Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 4th International Conference on Orthopedics & Rheumatology Baltimore, Maryland, USA.

Day 2 :

Keynote Forum

Margaret Wislowska

Centralny Szpital Kliniczny MSW, Poland

Keynote: Rheumatology in the 21st century

Time : 09:00-09:35

OMICS International Orthopedics-2015 International Conference Keynote Speaker Margaret  Wislowska photo
Biography:

Margaret Wisłowska, Head of the Department of Internal Medicine and Rheumatology CSK MSW, the specialist in internal medicine, rheumatology, rehabilitation medicine, hypertention, the author of over 190 scientific papers and books. She has participated in numerous scientific meetings. Promoter of 10 PhD theses. She took trainings at Guy and St Thomas' Hospitals in London, Charity Hospital in Berlin, Rheumatology Institutes in Prague and Moscow. In 2003 she created the Department of Internal Medicine and Rheumatology, and in 2010 Clinic of Internal Medicine and Rheumatology CSK MSW. Prof Margaret Wisłowska is the professor lecturer at the Medical University of Warsaw.

Abstract:

Rheumatology in the 21st century specializes in a number of disorders that have defied understanding by the application of current cellular, biochemical and immunologic techniques. The genome revolution does provide us with new tools, which are already beginning to have an impact. Polymorphisms in drugs metabolizing enzymes have been associated with both clinical response and adverse effects of treatment. Proteomics and genomics offer new opportunities to identify biomarkers that provide surrogates of disease activity and response to therapy. MicroRNAs are small, double-stranded RNAs expressed in all cells that regulate the expression of hundreds of genes. MicroRNAs act as master regulators of how a cell responds to changes in its environment, including stresses and inflammation. There have been substantial advances in the field of rheumatology with considerable changes in the management approach of rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE). There is a need to consider the selection of the most appropriate therapy for an individual RA patient and to review how and when to switch treatments in those patients who do not show an optimal response. On 6 November 2012 FDA approve inhibitors of kinases to RA treatment. In SpA the new Assessment of SpondyloArthritis International Society (ASAS) classification criteria have been developed, e.g. classification criteria for axial and for peripheral SpA. In lupus, belimumab, a fully human monoclonal antibody that inhibits B-lymphocyte stimulator BLYSS, was approved for the treatment of lupus in 2011 and there are a number of other therapies in development.

Keynote Forum

Navtej Sathi

Forth Valley Royal Hospital, UK

Keynote: Is pain crowding the company of orthopaedics and rheumatology?

Time : 09:35-10:10

OMICS International Orthopedics-2015 International Conference Keynote Speaker Navtej Sathi photo
Biography:

Sathi is currently working as a consultant in Acute Medicine in Scotland. Previously he has previously held posts as a Consultant in Acute Medicine and Rheumatology. His interests include pain, integrated medicine, rheumatology, methotrexate side effects and interstitial lung disease. He holds an M.Sc. in Pain Management from Cardiff University. His research governance score (from Research Gate) is above 20, placing him in the top 30 percent in the world. He is a reviewer for Clinical Rheumatology.

Abstract:

Medical problems related to orthopaedics and rheumatology have been around for thousands of years in the context of humanity. Both specialities have become more defined over the last few centuries. Pain on the other hand has been recognised more as a symptom which has been treated for thousands of years with morphine based drugs as reflected in the traditional World Health Organisation Pain Ladder. For the purpose of the Keynote Speech for Day 2 there will focus on pain and it’s relationship to orthopaedics and rheumatology. Pain is defined by the International Association for the Study of Pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. The talk will focus on the current published research in the areas pain, distraction and it’s relationship with orthopaedics and rheumatology. Dr. Sathi will talk about his related research work in the field of pain, neuro-oscillations and distraction. A brief review of the modern understanding of pain pathway will also be presented. The idea is to provide a snap shot of the current practice and thinking in this area as well as potentially enthuse the audience to think about ways of reducing pain and thus disability in our orthopaedic and rheumatology patient populations. Thus seeing pain as complementary, and not crowding, to our understanding of patients with orthopaedic and rheumatology problems.

  • Ultrasound, Imaging and Diagnostic Techniques
    Orthopedic Surgery and Orthopedic Trauma
    Musculoskeletal Outcomes: Theory and Practice
Speaker
Biography:

Miller completed his M.D. and Ph.D. degrees from SUNY-Downstate Medical Center and his clinical residency and post-doctoral fellowship training at UCLA School of Medicine. He currently is an Associate Professor in the Johns Hopkins Departments of Dermatology, Medicine (Division of Infectious Diseases) and Orthopaedic Surgery. He has published over 30 peer-reviewed manuscripts, including high impact publications in Immunity and Journal of Clinical Investigation. For more than 10 years, Dr. Miller has been a pioneer in utilizing in vivo whole animal optical (bioluminescence and fluorescence imaging), µCT and photoacoustic imaging to study infectious diseases, including orthopaedic implant infections.

Abstract:

Infection isa devastating complication following orthopaedic surgical procedures.Bacteria form biofilmson the implanted materials,creatingchronic infection and inflammation that leads to periprosthetic osteolysis, implant loosening and failure.These infections are challenging to diagnose and treatment is difficult and typically requiresreoperations, prolonged systemic antibiotic courses, extended disability and rehabilitation. To study the these infections, we developed a mouse model of an orthopaedic implant infectionin which a bioluminescent strain of Staphylococcus aureus was inoculated into a post-surgical knee joint of LysEGFP mice (expressing fluorescent neutrophils) that contained a titanium Kirschner-wire extending from the femur. In vivo bioluminescence and fluorescence imaging was used to noninvasivelyquantify the bacterial burden andneutrophil recruitment, respectively. We found that bioluminescent bacteria persisted for the 48 day experiment whereas EGFP-neutrophil signals decreasedwithin the first 14-21 days. Using µCT imaging, the outer bone volume of the femur doubled, which was associated with low-density signals and bone loss, consistent with peri-implant osteolysis.This model was used to evaluate optimal antibiotic combinations to treat an existing infection as well as the novel antimicrobial implant coatings. Finally,as a new diagnostic approach, near-infrared fluorescent probes were used in combination with advanced techniques of photoacoustic imaging. This imaging modalityhas the potential for clinical translation since photoacoustic signals can be detected several centimetersinto tissue. Taken together, bioluminescence, fluorescence, µCT and photoacoustic imaging represent valuable noninvasive techniques to study the pathogenesis of orthopaedic implant infections and to evaluate novel therapeutic and diagnostic strategies.

Speaker
Biography:

Artur Yudi Utino has completed his medical degree at Universidade Federal de São Paulo, Brazil, in 2011. Concluded his residency in orthopaedics surgery in 2015 and currently is doing a fellowship on Shoulder and Elbow Surgery. Completed his master’s degree in 2015 at the same university

Abstract:

Background: Despite the use of non-surgical methods to treat for the majority of mid-shaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function. Methods: We conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated non-surgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture mal-union. Information was also collected regarding the mechanism of injury, patient’s daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening. Results: Patients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD=0.64). There was no correlation between the degree of shortening and DASH score after six weeks and one year (p=0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change. Conclusion: We conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm.

Break: Coffee Break: 11:00-11:20 @ Foyer

Navtej Sathi

Forth Valley Royal Hospital, UK

Title: Musculoskeletal aspects of hypoadrenalism: Just a load of aches and pain?

Time : 11:20-11:45

Speaker
Biography:

Sathi is currently working as a consultant in Acute Medicine in Scotland. Previously he has previously held posts as a Consultant in Acute Medicine and Rheumatology. His interests include pain, integrated medicine, rheumatology, methotrexate side effects and interstitial lung disease. He holds an M.Sc. in Pain Management from Cardiff University. His research governance score (from Research Gate) is above 20, placing him in the top 30 percent in the world. His talk on musculoskeletal aspects of hypoadrenalism may provide some insight into how chronic disease can give rise to musculoskeletal symptoms and signs

Abstract:

Hypoadrenalism remains an underdiagnosed disease process. It’s musculoskeletal features are less well described in the literature when compared to diabetes or thyroid disorders. As a consequence considering hypoadrenalism in a patient with mainly musculoskeletal features may be difficult and delayed. The paper will include three cases from our own experience as well as all the relevant cases of hypoadrenalism in the English, French and Spanish language medical literature, going back to the time of Thomas Addison. There will be a summary of the relevant signs, symptoms and investigation findings which may help clinicians diagnose and treat this disease. Also the relationship of hypoadrenalism and chronic disease may be explored during the talk.

Renato A Sernik

Sirio Libanes Hospital, Brazil

Title: Update on the use of ultrasound in the diagnostic of carpal tunnel syndrome

Time : 11:45-12:10

Speaker
Biography:

Renato A Sernik is a Doctor and obtained his PhD from the University of Sao Paulo. He is a Radiologist at the Medical School Hospital of the University of SaoPaulo for 16 years. He is the author of some books “Ultrasound of the Musculoskeletal System (1999) and Ultrasound of the Musculoskeletal System-Correlation with MRI (2009)”, translated into Spanish and Italian. He is working as a Radiologist at the Sirio Libanes Hospital from 14 years.

Abstract:

Ultrasonography has become one of the main complementary tests for the diagnosis of carpal tunnel syndrome, especially in patients with a history of diseases that may be associated with peripheral neuropathy, such as diabetes mellitus, or in cases where the electroneuromyography is doubtful. The method has also been useful in patients with unsatisfactory results after surgical treatment, where fibrosis, adhesions and neuromas can be identified, having the advantage compared to MRI to be dynamic examination and lower cost. However, the method is operator-dependent with a longer learning curve. Between 2006 and 2014 we analyzed about 120 wrists of patients with clinical suspicion of carpal tunnel syndrome, with electroneuromyographic correlation, being part of the results published in the journal Skeletal Radiology (2008). The increase in cross-sectional area associated with the change in echotexture of the median nerve are the main criteria used for the diagnosis of carpal tunnel syndrome.

Speaker
Biography:

Adham Elgeidi has completed his MD at the age of 35 years from Mansoura University and postdoctoral studies from both Mansoura University School of Medicine, Egypt and Peninsula University School of Medicine, UK. He is currently a consultant and assistant professor of Orthopaedics and Trauma with special interest in sports medicine and arthroplasty. He is the director of Orthopaedics and Trauma undergraduate teaching and training program Mansoura University. He has published more than 20 papers in reputed journals and has been serving as an editorial board member of repute. He has supervised more than 15 MSc & MD thesis. He has presented more than 30 papers in different conferences. He used to work in Plymouth, UK (May 2003 to August 2006), Tuebingen, Germany (September 2005 to October 2005) and Bordeaux, France (March 2007).

Abstract:

Purpose: to evaluate diagnostic value of interleukin- 6 (IL-6) and other inflammatory markers; C- reactive protein (CRP), Erythrocyte sedimentation rate (ESR), and White blood cell count (WCC) in diagnosis of PJI. Methods: Study group included 40 patients (21 males, 19 females) admitted for surgical intervention after knee or hip arthroplasties. Patients were subjected to careful history taking, thorough clinical examination and preoperative laboratory investigations including serum IL-6, CRP, WCC and ESR. Peri-implant tissue specimens were subjected to microbiological culture and histopathological examination. Results: Mean age of studied patients was 58.4 years (range, 38-72 years). Intraoperative cultures and histopathological examination revealed 11 patients had been infected (PJI) and 29 patients were aseptic failure of prosthesis. Four presumed markers of infection were tested preoperatively: ESR; CRP; WCC; and IL-6. ESR (p=0.0001), CRP (p=0.004), WCC (0.0001), and IL-6 (p=0.0001) were significantly higher in patients with septic revision than those with aseptic failure of the prosthesis. Serum IL-6 (> 10.4pg/ml) reportedly had a sensitivity (100%), a specificity (90.9%), a PPV (79%), a NPV (100%), and accuracy (92.5%). Conclusions: The present study demonstrated that IL-6 has been found to be the most accurate laboratory marker for diagnosing PJI when compared to ESR, CRP, and WCC. IL-6 above 10.4 pg/ml and CRP level above 18 mg/L will identify all patients with PJI and the combination of CRP + IL-6 is an excellent screening test to identify all such patients (sensitivity 100%, NPV 100%).

Speaker
Biography:

Tesfaye Leta received BEd in Pedagogical Sciencefrom Bahir Dar University, Ethiopia in 1998, BSC inNursing from Bergen University College in 2008, andMPhil in International Health from University of Bergen in 2010. He is working as authorized nurse at the department of orthopeadic surgery, Haukeland University Hospital since 2010: Currently he is a PhD candidate atthe University of Bergen, Bergen,Norway since 2013. The title of his PhD project is Outcome of revision knee arthroplasty in Norway (1994-2011) with special focus on implants survival rate, risk of re-revision, pain, satisfaction, and health related quality of life.

Abstract:

Background: The general recommendation for a failed primary unicompartmental knee arthroplasty (UKA) is revision to a total knee arthroplasty (TKA). Many surgeons prefer to use UKAs in younger patients to postpone TKA believing that the results after revision from a UKA to a TKA is equal to a primary TKA and better than a revision TKA. For this to be true the rev-UKA should outperform the rev-TKA. The purpose of the present study was to compare the outcomes, surgical procedures, and mode of failure of failed primary UKAs and primary TKAs revised to TKAs. Method: The study was based on 768 failed primary TKAs revised to TKAs (rev-TKAs) and 578 failed primary UKAs revised to TKAs (rev-UKAs) and reported to the Norwegian Arthroplasty Register between 1994 and 2011. Patient-reported outcome measures (PROMs) including the EQ-5D, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and Visual Analogue Scales assessing satisfaction and pain were used. Kaplan-Meier and Cox-regression analyses were performed to assess the survival rate and the risk of re-revision. The independent student’s t-test and multiple linear regression were used to estimate the differences in mean scores in PROMs between the two groups. Results: Overall, 12% of rev-UKAs and 13% of rev-TKAs were re-revised between 1994 and 2011. The 10 years survival percentage of rev-UKAs vs rev-TKAs was 82 vs 81%, respectively (p=0.1). There was no difference in the overall risk of re-revision for rev-UKAs vs rev-TKAs (RR= 1.3; p=0.1), nor did we find any differences in the PROM scores. However, the risk of re-revision was 2 times higher for rev-TKA patients aged over 70 years (RR= 2.2; p=0.04). Loose tibia (28 vs 17%), pain alone (22 vs 12%), instability (19 vs 19%), and deep infection (16 vs 31%) were major causes of re-revision for rev-UKAs vs rev-TKAs, respectively but the observed differences were not statistically significant. The surgical procedure for rev-TKAs took longer time (mean=150 vs 114 minutes) and more of the operations needed stems (58 vs 19%), and stabilization (27 vs 9%) compared to rev-UKAs. Conclusion: Despite the surgical procedure of rev-TKA seeming technically more difficult compared to that of rev-UKA, the mode of failure and the overall outcome of rev-UKAs and rev-TKAs were similar. Thus, the argument that the outcome of revising UKA to TKA is similar to primary TKA could not be supported by the present study findings.

Cary Fletcher

St. Ann’s Bay Hospital, Jamaica

Title: Open locked nailing using an expandable nail: An alternative approach

Time : 13:50-14:15

Speaker
Biography:

Cary Fletcher completed his MBBS degree at University of the West Indies in 2001 and went on to complete his Doctorate in Orthopaedics in 2012, also at The University of the West Indies at the age of 37 years. He is now an Orthopaedic surgeon at St. Ann’s Bay Regional Hospital where he functions as the academic coordinator of the Orthopaedic service. As coordinator, he functions to moderate presentations at all levels of medical staff including residents, interns and student nurses and hence ensure continuing up to date medical education. Doctor Fletcher serves as one of the senior surgeons on the service in which the majority of cases involve Orthopaedic trauma. He is first author on two publications, fifth author on a third and first author on a case report which has been accepted for publication.

Abstract:

Objective: The main objective is to evaluate various outcomes of open intramedullary nailing using the Fixion expanding nail at our institution. Method: A retrospective study was performed using the hospital records. The mechanism of injury, the time between injury and surgery, blood transfusion requirements, blood loss, surgical times, time taken to weight bear (for the femoral/tibial fractures), time for commencement of upper limb use (for humeral fractures), complication rates and the average follow up times were documented. Fifty-seven Long bone fractures in 57 patients were included in this study. Complete results including preoperative X-Rays were available for 27 patients. In 30 cases, the actual X-Rays were not located but documentation by the treating surgeons was available. Results: There were 44 acute femoral fractures, 6 acute tibial fractures, 3 acute humeral fractures, 2 humeral nonunion, 1 tibial nonunion and 1 pathological femoral fracture. All patients achieved radiological union and the complication rates were deemed acceptable. Conclusion: Open intramedullary nailing using an expanding nail may be used for a variety of indications involving the humerus, tibia and femur.

Tariq Alotaibi

King Saud University, Saudi Arabia

Title: Thoracic vertebral hemangioma causing lower limb spastic paresis (case report)

Time : 14:15-14:40

Speaker
Biography:

Tariq alotaibi : medical student in the final year from king saud university ,riyadh saudi arabia . He is interested in orthopedic. Working on two different research projects in orthopedic.

Abstract:

In this paper we report a rare case of aggressive vertebral hemangioma in an 18-year old male presenting with paraparesis, disturbed sensations and spasticity. Vertebral hemangioma can present with wide variety of symptoms based on extension and compression of the spinal cord. It’s more common in adult. Radiological Imaging were diagnostic of vertebral hemangioma in the level of T8 involving the whole vertebral body. Patient was treated surgically and recovered completely. The clinical presentation, finding on radiological studies, and the management are discussed below.

Speaker
Biography:

Abed Abdel Latif Mohammed Al Negery is a medical Practitioner at Mansoura University hospital and Abed Orthopedic Center, Egypt. He is a professional member of Egyptian Orthopaedic Association and Egyptian Oncology Association.

Abstract:

Purpose: The purpose of this study was to evaluate the functional and oncologic results of fibular medialization when used along as a single-stage reconstructive technique after wide excision of malignant tumors of proximal, middle or distal tibia. Methods: Between December 2010 and May 2015, 14 patients (6 males and 8 females) with primary malignant tumors of the tibia (8 proximal, 4 diaphyseal, 2 distal) were treated by wide excision. The mean age of the patients at the time of surgery was 23.2 years (11 to 38). The fibula was mobilized medially with its vascular pedicle to fill the defect. The average size of the defects reconstructed was 19.5 cm (18 to 22). Full weight bearing was achieved at 6.2 months (range: 4 to 10) postoperatively. Patients were evaluated functionally using the Musculoskeletal Tumor Society evaluation system. Results: The mean follow-up period was 31.3 months (range: 17 to 54). The average time for complete union was 6.2 months (range: 4 to 10). At final follow up all patients had fully united grafts; 9 walked without aids. Chest metastases developed in one patient, superficial wound infection in one patient and leg length discrepancy in three patients. The mean Musculoskeletal Tumor Society Score was 23/30 points (76.5%). The minimum score was 40% and the maximum was 90%. Conclusion: Ipsilateral pedicled vascularized fibular centralization or medialization is a durable reconstruction for tibial defects after wide excision of bone tumors with an acceptable functional outcome. Stable osteo-synthesis is the key to union.

Garima Gupta

Saaii College of Medical Science and Technology, India

Title: Prevalence of musculoskeletal disorders in farmers of Kanpur-rural, India

Time : 15:05-15:30

Speaker
Biography:

Garima Gupta is result oriented physiotherapist. She is presently working as a Head of Department, Researcher and Assistant Professor in Saaii College of Medical Science and Technology, India. She has done her graduation from super specialty HOSMAT hospital Bangalore. In 2010 she completed her Masters in Physiotherapy (Neurology) from Indian Spinal Injury Center, New Delhi. She is actively involved in various ongoing research projects and has multiple international books and research publication in the field of physiotherapy. She actively contributes as reviewer for many international journals. She has also presented two papers in international conferences

Abstract:

Background: Musculoskeletal Disorders are prevalent and the impact is pervasive across a wide spectrum of occupations, as is evident from numerous studies conducted across the globe. However, there are very few studies that document the prevalence of MSDs in India, and there are hardly any studies that focus on the country’s farming community, which constitutes more than 58 percent of the Indian work force. Thus in the present study an attempt has been made to analyze the prevalence of MSDs in farmers of Kanpur-Rural, India. Methods: A sample of 300 farmers of Kanpur rural district, aged between 20-70 years, was selected. NMQ to measure the musculoskeletal disorders was given to all the farmers. Results: Analysis of data identified four most common MSD affecting the farmers of Kanpur-Rural: LBP (60%); knee pain (39%), shoulder pain (22%), and neck pain (10%). Conclusion: Finding of the present study shows that yearly prevalence of MSDs in farmers of Kanpur-Rural, India is alarmingly high and it suggests that nearly 60 percent of Indian cultivators could be afflicted by this disease, which urgently needs to be corroborated by similar studies at the national level. LBP is the most prevalent type of MSDs affecting the famers. Knee, shoulder and neck pain are other important MSDs affecting farmers in the study area.Observations made during the present study suggest that poor postures and lack of ergonomic awareness in the farming community are the two principal causative factors contributing to the development of MSDs.

Speaker
Biography:

Sameer Naranje has completed his fellowship in joint replacement and adult reconstructive surgery from University of Minnesota after completing his M.R.C.S from Royal College of Physicians and Surgeons, Glasgow and Orthopaedic Residency from prestigious All India Institute of Medical Sciences, New Delhi, India. He is currently Chief of Surgery and Orthopaedics at Helena Regional Medical Center, AR, USA and Consultant Orthopaedic Surgeon at East Arkansas Orthopaedic Associates, AR, USA. He has extensive research background, numerous conference presentations, has published more than 30 papers in reputed journals and has been serving as an editorial board member and reviewer of number of reputed Orthopaedic journals.

Abstract:

More than 2/3rd of patients of Rheumatoid arthritis (RA) become disabled 20 years from primary diagnosis. RA is one of the most common indications for lower limb joint replacement in Northern Europe and North America. Though improved medical treatment of RA over last 2 decades have decreased the rate of hip and knee surgery, over a third of patients will need a major joint replacement, of which the majority will receive a total hip or knee replacement (THR and TKR). This paper summarizes an update on the major lower limb arthroplasty surgery for patients with RA. A multidisciplinary approach is needed for preoperative optimization. RA patients may need joint replacement at relatively younger age when compared to the patients with osteoarthritis and may need mutilple revision surgeries over their lifespan. Patients should be made aware of this and increased risk of infection and periprosthetic fracture rates associated with their disease. Biologic agents should be stopped pre-operatively due the increased infection rate. However, continued use of methotrexate does not increase infection risk, and may infact be helpful in recovery. The surgical sequence is commonly hip, knee and then ankle. Cemented total hip replacement (THR) and total knee replacement (TKR) have superior survival rates over uncemented components. Achieving ligamentous balance may be challenging in knee replacements in these patients and more constrained implants may be needed in patients with poor ligaments and severe deformities. The evidence is not clear regarding a cruciate sacrificing versus retaining in TKR, but a cruciate sacrificing component limits the risk early instability and potential revision. The results of total ankle replacement remain inferior to THR and TKR though the science of ankle replacement continues to evolve. RA patients achieve equivalent pain relief after joint replacement, but their rehabilitation is slower and their functional outcome may not be optimum due to continued presence or worsening of the disease. Again, the key to managing these complicated patients is to work as part of a multidisciplinary team to optimize their outcome

Break: Coffee Break: 16:00-16:20 @ Foyer