CIMIT blog

Inhalation Technology Podcasts

Next Tuesday's forum is on the topic of inhalation technology and also happens to be the inaugural CIMIT Inhalation Technology Program kick-off. First, we sat down with Augustine Choi, MD and Jose Venegas, PhD to discuss what inhalation technology is, it's implications, challenges and opportunities.

Then we followed up our discussion with a phone call to Jussi Saukkonen who tells us about cross-disciplinary collaboration and the impact inhalation technology will have on other areas of science.


For more information on attending the forum and directions please click here

SPEAKER: WARREN M. ZAPOL, MD
Professor of Anaesthesia, Harvard Medical School; Reginald Jenney Professor of Anaesthesia,
Harvard Medical School; Director, Anesthesia Center for Critical Care Research, MGH

MODERATOR: AUGUSTINE MK CHOI, MD
Chief, Pulmonary and Critical Care Medicine at Brigham and Women's Hospital; Co-Program Leader, Inhalation Technology, CIMIT

SPEAKER: MYRNA DOLOVICH, P ENG
Associate Clinical Professor, Medicine, Faculty of Health Sciences; Head, Firestone Research Aerosol Laboratory/Center for Molecular Imaging of the Lung, McMaster University, St Joseph's Healthcare

MODERATOR: JOSÉ G. VENEGAS, PHD
Massachusetts General Hospital in the Department of Anesthesia and Critical Care; Co-Program Leader, Inhalation Technology, CIMIT

Trauma and Critical Care in Iraq, Afghanistan and at Home

Trauma and Critical Care  
 
The Golden Hour: in Modern Combat Trauma: Different Battlefields, Same Problems 
Matthew J. Martin, MD, FACS, Trauma Medical Director, Associate Residency Director, Madigan Army Medical Center, Tacoma, Washington, matthew.martin1@us.army.mil 
Moderator: George Velmahos, MD, PhD, Professor of Surgery at Harvard Medical School and the Chief of the Division of Trauma, Emergency Surgery, and Surgical Critical Care at the Massachusetts General Hospital; CIMIT Program Leader, Trauma & Casualty Care

One of the few benefits of combat operations throughout history has been the significant advances realized in medical and surgical care of war casualties. In the current theater of operations in Iraq and Afghanistan, the United States has successfully projected a modern and robust system for the evacuation and acute care of wounded soldiers and civilians. This has been coupled with a research and administrative infrastructure capable of real-time data collection, analysis, and feedback to implement continuous quality-improvement measures at all levels of care. Matthew Martin will focus on two of the most pressing current issues in early combat casualty care: 1) The collection and transmission forward of prehospital medical data, and 2) New approaches to the early management of the bleeding patient.

The majority of combat-related fatalities occur prior to arrival at a level II or III facility (surgical capability), and are most commonly due to uncontrolled hemorrhage, head injury, or airway compromise. Although there has been significant improvement in controlling compressible extremity hemorrhage, the management of non-compressible (truncal) hemorrhage continues to represent an unsolved and often fatal problem. In addition, significant morbidity and late mortality among those who survive their initial injury may be attributed to problems in point-of-injury and pre-hospital care. A full exploration and analysis of these critical issues is hampered by the paucity of available data from the pre-hospital environment. Data collection in a chaotic and dangerous battlefield environment is hindered by a variety of situational factors and technical impediments.

Care in the "golden hour" is particularly critical in these most-severely injured patients.  Robust and reliable data regarding the epidemiology, mechanisms, timing, physiologic response, and treatments for these injuries from the pre-hospital setting must be collected and analyzed in order to guide systematic approaches to improving outcomes. This will most likely require the development of new technology for more user-friendly and automated noninvasive patient monitoring and data collection equipment.  Similarly, improving the early management of the patient with ongoing non-compressible hemorrhage will require new technology and novel approaches to metabolic and physiologic manipulation in an austere environment. Cooperation and coordination between experts from a wide variety of medical and non-medical disciplines to provide focused solutions is critically needed.

Continuity of Combat Casualty Care: The Case for Immediate Technological Improvement

David King, MD, MAJ, MC, USAR, Attending Trauma Surgeon, Attending Emergency General Surgeon, Attending Intensive Care Surgeon and Clinical Instructor in Surgery, Massachusetts General Hospital, Harvard Medical School, dking3@partners.org 
Moderator: Marc de Moya, MD, Surgeon, Division of Trauma, Emergency Surgery and Surgical Critical Care; Associate Director of Advanced Trauma Operative Management; Attending Surgeon, Surgical Intensive Care Unit; Medical Director, Trauma and ER Surgical Nurse Practitioner Program - Massachusetts General Hospital; Assistant Professor of Surgery, Harvard Medical School, mdemoya@partners.org

Surgical care of combat casualties remains extremely challenging. Often, complex non-standard operative interventions are carried out at far-forward low-echelon units in order to preserve life and limb. Paper medical records are commonly and routinely lost during multiple aero-medical transports within theater. Currently, there is no reliable effective mechanism in place to transmit critical patient care information as patients are evacuated through the lower levels of the military medical system. It is common for a patient to undergo multiple unnecessary operations, interventions, and imaging studies for lack of available historical clinical information. A new medical data collection system must be created which is reliable, reusable, and intrinsic to the patient, such that separation is exceedingly unlikely or impossible. 

Health 2.0

Connecting, Enabling Healthy Behaviors and Taking Charge of Health Records
 
 
 
Personally Controlled Health Records: Tectonic Shifts in the Health Information Economy 
Kenneth D. Mandl, MD, MPH, Associate Professor, Children's Hospital Boston|Harvard Medical School, Harvard-MIT Health Sciences and Technology, kenneth.mandl@childrens.harvard.edu
Personally controlled health record platforms have been adopted by major technology companies, including Google and Microsoft, and by a large employer consortium (Dossia). Mandl will discuss the opportunities created as well as challenges faced in these real-world deployments.  
 
 
 

Persuasive Interfaces for Medicine: Enabling Patients to Change Health-related Behaviors 
John Moore, MD, Research Assistant, New Media Medicine Group, MIT Media Lab, jom@mit.edu
We know, in medicine, that patients are complex individuals with the need for understanding and social support. We need to make decisions with them rather than for them. Unfortunately, health information technology today fails to adhere to these principles. It focuses on giving doctors tools to enter, manage, explore, and reason with data, but it does not include the most important person, the patient. We spend tremendous time and effort on problems in data integration, but we fail to ask the courageous question: Is this data going to make patients healthier? The answer is, no, not on its own. It is not going to improve the fact that only 50% of chronic disease patients take their medications correctly. It is not going to slow or reverse our obesity epidemic. And it is not going to stop deaths from preventable and treatable diseases such as breast cancer and colon cancer. Patient trust in providers is fading, and technology that alienates the patient is only going to cause a wider rift. We need technology that works for patients by giving them new abilities and new power. It needs to help patients understand their diseases, track and reflect on their performance, and continually collaborate and receive support from their providers and caregivers. This patient-centric approach to technology, which leverages its persuasive powers and coaching from physicians, is what is going to help patients take an active role in their care, change their behaviors, and lead healthier lives. 
 
 
 
HelloHealth: A Social Network for Clinicians to Communicate with Patients and Clinicians 
Jay Parkinson, MD, MPH, Myca, jayparkinsonmd@gmail.com 
Facebook has given us a look at how the social Web can keep you up to date on all your friends. What if an equivalent was used to keep you up to date on all your patients? We'll explore what this means to physicians and patients and to our society as a whole. Because when we change the way we communicate, we change society.

Neurocircuitry & Second Life for Health - A CIMIT Mixed Bag

 
Optical Brain Control: Analyzing and Engineering Normal and Pathological Neural Circuit Dynamics 
 
 
Ed Boyden, PhD, Assistant Professor of Media Arts and Sciences, Benesse Career Development Professor of Research in Education, MIT Media Lab, esb@media.mit.edu  
 
Many pathologies are associated with abnormalities in coordination of neurons within and between multiple brain areas. Ed Boyden will discuss the bioengineering of a new class of optical control technologies that permit activation and silencing of neurons with multiple colors of light. He will also explore how these technologies can be used to alter information processing in neural circuits, ideally for therapeutic benefit, along with some recent translational insights.

 
Providing Real Care in a Virtual Environment: The Challenges and Potential of Clinical Practice in a Virtual World  
 
 
Dan Hoch, MD, Neurologist, Massachusetts General Hospital; Assistant Professor, Harvard Medical School, dhoch@partners.org 
 
The Internet has been used as an educational platform in healthcare for many years. More recently, Web-based behavioral interventions have also been deployed. However, the emotional connections and richness of interaction available using a browser are limited. Three dimensional virtual worlds like Second Life may offer a significant opportunity for education, coaching and intervention. A collaboration between the department of Neurology and the Benson Henry Institute for Mind Body Medicine at the Massachusetts General Hospital and Partners Center for Connected Health has been developed to explore this idea by determining if the relaxation response can be taught to subjects through group teaching sessions in Second Life. An existing program was adapted and volunteers were recruited from within Second Life. Pre and post testing, using symptom monitoring and quality of life instruments, was employed to assess impact. The data are presently being analyzed, but qualitative feedback from the project has already been collected and will be presented.  

Moderator: Steven C. Schachter, MD, Program Leader, CIMIT Neurotechnology Program and CIMIT Site Miner, Beth Israel Deaconess Medical Center (BIDMC); Professor of Neurology, Harvard Medical School, Director of Research, Department of Neurology, BIDMC; Associate Director, Clinical Research, Harvard Medical School Osher Institute; Member, Board of the Epilepsy Therapy Development Project; Founder & Editor-in–Chief, Epilepsy & Behavior; Editor-in-Chief of Epilepsy.com; President, American Epilepsy Society, sschacht@bidmc.harvard.edu 

The Golden Hour of Soldier Care and Black Box Patients

This week Lynn and I sat down to talk with Dr. Martin and Dr. King to talk about Trauma and Critical Care in the military and domestic theaters. For more information, speaker bios and directions to the forum please click here.

SPEAKER: MATTHEW J. MARTIN, MD, FACS
Trauma Medical Director, Associate Residency Director, Madigan Army Medical Center, Tacoma, Washington

One of the few benefits of combat operations throughout history has been the significant advances realized in medical and surgical care of war casualties. In the current theater of operations in Iraq and Afghanistan, the United States has successfully projected a modern and robust system for the evacuation and acute care of wounded soldiers and civilians. This has been coupled with a research and administrative infrastructure capable of real-time data collection, analysis, and feedback to implement continuous quality-improvement measures at all levels of care. This presentation will focus on two of the most pressing current issues in early combat casualty care: 1) The collection and transmission forward of prehospital medical data, and 2) New approaches to the early management of the bleeding patient... read more...

SPEAKER: DAVID KING, MD, MAJ, MC, USAR
Attending Trauma Surgeon, Attending Emergency General Surgeon, Attending Intensive Care Surgeon and Clinical Instructor in Surgery, Massachusetts General Hospital, Harvard Medical School

Surgical care of combat casualties remains extremely challenging. Often, complex non-standard operative interventions are carried out at far-forward low-echelon units in order to preserve life and limb. Paper medical records are commonly and routinely lost during multiple aero-medical transports within theater. Currently, there is no reliable effective mechanism in place to transmit critical patient care information as patients are evacuated through the lower levels of the military medical system. It is common for a patient to undergo multiple unnecessary operations, interventions, and imaging studies for lack of available historical clinical information. A new medical data collection system must be created which is reliable, reusable, and intrinsic to the patient, such that separation is exceedingly unlikely or impossible... read more...

And we'll see you at the forum!

Are Two Photons Better Than One?

Are Two Photons Better than One? Non-linear Photoactivation for Micro-targeting of Cells and Vasculature

Brian Wilson, PhD, Head, Division of Biophysics and Bioimaging, Ontario Cancer Institute, and Professor of Medical Biophysics, Faculty of Medicine, University of Toronto, wilson@uhnresearch.ca

Moderator: Irene Kochevar, PhD, Biochemist, Wellman Center for Photomedicine, Massachusetts General Hospital and Professor, Harvard Medical School, ikochevar@partners.org

The use of short-pulse (~100 fs), near-infrared laser activation of photosensitizers (simultaneous 2-photon activation) offers the potential for exquisite (diffraction limited) localization of photodynamic damage. The feasibility of this approach has been demonstrated and evaluated through 2-y spectroscopy of photosensitizer molecules, in vitro cell photocytotoxicity and in vivo responses of microvessels, using both the chick chorioallantoic membrane and dorsal skin window chamber models. A major challenge has been to synthesize photosensitizers with high 2-y cross-section, and this has been achieved using porphyrin dimer structures.

While 2-y PDT is conceptually attractive, there are technological hurdles to implementing it for specific medical applications, not the least of which is to identify applications where there is enough added value for the complexity and cost of the technique to be justified. Potential applications in ophthalmology, dermatology and surgery will serve to frame this discussion.  

PDT for Neovasculature

Tayyaba Hasan, PhD, Professor of Dermatology, Harvard Medical School; Director, Office for Research Career Development, Massachusetts General Hospital, thasan@partners.org

Moderator: Charles Lin, PhD, Associate Professor, Wellman Center for Photomedicine, Massachusetts General Hospital clin0@partners.org 

Photodynamic Therapy (PDT) of neovasculature in best known for its application in the treatment of Age Related Macular Degeneration (AMD). Despite being broadly used for AMD, the treatment remains imperfect requiring several treatments or combinations with other agents. In addition to AMD, there are other applications of eradication of pathological neovasculature, such as in the treatment of cancer. This presentation will discuss strategies for optimizing vascularly-targeted PDT outcomes. 
 
 
 
 

Unleasing Innovation CIMIT Videos

Unleashing Innovation on the Front Lines—Preventing MRSA Transmissions & Transforming Culture 
Keith McCandless, Social Invention Group, keithmccandless@earthlink.net, www.socialinvention.net  
Moderator: Lynn Osborn, Director, CIMIT Education and Convening, losborn@partners.org

MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. Each year, 100,000 people in the US contract serious MRSA infections, almost 20,000 of them die each year (more than succumb to AIDS).  

Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA. More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia.

Despite conscientious efforts, conventional approaches to prevention such as hand hygiene, education campaigns, infection control protocols, monitoring, and legislative mandates have not succeeded. Innovations in how we prevent MRSA are much needed. 

The Billings Clinic in Montana is getting spectacular results eliminating transmissions of MRSA. A variety of socially-inventive approaches are being used to unleash hundreds of small innovations. The approaches—Positive Deviance, Improv Learning Simulations, and Social Network Mapping—engage frontline staff in discovering tacit and emergent solutions for themselves… not waiting for experts in infection control or managers to solve the problem.   

Changes in self-organizing behaviors at the unit level have shifted behaviors toward a more collectively mindful culture. As experts and leaders let go of over-control, front line staff take on more responsibility for safety and innovation. The results include more joy in work, safe practice, and spectacular results.  

The focus of this session will be on socially inventive methods and surprises along the way.  We can act our way into new thinking about change and innovation. 

 
Innovation “Now: in the Clinical Office Practice 
Ronald Dixon, MD, MA, Associate Medical Director, MGH Beacon Hill Internal Medicine Associates; Director, Virtual Practice Pilot at Massachusetts General Hospital, rdixon@partners.org

Ron Dixon will address approaches to larger scale innovation in the delivery of healthcare services within a general medicine office practice. Innovations to be discussed are technology based, with the potential to reduce in person office visits. We will focus on the process, with discussion about the enablers and barriers to implementation. 

Incubator Designed for Developing Countries

Yesterday's forum on Global Health was exciting and filled with energy. It was a full room with many left standing. And a special thanks to our good friends from Australia who joined us via our live webcast.

The forum video form yesterday will be up shortly, but for now you can see Dr. Olson's segment on NECN where you get a chance to see the Car Part Incubator in action saving the lives of babies in the developing world.

And finally, CIMIT's Global Health Initiative (GHI) has begun a Facebook Cause. Causes lets you join the GHI Cause you care about and begin making a direct impact on healthcare in the developing world. You can join, show support, add information, ideas or content - Become an involved member or just show your support. It will also provide you with avenues for direct donation.

So please join today and help us give new life to the developing world.

BBC International on Car Part Incubators with Dr. Kris Olson - The Silent Tsunami

Our good friend and CIMIT Program leader Dr. Kris Olson is in the news again. BBC International recently did an interview with Kris to talk about his initiative with Car Part Incubators in the developing world.

Kris tells us that the most important people in helping to develop and implement life saving devices for babies in the developing world are those actually holding and caring for children as they try to survive.

Kris calls this epidemic the Silent Tsunami.

And come to the January 6th CIMIT Forum for Dr. Olson's new presentation.

Getting It Right in Global Health - With Pictures

A transition of technological design for Global Health is underway. The developing world has graveyards of medical devices that were not designed for the settings where they are found. Delivery systems are not functioning and beleaguered health care providers cannot keep up. An intersection of disciplines ranging from clinical, public health, anthropology, design, engineering, and business is needed. Insights of would-be users of equipment and those that stand to maintain them are essential components to develop life-saving technologies for areas where necessity should be the mother of innovation.

We will be holding our weekly forum tomorrow January 6th, 2009 at MGH.

Speakers Tomorrow: JOHN SHERRY - Intel / Bill and Melinda Gates Foundation. JOSE GOMEZ MARQUEZ Innovations in International Health, MIT. KRIS OLSON Massachusetts General Hospital & Program Leader, CIMIT Global Health

Please click here for a detailed agenda, information and directions

Assessing technology longevity - looking at the resuscitation device and determining whether it could still produce enough air pressure.


Resuscitation devices: From the far right: bag valve mask - gold standard, cost $50; 1st generation TeknoTube produced in Indonesia scaled post-Tsunami in Aceh by Kris Copsy $7; 2nd generation TeknoTube; Tube and Mask produced in Europe - donated to Indonesia


Resuscitation device evaluation: both devices connected to the tube measure whether the tube can produce 30cm of air pressure.


Midwives completing survey to determine whether the neonatal resuscitation program implemented post-Tsunami by Kris was effective.

And we'll see you at the forum!