Скачать презентацию A physiologic approach to scientific presentations Eugene H Скачать презентацию A physiologic approach to scientific presentations Eugene H

7f207dd9f21560342b9ba17398033cd2.ppt

  • Количество слайдов: 153

A physiologic approach to scientific presentations Eugene H. Blackstone, MD A physiologic approach to scientific presentations Eugene H. Blackstone, MD

Objectives (1) Essential preparation • How long do I have? • Who is my Objectives (1) Essential preparation • How long do I have? • Who is my audience? • What am I going to say? Text • A physiologic approach to oral scientific presentations

Objectives (2) Visuals • The good, the bad, and the ugly • What Yahoo! Objectives (2) Visuals • The good, the bad, and the ugly • What Yahoo! taught us Delivery • Presidential secrets for effective speeches Q&A • What questions do you have for my answers?

Who cares? See one, do one, teach one • Most scientific presentations are poor Who cares? See one, do one, teach one • Most scientific presentations are poor models • Principles of a good presentation are rarely taught • Most principles not intuitively obvious—until pointed out

Talks I have listened to… What I hated What I liked …and why! Talks I have listened to… What I hated What I liked …and why!

Essential Preparation Essential Preparation

Before writing the text… How long do I have? Who is my audience? What Before writing the text… How long do I have? Who is my audience? What is my message?

How long do I have? Short • Original research presentation • 5 to 10 How long do I have? Short • Original research presentation • 5 to 10 minute slide presentation • Selected on basis of abstract Long • Grand rounds, invited talk • 15 to 50 minutes (usually slides) • Assigned by organizers

How long do I have? Short • Original research presentation • 5 to 10 How long do I have? Short • Original research presentation • 5 to 10 minute slide presentation • Selected on basis of abstract Long Our et targ • Grand rounds, invited talk • 15 to 50 minutes (usually slides) • Assigned by organizers

Who is my audience? What can I assume they know? What are they not Who is my audience? What can I assume they know? What are they not likely to know?

What is my message? For short talk • 2 -3 sentences, often the conclusions What is my message? For short talk • 2 -3 sentences, often the conclusions Purpose of talk • To marshal evidence supporting your message…no more, no less! Utility • They dictate key points & order for objectives and results Typically takes ~ 3 hours

Text Text

Organizational Structure How were various talks you have heard organized? • Describe different types Organizational Structure How were various talks you have heard organized? • Describe different types • Evaluate effectiveness • What you liked, what you hated about organization How do you wish scientific talks were structured?

Physiologic Approach Ears • First hearing—listener doesn’t know what to expect • Has to Physiologic Approach Ears • First hearing—listener doesn’t know what to expect • Has to keep up—a serial process • Mind can’t wander or be distracted— but you are speaking at ½ speed of thinking (~114 wpm vs. ~ 300) • Relies on signposts you provide Make listening easy!

Easy Listening Structure clear • Purpose, results, conclusions in same order with same words Easy Listening Structure clear • Purpose, results, conclusions in same order with same words Just in time listening • Introduce nothing before it is needed Leave no loose ends • Wrap up prevents missing both current point and next point

Easy Listening One idea per sentence • Break into absorbable bites Semi-conversational • Balance Easy Listening One idea per sentence • Break into absorbable bites Semi-conversational • Balance formal vs. casual style • Active vs. passive Emphasize message • Complex methods and statistics loose audience if they are not central to the message

Easy Listening Connect with audience • Attitude, energy, motions Be plain • No bloat, Easy Listening Connect with audience • Attitude, energy, motions Be plain • No bloat, unnecessary jargon, or speaking in abbreviations Keep audience in the present • Pairs: on the one hand, on the other • Tee up comparisons, anticipation • Occasional pauses; change pace

Easy Listening A few specific observations • • • Things come in 3 s Easy Listening A few specific observations • • • Things come in 3 s Talk vs. medical writing Bookends Nuggets The end

Easy Listening Things come in 3 s • Let’s get started. Together. Today. • Easy Listening Things come in 3 s • Let’s get started. Together. Today. • I came. I saw. I conquered. • Of the people. For the people. By the people. • The good; the bad; the ugly

From Trees to Wood and Back Eugene H. Blackstone, MD From Trees to Wood and Back Eugene H. Blackstone, MD

Trees Patient Data Trees Patient Data

Information Collection of • Workflow documentation • Recorded observations • Materials Usually • Recorded Information Collection of • Workflow documentation • Recorded observations • Materials Usually • Recorded as narrative Usability • Low

Data Definition • Organized values for variables Expression • Symbolically (numbers, controlled vocabulary) Presentation Data Definition • Organized values for variables Expression • Symbolically (numbers, controlled vocabulary) Presentation • Can be summarized by descriptive statistics

Bases for Medical Practice Evidence-based medicine • Randomized trials • Crude guidelines for therapy Bases for Medical Practice Evidence-based medicine • Randomized trials • Crude guidelines for therapy Information-based medicine • Observational clinical data • Patient-specific therapy Personalized medicine • -omic studies + clinical data • Tailored (n=1) therapy

A talk is not a manuscript! IMRD structure • Introduction What question was studied? A talk is not a manuscript! IMRD structure • Introduction What question was studied? • Methods How was the question studied? • Results What was found? • Discussion What do the results mean?

IMRD Introduced • by Pasteur in 1870 s Neither • prose nor poetry A IMRD Introduced • by Pasteur in 1870 s Neither • prose nor poetry A roadmap • with standardized signposts

Why adopt IMRD? It is a standardized aid for… • Selective • Strategic …reading Why adopt IMRD? It is a standardized aid for… • Selective • Strategic …reading

Oops! Listening • Not reading • Not selective • Not strategic It’s serial! Oops! Listening • Not reading • Not selective • Not strategic It’s serial!

Early Listening—Bookends Story-telling • Once upon a time in a land far, far away… Early Listening—Bookends Story-telling • Once upon a time in a land far, far away… • …and they lived happily ever after!

Easy Listening Bookends • Capture attention immediately • What I am saying is important Easy Listening Bookends • Capture attention immediately • What I am saying is important to you! • Return to this at end: what it means to you!

Mitral anulus calcification: To debride or not to debride? Syed Tarique Hussain Mitral anulus calcification: To debride or not to debride? Syed Tarique Hussain

Mitral Anular Calcification Mitral Anular Calcification

Surgery for fungal infective endocarditis: A comparison with non-fungal cases Victor Chao Surgery for fungal infective endocarditis: A comparison with non-fungal cases Victor Chao

Aortic Stenosis Echo videos Aortic Stenosis Echo videos

Survival: LV Mass Index <100 g·m-2 % ≥ 185 g·m-2 Years Survival: LV Mass Index <100 g·m-2 % ≥ 185 g·m-2 Years

Don't Wait for Symptoms! Watch the Ventricle Residual Hypertrophy After Aortic Valve Replacement Jocelyn Don't Wait for Symptoms! Watch the Ventricle Residual Hypertrophy After Aortic Valve Replacement Jocelyn Beach

Easy Listening—Nuggets Objectives • The roadmap we’ll follow together Nuggets of discovery • They Easy Listening—Nuggets Objectives • The roadmap we’ll follow together Nuggets of discovery • They follow order of objectives • Include, if necessary, methods • Present results—what you have discovered • Discuss—wrap up the nugget

Example Fungal & non-fungal endocarditis Example Fungal & non-fungal endocarditis

Objectives Compare • Early and late outcomes of surgery for fungal and non-fungal endocarditis Objectives Compare • Early and late outcomes of surgery for fungal and non-fungal endocarditis Account for • Patient and disease characteristics

Early Outcomes Early Outcomes

Morbidity 40 Unadjusted Fungal Non-fungal 30 % 20 10 0 Stroke Respiratory Sepsis insufficiency Morbidity 40 Unadjusted Fungal Non-fungal 30 % 20 10 0 Stroke Respiratory Sepsis insufficiency

Problem: Patient Characteristics Differ Problem: Patient Characteristics Differ

Characteristics 100 Unadjusted 80 % Fungal Non-fungal 60 40 20 0 DM Stroke Renal Characteristics 100 Unadjusted 80 % Fungal Non-fungal 60 40 20 0 DM Stroke Renal COPD disease

39 Matched Pairs 39 Matched Pairs

Characteristics: Matched 100 Fungal Non-fungal 80 % 60 40 20 0 DM Stroke Renal Characteristics: Matched 100 Fungal Non-fungal 80 % 60 40 20 0 DM Stroke Renal COPD disease

Morbidity: Matched 40 Fungal Non-fungal 30 P=. 01 % 20 10 0 Stroke Respiratory Morbidity: Matched 40 Fungal Non-fungal 30 P=. 01 % 20 10 0 Stroke Respiratory Sepsis insufficiency

Late Outcomes Late Outcomes

Survival: Unadjusted 84 % 76 70 Nonfungal 62 51 Years 41 Fungal Survival: Unadjusted 84 % 76 70 Nonfungal 62 51 Years 41 Fungal

Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Fungal

Easy Listening—the Message What do you want to hear at the end of a Easy Listening—the Message What do you want to hear at the end of a talk?

Easy Listening—the Message Summary? • In short talk it shouldn’t be necessary Conclusions • Easy Listening—the Message Summary? • In short talk it shouldn’t be necessary Conclusions • Take home message • May include recommendations Clear ending • Bookend • Thank you!

Visuals (“slides”) with thanks to Yahoo! Visuals (“slides”) with thanks to Yahoo!

Critique some slides… Critique some slides…

• Reflective of the scarcity of resource, complexities of donor organ allocation and • Reflective of the scarcity of resource, complexities of donor organ allocation and increased number of patients awaiting cardiac transplantation, is the acuity of those undergoing the procedure. In 1988, 42. 2% of patients undergoing transplant were Status II, waiting at home. In 1994, only 38. 3% were called in from home.

References Belelli D, Lambert JJ, Peters JA, Wafford K, Whiting PJ: The interaction of References Belelli D, Lambert JJ, Peters JA, Wafford K, Whiting PJ: The interaction of the general anesthetic etomidate with the -aminobutyric acid type A receptor is influenced by a single amino acid. Proc Natl Acad Sci U S A 1997; 94: 11031– 6 Mihic SJ, Ye Q, Wick MJ, Koltchine VV, Krasowski MD, Finn SE, Mascia MP, Valenzuela CF, Hanson KK, Greenblatt EP, Harris RA, Harrison NL: Sites of alcohol and volatile anaesthetic action on GABA(A) and glycine receptors. Nature. 1997; 389: 385– 9 Jurd R, Arras M, Lambert S, Drexler B, Siegwart R, Crestani F, Zaugg M, Vogt KE, Ledermann B, Antkowiak B, Rudolph U: General anesthetic actions in vivo strongly attenuated by a point mutation in the GABAA receptor alpha-3 subunit. FASEB J 2003; 17: 250– 2

Type I has normal motion of the leaflets and mitral regurgitation is on the Type I has normal motion of the leaflets and mitral regurgitation is on the basis of the leaflet perforation or annular dilatation. type II dysfunction (increased leaflet motion) the free edge of the leaflet travels above the plane of the mitral annulus during systole due to chordal elongation or rupture. Type IIIa dysfunction implies restricted opening leaflet motion during diastole and systole due to rheumatic changes. Type IIIb dysfunction correlates to restricted leaflet motion during systole secondary to papillary muscle displacement

NSRT Volumes + LV Mass A 200 B End Diastolic Volume *p<0. 05 vs NSRT Volumes + LV Mass A 200 B End Diastolic Volume *p<0. 05 vs baseline Wall Thickness at Mitral Valve Level 90 ml mm 150 100 50 30 50 C 110 Baseline (96+19) (96+ 1 year (117+23*) (117+ 2 year (124+26*) (124+ Wall Thickness at Papillary Level *p<0. 05 vs baseline †p<0. 05 vs 1 year 90 70 D 50 *p<0. 05 vs baseline †p<0. 05 vs 1 year Baseline (72. 4+10. 5) (72. 4+ 1 year (57. 5+11*) (57. 5+ 2 year (51. 5+9*†) (51. 5+ 500 Left Ventricular Mass *p<0. 05 vs baseline †p<0. 05 vs 1 year 400 gm mm 70 300 200 30 100 Baseline (73+11) (73+ Mazur et al Circ 2001 1 year (59+8. 8*) (59+ 2 year (53+8. 7*†) (53+ Baseline (30+78) (30+ 1 year (223+52*) (223+ 2 year (190+58*†) (190+

Unadjusted Outcome for Selected Variables Stroke Variable Reoperation Emergency Aortic dissection Aortic aneurysm Aortic Unadjusted Outcome for Selected Variables Stroke Variable Reoperation Emergency Aortic dissection Aortic aneurysm Aortic atherosclerosis Aortic calcification Previous aortic graft Ascending aortic repair only Aortic arch** Descending aortic repair only Aortic valve procedure CABG Mitral Valve Replacement Hospital Mortality n No. % CL(%) P* No. 432 272 439 711 301 278 71 25 23 25 34 28 27 3 5. 8 8. 5 5. 6 4. 8 9. 3 9. 7 4. 2 4. 6 -7. 2 6. 7 -10. 6 4. 6 -7. 1 4. 0 -5. 8 7. 6 -11. 4 7. 9 -11. 9 -8. 3 . 8. 06. 7. 04. 008. 004. 8 41 39 50 49 23 26 5 802 415 44 25 5. 5 6 4. 7 -6. 4 4. 8 -7. 5 . 3 7. 9 107 770 474 12 43 36 11. 2 5. 6 7. 6 8. 0 -15 4. 7 -6. 6 6. 3 -9. 1 42 8 19 13 -27 % CL(%) P* 9. 5 14 11 6. 9 7. 6 9. 4 7. 0 8. 0 -11 12 -17 9. 8 -13 5. 9 -8. 0 6. 1 -9. 6 7. 5 -12 3. 9 -12 . 3 <. 0001. 006. 04. 6. 5. 8 56 40 7. 0 9. 6 6. 0 -8. 0 8. 1 -11 . 02. 3 . 02. 4. 08 14 4 42 13 6. 1 8. 9 9. 7 -17 5. 2 -7. 1 7. 5 -10 . 07. 0005. 6 . 0003 6 16 8. 6 -22 . 16 KEY: CABG, coronary artery bypass grafting; CL, confidence limits (68%) *P for presence of the variable in comparison to other patients with the variable absent **Only or in combinatin with ascending or descending aortic repair

End-systolic Wall Stress Baseline Acute Change Meridional Stress ESWS (103 dynes/cm 2) = 0. End-systolic Wall Stress Baseline Acute Change Meridional Stress ESWS (103 dynes/cm 2) = 0. 334 x P x LVID h(1 + h / LVID) 250 200 * P <0. 001 vs Control Acute Change P <0. 05 P <0. 001 150 100 * 50 0 Test (n=5) Control (n=4)

Results • Stroke 6. 1% (CL 5. 4% - 6. 8%) - AX/SCA+SG 4% Results • Stroke 6. 1% (CL 5. 4% - 6. 8%) - AX/SCA+SG 4% versus Other 6. 7% • P=. 05 (Propensity matched) • Hospital Mortality 8. 3% (CL 7. 6% - 9. 2%) - Femoral 11% versus AX/SCA+SG 7% • P=. 02 (Propensity matched)

Results Bicuspid Valves replace 6 repair 21 27 patients: 21 (78%) repaired, 6 (22%) Results Bicuspid Valves replace 6 repair 21 27 patients: 21 (78%) repaired, 6 (22%) replaced repaired patients: 17 male, 4 female (average 38. 4) replaced patients: 6 male (average 48. 5) repaired fusions: partial: RCC-LCC (14, 66%), RCC-NCC (2, 10%) complete: RCC-LCC (3, 0. 14%), RCC-NCC (2, 10%) replaced fusions: partial: RCC-LCC (3, 50%), RCC-NCC (2, 33%) complete: RCC-LCC (1, 0. 17%)

Can we do better than this? Can we do better than this?

Purpose What is the purpose of slides? Are they always needed? Must they be Purpose What is the purpose of slides? Are they always needed? Must they be visible all the time?

Purpose Who’s the driver? • The talk? • The slides? • Opinion: Ideas drive Purpose Who’s the driver? • The talk? • The slides? • Opinion: Ideas drive the visuals and not the reverse Entertainment? Parallel / supplemental information? Talk to the slides?

Color Background / foreground • Give audience a break! • Contrast, but not stark Color Background / foreground • Give audience a break! • Contrast, but not stark • Easiest on the eyes in dark room is darker background, lighter letters • Reverse for light room Example • Blue background • Yellow and white letters

Problem Colors Red • Can stand out • Can disappear--unpredictable Pastels • Can be Problem Colors Red • Can stand out • Can disappear--unpredictable Pastels • Can be perfect • Can be bland be indistinguishable from white

Background Keep it plain! • No distractions—nothing, absolutely nothing, extraneous on slide • Avoid Background Keep it plain! • No distractions—nothing, absolutely nothing, extraneous on slide • Avoid textured and watermarked backgrounds • If shading used: darker on top, lighter on bottom • Avoid “cute” transitions

• Reflective of the scarcity of resource, complexities of donor organ allocation and • Reflective of the scarcity of resource, complexities of donor organ allocation and increased number of patients awaiting cardiac transplantation, is the acuity of those undergoing the procedure. In 1988, 42. 2% of patients undergoing transplant were Status II, waiting at home. In 1994, only 38. 3% were called in from home.

Word Slides Use as few as possible • Simple graphs & simple figures more Word Slides Use as few as possible • Simple graphs & simple figures more effective • One thought “package” per slide • Avoid complete sentences & articles

Word Slides Layout • Avoid multiline titles • 3 or fewer major heads / Word Slides Layout • Avoid multiline titles • 3 or fewer major heads / slide • First level needs no bullet Implications • “One concept per slide” • Fewest possible words • Minimize depth of “indents”

MVRr with LV Reconstruction © © © The combination of LV reconstruction, MV repair, MVRr with LV Reconstruction © © © The combination of LV reconstruction, MV repair, and coronary revascularization provides significant reduction in LV volumes and improvement in LV ejection fraction Sustained for at least 1 year with a cardiac event free survival of 84% at the first year. MV repair, if successful, may prevent LV redilation, as patients with recurrent MR demonstrate increases in LV volumes and less functional improvement Importance of the mitral valve repair in patients with ischemic mitral regurgitation. Further studies are needed to address the causes and effects of recurrent MR in patients with LV reconstruction. Gillinov et. al. Circulation. 2003; 108[suppl II]: II-241 -II-246.

Summary: Protecting the Spinal Cord Diminish ischemia with distal perfusion Passive shunt Atrial-femoral bypass Summary: Protecting the Spinal Cord Diminish ischemia with distal perfusion Passive shunt Atrial-femoral bypass Femoral- femoral bypass with oxygenator Increase collateral flow - diminish ischemia Maintain proximal pressure Intrathecal papavarine Decrease intrathecal pressure CSF drainage ? Progressive occlusion of intercostals Protect cord during ischemia Cold Deep systemic hypothermic circulatory arrest Local (intrathecal) cold Pharmacologic intervention (papaverine, lidocaine, etc. ) Prevent post-operative ischemia Reimplantation of intercostal arteries

Myosplint Safety Studies • 20 patients implanted worldwide • 17 in Europe • 9 Myosplint Safety Studies • 20 patients implanted worldwide • 17 in Europe • 9 Myosplint sole therapy • 8 concomitant with mitral repair/replacement • 3 in the US • All concomitant with mitral repair

Word Slides Format • Keep words in same location, even if the slide looks Word Slides Format • Keep words in same location, even if the slide looks bare! • Avoid centering • Avoid unique spacing from slide to slide Rationale • Minimize work of audience!

Example Fungal & non-fungal endocarditis Example Fungal & non-fungal endocarditis

Another Later Example Cues • Identify before talking • Keep colors consistent Another Later Example Cues • Identify before talking • Keep colors consistent

Example Fungal & non-fungal endocarditis Example Fungal & non-fungal endocarditis

Another Later Example Cues • Identify before talking • Keep colors consistent Another Later Example Cues • Identify before talking • Keep colors consistent

Word Slides Font • Mixed upper- & lower case most readable • Sans serif Word Slides Font • Mixed upper- & lower case most readable • Sans serif • At the moment: Arial Font size • Minimum 32 point A new kid on the block! • Clearview

Creeping Cellulitis RCA LCx LVOT Creeping Cellulitis RCA LCx LVOT

Creeping Cellulitis RCA LCx LVOT Creeping Cellulitis RCA LCx LVOT

The problem with I Is it • Personal pronoun: I? • Letter after k: The problem with I Is it • Personal pronoun: I? • Letter after k: l? • Number one: 1?

Old & New: Clearview Old & New: Clearview

Clearview Highway Signs Clearview Highway Signs

Clearview Clearview

Physiologic Approach Minimize • Fewest words • Simplest graphs Visual order • Top to Physiologic Approach Minimize • Fewest words • Simplest graphs Visual order • Top to bottom • Left to right • Clockwise

Survival AVR % AVR + CABG Years Survival AVR % AVR + CABG Years

Patients 1990 to 2008 n = 2, 277 Left-sided Valve Lesion With Functional TR Patients 1990 to 2008 n = 2, 277 Left-sided Valve Lesion With Functional TR

40 Patient Characteristics Simple valve Allograft 30 % 20 10 0 Carotid PAD CAD 40 Patient Characteristics Simple valve Allograft 30 % 20 10 0 Carotid PAD CAD Re-op

Anterior Leaflet Repairs Ring Chordae: Transfer Shorten Artificial 0 20 40 60 80 100 Anterior Leaflet Repairs Ring Chordae: Transfer Shorten Artificial 0 20 40 60 80 100

TV Procedures Flexible ring Rigid ring 46% 7. 5% 26% 17% Edge-to-edge Peri. Guard TV Procedures Flexible ring Rigid ring 46% 7. 5% 26% 17% Edge-to-edge Peri. Guard 3. 5% de. Vega / Kay

TV Procedures Flexible ring Rigid ring 46% 26% 17% 7. 5% Edge-to-edge de. Vega TV Procedures Flexible ring Rigid ring 46% 26% 17% 7. 5% Edge-to-edge de. Vega / Kay 3. 5% Peri. Guard

Physiologic Approach Cues • Identify before talking • Keep colors consistent Physiologic Approach Cues • Identify before talking • Keep colors consistent

Morbidity: Matched Pts 40 Fungal Non-fungal 30 P=. 01 % 20 10 0 Stroke Morbidity: Matched Pts 40 Fungal Non-fungal 30 P=. 01 % 20 10 0 Stroke Respiratory Sepsis insufficiency

Survival: Matched Pts 80 % 69 62 51 P =. 5 Years 65 41 Survival: Matched Pts 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Fungal

Physiologic Approach Distractions • Minimize “entertainment” that can obscure message • No jumping slides Physiologic Approach Distractions • Minimize “entertainment” that can obscure message • No jumping slides • Non-obvious title centering

SURVIVAL BY AKINETIC/DYSKINETIC 100 0 DOR PROCEDURES 7/97 - 03/00 3 6 9 MONTHS SURVIVAL BY AKINETIC/DYSKINETIC 100 0 DOR PROCEDURES 7/97 - 03/00 3 6 9 MONTHS 12 15 18

SURVIVAL AND EVENT-FREE SURVIVAL DOR PATIENTS 7/97 - 03/00 100 0 3 6 9 SURVIVAL AND EVENT-FREE SURVIVAL DOR PATIENTS 7/97 - 03/00 100 0 3 6 9 MONTHS 12 15 18

0 3 6 9 MONTHS 12 15 18 0 3 6 9 MONTHS 12 15 18

Survival: Unadjusted 84 % 76 70 Nonfungal 62 51 Years 41 Fungal Survival: Unadjusted 84 % 76 70 Nonfungal 62 51 Years 41 Fungal

Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Fungal

Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Fungal

Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Survival: Matched 80 % 69 62 51 P =. 5 Years 65 41 Nonfungal Fungal

Tables Eliminate If information essential • Convert to graphical display If table can’t be Tables Eliminate If information essential • Convert to graphical display If table can’t be avoided • Everything on table must have a purpose • Everything must be discussed (That should cure you!)

Unadjusted Outcome for Selected Variables Stroke Variable Reoperation Emergency Aortic dissection Aortic aneurysm Aortic Unadjusted Outcome for Selected Variables Stroke Variable Reoperation Emergency Aortic dissection Aortic aneurysm Aortic atherosclerosis Aortic calcification Previous aortic graft Ascending aortic repair only Aortic arch** Descending aortic repair only Aortic valve procedure CABG Mitral Valve Replacement Hospital Mortality n No. % CL(%) P* No. 432 272 439 711 301 278 71 25 23 25 34 28 27 3 5. 8 8. 5 5. 6 4. 8 9. 3 9. 7 4. 2 4. 6 -7. 2 6. 7 -10. 6 4. 6 -7. 1 4. 0 -5. 8 7. 6 -11. 4 7. 9 -11. 9 -8. 3 . 8. 06. 7. 04. 008. 004. 8 41 39 50 49 23 26 5 802 415 44 25 5. 5 6 4. 7 -6. 4 4. 8 -7. 5 . 3 7. 9 107 770 474 12 43 36 11. 2 5. 6 7. 6 8. 0 -15 4. 7 -6. 6 6. 3 -9. 1 42 8 19 13 -27 % CL(%) P* 9. 5 14 11 6. 9 7. 6 9. 4 7. 0 8. 0 -11 12 -17 9. 8 -13 5. 9 -8. 0 6. 1 -9. 6 7. 5 -12 3. 9 -12 . 3 <. 0001. 006. 04. 6. 5. 8 56 40 7. 0 9. 6 6. 0 -8. 0 8. 1 -11 . 02. 3 . 02. 4. 08 14 4 42 13 6. 1 8. 9 9. 7 -17 5. 2 -7. 1 7. 5 -10 . 07. 0005. 6 . 0003 6 16 8. 6 -22 . 16 KEY: CABG, coronary artery bypass grafting; CL, confidence limits (68%) *P for presence of the variable in comparison to other patients with the variable absent **Only or in combinatin with ascending or descending aortic repair

Physiologic Approach Keep it natural • If a slide does not feel right, it Physiologic Approach Keep it natural • If a slide does not feel right, it probably is not right

CONCEPT OF COMPLETELY IMPLANTABLE LVAD Bert Kosserow 1960 “A power connection across the body CONCEPT OF COMPLETELY IMPLANTABLE LVAD Bert Kosserow 1960 “A power connection across the body wall is less than ideal since (1) infection, necrosis & air leaks may occur about the power line and (2)unanticipated traction of tension may produce tearing of tissue, bleeding & possible interruption of the power line itself. ”

CONCEPT OF COMPLETELY IMPLANTABLE LVAD “A power connection across the body wall is less CONCEPT OF COMPLETELY IMPLANTABLE LVAD “A power connection across the body wall is less than ideal since (1) infection, necrosis & air leaks may occur about the power line and (2)unanticipated traction of tension may produce tearing of tissue, bleeding & possible interruption of the power line itself. ” Bert Kosserow 1960

Delivery Delivery

Delivery Memorize? Read? Wing it? Delivery Memorize? Read? Wing it?

Cameron Speech Box Used • By presidents from at least Nixon through Clinton Cameron Speech Box Used • By presidents from at least Nixon through Clinton

Cameron Speech Box Format • 20 -point Times • Every sentence a paragraph • Cameron Speech Box Format • 20 -point Times • Every sentence a paragraph • Underscores for emphasis—not italics • Arrow for sliding paper to left

Delivery Let’s practice! Delivery Let’s practice!

The Future of Healthcare Delivery A View from Inside and Outside the Box The Future of Healthcare Delivery A View from Inside and Outside the Box

National Health Expenditure 4. 25 Trillion $ 3. 75 3. 25 2. 75 2. National Health Expenditure 4. 25 Trillion $ 3. 75 3. 25 2. 75 2. 25 1. 75 2007 2009 2011 2013 2015

Future of Healthcare Delivery 3 themes… • Importance of data • Importance of analytics Future of Healthcare Delivery 3 themes… • Importance of data • Importance of analytics • Importance of people …and their potential contribution to the future of healthcare delivery

A Christmas Carol “You don't believe in me, ” observed the Ghost. “I don't, A Christmas Carol “You don't believe in me, ” observed the Ghost. “I don't, ” said Scrooge. “What evidence would you have of my reality beyond that of your senses? ” “I don't know, ” said Scrooge…”

Lies, D…d Lies, & Statistics Lies, D…d Lies, & Statistics

Physiology of Delivery Eyes • Up at beginning of sentence • Down in middle Physiology of Delivery Eyes • Up at beginning of sentence • Down in middle • Up again at end Exceptions • Quotes: eyes down, eyes up when finished • Names & numbers: eyes up

Q&A With Thanks to Richard Butterfield Q&A With Thanks to Richard Butterfield

Q&A Characterize Q & A period you have liked Characterize those you have hated Q&A Characterize Q & A period you have liked Characterize those you have hated • • What is terrifying? What should you say? What shouldn’t you say? Is there a strategy here? ? ?

Q&A Reality, attitude, and opportunity • It is a part of your presentation Q&A Reality, attitude, and opportunity • It is a part of your presentation

Dangers Saying too much • Over-elaboration • Wandering off target Flubbing a question • Dangers Saying too much • Over-elaboration • Wandering off target Flubbing a question • …for which you are unprepared Loosing control • To hostile or aggressive questioning Promissory notes

Preparation Anticipation • Anticipate and prepare for questions You’re not alone • Get help Preparation Anticipation • Anticipate and prepare for questions You’re not alone • Get help from knowledgeable source Arm yourself • Against hostility

Mind Set You are not a schoolchild trying to please the teacher! • This Mind Set You are not a schoolchild trying to please the teacher! • This is your opportunity to drive home your message — to say what you want to say • Because it comes last, it constitutes the audience’s lasting impression of you

Learn from politicians… What questions do you have for my answers? • You don’t Learn from politicians… What questions do you have for my answers? • You don’t have to answer the question asked • Answer the question they should have asked • Answer most questions with something you have already said — repeat key messages

Learn from politicians… What questions do you have for my answers? • • There’s Learn from politicians… What questions do you have for my answers? • • There’s a bigger issue… What may not be apparent here… We have been more interested in… I’d like to return to what’s really important…

You! Confidence • You are the expert • You know what you know • You! Confidence • You are the expert • You know what you know • You know what you don’t know Danger • Not knowing what you don’t know!

You! Body language • Open posture • Sparkle a bit! • Pretend audience is You! Body language • Open posture • Sparkle a bit! • Pretend audience is your friend not your enemy

You! Tone & attitude • Confident • Inspired, informative, interactive • Address questioner at You! Tone & attitude • Confident • Inspired, informative, interactive • Address questioner at first, then deliver message to audience

You! Non-defensive • Deflect the “negative” questioner • Admit limitations • But!!! …drive toward You! Non-defensive • Deflect the “negative” questioner • Admit limitations • But!!! …drive toward a positive focus on what you have discovered

You! Golden Rule: Think of others • Don’t waste time • Make the point You! Golden Rule: Think of others • Don’t waste time • Make the point • Stop — let others ask a question

Caught off Guard! Buy yourself some time • Repeat question • Rephrase question to Caught off Guard! Buy yourself some time • Repeat question • Rephrase question to the way you want to answer it • Pause and think, answer deliberately and honestly • “I don’t have a good answer right now, but…” …transition to message, not a promissory note!

Special Situations Non-questions Hostile questioner There are no questions Special Situations Non-questions Hostile questioner There are no questions

The Non-Question Temptation • “Thank you for sharing your experience. ” Instead • Tie The Non-Question Temptation • “Thank you for sharing your experience. ” Instead • Tie it to your message

Hostile Questioner Manage the hostility • Correct clear false statements • Choose non-inflammatory terms: Hostile Questioner Manage the hostility • Correct clear false statements • Choose non-inflammatory terms: “limitation” not “fatal flaw” • Stay on track with message • No sarcasm — be careful about jokes • Stick to the truth, and nothing but the truth

No Questions! For shame! • The moderator is unprepared! Opportunity to reinforce message • No Questions! For shame! • The moderator is unprepared! Opportunity to reinforce message • “You may be wondering…” • “One question I’ve been thinking about…” This approach • Encourages audience to ask questions