Sri Lanka's first cochlear implant at a public hospital

By Nilma DOLE

Kalana's parents were heart-broken when they found that their precious son was stricken with meningitis at the age of seven.

Even though Kalana was cured of the condition eventually, he was handicapped.

Losing the ability to hear in both ears, Kalana was destined to lead a soundless life. However, his parents thought that there had to be a way to restore Kalana's ability to hear.

They sought medical advice from the Lady Ridgeway Children's Hospital and were happy to know that there was a possible cure.

Breakthrough

A breakthrough technology existed with a cochlear implant that would be done at the Hospital. Resident medical expert Dr. S. Yasawardena was the doctor who was to perform Sri Lanka's first cochlear implant operation at a government hospital.

On November 20, 2008, the Galle-born Kalana became the first to have a cochlear implant fitted in his ear at the Lady Ridgeway Children's Hospital. Kalana was lucky to get back his hearing but many children still suffer in silence and their parents think that there is no hope.

"More than 50 percent of children who can't hear are born to parents who are closely related.

"Most of the reasons are genetically-linked," said the doctor. Other causes such as rubella during the mother's pregnancy and complications during childbirth where there is a lack of oxygen can also cause the child to lose hearing.

"The cochlear implant is a critical device for patients to hear better than hearing aids," said the doctor.

He said that hearing aids offer hearing to patients to a certain extent but cochlear implants allow patients to hear more than 90 decibels. Dr. Yasawardena said, "Cochlear implant devices have revolutionalised hearing and have been proven to be better than hearing aids, making them a more permenant solution."

Cochlear implant devices work as a speech processor and receiver's stimulator. According to the doctor, there are two components that make up the cochlear implant device.

"One is the outer ear where the rechargeable battery is stored and the inner ear component is fitted inside. Hence, the implant picks up sound waves from outside and converts it to electric impulses which then transmits into the inner ear so that the patient can hear it via electrodes.

"We have high-quality cochlear implants which encompass two brands namely 'Cochlear' from Australia and 'Medel' from Austria," said the doctor. Dr. Yasawardena said that from the time of Kalana's operation, about 40 operations have been conducted successfully at the Hospital. "We have seen immense dedication on the part of the parents who have committed to teaching their children through our therapy sessions.

"They have fully involved themselves in Child Development therapy where learning takes place at a slower pace but the results have been great," said the doctor.

Education

In Sri Lanka, parental concern for their child's education is a priority and this is the reason how this technological breakthrough together with therapy is beneficial. He said, "This is why we tell parents to detect the problem early. While some parents would readily seek medical advice, there are others who accept that their child will be deaf forever due to bad Karma, which is not good."

Universal screening is done which determines and diagnoses the problem of the child's hearing and the extent of the problem. "Other children immediately identify when another child can't hear and they are less likely to associate with them because sound is an important medium ofcommunication at a young age," said the doctor.

According to the doctor, fitting your child with a cochlear implant or a hearing device for that matter is beneficial unlike having a child who can't hear.

He said, "The implant is not very visible and can be easily hidden under the child's hair which would make it seem less obvious," said the doctor. Dr. Yasawardena said that the only issue was the cost factor.

For a cochlear implant operation, the minimum cost would be Rs 1.5m and for a technologically-innovative cochlear device will be Rs 2.8m.

The doctor said, "Even though Kalana's parents didn't have much money to fund the operation, there were well-wishers who gave generous contributions for the operation."

However, the Health Ministry has promised to fund at least 10 operations a year and if they can't do many operations due to the huge demand at least some funds will be given as compensation.

"We have four in-house speech therapists who are qualified from the Kelaniya University's Disabilities Studies Unit specialising in Speech and Language therapy," said the doctor.

The Lady Ridgeway Children's Hospital has had a few hiccups with less theatre time and insufficient funds but they have the most experienced medical professionals who can do a good surgery pertaining to cochlear implantation.

"We appeal to corporates and philanthropists to help fund the cochlear implant surgeries of under-privileged children to give them a better tomorrow because it will be beneficial to society to make them able instead of disabled," said the doctor.

Integrated care and the role of technology

by Dr. Mehdi Khaled

In the age of modern medicine and at a time where translational medicine is getting up close and personal, the increasing burden of chronic and long-term diseases is reaching disturbing levels.

Although the shift in care delivery models from site- to person-specific represents an encouraging path, some key processes and tools used to enable the latter still lack wide adoption, maturity or both.

Moreover, while health policy researchers, practitioners and policymakers are increasingly referring to the need to establish a 360°-participatory care model the term 'integrated care' still remains vague for all too many and the IT tools to enable it widely misused.

Cycles of care vs discrete services

Healthcare is increasingly being co-produced between the patient and the medical team.

The patient and his/her family must be therefore actively involved in the care delivery process. Prevention, screening, and ongoing disease management are integral to the care cycle of every medical condition. Leading care providers make patient engagement and compliance monitoring an integral part of care delivery.

Henceforth, medical condition management must become integral to the provision of care delivery, and cease from being an overlay.As a consequence, the full value can only be created by the cycle of care, not individual interventions.

What is integrated care?

The World Health Organisation (WHO) gives the following definition: Integrated care is a concept bringing together inputs, delivery, management and organisation of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency.

In other [simplified] words, integrated care is "the organisation and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money".

Integration can therefore represent one or more of the following interventions:• A package of preventive and curative health interventions for a particular population group• A multi-purpose service delivery points (horizontal integration)• Vertical integration of different levels of service (referrals)• Continuity of care over time• Integrated policy-making and management• Insurance function and healthcare provision are delivered by the same organisation.

According to the aforementioned definition and the various set-up options, it becomes clear that the integration of care is just a 'means to an end'.

Policymakers may be drawn to integrated care for different reasons. Five main drivers behind the integrated care agenda are:

• Changing demand for care • Recognition that health and social care outcomes are interdependent • Integrated Care as a vehicle towards social integration of society's more vulnerable groups • Integrated Care may lead to better system efficiency • Integrated Care may improve the quality and continuity of care

What it means for the patient

The concept of continuity of care is closely related to integrated care; it emphasizes the patient's perspective through the system of health and social services, providing valuable lessons for the integration of systems. Continuity of care is often subdivided in three components:• The continuity of information (through shared records such as electronic health records),• The continuity across the secondary-primary care interface (discharge planning from specialist to generalist care),• The provider continuity (seeing the same professional each time adding value can build the patient-healthcare relationship). Serious illnesses and complex associations of medical conditions intensifies the need for a 'whole-person' integrated service.

Key considerations

It is important to ensure that the development of integrated care is consistent with other health and social care policies within a country or the value of attempting full integration is not as valuable. Setting realistic objectives for integrated care models is fundamental to the success of the project and this can be facilitated by paying close attention to the possible challenges during the implementation.

It is essential to adequately invest in the training of all professionals to bridge the cultural divide between health and social care.

This will facilitate coordination of care and encourage mutual respect. It is also important to find the appropriate balance between user and provider integration. This can be established by harnessing closer links between policymakers, practitioners and researchers to learn from experience.

It is also valuable to share research and best practice within and across countries. The great advantage is that research can be conducted on the cost-effectiveness to determine the effects of different models of integrated care on resource use as well as health outcomes.

Information Technology can be defined as the fourth dimension of integrated care: it supports standardisation, automation and ensures vertical and horizontal information integration at a minimum. Both the role and scope of information and communication technology need to be thoroughly assessed and revisited during the implementation of integrated care.

Emerging need

The urgent and emerging need for integrated care is already reshaping the way healthcare is delivered. Building consistency across health and social care policies as well as a global knowledge base for evidence-based successful practices may be the most challenging undertakings for integrated care programs to succeed.

IT tools and related governance models have reached a significant level of advancement to become a major success factor if rightly adopted. The Current PCEHR project in Australia will enable healthcare information sharing with the various stakeholders and solidify its consistency.

This is not only the cornerstone for any modern healthcare system, but this consistency will also allow for an enhanced integration of care processes at many levels.

(The writer is the Vice President of Healthcare and Life Sciences, Asia Pacific and Japan, Oracle Corporation. He is also a medical doctor specialising in internal medicine and holds a degree in IT and software engineering)

Scientists show how Internet dependency alters the human brain

by Jeremy Laurance

Internet addiction has for the first time been linked with changes in the brain similar to those seen in people addicted to alcohol, cocaine and cannabis. In a groundbreaking study, researchers used MRI scanners to reveal abnormalities in the brains of adolescents who spent many hours on the internet, to the detriment of their social and personal lives. The finding could throw light on other behavioural problems and lead to the development of new approaches to treatment, researchers said.

An estimated 5 to 10 percent of internet users are thought to be addicted - meaning they are unable to control their use. The majority are game-players who become so absorbed in the activity they go without food or drink for long periods and their education, work and relationships suffer.

Although most of the population was spending longer online, that was not evidence of addiction, she said. "It is different. We are doing it because modern life requires us to link up over the net in regard to jobs, professional and social connections - but not in an obsessive way. When someone comes to you and says they did not sleep last night because they spent 14 hours playing games, and it was the same the previous night, and they tried to stop but they couldn't - you know they have a problem. It does tend to be the gaming that catches people out."

Researchers in China scanned the brains of 17 adolescents diagnosed with "internet addiction disorder" who had been referred to the Shanghai Mental Health Centre, and compared the results with scans from 16 of their peers.

The results showed impairment of white matter fibres in the brain connecting regions involved in emotional processing, attention, decision making and cognitive control. Similar changes to the white matter have been observed in other forms of addiction to substances such as alcohol and cocaine.

"The findings suggest that white matter integrity may serve as a potential new treatment target in internet addiction disorder," they say in the online journal Public Library of Science One. The authors acknowledge that they cannot tell whether the brain changes are the cause or the consequence of the internet addiction. It could be that young people with the brain changes observed are more prone to becoming addicted. - The Independent

An easier way to remove gallstones

For more than 100 years, the traditional treatment for the painful growths called gallstones has been removal of the gallbladder, or cholecystectomy. But a new device, patented in China, promises to make removing the entire organ unnecessary.

A group of scientists from China developed an endoscope specially designed for locating and clearing out gallstones and other gallbladder lesions.

The authors describe the device in a paper accepted to the AIP's Review of Scientific Instruments.

A tiny ultrasonic probe at the tip of the endoscope locates gallstones, even small ones embedded in the organ's lining.

Surgeons can use the horn-shaped "absorbing box" to get rid of fine, difficult-to-remove "sludge-like" gallstones - which the authors say can be compared with "sand sprinkled on a carpet" - by sucking them out like a vacuum cleaner.

A channel for fluids can inject water into the gallbladder to increase the size of the cavity for ease of performing a surgery, and all the interfaces on the device are standardised, so it can connect to camera systems worldwide.

Clinical trials at two hospitals showed "no significant difference" in the surgical safety of the new method compared to another type of endoscope that is often used for cholecystectomies, the authors write.

The authors report, the flexibility and reliability of the device was superior to existing devices, and the image quality was better as well. Approximately ten percent of the population suffers from gallstones, hard, pebble-like deposits that can be as small as a grain of sand or as large as a golf ball.

esciencenews.com

Greater brain activation reported after cognitive rehabilitation for multiple sclerosis

Neuroscientists have documented increased cerebral activation in patients with multiple sclerosis (MS) following memory retraining using the modified Story Memory Technique (mSMT). This is the first study to demonstrate that behavioral interventions can have a positive effect on brain function in people with cognitive disability caused by MS, an important step in validating the clinical utility of cognitive rehabilitation.

According to Nancy Chiaravalloti, PhD, director of Neuropsychology and Neuroscience Research at Kessler Foundation, "This demonstrates that an effective cognitive rehabilitation protocol can lead to changes in the way the brain is actually processing information." Dr. Chiaravalloti is lead author of the article, which was published online by the Journal of Neurology.

Cognitive deficits are common in MS, though few studies have examined the efficacy of memory retraining in this population. Previous research conducted at Kessler Foundation demonstrated that mSMT improves new learning and memory in MS.

The new study utilised functional magnetic resonance imaging (fMRI) to document brain activation patterns before and after memory retraining.

In the double-blind, placebo-controlled, randomised clinical trial, 16 individuals were randomly assigned to treatment (n = 8) or placebo (n = 8) groups. Each underwent 10 memory retraining sessions (twice weekly for 5 weeks). After treatment, greater activation was evident on fMRI in the treatment group during performance of a memory task; no change was seen in the placebo group.

Increased activation was associated with improved memory performance. These benefits may warrant third-party reimbursement for this intervention in selected patients.

- MNT