Patient-focused Care Research Articles

Improving type 2 diabetes mellitus management in Ministry of Defense Hospitals in the Kingdom of Saudi Arabia 2018–2021

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such...

Patient satisfaction and associated factors towards surgical service among patients undergoing surgery at referral hospitals in western Amhara Regional State, Ethiopia

BackgroundPatient satisfaction is a growing concern in all aspects of healthcare. Assessing patient satisfaction has paramount importance for measuring the level of care provided by a health system. The present study aimed to measure the levels of satisfaction among patients undergoing invasive surgery in the referral hospitals of the Western Amhara Regional State. MethodsA cross-sectional study design was employed. The data were collected from 422 study participants from February 6 to April 6, 2020. The participants were selected using systematic random sampling technique. Interviewer administered questionnaire and chart review were used for data collection. A binary logistic regression model was used to identify the association between independent variables and patient satisfaction. Level of significance was considered at p value less than 0.05 with 95% confidence level. ResultOf the total participants, 290 (68.7%, 95% CI: 64.5–73.5) were found to be satisfied with surgical service. Factors such as age >58 years [AOR = 3.80, 95% CI (1.53–9.46)], 47–58 years [AOR = 2.47, 95%CI (1.07–5.71)], those with no formal education [AOR = 2.73, 95% CI (1.18–6.32)], primary school education [AOR = 3.89, 95%CI (1.65–9.17)] and secondary school education [AOR = 3.37, 95%CI (1.38–8.23)], no history of previous surgical admission [AOR = 2.09, 95%CI (1.07–4.08)], length of stay in the hospital <7 days [AOR = 2.13,95%CI(1.21–3.75)] and elective admission for surgery [AOR = 1.75, 95%CI (1.03–2.99)] were significantly associated with patient satisfaction towards surgical service. ConclusionThe proportion of patient satisfaction towards surgical service was found to be low. Factors including age, educational status, history of previous surgical admission, length of stay in the hospital and elective admission for surgery were associated with patient satisfaction. This suggests that healthcare organizations should focus on providing patients with respectful and compassionate patient care approach while paying close attention to how patients are treated.Moreover, in order to provide patient-focused care, health care providers should strengthen their usage of patient characteristics including age, educational level, and type of surgery while developing patient focused care plan.

New horizons in managing older cancer survivors: complexities and opportunities

Older adults represent a growing population amongst cancer survivors who require specific consideration given the complex and largely unknown interactions between cancer-related concerns and age-related conditions. The increasing use of geriatric assessment (GA) has enabled oncologists to appropriately assess older patients' overall health status, personalise anti-cancer treatment and improve survival. However, whilst current research and practice focus on improving the management of older adults with cancer in the acute setting, the progress in the field of survivorship research in geriatric oncology is lagging. As cancer survivorship is a continuum, planning for a healthy survivorship should start at the time of cancer diagnosis. GA can play an important role in identifying potential survivorship issues and optimising delivery of survivorship care. A goal-directed, patient-focused geriatric survivorship care plan that involves a multidisciplinary team provides a framework for a personalised delivery of survivorship care in this patient group and there is a need for tailored interventions that support self-management and care integration. Research on the impact of cancer and its treatment on geriatric-specific outcomes needs to be prioritised through global initiatives to encompass a diverse and heterogenous population of adult cancer survivors.

A multidisciplinary team evaluation of management guidelines for adult short bowel syndrome

An international, multidisciplinary management working group (MWG) convened to review clinically useful short bowel syndrome (SBS) literature and identify gaps and inconsistencies in the management of adults with SBS. Using nominal group technique for literature review, key publications were identified, discussed, and ranked by importance related to management of SBS. Gaps in management recommendations for SBS were identified upon critical review of the selected publications. Five guidelines, seven review articles, one series of six articles, and one single center series were selected and prioritized for their importance to SBS management. Evaluation of the articles by the MWG identified ten gaps and opportunities to standardize and improve SBS management. The main practice areas in need of more definitive guidelines are the management of high stool output and strategies to improve absorption of medications, nutrients, and fluids. An understanding of current real-world clinical practices related to these gaps could allow for development of best practice standards and improve patient-focused care.

The digital redesign of mental health: leveraging connected digital technologies for agency-driven patient-focused care.

Digital psychiatry could empower individuals to navigate their context-specific experiences outside healthcare visits. This editorial discusses how leveraging digital health technologies could dramatically transform how we conceptualise mental health and the mental health professional's day-day practice, and how patients could be enabled to navigate their mental health with greater agency.

Comparing the effectiveness of Family Support for Health Action (FAM-ACT) with traditional community health worker-led interventions to improve adult diabetes management and outcomes: study protocol for a randomized controlled trial

BackgroundDiabetes self-management education and support (DSMES) programs have struggled to deliver sustainable, effective support for adults with diabetes (AWDs) to improve self-management behaviors, achieve glycemic goals, and reduce risk for complications. One largely untapped resource for this support is AWDs’ social networks. Fifty to 75% of AWDs have an unpaid family member or friend (“support person”) who provides ongoing help with diabetes management. However, DSMES interventions to date lack structured and effective approaches to directly engage support persons in AWDs’ diabetes management.MethodsThis parallel arm randomized trial is designed to determine the effectiveness of Family Support for Health Action (FAM-ACT), a novel community health worker (CHW)-delivered program focused on educating and supporting patients with type 2 diabetes (T2D) and their support persons (SPs), relative to an established, CHW-delivered, individual patient-focused DSMES and care management (I-DSMES) intervention. Both interventions were developed using a community-based participatory research (CBPR) approach.The study will be conducted in partnership with an urban Federally Qualified Health Center (FQHC) serving a low-income, Latino/a community, with target enrollment of 268 dyads consisting of an FQHC patient with T2D with high HbA1c and an SP. Patient-SP dyads will be randomized to receive FAM-ACT or I-DSMES over 6 months.The primary outcome is change in patient HbA1c from baseline to 6 months. Secondary patient outcomes include 12-month change in HbA1c, changes in patient blood pressure, diabetes self-management behaviors, diabetes distress, patient activation, diabetes self-efficacy, and perceptions of and satisfaction with SP support for diabetes. Secondary SP outcomes include self-efficacy for helping the patient with diabetes management and SP distress about the patient’s diabetes. We also will assess the effect of the COVID-19 pandemic on patient’s ability to manage diabetes.DiscussionThis study will inform scalable, evidence-based approaches that leverage family support to help AWDs improve and sustain self-management strategies that underpin optimal management of multiple diabetes complication risk factors. The protocol is designed for and evaluated with a low-income and predominantly Latino/a community, which may increase applicability to other similar communities. The COVID-19 pandemic presented several challenges to study protocol and intervention delivery; modifications made to address these challenges are described.Trial registrationClinicalTrials.gov NCT03812614. Registered on 18 January 2019.

Palliative radiation therapy pathway for patients on hospice in a statewide quality improvement collaborative.

201 Background: Patients on hospice receive care directed at alleviating symptoms with the goal of reducing burdensome and unnecessary healthcare. Single-fraction radiation therapy is an effective palliative treatment for cancer‐related bleeding. Hospice physicians and radiation oncologists are driven by the same goals of relieving symptoms and decreasing the burden of treatment. In general, hospices are not able to support the costs of providing palliative radiation in eligible patients. The inability to receive radiation therapy may pose a barrier to hospice enrollment. Methods: The Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly 90% of oncologists in Michigan, partnered with radiation oncologists, hospice directors, and patients and caregivers to create a pathway for the referral and treatment of patients with cancer-related bleeding. Through regular meetings, the collaboration created a pathway for patients on hospice or eligible for hospice who were candidates for palliative radiation therapy for bleeding. In patients with cancer-related bleeding, the hospice clinician collaborates with a participating radiation oncologist to confirm eligibility. This decreases the hospice costs of treatment, increases access to palliative radiation, and alleviates the financial and emotional burdens on the patient and family. Results: In Michigan radiation oncology practices and hospices with statewide representation approved the pathway. Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on MOQC website. In addition to this treatment pathway, the previously adopted palliative radiation pathway for oncology patients with bone metastases may be found on MOQC website. Conclusions: The radiation therapy pathway for patients with bleeding ensures a unified approach to providing a patient-focused care in patients with limited life expectancy. Challenges to the implementation of the pathway include dissemination of the document across over 100 Michigan hospices and the upfront effort required to screen patients.[Table: see text]

What matters most: Qualitative investigation of goals and values in a diverse sample of patients with advanced cancer.

252 Background: Goals of care conversations (GOCC) are a complex part of patient-focused care. Current understanding of GOCC content is limited to post-hoc patient satisfaction surveys and focus groups evaluating end-of-life advance care planning physician-patient interactions, and documentation. We investigated patient goals and values through standardized GOCC documentation by oncologists in patients with advanced cancer. Methods: This pilot qualitative analysis of patient goals and values included all adult patients &gt; 18 years with advanced recurrent or stage IV cancer seen at Kaiser Permanente San Francisco with an oncologist documented GOCC between 1/1/2022 to 5/14/22. Our team developed a templated GOCC automated phrase (Smartphrase) within our electronic medical record (EMR), with a selection tab that included a listing of common patient goals and values and an option to add free text. Team members reviewed each patient’s initial GOCC content was reviewed for frequently occurring themes consistent with goals and values. Results: A total of 178 patients had EMR documented GOCC, with a mean of 1.8 GOCC per patient. These patients were 51% (n = 94) female, with a median age of 68.5 years old. The population was racially diverse with 46% identifying as White, 32% Asian/Pacific Islander, 13% Black, 8% Hispanic/Latino, and 1% Other. The most common cancer types included breast (19%, n = 34), lower GI (16%, n = 29), and thoracic (14%, n = 25). Family members were present in 35% (n = 63) of GOCC. Table summarizes thematically grouped goals and values. Conclusions: Our findings highlight the importance of GOCC in routine oncology visits. Our standardized documentation tool for GOCC prompted medical oncologists to identify what matters most to patients with advanced or recurrent cancer regarding their values and goals related to care and quality of life. Among the wide range of responses, we identified that the most important goals and values to our patients include avoiding pain and suffering, physical independence, and living as long as possible. In contrast, patients rarely identified comfort-only treatment as a priority. This tool can guide goal-concordant care at initial onset of the cancer journey and be revisited as these conversations evolve over time. Future investigation is needed to understand how GOCC goals and values identified early impact patient satisfaction, change over time, influence treatment decisions, and potentially lead to an evolution in standard for goal-concordant care.[Table: see text]

Impact of the Coronavirus Disease 2019 Pandemic on Obstetric Interventions at a Public Hospital.

IntroductionIn response to the coronavirus disease 2019 (COVID-19) pandemic, health systems quickly implemented changes in care delivery with a goal of balancing patient-focused obstetric care with the need to protect pregnant persons and health care providers from infection. Yet, there is no consensus within the scientific community on the impact these measures have on obstetric outcomes in vulnerable populations. We aimed to assess the impact of the COVID-19 pandemic on rates of obstetric procedures and severe maternal morbidity (SMM) among births at an urban safety net institution.MethodsWe used an interrupted time series design to calculate risk ratios (RRs) and 95% confidence intervals (CIs) comparing monthly rates of labor induction, cesarean births (overall and among nulliparous, term, singleton, vertex births), operative vaginal births, and SMM among births occurring at a public hospital before (March 1, 2016, to February 29, 2020) and during (March 1, 2020, to May 31, 2021) the COVID-19 pandemic.ResultsThere were 10,714 and 2,736 births in the prepandemic and postpandemic periods, respectively. Overall, the rates of obstetric interventions and SMM were constant over the two time periods. There were no significant differences in rates of labor induction (42% during prepandemic period vs. 45% during pandemic period; RR, 1.12; 95% CI, 0.93–1.34), operative vaginal births (5% vs. 6%; RR, 1.24; 95% CI, 0.88–1.76), cesarean births (28% vs. 33%; RR, 1.10; 95% CI, 0.94–1.28), or nulliparous, term, singleton, vertex cesarean births (24% vs. 31%; RR, 1.27; 95% CI, 0.92–1.74). Rates of SMM (7% vs. 8%; RR, 1.19; 95% CI, 0.86–1.65) were also unchanged.ConclusionsOur findings indicate that the rapid implementation of measures to reduce viral transmission in the labor and delivery setting did not materially affect routine clinical management or rates of serious maternal complications.

Physicians Make the Best CEOs: Resource Utilization Before and During the COVID-19 Pandemic

Prior studies have shown that physician-led hospitals have several advantages over non-physician-led hospitals. This study seeks to test whether this continues to hold true during the COVID-19 Pandemic. We find that among top-rated hospitals, those that are physician-led achieve higher patient satisfaction ratings through patient-focused care and are more likely to have higher utilization rates. Two outcomes are an increase in patient willingness to recommend the hospital and an increase in Medicare reimbursements. While the COVID-19 Pandemic generated greater demand for inpatient beds, physician-led hospitals improved their hospitals’ operating efficiency as compared with those led by non-physician leaders, but CEO tenure did not have any effects on hospital utilization. Recruiting and retaining physicians to lead hospitals, especially during catastrophic times, is a strategy that makes sense. Implications for theory and practice and directions for future research are also provided.

"Incorporating a Gym Facility in a Lifestyle Medicine Practice for Patients with Diabetes Mellitus".

Incorporating a gym or fitness facility into a lifestyle-focused clinic is potentially one of the most critical facets of the patient-focused care, especially for those with obesity, cardiometabolic disease, and all types of diabetes mellitus. The evidence for prioritizing physical activity and exercise as medicine is well-researched and universally recommended as first-line therapy plus prevention of many chronic disease states. Having a fitness center on-site as part of any clinic could improve patient utilization, reduce barrier to entry, and decrease hesitation to engage in exercise like resistance training. While the conceptualization may seem simple, the pragmatic application and implementation takes proper planning. Developing such a gym will depend upon gym size preference, program development, cost, and available personnel. Thought needs to be put into deciding which type of exercise and ancillary equipment, ranging from aerobic or resistance machines to free weights, will be included and in what format. Fee and payment options should be carefully considered to assure the budget works financially for both the clinic and patient population. Finally, graphic examples of clinical gyms are described to convey the potential reality of such an optimal setting.

Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston

From the Front Lines| April 2022 Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston Shahla Siddiqui, MD, MSc, FCCM; Shahla Siddiqui, MD, MSc, FCCM Search for other works by this author on: This Site PubMed Google Scholar Vanessa T. Wong, BS; Vanessa T. Wong, BS Search for other works by this author on: This Site PubMed Google Scholar Mary Ellis, BSN, RN; Mary Ellis, BSN, RN Search for other works by this author on: This Site PubMed Google Scholar Tara S. Kent, MD, MS, FACS; Tara S. Kent, MD, MS, FACS Search for other works by this author on: This Site PubMed Google Scholar Michael J. Chen, BS; Michael J. Chen, BS Search for other works by this author on: This Site PubMed Google Scholar John D. Mitchell, MD John D. Mitchell, MD Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor April 2022, Vol. 86, 40–41. https://doi.org/10.1097/01.ASM.0000827012.35158.01 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Cite Icon Cite Get Permissions Search Site Citation Shahla Siddiqui, Vanessa T. Wong, Mary Ellis, Tara S. Kent, Michael J. Chen, John D. Mitchell; Interprofessional Teamwork in a Tertiary Referral Academic Hospital in Boston. ASA Monitor 2022; 86:40–41 doi: https://doi.org/10.1097/01.ASM.0000827012.35158.01 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: patient referral, work teams Our institution, Beth Israel Deaconess Medical Center (BIDMC) in Boston, is a teaching tertiary referral academic hospital of Harvard Medical School. There are 673 licensed beds, including 493 medical/surgical beds. There are 77 critical care beds and 62 OB/GYN beds. The perioperative nursing staff provides patient-focused care to the surgical patient population as well as surge ICUs during the pandemic. The patient population includes cardiothoracic, vascular, orthopedics, neurosurgery, transplant, general surgery, trauma, ENT, GYN, podiatry, GI, ophthalmology, cardiology, and urology patients on two campuses. A multidisciplinary team consisting of RNs and surgical and anesthesia teams provide perioperative patient care. The COVID-19 pandemic has wrought havoc among health care staff and the general population. Communication and teamwork among anesthesia providers, surgeons, and nurses can be key in the smooth transition and delivery of perioperative patient care and satisfaction. Therefore, interprofessional interaction and teamwork are valuable skills for our anesthesiology residents rotating... You do not currently have access to this content.

The agenda of the global patient reported outcomes for multiple sclerosis (PROMS) initiative: Progresses and open questions

On 12 September 2019, the global Patient Reported Outcome for Multiple Sclerosis (PROMS) Initiative was launched at the 35th Congress of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS). The multi-stakeholder PROMS Initiative is jointly led by the European Charcot Foundation (ECF) and the Multiple Sclerosis International Federation (MSIF), with the Italian Multiple Sclerosis Society (AISM) acting as the lead agency for and on behalf of the global MSIF movement. The initiative has the ambitious mission to (i) maximize the impact of science with and of patient input on the life of people affected by MS, and (ii) to represent a unified view on Patient-Reported Outcomes for MS to people affected by MS, healthcare providers, regulatory agencies and Health Technologies Assessments agencies. Equipped with an innovative participatory governance of an international and interdisciplinary network of different stakeholders, PROMS has the potential to guide future breakthroughs in MS patient-focused research and care. In this paper we present the progresses of the global PROMS Initiative and discuss the open questions that we aim to address.

Challenges perceived by nursing professionals in physician-centred organizations: An exploratory qualitative study.

To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance. Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere. A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist. Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses. These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession. This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right.

Effects of guided imagery relaxation in hematopoietic stem-cell transplantation patients: a quasi-experimental study.

To analyze the effects of the technique of virtual reality guided imagery in the vital signs of hematopoietic stem-cell transplantation patients. Quasi-experimental study with 35 participants who received an intervention using virtual reality guided imagery with progressive muscle relaxation, applied three times a week for four weeks in a referral hospital for transplants in the south of Brazil. Data collected included: temperature, arterial pressure, respiratory rate, heart rate, pain, and oxygen saturation, before and after each intervention. The comparisons were analyzed using Wilcoxon's test. There was a clinical significance between the mean measurements before and after for respiratory rate (p=0.00) in all stages, and for the variables Heart rate, Temperature, and Oxygen saturation from the 1st to the 12th measurements (p=0.05). The intervention was low cost, easy to apply, and showed positive effects, presenting itself as an option for patient-focused care.

BPM Support for Patient-Centred Clinical Pathways in Chronic Diseases.

Epidemiological trends over the past decade show a significant worldwide increase in the burden of chronic diseases. At the same time, the human resources of health care are becoming increasingly scarce and expensive. One of the management concepts that can help in solving this problem is business process management (BPM). The results of research conducted in the healthcare sector thus far prove that BPM is an effective tool for optimizing clinical processes, as it allows for the ongoing automatic tracking of key health parameters of an individual patient without the need to involve medical personnel. The aim of this article is to present and evaluate the redesign of diagnostic and therapeutic processes enabling the patient-centric organization of therapy thanks to the use of new telemedicine techniques and elements of hyperautomation. By using an illustrative case study of one of the most common chronic diseases, Chronic Obstructive Pulmonary Disease (COPD), we discuss the use of clinical pathways (CPs) prepared on the basis of the current version of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a communication tool between healthcare professionals, the patient and his or her caregivers, as well as the method of identifying and verifying new knowledge generated on an ongoing basis in diagnostic and therapeutic processes. We also show how conducting comprehensive, patient-focused primary health care relieves the health care system, and at the same time, thanks to the use of patient engagement and elements of artificial intelligence (predictive analyses), reduces the significant clinical risk of therapy.

Less Complexity in Hemodialysis Machines Reduces Time and Physical Load for Operator Actions.

PurposeInnovative hemodialysis systems are designed to ensure user safety and reduce operational time to allow health-care personnel to focus on patient care. The 6008 CareSystem has been developed to simplify the extracorporeal circuit of the system through a disposable cassette, automate operation steps, and facilitate handling in comparison to its predecessor — the 5008 CorDiax. The present investigations were performed with the aim of evaluating usability, safety, and ergonomic aspects of the new therapy system.MethodsA time–motion study compared these two hemodialysis systems with video and time recording of handling steps required to prepare, operate, and dismantle a dialysis machine. The ergonomic burden on hands and finger joints was evaluated in a second study, again by video-recording the simulated operation of both dialysis systems.ResultsThe number of handling steps required for the 6008 CareSystem and critical contact points were reduced by 26% in comparison to the 5008 CorDiax for patients with arteriovenous fistula used for vascular access and by 22% for those with a catheter used for vascular access. Total process time was reduced by 2.83 and 2.57 minutes using fistulae and catheters for vascular access, respectively. The number of hand grips and finger and thumb presses was reduced by approximately 50% and required less strength to execute.ConclusionThe most recent hemodialysis system confirmed its ease of use and user safety through fewer handling steps and less physical burden on the user. Shorter operational time should enable more patient-focused care.

Analysis of the Implementation of Patient Safety Culture with the AHRQ Model at Mitra Medika Hospital Tanjung Mulia Medan

Safety Culture is a collaborative environment where clinical staff treat one another with respect by involving or empowering patients and families so that each Professional provides patient-focused care. The purpose of this study was to determine the implementation of a patient safety culture with the AHRQ model in Mitra Medika Tanjung Mulia General Hospital Medan. This research uses a mix of methods, namely qualitative and quantitative. The population of this study were all staff on duty in each hospital unit associated with 450 patients at MItra Medika Hospital, so the sample was 75 people using simple random sampling technique. The main research informants were one officer each in each installation.Unit Mitra Medika Tanjung Mulia General Hospital Medan, namely 10 people, one key informant, and one triangulation informant.The results of the study show that the description of expectations and managerial actions of patient safety is 68%, organizational learning is 100%, cooperation in units is 76%, communication open by 80%, feedback about the error of 75%, the dimension of non-punitive response to errors is 55%,Staffing 51%, management support for patient safety efforts by 77%, cooperation between units of 61%, handsoff work and changing patients was 71%,the overall perception of hospital staff about patient safety was 63%, reporting frequency was 63%. With the research results, it is expected that Mitra Media Tanjung Mulia General Hospital Medan is expected to be able to initiate, maintain, and develop an ongoing patient safety program and implement the existing safety culture.

Perioperative Neurocognitive Screening Tools for At-Risk Surgical Patients.

Perioperative neurocognitive disorders are common after surgery and have serious socioeconomic impacts. Despite this, these disorders remain under-recognized and underdiagnosed. To facilitate detection and direct patients toward appropriate preventative interventions, assessment of cognition during the perioperative period is of critical importance. However, there are considerable barriers to the widespread clinical implementation of cognitive assessments, including a lack of consensus regarding the optimal tool for use in specific clinical scenarios. We provide an overview of the most widely used and validated cognitive assessment tools, including those that permit telemedicine-enabled patient encounters. No single tool is optimal for all contexts. This narrative review can help clinicians to identify the appropriate cognitive screening tool for their needs by describing the advantages and disadvantages of several available tools, thereby enabling the identification of patients at risk of cognitive decline and facilitating optimization of patient-focused perioperative care.

Practicing Defensive Medicine Benefits No one

Background: More doctors are practising defensive medicine, which may have an impact on patient care. This paper explores the consequences and reasons, for the widespread trend, and recommendations for patient-focused clinical care.&#x0D; Objective: A malpractice suit is the most scarring ordeal that a physician can undergo emotionally and financially. Excessive investigations may be counterproductive. Avoiding certain procedures or patients, for the fear of adverse outcome can be hazardous. There is a need for a better, discerning and judicious system, to minimise the trauma to the largely conscientious and dedicated medical professionals.&#x0D; Discussion&#x0D; How and when the term defensive medicine started, is difficult to trace. However, over the past few decades, it seems to be a well-known practice in industrialised countries. It may have been due to increasing complaints against doctors heralding potential litigation and malpractice suit. Most doctors do not take the privilege of the trust of their patients lightly and respond to it with utmost sincerity.