Benefits of preoperative education for adult elective surgery patients

Team-based care in specialist practice: a path to improved physician experience in British Columbia

BACKGROUND

Specialist physicians in the province of British Columbia commonly work on teams in acute care settings such as operating rooms or inpatient hospital units. However, while the implementation of team-based care (TBC) has been supported in primary care clinics, no formal mechanisms have supported specialist physicians in adopting TBC in their private outpatient offices. Adopting TBC models is associated with improving physician experience, efficiency, and patient experience.

METHODS

The Institute for Healthcare Improvement Breakthrough Series guided a program to support 11 specialist physicians, representing nine different specialties, to develop and implement TBC in outpatient offices. Participants were supported through resources including funding, mentorship, and learning opportunities. To determine whether the program improved physician experience, quantitative data were collected using the validated Mini Z survey and qualitative data were collected through monthly reports, semi-structured interviews, and focus groups. Patient experience data were collected through surveys and follow-up calls.

RESULTS

The fifteen-month program was successful, with 10 of the 11 specialists implementing TBC in their offices. The Mini Z results demonstrated that physician experience improved over the course of the program, with scores on job satisfaction, work pace, and time spent on the electronic medical record improving the most. Interviews with specialists and focus groups with specialists' team members support these findings, with participants stating that TBC modulates workloads, begins to affect burnout, improves work-life balance, and increases the efficiency of care. Patients reported positive experiences while receiving TBC. Patients were less likely to visit the emergency department after consultations with specialist teams, and providers agreed that their patients would be less likely to seek acute care because of the new practice models.

CONCLUSION

TBC is a viable model for specialist physicians and their health care teams practicing in British Columbia to foster well-being, job satisfaction, and efficiency, and to improve patient experience. These findings may be of interest to specialists, health care providers, policymakers, and administrators looking to better support and retain specialist practices that are integral to patient care.

Patient education in the digital age: An analysis of quality and readability of online information on rhinoplasty

This study aimed to investigate quality and readability of online rhinoplasty information provided on Turkish websites. We searched for the terms "rhinoplasty" (rinoplasti) and "nose job" (burun estetiği) in Turkish using the Google search engine in May 2023. The first 30 sites for each term were included in the evaluation. We used the DISCERN tool to evaluate quality and the Atesman and Cetinkaya-Uzun formulas to assess readability. According to the Atesman formula, the readability scores of all the websites were moderately difficult. According to the Cetinkaya-Uzun formula, the readability scores of websites were at the instructional reading level. The mean total DISCERN score was 2.33 ± 0.60, indicating poor quality. No statistically significant correlations were found between the Atesman or Cetinkaya-Uzun readability scores and the DISCERN scores across all websites (P > .05). Our analysis revealed key areas in which Turkish websites can improve the quality and readability of rhinoplasty information to support decision-making.

Role of Preoperative Information and Education of Patients Undergoing Total Hip Arthroplasty: A Narrative Review of the Literature

Total hip arthroplasty (THA) is a common and highly effective surgical procedure used to relieve pain and improve function in patients with severe hip arthritis and other hip disorders. While the surgical techniques and implants used in THA have advanced significantly, the importance of preoperative information and education cannot be overstated. The aim of this narrative review is to explore the effect of preoperative information and education on the outcome of THA. Key components of preoperative education and information include detailed information about the operation itself, the preoperative preparation, the postoperative pain management and rehabilitation, the possibility of postoperative complications, psychosocial support, and answers to frequently asked questions. The results of the study have confirmed the contradictory findings found in the literature concerning the impact of preoperative education on THA clinical outcomes, including pain, anxiety, functionality, postoperative rehabilitation, duration of hospitalization, and rate of complications. While, theoretically, preoperative education should have a positive effect on clinical outcomes, a plethora of studies have failed to support this hypothesis. Thus, there is a great need for properly designed, prospective, randomized, and controlled studies that have sufficient power in order to fully elucidate the role of preoperative education and information on THA outcomes.

The EUropean PErioperative MEdical Networking (EUPEMEN) project and recommendations for perioperative care in colorectal surgery: a quality improvement study

BACKGROUND

Despite consensus supporting enhanced recovery programs, their full implementation in such a context is difficult due to conventional practices within various groups of professionals. The goal of the EUropean PErioperative MEdical Networking (EUPEMEN) project was to bring together the expertise and experience of national clinical professionals who have previously helped deliver major change programs in their countries and to use them to spread enhanced recovery after surgery protocols (ERAS) in Europe. The specific aim of this study is to present and discuss the key points of the proposed recommendations for colorectal surgery.

MATERIALS AND METHODS

Five partners from university hospitals in four European countries developed the project as partners. Following a non-systematic review of the literature, the European consensus panel generated a list of recommendations for perioperative care in colorectal surgery. A list of recommendations was formulated and distributed to collaborators at each center to allow modifications or additional statements. These recommendations were then discussed in three consecutive meetings to share uniform ERAS protocols to be disseminated.

RESULT

The working group developed (1) the EUPEMEN online platform to offer, free of charge, evidence-based standardized perioperative care protocols, learning activities, and assistance to health professionals interested in enhancing the recovery of their patients; (2) the preparation of the EUPEMEN Multimodal Rehabilitation manuals; (3) the training of the trainers to teach future teachers; and (4) the dissemination of the results in five multiplier events, one for each partner, to promote and disseminate the protocols.

CONCLUSION

The EUPEMEN project allowed the sharing of the expertise of many professionals from four different European countries with the objective of training the new generations in the dissemination of ERAS protocols in daily clinical practice through a new learning system. This project was proposed as an additional training tool for all the enhanced recovery program teams.

The Effectiveness of Patient Education on Laparoscopic Surgery Postoperative Outcomes to Determine Whether Direct Coaching Is the Best Approach: Systematic Review of Randomized Controlled Trials

BACKGROUND

As of 2022, patient adherence to postoperative guidelines can reduce the risk of complications by up to 52.4% following laparoscopic abdominal surgery. With the availability of various preoperative education interventions (POEIs), understanding which POEI results in improvement in patient outcomes across the procedures is imperative.

OBJECTIVE

This study aims to determine which POEI could be the most effective on patient outcomes by systematically reviewing all the POEIs reported in the literature.

METHODS

In total, 4753 articles investigating various POEIs (eg, videos, presentations, mobile apps, and one-on-one education or coaching) were collected from the PubMed, Embase, and Scopus databases. Inclusion criteria were adult patients undergoing abdominal laparoscopic surgery, randomized controlled trials, and studies that provided postoperative outcomes. Exclusion criteria included studies not published in English and with no outcomes reported. Title and abstract and full-text articles with POEI randomized controlled studies were screened based on the above criteria through a blinded, dual review using Covidence (Veritas Health Innovation). Study quality was assessed through the Cochrane Risk of Bias tool. The included articles were analyzed for educational content, intervention timing, intervention type, and postoperative outcomes appropriate for a particular surgery.

RESULTS

Only 17 studies matched our criteria, with 1831 patients undergoing laparoscopic cholecystectomy, bariatric surgery (gastric bypass and gastric sleeve), and colectomy. In total, 15 studies reported a statistically significant improvement in at least 1 patient postoperative outcome. None of these studies were found to have an overall high risk of bias according to Cochrane standards. In total, 41% (7/17) of the included studies using direct individual education improved outcomes in almost all surgery types, while educational videos had the greatest statistically significant impact for anxiety, nausea, and pain postoperatively (P<.01). Direct group education demonstrated significant improvement in weight, BMI, exercise, and depressive symptoms in 33% (2/6) of the laparoscopic gastric bypass studies.

CONCLUSIONS

Direct education (individual or group based) positively impacts postoperative laparoscopic surgery outcomes.

TRIAL REGISTRATION

PROSPERO CRD42023438698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=438698.

Comparison of Patients' and Surgeons' Expectations before Shoulder Arthroplasty

Background: Patients suffering from osteoarthritis particularly complain about pain during day and night as well as loss of function. This consequently leads to impaired quality of life and therefore psychological stress. The surgical therapy of choice is joint replacement. Regarding the outcome after operation, expectations might differ between the patient and the surgeon. This can lead to dissatisfaction on both sides. This study aimed to document patients' expectations of a planned shoulder joint replacement. The results were compared with assessments made by shoulder surgeons. Methods: In total, 50 patients scheduled for operative shoulder joint replacement were included in this study, as well as 10 shoulder surgeons. Patients were requested to fill out questionnaires preoperatively to provide sociodemographic data, PROMS (Patient-Reported Outcome Measures) with regard to the pathology and their expectations about surgery in terms of pain relief, gain of range of motion, strength as well as the impact on activities of daily and professional life and sports. In addition, surgeons were asked what they thought their patients expect. Results: The most important goal to achieve for patients was to relieve daytime pain, followed by improvement of self-care and the ability to reach above shoulder level. The most important factors for patients to achieve after operation were 'pain relief' in first place, 'movement' in second and 'strength' in third. This also applied to shoulder surgeons, who ranked 'pain relief' first, followed by 'movement' and 'strength'. When patients where asked what is most important when it comes to choosing their surgeon, 68% voted for 'surgical skills', 28% for 'age/experience', followed by 'empathy', 'sympathy' and 'appearance'. For surgeons, 'age/experience' obtained rank one, 'surgical skills' was ranked second, followed by 'sympathy', 'empathy' and 'appearance'. Surgeons significantly underrated the factor 'empathy' in favor of 'sympathy'. Conclusions: This study shows that patients' expectations for shoulder joint replacement and surgeons' assessments do not differ significantly. Relief from pain and better shoulder movement were crucial for patients to achieve after operation, which was in line with surgeons' expectations. The most important factor for choosing the surgeon was 'surgical skills' for patients, while surgeons thought they would care more about 'age and experience'. This underlines that patients' expectations should be taken into account within the preoperative medical interview. This might allow an optimization of compliance of the patients and lead to a better satisfaction on both sides.

Systematic review and narrative description of the outcomes of group preoperative education before elective major surgery

Background

Group preoperative education is becoming standard care for patients preparing for surgery, alongside optimisation of exercise, diet, and wellbeing. Although patient education is essential, the effectiveness of group education programmes or 'surgery schools' as a means of delivery is unclear. This review examines whether attending group preoperative education improves patient outcomes.

Methods

We systematically reviewed studies of group perioperative education before major elective surgery. Observational or intervention studies with a baseline group or control arm were included. All outcomes reported were collected and, where possible, effect estimates were summarised using random effects meta-analysis.

Results

Twenty-seven studies reported on 48 different outcomes after group education. Overall, there was a 0.7 (95% confidence interval 0.27-1.13) day reduction in mean length of stay. The odds ratio for postoperative complications after abdominal surgery was 0.56 (95% confidence interval 0.36-0.85; nine studies). Patient-centred outcomes were grouped into themes. Most studies reported a benefit from group education, but only postoperative physical impairment, pain, knowledge, activation, preoperative anxiety, and some elements of quality of life were statistically significant.

Conclusion

This review presents a summary of published evidence available for group preoperative education. While these data lend support for such programmes, there is a need for adequately powered prospective studies to evaluate the effectiveness of preoperative education on clinical outcomes and to evaluate whether behaviour change is sustained. Furthermore, the content, timing and mode of delivery, and evaluation measures of preoperative education require standardisation.

Systematic review protocol

PROSPERO (166297).

Preoperative Patient Education: Perceptions and Actual Practice among Nurses Working in Surgical Units

Introduction

Preoperative education is an essential nursing task that can be affected by the nurses' perception. Patients may be receiving insufficient vital information before surgery. However, the essential information that should be provided to patients undergoing surgery is not fully addressed.

Objective

To assess the essential elements of preoperative information as perceived by the surgical nurses.

Methods

This was a cross-sectional study. A convenience sample of 224 registered nurses who were working at surgical units was recruited from two hospitals. A preoperative teaching questionnaire was used.

Results

Details about the operation (4.39 ± 0.61) and preoperative preparation (4.36 ± 0.61) were the most important domains of preoperative education as perceived by nurses. The results show significant differences between the perceived and actual preoperative educational practice across all domains except the preoperative preparation.

Conclusions

The delivery of preoperative education could be affected by nurses' perceptions. Efforts to facilitate the implementation of effective education as perceived by nurses should be conducted by minimizing potential barriers.

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.

Levels of Surgical Patients' Education Related to Surgical Interventions Among Patients in Saudi Arabia

BACKGROUND

Patient education and counseling should simplify and clarify the condition, surgery, postoperative care, and potential complications. This study aimed to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia.

METHOD

This was an online survey study that was conducted between January and May 2023 to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. The study population was patients who underwent surgeries (elective and emergency) living in Saudi Arabia. The questionnaire tool used in this study was developed based on an extensive literature review in the field of patients' education regarding surgical interventions. Binary logistic regression analysis was used to identify predictors of satisfaction with the callouts and the surgeon-consultant's communication quality.

RESULTS

A total of 1360 participants were involved in this study. Around 40.5% of the participants reported that they met the surgeon after diagnosing and recommending the issue. Almost 70.0% of research participants reported that the consultant surgeon personally explained a diagnosis or strategy to attain it and the surgical technique, method, and purpose before signing the informed consent. The majority of study participants reported that the consulting surgeon or a member of his surgical team explained the stages of reaching a diagnosis and the steps he/she will take to diagnose their condition (83.2%), discussed the diagnosis with them and how certain they are of the diagnosis (88.1%), described the surgery clearly and simply (85.5%), informed them of alternatives to surgical intervention (63.1%), and discussed the entire postoperative treatment plan (81.8%), informed them of possible postoperative complications (79.6%), used additional callout during the discussion (81.3%), and spoke to them after the surgery and before they left the hospital (69.2%). After a conversation with their doctors, 36.3% of study participants said they did not require an outside source to understand the diagnosis, operation, probable problems, treatment plan, and follow-up. Discussion "Just talk," sketching, and pictograms were the most popular callouts during patient education, with 78.3%, 22.3%, and 17.9%, respectively. Saudi participants were more likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). At the same time, participants who live in the Southern area were less likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05).

CONCLUSION

This study highlights the crucial role of surgeons in preoperative patient education as well as the significance of surgical team participation in this process. In order to increase patient knowledge, facilitate treatment decisions, and assure informed consent, it is necessary to establish guidelines and roles to improve surgeon-patient communication, increase patient and surgeon awareness, nurture patient concern expression, and encourage non-medical patient participation.

Effects of pre-operative education tailored to information-seeking styles on pre-operative anxiety and depression among patients undergoing percutaneous coronary intervention: A randomized controlled trial

Objective

This study aimed to evaluate the impact of pre-operative education tailored to percutaneous coronary intervention (PCI) patients' information-seeking styles on pre-operative anxiety and depression.

Methods

A single-blind randomized control trial was conducted. A total of 114 participants were recruited from the cardiology department in a tertiary hospital in Kunming, Southwest China from April to September 2020 and randomly allocated to the intervention group (n = 57) or control group (n = 57). All patients received oral pre-operative education as well as printed pre-operative education manuals and divided into monitors or blunters by the Chinese Version of the Monitoring Subscale of the Miller Behavioral Style Scale (C-MMBSS). The intervention group received pre-operative education tailored to information-seeking styles, while the control group received routine education. Anxiety and depression were measured at baseline and 1 h before the operation. Satisfaction with pre-operative education and length of stay were assessed at discharge.

Results

A total of 104 participants completed the study (52 participants in each group). Pre-operative education tailored to information-seeking styles was beneficial for reducing pre-operative anxiety (P < 0.01), reducing pre-operative depression (P < 0.01), and improving satisfaction with pre-operative education (P < 0.01) compared with routine education. There was no significant difference in length of stay between the intervention and control groups (P = 0.209). Conversely, pre-operative anxiety of patients was increased (P = 0.017) after pre-operative education in the control group.

Conclusion

This study confirmed that pre-operative education tailored to information-seeking styles effectively reduces pre-operative anxiety and depression and improves satisfaction with preoperative education.

Knowledge, practice, and associated factors of preoperative patient teaching among surgical unit nurses, at Northwest Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, 2022

BACKGROUND

Preoperative teaching practice is very important to surgical clients in freeing them from anxiety and post-operative complications. The preoperative education received by the patients depends on the knowledge and experience of nurses. The diversity in the degree of knowledge and experience possessed by nurses may result in inadequate and ineffective preoperative preparation of patients. Therefore, this study aimed to assess the knowledge, practice, and associated factors of preoperative patient teaching among nurses working at surgical units in Northwest Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia, 2022.

METHOD

An institutional-based cross-sectional study triangulated with a qualitative approach was conducted from April to June 2022. The data were collected using a semi-structured self-administered questionnaire and in-depth interviews. The descriptive statistics were presented in text and tables. Analytical analysis schemes including bivariable and multivariable logistic regression were computed considering P-value < 0.05 to identify statistically significant factors. Qualitative data were analyzed with thematic analysis.

RESULT

A total of 406 participants were involved in this study with a 95.8% response rate. The adequate knowledge of nurses was 61.6% with 95% CI: (56.7, 66.3) and significantly associated with being male, nurse use of guidelines, nurses they have been trained, and nurses' who say they do not a staff shortage had good knowledge than the counterparts. Good practice of nurses regarding preoperative patient education was 46.3% with 95% CI (41.4, 51.0) significantly associated with the presence of preoperative teaching guidelines, took training on patient education, nurses who said no staff shortage, and knowledge of preoperative patient education.. Nurses have a positive interaction with the patient and much work experience had good practice but lack of training; inadequate supplies and lack of professional prerequisites are some of the barriers identified.

CONCLUSION

Nurses' knowledge and practice regarding preoperative patient teaching were found to be inadequate. So, it is better to strengthen training, adequate staffing, equip wards with standardized guidelines and teaching materials, motivate and create a safe working environment. Most nurses explore factors of preoperative patients' teaching as institutional, Nurse's related, and patient-related factors.

Patient response to osteotomy around the knee joint at one year post-operation-fulfilment of expectations and current health status

INTRODUCTION

The aim of this study was to investigate patient satisfaction and fulfilment of expectations after osteotomy around the knee at one year postoperatively, using patient-related outcome measures.

MATERIALS AND METHODS

From the initial sample of 264 patients, a total of 132 patients (age 48y ± 11) were enrolled in this prospective study (response rate 49.3%). Data were collected using the Hospital For Special Surgery-Knee Surgery Expectations Survey (HFSS-KSES), items for satisfaction and the Knee injury and Osteoarthritis Outcome Score (KOOS) measures. At one year postoperative follow-up, an individualized questionnaire asked whether the specific person-related expectations had been fulfilled.

RESULTS

Satisfaction was high with 83.2% of all participants at one year after surgery. A total of 78% of patients stated they would decide to do the surgery again. This decision was significantly associated with satisfaction, younger age and better KOOS scores scales before surgery for pain, activity and sports. We found high correlations between satisfaction and fulfilment of expectations for the HFES-KSES. Fulfilment of expectations one year after surgery was significantly associated with significant improvements in KOOS scales at one year post-operation. Expectations (1) "to get the knee back to normal status", (2) "improve ability to squat", (3) "improve ability to run", (4) "improve ability to kneel" had been fulfilled worst. A multiple linear regression model for satisfaction had an R² = 0.797 of the variance. The most influential was the variable fulfilment of "maintain health" that had 70.7% of variance.

CONCLUSIONS

The fulfilled expectation concerning an improvement of the ability to maintain health was the most influential parameter for satisfaction at one year post-osteotomy. Patients with better health status of the knee and younger age rated the surgery to be more positive and were also more likely to do the surgery again. This provides an indication for an earlier intervention, before the knee and overall health status becomes more detrimental.

LEVEL OF EVIDENCE

Level II (Therapeutic study).

"Air Anatomy" - Teaching Complex Spatial Anatomy Using Simple Hand Gestures

Spatial understanding of complex anatomical concepts is often a challenge for learners, as well as for educators. It is even more challenging for students with low mental spatial abilities. There are many options to teach spatial relationships, ranging from simple models to high-end three-dimensional (3D) virtual reality tools. Using a randomized controlled trial design, this study explored the use of a unique combination of deictic and iconic hand gestures to enhance spatial anatomical understanding, coining the term "Air Anatomy". The control group (n = 45) was given a lecture on the anatomy of extraocular muscles, while the intervention group (n = 49) received the same lecture including "Air Anatomy" hand gestures. When compared to the control group, the post-test scores for the intervention group were significantly higher for basic recall (P < 0.001; Mann-Whitney U test) and for the application of knowledge (P = 0.015; Mann-Whitney U test). Students with low to moderate spatial ability (as assessed by a mental rotation test) were found to benefit most by this technique. Students in the intervention group also reported a lower extrinsic cognitive load and higher germane load, when compared to the control group. An instructional skills questionnaire survey indicated the effectiveness of this technique in improving overall classroom experience. Feedback of the students in the intervention group was also favorable for instruction using "Air Anatomy". The study suggests that "Air Anatomy" is a useful, "no-cost", accessible method that aids spatial understanding of anatomical concepts.

Different expectations of patients and surgeons with regard to rotator cuff repair

BACKGROUND

Rotator cuff lesions are a common shoulder pathology mainly affecting patients aged >50 years. This condition is accompanied by not only pain and loss of function but also impaired quality of life and psychological stress. A frequently employed treatment option is arthroscopic repair. But expectations regarding the outcome after surgery might differ between patients and surgeons and therefore lead to dissatisfaction on both sides. The aim of this study was to document patient expectations of a planned arthroscopic rotator cuff repair and compare the results with the assessment of shoulder surgeons.

MATERIALS AND METHODS

A total of 303 patients and 25 surgeons were involved in this study. Patients with partial- or full-thickness tear of the rotator cuff scheduled for arthroscopic repair were included in this study. Preoperatively, they were asked to fill out questionnaires inquiring sociodemographic data, scores of the underlying pathology, as well as expectations regarding the operation with regard to pain relief, gain of range of motion and strength, as well as the effect on activities of daily life, work, and sports. Furthermore, 25 surgeons were surveyed on what they think their patients expected using the same standardized questions.

RESULTS

Among the patients, 43.9% considered gain of range of motion to be the most important goal after rotator cuff repair, followed by pain relief (30.6%) and gain of force (13.7%). Among the surgeons, 72% believed pain relief to be the most important for their patient followed by movement (20%) and strength (8%). When asked which parameter was the most important to achieve after operation, for patients, movement was on first place, pain second, and strength third. For shoulder specialists, the ranking was pain, movement, and strength. Surgeons significantly overrated pain relief when ranking against movement compared with their patients.

CONCLUSION

The expectations of patients regarding their operation differ from the surgeon's assessment. Whereas gaining range of motion was more important for patients, surgeons clearly voted for pain relief. Different expectations should therefore be discussed within the pretreatment interview and taken into account when planning the right therapy. This might lead to better satisfaction on both sides.

The clinical effect and safety of new preoperative fasting time guidelines for elective surgery: a systematic review and meta-analysis

BACKGROUND

Traditional fasting and no drinking schemes (fasting for 8-12 hours and no drinking for 4-6 hours) affect the metabolism of the body. The new guidelines put forward by the American Association of Anesthesiologists (fasting for 6 hours, no drinking for 2 hours) obviously reduce the time of fasting and no drinking, but the clinical efficacy and safety need to be further confirmed. In this study, a meta-analysis of randomized controlled trials (RCTs) using the new guidelines and traditional protocols was conducted to provide an evidence-based foundation for elective surgery.

METHODS

The articles were searched in PubMed, EBSCO, MEDLINE, Science Direct, Cochrane Library, CNKI, China Biomedical Resources Database, Wanfang Database, Weipu, and Western Biomedical Journal Literature Database. RCTs related to fasting before surgery during the screening period were selected. Chinese and English search keywords included elective surgery, preoperative, fasting and no drinking, patient comfort, thirst, hunger, collapse, hypoglycemia, preoperative gastric volume, preoperative gastric juice pH, and intraoperative gastric volume. The RevMan 5.3 software provided by Cochrane collaboration network was used to evaluate the quality of included documents. Two professionals independently screened the literature, extracted data, and assessed the risk of bias.

RESULTS

A total of 6 studies were included. The incidence of hunger in patients undergoing elective surgery in the experimental group and control group was significantly different [Z=3.90; relative risk (RR) =0.58; 95% confidence interval (CI): 0.44, 0.76; P<0.0001]. The incidence of thirst was significantly different between the experimental group and control group (Z=7.22; RR =0.21; 95% CI: 0.13, 0.32; P<0.00001).

DISCUSSION

Meta-analysis results confirmed that the new guidelines can significantly reduce the hunger and thirst of patients, improve their satisfaction after surgery, and can be applied clinically.

Quality of recovery assessment of day case and multiday stay patients undergoing elective laparoscopic cholecystectomy

Objectives

Many laparoscopic cholecystectomy operations are performed with at least overnight admission. Current research shows that laparoscopic cholecystectomy is safe and feasible to do as a day case. Patient centred outcomes are less well understood.

Material and Methods

Elective laparoscopic cholecystectomy patients at a single metropolitan hospital in Melbourne, Australia were surveyed 24 hours after surgery using the 15-question Quality of Recovery (QoR-15) survey. A comparison was made between day case surgeries and multi-day surgeries.

Results

One hundred and eight patients were recruited consisting of 34 day case and 74 multi-day patients. Patient groups did not differ in terms of age, sex or postoperative morbidity. The multi-day group had a higher proportion of comorbid patients (p-value = 0.03). There was no significant dif- ference in overall QoR-15 score between the two groups, although there was an observed trend towards a higher score in the day case group (132.0 vs 127.9, p= 0.147). QoR-15 individual question results showed that day cases rated significantly better for sleep quality and for less feelings of anxiety or worry. The differences narrowed when comparing patient groups as they were booked (intention-to-treat). There were no identified sub-groups that had a significantly higher score if admitted multi-day.

Conclusion

Quality of recovery following day case laparoscopic cholecystectomy is just as good, if not better, than multi-day cases. Laparoscopic cholecystectomy as a day case is both safe and economically superior to multi-day management. This gives further weight to current recommendations suggesting that the majority of laparoscopic cholecystectomy operations could be performed as day cases.

3D Modeling and Advanced Visualization of the Pediatric Brain, Neck, and Spine

The ready availability of advanced visualization tools on picture archiving and communication systems workstations or even standard laptops through server-based or cloud-based solutions has enabled greater adoption of these techniques. We describe how radiologists can tailor imaging techniques for optimal 3D reconstructions provide a brief overview of the standard and newer "on-screen" techniques. We describe the process of creating 3D printed models for surgical simulation and education, with examples from the authors' institution and the existing literature. Finally, the review highlights current uses and potential future use cases for virtual reality and augmented reality applications in a pediatric neuroimaging setting.

Differences in Patients' and Surgeons' Expectations before Shoulder Stabilization Surgery

Purpose: The primary goal of shoulder stabilization procedures is to re-establish stability and many surgeons measure the success after shoulder stabilization surgery only by the absence of re-dislocation. However, patients might also suffer from pain, loss of range of motion and strength as well as anxiety and stigmatization and therefore have other expectations from a stabilization surgery than just a stable shoulder. Purpose of this study was to analyze if surgeons know what their patients typically expect from a shoulder stabilization surgery. Furthermore, the aim was to analyze the influence of various factors on patients’ expectations. Materials and Methods: 204 patients with a diagnosis of shoulder instability scheduled for surgical treatment were included in this prospective multicentric study. Preoperatively, objective and subjective scores were obtained and patients were asked about their postoperative expectations. Additionally, 25 surgeons were interviewed with regard to what they think their patients expect from the surgery using standardized questions. Results: With regard to postoperative expectations surveyed by the Hospital for Special Surgery questionnaire (HSS), the most important goal to achieve for the patients was ‘stopping the shoulder from dislocation’, followed by ‘to improve the ability to exercise or participate in sports’ and ‘being the shoulder to be back the way it was before the issue started’. The ranking of factors for patients was ‘stability’ as the most important to achieve, followed by ‘movement’, ‘strength’, ‘pain’ and ‘cosmetics’. For surgeons, the order was ‘stability’ (p = 0.004 **), ‘movement’ (p = 0.225), ‘pain’ (p = 0.509), ‘strength’ (p = 0.007 **) and ‘cosmetics’ (p = 0.181). There was a significant difference between patients and surgeons with regard to gaining stability at the cost of movement (p = 0.001 **). Conclusion: Patients and surgeons expectations regarding outcome after surgical shoulder stabilization procedures are quite similar with limited topics of disagreement. Generally, surgeons tend to overrate the importance of stability at the costs of other factors.

Quality of YouTube Videos on Laparoscopic Cholecystectomy for Patient Education

Background

Surgical patients frequently seek information from digital sources, particularly before common operations such as laparoscopic cholecystectomy (LC). YouTube provides a large amount of free educational content; however, it lacks regulation or peer review. To inform patient education, we evaluated the quality of YouTube videos on LC.

Methods

We searched YouTube with the phrase “laparoscopic cholecystectomy.” Two authors independently rated quality of the first 50 videos retrieved using the JAMA, Health on the Net (HON), and DISCERN scoring systems. Data collected for each video included total views, time since upload, video length, total comments, and percentage positivity (proportion of likes relative to total likes plus dislikes). Interobserver reliability was assessed using an intraclass correlation coefficient (ICC). Association between quality and video characteristics was tested.

Results

Mean video quality scores were poor, scoring 1.9/4 for JAMA, 2.0/5.0 for DISCERN, and 4.9/8.0 for HON. There was good interobserver reliability with an ICC of 0.78, 0.81, and 0.74, respectively. Median number of views was 21,789 (IQR 3000–61,690). Videos were mostly published by private corporations. No video characteristic demonstrated significant association with video quality.

Conclusion

YouTube videos for LC are of low quality and insufficient for patient education. Treating surgeons should advise of the website's limitations and direct patients to trusted sources of information.

Quality, Reliability, and Readability of Online Information on Rhinoplasty

BACKGROUND

With an ever-growing reliance on technology, patients are increasingly resorting to websites for their medical information. This study evaluates the readability, quality, and reliability of online information available on rhinoplasty provided by academic centers or impartial reference sources and private practice websites.

METHODS

A cross-sectional study from July to August 2019 was performed looking at the first 42 informational websites on a Google search for the term nose job. Websites were categorized as belonging to impartial sources and academic centers or private practices. Two independent reviewers evaluated websites on their quality, readability, reliability, and technical qualities using several validated measures. The Health on the Net code (HONcode) and DISCERN questionnaire were used to assess the quality and reliability of the information presented on the websites. Significance tests were performed using SPSS Version 25.

RESULTS

Of the 42 websites, 23 were impartial sources or academic centers (54.8%) and 19 were private practice websites (47.6%). The mean (±SD) for the HONcode and DISCERN scores were 5.7 (±2.8) and 2.6 (±0.7), respectively. The mean (SD) HONcode scores for impartial sources and private practice websites were 7.1 (±2.9) and 4.1 (±1.5), respectively (P < 0.001). The mean (±SD) DISCERN scores were 2.9 (±0.7) and 2.3 (±0.5), respectively (P = 0.009). There was no statistically significant difference in scores for readability and technical qualities.

CONCLUSIONS

While impartial sources and academic centers score higher on quality and reliability scores, their scores were also low. These findings are concerning as many consumers use the information provided by online websites to guide decisions regarding their health.

Empowerment-Based Education in Urological Patients: A Scoping Review

Prostate, kidney, and bladder cancer are the three most frequently diagnosed urological cancers. Educational programs could teach patients to become experts in disease management. The aim of this scoping review was to explore the literature to identify the educational requirements and strategies for improving and implementing educational processes for urological patients undergoing surgery. We searched several databases, including PubMed, CINAHL, Embase, Scopus, PsycINFO, and Cochrane Library. All adult patients undergoing urological educational interventions were included in the review. Of 3,197 initially identified articles, 42 were retained. Urological patients undergoing prostatectomy, cystectomy, and nephrectomy require cognitive, psychological, and functional support. For each level of support, several methods exist to provide support, including informational brochures, preoperative counseling, telephone support, online content, educational videos, support groups, individual stress management interventions, peer support, online interventions, partner support, and various educational programs that help the patient manage negative effects associated with the urological intervention.

The Effect of Photographic Visual Aids in Preoperative Patient Counseling in Oculoplastic Surgery

PURPOSE

To investigate the effect of visual supplementation and its mode of delivery in preoperative counseling of patients undergoing oculoplastic surgery.

METHODS

A prospective randomized controlled trial of consecutive patients undergoing oculoplastic eyebrow and eyelid surgery was conducted. Patients were randomized to an "oral only" group receiving routine preoperative oral counseling or an "oral and visual" group receiving identical counseling visually supplemented with photographs demonstrating common postoperative physical findings. Patients in the "oral and visual" group were further randomized to receive education from the medical team in person versus prerecorded video. Patient emotions and expectations regarding postoperative healing were assessed preoperatively and at 1 week and 2 months postoperatively.

RESULTS

103 patients were included: 32 received in-person oral education, 33 received in-person oral education with photographs, and 38 received education with photographs via video. There were no significant differences in demographics or preoperative patient fear, anxiety, or preparedness. The "oral and visual" group expected more severe postsurgical discomfort and physical findings at postoperative day 1 and week 1. There were no significant differences between groups in surgery signup, cancellation, or triage call rates; patient expectations of postoperative months 2 and 4; or in anxiety, preparedness, or satisfaction.

CONCLUSIONS

Visual supplementation in preoperative counseling increases patient expectations of postoperative physical findings without escalating fear or anxiety, and has no significant impact on patient emotions, triage call rates, and satisfaction throughout their surgical experience. Preoperative education via video is perceived by patients to be equivalent to counseling in person by the surgeon.

Quality of life in patients with endometrial carcinoma: A Longitudinal Study

AIM

To investigate the quality of life in patients with endometrial carcinoma and provide theoretical basis for nursing care.

DESIGN

In this study, 69 patients diagnosed with endometrial carcinoma from 2016-2018 were included in the cohort.

METHODS

Sixty-nine patients from our hospital who underwent endometrial cancer surgeries were selected. The SF-36 was used to investigate and analyse the patients' quality of life in the first, second and third months after their operations. Questionnaires were administered to analyse the factors affecting postoperative quality of life.

RESULTS

Quality of life for the second and third months was obviously better than that for the first month after the operation (p < .05). Based on multivariate regression analysis, we found that patients with higher family income had better quality of life after surgery(p < .05). These results can provide some guidance for daily nursing work after endometrial cancer operation.

Preoperative education: making every contact count

Patient education is an important part of obtaining informed consent, but can also be used to educate patients about how to prepare for surgery and help them take responsibility for improving their own health to reduce their risk of perioperative complications.

Reduced Need for Urinary Bladder Catheterization in the Postanesthesia Care Unit After Implementation of an Evidence-based Protocol: A Prospective Cohort Comparison Study

Background

Postoperative urinary retention (POUR) is a known complication in the postanesthesia care unit (PACU). The variations in catheterization thresholds contribute to unnecessary invasive procedures.

Objective

In the current study, we implemented an algorithm for a sterile intermittent catheterization (SIC) threshold of 800 ml with volume-dependent bladder scan intervals and compared the incidence of SIC with that of a matched patient cohort threshold of 400 ml.

Design, setting, and participants

This comparative study of two prospective historical cohorts represented two thresholds for POUR, set at 400 ml without a standardized bladder scan protocol and 800 ml with a volume-dependent bladder scan protocol.

Outcome measurements and statistical analysis

The primary outcome was the frequency of catheterization during the PACU stay. Secondary outcomes evaluated patient safety aspects in occurrence of thresholds above 400/800 ml. The study was set at the PACU under the Department of Anesthesia, Center for Cancer and Organ Diseases, Rigshospitalet, Denmark.

Results and limitations

In total, 741 patients were consecutively included, with 307 in the POUR-400 and 434 in the POUR-800 group, and with comparable group characteristics. Significantly fewer patients fulfilled the SIC/catheter a’ demeure (CAD) criteria in the POUR-800 (5.0%) versus POUR-400 (14.3%) group, equivalent to a 65.0% relative reduction in SIC.

Conclusions

Implementation of a standardized ultrasound-guided protocol with volume-dependent scan intervals and an evidence-based catheterization threshold of 800 ml decreases the need for SIC by >65%, without increasing the need for urinary catheterization at the wards.

Patient summary

In this study, we implemented an algorithm for a sterile intermittent catheterization threshold of 800 ml with volume-dependent bladder scan intervals. A marked reduction was seen in catheterization in the postanesthesia care unit, without increasing catheterization rates at the ward.

Perceptions of patients undergoing percutaneous coronary intervention on pre-operative education in China: A qualitative study

Objectives

To explore the perceptions of patients undergoing percutaneous coronary intervention (PCI) regarding their pre‐operative health education.

Methods

A qualitative study using semi‐structured, in‐depth interviews was conducted in one cardiology unit in China from July 2019 to December 2019. Purposeful sampling of 17 patients undergoing PCI was interviewed about their perceptions of pre‐operative health education. Thematic analysis of the transcribed data was then used to identify the themes.

Results

Four themes emerged from the data:(a) triple roles of pre‐operative education with the categories of relief (reliving fear); burden (leading to stress); and meaningless (changing nothing); (b) family member involvement with the categories of shared responsibility and family members’ duty; (c) facilitators in the process of pre‐operative health education with the categories of emotional support, plain language and individualized pre‐operative education; (d) inhibitors in the process of pre‐operative health education with the categories of contradiction and threatening words.

Conclusions

Pre‐operative health education for patients undergoing PCI should be aligned with the individual patients’ information‐seeking styles and personal differences, emphasizing individualized patient education. Traditional Chinese philosophy should be considered in the practice of pre‐operative education for patients undergoing PCI, which emphasizes family member involvement; at the same time, patient empowerment and self‐care should also be stressed. In addition, emotional support and plain language from health professionals are important in pre‐operative health education for patients undergoing PCI; contradiction should be avoided, and threatening words should be used with caution and with consideration for cultural variations during pre‐operative education for patients undergoing PCI.

Virtual and augmented reality: potential applications in radiology

The modern-day radiologist must be adept at image interpretation, and the one who most successfully leverages new technologies may provide the highest value to patients, clinicians, and trainees. Applications of virtual reality (VR) and augmented reality (AR) have the potential to revolutionize how imaging information is applied in clinical practice and how radiologists practice. This review provides an overview of VR and AR, highlights current applications, future developments, and limitations hindering adoption.

A quasi-experimental study examining QR code-based video education program on anxiety, adherence, and satisfaction in coronary angiography patients

Background: QR (quick response) codes are a promising tool for health education, however effects of QR code application in providing peri-procedure education to patients with coronary angiography is unclear.Aim/Objective: This study investigated the effect of a QR code-based video education program on anxiety, adherence, and satisfaction in Chinese coronary angiography patients.Material and Methods: This prospective controlled clinical trial included 335 patients undergoing coronary angiography, including 166 patients in the experimental group and 169 patients in the control group. On the day before coronary angiography, patients in the experimental group had access to and could watch an educational video on their smartphones by scanning a QR code for multiple times, while patients in the control group watched the same video on a tablet once only. The primary outcome was anxiety assessed using the Chinese State Anxiety Inventory (C-SAI). Adherence to instructions and patient satisfaction with the information delivery method were also evaluated.Results: The C-SAI scores improved in the experimental group compared to the control group (F = 9.8, P < 0.001) over time. There is a significant difference in the changes of anxiety scores from baseline to pre-procedure (P < 0.001) and post-procedure (P < 0.01) between the two groups. Individuals in the experimental group showed better adherence to instructions on removing dentures and jewelry, and taking medicines before the procedure (P < 0.05), and limb activity, water consumption, and diet after the procedure (P < 0.001).Conclusion: Patient education programs on smartphone that can be accessed multiple times by scanning a QR code can be an effective and convenient approach to reducing anxiety and enhancing adherence to instructions among Chinese coronary angiography patients. Hospitals and clinicians should consider more investments in developing such patient education programs and also help improve ehealth literacy.

Video Education to Improve Preoperative Anxiety in the Bariatric Surgical Patient: A Quality Improvement Project

PURPOSE

Evidence supports that providing preoperative education using an audiovisual format is an effective method to reduce anxiety in the surgical patient. The purpose of this quality improvement project was to evaluate the effect of viewing a video tour of the perioperative division had on patient-perceived preoperative anxiety.

DESIGN

A quasi-experimental design using a pre-post survey method of two individual groups.

METHODS

Sixty bariatric surgery patients completed a visual analog scale for anxiety (VAS-A), consisting of 10 items, on arrival and at the end of their preassessment appointment. Thirty patients in the comparison group received preoperative education with the current process of written and verbal instructions. Thirty patients in the intervention group received education with written and verbal instructions as well as inclusion of an informational video tour of the perioperative division. A paired sample t test was used to compare VAS-A results of the comparison and intervention groups.

FINDINGS

Data supported that bariatric patients who received only verbal and written instructions preoperatively had a statistically significant reduction in anxiety levels in five of 10 items on the VAS-A. Bariatric patients who received education with verbal and written instructions, as well as inclusion of the informational video tour, had a statistically significant reduction in self-perceived anxiety in 9 of 10 items on the VAS-A.

CONCLUSIONS

Data supported that the addition of an audiovisual component in the form of an informational tour of the perioperative division is an effective method to reduce perceived preoperative anxiety in patients having bariatric surgery.

Effect of preoperative in-bed exercises and mobilization training on postoperative anxiety and mobilization level

AIM

This study examines the effect of preoperative training on postoperative mobility and anxiety levels in patients undergoing total knee arthroplasty.

METHODS

This was a randomized controlled study. The sample of this study consisted of 60 (30 experimental group, 30 control group) total knee arthroplasty patients who were admitted to a public hospital's orthopedic department between January 2019 and May 2019. To collect data, a demographic information form, patient mobility scale, observer mobility scale, and state-trait anxiety inventory were used. The patients in the intervention group practiced bed exercise and mobilization training before total knee arthroplasty surgery. The control group had no intervention.

RESULTS

It was determined that the patient mobility scale (2.0 ± 0.83) and observer mobility scale scores (6.93 ± 1.61) of the patients in the experimental group were significantly lower than the patients in the control group (respectively: 4.16 ± 1.31, 11.0 ± 1.74; p < .05). In the postoperative period, the mean scores of the state (38.86 ± 6.11) and trait anxiety scores (38.26 ± 3.85) of the patients in the experimental group were found to be significantly lower than the patients in the control group (respectively: 59.03 ± 9.10, 43.80 ± 4.38; p < .05).

CONCLUSION

Preoperative training reduced the postoperative anxiety and increased the level of patient mobility after total knee arthroplasty in this study.

Team Approach: Safety and Value in the Practice of Complex Adult Spinal Surgery

Surgical management of complex adult spinal deformities is of high risk, with a substantial risk of operative mortality. Current evidence shows that potential risk and morbidity resulting from surgery for complex spinal deformity may be minimized through risk-factor optimization. The multidisciplinary team care model includes neurosurgeons, orthopaedic surgeons, physiatrists, anesthesiologists, hospitalists, psychologists, physical therapists, specialized physician assistants, and nurses. The multidisciplinary care model mimics previously described integrated care pathways designed to offer a structured means of providing a comprehensive preoperative medical evaluation and evidence-based multimodal perioperative care. The role of each team member is illustrated in the case of a 66-year-old male patient with previous incomplete spinal cord injury, now presenting with Charcot spinal arthropathy and progressive vertebral-body destruction resulting in lumbar kyphosis.

Prospective Qualitative Multidimensional Assessment of the Postoperative Rhinoplasty Experience

Background: Understanding the multidimensional postoperative patient experience after rhinoplasty is critical for preoperative counseling and postoperative management. Methods: A prospective clinical study was conducted from June to December 2019 for 60 patients undergoing cosmetic and/or functional rhinoplasty by two facial plastic surgeons. All patients were administered the brief pain inventory, a clinically validated pain instrument, including multiple quality of life (QOL) domains, survey at postoperative days (PODs) 1, 2, 3, and 8. Nasal Obstruction Symptom Evaluation (NOSE) scores were used to predict patients having greatest QOL disturbance. Primary outcomes were postoperative QOL domains, pain scores, and oxycodone usage. Statistical analysis was performed using STATA 14.0 (STATA Corp., College Station, TX). Preoperative NOSE and postoperative Euro Quality of Life 5-Dimension scores were also recorded. Results: Patients showed greatest disruption to QOL in the first 3 PODs and essentially returned to normal levels by POD8, which mirrored trends in pain and opioid usage. All tested QOL domains (general activity, sleep, work, mood, enjoyment, and relationships) were strongly correlated with overall pain. NOSE scores were not significantly associated with pain or QOL impairment. Conclusions: This is the first study to prospectively evaluate the rhinoplasty patient's postoperative experience using a pain instrument, including multiple QOL domains. Utilizing a validated clinical instrument allows for standardized comparison of postrhinoplasty pain and QOL disruption with other surgical procedures and disease processes. These data may help guide preoperative counseling and set accurate patient expectations for the postoperative period.

Clinical pathway efficiency for elective joint replacement surgeries: a case study

PURPOSE

The purpose of this paper is to define a clinical pathway for total joint replacement (TJR) surgery, estimate the effect of delays between steps of the pathway on wait time for surgery and to identify factors contributing to more efficient operations and challenges to their implementation.

DESIGN/METHODOLOGY/APPROACH

This is a case study with a mixed methods approach. The authors conducted interviews with hospital staff. Data collected in the interviews and through on-site observation were analyzed to map the TJR process and identify the steps of the care pathway. The authors extracted and analyzed data (time stamps) from 60 hospital patient records for each step in the pathway and ran a regression on the duration of the whole trajectory.

FINDINGS

There were wide variations in the delays observed between the seven steps identified. The delay between Step 1 and Step 2 was the only significant variable in predicting the total wait time to surgery. In one hospital, one delay explained 50 percent of the variation. There was misalignment between findings from the qualitative data in terms of strategies implemented to increase efficiency of the clinical pathway to the quantitative data on delays between the steps.

RESEARCH LIMITATIONS/IMPLICATIONS

The study identified the clinical pathway from the consultation with an orthopaedic surgeon to the surgery. However, it did not go beyond the surgery. Future research could investigate the relationship between specific processes and delays between steps of the process and patient outcomes, including length of stay, mobilization and functionality in activities of daily living, as well as potential complications from surgery, readmission and the services required after the patient was discharged.

PRACTICAL IMPLICATIONS

Wait times can be addressed by implementing strategies at the health system level or at the organizational level. The authors found and discuss areas where there could be efficiency gains for health care organizations.

SOCIAL IMPLICATIONS

Stakeholders in care processes are diverse and they each have their preferences in how they practice (in the case of providers) and how they perceive and wish to respond adequately to patients' needs in contexts that have different norms and approaches. The approach in this study enables a better understanding of the processes, the organizational culture and how these may affect each other.

ORIGINALITY/VALUE

Our mixed methods enabled a process mapping and the identification of factors that significantly affected the efficiency of the TJR surgery process. It combines methods from process engineering with health services and management research. To some extent, this study demonstrates that although managers can define and enforce processes, organizational culture and practices are harder to influence.

Patients' Perspectives of Surgical Safety Before and After Their Elective Surgeries at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Background Patients need to be educated and all possible treatment alternatives should be explored. Patients should be given options that they can choose from based on their demographic information, clinical information, and possible options for treating a given issue. This is especially true in elective surgery. The concept of safety plays a major part in every field, particularly in medicine. The patient's safety is a key factor for a better experience and a better outcome.  Objective This study aims to determine patient perceptions of surgical safety with an emphasis on surgical team interaction throughout the phases of care. Methods A descriptive cross-sectional prospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients undergoing elective surgery and hospitalized for more than 24 hours were asked to give their opinions regarding interactions between them and the surgical teams, including the nurses, anesthesiologists, and surgeons who operated on them. Only patients aged 18 or above were included in the sample. The analysis was carried out using the IBM Statistical Package for Social Sciences (SPSS), version 25 (IBM SPSS Statistics, Armonk, NY). Results More than 70% of the study respondents had had more than one surgery. One hundred and ten of the study respondents said that the specific surgeons who attended to them encouraged them to ask questions. The majority of the respondents (76.7%) said that the surgical team gave them definite physical comfort, while the rest (23.3%) stated that they got somewhat less physical comfort from the surgical team. The average rating of the satisfaction pre-surgery was mean (M) = 8.51, standard deviation (SD) = 1.9, (95% confidence interval (CI): 8.19 - 8.83) while the average satisfaction rating for postoperative care was M = 9.05, SD = 1.35, (95% CI: 8.82 - 9.27). Conclusions Most patients valued surgeon-patient interaction as it was seen to reduce pre-surgery anxiety, helped in giving options, and improved the patient's overall understanding of the surgical procedure. Surgical teams are generally highly rated in terms of overall service pre- and post-surgery.

Patients' expectations of osteotomies around the knee are high regarding activities of daily living

PURPOSE

This study was conducted to investigate patients' expectations on high tibial osteotomies, distal femur osteotomies, and double-level osteotomies in different health-related domains. It was hypothesized that expectations are high in terms of capacity to work, pain relief, and restoring knee function.

METHODS

A total of 264 patients (age 47 years ± 11 years) were enrolled in this study from March 2015 until May 2016 in seven specialized orthopaedic surgery departments. Data were collected via the Knee injury and Osteoarthritis Outcome Score, the Hospital for Special Surgery-Knee Surgery Expectations Survey, and a ten-item (non-validated) questionnaire to specifically ask about expectations of osteotomies around the knee 24-48 h prior to surgery. In addition, self-efficacy was assessed. Parametric tests were used to test the hypothesis.

RESULTS

Knee injury and Osteoarthritis Outcome Score test results showed that all patients suffered because of their knee impairments prior to surgery. All participants had high expectations in all aspects regarding the surgical outcome: on a four-point Likert scale ranging from 1 (very important) to 4 (not important), all mean values were between 1.2 and 1.7. For patients who had a demanding physical work, the ability to keep a stressful working posture was more important than for other patients (i.e. to kneel, to squat). Furthermore, preoperative lower quality of life was associated with higher expectations concerning improving the ability to walk, to achieve improvements in activities of daily living and social well-being.

CONCLUSIONS

Patients' expectations of osteotomies around the knee are high in terms of capacity to work, pain relief, and restoring functions. The natural course of osteoarthritis and the potential need for conversion to TKA were underestimated by a substantial proportion of the study population. However, the expectation regarding survival rate is in line with the reported literature. The results of this study should assist surgeons in discussing realistic expectations when considering and counselling patients regarding osteotomies around the knee. This may help to clarify realistic expectations preoperatively and ultimately improve patients' satisfaction.

LEVEL OF EVIDENCE

Therapeutic study, Level II.

Creation and Evaluation of a Preoperative Education Website for Hip and Knee Replacement Patients-A Pilot Study

Background and Objectives: There is limited research on the question of whether web-based preoperative education can improve surgical patient outcomes. The purpose of this pilot study was to determine the usability, utility, and feasibility of a website created to increase engagement and improve the quality of the preoperative education that patients having hip and knee arthroplasty surgery receive. Materials and Methods: A website was created, and its appearance was designed with evidence-based “menu-driven” drop-downs to make the screen options age-appropriate to the patient population; the content was supported with video and PDFs of educational material, the same or similar to the usual education provided to patients. The patient-specific outcomes included qualitative data regarding patient knowledge, satisfaction, utilities, and usability. These objectives were assessed based on the perceived health website usability questionnaire online survey. Eighty patients who met inclusion criteria were recruited, ranging in age from 40 to 65 years old. Among them, 52.5% were female, 71.25% were scheduled for knee arthroplasty, and 28.75% hip arthroplasty. The patients were randomly assigned to the paper only or website education cohorts in a 50:50 ratio. However, only 19 from each cohort participated in the survey questionnaire. Results and Conclusions: We hypothesized that findings would show that patients receiving web-based education would feel more knowledgeable about their procedure, have less anxiety, and greater satisfaction with the addition of the website content; and that nurses would report that a website could conserve nursing time and resources. The study revealed no statistically significant differences between the cohorts, with an Alpha level set at 0.05. However, survey results showed that patients using the website rated self-perceived increase in knowledge, and their satisfaction in the time to find and review the information was higher than that of the paper-only cohort. The nursing survey revealed that website education improved workflow, efficiency, and patient education.

A Multidisciplinary Preoperative Teaching Session for Women Awaiting Breast Cancer Surgery: A Quality Improvement Initiative

Purpose:

Most of the breast cancer diagnoses are recommended for breast surgery. Unfortunately, many patients report preoperative anxiety, which can affect postoperative recovery. Preoperative teaching sessions have been shown to reduce anxiety and improve recovery for the patients with breast cancer. To better support the patients at our cancer center, a multidisciplinary preoperative teaching session was developed and delivered as a quality improvement initiative.

Methods:

Participants scheduled for breast surgery were invited to attend a group-delivered preoperative teaching session, either for breast-conserving surgery or mastectomy. The sessions were presented by a nurse, occupational therapist, and physiotherapist. Data were collected through a researcher-developed 2-item questionnaire administered before and after sessions to compare self-reported anxiety and knowledge levels, along with qualitative feedback.

Results:

A total of 94 participants attended the preoperative sessions, piloted over a year. The majority were scheduled for breast-conserving surgery. Wilcoxon signed rank tests showed that after session, self-reported levels of anxiety decreased, whereas levels of knowledge increased. Most participants found the session to be very helpful and would recommend it to other patients/families awaiting surgery.

Conclusions:

Patients awaiting surgery for breast cancer may be better supported through a multidisciplinary group teaching session by decreasing anxiety and improving knowledge related to the procedure. Future directions could explore the effect of specific session elements on anxiety, knowledge, and postoperative complications using psychometrically sound instruments and additional time points.

Implications for cancer survivors:

Standardization of these preoperative teaching sessions may enhance breast cancer care, reduce postoperative complications, and improve patient recovery.

Educational impact of joint replacement school for patients undergoing total hip and knee arthroplasty: a prospective cohort study

INTRODUCTION

Enhanced recovery programmes for hip and knee arthroplasty surgery have been shown to decrease length of stay and improve patient outcomes in the elective setting. There are limited studies looking at pre-operative patient education alone and its role, however, more recent studies have demonstrated that it can help reduce length of stay and health care costs. The elective orthopaedic unit at Tullamore Hospital was the first unit in the Irish public health system to have a joint school, pre-operative, educational session, and the aim of this study was to assess our patient understanding of this session to ensure a sustained, high level of patient care, quality assurance and educational standards.

METHODS

A sample size of n = 51 was calculated to adequately power the study. Final sample size was 57. Data was collected across four joint school sessions. Patients were asked to complete a questionnaire before and after the session.

RESULTS

Twenty-seven male (47.3%) and 30 female (52.7%) patients completed the surveys. Mean age overall was 64.5 years. All survey questions except those related to anaesthesia and physiotherapy showed a statistically significant improvement after the joint school session. A total knowledge score was calculated and revealed a statistically significant difference between pre- and post-joint school survey answering (P value < 0.001).

CONCLUSION

Our joint school, pre-operative educational session remains a very effective way of delivering content to patients regarding their surgery. Continuous auditing is paramount to its success and there is potential scope for web-based learning as an adjunct to this validated session.

Preoperative education in hip and knee arthroplasty patients in Bloemfontein

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are frequently performed surgeries worldwide. Preoperative education enhances patient physiotherapy management and satisfaction and should be tailored to patients’ educational needs. Limited research is available regarding the preoperative educational needs for these patients.Objectives: To determine the extent of preoperative education received and the preoperative educational needs of patients undergoing THA and TKA.Method: A structured interview utilising a self-developed questionnaire was used and included questions exploring preoperative education, educational needs, method of education and health care professional providing education. A total of 14 THA and 36 TKA patients, 2–4 days post-operatively at private hospitals in Bloemfontein, were conveniently sampled.Results: All participants had arthroplasties because of osteoarthritis. All participants with THA and 35 (98%) participants with TKA received preoperative education from orthopaedic surgeons, and 8 (57%) participants with THA and 9 (25%) participants with TKA received preoperative education from physiotherapists. Education was mostly given as pamphlets months before the surgery. Participants received the least amount of information regarding exercises, especially preoperative exercise, pain relief and activities of daily living.Conclusion: This study highlights the need for improvement in patient engagement and education, together with enhanced health care practitioner communication and collaboration. Patient centeredness and individualised THA and TKA preoperative education programmes are recognised as a necessary attribute of quality health care and can lead to improved THA and TKA outcomes. The importance of exercise as part of preoperative interprofessional education in the management of THA and TKA should be emphasised as exercise is the cornerstone for rehabilitation of THA and TKA.Clinical implications: This study aimed to emphasise the importance of tailored preoperative education for THA and TKA patients to improve patient outcomes.

The Quality of Patient Education in Day Surgery by Adult Patients

PURPOSE

The purpose of the study was to describe the quality of patient education in day surgery as evaluated by adult patients.

DESIGN

Descriptive design using survey methodology.

METHODS

The data were collected by questionnaire and measured the quality and implementation of education resources for day surgery patients (n = 600) in a university hospital. The data were analyzed statistically using basic and multivariate methods.

FINDINGS

The implementation of patient education has been done in a patient-centered and goal-oriented way by half of respondents. Most respondents (81%) were satisfied with the interaction in patient education. The education resources were reported as good by 77% of respondents.

CONCLUSIONS

Health care staff should assess for the presence of anxiety as a barrier to the comprehension of information. In developing patient education, the professional expertise and skills of health care staff in educating patients should be used.

Patient Decision-Making About Emergency and Planned Stoma Surgery for IBD: A Qualitative Exploration of Patient and Clinician Perspectives

BACKGROUND

Many inflammatory bowel disease (IBD) patients worry about stoma-forming surgery (SFS), sometimes enduring poor bowel-related quality of life to avoid it. Anticipation of SFS and whether expectations match experience is underreported. This qualitative study explored influences on patients' SFS decision-making and compared preoperative concerns with postoperative outcomes.

METHODS

We purposively recruited participants with IBD from UK hospital outpatient and community sources, and IBD clinicians from public hospitals. Four focus groups, 29 semistructured patient participant interviews, and 18 clinician interviews were audio recorded, transcribed, and analysed thematically. Participants had a current temporary, recently-reversed, or permanent stoma, or were stoma naive.

RESULTS

Four themes emerged: Preoperative concerns and expectations, Patient decision-making, Surgery and recovery, and Long-term outcomes. Participants and clinicians agreed about most preoperative concerns, that outcomes were often better than expected, and support from others with a stoma is beneficial. Patient decision-making involves multiple factors, including disease status. Some clinicians avoid discussing SFS, and the phrase 'last resort' can bias patient perceptions; others recommend early discussion, increasing dialogue when medical management becomes ineffective. The postoperative period is particularly challenging for patients. Stoma acceptance is influenced by personal perceptions and pre- and postoperative clinical and social support.

CONCLUSION

Patients need balanced information on all treatment options, including surgery, from an early stage. Early multidisciplinary team dialogue about SFS, and contact with others living well with a stoma, could enable informed decision-making. Life with a stoma is often better than anticipated, improving quality of life and control. Ongoing specialist nursing support aids recovery and adjustment.

The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol

REVIEW OBJECTIVE

The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings.

BACKGROUND

Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence and empowerment were all improved as a result of patient education. While Johansson et al. included studies up to 2003, the proposed systematic review will include studies from 2003 to 2013.Kruzik also reported benefits of decreased length of stay, reduced pain medication requested post-operatively together with increased patient and family member satisfaction. Bastable reported benefits of patient education, including increased patient satisfaction, improved quality of life, enhanced continuity of care, decreased anxiety, fewer complications, promotion of adherence to the plan of care, maximized independence, and empowerment.Types of education involved in this systematic review are patient education, pre-operative education, and discharge education. Only one study discussed discharge education and the outcome from this review. The outcomes that have been discussed in this systematic review include length of stay, satisfaction, pain level,, 21 cost of care, functional abilities, knowledge, anxiety, and quality of life.Major outcomes discussed in these studies are length of stay, pain,, 21 functional abilities, and anxiety. Most of these studies found significant results of reduced length of stay on those patients who received patient education compared to patient who did not received any patient education or information. Studies support the positive outcomes around length of stay.Common orthopedic conditions that have been discussed are osteoarthritis with total arthroplasty either hip or knee or joint replacement. A study on spinal surgery patients and the effects of pre-operative education, which stated that although there are many studies on the effectiveness on patient education, there are missing data on spinal surgery. This study found that the implementation of patient education has positive impacts upon patient satisfaction especially in managing pain.This review will look specifically at the effectiveness of orthopedic patient education for length of stay, satisfaction, pain level, cost of care, functional ability, knowledge, anxiety, and quality of life.