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Perioperative Research

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124 papers 100 to 500 followers
By Ron George Anesthesiologist with special interests in Obstetrics, Pain, and Global Health
https://www.readbyqxmd.com/read/29452519/patient-engagement-in-clinical-trials-the-clinical-trials-transformation-initiative-s-leadership-from-theory-to-practical-implementation
#1
Bray Patrick-Lake
Patient engagement is an increasingly important aspect of successful clinical trials. Over the past decade, as patient group involvement in clinical trials has continued to increase and diversify, the Clinical Trials Transformation Initiative has not only recognized the crucial role patients play in improving the clinical trial enterprise but also made a deep commitment to help grow and shape the emerging field of patient engagement. This article describes the evolution of patient engagement including the origins of the patient engagement movement; barriers to successful engagement and remaining challenges to full and valuable collaboration between patient groups and trial sponsors; and Clinical Trials Transformation Initiative's role in influencing the field through organizational practices, formal project work and resulting recommendations, and external advocacy efforts...
February 2018: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/29411037/guidelines-for-inclusion-of-patient-reported-outcomes-in-clinical-trial-protocols-the-spirit-pro-extension
#2
Melanie Calvert, Derek Kyte, Rebecca Mercieca-Bebber, Anita Slade, An-Wen Chan, Madeleine T King, Amanda Hunn, Andrew Bottomley, Antoine Regnault, An-Wen Chan, Carolyn Ells, Daniel O'Connor, Dennis Revicki, Donald Patrick, Doug Altman, Ethan Basch, Galina Velikova, Gary Price, Heather Draper, Jane Blazeby, Jane Scott, Joanna Coast, Josephine Norquist, Julia Brown, Kirstie Haywood, Laura Lee Johnson, Lisa Campbell, Lori Frank, Maria von Hildebrand, Michael Brundage, Michael Palmer, Paul Kluetz, Richard Stephens, Robert M Golub, Sandra Mitchell, Trish Groves
Importance: Patient-reported outcome (PRO) data from clinical trials can provide valuable evidence to inform shared decision making, labeling claims, clinical guidelines, and health policy; however, the PRO content of clinical trial protocols is often suboptimal. The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement was published in 2013 and aims to improve the completeness of trial protocols by providing evidence-based recommendations for the minimum set of items to be addressed, but it does not provide PRO-specific guidance...
February 6, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29361334/progress-in-clinical-research-in-surgery-and-ideal
#3
Peter McCulloch, Joshua Feinberg, Yiannis Philippou, Angelos Kolias, Sean Kehoe, Gillian Lancaster, Jenny Donovan, Tatjana Petrinic, Riaz Agha, Christopher Pennell
The quality of clinical research in surgery has long attracted criticism. High-quality randomised trials have proved difficult to undertake in surgery, and many surgical treatments have therefore been adopted without adequate supporting evidence of efficacy and safety. This evidence deficit can adversely affect research funding and reimbursement decisions, lead to slow adoption of innovations, and permit widespread adoption of procedures that offer no benefit, or cause harm. Improvement in the quality of surgical evidence would therefore be valuable...
January 17, 2018: Lancet
https://www.readbyqxmd.com/read/29343479/postsurgical-prescriptions-for-opioid-naive-patients-and-association-with-overdose-and-misuse-retrospective-cohort-study
#4
Gabriel A Brat, Denis Agniel, Andrew Beam, Brian Yorkgitis, Mark Bicket, Mark Homer, Kathe P Fox, Daniel B Knecht, Cheryl N McMahill-Walraven, Nathan Palmer, Isaac Kohane
OBJECTIVE: To quantify the effects of varying opioid prescribing patterns after surgery on dependence, overdose, or abuse in an opioid naive population. DESIGN: Retrospective cohort study. SETTING: Surgical claims from a linked medical and pharmacy administrative database of 37 651 619 commercially insured patients between 2008 and 2016. PARTICIPANTS: 1 015 116 opioid naive patients undergoing surgery. MAIN OUTCOME MEASURES: Use of oral opioids after discharge as defined by refills and total dosage and duration of use...
January 17, 2018: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/29344622/barriers-to-and-facilitators-of-implementing-enhanced-recovery-pathways-using-an-implementation-framework-a-systematic-review
#5
(no author information available yet)
No abstract text is available yet for this article.
March 1, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/28576285/intraoperative-ketamine-for-prevention-of-postoperative-delirium-or-pain-after-major-surgery-in-older-adults-an-international-multicentre-double-blind-randomised-clinical-trial
#6
RANDOMIZED CONTROLLED TRIAL
Michael S Avidan, Hannah R Maybrier, Arbi Ben Abdallah, Eric Jacobsohn, Phillip E Vlisides, Kane O Pryor, Robert A Veselis, Hilary P Grocott, Daniel A Emmert, Emma M Rogers, Robert J Downey, Heidi Yulico, Gyu-Jeong Noh, Yonghun H Lee, Christine M Waszynski, Virendra K Arya, Paul S Pagel, Judith A Hudetz, Maxwell R Muench, Bradley A Fritz, Witold Waberski, Sharon K Inouye, George A Mashour
BACKGROUND: Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention of postoperative delirium in older adults. METHODS: The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia...
July 15, 2017: Lancet
https://www.readbyqxmd.com/read/28351670/preemptive-analgesia-for-postoperative-hysterectomy-pain-control-systematic-review-and-clinical-practice-guidelines
#7
REVIEW
Adam C Steinberg, Megan O Schimpf, Amanda B White, Cara Mathews, David R Ellington, Peter Jeppson, Catrina Crisp, Sarit O Aschkenazi, Mamta M Mamik, Ethan M Balk, Miles Murphy
OBJECTIVE: The objective of the study was to investigate the effectiveness of preemptive analgesia at pain control in women undergoing total abdominal hysterectomy. DATA SOURCES: Eligible studies, published through May 31, 2016, were retrieved through Medline, Cochrane Central Register for Controlled Trials, and Cochrane Database of Systematic Reviews. STUDY ELIGIBILITY: We included randomized controlled trials with the primary outcome of pain control in women receiving a preemptive medication prior to total abdominal hysterectomy...
September 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28288254/variation-in-physician-spending-and-association-with-patient-outcomes
#8
Yusuke Tsugawa, Ashish K Jha, Joseph P Newhouse, Alan M Zaslavsky, Anupam B Jena
Importance: While the substantial variation in health care spending across regions and hospitals is well known, key clinical decisions are ultimately made by physicians. However, the degree to which spending varies across physicians and the clinical consequences of that variation are unknown. Objective: To investigate variation in spending across physicians and its association with patient outcomes. Design, Setting, and Participants: For this retrospective data analysis, we analyzed a 20% random sample of Medicare fee-for-service beneficiaries 65 years and older who were hospitalized with a nonelective medical condition and treated by a general internist between January 1, 2011, and December 31, 2014...
May 1, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28219884/measuring-what-matters-to-patients
#9
EDITORIAL
Angela Coulter
No abstract text is available yet for this article.
February 20, 2017: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/28137536/postoperative-complications-and-hospital-payment-implications-for-achieving-value
#10
Jason B Liu, Julia R Berian, Shenglin Chen, Mark E Cohen, Karl Y Bilimoria, Bruce L Hall, Clifford Y Ko
BACKGROUND: As the current healthcare structure moves toward value-based purchasing, it is helpful for stakeholders to understand costs, particularly for those associated with postoperative complications. The objectives of this study were to assess hospital reimbursements for postoperative complications and generate insight into sustainability of quality. STUDY DESIGN: American College of Surgeons NSQIP and Medicare claims data from 2009 to 2012 were merged for elective colectomy, total knee arthroplasty, and carotid endarterectomy...
May 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/27984343/value-based-purchasing-for-osteoarthritis-and-total-knee-arthroplasty-what-role-for-patient-reported-outcomes
#11
Catherine MacLean
Prompted by the aims to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the US healthcare system is embarking upon a new era in care delivery that seeks to optimize healthcare value. Value, the consideration of quality relative to cost, can be increased by improving quality, reducing cost, or doing both. Given that patient-reported outcomes related to pain, function, and quality of life underlay both the reason patients seek care for and the benchmarks by which treatment success is measured for osteoarthritis, measures of these patient-reported outcomes figure prominently in understanding the quality and hence value...
February 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/25388883/development-and-validation-of-the-surgical-outcome-risk-tool-sort
#12
MULTICENTER STUDY
K L Protopapa, J C Simpson, N C E Smith, S R Moonesinghe
BACKGROUND: Existing risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study. METHODS: The data set was split into derivation and validation cohorts...
December 2014: British Journal of Surgery
https://www.readbyqxmd.com/read/25689757/measurement-of-disability-free-survival-after-surgery
#13
MULTICENTER STUDY
Mark A Shulman, Paul S Myles, Matthew T V Chan, David R McIlroy, Sophie Wallace, Jennie Ponsford
BACKGROUND: Survival and freedom from disability are arguably the most important patient-centered outcomes after surgery, but it is unclear how postoperative disability should be measured. The authors thus evaluated the World Health Organization Disability Assessment Schedule 2.0 in a surgical population. METHODS: The authors examined the psychometric properties of World Health Organization Disability Assessment Schedule 2.0 in a diverse cohort of 510 surgical patients...
March 2015: Anesthesiology
https://www.readbyqxmd.com/read/23471753/measurement-of-quality-of-recovery-using-the-qor-40-a-quantitative-systematic-review
#14
REVIEW
B F Gornall, P S Myles, C L Smith, J A Burke, K Leslie, M J Pereira, J E Bost, K B Kluivers, U G Nilsson, Y Tanaka, A Forbes
BACKGROUND: Several rating scales have been developed to measure quality of recovery after surgery and anaesthesia, but the most extensively used is the QoR-40, a 40-item questionnaire that provides a global score and subscores across five dimensions: patient support, comfort, emotions, physical independence, and pain. It has been evaluated in a variety of settings, but its overall psychometric properties (validity, reliability, ease of use, and interpretation) and clinical utility are uncertain...
August 2013: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/11605925/relation-between-quality-of-recovery-in-hospital-and-quality-of-life-at-3-months-after-cardiac-surgery
#15
RANDOMIZED CONTROLLED TRIAL
P S Myles, J O Hunt, H Fletcher, R Solly, D Woodward, S Kelly
BACKGROUND: Improved quality of life (QoL) is a desirable outcome of cardiac surgery. The aim of the current study was to measure the association between quality of recovery 3 days after surgery and QoL measured 3 months later. METHODS: After obtaining ethics committee approval and consent, 120 adult cardiac surgical patients were studied. A 40-item quality of recovery score (QoR-40) was used to measure postoperative health status on days 1-3 and 1 month after surgery...
October 2001: Anesthesiology
https://www.readbyqxmd.com/read/27537929/the-impact-of-residual-neuromuscular-blockade-oversedation-and-hypothermia-on-adverse-respiratory-events-in-a-postanesthetic-care-unit-a-prospective-study-of-prevalence-predictors-and-outcomes
#16
Paul A Stewart, Sophie S Liang, Qiushuang Susan Li, Min Li Huang, Ayse B Bilgin, Dukyeon Kim, Stephanie Phillips
BACKGROUND: Residual neuromuscular blockade (RNMB) has been linked to adverse respiratory events (AREs) in the postanesthetic care unit (PACU). However, these events are often not attributed to RNMB by anesthesiologists because they may also be precipitated by other factors including obstructive sleep apnea, opioids, or hypnotic agents. Many anesthesiologists believe RNMB occurs infrequently and is rarely associated with adverse outcomes. This study evaluated the prevalence and predictors of RNMB and AREs...
October 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/26325514/the-effects-of-dexmedetomidine-and-remifentanil-on-hemodynamic-stability-and-analgesic-requirement-after-craniotomy-a-randomized-controlled-trial
#17
RANDOMIZED CONTROLLED TRIAL
Shobana Rajan, Matthew T Hutcherson, Daniel I Sessler, Andrea Kurz, Dongsheng Yang, Michael Ghobrial, Jinbo Liu, Rafi Avitsian
BACKGROUND: Anesthesia for craniotomies should blunt responses to noxious stimuli, whereas subsequently leaving patients sufficiently alert for early neurological evaluation. The aim was to compare postoperative blood pressure control, pain, and opioid requirement after anesthesia with dexmedetomidine versus remifentanil. We therefore tested 2 primary hypotheses: (1) intraoperative administration of dexmedetomidine provides better control of postoperative blood pressure than remifentanil; and (2) patients given dexmedetomidine have less postoperative pain and use less opioid...
October 2016: Journal of Neurosurgical Anesthesiology
https://www.readbyqxmd.com/read/27496687/the-management-of-myelomeningocele-study-obstetrical-outcomes-and-risk-factors-for-obstetrical-complications-following-prenatal-surgery
#18
RANDOMIZED CONTROLLED TRIAL
Mark P Johnson, Kelly A Bennett, Larry Rand, Pamela K Burrows, Elizabeth A Thom, Lori J Howell, Jody A Farrell, Mary E Dabrowiak, John W Brock, Diana L Farmer, N Scott Adzick
BACKGROUND: The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal closure of myelomeningocele. The trial was stopped early at recommendation of the data and safety monitoring committee and outcome data for 158 of the 183 randomized women published. OBJECTIVE: In this report, pregnancy outcomes for the complete trial cohort are presented. We also sought to analyze risk factors for adverse pregnancy outcome among those women who underwent prenatal myelomeningocele repair...
December 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27470494/prediction-of-postoperative-opioid-analgesia-using-clinical-experimental-parameters-and-electroencephalography
#19
M Gram, J Erlenwein, F Petzke, D Falla, M Przemeck, M I Emons, M Reuster, S S Olesen, A M Drewes
BACKGROUND: Opioids are often used for pain treatment, but the response is often insufficient and dependent on e.g. the pain condition, genetic factors and drug class. Thus, there is an urgent need to identify biomarkers to enable selection of the appropriate drug for the individual patient, a concept known as personalized medicine. Quantitative sensory testing (QST) and clinical parameters can provide some guidance for response, but better and more objective biomarkers are urgently warranted...
February 2017: European Journal of Pain: EJP
https://www.readbyqxmd.com/read/27473003/accreta-placentation-a-systematic-review-of-prenatal-ultrasound-imaging-and-grading-of-villous-invasiveness
#20
REVIEW
Eric Jauniaux, Sally L Collins, Davor Jurkovic, Graham J Burton
BACKGROUND: Determining the depth of villous invasiveness before delivery is pivotal in planning individual management of placenta accreta. We have evaluated the value of various ultrasound signs proposed in the international literature for the prenatal diagnosis of accreta placentation and assessment of the depth of villous invasiveness. OBJECTIVE: We undertook a PubMed and MEDLINE search of the relevant studies published from the first prenatal ultrasound description of placenta accreta in 1982 through March 30, 2016, using key words "placenta accreta," "placenta increta," "placenta percreta," "abnormally invasive placenta," "morbidly adherent placenta," and "placenta adhesive disorder" as related to "sonography," "ultrasound diagnosis," "prenatal diagnosis," "gray-scale imaging," "3-dimensional ultrasound", and "color Doppler imaging...
December 2016: American Journal of Obstetrics and Gynecology
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