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The Future of Froedtert
The People of Froedtert & Medical College of Wisconsin Envision the Future of Medicine
Doctors live in two different worlds. One world is all about treating patients with tools available right now. The other is a realm of tantalizing medical possibilities that could be one year, three years, 10 years down the road.
Recently, a handful of Medical College of Wisconsin physicians, plus several Froedtert Hospital nurses, took a few moments away from busy schedules to talk about the medicine of tomorrow.
They envision a world where custom-designed antibodies seek out and destroy cancer cells, and Alzheimer’s patients can return to normal living. Where surgery is less invasive, and super-fast imaging cameras “freeze” the heart in mid-beat. Where familiar treatments have become obsolete, but patient involvement is more important than ever.
It is a fascinating world of new ideas and old-fashioned ingenuity, and it is taking shape today.
Dramatic Transformations
Brian Kopell, MD, is a fellowship-trained Medical College of Wisconsin neurosurgeon. He is heavily involved in Deep Brain Stimulation (DBS), one of the newest therapies in medicine. Dr. Kopell believes this technique could soon lead to cures for some of the diseases people struggle with most.
DBS was introduced in the 1990s as a treatment for people with disease symptoms such as tremors and rigidity that can affect quality of life. During the procedure, surgeons implant an electrode in the area of the brain causing the symptoms. The electrode, connected to a device called a neurostimulator, is placed under the skin at the collarbone. When activated, the neurostimulator delivers impulses that help regulate the electrical activity of the brain, resulting in better movementcontrol and symptom relief.
The outcome can be dramatic. Dr. Kopell recently treated a woman with symptoms of Parkinson’s disease: a shuffling gait, general slowness, a distant mien. With DBS, she walks and moves almost normally. The most astonishing transformation is in her face — when she turns the neurostimulator on, her eyes light up, she smiles — she seems completely present.
Dr. Kopell believes movement disorders are just the tip of the iceberg for restorative neurosurgery like DBS. “These devices will evolve and change in the years ahead,” he says. “I believe we will be able to alter disease in ways we have only dreamed about.”
Currently, DBS is used to treat pain and movement disorders. “In the next five years,” Dr. Kopell notes, “I think we will see more sophisticated procedures for addressing difficult cases of depression, for Obsessive-Compulsive Disorder and Tourette’s syndrome.” He also believes DBS could prove effective in treating addictions, tinnitus (ringing in the ears), some types of learning disabilities like dyslexia, perhaps autism. Further down the road, it might even yield new hope for patients with Alzheimer’s disease.
“Our ability to develop devices to alter the modality of the nervous system electrically and chemically will be much greater than our ability to manipulate it on a cellular level — for instance, through gene or stem cell therapy,” says Dr. Kopell.
He predicts today’s technology will eventually evolve into devices that treat epilepsy. “Our current approach is to find the area of the brain causing seizures and cut it out. It works well, but of course there are side effects,” he says. “If we could regulate the electrical activity that gives rise to the seizures, we could potentially cure the condition.”
Dr. Kopell thinks restorative technology could some day help reverse the damage done by neurological trauma. “Within 10 years, we could begin to see neuro-prosthetic devices to treat patients with damage caused by stroke or spinal cord injury.”
Precision TargetingJ. Frank Wilson, MD, FACR, Medical College of Wisconsin radiation oncologist and chairman of Radiation Oncology, has more than three decades of experience using radiation energy to treat cancer.
The objectives are easy to grasp: hit the cancerous tissue, avoid the healthy tissue. According to Dr. Wilson, radiation oncology’s future belongs to image-guided radiotherapy — an approach that will accomplish both objectives better than previous technology.
Currently, physicians base radiation treatments on CT scans taken days or weeks in advance. The problem is tumors can change in a short time. Doctors perform a confirming scan right before therapy, but “targeting” the tumor with one device and “shooting” it with another introduces inaccuracies.
Dr. Wilson says image-guided radiotherapy solves both problems by incorporating a low-dose CT scanner in the treatment system. The onboard CT provides an instant update on the size and shape of the tumor. Doctors can make last-minute adjustments to the treatment plan. The bottom line is greater precision. “You see the tumor as you are treating it,” says Dr. Wilson, “You know radiation is going where it’s needed.”
This ability to pinpoint tumors raises the possibility of safely increasing the radiation dose for a variety of cancers. “In the future, we may be able to raise the intensity of daily treatments so that overall treatment time is shorter,” he says. How much shorter? “Depending on the situation, perhaps from six weeks down to two.”
Reading Cancer’s SignatureMark Malkin, MD, Medical College of Wisconsin neuro-oncologist, specializes in treating patients with brain tumors and related conditions.
Advances in genetic science and computer technology could someday help doctors create tailor-made cancer therapies.
Today, two people with the same kind of tumor typically receive the same treatment. The puzzle is that one patient might respond well, while the other does not. Why? According to Dr. Malkin, one reason is the individual genetic makeup of each tumor. If physicians could decode the genes of a tumor, they could pinpoint processes driving its growth. In theory, they could then administer drugs to block those processes.
Dr. Malkin says the technology already exists for reading the genetic signature of several tumors. Researchers have developed microchips covered with rows and columns of DNA material. “You extract DNA from a tumor and put it on top of the chip,” he says. “If the tumor makes the same DNA as what is on the microchip, there’s a green signal. If not, it’s a red signal.” By adding genes, he says, these chips will become more sophisticated at reading tumor DNA.
Dr. Malkin believes pharmaceutical companies will develop an array of drugs to take advantage of genetic information in the next several years. Drug therapies will be complex, but individualized. “We’ll have to give multiple drugs,” he says. “Not necessarily in one day — they may be timed so you first slow down process A, knowing process B will ramp up. Then you attack with a drug that handles process B.”
Breaking the Speed LimitWhile technology will help penetrate the microcosm of tumor genetics, other advances will enable caregivers to surpass medicine’s “speed barriers.”
Dennis Foley, MD, Medical College of Wisconsin radiologist, foresees the day when super-fast scanners replace some invasive procedures used to diagnose emergency symptoms.
Today, a patient with chest pain is often sent to the Cardiac Catheterization Laboratory for a coronary arteriogram. While safe and effective, it can take an hour or more and requires sedation, an incision and several hours of follow-up observation. Dr. Foley, chief of Digital Imaging at Froedtert & Medical College of Wisconsin, believes the same patient could someday be checked over in 10 minutes using GE’s LightspeedVCT imaging technology.
Froedtert & Medical College of Wisconsin recently became the first hospital in the world with a 64 channel VCT scanner — a computed tomography system that operates four times faster than a 16 channel CT. Speed enables the VCT to capture crisp images of the heart and arteries that show up as blurs on standard equipment.
If proven effective, the benefits of non-invasive imaging could go beyond heart care. Dr. Foley thinks VCT technology could one day help doctors quickly evaluate people with stroke symptoms.
Not Business as UsualWhile technology is driving many of the changes that will transform medicine in the future, others are coming from an unexpected quarter — the business world. Radiologist Dr. Dennis Foley puts it succinctly: “If you could get a hospital to function according to the standards of business, you would be doing a marvelous thing.”
For example, Dr. Foley thinks greater electronic integration — converting patient medical records to an electronic format — is one business efficiency in medicine’s future. He believes this will result in better communication between caregivers. “Clinicians could have fast access to diagnostic images,” he says. “At the same time, imaging departments could access clinical information that tells us how to tailor exams.”
Rob Becker, RN, BSN, a surgical nurse, believes computer technology will help streamline the nursing workload. Computer tracking systems for supply management are already in place at Froedtert & Medical College of Wisconsin in the angiography area, and Becker thinks they’ll become more widespread. He also anticipates patient charting will go electronic: “That would mean less paperwork for nurses.”
One of the most important trends at Froedtert & Medical College of Wisconsin comes directly from manufacturing — a quality improvement methodology known as Six Sigma. Cathy Buck, executive vice president and chief operations officer, says Six Sigma was developed in the early 1980s by engineers at Motorola. In 2000, Froedtert became one of the first healthcare organizations in the country to apply the methodology to the hospital environment.
Six Sigma improves processes by eliminating variations that lead to errors and inefficiencies. Froedtert project teams have used it to reduce the risk of medical errors, standardize treatment protocols and improve patient access and flow. “In almost all of these initiatives, we have, on average, accomplished 50% or better improvement in performance,” says Buck.
Only a handful of hospitals use Six Sigma, but Buck thinks it will become more common in the future. “Historically, medicine has been research-driven. On the other hand, efforts to improve quality have been more anecdotally driven,” she notes. “I see Six Sigma putting a lot more discipline around quality efforts.”
Steady Trends, Fresh DevelopmentsLike other doctors, Mark Adams, MD, MS, foresees advances that will lead to new treatments and cures — and alter some of the most familiar aspects of healthcare.
Chairman of Surgery at Froedtert & Medical College of Wisconsin, Dr. Adams predicts large parts of his discipline will change in the coming years.
“In 10 to 20 years, cancer surgery could become a thing of the past,” he remarks. What will replace it? He believes the answer might be monoclonal antibodies — proteins engineered to attack particular forms of cancer. They work in much the same way that natural antibodies attack bacteria and viruses in the human body. Still, says Dr. Adams, surgery is by no means dead: “Surgeries for structural problems — for example, hernia repair and procedures for degenerative hip disorders — won’t be displaced.” Minimally invasive surgery, he adds, will continue to develop. “We’ll see further development of this technology — new cameras and laparoscopic equipment. The result will be surgeries performed with smaller and smaller incisions.”
Dr. Adams notes changes in surgery will have as much to do with shifting demographics as with advancing technology. “Over the last 20 to 30 years, the number of surgeries per person has increased,” he says. “With the aging of the population, this trend will continue.” These same forces could also make surgeons more scarce. “There will be a shortage of general surgeons within the next 10 years,” says Dr. Adams.
He also predicts that although more people will need organ transplants in the coming years, the organ supply will shrink. “When I was in training, we would not consider a transplant donation from anyone older than 50,” says Dr. Adams. “Now we transplant organs donated from people in their 70s.”
The Human TouchWhile medicine becomes increasingly high-tech, many people at Froedtert talk about a future that is high-touch as well. Medicine will call for more patient involvement, not less.
Stephanie Christian-Lobley, APNP, CNRN, a nurse practitioner on the neurosurgery team, thinks making people aware of health issues will be critical. “Prevention will be key,” she says. “We see many ads for managing stroke, high blood pressure, diabetes.” In the coming years, Christian-Lobley thinks we’ll also see more stroke clinical trials investigating preventive treatments in this patient population.
Julie Griffie, APRN-BC, a clinical nurse specialist in the Froedtert & Medical College of Wisconsin Breast Cancer Program, says the increasing emphasis on genetics will make it important for patients to know their family health histories. “A lot of family history is unclear or incomplete,” she says. “Your parents may know grandma’s sister died, but not what she died of.”
Health professionals will likely help patients complete two or three-generation family medical histories. “We need to educate families on how to obtain this information so it isn’t lost,” Griffie says. “It will be important for prevention, as well as for treatment.”
A Vanishing FrontierFor Radiation Oncologist Dr. J. Frank Wilson, looking ahead to the future of medicine goes hand in hand with looking back at its past. He is struck by the distance between where we are now and where we were not that long ago.
“Looking back at my decades in the field, I can say we don’t do anything now the way we did it 35 years ago,” he says. “And I think that’s a trend that will continue — probably indefinitely.”
Dr. Wilson has a keen sense of the difficulty of peering into the horizon. “In the next 30 years, I speculate medicine will be totally transformed — but I don’t know how.”
Source: Froedtert Today Date: September 2005 |
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