Preoperative Needs-Based Education to Reduce Anxiety, Increase Satisfaction, and Decrease Time Spent in Day Surgery: A Randomized Controlled Trial

Investigating the impact of patient-centered peer counseling on anxiety and pain among burn patients: A randomized controlled trial

OBJECTIVE

Pain and anxiety are common complications in burn patients, significantly impacting treatment effectiveness and overall patient well-being. Peer counseling, a form of patient education provided by individuals with shared experiences, may hold potential to alleviate this pain and anxiety. This study seeks to investigate the effectiveness of patient-centered education through peer counseling on background pain and state anxiety levels in these patients.

METHODS

A two-arm, parallel, randomized, controlled trial design was employed. A total of 86 participants were randomly allocated to one of two groups: control and intervention groups. State anxiety and background pain levels were assessed using the Spielberger State Anxiety Inventory (STAI) and Visual Analogue Scale (VAS), respectively, before and after intervention. Statistical analyses, including Chi-square test, Fisher's exact test, independent t-test, and paired t-test, were employed to analyze the data.

RESULTS

The intervention significantly reduced pain and anxiety in the intervention group compared to baseline (p < .001). There was no significant difference between the control and intervention groups in baseline levels, but there was a significant difference after the intervention (p < .001).

CONCLUSION

This study demonstrates the efficacy of patient-centered education through peer counseling in reducing background pain and state anxiety levels in burn patients. Compared to standard education, peer counseling led to a more pronounced reduction in both pain and anxiety, suggesting its potential as a valuable nonpharmaceutical intervention to improve patient well-being during burn recovery.

PRACTICE IMPLICATIONS

Based on our findings, we recommend that healthcare providers consider implementing peer-based education programs in burn care settings.

The Effect of Different Education Methods Before Invasive Urodynamics on Patients' Anxiety, Pain, Readiness and Satisfaction Levels: Randomized Controlled Clinical Trial

BACKGROUND

Urodynamic testing is an invasive procedure that causes pain and anxiety. Patient education is an evidence-based nursing intervention that relieves pain and anxiety and increases patient satisfaction.

AIMS

This study was carried out to compare the effects of different education methods utilized before a urodynamic testing procedure on patients' pain, anxiety, readiness for the procedure, and satisfaction.

METHODS

The study is a randomized controlled clinical trial. Participants (n = 80) were randomly assigned to four groups. While patients in the control group were provided with routine clinical information, patients in the intervention group were given education with brochures, videos, and brochure-supported videos. The research data were collected by using a Data Collection Form with items about participants' descriptive characteristics, the Visual Analog Scale, and the State Anxiety Inventory.

RESULTS

It was determined that pain expectation before urodynamics and the severity of pain during urodynamics were lower in intervention groups than in the control group. Pain expectation before urodynamics was lower in the brochure-supported video education group than in the brochure education group. Anxiety levels were lower and satisfaction levels were higher in the video education and brochure-supported video education groups than in the control and brochure education groups.

CONCLUSIONS

Of the methods utilized, it was determined that the most effective one was brochure-supported video education as it affected all parameters positively.

What Matters to Patients on the Day of Surgery-A Flash Mob Study

PURPOSE

To explore what matters to patients on the day of surgery, to describe how a flash mob study was conducted in a perioperative setting and to provide recommendations for future studies adopting the flash mob design.

DESIGN

Flash mob study.

METHODS

On June 6 to June 7, 2023, a 24-hour flash mob study was carried out in eight Danish perioperative units. Eligible for inclusion were adult patients scheduled for elective or acute surgery. After giving informed consent, patients answered two qualitative questions: what mattered to them on the day of surgery, and whether the staff were aware of this. Data were analyzed using content analysis. Patient characteristics were presented using descriptive statistics.

FINDINGS

Patients expressed a need to feel safe and cared for, be informed, and to receive proper anesthesia and postoperative care. Twenty-nine percent had not told health care staff, most often because they had not been asked about what mattered to them and because they did not want to be a nuisance.

CONCLUSIONS

The flash mob study was feasible and provided insight into patients' perspectives on the day of surgery. To gain insight into what matters on the day of surgery, health care professionals must actively ask patients. Furthermore, the flash mob proved to be an opportunity to create attention to what matters to patients on the day of surgery.

Management of Patients with Colorectal Cancer through Fast-Track Surgery

Colorectal cancer (CRC) is the third most common cancer in men and the second most common in women globally. CRC is considered a priority public health issue due to its incidence and the high associated costs. Surgery is the predominant therapeutic approach for CRC. Given the involvement of the intestinal tract in the surgical process, there is a significant increase in postoperative morbidity rates, and the average length of hospital stay (LOS) tends to lengthen. In this research, we employed the Lean Six Sigma (LSS) methodology, specifically utilizing the DMAIC cycle, to identify and subsequently examine the effects of fast-track surgery on hospitalization times for interventions related to CRC at the AORN "Antonio Cardarelli" Hospital in Naples (Italy). The process analysis, guided by the DMAIC cycle, facilitated a reduction in the median LOS from 14 days to 12 days. The most notable improvement was observed in the 66-75 age group without comorbidities. The LSS approach provides methodological rigor, as previously recognized, enabling substantial enhancements to the process. This involves standardizing outcomes, minimizing variability, and achieving an overall reduction in the LOS from 14 to 12 days.

Association of quality of life with marital satisfaction, stress, and anxiety in middle-aged women

Background

Marital satisfaction is one of the important components of quality of life. Women's marital satisfaction is affected when they enter the middle age period, due to the mental and emotional tensions caused by the physical changes. In this regard, the present study aimed to investigate the association of quality of life with marital satisfaction, stress, and anxiety in middle-aged women referring to health centers of Ahvaz city, Iran.

Methods

This cross-sectional descriptive-analytical study was conducted on 1,000 middle-aged married women (30-59 year of age) under the auspices of health centers of Ahvaz city, Iran in 2019. The subjects were selected by simple random sampling method, and were asked to complete demographic characteristics, quality of life questionnaire, Enrich marital satisfaction questionnaire, Holmes-Raheh stress questionnaire, and Spielberger state-trait anxiety inventory. The data were analyzed by using SPSS 0.22 software through mean, standard deviation, frequency, Pearson correlation and regression (p = 0.05).

Results

Based on the results, 42.4% of the participants were between 40 and 50 years of age, 35.6% had a high school diploma, and 50% of them were housewives. Also, the results of Pearson's correlation showed a positive and significant relationship between quality of life and marital satisfaction (r = 0.178) (p < 0.001). However, quality of life had a negative and significant relationship with anxiety (r = -0.552) (r < 0.001) and stress (r = -0.188) (p < 0.001).

Conclusion

Given the positive and significant relationship between quality of life and marital satisfaction, appropriate trainings are highly recommended for couples to increase the quality of life and marital satisfaction of middle-aged women and thus strengthen the health of family and society.

Clinical Accuracy, Relevance, Clarity, and Emotional Sensitivity of Large Language Models to Surgical Patient Questions: Cross-Sectional Study

This cross-sectional study evaluates the clinical accuracy, relevance, clarity, and emotional sensitivity of responses to inquiries from patients undergoing surgery provided by large language models (LLMs), highlighting their potential as adjunct tools in patient communication and education. Our findings demonstrated high performance of LLMs across accuracy, relevance, clarity, and emotional sensitivity, with Anthropic's Claude 2 outperforming OpenAI's ChatGPT and Google's Bard, suggesting LLMs' potential to serve as complementary tools for enhanced information delivery and patient-surgeon interaction.

Preoperative Education is Associated with Adherence to Downstream Components and Outcomes in a Colorectal Surgery Enhanced Recovery Program

Objective

This study evaluated the association between preoperative education and adherence to downstream components of enhanced recovery programs (ERPs) and surgical outcomes among patients undergoing elective colorectal surgery.

Background

ERPs improve outcomes for surgical patients. While preoperative education is an essential component of ERPs, its relationship with other components is unclear.

Methods

This was a retrospective cohort study of all ERP patients undergoing elective colorectal surgery from 2019 to 2022. Our institutional ERP database was linked with American College of Surgeons National Surgical Quality Improvement Program data and stratified by adherence to preoperative education. Primary outcomes included adherence to individual ERP components and secondary outcomes included high-level ERP adherence (>70% of components), length of stay (LOS), readmissions, and 30-day complications.

Results

A total of 997 patients were included. The mean (SD) age was 56.5 (15.8) years, 686 (57.3%) were female, and 717 (71.9%) were white. On adjusted analysis, patients who received preoperative education (n = 877, 88%) had higher adherence rates for the following ERP components: no prolonged fasting (estimate = +19.6%; P < 0.001), preoperative blocks (+8.0%; P = 0.02), preoperative multimodal analgesia (+18.0%; P < 0.001), early regular diet (+15.9%; P < 0.001), and postoperative multimodal analgesia (+6.4%; P < 0.001). High-level ERP adherence was 13.4% higher (P < 0.01) and LOS was 2.0 days shorter (P < 0.001) for those who received preoperative education. Classification and regression tree analysis identified preoperative education as the first-level predictor for adherence to early regular diet, the second-level predictor for LOS, and the third-level predictor for ERP high-level adherence.

Conclusion

Preoperative education is associated with adherence to ERP components and improved surgical outcomes.

Post-abortion needs-based education via the WeChat platform to lessen fear and encourage effective contraception: a post-abortion care service intervention-controlled trial

OBJECTIVE

Our study aims to investigate post-abortion needs-based education via the WeChat platform for women who had intended abortion in the first trimester, whether they are using effective contraception or becoming pregnant again.

DESIGN

This single hospital intervention-controlled trial used a nearly 1:1 allocation ratio. Women who had intended abortions were randomly assigned to a Wechat group (needs-based education) and a control group (Traditional education). The women's ability to use effective contraception was the main result. Whether they unknowingly became pregnant again was the second result. Another result was patient anxiousness. Before and after education, women filled out questionnaires to assess their contraception methods and anxiety.

METHODS

Based on the theoretical framework of contraceptions of IBL (inquiry-based learning), post-abortion women were included in WeChat groups. We use WeChat Group Announcement, regularly sending health education information, one-on-one answers to questions, and consultation methods to explore the possibilities and advantages of WeChat health education for women after abortion. A knowledge paradigm for post-abortion health education was established: From November 2021 until December 2021, 180 women who had an unintended pregnancy and undergone an induced or medical abortion were recruited, their progress was tracked for four months, and the PAC service team monitored the women's speech, discussed and classified the speech entries and summarized the common post-abortion needs in 8 aspects. At least 2 research group members routinely extracted records and categorized the outcomes.

RESULTS

Before education, there were no appreciable variations between the two groups regarding sociodemographic characteristics, obstetrical conditions, abortion rates, or methods of contraception (P > 0.05). Following education, the WeChat group had a greater rate of effective contraception (63.0%) than the control group (28.6%), and their SAS score dropped statistically more than that of the control group (P < 0.05). Following the education, there were no unwanted pregnancies in the WeChat group, whereas there were 2 in the traditional PAC group. Only 5 participants in the WeChat group and 32 in the conventional PAC group reported mild anxiety after the education.

Construction of the whole-process nursing service system for day surgery patient based on the Kano model: A pilot cluster randomized controlled trial

Objective

The types and number of day surgeries have significantly increased, but the construction of the whole process nursing service system (WPNSS) for preoperative education, intraoperative cooperation, postoperative knowledge, and follow-up for day surgery patients is still in the exploratory stage. The aim of this study is to establish the WPNSS for day surgery patients using the Kano model and to preliminarily assess its efficacy.

Methods

WPNSS for day surgery was devised leveraging Internet hospital information systems and patient mobile terminals (WeChat), guided by the World Health Organization's conceptual framework for scaling-up strategies. The system was methodically developed, progressing from defining the overall framework to delineating modular functions and developing specific educational materials and tools. A pilot test was conducted in a hospital in China.

Results

WPNSS, a patient-centric remote education and monitoring system, seamlessly amalgamates health education, online consultations, and follow-up functionalities; offering semi-automated surgical consultations, inquiry services, and postoperative follow-ups, as well as autonomously disseminating perioperative health education content. Comprising both client and server components, patients utilizing the system are inclined to recommend day surgery at the hospital to others.

Conclusions

WPNSS delivers personalized and precise health education, consultation, and postoperative follow-up services for day surgery patients. Current results suggest that the WPNSS may improve patients' experience.

Trial Registration

Chinese Clinical Trial Register (ChiCTR2200066782).

Does a 30-minute introductory visit to the operating room reduce patients' anxiety before elective surgery? a prospective controlled observational study

BACKGROUND

Patients scheduled for elective surgery typically suffer from preoperative anxiety related to the unknown environment and unclear expectations. We hypothesized that a virtual or in-person introductory visit to the operating room one day before surgery may decrease the extent of preoperative anxiety by familiarizing patients and their families with the operating room environment. So, this study aimed to evaluate the impact of operating room visits, conducted both in-person and virtual reality, on patients' preoperative anxiety.

METHODS

This prospеctivе controllеd obsеrvational study еxaminеd patiеnts who wеrе candidatеs for gеnеral surgеry in a tеaching hospital in Iran. All patiеnts agеd bеtwееn 18-60 yеars, who wеrе undеrgoing gеnеral surgеry bеtwееn April and Sеptеmbеr 2022 and had prеopеrativе anxiеty basеd on thе Spiеlbеrgеr quеstionnairе, wеrе sеlеctеd. Patients who had emergency surgery or were taking anti-anxiety drugs were excluded from the study. Patiеnts wеrе thеn randomly assignеd to thе in-pеrson visit, virtual rеality visit, and control groups. In thе in-pеrson group, individuals visitеd thе opеrating room for 30 minutеs on thе day bеforе surgеry. In contrast, in thе virtual rеality group, visits wеrе conductеd via a 'livе' virtual vidеo tour of thе opеrating room for thе samе duration on thе day bеforе surgеry. The control group received routine care such as prе-surgеry hospitalization and mеdication. All participants completed the Spielberger questionnaire before the intervention (the day before surgery) and again two hours before surgery. Data were analyzed using variance analysis, t-tests, and Chi-square tests in SPSS 22 software.

RESULTS

Wе idеntifiеd 105 patiеnts undеrgoing gеnеral surgеry who wеrе dividеd into thrее groups of 35 pеoplе еach. Thе rеsults showеd that, bеforе thе intеrvеntion, thеrе wеrе no statistically significant diffеrеncеs among thе thrее groups in tеrms of dеmographic data and prеopеrativе anxiеty (p > 0.05). Aftеr thе intеrvеntion, thе mеan scorеs of prеopеrativе anxiеty in thе in-pеrson visit, virtual rеality visit, and control groups wеrе 52.82 ± 4.51, 54.48 ± 5.04, and 53.42 ± 4.62, rеspеctivеly, with no significant statistical diffеrеncе (p = 0.33). Furthermore, there was no significant difference in preoperative anxiety scores before and after the intervention in the in-person visit (p = 0.13), virtual reality visit (p = 0.10), and control (p = 0.33) groups.

CONCLUSION

A 30-minute visit to familiarize patients with the operating room environment, equipment, and staff, whether conducted in-person or virtually, does not significantly affect patients' preoperative anxiety or reduce their anxiety levels.

The Impact of Preoperative Patient Education on Postoperative Pain, Opioid Use, and Psychological Outcomes: A Narrative Review

Background

Recent studies have shown that preoperative education can positively impact postoperative recovery, improving postoperative pain management and patient satisfaction. Gaps in preoperative education regarding postoperative pain and opioid use may lead to increased patient anxiety and persistent postoperative opioid use.

Objectives

The objective of this narrative review was to identify, examine, and summarize the available evidence on the use and effectiveness of preoperative educational interventions with respect to postoperative outcomes.

Method

The current narrative review focused on studies that assessed the impact of preoperative educational interventions on postoperative pain, opioid use, and psychological outcomes. The search strategy used concept blocks including "preoperative" AND "patient education" AND "elective surgery," limited to the English language, humans, and adults, using the MEDLINE ALL database. Studies reporting on preoperative educational interventions that included postoperative outcomes were included. Studies reporting on enhanced recovery after surgery protocols were excluded.

Results

From a total of 761 retrieved articles, 721 were screened in full and 34 met criteria for inclusion. Of 12 studies that assessed the impact of preoperative educational interventions on postoperative pain, 5 reported a benefit for pain reduction. Eight studies examined postoperative opioid use, and all found a significant reduction in opioid consumption after preoperative education. Twenty-four studies reported on postoperative psychological outcomes, and 20 of these showed benefits of preoperative education, especially on postoperative anxiety.

Conclusion

Preoperative patient education interventions demonstrate promise for improving postoperative outcomes. Preoperative education programs should become a prerequisite and an available resource for all patients undergoing elective surgery.

Right Information, Right Patient, Right Time: Utilizing the MyCareCompass Platform to Deliver Patient Education in the Oncology Setting

Patient education is an important part of cancer care as it increases patient activation and informed decision-making, reduces anxiety, and improves outcomes. However, challenges to providing appropriate education to patients exist on both the health provider and patient side of the equation, e.g., time constraints and health literacy issues. Digital health education is a fast-growing field of interest that has been shown to improve health outcomes, increase effectiveness of medical treatments and education, lower medical costs, and enhance both clinical diagnosis and research opportunities by streamlining data collection, sharing, and analysis. In 2019, Fox Chase Cancer Center was selected by ARCHES, an established patient education software company, to pilot its award-winning digital patient engagement system MyCareCompass. During the pilot, patients scheduled for port insertions were sent electronic messages inviting them to review various online educational materials related to their procedure and subsequent concerns. The invitations and resources were seamlessly integrated into the scheduling system and timed to arrive when patients would most need them. There was high usage of the port-related materials and patients reported a high level of satisfaction with the delivery system and the information. This automated process of delivering high-quality and relevant patient education was able to be implemented smoothly with IT involvement, had a positive impact on patients without adding any extra burden to the care team, and highlighted opportunities to integrate these types of interventions into routine care.

Augmented Reality for Perioperative Anxiety in Patients Undergoing Surgery: A Randomized Clinical Trial

Importance

Both augmented reality (AR) and virtual reality (VR) have had increasing applications in medicine, including medical training, psychology, physical medicine, rehabilitation, and surgical specialties, such as neurosurgery and orthopedic surgery. There are little data on AR's effect on patients' anxiety and experiences.

Objective

To determine whether the use of an AR walkthrough effects patient perioperative anxiety.

Design, Setting, and Participants

This randomized clinical trial was conducted at an outpatient surgery center in 2021 to 2022. All patients undergoing elective orthopedic surgery with the senior author were randomized to the treatment or control group. Analyses were conducted per protocol. Data analysis was performed in November 2022.

Intervention

AR experience explaining to patients what to expect on their day of surgery and walking them through the surgery space. The control group received the standard educational packet.

Main Outcomes and Measures

The main outcome was change in State-Trait Anxiety Inventory (STAI) from the screening survey to the preoperative survey.

Results

A total of 140 patients were eligible, and 45 patients either declined or were excluded. Therefore, 95 patients (63 [66.3%] male; mean [SD] age, 38 [16] years) were recruited for the study and included in the final analysis; 46 patients received the AR intervention, and 49 patients received standard instructions. The AR group experienced a decrease in anxiety from the screening to preoperative survey (mean score change, -2.4 [95% CI, -4.6 to -0.3]), while the standard care group experienced an increase (mean score change, 2.6 [95% CI, 0.2 to 4.9]; P = .01). All patients postoperatively experienced a mean decrease in anxiety score compared with both the screening survey (mean change: AR, -5.4 [95% CI, -7.9 to -2.9]; standard care, -6.9 [95% CI, -11.5 to -2.2]; P = .32) and preoperative survey (mean change: AR, -8.0 [95% CI, -10.3 to -5.7]; standard care, -4.2 [95% CI, -8.6 to 0.2]; P = .19). Of 42 patients in the AR group who completed the postoperative follow-up survey, 30 (71.4%) agreed or strongly agreed that they enjoyed the experience, 29 (69.0%) agreed or strongly agreed that they would recommend the experience, and 28 (66.7%) agreed or strongly agreed that they would use the experience again. No differences were observed in postoperative pain levels or narcotic use.

Conclusions and Relevance

In this randomized clinical trial, the use of AR decreased preoperative anxiety compared with traditional perioperative education and handouts, but there was no significant effect on postoperative anxiety, pain levels, or narcotic use. These findings suggest that AR may serve as an effective means of decreasing preoperative patient anxiety.

Trial Registration

ClinicalTrials.gov Identifier: NCT04727697.

Are religious patients less afraid of surgery? A cross-sectional study on the relationship between dimensions of religiousness and surgical fear

INTRODUCTION

Surgical fear is common and has a negative impact on surgery and its outcome. Recent research has identified individual religiousness as an important factor among patients with associations to mental health, particularly anxiety.

OBJECTIVE

This study aimed to examine associations between religiousness and surgical fear in a representative sample of adult surgical patients in Croatia.

DESIGN

Cross-sectional study among elective surgery patients at different departments of a single hospital.

SETTING

University Hospital Sveti Duh, a tertiary health care facility in Croatia.

MEASUREMENTS

Religiousness and surgical fear were the variables of interest and assessed through self-report instruments. The Croatian version of the Duke Religiosity Index questionnaire (DUREL) assessed organizational religious activity (ORA), non-organizational religious activity (NORA), and intrinsic religiousness (IR). The Croatian version of the Surgical Fear Questionnaire (SFQ) measured surgical fear and its subscales the fear of the short-term and long-term consequences of surgery. Additionally, sociodemographic characteristics and medical history were assessed. Analyses were carried out using descriptive and linear regression analyses.

RESULTS

178 subjects were included for data analysis. Univariate linear regression found two dimensions of religiousness (non-organizational religious activity, intrinsic religiousness) to be weak, but significant predictors of greater surgical fear (adj. R2 = 0.02 and 0.03 respectively). In the multiple linear regression model together with age, gender, education and type of surgery, all three dimensions of religiousness were found to be significant independent predictors of greater surgical fear.

LIMITATIONS

The study was single-center and cross-sectional and did not assess patients' specific religious identity.

CONCLUSIONS

This study demonstrated significant positive associations between dimensions of religiousness and surgical fear, potentially suggesting that surgical patients experience increased religiousness to cope with heightened anxiety. Assessment and intervention to address patient religiousness is warranted in the context of surgical fear among religious patients, and the importance of religiousness in the context of surgical fear needs to be further addressed in research.

The EUPEMEN (EUropean PErioperative MEdical Networking) Protocol for Bowel Obstruction: Recommendations for Perioperative Care

Mechanical bowel obstruction is a common symptom for admission to emergency services, diagnosed annually in more than 300,000 patients in the States, from whom 51% will undergo emergency laparotomy. This condition is associated with serious morbidity and mortality, but it also causes a high financial burden due to long hospital stay. The EUPEMEN project aims to incorporate the expertise and clinical experience of national clinical specialists into development of perioperative rehabilitation protocols. Providing special recommendations for all aspects of patient perioperative care and the participation of diverse specialists, the EUPEMEN protocol for bowel obstruction, as presented in the current paper, aims to provide faster postoperative recovery and reduce length of hospital stay, postoperative morbidity and mortality rate.

A framework for perioperative care for lower extremity vascular bypasses: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery

The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based suggestions for coordinated perioperative care for patients undergoing infrainguinal bypass surgery for peripheral artery disease. Structured around the ERAS core elements, 26 suggestions were made and organized into preadmission, preoperative, intraoperative, and postoperative sections.

High Satisfaction With a Virtual Assistant for Plastic Surgery Frequently Asked Questions

BACKGROUND

Most of a surgeon's office time is dedicated to patient education, preventing an appropriate patient-physician relationship. Telephone-accessed artificial intelligent virtual assistants (AIVAs) that simulate a human conversation and answer preoperative frequently asked questions (FAQs) can be effective solutions to this matter. An AIVA capable of answering preoperative plastic surgery-related FAQs has previously been described by the authors.

OBJECTIVES

The aim of this paper was to determine patients' perception and satisfaction with an AIVA.

METHODS

Twenty-six adult patients from a plastic surgery service answered a 3-part survey consisting of: (1) an evaluation of the answers' correctness, (2) their agreement with the feasibility, usefulness, and future uses of the AIVA, and (3) a section on comments. The first part made it possible to measure the system's accuracy, and the second to evaluate perception and satisfaction. The data were analyzed with Microsoft Excel 2010 (Microsoft Corporation, Redmond, WA).

RESULTS

The AIVA correctly answered the patients' questions 98.5% of the time, and the topic with the lowest accuracy was "nausea." Additionally, 88% of patients agreed with the statements of the second part of the survey. Thus, the patients' perception was positive and overall satisfaction with the AIVA was high. Patients agreed the least with using the AIVA to select their surgical procedure. The comments provided improvement areas for subsequent stages of the project.

CONCLUSIONS

The results show that patients were satisfied and expressed a positive experience with using the AIVA to answer plastic surgery FAQs before surgery. The system is also highly accurate.

Ambulatory colectomy for cancer: Results from a prospective bicentric study of 177 patients

BACKGROUND

The implementation of an Enhanced Recovery After Surgery programme after colectomy reduces postoperative morbidity and shortens the length of hospital stay.

OBJECTIVE

To evaluate the short and midterm outcomes of ambulatory colectomy for cancer.

METHODS

This was a two-centre, observational study of a database maintained prospectively between 2013 and 2021. Short-term outcome measures were complications, admissions, unplanned consultations and readmission rates. Midterm outcome measures were the delay between surgery and initiation of adjuvant chemotherapy, length of disease-free survival and 2-year disease-free survival rate.

RESULTS

A total of 177 patients were included. The overall morbidity rate was 15% and the mortality rate was 0%. The admission rate was 13% and 11% patients left hospital within 24 h of surgery. The readmission rate was 9% and all readmissions occurred before postoperative Day 4. Eight patients underwent repeat surgery because of anastomotic fistula (n = 7) or anastomotic ileocolic bleeding (n = 1). These patients had an uneventful recovery. Sixty-one patients required adjuvant chemotherapy with a median delay between surgery and chemotherapy initiation of 35 days.

CONCLUSIONS

Ambulatory colectomy for cancer is feasible and safe. Adjuvant chemotherapy could be initiated before 6 weeks postsurgery. The ambulatory approach may be a step forward to further improve morbidity and oncologic prognosis.

Impact of Virtual Operating Room Tours on Relieving Perioperative Anxiety in Adult Patients: A Systematic Review

PURPOSE

To evaluate the effects of virtual operating room tours on perioperative anxiety in adult patients.

DESIGN

This study was a systematic review of randomized controlled trials (RCTs).

METHODS

PubMed, Cochrane Library, Embase, Web of Science, Proquest, Scopus, SinoMed, CNKI, and WanFang were systematically searched for English and Chinese RCTs published up to November 18, 2021, for studies on the effectiveness of virtual operating room tours in reducing perioperative anxiety in adult patients (>18 years of age). Primary and secondary outcomes were perioperative anxiety levels and understanding level of perioperative information and patient satisfaction, respectively. The data were synthesized using a qualitative method.

FINDINGS

Five studies were found eligible for inclusion; 3 studies showed a significant decrease in perioperative anxiety levels in patients of the virtual operating room tours group. Furthermore, the overall satisfaction, understanding of perioperative information, and preoperative preparedness were significantly enhanced respectively in 3 studies.

CONCLUSIONS

This study showed the effectiveness of virtual operating room tour on alleviating perioperative anxiety on adult patients. Furthermore, the satisfaction and understanding of perioperative information in intervention group improved owing to these tours. Future quantitative studies are needed to support these findings.

The effectiveness of using virtual reality technology for perioperative anxiety among adults undergoing elective surgery: a randomised controlled trial protocol

BACKGROUND

More than 2.5 million people are admitted for surgery in Australia each year, and between 40 to 80% will experience moderate to high preoperative anxiety. Elevated levels of preoperative anxiety can increase the risk of postoperative complications such as pain, delayed wound healing, infection, prolonged recovery, and longer hospitalisation. Limited previous research on Virtual Reality (VR) indicates a positive impact on surgery-related anxiety and suggests that the intervention potentially leads to reduce postoperative complications.

OBJECTIVE

To evaluate the effectiveness of using VR technology for perioperative anxiety among adults undergoing elective surgery.

METHOD

A two-group parallel randomised controlled trial (RCT) will be conducted, including 150 adult patients (aged 18 years and over) undergoing elective surgery and requiring an overnight stay at a major metropolitan hospital. Eligible participants will be screened for anxiety via the Amsterdam Preoperative Anxiety and Information score (APAIS). Those with moderate to severe anxiety will be randomly allocated to receive the VR session or usual care, in the preoperative holding area. Intervention participants will use a head-mounted VR device to watch and listen to a nature scene for 10 minutes.

STUDY OUTCOMES

The primary outcome is perioperative anxiety measured using the visual analogue scale for anxiety (VAS-A). Secondary outcomes include stress levels (measured by saliva cortisol level and heart rate), postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events.

CONCLUSION

This study will help evaluate if a brief preoperative VR session can reduce perioperative anxiety for adult elective surgical patients.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001350910.

An endeavour for change and self-efficacy in transition: patient perspectives on postoperative recovery after bariatric surgery-a qualitative study

PURPOSE

Self-efficacy plays a role in the process of making lifestyle changes. After bariatric surgery, patients must adapt to several lifelong lifestyle changes. The aim of this study was to explore patients' experiences of recovery after bariatric surgery in those reporting low preoperative self-efficacy.

METHODS

This qualitative inductive interview study included 18 participants. Individual interviews were conducted approximately one year after the surgery. Data were analysed using thematic analysis.

RESULTS

The analysis identified one theme, and five subthemes describing recovery after bariatric surgery. Participants described being at a crossroads before surgery and having to make a change. After surgery, they had to learn to handle their new situation, which included getting to know their new body, handling thoughts about themselves, and managing social relations. To enhance their situation, support and information were essential. Social relations, support, successes, and challenges influenced their self-efficacy, and thoughts about adopting lifestyle changes, maintaining motivation, and handling setbacks.

CONCLUSIONS

Recovery one year after bariatric surgery is an ongoing process that involves challenges encountered in lifestyle changes and physical and psychological transformations. Self-efficacy is not static and is influenced during the recovery process. Support and information are essential to enhance patient recovery after bariatric surgery.

A psychometric assessment on patient education: Developing a satisfaction scale

PURPOSE

The research aimed to develop a valid and reliable measurement instrument to determine patient satisfaction with patient education.

DESIGN AND METHODS

Data were collected by the researchers with the "Patient Information Form" and the "Patient Education Satisfaction Scale (PESS)."

FINDINGS

The factor load values of the scale items range from 0.534 to 0.890. X² /SD was 3.49, the goodness-of-fit index was 0.91, the adjusted goodness-of-fit index was 0.92, the comparative fit index was 0.91, root mean square error of approximation was 0.061, and standardized root mean square residual was 0.061. The scale was shaped with 30 items and a single dimension. Cronbach's α value of the scale was 0.93. The item-total correlation scores range between 0.68 and 0.87.

PRACTICE IMPLICATIONS

PESS is a valid and reliable scale. It is thought that this measurement tool will be useful for researchers working with patient education.

Preoperative Surgical Fear and Related Factors of Patients Undergoing Brain Tumor Surgery

PURPOSE

Patients with brain tumors may experience preoperative fear due to various reasons such as obscurity, pain, and loss of function. This study was carried out to reveal the pre-operative fear levels of patients undergoing brain tumor surgery.

DESIGN

This descriptive and cross-sectional study was completed with 144 patients.

METHODS

Data were obtained using patient identification forms and the Surgical Fear Questionnaire (SFQ). Descriptive statistics, independent t test, one-way Anova, Pearson correlation, and multiple regression analysis were used.

FINDINGS

The results revealed that the duration of preoperative hospital stay was 3.05 ± 2.26 days, the mean age of the patients was 51.44 ± 13.76 years, and more than half (54.1%) were male. The SFQ total and subscale mean scores of patients who are not working were higher (P < .05). The mean SFQ total and subscale mean scores of those aged 53 and over were lower. (P < .05). Duration of preoperative hospital stay, age, and female gender were statistically significant predictors of SFQ. Duration of preoperative hospital stay was responsible for 62.3% of the change in the SFQ, female gender was responsible for 17.6%, and age was responsible for 20.4%.

CONCLUSION

Understanding the risk factors for preoperative fear can help identify patients at risk. Factors that cause fear should be investigated and information deficiencies that increase the level of fear should be eliminated. It is recommended to use pharmacological and nonpharmacological methods in managing the fear of risk groups.

Preoperative Patient Education Programs for Orthopaedic Surgery: What Do the Programs Include? How Are They Delivered? What Are the Knowledge Gaps? A Scoping Review of 46 Studies

OBJECTIVES

To (1) describe the nature and content of the current literature on preoperative education programs for patients preparing for orthopaedic surgery, (2) assess the completeness of reporting program descriptions, and (3) report gaps within the literature.

DESIGN

Scoping review.

LITERATURE SEARCH

We searched the CINAHL, Embase, PubMed, Cochrane Reviews, PsycINFO, Web of Science, and Google Scholar databases for studies that (1) addressed preoperative education in elective orthopaedic surgery or (2) provided descriptions or evaluations of a preoperative program, including the content or outcomes of the program.

STUDY SELECTION CRITERIA

Articles were included if they addressed preoperative patient education focused on an elective orthopaedic surgery and any of the (1) descriptions of an education program including any theoretical frameworks, content, or delivery, or (2) evaluations of the process of a preoperative educational program. Studies were excluded if they were treatment programs with the goal of resolving the problem occurring prior to surgery (eg, rehabilitation or pain management prior to surgery).

DATA SYNTHESIS

We used the template for intervention description and replication (TIDieR) checklist and guide to assess the completeness of reporting of the content of educational programs. Content was synthesized descriptively and by intervention mapping. The results informed of a draft operational definition of preoperative education that we refined based on expert consultation.

RESULTS

Forty-six articles were included. There was variation in study designs, target populations, and intervention content. Preoperative education was defined in 1 out of 5 studies. Thirteen studies used a platform of video-based modules to deliver their program; 3 studies implemented virtual platforms. Results from the TIDieR checklist indicated that 30% of studies tracked adherence to and fidelity of their programs. A definition and conceptual map indicated that the length of stay, functional abilities, patient knowledge, and satisfaction were expected benefits.

CONCLUSION

Poor reporting of content, rationale, and frameworks for preoperative programs in orthopedics may explain why systematic reviews have not found support for their value. Future trials must improve rigor in design and reporting. J Orthop Sports Phys Ther 2022;52(9):572-585. Epub: 9 July 2022. doi:10.2519/jospt.2022.10614.

Efficacy of a new day surgery management mode based on WeChat: a study protocol for randomised controlled trials

INTRODUCTION

There is an enormous imbalance between the rapid development of day surgery and the current conventional medical services. Hence, an effective day surgery management mode should be developed that can be used to constantly follow up on patients both preoperatively and postoperatively. In this study, WeChat was chosen as the platform. This study aimed to investigate the feasibility and effectiveness of a new day surgery management mode.

METHODS AND ANALYSIS

This randomised controlled study investigated the efficacy of a new day surgery management mode based on WeChat. The target number of participants was 1000 per group. The application (app) will send personalised information based on the medical history of the patient and the type of surgery at different time points preoperatively and postoperatively. The healthcare worker can follow up the patient and acquire clinical data by simply signing into the app. The patient and the healthcare worker can also engage in video or voice chats using the app when necessary. Multiple departments, including anaesthesiology, internal medicine, surgery, nursing and psychology, will participate in this new mode.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the West China Hospital of Sichuan University Biomedical Research Ethics Committee. Results of this study will be published in peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

ChiCTR2100050793.

Guidelines for Perioperative Care in Elective Abdominal and Pelvic Surgery at Primary and Secondary Hospitals in Low-Middle-Income Countries (LMIC's): Enhanced Recovery After Surgery (ERAS) Society Recommendation

BACKGROUND

This is the first Enhanced Recovery After Surgery (ERAS®) Society guideline for primary and secondary hospitals in low-middle-income countries (LMIC's) for elective abdominal and gynecologic care.

METHODS

The ERAS LMIC Guidelines group was established by the ERAS® Society in collaboration with different representatives of perioperative care from LMIC's. The group consisted of seven members from the ERAS® Society and eight members from LMIC's. An updated systematic literature search and evaluation of evidence from previous ERAS® guidelines was performed by the leading authors of the Colorectal (2018) and Gynecologic (2019) surgery guidelines (Gustafsson et al in World J Surg 43:6592-695, Nelson et al in Int J Gynecol Cancer 29(4):651-668). Meta-analyses randomized controlled trials (RCTs), prospective and retrospective cohort studies from both HIC's and LMIC's were considered for each perioperative item. The members in the LMIC group then applied the current evidence and adapted the recommendations for each intervention as well as identifying possible new items relevant to LMIC's. The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE) methodology was used to determine the quality of the published evidence. The strength of the recommendations was based on importance of the problem, quality of evidence, balance between desirable and undesirable effects, acceptability to key stakeholders, cost of implementation and specifically the feasibility of implementing in LMIC's and determined through discussions and consensus.

RESULTS

In addition to previously described ERAS® Society interventions, the following items were included, revised or discussed: the Surgical Safety Checklist (SSC), preoperative routine human immunodeficiency virus (HIV) testing in countries with a high prevalence of HIV/AIDS (CD4 and viral load for those patients that are HIV positive), delirium screening and prevention, COVID 19 screening, VTE prophylaxis, immuno-nutrition, prehabilitation, minimally invasive surgery (MIS) and a standardized postoperative monitoring guideline.

CONCLUSIONS

These guidelines are seen as a starting point to address the urgent need to improve perioperative care and to effect data-driven, evidence-based care in LMIC's.

Nursing Telemedicine Educational Encounters: Improved Patient Satisfaction in Radiation Therapy Clinics

BACKGROUND

 Nurse-led education can improve patient satisfaction, and telemedicine has increased patient access during the COVID-19 pandemic.

OBJECTIVES

 The aim of this article was to investigate how nursing telemedicine educational visits influence patient satisfaction.

METHODS

 Patients receiving standard of care in-person education for breast cancer radiation therapy (RT) between January 2019 and June 2019 comprised the preintervention cohort. After July 2019, patients received the same information virtually and represented the postintervention cohort. Press Ganey surveys were used to evaluate patient satisfaction, t tests were performed to differentiate satisfaction scores, and f tests were calculated to determine differences in the variances of response.

FINDINGS

 Patient satisfaction increased in the postintervention cohort for what to expect during RT, how to manage side effects, and nurses' attentiveness to patient questions and worries. There was decreased variance in patient satisfaction in the postintervention group for quality of care received from nurses and caring manner of nurses.

The effect of an informative 360-degree virtual reality video on anxiety for women visiting the one-stop clinic for abnormal uterine bleeding: A randomized controlled trial (VISION-trial)

OBJECTIVE

To evaluate the effect of an informative 360-degree virtual reality (VR) video on preoperative anxiety before visiting a one-stop clinic for abnormal uterine bleeding.

STUDY DESIGN

A randomized controlled trial was performed in a teaching hospital in the Netherlands. A total of 83 women scheduled for a first consultation at the one-stop clinic between April 2017 and September 2017 were included in the analysis. All women received a standard information leaflet about the clinic. 40 women were randomized to receive a 360-degree VR-video of the clinic in addition. The primary outcome was change in the Visual Analogue Scale for Anxiety (VAS-A), measured at baseline (before randomization) and in the waiting room (before visit, after randomization). Anxiety assessed with the State-Trait Anxiety Inventory (STAI-S) was a secondary outcome. Other secondary outcomes included anxiety during the visit and the opinion of the women about the provided information.

RESULTS

Only 27 out of the 40 women actually watched the VR-video. Women in the VR-group who actually watched the video reported lower levels of anxiety at baseline compared to women in the VR-group who did not watch the video. In the intention-to-treat analysis, there was no difference in change in anxiety between the VR-group and the control group (mean difference VAS-A = 0.07, 95% CI -0.96 to 1.10; mean difference STAI-S = 1.97, 95% CI -1.82 to 5.77). In the per-protocol analysis, women in the VR-group reported lower anxiety scores in the waiting room. However, the change in anxiety scores between baseline and waiting room was comparable in both groups. 31% of the women who watched the VR-video reported that the video resulted in a reduction of anxiety, 69% reported that the video is of added value and 65% would use a VR-video again in future.

CONCLUSIONS

Adding the informative 360-degree VR-video to conventional information did not result in a reduction of anxiety prior to visiting the one-stop clinic. However, the majority of women who watched the video felt that it was of added value. Remarkable was that women who reported higher anxiety at baseline seemed less willing to watch the video.

Effects of needs-based education for prenatal anxiety in advanced multiparas: a randomized controlled trial

Background

Prenatal anxiety is a common concern which may have adverse effects on maternal and infant health outcomes. Studies addressing needs-based education interventions for prenatal anxiety are limited.

Aim

To explore the effects of needs-based education on alleviating prenatal anxiety among advanced multiparas when compared with routine prenatal health education.

Methods

A total of 86 advanced multiparas were randomized into the intervention group (n = 43) or the control group (n = 43) in this study. The control group received routine prenatal care. The intervention group received five needs-based education programs presented by trained researchers. The Pregnancy-related Anxiety Questionnaire was used to evaluate changes in anxiety level of participants. Concurrent physiological parameters, including blood pressure, heart rate and non-stress test were also measured.

Results

Scores on the Pregnancy-related Anxiety Questionnaire of the intervention group were significantly lower than those of the control group (t = 4.21, P < 0.05). Systolic blood pressure (t = 3.64, P < 0.05) and heart rate (t = 2.39, P < 0.05) of the intervention group were also significantly lower than the control group whereas no differences were noted in diastolic blood pressure and non-stress test.

Conclusion

A needs-based education program is an effective intervention strategy to allay prenatal anxiety in advanced multiparas.

Trial registration

The trial was retrospectively registered in the Chinese Clinical Trial Registry as number ChiCTR2100047552.

Indicators and predictors modifiable by the nursing department during the preoperative period: A scoping review

AIM AND OBJECTIVES

The aim of this study is to identify preoperative indicators and/or predictors of complications or inefficiencies in the surgical process that can be modified within nursing practice.

BACKGROUND

Due to rapid sociodemographic and technological change, the global demand for surgical attention is rising exponentially, requiring new strategies for optimisation and sustainability in perioperative care.

DESIGN

We conduced the scoping review using the methodology recommended by the Joanna Briggs Institute supported with The PAGER framework and guided by the PRISMA-ScR Checklist.

METHODS

Four databases (CINAHL, MEDLINE, SCOPUS and PUBMED) were examined to extract relevant published results for elective surgery on adult patients during the period 2011-2021. This process identified 609 records. Exclusion criteria were applied, and the sample was then evaluated with the Quality Assessment Tool for Studies with Diverse Designs (QATSDD), after which 15 studies remained.

RESULTS

The following preoperative indicators and/or predictors were considered: (1) Anxiety; (2) Pain; (3) Health education, knowledge and training; (4) Satisfaction; (5) Management/organisation (including costs, resources used/available, organisational issues, hospital stay (preoperative), standardisation and protocolisation.

CONCLUSION

The identification of five indicators and/or predictors of complications or inefficiencies in the surgical process, which can be modified by nursing, allows the effective application of interventions in the preoperative phase, optimising care and improving health outcomes.

RELEVANCE TO CLINICAL PRACTICE

The development and implementation of specific nursing skills in the preoperative phase are essential to optimise the surgical process.

Perioperative care in open aortic vascular surgery: A Consensus Statement by the Enhanced Recovery after Surgery (ERAS®) Society and Society for Vascular Surgery

The Society for Vascular Surgery and the Enhanced Recovery After Surgery (ERAS®) Society formally collaborated and elected an international, multi-disciplinary panel of experts to review the literature and provide evidence-based recommendations related to all of the health care received in the perioperative period for patients undergoing open abdominal aortic operations (both transabdominal and retroperitoneal approaches, including supraceliac, suprarenal, and infrarenal clamp sites, for aortic aneurysm and aortoiliac occlusive disease). Structured around the ERAS® core elements, 36 recommendations were made and organized into preadmission, preoperative, intraoperative, and postoperative recommendations.

Enhanced recovery after surgery: operation-related factors

Background: The enhanced recovery after surgery (ERAS) program, which has been recently introduced in the field of perioperative care, represents a multimodal strategy to attenuate the loss, and improve the restoration, of functional capacity after surgery. This program aims to reduce morbidity and enhance recovery by reducing surgical stress, optimizing pain control, and facilitating early resumption of an oral diet and early mobilization. Considering this perspective, protocols for enhanced recovery should include comprehensive and evidence-based guidelines for best perioperative care. Appropriate protocol implementation may reduce complication rates and enhance functional recovery and thereby reduce the duration of hospitalization.Current Concepts: In major abdominal surgeries, the recommended ERAS protocols involve common items such as preoperative counseling, preoperative optimization, prehabilitation, preoperative nutrition, fasting and carbohydrate loading, bowel preparation, thromboprophylaxis, antimicrobial prophylaxis, surgical access, drainage, nasogastric intubation, urinary drainage, early mobilization and prevention of postoperative ileus, postoperative glycemic control, and postoperative nutritional care. These items have been briefly reviewed with the relevant evidence.Discussion and Conclusion: ERAS is a comprehensive and evidence-based guideline for optimal perioperative care. Although a number of ERAS items still require high-level evidence through well-designed randomized controlled trials, the ERAS guidelines can serve as adequate recommendations for our practice. Thus, these items can be introduced and adopted with evidence. In addition, it is important to remove items that are not supported by evidence from routine procedures.

An Evaluation of Timing of Discharge Instruction and the Impact on Patient Satisfaction

PURPOSE

Surgical patients face unique challenges with discharge instructions and retention. The volume of information provided to patients, frequently combined with sedatives and opioids, leads to failure to retain this crucial information needed for home care. The purpose of this project was to implement a preoperative teaching intervention to provide written and verbal discharge instructions in the preoperative area before the administration of anesthetic agents to improve patient retention of information, and improve percentile ranking on the Outpatient Ambulatory Surgery- Consumer Assessment of Health Care Providers and Systems (OAS-CAHPS) survey.

DESIGN

Cross-sectional descriptive METHODS: An additional educational intervention was implemented to provide discharge instructions in the preoperative area. Data was collected from the Press-Ganey database on patient responses to questions 13, 14, 15, 17, 19, and 21 and the global discharge domain scores of the OAS-CAHPS survey over a period of 12 weeks. This data was compared to the patient responses to the same questions over the same date range in the year time prior.

FINDINGS

Statistical analysis demonstrated significant change in the percentile rank scores for the intervention period (P = .0024). Average percentile rank change on discharge domain questions was an increase by 50 points. Patient and staff feedback further demonstrated value to the intervention.

CONCLUSIONS

Providing discharge instructions in the preoperative area in addition to providing instructions immediately before discharge can improve the percentile rankings associated with OAS-CAHPS questions related to discharge.

Preoperative nutrition care in Enhanced Recovery After Surgery programs: are we missing an opportunity?

PURPOSE OF REVIEW

A key component of Enhanced Recovery After Surgery (ERAS) is the integration of nutrition care elements into the surgical pathway, recognizing that preoperative nutrition status affects outcomes of surgery and must be optimized for recovery. We reviewed the preoperative nutrition care recommendations included in ERAS Society guidelines for adults undergoing major surgery and their implementation.

RECENT FINDINGS

All ERAS Society guidelines reviewed recommend preoperative patient education to describe the procedures and expectations of surgery; however, only one guideline specifies inclusion of routine nutrition education before surgery. All guidelines included a recommendation for at least one of the following nutrition care elements: nutrition risk screening, nutrition assessment, and nutrition intervention. However, the impact of preoperative nutrition care could not be evaluated because it was rarely reported in recent literature for most surgical disciplines. A small number of studies reported on the preoperative nutrition care elements within their ERAS programs and found a positive impact of ERAS implementation on nutrition care practices, including increased rates of nutrition risk screening.

SUMMARY

There is an opportunity to improve the reporting of preoperative nutrition care elements within ERAS programs, which will enhance our understanding of how nutrition care elements influence patient outcomes and experiences.

Dealing with Anxious Patients: An Integrative Review of the Literature on Nonpharmaceutical Interventions to Reduce Anxiety in Patients Undergoing Medical or Dental Procedures

Objectives: A previous systematic literature review (SLR) evaluated 501 experiments on reducing patient anxiety across medical and dental environments. This integrative review examines those interventions and explores possible mechanisms leading to relative success or failure within those environments, in the interest of interprofessional education and communication. Methods: Reviewers evaluated 501 experiments testing interventions for reducing patient anxiety in a variety of medical and dental health care settings. Methodology for the SLR, largely following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is briefly reviewed. Results: A total of 501 experiments (from 408 articles) met review criteria. One hundred and forty-three Music experiments were included, and Music interventions were largely effective, except in the case of colonoscopy. Education is the only intervention that occasionally (5 times of 130 experiments) raised patient anxiety in the face of a procedure; the discussion focuses on the wisdom of assessing patient need for information. Thirty-seven Cognitive Behavioral Therapy (CBT) experiments of various types are included, with a success rate of 89%, with a particularly high rate of success (12 of 12 experiments) in dentistry. Massage has a success rate that is similar to that of CBT, but Massage has been tested in far fewer specialty areas. Relaxation has been tested in every specialty area, except mechanical ventilation, with promising results. Acupuncture and Acupressure have not been widely tested, but their effectiveness rate is 100% when it comes to reducing patient anxiety in various procedural settings. Similarly, experiments show Hypnosis to be successful in 90% of trials. In contrast, Distraction was successful in only 40% of the experiments summarized, although it was more effective in dentistry. A variety of Nature-based Interventions (Aromatherapy, Nature Sounds, and Visual Stimuli) were highly successful across a variety of settings. Discussion: Possible mechanisms are discussed, along with commentary on feasibility. Limitations include publication bias, small sample sizes, and the lack of placebo controls. Future areas of research are pointed out.

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

BACKGROUND

Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery.

PURPOSE

This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.

STUDY DESIGN

This is a review article.

METHODS

Under the impetus of the ERAS® society, a multidisciplinary guideline development group was constituted by bringing together international experts involved in the practice of ERAS and spine surgery. This group identified 22 ERAS items for lumbar fusion. A systematic search in the English language was performed in MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Systematic reviews, randomized controlled trials, and cohort studies were included, and the evidence was graded according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Consensus recommendation was reached by the group after a critical appraisal of the literature.

RESULTS

Two hundred fifty-six articles were included to develop the consensus statements for 22 ERAS items; one ERAS item (prehabilitation) was excluded from the final summary due to very poor quality and conflicting evidence in lumbar spinal fusion. From these remaining 21 ERAS items, 28 recommendations were included. All recommendations on ERAS protocol items are based on the best available evidence. These included nine preoperative, eleven intraoperative, and six postoperative recommendations. They span topics from preoperative patient education and nutritional evaluation, intraoperative anesthetic and surgical techniques, and postoperative multimodal analgesic strategies. The level of evidence for the use of each recommendation is presented.

CONCLUSION

Based on the best evidence available for each ERAS item within the multidisciplinary perioperative care pathways, the ERAS® Society presents this comprehensive consensus review for perioperative care in lumbar fusion.

Effectiveness of nursing interventions for preoperative anxiety in adults: A systematic review with meta-analysis

AIMS

The aim of this review and meta-analysis is to analyse the effectiveness of nursing interventions for the management of preoperative anxiety in adults.

BACKGROUND

The perioperative process is a stressful situation for many people who are going to be operated and it can generate feelings of anxiety. Also, preoperative anxiety can appear in the perioperative period. Nursing management of preoperative anxiety through individualized interventions can be effective for reducing anxiety.

DESIGN

A systematic review with meta-analysis was performed.

DATA SOURCES

CINAHL, CUIDEN, Pubmed, ProQuest and Scopus databases were consulted without restriction per year of publication. The search was conducted in February 2020.

REVIEW METHODS

Experimental studies on nursing management in preoperative anxiety with adults sample (>18 years) published in English and/or Spanish were included. All types of surgery were included in the review. A random effects meta-analysis was performed to estimate the effect size for preoperative anxiety measured with STAI.

RESULTS

After the selection process n = 9 quantitative studies with nursing interventions for preoperative anxiety were included. A preoperative educational and informative interview was used in six studies, one study used empathic interview, one used motivational interview and one used hand massage. The meta-analysis, including four studies using nursing interviews, had a sample of n = 419 in the intervention group and n = 445 in the control group. The mean difference in preoperative state anxiety measured with the STAI was in favour of the nursing intervention.

CONCLUSION

Nursing interventions for patients who are going to be operated seems to have a positive impact in their preoperative anxiety. However, due to the low number of studies and the heterogeneity of the sample, more research is needed about the topic.

Pathway for enhanced recovery after spinal surgery-a systematic review of evidence for use of individual components

BACKGROUND

Enhanced recovery in spinal surgery (ERSS) has shown promising improvements in clinical and economical outcomes. We have proposed an ERSS pathway based on available evidence. We aimed to delineate the clinical efficacy of individual pathway components in ERSS through a systematic narrative review.

METHODS

We included systematic reviews and meta-analysis, randomized controlled trials, non-randomized controlled studies, and observational studies in adults and pediatric patients evaluating any one of the 22 pre-defined components. Our primary outcomes included all-cause mortality, morbidity outcomes (e.g., pulmonary, cardiac, renal, surgical complications), patient-reported outcomes and experiences (e.g., pain, quality of care experience), and health services outcomes (e.g., length of stay and costs). Following databases (1990 onwards) were searched: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two authors screened the citations, full-text articles, and extracted data. A narrative synthesis was provided. We constructed Evidence Profile (EP) tables for each component of the pathway, where appropriate information was available. Due to clinical and methodological heterogeneity, we did not conduct a meta-analyses. GRADE system was used to classify confidence in cumulative evidence for each component of the pathway.

RESULTS

We identified 5423 relevant studies excluding duplicates as relating to the 22 pre-defined components of enhanced recovery in spinal surgery. We included 664 studies in the systematic review. We identified specific evidence within the context of spinal surgery for 14/22 proposed components. Evidence was summarized in EP tables where suitable. We performed thematic synthesis without EP for 6/22 elements. We identified appropriate societal guidelines for the remainder of the components.

CONCLUSIONS

We identified the following components with high quality of evidence as per GRADE system: pre-emptive analgesia, peri-operative blood conservation (antifibrinolytic use), surgical site preparation and antibiotic prophylaxis. There was moderate level of evidence for implementation of prehabilitation, minimally invasive surgery, multimodal perioperative analgesia, intravenous lignocaine and ketamine use as well as early mobilization. This review allows for the first formalized evidence-based unified protocol in the field of ERSS. Further studies validating the multimodal ERSS framework are essential to guide the future evolution of care in patients undergoing spinal surgery.

Effects of preoperative individualized audiovisual education on anxiety and comfort in patients undergoing laparoscopic cholecystectomy: randomised controlled study

OBJECTIVE

The study aimed to determine the effects of preoperative individualized audiovisual education for laparoscopic cholecystectomy patients on postoperative anxiety and comfort (pain, nausea, and vomiting).

METHOD

This study was a randomized clinical trial on 124 patients undergoing laparoscopic cholecystectomy. Patients were randomized into an intervention group (individualized audiovisual education) or a control group (standard education). The primary outcome was change in anxiety and comfort levels between the intervention and control groups at baseline and follow-up. Secondary outcomes were change between groups in Patient Learning Needs Scale scores and vital signs.

RESULTS

Although the preoperative visual analog scale (VAS)-pain and VAS-nausea scores of the patients in both groups were similar, the postoperative VAS-pain and VAS-nausea levels of the intervention group were significantly lower than that of the control group (p < 0.05). The anxiety levels of the intervention group were also lower both before (42.79 ± 4.29) and after (39.08 ± 3.49) surgery than that of the control group (50.98 ± 5.45 and 44.41 ± 4.77, respectively).

CONCLUSION

This study showed that preoperative individualized audiovisual education was effective in reducing anxiety and improving patient comfort.

PRACTICE IMPLICATIONS

Preoperative individualized audiovisual education is crucial for clinical care and can be integrated into other patients because of its positive effects on postoperative recovery outcomes.

The role of video-based multimedia information in reduction of anxiety before dilatation and curettage

OBJECTIVE

Considerable amount of women undergoing dilatation and curettage (D&C) are subject to preoperative anxiety. We hypothesized that the implementation of video-based multimedia information (MMI) before the D&C might facilitate patients' education and provide clear information regarding the procedure. This study aimed to compare the impact of video-based MMI and conventional written information on anxiety, pain severity, and satisfaction in patients undergoing D&C.

METHODS

Seventy four women scheduled for D&C for abnormal uterine bleeding were enrolled in this prospective randomized study. Subjects were assigned to receive a video-based MMI or conventional written information (controls). The trait and state anxiety were assessed using the State and Trait Anxiety Inventory (STAI) before the MMI or written information. STAI-state (STAI-S) was repeated after the application of the MMI or written information. All patients underwent D&C by the same gynecologist. Following D&C, patient satisfaction and procedural pain were ranked using a Likert scale and Visual Analogue Scale.

RESULTS

Post-informational STAI-S score was significantly lower than the pre-informational STAI-S score in the video group (p<0.001), whereas no significant change occurred in STAI-S score in the control group (p=0.210). The satisfaction rate of the patients receiving MMI before the D&C was significantly higher than the satisfaction rate of the controls (75% vs. 50%, p=0.027).

CONCLUSION

Implementation of MMI before the D&C procedure is associated with less anxiety, less severe postoperative pain and improved patients satisfaction, compared to the conventional written information.

Women's experiences of an enhanced recovery after surgery program: A qualitative study

The Enhanced Recovery After Surgery Program aims to transfer much of the responsibility for postoperative recovery to the patient and their next of kin. The aim of the study was to identify and describe women's experiences of care within this program in relation to gynecological abdominal surgery. A qualitative approach was used where 16 women were interviewed within 1 to 2 weeks of their surgery. A thematic analysis focusing on interpretation of latent content was performed. Three themes were identified: Empowerment, Self-care, and Participation. Empowerment represents aspects of the recovery program that strengthen self-efficacy, such as being seen, being given information, and continuity of care. Self-care identifies the practical implications of empowerment, namely internal resources, knowledge, and external resources. These two themes were identified as separate but interlinked through the theme Participation. Preoperative information, postoperative encouragement, and follow-up empowered the women in their recovery. Early discharge from hospital was beneficial for recovery if accompanied by social support and sufficient self-care ability. A desire for a person-centered approach in the preoperative meeting and in postoperative care was identified.

Patient Information Leaflets for Lumbar Spine Surgery: A Missed Opportunity

BACKGROUND

High-quality patient information is recommended to help reduce procedure-related anxiety and encourage patients to become active participants in their recovery. The objective of this study was to analyze the quality of patient information leaflets (PILs) given to National Health Service (NHS) patients ahead of lumbar spine surgery.

METHODS

The DISCERN tool was used to evaluate the quality of PILs, sourced from NHS websites.

RESULTS

Thirty-two PILs on lumbar surgery were included. Two (6%) leaflets were considered poor, 13 (41%) were marked as fair, 14 (44%) were of good quality, and 3 (9%) were scored as excellent. The total mean score was 55 (30-74), which corresponds to good quality. The lowest scoring questions were sources of information (Q4), balanced/unbiased content (Q6), and explanation of no treatment (Q12).

CONCLUSIONS

There is considerable variation in the quality of PILs provided ahead of lumbar spine surgery. The scope for improvement is clear, and as the move toward patient-centered, evidence-based care continues, it is important that hospital resources provide recommendations based upon evidence of clinical effectiveness.

Factors influencing day surgery patients' quality of postoperative recovery and satisfaction with recovery: a narrative review

The aim of healthcare services is to provide a high quality of care. One way to ensure that this aim has been fulfilled is to assess patients' satisfaction with their care. Although satisfaction is a complex concept, it is an important outcome in perioperative care. The objective of this paper is to discuss and reflect on factors that can affect patients' quality of postoperative recovery and satisfaction with recovery after day surgery. Involving patients in shared decision-making (SDM) and providing sufficient preoperative and postoperative information can improve their satisfaction. It is important to assess whether patients experience poor recovery, which can be both distressing and dissatisfying. We suggest that patients' age, sex, mental health status, and health literacy (HL) skills should be assessed preoperatively, since these factors seem to have a negative impact on patients' postoperative recovery. Identifying factors that have a negative impact on patients' quality of postoperative recovery and satisfaction with recovery after day surgery will assist healthcare professionals in supporting vulnerable patients, such as those with limited HL and poor mental health. Treating patients with respect and dignity and providing SDM can increase their quality of postoperative recovery and satisfaction with recovery.