On MRSA Infections Worldwide

June 20, 2011

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly common in recent years, due in large part to overuse of antibiotics. According to a 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), the average number of MRSA infections doubled nationwide between 1999 and 2005 – from 127,000 to 278,000. During the same period, the number of annual deaths from MRSA infection increased from 11,000 to more than 17,000. By increasing awareness about the risk factors associated with and steps that can be taken to avoid MRSA infection, it may be possible to reduce or eliminate its spread.

MRSA infection is caused by a strain of Staphylococcus (staph) bacteria that has become resistant to the antibiotics commonly used to treat staph infections, which include methicillin and penicillin. Generally, MRSA is spread through skin-to-skin contact, openings in the skin (cuts or abrasions), contact with contaminated surfaces, crowded living conditions, or poor hygiene. MRSA frequently manifests first on the skin as a reddish rash with lesions resembling pimples which may begin to drain pus, or lead to cellulitis, abscesses, and impetigo. In addition, the initial skin infection can spread to almost any other organ in the body, resulting in more serious symptoms and potential complications.

Designations are made between types of MRSA infection based on the location where the infection took place. Hospital-acquired MRSA (also called health-care-acquired, HA-MRSA, or HMRSA) remains one of the most common types of infection. Individuals who are hospitalized, those with invasive medical devices such as catheters, and those residing in nursing homes are at an increased risk of acquiring HA-MRSA. Community-acquired MRSA (CA-MRSA or CMRSA) is another common type of infection, and is seen most frequently in individuals participating in contact sports or those living in crowded or unsanitary conditions. While the average adult death rate among individuals with MRSA is estimated at five percent of infected patients, individuals with HA-MRSA are at an increased risk of experiencing complications including organ damage.

Dr. Marc Siegel, an associated professor of medicine at New York University, and others recommend an evaluation of the overuse of antibiotics by humans as well as in livestock as a means of eradicating MRSA and reducing drug resistance in other strains of bacteria. In addition, experts note the importance of good hygiene practices  including washing hands frequently, keeping wounds covered with bandages until they have healed, and washing soiled clothes and sheets in hot water can help to prevent the spread of MRSA. The timely diagnosis of individuals infected with MRSA achieved through an analysis of a skin sample helps to better ensure not only treatment for the individual, but also a decreased risk of infecting others.

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On Crisis Mapping

April 11, 2011

Web-based mapping tools have been used to track disease outbreaks, and more recently have been employed in response to natural disasters. Many humanitarian relief efforts have employed crowd-sourcing as a means to gather and share information. By utilizing crowd-sourcing tools including digital maps, government agencies, non-governmental organizations, and other interested parties can collaborate more effectively and improve humanitarian relief responses to natural disasters. For example, crowd-sourced maps can provide disparate networks of volunteers with a simplified way to share information, and can give local relief workers a clearer picture of the situation on the ground as they establish priorities for food, shelter, sanitation services, and healthcare facilities.

The web-reporting platform Ushahidi has been used by human rights and humanitarian aid workers to document and track progress during and immediately following crisis and natural disaster situations. Unlike other similar tools, Ushahidi is open source, and allows for information to be input using cell phones and other web-connected devices. Specialized versions of the Ushahidi crisis-mapping tool are frequently developed following natural disasters, including the recent earthquake in Japan, to allow individuals on the ground to text the locations of individuals in need of assistance or the locations of clinics or hospitals. Recent iterations of Ushahidi have integrated “check-in” functionality as well, further simplifying the process of adding data to the map.

Though crisis-mapping tools were utilized following the 2010 earthquake in Haiti, the majority of their use was by international aid organizations. In contrast, updates to the Japan Crisis Map have been posted by volunteers, government employees, and others. By encouraging the active participation of more individuals, these types of crisis maps can give a fuller understanding of the situation on the ground. In addition, representatives from academic institutions are participating in efforts to examine the data gathered using crowd-sourced crisis maps and identify ways of improving how information is shared during and immediately following natural disasters. A recent report entitled “Disaster Relief 2.0: The Future of Information Sharing in Humanitarian Emergencies” is guiding these efforts by examining how new technologies can influence emergency relief work. The report documents how technology was used during the earthquake in Haiti and in the weeks and months following to locate survivors, provide information about where to receive assistance, and gather donations for aid organizations.

According to experts, “the crisis-mapping response to the earthquake that struck Haiti in 2010 was striking proof of the potential of new mapping tools,” and by examining the successes and shortcomings, the tools and technologies can be improved faster, and more efficient.”

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Using the Internet to Assist Japan

March 15, 2011

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:

On Robot-Assisted Surgery

January 31, 2011

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.

January 18, 2011

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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Maternal Mortality Worldwide

November 15, 2010

Worldwide, a reported 1,500 women die each day as a result of pregnancy-related causes. According to the World Health Organization’s (WHO) “Trends in Maternal Mortality” report, maternal mortality rates (MMR) worldwide have decreased, but remain a persistent public health concern. As noted in previous WHO reports on women’s health, medical staff and services, educational programs, and information pertaining to pregnancy and childbirth may be lacking in some areas. By ensuring that trained medical personnel are available, and that women are able to access pre- and postnatal care, MMR can be further reduced.

The number of women dying due to complications during pregnancy has decreased from 546,000 in 1990 to 358,000 in 2008 with an estimated 99 percent of these deaths occurring in developing nations. Reports indicate that women in developing nations are 36 times more likely to die from a pregnancy-related cause than those in developed countries. Though rates vary within and between countries due to differences in income and between urban and rural populations, the average risk of maternal mortality in developing nations is one in 75, compared with one in 7,300 in developed areas. According to experts, most maternal deaths are avoidable, and are due to four major causes: severe bleeding after childbirth, infections, hypertensive disorders, and unsafe abortions. In addition, approximately 20 percent of maternal deaths are due to indirect causes, including diseases that complicate pregnancy or are aggravated by it such as malaria, anemia, and HIV/AIDS.

Many of these deaths are due, at least in part, to a lack of trained medical personnel available to care for pregnant women and new mothers. WHO data show that less than two-thirds of women in developing countries receive assistance from a healthcare worker during childbirth. In addition to care during delivery, antenatal care is often limited in developing regions. In low- and middle-income countries approximately two-thirds of women have at least one antenatal visit, while in high-income nations nearly all women have at least four antenatal visits, receive postnatal care, and are attended by a midwife or doctor during childbirth. According to the WHO’s Colin Mathers, reducing the MMR worldwide will require countries, international organizations, and charities to collaborate to educate and train additional medical personnel to attend to pregnant women. Dr. Margaret Chan, Director-General of the WHO, has also stated that “No woman should die due to inadequate access to family planning and to pregnancy and delivery care.”

In addition to ensuring that trained personnel are available locally, telemedicine initiatives such as the iConsult program may prove beneficial in lowering the MMR. By combining a software application and website, iConsult may enables healthcare providers in remote and medically underserved areas (Requestors) to receive free advice on difficult cases from medical specialists (Volunteers) including Obstetricians and other maternal and fetal health experts. This type of telemedicine program may be employed to improve health outcomes and lower maternal mortality rates in regions where the necessary personnel are not available.

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On Food Allergies and Intolerances

October 18, 2010

Individuals may experience allergies to any number of substances, but reports indicate that a growing number of Americans suffer from allergies to particular foods. Food allergies affect approximately 12 million Americans, including three million children. ”Food intolerances,” though frequently discussed in conjunction with food allergies, are quite different. Individuals with “intolerance” to certain foods may experience adverse reactions and discomfort if they are consumed. It is important to have an understanding not only of the severity and potential risk of food allergies, but of the difference between true allergies and intolerances.

The majority of adverse reactions linked to particular foods are due food intolerances. Individuals can be intolerant to lactose, gluten, or other foods, and may experience nausea, vomiting, stomach cramping, and diarrhea. While these symptoms are surely unpleasant, they are markedly different from the immune response seen in individuals with food allergies. In addition to bowel discomfort, food allergies can cause an anaphylactic response, leading to tingling and swelling of the mouth and face, hives, trouble breathing, dizziness, or fainting. These symptoms are caused by an response in which the body’s immune system mistakenly identifies a particular food as a harmful substance. An allergic reaction involves two components of the immune system: an antibody called immunoglobulin E (IgE), and a mast cell. When an individual consumes – or in some cases is in close contact with – a food to which they have an allergy, the allergen stimulates specialized white blood cells called lymphocytes which produce the IgE antibody for that specific allergen. This IgE is then released and attaches to the surface of the mast cells in the tissues of the body, prompting the cells to release histamine.

Allergic reactions can range in severity, but reports indicate that they cause 30,000 cases of anaphylaxis, 2,000 hospitalizations, and 150 deaths each year in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), there are eight foods which account for 90 percent for all food-allergy reactions: cow’s milk, eggs, peanuts, tree nuts (walnuts, pecans, etc.), fish, shellfish, soybeans, and wheat. One of the most common food allergies in the United States is to peanuts, affecting an estimated 3.3 million Americans. The incidence of peanut allergies is increasing, and reports indicate that between 1997 and 2008, the rate of child peanut allergies has tripled. Rates of other food allergies have also increased in recent years, and according to the CDC, the number of children with food allergies increased by 18 percent, between 1997 and 2007. While the cause of the increase is not fully understood, it may be due in part to the risk factors associated with food allergies, which include a family history of asthma and allergies, and elevated IgE levels.

Though there is no proven treatment for food allergies other than the avoidance of the allergen, experts recommend that individuals with food allergies carry injectable epinephrine at all times, as it can help to mitigate severity of the allergic response. In addition to the physical health-related issues resulting from food allergies, reports indicate that more than 30 percent of children with food allergies have experienced teasing or bullying related to their allergy. By gaining an understanding of food allergies and sharing information about them with others, it may be possible ensure that individuals are better informed about how to help prevent allergic reactions, and lessen the stigma faced by children with food allergies.

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