clinical innovations - Top Ten Technical Medical Innovations for 2009

A panel of doctors at the Cleveland Clinic has picked its top ten innovations for 2009. These innovations were unveiled at the Clinis 2008 Medical Innovation Summit and were presented in the style of Dave Letterman, from 10 to 1. I shall now comment on what I think of these innovations.

10. Private Sector National Health Information Exchange: A comprehensive system of electronic health records that link consumers, general practitioners, specialists, hospitals, pharmacies, nursing homes, and insurance companies is in the process of being established. Primarily a private-sector effort, this computerized system has the potential to replace paper-based medical files with digitized records of patients’ complete medical history.

Comment: This is unlikely to occur in next decade, and certainly not in 2009. More than EMRs exist, and most do not talk to one another. And given current economic conditions, most doctors and health care entities are reluctant to pour money into IT enterprises.

9. Doppler-Guided Uterine Artery Occlusion: Fibroid tumors occur in upwards of 40% of women older than 35, triggering pelvic pain, pregnancy complications, and heavy bleeding. There is a new, non-invasive approach to treat fibroids called Doppler-guided uterine artery occlusion, or DUAO.

Comment: This sounds reasonable to me. It can be done with existing technology.

8. Integration of Diffusion Tensor Imaging (Tractography): Diffusion tensor imaging (DTI) is the new technology that allows neuroscientists to non-invasively probe the long-neglected half of the brain called white matter, with its densely packed collection of intertwining insulated projections of neurons that join all four of the brain’s lobes, allowing them to communicate with each other.

Comment: I will take the Cleveland Clinics word on this.

7. LESS and NOTES Applications: LESS (laparoendoscopic single-site surgery) takes laparoscopic surgery to an entirely new level by reducing the process to a small cut in the belly button. NOTES (natural orifice transluminal endoscopic surgery) bypasses normal laparoscopic incisions altogether. Instead, the surgeon gets to an appendix, prostate, kidney, or gallbladder through one of the body’s natural cavities, such as the mouth, vagina, or colon.

Comment: Laproscopic insertions through existing orifices personifies new minimally invasive surgical techniques.

6. New Strategies for Creating Vaccines for Avian Flu: A newer vaccine approach that uses a mock version of the bird virus called a virus-like particle (VLP) may offer a better solution to protect people against infection from the deadly avian virus.

Comment: Let’s hope this innovative development wards off a potential avian flu epidemic, which could kill millions.

5. Percutaneous Mitral Valve Regurgitation Repair: Using a tiny barbed, wishbone-shaped device, the heart is fixed non-surgically from the inside out. A catheter is carefully guided through the femoral vein in the groin, up to the heart’s mitral valves. The clip on the tip of a catheter is then clamped on the center of the valve leaflets, which holds them together and quickly helps restore normal blood flow out through the leaflets.

Comment: The Cleveland Clinic has pioneered intraluminal devices inserted through the femoral vein.

4. Multi-Spectral Imaging Systems: The imaging system is attached to a standard microscope, where researchers can stain up to four proteins using different colors and look at tissue samples with 10 to 30 different wavelengths, allowing for the accumulation of more information than is currently available. This helps researchers to better understand the complicated signaling pathways in cancer cells, and to develop more targeted therapies, which might allow physicians to better personalize treatment for individual patients.

Comment: Targeting target cells by identifying them with color coding may be the start of the much heralded personalized therapies.

3. Diaphragm Pacing System: Four electrodes are connected to the phrenic nerves on the diaphragm. Wires from the electrodes run to and from a control box about the size of two decks of playing cards worn outside the body. When the electrodes are stimulated by current, the diaphragm contracts and air is sucked into the lungs. When not stimulated, the diaphragm relaxes and air moves out of the lungs.

Comment: We have long needed something to simulate in and out breathing.

2. Warm Organ Perfusion Device: Once a heart becomes available for transplant, surgeons have just four hours before the organ begins to decay. This device, though, recreates conditions within the body to keep the heart pumping for up to 12 hours.

Comment: Anything that keeps a donor-heart alive and pumping has got to be a good thing. This heart-warming thought may go a long way in improving heart transplant odds.

1. Use of Circulating Tumor Cell Technology: A blood test that measures circulating tumor cells - cancer cells that have broken away from an existing tumor and entered the bloodstream - has the ability to detect recurrent cancer sooner, while also predicting how well treatment is working and the patient’s probable outcome. The test results will allow physicians to better monitor a patient’s progress, adjusting treatment if necessary.

Comment: Spotting metastases early has always been a nettlesome and troublesome problem and will go a long way in creating curative treatment and prolonging the prognosis.

Conclusion. These innovations are all of a technical nature, something for which the Cleveland Clinic has a superb track record. There are also organizational nature, which will be grist for another blog on another day. For those interested in innovations by other large organizatins, I recommend the Innovation Learning Netword, http:iln-public-pbwiki.com.