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Sleep and Sleepiness: Beyond OSAS
P24
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
marines, nuclear power plants, and some manufacturing plants. Organizations with extremely low failure rates have been found to have many similarities in structure and function; many of these features might be applicable to health care systems. Good surgical care can never occur in the absence of a competent, well-trained, skillful and conscientious surgeon. But even the best surgeon cannot ensure good care if he or she is practicing in a dysfunctional OR, office, or inpatient unit. Understanding the principles that underlie highly effective systems will help the otolaryngologist act effectively to help mediate change in his or her own practice environment.
Sentinel Node Biopsy in Head & Neck Cancer Edmund A Pribitkin, MD (moderator); Jesus E Medina, MD; Francisco J Civantos, MD; William M Keane, MD; Robert L Ferris, MD, PhD; David M. Cognetti, MD; Marc R Rosen, MD Nodal metastasis is the single worst prognostic factor for patients with head and neck squamous cell carcinoma (HNSCC), decreasing survival by nearly 50%. Unfortunately, microscopic nodal disease cannot be accurately predicted by clinical or radiographic examination. Therefore, the N0 neck is traditionally treated with elective neck dissection or radiotherapy when the risk of subclinical metastasis is greater than 15-20%. This practice results in unnecessary treatment of the clinically N0 neck in up to 85% of patients with early stage oral cavity SCC. Sentinel Node Biopsy (SNB) employs lymphoscintigraphy and/or blue dye to identify the first echelon lymph node(s) receiving lymphatic drainage from a lesion. In breast cancer and cutaneous malignant melanoma, the pathologic status of the sentinel node has been demonstrated to predict the pathologic status of the entire draining nodal basin. Despite numerous published international and American investigations of SNB in HNSCC, the procedure remains investigational and has not achieved the status of “standard of care” for the treatment of head and neck patients. This panel will discuss the current status and the future of SNB in the diagnosis and treatment of HNSCC. 1) Introduction to SNB- What have we learned from SNB in Breast Cancer and Cutaneous Malignant Melanoma? 2) Controversies in the treatment of the N0 neck- Should we consider SNB given the outcomes of elective Radiotherapy or Selective Neck Dissection? 3) Technical Aspects of SNB- What must we master in order to achieve consistent, accurate results with SNB? 4) Current State of the literature in SNB for HNSCC-Is the data compelling? 5) Future directions- Can we overcome shortcomings of SNB with novel detection agents?
Sleep and Sleepiness: Beyond OSAS Samuel A Mickelson, MD (moderator); B Tucker Woodson, MD; Kevin E McLaughlin, MD;
Mark A D’Agostino, MD; Lynne Jacobs, MSN, RN, CRNP Obstructive sleep apnea syndrome (OSAS) is a common and clinically important disease, frequently encountered by the otolaryngologist, who is called upon to diagnose and treat the disease. Clinically, OSAS is often complicated by coexisting sleep disorders which may also lead to sleep disruption and excessive daytime somnolence. The otolaryngologist is commonly confronted with the question of how to manage these coexisting disorders. The goal of this course is to describe normal sleep and the most common sleep disorders that lead to poor sleep quality, sleep fragmentation and excessive daytime sleepiness. Diagnostic criteria of common coexisting sleep disorders will be discussed. Diagnostic and treatment regimens will be addressed. Following the course, participants will have increased understanding of normal sleep and other sleep disorders and will be better able to utilize current forms of medical treatment including CPAP and medications. This course will be presented in a case-based fashion focusing on patients who present with snoring, observed apnea, or excessive daytime sleepiness. The panel will discuss: normal adult sleep, obstructive sleep apnea syndrome and upper airway resistance syndrome, narcolepsy, restless leg syndrome / periodic limb movement disorder, and insomnia.
Start Smart: Expert Advice for Early Career Success Susan R Cordes, MD (moderator); Rhoda Wynn, MD; Michael G Stewart, MD, MPH; Peter H Hwang, MD; Jerry M Schreibstein, MD; Larisa Kunda, MD The early years of practice involve many unique challenges, some of which can be anticipated and many of which are surprising. This miniseminar will identify the issues common and unique to both private and academic medicine. A panel of prominent otolaryngologists will explore these topics and share their insight into strategies for developing a fulfilling career. Specifically, speakers will address common transitional issues including “leaving the nest”, generational differences with colleagues, and dealing with difficult employees. Audience members will also gain an understanding of the importance of ‘wellness’ in the workplace, including environment enhancement and personal health. Ideas for private practitioners staying involved in academia and state/local/national societies will be offered. Academic otolaryngologists will offer advice for achieving promotion and recognition, avoiding common problems and balancing research, teaching, and mentoring while maintaining a robust patient care practice. At the conclusion of the seminar, attendees will be able to identify the challenges encountered during the transition from residency and fellowship into the early years of practice, and
Otolaryngology-Head and Neck Surgery, Vol 139, No 2S1, August 2008
marines, nuclear power plants, and some manufacturing plants. Organizations with extremely low failure rates have been found to have many similarities in structure and function; many of these features might be applicable to health care systems. Good surgical care can never occur in the absence of a competent, well-trained, skillful and conscientious surgeon. But even the best surgeon cannot ensure good care if he or she is practicing in a dysfunctional OR, office, or inpatient unit. Understanding the principles that underlie highly effective systems will help the otolaryngologist act effectively to help mediate change in his or her own practice environment.
Sentinel Node Biopsy in Head & Neck Cancer Edmund A Pribitkin, MD (moderator); Jesus E Medina, MD; Francisco J Civantos, MD; William M Keane, MD; Robert L Ferris, MD, PhD; David M. Cognetti, MD; Marc R Rosen, MD Nodal metastasis is the single worst prognostic factor for patients with head and neck squamous cell carcinoma (HNSCC), decreasing survival by nearly 50%. Unfortunately, microscopic nodal disease cannot be accurately predicted by clinical or radiographic examination. Therefore, the N0 neck is traditionally treated with elective neck dissection or radiotherapy when the risk of subclinical metastasis is greater than 15-20%. This practice results in unnecessary treatment of the clinically N0 neck in up to 85% of patients with early stage oral cavity SCC. Sentinel Node Biopsy (SNB) employs lymphoscintigraphy and/or blue dye to identify the first echelon lymph node(s) receiving lymphatic drainage from a lesion. In breast cancer and cutaneous malignant melanoma, the pathologic status of the sentinel node has been demonstrated to predict the pathologic status of the entire draining nodal basin. Despite numerous published international and American investigations of SNB in HNSCC, the procedure remains investigational and has not achieved the status of “standard of care” for the treatment of head and neck patients. This panel will discuss the current status and the future of SNB in the diagnosis and treatment of HNSCC. 1) Introduction to SNB- What have we learned from SNB in Breast Cancer and Cutaneous Malignant Melanoma? 2) Controversies in the treatment of the N0 neck- Should we consider SNB given the outcomes of elective Radiotherapy or Selective Neck Dissection? 3) Technical Aspects of SNB- What must we master in order to achieve consistent, accurate results with SNB? 4) Current State of the literature in SNB for HNSCC-Is the data compelling? 5) Future directions- Can we overcome shortcomings of SNB with novel detection agents?
Sleep and Sleepiness: Beyond OSAS Samuel A Mickelson, MD (moderator); B Tucker Woodson, MD; Kevin E McLaughlin, MD;
Mark A D’Agostino, MD; Lynne Jacobs, MSN, RN, CRNP Obstructive sleep apnea syndrome (OSAS) is a common and clinically important disease, frequently encountered by the otolaryngologist, who is called upon to diagnose and treat the disease. Clinically, OSAS is often complicated by coexisting sleep disorders which may also lead to sleep disruption and excessive daytime somnolence. The otolaryngologist is commonly confronted with the question of how to manage these coexisting disorders. The goal of this course is to describe normal sleep and the most common sleep disorders that lead to poor sleep quality, sleep fragmentation and excessive daytime sleepiness. Diagnostic criteria of common coexisting sleep disorders will be discussed. Diagnostic and treatment regimens will be addressed. Following the course, participants will have increased understanding of normal sleep and other sleep disorders and will be better able to utilize current forms of medical treatment including CPAP and medications. This course will be presented in a case-based fashion focusing on patients who present with snoring, observed apnea, or excessive daytime sleepiness. The panel will discuss: normal adult sleep, obstructive sleep apnea syndrome and upper airway resistance syndrome, narcolepsy, restless leg syndrome / periodic limb movement disorder, and insomnia.
Start Smart: Expert Advice for Early Career Success Susan R Cordes, MD (moderator); Rhoda Wynn, MD; Michael G Stewart, MD, MPH; Peter H Hwang, MD; Jerry M Schreibstein, MD; Larisa Kunda, MD The early years of practice involve many unique challenges, some of which can be anticipated and many of which are surprising. This miniseminar will identify the issues common and unique to both private and academic medicine. A panel of prominent otolaryngologists will explore these topics and share their insight into strategies for developing a fulfilling career. Specifically, speakers will address common transitional issues including “leaving the nest”, generational differences with colleagues, and dealing with difficult employees. Audience members will also gain an understanding of the importance of ‘wellness’ in the workplace, including environment enhancement and personal health. Ideas for private practitioners staying involved in academia and state/local/national societies will be offered. Academic otolaryngologists will offer advice for achieving promotion and recognition, avoiding common problems and balancing research, teaching, and mentoring while maintaining a robust patient care practice. At the conclusion of the seminar, attendees will be able to identify the challenges encountered during the transition from residency and fellowship into the early years of practice, and