Day 1 :
Keynote Forum
Roberto Pinelli
Keynote: Long-term results of accelerated trans-epithelial cross-linking for keratoconus with osmotic riboflavin solution (ParacelTM)
Time : 09:10-09:40
Biography:
Roberto Pinelli graduated in Medicine and Surgery at the State University of Milan, and specialized in Ophthalmology. He trained in refractive surgery with Dr Michael Gordon at the Vision Surgery Laser Center in San Diego, the United States (currently the Gordon-Weiss-Schanzlin Vision Institute). In 2013 he undertook a new project in the Canton of Ticino, SERI Switzerland Eye Research Institute in Lugano, an eye surgery and ophthalmology research institute and care centre for visual defects and all kinds of eye diseases. Until 2014, he was a lecturer in corneal pathology and refractive surgery techniques at the ESASO, European School for Advanced Studies in Ophthalmology in Lugano. An ophthalmology and eye surgery specialist with the FMH (Swiss Medical Association), he has pioneered leading-edge surgery and innovation in ophthalmology, including P-Curve for presbyopia correction, osmotic transepithelial corneal cross-linking for the treatment of keratoconus, and the ParaCel eyewash. He was invited to join the exclusive International Intra-Ocular Implant Club (IIIC) for surgeons founded by Sir Harold Ridley. In 2009-10, in view of his groundbreaking research activity in the field of refractive surgery and the science of vision, he was invited to join the executive committee of the world’s most prominent ophthalmology association, the American Academy of Ophthalmology (ISRS/AAO). Currently a member of the Scientific Advisory Board of Biosyntrx (Colorado Springs, Colorado), a biotech company operating in the field of ophthalmology, and the Medical Advisory Board of Avedro (Waltham, Massachusetts), a leading company in the calibration of instruments and devices for eye pathologies.
Abstract:
Aim: The aim is to present the long-term results of accelerated transepithelial cross-linking (CXL) for keratoconus with osmotic riboflavin solution. Methods: Patient with progressive keratoconus had accelerated transepithelial CXL. Visual and refractive outcomes and the endothelial cell density /ECD) were evaluated preoperatively and postoperatively. Results: Thirty-five patients were examined unilaterally; postoperatively 35 eyes were evaluated at 3 months, 6 months, 1 year and 2 years form the treatment. No intraoperative or postoperative complications occurred. The mean uncorrected distance visual acuity improved significantly form 1.12 ± 0.60 logMAR preoperatively to 0.68 ± 0.49 logMAR at the last follow up and the mean corrected visual acuity form 0.37 ± 0.25 logMAR to 0.09 ± 0.15 logMAR, respectively. The mean steep and the mean flat keratometry readings decreased significantly form 54.71 ± 5.26 diopters (D) and 46.82 ± 3.29, respectively, preoperatively to 46.82 ± 3.69 D and 44.93 ± 3.61 D, respectively, at the last follow-up. The mean corneal astigmatism improved significantly from -6.75 ± 4.38 D preoperatively to -2.50 ± 3.10 D at the last follow-up. No significant ECD alteration occurred. Conclusion: Accelerated trans-epithelial CXL was effective and safe in keratoconic patients over a long-term follow-up.
Keynote Forum
Joan Prat
Keynote: Ophthalmologic biomarkers in pediatric psychiatric diseases
Time : 9:40-10:20
Biography:
Joan Prat has completed studies in Medicine (Autonomous University of Barcelona) and Ophthalmology in 1991. From 1991 to 2002 he worked in orbital diseases in Bellvitge Hospital (Barcelona) and later became the Head of Department of Pediatric Ophthalmology in Hospital Sant Joan de Déu de Barcelona until today. He has innovated in eyetracking both in research and development of medical devices for pediatric use and has been attending conferences in WCPOS and EPOS. He is now the Director
of Master’s degree in Pediatric Ophthalmology in Barcelona University and President of Spanish Society of Ocular and Orbital Plastic Surgery.
Abstract:
Psychiatric disorders are usually evaluated through different specific methods such as interviews, questionnaires or family references. The lack of known biomarkers is an important problem to have an objective diagnosis, that is why researchers have been studying the presence of ocular signs associated to several psychiatric disorders in the last two decades. Ocular motility alterations have been found using eye-tracking devices consisting on infrared video cameras and a computer vision software. Schizophrenia has been the most studied disorder, characterized by some defects in smooth pursuit movements. Patients can not follow a target in a medium velocity and have more frequent compensatory and intrusive saccades. Convergence defects and abnormal patterns of scene scanning have been observed, too. Other physical observations are thick retinal venules and thin retinal nervous fiber layer with OCT. These biomarkers can be used to identify adolescents with risk to present psychotic disorders, due to these alterations can appear earlier. Other disease well documented in children is the attention deficit hyperactivity disorder (ADHD). The characteristic failure of inhibitory systems of ADHD seems to produce abnormalities in saccades, specifically in antisaccades. Likewise, an improvement of saccades has been observed after treatment with amphetamines. One of the most important advances are related with early diagnosis of autism (ASD). In visual preferences test, ASD toddlers show preference to look at geometric images instead of faces and other social images, contrary to well-developed children. Moreover, several studies including 6 to 24-month children show a correlation between the performance of the test and the presence and severity of the disorder. In conclusion, the study of ocular biomarkers by noninvasive eye-tracking techniques in psychiatric disorders can help to obtain an early diagnosis, a better categorization and a better treatment. We encourage pediatric ophthalmologists to collaborate with mental health professionals in eye-tracking diagnosis of psychiatric diseases.
- Primary Care| Nursing Care| General Practice and Cardiology | Family Practice
Location: SERI, Switzerland
Chair
Helen Senderovich
University of Toronto, Canada
Session Introduction
Heike Schutze
Australian Health Services Research Institute
Title: Using unnounced standardised patients as a quality improvement tool to improve primary care
Biography:
Heike Schütze is a Lecturer and Research Fellow at the University of Wollongong. Her research interests include health services research, Aboriginal and Torres Strait Islander health, indigenous health, health inequity, translational research, and the prevention and management of chronic disease.
Abstract:
Aim: To improve the quality and appropriateness of targeted care in general practice for Aboriginal patients using unannounced standardised patients (USP).
Methods: This research was a mixed-methods multiple-site case study. USPs from the local Aboriginal communities anonymously attended general practices. Data from these visits were combined with data from focus groups, clinical records audit, interviews and surveys with practitioners and staff, and best practice guidelines, and were used to develop a tailor-made intervention to improve the acceptability and appropriateness of care provided to Aboriginal patients in general practice.
Findings: Most practices improved their Indigenous-status identification processes and provided more acceptable and appropriately targeted care to their Aboriginal patients. The use of USPs as a quality improvement tool was acceptable to providers and staff and provided the local Aboriginal communities a voice regarding the care they received.
Implications/Conclusions: USPs provide direct patient feedback whilst overcoming many of the inherent biases found in other research methods. Using USPs from the local Aboriginal communities ensured relevance with their priorities and was central to the uptake of the intervention. The method can be adapted as a tool for improving access to primary health care to other minority and marginalised populations.
Recent Publications:
Schütze H;Pulver LJ;Harris M, 2016, 'The uptake of Aboriginal and Torres Strait Islander health assessments fails to improve in some areas', Australian Family Physician, vol. 45, pp. 415 - 420
Schtze H;Rix EF;Laws RA;Passey M;Fanaian M;Harris MF, 2012, 'How feasible are lifestyle modification programs for disease prevention in general practice?', Australian Journal of Primary Health, vol. 18, pp. 129 - 137, http://dx.doi.org/10.1071/PY10106
Harris MF;Fanaian M;Jayasinghe UW;Passey ME;McKenzie SH;Davies GP;Lyle DM;Laws RA;Schütze H;Wan Q, 2012, 'A cluster randomised controlled trial of vascular risk factor management in general practice', Medical Journal of Australia, vol. 197, pp. 387 - 393, http://dx.doi.org/10.5694/mja12.10313
Denney-Wilson E;Fanaian M;Wan Q;Vagholkar S;Schütze H;Harris M, 2010, 'Lifestyle risk factors in general practice: Routine assessment and management', Australian Family Physician, vol. 39, pp. 950 - 953
Helen Senderovich
University of Toronto, Canada
Title: Integrated end-of-life care in advanced congestive heart failure: where are we now? 2015 update
Biography:
Helen Senderovich is a physician at Baycrest Health Science System with practice focused on Palliative Care, Pain Medicine and Geriatrics. She is an Assistant professor at the Department of Family and Community Medicine, and Division of Palliative Care at the University of Toronto who actively involved teaching medical students and residents. She has a broad international experience and a solid research background. Her research was accepted nationally and internationally. She is an author of multiple manuscripts focused on geriatrics, patient’s centered care, ethical and legal aspect of doctor patient relationship, palliative and end-of-life care.
Abstract:
Introduction: Congestive heart failure (CHF) is an increasingly prevalent terminal illness in our globally aging population. Despite optimal medical management, the reality of a poor overall prognosis for CHF is seldom communicated to patients and/or their families. There is an evolving evidence base suggestive that in patients with end-stage CHF, palliative care consultation can improve heart failure symptoms and address spiritual/emotional needs of both patients and caregivers. Despite this evidence, palliative care services remain woefully underutilized by patients with CHF.
Objective: To articulate specific challenges to accessing and implementing palliative care based on available literature and formulate recommendations for practice.
Methods: We performed an extensive literature review of all articles pertaining to end-of-life care for patients with CHF over the past 20 years. Recommendations for practice were made based on primary quantitative/qualitative research as well as expert opinion.
Results: Accessing palliative care services for patients with CHF remains a challenge for several factors including prognostic uncertainty, pervasive misconceptions in both the general public and healthcare providers around what palliative care is, and, unique to CHF, difficulty recognizing when a patient is suitable for referral. We identified key gaps in the delivery of appropriate care to patients with CHF, which included education to abolish current misconceptions, as well as addressing prognosis and goals-of-care effectively. To improve access to – and benefit from – palliative cares, a team-based approach is essential and a movement towards concurrent palliative care delivery alongside active medical therapy needs to be established.
Conclusion: Heart failure is a terminal illness that affects a significant portion of the population that is only increasing in size. Despite growing evidence that palliative care has a role in improving symptom control and overall quality of life in patients with CHF, a multitude of challenges exist and this ultimately hinders access to appropriate palliative care services. As the evidence base continues to grow, education to abolish pre-existing misconceptions and a movement towards team-based palliative care delivery concurrent with traditional medical management will likely improve access to, and benefit from, palliative care services for patients suffering from CHF.
Recent Publications:
Helen Senderovich; New Insights in Clinical Medicine The Role of Exercises in Osteoporotic Fracture Prevention and Current Care Gaps. Where Are We Now? Recent Updates DOI: 10.5041/RMMJ.10308
Shaira Wignarajah; Helen Senderovich Overcoming the challenges associated with symptom management in palliative care DOI: 10.21037/apm.2016.11.05
Evan J. Lilly Helen Senderovich Palliative care in chronic obstructive pulmonary disease Journal of critical care http://dx.doi.org/10.1016/j.jcrc.2016.05.019
Heike Schutze
Australian Health Services Research Institute, Australia
Title: Patient, oncologist and gp views about cancer follow-up care in general practice
Biography:
Heike Schütze is a Lecturer and Research Fellow at the University of Wollongong. Her research interests include health services research, Aboriginal and Torres Strait Islander health, indigenous health, health inequity, translational research, and the prevention and management of chronic disease.
Abstract:
Aim: To explore cancer survivors, their oncologists and general practitioners (GP) views about GPs taking a more active role in ongoing follow-up monitoring and care.
Methods: Collective instrumental case study of cancer survivors (patients), their general practitioners and oncologists. Patients were eligible if they had completed their active treatment for breast or colon cancer and had no current evidence of reoccurrence. Semi-structured interviews were conducted face-to-face or by telephone. Respondents were asked their views on the specialist hospital-based model for cancer follow-up care and their views on their GPs taking a greater or leading role in follow-up care. Thematic analyses within and across-cases were performed in Nvivo version 10. Researcher triangulation was used to refine the coding framework and emergent themes; source triangulation and participant validation were used to increase credibility.
Results: Fifty six interviews were conducted (patients 22, oncologists 16, GPs 18), with 19 cases involving patient, their GP and one or more of their oncologists. Within-case analysis (patient-specialists-GP) highlighted the importance of specialist cancer knowledge, the psychosocial aspect of specialist care, and the need for GPs to have an interest in and time for cancer follow-up care. Across-case analysis indicated that a staged, shared care team arrangement with both GPs and specialists flexibly providing continuing care would be acceptable for most.
Conclusions: Collaborative care of cancer survivors may lessen the load on specialist oncology clinics. The findings suggest that building this model will require early and ongoing shared care processes. This may be facilitated by shared electronic care plans involving patients, oncologists and GPs.
Recent Publications:
Schütze H;Pulver LJ;Harris M, 2016, 'The uptake of Aboriginal and Torres Strait Islander health assessments fails to improve in some areas', Australian Family Physician, vol. 45, pp. 415 - 420
Schtze H;Rix EF;Laws RA;Passey M;Fanaian M;Harris MF, 2012, 'How feasible are lifestyle modification programs for disease prevention in general practice?', Australian Journal of Primary Health, vol. 18, pp. 129 - 137, http://dx.doi.org/10.1071/PY10106
Harris MF;Fanaian M;Jayasinghe UW;Passey ME;McKenzie SH;Davies GP;Lyle DM;Laws RA;Schütze H;Wan Q, 2012, 'A cluster randomised controlled trial of vascular risk factor management in general practice', Medical Journal of Australia, vol. 197, pp. 387 - 393, http://dx.doi.org/10.5694/mja12.10313
Denney-Wilson E;Fanaian M;Wan Q;Vagholkar S;Schütze H;Harris M, 2010, 'Lifestyle risk factors in general practice: Routine assessment and management', Australian Family Physician, vol. 39, pp. 950 - 953
Melanie Koeller
College of Medicine, Germany
Title: Maintaining nursing care quality clinical care guidelines for cystic fibrosis - outpatient and inpatient
Biography:
Melanie Köller works as a Childrens Nurse since 1997. In 2006 she graduated from the University of Applied Sciences Bielefeld as a Certified Nursing Pedagogue. Her experience in the field of Cystic Fibrosis care covers nearly 16 years in one of the greatest special clinic of rehabilitation on the Island of Amrum. Since 2014 she is in the board of the Care Committee of the Mukoviszidose e.V.. She has published several posters for the German Congress for CF in Würzburg about salutogenesis, history of caring CF in Germany and the advantages of rehabilitation by CF.
Abstract:
The Care Committee of the Mukoviszidose e.V. (Chairwoman C. Meyer, University of Tübingen, College of Medicine) has drawn up a completely revised version of the german guidelines to ``Care in Cystic Fibrosis''. It addresses all nursing staff concerning children, adolescents or adults with cystic fibrosis (CF) either in an inpatient and outpatient setting or for rehab clinics. Since the first edition of the German Guidelines to Care in Cystic Fibrosis which had been published in 1998 the guidelines are being revised regularly. The information material evolves along with the increased life expectancy of cystic fibrosis patients and improved quality of life which is described by CF patients and is observed by the therapeutic CF team. The treatment of secondary diseases like CFDR (CF related diabetes) which comes along with an increased life expectancy has been added over the years. Therefore, it is essential that within such a complex disease pattern, professional experience of care staff who worked in specialized CF care centers (50+ patients per year) for many years has been made available for other nursing staff or beginners. This is especially important in the context of the heterogeneous characteristics of this disease. In many cases it can be often seen that the quality of the care for CF patients depends on the know-how and experience of the interdisciplinary therapists team. Moreover, it depends also on the knowledge which the patient him-/herself have gathered over the years and, of course, its relatives especially parents or partner.(Up
Melanie Koeller
College of Medicine, Germany
Title: Maintaining nursing care quality clinical care guidelines for cystic fibrosis - outpatient and inpatient
Biography:
Melanie Köller works as a Childrens Nurse since 1997. In 2006 she graduated from the University of Applied Sciences Bielefeld as a Certified Nursing Pedagogue. Her experience in the field of Cystic Fibrosis care covers nearly 16 years in one of the greatest special clinic of rehabilitation on the Island of Amrum. Since 2014 she is in the board of the Care Committee of the Mukoviszidose e.V.. She has published several posters for the German Congress for CF in Würzburg about salutogenesis, history of caring CF in Germany and the advantages of rehabilitation by CF.
Abstract:
The Care Committee of the Mukoviszidose e.V. (Chairwoman C. Meyer, University of Tübingen, College of Medicine) has drawn up a completely revised version of the german guidelines to ``Care in Cystic Fibrosis''. It addresses all nursing staff concerning children, adolescents or adults with cystic fibrosis (CF) either in an inpatient and outpatient setting or for rehab clinics. Since the first edition of the German Guidelines to Care in Cystic Fibrosis which had been published in 1998 the guidelines are being revised regularly. The information material evolves along with the increased life expectancy of cystic fibrosis patients and improved quality of life which is described by CF patients and is observed by the therapeutic CF team. The treatment of secondary diseases like CFDR (CF related diabetes) which comes along with an increased life expectancy has been added over the years. Therefore, it is essential that within such a complex disease pattern, professional experience of care staff who worked in specialized CF care centers (50+ patients per year) for many years has been made available for other nursing stuff or beginners. This is especially important in the context of the heterogeneous characteristics of this disease. In many cases it can be often seen that the quality of the care for CF patients depends on the know-how and experience of the interdisciplinary therapists team. Moreover, it depends also on the knowledge which the patient him-/herself have gathered over the years and, of course, its relatives especially parents or partner.(Up
Biography:
Abdia Naidoo Graduated from Somerset Hospital (Cape Town and Coronation Hospital) Johannesburg women and childrens hospital including Durban University of Technology and The University of Stellenbosh South Africa with the folowing qualifications: Registered nurse and Midwife,Community Health Nurse with the specialties of HIVand AIDS Management. She was employed by Dfid to manage an HIV/AIDS Health and Wellness Program on the remote Island of St Helena South Atlantic Ocean and was awarded multiple achievments awards with her work both locally and internationally.
Abstract:
The individual,the family and the community all forms a part of a complete and integrated system. As a community health nurse and practioner I observed on a daily basis how patients were treated by health practioners only for a disease or ailment without seeing the person in a holistic way or as a whole person. Patients were often misdiagnosed or seemingly not satisfied when they were seen as just another patient with an ailment and not as an individual who had muliple facets to their lives besides being a patient.
I started changing my own attitude towards patients when treating my patients and clients as a whole person. I developed a programme called the Whole Person Wellness Model and used this model to change certain behavious and attitudes when treating the individual patients.
The aim of this presentation/workshop is to create more awareness for health nurse pratitioners and health service providers to treat patients with a more authentic wholistic view and approach and treat persons with a disease or ailment with an holistic and wholesome approach in order to effect a more complete health and wellbeing out come.