Utilizing a Sedation Decision Aid in Ambulatory Venous Access Device Placement: Effects on Patient Choice,Workup, and Recovery Time

This study was undertaken to determine the influence of using a sedation decision aid when selecting a sedation option for totally implantable vascular access device placement on patient choice, workup, and recovery time. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 76 patients (aged 23-89 years, 58% female) presenting to a vascular interventional radiology department between January 2, 2017, and May 5, 2017. Patients were given a decision aid that inquired about personal values and goals, and provided information about expectations; benefits; and risks of the options, including undergoing the procedure with no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine), or moderate sedation (benzodiazepine and opiate). No sedation was selected by 15 out of 76 patients (19.7%), minimal sedation was selected by 26 out of 76 patients (34.2%), and moderate sedation was selected by 34 out of 76 patients (44.7%). Postprocedure recovery time differences were significant (P?<?.001) with a mean of 17.4 minutes for no sedation, 49.3 minutes for minimal sedation, and 70.8 minutes for moderate sedation. The use of a decision aid did not slow down the process because workup times were not significantly different: 15.9 minutes for no sedation, 22.1 minutes for minimal sedation, and 18.4 minutes for moderate sedation. Patient sedation preference for totally implantable vascular access device is variable, signifying there is a role for utilizing a decision aid because it empowers a patient to select the option most aligned with his or her goals. Influence on departmental flow is notable because this does not slow down the workup and a majority of patients choose no or minimal sedation, resulting in a decreased postprocedure recovery time burden.     

Perspectives of Patients and Providers in Using Shared Decision Making in Psychiatry

Community Mental Health Journal - There is increased interest over the last decade in the use of Shared Decision Making with individuals with serious mental illness to improve engagement in...     

Longitudinal Stability of Intellectual Functioning in Autism Spectrum Disorder: From Age 3 Through Mid-adulthood

Journal of Autism and Developmental Disorders - Intelligence (IQ) scores are used in educational and vocational planning for individuals with autism spectrum disorder (ASD) yet little is known...     

Do no harm: the role of perioperative heparin in urethroplasty

International Urology and Nephrology - To examine the safety of single modality mechanical venous thromboembolism (VTE) prophylaxis in patients undergoing urethroplasty. VTE is a perioperative...     

Human papilloma virus circulating tumor DNA assay predicts treatment response in recurrent/metastatic head and neck squamous cell carcinoma

Despite the rising incidence of human papillomavirus related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), treatment of metastatic disease remains palliative. Even with new treatments such as immunotherapy, response rates are low and can be delayed, while even mild tumor progression in the face of an ineffective therapy can lead to rapid death. Real-time biomarkers of response to therapy could improve outcomes by guiding early change of therapy in the metastatic setting. Herein, we developed and analytically validated a new droplet digital PCR (ddPCR)-based assay for HPV16 circulating tumor DNA (ctDNA) and evaluated plasma HPV16 ctDNA for predicting treatment response in metastatic HPV+ OPSCC. We found that longitudinal changes HPV16 ctDNA correlate with treatment response and that ctDNA responses are observed earlier than conventional imaging (average 70 days, range: 35–166). With additional validation in multi-site studies, this assay may enable early identification of treatment failure, allowing patients to be directed promptly toward clinical trials or alternative therapies.     

Salvage of locally recurrent breast cancer with repeat breast conservation using 45 Gy hyperfractionated partial breast re-irradiation

Breast Cancer Research and Treatment - Mastectomy has long been the preferred approach for local salvage of recurrent breast cancer following breast-conservation therapy (BCT). Growing interest in...