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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
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.
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,
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.
A superbug is defined as a strain of bacteria that is resistant to all
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
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.
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.
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.
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.
Answers.com Definition of superbug
NHS superbug death rate doubles
24 February, 2005, http://news.bbc.co.uk/1/hi/health/4293765.stm
VWN News on DETECT
Inventor of DETECT
Portable X-ray systems
(for example only) http://www.pnwx.com/Equipment/MedXray/Soyee/SY-31/