When an Iowa-Minnesota tactical team conducted a simulated school shooter incident at an Iowa elementary school, it took seven and a half minutes to find the shooter using traditional tools. But when a second group of first responders used a proprietary digital twin imaging technology “map” of the school grounds, they found the shooter in just 31 seconds – 15 times faster.
Meet Dr. Maria Bell, a South Dakota-based surgeon who has used digital twin imaging technology in performing over 5,000 robotic surgeries. She started Digital Twin Imaging (DTI) a little over a year ago, with a goal to find new medical applications for the Da Vinci Robot she has long used in operating rooms to save women’s lives and health.
The Uvalde school shooting, however, led her to refocus her energies (in addition to her full-time medical practice and various hobbies) on deploying 3D imaging technology to assist first responders in gaining full access to public buildings, starting with public schools (for which federal grant money is available).
She invested in the LiDAR [Light Detection and Ranging) scanning technology, used by NASA for space missions (and in the iPhone 12 Pro series) to build 3D maps. These scanners enable a perception of depth that is quite like that of the human eye. Bell thought, if real estate firms can use this technology for selling homes, imagine what we can do to map out schools and other public buildings for use in crises that require prompt, decisive action.
Bell convinced Dickinson County (IA) Sheriff Greg Baloun to let DTI map out one school building and train local emergency management staff, teachers, and even students in how to use the technology. It took 22 hours of work to scan the entire school building and grounds, and another 10 to 12 hours of editing and adding information to complete the school map.
The result is a user-friendly map that shows every wall, floor, window, fire extinguisher, electric outlet, video surveillance camera, and large structure, from the rooftop to the ground, the parking lots, and other structures on school property. An interactive compass (other proprietary tech) and a pen can show first responders key areas (like individual classrooms). As the technology evolves, DTI endeavors to add new features to the system.
Dickinson County then mandated training on how to use this mapping technology for all of its first responders, and DTI has continued to map more schools – and the Dickinson County courthouse. As a bonus, the company is teaching faculty and students (who get a small scholarship and a certificate for their help) in the scanning process. DTI also created a nonprofit to funnel grant monies and donations into the scholarship program.
DTI has all of its mapped facilities stored in the cloud and available at a moment’s notice for all first responders at the outset of a school emergency (whether an intruder, a fire, or any other incident). Sheriff’s deputy Bruce Lee organized the tactical team experiment that involved only first responders with no local training or prior access to the school maps.
Dr. Bell, a South Dakota native, was one of the first surgeons to pioneer robotic hysterectomy surgery and instruction worldwide. Her expertise in the medical field includes gynecology, gynecologic oncology, hospice and palliative care, robotic surgeries, telemedicine, and community and population health with a focus on serving Native American people groups. She is also a private pilot who co-built an RV-14 experimental aircraft.
Bell parlayed her small-town upbringing into a medical degree from the University of South Dakota [USD] to a master’s in public health from The Johns Hopkins University to an MBA in health sector management from Duke University’s Fuqua School of Business. She served in Louisiana, Alabama, and Colorado before returning “home” to become Chief Medical Officer, Sanford Research, at USD.
She admits to running DTI at night after full days in her “real job.”
Bell says she has devoted her career (in addition to patient care) to driving innovation in healthcare technology and contributing to the field through clinical research, analysis, publication, academic instruction, and healthcare leadership. It is this drive, combined with a passion for forward-thinking solutions and emerging technologies, that enabled her to create this valuable new use for digital twin imaging technology that has great potential for saving the lives of children and school employees – and first responders as well.
According to Elliott Barnes, who heads up tech services for DTI, the modeling includes a sky view that provides an overhead image of the entire school property along with a 2D floor plan placed on top of the roof that enables first responders to set up a command post at a safe distance from impacted buildings (especially valuable in case of fire). This mapping enables responders to prioritize specific areas; for example, clearing spaces below heavy rooftop HVAC units that might collapse during a fire.
Barnes says the company’s technology shows promise for safety management at industrial facilities and large factories with hazards even more difficult to navigate without proper mapping. But for the moment, the focus is on schools. . South Lake Middle and High School principal Greg Hiemstra has given the DTI technology high praise.
And Dr. Bell? The small-towner with big ideas smiles as she recounts the serendipity that enabled her small team to achieve big results so quickly.
“Our story is a cool one,” she muses. “It shows the great value of rural America to create and demonstrate a technology that can be applied anywhere in far more uses than we even realize today. As we continue to tweak this tech, it is only going to get better.”
Duggan Flanakin is Director of Policy Research with the Committee For A Constructive Tomorrow who writes about a multitude of issues, innovations, and ideas.
The MarketWatch News Department was not involved in the creation of this content.
The Surgical Skin Closure Device Market research report presents a comprehensive analysis of the market with detailed insights on manufacturers, types, applications, and regions. The report offers a thorough overview of the market, providing a competitive landscape that includes business profiles, investment plans, project usability analysis, SWOT analysis, CAGR status, and key organizations involved in the industry. The Surgical Skin Closure Device market report also covers global industry trends, manufacturing cost structure, value and volume, revenue, and gross productivity during the forecast period. With a detailed analysis of the market, this report provides valuable information for stakeholders to make informed decisions and stay ahead of the competition.
Additionally, SWOT and PESTLE analyses are commonly used tools in market research reports to evaluate a company or market's strengths, weaknesses, opportunities, threats, political, economic, social, technological, legal, and environmental factors. These tools help identify potential risks and opportunities that may affect a company's performance in the market.
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This report is a detailed and comprehensive analysis for global Surgical Skin Closure Device market. Both quantitative and qualitative analyses are presented by manufacturers, by region and country, by Type and by Application. As the market is constantly changing, this report explores the competition, supply and demand trends, as well as key factors that contribute to its changing demands across many markets. Company profiles and product examples of selected competitors, along with market share estimates of some of the selected leaders for the year 2023, are provided.
Major Players Studied in the Research Report Are:
● Medtronic
● Medline Industries
● Teleflex
● BSN medical
● Baxter International
● Radi Medical Systems
● Abbott Vascular
● NeatStitch
● Derma Sciences
● Ethicon (Johnson and Johnson)
This report profiles key players in the global Surgical Skin Closure Device market based on the following parameters - company overview, production, value, price, gross margin, product portfolio, geographical presence, and key developments. This report also provides key insights about market drivers, restraints, opportunities, new product launches or approvals, COVID-19 and Russia-Ukraine War Influence.
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Market Segmentation:
Surgical Skin Closure Device market is split by Type and by Application. For the period 2018-2029, the growth among segments provides accurate calculations and forecasts for consumption value by Type, and by Application in terms of volume and value. This analysis can help you expand your business by targeting qualified niche markets.
Market Segment by Type:
● Closure Strips
● Tissue Adhesive
● Sutures
Market Segment by Application:
● Hospitals
● Clinics
● Ambulatory Surgery Centers
Some Questions Answered in the Surgical Skin Closure Device Market Report:
● What will the Surgical Skin Closure Device market size and the growth rate be in 2029? ● What are the key factors driving the global Surgical Skin Closure Device industry? ● What are the key market trends impacting the growth of the Surgical Skin Closure Device market? ● What are the Surgical Skin Closure Device market challenges to market growth? ● What are the Surgical Skin Closure Device market opportunities and threats faced by the vendors in the global Surgical Skin Closure Device market? ● What are the upstream raw materials and manufacturing equipment of Surgical Skin Closure Device What being the manufacturing process of Surgical Skin Closure Device? ● What are the types and applications of Surgical Skin Closure Device What being the market share of each type and application?Inquire or Share Your Questions If Any Before the Purchasing This Report - https://www.marketresearchguru.com/enquiry/pre-order-enquiry/22467300
What Our Surgical Skin Closure Device Market Report Offers:
● Surgical Skin Closure Device Market share estimates of the segments on country and global level ● Surgical Skin Closure Device market Share analysis of the major players ● Key Opportunities for new market entrants ● Surgical Skin Closure Device Market forecast for all the segments, sub-segments in various countries and regions ● Surgical Skin Closure Device Market Trends (drivers, restraints, opportunities, threats, challenges, investment opportunities, and approvals) ● Strategic endorsements in key business segments on the basis of market valuations ● Competitive scenario mapping the key development patterns. ● Company profiling with comprehensive strategies, financial details, and latest progressions. ● Supply chain trends representing the latest technological advancements.Market segment by region, regional analysis covers
● North America (United States, Canada and Mexico) ● Europe (Germany, France, United Kingdom, Russia, Italy, and Rest of Europe) ● Asia-Pacific (China, Japan, Korea, India, Southeast Asia, and Australia) ● South America (Brazil, Argentina, Colombia, and Rest of South America) ● Middle East and Africa (Saudi Arabia, UAE, Egypt, South Africa, and Rest of Middle East and Africa)To Understand How Covid-19 Impact Is Covered in This Report - https://marketresearchguru.com/enquiry/request-covid19/22467300
The content of the study subjects, includes a total of 15 chapters:
Chapter 1, to describe Surgical Skin Closure Device product scope, market overview, market estimation caveats and base year.
Chapter 2, to profile the top manufacturers of Surgical Skin Closure Device, with price, sales, revenue and global market share of Surgical Skin Closure Device from 2018 to 2023.
Chapter 3, the Surgical Skin Closure Device competitive situation, sales quantity, revenue and global market share of top manufacturers are analyzed emphatically by landscape contrast.
Chapter 4, the Surgical Skin Closure Device breakdown data are shown at the regional level, to show the sales quantity, consumption value and growth by regions, from 2018 to 2029.
Chapter 5 and 6, to segment the sales by Type and application, with sales market share and growth rate by type, application, from 2018 to 2029.
Chapter 7, 8, 9, 10 and 11, to break the sales data at the country level, with sales quantity, consumption value and market share for key countries in the world, from 2017 to 2022.and Surgical Skin Closure Device market forecast, by regions, type and application, with sales and revenue, from 2024 to 2029.
Chapter 12, market dynamics, drivers, restraints, trends, Porters Five Forces analysis, and Influence of COVID-19 and Russia-Ukraine War.
Chapter 13, the key raw materials and key suppliers, and industry chain of Surgical Skin Closure Device.
Chapter 14 and 15, to describe Surgical Skin Closure Device sales channel, distributors, customers, research findings and conclusion.
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Main Points from Table of Contents:
1 Market Overview
1.1 Product Overview and Scope of Surgical Skin Closure Device
1.2 Market Estimation Caveats and Base Year
1.3 Market Analysis by Type
1.4 Market Analysis by Application
1.5 Global Surgical Skin Closure Device Market Size and Forecast
2 Manufacturers Profiles
3 Competitive Environment: Surgical Skin Closure Device by Manufacturer
3.1 Global Surgical Skin Closure Device Sales Quantity by Manufacturer (2018-2023)
3.2 Global Surgical Skin Closure Device Revenue by Manufacturer (2018-2023)
3.3 Global Surgical Skin Closure Device Average Price by Manufacturer (2018-2023)
3.4 Market Share Analysis (2022)
3.5 Surgical Skin Closure Device Market: Overall Company Footprint Analysis
3.6 New Market Entrants and Barriers to Market Entry
3.7 Mergers, Acquisition, Agreements, and Collaborations
4 Consumption Analysis by Region
4.1 Global Surgical Skin Closure Device Market Size by Region
4.2 North America Surgical Skin Closure Device Consumption Value (2018-2029)
4.3 Europe Surgical Skin Closure Device Consumption Value (2018-2029)
4.4 Asia-Pacific Surgical Skin Closure Device Consumption Value (2018-2029)
4.5 South America Surgical Skin Closure Device Consumption Value (2018-2029)
4.6 Middle East and Africa Surgical Skin Closure Device Consumption Value (2018-2029)
5 Market Segment by Type
5.1 Global Surgical Skin Closure Device Sales Quantity by Type (2018-2029)
5.2 Global Surgical Skin Closure Device Consumption Value by Type (2018-2029)
5.3 Global Surgical Skin Closure Device Average Price by Type (2018-2029)
6 Market Segment by Application
6.1 Global Surgical Skin Closure Device Sales Quantity by Application (2018-2029)
6.2 Global Surgical Skin Closure Device Consumption Value by Application (2018-2029)
6.3 Global Surgical Skin Closure Device Average Price by Application (2018-2029)
7 North America
8 Europe
9 Asia-Pacific
10 South America
11 Middle East and Africa
12 Market Dynamics
12.1 Surgical Skin Closure Device Market Drivers
12.2 Surgical Skin Closure Device Market Restraints
12.3 Surgical Skin Closure Device Trends Analysis
12.4 Porters Five Forces Analysis
12.5 Influence of COVID-19 and Russia-Ukraine War
13 Raw Material and Industry Chain
13.1 Raw Material of Surgical Skin Closure Device and Key Manufacturers
13.2 Manufacturing Costs Percentage of Surgical Skin Closure Device
13.3 Surgical Skin Closure Device Production Process
13.4 Surgical Skin Closure Device Industrial Chain
And More…
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Press Release Distributed by The Express Wire
To view the original version on The Express Wire visit The Future of Surgical Skin Closure Device Market 2023: Challenging Traditional Approaches to Reach Highest Growth by 2029
COMTEX_424534172/2598/2023-02-15T06:57:05
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Abstract and Introduction
Between 10% and 15% of individuals in the industrialized world have gallstones. The standard treatment is laparoscopic cholecystectomy, making gallstone disease the second most costly digestive disorder in most Western countries. Despite a rapid convalescence, the procedure is not devoid of morbidity or even mortality. Bile duct injury is particularly troublesome, occurring in 0.1% to 0.5% of cases, even in the most experienced hands. Moreover, some 20% of patients continue to suffer from pain (the main indication for treatment) after cholecystectomy. In patients with mild symptoms, surgical treatment has been associated with a higher morbidity than the natural course of the disease. Medical dissolution therapy with bile acids is an alternative for patients with mild-to-moderate symptoms due to cholesterol gallstones. Chenodeoxycholic acid (CDCA, chenodiol) has been largely replaced by the safer and more efficient ursodeoxycholic acid (UDCA). The main drawbacks of UDCA treatment are its low efficacy (approximately 40%), slowness in action, and the possibility of stone recurrence. However, this treatment is extremely safe, and the efficacy and slowness can be somewhat improved by stricter patient selection. Moreover, patient symptoms may respond to this therapy even without complete stone dissolution. New strategies employing more efficient bile acids or related compounds may increase the efficacy of medical dissolution. Furthermore, latest advances in the understanding of biliary lipid secretion and regulation should offer novel opportunities to further Boost the prospects of medical treatment of gallstones.
Gallstones are one of the most common and costly digestive disorders in the modern industrialized world.[1] Some 15% of populations in most Western countries have gallstones. The primary treatment for gallstones has been surgery ever since the introduction of cholecystectomy by Langenbuch approximately 120 years ago. However, the costs as well as the risks associated with surgical therapy have stimulated attempts to treat gallstones by nonsurgical means. Although initial reports of medical therapy were published almost a century ago, it was not until the 1970s that medical dissolution of gallstones became a practical option.
The first drug, CDCA, was largely replaced by the safer UDCA during the 1980s. Shock-wave lithotripsy introduced in Germany in the mid-1980s increased the pool of potential candidates for nonsurgical therapy and made medical therapy quite popular, especially in Europe. However, the success rate of dissolution was low, and the introduction of laparoscopic cholecystectomy about 15 years ago rapidly extinguished the demand for nonsurgical therapy in most countries. Hence today, despite a significant increase in cholecystectomies performed during the last decade, the popularity of medical dissolution therapy has declined, and many gastroenterologists (not to mention surgeons) do not even offer the option of medical therapy to their patients.
During my career as an ICU nurse, when we were treating patients, the medical team always had a detailed debate on the risks and benefits of every intervention when developing a patient's plan of care.
All medical interventions, from complex surgical care to common pharmacological prescriptions, carry risk. Medicine is practiced under that guiding principle of providing the patient with the least invasive interventions possible, so as to minimize risk of additional complications and potential harm.
This principle is utilized broadly in health care with one glaring exception: the treatment of gender dysphoria in minors.
Gender Dysphoria is defined by the DSM-5 as, “a marked incongruence between one’s experienced/expressed gender and their assigned gender” (Patients cannot receive insurance reimbursements for medical interventions without this diagnosis).
While there are non-invasive, successful options to treat Gender Dysphoria, highly invasive interventions that can lead to permanent fertility loss, among other things, are being pushed onto families as the first-line standard of care through the “gender-affirming” model of care.
For example, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association are all strong advocates for pediatric “gender-affirming” care.
While the medical community is all in on pediatric “gender-affirming” care, state legislators across the country are now debating the ethics and necessity of these treatments.
In 2020, the Pennsylvania House Subcommittee on Health Care held two hearings, in March and September, discussing treatment standards for minors experiencing Gender Dysphoria.
At the March hearing Dr. Stephen Levine, a clinical professor of psychiatry, gave an impactful testimony describing three different models of care for the treatment of gender dysphoria in children.
Dr. Levine describes the first approach as “watchful waiting” saying,
“A watchful waiting approach cooperates with this fluid, changeable nature of gender identity in children, the fluid changeable nature of gender identity, and seeks to allow time, safety, and support for the process to happen. In the meantime, the professional will often seek to treat any associated mental illness in the child or symptoms in the child but without focusing on gender at all, separation anxiety, compulsivity, compulsions, and so forth.”
He further noted that multiple studies show that the “large majority of young children who present with gender dysphoria, if left untreated, uninvolved with will evolve to a gender identity continent with their biological sex by the end of adolescence.”
The second approach he discussed is the psychotherapy model that focuses on working with patients to identify causes of psychological distress and applying standard psychotherapeutic approaches to resolve it.
The third model of care he identified is known as “gender-affirmation” care, which includes a range of interventions from “social affirmation,” such as name and pronoun changes, to the administration of puberty blockers, sterilizing cross-sex hormones, and irreversible surgical interventions, like double mastectomies.
The hearing in September 2020 was focused entirely on the “gendering-affirming” model of care.
Public records from February 2020 show Dr. Rachel Levine, as Pennsylvania’s Secretary Health, reaching out to Nadia Dowshen and Linda Hawkins, the co-founders and co-directors of the Children’s Hospital of Philadelphia’s (CHOP) Gender and Sexuality Clinic, asking if they’d testify at the hearing writing,
“I would very much like you both to join me if you are able…
…I am mindful that the committee might also invite other individuals to testify who do not have the level of knowledge and experience that you and your team bring from CHOP. I am also mindful that other testifiers might have a quite divergent opinion than ours on the efficacy of transgender confirmation health care.”
Dowshen responded, “I am pleased to do anything I can to stand with you...”
At the September hearing, Dowshen testified in favor of gender-affirming care for over an hour.
In her testimony, Dowshen supported giving puberty blockers to prepubescent children and cross-sex hormones to minors.
When asked how young she referred children for sex reassignment surgery, sometimes called “bottom surgery,” Dowshen did not provide a clear answer. However, in a 2017 email written to Rachel Levine, Dowshen states one of her patients received “bottom surgery” at age 17. In her testimony, she admitted to referring girls as young as 14 to receive double mastectomies.
Giving these invasive and experimental medical treatments to children is a new phenomenon. We don’t know the long-term physical and psychological impacts of these treatments nor the depths of regret transitioned children will face.
For example, regularly-prescribed puberty blockers such as Supprelin LA and Lupron Depot have not been approved as a gender dysphoria treatment and are being prescribed off-label by many pediatric gender clinics.
In December 2022, Texas Attorney General Ken Paxton announced that he was investigating the makers of these drugs under the Texas Deceptive Trade Practices Act. Saying in a press release,
“The manufacture, sale, prescription, and use of puberty blockers on young teens and minors is dangerous and reckless…”
“These drugs were approved for very different purposes and can have detrimental and even irreversible side effects. I will not allow pharmaceutical companies to take advantage of Texas children.”
Not only are these interventions experimental, but they’re also expensive. In a 2018 NIH presentation, Nadia Dowshen stated that cross-sex hormone treatments can cost as much as $40,000 a year; and taxpayers are often footing the bill. A public records request by the Pennsylvania Family Council found that since 2015, Pennsylvania taxpayers spent more than $16.7 million on, “sex reassignment and transition related services and drugs for service.”
As the first generation of pediatric gender-affirmation patients is moving into adulthood, we are seeing a wave of detransitioners, such as Chloe Cole, who are speaking out against pediatric “gender-affirming” care.
The high-risk stakes of “gender-affirming” care beg a simple question: Why is American mainstream medicine almost exclusively recommending the most invasive treatment pathway to children struggling with Gender Dysphoria, when there are successful, less invasive options? Have they not abandoned their duty to “First, do no harm?”
Meanwhile, several European nations are recognizing these risks and halting their pediatric gender-affirmation programs whereas American institutions are moving full-steam ahead, continuing to push on families the false choice of “having a dead daughter or a living son,” delivering care under that incorrect notion that invasive medical treatments are the only solution to a complex psychiatric condition.
We must take note that history repeats for those who don’t learn from it.
In 1935, neurosurgeon Dr. Egas Moniz discovered a psychiatric illness cure-all, the lobotomy (he’d go on to win a Nobel Prize for this “advancement”). Over two decades, thousands of patients received these barbaric surgeries under the guise of psychiatric healing, until the madness and danger of this surgery were widely recognized and the procedure was eventually stopped.
In one of the most poignant lines of his testimony, Dr. Levine, who is presently the federal Assistant Secretary for Health and Human Services, said,
“And since doctors gave up performing lobotomies to treat psychiatric disorders many decades ago, gender dysphoria is the only psychiatric diagnosis which doctors are attempting to treat by surgery.”
Those who fail to recognize history are doomed to repeat it.
Meg is a photographer, former nurse, and a grassroots parental rights activist living in the Philadelphia suburbs with her husband and two kids. She is passionate about protecting the well-being of children.
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China: A delayed surgical step-up approach (DSU) is the optimal strategy for treating necrotizing pancreatitis, says a latest study.The findings from a meta-analysis of randomized controlled trials (RCTs) were published in the World Journal of Emergency Surgery on January 27 2023. In clinical practice, the researchers suggest avoiding drainage alone. The study further found that any...
China: A delayed surgical step-up approach (DSU) is the optimal strategy for treating necrotizing pancreatitis, says a latest study.
The findings from a meta-analysis of randomized controlled trials (RCTs) were published in the World Journal of Emergency Surgery on January 27 2023. In clinical practice, the researchers suggest avoiding drainage alone.
The study further found that any interventions should be postponed for at least four weeks. The findings might help clinicians choose the optimal treatment strategy in clinical practice.
Acute pancreatitis (AP) is a pancreas' inflammatory disorder with 10% to 40% mortality. Two significant forms of acute pancreatitis exist: necrotizing and interstitial. About 20% of acute pancreatitis patients advance to necrotizing pancreatitis (NP), which is linked with walled-off necrosis (WON) or acute necrotic collections (ANC), with a significant mortality risk of 20–30%. Intervention is required in 40–63% of patients who develop necrotizing pancreatitis.
A series of randomized controlled trials have examined the safety and efficacy of different things and methods of interventions. However, there still needs to be a consensus on the optimal treatment strategy. Considering this, Yang Yang, Tianjin Medical University, Tianjin, China, and colleagues conducted a comprehensive Bayesian network meta-analysis (NMA) of RCTs to determine the optimal intervention and timing for necrotizing pancreatitis comparing safety and efficacy through direct and indirect evidence.
For this purpose, the researchers searched the online databases until November 30, 2022. A systematic review and Bayesian NMA were performed following the PRISMA guidelines. Trials that compared different treatment strategies for NP were included.
The authors analyzed ten studies comprising 570 patients and eight treatment strategies.
The study led to the following findings:
- The researchers identified no statistically significant differences comparing odds ratios, but the surface confirmed the trends under the cumulative ranking (SUCRA) scores.
- The interventions having a low rate of mortality included delayed surgical step-up approach (DSU), delayed surgery (DS), and delayed endoscopic step-up approach (DEU). In contrast, the interventions with a low rate of significant complications were DEU, DSU and DS.
- According to the clustered ranking plot, DSU was overall superior in lowering mortality and major complications, while delayed drainage performed the worst.
- Analysis of the secondary endpoints confirmed DEU and DSU's superiority concerning individual components of major complications (pancreatic fistula, organ failure, bleeding, and visceral organ or enterocutaneous fistula), endocrine insufficiency, exocrine insufficiency, and length of stay. Overall, DSU was superior to other interventions.
"The network meta-analysis on comparing the outcomes of 8 interventions for NP across ten studies with a total of 816 patients identified the optimal treatment strategy for NP with low risk of major complications and mortality as DSU," the researchers wrote.
"Our findings indicated that postponement strategy interventions and step-up approach, usually selected in the current clinical practice, were reasonable," they conclude.
Reference:
Yang, Y., Zhang, Y., Wen, S. et al. The optimal timing and intervention to reduce mortality for necrotizing pancreatitis: a systematic review and network meta-analysis. World J Emerg Surg 18, 9 (2023). https://doi.org/10.1186/s13017-023-00479-7
Organisation:
Western Health & Social Care Trust
Published date:
January 2017
Key to the role of a pharmacist, is medicines reconciliation at the interfaces of care (NICE NG5 recommendations 1.3.1, 1.3.2 &1.3.5). This involves aligning pre-admission medications against those prescribed in hospital using at least two sources, including the Electronic Care Record (ECR).
Prescribers are consulted to ensure errors are corrected and discrepancies resolved, which ultimately prevents patients from coming to harm. Changes are documented using the ECR proforma, thereby resulting in a complete list of medicines accurately communicated within the patient’s medical notes (NG5 recommendation 1.3.7).
The categorisation of errors identified during a baseline audit indicated that most could be attributed to inappropriate or incomplete medicines reconciliation by prescribers and an over-reliance on the ECR record as a single source. Relating the project to the strategic themes of Quality 2020, we aimed to transform the culture towards medicines reconciliation and engage a more multidisciplinary approach (recommendation 1.3.4).
Our co-authors were:
- Ms R Johnston (WHSCT Clinical Pharmacist)
- Mr B Skelly (Surgical Registrar)
- Mr Z Bali (Associate Specialist General Surgery)
- Mr A Gidwani (Consultant General Surgeon)
Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
No
Does the example relate to a specific implementation of a specific piece of NICE guidance?
Yes
Example
Aims and objectives
Prescribing errors occur in 1-15% of medication written for hospital inpatients 1. The EQUIP study found that prescribing error rates for junior doctors are around 9%2. Errors made during drug prescription are the most common type of avoidable medication error, and are hence an important target for improvement3,4. Recognising vulnerabilities for errors, medicines reconciliation at interfaces of care has thus become an important recognised element of patient safety.
Locally an observed increase in the number of pharmacist interventions at admission and discharge and a concurrent series of ‘near miss’ events prompted the initiation of a Quality Improvement Project (QIP) to look at system improvements / Plan-Do-Study-Act (PDSA) cycles to Boost the situation. This QIP aimed to address incomplete or inaccurate medicines reconciliation and to engage prescribers to ensure a more multi-disciplinary approach so as to Boost medicine prescription practice. For motivational purposes a staggered reduction in the rate of prescription error per patient (relative to baseline) of 25% by the end of June 2015 and 50% by the end of July 2015 were agreed.
Reasons for implementing your project
This QIP took place in a general surgical ward at Altnagelvin Area Hospital, L’Derry, Northern Ireland, between March – November 2015. Per annum there are approximately 1500 elective admissions to the ward. Prior to the project initiation there had been an observed number of pharmacist recommendations to prescribers to amend the kardex after completion and verification of a patient’s pre-admission medications (medicines reconciliation on admission). Concurrently there was also a series of ‘near-miss’ events involving critical medicines being omitted / prescribed incorrectly and thereby impacting on patient safety.
Identification and buy in from a surgical champion was initially achieved and a baseline audit undertaken. Results were categorised and resources focussed on the admission stage of the patient journey. After presentation at a lunchtime learning event it was agreed that to move the project forward International Healthcare Improvement (IHI) quality improvement methodology would be utilised to help adapt a multi-disciplinary approach to Boost medicines accuracy on admission and thereby ensure that the kardex is a true and accurate reflection of the prescriber’s intentions.
Key to this would be pharmacists and prescribers working in collaboration to agree and introduce changes in a stepped manner with an appropriate measure to reflect the impact of these. Given that prescribing errors are largely preventable and are associated with pro-longed hospital stays and medication related hospital re-admissions, the project had significant potential to Boost patient care and assist with patient flow.
How did you implement the project
A prospective baseline audit was undertaken from 9th-12th March 2015 inclusive, examining admission and discharge prescriptions for 73.5% of all patients on the ward during the allocated time period. The types of prescription error, stage of patient journey and prescriber grade were recorded with the key measure reported as the average error rate per patient.
Data indicated the highest incidence of errors occurred on admission, hence resources were targeted here as this should minimise the potential of medication inaccuracies being carried through to discharge. The results were fed back to a surgical champion and a multi-disciplinary brain storming session undertaken that explored the stages of the admission process and sought to identify where prescribing errors can occur and generate potential solutions to overcome these (Figure 1 in the supporting material). To move forward a driver diagram (Figure 2 in the supporting material) was developed and ‘buy in’ was achieved from all prescribers. Aligning the project to both the strategic goals (Figure 3 in the supporting material) and level 2 of the attributes framework of Quality 2020, which is a 10 year strategy designed to protect and Boost quality in health and social care in Northern Ireland, the whole team were engaged in introducing a series of PDSA cycles and agreeing the measure. These enabled the project to be taken forward using small tests of change that were introduced and tested quickly.
Multiple cycles were utilised to refine and streamline the process, including printing of the Electronic Care Record (ECR) on admission by prescribers, multi-disciplinary education on the appropriate use of ECR and engagement with Surgical Consultants. An email group in addition to weekly ‘huddles’ was established to supply feedback on progress and maintain momentum. Snap shot audits were undertaken focussing on two key measures – a process measure in the mean number of ECRs printed on admission by medical staff and an outcome measure in the mean number of prescribing errors per patient. A run chart of progress was plotted and emailed to prescribers each week.
While no costs were incurred, the biggest challenge faced was sustainability of champions and recruitment of a nursing champion due to long-term illness. To counter balance these at the switch over of medical staff in August 2015, a permanent staff grade was recruited as the surgical champion and subsequently the Lead Surgical Consultant and Lead Nurse Manager were both engaged more fully on a frequent basis.
Key findings
Baseline data collection recorded 158 unintentional prescribing errors with the majority occurring on admission compared to discharge (4.38 per patient Vs 0.61 per patient). Focussing on the admission stage, PDSA cycles were introduced and their impact on reducing error rate is annotated in Figure 4 in the supporting material.
Errors reduced to 2.6 per patient subsequent to the change of practice in the admission process of printing the ECR (40.7% reduction from baseline), thereby achieving the target of 25% reduction relative to baseline by June 2015. However, with changeover of medical staff and the absence of ward based champions the error rate increased to 3.7 per patient, resulting in the July 2015 target of 50% from baseline not being met.
After the introduction of weekly huddles, training of prescribers and discussion with the Lead Surgical Consultant the error rate reduced to 1.3 per patient, equivalent to a 70.3% reduction from baseline (target 50%). Posters and the ‘ADMIT’ strategy were then launched which, while still below target, saw a small increase in overall error rate. To target all prescribers, including those who do not normally work in the project area, but who may participate in cover, the QIP was presented and discussed at Thursday lunchtime teaching. Subsequently errors were reduced to 1.08 per patient by 27th October and 0.8 per patient by 3rd November respectively (81.7% from baseline). A clear correlation was demonstrated between mean number of prescribing errors per patient (outcome measure) and printing of ECR on admission (process measure).
Key learning points
The switchover of medical staff and the absence of ward based champions had a significant impact on the error rate. It is therefore key to include training on induction for prescribers on ECR and medicines reconciliation. Furthermore, a surgical champion who is a permanent member of staff should counter balance the impact of medical rotations and help Boost consistency of results. In addition results would have been more likely to be sustained had a systems approach been adapted with multiple areas undertaking the same QIP, rather than just an isolated clinical pocket. A systems bundle would potentially have negated the impact of the absence of champions as it would have been owned by the clinical team rather than individuals.
Weekly feedback in the form of emails and huddles gives support, encouragement and provides learning to the multi-disciplinary team. However, despite the nature of the information presented within the run chart in retrospect this would have potentially had a bigger impact and influencing role on medical, nursing and pharmacy colleagues had it been displayed within the clinical area rather than being disseminated via email.
IHI Improvement methodology is an effective tool to demonstrate how tests of change can Boost processes. Key to success is having a specific aim that is both realistic and the impact of which can be observed in ‘real time’. This helps motivation and momentum and in the context of health care ultimately impacts on patient safety.
References:
- Creation of a better medication safety culture in Europe: Building safe medication practices. Council of Europe Expert Group on Safe Medication Practices (2006).
- Dornan T, Ashcroft D, Heatherfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council; 2009
- Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA 1995; 274: 35–43.
- Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events: implications for prevention. JAMA 1995; 274: 29–34.
Contact details
Job:
Lead Clinical Pharmacist Surgery & Anaesthetics
Organisation:
Western Health & Social Care Trust
Email:
majella.warnock@westerntrust.hscni.net
Is the example industry-sponsored in any way?
No
IX Innovation, a medical IP company today announced the USPTO issued U.S. patent 11,389,248 entitled 'Surgical Robot Evolution and Handoff'.
SEATTLE, WA, UNITED STATES, February 15, 2023 /einpresswire.com / -- IX Innovation, a medical IP creation and monetization company focused on inventing the future of human surgery, and portfolio company of intuitivex , today announced the U.S. Patent and Trademark Office (USPTO) issued U.S. patent 11,389,248 entitled 'surgical robot evolution and handoff '. This patent is the third in a series of many robotic surgery related assets which will be issued over the course of the year.The 'Surgical Robot Evolution and Handoff'' patent relates to the use of a robotic system for performing surgery wherein the robotic system is controlled jointly by an artificial intelligence and a surgeon. As of today, existing surgical robotic systems only provide assistance to surgeons such as removing tremors and offering improved visualizations and less invasive ways of operating within a patient. Despite their complexity and myriad of features, these systems are simply tools which are incapable of replacing the role of the surgeon, and while they may relieve some burdens from the surgeon and Boost their stability, they are not alone sufficient to significantly impact patient outcomes from complications beyond facilitating less invasive procedures.
The robotic system has the capacity to enable the surgeon to perform the entire surgery or alternatively allow the artificial intelligence to control the robot and perform part or the entirety of the surgery. With this approach, the artificial intelligence is trained by data from previous surgeries and may provide indication to the surgeon when it has sufficient data to take over parts of a surgery and can prompt the surgeon when there is insufficient data for the artificial intelligence to continue. Alternatively, a supervising surgeon may manually take back control of the robot from the artificial intelligence.
'The combination of artificial intelligence and human expertise in the realm of surgical robotics marks a new era of precision, efficiency, and improved patient outcomes.' Commented mark han , Chief Legal Officer of IntuitiveX. 'I recognize the immense value in harnessing these cutting-edge technologies to deliver innovative solutions that can transform the way we approach surgical procedures and Boost the quality of life for patients everywhere.'
About IX Innovation
IX Innovation is a portfolio company of IntuitiveX functioning as an internal IP creation and monetization engine which, through its internal collections of world renowned medical professionals, IP experts and patent attorneys, aims to be on the leading edge of medical innovation, as such, the issuance of the new patent is the first of many opportunities to help spearhead and catalyze breakthroughs within the surgical arena. The company anticipates many more patent issuances over the coming weeks and months.
About IntuitiveX
IntuitiveX is a Medical Innovation Incubator and Consultancy with deep expertise in the development and commercialization of emerging technology companies within the Healthcare and Life Sciences. As intellectual property and commercialization experts, IntuitiveX specializes in creating healthcare enterprises, adopting new technologies, and developing early-stage healthcare startups. From ideation to commercialization, IntuitiveX's team of life science and healthcare entrepreneurs, practitioners, and investors combine 100+ years of experience to accelerate successful medical innovation in biotech, pharma, digital health and medical devices.
Media Contact:
Simon Robinson
Managing Partner of IX Innovation
Emeka Alozie
IntuitiveX
email us here
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Dr B Karunakar Reddy, Vice-Chancellor, Kaloji Narayana Rao University of Health Sciences (KNRUHS), announced that a surgical boot camp programme will be introduced in all medical colleges in Telangana state from the next academic year. During his visit to the ongoing surgical boot camp at GSL Medical College and General Hospital, he spoke to the media about the benefits of the boot camp approach, which increases teamwork, time management and skills among medical professionals when attending to patients, stated a report by The New Indian Express.
The health university plans to implement the boot camp as an academic programme from next year. The boot camp is a comprehensive and short-term training programme, similar to those provided to defence forces, to help students understand the challenges they will face.
The GSL medical college is organising a boot camp for its surgery students, which involves training them as a team in surgeries using medical simulation units, animal tissues and real-time surgeries. The boot camp covers 15 different types of surgeries and is a small and comprehensive module on gastrointestinal surgeries, which surgical students can learn over three years. Dr Lakshmana Murthy from Kakinada and noted surgeons Dr Sameer Ranjan Nayak and Dr Ganni Bhaskararao were also present during the boot camp. The Vice-Chancellor believes that other medical colleges will follow this in the years to come in academic interest, reported The New Indian Express.
TORONTO, Feb. 7, 2023 /CNW/ - Medical Facilities Corporation ("Medical Facilities" or the "Company") (TSX: DR), is pleased to announce that Black Hills Surgical Hospital ("BHSH") has been ranked as the #1 Hospital in the United States for Major Orthopedic Surgery for Medical Excellence by CareChex® for 2023. This award and ranking is based on a comprehensive quality scoring that compares inpatient performance across general, acute and non-federal hospitals – nearly 5,000 U.S. hospitals in total.
The ranking is the result of BHSH having the lowest incidents of patient mortality, complications, and readmissions, and the highest levels of patient safety, inpatient service and surgical quality, when compared to nearly 5,000 U.S. hospitals.
"Medical Facilities is a proud partner of the team at BHSH and we congratulate them on receiving this incredible accolade," said Jason Redman, President and CEO of Medical Facilities. "This ranking reflects BHSH's patient-centred care approach and the outstanding quality and expertise of their incredible physicians and staff. Superior service and state-of-the-art equipment enable BHSH to meet and exceed the needs of patients – something the hospital has been doing since 1997."
"To be named as the #1 Hospital in the Nation for Major Orthopedic Surgery is a tremendous honor," said Lew Papendick, Orthopedic Surgeon and Chairman of the Board, Black Hills Surgical Hospital. "Our goal is always providing the absolute best care, the safest care, and the best experience possible for our patients. To be recognized as being the best in the nation is a testament to the dedication and talents of our exceptional staff and surgeons. Quality expert care leads to quality outcomes and better quality of life and BHSH offers that quality better than anyplace else in the country."
CareChex also ranked BHSH as the #1 Hospital in the Market for Overall Hospital Care, Overall Surgical Care, and General Surgery for 2023 in both Medical Excellence and Patient Safety categories.
BHSH's orthopedic services include a highly personalized Hip and Knee Center, with nurse navigators that work with patients throughout the entire continuum of care, a class-leading total joint replacement robotics program featuring Mako SmartRobotics™, and minimally invasive spine (MIS) surgery; both offering shortened hospital stays, less pain and smaller incisions. BHSH also performs foot and ankle surgeries, arthroscopic shoulder and shoulder replacement surgeries, and various hand procedures.
About Medical Facilities
Medical Facilities, in partnership with physicians, owns a diverse portfolio of highly rated, high-quality surgical facilities in the United States. MFC's ownership includes controlling interest in four specialty surgical hospitals located in Arkansas, Oklahoma, and South Dakota, and an ambulatory surgery center ("ASC") located in California. In addition, through a partnership with NueHealth LLC, Medical Facilities owns a controlling interest in five ambulatory surgery centers located in Michigan, Missouri, Nebraska, Ohio and Pennsylvania. MFC also owns a non-controlling interest in an ASC in Missouri. The specialty surgical hospitals perform scheduled surgical, imaging, diagnostic and other procedures, including primary and urgent care, and derive their revenue from the fees charged for the use of their facilities. The ASCs specialize in outpatient surgical procedures, with patient stays of less than 24 hours. For more information, please visit www.medicalfacilitiescorp.ca.
About Black Hills Surgical Hospital
For more than 25 years, Black Hills Surgical Hospital has been a regional and national leader in quality healthcare. Consistently recognized for patient satisfaction, medical excellence, and patient safety, Black Hills Surgical Hospital employees nearly 500 highly skilled professionals and offers integrated surgical, imaging, pain management, sports medicine and urgent care services. Black Hills Surgical Hospital is proudly owned by physicians.
About Quantros CareChex
CareChex Awards by Quantros utilizes a peer-reviewed risk-adjustment methodology to more reliably measure rates of mortality, complications and readmissions — appropriately weighting and accounting for all of the risk factors relating to a patient's principal and secondary diagnosis, as well as other patient characteristics that may increase the probability for adverse clinical outcomes. These rankings do not include any self-reported data.
SOURCE Medical Facilities Corporation
View original content: http://www.newswire.ca/en/releases/archive/February2023/07/c4713.html
