scholarly journals Surgeon-driven preoperative psychiatric evaluation of plastic surgery patients

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Phillipa Van Essen ◽  
Natasha Keillor ◽  
Randall Long ◽  
Nicola Dean
Keyword(s):  
Plastic Surgery ◽  
Psychiatric Care ◽  
Clinical Decision Making ◽  
Body Dysmorphic Disorder ◽  
Elective Surgery ◽  
South Australia ◽  
Clinical Decision ◽  
Psychiatric Evaluation ◽  
Post Traumatic Stress ◽  
Select Group

Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates. Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery. Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes. Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical /psychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.

scholarly journals Dose response and working memory limit in an eye movement desensitisation and reprocessing prospective case series

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1471
Author(s):  
Alan Hassard ◽  
Heather Turner ◽  
Kathryn Smith
Keyword(s):  
Working Memory ◽  
Eye Movement ◽  
Common Ground ◽  
Clinical Decision Making ◽  
Case Series ◽  
Clinical Decision ◽  
Health Clinic ◽  
Post Traumatic Stress ◽  
Retrospective Case ◽  
Prospective Case Series

Background: Eye movement desensitization and reprocessing (EMDR) is a psychological therapy for post-traumatic stress disorder, or any disorder where the patient reports distressing imagery. We report here a prospective case series to test the prediction that the average number of distress images tends to seven. Methods: Patients in a sexual health clinic were offered EMDR treatment. In total, 130 were entered and 50 completed treatment. All distressing images to all bad life events and anxieties reported were treated. Images that caused high distress or stopped progressing were usually decomposed until progress resumed. Results: The median number of images per patient was seven. This required three treatment sessions in a total of five appointments, on average. This result was replicated twice in separate retrospective case series. Conclusion: We propose that EMDR works by unloading an overloaded memory buffer. If this bandwidth is liberated by treatment, this permits the cognitive and emotional change observed in EMDR treatment. The tendency to seven may signal involvement of the working memory limit. This approach enables clinical decision making and gives common ground with other psychotherapy methods.

scholarly journals Mining Major Transitions of Chronic Conditions in Patients with Multiple Chronic Conditions

2017 ◽  
Vol 56 (05) ◽  
pp. 391-400 ◽  
Author(s):  
Carlos A. Jaramillo ◽  
Syed H. A. Faruqui ◽  
Mary J. Pugh ◽  
Adel Alaeddini
Keyword(s):  
Risk Factors ◽  
Decision Making ◽  
Chronic Conditions ◽  
Clinical Decision Making ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Clinical Decision ◽  
Multiple Chronic Conditions ◽  
Post Traumatic Stress ◽  
Major Transitions

SummaryObjectives: Evolution of multiple chronic conditions (MCC) follows a complex stochastic process, influenced by several factors including the inter-relationship of existing conditions, and patient-level risk factors. Nearly 20% of citizens aged 18 years and older are burdened with two or more (multiple) chronic conditions (MCC). Treatment for people living with MCC currently accounts for an estimated 66% of the Nation’s healthcare costs. However, it is still not known precisely how MCC emerge and accumulate among individuals or in the general population. This study investigates major patterns of MCC transitions in a diverse population of patients and identifies the risk factors affecting the transition process.Methods: A Latent regression Markov clustering (LRMCL) algorithm is proposed to identify major transitions of four MCC that include hypertension (HTN), depression, Post- Traumatic Stress Disorder (PTSD), and back pain. A cohort of 601,805 individuals randomly selected from the population of Iraq and Afghanistan war Veterans (IAVs) who received VA care during three or more years between 2002-2015, is used for training the proposed LRMCL algorithm.Results: Two major clusters of MCC transition patterns with 78% and 22% probability of membership respectively were identified. The primary cluster demonstrated the possibility of improvement when the number of MCC is small and an increase in probability of MCC accumulation as the number of co- morbidities increased. The second cluster showed stability (no change) of MCC overtime as the major pattern. Age was the most significant risk factor associated with the most probable cluster for each IAV.Conclusions: These findings suggest that our proposed LRMCL algorithm can be used to describe and understand MCC transitions, which may ultimately allow healthcare systems to support optimal clinical decision- making. This method will be used to describe a broader range of MCC transitions in this and non-VA populations, and will add treatment information to see if models including treatments and MCC emergence can be used to support clinical decision-making in patient care.

scholarly journals Use of an innovative syringe pump to deliver bolus rFVIIa for patients with haemophilia and inhibitors undergoing surgery

2017 ◽  
Vol 4 (1) ◽  
pp. 35-39
Author(s):  
Debra Pollard ◽  
Barbara Subel ◽  
Pratima Chowdary ◽  
Keith Gomez
Keyword(s):  
Clinical Decision Making ◽  
Elective Surgery ◽  
Infusion Pump ◽  
Clinical Decision ◽  
Severe Haemophilia ◽  
Syringe Pump ◽  
Nursing Time ◽  
Rfviia Administration ◽  
Syringe Driver ◽  
Efficacy Criteria

Abstract Aim: To evaluate the efficacy and safety of using a syringe driver perfusor pump to deliver frequent regular bolus doses of rFVIIa peri- and postoperatively to patients with severe haemophilia and inhibitors. Background: The provision of surgical haemostatic coverage with rFVIIa requires regular bolus doses, initially every two hours and subsequently three-hourly, moving to four- to six-hourly post-operatively. This has implications for safety and nursing time, and can influence clinical decision-making. We investigated the use of an infusion pump to deliver timed and accurate rFVIIa bolus doses during the postoperative period. Methods: Two patients with severe haemophilia A and inhibitors undergoing three procedures were managed with a pre-surgical bolus infusion of 120mcg/kg of rFVIIa, followed by postoperative doses of 90mcg/kg every two hours for the first 72 hours, and every three hours subsequently, with increasing dose intervals thereafter. All postoperative bolus doses were delivered via a pre-programmed infusion pump. The pump also required a constant background infusion set at 0.1ml/ hour for the first patient, and reduced to 0.01ml/hour for the second patient. Results: The pump was simple to use and readily accepted by patients and nursing staff. There were no delayed or missed doses, and good haemostasis was maintained. Overall nursing time involved in reconstituting and administering rFVIIa was reduced from three to six hours per treatment day (with conventional bolus dosing) to just one to two hours per day with the pump. Conclusions: The syringe pump successfully delivered the correct doses at the specified time intervals for all three procedures. The technique met the centre’s safety and efficacy criteria and resulted in a significant reduction in the amount of nursing time needed over a 24-hour period. This novel method of rFVIIa administration appears to be safe and effective in the elective surgery setting, and should be further investigated.

scholarly journals Usefulness of a radial applanation tonometry device in blood pressure related clinical decision making by anesthesiologists

2020 ◽  
Author(s):  
Xiaoshuang Zhou ◽  
Bin Liu ◽  
Haidan Lan ◽  
Jin Liu ◽  
Xiao Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Elective Surgery ◽  
Clinical Decision ◽  
Applanation Tonometry ◽  
Percentage Error ◽  
Arterial Blood ◽  
Efficient Information ◽  
The Right

Abstract Purpose: Radial artery tonometry (AT) can continuously measure arterial blood pressure (ABP) noninvasively. This study aimed to evaluate AT for continuous ABP monitoring during anesthesia and compared AT to invasive (IBP) and non-invasive (NIBP) ABP measurements at clinical decision-making moments. Methods: 243 patients undergoing elective surgery were prospectively included in the study and AT was applied on the right or left arm while IBP and NIBP were recorded simultaneously. At moments when the IBP signal required a clinical decision by the anesthesiologist for situations of hyper- or hypotension, comparison was made whether AT and NIPB signals would require a clinical decision as well. Agreement/discrepancy of clinical decision-making was analyzed, additionally bias, precision, and percentage error of AT was compared to IBP at these moments. Results: 513 clinical decision moments were recorded. Decision moments based on AT signal did not differ significantly from decision moments based on IBP (1 vs. 1; IQR, 1 – 2 vs. 0 – 3, P = 0.06), while NIBP based decision moments showed significant differences (0 vs. 1; IQR, 0 – 2 vs. 0 – 3, P＜0.001). Subgroup analysis of patients divided by age, BMI and surgery time also showed no significant differences between IBP and AT. Conclusions: ABP measurement using AT is feasible and safe. AT provides relevant and efficient information to anesthesiologists; at moments when IBP called for action, AT called for action as well, but not NIBP. AT also showed clinically satisfactory agreement with IBP at moments of hypo- and hypertension.

scholarly journals Usefulness of a radial applanation tonometry device in blood pressure related clinical decision making by anesthesiologists

2019 ◽  
Author(s):  
Guo Chen ◽  
Xiaoshuang Zhou ◽  
Bin Liu ◽  
Haidan Lan ◽  
Jin Liu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Elective Surgery ◽  
Clinical Decision ◽  
Applanation Tonometry ◽  
Percentage Error ◽  
Arterial Blood ◽  
Efficient Information ◽  
The Right

Abstract Purpose: Radial artery tonometry (AT) can continuously measure arterial blood pressure (ABP) noninvasively. This study aimed to evaluate AT for continuous ABP monitoring during anesthesia and compared AT to invasive (IBP) and non-invasive (NIBP) ABP measurements at clinical decision-making moments. Methods: 243 patients undergoing elective surgery were prospectively included in the study and AT was applied on the right or left arm while IBP and NIBP were recorded simultaneously. At moments when the IBP signal required a clinical decision by the anesthesiologist for situations of hyper- or hypotension, comparison was made whether AT and NIPB signals would require a clinical decision as well. Agreement/discrepancy of clinical decision-making was analyzed, additionally bias, precision, and percentage error of AT was compared to IBP at these moments. Results: 513 clinical decision moments were recorded. Decision moments based on AT signal did not differ significantly from decision moments based on IBP (1 vs. 1; IQR, 1 – 2 vs. 0 – 3, P = 0.06), while NIBP based decision moments showed significant differences (0 vs. 1; IQR, 0 – 2 vs. 0 – 3, P＜0.001). Subgroup analysis of patients divided by age, BMI and surgery time also showed no significant differences between IBP and AT. Conclusions: ABP measurement using AT is feasible and safe. AT provides relevant and efficient information to anesthesiologists; at moments when IBP called for action, AT called for action as well, but not NIBP. AT also showed clinically satisfactory agreement with IBP at moments of hypo- and hypertension.

Preliminary Findings on the Use of Session Questionnaires to Improve Clinician-Client Alliance With Special Consideration to Clinical Education

2015 ◽  
Vol 25 (1) ◽  
pp. 50-60
Author(s):  
Anu Subramanian
Keyword(s):  
Graduate Students ◽  
Clinical Education ◽  
Clinical Decision Making ◽  
Rating Scale ◽  
Treatment Effectiveness ◽  
Clinical Decision ◽  
Added Value ◽  
Therapeutic Outcomes ◽  
Specific Feedback ◽  
Stakeholder Perspective

ASHA's focus on evidence-based practice (EBP) includes the family/stakeholder perspective as an important tenet in clinical decision making. The common factors model for treatment effectiveness postulates that clinician-client alliance positively impacts therapeutic outcomes and may be the most important factor for success. One strategy to improve alliance between a client and clinician is the use of outcome questionnaires. In the current study, eight parents of toddlers who attended therapy sessions at a university clinic responded to a session outcome questionnaire that included both rating scale and descriptive questions. Six graduate students completed a survey that included a question about the utility of the questionnaire. Results indicated that the descriptive questions added value and information compared to using only the rating scale. The students were varied in their responses regarding the effectiveness of the questionnaire to increase their comfort with parents. Information gathered from the questionnaire allowed for specific feedback to graduate students to change behaviors and created opportunities for general discussions regarding effective therapy techniques. In addition, the responses generated conversations between the client and clinician focused on clients' concerns. Involving the stakeholder in identifying both effective and ineffective aspects of therapy has advantages for clinical practice and education.

Clinical Decision-Making for Stroke and Aphasia in the Older Adult

2009 ◽  
Vol 14 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Jacqueline Hinckley
Keyword(s):  
Executive Function ◽  
Cerebrovascular Disease ◽  
Cognitive Abilities ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cognitive Profile ◽  
Focal Lesion ◽  
Cognitive Profiles ◽  
Supportive Communication ◽  
Spaced Retrieval

Abstract A patient with aphasia that is uncomplicated by other cognitive abilities will usually show a primary impairment of language. The frequency of additional cognitive impairments associated with cerebrovascular disease, multiple (silent or diagnosed) infarcts, or dementia increases with age and can complicate a single focal lesion that produces aphasia. The typical cognitive profiles of vascular dementia or dementia due to cerebrovascular disease may differ from the cognitive profile of patients with Alzheimer's dementia. In order to complete effective treatment selection, clinicians must know the cognitive profile of the patient and choose treatments accordingly. When attention, memory, and executive function are relatively preserved, strategy-based and conversation-based interventions provide the best choices to target personally relevant communication abilities. Examples of treatments in this category include PACE and Response Elaboration Training. When patients with aphasia have co-occurring episodic memory or executive function impairments, treatments that rely less on these abilities should be selected. Examples of treatments that fit these selection criteria include spaced retrieval and errorless learning. Finally, training caregivers in the use of supportive communication strategies is helpful to patients with aphasia, with or without additional cognitive complications.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

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