Shared decision making in surgery: A scoping review of the literature.

BACKGROUND: Shared decision making (SDM) has been increasingly implemented to improve health-care outcomes. Despite the mixed efficacy of SDM to provide better patient-guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery. DESIGN: The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2-person title and abstract screen, full-text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross-sectional studies, as well as RCTs, were included. RESULTS: A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross-sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome. CONCLUSION: SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.

Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study.

BACKGROUND: Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. OBJECTIVE: We investigated Donald J Trump's speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. METHODS: Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump's time spent discussing unverified treatments on the United States' 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. RESULTS: From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump's average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. CONCLUSIONS: Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals' claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19.

The principles and practice of death: The Oslerian conflicted conception of dying.

Sir William Osler espoused a particularly idealized medical life that included the patient in the physician's worldview. Disease is not considered a monolith, only a reflection of one's broader health. Death, too, is configured as a part of one's being, not as a thing apart from life. The wholesomeness that characterized Osler's practice is well known-however, his long discussions and thoughts on death have not been sufficiently analyzed. His clinical views have been hinted at and numerous medical historians have noted that Osler's worldview on death was avant-garde for its time, one in which he described finality not as a time of suffering and anguish, but as "singularly free from mental distress." This essay contends with this simple view. This straightforward understanding becomes complicated when delving into such primary resources as Osler's Study on Dying cards, his writings on other medical conditions, and personal reflections following the personal losses of his sons Edward Revere Osler and Paul Revere Osler. This essay contends that the loss and the death he imagines is not one of peace, but rather, of horror and terror. Furthermore, the primary sources show Osler not as the paragon of flawless clinical acumen and reasoning, but a man of personal beliefs that were in conflict with views he espoused more publicly. The essay therefore reconceptualizes the common understanding of a stoic Osler, determines how death prefigures into Oslerian thought, and challenges the idea of an Oslerian simple death.

Criteria for selection to anesthesia residency programs: a survey of Canadian anesthesia program directors.

INTRODUCTION: Applicants to specialty programs lack guidance on knowing what exactly is desired by selection committees and program directors. Anesthesia is especially opaque, given its failure to provide transparency reports nationally. This study was developed to survey Canadian anesthesia program directors about the aspects of the application package desired in an anesthesia applicant. The primary objective is to identify the preferred attributes of anesthesia applications by those mandating the selection committees. METHODS: Survey was developed via Google Surveys, and sent online over a period of two months in June and July 2020. All program directors were sent requests for filling in the survey. STATA was used for all statistical analyses. Two analyses, Mann-Whitney and ANOVA tests, were performed for comparison groups. A p < 0.05 was considered significant. RESULTS: Fourteen of seventeen (83%) Canadian anesthesia program directors completed the survey. Having done an anesthesia elective, good performance in it, and excellence of preclinical academic performance were considered among the most important aspects of the application package with the highest ranking important and smallest standard deviation. Any form of red flag was also considered an important criterion, again with little variation among program directors. The reference letters selected by the applicants were also important, with a personal relationship and well written reference being identified as most important (p < 0.05). CONCLUSIONS: An applicant who has good academic performance, having anesthesia elective experience, personal, well-written reference letters, and general activity and interests that are not necessarily anesthesia-focused would be favoured by Canadian anesthesia programs.

INTRODUCTION: Les candidats aux programmes de spécialité sont mal informés quant aux attentes des comités de sélection et des directeurs de programmes. Dans la mesure où les directions de programmes en anesthésiologie n'ont pas publié de rapports de transparence à l'échelle nationale, les attentes de ces programmes-là sont particulièrement indéchiffrables. La présente étude a été élaborée pour sonder les directeurs de programmes d'anesthésiologie au Canada sur les aspects privilégiés dans les dossiers de candidature. L'objectif principal était de dégager les éléments que ceux qui formulent les mandats des comités de sélection valorisent dans les dossiers des candidats. MÉTHODES: Au cours d'une période de deux mois, juin et juillet 2020, un sondage en ligne, élaboré par le biais de Google Surveys, a été envoyé à tous les directeurs de programmes. STATA a été utilisé pour toutes les analyses statistiques. Deux analyses, les tests de Mann-Whitney et d'ANOVA, ont été effectuées pour les groupes de comparaison. Un p<0,05 a été considéré comme significatif. RÉSULTATS: Quatorze des dix-sept (83 %) directeurs de programmes d'anesthésie au Canada ont répondu au sondage. Le fait d'avoir effectué un stage en anesthésiologie, la bonne performance dans ce stage et l'excellence de la performance académique au pré-externat sont considérés comme les aspects les plus importants du dossier de candidature, avec les cotes les plus importantes et l'écart-type est le plus étroit. La présence d'un signal d'alerte se dégage également comme un critère important, là encore avec peu de variation entre les directeurs de programme. Les lettres de recommandation fournies, où la qualité de la rédaction et le fait de laisser transparaître une relation personnelle avec le candidat, sont également déterminantes (p<0,05). CONCLUSIONS: Les programmes d'anesthésie au Canada favoriseraient les candidats qui ont un bon rendement académique, une expérience de stage en anesthésie, des lettres de recommandation bien rédigées dont l'auteur connaît le candidat de façon personnelle, et les candidats qui ont des activités et des intérêts généraux sans lien avec l'anesthésiologie.

Telehealth and chronic pain management from rapid adaptation to long-term implementation in pain medicine: A narrative review.

The COVID-19 pandemic called for drastic changes to expand and rapidly implement telehealth to prevent breach of care for chronic patients. Responding to the challenge of implementing remote care in chronic pain services, a specialty highly dependent on doctor-patient rapport, physical examination, and frequent follow-up visits requires extensive adaptation involving administrative processes and clinical routines. We present our experience of a successful rapid adaptation to telemedicine paradigm as a response to the COVID-19 pandemic during a time of marked restriction of access to ambulatory hospital services for pediatric and adult chronic pain patients. This narrative review covers current scientific evidence for the use of telehealth for chronic pain management and describes in detail the challenges to implement telemedicine in ambulatory clinics from different perspectives. Best practices for telehealth use are recommended. A proposal for remote physical examination of pain patients is made, based on available evidence in the fields of musculoskeletal medicine and neurology comparing in-person vs remote physical examination. As an internal quality control process, an informal online survey was conducted to assess thoughts and experiences among patients and caregivers using telemedicine consultation services at the pediatric pain clinic. Providing chronic pain management services through telehealth is a viable option for many patients and health care professionals. This is reliant on the availability of appropriate materials and training, with guidelines for both patients and health care workers. With the rapid pace of technological advancements, even further integration of telehealth into routine health care is possible.

Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents.

Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient's Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children's Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.

The Community Health and Social Medicine Incubator: a service-learning framework for medical student-led projects.

The Community Health and Social Medicine (CHASM) Incubator is a social impact venture that gives medical and other health care students the opportunity to develop initiatives that sustainably promote health equity for, and in partnership with, community partners and historically marginalized communities. Students learn how to develop projects with project management curricula, are paired with community health mentors, and are given seed micro-financing. As the first community health incubator driven by medical students, CHASM provides a framework for students interested in implementing sustainable solutions to local health disparities which extends the service-learning opportunities offered in existing curricula.

L'incubateur CHASM (Community Health and Social Medicine) est une initiative visant à créer un impact social en donnant aux étudiants en médecine et des autres sciences de la santé la possibilité de développer des initiatives durables en collaboration avec des partenaires communautaires et des communautés historiquement marginalisées. CHASM met en valeur l'équité en matière de santé. Les étudiants apprennent à élaborer des projets via un cursus de gestion de projet, sont jumelés à des mentors en santé communautaire et bénéficient de micro-financement de départ. Ce premier incubateur de santé communautaire mené par des étudiants en médecine fournit un cadre aux étudiants qui souhaitent mettre en œuvre des solutions durables aux inégalités en matière de santé. Il élargit également les possibilités d'apprentissage par le service offertes dans les cursus existants.

Guide to every death and a little life.

The following is a narrativised story of my experience rotating in palliative care. It is lively.

A corona virus tracker for clinicians and students: Assessing education during an evolving phenomenon.

This article was migrated. The article was marked as recommended.

Shared Decision Making in Surgery: A Meta-Analysis of Existing Literature.

BACKGROUND: Shared decision making (SDM) is a popular care paradigm between patients and clinicians to facilitate treatment agreement by building consensus and sharing information. Decisional aids (DAs) are tools frequently used in SDM for improving knowledge sharing and facilitating the decision process. The use and outcomes of decisional aids in surgery, however, have not been investigated. This study investigates whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes, such as an increase in knowledge and decisional satisfaction, as well as decreased decisional regret and anxiety. METHODS: The search strategy was developed with a medical librarian to address the question of whether SDM in surgery benefits any type of surgical patient compared with non-SDM treatment using patient-defined outcomes. Seven databases (Medline [Ovid], Embase [Ovid], Cochrane [Wiley], Africa-Wide [EBSCO], Global Health [Ovid], Global Index Medicus (WHO), Web of Science [Clarivate Analytics]) were searched from inception until September 9th, 2019, with no language restriction. A two-person title and abstract screen was performed, followed by a full-text publication review. A DerSimonian-Laird random effects model was used for the meta-analysis, with heterogeneity established. Mean and standard deviation were collected for all study outcomes. Study eligibility was determined with strict inclusion and exclusion criteria. Study quality was assessed using the Cochrane Bias Risk Assessment Tool. RESULTS: In total, 6060 studies were retrieved. After duplicates were removed, 5303 titles and abstracts were screened, and of 356 full texts reviewed, 42 studies were included in the analysis. Heterogeneity was high in three of six variables (surgery chosen, decisional conflict, and knowledge gained), moderate in two (decisional anxiety and decisional satisfaction), and low in one (decisional regret). For all except the rates of surgical intervention, the results for decisional conflict, knowledge gained, decisional satisfaction, and decisional anxiety were significant at a 95% confidence interval. Decisional conflict decreased in 20/24 of the papers that recorded it; rates of choosing surgery decreased in 8 of the 11; and patient knowledge increased in 19 of the 22 that recorded it. The majority of papers had risk of bias, however, with the evidence of generally low quality. CONCLUSION: The results suggest that SDM in surgery is associated with greater quality of patient satisfaction and value agreement, leading to decreased conflict and anxiety, and increased knowledge and translation. This data is useful in guiding the development of SDM protocols for use in surgical disciplines. REVIEW REGISTRATION: Registered on PROSPERO-ID: CRD42018097286 [13].

Shared decision making (SDM) has been used in various healthcare disciplines to benefit patient care but has not been explored in surgical disciplines. This study investigated whether SDM in surgery benefits surgical patients compared with non-SDM treatment using patient-defined outcomes. Patients who used SDM in surgery were found to have less conflict and more satisfaction making decisions, as well as increased knowledge about their surgery compared with non-SDM patients. This study suggests that SDM is likely to benefit surgical patients to have better care outcomes.

Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis.

PROBLEM IDENTIFICATION: The comparative effectiveness of available management options for cancer-related secondary lymphedema is unknown. LITERATURE SEARCH: CINAHL®, Embase®, and MEDLINE® were searched for randomized trials comparing conservative treatment strategies. DATA EVALUATION: A network meta-analysis was conducted for lymphedema volume, along with pairwise meta-analyses for remaining outcomes. Evidence certainty was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. SYNTHESIS: Overall, 36 studies with a total of 1,651 participants were included. Compared to standard care, conservative treatments did not significantly reduce lymphedema volume. There was low to very low certainty evidence of benefit for several treatments on secondary outcomes. IMPLICATIONS FOR PRACTICE: There is insufficient evidence to suggest important differences between standard care and conservative treatment strategies for reducing lymphedema volume and improving lymphedema-related symptoms. SUPPLEMENTAL MATERIAL CAN BE FOUND AT&NBSP;HTTPS: //onf.ons.org/supplementary-material-conservative-intervention-strategies-adult-cancer-related-lymphedema.