Novel automated anesthetic technique
May 7, 2008
Devices/Technology
Researchers at McGill University and the McGill University Health Centre (MUHC) have performed the world’s first totally automated administration of an anesthetic. Nicknamed “McSleepy,” the new system developed by the researchers administers drugs for general anesthesia and monitors their separate effects completely automatically, with no manual intervention.
“We have been working on closed-loop systems, where drugs are administered, their effects continuously monitored, and the doses are adjusted accordingly, for the last 5 years,” said Dr. Thomas M. Hemmerling of McGill’s Department of Anesthesia and the Montreal General Hospital, who heads ITAG (Intelligent Technology in Anesthesia research group), a team of anesthesiologists, biomedical scientists and engineers. “Think of “McSleepy” as a sort of humanoid anesthesiologist that thinks like an anesthesiologist, analyses biological information and constantly adapts its own behavior, even recognizing monitoring malfunction.”
The anesthetic technique was used on a patient who underwent a partial nephrectomy, a procedure that removes a kidney tumor while leaving the non-cancerous part of the kidney intact, over a period of 3 hours and 30 minutes. To manipulate the various components of general anesthesia, the automated system measures three separate parameters displayed on a new Integrated monitor of anesthesia (IMATM): depth of hypnosis via EEG analysis, pain via a new pain score, called AnalgoscoreTM, and muscle relaxation via phonomyographyTM, all developed by ITAG. The system then administers the appropriate drugs using conventional infusion pumps, controlled by a laptop computer on which “McSleepy” is installed. Using these three separate parameters and complex algorithms, the automated system calculates faster and more precisely than a human can the appropriate drug doses for any given moment of anesthesia. “McSleepy” assists the anesthesiologist in the same way an automatic transmission assists people when driving. As such, anesthesiologists can focus more on other aspects of direct patient care. An additional feature is that the system can communicate with personal digital assistants (PDAs), making distant monitoring and anesthetic control possible. In addition, this technology can be easily incorporated into modern medical teaching programs such as simulation centers and web-based learning platforms.
Anesthesia care is characterized by many biological and pharmacological parameters to monitor record and analyze. “It will probably take two years to perfect the system,” Dr. Hemmerling said. “Many people are reluctant to rely on automated systems, especially when they are not visible - it is not clear what they are actually doing or how - , the fear of a ‘black box’ which suddenly takes over”. In designing “McSleepy”, we put in considerable research on the design of an interface which is clear, easy to read, resembles displays of our everyday practice but still provides a detailed clinical picture of what is going on and what has happened.
Dr. Hemmerling hopes that a commercial system might be available within the next 5 years.
http://www.mcgill.ca/
Novel newborn screening kits developed by NovaUCD-based Enzolve Technologies
April 30, 2008
Devices/Technology
Enzolve Technologies, a UCD spin-out company based at NovaUCD the Innovation and Technology Transfer Centre at University College Dublin, has received substantial investment from Enterprise Ireland under the National Development Plan (2007-2013) and private investors.
This investment will enable it to commence production of ‘NeoScreenPak’, a range of diagnostic kits for screening a variety of disorders that affect newborn infants. The initial test in the ‘NeoScreenPak’ range will screen for phenylketonuria (PKU) and each kit will contain sufficient materials to allow up to 1,000 newborns to be tested.
The screening of newborn infants for a variety of disorders that seriously damage their long term health is well established in economically developed countries but less so in under-developed countries. In Ireland all newborns are routinely tested for five common disorders, phenylketonuria (PKU), maple syrup urine disease, homocystinuria, galactosaemia and congenital hypothyroidism. If left undetected and untreated any of these disorders will cause long term and serious impairment to the infant.
‘NeoScreenPak’ is a single format test-package which will be used to screen for seven of the eleven most commonly screened disorders affecting newborns, thus eliminating the necessity for completely different set-ups for screening each of these conditions. Professor Paul C. Engel, Director of Enzolve Technologies and UCD’s Professor of Biochemistry, said, “The ‘package deal’ aspect of Enzolve’s screening kits is really compelling. It makes it easy to use by hospital laboratory staff and it is cost effective, which is very important in less economically developed countries.”
http://www.ucd.ie/
FDA approves coronary artery plaque imaging device
April 30, 2008
Devices/Technology
The U.S. Food and Drug Administration has cleared for marketing a device that a doctor can use to see inside a blood vessel to assess the fat content of the plaque which builds up on the wall of the coronary arteries.
Plaque is a deposit made up of cholesterol-rich fat, calcium, and other substances found in the blood. As plaque accumulates on the artery wall, it reduces blood flow to the heart muscle and increases the risk of blood clots which can lead to a heart attack.
Nearly one million Americans suffer a heart attack every year and about half die. Many heart attacks occur when a fatty coronary plaque ruptures, forming dangerous blood clots. Pathologic studies of patients who died from heart attack have identified a large lipid (fatty) core among features of coronary artery disease that were associated with plaque rupture and thrombosis (blood clots). Research is currently underway to determine how plaques that are prone to rupture can best be identified before they cause a heart attack.
“This is the first device that can help assess the chemical make-up of coronary artery plaques and help physicians identify those plaques with lipid cores, which may be of particular concern,” said Daniel Schultz, M.D., director of the Center for Devices and Radiological Health.
The InfraReDx LipiScan NIR Catheter Imaging System uses infrared imaging to detect lipid core-containing plaques of interest and assess a patient’s coronary artery lipid core burden index. The device works by placing a catheter equipped with a fiber-optic laser light into the artery. The device shines the near infrared light delivered through the blood to the artery wall, and measures the light reflected back from the artery wall, a technique called spectroscopy. The reflected wavelengths vary depending on how much fat and other substances are in the plaque in the illuminated portion of the wall.
LipiScan is manufactured by InfraReDx Inc. of Burlington, Mass. The device is cleared for use by physicians who are evaluating patients with symptoms of coronary heart disease during a heart test known as cardiac angiography, to help in detection of plaques that have lipid (fatty) cores.
http://www.fda.gov
New imaging technology lights up lungs to diagnose disease
April 29, 2008
Devices/Technology
Researchers at the University of Sheffield have developed innovative technology which illuminates a person’s lungs and helps clinicians identify if they are functioning correctly. The new technology could result in earlier diagnosis of emphysema and smoking related damage, as well as other lung conditions and diseases.
Lung diseases are of growing concern to the health of the nation, with people suffering from conditions as mild as asthma or as severe as lung cancer. By detecting lung damage early, doctors could help slow down or stop the conditions.
The technique developed at Sheffield involves a person inhaling small amounts of harmless hyperpolarised (HP) noble gases (Helium-3 and Xenon-129), which are then imaged inside an MRI scanner. The gases are hyperpolarised using high power lasers by a process called optical pumping. The high resolution images of the airspaces that are produced offer additional functional information that is currently not available with traditional X-rays and lung CT scans.
The first clinical studies using this novel method have been carried out at the University of Sheffield, with the University holding the alt=”Researchers at the University of Sheffield have developed innovative technology which illuminates a person’s lungs and helps clinicians identify if they are functioning correctly. The new technology could result in earlier diagnosis of emphysema and smoking related damage, as well as other lung conditions and diseases.” “border=”0″ align=”left” vspace=”0″ hspace=”0″ >An image of a person’s lung who has emphysema. Credit: The University of Sheffield
The technology has also been used to help detect the early stages of lung obstruction in children with Cystic Fibrosis, something which a traditional X-ray would miss. The technique also allows repeated investigations in children without the fear of radiation exposure. The researchers are also now looking at using the technology to assess inhaled therapies for asthma patients and help plan radiotherapy treatment in patients with lung cancer.
Jim Wild, a physicist from the University’s Academic Unit of Radiology and the lead academic involved in the project, said: “The images produced are providing clinicians with functional information of the lungs that has previously been unattainable. The high sensitivity of the technology means that it offers real hope for detecting lung damage early.
“Being able to detect lung conditions and disease at an early stage could radically affect the lifespan and quality of life of patients. For children with cystic fibrosis it means that, with the right treatment, they could live longer. Patients who have successfully stopped smoking can also see how they can halt or slow down the damage being done to their lungs.”
http://www.shef.ac.uk/
Mutation database helps personalized treatment of lung cancer
April 29, 2008
Devices/Technology
A groundbreaking free tool to help oncologists choose the best therapies for patients with non-small-cell lung cancer has been launched this week by scientists at the 1st European Lung Cancer Conference jointly organized by the European Society for Medical Oncology (ESMO) and the International Association for the Study of Lung Cancer (IASLC) in Geneva, Switzerland.
The online database brings together data on all the known somatic mutations (tumor derived - tumor specific) in a molecule called epithelial growth factor receptor (EGFR). Somatic mutations in this cell-surface molecule are known to affect treatment with the newer tyrosine kinase inhibitor class of drugs.
“We have known for some time that some EGFR mutations correlate with response to tyrosine kinase inhibitors for lung cancer patients,” says Dr. Samuel Murray from Department of Molecular Pathology and Translational Oncology, Metropolitan Hospital, Athens, Greece. “But there have been so many articles published on this topic that we felt that it would be virtually impossible for any given center or individual to interpret the clinical relevance of a given mutation.”
“So we worked on the assumption that a comprehensive list of all somatic EGFR mutations coupled with data on the response of non-small-cell lung cancers treated with tyrosine kinase inhibitors (TKIs) would help clinicians determine whether a specific mutation was likely to correlate with clinical benefit.”
The database includes cumulative data from thousands of patients. In addition, independent patient data (IPD) for patients who have been treated with tyrosine kinase inhibitors and some who have not, is being added. A total of 12,244 patients are included, of whom 3,381 had somatic mutations in EGFR. The researchers catalogued 254 different mutations.
Ultimately, the database offers a chance to improve treatment for people receiving tyrosine kinase inhibitors. “We believe that for the more common mutations the database allows clinicians to make more robust decisions concerning their treatment options for NSCLC,” says Dr. Murray.
http://www.esmo.org/activities/jntconf/jntlung
New 3-D ultrasound provides clear images of the major arteries within the brain
April 25, 2008
Devices/Technology
Using 3-D ultrasound technology they designed, Duke University bioengineers can compensate for the thickness and unevenness of the skull to see in real-time the arteries within the brain that most often clog up and cause strokes.
The researchers believe that these advances will ultimately improve the treatment of stroke patients, whether by giving emergency medical technicians (EMT) the ability to quickly scan the heads of potential stroke victims while in the ambulance or allowing physicians to easily monitor in real time the patients’ response to therapy at the bedside.
The results of the latest studies were reported online in the journal Ultrasound in Medicine & Biology. The research was supported by the National Institutes of Health and the Duke Translational Medicine Institute, with assistance from the Duke Echocardiography Laboratory.
“To our knowledge, this is the first time that real time 3-D ultrasound provided clear images of the major arteries within the brain,” said Nikolas Ivancevich, graduate student in Duke’s Pratt School of Engineering and first author of the paper. “Also for the first time, we have been able overcome the most challenging aspect of using ultrasound to scan the brain - the skull.”
The Duke laboratory, led by biomedical engineering professor Stephen Smith, has a long track record of modifying traditional 2-D ultrasound - like that used to image babies in utero - into more advanced 3-D scans, which can provide more detailed information. After inventing the technique in 1991, the team has shown its utility in developing specialized catheters and endoscopes for imaging the heart and blood vessels.
“This is an important step forward for scanning the vessels of the brain through the skull, and we believe that there are now no major technological barriers to ultimately using 3-D ultrasound to quickly diagnose stroke patients,” said Smith, senior author of the paper.
“I think it’s safe to say that within five to 10 years, the technology will be miniaturized to the point where EMTs in an ambulance can scan the brain of a stroke patient and transmit the results ahead to the hospital,” Smith continued. “Speed is important because the only approved medical treatment for stroke must be given within three hours of the first symptoms.”
Ultrasound devices emit sound waves and then create images by calculating the angle of the waves as they bounce back.
For their experiments, the Duke team studied 17 healthy people. After injecting them with a contrast dye to enhance the images, the researchers aimed ultrasound “wands,” or transducers, into the brain from three vantage points - the temples on each side of the head and upwards from the base of the neck. The temple locations were chosen because the skull is thinnest at these points.
Ivancevich took this approach one step further to compensate for the thickness and unevenness of the skull in one subject.
“The speed of the sound waves is faster in bone than it is in soft tissue, so we took measurements to better understand how the bone alters the movement of sound waves,” Ivancevich explained. “With this knowledge, we were able to program the computer to ‘correct’ for the skull’s interference, resulting in even clearer images of the arteries.”
The key to obtaining these images lies in the design of the transducer. In traditional 2-D ultrasound, the sound is emitted by a row of sensors. In the new design, the sensors are arranged in a checkerboard fashion, allowing compensation for the skull’s thickness over a whole area, instead of a single line.
The 3-D ultrasound has the benefit of being less expensive and faster than the traditional methods of assessing blood flow in the brain - MRI or CT scanning, Ivancevich said. Though 3-D ultrasound will not totally displace MRI or CT scans, he said that the new technology would give physicians more flexibility in treating their patients.
http://www.duke.edu/
Researchers develop breath-monitoring device to monitor treatment adherence among HIV-positive people
April 25, 2008
Devices/Technology
Researchers at the University of Florida and Xhale have developed a breath-monitoring device that can detect whether people living with HIV/AIDS adhere to their treatment regimens, ANI/Thaindian News reports.
According to Richard Melker, a professor of anesthesiology at the University of Florida College of Medicine and chief technology officer at Xhale, the shoebox-sized device makes a beeping sound when it is time for HIV-positive people to take their antiretroviral drugs. If patients do not press a button to signal that they have taken their medication after five minutes, the device begins to beep at an increasingly louder volume until the button is pressed, Melker said. He added that if the button is not pressed after a set amount of time, the device can contact treatment coordinators to indicate that patients did not follow their treatment regimens.
The device also is programmed to record the results of a breath test that measures whether patients have taken their antiretrovirals. Patients can then take a memory card that contains data from the breath tests to antiretroviral clinics width=396 align=left vspace=5 border=0>This article is republished with kind permission from our friends at the The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. Copyright 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
Simulating surgery to reduce implant complications
April 25, 2008
Devices/Technology
A computer simulation breakthrough could mean fewer medical complications and better surgical outcomes for patients undergoing hip, knee or spinal implant surgery.
Each year surgeons across Europe perform a staggering 900,000 hip, knee and spinal implant operations. Implant surgery is one of the most remarkable advances in medical science. Such operations restore increased mobility and a vastly improved quality of life to millions of Europeans.
Implant surgery also has one of the most remarkable success rates in medical practice, with reliable, predictable outcomes and very few complications. But it is not complication free.
“About 10 per cent of operations have complications, often requiring a new implant, or a further surgery,” explains Dr. Ing. Ruben Lafuente, technical manager of the Spanish IT consulting firm Adapting S.L. and co-ordinator of the OrthoSim project. “It means increased pain and inconvenience, a drain on human resources and of course it is expensive, too.”
Enter the EU-funded OrthoSim project. Set up to develop an orthopaedic surgery planning tool, OrthoSim has developed a platform that can significantly reduce the risk of post-op complications, as well as provide a means for testing new implant devices, the researchers claim. And in the very near future the platform will provide the base for a new surgical training tool.
The OrthoSim platform is a system using computer software to create anatomical and implant simulations. The simulation models are based on the work of two leading European biomechanics research centres.
“Our lumbar spinal region model is the result of over 20 years of research at the Laboratoire de Biomecanique of L’Ecole Nationale Superieure d’Arts et Metiers in Paris,” explains Lafuente. “It was enhanced and complemented by a lumbar implant model provided by the Instituto de Biomecánica de Valencia in Spain.”
These models were combined to provide a reliable simulation of the interface between the artificial implant and the living tissue, providing surgeons with vital pre-op information.
“With this service, a surgeon or implant engineer can effectively call on the expertise of the best people in any field of orthopaedic surgery, where biomechanical simulation can offer new insights for patient care,” Lafuente says.
Even better, the tool can be used to study the suitability of new implant devices and can help pinpoint any problems with the design at an early stage.
“Implant designers get the opportunity to test their new designs initially without the need for actual implantations,” notes Lafuente. “It will mean better implant designs at an early stage, cutting costs and research time, as well as improving outcomes early on.”
Solving the integration problem
The models are linked together and are hosted at an online service. Integrating the various models and algorithms into a unified platform was a difficult computer science problem to solve.
“We had to work very hard to get the protocols right and we spent a lot of time developing the user interface, too,” says Lafuente. “We wanted to make the service as simple to use as possible.”
The OrthoSim project ended in March last year, with the research team successfully combining the various elements of the project. Since then the partners have been developing the service offering further and are looking for financial support.
“Initially we had a model just for lumbar spine implants, but in the last months we have almost completed a validated model for hip implants,” says Lafuente. “We believe that once we finish perfecting a model for knee implants we will have a very strong set of tools to offer surgeons.”
But Lafuente warns that developing new products for the health market is a very difficult task in itself.
“The quality assurance and validation issues are very important in healthcare directed products, and will require more work,” he says.
That work continues. A follow-on project, called OrthoTraining, is taking the OrthoSim toolset a step further. Over the next two years OrthoTraining’s researchers plan to develop a surgical training tool based on OrthoSim’s work.
“It will enhance training for students and it will mean that newly qualified surgeons will have better training and an enhanced skill set,” Lafuente says. “This will improve the medical services and quality of life of European citizens.”
OrthoSim was funded under the EU’s eTEN programme for market validation and implementation.
http://cordis.europa.eu/
Northern Devon Healthcare Trust reduces call waiting times with speech recognition solution
April 24, 2008
Devices/Technology
The Northern Devon Healthcare Trust (NDHT) is using a speech recognition solution, from voice automation specialist Telephonetics VIP, to answer external calls at busy times.
Callers are politely answered by a speech driven automated call routing product and simply need to say the name of the person, department or ward they require to be connected to, quickly, and without the need for human intervention. This relieves pressure on switchboard operators and makes them available to deal with more complex enquiries.
Northern Devon Healthcare Trust has hospitals and resource centres in seven locations across Northern Devon. The main hospital site in Barnstaple, North Devon District Hospital (NDDH) has used ContactPortal(r), the speech driven automated call routing solution from Telephonetics VIP, to answer all internal calls since October 2007. The introduction saw an immediate decrease in the number of internal calls to the main switchboard, with NDDH staff successfully getting through to other members of staff across the hospital and community sites, without having to rely on paper directories. It was a logical next step to extend the service to external callers.
The Trust receives approximately 2,000 calls per day and sometimes these calls cannot all be answered promptly by the reception team. Since January 2008, ContactPortal has ensured that all calls are answered either by reception within one minute or by ContactPortal, after one minute.
Tricia Hawson, Facilities Manager, Northern Devon Healthcare Trust explains, “We introduced this system to ensure that we offer a good service to people telephoning the main switchboard. Monday mornings are the busiest times for reception staff and we appreciate that in the past some callers may have had to wait a long time to get a reply. This system supports our reception teams when the volume of calls exceeds staff availability. Having the flexibility to add extra services to the Telephonetics VIP solution is a great benefit to us.”
http://www.telephoneticsvip.co.uk
Wireless technology needed to build recession proof health services
April 24, 2008
Devices/Technology
Healthcare providers are increasingly using wireless technology to minimise the cost and disruption associated with the deployment of innovative ehealth and telecare services.
According to a report published this week by Cambridge UK based analysts, Wireless Healthcare, when healthcare providers are looking for technology that will reduce the cost of care, wireless is often the networking platform of choice.
The report, “Wireless Healthcare 2008″, also identifies a number of consumer electronics companies that are seeking a safe harbour in the healthcare market as the recession impacts on their traditional markets. However, Wireless Healthcare warns that as a significant number of medical devices are purchased privately the healthcare market could also be adversely affected by the economic downturn. Peter Kruger, Analyst with Wireless Healthcare, points out, “Senior citizens, regarded as a key driver in the medical device market, sometimes fund their healthcare by withdrawing equity from their homes - something they will be unable to do when property values fall”. Despite this, the report predicts continued growth in the market for fitness and wellbeing devices.
In Wireless Healthcare’s last major study of the healthcare IT sector the lack of back office infrastructure, particularly electronic patient records (EPR), was highlighted as an inhibiter within the wireless medical device market. The latest report notes that some healthcare providers in the US and Europe have started to roll out EPR but sees incumbent providers facing increased competition from next generation healthcare providers who are deploying Health 2.0 based services.
“While there is a significant amount of hype regarding Health 2.0 a key component of this new healthcare concept, hosted patient records, will become increasingly important in driving demand for wireless ehealth services,” states Kruger, who goes on to say, “We are seeing medical device vendors marketing products as ‘Google Health ready’ or building ehealth services using the Microsoft HealthVault SDK”.
The report explains that while hosted patient records are a controversial issue within the healthcare sector they do provide the medical device developer with an alternative entry point into the healthcare market.
http://www.wirelesshealthcare.co.uk
