Sicko. (2007) - A documentary comparing the highly profitable American health care industry to other nations.

Note:-  👇 The below documentary was collected from YouTube.

Synopsis:

Filmmaker Michael Moore examines America's health-care crisis and why millions of citizens are without coverage. Moore spotlights the cases of several ordinary citizens whose lives have been shattered by bureaucratic red tape, refusal of payment, and other health-care catastrophes. He explains how the system has become so problematic, and he visits countries where citizens receive free health care, as in Canada, France and the U.K.......

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Escape Fire: The Fight to Rescue American Healthcare. (2012) - An investigative documentary that uncovers the U.S. healthcare system's true design.

Note:-  👇 The below documentary was collected from YouTube.

Synopsis:

Filmmakers Susan Froemke and Matthew Heineman use personal stories and expert analysis to diagnose serious problems in the U.S. healthcare system.....

👉 Click here to watch the full Documentary..... 👈

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The Waiting Room (2012) - A Documentary on an American public hospital

Note:-  👇 The below documentary was collected from YouTube.

Synopsis:

Go behind the doors of an American public hospital struggling to care for a community of largely uninsured patients.....

👉 Click here to watch the full Documentary..... 👈

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The Bleeding Edge (2018) - A Documentary on Advanced Medical Technology Devices.

Note:- 👇The below documentary and its synopsis were collected from https://yts.am

Synopsis:
A look at the unforeseen consequences of advanced technological medical devices used in the medical field....

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mHealth.

mHealth; also known as mobile health in general terms, refers to the practice of medicine and public health supported by mobile devices such as mobile phones, tablets, personal digital assistants (PDAs) and the wireless infrastructure.

Within digital health, mHealth encompasses all applications of telecommunications and multimedia technologies for the delivery of healthcare and health information.

The increased penetration of smartphones and expanding wireless network coverage provides digital health systems with new possibilities to address challenges associated with accessibility, quality, effectiveness, efficiency and cost of healthcare. 

The most common digital health applications for mHealth which are leading to an increasing acceptance of mHealth in the digital health community are given below:

v  Education and awareness

v  Diagnostic and treatment support

v  Disease and epidemic outbreak tracking

v  Healthcare supply chain management

v  Remote data collection

v  Remote monitoring

v  Healthcare worker telecommunication and training

v  Telehealth / telemedicine

v  Chronic disease management

Tools for mHealth:

mHealth is becoming a popular option in underserved areas where there is a large population and widespread mobile phone usage.

These “mHealth” or “mobile health” technologies are usually delivered on smart phones, but some also are accessed via earlier-generation mobile devices that feature only voice and text messaging. Such devices are most common in the developing world where there is limited but fast-growing Internet connectivity.

mHealth is dynamic and growing, as technology always is rapidly changing. Newer basic phones can accommodate a memory card, carrying video and other media, and smart phones are becoming more and more affordable.

Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes.

Applications of mHealth:

Innovations in mobile technology in low and middle income countries have provided effective ways to improve access to health services and health information, reduce the cost of healthcare delivery, and provide quality data for decision making.

Mobile platforms are the world’s most pervasive technology trend with more than five billion people using them. The most common application of mHealth is the use of mobile phones and communication devices to educate consumers about preventive health care services. However, mHealth is also used for disease surveillance, treatment support, epidemic outbreak tracking and chronic disease management.

Practical examples of mHealth applications include voice information from a provider, and mobile messaging to improve health behaviors including, for example, medication adherence, prenatal care reminders and alerts, and chronic disease self management. At the level of policy and health services decision making, mobile technologies have helped to improve training and service quality of healthcare workers; lower the cost of services by reducing redundancy and duplication; and enhance access to reliable data to facilitate decision making.

Numerous mHealth initiatives across the world have demonstrated the efficacy of using mobile devices to deliver such health solutions in a cost effective manner include:

Ø  Patients make and receive phone calls or text/voice messages related to health education, treatment adherence, contacting health workers or organizing transport to health services.

Ø  Healthcare workers are provided with needed resources to access the most up-to-date clinical guidelines, collaborate with colleagues, analyze data, receive diagnostic support, and interact with clients.

Ø  Positive outcomes are achieved through SMS alerts which have a proven ability to influence behavior in a manner superior to radio and television campaigns.

Ø  Remote data collection is achieved which reduces the health information gap that exists in many developing countries and enables officials to evaluate the effectiveness of public health initiatives, allocate resources appropriately, and optimize policies and programs.

Ø  Medication adherence and chronic care management is supported as evidenced by Smart Alert Systems that notify physicians via a cloud based platform if a patient is not taking medications as prescribed, and requires intervention.

Ø  Access to quality care is optimized helping to address the shortage of skilled healthcare workers, and lessening the burden on those trying to bridge the gap.

Emerging Trends in mHealth Applications:

• Emergency response systems
• Home based remote patient monitoring
• Human resources coordination, management, and supervision
• Mobile synchronous (voice) and asynchronous (SMS) diagnostic and decision support for remote   clinicians
• Point-of-care clinician support which includes an evidence based formulary, as well as database and     decision support information
• Pharmaceutical supply chain integrity
• Patient safety systems
• Remote monitoring and clinical care
• Health extension services
• Health services monitoring and reporting
• Health related mLearning for the general public
• Training and continuing professional development for healthcare workers
• Health promotion and community mobilization
• Support for chronic care management such as diabetes, asthma and cancer
• Peer-to-peer personal health management for telemedicine
• Current Market and Industry Trends for mHealth

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References:

• mHealth — MEASURE Evaluation. 2018. mHealth — MEASURE Evaluation. [ONLINE] Available at: https://www.measureevaluation.org/our-work/mhealth. [Accessed 22 July 2018].
• SearchHealthIT. 2018. What is mHealth? - Definition from WhatIs.com. [ONLINE] Available at: https://searchhealthit.techtarget.com/definition/mHealth. [Accessed 22 July 2018].
• www.ncbi.nlm.nih.gov. 2018. No page title. [ONLINE] Available at:          https://www.ncbi.nlm.nih.gov/pubmed/23867031. [Accessed 22 July 2018].

Telehealth.

The word ‘Telehealth’ defines as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Consulting a Patient.

In another words, telehealth is the remote exchange of the medical data between a patient at home and their clinician(s) to assist in diagnosis and monitoring typically used to support patients with Long Term Conditions, including Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF), Diabetes and Epilepsy.

Also Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services. These include, but are not at all limited to:

·         Dentistry

·         Counseling

·         Physical and occupational therapy

·         Home health

·         Chronic disease monitoring and management

·         Disaster management

·         Consumer and professional education

Therefore telehealth is not a specific service, but a collection of means to enhance care and education delivery via the technologies of telecommunication.

Telehealth Equipment.

There is a wide range of telehealth equipment that can be used to develop a service package that is tailored to an individual’s health needs. Among other things it comprises of fixed or mobile home units to measure and monitor the vital signs parameters (and the answering of targeted questions) for clinical review at a remote location using phone lines or wireless technology.

Some telehealth tools.

Telehealth enables individuals to take more control over their own health, and becomes an intrinsic part of the individuals care pathway, with information about their health condition being monitored regularly to flag up issues before they become ‘care critical’. It works by monitoring vital signs, such as body temperature, pulse rate, respiration rate and along with that blood pressure and transmitting the data, via a telephone line, or broadband, to a telehealth monitoring centre or a health care professional, where it is monitored against parameters set by the individual's clinician. Evidence that vital signs are outside of 'normal' parameters, which may indicate deterioration in health, instigates an appropriate response. 

Telehealth examples also include virtual home health care, where patients such as the chronically ill or the elderly may receive guidance in certain procedures while remaining at home. Telehealth has also made it easier for health care workers in remote field settings to obtain guidance from professionals elsewhere in diagnosis, care and referral of patients. Training can sometimes also be delivered via telehealth schemes or with related technologies such as eHealth, which make use of small computers and internet.

Benefits of Telehealth.

There are real benefits for both the patient and the clinician. The individual patient has more control and understanding of their long term health condition, and the clinicians utilizing telehealth as part of a care pathway can ensure that they are proactively involved in the ongoing well being of their patient, managing timely interventions and helping to improve their patient's quality of life.

Well-designed telehealth schemes can improve health care access and outcomes, particularly for chronic disease treatment and for vulnerable groups. Not only do they reduce demands on crowded facilities, but they also create cost savings and make the health sector more resilient.

A  patient is getting medical advice from his home.

Since remote communication and treatment of patients reduces the number of visits for health services, both transport-related emissions and emissions related to operational requirements are reduced. 

In addition, fewer space demands can potentially result in smaller health facilities, with concurrent reductions in construction materials, energy and water consumption, waste, and overall environmental impact.

Telehealth Modalities / Applications.

Telehealth encompasses four distinct domains of applications.  These are commonly known as:

1.      Live videoconferencing (synchronous):

Live videoconferencing with a pediatrician.

Live, two-way interaction (audiovisual link) between a person (patient, caregiver, or provider) and a provider using audiovisual telecommunications technology.  This type of service is also referred to as “real-time” and may serve as a substitute for an in-person encounter when it is not available. Live video can be used for both consultative and diagnostic and treatment services.

2.      Store-and-forward videoconferencing (asynchronous):

Pre-recorded digital x-ray images.

Transmission of recorded health history (for example, pre-recorded videos and digital images such as x-rays and photos) through a secure electronic communications system to a practitioner, usually a specialist, who uses the information to evaluate the case or render a service outside of a real-time or live interaction. As compared to a real-time visit, this service provides access to the medical data after it has been collected, and involve communication tools such as secure email. 

3.      Remote patient monitoring (RPM):

Remote Patient Monitoring.

Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a healthcare provider for review (sometimes via a data processing service) who may be in a different location and time for use in care and related support. This type of service allows a healthcare provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates. 

4.      Mobile health (mHealth): (👈 Click to read the full article.)

mHealth.

Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and PDAs (Personal Digital Assistance). The delivering information may include general educational information, targeted texts messages that promote healthy behaviors, and notifications about disease outbreaks.

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References:

• What is Telehealth? | Center for Connected Health Policy. 2018. What is Telehealth? | Center for Connected Health Policy. [ONLINE] Available at: http://www.cchpca.org/what-is-telehealth. [Accessed 21 July 2018].
• mHealthIntelligence. 2018. Is There a Difference between Telemedicine and Telehealth?. [ONLINE] Available at: https://mhealthintelligence.com/features/is-there-a-difference-between-telemedicine-and-telehealth. [Accessed 21 July 2018].
• What is Telehealth?. 2018. What is Telehealth?. [ONLINE] Available at: https://www.tsa-voice.org.uk/consumer-services/what-is-telehealth. [Accessed 21 July 2018].
• What is telehealth? How is telehealth different from telemedicine? | HealthIT.gov. 2018. What is telehealth? How is telehealth different from telemedicine? | HealthIT.gov. [ONLINE] Available at: https://www.healthit.gov/faq/what-telehealth-how-telehealth-different-telemedicine. [Accessed 21 July 2018].
• Telemedicine and Telehealth | HealthIT.gov. 2018. Telemedicine and Telehealth | HealthIT.gov. [ONLINE] Available at: https://www.healthit.gov/topic/health-it-initiatives/telemedicine-and-telehealth. [Accessed 21 July 2018].
• World Health Organization. 2018. WHO | Telehealth. [ONLINE] Available at: http://www.who.int/sustainable-development/health-sector/strategies/telehealth/en/. [Accessed 21 July 2018].

Cochlear Implant.

Hearing Mechanism and Problems Related to It:

Before going into the subject I think it would be helpful that, if we quickly refresh our theories of the working mechanism of human ear as short as we can. Then you can easily understand the functions of the Cochlear implants and the Hearing Aids 👈(My previous article. If you like to read those, please click this link).

Diagram of the Human Ear.

Working Mechanism of Human Ear:

There are three anatomical parts in ear which are:

     1. Outer Ear.

         The outer ear consists of the pinna (also called auricle), ear canal and eardrum

     2. Middle Ear.

         The middle ear consists of three ossicles (tiny ear bones) which are 

• Malleus [hammer]  
• Incus [anvil] 
• Stapes [stirrup]) 

         and the ear drum is at last (which is connected to the Stapes).

     3. Inner Ear.

        The inner ear, which contents the cochlea. (‘Cochlea’ means ‘snail’ in Latin; the cochlea gets its          name from its distinctive coiled up shape). Apart from Cochlea the inner ear consists of the the            auditory (hearing) nerves which connects with the brain.

Sound waves from the environment enter the ear canal with the help of the Pinna which is the only visible part of the entire anatomy of the ear and it helps to focus all the sound waves to go into the ear canal and make the ear drum vibrate. This action moves the tiny chain of bones (ossicles – malleus, incus, stapes) in the middle ear. The last bone in this chain ‘knocks’ on the membrane window of the cochlea and makes the fluid in the cochlea move.  When the cochlea's hair cells which are inside of the cochlea, are stimulated by the fluid waves a neurochemical event takes place which excites the nerves of hearing. The physical characteristics of the original acoustic signal are preserved at every energy change along the way until this code becomes one that the central auditory pathways can direct to the temporal lobe of the brain for sound recognition and processing.

What Happens Internally when We Have Hearing Problems?

When the ear is working normally, information is being passed through the different parts of the ear to the brain.

The type of hearing problems we face, are depended on which part of the ear is not responding or functioning well.

1. Conductive Hearing Loss:

Outer ear or middle ear problems lead to inefficient transfer of sound. The cochlea is still working but may not receive enough information through the previous two regions. This type of hearing loss is called conductive hearing loss. The problem is that the sound is not being conducted (transferred) well enough. Conductive deafness can be caused by things such as an ear infection, a hole in the eardrum, otosclerosis (It’s a disease of the bones of the middle and inner ear), etc…

2. Sensorineural Hearing Loss:

An inner ear (cochlear) problem means that sound arrives at the cochlea, but is then not fully passed on to the hearing nerve. Also it is possible that the hearing nerve itself is not passing on information well, or fails to pass on the sound at all. A cochlear or neural hearing loss is called a sensorineural hearing loss. Sensorineural hearing loss can be caused by things such as old age, loud noise, Ménière’s Disease (It’s a disorder of the inner ear that causes episodes in which you feel as if you're spinning (vertigo), and you have fluctuating hearing loss with a progressive, ultimately permanent loss of hearing, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear), etc…

Note:- It is possible to have a mixed hearing loss with both a conductive and sensorineural element.

Type of hearing problems.

Introducing the Cochlear Implant:

While most people with hearing loss are quite successful with hearing aids, there are some individuals with severe to profound hearing loss for which hearing aids do not provide enough benefit. For these people with severe damage to the sensory cells in the inner ear, a cochlear implant is often the best option for better hearing.

A cochlear implant is an electronic device which is also considered as a prosthetic substitute which directly stimulates the cochlea that partially restores hearing. It can be an option for people who have severe hearing loss from inner-ear (cochlea) damage and who receive limited benefit from hearing aids by providing sound signals to the brain.

Cochlear Implant.

These tiny, complex medical devices work differently than hearing aids. Rather than amplifying sound, which helps an individual with residual hearing ability; a cochlear implant provides the sense of sound by stimulating the auditory nerve directly. Cochlear implants do not cure hearing loss or restore hearing, but they do provide an opportunity for the severely hard of hearing or deaf to perceive the sensation of sound by bypassing the damaged inner ear.

Note:-

• Many people have cochlear implants in both ears (bilateral). Listening with two ears can improve the ability to identify the direction of sound and separate the sounds we want to hear from those we don’t.
• It takes time and training to learn to interpret the signals received from a cochlear implant. Within a year of use, most people with cochlear implants make considerable gains in understanding speech.

Parts and Its functions of a Cochlear Implant:

A cochlear implant operates using two main components which are coupled using a powerful magnet: 

1. External part that hooks over the ear:

The external component of a cochlear implant contains a microphone, a speech processor and a transmitter. The microphone and speech processor are housed in a small unit that looks like a behind-the-ear hearing aid. A small wire usually links them to the transmitter, which is positioned over the internal part of the device. The microphone picks up acoustic sounds and sends it to the speech processor. The processor analyzes and digitizes the signal before sending it to the transmitter. The transmitter then codes the signals and sends them to the implanted receiver via the magnetic coupling.

External Part.

2. Surgically implanted internal part:

The internal part of a cochlear implant includes a receiver, which is located under the skin on the temporal bone, and one or more electrode arrays. The receiver collects the signals from the transmitter and converts them to electrical pulses. It then dispatches the pulses to the electrodes that have been inserted deeply into the inner ear. These electrodes directly stimulate the auditory nerve throughout a portion of the cochlea and the brain then interprets these signals as sound.

Internal Part.

Note:-  All cochlear implant systems have the same broad characteristics and design principles and are all well engineered. Variations arise in styling, accessories and battery type. Particular differences exist in electrode design, MRI compatibility and speech processing strategies which encode the external sound frequency details into digital signals.

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References:

• Cochlear Implants | Hearing Loss Treatments | Cochlear™ AU/NZ. 2018. Cochlear Implants | Hearing Loss Treatments | Cochlear™ AU/NZ. [ONLINE] Available at: https://www.cochlear.com/au/home/understand/hearing-and-hl/hl-treatments/cochlear-implant. [Accessed 13 July 2018].
• Cochlear implants. 2018. - Mayo Clinic. [ONLINE] Available at: https://www.mayoclinic.org/tests-procedures/cochlear-implants/about/pac-20385021. [Accessed 13 July 2018].
• Healthy Hearing. 2018. Cochlear implants: Who, how and why?. [ONLINE] Available at: https://www.healthyhearing.com/help/hearing-aids/cochlear-implants. [Accessed 13 July 2018].
• Hearing Link. 2018. Cochlear implants - Hearing Link. [ONLINE] Available at: https://www.hearinglink.org/your-hearing/implants/cochlear-implants/. [Accessed 13 July 2018].
• Hearing Link. 2018. Understanding how the ear works - Hearing Link. [ONLINE] Available at: https://www.hearinglink.org/your-hearing/how-the-ear-works/. [Accessed 13 July 2018].
• How We Hear | The Process of Hearing & How the Ear Works. 2018. How We Hear | The Process of Hearing & How the Ear Works. [ONLINE] Available at: http://www.betterhearing.org/hearingpedia/how-we-hear. [Accessed 13 July 2018].
• NIDCD. 2018. Cochlear Implants | NIDCD. [ONLINE] Available at: https://www.nidcd.nih.gov/health/cochlear-implants. [Accessed 13 July 2018].