AI Integration in the Fight Against Age-Related Macular Degeneration

Wen Hwa Lee

In this interview, Wen Hwa Lee, CEO, and Chief Scientist at Action Against Age-Related Macular Degeneration (AAAMD), offers an enlightening perspective on merging AI with ophthalmology to forge new paths in healthcare and drug discovery.

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Pediatric telehealth for mental health needs filled a critical deficit in the immediate period following the emergence of COVID-19, and continues to account for a substantial portion of pediatric mental health service utilization and spending, according to a new research letter in JAMA Network Open.

Because of that, commercial health insurers should use telehealth to make up for the lack of mental health providers focusing on youth, the research determined.

Focusing on children and youths younger than 19 who have received common pediatric mental health diagnoses (anxiety, adjustment disorder, attention-deficit/hyperactivity disorder, etc.), the team quantifies trends and changes in monthly utilization and spending rates between three phases of COVID-19: pre-pandemic, the midst of the pandemic before vaccine availability, and post-pandemic. 

Monthly medical claims data provided by Castlight Health were used to measure trends in utilization per 1,000 beneficiaries and spending (accounting for inflation by indexing 2020 to 2022 rates to 2019) per 10,000 beneficiaries among roughly 1.9 million children and youths with commercial insurance throughout the U.S.

Utilization and spending trends were generally consistent across pediatric mental health diagnoses. Compared with pre-pandemic, in-person pediatric mental health services declined by 42% during the pandemic's acute phase, while pediatric telehealth services increased 30-fold (3,027%), representing a 13% relative increase in overall utilization.

By August 2022, in-person services returned to 75% of pre-pandemic levels and telemental health utilization was 2,300% higher than pre-pandemic levels.

During the post-pandemic period, there was a gradual increase in spending rates compared with pre-pandemic for in-person, telehealth and total visits. From January 2019 to August 2022, mental health service utilization increased by 21.7%, while mental health spending rates increased by 26.1%.

WHAT'S THE IMPACT?

The COVID-19 pandemic severely tested the mental health of children and youths due to unprecedented school closures, social isolation and distancing, and COVID-19-related mortality among families, according to research in JAMA Pediatrics. 

In response, health systems offered telehealth to increase access to pediatric mental healthcare, but the extent to which telehealth availability led to greater utilization and spending was largely unknown.

As it turns out, utilization and spending increased over the entire timeframe. ADHD, anxiety disorders, and adjustment disorder accounted for most visits and spending in all phases.

Supported by evidence that telehealth can effectively deliver mental health treatment for children and youths, the findings have important implications for telehealth sustainability beyond the effects of COVID-19, authors said.

THE LARGER TREND

A stark generation gap has emerged between millennials and baby boomers when it comes to telehealth, with younger patients driving the highest overall satisfaction scores and older patients experiencing significantly lower levels of satisfaction, according to the J.D. Power 2023 U.S. Telehealth Satisfaction Study, published last month.

The satisfaction gap is widest in digital channels and appointment scheduling, suggesting that older telehealth users are having problems using telehealth providers' digital interfaces.

Also in September, Epic Research determined that despite being able to be reimbursed for telehealth services at the higher facility rate for another year, providers are frequently billing for these virtual visits at a lower level-of-service code, a trend that holds true for both primary and specialty care. Telehealth visits are more frequently coded with a lower level-of-service billing code than in-person office visits of the same specialty.

In October 2022, after three months of relative stability, national telehealth utilization declined 3.7%. Looking at one specific metric, telehealth went from 5.4% of medical claim lines in September, to 5.2% in October, according to FAIR Health's Monthly Telehealth Regional Tracker.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com

Researchers found that applying gentle, non-invasive electrical stimulation to the brain during virtual reality training helped budding surgeons to more easily transfer the skills they’d learned to a real-life setting. In addition to training better future surgeons, the approach could help skill acquisition in other industries.

Motor learning allows us to develop new skills, like mastering a tennis serve or, in the case of a surgeon, developing precision suturing skills. These days, surgeons are likely to learn these types of skills in a virtual reality (VR) environment before they transition to the real world.

Researchers at Johns Hopkins University in the US have developed a method of improving how medicos learn surgical skills in a virtual environment so that their learned skills are transferred more effectively to a real-life scenario.

“Training in virtual reality is not the same as training in a real setting, and we’ve shown with previous research that it can be difficult to transfer a skill learning in a simulation into the real world,” said Jeremy Brown, a study co-author. “It’s very hard to claim statistical exactness, but they concluded people in the study were able to transfer skills from virtual reality to the real world much more easily when they had this stimulation.”

By “this stimulation”, Brown is talking about a gentle electric current delivered to the head, more specifically, the cerebellum, a part of the brain that plays a critical role in error-based learning. Non-invasive brain stimulation (NIBS) has been used before in attempts to Improve motor learning. One form of NIBS, the one that was used in the current study, is anodal transcranial direct current stimulation (atDCS), the application of a constant electric current to specific areas of the brain. Anodal stimulation depolarizes the neurons, increasing the probability of an action potential – a rapid sequence of voltage changes – occurring. The action potential and subsequent neurotransmitter release enable one neuron to communicate with others.

The researchers recruited 36 participants, 17 females and 19 males, with a mean age of 27. While 12 had medical backgrounds, none had prior experience with laparoscopy, robotic surgery, or any other teleoperation device. Each was asked to perform a complex visuomotor surgical training task in a real or virtual environment and then switch to the opposite training environment. The task involved driving a curved surgical needle through three rings with a 2 mm radius distributed at 45-degree increments inside the vertical plane. ‘Real’ training environment in the context of this study meant performing the task using the da Vinci Research Kit (dVRK), an open-source research robot, to control the surgical instruments.

Participants received either atDCS or sham cerebellar stimulation during the training task, which they had to perform at three speeds: fast, medium, and slow. While all participants showed improvement from baseline, groups receiving cerebellar atDCS showed significantly improved skill transfer from the virtual to the real environment at fast and moderate speeds, whereas groups receiving the sham stimulation did not.

“The group that didn’t receive stimulation struggled a bit more to apply the skills they learned in virtual reality to the actual robot, especially the most complex moves involving quick motions,” said Guido Caccianiga, the study’s lead and corresponding author. “The groups that received brain stimulation were better at those tasks.”

The researchers say validating their findings using a larger sample could significantly impact robotic surgery training programs. Enhancing skill transfer through NIBS could speed up training time and shorten the learning curve. Outside of training surgeons, the approach could help with skill acquisition in other industries or learning more generally.

“What if they could show that with brain stimulation, you can learn new skills in half the time?” Caccianiga said. “That’s a huge margin on the costs because you’d be training people faster; you could save a lot of resources to train more surgeons or engineers who will deal with these technologies frequently in the future.”

The study was published in the journal Nature Scientific Reports, and the below video, produced by Johns Hopkins, shows a participant receiving cerebellar atDCS during training.

Source: Johns Hopkins University