The Channel - Cook Medical

The Channel
A COOK NEWS PUBLICATION
ISSUE 1, 2016
Our Generations series
continues with physicians
who trained with the pioneers
featured in the 40 Years of
Interventional ERCP series.
page 7
Gastrointestinal cancer
treatment solutions expand
in China with a focus on early
diagnosis and treatment,
physician education and new
techniques such as multi-band
mucosectomy.
page 12
Dr. Steve Bensen shares an
update on training initiatives
in Rwanda and discusses plans
for continued expansion of
education support.
page 14
Focus on education
and training
Today’s clinicians are busier than ever and have less and less time
and resources for training. To help customers meet educational
needs, Cook Medical recently initiated Vista Education and Training
Programs. The company annually hosts thousands of these hands-on,
highly interactive events around the globe. It’s the latest initiative in
Cook’s 30-plus-year commitment to provide education and training
to help physicians, nurses and technicians deliver the best care
possible for their patients.
Continued on page 3
Remembering Bill
Last October, the Cook Medical
family lost one of its own when
Bill Gibbons, Global Vice
President of Engineering, and
his teenage daughter, Abbey,
died in a plane crash. Starting
his career with Cook in 1999,
Bill’s leadership abilities were
recognized early, resulting in
his presidency of the Cook
Winston-Salem division and
his major impact on its work
developing and manufacturing
GI endoscopic accessories. In
2009, Bill and his family moved to Bloomington, Indiana, where he would
head Cook’s worldwide engineering efforts.
In the wake of Bill’s passing, Cook family members and Cook customers, who
knew directly of Bill’s passion for his work, shared memories of his influence,
his example and his dedication. Countless people spoke of him as a friend
and a mentor. His absence is a void in our lives and in our work, but his legacy
is the inspiration to continue what he loved with similar commitment and
enthusiasm for excellence.
Bill treasured his roles of husband and father above all else. In speaking of his
wife Emily and his twins, Abbey and Will, it was clear that, for Bill, his family
priority informed the others in his life.
As a fitting commemoration to Bill, we have planted a 20-foot southern
magnolia on the Winston-Salem campus in recognition of his lifelong concern
for the environment. A beautifully engraved wooden bench is located nearby
and features his trademark motto, “Finish Something,” along with an inset
replica of the wizard’s wand from the Harry Potter books in tribute to Bill and
Abbey’s shared love of those stories.
Thanks to everyone who contacted us to share memories of Bill. They will
surely continue to inspire us for years to come.
President, Cook Medical Winston-Salem
SBU Leader, Endoscopy
2
www.cookmedical.com
Focus on Education and Training, continued from page 1
Vista programs offer the opportunity to focus on best practices
and advanced techniques in a wide range of clinical specialties,
such as ERCP, EUS, stricture management, hemostasis, EMR and
more. Created and led by leading practitioners, each Vista event
is customized to meet the specific training goals for its target
audiences.
Jeff Randall, Cook Medical Sales
Development Manager, states, “Vistas are
a great opportunity to tap the experience
and knowledge of physicians, nurses, and
technicians to educate their peers. With
these excellent education events, we hope
to further expand Cook’s ultimate goal of
improving patient outcomes.”
The following affords a closer look at four
major Vista events which include participation
by distinguished endoscopy educators who Jeff Randall
collaborate with the Cook Medical team
worldwide to address key learning needs:
MUSC Workshop for GI Nurses and
Technicians
Charleston, South Carolina
Intended specifically to accommodate the educational
interests of advanced therapeutic endoscopy nurses and
technicians, this recurring series of workshops is held at the
Medical University of South Carolina and supported by the
course leadership and expertise of Drs. Brenda Hoffman
and Gregory Cote. Patient and procedural aspects involved
in the areas of ERCP, EUS, hemostasis and EMR are the
primary focus for lecture discussion and hands-on device
opportunities. Model simulation and review of specific case
examples combine with live case observation to enhance
participant learning.
Steve Levy, Senior Field Product
Specialist, shares his thoughts
on device education via the Vista
experience: “The Field Product
Specialist team lends support through
their extensive procedural and
product knowledge. We assist with
training in the hands-on segment and
can review decision making options
as to possible device selection and
techniques depending on the case
scenario. One-on-one training with Steve Levy
devices and models, such as the ERCP
Trainer, encourage questions that would be difficult to ask
during actual procedures.”
Advanced Therapeutics and EUS:
A Team Approach
Jacksonville, Florida
This team training format invites combinations of physician/
nurse or technician participants in the US to experience this
learning opportunity together, which in turn expands the
training benefit to their respective endoscopy programs.
Dr. Michael Wallace describes this experience hosted
by the Mayo Clinic GI faculty and clinicians: “The course
is designed to enhance the professional expertise in
advanced therapeutic endoscopy, particularly in the areas
of endoscopic ultrasound biopsy and drainage procedures,
as well as endoscopic mucosal resection. It is a small group
format with our experts providing one-on-one training.”
Michael B. Wallace, MD, MPH
Professor of Medicine
Mayo Clinic, Jacksonville, FL
Editor in Chief, Gastrointestinal
Endoscopy
ERCP Basic Training at EETC
(European Endoscopy Training
Center)
Rome, Italy
Led by Course Directors Prof. Guido
Costamagna and Dr. Ivo Boškoski,
this learning experience provides
f u n d a m e n t a l E R C P e d u c at i o n ,
including basic cannulation
techniques, stricture and stone
management, and considerations
for potential ERCP procedural
complications. The event includes
didactic learning, live case discussion
and hands-on device training, utilizing
Prof. Guido
a specially designed ERCP training
Costamagna
model to replicate scope maneuvers
and facilitate learning specific
device techniques. This program
is primarily intended to support
European physician training but can
also involve special event regional
training. International guest faculty
physicians also participate in certain
course offerings, which extends the
diversity of expertise and clinical
opinion offered to attendees.
Dr. Ivo Boškoski
www.cookmedical.com 3
Interventional Endoscopy Workshop
for GI Fellows
Downers Grove, IL
With a curriculum focus mainly in ERCP, EUS and also EMR,
this workshop experience offers advanced endoscopy GI
fellows a chance to interact directly with multiple expert guest
faculty instructing in these areas. Didactic presentations,
followed by hands-on device technique discussion, facilitate
learning and Q&A opportunities during a daylong session.
Held at the ASGE’s ITT Center, state-of-the-art equipment
and an environment geared to learning endoscopic skills
support the attendee’s educational interests.
“The Vista programs have been really
beneficial because it allows fellows in
training to work closely with experts
in our field, and the way the programs
are structured is to have a didactic
session, where they’re learning about
a technique and then move right
to the animal lab to practice that
technique. That type of experience is
priceless.” — Course Director Seth A.
Gross, MD, FACG, FASGE
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www.cookmedical.com
Seth A. Gross, MD
Accra, Ghana physicians advance ERCP
skills through EETC Basic Training
Lars Aabakken, Professor of Medicine and Chief of GI Endoscopy
at Oslo University Hospital in Oslo, Norway, was the expert
guest faculty physician participating in the December 2015
EETC course. In addition to the fellows from the local Agostino
Gemelli Teaching Hospital, faculty and staff welcomed attendee
physicians Dr. Nii Armah Quarmina Adu-Aryee and Dr. Adwoa
Afrakoma Agyei from Korle Bu Teaching Hospital,the largest
referral center in Ghana and the third largest hospital in Africa.
Prof. Aabakken explained the specific objectives of this learning
experience as follows:
“This specific course addressed the needs of our colleagues
from Accra, Ghana, who have had very modest exposure to
ERCP but who want to set up this service in Accra. The objectives
were to cover the theoretical basics of ERCP, show some telltale
examples by live transmission and do hands-on practical training
in the context of expert tutoring and guidance.”
Regarding the ERCP Trainer, Prof. Aabakken remarks, “The
utility of the ERCP Trainer to mimic the real life handling and
movements of the endoscope and to practice all the basic
moves of ERCP without worrying about a real patient was very
effective. It created a very relaxed and stimulating teaching
atmosphere which appeared hugely useful for the attendees. It
goes a long way in reducing the gap between theory lectures
and real live cases, which can sometimes be daunting.”
All Vista faculty are paid consultants for Cook Medical.
www.cookmedical.com 5
ERCP Trainer enhances teaching and learning
The ERCP Trainer is a model simulator, which is a key contributor to learning
throughout many Vista training events. Designed by Prof. Guido Costamagna and
Dr. Ivo Boškoski in a collaborative effort with Cook Medical, this model design
offers a mechanical replication of the relationship between the endoscope and
its target of examination, the pancreatobiliary anatomy.
Simon Brouwers
Simon Brouwers, Cook Medical Global Projects Manager,
supported the physician efforts in the development of
the Trainer and now, together with his Cook colleagues,
facilitates its ongoing teaching benefit. “The most difficult
task in ERCP is to get access and to understand the
directions of the common bile duct and the pancreatic
duct,” says Brouwers. “Previously, there was no mechanical
simulator that replicates the necessary scope maneuvers
in advance of the papilla, and this model allows early
training practice with a real scope and understanding of
what movements are needed in typical patient anatomy
presentations.”
To learn more about the ERCP Trainer and how it supports fundamental ERCP
device training needs, please contact your local Cook Medical representative.
Vista
®
Education
and Training
Interested in Cook’s Vista programs?
For more information on the Cook Medical Vista Education and
Training Programs, contact your local Cook sales representative
or go to vista.cookmedical.com.
Professor Norman Marcon receives insignia of
Officer of the Order of Canada
In February, prominent Toronto gastroenterologist
Professor Norman Marcon (left) was presented
the insignia of Officer of the Order of Canada
by His Excellency the Right Honourable David
Johnston, Governor General of Canada. The
insignia acknowledges outstanding achievement,
dedication to the community and service to
the country. In bestowing the honor, the Order
recognized Prof. Marcon for “his contributions
to the treatment of gastrointestinal diseases and
for his work to disseminate the latest advances in
therapeutic endoscopy.”
In the early 1980s, Prof. Marcon worked closely with
Cook’s Endoscopy division co-founder Don Wilson
to adapt radiological devices for endoscopic
use, changing the field of gastroenterology
forever. Marcon also founded the world’s premier
international course in therapeutic endoscopy,
which has disseminated the latest developments
in the field for over a quarter century.
Learn more about Prof. Marcon and the
development of GI endoscopy through the
video interview series with Dr. Greg Haber at
cookmedical.com/p/marcon. ■
Prof. Norman Marcon is not a paid consultant for
Cook Medical.
6
www.cookmedical.com
Photo by MCpl Vincent Carbonneau, Rideau Hall © OSGG, 2016
Generations:
Continuing the legacy of the
interventional ERCP pioneers
Gary Vitale
Gary C. Vitale, MD FACS
Professor of Surgery
University of Louisville
Louisville, KY
Cotton: And you did. That must have been a great experience in
many ways. Please tell us all about that.
Our Generations series continues with
physicians who trained with the pioneers
featured in the 40 Years of Interventional
ERCP series (information about the two
volume Channel Pioneer series is available
at the conclusion of this interview).
Peter Cotton: Gary, thanks for agreeing
to participate in this project. As you know,
I have recently interviewed the pioneers
of therapeutic ERCP, including Claude
Liguory. I know that you studied with him
and became a close friend. We would like
to know more about that. But, first, let’s
hear about you. Where does your name
come from?
Claude taught me about gastronomy as well as gastroenterology.
Vitale: It started off with my wife and I both learning French. We
took a full-immersion Berlitz course. That turned out to be a good
decision, even though Claude spoke English, and some of the team
members liked to practice their English. If you spoke French, you
were really accepted much better. We had a great time there, but it
was a little traumatic initially, especially finding an apartment.
Peter B. Cotton, MD,
FRCP, FRCS
Professor
Gastroenterology and
Hepatology
Digestive Disease Center
Medical University of
South Carolina
Charleston, SC
G a r y V i t a l e : I t ’s I t a l i a n . M y g re at
grandparents immigrated in the 1890s
through Ellis Island. My mother’s side was
from Abruzzo, and the Vitale family came from the Naples area. The
Vitales settled in Connecticut. That’s where I was born, but I grew up
in Florida, after my dad moved with his business.
Cotton: You’re now a professor of surgery at the University of
Louisville?
Vitale: Yes. I did my residency at the University of Louisville from
‘79 onward, and then a two-year fellowship in biliary-pancreatic
surgery with Alfred Cuschieri in Dundee, Scotland. It was there that
I recognized the need for ERCP, but was kind of laughed at when
asking if I could find some place to learn it. That was in the early
‘80s and people, at least in Louisville, thought that it was foolish.
One person who really understood was our chairman, Hiram Polk.
He’s always been a bit of a visionary. Fortunately, a famous French
pancreatic surgeon named Maurice Mercardier used to visit
Louisville for the Kentucky Derby. Hiram called Maurice, who said, “If
he’s going to learn the ERCP, there’s only one person I would send
him to, and that’s Claude Liguory.”
I met Claude first on a Saturday morning in his clinic, cleaning up a
few cases. He said, “Well, let’s go to lunch.” We went to a restaurant
called Chez Georges, which was one of his favorite places near the
Porte Maillot, past the Arc de Triomphe. He was impressed with
my rudimentary French, but it did not extend to gastronomy. Turns
out, he was testing me to see if I was going to be a suitable friend
for the next year in the restaurant scene. He ordered a particularly
difficult dish, some kind of tripe with sauce. I had no idea. I just ate
it. Claude was extremely impressed. He said after that lunch that he
accepted me. He said I spoke French, and I ate one of his favorite
country dishes without complaining. He said he’d never seen an
American do either of those two things. My time in Paris turned out
to be a great fellowship in gastronomy, as well as gastroenterology.
The French were in no way slouches about working. We started at 7
a.m. sharp every day. If I was five minutes late, he would say, “Where’s
the American?” He loved to tease me about that. We stopped for
lunch weekdays around noon or 1 p.m. and we picked back up
around 3 p.m. We would finish 8 or 8:30. By the time I walked and
took the metro, I’d get home anywhere from 9:30 to 10 p.m., so it
was a very long day.
One thing that I remember very distinctly was, when the elevators
would go out, the porters would carry the patients from the second
floor on their shoulders, up about five flights of stairs and lay them
on the table. I remember also that the patients all had a little bottle
of wine on their lunch trays. They called it the French oxygen. I have
great memories of learning ERCP. It was difficult. When we started,
we did not have a video scope. It was a scope with a teaching
attachment, which was really difficult.
www.cookmedical.com 7
Claude Liguory enjoying the canyon.
“The best interventional
gastroenterologists see, think
and talk like surgeons.”
– Gary Vitale
Cotton: Tell us a little bit more about Claude.
Vitale: He was and is a special guy. He had a surgical mentality,
aggressive, getting things done. He was a hard worker, and that was
different, too, than the average person around there. He had very
few problems or complications because of his technical skill. He
started off very early in all of this. He was one of the originators in
his part of the world and innovative for both ideas and techniques.
He did the first ERCP in France, and the first sphincterotomy. He talks
about having a wire tied to the top of the catheter and touching an
electric coagulation cautery to the wire.
Cotton: Were there other people training with him at the time?
Vitale: Yes, there were two Brazilian guys.
Cotton: He’s had a close connection with Brazil ever since that
time. Changing the subject. Why do you think it was that surgeons,
in general, were rather dismissive of endoscopy in the early days?
Vitale: They did miss out. They caught up a little bit with EGD and
colonoscopy, certainly in rural areas, but they missed out on ERCP.
Once surgeons got interested it was difficult to get good training,
and you don’t want two tiers. If you’re going to do it, you want to
do it as well as anybody else.
Cotton: Surgeons were also slow to embrace laparoscopy, I think?
8
www.cookmedical.com
Vitale: Yes, most in the main centers had the concept that the
bigger the incision, the better. Our GI group was doing diagnostic
laparoscopy in the ‘70s and ‘80s.
Cotton: I know that Claude Liguory did laparoscopy and I believe
that he did at least one laparoscopic cholecystectomy.
Vitale: I was with him when he did it! It was in Bordeaux, with Jacques
Perissat, who I had met before going to France at the SAGES meeting
in the spring of ‘89. He had asked to present his work on removal of
the gallbladder through a scope. He was denied, but he was given a
booth in a corner. He had the video going and crowds came around.
This was before it had been done in the US. I said to him, “I’m going
to France in a couple of months to Claude Liguory to learn ERCP. Can
I come and visit you in Bordeaux?” He said, “By all means.”
That turned out to be a lifelong friendship, as well. I used to take the
night train from the Gare Austerlitz, and I would arrive in Bordeaux at
about 6:30 in the morning. I would take a shower in the train station
and take a bus to the hospital.
I’d get an afternoon train and get back at probably 10 at night.
It was an unbelievable experience. Claude got interested, partly
because I kept telling him of my experience. He said, “You know, I
did laparoscopy and I should learn this.” He came down and did at
least one cholecystectomy. It was a routine case and I remember
it very well. He held up the gallbladder, but said, “You know, with
1,200 ERCPs a year, I’m not sure I need to do this.”
Out of that experience, Claude and I wrote the article called “Biliary
Perestroika,” discussing the need for multidisciplinary collaboration
in the new world of biliary intervention.
Cotton: I remember that article well. As you know, I’ve been
preaching about med-surg collaboration for a long time, which led
to my development of the center here at MUSC.
“I would like to
emphasize for the
young people that it
is absolutely worth
taking a little risk and
doing extra training,
even if it means going
someplace unusual or
even where you don’t
know the language.
Sometimes, very good
things come out of it.”
– Gary Vitale
Gary Vitale with faculty colleague, Mike Bahr, who he trained, thus Claude’s “grand
fellow.”
Was it difficult getting established and doing ERCP back home?
Was there competition?
Vitale: It was not a problem. No one in our GI group was overly
interested in it. Eventually, they could see I was getting busy, so they
hired Whitney Jones, who trained in Canada with a special interest in
ERCP. We’ve helped each other a lot. Things built up pretty quickly.
My mantra was, “I’m not interested in doing just simple diagnostic
ERCPs; I’m a surgeon, I’m interested in interventional problems.” I
focused on pancreatitis, and quickly built up a busy practice.
Cotton: Did the two of you train other gastroenterologists and
surgeons together, or did you keep the trainees separate?
Vitale: The trainees ended up being separate. We were working
at different hospitals. I did get an appointment in GI, as well, and I
have trained some gastroenterologists.
Cotton: I trained some surgeons to do ERCP in the early days in
England and even some radiologists. As you know, some of the
early ERCP pioneers, like Nib Soehendra and Guido Costamagna,
started off as surgeons. Do you think that surgical training gave
you an advantage in pursuing some of the more complicated stuff?
Vitale: I always have thought that it did. I was a little more willing to
be aggressive, and I can certainly take care of my own complications.
What you don’t want is an inadequately trained surgeon doing ERCP.
The best interventional gastroenterologists see, think and talk like
surgeons. There is a subset of gastroenterologists, who probably
could do therapeutic laparoscopy, and are developing some of
these ideas in the natural orifice therapy, NOTES.
Cotton: Do you think NOTES is going to blossom sometime? It’s
been a bit quiet for the last few years.
Vitale: It will, at some time in the future, when someone’s willing
to invest to develop the tools. Right now, I’m not too excited about
taking the gallbladder out though the mouth. Long term, if we can
get some better instruments, the natural orifice approach may well
be useful.
Cotton: I agree. Let’s change subjects. As you know, this project
was initiated and is being supported by Cook Medical. That was
formerly called Wilson-Cook, which was founded by Don Wilson, a
good friend of mine and a supporter of the pioneers, their trainees
and courses. Tell us about your interactions with Cook.
Vitale: They were very supportive of Claude. Marsha Dreyer, the
international vice president, came once a year to Paris for Claude’s
live course, which was the first of its kind. I went back every year as a
faculty on that course, and there was a very close relationship there.
Cotton: Do your kids have any memories of their time in Paris?
Vitale: Yes. They all learned French and still speak French. Two of
the kids are in medicine now. My daughter is in residency at Yale
and she wants to do endocrinology. My son is doing pediatric
gastroenterology at Cincinnati Children’s Hospital. They actually try
to learn ERCP because there are some Peds GI people who do that.
They have great memories of France because we went back, of
course, and we had a lot of visits from our French friends here to
the US. That fellowship started a long friendship. Claude and I just
spent, with my wife, 12 or 13 days out West. This was an 80th birthday
present from us to him, actually. We went to southern Utah with Bryce
and Zion National Park, and then we went to Yellowstone and spent
a good deal of time traveling around that area. Fly fishing is one of
my hobbies, and so we stayed in our cabin for a while.
Cotton: Any regrets looking back?
www.cookmedical.com 9
Vitale: I have no regrets other than I kind of wish I had done two
years in Paris. It was a tremendous effort on our part to learn French,
to go without income for a year and the apartments there were very
expensive. It just turned out to be a very good decision for me,
though, long term. It steered my practice in the direction I wanted it
to. One year seemed like enough. Hiram Polk was yelling at me to get
back. I was going to be junior faculty there. They knew I had learned
laparoscopy. “This thing’s going crazy here, you better get back.”
I started an ERCP fellowship in 1990. I have had over 30 trainees and
most of them are still doing ERCP. They all consider themselves part
of the French Connection because I emphasized certain aspects of
my French experience. I have a little wine cellar now, and we always
talk about Claude, and he’s been over and met several of them at
different times. This idea of a school of trainees, I think, is missing in
modern medicine. It’s gone by the wayside, but at least with Claude
and myself and my guys, there is that absolute shared thread of
training that makes us all a part of this little French school. I know
your trainees feel the same. To me, that’s a big plus in a world that’s
become much less personal in recent years.
I would like to emphasize for the young people that it is absolutely
worth taking a little risk and doing extra training, even if it means
going someplace unusual or even where you don’t know the
language. Sometimes, very good things come out of it.
Cotton: Gary, many thanks for sharing this conversation with us. It
has been fun reminiscing about our friend Claude Liguory. Do you
remember his often phrase, “La vie d’artiste c’est difficile”?
Vitale: Yes, it was one of his favorite sayings. Peter, I want to thank
you for doing this. This anecdotal history is just wonderful. I’m so
glad you’re doing it. ■
Read about the ERCP
pioneers who influenced
generations of practitioners
in Volumes 1 and 2 of 40
Years of Interventional ERCP.
In these commemorative
issues of The Channel,
you will find fascinating, candid
interviews by and tributes to the
pioneers who created and shaped
the field of interventional GI
endoscopy.
You can access Volume 1 and 2 at
https://www.cookmedical.com/
endoscopy/40-years-of-interventional-ercp-stories-fromthe-pioneers-volume-2/.
Or ask your regional sales representative for copies.
Dr. Gary Vitale is not a paid consultant for Cook Medical.
Dr. Peter Cotton is a paid consultant for Cook Medical.
The Cotton/Vitale interview was
recorded before the horrific events
in Paris on November 13, 2015.
Our hearts embrace all those
affected by it, and we reemphasize
our support and admiration for all
our French friends.
10
www.cookmedical.com
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Early detection
and treatment of
gastrointestinal
cancer popularized at
community hospitals
in China
By G. Q. Wang, MD, PhD
Director / Doctoral Supervisor
Department of Endoscopy of Cancer Hospital Chinese Academy of
Medical Sciences
Chaoyang, Beijing, China
The “China Tour of Early Detection and Treatment of Cancer” is
a series of academic exchange and training activities focused on
the diagnosis and treatment techniques of early digestive system
cancer in community medical institutions. Sponsored by the Cancer
Foundation of China, Expert Committee of Early Detection and
Treatment of Cancer Project, as well as Professional Committee of
Tumor Endoscopy, Chinese Anti-Cancer Association, and organized
by local cancer prevention and control institutions, this effort is
designed to promote the standardization and professional level
of the early digestive system cancer screening at the community
medical institutions along with improving the efficiency of
endoscopy and pathological diagnosis.
Based on the “Early Detection and Diagnosis Project,” a special
medical reform program launched by the Chinese government,
the training in endoscopically assisted, minimally invasive
treatment promotes the popularization of EMR and MBM in
qualified community medical institutions, while also consolidating
and improving the professional skills of local endoscopic and
pathological physicians.
In order to support the community medical institutions in carrying
out endoscopically assisted, minimally invasive treatment of early
gastrointestinal cancer, Cancer Hospital Chinese Academy of
Medical Sciences offers a long-term training course on endoscopic
treatment. Through two months of clinical teaching, operation
observation, case discussion, academic lecture, animal explant
models and animal experiment and technical support, specialist
physicians can be further trained to carry out the work as a regional
demonstration center. In 2015, the Tour covered six cities including
Hangzhou, Zhejiang Province; Anqing, Anhui Province; Gaotai,
Gansu Province; Huzhu, Qinghai Province; Suining, Sichuan Province;
and Xiangyuan, Shanxi Province.
Endoscopic resection
Endoscopic resection (ER) is one of the most important and effective
techniques for the treatment of early gastrointestinal cancer.
However, higher requirements for surgeons hinder the development
of ER technique because they need time to learn and accumulate
the clinical experience. The imbalanced distribution of medical
resources in China is a barrier to ER availability. A more appropriate
and effective ER technique for early gastrointestinal cancer is a
desperate need.
Multi-band mucosectomy (MBM) is a therapeutic technique for
esophageal cancer and precancerous lesions suitable as a clinical
solution to patients in all areas of China. It has strong operability,
and physicians can perform this procedure after standard training
for a short period of time.
In addition, it has significant advantages in terms of operation
time and economic cost, higher safety and lower incidence of
complication. Compared with en bloc resection in ESD, multi-band
resection is operated under the principle of standardization, and
residual lesion and relapse risks are also reduced to the controllable
range. ■
Dr. G.Q. Wang is not a paid consultant for Cook Medical.
Overview of early digestive cancer in China
In China, the age-standardized incidences of esophageal cancer,
gastric cancer and colorectal cancer rank fifth, second and sixth,
respectively, among all malignant tumors, and fifth, fourth and
third, respectively, in terms of age-standardized death rate.
Current statistical data from a few tertiary hospitals in China
showed that early gastric cancer only accounted for 15% of the
gastric cancer confirmed, much lower than that of Japan (70%)
and Korea (55%), while the early detection rate of colorectal
cancer was lower than 10%.
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www.cookmedical.com
The data released by the Ministry of Health showed that
postoperative five-year survival rate of early gastrointestinal
cancer in China was over 90%, the incidence of postoperative
complications was much lower than that of advanced cancers
and postoperative quality of life was better than that of patients
with advanced cancer. Under the current situation in which
tumorigenesis cannot be prevented, early detection and
treatment is the key to the diagnosis and treatment, which is
the common prevention strategy for tumors proposed by the
whole world.
Origins of China’s early detection and treatment of cancer project
Based on thorough epidemiological design and technical
protocol, screening, early detection and treatment are
completed through rational population selection, cohort
establishment and target population screening and control.
Meanwhile, training and on-site instruction are also provided
on a regular basis.
It has been eleven years since the establishment of demonstration
base of early detection and treatment of esophageal cancer in
Linzhou, Henan Province: Cixian, Hebei Province; and Feicheng
in Shandong Province. Eleven years of practice has seen fruitful
achievements in terms of early detection and treatment of
esophageal cancer/cardiac cancer. The current statistical data
shows that: a total of 621,979 patients had been screened in
2006-2013, and cancer had been detected in 9,056 (1.46%)
patients, of which there were 6,323 at early stage (69.82%), and
6,688 (73.85%) were treated. This has completely changed the
situation featured with low detection rate (5%), high medical
expenses and poor efficacy among the patients treated in large
hospitals. Currently, the number of project sites for esophageal
cancer/cardiac cancer has increased from 8 to 144, and the
population screened has increased from more than 10,000 to
more than 180,000 each year.
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www.cookmedical.com 13
Paying it forward
The power of shared knowledge
Editor’s note: Dr. Steve Bensen, an associate professor of medicine at
Dartmouth’s Geisel School of Medicine and physician at DartmouthHitchcock Medical Center, was the first gastroenterologist to
participate in the Human Resources for Health (HRH) program. In
2014, he spent two months helping to train physicians and residents
at two hospitals in Rwanda. (See story in The Channel, Issue 3,
2015.) In 2015, Dr. Bensen, who specializes in gastroenterology and
hepatology, made his second trip to Rwanda. Below he shares his
thoughts with The Channel about the impact of the learning and his
hopes of creating further teaching interactions now and in the future.
The Channel: Can you update us on your endoscopy teaching
collaboration with the Rwandans and the progress that is being
made?
Dr. Bensen: The second trip was even more powerful and in some
ways more productive than the first one because we hit the ground
running. In the interim period—between when I was in Rwanda
the first two months last year and then going the second time in
2015—we were busy on a number of fronts. One was that we created
external rotations for six of the Rwandan physicians to come here,
five residents and one faculty, who was my “twin” or partner, Dr.
Vincent Dusabejambo. The fact that they were able to come and
train here [Dartmouth’s Geisel School of Medicine] in our internal
medicine program for three months each just enriched the whole
exchange experience. When we went back to Rwanda, we were very
well received and had many, many friends.
The other major front was an educational exchange. For the second
trip, I brought two medical students and a GI fellow with me. In
While mountain biking the Congo-Nile trail, a patchwork of village
dirt roads and trails through the mountains and hills overlooking
beautiful Lake Kivo, a group of village children greeted me and are
fascinated by the picture I had just taken of them on my iPhone.
preparation for them coming, we shared most of the curricula that we
used for our first years of medical school here and facilitated it being
uploaded to a University of Rwanda website, so Rwandan faculty
can actually use our medical school curricula (lectures, PowerPoints,
references) in the courses they’re designing. There was a lot of work
that went into this transfer of course content before we went. Once
we arrived, our GI Fellow, Zila Hussain, was an awesome instructor.
She did a lot of teaching of the Rwandan doctors in the endoscopy
unit at one hospital, CHUK [University Central Hospital of Kigali],
which allowed me to work at other sites.
Although the focus of our stay was our work during the day in the
hospital and at the University of Rwanda in Butare teaching, there
was a lot that went on outside of the hospital, which allowed for
significant relationship building. We were well received by all the
different doctors’ families, went into their homes for meals and
really assimilated into their culture for the two months that we were
there. It was richer this time in that regard because we’ve built many
friendships and relationships now.
In remote Ruhengeri District Hospital, near the home of the
mountain gorillas, Dr. Vincent Dusabejamo conducts a teaching
session with a Congolese GP. With availability of this single thirtyyear-old fiberoptic endoscope, diagnostic upper endoscopy is
now possible in this isolated area.
14
www.cookmedical.com
In terms of their endoscopy, the physicians we have worked with are
becoming increasingly skilled at therapeutic endoscopic procedures.
When I was there, we continued to work on balloon dilation utilizing
our donated device supplies. They had been working on balloon
dilating pyloric stenosis and esophageal stenosis after my first trip
and we continued refining these skills during the second visit. The
other very important technique we continued to work on with our
Our GI fellow, Dr. Zila Hussain, supported many teaching
opportunities with the Rwandan physicians, and during this
endoscopy procedure, she is surrounded by a number of learning
observers.
Rwandan colleagues was variceal band ligation. Although I brought
certainly no formal GI training. There’s no pulmonary training, no
a lot of bands with me the first time I went, they had used them all up
cardiology, no medical subspecialties, nor surgical subspecialties
by the time I returned because they became so proficient at it. I was
or pediatric subspecialties.
able to bring a limited supply during the second visit but there is still
One of the main charges, I feel, is to develop training in
a big need for continued support in providing esophageal
gastroenterology. There’s a big need. There are internists
band ligators to treat esophageal varices. The burden
and surgeons performing endoscopic procedures
of chronic liver disease and noncirrhotic portal
and treating people with chronic liver disease
“We’re working on
hypertension is very high in Rwanda. That’s a
and chronic GI illness, but they’re not formally
technique that few in the country were doing
developing a GI fellowship
trained yet. We’re working on developing a
before and now we have five or six Rwandan
program that would involve
GI fellowship program that would involve
physicians able to perform variceal band
training within the country, as well as visits
training within the country, as well as
ligation, so all of the four referral hospitals
to other African countries where there are
visits
to
other
African
countries
where
in the country have the capability when
centers
of excellence, and maybe some
there are centers of excellence, and
supplies are available.
exposure and training in the US, as well.
maybe some exposure and training
The Channel: What will be the next priority
We put forth a proposal for a GI fellowship
in the US, as well.”
to focus on in terms of helping them expand
that has gone to the Ministry of Health, and
their capabilities?
are hoping that will move through and that we
– Dr. Steve Bensen
can secure funding. We are also trying to establish
Dr. Bensen: My visits to Rwanda were through
relationships with other institutions internationally
Dartmouth’s involvement with a program called Human
within Africa and then elsewhere to grow the fellowship.
Resources for Health, a seven-year partnership between the
University of Rwanda and 12 leading medical schools in the US. This
The Channel: How challenged are they with equipment availability?
partnership is intended to facilitate medical education efforts in
Dr. Bensen: They are challenged. They have endoscopes. They
Rwanda and we are now into year four of the seven-year program.
frequently, like ours, need maintenance, and then they break down.
We’re going to have funding for GI involvement through the life
They don’t have the “ready, send it off, it comes back a week later”
of that program but we’re building relationships that we hope will
repair support that we have. It’s always tenuous whether we have
continue these exchanges into the future. At Dartmouth, we’ve had
enough scopes to be actually functioning at the sites. Right now, we
more than 15 physicians participate during the first three years of
do, but that can change with one cable break. That’s a challenge. The
HRH. I’ve been there the shortest time, two months times two. Others,
consumables are a challenge, too. I came over with a lot of biopsy
internists, pediatricians, general surgeons and anesthesiologists,
forceps and snares, balloon dilators and variceal band ligators. We
have gone for a whole year. There are a lot of people at Dartmouth
do run out of balloons, and we definitely have run out of bands, so
and at other academic institutions, too, that have made connections,
we can really use more of those. We’re trying to secure pathways
relationships. We’re trying to build on that and continue that into
with industry so they can get them at discounted rates because, as
the future, to have exchanges between our students and trainees
you know, they have limited resources.
and with the Rwandans. That’s one for the future.
The GI burden of disease is very, very high. When we’re in the
We’re really trying hard to establish a GI fellowship program for the
endoscopy unit doing procedures as opposed to here, almost
country. That was a charge from the Ministry of Health. There are
everybody who’s coming in to get endoscopy, because they’ve
basically only five specialty areas currently with training programs in
had to go through so many levels to get to the four referral
Rwanda—internal medicine, surgery, anesthesia, OB and pediatrics
hospitals, has underlying pathology—ulcer disease, gastric cancer,
but no subspecialty training. Most physicians in the country are
outlet obstruction, esophageal stenosis. There’s a very, very high
general practitioners without any specialty training, and there’s
www.cookmedical.com 15
prevalence of serious pathology in the people who eventually come
to get endoscopy.
The Channel: What will be the challenges to train the local
practitioners in getting these patients referred faster, to get them
diagnosed faster?
Dr. Bensen: The challenges are just resources. There are many
brilliant young physicians and students in Rwanda eager to learn
and work hard to develop the skills and expertise their country so
desperately needs. In a country of 12 million people, there are 400
community health centers, which are pretty rudimentary clinics
staffed by basically nurses and community health workers. Then
there are about forty district hospitals, mostly staffed by general
practitioners, meaning they have gone to medical school and have
had one to two years of a general internship. They don’t have formal
training in a specialty. Then there are only four referral hospitals for
12 million people that these district hospitals can refer to. That’s a
very, very small number for so many people.
The Ministry of Health is planning to open up three or four more
new tertiary care centers by converting the bigger district hospitals
into referral hospitals. These will need to be staffed by new trainees
coming out of residency training, and they will need to have the
equipment to provide care: bronchoscopy, endoscopy, have ICUs
and NICUs; provide all that is currently being done in the referral
hospitals. There are limitations, for sure, and funding is always an
issue in providing this level of care, especially when it comes to
supporting training programs. That’s part of our mission through the
HRH program: To work with the people who are currently attendings
but also to train the next generation of residents coming up that will
staff these new referral hospitals.
My partner in our GI educational efforts, Dr. Vincent Dusabejambo,
is first and foremost an excellent internist with a smaller practice
focus in GI. Here he teaches the basics of a neurologic exam.
The Channel: You probably had a lot of surprises in this work, but
was there anything that really stood out about this experience that
was most surprising to you?
Dr. Bensen: We went with the intent to give in some way and to
educate and to work but, in the end, I probably got more out of
it than I was able to contribute. It’s hard to quantitate that, but
just how it changes you as a person to see the great need
and see the resilience of the people and how well
“Industry
and
Dr. Bensen: Just do it, because there are so many
they do with so little. We have a lot to learn from
physicians both have
areas of the world that need help, Rwanda
them in that regard—the compassion, the family
being one. There are a lot of NGOs [Nona responsibility in patient
support of the sick patients, and the Rwandan or
Governmental Organizations] and other
care, facilitating the provision of
the African attitudes towards life and death. It’s
government-sponsored programs, such as
resources and education and the
really profound.
the Human Resources for Health, through
transfer of medical knowledge. It
The surprise was how much it changed me
which a physician, nurse or other health
is what we are called to do as
and how powerful an experience it was. The
care provider can become involved. I was
physicians.”
friendships I have developed, the relationships that
just in Togo with my daughter, who works for
have
been established. The gratitude was profound
an NGO there, and that’s a country that’s very
– Dr. Steve Bensen
but, also, how I was able to connect with my Rwandan
backward. It does not engage well with the West.
colleagues, understand their lives a bit and what they have
Their medical system is fifteen years behind Rwanda’s
endured, hear their stories, meet their families, eat with them. That
and way behind most of Africa. They’re right down there at
was incredibly enriching. The surprise was just how much it affected
the bottom of the world with Sierra Leone and Guinea in terms of
me. I went there to give and serve, but you get so much back in return.
medical care and other metrics by which countries are measured.
You can see what happened in those two countries and how easily
It reinforces why you went into this. We’re all busy clinicians. We have
Ebola took off in that type of setting that is so impoverished with a
our frustrations with productivity, with RVUs and electronic medical
primitive healthcare system. We are so wealthy and spend so much
records and our educational demands and responsibilities. It was
on our healthcare in the US, we have an obligation to help. Industry
an incredible sabbatical to be removed from all of that and really
and physicians both have a responsibility in patient care, facilitating
focus on why you went into medicine in the first place. ■
the provision of resources and education and the transfer of medical
Photos by Dr. Steve Bensen
knowledge. It is what we are called to do as physicians. The world
is a much smaller place now than when I went to medical school.
Dr. Steve Bensen is not a paid consultant for Cook Medical.
We are much more interconnected. There is a great need in subSaharan Africa and in many, many countries, and there are many
ways for us to get involved.
The Channel: What would you say to your colleagues who are
interested in getting involved and teaching and providing
their support to this work?
I’m mid-career, and I just did it, and now I’m hooked and will
continue to be involved. Next year I will go back, as will several of
my colleagues and students.
16
www.cookmedical.com
Enhancing nutritional
support through
education, advocacy
and networking
In this issue of The Channel, we speak
with Lisa Crosby Metzger, Director of
Community Engagement for the Oley
Foundation, about Oley Foundation’s
overarching mission and the programs
aimed at accomplishing that mission.
Help along the way
The Channel: What is the mission of the Oley Foundation? What’s
the primary focus of your work?
Lisa Metzger: I’d like to share our mission statement almost
verbatim: “Striving to enrich the lives of those living with home
intravenous (or parenteral) nutrition and tube feeding (enteral
nutrition) through education, advocacy and networking.” We are also
a resource for consumers, family, clinicians, industry representatives
and other interested parties.
The Channel: When you think about that mission statement,
generally how does Oley carry that out? What are the major
overarching efforts that allow you to work towards accomplishing
that mission?
Lisa Metzger: We have a lot of programs in place to address the
different aspects of our mission. We approach education, advocacy
and networking all from different angles. Our bimonthly newsletter
reaches all of our members. It is mostly educational and allows us to
cover the medical and coping aspects of living with nutrition support
with a goal of improving people’s quality of life. We have an annual
consumer and clinician conference, which reaches a sector of our
membership, maybe 300 to 400 people annually. We also have
regional conferences, which give us a smaller presence in different
parts of the United States.
Our goal is to provide members with information that they may
need, especially if they are working with a doctor who may not have
a concentration in nutrition support. They can share that information
with their doctor, who can then determine if it is appropriate for their
care. We also share member-to-member coping skills to help people
integrate tube feeding or parenteral nutrition into their lives. We
have a body of volunteers, called our Oley Ambassadors, who are
available to answer questions. They make their contact information
available publicly on our website, and they are available to answer
questions, to listen, to be a shoulder to lean on, and to share some
of their own coping techniques. This program is not intended to
provide medical advice but rather to help people with their dayto-day concerns.
The Channel: Are the Ambassadors also patients who have had
direct experience, or are they possibly clinicians who are interested
in your mission and helping you with providing additional
information?
Lisa Metzger: They’re all consumers or caregivers or those who
have been on therapy. They may be off therapy now but previously
received nutrition support. There is a range of diagnoses, ages and
therapies represented through the Ambassadors.
The Channel: How are Oley Ambassadors recruited? How do they
find out about this program?
Lisa Metzger: We were fortunate to add six new Ambassadors
at the 2015 Annual Conference, which was great. They attended
our Ambassador workshop and learned about the program, then
applied and were accepted as Ambassadors. Potential Ambassadors
reach out to us because they’re motivated by the desire to give
back. We hear that a lot. They have found the help that they needed
through the Oley Foundation and now they want to give back to
the community.
More often than not, they seek us out, but sometimes we’re really
inspired to invite someone to apply because they’ve shown such
balance in their own lives or they’ve set such a good example in
dealing with some of the difficulties of home nutrition support.
The Channel: In thinking about the different ways that you reach
patients and their families, are you also interacting via social media?
Is that a resource for you, as well?
Lisa Metzger: We do have a Facebook page but our staffing support
means the activity is more sporadic than we would like it to be. We
also have the Oley-Inspire Forum. Inspire provides a platform for
organizations like ours to set up a forum without having to do all the
legwork involved. The Oley-Inspire forum has over 6,500 members.
Oley has a YouTube channel where we share awareness information.
Over the last two years, we’ve focused on sharing information during
Feeding Tube Awareness Week in February and HPN Awareness
Week in August. We put out press releases and we’re very active on
social media during those two weeks. We produce a video, which can
be seen on our YouTube channel, where we try to get the message
out that people can survive and thrive with nutrition support.
www.cookmedical.com 17
We share the message that it’s not an end-of-the-road therapy but
rather can offer you opportunities to regain strength if you’ve lost
a lot of weight or if your energy is waning. We communicate that
this may be a way to help you get back on your feet and feel better.
We also hope to convey the message that while managing it isn’t
without challenges, nutrition support doesn’t have to keep you from
doing the things that bring you joy, such as gardening, traveling or
being with family.
The Channel: For many people, the perception might be that
nutrition support is an end-of-life therapy. Does this possibly impact
people’s willingness to get involved with your work?
Lisa Metzger: I don’t know if it makes them reluctant to get involved
with Oley, but we have heard people say that they were reluctant to
start on tube feeding until they saw one of the tube feeding videos.
There are reports of parents who are sent home with babies on IV
nutrition and they’re told that they’re basically just bringing their
child home to die. When they hear stories of people who have
survived for many years with intestinal failure on parenteral nutrition,
they take heart and they’re maybe a little bit more aggressive in
finding the kind of care that will help their child to thrive.
We ran an article recently in the newsletter about a man who had
had head and neck cancer. He was having trouble swallowing after
the radiation and he just did not want to tube feed. He kept putting
it off and described himself as being very macho and not wanting
to undergo tube feeding. When he finally agreed, he said, “Wow, I
should have done this years ago.”
The Channel: Are any international organizations collaborating with
you on issues where you have mutual interest or shared concerns
on patients?
Lisa Metzger: We collaborate with organizations in several other
countries, especially on initiatives such as HPN Awareness Week.
Several of the groups have a representative who also serves
as an Oley Ambassador, which facilitates exchange between
our organization and theirs. We try to form a relationship, when
appropriate, with other organizations whenever we can, wherever
they are. Our executive director or our medical advisor, Dr. Kelly,
usually goes to ESPEN (see sidebar) meetings. Dr. Kelly has long
been active with their HAN group, which is the Home Artificial
Nutrition group.
The Channel: What can be done to help clinicians become more
aware of the work of your organization and others, such as A.S.P.E.N.
and GEDSA, so that they can seek out your resource support?
Lisa Metzger: That’s always been a big question. How do we let
people know about the Oley Foundation? There are many different
specialists who put people on nutrition support—from internists to
gastroenterologists to surgeons—and most clinicians manage only a
few patients, so it’s difficult to target them all. One way The Channel
readers can help is to share the Oley information with their patients.
The Internet has been a huge help to us. People hear about us via
the Internet, through Google searches. Many people hear about us
through our Equipment/Supply Exchange program. If your formula
is not covered by insurance, we try to make a match with another
consumer who has the product to donate.
It’s often the need for formula that results in a call to us. Sometimes
the only way someone has met another parent or another person
on tube feeding has been through our Equipment/Supply Exchange.
They realize it’s really beneficial for them and then they become part
of the organization as a whole.
18
www.cookmedical.com
Global initiatives
Below, Lisa Metzger discusses international organizations
with goals similar to the Oley Foundation, representing
patient and consumer interests in their specific countries,
including a recently formed international alliance that will
enhance collaboration and shared resources.
PINNT (British organization for homePEN consumers) is in the
UK and PN Down Under (PNDU) serves Australia and New
Zealand. There is also Appetite for Life in Poland and another
group in Italy. Along with representatives from PINNT and
PNDU, we had a representative from the Czech Republic at
the 2015 Oley Annual Conference.
Oley recognizes that consumers who are traveling abroad
benefit from connecting with others familiar with nutrition
support in the countries they are visiting. Whenever possible,
we connect members to a consumer and/or clinician and
whatever other resources we know of in that country.
In the fall of 2015, an international alliance of home nutrition
support consumer groups, including the Oley Foundation,
was introduced with an exhibit at the annual meeting of
the European Society for Clinical Nutrition and Metabolism
(ESPEN) in Lisbon, Portugal. The newly organized International
Alliance of Patient Organisations for Chronic Intestinal Failure
and Home Artificial Nutrition (PACIFHAN) will facilitate
the international sharing of information and resources to
improve the quality of life of home artificial nutrition (HAN, the
equivalent of our term “HPEN”) consumers. As of September
2015, the alliance included the Oley Foundation (US), PINNT
(UK), PNDU (Australia and New Zealand), Život bez střeva (the
Czech Republic), Un Filo per la Vita (Italy), Stowarzyszenie
Apetyt na Życie (Poland) and Svenska HPN-Föreningen Barn &
Ungdom (Sweden). The alliance website is www.pacifhan.org.
If we could reach more discharge planners and give them a sense
of what the needs are for members when they go home, that could
be a great way for us to reach both consumers and clinicians.
The Channel: If I’m a clinician and I was interested in getting
involved in your work, how do I reach out to Oley? How do I make
contact to see how you could use my help?
Lisa Metzger: There are five of us who make up the Oley staff, and
we make a point of being very accessible. Anyone interested is
welcome to contact us by phone and speak directly with any of our
team members for more information on opportunities to support
our work. We are also readily available by email.
We also have a brand new website. It is easy to navigate and includes
an integrated database. All of our member information remains
completely private (we don’t share it at all), but members are able
to record a little bit more about their circumstances. For example,
on the new site, people are in charge of their own profiles and can
update their personal details related to nutrition status at any time.
This will help us to better understand our community and their
needs, as well as what the community looks like overall. It is a really
exciting opportunity for us.
The Channel: Do you have a speakers’ bureau that organizes
supporting talks to interested audiences?
Lisa Metzger: We don’t have a published speakers’ bureau, per se,
but we have a body of volunteers that we’re familiar with who can
help meet such needs. We have an active group that we can draw
on, as with the awareness weeks when we really try to encourage
in-services and we do a lot of press releases about individual
members. We try to generate some interest within their local
communities.
Sometimes people ask us where we got our name. The Oley
Foundation was founded in 1983 by Dr. Lyn Howard and one of her
patients, Clarence “Oley” Oldenburg. Dr. Howard was involved in
nutrition support here in Albany and saw the need and how much
people benefited from being at clinic the same day. They were able
to discuss their concerns and their issues with one another. That’s
partly how the Oley Foundation was born.
From a clinician’s perspective, it may be important to know that the
Oley Foundation was founded by a doctor and also that we have a
very active board with a mix of clinicians and consumers. All of our
pieces are medically reviewed if they have any medical component.
Everything on our website or in our newsletter is fully reviewed.
The Channel: In closing, can you tell us about plans for the 2016
Annual Conference?
Lisa Metzger: We are excited to be in Newport Beach, California for
the 2016 event. It will be held from July 5th through the 9th at the
Marriott Newport Beach Hotel and Spa. This conference gives us a
chance to obtain a lot of excellent feedback from participants, and
that helps us continue to grow and plan to meet their needs. Please
check our website (Oley.org) for more information coming soon. ■
Oley Foundation
at a glance
The Oley Foundation provides its 15,000+
members with critical information on topics
such as medical advances, research, and
health insurance. The Foundation is also
a source of support, helping consumers
on home IV nutrition and tube feeding
overcome challenges, such as their
inability to eat and altered body image. All
Oley programs are offered free of charge
to consumers and their families.
Leadership
Joan Bishop
Executive Director
[email protected]
Lisa Crosby Metzger
Editor, LifelineLetter;
Director, Community Engagement
[email protected]
Oley Foundation Programs
Roslyn Dahl
Communications & Development Director
[email protected]
LifelineLetter: A bimonthly newsletter
with articles about medical advances,
personal experiences, tube feeding tips,
and more
Cathy Harrington
Administrative Assistant
[email protected]
Information Clearinghouse: A resource
designed for answering questions about home IV nutrition and
tube feeding through a toll-free hotline, website, online education program,
and DVD/video library
Andrea Guidi
Executive Assistant
[email protected]
Consumer Networking: A source of peer support that includes an online
chat forum, and the ability to call or e-mail experienced consumers and
caregivers
Darlene Kelly, MD, PhD, FACP
Science & Medicine Advisor
Conferences: An opportunity for consumers, clinicians, providers, and
industry representatives to share information and support
Ambassador Network: A grassroots network of 60+ volunteer consumers
and caregivers in the US, Australia, Canada, New Zealand, Norway, Poland,
and the UK
Equipment/Supply Exchange: A way to get supplies, formula, or equipment
related to home IV nutrition or tube feeding from people who have them
to donate into the hands of people who need these items
Lyn Howard, MB, FRCP, FACP
Medical Director/Co-Founder
Contact Information:
43 New Scotland Ave, MC28
Albany Medical Center
Albany, NY 12208
518-262-5079 / 800-776-6539
FAX 518-262-5528
Oley.org
www.cookmedical.com 19
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upon removal,
making overall stylet
management more efficient. This
innovative stylet, featured on the
20 gauge EchoTip ProCore®, can
potentially minimize the risk of
contamination.
Oct. 12-14
Twenty-Ninth International Course on
Therapeutic Endoscopy
Toronto, Canada
Oct. 15-19
UEG Week 2016
Vienna, Austria
Oct. 16-18
ACG
Las Vegas, NV
NOVEMBER 2016
EchoTip ProCore
Nov. 2-5
Asian Pacific Digestive Disease Week
Kobe, Japan
Nov. 3-6
Japan Digestive Disease Week
Kobe, Japan
®
H D U LT R A S O U N D B I O P S Y N E E D L E
@CookMedical
@CookGastro
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