The Experts below are selected from a list of 234870 Experts worldwide ranked by ideXlab platform

Nicolas Hariton - One of the best experts on this subject based on the ideXlab platform.

Kenneth Locke - One of the best experts on this subject based on the ideXlab platform.

Emily Hladkowicz - One of the best experts on this subject based on the ideXlab platform.

  • evaluation of a preoperative personalized risk Communication Tool a prospective before and after study
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2020
    Co-Authors: Emily Hladkowicz, David Yachnin, Laura Boland, Kumanan Wilson, Annette Mckinnon
    Abstract:

    PURPOSE Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk Communication Tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. METHODS We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application's materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. RESULTS We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (- 1.9%; 95% CI, - 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. CONCLUSION Exposure to a patient-facing, personalized risk Communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. TRIAL REGISTRATION www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.

  • Evaluation of a preoperative personalized risk Communication Tool: a prospective before-and-after study
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2020
    Co-Authors: Emily Hladkowicz, David Yachnin, Laura Boland, Kumanan Wilson, Annette Mckinnon, Kira Hawrysh, Terry Hawrysh, Cameron Bell, Katherine Atkinson, Carl Walraven
    Abstract:

    Objectif Les patients veulent disposer d’informations personnalisées avant leur chirurgie, mais la plupart d’entre eux ne reçoivent pas d’estimations de leur risque personnalisées. Des informations inadéquates contribuent à une mauvaise expérience et à des plaintes médicolégales. Nous avons émis l’hypothèse qu’une exposition à l’application PREDICT ( Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment ), un outil de Communication du risque personnalisé, améliorerait les connaissances et la satisfaction des patients après leurs consultations en anesthésiologie comparativement à des soins standard. Méthode Nous avons réalisé une étude clinique prospective (de type avant-après) et utilisé les données rapportées par les patients afin de calculer leur risque personnalisé de morbidité et de mortalité, ainsi que la durée de séjour anticipée à l’aide d’un calculateur de risque tiré du Programme national d’amélioration de la qualité chirurgicale que nous avons calibré localement et intégré à l’application PREDICT. Dans la phase de soins standard (avant), le contenu et les résultats de l’application n’étaient pas divulgués aux participants; dans la phase comportant l’application PREDICT (après), les risques personnalisés étaient communiqués. Notre critère d’évaluation principal était le score des connaissances des patients après la consultation en anesthésiologie. Les critères d’évaluation secondaires comprenaient la satisfaction des patients et leur niveau d’anxiété ainsi que la faisabilité et l’acceptabilité d’une telle approche. Résultats Nous avons inclus 183 participants (90 avant; 93 après). Comparativement à la phase de soins standard, la phase avec l’application PREDICT a démontré un niveau plus élevé de connaissances des risques post consultation (14,3 % plus élevé; intervalle de confiance [IC] 95 %, 6,5 à 22,0; P < 0,001) et de satisfaction (0,8 point; IC 95 %, 0,1 à 1,4; P = 0,03). L’anxiété est demeurée inchangée (− 1,9 %; IC 95 %, − 4,2 à 0,5; P = 0,13). L’acceptabilité était élevée, tant chez les patients que chez les anesthésiologistes. Conclusion L’exposition des patients à une application de Communication du risque personnalisé a amélioré leurs connaissances de leur risque personnalisé et augmenté la satisfaction des adultes avant une chirurgie non urgente et non ambulatoire. Enregistrement de l’étude www.clinicaltrials.gov (NCT03422133); enregistrée le 5 février 2018. Purpose Patients want personalized information before surgery; most do not receive personalized risk estimates. Inadequate information contributes to poor experience and medicolegal complaints. We hypothesized that exposure to the Personalized Risk Evaluation and Decision Making in Preoperative Clinical Assessment (PREDICT) app, a personalized risk Communication Tool, would improve patient knowledge and satisfaction after anesthesiology consultations compared with standard care. Methods We conducted a prospective clinical study (before-after design) and used patient-reported data to calculate personalized risks of morbidity, mortality, and expected length of stay using a locally calibrated National Surgical Quality Improvement Program risk calculator embedded in the PREDICT app. In the standard care (before) phase, the application’s materials and output were not available to participants; in the PREDICT app (after) phase, personalized risks were communicated. Our primary outcome was knowledge score after the anesthesiology consultation. Secondary outcomes included patient satisfaction, anxiety, feasibility, and acceptability. Results We included 183 participants (90 before; 93 after). Compared with standard care phase, the PREDICT app phase had higher post-consultation: knowledge of risks (14.3% higher; 95% confidence interval [CI], 6.5 to 22.0; P < 0.001) and satisfaction (0.8 points; 95% CI, 0.1 to 1.4; P = 0.03). Anxiety was unchanged (− 1.9%; 95% CI, − 4.2 to 0.5; P = 0.13). Acceptability was high for patients and anesthesiologists. Conclusion Exposure to a patient-facing, personalized risk Communication app improved knowledge of personalized risk and increased satisfaction for adults before elective inpatient surgery. Trial registration www.clinicaltrials.gov (NCT03422133); registered 5 February 2018.

Margaret L Schwarze - One of the best experts on this subject based on the ideXlab platform.

  • best case worst case training surgeons to use a novel Communication Tool for high risk acute surgical problems
    Journal of Pain and Symptom Management, 2017
    Co-Authors: Jacqueline M Kruser, Michael J Nabozny, Nicole M Steffens, Toby C Campbell, Lauren J Taylor, Amy Zelenski, Sara K Johnson, Jennifer L Tucholka, Kris L Kwekkeboom, Margaret L Schwarze
    Abstract:

    Abstract Context Older adults often have surgery in the months preceding death, which can initiate postoperative treatments inconsistent with end-of-life values. "Best Case/Worst Case" (BC/WC) is a Communication Tool designed to promote goal-concordant care during discussions about high-risk surgery. Objective The objective of this study was to evaluate a structured training program designed to teach surgeons how to use BC/WC. Methods Twenty-five surgeons from one tertiary care hospital completed a two-hour training session followed by individual coaching. We audio-recorded surgeons using BC/WC with standardized patients and 20 hospitalized patients. Hospitalized patients and their families participated in an open-ended interview 30 to 120 days after enrollment. We used a checklist of 11 BC/WC elements to measure Tool fidelity and surgeons completed the Practitioner Opinion Survey to measure acceptability of the Tool. We used qualitative analysis to evaluate variability in Tool content and to characterize patient and family perceptions of the Tool. Results Surgeons completed a median of 10 of 11 BC/WC elements with both standardized and hospitalized patients (range 5–11). We found moderate variability in presentation of treatment options and description of outcomes. Three months after training, 79% of surgeons reported BC/WC is better than their usual approach and 71% endorsed active use of BC/WC in clinical practice. Patients and families found that BC/WC established expectations, provided clarity, and facilitated deliberation. Conclusions Surgeons can learn to use BC/WC with older patients considering acute high-risk surgical interventions. Surgeons, patients, and family members endorse BC/WC as a strategy to support complex decision making.

  • best case worst case qualitative evaluation of a novel Communication Tool for difficult in the moment surgical decisions
    Journal of the American Geriatrics Society, 2015
    Co-Authors: Jacqueline M Kruser, Michael J Nabozny, Nicole M Steffens, Karen J Brasel, Toby C Campbell, Martha E Gaines, Margaret L Schwarze
    Abstract:

    Objectives To evaluate a Communication Tool called “Best Case/Worst Case” (BC/WC) based on an established conceptual model of shared decision-making. Design Focus group study. Setting Older adults (four focus groups) and surgeons (two focus groups) using modified questions from the Decision Aid Acceptability Scale and the Decisional Conflict Scale to evaluate and revise the Communication Tool. Participants Individuals aged 60 and older recruited from senior centers (n = 37) and surgeons from academic and private practices in Wisconsin (n = 17). Measurements Qualitative content analysis was used to explore themes and concepts that focus group respondents identified. Results Seniors and surgeons praised the Tool for the unambiguous illustration of multiple treatment options and the clarity gained from presentation of an array of treatment outcomes. Participants noted that the Tool provides an opportunity for in-the-moment, preference-based deliberation about options and a platform for further discussion with other clinicians and loved ones. Older adults worried that the format of the Tool was not universally accessible for people with different educational backgrounds, and surgeons had concerns that the Tool was vulnerable to physicians’ subjective biases. Conclusion The BC/WC Tool is a novel decision support intervention that may help facilitate difficult decision-making for older adults and their physicians when considering invasive, acute medical treatments such as surgery.

Netta Bentur - One of the best experts on this subject based on the ideXlab platform.

  • Implementation of a structured Communication Tool improves family satisfaction and expectations in the intensive care unit.
    Journal of Critical Care, 2019
    Co-Authors: Sigal Sviri, Peter Vernon Vanheerden, Marc Romain, Hashem Rawhi, Avraham Abutbul, Efrat Orenbuch-harroch, Dekel Geva, Netta Bentur
    Abstract:

    Abstract Background Intensive care unit (ICU) physicians should provide relatives of critically ill patients with appropriate and clear information, regarding prognosis, treatment options and expectations. Objectives To assess whether a structured Communication Tool improves satisfaction with care and engenders realistic expectations among relatives of critically ill patients. Study design A controlled, pre-post intervention design was implemented in the General and Medical ICUs in the Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Methods Forty relatives of patients who received usual Communication from the medical staff (control group) were interviewed. We then implemented a structured Communication Tool and another forty family members were interviewed (intervention group). The ICU physicians who participated in the family meeting were also interviewed. Results Satisfaction in the intervention group was higher regarding ease of obtaining the information (90% vs 70%, p = .025) and the consistency of information provided (92.5% vs 77.5%, p = .057). There was better correlation between physicians' and relatives' expectations in the intervention group regarding hospital survival (Kappa 0.322 vs 0.054, p = .01). Physicians predicted more accurately patients' actual hospital survival. Conclusions A structured Communication Tool was associated with improved family satisfaction with Communication and expectations regarding hospital survival. Further research is required to evaluate this promising intervention.