The influence of surgical oncology fellowship programs in training hepatopancreatobiliary surgeons.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 358-358
Author(s):  
Rebecca Lynn Wiatrek ◽  
Wendy Lee ◽  
Curtis Jackson Wray ◽  
Gagandeep Singh ◽  
John H Yim ◽  
...  

358 Background: It is unclear how the physician shortage in the US will affect cancer care for our aging population and specifically how it will affect the care of hepatopancreatobiliary (HPB) malignancies. Our objective was to assess the clinical practices of recent surgical oncology fellowship graduates to determine their contribution in caring for this patient population. Methods: Practice data was gathered for surgeons who completed Society of Surgical Oncology (SSO)-approved surgical oncology fellowship programs between 2003-2008. Types of practice were defined as: (1) University Hospital or NCI-designated Cancer Center (NCICC); (2) University-affiliated hospital with resident training; (3) Private/community hospital with residency training program; (4) Private practice; (5) Military; and (6) International. Results: Of 253 surgeons who matched into SSO approved programs during our study period, 10 did not complete training, 11 entered military positions, and 17 are practicing internationally. Of the remaining 215 surgeons, 75% (n=161) obtained teaching positions and 25% (n=54) entered private practice. Of those in teaching positions, the majority were at University Hospitals/NCICC (n=133); followed by University-affiliated hospitals (n=16) and private/community hospitals with resident training (n=12). Overall, the practice focus was most commonly general surgical oncology (60%, n=130) followed by primary HPB (20%, n=43), breast/endocrine or melanoma/sarcoma (17%, n=36), and breast alone (3%, n=6). Conclusions: Our investigation shows that the majority of trainees from surgical oncology fellowship training programs obtain teaching positions with at least a portion of their practice covering HPB malignancies. Thus, recent surgical oncology fellowship graduates are positively contributing to the workforce treating HPB malignancies.

1996 ◽  
Vol 14 (12) ◽  
pp. 3148-3155 ◽  
Author(s):  
D S Fischer ◽  
S Alfano ◽  
M T Knobf ◽  
C Donovan ◽  
N Beaulieu

PURPOSE Reports of the tragic consequences of erroneous cancer chemotherapy overdoses at a prominent cancer center and a university hospital prompted a review of our institution's practices and those of 123 other hospitals to ascertain for each the current in-house process to prevent chemotherapy errors. METHODS A multidisciplinary committee of oncologists, nurses, and pharmacists reviewed the chemotherapy use process and identified opportunities for improvement. A 1-page facsimile survey was answered by 150 of 215 members of the American Society of Clinical Oncology (ASCO) who received it. RESULTS We further restricted the writing of cytotoxic chemotherapy orders to physicians who were board-certified or -eligible in hematology or medical, pediatric, and gynecologic oncology and their approved fellows. Dispensation of drugs is limited to oncology-certified pharmacists, and administration to chemotherapy-certified nurses. Standard orders are used either on special oncology forms or designated order sets in the computer. Procedures to regulate the ordering of antineoplastic drugs for nonmalignant indications by nononcology specialists are outlined. A process to prevent chemotherapy errors is in place in 95% of hospitals. Dedicated medical oncology units are ubiquitous, and most cancer centers and university hospitals have dedicated gynecologic and pediatric oncology units. Chemotherapy orders are generally written by oncology fellows and countersigned by an attending oncologist in cancer centers and university hospitals, whereas private oncology attending physicians write them in most community hospitals. Drugs are administered by oncology-certified nurses in most institutions. CONCLUSIONS These recommendations should improve the safety and effective use of chemotherapy and reduce the error rate to as close to zero as human fallibility will allow.


Author(s):  
Seon-Ju Kam ◽  
Young-Sun Yoo

Patients’ emotional responses to the hospital environment can be considered as important as medical technology and equipment. Therefore, this study investigated their experiences to determine whether the pattern using hospital identity (HI) elements, a widely used design method for patient clothing in university hospitals, can affect their emotional response and contribute to healing. It aimed to identify whether controlling the motif characteristics, arrangement, and spacing in this pattern design, and the direction between motifs, could be a method to design patient clothing for healing. To investigate patients’ emotional response and suggestions for patient clothing design, an interview-based qualitative approach was used. In-depth interviews were conducted with 12 patients discharged from Kyung Hee University Hospital Medical Center (KHUMC), Seoul. The interview questions consisted of two parts. One part featured questions about participants’ emotional responses to the medical environment and their latest patient clothing experience, and the other featured questions about their emotional response to, and suggestions for, the healing expression of pattern design using HI. The results confirmed that the motif characteristics, arrangement, and spacing, and the direction between motifs, influenced patients’ positive emotions and contributed to the healing effect. Therefore, when the HI elements of a medical institution are applied in the design of patient clothing with the characteristics of a healing design, patients perceive this as providing stability and comfort. The design of patient clothing becomes a medium that not only builds the brand image of medical institutions, but also enhances the quality of medical services centered on patient healing.


2021 ◽  
pp. 014556132098603
Author(s):  
Anni Koskinen ◽  
Marie Lundberg ◽  
Markus Lilja ◽  
Jyri Myller ◽  
Matti Penttilä ◽  
...  

Objectives: The aim of this controlled follow-up study was to compare the need for revision surgery, long-term efficacy, and satisfaction in chronic rhinosinusitis patients who had undergone maxillary sinus operation with either balloon sinuplasty or traditional endoscopic sinus surgery (ESS) technique. Methods: Thirty-nine ESS patients and 36 balloon patients of our previously described cohort, who had been primarily operated in 2008 to 2010, were contacted by phone. Symptoms, satisfaction, and need for revision surgery were asked. In addition, we collected data of patients who had undergone primary maxillary sinus balloon sinuplasty in the Helsinki University Hospital during the years 2005 to 2019. As a control group, we collected data of patients who had undergone primary maxillary sinus ESS at 3 Finnish University Hospitals, and 1 Central Hospital in years 2005, 2008, and 2011. Results: Altogether, 77 balloon patients and 82 ESS patients were included. The mean follow-up time was 5.3 years in balloon group and 9.8 years in ESS group. Revision surgery was performed on 17 balloon patients and 6 ESS patients. In the survival analysis, the balloon sinuplasty associated significantly with a higher risk of revision surgery compared to ESS. According to the phone interviews, 82% of ESS patients and 75% of balloon patients were very satisfied with the primary operation. Conclusion: Although the patient groups expressed equal satisfaction and change in symptoms after the operations, the need for revision surgery was higher after balloon sinuplasty than after ESS. This should be emphasized when counselling patients regarding surgical options.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilaria Corazza ◽  
Kendall Jamieson Gilmore ◽  
Francesca Menegazzo ◽  
Valts Abols

Abstract Background Patient Reported Experience Measures (PREMs) are recognized as an important indicator of high quality care and person-centeredness. PREMs are increasingly adopted for paediatric care, but there is little published evidence on how to administer, collect, and report paediatric PREMs at scale. Methods This paper describes the development of a PREMs questionnaire and administration system for the Meyer Children’s University Hospital in Florence (Meyer) and the Children’s Clinical University Hospital in Riga (CCUH). The system continuously recruits participants into the electronic administration model, with surveys completed by caregivers or adolescents at their convenience, post-discharge. We analyse 1661 responses from Meyer and 6585 from CCUH, collected from 1st December 2018 to 21st January 2020. Quantitative and qualitative experience analyses are included, using Pearson chi-square tests, Fisher’s exact tests and narrative evidence from free text responses. Results The large populations reached in both countries suggest the continuous, digital collection of paediatric PREMs described is feasible for collecting paediatric PREMs at scale. Overall response rates were 59% in Meyer and 45% in CCUH. There was very low variation in mean scores between the hospitals, with greater clustering of Likert scores around the mean in CCUH and a wider spread in Meyer for a number of items. The significant majority of responses represent the carers’ point of view or the perspective of children and adolescents expressed through proxy reporting by carers. Conclusions Very similar reported scores may reflect broadly shared preferences among children, adolescents and carers in the two countries, and the ability of both hospitals in this study to meet their expectations. The model has several interesting features: inclusion of a narrative element; electronic administration and completion after discharge from hospital, with high completion rates and easy data management; access for staff and researchers through an online platform, with real time analysis and visualization; dual implementation in two sites in different settings, with comparison and shared learning. These bring new opportunities for the utilization of PREMs for more person-centered and better quality care, although further research is needed in order to access direct reporting by children and adolescents.


2020 ◽  
Vol 86 (2) ◽  
pp. 140-145
Author(s):  
Shoshana Levi ◽  
Emily Alberto ◽  
Dakota Urban ◽  
Nicholas Petrelli ◽  
Gregory Tiesi

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers’ views. Our study examined health-care workers’ perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures—hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60–64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.


PEDIATRICS ◽  
1962 ◽  
Vol 29 (4) ◽  
pp. 678-679
Author(s):  
H. William Fink

I write with concern for the future of good community hospitals with qualified attending pediatricians and plenty of patient material but no residents. In the ever-increasing competition for residents, such hospitals are slowly being strangled by the more fortunate university hospitals with their access to medical students and interns. I fear that the ultimate consequences will be the downgrading of pediatric practice throughout the county in those areas where there is not a medical school.


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e22527-e22527
Author(s):  
Michael J. Hall ◽  
Paul D'Avanzo ◽  
Yana Chertock ◽  
Jesse A Brajuha ◽  
Sarah Bauerle Bass

e22527 Background: TGP is widely used to identify targetable mutations for precision cancer treatment and clinical trials. Many patients have poor understanding of TGP and are unaware of possible secondary hereditary risks. Lack of clarity regarding the relevance of informed consent and genetic counseling further magnify risks for patients. AA patients have lower genetic knowledge and health literacy and higher MM than Caucasian patients, making them especially vulnerable in the clinical setting. Perceptions of TGP in AA cancer patients have not been well-characterized. Methods: 120 AA pts from 1 suburban and 1 urban site (Fox Chase Cancer Center[FCCC] and Temple University Hospital[TUH]) were surveyed. A k-means cluster analysis using a modified MM scale was conducted; chi-square analysis assessed demographic differences. Perceptual mapping (PM)/multidimensional scaling and vector modeling was used to create 3-dimensional maps to study how TGP barriers/facilitators differed by MM group and how message strategies for communicating about TGP may also differ. Results: Data from 112 analyzable patients from FCCC (55%) and TUH (45%) were parsed into less MM (MM-L, n = 42, 37.5%) and more MM (MM-H, n = 70, 72.5%) clusters. MM-L and MM-H clusters were demographically indistinct with no significant associations by sex (p = 0.49), education (p = 0.3), income (p = 0.65), or location (p = 0.43); only age was significant (older = higher MM, p = 0.006). Patients in the MM-H cluster reported higher concerns about TGP, including cost (p < 0.001), insurance discrimination (p < 0.001), privacy breaches (p = 0.001), test performance/accuracy (p = 0.001), secondary gain by providers (p < 0.001) and provider ability to explain results (p = 0.04). Perceptual mapping identified both shared and contrasting barriers between MM clusters (Table). Conclusions: More than 2/3 of AA patients comprised a MM-H cluster. Communication strategies should focus on concerns about family and how to discuss TGP with an oncologist. PM can identify distinct and shared information needs of vulnerable populations undergoing TGP. [Table: see text]


2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi24-vi24
Author(s):  
Anthony Sloan ◽  
Harry Hoffman ◽  
Peggy Harris ◽  
Christine Lee-Poturalski ◽  
Theresa Elder ◽  
...  

Abstract The effect of platelets on oncogenesis has been studied extensively in cancer metastasis, but not in glioblastoma (GBM), where metastasis is rare. Here we identify the unique crosstalk between glioma stem cells (GSCs) and platelets within GBM solid tumors that enhance disease progression. Targeting GSCs is considered a promising therapeutic approach; however, no clear method has been identified. High platelet counts have been associated with poor clinical outcome in many cancers including ovarian and endometrial cancer. While platelets are known to affect progression of other tumors, mechanisms by which platelets influence GBM oncogenesis are unknown. Immunofluorescence, qPCR, and western blot were used to evaluate the presence of GSCs and platelets and their colocalization in GBM patient tissue at University Hospitals-Seidman Cancer Center. Functional assays followed by RNA sequencing were conducted to determine the functional effect of healthy and GBM platelets on growth of patient derived, autologous GSCs. Our clinical studies suggest elevated platelet counts positively correlate with GSC proliferation and negatively correlate with overall survival in patients with GBM. Patients with high platelet counts ( &gt;350k/µl) had a median survival time of 9 months compared to 16 months median survival for patients with normal platelet count (150-350/µl) (p&lt;0.05). We demonstrate platelet and GSC co-localization in GBM solid tissue and platelet exposure to patient derived GSCs cell lines results in a ≥ 3-fold increase in GSC proliferation compared to GSCs not exposed to platelets (p&lt;0.0005). Similarly we found that platelets increased the self-renewing capacity by enhancing the average sphere size (p &lt; 0.005), and increasing the GSC “Stem-like” transcriptional pattern (P&lt; 0.05). Conversely, pharmacologic inhibition of platelet activation reversed the effect of platelets on GSC proliferation (p ranging from 0.05-0.005). These studies suggests the platelet-GSC interactions appear to stimulate GBM oncogenesis, identifying a potential therapeutic target for the treatment of GBM.


Author(s):  
Cesar Cuero

<p>La Academia Panameña de Medicina y Cirugía, se siente honrada, en resaltar la figura de uno de sus miembros distinguidos, el Académico Titular José Manuel Fábrega Sosa, MD, FACS, FSSO, APMC. Este distinguido cirujano, panameño, hizo sus estudios profesionales en la Universidad de Notre Dame, Notre Dame, Indiana donde se graduó con honores siendo miembro de la Sociedad de honor AlphaEpsilonDelta. Continuó sus estudios de medicina en la George Washington University School of Medicine, Washington, DC., donde obtuvo el grado de Medicina, graduándose también con honores siendo nombrado en la Sociedad de Honor de Medicina de los Estados Unidos, AlphaOmegaAlpha. Hizo su residencia en cirugía en el New York Hospital Cornell Medical Center y en Oncología Quirúrgica en el Memorial Sloan Kettering Cancer Center de Nueva York. Ha sido Certificado y Recertificado por el American Board of Surgery. Fellow y ExGobernador del American College of Surgeons y Ex Presidente del Capítulo de Panamá del American College of Surgeons. Además de Fellow de la Society of Surgical Oncology. A nivel local, entre otros es Ex Presidente de la Academia Panameña de Medicina y Cirugía. Y Profesor Extraordinario de Cirugía, de la Facultad de Medicina, de la Universidad de Panamá. Presidente y miembro fundador de la Asociación Panameña de Cirugía Oncológica (APCO). Aparte de tener licencia en la República de Panamá, tiene licencia del estado de California y de Washington DC en los Estados Unidos. Recientemente, ha sido merecedor a un reconocimiento, reservado para pocos cirujanos destacados, en el mundo, ser reconocido como Honorary Fellow del American College of Surgeons (Colegio Americano de Cirujanos), luego de 43 años de brindar sus conocimientos para el cuidado y bienestar de sus pacientes. Cabe destacar que al presente Solo hay 487 cirujanos en el mundo entero que han recibido tal distinción. El Colegio Americano de Cirujanos otorga este honor cada año, a cuatro o cinco candidatos que han prestado servicios humanitarios, especialmente en el campo de la ciencia médica. Es el tercer panameño en recibir este reconocimiento; el primero en ser distinguido fue el doctor Augusto S. Boyd, en 1923; luego el neurólogo Antonio González Revilla, en 1973. La universidad de Cornell, de donde egresó, lo declaró exalumno meritorio y es el único egresado en recibir esa distinción. En Panamá; la Asamblea Nacional lo reconoció como ciudadano ejemplar y meritorio y el presidente de la república lo condecoró con la Orden Manuel Amador Guerrero en el “Grado de Gran Cruz”. Honrar, honra, y la Academia Panameña de Medicina y Cirugía, y La Revista Médica de Panamá, se enorgullecen de presentar a este ilustre panameño y latinoamericano.</p><p>ABSTRACT</p><p>The Panamanian Academy of Medicine and Surgery is honored to highlight the figure of one of its distinguished members, the Tenured Academician José Manuel Fábrega Sosa, MD, FACS, FSSO, APMC. This distinguished Panamanian surgeon did his professional studies at the University of Notre Dame, Notre Dame, Indiana where he graduated with honors as a member of the AlphaEpsilonDelta Honor Society. He continued his medical studies at the George Washington University School of Medicine, Washington, DC., Where he obtained a degree in Medicine, also graduating with honors and being named in the American Honor Society of Medicine, AlphaOmegaAlpha. He did his residency in surgery at New York Hospital Cornell Medical Center and in Surgical Oncology at Memorial Sloan Kettering Cancer Center in New York. He has been Certified and Recertified by the American Board of Surgery. Fellow and Former Governor of the American College of Surgeons and Former President of the Panama Chapter of the American College of Surgeons. In addition to Fellow of the Society of Surgical Oncology. At the local level, among others, he is Former President of the Panamanian Academy of Medicine and Surgery. And Extraordinary Professor of Surgery, Faculty of Medicine, University of Panama.</p><p>President and founding member of the Panamanian Association of Oncological Surgery (APCO). Apart from being licensed in the Republic of Panama, it is licensed by the state of California and Washington DC in the United States. Recently, he has been worthy of a recognition, reserved for few outstanding surgeons, in the world, being recognized as Honorary Fellow of the American College of Surgeons (American College of Surgeons), after 43 years of providing his knowledge for the care and well-being of your patients. It should be noted that there are currently only 487 surgeons worldwide who have received such a distinction. The American College of Surgeons awards this honor each year to four or five candidates who have provided humanitarian services, especially in the field of medical science. He is the third Panamanian to receive this recognition; the first to be distinguished was Dr. Augusto S. Boyd, in 1923, then the neurologist Antonio González Revilla, in 1973. Cornell University, where he graduated, declared him a meritorious alumnus and is the only graduate to receive that distinction. In Panama, the National Assembly recognized him as an exemplary and meritorious citizen and the President of the Republic decorated him with the Manuel Amador Guerrero Order in the “Grand Cross Degree”. Honor, honor, and the Panamanian Academy of Medicine and Surgery, and La Revista Médica de Panama, are proud to present this illustrious Panamanian and Latin American.</p>


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