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Emergency Preparedness and Disaster Management: What You Need to Know
Cultural Competency, Health Literacy, and Health Disparities Ronald B. Kuppersmith, MD, MBA (moderator); Amy Y Chen, MD, MPH; Anita L Jackson, MD, MPH; Lisa Perry-Gilkes, MD; Duane J Taylor, MD No matter where an otolaryngologist practices, each day they encounter patients from all different cultural and socioeconomic backgrounds. Understanding issues related to cultural competency, health literacy, and disparities are essential to improve communications with patients and to provide better patient care. Failure to recognize the importance of these issues can lead to poor patient compliance and even potential liability for the practicing physician. This miniseminar presented by members of the AAO-HNS’s Task Force on Diversity will focus on defining the terms: “Cultural Competency,” “Health Literacy,” and “Health Care Disparities” and provide an understanding of their implications in the practice of otolaryngology.
Culture or PCR for Infectious Diseases Patrick J Antonelli, MD (moderator); James C. Post, MD, PhD; Garth David Ehrlich, PhD; Itzhak Brook MD, MSc; James N Palmer, MD Microbiologic cultures and antibiotic sensitivities have historically been the primary means of selecting optimal antimicrobial therapy. In recent years, molecular diagnostic techniques, such as polymerase chain reaction (PCR), have emerged as powerful means of detecting the presence of micro-organisms in both healthy and disease states. Molecular analysis may reveal a range of microorganisms, including those felt to be pathogens and others that are of unknown significance. Molecular analysis may reveal additional genotypic information that could alter management. The information gleaned from molecular microbiological testing forces us to take a fresh look at the pathogenesis, diagnosis, and management of infectious diseases. In this symposium, the speakers will address the general considerations of conventional and molecular diagnostic testing, then elaborate more fully on common upper respiratory tract infections. Otitis, sinusitis, and pharyngitis will be discussed.
Defining the Role of Primary Surgery in the Era of Chemoradiation Therapy Jonas T Johnson, MD (moderator); Bruce H Haughey, MBChB, FRACS; Guy J Petruzzelli, MD, MBA, PhD; William M Keane, MD; Christine G. Gourin, MD This miniseminar will include evidence-based presentations, followed by discussion of illustrative cases. Audience participation is encouraged. The introduction of evidence which demonstrates that chemoradiation may result in effective organ preservation has
P13 resulted in great changes in the world of head and neck surgery. Many physicians have apparently extrapolated that chemoradiation should be used to treat all head and neck cancers. This is wrong! Many patients with small tumors can be safely and effectively treated with surgery alone. These patients benefit from avoidance of the well-known toxicities of chemoradiation therapy. This is especially true of most early Stage I or Stage II tumors. An increasing body of evidence exists which suggest that some patients benefit from primary surgical care. Surgery offers the advantage of precise pathologic staging. Accordingly, patients can be upstaged when necessary and offered adjuvant chemoradiation. Patients with limited tumors can, once again, be spared the toxicities of unnecessary therapies. Patients presenting with advanced primary tumors (T4) may, under some circumstances, not reasonably expect that chemoradiation will affect “organ preservation.” These patients benefit preferentially from resection and reconstruction. This mini-seminar seeks to provide evidence-based discussion in a setting of illustrative clinical situations. Audience interaction is encouraged.
Electronic Medical Records for the Otolaryngologist Howard S Kotler, MD (moderator); Ronald B. Kuppersmith, MD, MBA; Mark Whipple, MD, MS; Rodney P. Lusk, MD; D Thomas Upchurch, MD Electronic medical record systems offer great promise in improving the safety, quality and efficiency of health care by redicomg common medical errors, improving documentation and charge capture, coding and HIPAA compliance, and facilitating insurance verification and payer collections. Clearly, the benefits of EMRs are now recognized by both the private and government sector. The challenge now remains to make this change in a financially acceptable and practice efficient manner. While an EMR system may now be a more practical and affordable consideration, the selection and implementation process remains a particularly difficult task. This miniseminar will provide an overview of the benefits of EMR and share the authors’ extensive experience in the selection factors and important challenges facing EMR implementation. Practical strategies will be outlined and the avoidance of pitfalls detailed. The authors will provide sufficient time for questions regarding the selection and implementation of an EMR.
Emergency Preparedness and Disaster Management: What You Need to Know Anna M Pou, MD (moderator); G Richard Holt, MD, MSE, MPH; Don May; Joseph Brennan, MD; Rick Simmons Hurricane Katrina represented an unprecedented disaster of cataclysmic proportions. Local, State, and Federal resources
MINISEM.
Miniseminars
P14
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
were ill-prepared and overwhelmed, as were hospital systems. Evacuations were not always executed according to plan and the consequences of poor (lack of) communication systems were underestimated leading to a total collapse of order in the city of New Orleans. Much has been learned regarding emergency preparedness and execution that hopefully will benefit patients and healthcare providers in future disasters. This symposium will discuss what is needed to adequately plan for disasters from the standpoint of clinicians, hospitals, and military, in addition to the challenges inherent to the situation. A disaster management team should be in place with designated physicians that are assigned specific roles and responsibilities. Adequate and rehearsed preparation cannot be overstated and the need for evacuation of hospitals prior to the disaster, when applicable, is paramount. The method of patient transfer and a list of facilities willing to accept patients in transfer should be known. The feasibility of whole hospital evacuation pending a disaster, including costs, medical liability and recuperation of losses will be discussed. During disasters, resources (hospital and other) may be overwhelmed and/or limited. When this occurs, rules of daily clinical practice do not always apply. Triage may be changed to ultimately save those who can be saved. Disaster (reverse) triage and military disaster rescue protocols, as well as related ethical issues, will be discussed so that there is a better understanding of the evacuation process of hospitalized patients. Many healthcare providers are facing civil lawsuits following Katrina for patient abandonment and negligence. To date, no legal protection exists for those providing care to patients during disasters. Legal issues such as the Good Samaritan Law and strategies to better protect healthcare providers against civil litigation will also be discussed. The risk of natural disaster and the threat of terrorism are now a well-understood part of life and are not unique to a particular region. In addition to being prepared, the need for medical and ethical guidelines to be used during disasters will be evident.
virtually atraumatically. Implantation of the higher order pathways has already been performed with combinations of penetrating needles or electrode paddles at the brainstem. Prototypes even exist for stimulation as high up as the auditory cortex. We are now also witnessing the development of highly focused fiberoptic delivery systems for infrared laser energy as the stimulus source. A panel of surgeons and scientists, all of whom have been involved in both clinical and basic science of auditory implants, will debate the strategies being developed to foster the next leap in performance gains. The seminar will begin with a candid appraisal of the successes of currently marketed achievements including modiolar hugging electrodes, hearing preservation hybrid implants, compressed and split arrays for severely malformed and obstructed cochleae, and bilateral implantation. Minimally invasive surgical techniques will be examined with the questions posed: What truly constitutes a minimally invasive procedure? What technical features need to be retained in order to maintain necessary safeguards and precautions? The variable successes of auditory brainstem implantation will be reviewed with an eye towards future improvement. The panelist will then present their collective experience with emerging technologies aiming to push the envelope of performance higher into the future. The constant gains in microprocessor speeds will offer opportunities for development of novel processing strategies including current steering. The emerging concept of integrated drug delivery systems will require a careful re-exploration of the well-known design problems of hermeticity, durability and ultrastructural trauma induction. Changes in stimulus energy source (e.g. infrared laser) will undoubtedly require radical changes in device designs and coding strategies. It is the hope of the organizers that this miniseminar will benefit both the attendees and the panelists through the process of evaluative debate and exploration of new ideas.
Emerging Technologies in Implantable Auditory Prostheses
Alexander G Chiu, MD (moderator); Pete S Batra, MD; Rakesh K Chandra, MD; Joseph Han, MD; Eric H Holbrook, MD; Raj Sindwani, MD, FRCS
Andrew J Fishman, MD (moderator); J Thomas Roland, Jr, MD; Jay T Rubinstein MD, PhD; Claus-Peter Richter MD, PhD; Alan G Micco, MD; Mario A Svirsky Current prosthetic auditory implants have achieved a high level of success, however, it would be fair to say that performance gains over the last decade have reached a stable plateau. The latest phase of development has centered primarily on increasing stimulus resolution, preserving residual auditory ultrastructure and function, and implanting higher order neural pathways. To serve these objectives, electrodes have been designed to more closely approximate the spiral ganglion and be inserted
Evidence and Innovations in the Management of CRS Recalcitrant to FESS
Patients with chronic rhinosinusitis (CRS) who remain symptomatic despite undergoing functional endoscopic sinus surgery (FESS) are some of the most challenging patients for otolaryngologists to manage. Systemic and topical antibiotics, antifungals, corticosteroids and immunemodulators are just some examples of the medications being used, and industry has been aggressive in marketing these agents, as well as new mechanical delivery devices, to otolaryngologists desperate for an effective treatment for their symptomatic patients. There are no current guidelines or recognized standards of care in treat-
Culture or PCR for Infectious Diseases Patrick J Antonelli, MD (moderator); James C. Post, MD, PhD; Garth David Ehrlich, PhD; Itzhak Brook MD, MSc; James N Palmer, MD Microbiologic cultures and antibiotic sensitivities have historically been the primary means of selecting optimal antimicrobial therapy. In recent years, molecular diagnostic techniques, such as polymerase chain reaction (PCR), have emerged as powerful means of detecting the presence of micro-organisms in both healthy and disease states. Molecular analysis may reveal a range of microorganisms, including those felt to be pathogens and others that are of unknown significance. Molecular analysis may reveal additional genotypic information that could alter management. The information gleaned from molecular microbiological testing forces us to take a fresh look at the pathogenesis, diagnosis, and management of infectious diseases. In this symposium, the speakers will address the general considerations of conventional and molecular diagnostic testing, then elaborate more fully on common upper respiratory tract infections. Otitis, sinusitis, and pharyngitis will be discussed.
Defining the Role of Primary Surgery in the Era of Chemoradiation Therapy Jonas T Johnson, MD (moderator); Bruce H Haughey, MBChB, FRACS; Guy J Petruzzelli, MD, MBA, PhD; William M Keane, MD; Christine G. Gourin, MD This miniseminar will include evidence-based presentations, followed by discussion of illustrative cases. Audience participation is encouraged. The introduction of evidence which demonstrates that chemoradiation may result in effective organ preservation has
P13 resulted in great changes in the world of head and neck surgery. Many physicians have apparently extrapolated that chemoradiation should be used to treat all head and neck cancers. This is wrong! Many patients with small tumors can be safely and effectively treated with surgery alone. These patients benefit from avoidance of the well-known toxicities of chemoradiation therapy. This is especially true of most early Stage I or Stage II tumors. An increasing body of evidence exists which suggest that some patients benefit from primary surgical care. Surgery offers the advantage of precise pathologic staging. Accordingly, patients can be upstaged when necessary and offered adjuvant chemoradiation. Patients with limited tumors can, once again, be spared the toxicities of unnecessary therapies. Patients presenting with advanced primary tumors (T4) may, under some circumstances, not reasonably expect that chemoradiation will affect “organ preservation.” These patients benefit preferentially from resection and reconstruction. This mini-seminar seeks to provide evidence-based discussion in a setting of illustrative clinical situations. Audience interaction is encouraged.
Electronic Medical Records for the Otolaryngologist Howard S Kotler, MD (moderator); Ronald B. Kuppersmith, MD, MBA; Mark Whipple, MD, MS; Rodney P. Lusk, MD; D Thomas Upchurch, MD Electronic medical record systems offer great promise in improving the safety, quality and efficiency of health care by redicomg common medical errors, improving documentation and charge capture, coding and HIPAA compliance, and facilitating insurance verification and payer collections. Clearly, the benefits of EMRs are now recognized by both the private and government sector. The challenge now remains to make this change in a financially acceptable and practice efficient manner. While an EMR system may now be a more practical and affordable consideration, the selection and implementation process remains a particularly difficult task. This miniseminar will provide an overview of the benefits of EMR and share the authors’ extensive experience in the selection factors and important challenges facing EMR implementation. Practical strategies will be outlined and the avoidance of pitfalls detailed. The authors will provide sufficient time for questions regarding the selection and implementation of an EMR.
Emergency Preparedness and Disaster Management: What You Need to Know Anna M Pou, MD (moderator); G Richard Holt, MD, MSE, MPH; Don May; Joseph Brennan, MD; Rick Simmons Hurricane Katrina represented an unprecedented disaster of cataclysmic proportions. Local, State, and Federal resources
MINISEM.
Miniseminars
P14
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
were ill-prepared and overwhelmed, as were hospital systems. Evacuations were not always executed according to plan and the consequences of poor (lack of) communication systems were underestimated leading to a total collapse of order in the city of New Orleans. Much has been learned regarding emergency preparedness and execution that hopefully will benefit patients and healthcare providers in future disasters. This symposium will discuss what is needed to adequately plan for disasters from the standpoint of clinicians, hospitals, and military, in addition to the challenges inherent to the situation. A disaster management team should be in place with designated physicians that are assigned specific roles and responsibilities. Adequate and rehearsed preparation cannot be overstated and the need for evacuation of hospitals prior to the disaster, when applicable, is paramount. The method of patient transfer and a list of facilities willing to accept patients in transfer should be known. The feasibility of whole hospital evacuation pending a disaster, including costs, medical liability and recuperation of losses will be discussed. During disasters, resources (hospital and other) may be overwhelmed and/or limited. When this occurs, rules of daily clinical practice do not always apply. Triage may be changed to ultimately save those who can be saved. Disaster (reverse) triage and military disaster rescue protocols, as well as related ethical issues, will be discussed so that there is a better understanding of the evacuation process of hospitalized patients. Many healthcare providers are facing civil lawsuits following Katrina for patient abandonment and negligence. To date, no legal protection exists for those providing care to patients during disasters. Legal issues such as the Good Samaritan Law and strategies to better protect healthcare providers against civil litigation will also be discussed. The risk of natural disaster and the threat of terrorism are now a well-understood part of life and are not unique to a particular region. In addition to being prepared, the need for medical and ethical guidelines to be used during disasters will be evident.
virtually atraumatically. Implantation of the higher order pathways has already been performed with combinations of penetrating needles or electrode paddles at the brainstem. Prototypes even exist for stimulation as high up as the auditory cortex. We are now also witnessing the development of highly focused fiberoptic delivery systems for infrared laser energy as the stimulus source. A panel of surgeons and scientists, all of whom have been involved in both clinical and basic science of auditory implants, will debate the strategies being developed to foster the next leap in performance gains. The seminar will begin with a candid appraisal of the successes of currently marketed achievements including modiolar hugging electrodes, hearing preservation hybrid implants, compressed and split arrays for severely malformed and obstructed cochleae, and bilateral implantation. Minimally invasive surgical techniques will be examined with the questions posed: What truly constitutes a minimally invasive procedure? What technical features need to be retained in order to maintain necessary safeguards and precautions? The variable successes of auditory brainstem implantation will be reviewed with an eye towards future improvement. The panelist will then present their collective experience with emerging technologies aiming to push the envelope of performance higher into the future. The constant gains in microprocessor speeds will offer opportunities for development of novel processing strategies including current steering. The emerging concept of integrated drug delivery systems will require a careful re-exploration of the well-known design problems of hermeticity, durability and ultrastructural trauma induction. Changes in stimulus energy source (e.g. infrared laser) will undoubtedly require radical changes in device designs and coding strategies. It is the hope of the organizers that this miniseminar will benefit both the attendees and the panelists through the process of evaluative debate and exploration of new ideas.
Emerging Technologies in Implantable Auditory Prostheses
Alexander G Chiu, MD (moderator); Pete S Batra, MD; Rakesh K Chandra, MD; Joseph Han, MD; Eric H Holbrook, MD; Raj Sindwani, MD, FRCS
Andrew J Fishman, MD (moderator); J Thomas Roland, Jr, MD; Jay T Rubinstein MD, PhD; Claus-Peter Richter MD, PhD; Alan G Micco, MD; Mario A Svirsky Current prosthetic auditory implants have achieved a high level of success, however, it would be fair to say that performance gains over the last decade have reached a stable plateau. The latest phase of development has centered primarily on increasing stimulus resolution, preserving residual auditory ultrastructure and function, and implanting higher order neural pathways. To serve these objectives, electrodes have been designed to more closely approximate the spiral ganglion and be inserted
Evidence and Innovations in the Management of CRS Recalcitrant to FESS
Patients with chronic rhinosinusitis (CRS) who remain symptomatic despite undergoing functional endoscopic sinus surgery (FESS) are some of the most challenging patients for otolaryngologists to manage. Systemic and topical antibiotics, antifungals, corticosteroids and immunemodulators are just some examples of the medications being used, and industry has been aggressive in marketing these agents, as well as new mechanical delivery devices, to otolaryngologists desperate for an effective treatment for their symptomatic patients. There are no current guidelines or recognized standards of care in treat-