Search Results (81)

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU staff should support parents in understanding their baby’s needs and in strengthening the parent–infant bond. Although many tools outline what parents should learn, there is a limited structured framework to monitor their involvement in the infant’s care. Tracking parental participation in daily caregiving activities could support professionals in effectively guiding families, ensuring a smoother transition to discharge. Aims: The aim of this study was to evaluate the adherence to and effectiveness of a structured tool for parental involvement in the NICU. This tool serves several key purposes: to track the progression and timing of parents’ autonomy in caring for their baby, to support parents in building caregiving competencies before discharge, and to standardize the approach of NICU professionals in promoting both infant care and family engagement. Methods: A structured template form for documenting parental involvement (“together TO-CARE template”, TTCT) was integrated into the computerized chart adopted in the NICU of Modena. Nurses were asked to complete the TTCT at each shift. The template included the following assessment items: parental presence; type of contact with the baby (touch; voice; skin-to-skin); parental involvement in care activities (diaper changing; gavage feeding; bottle feeding; breast feeding); and level of autonomy in care (observer; supported by nurse; autonomous). We evaluated TTCT uploaded data for very low birth weight (VLBW) preterm infants admitted in the Modena NICU between 1 January 2023 and 31 December 2024. Staff compliance in filling out the TTCT was assessed. The timing at which parents achieved autonomy in different care tasks was also measured. Results: The TTCT was completed with an average of one entry per day, during the NICU stay. Parents reached full autonomy in diaper changing at a mean of 21.1 ± 15.3 days and in bottle feeding at a mean of 48.0 ± 22.4 days after admission. The mean length of hospitalization was 53 ± 38 days. Conclusions: The adoption of the TTCT in the NICU is feasible and should become a central component of care for preterm infants. It promotes family-centered care by addressing the needs of both the baby and the family. Encouraging early and progressive parental involvement enhances parenting skills, builds confidence, and may help reduce post-discharge complications and readmissions. Furthermore, the use of a standardized template aims to foster consistency among NICU staff, reduce disparities in care delivery, and strengthen the support provided to families of preterm infants. Full article

Background/Objectives: Breastmilk offers numerous benefits for the health and development of preterm infants, while prolonged hospitalization may impair neurodevelopment. At our institution, the implementation of enhanced family-centered care (FCC) has enabled earlier discharge of preterm infants. This study aimed to assess the impact of early discharge on breastfeeding and breastmilk provision. Methods: This analysis is based on data from a prospective single-center longitudinal cohort study conducted from October 2020 to November 2023, involving six consecutive cohorts (one baseline and five intervention cohorts; n = 184). FCC was progressively enhanced across cohorts. The primary outcome of the main study was postmenstrual age (PMA) at discharge. In this secondary analysis, breastfeeding and breastmilk provision were assessed at four time points: 4 weeks postnatal age, at discharge, 4 weeks post-discharge, and at 3 months PMA. Results: From baseline to intervention cohort 5, the PMA at discharge declined significantly from 37.8 ± 2.1 to 35.7 ± 0.91 weeks (p = 0.03), while the percentage of infants necessitating home nasogastric tube feeding increased from 6.3% to 66.7% (p < 0.01). The proportion of breastmilk of daily feeding volume remained unchanged at 4 weeks postnatal age (0.66 ± 0.42 vs. 0.9 ± 0.28) and at discharge (0.6 ± 0.45 vs. 0.79 ± 0.36). At 4 weeks post-discharge, 65.8% vs. 62.5% of the infants were on partial or exclusive breastmilk (p = 0.91) feeding. Similarly, the percentage of exclusively breastfed infants at 4 weeks post-discharge (23.7% vs. 19.8%) and at 3 months PMA (20% vs. 28.6%) did not differ significantly between baseline and intervention cohort 5. Conclusions: Early discharge did not reduce breastmilk supply or exclusive breastfeeding. However, the persistently low rate of exclusive breastfeeding post-discharge highlights the need for additional support strategies during and after hospitalization. Full article

Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article

Background/Objectives: Patients undergoing open aortic and valvular surgery often experience postoperative deconditioning, yet research on the role of inpatient cardiac rehabilitation (CR) in this population remains limited. This study aimed to examine the effects of inpatient CR on muscle strength, mobility, psychological well-being, and quality of life in patients recovering from open aortic surgery. Methods: We conducted a retrospective study using the medical records of patients who participated in inpatient CR after open aortic surgery. Functional and psychological outcomes were evaluated using the Medical Research Council (MRC) sum score, Timed Up and Go (TUG) test, Five Times Sit-to-Stand test (5STS), Six-Minute Walk Distance (6MWD), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Patient Health Questionnaire-9 (PHQ-9), and the EuroQol-5D (EQ-5D). Pre- and post-rehabilitation scores were compared to assess changes in functional status, mobility, and quality of life. A post-discharge satisfaction survey was also analyzed. Results: A total of 33 patients were included. Significant improvements were observed in MBI (p < 0.001), MRC sum score (p < 0.001), 6MWD (p < 0.001), BBS (p < 0.001), TUG (p = 0.003), 5STS (p < 0.001), EQ-5D (p = 0.011), and PHQ-9 (p = 0.009) following inpatient CR. Patients with lower baseline mobility (6MWD ≤ 120 m) exhibited greater improvement in MBI (p = 0.034). Of the 33 patients, 26 completed the satisfaction survey; most reported high satisfaction, perceived health improvements, and willingness to recommend the program. Conclusions: Inpatient CR following open aortic and valvular surgery resulted in significant gains in muscle strength, mobility, psychological health, and overall quality of life. Patients with greater initial impairment demonstrated especially notable functional improvement, supporting the value of tailored CR in this population. Full article

Background: Hospitalization during the COVID-19 pandemic has been linked with increased psychological distress, cognitive impairment, and reduced quality of life (QoL). Posttraumatic stress symptoms (PTSS) and rumination may significantly influence QoL outcomes, yet the mechanisms underlying these effects remain poorly understood. Based on the Cognitive Aging Model, this study examines the mediating effects of cognitive and emotional functioning, loneliness, and posttraumatic growth (PTG) on the connection between PTSS/rumination and QoL among patients hospitalized with COVID-19, including the moderator effect of sex, time since discharge, and admission to the intensive care unit (ICU). Methods: A cohort of 258 patients previously hospitalized with COVID-19 as the primary or secondary diagnosis was assessed 6 to 24 months post-discharge. Participants completed validated self-report and neuropsychological assessments of PTSS, rumination, cognitive function, psychological morbidity (depression and anxiety), loneliness, PTG, and QoL. Path analysis and multigroup analysis were employed to assess mediating and moderating effects. Results: PTSS and rumination were associated with reduced physical and mental QoL, primarily via increased psychological morbidity, impaired cognitive functioning, loneliness, and reduced PTG. Rumination showed strong direct and indirect effects on multiple mediators. Only sex and time since discharge significantly moderated pathways, with women showing a strong association between rumination and cognitive impairment/loneliness, while the association between loneliness and mental QoL was significant only in men and in recently discharged patients. Conclusions: PTSS and rumination contribute negatively to QoL in post-discharged patients with COVID-19 through emotional, cognitive, and social pathways, influenced by sex and duration since discharge. The findings underscore the significance of comprehensive long-term care methods focused on cognitive rehabilitation, psychosocial sT, and social reintegration for COVID-19 survivors. Full article

A five-month-old female mixed-breed dog presented with a two-week history of polyuria, polydipsia, and vomiting. Clinical examination revealed poor body condition, growth retardation, pale oral mucous membranes, weak pulse, and prolonged capillary refill time. Laboratory findings included neutrophilic leukocytosis with a regenerative left shift, fasting hyperglycemia, elevated fructosamine, glycated hemoglobin, and β-hydroxybutyrate concentrations, while the acid–base balance remained normal. Canine-specific pancreatic lipase and trypsin-like immunoreactivity concentrations ruled out an underlying pancreatitis or exocrine pancreatic insufficiency, respectively. Urinalysis showed glycosuria and ketonuria. Supportive care included antibiotics and regular insulin administration. Abdominal ultrasonography identified a pancreatic cavity with a thick wall and mixed echogenic fluid. Ultrasound-guided drainage was performed without complications. Cytology confirmed a pancreatic abscess with pyogranulomatous inflammation, though the culture results were negative. The dog was discharged with intermediate-acting lente insulin. Follow-up ultrasonographic evaluations at 7, 14, and 21 days and 5 months post-drainage showed no recurrence. The diabetes remained well-controlled one year post-discharge. This case report describes the successful management of a dog with juvenile diabetes mellitus complicated by a pancreatic abscess, highlighting the effectiveness of percutaneous ultrasound-guided drainage combined with medical therapy. Full article

Background/Objectives: Vaccination is a key preventive measure against pneumococcal disease, but uptake rates remain low in high-risk populations. Limited information exists on pneumococcal vaccine uptake in individuals with a history of pneumococcal disease. This study aims to assess pneumococcal vaccine uptake and the factors associated with it in patients hospitalized for pneumococcal disease, before and after hospitalization, across time periods before, during, and after the COVID-19 pandemic. Methods: Data for patients aged ≥18 years who were hospitalized for pneumococcal disease between 2015 and 2024 were extracted from the Hospital Authority’s territory-wide electronic medical record database. The uptake of pneumococcal vaccines in subgroups aged 18–64 years and ≥65 years, with and without risk conditions, both before and after hospitalization for pneumococcal disease, was assessed, followed by multivariate analyses of the factors associated with vaccination uptake by logistic regression models. Results: This study included 5517 patients hospitalized for pneumococcal disease. Prior to hospitalization, the vaccination uptake among the eligible patients was 20.5%, with only 8.1% fully vaccinated, despite the majority (87.9%) having previous hospitalizations (subgroup medians 3–9 times) or outpatient clinic visits (subgroup median 61–107 times). After discharge, during a median follow-up of 1.85 years, almost all the eligible patients (98.4%) received subsequent inpatient (subgroup medians 3–4 times) and outpatient (subgroup medians 21–28 times) care, but only 32.2% of the eligible patients received the vaccine. Factors associated with increased vaccine uptake post-discharge included age ≥75 years (OR 1.6), ≥10 subsequent hospitalizations (OR 2.1), and ≥10 subsequent clinic visits (OR 55.9). Vaccination rates within 12 months post-discharge were significantly lower in the patients hospitalized during the COVID-19 pandemic (3.5%) compared to the baseline (11.6%) and post-COVID-19 (6.6%) periods. Conclusions: The uptake of the pneumococcal vaccine before hospitalization for pneumococcal disease was low and continued to be suboptimal post-discharge. Numerous vaccination opportunities were missed in both the inpatient and outpatient settings. These findings indicate a need to improve vaccination strategies. Full article

Background/Objectives: The inadequate management of postsurgical pain represents a major clinical issue, often leading to suboptimal outcomes in the immediate postoperative period and an increased risk of developing chronic postsurgical pain. The present study aimed to examine the relationship between postsurgical pain, mood, and the use of prescribed analgesics after total knee arthroplasty (TKA). Methods: This prospective observational explorative study enrolled 28 patients scheduled for TKA between February 2018 and March 2019. Using a digital experience sampling method (ESM) tool that included questions on pain, analgesic use, and both positive and negative effects, patients reported their current status up to ten times daily. The questions were administered over five days following postoperative discharge. Data analysis was performed using descriptive statistics and multilevel regression, accounting for the hierarchical structure of the data. Results: On 85.5% of the days post-discharge, the patients did not adhere to the prescribed acetaminophen regimen. Multilevel analyses revealed that the groups who overused or underused acetaminophen reported significantly heightened levels of pain. NSAIDs were generally underused. Post-discharge opioid use decreased over time, with no evidence of abuse. Overall, the non-adherent group reported lower mood levels and higher pain scores than the adherent group. Conclusions: Most patients did not adhere to the prescribed analgesics despite experiencing pain. Therefore, clinical interventions should prioritize identifying patient subtypes to tailor analgesic use effectively. This approach will facilitate the development and improvement of personalized acute postsurgical pain treatment protocols, ensuring more precise and effective pain management strategies for patients. Full article

Background/Objectives: Extrauterine growth restriction (EUGR) and exclusive breastfeeding (EBF) are critical factors influencing early post-discharge growth in preterm infants. Although EBF is recommended in Kangaroo Mother Care (KMC) programs, its association with early anthropometric recovery remains unclear. This study evaluated the association between EUGR at 40 weeks of corrected age and EBF at 40 weeks, 3 months, and 6 months with anthropometric growth and acute malnutrition in preterm infants during the first six months of corrected age. Methods: A retrospective longitudinal cohort study was conducted, including 117 preterm infants (≤34 weeks of gestation) enrolled in the KMC program. Changes in weight, length, and head circumference z-scores and the incidence of acute malnutrition were analyzed using generalized estimating equations (GEEs). EUGR was defined as weight <10th percentile at 40 weeks. Acute malnutrition was defined as a weight-for-length z-score ≤−2. Results: EUGR was observed in 23.9% of the infants. EBF prevalence was 53% at 40 weeks and 40% at three and six months, respectively. EBF at 40 weeks was associated with a reduced weight z-score (coefficient: −0.29; p = 0.030), EBF at 3 months increased the weight z-score (coefficient: 0.34; p = 0.014), and EBF at 6 months reduced the risk of acute malnutrition (coefficient: −1.02; p = 0.036). Infants with EUGR showed greater weight gain over time (coefficient: 0.37; p = 0.020) yet remained below their non-EUGR peers. Conclusions: EBF during the first six months post-discharge supports weight gain and reduces the risk of malnutrition. However, EBF at 40 weeks may not ensure the immediate recovery of weight. EUGR is a key determinant of early growth. Full article

This study explored the effectiveness of plasma-activated water (PAW), generated by a newly developed compact generator, for decontaminating foodborne bacteria in oyster meats. The generator effectively produced PAW with antibacterial activity when the water passed through the plasma reactor in a single cycle. The temperature of the PAW produced by the developed device did not exceed 40 °C, enabling its direct application to biological tissues immediately after production and discharge from the plasma reactor. The effects of flow rates and post-discharge times on key reactive species—including hydrogen peroxide, nitrite, and nitrate—were analyzed, along with pH and temperature. Freshly produced PAW can completely inhibit both E. coli and S. aureus in vitro, with a 5-log reduction within 5 min of treatment. Application to oyster meats led to an 86.6% and 87.9% inactivation of V. cholerae and V. parahaemolyticus, respectively. These research findings indicate that PAW generated using the developed compact flow-through generator holds promise as a food safety solution for households. The fact that complete foodborne pathogen elimination was not achieved emphasizes the need for further optimization. Full article

Chronic pain syndrome poses a significant challenge to healthcare systems worldwide, affecting millions of individuals and resulting in reduced quality of life and substantial socio-economic costs. This prospective, non-interventional, single-center study evaluated the effectiveness of a four-week interdisciplinary multimodal pain therapy (IMPT) program incorporating neuromuscular training with the HUBER^® 360 evolution device. The study included 66 patients diagnosed with chronic pain disorder, divided into an intervention group (n = 49) that completed weekly supervised HUBER^® 360 sessions and a control group (n = 17). Measurements were taken at four time points: day of admission (t1), during therapy (t2), at discharge (t3), and three months post-discharge (t4). The study assessed changes in psychological factors, pain intensity, postural control, and quality of life. The results show that this four-week therapy led to significant improvements in psychological factors such as depression, anxiety, and stress, and significantly reduced the subjects’ pain. The intervention group showed more pronounced improvements compared to the control group. These findings highlight the potential benefits of IMPT in managing chronic pain and improving both physical and psychological health outcomes. This study contributes to the ongoing development of chronic pain management strategies, emphasizing the importance of a multidisciplinary, patient-centered approach. Future research should explore the scalability of IMPT, stratify results based on demographic factors, and evaluate the long-term efficacy of adjunctive tools like the HUBER^® 360 device. Full article

Venous thromboembolism (VTE) is a relatively common condition that is the leading cause of preventable deaths in developed nations. VTE encompasses deep vein thrombosis (DVT) and pulmonary embolism (PE) and affects both hospitalized and non-hospitalized patients. When left untreated, VTE is associated with substantial morbidity and mortality; accurate risk assessment and appropriate prophylaxis programs are therefore vital, as overlooked risk factors of these processes can potentially result in misdiagnosis and inappropriate treatment of the condition, with associated complications. In this study, we aimed to assess the impact of active monitoring on VTE management practices among healthcare providers to improve patient outcomes at Imam Abdulrahman Al Faisal Hospital (IAFH) in Riyadh, Saudi Arabia, from April 2018 to July 2023. In this study, a longitudinal retrospective study design was utilized and data from 33,237 admitted patients were analyzed using a Statistical Process Control (SPC) chart to evaluate the relationship between VTE risk assessment, active monitoring, and patient outcomes. In total, 11 cases of hospital-acquired VTE were identified, with patients aged 18–40 years representing most cases (7 out of 11 cases) and a male predominance of 54.5%. The overall VTE incidence rate during the study period was 0.31%, or one case per 11,000 admissions, including four cases of PE and seven cases of DVT. The results of this study indicate that active monitoring through continuous education and regular patient rounds significantly improves adherence to VTE risk assessment and prophylaxis at IAFH. The researchers attributed the increased identification and timely reporting of VTE cases to vigilance by healthcare providers and not to a decline in the quality of care. A comprehensive multidisciplinary strategy for VTE management and continuous quality improvement can aid in reducing VTE-related morbidity and improve patient outcomes. Lastly, we recommend addressing the risk factors associated with the occurrence of hospital-acquired VTE and performing post-discharge follow-ups of patients. Full article

Background/Objectives: Older trauma patients experience increased in-hospital mortality due to the physiological challenges associated with aging and injury severity. However, limited data exist on long-term mortality rates beyond hospital discharge, particularly among severely injured elderly trauma patients. Understanding these outcomes is essential for improving clinical management and rehabilitation strategies. The objective of this study was to evaluate cumulative mortality rates (in-hospital, 28-day, 1-year, 2-year, and 3-year) in older trauma patients with an Injury Severity Score (ISS) ≥ 16. Independent risk factors for 1-year mortality were also identified. Methods: This retrospective cohort study included all trauma patients aged ≥ 65 years with ISS ≥ 16 admitted to the Emergency Department of our level 1 trauma center between January 2017 and December 2022. Demographic characteristics, injury patterns (Abbreviated Injury Scale (AIS) scores, ISS), and mortality rates were collected from electronic health records. Patients were stratified into two age groups: 65–80 years and >80 years. Mortality rates were compared with those in the corresponding age groups in the general Swiss population. Statistical analysis included Kaplan–Meier survival curves and logistic regression for identifying risk factors associated with 1-year mortality. Results: A total of 1189 older trauma patients with a mean ISS of 24.3 ± 7.9 were included. The most common injury was severe head trauma (AIS head ≥ 3: 70.6%), followed by chest trauma (AIS chest ≥ 3: 28.2%) and extremity injuries (AIS extremity ≥ 3: 17.4%). The overall in-hospital mortality rate was 10.3%. Mortality rates at 28 days, 1 year, 2 years, and 3 years were 15.8%, 26.5%, 31.5%, and 36.3%, respectively. Age-stratified analysis showed significantly higher mortality rates in patients aged > 80 years compared to the 65- to 80-year group at all post-discharge time points (28-day: 22.6% vs. 11.9%, p < 0.001; 1-year: 39.9% vs. 18.8%, p < 0.001; 2-year: 46.5% vs. 22.8%, p < 0.001; 3-year: 56.4% vs. 24.9%, p < 0.001). Compared to the general Swiss population, we observed significantly higher mortality rates at all measured time points in elderly trauma patients, particularly in those aged over 80 years, with 1-year mortality rates of 39.9% vs. 10% in the general population and 3-year mortality rates of 56.4% vs. 30% in the general population. Independent risk factors for 1-year mortality included advanced age and severe head injury (AIS head ≥ 3, p < 0.001). Conclusions: Severely injured elderly trauma patients face high long-term mortality risks, with 1-year mortality rates reaching 26.5% overall and nearly 40% in patients aged > 80 years. These findings highlight the need for research on tailored, holistic management strategies, including comprehensive in-hospital care, specialized neurorehabilitation, and post-discharge follow-up programs to improve survival and functional recovery in this vulnerable population. Full article

Background and Objectives: Pediatric patients with complex medical conditions, including neurological impairments, genetic syndromes, dysphagia, and malnutrition, often face feeding difficulties that require enteral nutrition support. The optimal technique for gastrostomy tube (GT) placement in children remains unclear, with options such as laparoscopic gastrostomy and percutaneous endoscopic gastrostomy (PEG) being compared in previous studies. This study evaluates outcomes, including complications and caregiver satisfaction, associated with different GT placement techniques in pediatric patients, focusing on the impact of concomitant anti-reflux surgery (fundoplication). Materials and Methods: This retrospective analysis of 71 children (34 with anti-reflux surgery [Group 1], 37 without [Group 2]) undergoing GT placement between 2019 and 2024. Data included demographics, procedural details, complications, and caregiver satisfaction assessed via the Structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8). Results: A total of 71 patients (34 in Group 1, 37 in Group 2) were included in the final analysis. The mean age at the time of the procedure was 5.0 ± 1.1 years, with cerebral palsy being the most common underlying condition. Laparoscopic GT was performed in 97% of cases (69/71), with two percutaneous endoscopic gastrostomy (PEG) placements. Common complications included suppuration (32.35% Group 1 vs. 21.62% Group 2, p = 0.88) and infection (5.88% vs. 2.70%, p = 0.67). There were no significant differences between groups in terms of complication rates, although patients in Group 1 had longer hospitalization durations (7.51 ± 3.56 days vs. 4.22 ± 2.13 days, p < 0.005). Caregiver satisfaction, as assessed by the SAGA-8, was high, with 84.5% of families reporting positive outcomes. Factors influencing satisfaction included previous aspiration pneumonia and the use of home blenderized diets post-discharge. Conclusions: Both laparoscopic and PEG techniques are associated with low complication rates and high caregiver satisfaction in pediatric patients requiring gastrostomy placement. The laparoscopic approach may be preferred for patients undergoing concomitant fundoplication. Full article

Background/Objectives: To map and analyze patient expectations regarding communication in IC and identify communication that both heightens anxiety in the IC process and reduces anxiety in the IC process before surgery. Methods: Ethics approval was granted. A power analysis indicated a required sample of 90 patients. A conjoint-based experimental design was performed, post-discharge, overcoming typical biases of surveys. Results: The sample comprised 104 patients who underwent surgery in the last year. Three verbal communication messages were perceived as significantly decreasing pre-operative anxiety for the total sample. Mathematical clustering yielded three distinct mindsets. Post hoc ANOVA indices indicated that the mindsets were significantly different. Patients belonging to each mindset differed from patients belonging to other mindsets in their expectations from the dialogue with surgeons to mitigate their anxiety. Mindset 1 (70% of the sample) comprised patients who expected information that was tailored to their specific situation. To feel safer, they needed to know that nothing unexpected would happen. Mindset 2 (13%) comprised patients who expected providers to talk with them about benefits and risks at the clinic, not at the hospital, and have a dialogue with them. Mindset 3 (17%) comprised patients who perceived a lack of information regarding the purpose of signing the informed consent and lack of sufficient time to thoroughly read the form or signing the form minutes before the procedure as elements that would heighten their anxiety. Conclusions: Three verbal communication messages in the IC dialogue were thought to decrease pre-operative anxiety for all patients, as follows. “I want to make sure you read and understand the consent form entirely” “Everything is provided in clear and simple terms”. The surgeon says, “Let’s go over the entire form”. Full article