The AAGL Global Society for Gynecologic Minimally Invasive Surgery Launches Center of Excellence in Minimally Invasive Gynecologic Surgery Program at Annual Meeting November 16-20, 2009 in Orlando, Florida —dedicated to establish and verify standards at surgical facilities and hospitals.

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The primary objective of the AAGL and its professional interest partner the Council of Gynecologic Endoscopy (CGE) is to promote the adoption of minimally invasive gynecologic surgery with its reduced morbidity, shorter post-operative recovery time, less invasiveness, and reduced costs.

Our Analysis of patient and provider needs worldwide showed that there are widely divergent qualities of practice and that patients and providers have difficulty in identifying excellence.  There is a lack of national standards to improve outcomes.  While payors seek to control costs/outcomes patients lack access to the educational resources to direct them to the appropriate center to meet their needs in many cases.  As I stated in my address:

We recognize in the modern era of health care we have a unique opportunity as well as an obligation to use our educational resources and multidisciplinary expertise to help promote those systems and procedure which can improve patient outcomes in women’s health while reducing costs to both patient, payor, and society as a whole.

The CGE has therefore launched two new programs to address these needs.

First is an individual registry of physicians based upon peer review of operative experience and complications. The CGE, founded in 1996 has over 1100 individual gyn surgeons who have meet its standards.  The new program integrates an evaluation based on today’s complexity of procedures in minimally invasive surgery.  It is a tiered system with 3 levels of practice (based on procedure complexity) and 4 areas of proactive experience and specialization (General Gynecology Procedures, Fertility Enhancement Surgery Procedures, Repair of Pelvic Floor Defects & Urogynecology Procedures, Gynecologic Oncology Procedures)

Second is a Center of Excellence Program In Minimally Invasive Gyn Surgery.  This is in recognition  of the modern notion that to achieve best-in classs surgical outcomes requires not only an expert surgeon, but an integrated multidisciplinary surgical facility with systems and procedures in place to maximize quality cost effective safe outcomes for patients.

9 Requirements: Areas of Review To Qualify as a COEMIG:

1. Institutional Commitment to MIGS
2. Director of Division
3. Medical Staff Physician Qualifications
   -Dedicated Educational Program
   -Formalized Credentialing Guidelines & Systems to Introduce New Procedures
   -Procedures for Minimizing Complications
4. Sufficient Experience with Procedures
5. A Full Complement of required Non-Surgeon Consultative Staff
6. Ancillary Staff
   -Dedicated Team-Based Concept
   -Dedicated non-physician Educational Program
7. Equipment Guidelines
   -Availability & maintenance
8. Treatment pathways
   -Linked to Peer reviewed Practice Guidelines
9. HIPAA Compliant prospective Outcomes Data Tracking

In my presentation launching this program at the AAGL annual meeting I shared

The AAGL is extremely excited and totally committed to the concept of Gynecologic Minimally Invasive Surgery Centers of Excellence.  It represents a unified vision for women’s health that integrates our entire educational mission and expertise over the past 38 years.

First Ever Global Opportunity for Standards of Excellence:I was equally excited to present the concept to the Affiliated Societies of the AAGL which is made of representatives of National Minimally Invasive Gyn Societies from around the World.  Our dedication to this concept and recognition of its value was shared by representatives of Partner Societies from South America, Europe, and Asia.  We agreed to work together collaboratively to establish a shared Global Standard and to establish a shared program to advance Women’s health under the AAGL CGE COEMIGS program in cooperation with each Nation’s Society.

I will share further details of the program with you here as they are released!

Details of the society are are on the website of the AAGL

Information on the CGE

Information and Applications for the COEMIG Program

 

 AAGL CGE COEMIGS Program Launch Information [10:57m]: Play Now | Play in Popup | Download

Gizmodo is reporting today about how White Sox catcher A.J. Pierzynski said he improved his performance though the daily use of a Nintendo video game. This reminded me of research I did while at Yale on similar visual testing on surgeons. We found back then that for both athletes, and surgeons (especially endoscopic surgeons) visual acuity correlated with performance and both could be improved with exercises.

First the report on the catcher and the video game. Gizmodo writes:

We were just about to stuff Nintendo’s Flash Focus vision game into the snake oil file when White Sox catcher A.J. Pierzynski revealed he actually improved his hitting through daily use of the software. Like many of the White Sox batters last year, Pierzynski stunk, and to come around he played Flash Focus in the off season. Now, one week into the 2008 schedule, the hapless catcher has two home runs, a .529 average and a team-leading seven RBIs.

What is Flash Focus?: Flash Focus is a video game for the Nintendo DS. Basically it is a series of hand eye coordination exercises designed to improve overall visual acuity through vision “exercises”. A review of the game and screen shots are here.

The Concept of Optomeric Testing for Athletes and Surgeons: The idea behind optomic testing is two fold. First, there are innate differences in visual performance between people second, elite athletes perform significantly better on objective tests of visual performance and hand-eye coordination, and third, specific testing and exercises can identify areas of optical performance weakness and improve them- and performance.

A review of optometric testing in general for athletes can be read here:

The basic tests they mention are:

1. Visual acuity – right and left eye separately without an occluder
2. Stereopsis at distance – contour and random dot
3. Ocular dominance – independent of handedness
4. Letter contrast
5. Contrast sensitivity – at spatial frequencies known to be related to sport performance
6. Contrast sensitivity with glare
7. Reaction time
8. Reaction time with varying targets

Our experiments with surgeons- Some years ago whenI was at Yale My Partner David Olive and I conducted a lerge study of novice and expert endoscopic surgeons using the validated athletic optometric testing tools. We testing a very large group of trainees as well as experts at an international AAGL conference. We found similar patterns as with the athletes. Namely significant differerences existed between visual ability and eye hand coordination skills and these were related to measures of performance and skill. We also found that with exercise performance could improve.

Medication errors in the hospital are a major cause of preventable suffering and death. I wanted to share with you the top 6 handwriting errors of doctors in the hospital that have been banned in to prevent these errors.

First some background:  You may recall the landmark Institute of Medicine (IOM) study that found medication errors injure 1.5 million people and cost billions of dollars annually.  Their report found “the extra medical costs of treating drug-related injuries occurring in hospitals alone conservatively amount to $3.5 billion a year, and this estimate does not take into account lost wages and  productivity or additional health care costs.”  The press release of the report and summary is here and the enormous full report can be searched and read here. 

Every hospital I go to has implemented warning sheets (some in bright yellow with red stop signs on them) of the “Top 6 Forbidden Medication Orders”  These are abbreviations so often misread or mistranscribed that they have been banned in the hospital!  (not the drug or the order but the abbreviations have been banned!).  You all know how awful doctor’s handwriting is!

1. U for units with heparin insulin and pitocin can be misread as zero or cc’s causing dangerous overdoses
2. IU for nternational units can be mistaken for IV (intravenous) or 10 (ten)
3. q.d. means once a day in latin but can be mistaken for qid or qod (four times a day or every other day) if the period is written above the line
4. .1 must be written as 0.1 else 10 fold dose errors can occur
5. 1.0 should never be written – the decimal can be missed and a 10 fold dose error occur
6. morphine and magnesium can be mixed up with lethal consequences- the use of MS, MSo4, or MgSO4 have been banned

a fun view of how bad the handsriting is can be read here

It was just reported today that: “A Harvard University scientist backed by Google Inc. and OrbiMed Advisors LLC plans to unlock the secrets of common diseases by decoding the DNA of 100,000 people in the world’s biggest gene sequencing project.”

What nothing better to spend $1Billion on?  Why are they doing this you ask….

Harvard’s George Church plans to spend $1 billion to tie DNA information to each person’s health history, creating a database for finding new medicines. The U.S., U.K., China and Sweden this year began working together to decipher the genetic makeup of 1,000 people at a cost of $50 million.

Google, owner of the most popular Internet search engine, is looking for ways to give people greater control over their medical data. Along with the unspecified donation to Church, the Mountain View, California-based company said last week that it would work with the Cleveland Clinic to better organize health records, and last year gave $3.9 million to 23andme Inc., a seller of genomic data to individuals.

Church’s plan “would be the largest human genome sequencing project in the world,” Stephen Elledge, a geneticist at Harvard Medical School in Boston, said in a telephone interview today. “The genetic variations are what make people different, and we need to understand the connections to human disease. They’ll get a tremendous amount of information from this,” said Elledge, who isn’t involved in the project….“If we can expand the project, we’ll probably go for a million genomes,” Church said.

Personalized genetics and genomics are hot topics - Read more about the concepts here.  With these two you either look to an individual’s genetics to see how it will impact a disease or a treatment (a single gene) or with genomics “This is the dream of everyone gets a genome sequenced at birth, we assess risk, create prevention plans, identify idosyncratic drug reactions prior to medication therapy”.

The medical and financial impact for the company owning this data in unimaginable.  The source of individual variability of response to drugs and individual susceptability to disease could be greatly unlocked - as well as mined for new therapeutics.  Google of course is getting into all medical databasing starting with your health record and I predict images of your diseases next.

More and more social networking sites, web 2.0 sites, and other initially recreational new internet systems are migrating to work and educational related functionality.  The potential for medical uses, online research, education, and patient networking is seemingly endless.

This wiki lists general grid and teen grid educational sites on second life as does this very comprehensive one.

On May 25, 2007, 1300 educators from around the world gathered at the Second Life Best Practices in Education: Teaching, Learning, and Research 2007 International Conference in the virtual world of Second Life. The event was the first 24 hour, international conference ever to take place entirely within a virtual world.  Details are here.

My award winning friend-blogger Bertalan Mesko has the most comprehensive blog on web 2.0 medical resources has put together this great list of everything about seond life and medical education.

Check this out.  I’ll be writing much more about vitual communities in the future and medical uses.