Pub Date : 2018-10-01DOI: 10.1093/MED/9780190850036.003.0019
Sandra Machado
Deep brain stimulation (DBS) is now a widely accepted treatment option for patients with movement disorders such as parkinsonism and essential tremor. DBS surgery presents challenges to the anesthesiologist as often these patients are required to be awake for accurate placement of the stimulators. Additionally, patients with movement disorders often have comorbidities that increase their risk of perioperative and postoperative complications. DBS surgery is often divided into two stages (1) stereotactic implantation of the DBS leads and (2) internalization of the pulse generator, with each of these stages stage having distinct anesthesia demands. Ongoing studies are exploring other indications for the effective use of DBS surgery.
{"title":"Deep Brain Stimulation/Stereotaxic Surgery","authors":"Sandra Machado","doi":"10.1093/MED/9780190850036.003.0019","DOIUrl":"https://doi.org/10.1093/MED/9780190850036.003.0019","url":null,"abstract":"Deep brain stimulation (DBS) is now a widely accepted treatment option for patients with movement disorders such as parkinsonism and essential tremor. DBS surgery presents challenges to the anesthesiologist as often these patients are required to be awake for accurate placement of the stimulators. Additionally, patients with movement disorders often have comorbidities that increase their risk of perioperative and postoperative complications. DBS surgery is often divided into two stages (1) stereotactic implantation of the DBS leads and (2) internalization of the pulse generator, with each of these stages stage having distinct anesthesia demands. Ongoing studies are exploring other indications for the effective use of DBS surgery.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75227445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190647421.003.0024
M. Scheuner, M. Russell, Jane Peredo, Alison B. Hamilton, E. Yano
Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Diagnosis of LS has important clinical implications for CRC patients and their family members. LS screening in tumor tissue is possible, and screen-positive cases are referred for diagnostic testing. This case study describes how implementation science informed a population-based LS screening program in the Veterans Health Administration (VHA), the largest integrated health care delivery system in the United States. Successful implementation strategies relied on the organizational structures and processes characteristic of integrated health care systems, including data warehousing methods that leverage the electronic health record, case management, and centralized technical assistance. Challenges to sustainability of the population-based program include low prevalence of LS among veterans, limited expertise, organizational changes, and the rapidly evolving field of precision oncology. LS screening is an exemplar case study for implementation science in integrated health care delivery systems.
{"title":"Implementing Lynch Syndrome Screening in the Veterans Health Administration","authors":"M. Scheuner, M. Russell, Jane Peredo, Alison B. Hamilton, E. Yano","doi":"10.1093/med/9780190647421.003.0024","DOIUrl":"https://doi.org/10.1093/med/9780190647421.003.0024","url":null,"abstract":"Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Diagnosis of LS has important clinical implications for CRC patients and their family members. LS screening in tumor tissue is possible, and screen-positive cases are referred for diagnostic testing. This case study describes how implementation science informed a population-based LS screening program in the Veterans Health Administration (VHA), the largest integrated health care delivery system in the United States. Successful implementation strategies relied on the organizational structures and processes characteristic of integrated health care systems, including data warehousing methods that leverage the electronic health record, case management, and centralized technical assistance. Challenges to sustainability of the population-based program include low prevalence of LS among veterans, limited expertise, organizational changes, and the rapidly evolving field of precision oncology. LS screening is an exemplar case study for implementation science in integrated health care delivery systems.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75643087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190647421.003.0030
M. Maza, K. Alfaro, J. Gage, M. Cremer
The Cervical Cancer Prevention in El Salvador (CAPE) program completed a series of human papillomavirus (HPV)-based screening demonstration projects that resulted in modification of screening guidelines and set the stage for national implementation of HPV primary screening. This chapter outlines the elements that contributed to the success of CAPE within a process of change model called PREVENTABLE. The model rests on two pillars, political will and evidence, which feed and complement one another. Recognizing political windows of opportunity and obtaining government commitment are crucial to support innovative programs and effect significant transformations. Simultaneously, convincing evidence motivates and channels political will. Thus, primary drivers of the model are research and evaluation of outcomes that reinforce the main pillars; secondary drivers are context dependent, including education, advocacy, negotiation, the legal framework, and budgetary constraints. The experiences from CAPE and PREVENTABLE provide possible blueprints to renovate existing paradigms of cancer control programs.
{"title":"Adopting the PREVENTABLE Model","authors":"M. Maza, K. Alfaro, J. Gage, M. Cremer","doi":"10.1093/MED/9780190647421.003.0030","DOIUrl":"https://doi.org/10.1093/MED/9780190647421.003.0030","url":null,"abstract":"The Cervical Cancer Prevention in El Salvador (CAPE) program completed a series of human papillomavirus (HPV)-based screening demonstration projects that resulted in modification of screening guidelines and set the stage for national implementation of HPV primary screening. This chapter outlines the elements that contributed to the success of CAPE within a process of change model called PREVENTABLE. The model rests on two pillars, political will and evidence, which feed and complement one another. Recognizing political windows of opportunity and obtaining government commitment are crucial to support innovative programs and effect significant transformations. Simultaneously, convincing evidence motivates and channels political will. Thus, primary drivers of the model are research and evaluation of outcomes that reinforce the main pillars; secondary drivers are context dependent, including education, advocacy, negotiation, the legal framework, and budgetary constraints. The experiences from CAPE and PREVENTABLE provide possible blueprints to renovate existing paradigms of cancer control programs.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75724090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190617127.003.0020
Marie‐noëlle Hébert‐blouin
Malignant peripheral nerve sheath tumors (PNSTs) are soft tissue sarcomas arising from a peripheral nerve or a pre-existing benign nerve sheath tumor or are sarcomas with features of Schwann-cell differentiation. Differentiating between benign and malignant PNSTs can be challenging. The chapter begins with a case example and then discusses assessment, investigations (including imaging), and diagnosis of malignant PNSTs, as well as the steps involved in decision-making about management of a malignant PNST. The surgical principles and goals for resection of a malignant PNST, the adjuvant therapies used in treatment, and the complications and outcomes of treatment are presented.
{"title":"Malignant Peripheral Nerve Sheath Tumors","authors":"Marie‐noëlle Hébert‐blouin","doi":"10.1093/MED/9780190617127.003.0020","DOIUrl":"https://doi.org/10.1093/MED/9780190617127.003.0020","url":null,"abstract":"Malignant peripheral nerve sheath tumors (PNSTs) are soft tissue sarcomas arising from a peripheral nerve or a pre-existing benign nerve sheath tumor or are sarcomas with features of Schwann-cell differentiation. Differentiating between benign and malignant PNSTs can be challenging. The chapter begins with a case example and then discusses assessment, investigations (including imaging), and diagnosis of malignant PNSTs, as well as the steps involved in decision-making about management of a malignant PNST. The surgical principles and goals for resection of a malignant PNST, the adjuvant therapies used in treatment, and the complications and outcomes of treatment are presented.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78035351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190678333.003.0010
M. J. Kibelbek, Lori A. Aronson, L. Heyden
Anesthesiologists and sedationists often use propofol as the main anesthetic agent for brief procedures, such as esophagogastroduodenoscopy with biopsy for eosinophilic esophagitis (EoE). Pediatric patients presenting for endoscopy often have a history of reflux as well as drug and food allergies. Specifically, patients with EoE often have sensitivity to egg and soy, as well as milk and dairy products, tree nuts/peanuts, and seafood (fish/shellfish). Propofol use is often cited as a contraindication in patients with hypersensitivity to egg and soy. Current literature does not support avoiding propofol in egg- and soy-allergic patients. Most practitioners, however, continue to avoid propofol in patients with a history of egg anaphylaxis due to lack of evidence supporting its safe use in this population.
{"title":"Egg and Soy Allergies and Propofol Use","authors":"M. J. Kibelbek, Lori A. Aronson, L. Heyden","doi":"10.1093/MED/9780190678333.003.0010","DOIUrl":"https://doi.org/10.1093/MED/9780190678333.003.0010","url":null,"abstract":"Anesthesiologists and sedationists often use propofol as the main anesthetic agent for brief procedures, such as esophagogastroduodenoscopy with biopsy for eosinophilic esophagitis (EoE). Pediatric patients presenting for endoscopy often have a history of reflux as well as drug and food allergies. Specifically, patients with EoE often have sensitivity to egg and soy, as well as milk and dairy products, tree nuts/peanuts, and seafood (fish/shellfish). Propofol use is often cited as a contraindication in patients with hypersensitivity to egg and soy. Current literature does not support avoiding propofol in egg- and soy-allergic patients. Most practitioners, however, continue to avoid propofol in patients with a history of egg anaphylaxis due to lack of evidence supporting its safe use in this population.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79807564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190696696.003.0002
C. Eseonu, Jordina Rincon-Torroella, A. Quiñones‐Hinojosa
Patients with intra-axial brain tumors often present with neurologic symptoms based on the anatomic location of their tumor. Workup for a brain tumor includes cranial imaging such as magnetic resonance imaging and computed tomography, as well as systemic imaging to assess for primary tumor if metastasis is suspected. Maximal safe resection optimizes outcomes including overall survival. Surgical decisions are based on variables such as medical comorbidities and anatomic location of the tumor. Gliomas in eloquent areas may require intraoperative cortical and subcortical mapping of motor and/or language areas to optimize safety and help maximize resection. Adjuvant chemotherapy and radiation lead to a median survival of 14.6 months for patients with glioblastoma. Rapidly recurring glioblastoma after surgery has a poor prognosis.
{"title":"Unusual Gliomas","authors":"C. Eseonu, Jordina Rincon-Torroella, A. Quiñones‐Hinojosa","doi":"10.1093/med/9780190696696.003.0002","DOIUrl":"https://doi.org/10.1093/med/9780190696696.003.0002","url":null,"abstract":"Patients with intra-axial brain tumors often present with neurologic symptoms based on the anatomic location of their tumor. Workup for a brain tumor includes cranial imaging such as magnetic resonance imaging and computed tomography, as well as systemic imaging to assess for primary tumor if metastasis is suspected. Maximal safe resection optimizes outcomes including overall survival. Surgical decisions are based on variables such as medical comorbidities and anatomic location of the tumor. Gliomas in eloquent areas may require intraoperative cortical and subcortical mapping of motor and/or language areas to optimize safety and help maximize resection. Adjuvant chemotherapy and radiation lead to a median survival of 14.6 months for patients with glioblastoma. Rapidly recurring glioblastoma after surgery has a poor prognosis.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80023971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190685157.003.0022
Annery G. Garcia‐Marcinkiewicz, J. Fiadjoe
This chapter on laryngotracheal reconstruction (LTR) describes and reviews the preoperative, intraoperative, and postoperative course of a virtual case of a patient undergoing double stage laryngotracheal reconstruction (ds-LTR). The discussion section reviews the etiology and pathogenesis of subglottic stenosis (SGS) and describes the Myer-Cotton classification system of SGS. The chapter also reviews the medical management of gastroesophageal reflux disease, endoscopic treatment of granulations, anterior cricoid split, LTR with cartilage augmentation (single and double stage), and cricotracheal resection. The differences in the technique and patient selection of single stage LTR (ss-LTR) and ds-LTR are reviewed. The intraoperative and postoperative complications of LTR and postoperative sedation management are also discussed.
{"title":"Laryngotracheal Reconstruction","authors":"Annery G. Garcia‐Marcinkiewicz, J. Fiadjoe","doi":"10.1093/med/9780190685157.003.0022","DOIUrl":"https://doi.org/10.1093/med/9780190685157.003.0022","url":null,"abstract":"This chapter on laryngotracheal reconstruction (LTR) describes and reviews the preoperative, intraoperative, and postoperative course of a virtual case of a patient undergoing double stage laryngotracheal reconstruction (ds-LTR). The discussion section reviews the etiology and pathogenesis of subglottic stenosis (SGS) and describes the Myer-Cotton classification system of SGS. The chapter also reviews the medical management of gastroesophageal reflux disease, endoscopic treatment of granulations, anterior cricoid split, LTR with cartilage augmentation (single and double stage), and cricotracheal resection. The differences in the technique and patient selection of single stage LTR (ss-LTR) and ds-LTR are reviewed. The intraoperative and postoperative complications of LTR and postoperative sedation management are also discussed.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79246730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780190678333.003.0059
Catherine P. Seipel, T. Aina
Mucopolysaccharidoses are progressive disease processes characterized by deficiencies in lysosomal enzymes required for catabolism of glycosaminoglycans. This leads to the accumulation of glycosaminoglycans (GAGs) in multiple organs and tissue. In particular, the deposition of GAGs in soft tissue, the central nervous system, and the cervical spine have implications for the anesthetic management of these patients. A detailed history and examination, with a focus on cardiopulmonary status and past airway management, is required pre-operatively. Enzyme replacement therapy and, in select cases, hematopoietic stem cell transplantation may modify disease progression. This chapter illustrates the perioperative considerations necessary to care for patients with this uncommon disease.
{"title":"Mucopolysaccharidoses","authors":"Catherine P. Seipel, T. Aina","doi":"10.1093/med/9780190678333.003.0059","DOIUrl":"https://doi.org/10.1093/med/9780190678333.003.0059","url":null,"abstract":"Mucopolysaccharidoses are progressive disease processes characterized by deficiencies in lysosomal enzymes required for catabolism of glycosaminoglycans. This leads to the accumulation of glycosaminoglycans (GAGs) in multiple organs and tissue. In particular, the deposition of GAGs in soft tissue, the central nervous system, and the cervical spine have implications for the anesthetic management of these patients. A detailed history and examination, with a focus on cardiopulmonary status and past airway management, is required pre-operatively. Enzyme replacement therapy and, in select cases, hematopoietic stem cell transplantation may modify disease progression. This chapter illustrates the perioperative considerations necessary to care for patients with this uncommon disease.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81428250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/med/9780199325764.003.0011
M. Balboni, T. Balboni
There is an underlying structural bond between medicine and religious monotheism. There are shared assumptions, values, and institutional structures that create a deep underlying unity between these two spheres. There are five broadly shared connections between secular medicine and the monotheistic religions—especially akin to Jewish and Christian traditions—where medicine and religion mirror one another in values and structures. These five points of connection include sickness/sin, the role of the healing mediator, therapy, patient disposition, and the healing milieu. When the spheres of medicine and religion become overtly disconnected from one another as partners, as now is the case in secular medicine, medicine rises perilously to the level of a functional-like religion. While contemporary medicine attempts to be consciously neutral toward traditional religions, medicine’s internal structures mirror deeper religious concepts, in tension with secular interpretations.
{"title":"The Sacramental Nature of Medicine","authors":"M. Balboni, T. Balboni","doi":"10.1093/med/9780199325764.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780199325764.003.0011","url":null,"abstract":"There is an underlying structural bond between medicine and religious monotheism. There are shared assumptions, values, and institutional structures that create a deep underlying unity between these two spheres. There are five broadly shared connections between secular medicine and the monotheistic religions—especially akin to Jewish and Christian traditions—where medicine and religion mirror one another in values and structures. These five points of connection include sickness/sin, the role of the healing mediator, therapy, patient disposition, and the healing milieu. When the spheres of medicine and religion become overtly disconnected from one another as partners, as now is the case in secular medicine, medicine rises perilously to the level of a functional-like religion. While contemporary medicine attempts to be consciously neutral toward traditional religions, medicine’s internal structures mirror deeper religious concepts, in tension with secular interpretations.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81722087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-10-01DOI: 10.1093/MED/9780190678333.003.0003
Kenneth Wayman, Nancy B. Samol, E. Wittkugel
The child with an upper respiratory tract infection presenting for surgery is probably the most common dilemma that faces the pediatric anesthesiologist. While cancellation of such a child’s operation had been a common practice in the past, nowadays, an anesthesiologist will more than likely proceed with the anesthetic management of a child with a mild common cold. Research has shown that while perioperative respiratory adverse events are likely to occur in a child with a mild cold, these events are very easily managed. In addition, the use of a laryngeal mask airway which prevents instrumentation of a child’s airway drastically decreases the incidence of perioperative adverse events in this patient population. Planned airway surgery, history of prematurity, reactive airway disease, and passive smoking in the home are factors that increase the incidence of perioperative adverse respiratory events in a child with an active cold.
{"title":"Upper Respiratory Infection","authors":"Kenneth Wayman, Nancy B. Samol, E. Wittkugel","doi":"10.1093/MED/9780190678333.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780190678333.003.0003","url":null,"abstract":"The child with an upper respiratory tract infection presenting for surgery is probably the most common dilemma that faces the pediatric anesthesiologist. While cancellation of such a child’s operation had been a common practice in the past, nowadays, an anesthesiologist will more than likely proceed with the anesthetic management of a child with a mild common cold. Research has shown that while perioperative respiratory adverse events are likely to occur in a child with a mild cold, these events are very easily managed. In addition, the use of a laryngeal mask airway which prevents instrumentation of a child’s airway drastically decreases the incidence of perioperative adverse events in this patient population. Planned airway surgery, history of prematurity, reactive airway disease, and passive smoking in the home are factors that increase the incidence of perioperative adverse respiratory events in a child with an active cold.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81902628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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