On Robot-Assisted Surgery

In recent years, robot-assisted surgeries are becoming increasingly common, and researchers are working to develop new equipment and procedures. Study findings of robotic surgery procedures indicate that they ensure a high quality of care, and according to experts “Robots will not replace doctors but help them to perform to the highest standards.” Robots have now been employed during gynecological, urological, cardiac surgery, and general surgery procedures. Surgeons have also utilized these high-tech devices to perform gastric bypass surgeries, excise cancerous tumors from the head and neck, and deliver anesthesia. When used by surgeons with appropriate training, these devices may help to provide improved health outcomes and even deliver care remotely.

A reported 1,068 surgeries were completed in 2010 using the da Vinci Surgical System. In use at 852 hospitals across the United States, the da Vinci has become the most well-known of the surgical robots currently being utilized. The da Vinci allows for procedures to be conducted laparoscopically (using smaller incisions), resulting in faster healing, lower risk of infection, and quicker recovery. The da Vinci features a high-resolution camera that produces magnified 3D images and micro-instruments allow for the translation of a surgeon’s hand movements to smaller, more precise ones by the device’s four arms. As with any new procedure or medical equipment, surgeons and surgical staff must be trained properly to ensure that they are using the device effectively and some newer models of da Vinci Surgical Systems feature two sets of controls, allowing an opportunity for residents to safely receive hands-on training, or two surgeons to work simultaneously to complete a procedure.

Though robotic-assisted surgeries for certain types of tumors have been found to be as effective as other minimally invasive surgical techniques, experts note the importance of the surgeon having proper training on the device. Despite the increased precision made possible by magnified images and the dexterity of the machine’s tools, the robot is still “an instrument that is constantly being controlled by the surgeon,” according to Dr. Balasubramaniam Sivakumar, a general surgeon of 32 years and medical staff vice president at St. Joseph’s Hospital Health Center.

The da Vinci has been used in conjunction with other surgical robots, including the McSleepy, an anesthetic robot. According to Dr. TM Hemmerling, “Automated anesthesia delivery via McSleepy guarantees the same high quality of care every time it is used.” Success has also been noted in surgeries utilizing the SpineAssist, a small robotic arm coupled with a work station that allows surgeons to map out a patient’s spinal anatomy in advance of the procedure. Innovations in cardiac surgery have also been made thanks to tiny, jointed robots like the CardioArm, which provides greater precision than a flexible endoscope and is easy to control. Despite their potential benefit to patients, surgical robots are often quite costly and it is frequently cost-prohibitive to introduce them into clinics and hospitals. Though these devices could allow surgeons to complete procedures remotely, in medically underserved areas, surgical robots are often not available. With continued advancements in the field of robot-assisted surgery, the cost of the equipment may decrease and their availability may increase worldwide.



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Healthcare Shortages in the U.S.

In remote areas worldwide, the availability of trained medical personnel continues to be problematic, but new research shows that there are also shortages of healthcare providers in the United States. Recent reports indicate that approximately 65 million Americans live in federally-designated primary-care health-professional shortage areas (HPSAs), defined as regions with 2,000 or more residents per primary-care doctor. A recent study in the journal Academic Emergency Medicine found that three-quarters of U.S. emergency department directors indicated that they did not have adequate on-call trauma surgeon coverage. In addition to a lack of emergency department personnel, some regions of the U.S. are experiencing shortages of ophthalmologists, pediatricians, nurses, and dentists, all of which result in a lack of quality healthcare services. Treatment outcomes can be improved by finding alternative means of ensuring that patients have access to specialty healthcare.

Nearly a quarter of the U.S. hospital emergency departments that participated in a recent study reported an increase in the number of patients who left the facility before being seen by a specialist. According to the study’s lead author Dr. Mitesh Rao, 21 percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Further, more than 70 percent of participating emergency departments noted staff shortages in neurosurgery and hand surgery, and for patients with traumatic brain or hand injuries, the resulting delays in care could significantly increase the risk of lifetime disability, and according to Dr. Rao, the study’s lead author, “Transferring patients significant distances to an available specialist is sometimes the only option.”

In regions with a dearth of a particular type of medical professionals, availability of general treatment may also be significantly limited. Reports indicate that 14 of 81 counties in Kansas have no dentists, leaving residents with few options. Without appropriate dental care, patients’ risk of developing infections detrimental to the heart and lungs can increase, as can the risk of other conditions. Pediatricians and family care physicians are also lacking in some areas of the U.S. According to a recent study, nearly one million children live in areas with no local doctor. Nurses are also in short supply in many areas, and according to experts, by 2020 the nation will have 29 percent fewer nurses than are needed to provide care.

To ensure the provision of care to patients in areas that lack clinical staff, some experts suggest the use of telemedicine and remote screening programs. Through these programs, specialists can provide clinical advice to clinicians remotely and improve the level of care provided without requiring transport of the patient. Remote screening and diagnosis have been proven effective for diabetic retinopathy in areas where expert ophthalmologists are not available. Using a special camera, clinical staff and technicians captured a picture of a patient’s eye and send it to a trained professional. Eighty-three percent of individuals with retinopathy were diagnosed correctly using this remote screening technique regardless of the level of medical training of the individual taking the photograph. Teleradiology programs have also been implemented in some areas, a number of which are now utilizing fourth-generation wireless networks to allow radiologists to transfer images more and make preliminary evaluations more quickly.

Comprehensive telemedicine programs can help to ensure the delivery of specialty healthcare in underserved areas of the U.S. and worldwide. The iCons in Medicine program is an global telehealth and humanitarian medicine volunteer alliance that serves to connect volunteer healthcare providers with individuals and clinics requesting assistance on challenging cases. Membership in the iCons in Medicine network includes nearly 400 individuals in 12 countries around the world. These individuals represent 35 academic and medical centers, and include renowned experts in telemedicine, e-health, and global health disparities. Over 130 physicians with expertise in 35 medical specialties are available to respond to teleconsultation requests from individuals representing over 20 organizations in 10 countries. Through the use of telemedicine and remote diagnosis and screening programs, the delivery of specialty care in remote areas and treatment outcomes can be improved.



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On Polio Worldwide

Though cases of polio worldwide have been reduced by 99 percent since 1988, it continues to be a major public health concern in Afghanistan, India, Nigeria, and Pakistan. Recent outbreaks have also been seen in the Congo Republic. Vaccination programs have been put in place in the hopes of eradicating the disease, but according to experts, infection in even one individual can put an entire population at risk. Though previous vaccination efforts helped to reduce the number of cases in many regions, in Nigeria and some other African nations the social stigma and fear associated with vaccinations must be overcome. By utilizing a newly developed, more effective polio vaccine and working to educate individuals about the importance of getting vaccinated, it may be possible to meet the Global Polio Eradication Initiative’s (GPEI) goal of eradication polio worldwide by 2013.

Polio (poliomyelitis) is a contagious viral illness that, in its most severe form, can cause paralysis, difficulty breathing, and death. Often contracted through contact with the feces of an infected person, polio can be spread through contaminated food or water, and the risk of contamination is particularly in areas with poor sanitation. Though individuals of all ages can contract polio, children under five years of age, pregnant women, and individuals with weakened immune systems are even more vulnerable. Ninety-five percent of individuals infected with polio have no symptoms, and between four and eight percent experience minor, flu-like symptoms including fever, fatigue, and stiffness or pain in the back, neck, or limbs. Individuals with polio who show no symptoms or only minor symptoms may still spread the virus to others.

Though infection rates of non-paralytic and paralytic polio were significant in the 1950s in the United States and other areas worldwide, in recent years fewer than one percent of individuals who contract polio develop paralytic polio, the most serious form of the disease, which can lead to loss of reflexes, severe muscle aches and spasms, and paralysis. Paralytic polio can manifest in a variety of ways, and is classified by the areas of the body that are most affected. Spinal polio, the most common form of paralytic polio, attacks the motor neurons in the spinal cord and may cause paralysis of the muscles that control breathing and movement of the arms and legs. Bulbar polio affects the motor neurons of the brainstem, impacting an individual’s ability to see, hear, smell, taste, and swallow, and may also affect intestine, heart, and lung function. A combination of both, bulbospinal polio can lead to paralysis of the limbs, as well as affecting breathing, swallowing, and heart function.

The lack of a cure for polio and limited treatment options available underscore the need for effective vaccination campaigns. Inactivated polio vaccine (IPV), an injection given in the arm or leg, has been used in the United States since 2000. Most children in the U.S. are given four doses of IPV, which has been found to be 90 percent effective after two shots, and 99 percent effective after three. The oral polio vaccine (OPV) is used throughout much of the world, but may soon be replaced by the newly developed bivalent oral polio vaccine (bOPV). The bOPV contains two key strains of the virus and thus may provide improved inoculation results. In addition to efforts to increase vaccination rates, improved sanitation and education related to personal hygiene can help to reduce the spread of polio, as well as cholera and other water-borne illnesses.

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