Mahidol Mah Univ University Wisdom of the Land “If ever a field needed remodelling, it is medicine” N EW ERA IN MUTI - DISCIPLINARY RESEARCH : B IOMEDICAL ENGINEERING I NNOVATIVE STRATEGIES Chumpon Wilasrusmee Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
AIM - S CIENTIFIC PAPER - I NNOVATION � Improve patient care � Improve patient-physician relationship � Eliminate potential errors � Is it true: � Chaotic, inefficient, and often ineffective, health care is dying for innovation � มีก็ไมใช � Standard � Diffusion and resistance
W HAT IS ?? � Application of new solutions that meet new requirements, needs � More effective products, processes, services, technologies, or ideas � Original and new that "breaks in to" the market or into society � Important in some way � Process that brings together various novel ideas in a way that they have an impact on society � Differs from invention: use of a better � Invention: creation of idea or method itself � Differs from improvement � doing something different rather than doing the same thing better.
Innovation Inputs Innovation Rank Country Overall Performance United States 2 1.80 1.28 2.16 Japan 3 1.79 1.16 2.25 Sweden 4 1.64 1.25 1.88 Netherlands 5 1.55 1.40 1.55 Canada 6 1.42 1.39 1.32 ปจจุบันประเทศไทยมีงานวิจัยและสิ่งประดิษฐที่มี United Kingdom 1.42 7 1.33 1.37 ศักยภาพจํานวนมากที่ยังไมไดถูกเปดเผยและไมได Germany 8 1.12 1.05 1.09 ถูกนํามาใชงานอยางแพรหลาย เนื่องจากที่ผาน France 9 1.12 1.17 0.96 Australia มายังขาดการพัฒนาตอยอดหรือขยายผลไปสู 10 1.02 0.89 1.05 Spain 11 0.93 0.83 0.95 ผลงานในเชิงนวัตกรรม ดังจะเห็นไดจากผลการจัด Belgium 12 0.86 0.85 0.79 อันดับความสามารถดานนวัตกรรมในป พ . ศ . China 13 0.73 0.07 1.32 2554-2555 ของ World Economic Italy 14 0.21 0.16 0.24 − 0.02 India Forum พบวา ประเทศไทยอยูในอันดับที่ 51 15 0.06 0.14 − 0.09 − 0.02 − 0.16 Russia 16 − 0.16 รองจากประเทศเพื่อนบานในภูมิภาคอาเซียนถึง 3 − 0.42 Mexico 17 0.11 − 0.21 − 0.55 Turkey 18 0.15 ประเทศ ไดแก มาเลเซีย สิงคโปร อินโดนีเซีย − 0.57 − 0.63 − 0.46 Indonesia 19
B IOMEDICAL ENGINEERING : I NNOVATIVE STRATEGY � Core mission � Core value � Future of organization Laparoscopic versus conventional appendectomy in suspected appendicitis during pregnancy: A systematic review and meta-analysis -British Journal of Surgery 2012
A FTER PUBLICATION Sir, � Congratulations on an excellent analysis, which seems to be the largest systemic review of � appendectomy for suspected appendicitis in pregnancy. However, I have several comments . Thank you for your comment in our publication” Systematic review and meta-analysis of safety of laparoscopic versus � open appendicectomy for suspected appendicitis in pregnancy” We hope that these answers will give additional information regarding our analysis. � First, laparoscopy has the benefit of identifying other intra-abdominal pathology which may mimic appendicitis and harbor pregnancy risks. Besides, pelvic toileting could be performed more safely under the vision of laparoscopy. Irrigation and suction of pelvic fluid could lower the risk of possible abscess formation, uterus irritation and further fetal loss. We truly agree with the technical advantage of laparoscopic appendectomy (LA). Recent publication by Khiria, et al � also showed the safety of LA in complicated appendicitis (Ref1). However, evidence from Cochrane data base showed that the incidence of intraabdominal abscesses was increased (OR 1.87; CI 1.19 to 2.93) and the duration of surgery was 10 minutes (CI 6 to 15) longer for LA (ref2) � Second, laparoscopic approach could lessen and avoid unexpected wound extension, compared with McBurney's incision due to migration of appendix in the pregnant. Thus, post-operative wound pain and associated pulmonary complication could be decreased when using laparoscopic approach.
R EVIEWER COMMENTS the moment; references are of 1990 and 1995; 2- performance of the CT scan are very high and low resolution CT scan and/or IRM have the same sensibility and specificity to diagnose appendicitis; 3- recent works on epidemiology of appendicitis demonstrated that there are two forms of appendicitis, with no relation together: uncomplicated and complicated, so negative laparotomy or laparoscopy must not be any more performed; patients can be se one day later if any doubt subsist. all the paper must be rewritten
I NNOVATION - FIGHTING DISEASE � Andrease Vesalius: human anatomy-hand on dissection � James Lind: Scurvy – lemon, vitamin C � Edward Jerner: smallpox � Group of people who continue developing innovation to optimum or best practice
F AILURE � External: outside influence of control � Internal: within the control � Associated with the cultural infrastructure � Associated with the innovation process itself: - Poor goal definition - Poor alignment of actions to goals - Poor participation in teams - Poor monitoring of results - Poor communication and access to information
Robotic monofilament inspector • Difference screening tests result in different detection prevalence of diabetic neuropathy even in the same group of patients • The RMI could be used as a reliable tool in the screening of diabetic neuropathy.
C OMPARISON OF RECEIVER OPERATING CHARACTERISTIC CURVES OF RMI, SW, VP, AND TC FOR THE DETECTION OF DIABETIC NEUROPATHY
Mah Mahidol Univ University RMI Model I, II, III Wisdom of the Land
PROMOTING INNOVATION � Encourage the continuous development � Increase in value � Providing a much greater health benefit or wider societal benefits � Patency: � Set of exclusive rights granted by a state (national government) to an inventor or their assignee for a limited period of time in exchange for the public disclosure of an invention � Gateway
M ETA - ANALYSIS Study % % ID RR (95% CI) RR (95% CI) Weight Weight Eikhoff (1983) 1.87 (1.30, 2.67) 1.87 (1.30, 2.67) 14.60 14.60 Eikhoff (1987) 1.89 (1.04, 3.43) 1.89 (1.04, 3.43) 6.47 6.47 McCollum (1991) 1.20 (0.91, 1.56) 1.20 (0.91, 1.56) 21.01 21.01 Enzler (1996) 1.23 (0.95, 1.59) 1.23 (0.95, 1.59) 22.03 22.03 Koch (1996) 1.09 (0.87, 1.35) 1.09 (0.87, 1.35) 26.24 26.24 Wang (1996) 1.38 (0.76, 2.51) 1.38 (0.76, 2.51) 6.39 6.39 Bacchini (2001) 1.56 (0.66, 3.72) 1.56 (0.66, 3.72) 3.27 3.27 Overall (I-squared = 30.7%, p = 0.194) 1.31 (1.12, 1.54) 1.31 (1.12, 1.54) 100.00 100.00 NOTE: Weights are from random effects analysis .2 .4 .5 .7 1 1 1.3 2
B IOGRAFT � This was a first systematic review and meta- analysis of studies comparing BP and PTFE in peripheral vascular reconstruction � Our first meta-analysis indicated that the biosynthetic prosthesis might be benefit over PTFE by increasing graft patency � An updated meta-analysis or a large scale randomized control trial is required to confirm this benefit
R ECENT INTERESTING FIELD � Intelligent interpretation of x-ray images � Computer axial tomography scans, ultrasound images and other sensor data � Medical data mining; medical informatics; smart patient record systems � Medical sensors and sensor systems; wired and wireless sensor networks; smart monitoring and reporting � Expert and case-based reasoning systems for medical diagnosis and decision support in medicine and healthcare � Robotics surgical and micro-surgical systems; robotic surgical assistants � Robotic artificial joints and joint assistance systems � Integrated medical systems to assist in delivering quality health care during spaceflight and exploration � The use of smart systems to to alleviate problems in the aging population � Smart medical devices � Neural networks, fuzzy paradigms, genetic algorithms, expert systems in medical and healthcare applications
D IFFERENCE : V ARICOSE VEINS : M YTH : W ORKING ASSOCIATED DISEASE ? � Dominated by cosmetic component: not cover by insurance � Poor concerning, education, and prevention of ergonomic � Thesis: � Faculty of Health Sciences
N URSE VS F ACTORY EMPLOYEE Figure 1 : Severity classification of chronic venous disease
O BJECT T RACKING FOR L APAROSCOPIC S URGERY U SING THE A DAPTIVE M EAN -S HIFT K ALMAN A LGORITHM
M ULTI - DISCIPLINARY
C ASE REPORT Vixol - gastric outlet obstruction
VIRTUAL REALITY SURGICAL TRAINING SYSTEM
R EGISTRATION BEFORE PUBLICATION : RCT E THICAL CONSIDERATION
B IOMEDICAL - MULTIDISCIPLINARY - INNOVATION I-nversion N-ew N-eed O-bsess V-isibility A-mbition T-alent I-ntegration O-bvious N-iche, network
I-Inversion E NDOTHELIAL INJURY
I N VITRO TO IN VIVO
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