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Ukazujem Revíziu 4 vytvorenú 05/08/2020 od MadisonHensel96.

  1. My name is Dr. Moses deGraft-Johnson.
  2. The term “assistive technology” is defined
  3. by the World Health Organization (WHO)
  4. as an umbrella term that covers
  5. systems and services that are related to
  6. the delivery of assistive products and
  7. services, and the whole purpose
  8. of this is to aid an individual by giving
  9. them independence and promoting their
  10. overall well-being.
  11. Now, as my colleague here just showed us
  12. some very cool innovations,
  13. some of the innovations that we
  14. are very familiar with are the simplest
  15. things such as the hearing aids,
  16. wheelchairs, and the prosthesis. Even
  17. something as simple as pill organizers,
  18. because this is something even people
  19. without a true disability utilize, you
  20. know? My mother utilizes pill organizers.
  21. So we find that there are certain
  22. assistive technologies that even
  23. individuals who do not have a true
  24. disability also utilize in their daily
  25. lives. And we’re seeing more and more
  26. of that globally; more than
  27. one billion people need one or more
  28. assistive products.
  29. Now this is the part that I really want to
  30. get into, because this really talks about
  31. what I do for a living,
  32. and recently what we’ve seen is that the
  33. World Health Organization released some
  34. data, and what we see is a rise in
  35. non-communicable diseases that are
  36. causing persons with disability.
  37. And one of the most common ones that was
  38. mentioned was diabetes. But also, along
  39. with diabetes was hypertension and
  40. hyperlipidemia, also known simply
  41. as high cholesterol, obesity, and smoking.
  42. Now what’s interesting is that these five
  43. variables are also known in cardiovascular
  44. medicine as the five major risk factors
  45. for a major cardiovascular event
  46. They lead to something called
    atheromatous plaque.
  47. This is plaque formation of buildup in
  48. our blood vessels. This is an example of a
  49. normal coronary artery in the heart,
  50. and as we see, over time we get damages,
  51. buildups, and eventually we have lack of
  52. perfusion, or lack of blood flow.
  53. And that’s what eventually leads to heart
  54. attacks, strokes, and poor circulation,
  55. commonly known as “P-A-D.”
  56. Now, at the Heart and Vascular Institute,
  57. what we have done is we have an
  58. initiative called the
    "Save a Limb Initiative."
  59. One of the things that my goal was was to
  60. at least limit the amount of amputations
  61. that were occurring in that community.
  62. When we see patients who have these
  63. sorts of problems, the first thing we
  64. do after we’ve assessed them is called
  65. acute limb ischemia. We take them
  66. into the operating room and utilize a
  67. GE system called a C-ARM.
  68. What it does is it’s an X-ray that takes
  69. pictures of the legs from the bellybutton
  70. all the way down to the feet.
  71. We use contrast dye to inject into the
  72. patients so it will allow us to give us an
  73. image, sort of like this.
  74. So this first picture here… clearly you
  75. don’t need to be a doctor to see there’s a
  76. significant problem here. This is called
  77. This is called the superficial femoral
  78. artery. this is the big vessel that lies
  79. between your hip and your knee.
  80. It’s like a highway that’s not complete
  81. because there’s something missing here,
  82. right in the middle.
  83. So this individual has developed a
  84. blockage in that blood vessel that has
  85. definitely caused a total occlusion of
  86. blood flow flowing from this part,
  87. which is coming from the belly button area
  88. going down to the knee.
  89. So once we take that picture with that GE
  90. system, I’m able to see this and initial,
  91. and right here I’m able to, just like a
  92. plumber does, you know, you
    snake the pipes.
  93. So here you have a specific type of water
  94. system that I use to cross the artery.
  95. And once I cross the water system, on this
  96. side… I’m going to show you this picture
  97. here… I use a system called
  98. a jetstream atherectomy device.
  99. Now this system is a system that is made
  100. by a company called Boston Scientific.
  101. Boston Scientific is a medical device
  102. company based out of
  103. Maple Grove Minneapolis, in Minnesota.
  104. And what it is is that basically we use
  105. this device, it’s like a drilling system.
  106. Just like in the oil fields, they drill
  107. the ground. We use this system over that
  108. wire that I’ve put into the system and
  109. we’re able to go over the wire and clean
  110. out the plaques that have formed.
  111. Once that plaque is cleaned out, we use a
  112. balloon system to stretch out the
  113. blood vessels to really give it a wide
  114. opening, and sometimes once it stays open,
  115. if it stays open it’s fine but if it
  116. doesn’t stay open, it has a tendency
  117. to constrict again, and that’s when
  118. we have a tendency to put in a stent
  119. to keep it open. So in this picture right
  120. here, this diagram, you see that we were
  121. successful opening up this total occlusion
  122. here, and opening it up and restoring
  123. blood flow back to the limb.
  124. This is an actual photograph of one of my
  125. patients. Unfortunately, this was a
  126. gentleman that we were not able to save
  127. his leg. So this is six weeks
  128. after surgery after I amputated.
  129. This is called a BKA, a below the knee
  130. amputation. And I often say that if
  131. you’re not fortunate enough for me to save
  132. the limb, I’d rather you have a
  133. below the knee amputation versus
  134. above the knee amputation, because
  135. functionality-wise it’s better for the
  136. individual because we’re able to really
  137. fit him very well with a good prosthesis,
  138. that they can go back and handle it and
  139. walk as if nothing ever happened.
  140. But it becomes a huge challenge once you
  141. go above the knee. It’s very hard to fit
  142. someone for any good prosthesis,
  143. for them to bear weight.
  144. We call this the “stump line.”
  145. And we have a tendency to have a lot of
  146. breakdown on this stump line.
  147. So it just makes things a little bit
  148. difficult. So unfortunately, I was not
  149. able to save this man’s leg sine we had
  150. the surgery, and this is him and his wife
  151. after surgery.
  152. So this is the sort of assistive
  153. technology we’re used to seeing.
  154. And in the past, I have to admit,
  155. I have to be clear and be honest with you,
  156. I never really paid attention to a lot of
  157. this stuff until I met Chet Cooper.
  158. That’s when I started to really focus and
  159. pay attention to these things.
  160. They’re right in front of us, they’re
  161. right around us, but we’re so busy with
  162. our daily lives we don’t pay attention to
  163. things that are happening.
  164. But this is now a big problem and a part
  165. of my practice right now, of what I do.
  166. So once we have saved the limb,
  167. the question is then how do you prevent
  168. them from ending up like this gentleman.
  169. So we have a technology called the SPY.
  170. The SPY was developed by a company
  171. called Novadaq and then they sold it off
  172. to a company called Stryker.
  173. Stryker is a big medical device company
  174. that does a lot of spine surgery for
  175. people with back problems and this sort
  176. of thing. So it’s kind of shocking why
  177. they got into the vascular business. But
  178. anyway, with SPY technology, what it does
  179. is that it utilizes a fluorescent agent
  180. that we inject into the patient, so after
  181. the patient has had the
    revascularization procedure,
  182. they follow up at the office, we inject
  183. them with the fluorescent agent,
  184. and what it does is that we’re able to put
  185. this camera right on their feet, right
  186. overhead, and it gives us
    this thermal imaging.
  187. So when you see this right here, that’s
  188. good news. Actually the redder, the more
  189. red it is, the better it is. It means you
  190. have really good flow.
  191. And as the area gets a little bit blue,
  192. that means you have diminishing blood
  193. flow in that area. And when it gets to be
  194. like this, you know you have a serious
  195. problem. So this type of stuff is what
  196. we’ve been doing for people in Miami,
  197. for people in the Florida region.
  198. And so I started to take this type of
  199. practice back to Ghana.
  200. Ghana is very interesting to me, not only
  201. because I’m from Ghana,
  202. but I’ve been very impressed with the
  203. government of Ghana in terms of their
  204. initiatives, which is a little bit
  205. surprising to me because in those parts
  206. of the world there’s a stigma that is
  207. associated with individuals or persons
  208. with disability.
  209. Ghana is a small country in West Africa,
  210. the population is about 28 million.
  211. The GDP is about $130 billion. That puts
  212. them at number 12 out of 52 of African
  213. countries, and it’s actually the blueprint
  214. for African democracy. It’s a
  215. constitutional republic.
  216. And English is the official language
    of the country.
  217. About 15 percent of the Ghana population
  218. are persons with disability.
  219. In 2006, the country passed a disability
  220. law, and the purpose for this was to end
  221. discrimination against individuals with
  222. disability in the country.
  223. The country has been working very very
  224. hard to improve the living conditions
  225. of individuals that live there.
  226. My foundation, what we’ve done is that,
  227. we’re really focusing on, because
  228. disabilities, there are so many causes of
  229. disabilities, from congenital diseases to
  230. hereditary diseases and also acquired
  231. diseases. With the acquired diseases,
  232. my focus is really on the
  233. noncommunicable diseases, because it
  234. really falls in line with something we
  235. have knowledge on. So what I've done is
  236. that I’ve invested my own money into
  237. building a hospital. This is a rendering,
  238. a rendition, of the hospital,
    the deGraft Research Hospital,
  239. and the purpose of this hospital
  240. is to facilitate the work that we
  241. have done very successfully in Florida.
  242. This is more images, and this is the
  243. current progress of the hospital.
  244. So hopefully by the end of next year
  245. we will complete this project,
  246. and then we will be able to offer the same
  247. things we offer the people of Florida,
  248. in Ghana. Thank you.