Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction
ABSTRACT Continuous care (one anaesthesiologist per patient) and anaesthesiologist empathy at the preoperative visit could affect patient anxiety and satisfaction. We tested both unproven issues in a population at increased risk of anxiety and dissatisfaction.
In this single-blinded single-centre study, 136 women undergoing gynaecologic day-care surgery were sequentially randomized into four groups: (i) preoperative visit by an anaesthesiologist with either an empathic or a neutral attitude, and (ii) receiving either continuous or divided care (preoperative visit and anaesthesia performed by two different anaesthesiologists). Preoperative anxiety and wish for information were rated before and after the preoperative visit. Patient appraisal of the anaesthesiologist's attitude and the quality of care provided was obtained in the operating theatre.
An empathic attitude at the preoperative visit significantly improved the perception of both the anaesthesiologist attitude (P<0.001) and the quality of information delivered (P<0.001), compared with a neutral anaesthesiologist attitude. Empathic attitude tended to decrease patient anxiety. In the operating theatre, patients who had the same anaesthesiologist (continuous care) exhibited greater satisfaction levels regarding anaesthesiologist behaviour and quality of care (P<0.001). Principal component analysis confirmed these findings, revealing that an empathic preoperative visit was linked to a reduction in preoperative patient anxiety.
The 'one patient, one anaesthesiologist' model, in addition to ensuring sufficient time for open discussion and questions at the preoperative visit, improved patient satisfaction.
SourceAvailable from: Radmilo Jankovic[Show abstract] [Hide abstract]
ABSTRACT: INTRODUCTION.Ruptured abdominal aortic aneurysm (AAA) is a life-threatening condition with an overall mortality rate of 65%. Massive haemorrhage requires infusion of fluids that do not contain clotting factors which develops dilutional coagulopathy. Rotational thrombelastometry (ROTEM) permits differential diagnosis of the underlying pathomechanism of coagulopathy. PCC showed much efficiency in the treatment of intraoperative massive bleeding . CASE REPORT. A 79-year-old man was addmited to Vascular Surgery Department, Clinical center in Nis as an emergency with the symptoms of AAA rupture. After resuscitation he was trasported to the operation room (Hgb: 45 g/L, HCT: 15%, BP: 80/40 mmHg). Massive infusion of crystalloids, colloids and plasma expanders kept the patient hemodinamically stable but led to dilutional coagulopathy. Transfusion of platelets, cryoprecipitate and fresh-frozen plasma (FFP) were provided together with tranexamic acid. Total blood loss during the surgery was 5L and 1.85L was returned to the patient by autotransfusion. Coagulation status was checked by ROTEM. The greatest deviation was found in the INTEM, CFT=3374s and α=12o (Picture 1) and in the EXTEM, CFT=169s and α=66o (Picture 2). After the infusion of 500IJ PCC, the results of INTEM went back to normal ranges (CFT=71s, α=76o) (Picture 3), as well as the results of EXTEM (CFT=71s, α=77o) (Picture 4). After the extensive operation, the patient spend 5 days in the Intensive care unit and was discharget from hospital after 26 days. CONCLUSION. PCC improves coagulation stability faster and more efficient than FFP without the risk of transfusion, volume load and infectious complications.XII SERBIAN CONGRESS OF ANESTHESIOLOGISTS&INTESIVISTS, Belgrade; 10/2014
[Show abstract] [Hide abstract]
ABSTRACT: PURPOSE: To review systematically the impact of clinicians' personality and observed interpersonal behaviors on the quality of their patient care. DATA SOURCES: We searched MEDLINE, EMBASE and PsycINFO from inception through January 2014, using both free text words and subject headings, without language restriction. Additional hand-searching was performed. STUDY SELECTION: The PRISMA framework guided (the reporting of) study selection and data extraction. Eligible articles were selected by title, abstract and full text review subsequently. DATA EXTRACTION: Data on study setting, participants, personality traits or interpersonal behaviors, outcome measures and limitations were extracted in a systematic way. RESULTS OF DATA SYNTHESIS: Our systematic search yielded 10 476 unique hits. Ultimately, 85 studies met all inclusion criteria, 4 on clinicians' personality and 81 on their interpersonal behaviors. The studies on interpersonal behaviors reported instrumental (n = 45) and affective (n = 59) verbal behaviors or nonverbal behaviors (n = 20). Outcome measures in the studies were quality of processes of care (n = 68) and patient health outcomes (n = 35). The above categories were non-exclusive. The majority of the studies found little or no effect of clinicians' personality traits and their interpersonal behaviors on the quality of patient care. The few studies that found an effect were mostly observational studies that did not address possible uncontrolled confounding. CONCLUSIONS: There is no strong empirical evidence that specific interpersonal behaviors will lead to enhanced quality of care. These findings could imply that clinicians can adapt their interactions toward patients' needs and preferences instead of displaying certain specific behaviors per seInternational Journal for Quality in Health Care 01/2008; 26(4):426-481. DOI:10.1093/intqhc/mzu055 · 1.58 Impact Factor
Conference Paper: ROLE OF BIOMARKERS IN CARDIAC RISK ASSESSMENT FOR NON-CARDIAC SURGERYXII SERBIAN CONGRESS OF ANESTHESIOLOGISTS&INTESIVISTS, Belgrade; 10/2014