The Top 10 Medical Innovations of 2009.
Recently, I had the opportunity to attend the unveiling of the Cleveland Clinic's third edition of the Top 10 Medical Innovations. The annual Medical Innovations Summit at the Cleveland Clinic is one of the more fascinating conferences in the world of medical design and innovation. This conference draws about 3,500 of the world's foremost leaders in intellectual property, finance and medical innovation. I found it quite interesting to listen to leaders from every facet of health care discuss topics ranging from the cognitive psychology of innovation and the creative process to intellectual property law, and then easily switch gears and outline the processes involved in the commercialization of an idea to the marketplace.The Cleveland Clinic Top 10 list is the product of a rather rigorous selection process that seeks to recognize the procedures and products that may emerge with the greatest impact on medicine in the coming year. The selection process can be boiled down to a simple question: What new or innovative medical technology, device or therapy will emerge in 2009?
The inclusionary criteria for winning innovations were:
* It must have significant potential for short-term clinical impact
* It must have a high probability of success
* It must either be on the market or close to being introduced
* The innovation must be supported by data.
As I examined this list and heard the winning innovations announced, two real standouts seemed to be No. 10 and No. 4. I think that No. 10 will re-frame how we treat patients and how patients seek their treatment, and No. 4 will be with us for quite a while and will totally change diagnostic protocols as we now know them. Listed below are the Top Ten Medical Innovations for 2009.
10: Private Sector National Health Information Exchange
In case you were wondering, terabytes of your health care information are already stored on the servers of hospitals, insurance companies, schools and pharmacies throughout the country. A thorough scheme of e-based health records that links patients, medical practitioners, hospitals, pharmacies and insurance companies is already being established.
The creation of a computerized system that will become the fundamental medical file and digitized record of a patient's complete medical history will be actualized within this generation. Sooner than later, you will access and store your medical records in the same way that you access e-mail. This is a system-changing innovation that will improve both patient safety and outcomes and may enhance "travel" medicine.
9: Doppler-Guided Uterine Artery Occlusion
"One-third of the 600,000 hysterectomies performed each year in the United States are for uterine fibroids, non-cancerous abnormal growths of fat in the wall of the uterus that can grow to the size of a cantaloupe." Until now, a hysterectomy has been the most common treatment for uterine fibroids.
An innovative, noninvasive method, Doppler-guided uterine artery occlusion (DUAO) is currently in clinical trials at medical centers in North America and Europe. This procedure creates a hypoxic programmed death of the fibroids while maintaining all other anatomical structures. In the U.S. alone, this has the potential of sparing approximately 200,000 women a year the pain and heartache of undergoing a hysterectomy.
8: Integration of Diffusion Tensor Imaging (Tractography)
Diffusion tensor imaging (DTI) has the capacity to delineate the fiber pathways that connect the hundreds of billions of neurons in the brain. DTI is an innovative breakthrough technology that noninvasively explores the brain's white matter.
Utilizing DTI technology neuroscientists can establish the orientation of nerve fiber bundles, allowing for the accurate noninvasive mapping of the living brain. The "brain maps" are rendered as 2-D and 3-D color images. DTI is a leap forward in the technology for understanding and mapping the brain
7: LESS and NOTES Applications
LESS (LaparoEndoscopic Single-site Surgery) is laparoscopic surgery performed through a single incision in a patient's navel. LESS also may reduce complications that might occur after traditional open or laparoscopic abdominal surgery.
Recently this procedure was performed at the Cleveland Clinic in live-donor nephrectomies in live kidney donors for kidney transplantation. Live donor kidney harvesting is accomplished though a small incision in the navel. The living kidney donors recovered within two weeks with only an insignificant scar hidden by their belly button.
The NOTES (Natural Orifice Transluminal Endoscopic Surgery) process is unique and innovative in that the surgeon reaches an appendix, prostate, kidney or gallbladder via the body's natural cavities--the mouth, vagina or colon. The surgical procedure is effectively performed from the inside out with faster healing times, less pain and fewer potential complications.
LESS and NOTES both enhance the performance of surgeries with a bare minimum of wounding and, effectively, no scarring. The patient's pain levels are significantly reduced and the recovery period is shortened.
6: New Strategies for Creating Vaccines for Avian Flu
Epidemiologists know it is very likely that the world is going to experience a lethal flu pandemic. Avian influenza is adept at mutating and spreading in an effective manner, making avian flu pandemics bona fide concerns and almost expected realities. Avian flu is set in motion by a mutating virus that can pass from birds to humans, and it remains a continued threat. Experts estimate that the virus could brutally attack nearly a half million Americans and kill as many as 200,000. A contemporary vaccine that uses an imitation version of the bird virus called a virus-like particle (VLP) may be a superior response in protecting against infection from the avian virus. VLPs for avian flu are created with a structure similar to a virus, only they are benign. VLPs bind to cells thereby triggering a native immune response sufficient to protect one exposed to the virus.
Recently, an experimental VLP vaccine produced an immune response in opposition to H5N1. VLPs are easier to develop, produce and manufacture, and they are eminently adaptable. This innovative technology could literally save the world one day.
5: Percutaneous Mitral Valve Regurgitation Repair
Mitral valve regurgitation (MVR) is present in cases where the mitral valve fails to seal completely. This all too common valvular disorder may arise from abnormalities in any part of the mitral valve. The patient typically presents with exertional dyspnea and fatigue due to the combination of a decreased cardiac output and an increase in left atrial pressure secondary to the backflow across the mitral valve. Some patients may present with intermittent or persistent atrial fibrillation.
Percutaneous mitral valve regurgitation repair, an innovative and experimental nonsurgical MVR procedure, involves a special clip that is a tiny barbed wishbone-shaped device. A cardiac catheter is carefully guided through the femoral vein to the heart's mitral valve. The clip, riding the tip of a catheter, is clamped on the central valve leaflets, which holds them together and re-establishes normal blood flow. This clip is now in the eighth year of human testing and will be available very soon. In this fashion, the mitral valve is repaired, nonsurgically from the inside out.
4: Multi-Spectral Imaging Systems
The current standard of care is for pathologists to use an immunohistochemical staining technique for protein distributions. This form of assessment allows pathologists to examine tumor sections with a microscope and color camera. Currently, these cameras detect only three visible wavelengths and, utilizing this technology, pathologists must look at one microscope slide for each single protein. Multispectral imaging technology systems permit researchers to spectrally assess up to six chromogens (colors) in a single tissue section and look at tissue samples with 10 to 30 different wavelengths. This generates more diagnostically significant information and facilitates the understanding of intricate and complex signaling pathways in cancer cells. This quantum leap in imaging examination, assessment and knowledge will aid in the development of specifically targeted therapies for individual patients. Multispectral imaging is truly revolutionary.
3: Diaphragm Pacing System
Diaphragmatic pacing is accomplished with a series of electrodes connected to the phrenic nerves on the diaphragm. Wires from the electrodes run to and from a control box that is approximately the size of two decks of playing cards. When the electrodes are activated, the current causes the diaphragm to contract rapidly, expanding the thoracic area and gas flows into the lungs following the resulting naturally occurring pressure gradient. The electrodes then de-activate, causing the diaphragm to relax, and the patient exhales passively due to the elastic recoil of the lung parenchyma.
The diaphragmatic pacing device is an extraordinary leap forward and has tremendous potential for patients unable to maintain adequate minute ventilation due to diaphragmatic malfunction. This innovative technology will free thousands from the disastrous effects of prolonged respiratory pump failure and mechanical ventilation.
2: Warm Organ Perfusion Device
Many people find it rather shocking that for the past 30 years, human organs on their way to new homes have been transported in coolers that are very similar to the ones that can be found at any tailgating party. This has been a major concern for transplant specialists who have attempted several solutions without success. There may be a superior system for the transport of a variety of living organs. This new device is a smaller, portable rendition of a cardiac perfusion device. Upon harvesting the organ, donor blood is circulated through the heart-lung pump to the warm, living organ. The donor blood is heated and oxygenated, and the organ is transplanted in a pre-oxygenated state. This warm organ perfusion device will greatly expand the currently limited transplant window. This breakthrough innovation will have a significant impact on all organ transplants.
1: Use of Circulating Tumor Cell Technology
A new technology will enable oncologists to measure circulating tumor cells (CTCs) in a sample of blood. CTCs are cancer cells that have broken away from an existing tumor cell and are found in circulating blood samples. The detection of CTCs is a significant finding and may help predict a patient's prognosis.
This technological advance will facilitate the early detection of rogue cancer cells in patients who have experienced recurrent cancer. This will give patients the ability to assess their progress with treatment and focus the patient-physician team on future therapeutic options. This breakout technology will have critically important reproductions in the lives of many cancer patients' worldwide and will help in guiding future therapeutics.
The informed clinician will, of course, understand that this has been but a perfunctory review of these exciting technologies. I think it is an essential component of compassionate, evidence-based care that clinicians maintain a contemporary knowledge of evolutionary therapeutic options. To that end, I would encourage further investigation of these innovations.
by David Wheeler RRT, NPS
David Wheeler, RRT-NPS is the Educational Coordinator for the Cardio-Thoracic Anesthesia and Respiratory Therapy Departments at the Cleveland Clinic. He can be reached at wheeled@ccf.org.
David Wheeler will be a featured speaker at the 9th annual Focus Conference May 14-16, 2009 Disney's Coronado Springs Resort Orlando, Florida
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| Author: | Wheeler, David |
|---|---|
| Publication: | FOCUS: Journal for Respiratory Care & Sleep Medicine |
| Date: | Jan 1, 2009 |
| Words: | 1794 |
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