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New AI app could hold key to better older patient-doctor communication



A new app developed by a second-year medical student could hold the key to helping doctors and other health professionals communicate better with older patients.

Various studies have shown that physicians often find it difficult to converse with older people, leading to many over-65s avoiding seeking medical care.

Research published in the Journal of Applied Gerontology in 2020 looking at Medical Care Avoidance Among Older Adults in the US found that one-fourth of people aged 65 and older had side-stepped remedial help.

The findings based on 2,155 participants from the 2008 Health Information National Trends Survey, revealed that while feeling uncomfortable about having their bodies examined and fearing being diagnosed with a serious illness were major factors in medical care avoidance amongst older people, lower confidence in obtaining health information and less trust in doctors and patient-centred communication, also played a part.

Meanwhile, a National Health and Retirement study published in 2015 found that one in five adults over 50 in the US, claimed to have experienced age-related discrimination in healthcare settings, with one in 17 saying they were subjected to it often.

Other studies have found that compared to younger patients, older adults were less involved in their own healthcare decisions, with doctors cited as being less tolerant, respectful, and optimistic.

Age-based discrimination was found to be common when it came to diagnostic procedures and the types of treatment offered, most especially regarding stroke and cardiological and oncological conditions.

But the new app which uses artificial intelligence to give unique rather than pre-prescribed responses to help medical students develop empathy with patients, could in the future play a vital role in facilitating better communication, diagnosis, and treatment for older people.

It is the brainchild of Eddie Guo, a second-year medical student at the University of Calgary’s Cummings School of Medicine in Canada.

The 23-year-old who is hoping to specialise in neurosurgery, was prompted to develop the platform after realising he needed more practice talking to patients.

The result is OSCE-GPT, a free-to-use objective structured clinical examination program where the computer is the patient.

Users choose whether the patient is male or female and either select a specific scenario or allow the computer to pick a random one for them, letting them practice inquiry-based conversations.


Believed to be the first app of its kind to use one-off replies every time, it is already being used by healthcare professionals in 35 countries, including Canada, the US, Japan, Australia, India, and the UK.

Powered by Whisper, GPT-4, and Google text-to-speech, users speak any language they want, and the app translates it into English.

Developed with the support of the Canadian Federation of Medical Students, scenarios currently include everything from dealing with a patient presenting with a brain bleed, chest pain, or spine trauma, to how to break bad news.

But Guo – who was inspired to become a medic after a neurosurgeon visited his school resulting in an invitation to sit in on a Parkinson’s disease consultation – said within the next few months he hoped to have included scenarios dealing with geriatric care and how to talk to older patients.

He told Agetech World: “It’s certainly an area that needs looking at. I remember we had a geriatric session, and I was just mind-blown by the amount of various complex medical issues that are present in that patient population. Certainly, some cases can be added.

“The reason why there aren’t any cases currently is because I personally haven’t come across them in the clinic. But some things I can think of off the top of my head, are issues such as polypharmacy.

“Oftentimes, older individuals are on quite a few drugs for various medical conditions, and sometimes those drugs can add up, and they each have side effects. Sometimes with these side effects, patients are prescribed more drugs to fix the secondary issue, and it’s just a perpetual cycle.

“That is one major area that could be easily added to the scenarios for someone to manage. Just having that conversation about what drugs an older patient is taking, what doses they are taking, and how can we best manage this with you.

“Other scenarios that could be added in the future are with multiple people all speaking in different voices, such as a provider, an older individual, as well as their primary care giver if they have one, or their children.

“That way it could simulate the sort of conversations you’re likely to have to face, so medical students will have the opportunity to practice with it.

“There is a lot of opportunity to add these sorts of cases involving older people. The way the program is structured is such that if anyone has an idea of a case they want to share, it is quite easy to add it.”

Medical students practice their communication skills in what are known as Objective Structured Clinical Examination (OSCE) stations. However, these require a room, a preceptor, an actor, and a student.

The chance to take part in additional practice opportunities are usually few and far between.

Mehul Gupta, left, and Eddie Guo. Credit: Nada Hassanin, University of Calgary

As Guo said: “It’s really hard to practice communication skills with friends as it’s difficult to replicate what a professional actor can do. Also, when you’re in a clinic, or shadowing someone, patients don’t give feedback on a person’s communication skills.”

It’s not just medical students that could benefit from the platform. Seasoned professionals could too. Guo said: “As you go through medical school, residency, and practice, there is often a trend that physicians become less empathetic.

“There was a study on this a while ago that showed that when you first enter medical school is when you have the most empathy. That slowly declined over the years of training. You’re also working crazy hours and if you can imagine having to go through that for a decade, two decades, then you become worn down.

“It doesn’t make up for the loss of empathy, but it perhaps explains why practicing physicians who are older, may show less empathy with their communication skills compared to their younger counterparts.”

It’s never been more important, however, that those skills are honed when dealing with older patients – especially as we’re living with an ageing planet. The populations of many countries will soon have significantly higher proportions of older people than young adults.

Globally, one-fifth of the population is predicted to be over the age of 60 by 2050.

This demographic timebomb brings with it a host of serious health implications with diabetes, certain types of cancer, dementia, cardiovascular diseases, stroke, mental health issues, and age-related hearing and sight loss and mobility problems, all becoming more prevalent.

Yet despite the health issues facing many older people, they are less likely to seek out medical help because of an assumption that pain, tiredness, dependency, and depression are all part of the ‘ageing process’ – a belief shared by many physicians.

And as research has shown, those who do seek medical help often find themselves undertreated because of factors like hearing loss, mobility problems, or cognitive decline, which may make it difficult to communicate and be mistakenly seen as non-cooperation.

Studies from the American Society on Aging have revealed that healthcare professionals also communicate differently with older people than with younger ones, often being less patient and engaged, and providing less information.

Guo said around three weeks had been given over to geriatrics as part of an ageing, neurosciences and special senses course, and added: “Geriatrics was emphasised during our small group cases as being an area to really consider and focus on, especially with the ageing population.

“As the population ages, the more patients you will be seeing that are of an older age and oftentimes they will be sicker patients, simply because they gather so many medical issues.

Mehul Gupta, left, and Eddie Guo discuss how an AI tool will work to help students develop empathy. Credit: Nada Hassanin, University of Calgary

“Currently, the way we are trained, the model is you have an issue and either we go in and fix it or we investigate and we come up with a plan and we try to tackle it.

“However, if you have multiple issues, for example, heart failure, liver failure, or perhaps multi-system organ failure, or even just disease of multiple organs, that is something that is a little trickier to deal with, because the way we are taught is system by system currently.

“I think medical schools should begin transitioning into more of these complex patient presentations, especially towards the end of medical training as you gain foundational knowledge.”

It is in situations such as this that Guo’s app could come into its own.

“Having that set base of this is actually the general direction you want to take this conversation before going in and seeing the patient, is likely going to be a positive experience for both the patient and the provider,” he said.

Currently medical students the world over use the Calgary-Cambridge guides for interviewing patients. These were developed by a team based at the University of Calgary and the University of Cambridge in the UK.

The first publication was in 1998 and the model which is based on 71 skills and techniques to improve patient interviews, has since been adapted for veterinarians.

Guo was helped in the creation of OSCE-GPT by University of Calgary alumini, Dr Mehul Gupta.

He said of his decision to become involved: “As a resident, I see what a critical skill communication is. How you phrase things and approach situations matters. Communicating effectively requires practice. This system has the promise to really change the way health professionals interact with patients.”

Guo maintains the interaction with the computer is surprisingly human-like.

He explained: “Developing empathy is a critical skill for health professionals and the real world can be intimidating. The platform offers a safe environment so someone can practice and fumble and learn from mistakes so they can be more confident when they do see a real patient.

“As you can imagine, it might not be the best idea to go see a real patient to learn to communicate with them, especially if they are coming in with an issue and you don’t know how to approach it.

“That decreases the care for both the patient and provider. But by having extra practice with this app, providers and trainees get the opportunity to have seen a case, to have seen a general approach, and to have seen what does and doesn’t work, and what does and doesn’t come naturally to them.”


Early Alzheimer’s prediction platform secures €21 million investment



PREDICTOM Dag Aarsland. Photo: Frida Moberg.
PREDICTOM's Dag Aarsland. Photo: Frida Moberg.

The project aims to identify people at risk of dementia before symptoms appear.

More than 7 million people are living with dementia in the EU. This number is projected to double, reaching 14 million by 2050.

There is currently no cure for Alzheimer’s disease. Although the search for potential treatments is showing promise, it is anticipated that these medications will be most effective in the early stages of the disease.

The recently launched AI screening platform, PREDICTOM aims to identify individuals at risk of developing dementia, even before symptoms manifest.

The cognitive and biomarker screening platform has this week announced it will be backed by €21 million in funding, with €8 million from the EU, €9 million from industry and €4 million from UKRI.

A consortium of 30 partners from academia, business, civil society and hospitals is steering the project. The Consortium includes partners from 15 countries across Europe, Asia and America and is led by Stavanger University Hospital.

Dag Aarsland, Professor of Old Age Psychiatry at King’s College London and research lead at Stavanger University Hospital, is the leading the project.

“Detecting early signs of dementia is key to slowing its progression. Unfortunately, a majority of those at risk are not identified in time. Our platform seeks to change this by enabling early discovery, allowing timely intervention and preventative treatment,” Aarsland said.

A crucial aspect of PREDICTOM is that much of the screening can be performed by the patients themselves in the comfort of their homes.

By initiating the process at home, the project aims to reduce strain on healthcare services and associated costs. Biomarkers, including saliva, stool, digital markers and blood via prick-tests, will be collected at participants’ homes or GP offices, streamlining a process traditionally carried out in hospitals or specialised clinics.

More than 4000 participants will partake in PREDICTOM’s trial project. The samples will be based on a pool of people from previous initiatives like PROTECT UK, PROTECT Norway and Radar-AD, as well as people from the catchment area of other participating centres in Germany, France, Switzerland, Belgium and Spain.

“If our project succeeds, there will be significant savings in both cost and time,” Aarsland said

After the home collection, samples will be sent to PREDICTOM, where their platform will process the participant data, integrating blood, cerebrospinal fluid, imaging, electrophysiological and digital biomarkers.

AI algorithms will generate risk assessments, early diagnoses and prognoses, laying the foundation for early intervention and treatment.

This project is part of the Innovative Health Initiative (IHI), a public-private partnership (PPP) between the European Union and the European life science industries.

“We are very pleased to have such a robust team with top notch expertise spanning diverse fields, including IT, AI, medicine, ageing research and professionals from both small and large businesses,” Aarsland added.

The project runs from 1st November 2023 to 31st October 2027.

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New partnership to bring dementia-specific programmes to Washington State



Washington state dementia

The partnership will bring non-pharmacological interventions for dementia and alternatives to high-cost drugs to patients across Washington State.

A new partnership between brain health company, Together Senior Health and accountable care organisation, Rainier Health Network,

The partnership will introduce Together’s suite of dementia-specific programs, including in-home virtual interventions, to patients across Rainier Health Network in Washington state where the organisation oversees the healthcare of over 60,000 Medicare patients.

Alzheimer’s and related dementias affect more than 6.7 million Americans with 14 million projected cases by 2060. The associated healthcare costs for individuals with dementia are among the highest of any condition. Payers and providers face significant challenges in managing this expanding population.

According to a recent survey conducted by Sage Growth Partners, 77 per cent of health plans and value-based care organizations agree the need to address the growing cost of ADRD is urgent or very urgent; however, only 4 per cent have a fully-developed solution in place to support this population.

Approximately half of those surveyed also indicated a concern with the costs of Leqembi and other high-cost pharmaceuticals.

Together’s Moving Together programme offers a non-pharmacological intervention for dementia and a safe alternative to high-cost drugs that are not clinically appropriate for many dementia patients and have potential side effects.

The programme allows payers and risk-bearing healthcare organisations to more effectively manage patients. Together Senior Health says the programme results in improved engagement, reduced costs and improved health outcomes.

Recently, the company has been gaining industry traction. In addition to its partnership with Rainer Health Network, the firm is affiliated with the likes of VNS Health, VillageMD and the Alzheimer’s Association.

“Supporting our members with Alzheimer’s disease and related dementias is critical,” said Dr Francis Mercado chief medical officer and board chair at Rainier Health Network.It’s a vulnerable population and Together Senior Health’s Moving Together™ solution is a proven, natural way to improve their lives and control costs.”

Together’s Moving Together™ programme is based on over ten years of clinical research in neuroscience with the University of California, San Francisco (UCSF) and the National Institutes of Health (NIH).

Results from Together’s randomised control trial show statistically significant improvements in quality of life for individuals with cognitive decline and in caregiver ability to manage stress. The data also shows a reduction in falls and proven annual cost savings of up to $4,300 per participant per year.

Caregivers in the programme have also benefited, reporting enhanced caregiving skills.

Together is in the process of commercialising RADAR, its proprietary dementia identification and stratification algorithm. The algorithm helps payors and risk-bearing healthcare organisations identify people at highest risk for Alzheimer’s disease, dementia and cognitive decline using claims data, electronic health record information and other relevant data.

“We are proud of the positive impact Together is making on the lives of those affected by dementia and are excited to partner with one of the nation’s premier ACOs to extend dementia-specific programs to its patients,” said Alissa Meade, CEO of Together Senior Health.

“Rainier Health Network, Virginia Mason Franciscan Health and Together share a deep commitment to providing holistic dementia solutions that enrich the lives of participants while empowering forward-thinking, risk-bearing organizations to engage and manage this rapidly growing patient population effectively.”

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One in 25 carry genotype associated with shortened lifespan



Genotype associated with shortened lifespan found in 1 in 25.
Kari Stefansson, Patrick Sulem and Brynjar Örn Jensson scientists at deCODE genetics and authors on the paper

The study used genomic data from 58,000 Icelanders and discovered the presence of a life-shortening genotype across 4 per cent of the population.

Scientists at deCODE Genetics, a subsidiary of Amgen, have published a study on actionable genotypes detected in the Icelandic population and their association with lifespan.

The researchers determined that 1 in 25 individuals carried an actionable genotype and have, on average, a shortened lifespan.

“The identification and disclosure of actionable genotypes to participants can guide clinical decision-making, which may result in improved patient outcomes,” said Kari Stefansson, author of the paper and CEO of deCODE Genetics. “This knowledge therefore has significant potential to mitigate disease burden for individuals and society as a whole.”

The study, published today in the New England Journal of Medicine, focuses on genotypes that increase the risk of a disease for which preventive or therapeutic measures have been established. These genotypes are termed actionable genotypes.

The scientists used a population-based data set, consisting of 58,000 whole-genome sequenced Icelanders, to assess the fraction of individuals carrying actionable genotypes.

Using a list of 73 actionable genes from the guidelines from the American College of Medical Genetics and Genomics (ACMG), the scientists found that 4 per cent of Icelanders carry an actionable genotype in one or more of these genes. The diseases caused by these genotypes include cardiovascular, cancer and metabolic diseases.

The study assessed the relationship between actionable genotypes and the lifespan of their carriers. The largest effect was observed among carriers of cancer-predisposing genotypes, which had three years shorter median survival than non-carriers.

A pathogenic variant in BRCA2, predisposing to breast, ovarian and pancreatic cancer, shortened lifespan by seven years and a variant in LDLR, which causes high levels of cholesterol and cardiovascular disease, shortened lifespan by six years.

“Our results suggest that the actionable genotypes identified in our study, which are all predicted to cause serious disease, may have a drastic effect on lifespan,” said Patrick Sulem author of the paper and scientist at deCODE Genetics.

The results showed that carriers of particular actionable genotypes were more likely to have died from the disease caused by these genotypes. Individuals with a pathogenic variant in BRCA2, have a seven-fold risk of dying from breast, ovarian or pancreatic cancer.

They are also 3.5 times more likely to develop prostate cancer and seven times more likely to die from prostate cancer than those who do not carry the variant.

The results of this study are among the factors that have motivated the government of Iceland to announce a nationwide effort in precision medicine.

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