Endoscopic Ultrasound Aids in Diagnosis and Treatment of Pancreatic Cancer
NCH advanced gastroenterologist, Dr. Maged Bakr, MD, Director of Advanced Endoscopy, is utilizing an imaging procedure called endoscopic ultrasound (EUS) to aid in the diagnosis and treatment of pancreatic cancer, which ranks as the fourth leading cause of cancer- related deaths in the United States and the second in Florida. In the United States, 57,000 people are diagnosed with pancreatic cancer each year, with a higher incidence in black men over the age of 45. It is the second-leading cause of death in digestive cancer cases, after colorectal cancer. With the aid of EUS, physicians are better able to detect pancreatic cancer in its early stages, as well as determine the cancer’s advancement on the “stage” scale with a high degree of accuracy. According to Dr. Bakr, EUS combines endoscopy and ultrasound in order to obtain images and information about the digestive
tract, as well as surrounding tissues and organs. The procedure is performed like a regular endoscopy and patients must be fasting. Patients are sedated during the procedure that usually lasts from 30-45 minutes and uses a long, flexible tube passed into the body through the mouth or rectum. Adding ultrasound
ultrasound images. We can also utilize Doppler ultrasound, if a biopsy is needed, which enables us to avoid passing a needle through a blood
vessel and hence decrease
to endoscopy allows high frequency sound waves to produce images of bodily structures and internal organs, such as the liver,
risk of bleeding."
“For patients with elevated liver enzymes with abdominal pain, we can do
a regular endoscopy to rule out ulcers,” says Dr. Bakr, “and then, during the same procedure, use the ultrasound probe to evaluate the bile ducts, gallbladder and pancreas." “In cases where there is no explanation for elevated liver enzymes, I can do a EUS- guided liver biopsy and obtain a liver sample in the same setting, thereby reducing the number of procedures the individual has to go through.” The best candidates for EUS are any patients who can undergo a regular endoscopy, in addition to obese patients or those with pacemakers who cannot have an MRI.
gallbladder, pancreas
or aorta. “I have seen some cases
where CT scan or MRI can’t precisely see or diagnose a pancreatic mass or tumor,” says Dr. Bakr. “Using EUS, the transducer can get closer to the organs. The images are more clear, accurate and detailed than those from traditional
Dr. Maged Bakr, MD
For more information contact the NCH Gastroenterology-Hepatology Department at (239) 624-2730
NICHE Care is Ideal for Older Adults
Kristin Miller stands with Danna Trobaugh who cradles a stuffed animal from NCH’s NICHE program.
NCH has a new NICHE for patient care. As an
acronym, NICHE stands for Nurses Improving Care for Healthsystem
Elders. Developed by New York University, the program educates nurses and support staff on best practices and protocols in the care of older adults. NCH launched NICHE last year in neurology, earning certification. “Becoming a NICHE hospital aligns with the NCH mission to properly and safely care for our aging population,” says Kristin
Miller, MSN, RN, CVRN-BC, GRN, Certified Dementia Practitioner and NCH NICHE coordinator. “We recognized the need in our community.” Cognitive patients, or those with memory and other thought-processing issues requiring specific care, make that particular specialty an ideal area to begin the NICHE certification. “We’ve developed tools to ease these patients’ anxiousness,” Miller explains. The cognitive tool kit has coloring books, fidget boards, stuffed animals, and other items meant to relieve a patient’s anxiety. Patients receive an item and perhaps a visit from care volunteer Danna Trobaugh, who helps ease the stress of a new arrival. Often, a patient with an altered mental state may have anxiety when admitted, Miller adds. These tools provide purpose, comfort and distraction. “Our nurses are educated on the best practices
and evidence-based guidelines in treating patients who may have an altered mental state,” Miller says. “Just coming into a new environment can be troubling. We want to make it a smooth transition.” Another valuable tool is the Life Profile form that gives a snapshot into a person’s preferences. “We want to learn more about the patient, for example, the patient’s preferred name or their favorite color,” Miller continues, “anything to help a patient feel more comfortable.” NCH is gradually branching NICHE care practices to other areas. Future plans call for a geriatric emergency room, which will focus on better layouts, lighting, noise level and other attributes older adults find comforting. Miller summed it up: “NICHE is a wonderful approach to the care of older patients who deserve a special focus.”
For more information about the NICHE program, contact Kristin Miller, NCH NICHE coordinator , at (239) 624-4715
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