Second Life offers opportunities for doctors and patients to interact in a novel way. Second Life expands upon the ability of providers and patients to talk to each other on line in formats such as chat and message boards.
Some of the advantages of Second Life are the virtual reality feel, the ability to meet from any location, the ability to use multimedia, and the ability to express emotion. Instant messaging or chat is two dimensional. Both parties know that they are simply sending text back and forth. It may not have the feel of being in the presence of someone else, and for some people, this may change their behaviour presentation. A doctor may choose an environment to soothe a patient - maybe the doctor and patient can meet on a quiet sunny beach, or in a grassy field, where natural noises such as the ocean or the wind can help lower stress in a patient. Despite being able to meet in such natural settings, both parties can access the meeting from where they are, with no need for the expense and inconvenience of physical travel. This is especially important in today's busy world, where many people work long or odd hours and may have difficulty finding time to go to a doctor's office. Second Life allows for use of multiple kinds of media, such as audio, allowing real time talking over the internet, video displays of either the doctor and patient or educational videos, and interactive simulations, which can be educational or may actually provide training exercises for the patient. A patient with a leg injury, for example, may be able to view a video, live action or simulated, of appropriate physical therapy exercises the doctor recommends for recovery. A virtual coach can be programmed to help keep the client on track. A patient can also do a walk through of proposed procedures, which can reduce stress on the actual procedure day. Second Life also allows for participants to express emotions via their avatars in pre-programmed ways. I think this is a unique advantage for people who may be uncomfortable expressing emotions or who suffer from autism-spectrum disorders. Someone like that who normally may be stoic in response to direction, questions or input from their provider may be able to be more expressive, showing excitement, fear, or distaste, allowing the provider to have a better understanding of how the patient feels about the diagnostic or treatment process.
There are some disadvantages to Second Life. First, the very heavily visual environment uses a lot of computer power and memory. My experience was that it could run slowly or be "bumpy". I ran into several instances where multimedia was extremely slow to load or unavailable, making the experience very frustrating. Secondly, Second Life has most advantages when used as a synchronous medium. For those of us that work graveyards, having to wake up in the middle of the day to meet with the doctor is a definite negative when it would be much better to carry on an asynchronous conversation via email. Third, a lot of the environment appears to take a great effort to program, potentially limiting how personalized it can be. I think that an IM chat, with links to video files on youtube or powerpoint files on a provider's website combined with emailed pdfs can provide much of the multimedia available in Second Life, and can be made more personalised. With the availability of Skype, video chat is possible, so doctors and patients can meet actually face to face. Fourth, Second Life has no particular privacy guards, creating worries about HIPAA compliance.
Monday, October 24, 2011
Tuesday, October 11, 2011
Hallucination simulation
I just had a walk through of the virtual hallucinations exhibit in Second Life. I have no previous exposure to schizophrenia via relatives or clinical cases (dogs don't tell me what they're seeing and hearing, although we do have dogs that act in inexplicably aggressive ways, so who knows?). I had been aware that people with schizophrenia can have hallucinations. What surprised me was the content of the hallucinations - there was a lot of emphasis on death and self-hatred. What I found most interesting was that there wasn't anything particularly strange about the content of the messages (you are worthless, you don't deserve resources, you should kill yourself to stop contaminating the world). Anyone who has been suicidal will tell you that these messages are very very typical; the only difference between a suicidal person's perception and what I gathered from the simulation is that a suicidal person hears these messages in their head and understands that it is their own brain or inner voice saying those things, whereas for a person with schizophrenia it appears to be coming from an external source. So who is less sane? A suicidal who argues with themselves, or a schizophrenic who argues with an imaginary outsider?
Monday, October 10, 2011
Prostate cancer screening NOT recommended
Link to CNN.com article
The U.S. Preventive Services Task Force has reviewed available data about prostate screening and has issued a recommendation that screening using the PSA (prostate-specific antigen test) with or without a rectal exam not be performed.
It sounds counterintuitive at first, but if you look at the evidence, it makes sense. The reason that screening is not recommended is twofold: 1. screening does not lead to a reduction in prostate cancer-related deaths and 2. treatments or tests that are done because of the positive screening tests have negative effects.
The test has a fairly high false positive rate - up to 80% using a certain cut off for serum levels. If a positive test leads to a biopsy, even the biopsy can be read out as cancer, but the cancer may be so slow growing that it would never cause problems for the patient.
Populations that had been screened for PSA were followed for up to 12 years, and the reduction in deaths from prostate cancer were miniscule and statistically insignificant - as low as a 0.03% reduction.
So we have a test with high false positives and no benefit in survival.
On top of that, there are negative aspects to getting a positive test. The patient may have stress and worry over the possibility of cancer, and stress is known to inhibit the immune system and contribute to other diseases. Some men may get biopsies, which can cause a range of side effects from pain to infection to dysfunction. And some men may get their prostates removed, which can lead to complete erectile dysfunction and urinary incontinence. Hormone treatment may involve castration or use of injectable hormones to suppress androgens - basically causing emasculation and possibly contributing to feminization of the patient! All of these are very significant side effects, causing considerable distress to the patient. If the patient would have the same outcome regardless of early screening, and if they potentially have a "cancer" that will never act like a cancer, it does make sense to just not look for it. The patients will have less stress, less side effects, and spend less time under potentially harmful treatment when it is not necessary.
An exception to the "no screening" recommendation is for men that have signs of prostate cancer, and it is unknown if these recommendations hold for men receiving post surgery or treatment screening for recurrence.
More research is obviously needed to find a better test to screen for malignant behaving prostate cancer. RNA microarray analysis of men with malignant prostate cancer is a good place to look. This research is already ongoing, with just this month articles such as this have been published identifying markers associated with outcome.
Link to draft by Preventive Services Task Force
The U.S. Preventive Services Task Force has reviewed available data about prostate screening and has issued a recommendation that screening using the PSA (prostate-specific antigen test) with or without a rectal exam not be performed.
It sounds counterintuitive at first, but if you look at the evidence, it makes sense. The reason that screening is not recommended is twofold: 1. screening does not lead to a reduction in prostate cancer-related deaths and 2. treatments or tests that are done because of the positive screening tests have negative effects.
The test has a fairly high false positive rate - up to 80% using a certain cut off for serum levels. If a positive test leads to a biopsy, even the biopsy can be read out as cancer, but the cancer may be so slow growing that it would never cause problems for the patient.
Populations that had been screened for PSA were followed for up to 12 years, and the reduction in deaths from prostate cancer were miniscule and statistically insignificant - as low as a 0.03% reduction.
So we have a test with high false positives and no benefit in survival.
On top of that, there are negative aspects to getting a positive test. The patient may have stress and worry over the possibility of cancer, and stress is known to inhibit the immune system and contribute to other diseases. Some men may get biopsies, which can cause a range of side effects from pain to infection to dysfunction. And some men may get their prostates removed, which can lead to complete erectile dysfunction and urinary incontinence. Hormone treatment may involve castration or use of injectable hormones to suppress androgens - basically causing emasculation and possibly contributing to feminization of the patient! All of these are very significant side effects, causing considerable distress to the patient. If the patient would have the same outcome regardless of early screening, and if they potentially have a "cancer" that will never act like a cancer, it does make sense to just not look for it. The patients will have less stress, less side effects, and spend less time under potentially harmful treatment when it is not necessary.
An exception to the "no screening" recommendation is for men that have signs of prostate cancer, and it is unknown if these recommendations hold for men receiving post surgery or treatment screening for recurrence.
More research is obviously needed to find a better test to screen for malignant behaving prostate cancer. RNA microarray analysis of men with malignant prostate cancer is a good place to look. This research is already ongoing, with just this month articles such as this have been published identifying markers associated with outcome.
Link to draft by Preventive Services Task Force
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