Expert review of medical devices
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Expert Rev Med Devices · Jan 2011
ReviewCost-effectiveness of robotic-assisted laparoscopic procedures in urologic surgery in the USA.
New technologies such as robotic-assisted surgery are constantly introduced clinically without a complete understanding of benefits and costs. This article will discuss general concepts of health economics and apply them to the application of robotic-assisted surgery to urologic procedures. Utilization of robotic surgery has increased dramatically in recent years. ⋯ In order for the robot to be cost effective, there needs to be an improvement in efficacy over alternative approaches, and a decrease in costs of the robot or instrumentation. Robotic surgery has not been found to be cost effective in urology. Future studies may yet reveal indirect benefits that are not yet obvious.
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Cardiac output (CO) measurement is becoming increasingly important in the field of pediatric intensive care medicine and pediatric anesthesia. In the past few decades, various new technologies have been developed for the measurement of CO. Some of these methods are applicable to pediatric patients and some are already being used in children. ⋯ This article focuses on the currently available minimally invasive and noninvasive monitoring devices for CO measurement in children. A brief explanation of the technical aspects of each method and clinical use will be followed by the knowledge gained from infant animal and clinical pediatric studies. The goal of this article is to give an update of the various CO measurement technologies in children.
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Expert Rev Med Devices · Mar 2010
High-intensity focused ultrasound in the management of prostate cancer.
The treatment of localized prostate cancer with high-intensity focused ultrasound (HIFU) has been researched since the 1990s and today the treatment is an actively used therapy for the disease. HIFU works in two ways to destroy tissue, namely thermal and mechanical effects. ⋯ An additional benefit of HIFU is that it can be used as salvage therapy after radical prostatectomy and external-beam radiotherapy. A new area of research with HIFU involves focal therapy, where tumor sites within the gland are directly targeted with the objective of reducing morbidity.
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Expert Rev Med Devices · Jan 2010
ReviewWhy do some promising brain-stimulation devices fail the next steps of clinical development?
Interest in techniques of noninvasive brain stimulation (NIBS) has been growing exponentially in the last decade. Recent studies have shown that some of these techniques induce significant neurophysiological and clinical effects. Although recent results are promising, there are several techniques that have been abandoned despite positive initial results. ⋯ We identified five devices (transmeatal cochlear laser stimulation, transcranial micropolarization, transcranial electrostimulation, cranial electric stimulation and stimulation with weak electromagnetic fields) and compared them with two established NIBS devices (transcranial magnetic stimulation and transcranial direct current stimulation) and with well-known drugs used in neuropsychiatry (pramipexole and escitalopram) in order to understand the reasons why they failed to reach clinical practice and further steps of research development. Finally, we also discuss novel NIBS devices that have recently showed promising results: brain ultrasound and transcranial high-frequency random noise stimulation. Our results show that some of the reasons for the failure of NIBS devices with promising clinical findings are the difficulty to disseminate results, lack of controlled studies, duration of research development, mixed results and lack of standardization.
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Expert Rev Med Devices · Jul 2009
ReviewArtificial pancreas: an emerging approach to treat Type 1 diabetes.
Intensive insulin therapy aimed at achieving normal glucose levels significantly reduces the complications that are associated with diabetes but is also associated with an increased risk of low glucose levels (hypoglycemia). The growing use of continuous glucose monitors has stimulated the development of the artificial pancreas, a closed-loop insulin-delivery system aimed at restoring near-normal glucose levels while reducing the risk of hypoglycemia. The artificial pancreas comprises three components: a continuous glucose monitor, an insulin infusion pump and a control algorithm delivering insulin according to real-time glucose readings. In this article, we review closed-loop glucose control, including its components, development, testing and clinical application.