The Smart Magazine About Medical Technology Innovations
#36 – Ergonomics for Caregivers
In this new issue, you’ll read about the “HospitaCité” project to make hospitals more human. Its conceptors use architecture to psychologically favor patients’ recovery and the well-being of healthcare staff. You’ll also find out how the introduction of cutting-edge ergonomic equipment into the healthcare workplace can benefit caregivers by reducing fatigue and physical strain—a major public health issue nowadays.
On a completely different note, a new startup co-founded by the famous geneticist George Church is trying to reverse aging in dogs—and maybe later in humans. And it’s not science-fiction! Also read an op-ed written by two members of the International Finance Corporation about how emerging markets are embracing big data and personalized medicine.
“HospitaCité” is a joint project between the Belgian firm VK Architects & Engineers and the French company Michel Rémon & Associés to renovate the Saint-Luc University Clinic in Brussels in order to make it “more human.” The goal is to reconnect the hospital to the university town and use the architecture to...
The introduction of cutting-edge ergonomic equipment into the health care workplace can benefit caregivers by reducing the fatigue and physical strain—a major public health issue.
Today health care organizations are tasked with providing high quality patient care while simultaneously improving efficiency, accuracy and profitability. The combined impact of reduced manpower as well as space and budget constraints, technological developments and new regulations means caregivers often face situations where they are at risk of physical injury.
In a recent survey of 250 full-time nurses by Minnesota-based ergonomic product manufacturer Ergotron, 60 percent were concerned that their job was having a negative impact on their personal health. More than three-quarters reported experiencing physical discomfort in the workplace, while 12 percent reported being injured on the job over the previous year.
Christian Stentoft, Executive Vice President of Corporate Development at Swedish medical technology company Arjo, said:
Across the world fewer medical personnel are now handling more patients over shorter timeframes. In terms of patient handling, nurses are estimated to manually lift more than carpenters on a daily basis, meaning this profession has one of the highest risk ratings for back injuries.
Taking the Strain
The introduction of cutting-edge ergonomic equipment into the health care workplace can not only boost productivity but also reduce the fatigue, exertion and musculoskeletal disorders that so frequently impair those providing care. Arjo develops and sells a range of innovative patient handling solutions to reduce the physical strain on health care professionals.
Seba (Courtesy of Arjo)
The company’s “Seba“ product, for example, is a transfer aid which allows patients to be moved from a supine to a seated position at the edge of the bed (and back again) in one simple motion. It significantly reduces the load on the caregiver and keeps the patient’s spine straight throughout the lift.
This year has seen Arjo launch two new products—IndiGo and the Arjo Locate equipment tracking solution. The former is a fifth wheel that can be mounted underneath medical beds. By means of intelligent sensoring it amplifies the push/pull efforts of the caregiver and thereby eases manoeuvring. Arjo Locate is a Bluetooth-based solution that can help caregivers locate lifting equipment through a handheld device such as an iPad. After a period of time an algorithm suggests more appropriate storage locations for such equipment to minimize the time spent by caregivers retrieving it.
Nurses are not the only health care professionals in need of advanced ergonomic equipment. Dentsply Sirona, an American dental equipment maker, recently launched the award-winning Intego Ambidextrous. Boasting an intelligent swivel mechanism, this dental treatment center can be used by both left and right-handed practitioners.
Ambidextrous (Courtesy of Dentsply Sirona)
Adjusting the setup of the Intego Ambidextrous is a simple and smooth operation, with features such as the backrest, operating light, monitor and dentist element all easily repositioned in a matter of seconds. The highly adjustable design means the center can be configured to meet the user’s requirements exactly. Ian Ellis, Marketing Director of Dentsply Sirona UK & Ireland, explained:
Using instruments and tools for long periods of time can lead to repetitive strain injury. The Ambidextrous is a leading example of how ergonomic equipment can significantly reduce everyday stress for dental professionals.
Best of the Rest
German company Provita Medical also produces ergonomic health care equipment. Its BRANCA range of ergonomic treatment units, which were developed in collaboration with health care professionals, significantly reduces the load on the caregiver’s spinal column with a gas spring, height-adjustable saddle seat and other height adjustable features.
Swiss company Samarit has developed a “Patient Turning System” (or PTS) which allows patients to be moved from the supine to the prone position in operating rooms with reduced physical strain on operating staff. And the Power-PRO XT Cot from Michigan-headquartered Stryker EMS helps paramedics asily lift casualties into and out of ambulances with its battery-powered hydraulic system and pneumatically assisted backrest.
A new company called Rejuvenate Bio wants to make dogs live forever—and humans could be next.
The key to eternal life may lie in a cocker spaniel. A new startup co-founded by famous geneticist George Church is trying to reverse aging—not in humans, but in dogs. Our four-legged friends are the perfect stepping stone...
A significant medical advance has been made in treating throat disease. Aortas harvested from human donors have been successfully grafted onto the windpipes of a dozen patients to replace tracheas or surrounding tissues afflicted with lesions or cancerous growths.
The man behind the breakthrough is Dr. Emmanuel Martinod, a surgeon at Avicenne Hospital AP-HP, part of the network of 39 university hospitals serving Paris. His study was recently published in JAMA, the Journal of the American Medical Association.
The publication is the culmination of 20 years of research. In an interview with MedicalExpo e-magazine, Dr. Martinod said he had explored “all the options” before deciding on this procedure, which involves grafting an aorta, the human body’s largest artery that pumps blood from the heart. He said:
Because the aorta is flexible and strong, we could adapt it to align with the correct dimensions of the trachea or bronchus, which is a bit smaller. We used donor bank aortas preserved by freezing them at minus 80 degrees.
Twenty patients with diseases of the trachea, bronchus or carina (the area where the trachea splits into two bronchi) were selected for the study, of which thirteen underwent the graft from 2009-2017. The other patients were treated using conventional methods. Twelve of the thirteen patients who received the graft survived at least ninety days; ten were still living when the study was published. The study demonstrated “feasibility for complex tracheal and bronchial reconstruction,” while “further research is needed to assess efficacy and safety,” the JAMA article indicates.
Dr. Emmanuel Martinod (Courtesy of Christophe Simon AFP)As part of the procedure, a metallic trellis stent was inserted inside the aortic graft to prevent it from closing up. After the operation, the patients’ own cartilage began to grow around the aortic graft, further buttressing it. “Once the cartilage has regenerated and is functional, we can remove the stent within an average of 18.2 months. So you get a solution that is 100 percent biologic,” said Martinod. The patients’ immune systems accepted the graft without complications. “We see few reactions of rejection with this kind of tissue. Sometimes there was inflammation but that may have been due to the reparation surgery, not the graft,” he said.
Procedure First Tested on Sheep
According to an editorial article in JAMA, the Martinod study “is an excellent example of high-quality bench-to-bedside research.” Previous efforts to perform aortic grafts had produced disappointing results. An Italian surgeon, Paolo Macchiarini, performed procedures on eight patients between 2011 and 2014 involving the insertion of artificial tubes seeded with patient stem cells but seven of the patients died of complications. Martinod’s study “is in marked contrast” to the Macchiarini study, which was later found to be fraudulent, JAMA says.
Dr. Martinod tested the procedure on sheep in a laboratory prior to operating on patients. He said:
When we were doing transplants on the model, we noticed that the epithelium [the windpipe’s protective, lubricating lining] started to regenerate and cartilage to form. That was a surprise. This regeneration took a bit longer in the patients than the laboratory models.
Given the procedure’s success, an increase in demand for it can be expected. Apart from the 95 percent survival rate, it offers additional advantages over the existing, widely-used procedure for treating trachea diseases, a tracheotomy, where a hole is surgically created in a person’s neck through which they breathe. “The aortic graft solution gives you a better quality of life. Also, in the case of certain cancers, it is part of the overall cure,” said Martinod.
Keriton’s milk management platform helps nurses be nurses, moms be moms—and preemies be safely fed breast milk.
More than 300,000 babies are born prematurely each year in the European Union, according to Eurostat. And about 1 of every 10 infants born in the United States is considered a preterm baby, according to the CDC. Exclusive feeding with maternal milk is highly recommended for these newborns. But for these preemies hospitalized in neonatal intensive care units—or NICUs—while their mothers are sent back home, the feeding process is highly complex and subject to very strict hygiene conditions.
Mothers pump and send their milk to the hospital. Nurses feed it fresh to the newborns, or they pasteurize it, they can also freeze and store it. Some bottles have to be thawed before use, others combined and split, or have vitamins added for fortification.
For nurses, this makes breast milk “bartending” highly time-consuming, and extremely manual. As for mothers, who usually undergo a highly traumatic situation, pumping their milk can be yet another stressful experience.
That is, until Keriton came in.
Keriton founder Vidur Bhatnagar (Courtesy of Technically Philly)
Its CEO, Vidur Bhatnagar, took part in the 2016 PennApps hackathon. A couple of nurses from an intensive care nursery came over to ask for an app that would track mothers’ pumping supply. If this supply went down, lactation consultants would be able to intervene faster.
The request instantly clicked with Bhatnagar: “My sister had a preemie son, so I could personally relate to it,” he explained. During the hackathon he and his team sat in the NICU night and day to observe the feeding process. The automation of the milk tracking process that they proposed won them the hackathon’s second price.
Thirty days later Keriton was born. Keriton Kare has now been conducted for about fourteen months. The platform consists in two connected apps, Kare Mom and Kare Nurse, both available on smartphones.
A Fast-Tracked Process
“Our secret source is a pre-printed barcoded label for a particular mother,” Bhatnagar explained. At home, the mother pumps, labels her bottles and enters how much and when she pumped into her Kare Mom app. This data is synced with a secured server, so in the hospital the data is immediately available to nurses by scanning the labels. “It used to take five times as long to check in the bottles,” Bhatnagar said.
“We have taken down the time of intervention from three to five days to three to five minutes.”
The Kare Nurse app has every single step of inventory management, from expiration tracking to sending the nurses notifications or showing them graphs. Expiration of breast milk was brought down by 50 percent. The system takes care of all the manual checks and flags errors at each step. “That’s how we help nurses be nurses,” Bhatnagar said.
In the Keriton Kare system, mothers are actively involved in caring for their babies. Nurses are also more efficient in supporting them. With the app’s real-time graphs they directly spot mothers who have trouble pumping and communicate with them through the platform’s chat function. “These are millennial moms, you call them nobody picks up, you text them they reply back after three minutes,” Bhatnagar said. “We have taken down the time of intervention from three to five days to three to five minutes,” he added.
Preemies in the NICU (Courtesy of Krista Gantt)
Finally, there is an in-built photo function allowing nurses to share pictures of the babies. It also stimulates the mothers’ pumping. “We proved that with a photo of their baby they pump 72 ml more milk,” the young entrepreneur explained. A key achievement for him: “Breastmilk is liquid gold for babies,” he said.
The Keriton platform is also streamlining the process for donors’ milk and for formula feeding. The independent donor app also traces a donor’s journey by providing details of the approval data needed to donate milk.
Bhatnagar has big plans for Keriton. They have just started expanding their geographic reach, especially to Europe, and hope to go global with these products. The apps are coded to be language customizable. They are currently available in English and Spanish. All are HIPAA-compliant.
David Ferreira & Monique Mrazek, International Finance Corporation (IFC).
The rapid evolution of technologies that collect and analyze data of individuals on an ongoing basis, making such data more available, accessible, and useful, has important implications for healthcare. Combined with other technological advances such as machine learning and image recognition, this is creating a more data-driven, personalized system of healthcare, a trend that is starting to penetrate emerging markets too.
Newer applications are all about interpreting the data: what does it say about what is wrong with me as I go about my daily life? This differs from the traditional assessment of my health status at a single point in time, such as when I visit a doctor or have a blood test. The next step is responding to that interpretation, acting on the data. What medication, medical procedure, exercise or nutrition do I need?
“In China, companies are building capacity in genome sequencing that, in some ways, sets them ahead of many developed markets.”
Technology is making these steps more feasible and accurate. Collecting and aggregating large volumes of data enable conclusions to be drawn, which ultimately influence and benefit an individual’s diagnosis and care path. The increasing connectivity of the world makes it easier to connect data to the best expertise, whether that is a machine or a human accessing the data remotely. As well as making the diagnosis and treatment of health conditions more targeted and tailored to an individual, these technologies can lower the cost of an intervention by reducing or removing constraints imposed by scarcities in human capital or lack of physical infrastructure.
Personalized medicine is a term often linked to genomics. In China, companies are building capacity in genome sequencing that, in some ways, sets them ahead of many developed markets. Companies such as BGI and Wuxi AppTec are emerging leaders, operating both inside and outside China, in areas ranging from genomic research and sequencing services to diagnostic applications personalizing care.
Chinese company BGI (Courtesy of Asian Scientist)
However, personalization of medicine can also mean the way care is delivered. For example, we are seeing the emergence of online health consultation platforms that enable not only care at home but also in remote locations. AI-driven ‘chatbots’ pre-screen primary care patients, a preliminary step followed up with text or video consultations with nurses, doctors or specialists. For instance, Babylon Health is a UK-based solution that works with the government of Rwanda to provide remote health consultations. DocsApp in India has created a virtual care path, including e-prescribing and links to off-line labs, if needed following the virtual consultation.
Sometimes, tech-based healthcare companies fail or under-perform because they are not sufficiently cognizant of the broader healthcare ecosystem. While some technology can be appropriately left entirely with the consumer, for the most part, technology that promotes health should integrate into the system or the service provider to ensure the patient’s continuity of care. Take South Africa’s Discovery Health: primarily an insurance business, it has a significant tech-enabled wellness management capability through its Vitality offering. The company identified from the get-go the benefit of integrating data to optimize care for the individual.
IFC has recently expanded TechEmerge to Brazil. (Courtesy of Barron’s)
IFC, the arm of the World Bank that invests in the private sector in emerging markets, has been doing its part to facilitate market access that links innovative technologies to off-line health providers in emerging markets through its TechEmerge program. Initially launched in 2016, with a focus on healthcare in India, TechEmerge received 330 applications from earlier stage health technology companies around the world. This unique matchmaking program led to 17 pilots between tech companies and Indian healthcare providers.
“Over time, we expect data-enabled technologies to result in more personalized care in emerging markets.”
Examples include Israeli company MobileODT, which supplied Apollo Healthcare Group with handheld, point-of-care cervical diagnostic imaging devices that can screen for precancerous clinical abnormalities. Another example is India-based Tricog, that partnered with Cygnus Hospitals to enable remote reading of ECGs by cardiologists supported by an algorithm. In both instances with each case comes additional data that serves to improve the algorithm and overall predictive capacity of the solution. IFC has recently expanded TechEmerge to Brazil.
Over the last few years, the number of solutions that leverage data to aid diagnosis, improve care pathways, and optimize provider workflows, amongst others, has been rapidly changing the healthcare landscape in emerging markets. We expect this trend to continue. Over time, we expect data-enabled technologies to result in more personalized care in emerging markets, which ultimately should reduce costs, enhance access, and improve outcomes for patients.
Read more about personalized medicine in MedicalExpo e-magazine’s issue #35.
Monique Mrazek is a Senior Investment Officer at the International Finance Corporation (IFC), the private-sector arm of the World Bank Group. She leads investments in IFC’s health care practice, including venture capital and has extensive experience globally.
David Ferreira is a senior executive in the global health investments team of the International Finance Corporation (IFC), the arm of the World Bank that invests in private sector of emerging markets. He has a more than two decades-long track record in health care and education investments in emerging economies.