- Email: [email protected]
Regarding “Google Maps offers a new way to evaluate claudication”
Journal of Vascular Surgery
Letters to the Editor
1309
Volume 66, Number 4
One unique way he kept in touch was by postcard. If he heard an interesting presentation, he would send me a postcard describing it. The practice of lunch with younger colleagues was so unique that I decided to do the same with younger surgeons who landed in Chicago. In addition to those mentioned in the article and Geza de Takats, there remain quite a few immigrant vascular surgeons who helped the development of vascular surgery in America. These are Henry Haimovici (RomaniaFrance), Leonel Villavicencio (Mexico), Hassan Najafi (Iran), Ramon Berguer (Spain), Enrico Ascher (Brazil), Anton Sidawy (Syria), Christopher Zarins (Latvia), Robert Linton (Scotland), and Charles Rob (United Kingdom). Each of these has made significant contributions to vascular surgery. It has been said that immigrants make up America and it is the land of opportunities. We all are fortunate to have been given the opportunity to develop vascular surgery in America. We succeed because of the rich resources, the strong support, and, most important, the generosity of Americans.
James S. T. Yao, MD, PhD Division of Vascular Surgery Feinberg School of Medicine Northwestern University Chicago, Ill
Roger T. Gregory, MD Department of Surgery Eastern Virginia Medical School Norfolk, Va (retired)
Walter J. McCarthy, MD Department of Cardiovascular-Thoracic Surgery Rush University Medical Center Chicago, Ill
William H. Pearce, MD Division of Vascular Surgery Feinberg School of Medicine Northwestern University Chicago, Ill
REFERENCES 1. Sterpetti AV, Ventura M. The role of immigrants to United States of America in the development of cardiovascular surgery. J Vasc Surg 2017;65:1528-30. 2. de Takats G. Symposium on venous problem: introductory remarks. In: Bergan JJ, Yao JS, editors. Venous problems. Chicago: Year Book Medical Publishers; 1978. p. 1-2. 3. dos Santos JC. Sur la désobstruction des thromboses artérielles anciennes. Mem Acad Chir (Paris) 1947;73:409-11. 4. Yao JS. Society for Vascular Surgery (SVS)dthe beginning. J Vasc Surg 2010;51:776-9.
5. Weinberg M Jr, Fell EH, de Takats G, McElwaine N. Use of homografts dispensed by Central Artery Bank of Chicago Heart Association. JAMA 1959;170:2132-4. 6. de Takats G. The subcutaneous use of heparin. A summary of observations. Circulation 1950;2:837-44. 7. Scupham GW, de Takats G, Van Dellen TR, Marcus PL. Vascular diseases: eighth annual review. Arch Intern Med (Chic) 1942;70:444-510. 8. de Takats G. Breach of etiquette and other short stories. Self published 1971. 9. de Takats G. Vascular surgery. Philadelphia: WB Saunders; 1959. http://dx.doi.org/10.1016/j.jvs.2017.06.091
Regarding “Google Maps offers a new way to evaluate claudication” We read with great interest the paper “Google Maps offers a new way to evaluate claudication” from Khambati et al.1 We do agree that Google Maps proposes a readily available GPS-based mapping tool that could be considered an accessible method of evaluating claudication. We are convinced that GPSbased determination of walking is of great interest in claudication.2,3 Nevertheless, one reason that we previously used an autonomous GPS data logger with no real-time transmission and local data analysis was related to potential privacy and security issues. In their recent paper screening 17,979 health-related applications, Mense et al4 concluded that 95% of these apps pose at least some potential damage through information security and privacy infringements, with >11% having the highest assessment of potential damage. The Privacy Rights Clearinghouse Association through a grant from the California Consumer Protection Foundation estimated in 2013 that 40% of apps are at high risk because of insufficient protection or sharing of personal data with a third party.5 The Association also estimated that the risk is particularly generally higher in free than in paid applications. Even institutional European administrations underlined that public sources of information can be exploited by potential adversaries, among which are free geographic data provided by Google Maps.6 In his recent review, Ornes7 recalled that the “Internet of Things” health care market would reach $117 billion by 2020 and that 5 million devices go online every day in 2016. Thereby, although the worldwide development of personal ePhone or tablets appears an attractive may to use personal tools for medical purposes by clinicians, we suggest that clinicians should rather focus on the use of a nonconnected data logger, allowing secured transmission (if any) and local (not Internet) analysis of geographic results.
1310
Journal of Vascular Surgery
Letters to the Editor
October 2017
Samir Henni, MD Vascular Investigational Department Teaching Hospital Center Angers, France
Pierre Abraham, MD, PhD Richard Vilret, MD Department of Physiology and Functional Investigations MitoVasc Institute Université Bretagne-Loire Angers, France
REFERENCES 1. Khambati H, Boles K, Jetty P. Google Maps offers a new way to evaluate claudication. J Vasc Surg 2017;65:1467-72. 2. Le Faucheur A, Abraham P, Jaquinandi V, Bouye P, Saumet JL, Noury-Desvaux B. Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation 2008;117:897-904. 3. Le Faucheur A, Noury-Desvaux B, Mahe G, Sauvaget T, Saumet JL, Leftheriotis G, et al. Variability and short-term determinants of walking capacity in patients with intermittent claudication. J Vasc Surg 2010;51:886-92. 4. Mense A, Steger S, Sulek M, Jukic-Sunaric D, Mészáros A. Analyzing privacy risks of mHealth applications. Stud Health Technol Inform 2016;221:41-5. 5. Mobile health and fitness apps: what are the privacy risks? Available at: https://www.privacyrights.org/consumer-guides/ mobile-health-and-fitness-apps-what-are-privacy-risks. Accessed March 30, 2017. 6. Directive 2009/136/EC of the European Parliament and of the Council of 25 November 2009 amending Directive 2002/22/ EC on universal service and users’ rights relating to electronic communications networks and services, Directive 2002/58/EC concerning the processing of personal data and the protection of privacy in the electronic communications sector and Regulation (EC) No 2006/2004 on cooperation between national authorities responsible for the enforcement of
consumer protection laws. Available at: http://eur-lex.europa. eu/legal-content/en/TXT/?uri¼CELEX%3A32009L0136. Accessed March 30, 2017. 7. Ornes S. Core concept: the Internet of Things and the explosion of interconnectivity. Proc Natl Acad Sci U S A 2016;113:11059-60. http://dx.doi.org/10.1016/j.jvs.2017.04.079
Reply Thank you for your interest and letter in response to the article “Google Maps offers a new way to evaluate claudication.” We agree that an objective assessment of walking distance is an important aspect in the evaluation of patients with claudication. We also appreciate the potential issues of the patient’s privacy and security when using Internet-based applications. Fortunately, with the method described in our study, the Google Maps application can be used securely by the physician and the patient to immediately determine walking distances, using a desktop or mobile device in the office, without the need to store any patient-level data online. We appreciate that this method has its limitations compared with GPS-based monitors that, in theory, avoid the potential of recall bias.
Husain Khambati, MD Prasad Jetty, MD Division of Vascular and Endovascular Surgery Ottawa Hospital and the University of Ottawa Ottawa, Ontario, Canada
http://dx.doi.org/10.1016/j.jvs.2017.07.069
Letters to the Editor
1309
Volume 66, Number 4
One unique way he kept in touch was by postcard. If he heard an interesting presentation, he would send me a postcard describing it. The practice of lunch with younger colleagues was so unique that I decided to do the same with younger surgeons who landed in Chicago. In addition to those mentioned in the article and Geza de Takats, there remain quite a few immigrant vascular surgeons who helped the development of vascular surgery in America. These are Henry Haimovici (RomaniaFrance), Leonel Villavicencio (Mexico), Hassan Najafi (Iran), Ramon Berguer (Spain), Enrico Ascher (Brazil), Anton Sidawy (Syria), Christopher Zarins (Latvia), Robert Linton (Scotland), and Charles Rob (United Kingdom). Each of these has made significant contributions to vascular surgery. It has been said that immigrants make up America and it is the land of opportunities. We all are fortunate to have been given the opportunity to develop vascular surgery in America. We succeed because of the rich resources, the strong support, and, most important, the generosity of Americans.
James S. T. Yao, MD, PhD Division of Vascular Surgery Feinberg School of Medicine Northwestern University Chicago, Ill
Roger T. Gregory, MD Department of Surgery Eastern Virginia Medical School Norfolk, Va (retired)
Walter J. McCarthy, MD Department of Cardiovascular-Thoracic Surgery Rush University Medical Center Chicago, Ill
William H. Pearce, MD Division of Vascular Surgery Feinberg School of Medicine Northwestern University Chicago, Ill
REFERENCES 1. Sterpetti AV, Ventura M. The role of immigrants to United States of America in the development of cardiovascular surgery. J Vasc Surg 2017;65:1528-30. 2. de Takats G. Symposium on venous problem: introductory remarks. In: Bergan JJ, Yao JS, editors. Venous problems. Chicago: Year Book Medical Publishers; 1978. p. 1-2. 3. dos Santos JC. Sur la désobstruction des thromboses artérielles anciennes. Mem Acad Chir (Paris) 1947;73:409-11. 4. Yao JS. Society for Vascular Surgery (SVS)dthe beginning. J Vasc Surg 2010;51:776-9.
5. Weinberg M Jr, Fell EH, de Takats G, McElwaine N. Use of homografts dispensed by Central Artery Bank of Chicago Heart Association. JAMA 1959;170:2132-4. 6. de Takats G. The subcutaneous use of heparin. A summary of observations. Circulation 1950;2:837-44. 7. Scupham GW, de Takats G, Van Dellen TR, Marcus PL. Vascular diseases: eighth annual review. Arch Intern Med (Chic) 1942;70:444-510. 8. de Takats G. Breach of etiquette and other short stories. Self published 1971. 9. de Takats G. Vascular surgery. Philadelphia: WB Saunders; 1959. http://dx.doi.org/10.1016/j.jvs.2017.06.091
Regarding “Google Maps offers a new way to evaluate claudication” We read with great interest the paper “Google Maps offers a new way to evaluate claudication” from Khambati et al.1 We do agree that Google Maps proposes a readily available GPS-based mapping tool that could be considered an accessible method of evaluating claudication. We are convinced that GPSbased determination of walking is of great interest in claudication.2,3 Nevertheless, one reason that we previously used an autonomous GPS data logger with no real-time transmission and local data analysis was related to potential privacy and security issues. In their recent paper screening 17,979 health-related applications, Mense et al4 concluded that 95% of these apps pose at least some potential damage through information security and privacy infringements, with >11% having the highest assessment of potential damage. The Privacy Rights Clearinghouse Association through a grant from the California Consumer Protection Foundation estimated in 2013 that 40% of apps are at high risk because of insufficient protection or sharing of personal data with a third party.5 The Association also estimated that the risk is particularly generally higher in free than in paid applications. Even institutional European administrations underlined that public sources of information can be exploited by potential adversaries, among which are free geographic data provided by Google Maps.6 In his recent review, Ornes7 recalled that the “Internet of Things” health care market would reach $117 billion by 2020 and that 5 million devices go online every day in 2016. Thereby, although the worldwide development of personal ePhone or tablets appears an attractive may to use personal tools for medical purposes by clinicians, we suggest that clinicians should rather focus on the use of a nonconnected data logger, allowing secured transmission (if any) and local (not Internet) analysis of geographic results.
1310
Journal of Vascular Surgery
Letters to the Editor
October 2017
Samir Henni, MD Vascular Investigational Department Teaching Hospital Center Angers, France
Pierre Abraham, MD, PhD Richard Vilret, MD Department of Physiology and Functional Investigations MitoVasc Institute Université Bretagne-Loire Angers, France
REFERENCES 1. Khambati H, Boles K, Jetty P. Google Maps offers a new way to evaluate claudication. J Vasc Surg 2017;65:1467-72. 2. Le Faucheur A, Abraham P, Jaquinandi V, Bouye P, Saumet JL, Noury-Desvaux B. Measurement of walking distance and speed in patients with peripheral arterial disease: a novel method using a global positioning system. Circulation 2008;117:897-904. 3. Le Faucheur A, Noury-Desvaux B, Mahe G, Sauvaget T, Saumet JL, Leftheriotis G, et al. Variability and short-term determinants of walking capacity in patients with intermittent claudication. J Vasc Surg 2010;51:886-92. 4. Mense A, Steger S, Sulek M, Jukic-Sunaric D, Mészáros A. Analyzing privacy risks of mHealth applications. Stud Health Technol Inform 2016;221:41-5. 5. Mobile health and fitness apps: what are the privacy risks? Available at: https://www.privacyrights.org/consumer-guides/ mobile-health-and-fitness-apps-what-are-privacy-risks. Accessed March 30, 2017. 6. Directive 2009/136/EC of the European Parliament and of the Council of 25 November 2009 amending Directive 2002/22/ EC on universal service and users’ rights relating to electronic communications networks and services, Directive 2002/58/EC concerning the processing of personal data and the protection of privacy in the electronic communications sector and Regulation (EC) No 2006/2004 on cooperation between national authorities responsible for the enforcement of
consumer protection laws. Available at: http://eur-lex.europa. eu/legal-content/en/TXT/?uri¼CELEX%3A32009L0136. Accessed March 30, 2017. 7. Ornes S. Core concept: the Internet of Things and the explosion of interconnectivity. Proc Natl Acad Sci U S A 2016;113:11059-60. http://dx.doi.org/10.1016/j.jvs.2017.04.079
Reply Thank you for your interest and letter in response to the article “Google Maps offers a new way to evaluate claudication.” We agree that an objective assessment of walking distance is an important aspect in the evaluation of patients with claudication. We also appreciate the potential issues of the patient’s privacy and security when using Internet-based applications. Fortunately, with the method described in our study, the Google Maps application can be used securely by the physician and the patient to immediately determine walking distances, using a desktop or mobile device in the office, without the need to store any patient-level data online. We appreciate that this method has its limitations compared with GPS-based monitors that, in theory, avoid the potential of recall bias.
Husain Khambati, MD Prasad Jetty, MD Division of Vascular and Endovascular Surgery Ottawa Hospital and the University of Ottawa Ottawa, Ontario, Canada
http://dx.doi.org/10.1016/j.jvs.2017.07.069