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Home V Hospital
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Home V Hospital

In the past year in the UK, there has been increasing interest in 'home hospitalisation'. People look after a spouse, or relative at home in preference to having them treated in a hospital.

Whilst this can be extremely exhausting for the carer, it does have the immediate advantages of saving the journey, trundling up to the local hospital and back, sometimes for days, or weeks at a time.

With a good degree of Telehealth advice available from the local general practitioners, and readily given advice, and drug delivery from pharmacies, all drugs can be phoned for and administered at home, allowing the sick to be kept there, in familiar surroundings. Thr alternative, of course, is to take them to the austerity and superbug breeding grounds of a hospital, where an all-too-valuable bed would be used.

Should a home hospitalised patient's symptoms become unmanageable, most UK hospitals now have an external respiratory team, who can take over care management with home visits. This is still cheaper for the UK National Health Service than actual hospitalisation, and maintains the serenity and comfort of home care.

Improving this picture

Whilst the above is certainly a step in the right direction, decentralising healthcare services, and allowing for medical care in the home, it neither goes far enough, nor is sufficiently relaxed and low-key for the human carer. It could be, if technology takes over the bulk of the work.

Diagnosis

At present, whilst drug treatment and bedrest can be taken care of in the home environment, all diagnosis must be done at the hospital. Any treatments that do not involve medication or verbal therapeutics - intensive physiotherapy, or surgery.

Surgery at home in the near future is…unlikely. However, physiotherapy, and muscle workouts are very likely, as their use benefits so many other areas of daily life - exercise for couch potatoes.

The main danger of hospital diagnosis, is the prevalence of superbugs. At the time of writing, a UK hospital - Broomfield - has just recently been quarantined due to such a bug. No-one is going in or out that does not have to, until the hospital is sterilised.

The Superbug

A superbug is defined as a strain of bacteria that is resistant to all antibiotics.
In the UK, each year, at least 100,000 people who go into hospital gets an infection there.

There are countless different strains of a single type of bacteria, and each has subtle natural genetic mutations that make it different from the other. Even in a single strain, genes are mutating with each generation, and new strains may emerge in weeks.

Sometimes the bacteria's genetic makeup will give them an edge when they encounter a particular antibiotic. Thicker cell walls, or the ability to process the chemicals the drug is made of, perhaps lack of receptors for it to bind.

When antibiotics are applied, most bacteria die out, all the strains except the ones with the resistant makeup. These may require longer exposure to the antibiotic to kill, as an accumulative effect. This is the reason doctors always advise finishing the entire course even when the patient feels better. After all they may feel better because 97% of the bacteria are dead, but the remaining 3%, the resistant strains, will breed and multiply unless they are killed off as well.

Once a resistance is developed, over time the bacteria carrying it will multiply, whilst others are continually killed off, until the bulk of strains will be resistant. Meanwhile, continual mutation will result in bacteria that are resistant to a second antibiotic, and a third. This is the birth of a superbug.

In a hospital, so many different strains are being thrown together with so many doses of antibiotics that the entire natural selection process that drives this adaptation is tremendously accelerated.

Eventually strains emerge which are resistant or immune to everything, and they have to infect, people whose immune systems are already under strain, as they are ill.

Diagnosing away from the Hospital

In the past few years, great strides have been made in diagnosis equipment, which can be stored in a surgery, or in the home, as stand-alone, or a modification to existing equipment - modification without removing the existing function.

Diagnosing Head Trauma

You have been hit on the head, but are you concussed? There have always been two ways to check: A second blow to the head; could be fatal if you are concussed, and whilst an obvious diagnosis, is hardly acceptable.

The second way, takes hours of testing by professionals. In an emergency, when it is a matter of life or death, you may not have the luxury of waiting several hours.

Ambulances always assume concussion if there is any chance of head injury - they have to, to be safe. But, there is a way for the ambulance, or even the home environment to tell if a head blow has led to a concussion or not.

DETECT (Display Enhanced TEsting for Concussion and mild Traumatic brain injury) is basically a modified VR total immersion HMD - covers the ear and eyes. In theory, any such device, by any manufacturer would work, it just needs the software, so it could be used for other purposes most of the time.

The person who has suffered the blow wears the headset, and is given a joystick for input. The system puts the wearer through an array of neuropsychological tests designed to pick up reduced reaction times and deficits in working memory, conditions that would indicate injuries to different parts of the brain.

By measuring reactions times in a battery of tests, the system is designed to detect even mild cognitive deficits associated with concussion or early dementia. DETECT completes its tests in about 7 minutes, and requires only a low-end computer system, a HMD, joystick, and the control software.

Biochip labs

A biochip is a wafer shaped chip, which is partially a mass of computer circuitry, and partially a maze of tiny canals for fluid. They are massive laboratories on a tiny scale. The maze of tiny canals are usually filled with blood from a patient. Alternatively, they may be filled up with a urine sample, stomach acids, bile, or any other fluidic substance being tested.

The tiny canals are arranged in repeating patterns, with one way valves, allowing fluid in, but not back out again. These patterns are basically miniaturised test sites arranged in a micro array such that several thousand experiments can be performed on the same sample in parallel.

In the same length of time as it takes to perform one test, as many as 2,000 are performed instead; each looking for the presence of a different element, immune response, or functional level.

A biochip lab can take a sample of blood or urine, onto a biochip, and check it for the presence of several thousand possible harmful chemicals, or several thousand types of bacteria or virus, all in a few hours. Then at the end, it analyses the results, and lets you know what it's found.

A modern biochip lab, is about the size of a shoebox, and the biochips slot into that. For sanitary reasons, each biochip is disposable, and is thrown away after use, much as a needle is.

Bone Fractures

One area not covered yet in this look at home hospitalisation is determining a fractured bone. That a bone is actually broken can often be determined by an unnatural angle, or a loss of feeling in a limb; a screaming pain when a rib is touched, or a skull that gives slightly. However, this is far from medically precise, and does not help with determining a clean break, a spiralling fracture or a compound fracture.

It is perhaps unreasonable for the near future to imagine every home having equipment to diagnose broken bones, or create the casts to set them, due to the current cost of fabrication.

Portable X-Ray

Low-frequency, compact, Portable X-Ray units have actually been available for some time, for vetinary use. As qualified health personnel are not insured to use them on humans, they, at the moment, do not.

That does not mean that low-power X-ray cannot be used in a home environment, to quickly check if what feels like it might be broken, actually is broken, without leaving the home.

References

Answers.com Definition of superbug
http://www.answers.com/superbug&r=67

NHS superbug death rate doubles
24 February, 2005, http://news.bbc.co.uk/1/hi/health/4293765.stm

VWN News on DETECT
29/04/2005, http://www.virtualworldlets.net/Archive/IndividualNews.php?News=1014

Inventor of DETECT
http://www.neuro.gatech.edu/groups/laplaca/laplaca.html

Portable X-ray systems
(for example only) http://www.pnwx.com/Equipment/MedXray/Soyee/SY-31/

Staff Comments

 


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