VR/AR May Help Physicians Overcome Cognitive Biases To Admitting Errors

MedicalResearch.com Interview with:

Jason Han, MD Resident, Cardiothoracic Surgery Hospital at the University of Pennsylvania

Dr. Han

Jason Han, MD
Resident, Cardiothoracic Surgery
Hospital at the University of Pennsylvania

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The inspiration for this study comes from my personal experience as a medical student on clinical rotations. Despite having been a victim of a medical error while growing up myself, I found it extraordinarily difficult to admit to even some of my smallest errors to my patients and team. Perplexed by the psychological barriers that impeded error disclosure, I began to discuss this subject with my advisory Dean and mentor, Dr. Neha Vapiwala. We wanted to analyze the topic more robustly through an academic lens and researched cognitive biases that must be overcome in order to facilitate effective disclosure of error, and began to think about potential ways to implement these strategies into the medical school curriculum with the help of the director of the Standardized Patient program at the Perelman School of Medicine, Denise LaMarra.

We ultimately contend that any educational strategy that aims to truly address and improve error disclosure must target the cognitive roots of this paradigm. And at this point in time, simulation-based learning seems to be the most direct way to do so, but also remain hopeful that emerging technologies such as virtual and augmented reality may offer ways for students as well as staff to rehearse difficult patient encounters and improve.

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Using Virtual Reality To Teach Medical Student Empathetic Communication Skills

MedicalResearch.com Interview with:
Frederick W. Kron, MD

President and Founder of Medical Cyberworlds, Inc
Department of Family Medicine,Ann Arbor, MI and
Michael D. Fetters, M.D., M.P.H., M.A.
Professor of Family Medicine
University of Michigan

MedicalResearch.com: What is the background for this technology and study?

Dr. Kron: Communication is the most important component of the doctor-patient relationship. I know that through research, but also through personal experience. As a cancer survivor, I’ve seen first-hand the difference that outstanding communication skill can make to a vulnerable patient.

At the beginning of the project, we asked medical educators about the challenges they had in assessing and training communication competency. They told us that technical skills are easy to teach and assess, but communication skills are mainly behavioral skills that involve verbal and nonverbal behaviors, facial expressions, and many other cues that pass between patient and provider. That’s hard to teach and assess. Activities like role play with standardized patients (SPs) have been widely used, but it’s impossible for SPs to accurately portray these behaviors, or for faculty to fully assess the nuanced behaviors of both learner and patient. Supporting this idea is a lack of evidence proving that SP encounters translate in behavioral changes or transfer into clinical settings.

Developments in virtual reality provided us with a great opportunity for assessing and teaching of communication behaviors. Working with a national group of experts, we created computer-based Virtual Humans that interact with learners using the full range of behaviors you’d expect from two people talking together. They are so behaviorally realistic and compelling, that they trigger emotional responses in learners, and make learners want to learn so they can do their best.

Dr. Fetters: Our team has particular interest in doctor-patient communication in the context of cancer. There are many critical aspects of cancer communication: breaking the bad news to the patient, negotiating sometimes conflicting family opinions about treatment, and communication among team members about the patient’s care, just to name a few. We’ve begun building out those scenarios in the technological platform we developed, Mpathic-VR.

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Noninvasive Patch Test Can Improve Clinical Diagnosis of Melanoma

MedicalResearch.com Interview with:

Laura Korb Ferris, MD, PhD</strong> Associate Professor, University of Pittsburgh Clinical and Translational Science Institute Director of Clinical Trials, Department of Dermatology University of Pittsburgh Medical Center

Dr. Laura K. Ferris

Laura Korb Ferris, MD, PhD
Associate Professor, University of Pittsburgh Clinical and Translational Science Institute
Director of Clinical Trials
Department of Dermatology
University of Pittsburgh Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We found that a non-invasive adhesive patch applied to the skin over a pigmented skin lesion allowed us to capture enough genetic material from the lesion to analyze and predict if that lesion is likely to be melanoma, meaning a biopsy is warranted, or if it is likely benign, meaning the patient would not need a skin biopsy.

In this study, we asked dermatologists to use their clinical judgement to decide if they would recommend biopsying a skin lesion based on photos and information about the lesion and the patients, such as the patient’s age, personal and family history of skin cancer, and if the lesion was new or changing. We then provided them the read out of the gene test and asked them how this influence their decision. We found that with this test result, dermatologists were more accurate in their decision making, meaning they were more likely to recommend biopsy of melanomas and less likely to biopsy harmless moles than they were without the test. This is important as it means this test has the potential to reduce the number of unnecessary skin biopsies performed, saving patients from undergoing a procedure and having a scar as a result, without increasing the risk of missing a melanoma.

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Human Stem Cells Can Be Used For 3-D Printing of Tissue Stuctures

MedicalResearch.com Interview with:

Sang Jin Lee, Ph.D. Associate Professor of Wake Forest Institute for Regenerative Medicine Wake Forest School of Medicine Wake Forest University

Dr. Sang Jin Lee

Sang Jin Lee, Ph.D.
Associate Professor of Wake Forest Institute for Regenerative Medicine
Wake Forest School of Medicine
Wake Forest University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: I received my Ph.D. in Chemical Engineering at Hanyang University, Seoul, South Korea in 2003 and took a postdoctoral fellowship in the Laboratories for Tissue Engineering and Cellular Therapeutics at Harvard Medical School and Children’s Hospital Boston and the Wake Forest Institute for Regenerative Medicine where I am currently a faculty member. My research works have focused on development of smart biomaterial systems that support the regenerative medicine strategies and approaches. These biomaterial systems combined with drug/protein delivery system, nano/micro-scaled topographical feature, or hybrid materials that could actively participate in functional tissue regeneration. Recently my research works utilize 3D bioprinting strategy to manufacture complex, multi-cellular living tissue constructs that mimic the structure of native tissues. This can be accomplished by optimizing the formulation of biomaterials to serve as the scaffolding for 3D bioprinting, and by providing the biological environment needed for the successful delivery of cells and biomaterials to discrete locations within the 3D structure.

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Sonoillumination May Expand Skin Types That Can Be Treated With Laser Therapy

MedicalResearch.com Interview with:

Paul J.D. Whiteside, doctoral candidate and Dr. Heather Hunt, assistant professor of bioengineering University of Missouri

Dr. Heather Hunt and Paul Whiteside

Paul J.D. Whiteside, doctoral candidate and
Dr. Heather Hunt, assistant professor of bioengineering
University of Missouri

MedicalResearch.com: What is the background for this technology? What are the barriers to the use of conventional laser treatment of tattoos?

Response: Traditional laser treatments rely on the concept of selective photothermolysis (laser-induced heating) to specifically target certain structures for treatment, while leaving other parts of the skin unaffected. The problem with traditional laser treatments is that the laser needs to transmit through the epidermis, which acts as a barrier to laser transmission both due to its reflective properties and because it is filled with light-absorbing melanin, the pigment that gives our skin its color. Sonoillumination acts to change the properties of the epidermis temporarily using painless ultrasound technology, thereby allowing more laser light to penetrate deeper into the skin to impact desired targets, such as hair follicles, tattoos, and blood vessels. Funding for clinical trials is currently being sought to provide evidence for what we surmise may be benefits of this technology relative to traditional laser treatments. These benefits may include being able to treat darker-skinned people more effectively, being able to provide laser therapy with less risk of scarring or pigment changes, and being able to do treatments with less discomfort, fewer treatments, and lower laser energy settings.

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Advanced Heart Failure Patients Should Have Option of LVAD Device

MedicalResearch.com Interview with:
Amrut V. Ambardekar, MD
Medical Director Cardiac Transplant Program
Division of Cardiology, Section of Advanced Heart Failure-Transplant Cardiology
University of Colorado

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As left ventricular assist device (LVAD) technology has improved, the appropriate timing for implant of these devices (essential a form of an artificial heart pump) in patients with advanced heart failure is unknown.

The goal of the MedaMACS study was to describe the prognosis of a group of patients with advanced heart failure who currently do not require intravenous therapies, and determine how they compare to a similar group of patients who received a LVAD.

The main finding from this study is that the “sickest” group of patients with advanced heart failure on oral medical therapy (known as INTERMACS profile 4 patients) have very poor outcomes with a strong trend for improvement in survival with LVAD therapy.

The other take home message is that among all of the patients enrolled in the study on medical therapy, only approximately half were alive after an average of 12 months of follow up without needing a heart transplant or LVAD placement.

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One Drop | Mobile APP Leads To Improved A1c in Diabetes

MedicalResearch.com Interview with:
Chandra Y. Osborn, PhD, MPH
VP, Health & Behavioral Informatics
One Drop
Informed Data Systems, Inc.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are over 1,500 mobile apps for people with diabetes, but minimal evidence on their benefit. The One Drop | Mobile app launched in April 2015. Users manually and automatically track their blood glucose and self-care activities via One Drop’s | Chrome glucose meter, other Bluetooth-enabled meters, CGMs or other health apps. Users leverage One Drop’s food library, medication scheduler, automatic activity tracking, educational content, recipes, health tips, user polls, and peer support (‘likes’, stickers, and data sharing), and can set blood glucose, medication, carbohydrate intake, and activity goals, receive data-driven insights to draw connections between their behaviors, goals, and blood glucose readings. They can also self-report and track their hemoglobin A1c (A1c) and weight.

In July 2016, we queried data on ~50,000 people using One Drop | Mobile. In March 2017, we queried data on >160,000 users. Only users who had entered an A1c value when they started using the app, and entered a second A1c at least 60 days apart, but no more than 365 days apart, were included. In July 2016, people with diabetes using One Drop | Mobile reported a nearly 0.7% reduction in A1c during 2-12 months of using One Drop. In March 2017, users reported a 1.0% reduction in A1c for the same timeframe. A more recent diabetes diagnosis and using One Drop to track self-care activities was associated with more A1c improvement.

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Multiple Sclerosis Patients Show Cognitive Benefit From Remotely Supervised Transcranial Direct Current Stimulation

MedicalResearch.com Interview with:

Leigh E. Charvet, PhD Associate Professor, Department of Neurology Department of Neurology New York University Langone Medical Center New York, NY

Dr. Charvet

Leigh E. Charvet, PhD
Associate Professor, Department of Neurology
Department of Neurology
New York University Langone Medical Center
New York, NY

MedicalResearch.com: What is the background for transcranial direct current stimulation? What are the main findings of this study in multiple sclerosis patients?

Response: The application of tDCS is a relatively recent therapeutic development that utilizes low amplitude direct currents to induce changes in cortical excitability. When paired with a rehabilitation activity, it may improve learning rates and outcomes.

Multiple repeated sessions are needed for both tDCS and cognitive training sessions to see a benefit. Because it is not feasible to have participants come to clinic daily for treatments, we developed a method to deliver tDCS paired with cognitive training (using computer-based training games) to patients at home. Our protocol uses a telemedicine platform with videoconferencing to assist study participants with all the procedures and to ensure safety and consistency across treatment sessions.

When testing our methods, we enrolled 25 participants with multiple sclerosis (MS) completed 10 sessions of tDCS (2.0 mA x 20 minutes, dorsolateral prefrontal cortex, left anodal) using the remotely-supervised telerehabilitation protocol. This group was compared to n=20 MS participants who completed 10 sessions of cognitive training only (also through remote supervision).

We administered cognitive testing measures at baseline and study end. We found that both the tDCS and cognitive training only group had similar and slight improvements on composites of standard neuropsychological measures and basic attention. However, the tDCS group had a significantly greater gain on computer-based measures of complex attention and on a measure of intra-individual variability in response times.

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New Recording System Enables Identification of Complex Cardiac Arrhythmias

MedicalResearch.com Interview with:

Jay Millerhagen

Jay Millerhagen

MedicalResearch.com: What is the background for this study?

Response: Journal of the American College of Cardiology (JACC): Clinical Electrophysiology (JACC CEP) publication entitled, “Novel Electrophysiology Recording System Enables Specific Visualization of the Purkinje Network and Other High-Frequency Signals” reports important findings obtained using BioSig Technologies’ PURE EP System during a series of pre-clinical studies conducted at Mayo Clinic in Rochester, Minnesota. These studies are part of a company-funded Advanced Research Program announced on March 28, 2016. The JACC CEP manuscript provides an excellent example of the PURE EP System’s ability to record challenging high frequency signals known as Purkinje potentials. These signals are of great interest to electrophysiologists when assessing arrhythmia syndromes dependent on the Purkinje network.

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Medtronic Pipeline Embolization Device Found Safe For Smaller Aneurysms

MedicalResearch.com Interview with:

Ricardo A Hanel, MD PhD Endovascular and Skull Base Neurosurgery Director, Baptist Neurological Institute Endowed Chair, Stroke and Cerebrovascular Surgery Jacksonville, FL

Dr. Hanel

Ricardo A Hanel, MD PhD
Endovascular and Skull Base Neurosurgery
Director, Baptist Neurological Institute
Endowed Chair, Stroke and Cerebrovascular Surgery
Jacksonville, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medtronic Pipeline Embolization Device has been approved for carotid artery aneurysms over 10mm in size, from the petrous to clinoid segment but given the efficacy of results on these larger lesions, it has been widely utilized for treatment of smaller lesions. PREMIER came from the need of assessing the results , safety and efficacy, of pipeline for use of aneurysms under 12mm, located on the carotid artery, all segments, and V3 segment of the vertebral artery.
PREMIER enrolled 141 patients treated at 22 centers (21 US, 1 Canada). Primary Safety effectiveness defined as total aneurysm occlusion, core lab adjudicated , at 1 year was 83.5%; with safety endpoint of major stroke/death at 30 days of 1.4% (2 patients), with 1-year major stroke and death rate of 2.1%.

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Radiofrequency Therapy For The Treatment Of Vaginal Laxity

MedicalResearch.com Interview with:

Dr. Michael Krychman

Dr. Michael Krychman

Dr. Krychman is Executive Director, President, and CEO of the Southern California Center for Sexual Health and Survivorship Medicine and Associate Clinical Professor at the University of California, Irvine, Department of Obstetrics and Gynecology. He is a Member of the International Society for the Study of Women’s Sexual Health (ISSWSH), The International Society for Sexual Medicine (ISSM) and a Certified Sexual Counselor by the American Association of Sexuality Educators, Counselors and Therapists (AASECT). He served as a member of the Standards Committee for the International Society for Sexual Medicine during their 2016 International Consensus Meeting.  

MedicalResearch.com:  What is the background for this technology and study? What are the main findings?

Response: Viveve Medical, Inc. is a women’s health and wellness company committed to advancing new solutions to improve women’s overall well-being and quality of life.  The internationally patented Viveve® technology and the GENEVEVE™ treatment, incorporates clinically-proven, cryogen-cooled monopolar radiofrequency (CMRF) energy to uniformly deliver non-ablative, deep penetrating volumetric heat into the submucosal layer of the vaginal introitus (opening) while gently cooling surface tissue to generate robust neocollagenesis.  One 30-minute in-office session tightens and restores the tissue around the vaginal introitus addressing the common medical condition of vaginal laxity and can improve a woman’s sexual function.

VIVEVE I is a landmark study.  Results of the VIVEVE I clinical study, “Effect of Single-Treatment, Surface-Cooled Radiofrequency Therapy on Vaginal Laxity and Female Sexual Function: The VIVEVE I Randomized Controlled Trial,” were recently published in the February 2017 issue of the Journal of Sexual Medicine (JSM) under the Female Sexual Function category.   Some of my high-level thoughts to reiterate from this study are:

It is the first-ever large, randomized, sham-controlled study to demonstrate the safety and efficacy of energy-based procedures in gynecological applications, including vaginal laxity, which is a significant medical condition affecting millions of women worldwide that may lead to a reduction in sexual function.

The primary endpoint of the VIVEVE I study was a comparison of the proportion of women reporting no vaginal laxity in the treatment group versus the sham group at 6 months post-treatment.

Subjects receiving the active treatment were three times more likely to report no vaginal laxity at six months versus the sham group (p-value = 0.006).

Statistically significant and sustained improvement in sexual function (baseline FSFI total score ≤26.5) after a single treatment, with an adjusted mean difference in the active group vs sham group of 3.2 at 6 months (p-value = 0.009). “Placebo Effect” in the sham group did not rise above dysfunctional (FSFI ≤26.5) and diminished at 6 months.

Statistically significant improvement in sexual function was achieved in 93% of subjects in the active group vs the sham group in two individual key domains of FSFI (p-value = 0.007).

Bottom line: Geneveve is a safe effective treatment that can be performed as an outpatient in one 30-minute visit to improve sexual function as it has been affected by vaginal laxity.

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We Spend More Time on Facebook Than We Think

Dr-Lazaros-Gonidis.jpg

Dr Dinkar Sharma and Dr. Lazaros Gonidis

MedicalResearch.com Interview with:
Lazaros Gonidis PhD candidate
Postgraduate Researcher
University of Kent

MedicalResearch.com: In general, why do we tend to underestimate time when we are distracted versus when we are doing something boring? Is the adage that “time flies when you’re having fun” true?

Response:  In order to be accurate at time “keeping” we need to attend to it. Anything that distracts us makes us less accurate, and to be more specific, it makes us underestimate the duration of events. In simple terms when we experience an event that last 10 minutes a distraction could make it feel like 5 minutes. On the other hand when we are bored, let’s say during a non-interesting event, we tend to focus more on time keeping looking forward for the event to finish. In this case we would overestimate the event and 10 minutes could feel like 15 minutes.

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