If ever a field needed remodelling, it is medicine N EW ERA IN MUTI - - PowerPoint PPT Presentation
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,
RESEARCH:
Chumpon Wilasrusmee Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok
Univ University
Wisdom of the Land
Improve patient care Improve patient-physician relationship Eliminate potential errors Is it true: Chaotic, inefficient, and often ineffective, health care
is dying for innovation
Standard
Diffusion and resistance
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.
Rank Country Overall Innovation Inputs Innovation Performance 2 United States 1.80 1.28 2.16 3 Japan 1.79 1.16 2.25 4 Sweden 1.64 1.25 1.88 5 Netherlands 1.55 1.40 1.55 6 Canada 1.42 1.39 1.32 7 United Kingdom 1.42 1.33 1.37 8 Germany 1.12 1.05 1.09 9 France 1.12 1.17 0.96 10 Australia 1.02 0.89 1.05 11 Spain 0.93 0.83 0.95 12 Belgium 0.86 0.85 0.79 13 China 0.73 0.07 1.32 14 Italy 0.21 0.16 0.24 15 India 0.06 0.14 −0.02 16 Russia −0.09 −0.02 −0.16 17 Mexico −0.16 0.11 −0.42 18 Turkey −0.21 0.15 −0.55 19 Indonesia −0.57 −0.63 −0.46
Core mission Core value Future of organization
appendectomy for suspected appendicitis in pregnancy. However, I have several comments.
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
possible abscess formation, uterus irritation and further fetal loss.
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.
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.
Andrease Vesalius: human anatomy-hand on
James Lind: Scurvy – lemon, vitamin C Edward Jerner: smallpox Group of people who continue developing
External: outside influence of control Internal: within the control Associated with the cultural infrastructure Associated with the innovation process itself:
to information
CURVES OF RMI, SW, VP, AND TC FOR THE DETECTION OF DIABETIC NEUROPATHY
Univ University
Wisdom of the Land
Encourage the continuous development Increase in value Providing a much greater health benefit or wider
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
NOTE: Weights are from random effects analysis Overall (I-squared = 30.7%, p = 0.194) Enzler (1996) Wang (1996) Bacchini (2001) Eikhoff (1987) McCollum (1991) Study ID Eikhoff (1983) Koch (1996) 1.31 (1.12, 1.54) 1.23 (0.95, 1.59) 1.38 (0.76, 2.51) 1.56 (0.66, 3.72) 1.89 (1.04, 3.43) 1.20 (0.91, 1.56) RR (95% CI) 1.87 (1.30, 2.67) 1.09 (0.87, 1.35) 100.00 22.03 6.39 3.27 6.47 21.01 % Weight 14.60 26.24 1.31 (1.12, 1.54) 1.23 (0.95, 1.59) 1.38 (0.76, 2.51) 1.56 (0.66, 3.72) 1.89 (1.04, 3.43) 1.20 (0.91, 1.56) RR (95% CI) 1.87 (1.30, 2.67) 1.09 (0.87, 1.35) 100.00 22.03 6.39 3.27 6.47 21.01 % Weight 14.60 26.24 1 .2 .4 .5 .7 1 1.3 2
This was a first systematic review and meta-
Our first meta-analysis indicated that the
An updated meta-analysis or a large scale
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
Dominated by cosmetic component: not cover by
Poor concerning, education, and prevention of
Thesis: Faculty of Health Sciences
VARICOSE VEINS: MYTH: WORKING ASSOCIATED DISEASE?
Figure 1 : Severity classification of chronic venous disease
“ The beautiful is a phenomenon which is never apparent of itself, but is reflected in a thousand different works of the creator. ” — Johann Wolfgang von Goethe
Perioperative steroids have a favourable impact on
postoperative outcomes after liver resection
Intravenous glucocorticoids were 24 per cent less likely to
suffer postoperative morbidity compared with controls (risk ratio 0.76, 95 %CI 0.57 to 0.99; P = 0.047)
The treated group experienced a significantly greater rise in
early postoperative interleukin (IL) 10 levels compared with controls
In addition, steroids significantly reduced postoperative blood
levels of bilirubin, and of inflammatory markers such as IL-6 and C-reactive protein
There was no evidence supporting a risk difference in infectious
complications and wound healing between study groups.
BR J SURG. 2013 APR;100(5):600-9EPUB 2013 JAN 21. SYSTEMATIC REVIEW AND META-ANALYSIS OF THE EFFECT OF PERIOPERATIVE STEROIDS ON
ISCHAEMIA-REPERFUSION INJURY AND SURGICAL STRESS RESPONSE IN PATIENTS UNDERGOING LIVER RESECTION
New medications, new diagnostic techniques, and
Change is necessary because our society needs
New knowledge plus existing knowledge adapted