DiversityNursing Blog

By LAUREN SILVERMAN

In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each medication to make sure it's the right one in the right dose.

It's part of the hospital's efforts to cut down on medication errors and dangerous drug interactions, which contribute to more than 7,000 deaths across the country each year.

At Children's in Dallas, there are 10 full-time emergency pharmacists, more than anywhere else in the country, and they are on call 24 hours a day. The pharmacists provide a vital safety net, according to Dr. Rustin Morse, chief quality officer and a pediatric ER physician.

"Every single order I put in," Morse says, "is reviewed in real time by a pharmacist in the emergency department prior to dispensing and administering the medication."

That may sound obvious, but Morse says doctors like him, are used to jotting down a type and quantity of drugs and moving on. If there's a problem, a pharmacist will hopefully catch it and get in touch later. But later won't work in the emergency room.

The extra review is particularly important at Children's because medication errors are three times more likely to occur with children than with adults. That's because kids are not "just little adults," says Dr. Brenda Darling, the clinical pharmacy manager for Children's Medical Center.

"They have completely different metabolic rates that you have to look at," Darling says, "so you have to know your patients."

On any given week, pharmacists at Children's review nearly 20,000 prescriptions and medication orders, looking at things like the child's weight, allergies, medications and health insurance.

There are also automatic reviews by an electronic medical record system designed to essentially "spell check" orders to prevent errors. You need both, says Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, because the electronic medical record doesn't catch all errors.

Svenson co-authored a study in the Annals of Emergency Medicine that found that even with an electronic medical record, 25 percent of children's prescriptions had errors, as did 10 percent of adults'. Now his hospital also has a pharmacist in the emergency department 24 hours a day.

So why doesn't every hospital do this? The main reason, Svenson says, is money.

"If you're in a small ER, it's hard enough just to have adequate staffing for your patients in terms of nursing and techs, let alone to have a pharmacist sitting down. If the volume isn't there, it's hard to justify."

Hiring pharmacists is expensive, but Morse points to research showing prescription review can reduce the number of hospital readmissions, thereby saving money and lives.

"People do make mistakes," Morse says, and you need to make sure "a patient doesn't get a drug that could potentially stop them breathing because it's the wrong dose."

Source: npr.org

BY LINDA CARROLL

Want a healthy baby? You may want to roll her around in dirt.

For decades, parents have shielded infants from bacteria and other possible triggers for illness, allergies and asthma.

Interestingly, contact with bacteria and dander after age 1 was not protective — it actually increased the risk.

“It was the opposite of what we expected,” said Dr. Robert Wood, chief of the division of allergy and immunology at the Johns Hopkins Children’s Center and co-author of the study in the Journal of Allergy and Clinical Immunology. “We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

 The new findings may help explain some contradictions in research on the so-called hygiene hypothesis, which suggested that kids growing up in a super clean environment were more likely to develop allergies.

“This doesn't completely resolve the controversy, but it does add a big piece of the puzzle,” said Dr. Jonathan Spergel, a professor of pediatrics and chief of allergy at the Children’s Hospital of Philadelphia.

“We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

The theory “is that as we clean up our environment, our immune system moves away from being geared toward fighting bacteria and parasites,” said Dr. Maria Garcia Lloret, an assistant clinical professor of pediatric allergy and immunology at the Mattel Children’s Hospital at the University of California, Los Angeles. “It then has nothing to do and starts to react against things that are normally not harmful, like dust mites, or cat dander or cockroaches or peanuts.”

A chink in the hygiene hypothesis seemed to be the high rates of allergy and asthma in inner-city environments. But the new study may help explain the contradictions by showing that early exposure is crucial.

“It’s all about being exposed to the right bacteria at the right time,” Spergel said.

Wood and his colleagues followed 467 newborns for three years, screening them for allergies annually and testing the dust in the houses where they lived for allergens and bacteria. To the researchers’ surprise, kids who were exposed before their first birthday to mouse and cat dander along with cockroach droppings had lower rates of allergies and wheezing by age 3, compared to those who were not exposed so early on.

 In fact, wheezing was three times as common among children who had less exposure to those allergens early in life.

The protective effect of early exposure to allergens was amplified if the home also contained a wide variety of bacteria.

The reason may be that “a lot of immune system development that may lead someone down the path to allergies and asthma may be set down early in life,” Wood said.

Researchers aren’t ready to try to translate the new findings into practical advice for parents. But, Lloret said, we now know that “strict avoidance of allergens from the beginning does not protect you, and early exposure in the right context may make the difference between disease and tolerance. You could say that this is the downside of cleanliness.”

The new findings may upend advice experts have been giving to parents on the topic of pets and newborns.

“Twenty years ago we used to tell parents to get the cats and dogs out of the house,” Wood said. “This shows that the younger the child is when you get a pet, the better.”

Source: nbcnews.com

By AGATA BLASZCZAK-BOXE

Do men and women feel pain differently? A new study finds an unexpected gender divide.

Researchers found that men tend to report feeling more pain after major surgeries than women, whereas women tend to report experiencing more pain after minor surgical procedures than men.

In the study, researchers found that men were 27 percent more likely to report higher pain ratings after a major surgery such as a knee replacement, while women were 34 percent more likely to report experiencing more pain after procedures that the researchers labeled as minor, such as biopsies. (The researchers differentiated between "major" and "minor" procedures depending on the intensity of pain that people typically expect to feel after a particular procedure.)

To conduct the study, the researchers interviewed 10,200 patients from the University Hospitals of the Ruhr University of Bochum, Germany, following an operation, over more than four years. About 42 percent of the patients were male and 58 percent were female.

Initially, the study authors didn't find significant differences between the genders in people's overall experience of postoperative pain. However, that changed when the researchers distinguished between different kinds of surgeries.

The researchers are not sure where these differences stem from; however, they speculate that a lot may depend on the kind of surgery a person is undergoing. For instance, procedures such as cancer-related biopsies or an abortion may take a particularly serious emotional toll on women, and therefore exacerbate their individual perceptions of pain.

"It could be anxiety," study author Dr. Andreas Sandner-Kiesling of Medical University of Graz, Austria, told CBS News.

"This is a very interesting study," Dr. M. Fahad Khan, an assistant professor in the Department of Anesthesiology at NYU Langone Medical Center, told CBS News. "Ten thousand patients in any type of study is a huge number, and it is really great to see studies on that number of patients because it can limit a lot of the bias that some studies have."

Khan noted he found it interesting that in women, even smaller procedures "can be fraught with the development of pain problems after the procedure," which many people may not expect when they go to the hospital for a simple biopsy, he said.

Sandner-Kiesling said he did not think the findings should change the way men and women are treated for pain. "Clinically, there is no relevance," he said.

According to certain popular cultural stereotypes, women are often considered to be tougher about dealing with pain than men, but is this really the case?

"Anecdotally, people will say that women have a higher threshold for pain and they are more tolerant to pain, just because of their life experience. And perhaps, emotionally, maybe they are stronger than men," Khan said. "However, medically, in my experience, we haven't really noticed much of a difference with regard to men and women in the development of problems with dealing with severe and chronic pain."

The new study is presented at this year's Euroanaesthesia meeting in Stockholm.

Source:cbsnews.com

BY JAMIE DAVIS

First up in this week’s news is a look at an article on humor and the mental health of senior citizens I found over at healthday.com. A new study from researchers at Loma Linda University in California looked at the effects of the stress hormone cortisol on aging patients’ memory and mental acuity. They studied the possibility that laughter might lower the effects of cortisol on the seniors.

Healing Power of Funny Videos

Two groups of senior citizens were shown a funny 20 minute video and then were tested on their memory and mental acuity as well as cortisol levels. This was then compared to tests on a group who did not see the video. The subjects who saw the funny video were found to score better on the memory tests and had lower cortisol levels suggesting that regular exposure to funny and humorous things can improve memory and mental state of seniors.

The study was presented recently at the Experimental Biology conference in San Diego. One of the authors summed up the research saying, “it’s simple, the less stress you have, the better your memory.” This doesn’t mean that we need to be comedians in the midst of our care for patients but it does point to the core nursing tenet that when we treat the whole patient we manage their overall health better.

Make sure your hospitals have access to humorous videos and movies in their in-house TV system. Maybe even share a suggested funny YouTube video of the day with your patients who wish to view it. When appropriate, you could even open up your patient interactions with a simple joke. Maybe “why did the chicken cross the road” will be a precursor to better patient interactions in the future.

Source: nursingshow.com

By Melissa McGlensey

Melvyn Amrine, of Little Rock, Ark., may not remember the details of his life since his Alzheimer's diagnosis, but he recently proved that his love for his wife transcends memory.

Melvyn was diagnosed with Alzheimer's disease three years ago and since then it hasn't been easy for his wife, Doris, CBS News reported. Melvyn at times doesn't remember details like whether he proposed to his wife, or vice versa. However a recent holiday prompted Melvyn to remember the most important thing.

On the day before Mother's Day, Melvyn went missing. Considering he normally requires assistance to do any walking, his family was alarmed and notified the police.

When police found Melvyn, he was 2 miles from his house and he was resolute in his goal, according to Fox 16. He was going to the store to buy flowers for his wife for Mother's Day, just like he had done every year since they had their first child.

Sgt. Brian Grigsby and Officer Troy Dillard were touched by Melvyn's determination, and decided to help the elderly man complete his mission by taking him to a store and even paying for the flowers.

"We had to get those flowers," Grigsby told CBS News. "We had to get them. I didn't have a choice."

Melvyn's flowers made a very sweet surprise for his wife of 60 years, Doris, as well as a reminder to the rest of us that love knows no obstacles.

"When I saw him waking up with those flowers in hand, it just about broke my heart because I thought 'Oh he went there to get me flowers because he loves me,'" Doris told Fox 16.

She added to CBS News: "It's special, because even though the mind doesn't remember everything, the heart remembers."

Source: Huffingtonpost.com

By Ilene MacDonald

Despite new technology and evidence-based guidelines, medical mistakes happen too frequently and may lead to as many as 400,000 preventable deaths each year.

But two new programs, launched at the University of Virginia Medical Center, offer a new approach to patient safety that may prevent medical errors, WVTF Public Radio reports.

This year the organization introduced a simulation lab in the pediatric intensive care unit. The "Room of Errors" features high-tech infant mannequins attached to monitors. When doctors and nurses enter the lab, they have seven minutes to determine what is wrong.

As part of a recent exercise, a doctor-nurse team worked together to spot 54 problems with the scenario, including the fact the ventilator wasn't plugged into the correct outlet, the heat wasn't turned on and the potassium chloride was programmed at the wrong concentration.

The interpersonal, team-based learning approach helps doctors and nurses improve their ability to make decisions together and communicate with one another, Valentina Brashers, M.D., co-director of the Center for Interprofessional Research and Education, an effort headquartered at UVa's Schools of Nursing and Medicine, told WVTF.

"Knowing that there are others that you can work to think with you and share with you their concerns as you work through difficult problems makes care provision a much more enjoyable and rewarding activity. It reduces staff turnover. It creates an environment where we feel like we're all in it together with the patient," she said.

The pilot proved so successful that the medical center intends to roll it out to the entire hospital.

In its quest to eliminate medical mistakes at the organization, UVa also launched a second patient safety initiative that calls for hospital administrators to meet each morning to talk about any problems that occurred in the previous 24 hours, according to a second WVFT article.

The "Situation Room" features white boards and monitors, where administrators review every new infection and unexpected death and then visit the places where the problems took place.

Sometimes the solutions are easy fixes, such as a receptionist who removed a mat that caused patients to trip at the entrance of an outpatient building. Others, caused by communication problems, are more complicated, Richard  Shannon, M.D., executive vice president for health affairs, told the publication. To address it, Shannon wants to shake up the medical hierarchy where the physician sits at the top.

"The physician may spend 20 minutes at the bedside a day. The nurse is there 24/7 and has about 13 times more direct contact with the patient than does the physician," he told WVFT. "You can't have someone at the head of the pyramid who is absent a lot of the time."

Finally, to encourage better communication among caregivers, patients and families, Shannon now encourages healthcare professionals to make rounds in the afternoon, when visitors are on premises.

Source: fiercehealthcare.com

By: Alice Park

People who speak more than one language tend to score higher on memory and other cognitive function tests as they get older, but researchers haven’t been able to credit bilingualism as the definitive reason for their sharper intellects. It wasn’t clear, for example, whether people who spoke multiple languages have higher childhood intelligence, or whether they share some other characteristics, such as higher education overall, that could explain their higher scores.

Now, scientists think they can say with more certainty that speaking a second language may indeed help to improve memory and other intellectual skills later in life. Working with a unique population of 853 people born in 1936 who were tested and followed until 2008-2010, when they were in their 70s, researchers found that those who picked up a second language, whether during childhood or as adults, were more likely to score higher on general intelligence, reading and verbal abilities than those who spoke one language their entire lives. Because the participants, all of whom were born and lived near Edinburgh, Scotland, took aptitude tests when they were 11, the investigators could see that the effect held true even after they accounted for the volunteers’ starting levels of intelligence.

Reporting in the Annals of Neurology, they say that those who began with higher intellect scores did show more benefit from being bilingual, but the improvements were significant for all of the participants. That’s because, the authors suspect, learning a second language activates neurons in the frontal or executive functions of the brain that are generally responsible for skills such as reasoning, planning and organizing information.

Even more encouraging, not all of the bilingual people were necessarily fluent in their second language. All they needed was enough vocabulary and grammar skills in order to communicate on a basic level. So it’s never too late to learn another language – and you’ll be sharper for it later in life.

Source: Time.com

Maya Angelou was born Marguerite Annie Johnson in St. Louis, Missouri. Her parents divorced when she was only three and she was sent with her brother Bailey to live with their grandmother in the small town of Stamps, Arkansas. In Stamps, the young girl experienced the racial discrimination that was the legally enforced way of life in the American South, but she also absorbed the deep religious faith and old-fashioned courtesy of traditional African American life. She credits her grandmother and her extended family with instilling in her the values that informed her later life and career. She enjoyed a close relationship with her brother. Unable to pronounce her name because of a stutter, Bailey called her "My" for "My sister." A few years later, when he read a book about the Maya Indians, he began to call her "Maya," and the name stuck.

At age seven, while visiting her mother in Chicago, she was sexually molested by her mother's boyfriend. Too ashamed to tell any of the adults in her life, she confided in her brother. When she later heard the news that an uncle had killed her attacker, she felt that her words had killed the man. She fell silent and did not speak for five years.

Maya began to speak again at 13, when she and her brother rejoined their mother in San Francisco. Maya attended Mission High School and won a scholarship to study dance and drama at San Francisco's Labor School, where she was exposed to the progressive ideals that animated her later political activism. She dropped out of school in her teens to become San Francisco's first African American female cable car conductor. She later returned to high school, but became pregnant in her senior year and graduated a few weeks before giving birth to her son, Guy. She left home at 16 and took on the difficult life of a single mother, supporting herself and her son by working as a waitress and cook, but she had not given up on her talents for music, dance, performance and poetry.

In 1952, she married a Greek sailor named Anastasios Angelopulos. When she began her career as a nightclub singer, she took the professional name Maya Angelou, combining her childhood nickname with a form of her husband's name. Although the marriage did not last, her performing career flourished. She toured Europe with a production of the opera Porgy and Bess in 1954 and 1955. She studied modern dance with Martha Graham, danced with Alvin Ailey on television variety shows, and recorded her first record album, Calypso Lady in 1957.

She had composed song lyrics and poems for many years, and by the end of the 1950s was increasingly interested in developing her skills as a writer. She moved to New York, where she joined the Harlem Writers Guild and took her place among the growing number of young black writers and artists associated with the Civil Rights Movement. She acted in the historic Off-Broadway production of Jean Genet's The Blacks and wrote and performed a Cabaret for Freedom with the actor and comedian Godfrey Cambridge.

In New York, she fell in love with the South African civil rights activist Vusumzi Make and in 1960, the couple moved, with Angelou's son, to Cairo, Egypt. In Cairo, Angelou served as editor of the English language weekly The Arab Observer. Angelou and Guy later moved to Ghana, where she joined a thriving group of African American expatriates. She served as an instructor and assistant administrator at the University of Ghana's School of Music and Drama, worked as feature editor forThe African Review and wrote for The Ghanaian Times and the Ghanaian Broadcasting Company.

During her years abroad, she read and studied voraciously, mastering French, Spanish, Italian, Arabic and the West African language Fanti. She met with the American dissident leader Malcolm X in his visits to Ghana, and corresponded with him as his thinking evolved from the racially polarized thinking of his youth to the more inclusive vision of his maturity.

Maya Angelou returned to America in 1964, with the intention of helping Malcolm X build his new Organization of African American Unity. Shortly after her arrival in the United States, Malcolm X was assassinated, and his plans for a new organization died with him. Angelou involved herself in television production and remained active in the Civil Rights Movement, working more closely with Dr. Martin Luther King, Jr., who requested that Angelou serve as Northern Coordinator for the Southern Christian Leadership Conference. His assassination, falling on her birthday in 1968, left her devastated. With the guidance of her friend, the novelist James Baldwin, she found solace in writing, and began work on the book that would become I Know Why the Caged Bird Sings. The book tells the story of her life from her childhood in Arkansas to the birth of her child. I Know Why the Caged Bird Sings was published in 1970 to widespread critical acclaim and enormous popular success.

Seemingly overnight, Angelou became a national figure. In the following years, books of her verse and the subsequent volumes of her autobiographical narrative won her a huge international audience. She was increasingly in demand as a teacher and lecturer and continued to explore dramatic forms as well. She wrote the screenplay and composed the score for the film Georgia, Georgia (1972). Her screenplay, the first by an African American woman ever to be filmed, was nominated for a Pulitzer Prize.

Angelou was invited by successive Presidents of the United States to serve in various capacities. President Ford appointed her to the American Revolution Bicentennial Commission and President Carter invited her to serve on the Presidential Commission for the International Year of the Woman. President Clinton requested that she compose a poem to read at his inauguration in 1993. Angelou's reading of her poem "On the Pulse of the Morning" was broadcast live around the world.

Since 1981, Angelou has served as Reynolds Professor of American Studies at Wake Forest University in Winston-Salem, North Carolina. She has continued to appear on television and in films including Poetic Justice (1993) and the landmark television adaptation of Roots (1977). She directed numerous dramatic and documentary programs on television and directed a feature film,Down in the Delta, in 1996.

The list of her published works includes more than 30 titles. These include numerous volumes of verse, beginning with Just Give Me a Cool Drink of Water 'Fore I Die (1971). Books of her stories and essays include Wouldn't Take Nothing For My Journey Now (1993) and Even the Stars Look Lonesome(1997). She continued the compelling narrative of her life in the books Gather Together in My Name (1974), Singin' and Swingin' and Gettin' Merry Like Christmas (1976), The Heart of a Woman (1981), All God's Children Need Traveling Shoes(1987) and A Song Flung Up to Heaven (2002).

In 2000, Dr. Angelou was honored with the Presidential Medal of the Arts; she received the Ford's Theatre Lincoln Medal in 2008. The same year, she narrated the award-winning documentary film The Black Candle and published a book of guidance for young women, Letter to My Daughter. In 2011, President Barack Obama awarded her the nation's highest civilian honor, the Presidential Medal of Freedom.

Maya Angelou participated in a series of live broadcasts for Achievement Television in 1991, 1994 and 1997, taking questions submitted by students from across the United States. The interview with Maya Angelou on this web site has been condensed from these broadcasts.

Source: achievement.org

By JAN HOFFMAN

How well can computers interact with humans? Certainly computers play a mean game of chess, which requires strategy and logic, and “Jeopardy!,” in which they must process language to understand the clues read by Alex Trebek (and buzz in with the correct question).

But in recent years, scientists have striven for an even more complex goal: programming computers to read human facial expressions.

The practical applications could be profound. Computers could supplement or even replace lie detectors. They could be installed at border crossings and airport security checks. They could serve as diagnostic aids for doctors.

Researchers at the University of California, San Diego, have written software that not only detected whether a person’s face revealed genuine or faked pain, but did so far more accurately than human observers.

While other scientists have already refined a computer’s ability to identify nuances of smiles and grimaces, this may be the first time a computer has triumphed over humans at reading their own species.

“A particular success like this has been elusive,” said Matthew A. Turk, a professor of computer science at the University of California, Santa Barbara. “It’s one of several recent examples of how the field is now producing useful technologies rather than research that only stays in the lab. We’re affecting the real world.”

People generally excel at using nonverbal cues, including facial expressions, to deceive others (hence the poker face). They are good at mimicking pain, instinctively knowing how to contort their features to convey physical discomfort.

And other people, studies show, typically do poorly at detecting those deceptions.

In a new study, in Current Biology, by researchers at San Diego, the University of Toronto and the State University of New York at Buffalo, humans and a computer were shown videos of people in real pain or pretending. The computer differentiated suffering from faking with greater accuracy by tracking subtle muscle movement patterns in the subjects’ faces.

“We have a fair amount of evidence to show that humans are paying attention to the wrong cues,” said Marian S. Bartlett, a research professor at the Institute for Neural Computation at San Diego and the lead author of the study.

For the study, researchers used a standard protocol to produce pain, with individuals plunging an arm in ice water for a minute (the pain is immediate and genuine but neither harmful nor protracted). Researchers also asked the subjects to dip an arm in warm water for a moment and to fake an expression of pain.

Observers watched one-minute silent videos of those faces, trying to identify who was in pain and who was pretending. Only about half the answers were correct, a rate comparable to guessing.

Then researchers provided an hour of training to a new group of observers. They were shown videos, asked to guess who was really in pain, and told immediately whom they had identified correctly. Then the observers were shown more videos and again asked to judge. But the training made little difference: The rate of accuracy scarcely improved, to 55 percent.

Then a computer took on the challenge. Using a program that the San Diego researchers have named CERT, for computer expression recognition toolbox, it measured the presence, absence and frequency of 20 facial muscle movements in each of the 1,800 frames of one-minute videos. The computer assessed the same 50 videos that had been shown to the original, untrained human observers.

The computer learned to identify cues that were so small and swift that they eluded the human eye. Although the same muscles were often engaged by fakers and those in real pain, the computer could detect speed, smoothness and duration of the muscle contractions that pointed toward or away from deception. When the person was experiencing real pain, for instance, the length of time the mouth was open varied; when the person faked pain, the time the mouth opened was regular and consistent. Other combinations of muscle movements were the furrowing between eyebrows, the tightening of the orbital muscles around the eyes, and the deepening of the furrows on either side of the nose.

The computer’s accuracy: about 85 percent.

Jeffrey Cohn, a University of Pittsburgh professor of psychology who also conducts research on computers and facial expressions, said the CERT study addressed “an important problem, medically and socially,” referring to the difficulty of assessing patients who claim to be in pain. But he noted that the study’s observers were university students, not pain specialists.

Dr. Bartlett said she didn’t mean to imply that doctors or nurses do not perceive pain accurately. But “we shouldn’t assume human perception is better than it is,” she said. “There are signals in nonverbal behavior that our perceptual system may not detect or we don’t attend to them.”

Dr. Turk said that among the study’s limitations were that all the faces had the same frontal view and lighting. “No one is wearing sunglasses or hasn’t shaved for five days,” he said.

Dr. Bartlett and Dr. Cohn are working on applying facial expression technology to health care. Dr. Bartlett is working with a San Diego hospital to refine a program that will detect pain intensity in children.

“Kids don’t realize they can ask for pain medication, and the younger ones can’t communicate,” she said. A child could sit in front of a computer camera, she said, referring to a current project, and “the computer could sample the child’s facial expression and get estimates of pain. The prognosis is better for the patient if the pain is managed well and early.”

Dr. Cohn noted that his colleagues have been working with the University of Pittsburgh Medical Center’s psychiatry department, focusing on severe depression. One project is for a computer to identify changing patterns in vocal sounds and facial expressionsthroughout a patient’s therapy as an objective aid to the therapist.

“We have found that depression in the facial muscles serves the function of keeping others away, of signaling, ‘Leave me alone,’ ” Dr. Cohn said. The tight-lipped smiles of the severely depressed, he said, were tinged with contempt or disgust, keeping others at bay.

“As they become less depressed, their faces show more sadness,” he said. Those expressions reveal that the patient is implicitly asking for solace and help, he added. That is one way the computer can signal to the therapist that the patient is getting better.

Source: Nytimes.com

DURHAM, N.C. — Before scrubbing in on a recent Tuesday morning, Dr. Selene Parekh, an orthopedic surgeon here at Duke Medical Center, slipped on a pair of sleek, black glasses — Google Glass, the wearable computer with a built-in camera and monitor.

He gave the Internet-connected glasses a voice command to start recording and turned to the middle-aged motorcycle crash victim on the operating table. He chiseled through bone, repaired a broken metatarsal and drilled a metal plate into the patient’s foot.

Dr. Parekh has been using Glass since last year, when Google began selling test versions of its device to thousands of handpicked “explorers” for $1,500. He now uses it to record and archive all of his surgeries at Duke, and soon he will use it to stream live feeds of his operations to hospitals in India as a way to train and educate orthopedic surgeons there.

“In India, foot and ankle surgery is about 40 years behind where we are in the U.S.,” he said. “So to be able to use Glass to broadcast this and have orthopedic surgeons around the world watch and learn from expert surgeons in the U.S. would be tremendous.”

At Duke and other hospitals, a growing number of surgeons are using Google Glass to stream their operations online, float medical images in their field of view, and hold video consultations with colleagues as they operate.

Software developers, too, have created programs that transform the Glass projector into a medical dashboard that displays patient vital signs, urgent lab results and surgical checklists.

“I’m sure we’re going to use this in medicine,” said Dr. Oliver J. Muensterer, a pediatric surgeon who recently published the first peer-reviewed study on the use of Glass in clinical medicine. “Not the current version, but a version in the future that is specially made for health care with all the privacy, hardware and software issues worked out.”

For his study, published in The International Journal of Surgery, Dr. Muensterer wore the device daily for four weeks at Maria Fareri Children’s Hospital at Westchester Medical Center in New York. He found that filming rapidly drains the battery and that the camera — which is mounted straight ahead — does not point directly at what he is looking at when he is hunched over a patient with his eyes tilted downward.

He also had to keep the device disconnected from the Internet most of the time to prevent patient data and images from being automatically uploaded to the cloud. “Once it’s on the cloud, you don’t know who has access to it,” Dr. Muensterer said.

Google has yet to announce a release date for Glass, and the company declined to comment on how many of its testers were doctors or affiliated with hospitals. But “demand is high,” said Nate Gross, a co-founder of Rock Health, a medical technology incubator. “I probably get asked every few days by another doctor who wants to somehow incorporate Glass into their practice.”

And already, outside hospitals, privacy concerns have led some bars and restaurants to ban the devices. Legislators have proposed restrictions on the use of Google Glass while driving, citing concerns about distraction. Doctors, too, are raising similar concerns.

The Glass projector is slightly above the user’s right eye, allowing doctors to see medical information without turning away from patients. But the display can also be used to see email and surf the web, potentially allowing doctors to take multitasking to dangerous new levels, said Dr. Peter J. Papadakos at the University of Rochester Medical Center, who has published articles on electronic distractions in medicine.

“Being able to see your laparoscopic images when you’re operating face to face instead of looking across the room at a projection screen is just mind-bogglingly fantastic,” he said. “But the downside is you don’t want that same surgeon interacting with social media while he’s operating.”

Indeed, similar technology has not always had the smoothest results. Studies have found, for example, that navigational displays can help surgeons find tumors, but they can also induce a form of tunnel vision, or perceptual blindness, that makes them more likely to miss unrelated lesions or problems in surrounding tissue. And in aviation, pilots who wear head-mounted displays that show crucial flight information can lose sight of what is happening outside their windshields, said Dr. Caroline G. L. Cao, who studies image-guided surgery at Wright State University.

“Pilots can get so focused on aligning the icons that help them land the plane,” she said, “that they miss another plane that is crossing the runway.”

One doctor who does not allow the device in his practice, Dr. Matthew S. Katz, the medical director of radiation oncology at Lowell General Hospital in Massachusetts, said that security and distractions were primary concerns. A doctor wearing Glass could accidentally stream confidential medical information online, he said, and patients might not feel comfortable with their doctors wearing cameras on their faces.

Until Glass has been better studied in health care and equipped with safeguards, Dr. Katz said, doctors should be forced to check their wearable computers at the clinic door.

“From an ethical standpoint, the bar is higher for use in a medical setting,” said Dr. Katz, who is also an outside adviser for the Mayo Clinic Center for Social Media. “As a doctor, I have to make sure that what I’m doing is safe and secure for my patients — ‘First, do no harm.’ Until I am, I don’t want it in my practice.”

Bakul Patel, the senior policy adviser at the Food and Drug Administration’s Center for Devices, said the agency would regulate only those Glass software programs that function as medical devices, the same approach it takes on health applications on hand-held devices.

“The glasses have been on our radar and we’re excited about it,” Mr. Patel said.

Hospitals that are experimenting with Glass say they are doing so very carefully — obtaining patient consent before procedures, using encrypted networks, and complying with the federal regulation that protects patient privacy, known as Hipaa.

Medical software developers say they, too, have security and privacy in mind. Pristine, a company based in Austin, Tex., createdan app that lets emergency room nurses and doctors beam in specialists for consultations. The company plans to sell a customized version of Glass directly to hospitals. It erases Google’s software and configures the glasses with its own Hipaa-compliant programs.

Another company, Augmedix, which has done pilot tests of Glass at medical centers in the San Francisco area, said patients were informed that their doctors would be wearing the device. In a study of 200 cases, only two or three patients asked that their doctors remove it, said Ian K. Shakil, a co-founder of Augmedix.

Some hospitals see Glass as a relatively low-cost and versatile innovation, much like smartphones and tablets, which more than half of all health care providers use to get access to patient data and other medical information.

But hand-held devices are not very useful in the sterile world of surgery. Because Glass is voice-activated and hands-free, it may be particularly well suited for the surgical suite, where camera-guided instruments, robotics and 3D navigation systems have been commonplace for years.

Dr. Pierre Theodore, a cardiothoracic surgeon at the University of California, San Francisco, calls wearable computers “a game changer.”

“In surgery, Google Glass is incredibly illuminating,” said Dr. Theodore, who uses Glass to float X-rays and CT scans in his field of view at the operating table. “It helps you pinpoint what you’re looking for, so you don’t have to shift your attention away from the operation to look at a monitor somewhere else.”

At Indiana University Health, Dr. Paul P. Szotek, a Level 1 trauma surgeon, is developing an app for Glass for use by paramedics.

The app streams a live feed from the glasses to the closest emergency rooms, so that doctors can see accident victims at the scene and give paramedics potentially lifesaving instructions — like when to go directly to a Level 1 trauma center.

“Last year, I lost a lady on the table from a spleen injury that was absolutely survivable because she was taken to a local hospital and then the delay was over two hours to get her to me,” Dr. Szotek said. “With this wearable technology, we’ll be able to assess patients on the scene and decrease the mortality associated with trauma significantly.”

Dr. Szotek met with Google in March to discuss his software, called 1st Sight. He and other Glass-wearing surgeons recently founded a group — the International Society for Wearable Technology in Healthcare — that is holding its first meeting in Indianapolis in July.

At Duke, Dr. Parekh performs back-to-back surgeries on most days, wearing the Glass headset as he moves from one patient to the next.

About six years ago, he founded a charity with the goal of advancing foot and ankle surgery in India. He travels there every year with a team of expert surgeons to hold clinics and training sessions for local orthopedic surgeons.

In January, at a conference in Jaipur, Dr. Parekh performed surgery and used Glass to stream the procedure on his personal website. That day, the site drew in so many visitors from India and elsewhere that it crashed.

“I’ve been even more excited about Google Glass since then,” he said.

Source: nytimes.com