The Experts below are selected from a list of 1602 Experts worldwide ranked by ideXlab platform
Armin Shahrokni - One of the best experts on this subject based on the ideXlab platform.
-
association of frailty with 90 day postoperative mortality geriatric Comanagement among older adults with cancer
Ejso, 2021Co-Authors: Sincere Mcmillan, Soo Jung Kim, Robert J Downey, Beatriz Korcgrodzicki, Amy Tin, Andrew J Vickers, Armin ShahrokniAbstract:INTRODUCTION Geriatric medical Comanagement of older surgical patients with cancer is associated with lower 90-day postoperative mortality. Here, we investigate the hypothesis that this association varies on the basis of the degree of a patient's frailty. METHODS Frailty was assessed using the Memorial Sloan Kettering Frailty Index. Our hypothesis was evaluated using two approaches, both adjusted for age, sex, American Society of Anesthesiologists Physical Status, preoperative albumin, operating room duration, and estimated blood loss. A logistic regression was performed with 90-day mortality as the outcome and geriatric Comanagement, continuous Memorial Sloan Kettering Frailty Index, and an interaction term between these two variables as the primary predictors. We then categorized frailty into four levels and, within each level, performed logistic regression with geriatric Comanagement as the primary predictor and 90-day mortality as the outcome. Finally, we extracted the effect size and used a meta-analytic approach to test for heterogeneity. RESULTS Of 1687 patients aged ≥75 years who underwent elective cancer surgery with a length of stay of ≥1 day, 931 (55%) received Comanagement; 31 patients (3.3%) who received Comanagement died within 90 days, compared with 72 (9.5%) who did not. Ninety-day mortality was not statistically significantly different by degree of frailty in either analysis (interaction P = 0.4; test of heterogeneity P = 0.8). CONCLUSION Geriatric Comanagement is valuable for all older surgical patients, not just the frail, and should be provided to as large a portion of the older surgical population as possible. Further research should examine predictors of response to geriatric Comanagement.
-
association of geriatric Comanagement and 90 day postoperative mortality among patients aged 75 years and older with cancer
JAMA Network Open, 2020Co-Authors: Armin Shahrokni, Saman Sarraf, Koshy Alexander, Soo Jung Kim, Heidi Yulico, Sincere Mcmillan, Amy Tin, Steve Sun, Farnia Amirnia, Robert J DowneyAbstract:Importance Collaboration between geriatricians and surgeons in the perioperative treatment of older patients has been associated with improved outcomes in several nononcologic specialties. Similar associations may be possible among older patients with cancer. Objective To investigate the associations of geriatric Comanagement of care for older patients undergoing cancer-related surgical treatment with 90-day postoperative mortality, rate of adverse surgical events, and postoperative use of inpatient supportive care services. Design, Setting, and Participants This retrospective cohort study assessed outcomes of patients who received geriatric comanaged care vs those who did not using multivariable logistic regression analysis, with 90-day mortality as the outcome and geriatric Comanagement of care as the main variable, with adjustment for age, sex, American Society of Anesthesiology score, Memorial Sloan Kettering Frailty Index score, preoperative albumin level, operative time, and estimated blood loss. A similar model was used to assess the association of geriatric Comanagement with adverse surgical events, defined as any major complication, readmission, or emergency department visit within 30 days. Patients aged 75 years and older who underwent an elective surgical procedure with a hospital stay of at least 1 day at a single tertiary-care cancer center between February 2015 and February 2018 were included. Data were analyzed from January to July 2019. Exposures Postoperative care comanaged by the geriatrics service and surgical service (geriatric Comanagement group) vs by the surgical service only (surgical service group). Main Outcomes and Measures 90-day mortality, adverse surgical events, and use of supportive care services. Results Of 1892 patients included, 1020 (53.9%) received geriatric Comanagement of care; these patients, compared with those who received care managed by the surgery service only, were older (mean [SD] age, 81 [4] years vs 80 [4] years;P Conclusions and Relevance This cohort study found that geriatric Comanagement was associated with significantly lower 90-day postoperative mortality among older patients with cancer. These findings suggest that such patients may benefit from geriatric Comanagement, which could improve their ability to survive adverse postoperative events.
-
reduced 90 day postoperative mortality through geriatric Comanagement after cancer surgery
Journal of Clinical Oncology, 2019Co-Authors: Armin Shahrokni, Saman Sarraf, Koshy Alexander, Soo Jung Kim, Heidi Yulico, Sincere Mcmillan, Robert J Downey, Amy Tin, Andrew J Vickers, Beatriz KorcgrodzickiAbstract:11512Background: We explored the association between geriatric Comanagement and 90-day postoperative mortality of cancer patients aged 75 or older. Methods: A retrospective review of a prospectivel...
-
geriatric Comanagement and surgical outcomes of older cancer patients
Journal of Clinical Oncology, 2018Co-Authors: Armin Shahrokni, Saman Sarraf, Koshy Alexander, Sung W Sun, Soo Jung Kim, Heidi Yulico, Sincere Mcmillan, Robert J Downey, Beatriz KorcgrodzickiAbstract:10035Background: Perioperative Geriatric Comanagement may improve surgical outcomes of older frail cancer patients. We present our 3 year experience with perioperative geriatric Comanagement & the ...
Tamara D Simon - One of the best experts on this subject based on the ideXlab platform.
-
pediatric hospital medicine role in the Comanagement of the hospitalized surgical patient
Pediatric Clinics of North America, 2014Co-Authors: Joshua K Schaffzin, Tamara D SimonAbstract:Medical Comanagement of surgical patients by pediatric hospital medicine providers has become increasingly common. Subjectively, the Comanagement model is superior to more traditional consultative models because of the anticipatory preventive care and coordination hospitalists provide to patients and hospital colleagues. Although some studies have demonstrated the value of the Comanagement model in adults and children, others have failed to do so. The coming years are both exciting and challenging for this emerging field as it attempts to sustain its early progress and define its future in pediatric hospital medicine.
-
how best to design surgical Comanagement services for pediatric surgical patients
Hospital pediatrics, 2013Co-Authors: Tamara D SimonAbstract:In this issue of Hospital Pediatrics , Dr David Rappaport and colleagues report on the outcomes and costs associated with implementation of a surgical hospitalist Comanagement service for medically complex children undergoing spine fusion surgery at Nemours/Alfred I. duPont Hospital for Children (duPont) that was started in September 2005.1 This report is of great personal interest because it is the first on the topic of pediatric hospitalist Comanagement of spine fusion surgery patients after our study at Children’s Hospital in Denver at the same time.2 Since then, a substantial number of surgical hospitalist Comanagement services have been initiated across the nation. Because very little evidence exists to guide the organization of such services, a diversity of approaches to Comanagement have been implemented. As with the program at duPont, numerous surgical hospitalist Comanagement services at tertiary care pediatric hospitals have been initiated after sentinel events. Although rare, sentinel events result in action and are frequently the most effective initiator for change in the real-world setting. However, the ability of these new services to reduce an already rare number of sentinel events is limited. Instead, we might expect surgical Comanagement …
-
pediatric hospitalist Comanagement of spinal fusion surgery patients
Journal of Hospital Medicine, 2007Co-Authors: Tamara D Simon, Robert Eilert, Miriam L Dickinson, Allison Kempe, Elise M Benefield, Stephen BermanAbstract:BACKGROUND: There are no published studies of hospitalist Comanagement of pediatric surgical patients. OBJECTIVES: (1) To describe Comanagement activities; (2) to determine the association of hospitalist Comanagement with length of stay (LOS) following spinal fusion surgery DESIGN: Retrospective analysis of the surgeons' log. SETTING: Tertiary-care pediatric hospital. PATIENTS: Patients who underwent initial spinal fusion surgery (n = 759) between July 2000 and October 2005. INTERVENTION: Hospitalist pre- and perioperative evaluation and management of medically complex patients (from December 2004 to October 2005). MEASUREMENTS: Log-transformed LOS and trend in LOS by piecewise regression were measured, adjusting for patient covariates and clustering by surgeon. RESULTS: After December 2004, 12% of all spinal fusion surgery patients (14 of 115) were comanaged by a hospitalist. Nine-three percent (13 of 14) of comanaged patients had neuromuscular scoliosis, and comanaged patients represented 37% (13 of 35) of all neuromuscular patients. Mean LOS for all spinal fusion surgeries decreased from 6.5 days (95% CI: 6.2–6.7) to 4.8 days (95% CI: 4.5–5.1) after December 2004. Mean LOS decreased more for neuromuscular patients (8.6 days [95% CI: 8.0– 9.2] to 6.2 days [95% CI: 5.5–6.9]) than for idiopathic patients (5.2 days [95% CI: 5.0–5.4] to 4.1 days [95% CI: 3.9–4.4]). Variability in LOS also decreased significantly for both groups. Prior to hospitalist Comanagement, there was no change in adjusted LOS over time. After December 2004, there was a significant decline in average adjusted LOS (neuromuscular slope = −0.23 to −0.31 days/month, P = .0075; idiopathic slope = −0.10 to −0.12 days/month; P = .0007). CONCLUSIONS: The introduction of selective hospitalist Comanagement of pediatric spinal fusion surgery patients was associated with significant decreases in LOS and variability in LOS. Journal of Hospital Medicine 2007;2:23–30. © 2007 Society of Hospital Medicine.
Beatriz Korcgrodzicki - One of the best experts on this subject based on the ideXlab platform.
-
association of frailty with 90 day postoperative mortality geriatric Comanagement among older adults with cancer
Ejso, 2021Co-Authors: Sincere Mcmillan, Soo Jung Kim, Robert J Downey, Beatriz Korcgrodzicki, Amy Tin, Andrew J Vickers, Armin ShahrokniAbstract:INTRODUCTION Geriatric medical Comanagement of older surgical patients with cancer is associated with lower 90-day postoperative mortality. Here, we investigate the hypothesis that this association varies on the basis of the degree of a patient's frailty. METHODS Frailty was assessed using the Memorial Sloan Kettering Frailty Index. Our hypothesis was evaluated using two approaches, both adjusted for age, sex, American Society of Anesthesiologists Physical Status, preoperative albumin, operating room duration, and estimated blood loss. A logistic regression was performed with 90-day mortality as the outcome and geriatric Comanagement, continuous Memorial Sloan Kettering Frailty Index, and an interaction term between these two variables as the primary predictors. We then categorized frailty into four levels and, within each level, performed logistic regression with geriatric Comanagement as the primary predictor and 90-day mortality as the outcome. Finally, we extracted the effect size and used a meta-analytic approach to test for heterogeneity. RESULTS Of 1687 patients aged ≥75 years who underwent elective cancer surgery with a length of stay of ≥1 day, 931 (55%) received Comanagement; 31 patients (3.3%) who received Comanagement died within 90 days, compared with 72 (9.5%) who did not. Ninety-day mortality was not statistically significantly different by degree of frailty in either analysis (interaction P = 0.4; test of heterogeneity P = 0.8). CONCLUSION Geriatric Comanagement is valuable for all older surgical patients, not just the frail, and should be provided to as large a portion of the older surgical population as possible. Further research should examine predictors of response to geriatric Comanagement.
-
reduced 90 day postoperative mortality through geriatric Comanagement after cancer surgery
Journal of Clinical Oncology, 2019Co-Authors: Armin Shahrokni, Saman Sarraf, Koshy Alexander, Soo Jung Kim, Heidi Yulico, Sincere Mcmillan, Robert J Downey, Amy Tin, Andrew J Vickers, Beatriz KorcgrodzickiAbstract:11512Background: We explored the association between geriatric Comanagement and 90-day postoperative mortality of cancer patients aged 75 or older. Methods: A retrospective review of a prospectivel...
-
geriatric Comanagement and surgical outcomes of older cancer patients
Journal of Clinical Oncology, 2018Co-Authors: Armin Shahrokni, Saman Sarraf, Koshy Alexander, Sung W Sun, Soo Jung Kim, Heidi Yulico, Sincere Mcmillan, Robert J Downey, Beatriz KorcgrodzickiAbstract:10035Background: Perioperative Geriatric Comanagement may improve surgical outcomes of older frail cancer patients. We present our 3 year experience with perioperative geriatric Comanagement & the ...
Ryan Plummer - One of the best experts on this subject based on the ideXlab platform.
-
diagnosing adaptive Comanagement across multiple cases
Ecology and Society, 2017Co-Authors: Ryan Plummer, Derek Armitage, Julia Baird, Orjan Bodin, Lisen SchultzAbstract:Adaptive Comanagement is at an important cross-road: different research paths forward are possible, and a diagnostic approach has been identified as a promising one. Accordingly, we operationalize ...
-
can adaptive Comanagement help to address the challenges of climate change adaptation
Ecology and Society, 2013Co-Authors: Ryan PlummerAbstract:A shift is taking place within environmental governance that draws attention to modes and instruments that respond to system dynamics, uncertainty, and contested values. Adaptive Comanagement is one process being advanced to make governance operational as it emphasizes collaboration among diverse actors, functions across scales and levels, and fosters learning though iterative feedback. Although extensive experience with adaptive Comanagement has been gained in relation to other environmental and resource issues, its potential contribution to the governance of adaption is largely unexplored. This paper probes how adaptive Comanagement might offer support to climate change adaptation and identifies gaps in knowledge requiring attention. In drawing upon existing literature and applied experiences, it is argued that adaptive Comanagement may contribute to climate change adaptation by building generalized adaptive capacity as well as providing a novel institutional arrangement to generate adaptive responses. At the same time, several questions emerge about adaptive Comanagement in this context. Considerations are thus discussed for adaptive Comanagement scholarship and application in addressing the challenge of climate change adaptation.
-
adaptive Comanagement and its relationship to environmental governance
Ecology and Society, 2013Co-Authors: Ryan Plummer, Derek Armitage, Rob C De LoeAbstract:We provide a systematic review of the adaptive Comanagement (ACM) literature to (i) investigate how the concept of governance is considered and (ii) examine what insights ACM offers with reference to six key concerns in environmental governance literature: accountability and legitimacy; actors and roles; fit, interplay, and scale; adaptiveness, flexibility, and learning; evaluation and monitoring; and, knowledge. Findings from the systematic review uncover a complicated relationship with evidence of conceptual closeness as well as relational ambiguities. The findings also reveal several specific contributions from the ACM literature to each of the six key environmental governance concerns, including applied strategies for sharing power and responsibility and value of systems approaches in understanding problems of fit. More broadly, the research suggests a dissolving or fuzzy boundary between ACM and governance, with implications for understanding emerging approaches to navigate social-ecological system change. Future research opportunities may be found at the confluence of ACM and environmental governance scholarship, such as identifying ways to build adaptive capacity and encouraging the development of more flexible governance arrangements.
-
adaptive Comanagement a systematic review and analysis
Ecology and Society, 2012Co-Authors: Ryan Plummer, Per Olsson, Beatrice Crona, Derek Armitage, Maria Tengo, Olga YudinaAbstract:This paper outlines the results of a systematic review of the literature on adaptive Comanagement (ACM). Adaptive Comanagement is an emergent governance approach for complex social-ecological systems that links the learning function of adaptive management (experimental and experiential) and the linking (vertically and horizontally) function of Comanagement. Given the rapid growth of adaptive Comanagement scholarship, there is value in a systematic analysis of how the concept is being conceptualized to elucidate agreement and discrepancies and to examine the challenges this presents for cross-case comparisons and the possibility of arriving at more generalizable insights. A synthesis-based methodology has been developed involving a comprehensive search and screening of academic databases and the internet. A detailed analysis of 108 documents was undertaken to characterize the state of the ACM literature, unpack the construct of ACM, and examine relationships among aspects of ACM based on accumulated experiences to date. The systematic review and analysis reveals imprecision, inconsistency, and confusion with the concept. Robust evidentiary insights into how the variables or components of ACM interrelate as well as relate to goals and outcomes are, therefore, presently not possible. These findings lead to the discussion of a series of challenges for ACM scholarship. Opportunities remain for ACM scholars to pursue theoretical development in rigorous ways that facilitate empirically based cross-site comparisons.
-
sharing the management of a river corridor a case study of the Comanagement process
Society & Natural Resources, 2006Co-Authors: Ryan PlummerAbstract:River corridors are of immense importance and increasingly coming under pressure for both in-stream and withdrawal uses. The dynamic character of these resources and the complex property regimes in which they are held present considerable challenges to resource managers. Comanagement is a novel approach for manaing river resources, consistent with the movement toward decentralized planning and a particular variant of collaboration. A case study of developing Comanagement in a Canadian river corridor is presented. Inductive analysis from the case study illuminates processes embedded within the phenomena and leads to the construction of a synthetic model of the Comanagement process. Undercurrents emerging throughout the analysis (communicative planing, social learning and adaptive management) and aspects requiring future research are reflected upon in the conclusion.
Lusine Poghosyan - One of the best experts on this subject based on the ideXlab platform.
-
nurse practitioner physician Comanagement of patients in primary care
Policy Politics & Nursing Practice, 2018Co-Authors: Allison A Norful, Mieke Van Derbiezen, Lusine PoghosyanAbstract:Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider Comanagement of the same patient has emerged in practice. Provider Comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician-physician Comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)-physician Comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP-physician Comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that Comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP-physician Comanagement. Physicians and NPs are optimistic about Comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP-physician Comanagement should be supported in clinical practice.
-
nurse practitioner physician Comanagement a theoretical model to alleviate primary care strain
Annals of Family Medicine, 2018Co-Authors: Allison A Norful, Krystyna De Jacq, Richard Carlino, Lusine PoghosyanAbstract:PURPOSE Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is Comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner–physician Comanagement. METHODS We conducted a literature search using the following key words: Comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner–physician Comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner–physician Comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner–physician Comanagement. Results were compiled to create our conceptual nurse practitioner–physician Comanagement model. RESULTS Our model of nurse practitioner–physician Comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful Comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. CONCLUSIONS Future research should focus on developing instruments to measure and further assess nurse practitioner–physician Comanagement in the primary care practice setting.
-
nurse practitioner physician Comanagement of primary care patients the promise of a new delivery care model to improve quality of care
Health Care Management Review, 2017Co-Authors: Allison A Norful, Kyleen Swords, Mickaela Marichal, Hwayoung Cho, Lusine PoghosyanAbstract:Background The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse practitioner (NP)-physician Comanagement of primary care patients has been proposed by some policy makers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP-physician Comanagement in primary care. Purpose This is the first review to synthesize all available studies that compare the effects of NP-physician Comanagement to an individual physician managing primary care. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed, and inclusion/exclusion criteria were applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black's quality checklist for randomized and nonrandomized studies. Results Six studies were identified for synthesis. Three outcome categories emerged: (a) primary care provider adherence to recommended care guidelines, (b) empirical changes in clinical patient outcomes, and (c) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP-physician Comanagement. There was variability of clinical patient outcomes with some findings favoring the Comanagement model. Limited differences in patient quality of life were found. Across all studies, the NP-physician Comanagementcare delivery model was determined to produce no detrimental effect on measured outcomes and, in some cases, was more beneficial in reaching practice and clinical targets. Practice implications The use of NP-physician Comanagement of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP-physician interactions and processes to isolate the attributes of a successful NP-physician Comanagement model.