INTERVENTIONAL GLAUCOMA: SLT AND MIGS
A Roundtable Discussion Of Nondestructive Interventional Treatments For Open-angle Glaucoma
Cataract & Refractive Surgery Today
SUPPLEMENT | AUGUST 2018
Sponsored by Ellex Medical
Source: https://crstoday.com/articles/2018-aug/interventional-glaucoma-slt-and-migs/
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Iqbal Ike K. Ahmed, MD, FRCSC, introduces this roundtable discussion of different paradigms in glaucoma therapy, with Mahmoud A. Khaimi, MD; Mark J. Gallardo, MD; David Richardson, MD; Nathan M. Radcliffe, MD; and I. Paul Singh, MD. The surgeons share their current treatment strategies for open-angle glaucoma and discuss how to incorporate selective laser trabeculoplasty and minimally invasive glaucoma surgery (MIGS) into practice.
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At ASCRS 2018 in Washington, DC, a group of surgeons experienced in interventional glaucoma therapies sat down to discuss the roles of selective laser trabeculoplasty (SLT) and microinvasive glaucoma surgery (MIGS) for treatment of openangle glaucoma (OAG).
The term interventional glaucoma refers to more than simply technology. It is a mindset that the available technologies bring to us as surgeons and clinicians. Instead of being passive and watchful, waiting for our patients to progress, interventional glaucoma allows us to be actively involved in their care by providing interventional therapies that change the course of the disease. I am very excited about interventional glaucoma and how it shapes the future of glaucoma care.
In this roundtable, we will discuss a number of technologies used in the interventional glaucoma model. First, we want to hear about SLT and its relevance in glaucoma therapy today, including the interplay of SLT and MIGS options. We also will talk about our experiences with ab interno canaloplasty (ABiC) performed with the iTrack surgical system (Ellex), its role in rejuvenating the natural outflow system, and its place among MIGS procedures.
—Iqbal “Ike” K. Ahmed, MD, FRCSC, Moderator
INTERVENTIONAL GLAUCOMA: SLT AND MIGS
A Roundtable Discussion Of Nondestructive Interventional Treatments For Open-angle Glaucoma
Cataract & Refractive Surgery Today
SUPPLEMENT | AUGUST 2018
Sponsored by Ellex Medical
Source: https://crstoday.com/articles/2018-aug/interventional-glaucoma-slt-and-migs/
-----
Iqbal Ike K. Ahmed, MD, FRCSC, introduces this roundtable discussion of different paradigms in glaucoma therapy, with Mahmoud A. Khaimi, MD; Mark J. Gallardo, MD; David Richardson, MD; Nathan M. Radcliffe, MD; and I. Paul Singh, MD. The surgeons share their current treatment strategies for open-angle glaucoma and discuss how to incorporate selective laser trabeculoplasty and minimally invasive glaucoma surgery (MIGS) into practice.
-----
At ASCRS 2018 in Washington, DC, a group of surgeons experienced in interventional glaucoma therapies sat down to discuss the roles of selective laser trabeculoplasty (SLT) and microinvasive glaucoma surgery (MIGS) for treatment of openangle glaucoma (OAG).
The term interventional glaucoma refers to more than simply technology. It is a mindset that the available technologies bring to us as surgeons and clinicians. Instead of being passive and watchful, waiting for our patients to progress, interventional glaucoma allows us to be actively involved in their care by providing interventional therapies that change the course of the disease. I am very excited about interventional glaucoma and how it shapes the future of glaucoma care.
In this roundtable, we will discuss a number of technologies used in the interventional glaucoma model. First, we want to hear about SLT and its relevance in glaucoma therapy today, including the interplay of SLT and MIGS options. We also will talk about our experiences with ab interno canaloplasty (ABiC) performed with the iTrack surgical system (Ellex), its role in rejuvenating the natural outflow system, and its place among MIGS procedures.
—Iqbal “Ike” K. Ahmed, MD, FRCSC, Moderator
How is the increased interest in shared services for HR impacting HRO? At this month’s Publications & Practices Committee meeting, we will meet with three executives who are experts in Shared Services. After level setting us on what’s hot in Shared Services today, they will share their views on whether its competing, helping move folks towards HRO, and/ or resulting in some type of hybrid solutions.
with Kathleen Bienkowski of Kelly Services, Colin Brennan of Aon Hewitt, and Maribeth Sivak of ISG, moderated by Debora Card of ISG.
Coffee Bean RTA Vanity Cabinets come with butt-joint drawers and standard side mounted full extension drawer glides. The sides of the cabinets are finished with a wood composite veneer and a skin is not necessary but highly recommend for any ends that will be exposed once the cabinets are installed.
Chocolate RTA Vanity Cabinets come with butt-joint drawers and standard side mount drawer glides. The sides of the cabinets are finished with a wood composite veneer and a skin is not necessary but highly recommend for any ends that will be exposed once the cabinets are installed.
Fontana di Sucesso, Salas Comerciais, Taguara, Mega 18, 2556-5838Suely Maia
EMPRESARIAL FONTANA DI SUCCESSO
“Uma oportunidade única para atender às expectativas e desejos de investidores e compradores.”
Localização: Taquara
Endereço: Rua Mapendi, 910
Incorporador: Mega 18 Construtora
Tipologia: Dois edifícios com 358 salas comerciais de 18m² a 30m² com possibilidade de junção e andares corporativos; e 14 lojas de 22 a 237m². Estrutura comercial completa, com salas de reunião, hall social no térreo com 2 salas de espera e recepção, foyer, café e refeitório. Estacionamento e Bicicletário.
Vendas e Informações: (21) 2556-5838
A Context-aware Patient Safety System for the Operating RoomJakob Bardram
This is the presentation of the paper entitled "A Context-aware Patient Safety System for the Operating Room" by Jakob E. Bardram and Niels Nørskov. Presented at UbiComp September 2008 in Seoul, Korea.
How is the increased interest in shared services for HR impacting HRO? At this month’s Publications & Practices Committee meeting, we will meet with three executives who are experts in Shared Services. After level setting us on what’s hot in Shared Services today, they will share their views on whether its competing, helping move folks towards HRO, and/ or resulting in some type of hybrid solutions.
with Kathleen Bienkowski of Kelly Services, Colin Brennan of Aon Hewitt, and Maribeth Sivak of ISG, moderated by Debora Card of ISG.
Coffee Bean RTA Vanity Cabinets come with butt-joint drawers and standard side mounted full extension drawer glides. The sides of the cabinets are finished with a wood composite veneer and a skin is not necessary but highly recommend for any ends that will be exposed once the cabinets are installed.
Chocolate RTA Vanity Cabinets come with butt-joint drawers and standard side mount drawer glides. The sides of the cabinets are finished with a wood composite veneer and a skin is not necessary but highly recommend for any ends that will be exposed once the cabinets are installed.
Fontana di Sucesso, Salas Comerciais, Taguara, Mega 18, 2556-5838Suely Maia
EMPRESARIAL FONTANA DI SUCCESSO
“Uma oportunidade única para atender às expectativas e desejos de investidores e compradores.”
Localização: Taquara
Endereço: Rua Mapendi, 910
Incorporador: Mega 18 Construtora
Tipologia: Dois edifícios com 358 salas comerciais de 18m² a 30m² com possibilidade de junção e andares corporativos; e 14 lojas de 22 a 237m². Estrutura comercial completa, com salas de reunião, hall social no térreo com 2 salas de espera e recepção, foyer, café e refeitório. Estacionamento e Bicicletário.
Vendas e Informações: (21) 2556-5838
A Context-aware Patient Safety System for the Operating RoomJakob Bardram
This is the presentation of the paper entitled "A Context-aware Patient Safety System for the Operating Room" by Jakob E. Bardram and Niels Nørskov. Presented at UbiComp September 2008 in Seoul, Korea.
4. Use α=.01, and n=100Determine the Chi-Square value, and come to.docxgilbertkpeters11344
4. Use α=.01, and n=100Determine the Chi-Square value, and come to the appropriate conclusion concerning this goodness of fit procedure.
*From the Table of Random Numbers…all have a probability of 1/10 “numbers from 0-9”
Number
Observed
Expected
0
5
10
25
2.5
1
15
10
25
2.5
2
10
10
0
0
3
8
10
4
0.4
4
12
10
4
0.4
5
15
10
25
2.5
6
5
10
25
2.5
7
10
10
0
0
8
10
10
0
0
9
10
10
0
0
Total
100
100
108
10.8
5. Construct a confidence interval for σ2 using the following values of the variable, X. You may assume that the variable itself is normally distributed.
X
30
32
28
25
31
34
30
20
40
A. let alpha be .01, and construct the confidence interval.
B. Now let alpha be .10, and again construct the confidence interval.
C. Why did we have to assume that the variable itself was normally distributed?
1
310 week 5 Response:
Response needed to each Post! I have listed an example of a “response” in RED. There are four “post” total that need responses.
· Post: Lisa Kaufman posted Nov 17, 2015 1:21 PM
The Medical Device Safety Act (MDSA)
I found this “ACT/LAW” very much and advocate for the patient….The Medical Device Safety Act (MDSA) was implemented in 2009. This law will restore patients’ ability to hold medical device manufacturers accountable for injuries caused by defective medical devices. Medical devices range from catheters, implantable defibrillators, pacemaker wires and artificial heart valves.
“Although, the bill replies to a 2008 Supreme Court decision, Riegel v. Medtronic.” That case held that a medical device manufacturer usually cannot be sued by injured patients if the Food and Drug Administration (FDA) approved the device for marketing through its premarket approval (PMA) process.
This bill has two important goals;
▪Improved Recall Processes: This bill has implantation to have the Government Accountability Office (GAO) to improve the handling on the FDA’s recall of defective devices. The GAO will require the FDA to assess and revaluate each device that falls under the unsafe device and expedite the recalls once the “problem” is discovered.
▪ Enhance Post-Market Surveillance Tools: “This legislation would improve FDA’s ability to conduct post-market surveillance for 510(k) cleared devices by allowing FDA to require the collection of post-market data as a condition of approval.” “The authority would mirror the post-market studies that can be required as a condition of a Pre-Market Approval (PMA) for highest risk devices. Under this legislation, the FDA could require conditions of clearance for 510(k) cleared devices that may have safety concerns. If FDA found a device substantially equivalent to a predicate for a higher-risk device, FDA could clear the device for market through 510(k) but require companies to conduct clinical studies and collect and report more complete data”.
Background
FDA’s oversight of medical devices has landed the agency on GAO’s “high-risk list”.2 GAO cites its concerns about FDA’s post-ma.
Presentation given to health-care management class discussing how military research impacts medical innovations eventually benefiting the civilian population
A KNOWLEDGE BASED AUTOMATIC RADIATION TREATMENT PLAN ALERT SYSTEMijaia
In radiation therapy, preventing treatment plan errors is of paramount importance. In this paper, an alert system is proposed and developed for checking if the pending cancer treatment plan is consistent with the intended use. A key step in the development of the paper is characterization of various treatment plan fingerprints by three-dimension vectors taken from possibly thousands of variables in each treatment plan. Then three machine learning based algorithms are developed and tested in the paper. The first algorithm is a knowledge-based support vector machine method. If an incorrect treatment plan were offered, the algorithm would tell that the pending treatment plan is inconsistent with the intended use and provide a red flag. The algorithm is tested on the actual patient data sets with 100% successful rate and 0% failure rate. In addition, two algorithms based on the well-known k-nearest neighbour and Bayesian approach respectively are developed. Similar to the support vector machine algorithm, these two algorithms are also tested with 100% success rate and 0% failure rate. The key seems to pick up the right features.
Have you ever wanted to learn more about human factors in health care and it’s impact on patient safety? Well now is the time. Join us on Oct. 4th at noon ET as Dr. Kathy Momtahan and Dr. Gianni D’Egidio explore the work of the Canadian Human Factors in Healthcare Network and recent human factors evaluations of hospital external defibrillators.
1. Safety is everybody’s business. According the Hippocratic oath from 5th century : “ Never do harm to anyone” Safer Surgery can be defined as a reduction in avoidable harm to a surgical patient
2. It is a part of medical specialty that uses operative manual and instrumental technique on a patient to investigate or treat a pathological condition. Surgical team: 1. Surgeon 2. Surgeon’s assistance 3. Anesthetist 4. Scrub nurse 5. Scouting nurse 6. Surgical technologist
3. Time or duration when patient admitted and discharge after completion of surgery. So, surgical safety has broadly included in different phases: 1. Preoperative(Diagnosis, investigation) 2. Per operative 3. Postoperative(Up to discharge)
4. 1. Adverse events: An incident which result in harm to the patient. 2. Near Miss: An incident which could resulted in unwanted harm but did not. 3. No-harm events: An incident that occur and reach to the patient but result in no injury.
5. An article in the Gurdian newspaper UK in March 2013 claimed that “five worst medical” nightmares a Pt faces, three related to surgery: 1. Wrong site surgery 2. Wrong patient surgery 3. Retained instruments and swabs The rate of harm in surgical patient is unknown but probably occur in about 10% surgical patient, though much of this harm will be minor.
6. 1. Patients themselves. 2. Healthcare professional 3. System failure. 4. Medical complexity
7. Patients Themselves 1. A variety of presentation. 2. Differing co-morbidities 3. Differing response to treatment 4. Patients are reluctant to speak up. 5. Refuse to co-operate 6. Hide and seek
8. Healthcare professional 1. Inadequate Pt assessment(delay or error in Diagnosis) 2. Failure to use or interpret appropriate test 3. Error in performance of an operation and test. 4. Inadequate monitoring or follow-up. 5. Deficient training or experience 6. Fatigue, overwork or time pressure. 7. Personal or psychological factor i.e. drug abuse or depression. 8. Lack of recognition of the danger of medical errors.
9. System failure 1. Poor communication between healthcare provider. 2. Inadequate staffing level 3. Overreliance on investigation 4. Lack of coordination at handover 5. Drug similarities. 6. Equipment failure due to lack of skilled operators. 7. Inadequate system to report and review patient safety incident.
10. Medical complexity 1. Advance and new technologies(laparoscopic, robotic surgery) 2. Potent drug and their side effects and interaction. 3. Working environment- Surgical ICU, HDU and Operation theatre
11. Surgery is one of the most complex health intervention to deliver. More than 100 million people worldwide require surgical treatment every year for different reason. Great Professor of Surgery Sir Alfred Cuschieri and other describes surgical errors in different categories that committed by the surgeons during care of the Patients.
12. 1. Diagnosis and management erro
1. Surgical 'black box' could reduce errors
Story highlights
"Black box" would record surgeons' movements and identify errors in real time
Surgical black box could be used to prevent major patient complications
Doctors and lawyers debate whether recordings would be used in malpractice lawsuits
Inside the operating room, video cameras track every movement. Outside, a small computer-like
device analyzes the recordings, identifying when mistakes are made and providing instant feedback
to surgeons as they operate.
This is the dream of the surgical "black box." Operations could become flawless. Post-operative
complications could be significantly reduced. Surgeons could review the footage to improve their
technique and prep for the next big case.
Such a device isn't far from reality.
Researchers in Canada are working on a surgical tracking box -- like the ones placed in airplanes --
that records surgeons' movements and identifies errors during an operation.
By pinpointing mistakes and telling surgeons when they're veering "off course," a black box could
prevent future slip-ups, says Dr. Teodor Grantcharov, a minimally invasive surgeon at St. Michael's
Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters
occur, the surgical black box Grantcharov is creating will be used proactively to prevent major
patient complications.
A number of hospitals have already expressed interest in using the device, Grantcharov says.
But the litigious medical environment may make its implementation problematic. If the recordings
were used in court, they could open the floodgates to a new wave of malpractice concerns, which
would be counterproductive to surgeons and patients, Grantcharov says.
"We have to ensure the black box is used as an educational tool to help surgeons evaluate their
performance and improve," he says.
A work in progress
Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating
room microphones and cameras that record the surgery, the surgeon's movements and details about
team dynamics.
It will allow surgeons to hone in on exactly what went wrong and why.
The black box will eventually assess everything from how surgeons stitch to how delicately they
handle organs and communicate with nurses during high-stress situations. Error-analysis software
within the black box will help surgeons identify when they are "deviating" from the norm or using
2. techniques linked to higher rates of complications.
So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic
weight-loss surgery.
"At this initial stage, we are analyzing surgeries to determine how many errors occur and which
ones actually lead to bad results for patients," Grantcharov says. Not every error will result in a
patient complication.
Grantcharov's initial research has shown that surgeons recognize few of their mistakes, and, on
average, make about 20 errors per surgery -- regardless of experience level. Once Grantcharov's
team determines which errors affect patient safety, it hopes to be able to provide this information to
surgeons in real time. The team has also developed software that can synthesize the recorded data
into user-friendly and interpretable information for surgeons.
The concept of using a black box in surgery isn't new. But until now, the technology never made it
out of the laboratory because it lacked comprehensiveness, Grantcharov says. Earlier surgical black
boxes didn't record all the important elements of the operating room, he says, leaving pieces of the
puzzle missing.
"To truly understand what causes an error, you need to know all the factors that may come into
play."
Recording mistakes
Grantcharov was inspired to develop the surgical black box after years of witnessing how patient
complications affected surgeons.
"The feeling of not knowing what causes a complication, whether it's surgical technique,
communication in the operating room or the patient's condition itself, is tormenting," Grantcharov
says.
Many surgeons, however, may be uncomfortable with using a black box in the operating room, says
Dr. Teodoro Forcht Dagi with the American College of Surgeons Perioperative Care Committee.
"If there was a legal requirement to record every operation, then many surgeons would be
resistant," Forcht Dagi says. He says he believes doing so would create a sense of nervousness that
would paralyze a surgeon's ability to operate and end up ultimately harming patients.
"The black box needs to be used solely by surgeons for their own education, in which case I think it's
a great idea," Forcht Dagi says.
Errors during surgery have generally been dealt with after the fact, and only once a complication
during the patient's recovery occurs. Weeks after surgery, cases with complications are presented to
a panel of experts, who weigh in on what may have gone wrong during the operation.
Yet in many cases nothing is recorded apart from an audio transcript of the operation, making it
tough to identify what caused each complication. The black box would add much needed context.
"I would rush (a black box) into service immediately," says Richard Epstein, professor of law at New
York University's School of Law. Since most medical lawsuits end up being "he said, she said"
3. arguments, not knowing exactly what happened in the operating room just adds to the level of
distrust, Epstein says.
In the United States, the Healthcare Quality Improvement Act prevents courts from using data that
doctors and hospitals use for peer review, a self-regulation process in which experts or "peers"
evaluate one another. The law allows doctors to assess each other openly and identify areas for
improvement without fear of litigation.
But there are exceptions to this rule, says William McMurry, president of the American Board of
Professional Liability Attorneys. For instance, cases where surgeries are recorded but don't receive
any peer review can be used in court.
While McMurry says that "keeping patients in the dark about the details of their surgery is never
OK," he points out that litigation concerns should not derail use of the black box. It will be an asset
to the health care system regardless of whether it can be used in court, he says.
"We care about better health care, and the black box will provide surgeons with the information they
need to avoid mistakes," McMurry says. "It's a win-win situation."
The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in
the next few months. Talks are also under way with a number of American hospitals.
If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black
box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug
Administration.
Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made
me a safer surgeon and a better teacher."
http://www.cnn.com/2014/08/22/health/black-box-surgery/