bluuebunny/crossref_metadata_2025 huggingface dataset:
Medikamentöse Therapie der Peritonealkarzinose
Authors: Lordick Florian , Forstmeyer Dirk , Ahlborn Miriam , Becker-Schiebe Martina , Hoffmann Wolfgang , Schumacher Guido
Published: August 2013

Hintergrund: Die Behandlung der Peritonealkarzinose ist eine interdisziplinäre medizinische Herausforderung. Betreffend der medikamentösen Therapie fehlt bislang eine Standardisierung. Methode: Relevante Artikel zum Thema Peritonealkarzinose aus den Datenbanken der U.S. National Library of Medicine (PubMed) sowie der Kongressregister der American Society of Clinical Oncology und der European Society of Medical Oncology wurden durchsucht. Die Bedeutung der Berichte für die klinische Praxis wurde zwischen den Autoren diskutiert und interdisziplinär abgestimmt. Es wurden praxisnahe Folgerungen und Empfehlungen abgeleitet. Ergebnisse: PubMed weist eine ansteigende Zahl an Publikationen zum Thema Peritonealkarzinose auf. In 2012 wurden 563 Arbeiten unter dem Stichwort abgelegt. Die medikamentöse Therapie der Peritonealkarzinose ist ein Teil der multimodalen Behandlung, zu der die lokalen chirurgischen und physikalischen Therapiemaßnahmen zählen. Die Auswahl der Chemotherapeutika richtet sich nach der entsprechenden malignen Grunderkrankung. Aktuelle zielgerichtete Ansätze wie die anti-angiogene Therapie und die gegen das epitheliale Zelladhäsionsmolekül (EpCAM) gerichtete Immuntherapie ergänzen neuerdings das Behandlungsspektrum bei Peritonealkarzinose und malignem Aszites. Schlussfolgerungen: Die medikamentöse Behandlung der Peritonealkarzinose bleibt eine medizinische Herausforderung. Die zunehmende Zahl an Publikationen und Studien auf dem Gebiet lässt aber mittlerweile mehr evidenzbasierte Entscheidungen zu. Die interdisziplinäre Abstimmung eines individuellen Behandlungskonzepts bleibt bis auf Weiteres der Goldstandard auch für die medikamentöse Therapie der Peritonealkarzinose.
Afatinib, Erlotinib and Gefitinib in the First-Line Therapy of EGFR Mutation-Positive Lung Adenocarcinoma: A Review
Authors: Köhler Jens , Schuler Martin
Published: August 2013

Non-small cell lung cancer (NSCLC) consists of several histomorphologically defined phenotypes that display an enormous genetic variability. In recent years, epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma has emerged as a unique subset of NSCLC in terms of etiopathogenesis and tumor biology. Since the introduction of the reversible EGFR tyrosine kinase inhibitors (TKIs) erlotinib and gefitinib, patients with metastatic EGFR mutation-positive lung cancer can be offered a therapeutic alternative that has proven its superiority over standard platinum-based chemotherapy. However, primary or acquired resistance limits the therapeutic success of these targeted agents. Irreversible inhibitors targeting all ErbB family receptor tyrosine kinases, such as afatinib and dacomitinib, have been developed to confer sustained disease control in ErbB-dependent cancers. The large LUX-Lung 3 phase III trial recently reported afatinib to be clearly superior over the most effective platinum doublet in patients with EGFR mutation-positive lung cancer. To fully exploit the clinical activity of afatinib, proactive management of its gastrointestinal and dermatologic toxicities is advised.
Relationship Among Circulating Inflammatory Proteins, Platelet Gene Expression, and Cardiovascular Risk
Authors: McManus David D. , Beaulieu Lea M. , Mick Eric , Tanriverdi Kahraman , Larson Martin G. , Keaney John F. , Benjamin Emelia J. , Freedman Jane E.
Published: August 2013

Objective—

Cardiovascular disease is a complex disorder influenced by interactions of genetic variants with environmental factors. However, there is no information from large community-based studies examining the relationship of circulating cell–specific RNA to inflammatory proteins. In light of the associations among inflammatory biomarkers, obesity, platelet function, and cardiovascular disease, we sought to examine the relationships of C-reactive protein (CRP) and interleukin-6 (IL-6) to the expression of key inflammatory transcripts in platelets.

Approach and Results—

We quantified circulating levels of CRP and IL-6 in 1625 participants of the Framingham Heart Study (FHS) Offspring cohort examination 8 (mean age, 66.6±6.6 years; 46% men). We measured the expression of 15 relevant genes by high-throughput quantitative reverse transcriptase polymerase chain reaction from platelet-derived RNA and used multivariable regression to relate serum concentrations of CRP and IL-6 with gene expression. Levels of CRP and IL-6 were associated with 10 of the 15 platelet-derived inflammatory transcripts,
ALOX5
,
CRP
,
IFIT1
,
IL6
,
PTGER2
,
S100A9
,
SELENBP1
,
TLR2
,
TLR4
, and
TNFRSF1B
(
P
<0.001). Associations between platelet mRNA expression with CRP and IL-6 persisted after multivariable adjustment for potentially confounding factors. Six genes positively associated with CRP or IL-6 in the FHS sample were also upregulated in megakaryocytes in response to CRP or IL-6 exposure.

Conclusions—

Our data highlight the strong connection between the circulating inflammatory biomarkers CRP and IL-6 and platelet gene expression, adjusting for cardiovascular disease risk factors. Our results also suggest that body weight may directly influence these associations.
The Role of Shear-Induced Transforming Growth Factor-β Signaling in the Endothelium
Authors: Walshe Tony E. , dela Paz Nathaniel G. , D’Amore Patricia A.
Published: August 2013

Objective—

Vascular endothelial cells (ECs) are continuously exposed to blood flow that contributes to the maintenance of vessel structure and function; however, the effect of hemodynamic forces on transforming growth factor-β (TGF-β) signaling in the endothelium is poorly described. We examined the potential role of TGF-β signaling in mediating the protective effects of shear stress on ECs.

Approach and Results—

Human umbilical vein ECs (HUVECs) exposed to shear stress were compared with cells grown under static conditions. Signaling through the TGF-β receptor ALK5 was inhibited with SB525334. Cells were examined for morphological changes and harvested for analysis by real-time polymerase chain reaction, Western blot analysis, apoptosis, proliferation, and immunocytochemistry. Shear stress resulted in ALK5-dependent alignment of HUVECs as well as attenuation of apoptosis and proliferation compared with static controls. Shear stress led to an ALK5-dependent increase in TGF-β3 and Krüppel-like factor 2, phosphorylation of endothelial NO synthase, and NO release. Addition of the NO donor S-nitroso-N-acetylpenicillamine rescued the cells from apoptosis attributable to ALK5 inhibition under shear stress. Knockdown of TGF-β3, but not TGF-β1, disrupted the HUVEC monolayer and prevented the induction of Krüppel-like factor 2 by shear.

Conclusions—

Shear stress of HUVECs induces TGF-β3 signaling and subsequent activation of Krüppel-like factor 2 and NO, and represents a novel role for TGF-β3 in the maintenance of HUVEC homeostasis in a hemodynamic environment.
β
1
-Adrenergic Receptor and Sphingosine-1-Phosphate Receptor 1 (S1PR1) Reciprocal Downregulation Influences Cardiac Hypertrophic Response and Progression to Heart Failure
Authors: Cannavo Alessandro , Rengo Giuseppe , Liccardo Daniela , Pagano Gennaro , Zincarelli Carmela , De Angelis Maria Carmen , Puglia Roberto , Di Pietro Elisa , Rabinowitz Joseph E. , Barone Maria Vittoria , Cirillo Plinio , Trimarco Bruno , Palmer Timothy M. , Ferrara Nicola , Koch Walter J. , Leosco Dario , Rapacciuolo Antonio
Published: August 2013

Background—

The sphingosine-1-phosphate receptor 1 (S1PR1) and β
1
-adrenergic receptor (β1AR) are G-protein–coupled receptors expressed in the heart. These 2 receptors have opposing actions on adenylyl cyclase because of differential G-protein coupling. Importantly, both of these receptors can be regulated by the actions of G-protein–coupled receptor kinase-2, which triggers desensitization and downregulation processes. Although classic signaling paradigms suggest that simultaneous activation of β1ARs and S1PR1s in a myocyte would simply result in opposing action on cAMP production, in this report we have uncovered a direct interaction between these 2 receptors, with regulatory involvement of G-protein–coupled receptor kinase-2.

Methods and Results—

In HEK (human embryonic kidney) 293 cells overexpressing both β1AR and S1PR1, we demonstrated that β1AR downregulation can occur after stimulation with sphingosine-1-phosphate (an S1PR1 agonist), whereas S1PR1 downregulation can be triggered by isoproterenol (a β-adrenergic receptor agonist) treatment. This cross talk between these 2 distinct G-protein–coupled receptors appears to have physiological significance, because they interact and show reciprocal regulation in mouse hearts undergoing chronic β-adrenergic receptor stimulation and in a rat model of postischemic heart failure.

Conclusions—

We demonstrate that restoration of cardiac plasma membrane levels of S1PR1 produces beneficial effects that counterbalance the deleterious β1AR overstimulation in heart failure.
Coronary Artery Bypass Graft Surgery Using the Radial Artery as a Secondary Conduit Improves Patient Survival
Authors: Lin John , Cheng Wen , Czer Lawrence S. , De Robertis Michele A. , Mirocha James , Ruzza Andrea , Kass Robert M. , Khoynezhad Ali , Ramzy Danny , Esmailian Fardad , Trento Alfredo
Published: August 2013

Background

The clinical benefits of the left internal thoracic artery–to–left anterior descending coronary artery graft are well established in coronary artery bypass graft surgery (
CABG
). However, limited data are available regarding the long‐term outcome of the radial artery (
RA
) as a secondary conduit over the established standard of the saphenous venous graft.

Methods and Results

We compared the 12‐year survival outcome in a set of propensity‐matched
CABG
patients who received either the
RA
or the saphenous vein as a secondary conduit. A multivariable logistic regression that included 18 baseline characteristics was used to define the propensity of receiving an RA graft. The propensity model resulted in 260 matched pairs who underwent first‐time isolated
CABG
from 1996 to 2001 with similar preoperative characteristics (C statistic=0.86). The cumulative 12‐year survival estimated by use of the
K
aplan–
M
eier method was higher for the
RA
graft patients (hazard ratio 0.76;
P
=0.03). This survival advantage was especially significant in diabetics (
P
=0.005), in women (
P
=0.02), and in the elderly (
P
=0.04.) The protective effect appeared beginning at year 5 post surgical intervention.

Conclusion

The RA as a secondary conduit provided superior long‐term survival after
CABG
, especially in diabetic patients, women, and the elderly. This effect was most pronounced >5 years after surgery.
Ultra-Early Intravenous Stroke Thrombolysis
Authors: Strbian Daniel , Ringleb Peter , Michel Patrik , Breuer Lorenz , Ollikainen Jyrki , Murao Kei , Seiffge David J. , Jung Simon , Obach Victor , Weder Bruno , Eskandari Ashraf , Gensicke Henrik , Chamorro Angel , Mattle Heinrich P. , Engelter Stefan , Leys Didier , Numminen Heikki , Köhrmann Martin , Hacke Werner , Tatlisumak Turgut
Published: August 2013

Background and Purpose—

We previously reported increased benefit and reduced mortality after ultra-early stroke thrombolysis in a single center. We now explored in a large multicenter cohort whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis.

Methods—

Prospectively collected data of consecutive ischemic stroke patients who received IV thrombolysis in 10 European stroke centers were merged. Logistic regression tested association between treatment delays, as well as excellent 3-month outcome (modified Rankin scale, 0–1), and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale.

Results—

In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome (
P
<0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11–1.70;
P
=0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76–1.32;
P
=0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78–1.39;
P
=0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14–2.01;
P
<0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality.

Conclusions—

IV thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.
Modeling the Impact of Wind Intensification on Antarctic Sea Ice Volume
Authors: Zhang Jinlun
Published: August 2013

A global sea ice–ocean model is used to examine the impact of wind intensification on Antarctic sea ice volume. Based on the NCEP–NCAR reanalysis data, there are increases in surface wind speed (0.13% yr−1) and convergence (0.66% yr−1) over the ice-covered areas of the Southern Ocean during the period 1979–2010. Driven by the intensifying winds, the model simulates an increase in sea ice speed, convergence, and shear deformation rate, which produces an increase in ridge ice production in the Southern Ocean (1.1% yr−1). The increased ridged ice production is mostly in the Weddell, Bellingshausen, Amundsen, and Ross Seas where an increase in wind convergence dominates. The increase in ridging production contributes to an increase in the volume of thick ice (thickness > 2 m) in the Southern Ocean, while the volumes of thin ice (thickness ≤ 1 m) and medium thick ice (1 m < thickness ≤ 2 m) remain unchanged over the period 1979–2010. The increase in thick ice leads to an increase in ice volume in the Southern Ocean, particularly in the southern Weddell Sea where a significant increase in ice concentration is observed. The simulated increase in either the thick ice volume (0.91% yr−1) or total ice volume (0.46% yr−1) is significantly greater than other ice parameters (simulated or observed) such as ice extent (0.14–0.21% yr−1) or ice area fraction (0.24%–0.28% yr−1), suggesting that ice volume is a potentially strong measure of change.
Greenland Surface Mass Balance as Simulated by the Community Earth System Model. Part II: Twenty-First-Century Changes
Authors: Vizcaíno Miren , Lipscomb William H. , Sacks William J. , van den Broeke Michiel
Published: August 2013

This study presents the first twenty-first-century projections of surface mass balance (SMB) changes for the Greenland Ice Sheet (GIS) with the Community Earth System Model (CESM), which includes a new ice sheet component. For glaciated surfaces, CESM includes a sophisticated calculation of energy fluxes, surface albedo, and snowpack hydrology (melt, percolation, refreezing, etc.). To efficiently resolve the high SMB gradients at the ice sheet margins and provide surface forcing at the scale needed by ice sheet models, the SMB is calculated at multiple elevations and interpolated to a finer 5-km ice sheet grid. During a twenty-first-century simulation driven by representative concentration pathway 8.5 (RCP8.5) forcing, the SMB decreases from 372 ± 100 Gt yr−1 in 1980–99 to −78 ± 143 Gt yr−1 in 2080–99. The 2080–99 near-surface temperatures over the GIS increase by 4.7 K (annual mean) with respect to 1980–99, only 1.3 times the global increase (+3.7 K). Snowfall increases by 18%, while surface melt doubles. The ablation area increases from 9% of the GIS in 1980–99 to 28% in 2080–99. Over the ablation areas, summer downward longwave radiation and turbulent fluxes increase, while incoming shortwave radiation decreases owing to increased cloud cover. The reduction in GIS-averaged July albedo from 0.78 in 1980–99 to 0.75 in 2080–99 increases the absorbed solar radiation in this month by 12%. Summer warming is strongest in the north and east of Greenland owing to reduced sea ice cover. In the ablation area, summer temperature increases are smaller due to frequent periods of surface melt.
Sex Differences in Succumbing to Sexual Temptations
Authors: Tidwell Natasha D. , Eastwick Paul W.
Published: August 2013

Men succumb to sexual temptations (e.g., infidelity, mate poaching) more than women. Explanations for this effect vary; some researchers propose that men and women differ in sexual impulse strength, whereas others posit a difference in sexual self-control. These studies are the first to test such underlying mechanisms. In Study 1, participants reported on their impulses and intentional control exertion when they encountered a real-life tempting but forbidden potential partner. Study 2 required participants to perform a reaction-time task in which they accepted/rejected potential partners, and we used process dissociation to separate the effects of impulse and control. In both studies, men succumbed to the sexual temptations more than women, and this sex difference emerged because men experienced stronger impulses, not because they exerted less intentional control. Implications for the integration of evolutionary and self-regulatory perspectives on sex differences are discussed.
A General Approach for Assessing Person Fit and Person Reliability in Typical-Response Measurement
Authors: Ferrando Pere J.
Published: August 2013

In constant-θ IRT models, person unreliability is regarded as a source of person misfit. In Variable-θ IRT models, on the other hand, it is regarded as a relevant individual characteristic, which is modeled as an additional person parameter. As in any IRT application, person fit must be assessed when a variable-θ model is fitted to real data. This assessment aims to detect inconsistent response patterns once person unreliability has been taken into account. The present paper makes a general proposal for assessing person fit based on variable-θ models that are intended to be used with personality and attitude measures. For the three types of variable-θ IRT models developed to date—binary, graded, and (approximately) continuous response models—(a) graphical procedures, (b) global person-fit indices, and (c) residual indices at the item level are proposed and discussed. A multistage approach for using the indices and procedures is also proposed and illustrated using an empirical example.
Managing Postacute Malnutrition (Undernutrition) Risk
Authors: White Jane V. , Stotts Nancy , Jones Sandra W. , Granieri Evelyn
Published: August 2013

Although a direct correlation between poor nutrition status and increased risk of readmission has yet to be established, it is reasonable to assume that patients who are identified as undernourished while hospitalized would be “at increased risk of adverse outcomes” following discharge. Also, the evidence that links nonadherence to dietary prescriptions after discharge, with increased readmissions in patients with heart failure (HF), is fairly robust. Nutrition screening prior to discharge should be mandated, just as it is at admission. However, the criteria to assess a patient's ability to adequately and appropriately nourish themselves after discharge are very different from those used to diagnose and treat malnutrition on admission or during a hospital stay. The U.S. healthcare environment germane to the readmissions rates policy that was adopted for implementation in October 2012 by the Centers for Medicare & Medicaid Services is characterized. Factors critical to the successful development and implementation of a post–acute nutrition care plan are described. Nutrition‐related contributors to readmissions in HF are delineated. Transitional care models that could be adapted to enhance nutrition care plan efficacy are identified, as is the need to adopt a multidisciplinary approach to nutrition in transitional care that includes care coordination and routine follow‐up. An evidence‐based systematic approach to determine those patients in whom palliative vs restorative nutrition care is appropriate needs to be developed.
Avenues to Leadership: Opportunities at Every Level
Authors: Teng Marita S. , Simon Lawrence M. , Couch Marion E. , Zaretsky Lauren S. , Gray Stacey T. , Derkay Craig S. , Choi Sukgi S.
Published: August 2013

Program Description:

This miniseminar is designed to help physicians in the Academy find ways to become leaders in their own environments. The panelists will include leaders within national organizations such as the AAO‐HNS, ACGME, and ACS, as well as local leaders, including a department chair and residency program director. Emphasis will be placed on career crossroads and how to navigate them. Several of the panelists are women and will comment on experiences unique to female leaders in our field.

Educational Objectives:

1) Recognize individualized ways to become leaders in various environments. 2) Characterize the role of medical leaders in our departments, institutions, clinical specialties, and national organizations. 3) Apply leadership principles to everyday practice.
Functional Rhinoplasty
Authors: Jordan James R. , Cilento Benjamin W. , Barrera Jose E. , Pribitkin Edmund A.
Published: August 2013

Program Description:

Functional rhinoplasty techniques are intended to improve the nasal airway and are used in patients with more complex nasal deformities that may not be corrected with more standard techniques. This panel will address deformities of the nasal septum, internal valve, and nasal vault, along with techniques to correct these deformities.

Educational Objectives:

1) Describe the various components of anatomic nasal obstruction. 2) Develop strategies to approach complex nasal deformities. 3) Implement surgical techniques to correct more complex nasal deformities.
Parotidectomy Defect: To Reconstruct or Not
Authors: Militsakh Oleg N. , Girod Douglas A. , Hanasono Matthew M. , Lin Derrick T.
Published: August 2013

Program Description:

Parotidectomy is a common head and neck surgical procedure. While management options of facial nerve injury are well understood, the issues related to soft tissue deficit are underappreciated and frequently untreated. This miniseminar will characterize various parotidectomy soft tissue defects and describe the impact on facial cosmesis, Frey's syndrome, and preparation of the wound for adjuvant therapy. A case based presentation will discuss the use of allografts, avascular autografts, and pedicled and free flaps to correct external surface and contour/volume defects. Frey's syndrome and its prophylactic and symptomatic management will be discussed.

Educational Objectives:

1) Recognize cosmetic and functional deficits associated with parotid surgery. 2) Formulate reconstructive options for correction of surface and volume defects. 3) Evaluate pathophysiology and management of Frey's Syndrome.
Surgical Management of the Patient with Facial Paralysis
Authors: Wax Mark K. , Rosenthal Eben L. , Fedok Fred G. , Wang Tom D.
Published: August 2013

Program Description:

Patients with facial nerve paralysis suffer significant cosmetic and functional morbidity. Management of the eye involves both loading the upper eyelid and tightening the lower eyelid. Mid face reconstruction can be addressed by midface lifting or by nasal valve repair. The lower face functions to allow for proper articulation and deglutition. Reconstructive options are either dynamic, using a temporalis muscle sling, or adynamic with acellular suspension. Each panelist in this multidisciplinary presentation will present his preferred method of rehabilitation, and case scenarios will then be used to explore subtleties of each surgical approach.

Educational Objectives:

1) Rehabilitate the paralyzed upper eyelid. 2) Assess and manage the nasal airway in patients with facial paralysis. 3) Apply a management paradigm for the lower face that will allow comparison of dynamic and adynamic reconstruction.
Efficacy of Surgical Simulators for Otolaryngology Training
Authors: Lee Kenneth H. , Wiet Gregory J. , Fried Marvin P. , Jabbour Noel , Johnson Kaalan E.
Published: August 2013

Program Description:

Recently, there has been growing interest in developing and using simulation technologies for basic surgical skills training for residents. In addition, as our specialty continually evolves and we make efforts for quality and lifelong learning, simulation technologies may also be useful for keeping experienced surgeons up‐to‐date with their skills. We will present currently available surgical simulators for temporal bone dissection, endoscopic sinus surgery, airway endoscopy, and tonsillectomy. The presenters will provide descriptions and show videos demonstrating the function of these devices. In addition, each panelist will present data evaluating the efficacy of these simulators as being effective teaching instruments.

Educational Objectives:

1) Differentiate the variety of simulation technology devices available for surgical skills training in otolaryngology–head neck surgery. 2) Recognize the advantages and limitations of using simulation technologies for acquiring and maintaining surgical skills. 3) Assess the validity of the studies presented to evaluate the efficacy of simulation devices as valuable learning tools.
Exercises in Futility: Ethical Challenges in Otolaryngology
Authors: Shuman Andrew G. , McCammon Susan D. , Cole Roger D.
Published: August 2013

Program Description:

Medical futility is an evolving ethical dilemma with which otolaryngologists must become familiar, as we shoulder unique challenges regarding limitations upon what we can and should offer our patients. This course will describe an ethical framework that integrates existing clinical practice guidelines, professional codes of conduct, and healthcare law, designed to help participants make practical bedside decisions. Case studies will be presented exploring issues including tracheotomy requests for critically ill patients and end‐of‐life care in head and neck cancer. Using audience participation, we will probe these difficult questions, hone analytic skills, and suggest nuanced and practical approaches in an interactive format.

Educational Objectives:

1) Define the concept of medical futility as it relates to the practice of otolaryngology. 2) Describe an ethical context addressing medical futility that integrates existing clinical practice guidelines, professional codes of conduct, and healthcare law. 3) Apply this framework to approach challenging ethical dilemmas at the bedside and appropriately engage patients and families when making clinical decisions.
From Simulation to Surgery: Making It Real
Authors: Deutsch Ellen S. , Fried Marvin P. , Wiet Gregory J. , Amin Milan R. , Malekzadeh Sonya , Ishman Stacey L. , Wang Eric
Published: August 2013

Program Description:

Does learning on a simulator really help surgeons operate better? Can learning or directed practice on a simulator contribute to faster or better skill acquisition? What are the advantages and disadvantages of virtual, high tech, or home‐made simulators? How do I get started? A panel of experts will provide examples from otology, sinus, and airway surgery; and describe their experiences, recommendations, and visions for the future. Dr. Fried: virtual sinus surgery; Dr. Wiet: virtual temporal bone surgery; Dr. Amin: simulation for office‐based procedures; Dr. Malekzadeh: make it yourself; Dr. Ishman: how do we assess competency? Dr. Wang: return on investment.

Educational Objectives:

1) Describe how simulators can be used to develop or improve surgical skills. 2) Compare the advantages of different types of simulators. 3) Use a competency‐based assessment tool.
Getting Published: Letters, Commentaries, and Social Media
Authors: Rosenfeld Richard M. , Raol Nikhila M. , Liu Jeffrey C. , Cavanagh Eileen , Pugh Courtney
Published: August 2013

Program Description:

Getting Published is a results‐oriented miniseminar for clinicians seeking to publish in medical journals, with an emphasis this year on letters, commentaries, and social media. The goal is to offer explicit strategies that help authors understand the role of correspondence (commentaries, brief reports, and letters to the editor) in a peer‐reviewed journal from a myriad of viewpoints: publisher, editor in chief, managing editor, resident physician, and young physician (junior faculty member). Writing correspondence is one of the best ways for residents and young physicians to experience the thrill of getting published, so specific presentations will be targeted to these groups.

Educational Objectives:

1) Describe the roles of letters, commentaries, and social media in a peer‐reviewed journal. 2) Apply current strategies to help authors maximize their success in getting correspondence published. 3) Avoid common pitfalls when submitting correspondence for publication.
Hot Topics for the General Otolaryngologists
Authors: Stolovitzky J. Pablo , Kennedy David W. , Poe Dennis S. , Friedman Michael
Published: August 2013

Program Description:

This miniseminar is designed to update general otolaryngologists on cutting edge advances in our specialty by a panel of experts. Dr. David Kennedy will highlight the key principles of endoscopic resection of tumors of the skull base and the importance of preoperative planning of the skull base closure. Dr. Dennis Poe will present recent developments in diagnostic methods, medical treatment, and updates in research on surgical therapy for chronic Eustachian tube dysfunction. Dr. Michael Friedman will review new noninvasive and multilevel minimally invasive treatment options including transoral robotic surgery for the treatment of snoring and obstructive sleep apnea (OSA).

Educational Objectives:

1) Improve knowledge of the surgical principles of skull base tumor surgery. 2) Understand the mechanisms of Eustachian tube pathophysiology and be able to diagnose disorders. 3) Describe noninvasive and multilevel minimally invasive treatment options for OSA that should be incorporated in a general otolaryngology practice.
Multiresistant Bacterial Infections in 2013
Authors: Valdez Tulio A. , Sobol Steven E. , Post James C. , Eisenberg Lee D.
Published: August 2013

Program Description:

The last decade has seen a dramatic increase of infections by multi‐resistant organisms in the head and neck. The increased incidence of infections by Methicillin‐resistant Staphylococcus aureus has brought national attention to multiresistant bacterial infections. Other bacteria such as Streptococcus and Pseudomonas are also becoming non‐susceptible to commonly used antimicrobials. This miniseminar will provide an overview of the most common multi‐resistant organisms in otolaryngology, including their clinical presentations, mechanism of resistance, and treatments. Special emphasis will be placed on current guidelines for isolation, antibiotic stewardship programs, and future policy changes regarding multi‐resistant infections.

Educational Objectives:

1) Identify the most common multi‐resistant infections in otolaryngology and current treatment strategies. 2) Describe the mechanisms of antibiotic resistance. 3) Apply current policies for isolation measures in the inpatient and outpatient setting.
Optimize Patient Education for Patient Satisfaction
Authors: Sardesai Maya G. , Whipple Mark , Weaver Edward M. , Deutsch Ellen S. , Kim Sara
Published: August 2013

Program Description:

This miniseminar will discuss various modalities for providing patient education in otolaryngology practice, highlighting some evidence, relevant educational concepts, and otolaryngologists’ experiences. Patient education is a critical component of patient‐centered care in today's outcomes‐focused environment, in which patients obtain information from various educational media, and in which patient satisfaction is an increasingly‐emphasized metric. Speakers will use combinations of literature evidence, educational theory, and critical, reflective “How I do it” descriptions to highlight different approaches to patient education. Short overview didactic sessions will be followed by a panel discussion with input from the audience.

Educational Objectives:

1) Describe selected relevant concepts in medical education, and apply these in developing strategies for patient education; summarize the literature evidence for written materials in patient education. 2) Interpret techniques for use of seminars and simulation for patient education, and recognize their benefits and limitations. 3) Consider when educating medical staff and trainees is best to provide patient education.
Detailed Analysis on Selecting/Installing/Using an Otolaryngology Electronic Medical Record System
Authors: Lee K. J. , Das Subinoy , Ermini Edward B. , Gordon Lawrence J. , Nielsen David R. , Upchurch David T.
Published: August 2013

Program Description:

Otolaryngologists are now focusing on acquiring an electronic medical record (EMR) system, learning to use EMRs, and/or replacing those that are outdated and do not meet their needs. Panelists will analyze specifics.

Educational Objectives:

1) Critique an EMR system on the basis of cost, usability, workflow, quality, support, and return on investment. 2) Comply with meaningful use criteria to receive incentive money.
Practical Management of Complications in Otolaryngology
Authors: Verma Sunil P. , Batra Pete S. , Wilkinson Eric P. , McCulloch Timothy M. , Simental Alfred A.
Published: August 2013

Program Description:

Otolaryngologists perform a variety of surgeries, many of which inherently have a small margin for error. While most surgeries are uneventful, complications present special challenges and may create anxiety among surgeons. This miniseminar will employ a multidisciplinary approach to create a paradigm for management of the unwanted surgical complication. A case‐based approach will be used to highlight common complications. Methods for prevention will be reviewed and keys for management of the unwanted complication will be presented. Cases from each otolaryngology subspecialty will be presented with opportunity for audience interaction and questions.

Educational Objectives:

1) Recognize common complications within otolaryngology‐head and neck surgery. 2) Evaluate measures that can be taken preoperatively and intraoperatively to prevent complications. 3) Describe methods to manage common complications.
Scary Cases 2013
Authors: Platt Michael P. , Setzen Gavin , Grillone Gregory A. , Rebeiz Elie E. , Song Phillip , Chong Cathy D. , Tunkel David E.
Published: August 2013

Program Description:

The Scary Cases 2013 miniseminar uses a case‐based, interactive approach to education in patient care and limiting risk. Cases presented by well‐known experts and community‐based clinicians will focus on what could go wrong or has gone wrong in the management of otolaryngology patients. Each expert will present a specific case that was difficult to manage, had unexpected morbidity, or resulted in litigation. Attendees will participate with an audience response system for key decisions during the case. Difficult cases are often great sources of learning. This miniseminar will provide education on how to anticipate and avoid unwanted outcomes.

Educational Objectives:

1) Identify pitfalls that may lead to adverse outcomes or put patients at risk. 2) Diagnose certain otolaryngologic conditions that can easily go undetected. 3) Evaluate the management of cases with high potential for malpractice litigation.
Seventh Annual Academic Bowl
Authors: Wax Mark K. , Malekzadeh Sonya
Published: August 2013

Program Description:

Each year the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO‐HNSF) education committees contribute a series of questions for the Academic Bowl. These questions are designed to test the knowledge base of the top performing residency programs in North America. Audience participation allows the audience to compare their knowledge base to that of the resident competitors. This forum will also allow the attendee to determine areas that perhaps could use some tuning up.

Educational Objectives:

1) Critique the quality of current resident education. 2) Compare their knowledge base to those of the top ranked residency programs.
To Operate or Not: How to Approach the Older Patient
Authors: Tulunay‐Ugur Ozlem E. , Eibling David E. , Sataloff Robert T. , McKinnon Brian J. , Edelstein David R. , Hartig Gregory K. , Kost Karen M.
Published: August 2013

Program Description:

As baby‐boomers are turning 65, there is more need than ever to address the needs of an aging US population, which is expected to live longer and require more medical interventions. Interestingly, review of the literature reveals scant information on how to approach the older surgical patient, without well‐established guidelines. The purpose of this miniseminar is to provide expert opinion in multiple subspecialties, such as facial plastics, head‐neck oncology, laryngology, and neurotology. Participants will also learn how to prepare older patients for surgery, when to operate, and how to improve post‐operative outcomes/care. We aim to have an open discussion, with multiple case presentations.

Educational Objectives:

1) Determine which older patients are good surgical candidates, patient workup, and necessary pre/post‐operative consultations and considerations, and address poly‐pharmacy and post‐operative complications such as delirium. 2) Recognize which patients will benefit from surgery and which from observation, as well as alternative treatments in each subspecialty. Participants will leave with ample information on new, less invasive surgical approaches. 3) Interpret pearls to successful surgical outcomes in facial plastic and otologic surgeries.
Clinic‐Based Decision Making for Head and Neck Endocrine Disease
Authors: Smith Russell B. , Caruana Salvatore M. , Hunt Jason P. , Shindo Maisie L. , Steward David L. , Tufano Ralph P.
Published: August 2013

Program Description:

Patients with thyroid and parathyroid disease are commonly encountered in a head and neck surgery practice. While the evaluation and management of many patients is relatively straightforward, others are significantly more complicated. The goal of this session is to discuss complex clinical scenarios encountered in the outpatient clinic. The cost‐effective use of diagnostic testing as well as the factors critical in treatment planning will be outlined. The entities reviewed will include: 1) Fine‐needle aspiration (FNA) for thyroid nodules; 2) Evaluation and decision for surgery in hyperthyroidism; 3) Surveillance of patients with well differentiated thyroid cancer; 4) Evaluation and decision for surgery in hyperparathyroidism.

Educational Objectives:

1) Describe the appropriate use of FNA biopsy and other diagnostic studies with a focus on patients with suspected or known Hashimoto's thyroiditis. 2) Interpret the diagnostic evaluation and decision making for patients with functional thyroid disease with a focus on hyperthyroidism. 3) Outline the evaluation and treatment plan for patients’ hyperparathyroidism with a focus on non‐localizing disease and recurrent disease.
Head and Neck Skin Cancer: When Mohs Is Not Enough
Authors: Gourin Christine G. , Lin Derrick T. , Schmalbach Cecelia E. , Bradford Carol R. , Weber Randal S.
Published: August 2013

Program Description:

Skin cancer is the most common cancer in the United States and is increasing in incidence. While most skin cancer patients have an excellent prognosis following outpatient treatment with Mohs surgery, a subset demonstrate aggressive features with metastatsis, recurrence, and decreased survival. Failure to identify these high‐risk patients can lead to undertreatment and poor outcomes. This evidence‐based miniseminar will discuss the role and extent of surgery in the management of local disease, detection and treatment of metastases, and the role of adjuvant therapy in the management of melanoma and non‐melanoma skin cancers.

Educational Objectives:

1) Describe the extent of surgery required in the management of head and neck skin cancer. 2) Interpret the role of sentinel node biopsy and indications for neck dissection in the management of head and neck skin cancer. 3) Recognize the indications for adjuvant treatment in the management of advanced head and neck skin cancers.
The New Cancer Patient: Young, Non‐smoker, HPV+: Evaluation
Authors: Deschler Daniel G. , Ferris Robert L. , Wang Marilene B. , Khariwala Samir S. , Richmon Jeremy D.
Published: August 2013

Program Description:

The near‐epidemic rise of the incidence of human papillomavirus (HPV)‐related oropharyngeal carcinomas presents the practitioner with a “new” head and neck cancer patient, vastly different from those with the traditional risk factors who formed the basis of our training experience. Accordingly, a thorough and disease‐specific evaluation process is necessitated. Using a case‐based format and the following presentations from experts in the field, this miniseminar will review the evaluation of the HPV‐related cancer patient: The HPV oropharyngeal cancer epidemic: surgeon's perspective, role of imaging, evaluation of the neck mass, evaluation of the primary questions every patient wants to ask.

Educational Objectives:

1) Recognize the key clinical, epidemiological and pathologic features differentiating HPV‐positive oropharyngeal cancer from cancers related to traditional risk factors. 2) Implement a consistent, efficient, and evidence‐based evaluation process for the increasing number of patients presenting with oropharyngeal cancers that may be HPV related. 3) Acknowledge and prepare for patient questions related to the viral etiology of HPV‐positive oropharyngeal cancer.
The New Cancer Patient: Young, Non‐smoker, HPV+: Management
Authors: Smith Richard V. , Scharpf Joseph , Moore Eric J. , Nussenbaum Brian , Gourin Christine G.
Published: August 2013

Program Description:

As the demographics of oropharyngeal cancer change, so too will its management. Since these patients are often younger, have a better prognosis, and have presumably a longer life expectancy, we will discuss variations in treatment regimens. Using a case‐based format and presentations from experts in the field, this miniseminar will review the management of the HPV‐related cancer patient: molecular markers, chemotherapy and radiotherapy, the expanding role of surgery, neck management, and the potential for de‐escalation of therapy. We will provide the practitioner with a practical, useful, and evidence based approach to the treatment of the HPV positive cancer patient.

Educational Objectives:

1) Recognize biomarkers for HPV‐related head and neck cancer and understand their utility and limitations in clinical practice. 2) Develop a rational treatment plan for HPV‐related head and neck cancer patients.
Hot Topics in Otolaryngology 2013: Accountable Care Organizations
Authors: Stern Wendy B. , King Raymund C. , Denneny James C. , Johnson C. Brett , LaFreniere Denis C.
Published: August 2013

Program Description:

The practice of medicine is rapidly transforming in response to healthcare reform and cost reduction efforts. ACOs, first introduced into the Patient Protection and Affordable Care Act in 2009, are a payment and care delivery model that tie reimbursements to performance and cost reduction for a defined patient population. The physician must understand the laws and economics that affect the delivery of healthcare. Participants will gain an understanding of 1) Healthcare laws 2) ACOs, with a focus on outcomes, safety, and satisfaction while decreasing costs, negotiation tactics, and methods of awarding any shared savings. 3) Socioeconomic factors and concerns regarding emerging payment paradigms.

Educational Objectives:

1) Evaluate the current and future impact of Federal Healthcare Regulations upon otolaryngologic practice. 2) Comprehend physician and hospital organized ACOs, their objectives and considerations that will affect your role within that structure. 3) Recognize socioeconomic concerns related to transitioning from a fee for service model into ACOs and other future payment paradigms and what the Board of Governors is doing on behalf of our members.
Reconstruction after Salvage Laryngectomy
Authors: Chepeha Douglas B. , Hanasono Matthew M. , Patel Urjeet , Genden Eric M. , Rosco Andrew , Chanowski Eric
Published: August 2013

Program Description:

Patients undergoing salvage laryngectomy after concurrent chemoradiation are predisposed to impaired wound healing that can lead to pharyngocutaneous fistula (PCF). When a PCF develops, extended hospitalization and/or re‐operation are often required. A variety of reconstructive techniques are used to try and mitigate this complication and improve outcome. The microvascular committee conducted a multicenter retrospective review at 19 institutions. Data on over 450 patients will be presented. Overall, pharyngocutaneous fistula rates were 36% and ranged from 21‐46% based on reconstructive approach and size of accompanying pharyngeal defect. Differences in reconstructive approach and guidelines for treating this patient group will be presented.

Educational Objectives:

1) Demonstrate the research approach to a multi‐institutional review to establish treatment guidelines for the reconstruction of salvage laryngectomy patients. 2) Contrast reconstructive approaches for the patient undergoing salvage laryngectomy. 3) Provide practice‐based evidence for the reconstruction of the salvage laryngectomy patient.
Sialendoscopy: The Beginner's Guide to Success
Authors: Siegel Gordon J. , Schaitkin Barry M. , Zenk Johannes , Eisele David W. , Fritsch Michael H.
Published: August 2013

Program Description:

Sialendoscopy is a relatively new addition to otolaryngology. It offers the opportunity to work with salivary gland disease with non‐invasive procedures that yield potentially superior outcomes to previous techniques. It is exciting but very challenging. This miniseminar is geared towards the beginner. It will give basic techniques and point out potential pitfalls. Additional information will include the appropriate diagnostic work‐up, operative setting, and patient selection. The interactive format will allow the participant to know if he understands basic techniques and is ready to incorporate sialendoscopy in his practice.

Educational Objectives:

1) Use basic instrumentation for sialendoscopy. 2) Describe appropriate patient selection for sialendoscopy. 3) Perform sialendoscopy in your practice. Experienced experts will explain beginning basic techniques. Mistakes and pitfalls common to the beginner will be described.
Airway: Advances in Management
Authors: Weinberger Paul M. , Courey Mark S. , Lorenz Robert R. , Birchall Martin A.
Published: August 2013

Program Description:

This miniseminar will highlight advances in clinical case management of patients with dyspnea associated with upper airway tract abnormalities. Both endoscopic and open management of the difficult airway will be discussed. A perspective on advances and options for office based management will be offered. A perspective on indications for advanced techniques including airway transplantation will be offered. This miniseminar will be interactive, with audience participation encouraged.

Educational Objectives:

1) Differentiate options and indications for endoscopic and open management of upper airway stenosis. 2) Demonstrate office based management of the difficult airway. 3) Recite the decision pathway for upper airway transplantation.