Despite guidelines, too many medical tests are performed before low-risk procedures

Despite guidelines, too many medical tests are performed before low-risk procedures.

From the 1 June 2015 EurkAlert

Despite guideline recommendations to limit medical tests before low-risk surgeries, electrocardiograms (ECGs) and chest x-rays are still performed frequently, found a study inCMAJ (Canadian Medical Association Journal).

Evidence indicates that for patients undergoing low-risk surgery, routine testing does not improve outcomes and can actually lead to surgical delays, patient anxiety and other issues. The Choosing Wisely campaign, which started in the United States and spread to Canada and other countries, aims to raise awareness of unnecessary tests and procedures among physicians and patients to decrease their use.

…

“Rates of preoperative testing before low-risk procedures were higher than expected, given current guidelines and recommendations, with a significant degree of regional and institutional-level variation across hospitals in a large, diverse jurisdiction with a single-payer health system,” writes Dr. Sacha Bhatia, Department of Cardiology and the Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, with coauthors.

There was a 30-fold difference between institutions with the lowest and highest rates of ordering preoperative tests.

Previous studies have looked at patients over age 65, whereas this study included all patients over age 18.

“Our finding emphasizes the need for re-evaluation of ordering decisions and clinical pathways for patients preparing for low-risk procedures. In particular, preoperative anesthesia and medical consultations have been shown to increase preoperative testing rates.”

The authors suggest more research to understand why these tests continue to be performed, which may be useful for institutions in improving their ordering practices.

[Reblog] Reducing Pain of Varicose Vein Surgery

Reducing pain of varicose vein surgery has been a priority of The Whiteley Clinic.(31 January 2015)

This latest research studied how pain and anxietycan be reduced under local anaesthetic varicose vein surgery. This sort of surgery is also called “keyhole” orendovenous surgery for varicose veins.

Reducing pain of varicose vein surgery – Research from The Whiteley Clinic and University of Surrey

The research showed that both:

• one-to-one talking with a specific nurse
• using a stress ball

both significantly reduced the pain and anxiety of the varicose vein surgery.Interesting, watching a DVD during the surgery reduced the anxiety, but not the pain of varicose vein surgery. Listening to music had no effect.
This study is part of the continuing research program that makes treatment at The Whiteley Clinic unique.This projectwas funded by The Whiteley Clinic andwas performed at our Whiteley Clinic, Guildford.The researcher, Briony Hudson,was supervised by Prof Jane Ogden at The University of Surrey and Prof Mark Whiteley. Her workhas been submitted to the University of Surrey and shewas awarded her PhD in Autumn 2014.The workis going to be published:

• Hudson BF, Ogden J, Whiteley MS. Randomised Controlled Trial to Compare the Effect of Simple Distraction Interventions on Pain and Anxiety Experienced During Conscious Surgery. European Journal of Pain. 2015.

See link: http://www.medicaldaily.com/how-reduce-anxiety-and-pain-during-surgery-small-talk-and-stress-balls-320176

Related articles

• How To Reduce Anxiety And Pain During Surgery With Small Talk And Stress Balls
• Talk to nurse to ease pain, anxiety during surgery

[News Article] Take note: Jazz and silence help reduce heart rate after surgery, study shows — ScienceDaily

Showing 13.5φEX Headphone with noise cancellation from Sony Walkman Series NW-S705F (Photo credit: Wikipedia)

Take note: Jazz and silence help reduce heart rate after surgery, study shows — ScienceDaily.

 

From the 13 October 2014 article

Jazz is good for you. Patients undergoing elective hysterectomies who listened to jazz music during their recovery experienced significantly lower heart rates, suggests a study presented at the ANESTHESIOLOGY™ 2014 annual meeting.

But the research also found that silence is golden. Patients who wore noise-cancelling headphones also had lower heart rates, as well as less pain.

The results provide hope that patients who listen to music or experience silence while recovering from surgery might need less pain medication, and may be more relaxed and satisfied, note the researchers.

“The thought of having a surgical procedure — in addition to the fears associated with anesthesia — creates emotional stress and anxiety for many patients,” said Flower Austin, D.O., anesthesiology resident, Penn State Milton S. Hershey Medical Center, Hershey, Pa., and lead study author. “Physician anesthesiologists provide patients with pain relief medication right after surgery. But some of these medications can cause significant side effects.”

 

Related articles

• Take Note: Study Shows Jazz and Silence Help Reduce Heart Rate After Surgery
• Smooth Recovery: Jazz Music Lessens Anxiety In Patients Undergoing Surgery
• Post-operative pain management: Listening to jazz may ease recovery after surgery

Medical devices and shared decision-making

Medical devices and shared decision-making.

From the 18 October 2012 article at HealthNewsReview.org

The journal Arthritis Care & Research has accepted for future publication – and posted online (for subscribers) – an unedited paper, “Preceding the Procedure:  Medical Devices and Shared Decision-Making.”  The paper builds on a hypothetical example of a man in his 50s with hip arthritis who is facing a decision about total hip replacement.  Excerpts:

“(The surgeon – Dr. Jones) reviews the procedure with him and confirms that he understands his options. Then (the patient – Mr.Thomas) signs the surgical consent form. This discussion appears to include all the elements of informed consent, but several ethical questions linger beneath the surface. Dr. Jones discussed the risks and benefits of total hip replacement in some detail to help Mr. Thomas decide whether or not to have surgery, but should Mr. Thomas also have participated in the decision about the specific implant to be used?…

This article teases out the ethical issues underlying the choice of a medical device for surgical procedures, using the example of total joint arthroplasty to illustrate the interactions between surgeons and their patients. We highlight shortcomings in the current regulatory process that result in a thin evidence base on which to anchor these technical decisions, and we note the potential for decisions to be influenced by the surgeon’s personal beliefs and possible conflicts of interest. We suggest that the informed consent process could be enriched with a greater focus on shared decision-making. This would include discussing the choice of implant and other technical decisions that may affect the outcome of the procedure, in addition to disclosing any relevant financial relationships. We note the challenge of providing patients with easily digestible information that helps them make decisions consistent with their own values. …

 

…

urgeons reporting “that that they typically face few institutional constraints on their choice of implants, so many are able to decide for themselves when they wish to begin using newer models.”

Photo credit: dpstyles™ via Flickr

And it provides background for consideration of conflicts of interest:  “The choice of implant is complicated further by the possibility for conflicts of interest stemming from the consulting fees that some orthopedists receive from device manufacturers. In 2007, the five largest manufacturers made payments to approximately 4% of the 25,000 registeredorthopedic surgeons in the United States. These payments typically involve surgeons in high volume practices and academic settings. Orthopedists who receive industry support express, on average, a greater sense of shared goals and priorities with their vendors and sales representatives than surgeons who don’t.”

Related articles

• Shared decision making leads to a better patient experience and higher levels of patient satisfaction (introcommblog.wordpress.com)
• What is the Impact on Shared Decision Making of the Daily Tsunami of Health News? (engagingthepatient.com)
• Addressing Health Literacy: A Variation of Perspectives (engagingthepatient.com)

 

Skeptical Scalpel: Robots attack America, but Canada not so much

A laparoscopic robotic surgery machine. Patient-side cart of the da Vinci surgical system. Into the sealed Computer God Robot Operating Cabinet, as a Frankenstein slave, at night. Da Vinci Surgical System. (Photo credit: Wikipedia)

Robotic surgery has its place. However, robotic surgery is not superior to traditional surgery in every case or for every surgery candidate.  It is best to discuss the pros and cons (and alternatives)  of any surgical procedure with trusted health care professionals.
Discussion starters below under Related Resources.

Why I am posting this? Partly because a recent article in my local newspaper read more like an advertisement for robotic surgery than an unbiased news item.  It seemed to have been written the surgeon interviewed (or at least had only one source of information — the surgeon who touted robotic devices). Am seriously considering a letter to the editor gently inquiring about their journalistic standards. I know they have a skeletal staff of reporters, and no longer have a staff librarian to do research. Still.

Skeptical Scalpel: Robots attack America, but Canada not so much

As of December 2011, 1548 surgical robots have been sold and installed in the United States as opposed to 16 in Canada.

The estimated population of the U.S is 313,388,000 and for Canada, 34,764, 600.

Canada has a population that is 11.1% of the U.S. population but Canada has only about 1% as many robots. Or put another way, Canada has 1 surgical robot for every 97 robots in the U.S….

..

The estimated population of the U.S is 313,388,000 and for Canada, 34,764, 600.

Canada has a population that is 11.1% of the U.S. population but Canada has only about 1% as many robots. Or put another way, Canada has 1 surgical robot for every 97 robots in the U.S.

California’s population is 37,691,912, which is about 3 million more than the population of Canada, but California, with 114 robots, has seven times as many robots as Canada..

Related Resources (will be adding resources included unbiased items about robotic surgery by the end of the week)

• Explore your treatment options: start the conversation (one of a series of great tips by the US Agency for Healthcare Reseearch and Quality (AHRQ) )
• Questions are the answer – your health care depends on good communication (AHRQ)
  This Web site lets you make a list of questions that you can bring to your medical appointments and gives you tips on talking with your doctor.
• More assistance & helpful tips via AHRQ via the Patient/Consumer site

Related articles (Pros and Cons for informational purposes)

• [Reblog] How hospitals recoup the cost of buying robotic surgery systems (jflahiff.wordpress.com)
• Robotic surgery shouldn’t be universally dismissed (kevinmd.com)
• DistalMotion’s Surgical Tool Combines the Best of Robotic and Endoscopic Surgery (medgadget.com)
• Robot Performs Prostate Surgery (blogs.wsj.com)
• Intuitive Surgical Sued In New York Over Death of 24 Year Old Woman Arising from the Use of the daVinci Robot During a Hysterectomy (ducknetweb.blogspot.com)
• Could pricey surgical robots make their way into medium-sized hospitals? (medcitynews.com)
• Open-source Platform Aids Surgical Robotics Research (it4good.wordpress.com)
• Fewer deaths, complications with robotic bladder cancer surgery, but cost is higher (medicalxpress.com)

[Reblog] How hospitals recoup the cost of buying robotic surgery systems (& questions to ask surgeon before consenting to robotic surgery)

Image via Wikipedia

Posted February 6, 2012 by Gary Schwitzer at HealthNewsReview.org 

The blogger known only as the Skeptical Scalpel (self-described as a surgeon for 40 years and a surgical department chairman and residency program director for over 23 of those years) continueshis thread of posts raising questions about the proliferation of robotic surgery.

The latest is entitled “Study: Robotic surgery financials explained.” It’s his take on a paper presented at the annual meeting of the American Association of Gynecologic Laparoscopists.  Excerpts:

The headline, “Robotic Hysterectomy Cuts Blood Loss in Obese,” is certainly catchy. Let’s look deeper. 

…

The lead author said, “The robotic hysterectomy does … offer lower rates of conversion to laparotomy but does cause higher facility and total charges, as well as higher reimbursement rates.” The mean total hospital charge for robotic hysterectomy was $44,700 versus $25,557, a statistically significant difference. The average charge for the robotic instruments was $8,322 compared to $3,762 for standard laparoscopy equipment, also a significant difference. In response to a question about why there was such a disparity, the lead author said: “The charges are likely to recoup the cost of the robot purchase. We have multiple robots … four at our main institution and several others at other sites.”

The reimbursement actually received for robotic hysterectomy was $19,000 and for standard laparoscopic, a mere $$8,000.

I congratulate the authors for their candor [though no doubt inadvertent] in sharing the financial data and the reasons why robotic surgery is more costly. I am gobsmacked* at the differential in charges and reimbursement for the two types of hysterectomy and that the secret would be so openly shared.

I guess someone has to help the hospital “recoup the cost of the robot purchase.” But I wonder why third party payers are shelling out almost two-and-a half times more money for a procedure that has not been proven more effective than standard laparoscopic surgery?

And you wonder why health care costs are skyrocketing?

Comments

Walter Lipman posted on February 13, 2012 at 9:25 am

Using this “pay as you use” logic, I wouldn’t be the least bit surprised to see one set of charges for your bed being located in the hospital’s parking lot versus another and higher set of charges for your bed being located in a room inside the hospital.

Reply

Michelle Luthringshausen, MD posted on February 21, 2012 at 8:54 am

As a surgeon, I am fascinated by this shallow analysis of cost and complete disregard for what is best for the patient. An open hysterectomy has a complication rate of 11%, highest in obese patients. A robotic hysterectomy done by an experienced surgeon in an obese patient has a complication rate of 3%. Complications are expensive for hospitals, health systems and especially patients. According to the American College of Surgeons NSQIP data, one complication’s DIRECT costs are around $12,000.
My second comment is that “charges” are only relevant in the uninsured patient, which will rarely be recouped anyway. The “cost” is what the insurance company and patients actually pay or reimburse, which is a contracted price based on the procedure done, NOT the way it was done, in an insured patient. In most cases, the hospital and surgeon get paid the same fee whether the robot was used or not…..

Related article

A 27 February 2012 article at HealthNewsReview.org summarizes a recent Chicago Tribune article on the evidence (sorely lacking) that robotic surgery allows for quicker healing and less pain.

Excerpts

Despite a flood of scientific papers associated with the da Vinci, there is a dearth of randomized, controlled studies showing patients do best if procedures are performed with the da Vinci. Federal oversight of medical devices such as the da Vinci is light. There have been voluntary recalls — more than a dozen since 2005 — involving problems with software and surgical instruments. Lawsuits have helped raise concerns that some surgeons are using the devices before the doctors are adequately trained.

Here are some questions patients should ask their surgeon when considering a robot-assisted procedure:

•When did you do your first robot-assisted procedure? How were you trained? How many robot-assisted cases have you done? How often do you do them? How many robot-assisted cases have you done of my procedure?

•Are you more comfortable doing this type of procedure laparoscopically, robot-assisted or the traditional open approach? What are the pros and cons of each?

•What happens if the robot malfunctions during surgery or you have to convert to open surgery? How many open cases of my procedure have you performed? How often do you do them?

•What kind of training on the da Vinci do the nurses and other surgeons in the operating room get? How experienced are they? How experienced are they in converting to an open procedure mid-surgery?

•Will you be mentoring another surgeon during my procedure? Will he or she be doing any of it? If so, how many cases has he or she performed?

 

Related articles

• Could pricey surgical robots make their way into medium-sized hospitals? (medcitynews.com)
• Health Watch: Robotic Sleep Apnea Surgery (philadelphia.cbslocal.com)
• Men’s hopes for robot prostate surgery unrealistic: Study (vancouversun.com)
• Pricey Surgery Robots Lack Clear Benefits (nlm.nih.gov)
• Stemming the Tide of Overtreatment in Health Care (Chicago Tribune)
• Robotic surgeries costlier but safer than more invasive techniques (healthzone.ca)
• Remote-control surgery grows despite inconclusive evidence (seattletimes.nwsource.com)
• Houston Colorectal Surgeon Discusses Advanced Robotic Surgery for Cancer Treatment (prweb.com)
• Problems with robotic surgery (myblogroboticsurgery.wordpress.com)
• So many questions…. (myblogroboticsurgery.wordpress.com)

“When hospitals buy robots they also use them as a marketing tool in direct-to-consumer marketing. That startedwith the drug companies and it worked well. It’s very effective,” said Dr. Hugh Lavery, a urologist at Mount Sinai Medical Center in New York who authored the study.”

Surgery as a public health intervention: common misconceptions versus the truth

From the Bulletin of the World Health Organization (WHO)

The world’s attention has recently been focused on the escalation of violence in north and west Africa. Daily reports of deaths and injuries from the region have raised concerns. What is missing from the picture, however, is the fact that many of these countries lack surgical capacity to treat the injured, and this inability to provide surgical care is contributing to a significant rise in the death toll. A recent World Health Organization (WHO) study found that more than 90% of deaths from injuries occur in low- and middle-income countries.1 This is not surprising, considering that the poorest third of the world’s population receives only 3.5% of the surgical operations undertaken worldwide.2 Many hospitals in these countries do not have a reliable supply of clean water, oxygen, electricity and anaesthetics, making it extremely challenging to perform even the most basic surgical operations.3 Despite such a surgical imbalance around the world, surgery is still “the neglected stepchild of global health”.4 No global funding organization focuses specifically on the provision of surgical care, and none of the major donors are willing to support and acknowledge surgery as an imperative part of global public health. This is largely due to the following common misperceptions about surgery that are not grounded in truth. First, many people think that surgical care can only address a very limited part of the global burden of diseases and thus is of low priority. In reality, injuries kill more than five million people worldwide each year, accounting for nearly one out of every ten deaths globally….. …Second, there is a common notion that surgical care is too expensive to be implemented as part of public health interventions. However, surgery can be remarkably cost-effective, even in comparison to non-surgical interventions that are commonly implemented as public health measures. …. ….Lastly, the focus of the global health community on the issue of surgical imbalance has been largely confined to providing short-term relief through medical missions. …

Read the entire article

Surgery as a public health intervention: common misconceptions versus the truth

 

From the Bulletin of the World Health Organization (WHO)

The world’s attention has recently been focused on the escalation of violence in north and west Africa. Daily reports of deaths and injuries from the region have raised concerns. What is missing from the picture, however, is the fact that many of these countries lack surgical capacity to treat the injured, and this inability to provide surgical care is contributing to a significant rise in the death toll. A recent World Health Organization (WHO) study found that more than 90% of deaths from injuries occur in low- and middle-income countries.1 This is not surprising, considering that the poorest third of the world’s population receives only 3.5% of the surgical operations undertaken worldwide.2 Many hospitals in these countries do not have a reliable supply of clean water, oxygen, electricity and anaesthetics, making it extremely challenging to perform even the most basic surgical operations.3

Despite such a surgical imbalance around the world, surgery is still “the neglected stepchild of global health”.4 No global funding organization focuses specifically on the provision of surgical care, and none of the major donors are willing to support and acknowledge surgery as an imperative part of global public health. This is largely due to the following common misperceptions about surgery that are not grounded in truth.

First, many people think that surgical care can only address a very limited part of the global burden of diseases and thus is of low priority. In reality, injuries kill more than five million people worldwide each year, accounting for nearly one out of every ten deaths globally…..

…Second, there is a common notion that surgical care is too expensive to be implemented as part of public health interventions. However, surgery can be remarkably cost-effective, even in comparison to non-surgical interventions that are commonly implemented as public health measures. ….

….Lastly, the focus of the global health community on the issue of surgical imbalance has been largely confined to providing short-term relief through medical missions. …

Read the entire article

Is Anesthesia Dangerous?

From the 22 July Medical News Today article

In pure numerical terms, anesthesia-associated mortality has risen again. The reasons for this are the disproportionate increase in the numbers of older and multimorbid patients and surgical procedures that would have been unthinkable in the past. This is the result of a selective literature review of André Gottschalk’s working group at the Bochum University Hospital in the current issue of Deutsches Arzteblatt International (Dtsch Arztebl Int 2011; 108[27]: 469-74)….

Click here to read the rest of the article

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• The Anesthesia Patient Safety Foundation improves patient safety (kevinmd.com)
• General Anesthesia VS IV Sedation (palmercosmeticsurgery.wordpress.com)
• Anesthesia-monitoring device maker NeuroWave looking for $5M investment (medcitynews.com)
• Misuse of anesthesia could cause hepatitis virus transmission (physorg.com)

New ‘mini’ surgeries offer little over original

New ‘mini’ surgeries offer little over original

From a January 31, 2011 Health Day news item by Lynn Peeples

Single Incision Laparscopic Surgery 3

http://www.flickr.com/photos/35273611@N07/3831389492

 

NEW YORK (Reuters Health) – A new surgical technique that involves “mini” incisions may not offer many advantages over the already minimally invasive standard, suggests a new review of studies comparing the two types of laparoscopic gallbladder surgeries.

“To be honest, it is really hard to improve on conventional laparoscopic,” senior researcher Dr. Shiva Jayaraman of the University of Toronto told Reuters Health in an e-mail.

The surgical removal of the gallbladder is primarily performed to treat gallstones. The standard “closed” procedure — so called because the abdomen doesn’t need to be opened with a large incision — debuted in 1987. It’s already an improvement over earlier surgeries that left patients in greater pain and with larger scars

But a desire for even better cosmetic results has led to an increasing push toward surgical options that are less and less invasive, said Jayaraman.

To see if the newer options are worthwhile for patients, he and his colleagues looked to the literature for studies that compared conventional laparoscopy in gallbladder surgery to the newer, more cosmetically friendly approach: mini-laparoscopy.

The team pulled together 18 studies conducted between 1999 and 2007, including a total of more than 1,500 patients.

They found that the odds of a surgery technique failing — and being completed by a different procedure — were more than twice as high for a patient undergoing mini-laparoscopy compared to the conventional version: 10 percent versus 4 percent.

However, while failed conventional laparoscopic surgeries are always converted to open procedures, mini-laparoscopies could simply transition into conventional laparoscopies.

This higher failure rate of the mini-laparoscopy might also be reflecting the newness of the procedure to surgeons, and the difficulties they may have learning it.

The smaller cuts and miniature tools involved in mini-laparoscopy did provide somewhat better cosmetic results. A month after the surgery, patients gave their scars an average rating of one on a scale of one to ten, while the average score in the conventional group was a three.

Most patients undergoing either conventional or mini-laparoscopy to remove their gallbladder go home the same day as their surgery, and return to work within four to six weeks. Mini-laparoscopy patients in Jayaraman’s study returned to their normal activities slightly sooner than the conventional laparoscopy patients, report the researchers in the Annals of Surgery.***

“That may represent a cost-savings to society from less work days lost,” noted Jayaraman.

The length of the surgery and risks of complications, including severe bleeding and infections, were similar between the groups. No deaths occurred from either surgery.

The researchers note that specialized equipment could put a slightly higher price tag on mini-laparoscopy, although the reusability of the instruments should keep costs comparable. Conventional laparoscopy runs around $7,000.

Jayaraman’s team suggests that more research is needed to clarify the costs and benefits of mini-laparoscopy, and if certain variations on the technique are better than others.

“Conventional laparoscopic gallbladder surgery is very successful at providing minimally-invasive, cosmetic, and effective treatment of diseases of the gallbladder,” said Jayaraman.

“In the end, both of these approaches are very safe,” he added. “If cosmetics is very important to a patient, then a ‘mini’ approach might be a good option.”

*** For suggestions on how to get this article for free or at low cost, click here

AHRQ Researchers Find That Inpatient Operating Room Procedures Account For Nearly Half of Hospitals’ Treatment Costs

The image shows an operating room. A patient is being prepared for surgery. (Photo credit: Wikipedia)

AHRQ (Agency for Healthcare Research and Quality Researchers Find That Inpatient Operating Room Procedures Account For Nearly Half of Hospitals’ Treatment Costs

From the AHRQ newsletter , January 2011 #304

Although only a quarter of patient stays in U.S. hospitals in 2007 involved procedures that were conducted in operating rooms, such stays accounted for 47 percent of hospitals’ costs – a total of $161 billion for patients receiving procedures, according to a new study by AHRQ researchers that was published in the December 2010 issue of the Archives of Surgery.  The researchers found that one-third of the 15 million operating room procedures that year involved people age 65 and older and that older patients were two to three times more likely to undergo surgery than younger patients.  Surgical patients tended to be less severely ill than non-surgical patients, but their daily cost was double — $2,900 versus $1,400 a day.  Fifteen procedures accounted for half of hospitals’ costs for surgical patient stays and one-quarter of overall hospital costs.  Four of the most expensive procedures – angioplasty, cesarean section delivery, knee replacement and spinal fusion – increased in volume by between 20 percent and 46 percent between 1997 and 2007, while heart bypass surgery plummeted by 70 percent.  More than half of all procedures were elective.  According to AHRQ researchers and study authors, Anne Elixhauser, Ph.D., and Roxanne M. Andrews, Ph.D., the findings highlight the important role that inpatient surgical procedures play in U.S. health care. The study is based on data in AHRQ’s Nationwide Inpatient Sample, a database of hospital inpatient stays in short-term, nonfederal hospitals, which includes all patients, regardless of their type of insurance type, as well as the uninsured.  Select to access the abstract on PubMed.® A free print copy is available by sending an e-mail to AHRQPubs@ahrq.hhs.gov.

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• Patient Safety Toolkits from AHRQ | Christina’s Considerations (thielst.typepad.com)
• Technology and Better Healthcare (thetechscoop.net)
• Technology Mishaps Behind 1 in 4 Operating Room Errors: Study (news.health.com)
• AHRQ Releases New Guide to Help Hospitals Engage Patients and Families in Their Health Care (sys-con.com)
• Predictive Accuracy of 29-Comorbidity Index for In-Hospital Deaths in US Adult Hospitalizations with a Diagnosis of Venous Thromboembolism (plosone.org)
• Clinical-community relationships as a pathway to improve health – Webinar from AHRQ (phlibraryres.wordpress.com)

(With Video!) Invention helps students learn surgical techniques before operating on patients

From a November 19, 2010 Eureka news alert

FORT COLLINS – In the last 50 years, modern medicine has made astounding advances in surgery, yet many of today’s veterinary and human medicine students still hone basic surgical and suturing skills on carpet pads and pig’s feet before transitioning to a live patient. An invention by Colorado State University veterinarians provides students with artificial body parts that look, feel, behave, and even bleed just like real skin, muscles and vessels.

The artificial replicas of sections of human and animal bodies — such as an abdominal wall — give students a realistic learning environment that will bridge the gap between classroom lectures and procedures such as surgical cuts and sutures on real human or animal patients.

“It is a significant, stressful leap for medical and veterinary students from the classroom to the surgery suite,” said Dr. Dean Hendrickson, a veterinarian and director of CSU’s Veterinary Teaching Hospital and one of the inventors. “Industry standards for training sometimes actually teach incorrect techniques, or skills that don’t translate into real-world situations, so students don’t have the ability to realistically prepare for surgery before a live patient. These artificial simulations help students master their technique, dexterity and confidence before they operate for the first time on a person or someone’s pet.”

The artificial tissues consist of layers of silicone that closely simulate skin, connective tissue and muscle. Built into the silicone are realistically placed and sized “blood vessels” that are connected to an artificial blood source that supplies the tissue with realistic bleeding. For example, students practicing sutures will experience blood coming into a wound or incision from both sides of the tissue at realistic locations and rates.

Some models are colored realistically, such as a brown-skinned abdominal wall of a horse, with white layers and red layers representing muscles and tissues. However, students also may use simulated tissue in translucent material so they can better view and understand, for example, suture patterns from a three-dimensional perspective while learning correct stitches.

“Our hope is that, with this model, we can begin to help students build better skills that will make for better outcomes,” said Dr. Fausto Bellezzo, a co-creator of the technology with Hendrickson. Bellezzo is also a veterinarian and researcher at CSU’s Veterinary Teaching Hospital.

The creators are working with CSU Ventures to identify investors and partners to advance development of the model for teaching animal and human medicine. CSU Ventures is a subsidiary corporation of the Colorado State University Research Foundation, a private, non-profit foundation that helps the university move technologies from the university into the commercial sector. The foundation has filed a provisional patent for the technology.

###
Colorado State University’s Animal Teaching Hospital is part of the College of Veterinary Medicine and Biomedical Sciences.

A video illustrating this model is available on CSU’s YouTube channel at http://www.youtube.com/watch?v=ILV-tI1hdA8.

Hospital Collaboration May Boost Surgical Patient Safety

Sharing data on successful medical practices helped cut complication rates, study found

From a Health Day News Item

By Robert Preidt
Monday, October 18, 2010

MONDAY, Oct. 18 (HealthDay News) — The rate of surgical complications decreased nearly 10 percent at 16 Michigan hospitals after they began to share information about what methods they use to keep patients safe, a new study has found.

Among the 300,000 study patients who underwent general and vascular surgery between 2005 and 2007, the reduction in ventilator-associated pneumonia alone could save $13 million a year in health care spending, the findings indicated.

The program, called the Michigan Surgical Quality Collaborative, is led by the University of Michigan.

“The collaboration of hospitals in terms of identifying and disseminating information about best practices is actually a much more effective way of improving quality than just relying on each hospital alone to come up with what they think is a way to improve quality,” study author Dr. Darrell A. Campbell Jr., a professor of surgery and chief medical officer at the University of Michigan Health System, said in a university news release.

 

 

Sensors in Surgical Sponges May Mean Fewer Left Behind

Radio-frequency tags plus counting could improve patient safety, surgeons report

From a Oct 5 HealthDay news item

Placing radio-frequency tags inside surgical sponges could help reduce the number left behind in patients after operations, according to U.S. researchers.

The tags — which use the same technology as clothing store tags and pet microchips — could be used along with manual counting and X-ray detection to improve patient safety, said the surgeons at the University of North Carolina (UNC) at Chapel Hill School of Medicine.

“Any foreign body present long enough has a risk of causing infection,” lead investigator Dr. Christopher Rupp, a gastrointestinal surgeon, said in a UNC news release. “We have seen patients in whom sponges have eroded into other organs, mainly the intestines. People can come back with chronic pain issues after an operation that also leads to detection of a retained surgical sponge.”