• Devices
  • CADence digital stethoscope's better than a conventional one

    It may be about time the technology of the stethoscope, derived from the Greek for chest exploration, was upgraded. It was invented in 1816, the years that the Mfecane wars started in South East Africa. That’s when Rene Theophile Hyacinthe Laennec, a young French physician at the Hôpital Necker-Enfants malades in Paris, was examining a young female patient. It seems he was too embarrassed to place his ear to her chest to listen to its revealing sounds, a technique known as immediate auscultation, a form of listening, and used by physicians of the time. Instead, he invented the stethoscope and with it, clinical auscultation.

    Now, Dr Marie Johnson, a USA engineer, has invented CADence, a digital device to do the job, and described it at Royal Society of Medicine (RSM) Innovation Summit in September.

    Her company, AUM Cardiovascular has a core goal of diagnosing obstructive coronary artery disease in patients with chest pain and two or more risk factors. AUM is a Sanskrit syllable meaning “to make a continuous low humming sound.” CADence is a hand-held, fast, affordable device that picks these low frequency noises from feeble diastolic murmurs that conventional stethoscopes don’t pick up. The motivation for CADence is direct experience of personal, unexpected cardiovascular tragedies.

    It take about twelve minutes to have a reading from CADence’s algorithms, about eight minutes for measurement, then four minutes for data transmission, using WiFI and Bluetooth. CADence is used in 25 sites, is available in the USA, and is awaiting Food and Drugs Administration (FDA) approval. It could be several years before it’s on sale in Africa, but it’ll soon replace Laennec’s techology

  • D3: the cancer detecting mHealth solution

    mHealth’s revolutionising healthcare. Dr Ralph Weissleder and Dr Hakho Lee from the Center for Systems Biology at Massachusetts General Hospital are making a huge transformation. They’re responsible for creating the D3 system, an mhealth solution for digital diffraction diagnosis. Born of Dr. Weissleder’s efforts to improve healthcare in remote parts of Africa, D3 is said to be convenient, efficient and easy to use. The device attaches to a smartphone, allowing the phone to take images of cells and samples and provide an accurate diagnosis within an hour. It drastically cuts waiting times and has the potential to save countless lives.

    An article in Massachusetts General Hospital explains how the D3 system works. First, a doctor collects cells from a patient, either from a blood sample, a fine needle biopsy or, if cervical cancer is suspected, a Pap smear. The cells are then loaded onto a tiny slide, which is pushed into the D3 imaging system using a clip-on device attached to the smartphone. D3’s imaging module with a battery-powered LED light uses the smartphone’s camera to record a high-resolution image. It has more power than a traditional microscope.

    The idea for 3D originated a few years ago, when Dr. Weissleder was in South Africa to learn how technology could improve healthcare for people living in remote areas. Many African countries have too few pathologists, and lab results are often delayed. Even in developed countries, like the US, biopsy results can take over a week to get back.

    When Dr. Weissleder saw that even in Africa’s remote areas, people were using smartphones, he realised mobiles can improve and support healthcare. Work on D3 started soon after. The team added a coin-sized battery to address the sporadic electricity supply, a common challenge for providers in Africa.

    There have been two pilot studies. At Massachusetts General, D3 reliably and rapidly reported whether cervical biopsy samples were high-risk, low-risk or benign. The results showed that D3 performed as accurately as pathologists. D3 also fared well in a second pilot study, where it correctly recorded the difference between samples from four patients who had lymphoma and four who had benign tumors.

    D3 works by processing blood or tissue by sending tiny antibodies to find cancer-related molecules. When these antibodies detect cancer, they light up. “The smartphone picks up the shining of the antibodies when the photo is snapped. And researchers can use this signal to diagnosis a patient with cancer,” Dr. Weissleder says.

    Dr. Weissleder envisages D3 having many applications for many different settings. In a large hospital, D3 could provide faster test results for patients. At home, it might help patients monitor their diabetes or detect sexually transmitted diseases. The technology could be used for other diseases in Africa and help track malaria, TB, HIV and avian flu outbreaks.

    Cell phones have changed the world says Dr. Lee says, adding, “The next big push will be healthcare applications, and we are excited to lead the way.” The team’s about to receive funding from the National Institutes of Health for a large clinical trial in Africa.

  • New BP and shock detection device is tested in Africa

    Pregnant women with shock and high Blood Pressure (BP) are at increased risk of dying. A new hand-held device, Microlife’s Vital Signs Alert (VSA) is being tested in some African countries with an aim to reduce maternal deaths by 25%. The initiative was presented at Royal Society of Medicine (RSM) Innovation Summit in September.

    The development team from London’s Guy’s and St Thomas’ Hospital in London, King’s College London and Jhpiego, a global organisation specialising in gynaecology and obstetrics and affiliated to Johns Hopkins University have had a $1m grant from the Bill and Melinda Gates Foundation for the project. Microlife, a company specialising in BP measurement is also involved. It’s producing VSA, subsidising its pricing for low and middle income countries.

    VSA measures BP and pulse rate, and contains algorithms that use the data to identify shock. This’s a state where a body can’t cope with blood loss or infection, and there’s insufficient blood to supply the brain and organs adequately. High BP in pregnancy can indicate pre-eclampsia, a potentially deadly condition for both mothers and babies. With more accurate readings than conventional BP devices, VSA has a better chance of identifying problems earlier.

    It’s more accurate than conventional BP devices, and doesn’t need calibrating. It’s also cheaper, by about a third. Its traffic light reporting using hypertension thresholds helps to make clinical decision taking easier. Stepped wedge random control trials are underway in several African countries. It’s in use in parts of Zambia, where it was mainly developed, Egypt, Nigeria and South Africa.

    VSA uses batteries that are recharged using a USB connector. These are used for smartphones, which are in increasingly plentiful supply in Africa.

    It’s already recognised by the Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia  (CRADLE) and has won a PATH award.  It’s also the first device of its type to achieve WHO’s standards for use in under-resourced settings.

    With VSA products now available, the challenge is to expand their use in Africa. With price gains for health systems, and direct benefits for pregnant women, the business case for VSA is appealing. Africa’s health ministries need rolling programmes to introduce VSA.

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    Image from The Independent 

  • A BYOD policy template Africa's healthcare can use

    Mobiles aren’t truly ubiquitous, but they’re closing in. Many health workers use theirs for their health duties, Bring Your Own Devices (BYOD). Health organisations need policies to deal with them. Tiger Text’s provided policy guidelines for healthcare. They apply to general use of personal devices in the workplace, and include:

    The healthcare organisation will use its discretion to decide which employees may use BYOD All personal devices must be approved by the Information Security Department before they’re used Exercise discretion as personal devices may interfere with productivity and distract others Personal devices may only be used during breaks and meal periods Ensure that friends and family members are aware of this policy The healthcare organisation will not be liable for the loss, theft or damage of any personal devices To ensure confidentiality of Protected Health Information (PHI), never use traditional text messaging or multimedia messaging services when sending work related data with your personal device Download and use the TigerText application when sending messages containing PHI, social security numbers, or financial account information Using TigerText’s subject to the healthcare organisation’s Secure Messaging Policy and employees must read and understand this policy in detail before using TigerText Work related pictures, video, voice files, and other data must be sent within the TigerText application Local storage of work data in personal devices is never allowed Applications that interfere with the functionality of TigerText must never be downloaded on personal devices The healthcare organisations policy prohibits screen capture or sharing PHI with users who are not bound by the healthcare organisation’s Privacy Policy All data transmitted for work related purposes using personal devices is the healthcare organisation’s sole property The healthcare organisation has an absolute right of access to all of the data sent with a personal device and may exercise its right whenever management deems it appropriate Personal device users have no privacy rights when using their personal devices in the workplace and healthcare facility Personal devices and messages sent by it can be reviewed whenever management deems it appropriate The healthcare organisation’s general policy for using mobile and personal devices determines when and where they may be used Using them near some types of equipment, or in some parts of the healthcare facility, may be prohibited If personal devices are lost or stolen, owners must notify the healthcare organisation immediately so that the data stored in a TigerText account can be remotely wiped from the devices Users should implement a password on all personal devices used in the workplace to ensure that third party access to content is limited Personal devices in healthcare facilities and property are subject to general policies for safeguarding against cross-contamination and other patient health concerns Disposal or sale of personal devices should be done only after all the healthcare organisation’s data and content is removed, including the TigerText application If employment’s terminated, all the healthcare organisations’ content, including the TigerText application, must be removed from leavers’ personal devices All costs associated with personal devices shall be borne by owners, except for the costs of access to TigerText Employee found to have violated this policy may be subject to disciplinary action, up to and including termination of employment.

    TigerText is a secure, real-time message app. Africa’s healthcare organisations may have other, equivalent apps, replacing Tiger Text in the policy template. Tiger Text point out that their policy template isn’t legal advice. It does provide a helpful start point for Africa’s health systems to begin the process of this part of eHealth regulation.

  • Low-cost 3D hand wins Dyson Award 2015

    The James Dyson Award challenges young engineers and scientists around the world to develop something that solves a problem. This year, Joel Gibbard did it, and won the UK award of $3,500, with his Open Bionics project that produced a prototype, low-cost 3D-printed robotic hand and arm. It can be made faster and more cheaply than alternatives. He plans to sell prosthetics next year for about £2,000, about $3,160, about the same price as conventional prosthetic with hooks.

    His hand is a skeleton covered with an artificial skin and has controllable fingers. These usually cost at least ten times more than Gibbard’s prosthetic. His Open Bionic hand uses myoelectric signals from muscle movements detected by sensors stuck to wearers' skin, then uses them to control grip.

    A single flex opens and closes the fingers. Two flexes forms a grip. Sensors can tell when fingers make contact with an object and limit the pressure they exert.

    Gibbard started Open Bionics as a crowdfunding project in 2013. It’s supported by Bristol Robotics Laboratory. They’ve shown how engineering and innovation can help healthcare across the world.

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    Image from Open Bionics

  • Africa has many innovators in health

    Ventures Africa has been researching Africa’s innovators. Its website lists 40. Ten are working in health. They’re:

    6: Oluyombo Awojobi at the Awojobi Clinic, Eruwa, Nigeria, who’s built a clinic that delivers quality care using techniques and improvised devices constructed on site.

    7: Andrew Bastawrous, an Egyptian ophthalmologist, has a Portable Eye Examination Kit (PEEK) in Kenya dealing with the 16.6% of avoidable blindness and several curable conditions such as cataracts, glaucoma, trachoma and onchocerciasis and avoiding needless suffering.

    9: Moctar Dembele and Gerard Niyondiko in Burkina Faso and Burundi created the anti-malaria Faso Soap from locally sourced herbs to help reduce Africa’s malaria burden.

    13: Nicolaas Duneas and Nuno Pires created the Osteogenic Bone Matrix (OBM) in South Africa to revolutionise treatment of orthopaedic injuries.

    24: Souleymane Mboup, a Professor of Microbiology, developed HIV Testing in Senegal by separating DNA from white blood cells infected with HIV-2.

    28: Tebello Nyokong, a Professor of Medicinal Chemistry and Nanotechnology developed Photodynamic Therapy (PDT) in South Africa for safer and more effective alternative treatment for, a new cancer diagnosis and treatment methodology that’s less invasive and more efficient than chemotherapy.

    33: Khaled Shady from Egypt developed Mubser to help blind people regain independence by using a wearable belt with a Bluetooth-connected headset that leverages digital red, green and blue (RGB) imaging and infrared data captured by a 3D camera to assist the visually impaired in identifying and navigating around everyday obstacles.

    37: Ashley Uys developed the Malaria Diagnostic Kit in South Africa to reduce the number of undiagnosed and untreated malaria cases in Africa and the world.

    38: Zane Wilson of the South African Depression and Anxiety Support Group (SADAG), developed The Speaking Book in South Africa to improve health workers’ ability to provide mental healthcare information to low-literacy communities where such issues are prevalent but not discussed.

    40: Marc “Arthur” Zang developed Cardiopad in Cameroon, the first medical touch tablet in Africa, which performs remote heart examinations and cardiac diagnosis.

    There are many others across Africa. A challenge is for countries to develop policies and strategies to encourage more, including mHealth initiatives.

  • Modest Google Glass's back

    Google’s distributing a new version of its Google Glass to software developers. The aim’s for them to create programs for specific industries and services, and healthcare’s included. It won’t be sold to consumers for the foreseeable future. It was withdrawn in January 2015.

    Business Insider UK has a report that refers to the report in the Wall Street Journal , saying the new version’s called Google Glass Enterprise Edition. It’s certified by Glass for Work partners who are authorised by Google. The new version includes support for faster, next-generation WiFi and a bigger, longer-life battery. Glass for Work start-ups can refine the hardware to fit specific use cases. This may improve its potential for healthcare. Whether it does on a big scale, remains to be seen.

  • Selfies will soon look behind faces

    Like them or loath them, selfies are popular. So far, they haven’t been able to look behind a face. Now, a team from Massachusetts Institute of Technology (MIT) Media Lab seems to have done it. Tristan Swedish and his colleagues will present their findings and propositions at a conference of the Association for Computing Machinery and Graphics (ACM), a non-for-profit organisation that claims to be the world’s biggest educational and scientific computing society.

    They’ll present their paper, Self-Directed Eye Alignment Using Reciprocal Eye-Box Imaging, at ACM’s Special Interest Group on Computer GRAPHics and Interactive Techniques (SIGGRAPH) conference in August 2015 and say their approach is a user-interface challenge, and exploits the reciprocity of reversible light, so if you can see me, I can see you. The technology will develop near-eye alignment displays essential for Head Mounted Displays (HMD), biometrics and retinal imaging.

    The retinal imaging part is exciting. Retinas can reveal evidence of several diseases, such as heart conditions, strokes, diabetes, Alzheimer’s and multiple sclerosis. Interpreting the condition of retinas, such as their colours and blood vessels, is needed to diagnose many conditions. This may be Tristan’s Swedish’s next project. His team’s already working on software that will collect, analyse and report on the data.

    For Africa, this may help overstretched medical teams to have rapid information and reports on diagnoses and the trends in conditions that they can use to intervene and help to slow down conditions. A combined gain in efficiency and effectiveness is a boon to Africa’s healthcare.

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    Image courtesy of storyhoney.com.

  • Has the Petri dish had its day?

    We’ll never know what Julius Petri, the German bacteriologist who invented the Petri dish in 1887, would think of the commercialisation of Organs-on-Chips by Emulate. At the Royal Society of Medicine’s Spring, Innovation Summit 2015, Dr Geraldine Hamilton, Emulate’s chief scientific officer, showed how an automated human bioemulation platform that uses a microchip can mimic human physiology and improve the results of tests for new medications, chemicals and disease behaviours.

    Emulate was founded by Organs-on-Chips pioneers, such as Donald Ingber, Director of the Wyss Institute for Biologically Inspired Engineering at Harvard University. One feature of Organs-on-Chips is emulating the mechanical behaviour of cells, a phenomenon that a Petri dish can’t do.

    There are two constructs. One is using Organs-on-Chips to test the effect on a specific organ, such as a heart. On its own, this has considerable benefits to conventional approaches. The other is to connect these together to create a virtual physiological human. This enables researchers to test the effect of a new drug on several organs, such as the heart, lungs, liver and kidneys, to test a new drugs effect on the deficient organ, the drug’s impact on patients’ metabolisms and how it’s excreted.

    It’s a long stride along the road to personalised medicine and precision medicine. Bespoke healthcare’s on the way. Organs-on-Chips is a prime example of how technology can drive health strategies. Responding to the opportunities, African countries need iterative health, health technology and eHealth strategies. These are often challenging to assemble, but provide an essential response to ways the drivers of better health and healthcare. If Petri’s dish has an impact that exceeds a century, Organs-on-Chips might last as long too.

  • Google now has a stick that's a computer

    There are already a few sticks that are computers. The latest one is Google’s Asus Chromebit. It’s a PC that looks like a big USB stick, or a Google Chromecast. By plugging it into an LCD display or TV, it can run the software usually run by a PC. It’s cheap, about $149, and aimed especially at schools. It could improve affordability for Africa’s healthcare and intensify competition with Microsoft.

    It’s potential’s reviewed by Wired. It says that it’s part of a new wave of Google devices that use Chrome OS, which is designed for internet-based applications such as Google’s Gmail and Google Docs word processor. By moving tasks onto cheaper hardware, it reduces dependence on bulky software on PCs. One benefit may be improving security.

    Today, Google is unveiling several of these laptops, including two $149 models. It’s made by Haier and Hisense, and is for sale from Amazon and Walmart. This summer, Asus will release an ultra-thin Chromebook that converts into a touchscreen tablet.

    Chromebit is seen as the most intriguing initiative. It shows how small and how inexpensive PC hardware has become, and the blurred distinction between PCs, TVs, and mobiles.

    In a few weeks, Intel will release its Computer Stick, a similar device that brings Microsoft’s Windows OS to TVs and other displays. Dell already supplies its Wyse Cloud Connect, also like Chromebit.

    J.P. Gownder, an analyst with research outfit Forrester Research  analyst, J P Gownder says that “A device like this has utility, but the problem is interface. The utility is not as cut and dried as it may seem, and because Chrome machines aren’t really built to run local software, they aren’t suited to all situations.”

    This new miniature technological market can contribute to the affordability challenges of Africa’s eHealth programmes. While the technology is still developing, it sets a new opportunity for Africa’s healthcare to include in their eHealth strategies and plans. Shared experiences with Africa’s schools may be a good way to learn how to exploit these computers in sticks.