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Lazenby BS, Guidry A, Donovan EE, Dailey R, Ivatury SJ. 'That gave me a lot of comfort, that he would ask my opinion about how we wanted to talk about this': A qualitative analysis of clinical communication experiences of ostomy patients. BMJ Open 2024; 14:e079362. [PMID: 38326256 PMCID: PMC10859983 DOI: 10.1136/bmjopen-2023-079362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/26/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the communication challenges and successes that people with ostomies experienced during their healthcare encounters. DESIGN We conducted semistructured interviews of people with ostomies. Interviews focused on important social situations and health communication strategies for managing these situations. We transcribed interviews and coded them to create themes. PARTICIPANTS Participants were eligible to participate if they were above the age of 18 and have had an ostomy for at least a year. 27 people participated in the study. SETTING The study was conducted in a university setting. RESULTS Interviews with ostomates surfaced several themes related to ostomate needs. Participants benefited from communication that was open, thorough and had a positive outlook on ostomies. Participants found patient-clinician communication to be challenging when there was a lack of knowledge surrounding ostomy care, communication was unclear or inadequate, and when clinicians had a negative outlook on ostomies. CONCLUSIONS Findings from this project are intended to amplify existing patient and clinician education materials and to inform the creation of a communication guide specifically for the ostomy context.
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Affiliation(s)
- Braidyn S Lazenby
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Ashley Guidry
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Erin E Donovan
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - René Dailey
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, The University of Texas at Austin, Austin, Texas, USA
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Allen RW, Shaw RD, Burney CP, Newton LE, Lee AY, Judd BG, Ivatury SJ. Deep sleep and beeps II: Sleep quality improvement project in general surgery patients. Surgery 2022; 172:1697-1703. [PMID: 38375787 DOI: 10.1016/j.surg.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Poor sleep leads to poor health outcomes. Phase I of our sleep quality improvement project showed severe sleep disturbance in the ward setting. We implemented a novel PostOp Pack to improve sleep quality. METHODS Patients underwent elective, general surgery procedures. Fitbit trackers measured total sleep time. Patients completed the inpatient Richards-Campbell Sleep Questionnaire, which combines 5 domains into a cumulative score (0-100). Patients completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. Patients received the PostOp Pack, which included physical items and a sleep-protective order set to reduce nighttime awakenings. Patients from phase I served as the historical control. The primary outcome was the percentage of patients with Richards-Campbell Sleep Questionnaire total sleep score ≥50. The secondary outcomes included the mean Richards-Campbell Sleep Questionnaire domain scores and Fitbit total sleep time. RESULTS A total of 49 patients were compared with 64 historical controls. The percentage of patients with a total sleep score ≥50 was significantly higher in patients receiving a PostOp Pack versus historical control (69% vs. 44%, difference 26%, 95% confidence interval 6.1-45%, P = .01). The mean Richards-Campbell Sleep Questionnaire Total Sleep Score was significantly higher in patients with a PostOp Pack (62 vs 49, mean difference 13, 95% confidence interval 6-21, P ≤ .01). The PostOp Pack Richards-Campbell Sleep Questionnaire domain scores were significantly higher in various areas: Sleep Latency (68 vs 49, P ≤ .01), Awakenings (56 vs 40, P = .01), Sleep Quality (61 vs 49, P = .02), and Noise Disturbance (70 vs 59, P = .04). Of all patients, 92% would use PostOp Pack again in a future hospitalization. No patients had a failure to rescue event with PostOp Pack. The mean total sleep time was significantly improved with PostOp Pack on night 1 (6.4 vs 4.7 hours, P = .03). CONCLUSION The PostOp Pack improves inpatient sleep quality and is safe.
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Affiliation(s)
- Robert W Allen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Robert D Shaw
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Charles P Burney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Laura E Newton
- Geisel School of Medicine, Dartmouth College, Lebanon, NH
| | - Andrew Y Lee
- Geisel School of Medicine, Dartmouth College, Lebanon, NH
| | - Brooke G Judd
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth College, Lebanon, NH; Sleep Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Srinivas Joga Ivatury
- Department of Surgery and Perioperative Care, University of Texas Dell Medical School, Austin TX
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Abstract
BACKGROUND Rectal cancer patients often face complex surgical treatment decisions, but there are few available tools to aid in decision-making. OBJECTIVE We aimed to identify content and delivery preferences of rectal cancer patients and colorectal surgeons to guide future surgical decision aid creation. DESIGN Qualitative study: inductive thematic analysis of semi-structured interviews. SETTING In-person and phone interviews. PATIENTS We purposively sampled 15 rectal cancer survivors based on demographics and surgery type. Five caregivers also participated. We purposively selected 10 surgeons based on practice type and years of experience. INTERVENTIONS Semi-structured interviews. MAIN OUTCOME MEASURES Major and minor themes for survivors and surgeons with thematic saturation. RESULTS Interviews were a median of 61 minutes (41-93) for patients and 35 minutes (25-59) for surgeons. Nine survivors were younger than 65 years; 7 were female. Surgeons had been practicing for a mean of 10 years (SD 7.4), with 7 in academic and 3 in private settings. Participating survivors and surgeons wanted a comprehensive educational tool-not just a surgical decision aid. Survivors wanted more information on rectal cancer basics and lifestyle, care timelines, and resources during treatment. Surgeons thought patients mostly desired information about surgical options and bowel function. Both patients and surgeons wanted a tool that was personalized, simple, understandable, visually appealing, interactive, short, and in multiple formats. LIMITATIONS Results may not be generalizable due to selection bias of participants. CONCLUSION Rectal cancer survivors, their caregivers, and colorectal surgeons wanted an educational support tool that would address substantial educational needs through the continuum of disease rather than a surgical decision aid focusing on a discrete surgical choice only. See Video Abstract at http://links.lww.com/DCR/C20 . UNA AYUDA PARA LA DECISIN QUIRRGICA DEL CNCER DE RECTO NO ES SUFICIENTE UN ESTUDIO CUALITATIVO ANTECEDENTES:Los pacientes con cáncer de recto a menudo enfrentan decisiones de tratamiento quirúrgico complejas, pero hay pocas herramientas disponibles para ayudar en la toma de decisiones.OBJETIVO:Nuestro objetivo fue identificar el contenido y las preferencias de entrega de los pacientes con cáncer de recto y los cirujanos colorrectales para guiar la futura creación de ayuda para la toma de decisiones quirúrgicas.DISEÑO:Estudio cualitativo: análisis temático inductivo de entrevistas semiestructuradas.ESCENARIO:Entrevistas en persona y por teléfono.PACIENTES:Tomamos muestras intencionalmente de 15 sobrevivientes de cáncer de recto, según la demografía y el tipo de cirugía. También participaron cinco cuidadores. Seleccionamos intencionalmente a 10 cirujanos según el tipo de práctica y los años de experiencia.INTERVENCIONES:Entrevistas semiestructuradas.PRINCIPALES MEDIDAS DE RESULTADO:Temas principales y secundarios para sobrevivientes y cirujanos con saturación temática.RESULTADOS:Las entrevistas tuvieron una mediana de 61 minutos (41-93) para pacientes y 35 minutos (25-59) para cirujanos. Nueve sobrevivientes tenían menos de 65 años; siete eran mujeres. Los cirujanos habían estado ejerciendo una media de 10 años (DE 7,4), con siete en entornos académicos y 3 en entornos privados. Los sobrevivientes y cirujanos participantes querían una herramienta educativa comprensible, no solo una ayuda para la decisión quirúrgica. Los sobrevivientes querían más información sobre los conceptos básicos y el estilo de vida del cáncer de recto, los plazos de atención y los recursos durante el tratamiento. Los cirujanos pensaron que los pacientes en su mayoría deseaban información sobre las opciones quirúrgicas y la función intestinal. Tanto los pacientes como los cirujanos querían una herramienta que fuera personalizada, simple, comprensible, visualmente atractiva, interactiva, corta y en múltiples formatos.LIMITACIONES:Los resultados pueden no ser generalizables debido al sesgo de selección de los participantes.CONCLUSIÓN:Los sobrevivientes de cáncer rectal, sus cuidadores y los cirujanos colorrectales querían una herramienta de apoyo educativo que cubriera las necesidades educativas sustanciales a lo largo del tratamiento de la enfermedad en lugar de una ayuda para la decisión quirúrgica que se centre solo en una opción quirúrgica discreta. Consulte Video Resumen en http://links.lww.com/DCR/C20 . (Traducción-Dr. Yolanda Colorado ).
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Affiliation(s)
- Jenaya L Goldwag
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Catherine H Saunders
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Jackson T Read
- University of Texas at Austin Dell Medical School, Austin, TX
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH
| | - Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.,University of Texas at Austin Dell Medical School, Austin, TX
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Shaw RD, Goldwag JL, Wilson LR, Ivatury SJ, Tsapakos MJ, Pauli EM, Wilson MZ. Retrorectus mesh reinforcement of ileostomy site fascial closure: stoma closure and reinforcement (SCAR) trial phase I/II results. Hernia 2022; 26:1645-1652. [PMID: 36167868 DOI: 10.1007/s10029-022-02681-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Loop ileostomy (LI) is commonly employed during colorectal surgeries to reduce the consequences of anastomotic leak. Unfortunately, LI is associated with a 10-30% incisional hernia (IH) rate after closure. We hypothesized that prophylactic mesh reinforcement during LI takedown would safely prevent subsequent IH formation. METHODS This single-center, phase I/II prospective study evaluated adult patients undergoing LI closure after left-sided colorectal cancer procedures. After LI closure, the posterior rectus sheath was mobilized and reapproximated with absorbable suture. A reduced-weight, macroporous, polypropylene mesh (Softmesh, BD) was placed in the retrorectus position to allow 3 cm of overlap and secured with fibrin sealant. The anterior fascia was closed with slowly absorbable suture. CT images obtained for cancer surveillance were reviewed by a radiologist blinded to the study intervention to evaluate for evidence of hernia or surgical site occurrence (SSO). RESULTS Twenty patients were included with mean defect and mesh sizes of 11.2 cm2 and 64.2 cm2, respectively. Mean operative time for LI takedown and mesh augmented closure was 84 min with mesh implantation time being 16.4 min. Two patients were readmitted within 30 days for ileus, no patient required procedural intervention. Over a mean follow-up period of 20 ± 7 months, no SSO or hernias were observed clinically or on CT imaging. CONCLUSION In our small series, retromuscular mesh reinforcement of LI closure appears feasible, safe and effective. This mesh reinforcement approach should be further investigated to evaluate its long-term effectiveness.
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Affiliation(s)
- R D Shaw
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - J L Goldwag
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA
| | - L R Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA.,Geisel School of Medicine, Hanover, NH, USA
| | - S J Ivatury
- Dell Medical School, UT Health, Austin, TX, USA
| | - M J Tsapakos
- Geisel School of Medicine, Hanover, NH, USA.,Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - E M Pauli
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - M Z Wilson
- Department of Surgery, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03756, USA. .,Geisel School of Medicine, Hanover, NH, USA.
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Ivatury SJ. Recurrent Diverticulitis: Where Uncomplicated Is Complicated. Ann Surg Open 2022; 3:e170. [PMID: 37601616 PMCID: PMC10431563 DOI: 10.1097/as9.0000000000000170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Srinivas Joga Ivatury
- From the Department of Surgery and Perioperative Care, The University of Texas at Austin - Dell Medical School, Austin, TX
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Affiliation(s)
- C Ann Vitous
- Centers for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Srinivas Joga Ivatury
- Division of Colorectal Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Pasithorn A Suwanabol
- Centers for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor, Michigan
- Division of Colorectal Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
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Kang R, Saunders CH, Carpenter-Song EA, Moore KO, Trooboff SW, Columbo JA, Goodney PP, Wong SL, Joga Ivatury S. A Mixed-Methods Evaluation of Patient Education Materials for Colorectal Cancer. Dis Colon Rectum 2021; 64:1249-1258. [PMID: 34516444 DOI: 10.1097/dcr.0000000000001917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patient education materials are created by professional organizations to inform patients about their disease and its treatment. However, it remains unclear if these materials are appropriate for patients. OBJECTIVE This study aims to broadly evaluate the education materials for patients with colorectal cancer. DESIGN Patient education materials from the National Comprehensive Cancer Network, the National Cancer Institute, and the American Society of Colon and Rectal Surgeons were assessed quantitatively by using 1) the Flesch-Kincaid readability formula and 2) the Patient Education Material Assessment Tool. The Patient Education Material Assessment Tool scores materials in 2 domains: understandability and actionability. These materials were further evaluated qualitatively via an exploratory focus group with patients and their caregivers (n = 5) and semi-structured interviews with board-certified/eligible colorectal surgeons (n = 10). SETTING This study was conducted at academic centers and a regional professional society meeting. PARTICIPANTS The mean patient age was 63. Most surgeons (8/10) practiced in an academic setting, and 4/10 were female. MAIN OUTCOME MEASURES The primary outcomes measured were reading grade level and domain scores for the Patient Education Material Assessment Tool. Qualitative data were recorded, transcribed, and coded. Themes were generated through data interpretation and data reduction. RESULTS Materials ranged from 7th to 11th grade reading level. National Comprehensive Cancer Network materials scored highest for understandability (92.2% ± 6.1%, mean ± SD), followed by National Cancer Institute (84.0% ± 6.6%) and American Society of Colon and Rectal Surgeons (82.2% ± 6.3%) materials. Actionability scores varied; the National Comprehensive Cancer Network materials scored 82.5% ± 1.7%, whereas the National Cancer Institute and American Society of Colon and Rectal Surgeons materials scored 23.3% ± 6.7% and 50.0% ± 8.2%. Critical gaps were identified in the content of these materials. Patients wanted more information about self-care, both emotional and physical. Specifically, patients sought details about postoperative bowel function. Whereas surgeons wanted information about the typical hospital course and recovery, all wanted materials to be customizable. LIMITATIONS A limited number of materials were reviewed, and patient focus groups were exploratory. CONCLUSIONS Commonly available printed education materials for colorectal cancer are written at a high reading grade level, vary in their usability, and neglect important details about postoperative recovery. See Video Abstract at http://links.lww.com/DCR/B535. EVALUACIN DE MTODOS MIXTOS DE MATERIALES EDUCATIVOS PARA PACIENTES SOBRE CNCER COLORECTAL ANTECEDENTES:Los materiales educativos para pacientes son creados por organizaciones profesionales para informar a los pacientes sobre su enfermedad y su tratamiento. Sin embargo, no está claro si estos materiales son apropiados para los pacientes.OBJETIVO:Evaluar ampliamente los materiales para el cáncer colorrectal.DISEÑO:Los materiales educativos para pacientes de la Red Nacional Integral del Cáncer (NCCN), el Instituto Nacional del Cáncer (NCI) y la Sociedad Americana de Cirujanos de Colon y Recto (ASCRS) se evaluaron cuantitativamente utilizando (1) la fórmula de legibilidad de Flesch-Kincaid y (2) la herramienta de evaluación de material educativo para pacientes. La Herramienta de evaluación de materiales educativos para pacientes califica los materiales en dos dominios: comprensibilidad y viabilidad. Estos materiales fueron evaluados cualitativamente a través de un grupo de enfoque exploratorio con pacientes y sus cuidadores (n = 5) y entrevistas semiestructuradas con cirujanos colorrectales certificados o elegibles para certificación por el consejo (n = 10).ESCENARIO:Centros académicos y un encuentro regional de una sociedad profesional.PACIENTES:La edad media de los pacientes fue de 63 años. La mayoría de los cirujanos (8/10) practicaban en un entorno académico, y 4/10 eran mujeres.PRINCIPALES MEDIDAS DE RESULTADO:Nivel de grado de lectura y puntajes de dominios para la Herramienta de evaluación de materiales educativos para pacientes. Los datos cualitativos se registraron, transcribieron y codificaron. Los temas se generaron mediante la interpretación y la reducción de datos.RESULTADOS:Los materiales variaron desde el nivel de lectura del 7° al 11° grado. Los materiales de la NCCN obtuvieron la puntuación más alta en comprensibilidad (92.2 ± 6.1%, media ± DE), seguidos por los materiales de NCI (84.0 ± 6.6%) y ASCRS (82.2 ± 6.3%). Los puntajes de viabilidad variaron; Los materiales de NCCN obtuvieron una puntuación de 82.5 ± 1.7%, mientras que los materiales de NCI y ASCRS obtuvieron una puntuación de 23.3 ± 6.7% y 50.0 ± 8.2%, respectivamente. Se identificaron lagunas críticas en el contenido de estos materiales. Los pacientes querían más información sobre el autocuidado, tanto emocional como físico. Específicamente, los pacientes buscaron detalles sobre la función intestinal posoperatoria. Mientras que los cirujanos querían información sobre el curso hospitalario típico y la recuperación, y todos querían que los materiales fueran personalizables.LIMITACIONES:Se revisó una cantidad limitada de materiales y los grupos de enfoque de pacientes fueron exploratorios.CONCLUSIONES:Los materiales educativos impresos comúnmente disponibles para el cáncer colorrectal están escritos a un alto nivel de grado de lectura, varían en su usabilidad y omiten detalles importantes sobre la recuperación postoperatoria. Consulte Video Resumen en http://links.lww.com/DCR/B535.
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Affiliation(s)
- Ravinder Kang
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Veterans Affairs Outcomes Group, White River Junction, Vermont
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Catherine H Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Elizabeth A Carpenter-Song
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
- Department of Anthropology, Dartmouth College, Hanover, New Hampshire
| | - Kayla O Moore
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Spencer W Trooboff
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Veterans Affairs Outcomes Group, White River Junction, Vermont
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Jesse A Columbo
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Veterans Affairs Outcomes Group, White River Junction, Vermont
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Philip P Goodney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Veterans Affairs Outcomes Group, White River Junction, Vermont
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Allen RW, Burney CP, Davis A, Henkin J, Kelly J, Judd BG, Ivatury SJ. Deep Sleep and Beeps: Sleep Quality Improvement Project in General Surgery Patients. J Am Coll Surg 2021; 232:882-888. [PMID: 33675989 DOI: 10.1016/j.jamcollsurg.2021.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Poor sleep leads to poor health outcomes. Inpatient sleep disturbance has been studied primarily in the ICU. Minimal research exists on sleep in surgical populations. METHODS We recruited patients undergoing elective, inpatient general surgery procedures. Participants wore Fitbit trackers while inpatient to measure total sleep time (CDC recommendation is 7 or more hours per night). At discharge, patients completed the Richards-Campbell Sleep Questionnaire (RCSQ) to measure inpatient sleep quality. The RCSQ combines 5 domains into a cumulative score (0 to 100); a higher score means better sleep quality. Patients also completed the outpatient Pittsburgh Sleep Quality Index preoperatively and postoperatively. The primary end point was percentage of patients with total sleep score ≥ 50. Secondary outcomes included mean RCSQ domain scores, Fitbit total sleep time, and percentage with Pittsburgh Sleep Quality Index Score indicating poor sleep. RESULTS We included 64 patients (mean ± SD age 55.0 ± 14.1 years). Mean ± SD RCSQ total sleep score was 49 ± 20.5 and 53.1% with total sleep score < 50. Mean ± SD RCSQ domain scores were Awakenings: 40.4 ± 22.8, Sleep Quality: 49.1 ± 27.9, Sleep Latency: 49.2 ± 25.3, Sleep Depth: 50.2 ± 26.5, Returning to Sleep: 55.9 ± 28.1, and Noise Disturbance: 59.1 ± 27.9. On night one, 25 devices (40%) had recorded sleep data due to enough sleep. Mean ± SD total sleep time on night 1 was 4.7 ± 2.8 hours. Mean total sleep time for nights 2, 3, and 4 remained fewer than 7 hours. Percentages for each night that achieved the CDC goal of 7 or more hours were as follows: night one 10.9%, night two 32.8%, night three 35.3%, and night four 27.6%. Per the Pittsburgh Sleep Quality Index, 88.1% of patients were poor sleepers preoperatively and 84.5% were poor sleepers at follow-up (p = 0.6). CONCLUSIONS Elective general surgery patients experience a severe inpatient sleep disturbance, worse than in similarly studied ICU cohorts. This disturbance is driven primarily by nighttime awakenings.
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Affiliation(s)
- Robert W Allen
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
| | - Charles P Burney
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Amy Davis
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jessica Henkin
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Julia Kelly
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Brooke G Judd
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Sleep Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth College, Lebanon, NH
| | - Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine, Dartmouth College, Lebanon, NH
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Ivatury SJ, Wilson LR, Paquette IM. Surgical Treatment Alternatives to Sacral Neuromodulation for Fecal Incontinence: Injectables, Sphincter Repair, and Colostomy. Clin Colon Rectal Surg 2021; 34:40-48. [PMID: 33536848 DOI: 10.1055/s-0040-1714285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fecal incontinence is a prevalent health problem that affects over 20% of healthy women. Many surgical treatment options exist for fecal incontinence after attempts at non-operative management. In this article, the authors discuss surgical treatment options for fecal incontinence other than sacral neuromodulation.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Lebanon, New Hampshire
| | - Lauren R Wilson
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine, Lebanon, New Hampshire
| | - Ian M Paquette
- University of Cincinnati Surgeons, College of Medicine, Cincinnati, Ohio
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Gray P, Goldwag J, Eid M, Ivatury SJ. What Are the Long-Term Changes to Bowel Function Patient-Reported Outcomes after Elective Sigmoidectomy for Diverticular Disease? J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ivatury SJ, Hazard-Jenkins HW, Brooks GA, McCleary NJ, Wong SL, Schrag D. Translation of Patient-Reported Outcomes in Oncology Clinical Trials to Everyday Practice. Ann Surg Oncol 2020; 27:65-72. [PMID: 31452053 PMCID: PMC6925618 DOI: 10.1245/s10434-019-07749-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE Clinical trials in oncology evaluating the effects of patient-reported outcomes (PRO) collection have found that monitoring of symptoms with PROs is associated with improved clinical care through reduced acute care utilization and decreased patient symptom burden. This educational review will evaluate strategies for systematic PRO integration into everyday oncology clinical practice. METHODS We outline key considerations for using PROs in clinical practice, highlighting evidence from published studies. We also discuss the benefits and challenges of PRO implementation in oncology. RESULTS Implementing PRO collection in clinical practice can improve care delivery and facilitate patient-centered clinical research. Considerations for using PROs in clinical practice include choice of instrument, method of delivery, and frequency of query. Challenges with implementing systematic PRO collection include the costs and resources needed for implementation, impact on clinical workflow, and controlling/monitoring physician burnout. CONCLUSIONS While challenges exist in terms of financial resources and staff participation/burnout, patient-reported outcomes in clinical practice provide a number of benefits, including symptom monitoring, clinical research, and potential real-time personalized clinical-decision support.
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Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
- Geisel School of Medicine, Lebanon, NH, USA.
| | | | - Gabriel A Brooks
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine, Lebanon, NH, USA
| | | | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Geisel School of Medicine, Lebanon, NH, USA
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Ivatury SJ, Wong SL, Schrag D. ASO Author Reflections: Patient-Reported Outcomes-Bench to Bedside. Ann Surg Oncol 2019; 27:725-726. [PMID: 31741111 DOI: 10.1245/s10434-019-07920-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Srinivas Joga Ivatury
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. .,Geisel School of Medicine, Lebanon, NH, USA.
| | - Sandra L Wong
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine, Lebanon, NH, USA
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Swarup A, Mathis KA, Hill MV, Ivatury SJ. Patterns of opioid use and prescribing for outpatient anorectal operations. J Surg Res 2018; 229:283-287. [PMID: 29937003 DOI: 10.1016/j.jss.2018.04.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/18/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Surgery for anorectal diseases is thought to cause significant pain postoperatively. There is little known regarding standardized opioid-prescribing trends and patient use following surgery for anorectal diseases. We aimed to evaluate and analyze opioid-prescribing trends and patient use for outpatient anorectal operations. MATERIALS AND METHODS All patients who underwent outpatient anorectal surgery performed over a 1-y period at a single institution were eligible. Procedures included hemorrhoidectomy, anal fistula repair/seton, anal fissure treatment with sphincterotomy, and transanal excision of rectal tumors. Demographic, operative, and postoperative data were obtained. Patients were given a survey to determine postoperative pain control with opioid and non-narcotic analgesia use; respondents were included in analysis. RESULTS Forty-two outpatient anorectal surgery patients were included: 13 had hemorrhoidectomy, 22 had anal fistula repair/seton, one had sphincterotomy, and six had transanal excisions. All patients had multimodality treatment with either an anal block and/or postoperative nonopioid analgesics. Ninety percent were prescribed opioids postoperatively with a median of 20 pills (range: 0-120 pills). Forty-three percent (18/42) did not fill their prescription. For those who used opioids, the median number of pills taken was four. Eighty percent of pills prescribed were not used. One patient required a refill. Greater than 60% of respondents reported good to excellent pain control on a five-point scale. CONCLUSIONS Most patients had adequate pain control after anorectal surgery with little to no use of opioids and that more than 80% of opioid pills prescribed were not consumed. We intend to standardize our prescribing opioid quantities for outpatient anorectal operations to reflect this reduced use.
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Affiliation(s)
- Abhishek Swarup
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Lebanon, New Hampshire
| | | | - Maureen V Hill
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Lebanon, New Hampshire
| | - Srinivas Joga Ivatury
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine, Lebanon, New Hampshire.
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Bostock IC, Hill MV, Counihan TC, Ivatury SJ. Mortality after emergency Hartmann's procedure in octogenarians: a propensity score-matched analysis. J Surg Res 2017; 221:167-172. [PMID: 29229124 DOI: 10.1016/j.jss.2017.08.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Complicated diverticulitis is associated with a postoperative mortality rate of 20%. We hypothesized that age ≥80 was an independent risk factor for mortality after Hartmann's procedure for diverticular disease when controlling for baseline comorbidities. METHODS Patients who underwent an urgent or emergent Hartmann's procedure (Current Procedural Terminology codes 44143 and 44206) for diverticular disease (International Classification of Diseases-9:562.xx) were identified using the American College of Surgeons National Surgical Quality Improvement Project 2005-2013 user file. Using propensity score matching to control for baseline comorbidities, a group of patients ≥80 years old was matched to a group of those <80 years old. Univariate and multivariable logistic regression were performed. A P value <0.05 was considered statistically significant with a confidence interval (CI) of 95%. RESULTS From a total of 2986 patients, 464 patients (15.5%) were ≥80 years old. Two groups of 284 patients in each study arm were matched using propensity-matching. The mean age of the ≥80 group and <80 group was 84.4 ± 3.3 versus 63.77 ± 911.8; P < 0.0001, respectively. There was no statistical difference in baseline comorbidities or operative time between the groups. There was a significant difference in mortality with 19% and 9.2% in the >80 group versus <80 groups, respectively (P = 0.001). Factors associated with mortality included ascites (odds ratio [OR] 4.95, confidence interval [CI] 1.64-14.93, P = 0.005), previous cardiac surgery (OR 3.68, CI 1.46-9.26, P = 0.006), partially dependent or fully dependent functional status (OR 2.51, CI 1.12-5.56, P = 0.02), albumin <3 (OR 2.49, CI 1.18-5.29, P = 0.01), and American Society of Anesthesiologist class >3 (OR 2.10, CI 1.10-4.46, P = 0.05). CONCLUSIONS Octogenarians presenting with complicated diverticulitis requiring an emergent Hartmann's procedure have a higher mortality rate compared to those <80, even after controlling for baseline comorbidities. STUDY TYPE This is a retrospective, descriptive study.
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Affiliation(s)
- Ian C Bostock
- Department of Colorectal Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Maureen V Hill
- Department of Colorectal Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Timothy C Counihan
- Department of Colorectal Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Srinivas Joga Ivatury
- Department of Colorectal Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Colorectal Surgery, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
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Ivatury SJ, Louden CL. Evaluation of operative type and timing on postoperative length of stay for laparoscopic and open appendectomy. J Am Coll Surg 2010. [DOI: 10.1016/j.jamcollsurg.2010.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ivatury SJ, Deal LE, Williams HJ, Louden CL, Wolf SE. Evaluation of glycemic control methods on postoperative glucose control in patients undergoing coronary artery bypass grafting. J Am Coll Surg 2009. [DOI: 10.1016/j.jamcollsurg.2009.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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