Reducing risks of gallbladder and other operations with Canadian technology assembled in Richmond, BCMay 14, 2015. 12:15 pm • Section: Medicine Matters Reducing risks of gallbladder and other operations with Canadian technology assembled in Richmond, BC Posted on May 14, 2015 Posted on May 12, 2015 BY PAMELA FAYERMAN The University of BC Hospital is the first in Canada to use a new surgical imaging system from a local manufacturing facility in Richmond to help reduce risks of surgical complications during small-incision (laparoscopic) gallbladder surgery. Dr. Neely Panton, head of general surgery at both UBC and Vancouver General hospitals, said in an interview that a "test-drive" of the $150,000 technology developed by a Canadian company called Novadaq showed it is a significant advance. On a mobile cart that can move from one operating room to another, it combines camera-tipped surgical tools (inserted through small incisions) and a real-time image capturing system that allows surgeons to see critical organs, tissues and vessels that they don't want to accidentally nick during operations. Patients prefer small incision surgery because of reduced pain, faster recovery and smaller scars. But Panton said smaller incisions can make it more challenging for surgeons to see where they are working inside the abdominal cavity or anywhere else for that matter. So tools that enable better visualization of critical anatomical structures and blood flow are highly desirable. Said Panton: "The technology allows us to see the biliary tree and blood vessels, potentially preventing bile duct injuries which continues to be a rare, but serious problem, despite the fact that the surgery has been performed for over three decades." Minimally invasive gall bladder removal surgery is called laparoscopic cholecystectomy. "It's a nickel and dime operation with million dollar complications," Panton said, referring to the fact that it's such a common procedure (about 100,000 done/year in Canada) but pays surgeons a relatively low fee ($519). Meanwhile, if a mistake is made, grave consequences for the patient can ensue, including infections, internal bleeding and reconstruction surgery, not to mention longer stays in hospital. Some of the more serious complications include nicking the liver, small intestine or abdominal blood vessels. Bile duct injuries are said to occur less than one per cent of the time, but according to a provincial government resource (Healthlink), in five to 10 per cent of all gallbladder operations, surgeons have to make a bigger incision to either repair damage caused by surgical instruments or to get a better view of the operative area. The PINPOINT Endoscopic Fluorescence Imaging System – a Canadian innovation now being acquired by hospitals across North America, including the University of BC Hospital. Panton said inflammation and unexpected anatomical anomalies are sometimes factors in what makes usually straightforward procedures riskier. The Novadaq Pinpoint Endoscopic Fluorescence Imaging System is a high definition system with various lighting choices, depending on what part of the body surgeons want to highlight. The organs or tissues fluoresce (light up) after the patient is injected with a special dye called indocyanine green. The dye is used because it accumulates in the tissues surgeons want to see, is non-toxic, and is excreted entirely by the liver. Panton said five general surgeons used the equipment after it was loaned from the company for a one-month trial. During the trial period, 12 patients had scheduled gallbladder operations at UBC. Results of the pilot showed that most surgeons felt the technology gave them more confidence that they had a better view of the surgical field and that the technology allowed them to see anatomical structures clearly. If there was one complaint, it was that the administration of the intravenous dye used up a bit more time and doctors tried to figure out if it should be injected by anesthesiologists or the surgeons. Panton said only one of the five surgeons was uncertain about whether he would use the technology. He expects the indications for its use will expand. Plastic surgeons already use the technology when doing breast reconstruction. The equipment will be purchased by the VGH/UBC Hospital Foundation. Ongoing research will continue to explore whether it helps reduce surgical complications. Gagan Gill, the national sales manager for Novadaq, said while UBC Hospital is the first to use the technology for gallbladder surgery, there are four hospitals in Quebec and Ontario where it's being used for other types of operations. Over 100 hospitals in the United States have purchased it. There are about 60 employees, he said, at the Richmond facility, employed in research, development and engineering positions. The company was founded in Winnipeg but is now headquartered in Mississauga, Ontario. Sun Health Issues Reporter
Monday, May 25, 2015
環瑞醫 內視鏡螢光影像系統(Novadaq PINPOINT)& 手術影像整合(SPY) : 澳/菲/日 將陸續出貨
環瑞醫延後出貨 首季每股虧1.26元 2015年05月25日 環瑞醫因新機型銷售延後出貨等因素，首季財報虧損。莊宗達攝 【黃馨儀╱台北報導】醫學影像診斷廠環瑞醫(4198)第1季因加速新產品推廣與銷售，導致新機型銷售延後出貨，加上中國春節連節影響機台銷售，及埃及300萬美元數位X光機標案遞延至第2季入帳，影響整體營收與毛利表現；首季合併營收為1.13億元，稅後虧損1.91億元，每股虧損1.26元。
虧損金額大於營收 環瑞醫已於台灣設立研發中心，今年並將部分X光機生產線移回台灣，希望開發具全球競爭力及適合亞洲人的新型數位X光機產品及供應鏈。今年首季已全面啟動新機型銷售計劃，包括移動式Cruze、Corelab立柱型等新機型出貨及完成Versa天井式Ｘ光機之安裝與測試等。環瑞醫表示，未來將持續開發下一代X光機產品，如低劑量嬰幼兒移動式數位X光原型機，已在今年1月28日正式驗證，預計於11月北美放射醫學年會上進行新產品發表，預期2016年正式上市。此外，Norland骨質密度測量儀器部份，未來將以中國為主要銷售市場，並重啟歐洲市場銷售，加上原有北美銷售市場，預期第2季營收有高度成長。 而Novadaq內視鏡螢光影像系統PINPOINT及外科手術SPY影像整合系統，目前已取得澳洲、菲律賓當地輸入許可，並在去年度銷售出貨，日本則預計在2016年銷售出貨。 環瑞醫表示，為提升營運成長空間並改善獲利能力，已全面展開營收倍增計劃。此外，環瑞醫重新評估人力計劃，預計自第2季起即可達有效管控成本費用與毛利率提升綜效，仍樂觀看待2016年營收獲利成長。
PINPOINT Increases Confidence in Minimally Invasive Procedures One of the most significant developments in surgery over the past few decades has been a shift towards minimally invasive (MI) procedures. This change in methodology has been driven by the associated reduction in trauma to the patient from smaller incisions, which results in shorter hospital stays and reduced recovery times. One major obstacle of minimally invasive surgery (MIS) is the lack of visibility to the area being operated on. While imaging scopes are continually improving, none have been able to offer angiographic image functionality along with high definition white light until now. The PINPOINT Endoscopic Fluorescence Imaging System may be used similarly to other endoscopes commonly used in laproscopic surgeries performed today. In addition to providing the typical images obtained through a conventional endoscope, PINPOINT enables surgeons performing minimally invasive procedures to visualize blood flow in vessels and tissue perfusion in real-time while in the operating room. PINPOINT also offers surgeons the unique ability to view images in an "overlay" mode, which displays a combined visible and fluorescence image. The overlay mode allows surgeons to clearly visualize both anatomical structures and physiologic information in a single image - which has been described as the best of both worlds. The overlay mode can act as a surgical map allowing the surgeon to clearly identify nodes and leaks while still remaining keenly aware of anatomical orientation. By providing clinically relevant anatomic and physiologic information simultaneously and in real-time, PINPOINT can equip surgeons performing MIS procedures with the information they need to make critical decisions in the operating room. PINPOINT can increase surgeon confidence in performing MIS surgeries and its use has been associated with lower rates of potentially costly post-operative complications.
日本 給 全歐盟 產地證明! 台灣…等等 !
僅台灣嘸食品產地證明 綠委批食藥署喪權辱國 新頭殼newtalk | 翁嫆琄 台北報導 發布 2015.04.08 | 04:52 PM民進黨立委林淑芬今(8)日批評，日本開食品產地證明給其他國家，不開給台灣，食藥署卻只會幫日本講話。食藥署遲遲未公告日本輸台食物需附產地證明的規定，食藥署食品組組長潘志寬今(8)日坦言，會儘量於下週公告，但需要評估日方行政作業進度及避免台日貿易障礙，要如期上路有困難。對此，民進黨立委林淑芬批評，日本開了產地證明給全歐盟，所以根本不是不能開，食藥署卻還「喪權辱國」的為日本講話。食藥署早在去年10月28日預告，日本輸台食品須全面檢附產地證明，但直到現在仍未公告。食藥署長姜郁美日前指出，因為還要做些準備，所以最快可能是6月才能實施。而立法院已決議，食藥署必須要在下週公告新辦法。不過，雖然立院已要求食藥署儘早公告，潘志寬仍坦言，目前還在與日本溝通，要如期上路可能有困難。因此，即使配合立院要求於下週公告，但不排除公告後有緩衝期，並不會立即實施。對此，林淑芬批評，食藥署說要求日本食品輸入台灣要檢附產地證明，恐造成「貿易障礙」，簡直是胡說八道，因為兩國已經談判1、2年了，不是開不出來，而是日本不願意開。她透露，日本政府開給全歐盟產地證明，衛福部卻是「餵毒部」，喪權辱國替日本人講話，想方設法拖延產地證明，像是要拖到6月直接開放福島5縣市產品來台，然後只管制5縣市需要產地證明，這不只是無能，還出賣人民健康給日本，立法院的決議可以踩在腳底下，全部聽日本官方的意見。林淑芬也指出，立法院長王金平率團去日本，不但不敢要求日本食品輸入來台灣要檢附產地證明，反而讓日本政府要求開放對福島5縣市食品輸台的解禁，不是日本政府無法開產地證明，是日本政府要以開放福島5縣市當交換條件。她還質疑，台灣只是要求跟歐盟一樣的產地證明，都沒看見日本出來說不行，反而只看到台灣官員出來表示反對。
稱外界誤解食藥署 姜郁美自請處分 新頭殼newtalk | 翁嫆琄 台北報導 發布 2015.03.27 | 01:07 PM對於日本核災區食品輸台案，食藥署長姜郁美今(27)日自請處份。日本核災5縣的食品違規輸台，行政院長毛治國昨天要求懲處，衛福部今(27)天公布首波懲處，北區管理中心負責基隆辦事處邊境查驗業務的黃姓科長，今起調離主管職，降職為技正，原因是未在第一時間將基層人員查獲事實上報；發現改標的2名科員則予以敘獎；而食藥署長姜郁美也自請處分。日前發現有進口商疑似更改日本食品產地標籤，將核災區出產的食品輸台，不過，雖然是食藥署主動發現，但有立委踢爆，食藥署基層2月就發現，高層卻到3月多才稽查、公布，因此，食藥署遭外界質疑隱匿，連毛治國都認為這段時間差需檢討，有問題就處分。對此，衛福部上午公布獎懲名單，北區區管中心負責基隆港查驗業務的黃姓科長因未積極、主動通報，即日起調離主管職，降調為技正；另外2名在基隆辦事處工作的曾姓辦事員、柯姓助理研究員，則因發現貼標事實且即刻通報，表現積極，將給予獎勵。另外，衛福部發言人王哲超指出，食藥署署長姜郁美、北區管理中心主任馮潤蘭，日前均已自請處分，衛福部人事處及食藥署都將儘速審核。姜郁美表示，自行處分是因為外界對於食藥署的努力情形有誤解，因此，自請處分是她應該要做的行政程序。針對食藥署查獲此事，卻遭政院要求檢討，姜郁美說，2月在海關發現此事時，因為還無法確定，所以才啟動調查，經過重重研究，才確定下架名單，不是說一發現事情，就能公布這項未查證的事。不過，她也坦承，專案性查緝的啟動時機與告訴民眾的時機，都是內部可以檢討的部份，但她也強調，讓消費者得知正確的資訊是很重要的，食藥署只是希望能讓消費者安心，而食藥署這次也有做到「即時提供非常正確和非常完整的訊息」。截至今天上午10時，經持續查證，目前總計查獲299件產品製造地疑似為已公告暫停受理輸入報驗之日本福島(19件)、茨城(83件)、櫪木(43件)、群馬(112件)、千葉(38+4件)等5縣，現場已封存疑似違規產品共104.4公噸。
胸悶/眩暈 ! 心肌梗塞前兆!
心肌梗塞真要命 自救一念間 2015-05-25 圖‧文／牛亞蕾 開車回家時突覺胸悶、胸痛，這時是要先回家？還是開去醫院？78歲的蔡先生（化名）選擇開到附近的醫院，雖然他停好車，走進醫院，把健保卡放櫃檯，人就昏倒了，但醫護人員及時急救，撿回一命。 出現胸悶、胸痛症狀一定要就醫檢查，找出症狀發生原因，以免錯失早期治療的機會；圖為情境照， 出現胸悶、胸痛症狀一定要就醫檢查，找出症狀發生原因，以免錯失早期治療的機會；圖為情境照，圖中人物非本文當事人。（照片提供／牛亞蕾） 「碰」的一聲，蔡先生應聲倒地，把急診櫃檯的小姐嚇了一大跳，趕緊通知急診醫護人員前來救援；開始急救時，蔡先生的心電圖顯示為心室頻脈，經幾次電擊之後恢復了正常心跳，從心電圖、心肌酶等各項檢查，確診蔡先生為心肌梗塞，其心臟冠狀動脈中的左迴旋枝已完全阻塞，於是心臟內科醫師為他進行緊急心導管及血管擴張術，置放一個支架擴張血管暢通血流。 蔡先生術後住進加護病房，一週後順利出院。蔡先生說，因為胸悶、胸痛時已快到家，當時曾經閃過要先回家，還是直接去醫院的念頭，還好方向盤直往醫院，真是救命一念間。 據蔡先生表示，兩年前也是胸口悶，好像大象踩在胸口般的不舒服，家人陪著去急診，診斷為心肌梗塞，接受緊急心導管及置放支架，但近兩年來並沒有定期就醫及按時吃藥。心臟是身體內的幫浦，位在身體胸腔的左下方，大小如拳頭，而冠狀動脈是供給心臟營養及氧氣的血管，分為右冠狀動脈、左主冠狀動脈，有二分枝，左前降枝冠狀動脈及左迴旋枝冠狀動脈。 心臟所需要的氧氣及營養是由冠狀動脈的血液供給，心肌梗塞即是供應心臟的血管發生阻塞，心肌無法獲得足夠的氧氣及營養，而引起心臟肌肉壞死，進而影響心臟功能，嚴重時會危及生命。心肌梗塞發生的危險因子包括：吸菸、高血壓、高血脂、糖尿病、家族病史及缺乏運動、生活壓力、肥胖等。因此，預防之道為戒菸、低脂肪及低膽固醇飲食、減輕體重、規則運動、壓力管理、糖尿病控制及血壓控制。由於近年來心肌梗塞患者年齡有下降的現象，所以人人都要重視前述的預防之道。另外，提醒心臟血管有置放支架的患者，除了做好日常的預防保健，一定要按時吃藥、定期就醫，以防發生血管再狹窄「塞」出人命。 萬一在外出現胸悶、胸痛、冒汗、噁心、眩暈的不舒服情形，最好請救護車送醫，不要自己開車比較安全。（作者為彰濱秀傳紀念醫院心臟內科主治醫師）
台中衛生局長 徐永年 推動 全人醫療!!!
全人醫療服務 可減醫療糾紛 2015-05-25 02:35:12 聯合報 記者陳宏睿／高雄報導過去醫療資訊常是透過醫師「單向、權威式」告知病患及其家屬，衛福部台中醫院10年前首推「全人醫療服務」，讓家屬也能成為醫療決策團隊的成員，可減少醫療糾紛。10年前擔任衛福部台中醫院院長的徐永年（現為中市衛生局長）在院內首推「全人醫療服務」，獲得醫界回響，讓健保署在中部地區推動試辦計畫。徐表示，全人醫療服務不再是過去父權式、醫師權威的單向醫學資訊輸出，而是網絡式、整合性的醫療照護模式。徐永年表示，醫師除了在臨床醫療過程中，提供跨專業領域服務外，也將病人、家屬納入醫療團隊成員，使病家能在醫療資訊充足情況下，共同參與醫療決策。衛福部台中醫院院長李孟智說，全人醫療服務推動對於改善醫病關係、減少醫療糾紛有顯著效果，老年化社會來臨，罹患多重疾病的人口快速增加，以「病人為中心、團隊為基礎」的醫療服務才能提供全面的醫療。他舉江母的病為例，牽涉到內、外科、復健科的醫療範疇，三科醫師應約病患、家屬在病房進行整合性的病情說明與醫療處置，讓病家全方位接收醫療資訊供判斷，與過去單一科別的醫師分頭進行說明的方式有別。他說，跨領域的醫師在對家屬說明前，也會先共同開會討論，依病患狀況提出最優的處置方案。
Posts
