Author: joelarunsursas

Originally published on droidmen.com

Healthcare is on the cusp of a digital revolution powered by technological developments across several fields as a result of new workflows, data gathering, and hardware innovation. Over the next five to ten years, expect digitization to rapidly transform much of the health industry, from in-person patient care to remote diagnosis Still, medical advancements are part of the game, so why is now different? Frankly, apart from dedicated medical staff, technology is the primary force behind the influential trends and transformative curves of change sweeping the industry. Much of its strength resides in accessibility via digitization and miniaturization. Visual tech, especially, is helping lead the way in virtual medicine. As more providers, medical units, and patients adopt and embrace the new tech, shortcomings of the current system will slowly diminish.

In this article, Joel Arun Sursas, Health Informatician and Medical Doctor reviews the radical transformation within the healthcare industry as well as prospective milestones in medical science as a result of emerging technologies.

Digitization & Mobility 

As external bureaucratic and political pressures threaten to disrupt medical business models, healthcare, though relatively progressive, is yearning for administrative reform and harmony. The opportunity, as well as the challenge, lies within digitization. Not only can digital upgrades improve operational budgets and bottom lines for companies, but it also generates a halo effect that elevates the patient experience, notably in mobility and reach of care.

While healthcare is a dignified industry, it remains a market influenced by consumer demand. And as a result of the internet and smartphones, consumer behavior demands speed, convenience, and accessibility at all times. The culmination of these factors has bolstered the feasibility of Telemedicine as a revenue stream.

Telemedicine allows patients to seek medical care via a digital connection. While a significant number of eligible patients remain wary of this new frontier, the research suggests that Telemedicine, especially utilized in conjunction with a home-based health monitoring device, can improve survival rates and lower hospitalization. This type of healthcare also allows medical professionals to broaden their service of care by nurturing patients in rural areas that might otherwise forego consistent medical attention altogether due to distance and economic restrictions. It also provides a digitized health record synced to a patient’s profile, ideally in a portal, which improves logistical efficiency.

Of course, digitization is quite broad in application, and healthcare is extraordinarily complex, which begs the question: what is driving digital adoption amongst patients? Connecting individuals to medical providers, thanks to global internet infrastructure, is one answer. Technology is another.

Tech Miniaturization 

To truly personalize medical care, doctors require access to patients’ lifestyles and behaviors that affect their health daily. Decades ago, this would not be possible without a clinical setting; however, it is now a reality thanks to the genius of engineers. Technological advancements in smartphone health applications, wireless connectivity, wearables with miniaturized biometric sensors, and handheld-imaging platforms are already helping reduce healthcare costs, increasing patient engagement and improving treatment and outcomes.

Smaller health sensors that capture metrics such as heart rate, blood pressure, and even oxygen levels allow for more refined hardware designs. If the tech is unsightly or uncomfortable to wear, humans subconsciously reject it on some level and are therefore less likely to wear it, thus diminishing the care. However, health wearables like Fitbit and smartwatches have proven that slick product design can act as an incentive to wear health monitoring devices.

Furthermore, the miniaturization of visual sensors and image capture capabilities may soon allow patients to undergo body scans from the convenience of their own home. Some of the more progressive innovation involves live imaging transmitted from an ingestible camera.

Beyond sensor capabilities, another exciting development is microfluidics. In layman’s terms, it’s a medical lab in the form of a microchip. Microfluidics, like labs, can detect infectious diseases, offer point-of-care tests, provide a diagnosis with a smaller sample size at a faster rate, and lower test costs, which is a major concern for patients that have insurance plans with a high deductible.

Next up, nanobots. It may sound like a talking point out of science fiction, yet it’s being heralded as the future of healthcare. Nanobots are microscopic robots with magnetic nanoparticles programmed by medical practitioners to assist in complex tasks — even surgery.

Data 

Patient records contain enormous amounts of information (aka data), and without an adequate digital summary accessible on a computer, extracting meaningful data can be quite archaic.

Digitizing data reduces the demand for physical storage, thus lowering overhead costs, but more importantly, it improves analysis. Wearable devices and digital applications seamlessly record biometric data and can easily be exported to medical offices around the world. Physicians and lab techs can then use computer programs to analyze the data in meaningful ways by simultaneously cross-referencing the patent’s digital summary against decades of medical research. The diagnosis can then be treated with an actionable and more personalized health plan.

The most promising aspect of digitizing a patient’s medical history lies within predictive analytics. This strategic use of data may one day revolutionize preventative healthcare, identifying potential problems and causes for concern weeks or even months before traditional care.

Outlook 

By the end of the decade, it will be more common for a significant portion of patients to receive primary medical care remotely through technology operated by a digital interface rather than at an office. This imminent change is fueled by the digitization of medical science, especially new developments of medical devices that are easy enough to use in a casual home setting and real-time data analytical capabilities. It provides a glimpse of what personalized healthcare can and should be.

Originally published on healthtransformation.net 

Technology has advanced the medical field immensely in the last decade and continues to embed itself in everything from treatments to education. It’s made it easier and faster for patients to receive test results and make appointments, and doctors use delicate, precise devices and robots to aid them in performing countless procedures from checking patients’ ears to complex brain surgeries. While many people may feel nervous about adding these new machines to the operating room, the accuracy of these devices remains unmatched and can really help provide optimal care for patients. Here, Dr. Joel Arun Sursas – the head of Clinical Affairs at Biorithm – explains the uses of virtual reality (VR) in medical education.

Today, educators are using equipment, such as virtual reality, to provide students with an exact model of real-life scenarios, without the real-life patients. This prepares students for a variety of different medical scenarios without genuine risks. That way, when they finish their education and head out as residents, they already have some experience.

As of today, numerous studies have been conducted to see how virtual reality affects students. Thus far, it has produced favorable results and medical professionals and educators view it as a great tool in educating future medical professionals.What is Virtual Reality?

Virtual reality, or VR, is electronic equipment that looks similar to ski goggles. It is placed over the eyes of the user and allows he/she to enter a virtual world through a three-dimensional, computer-generated program. It has been extremely popular in households all across the world for everything from traveling the world (virtually) to gaming, but it can also simulate actual medical procedures.

The graphics can be quite realistic, which is why it’s the perfect tool for medical students to use.How is VR Used in Medical Education?

Because VR can render such life-like situations, professors have begun to use VR as a way to teach both clinical and surgical procedures, how to treat elderly patients, and as an aid in general learning so the student is ready to treat a real patient.

The ability to manipulate three-dimensional avatars in a virtual world allows the students to access educational programs to study human anatomy and treatment techniques, and practice how they would respond and treat a patient. Because it is all done virtually, there are no risks, a student can go back to a certain spot and try again, and they can record how well they do to track their progress.

Another way medical students could benefit from VR is from gaining “hands on” experience when treating elderly and dementia patients. Older patients usually require a completely different approach since they are likely to suffer from forms of dementia and other ailments, such as macular degeneration and hearing loss, which can often make treatment far more difficult than any other average patient. VR allows them to train for these situations so that the students will be ready when an elderly patient presents these predicaments in the hospital or clinic they are assigned to.

Lastly, VR is an unmatched study tool. Being able to examine and experiment on VR avatars gives an advanced visual approach that textbooks simply fall short on. Watching various medical scenarios played out in a near-authentic way will also help students prepare for difficult circumstances. As mentioned above, they also have the option to practice medical procedures by manipulating the VR avatars and gives them a chance to develop bedside manners.Outcomes of Using VR in Medical Education

Since other studies that focus on the effects of the excessive use of technology shows that it negatively impacts users, one can only wonder how adding technology to the classroom can affect students.

In recent years, there have been several studies following the effects of VR in medical education. Thus far, the results have been favorable. However, these studies have revealed that while VR does have a positive effect on students, the effect is fairly minimal. Though VR only slightly improves students’ medical knowledge and skill set, the fact of the matter is that it remains a constructive pedagogical tool and many may argue that its positive influence should continue to be applied in the classroom.

A recent study reviewed several surveys and findings of several other studies and divided the results into two groups: one that only used traditional learning and the other that incorporated VR in the educational pedagogy. The purpose of this study was to see if it improved students’ cognitive skills, overall comprehension of medical facts, and how to practice procedures. The results showed that when compared to traditional learning, the use of VR in medical education somewhat improved students’ comprehension, as reported in their test scores, and none of the students recounted any harmful effects.

Another study followed how students responded to elderly and dementia patients while using a VR simulation. The goal of this study was to improve treatment when dealing with a patient who may have an ailment that inhibits communication. From hearing impairments to dementia, VR simulations can replicate scenarios where a patient may have these impediments which give students the opportunity to work with them and get valuable practice time.

Overall, using VR as a teaching method has proved to be fairly useful in medical education and will likely continue to benefit students in the future as technology advances.

About Dr. Joel Arun Sursas:

Joel Arun Sursas is a skilled Medical Doctor and Health Informatician motivated to solve administrative problems in healthcare. His determination to work tirelessly to bridge the gap between doctors and engineers is resulting in medical technology solutions that improve patient outcomes, enhance monitoring, and protect patient privacy. Dr. Joel Arun Sursas is an effective communicator who facilitates the achievement of team goals.

Originally published on sitepronews.com

User Interface (UI) and User Experience (UX) is becoming an increasingly important consideration for developers and distributors of medical systems and devices. Hardware design and usefulness, customization, regulatory compliance, and multiple other factors are critical to providing healthcare providers with the materials they need to maximize patient care and effective treatment. In this article, Dr. Joel Arun Sursas discusses the importance of UI and UX in the healthcare environment.

Why UI/UX Is Important

Generally speaking, any UX involves a user’s ability to effectively and appropriately use and respond to any device or system. In healthcare, the UI directly impacts the UX functionality of any medical device, application, or system that is used to diagnose and treat patients. The rapid pace of innovation and technological development in healthcare in recent years requires a close look at the UI and UX aspects of all new devices and software to maximize patient care. Products and processes should be designed with the user in mind, and UX is a great metric for measuring how well new products deliver results for patients.

Strong UX Promotes Efficiency

Ease of use is essential for any process, product, or system. When a product is easy to use, it is more efficient than other options. Products that maximize simple operation are easier to learn and master for users of all skill levels. The art of turning complex systems into understandable systems that are repetitive and predictable promotes a UX that promotes proper and more efficient use. Users who can intuitively use products spend less time and make fewer errors in providing healthcare services.

Products with Solid UX Work and Provide Value

Products that do not actually provide solutions or do not work properly are counter-productive and create additional problems in the healthcare workplace. Measuring UX helps ensure that the products are adequately designed for their intended tasks. If a new product is challenging to operate or does not function properly, users are likely to resort to older and less efficient technologies to get a task done. Product and system design should always consider user preferences regarding routine tasks and how hardware and software are used in the real world.

Proper UX Protects Patient Data and Safety

Traditional electronic medical record systems are rapidly losing usefulness in the healthcare world that is being redesigned around new technologies. Record-keeping systems do much more than traditional systems were ever designed to handle, and to maximize the value of new systems, UX should be placed front and center in all parts of the process. Users must be able to easily and quickly use systems to collect data securely so that systems can present results to providers reliably. Systems that are user-friendly and predictable significantly reduce the risk of errors and poor patient outcomes.

About Dr. Joel Arun Sursas

Dr. Joel Arun Sursas is a Medical Doctor and Health Informatician with a primary focus on solving administrative problems in healthcare through advanced technologies. His interest in the field of Medical Informatics emerged when he began working as a Project Officer for PACES — the Patient Care Enhancement System for Singapore Armed Forces (SAF). Dr. Sursas works continuously on developing technological advances between doctors and engineers to improve patient outcomes through improved monitoring while protecting patient privacy. He holds a Bachelor’s Degree in Medicine and a Bachelor’s Degree in Surgery from the National University of Singapore. He is currently pursuing a Certificate in Safety, Quality, Informatics, and Leadership from the Harvard Medical School and a Masters in Applied Health Science Informatics from Johns Hopkins University, both of which are expected in 2020.

Originally published on thriveglobal.com

Introduction

There has been much furore regarding the gut microbiome, and many international academic and research centres have focused their research agendas on delineating the specific functionalities and therapeutic potentials of alterations in the gut microbiome. Innovative solutions are being pitched – from alterations to the composition of the gut microbiome, curated analysis of the gut microbiome to disease-targeting gut microbiome interventions; these solutions are predicated on the intricate relationship between the gut microbiome and the brain. In this article, I want to shed some light on the gut-brain-microbiome axis and dive deeper into this relationship.

The Gut Microbiome

The vast plethora of microbes which inhabit our gastrointestinal tracts, collectively termed the gut microbiome profoundly orchestrate and influence different facets of our physiology. An average-sized adult human body consists of approximately 10 trillion human cells. In stark comparison, the same body will harbour approximately 100 trillion microbial cells [19]. The gut microbiome contributes almost 2 kilograms of weight to the average sized adult human [10].

Furthermore, from a genetic standpoint, each of us contains about 20,000 genes, but as many as 2 – 20 million microbial genes. Each human body is a vast, rich, and complex ecosystem which is capable of influencing normal physiologic, immunologic, and metabolic processes. The human gut microbiome’s composition depends on a variety of factors including nutrition, mode of delivery, antibiotic usage, presence or absence of disease states (e.g., Celiac Disease, Inflammatory Bowel Disease, etc.) and physical activity amongst others.

For most humans, the maternal vaginal and perianal microbiota represent the first postnatal microbial exposure. A healthy human adult will harbour more than 1000 species of bacteria, amongst which the Bacteroidetes and Firmicutes phyla dominate [14]. Functionally, the gut microbiome is chiefly responsible for digestion and nutrition. For example, the capacity to digest xyloglucans which are found in certain vegetables was mapped to a single locus in a species of Bacteroides. This ability is a rare trait in Bacteroides – yet, 92% of human individuals harbour at least one of these rare Bacteroides species, conferring themselves with the ability to digest xyloglucans [14].

However, emerging research has shown that the gut microbiome is also capable of influencing the metabolism and immunology of the host. With respect to metabolism, several studies have shown that differences in energy consumption can be attributed to gut microbial composition. Individuals with a more efficient gut microbiome can extract dietary energy more efficiently and consequently may be predisposed to obesity [10]. Notwithstanding the gut microbiome’s physiologic and metabolic implications on the host, this paper’s primary focus will be on the potential health benefits of the gut-microbiota-brain axis on the central nervous system (CNS) and immune systems, particularly in chronic inflammatory processes.

Gut-Microbiota-Brain Axis

To define the gut-microbiota-brain axis, one must fully understand its individual components. The gut-microbiota-brain axis consists of the CNS, hypothalamic-pituitary-adrenal axis (HPA axis), the autonomic nervous system (ANS), the enteric nervous system (ENS), and the gut microbiome. The enteric nervous system (ENS), itself a division of the peripheral nervous system (PNS), is a complex entity comprising of myenteric, submucosal, and mucosal layers of neurons. Anatomically, it is large – comprising of more than 100 million neurons which form a complex network through the layers of the small and large intestines.  Functionally, it is able to control gastrointestinal behaviour independently of the central nervous system. For example, the myenteric plexus which is localised between the longitudinal and circular layers of smooth muscle regulates smooth-muscle function, whereas the submucosal plexus which is localised in the connective tissue of the submucosa alters the secretory and absorptive capacities of the gastrointestinal tract. However, recent evidence shows that despite this autonomy accorded to the ENS by virtue of its intrinsic microcircuits, the gastrointestinal tract is still profoundly influenced by the CNS. This gut microbiome forms a symbiotic relationship with the brain by modulation of the CNS via several immune pathways. This relationship is bidirectional, in the sense that changes in CNS biochemistry can consequently alter the microbial composition via the HPA axis. This is achieved by altering the intestinal permeability to allow bacterial antigens to penetrate the epithelium, hence achieving an immune response in the intestinal mucosa [2]. Emotional and psychological stressors have also been shown to influence the composition of the gut microbiota, as evidenced by a study conducted in 2013 which found that healthy students exposed to stress had fewer Lactobacilli in their stool when compared to periods bereft of stress [4].

Dysbiosis and the CNS

Several studies have elucidated the potential benefits that the gut-microbiota-brain axis can confer upon the CNS. Probiotics such as VSL3, Bifidobacterium, and Lactobacillus induce Ly6C+ monocytes to increase neurogenesis and augment memory. They also exhibit anti-inflammatory properties and can attenuate mood disorders such as anxiety and depression [9]. A study conducted by Dinan, Stanton, and Cryan in 2013 also showed that the administration of “psychobiotics” – live microbes which confer health benefits when ingested by patients suffering from mood disorders. Another study conducted in 2002 observed a higher prevalence of Bifidobacteria in healthy children when compared to children with Autism Spectrum Disorder (ASD). However, children with ASD had a higher prevalence of Bacteroides Vulgatus and Desulfovibrio species in their stool [2].

The proposed mechanism for this observation is that dysbiosis (defined as a disruption in the normal homeostatic mechanisms which regulate the structure or function of the gut microbiota) leads to increased permeability and leakiness of the intestinal epithelium, hence allowing bacterial antigens and cytokines to enter the bloodstream and cross the blood-brain-barrier to affect behaviour [13]. A study conducted by Berer et al. in 2011 suggested that the gut microbiome may be implicated in the pathogenesis of Multiple Sclerosis (MS) – a chronic disease characterized by inflammation, demyelination, gliosis, and neuronal loss. Germ-free mice saw a delay in induced experimental autoimmune encephalitis (EAE), probably due to a mitigated inflammatory response. The amalgamated findings from multiple studies focusing on memory, mood, ASDs, and MS suggest that the gut-microbiome-brain axis represents a promising target for therapy in CNS pathologies.

Potential Benefits of the Gut-Microbiome-Brain Axis

To realise the reversal of dysbiosis, several strategies have been formulated to achieve the favourable state conferred by gut homeostasis. These treatment strategies include probiotics (live microorganisms), prebiotics (non-digestible fermentable oligosaccharides), dietary fibre (non-digestible carbohydrates of plant origin) and faecal microbiota transplantation (FMT). Probiotics are the most commonly used treatment strategy and have been shown to promote immune tolerance for certain allergies, specifically eczema [18]. However, probiotic intervention has not yet proved to be efficacious with regards to preventing other immune-mediated pathologies such as asthma [7].

Further research should be conducted on the timing of administration, as well as the specific constituents of the probiotic mixtures to achieve an optimal therapeutic index. A diet that is depleted of fibre has also been shown to be associated with a decrease in the Bacteroidetes levels in the gut [16]. Antibiotics have long been known to alter gut microbiota composition, and therefore are capable of inducing dysbiosis. FMT has been shown to be useful in treating antibiotic-resistant Clostridium Difficile induced diarrhoea [17]. but there is no concrete evidence that it is a viable treatment option for IBD despite modest results from several trials [15]. A controlled trial in the future may shed further light on this matter.

It is still not clear if the disparities in microbial variation seen in CNS pathologies and chronic inflammatory states are themselves a cause of the disease states or sequelae. What is clear is that reduced microbial diversity and specific variations in the microbiota are associated with these disease states. We also know that the gut microbiota is vital in exerting its physiologic, metabolic and immunologic functions and that dysbiosis can have remarkable ramifications for the host. Further research should be conducted to clearly establish the relationship between dysbiosis and disease states, as well as the therapeutic potentials of the treatment mentioned above strategies.

Joel Arun Sursas is a team leader and facilitator with a proven track record and a niche skill-set developed over the past seven years in his capacity as an established Medical Doctor and Health Informatician. He is most passionate about Medical Informatics, working to bridge the gap between doctors and engineers to improve patient care. His interest in the field emerged when he began working as a Project Officer for PACES — the Patient Care Enhancement System for Singapore Armed Forces (SAF).

At the SAF, his extensive collaboration with other doctors and engineers resulted in designing and implementing the largest Electronic Medical Record (EMR) system in Singapore, spanning 53 medical centers, as well as developing a data analytics platform to trend epidemiological data.
Joel Arun Sursas holds a Bachelor’s Degree in Medicine and Bachelor’s Degree in Surgery from the National University of Singapore, and is continuing his education to obtain Certificate in Safety, Quality, Informatics and Leadership from the Harvard Medical School, and Masters in Applied Health Science Informatics from the Johns Hopkins University (both expected in 2020). His technical skills include SPSS, RevMan, and Python.

Dr. Arun’s most recent engagement is with a medical device start-up company Biorithm where he serves as Head of Clinical Affairs, working to take fetal surveillance out of the hospital and into the home, revolutionizing the obstetric practice globally.

Elsewhere on the net:

Joel Arun Sursas

https://www.singhealthacademy.edu.sg/residency/life-singhealth-residency/2015-winners
https://sg.linkedin.com/in/joel-arun-136099153
http://inspirery.com/an-interview-with-joel-arun-sursas-medical-doctor-and-health-informatician/
https://www.vizaca.com/joel-arun-sursas-head-of-clinical-affairs-at-biorithm/
https://www.playbuzz.com/item/783b399b-7c67-4469-8b8a-18fdddb008e9
https://medium.com/@joelarunsursas/joel-arun-sursas-on-artificial-intelligence-alternative-or-adjunct-1051f3069353
https://thriveglobal.com/stories/the-gut-brain-microbiome-axis-and-its-influence-on-the-central-nervous-system/