Bradley Kushner
31 statements · 1 topic
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what we've actually found is that the most important parts of the aid was, was not actually going through all the decision-making with them, but actually having it written down. Um, for the patient itself so that they could take home and they could discuss with their loved ones.
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Umbilical Hernia
Shared decision making defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences is ideally suited to the complex abdominal wall surgery.
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Umbilical Hernia
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Bradley's statements about Umbilical Hernia 31 statements
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Best of the Best Gen Surg - Pilot Randomized Control Trial Evaluating the Use of a Shared Decision Making Aid for Older Ventral Hernia Patients - Dr. Kushner
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Phase 2 of the longitudinal geriatric assessment and medical perspective screening, the GRMS program. That's what my grandchildren call me.
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The novel shared decision-making tool was designed based on the Agency for Healthcare Research and Quality suggested framework and included 5 key parts.
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The tool was designed to be completed in real time during patient consultation and to act as a living document that patients could reference and bring to their surgery date or subsequent appointments.
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75% of patients in the experimental group perceived their visit as shared decision making as compared to only 50% in the control group when using the collaborate scale.
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There was a meaningful clinical decrease in the decisional conflict of patients in the experimental group, with a difference of 6 points on the decisional conflict scale.
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Previous groups have found that for every point decrease on the decisional conflict scale, there was an associated 19% less likelihood to blame doctors for poorer outcomes.
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The two most important treatment goals identified by patients in the experimental group were improving quality of life and preventing hernia recurrence.
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Only 1 patient in the experimental group had previously discussed their code status with their doctor, and only 33% had a documented power of attorney.
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100% of patients in the experimental group both enjoyed the shared decision making aid and found it to be a useful exercise when asked about it on exit interview.
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By the year 2050, the number of adults 60 years of age or older will at least double.
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Shared decision making defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences is ideally suited to the complex abdominal wall surgery.
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Unfortunately, surgeons often struggle to perceive and to incorporate shared decision making into their practice.
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By the year 2050, the number of adults 60 years of age or older will at least double.
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During the 4 month trial enrollment period, 18 patients were consented and randomized, half to each of the experimental and control groups, with overall recruitment percentage greater than 95%.
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There was higher retention of key hernia knowledge in the experimental group when patients were given a follow-up hernia quiz one week after the initial consultation.
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Age-related risk factors and morbidities have been shown to predict mortality and morbidity following ventral hernia repair.
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Patients were excluded if they were deemed to be a non-operative candidate despite potential future prehabilitation options or who had a documented history of cognitive impairment.
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Shared decision making is defined as care that is evidence informed, respectful, and responsive to an individual patient's preferences.
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In phase 1 of the GRAMPS program, age-related risk factors in the elective hernia population were demonstrated to be both common and present a real challenge to the hernia surgeon.
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there's so much to discuss with the patient and so many different options in hernia surgery that we can go so many different ways.
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For a 60-year-old gentleman with a primary 4 centimeter ventral hernia or primary umbilical hernia, asking 10 hernia surgeons might yield 10 different repair approaches.
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Different hernia repair approaches have potential for different quality of life outcomes for the patient in terms of operation size, percentage of hernia recurrence, and potential options for the future.
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It is unknown whether an IPOM repair is any different long term than a retromuscular repair.
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is, is an iPod. Um, any different long term than, uh, you know, uh, a retromuscular repair. We, you know, we don't really know.
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The most important parts of the shared decision-making aid were not actually going through all the decision-making with patients, but having it written down for the patient to take home and discuss with loved ones.
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A condensed form of the shared decision-making aid is currently being tested in another randomized controlled trial.
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what we've actually found is that the most important parts of the aid was, was not actually going through all the decision-making with them, but actually having it written down. Um, for the patient itself so that they could take home and they could discuss with their loved ones.
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