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March MK, Harmer AR, Thomas B, Maitland A, Black D, Dennis S. Does resilience predict hospital length of stay after total knee arthroplasty? A prospective observational cohort study. ARTHROPLASTY 2022; 4:27. [PMID: 35794680 PMCID: PMC9261017 DOI: 10.1186/s42836-022-00128-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Resilience, or the ability to bounce back from stress, is a key psychological factor that is associated with ongoing functional independence and higher quality of life in older adults in the context of chronic health conditions. Emerging research has explored resilience and patient-reported outcomes after TKA. Our primary aim was to explore the relationship between resilience and acute hospital length of stay after total knee arthroplasty (TKA).
Methods
A prospective observational study recruited 75 participants one month before total knee arthroplasty from two Australian hospitals. Two preoperative psychological measures were used: the Brief Resilience Scale, and for comparison, the Depression, Anxiety and Stress Scale-21 (DASS-21). We collected sociodemographic, medical and surgical details, patient-reported pain, function, fatigue and quality of life one month before TKA. Health service data describing acute hospital length of stay, inpatient rehabilitation use, and physiotherapy occasions of service were collected after TKA. Non-parametric analysis was used to determine any differences in length of stay between those with low or high resilience and DASS-21 scores. Secondary regression analysis explored the preoperative factors affecting acute hospital length of stay.
Results
No significant difference was detected in length of stay between those with a low or a high resilience score before TKA. However, the group reporting psychological symptoms as measured by the DASS-21 before TKA had a significantly longer acute hospital length of stay after TKA compared to those with no psychological symptoms [median length of stay 6 (IQR 2.5) days vs. 5 (IQR 2) days, respectively (Mann-Whitney U = 495.5, P=0.03)]. Multivariate regression analysis showed that anesthetic risk score and fatigue were significant predictors of length of stay, with the overall model demonstrating significance (χ2=12.426, df = 4, P=0.014).
Conclusions
No association was detected between the brief resilience score before TKA and acute hospital length of stay after TKA, however, symptoms on the DASS-21 were associated with longer acute hospital length of stay. Preoperative screening for psychological symptoms using the DASS-21 is useful for health services to identify those at higher risk of longer acute hospital length of stay after TKA.
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Tsapakis EM, Tsiridis E, Hunter A, Gamie Z, Georgakarakos N, Thomas P, Schizas C, West RM. Modelling the effect of minor orthopaedic day surgery on patient mood at the early post-operative period: A prospective population-based cohort study. Eur Psychiatry 2020; 24:112-8. [DOI: 10.1016/j.eurpsy.2008.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 09/02/2008] [Accepted: 09/07/2008] [Indexed: 11/17/2022] Open
Abstract
AbstractObjectiveThe effect of minor orthopaedic day surgery (MiODS) on patient’s mood.MethodsA prospective population-based cohort study of 148 consecutive patients with age above 18 and less than 65, an American Society of Anaesthesiology (ASA) score of 1, and the requirement of general anaesthesia (GA) were included. The Medical Outcomes Study – Short Form 36 (SF-36), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) were used pre- and post-operatively.ResultsThe mean physical component score of SF-36 before surgery was 45.3 (SD = ±10.1) and 8 weeks following surgery was 44.9 (SD = ±11.04) [n= 148,p= 0.51, 95% CI = (−1.03 to 1.52)]. For the measurement of the changes in mood using BDI, BAI and SF-36, latent construct modelling was employed to increase validity. The covariance between mood pre- and post-operatively (cov = 69.44) corresponded to a correlation coefficient,r= 0.88 indicating that patients suffering a greater number of mood symptoms before surgery continue to have a greater number of symptoms following surgery. When the latent mood constructs were permitted to have different means the model fitted well withχ2(df = 1) = 0.86 for whichp= 0.77, thus the null hypothesis that MiODS has no effect on patient mood was rejected.ConclusionsMiODS affects patient mood which deteriorates at 8 weeks post-operatively regardless of the pre-operative patient mood state. More importantly patients suffering a greater number of mood symptoms before MiODS continue to have a greater number of symptoms following surgery.
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Cremeans-Smith JK, Greene K, Delahanty DL. Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain. PAIN MEDICINE 2016; 17:970-9. [PMID: 26814277 DOI: 10.1093/pm/pnv043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/27/2015] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS Participants included 110 patients undergoing total knee arthroplasty. METHODS Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a 3-month follow-up. RESULTS Contrary to expectations, lower stress hormone levels at baseline were related to more severe post-operative pain. Data at later time points, however, supported our hypothesis: cardiovascular tone shortly before surgery and urinary levels of epinephrine 1 month following surgery were positively related to pain severity 3 months later. CONCLUSION Results suggest that the occurrence of post-operative pain can be predicted on the basis of stress physiology prior to and following arthroplastic surgery.
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Affiliation(s)
- Julie K Cremeans-Smith
- *Department of Psychological Sciences, Kent State University at Stark, North Canton, Ohio;
| | - Kenneth Greene
- Department of Orthopedics, Cleveland Clinic, Cleveland, Ohio
| | - Douglas L Delahanty
- Department of Psychological Sciences, Kent State University, Kent, Ohio; Department of Psychology in Psychiatry, Northeast Ohio Medical University (NEOMED), Rootstown, Ohio, USA
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Morganstern I, Tejani-Butt S. Differential patterns of alcohol consumption and dopamine-2 receptor binding in Wistar-Kyoto and Wistar rats. Neurochem Res 2010; 35:1708-15. [PMID: 20680460 PMCID: PMC2997530 DOI: 10.1007/s11064-010-0233-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2010] [Indexed: 11/28/2022]
Abstract
The Wistar-Kyoto (WKY) rat strain has been described as an animal model of depressive behavior that consumes significantly greater amounts of alcohol compared to the Wistar (WIS) rat strain. Since the mesolimbic dopamine (DA) type-2 (D2) receptors mediate reward-related behaviors, the present study measured the binding of [(125)I]-Iodosulpiride to D2 receptors in the brains of WKY versus WIS rats following 24 days of voluntary alcohol or water consumption. Alcohol consuming WKY rats showed a significant increase in D2 receptor binding in several regions of the mesolimbic and nigrostriatal systems. In contrast, alcohol consuming WIS rats showed a reduction in D2 receptor binding in DA cell body areas. The differential regulation of D2 receptors by voluntary alcohol consumption in the two rat strains suggests that D2 receptor mediated neurotransmission may be playing a role in the increased alcohol drinking behavior reported in WKY rats.
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Affiliation(s)
- Irene Morganstern
- Department of Pharmaceutical Sciences (Box 118), University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104, USA
| | - Shanaz Tejani-Butt
- Department of Pharmaceutical Sciences (Box 118), University of the Sciences in Philadelphia, 600 South 43rd Street, Philadelphia, PA 19104, USA
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Nickinson RSJ, Board TN, Kay PR. Post-operative anxiety and depression levels in orthopaedic surgery: a study of 56 patients undergoing hip or knee arthroplasty. J Eval Clin Pract 2009; 15:307-10. [PMID: 19335489 DOI: 10.1111/j.1365-2753.2008.01001.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the presence and rates of anxiety and depression in postsurgical patients. METHODS The Hospital Anxiety and Depression Scale was used to measure anxiety and depression levels. Patients completed the questionnaire on the day prior to surgery, then on each post-operative day up to and including their day of discharge. Statistical analysis using logistic regression was performed to determine whether any variables were risk factors for developing anxiety or depression. Fifty-six patients undergoing lower limb arthroplasty agreed to take part. RESULTS Post-operatively 17 patients became anxious prior to discharge. No variables were significant predictors of anxiety. Post-operatively 28 subjects (50%) became depressed at some point prior to discharge. Females were more likely to become depressed than males odds ratio (OR) = 3.48 [95% confidence interval (CI) 1.01-11.88]. Those who had had a previous lower limb arthroplasty were more likely to develop post-operative depression, OR = 3.92 (95% CI 1.05-14.6). Site of operation was not found to be significant, OR = 0.67 (95% CI 0.20-2.22). Age and anaesthetic method were not predictive of depression. The mean time point for development of depression was 2.43 days (SD = 1.40 days) and the time of deepest depression was 2.93 days (SD = 1.72 days). The mean length of depression was 1.93 days (SD = 1.21 days). The mean length of stay for depressed patients was 5 days (SD = 1.72), compared with 4 days for the non-depressed patients (SD = 1.62 days). CONCLUSION The results suggest that post-operative depression does occur in orthopaedic surgery. The prevalence may be higher than that reported in other surgical specialities. These findings emphasize the need for evaluation of patients' psychiatric state post-operatively.
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Affiliation(s)
- Richard S J Nickinson
- Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Appley Bridge, Wigan, Lancashire, UK.
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Uppal HS, Makrides P, Eltigani EA, Joshi RN. A case report of acute mania secondary to pedicled latissimus dorsi breast reconstruction and amitriptyline withdrawal. J Plast Reconstr Aesthet Surg 2008; 62:e117-8. [PMID: 18996072 DOI: 10.1016/j.bjps.2008.06.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 05/17/2008] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
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Rubin GJ, Hardy R, Hotopf M. A systematic review and meta-analysis of the incidence and severity of postoperative fatigue. J Psychosom Res 2004; 57:317-26. [PMID: 15507259 DOI: 10.1016/s0022-3999(03)00615-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Accepted: 10/12/2003] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Postoperative fatigue is common following major abdominal surgery. Less is known about its prevalence in other surgical subgroups, and about its long-term prognosis. A systematic review of prospective cohort studies was conducted to clarify these issues. METHOD Studies were identified from an extensive literature search. Overall estimates of pre- to postoperative change in fatigue severity and the incidence of clinically significant postoperative fatigue were calculated using meta-analyses. RESULTS Eighty-one cohorts were identified. Type of surgery was found to be a possible predictor of fatigue severity, with major abdominal, gynaecological, cardiac and minor surgery apparently associated with greater fatigue than orthopaedic surgery. Limited data were available regarding the long-term persistence of postoperative fatigue. CONCLUSION Postoperative fatigue appears to be an important problem following only certain forms of surgery. Why this is so remains unclear, and further work using better fatigue questionnaires is now required to confirm these differences.
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Affiliation(s)
- G James Rubin
- Section of General Hospital Psychiatry, Division of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine, UK.
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Hahm TS, Cho HS, Lee KH, Chung IS, Kim JA, Kim MH. Clonidine premedication prevents preoperative hypokalemia. J Clin Anesth 2002; 14:6-9. [PMID: 11880014 DOI: 10.1016/s0952-8180(01)00342-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE To test the hypothesis that clonidine premedication could prevent an increase of plasma epinephrine occurring as a result of anxiety, and a decrease of the serum potassium (K+) levels before the induction of anesthesia. DESIGN Randomized, double-blinded study. SETTING University Hospital of Seoul. PATIENTS 44 ASA physical status I and II patients, aged 20 to 50 years, scheduled for knee, ear, or nose surgery. INTERVENTION 44 patients were randomly allocated into one of two groups: 22 patients (clonidine group) received clonidine 300 microg orally at 120 minutes before the induction of anesthesia. The other 22 patients (control group) received a placebo. MEASUREMENTS AND MAIN RESULTS Anxiety level, serum K+, and plasma epinephrine were measured at an outpatient clinic, and immediately before the induction of anesthesia. There were no differences between groups in degree of anxiety experienced, serum K+, or plasma epinephrine levels as measured at the out-patient clinic. Immediately before the induction of anesthesia, the serum K+ levels of the clonidine group were higher than those of the control group (3.89 +/- 0.26 mEq/L vs. 3.50 +/- 0.36 mEq/L), and anxiety and plasma epinephrine levels of clonidine group were lower than those of the control group (p < 0.05). The frequency of hypokalemia (K+ < or = 3.5 mEq/L) of the clonidine group immediately before the induction of anesthesia was significantly lower than that of the control group (0% vs. 50%). CONCLUSIONS Clonidine premedication was effective in preventing hypokalemic episodes occurring before the induction of anesthesia.
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Affiliation(s)
- Tae S Hahm
- Department of Anesthesiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Cupples SA, Paige-Dobson B, Armstrong D. Psychophysiological manifestations of anxiety in patients undergoing electrophysiology studies. Heart Lung 1998; 27:374-86. [PMID: 9835669 DOI: 10.1016/s0147-9563(98)90085-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure state anxiety and related physiological correlates at 3 selected times when patient education regarding electrophysiology (EP) studies is likely to occur: 24 hours before the EP study (pre-procedure teaching), 1 hour before the EP study (reinforcement of pre-procedure teaching), and 3 hours after the EP study (explanation of results; reinforcement of post-procedure instructions). DESIGN Descriptive-exploratory. SETTING Military medical treatment facility in mid Atlantic region. SUBJECTS Thirty-two adults who underwent initial EP testing. OUTCOME MEASURES The Spielberger State Anxiety score, frontalis muscle tension, heart rate, electrodermal activity, electrothermal feedback, and mean arterial pressure. METHODS Outcome measures were obtained 1 day before (time 1), 1 hour before (time 2), and 3 hours after (time 3) the EP study. RESULTS Both state anxiety scores and physiological variables indicated minimal psychophysiological reactivity. CONCLUSION Patients undergoing initial EP studies experience moderate state anxiety and manifest a paradoxical pattern of autonomic responses over time. Moderate levels of state anxiety at each of the 3 assessment points would seem to indicate that patient education is appropriate at these times.
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Affiliation(s)
- S A Cupples
- Heart Transplant Program, Washington Hospital Center, Washington, DC 20010, USA
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Abstract
While the quality of medical intervention associated with day surgery has greatly improved, the position of psychological preparation has remained virtually unchanged. Recent evidence, however, has suggested that anxiety levels can be significantly reduced if preparatory information can be matched with individual coping styles. As choice of coping style has been strongly linked with locus of control, two questionnaires were given to 150 subjects undergoing minor gynaecological day surgery in order to compare their health locus of control (HLC) with their preferred level of preparatory information. No correlation was established between the HLC measures and the selected level of preparatory information although information requirements were established. The results are discussed and recommendations made for future pre-operative psycho-educational programmes.
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Affiliation(s)
- M Mitchell
- Department of Nursing, University of Salford, Eccles, Manchester, England
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Salmon P, Hall GM. A theory of postoperative fatigue: an interaction of biological, psychological, and social processes. Pharmacol Biochem Behav 1997; 56:623-8. [PMID: 9130286 DOI: 10.1016/s0091-3057(96)00429-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The concept of postoperative fatigue has been developed to explain the feelings of malaise and the reduction in activity during the convalescent period that follows surgery in humans. Fatigue has been assumed to reflect the degree of surgical trauma and to be a consequence of muscle weakness caused by physiological sequelae of the trauma. The evidence is inconsistent with this reductionist view. Instead we propose a theory that postoperative fatigue is based on an emotional and motivational change that has the function of ensuring inactivity so as to preserve homeostasis in vital systems in response to injury while preserving the physical capacity to respond to new challenge. This response, triggered by the patient's perception of the surgical stimulus, is prolonged by the influence of staff and patient expectations, which, in turn, reflect cultural beliefs in the necessity of convalescence. This theory can be tested by manipulation of clinical practice at pharmacological and psychological levels.
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Affiliation(s)
- P Salmon
- Department of Clinical Psychology, University of Liverpool, UK.
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McGrory BJ, Morrey BF, Rand JA, Ilstrup DM. Correlation of patient questionnaire responses and physician history in grading clinical outcome following hip and knee arthroplasty. A prospective study of 201 joint arthroplasties. J Arthroplasty 1996; 11:47-57. [PMID: 8676118 DOI: 10.1016/s0883-5403(96)80160-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Questionnaires are commonly used in orthopaedic outcome studies. This study sought to determine if responses to a simple standardized questionnaire correlated with responses obtained during a physician interview in evaluation of clinical outcome following hip and knee arthroplasty. One hundred sixty-two patients with 201 hip and knee arthroplasties were asked to fill out a questionnaire prior to returning for routine follow-up evaluation. There was a highly significant correlation (P < .0001, r = .74) between scores calculated from patient responses on the questionnaire and those calculated from responses recorded during the subsequent physician visit. There was no significant difference between patient and physician clinical hip scores, but physicians gave significantly higher knee scores than patients for both long- ( > 4.5 years, P < .05) and short-term ( < or = 4.5 years, P < .0001) follow-up periods; however, 97% of patient responses were within one grade of physician-recorded answers to the same questions. Eight and one-half percent of scores differed in overall evaluation from good-excellent to fair-poor categories. This study both validates and defines more clearly the limitations of questionnaires for follow-up evaluation of clinical results following total hip and knee arthroplasty.
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Affiliation(s)
- B J McGrory
- Department of Orthopaedic Surgery, Mayo Clinic and Foundation, Rochester, MN 55905, USA
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Steptoe A, Vögele C. Individual differences in the perception of bodily sensations: the role of trait anxiety and coping style. Behav Res Ther 1992; 30:597-607. [PMID: 1417685 DOI: 10.1016/0005-7967(92)90005-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thirty young women participated in an experiment in which heart rate, blood pressure, respiration rate, skin conductance level and palmar sweat index were monitored at rest and during the administration of mental arithmetic, mirror drawing and cold pressor tasks. The accuracy of perception of somatic states was estimated by calculating within-subject correlations between four bodily sensations (racing heart, high blood pressure, shortness of breath and sweaty hands) and corresponding physiological parameters, assessed on eight occasions during the experiment. The accuracy of heart rate perception was highest, with a mean correlation between actual heart rate and ratings of racing heart of 0.76 and 66% of participants showing significant within-subject effects. The mean accuracy was 0.55 for systolic blood pressure, 0.48 for respiration rate, 0.47 for skin conductance level, and 0.64 for palmar sweat index. Accurate perception across physiological parameters did not cluster within individuals, and was not dependent on the range either of physiological changes or sensation ratings. Trait anxiety was not significantly associated with accuracy of somatic perception. Subjects with high trait anxiety reported larger increases in shortness of breath during tasks than did low anxious subjects, but this was not reflected in objective physiological measures. Information-seeking coping style, indexed by the monitoring scale of the Miller Behavioral Style Scale, was related to the accuracy of perception of skin conductance level and heart rate. The use of within-subject correlational strategies for assessing individual differences in perception of bodily states is discussed.
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Affiliation(s)
- A Steptoe
- Department of Psychology, St. George's Hospital Medical School, London, England
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Abstract
A placebo effect on post-operative swelling was investigated as a possible model for studying psychological influences on recovery from surgery. 79 patients undergoing removal of impacted third-molars received one of five different procedures shortly after emerging from general anaesthetic. These included dentist-administered or placebo ultrasound (the latter given in two different ways to control for massage effects), untreated controls and a group instructed to apply facial massage to themselves. Pre- and post-operative measurements included trait and state-anxiety, coping style, emotional state, pain, plasma cortisol and facial swelling. Cortisol levels correlated with anxiety and avoidant coping. Post-operative anxiety was negatively correlated with pre-operative arousal. Neither coping nor emotional state was affected by the treatments, but swelling was reduced by a placebo effect of ultrasound. Cortisol levels also responded, apparently to an effect of massage. The coping and emotional factors which we measured here cannot, therefore, explain the effects of this psychological procedure on post-operative recovery.
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Affiliation(s)
- K H Ho
- Department of Oral Surgery, Eastman Dental Hospital, London, U.K
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Steptoe A, Horti J, Stanton S. Concern about cancer in women undergoing elective gynaecological surgery. Soc Sci Med 1986; 23:1139-45. [PMID: 3810198 DOI: 10.1016/0277-9536(86)90331-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Interviews were conducted with 63 women aged 18-75 shortly after their admission to hospital for routine non-cancer gynaecological surgery. Three groups were studied: major surgery, chiefly hysterectomy, carried out for benign conditions (n = 25); minor surgery such as dilatation and curettage (n = 29); fertility investigations and sterilisations (n = 9). Women were asked whether they worried if they were suffering from seven serious illnesses including heart disease, breast cancer and gynaecological cancer (cancer of the cervix, womb or ovaries). Significantly more women were concerned that they suffered from gynaecological cancer than any other illness. When asked why they were worried, over 85% of those expressing concern believed that their current gynaecological problem stemmed from cancer. Worry about gynaecological cancer was positively associated with psychiatric status and gynaecological knowledge, and negatively with satisfaction with treatment. A link with presenting clinical symptoms was also identified. This study revealed high levels of unwarranted distress in women undergoing routine surgery. Such fears may not be allayed, since surgeons and staff may not consider cancer to be relevant to the patient's clinical condition.
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