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Ductal Lavage in Women from BRCA1/2 Families: Is There a Future for Ductal Lavage in Women at Increased Genetic Risk of Breast Cancer?
1243 Ductal Lavage in Women from BRCA1/2 Families: Is There a Future for Ductal Lavage in Women at Increased Genetic Risk of Breast Cancer? Jennifer T. Loud,1 Anne C.M. Thie´baut,4 Andrea D. Abati,2 Armando C. Filie,2 Kathryn Nichols,5 David Danforth,2 Ruthann Giusti,6 Sheila A. Prindiville,3 and Mark H. Greene1 1Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, 2Division of Clinical Sciences, and 3Office of the Director, National Cancer Institute, NIH, Bethesda, Maryland; 4INSERM, U657, Pasteur Institute, Paris, France; and 5Westat Corporation; 6Center for Biologics Evaluation and Research, Food and Drug Administration, Department of Health and Human Services, Rockville, Maryland Abstract Purpose: Ductal lavage has been used for risk stratifi- z10 cells. Postmenopausal women with intact ovaries cation and biomarker development and to identify compared with premenopausal women [odds ratio intermediate endpoints for risk-reducing intervention (OR), 4.8; P = 0.03] and women without a prior breast trials. Little is known about patient characteristics cancer history (OR, 5.2; P = 0.04) had an increased associated with obtaining nipple aspirate fluid (NAF) likelihood of yielding NAF. Having breast-fed (OR, and adequate cell counts (z10 cells) in ductal lavage 3.4; P = 0.001), the presence of NAF before ductal specimens from BRCA mutation carriers. lavage (OR, 3.2; P = 0.003), and being premenopausal Methods: We evaluated patient characteristics associat- (OR, 3.0; P = 0.003) increased the likelihood of ductal ed with obtaining NAF and adequate cell counts in lavage cell count adequacy. In known BRCA1/2 ductal lavage specimens from the largest cohort of mutation carriers, only breast-feeding (OR, 2.5; P = women from BRCA families yet studied (BRCA1/2 = 0.01) and the presence of NAF (OR, 3.0; P = 0.01) were 146, mutation-negative = 23, untested = 2). -
Catheter Associated Urinary Tract Infection (CAUTI) Prevention
Catheter Associated Urinary Tract Infection (CAUTI) Prevention System CAUTI Prevention Team 1 Objectives At the end of this module, the participant will be able to: Identify risk factors for CAUTI Explain the relationship between catheter duration and CAUTI risk List the appropriate indications for urinary catheter insertion and continued use Implement evidence-based nursing practice to decrease the risk and incidence of CAUTI 2 The Problem All patients with an indwelling urinary catheter are at risk for developing a CAUTI. CAUTI increases pain and suffering, morbidity & mortality, length of stay, and healthcare costs. Appropriate indwelling catheter use can prevent about 400,000 infections and 9,000 deaths every year! (APIC, 2008; Gould et al, 2009) 3 2012 National Patient Safety Goal Implement evidence-based practices to prevent indwelling catheter associated urinary tract infections (CAUTI) Insert indwelling urinary catheters according to evidence-based guidelines Limit catheter use and duration Use aseptic technique for site preparation, equipment, and supplies (The Joint Commission (TJC), 2011) 4 2012 National Patient Safety Goal Manage indwelling urinary catheters according to evidence-based guidelines Secure catheters for unobstructed urine flow and drainage Maintain the sterility of the urine collection system Replace the urine collection system when required Collect urine samples using aseptic technique (TJC, 2011) 5 Sources of CAUTI Microorganisms Endogenous Meatal, rectal, or vaginal colonization Exogenous -
22Nd European Conference on General Thoracic Surgery ABSTRACTS
22ND EUROPEAO N C NFERENCE ON GENERAL THORACIC SURGERY COPENHAGEN – DENMARK 2014 22 nd European Conference European onGeneral ABSTRACTS 15 –18June2014 Copenhagen www.ests.org of Thoracic of Thoracic Surgeons SocietyEuropean – Thoracic SurgeryThoracic Denmark 22nd European Conference on General Thoracic Surgery 15 – 18 June 2014 Bella Center, Copenhagen, Denmark 01 ests2014_toc.indd 1 14.05.2014 14:05:18 22nd European Conference on General Thoracic Surgery 2 01 ests2014_toc.indd 2 14.05.2014 14:05:18 Copenhagen – Denmark – 2014 TABLE OF CONTENTS TABLE OF CONTENTS Monday, 16 June 2014 Session I/ Brompton 5 Session II/ Videos 17 Session III/ Pulmonary Non Neoplastic 23 Session IV/ Young Investigators Award 32 Session V/ Pulmonary Neoplastic I 51 Session VI/ Innovative/Experimental 63 Oscar Night Videos 78 Tuesday, 17 June 2014 Session VIII/ Mixed Thoracic I 85 Session IX/ Mixed Thoracic II 97 Session X/ Pulmonary Neoplastic II 109 Session XI/ Videos II 123 Session XII/ Interesting Cases 129 Session XIII/ Oesophagus/Mediastinum 134 Session XIV/ Airway/Transplantation 146 Session XV/ Chest Wall/Diaphragm/Pleura 155 Session XVI/ MITIG – VATS RESECTIONS 166 Posters 178 Nurse Symposium-Oral 332 Nurse Symposium-Posters 342 List of Authors 361 3 01 ests2014_toc.indd 3 14.05.2014 14:05:18 22nd European Conference on General Thoracic Surgery ABSTRACTS 4 02_ests2014.indd 4 14.05.2014 14:07:30 Abstracts 001 - 006 Copenhagen – Denmark – 2014 ABSTRACTS Monday A.M. MONDAY, 16 JUNE 2014 08:30 - 10:30 SESSION I: BROMPTON B-001 ERGON – TRIAL: ERGONOMIC EVALUATION OF SINGLE-PORT ACCESS VERSUS THREE-PORT ACCESS VIDEO-ASSISTED THORACIC SURGERY Luca Bertolaccini1, A. -
Breast Care / Breast Cancer
BREAST CARE / BREAST CANCER Overview The Kaiser Permanente Breast Care Management Algorithm provided on this site was developed by the Inter-Regional Breast Cancer leaders group (IRBC). This multidisciplinary group includes physicians from Primary Care, Surgery, Oncology, Obstetrics and Gynecology, Radiology, Mammography, Genetics and Women’s Services and representatives from various regional Breast Cancer Task force groups, Clinical Nursing, Quality Resource & Risk Management, Public Relations & Issues Management, Prevention Services, and the Permanente Federation. The algorithm was developed to: • Improve the quality of care for our members with breast complaints, • Improve the timeliness of the identification of breast abnormalities and diagnosis of breast cancer, • Improve the satisfaction of members with breast complaints, and • Respond to the increase in malpractice allegations of failure to diagnose breast cancer. In 2002, the IRBC group held periodic conference calls to develop information to assist primary care clinicians in improving the quality of care for patients with breast complaints. A multidisciplinary consensus-based method was used to develop the content of the algorithm. The group also identified additional information and resources available internally and externally which would support implementation.The Breast Care Leaders in each Region have been encouraged to review and modify the algorithm to reflect local operations. Therefore, prior to use, PCPs are advised to contact a Regional member of the Inter-Regional Breast Care leaders group about revisions for your Region This site is for use within Kaiser Permanente only. What is Available on this Site? The IRBC group and the project management staff from the Permanente Federation worked together to define the project scope and develop the following products and information: I. -
Caring for Your Urinary (Foley) Catheter
Caring for Your Urinary (Foley) Catheter This information will help you care for your urinary (Foley) catheter while you’re at home. You have had a urinary catheter (a thin, flexible tube) placed in your bladder to drain your urine (pee). It’s held inside your bladder by a balloon filled with water. The parts of the catheter outside your body are shown in Figure 1. Catheter Care ● You need to clean your catheter, change your drainage bags, and wash your drainage bags every day. ● You may see some blood or urine around where the catheter enters your body, especially when walking or having a bowel movement. This is normal, as long as there’s urine draining into the drainage bag. If there’s not, call your healthcare provider. ● While you have your catheter, drink 1 to 2 glasses of liquids every 2 hours while you’re awake. ● Make sure that the catheter is in place in a tension free manner. The catheter should not be tight and should sit loosely. Showering ● You can shower while you have your catheter in place. Don’t take a bath until after your catheter is removed. ● Make sure you always shower with your night bag. Don’t shower with your leg bag. You may find it easier to shower in the morning. Cleaning Your Catheter You can clean your catheter while you’re in the shower. You will need the following supplies: 1. Gather your supplies. You will need: ○ Mild soap ○ Water 2. Wash your hands with soap and water for at least 20 seconds. -
Acute Pancreatitis, Non-Alcoholic Fatty Pancreas Disease, and Pancreatic Cancer
JOP. J Pancreas (Online) 2017 Sep 29; 18(5):365-368. REVIEW ARTICLE The Burden of Systemic Adiposity on Pancreatic Disease: Acute Pancreatitis, Non-Alcoholic Fatty Pancreas Disease, and Pancreatic Cancer Ahmad Malli, Feng Li, Darwin L Conwell, Zobeida Cruz-Monserrate, Hisham Hussan, Somashekar G Krishna Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA ABSTRACT Obesity is a global epidemic as recognized by the World Health Organization. Obesity and its related comorbid conditions were recognized to have an important role in a multitude of acute, chronic, and critical illnesses including acute pancreatitis, nonalcoholic fatty pancreas disease, and pancreatic cancer. This review summarizes the impact of adiposity on a spectrum of pancreatic diseases. INTRODUCTION and even higher mortality in the setting of AP based on multiple reports [8, 9, 10, 11, 12]. Despite the rising incidence Obesity is a global epidemic as recognized by the World of AP over the past two decades, there has been a decrease Health Organization [1]. One third of the world’s population in its overall mortality rate without any obvious decrement is either overweight or obese, and it has doubled over the in the mortality rate among patients with concomitant AP past two decades with an alarming 70% increase in the and morbid obesity [12, 13]. Several prediction models and prevalence of morbid obesity from year 2000 to 2010 [2, risk scores were proposed to anticipate the severity and 3, 4]. Obesity and its related comorbid conditions were prognosis of patient with AP; however, their clinical utility recognized to have an important role in a multitude of is variable, not completely understood, and didn’t take acute, chronic, and critical pancreatic illnesses including obesity as a major contributor into consideration despite the acute pancreatitis, non-alcoholic fatty pancreas disease, aforementioned association [14]. -
Chapter 1 Cellular Reaction to Injury 3
Schneider_CH01-001-016.qxd 5/1/08 10:52 AM Page 1 chapter Cellular Reaction 1 to Injury I. ADAPTATION TO ENVIRONMENTAL STRESS A. Hypertrophy 1. Hypertrophy is an increase in the size of an organ or tissue due to an increase in the size of cells. 2. Other characteristics include an increase in protein synthesis and an increase in the size or number of intracellular organelles. 3. A cellular adaptation to increased workload results in hypertrophy, as exemplified by the increase in skeletal muscle mass associated with exercise and the enlargement of the left ventricle in hypertensive heart disease. B. Hyperplasia 1. Hyperplasia is an increase in the size of an organ or tissue caused by an increase in the number of cells. 2. It is exemplified by glandular proliferation in the breast during pregnancy. 3. In some cases, hyperplasia occurs together with hypertrophy. During pregnancy, uterine enlargement is caused by both hypertrophy and hyperplasia of the smooth muscle cells in the uterus. C. Aplasia 1. Aplasia is a failure of cell production. 2. During fetal development, aplasia results in agenesis, or absence of an organ due to failure of production. 3. Later in life, it can be caused by permanent loss of precursor cells in proliferative tissues, such as the bone marrow. D. Hypoplasia 1. Hypoplasia is a decrease in cell production that is less extreme than in aplasia. 2. It is seen in the partial lack of growth and maturation of gonadal structures in Turner syndrome and Klinefelter syndrome. E. Atrophy 1. Atrophy is a decrease in the size of an organ or tissue and results from a decrease in the mass of preexisting cells (Figure 1-1). -
Preliminary Programme VERSION 3 MAY 2017
PRELIMINARY PROGRAMME VERSION 3 MAY 2017 You can register online now CLICK HERE OPPortUNITIES AND CHALLENGES ANNUAL SCIENTIFIC MEETING 28 – 30 June 2017 ICC BIRMINGHAM PLATINUM SPONSOR British Association of Oral and Maxillofacial Surgeons The Royal College Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PE Email: [email protected] Website: www.baoms.org.uk Plan ahead Contact us at: [email protected] +44 1635 262 400 BAOMS Flyer.1.indd 3 3/21/17 2:33 PM BIRMINGHAM 2017 PRELIMINARY PROGRAMME 3 CONTINUING ProFESSIONAL DEVELOPMENT (CPD) CONTENTS This scientific meeting aims to provide attendees with the opportunity to gain up to date knowledge on the latest developments in research, audit, education, surgical techniques, INtroDUCTION clinical patient management and outcomes in the field of oral and maxillofacial surgery. from ThE BAOMS PRESIDEnT This is delivered through seminars led by experts in their field, masterclasses and short papers presenting the latest research and developments. Participants should verify their own attendance record out of the maximum hours 4 available, which have been calculated as follows: Wednesday 28 June CPD hours 5.25 BAOMS COunCIL 2017 Thursday 29 June CPD hours 6.25 Friday 30 June CPD hours 6.25 4 CERTIFicaTES OF ATTENdaNCE Certificates of attendance indicating the CPD hours for the elements of the meeting ExhIBITIOn PLAn & LISTIngS booked by the attendee will be sent by email after the conference. SIGNING THE ATTENdaNCE REGISTER 5 In order to meet the requirements of verifiable CPD attendees should sign in at the Registration Desk on each day that they attend the conference. -
Answer Key Chapter 1
Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 1 of 101 Answer Key Chapter 1 Introduction to Clinical Coding 1.1: Self-Assessment Exercise 1. The patient is seen as an outpatient for a bilateral mammogram. CPT Code: 77055-50 Note that the description for code 77055 is for a unilateral (one side) mammogram. 77056 is the correct code for a bilateral mammogram. Use of modifier -50 for bilateral is not appropriate when CPT code descriptions differentiate between unilateral and bilateral. 2. Physician performs a closed manipulation of a medial malleolus fracture—left ankle. CPT Code: 27766-LT The code represents an open treatment of the fracture, but the physician performed a closed manipulation. Correct code: 27762-LT 3. Surgeon performs a cystourethroscopy with dilation of a urethral stricture. CPT Code: 52341 The documentation states that it was a urethral stricture, but the CPT code identifies treatment of ureteral stricture. Correct code: 52281 4. The operative report states that the physician performed Strabismus surgery, requiring resection of the medial rectus muscle. CPT Code: 67314 The CPT code selection is for resection of one vertical muscle, but the medial rectus muscle is horizontal. Correct code: 67311 5. The chiropractor documents that he performed osteopathic manipulation on the neck and back (lumbar/thoracic). CPT Code: 98925 Note in the paragraph before code 98925, the body regions are identified. The neck would be the cervical region; the thoracic and lumbar regions are identified separately. Therefore, three body regions are identified. Correct code: 98926 Instructor's Guide AC210610: Basic CPT/HCPCS Exercises Page 2 of 101 6. -
ANNSURG-D-20-01577 Proofs.Pdf
CE: R.R.; ANNSURG-D-20-01577; Total nos of Pages: 8; ANNSURG-D-20-01577 REVIEW PAPER Electrocautery, Diathermy, and Surgical Energy Devices Are Surgical Teams at Risk During the COVID-19 Pandemic? à à à AQ2 Kimberley Zakka, Simon Erridge, MBBS, BSc, Swathikan Chidambaram, Michael Kynoch,y à à AQ3 James Kinross, and Sanjay Purkayastha Y, on behalf of the PanSurg collaborative group coronavirus disease-19 (COVID-19) pandemic there are understand- Objective: The aim of the study was to provide a rapid synthesis of available able concerns amongst the surgical community as to the risk of viral data to identify the risk posed by utilizing surgical energy devices intra- transmission within such surgical plumes. operatively due to the generation of surgical smoke, an aerosol. Secondarily it To date, live SARS-CoV2 has been detected in lower respira- aims to summarize methods to minimize potential risk to operating room staff. tory tract samples, saliva, feces, bile, and blood specimens.2,3 As Summary Background Data: Continuing operative practice during the such, during the perioperative process, precautions should be con- coronavirus disease-19 (COVID-19) pandemic places the health of operating sidered to minimize potential risk to the clinical team. Similar to the theatre staff at potential risk. SARS-CoV2 is transmitted through inhaled severe acute respiratory syndrome (SARS) and Middle East respira- droplets and aerosol particles, thus posing an inhalation threat even at tory syndrome outbreaks, there is a paucity of data on the potential of considerable distance. Surgical energy devices generate an aerosol of biolog- transmission of the virus intraoperatively. -
5. Effectiveness of Breast Cancer Screening
5. EFFECTIVENESS OF BREAST CANCER SCREENING This section considers measures of screening Nevertheless, the performance of a screening quality and major beneficial and harmful programme should be monitored to identify and outcomes. Beneficial outcomes include reduc- remedy shortcomings before enough time has tions in deaths from breast cancer and in elapsed to enable observation of mortality effects. advanced-stage disease, and the main example of a harmful outcome is overdiagnosis of breast (a) Screening standards cancer. The absolute reduction in breast cancer The randomized trials performed during mortality achieved by a particular screening the past 30 years have enabled the suggestion programme is the most crucial indicator of of several indicators of quality assurance for a programme’s effectiveness. This may vary screening services (Day et al., 1989; Tabár et according to the risk of breast cancer death in al., 1992; Feig, 2007; Perry et al., 2008; Wilson the target population, the rate of participation & Liston, 2011), including screening participa- in screening programmes, and the time scale tion rates, rates of recall for assessment, rates observed (Duffy et al., 2013). The technical quality of percutaneous and surgical biopsy, and breast of the screening, in both radiographic and radio- cancer detection rates. Detection rates are often logical terms, also has an impact on breast cancer classified by invasive/in situ status, tumour size, mortality. The observational analysis of breast lymph-node status, and histological grade. cancer mortality and of a screening programme’s Table 5.1 and Table 5.2 show selected quality performance may be assessed against several standards developed in England by the National process indicators. -
Non-Cancerous Breast Conditions Fibrosis and Simple Cysts in The
cancer.org | 1.800.227.2345 Non-cancerous Breast Conditions ● Fibrosis and Simple Cysts ● Ductal or Lobular Hyperplasia ● Lobular Carcinoma in Situ (LCIS) ● Adenosis ● Fibroadenomas ● Phyllodes Tumors ● Intraductal Papillomas ● Granular Cell Tumors ● Fat Necrosis and Oil Cysts ● Mastitis ● Duct Ectasia ● Other Non-cancerous Breast Conditions Fibrosis and Simple Cysts in the Breast Many breast lumps turn out to be caused by fibrosis and/or cysts, which are non- cancerous (benign) changes in breast tissue that many women get at some time in their lives. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease. 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 Fibrosis and cysts are most common in women of child-bearing age, but they can affect women of any age. They may be found in different parts of the breast and in both breasts at the same time. Fibrosis Fibrosis refers to a large amount of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch. Cysts Cysts are fluid-filled, round or oval sacs within the breasts. They are often felt as a round, movable lump, which might also be tender to the touch. They are most often found in women in their 40s, but they can occur in women of any age. Monthly hormone changes often cause cysts to get bigger and become painful and sometimes more noticeable just before the menstrual period. Cysts begin when fluid starts to build up inside the breast glands. Microcysts (tiny, microscopic cysts) are too small to feel and are found only when tissue is looked at under a microscope.