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Using technology to help preserve independence

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With the creation of the Luscii remote monitoring platform, people with ongoing care needs can avoid the necessity for regular medical appointments, while clinicians can ensure they’re being looked after from afar. NR Times speaks to its founder Professor Daan Dohmen about Luscii’s role in the future of healthcare

 

From his early experience of working part-time in a nursing home came a realisation that patients could and should play a more active role in their care and health. 

“For me, that was a really important step in my vision to use technology to help regain people’s independence,” says Professor Dr Daan Dohmen. 

“The nursing home had all good intentions but took away the independence of people living there – they put them in the shower, they did everything. 

“There was one day that I took an 82-year-old lady from the nursing home to a grocery store one block away. We weren’t supposed to do that as there was a store in the nursing home, but I said ‘Let’s go together’ and took her there in a wheelchair. 

“She said to me ‘Daan, this was the nicest thing to happen to me in ten years’ – and that made me think even more about how we can use technology to provide freedom to people who may not have that.”

And from that realisation has grown Luscii, a platform which enables home monitoring for patients, allowing clinicians to keep check from afar without the need for them to come in to hospital.

Founded in the Netherlands, it is now used in seven countries across Europe and Africa, including in the NHS, Luscii – named in tribute to Florence Nightingale, derived from the Latin ‘luscinia’ – is enabling a new digital approach to healthcare. 

Powered by its Clinical Engine, the use of AI supports and alerts healthcare providers when intervention may be needed, and contact can be made immediately via message or video connection. 

Clinicians can monitor patients remotely via a dashboard, using Luscii’s concept of virtual wards to correlate data and alerts for multiple patients, and then responding with intervention whenever required. 

“For managers of Trusts and CCGs, they understand this can help increase capacity and help with waiting lists, but it is even more important from the patients’ perspective in unlocking the power for them to use the tools independently,” says Daan. 

“And for doctors and nurses, who we call our ‘medical developers’, they can build their own digital pathway with e-learning modules and algorithms for their patients.”

With the launch of Luscii in a pre-COVID-19 era, in 2018, the events of the past year have seen the platform take on an even more fundamental role in healthcare.

“COVID really pushed the concept of digital,” says Daan. 

“We’d seen a lot of doctors and nurses who were quite anxious about digital health, thinking is it clinically relevant, will it lead to ‘cold care’? Often if a patient said they wanted to try digital apps, the doctor would say ‘That’s nice, but I don’t think it’s for you’. 

“The past year has forced clinicians to try digital means, and suddenly they are finding out that this can be beneficial in certain situations. 

“Through our virtual wards, we were able to support the early discharge and triage of COVID patients – sometimes it was 11 days earlier when patients could go home.”

And its response to COVID, which saw it develop the Corona Check app – which enabled hundreds of thousands of people to submit health data daily from their homes, allowing healthcare providers to determine who may have COVID-19 and who needed most immediate care – has been acknowledged with the Prix Galien Excellence COVID-19 MedTech Award. 

“We got out the digital Lego box and built a COVID app – we now have 20million registrations on that platform,” he says. 

Born out of his previous business FocusCura, a healthtech which uses smart tools to promote the autonomy of vulnerable people, Luscii continues to grow, particularly in light of the new-found digital adoption within healthcare. 

Now in seven countries – five of which came in during COVID – with its native Netherlands and the UK being some of the earlier adopters. Currently, it is used in more than half of all Dutch hospitals and was pioneered in the NHS by the All Together Better alliance in Sunderland, supporting elderly patients with chronic illnesses at home. 

And it was among elderly people, inspired by his experience of the nursing home, that Luscii’s potential was initially realised. 

“A lot of elderly people with chronic diseases had to go to hospital all the time, they often had to arrange for a family member to take them there, then they would get to hospital only for ten minutes later to be back outside as they were fine and able to leave. The rest of the week they’d be too tired to do anything,” says Daan. 

“We came up with the idea of how to support people with chronic illnesses to have remote check-ups. This was at a time when iPads had just launched and video calls were happening. But what started as a project got bigger and bigger so we had to split off independently.”

And from its origins in supporting elderly people, the roll-out is now including a much wider area of healthcare, as its role in COVID has helped to demonstrate. 

“Once we have virtual wards, people can understand how they could be used in other areas,” says Daan, 

“It’s a personal dream of mine that doctors create these programmes and share between them. Through collaboration, it becomes bigger than a product – it is a movement.”

Going forward, with the potential for digital healthcare continuing to be realised, the ongoing international roll-out is set to continue for Luscii. 

“We are now in seven countries worldwide, four of which we haven’t been to physically, the roll-out has all been done virtually,” says Daan. 

“We have shown we can scale quickly so we can support more patients in more areas.” 

News

Osteoarthritis: breaking the cycle

Medical technology company Ottobock shares its expertise on approaches to the condition.

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Sponsored feature

Why is Cartilage Important?

Bones that come in contact with other bones are covered by cartilage at their contact points. Cartilage does not have blood vessels – it is supplied with nutrients through movement of the joint. That’s why regular exercise is so important!

Cartilage ensures that the joint surfaces move against each other in the most efficient way and with little friction. It absorbs shock, cushioning the joint, and distributes the forces acting on the joint.

If cartilage is damaged and its gliding properties are affected, it can no longer serve its purpose and the joints range of movement can become limited.

Typical Progression of Osteoarthritis

When osteoarthritis of the knee develops due to joint malalignment, an accident, advancing age, obesity or excessive strain, the damaged cartilage is no longer able to properly fulfil its function.

This results in pain and re­duced mobility. The affected patient instinctively assumes a relieving posture to reduce strain on the knee.

However, this often leads to new prob­lems in other places, such as the hip, and reduces the supply of nutrients to the cartilage, for which movement is required – sparking a vicious circle.

The cartilage develops cracks and begins to break down. At the same time, the bone thickens at the site of the damage.

When the cartilage layer is completely worn away, the affected bones come into direct contact and rub against each other causing joint pain and inflammation.

The thickest joint cartilage is located behind the kneecap (patella). This is an area of high stress. Osteoarthritis occurring in this area is known as patellafemoral osteoarthritis

Signs and Symptoms

There are several common symptoms that signal knee osteoarthritis. They can occur individually or together. However, with the initial onset, you may not notice any of these symptoms

When symptoms appear they usually occur in the following order:

  • Cracking in the joint
  • Pain during load bearing activities, such as carrying a heavy object
  • Pain during every day activities, such as climbing the stairs
  • Reduced mobility
  • Swelling and inflammation

Non-Invasive Treatments

Joint specific exercises: with regular exercise mobility can be maintained and muscle strengthened, ensuring the cartilage is supplied with the nutrients it needs.

Temperature: with acute inflammation, cold relieves pain and reduces swelling. Heat relaxes the muscles and tendons and increases the flow of nutrients. Heat may only be applied when the joint is not inflamed.

Creams: various over the counter products are available at your local pharmacy including gels and creams that can help relieve pain.

Orthopaedic devices (braces and supports): these are applied externally to the knee, reducing pain and improving mobility.

Lifestyle: living a healthy lifestyle can help to combat osteoarthritis. A healthy diet and an active lifestyle reduces the chance of obesity, putting less stress and strain through the knee joints.

Orthotic Options

An orthotic fitting is a key component in the treatment of osteoarthritis. It can provide the following:

  • Pain relief
  • Support daily activities
  • Support during activities that affect the joint, whether at work or during sports

Did you know?

An osteoarthritis patient takes an average of around 1,200 tablets a year to manage pain. But this can lead to damage to the stomach, bowel and liver.

An orthosis from the Agilium line is therefore a good alternative. It’s worth-while for anyone with knee osteoarthritis to test the effectiveness of the orthoses themselves.

The Agilium Line

The braces in our Agilium line are designed specifically to target the symptoms of osteoarthritis of the knee.

Each works in a different way to address the various characteristics of osteoarthritis of the knee. At the same time, we placed great emphasis on their comfort and suitability for daily use.

The Agilium Freestep, the Agilium Reactive and the Agilium Softfit are used to treat unicompartmental osteoarthritis of the knee.

The Agilium Patella is used for patients with patellofemoral arthritis.

The Agilium Freestep is used to treat OA, although it is not applied directly to the knee. Instead is worn on the foot, right inside the shoe! For targeted relieve, it alters the load-line of the knee – the point where the body weight impacts the cartilage.

The Agilium Softfit is a pull on knee brace with a textile base and single upright that stabilises and relieves the knee using a three point force system to offload the affected compartment (side) of the knee.

The Agilium Reactive also uses a three point force system to offload the affected compartment (side) of the knee. However, the innovative closure system in the upper calf provides comfort while sitting without compromising the stable position when standing.

The Agilium Patella combines a textile structure and stabilising component with a dynamic re-alignment mechanism enabling it to maintain the central alignment of the knee cap, reducing pressure behind the knee cap.

Find the appropriate brace with Agilium Select.

Visit our website or go to ottobock.com/agilium-select

If you would like to know more about any of these products please get in touch via orthoticsuk@ottobock.com or visit our website for more information: www.ottobock.co.uk

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Dementia

Seven devices that are revolutionising dementia care

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dementia technology
From remote monitoring to GPS tracking, technology can help put family worries at ease when caring for someone with dementia

Technology in the care system has come a long way, with the COVID-19 pandemic highlighting the need for more remote assistive technology.

Although there is no cure for degenerative diseases like dementia, utilising technology can ease the burden on both carers and patients, particularly those living on their own.

A 2020 study from the University of Oxford found that 100 per cent of carers involved said they or their patients benefited from assistive technology.

With this in mind, NR Times takes a closer look at seven devices which are enabling greater independence and life quality for people with dementia.

SmartSole GPS tracker

One concern for families when their relatives with dementia live on their own is the fear that they will leave the house and get lost.

Research suggests this is quite a common problem, with an estimated 40,000 dementia patients going missing for the first time each year.

This is where the SmartSole GPS tracker can come in.

The product uses cellular technology to send its location every five minutes so relatives and carers can locate those living with dementia.

What makes the SmartSole unique is its discreteness. It fits into almost every shoe, so if someone does go missing, those with access to the monitoring system will be alerted straight away.

The Simple Music Player

Music can have a profound effect on people with neurological conditions. Being able to use the technology that provides this, however, can be difficult for those with dementia.

The Simple Music Player is a recommended product from the Alzheimer’s society and it makes listening to music straightforward.

Styled like a traditional radio – which is instantly recognisable for the elderly – the device is easy to use. Simply lift the lid and music will begin to play.

DayClox

Also keeping things simple is the DayClox which makes timekeeping easy and understandable for dementia patients.

Available in both traditional and digital forms, the clock simply shows what day it is and whether it is morning, afternoon, evening or night.

Working out specific times can be a challenge for those with dementia, so the DayClox can assist when it comes to things like keeping track of when someone needs to take their medication.

CaringBridge App

Although not specifically designed for dementia patients, CaringBridge is a free platform that allows everyone involved in caring for an individual to keep up-to-date with their progress.

It gives carers the chance to set up a personal webpage for a patient, which they can post photo and video updates about how they are progressing.

Other people can visit the page, where they can like (called Well Wishes) and comment on the updates, as well as reading their personal story and journal updates.

The Extra Simple Dementia Mobile Phone – Doro 580

The Extra Simple Dementia Mobile Phone, by tech giants Doro, takes away any complication around giving a loved one a phone call.

If the last year has taught us anything, it’s the importance of keeping in touch with loved ones; and some studies suggest that loneliness can speed up the onset of dementia.

With its easy-to-use set up and large buttons, the Dementia Mobile Phone makes calls seamless. Simply link a phone number to each button and press to begin.

Canary Care

Looking for an all-in-one monitoring system? The Canary Care portal is a discrete, wifi-free system that tracks a person’s behaviour without the use of cameras or microphones.

Not only can it follow a person’s movements, bathroom visits and sleeping patterns, it also allows caregivers to track their home’s temperature, sending alerts if anything looks unusual.

Care can be shared around the family through the portal and reminders can be set to check that the proper medication is being taken.

Howz

Howz is similar to Canary Care as it allows those in charge of care to keep track of a person’s activity, notifying them if anything unexpected occurs.

Funded by NHSX, the system is unique as it can connect to a Smart Meter to monitor the electricity output in a person’s home.

This means it can detect any sustained electrical activity, which can help dementia patients in the event they forget to turn off their appliances.

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Tech

Groundbreaking clinic uses AI in dementia fight

New AI approach being pioneered to help earlier diagnosis of dementia.

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A revolutionary AI-led approach to detecting pre-dementia symptoms is to form part of a new NHS clinic dedicated to driving improvements in early-stage dementia diagnosis.

Cognetivity’s technology is to be deployed within a new remote Brain Health Clinic at South London and Maudsley (SLaM) NHS Foundation Trust. Among the first of its kind in the world, the clinic will provide in-depth subtyping of patients with mild cognitive impairment (MCI), followed by periodic, remote assessment of those who are expected to progress to Alzheimer’s dementia.

The Integrated Cognitive Assessment (ICA) devised by Cognetivity will play a key role in the clinic’s aim of enhancing early diagnosis of patients with Alzheimer’s disease and provide timely access to treatment. 

Cognetivity’s iPad-based test also supports the clinic’s focus on remote medical assessment, the importance of which has been reinforced by the ongoing COVID-19 pandemic.

Proven through clinical trials and numerous peer-reviewed publications, the ICA developed by Cognetivity has been hailed as a game-changer in dementia diagnosis, used in both primary and secondary care to find pre-dementia symptoms through a simple test in a quicker time and at a lower cost than ever before. 

Broadly, its technology works by showing a patient a series of pictures, to which they have to respond as quickly and accurately as possible whether they have seen a pre-specified image category. 

AI algorithms then cluster test performance in terms of accuracy, speed and image properties, giving rapid and highly accurate results. 

The information can then prove crucial in determining next steps for patients, securing better outcomes, saving significant sums of money in care and examination costs, and offering “queue-busting functionality” in cutting waiting times and removing the need for potentially unnecessary appointments. 

Additionally, the ICA’s language independence and freedom from cultural bias is particularly significant in serving the highly diverse population of around 2 million patients to which SLaM provides services.

“This clinic is a really exciting prospect for dementia diagnosis and care,” says senior NHS geriatric psychiatrist Professor Dag Aarsland, who has overseen the clinic’s creation. 

“It’s fantastic to have the ICA involved, as a highly innovative tool, fit for a highly innovative project, that brings enormous potential to improve patient outcomes.”

Dr Sina Habibi, Cognetivity CEO, adds: “We’re thrilled to see the ICA deployed as part of this ground-breaking new clinic at one of the UK’s premier mental health trusts. 

“Early-stage diagnosis, facilitated by remote cognitive assessment and monitoring – this is the bright future of dementia medicine, without a doubt, and we’re delighted to be a part of it.”

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