Each week we like to trawl the internet for interesting and unusual medical articles to bring to you, dear reader.

Here’s a bunch of interesting articles that caught our attention this week at SCHILLER Australia.

• Study Published Detailing Interaction of Tasers with Methamphetamine
• UV Tattoos as Possible Password Storage for Implantable Devices
• The Toxicity Of Second-Hand Smoke In Cars: Myth Into Fact
• GP-led Primary Health Care Teams A Great Way Forward, Australia
• New Heart Valve Implant Cuts Surgical Risks
• Social Networks Help The Medicine Go Down
• WiFi Medical Devices to Improve Patient Monitoring, Reimbursement
• GSM Scale Autonomously Keeps Tabs on Personal Weight Loss
• Up to bat on healthcare reform in Australia

For more links and other interesting observations you should follow us on Twitter.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

Around the web this week 20/04/10

Each week we like to trawl the internet for interesting and unusual medical articles to bring to you, dear reader.

Here’s a bunch of interesting articles that caught our attention this week at SCHILLER Australia.

• Ultrasensative Quantum Magnetic Detector Digs for Fetal Arrythmias
• Body 2.0 – Continuous Monitoring Of The Human Body
• Coffee drinking is not linked to heart rhythm disturbance
• Welcome Boost For Hospital Emergency Departments, Australia
• Good Start But More Needed In Aged Care, Australia
• Obesity in Pregnancy Ups Risk of Heart Defect in Baby
• Large Study Shows Chocolate Lowers Cardiovascular Risk
• Sleep Apnea Increases Stroke Risk

For more links and other interesting observations you should follow us on Twitter.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

Around the web this week 13/04/10

A CareFlight medical evacuation flight operated by Pel-Air from Apia (Western Samoa) to Melbourne was scheduled to land at Norfolk Island for a planned fuel stop on Wednesday evening when it encountered deteriorating weather conditions.

After several unsuccessful approaches and with diminishing fuel, the pilot-in-command, Captain Dominic James, made the decision to carry out a controlled landing onto the water off the coast of Norfolk Island.

The aircraft, a specially-equipped medical retrieval Westwind jet carried out a successful landing on the water and the patient, accompanying spouse and two medical crew as well as the pilots evacuated safely. They were rescued by boat and brought to the local Norfolk Island hospital for observation. The Captain reported that all passengers and crew did not have any apparent injuries.

Further details are on CareFlight’s website.

CareFlight are a valued client of SCHILLER Australia, having outfitted several of their retrieval aircraft with ARGUS ProLifecare patient monitors, so we are very happy to see that no one was injured in the ditching of this aircraft.

And we’d like to extend a big “dude you’re awesome” to the Captain Dominic James for his text book ditching.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

CareFlight pilot hailed as a hero

Orlando, FL (AHN) – A common test prescribed to detect heart problems can often lead doctors to misdiagnose a common heart condition, according to a recent study.

Researchers at the Henry Ford Hospital studied 500 patients and found a false positive reading for the condition, known as left ventricular hypertrophy, between 77 and 82 percent in patients screened by electrocardiogram. The researchers said they found a false negative reading between 6 and 7 percent in the same sample.

Doctors typically give several ECGs before diagnosing left ventricular hypertrophy.

The researchers said is a statement that CT scans were a more accurate way of diagnosing the condition. An ECG measures the electrical activity of a heartbeat and a CT scan uses X-rays to take clear and detailed images of the heart.

The study was presented at the American Heart Association’s annual scientific conference in Orlando, Florida.

[From Study: EKGs May Misdiagnose Common Heart Condition]

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

ECGs May Misdiagnose Common Heart Condition

By now many of us are familiar with Nintendo’s Wii Fit, if not you can find out more information here, well now we’ve got the Wii Vitality sensor, Nintendo’s new addition to their revolutionary Wiimote game controller was announced at the recent E3 gaming industry expo in the USA.

From the press release – “Nintendo’s newest groundbreaking product, the Wii Vitality Sensor, expands the appeal of video games. It will initially sense the user’s pulse and a number of other signals being transmitted by their bodies, and will then provide information to the users about the body’s inner world.”

Straight away the applications are obvious, apart from integration with the Wii Fit platform, there’s a host of medical potential in Children’s Hospitals all over the world. How much easier would it be to check on your patients vitals if it was in the form of a game?

It’s certainly a converging world now with all sorts of technologies merging and becoming useful in so many ways we’ve never dreamt of in the past.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

Nintendo Wii Vitality

The strengths of Holter ECG monitoring include its simplicity and the lack of need for patient activation. The continuous monitoring allows capture of asymptomatic arrhythmias or arrhythmias associated with loss of consciousness as well as documentation of circadian variation in arrhythmia occurrence.

However the regular 24-hour Holter ECG’s imposed a very limited period of monitoring to a very short window that is often inadequate to diagnose the cause of symptoms.

With SCHILLER’s new MICROVIT MT-101 nano Holter ECG Recorder, you may now monitor your patients heart activity up to 72 hours.

The MT-101 nano Holter Recorder is designed for 2 or 3-channel ECG recordings, depending on the ECG cable you use.

To view and analyse your recorded data you may simply transmit the patients data via integrated USB interface or external SD card reader to any computer, featuring the Medilog Darwin analysis system.

On a very user-friendly Windows Interface, the MT-200 Analysis Software executes the most complicated operations, such as:

• Analysis of 2 or 3 channels in different combinations
• ST-Analysis
• HR Trend overview
• HR Variability (Fire of Life)
• Pacemaker Templates
• Template Matching
• Reclassification in less than 2 seconds by ‘Drag & Drop’ function

When it comes to administrating and saving your data, the system enables:

• Generation of PDF files
• E-mail function
• Connection to the SCHILLER SEMA-200 Data Management System

Are you interested in trying SCHILLER’s new 72-hour Holter ECG System? Just give us a call and we’ll take care of the rest!

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

72 hour Holter Recordings with MT-101 nano

It is now possible to hack implanted devices such as pacemakers to obtain patient information or even make them lethal, a study has warned.

Implanted devices are used to keep the heart beating regularly, to shock a heart that is beating chaotically, to stimulate parts of the brain or to deliver drugs. Millions are in use worldwide.

The implants are increasingly equipped with wireless technology, allowing for remote device checks and freeing patients from repeated doctor visits.

But this convenience may come with unanticipated risks, warns a team of researchers in the US.

The researchers, from three American universities, have demonstrated how to use a radio to hack a combination heart defibrillator and pacemaker, suggesting it could be possible to remotely control someone’s heart.

The team reports that it is possible to extract private medical information and reprogram the devices without a patient realising it.

They were able to reprogram the devices to shut down and to deliver jolts of electricity that would potentially be fatal had they been inside a person.

However, the researchers stressed that there had never been a reported case of a patient with an implantable cardiac defibrillator or pacemaker being targeted by hackers.

Their efforts cost $30,000 and the study was designed to identify and prevent future problems.

The research was led by two computer scientists – Tadayoshi Kohno of the University of Washington and Kevin Fu of the University of Massachusetts Amherst – with cardiologist Dr William Maisel of the Beth Israel Deaconess Medical Centre and Harvard Medical School.

The report, to published at www.secure-medicine.org, will be presented and published at the Institute of Electrical and Electronic Engineers Symposium on Security and Privacy in Oakland, California in May, though it omits key details to prevent abuse.

Dr Maisel said one aim of the research was “to encourage the medical device industry to think more carefully”.

“Fortunately, there are some safeguards already in place, but device manufacturers can do better,” he said.

“We hope our research is a wake-up call,” added Dr Kohno, an assistant professor of computer science and engineering at the University of Washington, who fears that this kind of hacking could soon be attempted.

“In the 1970s, the Bionic Woman was a dream, but modern technology is making it a reality. People will have sophisticated computers with wireless capabilities in their bodies. Our goal is to make sure those devices are secure, private, safe and effective.”

The team has set out three defence mechanisms that require no battery power, making them potentially easy to incorporate in the devices without extensive redesigning: a device that audibly alerts patients of security breaches, one that authenticates requests for access from outside devices and a vibrating device that patients can sense.

The researchers’ hacking experiments used an implantable cardiac defibrillator, a sophisticated device that automatically regulates the heart beat by sending small corrective electrical signals to the heart or by delivering a large shock to restore a potentially fatal heart rhythm back to normal.

The model they tested contained computers and radios that allow health care practitioners to diagnose patients, read and write private medical information, and adjust the device’s therapy settings wirelessly.

In computer laboratory bench tests, the research team used an inexpensive software radio to intercept and capture signals sent from the implantable device. They were able to obtain detailed information about a hypothetical patient, including name, diagnosis, date of birth and medical ID number.

Researchers could determine the make and model of the device and access real-time electrocardiogram results, as well as data on the hypothetical patient’s heart rate and cardiac activity.

The team then mounted attacks. They were able to turn off the therapy settings stored in the implantable device, rendering it incapable of responding to dangerous cardiac events. Additional commands were delivered, resulting in the delivery of a shock that could induce ventricular fibrillation, a potentially lethal arrhythmia.

Bruce Lindsay, an electrophysiologist at the Cleveland Clinic and president of the Heart Rhythm Society, said defibrillator transmissions were “not designed to withstand terrorist attacks”.

“But I don’t think the findings have any great clinical significance,” he added. “To hack the system, you have to get the programmer right up against the patient’s chest. It’s not as if somebody could do this from down the street.”

Key defibrillator makers are Medtronic Inc, Boston Scientific Corp and St Jude Medical Inc. It was Medtronic’s Maximo defibrillator that Maisel’s team studied.

Medtronic spokesman Rob Clark said the risk of any “deliberate, malicious or unauthorised manipulation of a device is extremely low.”

Future versions capable of transmitting signals as far as 30 feet from a patient will incorporate stronger security, he said.

Boston Scientific said its defibrillators “incorporate encryption and security technologies designed to mitigate these risks,” including measures to prevent unauthorized reprogramming.

St Jude said: “As the study points out, the likelihood of unauthorised or illegal manipulation of an implantable device is extremely remote, and St Jude Medical is not aware of such an event with our devices.”

The Food and Drug Administration said it was working on standards to raise the security of medical devices that receive instructions over radio waves but had not finalised them.

“The chance of an ICD being reprogrammed by a computer hacker is extremely remote,” said a spokeswoman, using the abbreviation for implanted defibrillator.

Prof Tipu Aziz of Oxford University, who does brain implants, comments: “This is a very interesting report,” but adds: “It is unlikely at present that this will be a risk to my patients. It is also even more unlikely to be of interest to hackers in general and very few terrorists.”

A British spokesman for the manufacturer Medtronic adds: “There has not been a single reported incident of such an event in more than 30 years of device telemetry use, which includes millions of implanted patients worldwide.”

The Medicines and Healthcare products Regulatory Agency, the UK government agency which is responsible for ensuring that medical are acceptably safe says it will investigate: “Despite an extensive database of adverse incidents, the Agency has never received any reports of hacking associated with implantable medical devices such as pacemakers or ICDs (implantable Cardioverter defibrillators).

“Nevertheless, as part of our adverse incident investigation process this we will look into this further, in consultation with the relevant device manufacturers.”

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

ICD ‘hacking’ being researched

Lifesaving procedures to open blocked heart arteries could begin much sooner for heart attack patients if electrocardiograms (ECGs) were recorded before they arrive at the hospital and used to put treatment teams into action, according to a scientific statement in Circulation: Journal of the American Heart Association.

Each year, about 920,000 people in the U.S. have a new or recurrent heart attack, also called myocardial infarction (MI). ST-segment elevation myocardial infarction (STEMI) is a common and especially severe type of heart attack. While there are no exact statistics for STEMI, the number has been estimated between 200,000 and 400,000.

Rapid treatment to reopen the blocked artery is vital because more heart muscle dies the longer it’s deprived of blood flow.

Current criteria for evaluating quality of care includes elapsed “door-to-balloon” or “door-to-drug” time — the time span from the moment a patient enters a hospital emergency room until blocked arteries are re-opened either by angioplasty or a clot-busting drug.

However, “the clock starts ticking from the moment a person develops symptoms of a heart attack,” said Henry H. Ting, M.D., lead author of the statement and a cardiologist at the Mayo Clinic in Rochester, Minn. “The pertinent measure of system performance is from the time of first medical contact with paramedics or other emergency medical personnel to reperfusion therapy (reestablishing blood flow to the heart muscle).”

Ting and colleagues evaluated progress since STEMI guidelines were first issued by the American Heart Association and the American College of Cardiology in 2004. They were updated last year. The guidelines recommend that all emergency medical services acquire and use pre-hospital electrocardiograms to evaluate patients with suspected acute coronary syndromes.

“If pre-hospital ECGs were more widely used and integrated with systems of care, the time from first medical contact to balloon reperfusion could be reduced to less than 60 minutes,” Ting said. The recommended goal is 90 minutes or less.

Delays from the time a person has heart attack symptoms to when they receive artery-opening treatment can be divided into four time intervals: (1) symptom onset-to-EMS arrival; (2) EMS arrival-to-hospital arrival; (3) hospital arrival-to-ECG; and (4) ECG-to-reperfusion. Pre-hospital ECG programs, if effectively implemented and coordinated with comprehensive systems of care, have the potential to decrease the latter three time intervals – and eliminate the third one.

The statement presents examples of using pre-hospital ECGs, including systems of care with door-to-balloon times approaching 30 minutes or less. In these systems, pre-hospital ECGs are used to activate the cardiac catheterization laboratory while the patient is en route to the hospital, and the patient is transported directly to the cath lab (bypassing the emergency room evaluation).

Despite the recent recommendations, fewer than 10 percent of EMS systems have adopted the use of pre-hospital ECGs, and the rate has not substantially changed since the mid-1990s.

“Furthermore, even when a pre-hospital ECG is acquired, the information is often not translated into effective action to decrease delays in treatment,” Ting said. “It is a lost opportunity to improve the quality of care for STEMI patients if the information from a prehospital ECG is not used to change downstream processes of care.”

The reluctance of patients with acute coronary syndromes to call 9-1-1 is a major obstacle to realizing the full public health benefits of pre-hospital ECGs and organizing systems of care. Studies show that more than half of STEMI patients take themselves to the hospital rather than use EMS. In addition, recent studies have shown that the longest delay for STEMI patients – two hours on average – is from the time of symptom onset to hospital arrival, said Ting.

Other barriers include:

• ensuring EMS and emergency rooms have the capacity to meet demand for services;
• developing standards for education and quality assurance for EMS providers;
• improving collaboration among EMS, emergency medicine physicians and cardiologists;
• co-ordinating hospital networks to provide the ideal patient care;
• overcoming insurance reimbursement issues for prehospital care;
• studying unintended consequences from implementing pre-hospital ECG programs.

Widespread implementation of pre-hospital ECGs is being addressed by the American Heart Association’s Mission: Lifeline, a national initiative launched in 2007 to improve regional systems of care for patients with STEMI. Mission: Lifeline’s initial phase includes emergency medical services system assessment and improvement.

Co-authors are Harlan M. Krumholz, M.D.; Elizabeth H. Bradley, Ph.D.; David C. Cone, M.D.; Jeptha P. Curtis, M.D.; Barbara J. Drew, R.N., Ph.D.; John M. Field, M.D.; William J. French, M.D.; W. Brian Gibler, M.D.; David C. Goff, M.D., Ph.D.; Alice K. Jacobs, M.D.; Brahmajee K. Nallamothu, M.D.; Robert E. O’Connor, M.D.; and Jeremiah D. Schuur, M.D. Author disclosures are available on the manuscript.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

Pre-hospital ECGs critical for heart attack patients

The American Heart Association is making it easier for you to evaluate your 10-year risk of having a heart attack and keep track of medical information to reduce your risk and better manage your health by offering the heart attack risk assessment tool on Google Health.

To use the American Heart Association heart attack risk assessment, go to the AHA’s risk assessment website http://www.americanheart.org/riskassessment or to the new Google Health website http://www.google.com/health. There, you enter your blood pressure and cholesterol levels, weight, age and other risk factors. You can then export data into your personal health record (PHR) on Google Health.

While taking the heart attack risk assessment, you can also find out if you have metabolic syndrome, a group of risk factors that greatly increases the chances of developing cardiovascular disease, including stroke and diabetes.

Those who haven’t taken the risk assessment, but have a PHR on Google Health, can also import data about their risk factors directly into the risk assessment tool and evaluate their risk without re-entering the data.

Personal health information entered into the American Heart Association’s Heart Attack Risk Assessment tool is collected, maintained and disclosed in accordance with the American Heart Association Privacy Policy, which is available here.

Joining forces with Google is one more way for the American Heart Association to reach out and help Americans live longer, healthier lives, free of heart disease and stroke.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

AHA and Google, attacking heart disease

Out-of-Hospital Cardiac Arrest

Each year, about 310,000 coronary heart disease deaths occur out-of-hospital or in emergency departments in the United States. Of those deaths, about 166,200 are due to sudden cardiac arrest – nearly 450 per day.

• Sudden cardiac arrest can happen to anyone at any time. Many victims appear healthy with no known heart disease or other risk factors.
• Sudden cardiac arrest is not the same as a heart attack. Sudden cardiac arrest occurs when electrical impulses in the heart become rapid or chaotic, which causes the heart to suddenly stop beating. A heart attack occurs when the blood supply to part of the heart muscle is blocked. A heart attack may cause cardiac arrest.

Cardiopulmonary Resuscitation (CPR)

• Less than one-third of out-of-hospital sudden cardiac arrest victims receive bystander CPR.
• Effective bystander CPR, provided immediately after sudden cardiac arrest, can double or triple a victim’s chance of survival.
• The American Heart Association trains more than 10 million people in CPR annually, including health professionals and members of the general public.
• The most effective rate for chest compressions is 100 compressions per minute – the same rhythm as the beat of the BeeGee’s song, “Stayin’ Alive.”

Automated External Defibrillators (AEDs)

• Unless CPR and defibrillation are provided within minutes of collapse, few attempts at resuscitation are successful.
• Even if CPR is performed, defibrillation with an AED is required to stop the abnormal rhythm and restore a normal heart rhythm.
• New technology has made AEDs simple and user-friendly. Clear audio and visual cues tell users what to do when using an AED and coach people through CPR. A shock is delivered only if the victim needs it.
• AEDs are now widely available in public places such as schools, airports and workplaces.

CPR/AED Awareness Survey

• Eighty-nine percent of respondents said they were willing and able to do something to help if they witnessed a medical emergency.
• Few Americans (12%-20%) are confident that they would know when it is appropriate to perform CPR or use an AED.
• At most, roughly four in ten are extremely or very likely to perform CPR on an adult (39%) or child (37%) they know personally.
• Less than 17 percent of Americans believe they are at risk for sudden cardiac arrest.
• The survey was conducted online within the United States by Harris Interactive on behalf of the American Heart Association between January 8, 2008 and January 21, 2008 among 1,132 U.S. residents aged 18 and older.

Public Policy for CPR/AEDs

The American Heart Association supports state public policy initiatives that:

• Promote the access and use of AEDs and establish quality AED programs in high-risk locations
• Encourage bystander CPR and CPR training for professionals who may need to respond to medical emergencies
• Promote increased quality and appropriate use of 9-1-1 systems
• Extend Good Samaritan legal liability protection to all users of AEDs

The American Heart Association also supports increased funding for the Rural and Community Access to Emergency Devices Program, which gives communities funding to place automated external defibrillators (AEDs) in rural areas and trains lay rescuers and first responders to use AEDs.

© SCHILLER Australia 2010 - find further information on our website www.schiller.com.au, and you can now follow us on twitter.

CPR / AED Awareness Week