Clinical Informatics Best Practice Awards

Michael Weilert MD Clinical Informatics NewsLast week, the winners of Clinical Informatics News’ Best Practices Awards were announced at the 2015 Summit for Clinical Ops Executives, SCOPE, in Orlando.  Three grand prizes were awarded that recognized organizations’ exemplary use of IT to improve patient services, clinical operations and clinical trial management.  Six additional companies were named finalists.  The winners were announced during the final plenary panel at SCOPE in an awards presentation hosted by Allison Proffitt, the editor of Clinical Informatics News.

ePharma Solutions won an award for their project “SitePortal: Moving Clinical Research Study Sites and Medical Institutions to a Paperless Clinical Trials Environment” in the category of “Patient Data Management”.  SitePortal is a product meant to provide sites with a validated, cloud-based portal, which they can use to manage clinical trial resources, maintain and archive all of their documents online.

Clinical Supplies Management (CSM) won in the category of “Study Startup and Design” for their direct-to-patient shipping project that enabled a complex pediatric clinical trial.  36 young patients across the country were required to take doses at three specific times every day for 14 days in a row.  The medication had to be prepped in a lab, shipped fresh every day, used within 48 hours and maintained at specific temperatures at all times.  CSM was able to design a patient kit that could be reconstituted daily and shipped overnight.

For “Clinical Data Intelligence”, Dabo Health won for “Quality Metrics: Date Transparency and User-customized Design Drive Frontline Engagement”.  Dabo Health had launched a pilot study with the Mayo Clinic cardiovascular unit to use a social environment to help foster a culture of teamwork, accountability and ultimately higher-quality patient care.  This platform was able to prompt a culture of transparency, improved metrics and communication.  This collaborative sharing of information and responsibility reduced duplicated effort and other inefficiencies.

As well as these three winners, entries from such companies as DDI, MarkoCare, DrugDev, PHT Corporation, CFS Financial and Parallax Online were cited as finalists.  Judges reviewed countless other entries, looking for such factors as industry impact, innovative use of technology and an effort to tackle areas with a large and unmet need for new solutions.

Learning from Venice

History, as the saying goes, repeats itself.  I recently came across an article that discusses an idea put forward by Dr. Igor Linkov, that the way in which Venice handled the bubonic plague in the 14th century holds a lesson on how to even mitigate modern threats such as climate change and the fresh outbreak of ebola.  When the bubonic plague hit Europe in the late 1340s, Venice was a hub of many trade routes into both central Europe and Asia.  The Venetians initially tried to mitigate what they believed to be the threat with traditional risk management such as prayer and rituals, they ultimately started to utilize what people currently call resilience management.  Instead of trying to target a poorly understood risk, authorities focused on managing physical movement, social interactions and data collection for the city as a system.  This included inspection, quarantine stations on nearby islands, quarantine periods and wearing protective clothing.  Although such actions were too late to stop the disease’s initial devastation, thanks to the efforts, Venice continued to flourish, experiencing only sporadic episodes of plague afterwards.  In other parts of southern Europe, such as Greece, similar epidemics continued for centuries.

Michael Weilert MD Bubonic Plague
While the Bubonic Plague hit southern Europe hard, the Venetians were able to effectively combat it.

As the world tries to deal with the current Ebola outbreak in West Africa, Linkov and his colleagues are trying to learn from the Venetians in resilience management.  In the case of Ebola, economic and cultural factors make risk management difficult.  It might take time to transform deeply rooted traditions that contribute to the spread of Ebola, health experts and national leaders could respond to the re-emergence of the disease.  Resilience management addresses the ability of a complex system, such as a city or community, to prepare, absorb, recover and ultimately adapt to unexpected threats.  Resilience management could be an excellent guide to effectively dealing with the current Ebola outbreak in Africa, as well as other issues such as population growth and the impacts of global climate change, according to Linkov.  Much like Venetian officials did some centuries earlier, approaching resilience at the system level provides a way to deal with the unknown and unquantifiable threats we are facing more and more frequently.

The Dangers of Loud Music

As they say in rock n’ roll, “if it’s too loud, you’re too old”.  That could very well be true, but according to a recent study done by neuroscientists at the University of Texas at Dallas, loud noises alter how the brain processes speech, potentially increasing the difficulty in distinguishing speech sounds.  In a paper published this week in Ear and Hearing, researchers demonstrated how noise-induced hearing loss affects the brain’s recognition of speech sounds.  Noise-induced hearing loss (NIHL) reaches all corners of the population, and affects an estimated 15 percent of Americans between the ages of 20 and 69.

Rawk Out
While it might be fun to rock out sometimes, it can also be potentially harmful.

Exposure to intensely loud sounds leads to permanent damage of the hair cells, which in turn act as sound receivers in the ear.  Once they’re damaged, these hair cells don’t grow back, which leads to NIHL.  As people have made machines and electronic devices more powerful, there arises a whole lot more potential to cause permanent damage.  Even the smaller MP3 players are able to reach volume levels that are extremely damaging to the ear in just a matter of minutes.  Before the study, scientists didn’t have a clear understanding of the direct effects of NIHL on how the brain responds to speech.

To simulate two different types of noise trauma that clinical populations face, UT Dallas scientists exposed rats to moderate or intense levels of noise for an hour.  One group heard a high-frequency noise at 115 decibels that induced moderate hearing loss, and the second group heard a low-frequency noise at 124 decibels, causing severe hearing loss.  In comparison, the American Speech-Language-Hearing Association lists the maximum output of an MP3 player or the sound of a chainsaw at about 110 decibels and the siren of an emergency vehicle at 120 decibels.  Regular exposure to sounds more than 100 decibels for more than a minute at a time could lead to permanent hearing loss.

Researchers observed how the two types of hearing loss affected speech sound processing in the rats by recording the neuronal response in the auditory cortex a month after the noise exposure.  The auditory cortex, one of the main areas that processes sounds in the brain, is organized on a scale, not unlike a piano.  Neurons at one end of the cortex respond to low-frequency sounds, while other neurons at the opposite end react to higher frequencies.

In the group with severe hearing loss, less than one third of the tested auditory cortex sites that normally respond to sound reacted to stimulation.  In the sites that did respond, there were noted unusual patterns of activity; neurons reacted more slowly, the sounds had to be louder and the neurons responded to frequency ranges more narrow than before.  In addition, the rats couldn’t tell the speech sounds apart in a behavioral task that they could successfully complete before the hearing loss.

In the group with moderate hearing loss, the area of the cortex responding to sounds didn’t change, although the reaction of the neurons did.  A much larger area of the auditory cortex responded to low-frequency sounds.  Neurons reacting to high frequencies needed more intense sound stimulation and responded much slower than those in normal hearing animals.  However, in spite of these changes, the rats still could discriminate the speech sounds in a behavioral task.