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

http://www.google.es/imgres?imgurl=http://4.bp.blogspot.com/_QZXzZ365U0Y/S4fvBddpAcI/AAAAAAAAACA/CSW8Yb4amIw/s320/logo%2Bmayo%2Bclinic.jpg&imgrefurl=http://mgprinmedia.blogspot.com/2010/02/investigadores-de-mayo-clinic-descubren.html&usg=__Z4lFXHid68aahAKJBy7BMubvmao=&h=300&w=300&sz=24&hl=es&start=1&zoom=1&um=1&itbs=1&tbnid=iE4BkZ-FVpVBzM:&tbnh=116&tbnw=116&prev=/images%3Fq%3Dmayo%2Bclinic%2Bfotos%26um%3D1%26hl%3Des%26sa%3DX%26tbs%3Disch:1

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 !