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Park C, Blevins KM, Paul AV, Long JS, Meyer LE, Anakwenze OA. Perioperative Management in Shoulder Arthroplasty: A Review of Current Practice. Orthop Clin North Am 2022; 53:483-90. [PMID: 36208890 DOI: 10.1016/j.ocl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Perioperative management for patients undergoing shoulder arthroplasty has evolved significantly over the years to reduce overt complications and improve patient outcomes. The groundwork for perioperative care encompasses initial patient selection and education strategies for achieving successful outcome. Multimodal pain management strategies have advanced patient care with the increased use of new regional/local anesthetics. In addition, complications resulting from blood loss and transfusions have been curtailed with the use of synthetic antifibrinolytic agents. It remains critical for shoulder arthroplasty surgeons to optimize patients during the perioperative period through various modalities to maximize functional progression, outcomes, and patient's satisfaction following shoulder arthroplasty.
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Marschollek P, Bąkowska K, Bąkowski W, Marschollek K, Tarkowski R. Oncologists and Breaking Bad News-From the Informed Patients' Point of View. The Evaluation of the SPIKES Protocol Implementation. J Cancer Educ 2019; 34:375-380. [PMID: 29399734 DOI: 10.1007/s13187-017-1315-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The way that bad news is disclosed to a cancer patient has a crucial impact on physician-patient cooperation and trust. Consensus-based guidelines provide widely accepted tools for disclosing unfavorable information. In oncology, the most popular one is called the SPIKES protocol. A 17-question survey was administered to a group of 226 patients with cancer (mean age 59.6 years) in order to determine a level of SPIKES implementation during first cancer disclosure. In our assessment, the patients felt that the highest compliance with the SPIKES protocol was with Setting up (70.6%), Knowledge (72.8%), and Emotions (75.3%). The lowest was with the Perception (27.7%), Invitation (30.4%), and Strategy & Summary (56.9%) parts. There could be improvement with each aspect of the protocol, but especially in Perception, Invitation, and Strategy & Summary. The latter is really important and must be done better. Older patients felt the doctors' language was more comprehensible (r = 0.17; p = 0.011). Patients' satisfaction of their knowledge about the disease and follow-up, regarded as an endpoint, was insufficient. Privacy was important in improving results (p < 0.01). In practice, the SPIKES protocol is implemented in a satisfactory standard, but it can be improved in each area, especially in Perception, Invitation, and Summary. It is suggested that more training should be done in undergraduate and graduate medical education and the effectiveness of the disclosure continue to be evaluated and improved.
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Affiliation(s)
- Paweł Marschollek
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Katarzyna Bąkowska
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Wojciech Bąkowski
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Karol Marschollek
- Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367, Wrocław, Poland
| | - Radosław Tarkowski
- Department of Oncology, Division of Surgical Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 53-413, Wrocław, Poland.
- 1st Department of Surgical Oncology, Lower Silesian Cancer Center, pl. Hirszfelda 12, 53-413, Wrocław, Poland.
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Tarkowski R, Szmigiel K, Rubin A, Borowiec G, Szelachowska J, Jagodziński W, Bębenek M. Patient's Education Before Mastectomy Influences the Rate of Reconstructive Surgery. J Cancer Educ 2017; 32:537-542. [PMID: 26792785 PMCID: PMC5543184 DOI: 10.1007/s13187-016-0982-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Breast reconstruction (BR) should be offered and discussed to each woman with breast cancer who planned for mastectomy, except the cases with severe comorbidities. However, the majority of these patients do not undergo reconstructive surgery. A 20-question survey was administered to a group of 50 women (age 29-83 years, median 53) treated with mastectomy. 22.4 % underwent reconstruction of the breast, 24.5 % declared an interest in BR in the future, 53.1 % were not interested in reconstructive surgery. 51.2 % obtained information concerning BR before surgery, 58.1 % after and 44.2 % both before and after mastectomy. 59.2 % were informed about reimbursement. Information given before surgery had a statistically significant impact on performing reconstruction or a declared interest in BR (X 2 = 4.950, df = 1, p < 0.05), as well as information about reimbursement (X 2 = 8.875, df = 1, p < 0.05). Age <55 years was another significant factor (X 2 = 13.522, df = 1, p < 0.05, C Pearson = 0.525). Level of education did not impact upon the choice (p > 0.05). The main reasons for the refusal were fear of complications (47.4 %), priority to recovery over aesthetic (36.8 %), age, defined by the patient as "advanced" (31.6 %), high level of acceptance of the body after amputation (31.6 %), fear of cancer recurrence (26.3 %) and fear of the pain and discomfort (15.8 %). Each patient who planned for mastectomy should obtain sufficient information regarding breast reconstruction. Exact information is of special benefit to women discouraged by imagined disadvantages of surgery. Patients' education impacts the quality of life-not only before surgery but also lifelong after finishing the treatment.
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Affiliation(s)
- R Tarkowski
- Department of Oncology, Division of Surgical Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland.
- 1st Department of Surgical Oncology, Lower Silesian Comprehensive Cancer Center, pl. Hirszfelda 12, 53-413, Wroclaw, Poland.
| | - K Szmigiel
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - A Rubin
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - G Borowiec
- Students' Scientific Society at the Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 513-413, Wroclaw, Poland
| | - J Szelachowska
- Department of Oncology, Wroclaw Medical University, pl. Hirszfelda 12, 53-413, Wroclaw, Poland
| | - W Jagodziński
- Analiza Badania Rozwój, Osiedle Stefana Batorego 11 lok 74, 60-687, Poznan, Poland
| | - M Bębenek
- 1st Department of Surgical Oncology, Lower Silesian Comprehensive Cancer Center, pl. Hirszfelda 12, 53-413, Wroclaw, Poland
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