"What I see you see". The name of the application developed by a Uruguayan team led by the traumatologist Alberto Fernández (and a team of international eminences in traumatology and orthopedics) refers to this maxim. ICUC, the name of this app available for free for iPad, symbolizes that very thing: I see you see, because that is how these letters are pronounced in English.
The application allows any user to access a database of more than 1,000 cases of fractures, including from the diagnosis to the postoperative period, as well as a follow-up of the patient's evolution; this allows to evaluate the results of the technique or techniques applied to solve the problem. These 1,000 cases, to which new ones are added every year -currently the Uruguayan team that processes them is working on 1,000 more to incorporate to the app- include hundreds of plates and photographs (more than 10 thousand) as well as videos and 3D animations which, together, allow to recreate almost first hand the ways in which, for example, a person with a complex fracture in his hand was operated, among many others.
The origin
This tool at the service of medicine was born out of the conviction of Fernández, who is director of the Master's program in Traumatology at the Center for Biomedical Sciences at the University of Montevideo and head of the Traumatology Service at the British Hospital, that the way doctors learn and experience new technologies is "out of date".
"This is the future of medical education," the trauma doctor told Cromo. "We can't automatically move what we learn in books and journals into a digital format. The dynamics are different," he said.
Traditionally, scientific knowledge has been disseminated through research published in journals that must follow certain procedures and methodologies. In this way, the way of acquiring knowledge was - and is - quite univocal, Fernandez considered.
This, and a few other reasons - including his entrepreneurial spirit and his conviction that only through innovation is it possible to improve the quality of medicine - were the germ of a project that ended up in this sophisticated application.
But behind what you see on the iPad (video images, still images, three-dimensional images, opinions of orthopedic surgeons from around the world and more) there is a complex process that begins when specially trained Uruguayan orthopedic surgeons are dedicated to collecting data in five internationally recognized orthopedic centers.
Stop talking and do
The myth that Fernández wanted to debunk this time is that everything that can and should be done in medicine is written in some specialized journal. Twelve years ago, the Uruguayan began to discuss the subject in depth with his Swiss colleague Stephan Perren, a doctor who is now 83 years old, recognized as an international authority on surgical fixation of bone fractures. Perren was director of the AO Research Institute in Davos, Switzerland, where he researched the mechanobiology of surgical fracture treatment.
"I said, Stephan, we're in trouble. In the journals we see two cases out of 100 that were operated on for a certain fracture and that were taken for that study, but I want to see all the cases and not just the two they chose, maybe because they liked the way they turned out. But I want to see all the cases and not just the two they chose, maybe because they were the ones they liked the way they looked. What about the others? What do we do?" Fernandez recalled telling his colleague.
Perren doubled the bet: "Alberto, stop talking and do something". The first step was to present his first idea to one of the largest publishing groups in Germany: to publish a special scientific journal whose main difference is that all the cases on which an investigation is based are included in detail on a CD that is part of the paper publication. The almost natural heir to this first format was the ICUC application, which includes cases and real experiences documented, once a year, at the British Hospital and at four other leading centres in the field of traumatology: Lucerne and Zurich (Switzerland), Freiburg (Germany) and Milan (Italy).
The result is translated into a digital format in which the physician can view and understand the surgical experience at his or her fingertips. Each surgery is recorded photographically, in some cases with video; certain procedures include explanatory 3D animations. Many cases are commented on by experienced surgeons, on such particular topics as a very specific shoulder fracture in which a particular technique was used or implemented for the first time, for example.
From Uruguay
The material that is part of the app is recorded every year, in a pre-selected period in which specially trained Uruguayan orthopedic surgeons travel to the centers that are part of the initiative, to record and photograph all the operations that are done in that time range.
These operations cannot be selected by the centers; the result is a tool that shows the reality without filters, the successes and failures, as well as the advantages and disadvantages of certain techniques. All the details of the procedures are included in the app and the only thing that remains anonymous is the patient's identity. In Uruguay, the images are processed to erase any trace that could give away who that person is: from a tattoo to a mole. The same is done with details that can identify the center where the surgery was performed.
The application is free and the material included therein can be used in medical presentations or other publications, simply by crediting the source. In a first approach the user must choose which type of fracture he/she wants to explore in depth. Once the option is made, the user can download reference cases that include photos of the operation, step by step, in which the techniques and tools used can be seen and commented.
Then, on the same case you chose to review, it is possible to go deeper from the opinion of experts, either in video format or 3D animations -produced in Uruguay- that demonstrate how the technique is performed. At the same time, in the application's "library" you can select cases ranging from simple to very complex, which include all the images taken before (diagnosis), during and after surgery, as well as images of the patient after surgery, in positions that show to what extent the operation restored the normal movement of the bone that suffered the fracture. Often, a single case includes hundreds of images: plates, photographs and animations.
"This is the beginning of a new concept: that of sharing medical information in a serious and much more audited way," Fernández said. "It's not that someone tells us in a journal how well they did or how badly they did (although the latter is almost never seen in scientific journals, despite the fact that there are many cases that go wrong). The concept is to see what went right, wrong and so-so," he told Cromo.
What for now is limited to fracture surgeries could become a format that could be extended to other medical specialties. "It should be the new way of learning," said the Uruguayan. The challenge, devised and also developed every day from Uruguay, has been set.
How to use
After downloading the app(available only for iPad), the user must create an account and can start browsing the hundreds of cases that are already part of this tool. They will be able to choose the content to consult it even without an internet connection. To start, you can choose between upper or lower limbs and, in particular, select specific points. In the Settings area of the app it is possible to activate a tutorial.
A surgeon inventor
Alberto Fernández, Director of the Master's Degree in Traumatology at the Biomedical Sciences Center of the University of Montevideo.
"I am an inventor surgeon". This is how Alberto Fernández, a physician with almost four decades of experience, who is the director of the Master's Degree in Traumatology at the Center for Biomedical Sciences of the University of Montevideo and head of the Traumatology Service of the British Hospital, has defined himself more than once. "To innovate is to define the problem and do it well. Then look for the solution," explained the first Latin American to join the Spanish Society of Orthopaedic Surgery. "The first thing I do is to debunk myths. Look for what everyone says is true and analyze if it is so true".
This was the impetus that led him to develop the ICUC app, but also a series of medical products - at least 20 - that he has patented and that are used in Uruguay and around the world in fracture surgeries, including special pins, plates and another series of mechanisms that are developed in his laboratory in Uruguay. He achieved all of this despite the fact that, as he once said in an interview on the program In Perspective, what he learned in medical school was to have a "copycat mentality". "They told me: 'You can't invent, you're Uruguayan, just copy and copy the best you can.
Source: Chrome
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