New Technologies for Improved Patient Care
In medicine, what's hot can change rapidly, so physicians at Rush University Medical Center stay abreast of what's most current to ensure the best outcomes for their patients. Here, three physicians explain what's hot within their specialties.
Open-chest cardiac surgery | Long-lasting hip implants | 24/7 stroke care
Open-chest cardiac surgery
"From the late 1950s on, cardiac surgeons have used wire to rejoin the sternum where it has been cut down the middle during open heart surgery. It was the technique used by pioneering cardiac surgeons back then, and it became standard practice. In the last few years, however, there's been a paradigm shift: Heart surgeons can now use specially designed metal plates and screws to rejoin the breastbone. This is a revolutionary change, really, that heralds new thinking about the way we handle the bony cage surrounding the heart.
"You see, bones rejoined with wire can slip, slowing the healing process and causing severe pain. Plates and screws create a secure connection — we call it rigid plate fixation. It prevents the bone from shifting when the patient moves, which, of course, happens with every breath. They also help to reduce bleeding, which is especially important for high-risk patients, such as those who have had prior cardiac surgeries. This technique of plating also allows us to expand the capability of minimally invasive cardiac surgery. Pain associated with surgery is dramatically reduced with plate fixation and the smaller incisions that this approach enables. For the patient, healing from open heart surgery faster and with much less pain is truly revolutionary."
Jai Raman, MD, PhD, is director of the Section of Adult Cardiac Surgery and surgical director of the Advanced Heart Failure, Heart Transplant and Mechanical Circulatory Support Program. He helped develop and refine the use of specialized plates and screws to rejoin bone after open heart surgery."
Long-lasting hip implants
"Given the tendency of implants in hip replacements to wear out relatively quickly, especially in younger patients, there's been a lot of research aimed at improving implant longevity.
"One recent breakthrough may have brought us closer to reaching that goal. I am part of a team of researchers and engineers who discovered that graphitic carbon is a key element in the lubricating layer that forms on both the ball and socket of metal-on-metal hip implants.
"This finding may pave the way for us to develop hip implants using materials that are less susceptible to normal wear and tear and last for the patient's lifetime. It's very exciting."
Joshua Jacobs, MD, is chairman of the Department of Orthopedic Surgery and a specialist in joint replacement. He has researched and published extensively on the effects of wear on joint implants.
24/7 stroke care
"What's hot right now for stroke neurologists at Rush is being able to share our expertise with community hospitals through telemedicine. Our on-call neurologist receives a call from a participating hospital and quickly logs on to a computer that connects with a remote-presence robot in that hospital's emergency room. The system's high-definition cameras allow us to interact with the patient and make an assessment as effectively as if we were physically present. We're already reaching six Chicago-area community hospitals where neurologists may not be on site 24/7.
"It might sound impersonal at first. But within a minute or so, you're talking with patients just like you're in the room with them. We can zoom in on crucial details such as pupil reaction in the patient's eyes. That can't be done over the telephone, which is how neurologists who aren't on-site often have their first interaction with a stroke patient.
"The results are measurable. Of the stroke patients at outside hospitals who are treated via Rush telemedicine consultations, 95 percent who are eligible are receiving TPA (tissue plasminogen activator), the clot-busting drug that has to be administered within 4½ hours of ischemic stroke onset. That's a big difference from the national use rate of 27 percent for those who are eligible. Clearly, that translates to better outcomes for stroke patients."
James Conners, MD, MS, is a stroke neurologist and medical director of the Comprehensive Stroke Program at Rush. His clinical expertise includes ischemic strokes, transient ischemic attacks, intracerebral hemorrhage and stroke prevention.
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