Day 3 :
Vice President , Brazilian Society of Cardiovascular Surgery, Brazil
Keynote: How can we change training for cardiovascular surgeons? A new way of looking at an old problem
Time : 09:00-09:50
Rui Manuel de Sousa Sequeira Antunes de Almeida is the Board Member of the Paraná’ Society of Cardiovascular Surgery, since 2002, and became its President (2006-08). He was elected as a President of the South Brazilian’ Society of Cardiovascular Surgery (2007-09), a Member of the Board of the Brazilian’ Society of Cardiovascular Surgery (2009-2010), President of the Board (2011-2013) and President of the Endovascular Department of the Brazilian’ Society of Cardiovascular Surgery (2011-2013), Scientific Director of the Brazilian’ Society of Cardiovascular Surgery (2014-15) and Vice-President for the period of 2016-17. He has published more than 100 papers in peer reviewed national and international medical journals and presented more than 250 papers in scientific meetings. He also served as the Editorial Board Member of 10 international journals and five Brazilian journals.
Cardiovascular surgery has always been a specialty that has a solid education, when we take training into account. In a country vast as Brazil, with a population growing, it is imperative to have the same strategies to teach in different subsets. Lately with the increasing number of new techniques and the diseases severity of most patients, it is becoming more difficult to train new surgeons, or for the matter, to retrain old surgeons, not only in new techniques, but also to intend to train to become expertise in some operations. It is know that to become an expert in a known technique a continuous training in a full time period will be needed for some years. It is also known that for a training program to be efficient, the trainers, tutors or teachers, should have skills different from what we were accustom to. In Brazil, through the national society of cardiovascular surgery, a program was started, to train new cardiovascular surgeons, after a four year residency in general cardiac surgery, or retrain established cardiac surgeons, into becoming experts in endovascular surgery. The program has a theoretical approach, followed by a part where the trainee is located to a “Hands On” lab or a biological simulator, under the supervision of specialists, and also to virtual simulators. After this, the trainee follows a strict program in a specialized center, where he has the opportunity not only to participate in all cases, being the theoretical discussion and the clinical and surgical part of the procedure. An integrated center for the theoretical and simulator part was created in the center of Brazil, in cooperation with the industry, and eight clinical centers, which receive the trainees, after a process of evaluation, so that they can actually perform the surgeries. These features are a way to solve the problems of training with good specialists in a vast country, with some logistic problems.
Chief Quality Officer, SKMC, Cleveland Clinic, UAE
Time : 09:50-10:40
Dr. Ellahham has served as Chief Quality Officer for SKMC since 2009. In his role, Dr. Ellahham has led the development of a quality and safety program that has been highly successful and visible and has been recognized internationally by a number of awards. As Chief Quality Officer and Global Leader, Dr. Ellahham has a focus on ensuring that that implementation of this best practices leads to breakthrough improvements in clinical quality and patient safety.
In most countries worldwide, the number of patients with chronic heart failure (HF) is growing, with 1–3% of the adult population suffering from this syndrome, rising to about 10% in the very elderly. In the near future a large part of the worldwide population will suffer from heart failure and society will be faced with the consequences. On average one in five patients is readmitted within 12 months, making heart failure one of the most common causes of hospitalization in people over 65 years of age. A multidisciplinary team approach involving several professionals with their own expertise is important in attaining an optimal effect. Physicians, nurses, and other health care professionals are key to ensuring the delivery of evidence based care. Markers of clinical (in) stability, psychosocial risk factors, and issues related to patient mobility might be important indicators to determine which inter-professional service might be most effective for which patient. Current HF guidelines recommend that HF patients are enrolled in a multidisciplinary-care management program to reduce the risk of HF hospitalization. A multidisciplinary approach to HF may reduce costs, decrease length of stay, curtail readmissions, improve compliance, and reduce mortality. An important limitation, however, is the substantial heterogeneity in both the terms of the models of care and the interventions offered, including: clinic or community-based systems of care, remote management, and enhanced patient self-care. Conventional trials that randomize individual patients may not be the best way to test the effect of a service; novel approaches, such as the cluster randomized controlled trial, may be superior. It is unlikely that any one approach is optimal. The best form of care might seek to compensate for the weaknesses of each approach by exploiting their strengths.
A strong HF cardiology lead, supported by primary care physicians, nurse specialists, and pharmacists in the hospital and community with the ability to offer patients remote support might offer the best service. Key to the success of multidisciplinary HF programs may be the coordination of care along the spectrum of severity of HF and throughout the chain-of-care delivered by the various services within the healthcare system. Further research is warranted to identify the most efficacious multidisciplinary approaches to HF.