100 Years from ANZAC Cove

Today, ANZAC Day, represents the 100 year anniversary of the entry of Australia and New Zealand into the battle of the Great War.  In many ways, it defined our nationhood and marked the time in history where our two nations stood on their own but also side by side.

There were many lessons learnt over the next 3 years, not least of which were in the medical management of such a large scale conflict.

Colonel Arthur Graham Butler was the first medical officer to land at Gallipoli and was later placed in charge of the Third Field Ambulance.  Most importantly, after the war he wrote the three-volume Official History of the Australian Army Medical Services 1914-1918.  The original books are now rare but thankfully they have been made available online by the Australian War Memorial.  This incredible collection covers areas such as resuscitation, infectious disease, surgical techniques, health promotion, mental health and healthcare systems, to name a few.

In the same way that some of the recent advances in the management of trauma have been born in the Iraq and Afghanistan theatre, Butler’s work describes the new understanding of trauma gained during the Great War.  These warrant highlighting today.

Butler’s description of the improvement in understanding of haemorrhage, shock and resuscitation:

One of the most striking features of medical work in the war is to be found in the initial emergence of the pre-war concept ”surgical shock” as a specific and unique syndrome, “wound shock,” and its subsequent gradual resolution in a complex of pathological degradations.

The identification of the causes that might bring about such an impasse, and the detection and exploitation of any opportunity for therapeutic intervention, constitute a remarkable episode in the history of scientific medicine.

The concept of “traumatic shock” emerged from the war an almost crudely clinical one, reflecting on the pathogenic side a curious congeries of causative and contributing agencies and their effects, such as psychic and physiological “pain,” and their reflex effects such as acapnia; “excitement” and fear and their related glandular (hormonic) reactions; haemorrhage, with resulting anoxaemia, and acidosis; thermogenic failure; cardio-vascular failure; neurogenic failure; septic toxaemia: other intoxications as by an “H” substance.

And from the Special Committee for Surgical Shock, this insightful assessment

In shock without haemorrhage the reduction in blood volume indicates a marked disturbance of the normal mechanism by which the blood volume is maintained. . . . With a certain degree of shock, fluid supplied to the body will cause an increase in the blood volume. But in graver states of shock the smaller vessels of the vascular system are unable to retain an adequate amount of fluid. . . . Further knowledge is needed as to the cause of this alteration in the peripheral vessels, which appears to be a common feature in many shock-like conditions.”

He outlines the constantly changing picture of current practice at the front, culminating in the Manual of Injuries and Diseases of War issued in 1918 in which transfusion of blood is introduced and the treatment prescribed was designed to combat three main conditions:

  1. loss of body heat
  2. a low blood pressure
  3. a decrease in the alkalinity of the blood

Our treatment goals now are not that different, despite a hundred years having passed.

The image above shows a group of twenty six medical officers talking outside a tent at Gallipoli on the effects of gunshot wounds to the head.  Captain (at the time) Butler was one of them.  His remarkable three volume work showcased these and many more incredible medical staff, some of whom could lay claim to being Australia’s fathers of trauma management.

Butler received the Distinguished Service Order (DSO) with the following citation:

During operations in the neighbourhood of Gaba Tepe on 25th April, 1915, and subsequent dates, for conspicuous gallantry and devotion to duty in attending wounded under heavy fire, continuously displaying courage of a high order.

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Even Dr. Oz can’t rebut John Oliver

Dr. Oz’s rebuttal yesterday to the letter from ten self-described “distinguished physicians” who demanded that Columbia Medical School cancel his faculty appointment was absolutely brilliant — recasting the narrative from the selling of snake oil to standing up for free speech and against the juggernaut agricultural-industrial complex.

But there’s no rebuttal to John Oliver.

See also Michael Specter’s New Yorker blog post on this issue, as well as his superb profile of Dr. Oz in the magazine.

Medtronic Activa Neurostimulators Approved in Europe for Full Body MRI Scans

Activa-PCMedtronic won European regulatory approval for its Activa line of deep brain stimulators (DBS) to be safe for use in full body MRI scans, given certain conditions. Previously, the company had approval for only head scans under MRI for patients wearing their DBS devices. The new announcement allows both future as well as existing patients to receive MRI scans of any part of the body, as long as specific precautions are taken by the radiology techs.

These are the only DBS systems to receive a full-body MR-conditional approval from the European authorities, allowing patients with Parkinson’s disease, essential tremor, refractory epilepsy, and dystonia to continue receiving medical care that requires MR scans. The implants have to be appropriately programmed before undergoing a scan, keeping them working so as to allow the acquisition of sharp images unaffected by the jerky motions associated with neuromotor disease.

Product page: Activa neurostimulators…

Source: Medtronic…

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Mobidiag Presents Two New Diagnostic Platforms at ECCMID 2015

Novodiag™ and Amplidiag™ Easy platforms to serve both low- and high-throughput customer needs with emphasis on accessibility and affordability

Espoo, Finland – April 22, 2015 – Mobidiag Ltd, a Finnish molecular diagnostics company specializing in the development of innovative diagnostics solutions for infectious diseases, today announced the first public presentation of two new diagnostic platforms – Novodiag and Amplidiag Easy – at ECCMID 2015 in Copenhagen on April 25-28.

The entirely new Novodiag platform is a fully integrated and automated system, enabling accessible and affordable molecular testing. The platform enables fast, very easy to use and highly multiplexed on-demand molecular testing for any throughput needs. It combines advanced features, ease of use, and affordability unmatched by currently available products, and requires no dedicated molecular testing expertise. The Novodiag platform will be readied for a full commercial launch in mid-2016 to serve various testing needs in the infectious diseases space, as well as in other potential markets which are unserved by current molecular platforms.

“Although molecular diagnostics has been around for a long time, the market has not seen solutions which leverage its full potential,” says Tuomas Tenkanen, CEO of Mobidiag.“Until now, major limitations have been complexity of use, the ability to detect only a very limited amount of pathogens, or simply too high a price. We aim to solve these issues with our Novodiag system by combining high multiplexing capacity with a simplified, easy-to-use design. The system and its benefits will be accessible to a broader group of diagnostic laboratories, both centralized and decentralized. Due to its simplified design, it represents industry-leading value, setting a new benchmark for affordability and functionality.”

Mobidiag is also launching its new Amplidiag Easy system for automating high-throughput gastrointestinal testing with Amplidiag test kits, including the recently CE-marked Amplidiag Bacterial GE and Amplidiag C. difficile+027. The system performs batch nucleic acid extraction and PCR plate setup from stool samples with unmatched speed and performance. Combined with Amplidiag test kits and Amplidiag Analyzer software for automatic result analysis, the platform provides ease of use and uncompromised reliability in high-throughput molecular testing.

“We value the feedback of our customers, and it is clear that in many high-throughput laboratories, automated systems are not only appreciated for reducing the burden of tight resources, but the only way of working,” Mr. Tenkanen continues. “That’s why we created Amplidiag Easy specifically to meet this need, combining automation with speed and reliability. For example, the system can process a batch of 48 C. difficile samples in one hour, from a liquid stool sample transfer vial ending up in a ready set-up PCR plate to be transferred to a qPCR instrument. In an optimized workflow, the results are available for a large batch of samples in two hours from sample to result. The best thing is that the high speed does not compromise performance at all.”

About Mobidiag

Established in 2000, Mobidiag develops novel technologies for improving the diagnostics of infectious diseases and has served the European clinical diagnostics market with its multiplex Prove-it™ product family since 2008. In 2013, Mobidiag successfully completed a three-way merger with Genewave and Amplidiag, solidifying its position in the field of molecular diagnostics. Mobidiag’s new Amplidiag™ product line encompasses innovative multiplex diagnostic tests for gastrointestinal infections. The products use well-established qPCR technology, ensuring optimal performance, suitability for high-volume screening use and cost-effectiveness in mid-sized to large laboratory settings. Mobidiag’s new Novodiag™ platform will set a new benchmark to automated, integrated molecular diagnostics. Mobidiag is headquartered in Espoo, Finland, with a subsidiary in Paris, France.


Mobidiag Oy/Ltd.
Tuomas Tenkanen, CEO
+350 50 553 4980

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IdentRx Promises to Prevent Nearly All Medication Errors

PerceptiMed-identrxMedication errors continue to plague the clinical community and even rare cases of mistakes can make a big splash in the news. And for a good reason: we all expect to be treated than harmed when receiving medical care. A new device is currently in the third round of pilot testing, including at major retail pharmacies and Purdue University, that may help avoid prescription errors altogether. The IdentRx system from PerceptiMed, a Mountain View, California firm, optically analyzes every single pill that will be given to a patient to make sure it precisely matches each prescription.

It is the only device that visually inspects each pill, recognizing the manufacturer imprints on them all. The system confirms that the pills themselves, and not only the container bottles, match the issued prescriptions, hopefully preventing errors just before the pills are handed to the patients.

Product page: IdentRx…

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