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Article ; Online: The need for patient decision aids in acute care settings.

Rosen, Joshua E / Flum, David R / Liao, Joshua M

2022 Volume 11, Issue 3, Page(s) 100639

MeSH term(s)	Humans ; Decision Making ; Decision Support Techniques
Language	English
Publishing date	2022-06-30
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2724773-9
ISSN	2213-0772 ; 2213-0764 ; 2213-0772
ISSN (online)	2213-0772 ; 2213-0764
ISSN	2213-0772
DOI	10.1016/j.hjdsi.2022.100639
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Article ; Online: Respiratory events after intensive care unit discharge in trauma patients: Epidemiology, outcomes, and risk factors.

Rosen, Joshua E / Bulger, Eileen M / Cuschieri, Joseph

The journal of trauma and acute care surgery

2021 Volume 92, Issue 1, Page(s) 28–37

Abstract: Background: Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of ...

Abstract	Background: Respiratory complications are associated with significant morbidity and mortality in trauma patients. The care transition from the intensive care unit (ICU) to the acute care ward is a vulnerable time for injured patients. There is a lack of knowledge about the epidemiology of respiratory events and their outcomes during this transition. Methods: Retrospective cohort study in a single Level I trauma center of injured patients 18 years and older initially admitted to the ICU from 2015 to 2019 who survived initial transfer to the acute care ward. The primary outcome was occurrence of a respiratory event, defined as escalation in oxygen therapy beyond nasal cannula or facemask for three or more consecutive hours. Secondary outcomes included unplanned intubation for a primary pulmonary cause, adjudicated via manual chart review, as well as in-hospital mortality and length of stay. Multivariable logistic regression was used to examine patient characteristics associated with posttransfer respiratory events. Results: There were 6,561 patients that met the inclusion criteria with a mean age of 52.3 years and median Injury Severity Score of 18 (interquartile range, 13-26). Two hundred and sixty-two patients (4.0%) experienced a respiratory event. Respiratory events occurred early after transfer (median, 2 days, interquartile range, 1-5 days), and were associated with high mortality (16% vs. 1.8%, p < 0.001), and ICU readmission rates (52.6% vs. 4.7%, p < 0.001). Increasing age, male sex, severe chest injury, and comorbidities, including preexisting alcohol use disorder, congestive heart failure, and chronic obstructive pulmonary disease, were associated with increased odds of a respiratory event. Fifty-eight patients experienced an unplanned intubation for a primary pulmonary cause, which was associated with an in-hospital mortality of 39.7%. Conclusion: Respiratory events after transfer to the acute care ward occur close to the time of transfer and are associated with high mortality. Interventions targeted at this critical time are warranted to improve patient outcomes. Level of evidence: Prognostic and Epidemiological study, level III.
MeSH term(s)	Critical Care/methods ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Needs Assessment ; Outcome and Process Assessment, Health Care ; Oxygen Inhalation Therapy/methods ; Patient Transfer/methods ; Patient Transfer/statistics & numerical data ; Respiration, Artificial/methods ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/mortality ; Respiratory Insufficiency/therapy ; Risk Factors ; Trauma Centers/statistics & numerical data ; Trauma Severity Indices ; United States/epidemiology ; Wounds and Injuries/mortality ; Wounds and Injuries/physiopathology ; Wounds and Injuries/therapy
Language	English
Publishing date	2021-07-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003362
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Article ; Online: Erratum to: Unrealistic optimism about treatment risks for acute appendicitis.

Rosen, Joshua E / Agrawal, Nidhi / Flum, David R / Liao, Joshua M

The British journal of surgery

2022 Volume 109, Issue 9, Page(s) 896

Language	English
Publishing date	2022-06-20
Publishing country	England
Document type	Published Erratum
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znac228
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Article ; Online: Unrealistic optimism about treatment risks for acute appendicitis.

Rosen, Joshua E / Agrawal, Nidhi / Flum, David R / Liao, Joshua M

The British journal of surgery

2022 Volume 109, Issue 5, Page(s) 405–407

MeSH term(s)	Acute Disease ; Appendicitis/surgery ; Humans ; Optimism ; Surveys and Questionnaires
Language	English
Publishing date	2022-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znac020
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Article ; Online: Verbal Descriptions of the Probability of Treatment Complications Lead to High Variability in Risk Perceptions: A Survey Study.

Rosen, Joshua E / Agrawal, Nidhi / Flum, David R / Liao, Joshua M

Annals of surgery

2021 Volume 277, Issue 4, Page(s) e766–e771

Abstract: Objective: To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception.: Background: Surgeons must communicate the ... ...

Abstract	Objective: To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception. Background: Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making. Methods: A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication. Results: Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea. Conclusion: Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.
MeSH term(s)	Adult ; Humans ; Appendicitis ; Probability ; Communication ; Informed Consent ; Surveys and Questionnaires
Language	English
Publishing date	2021-10-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0000000000005255
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Article ; Online: Development and Feasibility Testing of a Decision Aid for Acute Appendicitis.

Rosen, Joshua E / Yang, Frank F / Liao, Joshua M / Flum, David R / Kohler, Jonathan E / Agrawal, Nidhi A / Davidson, Giana H

The Journal of surgical research

2023 Volume 289, Page(s) 82–89

Abstract: Introduction: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are ... ...

Abstract	Introduction: Patients with acute uncomplicated appendicitis will be increasingly asked to choose between surgery and antibiotic management. We developed a novel decision aid for patients in the emergency department (ED) with acute appendicitis who are facing this choice. We describe the development of the decision aid and an initial feasibility study of its implementation in a busy tertiary care ED. Materials and methods: We conducted a prepost survey analysis comparing patients before and after standardized implementation of the decision aid. Patients were surveyed about their experience making treatment decisions after discharge from the hospital. The primary outcome measure was the total score on the decisional conflict scale (; 0-100; lower scores better). Results: The study included 24 participants (12 in the predecision aid period; 12 in the post period). Only 33% of participants in each group knew antibiotics were a treatment option prior to arriving at the ED. Prior to implementing the use of decision aid, only 75% of patients reported being told antibiotics were a treatment option, while this increased to 100% after implementation of the decision aid. The mean total decisional conflict scalescores were similar in the pre and post periods (mean difference = 0.13, 95% CI: -13 - 13, P > 0.9). Conclusions: This novel appendicitis decision aid was effectively integrated into clinical practice and helped toinform patients about multiple treatment options. These data support further large-scale testing of the decision aid as part of standardized pathways for the management of patients with acute appendicitis.
MeSH term(s)	Humans ; Decision Support Techniques ; Appendicitis/diagnosis ; Appendicitis/surgery ; Appendicitis/drug therapy ; Feasibility Studies ; Patient Participation ; Acute Disease ; Anti-Bacterial Agents/therapeutic use
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-04-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.03.028
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Article ; Online: Association Between Statewide Medicaid Opioid Policy and Postoperative Opioid Prescribing among Surgeons at a Large Safety-Net Hospital.

Zhang, Irene Y / Wong, Edwin S / Rosen, Joshua E / Gordon, Debra B / Flum, David R / Liao, Joshua M

Journal of the American College of Surgeons

2022 Volume 235, Issue 3, Page(s) 519–528

Abstract: Background: Restrictive state and payer policies may be effective in reducing opioid prescribing by surgeons, but their impact has not been well studied. In 2017, Washington Medicaid implemented an opiod prescribing limit of 42 pills, prompting a large ... ...

Abstract	Background: Restrictive state and payer policies may be effective in reducing opioid prescribing by surgeons, but their impact has not been well studied. In 2017, Washington Medicaid implemented an opiod prescribing limit of 42 pills, prompting a large regional safety-net hospital to implement a decision support intervention in response. We aimed to evaluate the effects on surgeons' prescribing. Study design: We retrospectively studied postoperative opioid prescribing (quantity of pills prescribed at discharge) to opioid-naïve surgical patients at a regional safety-net hospital from 2016 to 2020. We investigated associations between the policy and opioid prescribing by using interrupted time series analysis, adjusting for clinical and sociodemographic factors. Results: A total of 12,799 surgical encounters involving opioid-naïve patients (59% male, mean age 52) were analyzed. Opioids were prescribed for 75%. From 2016 to 2020, the mean prescribed opioid quantity decreased from 36 pills to 17 pills. In interrupted time series analysis, the Medicaid policy implementation was associated with an immediate change of -8.4 pills (95% CI -12 to -4.7; p < 0.001) per prescription and a subsequent rate of decrease similar to that prepolicy. In a comparison of changes between patients insured through Medicaid vs Medicare, Medicaid patients had an immediate change of -9.8 pills (95% CI -19 to -0.76; p = 0.03) after policy implementation and continued decreases similar to those prepolicy. No immediate or subsequent policy-related changes were observed among Medicare patients. Conclusion: In a large regional safety-net institution, postoperative opioid prescriptions decreased in size over time, with immediate changes associated with a state Medicaid policy and corresponding decision support intervention. These findings pose implications for surgeons, hospital leaders, and payers seeking to address opioid use via judicious prescribing.
MeSH term(s)	Aged ; Analgesics, Opioid/therapeutic use ; Female ; Humans ; Male ; Medicaid ; Medicare ; Middle Aged ; Pain, Postoperative/drug therapy ; Policy ; Practice Patterns, Physicians' ; Retrospective Studies ; Safety-net Providers ; Surgeons ; United States
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-08-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1097/XCS.0000000000000274
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Article: Association between Risk Communication Format and Perceived Risk of Adverse Events after COVID-19 Vaccination among US Adults.

Rosen, Joshua E / Chang, Sylvia Seo Eun / Williams, Spencer / Lee, Joy S / Han, DaHee / Agrawal, Nidhi / Joo, Joseph H / Hsieh, Gary / Reinecke, Katharina / Liao, Joshua M

Healthcare (Basel, Switzerland)

2023 Volume 11, Issue 3

Abstract: The format used to communicate probability-verbal versus numerical descriptors-can impact risk perceptions and behaviors. This issue is salient for the Coronavirus disease 2019 (COVID-19), where concerns about vaccine-related risks may reduce uptake and ... ...

Abstract	The format used to communicate probability-verbal versus numerical descriptors-can impact risk perceptions and behaviors. This issue is salient for the Coronavirus disease 2019 (COVID-19), where concerns about vaccine-related risks may reduce uptake and verbal descriptors have been widely used by public health, news organizations and on social media, to convey risk. Because the effect of risk-communication format on perceived COVID-19 vaccine-related risks remains unknown, we conducted an online randomized survey among 939 US adults. Participants were given risk information, using verbal or numerical descriptors and were asked to report their perceived risk of experiencing headache, fever, fatigue or myocarditis from COVID-19 vaccine. Associations between risk communication format and perceived risk were assessed using multivariable regression. Compared to numerical estimates, verbal descriptors were associated with higher perceived risk of headache (β = 5.0 percentage points, 95% CI = 2.0-8.1), fever (β = 27 percentage points, 95% CI = 23-30), fatigue (β = 4.9 percentage points, 95% = CI 1.8-8.0) and myocarditis (β = 4.6 percentage points, 95% CI = 2.1-7.2), as well as greater variability in risk perceptions. Social media influence was associated with differences in risk perceptions for myocarditis, but not side effects. Verbal descriptors may lead to greater, more inaccurate and variable vaccine-related risk perceptions compared to numerical descriptors.
Language	English
Publishing date	2023-01-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare11030380
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Article ; Online: Postneoadjuvant adjuvant chemotherapy in resected N1 non-small cell lung cancer with residual nodal disease.

Smithy, James W / Rosen, Joshua E / Gao, Sarah J / Kim, Anthony W

Journal of surgical oncology

2017 Volume 116, Issue 8, Page(s) 1193–1196

Abstract: Background and objectives: Nodal positivity following neoadjuvant chemotherapy in locally advanced non-small cell lung cancer (NSCLC) is considered a poor prognostic sign, but little data are available on the efficacy of adjuvant chemotherapy in these ... ...

Abstract	Background and objectives: Nodal positivity following neoadjuvant chemotherapy in locally advanced non-small cell lung cancer (NSCLC) is considered a poor prognostic sign, but little data are available on the efficacy of adjuvant chemotherapy in these cases. This analysis sought to determine whether adjuvant chemotherapy was associated with increased survival in NSCLC patients with residual N1 disease at resection. Methods: Patients from the National Cancer Database (NCDB) with cN1T1-2M0 NSCLC treated with neoadjuvant chemotherapy and definitive resection between 2006 and 2012 were identified. Treatment groups were defined as those receiving no additional therapy or adjuvant chemotherapy ± radiation after resection. Five-year overall survival (OS) was estimated for each group. Cox proportional hazard regression was used to estimate hazard ratios adjusting for demographic, clinical, and facility characteristics. Results: Among 90 eligible patients, 5-year OS was 43% and 56% for patients receiving adjuvant chemotherapy and no additional treatment, respectively (P < 0.56). With multivariable analysis, the estimated hazard ratio was 0.61 (95% CI: 0.61-2.64, P = 0.51) for adjuvant chemotherapy compared to no additional therapy. Conclusion: This analysis suggests that adjuvant chemotherapy is not associated with increased survival in NSCLC patients with pathologic N1 NSCLC following neoadjuvant chemotherapy and resection.
MeSH term(s)	Carcinoma, Non-Small-Cell Lung/mortality ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/therapy ; Chemotherapy, Adjuvant ; Humans ; Lung Neoplasms/mortality ; Lung Neoplasms/pathology ; Lung Neoplasms/therapy ; Neoadjuvant Therapy ; Neoplasm Staging ; Neoplasm, Residual ; Proportional Hazards Models ; Retrospective Studies
Language	English
Publishing date	2017-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	82063-5
ISSN	1096-9098 ; 0022-4790
ISSN (online)	1096-9098
ISSN	0022-4790
DOI	10.1002/jso.24779
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Article ; Online: Surface functionalization of silica nanoparticles with cysteine: a low-fouling zwitterionic surface.

Rosen, Joshua E / Gu, Frank X

Langmuir : the ACS journal of surfaces and colloids

2011 Volume 27, Issue 17, Page(s) 10507–10513

Abstract: Herein, we report on the functionalization of silica nanoparticles with a small molecule, the amino acid cysteine, in order to create a low-fouling zwitterionic surface for nanomedicine applications. The cysteine functionalization was shown to impart the ...

Abstract	Herein, we report on the functionalization of silica nanoparticles with a small molecule, the amino acid cysteine, in order to create a low-fouling zwitterionic surface for nanomedicine applications. The cysteine functionalization was shown to impart the particles with excellent stability in both salt and single-protein solutions of lysozyme (positively charged) and bovine serum albumin (negatively charged). Bare silica particles precipitated immediately in a lysozyme solution, while cysteine-functionalized particles were stable for 20 h. Furthermore, the particles displayed excellent long-term stability in solutions of human serum showing no aggregation over a period of 14 days. The functionalized particles also possess multiple reactive surface groups for further coupling reactions. We believe that the surface functionalization schemes described in this report represent a versatile and effective method of stabilizing nanoparticle systems in biological media for their use in a variety of therapeutic and diagnostic applications.
MeSH term(s)	Animals ; Biofouling/prevention & control ; Cattle ; Cysteine/chemistry ; Humans ; Ions/chemistry ; Molecular Structure ; Muramidase/chemistry ; Muramidase/metabolism ; Nanomedicine/methods ; Nanoparticles/chemistry ; Particle Size ; Serum Albumin, Bovine/chemistry ; Silicon Dioxide/chemistry ; Static Electricity ; Surface Properties
Chemical Substances	Ions ; Serum Albumin, Bovine (27432CM55Q) ; Silicon Dioxide (7631-86-9) ; Muramidase (EC 3.2.1.17) ; Cysteine (K848JZ4886)
Language	English
Publishing date	2011-09-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2005937-1
ISSN	1520-5827 ; 0743-7463
ISSN (online)	1520-5827
ISSN	0743-7463
DOI	10.1021/la201940r
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