Showing 10 ideas for tag "surgery"

Goal 2: Reduce Human Disease

Support for Cardiothoracic Surgery and Pediatric Heart Clinical Trial Networks

Continued and expanded support for the Cardiothoracic Surgical Trials Network (CTSN) and Pediatric Heart Network (PHN) is essential as both design, conduct, and analyze multiple, collaborative clinical trials that evaluate surgical interventions, and related management approaches for the treatment of cardiovascular disease.

To date both networks have reported on and developed a portfolio of studies which need continued... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

The work and support provided to date have allowed for the creation of an infrastructure for both the CTSN and PHN. Each network is now providing valuable results to the cardiothoracic surgery specialty which will allow an increase in quality patient care in the years and decades to come. The continued support is essential for the success of these networks as any reduction will limit the resources available for site participation and ultimately results. Due to the existing infrastructure for each network, the financial burden associated with de-funding and then restarting the networks in future years would be at least triple the financial commitment currently in place.

Feasibility and challenges of addressing this CQ or CC

Conducting multi-center clinical trials is a substantial financial commitment but a vital part for the future of the cardiothoracic surgery specialty.

Name of idea submitter and other team members who worked on this idea Matt E.

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108 net votes
151 up votes
43 down votes
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Goal 2: Reduce Human Disease

Funding for Cardiothoracic Surgery Research

The continued development of new technologies requires cardiothoracic surgeons to maintain a strong level of research to ensure the highest quality of patient care and surgical outcomes are received across the world. The level of support for CT surgery within the NIH has continued to drop over the last decade. This is a substantial problem for the specialty as the limited funding available creates difficulty in the continued... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

CT Surgeons are performing procedures on some of the sickest patients while effecting some of the most dramatic favorable outcomes and the continue support for research in this specialty is essential to ensuring improvements in quality patient care. CT surgeons are provided the opportunity to participate in both the research lab and operating room which provides an important opportunity for a role in both the scientific discovery and implementation of new outcomes.

Feasibility and challenges of addressing this CQ or CC

Cardiothoracic diseases are one of the top health issues facing the global population and the research being conducted is integral in helping cure the issues facing the current generation. With expanded support for research, new areas of the heart, lung, and esophagus can be studied with the hopes of identifying new technologies and procedures to help ensure the next generation is given the highest quality of care possible.

Name of idea submitter and other team members who worked on this idea Matt E.

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105 net votes
155 up votes
50 down votes
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Goal 2: Reduce Human Disease

Understanding Cardiothoracic Surgery in Elderly Populations

There is a vital need for evidence-based clinical evaluation tools to assess operative risk and post-operative recovery in the elderly, including biomarkers of physiologic age and a simple/reliable clinical evaluation scheme to determine frailty as a risk factor for poor surgical outcomes.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Development of tools to assess operative risk and post-operative recover in the elderly would improve surgical outcomes in this growing patient population.

Feasibility and challenges of addressing this CQ or CC

This at risk population is growing rapidly.
Older patients represent an important, different, and under-studied subgroup of those undergoing cardiothoracic surgery according to the Joint NHLBI-AATS Working Group (http://aats.org/CME/2011-AATS-NHLBI-Symposium.cgi). Due to the aging of the US population and the increased severity of coronary and valve disease in older individuals, the use of cardiothoracic surgery in older patients in relative terms is growing rapidly. Between 1990 and 2008, the percentage of those aged 80 years or older has gone from 8% to 16% of total for bypass surgery and 14% to 30% of total for valve surgery.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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56 up votes
17 down votes
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Goal 2: Reduce Human Disease

Improving Representation of the Elderly in Clinical Research

There is a need to optimize long-term cognitive and functional outcomes in the aging population during and after cardiothorasic surgery, including the development of simple, objective tools to enable risk stratification for vulnerability to neurocognitive deficit. First, cardiothoracic surgical trials and clinical studies should be more "age-representative" and reflect the increasing proportion of the aging population.... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Many answers would result from including the elderly in ongoing and planned clinical research and trials.

Feasibility and challenges of addressing this CQ or CC

This population is growing rapidly and available to be studied.
Elderly patients as a group face higher acute risks for complications and death following cardiothoracic surgery or coronary interventions, yet may also gain more long-term benefits from surgery due to their more severe disease. The balance between risks and benefits of surgery may be different in the older patient than in their younger counterparts. Major randomized trials that defined the “standard” for the field (e.g., CASS, VA cooperative, RITA, BARI, STICH) often failed to enroll many, if any, patients aged 75 years or older. The Joint NHLBI-AATS Working Group (http://aats.org/CME/2011-AATS-NHLBI-Symposium.cgi) identified several areas of high priority for cardiothoracic surgery research in the elderly.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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24 net votes
37 up votes
13 down votes
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Goal 2: Reduce Human Disease

How should platelet (PLT) transfusions be used to treat active bleeding?

Multiple randomized controlled trials have been performed to evaluate the use of prophylactic PLT transfusions in non-bleeding, thrombocytopenic hematology-oncology patients. However no high-quality data exist to guide PLT transfusions in actively bleeding patients inclduing pediatric and adult medical and surgical patients. After hematology-oncology patients, cardiac surgery patients are the next largest group of PLT... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

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PLT count is almost always the only laboratory result considered in deciding to transfuse PLTs. But PLT counts provide no information about PLT hemostatic function and its contribution to bleeding. A variety of in vitro coagulation tests have been developed: viscoelastography, whole blood PLT aggregometry, etc. But while testing-based transfusion algorithms may reduce blood product utilization, it has not been established that any in vitro test can either predict or help reduce bleeding. There is a gold standard method to assess clinical efficacy of transfused PLTs: incidence of grade 2 or higher bleeding in clinical trials of thrombocytopenic hematology-oncology patients receiving prophylactic PLT transfusions. No analogous gold standard of PLT hemostatic efficacy exists for therapeutic PLT transfusions to treat active bleeding. There is a pressing need to develop such a standard. Establishing reliable methods for evaluating the effects of PLT transfusion in actively bleeding patients will improve our understanding of how different factors (storage conditions, pathogen reduction etc.) affect the functional performance of PLTs.

Feasibility and challenges of addressing this CQ or CC

PLT transfusions are administered routinely to support bleeding pediatric and adult medical and surgical patients. Opportunities to conduct clinical trials in various settings (cardiac surgery, neurosurgery, orthopedic surgery, trauma, etc.) are widely available. PLT transfusion is commonly used to support bleeding patients receiving perioperative supportive therapies such as extracorporeal membrane oxygenation (ECMO). These clinical situations represent critical opportunities to improve the care of bleeding patients. This approach will simultaneously facilitate comprehensive evaluation and validation of both current and novel in vitro tests of hemostasis. If a given in vitro test were reproducibly shown to correlate strongly with bleeding reduction caused by PLT transfusion, then by definition that would be a clinically meaningful test. Finally, this line of inquiry will allow assessment of the adverse effects of PLT transfusion in bleeding patients.

Name of idea submitter and other team members who worked on this idea Terry Gernsheimer, University of Washington, for the 2015 NHLBI for the State of the Science in Transfusion Medicine

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30 net votes
44 up votes
14 down votes
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Goal 2: Reduce Human Disease

Inflammation and outcomes following pediatric cardiac operations

What is the contribution of the inflammatory response to postoperative recovery following pediatric cardiac operations and what strategies can improve outcomes?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Congenital heart disease is the most common cause of birth defects, with about 40,000 new cases born per year in the US. Affected individuals experience morbidity and mortality that generate health and economic consequences significantly out of proportion to their numbers. An estimated 10,000 of these patients will undergo cardiac surgery involving cardiopulmonary bypass (CPB). Furthermore, it is estimated that over 300,000 children in the US under age 21 have congenital cardiovascular disease and that 38% of these children will have had one or more surgical procedures. The use of CPB in neonates in particular has increased steadily over the past two decades. Further, neonates are generally sicker and consume more resources, including postoperative mechanical ventilation, ICU stay and hospital stay. Consequently, reducing the deleterious effects of CPB will have the largest impact in this group of patients.

Feasibility and challenges of addressing this CQ or CC

Research has begun to assess the inflammatory response to cardiopulmonary bypass in pediatrics. However, the magnitude and importance of its contribution to complicating postoperative recovery remains elusive. Clinical trials have begun to assess the efficacy of generalized anti-inflammatory therapies, typically steroids, with conflicting results. No therapy has been recognized as the standard of care. It’s critical that we improve our understanding of the molecular and cellular mechanisms of this inflammatory response and resulting derangements in vascular permeability and develop novel treatment strategies for infants and children undergoing cardiopulmonary bypass.

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16 up votes
15 down votes
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Goal 1: Promote Human Health

Obesity and Morbid obesity

Obesity is a pervasive disease. It contributes to serious diseases such as heart, all the way down to cancer. In the past five decades it has been confirmed that the sugar from rich carbohydrate (CHO) foods increases the production of insulin which in turn converts the excess caloric intake into fat. So far neither dieting with highly processed foods rich in CHO’s, nor radical surgery have made a dent in this most... more »

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

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This is a fairly new idea of reducing glycemic indices of rich carbohydrate foods which may have an impact on our cultural diets and reduce obesity in children and adults.
Morbidly obese require an additional minimally invasive surgical approach which by GES will be able to curb appetite and produce weight loss.

Feasibility and challenges of addressing this CQ or CC

The preliminary feasibility studies have been performed in production of lower glycemic index foods such as rice.
US Patent # 8,568,820 B2
Issued October 29, 2013
To turn off the appetite of a hungry canine has been shown in experimental lab by stimulation of the funds of the stomach by pacemaker leads. It requires more experiments to create the sophisticated pacer with many parameters which would be controllable by radio frequency waves from outside. The minimally invasive operation would be performed by laproscopy.
United States Patent # 6,564,101
Issued May 13, 2003

Name of idea submitter and other team members who worked on this idea Prof. B.A. Zikria, MD, FACS (Emeritus)

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4 up votes
5 down votes
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Goal 2: Reduce Human Disease

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve

Controversies exist regarding the treatment of the thoracic aorta in those with bicuspid aortic valve (BAV), in particular: 1) conflicting views regarding criteria for elective surgery, particularly aneurysm size 2) extent of thoracic aortic aneurysm repair.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

This is a population that may approach 6 million Americans, without inclusion of their trileaflet aortic valve blood relatives. The controversy generally revolves around when to intervene surgically to prevent an aortic catastrophe, and how much of the ascending aorta should be removed (will any residual ascending aorta enlarge over time, and if so, what risk does this represent versus another aortic surgery later?).

Compounding this is the recognition in the literature of significant percentages of aortic dissection at sizes occurring below the guidelines for elective surgery. Patients do not realize that sometimes they are told to wait for elective surgery based on a size difference roughly as small as the thickness of a nickel (approximately 2 mm) or a dime (just over 1 mm).

The implications of this uncertainty in their treatment are staggering, particularly in light of the potential consequences for the most vulnerable individual, which include sudden death. Even those who survive an aortic emergency, with a chronically damaged aorta, face a very different future from that of someone with a non-emergent aortic repair with no residual aortic injury. Surgical uncertainty regarding the aorta should also consider valve surgeries needed by some individuals, and the total number of surgeries an individual may ultimately face.

Many with BAV are vibrant and active, if they avoid premature injury or death. Their disability or loss robs society of their many gifts.

Feasibility and challenges of addressing this CQ or CC

The medical literature reflects varying information and findings, perhaps due in part to the spectrum of expression across this large population, and the characterization of relatively small numbers of individuals under varied scenarios. Some may be carefully followed and receive medical treatment for blood pressure. Others may not receive those benefits, some being diagnosed only in emergency settings. Greater consistency in knowledge and treatment would benefit individuals and families. Advancements are very feasible within a five to ten year period and could greatly benefit the future of those undergoing surgery.

In the interim, patients are empowered when they understand these controversies: the known data regarding aortic size and dissection, and the considerations around the extent of aortic removal, and are fully engaged in elective surgery decisions.

Name of idea submitter and other team members who worked on this idea Arlys Velebir, Bicuspid Aortic Foundation

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-3 net votes
8 up votes
11 down votes
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Goal 2: Reduce Human Disease

Bariatric surgery and CV outcome

Does bariatric surgery reduce the risk of MI, stroke, heart failure, and premature death in moderately obese adults?

Does the type of surgery matter?

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Compelling Question (CQ)

Details on the impact of addressing this CQ or CC

Should bariatric surgery be offered to moderately obese adults as a way to prevent CV events.

Feasibility and challenges of addressing this CQ or CC

A number of smaller trials have been done and have shown that bariatric surgery can induce remission of diabetes. The bariatric surgery community is primed to conduct trials. Through the HCS collaboratory and PCORI, we believe it is possible to conduct pragmatic trials at reasonable cost by leveraging existing resources.
Bring in parties to aid in data collection and procedure payments (insurance companies, CMS, professional society registries)

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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-9 net votes
21 up votes
30 down votes
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Goal 2: Reduce Human Disease

Patient-Specific Blueprints to Guide Cardiac Surgery

In order to increase the success of robotic mitral valve repair, we need to stimulate a fusion of multi-modal functional imaging with 3-D valve models that can accurately predict valve shape and closure throughout the cardiac cycle, then develop surgical “blueprints” that overlay incision and suture maps on the surgeon’s console to guide perioperative robotic repair.

Is this idea a Compelling Question (CQ) or Critical Challenge (CC)? Critical Challenge (CC)

Details on the impact of addressing this CQ or CC

Improve the effectiveness of cardiac valve repair surgery, and provide a training tool to teach cardiac surgeons

Feasibility and challenges of addressing this CQ or CC

The scientific components all already exist. We need them to be integrated together, and there are already many examples of successful technology fusion of this sort.
Valve repair is a challenging procedure often requiring complex techniques and relying heavily on qualitative judgment and experience of the surgeon or interventionalist. It is also hampered by limited echocardiographic guidance, and difficult valve exposure and ergonomic access. Robotic surgery has been an important enabler for mitral valve repairs. The same overlays could be applied in training simulators so surgeons have the ability to emulate valve repair operations in 3-D digital platforms and get rapid feedback about the efficacy of the simulated repair.

Name of idea submitter and other team members who worked on this idea NHLBI Staff

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-19 net votes
6 up votes
25 down votes
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