High Tech Surgeon

Intubation bot lets doctors safely shove tubes down unconscious human throats

2011-04-16T13:04:00.000-05:00

This may appear, at first glance, to be crazy... It just looks like a whole lot of stuff doing a task that is performed by mere humans every single day. But this is just another step towards the future of medicine. At first, this technology will be developed by folks interested in deploying medical robots into hostile environments. These robots will be controlled by their human counterparts. Eventually they will be autonomous. I guarantee...

from Engadget by Michael Gorman

Intubation bot lets doctors safely shove tubes down unconscious human throats: "

We've seen all manner of medical robots 'round these parts, from bloodbots to surgical cyborgs. And now Dr. Thomas M. Hemmerling from McGill University Health Centre (who also helped develop the McSleepy anesthetic android) has created the world's first intubation robot. Called the Kepler Intubation System (KIS), it's a robotic arm with a video laryngoscope that's controlled via joystick -- allowing MDs to get their Dr. Mario on while sliding an endotracheal tube into any passed-out meatbag with minimal fuss and maximum safety. The first procedure using the device on a real, live human was a success, and clinical testing continues. We're not big on bots shoving anything anywhere (even if it does help us breathe while under the knife), but that's better than android appendages lobbing grenades our way.

Intubation bot lets doctors safely shove tubes down unconscious human throats originally appeared on Engadget on Sat, 16 Apr 2011 12:47:00 EDT. Please see our terms for use of feeds.

Permalink | McGill University Health Centre | Email this | Comments"

New DNA nanoforms take shape

2011-04-15T09:54:00.000-05:00

Holy Cow! There are some darn smart people in this world.

from KurzweilAI.net Accelerating Intelligence News

New DNA nanoforms take shape: "

2D nanoforms (top) with accompanying images of the resulting 3D structures (credit: The Biodesign Institute Arizona State University)

A team at Arizona State University’s Biodesign Institute has expanded the capability of DNA origami to construct arbitrary 2-D and 3-D shapes, mimicking those commonly found in nature.

The designers began by making simple 2-D concentric ring structures, each ring formed from a DNA double helix. The concentric rings are bound together by means of strategically placed crossover points. These are regions where one of the strands in a given double helix switches to an adjacent ring, bridging the gap between concentric helices. Such crossovers help maintain the structure of concentric rings, preventing the DNA from extending.

Varying the number of nucleotides between crossover points and the placement of crossovers allows the designer to combine sharp and rounded elements in a single 2D form. The network of crossover points can also be designed to produce combinations of in-plane and out-of-plane curvature, allowing for curved 3D nanostructures.

Combining the method of concentric helices with non-B-form DNA (with 9-12 base pairs/turn) enabled the team to produce sophisticated forms, including spheres, hemispheres, ellipsoid shells, and a round-bottomed nanoflask.

Ref.: Hao Yan & Yan Liu et al., DNA Origami with Complex Curvatures in Three-Dimensional Space, Science, April 15, 2011

How I Learned to Stop Worrying and Love the (EHR) Bomb

2011-03-28T10:46:00.000-05:00

This is fair and balanced ----

From The Health Care Blog

How I Learned to Stop Worrying and Love the (EHR) Bomb: "

By MARGALIT GUR-ARIE

Remember the fear mongering rhetoric about weapons of mass destruction and all sorts of other bogey men that sometimes led to war death and true destruction and other times to just animosity, hatred and counterproductive waste of time and resources?

This is exactly what we are witnessing today in Health Information Technology (HIT). Granted this is only a sideshow, while the main stage is occupied by the unprecedented Federal push to computerize medicine, but it has a very shrill voice and it seems to be confusing many good people. There are many legitimate questions that need to be asked, many strategies that should be debated, many errors that must be corrected, but the unsubstantiated, dogmatic and repetitive accusations directed towards HIT in general, EHR in particular, and chiefly at technology vendors and their employees, are borderline pathological in nature.

To be clear here, there are many practicing physicians and nurses who are either forced by an employer to use an EHR they dislike, have tried to use an EHR and didn’t enjoy the experience, or are opposed to the EHR concept on principle because the software has no return on investment in their situation, is not “ready for prime time” or is too closely aligned with the goals of the Federal government. These are all valid points of view and should be listened to and considered by policy makers as well as technology builders, and I have to confess that I do agree with much of what these practicing folks write and say, and as I said many times in the past, practicing physicians, i.e. those who see patients every day, are dangerously underrepresented in all HIT policy and technology decisions being made now at a federal level. Unfortunately, the practicing doctors’ message is being obscured and tainted by the “naysayers who predictably and monotonically chant the “HIT is evil” mantra at every opportunity” (quoting the famed HIT blogger, Mr. Histalk). These “self-proclaimed experts” and their incendiary and largely self-serving monologues are making it very easy to dismiss legitimate problems present in HIT policy and technology.

The #1 allegation against EHRs and those who build them is probably the one contending that EHRs kill people. HIT is supposedly an unauthorized human subject experiment which should be halted due to so many deaths and injuries. There is no evidence to support this assertion. Yes, there are several deaths documented, which have been associated with EHR software in one way or another, all in hospitals, but there is no documented evidence of mass injuries. The ugly truth is that people die in hospitals due to preventable errors of all types. They died before EHRs were introduced and they are still dying at similar rates after EHRs were installed. For every error attributed to software malfunction, there is a parallel error that can be attributed to lack of software or utilization of paper charts in general. For example, a software bug could cause records to end up in the wrong chart. How many times do paper records get filed in the wrong chart? How many times do paper records get misplaced never to be found again? How many times do paper charts disappear for long periods of time? Of course since paper is a passive medium, all errors arising from paper charts usage are directly attributable to users. When an EHR is used, some errors, not all and not most, are attributable to the software. Ergo, EHRs kill people while prior to EHRs people killed people. Net effect is the same, although fixing software bugs is a lot easier than remediating people’s error prone behaviors.

The #2 inflammatory allegation is squarely directed at the business entities that build and sell EHRs, and individually towards anybody associated with IT, whether at a hospital level or a vendor level. Supposedly, these dim-witted IT folks have no understanding of medical practice and a complete disregard for patient safety and human lives. I have no doubt that some IT folks would not score very well on Mensa tests and others may have little interest in anything other than their paycheck, and this is true about any randomly selected group of people, including clinicians. However, EHR vendors are for-profit technology companies, and as such have an overriding interest in creating revenue. You do not benefit your long term top-line by purposely selling defective products. Suggestions that EHRs should be produced by non-profits are a bit naive considering that this is health care we are talking about, and we all know how selfless, charitable and patient safety oriented other non-profits are in this industry. I would also like to point out the few and far between health care providers who are willing to treat Medicaid patients due to financial and business considerations. How are the sacred patient safety and human life considerations ranked by those providers? I would assume they come in right after staying in business, keeping the doors open and perhaps even an acceptable profit level. EHR vendors are no different.

As to hospital IT folks, the ones I had the pleasure of meeting always listed patient safety as their main concern. Was it just lip service? I don’t think so, but all I have is anecdotal evidence. In any case, the incompetence and profit concerns of hospital administrators who drive EHR deployments in hospitals and health systems, to the extent that they exist, are not indicative of HIT being murderous or evil. They are indicative of the need for transparency and learning from those that manage to deploy the same HIT tools successfully, and those do exist.

Moving on to #3, we find the widespread platitude contending that EHRs should be built “by doctors for doctors”. Guess what? Many are, and it doesn’t make those EHRs any better. Amongst the larger EHR vendors, there is none that does not employ physicians and some have dozens of MDs on staff and hundreds of other clinicians. Many medium and smaller EHR companies were founded, and some are still owned, by physicians. There are two issues here. One is that most physicians fully employed by technology companies are not practicing anymore and I am not certain they ever did after residency. I have personally witnessed multiple times the huge disconnect between the professional IT physicians and those seeing 30 patients each day. Couple that with the “I’m a doctor, so I know best” attitude, and you are guaranteed an academic product that will have little value in the “real world”. The second issue is that most physicians know as much about IT as engineers know about medicine. With very few exceptions, commercial EHRs should not be built by doctors as a side hobby. They should be built by professional software designers and builders with extensive input and guidance from customers, just like quality products are built in all other industries. And by customers, I don’t mean “ivory tower informatics experts” who happen to have an MD after their name. I mean hard working, six days a week, frazzled and discouraged, practicing doctors and nurses.

Finally the #4 issue is the perpetual cry from various quarters that EHRs should come under FDA supervision. I strongly agree. Any instrument used in the delivery of medical care should be supervised to an appropriate degree, and maybe such transparent supervision would put an end to the fictional assertions that EHRs are guilty of mass murder. Done right, FDA supervision will definitely help folks make better product choices and deploy and use EHR technology in more beneficial ways. With the recent proliferation of “certified” EHRs, triggered in large part by the glow of HITECH money, FDA supervision could also serve to separate the wheat from the increasing amounts of chaff. It is also useful to remember that people are killed every day by FDA approved drugs and devices due to improper use, human error, negligence, criminal intent and product faults that the FDA missed.

In conclusion I would be remiss if I did not mention the multiple legitimate complaints regarding EHR usability and utility. While there is much work to be done, many errors to be addressed and much technology innovation to be applied, the form and function of EHRs is ultimately dictated by the environment in which they are used. The business of medicine (a.k.a. billing) dictated most of the box-clicking nature of older EMRs and the new population health, cost cutting and research focus emanating from the Federal government will just increase the demand for structured data elements and the accompanying clicking on boxes. EHR vendors will build whatever customers are willing to buy. It is infinitely easier to build an EHR without click-boxes and templates, than it is to build one that records and maintains hundreds of templates, customizations, vocabularies, cross-walks, guide-lines, protocols and analytics to slice and dice everything. Vendors would be more than happy to just give you a blank text box where you can type, scribble or dictate to your heart’s content. But guess what every single physician looking to buy an EHR is asking right after the price question? “How many templates does your system have for my specialty?” The structure of EHRs is a symptom of quite a different problem and it will not be resolved until the root cause is addressed. So the lunatic fringe notwithstanding, EHR vendors are not out there to torture you or kill your patients. They are out there to sell you products and services and make some money in the process – just like Apple, Microsoft, Google, IBM, and you – and they build the products based on what the customer says he wants and what the Government says they must.

And no, you don’t have to buy one if you choose not to………

Margalit Gur-Arie was COO at GenesysMD (Purkinje), an HIT company focusing on web based EHR/PMS and billing services for physicians. Prior to GenesysMD, Margalit was Director of Product Management at Essence/Purkinje and HIT Consultant for SSM Healthcare, a large non-profit hospital organization. She shares her thoughts about HIT topics and issues at her blog, On Healthcare Technology.

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RhinoChill Non-Invasive Head Cooling System Poised For European Market Introduction

2011-02-09T13:13:00.000-06:00

This looking at this makes me feel like I am having the worst brain freeze of my life!

Story from Medgadget:

RhinoChill Non-Invasive Head Cooling System Poised For European Market Introduction: "

BeneChill (San Diego, CA) has partnered with Medtronic's Physio-Control division to release the RhinoChill IntraNasal Cooling System in Europe. As the name implies, RhinoChill cools the head and body via a nasal catheter and is designed for fast application on patients status post cardiac arrest, stroke or traumatic brain injury. The companies have also announced plans to develop 'additional applications for BeneChill and work towards making the RhinoChill System available in the U.S.'

More about the RhinoChill from a Medtronic press release:

The RhinoChill System uses a non-invasive nasal catheter that sprays a rapidly evaporating, inert coolant liquid into the nasal cavity, a large area situated beneath the brain that acts as a heat exchanger. As the liquid evaporates, heat is directly removed from the base of the skull and surrounding tissues via conduction and indirectly through the blood via convection.

The system is battery-powered, compact and does not require refrigeration, making it ideal for use in pre-hospital settings. Each coolant bottle holds enough liquid to cool a patient for 30 minutes at nominal flow, and bottles can be easily exchanged to maintain the cooling process.

A recently-published European clinical study4 has shown that when administered by Emergency Medical System (EMS) personnel as soon as they reach a cardiac arrest victim and continued during transport to hospital, the RhinoChill System effectively reduces body temperature by the time the victim reaches the hospital. Survival without loss of brain function was significantly improved in patients where resuscitation procedures and subsequent RhinoChill cooling were initiated within ten minutes of cardiac arrest, compared with patients who were not cooled in the pre-hospital setting.

Product page: RhinoChill Intra-Nasal Cooling System...

Press release: Physio-Control and BeneChill Partner to Bring Portable Therapeutic Hypothermia Solution to Market...

Flashback: RhinoChill Intra-Nasal Cooling System Effectively Chills Brain After Cardiac Arrest

SpineAnalyzer That Spots Bad Vertebrae Gets U.S. Clearance

2011-02-08T12:39:00.000-06:00

The domain of diagnostic radiology is ripe for decision support tools and virtual reality augmentation. There are huge numbers of images captured at locations that lack immediate expert radiologic services, especially in under-served areas and third world nations. Telemedicine alone isn't going to solve the need to augment the clinician at the point of care. Rather, sophisticated computerized imagery interpretation will eventually be an inexpensive tool that will elevate the non-radiologist clinician to a point that they can provide safe and accurate interpretations. Trust me on this one... it will happen. Below is just one example that is already on its way:

Story from Medgadget:

SpineAnalyzer That Spots Bad Vertebrae Gets U.S. Clearance: "

Mass High Tech is reporting that Optasia Medical out of Sudbury, MA received 510(k) clearance from the FDA for its SpineAnalyzer X-ray analysis software. The system can help identify deformed vertebrae between T4 and L4.

About the SpineAnalyzer from the product page:

SpineAnalyzer™ helps identify even subtle vertebral deformities by efficiently and comprehensively annotating spinal anatomy. This unique software workflow solution enables rapid and reproducible assessment of the accepted quantitative standard (6-point morphometry), by providing full, easily editable contours outlining vertebral shape. The software employs a proprietary statistical model-based image analysis technique, which uses simple manual single-point initialization to automatically segment the lateral vertebral margins of the spine on selected vertebrae from T4 to L4. SpineAnalyzer™ produces a report that shows deformed vertebrae and permits the physician to compare these to a report from other time-points.

Annotating vertebraeDeformity results table Workflow facilitation

SpineAnalyzer™ is designed to fit seamlessly into the existing workflow of scoring lateral spine images for vertebral deformity. On a PC with access to the x-ray or VFA (DXA) images from either PACS, DICOMDIR or network files, the clinician performs the following steps:

* Selects patient and displays lateral spine x-ray or VFA images.

* With a single click per vertebra, labels the vertebrae of interest. Any vertebrae between T4 and L4 can be analyzed.

SpineAnalyzer™ then performs the following steps:

* Automatically annotates vertebral body margins and places points for 6-point morphometry.

* Allows clinician to review validity of annotations and make corrections as needed.

* Grades the severity of deformity.

* Facilitates the reporting of SQ scoring and differential diagnosis.

* Produces a PDF format report and allows optional export of analysis data.

Product page: SpineAnalyzer...

Mass High Tech: Optasia gets FDA clearance on spinal imaging analyzer...

"Skin Gun" Uses Autologous Skin Cells to Heal Severe Burns in Days, Not Weeks

2011-02-04T07:45:00.000-06:00

This could be one of the single most important medical revolution of the decade, if not the last 25 years or more!

Story from Medgadget:

"Skin Gun" Uses Autologous Skin Cells to Heal Severe Burns in Days, Not Weeks: "

Currently when treating a burn victim, it can take weeks to generate an autologous skin graft when one is necessary to treat the affected areas. However, a team of researchers at the McGowan Institute for Regenerative Medicine have developed a new treatment which can reduce this time to just a few days. The researchers harvest healthy skin from the patient and use a 'skin gun' to spray the patient's own skin stem cells onto the wound. Following application of the autologous cells, the researchers used an artificial vascular system to further speed up the healing process by nourishing the stem cells.

From the McGowan Institute:

The expected protocol when a patient arrives at a hospital missing a sizable portion of skin would be as follows: Surgeons take a sample from a healthy piece of skin and isolate skin cells, including skin stem cells, using a method Gerlach and his colleagues developed.

Then the skin gun comes into play. A surgeon loads the stem cells into a sterile syringe, loads the syringe into the nozzle like a cartridge, and sprays the cells through the nozzle directly onto the wound.

Lastly, the other essential part of the Gerlach process is an innovative wound dressing. Enmeshed in what looks like a traditional dressing are tubes that are part of another bioreactor. Tubes extend from each end of the dressing—one does the work of an artery, the other a vein. When connected to an “artificial vascular system” the bioreactor bandage distributes glucose, sugar, amino acids, antibiotics, and electrolytes to the treated area. It cleans the wound, provides nutrition, and better supports the precious stem cells in the wound until they start to grow and regenerate new skin for the patient.

Press release: Burn Therapy: A Regenerative Medicine Approach

(hat tip: Kotaku)

Megaframe Imager takes its one million frames-per-second capabilities to the medical world

2010-11-29T07:22:00.000-06:00

Now this is truly going to be disruptive! .. Story from Engadget Alt:

Megaframe Imager takes its one million frames-per-second capabilities to the medical world: "The iconic Megaframe Imager has been kicking for a good while now, but gurus have been scratching their heads in an effort to figure out how to best take advantage of a sensor that can capture one million frames per second. A European consortium made up of the NPL, ST Microelectronics, the University of Edinburgh, and TU Delft have something in mind, and not surprisingly, it's in the medical realm. Researchers are currently looking to use this here device in 'cellular / sub-cellular imaging; neural imaging; biochemical sensors; DNA / protein microarray scanning; automotive collision studies; and high-sensitivity astronomical observations,' and for the first time, tests are proving that it could be a vital tool in the future of biosensing. Tangled in technobabble? Here's the long and short of it: a crew has demonstrated 'detection of viral DNA binding events using fluorescence lifetime imaging at the very low target concentrations relevant in biosensing applications with acquisition times of less than 30 seconds,' something that should be useful in disease screening, mutation and forensic analysis. So much for escaping the jargon, huh?

Megaframe Imager takes its one million frames-per-second capabilities to the medical world originally appeared on Engadget on Sun, 28 Nov 2010 23:59:00 EST. Please see our terms for use of feeds.

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Ultrasound Gets More Portable

2010-11-29T06:45:00.000-06:00

Phone, meet probe: An image of a fetus at 23 weeks is displayed on Mobisante’s phone-based ultrasound device. The probe connects to the device through a USB port.
Credit: Mobisante

This story "Ultrasound Gets More Portable" from Technology Review.com feature the ying and yang of medical technology. First the ying. As computing power improves, so will continue the miniaturization of ultrasound. This will translate into improved imaging. This will eventually make it so easy to read that all physicians will be able to use the technology without the assistance of a radiologist. Combine that with the rapidly decreasing cost of the technology itself, and you have truly disruptive innovation.

Now the yang. Marketers who grope for something to sell the product. Case in point, this quote from the article:

"Such a device would be useful for emergency responders, who could scan an injured person to detect internal bleeding or other trauma, and then immediately send an image to the hospital so physicians could be better prepared for the patient's arrival. Or a nurse practitioner visiting a pregnant woman's home could ask a specialist stationed elsewhere to weigh in on anomalies in the scan."

Really? Does this come quote come from the writer or from Mobisante? I don't know. But what it features is a lack of understanding about patient care. First. It would NEVER be used "so physicians could be better prepared for the patient's arrival". This is a common mis-application of technology. People continue to push this concept, and to date, I have not seen anything help a patient past getting the bleeding stopped, airway secured, and quickly transported to the most capable hospital. I can tell you flat out, no matter what that image looks like, the resources at the hospital will remain the same and the patient will undergo the same, immediate, well rehearsed trauma assessment despite the image. The second statement, "a nurse practitioner..." is a potential use, but still unlikely within the confines of the U.S.. However, it could be widely used in deeply rural areas in the U.S. or in third world nations.

The fact is, it's best and biggest markets will be for physician teams that deliver charitable and humanitarian care around the world. Additionally, it could be very useful for the military delivery of medical and surgical care in theaters of war. But my first point remains. That is, this is an area (ultrasound technology) that is poised to be disruptive. Improve the imaging. Give the practitioner computerized support that makes it easy to interpret the image. That's when the game will change.

Ardian's Hypertension Treatment Outperforms Traditional Medical Treatment in Clinical Trial

2010-11-17T14:45:00.000-06:00

Story from Medgadget:

Ardian's Hypertension Treatment Outperforms Traditional Medical Treatment in Clinical Trial: "

Mountain View, CA based Ardian Inc. has announced the results of a six month study which evaluated the company's Symplicity Catheter System for treatment of chronic drug resistant hypertension. The study compared the outcomes of patients taking three or more antihypertensive drugs to those treated with the Symplicity. The results of the study, reported in the Lancet, demonstrated that a six month treatment with Ardian's technology proved more effective than traditional medical treatment in patients with sustained grade 2 hypertension (baseline SBP of 160 mm Hg or more). The Symplicity System is a catheter-based low-power radiofrequency (RF) renal denervation device, thought to permanently treat hypertension by reducing or eliminating the sympathetic innervation of the renal arteries, hence 'reducing both the pathologic central sympathetic drive to the kidney and the renal contribution to central sympathetic hyperactivity.'

More from the press release:

The Symplicity HTN-2 trial was an international, multi-center, prospective, randomized, controlled study of the safety and effectiveness of renal denervation in patients with uncontrolled hypertension. One hundred-six patients were enrolled from 24 investigational sites. At baseline the randomized treatment and control patients had similar high blood pressures: 178/97 mmHg and 178/98 mmHg, respectively, despite both receiving an average daily regimen of five antihypertensive medications. After six months, the average blood pressure of the renal denervation group was reduced to 146/85 mmHg, compared to an average blood pressure of 179/98 mmHg for the control group.

The study also found that the therapy was safe, with no serious device or procedure-related events, no cardiovascular complications and no kidney-related complications.

Study summary at The Lancet: Renal sympathetic denervation in patients with treatment-resistant hypertension (The Symplicity HTN-2 Trial): a randomised controlled trial

Company's press statement: Ardian's Catheter-Based Treatment for Hypertension Demonstrates Substantial and Sustained Blood Pressure Reduction in Landmark Randomized Clinical Trial...

Product page: Symplicity Catheter.."

Mirador Gets FDA OK for Two Needle Pressure Devices

2010-10-28T07:40:00.001-05:00

We are now in the era of "Comparative Effectiveness"... but will our push for comparative effectiveness be diametrically opposed to our ongoing efforts to improve patient safety? I don't think the two need to be mutually exclusive as long as we ask the right questions and answer them honestly. So I ask... Do we need a pressure device for placement of every central venous line? To answer this question, we need to know a few things. First, what is the incidence of arterial puncture? Second, what is the cost of this complication?

In 2003, McGee published a review in the New England Journal of Medicine (N Engl J Med 2003;348:1123-33) on preventing complications of central venous catheterization. He notes that over 5 million central venous catheters (CVCs) are placed every year in the United States (It can only be more at this time) and that arterial puncture occurs in 6.3 to 15 percent of placements (depending on site of access). That would mean there are as many as 750,000 arterial punctures every year. Unfortunately, what we don't know is the cost of this complication. From my own experience, the vast majority (well over 98%) experience no clinical adversity from this event. In other words, the puncture does not lead to any need for additional medical treatment. That would leave (by my own estimate), approximately 15,000 patients per year across the country that would require some intervention. Usually that intervention would require a surgical procedure, who's cost is difficult to estimate (includes all the direct costs as well as indirect costs of increased hospital length of stay).

So I ask. Is this device necessary? How can we possibly know if the right studies and questions aren't asked and answered. I would like to know the answer, because my mission is to apply technology to improve patient safety while decreasing the cost of medicine. I believe that is exactly what well applied technologic innovation will do. There are others that believe technology is the root of the increasing cost burden to medicine. They will be proven correct if we continue to make technologies that don't address the needs of modern healthcare. New technologies should be created that decrease cost BY improving patient safety.

From Medgadget:

Mirador Gets FDA OK for Two Needle Pressure Devices: "

Here's an interesting simple technology that might come handy to anesthesiologists and others who tend to do lots of central lines. Making sure that you are not in a carotid (or subclavian or femoral arteries, etc) is not always as simple as many think. Sure, you can do a blood color comparison. You can also connect a vertical column, and see how far the blood will rise. But why to do these maneuvers, if you can have something at the end of a finder needle that does not add steps to your procedure? Meet Mirador Biomedical of Seattle, Washington that has just received FDA's 510(k) clearance for its Compass Vascular Access pressure measurement device, as well as a similarly designed Compass Lumbar Puncture pressure monitor.
From the Compass Vascular Access product page:

Focus on the Procedural Site

View your hands, the patient and the pressure without additional cabling, operators or connections
Integrate Seamlessly with Needles and Syringes
Easily incorporated into the Seldinger technique for inserting catheters
Eliminate “Blind” Guidewire Insertion
The port allows insertion of the guidewire while monitoring the pressure
From Compass Lumbar Puncture product page:

Indication of CSF Entrance:
Entrance into the target space is indicated by a pressure increase.
Seamless Integration with LP Needles:
The CompassTM LP connects to standard Lumbar puncture needles.
Immediate and Continuous Measurement of Opening Pressure:
View the pressure continuously without additional cabling, operators or connections.

Press release: Mirador Biomedical, developing the innovative Compass™ family of disposable medical devices, announced FDA 510(k) clearance of its two leading products... (.pdf)
Product page: Compass pressure measurement devices..."

Break Dancing with Intuitive Surgical's da Vinci Robot

2010-10-21T18:10:00.000-05:00

This is actually pretty funny and ... I would say this is actually good old fashion smart marketing.

Link from Medgadget:

Break Dancing with Intuitive Surgical's da Vinci Robot: "

Methodist Hospital of Henderson, Kentucky made quite a stylin' video promoting their da Vinci robot suite. This is really as cool as music videos of medical technology get. Enjoy:

Link: Methodist Hospital...

Medgadget's da Vinci archives...

Thanks to an anonymous reader for the tip..."

First all-robot surgery performed at McGill University

2010-10-21T08:54:00.000-05:00

Story From Engadget:

First all-robot surgery performed at McGill University: "

A team of surgeons at McGill University, including the da Vinci robo-surgeon and a robot anesthesiologist named, of all things, McSleepy, recently removed some dude's prostate during what is being billed as the world's first all-robotic surgery. The device transmits hi-def 3D images to a nearby workstation, where it is controlled by surgeons 'with a precision that cannot be provided by humans alone,' according to MUHC urologist-in-chief Dr. A. Aprikian. Of course, the robots are being kept on a tight leash by their human operators, with McGill's Dr. Thomas Hemmerling pointing out that '[r]obots will not replace doctors but help them to perform to the highest standards.' Just tell that to all the other medical robots we've seen in this space, eh, doc? We've heard they have plans. Bad plans.

Continue reading First all-robot surgery performed at McGill University

First all-robot surgery performed at McGill University originally appeared on Engadget on Wed, 20 Oct 2010 21:29:00 EDT. Please see our terms for use of feeds.

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Philips IntelliVue MX800 Brings Patient Data to One Screen

2010-10-12T16:37:00.000-05:00

WOW! It's.... another monitor :( ... I find it fascinating that EMR companies have failed to identify THEY are the hub and need to engage in the monitoring / clinical display business OR that the monitor companies have failed to buy a major EMR player and get into that business. Either way BOTH industries continue to dither along and act as if they are going to magically communicate with each other via HL7 or "embedded informatics platforms". FAIL FAIL FAIL. This area of clinical informatics remains wide open for the right player with real vision to capture the future. But who will it be? It isn't going to be Philips (that's just my personal opinion).

Philips IntelliVue MX800 Brings Patient Data to One Screen: "

Philips has introduced a new patient monitor, the IntelliVue MX800, that provides common vital sign data, but that can also display information coming from any other hospital database. The product essentially acts like a bridge that can deliver together patient information from different sources right to the point of care.

From the announcement:

The MX800 also enables applications to run natively on the embedded informatics platform while keeping the real time patient monitoring separate and protected. This allows clinicians to easily view patient data from sources such as electronic medical records (EMRs), imaging studies and other clinical applications, helping to save caregivers' time and aid in clinical decision making at the point of care.
Designed to facilitate more effective care delivery, the Philips IntelliVue MX800 delivers advanced clinical decision support and workflow applications. With access to a wider range of clinical information, the system presents clinicians with meaningful point of care information that may enable the earliest possible medical intervention. Access to this critical information is essential as healthcare facilities seek new and efficient ways to keep closer track of patients' status and better manage their care, whether in critical care settings or as patients are stepped down to general wards.
The IntelliVue MX800 is embedded with Philips' industry-standard informatics platform to deliver more valuable information without making any significant changes to the existing hospital environment. For the clinician, it is based on the familiar, easy to use IntelliVue user interface and applications, and its wide touch screen designed with smooth surfaces and a minimum number of seams, making it easy to clean and reducing the risk of cross-contamination.

Press release: Philips Introduces New Patient Monitoring System Enabling Easy Access to Patient Information and Facilitating Effective Care Delivery..."

MIT Medical Lab Mirror tells your pulse with a webcam (video)

2010-10-07T10:43:00.000-05:00

This is more important than it appears. ICU's are awash with tubes and wires that become abruptly dislodged for any number of reasons. Having the ability to monitor patients sans wires will be a great leap forward.

Story from Engadget:

MIT Medical Lab Mirror tells your pulse with a webcam (video): "

Mirror mirror on the wall, who has the highest arterial palpation of them all? If you went to MIT you might be able to answer that question thanks to the work of grad student Ming-Zher Poh, who has found a way to tell your pulse with just a simple webcam and some software. By looking at minute changes in the brightness of the face, the system can find the beating of your heart even at a low resolution, comparable to the results of a traditional FDA-approved pulse monitor. Right now the mirror above is just a proof of concept, but the idea is that the hospital beds or surgery rooms of tomorrow might be able to monitor a patient's pulse without requiring any wires or physical contact, encouraging news for anyone who has ever tried to sleep whilst wearing a heart monitor.

Continue reading MIT Medical Lab Mirror tells your pulse with a webcam (video)

MIT Medical Lab Mirror tells your pulse with a webcam (video) originally appeared on Engadget on Thu, 07 Oct 2010 11:12:00 EDT. Please see our terms for use of feeds.

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Bioconnect Optiflow Vascular Anastomotic System CE Approved

2010-09-21T15:20:00.000-05:00

Story from Medgadget:

Bioconnect Optiflow Vascular Anastomotic System CE Approved: "

Vascular access is of utmost importance in patients on hemodialysis. Usually it involves a vascular surgeon creating an arteriovenous shunt, which is a precarious operation that takes great skill. Bioconnect Systems has received CE approval in Europe for a little device, the Optiflow, that might make creating vascular access faster and easier. The Optiflow is a T-shaped device that is inserted into the end of a vein on one side, while the other side is inserted and anchored into the wall of an artery through a tiny incision. There is no manually sutured anastomosis involved. After implantation there is immediate high flow and sealing. An animation showing implantation of the device is available below.

Press release: Bioconnect Systems Gains CE Mark Approval for Optiflow Anastomotic System...

Product page: Bioconnect Systems...

Pump to Push Drugs Through Microneedle Patch

2010-08-31T12:11:00.000-05:00

Story from Medgadget:

Pump to Push Drugs Through Microneedle Patch: "

Many drugs that would benefit from transdermal delivery are either made of molecules too large to penetrate the skin or are hydrophilic and so don't absorb very well. To overcome these limitations, Purdue University scientists have created a pump to literally push drugs through microneedles of 20 micron diameter. The pump requires no batteries and is activated by pushing your finger against it for about twenty seconds.

The pump contains a liquid that boils at body temperature so that the heat from a finger's touch causes it to rapidly turn to a vapor, exerting enough pressure to force drugs through the microneedles.

The liquid is contained in a pouch separated from the drug by a thin membrane made of a rubberlike polymer, called polydimethylsiloxane, which is used as diaphragms in pumps.

Researchers have filed an application for a provisional patent on the device.

Ziaie has tested prototypes with liquids called fluorocarbons, which are used as refrigerants and also in semiconductor manufacturing.

Press release: New pump created for microneedle drug-delivery patch

First Real-Time MRI of Moving Organs and Joints

2010-08-31T07:12:00.000-05:00

Story from Medgadget:

First Real-Time MRI of Moving Organs and Joints: "

Moving MRI images of the heart and other organs are nothing new. However, up until now these were always reconstructed afterwards by combining signals and images from the same cardiac phase acquired during breath-holding into the resulting images. Researchers at the Max Planck in Göttingen have now proven it is possible to acquire images in real-time with up to fifty frames per second. Previously it was only possible to acquire images at a maximum rate of about one per second. They have used a combination of fast low angle shot (FLASH) gradient-echo imaging sequences, radial encoding and an iterative image reconstruction by regularized nonlinear inversion to greatly speed up imaging acquisition. The main improvement lays in the iterative reconstruction which has previously been used for reducing CT radiation dose, but has now shown to be very useful in MRI as well. For example, the images of a cross-section of the heart shown above were acquired at 33 milliseconds per image giving a framerate of 30 images per second, with an in-plane resolution of 1.5 millimeters and a slice thickness of 8 millimeters. Linked in the press release is a video of the beating heart and an impressive movie of movements during speech production. The possibility to do real-time dynamic imaging opens up a lot of new opportunities for MR imaging, including, for example, swallowing studies, cardiac and abdominal imaging without breath-holding and interventional procedures using MRI. In principle this technique is possible to implement on most current scanners, however the main limitation is the amount of computing power required to perform the real-time reconstruction. Currently one minute of images requires half an hour to process. However, the authors expect improvements in the image reconstruction algorithms for parallelized GPU's and other improvements to reduce reconstruction time and improve image quality. The results are published online in the journal NMR in Biomedicine.

Make sure to check out this jaw dropping video:

Press release: Going live to the beating heart...

Article abstract: Real-time MRI at a resolution of 20 ms...

Equinox's SutureAssist Aims to Improve Surgical Workflow and Patient Safety

2010-08-17T15:32:00.000-05:00

Reduce operative time by up to 30 percent?

Improve Patient Safety?

Decrease malpractice?

Decrease liability?

Reduces trauma and bleeding?

Wow... Does it also wash the dishes?

It's a box!

Maybe this company would like to show this surgeon the data. Personally, I find this type of marketing insulting to my intelligence. I think the product is nifty. I would maybe even find it nice to use. But after watching this video ... not a chance.

Story from Medgadget:

Equinox's SutureAssist Aims to Improve Surgical Workflow and Patient Safety: "

Reno, NV based Equinox Surgical Solutions has launched the SutureAssist, a device which allows for easier one-handed retrieval of sutures during surgery by holding suture trays in place. Equinox claims that using the device can reduce operative time by up to 30 percent (!?), which, if true, can translate to greater patient safety and cost savings for both patients and hospitals.

From the product page:

SutureAssist™ is a unique, stable, housing device for the retention and dispensing of prepared needles and sutures. As the needle trays are secured within the SutureAssist™, the scrub tech, with a single hand and without movement of the suture tray and needles, can confidently use the needle-driver to dislodge the needle, free from twisted or entangled sutures.

Through its ergonomic design as a needle park, SutureAssist™, was engineered to facilitate in providing the surgeon with the armed needle-holder and solves the problem of quickly dislodging the needle from the lightweight tray without disturbing its position on the Mayo stand.

Press release: Equinox Surgical Solutions Launches Flagship Product, SutureAssist®...

Product page: SutureAssist™...

MIT Researchers Use Raman Spectroscopy for Noninvasive Blood Glucose Measurements

2010-08-11T08:44:00.000-05:00

Story from Medgadget:

MIT Researchers Use Raman Spectroscopy for Noninvasive Blood Glucose Measurements: "

Researchers at MIT's Spectroscopy Laboratory have announced that they are currently working on a Raman spectroscopy machine which can measure blood glucose without a blood sample. The machine sends infrared light through the skin to determine glucose levels in the interstitial fluid. In a paper published in the July 15 issue of Analytical Chemistry, the researchers described their algorithm for determining blood glucose levels based on the interstitial concentration.

From MIT's press release:

Researchers in the Spectroscopy Lab have been developing this technology for about 15 years. One of the major obstacles they have faced is that near-infrared light penetrates only about half a millimeter below the skin, so it measures the amount of glucose in the fluid that bathes skin cells (known as interstitial fluid), not the amount in the blood. To overcome this, the team came up with an algorithm that relates the two concentrations, allowing them to predict blood glucose levels from the glucose concentration in interstitial fluid.

However, this calibration becomes more difficult immediately after the patient eats or drinks something sugary, because blood glucose soars rapidly, while it takes five to 10 minutes to see a corresponding surge in the interstitial fluid glucose levels. Therefore, interstitial fluid measurements do not give an accurate picture of what's happening in the bloodstream.

To address that lag time, Barman and Kong developed a new calibration method, called Dynamic Concentration Correction (DCC), which incorporates the rate at which glucose diffuses from the blood into the interstitial fluid. In a study of 10 healthy volunteers, the researchers used DCC-calibrated Raman spectroscopy to significantly boost the accuracy of blood glucose measurements - an average improvement of 15 percent, and up to 30 percent in some subjects.

Press release: Shining a light - literally - on diabetes...

Abstract of the researchers' paper: Accurate Spectroscopic Calibration for Noninvasive Glucose Monitoring by Modeling the Physiological Glucose Dynamics

Implantable blood sugar sensor could eliminate daily finger pricks

2010-08-07T17:25:00.000-05:00

Can you imagine a bunch of diabetics running around glowing green?... hmmmmm..

Story from Engadget:

Implantable blood sugar sensor could eliminate daily finger pricks: "

Science has been figuring out ways to sidestep those dreaded finger pricks for years now, but it's not often that we hear of such a permanent solution as this. A crew of researchers from The University of Tokyo and BEANS Research Institute are in the process of developing a newfangled blood sugar sensor that 'reacts to glucose and lights up inside the body.' 'Course, injecting dyes into humans in order to receive interpretable signals ain't exactly new, but hydrogel is what makes this approach unique. As the story goes, this jelly-esque material can be implanted within the body, enabling blood sugar levels to be monitored and measured externally with no pain or irritation whatsoever. In theory, a monitoring system could trigger an alert as soon as the internal levels dipped or rose beyond a predetermined extreme, giving those with diabetes a maximum amount of time to get things back in balance. There's nary a mention of when this goo will be green-lit by the FDA, but there's definitely a video explaining everything just past the break.

Continue reading Implantable blood sugar sensor could eliminate daily finger pricks

Implantable blood sugar sensor could eliminate daily finger pricks originally appeared on Engadget on Sat, 07 Aug 2010 06:53:00 EDT. Please see our terms for use of feeds.

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Delivering Vaccine With Dissolving Microneedles

2010-07-19T17:01:00.000-05:00

Story from Medgadget:

Delivering Vaccine With Dissolving Microneedles: "

Researchers from Emory University and the Georgia Institute of Technology have developed a new vaccine-delivery patch based on hundreds of microscopic needles that dissolve into the skin after application. The needles are just 650 microns in length and are assembled into an array of 100 needles. Application is painless and after application the needles quickly dissolve, leaving no sharps behind. The method eliminates the use of hypodermic needles and would allow for self-administration of vaccines. As the vaccine is delivered intradermally where there are many resident antigen-presenting cells, vaccination could potentially be even more effective than regular vaccination. Initial results are reported in the advance online publication of Nature Medicine, showing that vaccination against influenza using the patch was at least as effective as using hypodermic needle vaccination, and indeed by some measures more effective.

Press release: Vaccine-delivery patch with dissolving microneedles boosts protection

Article abstract: Dissolving polymer microneedle patches for influenza vaccination

DARPA-funded prosthetic arm reaches phase three, would-be cyborgs celebrate

2010-07-18T10:59:00.000-05:00

Story From Engadget:

DARPA-funded prosthetic arm reaches phase three, would-be cyborgs celebrate: "

Last we heard from Johns Hopkins University's Applied Physics Laboratory, it wanted a neurally-controlled bionic arm by 2009. Needless to say, the school overshot that goal by a tiny bit, and have now been beaten (twice) to the punch. But DARPA sees $34.5 million worth of promise in their third and final prototype, which will enable the nine pound kit (with 22 degrees of freedom and sensory feedback) to begin clinical trials. Rechristened the Modular Prosthetic Limb, it will be grafted onto as many as five real, live persons, the first within the year. Using the targeted muscle reinnervation technique pioneered at the Rehabilitation Institute of Chicago, patients will control these arms directly with their thoughts, and for their sakes and the fate of humanity, hopefully not the other way around. Press release after the break.

Continue reading DARPA-funded prosthetic arm reaches phase three, would-be cyborgs celebrate

DARPA-funded prosthetic arm reaches phase three, would-be cyborgs celebrate originally appeared on Engadget on Sun, 18 Jul 2010 10:47:00 EDT. Please see our terms for use of feeds.

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First Transoral and Transvaginal Cholecystectomies Performed in Human Trial

2010-07-13T07:25:00.000-05:00

Story From Medgadget

First Transoral and Transvaginal Cholecystectomies Performed in Human Trial: "

Back in 2007 we reported on the first transvaginal cholecystectomy. Since then the field of natural orifice translumenal endoscopic surgery has slowly progressed with research mainly focusing on optimization of the used techniques. However, now the first multicenter human trial of laparoscopic transvaginal and transoral cholecystectomy versus conventional laparoscopic cholecystectomy has started and the first gallbladders have been removed by both routes. In both cases one abdominal incision was still made for the camera and insufflation, but the surgical procedure itself was completely performed trough the mouth and vagina. The study is conducted by the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR), a joint effort of the American Society for Gastrointestinal Endoscopy (ASGE) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), and approximately 200 patients will be enrolled in the clinical trial.

Press release: NOSCAR Announces First NOTES Transoral and Transvaginal Gallbladder Removals Performed as Part of U.S. Multicenter Human Trial...

Consortium website: NOSCAR...

Image credit: Wellcome Images...

FDA Approves VisionCare's Implantable Miniature Telescope

2010-07-08T03:55:00.000-05:00

Story from Medgadget

Is this cool or what?

FDA Approves VisionCare's Implantable Miniature Telescope: "

Saratoga, CA based VisionCare Ophthalmic Technologies, Inc. has announced FDA approval of company's Implantable Miniature Telescope, which we have been following since 2005. The device is designed to treat end-stage age-related macular degeneration (AMD) as part of the CentraSight treatment program, in which one of a patient's eyes is implanted with the telescope. The implant will then enlarge images, causing them to be projected onto more healthy areas of the patient's retina. This reduces the negative effect of the AMD blind spot in the patient's vision.

From the press release:

Results from the two U.S. clinical trials, conducted at 28 leading ophthalmic centers, have been published in peer-reviewed scientific journals including Ophthalmology, American Journal of Ophthalmology, and Archives of Ophthalmology. The pivotal clinical trial showed that patients achieved clinically meaningful gains in visual acuity and quality of life with the telescope implant.

VisionCare will conduct a post-approval study to monitor patient outcomes under commercial conditions. The principal investigator of the study is Oliver D. Schein, M.D., M.P.H., Burton E. Grossman Professor of Ophthalmology at The Wilmer Eye Institute and Professor of Epidemiology at the Johns Hopkins University Bloomberg School of Public Health. A second smaller study will follow clinical trial patients for an additional two years.

Press release: VisionCare Announces FDA Approval for First-Ever Implantable Telescope for End-Stage Macular Degeneration...

Product page: Implantable Telescope Technology...

Flashbacks: The Implantable Miniature Telescope; VisionCare's Micro-telescope Prosthesis Close to FDA Approval; Implantable Telescope for AMD Expects FDA Approval

PatchAssist Laparoscopic Hernia Mesh Placement Tool Gets US Green Light

2010-06-24T21:49:00.000-05:00

Story From Medgadget

PatchAssist Laparoscopic Hernia Mesh Placement Tool Gets US Green Light: "

Israel's PolyTouch Medical has received FDA clearance to market its PatchAssist laparoscopic hernia mesh placement device. The tool was developed to allow surgeons a more predictable and standardized approach to apply hernia patches.

Realizing the need for an accurate and easy mesh deployment and placement technique, PolyTouch Medical has developed PatchAssist, a novel mesh deployment and placement technique for laparoscopic hernia repair.

PatchAssist easily unfolds the mesh inside the abdominal cavity, accurately places the mesh over the hernia defect and enables surgeon to verify the mesh position before attachment is made.

Patch Assist does not change laparoscopic techniques used today by surgeons, rather it eliminates manual, complicated, and time consuming tasks.

Advantages:

Accurate mesh positioning reduces the risk of hernia recurrence.

Quicker mesh deployment and placement reduces operation time by 30% - 50%.

Simplified current laparoscopic technique and rapid adoption.

Globes [online]: PolyTouch gains FDA nod...

Product page: PatchAssist...

Medical devices could be powered by nanowire generators and the human heart

2010-06-09T22:11:00.000-05:00

STORY FROM Engadget Alt

Do ya'll see the theme here? Nanotechnology along with disruptive innovation in delivery of medicine can save healthcare. Now... that's if the economy can hold itself together.

Medical devices could be powered by nanowire generators and the human heart: "

Researchers at Georgia Institute of Technology are getting to the heart of the matter, developing nanowire generators which could power medical devices inside a patient that are powered by the patient's own heart. The team -- led by Zhong Lin Wang --first demonstrated working nanowires back in 2005, and have since demo'd the wired generators being powered by a running hamster, tapping fingers, and piezoelectric solar cells. In the most recent and interesting turn of events Zhong and company have just demonstrated the nanowires functioning inside of a living animal (in this case, a rat). These zinc oxide nanogenerators could be ideally suited to as the power source for things like glucose level monitors and blood pressure in the somewhat near future. The ultimate goal, Zhong says, is to make what are essentially self-powered medical devices. Sounds a little creepy, if you ask us, but it's probably better than a hamster running in a wheel powering your pacemaker, right?

Medical devices could be powered by nanowire generators and the human heart originally appeared on Engadget on Wed, 09 Jun 2010 20:29:00 EST. Please see our terms for use of feeds.

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Nanoparticles Predict Return of Prostate Cancer

2010-06-09T03:59:00.000-05:00

STORY FROM Medgadget

Nanoparticles Predict Return of Prostate Cancer: "

At Northwestern University researchers have been testing a nanoparticle technology to predict the recurrence of prostate cancer. The underlying technology was developed at Northwestern, and is now being moved toward commercialization by Nanosphere out of Northbrook, Illinois. The latest results, just presented at the American Urological Association 2010 Annual Meeting, show a PSA sensitivity 300 times greater than that of currently available tests.

More about the technology and findings from a Northwestern announcement:

PSA is a protein normally secreted out of the prostate cells into the semen in high concentrations. Usually, very little diffuses into the blood stream, and the normal PSA value for men without prostate disease is less than 2 nanograms per milliliter. When the prostate gland has a disease process, such as inflammation, benign enlargement, or cancer, the barriers to PSA diffusion into the blood stream are breached, and PSA levels rise. In a man who has his cancerous prostate removed, there should be no PSA in the blood except for a minute amount produced by the periurethral glands. However, any PSA produced by cancer recurrence ends up in the blood stream and can be detected earlier with the more sensitive nanotechnology PSA assay.

For the new study, researchers obtained blood serum retrospectively from men whose PSA serum samples had been frozen after surgery and whose assays (blood analysis) showed an undetectable PSA level based on the conventional test. Northwestern researchers then tested those serum samples using the more sensitive nanotechnology-based test. They wanted to see if they could detect PSA at levels below the limit of the conventional test, and if those results could predict the cancer outcome for those patients, who were followed for up to 10 years.

Using the new test, Thaxton [C. Shad Thaxton, assistant professor of urology] and colleagues found that the low and non-rising PSA levels (presumably produced by the normal periurethral glands) of patients meant that the prostate cancer was effectively cured and did not return over a period of at least 10 years. Scientists also found a PSA level higher than that expected from the periurethral glands based on the new test meant the patients would have their disease recur.

As result of the study, researchers were able to assign a PSA level number to a cure for the first time, as well as a number that indicated the disease would recur and if it would recur aggressively. These newly identified levels were below what could have been detected with the conventional PSA test. The researchers were able to quantify PSA values at less than 0.1 nanograms per milliliter, the clinical limit of detection for commercial assays.

Press release: Nanoparticle PSA Test Predicts if Prostate Cancer Will Return...

Nanosphere technology backgrounder...

Product page: Nanosphere's Verigene nanoparticles...

Nanotattoo Monitors Blood Glucose, Looks Cool

2010-06-01T02:39:00.000-05:00

It remains so clear to me that nano technology is the future that will save medicine. It will change the economics of the diagnostic tests that we so heavily rely upon.

Story From Medgadget

Nanotattoo Monitors Blood Glucose, Looks Cool: "

Millions of people suffering from diabetes are forced to endure multiple finger pricks daily - an unpleasant practice that may impede compliance, and whose reliability is operator-dependent. Now, Dr. Paul Barone and Dr. Michael Strano at the MIT Department of Chemical Engineering are developing a new approach to glucose monitoring. Building on work they previously published in ACS Nano, the new technology employs a nanoparticle 'tattoo' as a glucose sensor, which can then be continuously monitored by a device on the surface of the body.

Breast cancer vaccine proves successful in tests on mice, moves on to human subjects

2010-05-31T23:13:00.000-05:00

Story From Engadget Alt

Breast cancer vaccine proves successful in tests on mice, moves on to human subjects: "

Here's a cause for optimism, albeit the cautious kind. Researchers at the Cleveland Clinic Lerner Research Institute have managed to isolate a human protein that plays part in the development of breast cancer, and have produced a vaccine against its creation that has delivered an impressive success rate in testing on mice. In a test group of genetically cancer-prone rodents, none of those injected with á-lactalbumin developed the potentially deadly disease. The progress of this drug trial to testing on humans has been met with reservation by cancer research groups, who remind us that we're years away from knowing if it will actually work on our species. Still, this is quite the little breakthrough and we hope all goes according to plan.

Breast cancer vaccine proves successful in tests on mice, moves on to human subjects originally appeared on Engadget on Mon, 31 May 2010 09:52:00 EST. Please see our terms for use of feeds.

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First self-replicating, synthetic bacterial cell

2010-05-20T22:00:00.001-05:00

Story From: Kurzweil

First self-replicating, synthetic bacterial cell: "Researchers at the J. Craig Venter Institute (JCVI), a not-for-profit genomic research organization, published results today describing the successful construction of the first self-replicating, synthetic bacterial cell.

The team synthesized the 1.08 million base pair chromosome of a modified Mycoplasma mycoides genome. The synthetic cell is called Mycoplasma mycoides JCVI-syn1.0 and is the proof of principle that genomes can be designed in the computer, chemically made in the laboratory and transplanted into a recipient cell to produce a new self-replicating cell controlled only by the synthetic genome.

'Its genome was designed in the computer and brought to life through chemical synthesis, without using any pieces of natural DNA,' said JCVI Distinguished Investigator Clyde Hutchison.

The JCVI scientists envision that the knowledge gained by constructing this first self-replicating synthetic cell, coupled with decreasing costs for DNA synthesis, will give rise to wider use of this powerful technology. This will undoubtedly lead to the development of many important applications and products including biofuels, vaccines, pharmaceuticals, clean water and food products.

'This will essentially enable us to design new life forms at a computer screen,' said Ray Kurzweil. 'This will be a fabulous creative tool for creating inexpensive clean fuels and other breakthroughs for agriculture, health, and the environment. It's also enabling for a bioterrorist, so we urgently need a rapid response system (like we do have for software viruses) that can protect us from new biological viruses and other life forms. The technologies to do this are in place -- we can now sequence a biological virus in about a day, a bacterium in a few days (HIV took five years), and we have a range of tools to deactivate these pathogens (such as RNA interference or antigen based vaccines). I've advised the Army on how to set up such a system and I know that it is underway, but we need to substantially increase its priority.'

The team designed and inserted 'watermarks' into the genome --specifically designed segments of DNA that use the 'alphabet' of genes and proteins that enable the researcher to spell out words and phrases. Encoded in the watermarks is a new DNA code for writing words, sentences and numbers. In addition, there is a web address to send emails to if you can successfully decode the new code, the names of 46 authors and other key contributors and three quotations: 'TO LIVE, TO ERR, TO FALL, TO TRIUMPH, TO RECREATE LIFE OUT OF LIFE.' - JAMES JOYCE; 'SEE THINGS NOT AS THEY ARE, BUT AS THEY MIGHT BE.'-A quote from the book, 'American Prometheus'; 'WHAT I CANNOT BUILD, I CANNOT UNDERSTAND.' - RICHARD FEYNMAN.

The assembly of a synthetic M. mycoides genome in yeast (Figure from Gibson, D. G., J. I. Glass, et al. 2010. Creation of a bacterial cell controlled by a chemically synthesized genome. Science, Published online May 20 2010)

More info: J. Craig Venter Institute news (Source: )"

Glass electrodes used in nanoscale pump

2010-05-18T22:20:00.001-05:00

Story From Kurzweil AI
Glass electrodes used in nanoscale pump: "A team of engineers from the U.S. and South Korea has developed what is believed to be the smallest man-made pump ever built, powered by a glass electrode. The pump is about the same size as a red blood corpuscle.

The pump works by electroosmosis, in which electricity pushes the fluids from one end of the pump to the other. The heart of the pump measures only four micrometers across, and the pump is capable of controlling a flow rate of one femtoliter per second.

Applications include delivering drugs to an individual cell and taking fluid samples from single cells. The glass electrodes could also be integrated into other nanoscale devices.

(Nature Nanotechnology)

(Source: http://www.physorg.com/news193298040.html)"

3D Surface Texture Melanoma Diagnosis

2010-05-17T23:33:00.001-05:00

Story From MedGadet
3D Surface Texture Melanoma Diagnosis: "
Researchers at the University of the West of England have built a device that captures 3D skin surface texture images of dermatological lesions and aids in the diagnosis of melanoma. The device includes a camera and six LED light sources. A separate image is recorded with each of the LEDs illuminating the lesion. A computer then generates a 3D image of the lesions and extracts several features from it, such as asymmetry, border, color variation, and diameter. An artificial neural network and heuristic rules are used to identify malignant melanoma using these features. The system has an equal sensitivity to models based on 2D skin line pattern features, but with a greatly increased specificity. The researchers describe the technique in detail in the latest issue of the International Journal of Modelling, Identification and Control.

Study abstract: A computer assisted diagnosis system for malignant melanoma using 3D skin surface texture features and artificial neural network...

Project homepage: Application of photometric stereo in dermatology...

"

New Polymers to Surpress Bacterial Virulence

2010-05-17T23:32:00.001-05:00

Story from Medgadet:
New Polymers to Surpress Bacterial Virulence: "
Dr. Elena Piletska of Cranfield University and colleagues have come up with an innovative new technology to help control bacterial virulence and biofilm production - a method unlikely to induce resistance that could reduce nosocomial infections significantly. The group has developed a new polymer designed to attenuate quorum sensing by bacteria. This is based on the observation that bacteria are able to sense population density (quorum sensing) and use signaling molecules dependent on that information to regulate virulence and biofilm production. By creating a polymer that absorbs these signaling molecules, the expression of virulence genes could be reduced or prevented completely.

The group suggests that the polymer could be applied to various surfaces, e.g. prostheses or catheters, and that specific polymers could be developed to target problematic bacteria such as Pseudomonas aeruginosa or Staphylococcus aureus.

Full text in Biomacromolecules: Attenuation of Vibrio fischeri Quorum Sensing Using Rationally Designed Polymers

American Chemical Society : New plastic-like materials may say 'shhhh' to hush disease-causing microbes...

"

Air Force Treating Wounds With Lasers and Nanotech

2010-05-16T04:37:00.001-05:00

Story From: Kurzweil AI
Air Force Treating Wounds With Lasers and Nanotech: "The Air Force is funding scientists who are using lasers to seal up wounds at a molecular level.

The process would replace the sutures and staples traditionally used to repair wounded skin. A patient's wound would be coated in a dye, then exposed to green light for 2-3 minutes. The dye absorbs the light and catalyzes molecular bonds between the tissue's collagen.

The bonds instantly create a seal that's watertight, which prevents inflammation or risk of infection, and speeds up the formation of scar tissue.
(Source: http://www.wired.com/dangerroom/2010/05/air-force-researchers-heal-wounds-with-lasers-and-nanotech/)"

Probe detects 2,000 viruses and 900 bacteria within 24 hours

2010-05-16T04:30:00.001-05:00

Story From Kurzweil AI
Probe detects 2,000 viruses and 900 bacteria within 24 hours: "The new Lawrence Livermore Microbial Detection Array (LLMDA) could enable law enforcement, medical professionals and others to detect within 24 hours any virus or bacteria that has been sequenced and included among the array's probes.

Livermore Microbial Detection Array contains 388,000 probes used to detect viruses and bacteria (Jacqueline McBride/LLNL)

The LLMDA detects viruses and bacteria with the use of 388,000 probes that fit in a checkerboard pattern in the middle of a one-inch wide, three-inch long glass slide.

One advantage of the Livermore array is that it provides researchers with the capability of detecting pathogens over the entire range of known viruses and bacteria. Current multiplex polymerase chain reaction (PCR) techniques can at most offer detection from among 50 organisms in one test.

The LLMDA process starts with the purification of DNA or RNA from a sample, such as sputum or blood. The sample is next labeled with a fluorescent dye and hybridized on the microarray at 42 degrees C or about 107.6 degrees Fahrenheit. In turn, a fluorescent scanner and analysis software are used to detect the probes that have lit up, identifying the presence of viral or bacterial sequences.

Current plans call for the detection array to be evaluated for operational bioforensic use at the Frederick, Md.-based National Biodefense Analysis and Countermeasures Center of the U.S. Department of Homeland Security.

As the cost of the array is reduced, the LLMDA technology could be used to improve public health diagnostics; dozens of bacteria and viruses can be detected in a single test from the entire spectrum of sequenced organisms.

Currently, the researchers are testing a next-generation LLMDA with 2.1 million probes, representing about 178,000 viral sequences from some 5,700 viruses, about 785,000 bacterial sequences from thousands of bacteria, 237,000 fungal sequences from thousands of fungi, and about 202,000 protozoa sequences from 75 protozoa.

More info: Lawrence Livermore National Laboratory news (Source: )"

PillCam Express When Traditional PillCam is Too Hard to Swallow

2010-05-16T04:29:00.003-05:00

Story from Medgadget:
PillCam Express When Traditional PillCam is Too Hard to Swallow: "

Given Imaging of Yoqneam, Israel is releasing a new manually guided GI scope based on PillCam swallowable devices. In some cases, patient anatomy does not allow for natural passage of large tablets the size of traditional PillCams, but with the help of an endoscope and a proprietary balloon deployment mechanism, the PillCam Express can be delivered through the stomach and into the small intestine. The system has yet to receive FDA regulatory approval and is not available in the US.

Press release: Given Imaging Launches RAPID(R) pH Software and PillCam(R) Express(TM)...

"

AngioDynamics Launches Centros Self-Centering Hemodialysis Catheter

2010-05-16T04:29:00.002-05:00

Story from Medgadget:
AngioDynamics Launches Centros Self-Centering Hemodialysis Catheter: "
AngioDynamics has launched the redesigned Centros self-centering, chronic hemodialysis access catheter. It is a 15 French dual lumen radiopaque catheter with a polyester cuff and preformed curved tips, which automatically center the catheter ports in the middle of the vessel and away from the vein walls, optimizing blood flow and minimizing recirculation. It is purposed for long-term hemodialysis and apheresis through the internal jugular vein, with the catheter tip located in the superior vena cava. A special guide-wire slit in the tip of the catheter ensures easy over-the-wire insertion.

Press release: AngioDynamics Launches Improved Centros Self-Centering Hemodialysis Catheter...

Product page: Centros Chronic Dialysis Catheter...

"

Building Artificial Tissues with Biological Legos

2010-05-16T04:27:00.001-05:00

Story from Medgadet:
Building Artificial Tissues with Biological Legos: "
Scientists at the MIT-Harvard Division of Health Sciences and Technology (HST) have developed a simple technique to transform sheets of cells grown in a lab into 3-dimensional shapes. Called 'micro-masonry', the new method uses a gel-like material to organize cells into cubes, which can then be fashioned into structures resembling organs. As the artificial organs are built, small channels can be left in place to provide nutrient access.

More from the press release:

The HST researchers built their 'biological Legos' by encapsulating cells within a polymer called polyethylene glycol (PEG), which has many medical uses. Their version of the polymer is a liquid that becomes a gel when illuminated, so when the PEG-coated cells are exposed to light, the polymer hardens and encases the cells in cubes with side lengths ranging from 100 to 500 millionths of a meter.

Once the cells are in cube form, they can be arranged in specific shapes using templates made of PDMS, a silicon-based polymer used in many medical devices. Both template and cell cubes are coated again with the PEG polymer, which acts as a glue that holds the cubes together as they pack themselves tightly onto the scaffold surface.

After the cubes are arranged properly, they are illuminated again, and the liquid holding the cubes together solidifies. When the template is removed, the cubes hold their new structure.

Press release: Building organs block by block...

Abstract in Advanced Materials: Micro-Masonry: Construction of 3D Structures by Microscale Self-Assembly

"

Nanotube transistor will help us bond with machines

2010-05-16T04:26:00.001-05:00

Story from Kurzweil AI:
Nanotube transistor will help us bond with machines: "Nanotube transistor will help us bond with machines: 'Lawrence Livermore National Laboratory researchers have developed a novel transistor. controlled by ATP (the chemical that provides the energy for our cells' metabolism), that could be a big step towards making prosthetic devices that can be wired directly into the nervous system.

The transistor comprises a carbon nanotube, which behaves as a semiconductor, bridging the gap between two metal electrodes, and coated with an insulating polymer layer that leaves the middle section of the nanotube exposed. The entire device is then coated again, this time with a lipid bi-layer (similar to those that form the membranes surrounding our body's cells) using a protein that, when exposed to ATP, acts as an ion pump, shuttling sodium and potassium ions across the membrane.

The build-up of ions creates an electric field around the exposed portion of the semiconducting nanotube, increasing its conductivity in proportion to the strength of the field. When the supply of ATP is reduced, ions leak back across the membrane and the flow of current through the transistor falls.

(Source: http://www.newscientist.com/article/dn18891-nanotube-transistor-will-help-us-bond-with-machines.html)'

Nanotube transistor will help us bond with machines

2010-05-14T07:18:00.000-05:00

Nanotube transistor will help us bond with machines: "Lawrence Livermore National Laboratory researchers have developed a novel transistor. controlled by ATP (the chemical that provides the energy for our cells' metabolism), that could be a big step towards making prosthetic devices that can be wired directly into the nervous system.

The transistor comprises a carbon nanotube, which behaves as a semiconductor, bridging the gap between two metal electrodes, and coated with an insulating polymer layer that leaves the middle section of the nanotube exposed. The entire device is then coated again, this time with a lipid bi-layer (similar to those that form the membranes surrounding our body's cells) using a protein that, when exposed to ATP, acts as an ion pump, shuttling sodium and potassium ions across the membrane.

The build-up of ions creates an electric field around the exposed portion of the semiconducting nanotube, increasing its conductivity in proportion to the strength of the field. When the supply of ATP is reduced, ions leak back across the membrane and the flow of current through the transistor falls.

(Source: http://www.newscientist.com/article/dn18891-nanotube-transistor-will-help-us-bond-with-machines.html)"

General Purpose Detector Identifies Pathogens Within 24 Hours

2010-05-09T05:48:00.001-05:00

Story from Medgadget:
General Purpose Detector Identifies Pathogens Within 24 Hours: "

Research scientists at Lawrence Livermore National Lab have been working on a detection technology that will be able to detect and identify just about any organism, including viruses, bacteria, fungi, and protozoa based on their endogeneous nucleic acid sequences. The current version of the Lawrence Livermore Microbial Detection Array (LLMDA), as the device is being called, contains 388,000 probes that together can screen for about 2,000 viruses and 900 bacteria. Moreover, there's nothing stopping the scientists (except funding, of course) in expanding the device to include all known microorganisms of interest.

Currently, Slezak's [Tom Slezak, LLNL's associate program leader for Informatics] team is testing a next-generation LLMDA that boasts 2.1 million probes. This version contains probes representing about 178,000 viral sequences from some 5,700 viruses, and about 785,000 bacterial sequences from thousands of bacteria.

The latest LLMDA version also encompasses fungi and protozoa – with probes representing about 237,000 fungal sequences from thousands of fungi and about 202,000 protozoa sequences from 75 protozoa.

The LLMDA process starts with the purification of DNA or RNA from a sample, such as sputum or blood. The sample is next labeled with a fluorescent dye and hybridized on the microarray at 42 degrees C or about 107.6 degrees Fahrenheit. In turn, a fluorescent scanner and analysis software are used to detect the probes that have lit up, identifying the presence of viral or bacterial sequences.

Press release: New LLNL detection technology identifies bacteria, viruses, other organisms within 24 hours...

Relevant abstract in Journal of Virology: Viral nucleic acids in live-attenuated vaccines: detection of minority variants and an adventitious virus.

"

Conscripts of the infinite armada: systemic cancer therapy using nanomaterials

2010-05-09T05:34:00.001-05:00

Story from Medgadet:
Conscripts of the infinite armada: systemic cancer therapy using nanomaterials: "
A group of nanoscientists from Molecular Pharmacology and Chemistry Program at Memorial Sloan-Kettering Cancer Center just published a fascinating review paper that looks at the latest efforts to develop new methods of imaging and attacking cancers with nanoparticles. The article appears in the latest issue of Nature Reviews Clinical Oncology, and it is available as a free download.

From the abstract:

The field of clinical nanomaterials is enlarging steadily, with more than a billion US dollars of funding allocated to research by US government agencies in the past decade. The first generation of anti-cancer agents using novel nanomaterials has successfully entered widespread use. Newer nanomaterials are garnering increasing interest as potential multifunctional therapeutic agents; these drugs are conferred novel properties, by virtue of their size and shape. The new features of these agents could potentially allow increased cancer selectivity, changes in pharmacokinetics, amplification of cytotoxic effects, and simultaneous imaging capabilities. After attachment to cancer target reactive-ligands, which interact with cell-surface antigens or receptors, these new constructs can deliver cytolytic and imaging payloads. The molecules also introduce new challenges for drug development. While nanoscale molecules are of a similar size to proteins, the paradigms for how cells, tissues and organs of the body react to the non-biological materials are not well understood, because most cellular and metabolic processes have evolved to deal with globular, enzyme degradable molecules. We discuss examples of different materials to illustrate interesting principles for development and future applications of these nanomaterial medicines with emphasis on the possible pharmacologic and safety hurdles for accomplishing therapeutic goals.

Full article in Nature Reviews Clinical Oncology: Conscripts of the infinite armada: systemic cancer therapy using nanomaterials...

"

Nanopatch May Represent the Future of Vaccine Delivery

2010-04-26T03:16:00.001-05:00

Story from Medgadget:
Nanopatch May Represent the Future of Vaccine Delivery: "
Professor Mark Kendall of the Australian Institute for Bioengineering and Nanotechnology and his team have been investigating a novel way to deliver vaccines. Their method makes use of nanopatches, which are fingernail-sized dermal patches with microscopic projections on their surface that hand vaccine off directly to the antigen-presenting cells just below the surface of the skin. The scientists' recent work in mice has shown that an immune response equivalent to that achievable by needle and syringe can be reached using 100 times less vaccine. Not only does the nanopatch appear to be a more effective delivery method, it is also cheaper to produce, and does not require refrigeration, adjuvants or multiple doses.

Professor Kendall said the Nanopatch was much smaller than a postage stamp and comprised of several thousands of densely packed projections invisible to the human eye.

The influenza vaccine was dry coated onto these projections and applied to the skin of mice for two minutes.

'By using far less vaccine we believe that the Nanopatch will enable the vaccination of many more people,' Professor Kendall said.

When compared to a needle and syringe a nanopatch is cheap to produce and it is easy to imagine a situation in which a government might provide vaccinations for a pandemic such as swine flu to be collected from a chemist or sent in the mail.

Press release from The University of Queensland: Less is more! Nanopatch is 100 times better than needle and syringe...

"

World's Smallest, Lightest Telemedicine Microscope

2010-04-24T07:10:00.001-05:00

Story from Medgadget:
World's Smallest, Lightest Telemedicine Microscope: "

Researchers at The California NanoSystems Institute at UCLA (CNSI) have developed a tiny telemedicine microscope for imaging blood samples or other fluids, testing water quality or other public health need in resource-limited settings.

From the press release:

Slightly wider than a US quarter and weighing just 46 grams, the lensless microscope is a self-contained imaging device. Using LUCAS (Lensless Ultra-wide-field Cell Monitoring Array) technology, it generates holographic images of microparticles or cells by employing a light-emitting diode to (LED) illuminate the objects and a digital sensor array to capture their images.

Samples are loaded using a small chip that can be filled with saliva or a blood smear for health monitoring. With blood smears, the lensless microscope is capable of accurately identifying cells and particles, including red blood cells, white blood cells and platelets. The technology has the potential to help monitor diseases like malaria, HIV and tuberculosis.

The microscope is fairly robust with few moving parts and a large aperture. Images can be uploaded via a direct USB connection to a smart phone or other device, and sent to a hospital.

Geek Out & Spec'it Out here: UCLA engineer invents world's smallest, lightest telemedicine microscope

"

Artificial Skin Developed for Research, Potential Future Therapy

2010-04-21T23:34:00.001-05:00

Story from Medgadget:
Artificial Skin Developed for Research, Potential Future Therapy: "
Spanish scientists at the University of Granada have developed a new recipe for making artificial human skin by using agarose-fibrin biomaterial as a foundation. The new skin was grafted onto laboratory mice and showed positive results in a number of tests.

Researchers from the University of Granada firstly selected the cells that would be employed in generating artificial skin. Then, they analysed the evolution of the in-vitro culture and, finally, they performed a quality control of the tissues grafted onto nude mice. To this purpose, several inmunofluorescence microscopy techniques had to be developed. These techniques allowed researchers to evaluate such factors as cell proliferation, the presence of differentiating morphological markers, the expression of cytokeratin, involucrine and filaggrin, angiogenesis and artificial skin development into the recipient organism.

To make this assay, researchers obtained human skin from small biopsies belonging to patients following surgery at the Plastic Surgery Service of the University Hospital Virgen de las Nieves in Granada. All patients gave their consent to take part in this research study.

To create artificial human skin, human fibrin from plasma of healthy donors was used. Researchers then added tranexamic acid -to prevent fibrinolysis-, and calcium chloride to precipitate fibrin coagulation, and 0.1% aragose. These artificial-skin substitutes were grafted on the back of the nude mice, with the purpose of observing its evolution in vivo. The equivalent skin substitutes were analysed by transmission and scanning light and electron microscopy and inmunofluorescence.

The skin created in the laboratory showed adequate biocompatibility rates with the recipient and no rejection, dehiscence or infection was registered. Additionally, the skin of all animals used in the study started to show granulation after six days from implantation. Within the following twenty days, cicatrization was complete.

Press release: Scientists create artificial human skin with biomechanical properties using tissue engineering...

"

Dell Smoke slaps Android in the wild form factor you secretly wanted

2010-04-21T23:20:00.001-05:00

Story from Engadget:
Dell Smoke slaps Android in the wild form factor you secretly wanted: "

Okay, so imagine a Pixi, but awesome. We think you'd end up with something closely resembling the phone that Dell's whipping up with a codename of 'Smoke,' running Android Froyo atop a 2.8-inch QVGA display (looks more like WVGA to us, but whatevs). Dell calls it a 'non-conforming style,' but we just call it drop-dead gorgeous -- assuming the final product even remotely resembles the company's renders -- and they're even promising a price that 'won't break the bank,' which is always a nice little bonus. The description we're reading of the phone leads us to believe that Dell will be targeting a corporate audience with the Smoke, and that's certainly the clique that tends to enjoy portrait QWERTY keyboards, so this should fit right in amongst the sea of BlackBerrys when it launches in the second quarter of 2011. That's a hell of a wait, yes, but in return, you'll be getting Qualcomm's next-gen MSM7230 processor at 800MHz, a 5 megapixel autofocus cam, 14.4Mbps HSPA, microSD expansion to 32GB, WiFi, Bluetooth 2.1 + EDR, and dual-mic noise canceling tech in a 12mm package. Check out the full gallery below!

Gallery: Dell Smoke slaps Android in the wild form factor you secretly wanted

Dell Smoke slaps Android in the wild form factor you secretly wanted originally appeared on Engadget on Wed, 21 Apr 2010 20:44:00 EST. Please see our terms for use of feeds.

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Laboratory on a Plastic Chip Monitors Body Functions

2010-04-21T02:57:00.001-05:00

Story from Medgadget:
Laboratory on a Plastic Chip Monitors Body Functions: "

Scientists at the Fraunhofer Institute for Reliability and Microintegration IZM in Munich have built a lab-on-a-chip, a small single-use cartridge for the biochemical analysis of a drop of blood. It consists of a polycarbonate plate, with a foil of 150 micrometers thickness, on which a filigree network with conductor lines and gold sensors for blood analysis is attached, and a 120 micrometer deep fluid channel for conducting blood to the analysis elements. Inside the sensor chamber antibodies are integrated on electrodes that allow to analyze the concentration of different markers.

Additionally, the team engineered a wristband (pictured above) that can measure body temperature, skin moisture and electromagnetic radiation using plastic chips and sensors only micrometers thick. Lighting elements, sensors and polymer resistances are printed on foils and connected into one system with integrated circuits made of silicon. Both devices can be manufactured cost-effectively both as individual sheets as well as by roll-to-roll production in larger batches.

Full storye: Plastic chips monitor body functions...

(hat tip: Engadget)

"

PELLA-DRX, A Greener Solution for Handling Medical Waste

2010-04-19T21:39:00.001-05:00

Story from Medgadet:
PELLA-DRX, A Greener Solution for Handling Medical Waste: "

Houston, TX based Sharps Compliance has announced a new process to recycle medical waste. Instead of ending up in a landfill, waste products are turned into PELLA-DRX, a material which can be used to make a number of new industrial products.

From the product page:

This first-of-its-kind Waste Conversion Process™ ("WCP") transforms discarded needles, syringes, lancets and other medical waste into a new product called PELLA-DRX™ – which is used in the manufacture of many types of resources including cement, vital to everything from homes to highways to high-rise buildings. This process renders the origin of the product indistinguishable and removes all hazards from the medical waste. WCP eliminates Sharps' landfill use by 100%.

Sharps Compliance Inc. Repurposes Medical Waste into New Products...

Product page: PELLA-DRX

"

FaST Surgeon in Afghanistan

2010-02-10T07:31:00.001-06:00

I will likely not post about technology for a while. But if you're interested, feel free to visit me for the next few months at my FaST Surgeon Blog

Garbage In - Garbage Out

2010-01-17T21:42:00.000-06:00

ClearCount Smart SmartSponge^®

Last year, Buckeye Surgeon wrote about "Pragmatic Innovation". Even a technophile like myself can agree that we must be thoughtful and pragmatic about the technology that we introduce in an effort to solve known problems. ClearCount Medical Solutions received FDA approval in 2007 for the use of their SmartSponge^® and SmartWand^® systems which track surgical sponges by using radio-frequency identification (RFID) technology. At first glance, this appears to be an innovative way to "take care" of the eliminating the problem of retained surgical foreign bodies (RSFBs). However, I question the usefulness and effectiveness of such a device.

ClearCount SmartWand^® System

There is no clear understanding as to the incidence of RSFBs. The literature has made estimates that ranged from 1/100 cases to 1/10,000. Quite frankly, it is clear that this does not occur in 1/100 cases. If it did, my hospital alone would generate at least 1 case per day. Most articles in 2009 use the estimate of 0.3 to 1 per 1,000 cases. Again, these are essentially "fuzzy" numbers. I would expect to see more firm numbers in the next 1 to 2 years, as the Joint Commission has required mandatory reporting for all RSFB events, regardless of whether or not there has been adverse sequelae.

Now, without an understanding of the incidence, how can one begin to understand the need for such a system, let alone what its return on investment will be. ClearCount claims that there is a RSFB event every 120 minutes. That might be true. However, it might also be misleading. In that, they might include any time in which the surgical team identifies that a RSFB event has occurred even before the operation is over (and thus removes said FB and concludes the operation without any adverse event).

I am skeptical as to the benefit that this system offers. This may be a case of introducing a technology to make up for the lack of following current procedural steps that are already in place, or should be in place. It is clear that we reduce the risk of leaving a foreign body in a patient by following a set of simple guidelines and maintaining good team communication. Another problem that I have with this system is its focus on surgical sponges. According to the current data, at least 30% of retained foreign bodies are instruments. Thus leaving a sizeable portion of RSFBs still not accounted for.

Buckeye Surgeon, you are correct. Without a pragmatic approach to introducing medical technology, we will only continue to squander our resources. This system would appear to me to increase cost which would otherwise be unnecessary if team procedures are followed. However I also believe the free market should be able to weed out the technologies which are not helpful. Therefore, if this system is worthwhile, then I expect to see it prove itself. The next few years will be crucial to understanding its usefulness.

Surgical Magnetism

2009-12-29T13:33:00.000-06:00

Most surgeons think they have this (surgical magnetism) inherently. But I'm not talking about surgical machismo. I am talking about the use of magnets in surgery. Magnet technology continues to advance, and surgical techniques continue to evolve into less invasive methods. Utilizing magnets in surgery is part of the next advance in minimally invasive surgery.

Researchers have been experimenting with using magnets to perform sutureless anastomoses such as depicted in the diagram above*. This technique could bring about a completely endoscopic gastrointestinal anastomotic procedure that will eliminate the need for general anesthesia and operating room time.

** Porcine gastrointestinal anastomosis created using magnet.

This has great potential to reduce the time needed for hand-sewn anastomoses. It can decrease costs associated with stapled anastomoses and has potential for decreasing the occurrence of early anastomotic leak. Therefore its use won't be limited to just minimally invasive approaches, but could be used in standard general surgical operations as well.

*** Augmenting NOTES surgery without need for laparoscopic ports.

Already we are seeing the first uses of magnets to assist in anchoring specialized laparoscopic instrumentation to the anterior abdominal wall, thus replacing standard transabdominal wall port placement as noted in the cartoon above. This has great advantages, not only in decreasing wound complications and potential port-site hernias, but it also will allow the surgeon to maneuver the instrumentation into any location without the downside now associated with fixed-trocar positions. The camera can move for improved viewing angles. Retracting instruments can be placed at will, without creating more holes in the abdominal wall. Working instruments can be moved to new sites at will for improved working angles.

(Image: Royal College of Surgeons / Scuola Superiore Sant'Anna)

Finally, the future of magnets, coupled with MEMS (micro-electro-mechanical systems) and robotics will introduce an era of general surgery that will be revolutionary. Current robotic setups are ginormous beasts that require massive resources and time to setup. Future robots will be deployed using NOTES or SILS techniques and have the capability to assemble themselves from multiple smaller units, such as that depicted above. The ARES (Assembling Reconfigurable Endoluminal Surgical system) robot is one such future concept. Imagine if your surgeon was able to deliver robots either via a single small incision or natural orifice, then control the unit or units via the wireless network from a simple control station. No time consuming setup. Much less expensive. Much more ergonomic with improved control and visualization. This is the future of minimally invasive surgery.

*AA Kutzetzov et. al. Application of magnetic devices and sorbents in gastrointestinal surgery; European Cells and Materials Vol. 3. Suppl. 2, 2002 (pages 179-180)

**C Myers et. al. Using external magnet guidance and endoscopically placed magnets to create suture-free gastrointestinal anastomoses; Surg Endosc DOI 10.1007/s00464-009-0735-5 Published online 24 Dec 2009.

***J Raman et. al. Role of Magnetic Anchors During Laparoendoscopic Single Site Surgery and NOTES; J Endourology Vol 23(5), May 2009

Disruptive Innovation - The Silver Bullet For Health Care

2009-12-20T22:11:00.005-06:00

My son performing his magic

Last week, I presented "Disruptive Innovation" at The Methodist Hospital Department of Surgery Grand Rounds. The main point centered on the crucial role that technology and clinical innovation will have on saving health care. Mind you, this post is not meant as a political commentary. I am looking at this problem simply from a technology perspective.

It is abundantly clear to anyone and everyone that the spending on health care is unsustainable. We simply cannot continue on the current pathway without the country collapsing under the weight of health care cost. I am not sure that I have heard any good answers coming from our leaders. Most of our politicians on the left seem to want believe that the government is the answer. Unfortunately, most of the politicians on the right seem to think that "the doctors" have the answer. Quite frankly, I am not sure I have heard any great answers coming from my peers. To me this is not just a clinical problem (although there is a lot that can be done on that end) but it is as much or more of an economic and business problem. "Doctors" are not economists and while many are forced to be business men and women, most are not very good at it. Ultimately, this is a pretty uncertain time with extraordinary challenges that await us. So, when challenged, I go to my happy place. That place is technology and innovation.

Robert Metcalfe

Now sitting in my happy place, I found myself listening to Robert Metcalfe presenting a radical concept concerning the future of energy. For those of you who do not know who Bob Metcalfe is.... well.. in a nutshell, he invented Ethernet, created the company 3Comm, made a bunch of money, then became a venture capatilist... and poof.. now he is out to solve the world's energy problem (hope that wasn't too simplistic for you Bob :)). Nonetheless, I found myself drawn into his talk about energy, and how the Internet should be a guide for solving the energy problem. He talked about how we will most certainly use more energy (not less), and that rationing the use of energy is a foolish endeavor (I am paraphrasing). In fact, we will see radical improvements in both the creation of energy, but also the we should see further advances in energy efficiency. His message is that we should not be spending all our resources on "Green" energy, but that we should recognize that technology will advance to a point in which we will have a "squanderable abundance" of cheap and clean energy.

(image from: http://fee.org/articles/tgif/markets-ration-health-care/)

Well, this talk from Bob Metcalfe really sent my mind for a spin, because I kept thinking that he was talking about health care! Energy = health care. Green energy = health care reform. Rationing Energy = Rationing health care. WOW!.... I felt like maybe I was onto something. So if you're with me, then maybe you can see the possibility that if energy can become cheap, clean and squanderable, then health care might become cheap, safe and squanderably abundant (stick with me... I don't know if 'squanderable and squanderably are even real words). For this to happen, health care needs something radical. Something that has happened to every industry. Health care needs "disruptive innovation".

Clayton M. Christensen - Harvard Professor

In 1997, Prof. Clayton M. Christensen coined the term "Disruptive Innovation" in his seminal book "The Innovator’s Dilemma". He has subsequently published "The Innovator's Prescription" this year (2009) covering the health care dilemma (I still have yet to read this... I will very very soon.). Despite my lack of education comparative to Dr. Christensen, I will tread out on these dangerous waters and deliver the rest of my opinions. Simply put, disruptive innovation is any technology or business / clinical practice that brings about a radical decrease in cost or creation of a new market. We have seen disruption in the transportation, textile, communication, entertainment and food industries to name a few. Since health care is said to be an industry... why would we not expect to see a disrupting technology here? I think we will and here are a few examples of what may change the economics of medicine.

GE's Vscan portable ultrasound

The future of radiology is directly linked to advances in computer technology. Computer technology continues to advance at a pace that is consistent with Moore's Law and thus will radiology. Devices such as the ultrasound pictured above will become so portable and inexpensive that we will treat it like a thermometer. Ionizing radiation dangers will decrease dramatically as detectors improve so much that the doses needed for imaging will be minuscule. Images will be interpolated and reconstructed so that we will be able to view inner space with life-like realism. This imaging may cost more, but the effects of being able to make accurate and reliable diagnoses will lower the complication rates of missed or delayed diagnoses. Radiology will have a disrupting effect on health care and costs will come down as a result.

Carbon nanotubes for the instant detection of bacteria

The medical laboratory industry is going to be turned upside down. Just like digital cameras have replaced sending your film off to get developed while you wait and wonder what will actually show up... so will it be will all things we otherwise have sent to the lab. Nanotechnology will replace "the lab". We will check most everything at the point of care with immediate results, for cheaper than ever before. In fact, when you check in to the hospital, we will put a few sensors on you (or in you) that will cost a few dollars a pop. These sensors will constantly check your blood for hundreds of parameters on a near continuous basis. If you have an infection, the nanodetector will know it before it becomes a systemic problem AND it will know exactly what bacteria is causing a problem. Sepsis (a leading cause of death in hospitals) will become a thing of the past. Nanotechnology will completely disrupt health care and costs will plummet.

Nanobees kill tumor cells at Washington University in St. Louis, MO

Nanotechnology will also allow medicine to change radically, albeit at a slower pace than other areas. Technology will allow for the delivery of therapeutic agents to a much more focused target. We will see dramatic decreases in unwanted side-effects. In oncology, we will be able to target tumors without the collateral damage seen with conventional chemotherapy. Antibiotics as we know them will become a thing of the past, as we learn how to completely destroy only the pathogenic bacteria.

Tissue engineering

Surgery will see amazing advances in transplant and reconstruction. Tissue engineering continues to advance and in 20 to 30 years organ transplant may be possible without the need for organ donors or immune suppression. When this occurs, cost associated with the care of patients with heart, lung, liver, or kidney failure will drop radically. The cost reduction due to surgical cures associated with diabetes, kidney failure, and cirrhosis will free up hundreds of billions of dollars.

Wellman Center for Photomedicine at Massachusetts General Hospital

Even general surgeons will benefit from the revolution in technology. In the near future we will re-approximate wounds with LASER instead of sutures. Wounds will become sealed by applying a photomaterial to tissue edges and then approximate them under a laser light that causes the material to create a seal - somewhat like velcro at a nanoscale. This will decrease tensile forces by spreading them out over a greater surface area. It will additionally create an immediate biologic barrier. Thus, complications associated with wound infection and wound disruption will drop dramatically. Latent incisional hernias will become a rare complication of abdominal surgery. "Laser suturing" will become disruptive in surgery.

Advanced Health Information Display Concept Proposed By Dr.'s JF Sucher and SL Jones

Finally, I will end with health care information. There are so many other areas poised to disrupt health care, but this is the one area that can make or break it. So much depends on information and unfortunately I feel that we remain bogged down in data input. Our physicians, nurses and other health care professionals have become slaves to data entry. This trend appears to continue unabated and is consuming an incredible amount of resources. Add to that, it creates piles upon piles of refuse because its collection is meant for anything but actually caring for our patients. In other words, we have a mountain of data with little return of information. Its information that we so desperately need. With information we can drive advanced decision support, and decrease the requirements for unnecessary tests and procedures. If we can radically revamp our information network and how we view ownership of data, we could save hundreds of billions of dollars. Needless duplication of tests occur every day due to lack of implementing a nationwide system of health care communication. Silos of information exist on individual patients, scattered throughout various physicians, clinics, labs, hospitals and diagnostic centers. Does anyone get this? The information about me belongs in one secure place that I can control with my doctors. There is so much more to talk about... but I need to go operate on a patient that has been to 5 different hospitals over the past 6 years and has seen more than 20 doctors. How much do you think I know about this patient's history from the patient.... how much information do you think I can get from the other hospitalizations?

We still have great challenges ahead. But I see a bright future for saving health care through disruptive innovation.

Service With A Smile - A Tribute To My OBLC Class

2009-12-17T20:16:00.002-06:00

As many of you know, I have taken a break from my academic surgical practice to attend the Army's Officers Basic Leaders Course (OBLC) - Reserve Component in preparation for deployment to Afghanistan. I returned from this school 2 weeks ago, and quickly prepared my presentation on "Disruptive Innovation" for The Methodist Hospital's Department of Surgery Grand Rounds (more on that later). So, as I sit here on call at the hospital and happy to have had a successful presentation completed, I thought to myself that I would like regale the reader with why someone like myself would decide to "join the Army". In doing so, it occurred to me how many great people that I've met. These people helped me see that American patriotism is alive in many others.

When I speak of patriotism, I am speaking of service to one's country with the motive to help others. I am not talking about patriotism that spews hatred for anyone or anything not American. That isn't patriotism. That's just hatred. Patriotism is good and charitable. Below is my story.

OBLC is an introductory course for new Army medical officers. Not quite "basic training", but rather, it is designed to equip a new officer with the basic knowledge needed to function in the military. However, this wasn't my first dance with the Army. Over 25 years ago, I enlisted straight out of high school (that's me in the photo above, wearing a CVC helmet and a dust rag over my face because sand tends to choke you up in the New Mexico desert). I entered as a private and proudly became a 19D Cavalry Scout. I served for 2 years of active duty and 4 years of reserve duty, leaving the Army just before the first Gulf War. I spent my entire active duty at Ft. Bliss, Texas with the 2d Squadron, 3d Armored Cavalry Regiment, and never served in combat.

I am on the right with the M16A1 (yes... I know Sgt Taylor appears to be pointing that M1911 at me)

I am very proud of my prior service. I enjoyed the military life and my job was very exciting (at times). But, like most things in the Army, the majority of time is quite boring. Fortunately for me, I did well, I learned from my experience and I went on to my civilian life to gain my advanced education, finally becoming a surgeon and specializing in acute care surgery, trauma and critical care. However, I always felt that I was missing a piece of myself. I felt disconnected and I always new which connection needed to be re-established. I needed to get back to the Army (especially in this time of need) with the relatively rare skill-set that I now possess.

First, I gained full clearance from my wife (who quite frankly is giving up more than me so that I may help our soldiers). Then, I was then fortunate to have an employer, chairman and partners who supported my return to the Army Reserves. As I prepare to deploy to Afghanistan, I wanted to say thank you to all those people who are supporting my mission to help our men and women in combat. I have learned a huge lesson. It takes an enormous amount of support to allow me to serve my country. All the people that I leave behind must work harder, and... they will worry for me. I Thank you all!

My experience at OBLC was outstanding. The leadership and ex-NCO instructors were fantastic professionals. The people that I met are all top-notch. I was amazed to meet so many individuals who had served many years as enlisted soldiers, only to gain advanced degrees and re-apply themselves as Army medical officers. Patriotism and service to country are alive and well in these Americans.

Here I am (on the right again but 23 years later) with Major Yamaguchi at Camp Bullis

Above, you see me pictured with Major Kai Yamaguchi, a transplant surgeon in Vermont. Dr. Yamaguchi did not have to come to OBLC. He did not have to volunteer for deployment oversees. He, and most everyone I met, felt called upon ("obligated" does not fit correctly in this sentence) to serve. I know this is my calling. I know, because I felt something that I never felt before. I feel something unexplainable. Its kind of like telling someone that they will know what love is when they know.

I met Lieutenant Paul Van der Voort. Paul is a CRNA in New York. He joined the Army after 9/11 and were's a tattoo commemorating the men and women who were murdered on that day. Paul has a heart of gold and is as tough as nails. He is what exemplifies the hardiness of New Yorkers. He is a great American.

Lt. Mike Sarber was a combat medic during the Gulf War. He is now a critical care nurse and will become a CRNA. Mike is a motivated, unstoppable, intelligent officer. He knows how to get the job done and he does it well. He is inspiring and a leader.

On my right is Lt. Vicky Tubens. Vicky is a terrific nurse. Despite being from New York, she is soft spoken and always appears happy. She works hard but is never boastful. She is just the type of person you enjoy working with because you know that she does not have some ulterior motive... she simply loves to help people. On my left is Lt. Jody Thorpe. Jody joined the Army immediately after 9/11 as an enlisted soldier and as a young mother. She has served in Landstuhl and now has become a nurse and an officer. Jody is cool and professional. I admire her for her ability to raise a child and serve our country with a smile. People like Jody (and most definitely, my wife Mary) are incredible. Their ability to work, raise children and attend school simply makes men look like little cry babies.

Last, but certainly not least is Capt. Shane Taylor. Capt. Taylor is now a dentist who served during Gulf War I as a combat engineer. He was my "Battle Buddy" during OBLC and I was darn lucky for it. Capt. Taylor was more of an "under the radar" kind of guy. You could not tell the depth that he had personally nor professionally. He was happy just being a friend. Interestingly, he should be a Major or possibly a LTC, but some paper work SNAFU put him in the National Guard as a Captain. He didn't say anything about it. Only after some time of getting to know him, and by me asking directly did he even mention the error. The point being that he was there serving with a smile.... not griping about some stupid rank on his chest. Capt. Taylor is a fine gentlemen and a heck of a terrific land-navigator (He made this old Cav Scout look great during the land navigation courses).

These are just a few examples of the many many many people that I had the fortune to spend a few weeks with in Fort Sam Houston. There really are so many more, but I fear any reader would be quite bored if I droned on any longer. I know they're not super heroes. I know that if you saw them on the street, they would be just like anyone else. But they're not. They are people that really care about others and they will help others knowing the sacrifice that it will take from themselves and their families. They volunteer their time and their skill for the men and women of our Armed Forces. They are great people. God bless them.

Boston Dynamics can Walk the Walk

2009-10-28T12:47:00.000-05:00

It really doesn't get much cooler than this. Boston Dynamics has rocketed into the engineering stratosphere with their "Big Dog" robot shown last year, but now they are going orbital with this new you tube video release of PETMAN prototype.

I envision the future with amputees able to walk again. Now, that's cool!

Between a Rock and a Hard Place

2009-10-23T20:10:00.000-05:00

Dr. Craig P. Fischer - Hepatobiliary Surgeon

(the screen shows the choledochoscopic view of a large stone in the common bile duct)

Life in general surgery is changing radically as we become more specialized. Fact is, it is simply impossible to be an expert across the wide breath of what is considered "general surgery". For those of you not in the business, the general surgeon is expected to have a command of surgical pathophysiology from the neck to the extremities and nearly everything in between (save for the heart and genitourinary system). However, as our understanding of surgical diseases has improved, our ability to intervene in meaningful and more sophisticated ways has increased in kind. Because of these increased capabilities, the general surgeon has been pushed into becoming more specialized. For example, we have colorectal surgeons, bariatric surgeons, vascular surgeons, thoracic surgeons, minimally invasive surgeons, endocrine surgeons, breast surgeons, acute care surgeons, and in this case hepatobiliary surgeons. Many of those listed have been specialized for many decades, but each area is still certainly one in which the general surgeon is expected to have the ability to manage if they are to become certified by the American Board of Surgery. Enter the benefit of having specialized training and expertise.

Intraoperative Cholangiogram (IOC)

Every general surgeon is expected to have a strong command of biliary stone disease. But not every case of gallbladder disease is the same. As seen above, this IOC reveals a rather impressive stone burden that fills the entire biliary system. Although, any good general surgeon can technically handle this case, saying that this is just another "gallbladder surgery" would be quite the understatement. Add to it that this patient has a BMI of over 55 and you have yourself a rather challenging operation ahead. Fortunately, patients such as this are able to be transferred to our medical center due to the expertise we have available.

Above the ruler: The contracted gallbladder

Below the ruler: Stones removed from the hepatic ducts and common bile duct (CBD).

Preoperatively, we knew the complexity of this patient's biliary disease. Given the availability of expertise, we proceeded with an attempt at a minimally invasive approach. This went smoothly, identifying the anatomy by IOC and accessing the CBD with laparoscopic choledochoscopy. Despite these maneuvers, the stone burden exceeded the technical limitations of the laparoscopic approach, and conversion to an open approach was required. Ultimately, every amount of expertise was brought to bear, as the shear amount of disease necessitated performing a choledochoduodenostomy. This last portion of the procedure, when performed with an expert in hepatobiliary surgery is rather enjoyable (enjoyable like a kid running around at his first county fair). I can only imagine that as a young general surgeon, alone in practice, this might be otherwise unnerving. It simply isn't something that you do everyday as a general surgeon.

The best part. The patient had a fantastic outcome. No complications. Fast recovery. You just can't ask for more.

The Tiny Just Got Smaller - The GE Vscan

2009-10-21T14:24:00.000-05:00

GE VScan Portable Ultrasound

I was truly impressed with the SonoSite NanoMaxx. However, GE has really blown me away with the GE Vscan "pocket" ultrasound. This is truly cool technology. Its cool not for technologies sake alone, but because it helps to crystallize a vision that what was once science fiction is clearly becoming so common place as to almost make medical technology a commodity. A commodity? you say. Yes, medical technologies will become commodities.

Jeff Immelt introducing the Vscan at the Web 2.0 Summit

We are still stuck with this idea that doctors and hospitals will be the only ones that will control these technologies. I believe those days are ending (at least definitely changing). The Internet has given patients unfettered access to knowledge, allowing them to become more educated about their own health. It's only a matter of time before patients have access to cheap but sophisticated medical technologies enabling them to control their own care.

This product is NOT being marketed to the general public, but I look at this and see Dr. "Bones" McCoy's medical tricorder. Just a wave over the body and poof! You've got your diagnosis. Give me 2 decades (and a stable economy), and I will give you a radical change in what patients will be able to do for themselves.

Story from GE Reports

Business of Innovation/Redefining Health Care - CNBC.com

2009-10-15T19:33:00.002-05:00

I have been exploring the concept of using telemedicine to augment our multidisciplinary team approach to the care of critically ill surgical patients. My particular spin on this technology was featured this week on CNBC as part of a series by Maria Bartiromo entitled Business of Innovation/Redefining Health Care - CNBC.com. My part starts around the 13:40 mark. But, as is typical, they edited the content to such a degree as to not really get my point across. That's OK... that's just the way things work in the media. Unfortunately, the "experts" only viewed this edited material and made the expected negative comments based on the lack of the whole story. Therefore, I will present a short version of "the whole story" here.

First, it should be noted that this technology is very very early in its lifespan. We honestly don't know how much of an impact that this will have on healthcare. My opinion is that we will see huge advances in this area in another decade. These advances will show us that the technology will be invaluable, just as the Internet as a whole has been invaluable for patient and physician access to information.

My implementation of this technology utilizes something termed Robotic Telepresence (RTP). The robot part comes from the ability for a provider to control a mobile unit from anywhere there is an Internet connection. This mobile unit comes equipped with a two way audio AND visual communication platform that sits on the top of the robot and is shown below.

My team uses this tool in a unique way. We have a multidisciplinary ICU team that sees all the surgical ICU patients. This team is comprised of a surgical intensivist, nurse practitioners, clinical pharmacists, bedside ICU nurses, surgical residents, respiratory therapists, nutritionists and social workers. Not to mention that this is a teaching facility, thus the team is also comprised of students from medical school, pharmacy school and nurse practitioner school. Additionally, we have a top-tier liver transplant program and we round with the transplant team that comprises the transplant surgeon, hepatologist, transplant pharmacist, transplant resident and.... Do you get the point? The team I have is ginormous!

Now, just think about the immense size of my team standing at the bedside or outside the hallway. Well, why don't I just paint you a picture below.

This large team is put together for the sole purpose of optimizing patient care by enhancing communication amongst the team of providers responsible for said patient. The resources that we pour into patient care is meant to ensure that all details are checked, double-checked and checked again. But the downside that we experience is that this team creates a noise and traffic problem in the patient care area. It is also difficult for the team to communicate well if the noise level is elevated. Additionally, having this many people show up at your bedside can be scary to the patient and their family.

Thus, we implemented a solution to this problem. We implemented Robotic Telepresence. Our doctors personally see the patient early in the morning, examining the patient and collecting the details. We then meet as a team in a remote conference room where the patient clinical information and xrays are projected onto large screens. We then use the robot to "see" the patient and his/her nurse at the bedside. In this way, the entire team is figuratively inside the robot. Thus the teams footprint and noise level is reduced to that of a single person. Just as importantly, the team can communicate better because they are in an environment that is designed for communication (a conference room). They all see the patient and the clinical information as a team. This enhances the ability for any individual on the team to engage in the patient's care, no matter what role they serve.

Finally, the team designs a plan of care for that patient. Once the plan of care is set, the surgical intensivist team re-engages directly and personally with the patient and bedside nurse to enact the care plan. We believe that this model enhances patient safety and helps to optimize our patients outcomes.

I have performed an as yet unpublished, IRB approved study that surveyed the patients and their families requesting their perception of the robot. I have an overwhelmingly positive response. That is the whole story.

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Rectusbanding: a method for the repair of incisional hernias

2009-10-11T18:54:00.002-05:00

M. Sahm
Email: m.sahm@drk-kliniken-berlin.de

Received: 22 November 2008 Accepted: 3 May 2009 Published online: 3 June 2009

In this October release of Hernia, Vol. 13, Issue 5 we find another report from our inventive German surgical colleagues detailing their experience with a technique they have been pioneering for the past decade termed "Rectus Banding". Their intention was to develop an inexpensive, simple and safe technique for the repair of incisional hernia while preventing postoperative "stiff abdomen".

My take; I find the study to be performed very well. They did an excellent job at defining their patient population and did as good, or better than most at followup. They have excellent outcomes. However, I don't think that they met the intended goal of developing an improved simpler technique. In fact, this technique appears considerably more difficult than a more traditional wide-underlay technique. Additionally, creating multiple fascial defects for placement of the bands appears to be counter-intuitive and poses a risk of creating more problems with iatrogenic hernia formation. I would think that multiple bands would have to result in dennervation of the rectus musculature, but the authors report that this is not the case.

Finally, I can understand that decreasing the amount of mesh can be helpful in improving the dynamic compliance of the abdominal wall, but there are increasing reports that lightweight mesh can and should be used to achieve this goal. In my opinion, the use of lightweight mesh will be the lasting trend in hernia repair which will achieve the goal of decreasing the so-called "stiff abdomen".

Link: SpringerLink - Journal Article

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Knot Tying 101 With a Pulmonary Artery Catheter

2009-10-09T17:27:00.001-05:00

I hear many outlandish stories in medicine and have come to accept that if it sounds unbelievable, then its probably true. During my training, I was taught to stop pulling on a pulmonary artery (PA) catheter if you meet resistance. The balloon might not have deflated, or it may have gotten caught in the chordae tendonae of the heart.

As you can see above, this PA catheter is literally tied in a knot. It is a rather unusual problem and in the 1980s this would have required a radical operation to get this catheter removed. Fortunately, in the 21st century with the technology used by interventional radiologists, this does not require an operation. In fact, this problem can be resolved via accessing the right internal jugular vein and manipulating the PA catheter with another catheter under flouroscopic guidance. The knot gets untied. The PA catheter is removed. No surgery. No anethesia. No adverse sequelae. No problem... Technology continues to advance.

Surgical Repair of Complex Abdominal Wall Defects

2009-10-06T16:38:00.000-05:00

I specialize in the repair of complex abdominal wall defects such as that pictured above. Over the past 5 years I have learned a great deal about this problem. The intricacies posed by the anatomical void are abound. Repairing these abdominal wall problems is fraught with a myriad of complications. In fact, maybe as much as 20-60% of these patients will have a failed repair in the first three years. Just as many will have a surgical wound complication that may necessitate the removal of mesh. These two facts alone have spawned the search for surgical techniques and implantable mesh that reduce the risk of these occurrences.

Many of us have moved towards performing bilateral rectus advancement flaps (components separation) to achieve advancement of local autologous tissue to the midline. This alone has not been successful in decreasing the rate of hernia recurrence. Additionally, often in these cases there just isn't enough living tissue to achieve midline closure. Therefore, some type of mesh is needed to bridge the defect as shown below.

In cases where contamination or fear that there is high risk for wound complications, placing biologic mesh has become a standard practice. Its the biologic mesh that is the crux of this post. There are many of these products now on the market. They are derived from a variety of sources; human, pig (porcine), cow (bovine). Some come from dermis, others from gut mucosa, and finally as seen in the latest release from The American Journal of Surgery, pericardium. All are processed in a variety of patented ways such to remove the cellular and antigenic components, leaving an acellular matrix that is free from the issues of xenograft rejection.

ScienceDirect - The American Journal of Surgery : Repair of abdominal wall defects with bovine pericardium

While I applaud the authors for their good work and a respectable 20% recurrence rate, I hesitate to use this article as one to which I can say bovine pericardium is good or bad for the repair of complicated ventral hernias. In fact, this paper suffers from the same problem all others before it. That is, small patient group of 26 patients (underpowered), recurrence is determined by the surgeon who operated (bias), surgical technique is not controlled (inlay, overlay, components separation/no separation), etc.. Clearly the authors are experts in this topic. Their comments are basically the same ones that I espouse. Unfortunately, this paper adds nothing to the confusing landscape of biologic mesh implantation.

What we do know is that these biologic products appear to have a very good safety profile. What we don't know is the long-term outcome (except for that of human acellular dermal matrix) AND we don't know which product is better than the other. What I am seeing in the industry is a huge marketing campaign. They all claim that their product is better than the other. But there is no data to support their claims. Additionally, there is no long-term data that shows if the outcomes of these expensive products are better than the traditional synthetic meshes. We need a large prospective randomized controlled multi-center trial. Who is up for that challenge?

JFS

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I Guess It's Better Than Swallowing a Rock

2009-10-06T14:02:00.000-05:00

From the original purveyors of imaging your small intestine (Given Imaging, Ltd, Yoqneam, Israel) comes the Agile patency capsule. GI endoscopy can only take you so far, and there are few people skilled in push and double-balloon enteroscopy. So, in 2000 the FDA cleared the way for Given Imaging's video capsule endoscopy (VCE) pill for identifying those obscure small bowel pathologies that just won't reveal themselves. We surgeon's joked often that you might as well give the patient a rock to swallow (it will get stuck in the place where the bad thing is happening). Of course, that's not completely true, but humor does usually have some basis in truth.

Nonetheless, the Agile patency system may make some sense. If the pill 'gets stuck' it will dissolve within 40-80 hours. However, in one study 1(noted at the bottom) 10% (2 patients) required emergency surgery due to symptoms of intestinal obstruction after ingesting this device. Subsequently the pill has been redesigned to allow for improved dissolution. This may have improved its safety profile.

I am not completely sold on the idea that you need a "patency capsule". If a patient needs to have their GI tract studied, then there likely is pathology that needs surgical intervention. If the PillCam SB becomes 'stuck' in the intestine, then you have your source of pathology and the surgeon has an area to focus his/her work. On the other hand, this forces you into a semi-urgent procedure.

I think what is more fascinating is the idea that in the future these devices will shed their diagnostic skin and become a therapeutic instrument through advances in nanotechnology. Some day, we may be able to send these devices through the bowel as vehicles for a small army of nanobots that will can deliver medications to the point of pathology, or laser seal bleeding mucosal vessels, thus terminating the need for surgeons to grotesquely enter the abdomen and resect large portions of intestine for otherwise small areas of disease.

1. Delvaux, M, Ben Soussan, E, Laurent, V, et al. Clinical Evaluation of the Use of the M2A Patency Capsule System Before a Capsule Endoscopy Procedure, in Patients with Known or Suspected Intestinal Stenosis. Endoscopy. 2005; 37:801

Improve Patient Care AND Reduce Costs With Better Technology

2009-10-05T15:44:00.000-05:00

Just a decade ago you wouldn't catch me dead using an ultrasound for vascular access procedures. Just the thought made me recoil in a rage of machismo. I don't think that I was/am too different from most surgeons out there. The reality is that I performed thousands of central venous access procedures safely. But truth be told, I had two instances that resulted in early complications. Now, one could argue that my safety record is phenomenal. But let me tell you that I vividly recall both of these complications over a decade later. I never want to have this happen again.

[SonoSite NanoMaxx]

Fast forward to the 21st century. For 5 years now I have performed every central venous access procedure with ultrasound guidance. This technique has been proven beyond a shadow of a doubt to reduce not only the immediate complications (carotid puncture, pneumothorax, etc.), but it reduces the more common near-term complications of catheter related blood-stream infection. Additionally, it increases the success rate of achieving access on the first attempt.

One aspect that I haven't personally seen in the literature, but have experienced first hand is that my surgical ICU residents have an astoundingly high success rate and incredibly only have two immediate complications in the last 3 years. That is unheard of in a busy tertiary care ICU where we are placing central venous catheters every day.

This all adds up to reduced complications, reduced hospital length of stay, improved patient outcomes and satisfaction. Featured above is the new SonoSite NanoMaxx. It is a testament to advancing technology. This type of unit is small and portable (6 lbs.) while still retaining incredible resolution and functionality. Bring on the technology!

SonoSite NanoMaxx Product Site

Surgical Augmented Reality

2009-09-30T07:12:00.000-05:00

Image from Naoki Suzuki paper "Benefits of augmented reality function for laparoscopic and endoscopic surgical robot systems" presented at AMIARCS08 Proceedings

Operating would be a lot easier if God would have labeled everything. This doesn't seem intuitive to those who are not surgeons. In fact, I suspect that most lay-people would assume that it should be rather simple for a surgeon to know what they're looking at when they are operating. Although this is true much of the time, the fact is that there are other times that its almost impossible to identify the anatomy. This can be due to a natural aberrant anatomy, disease, or post-surgical inflammatory changes, etc..

Fortunately, on the horizon is the potential for applying 'augmented reality' to the surgical theater. This is different from 'virtual reality'. In virtual reality, the imagery is completely manufactured (nothing is real). In augmented reality, the true image is present, and computerized imagery is applied over the real image in such a way as to augment the surgeon's visual perception. Thus, augmented reality could greatly help to decrease the incidence of technical complications in surgical procedures leading to improved patient safety and better outcomes.

Electronic Medical Records Have A Long Way To Go

2009-09-28T07:26:00.000-05:00

This photo was taken 10 years ago. I founded DocuMedix, Inc. in 1997 with the other two physicians in the picture. Our concept centered on improving patient care by ensuring physicians had unfettered access to reliable patient information. Unfortunately, what we found was a fragmented industry filled with fiefdoms that had no incentive to talk to each other. We also bumped into giants that were burning through millions of dollars a month to enter this market. It was a heck of a lesson. Ultimately, DocuMedix was acquired by another company and its ideas of a better EMR never really fully got off the white board.

Fast forward 10 years to today. What is different about your EMR? Not a whole heck of a lot in my opinion. Quite honestly, most everything that we developed in 1997 remains unchanged in today's EMRs. A few huge areas that remain problematic in the industry:

Suboptimal Computerized Provider Order Entry (CPOE) rollout and implementation.
Little to no Computerized Clinical Decision Support (CCDS).
Lack of integration with other clinical systems, thus creating 'silos' of information.
Obtrusive and cumbersome need for physicians to be data-entry clerks.
Lack of human factors engineering leading to:

Poor user-interfaces
Suboptimal aid for improving situation awareness.

Little to no help for improving the efficiency of medical documentation.

These are just a few. I could go on to 10 points, but I need to see my patients.

Now, I know that many of the vendors out there can make their own arguments to counter these points. However, what is clear today is the health care clinical informatics field continues to lack that 'killer' application. We are swamped with clinical software that continues to disappoint clinicians, and quite frankly, I don't understand why this is the case. There are a whole lot of really bright people working on this problem. So why do we seem to be stuck in the mud? Your guess is as good as mine (I certainly have a lot of theories).

Lions and Tigers and ... Robots?

2009-09-24T15:38:00.000-05:00

(Photographer: Jim Lo Scalzo for U.S. News & World Report)

Original artical from US News and World Report "The High-Tech Hospital of the Future. Technology of all kinds in transforming the way medical systems work." By Michell Andrews

I am fortunate to be an academic surgeon, working in the largest medical center in the world. In so, I get the opportunities to test, work with and experience cutting edge technologies. One of these is robotic telepresence (RTP). InTouch Technologies, Inc. is the maker of the RP7 unit pictured above. It allows me to 'beam in' to the surgical ICU to see patients and interact with the staff from anywhere in the world (as long as I have a computer with the software and an Internet connection). Now, the first question that comes to mind is; Why? Well, quite frankly I'm not sure yet. One idea is that we know that there aren't enough board certified critical care doctors (I am one) to meet the demand. Therefore, we need to find new and innovative ways to get that person with the specialized skills to be in more places, more often.

(Photographer: Jim Lo Scalzo for U.S. News & World Report

ICU team meeting discussing patient care while interacting with the patient via the RP7)

You see, doctors with expertise in critical care mainly help to improve patient outcomes in ICU's because they are good at identifying complex problems and then how to best treat the patient with those problems. They also help to coordinate the care of a patient with the other specialists of the team (this not only includes other doctors, but also the respiratory therapists, clinical pharmacists, nutritionists and ICU nurses). Therefore, if you can assemble a team to do just that and deliver their expertise across geographic distances in support of those practitioners "on-the-ground", then you just might be able to improve the quality of care for more critically ill patients.

Ray Kurzweil, Immortality and Surrogates

2009-09-23T11:01:00.000-05:00

Have you heard? We will be immortal in 20 years, at least according to Ray Kurzweil. This is one interesting cat. He is a well regarded super-genius and the author of multiple books including Singularity in Near. Based on his theory of the Law of accelerating returns, Kurzweil has predicted that the slope of knowledge and technology is increasing at an exponentially exponential pace. Therefore, this slope will be nearly a straight line vertical by the year 2060. At that point, we will achieve singularity, and machines will achieve 'consciousness' and have the ability to grasp spirituality. Therefore, the ability of us mere humans (notice the lack of the word 'mortals') to tell the difference between man and machine will be over.

Even more alarming is this concept of immortality. Do I believe that Kurzweils predictions are correct? Well... sort of. I don't believe in his timeline (he's already off by more than 2 decades from his 1999 predictions) and I don't believe in immortality. However, I think that his theories of singularity are plausible and that we will see the day where 'machine' will become part of 'man'. How that will play out in the future is unclear, but Hollywood sure gives us a scary look at it with movies like Surrogate.

Just Add Glue

2009-09-22T13:48:00.000-05:00

Surgical sealants are derived from numerous sources. All purporting to reduce the risk of intestinal anastomotic leaks and their resultant catastrophic complications. Personally, I continue to struggle with the concepts that surgical sealants in intestinal surgery will somehow attenuate this problem and here's why: Anastomoses fail due to one of four reasons. 1. poor blood supply. 2. poor local tissue. 3. infection and 4. poor surgical technique.

Surgical sealants do nothing to alleviate any of these problems. They simply cover the area. They don't improve the blood supply. They don't affect the character of the tissue. They won't prevent infection and they can't make up for poor technique. However, you might be able to make an argument that the sealant can cover a defect in the anastomosis for enough time as to prevent the early anastomotic leak, thus reducing the risk of contamination and resultant infection. This may indeed be true, but it is not clear what fraction of anastomotic complications that this would represent. My opinion is that this would be very few and far between.

Although I have not performed a critical review of the literature in this arena, I can say that I do not know of any compelling literature that shows these products to be of any benefit in intestinal surgery. However, I can say that the science behind the products are great and I applaud the scientists of the latest products from LifeBond.

I cannot tell you that these products are not effective. I suggest that the reader go to LifeBond's website , and PubMeb to form your own opinion. But for my patients, I will await more evidence and continue to ensure my surgical technique remains optimal.

Ma'm, I plan to use a Spider to remove your gallbladder.

2009-09-20T09:09:00.000-05:00

Single Port Laparsocopic Surgery (SILS) and Natural Orifice Translumenal Endoscopic Surgery (NOTES) are minimally invasive surgical techniques that have become increasingly obvious in the surgical literature over the past 3 years. Surgeons and patients continue to ask for "less invasive" surgery, past that of current conventional laparoscopic techniques. SILS and NOTES will be the future of laparoscpic surgery. But these techniques will require radical advancements in technology (I'll talk about NOTES at another time).

Current laparoscopic instrumentation is rather 'clunky'. The instruments are very limited in their degrees of freedom, thus requiring multiple ports must be placed in a triangulated fashion to allow for optimal visualization and retraction. Interestingly, SILS is counter-intuitive to solving the issue of improving visualization and retraction. In fact, SILS would seem to make any laparoscopic procedure significantly more difficult. However, what SILS and NOTES are doing is creating the energy to advance the technology of laparoscopic instrumentation, without which, these techniques would simply aggravate the existing problems.

In the latest online release of Surgical Endoscopy comes Single-Port Instrument Delivery Extended Reach (SPIDER) from TransEnterix (shown). While I would hesitate to market a device under this name (and I would be even more inclined never to use this acronym in discussing the surgery with my patient), I think that this device appears to be in line with what surgeons are looking for. That is, a minimally invasive technology that addresses the issues of triangulation, visualization and retraction. However, I will withhold further accolades until I can see if it addresses the ergonomics. It does not appear to address improvement in degrees of freedom (Only robotic systems are able to do this to the best of my knowledge). All of these issues are important to the surgeon.

Of course, the issues that are important to the patient remain the same. They expect to have a safe operation with minimal discomfort, quick healing and no visible scars. SILS may be the next big step in moving in that direction, but we need to have significant advances in instrument technology to get there.

The original publication is available at www.springerlink.com

Single-port cholecystectomy with the TransEnterix SPIDER: simple and safe

Hansen Medical: Products: Sensei X Robotic Catheter System

2009-09-18T11:49:00.001-05:00

Hansen Medical: Products: Sensei X Robotic Catheter System

Come on! This is wicked-cool stuff, and it has the word 'robot' in the title to boot. Honestly, this is cool. Medical technology is delivering on the future. This type of system will revolutionize endovascular therapies, making what was once incredibly risky into something that is more a matter of routine.

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Videos of 1930s Surgeries on the Brain, Belly and Tonsils

2009-09-18T11:22:00.001-05:00

Videos of 1930s Surgeries on the Brain, Belly and Tonsils

From Wired comes videos of surgery past. I love history, and it is clear that knowing the past is the key to understanding the future. However, this trip is more nostalgic.

Enjoy

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iPhone 3.1 problems flood our tip box (from TUAW)

2009-09-17T10:18:00.000-05:00

iPhone 3.1 problems flood our (TUAW) tip box

I like the iPhone. It doesn't have exactly what I need (a physical keyboard and a network that actually has coverage). But it is most definitely a market changing device. What kicks me in the pants is the over-love that people have for Apple with this idea that they can't do wrong.

Well, I am here to tell you. Apple has its issues. The Mac's have issues.. and the all-incredible iPhone has issues. Over 1/3 of the iPhone users report problems with the latest update. Whenever this happens on a Redmond device... you never hear the end of it.

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Inside America's Busiest Trauma Center

2009-09-16T17:44:00.001-05:00

ABC News did a good job highlighting the plight of Houston's trauma system. You can watch the video here:

Inside America's Busiest Trauma Center

Memorial Hermann Hospital is a world-class leading trauma center located on the north end of the Houston Medical Center. I did my general surgery residency, surgical critical care fellowship and acute care surgery fellowship at this Hospital.

During my time there I saw an ever increasing trauma burden on the system. Houston is home to 5 million people and only two Level 1 trauma centers. The American College of Surgeons has advocated that a city should have at least one Level 1 trauma center per million people.

You do the math.

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Defense Sciences Office - Revolutionizing Prosthetics

2009-09-16T17:21:00.001-05:00

Defense Sciences Office - Revolutionizing Prosthetics

We stand to see some of the greatest revolutions in medical technology during this next decade. Prosthetic limbs will function and appear just like the limb they replaced. The only thing that stands in the way is economic collapse.

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ECS - Device being developed for on-the-spot blood analysis

2009-09-16T12:02:00.001-05:00

ECS - Device being developed for on-the-spot blood analysis

On the heals of my previous post comes news of this technology from the University of Southhampton. The ability to rapidly analyze micro amounts of blood at the point of care with greater speed and decreased cost will be a reality very soon.

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American Society for Nanomedicine - Conference Info

2009-09-16T11:51:00.001-05:00

American Society for Nanomedicine - Conference Info

Without a doubt, nanotechnology will be one of the 3 most important advances in the future of medicine (1. New medicines and therapies for cancer treatments 2. Rapid evolution of computerization of medicine for things such as better communcation and artificial intelligence 3. Nanotechnology).

Nanotechnology will usher in new diagnostics and therapies of which we can hardly imagine now. Nanotechnology will have an impact on numbers 1 and 2 listed above. The inaugural conference of the American Society for Nanomedicine (ASNM), which is in the final stages of planning and will be held at the Bolger Center in Potomac, Maryland, USA during October 22-25, 2009.

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The Health Care Blog: What if I Had to do HIT All Over Again?

2009-09-16T11:10:00.001-05:00

The Health Care Blog: What if I Had to do HIT All Over Again?

This piece hit home for me. I have struggled for over 12 years with trying to understand how we will create software that allows clinicians to document encounters, create codified information for research and billing, AND improve communication, thus ultimately improving patient care.

The problem is that no matter what we do with the current tools, it slows the provider down. We need to really rethink how to optimize our use of the current technology.

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Welcome

2009-09-16T09:52:00.001-05:00

Hopefully this a true start to my medical and technology blogging. I have spent the last 2 years reading blogs such as those from Buckeye Surgeon, Wachter's World, Life as a Healthcare CIO, The Healthcare Blog and Kevin MD. I think these are some of the best blogs in the medical blogosphere.

I hope to simply share my particular view of the areas that I am most interested in. Those are medicine / surgery and computer technology.

Wish me luck.

J