Monday, December 11, 2017

Holiday treats, hectic schedules may increase risk of heart attack

Holiday treats, hectic schedules may increase risk of heart attack

Between the ubiquitous goody trays, unending to-do lists and stressful travel itineraries, it can be tough to stay on track when it comes to health during the holiday season, whether it's sticking to a diet or maintaining an exercise regimen.
11 dec 2017--Such holiday-fueled pressures may also contribute to the fact that the holidays are also the most dangerous time of year for heart attacks.

Research shows deaths from heart attacks peak during December and January, possibly due to changes in diet and alcohol consumption, stress from family interactions, strained finances, travel and entertaining, and respiratory problems from burning wood.
"We tend to exercise less and eat more during the holidays," said John Osborne, M.D., Ph.D., a Dallas-area preventive cardiologist. "It's a very stressful time. There's a lot of emotion attached to the holidays and that can be another factor to why we have more cardiovascular events."
As the holidays upend routines, taking medications as prescribed can also get lost in the shuffle, Osborne said.
"I can't tell you how often I get calls from patients who have traveled somewhere and forgot their medications," he said, adding that he worries more about the patients who don't contact him. "Some people figure they'll be fine to be off them for a week or so, but if you start missing medications, that can have a big impact on causing your blood pressure to be out of control."
For those who have already had a heart attack, the heightened risk during the holidays is particularly dangerous. That's because about one in five heart attack survivors age 45 and older will have another heart attack within five years.
Being with family during the holidays is a good time for patients to talk about their health history—not just heart attacks, but also high blood pressure and high cholesterol, experts say.
"We can dramatically lower the risk of cardiovascular events with lifestyle changes, but don't ignore your family history," Osborne said. "Genetics can catch up to you, even if you're doing all the right stuff."
Heart disease can be prevented in many cases through lifestyle factors, such as maintaining a healthy weight, exercising regularly, controlling cholesterol and blood pressure and not smoking, but "making lifestyle changes can be difficult," Osborne said.
"I admit to my patients that I don't love to exercise, but I really feel great having exercised," he said. "Getting that motivation can be painful, but it's fantastic when you get to the other side."
Osborne said tools such as mobile apps can provide education and electronic reminders to help people stay focused on heart health.
"I have a very brief period with patients," he said. "Tools like apps can encourage good health behaviors, being that gentle in-your-face technology."

More information: D. P. Phillips. Cardiac Mortality Is Higher Around Christmas and New Year's Than at Any Other Time: The Holidays as a Risk Factor for Death, Circulation (2004). DOI: 10.1161/01.CIR.0000151424.02045.F7


Provided by American Heart Association

Sunday, December 10, 2017

How to talk to your doctor about information you find online


How to talk to your doctor about information you find online
More and more people are going online to search for information about their health. Though it can be a minefield, where unverified sources abound, searching the internet can help people to understand different health problems, and give them access to emotional and social support.

10 dec 2017--For many in the UK, getting to actually see a GP remains difficult, and constraints around appointment times mean that some discussions are often cut short. But by using the internet, patients can prepare for appointments, or follow up on issues that were raised in the consulting room but left them with unanswered questions.
But not everyone is so keen on patients using the internet in this way. Some GPs and other heath professionals have doubts about the quality and usefulness of the information available. There are also suggestions that "cyberchrondria" may be fuelling a surge in unnecessary tests and appointments.
Similarly, though so many people are using online resources to fill in gaps in their knowledge, or to help them ask the right questions, they may not be comfortable bringing it up in the consulting room.
For our latest research project, we wanted to find out just why it can be so difficult to discuss online information with doctors. We found that in addition to people being embarrassed in case they have misunderstood the information, or can't remember it accurately, they also fear a negative reaction from the GP who may think they are difficult or challenging.

How to make it work

So how can you as a patient bring up online information with your doctor? First, it sounds obvious but you need a good, open relationship with your GP. Tell them you have been looking online, but ask for their feedback on the information, and for any useful sites they know of. We found that patients with a good doctor relationship felt able to discuss information and ideas from websites and online forums in a considered and critical manner.
Importantly, it is not about the patient trying to be the doctor. Ideally, patients should bring along their information, use it to help explain their key concerns, or detail the options they've explored, but also make clear that they still want and value their GP's input on their findings.
Some of the patients we spoke to told us that they are acutely aware of their doctor's negative feelings towards the internet. In these situations, people are sometimes tempted to disguise the source of their information. Rather than openly discussing their findings from the internet, they may pretend they got the information elsewhere when mentioning it to their doctor or be very careful not to reveal its origin at all.
For some people we spoke to, the process of trying to integrate the results of their web searches into their communications with the GP was frustrating to say the least. They felt uncomfortable, embarrassed, and sometimes held back key information. This made for unproductive meetings which were felt to be a waste of time.
This process can definitely be improved. As more appointments are going to be conducted over smartphone rather than face to face, and some GPs have admitted using Wikipedia to diagnose patients, the rest of the process needs to catch up with technology.
There needs to be a new and more productive way to integrate online information into doctor-patient discussions. First of all, there should be better ways for patients to collect and organise accurate information online so that they can organise their thoughts and prepare for a visit.
In the consulting room itself, GPs should use the research as an opportunity to have more productive discussions, and use it as a way to teach patients more about their own health issues. They need to question the information source, message and credibility, but GPs could also use it as an opportunity to nudge patients to think about their health options and consider what's important to them.
Just as a GP is not solely responsible for the health of a patient, neither is the patient themselves. Internet research can no longer be dismissed. Even if inaccurate, it can help build a better relationship between patient and doctor, and give them both a better understanding of managing health in the modern world.

This article was originally published on The Conversation. Read the original article.The Conversation

Provided by The Conversation

Saturday, December 09, 2017

Is prescribing drugs 'off label' bad medicine?

Is prescribing drugs 'off label' bad medicine?

A woman, let's call her Sarah, is a young actor looking to make her debut at a major theatre. She is fit and healthy, but gets nervous on opening nights and can't sleep. She's tried zopiclone, but it didn't work, so her GP prescribes a course of quetiapine. Quetiapine is usually used to treat bipolar disorder, but the doctor explains to Sarah that he is prescribing it "off label". In other words, for a condition the drug wasn't licensed to treat.

09 dec 2017--There are legitimate reason for prescribing off label – although, there are also legitimate criticisms of the practice.
In the UK, doctors, dentists, optometrists and other prescribers are discouraged from prescribing drugs off-label when a licensed alternative is available. But off-label prescribing is done, with caution, for several reasons.
First, each prescription drug has a product licence, that is, the company that makes it had to submit a mountain of evidence to the regulator proving not only that the drug is effective, but it is safe.
Second, the prescriber and the dispensing pharmacist are legally liable when things go wrong, so the patient can sue.
Finally, sometimes there are no alternative drugs for a given health problem. For example, in Sarah's case, quetiapine is not licensed to treat insomnia. However, she has tried all available drugs licensed to treat insomnia, and none of them have worked.

The right to say 'no thanks'

Drugs are prescribed off label based on limited evidence. Sometimes, doctors have to build the evidence as they use each medicine off label and learn from their experience – what works for a given condition and what doesn't. Published case studies can also provide clues about what other uses a drug might be useful for. Case studies, though, are at the bottom of the hierarchy of medical evidence.
GPs and other prescribers have to make decisions based on the available evidence, which may not be very much. Sometimes it's based on little more than an educated guess.
In Sarah's case, the doctor feels that quetiapine might help. If the drug doesn't work for her, she'll have to come back to see him, and perhaps try a different drug – also off label.
This highlights another problem, though. Some patients – especially the elderly – take their doctor's advice as gospel and follow it regardless of how a drug makes them feel. As a result, they can end up taking pills that aren't effective and may even have unpleasant side effects.
In this example, Sarah should go back to her GP if she is concerned and she has the right not to take medicine that she doesn't want to.

This article was originally published on The Conversation. Read the original article.The Conversation

Provided by The Conversation

Friday, December 08, 2017

New clinician resource available explains biological impact of aging on immunity

The American College of Physicians (ACP), the American Pharmacists Association (APhA), and The Gerontological Society of America (GSA), representing 220,000 clinicians, today released "Aging and Immunity: The Important Role of Vaccines", a new resource highlighting the biological impact of aging on immunity.

08 dec 2017--Developed with support by GSK, the guidebook is designed to help health care professionals understand the biological impact of aging on immunity and reinforce the importance of adult immunization, especially for vaccine-preventable diseases such as shingles, pneumonia, and influenza. The guidebook also offers practical tips and strategies for supporting aging patients' health and overcoming barriers to vaccination.

Age-related decline in immunity

"As we age, our immune system declines, making older adults more susceptible to serious conditions," said Jack Ende, MD, MACP, President, ACP. "Understanding the aging immune system is becoming increasingly important for clinicians because vaccination is an effective solution to overcoming some of this age-related decline in immunity."
Research has shown that one of the most important things health care professionals can do to support aging patients is to provide a strong recommendation for them to be vaccinated.
"At every opportunity, clinicians should recommend vaccination according to the schedule from the Advisory Committee on Immunization Practices, have a program that supports vaccine administration, or refer patients to a health care professional who administers vaccines, and document administration of vaccines," said Kelly Goode, PharmD, BCPS, FAPhA, Board of Trustees Member and Immediate Past President, APhA.

As individuals age, the chances of getting shingles increases

"Aging and Immunity" details how cell-mediated immunity deteriorates as a person ages. For instance, in people who had chickenpox as children, deteriorating cell-mediated immunity is considered a factor for why latent varicella zoster virus commonly becomes reactivated in older adults, causing shingles. About one million cases of shingles are diagnosed in the United States every year. Shingles occurs in one in every three people in the United States, mostly adults over the age of 50. For those who live to age 85, one in every two people will contract shingles. The painful condition occurs in people who are healthy as well as people with chronic diseases or immunosuppression. Vaccination is an important way of reducing risk of getting shingles and its complications, like postherpetic neuralgia (PHN) and necessity of prescribing pain relievers.
"Shingles is an example of a disease that afflicts one million adults every year and costs the economy $1 billion in health care expenses. It especially impacts older adults as a direct result of age-related decline in immunity," said James Appleby, BSPharm, MPH, Executive Director and CEO, GSA. "Shingles can affect anyone who carries the varicella zoster virus, and virtually all adults do, whether they had chickenpox during their childhood or not."

Addressing barriers to vaccination

"Aging and Immunity" explains barriers to vaccination at the patient and practice levels and offers recommendations about how clinicians can overcome them. Strategies to improve vaccination rates include using standing orders, collaborating with other health care team members, identifying a staff vaccine champion in the practice, adding reminders to charts, and counseling patients about recommended vaccines.
"We recognize the critical role health care professionals play in educating patients about vaccine-preventable diseases," said Barbara Howe, M.D., Vice President and Director, North American Vaccine Development, GSK. "Our collaboration with ACP, APhA, and GSA reinforces our commitment to educating health care professionals and patients about the importance of vaccination throughout an individual's life.
"
More information: www.acponline.org/system/files … d_immunity_guide.pdf


Provided by American College of Physicians

Wednesday, December 06, 2017

New easy-to-use tool can help determine Alzheimer's risk, similar to pediatric growth curves

A simple new tool that tracks cognitive performance in adults aims to help physicians identify people who may be on the path to Alzheimer disease or another form of dementia. The tool, called the QuoCo (cognitive quotient), is published in CMAJ (Canadian Medical Association Journal).

06 dec 2017--"Similar to 'growth charts' used in pediatrics, the QuoCo cognitive charts allow physicians to plot cognitive performance of any patient based on age, education and score on the Mini-Mental State Examination, and track cognitive change over time," says Dr. Robert Laforce Jr., Université Laval and CHU de Québec-Université Laval. "This would allow physicians to intervene and potentially treat an older adult who 'fell off' the curve."
Dementia is a growing problem world-wide with many undiagnosed cases. Although there are no cures, potential treatments are being tested and some risk factors, such as diet and exercise, can be addressed to delay onset.
The authors hope that the QuoCo tool will be used by health care professionals, especially family physicians, to monitor cognitive decline in patients before irreversible damage occurs.
"Dementing illnesses have reached pandemic levels," write the authors. "Early detection of cognitive impairment remains our best approach to disease management before irreversible brain damage occurs. Family physicians are in a key position to contribute to this approach; however, they are ill-equipped."
The authors note that the Mini-Mental State Examination is an imperfect screening measure and has its own limitations, although it is used internationally clinically and in research on dementia and cognitive decline.
In a related commentary, Dr. Andrew Costa, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, writes "the widespread benefits derived from cognitive charts for any screening examination rests on the assumption that at-risk patients are being screened systematically over time and that cognitive test results are communicated, or can be readily referenced by, physicians. We seem to be some distance away from that reality."
He notes that the success of any innovation rests upon training health care professionals to use these tools in clinical practice properly.

More information: Canadian Medical Association 
Journal (2017). www.cmaj.ca/lookup/doi/10.1503/cmaj.160792


Provided by Canadian Medical Association Journal

Sunday, December 03, 2017

Lack of communication puts older adults at risk of clashes between their medicines

Lack of communication puts older adults at risk of clashes between their medicines
Key results from the National Poll on Healthy Aging. 
Most older Americans take multiple medicines every day. But a new poll suggests they don't get - or seek - enough help to make sure those medicines actually mix safely.
That lack of communication could be putting older adults at risk of health problems from interactions between their drugs, and between their prescription drugs and other substances such as over-the-counter medicines, supplements, food and alcohol.

03 dec 2017--The new results, from the National Poll on Healthy Aging, show that only about one in three older Americans who take at least one prescription drug have talked to anyone about possible drug interactions in the past two years.
Even among those taking six or more different medicines, only 44 percent had talked to someone about possible drug interactions.
The results come from a nationally representative sample of 1,690 Americans between the ages of 50 and 80. The poll was conducted by the University of Michigan Institute for Healthcare Policy and Innovation, and sponsored by AARP and Michigan Medicine, U-M's academic medical center.

Disjointed sources of care

Part of the reason for lack of communication about drug interactions may lie in how older Americans get their health care and their medicines. One in five poll respondents said they have used more than one pharmacy in the past two years, including both retail and mail-order pharmacies. Three in five see multiple doctors for their care.
And even though 63 percent said their doctor and pharmacist are equally responsible for spotting and talking about possible drug interactions, only 36 percent said their pharmacist definitely knew about all the medications they're taking when they fill a prescription.
"Interactions between drugs, and other substances, can put older people at a real risk of everything from low blood sugar to kidney damage and accidents caused by sleepiness," says Preeti Malani, M.D., the director of the poll and a professor of internal medicine at the U-M Medical School.
"At the very least, a drug interaction could keep their medicine from absorbing properly," she adds. "It's important for anyone who takes medications to talk with a health care professional about these possibilities."
Malani notes that although 90 percent of poll respondents said they were confident that they knew how to avoid drug interactions, only 21 percent were very confident.
Given the wide range of prescription and over-the-counter drugs on the market, and the number of drugs that interact with supplements, alcohol and certain foods, Malani says it's hard for even medical professionals to catch all potential interactions.
Newer medical computer systems that flag patients' records for potential interactions automatically, based on the names of their drugs, are helping, Malani says.
Also helpful is Medicare coverage for prescription drug reviews, called Medication Therapy Management, for people who take medicines for multiple chronic conditions. But not all medical computer systems talk to one another, and an MTM must be approved by the patient's Medicare prescription drug benefit provider.
"Even with trackers and systems in place, patients need to be open with their providers and tell them all the medications and supplements they're taking, including herbal remedies," says Alison Bryant, Ph.D., senior vice president of research for AARP. "It's especially important for older adults to be vigilant about this because they tend to take multiple medications."
AARP has put together a free online drug interaction tracker that can identify potential risks. It's available at http://healthtools.aarp.org/drug-interactions, but should be used in conjunction with a patient's conversations with their health care providers and pharmacists.

Recommendations for patients and providers

Malani and her colleagues say that it is up to patients, pharmacists and doctors alike to reduce drug interaction risks.
Patents should write down the names and dosages of their prescription medicines, and of any supplements and over-the-counter drugs they take, and bring it all to their doctors' appointments or pharmacies, she says. It is also important to be truthful about alcohol consumption when asked, since alcohol use can affect many medications. And patients shouldn't just stop taking a medicine if they think they're experiencing a side effect - they should also call their doctor's office or speak with a pharmacist first.
Meanwhile, health care providers should ask patients more about what medicines and supplements they take, and counsel patients at risk of side effects using language they can understand.
The poll results are based on answers from those who said they took at least one prescription drug, among a nationally representative sample of about 2,000 people ages 50 to 80. The poll respondents answered a wide range of questions online. Questions were written, and data interpreted and compiled, by the IHPI team. Laptops and Internet access were provided to poll respondents who did not already have it.


Provided by University of Michigan

Saturday, December 02, 2017

Dual virtual reality/treadmill exercises promote brain plasticity in Parkinson's patients

Dual virtual reality/treadmill exercises promote brain plasticity in Parkinson's patients
A new Tel Aviv University study suggests that a therapy that combines Virtual Reality and treadmill exercise dramatically lowers the incidence of falling among Parkinson's patients by changing the brain's behavior and promoting beneficial brain plasticity, even in patients with neurodegenerative disease.

02 dec 2017--Patients with Parkinson's disease experience gradual neuronal loss, leading to cognitive and motor impairments that damage their ability to walk and cause debilitating, often fatal, falls. The new study shows that fall rates are reduced in response to treadmill with Virtual Reality. The number of neurons activated in the pre-frontal cortex is also reduced in response to the same combination. This reduction likely reflects enhancements in motor control and greater automaticity of cognitively demanding tasks.
The research underlines the importance of combining cognitive rehabilitation with the motor rehabilitation of Parkinson's disease patients.
The study was conducted by Prof. Jeff Hausdorff of TAU's Sackler School of Medicine and Tel Aviv Medical Center along with colleagues Dr. Inbal Maidan of Tel Aviv Medical Center and Dr. Anat Mirelman and Prof. Nir Giladi, both of TAU's Sackler School of Medicine and Tel Aviv Medical Center. The findings were recently published in the journal Neurology.
"In previous research, we showed that patients with Parkinson's disease use cognitive function, which is reflected in activation of the pre-frontal cortex of the brain, to compensate for impaired motor function," Prof. Hausdorff says. "We also showed that a specific form of exercise targeting the cognitive control of gait—combined treadmill training with a Virtual Reality representation of obstacles in a path—leads to a significantly lower fall rate in Parkinson's patients.
"The Virtual Reality gait program, in which patients must avoid obstacles, enhances the patient's cognitive performance and thus reduces the requirement for prefrontal brain activity," Prof. Hausdorff continues.
Seventeen subjects in two groups, one which combined treadmill training with Virtual Reality and one which used treadmill training alone, underwent a six-week intervention, exercising three times a week for about an hour each time. The Virtual Reality group played a "game" in which they viewed their feet walking in a city or park environment. Through the game, they implicitly learned how to deal with obstacles in the virtual environment, how to plan ahead and how to do two things at once—that is, address cognitive challenges related to safe ambulation.
The other group just walked on a treadmill without the VR components or cognitive challenges. Before and after the subjects participated in the exercise programs, the researchers used functional MRI imagery to evaluate the patients' brain activation patterns.
"The study's findings reinforce the hypothesis that training improves motor and cognitive performance through improved neuroplasticity—more so than that seen with treadmill training alone," Prof. Hausdorff explains. "Interestingly, the benefits of treadmill training with VR were specifically seen during walking conditions that require cognitive input (i.e., obstacle negotiation and dual tasking), conditions associated with falls in everyday environments. In these conditions, fewer neurons were needed after training with VR, while no change was seen in the group that trained by walking on a treadmill without VR."
Previous research conducted on mouse models of Parkinson's disease suggested the importance of task-specific exercises on the brain. However, the new TAU study is the first to show such findings in people with Parkinson's disease.
"Exercise that focuses on motor components promotes plasticity in brain areas associated with sensory-motor integration and coordination," Prof. Hausdorff says. "But exercise incorporating cognitive components also stimulates changes in brain regions related to cognition. It may therefore have a greater impact on compensatory brain function and the cognitive functions related to safe ambulation (i.e., walking without falling)."
"The takeaway here is that even relatively late in the disease, when 60-80 percent of dopaminergic neurons have died, there is still an opportunity to promote plasticity in the brain," Prof. Hausdorff concludes. "Moreover, to induce specific brain changes, exercise should be personalized and targeted to a specific clinical problem."


Provided by Tel Aviv University

Thursday, November 30, 2017

How to reduce medications in older generations

New research published today in the Journal of Gerontology has developed new ways to characterise older people who take multiple medicines and those who are open to "deprescribing", a process where medicines are reviewed in order to reduce or stop less effective medicines.

30 nov 2017--Lead researcher from the University of Sydney's School of Public Health, Kristie Weir, says; "Polypharmacy (multiple medications) in the older population is increasing and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing), but a collaborative approach between patient and doctor is required."
"Deprescribing isn't new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients. We provide a novel approach to describe these differences between older people who are happy to take multiple medicines, and those who are open to deprescribing.
"Ultimately, considering these variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.
"We categorized three distinct types of people which could help guide the type of advice given by clinicians to older patients when discussing the issues around taking multiple medicines," she says. "Recognising these three types of patients can help clinicians tailor their communication approaches," she says.

Type one:

People who are resistant to deprescribing and are very attached to their medications as they are perceived as highly important to their wellbeing. This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.

Type two:

These people indicated they were open to deprescribing and preferred an active role in decision making to share responsibility with their doctor. They would consider deprescribing and said they didn't like the idea of completely relying on medications to stay healthy. This group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:

People who were less engaged in decision making, most deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn't give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.
"This research shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care," says Ms Weir.
"For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.
"We need to develop ways to support clinicians and patients to have these important but challenging conversations," she says.


Provided by University of Sydney

Tuesday, November 28, 2017

Benzodiazepines increase mortality in persons with Alzheimer's disease

Benzodiazepine and related drug use is associated with a 40 percent increase in mortality among persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. The findings were published in the International Journal of Geriatric Psychiatry.

28 nov 2017--The study found that the risk of death was increased right from the initiation of benzodiazepine and related drug use. The increased risk of death may result from the adverse events of these drugs, including fall-related injuries, such as hip fractures, as well as pneumonia and stroke.
The study was based on the register-based MEDALZ (Medication Use and Alzheimer's Disease) cohort, which includes all persons diagnosed with Alzheimer's disease in Finland during 2005-2011. Persons who had used benzodiazepines and related drugs previously were excluded from this study, and therefore, the study population consisted of 10,380 new users of these drugs. They were compared with 20,760 persons who did not use these drugs.
Although several treatment guidelines state that non-pharmacological options are the first-line treatment of anxiety, agitation and insomnia in persons with dementia, benzodiazepines and related drugs are frequently used in the treatment of these symptoms. If benzodiazepine and related drug use is necessary, these drugs are recommended for short-term use only. These new results encourage more consideration for benzodiazepine and related drug use in persons with dementia.

More information: Laura Saarelainen et al. Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study, International Journal of Geriatric Psychiatry (2017). DOI: 10.1002/gps.4821


Provided by University of Eastern Finland

Sunday, November 26, 2017

Prototype ear plug sensor could improve monitoring of vital signs

Prototype ear plug sensor could improve monitoring of vital signs

Scientists have developed a sensor that fits in the ear, with the aim of monitoring the heart, brain and lungs functions for health and fitness.
In previous pilot studies that involved trialling the device with 24 people, the researchers from Imperial College London have demonstrated the prototype's potential for monitoring brain, heart and breathing activity.

26 nov 2017--Now, the latest study from Professor Danilo Mandic's team from Imperial has shown that their 'Hearable' technology also has potential as a heart monitor. In the preliminary study, the new in-ear heart monitoring device was found to accurately capture heart data in six people.
The device detected heart pulse by sensing the dilation and constriction of tiny blood vessels in the ear canal, using the 'mechanical' part of the electro-mechanical sensor. The electrode part of the sensor is used to detect a full and clinically valid electrocardiogram, which records the electrical activity of the heart.
The new research was published in the journal Royal Society Open Science.
Based on these results and previous preliminary findings, the researchers suggest Hearable may in the future go on to identify and manage heart conditions such as heart attack or irregular heart beat, and also serve to observe the general health state of body.
They suggest the device for heart monitoring may also be easier and more convenient for patients and clinicians to use. Traditional electrocardiogram (ECG) testing involves wearing a chest belt for 24 hours. However, the in-ear device fits discreetly in the ear, meaning it can be worn for longer, providing a longer-term picture of the patient's heart activity.
Hearable is made of foam and moulds to the shape of the ear like a conventional ear plug. As well as mechanical sensors, it uses electrical sensors to detect brain activity.
Prototype ear plug sensor could improve monitoring of vital signs
Credit: Imperial College London
Professor Mandic, lead author of the study from the Department of Electrical and Electronic Engineering, said: "This is the latest piece of research on what we think could be a versatile new piece of wearable technology. We've now completed a number of tests on our sensor that focused on detecting vital signs within the body. Our early results are proving interesting and, although we are still a way off from seeing it used outside of experiments, we have many exciting avenues to explore."

Future applications

The technology is still in its early development, but the researchers say the device also has other potential applications such as in sleep science and monitoring fatigue, epilepsy, drug delivery, and person authentication. By monitoring the brain, the device could be used as a new method for cyber security, where brain signals, much like the fingerprint lock on a smart phone, are used to activate a device. Unlike a fingerprint, brain waves are impossible to forge.
It may also be useful in other settings such as in the health and fitness industry. By monitoring the heart and lungs, the researchers believe that the sensor could perform similar functions to wrist-worn fitness trackers.
However, unlike wrist-worn trackers, which monitor from the arm at the body's extremity, the ear-worn sensor, despite a relatively weaker signal, may get more stable results because the position of the ear relative to the internal organs is nearly always the same.
During previous pilot trials in humans, the researchers showed that the prototype can be used to monitor a combination of vital signs and brain function, which could be used to screen for and monitor stress, anxiety, sleep disorders, and heart disease.
Ultimately, the researchers are aiming for the device to wirelessly transmit the data to clinicians in real-time to provide immediate results and analysis. This could open up new possibilities in patient care.
For example, patients who are monitored overnight in sleep clinics are usually asked to wear lung, heart, and brain monitors, all of which provide an unnatural sleeping environment. The earpiece would mean patients could be monitored for a number of days and sleep in their own beds, while transmitting data in real time, to improve monitoring.
Professor Mandic said: "This is a very exciting piece of technology but its evidence in humans is limited. We will now work to put these preliminary results into practice and could eventually use this in real life situations."

More information: Wilhelm von Rosenberg et al. Hearables: feasibility of recording cardiac rhythms from head and in-ear locations, Royal Society Open Science (2017). DOI: 10.1098/rsos.171214


Provided by Imperial College London