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Timing for Invasive Measurement to Detect Anemia During Surgery

Masimo  (NASDAQ: MASI) announced today the results of a study published in BMC Anesthesiology in which clinicians at Peking Union Medical College in Beijing evaluated the ability of noninvasive and continuous hemoglobin monitoring with Masimo SpHb ® to help clincians estimate when to conduct invasive hemoglobin measurement to detect possible anemia in patients undergoing spine or cytoreductive surgery. 1

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20190520005244/en/

Masimo Radical-7® with SpHb® (Photo: Business Wire)

Noting that because of the “invasive, time-consuming and intermittent” nature of invasive blood sampling, clincians often forgo these “objective indications” when making transfusion decisions during surgery, Dr. Tang and colleagues sought to determine whether noninvasive, continuous hemoglobin monitoring could aid clinicians in estimating when it might be appropriate to perform an invasive measurement. They enrolled 69 adult patients scheduled for spine surgery or cytoreductive surgery for whom estimated blood loss was more than 15% of total blood volume. The patients were randomly divided into an SpHb group (32 patients) and a standard care group (37 patients). In the SpHb group, diagnostic blood samples were drawn when a patient’s SpHb, measured using a Masimo Radical-7 ® Pulse CO-Oximeter ®, decreased by 1 g/dL. In the standard care group, they were drawn at the clinicians’ discretion. Blood gas analysis was performed using a Radiometer ABL800. The researchers determined the positive predictive value (PPV) of SpHb for the SpHb group and clinician perception in the standard care group in detecting a decrease in lab hemoglobin of more than 1 g/dL or lab hemoglobin of less than 10 g/dL.

The researchers found that the incidence of unnecessary hemoglobin measurement was lower in the SpHb group than the standard care group. For a decrease of greater than 1 g/dL in lab hemoglobin, SpHb had a PPV of 93.3%, compared to 54.5% for clinical perception (p = 0.002). For hemoglobin lower than 10 g/dL, SpHb had a PPV of 86.7%, compared to 50.0% for clinical perception (p = 0.015). In the SpHb group, lab hemoglobin was never less than 7 g/dL. In addition, using Bland-Altman analysis, the researchers calculated that, compared to lab hemoglobin, SpHb had bias and precision of -0.29 +/- 1.03 g/dL, with limits of agreement of -2.30 and 1.72 g/dL. No difference was observed in transfusion units or postoperative hemoglobin concentrations between the two groups.

The researchers concluded, “The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians.” They also noted that “This study was the first diagnostic randomized controlled trial to explore the triage role of Pulse CO-Oximetry in the intraoperative detection of anemia. We found that the trend in SpHb could detect a decrease in Hb in dynamic situations and indicate the appropriate timing for further Hb measurements.”

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New Study Evaluates Ability of Masimo SpHb

Masimo  (NASDAQ: MASI) announced today the results of a study published in BMC Anesthesiology in which clinicians at Peking Union Medical College in Beijing evaluated the ability of noninvasive and continuous hemoglobin monitoring with Masimo SpHb ® to help clincians estimate when to conduct invasive hemoglobin measurement to detect possible anemia in patients undergoing spine or cytoreductive surgery. 1

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20190520005244/en/

Masimo Radical-7® with SpHb® (Photo: Business Wire)

Noting that because of the “invasive, time-consuming and intermittent” nature of invasive blood sampling, clincians often forgo these “objective indications” when making transfusion decisions during surgery, Dr. Tang and colleagues sought to determine whether noninvasive, continuous hemoglobin monitoring could aid clinicians in estimating when it might be appropriate to perform an invasive measurement. They enrolled 69 adult patients scheduled for spine surgery or cytoreductive surgery for whom estimated blood loss was more than 15% of total blood volume. The patients were randomly divided into an SpHb group (32 patients) and a standard care group (37 patients). In the SpHb group, diagnostic blood samples were drawn when a patient’s SpHb, measured using a Masimo Radical-7 ® Pulse CO-Oximeter ®, decreased by 1 g/dL. In the standard care group, they were drawn at the clinicians’ discretion. Blood gas analysis was performed using a Radiometer ABL800. The researchers determined the positive predictive value (PPV) of SpHb for the SpHb group and clinician perception in the standard care group in detecting a decrease in lab hemoglobin of more than 1 g/dL or lab hemoglobin of less than 10 g/dL.

The researchers found that the incidence of unnecessary hemoglobin measurement was lower in the SpHb group than the standard care group. For a decrease of greater than 1 g/dL in lab hemoglobin, SpHb had a PPV of 93.3%, compared to 54.5% for clinical perception (p = 0.002). For hemoglobin lower than 10 g/dL, SpHb had a PPV of 86.7%, compared to 50.0% for clinical perception (p = 0.015). In the SpHb group, lab hemoglobin was never less than 7 g/dL. In addition, using Bland-Altman analysis, the researchers calculated that, compared to lab hemoglobin, SpHb had bias and precision of -0.29 +/- 1.03 g/dL, with limits of agreement of -2.30 and 1.72 g/dL. No difference was observed in transfusion units or postoperative hemoglobin concentrations between the two groups.

The researchers concluded, “The SpHb trend tracked changes in hemoglobin satisfactorily during surgery and more accurately estimated the appropriate timing for invasive hemoglobin measurements than the clinicians.” They also noted that “This study was the first diagnostic randomized controlled trial to explore the triage role of Pulse CO-Oximetry in the intraoperative detection of anemia. We found that the trend in SpHb could detect a decrease in Hb in dynamic situations and indicate the appropriate timing for further Hb measurements.”

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IDF medical innovation: Battlefield surgery of the future

Imagine this: You are a soldier behind enemy lines. A firefight has broken out between your squad and terrorists in the Gaza Strip, and your best friend is hit by gunfire. The paramedic whips out his VR glasses and, with the help of a doctor in Beersheba’s Soroka-University Medical Center, he saves his life.

While that scenario might seem fantastical, the reality is that it might not be so far away for the Israel Defense Forces.Established less than a year ago, the IDF’s Medical Innovation Branch has been working on several projects to improve the innovative spirit of the military’s Medical Corps.

“Where is the future of combat medicine going?” Lt.-Col. Ariel Furer, chief medical innovation officer at the IDF Medical Corps, explained to The Jerusalem Post at his base in the center of the country. “We need to be faster, more agile. We have to work much faster, plan faster and treat faster. And make the relevant changes much faster.”

The Medical Corps is one of the largest health organizations in the country and faces unique challenges, providing it with opportunities not available elsewhere.

The main purpose of Furer’s unit is not only to create new and innovative medical technology, but to promote a spirit among troops to collaborate with key players such as health organizations, government agencies and academic institutions both in Israel and abroad.

Israel is known as the Start-Up Nation, and “the military is just one segment of Israel’s innovative community,” Furer said. “We firmly believe that the digital era will enable us to get closer to our patients and bring forward innovative ideas and solutions to the most challenging environments.”

Furer said he believes his unit will “revolutionize healthcare in the country” with the best and brightest caregivers in the country, and he doesn’t want the answers but the challenges. “Medical innovations are very hot right now. There’s a lot of buzz surrounding them,” Furer said.

One such project is to use virtual reality glasses like Microsoft’s HoloLens. It allows for paramedics treating wounded soldiers on the battlefield to get guided treatment from a doctor in a hospital who does not have to deal with all of the sounds of battle in the background.

According to Furer, a trial with the HoloLens glasses showed that paramedics had more self-confidence while providing treatment. But with a cost per unit of $3,500, “the technology is challenging,” Furer admitted.

In July, IDF troops took an opportunity to try another innovative technique to drastically reduce the time that a wounded patient’s data gets to the doctors in hospitals.

“We had a problem that, from the time when we get to injured people and begin to treat them, to the time that their information gets to the relevant authorities down the chain of treatment, it takes time. And it takes time for them to physically arrive,” Furer explained.

His unit then came up with the idea of placing a bar code on the injured individual and develop a smartphone application where the paramedic in the field can place all of the patient’s relevant medical information.

“You take a picture of the bar code, open the application, fill in the fields, and the moment you press send, all of the information is shared with the entire chain of treatment in real time,” he said.

Furer explained to the Post that he had paramedics attach the bar code to wounded Syrians who came to Israel for medical treatment as part of the IDF’s Operation Good Neighbor, and saw that they were able to transfer all relevant medical information to doctors at Nahariya’s Galilee Medical Center .

“We had a paramedic try the system on injured Syrians, and the doctors in Nahariya were able to plan ahead to receive the patients, an hour and a half before they arrived.”