Pakistan Today

Doctors embrace social networking

In the waiting room, the patient's family members circled a Blackberry. About every 15 minutes, Dr. Carlos Wolf of Miami Plastic Surgery gave them a few keystrokes of information about how the patient was doing.

``M is asleep,'' one of Wolf's nurses typed at 9:13 a.m. on June 3. ``We will start surgery soon.''

Less than an hour later, the nose job was complete.

``Beautiful,'' the nurse typed. ``She's going to love it.''

Twitter, Facebook and YouTube aren't just for entertainment anymore. Wolf and doctors around South Florida and the rest of the country are using the social networking tools to bring patients' families and the general public into operating rooms, sometimes sharing step-by-step medical procedures. They favor the real-time updates and videos as a way to reduce the fear factor of surgeries and educate people about the realities of certain procedures, especially new ones.

Earlier this year, surgeons at a Detroit hospital used Twitter to report the blow-by-blow steps of an operation to remove a kidney tumor. In any given month at JFK Medical Center in Atlantis, Dr. Beth-Ann Lesnikoski likes to use Twitter as an educational tool during surgeries to treat breast cancer. Last month, anyone with Internet access could watch live as Dr. Harlan Selesnick repaired a knee ligament at Doctors Hospital in Coral Gables, courtesy of the Baptist Health South Florida website, which posts webcasts of surgeries on a regular basis.

Some physicians, such as Dr. Camil Sader, a South Florida surgeon, have gone so far as to create their own iPhone apps.

BEDSIDE MANNERS

Wolf says he masks patients' identities by using just one of their initials, and the posts are vague enough that strangers may have trouble figuring out what kind of operation is being performed.

``At this point, it's really to make those patients, family and friends feel comfortable,'' says Wolf, who has been practicing for more than 20 years. ``We don't have a two-way conversation. The most important thing is for me to concentrate on what I'm doing.''

And if something were to go wrong in surgery? Wolf says he or a nurse would step out to speak with the family -- just like in the past.

``People think of social media as being cold,'' says a South Florida mother whose teenage daughter lay on the table when Wolf performed his first surgical tweeting session. ``Although I couldn't see it, I felt like I was close to my daughter. It's modern-day bedside manner.''

But not everyone is comfortable with physicians posting updates from the operating room -- especially when tweets and webcasts are available for public consumption.

``If it doesn't serve the patient, using it is unacceptable,'' says Dr. Erika Schwartz, an internist and medical director of the South Florida-based health insurance agency Cinergy Health. ``Sometimes, we all get carried away with the novelty of something.''

Still, Schwartz has a Facebook page and encourages patients to communicate with her via e-mail. She says she has cut some of her patients' healthcare costs by answering questions electronically instead of requiring office visits.

``The Internet is a great opportunity to create a better connection between doctors and patients,'' Schwartz says. ``I'm a big fan of social networking. It reaches people. There's a lot of information that can be shared. But it's got to be done with respect to the doctor-patient relationship.''

When a patient sent her a medical question using Facebook, Schwartz says, she made a point not to answer it there.

At JFK Medical Center in Palm Beach County, Lesnikoski's inaugural tweets were designed to contrast the effect of breast cancer on a woman in her 40s and a woman in her 90s; she was operating on one of each that July day. The only information she revealed about the patients was their age.

Before the surgery, Lesnikoski prepared a series of facts about breast cancer that could be tweeted to her 70-plus followers, along with basic information about the surgery, from her account, drbethjfk.

Lesnikoski, who has a background as a medical educator, says every surgery is a highly prescribed process, so there are traditional stopping points that can be used to tweet without interrupting the operating team's concentration. She says the hospital is now looking into tweeting during surgery as a way to keep families informed about a patient's progress.

``Surgeries can last from 45 minutes to 2 ½ hours,'' Lesnikoski says. ``These families will get updates every 20 minutes. The patients we've done our focus groups with have loved this concept.''

BRIEF IS BETTER

Dr. Donna Bilu Martin of South Beach Dermatology has been sharing skin facts and product information this year with her Twitter account followers. It's a compressed version of information she might send out in an e-mail -- but tweets don't clog up someone's inbox or get stuck in a spam filter.

``We can do this without being annoying,'' says the dermatologist, who tweets under the user name drbilumartin.

``The risk of melanoma -- the most deadly form of skin cancer -- increased by 75 percent in people who started using sunbeds regularly before age 30,'' she tweeted last month.

In another post, she shared information about a drug recently approved to hide wrinkles.

While Twitter identities are the latest tool in some doctors' medical bags, Dr. Camil Sader now considers his iPhone a medical necessity.

Sader, who specializes in laparoscopic surgery in Broward and Palm Beach counties, sometimes visits 180 patients at four hospitals in a single week. Tracking which patients he saw, their prognosis and other details about their care had become a paperwork nightmare.

When Sader couldn't find a simple and secure database program, he created one. It's an iPhone app called ``Dr. Rounds'' and it debuted in July. The information now stored in it can be formatted into an e-mail and be sent to his office manager for billing. Or it can be sent to other physicians watching over Sader's patients.

``It makes all the difference. At the end of the week, I press a few buttons and I get a report of what I did rather than shuffle through seven to 12 pieces of paper to see `How many times did I see Mr. Smith?'' '' Sader says.

BY NIRVI SHAH

9h: The Luxury Capsule Hotel

If you go to Tokyo, you may want to check into 9h—Nainawasu in Japanese—a luxury capsule hotel that is 9 stories tall, storing 125 capsules that use Panasonic's environmental and lighting control system.
According to Panasonic, their system controls lighting to guarantee "good sleeping." I don't know about you but, to me, "good sleeping" means a large bed, a good duvet, and someone special to spoon with all night. Still, if you want to get close to the experience of hibernation in a deep space vessel, this is the place to go!

Digital Tattoo Interface Turns Your Skin Into A Display

There are implants which are purely aesthetic, and then there's the Digital Tattoo Interface concept. It's a blood-powered electronic interface which is embedded under skin to mimic a tattoo, display videos, or act as a phone or computer.

As great as it seems, this concept is seriously creepy because it powers itself by converting the glucose and oxygen found in blood into electricity. Though somehow getting your blood sucked by a gadget is worth it for the endless potential applications. I'd probably just end up using it to tweet, but what would you do first with your implant?

That's a Bad Cough, Let's Examine Your Genome

In 2003, we mapped the human genome, the 20,000-ish genes we all share. It cost $3 billion. Today, you can literally spit in a cup, place the saliva in the mail and get a peek at your own.

Services like 23andMe (proponents of the above-mentioned "spit parties") and Navigenics both examine specific snippets of your genome for known severe genetic conditions like diabetes, bipolar disorder and certain types of cancers (as well as goofier stuff like freckling and "food preference").

Meanwhile, a boutique genome mapping company named Knome maps not just snippets of DNA but your entire genome, using a blood sample. When it's ready, they sit you down with a doctor to explain their findings.

This thoroughness comes at a cost, of course. Knome's service will run you the price of a Porsche, while their competitors bill up to only a thousand dollars, often less. And while we can technically map the entire genome, we certainly can't understand everything we see.

Ari Kiirikki, a VP at Knome we met at TEDMED, decodes the future of genomics in this brief Q&A:

Where's genomics now?

The first human genome, completed in 2003, took 13 years and nearly $3 billion to decode. Today, we can sequence and interpret an entire human genome in a matter of weeks for less than $70,000 (our current price is $68,000). New software and other analytical tools have put decades of accumulated scientific research at our fingertips, enabling us to analyze an individual's DNA in order to identify risk for thousands of diseases and other inherited traits and conditions.

What will we be doing in 5 years?

Within 5 years, the cost of sequencing an entire human genome is expected to plummet below $1,000, which will dramatically increase the demand for genetic sequence interpretation. The resulting increase in raw data will enable scientists to make new and important discoveries linking our DNA to health and disease, thereby further increasing the clinical utility of DNA analysis. This will enable us to finally deliver on the promise of personalized medicine by allowing scientists to begin the development medicines and individualized "cocktails" of therapeutics tailored to individual genetic profiles.

In 10?

Ten years from now, sequencing a human genome will cost less than $100. Within the decade, scientists are likely to have unraveled precisely how DNA interacts with our environment to impact our risk for developing disease. Expect DNA sequencing to become a regular part of your annual check-up along with the introduction of new therapeutics that can be prescribed to help delay or completely avoid getting specific diseases that you may be predisposed to.

And now we're stretching it, what about 20?

Every medicine you take will be tailored specifically to your genome. Every newborn child will be sequenced at birth, enabling future generations to use their DNA to guide the management of their health over their entire lifetime. Perhaps most amazingly, your DNA will be fully integrated into your everyday life. Genetics will move beyond the clinic, into a broad range of consumer products—snacks, vitamins, mouthwash, skin creams, dating services, etc., all optimized for your unique genetic profile.
-Mark Wilson

I can't speak for everyone here, but I could certainly go for a stick of gum that, instead of being labeled "grape" or "spearmint," simply stated, "You'll enjoy DNA-certified flavor, fatty."

[Image: Human chromosomes "painted" by flourescent dyes to detect abnormal exchange of genetic material frequently present in cancer. Chromosome paints also serve as valuable resources for other clinical and research applications.

Human Genome Program, U.S. Department of Energy, Human Genome Program Report, 1997.]

Women who 'let go' may have better luck with IVF

Women who cope with the stress of infertility treatment by relinquishing control are nearly twice as likely to get pregnant as those who don't adopt this strategy, research from Israel shows.

The findings, say the researchers, suggest that techniques like meditation, which is focused on teaching people to "let go," could help improve women's chances of getting pregnant.

There is increasing evidence that stress and emotional distress can influence in-vitro fertilization (IVF) success, Dr. Nathalie Rapoport-Hubschman of the Rabin Medical Center in Petah Tikva and her colleagues note in the journal Fertility and Sterility. But evidence on the effects of other psychological factors has been inconclusive, they add.

Rapoport-Hubschman and her team theorized that coping mechanisms, rather than traits like anxiety or hostility, might play a role in IVF success. While problem-focused coping is an effective way to deal with situations that are under a person's control, so-called "emotion-focused coping," which can involve humor, denial, relaxation, and letting go, might be a less stressful way to handle infertility treatment, they suggest.

The researchers looked at 88 women undergoing IVF, 21 of whom got pregnant. The only factors that independently influenced IVF success, the researchers found, were a woman's age and whether she had high "letting go" coping levels at the beginning of the study.

IVF treatment is "highly uncontrollable," Rapoport-Hubschman and her colleagues note in their report. "When control is not possible, focusing on and regulating one's associated emotions may be more effective."

Women who don't use this approach may spend more time worrying and thinking about whether or not they will get pregnant, the researchers note; this can affect multiple systems in the body.

"The next logical step would be to test whether meditation, aimed at helping women relinquish control and improve letting go, could have positive effects on reproductive outcomes in women undergoing infertility and IVF treatments," the researchers conclude.

SOURCE: Fertility and Sterility, October 2009.

Intending mothers fight for maternity leave following surrogacy

Following new UK government guidelines on surrogacy published last month aimed at improving the rights of surrogacy patients, Ministers are now facing a new legal challenge calling for further changes in the law.

Specialist fertility law firm, Gamble and Ghevaert, have written to Ministers demanding that the current rules, which prevent women who use surrogates from receiving maternity benefits, be changed. At present, only women who themselves go through a successful pregnancy are entitled to paid maternity leave and employment protection - even in cases where they are not the genetic parent. Thus, surrogate mothers are entitled to all maternity benefits. However, no such rights are available for parents who use a surrogate or adopt, leading campaigners to describe the current position as discriminatory.

Natalie Gamble, partner at Gamble and Ghevaert, explained the situation thus: 'The lack of right to maternity leave is tied up with the fact the surrogate mother is regarded as the mother…In any other circumstances you would get maternity leave. Women aren't going to need a whole year. What would make sense is a system where you have some sort of sharing arrangement [for maternity leave]'. She continued, 'We also need to take account of our modern human rights and anti-discrimination laws which do not allow unfair treatment of minority groups, however small they are'. At present, approximately 40 babies are born through surrogacy in Britain each year, mainly due to medical reasons which prevent some women from giving birth themselves.

Surrogacy in Britain is laden with problems. Surrogates in Britain may not receive payment for the service they render, apart from expenses. Furthermore, surrogacy agreements are not legally binding, meaning the surrogate mother has the right to keep the baby she gives birth to, even if the child is not genetically related to her, and she has been paid all expenses. These restrictions have led to couples going overseas to carry through a surrogacy arrangement. However this can also present difficulties; the worst case scenario is that a much-wanted baby is recognised in neither Britain, nor the country of it's birth.

Sharmy Beaumont, aged 33, is one of the few UK women who has become a parent with the help of a surrogate. Beaumont was born with a rare condition which meant her womb could not cope with carrying a child. After learning of this in her twenties, Beaumont contacted Surrogacy UK and was put in touch with her surrogate, Liz Stringer. After a successful surrogate pregnancy and the birth of her baby daughter, Isabelle, Beaumont was forced to take unpaid leave in order to care for her.

She says, 'My work have been understanding and have allowed me some leave to look after Isabelle…However, the fact that parents through surrogacy are not entitled to any maternity benefits to spend time with their babies is unfair and the Government has not recognised this'.

'I love being a mum,' Beaumont concludes, 'but the system is unfair'.