I've developed an application that presents information about a patient's circulatory system to anaesthetists during surgery to give them clearer information about the patients heart and vasculature so that they can make finer grained, individualised treatment decisions. There's currently only a small group of users, as we haven't been able to afford to go through clinical trials yet, but the evidence is mounting that it is getting patients through surgery with fewer complications and better prospects of a full fast recovery. I've been in the theatre and watched someone wake up after a 9 hour surgery and instantly be alert enough to say they'd like a cup of tea, which the anaesthetist attributed to the decisions he was able to make informed by the software. It seems as if it has already had an significant positive impact on the health of the people treated by anaesthetists using the software. If further studies support the anecdotal evidence from our users, the software might have a significant impact on millions of people.
Would love to hear more. Discussed this sort of possibility with an anesthetist friend at length and heard all about the importance of intuition. And limitation/absurdities of existing technologies (“humans aren’t a solid ball of fat and flesh!”).
Clinical trials sound incredibly difficult to achieve - such a slow industry!
Hello Scyzork. thanks for asking, I'm still working out how to tell this story succinctly.
Here's today's effort:
Historically clinicians have had to work with blood pressure and heart rate as the key observable values they had to estimate oxygen perfusion to the tissues.
Newer technologies allow you to also measure the volume of blood ejected from the heart with each beat. With this additional information, you can infer how the work of the heart, and how the constriction of the vasculature around the volume of the blood in the circulatory system are each contributing to maintaining blood pressure. Clinicians understand that this is how blood pressure works, but our users are telling us that once they see the information plotted on a 2d field in our software, that something clicks that hadn't clicked before, and they are able to maintain patient's blood pressure more precisely within the 'normal' zone unique to that patient, and they are telling us they won't do major surgery without our software now. Interestingly we also been told that it's shifted some clinician's 'intuition', that they are administering less fluid and giving more vasopressors than before, or as it was said to me "less fill 'em, more squeeze 'em". Anecdotally they believe their patients are recovering faster, and that they can now operate on people they would previously categorized as too high risk. This is what they're telling us, it'll take some serious work to be able to confirm or reject this as objective fact.
My observation of the operating theatre is - I expected it to be like mission control, but it's more like a busy cafe where two people just rang in sick and someone wanted a soy latte but they think this might be almond milk.
The people in the theatre are smart, but they are very busy. Other people have tried to do what we are doing and not gained enough traction, I think it's because their interface was too complex for that environment, they were displaying too much, they hadn't distilled it down to the physiologically relevant actionable information. I think our software's working because because the physiological model underlying the displays is right, but also because we've stuck to a philosophy that it has to be simpler to use than a coffee machine, so that people have the headspace to be able to use it when they are busy and under pressure.
So I work in surgical simulation training. And yeah the OR in my observations has also not been this romanticized mission control thing that I was expecting.
My impression is that it is more like a mechanic shop: people are doing their jobs, they're looking at the clock, thinking schedule, they're listening to music or radio, they're maybe casually arguing about something. They're used to their tools and instruments, they're in some sort of routine, everybody has their individual subdomain or specialty.
This stuff is tricky because you're not just coming up with a device, you're coming up with new human behavior in connection with the device. The human (anesthetist) needs to be won over by the physiological model, and then they need to actually be effective with it.
The funny anecdotes I've heard from an anesthetist were along the lines of "They're introducing new equipment that rings alarms about things I already know, so my job becomes turning those alarms off".
How far along we are is a complex.
We've had an early version of the software used for several years,
So we've possibly reached the point where we have enough data for pre clinical studies, we have some senior clinicians with no financial links to the company that are converts and spruiking the model and software at major conferences and in lectures to their students. We've have a new version of the software to give to them before the end of the year. we have studies published. So it's got momentum, but we have the whole FDA journey ahead of us.
But with this part:
> This stuff is tricky because you're not just coming up with a device, you're coming up with new human > behavior in connection with the device. The human (anesthetist) needs to be won over by the
> physiological model, and then they need to actually be effective with it.
with our small sample group, I think we're going pretty well.
