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Cleveland Clinic Names Top 10 Medical Innovations for 2013

Bariatric surgery for control of diabetes leads annual list (Oct. 31)

The Cleveland Clinic has announced its list of Top 10 Medical Innovations that will have a major effect on improving patient care within the next year. The list is made up of devices, including a handheld optical scan for melanoma; drugs; diagnostic tests, such as three-dimensional (3D) mammography; and a government program that financially rewards patients for improving their health.

The list of breakthrough devices and therapies was selected by a panel of Cleveland Clinic physicians and scientists and was announced on October 31 during the clinic’s 2012 Medical Innovation Summit.

The clinic’s top 10 medical innovations for 2013 are:

1. Bariatric Surgery for Control of Diabetes

Surgery for obesity (bariatric surgery) shrinks the stomach into a small pouch and rearranges the digestive tract so that food enters the small intestine at a later point than usual.

Many diabetes experts believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes, and not as a last resort.

2. Neuromodulation Device for Cluster and Migraine Headaches

The sphenopalatine ganglion (SPG) nerve bundle — located behind the bridge of the nose — has been a specific target for the treatment of severe headache pain for many years.

Researchers have invented an on-demand, patient-controlled stimulator for the SPG nerve bundle. This miniaturized implantable neurostimulator — the size of an almond — is placed through a minimally invasive surgical incision in the upper gum above the second molar. The lead tip of the implant is placed at the SPG nerve bundle on the side of the face, where headache pain is typically experienced by the patient. Whenever a patient feels a headache coming on, a remote-control device (placed on the cheek) delivers as-needed stimulation to the SPG, blocking the headache pain in about 5 to 10 minutes.

3. Mass Spectrometry for Bacterial Identification

The identification of bacteria growing in culture can require days or weeks. Clinical microbiology laboratories throughout the world are now implementing new mass-spectrometry technology to provide rapid organism identification that is more accurate and less expensive than current biochemical methods.

Using one of the two MALDI-TOF mass-spectrometry systems currently available in the U.S. provides more accurate identification of bacteria in minutes rather than days.

4. Drugs for Advanced Prostate Cancer

In the past 2 years, five new drugs have been approved for advanced prostate cancer: sipuleucel-T (Provenge, Dendreon), denosumab (Prolia, Amgen), abiraterone (Zytiga, Centocor), cabazitaxel (Jevtana, Sanofi-Aventis), and enzalutamide (Xtandi, Estellas). A sixth, radium-223 dichloride, is expected to be approved later this year.

Many cancer researchers believe that these drugs, and others coming from the prostate cancer therapeutic pipeline, will one day help make advanced prostate cancer a chronic disease that can be successfully managed with a routine of daily medication, lifestyle modification, and regular checkups.

5. Hand-held Optical Scan for Melanoma

A new FDA-approved handheld office device assists dermatologists in identifying skin lesions that have the characteristics of melanoma. Without cutting the skin, the device — which uses imaging technology created by the military for guided missile navigation — is placed on the skin over the mole. Special lights of 10 specific wavelengths are shined on the skin, and the computerized system rapidly visualizes the micro-vessel structure of the lesion just below the skin’s surface.

The device compares the image findings it has developed with a database of 10,000 archived images of melanoma and other skin diseases. In less than a minute, an assessment of the skin lesion is given, and the dermatologist can then decide on possible next steps.

6. Femtosecond Laser Cataract Surgery

Unlike a surgical blade that cuts, a femtosecond laser separates tissue by ablating and cleaving it. The new FDA-approved bladeless cataract procedure is revolutionizing eye surgery by allowing surgeons to make smaller, more precise incisions. The bladeless procedure also requires less energy time inside the eye, causes less inflammation, and offers more stability when implanting a new lens.

7. Ex Vivo Lung Perfusion

Experts believe that as many as 40% of previously rejected donor lungs may now be suitable for transplantation thanks to a new approach called ex vivo lung perfusion. This novel “lung washing” procedure can reverse lung injury in many donor organs deemed unsuitable for transplantation, thereby allowing the use of these organs.

In this pioneering procedure, the damaged lungs are removed from a donor, placed in a bubble-like transparent chamber, and connected to a cardiopulmonary pump and a ventilator.

Over a 4- to 6-hour period, special proprietary fluids are forced through the blood vessels, and nutrients are used to renourish the lungs as they inflate and deflate. When necessary, targeted medications are introduced to clear infections. Once the lungs are determined to be viable, they are ready for immediate transplantation.

8. Modular Devices for Treating Complex Aneurysms

As many as 20% to 40% of patients with aortic aneurysms have anatomies that are not suitable for the grafts that are currently marketed, nor are they candidates for the more demanding open surgical repair procedure. Thanks to a new fenestrated stent graft system, however, surgeons can now treat patients with these complex aneurysms without having to take detailed measurements and then wait for weeks, sometimes months, for the customized endografts to be delivered.

The FDA recently approved a multicenter trial of the modular stent device for aneurysms that come close to the renal artery. The device incorporates individual branches to both renal arteries and the superior mesenteric artery.

9. Digital Breast Tomosynthesis (DBT)

Tomosynthesis — 3D mammography — is a diagnostic technology that was approved by the FDA in 2011. Breast tomosynthesis does not currently replace traditional two-dimensional mammography testing. Instead, it is performed along with the conventional mammogram to provide a more accurate view of the breast.

During the tomosynthesis portion of the exam, the x-ray arm of the machine makes a quick arc over the breast, taking dozens of images at a number of angles. Later combined to make a 3D rendering of the entire breast, the images can be viewed by a radiologist at a computer workstation to check areas of concern.

10. Health Insurance / Medicare Program / Rewards for Better Health

The bipartisan Medicare Better Health Rewards Program Act of 2012 has been presented to Congress as a way to improve healthcare and to control costs for Medicare participants. The goal of the program is to encourage people to take a more active role in their well-being by developing and maintaining healthy habits.

The Better Health Rewards Program is part of a growing wellness revolution in American healthcare that is designed to give everyone achievable health goals and a detailed plan to reach them, as well as financial incentives to keep motivated and follow through with the various health strategies.

The 3-year program uses the annual wellness visits Medicare already subsidizes to determine and measure improvements in six key areas of health: body mass index, diabetes indicators, blood pressure, cholesterol, vaccination status, and the use of tobacco products.

Source: Cleveland Clinic, October 31, 2012.

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