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Official Newspaper of the American College of Surgeons
Getting a handle on goals of care
She presented to the trauma bay after transfer from another hospital. She had fallen out of bed at the nursing home, and they had sent her to the emergency department for evaluation. Her head CT demonstrated a subacute chronic subdural hematoma. She had fallen a month ago and had been seen at the same hospital and was transferred to us then, too, but not as a trauma. Admitted to another service for a few days, she had subsequently been sent to the nursing home with weekly head CT scans for follow-up. Today’s CT showed continued resolution of her subdural hematoma, but since she had fallen and had an abnormal CT scan, she was transferred to us as a trauma for further evaluation.
The patient was elderly, in her 90s, with end-stage dementia. The trauma team descended on her as we do with all traumas – to evaluate for life-threatening injuries. Airway, breathing, circulation. Does she need to be intubated? What is her blood pressure? Place IVs and draw blood. Put her quickly on the monitors, undress her completely. Roll her on her side to examine her back. Make sure she is in a rigid C-collar and cannot move her neck until we are sure it isn’t fractured. She cannot sit up despite her desire to do so, thus requiring us to hold her down, so she doesn’t injure herself or others. In the midst of all this, she kept screaming, "Why do you keep doing this to me?" That was all she said. Repeatedly. As I sorted out the events of the past month, read the radiologist report from the referring institution that documented improvement in her scans, and reviewed all the CTs on disc, I wondered the same, "Why are we doing this to you?" She didn’t need a trauma center or the trauma team. What she needed was a goals of care discussion and POLST (Physician Orders for Life-Sustaining Treatment) document.
We, as doctors, are poor at discussing goals of care. Even for those patients who are expected to do well, we do not address code status, or ask them what they want if things go poorly. Recently, the University of California published their results with a quality improvement program to document advance care planning discussions. Between July 2011 and May 2012 on the medical service, they created an incentive program for documentation of goals of care and identification of a surrogate decision maker. If 75% of patients had the two items documented in the medical record, then the residents received a $400 incentive. Documentation (and likely actual discussion) increased from 22% in July to 90% by October and remained at that level. There were reminders and feedback, and it seems likely a component of peer pressure among the residents to ensure everyone received the incentive. The study did not track outcomes or documentation rates after the program was over. The study did show that behavior of initiating difficult end-of-life (EOL) planning discussions can be improved in a quality improvement program. (JAMA Intern. Med. 2013 [doi: 10.1001/jamainternmed.2013.8158]).
Ideally, the next step would be to document the use of POLST (www.polst.org) orders. POLST is a bright pink form that documents the patient’s preferences for code status, treatment options (full including ICU, limited, or comfort measures including no transport to hospital) artificial nutrition and hydration, and antibiotics. POLST is signed by a physician and, therefore, it can be applied across care settings. If it is signed by the patient, it cannot be overridden by the surrogate, and there are legal protections for health care providers.
We admitted the patient in the trauma bay, not because she needed acute care, but because she needed goals of care defined. We consulted Palliative Medicine and had the social worker identify a decision maker. Palliative Medicine worked with the surrogate decision maker to set goals of care: feeding tube, follow-up scans, code status, and most importantly POLST orders. Regrettably, it took a trip to the Trauma Bay after multiple interactions with the health care system to evaluate what really was in the best interest of the patient and what she would have wanted. She told us as best she could that she did not want what we were doing to her. This time, we listened.
Dr Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh, Pa. She has a Masters degree in bioethics and board-certification in hospice and palliative medicine.
She presented to the trauma bay after transfer from another hospital. She had fallen out of bed at the nursing home, and they had sent her to the emergency department for evaluation. Her head CT demonstrated a subacute chronic subdural hematoma. She had fallen a month ago and had been seen at the same hospital and was transferred to us then, too, but not as a trauma. Admitted to another service for a few days, she had subsequently been sent to the nursing home with weekly head CT scans for follow-up. Today’s CT showed continued resolution of her subdural hematoma, but since she had fallen and had an abnormal CT scan, she was transferred to us as a trauma for further evaluation.
The patient was elderly, in her 90s, with end-stage dementia. The trauma team descended on her as we do with all traumas – to evaluate for life-threatening injuries. Airway, breathing, circulation. Does she need to be intubated? What is her blood pressure? Place IVs and draw blood. Put her quickly on the monitors, undress her completely. Roll her on her side to examine her back. Make sure she is in a rigid C-collar and cannot move her neck until we are sure it isn’t fractured. She cannot sit up despite her desire to do so, thus requiring us to hold her down, so she doesn’t injure herself or others. In the midst of all this, she kept screaming, "Why do you keep doing this to me?" That was all she said. Repeatedly. As I sorted out the events of the past month, read the radiologist report from the referring institution that documented improvement in her scans, and reviewed all the CTs on disc, I wondered the same, "Why are we doing this to you?" She didn’t need a trauma center or the trauma team. What she needed was a goals of care discussion and POLST (Physician Orders for Life-Sustaining Treatment) document.
We, as doctors, are poor at discussing goals of care. Even for those patients who are expected to do well, we do not address code status, or ask them what they want if things go poorly. Recently, the University of California published their results with a quality improvement program to document advance care planning discussions. Between July 2011 and May 2012 on the medical service, they created an incentive program for documentation of goals of care and identification of a surrogate decision maker. If 75% of patients had the two items documented in the medical record, then the residents received a $400 incentive. Documentation (and likely actual discussion) increased from 22% in July to 90% by October and remained at that level. There were reminders and feedback, and it seems likely a component of peer pressure among the residents to ensure everyone received the incentive. The study did not track outcomes or documentation rates after the program was over. The study did show that behavior of initiating difficult end-of-life (EOL) planning discussions can be improved in a quality improvement program. (JAMA Intern. Med. 2013 [doi: 10.1001/jamainternmed.2013.8158]).
Ideally, the next step would be to document the use of POLST (www.polst.org) orders. POLST is a bright pink form that documents the patient’s preferences for code status, treatment options (full including ICU, limited, or comfort measures including no transport to hospital) artificial nutrition and hydration, and antibiotics. POLST is signed by a physician and, therefore, it can be applied across care settings. If it is signed by the patient, it cannot be overridden by the surrogate, and there are legal protections for health care providers.
We admitted the patient in the trauma bay, not because she needed acute care, but because she needed goals of care defined. We consulted Palliative Medicine and had the social worker identify a decision maker. Palliative Medicine worked with the surrogate decision maker to set goals of care: feeding tube, follow-up scans, code status, and most importantly POLST orders. Regrettably, it took a trip to the Trauma Bay after multiple interactions with the health care system to evaluate what really was in the best interest of the patient and what she would have wanted. She told us as best she could that she did not want what we were doing to her. This time, we listened.
Dr Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh, Pa. She has a Masters degree in bioethics and board-certification in hospice and palliative medicine.
She presented to the trauma bay after transfer from another hospital. She had fallen out of bed at the nursing home, and they had sent her to the emergency department for evaluation. Her head CT demonstrated a subacute chronic subdural hematoma. She had fallen a month ago and had been seen at the same hospital and was transferred to us then, too, but not as a trauma. Admitted to another service for a few days, she had subsequently been sent to the nursing home with weekly head CT scans for follow-up. Today’s CT showed continued resolution of her subdural hematoma, but since she had fallen and had an abnormal CT scan, she was transferred to us as a trauma for further evaluation.
The patient was elderly, in her 90s, with end-stage dementia. The trauma team descended on her as we do with all traumas – to evaluate for life-threatening injuries. Airway, breathing, circulation. Does she need to be intubated? What is her blood pressure? Place IVs and draw blood. Put her quickly on the monitors, undress her completely. Roll her on her side to examine her back. Make sure she is in a rigid C-collar and cannot move her neck until we are sure it isn’t fractured. She cannot sit up despite her desire to do so, thus requiring us to hold her down, so she doesn’t injure herself or others. In the midst of all this, she kept screaming, "Why do you keep doing this to me?" That was all she said. Repeatedly. As I sorted out the events of the past month, read the radiologist report from the referring institution that documented improvement in her scans, and reviewed all the CTs on disc, I wondered the same, "Why are we doing this to you?" She didn’t need a trauma center or the trauma team. What she needed was a goals of care discussion and POLST (Physician Orders for Life-Sustaining Treatment) document.
We, as doctors, are poor at discussing goals of care. Even for those patients who are expected to do well, we do not address code status, or ask them what they want if things go poorly. Recently, the University of California published their results with a quality improvement program to document advance care planning discussions. Between July 2011 and May 2012 on the medical service, they created an incentive program for documentation of goals of care and identification of a surrogate decision maker. If 75% of patients had the two items documented in the medical record, then the residents received a $400 incentive. Documentation (and likely actual discussion) increased from 22% in July to 90% by October and remained at that level. There were reminders and feedback, and it seems likely a component of peer pressure among the residents to ensure everyone received the incentive. The study did not track outcomes or documentation rates after the program was over. The study did show that behavior of initiating difficult end-of-life (EOL) planning discussions can be improved in a quality improvement program. (JAMA Intern. Med. 2013 [doi: 10.1001/jamainternmed.2013.8158]).
Ideally, the next step would be to document the use of POLST (www.polst.org) orders. POLST is a bright pink form that documents the patient’s preferences for code status, treatment options (full including ICU, limited, or comfort measures including no transport to hospital) artificial nutrition and hydration, and antibiotics. POLST is signed by a physician and, therefore, it can be applied across care settings. If it is signed by the patient, it cannot be overridden by the surrogate, and there are legal protections for health care providers.
We admitted the patient in the trauma bay, not because she needed acute care, but because she needed goals of care defined. We consulted Palliative Medicine and had the social worker identify a decision maker. Palliative Medicine worked with the surrogate decision maker to set goals of care: feeding tube, follow-up scans, code status, and most importantly POLST orders. Regrettably, it took a trip to the Trauma Bay after multiple interactions with the health care system to evaluate what really was in the best interest of the patient and what she would have wanted. She told us as best she could that she did not want what we were doing to her. This time, we listened.
Dr Toevs is a trauma critical care surgeon at Allegheny General Hospital in Pittsburgh, Pa. She has a Masters degree in bioethics and board-certification in hospice and palliative medicine.
New ACS NSQIP surgical risk calculator offers personalized estimates of surgical complications
The new American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator is a revolutionary new tool that quickly and easily estimates patient-specific postoperative complication risks for almost all operations, according to research findings that appear online in the Journal of the American College of Surgeons, http://www.journalacs.org/article/S1072-7515(13)00894-6/pdf. The study will appear in a print edition of the Journal later this year.
Surgeons and patients have long sought an accurate decision-support tool to estimate patients’ risks of complications after surgical procedures. This process is essential for patient-centered care, shared decision making with patients, and true informed consent. The Centers for Medicare and Medicaid Services – through the Physician Quality Reporting System (PQRS) – may soon provide a financial incentive for surgeons to calculate the risks of operations using the Surgical Risk Calculator and to discuss these patient-specific risks with patients before elective procedures performed in the U.S.
"Predicting postoperative risks, and identifying patients at a higher risk of complications, have traditionally been based on anecdotal experience of the individual surgeon or small studies from other institutions. Importantly, these risk estimates have been generic and not specific to an individual patient’s risk factors. To have truly informed consent and shared decision making with a patient, we need the ability to provide customized, personal risk estimates for patients undergoing any operation," according to Karl Bilimoria, MD, FACS, ACS faculty scholar, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University, Chicago, and lead author of the study.
For the study, Dr. Bilimoria and colleagues used highly detailed and accurate ACS NSQIP data collected from nearly 400 hospitals and 1.4 million patients to develop a universal surgical risk calculator that covers more than 1,500 unique surgical procedures across multiple specialties. The authors leveraged outcomes data collected by ACS NSQIP to create the Surgical Risk Calculator.
"The quality and rigor of the ACS NSQIP clinical outcomes data were critical to the development and reliability of the Surgical Risk Calculator," explained study coauthor Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care.
The Surgical Risk Calculator allows surgeons to enter a total of 22 preoperative patient risk factors about their patients. Next, the risk calculator estimates the potential risks of mortality and eight important postoperative complications and displays these risks in comparison to "an average patient’s risks." The authors worked to ensure that the information would be presented in a patient-friendly way, accommodating a broad range of health literacy needs.
The authors also performed rigorous tests to ensure the validity of the risk estimates provided by the Surgical Risk Calculator. The investigators reported that the ACS NSQIP Surgical Risk Calculator yielded excellent prediction results for death, overall complication, and serious complication rates, as well as six additional postoperative complications: pneumonia, heart problem, surgical site infection, urinary tract infection, blood clot, and kidney failure. In addition, the Surgical Risk Calculator estimates a customized length of hospital stay for the patient.
However, other hard-to-measure factors may increase a patient’s risk of postoperative complications, so the web-based risk calculator includes an important novel feature: a Surgeon Adjustment Score that allows surgeons to increase the risk of an operation based on their subjective assessment of a patient. This feature enables surgeons to better counsel patients using both the modeled estimate along with the surgeon’s experience and evaluation of the patient.
The risk calculator has been released publicly and is available to surgeons, clinicians, and the public at: www.riskcalculator.facs.org. According to Dr. Bilimoria, the calculator will be enhanced regularly with additional outcomes added to the tool, as well as release of mobile versions.
In addition to Dr. Bilimoria and Dr. Ko, other participants in the study were Yaoming Liu, PhD; Jennifer Paruch, MD; Lynn Zhou, PhD; Thomas E. Kmiecik, PhD; and Mark E. Cohen, PhD. The researchers are from the Division of Research and Optimal Patient Care, American College of Surgeons (Chicago, IL); Surgical Outcomes and Quality Improvement Center, department of surgery, Feinberg School of Medicine, Northwestern University (Chicago, IL) and the department of surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System. This study was supported in part by the Agency for Healthcare Research and Quality.
The new American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator is a revolutionary new tool that quickly and easily estimates patient-specific postoperative complication risks for almost all operations, according to research findings that appear online in the Journal of the American College of Surgeons, http://www.journalacs.org/article/S1072-7515(13)00894-6/pdf. The study will appear in a print edition of the Journal later this year.
Surgeons and patients have long sought an accurate decision-support tool to estimate patients’ risks of complications after surgical procedures. This process is essential for patient-centered care, shared decision making with patients, and true informed consent. The Centers for Medicare and Medicaid Services – through the Physician Quality Reporting System (PQRS) – may soon provide a financial incentive for surgeons to calculate the risks of operations using the Surgical Risk Calculator and to discuss these patient-specific risks with patients before elective procedures performed in the U.S.
"Predicting postoperative risks, and identifying patients at a higher risk of complications, have traditionally been based on anecdotal experience of the individual surgeon or small studies from other institutions. Importantly, these risk estimates have been generic and not specific to an individual patient’s risk factors. To have truly informed consent and shared decision making with a patient, we need the ability to provide customized, personal risk estimates for patients undergoing any operation," according to Karl Bilimoria, MD, FACS, ACS faculty scholar, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University, Chicago, and lead author of the study.
For the study, Dr. Bilimoria and colleagues used highly detailed and accurate ACS NSQIP data collected from nearly 400 hospitals and 1.4 million patients to develop a universal surgical risk calculator that covers more than 1,500 unique surgical procedures across multiple specialties. The authors leveraged outcomes data collected by ACS NSQIP to create the Surgical Risk Calculator.
"The quality and rigor of the ACS NSQIP clinical outcomes data were critical to the development and reliability of the Surgical Risk Calculator," explained study coauthor Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care.
The Surgical Risk Calculator allows surgeons to enter a total of 22 preoperative patient risk factors about their patients. Next, the risk calculator estimates the potential risks of mortality and eight important postoperative complications and displays these risks in comparison to "an average patient’s risks." The authors worked to ensure that the information would be presented in a patient-friendly way, accommodating a broad range of health literacy needs.
The authors also performed rigorous tests to ensure the validity of the risk estimates provided by the Surgical Risk Calculator. The investigators reported that the ACS NSQIP Surgical Risk Calculator yielded excellent prediction results for death, overall complication, and serious complication rates, as well as six additional postoperative complications: pneumonia, heart problem, surgical site infection, urinary tract infection, blood clot, and kidney failure. In addition, the Surgical Risk Calculator estimates a customized length of hospital stay for the patient.
However, other hard-to-measure factors may increase a patient’s risk of postoperative complications, so the web-based risk calculator includes an important novel feature: a Surgeon Adjustment Score that allows surgeons to increase the risk of an operation based on their subjective assessment of a patient. This feature enables surgeons to better counsel patients using both the modeled estimate along with the surgeon’s experience and evaluation of the patient.
The risk calculator has been released publicly and is available to surgeons, clinicians, and the public at: www.riskcalculator.facs.org. According to Dr. Bilimoria, the calculator will be enhanced regularly with additional outcomes added to the tool, as well as release of mobile versions.
In addition to Dr. Bilimoria and Dr. Ko, other participants in the study were Yaoming Liu, PhD; Jennifer Paruch, MD; Lynn Zhou, PhD; Thomas E. Kmiecik, PhD; and Mark E. Cohen, PhD. The researchers are from the Division of Research and Optimal Patient Care, American College of Surgeons (Chicago, IL); Surgical Outcomes and Quality Improvement Center, department of surgery, Feinberg School of Medicine, Northwestern University (Chicago, IL) and the department of surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System. This study was supported in part by the Agency for Healthcare Research and Quality.
The new American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator is a revolutionary new tool that quickly and easily estimates patient-specific postoperative complication risks for almost all operations, according to research findings that appear online in the Journal of the American College of Surgeons, http://www.journalacs.org/article/S1072-7515(13)00894-6/pdf. The study will appear in a print edition of the Journal later this year.
Surgeons and patients have long sought an accurate decision-support tool to estimate patients’ risks of complications after surgical procedures. This process is essential for patient-centered care, shared decision making with patients, and true informed consent. The Centers for Medicare and Medicaid Services – through the Physician Quality Reporting System (PQRS) – may soon provide a financial incentive for surgeons to calculate the risks of operations using the Surgical Risk Calculator and to discuss these patient-specific risks with patients before elective procedures performed in the U.S.
"Predicting postoperative risks, and identifying patients at a higher risk of complications, have traditionally been based on anecdotal experience of the individual surgeon or small studies from other institutions. Importantly, these risk estimates have been generic and not specific to an individual patient’s risk factors. To have truly informed consent and shared decision making with a patient, we need the ability to provide customized, personal risk estimates for patients undergoing any operation," according to Karl Bilimoria, MD, FACS, ACS faculty scholar, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University, Chicago, and lead author of the study.
For the study, Dr. Bilimoria and colleagues used highly detailed and accurate ACS NSQIP data collected from nearly 400 hospitals and 1.4 million patients to develop a universal surgical risk calculator that covers more than 1,500 unique surgical procedures across multiple specialties. The authors leveraged outcomes data collected by ACS NSQIP to create the Surgical Risk Calculator.
"The quality and rigor of the ACS NSQIP clinical outcomes data were critical to the development and reliability of the Surgical Risk Calculator," explained study coauthor Clifford Y. Ko, MD, FACS, director of the ACS Division of Research and Optimal Patient Care.
The Surgical Risk Calculator allows surgeons to enter a total of 22 preoperative patient risk factors about their patients. Next, the risk calculator estimates the potential risks of mortality and eight important postoperative complications and displays these risks in comparison to "an average patient’s risks." The authors worked to ensure that the information would be presented in a patient-friendly way, accommodating a broad range of health literacy needs.
The authors also performed rigorous tests to ensure the validity of the risk estimates provided by the Surgical Risk Calculator. The investigators reported that the ACS NSQIP Surgical Risk Calculator yielded excellent prediction results for death, overall complication, and serious complication rates, as well as six additional postoperative complications: pneumonia, heart problem, surgical site infection, urinary tract infection, blood clot, and kidney failure. In addition, the Surgical Risk Calculator estimates a customized length of hospital stay for the patient.
However, other hard-to-measure factors may increase a patient’s risk of postoperative complications, so the web-based risk calculator includes an important novel feature: a Surgeon Adjustment Score that allows surgeons to increase the risk of an operation based on their subjective assessment of a patient. This feature enables surgeons to better counsel patients using both the modeled estimate along with the surgeon’s experience and evaluation of the patient.
The risk calculator has been released publicly and is available to surgeons, clinicians, and the public at: www.riskcalculator.facs.org. According to Dr. Bilimoria, the calculator will be enhanced regularly with additional outcomes added to the tool, as well as release of mobile versions.
In addition to Dr. Bilimoria and Dr. Ko, other participants in the study were Yaoming Liu, PhD; Jennifer Paruch, MD; Lynn Zhou, PhD; Thomas E. Kmiecik, PhD; and Mark E. Cohen, PhD. The researchers are from the Division of Research and Optimal Patient Care, American College of Surgeons (Chicago, IL); Surgical Outcomes and Quality Improvement Center, department of surgery, Feinberg School of Medicine, Northwestern University (Chicago, IL) and the department of surgery, University of California, Los Angeles and VA Greater Los Angeles Healthcare System. This study was supported in part by the Agency for Healthcare Research and Quality.
Attend didactic and skills-oriented courses at Clinical Congress for Self-Assessment Hours
Didactic and Skills-Oriented Postgraduate and Skills-Oriented Courses with a designated II and III verification level will be offered at the American College of Surgeons (ACS) 2013 Clinical Congress, October 6-10, in Washington, DC. These courses offer a self-assessment component toward Maintenance of Certification (MOC) Part 2.
The American Board of Surgery requires that at least 60 of the 90 Category I CME hours completed in a three-year MOC cycle include self-assessment activity. All requirements of these Postgraduate Courses must be completed to receive AMA PRA Category 1 Credits(tm) and hours toward self assessment. Find course requirements on the Verification Level chart found with the listing of Postgraduate and Skills-Oriented Courses on the 2013 Clinical Congress website at http://www.facs.org/clincon2013/scientific/postgraduate.html.
Sign up for one of the following courses, complete the requirements, and receive your self-assessment hours:
PG16: Endocrine Surgery Review Course
PG21: General Surgery Review Course
PG25: MOC Review: Essentials for Surgical Specialties
PG26: Update in Surgical Critical Care
PG28: Review of the Essentials of Vascular Surgery
SC04: Flexible Endoscopy for General Surgeons
SC06: FAST Ultrasound
SC07: Thyroid and Parathyroid Ultrasound
SC08: Interoperative Decisions in Laparoscopic Inguinal and Ventral Hernia Repair
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC12: Practical Applications of Ultrasound in the ICU: ECHO and Thoracic
SC14: Rural Surgery
Verification of completion of Postgraduate and Skills-Oriented Courses will be posted on ACS members’ My CME Transcript, and certificates will be sent via e-mail to nonmembers within six to eight weeks after Clinical Congress.
To register for Clinical Congress, go to the ACS website at http://www.facs.org/clincon2013/registration/index.html.
Didactic and Skills-Oriented Postgraduate and Skills-Oriented Courses with a designated II and III verification level will be offered at the American College of Surgeons (ACS) 2013 Clinical Congress, October 6-10, in Washington, DC. These courses offer a self-assessment component toward Maintenance of Certification (MOC) Part 2.
The American Board of Surgery requires that at least 60 of the 90 Category I CME hours completed in a three-year MOC cycle include self-assessment activity. All requirements of these Postgraduate Courses must be completed to receive AMA PRA Category 1 Credits(tm) and hours toward self assessment. Find course requirements on the Verification Level chart found with the listing of Postgraduate and Skills-Oriented Courses on the 2013 Clinical Congress website at http://www.facs.org/clincon2013/scientific/postgraduate.html.
Sign up for one of the following courses, complete the requirements, and receive your self-assessment hours:
PG16: Endocrine Surgery Review Course
PG21: General Surgery Review Course
PG25: MOC Review: Essentials for Surgical Specialties
PG26: Update in Surgical Critical Care
PG28: Review of the Essentials of Vascular Surgery
SC04: Flexible Endoscopy for General Surgeons
SC06: FAST Ultrasound
SC07: Thyroid and Parathyroid Ultrasound
SC08: Interoperative Decisions in Laparoscopic Inguinal and Ventral Hernia Repair
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC12: Practical Applications of Ultrasound in the ICU: ECHO and Thoracic
SC14: Rural Surgery
Verification of completion of Postgraduate and Skills-Oriented Courses will be posted on ACS members’ My CME Transcript, and certificates will be sent via e-mail to nonmembers within six to eight weeks after Clinical Congress.
To register for Clinical Congress, go to the ACS website at http://www.facs.org/clincon2013/registration/index.html.
Didactic and Skills-Oriented Postgraduate and Skills-Oriented Courses with a designated II and III verification level will be offered at the American College of Surgeons (ACS) 2013 Clinical Congress, October 6-10, in Washington, DC. These courses offer a self-assessment component toward Maintenance of Certification (MOC) Part 2.
The American Board of Surgery requires that at least 60 of the 90 Category I CME hours completed in a three-year MOC cycle include self-assessment activity. All requirements of these Postgraduate Courses must be completed to receive AMA PRA Category 1 Credits(tm) and hours toward self assessment. Find course requirements on the Verification Level chart found with the listing of Postgraduate and Skills-Oriented Courses on the 2013 Clinical Congress website at http://www.facs.org/clincon2013/scientific/postgraduate.html.
Sign up for one of the following courses, complete the requirements, and receive your self-assessment hours:
PG16: Endocrine Surgery Review Course
PG21: General Surgery Review Course
PG25: MOC Review: Essentials for Surgical Specialties
PG26: Update in Surgical Critical Care
PG28: Review of the Essentials of Vascular Surgery
SC04: Flexible Endoscopy for General Surgeons
SC06: FAST Ultrasound
SC07: Thyroid and Parathyroid Ultrasound
SC08: Interoperative Decisions in Laparoscopic Inguinal and Ventral Hernia Repair
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC12: Practical Applications of Ultrasound in the ICU: ECHO and Thoracic
SC14: Rural Surgery
Verification of completion of Postgraduate and Skills-Oriented Courses will be posted on ACS members’ My CME Transcript, and certificates will be sent via e-mail to nonmembers within six to eight weeks after Clinical Congress.
To register for Clinical Congress, go to the ACS website at http://www.facs.org/clincon2013/registration/index.html.
ACS and CoC join Choosing Wisely Campaign to identify overused procedures
The American College of Surgeons (ACS) and the Commission on Cancer (CoC) have joined more than 30 leading medical specialty societies in phase III of the Choosing Wisely ® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation. The campaign is a response to a 2012 report from the Institute of Medicine, Best Care at Lower Cost, which noted that up to 30 percent of health care spending is duplicative or unnecessary. To date, the campaign has brought together more than 80 organizations, including medical societies, regional health collaboratives, and consumer partners to support important physician-patient conversations about using the most appropriate tests and treatments, and avoiding care if its harm outweighs the benefits.
To spark these conversations, leading specialty societies have created lists of evidence-based recommendations that should be discussed to help physicians and patients make wise decisions about the most appropriate care based on a patient’s individual situation.
Choosing Wisely currently has put forth a list of more than 130 potentially unnecessary medical tests and will add to that number in late 2013 and early 2014 with the lists submitted by phase III participating groups. The ACS and the CoC have recently developed evidence-based lists of five tests/and or procedures that may be overused in their specific fields. The ACS and CoC lists will be released concurrently on the ACS and Choosing Wisely websites on September 4. For more information, visit: choosingwisely.org.
The American College of Surgeons (ACS) and the Commission on Cancer (CoC) have joined more than 30 leading medical specialty societies in phase III of the Choosing Wisely ® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation. The campaign is a response to a 2012 report from the Institute of Medicine, Best Care at Lower Cost, which noted that up to 30 percent of health care spending is duplicative or unnecessary. To date, the campaign has brought together more than 80 organizations, including medical societies, regional health collaboratives, and consumer partners to support important physician-patient conversations about using the most appropriate tests and treatments, and avoiding care if its harm outweighs the benefits.
To spark these conversations, leading specialty societies have created lists of evidence-based recommendations that should be discussed to help physicians and patients make wise decisions about the most appropriate care based on a patient’s individual situation.
Choosing Wisely currently has put forth a list of more than 130 potentially unnecessary medical tests and will add to that number in late 2013 and early 2014 with the lists submitted by phase III participating groups. The ACS and the CoC have recently developed evidence-based lists of five tests/and or procedures that may be overused in their specific fields. The ACS and CoC lists will be released concurrently on the ACS and Choosing Wisely websites on September 4. For more information, visit: choosingwisely.org.
The American College of Surgeons (ACS) and the Commission on Cancer (CoC) have joined more than 30 leading medical specialty societies in phase III of the Choosing Wisely ® campaign initiated by the American Board of Internal Medicine (ABIM) Foundation. The campaign is a response to a 2012 report from the Institute of Medicine, Best Care at Lower Cost, which noted that up to 30 percent of health care spending is duplicative or unnecessary. To date, the campaign has brought together more than 80 organizations, including medical societies, regional health collaboratives, and consumer partners to support important physician-patient conversations about using the most appropriate tests and treatments, and avoiding care if its harm outweighs the benefits.
To spark these conversations, leading specialty societies have created lists of evidence-based recommendations that should be discussed to help physicians and patients make wise decisions about the most appropriate care based on a patient’s individual situation.
Choosing Wisely currently has put forth a list of more than 130 potentially unnecessary medical tests and will add to that number in late 2013 and early 2014 with the lists submitted by phase III participating groups. The ACS and the CoC have recently developed evidence-based lists of five tests/and or procedures that may be overused in their specific fields. The ACS and CoC lists will be released concurrently on the ACS and Choosing Wisely websites on September 4. For more information, visit: choosingwisely.org.
IOM’s Best Care at Lower Cost reviews U.S. health care challenges
Best Care at Lower Cost is the Institute of Medicine’s most comprehensive look at the nation’s health care issues and challenges since the Quality Chasm series of a dozen years ago. In this report, the IOM not only updates insights on the quality of care, but also chronicles and underscores the challenges of health care’s growing complexity, cost, and waste, identifying some $750 billion in unnecessary expenditures annually and reviewing the opportunities for continuous learning and improvement. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health care system into a "\"learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery. With practical reference to proven approaches, the committee’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation. Acting on the insights in this volume will improve care quality, the patient experience, health care outcomes, and lower costs. For more information on Best Care at Lower Cost, go to the IOM’s website at http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx, or view the Clinicians-focused brief at http://iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Sector-Briefs/LearningHealthFactClinicians.pdf.
Best Care at Lower Cost is the Institute of Medicine’s most comprehensive look at the nation’s health care issues and challenges since the Quality Chasm series of a dozen years ago. In this report, the IOM not only updates insights on the quality of care, but also chronicles and underscores the challenges of health care’s growing complexity, cost, and waste, identifying some $750 billion in unnecessary expenditures annually and reviewing the opportunities for continuous learning and improvement. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health care system into a "\"learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery. With practical reference to proven approaches, the committee’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation. Acting on the insights in this volume will improve care quality, the patient experience, health care outcomes, and lower costs. For more information on Best Care at Lower Cost, go to the IOM’s website at http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx, or view the Clinicians-focused brief at http://iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Sector-Briefs/LearningHealthFactClinicians.pdf.
Best Care at Lower Cost is the Institute of Medicine’s most comprehensive look at the nation’s health care issues and challenges since the Quality Chasm series of a dozen years ago. In this report, the IOM not only updates insights on the quality of care, but also chronicles and underscores the challenges of health care’s growing complexity, cost, and waste, identifying some $750 billion in unnecessary expenditures annually and reviewing the opportunities for continuous learning and improvement. Achieving higher quality care at lower cost will require an across-the-board commitment to transform the U.S. health care system into a "\"learning" system that continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery. With practical reference to proven approaches, the committee’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation. Acting on the insights in this volume will improve care quality, the patient experience, health care outcomes, and lower costs. For more information on Best Care at Lower Cost, go to the IOM’s website at http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx, or view the Clinicians-focused brief at http://iom.edu/~/media/Files/Report%20Files/2012/Best-Care/Sector-Briefs/LearningHealthFactClinicians.pdf.
Sun exposure, cancer facts revealed in new Recovery Room episode
The second installment of the Recovery Room podcast, covering the topics of sun exposure and skin cancer, is now available on the American College of Surgeons (ACS) website. In this episode, host Frederick L. Greene, MD, FACS, Charlotte, NC, calls on experts Briana Heniford, MD, and Jeffrey Gershenwald, MD, FACS, to address misconceptions about these subjects. Dr. Heniford is an otolaryngologist and plastic surgeon, Carolinas Medical Center, Charlotte, NC, and Dr. Gershenwald is an attending surgeon and professor, department of surgical oncology, University of Texas MD Anderson Cancer Center, Houston.
The episode covers commonly asked consumer questions, including the difference between sunscreen and sunblock, what sun protection factor (SPF) numbers mean, and the meaning of "broad spectrum" sunscreen.
The Recovery Room features interviews with medical and public health experts and covers developments in research, treatment, policy changes, and ethical debates. Listen to this and the first episode on the ACS website at http://www.facs.org/recoveryroom/.
The second installment of the Recovery Room podcast, covering the topics of sun exposure and skin cancer, is now available on the American College of Surgeons (ACS) website. In this episode, host Frederick L. Greene, MD, FACS, Charlotte, NC, calls on experts Briana Heniford, MD, and Jeffrey Gershenwald, MD, FACS, to address misconceptions about these subjects. Dr. Heniford is an otolaryngologist and plastic surgeon, Carolinas Medical Center, Charlotte, NC, and Dr. Gershenwald is an attending surgeon and professor, department of surgical oncology, University of Texas MD Anderson Cancer Center, Houston.
The episode covers commonly asked consumer questions, including the difference between sunscreen and sunblock, what sun protection factor (SPF) numbers mean, and the meaning of "broad spectrum" sunscreen.
The Recovery Room features interviews with medical and public health experts and covers developments in research, treatment, policy changes, and ethical debates. Listen to this and the first episode on the ACS website at http://www.facs.org/recoveryroom/.
The second installment of the Recovery Room podcast, covering the topics of sun exposure and skin cancer, is now available on the American College of Surgeons (ACS) website. In this episode, host Frederick L. Greene, MD, FACS, Charlotte, NC, calls on experts Briana Heniford, MD, and Jeffrey Gershenwald, MD, FACS, to address misconceptions about these subjects. Dr. Heniford is an otolaryngologist and plastic surgeon, Carolinas Medical Center, Charlotte, NC, and Dr. Gershenwald is an attending surgeon and professor, department of surgical oncology, University of Texas MD Anderson Cancer Center, Houston.
The episode covers commonly asked consumer questions, including the difference between sunscreen and sunblock, what sun protection factor (SPF) numbers mean, and the meaning of "broad spectrum" sunscreen.
The Recovery Room features interviews with medical and public health experts and covers developments in research, treatment, policy changes, and ethical debates. Listen to this and the first episode on the ACS website at http://www.facs.org/recoveryroom/.
Clinical Congress: Discuss the issues at Town Hall Meetings
The 2013 American College of Surgeons (ACS) Annual Clinical Congress will feature Town Hall Meetings, which provide a forum for informal discussions of issues relevant to ACS members.
Town Hall Meetings do not qualify for continuing medical education credit. Clinical Congress registration is required to attend the Town Hall Meetings. To register for the 2013 Clinical Congress, visit http://www.facs.org/clincon2013/index.html. Town Hall Meetings scheduled at press time are as follows:
Tuesday, October 8, 7:00–7:45 am
TH01: Who Will Be Available to Take General Surgical Calls in 2015?
TH02: What Are the Current Issues in Board Certification and Maintenance of Certification (MOC)?
TH03: Surgeons as Health Policy Advocates
TH10: Introspection: The New Surgical Time Out
Wednesday, October 9, 7:00–7:45 am
TH04: Robotic Surgery: Does It Fit in Your General Surgical Practice?
TH05: Rural Surgery: What Are the Challenges?
TH06: Medical Liability Reform 2013: Thinking Outside of the Box to Achieve Tort Reform
TH11: Transition to Independent Practice: New ACS Program for General Surgeons
Thursday, October 10, 7:00–7:45 am
TH07: ACS-CRP: Defining Cancer Surgical Guidelines and Reporting
TH08: Choosing a Surgical Discipline
TH09: Ethics in Advertising: What Is the Surgeon’s Responsibility?
TH12: The ACS Practice Guidelines Project
TH13: Surgeon-Specific Registry and Maintenance of Certification: What Does It Mean for the Practicing Surgeon?
The 2013 American College of Surgeons (ACS) Annual Clinical Congress will feature Town Hall Meetings, which provide a forum for informal discussions of issues relevant to ACS members.
Town Hall Meetings do not qualify for continuing medical education credit. Clinical Congress registration is required to attend the Town Hall Meetings. To register for the 2013 Clinical Congress, visit http://www.facs.org/clincon2013/index.html. Town Hall Meetings scheduled at press time are as follows:
Tuesday, October 8, 7:00–7:45 am
TH01: Who Will Be Available to Take General Surgical Calls in 2015?
TH02: What Are the Current Issues in Board Certification and Maintenance of Certification (MOC)?
TH03: Surgeons as Health Policy Advocates
TH10: Introspection: The New Surgical Time Out
Wednesday, October 9, 7:00–7:45 am
TH04: Robotic Surgery: Does It Fit in Your General Surgical Practice?
TH05: Rural Surgery: What Are the Challenges?
TH06: Medical Liability Reform 2013: Thinking Outside of the Box to Achieve Tort Reform
TH11: Transition to Independent Practice: New ACS Program for General Surgeons
Thursday, October 10, 7:00–7:45 am
TH07: ACS-CRP: Defining Cancer Surgical Guidelines and Reporting
TH08: Choosing a Surgical Discipline
TH09: Ethics in Advertising: What Is the Surgeon’s Responsibility?
TH12: The ACS Practice Guidelines Project
TH13: Surgeon-Specific Registry and Maintenance of Certification: What Does It Mean for the Practicing Surgeon?
The 2013 American College of Surgeons (ACS) Annual Clinical Congress will feature Town Hall Meetings, which provide a forum for informal discussions of issues relevant to ACS members.
Town Hall Meetings do not qualify for continuing medical education credit. Clinical Congress registration is required to attend the Town Hall Meetings. To register for the 2013 Clinical Congress, visit http://www.facs.org/clincon2013/index.html. Town Hall Meetings scheduled at press time are as follows:
Tuesday, October 8, 7:00–7:45 am
TH01: Who Will Be Available to Take General Surgical Calls in 2015?
TH02: What Are the Current Issues in Board Certification and Maintenance of Certification (MOC)?
TH03: Surgeons as Health Policy Advocates
TH10: Introspection: The New Surgical Time Out
Wednesday, October 9, 7:00–7:45 am
TH04: Robotic Surgery: Does It Fit in Your General Surgical Practice?
TH05: Rural Surgery: What Are the Challenges?
TH06: Medical Liability Reform 2013: Thinking Outside of the Box to Achieve Tort Reform
TH11: Transition to Independent Practice: New ACS Program for General Surgeons
Thursday, October 10, 7:00–7:45 am
TH07: ACS-CRP: Defining Cancer Surgical Guidelines and Reporting
TH08: Choosing a Surgical Discipline
TH09: Ethics in Advertising: What Is the Surgeon’s Responsibility?
TH12: The ACS Practice Guidelines Project
TH13: Surgeon-Specific Registry and Maintenance of Certification: What Does It Mean for the Practicing Surgeon?
Plan to participate in Meet-the-Expert Luncheons at ACS Clinical Congress
The popular Meet-the-Expert Luncheons will take place Monday, October 7, through Wednesday, October 9, during the 2013 Clinical Congress in Washington, DC. The fee per luncheon is $45, which includes a boxed lunch and the opportunity to informally discuss a focused topic with an expert in the field. It is certainly possible to attend a different luncheon each day. Advance registration is required and tickets are limited.
Luncheon titles include Burning Issues in Surgical Ethics: Collaborations with Industry and Potential Conflicts of Interest; Non-Operative Management of Solid Organ Injuries; Anal Neoplasia; How to Mentor a Newly Trained Partner; Developing a Robotic Surgery Program in Urology; Pediatric Urologic Surgery; Radiological Workup and the Breast; How to Create Your Own Bundled Payment for Surgical Reimbursement; and The Role of Surgeons in Reducing Never Events. Attend luncheons prepared to discuss your surgical cases. For more information, contact Gay Lynn Dykman at [email protected].
To register, go to www.facs.org/clincon2013/registration/index.html.
The popular Meet-the-Expert Luncheons will take place Monday, October 7, through Wednesday, October 9, during the 2013 Clinical Congress in Washington, DC. The fee per luncheon is $45, which includes a boxed lunch and the opportunity to informally discuss a focused topic with an expert in the field. It is certainly possible to attend a different luncheon each day. Advance registration is required and tickets are limited.
Luncheon titles include Burning Issues in Surgical Ethics: Collaborations with Industry and Potential Conflicts of Interest; Non-Operative Management of Solid Organ Injuries; Anal Neoplasia; How to Mentor a Newly Trained Partner; Developing a Robotic Surgery Program in Urology; Pediatric Urologic Surgery; Radiological Workup and the Breast; How to Create Your Own Bundled Payment for Surgical Reimbursement; and The Role of Surgeons in Reducing Never Events. Attend luncheons prepared to discuss your surgical cases. For more information, contact Gay Lynn Dykman at [email protected].
To register, go to www.facs.org/clincon2013/registration/index.html.
The popular Meet-the-Expert Luncheons will take place Monday, October 7, through Wednesday, October 9, during the 2013 Clinical Congress in Washington, DC. The fee per luncheon is $45, which includes a boxed lunch and the opportunity to informally discuss a focused topic with an expert in the field. It is certainly possible to attend a different luncheon each day. Advance registration is required and tickets are limited.
Luncheon titles include Burning Issues in Surgical Ethics: Collaborations with Industry and Potential Conflicts of Interest; Non-Operative Management of Solid Organ Injuries; Anal Neoplasia; How to Mentor a Newly Trained Partner; Developing a Robotic Surgery Program in Urology; Pediatric Urologic Surgery; Radiological Workup and the Breast; How to Create Your Own Bundled Payment for Surgical Reimbursement; and The Role of Surgeons in Reducing Never Events. Attend luncheons prepared to discuss your surgical cases. For more information, contact Gay Lynn Dykman at [email protected].
To register, go to www.facs.org/clincon2013/registration/index.html.
Register now for Clinical Congress offerings in patient safety and disaster readiness
This year’s American College of Surgeons (ACS) Clinical Congress, October 6–10, in Washington, DC, will include new Skills-Oriented and Didactic Postgraduate Courses and Panel Sessions on patient safety and casualty preparation and response.
Patient safety
Attendees may receive continuing medical education credit in patient safety for attending multiple courses and sessions, including:
PS100: Acute Cholecystitis: What to Do When the Patient Is Too Sick?
PS107: Complicated Diverticulitis: To Resect or Not?
PS121: Bleeding Ulcer: Endoscopy Suite, Interventional Radiology, or Operating Room?
PS200: Severe Acute Pancreatitis: Evolving Management Strategies
PS208: A Wild Night on Acute Care Surgery Call: Challenging Cases, Great Lessons
PS215: Acute Appendicitis: Operate Now, Wait until the Morning, or Treat with Antibiotics? Review of the Evidence
PS222: Managing Emergencies in Crohn’s Disease
PS229: Intestinal Stomas: Prevention and Management of Complications
PS301: Colorectal Emergencies for Noncolorectal Surgeons
PS306: Anastomotic Leak: Prevention and Management
PS312: Bariatric Surgical Complications: I Don’t Do Bariatric Surgery—But You Are the Only Surgeon on Call!
PS319: Quality Colorectal Cancer Care: What You Should Know
PS325: Help! I Can’t Close the Abdomen: Now What?
PS400: Ten Hot Topics in General Surgery
SC01: Humanitarian Surgery: Surgical Skills Training for the International Volunteer Surgeon
SC02: Bedside Procedures in the Surgical ICU: What, Why, and How
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC13: Emergency Airways
SC14: Advanced Skills Training for Rural Surgeons: Laparoscopic Common Bile Duct Exploration and Anesthesia in Rural Practice
PG22: Robotic Surgery for Gastrointestinal Operations: Program Planning, Approaches, and Applications
PG27: Non-Technical Skills for Surgeons in the Operating Room: Behaviors in High-Performing Teams
Attendance at Postgraduate Didactic and Skills-Oriented courses requires additional enrollment to the standard Clinical Congress registration.
Mass-casualty preparation and response
Two new Panel Sessions at the 2013 ACS Clinical Congress will explore proper emergency responses that boost the possibility of human survival during mass-casualty events. Panel speakers at these sessions will share firsthand experiences and provide lessons learned, in addition to practical strategies on how to coordinate with federal and local agencies when responding to crisis situations.
PS331: Lessons Learned from the Boston Marathon Bombing
Wednesday, October 9, 8:00–9:30 am
Moderator: Michael J. Zinner, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
Participants will discuss the lessons learned from the April 15 Boston Marathon bombing, a civilian mass-casualty event.
The exercises that preceded the event and the ACS Committee on Trauma’s certification of five adult and one pediatric Level 1 trauma centers in Boston helped save the lives of all the victims who were transported to hospitals.
PS310: Mass-Casualty Shootings: Saving the Patients
Wednesday, October 9, 9:45–11:15 am
Moderator: Lenworth M. Jacobs, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
The ACS has partnered with numerous organizations, including the FBI, local police and fire departments, and emergency prehospital management, to prepare a document that will encourage cooperation among all agencies involved in managing mass-casualty events. A panel of representatives from these groups will provide practical strategies for attendees to apply in their communities.
Admission to Panel Sessions is included with each paid Clinical Congress registration. For more information on the scientific sessions at the ACS 2013 Clinical Congress and to register, view the ACS Clinical Congress Web page at http://www.facs.org/clincon2013/.
This year’s American College of Surgeons (ACS) Clinical Congress, October 6–10, in Washington, DC, will include new Skills-Oriented and Didactic Postgraduate Courses and Panel Sessions on patient safety and casualty preparation and response.
Patient safety
Attendees may receive continuing medical education credit in patient safety for attending multiple courses and sessions, including:
PS100: Acute Cholecystitis: What to Do When the Patient Is Too Sick?
PS107: Complicated Diverticulitis: To Resect or Not?
PS121: Bleeding Ulcer: Endoscopy Suite, Interventional Radiology, or Operating Room?
PS200: Severe Acute Pancreatitis: Evolving Management Strategies
PS208: A Wild Night on Acute Care Surgery Call: Challenging Cases, Great Lessons
PS215: Acute Appendicitis: Operate Now, Wait until the Morning, or Treat with Antibiotics? Review of the Evidence
PS222: Managing Emergencies in Crohn’s Disease
PS229: Intestinal Stomas: Prevention and Management of Complications
PS301: Colorectal Emergencies for Noncolorectal Surgeons
PS306: Anastomotic Leak: Prevention and Management
PS312: Bariatric Surgical Complications: I Don’t Do Bariatric Surgery—But You Are the Only Surgeon on Call!
PS319: Quality Colorectal Cancer Care: What You Should Know
PS325: Help! I Can’t Close the Abdomen: Now What?
PS400: Ten Hot Topics in General Surgery
SC01: Humanitarian Surgery: Surgical Skills Training for the International Volunteer Surgeon
SC02: Bedside Procedures in the Surgical ICU: What, Why, and How
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC13: Emergency Airways
SC14: Advanced Skills Training for Rural Surgeons: Laparoscopic Common Bile Duct Exploration and Anesthesia in Rural Practice
PG22: Robotic Surgery for Gastrointestinal Operations: Program Planning, Approaches, and Applications
PG27: Non-Technical Skills for Surgeons in the Operating Room: Behaviors in High-Performing Teams
Attendance at Postgraduate Didactic and Skills-Oriented courses requires additional enrollment to the standard Clinical Congress registration.
Mass-casualty preparation and response
Two new Panel Sessions at the 2013 ACS Clinical Congress will explore proper emergency responses that boost the possibility of human survival during mass-casualty events. Panel speakers at these sessions will share firsthand experiences and provide lessons learned, in addition to practical strategies on how to coordinate with federal and local agencies when responding to crisis situations.
PS331: Lessons Learned from the Boston Marathon Bombing
Wednesday, October 9, 8:00–9:30 am
Moderator: Michael J. Zinner, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
Participants will discuss the lessons learned from the April 15 Boston Marathon bombing, a civilian mass-casualty event.
The exercises that preceded the event and the ACS Committee on Trauma’s certification of five adult and one pediatric Level 1 trauma centers in Boston helped save the lives of all the victims who were transported to hospitals.
PS310: Mass-Casualty Shootings: Saving the Patients
Wednesday, October 9, 9:45–11:15 am
Moderator: Lenworth M. Jacobs, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
The ACS has partnered with numerous organizations, including the FBI, local police and fire departments, and emergency prehospital management, to prepare a document that will encourage cooperation among all agencies involved in managing mass-casualty events. A panel of representatives from these groups will provide practical strategies for attendees to apply in their communities.
Admission to Panel Sessions is included with each paid Clinical Congress registration. For more information on the scientific sessions at the ACS 2013 Clinical Congress and to register, view the ACS Clinical Congress Web page at http://www.facs.org/clincon2013/.
This year’s American College of Surgeons (ACS) Clinical Congress, October 6–10, in Washington, DC, will include new Skills-Oriented and Didactic Postgraduate Courses and Panel Sessions on patient safety and casualty preparation and response.
Patient safety
Attendees may receive continuing medical education credit in patient safety for attending multiple courses and sessions, including:
PS100: Acute Cholecystitis: What to Do When the Patient Is Too Sick?
PS107: Complicated Diverticulitis: To Resect or Not?
PS121: Bleeding Ulcer: Endoscopy Suite, Interventional Radiology, or Operating Room?
PS200: Severe Acute Pancreatitis: Evolving Management Strategies
PS208: A Wild Night on Acute Care Surgery Call: Challenging Cases, Great Lessons
PS215: Acute Appendicitis: Operate Now, Wait until the Morning, or Treat with Antibiotics? Review of the Evidence
PS222: Managing Emergencies in Crohn’s Disease
PS229: Intestinal Stomas: Prevention and Management of Complications
PS301: Colorectal Emergencies for Noncolorectal Surgeons
PS306: Anastomotic Leak: Prevention and Management
PS312: Bariatric Surgical Complications: I Don’t Do Bariatric Surgery—But You Are the Only Surgeon on Call!
PS319: Quality Colorectal Cancer Care: What You Should Know
PS325: Help! I Can’t Close the Abdomen: Now What?
PS400: Ten Hot Topics in General Surgery
SC01: Humanitarian Surgery: Surgical Skills Training for the International Volunteer Surgeon
SC02: Bedside Procedures in the Surgical ICU: What, Why, and How
SC10: Measure Twice, Cut Once! Optimizing Surgical Systems of Care
SC13: Emergency Airways
SC14: Advanced Skills Training for Rural Surgeons: Laparoscopic Common Bile Duct Exploration and Anesthesia in Rural Practice
PG22: Robotic Surgery for Gastrointestinal Operations: Program Planning, Approaches, and Applications
PG27: Non-Technical Skills for Surgeons in the Operating Room: Behaviors in High-Performing Teams
Attendance at Postgraduate Didactic and Skills-Oriented courses requires additional enrollment to the standard Clinical Congress registration.
Mass-casualty preparation and response
Two new Panel Sessions at the 2013 ACS Clinical Congress will explore proper emergency responses that boost the possibility of human survival during mass-casualty events. Panel speakers at these sessions will share firsthand experiences and provide lessons learned, in addition to practical strategies on how to coordinate with federal and local agencies when responding to crisis situations.
PS331: Lessons Learned from the Boston Marathon Bombing
Wednesday, October 9, 8:00–9:30 am
Moderator: Michael J. Zinner, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
Participants will discuss the lessons learned from the April 15 Boston Marathon bombing, a civilian mass-casualty event.
The exercises that preceded the event and the ACS Committee on Trauma’s certification of five adult and one pediatric Level 1 trauma centers in Boston helped save the lives of all the victims who were transported to hospitals.
PS310: Mass-Casualty Shootings: Saving the Patients
Wednesday, October 9, 9:45–11:15 am
Moderator: Lenworth M. Jacobs, MD, FACS, ACS Regent
Co-Moderator: Michael F. Rotondo, MD, FACS, Chair, ACS Committee on Trauma
The ACS has partnered with numerous organizations, including the FBI, local police and fire departments, and emergency prehospital management, to prepare a document that will encourage cooperation among all agencies involved in managing mass-casualty events. A panel of representatives from these groups will provide practical strategies for attendees to apply in their communities.
Admission to Panel Sessions is included with each paid Clinical Congress registration. For more information on the scientific sessions at the ACS 2013 Clinical Congress and to register, view the ACS Clinical Congress Web page at http://www.facs.org/clincon2013/.
Lasers promising for onychomycosis treatment
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
DANA POINT, CALIF. – Lasers are playing a key role in the treatment of onychomycosis, with cure rates exceeding that of terbinafine in most cases, Dr. Jill S. Waibel said at a meeting sponsored by SkinCare Physicians and Northwestern University.
The development is welcome because currently approved treatment options are "suboptimal," said Dr. Waibel, a dermatologic surgeon with Miami (Fla.) Dermatology & Laser Institute. "There’s also a big need; 34% of diabetics have onychomycosis. They are at an increased risk of developing complications including foot ulcers and amputations. In addition, 50% of individuals over age 70 have onychomycosis. The market for treatment in the United States is $1.6 billion," she said.
All infectious agents can be killed by heat except prions, which makes laser therapy a promising option for onychomycosis, Dr. Waibel said. The mechanism of action is not fully understood, but she shared three hypotheses. The first is that water in the keratin of the nail absorbs the laser energy and creates nonspecific bulk heating, which denatures fungal organelles. The second hypothesis is that free radicals are created by the laser, and these kill the dermatophyte. The third hypothesis is that microscopic selective photothermolysis occurs in Trichophyton species that contain melanin in their cell walls. Microcavitation and acoustic shock waves are created, which decapsulate the spores. The mechanism of action "is probably a combination of all three," she speculated.
Before laser treatment, the patient’s toenails and the surrounding skin are cleaned, and photos are taken of the nails, Dr. Waibel said. The affected areas of nail are treated with randomly assigned laser or light wavelengths until a temperature of 46° C is reached.
"The thicker the nail, the more energy we put into it," Dr. Waibel said of the treatment. "For every 5° C increase in temperature, there is an exponential decrease in the time to cell death. When laser energy first strikes the nail bed, there is a rapid spike in temperature reaching the lower 60° C range," she explained. "If you’re at 60° C, it only takes about 6 seconds to kill the dermatophyte. At 70° C, that takes about 6 ms, so the lasers are getting to the temperature to kill the dermatophyte."
If the patient becomes uncomfortable, "We stop [the laser] and then return after a few seconds," Dr. Waibel said. "The average treatment time in my practice is 10 minutes. We give two to three treatments 1 week apart. The patients are very satisfied."
Post therapy, Dr. Waibel said she instructs patients to use antifungal spray in their shoes and to use fungal cream, "because you can get onychomycosis from having athlete’s foot." But, she added, "80% of toenail fungus comes from sleeping with your spouse. So if you treat the woman and you don’t treat the man, when they sleep at night and their toes touch, they’ll pass it back and forth."
In a prospective study conducted at the Dermatology & Laser Institute, 21 patients with positive dermatophytic periodic acid–Schiff (PAS) or positive cultures were randomly assigned to undergo treatment with one of three light source options: a 1,064-nm laser (at an energy fluence of 17 J/cm2, a pulse width of 0.3 ms, 5 pulses/sec, and a spot size of 3 mm); broadband light (with a SkinTyte filter delivered at 20° C for 30 seconds), or a 1,319-nm laser (at an energy fluence of 5 J/cm2, a pulse width of 10 ms, 5 pulses/sec, and a spot size of 3 mm). At 6 months’ follow-up, all but one patient in the 1,319-nm group was culture negative, "which is impressive," Dr. Waibel said. Oral terbinafine has a cure rate of only 50%, she noted.
In a separate retrospective study conducted at the center, 73 patients with onychomycosis were treated with the 1,064-nm laser with temperature feedback. Each patient completed three to four treatments 1 week apart. At 12 months’ follow-up, 67 patients were clear of infection, while 6 had a recurrent infection or had become newly infected. That’s still better than terbinafine, Dr. Waibel said.
She and her associates conducted a 12-month retrospective analysis of patients choosing therapy for positive culture/positive PAS during the year 2012. The patients were offered three treatment options: laser therapy, terbinafine, or no therapy. Nearly two-thirds (64%) chose laser, 20% chose terbinafine, and 16% chose no therapy.
Dr. Waibel disclosed that she is a speaker for and/or has received honoraria for equipment or clinical trials from numerous device and skin care product manufacturers.
EXPERT ANALYSIS FROM CONTROVERSIES AND CONVERSATIONS IN LASER AND COSMETIC SURGERY
