Posted by on in Clinical Decision Support

A while ago I was at a panel discussion on the advantages and concerns of electronic health records at a conference in Boston, MA. A few weeks before, our family physician passed away at the age of 89. He practiced in the day’s before the internet and his mind was our search engine for any health related issues. With his death, three generations' health information also passed away. I can’t remember a computer on his desk, but he still remembered to phone me on my birthday, 21 years after he assisted my transition into this life.

He auscultated each member of my extended family’s hearts. He knew exactly how our hearts were beating. He was also available 24/7. Always ready to assist.

While listening to the discussion on electronic health records, I thought to myself how uncomplicated were the days before information systems. When you had access to a single person with a wealth of information, not only on you, but your whole extended family. The days where there was a direct link between the cost, value and outcome of the service you received.

There is a school of thought that we should move back to a system where we have a single point of entry into the healthcare system. A point with access to my extended medical history. A point that could effectively manage my health. But how realistic is that? We are a generation that’s on the move.

So, the idea of building a relationship with a virtual doctor came to my mind. Imagine my family could also visit the same “virtual” doctor for the next few generations. Imagine if this doctor could learn the in’s and out’s of each of my family members' health. Imagine if this virtual doctor would know exactly how each family member's heart sounds. If it can provide you with individual care and specialist advice from the comfort of your couch.

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Posted by on in Clinical Techniques

One football program. Five years. Six deaths. Two life-altering injuries. Earlier this year I visited Tarleton University in Stephenville, Texas, "The Cowboy Capital of the world". I was devastated to hear about the tragedies that hammered this small community over the last few years. The immediate question that jumps to one's mind is, Why does this happen? Is this totally random, or could it be prevented? 

Why are tragedies happening on the sports field?

In the US, 10 to 15 million athletes participate in organized sport. Fewer than 300 die annually due to a cardiovascular cause, but with head injuries are the main cause for sports deaths. In the bigger picture, this is not a lot of fatal incidents, but are highly visible events with significant liability considerations.

Pre-participation examinations (PPE) are a rite of passage for young athletes. Will it minimize the number of tragedies? The fact is, PPEs are a challenge for most healthcare providers. And it is usually a last minute job.

A study published in the Clinical Journal of Sports Medicine examined PPE in clinical practice among AAP members and family practitioners in the State of Washington. Many participants reported barriers to the effective performance of PPE:

  • 37% were unsure on how to perform PPE.
  • 50% were unsure about the relative importance of a PPE.
  • 58% reported a lack of standardized approach.
  • 63% felt they did not have enough time with patients.

Guidance for performing effective PPEs is readily available and provided by the AAP and ACSM. The ACC also provides a specific statement on Cardiovascular Screening for competitive athletes

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Posted by on in Business Model

How do you decide on introducing a new technology to your practice? The cost is a concern and will it add value to your practice?

The healthcare industry is notorious for its slow adoption to new technologies. A recent Forbes report is listing the following 5 issues that are preventing technology adoption in healthcare:

  1. Many new technologies don’t address the real problem
  2. No one wants to pay for new technologies
  3. Physicians are reluctant to show patients their medical information
  4. Technology slows down many physicians
  5. Many physicians see technology as impersonal

The big question is, will new technology enhance your business model?

For me the real issue is: when does a new technology add value to my business or work. To make a decision on this, you need to understand how your practice or business creates, delivers and captures value. And what role will this technology play in this process.

To guide me through a decision I’m using the 9 basic building blocks of the business model canvas (feel free to consult the following book: Business Model Generation written by Alexander Osterwalder and Yves Pigneur):

1 - Any organization serves customers:

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Tagged in: auscultation heart

Posted by on in Clinical Decision Support

Please raise your hand if you ever felt that you would never use a computer program or app to diagnose a patient during a physical exam.

The healthcare sector is notorious for being slow when it comes to adopting new technologies. Even for some patients it could be scary if they know that their trusted physician is relying on a computer program to make a diagnosis.

The main arguments are that computers are lacking consciousness, human intuition and most of all, instinct. While physicians are naturally good at matching patterns, logic and knowledge with their instinct.

Where are we in the human vs. machine race today?

Where do you get a second opinion?

A recent article in the NY Times introduced Dr. Gurpreet Dhaliwal, 39, a self-effacing associate professor of clinical medicine at the University of California, San Francisco. He is considered one of the most skillful clinical diagnosticians in practice today.

©2015
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Tagged in: auscultation heart

Posted by on in Clinical Techniques

Users often ask us what they could do to get the best results from SensiCardiac. Here are a few tips from our experience:

  • If you can’t hear the heart sound, SensiCardiac can’t either.

Most users violate this rule! Make sure the S1/S2 heart sounds are clearly audible before you start recording.  This is sometimes challenging at the aortic position. Ask the patient to do three to five squats to make the heart work a little bit harder. This may help to hear the heart more clearly.

  • Get the heart as close as possible to the chest wall.

If the patient is in the supine position there’s always the possibility of creating a cavity between the heart and the chest wall. Sounds from within the body, especially the lungs, can resonate within these cavities, creating unwanted noise.

  • Avoid breathing sounds, at all cost.

Ask the patient to hold his/her breath for the duration of the recording.

  • Body tissue is a heart sound killer.

If the patient does have excessive body tissue around the chest/breast and the heart sounds are not audible, don’t use SensiCardiac, or limit the recordings to the positions where the heart sounds are audible.

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Posted by on in Uncategorized

This weekend, experts in internal medicine from around the world will convene at the American College of Physicians’s (ACP) Annual Meeting held Apr 28 – May 2, 2015, at the Boston Convention and Exhibition Center. The event garners 6,500+ practicing physicians and delivers scientific research and opinions designed to advance the practice of internal medicine and various subspecialities across global health care systems. What's making this event even more special is the fact that it marks the ACP's 100th anniversary.

We welcome attendees to join us at booth #1249. See how SensiCardiac is dedicated to enhance the way physicians performs cardiac assessments to improve clinical decision making and patient safety. SensiCardiac is an innovative, cloud based solution to record, interpret and share heart sounds. Optimised for effective early diagnosis and record keeping of auscultation findings.

Visit the SensiCardiac booth: #1249

Follow the conversation on Twitter: @Sensicardiac and @ACPinternests with hashtag #im2015

Read more about SensiCardiac here.

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Posted by on in Uncategorized

We frequently do get the question: What heart defects can SensiCardiac detect? The short answer is any structural defect of the heart that will create a murmur. The most common structural defect among children is a congenital heart defect (CHD) and is a structural defect presented at birth. In most cases this defect will be undiagnosed at discharge after birth. Common examples of CHDs include holes in the inside walls of the heart and narrowed or leaky valves. In more severe forms of CHDs, blood vessels or heart chambers may be missing, poorly formed, and/or in the wrong place.

Globally, every 100th baby is born with a CHD and is therefore the most common birth defect. Nearly 40,000 infants in the USA are born annually with CHDs. CHDs are therefore as common as autism. Between two and three million individuals are thought to be living in the United States with CHDs, with many of these individuals not being aware of it. Except for patient records, there's no other system in place to track CHDs beyond childhood. Due to improved care, the number of adults living with CHDs is increasing. The result is that CHDs are now the most common heart problem among pregnant women.

CHDs are still the most common cause of infant death due to birth defects. Nearly one in every four babies born with a CHD will need surgery or other interventions to survive. Most babies with a CHD will reach adulthood, but will face a life-long risk of health problems such as issues with growth and eating, developmental delays, difficulty with exercise, heart rhythm problems, heart failure, sudden cardiac arrest or stroke.

Although 15-20% of all CHDs are related to known genetic conditions, most causes are unknown. A combination of factors can lead to a CHD, but in most cases the damage is already done before most women know they are pregnant.

A structural defect of the heart can also be acquired later in life.Some infections and disorders that may lead to heart disease include:

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Posted by on in Uncategorized

According to the American Academy of Family Physicians (AAFP) distinguishing between pathological and benign (innocent) cardiac murmurs is perhaps the most challenging aspect of a physical examination. It is recommended that patients with signs or symptoms of a pathological murmur should be referred to a cardiologist.

This is even more true when making decisions during a pre-participation, school, college or DOT physical. When making eligible and disqualifying decisions, it is important to follow current clinical guidelines. Practitioners are often under pressure to clear a person for a certain activity, or may rush the exam, because no symptoms are presented.

Benign (functional, innocent or physiological) murmurs occurs in the absence of a cardiac structural abnormality with no symptoms or family history. The S2 sound pulse has a normal, physiological split, best heard at the pulmonary and there're no clicks or gallops. The murmur is usually early to mid-systolic with a musical, vibratory, or buzzing quality. And it is soft, grade two or lower.

The next image shows the relative mid-range energy distribution of the average heart beat for a patient with a benign murmur. The relative energy levels for the S1/S2 sound pulses, early-, mid- and late systole and diastole are also indicated. Note the relative low energy levels within the early and mid-systolic region. Typical for a benign murmur.

 Innocent Cardiac Murmurs

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Posted by on in Uncategorized

According to an article in the NY Times “a young athlete dies from a cardiac incident once every three days in the United States” (Hidden Threats to Young Athletes – May 11, 2013). Sudden cardiac arrest is the number one killer of young athletes and is typically brought on by a pre-existing, detectable condition that could have been treated. According to www.myoclinic.org nearly 360,000 sudden cardiac arrests occur outside of hospitals each year in the United States alone.

How could Sensi be used in pre-participation screening?

One of the key clinical findings to evaluate when screening athletes for cardiac defects are murmurs, to detect structural defects within the heart.

The American College of Preventive Medicine (ACPM) supports an evaluation prior to participating in high school and college sports using a history and physical assessment as developed by the American Heart Association[1]. This assessment includes 12 criteria for pre-participation cardiovascular screening of competitive athletes:

Personal History

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Posted by on in Uncategorized

A recent study at Johns Hopkins Hospital in Baltimore, Maryland, showed that cardiology residents were not able to identify 25% of the pathological murmurs presented to them.

How confident is a primary care clinician in identifying and classifying cardiac murmurs? To answer this question, two professions within the primary care sector were surveyed with the help of www.teamcme.com. Altogether 45 physicians (MDs) and 160 chiropractors (DCs) were surveyed. Both groups perform physical assessments as part of their daily routine and see the same population groups (See Figure 1).

b2ap3_thumbnail_Physical-assessments.png

Figure 1: Physical assessment services offered by MDs and DCs.

  How often are primary care clinicians confronted with cardiac murmurs?

Identifying S1/S2 and hearing a cardiac murmur are the first steps in classifying a murmur. Although they frequently perform cardiac auscultation, chiropractors indicated that they very seldom hear a cardiac murmur (more than 50%). Only 1,3% indicated that they do hear a cardiac murmur frequently.

Is this due to an absence of cardiac murmurs in their patient population?

Physicians hear cardiac murmurs more frequently, 24,4% indicated frequent to very frequent, but still a bigger percentage indicated that they hear a murmur seldom to very seldom (35,6%).

How confident are they in classifying the murmur?

Classifying cardiac murmurs accurately is a skill that takes years to master. Confidence in cardiac auscultation is built by frequently using a stethoscope and being exposed to heart murmurs. More than 30% of the physicians interviewed indicated that they are confident with their ability to distinguish between innocent and pathological cardiac murmurs, while 46,7% rated their confidence as average.

67,5% of chiropractors rated their confidence as limited.

Can this have a direct impact on the quality of their service?

b2ap3_thumbnail_How-often-do-your-hear-a-cardiac-murmur.png

Figure 2: The relative frequency with which MDs and DCs are confronted with a cardiac murmur. 

b2ap3_thumbnail_Rate-your-confidence.png

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Posted by on in Uncategorized

Identifying extra heart sounds while auscultating is very challenging. Especially in relation to the third (S3) and fourth (S4) heart sounds.

The third heart sound is very common in children and even in people under 40, but later in life it is an indication of serious problems, like heart failure, and only appears when the problem is relatively far advanced. In some cases the third heart sound may never be heard, due to chest size, obesity or lung sounds, or due to hearing constraints of the listener. Therefore, the absence of a third heart sound does not exclude ventricular dysfunction or volume overload.

The low intensity, very low frequency and small audible area challenge clinicians auscultation skills and in most cases the third heart sound falls outside the human ear’s audio range.

The ability to detect and monitor third heart sounds in older patients is very important as this is associated with heart failure.

Hearing skills of trained cardiologists were recently compared with Sensi. Results confirmed that Sensi detected and indicated the third heart sound in cases where the human ear could not detect it, as well as in cases where the human ear detected the sound. This confirmed the importance of having a tool to assist in identifying extra, impossible-to-hear, heart sounds.

The next two figures show heart sounds recorded at the APEX. Figure 1 shows the presence of a very subtle S3 sound while Figure 2 indicates a prominent S3 sound. In both cases Sensi was used to visually confirm the presence of an S3 sound. S1, S2 and S3 annotation were added by hand.

 

b2ap3_thumbnail_S3-1.png

Figure 1: Subtle S3 sound.

Although very small, a S3 sound pulse is present in the consecutive heart beats shown in Figure 1.

b2ap3_thumbnail_S3-2.png

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Posted by on in Uncategorized

Less than 50% of the people that suffered from rheumatic fever are aware of it. This could have  devastating effects  later on in life.

Diacoustic Medical Devices is proud to be part of the SUNHeart Project at Stellenbosch University and Tygerberg Hospital’s Cardiology Department where about 2 000 learners from Khayelitsha and Ravensmead are currently being screened for possible heart defects.

Africa has one of the highest prevalences of heart disease in children and young adults, including congenital and rheumatic heart disease, and there is an urgent need to improve access to early diagnosis and treatment for patients.

Children in the age group 6 to 21 have the highest risk of throat infection, a cause of rheumatic fever. According to Prof Anton Doubell, Head of Cardiology at Stellenbosch University, many sufferers of the disease are only diagnosed with heart defects later in life, especially during pregnancy.  

During the eight-week SUNHeart Project each child will undergo a physical examination, heart sound will be recorded and analysed with SensiCardiac to detect abnormal cardiac sound, and each child’s heart will be screened with a hand-held echo, as well as a traditional sonar.

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Posted by on in Strategy

How amazing it was to watch the soccer world cup and to see a team reap the benefits of a long-term strategy.

In the start-up world innovative business models are the talk of the day. Entrepreneurs are not only developing new products and services, but are challenging the status quo on how value is delivered to customers. In many cases entirely new industries are being formed.
Value creation is one of the challenges the healthcare industry has been struggling with for years. Many have written about this topic before, but we are still struggling to capture and deliver value to patients.

To really deliver value an organization needs a clear long-term vision and strategy based on innovation and value. This belief must be so well embedded within the organization, that no short term gain will distract the organization from the long term plan.

The soccer world cup in Brazil showed us what could be achieved if you have a well-articulated long term strategic plan and not playing for the romantic notions of passion and desire (as Ken Early described Brazil’s effort). Germany’s success was not (only) a result of a passionate team talk or playing to the expectations of the crowd. No, it started about 10 years ago after some major losses. They formulated a vision, set goals and created objectives. The got the buy-in of all the stakeholders, created structures, made investments in talent and executed the plan meticulously.

“Without a clear strategy, an organization lacks the clarity of direction to attain true excellence”. - Michael Porter

This is one of the major shortcomings of healthcare providers. You need a clear strategy. You need to map your own path to excellence. Define the value proposition you will deliver to patients, which problems you will solve, and which needs you will satisfy.
Michael Porter described three types of strategic problems common to the healthcare sector. Firstly, the range of services offered is too broad. This is where a hospital or physician group’s strategy is to become a one-stop shop. The services offered could also be too narrow and unintegrated. This is, in most cases, the result of the shotgun approach where the various service lines offered are narrow and discrete. The last mistake is where the focus is too localized, with no vision to compete geographically even in areas of medical excellence.


Which soccer team's strategy does your clinic, practice or hospital value?

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