New digital communication tools dramatically increase the prescribing rates of a life-saving heart failure medication, a new study shows.
An automated system that flags which patients would most benefit from an underused yet life-saving cardiology drug more than doubled new prescriptions, according to a pilot programme test by researchers at NYU Grossman School of Medicine.
The trial applied the new tool to heart failure, the condition in which the heart is increasingly unable to pump enough blood.
Medications called mineralocorticoid receptor antagonists (MRAs) can greatly increase survival rates, but past studies have shown that almost two-thirds of eligible patients are not prescribed these drugs.
Other research has blamed this treatment gap for more than 20,000 preventable deaths each year in the United States.
According to the study team, part of the challenge in prescribing MRAs is that the medical information needed to determine a patient’s eligibility is scattered throughout their electronic health record.
As a result, experts have been exploring the use of digital messaging tools that automatically analyse standard clinical guidelines and relevant medical data to make treatment decisions easier.
According to the study authors, it is the first to directly compare the effectiveness of alert message types that address heart failure.
“Our findings suggest that tailored electronic notifications can boost the prescription of life-saving drugs,” said study lead author and cardiologist Amrita Mukhopadhyay, MD, a clinical instructor in the Department of Medicine at NYU Langone Health.
“By compiling key information in one place, the system may help providers to spend less time searching through medical records during a visit and more time speaking with their patients.”
In the pilot program designed to find the most effective type of digital alert, researchers at NYU Grossman School of Medicine tested two automated technologies over six months that screened the records of more than 2,220 men and women in treatment for heart failure.
The results showed that cardiologists who received a banner-like alert on their computer screen prescribed MRA therapy for about 30 per cent of their patients over the course of the trial. Those who were instead sent monthly email-like messages did so roughly 16 per cent of the time. By contrast, those who received neither type of message prescribed the therapy for 12 per cent of their patients.
The research team tested the notification systems at more than 60 cardiology outpatient clinics within NYU Langone between April and October 2022. Adults with heart failure were randomly divided into three groups based on the type of support tool used by their cardiologist.
In the first group, alerts appeared on the top corner of patient healthcare charts, which are routinely reviewed during visits. They included data that could inform decisions around MRA therapy, such as blood pressure, estimated glomerular filtration rate (a measure of kidney function), and potassium levels in the blood.
Mukhopadhyay notes that the researchers aimed to avert overwhelming physicians with too many prompts. To prevent alarm fatigue, the alert was designed to exclude anyone who might be harmed by MRA treatment, such as those with certain kidney disorders, or who were already taking the medications.
For the second group of patients, cardiologists received a message each month that included a list of those eligible for MRAs. This system appeared similar to an email but was located within the healthcare system’s internal messaging platform. Through this “email,” healthcare providers could open medical charts and read information relevant for prescribing MRAs.
Those caring for patients in the final group received neither kind of notification.
Study senior author Saul Blecker, MD, commented: “Even though monthly ’emails’ limit interruptions during a consultation, alerts may be more effective because they allow physicians to discuss a recommended treatment in real-time.”
Blecker, an associate professor in the Departments of Medicine and Population Health at NYU Langone, cautions that the technologies were only tested in cardiology practices within a large, urban healthcare system.
As a result, Blecker says the team next plans to explore the effectiveness of these tools in other settings, such as primary care practices and smaller clinics.
Innovative robotic cup could empower older adults to stay hydrated
A one-of-a-kind robotic cup designed to help people living with cerebral palsy stay hydrated could also be a game-changer for older adults suffering from mobility impairments.
The aptly named RoboCup enables people with limited upper body mobility to stay hydrated without relying on a caregiver for help.
The battery-powered device, which can be mounted on a user’s wheelchair and customised to suit their mobility needs, is activated either by a button or a proximity sensor that brings a straw directly to their mouth.
The user can then take a drink, and once they have finished the straw automatically withdraws.
The cup is the brainchild of engineering students Thomas Kutcher and Rafe Neathery, who came up with the innovative idea after Rice University’s Oshman Engineering Design Kitchen (OEDK) in Houston, Texas, in the United States, was approached by spastic quadriplegic cerebral palsy patient Gary Lynn for help creating an assistive drinking device.
The result is RoboCup, which Thomas and Rafe hope will offer users greater freedom as they won’t need to rely on a caregiver whenever they need a drink.
To this end, the undergraduates have generously made their design available for free to anyone with access to a 3D printer to assemble their own drinking device by downloading instructions from RoboCup’s OEDK website.
Having made it possible for those living with cerebral palsy to drink water autonomously, Thomas and Rafe are now looking at the cup’s wider application – and believe it could prove to be a life-changing piece of technology for those with age-related eating and drinking problems caused by muscle weakness, pain, disease, and neurological conditions that can seriously affect mobility.
Thomas told AgeTech World: “While our client who had the idea for this device has cerebral palsy, the potential use cases spread far and wide. Rafe and I wanted our design to be as generalisable as possible.
“The device is catered to anyone with impaired mobility in a wheelchair, to the extent that they can either push a button or hold their finger in front of a motion sensor, and sip water from a straw.
“Once the device is set up it is very intuitive. It just needs to be set up in a manner where the straw rotates directly to a comfortable location for the user, and the sensor should be placed in a position where the user is able to trigger it.
“Once that criteria is met it should be very easy for the user.”
Dehydration is dangerous for anyone of any age. But older people are at a greater risk than any other age group.
This is because as people age their bodies don’t demand the same levels of liquid as they did in their younger years. This in turn changes a person’s sense of thirst.
However, the body still needs fluids to function, whether that be helping lubricate joints, regulating body temperature, pumping blood to the muscles, or ensuring the kidneys and urinary tract continue to function properly.
According to the British Nutrition Foundation, dehydration is not only a common cause of hospital admissions in older people but is associated with increased mortality.
For example, a two-fold increase in the mortality of stroke patients has been reported.
Even mild dehydration can be dangerous, affecting tiredness levels and mental performance, potentially leading to low blood pressure, dizziness, weakness, and an increased risk of falls.
In older people, dehydration is often associated with dementia, poorly controlled diabetes, Alzheimer’s disease, and stroke.
Certain medications can also cause dehydration.
The obvious way to prevent a lack of fluids is to drink more. But this can be easier said than done if you have impaired physical or mental abilities that may confine you to a bed or a wheelchair.
There are several hydration aids on the market aimed at older adults and those with cognitive impairments such as dementia and Alzheimer’s, from water sweets to sports-type bottles and wearable devices that can monitor fluid intake.
But Thomas and Rafe believe RoboCup is in a class of its own.
Rafe said: “RoboCup is primarily focused on allowing those with limited mobility to find increased autonomy in their day-to-day lives. The primary alternative to something like RoboCup would be a water bottle with a long adjustable straw that can be positioned near the user’s mouth.
“However, the issue with these products is that they intrude on the user’s headspace, and they tend to leak water down their shirt. RoboCup gives people autonomy to have hydration when they want it, and to have control over their own personal space.”
Whilst currently designed for use with a wheelchair, Rafe and Thomas say the RoboCup could be adapted for use in other situations, such as a hospital or care home environment, where a patient is confined to bed.
Thomas and Rafe, who are both 21 and in their final year at Rice University studying bioengineering and mechanical engineering respectively, are currently busy with senior design projects in other fields.
But Thomas said: “As far as assistive devices go our focus is still on RoboCup. As there is such a wide range of potential users, we’re still looking for and exploring ideas to make RoboCup more customisable.
“The main ones are investigating different sensors and locations to fit an individual’s personal ability, adjusting the design to accommodate more viscous fluids, or making it simpler for people to adjust the timing of the motion.”
Making the device as accessible as possible has meant simplifying it. During its development, the duo removed some of the more complicated or expensive parts and found alternatives for custom pieces that required special equipment to be made.
Rafe explained: “It was challenging walking that thin line between simplifying the device and sacrificing functionality or robustness. We wanted to keep it working well while still making it simpler and cheaper.
“Balancing all these considerations was really tricky, but we did get to a point where it’s now a lot easier to 3D print and assemble the device using simple, readily accessible tools.”
The pair worked closely with Gary Lynn during the development stage to optimise the design, which went through several iterations. An initial prototype featured a camelback but was scrapped for the current mounted cup-and-straw version.
Both Gary and his mother Andrea Lynn have expressed their hope that the project will bring attention to the struggles of people living with disabilities who can often strain with something as seemingly easy as drinking water.
Gary has said of Thomas and Rafe’s design: “This cup will give independence to people with limited mobility in their arms. Getting to do this little task by themselves will enhance the confidence of the person using the device.”
To help spread the word about RoboCup, Rafe and Thomas entered the device in the World Cerebral Palsy Day Remarkable Designa-thon competition intended to promote “ideas for a new product or service that could change lives” for people in the cerebral palsy community.
Sadly, RoboCup didn’t win. The prize went to a woman with cerebral palsy who developed an idea for an app that knows who she is, and where she is, and contains a list of her contacts for emergencies, allowing those with speech challenges to effectively communicate their needs to anyone.
Rafe said: “I’m glad the money is going to someone with cerebral palsy who has an important need to be met.”
That hasn’t stopped Rafe and Thomas from getting the word out about RoboCup.
But why did they decide to make their invention freely available rather than taking the entrepreneurial route?
Thomas said their goal had always been to bring it to as many people as possible, especially as they had neither the time nor the investment to commercialise it.
“Helping other people make their own is best,” he commented. “We have open-sourced the part files and code online, and everything else is available to buy from other vendors. After everything is printed, all it takes is a screwdriver and less than an hour to assemble Robocup – the instructions are also online with a few dozen pictures.
“The idea behind all of this effort is to enable others to make Robocup themselves, regardless of access to tools or machinery.
“The low cost, small size, and wide capabilities of a desktop 3D printer are bringing it into more and more households, as well as schools, labs, and maker spaces. There are also several online services that can print and ship 3D-printed parts.”
He added: “We hope the manufacturing process doesn’t prove too burdensome, as Rafe and I worked hard to make it as simple as possible. We do believe that the fully idealised version of this device is purchasable off the shelf to make it as easy as possible for the consumer.”
With graduation looming, Thomas and Rafe admit they are keen to move on to future endeavours. Rafe is going to work for SpaceX post-graduation and Thomas is planning to pursue a PhD in Neural Engineering.
That doesn’t mean if the RoboCup takes off, it might not become a commercial enterprise.
Thomas said: “Like I said before, Rafe and I have wanted to get the word out about RoboCup and move on, as we are graduating. We were potentially hoping that another organisation could take the reins on the RoboCup, or our open-source website could become popular.
“We mostly just wanted to get our work out there through open sourcing, but Rafe and I have more things to discuss in terms of making sure the RoboCup is successful, reaching as many people as possible.
“I personally am somewhat interested in turning it into a commercial enterprise if there is a clear path there, but I need to do more research.”
Agetech World podcast: Why it’s time to stop talking about generations
From post-war baby boomers to the current Generation Alphas, stage-of-life labels beloved of cultural commentators, researchers and marketers, will soon be a thing of the past, predicts the head of the globally influential UK National Innovation Centre for Ageing.
Researcher, teacher, writer and TEDx speaker, Professor Nic Palmarini, has told the latest Agetech World podcast he believes the arbitrary grouping of people born within a certain time frame and deemed to reflect the narrative of a particular period in world history, will no longer be a thing.
Click here to listen to the latest Agetech World podcast
Instead, the director of the NICA, said he expects to see a merging of the current peer groups to form one inter-generation, with no need for distinct categories.
“It is quite foolish to put cohorts who are born in very nearby years, but different years, different areas of the world, (and with) different experiences, to put them all together,” he said.
“We think that in the future there will be no more generations. We are literally thinking that there is a kind of fluidity on how we are interfacing our future society.
“My personal opinion, and again it is my opinion, but I think we are just going towards a sense of melting the generations one with the other and coming to one mega fluid generation where experiences are just more quickly flowing one to the other, not necessarily stopping at the station of each generation.
“And if you think, for example, what happened in the United States, where President Biden has been elected basically with the votes of the Gen Z, there is a sort of understanding of Gen Z and the Silent Generation (born up to the mid-1940s and including Joe Biden)…trusting each other, understanding each other, empowering each other, which I think is something we will see more and more often because, I guess, the only way to solve the main, or big issues, that we are seeing forward in our future…(is through) collaboration between the generations instead of framing the generations.”
He added there would always be some intergenerational conflict “which is good, because somehow it is making the generations in this case understand what could be the pain point that maybe others don’t see.”
The way to solve this discord he explained, was with collaboration.
“We know there is no other way. So I think that also this will probably lead us to a kind of inter-generation, as we call it.
“I keep on saying that the next generation won’t be called Alpha as they say. My point is it will be called ‘inter’ because it will be a generation made of many generations working together.”
Prof Palmarini was appointed director of the NICA in 2019. Headquartered in the North East of England, the NICA is jointly funded by the Medical Research Council and Newcastle University, and was set-up to work across academia, industry and the public to explore, test, and bring to market products which promote healthy ageing and wellbeing through life.
Prof Palmarini’s previous job was as head of AI for Healthy Ageing at IBM Research and AI Ethics Lead and Research Manager at the MIT-IBM Watson AI Lab in Massachusetts in the US.
He has a decade of experience in research in supporting older adults’ autonomy and independence, and his internationally-recognised career has demonstrated his commitment to exploring the impact of technologies and their applications in the life of the ageing population and people with disabilities.
With the longevity sphere potentially worth trillions of pounds in the UK and worldwide, a major part of the NICA’s work is to convince industries, such as the big technology players, the health sector, entertainment, fashion, and financial services, of the importance of targeting age discrimination through collaboration, innovation, exchange and interaction.
Prof Palmarini told the podcast that society also needs to rethink ‘age’ and the concept of retirement, especially as people are living longer thanks to medical and scientific advances.
He has no plans to retire, he said. “I’m very biased because on one side, not my research side, my father is 93 and is working. He is a doctor and he keeps on going to work, he drives, he lives his life like it was 20 or 30 years ago, which obviously teaches me one thing, that we all need a purpose to be that way.
“So, how do I see myself? I can’t think myself out of being engaged in things that matter to me, and I am very good in putting myself in things that matter to me. So that is my everyday job. I am curious. My job is to understand what are the dynamics happening now – and in the future.
“I am quite good in spotting what are the things that could be meaningful in the future, hence my future will probably be what I am doing today for the next whatever years until I die.
“I haven’t thought about retirement. Again, I don’t have examples in my day-to-day life of retirement. I have examples of people living their own life, being relevant to themselves and to others, which is something still I think we have to sustain and push, not for everybody. Do not misunderstand me. There are people that need to stop. People that need to slow down in certain stages of their life.
“I am saying in general we tend to think of this idea of retirement, like stopping being part of a society because that is how retirement, from a narrative perspective, has been designed.
“I think we have to go against the stigma of retirement; you just watch birds and take long walks every day, which is absolutely wonderful and must be done by whoever wants to do it, but also I think this idea of giving back permanently to others in the process of life, is something that we should have to start thinking more consistently, and understand that working in later life could be a blessing, not a bad thing.”
Model of human synovium could accelerate treatments for arthritis
Researchers have developed a new ‘organ-on-a-chip’ model of the human synovium, a membrane-like tissue that lines the joints.
The model, published in the journal Biomedical Materials, could help scientists to better understand the mechanisms of arthritis and to develop new treatments for the group of debilitating diseases.
Across the globe, more than 350 million people live with a form of arthritis, which affects the joints and can cause pain, stiffness, and swelling.
There is currently no cure and the search for new therapeutics is limited by a lack of accurate models.
The new synovium-on-a-chip model, developed at Queen Mary University of London, is a three-dimensional microfluidic device that contains human synovial cells and blood vessel cells.
The device is subjected to mechanical loading, which mimics the forces applied to the synovium during joint movement.
The model was able to mimic the behaviour of native human synovium, producing key synovial fluid components and responding to inflammation.
This suggests that the new platform has immense potential to help researchers understand disease mechanisms and identify and test new therapies for arthritic diseases.
“Our model is the first human, vascularised, synovium-on-a-chip model with applied mechanical loading and successfully replicates a number of key features of native synovium biology,” said Dr Timothy Hopkins, joint lead author of the study.
“The model was developed upon a commercially available platform (Emulate Inc.), that allows for widespread adoption without the need for specialist knowledge of chip fabrication.
“The vascularised synovium-on-a-chip can act as a foundational model for academic research, with which fundamental questions can be addressed, and complexity (further cell and tissue types) can be added.
“In addition, we envisage that our model could eventually form part of the drug discovery pipeline in an industrial setting. Some of these conversations have already commenced.”
The researchers are currently using the model to study the disease mechanisms of arthritis and to develop stratified and personalised organ-on-a-chip models of human synovium and associated tissues.
“We believe that our synovium-on-a-chip model, and related models of human joints currently under development in our lab, have the potential to transform pre-clinical testing, streamlining delivery of new therapeutics for treatment of arthritis,” Martin Knight, Professor of Mechanobiology, said.
“We are excited to share this model with the scientific community and to work with industry partners to bring new treatments to patients as quickly as possible.”
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