Live Case Format Spotlights Safety, Education    

      关键词

     4个各具特点的转播厅将使不同的参会者受益匪浅

      病例的选择

     从病人的安全和是否具有教育意义出发选择病例，TCT2008现场手术演示组织者相信其内容和形式将会对各位医师临床实践大有裨益。

     据在TCT组委会任职负责协调转播相关事宜的Martin B. Leon和Giora Weisz博士介绍，参会者将会看到从世界26个中心，包括14个美国之外的中心的现场手术转播。他们强调说在每个转播点我们并没有告诉他们那一个病例将会被转播，让他们基于该病例的教育意义和技术特点方面的价值综合考虑自己进行选择，当然，病人的安全永远是第一位的。

     病人的安全是最重要的，我们和每个转播点相关人员仔细研究，确保在不同情况下始终把病人的安全放在第一位。哥伦比亚大学医学中心心血管研究所创建者和名誉主席Leon教授说。我们首先要考虑的是每一个转播的病例都按它正常的处理程序进行，不因为要实况转播而推迟手术或重新安排诊疗计划。组织者已经制定一系列标准和措施以确保在病例选择及转播中病人的安全、治疗过程的专业化和整个操作符合医学伦理学的原则。在所要提供的病例相关资料中必须包括：HIPPA表格、术者的声明（是否存在利益关系）、FDA关于此类病例的告示和病人签署的的知情同意书。

     Leon 和 Weisz教授认为在现场转播过程中病人的安全性实际上提高了。首先，进行手术的术者都是介入心脏病学的顶尖专家，他们对他们使用的技术有极其丰富的经验。第二，TCT会议允许一个专家组对正在进行的手术发表评论。Leon教授说：“专家组可能发现术者没有注意到的问题”。最后，因为总是不止一个术者处理病人，进行手术的术者可能不需要对手术进行解释或回答问题。“当术者100%精力集中于这些挑战**例时，总会有其他一些人能掌控会场讨论，”Weisz 教授说。最后，Leon和Weisz教授都提到，TCT现场手术演示委员会积极工作以确保病人和器械的选择不受商业因素的干扰。

     内容的准备

现场手术直播的组织工作开始于TCT开始10月之前。首先是选择转播点，然后TCT组织委员会与各点的代表会面讨论相关操作过程及方案。然后在大会开始8周前每周和各转播点电话联系并建立备忘录以确保参与转播的每一个人明白整个程序：手术的执行、转播和讨论，Leon教授说。

    每一个转播中心有一个专业的技术团队以提供技术上的支持，以确保转播过程畅通无阻和转播图像高质量的显示。

    手术现场转播将在四个大厅进行：主会场、冠心病会场、血管内治疗会场和结构心脏病会场。每一个不同的会场将提供各自各具特色的病例以满足不同参会者要求。这种方式将使参会者受益匪浅，你仿佛亲身置身于导管室之中，在术者身旁---，在那里你能洞察手术技巧运用和手术策略制定的真谛。这些你不可能在书本或教室中学到。Leon教授说：“如果你要学到一些新东西，我向你首先推荐来到现场手术直播会场。”

（来源：www.tctmd.com）

 Live Case Format Spotlights Safety, Education    

Key Points:

• Four separate venues feature different themes geared to provide an in-depth learning experience for attendees.

By TCT Daily Staff

With a renewed focus on patient safety and educational value, organizers of the live case demonstrations at TCT 2008 believe the content and format have the potential to shape clinical practice.

Attendees can expect live case transmissions from 26 centers from around the world, including 14 located outside the United States, according to Martin B. Leon, MD, and Giora Weisz, MD, who both serve on the TCT committee that coordinates the live case component of the meeting.

They stressed that sites are not told what cases to present, but rather makes their own selections based on educational merits and technical interest. Yet patient safety is always paramount, Leon and Weisz said.

Focus on the patient

"Everything is focused on patient safety. We work with the sites to be certain that timing and circumstances of the case in no way will compromise patient safety," said Leon, founder and chairman emeritus of the Cardiovascular Research Foundation and professor at Columbia University Medical Center.

Of primary concern is that each case be handled just as it normally would (ie, no procedure should be postponed or rescheduled so it can be presented live) and patients should not have to wait because of the live transmission scheduling.
Organizers have put in place a litany of practices and standards to ensure patient safety and professional and ethical conduct. Among the documentation that must be secured are: HIPPA release forms; conflict of interest declarations on the part of the operators; FDA notification of cases done in the United States featuring devices or therapies that are not approved; and signed informed consent by the patient.

Leon and Weisz contend that patient safety is actually enhanced in the live case venue. First, the operators who are performing the procedures represent some of the top names in interventional cardiology and have extensive experience with the techniques they are presenting. Second, the format at TCT allows for comment from an expert panel while procedures are underway.

"The expert panel often sees and notices things that might not have occurred to the operator," Leon said.

Finally, since there is always more than one operator with the patient, the physician performing the procedure does not necessarily have to speak.

"When the operator has to concentrate 100% in those critical moments, there is always someone else who can handle the discussion [with the panel]," Weisz said.

Both Leon and Weisz noted that the TCT live case committee aggressively works to ensure that commercial interests do not influence the selection of cases or devices.

Cornerstone of educational process

The process of organizing the logistics of the live transmissions begins as early as 10 months before TCT. First the sites are selected and then the TCT organizing committee meets in person with representatives from the various sites to discuss procedures and protocol. There are then weekly memos and phone calls with each site starting about eight weeks before the meeting to ensure everyone understands the process and how the procedure will be performed, transmitted and discussed, Leon said.

Each center has a technical team that works to ensure the sites are wired with high-definition technology and that the transmissions go off without any glitches.

The culmination of this involved process can be found in four separate venues featuring live cases: the Main Arena; Coronary Theater; Endovascular Theater; and the Structural Heart Disease Auditorium. Each venue will feature a different theme geared to provide an in-depth experience for attendees.

"The experience takes people from a didactic environment to literally transport them to the operating theater or the catheterization laboratory . . . where you can see the key factors in decision-making," Leon said. "You can’t get that in a classroom or a book. When we think about what helps to teach, there are live cases and then there is everything else."