Saturday, March 29, 2014

New Statesman | Life and death at his fingertips: watching a brain surgeon at work

It is just after lunchtime on a wet Monday in February when Henry Marsh is finally able to return to the operating theatre in the Atkinson Morley Wing of St George's Hospital in Tooting, south London, and begin the work that will save a young woman's life.

Jenny is not long out of her teens; the previous week, she had collapsed – from a haemorrhage, the result of an abnormality in the veins and arteries of her brain. She had been close to death: late at night, Henry had operated to remove a blood clot and save her life. But a later scan showed that the abnormality remained. If the problem was not corrected, she could suffer another bleed at any time. So this will be the second time he has been inside her skull.

While Jenny is prepared, Henry paces the hospital's long corridors. There is time for us to sit and have a sandwich. He is restless: he wants to get on. He didn't get this right the first time. He needs to get it right now.

I first encountered Henry Marsh late one night on my sofa. I was too tired to go to bed, and so kept the television on as one programme ended and another started. This was The English Surgeon, a 2007 documentary by Geoffrey Smith about the work that Henry has been doing for over 20 years now at the Lipska Street Hospital in Kyiv, Ukraine. Following a meeting with Igor Kurilets, a Ukrainian neurosurgeon struggling against the post-Soviet culture of poor resources and entrenched, old-fashioned thinking about medical care, Henry began volunteering his time in Kyiv. He brought not only his skills but equipment that had been discarded – generally for no good reason – by the NHS, packed up in wooden crates he made himself.

It is a remarkable, moving film and I was struck by the humane, caustic eloquence of its subject, which seemed unusual for a man in his profession. At the time I was running the books pages of the Times; I thought that he would make a fine reviewer. I emailed him, care of the hospital, not really expecting an answer, but he replied by return. Sure enough, he proved an excellent addition to my stable – and this month he's published a fascinating memoir, Do No Harm: Stories of Life, Death and Brain Surgery, which is why I'm here with him now, waiting to stand beside him as he operates on Jenny.

Henry is 64: he will retire next year. He is tall and white-haired; outside the operating theatre he is given to wearing battered leather boots and a long duster coat. You read in books of people with "surgeon's hands", long, tapered and delicate. Henry's hands are not like that, but rather like the hands of a skilled woodworker, a keen gardener and an energetic beekeeper, all of which he is. He wears round, owlish spectacles that give him the air of the don he might have been; his first degree, from Oxford, was in philosophy, politics and economics. Medicine came later – he didn't become a junior doctor until the relatively late age of 29, after spells as a teacher in West Africa and a hospital porter in Ashington, Northumberland.

When he finally went to medical school, at the Royal Free Hospital in London, he wasn't sure about his choice. "I thought medicine was very boring," he says bluntly. Henry is not a man to refrain from speaking his mind. "I didn't like doctors. I didn't like surgeons. It all seemed a bit dumb to me." In Do No Harm he writes of his revulsion at what much surgery generally entails: "long bloody incisions and the handling of large and slippery body parts". But while working as a senior house officer, he observed a neurosurgeon use an operating microscope to clip off an aneurysm – a small, balloon-like blowout on the cerebral arteries that can cause catastrophic haemorrhages. It is intensely delicate work, using microscopic instruments to manipulate blood vessels just a few millimetres in diameter. It is also, as Henry says, like bomb disposal work, in that it can go very badly wrong – with the crucial difference that it is only the patient's life at risk, not the surgeon's. If this or any other kind of serious neurosurgery goes right, however, the doctor is a hero. "Neurosurgery," he smiles, "appealed to my sense of glory and self-importance."

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Thursday, March 27, 2014

Medical-Device Maker Stryker Acquires Patient Safety Technologies - Businessweek

When doctors sewing up a patient after an operation inadvertently leave surgical equipment like sponges inside the body, the result can harm or even kill the patient. Such mistakes also cost hundreds of thousands of dollars in further treatment and legal costs. Along with taking out the wrong kidney or operating on the wrong person, leaving a sponge in a patient is the kind of avoidable medical nightmare that health-care quality experts consider a never event—that is, it should never happen.

It's hard to know precisely how often it does. A review at the Mayo Clinic in Rochester, Minn., from 2003 to 2006 found a rate of about one "retained foreign object" case for every 5,500 surgeries. Another analysis of 20 years of malpractice settlements found that such incidents were the most common "never events," with an estimated 2,024 claims per year, or a rate of more than five each day. The U.S. has no comprehensive system for measuring how often doctors mistakenly leave items in patients' bodies. The lack of data itself is revealing, when you consider, for example, how scrupulously aviation accidents are tracked.

The most common approach for making sure all sponges come out of patients is to count them as they go in. But the current counting methods "are prone to human error," according to an October report (PDF) by the Joint Commission, a nonprofit that certifies health-care providers on quality standards. Counts are wrong about 10 percent to 15 percent of the time, and most cases where sponges are left in the patient "occur with what staff believe is a correct count," according to the report.

Executives from Stryker and Patient Safety Technologies were not available for an interview on Tuesday. Patient Safety Technologies had revenue of about $20 million in the 12 months through September 2013. A list of roughly three dozenclients on its website includes the Mayo Clinic, the Cleveland Clinic, Brigham and Women's Hospital, and the U.S. Department of Veterans Affairs.

A few other companies make high-tech sponges intended to reduce the risk that absent-minded doctors will leave one behind, including RF Surgical Systems and ClearCount. Stryker's acquisition puts a global sales force behind the technology.

Monday, March 24, 2014

This is Healthbook, Apple’s major first step into health -

Seven years out from the original iPhone's introduction, and four years past the iPad's launch, Apple has found its next market ripe for reinvention: the mobile healthcare and fitness-tracking industry. Apple's interest in healthcare and fitness tracking will be displayed in an iOS application codenamed Healthbook. I first wrote about Apple's plans for Healthbook in January, and multiple sources working directly on the initiative's development have since provided new details and images of Healthbook that provide a clearer view of Apple's plans for dramatically transforming the mobile healthcare and fitness-tracking space…

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