Breakthrough surgery: When the body doesn't miss a missing limb
Part of Jim Ewing’s left leg is missing, but the rest of his body doesn’t know it.
That’s the genius of a first-of-its-kind amputation in the US that preserves muscle and nerve connections typically severed when a limb is removed.
The procedure, performed by doctors at Brigham and Women’s Faulkner Hospital in Boston, was described publicly yesterday. It involves the insertion of a tendon pulley system in the leg that preserves the relationship between the brain, the muscles in the front of the leg and the back. This allows the leg to interact with a robotic prosthetic and restore more complicated muscle movements.
“The idea behind the operation is quite simple, we’re just trying to restore these natural dynamic relationships” in the leg, said Dr. Matthew Carty, the plastic surgeon who led the effort.
Ewing, who severely injured his leg in a 2014 climbing accident, has not yet received the robotic prosthetic, which will happen in the next few months after wireless sensors are implanted that allow for proper functioning. The 52-year-old engineer said he takes pride in being the first to undergo the procedure, which his doctors have named the “Ewing amputation.”
“This will give me and other amputees a far better quality of life than could previously be dreamed of,” he said.
When the diagnosis is grim, communication is crucial
In medicine, hope is a vital currency.
It gets families, patients and doctors through the darkest moments.
But in a First Opinion for STAT, Nora Wong writes of how hope of a long-shot recovery interfered with clear communication about her son’s illness and his improbability of overcoming it.
Her story — with an addendum by doctors familiar with her son’s condition — offers important insight for anyone facing or treating a potentially fatal illness.
Just in: After a car wreck, opioids no better at reducing pain than ibuprofen
Car accident victims often suffer from severe musculoskeletal pain.
But a new study by researchers at Brown University shows that opioids were no more effective in reducing pain than common medications such as ibuprofen. In fact, patients on opioids were 7.2 percent more likely to report moderate to severe pain six weeks after a crash.
While that finding is not statistically significant, this one is: the opioid patients were 17.5 percent more likely to report still using those drugs after six weeks, suggesting an increased risk of abuse.
The study examined pain outcomes of 948 people injured in car crashes and controlled for a variety of factors, such as age, level of pain, and type of injury.
The results also showed wide variability in response to treatment, with some patients getting better results from opioids and some faring better with ibuprofen and other anti-inflammatories. “These data further underscore the importance of individualized medicine — determining which treatment is right for which individual and under what conditions,” it concluded.
C-Suite Chats: Honing the algorithms of health care
As chief of GE’s digital health strategy, Charles Koontz is in charge of mining a vast trove of data to improve care and make hospitals run better. He spoke to me recently about GE’s efforts in radiology.
GE is developing a focus on improving the precision of radiology exams. What’s the play there?
About 35 percent of radiology exams are misdiagnosed, which can cause the wrong treatment and lead to higher costs. We know our algorithms can improve that number well into the 90s. We’re going to be developing cardiology suites, brain suites, and lung analytics and algorithms to really improve the throughput and accuracy.
How do you technically accomplish that higher accuracy?
The important thing when developing an algorithm is that you have curated data sets. For instance, you can look at 2,000 exams that are cancer of the lung. You can run those images through your algorithm and it gets smarter and smarter and smarter.
How does this help hospitals save money?
One of our big clients is the national health service in the UK. We have...tools that allow a scan to be made in Wales and read in Birmingham. The problem they’re solving is that it costs 60 pounds to read an exam, but they’re only reimbursed 20. They have such an acute shortage of radiologists that they have to outsource a lot of it.
Is machine learning going to replace radiologists?
I think radiologists will be around for awhile. The tool sets we’re working on are going to improve the read time. If you talk to a radiologist nowadays, they are under a lot of pressure to make certain numbers as far as the exams they go through.
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