This means that there will be greater demand for rehabilitation services, while there will be a growing need to “stretch our manpower resources”.

The service is one of three telemedicine initiatives that will begin this year. A remote vital signs monitoring system will launch later this year, while a national videoconferencing platform for healthcare services was launched in April.

Source: Undergoing physiotherapy exercises from home now a reality for patients

, , , , ,

Leave a comment

[WEB SITE] 4 Out of 5 Kids With Epilepsy Have Other Health Problems: Study: MedlinePlus

Monday, August 1, 2016

HealthDay news imageMONDAY, Aug. 1, 2016 (HealthDay News) — Nearly 80 percent of children who have the seizure disorder epilepsy also have other health conditions, such as digestive troubles and attention-deficit/hyperactivity disorder, a large Norwegian study finds.

“Parents should be aware of the increased risk of [other] problems for their children,” said study author Dr. Richard Chin.

Epilepsy is a chronic seizure disorder. It is estimated that nearly 4 million people in the United States have epilepsy, according to the U.S. Centers for Disease Control and Prevention.

The new study included health information on more than a million Norwegian children from 2008 through 2013. About 6,600 of the children had a diagnosis of epilepsy, the researchers said.

The data showed that nearly four out of five children with epilepsy had at least one other health issue. These included medical, neurological, developmental or psychiatric problems.

Just 30 percent of the children without epilepsy had additional health issues, the study authors found.

Children already diagnosed with “complicated” epilepsy had the highest overall levels of other health issues, but even the children with less complicated epilepsy were at risk compared to the general population. Complicated epilepsy is epilepsy that occurs with other disorders, and those disorders may share the same causes or risk factors with epilepsy, or in some cases they may even be the cause of the epilepsy, the study authors said.

While experts have long been aware of the risk for other health issues in epilepsy patients, Chin said the researchers “were surprised that it was as high as 80 percent.”

Chin is a senior clinical research fellow in pediatric neurosciences and director of the Muir Maxwell Epilepsy Centre, University of Edinburgh and the Royal Hospital for Sick Children Edinburgh in Scotland.

One strength of the new research is the size of the population studied and the wide range of issues the investigators looked at, the study authors said.

After digestive problems, other common medical problems included birth defects not involving the central nervous system, musculoskeletal problems, asthma and other respiratory issues.

Among the common neurological disorders were cerebral palsy, headache and neurologic birth defects (such as spina bifida). Attention-deficit/hyperactivity disorder (ADHD) was more than five times as common in children with epilepsy as in those without, affecting 12 percent of the children with the seizure disorder, the findings showed.

Chin said the study findings are in line with a new view of epilepsy that has been suggested by some experts. “New definition proposals have sought to frame epilepsy as not just a seizure disorder, but as a disorder with a wide range of neurobiological, cognitive, psychological and social aspects,” he said.

Whether the other health issues may decline with age isn’t certain, Chin said.

While the 80 percent figure seems high, “it’s believable,” said Dr. Ian Miller, pediatric neurologist and medical director of the comprehensive epilepsy program at Nicklaus Children’s Hospital in Miami. He reviewed the research.

As for why children with epilepsy may be so prone to other health problems, Miller said he can speculate about several possibilities. Besides Chin’s view that epilepsy is not just a seizure disorder, Miller explained that “kids with epilepsy take medications, which can cause side effects, which then [might] create a second problem.”

Seizures can cause injuries such as falls and fractures, and those can create additional problems, Miller noted.

For now, Chin said, the best advice for parents is to be sure their child is thoroughly assessed for all aspects of their health. Those aspects include their development, psychiatric health, nutrition, growth and sleep quality.

Miller added: “Make sure you discuss any new symptoms with your child’s neurologist and/or pediatrician. Just because you have one medical problem, it won’t protect you from having a second.”

SOURCES: Richard Chin, M.D., Ph.D., senior clinical research fellow, pediatric neurosciences and director, Muir Maxwell Epilepsy Centre, University of Edinburgh and Royal Hospital for Sick Children Edinburgh; Ian Miller, M.D., pediatric neurologist and medical director, comprehensive epilepsy program, Nicklaus Children’s Hospital, Miami; Aug. 1, 2016, Pediatrics, online

HealthDay
News stories are provided by HealthDay and do not reflect the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, the U.S. Department of Health and Human Services, or federal policy.
More Health News on:
Children’s Health

Recent Health News

Source: 4 Out of 5 Kids With Epilepsy Have Other Health Problems: Study: MedlinePlus

, , , , ,

Leave a comment

%d bloggers like this: