Showing posts with label Surgery. Show all posts
Showing posts with label Surgery. Show all posts
Surgeon uses Google Glass during operation: "90% of students want this type of learning to be part of curriculum"
From The Telegraph:
"Shafi Ahmed live streams an operation at The Royal London Hospital using a pair of Google Glasses while he removes cancerous tissue from the liver and bowel of a 78-year-old man
A surgeon at The Royal London Hospital removed a tumour from the liver and bowel of a patient in the world's first operation streamed live online using a pair of Google Glasses.
Mr Shafi Ahmed, Colorectal Cancer Lead at Barts Health NHS Trust, wore the glasses which allowed his view to be broadcast live to 13,000 surgical students around the globe who were able can interact and put their questions directly to him as he performed the operation.
The students typed their questions online as they watched, and their queries appeared on the bottom left-hand side of Mr Ahmed's Google Glasses who answered them verbally, transmitted via the online feed. The questions appear to the side of the Google Glass so it does not restrict the surgeon's view.
In an online questionnaire, 90 per cent of students who watched the live broadcast said that they wanted this type of learning to be part of the curriculum." Source: ITN
Here is a skeptical view on this news report from Skeptical Scalpel blog: Google Glass in the OR: Not ready for prime time http://buff.ly/1x8X1Vu
Women in medicine: Why are so few female doctors in leadership positions?
From Germany (a report from Germany's equivalent of BBC World Service):
Two thirds of medical students are women. But there are very few female doctors in leadership positions. Just ten percent make it to the top of their profession.
Chief physician Doris Henne-Bruns says that should be changed:
Comments from Twitter:
Lyall Furphy RN @Lyall: I know another profession that has a 91% 'quota' in favour of a dominant sex according to her logic. Would that chief surgeon let a junior doctor leave on time if he was a new dad with child care responsibilities? #justpondering
Ves Dimov, M.D. @DrVes: Yes, these are good questions. There is a tendency to oversimplify sometimes.
Two thirds of medical students are women. But there are very few female doctors in leadership positions. Just ten percent make it to the top of their profession.
Chief physician Doris Henne-Bruns says that should be changed:
Comments from Twitter:
Lyall Furphy RN @Lyall: I know another profession that has a 91% 'quota' in favour of a dominant sex according to her logic. Would that chief surgeon let a junior doctor leave on time if he was a new dad with child care responsibilities? #justpondering
Ves Dimov, M.D. @DrVes: Yes, these are good questions. There is a tendency to oversimplify sometimes.
Video Pre-Op Guide to Bariatric Surgery from Cleveland Clinic
A 13-minute video from the official Cleveland Clinic channel on YouTube:
"We can take care of you better if you understand your disease" - Cleveland Clinic's project for visual learners
In this White Board Series, Cleveland Clinic cardiothoracic surgeon Eric Roselli, MD, takes us on a tour of the heart that simply illustrates complex problems so everyone can understand. He says, "We can take care of you better if you understand your disease", and I could not agree more. The videos are below:
Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video)
From Swedish hospital YouTube channel: Dr. James Porter, medical director of robotic surgery at Swedish folds a small paper airplane with the da Vinci robot to demonstrate how this device gives surgeons greater surgical precision and dexterity over existing approaches.
With over 600,000 views, this video undoubtedly brings good publicity to the hospital.
However, the robot costs on average $1.3 million, in addition to several hundred thousand dollars of annual maintenance fees. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.
The manufacturer Intuitive Surgical has sold more than 1,000 units worldwide.
References:
Prepping Robots to Perform Surgery, The New York Times, 4 May 2008.
Wikipedia
Comments from Twitter:
Meenakshi Budhraja @gastromom: Cool !!
Westby Fisher, MD @doctorwes: Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video) bit.ly/KG2EG6 - Manual faster, no?
PDara MD, FACP @JediPD: da Vinci good for that
Skeptical Scalpel @Skepticscalpel: Finally a use. Maybe the airplanes could have the hospital's logo on them. Folding a paper airplane. Amazing feat by a surgical robot? I think not. My blog. is.gd/6tBcZp -- Folding a paper airplane. Amazing feat by the surgical robot? http://goo.gl/cz7lC
Ravi Pamnani @ravrav0: Surgical robots: Folding tiny paper airplanes - CHECK. Actually improving clinical outcomes - TBD. bit.ly/LEp3jg #medtech
Jenaro Fdez-Valencia @JenaroFV_MD: after all ... it doesn't fly! If he did a boat instead, it would work. Can he try?
With over 600,000 views, this video undoubtedly brings good publicity to the hospital.
However, the robot costs on average $1.3 million, in addition to several hundred thousand dollars of annual maintenance fees. Surgical procedures performed with the robot take longer than traditional ones. Critics say that hospitals have a hard time recovering the cost and that most clinical data does not support the claim of improved patient outcomes.
The manufacturer Intuitive Surgical has sold more than 1,000 units worldwide.
References:
Prepping Robots to Perform Surgery, The New York Times, 4 May 2008.
Wikipedia
Comments from Twitter:
Meenakshi Budhraja @gastromom: Cool !!
Westby Fisher, MD @doctorwes: Surgeon Folds and Throws Paper Airplane Using da Vinci Robot (video) bit.ly/KG2EG6 - Manual faster, no?
PDara MD, FACP @JediPD: da Vinci good for that
Skeptical Scalpel @Skepticscalpel: Finally a use. Maybe the airplanes could have the hospital's logo on them. Folding a paper airplane. Amazing feat by a surgical robot? I think not. My blog. is.gd/6tBcZp -- Folding a paper airplane. Amazing feat by the surgical robot? http://goo.gl/cz7lC
Ravi Pamnani @ravrav0: Surgical robots: Folding tiny paper airplanes - CHECK. Actually improving clinical outcomes - TBD. bit.ly/LEp3jg #medtech
Jenaro Fdez-Valencia @JenaroFV_MD: after all ... it doesn't fly! If he did a boat instead, it would work. Can he try?
Battling depression with "battery-powered brains" - CNN report on deep brain stimulation (DBS)
CNN reports on treating severe depression with electrodes inside the brain:
The procedure -- called deep brain stimulation, or DBS -- targets a small brain structure known as Area 25, the "ringleader" for the brain circuits that control our moods.
Area 25 is relatively overactive in depressed patients. One hypothesis is that in patients who do not improve with treatments for depression, Area 25 is somehow stuck in overdrive.
DBS had been used since 1997 as a treatment for movement disorders, including essential tremor, Parkinson's disease and dystonia.
References:
Treating depression with electrodes inside the brain. CNN, 2012.
The procedure -- called deep brain stimulation, or DBS -- targets a small brain structure known as Area 25, the "ringleader" for the brain circuits that control our moods.
Area 25 is relatively overactive in depressed patients. One hypothesis is that in patients who do not improve with treatments for depression, Area 25 is somehow stuck in overdrive.
DBS had been used since 1997 as a treatment for movement disorders, including essential tremor, Parkinson's disease and dystonia.
References:
Treating depression with electrodes inside the brain. CNN, 2012.
iPad App for Education of Heart Patients After Surgery - Mayo Clinic Video
From Mayo Clinic YouTube channel: "Being in the hospital after major surgery is no fun. On top of dealing with pain, patients have uncertainty. They also have to worry about getting all the information they need to support their recovery. That's not always easy in the hospital; things happen quickly and doctors and hospital staff are often really busy. Doctors at Mayo Clinic may have a solution to this issue. They're giving iPads to heart surgery patients to see if a new iPad app can make hospital stays easier and more satisfying."
Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:
PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318
A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.
Background:
During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.
Methods:
8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.
Conclusion:
Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.
Source: Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.
http://www.annallergy.org/supplements
Our research presented during the 2011 ACAAI meeting showed that 95% patients thought the iPad was helpful for coming to understanding of their condition:
PATIENT PERCEPTION OF A POINT-OF-CARE TABLET COMPUTER (IPAD™) BEING USED FOR PATIENT EDUCATION - P318
A. Nickels*, V. Dimov, V. Press, R.Wolf, Chicago, IL.
Background:
During the fall of 2010, the Internal Medicine/Pediatrics program at University of Chicago introduced Point-of-Care Tablet Computers (iPad™) for clinical use. iPads™ are intended to improve access to EMR, work flow, resident and patient education, and access to electronic clinical tools. The graphic display and ease of interface makes the iPad™ a potentially powerful tool to achieve these goals. This pilot study is designed to gauge the initial patient perception of the iPad™ when used for patient education.
Methods:
8 questions, physician administered, patient survey of Allergy Immunology patients or their parents. Preloaded iPads™ with education materials (“mind map” diagrams, clinical pictures) into the photo software were used to clinically education the patients. Simple percentages and Fisher’s exact non-parametric test were used for statistical analysis. Results: 20 patients surveyed (11 resident/9 attending). For those survey items without 100% agreement, there was no statistically significant difference in responses based on level of training (p≥0.45). 100% [0.861, 1] of participants liked the iPad™ being used to help explain their children’s condition, 95% [0.783, 0.997] of participants did not find it distracting. 100% [0.8601, 1] found it helpful. 100% [0.861, 1] would like it to be used again to help explain medical information. 95% [0.784, 0.9974386] thought the iPad™ was helpful for coming to understanding of their condition. Limitations of this study include a convenient sample, physician-administered survey, and observer bias.
Conclusion:
Patient perception was very positive toward the use of a Point-of-Care Tablet Computer (iPad™) in a clinical setting. While limited to only two operators, level of training did not have an effect on patient perception. Confirmation of the results may be required before wider implementation.
Source: Patient Perception of a Point-of-Care Tablet Computer (iPad) Being Used for Patient Education. A. Nickels, V. Dimov, V. Press, R. Wolf. American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Meeting.
http://www.annallergy.org/supplements
Blood Management Summit and App - Transfuse 2012
Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.
This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.
Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:
This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.
The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780
One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.
It should be a great conference. Go check it out.
This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.
Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:
This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.
The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780
One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.
It should be a great conference. Go check it out.
Headache? It could be that blade in skull (CNN video)
CNN: "I've got these stabbing pains" - Man complains about migraine, finds he has had a knife in his brain for 4 years.
Related reading:
From migrant worker to brain surgeon at Johns Hopkins
Dr. Alfredo Quiñones-Hinojosa is the Director of the Brain Tumor Stem Cell Laboratory at Johns Hopkins University School of Medicine.
Twenty years ago, Dr. Quinones-Hinojosa hopped a border fence from Mexico into the United States and became a migrant farm worker, living in the fields in a broken-down camper he bought for $300.
When told he would probably be a farm worker for the rest of his life, he signed up for English classes at a community college, where one of his teachers encouraged him to apply to UC-Berkeley. There, he developed a passion for science, and showed remarkable aptitude.
He went on to Harvard Medical School and graduated with honors, followed by a residency in neurosurgery at UC-San Francisco, where he completed a postdoctoral fellowship in developmental and stem cell biology.
References:
Dr. Alfredo Quinones-Hinojosa. BigThink.com.
Kidney Transplant Overview - Mayo Clinic Video
Mayo Clinic emphasizes living donor kidney transplants as the best option for patients. Martin Mai, M.D., nephrologist at Mayo Clinic offers information about living donation, statistics, including the fact that living donor kidneys last longer. Half of living donor kidneys transplanted today will still be functioning 25 years from now, whereas half of cadaveric kidneys will fail in the first 10 years.
Candy and Ellen's Story.
Oral factor Xa inhibitor apixaban - more effective than enoxaparin for thromboprophylaxis after knee replacement
Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.
Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.
The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.
References:
Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. The Lancet, Volume 375, Issue 9717, Pages 807 - 815, 6 March 2010.
Image source: Apixaban, Wikipedia, public domain.
Barbara Walters, US TV Anchor, to Undergo Heart Surgery to Replace a "Faulty Valve" - Sounds Like Aortic Stenosis
Walters announced that she will undergo surgery to replace a "faulty" heart valve later this week.
"You know how I always say to you how healthy I am. ... I've never missed a day's work," she began. "Later this week, I'm going to have surgery to replace one faulty heart valve."
From her description, the valve defect sounds like aortic stenosis. For a variety of reasons, mitral stenosis is a less likely possibility in the differential diagnosis.
Best wishes for successful surgery and speedy recovery!
References:
Barbara Walters to Undergo Heart Surgery. ABC.
Barbara Walters' Heart Surgery. WebMD.
Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections
Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism.
Eradication of colonization with S. aureus by screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections.
In a randomized, double-blind, placebo-controlled trial, S. aureus nasal carriers were treated with mupirocin nasal ointment and chlorhexidine soap.
A total of 6771 patients were screened on admission, 1270 nasal swabs from 1251 patients were positive for S. aureus. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin.
The rate of S. aureus infection was 3.4% in the mupirocin–chlorhexidine group, as compared with 7.7% in the placebo group (relative risk of infection, 0.42). The effect of mupirocin–chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21).
References:
Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM, 1/2009.GIANTmicrobes in Toys & Games section of Amazon.com http://goo.gl/gMrf
Concussions dangerous to teen brains - a hard to watch CNN video
"4 million sports and recreation-related concussions occur each year. The vast majority are suffered at the high school level, but few schools have rules governing how concussion is treated -- and few coaches are trained to identify it."
References:
Concussions extra dangerous to teen brains. CNN, 2010.
AP Video: Chopstick Pierces Toddler's Brain in China (Recovered After Surgery)
A 14-month-old toddler was playing in the kitchen when he fell, sending a chopstick up his nose. Surgeons were able to remove the chopstick.
Atul Gawande: "Doctors are human. We miss stuff" - Checklists can help
Atul Gawande on NPR:
Doctors are human, and that their profession is like any other.
"We miss stuff. We are inconsistent and unreliable because of the complexity of care," Gawande says. "I got a chance to visit Boeing and see how they make things work, and over and over again they fall back on checklists. The pilot's checklist is a crucial component, not just for how you handle takeoff and landing in normal circumstances, but even how you handle a crisis emergency when you only have a couple of minutes to make a critical decision."
References:
Atul Gawande's 'Checklist' For Surgery Success. NPR.
Related:
Whiplash injury: 2% are permanently disabled
Whiplash and whiplash-associated disorders (WAD) represent a range of injuries to the neck caused by or related to a sudden distortion of the neck. Whiplash is commonly associated with motor vehicle accidents, usually when the vehicle has been hit in the rear; however, the injury can be sustained in many other ways, including falls from bicycles or horses.
Patients present with:
- neck pain and stiffness
- occipital headache
- thoracolumbar back pain and upper-limb pain
- paraesthesia
Over 66% make a full recovery and 2% are permanently disabled.
References:
Whiplash injury. G. Bannister et al. Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 7, 845-850. doi: 10.1302/0301-620X.91B7.22639
References:
Whiplash injury. G. Bannister et al. Journal of Bone and Joint Surgery - British Volume, Vol 91-B, Issue 7, 845-850. doi: 10.1302/0301-620X.91B7.22639
Related:
Whiplash (medicine). Wikipedia.
Image source: A side collision in Tokyo, Japan. Wikipedia, Shuets Udono, Creative Commons Attribution ShareAlike 2.0 License.
TED Talks: Surgery's past, present and robotic future
"Surgeon and inventor Catherine Mohr tours the history of surgery (and its pre-painkiller, pre-antiseptic past), then demos some of the newest tools for surgery through tiny incisions, performed using nimble robot hands. Fascinating -- but not for the squeamish."
LRG urine test may help diagnose appendicitis
From Reuters:
Appendicitis is the most common emergency in childhood, yet 3-30% of appendectomies may be unnecessary. Urine test for leucine-rich alpha-2-glycoprotein (LRG) may help diagnose appendicitis in children.
Inflamed appendix removal by open surgery. Image source: Wikipedia, Dr Vgaikwad, Creative Commons Attribution 3.0 Unported License.
An example of a leucine-rich repeat protein, a porcine ribonuclease inhibitor. Image source: Wikipedia, GNU Free Documentation License.
Twitter comments:
hjluks better to remove a few normals than miss an appy that perforates.
Appendicitis is the most common emergency in childhood, yet 3-30% of appendectomies may be unnecessary. Urine test for leucine-rich alpha-2-glycoprotein (LRG) may help diagnose appendicitis in children.
Inflamed appendix removal by open surgery. Image source: Wikipedia, Dr Vgaikwad, Creative Commons Attribution 3.0 Unported License.
An example of a leucine-rich repeat protein, a porcine ribonuclease inhibitor. Image source: Wikipedia, GNU Free Documentation License.
Twitter comments:
Subscribe to:
Posts (Atom)