IHE Symposium 2023: Tackling Global Challenges

Engineering is about finding solutions to problems and that’s what we’re trying to do at the Institute of Healthcare Engineering. During this year’s Symposium, we had three guest speakers talk about how they’re tackling some of the issues we’re currently seeing in healthcare – things like data security, stillbirths, and our mental health.

 Here’s a summary of what they talked about:

Dr Irina Brass, Associate Professor in Regulation, Innovation and Public Policy: 
'Security and Algorithmic Integrity Challenges in Connected and Intelligent Medical Devices'

Imagine presenting to the A&E at 2am and your brain implant has malfunctioned and you’re presenting with symptoms doctors can’t diagnose. Most healthcare professionals are not equipped to deal with something of this nature – medical devices malfunctioning. So, how do you make sure this doesn’t happen? What if we add AI and other software onto the brain implant, adding another layer of complexity healthcare professionals must deal with. This is what Dr. Irina Brass talks to us today.

Let’s start at the beginning. Dr. Brass starts off by telling us about the 'Internet of Things' - a good way to sum up the ‘connected infrastructure of medical devices, their software applications and health systems and services’[1] which includes things like your FitBit, pacemakers and other wearables and implantables.

Everything is connected. But with that connection comes new challenges to security. Currently medical devices are strictly regulated to ensure the safety of the user with the onus being placed on the manufacturer who must conduct clinical trials to avoid safety risks but what happens after it’s delivered from the manufacturer?

Some of the post-delivery issues mentioned by Dr. Brass include the lack of software updates, default passwords not being changed so lack of security and the lack of training on the use of the medical devices. We’d have never have thought it but imagine your implantable cardiac device being a cybersecurity threat? Or your insulin pump being hacked?

Previously, the way regulator has ensured safety is by asking for some post marketing surveillance. But this doesn’t help with the issue of security. Dr. Brass does offer some solution: Monitoring shouldn’t happen momentarily but rather should be general practice, and clinicians need training and support in supporting their patients.

More on this: https://www.youtube.com/watch?v=ZlT2rEpf3Yg

Dr. Irina Brass' UCL Profile

Professor Anna David, Director of UCL’s Institute of Women’s Health, Professor and Consultant in Obstetrics and Maternal Fetal Medicine: 'Developing Engineering Solutions to Tackle Stillbirth and Premature Birth'

What happens when the fetal membranes rupture early, before the 37 weeks needed for full gestation? 

Quick answer: It causes a lot of problems, including pre-term birth, Fetal Growth Restrictions (FGR) and stillbirth. It’s not a small problem either; globally 13.4 million babies are born early which is the leading cause of neonatal death and surprisingly, this number isn’t going down with figures the same as they were 30 years ago!

Fetal Growth Restriction is ‘most often defined as an estimated fetal weight less than the 10th percentile for gestational age by prenatal ultrasound evaluation.’[2] It affects 10% of pregnancies and is the leading cause in stillbirth.  Apart from the loss of a young life, the monetary costs are huge with £2.4 billion spent in the UK per year looking after pre-term and small babies, amounting to a cost per neonatal cot of £2,000 a day.

Your start in life naturally affects you later in life and without proper growth of organs, babies face complications such as lower IQ, dementia, heart attacks, poor vision, cerebral palsy, breathing problems, strokes, and bowel damage.

The human placenta is so important in making sure fetal growth isn’t restricted. But it’s an organ that’s not researched much. The placenta acts as the lungs, brain, stomach and stem cells of a fetus. It’s a massive exchange system between the mother and child and so if there are issues with the placenta, it can lead to detrimental consequences for the baby.

Prof. Anna David’s team knows how important the placenta is so they’re imaging the organ to see if the images can give more information about fetal wellbeing in FGR and to find out why the fetus is small. Could it be a genetic problem or an issue with placental function? They already know that less oxygen saturation in the placenta occurs in FGR.

In their studies, they found that placentas in women with FGR had a different signal during MRI. They’re doing this by combining two different types of MRI: one being Diffusion MRI and the other being T2 Relaxometry – both these combined give a measure of oxygen saturation.

The team are at the stage of taking their research into non-human primates to validate their findings before using the MRI technique to improve the care of pregnant women with FGR to prevent stillbirth.

And lastly, a bit of advice from Prof. Anna David: sleep on your side in late pregnancy rather than lying on your back during pregnancy as sleeping on your back reduces fetal oxygen saturation and has a stronger effect in FGR pregnancy.

Prof. Anna David's UCL Profile

Credits also go out to Dr Andrew Melbourne, Dr Roz Aughwane and UCLH MRI and Research Midwifery teams

Dr. Bettina Moltrecht: 'Managing emotions using an app'

Are we angry? Sad? Happy? Stressed? Sometimes it’s hard to tell. Emotional regulation involves the evaluation and monitoring of emotions.

This might seem like a trivial thing for some but for those with mental health disorders, 90% go through emotional dysregulation. For those who aren’t diagnosed with mental health disorders, emotion dysregulation can be a predictor of later mental health difficulties.

A common intervention for emotion regulation used to be Cognitive Behavioural Therapy which is a type of talking therapy that teaches you the coping skills for dealing with your emotions and how they are linked to your thoughts and behaviours. Back in 2019, there were no emotion regulation apps which is where Dr. Bettina Moltrecht came in [3] . After scoping the project, going through focus groups, co-design workshops and testing, Dr. Bettina Moltrecht launched hernew app, EDA.

The app was targeted at children, with children helping to design and create the app. The app would help users to identify what feelings they had and tell them the strategies to manage their emotions but also how to practise the strategies they had learnt.

Whendeveloping the app, users mentioned how they wanted the app to be offline, that they wanted their data to be safe and they wanted to be able to control the app. This user insight was “invaluable” for developing the app according to Dr. Bettina Moltrecht. In the feedback, she realised that design was just as important as content and a  mental health app shouldn’t have to be childish looking even if it was designed for children .

As Dr.  Bettina Moltrecht mentions – it’s easy for researchers to think about what they are getting out of it but not always fully realising the needs and benefits for the end user which is why co-production is always beneficial.

Unfortunately, the app is no longer available as there was no funding for the regular updates that were are needed for apps. But the lesson of working closely with users is something Dr. Bettina Moltrecht stressed during her talk. As researchers, the goal might be what we want to get out of it, but we sometimes forget who the research is for.

Further reading:
Moltrecht, B., Patalay, P., Bear, H. A., Deighton, J., & Edbrooke-Childs, J. (2022). A transdiagnostic, emotion regulation app (Eda) for children: design, development, and lessons learned. JMIR Formative Research, 6(1), e28300.

Dr. Bettina Moltrecht's UCL Profile