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IHE Symposium 2023: Tackling Global Challenges

2 November 2023

Professor Anna David during her talk, standing behind a podium

Engineering is about finding solutions to problems and that鈥檚 what we鈥檙e trying to do at the Institute of Healthcare Engineering. During this year鈥檚 Symposium, we had three guest speakers talk about how they鈥檙e tackling some of the issues we鈥檙e currently seeing in healthcare 鈥 things like data security, stillbirths, and our mental health.

听Here鈥檚 a summary of what they talked about:

Dr Irina Brass, Associate Professor in Regulation, Innovation and Public Policy:听
'Security and Algorithmic Integrity Challenges in Connected and Intelligent Medical Devices'

Imagine presenting to the A&E at 2am and your brain implant has malfunctioned and you鈥檙e presenting with symptoms doctors can鈥檛 diagnose. Most healthcare professionals are not equipped to deal with something of this nature 鈥 medical devices malfunctioning. So, how do you make sure this doesn鈥檛 happen? What if we add AI and other software onto the brain implant, adding another layer of complexity healthcare professionals must deal with. This is what Dr. Irina Brass talks to us today.

Let鈥檚 start at the beginning. Dr. Brass starts off by telling us about the 'Internet of Things' - a good way to听sum up the 鈥榗onnected infrastructure of medical devices, their software applications and health systems and services鈥[1] which includes things like your FitBit, pacemakers and other wearables and implantables.

Everything is connected. But with that connection comes new challenges to security. Currently medical devices are strictly regulated to ensure the safety of the user with the onus being placed on the manufacturer who must conduct clinical trials to avoid safety risks but what happens after it鈥檚 delivered from the manufacturer?

Some of the post-delivery issues mentioned by Dr. Brass include the lack of software updates, default passwords not being changed so lack of security and the lack of training on the use of the medical devices. We鈥檇 have never have thought it but imagine your

Screenshot of BBC article where Johnson and Johnson say insulin pump can be hacked

Previously, the way regulator has ensured safety is by asking for some post marketing surveillance. But this doesn鈥檛 help with the issue of security. Dr. Brass does offer some solution: Monitoring 蝉丑辞耻濒诲苍鈥檛 happen momentarily but rather should be general practice, and clinicians need training and support in supporting their patients.

More on this:

Professor Anna David, Director of 香港六合彩鈥檚 Institute of Women鈥檚 Health, Professor and Consultant in Obstetrics and Maternal Fetal Medicine: 'Developing Engineering Solutions to Tackle Stillbirth and Premature Birth'

What happens when the听fetal membranes rupture听early, before the 37 weeks needed for full gestation?听

Quick answer: It causes a lot of problems, including pre-term birth, Fetal Growth Restrictions听(FGR)听and听stillbirth. It鈥檚 not a small problem either; globally 13.4 million babies are born early which is the leading cause of neonatal death and surprisingly, this number isn鈥檛 going down with figures the same as they were 30 years ago!

Map showing the preterm birth from 2020

Fetal Growth Restriction is 鈥榤ost often defined as听an estimated fetal weight less than the 10th percentile for gestational age by prenatal ultrasound evaluation.鈥[2] It affects 10% of pregnancies and is the leading cause in stillbirth.听听Apart from the loss of a young life, the monetary costs are huge with听拢2.4 billion spent in the UK per year听looking after pre-term and small babies, amounting听to a cost per neonatal cot of 拢2,000 a day.

Your start in life naturally affects you later in life and without proper growth of organs, babies face complications such as lower IQ, dementia, heart attacks, poor vision, cerebral palsy, breathing problems, strokes, and bowel damage.

The human placenta is so important in making sure fetal growth isn鈥檛 restricted. But it鈥檚 an organ that鈥檚 not researched much. The placenta acts as the lungs, brain, stomach and stem cells of a fetus. It鈥檚 a massive exchange system between the mother and child and so if there are issues with the placenta, it can lead to detrimental consequences for the baby.

Prof. Anna David鈥檚 team knows how important the placenta is so they鈥檙e imaging the organ to see if the images can听give more information about fetal wellbeing in FGR and to find out why the fetus is small.听Could it be a genetic problem or an issue with placental function?听They already know that less oxygen saturation in the placenta听occurs in听FGR.

In their studies, they found that placentas听in women with FGR听had a听different signal听during MRI.听They鈥檙e doing this by combining two different types of MRI: one being Diffusion MRI and the other being T2 Relaxometry 鈥 both these combined give a measure of oxygen saturation.

The team are at the stage of taking their research into non-human primates to validate their findings before using the MRI technique to improve the care of pregnant women with FGR to prevent stillbirth.

And lastly, a bit of advice from Prof. Anna David: sleep on your side听in late pregnancy听rather than lying on your back during pregnancy as sleeping on your back听reduces听fetal oxygen saturation and has a stronger effect in FGR pregnancy.

Credits also go out听to Dr Andrew Melbourne, Dr Roz Aughwane and 香港六合彩H MRI and Research Midwifery teams

Dr. Bettina Moltrecht:听'Managing emotions using an app'

Are we angry? Sad? Happy? Stressed? Sometimes it鈥檚 hard to tell. Emotional regulation involves the evaluation and monitoring of emotions.

This might seem like a trivial thing for some but for those with mental health disorders, 90% go through emotional dysregulation. For those who aren鈥檛 diagnosed with mental health disorders, emotion听dysregulation can be a predictor of later mental health difficulties.

A common intervention for emotion听regulation used to be Cognitive Behavioural Therapy which is a type of talking therapy that teaches you the coping skills for dealing with your emotions and how they are linked to your thoughts and behaviours. Back in 2019, there were no emotion regulation apps which is where Dr. Bettina Moltrecht came in [3]听.听After scoping the project, going through focus groups, co-design workshops and testing, Dr. Bettina Moltrecht launched hernew app, EDA.

The app was targeted at children, with children helping to design and create the app. The app would help users to identify what feelings they had and tell them听the strategies to manage their emotions but also how to practise the strategies they had learnt.

Whendeveloping the app, users mentioned how they wanted the app to be offline, that they wanted their data to be safe and they wanted to be able to control the app. This user insight was 鈥渋nvaluable鈥 for developing the app according to Dr. Bettina Moltrecht. In the feedback, she realised that design was just as important as content anda听 mental health app 蝉丑辞耻濒诲苍鈥檛 have to be childish looking even if it was designed for children .

As Dr. 听Bettina Moltrecht mentions 鈥 it鈥檚 easy for researchers to think about what they are getting out of it but not always fully realising the needs and benefits for the end user which is why co-production is always beneficial.

Unfortunately, the app is no longer available as there was no funding for the regular updates that were are needed for apps. But the lesson of working closely with users is something Dr. Bettina Moltrecht stressed during her talk. As researchers, the goal might be what we want to get out of it, but we sometimes forget who the research is for.

Further reading:
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[1] Ronte, H. et al. (2018) Medtech and the internet of medical things: How connected medical devices are transforming health care. Deloitte. Available at Care/gx-lshc-medtech-iomt-brochure.pdf.