Interprofessional Image Verification Workshop for Physician and Physics Residents: A Multi-Institutional Experience [Meeting Abstract]
Padilla, L.; Burmeister, J. W.; Burnett, O. L. L., III; Covington, E.; Den, R. B.; Dominello, M. M.; Du, K. L.; Galavis, P.; Junell, S.; Kahn, J.; Kishore, M.; Mooney, K.; Studenski, M. T.; Yechieli, R.; Fields, E. C.
Current Social Media Use Among Radiation Oncology Trainees [Meeting Abstract]
Albert, A. A.; Kahn, J.; Knoll, M. A.; Lirette, S. T.; Yechieli, R.; Gerber, N. K.; Jagsi, R.; Katz, M. S.
Survey of Twitter and Social Media Use Among US Radiation Oncologists [Meeting Abstract]
Knoll, M. A.; Albert, A. A.; Taussky, D.; Kahn, J.; Yechieli, R.; Gerber, N. K.; Katz, M. S.; Jagsi, R.
Identifying sources of greenhouse gas emissions in cataract care in the United States: Opportunities for resource efficiency in the operating theatre [Meeting Abstract]
Tauber, J; Kahn, J; Chinwuba, L; Rothschild, M; Kleyn, D; Coulon, S; Chen, D; Thiel, C
Purpose: Operating theatres are some of the most energy and resource intensive areas for medical treatment. As a result of resource production, use, and disposal, emissions are generated that harm the environment and human health. New tools are emerging to quantify these emissions and this study seeks to understand the footprint of cataract surgery at a US facility and to identify opportunities for reducing emissions.
Method(s): Eyefficiency, a new international cataract surgical services auditing tool that enables carbon emission calculations per surgical case, was used to quantify associated greenhouse gas (GHG) emissions in terms of kilograms of carbon dioxide equivalents (kg CO2e) for cataract surgeries conducted in an outpatient centre in the US. These include emissions from supplies, energy, and reusable instruments in an average case. This site also conducted audits of pharmaceutical waste disposal to determine the quantity of unused and wasted products at the end of an average case.
Result(s): Preliminary Eyefficiency data shows that a majority of this sites' GHG emissions from cataract surgery are generated from procurement (production) of single use products and pharmaceuticals, electricity used in the operating theatre, and travel of staff. Of GHGs from pharmaceutical production, 60% can be attributed to unused drugs that are disposed of after the case.
Conclusion(s): There are many avenues available to reduce resource consumption and GHG emissions from cataract surgical care, but quantifying and understanding the sources of emissions is an important first step
Quantification of the Cost and Potential Environmental Effects of Unused Pharmaceutical Products in Cataract Surgery
Tauber, Jenna; Chinwuba, Ijeoma; Kleyn, David; Rothschild, Michael; Kahn, Jonathan; Thiel, Cassandra L
Importance/UNASSIGNED:Pharmaceutical products, including unused portions, may contribute to financial and environmental costs in the United States. Because cataract surgery is performed millions of times each year in the United States and throughout the rest of the world, understanding these financial and environmental costs associated with cataract surgery is warranted. Objective/UNASSIGNED:To investigate the financial and environmental costs of unused pharmaceutical products after phacoemulsification surgery. Design, Setting, and Participants/UNASSIGNED:This descriptive qualitative study included 4 surgical sites in the northeastern United States (a private ambulatory care center, private tertiary care center, private outpatient center, and federally run medical center for veterans). Prices and data for use of services and pharmaceuticals were obtained for the tertiary care and outpatient centers from January 1 through April 30, 2016; for the ambulatory care center from June 1, 2017, through March 31, 2018; and the federal medical center from November 1, 2017, through February 28, 2018. Data were collected from routine phacoemulsification surgical procedures without vitreous loss or other complications. Volume or weight of medications remaining after surgery was measured. Total and mean costs of medications per case and month were calculated. Environmental effects were estimated using economic input-output life cycle assessment methods. Data were analyzed from December 1, 2017, through June 30, 2018. Main Outcomes and Measures/UNASSIGNED:Cost of unused pharmaceutical products (in US dollars) and kilogram equivalents of carbon emissions (carbon dioxide [CO2-e]), air pollution (fine particulate matter emissions of â‰¤10 Î¼m in diameter [PM10-e]), and eutrophication potential (nitrogen [N-e]). Results/UNASSIGNED:A total of 116 unique drugs were surveyed among the 4 centers. Assuming unmeasured medications had no materials left unused, a cumulative mean 83â€¯070 of 183â€¯304 mL per month (45.3%) of pharmaceuticals were unused by weight or volume across all sites. Annual unused product cost estimates reached approximately $195â€¯200 per site. A larger percentage of eyedrops (65.7% by volume) were unused compared with injections (24.8%) or systemic medications (59.9%). Monthly unused quantities at the ambulatory care center (65.9% by volume [54â€¯971 of 83â€¯440 mL]), tertiary care center (21.3% [17â€¯143 of 80â€¯344 mL]), federal medical center (38.5% [265 of 689 mL]), and outpatient center (56.8% [10â€¯691 of 18â€¯832 mL]) resulted in unnecessary potential emissions at each center of 2135, 2498, 418, and 711 kg CO2-e/mo, respectively. Unnecessary potential air pollution between sites varied from 0.8 to 4.5 kg PM10-e/mo, and unnecessary eutrophication potential between sites varied from 0.07 to 0.42 kg N-e/mo. Conclusions and Relevance/UNASSIGNED:This study suggests that unused pharmaceutical products during phacoemulsification result in relatively high financial and environmental costs. If these findings can be substantiated and shown to be generalizable in the United States or elsewhere, reducing these costs may be of value.
Assessment of Lymphoma and Other Hematologic Malignancies Training Needs Amongst Radiation Oncology Residents [Meeting Abstract]
Kahn, J; Gunther, J R; Yang, J C; Yahalom, J; Dabaja, B; Vapiwala, N; Hoppe, B S; Tseng, Y D; Parikh, R R; Plastaras, J P
Purpose/Objective(s): The use of radiation therapy in the management of hematologic (heme) malignancies is heterogeneous and radiation oncology resident comfort with the management of this diverse group of diseases is unknown. Together, the International Lymphoma Radiation Oncology Group (ILROG) and Association of Residents in Radiation Oncology (ARRO) performed a study to assess current training opportunities for RO residents in treatment of heme patients and interest in a dedicated away elective to augment their existing training experience. Materials/Methods: RO residents (PGY2-5) in the ARRO email database (n=572) were sent an anonymous questionnaire in December 2018. Question types included binary, Likert-type scale (1=not at all, 5=extremely; reported as median [interquartile range]), and multiple choice.
Result(s): 134 residents (23%) completed the survey with majority of responses from PGY4/5 residents (64%) and in programs with >=5 residents (93%). 112 residents (84%) reported having faculty who specialize in heme, and 95 residents (71%) reported having a heme rotation, most commonly >=8 weeks in length. However, only 38 residents (40%) reported that these heme rotations were dedicated, i.e. >50% heme patients. Of 112 respondents, the percentage of residents reporting at least 4 cases with each diagnosis were: Non-Hodgkin lymphoma (83%), multiple myeloma (82%), cutaneous lymphoma (59%), Hodgkin lymphoma (53%), adult leukemia (46%). Residents reporting at least 4 cases of specialized treatment techniques were: breath hold for mediastinal lymphoma (39%), adult craniospinal irradiation (17%), total skin irradiation (39%), adult total body irradiation (68%), and proton therapy (36%). Residents reported feeling "moderately" prepared to advocate for radiation therapy in multidisciplinary conferences (3 [2-3]), to make clinical decisions once patients are referred (3 [2-4]), to oversee and critique treatment planning (3 [2-4]).They reported feeling "moderately" to "quite" prepared to contour heme cases using the involved site radiation therapy (3.5 [3-4]) and "quite" prepared to incorporate the Five Point Scale into treatment decisions (4 [3-5]). Overall, residents felt only "moderately" (3[2-3]) prepared to treat heme patients with 23% of residents responding that they felt "quite" or "extremely" comfortable. 49% of respondents were potentially interested in a RO away elective focused on heme, to increase comfort with treating heme patients (65%). Residents rated hands-on contouring modules, oral exams, and instruction on specialized techniques as the most worthwhile activities in an elective.
Conclusion(s): Hematologic malignancies training is an important component of RO residency, yet less than 25% of surveyed trainees reported feeling well prepared to treat heme patients. Programs should explore opportunities to increase resident exposure; perhaps through participation in a dedicated heme elective in select programs or through on-line educational activities.
Infarcted Tarsal Pyogenic Granuloma Simulating Malignant Melanoma
Charles, Norman C; Kahn, Jonathan B
The authors describe a rapidly enlarging, pedunculated brown tarsal lesion in a 34-year-old man with a history of chalazia. Following excision, histopathologic analysis showed the features of a necrotic pyogenic granuloma. This unique case expands the differential diagnosis of conjunctival malignant melanoma.
Unusual case of iris metastases from breast carcinoma
Suhr, K S; Sperber, L T; Marr, B P; Kahn, J B
A 46-year-old white woman with a history of breast carcinoma presented at our clinic with new lesions of the left iris, anterior uveitis, and headache. Imaging of the head and orbits showed metastatic breast carcinoma of the brain. Iris lesions were diagnosed as metastatic breast carcinoma based on clinical presentation. The patient was treated at an outside facility with systemic chemotherapy and radiation therapy while simultaneously being managed with steroid eyedrops for intraocular inflammation. Her condition and vision improved over a 3-month period.
Late-onset capsular bag distension syndrome following antihistamine administration
Haberman, I D; Rusu, I M; Kahn, J B
A 51-year-old woman presented with acute myopic shift 3 years after uneventful cataract extraction in both eyes; recent medical history was remarkable for administration of intravenous meclizine 2 weeks prior to presentation. Examination of each eye revealed anterior chamber crowding and a posterior chamber intraocular lens (IOL) with distension of the capsular bag; clear fluid with a green hue was present between the IOL and the posterior capsule. We postulate a mechanism for the development of late-onset capsular bag distension syndrome. To our knowledge, no medication-induced incidences have been reported in the literature
Special considerations for cataract surgery in the face of pathologic myopia
Chapter by: Dodick, JM; Kahn, JB
in: Pathologic Myopia by