Experiències fora dels nostres hospitalsnostres hospitals Juan J. Fibla Hospital Universitari del...
Transcript of Experiències fora dels nostres hospitalsnostres hospitals Juan J. Fibla Hospital Universitari del...
Experiències fora dels
nostres hospitals
Juan J. Fibla
Hospital Universitari
del Sagrat Cor
La finalitat d aquesta xerrada es
mostrar lo útil que pot ser visitar
altres centres i establir contacte
amb diferents mètodes de treball
EVARTS A. GRAHAM
MEMORIAL TRAVELING
FELLOWSHIP
Estada de 12 mesos a diversos centres als
USA
Beca de la American Association for Thoracic
Surgery (AATS)
PRINCIPALS SOCIETATS CIENTÍFIQUES DE
CIRURGIA TORÀCICA ALS USA
STS
-SOCIETY OF THORACIC SURGEONS-
1964
Annals of Thoracic Surgery
AATS
-AMERICAN ASSOCIATION FOR THORACIC SURGERY-
1917
Journal of Thoracic and Cardiovascular Surgery
STS
The Society of Thoracic Surgeons is a not-for-profit
organization representing more than 6000 surgeons,
researchers and allied health care professionals worldwide
who are dedicated to ensuring the best possible outcomes for
surgeries of the heart, lung, and esophagus as well as other
surgical procedures within the chest.
AATS
Founded in 1917 by the earliest pioneers in
the field of thoracic surgery, the American
Association for Thoracic Surgery (AATS) is
now an international organization of 1200
members consisting of the world’s foremost
cardiothoracic surgeons representing 35
countries.
AATS Membership Guidelines Requirements for Membership
• 3 Sponsors who are currently active/Senior/Honorary members of the Association but not on the Membership Committee.
• Bibliography with evidence of significant contributions to thoracic surgical literature in national peer reviewed English language journals.
• Certification in Thoracic Surgery by either the American Board of Thoracic Surgery, Royal College of Surgeons of Canada, or other national certifying organization.
• Clinical Performance - knowledgeable, technically proficient and respected for patient care. A minimum of 2 years in current practice location is required.
• Professional Stature - evidence of leadership or innovation in cardiothoracic surgery, proficiency in teaching, awards to document outstanding achievements.
L Evarts A. Graham Memorial Traveling Fellowship va ser establert l any 1951 per la American Association for Thoracic Surgery (AATS)
Dona soport a que cirurgians cardiacs i toràcics d arreu del mon visitin els principals centres de l especialitat dels USA
Evarts A. Graham Memorial Traveling
Fellowship
Els objectius del programa son:
1) Ampliar la formació mèdica global
(overall training)
2) Fomentar els contactes internacionals
Evarts A. Graham Memorial Traveling
Fellowship
• Per optar a la beca el candidat ha de tenir dos “sponsors”:
-. Centre d origen.
-. Centre dintre dels USA.
• Els “sponsors” avalaran al candidat com l idoni per al premi i l sponsor dels USA dissenyarà el planning i objectius de l estada.
Evarts A. Graham Memorial Traveling
Fellowship
• PRIMARY CENTER. De 6 a 9 mesos
• SECONDARY CENTERS
El Fellow es compromet a acomplir els
objectius marcats: quiròfan, planta,
consulta, docència i investigació
El Fellowship proporciona un
estipendi de 75.000 $
Comença al Annual Meeting
de la AATS (Maig) -12 mesos-
SPONSORS
Stephen D. Cassivi i
Mark Allen
Mayo Clinic (Rochester)
Laureano Molins
HUSC (Barcelona)
• 2011-2012 Zhi-gang Li, M.D.Shanghai, China
• 2010-2011 Mohsen Ibrahim, M.D.Rome, Italy
• 2009-2010 Juan J Fibla, M.D. Ph.D.Barcelona, Spain
• 2008-2009 Sachin Talwar, M.D.New Delhi, India
• 2007-2008 Ioannis Toumpoulis, M.D.Athens, Greece
• 2006-2007Ari Mennander, M.D.Tampere, Finland
• 2005-2006 Zsolt Tóth, M.D., Ph.D.Pécs, Hungary
• 2004-2005 Smruti Ranjan Mohanty, M.D.Bangalore, Karnataka, India
• 2003-2004 Edvin Prifti, MDTirana, Albania
• 2002-2003 Cliff K.C. Choong, M.D.Auckland, New Zealand
• 2001-2002 Anna Maria Ciccone, M.D.Rome, Italy
• 2000-2001Albertus M. Scheule, M.D.Tuebingen, Germany
• 1999-2000Anders Franco-Cereceda, M.D.Sweden
AATS 89th annual meeting.
May 2009, Boston
AATS 89th annual meeting.
May 2009, Boston
Mayo Clinic
Primary center
Mayo Clinic
El Dr. William Worral Mayo juntament amb una
ordre religiosa –sisters of Saint Francis- crea la
Mayo Clinic al 1889 (Rochester -Minnesota)-.
7 bilions de dolarsPetit hospital rural
Mayo Clinic
Els seus dos fills William James Mayo (1865-1939)
i Charles Horace Mayo (1865-1939) pendran el
relleu i convertiran un petit hospital d un ciutat
petita del Midwest en l actual Mayo Clinic
Mayo Clinic
Juntament amb 6 metges mes funden al 1919 el
primer grup privat mèdic dels USA (The Mayo
Properties Association).
Els socis comparteixen els beneficis i van llogant
nous metges com a assalariats.
Mayo Clinic
Dr. Henry Plummer “l arquitecte de la pràctica
mèdica moderna”.
Dissenya molts dels sistemes ara universalment
acceptats (els dossiers mèdics individuals, el
telefon com a mètode de conexió entre
departaments).
Mayo Clinic Medical School
Pionera del mètode de formació i residència
Mayo Clinic. Actualitat
Organització que engloba tant pràctica
mèdica com investigació.
Mayo Clinic. Actualitat
• Centre especialitzat en “hard-to-treat
diseases”.
• Tractaments innovadors.
• Malalts procedents de arreu del mon
Mayo Clinic. Actualitat
• US. News and World Report: “top 10” durant els darrers 20 anys.
• Mes de 30.000 empleats només a la seu de Rochester. Mes de 1700 metges.
• Influència i respecte al món mèdic.
Mayo Clinic. Filosofia
“The needs of the patient always come first”
Mayo Clinic. Filosofia
“The needs of the patient always come first”
-. Coordinació global dels esforços de tot el grup
-. Dedicació del 40% dels recursos a la recerca
-. Metges tenen salaris fixes (“marketplace salaries”)
-. Els metges no es veuen afectats pel volum (s incentiva que passin mes temps amb els malalts)
Mayo Clinic. Actualitat
Es localitza a 3 centres:
a) Rochester (Minnesota)
b) Scottsdale (Arizona)
c) Jacksonville (Florida)
Mayo Clinic Thoracic Surgery
Division
Mayo Clinic General Thoracic
Surgery
Cl. Deschamps. M.D.
Chair Surgery Department
Dr. Fr. Nichols. M.D
Chair Thoracic Surgery
Division
Dr. R. Shen. M.DMayo Clinic
Transplant Center
Dr. M. Allen. M.D.
Chair Thoracic Surgery
Division
Dr. S. Cassivi. M.DMayo Clinic
Transplant Center
Dr. D. Wigle. M.D, Ph.D.Mayo Clinic Thoracic
Surgery Research Unit
Mayo Clinic General Thoracic Surgery.
Orange days / Blue days
Cl. Deschamps. M.D.
Dr. Fr. Nichols. M.D
Dr. R. Shen. M.DDr. M. Allen. M.D.
Dr. S. Cassivi. M.D Dr. D. Wigle. M.D, Ph.D.
Dia a dia a la Mayo Clinic (Campus)
QUIROFANS
(Saint Marys Hospital)
Volum
Eficiència
Optimització del temps
Dia a dia a la Mayo Clinic
PLANTA D´HOSPITALITZACIO
(Saint Marys Hospital)
Rounds and rounds and rounds….
Sessions a les 7:00h dijous i divendres
Dia a dia a la Mayo Clinic
CONSULTES
(Gonda Building)
Serietat
Prudència
Rapidesa !!!
Mayo Clinic. Robotic Skills Lab.
Centre amb Da Vinci dedicat exclussivament al “hands-on training”
Mayo Clinic. Robotic Skills Lab
Thoracic Surgery Clinical Research Unit
1) American College of Surgeons Oncology Group (ACOSOG). Z0030 Clinical Trial
2) Mayo Clinic Lung Biopsy for ILD Project
3) Lung transplantation in the elderly
4) Chest tubes and air leaks
Thoracic Surgery Clinical Research Unit.
Primary project:
American College of Surgeons Oncology Group(ACOSOG). Z0030 Clinical Trial “Randomized Study of Mediastinal Lymph Node Sampling Versus Complete Lymphadenectomy During
Pulmonary Resection in Patients with N0 or N1 (Less Than Hilar) Non-Small Cell Lung Cancer”.
Validation of the lung cancer staging system revisions using a large prospective
clinical trial database (ACOSOG Z0030). J. J. Fibla, S. D. Cassivi, P. A. Decker, M. S. Allen, G. E. Darling, R. J. Landreneau, R. J. McKenna, D. R. Jones, R. I. Inculet, J. B. Putnam. ACOSOG Z0030 Study Group.
* ASCO´s 2010 Annual Meeting, Session: Lung Cancer – Local-Regional and Adjuvant Therapy. Chicago (IL). June 2010.-.
Thoracic Surgery Clinical Research Unit.
Secondary projects:
Mayo Clinic Lung Biopsy for ILD Project
-. An aggregate risk score predicting mortality after surgical biopsy for interstitial
lung disease (AATS)
-. Microbiology specimens obtained at the time of surgical lung biopsy for interstitial
lung disease: clinical yield and cost analysis (ESTS)
-. Does the number and volume of surgical biopsies influence the diagnostic yield in
interstitial lung disease? A propensity score analysis
Thoracic Surgery Clinical Research Unit
Lung transplantation in the elderly
Lung transplantation in the elderly. Fibla JJ, Tomaszek SC, Cassivi SD. Cardio-
Thoracic Surgery in the Elderly (Ed. Springer 2010) -Chapter 41-.
Outcome of lung transplantation in elderly recipients. S.C. Tomaszek, J.J. Fibla,
J.P. Scott, K.R. Shen, D.A. Wigle, W.K. Kremers, S.D. Cassivi. Eur J Cardio-
Thorac Surg 2010
Thoracic Surgery Clinical Research Unit
Chest tubes and air leaks measurement
• Pleural pressure immediately after pulmonary lobectomy: Single versus double chest tubes for suction. Brunelli A, Cassivi SD, Fibla J, Di Nunzio L. J Thorac Cardiovasc Surg. 2010
• Digital measurements of air leak flow and intrapleural pressures in the immediate postoperative period predict risk of prolonged air leak after pulmonary lobectomy. Brunelli A, Cassivi SD, Salati M, Fibla J, Pompili C, Halgren LA, Wigle DA, Di Nunzio L. Eur J Cardiothorac Surg. 2010
Secondary centers
University of Pittsburgh Medical Center
Cleveland Clinic
Duke University
Washington University in St.Louis
University of Toronto
University of Pittsburgh Medical
Center – Pittsburgh, Pennsylvania
Duke University – Durham, North
Carolina
Duke University – Durham, North
Carolina
Cleveland Clinic – Cleveland, Ohio
Cleveland Clinic – Cleveland, Ohio
Washington University in St.
Louis – St. Louis, Missouri
Washington University in St. Louis –
St. Louis, Missouri
University of Toronto –
Toronto, Ontario, Canada
University of Toronto –
Toronto, Ontario, Canada
AATS 90th annual meeting.
May 2010, Toronto
Graham Reception
In-depth insight into 6 of the
most outstanding medical
institutions
in North America
Tot i els progressos aconseguits al món de les
telecomunicacions el contacte personal es encara una de les
maneres mes efectives d adquirir coneixements en
medicina
EL QUE TROBARAS A FALTAR
ALS USA…
Minnesota. Maig-Septembre
Minnesota. Octubre-Abril
Minnesota
-30ºC
Indoor activities
Ice Fishing
American Football
ASPEN SNOWMASS
NIAGARA FALLS
HAWAII
Recordant els companys…
Mentorship
Don t do it on
your own
GRÀCIES !