A new electronic medical record tool that tallies patients’ previous radiation exposure from CT scans helps reduce potentially unnecessary use of the tests among emergency room patients with abdominal pain, according to a study from researchers at the Perelman School of Medicine at the University of Pennsylvania. The new study shows that when the tool is in use, patients are 10 percent less likely to undergo a CT scan, without increasing the number of patients who are admitted to the hospital.
Abdominal pain is the most common reason why people seek care in emergency rooms in the United States, accounting for 10 million visits each year. But the symptoms may be caused by myriad problems, from those that can be fixed with a single dose of an over-the-counter drug to those that could prove life-threatening within hours: from a bout of GI distress to an ectopic pregnancy; from constipation to an appendix about to burst; from a hernia to signs of a chronic condition like Crohn’s disease.
This complex diagnostic face-off plays a huge role in why emergency physicians tend to lean heavily on tests like CT scans, even though they expose patients to radiation and there are few clear guidelines on which patients should get them. Since the mid-1990s, the use of CT scans to diagnose ER patients has surged, increasing ten-fold. Today, 14 percent of all emergency room patients get scanned

Robotics experts at UC Santa Cruz and the University of Washington (UW) have completed a set of seven advanced robotic surgery systems for use by major medical research laboratories throughout the United States. After a round of final tests, five of the systems will be shipped to medical robotics researchers at Harvard University, Johns Hopkins University, University of Nebraska, UC Berkeley, and UCLA, while the other two systems will remain at UC Santa Cruz and UW.
‘We decided to follow an open-source model, because if all of these labs have a common research platform for doing robotic surgery, the whole field will be able to advance more quickly,’ said Jacob Rosen, associate professor of computer engineering in the Baskin School of Engineering at UCSC and principal investigator on the project.
Rosen and Blake Hannaford, director of the UW Biorobotics Laboratory, lead the research groups that developed the Raven II robotic surgery system and its predecessor, Raven I. A grant from the National Science Foundation funded their work to create seven identical Raven II systems. Hannaford said the systems will be shipped out from UW by the end of January. After they are delivered and installed, all seven systems will be networked together over the Internet for collaborative experiments.
Robotic surgery has the potential to enable new surgical procedures that are less invasive than existing techniques. For some procedures, such as prostate surgery, the use of surgical robots is already standard practice. In addition, telesurgery, in which the surgeon operates a robotic system from a remote location, offers the potential to provide better access to expert care in remote areas and the developing world. Having a network of laboratories working on a common platform will make it easier for researchers to share software, replicate experiments, and collaborate in other ways.
Even though it meant giving competing laboratories the tools that had taken them years to develop, Rosen and Hannaford decided to share the Raven II because it seemed like the best way to move the field forward. ‘These are the leading labs in the nation in the field of surgical robotics, and with everyone working on the same platform we can more easily share new developments and innovations,’ Hannaford said.
According to Rosen, most research on surgical robotics in the United States has focused on developing new software for various commercially available robotic systems. ‘Academic researchers have had limited access to these proprietary systems. We are changing that by providing high-quality hardware developed within academia. Each lab will start with an identical, fully-operational system, but they can change the hardware and software and share new developments and algorithms, while retaining intellectual property rights for their own innovations,’ Rosen said.
The Raven II includes a surgical robot with two robotic arms, a camera for viewing the operational field, and a surgeon-interface system for remote operation of the robot. The system is powerful and precise enough to support research on advanced robotic surgery techniques, including online telesurgery. University of California – Santa Cruz

Migraine pain sits at the upper end of the typical pain scale

Abiraterone has been approved since September 2011 for men with metastatic prostate cancer that is no longer responsive to hormone therapy and progresses further during or after therapy with the cytostatic drug docetaxel. In an early benefit assessment pursuant to the ‘Act on the Reform of the Market for Medicinal Products’ (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) examined whether abiraterone offers an added benefit compared with the present standard therapy.
IQWiG finds an indication of a considerable added benefit of abiraterone in patients who are not eligible for further treatment with docetaxel. In contrast, an added benefit is not proven in patients who can still be treated with docetaxel, as the dossier submitted by the drug manufacturer provides inadequate information for this group of patients.
In accordance with the specifications of the Federal Joint Committee (G-BA), IQWiG separately assessed abiraterone in two groups of patients. The G-BA has specified different appropriate comparator therapies for the two groups.
The ‘best supportive care population’ contains patients who are not eligible for further treatment with docetaxel. The appropriate comparator therapy for this group is palliative treatment with dexamethasone, prednisone, prednisolone or methylprednisolone, as well as ‘best supportive care’.
‘Best supportive care’ means the therapy that provides the patient with the best possible individually optimised supportive treatment to alleviate symptoms (e.g. adequate pain therapy) and improve quality of life.
The ‘docetaxel-retherapy population’ comprises patients who are still eligible for further treatment with docetaxel. The appropriate comparator therapy for this patient population is docetaxel in combination with prednisone or prednisolone.
Indication of increase in survival and delay in consequences of disease
One study (COU-AA-301), which considers patient-relevant outcomes and provides relevant data, was included in the assessment of added benefit in the ‘best supportive care population’. This study compared treatment with abiraterone versus placebo, in each case combined with prednisone and ‘best supportive care’.
IQWiG finds an indication of an added benefit in patients treated with abiraterone: the above study provides indications that abiraterone can prolong survival and delay consequences of prostate cancer, such as fractures or operations due to bone metastases. In addition, the ‘time to pain progression’ was prolonged in study participants receiving abiraterone.
IQWiG classifies the extent of this added benefit as ‘considerable’. The corresponding legal ordinance has specified three grades to determine the extent of added benefit: ‘minor’, ‘considerable’ and ‘major’.
The study data presented on health-related quality of life assessments cannot be used; an added benefit of abiraterone is therefore not proven for this outcome.
The indications of advantages for abiraterone are not accompanied by proof of greater harm. Institute for Quality and Efficiency in Health Care

A six-year collaboration between two faculty members at the Miller School of Medicine