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GENERAL SESSIONS Monday, October 20, 2003: General Sessions Courses Tuesday, October 21, 2003: General Sessions Courses Wednesday, 22, 2003: General Sessions Courses Thursday, 23, 2003: General Sessions Courses MONDAY, OCTOBER 20, 2003 9:45 am–11:45 am This session will address the management of patients on long term anticoagulation who need surgical procedures. This session will also review the latest clinical evidence on prevention and management of perioperative venous thromboembolism. Back to Monday General Sessions 9:45 am–11:45 am Operative therapy is used less often for the treatment of peptic ulcer disease and its complications since the discovery of Helicobacter pylori and less invasive interventions for bleeding. This session will outline when operative treatment is indicated and which procedure is preferable for any given situation. Back to Monday General Sessions 9:45 am–12:15 pm Surgical patients have long been at risk for bacterial infection of the surgical site and bacterial nosocomial infections following procedures. With the HIV epidemic of the 1980s, increased attention has focused on viral and other pathogens that may be transmissible to the patient from blood products, transplantation, or even chronic infection of the surgeon. Three topics will be presented: (1) HIV infection: risks to patients and surgeons, (2) hepatitis infection: risk to patients and surgeons, and (3) newer pathogens of concern (prions, West Nile virus, and herpes viruses). This session will provide current information on risks to patients and to surgeons based on the most current information available. Back to Monday General Sessions 10:00 am–11:30 am The 2003 Initiate's Program will feature the inspiring tales of notable surgeons who have accepted challenges leading up to or during their surgical careers and have managed to overcome various obstacles, barriers, and stereo-types in order to practice and excel in their chosen fields of surgery. They provide inspiration for all surgeons who continue to face adversity in everyday practice, from mounting socioeconomic concerns to the recent medical malpractice dilemma. They are positive role models who exemplify the longstanding tradition of excellence in the surgical fields. These surgeons have helped pave the way for future generations (from all walks of life) in pursuit of a career in surgery, regardless or gender, socioeconomic or ethnic background, or physical limitations. Back to Monday General Sessions 10:00 am–12:00 noon Surgical treatment may be life saving and established by long standing practice patterns; however, such patterns often are not validated by evidence-based clinical trials. The effectiveness of new technology, on the other hand, must be "proved" on the basis of clinical trial evidence. What should stand as the standard of care—long standing established practice or evidence based new technology based treatments? This question can be debated in three debates involving three common clinical problems where new technology has been widely applied: morbid obesity, abdominal aortic aneurysms, and gastroesophageal reflux. The following proposals will be debated by two speakers (one pro and one con) on each topic with the focus on what is best for the patients in terms of long term outcomes.
Each speaker will present his/her point of view and then each will rebut his/her opponent's comments. An audience interactive response system will allow the audience to vote on the "winner" of each debate. Back to Monday General Sessions 10:00 am–12:00 pm The purpose of this session is to review the potential complications which may occur in the operating room, their frequency, how they are managed and most importantly, how they can be prevented. This will be an interactive session which consists of questions asked of the audience to which they can respond electronically. A case presentation will precede each of the three presentations from the panel of experts. The session will conclude with a question and answer panel discussion. The proposed topics that will be covered include: unexpected intraoperative emergencies including, sudden cardiovascular collapse, coagulopathy, transfusion reaction, anaphylaxis, and malignant hyperthermia. A second area that will be reviewed is the difficult airway. Emphasis will be placed on recognition of the difficult airway and management. Finally, a review of mechanical failures and hazards in the operating room with emphasis on electrical complications that may occur with laparoscopic equipment or other energy source injuries will be discussed. Back to Monday General Sessions 10:30 am–12:00 noon Many surgeons give their time in organized provision of pro bono care, both in domestic and international projects. The findings of the ACS study on surgical volunteerism will be presented. Panelists will exemplify their experiences, accomplishments, and satisfactions. Information will be provided on accessing existing programs and starting up new projects, including barriers incident to local conditions and customs, health and safety concerns, and liability. The different challenges for urban, rural, and international programs will be discussed. Back to Monday General Sessions 1:30 pm–3:30 pm In an era of rapidly proliferating new surgical procedures, the means by which practicing surgeons may gain competency in such procedures will be addressed. Back to Monday General Sessions 10:00 am–12:00 noon Treatment philosophy and results of treatment with preoperative chemotherapy and/or radiation therapy for Stage III breast cancer, locally advanced rectal cancer, soft tissue sarcoma, and cancer of the upper aerodigestive tract will be discussed. Back to Monday General Sessions 1:30 pm–3:30 pm This session will cover inflammatory bowel disease of small and large bowel (both operative and nonoperative management) and technical methods of preserving bowel length and intestinal continuity. Back to Monday General Sessions 1:30 pm–3:30 pm Diagnostic and therapeutic approaches to melanoma, including sentinel node biopsy, regional lymph node dissection, and chemotherapy will be discussed. It will include recommendations for margins or excision, sentinel node biopsy, regional lymph node dissection and systemic therapies. Back to Monday General Sessions 1:30 pm–3:30 pm The incidence of esophagogastric junction tumor is increasing. This session will discuss recent advances in staging the management of early cancers, the use of minimally invasive surgery, and adjuvant therapy of these cancers. Back to Monday General Sessions 1:30 pm–4:30 pm Four key aspects in the management of patients with rectal cancer will be discussed: (1) patient selection criteria and the expected outcomes of local excision and radiation therapy for early rectal cancer; (2) patient selection for neoadjuvant chemoradiation and the risks and benefits; (3) rationale and key aspects of total mesorectal excision; and (4) indications and benefits of colonic pouch reconstruction after low anterior resection. Back to Monday General Sessions 3:00 pm–5:00 pm It is believed that within the next few years, a viable hemoglobin substitute will become commercially available. This session will discuss the current status of these agents, their potential use for the trauma patient, massive transfusions, field transfusions, and potential side effects and complications. Back to Monday General Sessions 3:00 pm–5:30 pm General surgery is facing a crisis. The last three matches have clearly demonstrated that there has been a graduated declining interest in general surgery, as demonstrated by the decreasing number of medical students applying to the field, the increasing number of vacant positions, and the increasing number of positions filled by applicants who did not graduate from U.S. or Canadian medical schools. In contrast, several surgical subspecialties, such as urology, orthopaedics, otolaryngology and plastic surgery, remain very competitive and highly desirable. This symposium will explore explanations behind the differences between general surgery and the subspecialty programs. Back to Monday General Sessions 3:00 pm– 5:00 pm With the restructuring of the College into a 501c(3) and a 501c(6), there is much greater flexibility in the Washington, DC activities of the College. The changes have enabled much greater activity on the fellowship's behalf with some results, including Medicare reimbursement, which would not have been possible two years ago. The panel will inform the fellowship on these widespread activities and changes. Back to Monday General Sessions 3:30 pm–5:30 pm This session will describe the technique, sensitivity, and specificity of sentinel lymph node biopsy from the maturing data on this subject. The current indications for the technique and the information obtained from immunohistochemical stains will be reviewed and evaluated. Back to Monday General Sessions TUESDAY, OCTOBER 21, 2003 8:00 am–10:00 am Decisions concerning patient care are being made by health economists, MBAs, lawyers, and legislators. It is essential that surgeons have a place at the table as patient advocates. In order to do so, we must speak the language. Back to Tuesday General Sessions 8:00 am–10:00 am This session will discuss the many ongoing controversies regarding repair of groin hernias. Specifically, the relative advantages and disadvantages of laparoscopic versus open approach, general anesthesia versus local anesthesia, and the use of mesh versus tissue approximation will be debated. Back to Tuesday General Sessions 8:00 am–11:00 am This session will cover handheld devices at the point of care. Topics will include the type of data that will be available at the bedside and how to use these data to improve the quality of care. Back to Tuesday General Sessions 8:00 am–11:00 am The emphasis of this panel discussion will be on traumatic brain injury (TBI), which remains a major public health problem globally. In the United States, the incidence of TBI requiring hospital admission is conservatively estimated to be 200 per 100,000 population, and the incidence of penetrating head injury is estimated to be 12 per 100,000, the highest of any developed country in the world. Of approximately 500,000 new cases each year, a sizeable proportion demonstrate significant long term disabilities. This panel discussion will focus on specific strategies in the diagnosis and management of TBI and will critically evaluate the impact of recent evidence based guidelines and new clinical trial results in the care of these challenging patients. Back to Tuesday General Sessions 8:00 am–10:00 am This session will provide an introduction to the Patient Safety Manual and selected contributors. The panelists will address a variety of surgical issues related to patient safety as presented in the manual. Back to Tuesday General Sessions 8:30 am–10:00 am The Central Judiciary Committee (CJC) presents common and unusual reasons for which Fellows are brought for action before the CJC. This presentation will help demonstrate how surgeons can jeopardize their patients, damage their careers, face license loss or restrictions, and potentially face expulsion from the College. Some cases are tragically innocent, fueled by errors in judgment, erroneous communications, and anger. Other cases relate to chemical dependency, incompetence, breaches of professionalism, and felonious behavior that early self recognition could have avoided. A panel of experts will discuss cases, detail recognition of problems, and recommend avoidance of specific behaviors (based on CJC experience) for Fellows to measure their own lives and careers, and those of friends, for prevention. Back to Tuesday General Sessions 9:00 am–10:00 am Despite an increased understanding of the tumor biology in gastric cancer, the prognosis of patients with this disease in the United States remains poor. An increased utilization of multi-modality approaches to gastric cancer treatment has been advocated. However, the role and sequence of cytotoxic therapy in locally advanced but respectable gastric cancer remains controversial as does the need for extended lymphadenectomy. A discussion of neoadjuvant, surgical resection and adjuvant therapy approaches to respectable gastric cancer will be made to demonstrate current treatment approaches. Back to Tuesday General Sessions 10:15 am–12:45 pm Dedication of the Surgical Forum Volume (as published in the September, 2003, JACS Supplement) With the sequencing of the human genome there is now a plethora of information available to practicing surgeons, surgeon-scientists, patients, and the general public via the Internet. The 2.9 billion nucleotide codes of the human genome are available at www.ensembl.org. It is becoming increasingly apparent, however, that knowledge of a specific DNA sequence is not enough to unravel many of the mechanisms underlying human disease. This is due, in part, to the correlation coefficient between the amount of mRNA present to the corresponding protein abundance, which is less than 0.50. This has given rise to the need for proteomics, a field that characterizes the proteins that are the products of gene expression. The purpose of this session is to address the challenges of translating the benefits of sequencing the human genome and understanding the role of the products of gene expression to clinical medicine. Back to Tuesday General Sessions 10:30 am–11:30 am Pancreatic cystic neoplasms are being recognized with increasing frequency and must be discrimated from pseudocysts. Evolving indications and techniques for intervention mandate accurate diagnosis and tailored treatment. Back to Tuesday General Sessions 10:30 am–12:30 pm Three panelists representing the faculty, resident, and student views will present the impact of resident work hour limits on the educational experience of medical students. Included in the presentations will be the impact on learning about surgical problems as well as learning about surgery as a career. Time will be reserved at the conclusion for questions and answers from the audience. Back to Tuesday General Sessions 10:30 am–1:00 pm Bioterrorism continues to be a topical subject as acts of civilian terrorism remain a major source of public concern. Surgeons will be involved in the care of patients if biological agents are used against civilian targets. This program will provide detailed discussion of the three types of biological agents that may be used: (1) whole bacteria (such as anthrax, plague, and tularemia), (2) biological toxins (such as botulinum toxin and staphylococcal enterotoxin B), and (3) viral agents (such as smallpox, equine encephalitis virus, and hemorrhagic fever viruses). A 20–25- minute presentation will be given for each of the three categories, with the balance of the program for questions and answers. This session will expand on the session "Weapons of Mass Destruction" at the 2002 Clinical Congress. Back to Tuesday General Sessions 1:30 pm–3:00 pm This session will review the use of laparoscopy in the assessment of surgical resectability of gastrointestinal/lepatic tumors, including modalities such as ultrasound. Back to Tuesday General Sessions 1:30 pm–3:00 pm Pancreatic necrosis, the end result of severe pancreatitis, comprises a spectrum from focal injury to extensive regions of pancreatic tissue death, often complicated by bacterial and sometimes fungal injection. Appropriate treatment requires an appreciation of the evolution of injury and the indications for intervention vs. non-operative support. Back to Tuesday General Sessions 1:30 pm–3:30 pm Pain management is an important medical, economic, and social issue. The patient with chronic non-malignant pain frequently presents a challenge to the surgeon. This panel will review obstacles to the use of effective opioid analgesia, cost-based opioid pain management, the changing attitudes of government agencies towards effective pain management, and ethical issues in the use of opioids in acute pain management. Back to Tuesday General Sessions 2:30 pm–5:30 pm Complex extremity injuries are among the most costly and generate a disproportionate amount of long-term disability. This session will address the critical decisions and approaches in the multidisciplinary management of these complex injuries, including amputation, reconstruction, and rehabilitation. Back to Tuesday General Sessions 3:00 pm–4:00 pm This session will highlight the work being done at the Fistula Hospital in Addis Abadus, Ethiopia. It will feature Dr. Catherine Hamlin, a surgeon, who is making a valuable contribution to the community and science of surgery. Back to Tuesday General Sessions 3:00 pm–5:00 pm The program will provide an update on radiofrequency ablation (RFA), microwave coagulation therapy (MCT), and laser interstitial thermotherapy (LITT) to treat malignant tumors in the liver, lungs, breast, and other body sites. The availability of thermal ablation techniques has increased significantly in the past several years, and an understanding of the indications, limitations, complications, and outcomes is very important. The role of these intratumoral thermal treatment techniques combined with surgical and multimodality therapies will be discussed. Back to Tuesday General Sessions WEDNESDAY, OCTOBER 22, 2003 8:00 am–10:00 am This session will educate surgeons with respect to the new field of surgical tissue adhesives and hemostatic agents so that these materials may be used and applied in the safest, most effective, and efficient manner. Emphasis will be placed on using these agents in general surgery as well as several subspecialties. Both the potential benefits and limitations of the five major families of agents will be provided, specifically: fibrin sealant, cyanoacrylate, collagen and thrombin, polyethylene glycol polymers, and albumin cross linked with glutaraldehyde. Back to Wednesday General Sessions 8:00 am–10:00 am Since the 1960s, the College has supported nearly two hundred International Guest Scholars and other international travelers. The Year 2003 international travelers, promising young surgeons from nine different countries, will offer brief presentations on the surgical experience in their homeland and their own research pursuits. The ANZ Traveller, a North American Fellow, will comment on his visit to the annual meeting of the Royal Australasian College of Surgeons and surgical centers in Australia and New Zealand. Back to Wednesday General Sessions 8:00 am–10:00 am Exploration of the abdomen during a laparoscopic cholecystectomy procedure occasionally results in unexpected findings, including suspected gallbladder cancer, a mass in the liver, or a likely malignancy elsewhere in the abdomen. What to do when these surprises are encountered will be discussed. Back to Wednesday General Sessions 8:00 am–10:00 am The Division of Education of the American College of Surgeons has appointed four special task forces to address the competencies of interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. The task forces will address these competencies for practicing surgeons, surgery residents, and medical students and are making excellent progress. An update will be provided from each of the four task forces. Back to Wednesday General Sessions 10:30 am–12:00 noon There is a significant discrepancy in health care delivery to minority and underserved populations. The National Institutes of Health (NIH) and Centers for Medicare and Medicaid Services have both developed offices to address this issue. This session will discuss the multifaceted aspects of health care delivery to minority populations. Topics will include: a general statement on the health care problems in the United States; the creation of an Office of Racial Disparity at NIH; mechanisms to attract and maintain minority students; and an overview of racial disparity in surgical health care delivery, focusing on vascular and cardiac surgery. Back to Wednesday General Sessions 10:30 am–12:00 noon Since the events of September 11, America is involved in a new war, a war against terrorism. To face this new conflict, America must draw on its past experiences and develop new models to effectively deal with military casualties. America has also realized the necessity to develop a symbiotic relationship between military surgeons and civilian trauma surgeons. This session will cover past wartime experiences along with recent civilian experiences in dealing with casualties of terror and examine what large, inner city trauma centers with significant experiences in urban warfare can contribute to the overall effort. By looking at the past and present, it may be possible to develop a model to deal with both military and civilian casualties of terrorism and warfare in the future. Back to Wednesday General Sessions 10:30 am–12:00 noon Three, scripted, role-playing scenarios with surgeons will be presented: (1) pregnancy during residency—meeting the resident and chair of the department; (2) patient discrimination—the patient does not want a woman or a person of color to take care of him; (3) ethics and appropriate personal relationships. Interactive audience response will be used after each scenario, followed by panel discussion and audience questions to the panel. Back to Wednesday General Sessions 10:30 am–12:30 pm As the role of allied health providers continues to mature and the forces affecting surgery continue to change our environment, surgeons will increasingly employ or work with nonphysician providers. What will happen during the next decade? What will be the new role for nonphysicians in surgery? How can surgeons influence the direction that such progress will take? The panel will attempt to identify the forces driving this change and opportunities for surgeons to participate in decisions regarding who will assist in the care of surgical patients. Back to Wednesday General Sessions 1:00 pm–3:00 pm For the past 25 years, physicians have been dealing with the effects of a flawed system of dealing with medical injuries. The following is what occurs under our current system: 1) Fewer than one in eight patients who are negligently injured are compensated; 2) Over 60 per cent of premiums paid by physicians are consumed by legal fees; 3) A medical malpractice suit frequently causes severe emotional damage to both the physicians and their families, even physicians are later acquitted by the courts; 4) The current system promotes the practice of defensive medicine, the cost of which has been estimated to be as high as $50 billion per year; 5) Our current system impedes the development of a patient safety system which requires self-reporting of errors. This fault-based system, despite many efforts at reform, has led to our present crisis. Physicians are being forced to restrict their practices, relocate, or prematurely retire. As a consequence of this, access to care is being threatened. This session will present different viewpoints as to the abuse and possible remedies to the Medical Liability Crisis. Back to Wednesday General Sessions 1:30 pm–3:00 pm As endovascular methods improve, a wider array of acute injuries become amenable to a minimally invasive approach. As this technology becomes more broadly applied, issues such as optimal resources, training and education, scope of practice, and the basis for decision making will become increasingly important for the trauma surgeon, vascular surgeon, and interventional radiologist. This session will explore the developing trauma related uses for endovascular technology and the infrastructure necessary to support such use. Back to Wednesday General Sessions 1:30 pm–3:30 pm This session will review the current policy for the 80 hour work week and discuss the impact it has on resident education and patient care in teaching hospitals. Back to Wednesday General Sessions 1:30 pm–5:00 pm Intensive palliative care is a recent emphasis in the care of patients with advanced age or end stage organ failure. The importance of symptom palliation has been embraced by many physician organizations, including the American College of Surgeons and the American Board of Surgery. However, palliative care has been a long standing core principle of surgery throughout its history. Panelists will review the surgical tradition in light of symptom palliation as a driving force behind many innovations. Also discussed will be the outcomes evidence in the surgical practice of symptom management and the recent experience of palliative care education in 10 general surgical residencies. Present and possible future surgical procedures for symptom palliation will be presented. In view of the current litigious environment, the legal imperative of and legal protection for palliative care will also be addressed. Back to Wednesday General Sessions 3:00 pm–5:30 pm All surgeons involved in the care of trauma patients find themselves in a particularly difficult operative situation sooner or later. Likewise, most experienced trauma surgeons have developed a number of technical tricks for use in particularly "suboptimal" operative situations. In this session, a number of highly experienced trauma surgeons will describe operative techniques they have found useful in difficult situations in the neck, chest, and abdomen. Back to Wednesday General Sessions 3:30 pm–5:00 pm Medical malpractice and liability has become a growing concern for the clinicians, especially the surgeon. Complicated medical procedures and market place conditions of medical costs have contributed to high rates associated with malpractice. This session will focus on the current state of medical malpractice and methods that surgeons can follow to address the issue. Back to Wednesday General Sessions THURSDAY, OCTOBER 23, 2003 8:00 am–11:00 am This session will examine the surgeon's individual responsibility to evaluate and improve personal performance as it relates to patient safety. Back to Thursday General Sessions 8:00 am–11:00 am This session will focus on endocrine physiology and the treatment of metabolic and neoplastic disorders. Back to Thursday General Sessions 8:00 am–11:30 am Using case studies and debate format, the panel will address unprofessional physician behavior and the ability to detect and treat it. There are differences between impairment, incompetence and unethical physician behavior. These differences will be defined while looking at issues associated with aging, fatigue, anger management, and sexual impropriety. Distinguishing the differences has important implications for generating a response which can range from rehabilitation to disciplinary action. Back to Thursday General Sessions 8:00 am–12:00 noon This session will be simultaneously in Spanish and English to enhance the educational value and information exchange among Spanish speaking Fellows. It will consist of state-of-the-art presentations on endovascular surgery, trauma surgery, laparoscopic biliary surgery, rectal carcinoma carinoma staging and management, and melanoma management. Back to Thursday General Sessions 9:00 am–11:30 am Published investigational studies are based on data that are generated from the point of investigation or care; collected and entered/transmitted into a central database; and subjected to a wide variety of analytic methods and techniques. When these results are accepted for publication in a respected peer reviewed journal, the average reader does not question the validity and reliability of the data and assumes that the above processes have been properly conducted. Are readers safe in this assumption? This session is designed to address this and the following questions: Could published articles and/or national databases contain data that are unreliable, flawed, inappropriately analyzed or misused? If so, why? What type of data are most likely to be questionable? What are the forces that contribute to the publication of poor and questionable data? How can a clinical surgeon identify poor quality data in published peer-reviewed articles, and what should prompt him/her to suspect the integrity or misuse of those data? What should the surgical community do to improve of surgical data particularly those data upon which healthcare policy is being formulated? Back to Thursday General Sessions 10:30 am–12:00 noon Injury prevention is most effective at the local level, and surgeons are the appropriate leaders of these grassroots efforts. This session will acquaint practicing surgeons with programs that have been developed and implemented by surgeons in their communities to prevent injuries of various types. Back to Thursday General Sessions 8:00 am–10:30 am Six surgeons ( two each from the Army, Navy and Air Force) will describe their personal experiences in management of casualties in the recent War in Iraq. They will be preceded by an overview of the organization of these services by the Surgeon General of the US Army and his British counterpart. A representative from the Iraq surgical community has been invited to present the problem of civilian casualties management in this new type of modern war. Back to Thursday General Sessions 10:30 am–12:00 noon This program will provide survey information and findings collected over a five-year period on Fellows who have completed an American College of Surgeons Ultrasound Postgraduate course. Highlights will include the impact of the program nationally, measures of competence and knowledge in ultrasound technique and knowledge and restrictions faced by participants. This program will also include a historical perspective, current state, and future of the ultrasound postgraduate programs. Back to Thursday General Sessions August 7, 2003 |