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Friederike Lattig - One of the best experts on this subject based on the ideXlab platform.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient safety in surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient Safety in Surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety. Methods We conducted a retrospective analysis of a prospective database using a multiple choice questionnaire with 10 basic questions about anatomy, clinical symptoms and therapies of spinal diseases in our spine clinic at a German university hospital. Included were all patients at the spine clinic who agreed to the study and to fill in the questionnaire. Furthermore the patients age, mother tongue, the past spinal surgical history, the length of duration of symptoms and the patients education were inquired. The data were analyzed descriptive. Results Included were 248 patients with an average age of 59 years (16–88 a). 70 % of all patients used German as their mother tongue. 30 % of the included patients already had spinal surgery and suffered on average for 13.4 years because of their spinal disorder. Overall 32.6 % of all questions were answered correctly (range 0.8–68 %). A correlation of correctly answered questions and the patients’ age, duration of symptoms, mother tongue, education and past surgical history could not be described. Conclusion The percentage of correctly answered questions is almost as low as the likelihood of nearness in guessing. Having this in mind the patients do not choose any treatment option based on knowledge. The physicians need to provide more basic knowledge to the patients. This would increase the amount of successful therapies, content patients and the patients safety.
Sebastian Weckbach - One of the best experts on this subject based on the ideXlab platform.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient safety in surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient Safety in Surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety. Methods We conducted a retrospective analysis of a prospective database using a multiple choice questionnaire with 10 basic questions about anatomy, clinical symptoms and therapies of spinal diseases in our spine clinic at a German university hospital. Included were all patients at the spine clinic who agreed to the study and to fill in the questionnaire. Furthermore the patients age, mother tongue, the past spinal surgical history, the length of duration of symptoms and the patients education were inquired. The data were analyzed descriptive. Results Included were 248 patients with an average age of 59 years (16–88 a). 70 % of all patients used German as their mother tongue. 30 % of the included patients already had spinal surgery and suffered on average for 13.4 years because of their spinal disorder. Overall 32.6 % of all questions were answered correctly (range 0.8–68 %). A correlation of correctly answered questions and the patients’ age, duration of symptoms, mother tongue, education and past surgical history could not be described. Conclusion The percentage of correctly answered questions is almost as low as the likelihood of nearness in guessing. Having this in mind the patients do not choose any treatment option based on knowledge. The physicians need to provide more basic knowledge to the patients. This would increase the amount of successful therapies, content patients and the patients safety.
Heiko Reichel - One of the best experts on this subject based on the ideXlab platform.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient safety in surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient Safety in Surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety. Methods We conducted a retrospective analysis of a prospective database using a multiple choice questionnaire with 10 basic questions about anatomy, clinical symptoms and therapies of spinal diseases in our spine clinic at a German university hospital. Included were all patients at the spine clinic who agreed to the study and to fill in the questionnaire. Furthermore the patients age, mother tongue, the past spinal surgical history, the length of duration of symptoms and the patients education were inquired. The data were analyzed descriptive. Results Included were 248 patients with an average age of 59 years (16–88 a). 70 % of all patients used German as their mother tongue. 30 % of the included patients already had spinal surgery and suffered on average for 13.4 years because of their spinal disorder. Overall 32.6 % of all questions were answered correctly (range 0.8–68 %). A correlation of correctly answered questions and the patients’ age, duration of symptoms, mother tongue, education and past surgical history could not be described. Conclusion The percentage of correctly answered questions is almost as low as the likelihood of nearness in guessing. Having this in mind the patients do not choose any treatment option based on knowledge. The physicians need to provide more basic knowledge to the patients. This would increase the amount of successful therapies, content patients and the patients safety.
Tugrul Kocak - One of the best experts on this subject based on the ideXlab platform.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient safety in surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety.
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A survey on patients’ knowledge and expectations during informed Consent for spinal surgery: can we improve the shared decision-making process?
Patient Safety in Surgery, 2016Co-Authors: Sebastian Weckbach, Tugrul Kocak, Heiko Reichel, Friederike LattigAbstract:Background The informed Medical Consent in surgery requires to some point basic Medical knowledge. The treating physicians while explaining the details and risks of the recommended procedure often imply this. We hypothesized, that patients do not have adequate Medical understanding to decide about the ongoing therapy and its potential complications based on knowledge jeopardizing the patients’ safety. Methods We conducted a retrospective analysis of a prospective database using a multiple choice questionnaire with 10 basic questions about anatomy, clinical symptoms and therapies of spinal diseases in our spine clinic at a German university hospital. Included were all patients at the spine clinic who agreed to the study and to fill in the questionnaire. Furthermore the patients age, mother tongue, the past spinal surgical history, the length of duration of symptoms and the patients education were inquired. The data were analyzed descriptive. Results Included were 248 patients with an average age of 59 years (16–88 a). 70 % of all patients used German as their mother tongue. 30 % of the included patients already had spinal surgery and suffered on average for 13.4 years because of their spinal disorder. Overall 32.6 % of all questions were answered correctly (range 0.8–68 %). A correlation of correctly answered questions and the patients’ age, duration of symptoms, mother tongue, education and past surgical history could not be described. Conclusion The percentage of correctly answered questions is almost as low as the likelihood of nearness in guessing. Having this in mind the patients do not choose any treatment option based on knowledge. The physicians need to provide more basic knowledge to the patients. This would increase the amount of successful therapies, content patients and the patients safety.
Jason S. Haukoos - One of the best experts on this subject based on the ideXlab platform.
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Rapid HIV testing in an urban emergency department: using social workers to affect risk behaviors and overcome barriers.
Health & social work, 2009Co-Authors: Morgan Silverman, Kathryn Laperriere, Jason S. HaukoosAbstract:In the 27 years since HIV was first reported in the United States, an estimated 1.6 million people have been diagnosed with HIV, and more than 525,000 have died as a result of AIDS (Centers for Disease Control and Prevention [CDC], 2005). Currently, approximately 250,000 individuals in the United States are unknowingly infected with HIV, and approximately 40,000 new infections occur each year (CDC, 2006). As the HIV epidemic continues, the populations most deeply affected are racial and ethnic minorities and those who are socially and economically marginalized. These populations currently represent almost 70 percent of new cases of HIV infection (CDC, 2007). In addition to the disproportionate spread of HIV among these populations, access to primary and ongoing Medical or preventive care is often a financial or logistical impossibility. Emergency departments (EDs) serve as an important part of this country's Medical safety net, and those without access to primary Medical care commonly use EDs as their sole source of care. The ED, therefore, is often the only Medical venue available to target patients at increased risk of harboring unrecognized HIV infection, to identify those who are infected, and to link them into ongoing care. Successful performance of these services may ultimately affect this epidemic (Rothman, 2004). CDC RECOMMENDATIONS FOR HIV TESTING The CDC first released recommendations for performing HIV testing in health care settings in 1986, and in that document it encouraged voluntary HIV counseling and testing (CDC, 1986). Revised in 1993, the CDC recommendations focused further on the importance of prevention counseling--the process of engaging a patient in a discussion regarding HIV transmission and risk behaviors--and considered counseling a critical integrated component of testing (CDC, 1993). As the recommendations evolved, they continued to specifically advise that counseling be provided by a professional trained in HIV-specific counseling (CDC, 2001) and, until 2006, strongly endorsed the provision of counseling as part of HIV testing. To increase the absolute number of individuals tested for HIV infection and to minimize barriers associated with HIV testing, the CDC again revised its recommendations in September 2006. The most recent guidelines call for the following: incorporating nontargeted opt-out rapid HIV screening (that is, performing rapid HIV testing on all patients unless they specifically decline) into routine Medical practice, integrating informed Consent for HIV testing into the general Medical Consent (previously, separate informed Consent had been standard), and uncoupling prevention counseling from HIV testing (that is, instead of providing prevention counseling in all cases, prevention counseling is now only recommended for all patients who test positive for HIV infection) (CDC, 2006). STRATEGIES FOR PERFORMING HIV TESTING IN EDS Several distinct methods of performing HIV testing in EDs have been described and evaluated and include the following three: (1) identifying patients at increased risk of HIV infection and referring them from the ED for outpatient HIV counseling and testing; (2) performing conventional (nonrapid) HIV testing in the ED and referring the patients to obtain test results and counseling at an outpatient clinic; and (3) performing rapid HIV testing, in which patients are tested and receive test results during the same ED visit. Adherence rates with the former two methods are low, and therefore, various models of ED-based rapid HIV testing have been developed to determine how to most effectively test patients at risk of HIV infection. Current rapid HIV testing strategies in EDs have been described and include the following: diagnostic testing (that is, performing rapid HIV testing on the basis of a patient's clinical signs or symptoms), targeted screening (that is, performing rapid HIV testing on all patients with specific HIV-related risk characteristics), and nontargeted screening (that is, performing rapid HIV testing on all patients regardless of their risk characteristics) (Rothman, Lyons, & Haukoos, 2007). …
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Idealized models or incremental program evaluation: translating emergency department HIV testing into practice.
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2009Co-Authors: Jason S. Haukoos, Michael S. LyonsAbstract:As the human immunodeficiency virus (HIV) epidemic in the United States continues, it is estimated that over 1 million individuals are infected, and approximately 250,000 remain undiagnosed.1 Last year, the estimate of incidence was revised upward to approximately 56,000 new HIV infections annually.2 Past prevention efforts have been incompletely effective, and screening is increasingly recognized as a powerful prevention intervention.3, 4 Accordingly, in 2006 the Centers for Disease Control and Prevention (CDC) revised their recommendations for performing HIV testing in health care settings with significant focus on emergency departments (EDs).4 These recommendations called for performing nontargeted, opt-out, rapid HIV screening as an integrated part of Medical care for all patients aged 13 to 64 years in clinical settings where the estimated prevalence was 0.1% or higher. To overcome barriers to HIV screening, the CDC also recommended integrating Consent for HIV testing into the general Medical Consent process and uncoupling prevention counseling from testing. This multifaceted approach represents a dramatic paradigm shift and offers the promise of significantly changing the HIV testing landscape if it can be implemented in a widespread fashion.
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Patient Acceptance of Rapid HIV Testing Practices in an Urban Emergency Department : Assessment of the 2006 CDC Recommendations for HIV Screening in Health Care Settings
Annals of emergency medicine, 2008Co-Authors: Jason S. Haukoos, Emily Hopkins, Richard L. ByynyAbstract:Study objective The Centers for Disease Control and Prevention (CDC) recently released revised recommendations for HIV testing in health care settings, calling for the performance of nontargeted opt-out HIV screening, the integration of informed Consent for HIV testing into the general Consent for Medical care, and the uncoupling of prevention counseling and testing. It is unclear, however, whether patients will understand opt-out screening or be satisfied with integration of the Consent for HIV testing into the general Medical Consent or the uncoupling of counseling from testing. The objective of this study is to evaluate patients' acceptance of the CDC's revised recommendations in an urban emergency department (ED). Methods This was a cross-sectional survey study performed in the ED of an urban, public safety net hospital. The approximate annual ED census is 55,000 patients, and an approximate undiagnosed HIV seroprevalence ranges from 0.7% to 2.2%. A standardized survey instrument was developed and piloted and was then implemented with trained research assistants. Adult patients who were awake, alert, and agreed to participate in the study were included. Results During the 3-month study period, 529 patients were enrolled. The median age was 38 years (interquartile range 27 to 49 years; range 18 to 87 years), 57% were men, 48% were white, 28% were Hispanic, 18% were black, and 6% represented another race or ethnicity. When patients were asked whether they would have been tested had opt-out methodology been used, 81% (95% confidence interval [CI] 77% to 84%) would have agreed to be tested. When asked whether they would have been tested had opt-in methodology been used, there was no difference (absolute difference 0%; 95% CI –5% to 4%). However, explanation of opt-out screening was required for 11% (95% CI 8% to 14%), whereas explanation of opt-in screening was required for only 2% (95% CI 1% to 4%) (absolute difference 9%; 95% CI 5% to 11%). When asked whether the patient's physician recommended an HIV test during the ED visit, 93% (95% CI 91% to 95%) would have agreed to be tested. When asked whether Consent for HIV testing should be separate from Consent for general emergency Medical care, 50% (95% CI 46% to 54%) agreed. When asked whether counseling was necessary before performing an HIV test, 34% (95% CI 30% to 38%) agreed, and when asked whether counseling was necessary after receiving a negative HIV test result, 35% (95% CI 31% to 40%) agreed. Conclusion A large proportion of ED patients appear willing to be screened for HIV infection in accordance with the CDC's revised recommendations for HIV testing in health care settings. Similar proportions were willing to be tested when opt-out or opt-in screening strategies were used; however, a significantly greater proportion required explanation of opt-out screening.